Krazy Kodachromes Series
updated regularly - Approach image questions on exams and practice with hours of discourse and differentials with GW School of Medicine faculty. Watch the video at DermInReview.com.
Practical Applications for Medical and Aesthetic Treatment of Skin of Color With a New 650-Microsecond Laser
Individuals with skin of color are a rapidly growing portion of the cosmetic procedures market. There are unique challenges to treating
skin conditions in skin of color patients. This article and roundtable discussion focus on the use of energy-based modalities, particularly
a 650-microsecond 1064nm laser that delivers energy in a collimated beam. Alone or in combination with other therapies, the
650-microsecond 1064nm laser has been used successfully to treat melasma, acne, postinflammatory hyperpigmentation, pseudofolliculitis
barbae, hair removal, acne keloidalis nuchae, and aging skin in skin of color.
Dermatological Concerns in the Latino Population
Dermatological Concerns in the Latino Population
Not All Foams Are Created Equal: Vehicle Characteristics Can Affect Patient Outcomes
Topical delivery of therapeutic agents for skin diseases is a major advantage in dermatology. However, the efficacy and tolerability of topically applied therapies is dependent on several characteristics, including percutaneous penetration and permeation of active ingredient and lack of side effects, especially local tolerability reactions. Importantly, the ultimate performance of a topical product includes collectively the effects of the active ingredient and the impact that specific additives have on vehicle characteristics, such as penetration, permeation, epidermal barrier properties, relative irritancy, allergenicity potential, and patient acceptance/preference of the vehicle formulation used. Foam vehicles have evolved over time with the emergence of a menu of alcohol-based and aqueous-based variations that provide various advantages depending on clinical circumstances and the disease being treated. Aqueous-based foams have gained widespread acceptance and preference, especially due to favorable skin tolerability and the cosmetic elegance of the products. In this manuscript, data are presented supporting the efficacy, tolerability, and safety, of specific aqueous-based foam vehicles for calcipotriene used to treat plaque psoriasis, and for tazarotene used to treat acne vulgaris. Discussions include both vehicle-based properties that are relevant to clinical practice, and outcomes from the large-scale pivotal clinical trials that review efficacy and safety results and patient reported outcomes. The latter also discusses several practical subject assessments about use of the foam vehicle.
Atopic Dermatitis: A Review of Topical Treatment
Atopic dermatitis affects up to 20% of children and continues to increase in prevalence. Effective disease control is aimed at decreasing symptoms and reducing the frequency of flares, which may be complicated by secondary bacterial infections. Although recent advances have produced a number of non-systemic treatment options, topical corticosteroids remain a fundamental component of treatment algorithms.
From Babies to Boomers: Understanding Nuances for Stratum Corneum Care
Dermatologist recommendations of skin care products are critical to the management of compromised and healthy skin and appreciated by patients. Professionals must carefully weigh not only the safety and efficacy but also the aesthetics of products if they are to achieve the desired outcome of satisfied patients
Issues and Considerations for Optimal Outcomes in Acne Management
This supplement summarize recent advances in the scientific understanding of acne pathogenesis as it relates to effective treatment acne in patients of all skin types and describes the role of retinoids in the management of acne and effective treatment and prevention strategies for hypertrophic and atrophic acne scarring in all skin types.
Lifting the Veil on Suicidal Ideation and Behavior in Psoriasis
Research into the immunopathological mechanisms of plaque psoriasis has produced increasingly targeted biologic therapies. The specificity of these agents allows for high rates of efficacy and decreased adverse events, most notably reduced immune system suppression. In recent years, the recognition of interleukin (IL)-17 as an important component in the pathogenesis of psoriasis has led to the development of a new class of biologics.
Understanding the Complexities of Compounding
As specialists in the treatment of the skin, hair, and nails, we know what tools we need to accurately and efficiently diagnose and treat our patients. Therefore, we must take the time to understand the complexities of the new regulations for drug compounding, recognize the differences between legal and illegal compounding so that we can fight to preserve the appropriate and safe patient care and stop
the illegal compounding. If we do not fight the fight ourselves then someone else will do it for us, which will not be the best outcome
as we have seen in the past. As importantly, we must then respond to regulatory concerns with a reasonable argument to protect
our practices. We must advocate for ourselves and for our patients to protect access. No one else has a vested interest in protecting
our access to compounding.
Topical Vehicle Formulations in the Treatment of Acne
Acne vulgaris (AV) is one of the most common diseases that we encounter in our clinics every day. Yet, despite the dermatology community’s perceived familiarity with acne vulgaris, it is worthwhile to note that we continue to learn more and more about the epidemiology and the pathogenesis of AV as well as novel therapeutic options. Patients with acne desire clearance. Dermatology providers today have more options than ever to tailor treatment to each patient’s needs, in light of current best evidence regarding the pathogenesis and treatment of the disease. While no new chemical entities for topical delivery have revolutionized our approach to acne management, ongoing evolution in topical vehicle formulation is optimizing therapeutic benefit and the patient experience, leading to better clinical outcomes.
New Insight Into the Multifactorial Pathophysiology of Hair Loss: Inflammation, Stress, and Follicle Biology Take Front Stage
As our understanding of the microenvironment of the hair follicle deepens, it is becoming increasingly clear that targeting a single pathway in this complex system is not ideal. Androgens, cortisol, and corticotropin-releasing hormone, all of which are not in balance in hair loss due to internal and external stress, and gene expression of pro-inflammatory mediators all affect the hair follicle to suppress “normal” function and negatively influence hair growth.
Clinical Review: Secukinumab in Psoriatic Diseases
Psoriasis Is a Chronic Disease: Long Term Efficacy and Safety of New Biologics Is Important
Effect of a Blueberry-Derived Antioxidant Matrix on Infrared -A Induced Gene Expression in Human Dermal Fibroblasts
There is compelling evidence that Infrared A (IRA) from natural sunlight contributes to photoaging of human skin by inducing the expression of matrix metalloproteinase-1 (MMP-1) expression in human dermal fibroblasts. Corresponding mechanistic studies have shown that IRA does so by increasing the production of reactive oxygen species in irradiated cells. In the present study, we therefore asked if treatment of primary human skin fibroblasts with a blueberry-derived antioxidant matrix (BerrimatrixTM), which is employed as an active ingredient in commercially available skin care products that are topically applied, can prevent IRA-induced MMP-1 expression in these cells. In this in vitro study, we have found that this antioxidant containing matrix is well tolerated by fibroblast over a broad concentration range and that it efficiently prevents IRA-induced MMP-1 mRNA expression. It may thus be speculated that topical application of this antioxidant containing matrix may be efficient in protecting human skin against IRA-induced wrinkle formation.
Noninvasive Rejuvenation for Graceful Aging
At the Annual Meeting of the American Academy of Dermatology in 2016, I directed the symposium entitled ‘Aging Gracefully’ for the second time. The symposium’s primary learning objective was to give the audience a framework for managing aesthetic patients. In the last decade, there has been a significant increase in the options for and availability of noninvasive and minimally invasive rejuvenation. With that has been an associated surge in interest by physicians and patients. And, as the number of procedures across the globe increases, so too do the number of aesthetically poor outcomes. Most come from practitioners doing paint-by-numbers treatment. As experts in skin biology and treatment, dermatologists should practice the highest-level cosmetic as well as general dermatology. The faculty presented information to aid practitioners how best to approach patients and formulate a cosmetic plan. The faculty discussed important considerations based on patient gender, age, and skin type. Updated information on the science of cosmeceuticals and the benefits of early noninvasive intervention was presented as were next generation devices and alternatives to standard therapies. The faculty have kindly condensed their AAD presentations for this supplement. I thank L’Oréal and the Journal of Drugs in Dermatology for giving us the opportunity to present this information to a wider audience in this e-supplement.
Heidi A. Waldorf MD
Director of Laser & Cosmetic Dermatology, The Mount Sinai Hospital, New York, NY
Icahn School of Medicine of Mount Sinai, New York, NY
Waldorf Dermatology Aesthetics, Nanuet, NY
Photolyase: Introduction and Clinical Data Review
The limitations of photoprotection modalities have been the inability to arrest the progression of photodamage. Chemoprevention strategies involving a sunscreen has been incomplete because of the need to induce sustained repair of mutations and slow carcinogenesis. Photolyases, or photoreactivation enzymes, serve the role of repairing mutations and damage to DNA induced by ultraviolet (UV) radiation and therefore influence the initiation phases of carcinogenesis. As these enzymes are absent in humans, exogenous forms have been manufactured and are now utilized in topical agents to supplement and augment the innate repair mechanisms that are mostly inefficient.
J Drugs Dermatol. 2017;16(5 Suppl):61-66.
Treating Recurrent Herpes Simplex Labialis: A New Modality With a Novel Formulation Technology
Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.
J Drugs Dermatol. 2017;16(3 Suppl):s49-53.
Spotlight on the Use of Nitric Oxide in Dermatology
Nitric oxide (NO) is a diatomic gas that is synthesized within and released by multiple host cell types functioning to provide a variety of physiologic and homeostatic effects. Nitric oxide exhibits a variety of effects that relate significantly with outcomes that can provide therapeutic benefit if properly formulated and released. These include anti-inflammatory, immunomodulatory, antimicrobial, vasodilatory properties, and effects that are beneficial to wound healing. Lack of antibiotic resistance appears to be one major advantage of topically delivered NO. A specific topical formulation of NO has been developed that has been shown thus far in clinical studies to exhibit favorable efficacy and safety. This article provides a thorough review of the biologic effects of NO, discusses modes of action and potential pharmacologic benefits, and reviews currently available clinical data for acne.
Understanding the Complexities of the Stratum Corneum: Considerations and Strategies for Skin Barrier Maintenance Continuing Education Article Series
As the rst point of contact with a potentially drying external environment, the primary function of the stratum corneum (SC) is to limit evaporative water loss from the aqueous interior. Yet this is just one of many functionalities conferred by this unique barrier, also protecting against mechanical insults, the assault of foreign chemicals, and microorganisms, and even serving as the rst inherent defense against ultraviolet radiation. Beyond barrier function, the stratum corneum acts as a biosensor, reacting to and mobilizing as a result of both external and internal changes in order to maintain homeostasis and ultimately wear its multiple aforementioned hats.
Since the stratum corneum is so profoundly responsible for maintaining healthy skin, there has been signi cant motivation to bet- ter understand the mechanisms through which it protects the viable epidermis from offending agents, as well as elucidate the way in which the SC ensures adequate hydration in order to enable proper epidermal enzyme function and tactile perception. Much of our understanding of the stratum corneum’s functional structure is derived from various disease states in which key SC elements are dysfunctional or absent, thereby providing the impetus for utilizing said components or derivations thereof in a wide range of products. In the article by Lee and Friedman, the biology of the stratum is reviewed to provide the framework for translational thera- peutic indications.To better appreciate the impact of primary skin disease on barrier stability and functionalities and what strategies to consider, Jordan and Baldwin identify speci c alterations in the stratum corneum in the setting of Acne Vulgaris, both inherent and iatrogenic resulting from use of therapeutics targeting said skin disease. Lastly, Schwartz and Friedman breakdown the various categories and ingredients used in moisturizers and barrier repair devices with the epidermal biology in mind to help the reader identify which elements are important for maximum impact.
Targeted and personalized therapies don’t just have to be small molecule inhibitors and biologics – selecting even over the counter products based on their biologically relevant ingredients ts this popular and modern approach. Herein this supplement, we provide the tools to join the club.
Evidence-Based Skincare: The Importance of Offering Moisturization, Relief, and Protection in Common Skin Disorders
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.
Extracellular Matrix Modulation: Optimizing Skin Care and Rejuvenation Procedures
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.
Advances in Tinea Pedis Management
This supplement explores the microbiology of topical antifungal drugs, the science behind vehicle formulations and delivery systems, and the data on topical treatment efficacy. Armed with this knowledge, clinicians can more effectively target superficial cutaneous fungal infections and ultimately increasing their patients’ quality of life.
Inflammatory Acne Vulgaris: Current Concepts in Pathogenesis and Management
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.
A New Approach in Topical Hyaluronic Acid: Going Beyond Instant Benefits to Restore Epidermal HA Homeostasis
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.
Diagnostic and Therapeutic Considerations for Onychomycosis and Cutaneous Superficial Fungal Infections
Dermatophyte infections of the skin and nails are increasing, with up to 25% of the worldwide population affected; and they account for approximately 10% to 20% of all visits to the dermatology office in the United States. Increased awareness of the clinical impact of these infections is essential because, if left untreated, they can predispose patients to superinfections and potentially serious medical complications. Onychomycosis in particular constitutes an important public health problem because of its high prevalence and associated morbidity.
New antifungal medicines on the market include topical drugs such as luliconazole, naftifine, efinaconazole, and tavaborole. This CME supplement translates a plethora of recent data on efficacy, ease of use, and safety data for each drug into dermatologists’ real world practices to help them optimize clinical outcomes in the treatment of onychomycosis, tinea corporis, tinea cruris, and tinea pedis.
However, proper drug selection is only one part of achieving a successful clinical outcome. This supplement also explains the patient education needed to avoid primary treatment failure, recurrence, or spread to other body parts or close contacts.
The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments
In the United States alone, 50% of women suffer from hair loss at some point in their lives and 50% of men experience hair loss before the age of 50. In addition to aesthetic concerns, alopecia and thinning hair have adverse psychological effects, such as low self-esteem and poor self-confidence.
Identifying the causes of alopecia and thinning hair has proven especially complex in women. Current treatment options include topical formulations, prescription medications, oral supplements, and costly hair transplants; but they all have drawbacks, such that a novel therapy is needed.
This supplement presents a summary of clinical studies that have demonstrated the welcome safety and efficacy of the nutraceutical Viviscal® (Lifes2good, Inc., Chicago, IL), which contains a proprietary blend of proteins, lipids, and glycosaminoglycans of marine origin that provide essential nutrients for stimulating existing hair growth and reducing hair shedding. The summary is followed by a lively panel discussion on hair loss and current therapies amongst experts in dermatology and plastic surgery: Vivian Bucay MD (San Antonio, TX), Wendy Roberts MD (Palm Springs, CA), Heidi Waldorf MD (New York, NY), and Steven Dayan MD (Chicago, IL).
Total Defense + Repair: A Novel Concept in Solar Protection and Skin Rejuvenation
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.
Rosacea Management Strategies: Azelaic Acid 15% Gel in Clinical Practice
Ninety percent of people with rosacea say it lowers their self-esteem and can be accompanied by burning, itching, and stinging; but tolerable, effective therapies are increasingly available due to improved understanding of rosacea's inflammatory mediators and molecular basis.
Since being approved by the FDA over a decade ago, azelaic acid (AzA) 15% gel has boasted a long track-record in efficacy and safety in the topical treatment of papulopustular rosacea (PPR), both as monotherapy and in combination with oral therapy. AzA 15% gel markedly reduced both papulopustular lesions and overall facial erythema in pivotal Phase 3 studies.
This supplement gives the latest information on the pharmacologic properties of AzA that correlate with therapeutic action in rosacea; and explores new horizons related to formulation development, such as an oil-in-water emulsion foam of micronized AzA 15% that is proving to be well-tolerated and effective for patients with moderate to severe PPR.
New Insights Into Ideal Skin Care for the Acne Patient: Addressing Skin Barrier Disruption, Oil Control, and Ultraviolet Protection Through Advanced Formulations
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.
Clocortolone Pivalate 0.1% Cream: A New Way to Enhance Patient Access
Topical corticosteroids are used to treat a wide variety of eczematous and inflammatory skin disorders, such as atopic dermatitis. However, as topical products become available as generic formulations, patients often experience problems of increased allergies and irritancy, impairment of the epidermal barrier, and loss of efficacy. This is because although the active ingredient and its potency are the same, the vehicle excipients may differ. Dermatologists therefore report concerns in prescribing these generics to their patients.
Fortunately, Promius Pharma, one of the leaders in this field, has now brought to market a generic formulation of clocortolone pivalate 0.1% that is exactly the same as their original branded product. This has been shown to be effective and well tolerated in the management of several corticosteroid-responsive dermatoses, and is a welcome addition to the treatment armamentarium.
Hot Topics in Acne
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.
Treatment Options in Facial and Nonfacial Volumization: An Introduction to Poly-L-Lactic Acid
Restoring Facial Volume: The Growing Impact of Poly-L-Lactic Acid
Soft tissue augmentation is an important option in aesthetic enhancement and continues to grow in popularity for a number of reasons, including its minimally invasive nature and ability to directly nullify volume loss associated with facial ageing. Cosmetic agents that replace collagen are effective tools for addressing volume loss, and among these poly-L-lactic acid (PLLA) carries great potential, acting to volumize soft tissue in a gradual, progressive, and predictable manner, and providing natural-looking restoration of lost facial volume.
In the considerable time that has passed since the introduction of PLLA for soft tissue augmentation, methodology and patient selection has improved, leading to far fewer adverse events such as nodules or papules and better patient outcomes. An international group of experts was convened in 2013 to discuss the optimum use of PLLA, and this collective experience and requisite knowledge is described in this supplement.
The Periorbital Complex: Physical and Psychological Considerations for Non-Surgical Rejuvenation
New Technologies for the Rejuvenation of the Periorbital Region
As one of the most powerful and versatile features of the human face, the eyebrow informs the perception of beauty and plays a critical role in sexual dimorphism, facial recognition, and non-verbal communication. Eyebrow hair also serves many important biologic functions, including sensory transmission and protection from the elements, as well as playing an important role in cosmesis and expression.
New technologies to tighten and resurface the skin, to grow the hair of the eyelashes and eyebrows, to smooth-en and lighten the skin, and to replace volume lost from this area have created opportunities for rejuvenation that were not possible until recently. These include prostaglandin analogues that not only increase the length and width of the eyelashes but also improve the length and girth of eyebrow hair. Use of topical bimatoprost daily resulted in an improvement of eyelashes in 78.1% of subjects after 16 weeks. Using it in conjunction with botulinum toxins, light sources, topical cosmeceuticals, and fillers such as hyaluronic acid has vastly improved physicians' ability to treat the periorbital region.
New Advances in the Topical Treatment of Tinea Pedis, Tinea Cruris, and Tinea Corporis
Put Your Best Foot Forward: Advances in the Management of Tinea Pedis
Dermatophyte infections account for over 4 million physician visits each year in the United States. Moreover, recent analysis of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey for the period from 1995 to 2004 have found that improper treatment of tinea pedis, tinea corporis, and tinea cruris is common and expensive. However, the selection of inappropriate agents is just one impediment to effective care. Therapeutic non-adherence by patients, and especially failure to continue therapy until the infectious organisms are completely eradicated, are additional challenges. Naftifine cream 2% is a topical allylamine antifungal agent for the treatment of superficial dermatomycoses, and this novel topical formulation is a welcome new option. A study of naftifine cream 2% for the treatment of tinea pedis found that 2 weeks of treatment was significantly more effective than vehicle and equivalent to 4 weeks of treatment with naftifine 1% gel. Naftifine 2% cream offers a cosmetically elegant, once-daily topical treatment option for dermatomycoses that may lead to better compliance and better treatment outcome in patients.
Advanced Basal Cell Carcinoma: Therapeutic Options and Considerations for Patient Care
Vismodegib Ushers in New Era for the Treatment of Basal Cell Carcinoma
Approximately 2.8 million basal cell carcinomas (BCCs) occur in the United States each year, accounting for 80% of all non-melanoma skin cancers. Historically, BCCs that are not surgically resectable or candidates for radiation therapy have had few treatment options. However, the development of vismodegib and its approval by the United States Food and Drug Administration (FDA) for use in patients with locally advanced or metastatic BCC carries with it a renewed sense of hope. Vismodegib is the first oral medication approved by the FDA for adults with metastatic or locally advanced BCCs who are not candidates for surgery or radiation or for BCCs that have recurred after surgery. The overwhelming majority of BCCs are the result of hedgehog pathway activation, and vismodegib inhibits a key regulatory protein in the hedgehog pathway, resulting in response rates of between 30% to 60% for locally advanced and metastatic BCCs.
Advances in Natural Ingredients and Their Use in Skin Care
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.
A New Understanding of the Pathogenesis of Acne Vulgaris
A New Treatment Paradigm for Acne Vulgaris
The understanding of acne vulgaris (AV) has evolved with a greater recognition of the sequence of inflammation, especially prelesional inflammation. An important facet of the new paradigm is that a specific follicular pattern of innate inflammation occurs before and during follicular hyperkeratinization. Moreover, this inflammation persists during the resolution of the macular phase after inflammatory lesions flatten toward the end of their life cycle. The current understanding of AV pathogenesis presents novel therapeutic options for patients because the use of benzoyl peroxide and a topical retinoid suppresses several components of acne pathogenesis, including reduced follicular hyperkeratinization, decreased innate inflammation, and dermal matrix degradation.
Onychomycosis: Art and Science
Efinaconazole is a Promising Treatment for Onychomycosis
Onychomycosis is a fungal infection of the nail unit that is caused by a variety of fungi including dermatophytes, nondermatophyte molds, and Candida. Efinaconazole 10% solution is a new topical treatment for onychomycosis that has a broad spectrum of activity against dermatophyte, nondermatophyte, and numerous yeast species. In clinical trials of mild to moderate onychomycosis, mycologic and complete cure rates for efinaconazole are comparable to those seen with oral itraconazole. Efinaconazole may be an important primary medication for those patients for whom effective topical treatment would be ideal, and could also be used in combination with an oral agent, or with adjunct therapies such as lasers and debridement.
The Role of a Novel Daily Cleansing and Moisturizing Regimen in the Management of Atopic Dermatitis: A Clinical Review
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.
Decoding Acne: Genetic Markers, Molecules, and Propionibacterium Acnes
The understanding of acne vulgaris (AV) has evolved with a greater recognition of the sequence of inflammation, especially prelesional inflammation. Propionibacterium acnes is not the primary inducer of acne pathogenesis, but it promotes multiple mechanisms of inflammation that correlate mostly with inflammatory lesions. An important facet of the new paradigm is that a specific follicular pattern of innate inflammation occurs before and during follicular hyperkeratinization. Moreover, this inflammation persists during the resolution of the macular phase after inflammatory lesions flatten toward the end of their life cycle. The current understanding of AV pathogenesis presents novel therapeutic options for patients because the use of benzoyl peroxide and a topical retinoid suppresses several components of acne pathogenesis, including reduced follicular hyperkeratinization, decreased innate inflammation, and dermal matrix degradation.
This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 1 AMA PRA Category 1 Credit.
Status Report on Topical Tazarotene for the Management of Acne Vulgaris
Allergan's Tazorac is at the Vanguard of the Next Generation of Topical Retinoids
Over the last 4 decades, topical retinoids have become standard therapy for the treatment of acne vulgaris. Although the market currently encompasses multiple formulations of next-generation topical retinoids, Tazorac is unique among them due to its dual role as a treatment option for both acne vulgaris and psoriasis vulgaris. Tazorac has also demonstrated that it is highly effective for the treatment of acne vulgaris as a monotherapy or in combination with other agents. Recent studies show that Tazorac can be combined effectively with dapsone 5% gel or with a benzoyl-peroxide - containing formulation to augment efficacy. Additionally, Tazorac does not have a generic substitution, so physicians can be assured that their patients will receive exactly what they have been prescribed.
Clinical Experience With a Unique Multimodal Skin Brightener for Facial Hyperpigmentation
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.
Topical Corticosteroid Treatment Choice: A Clinical and Practical Discussion of Clocortolone Pivalate Cream
Clinicians treating corticosteroid-responsive dermatoses, such as eczema and atopic dermatitis, contact dermatitis, seborrheic dermatitis, and psoriasis, have numerous treatment options. The decision to choose a topical corticosteroid depends on several different factors, such as potency, formulation, dosage, cosmetic elegance, cost, etc. Among these, Promius Pharma's Cloderm (clocortolone pivalate cream 0.1%) was introduced into the market more than 3 decades ago, and it remains a versatile treatment option for dermatoses. Phase 3 clinical trial data have demonstrated the efficacy and tolerability of Cloderm in several steroid responsive dermatoses. In studies for eczema and atopic dermatitis, statistically significant improvement relative to placebo was seen at day 4 with Cloderm. In psoriasis trials, Cloderm cream demonstrated superiority to placebo by day 7, continuing at days 14, 21, and 28. Thus, Cloderm's early onset of action will contribute to increased compliance for patients.
Clinical and Economical Considerations in Topical Corticosteroid Selection
Taro Pharmaceuticals Solves a Puzzling Enigma for Dermatologists
FDA regulations require that generic topical steroids match the active ingredients, concentration, and dosage of brand topical steroids, but the generic formulations do not have to match the bioequivalence of branded formulations. Vasoconstrictor assays have found large differences in bioequivalence between generic and trade name topical steroid formulations containing the same steroid in the same concentration in both cream and ointment vehicles. However, Taro Pharmaceuticals desoximetasone 0.05% and desoximetasone 0.25% ointments are a notable exception. Both branded and generic desoximetasone 0.05% and desoximetasone 0.25% ointments are produced by Taro Pharmaceuticals and contain the same excipients in the vehicle. Consequently, physicians do not have to be concerned about differences in therapeutic effectiveness between Taro's generic and brand desoximetasone ointments.
Identifying Natural Ingredients and Their Use in Skin Care
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.
The New Face of Fillers: A Multi-Specialty CME Initiative (Part II of II)
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.
Real World Strategies for Customizing Acne Regimens for Improved Outcomes
This supplement covers practical, real world strategies for customizing acne regimens to the patients' specific needs. Dr. Linda Stein Gold presents information on topical retinoids and antibiotics and discusses the role of benzoyl peroxide. Dr. Joshua Zeichner describes the issues of acne treatment in specific populations, mainly pre-pubertal patients. Dr. Feldman describes the typical ways patients use their treatments and then concrete approaches dermatologists can undertake to enhance patients' adherence behavior.
This supplement to the Journal of Drugs in Dermatology help address various components of psoriasis and comorbidities, as well as hidradenitis suppurativa and biologic treatments. Dr. Kircik and Onumah's article covers psoriasis and its identified comorbidities or chronic proinflammatory disorders driven by similar immunopathologic expression of immune response mechanisms. Dr. Zeichner covers immunologic therapies for treatment of psoriasis-tumor necrosis factor (TNF) inhibitors and interleukin (IL)-12 and IL-23 inhibitors: etanercept, adalimumab, infliximab, golimumab, and ustekinumab. Dr. Zeichner also considers therapeutic management prior to initiating biologic therapy. Lastly, Drs. Elena Sotiriou MD PhD et al from Aristotle University in Thessaloniki, Greece provides perspectives on a prospective clinical trial of efficacy of adalimumab in the treatment of hidradenitis suppurativa. The study demonstrates the significant efficacy of the once weekly regimen, as well as its benefit regarding time to recurrence.
The New Face of Fillers: A Multi-Specialty CME Initiative (Part I of II)
Part I of this two-part supplement brings together experts from the U.S., Europe, Canada, and Israel to discuss the state-of-the-art in soft tissue fillers in a fair-balanced, CME-accredited format. It includes a roundtable discussion on hyaluronic acid (HA) fillers that charts the clinical and scientific path that has led dermatologists from wrinkle-chasing to true volumetry. International case vignettes with commentary highlight a variety of applications for fillers'some currently available in the U.S., and some available elsewhere and on the American horizon. Topics covered include single-product and multi-product volumetry, anatomic and safety considerations, and the use of blunt injection microcannulas. Quick poll surveys provide an engaging snapshot of the faculty's personal approaches, with the first three surveys focusing on the palette of HA fillers.
Emervel: Full-Face Rejuvenation With a Range of Customized Hyaluronic Acid Fillers
Emervel: Full-Face Rejuvenation With a Range of Customized Hyaluronic Acid Fillers
This supplement to the Journal of Drugs in Dermatology discusses a new range of hyaluronic acid fillers suited for various indications. The authors highlight the key physical properties of this new range of fillers and present results of a multi-center, comprehensive trial in which up to eight indications could be treated simultaneously (including nasolabial folds, marionette lines, periorbital lines, upper lip lines, cheek folds, tear-troughs, lips and cheeks) using this filler range.
Unique Laser Techniques in Patients With Skin of Color
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.
The Stratum Corneum Revisited: A New Understanding of Its Role in Healthy and Diseased Skin
This supplement to the Journal of Drugs in Dermatology seeks to advance our knowledge of the structure and function of the stratum corneum. Previously considered a "static" or unremarkable barrier, it has now attained new clinical importance in regards to its role in conditions such as atopic dermatitis and other cutaneous abnormalities. Dr. Brian Berman provides an insightful introduction to articles by Dr. James Q. Del Rosso and Dr. Jacquelyn Levin, as well as by Dr. Paul C. Contard, that discuss the role and relevance of the stratum corneum in today's dermatologic world.
Identifying Natural Ingredients & Their Use in Skin Care
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.
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.
Scientific Proceedings From Select Sessions at the2010 Orlando Dermatology Aesthetic & Clinical (ODAC) Conference–Part II
Scalp Psoriasis, How and When to Use Biologics in Psoriasis, Enhancing the Eyes: Use of Minimally Invasive Techniques for Periorbital Rejuvenation, and Facial Shaping: Beyond Lines and Folds With Fillers
Optimizing Patient Adherence: Update onCombination Acne Therapy—Teens and Beyond
Acne vulgaris can cause both physical and emotional scarring. Effective treatment requires an understanding of acne pathogenesis and the key elements of keratinocyte differentiation and comedone formation, sebum production, colonization with Propionibacterium acnes (P. acnes) and subsequent inflammation. Addressing issues of compliance is critical for good outcomes, and newer combination therapies help improve adherence to daily therapy.
Innovations in Natural Ingredients andTheir Use in Skin Care
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.
This supplement to the Journal of Drugs in Dermatology is supported by Graceway Pharmaceuticals, LLC,
Ortho Dermatologics, Inc., Osyris and The Procter & Gamble Company
Practical Applications of a New Botulinum Toxin
This supplement to the Journal of Drugs in Dermatology is supported by an educational grant from Medicis Pharmaceutical Corporation.
Expanding the Use of Neurotoxins in Facial Aesthetics: A Consensus Panel’s Assessment and Recommendations
This supplement to the Journal of Drugs in Dermatology is jointly sponsored by the Annenberg Center for Health Sciences at Eisenhower and Signature Business Solution, LLC.This activity is supported by an independent educational grant from Medicis Pharmaceutical Corporation.
Aesthetic Laser and Light Source Treatments:Skin Rejuvenation and Repair
This supplement to the Journal of Drugs in Dermatology is supported by
Alma Lasers, Candela Corporation, Cynosure, and Syneron.
Current Concepts in Utilization of Collagen Stimulators
This activity was made possible through an educational grant provided by Sanofi-Aventis
The Management of Psoriasis in the Age of Biologics: Clinical Update 2009
This supplement to the Journal of Drugs in Dermatology was supported by a medical education grant from Johnson & Johnson.
Role of Physiologically BalancedGrowth Factors in Skin Rejuvenation
This supplement to the Journal of Drugs in Dermatology was made possible through an educational grant provided by SkinMedica.
Critical Reviews of Clinical Data:Focus on T Cell Agents for theTreatment of Psoriasis
This supplement to the Journal of Drugs in Dermatology was made possible through an educational grant provided by Genentech, Inc.
Update on Injectable Facial Rejuvenation
This supplement to the Journal of Drugs in Dermatology was supported by a medical education grant from Cosmetic Bootcamp.
Cosmetic Bootcamp would like to thank the sponsors
of the JDD April 2009 supplement issue, "Update on
Injectable Facial Rejuvenation," for their dedication and ongoing commitment to core physician education and optimal patient outcomes.
Lip Augmentation and Contour Correction With a Ribose Cross-linked Collagen Dermal Filler
This supplement to the Journal of Drugs in Dermatology was supported by an independent educational grant from Ortho Dermatologics.
An Update on the Use ofTretinoin Microsphere Gel forthe Treatment of Acne
This supplement to the Journal of Drugs in Dermatology was supported by a medical education grant from Johnson & Johnson.
The Role of Natural Products in Clinical Practice
This supplement to the Journal of Drugs in Dermatology was supported by a medical education grant from Johnson & Johnson.
Managing Acne With Adapalene
0.1% and 0.3% Gels
This supplement to the Journal of Drugs in Dermatology was supported by an independent educational grant from Galderma.
Barrier Protection for the Optimum Managementof Wound Healing
This supplement to the Journal of Drugs in Dermatology was supported by a medical educational grant from OrthoNeutrogena.
Skin Through the Ages: State-of-the-Art Options for the Topical Treatment of Acne, Photodamage, and Aging
This supplement to the Journal of Drugs in Dermatology was supported by an independent educational grant from Obagi Medical.
Management of Nonmelanoma Skin Cancers
This supplement to the Journal of Drugs in Dermatology was supported by a medical education grant from Graceway Pharmaceauticals.
The Science of Next Generation Anti-Aging Cosmeceuticals
This supplement to the Journal of Drugs in Dermatology was supported by Dior
Poly-L-Lactic Acid: A New Class of Collagen Stimulators
This supplement to the Journal of Drugs in Dermatology was supported by Dermik.
Photodynamic Therapy: Current and Emerging Applications