Skin Care Is Important Element of Rejuvenation

In treating cosmetic dermatology patients for symptoms associated with aging, procedures are not enough, Dr. Leslie Baumann said in a Galderma-sponsored symposium held during the 21st World Congress of Dermatology in Buenos Aires.

"Skin care is also important," she said. "When you think about skin rejuvenation, you need to think about all components." Combination therapy is a key to treating aging-related skin problems.

In the epidermis, pigmentary therapy targets the melanocytes, and "barrier-restoring therapy" targets the keratinocytes. "Skin needs to be hydrated to look young," said Dr. Baumann, director of cosmetic dermatology at the University of Miami.

As skin ages, the levels of collagen and glycosaminoglycans in the dermis decrease and alterations in elastic tissue occur, she noted. Injection of hyaluronic acid or collagen fillers helps restore the structural integrity of the dermis. Vascular therapy prevents the enlargement of blood vessels in the dermis that is seen in the blushing associated with rosacea. Volume-restoring therapy targets the adipocytes in the subcutaneous tissue, and therapy that controls muscular movements, such as botulinum toxin, targets muscle fibers.

Retinoids prevent skin aging by increasing the production of collagen and hyaluronic acid. "You are doing your patients a disservice to give them botulinum toxin or fillers and not give them a retinoid," said Dr. Baumann.

Nearly half of the cosmetic dermatologists interviewed in a recent market survey acknowledged discussing makeup with their patients. Surprisingly, only a slightly higher percentage of those surveyed talked to their patients about the use of retinoids in skin rejuvenation. "If we are going to talk to our patients about how to look better, we need to tell them about the science," she said. Cosmetic dermatologists should explain to their patients the scientific basis underpinning the use of retinoids in skin rejuvenation.

Tolerability appears to be a problem. "We're just not seeing a lot of retinoid use. I think it is because retinoids cause redness and flaking, and patients don't want to use them," she said. "Doctors don't have time to explain to the patients how to use retinoids properly and how to get through that initial redness."

Dr. Baumann recommends the use of topical retinoids for treatment of photoaging, acne, pigmentation disorders such as melasma and solar lentigos, and rosacea. All retinoids that affect the retinoic acid receptor are thought to improve photoaging, but only tretinoin and Avage (tazarotene, Allergan) are approved by the Food and Drug Administration for the treatment of photoaging, she said.

Photoaging leads not just to wrinkles, but also to sunspots and pigmentary damage. In her own practice, Dr. Baumann uses Tri-Luma cream (fluocinolone acetonide/hydroquinone/tretinoin, Galderma) off label for treatment of photoaging.

"I use retinoids in rosacea patients," she said. "I know you've been taught not to, but I put all my rosacea patients on retinoids. I can do it by teaching them how to use the retinoids properly."

Dr. Baumann is an investigator for Galderma and other manufacturers of skin care products.

In treating cosmetic dermatology patients for symptoms associated with aging, procedures are not enough, Dr. Leslie Baumann said in a Galderma-sponsored symposium held during the 21st World Congress of Dermatology in Buenos Aires.

"Skin care is also important," she said. "When you think about skin rejuvenation, you need to think about all components." Combination therapy is a key to treating aging-related skin problems.

In the epidermis, pigmentary therapy targets the melanocytes, and "barrier-restoring therapy" targets the keratinocytes. "Skin needs to be hydrated to look young," said Dr. Baumann, director of cosmetic dermatology at the University of Miami.

As skin ages, the levels of collagen and glycosaminoglycans in the dermis decrease and alterations in elastic tissue occur, she noted. Injection of hyaluronic acid or collagen fillers helps restore the structural integrity of the dermis. Vascular therapy prevents the enlargement of blood vessels in the dermis that is seen in the blushing associated with rosacea. Volume-restoring therapy targets the adipocytes in the subcutaneous tissue, and therapy that controls muscular movements, such as botulinum toxin, targets muscle fibers.

Retinoids prevent skin aging by increasing the production of collagen and hyaluronic acid. "You are doing your patients a disservice to give them botulinum toxin or fillers and not give them a retinoid," said Dr. Baumann.

Nearly half of the cosmetic dermatologists interviewed in a recent market survey acknowledged discussing makeup with their patients. Surprisingly, only a slightly higher percentage of those surveyed talked to their patients about the use of retinoids in skin rejuvenation. "If we are going to talk to our patients about how to look better, we need to tell them about the science," she said. Cosmetic dermatologists should explain to their patients the scientific basis underpinning the use of retinoids in skin rejuvenation.

Tolerability appears to be a problem. "We're just not seeing a lot of retinoid use. I think it is because retinoids cause redness and flaking, and patients don't want to use them," she said. "Doctors don't have time to explain to the patients how to use retinoids properly and how to get through that initial redness."

Dr. Baumann recommends the use of topical retinoids for treatment of photoaging, acne, pigmentation disorders such as melasma and solar lentigos, and rosacea. All retinoids that affect the retinoic acid receptor are thought to improve photoaging, but only tretinoin and Avage (tazarotene, Allergan) are approved by the Food and Drug Administration for the treatment of photoaging, she said.

Photoaging leads not just to wrinkles, but also to sunspots and pigmentary damage. In her own practice, Dr. Baumann uses Tri-Luma cream (fluocinolone acetonide/hydroquinone/tretinoin, Galderma) off label for treatment of photoaging.

"I use retinoids in rosacea patients," she said. "I know you've been taught not to, but I put all my rosacea patients on retinoids. I can do it by teaching them how to use the retinoids properly."

Dr. Baumann is an investigator for Galderma and other manufacturers of skin care products.

In treating cosmetic dermatology patients for symptoms associated with aging, procedures are not enough, Dr. Leslie Baumann said in a Galderma-sponsored symposium held during the 21st World Congress of Dermatology in Buenos Aires.

"Skin care is also important," she said. "When you think about skin rejuvenation, you need to think about all components." Combination therapy is a key to treating aging-related skin problems.

In the epidermis, pigmentary therapy targets the melanocytes, and "barrier-restoring therapy" targets the keratinocytes. "Skin needs to be hydrated to look young," said Dr. Baumann, director of cosmetic dermatology at the University of Miami.

As skin ages, the levels of collagen and glycosaminoglycans in the dermis decrease and alterations in elastic tissue occur, she noted. Injection of hyaluronic acid or collagen fillers helps restore the structural integrity of the dermis. Vascular therapy prevents the enlargement of blood vessels in the dermis that is seen in the blushing associated with rosacea. Volume-restoring therapy targets the adipocytes in the subcutaneous tissue, and therapy that controls muscular movements, such as botulinum toxin, targets muscle fibers.

Retinoids prevent skin aging by increasing the production of collagen and hyaluronic acid. "You are doing your patients a disservice to give them botulinum toxin or fillers and not give them a retinoid," said Dr. Baumann.

Nearly half of the cosmetic dermatologists interviewed in a recent market survey acknowledged discussing makeup with their patients. Surprisingly, only a slightly higher percentage of those surveyed talked to their patients about the use of retinoids in skin rejuvenation. "If we are going to talk to our patients about how to look better, we need to tell them about the science," she said. Cosmetic dermatologists should explain to their patients the scientific basis underpinning the use of retinoids in skin rejuvenation.

Tolerability appears to be a problem. "We're just not seeing a lot of retinoid use. I think it is because retinoids cause redness and flaking, and patients don't want to use them," she said. "Doctors don't have time to explain to the patients how to use retinoids properly and how to get through that initial redness."

Dr. Baumann recommends the use of topical retinoids for treatment of photoaging, acne, pigmentation disorders such as melasma and solar lentigos, and rosacea. All retinoids that affect the retinoic acid receptor are thought to improve photoaging, but only tretinoin and Avage (tazarotene, Allergan) are approved by the Food and Drug Administration for the treatment of photoaging, she said.

Photoaging leads not just to wrinkles, but also to sunspots and pigmentary damage. In her own practice, Dr. Baumann uses Tri-Luma cream (fluocinolone acetonide/hydroquinone/tretinoin, Galderma) off label for treatment of photoaging.

"I use retinoids in rosacea patients," she said. "I know you've been taught not to, but I put all my rosacea patients on retinoids. I can do it by teaching them how to use the retinoids properly."

Dr. Baumann is an investigator for Galderma and other manufacturers of skin care products.