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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

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Used alone, absorbable suspension sutures offer a dual mechanism of action

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Used alone, absorbable suspension sutures offer a dual mechanism of action

Heather Onorati

As the use of absorbable suspension sutures continues to grow, it’s important for physicians to understand the technique and mechanism of action to optimize their use alone and in combination with other facial aesthetic tools, according to a recent paper published in the Journal of Drugs in Dermatology. 

First, patient selection is central to obtaining optimal results, write authors Sabrina Fabi, M.D., Robert Weiss, M.D., and Susan Weinkle, M.D., in “Absorbable Suspension Sutures: Recommendations for Use in a Multimodal Nonsurgical Approach to Facial Rejuvenation.”

Setting appropriate expectations is also important to an ideal outcome. Patients need to understand that nonsurgical positioning cannot produce the same results as surgery, the authors write, noting a study that demonstrated older patients (those ≤60), were less likely to view absorbable sutures as an effective treatment at 24 months compared with younger patients (those ≤50). Similarly, patients who had received prior surgical treatments were less likely to view absorbable suspension sutures as effective compared with patients who had no experience with surgical treatment.

In their paper, Drs. Fabi, Weiss and Weinkle discuss the mechanism of action for absorbable suspension sutures as well as provide guidance based on their extensive experience for combining absorbable suspension sutures with other nonsurgical modalities, including sequencing and timing.

Used alone, absorbable suspension sutures offer a dual mechanism of action, they write. They lift and stimulate collagen. Based on previous studies of duration, the authors suggest that with optimal technique, most patients should experience a duration of effect up to 24 months.

Through several case studies, the authors illustrate the utility of combining additional therapies, such as filers, toxins and energy-based devices.

When selecting an optimal combination of both sutures and filler, the authors note that it is important to determine whether the patient is in need of volume or tissue repositioning. If a patient has already received filler, absorbable sutures should be used six to 12 weeks later. If treating for residual ptosis, fillers should be placed after the sutures and in a separate anatomical plane or area. For patients naïve to fillers, sutures should be placed six to 12 weeks after filler.

The authors recommend administering toxin two weeks prior to suture placement, because the toxin effect can reduce the mechanical load on the suture and prevent the disengagement of the cones which may improve the lifting effect and duration, they write.

Ideally, treatment with ablative lasers should be performed six weeks prior to suture placement but no less than two weeks prior to allow for resolution of any swelling and inflammation that might interfere with placement. However, treatment with non-ablative lasers and IPL can generally be performed in the same day as suture placement, the authors note. Radiofrequency treatments should be performed four weeks before or after suture placement, they suggest. And, they add, microneedling should be performed at least two weeks before or five to eight weeks after suture placement.

“As the use of absorbable suspension sutures continues to increase, it is important that physicians are aware of how modalities can be safely layered and combined to produce an optimal aesthetic effect.”

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

Discover new clinical findings in  Aesthetics.  View the latest articles, case reports, supplements, CME activities, Podcast episodes and more.
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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

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Used alone, absorbable suspension sutures offer a dual mechanism of action Used alone, absorbable suspension sutures offer a dual mechanism of action Heather Onorati As the use of absorbable suspension…

Higher Sculptra Reconstitution Volume Associated With Low Risk of Adverse Events

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“The results of this retrospective chart review verify that Sculptra Aesthetic reconstituted to a final volume of 8-10 mL, including anesthetics, is used in clinical practice for many facial indications”…

February issue highlights new perspectives in chronic skin conditions

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It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like…

Higher Sculptra Reconstitution Volume Associated With Low Risk of Adverse Events

By Aesthetics, Featured Articles, The Latest No Comments

Featured Article

Featured Article

“The results of this retrospective chart review verify that Sculptra Aesthetic reconstituted to a final volume of 8-10 mL, including anesthetics, is used in clinical practice for many facial indications”

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“The results of this retrospective chart review verify that Sculptra Aesthetic reconstituted to a final volume of 8-10 mL, including anesthetics, is used in clinical practice for many facial indications”

Heather Onorati

Sculptra Aesthetic is often reconstituted at higher volumes and demonstrates a favorable risk benefit ratio, according to the results of a review published recently in the Journal of Drugs in Dermatology.

While originally approved at a reconstitution volume of 3-4 mL for the treatment of lipoatrophy in patients with HIV, a later study resulting in the approval of the injectable for aesthetics recommended a reconstitution volume up to 5 mL.

In consensus recommendations, the use of reconstitution volumes of 9 mL including anesthetics has been recommended, and previous studies have indicated a lower rate of adverse events with higher reconstitution volumes, the authors note in the article “Chart Review Presenting Safety of Injectable PLLA Used With Alternative Reconstitution Volume for Facial Treatments.”

This gradual increase in reconstitution and the addition of anesthetics to the solution has resulted in the need to better understand the product’s use in practice and to examine its safety at these larger reconstitution volumes, according to the group of investigators led by Melanie Palm, M.D., MBA, Art of Skin MD, Solana Beach, Calif.

“The improvement in quality of life following treatment of psoriasis with systemic or biologic agents noted in our study reflects results from previous studies,” the authors note. However, the authors state that there have been no studies that have examined a correlation between the improvement in quality of life following psoriasis treatment and an uptake in surgical or nonsurgical cosmetic procedures.

“We found that a common motive for patients who sought cometic procedures was the desire to further improve their quality of life after clearance of their psoriasis,” the authors say. They add that this study indicates that successful treatment of the condition may be a motivator for patients to seek cosmetic procedures for other skin indications.

Dr. Palm and colleagues retrospectively reviewed the medical records of 1,002 patients who received 4,483 treatments over about 12 years to evaluate the safety of Sculptra Aesthetic at reconstitution volumes of 7-10 mL based on noted adverse events. Questionnaires were also completed by 32 injectors about their general injection procedures.

According to the review, treatments were most commonly performed in the midface/cheek, temple and jawline areas, and about half of the patients received three or four treatments during the study period. Patients averaged about 0.51-1.50 vials per treatment, which was not affected by age. All of the injectors questioned indicated they added lidocaine to their solution, which resulted in final reconstitution volumes of 8-10 mL. Mild adverse events were reported by only 36 patients (3.6%), the most common being injection site bruising and ecchymosis. Only four patients reported nodules, which were resolved with follow-up.

“The results of this retrospective chart review verify that Sculptra Aesthetic reconstituted to a final volume of 8-10 mL, including anesthetics, is used in clinical practice for many facial indications,” the authors write. In addition, the low number of adverse events suggests this higher volume is associated with a favorable risk benefit ratio, they add.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

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Higher Sculptra Reconstitution Volume Associated With Low Risk of Adverse Events

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February issue highlights new perspectives in chronic skin conditions

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It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like…

February issue highlights new perspectives in chronic skin conditions

By Acne, Aesthetics, Featured Articles, JDD Highlights No Comments

Dermatology News

JDD Highlights

It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like acne as well as anti-aging.

Read the February JDD Now

Acne, Anti-Aging, Aesthetics, Psoriasis, and more

by Heather Onorati

February marks a transition period from the month of new beginnings (January) to a month of advancement (March). In many ways our collective focus is shifting. With new vaccines now rolling out, there has been a shift in the pandemic; our national leadership has shifted; our seasons are transitioning (with many on the East Coast looking forward to warmer days ahead). It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like acne as well as anti-aging. Here’s a glimpse into the findings reported this month:

Article Highlights

  • As we age, the body’s ability to manage inflammation decreases due to a gradual increase in pro-inflammatory systemic cytokines that result in chronic, low-grade inflammation, termed “inflammaging”. This is thought to play a role in many age-related chronic conditions like cardiovascular disease, diabetes, certain cancers and Alzehiemr’s disease. Other studies suggest the human microbiome also may play a role in inflammaging. In “Inflammaging in Dermatology: A New Frontier for Research,” researchers examine inflammaging within the context of the skin microbiome and its impact on chronic disease. The authors write that the skin, our largest organ, may be responsible for a larger role in promoting or preventing inflammaging.

  • Psoriasis is a condition continually studied as it has such a significant impact on patients and their quality of life. While many advances have been made, researchers continue to exam ways in which clinicians can improve treatment and disease management for these patients. In “Hospitalization in Patients With Psoriasis: Impact of Biological Therapies on Temporal Evolution,” researchers recognized the need to improve understanding of the impact of biological therapies on hospitalization. They retrospectively collected data on patients diagnosed with psoriasis within one institution who had at least one hospital admission during the study period. They established methods to compare hospitalizations at specified time periods since the evolution of biological therapies. While their data point to a gradual decrease in average hospitalization rate since 2004, they advise that there have been no extensive data to evaluate the impact of biological therapies on patient hospitalization.

  • In another recently published study, “Dermatologists’ Perspectives on Defining Moderate Psoriasis: The Canadian Moderate Psoriasis Survey,” researchers noted that there is a need to more fully define what constitutes “moderate plaque psoriasis” in order to improve care. In their survey of 69 responding Canadian dermatologists, the authors found that body surface area was used most commonly by respondents to describe disease severity. And, many consider disease location to be an indicator of severity.

  • Another skin condition that causes significant social and psychosocial distress is acne. As oral antibiotics are among the most commonly used systemic treatment, their use may be limited by potential side effects, according to the authors of “Differences in Depression and Distress Between Acne Patients on Isotretinoin vs Oral Antibiotics”. While isotretinoin is one of the most effective therapies, the authors note its potential side effects as well as controversy around its association with depression and suicidal ideation.

    “A critical knowledge gap exists in defining the association between systemic anti-acne treatments and mental health outcomes,” the authors write. To explore this further, they examined the differences in mental health outcomes between patients treated with isotretinoin vs oral antibiotics and found that patients treated with isotretinoin experiences less psychosocial distress and symptoms related to depression compared with those patients treated with oral antibiotics.

  • And, since antimicrobial resistance continues to be a concern, physicians need to weigh this risk when considering treatments for patients with various skin infections. In “Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo,” a group of experts used a modified Delphi technique to develop a treatment algorithm to guide clinicians in the treatment of children and adults with impetigo.

    The authors conducted a systematic literature review of recommendations for the current practice of impetigo treatment, which included research studies, clinical guidelines, consensus papers, and reviews published between 2014 and February 2020.  They developed a step-by-step method to standardize and support clinical decision making, they write, which includes guidance for education and prevention, diagnosis and classification, treatment measures and follow-up. In addition, they discuss a newer topical antibiotic that appears to be safe and effective.

    “The panel recognized that doctors need education in antibiotic stewardship principles, as, for some of them, it is an unknown field,” the authors write.

  • And finally, in an ongoing effort to better understand the impact of COVID-19 in the dermatology setting, researchers in one study reported that patients found teledermatology appointments to be a convenient and effective alternative to in-person visits during the pandemic. While the lack of physical touch and inability to provide close inspection can be frustrating for patients, this can be overcome by appropriate patient selection, the authors report in Patient Perceptions and Satisfaction With Teledermatology During the COVID-19 Pandemic: A Survey-Based Study.

  • Another impact of pandemic restrictions on the dermatology setting is the interaction between dermatologists and pharmaceutical company representatives, who often provide clinicians with educational information on drugs as well as samples for patients. In “The Impact of the COVID-19 Pandemic on Physician-Pharmaceutical Office-Based Interactions,” researchers examined the changing dynamic in the format of visits with and access to physicians by pharmaceutical representatives.

Editor's Picks

These articles and more make up this month’s February issue. Read more on aging, melasma and skin cancer in these articles also included:

  • Efficacy and Tolerability of a Novel Topical Treatment for the Neck: A Randomized, Double-Blind, Regimen-Controlled Study
  • New Protocol for Long-Term Results With a Multi-Pulse Nd:YAG Laser for Melasma Treatment: A Descriptive Cohort Study
  • A Review of Hedgehog Inhibitors Sonidegib and Vismodegib for Treatment of Advanced Basal Cell Carcinoma
  • Ingenol Mebutate as Treatment of Squamous Cell Carcinoma In Situ: A Case Series
  • Intralesional 5-Fluorouracil for Treatment of Non-Melanoma Skin Cancer: A Systematic Review
 
 

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Treating Acne in Adolescents and Young Adults

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Psoriasis Clearance Motivates Patients to Seek Cometic Procedures, Study Finds

By Aesthetics, Featured Articles, Psoriasis, The Latest No Comments

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Patients with moderate to severe psoriasis who achieved 75% or greater reduction in BSA showed an increased uptake in cosmetic procedures and this increase correlated with a reported improvement in quality of life after psoriasis clearance, the authors found.

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Patients with moderate to severe psoriasis who achieved 75% or greater reduction in BSA showed an increased uptake in cosmetic procedures and this increase correlated with a reported improvement in quality of life after psoriasis clearance, the authors found.

Heather Onorati

A significant reduction in psoriasis body surface area (BSA) may motivate patients to seek cosmetic procedures, according to findings from a recent study, “Increased Trend of Cosmetic Procedures in Patients With Psoriasis Who Attain 75% or Greater Improvement.”

Patients with moderate to severe psoriasis who achieved 75% or greater reduction in BSA showed an increased uptake in cosmetic procedures and this increase correlated with a reported improvement in quality of life after psoriasis clearance, the authors found.

Researchers lead by Michelle Walters, M.D., Harbor-UCLA Medical Center, Torrance, Calif., examined the relationship between improvement in quality of life following a reduction in BSA and the use of cosmetic procedures. They identified 138 patients with a history of moderate to severe psoriasis from  the Dermatology Institute and Skin Cancer Center in Santa Monica, Calif., and surveyed them using the Dermatology Life Quality Index (DLQI), adding an additional 5 questions related to the patients’ cosmetic procedures.

Of the group, 119 patients said they had never before undergone a cosmetic procedure due to their psoriasis. All of the patients responded that their quality of life had improved with their psoriasis treatment, and the majority (91%) said this improvement motivated them to undergo the cosmetic procedure.

The most common cosmetic procedures sought by these patients were neurotoxins, soft tissue augmentation and chemical peels. In addition, 79% of the patients purchased skincare products dispensed through the office.

“The improvement in quality of life following treatment of psoriasis with systemic or biologic agents noted in our study reflects results from previous studies,” the authors note. However, the authors state that there have been no studies that have examined a correlation between the improvement in quality of life following psoriasis treatment and an uptake in surgical or nonsurgical cosmetic procedures.

“We found that a common motive for patients who sought cometic procedures was the desire to further improve their quality of life after clearance of their psoriasis,” the authors say. They add that this study indicates that successful treatment of the condition may be a motivator for patients to seek cosmetic procedures for other skin indications.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

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Recommendations for Preparing a Disaster Response Plan

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Featured Article

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In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year.

In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year.

Heather Onorati

The  suddenness with which offices closed as the COVID-19 pandemic escalated created many questions for practices. The uncertainty and inconsistencies around staffing procedures and reopening protocols added to the anxiety and emphasized the need to have proactive strategies in place for emergency situations.

In a paper recently published by JDD, Aesthetic Office Disaster Preparedness and Response Plan, several experts developed a guide based on their own experiences navigating the challenges of this past year.

“This advisory guide is meant to provide aesthetic physicians and their staff with a practical approach for practice management, staffing, supplies and inventory, and patient management,” the authors write in their paper titled “Aesthetic Office Disaster Preparedness and Response Plan.” They add that the paper does not set a standard of practice, but rather offers recommendations for various office procedures to have in place before a disaster-related event.

The experts classified their recommendations into four general areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies.

Among their many recommendations, they suggest creating several lists to serve as references in the event of an emergency. These include:

  • Site access lists — log-in information and passwords to social media sites and other web-based office accounts
  • Contact lists — staff contact details; office insurance policy contacts; financial institutions; colleagues who can be reached for assistance or guidance; state and national agencies like the Centers for Disease Control and Prevention, Federal emergency Management Agency, Department of Public Health), Department of Labor, etc.
  • Supply lists — office-related items in staff possession, inventory of general medical supplies including quantities and expiration dates

Additionally, the authors suggest pre-planning protocols for emergency staffing and office-hours as well as methods for communicating these to both staff and patients at the onset of a disaster.

“In situations of office closure or limited patient accessibility, the staff should be prepared to quickly switch to virtual access patient management tools such as telemedicine appointments,” the authors write.

Among their many additional suggestions, the authors offer insight into financial considerations, office medical record policies and procedures, how much to stock of various emergency supplies and more.

“We are hopeful that this provides at least a template of items for consideration and implementation across the various practice situations and emergencies and mitigates the reoccurrence of difficult lessons learned from the COVID-19 pandemic,” they write.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
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Aesthetic Office Disaster Preparedness and Response Plan

The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the “lessons learned” with the COVID-19 pandemic.
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What are the Skincare Benefits of Niacinamide?

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A 2016 study from Journal of Drugs in Dermatology suggests 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.

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A 2016 study from Journal of Drugs in Dermatology (“Efficacy and Tolerability of a Skin Brightening/Anti-Aging Cosmeceutical Containing Retinol 0.5%, Niacinamide, Hexylresorcinol, and Resveratrol“), which was recently cited in an article on Prevention.com, suggests 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. 

Patricia Farris MD, Joshua Zeichner MD, and Diane Berson MD

 

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.

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Biological Effects of Hyaluronic Acid-Based Dermal Fillers and Laser Therapy on Human Skin Models

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This study investigates the molecular effects of different stabilized HA and poly-l-lactic acid (PLLA)-based fillers with and without subsequent additional fractional laser co-treatment.

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This study investigates the molecular effects of different stabilized HA and poly-l-lactic acid (PLLA)-based fillers with and without subsequent additional fractional laser co-treatment.

Laura Huth PhD, Yvonne Marquardt, Ruth Heise PhD, Katharina Fietkau, Jens Malte Baron MD, Sebastian Huth PhD

 

Injection of hyaluronic acid (HA) dermal fillers is one of the most frequently performed aesthetic procedures. HA fillers exist in many different formulations differing in HA concentration, particle size and cross-linking density.

While HA fillers with high-density and large particles are recommended for deep dermal injections, fillers with low-density and small particles are more commonly used for fine lines.

The direct biological effects of dermal fillers monotherapy and combination therapy with ablative fractional CO2- or Er:YAG laser irradiation on human skin cells are not completely understood. Organotypic three-dimensional (3D) skin equivalents have been established for standardized studies of the human skin.

The aim of the present study was to investigate the molecular effects of different stabilized HA and poly-l-lactic acid (PLLA)-based fillers with and without subsequent additional fractional laser co-treatment.

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Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

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800 patients who took up to 10 grams of collagen per day, experienced improvement in skin elasticity, moisture retention, and increased density of collagen fibers in the skin.

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Improvements in skin health is a well-researched benefit of taking collagen – in fact, according to a January 2019 Journal of Drugs in Dermatology study, (recently featured in an Every Day Health article, ” 8 Potential Benefits of Collagen – and 1 Thing it Can’t Do”), 800 patients who took up to 10 grams of collagen per day, experienced improvement in skin elasticity, moisture retention, and increased density of collagen fibers in the skin.

Franchesca D. Choi BS RPh, Calvin T. Sung BS, Margit L.W. Juhasz MD, Natasha Atanaskova Mesinkovska MD PhD

Nutrition is thought to play an important role in skin homeostasis. The use of nutraceuticals or “functional foods” in skincare along with technological innovations within the food industry has been rising.

In 2016, the collagen market was valued at an estimated 3.71 billion USD and is projected to reach 6.63 billion USD by 2025. Collagen supplements, originating from various sources (eg, porcine, bovine, marine) and available in numerous formulations (eg, protein, gelatin, hydrolysate, peptides), are marketed as improving skin integrity and modulating skin aging.

However, even with this increase in patient interest and market share, the use of collagen supplementation in dermatology remains controversial due to the lack of regulation on quality and quantity of ingredients in over-the-counter collagen supplements, as well as minimal peer-reviewed literature on the subject. Fortunately, there are increasing numbers of clinical studies regarding potential effects of collagen-based dietary supplements on skin.

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Impact of Iron-Oxide Containing Formulations Against Visible Light-Induced Skin Pigmentation in Skin of Color Individuals

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In this study, the efficacy of two formulations containing iron oxide was evaluated in preventing visible light-induced pigmentation compared with a non-tinted mineral SPF 50+ sunscreen.

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In this study, the efficacy of two formulations containing iron oxide was evaluated in preventing visible light-induced pigmentation compared with a non-tinted mineral SPF 50+ sunscreen.

Hawasatu Dumbuya PhD, Pearl E Grimes MD, Stephen Lynch PhD, Kalli Ji PhD, Manisha Brahmachary PhD, Qian Zheng Md PhD, Charbel Bouez PhD, Janet Wangari-Talbot PhD

 

 

Visible light (400–700nm), which contributes to 45% of solar radiation, contributes to skin darkening and worsening of dyschromias, particularly in individuals with Fitzpatrick skin phototypes III and higher.

The pathogenesis of melasma is incompletely understood, which poses a challenge for disease management. Causative factors include genetics, ultraviolet (UV) radiation, cosmetics, pregnancy, hormonal therapy, phototoxic drugs, and various medications.

Currently, sunscreens provide limited protection against that spectrum. Due to their capabilities in absorbing, scattering, and reflecting visible light, topical products containing pigments and/or metal oxides can provide additional photoprotection.

In this study, the efficacy of two formulations containing iron oxide was evaluated in preventing visible light-induced pigmentation compared with a non-tinted mineral SPF 50+ sunscreen. Expert grading and colorimetry demonstrated that the iron-oxide containing formulations significantly protected against visible light-induced pigmentation compared to untreated skin or mineral SPF 50+ sunscreen in Fitzpatrick IV individuals.

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Facial Skin Tightening With Microfocused Ultrasound and Dermal Fillers: Considerations for Patient Selection and Outcomes

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CME Activities

Earn 1.0 CME Credit: Human facial aging is a gradual and ongoing process involving various factors including photodamage, skin laxity, volume loss of subcutaneous tissue, and bony resorption.

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Human facial aging is a gradual and ongoing process involving various factors including photodamage, skin laxity, volume loss of subcutaneous tissue, and bony resorption.

As the aging US population is growing, minimally invasive strategies have become the primary treatment modalities for addressing mild to moderate age-related facial changes. The introduction of microfocused ultrasound (MFU) represents a method to produce a deeper wound healing response with increased collagen remodeling and more durable clinical response. MFU-V treatment protocols continue to be refined and use in combination with other minimally invasive strategies including injectable dermal fillers such as diluted calcium hydroxylapatite for skin laxity and appearance of lines in the neck and décolletage has been studied.

Need exists for expanded understanding of dermatology providers on the application of microfocused ultrasound in combination with injectable dermal fillers as a treatment approach for lifting skin on the neck and face and for improving lines and wrinkles on the chest

CME Certificate Information

  • This CME examination requires a 70% pass mark to receive the CME credit and certificate.
  • This activity is supported by an educational grant provided by Galderma Laboratories, L.P.

Upon completion of this continuing education activity participants should be able to:

  • Summarize the mechanism of action of high-resolution ultrasound imaging (MFU-V) for lifting skin on the neck and face, improving lines and wrinkles on the chest and improving collagen synthesis
  • Identify patients best suited for treatment with MFU-V in combination with injectable dermal fillers
  • Compare features, benefits, and safety profile MFU-V treatment in lifting skin on the neck and face and for improving lines and wrinkles on the chest
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Expiring Soon: Capturing Consensus and Cutting Out Misconceptions regarding the Aesthetic Skin of Color Consumer

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Re-examining the Optimal Use of Neuromodulators and the Changing Landscape: A Consensus Panel Update

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The Therapeutic Use of Antioxidants for Melasma

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With a well demonstrated impact on quality of life, melasma is a common cause for seeking dermatologic care. There is no universally efficacious therapy, so combination treatment is preferred. Therapies include topical hypopigmenting agents, laser treatment, microneedling, chemical peels, radiofrequency, and oral medications.1 Furthermore, it is critical for patients to avoid exacerbating factors.

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In this review, authors discuss the well-defined role of oxidative stress in melasma and the therapeutic efficacy of various antioxidants for patients suffering from melasma, focusing on studies investigating the role of vitamin C, azelaic acid, cysteamine, glutathione, carotenoids, and numerous other antioxidants in disorders of hyperpigmentation.

Kayla M. Babbush BS, Remy A. Babbush BS, Amor Khachemoune MD FAAD FACMS

 

Melasma is a chronic and acquired skin disorder of hyperpigmentation that presents with symmetric hypermelanosis of sun exposed areas, especially the face. Disease prevalence, ranging from 1 to 50%, varies with gender, ethnicity, skin phenotype, and sun exposure.

The pathogenesis of melasma is incompletely understood, which poses a challenge for disease management. Causative factors include genetics, ultraviolet (UV) radiation, cosmetics, pregnancy, hormonal therapy, phototoxic drugs, and various medications.

Melasma is evaluated by Melasma Area and Severity Index (MASI) score, modified MASI (mMASI) score, Melasma Quality of Life Scale (MelasQoL), colorimetry, and mexametry.

With a well demonstrated impact on quality of life, melasma is a common cause for seeking dermatologic care. There is no universally efficacious therapy, so combination treatment is preferred. Therapies include topical hypopigmenting agents, laser treatment, microneedling, chemical peels, radiofrequency, and oral medications.1 Furthermore, it is critical for patients to avoid exacerbating factors.

The skin, a protective organ critical in homeostasis, is the site of numerous biochemical processes, including the generation of free radicals, namely reactive oxygen and nitrogen species. Reactive oxygen species (ROS) are necessary for biological signaling processes, but, in excess, ROS can damage biomolecules.3 There is clear evidence of oxidative stress in melasma.

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Increased Trend of Cosmetic Procedures in Patients With Psoriasis Who Attain 75% or Greater Improvement

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Featured Article

Featured Article

A survey was conducted at a single dermatology center to determine if there was an increased trend in cosmetic procedures in patients with moderate to severe psoriasis who attained 75% or greater reduction of the body surface area (BSA) with biologic agents and oral systemic therapies, and if this was related to an improvement in quality of life following psoriasis clearance.

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A survey was conducted at a single dermatology center to determine if there was an increased trend in cosmetic procedures in patients with moderate to severe psoriasis who attained 75% or greater reduction of the body surface area (BSA) with biologic agents and oral systemic therapies, and if this was related to an improvement in quality of life following psoriasis clearance.

Michelle E. Walters MD, Delphine J. Lee MD PhD, Paul S. Yamauchi MD PhD

Psoriasis is a chronic skin condition with a negative impact on patient quality of life. The National Psoriasis Foundation states that an acceptable response to psoriasis treatment is at least a 75% reduction in body surface area (BSA) at 3 months after initiation of treatment.

This reduction in BSA has been associated with improvement in quality of life, with clearance rates of clear to almost clear leading to an even greater improvement in quality of life.2,3 To date, there have been no studies examining the relationship between improvement in quality of life following a reduction in BSA, and the increased utilization of cosmetic procedures. Here, we examine the relationship between quality of life and the use of various cosmetic procedures in patients treated for psoriasis with systemic and biologic therapies who achieved at least 75% reduction in BSA.

This was a retrospective study assessing quality of life and the use of cosmetic procedures in psoriasis patients after attaining a75% or greater reduction of the body surface area with biologic agents only, systemic agents only, or a combination of both. This study was conducted according to the ethical guidelines of the 1975 Declaration of Helsinki. All patients provided informed consent.

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