Search Results for "Skin of Color"
Heather C. Woolery-Lloyd MD, Jonette Keri MD, and Stefan Doig MD
In this review, we examine published data reporting the efficacy of pharmaceutical agents to treat associated postinflammatory hyperpigmentation commonly seen in skin of color. Retinoids and azelaic acid have been widely used to treat acne. Now there are increasing data describing their use in skin of color for the treatment of both acne and the subsequent postinflammatory hyperpigmentation. Historically, some dermatologists have been hesitant to use retinoids in skin of color because of perceived hypersensitivity in this patient population. However, recent data support the use of retinoids and azelaic acid in skin of color as both safe and beneficial.
J Drugs Dermatol. 2013;12(4):434-437.
The skin of color population in the United States is rapidly growing and the cosmetic industry is responding to the demand for skin of color targeted treatments. The aging face in skin of color patients has a unique pattern that can be successfully augmented by dermal fillers. Though many subjects with skin of color were not included in the pre-market dermal filler clinical trials, some post-market studies have examined the safety and risks of adverse events in this population. The safety data from a selection of these studies was examined. Though pigmentary changes occurred, there have been no reports of keloid development. Developing a patient-specific care plan and instituting close follow up is emphasized.
J Drugs Dermatol. 2011;10(5):494-498.
Tiffani K. Hamilton MD and Cheryl M. Burgess MD
With demand for minimally invasive cosmetic procedures rising in patients of color, it is becoming increasingly important for clinical
dermatologists to be aware of specific needs of these patients. This article therefore reviews considerations for using cosmetic
procedures on skin of color, and reports the authors’ clinical experience with the use of injectable poly-L-lactic acid (PLLA, Sculptra®,
Dermik Laboratories, a business of sanofi-aventis U.S. LLC) in this patient population. The authors’ experience indicates that patients
with skin of color may require an increased interval between treatments; however, with proper attention to patient selection and
administration technique, injectable PLLA can be used effectively in this patient group. Controlled clinical studies that include more
patients of color are needed to fully assess the benefits and risks of cosmetic products, such as injectable PLLA, in these populations.
In recent years, people of color have become an increasingly important market force for the cosmetics industry. Product
lines have been expanded to accommodate a broader spectrum of skin colors and marketing strategies have been specialized
in order to target specific ethnic populations. In addition, it is predicted that people with pigmented skin will
eventually comprise a majority of the domestic and international population during the 21st century. Not surprisingly,
people of color are increasingly seeking out products and procedures to fight the effects of aging, including an increase
in surgical and nonsurgical cosmetic procedures. Among nonsurgical procedures, soft tissue augmentation has experienced
dramatic growth. Today, clinicians are performing more and more of these procedures in people of color. As a
result of these shifts in the cosmetics industry, clinicians performing soft tissue augmentation require increased expertise
in the treatment of ethnic skin. This article reviews the important differences that exist between the appearance of
the aging faces of Caucasians and people of color. In addition, soft tissue augmentation strategies and injection techniques
that are specific to skin of color are discussed.
Chikoti M. Wheat MD,a Naissan O. Wesley MD,b and Brooke A. Jackson MDc
Sun protective behaviors are not as frequently practiced in skin of color as they are amongst Caucasians.1 Thus providing a reasonable assumption this behavior, or lack thereof, increases the risk of skin cancer in this skin of color populations. The aim of this study was two-fold-- the first was to understand whether patients with skin of color, when categorized by ethnicity or skin type, are able to recognize skin cancer lesions. The second was to examine the correlation between ethnicity and/or skin type and practice of sun protective behaviors. We surveyed 105 respondents presenting for various skin problems in a dermatology office in Chicago, IL. Topics covered in the survey included recognition of skin cancer appearance and choice of sun protective behaviors. We show that there is a tendency for patients to potentially recognize atypical pigmented lesions when they are “dark moles with irregular borders” or “new moles”. In contrast, there is a reduced ability among darkly pigmented skin types IV to VI, to recognize non-melanoma skin cancers. We also show that in addition to ethnicity, skin type within ethnic groups may also play an influential role on the decision to protect or not protect oneself from the sun.
J Drugs Dermatol. 2013;12(9):1029-1032.
Wallace Nozile MS, Cheri N. Adgerson MD, and George F. Cohen MD
Cutaneous Lupus Erythematosus (CLE) is a common manifestation in patients with Systemic Lupus Erythematosus. In a significant
population of patients, CLE is the predominant feature and, in some cases, patients suffer from cutaneous disease alone. Chronic
Cutaneous Lupus Erythematosus (CCLE) is a scarring subtype, more prevalent in blacks. Patients with skin of color may pose a
challenge to physicians due to exaggerated cutaneous findings and increased risk of post-inflammatory hyperpigmentation and
hypertrophic scarring. With the demographics of the United States rapidly shifting towards a greater population of non-Caucasian
racial and ethnic groups, it is imperative that we expand on the limited research into molecular variation, clinical presentation, and
therapeutic efficacy in CLE. The purpose of this review is to bring attention to the unique and severe aspects of CLE in persons of
color, which calls for early and aggressive treatment.
J Drugs Dermatol. 2015;14(4):343-349.
Sonia Badreshia MD, Zoe Diana Draelos MD
The changing face of America highlights the importance of understanding dermatologic conditions of skin of color.
Hyperpigmentation is the most common and distressing condition afflicting this unique subset of the population.
Dermatologists need to familiarize themselves with cosmeceutical skin lightening agents and corrective camouflage formulations.
This article will highlight common over-the-counter agents addressing their advantages and disadvantages.
Combination agents with sunscreen will often be the most effective treatment available.
Perry Robins MD, Eliot F. Battle Jr. MD, Andrew F. Alexis MD MPH, Fran Cook-Bolden MD, Yasser Alqubaisy MD, Michael P. McLeod MS, Keyvan Nouri MD, Nazanin Saedi MD, Henry H. Chan MBBS MD PhD, Jeffery S. Dover MD, Vasanop Vachiramon MD, Amy J. McMichael MD, Jason J. Emer MD, Candrice R. Heath MD, Susan C. Taylor MD, Joshua Zeichner MD
As the population of the world shifts to include more patients of skin of color than ever before, learning how to appropriately treat this patient population has become increasingly more important to practicing clinicians. Patients of skin of color face unique challenges when it comes to procedures such as laser hair removal and treatment of conditions such as Pseudofolliculitis Barbae. This body of work seeks to provide dermatologists with unique clinical pearls discussing the use of safe treatment modalities in the skin of color population. From the use of lasers to the effective use of fillers and injectables, this body of work is filled with expert advice for optimizing treatment outcomes and increasing patient satisfaction. Via these clinical pearls, dermatologists can better meet the needs of a changing patient population as well as expand their knowledge base.
Claire Battie PharmD,a Mona Gohara MD,b Michèle Verschoore MD,a and Wendy Roberts MDc
For many fair-skinned individuals around the world, skin cancer is the leading malignancy. Although skin cancer comprises only 1% to 2% of all malignancies in those with darker complexions, the mortality rates in this subgroup are substantially higher when compared with their Caucasian counterparts. This discrepancy is largely as a result of delayed detection/treatment, and a false perception among patient and physician that brown skin confers complete protection against skin cancer. Recent studies show that 65% of surveyed African Americans never wore sunscreen, despite living in sunny climates, and that more than 60% of minority respondents erroneously believed that they were not at risk for skin cancer.
Dark skin offers some protection from ultraviolet (UV) light. However, there is considerable heterogeneity in skin of color, a phenomenon that is accentuated by mixed heritage. Ethnicity does not confer skin type anymore. People of color do experience sunburn, and from a biological point of view, all skin types appear to be sensitive to UV-induced DNA damage, with an inverse relationship between skin color and sensitivity to UV light.
Our population is changing rapidly, and within the next few decades minority populations will become the majority. It is therefore imperative to educate both physicians and patients on the perceived immunity against cutaneous malignancies, the need for sun protection, and the clinical signs of skin cancer in non-Caucasian people, so that future unnecessary mortality can be avoided.
J Drugs Dermatol. 2013;12(2):194-198.
Candace Thornton Spann MD
During the 21st century, people with skin of color will account for a large portion of the US population. According to race projections from the US Census Bureau, persons of African American, Hispanic, Asian and Native American descent will make up nearly half of the total US population by the year 2050. Because of our changing demographics, it is important that all dermatologists become comfortable in treating skin of color. This article provides 10 practical pearls for management of acne vulgaris in patients with Fitzpatrick skin types IV-VI.
J Drugs Dermatol. 2011;10(6):654-657.
Eliot F. Battle Jr. MD
Laser hair removal, previously contraindicated in
patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer
wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The
longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such
as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the
potential for patient satisfaction.
J Drugs Dermatol. 2011;10(11):1235-1239.
Andrew F. Alexis MD MPH
According to the United States national survey data, acne vulgaris is the leading dermatologic diagnosis among African Americans,
Hispanics/Latinos, and Asians/Pacific Islanders. This patient population, collectively referred to as having skin of color, exhibits clinical
and therapeutic nuances that are relevant in the management of acne. Understanding the nuances in clinical presentation, safety
considerations, cultural factors, and desired treatment endpoints is key to ensuring successful outcomes.
J Drugs Dermatol. 2014;13(suppl 6):s61-s65.
Melasma is a chronic, relapsing disorder that can be disfiguring and can have adverse effects on quality of life. Recently, a unique hydroquinone-free topical product addressing multiple pathways involved in pigmentation was shown to have similar efficacy and equally well tolerated as 4% hydroquinone in females with facial hyperpigmentation. The goal herein was to further assess the efficacy and tolerability of this new multimodality product for the control of moderate melasma in skin of color.
Six female subjects with Fitzpatrick skin types IV-V in good general health between the ages of 46 and 63 years with moderate epidermal facial melasma are presented herein. Subjects applied the skin brightener twice daily, morning and evening, and returned to the clinic at weeks 4, 8, and 12. By week 12, Investigator Overall Hyperpigmentation scores and MASI scores improved by an average of 22% and 38% from baseline, respectively. Additionally, 100% of subjects showed at least a 25% increase in Global Improvement at week 12. The skin brightener was well tolerated with no reports of erythema, edema, scaling, burning/stinging, or itching.
Results from these case studies suggest that this multimodality skin brightener may provide an alternative treatment to hydroquinone for moderate melasma in skin of color. However additional clinical studies would be needed.
J Drugs Dermatol. 2014;13(3):364-366.
Objective: Acne is common in adolescents and especially difficult to manage in people with color. A fixed combination of clindamycin
phosphate and benzoyl peroxide (BPO) (clindamycin phosphate 1.2%/BPO 2.5% gel) was evaluated to determine its utility in treating
moderate to severe acne in adolescents with skin of color.
Methods: Three hundred thirty-seven adolescent acne subjects (aged 12 to <18 years) with skin of color were evaluated from 2 multicenter,
double-blind studies. Subjects were randomized to receive clindamycin phosphate 1.2%/BPO 2.5% gel or vehicle, once daily for
12 weeks. Efficacy and tolerability were evaluated. Data were compared with an adolescent (A) and skin of color (B) cohort from the
same pivotal study enrolling 2,813 subjects.
Results: Superior mean percent reductions in inflammatory, noninflammatory, and total lesion counts were observed in subjects receiving
clindamycin phosphate 1.2%/BPO 2.5% gel compared to vehicle. At week 12, clindamycin phosphate 1.2%/BPO 2.5% gel showed similar
lesion reduction compared to groups A and B (P<0.001). Treatment success with clindamycin phosphate 1.2%/BPO 2.5% gel, assessed by
investigator and subject, was superior to vehicle and comparable to that seen in groups A and B (P<0.001). Clindamycin phosphate 1.2%/
BPO 2.5% gel was associated with a low incidence of treatment-related AEs and a favorable cutaneous tolerability profile.
Conclusions: Clindamycin phosphate 1.2%/BPO 2.5% gel has been shown to be effective, safe, and well tolerated in moderate to
severe acne in adolescents with skin of color.
J Drugs Dermatol. 2012;11(7):818-824.
Fractional carbon dioxide (CO2) laser treatments have become a standard for treating a myriad of skin concerns. One of the biggest
challenges facing us in this regard is treating the vast number of patients with skin of color who we encounter regularly in our practices.
A novel superficial and deep CO2 ablative fractional device with both components coming from a single handpiece has been
developed and is now being evaluated for patients with skin of color. In the 5 patients studied, side effects were not apparent and
no postinflammatory hyperpigmentation was identified. This initial report suggests further evaluation is important to enhance our
ablative fractional therapies.
J Drugs Dermatol. 2012;11(11):1331-1335.
No abstract details for the moment.
No abstract details for the moment.
Fran E. Cook-Bolden MD
No abstract details for the moment.
No abstract details for the moment.
Andrew F. Alexis MD MPH
No abstract details for the moment.
Three conditions, erythema dyschromicum perstans (EDP), granulomatous periorificial dermatitis (GPD), and Kawasaki
disease (KD) are seen more frequently in children of color. EDP and GPD are benign and self-limited dermatoses; therapy
can shorten the course of the diseases. KD, a systemic vasculitis, can have life threatening cardiac consequences and
timely therapy is essential. In all 3 conditions, clinicians should proceed with prompt and appropriate evaluation, diagnosis,
and intervention when indicated. A case representing each condition is presented, followed by a discussion.
Marie Alexia Stoddard BS,a Jennifer Herrmann MD,b,c,d Lauren Moy MD,e and Ronald Moy MDb,f
BACKGROUND: Atrophic scarring in skin of color is a common, permanent, and distressing result of uncontrolled acne vulgaris. Ablative lasers and chemical peels are frequently used to improve the appearance of atrophic scars, primarily through the stimulation of collagen and elastin; however, these treatment modalities are associated with risks, such as dyspigmentation and hypertrophic scarring, especially in patients with darker skin.
OBJECTIVE: We evaluated the efficacy of topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars in skin of color.
METHODS: A single-center clinical trial was performed on twelve healthy men and women (average age 32.5) with Fitzpatrick Type IV-V skin and evidence of facial grade II-IV atrophic acne scars. Subjects applied topical EGF serum to the full-face twice daily for 12 weeks. Scar improvement was investigated at each visit using an Investigator Global Assessment (IGA), a Goodman grade, clinical photography, and patient self-assessment.
RESULTS: Eleven subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 3.36 (SEM = 0.15) to 2.18 (SEM = 0.33). Mean Goodman grade was reduced from 2.73 (SEM = 0.19) to 2.55 (SEM = 0.21). Of the eleven pairs of before and after photographs, nine were correctly chosen as the post-treatment image by a blind investigator. On self-assessment, 81% reported a “good” to “excellent” improvement in their scars compared to baseline (P = 0.004).
CONCLUSION: Topical EGF may improve the appearance of atrophic acne scars in skin of color. Additional, larger studies should be conducted to better characterize improvement.
J Drugs Dermatol. 2017;16(4):322-326.
Eliot F. Battle Jr. MD
No abstract details for the moment.
Periorbital hyperpigmentation (POH) is a common worldwide problem. It is challenging to treat, complex in pathogenesis, and lacking straightforward and repeatable therapeutic options. It may occur in the young and old, however the development of dark circles under the eyes in any age is of great aesthetic concern because it may depict the individual as sad, tired, stressed, and old. While “dark circles” are seen in all skin types, POH is often more commonly seen in skin of color patients worldwide.1 With a shifting US demographic characterized by growing number of aging patients as well as skin of color patients, we will encounter POH with greater frequency. As forecasted by the US Census, by 2030 1 in 5 Americans will be 65 plus years old and greater than 50% of the population will possess ethnic skin of color.2 The disparity in the medical community’s understanding of POH versus popular demand for treatment is best illustrated when you have only 65 cited articles to date indexed on PubMed line3 compared to the 150,000,000 results on Google search engine.4 Most importantly POH may be a final common pathway of dermatitis, allergy, systemic disorders, sleep disturbances, or nutritional deficiences that lends itself to medical, surgical, and cosmeceutical treatments. A complete medical history with ROS and physical examination is encouraged prior to treating the aesthetic component. Sun protection is a cornerstone of therapy. Safety issues are of utmost concern when embarking upon treatments such as chemical peeling, filler injection, and laser therapy as not to worsen the pigmentation. Without intervention, POH usually progresses over time so early intervention and management is encouraged. The objective of this study was to review the current body of knowledge on POH, provide the clinician with a guide to the evaluation and treatment of POH, and to present diverse clinical cases of POH that have responded to different therapies including non-ablative fractional photothermolysis in two skin of color patients.
J Drugs Dermatol. 2014;13(4):472-482.
Macular pigmentation of the tongue can be acquired following exposure to exogenous agents. Black lingual hyperpigmentation
was observed during the full body skin examination of a man with a history of recurrent metastatic malignant melanoma.
His tongue spontaneously returned to its normal pink color later that day. Bismuth subsalicylate (Pepto-Bismol) was suspected
as the pigment-inducing agent; subsequently, re-challange with the antacid confirmed it to be the cause of his acquired,
albeit transient, black tongue. The ingestion of medications, including other antacids, analgesics, antidepressants, antihypertensives
and several antimicrobials has been associated with the development of acquired macular lingual pigmentation. In
addition, hyperpigmentation of the tongue has been observed following the deposition of amalgam and the injection of local
anesthesia or doxorubicin or interferon alpha and ribavirin. Also, inhalation of heroin and methaqualone vapors or tobacco
has resulted in lingual hyperpigmentation. All of the patients with acquired macular lingual hyperpigmentation had tongues
with a smooth surface without enlargement of the filiform papillae. Many of the individuals with hyperpigmented tongue had
either black or dark skin color. The onset of tongue pigmentation varied from less than one day to several years after initial
exposure to the associated exogenous agent. The color of the tongue usually returned to normal after the pigment-inducing
agent was discontinued.
Heather Woolery-Lloyd MD and Adam Friedman MD
This supplement to the Journal of Drugs in Dermatology
was supported by a medical education grant from Johnson & Johnson
Patients with skin of color suffer from different cutaneous issues when compared with skin of light complexion, and therefore
management of the former must be representative of these variations. The most common pigmentary complaints in patients with
skin of color are post-inflammatory hyperpigmentation, melasma and sun-induced hyperpigmentation. Often, patients with darker
skin will turn to naturally occurring ingredients over synthetic analogues both to satisfy cultural preferences and to limit potential
adverse effects that have been tied to synthetics. Science-based natural products can offer an attractive adjunct to conventional
therapies that treat melasma, post-inflammatory hyperpigmentaion, and other dyschromias. Increasing data on the biological effects
and the efficacy of natural therapies support the use of these complementary therapies in treating hyperpigmentation.
Martha H. Viera MD, Caroline V. Caperton MD MSPH, Brian Berman MD PhD
Occurring with higher proportions in skin of color, keloid formation is seen in individuals of all races, with the lowest incidence in albinos.
Interestingly, prevalence of keloids is correlated to skin pigmentation, with dark-skinned individuals suffering disproportionately.
Many factors are taken into consideration when deciding which modalities to use in the treatment of keloids, including size, anatomical
site, cause, symptoms, duration of treatment and not least importantly, pigmentation of the patient. In patients with skin of darker color it is necessary to communicate the effects these treatments may have on epidermal pigmentation to the patient. Of course, the best treatment for keloids remains prevention. Physicians should be alert to delays in wound healing, persistent erythema, or pruritus as impending symptoms of possible keloid formation and make all reasonable attempts to reduce inflammation and tension on the skin with appropriate methods.
J Drugs Dermatol. 2011;10(5):468-480.
Ashish Bhatia MD,a Jeffrey TS Hsu MD,b and Basil M. Hantash MD PhDc
No abstract details for the moment.
Jeanine Downie MD, a Katie Schneider BS, b Lisa Goberdhan BA, b Elizabeth T. Makino BS CCRA MBA, b and Rahul C. Mehta PhD b
Dyschromia is one of the primary complaints for patients with skin of color. Treatments need to achieve a balance between tolerability and efficacy to address existing hyperpigmentation without causing additional damage that could trigger post-inflammatory hyperpigmentation (PIH). An open-label, single-center study was conducted to assess the efficacy of a novel comprehensive pigmentation control serum (LYT2) combined with a series of three very superficial chemical peels (VP) in skin of color subjects. Seventeen female and male subjects aged 36 to 69 years with Fitzpatrick Skin Types III-VI and moderate to severe facial hyperpigmentation were enrolled in the 12-week clinical study. Subjects identified as Asian, Hispanic, African American, or Caucasian ethnicities. Subjects received a series of 3 VP treatments every 4 weeks. LYT2 was applied twice-daily in between VP treatments. Investigator assessments for overall hyperpigmentation, overall photodamage, and skin tone unevenness, as well as standardized digital photography and subject self-assessment questionnaires were conducted at all visits (baseline and weeks 4, 8, and 12). In vivo reflectance confocal microscopy (RCM) of a target lesion was conducted (in a subset of subjects) at baseline and week 12. Fourteen subjects completed the study. The treatment regimen provided statistically significant improvements in all efficacy parameters at weeks 8 and 12 (all P less than equal to 0.03, student’s t-test). Standardized digital photography and RCM images support the improvements in overall hyperpigmentation observed by the investigator. At the end of treatment, the regimen was highly rated by subjects with 100% of subjects (strongly agree/agree) that the combination “decreased the appearance of uneven skin tone and discolorations” and “reduced the appearance of sun damage.” In addition to this clinical study, independent case studies with this combination treatment regimen at a separate study site were also conducted with results that corroborate the formal clinical study findings. The comprehensive results from these studies suggest that the combination of a comprehensive pigmentation control serum with a series of 3 very superficial chemical peels may provide an effective treatment approach for hyperpigmentation in skin of color patients.
J Drugs Dermatol. 2017;16(4):301-306.
Jonathan I. Silverberg MD PhD MPH and Nanette B. Silverberg MD
Background: Vitiligo vulgaris is a chronic autoimmune depigmenting disorder affecting individuals of all skin colors. Lesions are commonly noted in the periorificial face and over the upper and lower extremities in areas of friction. Although there have been many published reports of successful therapies for vitiligo, few have assessed differential response based on skin color.
Objective: To determine if topical tacrolimus is more effective at treating vitiligo in individuals of color.
Methods: An IRB-approved chart review of patients with a diagnosis of vitiligo was conducted including patients seen between May 2001 and April 2006. Patients with vitiligo were treated with tacrolimus 0.03% for children ages 2-15 years of age and tacrolimus 0.1% ointment for individuals 16 years of age or older, applied twice-daily to all hypopigmented or depigmented lesions. A review of clinical features, Fitzpatrick skin type and response to topical tacrolimus were recorded.
Results: Topical tacrolimus was effective in all Fitzpatrick skin types, with superior efficacy on body lesions in individuals of Fitzpatrick
types 3-4 (Fisher exact test, P=0.03). Further, individuals with Fitzpatrick type 3-4 skin had shorter interval to >75 percent improvement of lesions on the body (Kaplan-Meier Log-rank, P=0.03) and head and neck (P=0.016).
Conclusion: Topical tacrolimus is an effective treatment for vitiligo irrespective of skin tone, with greatest benefit in Fitzpatrick type 3-4 skin. Repigmentation of lesions on the head and neck is superior to repigmentation of the body and extremities in all racial subgroups.
J Drugs Dermatol. 2011;10(5):507-510.
Tracey C. Vlahovic DPM,a Dina Coronado BS,b Sanjay Chanda PhD,b Tejal Merchant MPharm,b and Lee T. Zane MDb
INTRODUCTION: Patients with onychomycosis may mask infected nails with polish. Tavaborole topical solution, 5% is a boron-based, small-molecule pharmaceutical approved for the treatment of toenail onychomycosis caused by Trichophyton rubrum and Trichophyton mentagrophytes; efinaconazole topical solution, 10% is approved for the same indication. Nail polish appearance after application of tavaborole (dropper) or efinaconazole (brush); respective applicator appearance; presence of color transfer from respective applicators; and color transfer to remaining solutions after dosing of polished nails were evaluated.
METHODS: Twelve ex vivo human cadaver fingernails were cleaned, polished with two coats of L’Oréal® Nail Color, Devil Wears Red #420, and mounted on floral foam. Nails were treated with tavaborole or efinaconazole solutions once daily for 7 days. Dropper and brush applicators were applied to white watercolor paper immediately after dosing to evaluate color transfer from polished nails. On day 7, remaining solutions were transferred to clear glass vials to evaluate color transfer from applicators to solutions. Nails, applicators, and papers were photographed daily following application; remaining solutions were photographed after 7 days of dosing.
RESULTS: Tavaborole-treated polished nails showed no polish discoloration, and tavaborole applicators did not change in appearance during treatment. No color transfer from polished nails was evident to applicator, paper, or remaining solution. Efinaconazole-treated polished nails showed substantial polish changes after the first day of treatment, with polish appearance and discoloration progressively
worsening over 7 days of treatment. Color transfer from nails was evident to applicator, paper, and remaining solution.
CONCLUSIONS: Daily dropper application of tavaborole to ex vivo polished nails did not alter polish appearance. Brush application of efinaconazole
produced visible changes in polish appearance and color transfer to applicators, paper, and remaining solution. Tavaborole topical solution, 5% may not alter nail polish appearance; the impact of nail polish on tavaborole clinical efficacy has not been evaluated.
J Drugs Dermatol. 2016;15(1):89-94.
Stephanie J. Kang DO,a Scott A. Davis MA,a Steven R. Feldman MD PhD,a,b,c and Amy J. McMichael MDa
BACKGROUND: Dyschromias are becoming a more common concern among patients, particularly among persons of color. There are a variety of treatments, including more novel agents for dyschromias. Evaluating common agents prescribed among various races may prompt efforts to enhance care for dyschromias in patients of color.
OBJECTIVE: To determine whether racial or ethnic groups are treated differently for dyschromia. The secondary objective is to discover the main treatments used and determine trends over time in demographics.
METHODS: We searched the 1993-2010 National Ambulatory Medical Care Survey (NAMCS) for visits associated with a diagnosis of dyschromia (ICD-9 codes 709.00 or 709.09). The demographics and leading treatments were tabulated, and trends over time were assessed by linear regression.
RESULTS: There were about 24.7 million visits for dyschromia over the 18-year period. Among 5,531,000 patients with the sole diagnosis of dyschromia, there were 2,800 visits from females and 1,200 visits from males per 100,000 population. Females were more likely to receive prescription combination therapy for dyschromia than males by a ratio of 10 to 1. Leading treatments overall prescribed by dermatologists included hydroquinone, topical corticosteroids, and retinoids. Asians were 27% more likely to receive a combination therapy than non-Asians. African Americans and Hispanics were less likely to have a procedure performed for dyschromia.
LIMITATIONS: Data are based on a number of ambulatory care visits, which does not allow direct estimation of prevalence.
CONCLUSIONS: Dyschromia is a significant concern for many patients, and this is especially true among patients of color. Treatment for dyschromia is influenced by skin type, and thus ethnic or racial groups are treated differently. Studies have shown that combination therapy may offer better results than a single medication for hyperpigmentation disorders. Combination agents may be underutilized in African Americans and Hispanics for dyschromia.
J Drugs Dermatol. 2014;13(4):401-406.
Jennifer N. Harb MD,a Alexandra L. Owens MD,a Kathryn Mooneyham Potter MD,a Michael Montuno MD,a Reordan O. De Jesus MD,b and Sailesh Konda MDa
Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer diagnosed in African Americans.1 Twenty to forty percent of cSCCs reported in African Americans are related to chronic scarring processes or areas of in ammation.2 Risk factors for developing cSCCs in patients of color include chronic scars resulting from burns, skin ulcers, and radiation sites; and chronic inflammatory diseases such as discoid lupus and hidradenitis suppuritiva.1
Although skin cancer only accounts for 1% to 2% of cancers diagnosed within African Americans, it is associated with increased morbidity and mortality in this population.1,3 Significant delays in diagnosis and treatment are largely thought to be responsible for this prognostic incongruity. The rate of metastasis in patients of color is 31%, compared with only 4% in Caucasians.4,5 Early recognition by physicians and increased awareness resulting in preventative measures by patients may decrease this noted disparity.
J Drugs Dermatol. 2016;16(1):81-84.
Rosacea is often under-recognized or misdiagnosed in patients with skin of color (Fitzpatrick Skin Types [FST] IV-VI). Subtle clinical features and a low index of suspicion likely contribute to less frequent diagnosis in this population. Clinical trials of therapeutic agents for rosacea generally include few patients from nonwhite racial/ethnic groups and therefore, potential differences in treatment outcomes have not been previously studied. The objective of this prospective analysis was to fill the gap in knowledge of the effectiveness and safety of treatment for rosacea in patients with skin of color. We analyzed data from 826 adults aged ≥18 years with papulopustular (subtype 2) rosacea (663 FST I-III; 163 FST IV-VI). All patients received doxycycline 40 mg capsules (30 mg immediate release and 10 mg delayed release beads) once daily as monotherapy for 12 weeks in this open-label, multicenter, community-based study. Investigators assessed disease severity with the Investigator's Global Assessment (IGA) and erythema with the Clinician's Erythema Assessment (CEA). Significant improvement in disease severity and erythema was obtained in patients with FST I-III and IV-VI at week 12 (P<.001). Treatment success, defined as an IGA score of 0 or 1 was achieved in 74.6% and 74.3% of patients with FST I-III and IV-VI, respectively. Approximately 12% of patients experienced adverse events with no difference between the two skin type groups. The results of this prospective subgroup analysis of data from a large community-based trial suggest that doxycycline produced similar effectiveness and safety profiles in patients with FST I-III and IV-VI.
J Drugs Dermatol. 2012;11(10):1219-1222.
Background: Acne in skin of color is an increasing problem, presenting unique challenges. Although combination therapy is now standard of care in acne, concerns exist with the increased potential irritation and dryness in skin of color. Although individual medications
can be titrated or applied at different times of the day to minimize irritation, this is not always practical or desirable. There is a paucity of
clinical studies that evaluate the safety and efficacy of acne medications in skin of color.
Methods: A post-hoc analysis of efficacy and cutaneous tolerability in 797 subjects receiving clindamycin phosphate 1.2% benzoyl peroxide (BPO) 2.5% gel from two 12-week, multi-center, double-blind studies that enrolled 2,813 subjects with moderate to severe acne. Efficacy, tolerability, and subject satisfaction in Fitzpatrick skin types I-III subjects were compared to subjects with Fitzpatrick skin types IV-VI.
Results: Median reductions in inflammatory lesions were comparable between the two groups. There was a small difference in non -
inflammatory and total lesions in favor of those patients with Fitzpatrick skin types I-III (P=0.013 and P=0.024, respectively). Median
reductions in inflammatory, noninflammatory, and total lesions at week 12 were 63%, 50%, and 52.4%, respectively for Fitzpatrick
skin types I-III and 65%, 47%, and 51.4%, respectively for Fitzpatrick skin types IV-VI. Treatment success was comparable between
the two groups and both groups had a high level of subject satisfaction at week 12. Cutaneous tolerability was excellent, with all mean
scores less than or equal to 0.2 at week 12 (where 1=mild). Results in the two groups were comparable, although there was slightly
more erythema reported in the Fitzpatrick skin types I-III subjects (0.2 versus 0.1). This could be due to the difficulty in vis ualizing erythema in subjects with darker skin.
Conclusions: Acne subjects with Fitzpatrick skin types IV-VI were not found to be more susceptible to cutaneous irritation from treatment
with clindamycin phosphate 1.2%/BPO 2.5% gel and both efficacy and tolerability was comparable across the two treatment groups.
J Drugs Dermatol. 2012;11(5):643-648.
Andrew F. Alexis MD MPH,a Cheryl Burgess MD,b Valerie D. Callender MD,c Jo L. Herzog MD,d Wendy E. Roberts MD,e Eric S. Schweiger MD,f Toni C. Stockton MD,g and Conor J. Gallagher PhDh
BACKGROUND: Topical dapsone gel, 5% is approved for treatment of acne vulgaris but has not been studied specifically in women with skin of color (SOC; Fitzpatrick skin types IV, V, or VI).
OBJECTIVE: Evaluate safety and efficacy of dapsone gel, 5% applied topically twice daily for 12 weeks in women with SOC.
METHODS: Females with SOC aged 18 years and older with facial acne participated in a multicenter, open-label, single-group, 12-week pilot study of twice-daily monotherapy with dapsone gel, 5%. The investigator-rated 5-point Global Acne Assessment Score (GAAS) was used to assess efficacy. The impact of acne on subjects was assessed using the validated Acne Symptom and Impact Scale (ASIS).
RESULTS: The study enrolled and treated 68 women with SOC and facial acne. GAAS decreased significantly from baseline to week 12 (mean, -1.2 [95% CI, -1.4, -1.0]; P<.001), a 39.0% improvement. Overall, 42.9% of subjects were responders based on a GAAS of 0 or 1 at week 12. Subjects also experienced significant reductions in mean total lesions (52% decrease), inflammatory lesions (65%), and comedo counts (41%; all P<.001). Dapsone gel, 5% monotherapy was associated with significant improvement in subject-assessed acne signs (P<.001) and impact on quality of life (QOL; P<.001), based on ASIS. Dapsone gel, 5% used twice daily was well tolerated, with no treatment-related adverse events. The local dermal tolerability scores tended to remain stable or decrease from baseline to week 12.
CONCLUSIONS: Monotherapy with dapsone gel, 5% administered twice daily was safe and effective for treatment of facial acne in women with SOC. Significant improvement in overall acne severity and both inflammatory lesions and comedones was observed. Further, study subjects reported considerable improvement in both acne signs and impact on QOL.
J Drugs Dermatol. 2016;15(2):197-204.
Ekaterina Kraeva BSN,a,b Derek Ho BS,a,b and Jared Jagdeo MD MSa,b,c
Rhinophyma, a late complication of rosacea (phymatous subtype), is a chronic, progressive dermatological condition. The classic pre- sentation of rhinophyma is nodular, thickened skin over the distal nose, and is often accompanied by underlying erythema secondary to in ammation. Due to the unpleasant aesthetic and dis guring appearance, rhinophyma may be associated with a signi cant nega- tive psychosocial impact, resulting in decreased patient quality-of-life. Treatment of rhinophyma is challenging as topical and systemic pharmacotherapies have shown limited ef cacy. We present a case of a 39-year-old African-American male with long-standing, mild rhinophyma who was successfully treated with two sessions of fractionated carbon dioxide (CO2) laser. We also review the medical literature on fractionated CO2 laser treatment of rhinophyma. To the best of our knowledge, this is the rst report of successful treat- ment of rhinophyma using fractionated CO2 laser in an African-American man (Fitzpatrick VI). We believe that fractionated CO2 laser may be a safe and ef cacious treatment modality for rhinophyma in skin of color patients (Fitzpatrick IV-VI) and early intervention with fractionated CO2 laser to prevent rhinophyma worsening may yield better results than late intervention.
J Drugs Dermatol. 2016;15(11):1465-1468.
Non-melanoma skin cancer most commonly affects Caucasians, and only rarely affects darker-skinned individuals. However, skin
cancer in these groups is associated with greater morbidity and mortality. Ultraviolet radiation is the major etiologic factor in basal
cell carcinoma (BCC) and likely plays a pivotal role in the development of other forms of skin cancer. Yet it is commonly thought
among patients as well as physicians that darker pigmentation inherently affords complete protection from skin cancer development. This low index of suspicion results in delayed diagnoses and poorer outcomes. This review follows a detailed computer
search that cross-matched the diagnosis of BCC with skin color type in a large commercial dermatopathology facility. The reported
skin types, all Fitzpatrick skin types IV, V, and VI, and histories were confirmed. A predominance of pigmented BCCs was found
in sun-exposed areas of these older individuals. Although less common in darker-skinned ethnic groups, BCC does occur and can
pose significant morbidity. Thus, it is essential that dermatologists are familiar with the epidemiology and clinical presentation of all
cutaneous malignancies in darker skin so that these patients are fully aware of risks as well as prevention of the disease.
J Drugs Dermatol. 2012;11(4):484-486.
Tuyet A. Nguyen BA BS and Adam J. Friedman MD
Curcumin, or diferuloylmethane, is a crystalline compound which gives the East Asian spice turmeric its bright yellow color. The medicinal properties of this spice have been referenced in numerous countries and cultures throughout the world. Today, there is growing scientific evidence suggesting curcumin’s utility in the treatment of chronic pain, inflammatory dermatoses, acceleration of wound closure, skin infections, as well as cosmetic ailments such as dyspigmentation. In addition, curcumin may have a protective role against various pollutants and cytotoxic agents, indicating that it may be beneficial in a mitigational or prophylaxis role. Although turmeric has been used for thousands of years in alternative medicine, curcumin has yet to emerge as a component of our mainstream dermatologic therapeutic armamentarium. Interestingly, curcumin provides an ideal alternative to current therapies because of its relative safety profile even at high doses. Although the advantageous properties of curcumin in medicine are well established, its therapeutic potential thus far has been limited because of its poor oral bioavailablity. Topical administration of curcumin can directly deliver it to the affected tissue making it useful in treating skin-related disorders. However, limitations still exist such as the cosmetically unpleasing bright yellow-orange color, its poor solubility, and its poor stability at a high pH. Here the current literature detailing the potential and current use of curcumin in dermatology is reviewed.
J Drugs Dermatol. 2013;12(10):1131-1137.
Vasanop Vachiramon MD,a,b Trudy Brown LEI CLS CPE,a,c Amy J. McMichael MDa
Background: Laser hair removal (LHR) is increasingly popular for the treatment of unwanted hair. To date, there have been few studies to evaluate patient satisfaction and complications after LHR among people of color.
Objectives: To determine patient satisfaction and complications with long-pulsed Nd:YAG laser assisted hair removal in dark-complexioned skin individuals from the patient's point of view.
Patients/Methods: A survey questionnaire was administered to subjects with Fitzpatrick skin type VI between the ages of 21-70 years who had been treated with long-pulsed Nd:YAG for unwanted hair. Questions were comprised of those related to satisfaction and complications from treatment with LHR. Satisfaction was recorded on a linear analogue scale (LAS=not at all satisfied; 100=extremely satisfied).
Results: Fifty patients (female 41, male 9) completed the survey. All patients were satisfied with Nd:YAG LHR treatment with the mean satisfaction score of 84.2. All patients favor LHR treatment as compared to alternative methods. The majority of patients (79.3%) who had completed six or more LHR treatments were removing their hair less frequently than before LHR treatment. Hyperpigmentation after treatment was noted in three patients (6%), which lasted for 3-10 days. No hypopigmentation, blistering, or scarring was observed. All patients completing the study would recommend LHR for patients with unwanted hair with the mean recommendation score of 91.5.
Conclusions: Nd:YAG laser-assisted hair removal gives a high rate of patient satisfaction in terms of hair reduction with minimal complication among subjects of color.
J Drugs Dermatol. 2012;11(2):191-195.
Background: Some dermatologic disorders are known to be much more common in patients of color, but the leading dermatologic
disorders in patients of color have not yet been described on the basis of nationally representative data.
Purpose: To determine the leading dermatologic disorders for each major racial and ethnic group in the United States.
Methods: We queried the National Ambulatory Medical Care Survey (NAMCS) for the leading diagnoses in patient visits to U.S. dermatologists from 1993 to 2009. The leading diagnoses were tabulated for each racial and ethnic group, and the top conditions were
compared between groups. In a separate analysis, visits for skin conditions regardless of physician specialty were analyzed for leading
diagnoses in each racial and ethnic group.
Results: The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or eczema,
seborrheic dermatitis, atopic dermatitis, and dyschromia. For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis, and seborrheic keratosis. By contrast, in Caucasian patients, the top five were
actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer. In Hispanic patients
of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin, and viral warts.
When the leading dermatologic diagnoses across all physician specialties were assessed, the top diagnoses for African-Americans were
unspecified dermatitis or eczema, acne, dermatophytosis of scalp and beard, sebaceous cyst, and cellulitis or abscess; for Asians or
Pacific Islanders were unspecified dermatitis or eczema, acne, atopic dermatitis, urticaria, and psoriasis; and for Caucasians were acne,
unspecified dermatitis or eczema, actinic keratosis, viral warts, and sebaceous cyst. For Hispanics of any race, they were unspecified
dermatitis or eczema, acne, sebaceous cyst, viral warts, and cellulitis or abscess. For a sole diagnosis of a dermatologic condition, only
28.5% of African-Americans' visits and 23.9% of Hispanics' visits were to dermatologists, as compared to 36.7% for Asians and Pacific
Islanders and 43.2% for Caucasians.
Limitations: The data are based on numbers of ambulatory care visits rather than numbers of patients. Data on race or ethnicity were
not collected for some patients.
Conclusions: Several dermatologic disorders are much more commonly seen in patients of color. Acne and unspecified dermatitis or
eczema are in the top five for all major U.S. racial and ethnic groups. There may be an opportunity to improve the care of patients of color
by ensuring they have equal access to dermatologists.
J Drugs Dermatol. 2012;11(4):466-473.
Background: Scalp hyperkeratosis and/or alopecia are common pediatric dermatologic findings. In Caucasian children, scalp hyperkeratosis
of childhood is most often associated with atopic and seborrheic dermatides. Recent data is lacking on the clinical meaning of scalp hyperkeratosis and alopecia in children of color.
Objective: To determine diagnosis associated with scalp hyperkeratosis and/or alopecia in a predominately Black and Hispanic pediatric
Methods: A retrospective chart review was conducted for all children (0-17 years of age) seen at our institution who had a scalp fungal culture for the evaluation of scalp hyperkeratosis and/or alopecia from January 2007 to September 2009. Fungal culture was performed using cotton swab technique, plating onto Sabouraud's and Mycosel media. Demographic features, fungal culture results, clinical symptoms, physical findings and final diagnosis were reviewed.
Results: 164 children were identified who were eligible for inclusion in the study, 75 of whom were Black and 56 Hispanic/Latino. Scalp hyperkeratosis was noted in 106 patients and alopecia was noted in 71 subjects. Tinea capitis was the final diagnosis in 50 out of 80 children who had hyperkeratosis without alopecia (60%), 16 of 43 children with alopecia alone (37.2%) and 23 of 28 children with both hyperkeratosis and alopecia (82.1%, P=0.0007). The odds ratio of tinea capitis in the presence of hyperkeratosis with alopecia
was 7.49 with a 95 percent confidence limit of 2.19-25.70.
Conclusion: Scalp hyperkeratosis, especially when accompanied by alopecia, is usually associated with tinea capitis in Black and Hispanic children. Fungal culture and empirical anti-fungal therapy are warranted in children of color with scalp hyperkeratosis.
J Drugs Dermatol. 2011;10(5):511-516.
Kavitha K. Reddy MDa, Jeremy A. Brauer MDa, Munir H. Idriss MDb, Robert Anolik MDa,Leonard Bernstein MDa, Lori Brightman MDa, Elizabeth Hale MDa, Julie Karen MDa,Elliot Weiss MDa, Dirk Elston MDb, and Roy G. Geronemus MDa
Background and Objective: Pulsed dye laser treatment often results in port-wine stain (PWS) improvement; however, results vary. A frequency-doubled neodymium-doped yttrium aluminum garnet (Nd:YAG) laser that allows for shorter pulse widths along with large spot sizes and high fluences has been developed for the treatment of cutaneous vascular lesions.
Study Design: A prospective, controlled study was performed in 5 adults with PWS using a frequency-doubled Nd:YAG laser (Excel V; Cutera Inc, Brisbane, CA) in 4 quadrants, using spot sizes of 6 to 10 mm, fluences of 4.8 to 9 J/cm2, and pulse durations of 3 to 6 ms. An adjacent control area was not treated. Each was assessed immediately posttreatment for purpura and edema and at 1 month for PWS color, size, texture, and thickness. Skin biopsies obtained immediately after and at 1 month posttreatment were evaluated.
Results: All treatment quadrants displayed purpura. At 1-month follow-up, all treatment quadrants showed at least 1 grade of color improvement, from a minimum of 1% to 25% to a maximum of 51% to 75% improvement (12/20 quadrants with 1%-25% improvement, 3/20 with 26%-50%, 5/20 with 51%-75%, and 0/20 with 76%-100%). Histologic evaluation of treatment quadrants revealed vascular changes ranging 0.35 to 4 mm in depth. Immediately posttreatment, thrombi and extravasated red blood cells were observed in treatment quadrants. Histology at 1 month revealed decreased number and diameter of vessels in treatment quadrants (superficial vessels decreased by mean 1.1 vessels per section [13%], and diameter by 3.0 μm [47%], midlevel vessels decreased in number by 2.3 [20%], diameter by 2.42 μm [25%], and deep vessels decreased in number by 1.5 [83%], and diameter by 7.44 μm [88%]).
Conclusions: A single treatment with a short pulse width, frequency-doubled Nd:YAG laser resulted in safe and effective improvement of PWS, with up to 75% improvement in color observed at 1 month. Histologic evaluation demonstrated vascular injury at depths of 0.35 to 4 mm with a reduction in vessel number and size at multiple dermal levels.
J Drugs Dermatol. 2013;12(1):66-71.
Stanislav N. Tolkachjov MD and Nneka I. Comfere MD
Hypopigmented mycosis fungoides (HMF) is a rare variant of cutaneous T-cell lymphoma (CTCL) that often manifests in younger patients
with darker skin types in a centripetal distribution.1 Average age of diagnosis is often 14 years.2 The diagnosis is often missed
due to its low incidence and lack of clinical suspicion. Misdiagnosis and failure to obtain biopsies lead to a long latency period from
onset of hypopigmented patches to diagnosis and treatment.
HMF has a clinically benign course and responds well to therapy; however, relapse is common.3 We report a case of HMF misdiagnosed
as vitiligo in order to illuminate diagnostic, histopathological, and treatment modalities.
J Drugs Dermatol. 2015;14(2):193-194.
Andrew F. Alexis MD MPH
The treatment of disorders of hyperpigmentation including
melasma, photoaging-related dyschromia, and postinflammatory
hyperpigmentation pose numerous challenges, especially in
patients with higher Fitzpatrick skin types (skin of color). Given
limitations in efficacy as well as safety and cost considerations
of available therapies, a “magic bullet” single treatment
modality for hyperpigmentation is currently lacking. Successful
treatment typically involves a combination of topical agents with
or without in-office procedures, exploiting the different mechanisms
of action of each agent or treatment modality. This article
will review recently published studies involving newer topical and
procedural approaches to this common dermatologic concern.
Diane Thiboutot MD, Andrew F. Alexis MD MPH, Leon H. Kircik MD
Despite the fact that acne is among the most common conditions treated by
dermatologists, challenges in managing acne patients are encountered on a
daily basis. The articles in this supplement help to address some of those
challenges, namely choice of appropriate topical formulations, management of
acne in patients with skin of color and appropriate use of oral antibiotics
in an age of emerging antibiotic-resistant bacteria.
This is a CME supplement; visit the JDD Medical Education Library
to participate in this activity and earn 1 category 1 CME Credit.
Anthony Rossi MD,a,d Rebecca Lu MD,a Melissa K. Frey MD,d Takako Kubota MD,c
Lauren A. Smith MD,e and Maritza Perez MDa,b
BACKGROUND: Keloids can be quite resistant to conventional methods of treatment. A wide range of treatment modalities exists, often
with suboptimal results, recurrences, and adverse events occurring. Laser therapy with the carbon dioxide, erbium:YAG, Q switched
frequency doubled neodymium-doped yttrium aluminium garnet (Nd:YAG), and 585/595 nm pulsed dye lasers have all be purported as
potential treatment modalities however with limited efficacy and data especially in the skin of color population is limited. We report the
successful use of the 300 microsecond 1064 nm Nd:YAG laser in treating keloids in patients with skin types ranging from Fitzpatrick I
through VI with special attention in treating skin of color patients.
OBJECTIVE: We examined the use of the 300 microsecond 1064 nanometer (nm) Nd:YAG laser for the treatment keloids in patients with
skin types ranging from Fitzpatrick I through VI.
METHODS & MATERIALS: A retrospective analysis of treatment efficacy was conducted on 44 patients with keloids. Three separate
treatment groups were compared. The groups consisted of: a “control group” in which the whole keloid was only treated with intralesional
corticosteroid (triamcinolone 10mg/cc) (16 patients); a “laser only” group in which the patient’s keloid was only treated with the
1064nm Nd:YAG laser at a fluency of 13 to 18 Joules / centimeter2 (J/cm2), a fixed pulse duration of 300 microseconds, 5mm spot size,
and a total of 2000 pulses (14 patients); and a “combination group” that received both the aforementioned laser therapy and adjuvant
intralesional triamcinolone (14 patients).
RESULTS: Patients in the "combination group" treated with the 300 microsecond 1064nm Nd:YAG laser therapy plus intralesional
corticosteroid and the "laser only" group both were observed to have durable clinical reduction in the thickness and erythema of the
keloids. These results were shown to be superior to the "control group" whom were only treated with intralesional corticosteroids.
Only mild and transient post treatment erythema was noted as an adverse effect.
STATISTICAL ANALYSIS: Data analysis was performed using IBM SPSS Statistics 19.0.0 (Armonk, NY). In order to assess the statistical
significance of differences in keloid improvement among the three treatment groups, The Kruskal-Wallis test (non-parametric ANOVA
test) was applied. The level of statistical significance was set at P<0.05. A statistically significant difference in keloid improvement was
appreciated between treatment groups (P<0.0001).
LIMITATIONS: A small sample size and the retrospective nature of the analysis are limitations to the study.
CONCLUSION: The 300 microsecond 1064nm Nd:YAG laser proved effective in improving the clinical appearance of keloids. We recommended
this laser protocol in conjunction with intralesional corticosteroids as a treatment option for patients with keloids, especially
in the skin of color population. The 1064nm Nd:YAG laser did not show post inflammatory hyperpigmentation nor hypopigmenatation,
which are concerns for skin types IV to VI, and therefore is a suitable option for such patients.
J Drugs Dermatol. 2013;12(11):1256-1262.
Whitney P. Bowe MD, Magdalene A. Dohil MD, Alan C. Logan ND, Andrew F. Alexis MD MPH
This CME supplement reviews the science behind a select group of natural ingredients in the context of treating cosmetic and medical conditions. Dr. Magdalene A. Dohil discusses the data supporting certain natural ingredients in the treatment of atopic dermatitis and a defective skin barrier. Drs. Whitney P. Bowe and Alan C. Logan address the role of antioxidants in acne vulgaris and aging and discuss biologically active ingredients as they relate to the skin. Finally, Dr. Andrew F. Alexis focuses on skin of color and the use of natural ingredients to aid in the management of hyperpigmentation. After reviewing this publication, practitioners should be in a better position to help their patients discriminate potentially effective over-the-counter products from those that lack any scientific basis for their claims.
This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 1 AMA PRA Category 1 Credits.
Elizabeth T. Makino BS CCRA MBA,a Priscilla Tan BA,a Kun Qian MD,b Michael Babcock MD FAAD,b and Rahul C. Mehta PhDa
Key features of lip aging include loss of volume, color, and definition as well as increases in lines/wrinkles and uneven skin texture. A single-center, open-label clinical study was conducted to assess the efficacy and tolerability of a novel, topical two-step lip treatment (HA5 LS) in female subjects presenting with mild to moderate lip dryness and mild to severe lip condition. Subjects were instructed to apply HA5 LS at least three times a day to ensure coverage 8 hours a day for four weeks. Clinical assessments for efficacy and tolerability were conducted at baseline, baseline post-application, week 2, and week 4. Standardized digital photography, subject self-assessment questionnaires, and instrumentation measurements for skin hydration (corneometer) and lip plumpness (digital caliper) were also conducted. Thirty-six female subjects aged 22-40 years enrolled in the study. HA5 LS provided instant and long term effects, achieving significant improvements in all clinical grading parameters including lip texture, color, definition/contour, scaling, cupping, lines/wrinkles, lip plumpness, and overall lip condition from baseline post-application to week 4 (all P less than equal to .001; Wilcoxon signed-rank test). Instrumentation measurements for hydration and digital caliper at weeks 2 and 4 were also significant (all P less than equal to .032; paired t-test). HA5 LS was also well-tolerated and highly-rated by subjects throughout the study duration. Results from this study suggest that HA5 LS addresses the key features of lip aging, providing both instant and long-term benefits.
J Drugs Dermatol. 2017;16(4):366-371.
Romain Roure MS,a Virginie Nollent Pharm.D,a Liliane Dayan MD,b Etienne Camel Pharm.D,c
Christiane Bertin MSa
The 5 main physical manifestations of aged skin are wrinkles, uneven tone, brown spots, loss of elasticity, and dryness. One mechanism resulting in these physical manifestations is increased activity of the nuclear factor kappa B (NFκB) protein. This 12-week, double-blind, placebo-controlled, randomized split-face study compared the antiaging effect and safety of a face cream containing 4-Hexyl-1, 3-phenylenediol, an NFκB inhibitor, and ascorbic acid-2 glucoside versus placebo in adult females aged 45–70 years old. Subjects (n=42) applied active treatment or placebo to the same half face twice daily at home for 12 weeks. Clinical evaluation was carried out by a dermatologist. Subjects carried out similar self-grading assessments. Colorimetric measurements analyzed skin color, and biomechanical skin properties were evaluated. Clinical grading showed that most wrinkle parameters were significantly improved after 8 weeks of active treatment compared with baseline and placebo (P≤.05), with improvements maintained after 12 weeks. Only Marionette wrinkles did not show a significant improvement. Brown spots (color intensity/number), overall photodamage, and most complexion parameters improved significantly after 8 and 12 weeks compared with baseline and placebo (P≤.05). Self-grading yielded similar results compared with baseline. Self-grading did not demonstrate improvements with active treatment versus placebo, except for skin firmness at 8 and 12 weeks (P≤.05). A significant difference was seen with active treatment compared with placebo in all colorimetric parameters (L*, b*, and ITA°) after 8 weeks, and in spot coloration (b*) after 12 weeks (P<.05). Improvements in skin elasticity were not significantly different between treatments. Overall tolerability of active treatment was judged as good. In conclusion, a cream containing 4-Hexyl-1, 3-phenylenediol and ascorbic acid-2 glucoside improves the clinical appearance of aged skin, validating the potential use of NFκB inhibition as a novel, effective method of topical antiaging.
J Drugs Dermatol. 2016;15(6):750-758.
Acne: Novel Findings and Treatment Paradigms
Acne is perhaps the most prevalent skin disease in Western societies, yet dermatologists are now learning that simply "dubbing the medicine on the pimples" is not the way to manage it successfully. Acne is primarily an inflammatory disease, so treatment needs to be aimed not only at eradicating existing lesions but also at preventing long-term scarring and hyperpigmentation by rapidly reducing inflammation.
Moreover, the old-fashioned way of using antibiotics long-term as monotherapy is contributing to the global public health challenge of antibiotic resistance, which requires a new treatment paradigm emphasizing antibiotic stewardship. Antibiotic limiting regimens, including a combination of topic retinoids and benzoyl peroxide, are shown to be effective; and topical probiotics can also play a useful role.
These new understandings of acne pathogenesis, treatment targets (including those in skin of color), and antibiotic stewardship are all discussed in this supplement.
Douglas Winstanley DO, Travis Blalock MD, Nancy Houghton BS, and E. Victor Ross MD
Background: Sebaceous hyperplasia is a common benign proliferation of sebaceous glands. Multiple treatment methods have been
applied in the past, including electrodessication, ablative and visible light lasers, applications of acids, and photodynamic therapy.
Often, however, only the superficial component of the lesion is treated, leading to rapid recurrence. It has been shown that human
fat has absorption peaks at 1,210 nm and 1,720 nm. We report the first use of a novel 1,720-nm laser in the treatment of sebaceous
hyperplasia in human subjects.
Methods: Four patients with sebaceous hyperplasia underwent a test spot treatment followed by 2 full treatment sessions using
the 1,720-nm laser. Photos were taken before treatment, at each treatment session, and 3 months following the last treatment.
Pretreatment photographs and 3-month follow-up photographs were compared to assess efficacy.
Results: Four weeks after the final treatment, 3 dermatologists blinded to the date of the photographs and uninvolved with the study
evaluated the photos and scored them based on a global assessment comprised of: 1) lesion diameter, 2) lesion height, and 3) lesion
color. Many of the lesions resolved almost completely after a single treatment, and no additional treatment was required. Overall,
there was a reduction in the color, diameter, and height of the lesions. Crusts were noted by all patients and resolved within 10 days.
Conclusion: The use of this novel device that exploits the intrinsic selectivity of 1,720 nm achieved nearly complete clearance of
sebaceous hyperplasia lesions without depressions or scarring. Complete heating of the sebaceous gland and sparing of the surrounding
skin offered by this device resulted in clinically apparent improvement with a minimum of adverse effects.
J Drugs Dermatol. 2012;11(11):1323-1326.
Nicole Van Buren MS and Tina S. Alster MD
Of the estimated 11.7 million cosmetic surgical and nonsurgical procedures performed in the United States (U.S.) in 2007, 22%
were performed on racial and ethnic minorities. Laser and light treatments rank in the top five most requested procedures in annual
surveys of cosmetic and dermatologic surgeons.
Recent U.S. population statistics reveal dramatically shifting demographics that would anticipate a likely increase in this percentage.
U.S. Census Bureau data projects that by 2050, people of color are expected to become the majority, comprising 54% of the
U.S. population, with Latinos accounting for 30%, African Americans 15%, and Asians 9.2%. The rising popularity of cutaneous
laser surgery as an accepted therapy for various skin pathologies, coupled with the diverse face of the patient population, has led to
increased demand for laser treatment of darker skin tones.
Although difficult, effective laser therapy in patients with darker skin phototypes can be achieved. When determining a treatment
protocol for an individual patient, the proper laser energy and wavelength are important in ensuring a substantial margin of safety
while still achieving satisfactory results.
Miriam Hanson MD, Vesna Petronic-Rosic MD
Diltiazem hydrochloride is a commonly prescribed medication in the treatment of cardiovascular disease. A case of diltiazem-induced
hyperpigmentation in a patient after signifi cant sun exposure is reported. The morphological appearance was reticulated and slategray
to blue in color. The pathogenesis of the hyperpigmentation is discussed and possible treatment options are reviewed.
Benjamin Barankin, MD; Ken Alanen, MD; Patricia T. Ting, BSc and Mariusz J.A. Sapijaszko, MD
A young woman presented to the office with a history of bluish discoloration involving the superior malar region bilaterally. When
the bluish discoloration became darker, she would press on her cheeks resulting in excretion of “black sweat” that temporarily lightened
her skin color. Examination revealed ill-defined slightly swollen soft plaques involving both superior cheeks. Upon pressure
on the cheeks, a dark brown fluid was expressed. Histologic examination revealed collections of ectopic apocrine glands within midreticular
dermis. The diagnosis of apocrine chromhidrosis was made, an uncommon cause of chromhidrosis and one in which bilateral
facial presentation is rare.
Carlos Galzote,a Mini Thomas PhD,b and Mukta Sachdev MDc
BACKGROUND: Ethnic differences in skin sensitivity suggest that greater emphasis be focused on understanding a product’s effect in diverse populations.
OBJECTIVE: The irritation and/or sensitization potential of 8 baby skin care products in Indian adults were evaluated using cumulative irritation tests (CIT) and human repeat insult patch testing (HRIPT) protocols.
PATIENTS/MATERIALS/METHODS: Healthy males or females aged 18 to 65 years of Indian ethnicity were treated with each of 6 products (cream, hair oil, lotion, body wash, shampoo, and baby soap) using CIT (n = 25) and HRIPT (n = 200). Baby powder and baby oil were evaluated by CIT (n = 25) and HRIPT (n = 107) in separate studies. CITs were conducted over 14 days; HRIPTs were conducted over 10 weeks.
RESULTS: In both CIT and HRIPT, most products were considered mild, with no irritation. Baby soap and powder elicited reactions in the HRIPT induction phase, with positive challenge phase reactions (3 subjects), but were affirmed to be nonallergenic in the rechallenge phase.
CONCLUSIONS: In these studies, 8 baby skin care products were evaluated by both CIT and HRIPT in Indian adults. The results of the studies indicated that all of the tested products were nonallergenic and nonirritating.
J Drugs Dermatol. 2016;15(10):1244-1248.
The projections of increases in the number of skin of color patients over the next several decades, necessitates expertise in cultural competence for health care providers. Acquiring competency begins with practitioners reflecting on their self identity and personal beliefs.
Additionally, understanding African-American cultural habits and practices and their impact on disease is critically important. We review,
in this article, the fundamentals of becoming cultural competent. Patients are best served when their physician embraces their culture,
their view of the health care system as well as habits and practices.
J Drugs Dermatol. 2012;11(4):460-465.
Krystie Lennox PA-C, Kenneth R. Beer MD
The lack of a naturally shaped nipple-areola complex following mastectomy presents a significant psychological hindrance
for many breast cancer patients. While tattoos may improve the overall color of the reconstructed breast, the shape of the
areola-nipple complex frequently remains deformed. Injecting hyaluronic acid may enable the 3-dimension contour of this
area to be restored to a more natural appearance. This restoration may be associated with improvement of self-image and
reduction in the depression that sometimes follows a mastectomy.
Gunter H. Willital MDa and Jeannette Simon MDb
Background: Contractubex® (Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a gel containing extractum cepae, heparin, and allantoin with proven efficacy in the prevention of excessive scarring and promotion of physiological scar formation.
Aim: To investigate the efficacy of early initiation of Contractubex in the prevention of excessive scarring and promotion of physiological scar formation.
Methods: In total, 1,268 patients were included in this observational, noninterventional study. Patients were assessed at visit 1 (within 3 weeks of the injury), when treatment was initiated, with subsequent assessments after 2 to 3 months of treatment, and at the end of the study (after 4 to 5 months of treatment). Parameters measured included scar size, color, and pliability (consistency/hardness), as well as patients' and physicians' subjective assessments of treatment efficacy and tolerability.
Results: After 2 to 3 months of treatment, there were statistically significant improvements in color and pliability of the scar, sensation of pain, tension, and pruritus compared with visit 1 (P<.0001). By the end of the study, further statistically significant improvements compared with visit 1 were observed for all parameters. Only about 1% of scars were rated as markedly red or markedly hardened at the final visit. In addition, there was a reduction of 31.5% in mean scar width and of 47.8% in mean scar height at the end of the observation period. A high percentage of patients (85.8%) and physicians (86.6%) rated the treatment as good or very good with respect to prevention of excessive scarring and promotion of physiological scar development. Tolerability was described as good or very good by 92.0% of physicians and 91.5% of patients.
Conclusions: The results of this study suggest that the scar gel is effective in preventing excessive scarring and promoting physiological scar formation when treatment is initiated early. In addition, the treatment was well tolerated.
J Drugs Dermatol. 2013;12(1):38-42.
Lidia Rudnicka MD PhD, Malgorzata Olszekska, Adriana Rakowska, Elzbieta Kowalska-Oledzka, Monika Slowinska
Videodermoscopy of hair and scalp (trichoscopy) is gaining popularity as a valuable tool in differential diagnosis of hair
loss. This method allows viewing of the hair and scalp at X20 to X160 magnifications. Structures which may be visualized
by trichoscopy include hair shafts of different types: vellus, terminal, micro-exclamation mark type, monilethrix,
Netherton type, and pili annulati hairs. The number of hairs in one pilosebaceous unit may be assessed. It may be distinguished
whether hair follicles are normal, empty, fibrotic (“white dots”), filled with hyperkeratotic plugs (“yellow dots”)
or containing cadaverized hair (“black dots”). Abnormalities of scalp skin color or structure which may be visualized by
trichoscopy include honeycomb-type hyperpigmentation, perifollicular discoloration (hyperpigmentation), and scaling.
Background: South Asians represent a rapidly growing part of the U.S. population, increasing 188 percent from 1990 to 2000 (0.27% to 0.78%). Studies investigating the epidemiology of skin disorders in South Asian Americans are lacking.
Objective: We sought to determine common skin conditions and concerns among this population.
Methods: This was a community-based survey study. The IRB-approved survey tool was distributed to South Asians adults in the New York City area. All data was self-reported.
Results: 190 surveys were completed. 54 percent of responders were female and 46 percent were male. The age of participants ranged from 18-74 years. The respondents were predominantly foreign born (76%), but a large minority (32%) reported living in the U.S. for over 20 years. Nearly half (49%) of the study population reported having visited a dermatologist in the past. The five most common dermatologic diagnoses included: acne (37%), eczema (22%), fungal infection (11%), warts (8%) and moles (8%). The five most common concerns included: dry skin (25%), hair loss (22%), uneven tone (21%), dark spots (18%) and acne (17%).
Conclusions: Our results suggest that the leading skin conditions and concerns in South Asian Americans are similar to those reported
in other populations with skin of color.
J Drugs Dermatol. 2011;10(5):524-528.
Alison M. Tisack MD, Richard H. Huggins MD, and Henry W. Lim MD
Erythema dyschromicum perstans (EDP), or ashy dermatosis, is characterized by oval, blue-gray macules, which are completely asymptomatic. In adults, the condition is primarily seen in patients of color, most commonly those of Hispanic descent, and typically follows a chronic course. We describe a pediatric case of EDP in a Caucasian patient. In the pediatric population, EDP is more commonly observed in Caucasian patients and often shows significant recovery or complete resolution in a matter of years. This case report outlines the differences in EDP between adult and pediatric patients.
J Drugs Dermatol. 2013;12(7):819-820.
Sung Bin Cho MD, Sang Ju Lee MD PhD, Won Soon Chung MD, Jin Moon Kang MD, Young Koo Kim MD
In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when
nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires
multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and
color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system
(Ultrapulse® EncoreTM Laser, Lumenis Inc., Santa Clara, CA).
Jorge Ocampo-Candiani MD,a Osvaldo T. Vázquez-Martínez MD,a José Luis Iglesias Benavides MD,b Kristin Buske MD,c Annette Lehn,d and Clemens Acker MDd
BACKGROUND: Abdominal Cesarean sections (C-sections) are frequently associated with an increased risk of excessive or unpleasant
scarring. A topical scar gel containing extract of Allium cepae, allantoin and heparin (Contractubex®; Merz Pharmaceuticals GmbH,
Germany), has shown efficacy in improving the appearance of various scar types.
OBJECTIVE: To investigate the efficacy of the topical scar gel, Contractubex, in the early treatment of C-section scars.
MATERIALS & METHODS: A total of 61 females, aged ≥18 years, who had given birth by elective C-section for the first time within the last
5–10 days, were included in this prospective, randomized, single-center study. Patients were advised to apply the topical scar gel twice daily
(treatment group), or received no treatment (control group). Efficacy was evaluated at 6 and 12 weeks after a baseline visit using the Patient
and Observer Scar Assessment Scale (POSAS), a validated scar assessment tool comprised of a Patient Scale and an Observer Scale.
RESULTS: Analysis revealed a significant change in the POSAS Patient Scale total score, with a 14.2% improvement in the treatment
group compared with a decline of similar magnitude (−14.8%) in the control group at week 6. Significant improvements were also
seen for POSAS Patient Scale sub-items in the treatment group compared with the control group for scar color (13.6% vs −18.5%,
respectively, P=0.0284), stiffness (12.5% vs −34.6%, respectively, P=0.0029), and irregularity (29.4% vs −46.2%, respectively,
P=0.0140) after 6 weeks of treatment. No significant changes were observed for the POSAS Observer Scale total score or its subitems
after treatment with the topical scar gel, although there was a strong overall trend in favor of the treatment group. No significant
adverse events were observed during the study.
CONCLUSION: Contractubex represents an efficacious and well-tolerated preventative treatment that rapidly and significantly improves
the color, stiffness and irregularity of C-section scars.
J Drugs Dermatol. 2014;13(1):176-182.
Dhaval Bhanusali MD, Marcelyn Coley MD, Jonathan I. Silverberg MD MPH PhD, Andrew Alexis MD MPH and Nanette B. Silverberg MD
Background: Tinea capitis periodically undergoes demographic shifts in causative dermatophyte and therapeutic response to oral
Objective: To determine prevalent fungal species and response to standard antifungal therapy in inner-city children of color.
Methods: An IRB-approved chart review of demographic, clinical, diagnostic, and therapeutic data was conducted for children and
young adults (0 to 18 years of age) who had scalp fungal culture performed for scalp hyperkeratosis and/or alopecia over a 2.5 year
time-period. Supplemental parental phone interview was performed for missing data points.
Results: A total of 84 patients with final diagnosis of tinea capitis were identified—52% male, 60.6% African-American, 28.2% Hispanic,
and 9.9% Caucasian. Complete resolution at 4 weeks was uncommon in all demographic groups (Hispanic: 11.7%, African-American:
41.3%). The Hispanic group and the youngest patients (aged less than 4 years) were less likely to respond to initial therapy, but the results
were not significant. Of the 80 tinea capitis patients initially treated with griseofulvin, 41 out of 54 children (76%) had complete response
to micronized suspension +/- crushed tablet (33% required shift to tablets from suspension) and 20 out of 26 (76.9%) cleared on crushed
tablets alone. Of the 19 griseofulvin failures, 5 cleared on fluconazole suspension, 7 on terbinafine sprinkles, 3 on itraconazole therapy,
and 4 were lost to follow-up. Of the 47 patients who could be evaluated long-term after a single course of oral griseofulvin at 6 weeks or
greater, 38 had documented long-term mycological cure (80.8%) and 42 had long-term clinical cure (89%). Trichophyton tonsurans (n=40)
was the most prevalent causative species identified on culture, followed by Alternaria species (n=10) and Microsporum canis (n=1).
Limitations: Retrospective chart review: patient population has a high rate of usage of over-the-counter antifungal creams and shampoos,
affecting culture results.
Conclusions: Tinea capitis is still the most common cause of Trichophyton tonsurans in New York City. Response rates to griseofulvin
are similar to rates seen in the 1970s, but require higher dosing and conversion to crushed tablets in partial responders. Usage of
crushed ultramicronized griseofulvin, terbinafine sprinkles, itraconazole, and fluconazole are alternative regimens for those children
whose tinea capitis does not clear on griseofulvin suspension.
J Drugs Dermatol. 2012;11(7):852-856.
Robert A. Swerlick MD aand Caren F. Campbell MD b
Excipients are defined as inert substances added to a drug or food to confer a suitable consistency, appearance, or form. They may be added for bulk, to change dissolution or the kinetics of absorption, to improve stability, to influence palatability, or to create a distinctive appearance. The last function may depend heavily on the use of coloring agents, especially when there are multiple dosages (such as with warfarin), and dose confusion may result in profound complications. While described as inert, excipients have been associated with triggering immunological reactions, although this is almost never considered in common practice when patients have reactions to medications, even when they appear to react to many different and distinct drugs. We have found a cohort of 11 patients with chronic, unexplained pruritic skin disorders that have responded to medication changes centered around avoidance of coloring agents, particularly FD&C Blue No. 1 (bright blue) and Blue No. 2 (indigo carmine). We believe that reactions to agents that color medications and foods may be more common than previously appreciated and that recognition of this phenomenon may provide therapeutic alternatives to patients with intractable pruritic disorders.
J Drugs Dermatol. 2013;12(1):99-102.
Yan Wu MD PhD,a* Xin Zheng,a* Xue-Gang Xu MD,a Yuan-Hong Li MD PhD,a Bin Wang PhD,a Xing-Hua Gao MD PhD,a Hong-Duo Chen MD,a Margarita Yatskayer MS,b and Christian Oresajo PhDb,c
OBJECTIVE: The objective of the study was to investigate whether a topical antioxidant complex containing vitamins C and E and ferulic acid can protect solar-simulated ultraviolet irradiation (ssUVR)-induced acute photodamage in human skin.
METHOD: Twelve healthy female Chinese subjects were enrolled in this study. Four unexposed sites on dorsal skin were marked for the experiment. The products containing antioxidant complex and vehicle were applied onto 2 sites, respectively, for 4 consecutive days. On day 4, the antioxidant complex-treated site, the vehicle-treated site, and the untreated site (positive control) received ssUVR (5 times the minimal erythema dose). The fourth site (negative control) received neither ssUVR nor treatment. Digital photographs were taken, and skin color was measured pre- and postirradiation. Skin biopsies were obtained 24 hours after exposure to ssUVR, for hematoxylin and eosin and immunohistochemical staining.
RESULTS: A single, 5 times the minimal erythema dose of ssUVR substantially induced large amounts of sunburn cell formation, thymine dimer formation, overexpression of p53 protein, and depletion of CD1a+ Langerhans cells. The antioxidant complex containing vitamins C and E and ferulic acid conferred significant protection against biological events compared with other irradiated sites.
CONCLUSION: A topical antioxidant complex containing vitamins C and E and ferulic acid has potential photoprotective effects against ssUVR-induced acute photodamage in human skin.
J Drugs Dermatol. 2013;12(4):464-468.
Background: Both ultrapulse-mode and superpulse-mode fractional CO2 lasers (UPCO2 and SPCO2) could be successfully used
in treating photoaged skin.
J Drugs Dermatol.
Objective: This evidence-based study was intended to compare the therapeutic and adverse effects of UPCO2 and SPCO2 in treating
photoaged skin in Chinese subjects.
Methods: Eighteen Chinese subjects with Fitzpatrick skin type IV were enrolled in a randomized, split-face trial. Subjects received
SPCO2 on one half of the face and UPCO2 on the other half. Before and after photos, skin color, epidermal water content,
sebum level, periorbital wrinkles, skin roughness, and self-esteem questionnaires were used.
Results: Global evaluation and subjects' self-esteem assessments showed a similar trend at 1-month and 3-month follow-up visits
on both sides. The UPCO2 laser has a shorter downtime of 6.25±2.71 days compared with 6.41±2.67 days for SPCO2, but has
a higher incidence of edema, spot bleeding, prolonged redness and postinflammatory hyperpigmentation. More subjects prefer
SPCO2 treatment because of similar efficacy and fewer adverse effects.
Conclusion: The effectiveness of the SPCO2 laser in treating photoaged skin is very similar to the UPCO2 laser, with less erythema,
but more crusting and longer downtime.
Manal Salah MD, Nevien Sami PhD, Maha Fadel PhD
Topical treatment of resistant psoriatic plaque stage lesions may be difﬁ cult and the systemic therapies seem inappropriate. There-
fore, a topical 0.1% methylene blue (MB) hydrogel was prepared and evaluated for percent drug content, drug uniformity, pH, rheo-
logical and organoleptic characters such as feel tackiness, grittiness sensation, and transparency in addition to release kinetics study
in vitro. The efﬁ ciency of the photodynamic therapy (PDT) of MB photo-activated using 565 mW Light emitting diode (LED) 670 nm
was evaluated in patients with resistant plaque psoriasis. The gel was evaluated in single blinded study. The patients were subjected
to repeated sessions of irradiation, skin biopsies from each patient in the beginning and at the end of the sessions were taken for
histopathological studies. Results showed the hydrogel was transparent nongritty and the drug uniformly dispersed with pH=7.2 and
viscosity value= 25.04 Pa. The drug content was found to be 99.4 ± 0.15 %. Drug release was following zero order kinetics with rate
constant K= 0.348 ± 0.01 and T
1\2 = 0.95±0.5 hours. Sixteen patients experienced complete clearance of their treated lesions. Skin
appeared normal in color, texture, and pliability with no complications indicating the lack of skin sensitivity. Histopathological examina-
tions showed nearly normal epidermis at the end of all sessions. The authors concluded that the prepared hydrogel was safe, stable,
and very effective. The results are encouraging to accept MB as a photosensitizer for PDT and as a safe and effective method for
treatment of selected cases of resistant localized psoriasis.
Michael H. Gold MDa,b and Conor Gallagher PhDc
BACKGROUND: Photoaging of the hands is common due to frequent exposure to environmental factors.
OBJECTIVE: To evaluate the efficacy of a topically applied cream formulated with an alpha-hydroxy acid, depigmenting agents, and antioxidants
to improve the appearance of characteristics associated with photodamaged hands.
METHODS: This was a single-site, open-label study of a proprietary topical treatment (Vivité Vibrance Décolleté, Allergan, Inc.) in adult
female subjects with moderate-to-severe photoaging of the hands. The treatment was administered to the hands twice daily over an
8-week period. Treatment efficacy was assessed at baseline and weeks 4 and 8 using the Investigator Global Assessment (IGA) score
based on the percentage coverage and color depth of photodamaged areas. The severity of age spots, freckles, and hand skin discoloration
were also assessed; digital and ultraviolet photography of the hands was performed. Subject-reported assessments of treatment
efficacy were evaluated using a questionnaire administered at week 8. Statistical significance was defined with an α set at P≤.05.
RESULTS: Thirty-five subjects were enrolled with a mean age of 55.6 years; 33 subjects completed the study. The IGA of the appearance
of hand photodamage improved from a mean (standard deviation) score of 5.0 (0.8) at baseline to 3.1 (1.5) and 2.6 (1.3) at weeks 4 and
8, respectively (1=mild; 9=severe). Based on expert-grader evaluation, subjects demonstrated statistically significant improvements
from baseline in IGA at weeks 4 and 8 in age spots and freckling at weeks 4 and 8, (P<.0003) and in skin discolorations at week 8
(P<.05). The majority of subjects reported that they perceived improvements in each of the 9 parameters associated with skin appearance.
No adverse events were reported.
CONCLUSIONS: The appearance of age-related hand pigmentation characteristics were significantly improved at 4 and 8 weeks of treatment.
Subjects reported post-treatment improvements in other characteristics associated with healthy skin.
J Drugs Dermatol. 2013;12(12):1468-1472.
Robert A. Weiss MD FAAD FACPh and Margaret A. Weiss MD
BACKGROUND / OBJECTIVE: This study investigates the efficacy, tolerance, and usability of a single product containing cycloastragenol,
growth factors, peptides, and antioxidants to decrease the visible signs of aging, including fine lines, and wrinkles, texture, pore size,
elasticity, skin color/clarity, redness, hydration, and overall skin quality.
METHODS: Twenty subjects were enrolled in a 12-week, open-label, patient-assessment study. Subjects used a gentle cleanser,
cycloastragenol, growth factors, peptides, and antioxidants (Regeneration Booster™, Jan Marini Skin Research (San Jose, CA) and
a broad spectrum SPF for the duration of the 12-week study. Assessments were taken at baseline, 2, 4, 8, and 12 weeks. All assessments
were compared against baseline for statistical significance.
RESULTS: Eighteen of the twenty subjects completed the 12-week study. Improvement was significant after just 2 weeks of use for
all measured categories except erythema and significant for all categories at 12 weeks. One hundred percent of study subjects noted
improvement in at least 3 or more of the 8 assessed categories with an average improvement in 6.7 categories. Improvement response
rate for individual categories ranged from 67% to 100% of study subjects. There were zero cases of sensitivity or irritation and product
smell, feel and ease of application were rated “positive” by 100% of study subjects. Photographic improvement was most notable in
texture and lines on the cheeks and eye area.
CONCLUSION: Regeneration Booster, when used as a stand–alone anti-aging solution, delivers rapid and significant reduction in the
visible signs of aging. Subject satisfaction was extremely high and there were zero reported cases of sensitivity or irritation. Based
on these observations, Regeneration Booster is a safe and effective topical product for individuals seeking significant improvement
in the appearance of aging skin.
J Drugs Dermatol. 2014;13(9):1135-1139.
Ritu Saini MD, Stephanie Lehrhoff MD, Deborah S. Sarnoff MD
The incidence of malignant melanoma has reached more than 62,000 people this past year alone. Much is unknown about the genetic
predisposition of this cancer. The authors present a 62-year-old woman with a history of Charcot-Marie-Tooth disease (CMTD),
diagnosed at age five, who has also developed multiple primary cutaneous malignant melanomas since 2003. The patient presented
to the authors’ clinic with a pigmented lesion on the left thigh, which was increasing in size and changing color. The patient was
diagnosed with malignant melanoma in situ on biopsy. As both CMTD and malignant melanoma are neural crest derived disorders,
this may suggest a shared underlying genetic defect. A gene locus of particular interest is 1p36, both previously recognized in the
proposed pathogenesis of CMTD and malignant melanoma (MM).
Shaundre Terrell BS, Daniel Aires MD, Eric S. Schweiger MD
Background: Studies indicate photodynamic therapy is an effective treatment of infl ammatory acne lesions on patients with Fitzpatrick
skin types 1–3. There is a lack of evidence in the literature regarding the use of photodynamic therapy to treat acne vulgaris in
African American patients. This article reports the fi rst case of blue light photodynamic therapy to treat moderate infl ammatory facial
acne on an African American patient with type 5 skin.
Observations: This article describes a 26-year-old African American woman with moderate infl ammatory facial acne vulgaris. On
examination, she had over 15 infl ammatory papules on her face and post-infl ammatory hyperpigmentation. The patient had a history
of treatment failure with the following therapies: topical benzoyl peroxide, topical antibiotics, topical retinoids and oral antibiotics. At
presentation, the patient was using a combination topical benzoyl peroxide/clindamycin product in the morning and tazoratene gel in
the evening without success. The patient was treated with 20% aminolevulinic acid/blue-light photodynamic therapy spaced monthly
for a total of four treatments, a once-daily application of hydroquinone 4% cream and her existing topical regimen. The patient reported
signifi cant improvement of infl ammatory acne lesions and post-infl ammatory hyperpigmentation following two treatments
with photodynamic therapy and was virtually clear of all acne lesions after the third treatment.
Conclusion: Photodynamic therapy is an emerging remedy for patients with acne vulgaris resistant to standard treatment, particularly
in patients with skin of color who are more sensitive to post-infl ammatory hyperpigmentation. In this African-American patient,
20% aminolevulinic acid/blue-light photodynamic therapy was effective in treating facial acne vulgaris.
Sushil T.Tahiliani MD and Harsh S.Tahiliani MD
Laser-based photoepilation of dark skin types demands a delicate combination of appropriate light wavelengths and spot size to achieve optimal epidermal-to-follicular energy absorption ratios. This prospective study assessed the axillary, arm, thigh, and back hair clearing ef cacy of the LightSheer In nity 1060 nm diode laser in 10 Fitzpatrick skin type IV-V patients. Each area was treated up to ve times, at 4-6-week intervals, after which immediate skin responses and adverse events were recorded. Hair count, color and coarseness were assessed before each treatment session, as well as 1, 3, and 6 months following the last session. Both patients and the treating physician rated the degree of improvement with time, and patients also ranked their satisfaction with the treatment outcome. Percent hair reduction from baseline gradually increased with treatment and peaked at 74.6%, 68.4%, and 65.7% for axillary, arm and thigh regions, respectively, 6 months following the last treatment session. Baseline hair growth patterns precluded effective selection of a representative area for hair counting. Patients satisfaction was consistently higher for axillary hair clearance rates, followed by thigh and arm responses. Throughout the follow-up period, the investigator rated 50-67% of the treated axillae as presenting “good” or “very good” hair clearance, and provided similar ratings for 67% of the treated thigh regions at both the 1 and 6 month follow-up sessions. Immediate responses to treatment were mild to moderate and short-lived and no incidents of brosis or scarring were reported. Taken together, the LightSheer In nity 1060 HS Handpiece provided for an ideal ef cacy-safety balance in treating dark-skinned patients, providing for long-term hair clearance with minimal downtime.
J Drugs Dermatol. 2016;15(11):1427-1434.
J. Mark Jackson MD FAAD,a Andrew Alexis FAAD MPH FAAD,b Brian Berman MD PhD FAAD,c Diane S. Berson MD FAAD,d Susan Taylor MD FAAD,e Jonathan S. Weiss MD FAADf
Seborrheic keratosis (SK) is among the most common cutaneous lesions, affecting some 83 million Americans. Biologically benign, SK lesions do not require removal for medical reasons unless histologic confirmation of the clinical diagnosis is required or the lesions are traumatized and/or become symptomatic. These macular or popular pigmented lesions are often of cosmetic concern to patients. In addition, their natural history of gradually increasing in size, thickness, and/or pigmentation often serves as the impetus compelling patients
to present to a dermatologist for evaluation and skin cancer screening; SK is diagnosed and managed primarily by dermatologists. Data regarding SK prevalence and management from a survey of 594 practicing, board-certified dermatologists are summarized herein: Dermatologists report they diagnose an average of 155 patients per month with SK. Among SK patients presenting to dermatologists, 33% have more than 15 SK lesions and 67% have 15 or fewer SK lesions. On average, dermatologists treat 43% of their SK patients to remove lesions. Cryosurgery is the most common removal method. Other commonly employed removal methods include shave excision, electrodessication, curettage or a combination of these. While these procedures can be used to remove SK lesions effectively, each has potential drawbacks and careful patient selection is required to optimize cosmetic results particularly in skin of color patients and patients with thick or numerous lesions. While there is great interest from both patients and providers in a topical non-invasive treatment for SK, no effective topical therapeutic agent has been developed, and this remains an area of unmet need.
J Drugs Dermatol. 2015;14(10):1119-1125.
Hema Sundaram MD, Susan Weinkle MD, Jason Pozner MD, Luc Dewandre MD, Joel L. Cohen MD, Lisa Donofrio MD, Daniel Cassuto MD, Timothy Flynn MD, Paul Lorenc MD, Steven Fagien MD, Gary Monheit MD, Philippe Kestemont MD, Mark G. Rubin MD, Rebecca Fitzgerald MD, Rod J. Rohrich MD, Andrew F. Alexis MD MPH, Murad Alam MD MSci, Julius W. Few MD, Gerhard Sattler MD, C. William Hanke MD MPH
Part II of this two-part supplement brings together experts from the U.S., France, Germany, and Italy to discuss state-of-the-art soft tissue fillers in a fair-balanced, CME-accredited format. It includes two roundtable discussions: the first, on new and emerging concepts in fillers, provides an overview of commonly used alloplastic filler products and examines how new strategies for soft tissue augmentation are developing as filler options continue to expand; the second discusses the physicochemical properties and potential clinical applications of two new ranges of hyaluronic acid fillers that display enhanced tissue integration after implantation. International case vignettes highlight our current understanding of facial fat compartments, special considerations for skin of color, and the Tower Technique for filler implantation. Finally, consensus recommendations for the use of blunt-tipped microcannulas in injecting soft tissue fillers are presented, as well as quick poll surveys on current hot topics.
This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 2 AMA PRA Category 1 Credits.
Reconstruction of full-thickness defects may benefit from integration of dermal substitutes, which serve as a foundation for split-thickness
skin grafts, thus enhancing short and long-term results. We present a series of 7 patients who were treated between 2010 and 2012 for
complicated full-thickness defects by the second-generation collagen/elastin matrix Matriderm® covered by a split-thickness skin graft.
The defects resulted from malignancy resection, trauma, and post-burn scar reconstruction. Overall graft take was excellent and no complications
were noted regarding the dermal substitute. Graft quality was close to normal skin in terms of elasticity, pliability, texture, and
color. Good contour and cushioning of defects in weight bearing areas was also achieved. Matriderm was found to be a useful adjunct to
full-thickness defect reconstruction, especially in difficult areas where the desired result is a scar of the highest quality possible.
J Drugs Dermatol. 2012;11(7):866-868.
Jacob Levitt, MD, Terry Feldman, MD; Ildiko Riss, MD and On-Tai Leung, MD
The physical and chemical compatibility of desoximetasone ointment 0.25% and tacrolimus ointment 0.1%, both widely used to treat
atopic dermatitis, were determined. A 1:1 (w/w) mixture of desoximetasone ointment 0.25% (Topicort®, Taro Pharmaceuticals USA,
Inc.) and tacrolimus ointment 0.1% (Protopic®, Fujisawa Healthcare, Inc.) were prepared and stored under three different temperature/
relative humidity conditions: 25oC/60% RH; 30oC/60% RH; and 40oC/75% RH. Unmixed ointments stored under the same temperature
and humidity conditions as the mixture served as controls. Samples were evaluated at days 1, 2, 7, 14, and 28 for color, degree
of physical separation, and chemical stability via reverse-phase high performance liquid chromatography. Ranges of relative recovery
for each active ingredient for all storage conditions ((% Mixture/% Control) x 100) were 89.6 - 109.3% for tacrolimus and 99.0 - 103.4%
for desoximetasone. No significant difference in physical appearance or chromatographic profile between the mixture and controls
was observed. Therefore, we conclude that desoximetasone ointment 0.25% (Topicort®) and tacrolimus ointment 0.1% (Protopic®)
are physically and chemically compatible up to four weeks when mixed in a ratio of 1:1 (w/w).
Mohammed S. Aldraibi MD PhD, Dany J. Touma MD, Amor Khachemoune MD CWS
Background: Laser hair removal targets melanin in the hair shaft. The abundance of melanin in the epidermis of
patients with dark skin color has always been regarded as hazardous due to the increased incidence of side effects in this
Objective: To establish the efficacy and safety of using the 3-msec alexandrite laser in patients with skin types IV to
VI, and evaluate the role of topical corticosteroids in preventing side effects.
Methods: Thirty-seven patients with skin types IV to VI and brown or black hair were recruited and divided into 2
groups. Twenty-six patients were treated with the 18-mm spot size and 11 patients were treated with the 15-mm spot
size. Hair shafts in the treatment and control areas were counted and clipped for measurement of the thickness at the
base. The laser was used with fluences between 8 and 32 J/cm2. Two 16-cm2 areas were treated; one area was pretreated
with a class I topical corticosteroid (TCS) cream (betamethasone dipropionate) 10 minutes prelaser and twice a day for
5 days postlaser. The dynamic cooling device (DCD) spray duration was set at 90 msec, and the delay was set at 20
msec. Pain was graded on a scale from 1 to 10. Patients were followed up on day 1 and day 7 and at 1, 3, and 6 months.
Histological samples from the 2 treatment areas and control were obtained from 5 patients. At follow-up visits, side
effects were graded on a scale from 1 to 3. Hair reduction was evaluated by performing hair counts. The thickness of
hair was measured microscopically at the base. Average hair count reduction and hair thickness were recorded at the
3- and 6-month visits.
Results: Thirty-one patients completed the study. The average hair count reduction at 6 months was 35.4%. The average
hair thickness reduction was 31.2%. At one week hyperpigmentation was seen in 48.4% of the laser only treated
area and in 45.2% of laser/TCS treated area. The effect of TCS was minimal and more prominent at 1 and 3 months.
The incidence of hyperpigmentation was higher in the 15-mm group than the 18-mm group as a result of using higher
fluence. Hypopigmentation was generally preceded by crust formation and lasted up to 3 months. Reducing spot size
resulted in decreased peripheral crust formation. TCS appears to have a role in reducing the erythema and crusting.
Histopathology of both groups at day one showed necrosis of the follicular infundibulum and the inner layer of the perifollicular
epithelium. No vascular damage was seen.
Conclusion: The 3-msec alexandrite laser utilized in this study provides a safe and effective treatment achieving longterm
reduction of unwanted, pigmented hair in skin types IV and V, but is less safe in skin type VI. Using a TCS helps
in minimizing post-treatment erythema and edema; it also decreases the duration of hyperpigmentation.
Ronald N. Shore MD, Paula Shore MEd†, Noel M. Monahan MHSc PA-C, James Sundeen MD
Objective: To determine the effectiveness of a serial screening program in achieving early detection and preventing death in patients
at increased risk for melanoma.
Design: Retrospective study.
Setting: Private dermatology practice.
Patients: The study included all patients at increased risk for melanoma who were screened in the program during the 17-year period,
July 1, 1992-June 30, 2009 (=1108 patients per year).
Main Outcome Measures: Survival and indicators of early detection.
Results: All melanomas that developed in program participants during the 17-year period were detected early and there were no
deaths, metastases, recurrences, nor need for sentinel node biopsies. An analysis of melanoma cases seen in five recent years revealed
additional evidence of consistent early detection: 80 percent of the lesions were in situ, no lesions were greater than 0.15 mm
in Breslow depth, and all lesions were in the radial growth phase, a stage almost always associated with cure. Four measures, often
absent in mass screening programs, contributed to very early detection and cure: thorough serial examinations, biopsying suspicious
lesions (particularly pigmented lesions that were highly irregular and/or approaching black in color), recalling patients every six months
to detect all melanomas in the radial growth phase, and educating patients on the need to return.
Conclusion: An office-based surveillance program that includes serial full skin examinations and ongoing recalls appears capable
of detecting melanoma at a very early stage when cures can be realized in almost every case. Therefore, when patients present
with recognized risk factors for melanoma, dermatologists should seriously consider recommending and performing such serial
Claudine Pierard-Franchimont MD PhD, Frederique Henry MD, Pascale Quatresooz MD PhD, Valerie Vroome PharmD, Gerald E. Pierard MD PhD
Background: Solar lentigines represent a common feature of photoaging, particularly on the back of the hands. Bleaching agents
are usually proposed to lighten the shade of the lesions.
Methods: The study was randomized and designed to assess the effect of a bleaching solution containing 2% mequinol (4-hy-
droxyanisole, 4HA) and 0.01% tretinoin (Solagé®). The formulation was applied twice daily for 3 months on solar lentigines present
on the back of one hand. The lesions on the other hand were treated with the ethyl alcohol vehicle which served as a control.
Clinical diagnosis was confirmed using dermoscopy. In addition, objective measurements of the hypermelanosis were performed
at 1-month intervals during and after treatment. Clinical assessments were used as well as narrow-band reflectance spectropho-
tometry, image analysis of video-recorded ultraviolet light-enhanced visualization (ULEV method) and photodensitometry of the
Results: The multipronged assessment of the lesional color demonstrated a significant lightening effect of the 4HA/tretinoin solu-
tion. This was demonstrated after 2 months of treatment and was maintained at least 2 months after stopping treatment.
Conclusion: Both the visual ratings and the objective bioinstrumental methods indicate the rapid lightening effect of the 4HA/
tretinoin formulation. After stopping treatment, the rate of repigmentation appeared to have slowed compared to the depigmenta-
Jennifer Ragi MD,a Amy Pappert MD,a Babar Rao MD,a Daphna Havkin-Frenkel PhD,b Sandy Milgraum MDa
Background: Wound healing is a dynamic and complex process affected by tissue hydration, the presence of bacteria, inflammation, and other variables. Oregano has potent antibacterial, antifungal, antioxidant, and anti-inflammatory properties. Studies of oregano ointment
on wound healing are lacking.
Objective: To determine the efficacy of 3% oregano extract ointment on wound healing.
Methods: An investigator initiated, randomized, double-blind, petrolatum-controlled study was performed to determine the effects of oregano ointment on wound healing. Forty patients who underwent surgical excision were enrolled and randomized. Cultures were obtained on day 12 and scars were evaluated using the Patient and Observer Scar Assessment tool on day 12, 45, and 90.
Results: The oregano ointment group had 19 percent of cultures test positive for Staphlococcus aureus compared to 41 percent in the petrolatum group. One patient in the oregano ointment group developed a cellulitis compared to three patients in the petrolatum group. The oregano group had a statistically significant improvement over petrolatum in scar color, pigmentation, and pliability.
Conclusion: Oregano extract ointment decreased bacterial contamination and subsequent infection on post-surgical wounds and had equivalent overall scar appearance compared to petrolatum.
J Drugs Dermatol. 2011;10(10):1168-1172.
Objective: This clinical study assessed the safety and efficacy of an investigational topical product for the treatment of onychomycosis (nail fungus).
Method: A prospective, multi-center, single-arm, self-controlled clinical investigation was done with adult subjects that met the inclusion criteria, primarily culture-confirmed dermatophyte infection of at least one great toe. Subjects self-treated in a weekly regimen of topical application for six months, with clinical assessment at one, three, and six months. Primary efficacy endpoint was clearance of fungal nail infection after six months of weekly treatment. Primary safety endpoint was freedom from product-related adverse events for the duration of the treatment term.
Results: Fifty males and 13 females, ages 24 to 65, infected with Trichophyton (n=62) or Epidermophyton (n=1) were enrolled; 53 completed six months of assessment. Sixty percent showed improvement in clinical parameters (nail color, nail plate involvement, onycholysis, thickness, and hyperkeratosis) at six months. Cumulative rates of dermatophyte-negative culture results (test of cure) were 28, 36, and 62 percent of subjects after one, three, and six months of treatment, respectively. Three minor adverse events were device-related, with no unanticipated or serious adverse events.
Limitations: This study was single-arm and self-controlled; 53 of 63 enrolled subjects completed the study.
Conclusion: This study describes a new topical medical device with safety and efficacy profiles that compare favorably to results reported for topically applied onychomycosis drug treatments.
J Drugs Dermatol. 2011;10(10):1186-1191.
The Skin Cancer Foundation is the only national and international organization devoted exclusively to malignancies of the skin. It conducts public and medical education programs and provides support for research and professional training to reduce the incidence, morbidity, and mortality of skin cancers.
The following article is abstracted from the Skin Cancer Foundation Journal. Outstanding articles from the foundation's award-winning publications, The Skin Cancer Foundation Journal, the Melanoma Letter, and Sun & Skin News will regularly appear here in upcoming issues.
Stephen W. Dusza MPH, Ruby Delgado MD, Klaus J. Busam MD, Ashfaq A. Marghoob MD, Allan C. Halpern MD
Objective: To assess the clinical and histologic effects of topical imiquimod therapy on dysplastic nevi, and to determine the
feasibility of using in vivo confocal microscopy (CSLM) to non-invasively monitor histological response of
dysplastic nevi to imiquimod therapy.
Design: Single-blinded pilot study with patients not blinded as to treatment status.
Setting: Dermatology Outpatient Clinic, Memorial Sloan-Kettering Cancer Center, New York, NY.
Patients: The study population comprised of 10 patients with clinically dysplastic (atypical) nevi and at least 8 large nevi,
(?5 mm) on their trunk.
Intervention: Sixteen weeks of imiquimod 5% cream applied to treatment lesions 3 times per week.
Main Outcome Measure: Clinical response as gauged by comparison of baseline and week 20 1:1 standardized photographs
for all study nevi and histological assessment of each patient’s 4 largest study nevi at completion of therapy.
Results: There were no obvious clinical changes in the size and morphology of the study nevi. Subtle changes in nevus color
could not be assessed due to imperfect spectral registration of images over the course of the study. Histologically, 4 of 14 treated
nevi and 0 of 14 untreated nevi p=0.03 showed a significant relative reduction of junctional and intraepidermal nevocytes
accompanied by papillary dermal fibroses and variable inflammation suggestive of partial regression. Non-invasive CSLM
imaging of study nevi demonstrated previously reported in vivo features of dysplastic nevi. but the imaging equipment and
protocol utilized proved inconsistent across lesions and time.
Conclusions: The histological changes seen in a subset of treated nevi suggest a possible role for the use of topical immune
response modifiers for the treatment of dysplastic nevi with the intent of melanoma chemoprevention. The dose regimen of
topical imiquimod utilized in this study failed to induce sufficient clinical or histological responses to warrant further study.
Targeting of dysplastic nevi and intermediate endpoints for melanoma chemoprevention with more intense and/or prolonged
treatment regimens with imiquimod or the use of other immune response modifiers seems promising. Technical improvements
are required for the use of non-invasive CSLM imaging in lieu of invasive histology for the study of topical nevus
Hilary E. Baldwin MD,a Neal D. Bhatia MD,b Adam Friedman MD,c Richard Martin Eng,d and Sophie Seité PhD e
The skin is constantly exposed to various endogenous and exogenous factors that may impact its barrier function at the physical, mechanical, immunological, and microbial levels. These factors have the potential to initiate or exacerbate a variety of inflammatory skin conditions, especially those associated with barrier dysfunction. The barrier function of the skin depends upon a symbiotic relationship between resident microbial communities and host tissue. This symbiosis results from complex signals involved in both the innate and adaptive immune responses. Recent research indicates that both bacterial diversity and the relative abundance of different microbes present on and in the skin, may contribute to skin barrier stability or dysfunction. The objectives of this review are to discuss the relationship between the skin microbiota and skin barrier function and to consider mechanisms that may help its preservation.
J Drugs Dermatol. 2017;16(1):12-18.
Monopolar radiofrequency (RF) devices are well established treatment modalities for tightening facial skin. A 60-yearold
woman presented with a desire to tighten the lax skin and improve the appearance of both upper arms. A combination
unipolar and bipolar RF device may provide volume reduction as well as skin tightening in the upper arm.
Skin aging is a combination of multifactorial mechanisms that are not fully understood. Intrinsic and extrinsic factors modulate skin aging, activating distinctive processes that share similar molecular pathways. One of the main characteristics of youthful skin is its large capacity to retain water, and this decreases significantly as we age. A key molecule involved in maintaining skin hydration is hyaluronic acid (HA). Concentration of HA in the skin is determined by the complex balance between its synthesis, deposition, association with cellular structures, and degradation. HA bio-equivalency and bio-compatibility have been fundamental in keeping this macromolecule as the favorite of the skincare industry for decades. Scientific evidence now shows that topically applied HA is unable to penetrate the skin and is rapidly degraded on the skin surface.
Katlein França MD MSc,a Joel L. Cohen MD,b and Lisa Grunebaum MDc
INTRODUCTION: Skin cancer is the most common form of cancer in the United States. According to the World Health Organization, the incidence of both nonmelanoma and melanoma skin cancers has increased over the past few decades.
OBJECTIVE: The objective of this article is to review studies about cosmeceuticals that can be used by people who previously had skin cancer and may work as agents that help in some way to prevent new skin cancer lesions.
CONCLUSION: Cosmeceuticals are antiaging skin products that overlap cosmetics and pharmaceuticals and are commonly available over the counter. This article reviewed several substances used in cosmeceuticals formulations that could be useful for individuals who have had previous skin cancers and need to prevent possible new lesions. Further studies are needed to better evaluate these products and their skin cancer preventive properties.
J Drugs Dermatol. 2013;12(5):516-518.
Impaired epidermal barrier function plays a role in causing inflammatory dermatoses, so skin care regimens are recognized by dermatologists to be critical for efficient barrier function and healthy skin. Acne vulgaris, however, has always presented a challenge when it comes to skin care products, as a delicate balance needs to be struck between maintaining the skin barrier whilst controlling oil and shine.
Cetaphil® DermaControl™ Moisturizer SPF 30 (Galderma Laboratories, L.P., Fort Worth, Texas) is a new widely available and affordable skin care therapy specifically designed for use by patients with acne-prone skin and acne-affected skin. Its state-of-the-art psuedoceramide technology helps maintain barrier function without adding excessive surface greasiness, which leads to better compliance and fewer side effects; and it also provides protection against ultraviolet radiation.
Rosemarie Osborne PhD, Lisa A. Mullins, Bradley B. Jarrold
Global gene expression profiling provides a useful means to identify key aspects of the skin aging process, and provides information
to help develop new skin technologies. Important aspects of skin aging that can be addressed include skin hydration, barrier, matrix,
pigmentation and antioxidant capacity. Human skin equivalent cultures allow topical application of test compounds, combinations
and products to their stratum corneum surface and measurement of predictive biomarkers. Using this in vitro biomarker approach,
it is possible to detect skin barrier enhancement in response to the compounds niacinamide and hexamidine, matrix effects to the
peptides Pal-KT and Pal-KTTKS, and hydration and matrix responses to niacinamide and N-acetylglucosamine.
David A. Sanchez BS,a,e Joshua D. Nosanchuk MD,b,c and Adam J. Friedman MDa,d,
Skin microbiome studies have elucidated clinically pertinent information regarding its potential role in the pathogenesis of certain
inflammatory skin disorders. Two of the most commonly diagnosed chronic inflammatory skin disorders that have been connected to
perturbation of the skin microbiome are psoriasis (PS) and atopic dermatitis (AD). The objective of this brief review is to recapitulate
some of the novel findings concerning the microbiome’s role in AD and PS.
J Drugs Dermatol. 2015;14(2):127-130.
Derek Ho BSa and Jared Jagdeo MD MSa,b,c
Skin grafts are utilized in dermatology to reconstruct a defect secondary to surgery or trauma of the skin. Common indications for skin grafts include surgical removal of cutaneous malignancies, replacement of tissue after burns or lacerations, and hair transplantation in alopecia. Skin grafts may be cosmetically displeasing, functionally limiting, and significantly impact patient’s quality-of-life. There is limited published data regarding skin graft revision to enhance aesthetics and function. Here, we present a case demonstrating excellent
aesthetic and functional outcome after fractionated carbon dioxide (CO2) laser skin graft revision surgery and review of the medical literature on laser skin graft revision techniques.
J Drugs Dermatol. 2015;14(11):1285-1288.
Melissa A. Bogle MD, Kenneth A. Arndt MD, Jeffrey S. Dover MD FRCPC
Plasma skin regeneration is a novel type of skin rejuvenation technology developed over the last 3 years. Plasma is the
fourth state of matter in which electrons are stripped from atoms to form an ionized gas. Although high temperature plasmas
have been used in surgery for over a decade, plasma had previously been used as a conduction medium for electric
current. Unlike lasers which rely on the principle of selective photothermolysis to deliver heat to specific targets in the
skin, plasma technology delivers heat energy directly to tissue upon contact without reliance on skin chromophores. The
plasma itself produces controlled thermal damage to the skin surface to elicit changes such as new collagen formation and
improvement in photodamaged skin. The technology can be used at varying energies for different depths of effect, from
superficial epidermal effects to deeper dermal heating.
The Future is Now With SkinMedica’s Lytera™
The gold standard for the treatment of abnormal melanin accumulation has long been 4% hydroquinone, but, given the proliferating safety concerns posed by hydroquinone, the search for novel skin brighteners has been ongoing. Several studies have demonstrated that the future for skin brighteners is now, because of the skin brightening efficacy of SkinMedica’s Lytera™, a hydroquinone-free skin-brightening complex. Lytera includes a series of formulations that utilize a multi-modal treatment approach, and it is as effective as hydroquinone over the course of 24 weeks for the treatment of facial hyperpigmentation without the concomitant toxicities of the latter.
Joseph R. Kaczvinsky, Jr. PhD and Pearl E. Grimes MD
Skin aging integrates the impact of extrinsic skin insults (e.g., ultraviolet [UV] light, etc.) with chronological, genetically programmed
decreases in cellular function. A genomic study of aged skin highlighted the mechanistic importance of skin barrier function, exfoliation,
control of reactive oxygen species and maintenance of extracellular matrix to the aging process. A set of topical products
designed to address these mechanistic themes was developed and clinically tested. The individual products improved skin barrier
function, hydration and skin turnover, as well as the smoothness and depth of periorbital wrinkles. Treatment with a regimen of
these products improved the appearance of facial wrinkles after eight weeks. Changes in treated subjects’ stratum corneum protein
biomarker levels were consistent with the mechanistic pathways identified in the genomic work. Thus, leveraging a genomic understanding
of skin aging led to the development of a clinically efficacious, aesthetically pleasing cosmetic regimen that improved the
appearance of aged skin.
From Sun & Skin News, Vol. 20, No.2
No abstract details for the moment.
Julia Schwartz MDa and Adam J. Friedman MDa,b
The stratum corneum (SC) is the skin’s outermost layer and serves the primary function of acting as a shield to keep foreign matter out and to essential elements, such as moisture and water, in. Maintenance of this skin barrier is crucial to healthy functioning skin. A damaged or diseased skin barrier is vulnerable to infection, irritants, and allergens. The cornerstone of skin barrier regulation and repair is through the use of moisturizers. While healthcare providers and patients may underestimate the importance of moisturizers due to their lack of active ingredients, the benefit of a well-planned moisturizer regimen for skin barrier regulation should not be discounted. Dermatologists should be comfortable prescribing and educating about over-the-counter moisturizers to patients with skin barrier is- sues. A general understanding of basic moisturizer ingredients and formulations will aid the dermatologist in providing a personalized moisturizer regimen to their patients.
J Drugs Dermatol. 2016;15(11):1289-1294.
Adam J. Luber BA, Shaheen H. Ensanyat BS, and Joshua A. Zeichner MD
The human circadian clock ensures that biochemical and physiological processes occur at the optimal time of day. In addition to a
central pacemaker in the body, recent evidence suggests that peripheral mammalian tissues also possess autonomous circadian oscillators,
which are regulated by genes linked to distinct tissue-specific functions. The skin is situated in a position naturally exposed
to diurnal environmental changes. The skin's chronobiological functioning influences skin aging, cell repair and development of skin
cancers, as well as optimal timing of drug delivery to the skin. An understanding of circadian skin-related functions and the impact
of their disruption allow clinicians to improve therapeutic decision-making and maximize the effectiveness of prescribed treatments.
J Drugs Dermatol. 2014;13(2):130-134.
Yang Yu BS,a,b Jackson Champer MS,a David Beynet MD,a Jenny Kim MD PhD,a,c Adam J. Friedman MDd,e
The human microbiome has recently gained prominence as a major factor in health and disease. Here we review the literature regarding
the microbiome and cancer and suggest how the microbiome may be manipulated for improved health outcomes. The gut
microbiome has been relatively well studied, and the mechanisms of how it may increase or decrease the risk of certain cancers may
apply to the skin microbiome. Additionally, the gut microbiome may directly impact the risk of cancer in the skin and other organs
by promoting systemic inflammation. The skin microbiome itself is as diverse as the gut microbiome, but research has just begun to
unravel its influence on the host. Like the gut microbiome, it affects the risk for several diseases, including cancer. By using healthpromoting
strains from the microbiome in oral or topical probiotics, it may be possible to reduce the risk of skin cancer and perhaps
even increase the likelihood of successful treatment.
J Drugs Dermatol. 2015;14(5):461-465.
Stem cells can propagate indefinitely in an undifferentiated state; or, with appropriate signals, differentiate into various types of mature cells. Strong interest in stem cell therapies for degenerative diseases has extended to skin aging, itself a degenerative process. This article reviews mechanisms of skin aging, and enables an evidence-based approach to topical skin rejuvenation - specifically, to formulations labeled as stem cell products.
J Drugs Dermatol. 2017;16(4):378-384.
Marie S. Tuttle MD, Neil J. Korman MD PhD, Jeremy Bordeaux MPH MD
Skin cancer risk from the use of immunosuppressive medications used to treat inflammatory conditions is not well understood,
though studies clearly establish an exaggerated risk of skin cancer in solid organ transplant recipients (SOTRs) receiving these
medications. The authors report a patient with Behcet’s disease treated with combination immunosuppressive therapy and common
variable immunodeficiency developing multiple squamous cell carcinomas (SCCs) of the skin, necessitating adjustment of her immunosuppressive
regimen. As more patients are treated with immunosuppressive medications for chronic inflammatory diseases,
clinicians must be aware of the possible increased risk of skin cancers associated with these medications. Skin cancer risk assessment,
screening for sub-clinical malignancies and frequent skin exams of high risk patients may represent strategies to improve the
safety of these medications.
The skin of patients with rosacea is extremely sensitive and hyper-reactive to dietary, environmental, and topical factors.
Accordingly, the management of rosacea involves not only choosing appropriate medication and treatment for
daily skin care, but also avoiding known trigger factors. Recently, 1% metronidazole, a mainstay of topical rosacea therapy,
was reformulated in a gel vehicle that contains hydrosolubilizing agents (HSA) niacinamide, beta cyclodextrin,
and a low concentration of propylene glycol. It is designed to solubilize greater concentrations of metronidazole than
is possible in water alone while reducing the potential for irritation and barrier disruption. A 2-week study was undertaken
by the author to evaluate the effect of the new 1% metronidazole gel on the skin barrier in 25 women with mild
to moderate rosacea. Statistically significant improvement in disease severity, erythema, desquamation, and skin irritation
was noted by the investigator by the end of week 1, which continued throughout the study. After 2 weeks, subjects
noted improvements in skin condition and rosacea. Results of noninvasive assessments showed no disruption of the skin
barrier. Furthermore, there was an increasing trend in skin hydration that approached statistical significance.
Michael K. Robinson PhD, Robert L. Binder PhD, Professor Christopher E.M. Griffiths
Like all tissues, the skin ages due to the passage of time (chronologic aging). However, skin is also exposed to external insults,
such as sunlight. Aging due to chronic sun exposure (photoaging) is characterized clinically by wrinkling, dyspigmentation and other
changes. Chronologic and photoaging of skin have been distinguished at the structural, cellular and molecular levels. However, many
underlying mechanisms remain a mystery. Recent sequencing of the human genome and development of genome-wide microarray
platforms now permit analysis of skin aging at the level of gene expression. Analysis of gene expression differences between young
and older sun-protected and sun-exposed skin showed that photoaging produces many similar (but more severe) changes in gene
expression versus chronologic aging. However, some changes are unique to one form of aging or the other. Bioinformatics tools
also enable an integrated analysis of gene expression themes and pathways, which may provide new insights into the mechanisms
of skin aging and possible interventions.
Ellen RM de Haas LLM MD PhD, Tamar Nijsten MD PhD, Esther de Vries PhD
Skin cancer is the most commonly diagnosed cancer in populations of predominantly Caucasian origins. As the main cause of skin
cancer is excessive sun exposure among a sun-sensitive population, most skin cancers are theoretically avoidable, and prevention is
an important topic for public health purposes. The development of skin cancer may be limited by effective primary prevention campaigns,
causing people to protect themselves from the sun. In order to be effective, the right people need to become aware of the
risks and benefits; they also need to be convinced that they can take effective protective measures.
Secondary skin cancer prevention aims to avoid skin cancer morbidity and mortality and is, therefore, mainly aimed at early detection
of cutaneous melanomas. Around the world, elderly men are the worst off in terms of melanoma mortality statistics and would be
an important target group for secondary prevention.
Several prevention initiatives have been developed, including awareness campaigns and voluntary skin cancer screening days. So
far, few of these initiatives have proven to be successful in changing population behavior and/or skin cancer related mortality. Most
of these initiatives appealed more to (young) women rather than the elderly males who would benefit most.
In this review, various aspects of primary and secondary skin cancer prevention are discussed, including the results of some of the
primary and secondary prevention initiatives.
Olha Ilnytska PhD, Simarna Kaur PhD, Suhyoun Chon PhD, Kurt A. Reynertson PhD, Judith Nebus MBA,
Michelle Garay MS, Khalid Mahmood PhD, and Michael D. Southall PhD
Oats (Avena sativa) are a centuries-old topical treatment for a variety of skin barrier conditions, including dry skin, skin rashes, and eczema; however, few studies have investigated the actual mechanism of action for the skin barrier strengthening activity of colloidal oatmeal. Four extracts of colloidal oatmeal were prepared with various solvents and tested in vitro for skin barrier related gene expression and activity. Extracts of colloidal oatmeal were found to induce the expression of genes related to epidermal differentiation, tight junctions and lipid regulation in skin, and provide pH-buffering capacity. Colloidal oatmeal boosted the expression of multiple target genes related to skin barrier, and resulted in recovery of barrier damage in an in vitro model of atopic dermatitis. In addition, an investigator-blinded study was performed with 50 healthy female subjects who exhibited bilateral moderate to severe dry skin on their lower legs. Subjects were treated with a colloidal oatmeal skin protectant lotion. Clinically, the colloidal oatmeal lotion showed significant clinical improvements in skin dryness, moisturization, and barrier. Taken together, these results demonstrate that colloidal oatmeal can provide clinically effective benefits for dry and compromised skin by strengthening skin barrier.
J Drugs Dermatol. 2016;15(6):684-690.
Michael H. Gold MD, Mitchel P. Goldman MD, Julie Biron
The crucial role of growth factors and cytokines in cutaneous wound healing is well described, but there has been little
investigation into their use for skin rejuvenation. A novel skin cream containing a mixture of human growth factors
and cytokines was recently marketed for skin rejuvenation. The mixture was obtained through a biotechnology
process using cultured human fetal skin cells, which originate from a dedicated cell bank originally established for the
development of products in wound healing. The cream significantly reduced periorbital and perioral wrinkles, as well
as improved skin texture of the chin after one month of treatment, which confirms the beneficial use of growth factors
and cytokines for skin rejuvenation reported in 2 earlier studies. After 60 days of twice-daily application, 83% of the
subject showed an improved average wrinkle score in the eye area, while 50% showed an improved average wrinkle
score in the mouth area. In order to exclude a placebo effect, the efficacy of this product should be confirmed with a
double-blind, randomized, placebo-controlled study. Also, the difference between mixtures of growth factor and cytokines should be further elaborated.
The Roberts Skin Type Classification System is a 4-part serial system that comprehensively identifies a patient's skin type
characteristics, and provides data to predict the skin's likely response to insult, injury, and inflammation (i/i/i) for individuals
of global skin types. The clinician evaluates 4 elements (phototype, hyperpigmentation, photoaging, and scarring) and assigns
a numeric "feature" to each, according to established and original scales. The 4-part serial profile is constructed based
on a combination of quantitative and qualitative assessment leading to the patient's skin type classification: (a) a review
of ancestral and clinical history, (b) visual examination, (c) test site reactions, and (d) physical examination of the patient's
skin. This classification system can uniquely help determine the course of treatment, clarify postprocedure expectations,
and optimize outcomes. This individualized approach to identifying features and elements in various skin types will positively
impact on physician communication, patient awareness and compliance, and preventive measures.
Michael S. Graves MD, Amanda A. Lloyd MD, and E.Victor Ross MD
Dihydroxyacetone (DHA) is a popular ingredient in sunless tanner and lotions. We sought to measure the absorption spectrum of hu- man skin after application of DHA. A male in his 30’s applied DHA to one underarm once daily for seven days. Re ectance spectropho- tometry was performed on the treated and untreated side. The area treated with DHA revealed increased absorption in the 400-700 nm range. Compared to normal skin, the absorption spectrum of human skin after application of DHA is altered from 400-700 nm. Care should be taking with using lasers in these wavelengths on skin treated with DHA.
J Drugs Dermatol. 2016;15(11):1459-1460.
The Dermatologic Benefits of Back to Nature
Natural supplements are currently experiencing a renaissance in dermatology. Although they have been used for centuries, many have been recently validated for various skin conditions by scientific studies. Natural supplements, such as mushroom extracts, are capable of accelerating the skin turnover rate and repairing dermal molecular components that provide structure and elasticity to the skin. Moreover, teas and feverfew have anti-inflammatory, anti-irritant, and antioxidant properties, and their applications include the treatment of sensitive skin, shaving-induced irritation or redness, and photoprotection. Dyschromia is one of the most common dermatological concerns in patients with darker skin, and blinded controlled studies have found that hyperpigmentation can be assuaged by the skin lightening effects of soy, niacinamide, n-acetylglucosamine, licorice extract, arbutin, vitamin c, kojic acid, emblica extract, lignin peroxidase, and glutathione. Blinded controlled studies have also demonstrated that atopic dermatitis can be mitigated by oatmeal, feverfew, chamomile, aloe vera, licorice, and dexpanthenol.
Abbas Zamanian MD, Mehdi Farshchian MD
Background: Immunosuppressive therapy is believed to be one of the most important risk factors in the development of
skin cancer in renal transplant recipients.
Objective: Our purpose was to determine the types of neoplastic skin lesions encountered in Iranian renal transplant recipients
and their associations with immunosuppressive regimens.
Methods: The entire bodies of renal transplant recipients attending an outpatient transplantation department were
Results: Neoplastic skin lesions were diagnosed in 13.1% of the renal transplant recipients. Actinic keratoses, squamous
cell carcinomas, and basal cell carcinomas were the most common neoplastic skin lesions observed. Transplant recipients
exposed to immunosuppressive therapy for more than 5 years have a significantly higher risk of developing skin cancers
than recipients with less than 5 years of immunosuppressive therapy.
Conclusions: Our study confirmed the relatively high prevalence of neoplastic skin lesions among renal transplant recipients in the Iranian population
Aikaterini I. Liakou MD,a Michael J. Theodorakis MD,b Bodo C. Melnik MD PhD,c
Apostolos Pappas PhD,d and Christos C. Zouboulis MD PhDa
BACKGROUND & AIMS: Nutrition has long been associated with skin health, beauty, integrity and aging through multiple pathways and cofactors implicated in skin biology. The onset and clinical course of various common skin diseases, especially acne, psoriasis, atopic dermatitis, and hair loss, have been suggested to be critically affected by nutrition patterns and habits. The relationship between acne and diet, predominantly the role of high glycemic load diets and dairy consumption have recently gained increased interest. Abnormal nutritional conditions such as obesity or malnutrition often manifest themselves by specific cutaneous features and altered skin function. Skin photoprotection, rendered by various nutrients, is well documented and appropriate nutritional supplementation has been shown to exert beneficial effects upon impaired skin integrity, restore its appearance and promote skin health. It is our intention to provide a comprehensive review of the most recent information on the role of nutrition for common skin diseases and regulation of skin biology.
METHODS: Nutritional clinical studies in dermatology have been reviewed using the MedLine literature source and the terms "diet" or "nutrition" and "skin".
RESULTS & CONCLUSIONS: The data on the relationship between nutrition and skin are until now controversial and much more work is needed to be done to clarify possible etiological correlations.
J Drugs Dermatol. 2013;12(10):1104-1109.
A recent and growing body of evidence now indicates that, along with ultraviolet (UV) light, both infrared (IR) and visible light from solar radiation may also contribute to extrinsic skin aging.
Currently, sunscreens play an important role in maintaining the health of the skin by providing “broad spectrum” protection against the harmful effects of UV radiation. However, this does not protect human skin from 94.2% of solar radiation (comprised of visible and IR lights), and nor does it prevent heat accumulation damage. Thus, none of the commercially-available sunscreens is able to block 100% of UV radiation.
Inspired by the need to provide patients with a more comprehensive solar protection, SkinMedica® has created Total Defense + Repair (TD+R), which combines broad spectrum UV protection with a unique blend of antioxidants (SOL-IR Advanced Antioxidant ComplexTM) that provide protection from IR radiation while promoting skin repair. These antioxidants are the product of scientific research and breakthrough technology, providing the next generation of multifunctional skin care products.
James Leyden MD, Gary Grove PhD, Charles Zerweck PhD
The facial tolerability of various topical retinoids was evaluated in 253 healthy volunteers in a series of split-face, randomized, investigator-
masked studies—all conducted at the same site by the same investigator. Four variables were evaluated to determine if they
influenced tolerability—retinoid concentration, formulation vehicle, skin sensitivity, and individual retinoid. Lower retinoid concentrations
were associated with less irritation. Vehicle influenced tolerability but whether a gel or cream formulation was better tolerated
varied from retinoid to retinoid. Tolerability was superior on normal skin than “sensitive skin.” On normal skin, tazarotene
cream was better tolerated than tretinoin cream whereas adapalene and tretinoin microsponge gels were better tolerated than
tazarotene gel. On sensitive skin, tazarotene and adapalene creams were better tolerated than tretinoin cream whereas adapalene gel
was better tolerated than tazarotene gel. Retinoid concentration, vehicle, skin sensitivity, and retinoid can all affect facial tolerability.
Skin vulnerability may be the most important factor.
Wendy E. Roberts MD FAAD
Worldwide air pollution is a major health concern. There is accumulating scientific evidence that air pollution plays an important role
in extrinsic aging. This article invites the reader to consider pollution as a possible emerging etiologic agent for the development of
melasma. Pollution may be a risk factor for melasma and other facial pigmentary dyschromias. Air pollution in the form of airborne
particulate matter (PM) and Polycyclic aromatic hydrocarbons (PAHs) enter the skin via nanoparticles and generate quinones, which are
redox-cycling chemicals that produce reactive oxygen species (ROS). The PM increases the amount of ROS that triggers the increase
of metalloproteinases that leads to extrinsic aging, which includes skin pigmentation. The incidence of disorders of facial hyperpigmentation
specifically, melasma, is increased in persons of skin type III-VI living in India and South East Asia. Interestingly, these are also
geographic regions with very heavy pollution. India, South East Asia, China, and United States lead the world in air pollution.
J Drugs Dermatol. 2015;14(4):337-341.
Joshua A. Zeichner MD
Onychomycosis is the most common fungal skin infection, and it is frequently seen in the setting of other concomitant fungal infections,
the most common being tinea pedis. Infected nails become a reservoir of fungal organisms that may infect the skin, and vice versa. Early, effective treatment of the nails is necessary for preventing not only permanent structural damage but also the spread and superinfection of the surrounding skin and soft tissue. Moreover, treatment of the skin is important for preventing re-infection of the nails.
J Drugs Dermatol. 2015;14(suppl 10):s32-s34.
Robert Lieberman MD, Lawrence Moy MD
Background and Objective: Melasma is a commonly acquired hypermelanosis of the skin due to various etiological factors,
including pregnancy and oral contraceptives. Estrogen receptor expression in affected skin has not yet been investigated.
The purpose of this study was to compare estrogen receptor expression in hyperpigmented and normal facial skin of patients
Methods: Biopsies of 3 mm were taken from affected and unaffected forehead skin of 2 female patients with melasma.
Frozen sections of the tissues were obtained and mouse monoclonal antibody against human estrogen receptors was tested
at various dilutions to determine the optimum concentrations required for reproducible immunostaining with minimal
background staining. Fluorescence was evaluated and compared qualitatively.
Results: The immunohistochemical staining of tissue from both patients reflected a qualitative increase in estrogen
receptor expression in melasma-affected skin compared to unaffected skin.
Conclusions: This study demonstrates the increased expression of estrogen receptors in melasma-affected skin and may
establish the basis for exploring topical anti-estrogen therapies in melasma.
Topical imiquimod has opened an entirely new area of dermatology that previously did not exist: medical therapy for
skin cancers. While surgery will continue to play a vital role in treating more aggressive tumors and in patients who
may not be imiquimod candidates, the availability of a viable medical therapy that can be used independently or in
combination with other modalities will considerably enhance our ability to treat skin cancer successfully.
The maintenance of normal hydration is an important function of the skin. The stratum corneum provides an antimicrobial, antioxidant,
and UV barrier and plays an integral role in maintaining skin hydration. Environmental factors and disease states may compromise
the barrier function of the stratum corneum, leading to excessively dry skin. Evidence supports the use of moisturizers in
the treatment of various skin conditions, and a wide variety of these products are currently available. The presence of moisturizing
agents in a compound, however, may not guarantee optimal moisturization effects. Pharmacologic and physiologic (eg, concentration,
bioavailability, proper determination of moisturization effects), as well as patient-based considerations, can potentially influence
the effects of moisturizer ingredients. While moisturizers as adjunctive therapy have proven benefits in enhancing the management
of certain dermatologic conditions, the incorporation of moisturizing ingredients into topical treatments may not translate into clinical
benefit, particularly in enhancing skin barrier function.
Jill S. Wallace MD-Cand and John C. Hall MD
Acute cutaneous necrosis is defined as a sudden onset of gangrenous skin changes in the skin, associated with significant morbidity
and mortality. The following diseases are included in this discussion: coumadin necrosis, heparin necrosis, brown recluse spider bite,
necrotizing fasciitis, vasculitis, pyoderma gangrenosum, calciphylaxis, clotting abnormalities and embolic phenomena. The importance
of early diagnosis, early distinction and early drug therapy or drug withdrawal must match the diagnosis for maximal preservation
of the skin and underlying tissue.
The skin is not only the body’s largest organ but is widely considered to be the sentinel organ of the human body as it is often the
first line of defense from environmental insults. Acting as both an environmental sensor and guardian, the skin responds to external
cues and helps us adapt to our surroundings in many ways, such as tanning to adapt to repeated ultraviolet (UV) exposure. In order
to better understand the molecular events that occur as the skin adapts to its environment, we need a deeper understanding of how
the genes in the cells comprising the skin are regulated and how this regulation leads to changes in biological response. Regulation
of messenger RNA (mRNA) ultimately results in changes in protein production, which is responsible for carrying out the physical
and chemical reactions responsible for the skin’s adaptation response. Each step in this cellular response is the subject of intense
research. In fact, scientific sub-disciplines have developed around understanding each of these steps: genomics, proteomics and
metabonomics. There are a myriad of applications for genomics in skin. Since capabilities, such as gene chips, provide fundamental
molecular insights into skin cell biology that can be exploited for the development of new products, it is anticipated that genomics
will continue to play an ever-increasing role in skin care.
Divya Sharma BS,a Mary-Margaret Kober MD,b and Whitney P. Bowe MDc
The body of evidence demonstrating the beneficial effects of probiotics on the skin continues to grow in the published literature. Insights into their effects at the molecular level, in animal models, and in human clinical trials build the case for their role in slowing the skin manifestations of both intrinsic and extrinsic aging. The reports reviewed in this manuscript demonstrate that probiotics can restore acidic skin pH, alleviate oxidative stress, attenuate photoaging, improve skin barrier function, and enhance hair quality.
J Drugs Dermatol. 2016;15(1):9-12.
Elizabeth V. Seiverling BS, Emmy M. Fernanadez MD, David Adams MD PharmD
EGFR Inhibitors are used to treat Non-Small-Cell Lung Cancer (NSCLC) and colorectal cancer (CRC). A common side
effect of EGFR Inhibitors is a follicular/pustular skin eruption. We report a case of gefitinib (Iressa) associated skin eruption.
The treatment regimen consisted of triamcinolone 0.1% cream twice daily, clindamycin 1% lotion twice daily and sodium
sulfacetamide lotion twice daily. The clinical presentation, etiology, and management options of EGFR Inhibitor associated
skin eruptions are discussed.
Michael H. Gold MD, Mitchel P. Goldman MD, Julie Biron
Growth factors, in addition to their crucial role in cutaneous wound healing, are also beneficial for skin rejuvenation.
Due to their multifunctional activities such as promoting skin cell proliferation and stimulating collagen formation, growth
factors may participate in skin rejuvenation at various levels. The present placebo-controlled study aimed to further investigate
the antiaging effects of a novel skin cream containing a mixture of human growth factors and cytokines, which
was obtained through a biotechnology process using cultured human fetal fibroblasts. Aside from clinical assessment of
skin wrinkles, the skin surface topography was analyzed by 3D in vivo optical skin imaging using the Phaseshift Rapid in
vivo Measurement of Skin (PRIMOS) device. This device allows fast, contact-free, and direct measurement of the skin
surface topography in vivo at high resolution. This technique is quantitative and more reliable than a visual assessment
of wrinkles using a scoring system, which is subjective and strongly dependent on investigator and assessment conditions.
Using the PRIMOS device, which is also regarded as a more accurate method than the commonly used silicon replica
technique, skin surface roughness was shown to significantly decrease between 10% and 18% depending on the roughness
parameter after 2 months of twice-daily application of the human growth factor and cytokine cream. This was compared
to treatment with the placebo formulation resulting in an approximate 10% decrease of 2 roughness parameters,
whereas the remaining parameters remained unchanged. We found that topical application of growth factors and cytokines
are beneficial in reducing signs of skin aging.
Jessica Hsu BA, Greg Skover PhD, Mitchel P. Goldman MD
This study evaluates the efficacy and tolerability of an investigational study cream composed of 3 ingredients (green and
white teas, mangosteen, and pomegranate extract), Vitaphenol™ Skin Cream (La Jolla Spa MD, La Jolla CA), as compared
to a placebo cream in rejuvenating facial skin. Twenty healthy females between the ages of 35 and 65 with demonstrable
facial wrinkling, achieving a Rao-Goldman wrinkle scale score of 2 or above, applied either Vitaphenol Skin Cream or
placebo cream to a randomized half of their face twice daily for 60 days and returned for follow-up after 2 weeks. Twice as
many subjects indicated an enhancement of skin texture (eg, reduction in pore size, roughness, and touch) with the usage
of Vitaphenol versus placebo. In all, 41% of the study subjects preferred the half of their face that had been receiving
Vitaphenol, while only 0.06% of the subjects favored the placebo side. PRIMOS images from periorbital skin treated with
Vitaphenol demonstrated an average improvement in skin smoothness of 1 mm3, whereas skin treated with placebo showed
an average decrease in smoothness or an increase in skin roughness of 0.9 mm3. The addition of 3 antioxidants, green and
white teas, mangosteen, and pomegranate, have an additive effect to enhance the improvement of age-related changes in
Gilberto E. Flores PhD,a Sophie Seité PhD,b Jessica B. Henley MS,c Richard Martin MS Ing,d
Hana Zelenkova MD,e Luc Aguilar PhD,f Noah Fierer PhDa,c
Atopic dermatitis (AD) is a chronic inflammatory skin disorder that results in areas of dry, itchy skin. Several cultivation-dependent and –independent studies have identified changes in the composition of microbial communities in these affected areas over time and when compared to healthy control individuals. However, how these communities vary on affected and unaffected skin of the same individual, and how these communities respond to emollient treatment, remains poorly understood. Here we characterized the microbial communities associated with affected and unaffected skin of 49 patients with AD before and after emollient treatment using high-throughput sequencing of the 16S rRNA gene. We found that microbial diversity and community composition was different between affected and unaffected skin of AD patients prior to treatment. Differences were driven primarily by the overabundance of Staphylococcus species on affected skin and a corresponding decrease in bacterial diversity. After 84-days of emollient treatment, the clinical symptoms of AD improved in 72% of the study population. Microbial communities associated with affected skin of these treatment responders more closely resembled unaffected skin after treatment as indicated by increased overall diversity and a decrease in the abundance of Staphylococcus species. Interestingly, Stenotrophomonas species were significantly more abundant in the communities of ‘responders’, suggesting a possible role in restoration of the skin microbiome in patients with AD. We demonstrated that the comparison of affected and unaffected skin from the same individual provides deeper insight into the bacterial communities involved in the skin dysbiosis associated with AD. These data support the importance of emollients in the management of AD although future studies should explore how emollients and other treatments help to restore skin dysbioses.
J Drugs Dermatol. 2014;13(11):1365-1372.
Whitney P. Bowe MDa and Leon H. Kircik MDb
Skin care products are recognized by dermatologists as critical adjunctive
therapeutic modalities for patients suffering from acne vulgaris (AV).
Prescribing an acne medication without reviewing a patient’s skin care
regimen can lead to poor compliance, intolerable side effects, and
resulting patient and physician frustration. Striking that delicate
balance between maintaining the skin barrier while controlling oil
and shine has always been a challenge when treating this chronic
inflammatory condition, and it necessitates a unique set of ingredients
and formulation. Cetaphil® DermaControl™ Moisturizer SPF 30 (Galderma
Laboratories, L.P., Fort Worth, Texas) is a new generation of skin care
specifically designed for acne-prone skin and acne-affected skin.
Both Cetaphil® DermaControl™ Foam Wash and Cetaphil DermaControl
Moisturizer SPF 30 incorporate pharmacologically tested, state-of-the-art
ingredients and technologies that studies have shown impart substantial benefits to AV patients.
J Drugs Dermatol. 2014;13(suppl 7):s89-s94.
Guy F. Webster MD PhD
Determinants of skin irritability are poorly understood. This study aims to assess differences in cutaneous safety/irritation based on Fitzpatrick skin type among patients with acne treated with tretinoin gel microsphere (TGM).
This was a phase 4, 12-week, prospective, nonrandomized, open-label, multicenter study. Approximately 500 patients with mild to moderate acne were treated with TGM 0.04% or 0.1% and assessed for cutaneous irritation at baseline and weeks 3, 6, and 12.
In this post hoc analysis of patients with Fitzpatrick skin type I-III vs Fitzpatrick skin type IV-VI, there was a general trend toward initial worsening of cutaneous adverse events (AEs) by week 3 across all variables and groups. This was followed by a trend toward improvement and resolution of skin-related AEs from week 3 to week 12 regardless of Fitzpatrick skin type, with a few exceptions. Erythema was the only cutaneous AE that consistently decreased among patients with darker skin. Results from a subsequent 3-group analysis (Fitzpatrick I-II vs Fitzpatrick III-IV vs Fitzpatrick V-VI) generally mirrored those from the 2-group study.
Study limitations include patient nonadherence, lack of a placebo arm, and lack of data regarding the impact of concurrent medications on outcomes. There was no correlation between irritation and Fitzpatrick skin type.
ABBREVIATIONS USED: adverse event (AE), analysis of variance (ANOVA), benzoyl peroxide (BP), case report form (CRF), modified Global Acne Grading Score (mGAGS), tretinoin gel microsphere (TGM)
J Drugs Dermatol. 2014;13(6):706-711.
Sandra Marchese Johnston, MD and Thomas D. Horn, MD, MBA
Warts are a common dermatologic problem. There are many treatments available. Intralesional injection of a skin test antigen has
been shown to be efficacious at eradicating all warts when only a part of one wart is injected. The aim of this study was to determine
whether injection of the combination of Candida albicans, mumps, and Trichophyton skin test antigens was more efficacious than and
as safe as single antigen injection. Seventy-one percent of subjects had resolution of their warts with the injection of the combination
of skin test antigens in this open label single arm study.
Hilary C. Reich MD,a Irmina Wallander BA,b Lacie Schulte BA,b Hilary Frickman BA,b
and Suzanne Flickenger BA,b Brian Zelickson MDb
The home beauty device market is rapidly growing, having more than tripled in the last four years. This study evaluates several
specific attachment heads using a novel home skincare platform (HSP). By incorporating multiple treatment heads for cleansing,
skin smoothing, and skin infusion, this device has the potential to address many potential treatment goals. The first subset of this
study is a blinded, randomized split-face study evaluating the efficacy of the HSP device with a standard brush head for make-up
removal and compares the HSP device to a currently marketed home cleansing device. The results show that the HSP cleansing
head was comparable to the leading home skin cleansing device on the market. The HSP’s skin smoothing head showed statistically
significant improvement in erythema and dryness over baseline levels with significant histologic changes including normalization
of epidermal thickness in only 10 days of use. This is comparable to and exceeds many well-studied antiaging treatments
after weeks and months of therapy. Finally, the infusion head demonstrated improvement in skin hydration over baseline levels.
J Drugs Dermatol. 2015;14(4):391-399.
Sina Aboutalebi MD, Faith M. Strickland PhD
Non-melanoma skin cancers such as squamous cell carcinoma and basal cell carcinoma are the most common types of
human neoplasms, representing one third of all new malignancies diagnosed in the US. The number of new cases diagnosed
per year in the US alone is approaching one million and continues to rise. Ultraviolet (UV) radiation from the sun is a major
cause of non-melanoma skin cancer in humans. Aside from the mutagenic effects of UV radiation, there are suggestions from
clinical studies and evidence in animal models that the immune system plays an important role in preventing skin cancer
development and progression, and is suppressed by cutaneous exposure to UV radiation. In this article, we review the
research on new and existing agents that are being developed to protect the skin immune response from suppression by UV
radiation. We also discuss the current state of knowledge regarding their mechanism of action in humans as well as animal
models of photosuppression, and their efficacy in cancer prevention.
Koichiro Kameyama MD PhD
Background and Objective: Deep heating or denaturation of collagen has been reported to be necessary for nonablative
skin rejuvenation. The purpose of this study was to examine whether thermally damaged collagen is an indispensable factor
to increase the amount of collagen in vivo. Epidermal and dermal responses to infrared light therapy using a Titan source
were examined with the aim of correlating histological and clinical responses in human and amelanotic mouse skin.
Study Design/Materials and Methods: Ten, 20, or 30 J/cm2 infrared light were irradiated on the human subject’s skin
(thigh), while 5, 10, 20, or 30 J/cm2 were used on amelanotic mouse skin. Biopsies were taken and analyzed using hematoxylin
and eosin (H&E) and Elastica von Gieson stain.
Results: Ten or 20 J/cm2 infrared light increased the amount of both collagen and elastin in all layers of the dermis without
denaturing the collagen in human skin. A higher dose of 30 J/cm2 also increased the amount of collagen and elastin,
but denatured the collagen in human skin. (In addition to the thigh, 2 treatments of 10 J/cm2 infrared light improved
skin toning and texture on the subject’s face.) In mouse skin, 5 or 10 J/cm2 remarkably increased the amount of both collagen
and elastin, and of epidermal cells. Twenty or 30 J/cm2 increased the amount of collagen and elastin and the number
of keratinocytes, but caused some vacuolated degeneration of keratinocytes. The presence of denatured collagen was
not evident due to the high density of collagen.
Conclusions: This study shows that the denaturation of collagen is not required to increase the amounts of collagen or
elastin in vivo in human skin. The activation of the mitochondria as well as the denaturation of collagen may play important
roles in infrared phototherapy.
Andrew Mamalis*,a,b Natallia Fiadorchanka MD*,c Lauren Adams MD,b Melissa Serravallo MD,c
Edward Heilman MD,c Daniel Siegel MD MS,c Neil Brody MD PhD,c and Jared Jagdeo MD MSa,b,c
Ultraviolet (UV) radiation results in a significant loss in years of healthy life, approximately 1.5 million disability-adjusted life years (DALYs), and is associated with greater than 60,000 deaths annually worldwide that are attributed to melanoma and other skin cancers. Currently, there are no standardized biomarkers or assay panels to assess oxidative stress skin injury patterns in human skin exposed to ionizing radiation. Using biopsy specimens from chronic solar UV-exposed and UV-protected skin, we demonstrate that UV radiation-induced oxidative skin injury can be evaluated by an immunohistochemical panel that stains 8-hydroxydeoxyguanosine (8-OH-dG) to assess DNA adducts, 4-hydroxy-2-nonenal (HNE) to assess lipid peroxidation, and advanced glycation end products (AGEs) to assess protein damage. We believe this panel contains the necessary cellular biomarkers to evaluate topical agents, such as sunscreens and anti-oxidants that are designed to prevent oxidative skin damage and may reduce UV-associated skin aging, carcinogenesis, and inflammatory skin diseases. We envision that this panel will become an important tool for researchers developing topical agents to protect against UV radiation and other oxidants and ultimately lead to reductions in lost years of healthy life, DALYs, and annual deaths associated with UV radiation.
J Drugs Dermatol. 2014;13(5):574-578.
Patrícia M.B.G. Maia Campos PhD, Mirela D.Gianeti PhD, Daiane G. Mercurio ScM, and Lorena R. Gaspar PhD
This study aimed to evaluate the effects of cosmetic formulations containing green tea (GT) and/or Ginkgo biloba (GB) extracts by preclinical
and clinical studies. For the preclinical study, histological analysis was performed after 5 day-period of formulations application on the
dorsum of hairless mice. For the clinical study, the formulations were applied on the forearm skin of 48 volunteers, and assessed before
and after 3 hours and after a 15 and 30 day-period of application. Histological analysis showed that the formulation with GT (FGT) and the
association of GT and GB (FBlend) significantly enhanced viable epidermis thickness and the number of cell layers, suggesting a moisturizing
effect in skin deeper layers and increased cell renewal. The clinical efficacy studies showed that the extracts had a moisturizing
effect and improved skin microrelief. In addition they synergistically acted on the skin elasticity and skin barrier function. In conclusion,
the formulation containing a combination of green tea and Ginkgo biloba extracts effectively improved skin conditions and the effect
of formulation FBlend on the improvement of skin elasticity was more pronounced. Finally, the results of the present study revealed
other important clinical benefits of Ginkgo biloba and green tea extracts on the skin besides their already known antioxidant action.
J Drugs Dermatol. 2014;13(9):1092-1097.
Atopic dermatitis (AD) is a common chronic inflammatory skin disease caused by a combination of genetic susceptibility,
epidermal barrier dysfunction and immune dysregulation. The intense pruritus associated with the disease causes an
itch-scratch cycle that worsens symptoms and can cause significant discomfort for the patient. Recently, the focus of the
atopic dermatitis treatment paradigm has shifted from targeting inflammation to the use of agents that normalize the skin
barrier, which may reduce the current dependence on topical steroids and immunomodulators. A new barrier repair cream
(EpiCeram® Skin Barrier Cream, Promius Pharma, Bridgewater, NJ) is a prescription topical agent indicated for the treatment
of dry skin conditions and the relief of itching and burning associated with various dermatoses. This article describes the
pathogenic rationale for using a barrier repair cream for the treatment of AD and discusses case report results focused on its
clinical benefit for AD.
Similar to how the chronic wound healing process requires wound bed preparation before therapeutic intervention, treatment of chronic aging of the skin would likely benefit from a “skin bed preparation” to optimize the outcome of rejuvenation procedures and skin maintenance programs. This involves introducing agents that can combat stress-induced oxidation, proteasome dysfunction, and non-enzymatic cross linkages involved in glycation end products, to collectively modulate the damaged extracellular matrix, and upregulate neocollagenesis and elastin production.
Flor A. Mayoral MD,a Julie R. Kenner MD PhD,b and Zoe Diana Draelos MDc
The use of cosmeceuticals by patients is now commonplace. Without consultation and direction from an informed clinician, marketing pressures can lead consumers to make poor product choices that can result in wasted money and unsatisfactory outcomes. Skin professionals need a scientifically based, succinct tool to guide their patients toward best topical skincare practices. The Skin Health and Beauty PyramidTM is an educational framework and product guide created from extensive scientific literature and study review on ingredients, formulations and technologies affecting skin biology. This clinical tool can simplify product choices for physicians and clinicians in the process of professionally guiding patients toward the optimal use of topical products to achieve best outcomes for skin health and beauty.
J Drugs Dermatol. 2014;13(4):414-421.
Staci Brandt PA-C MBA MSa and Peter Lio MDb
Sensitive skin is a common skin complaint frequently associated with skin diseases or adverse reactions to cosmetic products. Manufacturers have produced numerous products targeted for patients with sensitive skin and frequently label these products as being hypoallergenic. This term implies that the product may be less likely to cause an allergic reaction and be better suited for those with sensitive skin. However, there is no federal regulatory definition of this term and products may not have clinical support of their claim. Patch testing ingredients is frequently done to identify potential irritants; however, patch-testing product formulations may provide more realistic expectations about potential skin sensitivity and help support claims of hypoallergenicity. Ten skincare products were assessed for their sensitizing potential and hypoallergenicity in 14 repeat insult patch test clinical studies, involving over 2,000 subjects. In these studies, the products were deemed to be hypoallergenic if there was no evidence of sensitization or allergic reactions. The results from these trials demonstrated that all ten products were well tolerated, showed no sensitization or allergic reactions, and support claims of hypoallergenicity.
J Drugs Dermatol. 2014;13(3):264-266.
Michael H. Gold MD, Julie Biron
Background and Objectives: Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is becoming a more
popular dermatologic procedure. Newer protocols have virtually eliminated any associated untoward effects. Phototoxicity,
although rare, can still occur and requires aggressive post-therapy care. Recently, a new biorestorative skin care cream, containing
human growth factors and cytokines, was used to treat 2 severe cases of PDT-associated phototoxicity.
Materials and Methods: This paper describes 2 case reports of severe phototoxicity following ALA-PDT treatments. The
novel skin care cream was utilized in both cases phototoxicity.
Results: Complete resolution of the phototoxic reaction was seen, leaving both patients with normal skin texture and tone.
Conclusions: This novel skin care cream may prove useful in wound healing following treatment with lasers and light
sources or dermatologic surgery.
Adriana M Villa and MD, Brian Berman MD PhD
Therapeutic interventions to augment tumor antigenicity or increase the host’s immune response against cancer cells include recombinant
cytokines, immune modulators, vaccination with tumor antigens, T cell-based immunotherapy, and gene therapy. We describe
the current role of the immunomodulators (up-regulators of the immune response) in the therapy of skin cancer (non melanoma skin
cancer, melanoma, lymphoma, Kaposi sarcoma, and extramammary Paget’s disease).
Amer N. Kalaaji, MDa and Warren Wallo, MSb
Xerosis is a common skin condition, occurring most often in the winter and in low relative humidity, which results in loss of moisture, cracking, and desquamation. Many emollient creams and lotions are available for use as preventive moisturizers. However, few controlled experiments have been published comparing the efficacy of active moisturizing products versus the vehicle used to deliver the products to the skin. Therefore, we conducted this randomized, double-blind, controlled clinical study to objectively compare a commercially available moisturizing product against its own vehicle. The active colloidal oatmeal moisturizer used in this study showed significant benefits versus its vehicle control in several dermatological parameters used to measure skin dryness.
J Drugs Dermatol. 2014;13(10):1265-1268.
Kenneth Beer MD, Jill Waibel MD
A lesion detected on a positron emission tomography/computerized tomography (PET/CT) scan localized to the skin and was deter-
mined to be a large, recurrent basal cell carcinoma. This case demonstrates the ability of PET scans to detect recurrent, nonmelano-
ma skin cancers. It also serves as one example to dermatologists of how to manage incidental findings localizing to the skin. Finally,
a discussion of expanding the use of PET scans in dermatology is considered.
Eugene H. Gans PhD, Iqbal Sadiq MS, Tracy Stoudemayer, Marianne Stoudemayer BS, Albert M. Kligman MD PhD
Purpose: Prolonged topical corticosteroid use is often associated with atrophic skin changes. This trial compared signs
of skin atrophy related to 3 super-high-potency corticosteroids: fluocinonide 0.1% cream, clobetasol propionate 0.05%
cream, and 0.05% foam.
Patients and Methods: The test treatments were applied to the forearms 10 females twice daily for 21 days. Skin characteristics
were assessed pretreatment and posttreatment for atrophic changes. Further punch biopsies obtained from 5
subjects were assessed histologically.
Results: Clobetasol foam produced mild changes in noninvasive tests, but stained skin biopsies revealed structural changes
nearly comparable to clobetasol cream, which showed substantial atrophic changes. Fluocinonide cream was the least
atrophogenic, producing no or only mild effects that were slightly greater than vehicle.
Conclusions: Fluocinonide cream has a lower potential to produce atrophic changes of the skin than either clobetasol
cream or clobetasol propionate foam.
Jonith Y. Breadon MD, Chad A. Barnes
Photoepilation, utilizing lasers and noncoherent light sources, is designed to irradiate as much of the follicular unit as
possible, with melanin as the target chromophore. Wavelength absorption should generate energy sufficient to heat and
destroy the hair follicle, while preserving the surrounding tissue. When performing photoepilation on African-
American skin (Fitzpatrick skin types IV-VI) a greater risk of potential epidermal adverse events, such as dyspigmentation,
blistering, crusting, edema, and subsequent scarring, is possible. To reduce epidermal melanin absorption of energy
longer wavelengths are considered safer for use on Fitzpatrick skin types IV to VI. This article reviews and compares
the reported incidences of adverse events in African-American skin, utilizing lasers and noncoherent light sources for
assisted hair removal.
Magdalene A. Dohil MD
Active naturals in dermatology have been experiencing a renaissance. Many of the naturals that have been known for centuries to be effective for various skin conditions have now been scientifically validated with the unraveling of the pathophysiology behind their medicinal mechanism. This article seeks to present data on the clinical use of key dermatological active naturals such as oatmeal, feverfew, chamomile, aloe vera, licorice, and dexpanthenol, as well as on recent multicenter and international clinical studies that support their efficacy and safety profile for a variety of inflammatory skin conditions.
J Drugs Dermatol. 2013;12(suppl 9):s128-s132.
Kurt A. Reynertson PhD, Michelle Garay MS, Judith Nebus MBA, Suhyoun Chon PhD, Simarna Kaur PhD,
Khalid Mahmood PhD, Menas Kizoulis BA, Michael D. Southall PhD
BACKGROUND: Oat (Avena sativa) in colloidal form is a centuries-old topical treatment for a variety of skin conditions, including skin rashes,
erythema, burns, itch, and eczema; however, few studies have investigated the exact mechanism of action for the anti-inflammatory
activity of colloidal oatmeal.
METHODS: Four extracts of colloidal oatmeal were made with various solvents and tested in anti-inflammatory and antioxidant assays. In
addition, an investigator blind study was performed with twenty-nine healthy female subjects who exhibited bilateral mild to moderate
itch with moderate to severe dry skin on their lower legs. Subjects were treated with a colloidal oatmeal skin protectant lotion.
RESULTS: Extracts of colloidal oatmeal diminished pro-inflammatory cytokines in vitro and the colloidal oat skin protectant lotion showed
significant clinical improvements in skin dryness, scaling, roughness, and itch intensity.
CONCLUSIONS: These results demonstrate that colloidal oat extracts exhibit direct anti-oxidant and anti-inflammatory activities, which
may provide the mechanisms for observed dermatological benefits while using the colloidal oatmeal skin protectant lotion.
J Drugs Dermatol. 2015;14(1):43-48.
Suzanne Bruce MDa and JoAnne Watson DPMb
Introduction: A 4% hydroquinone/10% L-ascorbic acid treatment system aims to treat early signs of photodamage in normal to oily skin and help prevent further photodamage. The system also contains vitamin E, witch hazel, aloe barbadensis leaf juice, penetration-enhancing ingredients, micronized zinc oxide, and octinoxate.
Methods: Patients with minimal or mild facial photodamage and hyperpigmentation, and normal to oily facial skin, used the treatment system for 12 weeks.
Results: Of 34 females enrolled, 30 completed. Median scores for the overall integrated assessment of photodamage, overall intensity of pigmentation, fine lines and wrinkles, tactile roughness, and laxity were significantly improved at week 12 compared with baseline. Furthermore, ≥90 percent of patients considered their skin was smoother, softer, more evenly toned, and more radiant, and 100 percent were satisfied with the overall appearance of their skin.
Conclusion: The treatment system can help to ameliorate early signs of photodamage in normal to oily skin.
J Drugs Dermatol. 2011;10(12):1455-1461.
Brooke A. Jackson MDa and Mark R. Vogel MAb
BACKGROUND: Despite the frequent use of botulinumtoxin A (BoNTA) in non-Caucasian patients, safety and efficacy has not been well
characterized in persons with darker skin.
OBJECTIVE: To investigate the efficacy and safety of incobotulinumtoxin A [Xeomin® (XEO)] for the correction of glabellar lines among
non-Caucasian patients with Fitzpatrick skin types IV to VI.
METHODS: This open-label, single-center, post-marketing study treated 29 patients with Fitzpatrick skin types IV to VI with moderate
to severe glabellar frown lines. Evaluation at day 0 included standardized photographs and patient and investigator assessments. Post
evaluation, XEO was administered at 5 intramuscular injection sites with equal aliquots of 4 units per 0.1 mL. Photographs and assessments
were repeated at days 30 and 90.
RESULTS: Response to treatment was defined as a 1 or more point improvement in patient and investigator assessments. At day 30,
100% (n = 29; 95 C.I. 0.87, 1.00; P< .001) responded to treatment. At day 90, 69% (n=20; 95% C.I. 0.52, 0.83; P= .42) responded to
treatment. The safety profile was similar to previously reported trials with BoNTA.
CONCLUSION: The efficacy and safety of XEO among patients with skin types IV to VI is similar to that among persons with fairer skin.
J Drugs Dermatol. 2015;14(4):350-353.
The purpose of this supplement is to provide both the biological basis and clinical impact of several targeted products aimed at specific physiologic and pathologic states including aging skin, diaper dermatitis, occupational irritant dermatitis, and atopic dermatitis.
BACKGROUND: This study incorporates concurrent thermal camera imaging as a means of both safely extending the length of each
treatment session within skin surface temperature tolerances and to demonstrate not only the homogeneous nature of skin surface
temperature heating but the distribution of that heating pattern as a reflection of localization of subcutaneous fat distribution.
METHODS: Five subjects were selected because of a desire to reduce abdomen and flank fullness. Full treatment field thermal camera
imaging was captured at 15 minute intervals, specifically at 15, 30, and 45 minutes into active treatment with the purpose of monitoring
skin temperature and avoiding any patterns of skin temperature excess.
RESULTS: Peak areas of heating corresponded anatomically to the patients’ areas of greatest fat excess ie, visible “pinchable” fat.
CONCLUSION: Preliminary observation of high-resolution thermal camera imaging used concurrently with focused field RF therapy show
peak skin heating patterns overlying the areas of greatest fat excess.
J Drugs Dermatol. 2014;13(7):864-866.
INTRODUCTION: Atopic dermatitis (AD) is characterized by impaired epidermal barrier with increased transepidermal water loss (TEWL). Scratching further compromises skin integrity, contributing to a cycle of inflammation. The objective of the present study was to investigate a topical anti-itch foam in improving skin barrier and itch.
MATERIAL AND METHODS: A single center open study was performed on 26 adults previously diagnosed with AD but without active lesions. One leg was treated with a single application of an anti-itch foam. Dryness, scaling, roughness, cracking, and signs of scratching were assessed before, 6, and 24 hours after application. Skin hydration was measured at 24 hours. The same product was applied twice daily for 7.5 days to the other leg, and skin hydration and TEWL were measured at baseline and on days 2, 8, and 10. Pruritus was assessed by volunteers and by a dermatologist.
RESULTS: A significant increase in skin moisture (P less than 0.001) was measured 6 hours after a single application. Scores of dryness, scaling, roughness (P less than 0.001) and cracking (P=0.002) were significantly improved up to 24 hours after a single application. After a 7.5-day repeated application period, the anti-itch foam significantly reduced TEWL (P less than 0.001) compared to baseline. Skin hydration significantly improved (P less than 0.001) in the same time period. 48 hours after the last application, these improvements remained significant (P less than 0.001).
CONCLUSIONS: The anti-itch foam improved the skin barrier. It provided immediate relief of clinical signs of AD including pruritus. Moreover, it delivered a long-lasting moisturizing effect, comforting the skin, and improving overall skin condition.
J Drugs Dermatol. 2016;15(suppl 11):s77-80.
Timothy J. Falla PhD and Lijuan Zhang PhD
Due to a reduction in estrogen levels peri- and post-menopausal skin exhibit a specific phenotype characterized by reduced thickness,
reduced elasticity and increased dryness. Loss of these elements results in increased skin wrinkling and skin sagging. In addition, it
is well documented that reduced estrogen levels also negatively impacts dermal wound healing. As a result we tested the hypothesis
that molecules capable of stimulating and accelerating wound healing can supplement the skin’s diminished activities produced
by reduced estrogen. Heptapeptide-7, a fragment of a well-characterized wound healing peptide (HB-107), was found to stimulate
keratinocyte proliferation and migration and induce collagen synthesis. Microarray analysis of Heptapeptide-7-treated dermal keratinocytes
revealed an up-regulation of cell division, growth factor and extracellular matrix genes. Validation of this approach was seen
in a clinical study of 32 women (mean age 54) in which forehead wrinkles and skin texture were improved with the application of this
Isaac Zilinsky MD,a Perry Robins MD,b Alon Liran MD,a Oren Weissman MD,a Eran Millet MD,a Nimrod Farber MD,a Josef Haik MD,a Eyal Winkler MDa
Although Mohs surgery is considered a skin-sparing technique, when dealing with aggressive skin tumor that penetrates the deep tissues, the Mohs surgeon usually sacrifices uninvolved skin. We present our technique of 3D Mohs as a new concept for skinsparing surgery. After raising a skin flap above the residual tumor, Mohs resection was performed on the deep tissues horizontally and simultaneously on the inner plan of the flap vertically. When "clear" borders were achieved, the skin flap was sutured back into place. The results show that the defect was significantly smaller, and the hair on the Mohs-treated vertical flap continue to grow, thus contributing to a more aesthetic outcome. We conclude that careful use of the 3D Mohs technique as we describe spares the healthy uninvolved skin and offers better aesthetic and functional result.
J Drugs Dermatol. 2011;10(11):1271-1274.
Katrina E. Woodhall MD, Mitchel P. Goldman MD, Michael H. Gold MD, Julie Biron
A hydroquinone/tretinoin (HQ/tret) skin care system designed for use with non-surgical facial rejuvenation procedures has recently
become available. In this observer-masked study, 36 patients with moderate-to-severe wrinkling of the skin around the eyes and lips
were randomly assigned to use either the 4% hydroquinone/0.05% tretinoin skin care system or placebo products, each day for 90
days. In addition, all patients received intense pulsed light (IPL) treatment on days 30 and 60.
At day 90, ≥ 75% overall improvement was reported in 72% and 19% of patients in the HQ/tret + IPL group and the placebo + IPL
group, respectively. HQ/tret + IPL was also associated with significantly lower mean hyperpigmentation scores at days 30, 60 and 90
(P≤0.05), and significantly lower mean laxity scores at day 90 (P≤0.05) compared with placebo + IPL. Adjunctive use of the HQ/tret
system enhances the improvements in facial skin achieved with IPL treatment.
Kee Lee Tan MD, Caroline Kurniawati RN,Michael H. Gold MD
Background/Objective: Hyperpigmentation occurs in more than 37% of dark-skinned subjects treated with a fully ablative CO2 laser
device. This study assessed the risk of postinfl ammatory hyperpigmentation (PIH) in subjects with skin types 4 and 5 treated once
with a specifi c protocol of treatment using a fractional CO2 laser.
Methods: Seven subjects with photodamaged skin received a single facial treatment using a fractional CO2 laser. Anesthesia was
limited to a lidocaine and prilocaine cream for 1 hour before the single-pass treatment. Subjects were evaluated for improvement and
PIH on alternate days for 14 days, and at 1 month, 3 months, and 6 months posttreatment.
Results: All subjects achieved improvement in their specifi c skin conditions and in skin texture. Postinfl ammatory hyperpigmentation
was not observed in any subject. Four subjects experienced no pain during treatment, while 3 reported mild pain. Recovery was associated
with minimal pain and itching.
Conclusion: In dark-skinned subjects, fractional CO2 laser treatment and topical anesthesia subjectively improves common skin
conditions without PIH.
Andrew F. Alexis MD MPHa and Paul Blackcloud BA
Dyschromia is one of the most common dermatological concerns in patients with darker skin.1 Disorders of hyperpigmentation, including postinflammatory hyperpigmentation, melasma, solar lentigines, and miscellaneous causes of facial hyperpigmentation, are the most frequently treated dyschromias and can have a considerable psychosocial impact. Given the high prevalence of hyperpigmentation and the considerable demand for an even complexion, newer treatment options for hyperpigmentation are of growing interest among consumers, manufacturers, and dermatologists. Blinded, controlled studies demonstrating skin lightening effects in soy, niacinamide, n-acetylglucosamine, licorice extract, arbutin, vitamin c, kojic acid, emblica extract, lignin peroxidase, and glutathione have led to the development of a growing list of non-prescription skin care products that can be incorporated (mostly as adjuncts) in the management of hyperpigmentation.
J Drugs Dermatol. 2013;12(suppl 9):s123-s127.
Feng Sun PhD, Robert Anderson PhD, Guillermo Aguilar PhD
Novel cryopneumatic technology (CPx) and photopneumatic technology (PPx) have been developed to enhance the permeation of
the stratum corneum (SC) and percutaneous drug delivery (PDD). CPx produces micro-cracks at the skin surface by successively
freezing and stretching the skin with vacuum suction. PPx combines stretching of the skin by vacuum suction with intense pulsed
light. The enhancing effects of CPx and PPx were studied on ex vivo porcine skin and in vivo human skin models. Fluorescent hydrophilic
macromolecules (FITC and FITC-Dextran) were used as drug surrogates. Fluorescent images of in vivo experiments show
that the enhancing effect of CPx is due to drug permeation through the micro-cracks produced by freezing-stretching cycles, while
PPx could promote drug permeation through sweat glands. Both ex vivo and in vivo results strongly suggest that CPx and PPx can
effectively enhance the permeation of the SC and PDD for the delivery of hydrophilic macromolecules.
Patricia Farris MD,a Margarita Yatskayer MS,b Nannan Chen PhD,b Yevgeniy Krol BS,c Christian Oresajo PhDb
Resveratrol is an effective anti-aging molecule with diverse biologic activity. It functions as a dual antioxidant that can neutralize free
radicals and increase intrinsic antioxidant capacity. Additionally resveratrol increases mitochondrial biogenesis and has anti-inflammatory,
anti-diabetic, and anti-cancer activity. In this paper we will focus on the use of topically applied resveratrol using a proprietary blend
containing 1% resveratrol, 0.5% baicalin, and 1% vitamin E. This stabilized high concentration formulation demonstrates percutaneous
absorption and alterations in gene expression such as hemoxygenase-1 (HO-1), vascular endothelial growth factor (VEGFA), and collagen
3 (COL3A1). Clinical assessment showed a statistically significant improvement in fine lines and wrinkles, skin firmness, skin elasticity,
skin laxity, hyperpigmentation, radiance, and skin roughness over baseline in 12 weeks. Ultrasound measurements in the periorbital area
showed an average improvement of 18.9% in dermal thickness suggesting significant dermal remodeling. These studies confirm that
topical resveratrol, baicalin, and vitamin E are valuable ingredient that can be used for skin rejuvenation.
J Drugs Dermatol. 2014;13(12):1467-1472.
Cutaneous T-cell lymphomas (CTCLs) are a relatively uncommon group of lymphoproliferative disorders in
which a malignant population of T cells is localized to the skin at presentation. Of the 4 classic CTCL phases
(patches, infiltrated plaques, tumors, Sézary syndrome), the majority of patients present with early stage patch
or plaque disease, which can usually be effectively managed using skin-directed therapies. Traditional skindirected
therapies include topical corticosteroids, topical chemotherapeutic agents (mechlorethamine, carmustine),
electron beam therapy (local and total skin), and phototherapy (UV-A, UV-B). Each of these has
demonstrated efficacy in early stage disease; however, with the exception of topical corticosteroids, all have
some disadvantages and are associated with significant adverse events, particularly secondary skin malignancies
and skin damage. Bexarotene is a synthetic retinoid analog that selectively activates retinoid X receptors. In
clinical trials, bexarotene gel demonstrated efficacy for the topical treatment of cutaneous lesions in patients
with stage IA or IB CTCL who have refractory or persistent disease following other therapies or who cannot
tolerate other therapies. Initial evidence indicates that bexarotene gel may be active as first-line therapy in
early stage disease. Its role in combination with other treatments remains to be determined. Topical bexarotene
gel is generally well tolerated and offers patients greater convenience compared with traditional skin-directed
therapies, with a flexible administration regimen. The availability of bexarotene gel provides patients and
physicians with a new skin-directed treatment option for early stage CTCL.
Vicky Kwan Wong, BA; Christine Della Croce, MA; Sara Schonfeld; Anthony M. Mastrangelo, PhD and Mark Lebwohl, MD
Topical corticosteroids have improved the management of many inflammatory skin diseases, such as psoriasis
and atopic dermatitis. However, these medications are associated with certain adverse effects that are potentially
serious. The potent anti-inflammatory actions of these drugs increase susceptibility to bacterial and fungal
infections, and therefore may preclude them from use when infection is the known cause of the disease. In
addition, children may be more vulnerable than adults to systemic effects of topical corticosteroids because percutaneous
absorption is proportionately greater. These are important considerations, and physicians need to
weigh and compare the risks and benefits associated with these medications before initiating treatment. This
involves an appreciation of which patient populations are at high risk, which skin conditions are incompatible
with topical corticosteroid therapy, and which alternative nonsteroidal medications are effective in treating
inflammatory skin diseases.
Jared Jagdeo MD MS, Lauren Adams MD, Hadar Lev-Tov MD,Jolanta Sieminska BS, Josef Michl MD, Neil Brody MD PhD
The study of free radicals is particularly relevant in the context of human skin carcinogenesis and photoaging because of their ability to induce DNA mutations and damaging lipid peroxidation byproducts. Therefore, it is important to identify and evaluate agents with the ability to modulate intracellular free radicals. Significant interest exists in evaluating the chemotherapeutic and anti-oxidant properties of resveratrol (trans-3,4’,5-trihydroxystilbene). Resveratrol is a phytoalexin, a naturally occurring compound derived from the skin of grapes and other plants. Resveratrol was selected for evaluation because of demonstrated chemopreventive and chemotherapeutic
properties in a murine skin cancer model and other human cancer models through a variety of mechanisms. However, the intracellular anti-oxidant properties of resveratrol on free radicals in human skin cells in vitro is not well characterized. The purpose of this research is to investigate the ability of resveratrol to modulate the hydrogen peroxide-induced upregulation of reactive oxygen species (ROS) free radicals in normal human skin fibroblast cells in vitro. Hydrogen peroxide is a well known generator of free radicals that occurs during endogenous and UV-induced oxidation processes in the human skin and was used to upregulate ROS in normal human skin fibroblast cells. Using a flow cytometry-based assay, the results demonstrate highly significant (P<0.001) dose-dependent reduction
of intracellular hydrogen peroxide-upregulated ROS by resveratrol at 0.01%, 0.001% and 0.0001% concentrations in human skin fibroblasts in vitro.
Patricia Farris MD,a Joshua Zeichner MD,b and Diane Berson MDc
Consumers are increasingly interested in over-the-counter skin care products that can improve the appearance of photodamaged and aging skin. This 10-week, open-label, single- center study enrolled 25 subjects with mild to moderate hyperpigmentation and other clinical stigmata of cutaneous aging including fine lines, sallowness, lack of clarity, and wrinkling. Their mean age was 53.4±7.7 years. The test product contained retinol 0.5% in combination with niacinamide 4.4%, resveratrol 1%, and hexylresorcinol 1.1% in a moisturizing base. Subjects were provided a skin care regimen including a cleanser, hydrating serum, moisturizer, and an SPF 30 sunscreen for daily use. The test product was applied only at night.
The use of this skin brightening/anti-aging cosmeceutical was found to provide statistically significant improvements in all efficacy endpoints by study end. Fine lines, radiance, and smoothness were significantly improved as early as week 2 (P<.001). By week 4, hyperpigmentation, overall skin clarity, evenness of skin tone, and wrinkles showed statistically significant improvement compared to baseline. Mild retinoid dermatitis including flaking and redness occurred early in the study as reflected by tolerability scores. By week 10, subjects reported no stinging, itching, dryness, or tingling.
The results of this open-label clinical study suggest that a topical cream containing retinol 0.5% in combination with niacinamide, resveratrol, and hexylresorcinol is efficacious and tolerable for skin brightening/anti-aging when used with a complementary skin care regimen including SPF 30 sun protection.
J Drugs Dermatol. 2016;15(7):863-868.
Aditya K. Gupta MD PhD FRCP (C), Melody Chow HBSc
Prednicarbate is a non-halogenated, double-ester derivative of prednisolone that has become of interest for the treatment of inflammatory
skin diseases, for example atopic dermatitis. In the past, topical steroids have been a popular choice for treating these diseases;
however, the potential for significant local and systemic adverse events, such as skin atrophy and hypothalamic-pituitary-adrenal
(HPA) axis suppression have limited their use. Prednicarbate has been found to have a favorable benefit-risk ratio, with low skin
atrophy potential, and a high anti-inflammatory action. Prednicarbate may be particularly advantageous when used intermittently in
pediatric and elderly patients.
Jeremy B. Green MD,a,b Andrei I. Metelitsa MD FRCPC,c,d Joely Kaufman MD,a,b and Terrence Keaney MDe,f,g,h
Men represent an important evolving segment of the cosmetic market. With the growing acceptability of cosmetic procedures along with societal and workplace pressure to maintain youthfulness, men increasingly seek the advice of aesthetic practitioners. Despite this so-called "Menaissance," there is a paucity of published literature regarding laser and light treatments of male skin. Herein the differences in male cutaneous physiology are addressed, followed by a review of light-based treatment of conditions largely unique to male skin, pseudofolliculitis barbae, and rhinophyma. Next, the publications related to laser treatment of male skin specifically are examined. We conclude with a discussion of personal observations derived from clinical experience with laser and light-based treatments in men.
J Drugs Dermatol. 2015;14(9):1061-1064.
Eric S. Schweiger, MD; Noah S. Scheinfeld, MD; Hillarie R. Tishler, BA and Jeffrey M. Wienberg, MD
With the continuing development of clinical drug resistance among bacteria, the need for new, effective agents
to treat multi-drug-resistant Gram-positive infections remains important. With treatment options limited, it
has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged
as possible therapeutic alternatives. This review focuses on agents newly introduced and FDA-approved for the
treatment of skin and skin structure infections: linezolid and quinupristin/dalfopristin.
Jerry L. McCullough PhD, Raymond L. Garcia MD, Barry Reece
Objective: Pyratine 6™ has been shown to have antiaging effects in human skin cells. The purpose of this study is to determine
the cosmetic efficacy and tolerance of topical Pyratine 6 (0.10%) over 12 weeks for improving the baseline clinical
signs and symptoms of photodamaged facial skin.
Methods: A single-arm longitudinal study with observations at 2, 4, 8, and 12 weeks was conducted. Forty healthy women
with mild to moderate signs of photodamaged facial skin applied Pyratine 6 twice daily for 12 weeks. Efficacy and safety
were evaluated by clinical observations, digital photography, transepidermal water loss (TEWL), skin capacitance, and
silicon replicas at each time point.
Results: Topical Pyratine 6 achieved significant improvement from baseline in roughness and skin moisture content after
2 weeks. After 4 weeks, significant improvement in fine wrinkles, mottled hyperpigmentation, and TEWL were observed.
Improvements in most parameters were maintained throughout the remaining weeks of the study. For most silicon replica
parameters, changes were consistent with increased skin smoothing. Facial erythema was reduced at 2 weeks and further
reduced at 4, 8, and 12 weeks. Adverse effects were minimal and transient.
Conclusions: Treatment with Pyratine 6 over 12 weeks improves roughness and skin moisturization in 2 weeks compared
to baseline and mottled hyperpigmentation and fine wrinkles in 4 weeks compared to baseline. Reduction in facial erythema occurs as early as 2 weeks. Adverse effects are minimal and transient.
Katina Byrd-Miles MD, Ella L. Toombs MD, Gary L. Peck MD
Skin cancer most commonly affects Caucasians and rarely affects individuals of African, Asian, Latin-American, and
American-Indian descent. Although skin cancer is rare in these groups, the diagnosis may be associated with significant
morbidity and mortality. Many factors may account for this discrepancy. Skin cancers in these groups may have atypical
presentations. Melanoma usually involves areas not exposed to the sun, including palmoplantar skin and mucosal surfaces
with the acral lentiginous melanoma being the most common histologic subtype. Basal cell carcinomas may involve
sun-exposed areas such as the head and neck, while squamous cell carcinomas tend to involve unexposed areas in these
groups. Because of the low index of suspicion in both the medical community and the ethnic groups, diagnosis is often
delayed resulting in an advanced presentation and a worse prognosis.
Derek Ho BS,a,b Farzad Fereidouni PhD,c Richard M. Levenson MD,c and Jared Jagdeo MD MSa,b,d
BACKGROUND: Skin care products make up the largest part (36%) of the cosmetic market globally, of which the United States plays the largest role. In 2015, approximately 115 billion USD was spent globally on skin care products. Skin care products, in contradistinction to pharmaceuticals, are not strictly regulated by the FDA. A key factor for evaluation of a skin care product or topical drug is skin barrier function and effect on super cial skin. Thus, it is critical to have quantitative and qualitative methods to study the effects of skin care products on skin barrier and the super cial skin. Currently, no imaging method exists that can evaluate and track super cial skin changes visually in real-time.
OBJECTIVE: To report using a novel imaging modality, Microscopy using Ultraviolet Surface Excitation (MUSE), to provide real-time, high- resolution, in vivo characterization of super cial skin and moisturizing properties of topical moisturizer, and to highlight key bene ts of using MUSE to visualize the super cial skin and serve as an excellent complementary tool to current quantitative methods.
METHODS AND MATERIALS: The methodology of MUSE is based upon two main principles inherent to ultraviolet (UV) light and uorescent staining agents. In this study, the author’s (JJ) index ngertip was imaged using the MUSE instrument without and with moisturizer.
RESULTS: Dermatoglyphics of the fingertip consists of ridges (cristae super ciales) and grooves (sulci super ciales) proved to be straightforward to visualize at high resolution. Desquamation of superficial corneocytes and opening of an acrosyringium (the most superficial portion of eccrine ducts) were visualized in high-resolution. Post-application of a moisturizer, a uniform layer of moisturizer could be seen superficial to the corneocytes along the ridges and CONCLUSIONS: Real-time, high-resolution, in vivo characterization of super cial skin and moisturizing properties of moisturizer using MUSE is feasible. Its utility can be enhanced with downstream quantification using imaging software.
J Drugs Dermatol. 2016;15(11):1344-1346.
Dalia G. Aly MD,a Ihab Y. Abdallah MD,b Noha S. Hanafy MD,a Mohamed L. Elsaie MD,a,c and Neveen A. A. Hafizd
Background: Leptin, an adipocyte-derived hormone, has been shown to have several immunological effects similar to those of proinflammatory cytokines. The relationship between serum leptin, psoriasis, and obesity is still conflicted, and very few studies have investigated its role in skin diseases other than psoriasis.
Aim: To evaluate the possible relationship between serum leptin in nonobese patients with psoriasis and other randomly selected skin diseases.
Subjects and methods: Eighty subjects (40 patients with psoriasis, 20 patients with other randomly selected skin diseases, and 20 healthy controls) were included in the study. Fasting serum leptin levels of the study groups were examined by sandwich enzyme-linked immunosorbent assay.
Results: Elevated serum leptin levels were detected in both nonobese patients with psoriasis (P=.004) and those with other randomly selected skin diseases (P=.05). Leptin levels failed to correlate to the Psoriasis Area and Severity Index score of psoriatic patients. Both sexes demonstrated comparable levels of serum leptin in psoriatic patients, while female patients suffering from other skin diseases showed higher levels of serum leptin than did males of the same group.
Conclusion: Leptin may play a role in the immunopathogenesis of psoriasis and other skin diseases, even in the absence of obesity as a cofactor.
J Drugs Dermatol. 2013;12(2):e25-e29.
INTRODUCTION: Radiofrequency has remained a staple procedure for the treatment of skin laxity as therapeutic heat thresholds effectively
promote collagen remodeling. Nevertheless, comprehensive skin tightening involves both dermal and hypodermal collagen
remodeling. However, transcutaneous radiofrequency is unable to deliver consistent and measurable temperatures to the hypodermal
layers. Herein, we evaluated a newly emerging approach that provides precise and controlled subdermal heating is thermistor-controlled
subdermal skin tightening (ThermiTight) using a percutaneous radiofrequency treatment probe.
METHODS: A retrospective analysis of 35 patients was completed on patients having undergone ThermiTight for submental skin
tightening. Treated sites included under-chin and under-chin and jowls. The ThermiTight probe temperature was set between 50 to
60oC and was maintained using the thermistor integrated electrode. The probe was guided at a deliberate pace, treating a surface
area of 3.0 cm2 every two minutes. The clinical endpoint was an epidermal temperature of 42oC. Two blinded reviewers assessed
photographs taken at baseline and 30 days post-procedure. They were randomly presented with a photograph and asked to rate the
photograph using a 4.0 skin laxity scale.
RESULTS: The combined mean change comparing baseline and post-procedure skin laxity scores was -0.78, which was statistically significant (Table 2; P<0.0001). Each blinded reviewer correctly categorized photographs as either being “baseline” or “post-procedure” 89% of the time. No adverse events were reported.
DISCUSSION: These data demonstrate the safety and efficacy of the ThermiTIght procedure for the treatment of skin laxity.
J Drugs Dermatol. 2014;13(12):1485-1489.
Leon Kircik MD, James Del Rosso DO FAOCD
Atopic dermatitis (AD) is a chronic cyclical inflammatory skin disease that is increasing in incidence. Twenty percent
of those affected with AD are infants and young children. Despite the development of newer nonsteroidal topical therapies,
such as calcineurin inhibitors, topical corticosteroids remain the gold standard for the treatment of active eczematous
disease and management of exacerbation due to established efficacy and safety with appropriate use. The xerotic,
sensitive skin of AD patients mandates the use of nonirritating and nondrying topical vehicles. Recently, phase III clinical
studies have demonstrated the safety and efficacy of a novel aqueous hydrogel vehicle for desonide delivery in mild
to moderate AD, which is free of fragrances and surfactants. Corneometry and transepidermal water loss studies have
demonstrated that this patented hydrogel vehicle alone offers advantages including moisturization and skin barrier enhancement,
both of which are significant when treating eczematous and xerotic skin. Patient and physician preference
surveys suggest that the novel properties of this vehicle may aid in patient compliance with AD therapy
Adam J. Friedman MD FAAD,a Erika C. von Grote PhD,b Matthew H. Meckfessel PhDb
Urea is an important hygroscopic component of the epidermis, where it participates in the maintenance of skin hydration as part of the skin’s source of natural moisturizing factor (NMF) in the outer most layers. Xerotic skin, which is frequently characterized as NMF-deficient, is a unifying trait of dermatoses such as atopic dermatitis (AD), psoriasis, and ichthyosis vulgaris. The reduced hygroscopic potential of pathologically dry skin leads to unregulated transepidermal water loss (TEWL), epidermal hyperproliferation, and inhibited desquamation; all which clinically translate to hyperkeratotic and possibly pruritic skin. Common underlying etiologies link these dermatoses to aberrant expression of genes encoding epidermal structural and catalytic proteins. Intervention of dry skin pathologies with topical moisturizer formulations is a foundational management strategy. For over a century urea-containing formulations have been used in a concentration-dependent manner to restore skin hydration, thin hyperkeratosis, debride dystrophic nails, and enhance topical drug penetration. Recently, urea’s role in skin hydration and repair has expanded to include regulation of epidermal genes necessary for proper barrier function. Taken together, urea’s versatility in topical formulations and broad range of therapeutic mechanism highlights its utility to clinicians and benefit to patients.
J Drugs Dermatol. 2016;15(5):633-639.
Acne vulgaris (AV) is the most common skin disorder. It was traditionally thought that AV lesions developed after abnormal desquamation
of the keratinocytes that line the sebaceous follicle, leading to hyperkeratinization and microcomedone formation. However, in recent years there has been a paradigm shift with regard to understanding the pathogenesis of AV, and it is now viewed as a primary inflammatory skin disorder. Research has implicated the presence of subclinical inflammation in the normal skin of acne patients, even before microcomedone formation. This article will review the novel concepts that play a role in the new pathogenesis of acne vulgaris.
J Drugs Dermatol. 2016;15(1 Suppl 1):s7-s10.
Gabriel Nistor MD,a Aleksandra J. Poole PhD,a Zoe Draelos MD,b Mary Lupo MD,c Thomas Tzikas MD,d Jerome H. Liu MD,e and Hans S. Keirstead PhDa
These studies were designed to determine the effect of stem cell-derived skin lineage precursor secretions on the intrinsic and extrinsic symptoms of human skin aging.
Human stem cells cultivated in balanced conditions were differentiated into skin lineage precursors, and shown to secrete large amounts of fetuin as well as multiple growth factors beneficial for human skin development and maintenance. The cell secretions were incorporated in two simple cosmetic formulations (serum and lotion) and investigated in an IRB-approved 12-week human trial that included 25 subjects in each group. Subjects were examined at 2, 4, 8, and 12 weeks by a dermatologist to evaluate safety, trans-epidermal water loss, wrinkles, firmness, radiance, texture, softness, and overall appearance. A sub-group of subjects from each group consented for biopsies for histological analyses.
Protein analyses in the cell secretions revealed a high concentration of the multifunctional alpha 2-HS glycoprotein (fetuin) along with a multitude of protein factors involved in the development and maintenance of healthy human skin. Clinical investigation demonstrated significant amelioration of the clinical signs of intrinsic and extrinsic skin aging, findings that were confirmed by significant changes in skin morphology, filaggrin, aquaporin 3, and collagen I content.
Our data strongly support our hypothesis that cosmetic application of stem cell-derived skin lineage precursor secretions containing fetuin and growth factors beneficial for human skin development and maintenance, positively influence intrinsic and extrinsic aging.
J Drugs Dermatol. 2016;15(5):583-598.
Gary Grove PhD,a Charles Zerweck PhD,a Tim Houser MS,a Anthony Andrasfay BS,b Bob Gauthier MS,b Charles Holland PhD,b and Daniel Piacquadio MDb
BACKGROUND: This study measured skin hydration and occlusivity of two test products [halobetasol propionate lotion, 0.05% (HBP Lotion) and Ultravate® (halobetasol propionate) cream, 0.05% (HBP Cream)] at 2, 4, and 6 hours after application to skin test sites previously challenged by dry shaving, which was performed to compromise the integrity of the stratum corneum barrier.
METHODS: Trans-epidermal water loss (TEWL), an indicator of skin barrier function, was measured using cyberDERM, inc. RG-1 evaporimeter. Skin hydration was evaluated using IBS SkiCon-200 conductance meter. Test products were applied bilaterally on dry-shaved sites on the volar forearm sites, according to a randomization scheme, with two test sites untreated to serve as “dry-shaved” controls. TEWL and conductance were measured at 2, 4, and 6 hours post-treatment.
RESULTS: HBP Lotion displayed a significant increase in skin hydration at 2, 4, and 6 hours post-treatment compared to the baseline values and dry-shaved controls (each, P less than 0.001). However, HBP Cream produced statistically significant increased skin hydration only after 6 hours (P less than 0.05). HBP Lotion was significantly more effective than HBP Cream in increasing skin hydration at 2 and 4 hours post-treatment (each, P less than 0.001), and had a directional advantage (not statistically significant) at 6 hours. Neither test product had a significant occlusive effect as measured by TEWL at 2, 4, and 6 hours post-application.
CONCLUSION: Both formulations of HBP (Lotion and Cream) contributed to skin moisturization, as measured by skin conductance. HBP Lotion produced a significantly more rapid onset and higher level of moisturization at 2 and 4 hours post-application compared to HBP Cream. The TEWL results indicate that neither HBP Lotion nor HBP Cream provided any significant occlusivity to the skin.
J Drugs Dermatol. 2017;16(2):140-144.
Sabine Laquieze MD, Janusz Czernielewski MD, Marie-José Rueda MD
Despite their beneficial effects on the treatment of acne vulgaris, topical and oral retinoids may cause severe local irritation
(retinoid dermatitis) due to their mechanism of action, thereby jeopardizing patient adherence, and thus compromising treatment
efficacy. Alleviating dryness and improving skin comfort by using a moisturizer concomitantly to retinoids could
enhance efficacy. In the present study, 30 subjects receiving either oral isotretinoin for at least 2 months or topical tretinoin
for at least one month applied a moisturizing cream (Cetaphil® Moisturizing Cream) twice daily for 15 days on one half of
the face while the other side remained untreated. Clinical assessments, confirmed by biophysical measurements, showed that
the moisturizer provided a significant improvement in skin dryness, roughness, and desquamation. Skin properties and skin
discomfort were also greatly improved and subjects were very satisfied with the product. Retinoid-induced skin irritation can
be relieved by the regular use of a gentle moisturizing cream as an adjunctive treatment.
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb
Atopic dermatitis (AD) may be considered the “poster disease” for exemplifying the significance of abnormalities of the epidermal barrier that occur predominantly within the stratum corneum (SC) and upper epidermis. Specifically, impairments of the SC permeability barrier, antimicrobial barrier, and immunologic barrier contribute markedly to the fundamental pathophysiology of AD. The multiple clinical sequelae associated with epidermal barrier impairments inherent to AD include dry skin, pruritus, increased skin sensitivity to irritants and allergens, eczematous skin changes, staphylococcal skin and anterior nares colonization, and increase in some cutaneous infections (ie, molluscum contagiosum). This article addresses the pathophysiology of AD with clinically relevant correlations, and discusses the scientific basis of a specially designed cleanser and moisturizer system that incorporates ceramide technology and filaggrin degradation products along with other “barrier-friendly” excipients.
J Drugs Dermatol. 2013;12(7 suppl 1):s85-s91
Staci Brandt PA-C MBA MS,a Matthew H. Meckfessel PhD,a and Peter A. Lio MDb
Atopic dermatitis is a common skin disease characterized by eczematous eruptions and impaired skin barrier function. Patients,
as well as their families, frequently report reductions in quality of life. Pruritus, lack of sleep, and impaired social functioning
all contribute to this reduction. A skincare regimen of gentle cleansing and daily moisturization is integral to managing atopic
dermatitis. While there are a multitude of reports supporting the use of moisturizers, there is a paucity regarding the use of
cleansers, especially cleansers formulated with ingredients known to improve skin hydration. A clinical study was conducted to
assess the tolerability and cosmetic acceptability of a body wash formulated with the filaggrin break-down products arginine and
pyrrolidone carboxylic acid in subjects with atopic dermatitis-prone skin (Cetaphil® RestoraDerm® Body Wash). The results of this
study indicate that Cetaphil RestoraDerm Body Wash was well tolerated, reduced itch, improved quality of life, and was well-liked
by subjects with atopic dermatitis-prone skin.
J Drugs Dermatol. 2014;13(9):1108-1111.
Ronald B. Vender MD FRCPC, Orli Goldberg MD
Imiquimod (Aldara,™ 3M Pharmaceuticals) is a potent stimulator of the innate and adaptive arms of the immune system
through induction, synthesis, and release of cytokines and chemokines. An extensive review of clinical trials, case reports, and
letters published in peer-reviewed journals was performed regarding imiquimod use in skin disorders. A reference module was
developed for physicians to consult as a guide. Studies have validated the benefit of imiquimod in treating external genital and
perianal warts, superficial basal cell carcinomas, and actinic keratoses. This new topical therapeutic agent has shown to be of
benefit in other various skin disorders through its broad immunomodulatory properties. Since many skin conditions are
immunologically influenced, it is reasonable to expect several diseases to respond to imiquimod. Our research consolidates the
therapeutic trials and reports on the innovative uses of imiquimod, thereby serving as a useful resource to benefit dermatologists
treating patients with refractory or recalcitrant skin diseases.
Brooke Walls DO,a Laura Jordan MS4,b Lisa Diaz DO PGY1,b and Richard Miller DO FAOCDc
The field of cutaneous oncology is exploding with innovative treatment options, specifically in the field of targeted therapy. These advances
offer new hope to select patients with high risk skin cancers. In part two of our series on targeted therapy for skin cancer, we
focus our attention on squamous cell carcinoma. We begin with the epidermal growth factor receptor inhibitors and branch out into
newer areas of active research.
J Drugs Dermatol. 2014;13(8):955-958.
Richard L. Gallo MD PhD,a Vivian W. Bucay MD,b Ava T. Shamban MD,c Janice Lima-Maribona DO,d Amy B.
Lewis MD,e Cherie M. Ditre MD,f Flor A. Mayoral MD,g Michael H. Gold MDh
Heparan sulfate is an essential glycosaminoglycan that plays important roles in development, homeostasis, and disease. As a group, the glycosaminoglycans provide mechanical strength to skin, as they can absorb water and occupy the space between elastin fibers and collagen. Heparan sulfate is also a key participant in cell proliferation, cell migration, collagen fiber formation, basement membrane regeneration, granulation tissue formation, and cell adhesion associated with wound healing. A variety of dermatological disorders are associated with changes in glycosaminoglycans or their associated proteoglycans. A new topical formulation of low molecular weight heparan sulfate glycosaminoglycan has been shown to penetrate the epidermis, basement membrane, and dermis within 24 hours of application. In an 8-week study, 15 patients using this new formulation showed improvement in skin hydration, skin firmness, skin elasticity, skin barrier function, and global fine lines and wrinkles. Incorporating low molecular weight heparan sulfate into topically applied formulations may represent a new approach to improving the appearance of photodamaged skin.
J Drugs Dermatol. 2015;14(7):669-674.
Most dermatologists agree that antioxidants help fight free radical damage and can help maintain healthy skin. They do so by affecting intracellular signaling pathways involved in skin damage and protecting against photodamage, as well as preventing wrinkles and inflammation.
In today's modern world of the rising nutraceutical industry, many people, in addition to applying topical skin care products, turn to supplementation of the nutrients missing in their diets by taking multivitamins or isolated, man-made nutraceuticals, in what is known as the “Inside-Out” approach to skin care. However, ingestion of large quantities of isolated, fragmented nutrients can be harmful and is a poor representation of the kind of nutrition that can be obtained from whole food sources. In this comprehensive review, it was found that few studies on oral antioxidants benefiting the skin have been done using whole foods, and that the vast majority of current research is focused on the study of compounds in isolation. However, the public stands to benefit greatly if more research were to be devoted toward the impact that physiologic doses of antioxidants (obtained from fruits, vegetables, and whole grains) can have on skin health, and on health in general.
J Drugs Dermatol. 2012;11(9):e1-e4.
Wichai Hongcharu MDa and Michael Gold MDb
While radiofrequency has been used medically for decades to treat a wide variety of conditions, its use therapeutically to target conditions
affecting the skin is relatively new. With the development of fractional radiofrequency, which allows for the heat energy to be delivered in a more targeted manner through the use of needles as electrodes, this technique is now the preferred medical treatment option for many skin conditions given the reduction in recovery time and fewer number of reported side effects. The current study examined
the clinical effectiveness of SmartScanTM Nano-Fractional RFTM treatment. Participants included 12 healthy female volunteers who reported varying degrees of rhytides, hyperpigmentation, or acne redness. Participants each received one treatment of SmartScan Nano-Fractional RF. The areas receiving treatment were photographed in a standardized way, using high-resolution macrophotography, at baseline (prior to receiving the treatment) and one month after treatment. Baseline and post-treatment photographs were then visually
compared for treatment effects and analyzed through software-assisted quantification of variation in pigmentation and skin texture. The results indicated that this SmartScan technique for Nano-Fractional RF is effective in improving skin texture, and pigmentation.
J Drugs Dermatol. 2015;14(11):1298-1304.
Karen Meyer BS, Apostolos Pappas PhD, Kelly Dunn BS, Gabriela O. Cula PhD, InSeok Seo PhD, Eduardo Ruvolo JR MS, and Nikoleta Batchvarova PhD
The objective of this study was to compare facial skin of adolescent males with (acne) and without acne (non-acne) over the course of 1 year. At study entry, presence of acne was determined by clinical image analysis (acne n=7, non-acne n=10). Monthly evaluations
of skin condition were made using standard and fluorescent imaging, fluorescence spectroscopic analysis, sebum analysis, skin high frequency conductivity (moisture content), transepidermal water loss (TEWL), and sampling of skin bacteria (aerobic and anaerobic). Data were evaluated seasonally. Over the course of the study, subjects in the acne and non-acne groups had no significant
increase in their clinical acne score. Sebum production was significantly greater in subjects with acne than in those without for each season examined (P<0.019) and was lowest in the winter and highest in the fall. TEWL was higher in those with acne than without
acne across all seasons (P=0.001). Skin moisture in both groups was increased during summer and fall compared with winter (P≤0.016 for both seasons). Subjects with acne had a higher recovery of both aerobic and anaerobic bacteria compared with subjects without acne (P≤0.015). Analysis of cheek skin in the nasal area revealed significantly higher fluorescence (500-800 nm) in image-based and spectroscopic analysis from subjects with acne, suggesting the greater presence of the bacterial metabolite porphyrin in those with acne. In these cohorts of adolescent males, significant differences in sebum production, skin barrier function, moisture content, and microbial load (anaerobic and aerobic) were noted between those with and without acne. Evidence for seasonality was observed, with lower lipid production and reduced barrier function during the winter. More studies to quantify differences in skin lipid components and bacterial species among these cohorts are planned.
J Drugs Dermatol. 2015;14(6):593-601.
Mitchel P. Goldman MD and Michael H. Gold MD
Purpose: To determine the efficacy of a skin care system developed with a partially neutralized glycolic compound and natural antioxidants
when compared to Cetaphil moisturizing regimen for the treatment of photoaging of the face, eye and mouth.
Methods: A total of 36 patients between 35 and 65 years of age were randomized on a 3:1 ratio to use either Vivité Skin Care System
or Cetaphil cleanser and moisturizer for 60 days. Facial skin was evaluated at baseline, day 30 and day 60. Subjects were required to
fill out a self-evaluation of facial skin quality before, during, and after treatment. Investigators evaluated facial wrinkling using a common
wrinkling scale as well as a visual evaluation of skin texture in a masked manner.
Results: A similar proportion of patients in each group had a 1-point improvement on the hyperpigmentation scale (42% of Vivité patients,
44% of Cetaphil patients). There were no statistically significant between-group differences in investigator rating of wrinkles.
Subjectively, patients preferred Vivité to Cetaphil for noticeable improvement in fine lines or wrinkles (37.6–0%, respectively) at the
first follow-up. By the final follow-up, more than half the patients in the Vivité group continued to notice an improvement in fine lines
or wrinkles, compared with fewer than 25% in the Cetaphil group. More than twice the number of patients in the Vivité group noticed
improvement in skin elasticity or tightness compared with those in the Cetaphil group.
Conclusion: Patients reported that the Vivité skin care system improved the appearance of wrinkling and improved skin texture associated
with moderate photoaging of the face, eye and mouth areas. Vivité had a higher patient preference rating than a commonly
used moisturizing regimen. There were no differences noted in the physician evaluations.
Jeffrey M. Weinberg MD and Stephen K. Tyring MD PhD
Staphylococcus aureus (S. aureus) is the leading cause of nosocomial infections and responsible for more than 11 million skin and
soft tissue infections annually. Impetigo is a common skin infection and the most common bacterial skin infection in children aged
two to five years. The emergence of S. aureus isolates resistant to commonly utilized antibacterials for skin infections (β-lactams,
erythromycin, fluoroquinolones and mupirocin) makes successful treatment an ongoing challenge. To treat skin infections such as
impetigo, antibacterials with a short dosing schedule and low propensity to develop resistance should be used. In 2007, retapamulin
was the first agent for human use approved in the pleuromutilin class of antibacterials in the United States (U.S.), and is the first topical
antibacterial indicated to treat impetigo in over 20 years. In vitro, retapamulin is highly potent against S. aureus and has a lower
propensity to develop resistance than mupirocin. In clinical studies, the convenient five-day b.i.d. (twice-daily) dosing of retapamulin
is highly effective against impetigo due to methicillin- susceptible S. aureus and Streptococcus pyogenes and may play an important
role in limiting the development of resistance against systemic agents.
Sharona Yashar MD, Steven S. Wu MD, Scott W. Binder MD, Jonathan Cotliar MD
Acute graft-versus-host disease (GVHD) is a rare and life threatening complication after solid organ transplantation. The
diagnosis can be made with clinical and laboratory evidence of skin, liver, or intestinal involvement. The role of skin biopsy
in confirming acute GVHD is debatable. However, it is proposed that the skin biopsy is a valuable tool in confirming the
diagnosis in low prior probability settings. An atypical case of acute GVHD following orthotopic liver and small bowel
transplantation in a 2-year-old male is presented. Seven weeks posttransplantation, the patient developed a bullous eruption
limited to the buttocks and upper thighs. A skin biopsy was performed which showed interface dermatitis and epidermal
necrosis consistent with acute GVHD. Prompt treatment with daclizumab and intravenous corticosteroids was given and
the patient survived without evidence of systemic GVHD. This case highlights the importance of skin biopsy in establishing
the prompt diagnosis of GVHD in low prior probability settings.
Brooke Walls DO,a Laura Jordan MS4,b Lisa Diaz DO PGY1,b and Richard Miller DO FAOCDc
The field of cutaneous oncology is exploding with innovative treatment options, specifically in the field of targeted therapy. These advances
offer new hope to select patients with high risk skin cancers. Here we provide a two part series reviewing targeted therapy for
non-melanoma skin cancer. We begin our discussion with basal cell carcinoma, moving beyond the first-in-class hedgehog inhibitors
and highlighting promising clinical trials.
J Drugs Dermatol. 2014;13(8):947-952.
Gina Chacon MD, Timmy Nguyen MD, Akram Khan MD, Animesh Sinha MD PhD, Supriya Maddirala MDe
Warfarin-induced skin necrosis (WISN) and calciphylaxis share similar early clinical findings and can both lead to significant morbidity and mortality. The authors reviewed the literature on both conditions and describe a case of extensive skin necrosis in a patient with end-stage renal disease who was initially suspected to have calciphylaxis. Further investigation supported a diagnosis of WISN. The pathogenesis, clinical manifestations and treatment of WISN and calciphylaxis are discussed, with emphasis on a diagnostic approach for early recognition.
Yana Alexandrovna Yutskovskaya MD PhDa and Evgeniya Alexandrovna Kogan MD PhDb
BACKGROUND: Calcium hydroxylapatite (CaHA; Radiesse (R)) provides safe and effective correction of moderate-to-deep lines, volume replacement, lift and contour, and induction of neocollagenesis and neoelastogenesis for improved skin quality. CaHA hyperdilution takes advantage of its skin-tightening properties without a volumizing effect.
OBJECTIVE: To evaluate the collagen- and elastin-stimulating effects of diluted CaHA in subjects with skin laxity in the neck and décolletage. Methods: Twenty subjects with skin laxity in the neck and décolletage received multiple, linear, subdermal injections of CaHA diluted with preserved saline at baseline and 4 months: 1:2 dilution (normal skin), 1:4 dilution (thin skin), and 1:6 dilution (atrophic skin). Subjects also received deep subdermal injection of CaHA (~0.1 ml) of the same dilution in the peri-auricular area for skin biopsy. Biopsy tissue was obtained at baseline, 4 months, and 7 months for immunohistochemical evaluation of neocollagenesis. Changes to skin mechanical properties were measured by ultrasound scanning and cutometry. Subject and investigator satisfaction was evaluated using the Global Aesthetic Improvement Scale.
RESULTS: Immunohistochemical analysis of biopsy tissue demonstrated signi cant increases in collagen I expression at 4 months (P less than 0.05) and 7 months (P less than 0.00001) compared with baseline. Increases in collagen III levels were also significant at 4 months (P less than 0.00001); they declined by 7 months but remained above baseline. Staining for elastin and angiogenesis signi cantly increased at 4 months (P less than 0.05 and P less than 0.01, respectively) and 7 months (P less than 0.00001 for both) compared with baseline. Immunohistochemical data correlated with improvements in skin elasticity and pliability evaluated by cutometry, and with ultrasound-assessed increases in dermal thickness. Subject and investigator satisfaction was high, and the procedure was well tolerated.
CONCLUSIONS: Injection of diluted CaHA is very effective for skin tightening of the neck and décolletage.
J Drugs Dermatol. 2017;16(1):68-74.
Eric Simpson MD MCRa and Yves Dutronc MDb
Moisturizers result in an increase of skin hydration and restoration of the skin barrier function and play a prominent role in the longterm
management of atopic dermatitis (AD). Cetaphil Restoraderm™ Moisturizer (CRM) contains novel ingredients specifically designed
for AD, and its effects on skin hydration, skin barrier function and signs of AD were assessed in four studies, three of which
were evaluator-blinded, randomized and intra-individual comparison trials. A single application of CRM induced significantly greater
hydration than the untreated control for at least 24 hours (P<0.001). After the skin was disrupted with 0.5% sodium dodecyl sulfate
(SDS), applications of CRM led to a more rapid restoration of skin barrier function and maintained significantly greater skin hydration
compared to the untreated control (both P<0.05). After four weeks of twice-daily CRM application among subjects with a history of
AD, a significant decrease of itching/stinging scores compared to baseline was reported, as well as an improvement in the quality-of-life and a high level of satisfaction regarding the product. When CRM was used as an adjunctive treatment with topical steroid for
four weeks among subjects with mild-to-moderate AD, a more rapid decrease of overall disease severity was observed on days 7,
14 and 21 by the blinded investigator (P<0.05), compared to steroid treatment alone. In summary, CRM is suitable for the specific
needs of patients with AD and can be used either alone for long-term management or in adjunction with traditional treatment for
both short and long-term disease control.
J Drugs Dermatol. 2011;10(7):744-749.
This randomized, controlled, investigator-blinded study performed by an independent research organization evaluated the appearance of periorbital and perioral wrinkles following twice-daily application of a specific blend of matrikines and matrikine-like synthetic peptides
for skin rejuvenation over a 6-month period. Fine lines and wrinkles of 133 women, aged 38 years to 65 years, were assessed by an independent expert evaluator using a 5-point visual analogue score. Subjects were divided into 3 groups and randomized to receive either the matrikine-based technology (MPC) or 1 of the 2 materials containing traditional growth factors. Test materials were well tolerated, and all 3 significantly reduced the appearance of periorbital and perioral wrinkles after 3 and 6 months. In the group receiving
the matrikine-based technology, periorbital wrinkles improved (≥ 1 unit) in 28% of subjects after 1 month, in 65% after 3 months, and in 81% after 6 months. Perioral wrinkles improved (≥ 1 unit) in 39% of subjects after 1 month, in 41% after 3 months, and in 59% after 6 months. Improvements in skin firmness, tactile roughness, and pore appearance were also observed with each test material. Use of MPC was associated with significantly improved skin elasticity after 2 months (20%) and at 6 months (16%), whereas the comparator materials had no significant effects on elasticity. This study demonstrates that topical use of a specific blend of matrikines and matrikine-like peptides is suitable for skin rejuvenation. It also provides evidence that topical use of this novel technology provides comparable results to other technologies that use traditional growth factors for skin rejuvenation, with an additional potential benefit of improved skin elasticity.
J Drugs Dermatol. 2016;15(4):457-464.
Vesna Petronic-Rosic MD MSc, Elizabeth Myers, Christopher R. Shea MD, Thomas Krausz MD
Langerhans cell histiocytosis (LCH) is a histiocytic disorder in which the Langerhans cell is arrested in a premature, partially
active state. The disease comprises a spectrum of disorders, the most benign of which is a single-system unifocal disease.
Lesions in single-system LCH are typically limited to the bone. We report a case of a 66-year-old man with a
single-system disease limited to the skin, who was successfully treated with intralesional triamcinolone. This minimally
invasive treatment method warrants further studies of intralesional corticosteroid injection for skin lesions of LCH.
Linna Guan BS,a,* Amanda Suggs MD,a,* Sayeeda Ahsanuddin BS,a Madeline Tarrillion DO,a Jacqueline Selph MD,a Minh Lam PhD,a and Elma Baron MDa,b,c
Exposure of the skin to ultraviolet (UV) irradiation causes many detrimental effects through mechanisms related to oxidative stress and
DNA damage. Excessive oxidative stress can cause apoptosis and cellular dysfunction of epidermal cells leading to cellular senescence
and connective tissue degradation. Direct and indirect damage to DNA predisposes the skin to cancer formation. Chronic UV exposure
also leads to skin aging manifested as wrinkling, loss of skin tone, and decreased resilience. Fortunately, human skin has several natural
mechanisms for combating UV-induced damage. The mechanisms operate on a diurnal rhythm, a cycle that repeats approximately every
24 hours. It is known that the circadian rhythm is involved in many skin physiologic processes, including water regulation and epidermal
stem cell function. This study evaluated whether UV damage and the skin’s natural mechanisms of inflammation and repair are also
affected by circadian rhythm. We looked at UV-induced erythema on seven human subjects irradiated with simulated solar radiation in
the morning (at 08:00 h) versus in the afternoon (at 16:00 h). Our data suggest that the same dose of UV radiation induces significantly
more inflammation in the morning than in the afternoon. Changes in protein expression relevant to DNA damage, such as xeroderma
pigmentosum, complementation group A (XPA), and cyclobutane pyrimidine dimers (CPD) from skin biopsies correlated with our clinical
results. Both XPA and CPD levels were higher after the morning UV exposure compared with the afternoon exposure.
J Drugs Dermatol. 2016;15(9):1124-1130.
Lisa K. Chipps MD MS,a,b,c Jason Bentow MD,c Heidi B. Prather MD,d Jeffrey J. So MS PA-C,a
Jonathan M. Schouest BS,a and David M. Ozog MD,a,e Ronald L. Moy MDa,b
OBJECTIVE: To use 3D photography to evaluate the clinical efficacy of a novel radiofrequency delivery device used to improve the appearance
of rhytids and laxity of the face and neck.
STUDY DESIGN: Forty-nine subjects received a total of two radio-frequency treatments to the face and neck one-month apart. The novel
radio-frequency delivery device was used to heat the dermis between 41-43°C for five heat cycles. Primary outcome measures were
clinical efficacy quantified by the Global Assessment Improvement Scale (GAIS) and a patient survey that assessed treatment satisfaction.
RESULTS: Assessments of 3D photographs revealed an overall improvement in 74% of study subjects. 85% of patients noted an overall
improvement in the appearance of their skin. 81% of patients rated their post-treatment skin laxity as improved, 85% rated their skin
smoothness as improved and 62% rated their skin brightness as improved.
CONCLUSION: Subjects in this study demonstrated an overall improvement in face and neck appearance with regard to skin tightening,
wrinkles, and skin texture suggested by overall patient satisfaction (85%) and physician-rated GAIS improvement (74%). This study
suggests that radiofrequency applied with a continuous thermal treatment device is a safe and efficacious way to improve the overall
appearance of aging facial skin.
J Drugs Dermatol. 2013;12(11):1215-1218.
Antonio Rusciani MD, Giuseppe Curinga MD, Giulio Menichini MD, Carmine Alfano MD, Luigi Rusciani MD
Background: Improvement in skin laxity can be difficult to achieve without invasive surgical procedures. Monopolar radiofrequency
(RF) treatment is used by physicians to heat skin and promote tissue tightening and contouring. RF technology
produces an electric current that generates heat through resistance in the dermis and subcutaneous tissue. The
thermal effect depends on the conductivity features of the treated tissue. When heated, collagen fibrils will denature and
contract, which is believed to lead to the observed tissue tightening.
Methods: Ninety-three consecutive patients with mild to moderate laxity were included in the study. The Surgitron Dual
Frequency™ RF (Radiowave technology, Ellman International) was used to treat skin laxity. The application of RF energy
took place in an ambulatory setting with no need for skin sterilization or anesthesia.
Results: Patients immediately noticed a microlifting retraction in the treated tissues according to the vectors mapped
in the area. There were no significant complications and the majority of patients were satisfied with the procedure and
able to return to their daily routine after leaving the office, thereby substantiating the popularity of noninvasive rejuvenating procedures.
Deborah S. Sarnoff MD FAAD FACP, Ritu Saini MD FAAD
Epidermolytic hyperkeratosis is a rare genetic disorder of keratinization. In childhood, patients are erythrodermic and have
a compromised stratum corneum, replaced with generalized hyperkeratosis as the patients age. Treatment consists of topical
emollients as well as, topical and oral retinoids. Ultraviolet (UV) light, often in combination with psoralen ultraviolet
A (PUVA) is widely used as a therapeutic modality for a multitude of hyperproliferative disorders. Although not strictly
indicated for epidermolytic hyperkeratosis, it has been utilized as experimental treatment, particularly in the days prior
to retinoids. Psoralen ultraviolet A has also been implicated in the development of nonmelanoma skin cancers, especially,
squamous cell carcinoma (SCC). Retinoids are well-known to protect against nonmelanoma skin. A patient with epidermolytic
hyperkeratosis with multiple nonmelanoma skin cancers, previously treated with PUVA and long-standing oral
retinoids is reported.
Tian-Hua Xu MD,a John ZS Chen MD,b Yuan-Hong Li MD,a Yan Wu MD,a Yao-Jia Luo MD,a Xing-Hua Gao MD,a Hong-Duo Chen MDa
Background: L−ascorbic acid has been widely used to treat photo-aged skin. However, its aqueous formula is prone to oxidation. Therefore, a new formula that contains 23.8% L−ascorbic acid and a chemical penetration enhancer was developed.
Objective: Observe the efficacy and safety of topical 23.8% L−ascorbic acid serum on photo-aged skin.
Methods: Twenty Chinese women with photo-aged skin were enrolled in this split-face study. They were treated with topical L−ascorbic acid serum with iontophoresis on one side of the face once a day for 2 weeks; the other side of the face was spared treatment through participants´ self-control. Changes in photo-aged skin were evaluated using a global evaluation, an overall self-assessment, a spectrophotometer, the phase-shift rapid in vivo measurement of skin (PRIMOS) 3D, and a corneometer.
Results: Sixteen of 20 patients (80%) experienced a score decrease of 2 or 3 grades, according to the dermatologist. Fifteen patients (75%) rated their overall satisfaction as excellent or good. Dyspigmentation, surface roughness, and fine lines on the treated side improved significantly.
Conclusion: Topical 23.8% L−ascorbic acid serum is effective for the treatment of photo-aged skin and does not cause any obvious side effects.
J Drugs Dermatol.2012;11(1):51-56.
Macrene Alexiades-Armenakas MD PhD
A near-infrared laser with the ability to target different depths within skin has been developed and evaluated for the application
of facial and neck skin tightening in a pilot clinical study. The device consists of a combination of a 1310-nm
wavelength and sapphire contact cooling. Cooling temperature and laser pulse duration were varied to target different
dermal depths in various subgroups of the subject population. Quantitative changes in various categories characterizing
the aging skin employing a comprehensive grading scale as well as subject satisfaction were calculated. A mean improvement
of 7.9% (95% CI [confidence interval] 3.6-12.3) in laxity and 10.6% (95% CI 5.8-15.4) in rhytides was determined
by quantitative grading at one month after the treatment regimen. These values were 11.0% (5.5-16.5) and 11.7%
(5.8-17.7) at 3 months after the treatment regimen. The percent of patients reporting mild or better improvement in laxity
of the face and neck was 78% and 61% at one month, and 63% and 61% at 3 months, respectively. The discomfort
was minimal. Side effects were limited to short-term erythema and edema. In summary, a variable depth heating laser can
achieve skin tightening and wrinkle reduction with high subject satisfaction.
David Schairer BA, Laura Schairer BA, Adam Friedman MD
Most dermatologists will treat at least one patient suffering from
delusions of parasitosis (DP) in their career.1 These patients are
memorable not only for the peculiarity of their delusions and their
repeated visits to the office, but for the challenges they present
in their treatment. These patients are also frustrating. It seems
that if they could only stop scratching, picking and manipulating
their skin their symptoms would improve. However, these
cutaneous signs only hint at the underlying psychiatric problem
that drives these patients to manipulate their skin. These patients
seek out the assistance of dermatologists and eschew the help of
psychiatrists or therapists because they believe that they have a
primary skin disease. Although the treatment of DP is conceptually
simple, it is not intuitive. Thus as dermatologists, we should
have at the ready a full set of dermatologic, psychologic, and
pharmacologic tools to treat these patients.
Andrew S. Dorizas MD,a Amer H. Nassar MD,a and David J. Goldberg MDb,c
OBJECTIVE: We determine if the use of Multispectral Digital Skin Lesion Analysis for the evaluation of nevi in children and possible detection of malignancies.
EVIDENCE REVIEW: Evidence gathered from a pivotal study involving 1,383 patients with 1,831-pigmented lesions. The isolated use of the pediatric population within this study was used to determine the specificity and sensitivity of such a device with comparison to a dermatologists evaluation.
FINDINGS: For all lesions from the assessed pediatric population the biopsy ratio was equivalent for the Multispectral Digital Skin Lesion Analysis device as for the dermatologists when performing as independent reviewers. Furthermore analyzed data suggests that dermatologists who incorporate the Multispectral Digital Skin Lesion Analysis device perform better than they would independently or if they were to follow the device blindly without incorporating their own judgment.
CONCLUSION AND RELEVANCE: An approach that integrates automated imaging technology like the Multispectral Digital Skin Lesion Analysis device, along with another diagnostic aid, with the end result being cost-effective, easy to use by even non-experts and comforting for the pediatric patient is likely to compete to be the new gold standard in successful early diagnosis and management of melanoma.
J Drugs Dermatol. 2014;13(10):1269-1273.
Josef Haik MD,a,b Rachel Kornhaber PhD MN RN,c Moti Harats,b Hadar Israeli MD,b and Arie Orenstein MDd
INTRODUCTION: Q-switched neodymium:YAG (Nd:YAG) lasers are reported to be gold standard for laser tattoo removal. In particular, the Q-switched Nd:YAG laser at 1064 nm is widely recognized for the removal of blue/black amateur tattoos. However, treatment modalities in Fitzpatrick Type VI skin carry a greater risk of complications including alterations in pigmentation compared to fairer skin (Fitzpatrick Type I-IV skin). Therefore, the aim of this case series was to describe with the use of the Q-Switched Nd:YAG laser, the removal of carbon-based amateur tattoos on patients with Fitzpatrick Type VI skin as an effective and safe method.
METHODS: Twenty- five patients with Fitzpatrick type VI skin, from Ethiopian origins, with facial tribal tattoos, were treated with the Q- Switched Nd:YAG laser at 1064 nm. Digital images were taken upon every treatment and the clearance rates of the tattoo was evalu- ated by imaging software.
RESULTS: We observed an average tattoo clearance rate of 95% among the 45 facial tattoos in 25 patients presented in the case series with minimal pigmentary and textual changes evident.
DISCUSSION: These positive aesthetic results have a signi cant psychosocial impact on the lives of those with Fitzpatrick Type VI skin, in particular the Ethiopian Jewish population.
J Drugs Dermatol. 2016;15(11):1448-1452.
Meike Streker MD, Tilmann Reuther MD, Nils Krueger MD PhD, and Martina Kerscher MD
BACKGROUND: Mid-dermal injection of stabilized hyaluronic acid (HA) is well established as a treatment to reduce the effects of skin aging.
OBJECTIVE: To assess the efficacy and safety of a stabilized HA-based gel of non-animal origin manufactured using the patented NASHA® technology (Restylane® Vital Light, Q-Med AB, Uppsala, Sweden) administered using a pre-filled micropuncture injector device for rejuvenation of the skin.
METHODS: Three treatment sessions 4 weeks apart were performed on one side of the face, the dorsum of one of the hands and one side of the decolletage, leaving the other side untreated. Skin quality was assessed via blinded live evaluation and subject satisfaction by questionnaire. Aesthetic change was evaluated independently by the subject and a blinded evaluator. Subjects were followed up to week 36.
RESULTS: Thirty subjects aged 40–65 years were enrolled. Overall skin quality across all three treatment areas was judged to be improved on the treated side in over 80% of subjects throughout the study. Significant aesthetic improvements on the treated sides were observed at all visits, with the exception of the decolletage at week 36.
CONCLUSIONS: This was the first study that used a micropuncture injector device for injection of NASHA gel, and reveals that this is a promising treatment option for rejuvenation of the skin.
J Drugs Dermatol. 2013;12(9):990-994.
Steven H. Dayan MD,a,b John P. Arkins BS,c Vinny Sharma BS,d Elaine Paterson PhD,e David Barnes PhDf
Background: Despite an abundance of nutritional supplements, very few well-controlled trials have assessed their beneficial effect on the skin, such as hydration, antioxidant levels, texture or appearance. The objective of the following placebo-controlled, double-blind study was to determine the effects of the Skin Health Experimental Product (SHEP) on skin health.
Methods: The study enrolled healthy men and women aged 30 years or older. Subjects were randomized to receive a twice-daily regimen of SHEP or placebo. The effects SHEP had on overall skin appearance and health were assessed by measuring improvements
in: (1) skin hydration using a closed-aperture transepidermal water-loss moisture meter and a vapometer; (2) skin texture using silicon profilometry; (3) skin carotenoid concentration using Raman spectrometry; and (4) reported self-image assessments using the Global Aesthetic Improvement Scale (GAIS).
Results: SHEP-treated subjects demonstrated a significant reduction in fine lines compared to the placebo-treated group. Raman spectroscopy showed that SHEP increased carotenoids at some measurement sites. Based on the GAIS, SHEP-treated subjects were three times more likely to perceive an improvement in their appearance compared to placebo-treated subjects (P>0.049).
Conclusion: The orally-administered SHEP nutritional supplement improves skin texture, carotenoid levels in specific areas of the hand, and improves patients' perception of skin health.
J Drugs Dermatol. 2011;10(9):1106-1114.
Thomas Lee MD and Adam Friedman MD
The epidermis functions as a physical barrier that separates the inner body from the outside environment. The outermost layer of the epidermis, the stratum corneum, plays a key role in maintaining this barrier. There are numerous biochemical changes that take place to and in the keratinocyte as it migrates from the bottom, or startum basale, to the top layer of the epidermis in order for this barrier to function appropriately. In addition, external and internal factors, such as irritants and underlying medical diseases, can also affect the stratum corneum, both of which can potentially lead to disruption of barrier function and ultimately skin pathology. In this article, we will review keratinocyte biology as it relates to the formation and function of the stratum corneum. We will also review stratum corneum structure, physiology, and the impact of chemical agents and defective stratum corneum components that can lead to skin disease. Finally, we will briefly discuss how moisturizers repair defects in the stratum corneum and restore barrier function.
J Drugs Dermatol. 2016;15(9):1047-1051.
Martina Ulrich MD,a,b Susanne Lange-Asschenfeldt MD,a Kresten Skak PhD,c Torsten Skov MD,c Marie Louise Østerdal MsC,c Hans-Joachim Röwert-Huber MD,a John Robert Zibert PhD,c and Eggert Stockfleth MDa,d
Ingenol mebutate represents a topical treatment for fields with actinic keratosis (AK). The biological effects of ingenol mebutate in AK, subclinical (SC)-AK, and reference-skin were assessed and graded by in vivo reflectance confocal microscopy (RCM) and histology. Patients with AK and SC-AK lesions in one 25 cm2 field on hands or forearms, and with an area of reference skin on the inner upper arm, were included. The two fields were each treated with ingenol mebutate 0.05% gel (n=16), or vehicle (n=8), on 2 consecutive days; clinical and RCM assessments were performed on days 1, 2, 3, 8, and 57, and biopsies on day 3. Local skin responses were more pronounced in AK fields (6.1 (mean) ± 2.6 (SD)) compared with reference skin (3.5 ± 1.5). The clinical AK lesion reduction was 43.8% and 6.3% with ingenol mebutate and vehicle, respectively. RCM and histology evaluations showed that ingenol mebutate induced a significant pronounced cell death and immune response in AK and SC-AK lesions, compared with reference skin. Ingenol mebutate induced RCM-measured reduction in (investigator-1/investigator-2): AK lesions (34/28%), SC-AK lesions (72/56%), and solar elastosis in AK fields (mean, -0.22/-0.25). In conclusion, ingenol mebutate showed selective pronounced biological responses in AK and SC-AK as compared with reference skin.
J Drugs Dermatol. 2016;15(10):1181-1189.
Faris Azzouni MD,a Nathalie Zeitouni MD PhD,b and James Mohler MDa
5α-reductase (5α-R) isozymes are ubiquitously expressed in human tissues. This enzyme family is composed of 3 members that perform several important biologic functions. 5α-R isozymes play an important role in benign prostate hyperplasia, prostate cancer, and androgen-stimulated skin disorders, which include androgenic alopecia, acne, and hirsutism. Discovery of 5α-R type 2 deficiency in 1974 sparked interest in development of pharmaceutical agents to inhibit 5α-R isozymes, and 2 such inhibitors are currently available for clinical use: finasteride and dutasteride. 5α-R inhibitors are US Food and Drug Administration (FDA)-approved for the treatment of benign prostate hyperplasia. Only finasteride is FDA-approved for treatment of male androgenic alopecia. This article reviews the pathophysiology of androgen-stimulated skin disorders and the key clinical trials using 5α-R inhibitors in the treatment of androgen-stimulated skin disorders.
J Drugs Dermatol. 2013;12(2):e30-e35.
Jennifer Rivard MD, David Ozog MD
Background and Objectives: Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is becoming a more
popular dermatologic procedure. Newer protocols have virtually eliminated any associated untoward effects. Phototoxicity,
although rare, can still occur and requires aggressive post-therapy care. Recently, a new biorestorative skin care cream, containing
human growth factors and cytokines, was used to treat 2 severe cases of PDT-associated phototoxicity.
Materials and Methods: This paper describes 2 case reports of severe phototoxicity following ALA-PDT treatments. The
novel skin care cream was utilized in both cases phototoxicity.
Results: Complete resolution of the phototoxic reaction was seen, leaving both patients with normal skin texture and tone.
Conclusions: This novel skin care cream may prove useful in wound healing following treatment with lasers and light
sources or dermatologic surgery.
Maggie Chow MD PhD,a Kevin Lai MS,b Richard Ahn PhD,b Rashmi Gupta PhD,b Sarah Arron MD PhD,b and Wilson Liao MDb
BACKGROUND: Adalimumab is an anti-TNF biologic drug that is efficacious in the treatment of psoriasis. However, the effect of adalimumab on genome-wide gene expression changes in skin and peripheral blood is not well characterized.
METHODS: Thirty adult subjects with > 10% body surface area of chronic plaque psoriasis were recruited for the study. Lesional skin and peripheral blood mononuclear cell samples prior to and one month following treatment with adalimumab were collected. The skin samples were analyzed using genome-wide RNAseq, and the blood samples were analyzed using genome-wide Affymetrix microarrays. Data preprocessing and analysis were conducted using the EdgeR and Affy packages in R/Bioconductor.
RESULTS: In the skin, paired analysis before and after treatment revealed changes in pathways important to epidermal development and keratinocyte differentiation. Such important genes as keratin 6A and 6B, tubulin B6, desmocollin, and desmoglein 3 were among the top differentially expressed genes. In peripheral blood, pathways involved in hematopoetic cell lineage and immune response were found to be differentially expressed, including genes such as the Fc receptor-like A and 5, as well as immunoglobulin heavy chains. Using a principal components approach, we show that expression of genes in post-treatment skin more closely resembles that of healthy controls.
CONCLUSION: Treatment of psoriasis with adalimumab appears to be associated with modulation of keratinocyte and epidermal proliferation in the skin and with immunologic changes in the blood. We discuss the ramifications of these findings for the treatment for psoriasis.
J Drugs Dermatol. 2016;15(8):988-994.
BACKGROUND: Abnormal accumulation of melanin is a common aesthetic skin concern. For years, the gold standard for the treatment of hyperpigmentary disorders has been 4% hydroquinone (HQ). Due to regulatory agencies around the world questioning the safety of HQ, there has been interest in developing new HQ-free skin brightening/lightening products. A multimodality product (skin brightening complex) addressing various pathways for melanogenesis was developed as an alternative to HQ.
OBJECTIVE: The skin brightening complex was studied for efficacy and tolerability in subjects with moderate to severe facial hyperpigmentation.
METHODS: Subjects were instructed to apply skin brightening complex to the entire face twice daily and to follow a standard skin care regimen (facial cleanser, moisturizer, and sunscreen) during the course of the study. The study was conducted over a 12-week period and consisted of evaluation visits at baseline and at weeks 4, 8, and 12. At each visit, subjects were evaluated by an investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs and spectrophotometric assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. To assess longer-term safety and efficacy, 10 subjects elected to continue treatment for an additional 12 weeks (24 weeks total), with evaluations at weeks 18 and 24.
RESULTS: Twenty-six subjects completed the 12-week study, and 8 subjects completed treatment for an additional 12 weeks (24 weeks in total). In the 12-week study, the skin brightening complex was shown to be effective and significantly improved Overall Hyperpigmentation at weeks 4, 8, and 12 compared with baseline. The skin brightening complex also significantly improved the Mottled Pigmentation Area and Severity Index ([MoPASI], a modified Melasma Area and Severity Index [MASI] scale) at weeks 8 and 12 compared with baseline. These efficacy benefits continued at 24 weeks. The product was well tolerated at all evaluation visits. Subject questionnaires showed 80% or more of the subjects reporting pigmentation improvement and satisfaction with the skin brightening complex at all evaluation visits.
CONCLUSION: This HQ-free skin brightening complex was effective and well tolerated in subjects with facial hyperpigmentation who were treated for as long as 24 weeks.
J Drugs Dermatol. 2013;12(3 suppl 1):s27-s31.
Moris Topaz MD,a,b Narin-Nard Carmel BSc,c Guy Topaz BSc,c Isaac Zilinsky MDd
BACKGROUND: The skin of the scalp is relatively thick, minimally mobile, with distinct hair distribution.
TopClosure® is a novel device for skin stretching and secure wound closure.
OBJECTIVES: To evaluate the efficacy of the TopClosure® system in primary closure of moderate and large scalp defects, as a substitute for skin grafts, flaps, and tissue expanders.
METHODS: We report a retrospective series of 8 patients requiring resection of 9 scalp tumors resulting with moderate to large size defects that otherwise would have required reconstruction with skin grafts, flaps, or tissue expanders. TopClosure® was applied for intraoperative cycles of stress-relaxation, followed, when indicated, by additional steps of mechanical creep and scar secure.
RESULTS: Skin defects, averaging 3.5 cm, were managed by TopClosure®, enabling, primary closure in all wounds. Immediate wound edge approximation was reached through stress-relaxation in 2 wounds by heavy tension sutures within one hour. Further skin stretching by mechanical creep was required in 7 wounds, achieving staged primary closure in an outpatient setting. TopClosure® was further applied to secure the skin for up to 3 weeks following surgery.
CONCLUSIONS: The TopClosure system, effectively, aided closure of moderate and large scalp defects by stress-relaxation and mechanical creep and serving as a topical tension-relief platform for tension sutures, allowing mobilization of skin and subcutaneous tissue without undermining or need of drainage, for early, direct wound closure. Local complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced, and post-operative wound aesthetics were improved.
J Drugs Dermatol. 2014;13(1):48-55.
Ricardo Ruiz-Rodriguez MD PhD, Laura López-Rodriguez MD
As demand for less invasive, highly effective cosmetic procedures grows, dermatologists must continue to explore and
develop new treatment options. Nonablative skin resurfacing techniques offer an effective and noninvasive treatment for
photorejuvenation. Several studies have shown improvement of photodamaged skin and increased collagen production after
nonablative treatments using vascular lasers, mid-infrared lasers, intense pulsed light, radiofrequency devices, fractional
resurfacing, and plasma skin rejuvenation. Among the novel methods for maximizing the efficacy of nonablative treatment
is the concurrent use of a photosensitizing agent. The light sources currently most used for photodynamic rejuvenation are
intense pulsed light and pulsed dye laser. We present some preliminary results on rejuvenation using Metvix and red light.
We are still far from a thorough understanding of the molecular mechanism of rejuvenation with this technique, although a
nonspecific immune response could be involved. Understanding the laser-tissue interactions associated with photodynamic
therapy is crucial in selecting patients that will most likely benefit.
Teo Soleymani MD,a Nicholas A. Soter MD,a Lorcan M. Folan PhD,b Nada Elbuluk MD MSc,a Uchenna R. Okereke MD,a and David E. Cohen MD MPHa
BACKGROUND: While most of the attention regarding skin pigmentation has focused on the effects on ultraviolet radiation, the cutaneous effects of visible light (400 to 700nm) are rarely reported. In this report, we describe a case of painful erythema and induration that resulted from direct irradiation of UV-naïve skin with visible LED light in a patient with Fitzpatrick type II skin.
METHODS AND RESULTS: A 24-year-old healthy woman with Fitzpatrick type II skin presented to our department to participate in a clinical study. As part of the study, the subject underwent visible light irradiation with an LED and halogen incandescent visible light source. After 5 minutes of exposure, the patient complained of appreciable pain at the LED exposed site. Evaluation demonstrated erythema and mild induration. There were no subjective or objective findings at the halogen incandescent irradiated site, which received equivalent fluence (0.55 Watts / cm2). The study was halted as the subject was unable to tolerate the full duration of visible light irradiation.
CONCLUSION: This case illustrates the importance of recognizing the effects of visible light on skin. While the vast majority of investigational research has focused on ultraviolet light, the effects of visible light have been largely overlooked and must be taken into consideration, in all Fitzpatrick skin types.
J Drugs Dermatol. 2017;16(4):388-392.
Michael Kockaert, MD and Martino Neumann, MD, PhD
The rejuvenation of aging skin is a common desire for our patients, and several options are available. Although there are some systemic methods, the most commonly used treatments for rejuvenation of the skin are applied topically. The most frequently used topical drugs include retinoids, alpha hydroxy acids (AHAs), vitamin C, beta hydroxy acids, anti-oxidants, and tocopherol. Combination therapy is frequently used; particularly common is the combination of retinoids and AHAs1. Systemic therapies available include oral retinoids and vitamin C. Other available therapies such as chemical peels, face-lifts, collagen, and botulinum toxin injections are not discussed in this article.
Rajesh Balkrishnan PhD, Fabian T. Camacho MS, Daniel J. Pearce MD, Amit S. Kulkarni MS, Lori Spencer PhD, Alan B. Fleischer Jr. MD, Steven R. Feldman MD PhD
Of the topical preparations available, the ultra-high potency corticosteroids have an important role in treating psoriasis.
However, the use of these agents in many other conditions and patient populations may not be appropriate. This
study examines the prescribing patterns of Class I topical corticosteroids in patients with skin disease by analyzing data
from the National Ambulatory Medical Care Survey (1990-2000). Of the nearly 718 million visits for skin disease,
Class I topical corticosteroids were prescribed in nearly 3% of all skin disease-related visits, with prescription rates being
highest in psoriasis (22%). The study found greater prescription rates of Class I topical steroids by dermatologists compared
to non-dermatologists [Odds Ratio (OR) = 4.39 (95% CI: 2.15, 8.99)]. However, there were also a large number
of questionable prescriptions for other conditions, which could be construed as misuse of these medications. Despite
limitations and the potential dubious use seen here, Class I topical corticosteroid use is relatively commonplace.
Education efforts and novel preparations of Class I agents will help to ensure the best possible care for patients suffering from significant skin diseases like psoriasis.
Braden McKnight BS,a Rachel Seidel BA,b and Ron Moy MDa
BACKGROUND: Senile purpura presents itself as a largely unexplored challenge as it has been long thought of as a benign condition without long-term health sequelae. It is becoming increasingly accepted that skin aging not only results in cosmetic disturbances, but as a functional ones. With modern increases in lifespan, skin atrophy associated with solar damage is presenting as a clinically significant
inability to mechanically protect patients. This chronic cutaneous insufficiency/fragility syndrome was recently termed dermatoporosis
and senile purpura appears to be a visible marker of early stage dysfunction.
OBJECTIVE: To examine the effects of topically human epidermal growth factor on the clinical presence of senile purpura and its effect on skin thickness as measured via cutaneous ultrasound.
METHODS: Six subjects applied human epidermal growth factor morning and night for six weeks. Clinical outcomes were evaluated by comparing initial clinical photos to 6-week photos and performing a blinded investigator’s global assessment (IGA). Skin thickness was evaluated via cutaneous ultrasound measurement.
RESULTS: Ultrasound measurements indicated a mean skin thickening of 195.2 ± 35.7um (SEM) over 6 weeks. The average number of purpuric lesions decreased from 15 ± 4.6 (SEM) to 2.3 ± 0.7 (SEM) over that same period.
CONCLUSION: Senile purpura presents itself as a cosmetic disturbance posing significant psychological distress and serves as a marker of the severity of skin thinning. In this study, we demonstrate that topical h-EGF diminishes the appearance of senile purpura by thickening skin and may help prevent the development of late stage dermatoporosis.
J Drugs Dermatol. 2015;14(10):1147-1150.
Andrew Mamalis BS,a, b Duc-Huy Nguyen,a Neil Brody MD PhD,c and Jared Jagdeo MD MSa,b,c
The number of skin cancers continues to rise, accounting for approximately 40% of all cancers reported in the United States and approximately 9,500 deaths per year. Studies have shown reactive oxygen species (ROS) type free radicals are linked to skin cancer and aging. Therefore, it is important for us to identify agents that have anti-oxidant properties to protect skin against free radical damage. The purpose of this research is to investigate the anti-oxidant properties of bisabolol, silymarin, and ectoin that are components from chamomile, milk thistle, and halophilic bacteria, respectively. We measured the ability of bisabolol, silymarin, and ectoin to modulate the hydrogen peroxide (H2O2)-induced upregulation of ROS free radicals in normal human skin fibroblasts in vitro. Using a flow cytometry-based assay, we demonstrated that varying concentrations of these natural components were able to inhibit upregulation of H2O2-generated free radicals in human skin fibroblasts in vitro. Our results indicate components of chamomile, milk thistle, and halophilic bacteria exhibit anti-oxidant capabilities and warrant further study in clinical trials to characterize their anti-cancer and anti-aging capabilities.
J Drugs Dermatol. 2013;12(7):780-784.
Mitalee P. Christman MD,a Daniel Belkin MD,b Roy G. Geronemus MD, a,band Jeremy A. Brauer MDa,b
Cellulite is the common rippling or dimpling of skin of the thighs and buttocks of women, formed from a confluence of skin laxity, tethering fibrous septa, and fat herniation. We describe an anatomical approach to evaluating the cellulite patient and selecting the best treatment from among available non-invasive, minimally invasive, and invasive therapies. It is crucial to consider the anatomy of the patient and the morphology of cellulite while choosing a treatment. Diffuse rippling represents increased adiposity and/or increased skin laxity which may stand to benefit from lipolytic and skin tightening modalities. Dimpling represents tethering by fibrous septa which may stand to improve from subcision by minimally invasive devices such as Cell na. Patients with both morphologies may be treated with a combination of treatments or Cellulaze. Careful evaluation of the patient can help identify the best therapeutic strategy.
J Drugs Dermatol. 2017;16(1):58-61.
Jonathan I. Silverberg MD PhD MPH,a,b,c Jared Jagdeo MD MS,a Mital Patel MD,a Daniel Siegel MD MS,a Neil Brody MD PhDa
Oxidative damage by reactive oxygen species (ROS) plays a major role in skin aging, carcinogenesis and inflammation. Little is known about the protective effects of green tea extract (GTE) on toxic ROS-induced skin death. We use an in vitro model of normal human skin fibroblasts (AG13145) to study the effects of green tea extract (GTE) on hydrogen peroxide (H2O2) induced necrosis. Cell morphology, numbers, apoptosis, necrosis, and ROS were assessed by epifluorescence microscopy and flow cytometry. This study demonstrates that GTE protected from H2O2-induced necrosis in a dose-dependent manner, with highest dose GTE (100 ng/mL) resulting in the most protection from necrosis, as assessed by improved cell morphology, increased cell numbers, and decreased necrosis. The protective effects of GTE on H2O2-induced necrosis appear to be mediated directly by decreasing intracellular ROS. The present study suggests that pretreatment with high doses of GTE could protect from toxic ROS-induced injury of skin in the clinical setting. However, additional studies are necessary to determine the clinical utility of GTE for decreasing skin cell ROS, necrosis and inflammation.
J Drugs Dermatol. 2011;10(10):1096-1101.
Neil S. Sadick MD FACP FACS
Objective: To determine the safety and efficacy of a light and heat energy (LHE)-based system (SkinStaion® system; Radiancy
Inc, Orangeburg, NY, USA) for hair removal in subjects with skin types V and VI.
Methods: Thirty-one subjects with Fitzpatrick skin types V and VI were consented for treatment with the system.
Twenty-six subjects completed the 12-week follow-up. Safety was evaluated at each visit and efficacy was evaluated at both
Results: An average hair clearance of 41.7% from 57 treatment sites was reported at the 6-week follow-up visit and a
35.5% average hair clearance was reported at the 12-week follow-up. Edema was only reported in 2 cases (7.7%) of the study
population. Eleven cases of erythema were reported following treatment.
Conclusion: Treatment with the modified LHE system was safe and effective for hair removal in patients with skin types V and VI.
Ellinor R. Quay MD,a Yunyoung C. Chang MD,a and Emmy Graber MD MBAb
As the market for South Korean skin care products grows in the U.S. and worldwide, consumers will increasingly seek advice from dermatologists regarding their efficacy. In this paper, the evidence behind the anti-aging and skin whitening activity of ingredients in the most popular South Korean skin care products was reviewed and critically evaluated. Industry profit data from Euromonitor was obtained to identify the top cosmeceutical brands by retail value in South Korea. The top selling products and their ingredients were then identified from individual brand websites. A comprehensive literature search was conducted using Pubmed to identify and grade the anti-aging and whitening efficacy for nine popular ingredients: licorice, niacinamide, beta-glucan, snail mucus, ginkgo biloba, ginseng, green tea, pomegranate, and soy. Of the various ingredients reviewed, niacinamide, green tea, licorice, and soy have the most published data for anti-aging and whitening activity. Although the literature shows modest results, small sample sizes limit interpretation. High-level evidence to support the use of South Korean skin care products in anti-aging and skin whitening is lacking.
J Drugs Dermatol. 2017;16(4):358-364.
Jeff Wu PhD, Jeannette Chantalat MBA, Jue-Chen Liu PhD
Acne vulgaris is a common skin disease that is difficult to treat due to its multifactorial etiology. The presence of sebum and
keratinocytes within the hair follicle often prevent medication from penetrating deep into the follicle where the causal bacteria
are to be found. Medications able to penetrate into the follicle are often irritating to the skin. Recently, a technology has been
developed that can penetrate sebum and deliver medication deep in the follicle while also being gentle on the skin. This novel
microgel complex is therefore a critical next step in the treatment of acne and also an important tool for people who suffer from
a lower quality of life due to persistent acne breakouts.
J Drugs Dermatol. 2015;14(2):176-182.
Wendy E. Roberts MD FAAD
The proposed terminology Generational Dermatology encompasses prevention and involves medical, cosmetic, surgical and oncologic
strategies over the decades to optimize skin performance throughout the course of a lifetime. Organ failure is the inability of the organ
to perform its determined function as a part of normal physiology and it may be possible to take a Generational preventive approach
toward reducing morbidities associated with the failure of our largest organ, the skin. Outside of skin cancer prevention efforts we
have as a specialty primarily worked on the tertiary prevention realm. I advocate that we can increase our focus on the primary and
secondary tiers where we as Dermatologists have the training and education to identify risk factors and detect early symptoms of skin
disease. I appeal to the house of Dermatology to embrace this concept of Generational Dermatology as preventive medicine for the
evolving aging patient. The practice of Generational Dermatology will decrease patient morbidity and bring down the cost of healthcare.
Our global increased longevity increases the number of elderly worldwide. Longer lifespan means dermatologic needs will increase
as the skin must perform its basic function longer. There are also new unknowns and skin issues which arise from large numbers of
people in the 9th and 10th decades. Generational Dermatology is well suited to be a model for prevention as our patient's age and we can
intervene at any decade. I believe the specialty will increasingly focus on how the skin can optimally perform for a longer period. Lastly,
the practice of Generational Dermatology unifies the house of Dermatology as we need the innovations and input of every subspecialty
to contribute to the health of the people we serve.
J Drugs Dermatol. 2013;12(12):1396-1399.
Jenny A. Mandell MD, Jaimie B. Glick MD, and Ravneet Ruby Kaur MD
Scleromyxedema is a rare primary cutaneous mucinosis affecting middle-aged adults. It is characterized by dermal mucin deposition
with increased collagen in the skin and internal organs. We report a case of a 72-year-old man with classic skin findings of scleromyxedema
as well as a monoclonal gammopathy.
Aanand N. Geria MD, Christina N. Lawson MD, Rebat M. Halder MD
Topical retinoids are an important class of drugs for treating several dermatoses occurring more frequently in patients with pigmented skin, such as melasma, post-inflammatory hyperpigmentation, pseudofolliculits barbae and keloids. They also play a role in managing acne, psoriasis, photoaging, cutaneous T-cell lymphoma, Kaposi sarcoma and disorder of hyperkeratosis in this demographic as well. In general, topical retinoids are well tolerated in pigmented skins. There is little evidence to suggest that patients with darker skin are at increased risk of irritation. However, retinoid dermatitis can induce post-inflammatory hyperpigmentation and attempts should be made to reduce its occurrence by modifying treatment regimens in patients with pigmented skins.
J Drugs Dermatol. 2011;10(5):483-489.
Laura Jordan DO MS and Hilary E. Baldwin MD b
Stratum corneum (SC) abnormalities are associated with disease-affected skin conditions such as inflammatory acne. Current topical acne treatment options including benzoyl peroxide and retinoids can worsen the barrier dysfunctions by increasing transepidermal water loss, depleting SC vitamin E levels, and relatively decreasing SC thickness. However, strategies exist to employ these treatments in a more effective manner and lessen barrier function disruption including use of less irritating vehicles or concomitant application of moisturizers. Patients also play a role in the outcome of their skin barrier function based on their compliance and administration technique. By increasing patient compliance and proper application of treatments, patient skin barrier function can improve. Additionally, future treatments are on the horizon that may customize acne therapy at a molecular level.
J Drugs Dermatol. 2016;15(10):1170-1173.
Amanda Dahl BS, Margarita Yatskayer MS, Susana Raab BS, and Christian Oresajo PhD
Hydroquinone (HQ) is the benchmark prescription agent for skin lightening. However, HQ use is recently banned in Europe and in parts of Asia because of potential long-term consequences, including carcinogenesis when orally consumed. This has resulted in development of alternative skin-lightening agents with comparable efficacy to HQ, but better safety profiles. This study examined the skin-lightening ability of a topical product containing 0.5% ellagic acid and 0.1% salicylic acid and compared its efficacy with that of a prescription generic 4% HQ product. Fifty-four multiethnic subjects were randomly assigned to use the topical test formulation or generic 4% HQ twice daily for 12 weeks to evaluate product tolerability and efficacy. Under the conditions of this double-blinded clinical study, the test product demonstrated comparable tolerance and efficacy to that of a benchmark product 4% HQ, as assessed by clinical grading, physical measurement of spot size using image analysis, and questionnaire response analysis. This study suggests that this new product provided comparable skin depigmentation benefit to the benchmark product. In addition, the product appears to have better esthetics (texture, pleasantness to use, skin feel) than the 4% HQ product.
J Drugs Dermatol. 2013;12(1):52-58.
Natural ingredients are frequently used in an effort to address cosmetic concerns such as fine lines, wrinkles, uneven tone, and texture. Many of these ingredients found in nature possess potent antioxidant as well as anti-inflammatory properties. Some, such as mushroom extracts, are even capable of accelerating the skin turnover rate and repairing dermal molecular components that provide structure and elasticity to the skin. Others, such as green tea, provide photoprotection against ultraviolet-induced DNA damage. In this manuscript, the cosmetic benefits of mushrooms, feverfew, and tea are discussed in the context of their ability to improve the appearance of the skin. The healing effects that wheat complex can have on damaged hair are also addressed.
J Drugs Dermatol. 2013;12(suppl 9):s133-s136.
Richard W. McClain BS, Brad A. Yentzer MD, Steven R. Feldman MD PhD
Background: Topical corticosteroids are often considered to have greater safety and poorer efficacy than oral corticosteroids in
treating psoriasis and atopic dermatitis. There are limited data for assessing relative efficacy of topical and systemic corticosteroids,
however. The concentration of corticosteroid in skin, adjusted for the relative potency of the active compound, may be a predictor of
clinical efficacy and can be estimated for both topical and oral administration.
Purpose: To analyze the assumption that oral corticosteroid therapy should be more potent than topical therapy by comparing relative
corticosteroid concentrations in the skin expected with topical versus systemic administration.
Methods: The estimated skin concentration of prednisone following oral dosing was calculated based on data showing 70–100%
bioavailability and an even tissue distribution. Data on the concentration of corticosteroids found in skin after topical application were
obtained from the literature. The relative potencies of corticosteroid molecules were then used to compare skin concentrations of
corticosteroid following topical versus oral treatment.
Results: Data derived from the existing literature demonstrated that hydrocortisone 2.5% ointment, triamcinolone 0.1% ointment,
and clobetasol 0.05% foam achieved effective skin concentrations greater than the effective concentration achieved by oral prednisone.
Betamethasone 0.1% cream achieved effective concentrations in skin within the range created by oral prednisone.
Limitations: This analysis was limited by the paucity of data regarding cutaneous concentrations of corticosteroids after topical application,
and by the differing experimental designs utilized in the available studies.
Conclusion: Most topical corticosteroids have the potential to achieve greater effective drug levels in the superficial layers of skin
than those achieved with standard doses of oral prednisone. The apparently greater efficacy of oral corticosteroid therapy may be
attributable, in part, to poor patient compliance with topical therapy. Systemic alterations in immune function following oral, but not
topical, corticosteroid use may also play a role.
Robert A Weiss MD, Margaret A Weiss MD, Roy G Geronemus MD, David H McDaniel MD
Photomodulation is a process that manipulates or regulates cell activity using light sources without thermal effect. Previous studies
of LED photomodulation have shown skin textural improvement accompanied by increased collagen deposition with reduced MMP-
1 (collagenase) activity in the papillary dermis. The purpose of this study was to investigate a separate cohort of patients (N=93) with
a wide range of Fitzpatrick skin types treated by LED photomodulation using the Gentlewaves™ full panel 590 nm high energy LED
array with a specific sequence or code of pulsing in the millisecond domain. Results showed improvement of signs of photoaging in
90%. The majority of patients demonstrated improvement in peri-ocular wrinkles, reduction in Fitzpatrick photoaging classification,
global skin texture and background erythema, and pigmentation. No side effects were noted. LED photomodulation is a safe and
effective non-painful non-ablative modality for improvement of photoaging.
Magdalene Dohil MD, Leslie Baumann MD, Hema Sundaram MD, Jason Emer MD
The dermatologic application of natural ingredients in skin care has evolved
significantly in the past two decades. Research into the mechanisms and
biochemistry of natural ingredients has lead to the development of new
technologies and formulations that provide a therapeutic benefit in the
treatment of dermatologic conditions and the aging process.
Providing optimal patient outcomes continues to be a challenge in the
treatment and management of dermatologic conditions. Most physicians and
patients are interested in doing everything possible to optimize the
treatment of their skin disease. This is especially important in treating
patients with chronic disorders such as eczema, acne, psoriasis, rosacea,
photodamage and the negative effects of aging. Physicians and patients often
explore the therapeutic benefits of natural ingredients as alternative or
complementary treatments to conventional methods. It is important that
dermatologists remain up-to-date on the research and new advances in skin
care products with natural ingredients.
This is a CME supplement; visit the JDD Medical Education Library
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Alan D. Widgerow MBBCh MMed FCS FACS,a Sabrina G. Fabi MD FAAD FAACS,b
Roberta F. Palestine MD,c Alexander Rivkin MD,d Arisa Ortiz MD FAAD,b Vivian W. Bucay MD FAAD,e
Annie Chiu, MD,f Lina Naga MD,g Jason Emer MD,h and Paul E. Chasan MD FACSi
Normal aging and photoaging of the skin are chronic processes that progress gradually. The extracellular matrix (ECM), constituting over 70% of the skin, is the central hub for repair and regeneration of the skin. As such, the ECM is the area where changes related to photodamage are most evident. Degradation of the ECM with fragmentation of proteins significantly affects cross talk and signaling between
cells, the matrix, and its constituents. The accumulation of collagen fragments, amorphous elastin agglutinations, and abnormal cross-linkages between the collagen fragments impedes the ECM from its normal repair and regenerative capacity, which manifests as wrinkled, non-elastic skin. Similar to how the chronic wound healing process requires wound bed preparation before therapeutic intervention, treatment of chronic aging of the skin would likely benefit from a “skin bed preparation” to optimize the outcome of rejuvenation procedures and skin maintenance programs. This involves introducing agents that can combat stress-induced oxidation, proteasome dysfunction, and non-enzymatic cross linkages involved in glycation end products, to collectively modulate this damaged ECM, and upregulate neocollagenesis and elastin production. Agents of particular interest are matrikines, peptides originating from the fragmentation of matrix proteins that exhibit a wide range of biological activities. Peptides of this type (tripeptide and hexapeptide) are incorporated in ALASTIN™ Skin Nectar with TriHex™ technology (ALASTIN Skincare, Inc., Carlsbad, CA), which is designed to target ECM modulation with a goal of optimizing results following invasive and non-invasive dermal rejuvenating procedures.
J Drugs Dermatol. 2016;15(Suppl 4):s63-s71.
David McDaniel MD,a Robert Weiss MD,b Margaret Weiss MD,b Chris Mazur BS,a and Charmaine Griffin CCRPa
Multiple devices are currently on the market that employ radiofrequency to non-invasively treat skin laxity and wrinkle reduction. The study device was a unique monopolar radiofrequency device FDA cleared for the treatment of wrinkles and rhytids. The delivery system allows constant monitoring of the real-time local skin impedance changes, which allows radiofrequency energy to be more uniformly dosed over an entire treatment area.
OBJECTIVE: The objective was to validate effectiveness of a modified treatment protocol for a unique monopolar radiofrequency device, which has been engineered with greater power and self-monitoring circuitry.
METHODS: Twenty-four female subjects received bilateral monopolar radiofrequency treatments to the mid and lower face from the sub malar region to the submentum. Subjects completed 1 and 3 month follow ups with digital imaging. Skin biopsies (on 4 subjects) and ultrasound measurements (on 12 subjects) were completed.
RESULTS: Assessments demonstrated a reduction in skin laxity of 35%, a reduction in fine lines/wrinkles of 42%, and a reduction in the appearance of global photodamage of 33%. Expert photograding demonstrated 92% of subjects showing at least a mild improvement in skin laxity at three months post treatment. 50MHz ultrasound measurements in 12 subjects showed an increase of 19% in skin density. Histology showed a marked increase in dermal collagen and elastin fibers in two subjects who demonstrated a clinically noticeable reduction in skin laxity and minimal changes in two subjects who demonstrated minimal clinical improvements. There were no significant adverse events reported.
CONCLUSION: This modified radiofrequency device and treatment protocol was well tolerated and produced improvements in the appearance of skin laxity and overall anti-aging effects in the majority of subjects. Objective measurements including ultrasound and histology help explain the clinical outcome.
J Drugs Dermatol. 2014;13(9):1112-1117.
Maria Mekas BSN,a,b Jennifer Chwalek MD,a,c Jennifer MacGregor MD,a,d and Anne Chapas MDa,c
BACKGROUND: Glycolic acid acts by chemical destruction of adhesions between skin cells to exfoliate superficial skin layers and excess pigmentation. It is well known to improve the appearance of photoaged skin, but is associated with varying degrees of skin irritation. Hydrolyzed salmon roe proteins destroy cell adhesions enzymatically with potentially less irritation than acid treatments. This double-blind prospective study assesses the efficacy and tolerability of hydrolyzed roe versus glycolic acid, and glycolic acid with citric acid.
METHODS: 75 female subjects with mild to moderate photodamage, all skin types, and ages 31-70 years, were enrolled. In this 12 week study of twice daily self-treatments, patients were assigned to one of 3 groups; Group 1 (n-19) was assigned hydrolyzed roe cream, Group 2 (n=17), 4% glycolic acid, or Group 3 (n-16), 8% glycolic acid plus 2% citric acid. All patients used the same mild face wash and SPF 30 sunscreen throughout the study. Patients were evaluated at weeks 0, 8 and 12 for objective and subjective tolerability, improvement in photodamage by VISIA Complexion Analysis, modified Packman and Gans method, Visual Analog Scale (VAS), and answered an opinion questionnaire.
RESULTS: Group 1 improved in skin clarity from a VAS 44.1 to 55.7 (P=0.0317) at week 12. VISIA mean scores correlated with office evaluation showing improvement in brown spots from 453 to 417 (P = 0.0115) at 12 weeks. Group 2 improved in superficial fine lines at week 8 (-5.9, P=0.0428) and week 12 (-9.1, P=0.0019). Group 3 improved at week 12 in skin clarity (11.5, P = 0.0469) and skin roughness (-13.3, P = 0.0426), and in hyperpigmentation at week 8 (-9.4, P=0.0462) and week 12 (-14.6, P= 0.0019).
CONCLUSION: Topical hydrolyzed roe protein used twice daily improves skin clarity. It has good tolerability with fewer instances of stinging
and burning than the other glycolic acid containing creams. Patient’s opinions of the 3 products were similar.
J Drugs Dermatol. 2015;14(11):1306-1319.
Dorota Z. Korta PhD,a Jesse M. Lewin MD,b Shane A. Meehan MD,b and Sarika M. Ramachandran MDb
Skin metastases from visceral malignancies have been well documented in the literature, and may be the presenting sign of an occult internal malignancy. Lung cancer in particular is a relatively common cause of skin metastases, which are considered a poor prognostic sign. Rarely, patients with lung cancer develop a second primary lung cancer that may require a novel chemotherapeutic regimen. The frequency of second primary malignancies presenting with metastatic skin lesions is not documented in the literature. We present a case of a 50-year-old man with a history of metastatic lung adenocarcinoma who was referred for evaluation of a nodule overlying his right mandible, which had been progressively enlarging for two weeks. Biopsy demonstrated metastatic squamous cell carcinoma. Subsequent CT-guided biopsy of a left retroperitoneal lymph node was conducted and notable for squamous cell carcinoma. Therefore, this patient's skin lesion was the presenting sign of a second primary visceral tumor, likely originating in the lung. We present this case to raise clinical awareness of the rare phenomenon that cutaneous metastasis may be the first sign of a visceral cancer, even in the setting of a previous distinct primary malignancy.
J Drugs Dermatol. 2014;13(10):1277-1279.
Karen E. Burke,a Xueyan Zhou,a Yongyin Wang,f Joel Commisso,b Carl L. Keenb
Robert M. Nakamura,a Gerald F. Combs Jr.,d and Huachen Weia,e
Previous studies in mice have shown that topical L-selenomethionine (SeMet) can prevent UVB-induced skin cancer when applied continuously before, during, and after the radiation exposure. With topical application of SeMet, selenium levels were shown to increase in the skin and liver, as well as in tumor tissue. Thus, possibly, the timing of SeMet application could affect the degree of inhibition of UVB-tumorigenesis (or maybe even enhance tumorigenesis at some stage). The goal of this research was to determine whether topical SeMet best inhibits UV-induced skin cancer if (a) begun before and continued during and after UVB exposure, (b) if begun before UVB-exposure and discontinued when tumors are first clinically detected, or (c) if begun only after tumors are first detected and continued thereafter. Groups of ten Skh: 1 hairless, non-pigmented mice were treated topically with vehicle lotion, or with SeMet (0.05%) in that vehicle lotion applied either (a) before, during, and after UV exposure, (b) before UV radiation and continued only until the first tumor was detected, or (c) only after the first tumor was detected. In all cases, UV irradiation was discontinued at the time of detection of the first tumor. Optimal inhibition of skin cancer was achieved by application of topical SeMet before, during, and after exposure; significant protection was also attained with application only after the onset of tumors. Notably, statistically significant protection was not seen with SeMet application only prior to tumor detection. These results suggest that even beginning SeMet supplementation late in the process of tumorigenesis can help protect from UV-induced photodamage and skin cancer.
J Drugs Dermatol. 2014;13(10):1214-1223.
Mary L. Lupo MD, Joel L. Cohen MD, Marta I. Rendon MD
Evidence of the signs associated with skin aging often first appears in the periorbital area and includes wrinkles, eyelid
bags, circles around the eye, or a “tired” look. This multicenter study aimed to investigate a novel eye cream containing
a proprietary mixture of human growth factors and cytokines in combination with caffeine, bisabolol, glycyrrhetinic acid,
and sodium hyaluronate for periorbital rejuvenation. The study, which was completed by 37 female subjects between 36
to 65 years of age, revealed that clinical signs for wrinkles, lower eyelid bags or sagging, dark circles, and skin texture show
significant improvement (average 14%-28%) after 6 weeks of twice-daily application. These clinical improvements were
confirmed by a subject questionnaire. The subjects further reported that their tired look significantly improved by 32%
in average. All subjects tolerated the eye cream well and liked the way it felt. The cream’s efficacy, excellent tolerability
in the delicate periorbital skin area, and pleasant sensory properties explain why a large majority (78%) would continue
Jared Jagdeo MD MS and Neil Brody MD PhD
The study of free radicals is particularly relevant in the context of human skin carcinogenesis and photoaging because of these oxidants´
ability to induce DNA mutations and produce lipid peroxidation byproducts, including 4-hydroxy-2-nonenal (HNE). Therefore,
it is important to identify and evaluate agents with the ability to modulate intracellular free radicals and HNE. The purpose of this
research is to investigate the ability of antioxidants green tea polyphenols (GTPs) and caffeine, alone and in combination, to modulate
the hydrogen peroxide (H2O2)-induced upregulation of reactive oxygen species (ROS) free radicals and HNE in normal human skin
fibroblast WS-1 cells in vitro. GTPs and caffeine were selected for evaluation because these compounds have demonstrated antioxidative
properties in various skin models. Furthermore, GTPs and caffeine share a close natural botanical association as caffeine is
present in green tea, as well. Hydrogen peroxide is a well-known generator of free radicals that is produced during endogenous and
UV-induced oxidation processes in human skin and was used to upregulate ROS and HNE in normal human fibroblast WS-1 cells.
Using a flow cytometry-based assay, the results demonstrate that at 0.001% concentration, green tea polyphenols alone, and in
combination with 0.1 mM caffeine, inhibited the upregulation of H2O2-generated free radicals and HNE in human skin fibroblasts in
vitro. Caffeine alone demonstrated limited anti-oxidant properties.
J Drugs Dermatol. 2011;10(7):753-761.
Agustin Alomar MD,a Eggert Stockfleth MD,b Thomas Dirschka MD,c Girish Gupta FRCP,d Selim Aractingi MD PhD,e Rada Dakovic PhD,f and Ketty Peris MDg
BACKGROUND: Imiquimod 3.75% is an effective actinic keratosis (AK) treatment that detects and clears clinical and subclinical lesions across an entire sun-exposed field such as the full face or balding scalp.
OBJECTIVE: To determine the efficacy and safety of imiquimod 3.75% according to patients’ Fitzpatrick skin type.
METHODS: Data were pooled from two identical 14-week, double-blind studies. Patients were randomized to imiquimod 3.75% or placebo
and applied study medication to the full face or balding scalp each day for 2 two-week treatment cycles separated by a two-week treatment-free interval. End of study (EOS) was eight weeks after the last treatment application. Patients were subgrouped according to whether they had Fitzpatrick skin types I or II (FST I/II), or types III or IV (FST III/IV). Efficacy was analyzed using the reduction in lesions from Lmax (maximum lesion count during treatment) to EOS. This assesses whether clinical lesions, and subclinical lesions which become detectable during treatment, are cleared. Safety was assessed by monitoring local skin reactions.
RESULTS: In total, 173 patients with FST I/II and 142 with FST III/IV were included. The median percentage reductions in lesions from Lmax to EOS were similar in patients treated with imiquimod 3.75% with FST I/II and FST III/IV (94.2% and 89.7%, respectively) as were the median absolute reductions in lesions from Lmax to EOS (19.0 and 17.0, respectively). These reductions were significantly greater with imiquimod 3.75% versus placebo in the two respective FST subgroups (P<0.0001). The frequency of local skin reactions was similar in the two imiquimod 3.75% FST subgroups.
CONCLUSIONS: Imiquimod 3.75% is well tolerated and effective at clearing clinical and subclinical lesions across large areas of sun-exposed skin in patients with FST I–IV, and so can be considered for AK patients with any of these skin types.
J Drugs Dermatol. 2016;15(3):285-289.
Hilary Reich MD,a,b Irmina Wallander BA,a Lacie Schulte MS BA,a Molly Goodier BS,a and Brian Zelickson MDa
SUMMARY BACKGROUND: Many over the counter topical products claim to reverse the signs of cutaneous photo-damage. To date, the two most studied ingredients for improving the texture, tone, and pigmentation of the skin are topical retinoids and hydroquinone.1
OBJECTIVE: This split face study compares a mass market skincare regimen with a prescription skin care regimen for improvement in photo damaged skin.
METHODS: Twenty-seven subjects with moderate photo damaged facial skin were enrolled. Each subject was consented and assigned with the mass market anti-aging system (Treatment A) to one side of the face and the prescription anti-aging system (Treatment B or Treatment C) to the other side of the face. Treatment B contained 13 subjects whom did not use 0.025% Retinol cream. Treatment C contained 14 subjects who used a 0.025% Retinol Cream. Subjects had 4 visits over 12 weeks for digital photography and surveys. Photographs were evaluated by blinded physicians.
RESULTS: Physician objective analysis showed all three systems to have a statistically significant clinical improvement in photoaged skin seen in as little as 4 weeks of use. Participant’s surveys rated the mass market system higher than both of the professional systems for visible skin changes, ease of use, and likelihood to recommend to a friend. Twelve of twenty-seven subjects preferred the mass market system for overall improvement while twelve thought each system gave the same improvement.
CONCLUSION: This study demonstrates that a mass marketed skin care system can give similar clinical improvements in photo-aged skin as a professionally dispensed prescription system and the majority of participants preferred the mass-marketed system.
J Drugs Dermatol. 2016;15(1):37-44.
Background: Full-Thickness skin grafts are routinely used to reconstruct defects throughout the body. When planning the size of
the graft, the surgeon usually copies a template from the defect and measures the graft to fit its full dimensions. This may lead to
an oversized graft, resulting an unaesthetic outcome.
Objective: To evaluate discrepancy in size between the excised full-thickness skin and the excision (donor) site.
Methods: Data from 20 cases of full-thickness excisions was reviewed and analyzed.
Results: There was a considerable difference in length of both the short and long axes between the excised full-thickness skin and
the excision site.
Conclusions: The initial size of a full-thickness skin graft should be smaller than the defect it is planned to cover.
J Drugs Dermatol. 2012;11(4):520-523.
Ramsin Joseph Yadgar BS,a and Adam J. Friedman MDa,b
In recent decades, the stratum corneum (SC), has been recognized for its multifunctional role in maintaining the homeostasis of the human epidermal barrier. A better understanding of the SC’s ability to act as its own biosensor in detecting dysfunction and integrating restorative actions can help identify the origin of certain skin conditions. A more holistic understanding of the morphological changes of the SC during the natural aging process and how it deviates in disease states can help bring about new treatment strategies.
Some important recent clinical studies point to new treatments and add to the existing body of research on corneobiology. These studies offer some explanation of and validation for the various ingredients incorporated into moisturizers and barrier repair devices aimed at treating pruritus and xerosis associated with the aging skin.
J Drugs Dermatol. 2016;15(suppl 11):s91-94
Amy Forman Taub MD, Eliot F. Battle Jr. MD, Gregory Nikolaidis MD
Modalities for skin tightening include radiofrequency (RF) energy, lasers, and combination RF and diode lasers. A new
broadband infrared light device (BILD) (Titan, Cutera, Inc, Brisbane, CA) targets water to achieve dermal heating and
collagen remodeling for skin tightening. Although thousands of procedures have been performed worldwide with this device,
only one article (to the author’s knowledge) describing its performance in skin tightening has been published.
Three US dermatologists report their experience with and provide their perspective on facial skin tightening with the BILD
system. As early adopters, they each have 12 to 18 months experience with this system. One author (A.F.T.) treated
42 patients twice at 1-month intervals over 18 months. The mean improvement score was 1.83 (scale 0 to 4, with
4 denoting maximum improvement) with an average follow-up time of 3.7 months. More than 90% of treated patients
showed visible improvement. No complications were observed and patient satisfaction was high.
This paper presents the general consensus of the authors on patient selection and treatment protocol, their modifications of
the manufacturer’s treatment protocol, and the outcomes of 42 patients treated by one author (A.F.T.). The observations were
gathered separately and turned out to be very similar. The recommendations are presented to help practitioners achieve
consistently good results and avoid complications with the BILD procedure.
Yasmeen Kabir MD,a Rachel Seidel BA,b Braden Mcknight BS,c Ronald Moy MDc
The incidence of skin cancer continues to increase annually despite preventative measures. Non-melanoma skin cancer affects more than 1,000,000 people in the United States every year.1 The current preventative measures, such as sunscreens and topical antioxidants, have not shown to be effective in blocking the effects of UV radiation based on these statistics. The level of antioxidants contained in the majority of skin creams is not sufficient to majorly impact free radical damage. Sunscreens absorb only a portion of UV radiation and often are not photostable. In this review article, we present the novel use of exogenous DNA repair enzymes and describe their role in combating photocarcinogenesis and photoaging. Topical application of these enzymes serves to supplement intrinsic DNA repair mechanisms. The direct repair of DNA damage by endogenous repair enzymes lessens rates of mutagenesis and strengthens the immune response to tumor cells. However, these innate mechanisms are not 100% efficient. The use of exogenous DNA repair enzymes presents a novel way to supplement intrinsic mechanisms and improve their efficacy. Several DNA repair enzymes critical to the prevention of cutaneous malignancies have been isolated and added to topical preparations designed for skin cancer prevention. These DNA repair enzymes maximize the rate of DNA repair and provide a more efficient response to carcinogenesis.
J Drugs Dermatol. 2015;14(3):297-301.
Rachel Seidel BAa,c and Ronald Moy MD FAADb,c
BACKGROUND: Recently popularized in the field of cosmetic dermatology, subcutaneous carbon dioxide (CO2) injections have been shown to improve the skin’s appearance by augmenting oxygen delivery and thereby aiding cellular metabolism and neocollagenesis. However, they carry several risks and cannot be used on the entire face, leaving them best suited for the treatment of localized skin concerns. To combat these issues, a less invasive CO2 facial suited for full-face treatment has been developed, though its efficacy in oxygenating the skin has not been thoroughly investigated.
OBJECTIVE: The aim of this study was to evaluate the ability of the CO2 facial to oxygenate the skin.
METHODS AND MATERIALS: Twelve patients were enrolled in this split-face study. They were treated one week apart with a CO2 facial on one side of the face and particle-free microdermabrasion on the other. Measurements of transcutaneous oxygen tension (tcPO2) were recorded at baseline and after each treatment. Statistical significance was assessed by comparing the average tcPO2 difference in mmHg following microdermabrasion and after a carbon dioxide facial using a 1-tailed paired t-test (α = 0.05).
RESULTS: The average increase in tcPO2 after CO2 facial treatment was statistically significantly greater (p = .0252) than after microdermabrasion.
CONCLUSION: Carbon dioxide facials improve skin oxygenation immediately following treatment, attributable to the generation of an artificial Bohr effect.
J Drugs Dermatol. 2015;14(9):976-980.
Christina Marquez BS, Sarah M. Bair MD, Erica Smithberger MD, Basil S. Cherpelis MD, Neil Alan Fenske MD, L. Frank Glass MD
Patients at high risk for the development of multiple non-melanoma skin cancers, especially those receiving immunosuppressive medications following solid organ transplantation, are candidates for chemoprophylaxis. In patients where photo-protection and topical medications are insufficient to prevent the growth of new cancers, there is considerable evidence that oral retinoids, including vitamin A, and synthetics such as isotretinoin, etretinate and acitretin are efficacious in this regard. This manuscript is a review of the literature regarding the use of these agents for chemoprophylaxis of non-melanoma skin cancer. Also included is anecdotal evidence that bexarotene, a rexinoid, may be as effective as acitretin in terms of hemoprevention, with a comparable side effects at doses recommended for chemoprophylaxis.
BACKGROUND and OBJECTIVE: Scars from skin cancer surgery on the face can be quite prominent and not easily obscured by makeup. This report evaluates the use of an ablative fractional Er:YAG laser device for minimizing or blending scar lines in two patients who underwent repair of skin cancer defects on the face.
METHODS: Two patients underwent surgery to remove facial skin cancer tumors. The resulting scars after reconstruction of these skin cancer defects on the left cheek (Case 1) and right cheek (Case 2) each received 3 treatments with a fractional ablative laser device (ProFractional-XC, Sciton, Inc., Palo Alto, CA). Treatments were spaced about 1 month apart. Topical anesthetic cream applied 1 hour before treatment minimized patient discomfort during the procedure. Treatment depths ranged from 150 to 200 microns, 2 passes were performed, and coverage per pass was typically 22% and then 11% in the coagulation mode. Results were evaluated by digital photography before the initial treatment, approximately 4-5 weeks after each of the 3 treatments, and at approximately 7 months after the surgical procedures.
RESULTS: The fractional Er:YAG laser device significantly improved postsurgical scar lines in each patient without significant adverse effects. Prior to the laser sessions, these scars demonstrated hypopigmentation, hyperpigmentation, neovascularization, or diminished pore structures compared to the surrounding skin. These pigmentary, vascular or textural issues were all significantly improved by the fractional ablative Er:YAG laser.
CONCLUSION: The ablative fractional laser device of the present report safely minimizes and improves facial scars demonstrating not only textural alterations but also some pigmentary and vascular changes after reconstruction of skin cancer defects.
J Drugs Dermatol. 2013;12(10):1171-1173.
Aditya k. Gupta, MD;, PhD, FRCP(C) and Karyn A. Nicol, HBMSc
Seborrheic dermatitis is a common chronic infection of the lipid-rich areas of skin. While seborrheic dermatitis has been a recognized
clinical entity for decades, its etiology is far from clear. Early investigators of the development of seborrheic dermatitis focused
on the role of the Malassezia (previously Pityrosporum) yeasts. These yeasts are also normal skin commensals, thus their importance
as pathogens in this disorder came to be doubted. However, it was subsequently found that treatment of seborrheic dermatitis with
an antifungal agent not only resulted in clinical improvement but also reduced the number of Malassezia yeasts on the skin. This has
resulted in a resurgence of interest in the Malassezia yeasts. It has been hypothesized that there is an immunological component to
seborrheic dermatitis, possibly representing an abnormal host response to the Malassezia yeasts. This paper will discuss the role of
Malassezia in the etiology of seborrheic dermatitis, as well as the various treatment options.
Lauren Meshkov Bonati MD,a Gorana Kuka Epstein MD,b and Tamara Lazic Strugar MDa
INTRODUCTION: Microneedling procedures are growing in popularity for a wide variety of skin conditions. This paper comprehensively reviews the medical literature regarding skin needling efficacy and safety in all skin types and in multiple dermatologic conditions.
METHODS: A PubMed literature search was conducted in all languages without restriction and bibliographies of relevant articles reviewed. Search terms included: “microneedling,” “percutaneous collagen induction,” “needling,” “skin needling,” and “dermaroller.”
RESULTS: Microneedling is most commonly used for acne scars and cosmetic rejuvenation, however, treatment benefit has also been seen in varicella scars, burn scars, keloids, acne, alopecia, and periorbital melanosis, and has improved flap and graft survival, and enhanced transdermal delivery of topical products. Side effects were mild and self-limited, with few reports of post-inflammatory hyperpigmentation, and isolated reports of tram tracking, facial allergic granuloma, and systemic hypersensitivity.
DISCUSS: Microneedling represents a safe, cost-effective, and efficacious treatment option for a variety of dermatologic conditions in all skin types. More double-blinded, randomized, controlled trials are required to make more definitive conclusions.
J Drugs Dermatol. 2017;16(4):308-314.
Brent Hopson MMS PA C, Donald Richey MD, F. Paul Sajben MD
Lentigo maligna (LM) is an in situ melanoma that occurs in sun-damaged skin on the head and neck of elderly patients.
Surgical excision is the treatment of choice for LM. However, surgical options may be limited by the location of LM in
cosmetically sensitive areas. We present a woman with a history of skin cancer with a large, asymmetrically pigmented
lesion on her right superior cheek below her eyelid. The lesion had been present for approximately 15 years. Histologic
analysis confirmed that the lesion was an LM. Imiquimod 5% cream was applied topically once daily. Approximately 5
months later, the previous LM had healed well and no new lesions were observed. Histologic clearance of the lentigo maligna
was evident in skin biopsies. Imiquimod 5% cream appears effective in the treatment of lentigo maligna. We describe
the treatment of a patient with facial LM with imiquimod 5% cream.
Warren Wallo, Judith Nebus, James J. Leyden MD
Serine protease inhibitors (soybean trypsin inhibitor [STI] and Bowman-Birk protease inhibitor [BBI]) found in soybeans
have been shown to inhibit melanosome phagocytosis by keratinocytes via protease-activated receptor 2 (PAR-2). Preclinical
studies have confirmed the skin lightening potential of these molecules. In this study, we investigated the efficacy
of a novel soy moisturizer containing nondenaturated STI and BBI for the improvement of skin tone, pigmentation, and
other photoaging attributes. Sixty-five women, with moderate facial photodamage, were enrolled in the 12-week,
parallel, vehicle-controlled study. Efficacy was monitored through clinical observation, self-assessment, colorimetric evaluations,
and digital photography. The results showed that the novel soy moisturizer was significantly more efficacious than
the vehicle in improving mottled pigmentation, blotchiness, dullness, fine lines, overall texture, overall skin tone, and
overall appearance. Differences were significant from week 2 to week 12 for all above parameters (except dullness which
started at week 4). In this study, we found that a moisturizer containing stabilized soy extracts is safe and effective, and
can be used to ameliorate overall skin tone and texture attributes of photoaging.
Daniel J. Aires MD JD,a Graham Rockwell PhD,b Alan Menter MD,c Colton Nielson,d Jo Wick PhD,e Stephanie Sedivy MD,f Ossamma Tawfik MD PhD,g Anne Bowcock PhD,h and Animesh A. Sinha MD PhDi
BACKGROUND: Psoriasis is a common but complex chronic inflammatory skin Disease. Array-based studies can help identify therapeutic targets.
OBJECTIVE: To reproducibly assess single-gene transcriptional changes in psoriatic skin.
METHODS: We evaluated 210 top candidate genes from a first psoriasis study group (population 1), and then confirmed differential expression in a second independent psoriasis study group (population 2).
RESULTS: One hundred and thirty-eight differentially expressed genes were replicated in the 2 studies, of which 57 have not previously been reported as associated with psoriasis. This is significantly greater than the 10 expected false positives. Lesional skin vs uninvolved areas showed inflammatory and cell regulation changes.
CONCLUSION: Previously undescribed psoriasis-associated genes revealed in this study may provide potential future targets for development
and assessment of novel therapeutic agents for psoriasis.
J Drugs Dermatol. 2015;14(8):794-800.
Hema Sundaram MD,a Nicolas Mackiewicz PhD,b Emeline Burton MSc,b Laurent Peno-Mazzarino BSc,c Elian Lati PhD,c and Stéphane Meunier PhDb
BACKGROUND: Hyaluronic acid (HA) is a popular ingredient in topical formulations for cosmetic improvement of the skin. Most formulations
contain linear, non-crosslinked HA oligomers, low molecular weight (LMW) HA, and/or high molecular weight (HMW) HA. Crosslinking
of HA enhances its clinical longevity and mechanical characteristics. The objective of this study was to characterize the topical effects of a new, crosslinked resilient HA (RHA) that is also available as a cohesive, tissue-integrating injectable filler, compared with non-crosslinked HMW HA and LMW HA. Living human skin explants that preserve the 3-dimensional structure of in vivo skin were used to maximize clinical relevance.
METHODS: Standardized doses of each HA product were applied daily for 9 days to human skin explant surfaces. Untreated explants served as controls. Water content of the stratum corneum and entire epidermis was analyzed by Raman spectroscopy. Transepidermal water loss (TEWL) was measured to assess skin barrier function. Explant morphology and microrelief were evaluated by optical and scanning electron microscopy.
RESULTS: Crosslinked RHA achieved a significant increase in epidermal water content (7.6%) over the control. Spectral cartography confirmed a higher epidermal water content with RHA than with HMW HA or LMW HA. TEWL was reduced by 27.8% with RHA, and by 15.6% with HMW HA, but increased by 55.5% with LMW HA. Cutaneous microrelief improved with RHA. Corneocyte cohesion improved with RHA and HMW HA.
CONCLUSIONS: This comparative, multimodal study demonstrated greater benefits of topical crosslinked RHA over linear HMW HA or LMW HA in reducing TEWL, retaining and redistributing water within the epidermis, maintaining skin integrity, and improving skin barrier
structure and function. RHA was a more efficacious humectant than LMW HA, and a more efficacious occlusive moisturizer than HMW HA. These integrative epidermal repair activities are of significant value for addressing primary deficits of aging skin, improving tolerance to retinoids and other topical agents, and optimizing procedural outcomes. A combination of topical and injectable HA provides
an elegant model of synergistic, multi-level skin restoration.
J Drugs Dermatol. 2016;15(4):434-441.
Vic A. Narurkar MD,a Sabrina G. Fabi MD FAAD FAACS,b Vivian W. Bucay MD FAAD,c Ruth Tedaldi MD,d Jeanine B. Downie MD,e Joshua A. Zeichner MD,f Kimberly Butterwick MD,g Amy Taub MD,h Kuniko Kadoya PhD,i Elizabeth T. Makino BS MBA CCRA,i Rahul C. Mehta PhD,i and Virginia L. Vega PhDi
Skin aging is a combination of multifactorial mechanisms that are not fully understood. Intrinsic and extrinsic factors modulate skin aging, activating distinctive processes that share similar molecular pathways. One of the main characteristics of youthful skin is its large capacity to retain water, and this decreases significantly as we age. A key molecule involved in maintaining skin hydration is hyaluronic acid (HA). Concentration
of HA in the skin is determined by the complex balance between its synthesis, deposition, association with cellular structures, and degradation. HA bio-equivalency and bio-compatibility have been fundamental in keeping this macromolecule as the favorite of the skincare industry for decades. Scientific evidence now shows that topically applied HA is unable to penetrate the skin and is rapidly degraded on the skin surface.
SkinMedica’s HA5 Rejuvenating Hydrator (SkinMedica Inc., an Allergan company, Irvine, CA) promotes restoration of endogenous epidermal HA homeostasis and provides instant smoothing and hydration of the skin. These dual benefits are accomplished through the combination of 2 breakthrough technologies: 1) a unique blend of actives powered by SkinMedica proprietary flower-derived stem cell extract that restores the endogenous production of HA; and 2) a proprietary mix of 5 HA forms that plump the skin, decreasing the appearance of fine lines/wrinkles.
Pre-clinical studies demonstrated that HA5 induces expression of key epidermal differentiation and barrier markers as well as epidermal HA synthases. A decrease expression of hyaluronidases was also observed upon HA5 application. Initial clinical studies showed that within 15 minutes of application, HA5 instantly improves the appearance of fine lines/wrinkles and skin hydration. Subjects that continue using HA5 (for 8 weeks) demonstrated significant improvements in fine lines/wrinkles, tactile roughness, and skin hydration. In summary, the blend of these 2 key technologies present in HA5 promotes restoration of endogenous epidermal HA while delivering instant smoothing effects.
J Drugs Dermatol. 2016;15(1 Suppl 2):s24-s37.
Joseph Bikowski MD, Radhakrishnan Pillai PhD, Braham Shroot PhD
Multivesicular emulsion systems are a new patented technology for topical delivery of pharmaceutical and over-the-counter
actives. This novel technology involves the creation of a 2-phase, oil-in-water emulsion system that produces concentric
multilamellar spheres of oil and water. Active ingredients can be released from their respective layers upon application to the
skin. In addition to a controlled-release of active agents, the multivesicular emulsion base improves the biophysical properties
of the skin by reducing transepidermal water loss and enhancing skin hydration. This technology has been applied to 6%
salicylic acid formulations that in clinical experience show efficacy with high tolerance in several hyperkeratotic disorders.
Subjects’ self-assessment was clearly indicative of the excellent cosmetic elegance of the multivesicular emulsion system.
Macrene Alexiades MD PhD
BACKGROUND: The jasmonates are a novel class of plant-derived anti-aging compounds. Among these, LR2412-Cx (tetrahydrojasmonic acid, Visionnaire) has been demonstrated to reduce photoaging and the appearance of wrinkles, as well as to upregulate collagens, hyaluronic acid and fibrillin.
OBJECTIVE: To clinically study the cosmetic effects of a novel jasmonate complex LR2412-Cx in the treatment of visible skin aging.
METHODS: LR2412-Cx was evaluated in a 15-subject open-label prospective clinical trial for the treatment of fine wrinkle appearance, texture, and pores. Subjects were evaluated by an investigator at baseline, day 1, day 3, and week 6 with the Alexiades comprehensive grading scale of skin aging, and introducing a novel pore-grading scale and subject quality of life assessments.
RESULTS: The mean (SEM) at baseline and at week 6 following twice-daily application were: for the appearance of wrinkles 2.91 (0.12) and 2.70 (0.10); for texture 2.91 (0.10) and 2.55 (0.10); and for pores 3.29 (0.08) and 2.46 (0.09), respectively. The differences in all 3 categories at all follow-up intervals were statistically significant (P<.005). The percentage improvement in investigator-assessed grades relative to baseline at day 1, day 3, and week 6 were: 2.3%, 4.9%, and 7.4% for the appearance of wrinkles, 5.7%, 9.4%, and 12.4% for texture, and 14.2%, 21.6% and 25.2% for pores, respectively. No significant untoward effects were reported.
CONCLUSION: Visionnaire LR2412-Cx is a novel jasmonate-containing compound that is safe and effective for the cosmetic treatment of fine wrinkle appearance, texture, and pores of the facial skin.
J Drugs Dermatol. 2016;15(2):209-215.
David J. Goldberg MD, Snehal Amin MD, Bruce A. Russell MD, Robert Phelps MD, Norma Kellett MD, Laurence A. Reilly MD
Objectives: To evaluate the clinical efficacy and ultrastructural changes in photodamaged skin after combined 633-nm and
830-nm light-emitting diode (LED) treatments.
Methods: Thirty-six subjects received 9 LED treatments over the course of 5 weeks and were subsequently evaluated for final
clinical improvement 12 weeks after treatment. Five subjects were also biopsied to determine the ultrastuctural posttreatment
changes in collagen fibers.
Results: A statistically significant improvement in wrinkles was seen after profilometric analysis. The majority of subjects
reported improvements in softness, smoothness, and firmness at all time points. Electron microscopic analysis showed evidence
of post-LED treatment of thicker collagen fibers.
Conclusions: 633-nm and 830-nm LED treatments play a role in the treatment of photodamaged skin. LED treatments can be used as either a primary or adjunctive treatment modality.
Xiang Yang Han MD PhD,a Kurt Clement Sizer MD,a Hiok-Hee Tan MDb
Background: A new leprosy-causing species, namely Mycobacterium lepromatosis, was discovered recently to be the cause of diffuse
lepromatous leprosy (DLL) in Mexico. It is unknown whether this organism exists beyond Mexico.
Methods: We sought to determine the identity of the mycobacteria in the skin tissue of two patients from Singapore who died of DLL. DNA was extracted from archived biopsy tissue, and conserved polymerase chain reaction primers were used to amplify and sequence two to three mycobacterial genes in each skin sample.
Results: Both M. lepromatosis and the well-known leprosy agent Mycobacterium leprae were identified in each DLL skin sample. The M. lepromatosis gene sequences from the Singapore cases matched 99.9% with the known Mexican M. lepromatosis strain, but they only matched the corresponding M. leprae sequences by 89.2%.
Conclusions: The new species M. lepromatosis exists beyond Mexico and is the cause of DLL in Singapore. It may cause dual infections
along with M. leprae in endemic areas. Archived skin biopsy can be used to differentiate the leprosy agents.
J Drugs Dermatol. 2012;11(2):168-172.
Background: Although reliable prevalence data are not available, adult acne is thought to be somewhat common, and it is not unusual for patients
to have acne as well as early signs of skin aging. A novel anti-acne/anti-aging formulation (Treatment A) has been developed for daily use by
patients to address both signs of skin aging and facial acne vulgaris. The novel, non-prescription formulation includes several ingredients shown
to target factors underlying the pathogenesis of acne vulgaris while also addressing multiple components in the pathophysiology of skin aging.
Methods: A blinded, randomized, split-face study was conducted to evaluate and compare the tolerability and efficacy of the novel anti-acne/
anti-aging product in subjects with photodamaged skin and acne vulgaris relative to tretinoin cream 0.025% (Treatment B). All subjects also
were given supportive skincare, consisting of a cleanser, moisturizer, and sunscreen. Each treatment was assessed for its effects on subjects'
appearance, lesion count reductions, and tolerability.
Results: Treatment A produced statistically significantly greater improvements in skin tone evenness, skin tone clarity, and blemishes
and blotchiness. There were also statistically greater reductions in total lesion count for acne patients on the side of the face treated with
Treatment A compared to Treatment B; Treatment A was also associated with early (day 2) improvement in skin tone evenness and clarity,
tactile skin smoothness, and blemishes and blotchiness. Both treatments demonstrated favorable tolerability.
Conclusion: The novel topical anti-aging/anti-acne therapy (Treatment A) within a comprehensive skin care regimen of cleanser, moisturizer, and
sunscreen may maximize efficacy and tolerability and contribute to our armamentarium for treating both photodamage and acne at the same time.
J Drugs Dermatol. 2012;11(6):737-740
Acne vulgaris is the most common skin disease treated by physicians. Current topical and oral treatments may have shortand
long-term negative consequences. Since radiofrequency (RF) energy has been shown to reduce sebum production and
410-nm blue light has been shown to kill Propionibacterium acnes (P. acnes) cells, these modalities in combination should
be a highly effective treatment of acne vulgaris with little or no downtime or risk. This case report describes the efficacy
and safety of RF energy (Accent™, Alma Lasers Inc, Buffalo Grove, IL) and blue light (BLU-U®, Dusa Pharmaceuticals,
Inc, Wilmington, MA) used in combination to treat grade 4 cystic acne and acne scars in an Asian woman of skin type
IV. The results were considered excellent by both investigators and the patient, with improvement in the skin tone as an
added cosmetic benefit.
Background: Actinic keratoses (AKs) are in situ epidermal tumors that may progress to invasive squamous cell carcinomas (SCCs). Aminolevulinic acid with photodynamic therapy (ALA PDT) is a field treatment for AK.
Objective: To evaluate the time to development of new non-melanoma skin cancers (NMSC) within one year of ALA-PDT treatment in immunocompetent patients with AK and a history of skin cancer.
Methods and Materials: One hundred forty anatomic sites in 114 patients were treated with topical ALA for a 1 to 3 hour incubation period followed by photodynamic therapy (PDT) with a blue light. All new NMSCs within the treatment areas were recorded over a 1-year observational period.
Results: Eighty-three anatomic sites (59%) did not develop new skin cancers within 1 year. Additionally, 92%, 78%, and 64% of anatomic sites were free of new skin cancers at 3, 6, and 9 months after treatment was initiated. Although approximately 41% of patients treated on both the scalp and face developed new skin cancers within 1 year of treatment, the average time to develop skin cancer was longer for the face (7.09 months) than for the scalp (5.34 months).
Conclusion: In patients with a history of NMSC and multiple AKs, ALA PDT may be a valuable option for the prevention and delay of new NMSCs.
J Drugs Dermatol. 2012;11(5):593-597.
Background/ Objectives: The cellular surface modification of superficial epidermal keratinocytes can induce immediate skin tensioning effects
and may improve signs of skin aging. Tetrahydroxypropyl ethylenediamine (THPE) is an active that has been described to induce keratinocytes'
morphological changes in vitro. We conducted an in vivo study to assess anti-aging clinical benefits of a THPE-containing product.
Methods: An eight-week double-blind, randomized intra-individual placebo controlled clinical study was performed to evaluate the clinical benefits of a 2.5% THPE-containing cream. This study included 41 Caucasian women who received the THPE cream product on one side of the face and a placebo cream on the other side daily. Evaluations were performed at baseline, 45 minutes after first application, week 4 and week 8 and included clinical examination and digital photography.
Results: The study demonstrated the immediate lifting effect of a 2.5% THPE-containing cream. Forty-five minutes after a single application on the face, as the skin surface smoothed out, light reflection was modified: healthy glow and radiance of the skin were significantly improved (respectively 22.9% and 40% of improvement) and skin yellowishness was reduced (7.1%). Notably, the THPE-treated side was significantly lifted, both immediately after product application (8.1%) and after 8 weeks of application (14%), compared to the placebo-treated side.
Conclusion: This clinical study demonstrated that the effect of a 2.5% THPE-containing cream on the keratinocytes cells leads to an immediate and long-term clinical improvement of the skin appearance (radiance and skin firmness, skin lifting) and can therefore be considered as a new anti-aging cosmetic active.
J Drugs Dermatol. 2011;10(10):1102-1105.
John Mouzakis MD,a Charurut Somboonwit MD,b Seetha Lakshmi MBBS,c Mark Rumbak MDd John Sinnott MD,e Basil Cherpelis MD,f Jonathan Keshishian MDg
Levamisole is a veterinary anti-helminthic used to treat several autoimmune conditions but also commonly utilized as an additive in cocaine distribution. Toxicity resulting in agranulocytosis and cutaneous necrosis in association with cocaine use is an infrequently described phenomenon
of an emerging problem. Although levamisole is found extensively in the cocaine supply of the United States, relatively few cases of necrotic skin lesions associated with intranasal use have been reported. The skin necrosis secondary to levamisole toxicity is characterized by variable findings on biopsy, ranging from leukocytoclastic vasculitis to occlusive vasculopathy. The following case describes a 54-year-old male who developed fever, agranulocytosis, p-ANCA autoantibodies and extensive skin necrosis following heavy intranasal cocaine use. Necrosis of greater than 50% of the patient's total body surface area resulted and was followed by thorough wound debridement.
J Drugs Dermatol. 2011;10(10:1204-1207.
Timothy P. Wu BA and Jennifer A. Stein MD PhD
The increasing incidence of nonmelanoma skin cancer in young women is a growing public health concern. Varying environmental and lifestyle exposures in this specific population highlight the need for a broad understanding of the potential risk factors that may contribute to the early development of these tumors. Reducing the morbidity and mortality in this high-risk population is contingent on developing better strategies for prevention, education, and treatment.
J Drugs Dermatol. 2013;12(5):568-572.
Jean Carruthers MD, Alastair Carruthers MD
Hyaluronans have become the most popular agents used for soft tissue augmentation in the entire facial area. They are biodegradeable,
nonpermanent and have a remarkable safety profile. Their natural biocompatibility means that no pretreatment
skin test is necessary. The soft pliable enhancement of natural tissue turgor and contour makes them very acceptable in the
lips and perioral and periocular regions. The more viscous agents are very helpful in the treatment of facial lipoatrophy particularly
in the region of the cheeks and chin.
BACKGROUND: Radiofrequency-induced heating of dermal and subdermal tissue promotes skin contracture; however, the temperature
threshold for inducing an epidermal burn is lower than the therapeutic temperature thresholds required for collagen remodeling, and
therefore, there is the possibility of epidermal burn. Herein, we evaluate a radiofrequency treatment that provides novel real-time subdermal
and epidermal temperature monitoring.
METHODS: A retrospective chart review of 18 subjects undergoing thermistor-controlled subdermal skin tightening via percutaneous
radiofrequency was conducted. During the treatment, epidermal temperature was concurrently monitored by a handheld infrared laser
thermometer and a forward looking infrared camera system and peak temperatures readings were reported and evaluated.
RESULTS: Mean temperatures of 43.6 and 38.2oC were reported for the infrared camera and infrared thermometer. The Bland-Altman
plot analysis reported a bias of 5.38oC and 95% limits of agreement between 0.60 and 10.15oC. Additionally, the mean difference or
bias of 5.38oC was statistically significant (P less than 0.0001).
CONCLUSION: Our preliminary data supports a superior form of thermoregulation for the purposes of skin tightening that integrates
continuous subsurface and epidermal temperature monitoring.
J Drugs Dermatol. 2014;13(2):185-189.
Girish Munavalli MD MHS FAAD FACMS
Recent appreciation of the multifactorial pathophysiology of skin aging has led to increased use of parallel treatment regimens. This prospective, split-face, randomized study assessed the safety and efficacy of same-day sequential Q-switched Nd:YAG laser and 1565 nm non-ablative fractional laser (SST) facial rejuvenation treatment in comparison to fractional non-ablative laser (NAFL) treatment only. Seventeen patients underwent three treatment sessions, conducted at 4-6-week intervals, in which SST treatment was delivered on a randomly selected side of the face followed by NAFL treatment on the contralateral side immediately thereafter. Immediate skin responses were assessed within 30 minutes of treatment, while wrinkle/elastosis scores, and skin tone and texture were evaluated 1, 3, and 6 months following the final treatment session. While SST and NAFL proved equally safe, SST was associated with signi cantly lower pain scores in all three treatment sessions. Both treatment regimens yielded signi cant improvements in wrinkle/elastosis scores, which were maintained throughout the 6 months of follow up. Physician-evaluated skin tone and patient ratings of skin texture and overall improvement of the SST-treated side were consistently higher than the contralateral NAFL-treated side. Histological analysis suggested a broader effect, alongside sparing of the outermost epidermal layer with the SST versus NAFL treatment. Although the SST regimen failed to demonstrate statistically signi cant clinical superiority over the NAFL regimen, the significantly lower pain levels, consistently higher physician and patient ratings following SST may justify its regular use as a skin rejuvenation technique.
J Drugs Dermatol. 2016;15(11):1335-1342.
Kristin K. Marcum MD,a Neal D. Goldman MD,c and Laura F. Sandoval DOb
BACKGROUND: Photo documentation has become increasing important in medicine, especially given the demand for cosmetic procedures.
Standard photography is not always adequate; newer techniques exploring the use of polarized, cross and ultraviolet photography
can give detailed information on subtle skin lesions including skin pigmentation and skin surface characteristics.
OBJECTIVE: To use various methods of photography including standard photography, cross polarized light, parallel polarized light and ultraviolet passing photography to assess which method most effectively captures skin features such as texture, pigment, and/ or vascularity.
METHODS: A prospective analysis comparing advanced photographic techniques including standard photography, polarized light photography,
cross-polarized light photography and ultraviolet light passing photography. The photos were then evaluated and scored by
two experts and a blinded observer to characterize the differences visualized in each type of photography compared to standard photography in terms of subsurface skin features, hypopigmentation, hyperpigmentation, and rhytids.
RESULTS: 9 subjects completed the study. Overall, of the 3 photographic methods compared to standard photography, UV passing most
enhanced the visualization of subsurface features and hypopigmentation, with increased hyperpigmentation as well. Enhancement of
these features made UV passing best for capturing photodamage. Cross-polarized photography was best for visualizing hyperpigmentation,
but also heightened visualization of hypopigmentation and subsurface features such as vascularity. Parallel-polarized photography
enhanced visualization of skin texture.
CONCLUSIONS: These methods of photography show a quantifiable and reproducible selective ability to evaluate and document elements
such as skin texture, vascularity, and pigmentation. Each of these techniques has unique properties that can add to the precision
of the clinical evaluation and can be of particular value to providers of cosmetic procedures where photo documentation has become
increasingly important in providing an objective means of evaluating outcomes.
J Drugs Dermatol. 2015;14(2):134-139.
Emily P. Tierney MD and C. William Hanke MD MPH
Background: Ablative laser resurfacing of the neck has been tested with the ultrapulsed CO2, ablative Er:YAG and short pulse duration
CO2 laser with mixed results in terms of efficacy and side effect profiles. Given the preliminary reports of safety and efficacy of
ablative fractional photothermolysis (AFP) for the face, we set out to assess the efficacy of AFP for the neck.
Design: A prospective pilot study for neck resurfacing in 10 subjects with a series of one-to-three treatment sessions. Treatment sessions
were administered at six-to-eight week intervals with blinded physician photographic analysis of improvement at two months
post-treatment. Blinded physician photographic evaluation was performed of four clinical indicators, skin texture, skin laxity, rhytides
and overall cosmetic outcome.
Results: The number of treatments required for improvement of neck texture and laxity ranged from 1–3, with an average of 1.4.
For skin texture, the mean score improved 62.9% (95% CI: 57.4%, 68.4%), skin laxity, 57.0% (53.2%, 60.8%), and rhytides, 51.4%
(48.3%, 54.5%). For overall cosmetic outcome, the mean score improved 59.3% (55.1%, 63.5%) at two months post treatment.
Conclusion: In this prospective study, AFP was both safe and effective for the treatment of neck laxity, rhytids and skin texture. The
degree of improvement observed in wrinkling, texture and laxity after AFP coupled with the benign side effect profile has not been
reported with previous trials of ablative laser resurfacing of the neck.
Objective: To evaluate trends and identify deficiencies and disparities in primary skin cancer prevention efforts among Hispanics in the US.
Methods: PubMed/MEDLINE and SCOPUS were searched using the following keywords: awareness, knowledge, behavior, sunscreen, hat, clothing, minorities, ethnic skin, Hispanic, Latino, and skin. Reference lists of selected studies were checked for additional studies. Studies that quantitatively evaluated primary skin cancer prevention efforts among US Hispanics were selected. Primary outcome measures included 1) use of sunscreen or sunblock, 2) use of sun-protective clothing and/or hats, and 3) shade seeking behavior. Selected studies were reviewed and quantitative data for each primary outcome measure were extracted. Additionally, we examined survey methodology and demographics of the studied populations.
Results: Studies evaluating primary prevention of skin cancer among US Hispanics are limited in number and study populations. Overall, 9.5-29.9% of the Hispanics evaluated reported wearing sunscreen either most of the time or always compared to 16.5-35.9% of NHW. Hispanics reported slightly higher rates of wearing hats compared to NHW, with 23.9-25.0% of Hispanics reporting wearing hats either most of the time or always compared to 20-20.7% of NHW. Trends in wearing sun protective clothing and shade seeking varied between different Hispanic populations evaluated, but overall prevalence of these practices remained low.
Conclusion: The limited studies suggest that improvements are needed in primary skin cancer prevention practiced by Hispanics. Future studies and interventions need to account for heterogeneity in socio-cultural backgrounds, degree of acculturation, and occupation among US Hispanics.
J Drugs Dermatol. 2012;11(5):580-586.
Anjana Ray PhD,a,* Breanne Mordorski BA,b,* Angelo Landriscina BA,b Jamie Rosen BA,b Joshua Nosanchuk MD,a,c and Adam Friedman MDd
Shaving is an ubiquitous practice, and cutaneous irritation and inflammation are common sequelae, which may be worsened by underlying skin conditions or poor hair removal techniques. Moisturizing shaving creams and aftershaves are available to help maintain or restore the epidermal barrier; however, many continue to suffer from post-shave redness, itching, and pain. To reduce post-shave inflammation, some products have included botanical and other natural ingredients, which are often favored by consumers. We evaluated Bensal HP, an ointment containing 3% oak bark extract, 3% salicylic acid, and 6% benzoic acid, which has documented anti-inflammatory and antimicrobial properties, in a murine model of shave irritation to determine whether it would be useful in this clinical setting. Shaving dermatitis was simulated using a depilatory agent and electric clippers, and the shaved area was photographed and treated with Bensal HP daily for four days. Compared to untreated controls, mice treated with Bensal HP experienced a visible reduction in skin irritation and inflammation. These findings were mirrored on histology, as Bensal HP-treated areas demonstrated increased epidermal integrity and decreased dermal inflammatory infiltrate compared to untreated skin. Using immunohistochemistry, fewer neutrophils and macrophages were noted, and cytokine analysis also revealed decreased IL-6 in Bensal HP-treated skin at 24 and 96 hours after shaving. These results highlight the potential of Bensal HP as an anti-inflammatory treatment for shave irritation. Given the product’s application against a variety of inflammatory and infectious skin disorders, its use against shave irritation may also improve comorbid skin conditions, such as pseudofolliculitis barbae.
J Drugs Dermatol. 2016;15(7):836-840.
Background: Ablative fractional laser skin resurfacing (FLSR) has recently been used for the amelioration of acne scars, and previous
studies have shown clinical effectiveness. Despite its extensive use, few studies have focused on the associated changes in biophysical
properties of the epidermis. Herein, we evaluate transepidermal water loss, sebum levels, skin hydration, and skin elasticity, following
FLSR treatments with an Er:YSGG laser device (Pearl FractionalTM , Cutera Inc., Brisbane, CA), employing non-invasive measurements.
Methods: Five Japanese patients with facial acne scars underwent one FLSR session. Some acne scars appeared to become less
obvious as a consequence of the treatment. All patients were aware of a feeling of skin tightness in treated areas.
Results: Objective measurements on the lower lateral angle of the eye and on the inner cheeks were evaluated at baseline and at 3
days, 1 week, and 4 weeks after FLSR. Transepidermal water loss showed a significant two-fold (100%) increase at day 3, but had
returned to almost the baseline level at week 4 in both areas. Sebum secretion showed a 50% increase at day 3, but had returned
to the baseline level after day 7. Skin hydration showed a significant decrease at day 3, but had returned to the baseline level by day
7, and showed significant improvement at the end of the study. Skin elasticity (R2) was still at baseline on day 3, but showed some
improvement—an increase of at least 30%—at the end of the study.
Conclusions: Based on our findings, we believe that FLSR should be performed no more than once a month to allow sufficient time
for the damaged skin to recover its barrier function in most areas of the face.
J Drugs Dermatol. 2012;11(5):637-642.
Enzo Emanuele MD PhD,a James M. Spencer MD MS,b and Martin Braun MDc
The exposure to ultraviolet radiation (UVR) is a major risk factor for skin aging and the development of non-melanoma skin cancer (NMSC). Although traditional sunscreens remain the mainstay for the prevention of UVR-induced skin damage, they cannot ensure a complete protection against the whole spectrum of molecular lesions associated with UVR exposure. The formation of helix-distorting photoproducts such as cyclobutane pyrimidine dimers (CPD), as well as oxidative damage to DNA bases, including the formation of 8-oxo-7,8-dihydro-2’-deoxyguanosine (8OHdG) are among the key DNA lesions associated with photoaging and tumorigenesis. Besides DNA lesions, UVR-induced formation of free radicals can result in protein carbonylation (PC), a major form of irreversible protein damage that inactivates their biological function. This study compares a complex novel topical product (TPF50) consisting of three actives, ie, 1) traditional physical sunscreens (SPF 50), 2) a liposome-encapsulated DNA repair enzymes complex (photolyase, endonuclease, and 8-oxoguanine glycosylase [OGG1]), and 3) a potent antioxidant complex (carnosine, arazine, ergothionine) to existing products. Specifically, we assessed the ability of TFP50 vs those of DNA repair and antioxidant and growth factor topical products used with SPF 50 sunscreens in preventing CPD, 8OHdG, and PC formation in human skin biopsies after experimental irradiations. In head-to-head comparison studies, TPF50 showed the best efficacy in reducing all of the three molecular markers. The results indicated that the three TPF50 components had a synergistic effect in reducing CPD and PC, but not 8OHdG. Taken together, our results indicate that TPF50 improves the genomic and proteomic integrity of skin cells after repeated exposure to UVR, ultimately reducing the risk of skin aging and NMSC.
J Drugs Dermatol. 2014;13(3):309-314.
Suzanne Bruce MD,a Wendy Roberts MD,b Craig Teller MD,c and Lora Colvan BSd
BACKGROUND: Chemical peels are versatile treatments that involve chemical exfoliation of the skin for cosmetic improvement. Deeper peels produce more significant results, but can be associated with longer healing time and potential complications. Novel chemical resurfacing treatments (AGE and MELA) were developed in Europe to produce skin resurfacing via controlled inflammation to promote cell regeneration with minimum negative effects associated with conventional peelings. The AGE Resurfacing regimen is indicated for the treatment of photoaging, and consists of multi-ingredient peeling solution with trichloroacetic acid, pyruvic acid, salicylic acid, mandelic acid, and lactobionic acid. The MELA Resurfacing regimen addresses hyperpigmentation concerns and contains mandelic acid, potassium azeloyl diglycinate, retinol, salicylic acid, phytic acid, lactobionic acid, and lactic acid. Results of previously conducted US clinical experience trial of AGE and MELA resurfacing protocols rated 81% of subjects with some level of improvement according to physician assessment.
OBJECTIVES: To evaluate whether a daily skin care regimen used for 12 weeks could maintain the benefits achieved with AGE and MELA chemical resurfacing treatments.
METHODS: Subjects who completed participation in the AGE and MELA skin resurfacing clinical trial were recruited to participate in a continuation trial and used a daily regimen of MDRejuvena facial products for 12 weeks. No other facial products were permitted. Physicians assessed the severity of individual skin parameters at baseline and week 12 and provided global assessment. Subjects assessed improvement of individual skin parameters at week 12 and provided an overall assessment.
RESULTS: Thirteen subjects participated in the 12-week continuation trial. According to the physician’s global assessment, all subjects demonstrated some level of improvement at week 12 compared to baseline. Physician assessment showed a decrease in severity of all skin parameters assessed at week 12 compared to baseline. According to the subject overall assessment at week 12, 11 of 12 subjects noted some level of improvement, 1 subject saw no improvement, and 1 subject did not provide an overall assessment. Mild to moderate improvement was observed by subjects in all individual skin parameters assessed except for skin discoloration.
CONCLUSIONS: The results of the continuation study demonstrate that use of a daily skin care regimen, which include combination of 2 various strengths of MDRejuvena Rejuvaphyl® Rejuvenating Complex: low strength (LS) and high strength (HS), not only maintains but can enhance the beneficial effects of skin resurfacing treatments for at least 12 weeks.
J Drugs Dermatol. 2016;15(9):1145-1150.
Emily Stamell Ruiz MD,a Joel L. Cohen MD,b,c
and Adam Friedman MDd
Although the therapeutic gold standard for basal cell carcinomas
(BCCs) is surgical excision, imiquimod, fluorouracil
cream, and photodynamic therapy are frequently used. All 3
modalities have been shown to be efficacious for the treatment
of superficial BCCs as well as other nonmelanoma
skin cancers; however, recent reports have emerged implicating
these agents in causing more aggressive recurrent
subtypes of BCCs. Here we review this literature as well as
offer an alternative explanation for these tumors.
Jeffrey F. Scott MD, Barbara Reichert MD, Miesha Merati DO, Kord Honda MD, and Kevin D. Cooper MD
We report a case of cutaneous plasmacytomas developing in a patient with a 7-month history of progressive multiple myeloma
refractory to bortezomib and combination chemotherapy. When involving the skin, plasmacytomas typically arise in the setting of
multiple myeloma as contiguous extensions from underlying bony disease. More rarely, cutaneous plasmacytomas develop from
hematologic metastases in patients with a high systemic plasma cell tumor burden. In our patient, the presence of cutaneous
plasmacytomas involving two distinct sites, and malignant plasma cells within the dermis without infiltration into the subcutaneous
fat, suggest a diagnosis of metastatic multiple myeloma to the skin. Metastatic multiple myeloma to the skin portends a poor
prognosis, and treatment should be aimed at the underlying systemic disease.
Lisa T. Goberdhan BA, Lora Colvan BA, Elizabeth T. Makino BS CCRA MBA, Caroline Aguilar RN BSN, and Rahul C. Mehta PhD
The combination of in-office procedures such as chemical peels with topical maintenance therapies has been shown to provide greater efficacy than either treatment by itself in the management of melasma. A series of 3 case studies were conducted to evaluate the efficacy and tolerability of one superficial chemical peel (containing a proprietary blend of resorcinol, lactic acid, salicylic acid, and retinol) combined with a topical multimodal, hydroquinone-free skin brightener as postpeel maintenance therapy. Patients presented with moderate to severe facial hyperpigmentation. At baseline, subjects received the superficial chemical peel treatment followed by a standard postpeel skin care regimen (cleanser, moisturizer, and SPF 30+ sunscreen). Approximately 1 week after the peel procedure, subjects initiated twice-daily application of the skin brightener. Subjects were then evaluated for Global Improvement in Hyperpigmentation by the investigator for up to 7 weeks postpeel. Standardized digital photographs of the subjects facial skin and in vivo reflectance confocal microscopy (RCM) images were taken of a target hyperpigmented lesion at baseline and at follow-up. Standardized photography and in vivo RCM images at baseline and at postpeel show the improvements observed by the investigator. Results from these case studies suggest that the combination of a superficial chemical peel with topical maintenance and the multimodal skin brightener may provide an effective treatment approach for subjects with moderate to severe facial hyperpigmentation.
J Drugs Dermatol. 2013;12(3 suppl 1):s38-s41.
David H. McDaniel MD FAAD,a Iltefat H. Hamzavi MD,b Joshua A. Zeichner MD,cSabrina G. Fabi MD FAAD FAACS,d Vivian W. Bucay MD,e Julie C. Harper MD,f Jody A. Comstock MD,g Elizabeth T. Makino BS CCRA MBA,h Rahul C. Mehta PhD,h and Virginia L. Vega PhDh
For more than a century, solar radiation has been known to contribute significantly to the extrinsic aging of skin. Until recently, this was almost exclusively attributed to the photodamage caused by ultraviolet (UV) light. However, a growing body of evidence now indicates that both infrared (IR) and visible light may also contribute to extrinsic skin aging. Infrared radiation, comprised of IR-A, IR-B, and IR-C, accounts for 54.3% of the total solar radiation reaching the skin. Studies have shown that IR radiation is also responsible for skin aging. Thus, IR-A radiation regulates hundreds of genes in skin, with roles in extracellular matrix (ECM) homeostasis regulation, apoptosis, cell growth, and stress responses. IR-B and IR-C radiation are primarily responsible for the increase in skin temperature associated with solar exposure, and are implicated in heat-related skin destruction of collagen and elastin, which is characterized by an increase in the expression of matrix metalloproteinases (MMPs). The contribution of visible light to photoaging is less well understood; however, some preliminary indication associates visible light with the upregulation of MMPs’ expression, DNA damage, and keratinocyte proliferation. Interestingly, the common denominator that links skin damage to the different solar wavelengths is the enhanced production of reactive
molecule species (RMS) and therewith increased oxidative stress. SkinMedica® Total Defense + Repair (TD+R; SkinMedica Inc., an Allergan company, Irvine, CA) is a “superscreen,” which combines broad spectrum UV protection with a unique blend of antioxidants (SOL-IR Advanced Antioxidant Complex™) that provide protection from IR radiation while promoting skin repair. Preclinical studies have indicated that TD+R SPF34 prevents the formation of UV-induced sunburn cells and cyclobutane pyrimidine dimers while preserving or improving the expression of ECM genes. In addition, it prevents IR-A-triggered
fragmentation of elastin fibers and expression of MMP-1. Initial clinical studies indicate that TDR+R SPF34 reduces the increase in surface temperature seen with IR radiation. A significant improvement in the appearance of lines and wrinkles was reported as early as week 2 in patients using TDR+R SPF34. In summary, we observed that the unique blend of antioxidants present in TD+R acts in harmony with SPF active ingredients, expanding solar protection
beyond UV radiation and counterbalancing the deleterious effects of free radicals on skin cells by promoting endogenous repair.
J Drugs Dermatol. 2015;14(suppl 7):s3-s11.
Neil S. Sadick, MD, FACP, FAACS
Cosmeceutical skin care products, which fall somewhere between cosmetics and pharmaceuticals, are playing an increasing role in the dermatologist's daily practice1-9. These agents contain active ingredients with known and documented biologic effects on the skin. Cosmeceutical sales represent the greatest growth segment of the skin-care market10-11. Although many of these agents have previously been marketed in drug stores, department stores, and pharmacies, these agents are now commonly being dispensed by dermatologists in their office settings. There is therefore a growing strategic alliance between the dermatology community and the cosmetic industry, which is in a process of evolution1-4.
The major challenge facing the practicing dermatologist is how to employ this ever-growing array of products to improve patient care. Many questions are still unanswered, and the ultimate recommendation of which are optional products for the aging patient should be based upon peer-reviewed, scientifically based clinical research studies which prove the agent's therapeutic efficacy.
Samantha Tucker-Samaras PhD, Tara Zedayko, Curtis Cole PhD, Dara Miller, Warren Wallo MS, James J. Leyden MD
Retinol is a cosmetic ingredient that is structurally similar to all-trans-retinoic acid, which has been shown to be effective in the treatment
of photodamage. Since skin keratinocytes are reported to metabolize retinol to retinoic acid, investigators have hypothesized
that retinol may also be helpful in improving skin photodamage. In this eight-week, double‑blind, split-face, randomized clinical study, a
stabilized 0.1% retinol-containing moisturizer was tested (36 subjects) against the vehicle (28 subjects) in women with moderate facial
photodamage. Each product was applied once daily to the designated half side of the face. Subjects were evaluated at baseline and
after four and eight weeks of treatment using a 0–9 scale for photoaging parameters. The results showed that, after eight weeks, the
retinol moisturizer was significantly more efficacious than the vehicle in improving lines and wrinkles, pigmentation, elasticity, firmness
and overall photodamage. Many of these differences were significant at week 4, with a progressive improvement to week 8. This study
demonstrates that a formulation containing stabilized retinol is safe and effective to ameliorate the appearance of photoaged skin.
Heather Ciliberto MD,a Arta Farshidi MD,b David Berk MD,b and Susan Bayliss MDa
BACKGROUND: Current treatment options for keratosis pilaris (KP) are limited and are often found to be unsatisfactory to patients.
OBJECTIVE: Pilot study to determine if photopneumatic therapy (PPx) can improve the erythema and skin texture in KP.
METHODS: Ten patients with KP were treated with one session of PPx on the upper arm and then evaluated one month later for treatment efficacy.
RESULTS: Average investigator-assessed improvement was 27% in erythema and 56% in skin texture roughness. Average patient self-reported improvement was 52% in erythema and 53% in skin texture. The mean satisfaction score was 6.3 on a scale of 1 to 10 (median 7.5) and 8 out of 10 participants reported they would choose to receive PPx for their KP again in the future.
LIMITATIONS: Small number of patients, short follow-up period, and lack of blinding of the examiner and the patients making recall bias possible.
CONCLUSIONS: One treatment of PPx improved both the erythema and redness associated with KP over at least a one month period.
J Drugs Dermatol. 2013;12(7):804-806.
Anne Goldsberry MD MBA, C. William Hanke MD MPH, Katherine E. Hanke
Laser and Skin Surgery Center of Indiana, Carmel, IN
BACKGROUND: Dyspigmentation is a common complaint in the dermatology office.
OBJECTIVE: We also sought to evaluate whether the VISIA Complexion Analysis System (Canfield Imaging Systems, Fairfield, NJ) could be a tool to help patients better understand their skin complaints.
METHODS: Twenty-one consecutive women were recruited for VISIA analysis. Each subject underwent VISIA analysis and completed a follow up survey.
RESULTS: 86% of respondents reported that the VISIA analysis helped them understand their initial concern. 86% noted that the VISIA brought other skin problems to their attention. 100% of the subjects responded that they would recommend VISIA analysis to others. 62% of subjects responded that they would prefer to go to a practice with a VISIA system in comparison to a practice without VISIA.
CONCLUSION: The VISIA Complexion Analysis System is a beneficial tool for dermatology and aesthetic practices with the potential to aid in patient education.
Dvora Ancona MD and Bruce E. Katz MD
Background and Objective: The purpose of this study was to assess the efficacy and safety of a new fractional CO2 laser system
for improving periorbital rhytids, tightening skin and elevating the eyebrow.
Materials and Methods: One hundred subjects with periocular wrinkles, tissue laxity, photoaged skin and moderate dermatochalasis
of the face were prospectively treated one to four times in the periorbital area with a fractional CO2 laser device equipped with a
scanning handpiece. Improvements in eyelid wrinkles, crow’s feet and skin laxity were evaluated photographically by two blinded,
independent observers. Eyebrow elevation was measured by the investigators. Subjects also scored satisfaction and tolerability.
Results: Approximately half of subjects achieved or maintained 26–50% improvement at 12 months. Nearly 40% of subjects maintained
1–2 mm elevation of the brow at six and 12 months after treatment. Subject satisfaction was high and the procedure was well
tolerated. Mild-to-moderate erythema and edema persisted for up to three to four days.
Conclusion: Treatment with a fractional CO2 laser device improves periorbital rhytids, tightens skin and elevates the eyebrow with
minimal adverse effects.
Oscar M. Ramirez, MD FACS; Anjum S. Khan, BA and Keith M. Robertson, MB, Bch, BAO, LRCPI, LRCSI
Our lift lip technique consists of an excision of the white part of the upper lip directly beneath the nose in the
shape of a ‘bull’s-horn’, with advancement of the inferior border of the incision to the area directly beneath the
nose. Pre-operative markings on the skin ensure the lip lift is approximately symmetric. Advancement of the
inferior edge of skin directly beneath the nasal base lifts the lip, producing more visible vermilion and about 3
mm of tooth show at rest. The position of the final incision is such that it is located within the shadow of the
nose. Meticulous technique produces an almost invisible scar. The amount and width of skin excised is individualized
depending on the desired aesthetic goals.
The procedure is straightforward and is usually performed under local anesthetic. Abdominal fat is frequently
injected into both the upper and lower lips to increase the volume and improve the rejuvenation. Lip lifts using
this technique provide an immediate, dramatic, and permanent result.
Zoe Diana Draelos MD,a Jwala Karnik MD,b and Gail Naughton PhDc
Growth factors are a new category of ingredient found in modern cosmeceutical formulations. One novel method of obtaining cosmeceutical growth factors is the use of a bioreactor to culture neonatal broblasts on dextran microcarrier beads for 8 weeks under low oxygen tension (1-5%) mimicking embryonic conditions and eliminating the need for fetal bovine serum constituents in the final cosmetic material. This research evaluated the ingredient in a moisturizing vehicle on 40 females to determine its efficacy in improving overall facial skin appearance, as well as skin brightness, evenness, firmness, pore size, radiance, fine lines, coarse wrinkles, and blotchiness/ dispigmentation. Statistically significant improvement was seen in 90 days in skin hydration through corneometry, as well in global investigator and subject assessments.
J Drugs Dermatol. 2017;16(1):30-34.
Shivani S. Patel BS,a Karen E. Huang MS,a Alan B. Fleischer Jr. MD,a and Steven R. Feldman MD PhDa,b,c
BACKGROUND: There is a reported global decrease in the number of clinical trials conducted in recent years. We aimed to determine if
this declining trend can be extrapolated to dermatologic clinical trials.
METHODS: We conducted a query of ClinicalTrials.gov for dermatologic clinical trials from 2009 to 2013 for 6 common skin conditions:
acne, psoriasis, rosacea, eczema and atopic dermatitis, actinic keratosis, and skin cancer. Results were sorted by condition and number
of study subjects. This study did not involve any participants apart from the researchers.
RESULTS: Although there is an increasing trend in the number of trials performed annually, the results were not significant (P=.08).
The average number of patients per study has not significantly changed (P=.12), but there was a significant increase in the number
of large studies (201+ subjects) conducted over time (P=.002). Although there was significant variation based on dermatologic condition
studied (global statistic P=.01), only skin cancer demonstrated a significant change in the number of studies registered annually
(β=10.6 studies/year, P=.04).
CONCLUSIONS AND RELEVANCE: The sky does not appear to be falling, at least not yet, with regard to continued development of treatments
for patients with skin disease.
J Drugs Dermatol. 2015;14(5):497-500.
E. Victor Ross MD,a Travis W. Blalock MD,a Douglas Winstanley DO,a Joel L. Cohen MD,b and James J. Childs PhDc
A melanin meter has been created to assess real time skin pigmentation to optimize settings for visible light aesthetic applications.
METHODS: A handheld meter was applied to non sun-damaged skin on the back of volunteers to measure skin pigmentation prior to treatment with IPL light sources over a range of pulse widths and ascending fluences. Curves for maximum epidermal tolerances as a function of pigmentation were determined. These curves were then tabulated for each pulse width in device software to provide guidance in the selection of fluences. Based on these findings, the device was applied in over 300 patients at a comprehensive laser and cosmetic dermatology center.
RESULTS: A pigment meter evaluation led to treatment parameter guidance in intense pulsed light applications. These suggested ranges for settings based on the melanin index score proved useful, accurate, and safe in applications over a broad range of skin colors and across various anatomic units of the skin.
CONCLUSION: A pigment meter can be used to identify appropriate settings with IPL treatments in order to enhance safety and efficacy when treating epidermal pigmented lesions, vessels, general photodamage and excessive hair (where the principles of selective photothermolysis
J Drugs Dermatol. 2016;15(4):421-432.
Rajiv I. Nijhawan MDa and Maritza I. Perez MDb
Patients with traumatic scarring often seek both aesthetic and functional improvement and can be a challenge to treat; however, advances in laser and light technologies have helped to treat many of these patients with rather minimally invasive approaches. A nineteen year old girl with Fitzpatrick skin type III skin presented for the evaluation of extensive traumatic scarring involving her right cheek, right chin, and right oral commissure that she sustained after a motor vehicle accident. We report the successful use of the 1064 nm Nd:YAG laser in conjunction with the ablative 2790 nm YSGG laser for the treatment of traumatic scarring in this patient. Our patient noted a notable improvement in the appearance of her traumatic scarring in addition to decrease in contracture of the right oral commissure. The treatment regimen described provides an effective option for clinicians to utilize when treating traumatic scarring and skin textural changes.
J Drugs Dermatol. 2014;13(1):80-81.
Yujie Feng, Junying Zhao, Michael H. Gold MD
Background: Skin aging consists of photoaging and intrinsic aging. It is characterized clinically not only by rhytides, but
also by pigmentary alterations and facial telangiectasias. There continues to be a growing interest in the efficacy of intense
pulsed light (IPL) devices in the treatment of skin aging, as well as further defining its mechanism of action.
Objectives: The objective of this clinical trial was to evaluate the effects and the mechanism of action of an IPL by comparing
clinical photographs and biopsy results before and after treatment.
Methods: A total of 58 patients were treated using a new IPL device. Clinical photographs were taken before treatment
and compared to those taken 3 weeks after the treatment. Also, 4 cases had pathological analyses of tissues that were stained
by haematoxylin-eosin and Uana orcein. Immunohistology of human collagen of types 1 and 3 and quantitative analyses
of elastin and collagen were performed by a poly-functional digital image light microscope; a transmission electron
microscope was used for 2 of the cases to look for additional changes.
Results: After 3 treatments, 62.1% of the patients showed improvement in wrinkles and skin texture. Pigmentation improved
in 84.6% of the patients, and a reduction in telangiectasis was seen in 81.25% of the patients. Pathological examination
showed that both type 1 and type 3 collagens increased following treatment, but elastin content decreased;
however, the elastin fibers were arranged more neatly. In the transmission electron microscope study, the amount of
fibroblast activity increased, the fibroblasts were more active, and there were more collagen fibers neatly rearranged within
Conclusion: Clinical and pathological studies demonstrated that the IPL was effective in improving wrinkles and skin
texture. The mechanism of action may be through the increasing activity of the fibroblasts, hyperplasia of the fibroblasts,
and rearrangement of both collagen and elastin within the stroma.
Leslie Baumann MD,a Deysi K. Duque MS,a and Michael J. Schirripa PhDb
BACKGROUND: Vitamin C is commonly used to treat aged skin. It has shown regenerative effects on skin wrinkles, texture, strength, and evenness of tone through its roles as an antioxidant, tyrosinase inhibitor, and inducer of collagen synthesis. Available vitamin C formulations on the anti-aging skin care market vary by their pH, packaging, and vehicle, which may decrease absorption, and therefore, the efficacy of the product.
OBJECTIVE: The purpose of this study was to assess the subjective efficacy, wearability, tolerance and overall preference of two professional vitamin C topical serums and sunscreens in Caucasian females using a split face method.
METHODS: A virtual split-face study of 39 Caucasian women compared two popular vitamin C and SPF product combinations – C-ESTA® Face Serum and Marini Physical Protectant SPF 45 (Jan Marini Skin, San Jose, CA; Products A) and CE Ferulic® and Physical Fusion UV Defense SPF 50 (Products B; SkinCeuticals Inc, Garland, TX). The products were assigned to each subject’s left or right side of the face, and subjects rated and compared products through 5 online surveys at baseline, 24 hours, days 3, 7, and 14.
RESULTS: Over 86% of the 35 subjects who completed the study preferred the smell and 83% preferred the feel and application of vitamin C Serum A over Serum B. Seventy-one percent of subjects preferred the feel and application of Sunscreen A over Sunscreen B. Results also showed a significant skin texture improvement and skin tone with Products A vs Product B. Products A trended higher for multiple additional categories.
CONCLUSIONS: Products A exhibited superior anti-aging benefits than Products B. Subjects preferred the smell, feel, and application of Products A and experienced significantly less irritation than Products B. Overall, Products A were preferred over Products B with subjects willing to pay more for Products A over Products B.
J Drugs Dermatol. 2014;13(10):1208-1213.
Erika C. von Grote PhD, Kiruthi Palaniswamy PharmD, and Matthew H. Meckfessel PhD
Occupational irritant contact dermatitis (ICD) affecting the hands is a common and difficult-to-manage condition. Occupations that necessitate contact with harsh chemicals, use of alcohol-based disinfectants, and frequent hand washing elevate the risk of ICD. Management strategies that do not adequately prevent accumulated damage and repair skin, can develop into chronic dermatoses which negatively impact work productivity and quality of life. A 2-step skin-care regimen (Excipial Daily Protection Hand Cream (EP) and Excipial Rapid Repair Hand Cream (ER), Galderma Laboratories, L.P.) has been developed as a daily-use management strategy to protect and repair vulnerable hands. The protective barrier cream is formulated with aluminum chlorohydrate and designed for pre-exposure application to enhance the skin’s natural protective barrier and minimize excessive moisture while wearing protective gloves. The repair cream, a lipid-rich formulation, is intended for post-exposure application to rehydrate and facilitate the skin’s natural healing process. The results of 3 clinical studies highlighted in this review demonstrate how the use of a 2-step skin-care regimen offers a greater protective effect against ICD than the use of barrier cream alone, and also how the formulation of the barrier cream used in these studies helps minimize the occlusion effect caused by gloves and does not interfere with the antibacterial efficacy of an alcohol-based hand sanitizer. This 2-step skin-care regimen is effectively designed to manage and minimize the risk of ICD development in a variety of patients and provides clinicians an additional tool for helping patients manage ICD.
J Drugs Dermatol. 2016;15(12):1504-1510.
Yaxian Zhen MD PhD, Marianne Stoudemayer RN, George Vamvakias, Albert M. Kligman MD PhD
Topical therapies are effective in managing acne vulgaris but are associated with local adverse effects such as irritation
and dryness. This 4-week pilot study compared skin hydration in 36 healthy adult women randomized to treatment with
1 of 4 topical therapies: 2 different (jar and tube) clindamycin 1%/benzoyl peroxide 5% gels, sodium sulfacetamide 10%
lotion, or over-the-counter (OTC) moisturizing cream. Subjects treated with OTC moisturizer or sodium sulfacetamide
exhibited decreased water loss, increased water retention, similar or improved levels of skin hydration, and decreased desorption
rates. In contrast, subjects treated with jar or tube clindamycin/benzoyl peroxide had increased water loss, decreased
water retention, decreased hydration, and increased desorption rates. Skin dryness decreased slightly in the moisturizer
group. No serious adverse events occurred. Overall, the OTC moisturizer had the best skin hydration profile. Sodium sulfacetamide
demonstrated some moisturizing characteristics, and no clinically relevant differences were noted between jar
and tube clindamycin/benzoyl peroxide gels.
M.E. Balañá; C. Alvarez Roger; A. V. Dugour and N. A. Kerner
Most drugs used for treatment of androgen-related dermatological disorders are not completely satisfactory in terms of clinical efficacy
and potential secondary effects. There is, therefore, a need for a new generation of specific antiandrogens. This paper focuses on
an oligonucleotide antisense pharmacological strategy. Acceptor sites were first disclosed by mapping the human Androgen Receptor
(AR) mRNA conformation using an mRNA walking approach, oligonucleotide binding, and S1 protection assays. Antisense-sensitive
regions were localized by RNAse H degradation and AR in vitro translation inhibition. Oligonucleotides were then designed and
assessed, in primary cultures of human hair dermal papillae and skin derived fibroblasts, for their capability to down-regulate AR
expression. Some of them were able to inhibit more than 60 to 80% of the AR expression. These could be a new class of antiandrogen
oligonucleotides pharmacologically active in hair and skin derived cells, suitable for the treatment of dermatological disorders.
Erin Gilbert MD PhDa and Nicole L. Ward PhDb
Use of botulinum neurotoxin A (BoNTA) for treating inflammatory skin disease is an underexplored area in medical dermatology. Preclinical mouse studies have demonstrated efficacy of abobotulinumtoxinA in improving psoriasiform skin inflammation. We describe sustained local clearance of a psoriasis plaque in a patient following a single off-label injection of intradermal abobotulinumtoxinA. BoNTA may offer a novel therapeutic approach for treating recalcitrant plaque psoriasis.
Case reports and anecdotal evidence suggests that onabotulinumtoxinA may be useful for treating inverse psoriasis.1,2 We previously reported an improvement in skin phenotype in a preclinical mouse model following a single intradermal injection of abobotulinumtoxinA.3 Here we present a patient case report demonstrating efficacy of abobotulinumtoxinA in reversing plaque psoriasis.
J Drugs Dermatol. 2014;13(11):1407-1408.
INTRODUCTION AND OBJECTIVES: Newborns and babies are at risk of developing diaper dermatitis due to constant occlusion and exposure to irritants such as urine and feces. The aim of this study was to evaluate the clinical effectiveness of an almond oil-based ointment on diaper dermatitis in infants.
MATERIALS AND METHODS: A multicenter open-label trial of 60 infants (1-36 months) with a known history of recurrent diaper dermatitis was performed. The infants were clear at the time of enrollment. Inclusion criteria was a minimum of 3 episodes of rashes in the diaper area in the four weeks prior to enrollment. The almond oil-based ointment was used daily after each diaper change over 28 days, and data was recorded by the users (persons who applied the product) with daily report logs for the study duration including presence of diaper dermatitis, severity, as well as reports of teething and/or diarrhea. During each visit, a clinical evaluation was performed by an assessor (dermatologist or pediatrician) recording the degree of erythema, skin dryness, skin roughness to the touch, and skin suppleness using a scoring scale from 0 (null) to 9 (very severe). The users also performed an evaluation on product effectiveness and cosmetic qualities.
RESULTS: Clinical evaluations showed no erythema, a signi cant decrease (P less than 0.01) in skin dryness, roughness, and a signi cant in- crease (P less than 0.01) in skin suppleness after 28 days of product application compared to initial state. During the course of the study, 90% of the subjects showed a decrease in frequency or total absence of diaper dermatitis. One-hundred percent of users rated the product to have a pleasant texture, a good protective effect, spreads easily, and does not irritate the skin. The scent was judged as pleasant by 95%, and for 75% of those applying the product, the texture was described as non-oily.
CONCLUSIONS: For newborns and infants regularly developing diaper dermatitis, the almond oil-based ointment appears to confer a protective effect from future episodes of diaper dermatitis, improves dryness and suppleness of skin, and is cosmetically acceptable by the users.
J Drugs Dermatol. 2016;15(suppl 11):s86-90
Alexander L. Berlin MD, Mussarrat Hussain MD, Robert Phelps MD, David J. Goldberg MD
Background and Objective: Studies documenting improvement following combined laser and light-based devices are
needed. The objective of this study was to evaluate clinical, histological, and ultrastructural changes in photodamaged
facial skin following sequential treatment with ablative superficial erbium:YAG (Er:YAG) laser peels and nonablative
intense pulsed light, or broadband light (BBL), treatments.
Study Design/Materials and Methods: Fifteen subjects with photodamaged facial skin and Fitzpatrick skin types I to III
underwent 3 monthly treatments with the Profile™ system (Sciton, Inc, Palo Alto, CA) utilizing very superficial
MicroLaserPeel™ settings of 2.5 to 5.0 J/cm2 and BBL™ settings of 515-, 560-, or 590-nm filters, 10-msec pulse duration,
and fluences of 12 J/cm2. Five subjects underwent pre- and post-treatment postauricular skin biopsies for evaluation of
treatment-induced light and electron microscopic changes.
Results: Twelve subjects completed the study. Both blinded evaluator and subject assessment of clinical changes documented
significant improvement in photodamaged skin, with the greatest improvement achieved in overall appearance
and epidermal dyspigmentation. These results were largely maintained at 3 months following the last treatment. Light
microscopy showed changes in the epidermis, collagen, and elastic fibers consistent with a wound repair mechanism to
the depth of 250 to 350 microns. Electron microscopy revealed a slight decrease in the average collagen fiber thickness,
pointing to an increase in type III collagen.
Conclusion: A protocol utilizing multiple combined superficial Er:YAG ablative treatments and nonablative BBL treatments
lead to a significant improvement in the clinical signs of photodamaged skin, with histological and ultrastructural
evidence of new collagen formation.
BACKGROUND: Cellulite gives the skin surface an orange peel or mattress-like appearance thought to be caused by expansion of subcutaneous
fat, fibrotic septae and, dermal laxity and atrophy.
OBJECTIVE: To evaluate the safety and efficacy of a single cellulite treatment using an Nd:YAG 1440-nm laser delivered with a special
fiber delivery system and temperature control.
METHODS: Women with cellulite on their thighs and buttocks were enrolled in a prospective Institutional Review Board–approved study.
Subjects were 15 healthy females of all Fitzpatrick Skin types with cellulite (grades II-III). A single treatment was performed with an
average of seven 5 x 5 cm squares treated per leg. Evaluations with 2D and 3D imaging, patient and blinded evaluator scales as well
as skin histology were performed at baseline, 3 and 6 months post treatment.
RESULTS: In the 2D photographs, blinded evaluators were able to identify treated photographs versus baseline in 90% of cases and
the number of sites with improvement in contour irregularities was 94%. With 3D imaging, the average decrease in skin depressions
(dimples) was 49% at 6 months and 66% of patients showed improvement in overall skin contour at 6 months follow-up. Patient and
physician satisfaction scores were high and no adverse events were reported.
CONCLUSION: The Nd:YAG 1440 nm laser with a special fiber delivery system produced significant improvement in cellulite with one
treatment after 6 months of follow up. There were no adverse events.
J Drugs Dermatol. 2013;12(11):1224-1230.
Charlotte M. Clark MD MS, Jonathan I. Silverberg MD PhD MPH, and Andrew F. Alexis MD MPH
BACKGROUND: Laser resurfacing in patients with Fitzpatrick skin phototypes (SPT) IV to VI is associated with a higher risk of pigmentary alteration. There is a paucity of studies evaluating optimum treatment parameters for fractional lasers in darkly pigmented skin types.
METHODS: This is a retrospective review of medical records for patients with SPT IV to VI who were treated with a 1,550 nm erbium-doped fractional nonablative laser (Fraxel Re:Store SR 1550; Solta Medical, Hayword, CA). Data were collected from patient charts and the clinic laser logbook from January 2008 to January 2012. The frequency of treatment-associated postinflammatory hyperpigmentation (PIH) and treatment settings used were evaluated.
RESULTS: A total of 115 total laser sessions (45 patients) were included in our analysis. Five of the sessions (4%) were accompanied by PIH, 2 of which occurred in a single patient. Only 1 episode of PIH lasted longer than 1 month (2 months). Two of the 5 cases had only transient PIH (≤7 days), one of which was reported by the patient and not clinically evident on examination.
CONCLUSION: The 1,550 nm erbium-doped fractional laser is well tolerated in SPT IV to VI. Fractional laser resurfacing, with the settings used and pretreatment and posttreatment hydroquinone 4% cream, was associated with a low risk of PIH in darker skin types.
J Drugs Dermatol. 2013;12(4):428-431.
Leonard H. Goldberg MD and Adam J. Mamelak MD
Clinically, actinic keratoses (solar keratoses) are keratotic lesions that occur on chronically sunlight-exposed skin. Histologically, they
are epidermal tumors. Presenting with a spectrum of clinical features, actinic keratoses are believed to be predictors and precursors
of invasive squamous cell carcinoma. This, the first of a two-part overview, examines the etiology and epidemiology of actinic keratoses,
their clinical and histological features and their role in the development of nonmelanoma skin cancer.
E. Victor Ross MDa and James Childs PhDb
BACKGROUND AND OBJECTIVE: Wavelength, fluence and pulse width are primary device parameters for the treatment of skin and hair conditions. Wavelength selection is based on tissue scatter and target chromophores. Pulse width is chosen to optimize target heating. Energy absorbed by a target is determined by fluence and spot size of the light source as well as the depth of the target. We conducted an in vitro skin study and simulations to compare heating of a target at a particular depth versus spot size.
STUDY DESIGN/MATERIALS AND METHODS: Porcine skin and fat tissue were prepared and separated to form a 2mm skin layer above a 1 cm thick fat layer. A 50μm thermocouple was placed between the layers and centered beneath a 23 x 38 mm treatment window of an 805 nm diode laser device (Vectus, Cynosure, Westford, MA). Apertures provided various incident beam spot sizes and the temperature rise of the thermocouple was measured for a fixed fluence.
RESULTS: The 2mm deep target's temperature rise versus treatment area showed two regimes with different positive slopes. The first regime up to approximately 1 cm2 area has a greater temperature rise versus area than that for the regime greater than 1 cm2. The slope in the second regime is nonetheless appreciable and provides a fluence reduction factor for skin safety. The same temperature rise in a target at 2 mm depth (typical hair bulb depth in some areas) is realized by increasing the area from 1 to 4 cm2 while reducing the fluence by half.
CONCLUSIONS: The role of spot size and in situ beam divergence is an important consideration to determine optimum fluence settings that increase skin safety when treating deeper targets.
J Drugs Dermatol. 2015;14(12):1437-1442.
Thomas Lambert BA, Kimberly Mullinax MD, Jennifer Smith MD
A 73-year-old Caucasian male was treated in the dermatology clinic for squamous cell carcinoma (SCC) of the scalp by
Mohs micrographic surgery. The patient subsequently received radiation therapy because of possible calvarium invasion.
Approximately 2 years later, the patient developed Bowen’s disease within the previously irradiated skin flap. The lesion was
treated with topical 5-fluorouracil (5-FU) twice daily for 4 weeks, and subsequently developed a 2 x 2 cm full-thickness
ulceration with exposed calvarium.
Monya L. Sigler PhD, and Thomas J. Stephens PhD
BACKGROUND: Chronic exposure to the sun causes the skin to prematurely age. Photodamaged skin is characterized by progressive
damage to the dermal extracellular matrix with loss of collagen and degradation of elastin. Clinical manifestations of such photoaged
or photodamaged skin include wrinkles and irregular pigmentation. Various cosmetic treatments including topical retinoids, growth
factors, and skin lighteners have shown some benefit. Salts of copper chlorophyllin complex are semi-synthetic naturally derived compounds
with anti-oxidant and wound healing activity that has not been previously tested in photodamaged skin.
OBJECTIVES: This single-center pilot study was conducted to assess the efficacy and safety of a liposomal dispersion of topically applied
sodium copper chlorophyllin complex in women with mild-moderate fine lines and wrinkles in the periocular areas and facial solar
lentigenes over a course of 8 weeks.
METHODS: Subjects were supplied with the test product, a topical gel containing chlorophyllin complex salts (0.066%), with directions to
apply a pea-sized amount to the periocular areas, cheeks and nose every morning and evening. Clinical assessments were performed at
screening/baseline and at week 8. Standardized digital photographs were taken and self-assessment questionnaires were conducted.
RESULTS: Ten subjects completed the 8-week study. All clinical efficacy parameters showed statistically significant improvements over
baseline at week 8. The study product was well tolerated. Subject questionnaires showed the test product was highly rated.
CONCLUSIONS: In this pilot study, a topical formulation containing a liposomal dispersion of sodium copper chlorophyllin complex was shown
to be clinically effective and well tolerated for the treatment of mild-moderate photodamage and solar lentigenes when used for 8 weeks.
J Drugs Dermatol. 2015;14(4):401-404.
Neil S Sadick MD, Robert Weiss MD, Suzanne Kilmer MD, Patrick Bitter MD
This multi-center study evaluating the role of Intense Pulsed Light (IPL) in the non-ablative rejuvenation of Type I and Type II photoaged
skin study was conducted in order to evaluate the clinical efficacy and safety of using IPL in treating clinical indications associated
with photoaged skin. Ninety-three patients of Fitzpatrick skin phenotypes I-III, Fitzpatrick Wrinkle Classes I-II, and Elastosis
Scores 1-6 were enrolled in the study. Up to five treatments were performed at 4-week intervals with follow-up visits at 4 and 6
months after the last treatment. Patients received full-face treatments using the recommended parameters of the Quantum SR /HR
(Lumenis Ltd.) with the 560 or 640 nm cutoff filter. Parameters of elastometry, physicians’ evaluation of the Elastosis Score (‘W/ES’),
and global improvement as well as patient satisfaction were analyzed. Results showed that the average Fitzpatrick W/ES improved
significantly (p<0.001) by 1.39 and 1.32 units at the 4 and 6 months follow-ups, respectively; an improved W/ES evaluation was recorded
for 82% and 75% of the patients at each of these time points. In conclusion, IPL treatment is an effective non-invasive, non-ablative
method for rejuvenating photoaged skin with minimal adverse events, no downtime, excellent long-term results, and a very high
measure of patient satisfaction.
Joseph F. Fowler Jr. MD, Heather Woolery-Lloyd MD, Heidi Waldorf MD, Ritu Saini MD
Natural ingredients have been used traditionally for millennia and their application in topical creams, lotions and preparations within
the traditional medicines and healing traditions of many cultures has been observed. Over the last 20 years, clinical and laboratory
studies have identified the benefits of an array of natural ingredients for skin care. Consequently, a number of these ingredients and
compounds are today being developed, used or considered not only for anti-aging effects, but also for use in dermatologic disorders.
Certain ingredients, such as colloidal oatmeal and aloe vera, have been identified as beneficial in the treatment of psoriasis and atopic
dermatitis, respectively, due to their anti-inflammatory properties. For combating acne and rosacea, green tea, niacinamide and feverfew
are considered efficacious. As to hyperpigmentation and antioxidative capabilities, licorice, green tea, arbutin, soy, acai berry,
turmeric and pomegranate are among those plants and compounds found to be most beneficial. Additional research is needed to
determine to confirm and elucidate the benefits of these ingredients in the prevention and management of skin disease.
Robert H. Gotkin MD, Deborah S. Sarnoff MD, Giovanni Cannarozzo MD, Neil S. Sadick MD, Macrene Alexiades-Armenakas MD PhD
Carbon dioxide (CO
2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Re-
cently, a new generation of fractional or microablative CO
2 lasers has been introduced to the marketplace. According to the concept
of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An
array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas,
the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for
facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic
scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and
dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO
skin resurfacing and downtime is proportionately reduced.
A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO
2 laser. All
patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month post-
operative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data
were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those
undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).
Jay A. Goldstein MD, Ronald M. Gurge PhD
Ten patients enrolled in a single center, observational, prospective, open-label case study to assess the effectiveness and
safety of a 28 day regimen with Kerafoam® 30% urea emollient foam for treatment of hyperkeratosis. Clinician assessments
of skin condition were recorded at baseline, day 14, and day 28. In addition, patients’ ratings of the treatment impact on
quality of life and skin condition, as well as overall satisfaction with the product were obtained. Key results demonstrated
significant improvements in clinicians’ ratings of skin condition at the day 14 and day 28 visits compared to baseline and
significant improvements in patients’ ratings of quality of life. No adverse events were reported and all patients completed
the 28-day treatment regimen. Patient and clinician evaluations of the 30% urea emollient foam product were extremely
Emily P. Tierney MD and C. William Hanke MD MPH
Background: Previous laser treatments for Poikiloderma of Civatte (PC) (i.e., Pulsed dye, Intense Pulsed Light, KTP and Argon) are
limited by side effect profiles and/or efficacy. Given the high degree of safety and efficacy of ablative fractional photothermolysis
(AFP) for photoaging, we set out to assess the efficacy of PC with AFP.
Design: A prospective pilot study for PC in 10 subjects with a series of 1−3 treatment sessions. Treatment sessions were administered
at 6−8 week intervals with blinded physician photographic analysis of improvement at 2 months post-treatment. Evaluation was
performed of five clinical indicators, erythema/telangiecatasia, dyschromia, skin texture, skin laxity and cosmetic outcome.
Results: The number of treatments required for improvement of PC ranged from 1 to 3, with an average of 1.4. For erythema/telangiecatasia,
the mean score improved 65.0% (95% CI: 60.7%, 69.3%) dyschromia, 66.7% (95% CI: 61.8%, 71.6%), skin texture,
51.7% (95% CI: 48.3%, 55.1%) and skin laxity, 52.5% (95% CI: 49.6%, 55.4%). For cosmetic outcome, the mean score improved
66.7% (95% CI: 62.6%, 70.8%) at 2 months post treatment.
Conclusion: In this prospective study, AFP was both safe and effective for the treatment of the vascular, pigmentary and textural
components of PC. The degree of improvement observed in wrinkling, creping and laxity after AFP has not been reported with prior
laser treatments for PC.
Vanessa Lichon BS MS, Amor Khachemoune MD CWS
Xeroderma pigmentosum (XP) is a rare, autosomal-recessive inherited disease that is found worldwide at a frequency of
approximately 1:250,000. XP is caused by a deficiency in either nucleotide excision repair (NER) or postreplication repair
(PRR), and is characterized by severe actinic changes leading to early onset of skin cancers, various ocular manifestations,
and occasional neurological abnormalities. Diagnosis is usually made clinically and can be confirmed by unscheduled DNA
synthesis. Early preventative care is the most important treatment modality. We present a review of the history, clinical
manifestations, pathogenesis, diagnosis, and treatment of XP.
Maj. J. Scott Henning DO and Bahar F. Firoz MD MPH
Background: Since July 2004, the United States (U.S.) Army has operated a forward-deployed dermatology clinic in Baghdad, Iraq.
This paper outlines the prevalence of skin disease among deployed service men and women in Operation Iraqi Freedom.
Methods: A cross-sectional study was performed for all dermatology visits presenting to the Combat Dermatology Clinic, Ibn Sina,
Iraq, between January 15, 2008 and July 15, 2008.
Results: In the six-month period reviewed, 2,696 total patients were evaluated. The most prevalent diagnoses included eczematous
dermatitis [17%, n=462] and benign neoplasms [14%, n=375]. Eight percent (n=205) of the total visits were for skin cancer. This included:
basal cell carcinoma, squamous cell carcinoma both in-situ and invasive, mycosis fungoides and melanoma. Actinic keratosis
comprised 5% of the total visits (n=129). Bacterial infections comprised 6% (n=158) of the total visits and 31 of these cases were
community acquired methicillin resistant Staphylococcus aureus (MRSA).
Limitations: Cross-sectional study with referral bias.
Conclusion: This is the largest publication of the prevalence of skin disease in an exclusively dermatologic clinic in a combat setting.
For the first time the presence of skin cancer is noted in a combat setting. The prevalence of MRSA is noted and was exclusively seen
in U.S. soldiers. There was a statistically significant rise in the prevalence of eczematous dermatitides when compared with previous
conflicts. Dermatologists can have a significant and strategic impact on deployed military medicine.
Sindy Hu MD MS and Michael H. Gold MD
Modalities for the treatment of atrophic facial acne scars have been studied extensively. One, an erbium:yttrium-aluminum garnet (Er:YAG) laser device that generates both short, ablative pulses of high fluence and long, coagulative pulses of low fluence, has been shown to achieve tissue contraction, control intraoperative bleeding and deliver energy quickly and uniformly. The investigators were able to achieve significant depth and ablation with repetitive pulses at the same site and remove the epidermis with a single pass. Subsequent studies showed that facial acne scars of patients with dark skin types could be treated with a similar device. This report reviews the development of the Er:YAG laser and the preliminary results of a study in which moderate-to-severe facial acne scars of 180 Asian patients (skin types III–IV) were treated successfully with a dual-mode Er:YAG laser device.
Robert A. Weiss MD, Margaret A. Weiss MD, Girish Munavalli MD MHS, Karen L. Beasley MD
Background and Objectives: Monopolar radiofrequency skin heating coupled with cryogen cooling of facial skin for skin
tightening has been utilized on over 10,000 patients since 2002. In order to establish the actual rate and degree of side effects
in our clinical experience, a retrospective chart review was performed.
Study Design: Charts and clinical images of over 600 consecutive patient treatments between May 2002 and June 2006 using
a monopolar radiofrequency device (Thermacool®, Thermage, Haywood, CA) for skin tightening at the Maryland Laser, Skin
and Vein Institute were retrospectively reviewed. The primary presentation for treatment was skin laxity of the lower face.
Treatment was delivered with a 1-cm2 standard tip at fluences of 81 to 124 J/cm2 (level of 12.5 to 15), a 1-cm2 “fast” tip at
fluences of 62 to 109 J/cm2 (level of 72.0 to 76.0), a 1.5-cm2 “big fast” tip at fluences of 75 to 130 J/cm2 (level of 61.5 to 65),
and a 3-cm2 “bigger” tip at equivalent fluences as each became available. As treatment algorithms evolved over 4 years,
the algorithm of multiple passes at lower fluence associated with better clinical outcomes and greater patient acceptance has
Results: The most common immediate and expected clinical effects were erythema and edema lasting less than 24 hours,
although 6 patients reported edema lasting for up to 1 week. There were no permanent side effects. In total, 2.7% of treatments resulted in temporary side effects, the most significant of which was slight depression on the cheedk (n=1), which papules (n = 4) and a linear superficial crust (n=1) with the original tip, all of which resolved within 1 week. One patient reported small erythematous subcutaneous nodules resolving in 17 days. Tenderness of the neck lasting form 2 weeks (n=2) to 3 weeks (n=1) was also reported.
Conclusions: Our data, obtained in an office setting without injectable anesthetic or IV sedation, indicate that monopolar RF for skin tightening is ver safe procedure. The treatment algorithm and tips have evolved over several years leading to increased safety and efficacy. Side effects are infrequent, self-limited, and minor, comparing favorably to other nonablative devices utilized for facial rejuvenation.
Sandeep S. Saluja MD, Anneli R. Bowen MD, and Christopher M. Hull MD
Argyria is an uncommon blue-gray pigmentation of the skin (increased in sun-exposed areas), nail unit, and mucous membranes
caused by prolonged silver exposure. Commonly occurs in the setting of occupational exposure, silver-containing medications, or
systemic absorption from use of silver sulfadiazine on extensive burns/wounds. Recently, there appears to be an increase in the
practice of colloidal silver ingestion given the popularity and easy availability of alternative medicines and dietary supplements containing
various silver-containing compounds. We report a case of argyria in a 72-year-old male following ingestion of colloidal silver
as a supplement for over 10 years. He had a diffuse, blue-gray discoloration of his face and nails. A skin biopsy was performed and
histology supported the clinical diagnosis of argyria. Our objective is to increase the awareness for this rare dermatologic entity by
highlighting the clinical and histological features through a case report. Dermatologists should warn patients in regards to the use
of colloidal silver for alternative health practices.
Angelo Landriscina BA,a Tagai Musaev BA,a Bijal Amin MD,b and Adam J. Friedman MDa,c
An acute inflammatory nodule of unknown etiology can pose a formidable diagnostic challenge. Here, we highlight the importance
of including Mycobacterium avium intracellulare complex (MAC) and other atypical mycobacterial infections in the differential diagnosis
of a cutaneous nodule in an immunocompetent individual. We also explore the implications of eczema in the development
of a mycobacterial infectious process. We report a case of MAC skin infection in an immunocompetent individual. The patient is a
49-year-old male with a history of dyshidrotic eczema presenting with a fluctuant, non-draining nodule on his right forearm for 2 to
3 weeks, identified by tissue DNA probe to be a cutaneous MAC infection without systemic complications, as serologies and chest
X-ray were unremarkable. MAC should be included in the broader differential diagnosis of deep fungal vs atypical mycobacterial skin
infections. Nucleic acid-based assays are an important tool in making a definitive diagnosis, allowing for utilization of appropriate
therapy for the specific etiologic pathogen. Given the patient’s preceding diagnosis of eczema, it is possible that the compromised
skin barrier and dampened cytotoxic Th1 activity predisposed the patient to this infection, typically appreciated in the immunosuppressed,
warranting further investigation into the relative risk for atypical mycobacterial infections in the setting of eczema.
J Drugs Dermatol. 2014;13(12):1491-1493.
Jenna O’Neill MD, Sari Fien MD, Nathalie C. Zeitouni MDC M FRCPC
Cutaneous pseudolymphoma (CPL) is a benign skin condition that may cause cosmetic disfigurement, severe itch and, albeit rarely,
transformation to malignant lymphoma. The usual treatment modalities for CPL have been associated with adverse effects including
skin atrophy and scarring. This article reports the case of a patient with CPL on the cheek, which was treated with 5-aminolevulinic
acid photodynamic therapy (ALA-PDT). Clinically significant improvement in lesion size and symptoms was noted, with few side effects.
Controlled trials and long-term monitoring are warranted to further explore this treatment modality for CPL.
Lena Samuel MS, Eve J. Lowenstein MD PhD
Recombinant human interferon beta-1b is an immune-modulatory drug used for a variety of conditions including multiple
sclerosis (MS). Skin reactions to therapeutic use of injectable interferon beta-1b are relatively common, including injection
site reactions and exacerbation of underlying skin disease. Injection site reactions are seen much more frequently in females.
We discuss a case of prolonged susceptibility to injection site reaction with over a decade of use of interferon beta 1-b for MS.
Given the prevalence of such reactions, the dermatologist should be aware of the phenomenon and that it frequently does
not necessitate discontinuation of therapy.
Charlotte Bezzina PharmD, Emmanuelle Bondon-Guitton PharmD PhD, and Jean-Louis Montastruc MD PhD
An Afro-Caribbean girl showed localized hair depigmentation during treatment with inhaled fluticasone propionate. Although skin depigmentation is common after topical use of corticosteroids, hair depigmentation has never been reported with inhaled corticosteroids. The mechanisms underlying corticosteroid-induced skin depigmentation are not completely understood, but accepted hypotheses suggest a direct cytotoxic effect, changes in ground substance, vasoconstriction, mechanical effects of edema, or a dysregulation of melanogenesis.
J Drugs Dermatol. 2013;12(1):119-120.
Maria S. Aluma-Tenorio MD, Adam J. Mamelak MD FRCPC, Leonard H. Goldberg MD, Ming H. Jih MD PhD, Arash Kimyai-Asadi MD
The forehead is a common site for nonmelanoma skin cancer. For medium to large sized defects, the primary reconstructive challenge is the paucity of loose adjacent donor skin. The authors describe frontalis muscle plication, imbrication, and related surgical techniques utilized in reconstructing forehead defects. With these techniques, one can significantly reduce wound tension and increase the volume of tissue recruited to the defect site as necessary.
C. Stanley Chan MDa and Jeffrey S. Dover MDa-c aSkinCare Physicians, Chestnut Hill, MA bDepartment of Dermatology, Yale University School of Medicine, New Haven, CT cDepartment of Surgery, Dartmouth Medical School, Hanover, NH
Safe and effective laser treatments are crucial, especially in darker-skinned individuals. Herein, we report our experience treating Fitzpatrick skin types IV to VI with a long-pulsed, 1,064-nm neodymium-doped yttrium aluminum garnet laser. With the right treatment settings, darkly pigmented individuals can undergo laser hair removal effectively.
J Drugs Dermatol. 2013;12(3):366-367.
Julie Akiko Gladsjo MD PhD, Silvia Soohyun Kim BA, and Shang I Brian Jiang MD
Biobrane is a biosynthetic wound dressing that has been widely used in burn treatment and as a skin graft donor site dressing. Our aim for this review was to establish whether Biobrane serves as a useful tool for the field of Dermatology and Dermatologic surgery. It has been frequently used in the field of Dermatology for the management of burns, erosive skin diseases, laser procedures, and surgical procedures. From the past experiences evident in the literature and in our cases series, it has been shown to improve patient’s quality of life by reducing pain, healing time, and length of hospital stay. Our case series further demonstrate its use in temporary closures, delayed reconstructions, and secondary intention healing in Mohs surgery. Reports of successful use of Biobrane in the literature and in our case series support the fact that it is an effective therapeutic option to facilitate the healing process in the field of Dermatology and Dermatologic surgery.
J Drugs Dermatol. 2014;13(5):537-541.
Enzo Emanuele MD,a Velimir Altabas MD,b Karmela Altabas MD,b and Enzo Berardesca MDc
The exposure to ultraviolet radiation (UVR) is one of the most important risk factors for skin aging and increases the risk of malignant transformation. Telomere shortening and an altered expression of the proto-oncogene c-FOS are among the key molecular mechanisms associated with photoaging and tumorigenesis. Photolyase from A. nidulans and endonuclease from M. luteus are xenogenic DNA repair enzymes which can reverse the molecular events associated with skin aging and carcinogenosis caused by UVR exposure. Therefore, the purpose of this study was to investigate whether the topical application of preparations containing DNA repair enzymes may prevent UVR-induced acute telomere shortening and FOS gene hyperexpression in human skin biopsies. Twelve volunteers (Fitzpatrick skin types I and II) were enrolled for this experimental study, and six circular areas (10 mm diameter) were marked out on the nonexposed lower back of each participant. One site was left untreated (site 1: negative control), whereas the remaining five sites (designated sites 2–6) were exposed to solar-simulated UVR at 3 times the MED on four consecutive days. Site 2 received UVR only (site 2: positive control), whereas the following products were applied to sites 3–6, respectively: vehicle (moisturizer base cream; applied both 30 minutes before and immediately after each irradiation; site 3); a traditional sunscreen (SS, SPF 50) 30 minutes before irradiation and a vehicle immediately after irradiation (site 4); a SS 30 minutes before irradiation and an endonuclease preparation immediately after irradiation (site 5); a SS plus photolyase 30 minutes before irradiation and an endonuclease preparation immediately after irradiation (site 6). Skin biopsies were taken 24 h after the last irradiation. The degree of telomere shortening and c-FOS gene expression were measured in all specimens. Strikingly, the combined use of a SS plus photolyase 30 minutes before irradiation and an endonuclease preparation immediately after irradiation completely abrogated telomere shortening and c-FOS gene hyperexpression induced by the experimental irradiations. We conclude that the topical application of preparations containing both photolyase from A. nidulans and endonuclease from M. luteus may be clinically useful to prevent skin aging and carcinogenesis by abrogating UVR-induced telomere shortening and c-FOS gene hyperexpression.
J Drugs Dermatol. 2013;12(9):1017-1021.
Maria Rita Nasca MD PhD,a Francesco Lacarrubba MD,a Francesco Ferraù MD,b and Giuseppe Micali MDa
Vemurafenib is a potent and selective BRAF inhibitor, which is effective on patients with BRAF V600E mutated late-stage melanoma. Common and less common adverse skin reactions include photosensitivity, maculo-papular exanthema, hand-foot skin reactions, hyperkeratotic follicular rash, pruritus, benign verrucous papillomas, plantar hyperkeratosis, keratoacanthomas, squamous cell carcinomas, infections, and melanoma. To our knowledge, vitiligo has been reported in 2 cases only. This paper reports the case of a 63-year-old man with metastatic melanoma, who developed sudden facial depigmentation after 4 weeks of treatment with vemurafenib 960 mg twice daily. Features consistent with vitiligo were evident at clinical and ultraviolet light examination, as well as at in vivo reflectance confocal microscopy. The latter examination showed lack of normal brightly refractile papillary rings at the dermo-epidermal junction in lesional skin, as well as decreased brightness and half-rings with “scalloped border-like” features in adjacent non-lesional skin. Vitiligo is an adverse reaction to be expected in patients treated with vemurafenib and whether its occurrence may be associated with a positive outcome, as suggested by previous investigations, is still a matter of debate.
J Drugs Dermatol. 2016;15(6):766-768.
Anti-aging cosmeceutical efficacy is hampered by lack of active ingredient purity and lack of dosing standardization. These are two important key factors necessary to insure consistent, reproducible, and documentable skin effects. Without this type of standardization, it is not possible for cosmeceutical science to advance. Growth factors are interesting cosmeceutical ingredients with established cosmetic skin effects that can now be standardized due to the recent ability to manufacture recombinant epidermal growth factor. The concomitant use of a recombinant epidermal growth factor with a filler grade hyaluronic acid (EGF/RHA) was studied over 12 weeks in 60 females with mild to moderate photoaging as compared to a currently marketed spent fibroblast growth media and moisturizer (TNS). Investigator, noninvasive, and subject assessments were collected at baseline and weeks 2, 4, 8, and 12. The blinded investigator noted a statistically significant preference for the EGF/RHA at week 2 in terms of smoothness (P =0.003) and firmness (P =0.003). This improvement continued into weeks 4 and 8 with continued superior EGF/RHA results in fine lines (P =0.002), radiance (P =0.014), and overall appearance (P =0.027) by week 12. Transepidermal water loss was reduced for the EGF/RHA over the TNS at week 12 (P =0.005). The subjects gave high ratings to both study products. This research demonstrates the utility of recombinant growth factors, when combined with hyaluronic acid hydration, in improving skin cosmetic attributes. The ability to manufacture consistent pure recombinant growth factors lays the foundation for improved scientific study of this category of cosmeceutical actives.
J Drugs Dermatol. 2016;15(6):738-741.
Danielle Tartar PhD,a Tina Bhutani MD,b Monica Huynh BA,c Timothy Berger MD,b and John Koo MDb
Phototherapy is often used to treat inflammatory skin conditions such as psoriasis and eczema. Much progress has recently been made in understanding the mechanisms underlying the local, cutaneous immune effects induced by phototherapy. Unlike many immunosuppressive drugs used in the management of inflammatory skin disease, phototherapy not only targets effector immune cells but also appears to up-regulate regulatory T cells (Tregs). Additionally, phototherapy reverses epidermal barrier abnormalities common in these diseases, allowing for restoration of cutaneous homeostasis.
J Drugs Dermatol. 2014;13(5):564-568.
The repair and maintenance of the epidermal barrier is of the utmost importance in the treatment of atopic dermatitis (AD). While barrier
creams and emollients are considered to be a foundation of AD therapy, there is little comparative data between various product options.
This was a pilot study with a small sample size to investigate the use of skin barrier emulsion cream vs a commonly used moisturizing
lotion to improve the epidermal barrier in subjects with atopic dermatitis.
J Drugs Dermatol. 2014;13(12):1482-1484.
Joseph English, III, MD; Kenneth E. Greer, MD; Sara A. McCrone, MD James W. Patterson, MD and J. Scott Vanloock, MD
Allergic granulomatous vasculitis, or Churg-Strauss syndrome, is a small-vessel, multisystem vasculitis that
can affect the skin, lungs, heart, and nervous system. Recent reports have implicated leukotriene receptor
antagonists and inhaled corticosteroids in the development of this rare syndrome. We present a patient with
no history of allergic asthma who acutely developed skin-limited Churg-Strauss-like granulomatous
vasculitis after initiating therapy with inhaled fluticasone and salmeterol (Advair Diskus).
Allison P. Weinkle BS,a Bryan Sofen MD,b and Jason Emer MDc
There is an increasing trend shifting the aesthetic focus downward from the face with a significant number of new treatments aimed at the aging neck and below. Clinical characteristics of neck youth include clear skin texture and tone without laxity or fat, in addition to a well-defined cervicomental angle and distinct mandibular border. Similarly to treating facial aging, the neck requires a comprehensive assessment of all factors involved in the aging process – loss of volume, increased skin laxity, worsening texture and clarity, and crepe skin/wrinkling – as each requires a combination approach for improvement. It is essential to address each above factors for more than minimal improvement. A multitude of options including neuromodulators, energy based devices, surgery, and injectable agents for fat reduction are available in our armamentarium and understanding these options solo, or ideally in combination, is essential for best practice and optimal results. Herein, we describe synergic approaches to the treatment of neck aging.
J Drugs Dermatol. 2015;14(11):1215-1228.
David J. Narins, MD and Rhoda S. Narvins, MD
There has been considerable interest in using non-ablative methods to rejuvenate the skin. The ThermaCool
TC™ (Thermage® Inc.) is a radiofrequency (RF) device that has been introduced to induce tightening of the
address the problem of skin via a uniform volumetric heating into the deep dermis tightening, resulting in a
‘non-surgical facelift’. Radiofrequency produces a uniform volumetric heating into the deep dermis. Twenty
treatment areas in 17 patients were treated to evaluate the efficacy and safety of RF treatment to the brow and
jowls. The technique was found to produce gradual tightening in most patients, and there were no adverse
Lorena Lammoglia-Ordiales MD,a Judith Dominguez-Cherit MD,a Samantha Rivera-Macías DDM,b Alma A. Rodriguez-Carreón MD,a Verónica Fonte-Avalos MD,a Martha Contreras-Barrera MD,a and Sonia Toussaint-Caire MDa
BACKGROUND: There is a major controversy over the natural behavior of keratoacanthoma (KA). KAs have been described as benign lesions, but also as variants of squamous cell carcinoma (SCC). Microscopic differentiation between these 2 entities is problematic, and sometimes impossible. Syndecan-1 (CD138) is an adhesion molecule whose expression appears to be inversely correlated with tumor invasiveness. Elevated Ki-67 expression is indicative of a high proliferation index, a feature of malignant tumors.
METHODS: Syndecan-1 and Ki-67 expression were assessed in 22 KA skin samples and in 17 SCC skin biopsies.
RESULTS: Syndecan-1 expression was diminished in the SCC specimens compared with the KA specimens (P=.000). Ki-67 expression was increased in the SCC specimens compared with the KA specimens, with mean values of 9 and 0.08, respectively (P=.000).
LIMITATIONS: Further studies that compare intermediate risk KAs to typical KAs and SCCs are required to corroborate these findings.
CONCLUSION: The assessment of syndecan-1 and Ki-67 expression in skin biopsies is a helpful tool for differentiating KA and SCC.
J Drugs Dermatol. 2013;12(3):e53-e58.
Hema Sundaram MD,a Michael Gold MD,b Heidi Waldorf MD,c Mary Lupo MD,d Vivien L. Nguyen PharmD,e and Jwala Karnik MDe
BACKGROUND: This multicenter, open-label pilot study evaluated safety, efficacy and tolerability of a topical formulation containing a multipotent growth factor resignaling complex (MRCx), when applied to infraorbital and lateral canthal skin.
METHODS: Thirty-nine female subjects with mean age of 56.8 years who had periorbital lines and wrinkles, uneven skin texture, puffiness,
and lack of skin firmness were enrolled, and 38 completed the study. All subjects applied the multipotent growth factor formulation
bilaterally to the periorbital area, twice daily for 60 days. Efficacy and treatment-related adverse events were evaluated at Baseline and days 14, 30, and 60. Investigators rated the periorbital areas based on 10-point scales.
RESULTS: Subjects’ self-reported compliance with treatment was greater than 99% throughout the study. At day 60, all subjects had improvement in infraorbital brightness (≥ 2 points), moistness (≥ 2 points), wrinkles (≥ 1 point), sallowness (≥ 1 point), crepiness (≥ 1 point), smooth texture (≥ 1 point), skin tightness (≥ 1 point), and skin tone (≥ 1 point). Investigator-rated assessments showed ≥ 1-point improvement for lateral canthal wrinkles, dyschromia/mottled pigmentation, skin tone, overall brightness, and moistness. Investigator-rated scoring on the Global Aesthetic Improvement Scale (GAIS) demonstrated that 67.6% of subjects were much improved/improved at day 14, and 63.1% remained improved at day 60. Overall, 76.2% and 79.0% of subjects were very pleased/pleased/mostly pleased with the appearance of their infraorbital and lateral canthal areas at day 60. Adverse events comprised one case of mild canthal erythema,
and one case of mild eye irritation, both of which were respectively resolved.
CONCLUSIONS: This pilot study demonstrated that the topical multipotent growth factor formulation was safe, effective and well tolerated for periorbital skin rejuvenation.
J Drugs Dermatol. 2015;14(12):1410-1417.
Enzo Emanuele MD PhD,a James M. Spencer MD MS,b and Martin Braun MDc
Non-melanoma skin cancers (NMSC) are the most common human neoplasms and continue to represent an important public health issue with greater than one million cases diagnosed each year. The primary factor contributing to the molecular pathogenesis of NMSC is unprotected skin exposure to ultraviolet (UV) radiation, ie, UVA (wavelength: 315-400 nm) and UVB rays (wavelength: 280-315 nm) with additional albeit less damaging factors of infrared radiation (wavelength: ~750 nm -1 mm) and environmental pollutants. Skin carcinogenesis by DNA damage is the current predominant paradigm of UV toxicity, which may be caused by direct damaging effects of energy deposited by photons or indirect oxidative action of short-lived reactive oxygen species (ROS) formed from water that reacts with biomacromolecules. UV rays are capable to induce direct both DNA damages, mainly consisting in the formation of helix-distorting photoproducts such as cyclobutane pyrimidine dimers (CPDs), as well as oxidative damage to DNA bases, including the formation of 8-oxo-7, 8-dihydro-2’-deoxyguanosine (8OHdG). Growing evidence also suggests that the efficiency of DNA repair after exposure to UV radiation is crucially dependent on the levels of oxidative protein damage, including but not limited to DNA repair proteins. Besides DNA lesions, UV-induced oxidative stress can indeed result in carbonylation of proteins, a major form of irreversible protein damage that inactivates their biological function. Interestingly, microorganisms characterized by extreme resistance to UV rays have an intrinsic capacity to protect their proteome, rather than genome, from radiation-induced damage, suggesting that protein carbonylation (PC) may serve as a reliable and innovative biomarker of UV photodamage. This review discusses the main DNA and protein markers of UV-induced damage (eg, CPDs, 8OHdG, and PC) and their relationship and importance to the current understanding of skin carcinogenesis. The identification of key DNA and protein signatures of photodamage may represent a therapeutic target for translational studies of innovative therapeutic and preventive approaches for reducing both skin aging and the morbidity and mortality associated with NMSC.
J Drugs Dermatol. 2014;13(3):274-281.
Matthew T. Woods MD, Peter A. Brown BS, Shahana F. Baig-Lewis MPH, Eric L. Simpson MD MCR
Objective: To determine the effect a novel formulation of fluocinonide cream on skin barrier function in subjects with atopic dermatitis.
Design: The authors performed an open-label, investigator-blinded, side-by-side, controlled trial examining skin barrier function before
and after a two-week course of a class I, super-potent topical steroid.
Setting: Outpatient university-based dermatology clinic in Portland, OR.
Subjects: Twenty-five subjects aged 12 or older with a diagnosis of moderate, severe, or very severe AD were recruited for this study.
Intervention: Fluocinonide 0.1% cream, a novel formulation of a class I super-potent topical steroid was applied to all affected areas,
except a control site, once daily for two weeks or until clear. The control target site was treated with the vehicle once daily.
Main Outcome Measure(s): The study’s primary outcome was change in skin barrier function as measured by basal transepidermal
water loss (TEWL) in acute lesional skin from baseline as measured at two weeks.
Results: TEWL readings significantly decreased (reflecting improved barrier function) in both the active and control target sites. The active target site decreased 14.35±16 mg/cm2 per hour; 95 percent confidence interval, P<0.001. The control target site decreased 8.75±11.80 mg/cm2 per hour in 25 subjects; 95 percent confidence interval, P<0.001. Skin electrical capacitance also improved significantly, reflecting improved stratum corneum hydration with therapy. Pruritus, clinical severity, and quality of life scores all showed significant improvement by the end of the study.
Conclusion: The authors have shown that short-term treatment with a novel formulation of 0.1% fluocinonide led to significantly
improved barrier function as measured by basal TEWL in subjects with active moderate to severe AD. These data suggest short-term
treatment with AD with a super-potent corticosteroid improves skin barrier function.
J Drugs Dermatol. 2011;10(2):171-176.
Joanne E. Smucker BSa and Joslyn S. Kirby MDb
Riehl melanosis is a rare cause of skin hyperpigmentation that typically occurs on the face and neck and is characterized by the rapid onset of gray-brown reticular pigmentation. It is theorized to be a pigmented contact dermatitis or a lichenoid immune reaction that may be caused by intrinsic as well as extrinsic factors. Treatment is challenging; laser and intense pulsed light (IPL) therapy is a common treatment for other pigmented skin conditions. IPL has been reported twice for the treatment of Riehl melanosis and we report a case of Riehl melanosis successfully treated with q-switched Nd:YAG after proving recalcitrant to IPL treatment.
J Drugs Dermatol. 2014;13(3):356-358.
No abstract details for the moment.
No abstract details for the moment.
Leslie Baumann MDa and Brian Zelickson MDb
BACKGROUND: A novel device using micro-focused ultrasound with high-resolution ultrasound visualization (MFU-V) produces non-invasive lifting and tightening of lax skin on the face and neck when treatment is delivered at a single focal depth (Ulthera® System; Ulthera, Inc., Mesa, AZ).
OBJECTIVE: The following study was performed to test the hypothesis that customized application of MFU-V at two focal depths will produce clinical results that are superior to treatment at a single focal depth.
METHODS AND MATERIALS: Adult subjects (N=71) with skin laxity in the lower face and neck were enrolled; 64 met all entrance criteria and received treatment. On the basis of physical and anatomical characteristics, patients were assigned in nonrandomized fashion to one of three treatment groups to undergo treatment on the submental, submandibular, lower neck, and platysmal areas with MFU-V at single or dual depths.
RESULTS: Among evaluable subjects (N=64), investigator-assessment and subject-self-assessment demonstrated improved aesthetic changes at 60, 90, and 180 days after treatment. Overall, subjects that received MFU-V at two focal depths to the entire treatment area achieved slightly greater aesthetic improvement than subjects receiving MFU-V at single focal depths. There were no unexpected adverse events.
CONCLUSION: Applying treatment with MFU-V at two focal depths may provide improved aesthetic results in some subjects.
J Drugs Dermatol. 2016;15(5):607-614.
The pathogenesis of atopic dermatitis (AD) requires the orchestration of multiple immune cells that mediate inflammation and tissue remodeling in the skin. T helper cell subsets that secrete specific cytokines have a central role in regulating the inflammatory process. In this review we discuss defined roles for T helper subsets in AD, how the microbiome might impact the development and function of T helper subsets, and animal models that will be useful for testing hypotheses on the interactions of a polarized T-cell response with skin inflammation. Future studies that link these areas will provide important insight into the development of skin inflammation and AD.
J Drugs Dermatol. 2012;11(10):1174-1178.
Acne vulgaris is a chronic inflammatory cutaneous disease and is the most common skin disease in the United States, affecting 80% of the population at some point in their lifespan. Because the pathogenesis of acne is not fully understood, it is imperative that the dermatology healthcare practitioner expand their medical knowledge on the current understanding of the development of this condition so that effective treatment strategies may be explored and initiated with confidence. There is need for dermatologists to expand their knowledge of the rationale for combination therapy for the treatment of inflammatory acne, and to understand the efficacy of fixed dose combinations in the reduction of inflammatory and non-inflammatory acne lesions and acne severity and the reduction in skin irritation and dryness.
Ifedayo O. Kuye BAa and Gideon P. Smith MD PhDb
There is growing adoption of rituximab in the treatment of dermatomyositis patients whose disease is refractory to steroids. However, the effects have not been extensively studied. This is a retrospective study of 25 patients with dermatomyositis who were treated with rituximab. Data from January 2000 to July 2014 was obtained from a clinical data repository, which yielded results from two tertiary centers in the United States. We analyzed information on muscle weakness, skin disease, enzyme levels, and immunosuppressive medication use before and after treatment with rituximab. The follow-up time was six months. Among the patients with skin disease before treatment with rituximab, 72.2% had a clinical improvement in their skin disease at the follow-up visit (P less than0.01). Among the patients with proximal muscle weakness before treatment with rituximab, 81.8% had clinical improvement in their symptoms at the follow-up visit (P less than0.01). The average prednisone dose before rituximab therapy was 18.9 mg, and this dropped to 11.0 mg at follow up (P less than 0.05). The average number of immunosuppressive medications taken by patients dropped from 2.04 to 1.74 (P less than0.05). These changes were less in magnitude and significance among the subset of patient that had an additional connective tissue autoimmune condition.
J Drugs Dermatol. 2017;16(2):162-166.
Leon H. Kircik MD FAAD
Dysfunction of the epidermal barrier is generally considered a precursor of cutaneous inflammation that can directly contribute to the pathogenesis of skin diseases, notably atopic dermatitis (AD). We also know that topical corticosteroids may actually impair the epidermal barrier by interfering with epidermal lipid synthesis. Therefore, it is important to utilize topical corticosteroids in vehicles that will help at least to enhance the already disrupted epidermal barrier in atopic dermatitis patients. Two studies of identical design were conducted to determine and compare the occlusivity and moisturizing potential of three topical corticosteroid products when applied to skin whose barrier integrity has been disrupted by dry shaving. Findings in both studies showed the clocortolone pivalate cream decreased TEWL better than non-treatment or treatment with hydrocortisone butyrate lotion. Skin surface hydration increased significantly (P<0.001) in all three treated sites, compared to the non-treated damaged control and non-treated normal skin. Clocortolone pivalate cream increased skin surface hydration significantly (P<0.001) better than hydrocortisone butyrate lipocream or hydrocortisone butyrate lotion. These studies showed that clocortolone pivalate cream enhances barrier function by providing occlusion.
While understanding of the structure and function of the stratum corneum (SC) and epidermal barrier function has evolved tremendously over the last several decades, and especially over the last 15 years,1 confusion and misinformation still persist. Dysfunction of the epidermal barrier is generally considered a precursor of cutaneous inflammation that can directly contribute to the pathogenesis of skin diseases, notably atopic dermatitis (AD).2,3 Topical steroids are standard of care in treatment of atopic dermatitis. However, we also know that topical corticosteroids may actually impair epidermal barrier by interfering with epidermal lipid synthesis.4,5 In addition to that, various penetration enhancers in the topical steroid formulations also contribute to the impairment of the epidermal barrier.4 Therefore, it is important to utilize topical corticosteroids in vehicles that will help at least to enhance the already disrupted epidermal barrier in atopic dermatitis patients. In this regard, these studies were designed to determine the hydrating effects of clocortolone pivalate cream 0.1% (Cloderm Cream, Promius Pharma).
J Drugs Dermatol. 2014;13(5):582-585.
Ricardo Ruiz-Rodriguez MD PhD, Laura Lopez MD, Daniel Candelas MD, Javier Pedraz MD
Background: Photodynamic therapy has been proved to be effective in skin rejuvenation.
Objective: To evaluate clinical efficacy and side effects of photodynamic therapy using topical 5-methyl aminolevulinate
and red light for photorejuvenation.
Methods: A randomized, prospective, split-face comparison study of 10 white, adult patients with moderate photodamage,
Fitzpatrick skin types 2 or 3, and no occurrence of actinic keratosis was performed. Three treatments using topical
methyl aminolevulinate cream, applied for 1 hour on one half of the face and 3 hours on the other half before illumination
with red light. A blinded investigator prior to treatment and 2 months after the third treatment evaluated each side
of the subject’s faces.
Results: A moderate improvement in fine lines, tactile roughness, and skin tightness was observed in most of the patients,
mostly on the 3-hour time side. There were no changes in mottled pigmentation or telangiectasias. Side effects were observed
in all subjects (erythema, edema, scaling) mainly in the 3-hour incubation time side.
Limitations: The small number of patients and the lack of placebo group.
Conclusion: Methyl aminolevulinic-photodynamic therapy with red light can improve fine lines, tactile roughness and
skin tightness in patients with moderate photoaging and no occurrence of actinic keratosis.
Lawrence M. Field MD FIACS
The acceptance of visible marks on the skin as a result of surgical procedures varies by the necessity of the procedure
(ie, cosmetic or not) and by the cultural interpretation of those sequelae. As liposuction has become the most commonly
performed major cosmetic procedure in the US, and perhaps throughout the world, the visible stigmata resulting from
the surgical invasion may be of major consequence to some while they remain of little or no consequence to others. This
article explores the national, cultural, racial, and ethnic variations in the acceptance or rejection of visible marks on
the skin in several parts of world.
Hema Sundaram MD,a Ana Du BS,b Margarita Yatskayer MS,b Stephen Lynch PhD,b Yevgeniy Krol,c and Christian Oresajo PhDb
BACKGROUND: Topical products with epidermal lipids in a ceramide-dominant ratio were originally developed to address atopic dermatitis. They have been used by extension to address the barrier deficits of aging skin, and after laser resurfacing and other barrier-disrupting procedures. The purpose of this study was to evaluate efficacy, tolerability, and safety of a novel formulation containing high levels of physiological barrier lipids, in a unique cholesterol-dominant ratio hypothesized to directly address the specific epidermal lipid imbalances of aging skin.
METHODS: An 8-week, single-center study was conducted on females aged 55 to 75 with mild to moderate fine lines and wrinkles, and other stigmata of facial photodamage. Evaluations were performed at baseline, immediately after rst use of the cholesterol-dominant test formulation, and at weeks 4 and 8. Efficacy evaluations comprised blinded expert grading of 9 skin attributes, bioinstrumental measurements of trans-epidermal water loss (TEWL) and stratum corneum hydration, standardized digital imaging, and self-assessment questionnaires. Tolerability was scored objectively and subjectively, and by grading of skin dryness. Adhesive tape extracts were analyzed biochemically for epidermal lipids, and by double-staining to detect mature vs. immature corneocytes. In a separate study, the effects of pre- or post-treatment with the test formulation on barrier recovery following traumatic tape stripping of forearm skin were assessed via measurements of TEWL and stratum corneum hydration.
RESULTS: Statistically significant improvements occurred in all facial skin attributes (weeks 4 and 8), TEWL (week 8), and stratum cor- neum hydration (weeks 4 and 8). There were significant increases in total ceramides and cholesterol, including ceramide isoforms not present in the test formulation itself; and a statistically significant increase in the ratio of mature to immature corneocytes at week 8. Forearm skin treated with the test formulation after traumatic tape stripping recovered barrier function significantly faster than untreated skin. Pre-treatment for 1 week prior to traumatic tape stripping had a significant protective effect. Tolerability and safety of the test formulation were excellent.
CONCLUSIONS: This cholesterol-dominant lipid formulation offers a new paradigm of primary skin barrier repair specifically targeted to- ward aging skin. Correction of age-related epidermal lipid deficits directly addresses the underlying cause and the profound sequelae of barrier dysfunction in aging skin. This may also be of utility to optimize skin tolerance, response and recovery from aesthetic procedures and other topical treatments, and for dermatoses associated with barrier dysfunction, such as rosacea. The formulation achieved sustained improvements in barrier function throughout the course of the 8-week study, had a protective effect when applied prior to barrier insult, and mediated more rapid recovery when applied after barrier insult. Significant increases in total epidermal ceramides, cholesterol and triglycerides, and in mature versus immature corneocytes, indicated both structural and functional normalization of the skin barrier, and possibly a broader-based stimulation of ceramide synthesis. The formulation had excellent tolerability and safety profiles, even in subjects with sensitive skin.
J Drugs Dermatol. 2016;15(12):1513-1523.
Introduction: A rosacea treatment system (cleanser, metronidazole 0.75% gel, hydrating complexion corrector, and sunscreen SPF30) has been developed to treat rosacea.
Methods: Thirty women with mild or moderate erythema of rosacea on their facial cheeks were randomly assigned to use one of the following for 28 days: the rosacea treatment system (RTS); RTS minus metronidazole (RTS-M); or metronidazole 0.75% gel plus standard skin care (standard cleanser and standard moisturizer/sunscreen) (M+SSC).
Results: At day 28, global improvement was evident in 90 percent of patients using RTS, 60 percent using RTS-M, and 67 percent using M+SSC. Erythema was significantly lower with RTS from day 14 onward, and unchanged with M+SSC. The proportion of patients
reporting their skin was easily irritated at least sometimes was 40 percent with RTS, 70 percent with RTS-M, and 89 percent with M+SSC.
Conclusion: The rosacea treatment system may offer superior efficacy and tolerability to metronidazole plus the standard skin care used in this study.
J Drugs Dermatol. 2011;10(10):1179-1185.
Neil S. Sadick MD FACP FAACS, Macrene Alexiades-Armenakas MD PhD, Patrick Bitter Jr. MD, George Hruza MD, R. Stephen Mulholland MD
Background: The authors previously reported their experience achieving non-ablative skin enhancement with serial,
full-face, intense pulsed light treatments in a large series of patients. A new method for skin renewal electro-optical synergy
(ELOS), which combines intense pulsed optical energy and conducted bipolar radiofrequency (RF) energy into a
single pulse, has been recently introduced. Intense pulsed optical energy and bipolar RF energy have been used in dermatologic
surgery for many years; however, this study represents the therapeutic impact of the combined energies.
Objective: The authors report their experience using an ELOS system (Aurora SR, Syneron, Yokneam, Israel) on 108
consecutive patients treated with a series of full-face procedures.
Methods: Patients received 5 full-face treatments every 3 weeks. Each treatment consisted of 1 to 8 full-face and segmental
passes. The number of passes, specific wavelength of pulsed optical energy, and RF energy were determined by
the patient’s skin type, dyschromia, wrinkle pathology, and presence of a tan. A total of 540 treatments were performed
on 108 subjects. All patients had pre- and post-procedural photographs. Results were assessed by double-blinded physician
photographic evaluation and patient satisfaction scales.
Results: Overall skin improvement was rated at 75.3%. Overall average wrinkle improvement was 41.2%, with an
average Class 1 wrinkle improvement of 64.7%, Class 2 wrinkle improvement of 38.6%, and Class 3 wrinkle improvement
of 20.4%. Improvement in skin laxity was rated at 62.9%. Skin texture was reported to improve 74.1%.
Improvement in the appearance of pore size was rated at 65.1%. Average improvement in erythema and telangiectasia
was 68.4%. Average improvement in hyperpigmentation and dyschromia was 79.3%. Overall patient satisfaction was
92%. The overall minor complication rate, including blistering, crusting, and stripping was 8.3%, and the major complication
rate was less than 1%. One small, depressed nasal scar was observed in one patient.
Conclusions: This study demonstrates the safety and efficacy of a new technology using combined optical and conducted
bipolar RF energies for noninvasive skin rejuvenation. The results show improvement in wrinkle reduction and
amelioration of erythema, telangiectasia, and hyperpigmentation comparable to that reported for other intense pulsed
Thomas M. Proebstle MD PhD,a Gary Chung MS,b Ruth Weissberg MD,c and Tatjana Pavicic MDd
BACKGROUND: A quantitative numerical method for assessing the extent and duration of the inhibitory action of botulinum neurotoxin type A on mimetic muscles would potentially enable more detailed evaluation of the overall efficacy of this aesthetic treatment.
AIM: To evaluate skin displacement analysis (SDA) as a tool for assessment of the extent and duration of effect of incobotulinumtoxinA on mimetic muscles in the glabellar region in routine daily practice.
METHODS: A total dose of 30 U incobotulinumtoxinA was injected into the fronto-glabellar region of 16 subjects. SDA was performed at baseline and during onset and recovery from incobotulinumtoxinA treatment at various timepoints up to 24 weeks after treatment. The reference point for SDA was located at the upper margin of the eyebrow, 30 mm lateral to the median line. To correlate and validate SDA results, semi-quantitative wrinkle score assessments were performed in parallel.
RESULTS: At baseline, the mean horizontal skin displacement was 5.4 mm (standard deviation: ±1.4 mm). During onset of action after treatment, skin displacement values decreased from baseline (100%) by 46%, 85%, and 90% at day 2, week 1, and week 2, respectively. During recovery from incobotulinumtoxinA action, skin displacement values increased to 33%, 50%, and 93% of the baseline value at 6, 12, and 24 weeks after treatment, respectively. The inhibitory effect of incobotulinumtoxinA was highly variable among subjects, ranging from 25% to 68% of the baseline value 12 weeks after treatment. Overall agreement between SDA values and wrinkle scores was good.
CONCLUSION: SDA represents a novel, objective method for the quantitative evaluation of the effect of incobotulinumtoxinA on mimetic muscles underlying the fronto-glabellar region, and showed good correlation with wrinkle score assessments. Both SDA and wrinkle score indicated the persistence of treatment effects 24 weeks after injection.
J Drugs Dermatol. 2014;13(9):1067-1072.
James R. Schwartz PhD
Zinc pyrithione (ZPT) is an active material that has been used for over 50 years to effectively treat dandruff and seborrheic dermatitis (D/SD). It has become the most common material for that purpose, its use has expanded to include other skin benefits such as skin hygiene. However, there is much about ZPT that is unappreciated. It is a rationally developed molecule that was modeled after the naturally occurring antimicrobial aspergillic acid. The molecular basis for its antifungal activity has been elucidated. The efficacy of ZPT originates from two attributes. First, it has a very broad antimicrobial spectrum of activity, including fungi, gram-positive and -negative bacteria. Second, the material has very low solubility, resulting in formulation and delivery as a particulate material, which has distinct performance advantages. The particles are deposited and retained on the target skin surfaces even when delivered from rinse-off products. These particles slowly release molecularly active material to interact with the surface fungal and bacteria cells to control their population, functioning as slow-release reservoirs to provide extended and persistent benefits. This particulate nature, though, results in complex pharmaceutics to realize the full efficacy benefits; it is common to see products with the same ZPT level having widely varying levels of clinical performance. Several product matrix-determined factors directly impact resultant benefits: ZPT must be retained on the skin surface achieving uniform spatial distribution laterally as well as within hair follicles (especially on scalp); ZPT must be maintained as a physically stable dispersion in product; ZPT must be maintained in a chemically active form as there are many chemical
reactions that can occur that can harm ZPT bioactivity. The benefits achievable by employing ZPT require significant pharmaceutics expertise to realize the full benefits of this active material.
J Drugs Dermatol. 2016;15(2):140-144.
Oxidative damage by reactive oxygen species (ROS) plays a major role in aging and carcinogenesis. Little is known about either the
effects of acute ROS in necrosis and inflammation of skin or the therapeutic agents for prevention and treatment. Previously, our laboratory
identified caffeine as an inhibitor of hydrogen peroxide (H2O2)-generated lipid peroxidation products in human skin fibroblasts.
Here, we study effects of caffeine on acute ROS-mediated necrosis. Human skin fibroblasts were incubated with caffeine, followed by
H2O2 challenge. Flow cytometry was used to analyze cell morphology, counts, apoptosis and necrosis, and ROS. We found that caffeine
protects from H2O2 cell damage at lower (0.01 mM) and intermediate (0.1 mM) doses. The beneficial effects of caffeine appear to be
mediated by a mechanism other than antioxidant function.
J Drugs Dermatol. 2012;11(11):1342-1346.
Patricia K. Farris MD, Brenda L. Edison BA, Irina Brouda MA, Ronni L. Weinkauf PhD, andBarbara A. Green RPh MSPatricia K. Farris MD,a Brenda L. Edison BA,b Irina Brouda MA,b Ronni L. Weinkauf PhD,b and Barbara A. Green RPh MSb
Skin aging is a multifaceted biological process characterized by the appearance of wrinkles, pigmentation irregularities, and loss
of firmness. These symptoms cannot be fully addressed by any single skin care ingredient or noninvasive cosmetic procedure. A
comprehensive treatment approach, including the use of clinically proven topical skin care formulations, provides optimal antiaging
effects. A high-strength skin care regimen (NeoStrata Skin Active; NeoStrata Company, Inc, Princeton, NJ) was developed to deliver
a combination of more than 35% active bene!t ingredients, including the a-hydroxy acid glycolic acid, the polyhydroxy acid gluconolactone,
maltobionic acid, N-acetylglucosamine, retinol, peptides, antioxidants, and apple stem cell extract. The products (cleanser,
day cream, night cream, eye cream) were formulated to provide antiaging bene!ts across all skin layers via multiple mechanisms
of action. The regimen was evaluated in a randomized, double-blind, vehicle-controlled clinical trial over 16 weeks, with a subset
continuing to 30 weeks. Sixty-nine Caucasian women (active group, n=44; vehicle group, n=25) completed 16 weeks of twice-daily
treatment. Results showed the active group improved significantly better than the vehicle group for: all clinician-graded aging symptoms
beginning as early as 2 weeks; pinch recoil as a measure of firmness/elasticity; dermal density, which was measured using
ultrasound; and total skin thickness, which was measured using digital calipers. Clinical photography revealed younger-looking skin.
Seventeen subjects from the active group continued to receive the active regimen until week 30. Improvement in all parameters of
aging was shown to be significantly greater at week 30 than at week 16, and dermal density continued to increase. The comprehensive
benefits observed in this study over the cosmetic vehicles are believed to have been achieved through the synergistic actions
of the benefit ingredients in the active regimen.
J Drugs Dermatol 2012;11(12):1447-1454.
Debbie M. Palmer DO and Jennifer Silverman Kitchin MD
It is believed that oxidative stress is caused by an imbalance between the production of reactive oxygen and a biological system’s
ability to neutralize the reactive intermediates. Oxidative damage occurs because of both intrinsic and extrinsic mechanisms. Together,
intrinsic and extrinsic damage are the primary causes of skin aging. The skin uses a series of intrinsic antioxidants to protect
itself from free radical damage. Naturally occurring extrinsic antioxidants have also been widely shown to offset and alleviate these
changes. Unlike sunscreens, which have an SPF rating system to guide consumers in their purchases, there is no widely accepted
method to choose antioxidant anti-aging products. ORAC (Oxygen Radical Absorbance Capacity) and ABEL-RAC (Analysis By Emitted
Light-Relative Antioxidant Capacity), are both accepted worldwide as a standard measure of the antioxidant capacity of foods, and are
rating systems that could be applied to all antioxidant skincare products. The standardization of antioxidant creams could revolutionize
the cosmeceutical market and give physicians and consumers the ability to compare and choose effectively
Galderma's Novel OTC Formulations are a Game Changer for Atopic Dermatitis
The efficacy of Galderma’s Cetaphil® and Restoraderm® support the emerging and available data that epidermal barrier function and its repair are a crucial element in treating patients with atopic dermatitis and several other common dermatoses. The Galderma Restoraderm products are novel formulations that support the epidermal barrier by enhancing filaggrin expression, which restores natural moisturizing factors in the skin and helps to rebuild a healthy skin barrier. The Restoraderm products are over-the-counter, widely available, and competitively priced, making them accessible to a large majority of the patient population.
Richard Martin MSc,a Jessica B. Henley PhD,b Patrick Sarrazin MD,c and Sophie Seité PhDd
BACKGROUND: Changes in the composition of microbial communities that colonize skin have been linked to several diseases including psoriasis. Nevertheless, the intra-individual dynamics and how these communities respond to balneotherapy remain poorly understood.
METHODS: This open label study was conducted between July and September 2012. Microbial communities of patients with psoriasis vulgaris were characterized prior and post a 3-week selenium-rich water balneotherapy treatment at the thermal care center La Roche-Posay (La Roche-Posay, France). Balneotherapy consisted of high-pressure filiform showers, baths, facial, and body spray treatments as well as La Roche-Posay thermal spring water (LRP-TSW) consumption. Swabs were taken from affected and proximal unaffected skin and the 16S rRNA bacterial gene was used to analyze the composition of bacterial communities. Using the same 16S rRNA gene tool, we tried to describe the LRP-TSW bacterial landscape.
RESULTS: This study included 54 patients diagnosed with moderate to severe forms of psoriasis vulgaris. After eliminating individuals lacking paired samples from both visits, 29 individuals were analyzed for their microbiome profile. Shannon Diversity Index and global bacterial landscape indicate similar microbial communities on both unaffected and adjacent affected skin. PASI values decreased post-balneotherapy implying improvement of disease severity. No significant change in the Shannon Diversity Index was noticed at the end of the third week. The average taxonomic composition of skin microbial communities associated with unaffected and affected skin of psoriatic patients post-balneotherapy shows that treatment with LRP-TSW significantly increased the level of Xanthomonas genus and, to a lesser extent, Corynebacterium genus. The Xanthomonas genus belongs to the main Xanthomonadaceae family found in LRP-TSW and also on healthy skin.
CONCLUSIONS: In psoriatic patients, a poor bacterial biodiversity was noticed and the bacterial communities were similar on unaffected and affected adjacent skin. Family analysis identified, for the first time, Xanthomonadaceae belonging to Proteobacteria phylum and known to be keratolytic, associated with the clinical improvement observed after a 3-week balneotherapy treatment. This data supports the interest of selenium-rich thermal spring water in the treatment of psoriasis vulgaris.
J Drugs Dermatol. 2015;14(12):1400-1405.
Fiona P. Blanco MD, Richard K. Scher MD FACP
Trachyonychia is the term used to describe nail plate roughness, pitting, and ridging that may affect 1 to 20 nails. Alopecia
areata, psoriasis, lichen planus, atopic dermatitis, ichthyosis vulgaris, as well as other skin conditions have been associated
with trachyonychia, but the causal relationship is often challenging to demonstrate histologically. Clinical evidence of these
cutaneous disorders in conjunction with a nail matrix biopsy may help elucidate an etiology of trachyonychia, but many
cases often remain idiopathic. Nail biopsy findings may match skin histology, but more commonly show spongiotic or nonspecific
changes. We present an interesting case of a female with progressive development of trachyonychia in all 20 nails
coinciding with a new diagnosis of sarcoidosis.
Paula Bellot-Rojas MD, Rosalinda Posadas-Sanchez MSc, Nacu Caracas-Portilla MD, Jose Zamora-Gonzalez MSc, Guillermo Cardoso-Saldaña PhD, Fermin Jurado-Santacruz MD, Carlos Posadas-Romero MD
Background: Acanthosis nigricans (AN) is a skin condition commonly present on the neck of obese subjects. Obesity is
often accompanied by insulin resistance and/or hyperinsulinemia. Metformin and rosiglitazone are 2 pharmacologic agents
useful in conditions characterized by insulin resistance.
Objective: The aim of our study was to compare the efficacy of metformin versus rosiglitazone on AN lesions of the neck as
well as their effects on metabolic and anthropometric variables.
Methods: This 12-week randomized, open-label pilot study involved overweight or obese subjects with AN treat with either
metformin (n=14) or rosiglitazone (n=13).
Results: Only the rosiglitazone group showed a significant reduction in insulin levels. No effect on the severity of AN was
observed, but modest improvements of skin texture occurred in both treatment groups.
Conclusions: Metformin and rosiglitazone were well-tolerated. Although efficacy on skin lesions was very modest, their use
in acanthotic subjects might be useful during longer treatment periods.
S.I. Colby, BA; E.H. Schwartzel, PhD; F.J. Huber, BS; A. Highton, MD; D.J. Altman, MD, PHD; W.W. Epinette, MD and A. Highton, MD and E. Lyons, BS
The purpose of this open-label study was to determine the adverse event rate of topical 4HA/tretinoin when
used twice daily for up to 24 weeks with concomitant sunscreen in the treatment of solar lentigines and related
hyperpigmented lesions. There were two treatment areas: bilateral dorsal forearms, including the back of the
hands; and the face, including the forehead and cheek areas. Each treatment area had a target lesion at least
5mm in diameter and was moderately darker than the surrounding skin. A nine-point bipolar scale was used for
evaluation of Target Lesion Pigmentation (0 = extremely lighter than pigment of the surrounding skin, 4 =
equal with pigment of surrounding skin, 8 = extremely darker than pigment of surrounding skin). The other
solar lentigines present in the treatment areas also had to have an overall pigmentation grade of at least Grade
6. Twice daily applications to individual lesions in each treatment area were made for up to 24 weeks followed
by a 4-week follow-up phase. Sunscreen applications (sunscreen with sun protection factor (SPF) 25 or greater)
were made every morning and reapplied after six hours if additional sun exposure was expected. Clinical evaluations
were performed at weeks 0, 4, 8, 16, 24 and 28. The clinical signs of Target Lesion Pigmentation and
Overall Lesion Pigmentation were evaluated at each visit.
A total of 96 subjects were enrolled at four study centers; 77 (80%) subjects completed the study. Treatment-related
adverse events (AEs) for 4HA/tretinoin included erythema, burning/stinging/tingling, desquamation, pruritus,
skin irritation, halo hypopigmentation and hypopigmentation. Five (5%) subjects discontinued from the study due
to adverse events considered to be related to study medication. When used with sunscreen of SPF 25 or greater,
4HA/tretinoin was safe and well tolerated and did not produce any unexpected or unusual adverse events.
Christie R. Travelute MD and Todd V. Cartee MD
Close opposition of full-thickness skin grafts to the recipient wound bed is felt to be critical for graft survival. This is usually accomplished
by bolster dressings, basting sutures, or both. Herein, we describe a facile and rapid technique for placing quilting sutures in
full-thickness grafts on the ear using a plain gut suture with a short, straight needle. This technique is especially valuable in facilitating
precise approximation of grafts within the fossae of the anterior ear. In our experience, this approach promotes graft survival and produces
excellent cosmetic results.
J Drugs Dermatol. 2013;12(1):104-105.
No abstract details for the moment.
Skin is the most commonly affected organ in patients with HIV, and the incidence of cutaneous adverse reactions in persons
infected with HIV versus those who are not infected is significantly higher. Cutaneous drug reactions contribute to increased
morbidity and are often the cause of treatment nonadherence. Undoubtedly, the widespread use of highly active antiretroviral
therapy has had a positive effect on the natural course of the disease; however, advances in HIV therapy will continue to
increase the potential for cutaneous eruptions, further complicating the evaluation of skin manifestations that are so common
in this disease. Distinguishing between cutaneous drug reactions and other cutaneous diseases associated with HIV
infection can be challenging. Nevertheless, it is important for clinicians to be knowledgeable about the clinical characteristics
and presentations of these reactions and to determine whether drug discontinuation is indicated.
Cyndi Yag-Howard MD FAAD
No abstract details for the moment.
Lindsey Goddard BBA,a Todd Mollet MD,b and Travis Blalock MDb
Basal cell carcinoma (BCC) is the most common cutaneous malignancy, and usually presents on sun-exposed areas of the skin.
Unsurprisingly, BCC appearing on the nipple-areola complex (NAC) is rare, and even more so in females and dark skin types. BCC
of the NAC is more aggressive than other locations, thus diagnosis and treatment are imperative. We present a case of an African
American female with a lichenified, scaly plaque on her left areola that was unresponsive to clobetasol. After biopsy, the lesion was
identified as pigmented BCC of the NAC. The patient denied surgical treatment and was treated with topical 5-fluorouracil. The BCC
initially resolved but recurred at 22 month follow-up. We plan to treat the recurrence with Mohs surgery.
Maritza Perez MD, Janiene Luke MD, Anthony Rossi MD
Melasma is an acquired skin condition characterized by irregular brown or hyperpigmented patches typically located on the forehead, cheeks, nose, chin and upper lip. The pathogenesis of melasma is not completely understood, but is thought to be influenced by genetics, UV exposure, thyroid dysfunction and hormonal influences from either pregnancy or hormonal therapeutic medications. Peoples of Latin descent comprise a vast array of skin colors and skin phototypes. Similarly, disorders of pigmentation, particularly melasma, occur more frequently in people of Latin descent when compared to the general population. Melasma can be particularly distressing to patients and has been shown to impact a patient's quality of life in several studies. These factors can raise significant quality of life issues and therefore treatment is not only significant for improving patient clinical outcomes, but is crucial in improving important psychological and emotional aspects of patients' overall well being. This article provides a stepwise approach to the treatment
of melasma based on current literature recommendations.
J Drugs Dermatol. 2011;10(5):517-523.
Yohei Tanaka MD, Kiyoshi Matsuo MD PhD, Shunsuke Yuzuriha MD PhD
Background: Infrared irradiation stimulates collagen production, but histological differences in its long-term effects on type I versus
type III collagen and elastin in human tissue are unclear.
Objective: To investigate the effects of infrared irradiation.
Methods and Materials: In vivo human tissues in sun-protected and sun-exposed areas were irradiated with infrared. Histological
samples were analyzed, and visual changes were assessed up to 90 days post-treatment.
Results: Infrared irradiation provided long-term increases in collagen and elastin levels on post-irradiation days 30, 60 and 90 compared
to controls. Significant increases in type I collagen persisted until 30 and 60 days, and in sun-protected and exposed skin biopsies,
respectively. Significant increases in type III collagen and elastin persisted until 90 days in both sun-protected and sun-exposed
Conclusion: Infrared irradiation provides safe and effective long-term stimulation of collagen I and III and elastin, which is beneficial
for improving skin laxity and wrinkles.
Iron levels are tightly regulated in the body to maintain homeostasis.
When homeostatic mechanisms malfunction, excess
iron accumulation in the body has deleterious effects with important health consequences worldwide. Different degrees of iron accumulation complicate pathological conditions such as hereditary hemochromatosis (HH), porphyria cutanea tarda (PCT), venous stasis ulcers, diabetic wounds, skin cancer and sunburn. Despite the known association of systemic iron excess with cutaneous findings, little is known about the mechanism by which a surplus of systemic iron affects the skin. This paper explores the link between excess iron and dermatologic findings in the conditions listed above in order to illustrate potential mechanisms by which iron overload exacerbates the cutaneous manifestations associated with each disease.
Anne Marie Tremaine MD, Arisa Ortiz MD, Laila Elkeeb MD, Minh Tran, Gerald Weinstein MD
Background: Many patients with rosacea cannot tolerate extended treatment periods with topical agents because their skin sensitivity
is often increased.
Objective: To determine the long-term efficacy and tolerability of a new moisturizing lotion for improving the signs and symptoms
of mild-to-moderate rosacea.
Methods: In a 48-week, open-label study, a moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK-124 (0.125%,
Pyratine-XR™, Senetek PLC, Napa, CA) was applied twice daily by 18 subjects with mild-to-moderate rosacea. Clinical improvements
were assessed by the treating physician. Skin barrier function was measured by transepidermal water loss after treatment. Tolerability
and cosmetic outcome were evaluated by subjects.
Results: Subjects experienced a mean 44 percent reduction in erythema severity and a mean 89 percent reduction in inflammatory
lesion count at week 48. Reductions were significant (P≤0.05) in both erythema and lesions at weeks 24, 36 and 48. Statistically significant
(P≤0.05) improvements in telangiectasias, transepidermal water loss and dryness were noted. Overall clinical improvement
was observed in 81 percent of subjects and the investigator’s global assessment steadily improved throughout the study. Treatments
were well-tolerated and cosmetically acceptable. Treatment-induced skin irritation was not observed.
Conclusion: The new moisturizing lotion containing furfuryl tetrahydropyranyladenine as PRK 124 is efficacious, does not irritate skin,
and is well tolerated for at least 48 weeks.
BACKGROUND: Occupational irritant contact dermatitis (OICD) is a dif cult and hard to manage condition. It occurs more frequently in certain occupations where contact with harsh chemicals, use of alcohol-based disinfectants, and frequent hand washing heightens the risk. Treatment for OICD includes patient education in addition to physical, topical, and systemic therapies.
OBJECTIVE: To review the pathogenesis and treatment options for OICD and evaluate the ef cacy of a selective skin-care regimen involv- ing a hand protectant cream alone as well as combined with a repair cream and speci c cleanser.
MATERIALS AND METHODS: A single-center open study was performed comprising 42 healthy male and female adult volunteers prone to occupational irritant contact dermatitis due to frequent wet work or contact with detergents. Between day 0 and day 7, subjects applied a hand protectant cream as needed on both hands (at least twice daily). On days 7 to 14, subjects applied a hand protectant cream and cleanser as needed on both hands (at least twice daily) as well as a repair cream each evening. A diary log was given to each volunteer for application control and for a subjective evaluation of daily tolerability.
RESULTS: In these subjects prone to occupational irritant contact dermatitis, the hand protectant cream applied during the initial 7-day period was effective in restoring the damaged skin barrier and improving the stratum corneum hydration.
A regimen that combined the hand protectant and repair creams with a speci c cleanser during a further 7-day period allowed contin- ued improvement of skin hydration and additional clinical bene ts while respecting the skin barrier function.
CONCLUSION: The results of this study support the use of a 3-step approach for patients who are at risk of repeated exposure to external irritants.
J Drugs Dermatol. 2016;15(suppl 11):s81-85.
Jason Emer MD and Orit Markowitz MD
No abstract details for the moment.
Jonathan S. Dosik MD, Lori A. Johnson PhD
Background: Topical retinoids, including adapalene and tazarotene, are a primary treatment choice for patients with acne.
Adapalene is currently marketed in a 0.1% concentration in gel and cream formulation. A new gel containing a higher
concentration (0.3%) of adapalene has been developed. In clinical studies, adapalene 0.1% concentration has proven
to be better tolerated than other retinoids in skin treatment. However, the tolerability of adapalene gel 0.3% has yet to
be compared to other topical retinoids.
Purpose: The purpose of this study was to compare the local cutaneous tolerability of adapalene gel 0.3% once daily versus
tazarotene cream 0.05% once daily.
Methods: Subjects reported to the investigative site each day Monday through Friday, cleansed the faced and then applied
adapalene 0.3% gel to one side of the face and tazarotene 0.05% cream to the other in the presence of study personnel.
For the weekends, subjects were instructed to apply the treatment at home according to the same procedure.
Tolerability was assessed during each weekday visit. The study lasted for 3 weeks.
Result: Tolerability results for adapalene 0.3% gel and tazarotene 0.05% cream were statistically similar throughout the study. Investigator-assessed overall tolerability was in favor of adapalene at days 19 and 22 (P=.043). A cosmetic acceptability survey also showed results were better for adapalene 0.3% gel.
Conclusion: Adapalene gel 0.3% is very well-tolerated with good cosmetic acceptability.
Aaron M. Bruce DO, James M. Spencer MD MS
Background: The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue
infection (SSTI) in private practice dermatology offi ce is largely unknown and the prescribing of antibiotic treatment could be infl uenced
by such data.
Objective: Investigators sought to examine the period prevalence of CA-MRSA infections involving skin and soft tissue in a suburban
private practice dermatology setting.
Methods: Chart reviews of 170 patients who had bacterial cultures taken from January 2007 to November 2007 were performed,
with an analysis of sex, age, immune status, species of growth, type of lesion, and culture site.
Results: The mean age of the study population was 54.0 years (SD 21.8) and 51.1% were male. Of the 170 cultures taken, 135 (79%)
grew 1 or more bacteria and MRSA positive cultures were found in 28 (21%) of 135 cultures.
Limitations: Only 1 geographic location was represented.
Conclusion: The rising rates of CA-MRSA skin and soft tissue infections should be evaluated with consideration of the unique
populations that the majority of reports represent. There is little doubt that the prevalence of skin infections caused by CA-MRSA
have increased dramatically and will likely continue to do so in the future. However, the authors caution the empiric prescribing of
antibiotics presently known to be effective against CA-MRSA and advocate the culturing of all infectious lesions upon presentation
and reserve these antibiotics (tetracyclines, trimethoprim-sulfamethoxazole [TMP-SMX], clindamycin, rifampin) for the treatment of
high-risk patients and patients with culture proven CA-MRSA infections.
Teresa M. Weber PhD,a Frank Samarin MD,b Michael J. Babcock MD,c
Alexander Filbry PhD,d and Frank Rippke MDd
INTRODUCTION: Atopic dermatitis (AD) is a chronic skin condition associated with decreased barrier function resulting in periodic
flare-ups of erythematous and pruritic lesions. Guidelines recommend daily treatment of atopic skin with emollient moisturizers
for prevention of flares and maintenance of the flare-free state. This study evaluated the efficacy of 2 steroid-free, nonprescription
eczema skin care formulations for reducing the risk of flare and relieving symptoms in infants and children with AD: Body Cream
for the daily maintenance treatment of atopic skin and Flare Treatment for the treatment of atopic flares.
METHODS: After a 2-week washout period, subjects (N=45; mean age 3.5 years) were randomized to cleanser plus daily moisturizing
with Body Cream (moisturizer group) or cleanser only (control group) for 6 months or until flare. Subjects experiencing flare received
Flare Treatment for 4 weeks.
RESULTS: The incidence of flare was significantly lower in the moisturizer group compared with the control group (21% vs 65%;
P=.006), while the median time to flare was shorter in the control group (28 vs >180 days). Risk of flare was reduced by 44.1% after
6 months of Body Cream application. Flare Treatment reduced overall eczema symptom severity at week 2 and week 4; 78.9% of
flares had improved or cleared at week 4.
CONCLUSIONS: Body Cream reduced the incidence of flare and the time to flare, reinforcing guidelines that daily emollient therapy
should be an integral part of the maintenance treatment plan for the prevention of disease flares. Body Cream and Flare Treatment
are effective over-the-counter steroid-free options for management of AD in children.
J Drugs Dermatol. 2015;14(5):478-485.
Susan Boiko, MD and Allan C. Halpern, MD, MS
No abstract details for the moment.
Mitzi Moulds, Executive Director The Skin Cancer Foundation
No abstract details for the moment.
William Levis MD and Frank Martiniuk PhD
No abstract details for the moment.
Janelle M. Vega MDa, Vivian W. Bucay MDb, and Flor A. Mayoral MDa
Radiofrequency has been shown in a number of studies to be effective in tightening the skin of the face and neck. This multicenter study was undertaken to determine the efficacy of a monopolar radiofrequency system (Pelleve S5 Wrinkle Treatment Generator; Ellman International Inc, Oceanside, NY) in tightening the skin of the hands and is the first such study assessing the improvement of skin laxity of the hands. A total of 31 female patients with a median age of 56 years were enrolled in 2 centers. Each had a single hand treated, with randomization of the hand to be treated. A total of 3 treatments were performed at 2-week intervals. Follow-up photos were taken at 45 and 90 days after the final treatment. At 90 days, 89% of patients had visible improvement of the appearance of the treated hand based on the visual Global Aesthetic Improvement Scale. Of these, 50% had visible improvement from baseline, and 39% had marked improvement from baseline. Patients reported only mild to moderate discomfort during the treatment. No adverse events or side effects were reported. Monopolar radiofrequency was found to be safe and effective for treating hand wrinkles.
J Drugs Dermatol. 2013;12(1):24-26.
Kendra Gail Bergstrom MD FAAD
The management of skin infections has evolved over time
and new evidence suggests that less acute intervention may
be as good or better. For acute treatment, evidence from
the emergency medicine literature shows that empiric oral
antibiotics may not improve outcomes relative to incision and
drainage alone. The use of packing material for wounds after
draining does not lead to a decreased rate of recurrence, more
rapid healing, or fewer physician visits, but does cause more
pain. For patients with multiple or recurrent skin and soft tissue
infections, a comprehensive decolonization or eradication
strategy is the most effective at preventing further recurrences.
Several decolonization approaches exist and can be tailored to
find the most appropriate for a particular individual.
J Drugs Dermatol. 2014;13(1):89-92.
The primary treatment for superficial fungal infections is antifungal topical formulations, and allylamines and azoles represent the two major classes of topical formulations that are used to treat these infections. The stratum corneum (SC) is composed of keratinocytes that are surrounded by a matrix of lipids. The efficacy of topically applied formulations depends on their ability to penetrate this lipid matrix, and the vehicle plays an integral role in the penetration of active molecule into skin. There are several challenges to formulating topical drugs, which include the biotransformation of the active molecules as they pass through the SC and the physical changes that occur to the vehicle itself when it is applied to the skin. This article will review current and emerging topical antifungal vehicles.
J Drugs Dermatol. 2016;15(Suppl 2):s44-48.
Tatjana Pavicic,b Gerd G. Gauglitz,b Peter Lersch,a Khadija Schwach-Abdellaoui,c Birgitte Malle,c Hans Christian Korting,b Mike Farwickaa
Background: Due to its strong water-binding potential, hyaluronic acid (HA) is a well-known active ingredient for cosmetic applications. Native HA is proposed to help the skin to retain and maintain elasticity, turgor and moisture.
Objective: To observe the efficacy of topical application of 0.1% hyaluronan formulations of different molecular weights (MW) (50, 130, 300, 800 and 2000 kDa, respectively) in the periocular area as anti-wrinkle treatment.
Material and Methods: Seventy-six female subjects between 30 and 60 years of age with clinical signs of periocular wrinkles applied one of the formulations twice-daily to the area of interest in a randomized fashion for 60 days. Around the other eye, a vehicle control cream was applied. Measurements of skin hydration and skin elasticity were performed before treatment, 30 and 60 days thereafter. At similar time points negative replicas were taken and evaluated by semi-automated morphometry.
Results: All HA-based creams utilized in this study demonstrated a significant improvement in skin hydration and overall elasticity values (R2) when compared to placebo. Measurements of wrinkle depth using mean roughness (Ra) and maximum roughness (Rz) values revealed significant improvement in the 130 and the 50 kDa HA group after 60 days of treatment compared to placebo-treated area.
Conclusion: Topical application of all 0.1% HA formulations used in this study led to significant improvement in skin hydration and elasticity.
Application of low-molecular-weight (LMW) HA was associated with significant reduction of wrinkle depth, which may be due to better penetration abilities of LMW HA.
J Drugs Dermatol. 2011;10(9):990-1000.
Scott W. Dunbar MDa and David J. Goldberg MDa,b
Treatment options for cosmetic improvement of the skin and body continue to grow more numerous with each passing year. The decline
in utilization of invasive surgical treatments for aging and body contour correlates with the recent rise in laser and light devices. These light based technologies transmit either a single or broad wavelength of amplified light to the skin, resulting in volumetric tissue heating. Depending on the chromophore targeted and wavelength applied, varied applications exist to treat numerous cosmetic concerns.
Radiofrequency (RF) devices have become more popular recently as science has advanced and brought new, safer, and better therapies.
J Drugs Dermatol. 2015;14(11):1229-1238.
Beatriz G. Carpo MD, Vermén M. Verallo-Rowell MD, Jon Kabara MS PhD
Objective: A cross-sectional laboratory study to determine the in vitro sensitivity and resistance of organisms in culture
isolates from skin infections and mechanisms of action of monolaurin, a coconut lauric acid derivative, compared with
6 common antibiotics: penicillin, oxacillin, fusidic acid, mupirocin, erythromycin, and vancomycin.
Methods: Skin culture samples were taken from newborn to 18-year-old pediatric patients with primary and secondarily
infected dermatoses. Samples were collected and identified following standard guidelines, then sent to the laboratory
for sensitivity testing against the 6 selected antibiotics and monolaurin.
Results: Sensitivity rates of Gram-positive Staphylococcus aureus, Streptococcus spp., and coagulase-negative Staphylococcus,
Gram-negative E. vulneris, Enterobacter spp., and Enterococcus spp. to 20 mg/ml monolaurin was 100% and of Klebsiella
rhinoscleromatis was 92.31%. Escherichia coli had progressively less dense colony growths at increasing monolaurin
concentrations, and at 20 mg/ml was less dense than the control. Staphylococcus aureus, coagulase-negative Staphylococcus,
and Streptococcus spp. did not exhibit any resistance to monolaurin and had statistically significant (P <.05) differences
in resistance rates to these antibiotics.
Conclusions: Monolaurin has statistically significant in vitro broad-spectrum sensitivity against Gram-positive and
Gram-negative bacterial isolates from superficial skin infections. Most of the bacteria did not exhibit resistance to it. Monolaurin
needs further pharmacokinetic studies to better understand its novel mechanisms of action, toxicity, drug interactions,
and proper dosing in order to proceed to in vivo clinical studies.
Hilary Reich MD,a,b Irmina Wallander BA,a Lacie Schulte MS BA,a Molly Goodier BS,a and Brian Zelickson MDa
METHODS: In this split-face, evaluator-blinded study, 18 subjects were randomly assigned to receive either the SSR or NFL treatments on each side of the face. For the SSR facial sides subjects followed two morning-evening regimens. On the NFL sides subjects were treated 3 times with the 1927-nm laser at 4-week intervals. Three physician evaluators were asked to rate hyperpigmentation, global photoaging, and ne lines and wrinkles for each side of the face at baseline and at 3 months using a 5-point scale.
RESULTS: The SSR and NFL treatments provided comparable results for each skin attribute. Improvement from baseline was signi - cant in both treatment programs for each skin attribute. The greatest 3-month improvement for both programs was in hyperpigmen- tation. For global photoaging and ne lines and wrinkles, positive responses were slightly greater in the NFL than in the SSR facial sides. Subject preference for the SSR over the NFL was greatest for ne lines around the eyes, ne lines around the mouth, smooth texture, radiant complexion, and overall improvement while the NFL was preferred for skin rmness and evenness. When the study was completed5 of 18 split-face subjects decided to undergo NFR laser treatment on the non laser treated side along with using the SSR product and 13 of the 18 subjects continued to use the SSR products to their full face after the study.
CONCLUSION: The mass market skin care system of the present study provides improvement in hyperpigmentation, global photoaging, and ne lines and wrinkles comparable to that of a series of treatments with a non-ablative fractional laser.
J Drugs Dermatol. 2016;15(11):1366-1372.
J. Mark Jackson MDa and Michelle Pelle MDb
Many topical medications are available for the treatment of papulopustular rosacea. While treatments contain metronidazole, azelaic
acid, or sodium sulfacetamide-sulfur as the active ingredient, the composition of the vehicle formulations varies widely. These vehicles
come in gels, creams, lotions and foams; some ingredients are common to many vehicles, while some vehicles contain unique
ingredients designed to optimize skin penetration and delivery of the active drug to its target. Vehicles can also influence tolerability,
which is always a concern in patients with heightened skin sensitivity, and compliance, which is typically lower for topical treatments
than oral treatments. Ideally, the vehicle of any rosacea treatment should enhance drug delivery, be nonirritating and be easy to use.
Ingredients that help repair barrier function are also desirable. This review will focus on the key components of the vehicles from
the most commonly used topical therapies for papulopustular rosacea and how vehicle formulations influence the delivery of active
ingredient, skin barrier repair, tolerability and compliance.
J Drugs Dermatol. 2011;10(6):627-633.
Objectives: To assess the benefit of adjunctive use of a SPF 30 moisturizing lotion in reducing local side effects associated with atopical tretinoin cream.
Methods:This was a randomized, investigator/evaluator-blinded, split-face comparison in subjects with healthy skin. Subjects applied tretinoin
cream 0.05% once daily to the whole face and Cetaphil® Dermacontrol Moisturizer (CDM) once daily to one side of the face based on randomization. Tolerability, perference and skin hydration were evaluated at each week, and a cosmetic acceptability questionnaire regarding CDM was completed at the end of the study.
Results: The majority (about 83% to 86%) of subjects experienced skin irritations on both sides of their face, though predominantly mild for the CDM + tretinoin treated side. Tolerability preferences favored the CDM+tretinoin sides. Adjunctive use of CDM with a topical tretinoin
cream improves tolerance of the treatment.
J Drugs Dermatol. 2012;11(9):1104-1107.
Moetaz El-Domyati MD,a Tarek S. El-Ammawi MD,a Osama Moawad MD,b Walid Medhat MD,a, c Mỹ G. Mahoney PhD,c Jouni Uitto MD PhDc
Background: The use of intense pulsed light (IPL) for facial rejuvenation had been the topic of many studies. However, few of them
discussed quantitative changes in extracellular matrix proteins after IPL therapy.
Objective: To objectively quantify the histological changes in extracellular matrix proteins after IPL treatment for facial wrinkles.
Methods: Biopsy specimens were obtained from the periocular area of six volunteers of Fitzpatrick skin type III–IV and Glogau's class I–III wrinkles. They were subjected to three months of IPL treatment (six sessions at two-week intervals). Using histological and immunostaining analysis coupled with computerized morphometric analysis, quantitative evaluation of collagen types I, III and VII, newly
synthesized collagen, total elastin and tropoelastin was performed for skin biopsies at baseline, end of treatment, and three months post-treatment.
Results: Clinical assessment of volunteers did not show clinically noticeable improvement in facial wrinkles after IPL treatment. Furthermore, quantitative evaluation of extracellular matrix proteins showed no statistically significant changes (P>0.05) in response to IPL treatment.
Conclusion: Although 50 percent of volunteers showed mild improvement in skin texture at the end of IPL treatment, none of them reported improvement in skin tightening or wrinkles. No statistically significant histological changes were observed three months post IPL treatment.
J Drugs Dermatol. 2011;10(11):1246-1252.
Anh N. Tran MSa,b and John Y. Koo MDa
The eutectic mixture of lidocaine and prilocaine (EMLA, APP Pharmaceuticals, LLC.) is an anesthetic cream frequently used by dermatologists.
Although side effects of EMLA are usually mild local skin reactions (ie, edema, pallor, erythema), more severe complications
can be encountered including methemoglobinemia, central nervous system toxicity, and cardiotoxicity. This article reviewed
the literature regarding risk of systemic toxicity associated with use of EMLA in the pediatric and adult population. All 12 clinical trials
evaluating the safety of EMLA in either the pediatric or adult population generally followed dosing and administration guidelines set
by the manufacturer and reported clinically insignificant plasma levels of methemoglobin, lidocaine, prilocaine, and their respective
metabolites. To date, nine pediatric cases and three adult cases of systemic toxicity associated with EMLA have been published.
Possible factors that contributed to the development of systemic toxicity include excessive amount of EMLA, large application area,
prolonged application time, diseased and/or inflamed skin (eg, vascular malformations, molluscum contagiosum, eczema, previously
abraded skin), age less than 3 months, prematurity, and concomitant use of a methemoglobin-inducing agent. Recommendations
are provided on how to safely use EMLA to minimize the risk of systemic toxicity.
J Drugs Dermatol. 2014;13(9):1118-1122.
Stephanie Feldstein BAa and Jared Jagdeo MD MSb,c,d
Tattoo allergies are often eczematous skin rashes that can be complicated by ulceration and infection. These allergies are difficult to resolve, sometimes requiring surgical or laser intervention, with varying success. Here we present a case of a 29-year-old woman with a serious skin allergic reaction to red tattoo ink that ulcerated and became secondarily infected. The patient expressed a desire to have the tattoo allergic reaction treated while preserving the cosmetic appearance of her tattoo for sentimental reasons. This case is being presented to provide an effective treatment algorithm for managing allergic tattoo reactions with ulceration and co-infection, while preserving the aesthetic integrity of the tattoo.
J Drugs Dermatol. 2014;13(10):1274-1275.
Gary D. Monheit MDa and Frank Dreher PhDb
The safety and efficacy of a novel skin-lightening cream (SLC) with 4% hydroquinone (HQ), which additionally contains 4 skin-brightening actives, was compared with a triple combination cream (TCC) with 4% HQ, 0.05% tretinoin, and 0.01% fluocinolone acetonide for the treatment of melasma under measures of sun protection. The study was a randomized, investigator-blinded, split-face study including 20 Caucasian females with at least mild epidermal or mixed melasma. Evaluations were made before treatment, after 4 and 8 weeks, and after 12 weeks at the end of the once-daily treatment period with the creams. The evaluations included the investigator's tolerability assessments, the Investigator's Global Assessment, the Melasma Area and Severity Index (MASI), and a participant questionnaire. Under the conditions of the present study, the SLC was comparable in both efficacy and tolerability with the well-established TCC treatment for facial melasma. The MASI reduction became significant for both creams after 4 weeks and reached -77% for SLC and -79% for TCC cream after 12 weeks of once-daily use under measures of sun protection. None of the subjects discontinued treatment because of an intolerability or adverse event. About one-third of the subjects experienced at least one local intolerability (eg, erythema, dryness, or peeling) with both creams over the entire study period, while the remaining subjects did not experience any intolerabilities.
J Drugs Dermatol. 2013;12(3):270-274.
Daniel Bucks PhD, Pramod Sarpotdar PhD,Karen Yu PhD, Arturo Angel BS,James Del Rosso DO
Fixed combination products of clindamycin 1% (as 1.2% clindamycin phosphate) and benzoyl peroxide (BPO) 5% are commonly used
in the treatment of acne vulgaris. Although any given topical acne product may be therapeutically effective, signs and symptoms of
cutaneous tolerability may lead to missed applications by the patient, thus limiting adherence to therapy. BPO and other formulation
components such as surfactants, preservatives and high levels of organic solvents can cause cutaneous irritation and dryness. BPO
irritation is dose-dependent. An approach to optimizing the BPO concentration was undertaken to develop a surfactant- and preservative-
free, clindamycin and low concentration (<5%) BPO formulation. A 33% reduction in skin irritation was seen when the BPO
concentration was halved from 5% to 2.5% (clindamycin-BPO 2.5% gel), maintaining a comparable amount of total BPO delivered
to the skin. As a result, clindamycin-BPO 2.5% gel appears to provide effi cacy comparable to that of higher concentration (5%) fi xed
clindamycin-BPO combination products and should optimize patient compliance as a result of the reduction in cutaneous tolerability
reactions, including signs of skin irritation or dryness. Clinical studies have shown clindamycin-BPO 2.5% gel to be highly effective
with the potential for a more favorable tolerability profi le compared to products containing higher concentrations of BPO.
Elizabeth T. Makino BS CCRA MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa
There are numerous common skin disorders involving hyperpigmentation, including solar lentigines, postinflammatory hyperpigmentation, melasma, freckles, and dyschromia from photoaging. While these conditions are of an aesthetic nature, there is great interest in newer, safer, and more effective treatment modalities. Topical hydroquinone (HQ) has been the gold standard of skin lighteners for many years. However, regulatory authorities around the world are now questioning its safety. A randomized, double-blind, half-face study was conducted in females with moderate to severe facial hyperpigmentation to assess the efficacy and tolerability of 3 new skin brightener formulations containing SMA-432, a prostaglandin E2 inhibitor, compared with 4% HQ. Each subject was assigned 2 of the 4 test materials and was instructed to apply the product on the assigned side of the face twice daily for 12 weeks. Evaluation visits were conducted at baseline and at 4, 8, and 12 weeks. At each visit, subjects were evaluated by a blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photography and Chroma Meter assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. Sixty-eight Caucasian subjects (136 half faces) completed the study. All test materials significantly reduced Overall Hyperpigmentation and improved the Investigator's Global Hyperpigmentation Improvement rating at weeks 4, 8, and 12 compared with baseline. SMA-432 exhibited a dose-dependent improvement in hyperpigmentation. There were no major tolerability issues with any of the test materials. Self-assessments were generally favorable for all test materials. At the completion of the trial, subjects rated one of the tested multimodality brightener compositions as the most favorable product and 4% HQ as the least favorable. This study demonstrated that the new non-HQ-containing skin brightener formulations were as effective and equally well tolerated as the gold standard, 4% HQ, in females with facial hyperpigmentation.
J Drugs Dermatol. 2013;12(3 suppl 1):s21-s26.
Anne K. Miller BS, Reginald Dusing MD, Aaron Meggison MD, Daniel Aires MD
The prognosis for metastatic melanoma is grim, and treatment options are limited. Imiquimod is a topically applied immunemodulatorthat has been used to treat superficial cutaneous melanoma, but has not been reported to treat metastatic melanoma. We report a patient whose liver and iliac fossa melanoma metastases regressed after topical application of imiquimod cream to overlying skin. This supports further investigation of the potential use of imiquimod for metastatic melanoma.
J Drugs Dermatol. 2011;10(3):302-305.
Joy Makdisi BS and Adam Friedman MD FAAD
Mycosis fungoides was first described in 1806 by the French
physician Jean Louis Alibert in a patient whose skin lesions
developed into mushroom-like tumors. Though it is not an infectious
disease, it was termed mycosis fungoides (MF) due
to its fungating appearance.1 In 1870, Bazin further described
MF, proposing the three classical stages of the cutaneous
disease: patch, plaque, and tumor.2 The term cutaneous T-cell
lymphoma (CTCL) was first utilized in 1975 by Lutzner et al
to describe a group of malignant infiltrative disorders of the
skin including MF and Sézary syndrome.3 CTCLs comprise
a spectrum of extranodal non-Hodgkin’s lymphomas that
are characterized by primary cutaneous involvement of a
dominant clonal T-cell.4 As molecular biology and immunohistochemistry
techniques have become more developed, CTCL
has become understood to be a heterogeneous assembly
of disorders that vary with regards to clinical course, histopathology,
therapeutic considerations, and prognosis.2,5 MF,
a low-grade lymphoproliferative disorder, is the most common
type of CTCL, comprising 54% of CTCLs.6,7 It is a rare,
extranodal, non-Hodgkin’s lymphoma and is an epidermotropic
neoplasm composed of CD4+ (helper) lymphocytes.8
Sézary syndrome is a related leukemic subtype of CTCL that
presents with diffuse skin involvement as well as circulating
tumor cells in the peripheral blood.8.
Stanley S. Shapiro PhD,a Miri Seiberg PhD,b and Curtis A. Cole PhDc
The 1925 classical observation that vitamin A deficiency leads to squamous metaplasia and epithelial keratinization, coupled with the later finding that excess vitamin A inhibits keratinization of chick embryo skin, set the foundation for the potential therapeutic use of retinoids in cutaneous conditions of keratinization. Significant progress has since been made understanding the molecular biology, biochemistry, pharmacology, and toxicology of vitamin A and its derivatives, collectively named retinoids. Natural and synthetic retinoids are now routinely used to treat acne, psoriasis, skin keratinization disorders, and photodamage. Retinoids also inhibit tumor formation and skin cancer development in experimental systems and in humans. Retinol and retinyl palmitate (RP) are found in cosmetic products and in foods and dietary supplements, which are all considered safe, by inclusion in the Generally Recognized as Safe Substances Database. However, the safety of topical retinoids was questioned in one publication and in a recent National Toxicology Program report of RP-containing topical preparations, suggesting the possible earlier onset of ultraviolet-induced squamous cell carcinomas in the hairless mouse photocarcinogenesis model. This suggestion contradicts a large body of data indicating that topical retinoids are chemoprotective in humans, and it was immediately challenged by new reviews on the safety of RP in general and within sunscreens. This paper will review the preclinical and clinical data supporting the safety and chemopreventive activity of retinoids, with an emphasis on RP, and will examine the experimental systems used to evaluate the safety of topical vitamin A preparations in order to provide perspective relative to human skin.
J Drugs Dermatol. 2013;12(4):458-463.
No abstract details for the moment.
Lark G. Guss MD, Yevgeniy Balagula MD, Stefan Doig MD, Gulsun Erdag MD, Ginette A. Okoye MD
No abstract details for the moment.
Acne is a very common skin disease; frequently seen in adolescents and often persisting or occurring into adulthood. Topical therapy is very effective in mild to moderate disease, and is used as maintenance therapy. Fixed combination products have been studied in moderately severe disease. Combinations of benzoyl peroxide and either clindamycin or adapalene appear very effective. When utilizing a topical retinoid alone or in combination, it is essential to incorporate an appropriate skin care regimen to minimize local irritation. In the absence of direct comparative clinical trials, this review provides timely guidance for clinicians on the use of these agents, and their benefits in special populations.
J Drugs Dermatol. 2015;14(6):567-572.
The pathophysiology of rosacea has undergone renewed interest over the past decade, with a large body of evidence supporting the role
of an abnormal innate immune response in rosacea. Many mechanisms interact with the cutaneous innate immune system that may be
operative. A variety of potential triggers stimulate this immune detection system which is upregulated and hyper-responsive in facial skin
of patients with rosacea as compared to normal skin. Based on the most current data, two conclusions have been reached. First, the
major presentations of rosacea appear to be inflammatory dermatoses. Second, the presence of a microbial organism is not a primary
or mandatory component of the pathogenesis of rosacea. Available therapies for rosacea exhibit reported modes of action that appear
to correlate with the inhibition of inflammatory processes involved in the pathophysiology of at least some presentations of rosacea.
J Drugs Dermatol.2012;11(6):694-700.
Steven R. Feldman MD PhDa and Diana M. Chen MDb
Background: Products that may cause irritation are widely used to treat acne. Irritation has the potential to reduce treatment adherence.
How patients manage irritation and dryness is not well characterized.
Objectives: To study self-reported irritation, its impact and coping mechanisms in patients who had been treated for acne with a
clindamycin-5% benzoyl peroxide (BPO) product.
Methods: An Internet-based survey of 200 subjects, aged 15-40 years who had used a clindamycin-5% BPO fixed combination
product in the last six months on at least 50 percent of their face, at least five days per week.
Results: The majority of subjects (57%) had moderate acne, 28 percent had severe acne. Bothersome side effects of the clindamycin-
5% BPO combination included dry skin (55%), flaky/peeling skin (45%), irritated skin (44%), itchy skin (39%) and redness (37%).
As a result, subjects used the product only as a spot treatment (33%), only when breakouts seemed worse (28%), or less often than
recommended (32%); stopped using from time to time (32%); switched to a different prescription medication and/or an over-thecounter
acne product (28%); or stopped using altogether (10%). 41 percent of subjects reported using moisturizers to counteract
dryness and redness.
Limitations: We queried patients concerning use of combination clindamycin/BPO products and not other products.
Discussion: Irritation to clindamycin-5% BPO is a common problem that reduces patients' use of the medication. Strategies to
improve treatment include communication with patients on possible side effects, providing written instruction on how to manage
irritation and dryness and consideration of alternative topical treatments and treatment regimens.
J Drugs Dermatol. 2011;10(6):605-608.
Ashish C. Bhatia MDa,b and Felipe Jimenez PhDc
The biggest hurdle in the treatment of acne vulgaris is patient non-compliance that is due in large part to poor tolerability to common acne medications. As such, new acne treatments must be developed that balance good anti-acne efficacy with excellent tolerability in order to ensure patient adherence and by extension ensure good clinical outcomes. The goal of the present study was to determine the tolerability and efficacy of a novel skin care system, composed of a cleanser, containing 1% salicylic acid and botanical ingredients, and a treatment gel, containing 1% salicylic acid, 10% buffered glycolic acid and botanical ingredients for the treatment of mild acne. In this single-center, open-label clinical study, 25 male and female volunteers used the test cleanser and test gel twice daily over six weeks. Tolerability assessments showed that the skin care regimen was very well tolerated by all study volunteers. Acne severity was significantly reduced by two acne grades at six weeks. Inflammatory lesion counts were significantly reduced, on average, by 59.06% (P≤ 0.0001), 91.62% (P≤ 0.0001), 90.85% (P≤ 0.0001) and by 98.55% (P≤ 0.0001) at weeks 1, 2, 4, and 6, respectively. Non-inflammatory lesion counts were reduced, on average, by 13.54% (ns), 38.95% (P≤ 0.0001), 44.48% (P≤ 0.0001), and by 56.10% (P≤ 0.0001) at weeks 1, 2, 4, and 6, respectively. Standardized photography also demonstrated a progressive reduction in acne lesions over time. In conclusion, results of the present study suggest that the tested skin care regimen offers rapid acne clearance and excellent tolerability that together may help to improve patient adherence as well as treatment outcome.
J Drugs Dermatol. 2014;13(6):678-683.
George Hruza MD, Amy Forman Taub MD, Susannah L.Collier MD, Stephen Robert Mulholland MD
Introduction: Skin resurfacing has evolved rapidly over the past 15 years from ablative techniques to nonablative methods and most recently fractional ablative resurfacing. The purposes of this study were to analyze the degree of tissue ablation, coagulation, and
heating; and to evaluate the clinical efficacy and safety of a fractional radiofrequency (RF) device, for the treatment of wrinkles with
fractional skin ablation and coagulation.
Material and Methods: Individuals scheduled for abdominoplasty received fractional RF treatment to the abdomen area, using different
tips at varying energy densities and coverage rates. Biopsies were performed ex vivo following abdominoplasty and tissue
samples were routinely processed and stained, using hematoxylin and eosin). Another group of subjects received 3 facial treatments,
scheduled at 3 to 4 week intervals. Clinical improvement and response to therapy were evaluated with standardized photography and
clinical assessment by the subjects and investigators.
Results: Histological findings immediately posttreatment revealed demarcated zones of ablation/coagulation/necrosis and subnecrosis
up to a depth of 450 μm. Higher energy levels generated deeper effects. We noticed a tunable balance between ablation and
coagulation/necrosis. These effects were coverage mode and energy density dependent. Subjects undergoing facial treatment had
minimal pain, no permanent side effects, or significant downtime. Investigators’ assessment for improvement in skin texture correlated
with subjects’ evaluation and was greater than 40% for approximately 50% of subjects. Eighty percent of the subjects were
satisfied with the results. Higher energy levels and lower coverage rates produced better aesthetic results along with less pain.
Conclusion: The clinical observations and histological findings suggest that fractionated ablative skin resurfacing using a fractional
radiofrequency device resulted in a safe, tolerable and effective improvement in skin texture and reduction of wrinkles. The depth of
tissue ablation, coagulation and necrosis and the relative proportions of these phenomena were found to be controllable and could
be modulated to optimize treatment of variable dermatologic conditions.
Deborah S. Sarnoff MD FAAD FACP
BACKGROUND: Laser lipolysis is a less invasive approach to neck rejuvenation than open surgery or liposuction. Wavelengths utilized for lipolysis
liquefy fat and induce collagen remodeling, which tightens skin. A new Nd:YAG device has recently been developed that emits energy at a
wavelength of 1440nm; this wavelength is more highly absorbed by adipose tissue and water than other wavelengths currently available.
OBJECTIVE: To test the safety and efficacy of a pulsed 1440nm Nd:YAG wavelength and side-firing fiber for the treatment of subcutaneous
fat and skin laxity associated with the aging neck.
METHODS: Twenty-four subjects aged 40 to 65 years underwent laser lipolysis of the submental and anterior cervical areas. An average
of 1205J per 5x5cm square was delivered, with a maximum internal temperature setting of 47 degrees C. Cervicomental Angle Score (CAS),
Global Aesthetic Improvement Scale (GAIS), subject and investigator satisfaction, and safety were assessed.
RESULTS: At six months post-treatment, 79% of subjects had a significant improvement in the CAS (P<.001) and 79% demonstrated an
improvement on the GAIS. Clinical improvement was marked and evident for all but one subject, with physician and patient satisfaction
scores indicating overall satisfaction with the procedure and outcomes. Adverse events were mild and transient with no incidence of
burns, seromas, hematomas, infection, or nerve damage.
CONCLUSION: The 1440nm Nd:YAG device with the side-firing fiber was safe and effective for the treatment of subcutaneous fat and skin
laxity in the neck. This device offers an alternative to selected individuals aged 40 and over who do not wish to undergo rhytidectomy.
J Drugs Dermatol. 2013;12(12):1382-1388.
James Q. Del Rosso DO FAOCDa and Emil Tanghetti MDb
Tazarotene is a synthetic retinoid that, depending on the concentration and vehicle, is approved by the US Food and Drug Administration for the topical treatment of acne vulgaris (AV) and plaque psoriasis. Tazarotene is also used as adjunctive treatment for specified clinical manifestations of chronically photodamaged skin (facial fine wrinkling, mottled facial hypopigmentation and hyperpigmentation, and benign facial lentigines), along with comprehensive skin care and photoprotection from sunlight. The gel formulation was released in the United States in 1997, with the cream formulation made available in 2000. Multiple studies are available supporting the effective and safe use of topical tazarotene for each of its indications. This article provides an overview of the pharmacology of topically applied tazarotene, discussing in particular up-to-date information on the efficacy, tolerability, and safety of topical tazarotene for AV, including monotherapy and combination therapy studies. Topical tazarotene 0.1% in both formulations is highly effective in reducing both inflammatory and noninflammatory acne lesions, and can be used in combination with other topical agents, including formulations containing benzoyl peroxide or dapsone 5% gel. Although many patients tolerate the use of topical tazarotene without significant issues or concerns, some patients experience application-site tolerability reactions, which can usually be managed with proper skin care and are less frequent with the cream formulation.
J Drugs Dermatol.2013;12(3 suppl 2):s53-s58.
Jaimie B. Glick MD and Ravneet Ruby Kaur MD
No abstract details for the moment.
Aimee Krausz BA and Adam J. Friedman MD
No abstract details for the moment.
K. Wade Foster MD PhD, David J. Kouba MD PhD, Edgar F. Fincher MD PhD, Zachary S. Glicksman, Jennifer Hayes, Valerie Freeman PA, Helen H. Fincher MD, Ronald L. Moy MD
Background: Carbon dioxide laser resurfacing remains the gold standard for the treatment of photoaged skin. Today, however,
fewer patients will tolerate the postoperative downtime associated with the use of this device. Fractional photothermolysis
was designed to overcome the disadvantages associated with ablative resurfacing. Prototype fractional lasers
(Fraxel®, Reliant Technologies Inc.) have required the use of blue tracking dye to give evenly spaced microtreatment zones,
and treatments are associated with moderate levels of discomfort because of microtreatment zone depths reaching
nearly 1000 ?m. Newer technologies have evolved that do not require tracking dye, and are less painful than older prototypes because microtreatments are associated with moderate levels of discomfort because of microtreatment zones are more superficial (100 to 300um) than that of the Fraxel laser. Newer devices offere advances in treating facial ryhtides and skin laxity through the use of 2 laser wavelengths (1320 nm/1440 nm)emitted sequentially through a specialized diffractive lens array that produces high-intensity microtreatment zones surrounded by low level heating.
Observations: One to 3 treatments with this combination fractional laser device were performed on 16 Caucasian females with static periocular rhytides or skin laxity affecting the nasolabial crease. There was a 3-week period between treatments. Improvement was noted in both areas after a small number of treatments.
Conclusion: The technology behind fractional lasers is rapidly evolving, and new devices offer significant advances over older prototypes.
Sabrina G. Fabi MD and Mitchel P. Goldman MD
BACKGROUND: Photoaged skin, characterized by mottled, irregular areas of pigmentation, is a common skin condition that is often difficult to treat. The areas of hypermelanosis are an aesthetic concern to subjects and may lead to social distress and quality of life issues. There are many commercial hyperpigmentation regimens marketed to lighten dark spots and improve overall skin dyschromia. However, data to support efficacy of such kits are often lacking.
OBJECTIVE: This investigator-blinded, randomized trial was conducted to compare a new hydroquinone (HQ)-free hyperpigmentation regimen against a leading HQ-based hyperpigmentation regimen for the treatment of facial hyperpigmentation and photoaging.
METHODS: Subjects with mottled pigmentation and photodamaged facial skin were randomized to treatment with either the new 4-product (HQ-free) SkinMedica® Hyperpigmentation System (SKM; SkinMedica, an Allergan Company, Carlsbad, CA) kit or the 7-product (HQ-containing) Obagi Nu-Derm System (OMP; Obagi Medical Products, Long Beach, CA) kit. Subjects were evaluated by a blinded investigator for clinical efficacy and tolerability using grading scales at baseline and at weeks 4, 8, and 12. Standardized digital photographs were taken at baseline and week 12. Self-assessment questionnaires were completed at week 12.
RESULTS: Thirty-six female subjects (16: SKM; 20: OMP) completed the 12-week comparative study. Both hyperpigmentation regimens significantly reduced Overall Hyperpigmentation, Mottled Pigmentation Area and Severity Index (MoPASI), global photoaging, and sallowness at week 12 compared to baseline. Significant reductions in tactile roughness were seen with the OMP regimen at week 12. In these investigator-blinded assessments, there were no significant differences between treatment groups, nor was there a difference in global response to treatment. Investigator assessments of tolerability showed mean scores were mild or below for all parameters with both treatment regimens.
CONCLUSION: A new 4-product (HQ-free) regimen was shown to be as effective and tolerable as a 7-product (HQ-based) regimen in reducing facial hyperpigmentation and photoaging in females with mottled pigmentation and photodamaged facial skin.
J Drugs Dermatol. 2013;12(3 suppl 1):s32-s37.
David A. Kasper DO MBA, Joel L. Cohen MD, Aradhna Saxena MD, Greg S. Morganroth MD
Traditional scar revision has addressed issues of thickness with intralesional corticosteroids, superficial contours with dermabrasion
or laser resurfacing, and postrepair erythema with hemoglobin-targeted laser therapy. Historically, collagen fillers
have been used to address several types of scars, including acne, varicella, and trauma, as well as larger soft tissue contour
defects.1,2With the introduction of new types of fillers to the dermatologic surgeon’s armamentarium, many types of scars
with longer lasting results can be addressed. Success has been noted with the use of these newer and more durable fillers,
such as hyaluronic acid and calcium hydroxylapatite, to fill and blend postsurgical depressed scars following the reconstruction
of skin cancer defects.
Marta Rendon MD FAADa and Laurence Dryer PhDb
OBJECTIVE: To evaluate the treatment of mild-to-moderate epidermal melasma and photodamage using a 4% hydroquinone skin care system plus tretinoin 0.02% cream.
METHODS: Single-center, investigator-blinded study in 39 adult females with mild-to-moderate epidermal melasma, mild-to-marked pigmentation
intensity, and Fitzpatrick skin type III to VI treated for 24 weeks. Improvements in melasma severity, pigmentation intensity, photodamage, and patient satisfaction were assessed at weeks 4, 8, 12, 18, and 24. Cutaneous tolerability was assessed by investigator
(erythema, dryness, peeling) and patients (burning and stinging). Adverse events (AEs) were monitored throughout.
RESULTS: Melasma severity, pigmentation intensity, and melasma area and severity index (MASI) scores relative to baseline were all significantly reduced from week 4 onward (P<.001). In addition, signs of facial photodamage were significantly improved. At week 24, 87.9% of patients were “satisfied” or “very satisfied” with the overall treatment effectiveness and Quality of Life (QoL) was much improved. No patient discontinued due to lack of efficacy or treatment-related AEs. One patient (2.8%) reported severe cutaneous intolerability (erythema at week 4).
CONCLUSION: Treating mild-to-moderate melasma using a 4% hydroquinone skin care system plus 0.02% tretinoin cream can significantly
reduce the severity and intensity of melasma and associated pigmentation, and improve signs of photodamage within four weeks. Treatment was generally well tolerated and associated with high levels of patient satisfaction.
J Drugs Dermatol. 2016;15(4):466-475.
Sody Abby Naimer MD, Amnon Biton MD, Morris Topaz MD
Background: Removal of subcutaneous skin masses and certain deep skin injuries results in defects, which demand immediate
closure. Although primary closure of these defects in 2 layers is an acceptable solution, this technique has a number of
drawbacks, such as extended time consumption upon performance, demand for additional suture material and occasional tissue
response or foreign body reaction to retained absorbable stitches leading to infection and its sequelae.
Objective: We describe an approach intended to furnish a satisfactory solution to the needs of tissue closure in such cases.
The significant innovation of this technique is the closure of both deep and superficial layers of skin in one single suture.
Materials and Methods: Our suture combines the advantages of the classic mattress suture together with those of the buried
subcutaneous suture. We performed the vertical mattress suture with 3/0 polypropylene or monofilament suture and added a
subcutaneous loop to achieve sufficient approximation of deep tissue surfaces. This suture technique was applied in our first
50 cases. The defects were closed without adverse sequelae. No tissue infections were observed. Wound dehiscence occurred
in one case after premature suture removal. The stitches were slightly more difficult to remove than regular sutures. Review
of the resulting scars exhibited acceptable results similar to those of parallel closure techniques.
Conclusions: This easily performed technique yields the benefits of reducing suture cost, annulling foreign body reaction, and
resulting in both a functional and aesthetically pleasing outcome. The subcutaneous loop technique has become our standard closure of choice for wounds demanding cutanwous and subcutanwous repair.
Miriam S. Bettencourt MD
Actinic keratoses (AKs) are premalignant skin lesions caused by cumulative ultraviolet-light exposure that may progress to invasive squamous cell carcinoma (SCC). As the clinical presentation of AKs varies widely, only a histopathologic analysis of a biopsied sample can eliminate or confirm a diagnosis of invasive SCC. Reducing the burden of AK with a combination of lesion-directed and field-directed treatments may help to identify persistent, suspicious lesions that require further evaluation. We present 10 cases of SCC that were identified and histologically confirmed in 7 patients after complete or substantial clearance of AKs by sequential treatment of sun-damaged skin with cryosurgery and ingenol mebutate.
J Drugs Dermatol. 2015;14(8):813-818.
Jayashri V. Ghate MD and Carrie D. Alspaugh MD FAAD
Palmoplantar pustular psoriasis (PPP) is an uncommon form of chronic psoriasis. Characterized by sterile, intra-epidermal pustules located
on the palms and soles, it is highly resistant to treatment. A patient presented with palmar inflammation and throbbing joint pain
in his hands, as well as erythematous, pustular, and micaceous scaling skin on his right foot, legs, elbows and hands. Approximately
4% of his body surface area was involved, and he was diagnosed with PPP after skin biopsy. After conventional therapy failed, the
patient underwent treatment with adalimumab and the majority of his symptoms resolved after 16 weeks of therapy. Adalimumab
may be effective for the treatment of PPP. Adalimumab, a fully human, immunoglobulin G1 monoclonal antibody that binds to tumor
necrosis factor, has been approved for the treatment of moderate-to-severe psoriasis, in the U.S., Europe and elsewhere.
Elizabeth T. Makino BS MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa
aSkinMedica, Inc, Carlsbad, CA bThomas J. Stephens & Associates, Inc, Carrollton, TX cProPharmaCon, LLC, Carlsbad, CA
There are numerous common skin disorders involving hyperpigmentation, including solar lentigines, postinflammatory hyperpigmentation,
melasma, freckles, and dyschromia from photoaging. While these conditions are of an aesthetic nature, there is great interest
in newer, safer, and more effective treatment modalities. Topical hydroquinone (HQ) has been the gold standard of skin lighteners for
many years. However, regulatory authorities around the world are now questioning its safety. A randomized, double-blind, half-face
study was conducted in females having moderate to severe facial hyperpigmentation to assess the efficacy and tolerability of 3 new
skin brightener formulations containing SMA-432, a prostaglandin E2 inhibitor, compared with 4% HQ. Each subject was assigned 2
of the 4 test materials and was instructed to apply the product on the assigned side of the face twice daily for 12 weeks. Evaluation
visits were conducted at baseline and at 4, 8, and 12 weeks. At each visit, subjects were evaluated by a blinded investigator for clinical
efficacy and tolerability using grading scales. Standardized digital photography and Chroma Meter assessments were also taken.
Self-assessment questionnaires were completed at weeks 4, 8, and 12. Sixty-eight Caucasian subjects (136 half faces) completed the
study. All test materials significantly reduced Overall Hyperpigmentation and improved the Investigator's Global Hyperpigmentation
Improvement rating at weeks 4, 8, and 12 compared with baseline. SMA-432 exhibited a dose-dependent improvement in hyperpigmentation.
There were no major tolerability issues with any of the test materials. Self-assessments were generally favorable for all test
materials. At the completion of the trial, subjects rated one of the tested multimodality brightener compositions as the most favorable
product and 4% HQ as the least favorable. This study demonstrated that the new non-HQ-containing skin brightener formulations were
as effective and equally well tolerated as the gold standard, 4% HQ, in females with facial hyperpigmentation.
J Drugs Dermatol. 2012;11(12):1478-1482.
Whitney P. Bowe MD, Sharon Glick MD, Alan R. Shalita MD
No abstract details for the moment.
No abstract details for the moment.
Debbie M. Palmer DO and Jennifer Silverman Kitchin MD
Objective: This 12-week, double-blinded, randomized, controlled clinical usage study was conducted to evaluate the efficacy and tolerance of a novel topical, multi-ingredient, polyphenol, high antioxidant skin care system (facial wash, day lotion, night crème and eye serum) to reduce the appearance of photoaging. Methods: A total of 40 Caucasian female participants were randomly assigned to apply the test regimen or control regimen for 12 weeks. One group washed with the test antioxidant facial wash twice daily, applied the test antioxidant day lotion each morning and the test antioxidant night creme and eye serum each evening. The second group washed with a control facial wash twice daily and applied a control moisturizer each morning and evening. Clinical evaluations for efficacy were made by a board-certified dermatologist at baseline and after six and 12 weeks of product use. Efficacy was also measured by subjects’ self-assessments and via photography
and instrumentation. Results and Conclusion: Overall, the results of the study showed that the test regimen produced statistically significant improvements in the appearance of photodamaged skin. Most impressive was the significantly greater improvements produced by the test regimen over the control regimen for nearly every grading parameter. The results from this study demonstrate that this high Total ORACsc scoring antioxidant skin care system was well tolerated, with no adverse events reported by the participants during the course of the study, and improved, significantly greater than a control regimen, the appearance of wrinkles, firmness, hyper pigmentation, blotchy redness, tactile roughness and clarity in photodamaged skin. Post-baseline clinical grading scores, silicone replica parameters, cutometer and corneometer scores were statistically compared to baseline using a paired t test at the P≤0.05 significance level.
Ali Mohammad Saafan PhD and Manal Mohamed Salah MD
Objective: To evaluate the efficacy of application of dual long-pulsed dye/Nd:YAG lasers in the management of skin and mucous
membrane infantile hemangiomas.
Background: Management of hemangiomas may be a challenge. Different laser systems have been reported to be of significant
help for such cases with variable results.
Patients and Methods: In this study, the authors present a unique sequential laser system, which delivers pulsed dye laser (PDL)
595 nm followed by Nd:YAG 1064 nm, which they have found to be superior and more effective than other reported techniques.
Twenty-five cases of infantile hemangiomas in the skin and mucous membrane in the head and neck region were selected to be
enrolled in this study. Assessment for progress was achieved clinically.
Results: The authors achieved excellent results in eighteen patients (72%) out of the 25 treated patients, with no recurrence after sixmonth
follow-up. Laser application from skin and mucous membrane sides (sandwich technique) decreased number of sessions.
Conclusion: The sequential application of 595 nm PDL followed by 1064 nm Nd:YAG laser can be considered a superior method
for management of infantile hemangiomas, especially in the head and neck region, due to its excellent cosmetic results with fewer
Valerio Cervelli MD, Pietro Gentile MD, Diana Spallone MD, Fabio Nicoli MD, Stefano Verardi MD, Massimiliano Petrocelli MD, Alberto Balzani MD
Background and Objective: Scar management is a long-term process. A variety of modalities have been employed and, depending
on scar type, treatment may be invasive and/or conservative. The purpose of this study was to evaluate a new CO2 laser resurfacing
for post-traumatic and pathological scars and to compare this device with classic dermabrasion. The new fractionated ultrapulsed CO2
laser (Ultrapulse Encore, Lumenis Ltd., Santa Clara, CA) is equipped with two types of scanners: the first, ActiveFX, is non-sequential
while the second, DeepFX, is sequential and produces microspot.
Materials and Methods: From September 2008 to November 2008, a study on 60 patients was performed. The patients (average
age 47.3 years) enrolled in this study had severely scarred skin and were divided into two groups of 30 people. All patients were
Caucasian with skin type II or III. Each scar was photographed and scored by the authors using the Manchester Scar Scale (MSS).
Follow-up ranged from 12–15 months.
Results: Sixty patients were analyzed in two homogeneous groups. Significant improvement in skin tone, texture and appearance of
skin was noted in all patients treated with CO2 laser, lower improvement resulted with dermabrasion. Both subjects and investigators
noted similar aesthetic improvement. No major complications were found for both groups and minor complications included transient
erythema and edema.
Conclusion: Fractional ultrapulsed CO2 laser resurfacing has proven to be both safe and effective. The efficacy and favorable side effects
profile for this technology, with low incidence of pigmentary changes, make it a viable alternative for the treatment of moderateto-
Jean Carruthers MD, Steven R Cohen MD, John H. Joseph MD, Rhoda S. Narins MD, Mark Rubin MD
Our expanding understanding of the physiological and immunological conditions of the skin and, in particular, the aging face, has
prompted a growing field of aesthetic technology. Restorative procedures are taking advantage of improved and refined biotechnology,
which continues to evolve at a rapid pace. Whereas surgical correction of skin laxity was the norm in years past, there are now
many topical options available to encourage healthy, youthful skin, and an ever-growing, increasingly perfected depot of minimally
invasive, injectable dermal volumizers and stimulators, collectively referred to as dermal fillers. The growth indicators for this market
are as striking as the science. However, successful use of dermal fillers is not only a function of the quality of science leading to improved
biocompatibility but also the "art" of client selection, filler application and vigilant follow up. Even the "ideal" filler is subject
to unique interactions with both the practitioner and the patient. This article presents a review of the safety and efficacy of the most
commonly used dermal fillers with emphasis on those approved for facial aesthetics. The subtleties of improved filler technologies
that impact tissue acceptance and reaction, measures of effectiveness and a comparison of wrinkle-reduction outcomes, the nature
and incidence of acute and chronic tissue reaction, and a discussion of recommended or preferred filler applications are presented.
Salma Z. Pothiawala MD MPH, Brooke T. Baldwin MD, Basil S. Cherpelis MD, Mary H. Lien MD, Neil Alan Fenske MD
Cutaneous T-cell lymphoma (CTCL) is a type of non-Hodgkin’s lymphoma characterized by the malignant proliferation of T lymphocytes in the skin. Phototherapy has been proven an effective treatment modality for CTCL, in particular early stage disease (patch and plaque). Specifically, broadband ultraviolet B (BB-UVB), psoralen and ultraviolet A (PUVA),and more recently narrowband UVB (NB-UVB) are the skin-directed phototherapies typically utilized. Phototherapy poses the risk of sunburn, photoaging and photocarcinogenesis. Combination therapies with IFN-α, retinoids (acitretin and isotretinoin) and rexinoid (bexarotene) are adjunctive systemic therapies that facilitate enhanced therapeutic response and often allow for lower doses of phototherapy. Extracorporeal photopheresis (ECP) has also been shown to be effective in more advanced stage disease.
Intense pulsed light (IPL) has been a popular nonablative treatment of photodamage. A prospective, randomized, controlled,
single-blinded, split-face pilot study compared the efficacy and safety of 2 multitechnology broadband pulsed light
platform devices: an IPL device (Lumenis One, Lumenis Corporation, Santa Clara, CA) and a fluorescent pulsed light
with advanced fluorescent technology (AFT, Harmony System, Alma Lasers, Buffalo Grove, IL) device. Eight volunteer
subjects (skin types I-IV) with a 2.0 mean Global Score for Photoaging (scale 0-4) participated in the study. Subjects received
3 to 5 treatments 3 weeks apart in which one side of the face was treated with the IPL device and the other side
with the AFT device. During each treatment session, the face received 3 complete passes without anesthesia. Treatment
was aggressive and parameters were determined by test spot application. Treatment endpoints were mild erythema. Results
were evaluated by clinical observations of the investigator and comparison of pre- and post-treatment photographs
by subjects and 2 blinded dermatologists. Blinded evaluators agreed that improvements in dyspigmentation, telangiectasias,
erythema, and skin texture were similar on both sides of the face. Subject assessments of discomfort during treatment
were also comparable. Adverse effects were not observed.
Ann R. Tucker BA,a Ashley N. Emerson MD,a Julie P. Wyatt MD,b Robert T. Brodell MDc
Diaper dermatitis is the most common dermatologic disorder of infancy. Its cause can often be determined clinically based on the clinical
presentation. Primary diaper dermatitis is associated with irritants and spares the deep skin folds. Secondary diaper dermatitis is most
often caused by Candida yeast overgrowth and typically presents as a well-defined area of beefy red erythema covering the diaper area
and including the deep folds of skin with hallmark satellite pustules. Other causes include seborrheic dermatitis, psoriasis, acrodermatitis
enteropathica, allergic contact dermatitis, Langerhans cell histiocytosis, and, in the setting of a primarily pustular eruption, bacterial folliculitis.
A simple potassium hydroxide preparation (KOH) can confirm the diagnosis of candida diaper dermatitis and guide proper treatment.
Psoriasis is a chronic inflammatory skin disease that is characterized by thickened red plaques covered with silvery scales. Excimer laser therapy is a cutting-edge advancement in UVB phototherapy. In contrast to traditional phototherapy, the 308 nm excimer laser only targets psoriasis plaques, while it spares uninvolved skin. It allows for treatment with a supra-erythmogenic dose of UVB irradiation. Targeted UVB therapy is a possible treatment especially for many who have failed topical treatments, systemic therapy, and traditional phototherapy. For safe and effective psoriasis treatment, a combination of therapies may be used, including a combination of laser treatment with topical medications. We present two cases demonstrating effective treatment with excimer laser in conjunction with clobetasol spray and calcitriol ointment for 12 weeks. Long-term near-clearance of psoriasis was sustained after 6 months and one-year follow up periods without further therapy.
J Drugs Dermatol. 2012;11(8):994-996.
Tiffani K. Hamilton MD
Psoriasis and psoriatic arthritis (PsA) are chronic inflammatory disorders. Efalizumab targets several T-cell interactions central to psoriasis
immunopathogenesis. Etanercept and infliximab are antitumor necrosis factor (anti-TNF) agents that modify the inflammatory
and cell-mediated immune responses involved in the pathogenesis of psoriasis and PsA. All 3 agents are approved for the treatment
of plaque psoriasis, and etanercept and infliximab are also approved for the treatment of PsA. Twenty patients with psoriasis and PsA
have been successfully treated with a combination of efalizumab (1 mg/kg/wk) and etanercept (25 mg or 50 mg/wk) or infliximab (5 to
6 mg/kg). To date, no serious adverse events have been reported. Combination therapy was well tolerated and effectively controlled
both skin disease and arthritis. The complementary activity of efalizumab with an anti-TNF agent is most likely attributable to their differing mechanisms of action. Further investigation is warranted.
Objective: To quantify and compare the physiochemical properties of various topical emollients and to correlate these findings with the products' potential to maintain the stratum corneum (SC) acid milieu, while possessing the appropriate water content for skin rehydration, user adherence, and comfort.
Material and Methods: The pH and hydrophilic fraction of 31 skin moisturizers sold in the US were measured. Hydrophilic Index (HI) was calculated using the "HI equation." The two parameters were charted using a scatter plot with quadrant divisions. Products with lower hydrophilicity were considered "more greasy" and assigned a lower HI as compared to their counterparts with a higher hydrophilicity.
Results: Our findings are in good accordance with common clinical impressions: lotions generally have higher HI, while ointments have lower HI. The majority of the products tested fall into low HI, suggesting that a large percentage of the products may be rich in overall lipid content. The pH values range widely, from 3.7 to 8.2, with the majority of the products close to the physiologic skin pH of 4 to 6.
Conclusion: This study introduces HI as a novel method of quantifying the aqueous content of topical emollients. When considered together with pH, the two indices can guide providers in choosing the most suitable emollients for patients with skin diseases involving altered acid mantle and barrier disruption, such as atopic dermatitis, irritant contact dermatitis, and ichthyosis vulgaris.
J Drugs Dermatol. 2012;11(5):633-636.
Sara L. Swineford MD and Carol R. Drucker MD
Malignant acanthosis nigricans (MAN) with oral florid papillomatosis is a rare paraneoplastic condition affecting the skin and mucocutaneous
tissues associated with an underlying malignancy. It is characterized by proliferation of keratinocytes resulting in papillomatous
change and hyperpigmentation of the skin and multiple confluent warty or verrucous lesions of the oral mucous membranes.
The oral involvement can interfere with the patient’s ability to eat and drink. There is no specific therapy for this complication. Treatment
of the underlying malignancy can lead to improvement of symptoms, but the degree of improvement varies. Here, the authors
present a case of MAN with oral florid papillomatosis associated with gastric adenocarcinoma that was treated with oral retinoids resulting in significant clinical improvement of the hyperkeratosis and hyperpigmentation as well as improved patient functionality.
C. Cantisani MD,a G. Paolino MD,a U. Bottoni MD,b and S. Calvieri MDa
BACKGROUND: non-melanoma skin cancer (NMSC) is the most common malignancy, whose public health significance is often unrecognized.
Its incidence continues to grow at an alarming rate, becoming an occupational disease. Available treatments alternative to surgery include: photodynamic therapy, electrochemiotherapy, cryotherapy, ablative lasers, 5–fluorouracil, imiquimod, ingenol mebutate,
and diclofenac. Each of these options has its advantages and disadvantages. Photodynamic therapy (PDT), using topically applied photosensitizer precursors such as methylaminolaevulinate (MAL), is a useful nonsurgical treatment, well accepted by patients, but the main limitation is pain. Recently, in order to overcome this limit, visible light irradiation photherapy was considered.
AIM: we report our experience comparing conventional PDT (406 patients) with daylight-mediated PDT (D-PDT) 240 patients with multiple
actinic keratoses (AK), afferent to our photodynamic outpatients clinic from September 2013 to June 2014.
MATERIALS AND METHODS: to establish predictors for the clinical response to conventional PDT and daylight PDT (DPDT), a retrospective study on 646 patients was performed. The following parameters have been evaluated: sex, age, anatomic site of the primary tumor and local skin reactions. We used the Spearmen’s coefficient between the clinical response and the predictors analyzed; while Odds Ratio (OR) was performed to evaluate general clinical response and local skin reaction between PDT and D-PDT patients. Subsequently, we performed a sub-analysis, focusing to the anatomical sites, and we subdivided anatomical sites in face and scalp, nose, trunk, and extremities.
RESULTS: a total of 406 patients treated with PDT and 240 patients treated with D-PDT, were enrolled in the current report. The median age was 71 years in PDT and 73 years in D-PDT. The mean clinical response in PDT was of 74.4% and 95% in D-PDT. Performing OR between PDT and D-PDT, according to the clinical response, we found a better behavior in patients treated with D-PDT (P < 0.03); the same significance was maintained according to the presence or absence of local skin reaction (P < 0.0002). Using no parametric Spearman’s
Coefficient test among predictive factors and the therapeutical response we found that D-PDT showed a better clinical response in patients with AK size ≥0.6 mm (P < 0.03), while this evidence was not present in PDT. The nose remained in both PDT and DPDT the main anatomical site with a better clinical response to the treatment.
CONCLUSION: Since efficacy of D-PDT is comparable or superior to conventional type, but is simpler and better appreciated by patients, in our opinion it may be used routinely to treat sun exposed multiple AKs especially in sun damaged skin also for aesthetic purposes.
J Drugs Dermatol. 2015;14(11):1349-1353.
James M. Swinehart MD
Problem: Surgical therapy of moderate or severe acne scars in African-Americans, Hispanics, and other individuals with
darkly pigmented skin.
Challenges: Dyspigmentation in more darkly complected individuals following surgical or resurfacing operations creates an
additional risk in an already difficult series of procedures. Other challenges include the lack of response of deep acne scars
to lasers in general, the unpredictability of various techniques, and the long learning curve involved with dermabrasion.
Methods: Case reports are presented in which chemical peeling, punch grafting, punch elevation, subcision, dermal grafting,
and wire brush and diamond fraise dermabrasion were employed in one Hispanic and one African-American patient.
Results: A satisfactory outcome was attained in each patient.
Macrene Alexiades MD PhD
Jasmonates are plant-derived hormones from linoleic acid that were originally isolated from jasmine, and which are involved in plant stress regulation, wound repair and defense. They have been demonstrated through in vitro and in vivo studies to possess anti-neoplastic properties. Most recently, a novel jasmonate analog was developed, tetrahydrojasmonic acid (LR2412), which possesses favorable characteristics for cutaneous application and which induces improvements in epidermal hyaluronic acid and thickness. Clinical application of LR2412 to facial skin has been demonstrated to reduce the appearance of wrinkles and photoaging. In this issue, a clinical trial is published demonstrating the results of topical application of this agent for th cosmetic treatment of wrinkle appearance, poor texture and large pores.
J Drugs Dermatol. 2016;15(2):206-207.
Irene J. Vergilis-Kalner MDa and Joel L. Cohen MDb
Nawaf Al-Mutairi MD FRCP(C), Arun Joshi MD, Osama Nour-Eldin MSc
Hereditary punctate palmoplantar keratoderma (Buschke-Fischer-Brauer disease) is a rare disorder of keratinization.
We describe here a 49-year-old male patient of this condition with many unusual features such as late onset of the disease
in the fourth decade and nail changes (longitudinal pigmented striations, curved nails and pits in the fingernails;
and nail thickening, subungual hyperkeratosis and yellowish discoloration in toenails). The patient developed
histopathologically proven skin lesions typical of psoriasis 7 years after appearance of the keratoderma. This association
has not been reported earlier. The patient’s skin lesions cleared completely with acitretin therapy within
David McDaniel MDa and Paula Lozanova MDb
BACKGROUND: A previously published study used a radio frequency (RF) focused field device (Vanquish, BTL Industries Ltd., Framingham, MA) to reduce porcine abdominal fat. The purpose of this case study was to reproduce the veterinary study on human subjects. The primary objective was measurement of apoptotic index before and after treatment with the RF device. As a second outcome demonstrating
selective heating and safety, superficial skin temperature and temperature 1 and 2 cm into the subcutaneous tissue were measured.
METHODS and MEASUREMENTS: Two healthy female subjects underwent abdominal skin and fat biopsies at baseline and after one treatment with a similar focused field high frequency RF device capable of 200 watts for 45 minutes. Biopsies were performed 1 hour post-treatment and were analyzed using the TUNEL method. Infrared imaging of the skin surface temperature was measured in both subjects. Thermocouple measurements at 1 and 2 cm were performed during the treatment cycle on a single subject.
RESULTS: Histologic apoptotic index (pre and 1 hour post) showed an average increase of 487% (6.5 to 31.7). Thermal imaging demonstrated
an average surface temperature of 31.6C° pre-treatment and 39.2°C post-treatment. The 1 cm depth thermocouple showed an initial temperature of 40C° and reached a maximum of 45°C 15 minutes into the treatment. It remained stable at 45°C for the remaining 30 minutes treatment time. No adverse events were noted.
CONCLUSION: RF treatment induces an increase in apoptotic index in adipocytes 1 hour post-RF treatment. This is accompanied by a peak temperature of 45°C in the fat layer. Skin surface temperatures remain substantially lower than fat temperatures.
J Drugs Dermatol. 2015;14(6):622-623.
Inna Belenky PhD, Cruzy Tagger MD, and Andrea Bingham RE
The widely used intense pulse light (IPL) technology was first commercially launched to the medical market in 1994 and similar to lasers,
is based on the basic principle of selective photothermolysis. The main conflict during treatments with light-based technologies is between safety and efficacy of the treatment. The aim of this study was to evaluate new IPL technology, which integrates three different
pulse configurations, with specific attention on the safety and efficacy of the treatment. 101 volunteers (with Fitzpatrick skin types I-VI) were treated as follows: 9 patients underwent 8 bi-weekly acne clearance treatments, 51 patients underwent 6-12 hair removal treatments, 11 patients were treated for general skin rejuvenation, 15 patients were treated for pigmentation lesions, and 15 patients were treated for vascular lesions. No serious adverse events were recorded. All patients that were treated for hair removal achieved significant
hair clearance. The patients with facial rosacea responded the fastest to the treatment. Eight of nine patients that were treated for acne clearance achieved significant reduction in acne appearance. The results represented in this study support the approach that when taking into consideration both efficacy of the treatment and safety of the patients, the system should be “flexible” enough to allow exact treatment settings profile for each patient, according to their skin type and the symptom’s biophysical characteristics.
J Drugs Dermatol. 2015;14(11):1255-1260.
When simple chemical are applied to the skin, a series of events ensues that under some conditions ultimately results in contact sensitivity (CS), a proven cell-mediated immune response (CMI). Since the discovery of CMI using picryl-Cl (PCl) in 1942, we have learned a great deal on the cellular mechanisms involved in CS, including the potential to treat warts, skin cancer, autoimmune disorders, and allergies. In this review we summarize some of the basic mechanisms of both the innate and acquired immune systems involved in CS.
J Drugs Dermatol. 2012;11(10):1166-1173.
Novie Sroa MD, Shannon Campbell DO, Mark Bechtel MD
Scleromyxedema is a chronic, idiopathic disorder characterized by cutaneous dermal mucin deposition in association with increased
dermal collagen and absence of thyroid disease. The clinical features involve sclerosis of skin with numerous, 2–3 mm, firm, waxy,
papules in a symmetrical distribution pattern. The skin lesions may progress to widespread and indurated plaques resulting in patient
disability via decreased mobility, sclerodactyly and microstomia. Abnormalities in the muscular, neurologic, rheumatologic, pulmonary,
renal and cardiovascular systems may accompany the cutaneous lesions. Multiple attempts at therapeutic interventions have
failed due to inconsistent, unsatisfactory results and/or severe adverse effects.1–6 Herein, the authors describe a case of scleromyxedema
successfully treated with high-dose intravenous immunoglobulin (hdIVIG).
Jeremy C. Christman MS,a Deborah K. Fix BS MBA,b Sawanna C. Lucus BS,a Debrah Watson BS,a Emma Desmier BS,a Rolanda J. Johnson Wilkerson PhD,a Charles Fixler MDb
Background and Objective: Despite numerous body moisturizers being available, cosmetic xerosis continues to be a leading skin problem for consumers. We performed two 35-day studies to evaluate the ability of a variety of body moisturizers containing various levels of oils/lipids, humectants, as well as other ingredients (e.g., niacinamide) to improve stratum corneum integrity.
Methods: 63 and 58 female subjects were enrolled and randomized in an incomplete block design to six of nine products (eight moisturizers or no treatment control) in studies 1 and 2, respectively. The primary endpoints included visual dryness by a qualified skin grader, skin hydration as measured by Corneometer, and barrier integrity as measured by transepidermal water loss (TEWL). The primary comparisons for the two niacinamide/glycerin moisturizers were to the other six moisturizers and to the no treatment control for each endpoint.
Results: The two niacinamide/glycerin moisturizers demonstrated an overall better solution towards rapid and prolonged improvement of cosmetic xerosis due to functional improvement of stratum corneum barrier function compared to no treatment and the other moisturizers tested.
Conclusions: These studies establish the benefit of including niacinamide in a body moisturizer to improve the integrity of the stratum corneum and thus reduce cosmetic xerosis over time.
J Drugs Dermatol. 2012;11(1):22-29.
Sophie Seité PhD,a Florence Benech PharmD,b Sandrine Berdah PhD,b Muriel Bayer PharmD,b Sophie Veyrat PharmD,b Evelyne Segot PharmD PhD,b Marcela Sakalikova Mgr,c Lucia Gibejova Mgr,c Hana Zelenkova MD PhDc
OBJECTIVE: The objective of these studies was to investigate whether a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging can have an impact in the management of rosacea-prone skin subjects.
METHODS: Several studies were performed to evaluate the efficacy of this product in the management of rosacea prone skin, as either monotherapy or adjunctive therapy or to maintain the efficacy of a Metronidazole treatment. The first study was performed on 37 women aged 18-45 with added stage 2 erythro-couperosis, who applied test formula as monotherapy twice a day for 4 weeks. During a second study, a dermatological evaluation was performed on patients with stage I or II rosacea, a questionnaire containing information about patient characteristics, tolerance, clinical signs, symptoms and skin reactivity to “trigger factors” was completed by dermatologists at baseline and 2 months after treatment with the test formula as either monotherapy or adjunctive therapy. Finally, in a third study, 65 patients finishing a Metronidazole treatment applied once daily and the tested formula twice daily were divided into 2 groups using the test formula or vehicle control, twice a day for 8 weeks for the evaluation of efficacy as adjunctive therapy.
RESULTS: We noted that the test formula, as an adjunctive therapy, helped prolong the efficacy of a Metronidazole treatment. In monotherapy, there was a significant efficacy of the test formula associated with an excellent tolerance. A significant improvement of all the clinical signs and symptoms of rosacea and a reduction of the skin reactivity to "trigger factors" were shown.
CONCLUSIONS: These studies highlight the interest value and impact of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging in monotherapy or in combination with or after a therapeutic treatment in the management of patients suffering from rosacea.
J Drugs Dermatol. 2013;12(8):920-924.
Background: A novel percutaneous corrugator supercilii muscle terminal nerve CSMTN ablation technique is proposed for the treatment
of hyperdynamic vertical glabellar furrows (HVGF).
Technique: Two surgical marks are placed on each eyebrow. One is placed at the level of the lateral canthus and the second at the
outer border of the limbus. At each of the four marks, the following steps are carried out: (1) a guiding needle is used to punch the
frontal skin at 3 mm above the eyebrow (orifice A) and will then travel deeply at the level of the supraperiostium and emerge outside
the skin 3 mm below the eyebrow (orifice B) at the palpebral skin; (2) the needle is then reentered exactly at orifice B and will travel
underneath the skin at a more superficial level in the subcutaneous layer and then emerge outside exactly at orifice A. Both ends of
the thread are gently pulled in a sawing motion with counter tension until no more resistance is felt from the anatomical structures
involved, and then the loops of thread are withdrawn from orifice A.
Results: Forty-seven subjects underwent bilateral CSMTN ablation. In the first 10 cases, the authors performed only one neurotomy
per eye and observed a 50 percent HVGF recurrence rate. Then, the authors chose to perform two neurotomies per side and had a
three percent recurrence rate (1/37) with a high degree of patient satisfaction. Major complications such as deforming hematomas,
eyelid ptosis, abscess, scar formation or adhesions were not observed during follow up.
Conclusion: This novel technique may represent a simple and permanent solution for HVGF.
J Drugs Dermatol.2011;10(7):762-765.
The sequential use of topical therapies and short-incubation photodynamic therapy for actinic keratosis (AK) has not been extensively
studied. The author reports on treatment with sequential 5-fluorouracil (5-FU) cream 0.5% and 5-aminolevulinic acid-photodynamic
therapy (ALA-PDT) in three older men with photodamaged skin and a history of AK. These findings suggest that this combination
therapy, when compared with short-contact (1 hour) ALA-PDT alone, is more effective, minimizes the recurrence of areas of field
cancerization and improves the appearance of the skin. The use of 5-FU cream 0.5% before and after photodynamic therapy is effective
in revealing the presence of both clinical and subclinical AK lesions.
J Drugs Dermatol. 2011;10(4):372-378.
Leon Kircik MD,a,b Firas Hougeir MD,c and Joseph Bikowski MDd
Over the last half century, and especially over the last 15 years, understanding of the structure and function of the stratum corneum has evolved tremendously. Once conceptualized as an inactive film formed by lifeless, disintegrating keratinocytes, the stratum corneum is now recognized as a viable, functional structure that plays an important role in maintaining skin health and possibly mediating cutaneous diseases. Researchers and clinicians have also come to realize that the barrier functions not only to prevent the entry of exogenous factors, such as irritants or allergens, but that it also can mediate disease. We had already realized that dysfunction of the barrier may itself directly contribute to the pathogenesis of skin diseases, notably atopic dermatitis. More specifically, evidence shows that epidermal barrier dysfunction is likely to be a precursor of cutaneous inflammation.1,2
J Drugs Dermatol. 2013;12(9):1024-1027.
Lucija Kroepfl MBChBa and Jason J. Emer MDb
Acne is one of the most prevalent skin conditions seen by dermatologists. The cosmetic sequelae of severe acne, including scarring and pigmentation, have a profound psychological impact on those in icted. Topical (eg, retinoids, antibiotics, dapsone, hydroxyacids) and oral treatments (eg, antibiotics and/or spironolactone) are often bene cial to control acne or in the instance of oral isotretinoin use, rid the acne permanently; however, these treatments have very little affect on the ultimate cosmetic outcome of the acne scarring and skin texture that results. Given the variety of scar types that can form and the variability of responses seen in various skin types and textures, treatment options are vast without appropriate guidelines for pathways that dictate best timing, combinations, and options in given clinical scenarios. Current treatment options include solo or combina- tions of energy-based (eg, laser, radiofrequency), chemical-based (eg, peels, TCA cross), surgical-based options (eg, subcision, punch excision), microneedling, and llers and/or fat injections. Most recently, fractional radiofrequency-based treatments have been used to improve acne scarring with less reported downtime as compared to lasers or chemical peels and the ability to treat darker or sensitive skin types with less risk of scarring or hyperpigmentation. In severe cystic ares, scarring treatments are often postposed till the acne is under control and in many instances this can limit the dermatologists ability to affect future cosmetic treatments. Based on personal experience of various clinical scenarios in a busy laser practice that treats a signi cant number of patients with acne scarring, fractional radiofrequency is an excellent choice for treating all forms of acne scars with minimal risk to patients, even those on concurrent treatments such as isotretinoin. Additionally, fractional radiofrequency can be used in combination with all other treatment options to speed the time to clinical improvement appreciated by the patient. Here we present personal experiences of combination treatments for acne scarring, pigmentation and textural issues, and suggest that fractional radiofrequency be considered a “gold standard” treatment of acne scarring in those with dark or sensitive skin types or those on concurrent isotretinoin.
J Drugs Dermatol. 2016;15(11):1413-1419.
Mark B. Taylor MDa, Jamal S. Yanaki MS EdDb, David O. Draper PhDc, Joe C. Shurtz BSc, and Mark Coglianese PhDc
Background: Treatment of melasma and postinflammatory hyperpigmentation is often challenging. No ideal short-term and long-term treatment is available. Vitamin C alone and in combination with iontophoresis has been studied and found to be useful; however, no long-term studies have been published.
Methods: In this study, 35 patients (34 female, 1 male) were treated with a novel full-face iontophoresis mask (FFIM) and a proprietary vitamin C (ascorbyl glucoside) preparation. Patients received one in-office treatment and 12 to 24 at-home treatments over 1 to 2 months in conjunction with a strict maintenance regimen consisting of a mandelic/malic acid skin care regimen, broad-spectrum ultraviolet A/ultraviolet B sunblock, a wide-brimmed hat, and sun-avoidance behavior. Follow-up after the initial in-office treatment ranged from 1 to 54 months (mean, 26 months). Four independent observers graded improvement of melasma and PIH using a 4-point scale. Before the study, high-performance liquid chromatography was used to verify iontophoretic penetration of vitamin C into the skin to a level of 0.2 cm in healthy volunteers (2 male, 2 female).
Results: A mean 73% improvement in abnormal pigmentation was observed at the end of FFIM/vitamin C treatment. Greater than 25% improvement was observed in 32 of 35 patients, and greater than 50% improvement in 22 of 35 patients. Melasma Area and Severity Index scores demonstrated substantial improvement from baseline for all patients, with a mean improvement of 15.7.
Conclusions: Full-face iontophoresis of vitamin C appears to be an effective short-term treatment for melasma and postinflammatory hyperpigmentation. A protocol of strict sun avoidance in combination with a mandelic/malic acid skin care regimen appears to be useful in maintaining the improvement.
J Drugs Dermatol. 2013;12(1):45-50.
Paul S. Yamauchi MD PhD, Nicole Mau BS
2008 JDD Case Report Contest Winners
Hidradenitis suppurativa (HS), a chronic, inﬂammatory, relapsing disease of the apocrine glands in the skin, commonly occurs in
women aged 20 to 40 years. Patients typically present with discomfort and/or itching associated with papules or nodules that may
recur and lead to abscess formation and sinus tracts. Recent reports have demonstrated that adalimumab, a tumor necrosis factor
(TNF) antagonist, may be effective in the treatment of patients with HS who have failed conventional therapy. The authors describe
3 patients who experienced the resolution of skin lesions associated with HS after treatment with adalimumab. The patients found
this treatment to be convenient, as they could administer the therapy at home, and 1 patient was able to avoid surgical intervention
through use of TNF-antagonist therapy. Adalimumab may resolve symptoms of HS when conventional therapy fails. More studies
are necessary to investigate the efﬁcacy and safety of adalimumab for the treatment of HS.
Suzanne Bruce MD,a Jwala Karnik MD,b Laurence Dryer PhD,c and David Burkholder PhDd
BACKGROUND AND OBJECTIVES: The etiology of aging human skin includes intrinsic physiologic changes greatly accelerated by photoaging,
predominantly through exposure to UV light. Consumer interest and demand for anti-aging skin care products is extremely high especially
in light of aging populations. Prenatal (fetal) tissue has been shown to possess healing characteristics and regenerative effects.
A proprietary tissue engineering technology has been developed to produce a soluble human extracellular matrix material with growth
factors and proteins. Neonatal cells are cultured on microbeads under conditions of low oxygen tension. This human cell-conditioned
media (hCCM) contains a variety of growth factors and cytokines similar to those found in fetal cells and has been incorporated into a
topical preparation for use in facial wound healing (after laser resurfacing procedures) and improving the appearance of aging skin. The
objective of this study was to observe the effects of an MRCxTM-containing topical skincare regimen on subjects with demonstrated
aging skin damage (photodamage) when used consistently over a 3 month time period.
METHODS: Female subjects age 35-65 with Fitzpatrick Skin Type I-IV and mild to moderate amounts of photodamage, fine lines, and
wrinkles used Regenica® Replenishing Crème and Regenica® Renew SPF 15 for 3 months. At each visit, photos were taken of subjects
while investigators completed skin grading assessments and subjects completed self-assessments. Investigator assessments
included evaluation of tactile roughness, visual texture, wrinkles, blotchiness, skin tone evenness, radiance, and translucence on a
5-point scale. Subjects’ self-assessments included assessment of fine lines and wrinkles, firmness, evenness of skin tone, brightness,
resilience, clarity, and radiance. Changes from baseline were evaluated for each parameter and P values for changes from baseline to
each study visit for investigator’s assessments and to end-of-study for self-assessments were calculated.
RESULTS: Eighteen of 21 enrolled female subjects completed the study. Three subjects chose to drop from the study. Statistically significant
improvements in investigator assessments of tactile roughness, visual texture, wrinkles, blotchiness, skin tone evenness, radiance
and translucency compared to baseline were observed at weeks 4, 8, and 12 after initiating treatments. Progressive improvement
was seen through the last study visit (visit 5, week 12). Similar statistically significant improvements in subjects’ self-assessments
were seen comparing the first post-baseline visit (visit 2, week 2) to subsequent visits. 93.5 % subjects agreed (somewhat or strongly)
with all of the positive subject assessment statements at week 12. Importantly, 100 % of subjects indicated at the end of the study
that they would recommend the product to a friend and would want to purchase the product. No treatment-related adverse events
were recorded during the study.
CONCLUSIONS: Regenica was safe and clinically effective in reducing anti-aging effects in this group of female subjects aged 35-65 years
as measured by both investigator assessments and subjects’ self-assessments.
J Drugs Dermatol. 2014;13(9):1074-1081.
We report a case of solitary mastocytoma in a child which was successfully treated with a topical steroid of moderate potency. The
patient was an 18-month-old girl who presented with localized oval shape yellowish to hyperpigmented lesion on the medial aspect
of her right forearm noticed accidentally by the parents since the age of 6 months. The lesion was observed to get urticated mainly
after bathing, toweling, and scratching of the area, associated with reddening and itching confined to the lesion (Figure 1). No other
area of the body was affected with any similar lesion.
Examination of the skin revealed a yellow-tan oval shape patch 1 x 3 cm in diameter which was firm to the touch with intact overlying
skin. The lesion became swollen and itchy when it was rubbed vigorously (positive Darie