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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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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional quantification methods.

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Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional quantification methods.

Heather Onorati

Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional quantification methods.

Due to the nature and complexity of psoriasis, authors of the survey, reported in the Journal of Drugs in Dermatology, say that a clinically useful definition of moderate plaque psoriasis is necessary to improve patient care.

“Because assessment of severity informs therapeutic decision-making, it is critical to clearly define psoriasis disease severity and offer patients therapy that is appropriate for their condition,” writes Melinda Gooderham, M.D., M.Sc., SKiN Centre for Dermatology, Ontario, Canada, who was the lead author of the report.

In the study, which is detailed in “Dermatologists’ Perspectives on Defining Moderate Psoriasis: The Canadian Moderate Psoriasis Survey,” researchers distributed a survey to 69 dermatologists asking questions about their approach to identifying and managing patients with psoriasis.

Most of the responding dermatologists reported they used the psoriasis-involved body surface area (BSA) and Psoriasis Area and Severity Index (PASI) measures to evaluate a patient’s disease severity. However, BSA has been shown to have a weak correlation with patient perception of psoriasis severity and PASI measure has a tendency to underrepresent involvement of areas such as the scalp, nail, genital and palmoplantar areas, the authors report. Therefore, these traditional measures may not adequately capture psoriasis impact on quality of life.

In using traditional classification methods, respondents reported cutoff ranges varying from 5% to 5.3% (mean) for the lower end of the BSA and 10% to 11.5% (mean) on the upper end. Similarly, the lower and upper cutoff ranges for the PASI, Dermatology Life Quality Index (DLQI) and the Physicians Global Assessment (PGA) were reported at 6 to 6.3 (mean)  and 12 to 12.2 (mean), 7 to 7.3 (mean) and 11.5 to 13.0 (mean), and 2 to 2.2 and 3 to 3.2 (mean), respectively.

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.

More than three quarters (78%) of the dermatologists in this survey estimated that less than 40% of their patients with moderate plaque psoriasis were being treated with traditional systemic therapies.

According to the authors, more than one-third of patients with psoriasis were classified as having moderate disease in the US National Psoriasis Foundation national survey data. Among patients with moderate psoriasis, more than half reported dissatisfaction with their treatment.

“Despite these efforts to classify psoriasis disease severity, psoriasis categories are often combined or collapsed for diagnostic, research, and therapeutic purposes, which may leave therapeutic needs of patients with moderate psoriasis unmet,” the authors write. “It is therefore important to clearly define this population to better understand and address their treatment goals.”

The authors write that, according to this first survey of Canadian dermatologists on moderate psoriasis, data indicate that not only is there a need to develop a more meaningful and useful definition of moderate plaque psoriasis to improve care for these patients but it also essential to raise awareness about the definition among regulatory agencies and reimbursement authorities.

 

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

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Review Highlights Need for More Effective Rosacea Treatments

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“The inflammatory pathways underlying rosacea are becoming increasingly elucidated. What remains unknown is the mechanism of progression of these pathways, and how they can result in papules/pustules and/or phyma in some patients but not others”

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“The inflammatory pathways underlying rosacea are becoming increasingly elucidated. What remains unknown is the mechanism of progression of these pathways, and how they can result in papules/pustules and/or phyma in some patients but not others.”

Heather Onorati

While much progress has been made in better understanding the pathogenesis of rosacea, a need remains for more effective treatments to address the underlying inflammation and to improve clearance.

Current therapies for facial erythema provide temporary relief and are not consistent at helping patients achieve complete clearance of papules and pustules, according to authors Jerry Tan, MD, of Western University in Ontario, Canada, and J. Mark Jackson, MD, of the University of Louisville in Louisville, Ky, who published a review in the Journal of Drugs in Dermatology (“Treating Inflammation in Rosacea: Current Options and Unmet Needs”). They examined what is known about the underlying inflammatory nature of rosacea and its available treatments.

Ideally, the future of rosacea treatment should include addressing both the papules and pustules  as well as the inflammatory pathways leading to erythema and phyma, the authors say. Longer-term control and the ability to reduce the signs and symptoms of rosacea would be an important advance, they write.

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

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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Psoriasis Clearance Motivates Patients to Seek Cometic Procedures, Study Finds

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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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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

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Atopic Dermatitis Philipines

Recommendations for Topical AD Management in the Philippines

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Atopic Dermatitis Philipines

The prevalence of atopic dermatitis is increasing in Asia, patients have indicated they are not satisfied with disease control; yet, research indicates they are not correctly applying treatments or they prefer alternative therapies.

The prevalence of atopic dermatitis is increasing in Asia, patients have indicated they are not satisfied with disease control; yet, research indicates they are not correctly applying treatments or they prefer alternative therapies.

Heather Onorati

The prevalence of atopic dermatitis is increasing in Asia, patients have indicated they are not satisfied with disease control; yet, research indicates they are not correctly applying treatments or they prefer alternative therapies.

“AD is considered incurable, thus, there is a need for accepted guidelines to manage and reduce the burden that this condition brings,” write authors of a recent review (“The ABC Topical Management of Atopic Dermatitis in Philippines: Expert Recommendations“) published in the Journal of Drugs in Dermatology. 

Data from 744,673 dermatological consults in the Philippine Dermatological Society-accredited outpatient institutions collected between 2007 and 2011 showed that 65% of patients were children between 1-12 years old and 24% of patients were infants less than one year old. Because children rely on caregivers to administer treatments, disease control depends largely on the education, resources and attitudes toward treatment of the caregivers, the researchers note.

An earlier paper cited by the authors proposed an easy-to-follow ABC scheme based on characteristics of Atopic Dermatitis. In the current review, the authors build on this scheme with their suggestions.

The Anti-inflammatory phase focuses on using topical corticosteroids and/or topical calcineurin inhibitors to control inflammation during flare ups. The authors suggest considering patient characteristics in disease management as well as characteristics of anti-inflammatory agents. They also add, “Monitoring for overt signs of infection is another important focus, as this can further aggravate an AD flare.”

In the Barrier Restoration phase, the focus of treatment is on reestablishing the integrity of the skin barrier and lengthening time between flares.

“Existing AD guidelines have not provided consistent recommendations about the optimal frequency of moisturizer application but recent guidelines state that moisturizers should be prescribed in adequate amounts (ie, minimum of 250g/week, used at least twice daily) even on non-inflamed skin,” the authors note.

Finally, managing patients in the Basic Care phase focuses on maintaining an intact skin barrier through proper skin care, emollient application and avoiding potential irritants and allergans, the authors write.

The panel identified a lack of proper patient and caregiver education regarding chronicity, course, prognosis, and disease avoidance strategies; the inability to identify disease triggers; the absence of definite guidelines on the effective moisturizer amount and frequency of application; and the lack or absence of proper management of microbial colonization as contributing to the challenges of disease management.

“A holistic approach is essential in the success of AD management,” the authors write. “The ABC scheme presents a simple guide on AD management for the healthcare provider based on the key problems in the different phases of the disease.”

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

Atopic Dermatitis Resource Center

 

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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

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Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. The authors conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment.

Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. The authors conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment.

April W. Armstrong MD MPH, Joshua Hekmatjah BS, Leon H. Kircik MD

Acne vulgaris is a common skin disease affecting up to 70% of the population during their lifetime.  Cutibacterium acnes is the primary target of acne pathogenesis, and oral antibiotics, namely oral tetracyclines, have been the mainstay of systemic acne treatment for decades. In addition, oral tetracyclines possess an indirect anti-inflammatory effect against acne. Oral tetracyclines are an important part of the acne treatment regimen, and substantial evidence exists for their efficacy and safety for use in inflammatory acne.

Oral tetracyclines demonstrate bacteriostatic (inhibiting bacterial growth) effects against C. acnes; however, some tetracyclines also exhibit bacteriostatic effects on beneficial commensal organisms of the gut. This broad-spectrum effect can lead to a less diverse gut microbiome. Disruptions in the symbiotic relationship between the gut microbiome and the host have been associated with chronic diseases, such as obesity and inflammatory bowel disease (IBD).  Although a compositional definition of an ideal gut microbiome does not exist, greater microbial diversity is important for protection from pathogens, nutrient supply, and vitamin production.

While oral tetracyclines are widely prescribed for acne, a gap exists in synthesizing the most recent data on the efficacy and safety of these agents. We conducted a systematic review of the efficacy and safety of common oral tetracyclines (sarecycline, doxycycline, minocycline, and tetracycline) used for acne.

To determine the efficacy and safety of oral tetracyclines for acne, we followed the Preferred Reporting Items for Systematic Reviews guidelines and performed a systematic review using PubMed and Embase. Our search included published articles from January 1960 to April 2020, and our search criteria included the following: (“Acne”[MeSH] OR “Acne Vulgaris”[MeSH]) OR “acne vulgaris/drug therapy”[MeSH Major Topic]) AND tetracyclines [MeSH Terms].

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.

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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. We conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment. We identified 13 articles meeting inclusion for this review, which represented 226,019 pediatric and adult acne patients. Oral tetracyclines that were included in this systematic review were sarecycline (a novel narrow-spectrum tetracycline), doxycycline, minocycline, and tetracycline. Based on shared and divergent outcome measures, different oral tetracyclines were variably effective against facial acne. Sarecycline also demonstrated efficacy in truncal acne. Members of the oral tetracycline class also differed in their ability to minimize antibiotic resistance and gut dysbiosis.
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Recommendations for Preparing a Disaster Response Plan

By Aesthetics, COVID 19, Featured Articles, The Latest No Comments

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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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Dermatologist looking at skin

What’s New in Dermatology – January 2021

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Dermatologist looking at skin

In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

 

Heather Onorati

January always represents new beginnings. It’s the time of year we tend to reflect on the past, extract insight from experience and look toward the future with new hope and understanding. It is with this in mind that our January issue couples articles based in foresight and advances.

Groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

In Aesthetic Office Disaster Preparedness and Response Plan, authors look to their shared experiences to provide suggestions for a proactive approach to manage possible future disaster-related events that could affect aesthetic practice operations and financial viability. Leveraging Virtual Boot Camp to Alleviate First Year Dermatology Resident Anxiety illustrates compelling levels of anxiety among incoming first-year dermatology residents and suggests that formally addressing the tenets of the specialty at the onset of PGY-2 can strengthen the foundation and boost the confidence of trainees. And, in Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations, authors discuss how the field of dermatology must remain on the leading edge of patient safety and advocacy issues and remain compassionate and adaptable when facing new patient care issues.

In the spirit of advancing understanding, other articles look to build the knowledge well around therapeutic techniques and disease treatment. As we continue toward a better understanding COVID-19, New York and Brazilian researchers examine the cutaneous presentations that could be clues to diagnosis in Presentation and Management of Cutaneous Manifestations of COVID-19. In the article Aesthetic ONE21 Technique for Injecting IncobotulinumtoxinA into the Forehead: Initial Experience With 86 Patients, authors report safety and efficacy from a single-center, retrospective study. Researchers present a clinical evaluation of a drug-device combination product for the topical treatment of molluscum contagiosum in A Phase 2 Open-Label Study to Evaluate VP-102 for the Treatment of Molluscum Contagiosum.

In addition, experts examine the impact of psychosocial stress on skin health, investigate efficacy of a nutraceutical supplement for promoting hair growth, discuss recommendations for absorbable suspension sutures in nonsurgical facial rejuvenation, and much more.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
January 2021 JDD 

 

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Top 10 Most Talked About Articles of 2020

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As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year.  

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year.  

 

Heather Onorati

The second half of 2020 has seen the world still trying to navigate and overcome the COVID-19 pandemic, and the practice of dermatology has been no exception. However, while still an area of focus, dermatologists have been reading, sharing and discussing studies about a variety of other conditions and treatments relevant to their patients.  

In our year-end topten list, we’re sharing the case studies, reviews and investigations published by the Journal of Drugs in Dermatology that have been downloaded and read the most in the past 12 months.  

 

As the world sought to understand the emerging Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), or coronavirus disease 2019 (COVID-19), many potential signs and symptoms were investigated in connection with the virus, leading dermatologists to also grapple with identifying potentially afflicted patients. In a case study published early in the pandemic, authors in Cairo, Egypt, looked at whether a reported case of a pityriasis rosea-like rash could be connected with COVID-19. 

While COVID-19 remains a topic of interest, other issues like the use of neutraceuticals, approaches to treating melasma and hyperpigmentation, countering hair loss, and calming dermatitis have drawn attention.   

Nutrition and supplementation are topics of interest across medicine for their potential roles in overall health and wellness, including skincare. A literature review published in early 2019 examined the benefits of collagen supplementation in skin healing and anti-aging. The authors reported on a total of 11 studies that included 805 patients being treated for a range of issues from decubitus ulcers to anti-aging. In their analysis, the authors noted that collagen supplementation appeared to be promising with potential improvements in elasticity, hydration and dermal collagen density; however not all supplements are created equal and patients should be counselled with regard to ingredients and expectations, they noted. Another study that explored the use of a neutraceutical supplement for the treatment of hair loss highlighted botanical ingredients that may mitigate triggers for hair loss and help to restore balance to the follicle.   

In line with patient interest in “natural” treatments, investigators examined the mechanism of action for observed dermatologic benefits of colloidal oatmeal and found that extracts of colloidal oatmeal decreased pro-inflammatory cytokines in vitro. 

 

“Clinical evaluations showed that the colloidal oatmeal skin protectant lotion significantly improved dryness, scaling and roughness as early as 1 day after use, and these improvements were maintained over the duration of the study with continued use of the lotion,” the authors wrote. 

Among the investigations into treatments for common but challenging conditions, authors from the University of Kansas Medical Center, Kansas City, KS, reported on a case of chronic bilateral nasolabial fold seborrheic dermatitis. They hypothesized that Crisaborole 2% ointment, a PDE4 inhibitor would reduce the inflammation. After 2 treatments per week for 4 weeks, the investigators observed a notable reduction in scaling and erythema on the treatment site.  

Another commonly seen condition, xanthelasma palpebrae, can be a significant cosmetic concern for patients. In a case study published in 2016, researchers report on a case in which they used a hyfrecator for superficial tissue destruction resulting in excellent cosmetic results, the authors showed. 

Melasma and hyperpigmentation are among the challenging conditions dermatologists see. One study still garnering attention is an investigation into the benefit of Vitamin C plus iontophoresis. Investigators observed a mean 73% improvement in abnormal pigmentation after treatment combining Vitamin C with a full-face iontophoresis mask. A mean improvement of 15.7 on the Melasma Area and Severity Index was also noted.  

A review of 10 studies examining the efficacy of retinoids and azelaic acid for the treatment of acne and subsequent post-inflammatory hyperpigmentation in skin of color reported growing evidence that retinoids are well-tolerated and could be considered as first-line therapies to treat acne people with skin of color. In addition, azelaic acid may offer improvement in both acne and hyperpigmentation, the authors noted.  

Finally, a more recent review evaluated 35 randomized controlled trials of topical agents for the treatment of melasma found strong evidence for the recommendation of cysteamine, triple combination therapy, and tranexamic acid. 

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year. 

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
Read the top 10 most discussed articles in 2020: 

 

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Current field-directed treatments of actinic keratosis (AK), a pre-malignant condition, are often limited by severe local reactions and/or complex treatment. Tirbanibulin, a novel potent anti-proliferative synthetic agent that inhibits tubulin polymerization and Src kinase signalling, is being developed as a convenient, safe, and effective field treatment of actinic keratosis.

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Steven Kempers MD, Janet DuBois MD, Seth Forman MD, Amy Poon BS MA, Eva Cutler BS BA, Hui Wang PhD, David Cutler MD FRCP(C), Jane Fang MD, Rudolf Kwan MBBS MRCP

 

Actinic keratosis (AK) is a pre-malignant condition, associated with prolonged ultraviolet damage predominantly on the face/scalp, trunk, and extremities. AK affects ~58 million individuals in the US, and typically occurs in males, fair-skinned individuals, and those of advancing age. As the progression of AK to invasive squamous cell carcinoma (iSCC) is unpredictable, the generally accepted approach is to treat all AK.

Current treatments are lesion- or field-directed therapies. Lesion-directed therapies are used when the lesion burden is low; but these modalities can cause scarring and long-term pigmentary changes. Field-directed therapies are used to treat multiple lesions, large areas, and subclinical lesions.

Commonly used topical treatments, while effective, frequently cause moderate-to-severe application-site reactions and deleterious effects on uninvolved skin, which are often considered unacceptable to patients. Moreover, many of these treatments have lengthy or cumbersome dosing regimens that may undermine treatment compliance and compromise efficacy.

Given the disadvantages of available topical therapies, there is a need to develop an agent that has low potential for severe local reactions, effective AK clearance, and convenient dosing.

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The concept of human body rhythms has been popularized as important in overall body health. These rhythms are characterized as fluctuations in mental, physical, and emotional well-being based on the clock. These fluctuations are related to the day/night cycle, hormones, meals, sleep/wake cycle, adrenal gland production, thyroid gland, and clock genes.

The study of the body circadian rhythm is known as chronobiology with studies of the body’s inner clock dating back to the 18th century. There are three types of chronobiology rhythms: infradian rhythms, ultraradian rhythms, and circadian rhythms. Infradian rhythms last more than 24 hours and are repeated only every few days, weeks, or months representing such activities as female menses. Ultradian rhythms are shorter than 24 hours and often last several hours, such as ingestion of food. Finally, circadian rhythms last 24 hours with distinctive day/night cycles.

Circadian rhythms are endogenous and adjusted to the local environment by cues call zeitgebers, meaning “time giver” in German. The 2017 Nobel prize in physiology or medicine was awarded for research in molecular mechanisms controlling circadian rhythms in fruit flies. In humans, the circadian clock is in the suprachiasmatic nucleus, located in the hypothalamus. Information is transmitted to the suprachiasmatic nucleus via the retina that contains specialized photosensitive ganglion cells. PER1 and PER2 genes are expressed in the suprachiasmatic nucleus representing the primary circadian pacemaker in the human brain. These circadian rhythms are also important in the skin with robust autonomic clocks in keratinocytes, fibroblasts, melanocytes, mast cells, and hair follicles.

Important skin functions affected by circadian rhythms include free radical production and neutralization, DNA damage and repair, keratinocyte/fibroblast differentiation and proliferation, and barrier and immune functioning. Direct and indirect antioxidant protection play an important role in supporting these circadian rhythm skin functions.

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various mechanisms of action including direct anti-inflammatory, anti-pruritic, anti-oxidant, anti-fungal, pre-biotic, barrier repair properties, and beneficial effects on skin pH. These have been shown to be of particular benefit in the treatment of atopic dermatitis.

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Oatmeal has a longstanding and rich history pertaining to its dermatologic use. The first documentation of oatmeal for skin health dates back as early as 2000 BC in Arabia and Egypt, where it was described as soothing and protecting in dry or itchy, inflamed skin. Oatmeal flour was subsequently recognized as a topical therapy for a variety of dermatologic conditions in Roman medical literature. The first scientific studies on the skin benefits of oatmeal appeared in the 1930s, including information about the cleansing properties of oatmeal, its role in relieving itch, and its function as a skin protectant.

In the 1940s and 1950s colloidal oatmeal became commercially available both in powder form and mixed with emollient oils, instigating medical studies examining the benefits of colloi-dal oatmeal baths in various xerotic dermatoses.

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.

In 1989, the United States Food and Drug Administration (FDA) approved colloidal oatmeal as a safe and effective over-the-counter drug. In 2003, the FDA noted that colloidal oatmeal could relieve irritation and itching due to a number of dermatoses, providing temporary skin protection.5 Colloidal oatmeal is one of the few products that the FDA recognizes as a safe over the counter treatment. Today it is available in various forms including creams, lotions, shampoos, shaving gels, bath treat-ments, and body wash.

Colloidal oatmeal is the powder obtained from the grinding and processing of whole oat grain. Under strict protocols es-tablished by the US Pharmacopeia, oat grain is ground and processed until no more than 3% of the total particles in the powder exceed 150 μm in size and no more than 20% exceed 75 μm in size.6 The small size of the particles contributes to their ability to deposit on the skin and form an occlusive barrier when dispersed in water. Oat is composed of various types of phytochemicals, which contribute to its wide-ranging function and clinical use. Col-loidal oatmeal consists of sugars and amino acids (65%), proteins (15–20%), lipids (11%), and fiber (5%).7 The most important groups of phytochemicals present in oats include phenolics, β-glucans, lignans, avenanthramides, carotenoids, vitamin E, and phytosterols.

Of the phenolics present in oats, ferulic acid and caffeic acid are strong antioxidants, and fe-rulic acid also has UV absorbing properties.8 Flavonoids, a group of phenolic compounds present in oat, also are capable of absorbing ultraviolet A light from 320–370 nm. β-glucans are polysaccharides of D-glucose monomers and have a high viscosity largely due to their β-(1–3)-linkages.This viscosity contributes to the water-binding properties of oat. Oats also contain a wide range of minerals and vitamins, of which vita-min E is the most clinically relevant. Vitamin E is a naturally occurring antioxidant that protects against oxidative stress, inflammation, and photo-induced aging.

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