Aesthetic Dermatology

A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.

Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.

Stockbyte/Thinkstock

The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.

Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?

A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?

Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?

I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.

Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.

Stockbyte/Thinkstock

The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.

Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?

A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?

Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?

I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

A recent article in the New York Times ("How Well you Sleep May Hinge on Race," Aug. 20, 2012), discussed a link between ethnicity and quality of sleep. According to the story, non-Hispanic white patients sleep longer with less interruption than people of other ethnicities. Black patients are also most likely to get shorter, more restless sleep, according to the article.

Poor sleep quality has been associated with high blood pressure, obesity, and insulin resistance, which might help explain why people in some minority groups experience higher rates of chronic health conditions.

Stockbyte/Thinkstock

The article highlighted racial disparity evidence presented at the annual Associated Professional Sleep Societies meeting in Boston in June. White patients from the Chicago area were found to get an average of 7.4 hours of sleep per night; Hispanic and Asian patients averaged 6.9 hours; and black patients averaged 6.8 hours. Sleep quality – defined as ease in falling asleep and length of uninterrupted sleep – was also higher for white patients than for black patients. Even after adjusting for cardiovascular disease, sleep apnea, and obesity, black patients and other ethnic minorities still got less, and more disruptive, sleep than white patients.

Could differences in quality of sleep also be associated with dermatologic conditions that occur at a higher rate in certain ethnic groups?

A study, published earlier this year, found that sleep disturbance correlated with immune system dysregulation (Am. J. Geriatr. Psychiatry 2012 Feb. 10 [epub ahead of print]), which could help explain why atopic dermatitis is seem more frequently in children of Asian and African-American descent?

Interestingly, there have been reports of sleep disturbances in both infants and older children with atopic dermatitis (Asian Pac. J. Allergy Immunol. 2012;30:26-31). But is it the atopic dermatitis that causes poor sleep or the poor sleep that exacerbates the atopic dermatitis?

I think there is probably a relationship in both directions. It would be interesting to study whether socioeconomic and living conditions, regardless of race and ethnicity, are contributing factors. Insights into sleep quality and ethnic disparities may also offer further information on the same disparities seen in skin conditions.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.

Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.

Courtesy Wikimedia Commons

Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.

Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.

In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.

The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.

There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.

Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.

Courtesy Wikimedia Commons

Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.

Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.

In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.

The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.

There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

We were recently asked by a reader if there is any scientific evidence on the benefits of using argan oil to treat dry hair and scalp.

Argan oil is native to Morocco and has been used for centuries in foods and topical preparations. It is a plant oil produced from the argan tree (Argania Spinosa L). Studies have found that the oil has cardioprotective and anti-thrombotic effects when ingested.

Courtesy Wikimedia Commons

Over the past several years, it has become popular in hair care products. While the benefits of consumption of argan oil have been well-studied, its use for hair has not been documented in peer-reviewed literature.

Argan oil may be used on any hair type. It is available in shampoos, conditioners, and leave-in products. I have found that argan oil is beneficial for patients with curly hair, particularly those of African or African-American descent, because it helps to reduce frizz and adds shine. A small amount may be applied to the scalp if dry.

In patients with fine hair, too much oil can be greasy and may weigh curls down. In those cases, small amounts of the oil may be more beneficial. If too much product is used, clarifying shampoos may help remove excess oil.

The number of personal care products on the U.S. market with argan oil as an ingredient increased from just 2 in 2007 to over 100 in 2011. There are many hair care brands that contain argan oil including Moroccanoil, DermOrganic, Josie Maran, One 'N Only, and Organix, among others.

There has been one report of anaphylaxis to argan oil in the literature (Allergy 2010;65:662–3). Studies must be done to assess its actual efficacy for dermatologic scalp conditions and use for ethnic hair.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

DANA POINT, CALIF. – Finding ways to restore elasticity of the skin is a better goal than is developing and refining ways to tighten the skin, according to Dr. R. Rox Anderson.

"The loss of natural skin tension with aging is due to a loss of its elasticity," Dr. Anderson said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "It’s the impressive loss of cutaneous elastic recoil with aging that accounts for the effectiveness of Botox, for example. A simple hypothesis is that restoring skin elasticity is a better goal than tightening the skin."

The "players" in cutaneous elastic recoil, he said, are numerous, but it remains unknown which are pivotal. Is it the extracellular matrix content and cross-linking, the fibril microstructure, or the active cytoskeleton?

"When you lose elastic recoil, we don’t know which ones of these are most important," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston. "If we knew that, we could design treatments that actually treat the cause as opposed to [treating] flabby skin."

He said that "powerful, verified" research tools are needed to improve understanding of cutaneous elastic recoil, including "composite, dynamic structural models" to expand understanding of the difference between microscopic and macroscopic skin. "Those exist; we don’t have to invent them," he said. "I’m an adjunct professor at Massachusetts Institute of Technology, [which has] an entire department that does nothing but material science and modeling. They’re really good at composite materials. That’s what we [humans] are: we are complex composite material."

Stress-strain component analysis is another key tool to improve understanding of elastic recoil. "Each of those components has its own structural and dynamic behavior," said Dr. Anderson, who also directs the Wellman Center for Photomedicine. "I think it’s important to recognize that the skin is a dynamic system that responds to stress. So Langer’s lines are due to particular strain receptors and fibroblasts. The genes that are strain inducible have been at least partially noted, but they have not been studied in the context of skin tightening and rejuvenation. I would love to see that: a dose response analysis for strain-mediated gene expression."

Studies involving in vivo microscopy will also be important. "Elastin, for example, is easy as pie to image in vivo in human skin," he said. "We should be able to map mechanical properties of skin."

Dr. Anderson said that he had no relevant financial conflicts to disclose.

DANA POINT, CALIF. – Finding ways to restore elasticity of the skin is a better goal than is developing and refining ways to tighten the skin, according to Dr. R. Rox Anderson.

"The loss of natural skin tension with aging is due to a loss of its elasticity," Dr. Anderson said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "It’s the impressive loss of cutaneous elastic recoil with aging that accounts for the effectiveness of Botox, for example. A simple hypothesis is that restoring skin elasticity is a better goal than tightening the skin."

The "players" in cutaneous elastic recoil, he said, are numerous, but it remains unknown which are pivotal. Is it the extracellular matrix content and cross-linking, the fibril microstructure, or the active cytoskeleton?

"When you lose elastic recoil, we don’t know which ones of these are most important," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston. "If we knew that, we could design treatments that actually treat the cause as opposed to [treating] flabby skin."

He said that "powerful, verified" research tools are needed to improve understanding of cutaneous elastic recoil, including "composite, dynamic structural models" to expand understanding of the difference between microscopic and macroscopic skin. "Those exist; we don’t have to invent them," he said. "I’m an adjunct professor at Massachusetts Institute of Technology, [which has] an entire department that does nothing but material science and modeling. They’re really good at composite materials. That’s what we [humans] are: we are complex composite material."

Stress-strain component analysis is another key tool to improve understanding of elastic recoil. "Each of those components has its own structural and dynamic behavior," said Dr. Anderson, who also directs the Wellman Center for Photomedicine. "I think it’s important to recognize that the skin is a dynamic system that responds to stress. So Langer’s lines are due to particular strain receptors and fibroblasts. The genes that are strain inducible have been at least partially noted, but they have not been studied in the context of skin tightening and rejuvenation. I would love to see that: a dose response analysis for strain-mediated gene expression."

Studies involving in vivo microscopy will also be important. "Elastin, for example, is easy as pie to image in vivo in human skin," he said. "We should be able to map mechanical properties of skin."

Dr. Anderson said that he had no relevant financial conflicts to disclose.

DANA POINT, CALIF. – Finding ways to restore elasticity of the skin is a better goal than is developing and refining ways to tighten the skin, according to Dr. R. Rox Anderson.

"The loss of natural skin tension with aging is due to a loss of its elasticity," Dr. Anderson said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "It’s the impressive loss of cutaneous elastic recoil with aging that accounts for the effectiveness of Botox, for example. A simple hypothesis is that restoring skin elasticity is a better goal than tightening the skin."

The "players" in cutaneous elastic recoil, he said, are numerous, but it remains unknown which are pivotal. Is it the extracellular matrix content and cross-linking, the fibril microstructure, or the active cytoskeleton?

"When you lose elastic recoil, we don’t know which ones of these are most important," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston. "If we knew that, we could design treatments that actually treat the cause as opposed to [treating] flabby skin."

He said that "powerful, verified" research tools are needed to improve understanding of cutaneous elastic recoil, including "composite, dynamic structural models" to expand understanding of the difference between microscopic and macroscopic skin. "Those exist; we don’t have to invent them," he said. "I’m an adjunct professor at Massachusetts Institute of Technology, [which has] an entire department that does nothing but material science and modeling. They’re really good at composite materials. That’s what we [humans] are: we are complex composite material."

Stress-strain component analysis is another key tool to improve understanding of elastic recoil. "Each of those components has its own structural and dynamic behavior," said Dr. Anderson, who also directs the Wellman Center for Photomedicine. "I think it’s important to recognize that the skin is a dynamic system that responds to stress. So Langer’s lines are due to particular strain receptors and fibroblasts. The genes that are strain inducible have been at least partially noted, but they have not been studied in the context of skin tightening and rejuvenation. I would love to see that: a dose response analysis for strain-mediated gene expression."

Studies involving in vivo microscopy will also be important. "Elastin, for example, is easy as pie to image in vivo in human skin," he said. "We should be able to map mechanical properties of skin."

Dr. Anderson said that he had no relevant financial conflicts to disclose.

Melanoma accounts for 75% of all skin cancer deaths. Ultraviolet exposure is still targeted as the major etiologic factor, but for black patients, skin erythema has been estimated to occur at a UV radiation dose 6-to-33 times greater than that experienced by white patients. Many have concluded that this is why black patients experience lower rates of melanoma than white patients.

Black patients, however, present at a later stage and have a higher melanoma-specific mortality, both of which have been linked to time of diagnosis and the ability to seek care at the onset of localized disease. Thus, there still exists a barrier to the detection and treatment of melanoma in black patients.

Photos courtesy Dr. Gary Peck/Dr. Cherie Young

In the July issue of Archives of Dermatology (2012;148:797-801), an article highlighted the anatomic distribution of malignant melanoma in the non-Hispanic black patient in an effort to explore how distribution of melanoma relates to UV exposure.

Data from 46 population-based cancer registries were analyzed. The most frequent site of melanoma in non-Hispanic black patients – both male and female, between the years 1998 and 2007 – was found to be the lower limbs and hip (58.9%). Of those, 27% were of the acral lentiginous type, which is not associated with exposure to UV rays.

The second most common location was the trunk (16.5%), which affected patients at a younger age; 46% of females and 31% of males were less than 44 years of age. The median age was 56 years for males and 48 years for females at presentation.

This study reiterates the burden of melanoma in the black community. It also highlights gaps in the detection of melanoma, which may be because of site of diagnosis – such as those of the acral lentiginous types – and unclear risk factors, the general underestimation of risk, and access to care.

- Lily Talakoub, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

Melanoma accounts for 75% of all skin cancer deaths. Ultraviolet exposure is still targeted as the major etiologic factor, but for black patients, skin erythema has been estimated to occur at a UV radiation dose 6-to-33 times greater than that experienced by white patients. Many have concluded that this is why black patients experience lower rates of melanoma than white patients.

Black patients, however, present at a later stage and have a higher melanoma-specific mortality, both of which have been linked to time of diagnosis and the ability to seek care at the onset of localized disease. Thus, there still exists a barrier to the detection and treatment of melanoma in black patients.

Photos courtesy Dr. Gary Peck/Dr. Cherie Young

In the July issue of Archives of Dermatology (2012;148:797-801), an article highlighted the anatomic distribution of malignant melanoma in the non-Hispanic black patient in an effort to explore how distribution of melanoma relates to UV exposure.

Data from 46 population-based cancer registries were analyzed. The most frequent site of melanoma in non-Hispanic black patients – both male and female, between the years 1998 and 2007 – was found to be the lower limbs and hip (58.9%). Of those, 27% were of the acral lentiginous type, which is not associated with exposure to UV rays.

The second most common location was the trunk (16.5%), which affected patients at a younger age; 46% of females and 31% of males were less than 44 years of age. The median age was 56 years for males and 48 years for females at presentation.

This study reiterates the burden of melanoma in the black community. It also highlights gaps in the detection of melanoma, which may be because of site of diagnosis – such as those of the acral lentiginous types – and unclear risk factors, the general underestimation of risk, and access to care.

- Lily Talakoub, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

Melanoma accounts for 75% of all skin cancer deaths. Ultraviolet exposure is still targeted as the major etiologic factor, but for black patients, skin erythema has been estimated to occur at a UV radiation dose 6-to-33 times greater than that experienced by white patients. Many have concluded that this is why black patients experience lower rates of melanoma than white patients.

Black patients, however, present at a later stage and have a higher melanoma-specific mortality, both of which have been linked to time of diagnosis and the ability to seek care at the onset of localized disease. Thus, there still exists a barrier to the detection and treatment of melanoma in black patients.

Photos courtesy Dr. Gary Peck/Dr. Cherie Young

In the July issue of Archives of Dermatology (2012;148:797-801), an article highlighted the anatomic distribution of malignant melanoma in the non-Hispanic black patient in an effort to explore how distribution of melanoma relates to UV exposure.

Data from 46 population-based cancer registries were analyzed. The most frequent site of melanoma in non-Hispanic black patients – both male and female, between the years 1998 and 2007 – was found to be the lower limbs and hip (58.9%). Of those, 27% were of the acral lentiginous type, which is not associated with exposure to UV rays.

The second most common location was the trunk (16.5%), which affected patients at a younger age; 46% of females and 31% of males were less than 44 years of age. The median age was 56 years for males and 48 years for females at presentation.

This study reiterates the burden of melanoma in the black community. It also highlights gaps in the detection of melanoma, which may be because of site of diagnosis – such as those of the acral lentiginous types – and unclear risk factors, the general underestimation of risk, and access to care.

- Lily Talakoub, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

Ethnic hair can become dry, brittle, and fractured when exposed to harsh solvents, heat, and repeat chemical treatments. To combat these issues, consider discussing the use of dry shampoo with your patients.

Dry shampoo is a powdered substance used to absorb oil in hair when traditional shampoo is not available, or for use with hair that dries out after repeat washings.

The ingredients in dry shampoo are called "absorbing agents," which soak up excess oil and dirt on the scalp. The most common absorbing agents are Oryza sativa starch, aluminum starch octenylsuccinate, zea mays starch, and silica.

There are two types of dry shampoo: those that come in a loose powder form and those that come in an aerosol form.

Powder dry shampoo can be applied directly to the scalp from the bottle and either brushed through or massaged in. Dry shampoo aerosol can be sprayed directly onto the scalp from a few inches away.

Recent advances in dry shampoos have instituted different coloring agents to help match the hair, as well as fragrances to mask any odor.

Many of these products can be found on www.dryshampoo.com.

- Lily Talakoub, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

Ethnic hair can become dry, brittle, and fractured when exposed to harsh solvents, heat, and repeat chemical treatments. To combat these issues, consider discussing the use of dry shampoo with your patients.

Dry shampoo is a powdered substance used to absorb oil in hair when traditional shampoo is not available, or for use with hair that dries out after repeat washings.

The ingredients in dry shampoo are called "absorbing agents," which soak up excess oil and dirt on the scalp. The most common absorbing agents are Oryza sativa starch, aluminum starch octenylsuccinate, zea mays starch, and silica.

There are two types of dry shampoo: those that come in a loose powder form and those that come in an aerosol form.

Powder dry shampoo can be applied directly to the scalp from the bottle and either brushed through or massaged in. Dry shampoo aerosol can be sprayed directly onto the scalp from a few inches away.

Recent advances in dry shampoos have instituted different coloring agents to help match the hair, as well as fragrances to mask any odor.

Many of these products can be found on www.dryshampoo.com.

- Lily Talakoub, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

Ethnic hair can become dry, brittle, and fractured when exposed to harsh solvents, heat, and repeat chemical treatments. To combat these issues, consider discussing the use of dry shampoo with your patients.

Dry shampoo is a powdered substance used to absorb oil in hair when traditional shampoo is not available, or for use with hair that dries out after repeat washings.

The ingredients in dry shampoo are called "absorbing agents," which soak up excess oil and dirt on the scalp. The most common absorbing agents are Oryza sativa starch, aluminum starch octenylsuccinate, zea mays starch, and silica.

There are two types of dry shampoo: those that come in a loose powder form and those that come in an aerosol form.

Powder dry shampoo can be applied directly to the scalp from the bottle and either brushed through or massaged in. Dry shampoo aerosol can be sprayed directly onto the scalp from a few inches away.

Recent advances in dry shampoos have instituted different coloring agents to help match the hair, as well as fragrances to mask any odor.

Many of these products can be found on www.dryshampoo.com.

- Lily Talakoub, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

Dr. Joel L. Cohen shared his preferences among facial fillers for different areas of the face, and outlined his favorite techniques for achieving the best results at the SDEF Summit in Aesthetic Medicine in Dana Point, Calif.

For instance, he said that he prefers Restylane and Perlane for the periocular area below the eyes.

Dr. Cohen is in private practice in Englewood, Colo. He reported serving as a consultant or trial investigator for Allergan, Galderma, Medicis, and Merz. SDEF and this news organization are owned by Elsevier.

Dr. Joel L. Cohen shared his preferences among facial fillers for different areas of the face, and outlined his favorite techniques for achieving the best results at the SDEF Summit in Aesthetic Medicine in Dana Point, Calif.

For instance, he said that he prefers Restylane and Perlane for the periocular area below the eyes.

Dr. Cohen is in private practice in Englewood, Colo. He reported serving as a consultant or trial investigator for Allergan, Galderma, Medicis, and Merz. SDEF and this news organization are owned by Elsevier.

Dr. Joel L. Cohen shared his preferences among facial fillers for different areas of the face, and outlined his favorite techniques for achieving the best results at the SDEF Summit in Aesthetic Medicine in Dana Point, Calif.

For instance, he said that he prefers Restylane and Perlane for the periocular area below the eyes.

Dr. Cohen is in private practice in Englewood, Colo. He reported serving as a consultant or trial investigator for Allergan, Galderma, Medicis, and Merz. SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. – A growing body of evidence-based research supports the efficacy of cryolipolysis for noninvasive fat reduction in the abdomen and flanks.

At the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF), Dr. Lawrence S. Bass highlighted results from several recent studies that support its use.

In the first study, presented by Dr. Christine C. Dierickx at the 2012 American Society for Laser Medicine and Surgery (ASLMS) meeting, researchers cataloged side effects in a phone review conducted with patients 1 month following cryolipolysis. All interviewed patients reported erythema that lasted about 1 hour and paresthesia that lasted for up to 1 month after treatment. Other reported side effects were ecchymosis (4%), vasovagal reactions from treatments on the abdomen (2.1%), induration/edema (0.9% and lasting 2-5 weeks), and severe pain (0.6% and lasting for a maximum of 1 month).

A separate study, presented by Dr. Gerald Boey at the 2012 ASLMS meeting, found an amplified fat reduction when concomitant massage was used. For the trial, 10 patients underwent 2 minutes of massage to one side only after cryolipolysis treatment. Ultrasound evaluation revealed that an additional 68% reduction in fat was achieved on the massaged side.

A safety and efficacy trial, carried out at 16 centers and involving 314 patients, was presented by Dr. A. Jay Burns at the 2010 ASLMS meeting. The study found no serious side effects and no skin damage or pigment change from the procedure. Minor side effects included transient bruising, minor pain, reduced sensation, erythema, and edema – all of which resolved spontaneously.

Of 41 patients in the study who underwent ultrasound measurement, the average reduction in fat was 21% after a single procedure. "That’s a consistent number you see in many studies," said Dr. Bass, of the plastic surgery department at New York University School of Medicine.

In a separate study also presented at the 2010 ASLMS meeting, researchers led by Dr. Ivan A. Rosales-Berber investigated the effect of consecutive cryolipolysis treatments separated by 2-3 months. The second treatment resulted in a similar proportion of fat reduction as the first treatment (14.6% vs. 16.5%, respectively).

Three months after the second procedure, the fat layer reduction exceeded 25%. This "means that there is repeatability [with cryolipolysis]," Dr. Bass said. "That’s important, because unfortunately a lot of patients have more than one body contouring emergency in their lives."

An earlier published study determined that cryolipolysis associated with modest reversible short-term changes in peripheral nerve function (Aesthetic Plast. Surg. 2009;33:482-8). Ten patients underwent a thorough neurological evaluation at baseline and weekly after the procedure. All patients returned to baseline peripheral nerve function in an average of 3.6 weeks. The study also found that mean fat reduction by ultrasound was 20.4% at 2 months and 25.5% at 6 months. "Even though we think it takes about 90 days for this whole apoptotic process to resolve, there may be something ongoing, or some tissue consolidation taking place for a longer period of time, allowing patients to continue to improve," Dr. Bass noted.

He concluded his remarks by explaining how he stratifies candidates for liposuction or cryolipolysis. "The patient who wants the maximum improvement or who wants it in one step is definitely going to line up on the liposuction side," he said. "The patient who either needs a small change that’s very localized or prioritizes a quick recovery over the extent of the result is going to line up on the cryolipolysis side."

Dr. Bass disclosed that he is a member of the advisory board for Allergan, Kythera, and Merz Aesthetics. He is also an investigator for Kythera and a consultant to Palomar and Sanuwave.

SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. – A growing body of evidence-based research supports the efficacy of cryolipolysis for noninvasive fat reduction in the abdomen and flanks.

At the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF), Dr. Lawrence S. Bass highlighted results from several recent studies that support its use.

In the first study, presented by Dr. Christine C. Dierickx at the 2012 American Society for Laser Medicine and Surgery (ASLMS) meeting, researchers cataloged side effects in a phone review conducted with patients 1 month following cryolipolysis. All interviewed patients reported erythema that lasted about 1 hour and paresthesia that lasted for up to 1 month after treatment. Other reported side effects were ecchymosis (4%), vasovagal reactions from treatments on the abdomen (2.1%), induration/edema (0.9% and lasting 2-5 weeks), and severe pain (0.6% and lasting for a maximum of 1 month).

A separate study, presented by Dr. Gerald Boey at the 2012 ASLMS meeting, found an amplified fat reduction when concomitant massage was used. For the trial, 10 patients underwent 2 minutes of massage to one side only after cryolipolysis treatment. Ultrasound evaluation revealed that an additional 68% reduction in fat was achieved on the massaged side.

A safety and efficacy trial, carried out at 16 centers and involving 314 patients, was presented by Dr. A. Jay Burns at the 2010 ASLMS meeting. The study found no serious side effects and no skin damage or pigment change from the procedure. Minor side effects included transient bruising, minor pain, reduced sensation, erythema, and edema – all of which resolved spontaneously.

Of 41 patients in the study who underwent ultrasound measurement, the average reduction in fat was 21% after a single procedure. "That’s a consistent number you see in many studies," said Dr. Bass, of the plastic surgery department at New York University School of Medicine.

In a separate study also presented at the 2010 ASLMS meeting, researchers led by Dr. Ivan A. Rosales-Berber investigated the effect of consecutive cryolipolysis treatments separated by 2-3 months. The second treatment resulted in a similar proportion of fat reduction as the first treatment (14.6% vs. 16.5%, respectively).

Three months after the second procedure, the fat layer reduction exceeded 25%. This "means that there is repeatability [with cryolipolysis]," Dr. Bass said. "That’s important, because unfortunately a lot of patients have more than one body contouring emergency in their lives."

An earlier published study determined that cryolipolysis associated with modest reversible short-term changes in peripheral nerve function (Aesthetic Plast. Surg. 2009;33:482-8). Ten patients underwent a thorough neurological evaluation at baseline and weekly after the procedure. All patients returned to baseline peripheral nerve function in an average of 3.6 weeks. The study also found that mean fat reduction by ultrasound was 20.4% at 2 months and 25.5% at 6 months. "Even though we think it takes about 90 days for this whole apoptotic process to resolve, there may be something ongoing, or some tissue consolidation taking place for a longer period of time, allowing patients to continue to improve," Dr. Bass noted.

He concluded his remarks by explaining how he stratifies candidates for liposuction or cryolipolysis. "The patient who wants the maximum improvement or who wants it in one step is definitely going to line up on the liposuction side," he said. "The patient who either needs a small change that’s very localized or prioritizes a quick recovery over the extent of the result is going to line up on the cryolipolysis side."

Dr. Bass disclosed that he is a member of the advisory board for Allergan, Kythera, and Merz Aesthetics. He is also an investigator for Kythera and a consultant to Palomar and Sanuwave.

SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. – A growing body of evidence-based research supports the efficacy of cryolipolysis for noninvasive fat reduction in the abdomen and flanks.

At the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF), Dr. Lawrence S. Bass highlighted results from several recent studies that support its use.

In the first study, presented by Dr. Christine C. Dierickx at the 2012 American Society for Laser Medicine and Surgery (ASLMS) meeting, researchers cataloged side effects in a phone review conducted with patients 1 month following cryolipolysis. All interviewed patients reported erythema that lasted about 1 hour and paresthesia that lasted for up to 1 month after treatment. Other reported side effects were ecchymosis (4%), vasovagal reactions from treatments on the abdomen (2.1%), induration/edema (0.9% and lasting 2-5 weeks), and severe pain (0.6% and lasting for a maximum of 1 month).

A separate study, presented by Dr. Gerald Boey at the 2012 ASLMS meeting, found an amplified fat reduction when concomitant massage was used. For the trial, 10 patients underwent 2 minutes of massage to one side only after cryolipolysis treatment. Ultrasound evaluation revealed that an additional 68% reduction in fat was achieved on the massaged side.

A safety and efficacy trial, carried out at 16 centers and involving 314 patients, was presented by Dr. A. Jay Burns at the 2010 ASLMS meeting. The study found no serious side effects and no skin damage or pigment change from the procedure. Minor side effects included transient bruising, minor pain, reduced sensation, erythema, and edema – all of which resolved spontaneously.

Of 41 patients in the study who underwent ultrasound measurement, the average reduction in fat was 21% after a single procedure. "That’s a consistent number you see in many studies," said Dr. Bass, of the plastic surgery department at New York University School of Medicine.

In a separate study also presented at the 2010 ASLMS meeting, researchers led by Dr. Ivan A. Rosales-Berber investigated the effect of consecutive cryolipolysis treatments separated by 2-3 months. The second treatment resulted in a similar proportion of fat reduction as the first treatment (14.6% vs. 16.5%, respectively).

Three months after the second procedure, the fat layer reduction exceeded 25%. This "means that there is repeatability [with cryolipolysis]," Dr. Bass said. "That’s important, because unfortunately a lot of patients have more than one body contouring emergency in their lives."

An earlier published study determined that cryolipolysis associated with modest reversible short-term changes in peripheral nerve function (Aesthetic Plast. Surg. 2009;33:482-8). Ten patients underwent a thorough neurological evaluation at baseline and weekly after the procedure. All patients returned to baseline peripheral nerve function in an average of 3.6 weeks. The study also found that mean fat reduction by ultrasound was 20.4% at 2 months and 25.5% at 6 months. "Even though we think it takes about 90 days for this whole apoptotic process to resolve, there may be something ongoing, or some tissue consolidation taking place for a longer period of time, allowing patients to continue to improve," Dr. Bass noted.

He concluded his remarks by explaining how he stratifies candidates for liposuction or cryolipolysis. "The patient who wants the maximum improvement or who wants it in one step is definitely going to line up on the liposuction side," he said. "The patient who either needs a small change that’s very localized or prioritizes a quick recovery over the extent of the result is going to line up on the cryolipolysis side."

Dr. Bass disclosed that he is a member of the advisory board for Allergan, Kythera, and Merz Aesthetics. He is also an investigator for Kythera and a consultant to Palomar and Sanuwave.

SDEF and this news organization are owned by Elsevier.

RALEIGH, N.C. – A new once-daily topical gel containing a proprietary onion extract resulted in a 36% improvement in the appearance of recent postsurgical dermal scars at 8 weeks, according to the results of a randomized, controlled trial.

The over-the-counter product, Merz Pharmaceuticals’ Mederma Advanced Scar Gel, was studied in 44 adults, each of whom underwent surgical shave removal of two similar-size seborrheic keratoses on the chest. At 2 weeks, after the wounds had reepithelialized, patients were randomly assigned to apply the nonprescription onion extract gel once daily to one scar and no treatment to the other.

Blinded investigator assessment was carried out after 2, 4, and 8 weeks of once-daily therapy. Each scar was graded on a 0-3 scale for improvement over baseline for overall appearance and for more specific individual domains of texture, redness, and softness. Patients independently carried out the same assessments, explained Dr. Zoe D. Draelos, a clinical dermatologist and researcher in High Point, N.C.

At week 8, investigators rated the onion extract–treated scars as demonstrating a mean 2.6-point improvement over baseline in terms of overall appearance, with comparable improvements noted in texture, redness, and scar softness. These were significantly better outcomes than was the mean 2.1-point improvement in the overall appearance of untreated control scars, she noted.

The patients rated the onion extract gel–treated scars as showing a mean 2.0-point improvement at week 8, significantly better than the 1.5-point improvement noted in the control scars.

Although optimal results were seen at week 8, the topical gel–treated scars showed a significant advantage in appearance scores, compared with control scars, as early as week 4, with a nonsignificant favorable trend noted at week 2.

The chief advantage that the transparent onion extract gel offers over other scar treatment products is the convenience of once-daily application, noted Dr. Draelos.

Merz announced the launch of Mederma Advanced Scar Gel in the spring. It is available in the first-aid section of pharmacies nationwide at a retail price of about $20 for a 20-g tube and $32 for 50 g, according to the company.

Other Merz products containing Cepalin, the proprietary onion extract, include Mederma Scar Cream plus SPF 30, Mederma for Kids, and Mederma Stretch Marks Therapy.

Dr. Draelos received research funding from Merz to conduct the clinical trial.

RALEIGH, N.C. – A new once-daily topical gel containing a proprietary onion extract resulted in a 36% improvement in the appearance of recent postsurgical dermal scars at 8 weeks, according to the results of a randomized, controlled trial.

The over-the-counter product, Merz Pharmaceuticals’ Mederma Advanced Scar Gel, was studied in 44 adults, each of whom underwent surgical shave removal of two similar-size seborrheic keratoses on the chest. At 2 weeks, after the wounds had reepithelialized, patients were randomly assigned to apply the nonprescription onion extract gel once daily to one scar and no treatment to the other.

Blinded investigator assessment was carried out after 2, 4, and 8 weeks of once-daily therapy. Each scar was graded on a 0-3 scale for improvement over baseline for overall appearance and for more specific individual domains of texture, redness, and softness. Patients independently carried out the same assessments, explained Dr. Zoe D. Draelos, a clinical dermatologist and researcher in High Point, N.C.

At week 8, investigators rated the onion extract–treated scars as demonstrating a mean 2.6-point improvement over baseline in terms of overall appearance, with comparable improvements noted in texture, redness, and scar softness. These were significantly better outcomes than was the mean 2.1-point improvement in the overall appearance of untreated control scars, she noted.

The patients rated the onion extract gel–treated scars as showing a mean 2.0-point improvement at week 8, significantly better than the 1.5-point improvement noted in the control scars.

Although optimal results were seen at week 8, the topical gel–treated scars showed a significant advantage in appearance scores, compared with control scars, as early as week 4, with a nonsignificant favorable trend noted at week 2.

The chief advantage that the transparent onion extract gel offers over other scar treatment products is the convenience of once-daily application, noted Dr. Draelos.

Merz announced the launch of Mederma Advanced Scar Gel in the spring. It is available in the first-aid section of pharmacies nationwide at a retail price of about $20 for a 20-g tube and $32 for 50 g, according to the company.

Other Merz products containing Cepalin, the proprietary onion extract, include Mederma Scar Cream plus SPF 30, Mederma for Kids, and Mederma Stretch Marks Therapy.

Dr. Draelos received research funding from Merz to conduct the clinical trial.

RALEIGH, N.C. – A new once-daily topical gel containing a proprietary onion extract resulted in a 36% improvement in the appearance of recent postsurgical dermal scars at 8 weeks, according to the results of a randomized, controlled trial.

The over-the-counter product, Merz Pharmaceuticals’ Mederma Advanced Scar Gel, was studied in 44 adults, each of whom underwent surgical shave removal of two similar-size seborrheic keratoses on the chest. At 2 weeks, after the wounds had reepithelialized, patients were randomly assigned to apply the nonprescription onion extract gel once daily to one scar and no treatment to the other.

Blinded investigator assessment was carried out after 2, 4, and 8 weeks of once-daily therapy. Each scar was graded on a 0-3 scale for improvement over baseline for overall appearance and for more specific individual domains of texture, redness, and softness. Patients independently carried out the same assessments, explained Dr. Zoe D. Draelos, a clinical dermatologist and researcher in High Point, N.C.

At week 8, investigators rated the onion extract–treated scars as demonstrating a mean 2.6-point improvement over baseline in terms of overall appearance, with comparable improvements noted in texture, redness, and scar softness. These were significantly better outcomes than was the mean 2.1-point improvement in the overall appearance of untreated control scars, she noted.

The patients rated the onion extract gel–treated scars as showing a mean 2.0-point improvement at week 8, significantly better than the 1.5-point improvement noted in the control scars.

Although optimal results were seen at week 8, the topical gel–treated scars showed a significant advantage in appearance scores, compared with control scars, as early as week 4, with a nonsignificant favorable trend noted at week 2.

The chief advantage that the transparent onion extract gel offers over other scar treatment products is the convenience of once-daily application, noted Dr. Draelos.

Merz announced the launch of Mederma Advanced Scar Gel in the spring. It is available in the first-aid section of pharmacies nationwide at a retail price of about $20 for a 20-g tube and $32 for 50 g, according to the company.

Other Merz products containing Cepalin, the proprietary onion extract, include Mederma Scar Cream plus SPF 30, Mederma for Kids, and Mederma Stretch Marks Therapy.

Dr. Draelos received research funding from Merz to conduct the clinical trial.

For many years, cocoa butter has played a major role in the ethnic skin care market. Derived from cocoa beans in tropical regions, it has been used in topicals for moisturization, stretch marks, scars, fade creams, and more. In recent years, shea butter has also become prominent in emollient creams and lotions. Cocoa butter, shea butter, mango seed butter, and cupuacu butter are all found as ingredients in many products.

So which butter is better for your patients? The answer is not a simple one, but here are some fun facts and the latest research about each option.

Cocoa butter

Cocoa butter – also called theobroma oil – is a pale yellow, pure, edible vegetable fat extracted from the cocoa bean. It is used to make chocolate and baked goods, and it is also used in topical preparations, including moisturizers and striae creams.

Cocoa butter is currently available in many skin care brands, but Palmer's is one of the most well-known brands of topical cocoa butter preparations on the market. The brand has been family-owned since the mid-19th century and under current ownership since 1971.

Ex vivo studies demonstrate that cocoa polyphenols improve skin elasticity and skin tone, namely, glycosaminoglycans and collagen I, III, and IV (Int. J. Cosmet. Sci. 2008;30:339-45).

However, one study that examined comedogenicity of ingredients and vehicles in cosmetics, found cocoa butter to be comedogenic in external rabbit ear canals (Cutan. Ocul. Toxicol. 2007;26:287-92).

A randomized, double-blind placebo controlled trial of 300 pregnant Afro-Caribbean women in Jamaica found that cocoa butter cream did not prevent striae gravidarum. This study found that development of striae was related to the young age of the mother and large neonates (Int. J. Gynaecol. Obstet. 2010;108:65-8).

And another randomized placebo controlled trial of 210 nulliparous women in Lebanon also found that topical application of cocoa butter cream did not decrease the likelihood of striae gravidarum, compared with placebo (BJOG 2008;115:1138-42).

Ingestion of cocoa butter in the forms of baked goods or chocolate has some antioxidant value because of the high levels of polyphenols. Oral consumption of cocoa also has anecdotal antimalarial effects through increased availability of antioxidants in plasma, membrane effects in general and erythrocyte membrane in particular, increased plasma levels of nitric oxide, antimalarial activity of cocoa flavanoids and their derivatives, and boosted immune system mediated by components of cocoa, including cocoa butter, polyphenols, magnesium, and zinc.

Shea butter

Shea butter is a slightly yellowish or ivory-colored fat extracted from the nut of the African shea tree (Vitellaria paradoxa). It has been used traditionally throughout Africa as a moisturizer; it has also been used in combination with coconut oil, palm oil, and gobi oil as a natural mosquito repellant (one that also protects against onchocerciasis).

In Africa, shea butter is used as cooking oil, as a waterproofing wax, for hairdressing, for candle-making, and as an ingredient in medicinal ointments. It is also used by makers of traditional African percussion instruments to increase the durability of wood.

Shea butter has been shown to have anti-inflammatory effects in studies through inhibition of iNOS, COX-2, and cytokines via the Nf-κB pathway in LPS-activated J774 macrophage cells (J. Complement. Integr. Med. 2012;9:Article 4).

Like cocoa butter, shea butter contains polyphenols. It also contains exceptionally high levels of triterpenes, indicating that shea nuts and shea fat constitute a significant source of anti-inflammatory and anti-tumor promoting compounds (J. Oleo. Sci. 2010;59:273-80).

Shea butter also contains no IgE-binding soluble proteins, making it of low allergenic potential (J. Allergy Clin. Immunol. 2011;127:680-2).

Mango seed butter

Mango seed butter's solid content profile is very similar to that of cocoa butterexcept it is softer (Bioresour. Technol. 2004;92:71-8). It is rich in beta carotene, essential fatty acids, and vitamins A and E. It is also used in skin creams, but not much has been published about mango seed butter in peer-reviewed journals.

Cupuacu butter

Cupuaçu (Theobroma grandiflorum) is a tropical rainforest tree related to cacao. Common throughout the Amazon basin, it is widely cultivated in the jungles of Colombia, Bolivia, Peru, and in northern Brazil. Some skin care brands, particularly in Brazil, use cupuaçu butter in topical emollient creams.

It has been shown to contain high concentrations of polyphenolic antioxidants, but less caffeine than its cocoa counterpart.

Activity-guided fractionation of cupuacu seeds in one study resulted in the identification of new sulfated flavonoid glycosides, theograndins I and II. In addition, nine flavonoid antioxidants were identified (J. Nat. Prod. 2003;66:1501-4). The theograndins had antioxidant effects and were weakly cytotoxic against human colon cancer cells.

No head-to-head comparative studies have been performed on these butters. Given the research to date, shea butter has a slight edge due to the sheer number of studies that show positive properties.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

For many years, cocoa butter has played a major role in the ethnic skin care market. Derived from cocoa beans in tropical regions, it has been used in topicals for moisturization, stretch marks, scars, fade creams, and more. In recent years, shea butter has also become prominent in emollient creams and lotions. Cocoa butter, shea butter, mango seed butter, and cupuacu butter are all found as ingredients in many products.

So which butter is better for your patients? The answer is not a simple one, but here are some fun facts and the latest research about each option.

Cocoa butter

Cocoa butter – also called theobroma oil – is a pale yellow, pure, edible vegetable fat extracted from the cocoa bean. It is used to make chocolate and baked goods, and it is also used in topical preparations, including moisturizers and striae creams.

Cocoa butter is currently available in many skin care brands, but Palmer's is one of the most well-known brands of topical cocoa butter preparations on the market. The brand has been family-owned since the mid-19th century and under current ownership since 1971.

Ex vivo studies demonstrate that cocoa polyphenols improve skin elasticity and skin tone, namely, glycosaminoglycans and collagen I, III, and IV (Int. J. Cosmet. Sci. 2008;30:339-45).

However, one study that examined comedogenicity of ingredients and vehicles in cosmetics, found cocoa butter to be comedogenic in external rabbit ear canals (Cutan. Ocul. Toxicol. 2007;26:287-92).

A randomized, double-blind placebo controlled trial of 300 pregnant Afro-Caribbean women in Jamaica found that cocoa butter cream did not prevent striae gravidarum. This study found that development of striae was related to the young age of the mother and large neonates (Int. J. Gynaecol. Obstet. 2010;108:65-8).

And another randomized placebo controlled trial of 210 nulliparous women in Lebanon also found that topical application of cocoa butter cream did not decrease the likelihood of striae gravidarum, compared with placebo (BJOG 2008;115:1138-42).

Ingestion of cocoa butter in the forms of baked goods or chocolate has some antioxidant value because of the high levels of polyphenols. Oral consumption of cocoa also has anecdotal antimalarial effects through increased availability of antioxidants in plasma, membrane effects in general and erythrocyte membrane in particular, increased plasma levels of nitric oxide, antimalarial activity of cocoa flavanoids and their derivatives, and boosted immune system mediated by components of cocoa, including cocoa butter, polyphenols, magnesium, and zinc.

Shea butter

Shea butter is a slightly yellowish or ivory-colored fat extracted from the nut of the African shea tree (Vitellaria paradoxa). It has been used traditionally throughout Africa as a moisturizer; it has also been used in combination with coconut oil, palm oil, and gobi oil as a natural mosquito repellant (one that also protects against onchocerciasis).

In Africa, shea butter is used as cooking oil, as a waterproofing wax, for hairdressing, for candle-making, and as an ingredient in medicinal ointments. It is also used by makers of traditional African percussion instruments to increase the durability of wood.

Shea butter has been shown to have anti-inflammatory effects in studies through inhibition of iNOS, COX-2, and cytokines via the Nf-κB pathway in LPS-activated J774 macrophage cells (J. Complement. Integr. Med. 2012;9:Article 4).

Like cocoa butter, shea butter contains polyphenols. It also contains exceptionally high levels of triterpenes, indicating that shea nuts and shea fat constitute a significant source of anti-inflammatory and anti-tumor promoting compounds (J. Oleo. Sci. 2010;59:273-80).

Shea butter also contains no IgE-binding soluble proteins, making it of low allergenic potential (J. Allergy Clin. Immunol. 2011;127:680-2).

Mango seed butter

Mango seed butter's solid content profile is very similar to that of cocoa butterexcept it is softer (Bioresour. Technol. 2004;92:71-8). It is rich in beta carotene, essential fatty acids, and vitamins A and E. It is also used in skin creams, but not much has been published about mango seed butter in peer-reviewed journals.

Cupuacu butter

Cupuaçu (Theobroma grandiflorum) is a tropical rainforest tree related to cacao. Common throughout the Amazon basin, it is widely cultivated in the jungles of Colombia, Bolivia, Peru, and in northern Brazil. Some skin care brands, particularly in Brazil, use cupuaçu butter in topical emollient creams.

It has been shown to contain high concentrations of polyphenolic antioxidants, but less caffeine than its cocoa counterpart.

Activity-guided fractionation of cupuacu seeds in one study resulted in the identification of new sulfated flavonoid glycosides, theograndins I and II. In addition, nine flavonoid antioxidants were identified (J. Nat. Prod. 2003;66:1501-4). The theograndins had antioxidant effects and were weakly cytotoxic against human colon cancer cells.

No head-to-head comparative studies have been performed on these butters. Given the research to date, shea butter has a slight edge due to the sheer number of studies that show positive properties.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].

For many years, cocoa butter has played a major role in the ethnic skin care market. Derived from cocoa beans in tropical regions, it has been used in topicals for moisturization, stretch marks, scars, fade creams, and more. In recent years, shea butter has also become prominent in emollient creams and lotions. Cocoa butter, shea butter, mango seed butter, and cupuacu butter are all found as ingredients in many products.

So which butter is better for your patients? The answer is not a simple one, but here are some fun facts and the latest research about each option.

Cocoa butter

Cocoa butter – also called theobroma oil – is a pale yellow, pure, edible vegetable fat extracted from the cocoa bean. It is used to make chocolate and baked goods, and it is also used in topical preparations, including moisturizers and striae creams.

Cocoa butter is currently available in many skin care brands, but Palmer's is one of the most well-known brands of topical cocoa butter preparations on the market. The brand has been family-owned since the mid-19th century and under current ownership since 1971.

Ex vivo studies demonstrate that cocoa polyphenols improve skin elasticity and skin tone, namely, glycosaminoglycans and collagen I, III, and IV (Int. J. Cosmet. Sci. 2008;30:339-45).

However, one study that examined comedogenicity of ingredients and vehicles in cosmetics, found cocoa butter to be comedogenic in external rabbit ear canals (Cutan. Ocul. Toxicol. 2007;26:287-92).

A randomized, double-blind placebo controlled trial of 300 pregnant Afro-Caribbean women in Jamaica found that cocoa butter cream did not prevent striae gravidarum. This study found that development of striae was related to the young age of the mother and large neonates (Int. J. Gynaecol. Obstet. 2010;108:65-8).

And another randomized placebo controlled trial of 210 nulliparous women in Lebanon also found that topical application of cocoa butter cream did not decrease the likelihood of striae gravidarum, compared with placebo (BJOG 2008;115:1138-42).

Ingestion of cocoa butter in the forms of baked goods or chocolate has some antioxidant value because of the high levels of polyphenols. Oral consumption of cocoa also has anecdotal antimalarial effects through increased availability of antioxidants in plasma, membrane effects in general and erythrocyte membrane in particular, increased plasma levels of nitric oxide, antimalarial activity of cocoa flavanoids and their derivatives, and boosted immune system mediated by components of cocoa, including cocoa butter, polyphenols, magnesium, and zinc.

Shea butter

Shea butter is a slightly yellowish or ivory-colored fat extracted from the nut of the African shea tree (Vitellaria paradoxa). It has been used traditionally throughout Africa as a moisturizer; it has also been used in combination with coconut oil, palm oil, and gobi oil as a natural mosquito repellant (one that also protects against onchocerciasis).

In Africa, shea butter is used as cooking oil, as a waterproofing wax, for hairdressing, for candle-making, and as an ingredient in medicinal ointments. It is also used by makers of traditional African percussion instruments to increase the durability of wood.

Shea butter has been shown to have anti-inflammatory effects in studies through inhibition of iNOS, COX-2, and cytokines via the Nf-κB pathway in LPS-activated J774 macrophage cells (J. Complement. Integr. Med. 2012;9:Article 4).

Like cocoa butter, shea butter contains polyphenols. It also contains exceptionally high levels of triterpenes, indicating that shea nuts and shea fat constitute a significant source of anti-inflammatory and anti-tumor promoting compounds (J. Oleo. Sci. 2010;59:273-80).

Shea butter also contains no IgE-binding soluble proteins, making it of low allergenic potential (J. Allergy Clin. Immunol. 2011;127:680-2).

Mango seed butter

Mango seed butter's solid content profile is very similar to that of cocoa butterexcept it is softer (Bioresour. Technol. 2004;92:71-8). It is rich in beta carotene, essential fatty acids, and vitamins A and E. It is also used in skin creams, but not much has been published about mango seed butter in peer-reviewed journals.

Cupuacu butter

Cupuaçu (Theobroma grandiflorum) is a tropical rainforest tree related to cacao. Common throughout the Amazon basin, it is widely cultivated in the jungles of Colombia, Bolivia, Peru, and in northern Brazil. Some skin care brands, particularly in Brazil, use cupuaçu butter in topical emollient creams.

It has been shown to contain high concentrations of polyphenolic antioxidants, but less caffeine than its cocoa counterpart.

Activity-guided fractionation of cupuacu seeds in one study resulted in the identification of new sulfated flavonoid glycosides, theograndins I and II. In addition, nine flavonoid antioxidants were identified (J. Nat. Prod. 2003;66:1501-4). The theograndins had antioxidant effects and were weakly cytotoxic against human colon cancer cells.

No head-to-head comparative studies have been performed on these butters. Given the research to date, shea butter has a slight edge due to the sheer number of studies that show positive properties.

- Naissan Wesley, M.D.

Do you have questions about treating patients with darker skin? If so, send them to [email protected].