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Skin of Color: The Lack of Insurance Coverage for Melasma
Why is it that office visits for pigmentary disorders, such as vitiligo and hypo- and hyperpigmentation, are often covered by many health insurance plans but a diagnosis code for melasma is not?
Additionally, why are the treatments for vitiligo – including prescriptions such as corticosteroids and phototherapy – covered but treatments for melasma – including topical hydroquinone, chemical peels, and lasers – are not?
I've searched for answers to the these questions, even discussing them with my billing office, but the only answer I've been able to get is that insurance companies consider melasma to be "cosmetic." Even though both conditions may alter a person's appearance and cause cosmetic concerns, vitiligo has been delineated a medical condition because of research demonstrating that the etiology of vitiligo is autoimmune.
While melasma, like photoaging, does harbor sun exposure as a significant factor in the etiology and severity of the condition, melasma is not always due to sun exposure alone.
It has been well-documented that there is often a genetic predisposition and hormonal contribution to melasma. In clinical practice, we often see patients with hormonal shifts, because of either pregnancy or hormonal contraceptives, that develop melasma despite vigorous photoprotection.
Maybe if, in the future, a specific inherited gene is identified that shows a predisposition to melasma in certain individuals, the coverage may change.
Last year, a study was published in the Journal of Investigative Dermatology that identified upregulation of expression of certain genes associated with tyrosinase and Wnt in skin affected by melasma, as well as a down regulation of lipid metabolism associated genes, when compared with non-lesional skin (J. Invest. Dermatol. 2011;131:1692-700).
This type of research is a step in the right direction in identifying the true etiology of melasma. Until we find an answer, does anyone have any other insight as to why insurance coverage is the way it is?
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Why is it that office visits for pigmentary disorders, such as vitiligo and hypo- and hyperpigmentation, are often covered by many health insurance plans but a diagnosis code for melasma is not?
Additionally, why are the treatments for vitiligo – including prescriptions such as corticosteroids and phototherapy – covered but treatments for melasma – including topical hydroquinone, chemical peels, and lasers – are not?
I've searched for answers to the these questions, even discussing them with my billing office, but the only answer I've been able to get is that insurance companies consider melasma to be "cosmetic." Even though both conditions may alter a person's appearance and cause cosmetic concerns, vitiligo has been delineated a medical condition because of research demonstrating that the etiology of vitiligo is autoimmune.
While melasma, like photoaging, does harbor sun exposure as a significant factor in the etiology and severity of the condition, melasma is not always due to sun exposure alone.
It has been well-documented that there is often a genetic predisposition and hormonal contribution to melasma. In clinical practice, we often see patients with hormonal shifts, because of either pregnancy or hormonal contraceptives, that develop melasma despite vigorous photoprotection.
Maybe if, in the future, a specific inherited gene is identified that shows a predisposition to melasma in certain individuals, the coverage may change.
Last year, a study was published in the Journal of Investigative Dermatology that identified upregulation of expression of certain genes associated with tyrosinase and Wnt in skin affected by melasma, as well as a down regulation of lipid metabolism associated genes, when compared with non-lesional skin (J. Invest. Dermatol. 2011;131:1692-700).
This type of research is a step in the right direction in identifying the true etiology of melasma. Until we find an answer, does anyone have any other insight as to why insurance coverage is the way it is?
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Why is it that office visits for pigmentary disorders, such as vitiligo and hypo- and hyperpigmentation, are often covered by many health insurance plans but a diagnosis code for melasma is not?
Additionally, why are the treatments for vitiligo – including prescriptions such as corticosteroids and phototherapy – covered but treatments for melasma – including topical hydroquinone, chemical peels, and lasers – are not?
I've searched for answers to the these questions, even discussing them with my billing office, but the only answer I've been able to get is that insurance companies consider melasma to be "cosmetic." Even though both conditions may alter a person's appearance and cause cosmetic concerns, vitiligo has been delineated a medical condition because of research demonstrating that the etiology of vitiligo is autoimmune.
While melasma, like photoaging, does harbor sun exposure as a significant factor in the etiology and severity of the condition, melasma is not always due to sun exposure alone.
It has been well-documented that there is often a genetic predisposition and hormonal contribution to melasma. In clinical practice, we often see patients with hormonal shifts, because of either pregnancy or hormonal contraceptives, that develop melasma despite vigorous photoprotection.
Maybe if, in the future, a specific inherited gene is identified that shows a predisposition to melasma in certain individuals, the coverage may change.
Last year, a study was published in the Journal of Investigative Dermatology that identified upregulation of expression of certain genes associated with tyrosinase and Wnt in skin affected by melasma, as well as a down regulation of lipid metabolism associated genes, when compared with non-lesional skin (J. Invest. Dermatol. 2011;131:1692-700).
This type of research is a step in the right direction in identifying the true etiology of melasma. Until we find an answer, does anyone have any other insight as to why insurance coverage is the way it is?
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Skin of Color: Five Steps to Treating Earlobe Keloids
Earlobe keloids are a common problem in skin of color patients that can be frustrating to both patients and physicians.
An article in the March issue of Dermatologic Surgery (2012;38:406-12) described a new morphologic classification for earlobe keloids and a surgical approach for their management.
Although surgical management is important for resistant, recurrent keloids, I often use a five-step nonsurgical regimen for treating earlobe keloids.
Set expectations and counsel the patient. Keloids can recur.
Avoid triggers. Make sure there is no underlying contact dermatitis from nickel or other metal alloys that can cause inflammation contributing to the scar tissue formation.
Intralesional steroids. Consider starting with Kenalog 20 mg/cc and increase by 10 mg/cc at each 4 week visit for optimal benefit. Often times, I use very gentle subscision in the tough scar tissue with a 26 gauge ½ inch needle to open up channels for the Kenalog to penetrate.
Compression therapy. Clip on compression earrings or a medical compression device called a Zimmer splint, which has two discs that clip on the ear placing pressure on both sides of the lobe.
Use silicone based gels and instruct patients to massage the area several times daily.
Keloids can be a frustrating and aesthetically unacceptable problem. Surgical methods are useful, including keloidectomy, core extirpation, or a combination.
However, in-office and home-based remedies both decrease recurrence rates and improve the size and thickness of keloids so that surgery can be reserved as an adjunct treatment by removing redundant skin rather than thick keloidal scar tissue.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Earlobe keloids are a common problem in skin of color patients that can be frustrating to both patients and physicians.
An article in the March issue of Dermatologic Surgery (2012;38:406-12) described a new morphologic classification for earlobe keloids and a surgical approach for their management.
Although surgical management is important for resistant, recurrent keloids, I often use a five-step nonsurgical regimen for treating earlobe keloids.
Set expectations and counsel the patient. Keloids can recur.
Avoid triggers. Make sure there is no underlying contact dermatitis from nickel or other metal alloys that can cause inflammation contributing to the scar tissue formation.
Intralesional steroids. Consider starting with Kenalog 20 mg/cc and increase by 10 mg/cc at each 4 week visit for optimal benefit. Often times, I use very gentle subscision in the tough scar tissue with a 26 gauge ½ inch needle to open up channels for the Kenalog to penetrate.
Compression therapy. Clip on compression earrings or a medical compression device called a Zimmer splint, which has two discs that clip on the ear placing pressure on both sides of the lobe.
Use silicone based gels and instruct patients to massage the area several times daily.
Keloids can be a frustrating and aesthetically unacceptable problem. Surgical methods are useful, including keloidectomy, core extirpation, or a combination.
However, in-office and home-based remedies both decrease recurrence rates and improve the size and thickness of keloids so that surgery can be reserved as an adjunct treatment by removing redundant skin rather than thick keloidal scar tissue.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Earlobe keloids are a common problem in skin of color patients that can be frustrating to both patients and physicians.
An article in the March issue of Dermatologic Surgery (2012;38:406-12) described a new morphologic classification for earlobe keloids and a surgical approach for their management.
Although surgical management is important for resistant, recurrent keloids, I often use a five-step nonsurgical regimen for treating earlobe keloids.
Set expectations and counsel the patient. Keloids can recur.
Avoid triggers. Make sure there is no underlying contact dermatitis from nickel or other metal alloys that can cause inflammation contributing to the scar tissue formation.
Intralesional steroids. Consider starting with Kenalog 20 mg/cc and increase by 10 mg/cc at each 4 week visit for optimal benefit. Often times, I use very gentle subscision in the tough scar tissue with a 26 gauge ½ inch needle to open up channels for the Kenalog to penetrate.
Compression therapy. Clip on compression earrings or a medical compression device called a Zimmer splint, which has two discs that clip on the ear placing pressure on both sides of the lobe.
Use silicone based gels and instruct patients to massage the area several times daily.
Keloids can be a frustrating and aesthetically unacceptable problem. Surgical methods are useful, including keloidectomy, core extirpation, or a combination.
However, in-office and home-based remedies both decrease recurrence rates and improve the size and thickness of keloids so that surgery can be reserved as an adjunct treatment by removing redundant skin rather than thick keloidal scar tissue.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Skin of Color: Keloid Scarring Rates Lower Than Expected
A presentation at the Triological Society's 2012 Combined Sections Meeting held in January highlighted that, when compared with white patients, black patients have a sevenfold increased risk for developing keloid scarring following surgery in the head and neck area.
Dr. Lamont Jones and colleagues at Henry Ford Hospital, Detroit, conducted a retrospective chart review of 6,692 patients who had head and neck procedures requiring incisions between 2005 and 2009. Twenty patients developed keloid scarring as a result of their surgery. Keloid rates according to ethnicity were 0.8% in black patients, 0.1% in white patients, and 0.2% in other ethnic groups.
They explain, however, that the keloid rate in black patients is actually significantly lower than previous estimates, which have been as high as 16%.
There were no differences in keloid formation according to gender. Patients who developed keloid scars tended to be younger in age, but the age difference was not statistically significant.
While the decreased rates of keloid formation compared to previous estimates can be reassuring for many black patients who fear surgery, the increased risk over other ethnic groups is still real and should be discussed in preoperative discussions.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
A presentation at the Triological Society's 2012 Combined Sections Meeting held in January highlighted that, when compared with white patients, black patients have a sevenfold increased risk for developing keloid scarring following surgery in the head and neck area.
Dr. Lamont Jones and colleagues at Henry Ford Hospital, Detroit, conducted a retrospective chart review of 6,692 patients who had head and neck procedures requiring incisions between 2005 and 2009. Twenty patients developed keloid scarring as a result of their surgery. Keloid rates according to ethnicity were 0.8% in black patients, 0.1% in white patients, and 0.2% in other ethnic groups.
They explain, however, that the keloid rate in black patients is actually significantly lower than previous estimates, which have been as high as 16%.
There were no differences in keloid formation according to gender. Patients who developed keloid scars tended to be younger in age, but the age difference was not statistically significant.
While the decreased rates of keloid formation compared to previous estimates can be reassuring for many black patients who fear surgery, the increased risk over other ethnic groups is still real and should be discussed in preoperative discussions.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
A presentation at the Triological Society's 2012 Combined Sections Meeting held in January highlighted that, when compared with white patients, black patients have a sevenfold increased risk for developing keloid scarring following surgery in the head and neck area.
Dr. Lamont Jones and colleagues at Henry Ford Hospital, Detroit, conducted a retrospective chart review of 6,692 patients who had head and neck procedures requiring incisions between 2005 and 2009. Twenty patients developed keloid scarring as a result of their surgery. Keloid rates according to ethnicity were 0.8% in black patients, 0.1% in white patients, and 0.2% in other ethnic groups.
They explain, however, that the keloid rate in black patients is actually significantly lower than previous estimates, which have been as high as 16%.
There were no differences in keloid formation according to gender. Patients who developed keloid scars tended to be younger in age, but the age difference was not statistically significant.
While the decreased rates of keloid formation compared to previous estimates can be reassuring for many black patients who fear surgery, the increased risk over other ethnic groups is still real and should be discussed in preoperative discussions.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Clinical Tips Can Tailor Your Cannula Technique
MIAMI BEACH – As more U.S. dermatologists are using cannulas to deliver soft tissue fillers for rejuvenation, tips to refine the technique and optimize patient outcomes are emerging.
Cannula use "seems to be gaining a lot of momentum in this country, and some of that really stems from the European experience," Dr. Joel L. Cohen said in an interview.
The size of the cannula, as well as the gauge of the needle that creates the entry point, can determine outcomes in different anatomic areas, Dr. Cohen said at the South Beach Symposium. "Cannulas have very specific roles in very specific areas. Personally, I have found them useful in the cheek, the infraorbital area, in the décolleté, and the dorsal hands."
He also shared a practical tip that eases cannula insertion. To deliver filler product using a 27 G cannula, for example, Dr. Cohen first nicks the skin with a slightly larger 25 G needle where he wants his entry point. Then, he pinches and holds the skin around the needle while his assistant removes it. That way, he knows the precise point to insert the cannula "rather than [later] fumbling around in a little bit of bleeding to find it. It’s really a helpful trick we’ve incorporated into our office."
A 25 G cannula can also be used to deliver fillers to the décolleté or dorsal side of the hands, said Dr. Cohen, who is in private practice in Englewood, Colo. In contrast, a smaller 30 G cannula may be more appropriate for rejuvenation of the infraorbital area, he said. "Using a 30 G cannula below the eyes, I feel that I am seeing less bruising and less swelling in this area, but at the same time, I am able to precisely deliver the filler product deep into the muscle along the periosteum."
An ability to fan product out in multiple directions from one entry point is an advantage of the cannula. "It’s a useful technique, and cannulas have helped me get better results with less bruising in my practice," Dr. Cohen said. The lower bruising potential seems to come from the cannula’s blunt tip, which can tuck under, above, or around a blood vessel. In contrast, a sharp needle is more likely to puncture the same vessel and cause postprocedure bruising, he said. And, fanning a needle around under the skin can increase the risk of bruising even further (Derm. Surg. 2008;34:S105-9).
"Some physicians, including me, actually have found patients experience less pain" with a cannula than with a needle, he added.
Although dermatologic use of cannulas has grown over the past year, "I don’t think it’s going to completely take over. You definitely still need needles for many different areas. I continue top use needles in the nasolabial folds [and] the oral commissure. For fine lines and wrinkles and more shallow rhytids, you definitely still need needles," he said
More information on cannulas can be found in an article published by Dr. Cohen and his colleague Dr. Joshua A. Zeichner (J. Drugs. Dermatol. 2012;11:70-2).
Dr. Cohen reported that he had no relevant disclosures.
MIAMI BEACH – As more U.S. dermatologists are using cannulas to deliver soft tissue fillers for rejuvenation, tips to refine the technique and optimize patient outcomes are emerging.
Cannula use "seems to be gaining a lot of momentum in this country, and some of that really stems from the European experience," Dr. Joel L. Cohen said in an interview.
The size of the cannula, as well as the gauge of the needle that creates the entry point, can determine outcomes in different anatomic areas, Dr. Cohen said at the South Beach Symposium. "Cannulas have very specific roles in very specific areas. Personally, I have found them useful in the cheek, the infraorbital area, in the décolleté, and the dorsal hands."
He also shared a practical tip that eases cannula insertion. To deliver filler product using a 27 G cannula, for example, Dr. Cohen first nicks the skin with a slightly larger 25 G needle where he wants his entry point. Then, he pinches and holds the skin around the needle while his assistant removes it. That way, he knows the precise point to insert the cannula "rather than [later] fumbling around in a little bit of bleeding to find it. It’s really a helpful trick we’ve incorporated into our office."
A 25 G cannula can also be used to deliver fillers to the décolleté or dorsal side of the hands, said Dr. Cohen, who is in private practice in Englewood, Colo. In contrast, a smaller 30 G cannula may be more appropriate for rejuvenation of the infraorbital area, he said. "Using a 30 G cannula below the eyes, I feel that I am seeing less bruising and less swelling in this area, but at the same time, I am able to precisely deliver the filler product deep into the muscle along the periosteum."
An ability to fan product out in multiple directions from one entry point is an advantage of the cannula. "It’s a useful technique, and cannulas have helped me get better results with less bruising in my practice," Dr. Cohen said. The lower bruising potential seems to come from the cannula’s blunt tip, which can tuck under, above, or around a blood vessel. In contrast, a sharp needle is more likely to puncture the same vessel and cause postprocedure bruising, he said. And, fanning a needle around under the skin can increase the risk of bruising even further (Derm. Surg. 2008;34:S105-9).
"Some physicians, including me, actually have found patients experience less pain" with a cannula than with a needle, he added.
Although dermatologic use of cannulas has grown over the past year, "I don’t think it’s going to completely take over. You definitely still need needles for many different areas. I continue top use needles in the nasolabial folds [and] the oral commissure. For fine lines and wrinkles and more shallow rhytids, you definitely still need needles," he said
More information on cannulas can be found in an article published by Dr. Cohen and his colleague Dr. Joshua A. Zeichner (J. Drugs. Dermatol. 2012;11:70-2).
Dr. Cohen reported that he had no relevant disclosures.
MIAMI BEACH – As more U.S. dermatologists are using cannulas to deliver soft tissue fillers for rejuvenation, tips to refine the technique and optimize patient outcomes are emerging.
Cannula use "seems to be gaining a lot of momentum in this country, and some of that really stems from the European experience," Dr. Joel L. Cohen said in an interview.
The size of the cannula, as well as the gauge of the needle that creates the entry point, can determine outcomes in different anatomic areas, Dr. Cohen said at the South Beach Symposium. "Cannulas have very specific roles in very specific areas. Personally, I have found them useful in the cheek, the infraorbital area, in the décolleté, and the dorsal hands."
He also shared a practical tip that eases cannula insertion. To deliver filler product using a 27 G cannula, for example, Dr. Cohen first nicks the skin with a slightly larger 25 G needle where he wants his entry point. Then, he pinches and holds the skin around the needle while his assistant removes it. That way, he knows the precise point to insert the cannula "rather than [later] fumbling around in a little bit of bleeding to find it. It’s really a helpful trick we’ve incorporated into our office."
A 25 G cannula can also be used to deliver fillers to the décolleté or dorsal side of the hands, said Dr. Cohen, who is in private practice in Englewood, Colo. In contrast, a smaller 30 G cannula may be more appropriate for rejuvenation of the infraorbital area, he said. "Using a 30 G cannula below the eyes, I feel that I am seeing less bruising and less swelling in this area, but at the same time, I am able to precisely deliver the filler product deep into the muscle along the periosteum."
An ability to fan product out in multiple directions from one entry point is an advantage of the cannula. "It’s a useful technique, and cannulas have helped me get better results with less bruising in my practice," Dr. Cohen said. The lower bruising potential seems to come from the cannula’s blunt tip, which can tuck under, above, or around a blood vessel. In contrast, a sharp needle is more likely to puncture the same vessel and cause postprocedure bruising, he said. And, fanning a needle around under the skin can increase the risk of bruising even further (Derm. Surg. 2008;34:S105-9).
"Some physicians, including me, actually have found patients experience less pain" with a cannula than with a needle, he added.
Although dermatologic use of cannulas has grown over the past year, "I don’t think it’s going to completely take over. You definitely still need needles for many different areas. I continue top use needles in the nasolabial folds [and] the oral commissure. For fine lines and wrinkles and more shallow rhytids, you definitely still need needles," he said
More information on cannulas can be found in an article published by Dr. Cohen and his colleague Dr. Joshua A. Zeichner (J. Drugs. Dermatol. 2012;11:70-2).
Dr. Cohen reported that he had no relevant disclosures.
EXPERT ANALYSIS FROM THE SOUTH BEACH SYMPOSIUM
Skin of Color: Brush Up at the AAD
It's always a good idea to expand your knowledge and expertise in regards to patients with skin of color. Here is a synopsis of the skin of color-themed presentations taking place at the annual American Academy of Dermatology Meeting in San Diego from March 16-20.
On Saturday, March 17, there will be a focus session on Medical & Aesthetic Dermatology in Skin of Color (U041) starting from 7:15 a.m. to 8:45 a.m., followed by a focus session entitled Practical Approach to Medical and Cosmetic Dermatology in Skin of Color Patients (U051) from 12:15 p.m. to 1:45 p.m. There will be a symposium on Disorders of Pigmentation (S019) from 2:00 p.m. to 5 p.m.
On Sunday, March 18, a focus session from 7 a.m. to 8 a.m. will cover Building Beauty: Understanding Facial Proportions, Phi, and Use of Volumizing Soft Tissue Fillers (U073).
Finally, on Monday, March 19, an early focus session from 7:15 a.m. to 8:45 a.m. will cover Hair Disease & the African American Patient (U108), and a second focus session from 2:30 p.m. to 4 p.m. will cover Melasma: Pathogenesis and Treatment (U129). There will also be a forum starting at 12 p.m. to 2 p.m. on Vitiligo (F063).
The online version of the scientific program contains all the information you'll need in regards to the meeting. Hope to see you there!
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
It's always a good idea to expand your knowledge and expertise in regards to patients with skin of color. Here is a synopsis of the skin of color-themed presentations taking place at the annual American Academy of Dermatology Meeting in San Diego from March 16-20.
On Saturday, March 17, there will be a focus session on Medical & Aesthetic Dermatology in Skin of Color (U041) starting from 7:15 a.m. to 8:45 a.m., followed by a focus session entitled Practical Approach to Medical and Cosmetic Dermatology in Skin of Color Patients (U051) from 12:15 p.m. to 1:45 p.m. There will be a symposium on Disorders of Pigmentation (S019) from 2:00 p.m. to 5 p.m.
On Sunday, March 18, a focus session from 7 a.m. to 8 a.m. will cover Building Beauty: Understanding Facial Proportions, Phi, and Use of Volumizing Soft Tissue Fillers (U073).
Finally, on Monday, March 19, an early focus session from 7:15 a.m. to 8:45 a.m. will cover Hair Disease & the African American Patient (U108), and a second focus session from 2:30 p.m. to 4 p.m. will cover Melasma: Pathogenesis and Treatment (U129). There will also be a forum starting at 12 p.m. to 2 p.m. on Vitiligo (F063).
The online version of the scientific program contains all the information you'll need in regards to the meeting. Hope to see you there!
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
It's always a good idea to expand your knowledge and expertise in regards to patients with skin of color. Here is a synopsis of the skin of color-themed presentations taking place at the annual American Academy of Dermatology Meeting in San Diego from March 16-20.
On Saturday, March 17, there will be a focus session on Medical & Aesthetic Dermatology in Skin of Color (U041) starting from 7:15 a.m. to 8:45 a.m., followed by a focus session entitled Practical Approach to Medical and Cosmetic Dermatology in Skin of Color Patients (U051) from 12:15 p.m. to 1:45 p.m. There will be a symposium on Disorders of Pigmentation (S019) from 2:00 p.m. to 5 p.m.
On Sunday, March 18, a focus session from 7 a.m. to 8 a.m. will cover Building Beauty: Understanding Facial Proportions, Phi, and Use of Volumizing Soft Tissue Fillers (U073).
Finally, on Monday, March 19, an early focus session from 7:15 a.m. to 8:45 a.m. will cover Hair Disease & the African American Patient (U108), and a second focus session from 2:30 p.m. to 4 p.m. will cover Melasma: Pathogenesis and Treatment (U129). There will also be a forum starting at 12 p.m. to 2 p.m. on Vitiligo (F063).
The online version of the scientific program contains all the information you'll need in regards to the meeting. Hope to see you there!
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Mineral Makeup Is a Dermatologist's 'Fire Extinguisher'
WAIKOLOA, HAWAII – Mineral makeup has been game changing for everything from covering acne blemishes to masking postprocedure discoloration, noted Dr. Howard K. Steinman.
"Mineral makeup has done to medical makeup what fillers and Botox have done to the field of facial cosmetic surgery. You now have little excuse for not using makeup in your office," said Steinman, director of dermatologic and skin cancer surgery at Scott and White Medical Center, Temple, Texas.
Mineral makeup is easy for patients to learn how to apply effectively; anyone on the office staff can be trained to teach patients how, he said. The products take up a trivial amount of office space, cost very little, pose negligible risk, and generate considerable patient satisfaction.
"Mineral makeup achieves really spectacular results," said Dr. Steinman at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).
Patients go to a dermatologist because they want cure or control of a medical condition, symptomatic relief, and an improved appearance. But while successful treatment of melasma, for example, may take months, the patient’s appearance can be improved immediately in the interim – on day 1 of therapy –through the use of mineral makeup.
Mineral makeup provides complete coverage for macular medical conditions including acne erythema, rosacea, vitiligo, sarcoidosis, port wine stains, and spider vessels. These products are also the answer to postprocedure discoloration following chemical peels, laser resurfacing, and fillers.
"It’s your fire extinguisher for procedural misadventures. The nice thing about having mineral makeups in your office is you don’t have to worry about these things as much because the problem is going to leave the office fixed," Dr. Steinman explained.
Green-tinted concealer is a popular but ineffective solution for red discoloration of skin. The results tend to be muddy looking and unconvincing. Mineral makeup, he said, is far superior.
Dr. Steinman singled out four companies as the major players in the mineral makeup market: Youngblood, Bare Minerals, Color Science, and Jane Iredale. All have been in business a long time, offer products of excellent quality, and provide reasonably good service to physicians, he said.
He prefers Youngblood in his own office because his wife, a paramedical camouflage therapist trained to cover burn scars and disfiguring surgical wounds, prefers the quality.
"My suggestion is to have your esthetician, or whoever will be doing your makeup, try them all and decide which one they prefer," said Dr. Steinman.
He also recommends Dermacolor (Kryolan), a specialized camouflage foundation system made in Germany that is formulated for postoperative skin and contains an opaque sunscreen. Unlike mineral makeup, Dermacolor is waterproof even with swimming. The company offers more than 70 premixed colors, although a selection of about 20 is sufficient to cover virtually any clinical situation, he said.
Dr. Steinman suggested that the makeup artist match the patient’s skin tones before surgery so Dermacolor is ready to be applied at the first postoperative visit.
Dr. Steinman said a relatively new comprehensive line of makeup products he recommends is Cover FX. The product texture and coverage are outstanding, it’s easy for patients to apply, and the company caters to physicians, he said.
Camouflage makeup does have limitations. It won’t effectively cover three-dimensional lesions, such as acne scars or keloids. And it can’t do much for burn scars with absent hair and skin pores, he noted.
That being said, Dr. Steinman considers makeup in the office an indispensable part of his practice. "Makeup is just essential, I think, if you’re going to do cosmetic surgery or you want to treat patients with medical macular problems," he said.
Dr. Steinman reported having no financial relationships with any of the companies he discussed.
SDEF and this news organization are owned by Elsevier.
*This post was updated on 3/7/12.
WAIKOLOA, HAWAII – Mineral makeup has been game changing for everything from covering acne blemishes to masking postprocedure discoloration, noted Dr. Howard K. Steinman.
"Mineral makeup has done to medical makeup what fillers and Botox have done to the field of facial cosmetic surgery. You now have little excuse for not using makeup in your office," said Steinman, director of dermatologic and skin cancer surgery at Scott and White Medical Center, Temple, Texas.
Mineral makeup is easy for patients to learn how to apply effectively; anyone on the office staff can be trained to teach patients how, he said. The products take up a trivial amount of office space, cost very little, pose negligible risk, and generate considerable patient satisfaction.
"Mineral makeup achieves really spectacular results," said Dr. Steinman at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).
Patients go to a dermatologist because they want cure or control of a medical condition, symptomatic relief, and an improved appearance. But while successful treatment of melasma, for example, may take months, the patient’s appearance can be improved immediately in the interim – on day 1 of therapy –through the use of mineral makeup.
Mineral makeup provides complete coverage for macular medical conditions including acne erythema, rosacea, vitiligo, sarcoidosis, port wine stains, and spider vessels. These products are also the answer to postprocedure discoloration following chemical peels, laser resurfacing, and fillers.
"It’s your fire extinguisher for procedural misadventures. The nice thing about having mineral makeups in your office is you don’t have to worry about these things as much because the problem is going to leave the office fixed," Dr. Steinman explained.
Green-tinted concealer is a popular but ineffective solution for red discoloration of skin. The results tend to be muddy looking and unconvincing. Mineral makeup, he said, is far superior.
Dr. Steinman singled out four companies as the major players in the mineral makeup market: Youngblood, Bare Minerals, Color Science, and Jane Iredale. All have been in business a long time, offer products of excellent quality, and provide reasonably good service to physicians, he said.
He prefers Youngblood in his own office because his wife, a paramedical camouflage therapist trained to cover burn scars and disfiguring surgical wounds, prefers the quality.
"My suggestion is to have your esthetician, or whoever will be doing your makeup, try them all and decide which one they prefer," said Dr. Steinman.
He also recommends Dermacolor (Kryolan), a specialized camouflage foundation system made in Germany that is formulated for postoperative skin and contains an opaque sunscreen. Unlike mineral makeup, Dermacolor is waterproof even with swimming. The company offers more than 70 premixed colors, although a selection of about 20 is sufficient to cover virtually any clinical situation, he said.
Dr. Steinman suggested that the makeup artist match the patient’s skin tones before surgery so Dermacolor is ready to be applied at the first postoperative visit.
Dr. Steinman said a relatively new comprehensive line of makeup products he recommends is Cover FX. The product texture and coverage are outstanding, it’s easy for patients to apply, and the company caters to physicians, he said.
Camouflage makeup does have limitations. It won’t effectively cover three-dimensional lesions, such as acne scars or keloids. And it can’t do much for burn scars with absent hair and skin pores, he noted.
That being said, Dr. Steinman considers makeup in the office an indispensable part of his practice. "Makeup is just essential, I think, if you’re going to do cosmetic surgery or you want to treat patients with medical macular problems," he said.
Dr. Steinman reported having no financial relationships with any of the companies he discussed.
SDEF and this news organization are owned by Elsevier.
*This post was updated on 3/7/12.
WAIKOLOA, HAWAII – Mineral makeup has been game changing for everything from covering acne blemishes to masking postprocedure discoloration, noted Dr. Howard K. Steinman.
"Mineral makeup has done to medical makeup what fillers and Botox have done to the field of facial cosmetic surgery. You now have little excuse for not using makeup in your office," said Steinman, director of dermatologic and skin cancer surgery at Scott and White Medical Center, Temple, Texas.
Mineral makeup is easy for patients to learn how to apply effectively; anyone on the office staff can be trained to teach patients how, he said. The products take up a trivial amount of office space, cost very little, pose negligible risk, and generate considerable patient satisfaction.
"Mineral makeup achieves really spectacular results," said Dr. Steinman at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).
Patients go to a dermatologist because they want cure or control of a medical condition, symptomatic relief, and an improved appearance. But while successful treatment of melasma, for example, may take months, the patient’s appearance can be improved immediately in the interim – on day 1 of therapy –through the use of mineral makeup.
Mineral makeup provides complete coverage for macular medical conditions including acne erythema, rosacea, vitiligo, sarcoidosis, port wine stains, and spider vessels. These products are also the answer to postprocedure discoloration following chemical peels, laser resurfacing, and fillers.
"It’s your fire extinguisher for procedural misadventures. The nice thing about having mineral makeups in your office is you don’t have to worry about these things as much because the problem is going to leave the office fixed," Dr. Steinman explained.
Green-tinted concealer is a popular but ineffective solution for red discoloration of skin. The results tend to be muddy looking and unconvincing. Mineral makeup, he said, is far superior.
Dr. Steinman singled out four companies as the major players in the mineral makeup market: Youngblood, Bare Minerals, Color Science, and Jane Iredale. All have been in business a long time, offer products of excellent quality, and provide reasonably good service to physicians, he said.
He prefers Youngblood in his own office because his wife, a paramedical camouflage therapist trained to cover burn scars and disfiguring surgical wounds, prefers the quality.
"My suggestion is to have your esthetician, or whoever will be doing your makeup, try them all and decide which one they prefer," said Dr. Steinman.
He also recommends Dermacolor (Kryolan), a specialized camouflage foundation system made in Germany that is formulated for postoperative skin and contains an opaque sunscreen. Unlike mineral makeup, Dermacolor is waterproof even with swimming. The company offers more than 70 premixed colors, although a selection of about 20 is sufficient to cover virtually any clinical situation, he said.
Dr. Steinman suggested that the makeup artist match the patient’s skin tones before surgery so Dermacolor is ready to be applied at the first postoperative visit.
Dr. Steinman said a relatively new comprehensive line of makeup products he recommends is Cover FX. The product texture and coverage are outstanding, it’s easy for patients to apply, and the company caters to physicians, he said.
Camouflage makeup does have limitations. It won’t effectively cover three-dimensional lesions, such as acne scars or keloids. And it can’t do much for burn scars with absent hair and skin pores, he noted.
That being said, Dr. Steinman considers makeup in the office an indispensable part of his practice. "Makeup is just essential, I think, if you’re going to do cosmetic surgery or you want to treat patients with medical macular problems," he said.
Dr. Steinman reported having no financial relationships with any of the companies he discussed.
SDEF and this news organization are owned by Elsevier.
*This post was updated on 3/7/12.
EXPERT ANALYSIS FROM THE SDEF HAWAII DERMATOLOGY SEMINAR
Several Sharp Needles Needed for Tear Trough Deformities
LAS VEGAS – When treating tear trough deformities with hyaluronic acid fillers, Dr. Suzan Obagi makes it a point to have a set of sharp 30-gauge needles handy.
"There’s nothing worse than trying to do a treatment in the periorbital region, and then have your needles dull," she said during a demonstration on dermal fillers at the annual meeting of the American Academy of Cosmetic Surgery. "This can cause discomfort for the patient and probably more bruising. In a single session I may go through four or five needles. You’re better off having a sharp needle handy."
Dr. Obagi, who directs the University of Pittsburgh Medical Center's Cosmetic Surgery and Skin Health Center, likes to have an assistant on hand during periorbital injections of hyaluronic acid fillers, "so if you need to finish one side, the assistant can hold very gentle pressure on the treated area to minimize swelling and bruising," she said. "What you don’t want to do is push too hard. You’re in an area where you can easily move this filler to different regions. It should always be very light pressure on the area. I always tell patients not to rub or massage for 24 hours after the injection."
Some clinicians will treat the tear trough deformity without treating the rest of the orbital rim, she continued. "If patients have volume loss, it’s not just going to be the tear trough; it’s going to continue out to the sides of the orbit rim, especially in older patients," she said. "So it’s important to build up that area as well."
Dr. Obagi, who is also the immediate past vice president of the American Board of Cosmetic Surgery, prefers to use hyaluronic acid fillers that are smaller in particle size such as Medicis’ Restylane for tear trough deformities, adding lidocaine plus epinephrine prior to injection. "I use 0.3 mL 1% lidocaine with epinephrine and 0.2 mL sodium bicarbonate, and I use a Luer lock adapter to mix them together," she said. "I’m going to be working in an area where I want no bruising; in order to do that I need the epinephrine in there."
Dr. Obagi said that she had no relevant financial conflicts to disclose.
LAS VEGAS – When treating tear trough deformities with hyaluronic acid fillers, Dr. Suzan Obagi makes it a point to have a set of sharp 30-gauge needles handy.
"There’s nothing worse than trying to do a treatment in the periorbital region, and then have your needles dull," she said during a demonstration on dermal fillers at the annual meeting of the American Academy of Cosmetic Surgery. "This can cause discomfort for the patient and probably more bruising. In a single session I may go through four or five needles. You’re better off having a sharp needle handy."
Dr. Obagi, who directs the University of Pittsburgh Medical Center's Cosmetic Surgery and Skin Health Center, likes to have an assistant on hand during periorbital injections of hyaluronic acid fillers, "so if you need to finish one side, the assistant can hold very gentle pressure on the treated area to minimize swelling and bruising," she said. "What you don’t want to do is push too hard. You’re in an area where you can easily move this filler to different regions. It should always be very light pressure on the area. I always tell patients not to rub or massage for 24 hours after the injection."
Some clinicians will treat the tear trough deformity without treating the rest of the orbital rim, she continued. "If patients have volume loss, it’s not just going to be the tear trough; it’s going to continue out to the sides of the orbit rim, especially in older patients," she said. "So it’s important to build up that area as well."
Dr. Obagi, who is also the immediate past vice president of the American Board of Cosmetic Surgery, prefers to use hyaluronic acid fillers that are smaller in particle size such as Medicis’ Restylane for tear trough deformities, adding lidocaine plus epinephrine prior to injection. "I use 0.3 mL 1% lidocaine with epinephrine and 0.2 mL sodium bicarbonate, and I use a Luer lock adapter to mix them together," she said. "I’m going to be working in an area where I want no bruising; in order to do that I need the epinephrine in there."
Dr. Obagi said that she had no relevant financial conflicts to disclose.
LAS VEGAS – When treating tear trough deformities with hyaluronic acid fillers, Dr. Suzan Obagi makes it a point to have a set of sharp 30-gauge needles handy.
"There’s nothing worse than trying to do a treatment in the periorbital region, and then have your needles dull," she said during a demonstration on dermal fillers at the annual meeting of the American Academy of Cosmetic Surgery. "This can cause discomfort for the patient and probably more bruising. In a single session I may go through four or five needles. You’re better off having a sharp needle handy."
Dr. Obagi, who directs the University of Pittsburgh Medical Center's Cosmetic Surgery and Skin Health Center, likes to have an assistant on hand during periorbital injections of hyaluronic acid fillers, "so if you need to finish one side, the assistant can hold very gentle pressure on the treated area to minimize swelling and bruising," she said. "What you don’t want to do is push too hard. You’re in an area where you can easily move this filler to different regions. It should always be very light pressure on the area. I always tell patients not to rub or massage for 24 hours after the injection."
Some clinicians will treat the tear trough deformity without treating the rest of the orbital rim, she continued. "If patients have volume loss, it’s not just going to be the tear trough; it’s going to continue out to the sides of the orbit rim, especially in older patients," she said. "So it’s important to build up that area as well."
Dr. Obagi, who is also the immediate past vice president of the American Board of Cosmetic Surgery, prefers to use hyaluronic acid fillers that are smaller in particle size such as Medicis’ Restylane for tear trough deformities, adding lidocaine plus epinephrine prior to injection. "I use 0.3 mL 1% lidocaine with epinephrine and 0.2 mL sodium bicarbonate, and I use a Luer lock adapter to mix them together," she said. "I’m going to be working in an area where I want no bruising; in order to do that I need the epinephrine in there."
Dr. Obagi said that she had no relevant financial conflicts to disclose.
EXPERT ANALYSIS FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF COSMETIC SURGERY
Ablative Lasers Effective, but Painful for Treating Acne Scars
Ablative fractional laser resurfacing is more effective than nonablative therapy for the treatment of acne scaring, albeit, with greater side effects and pain, according to a new review.
Ms. Michal Wen Sheue Ong and Dr. Saquib Bashir, of King’s College Hospital NHS Foundation Trust in London, conducted literature searches using the PubMed and Scopus databases for English-language articles published between 2003 and January 2011 that reported on "acne scars" and "fractional photothermolysis."
A total of 26 papers, published between 2008 and 2011, met the criteria – 13 papers on ablative fractional lasers and an equal number on nonablative fractional lasers (Br. J. Dermatol. 2012 Feb. 1 [doi: 10.1111/j.1365-2133.2012.10870.x]).
"Most ablative studies reported a percentage of improvement within the range of 26% to 75%," they wrote. In two cases, studies claimed 79.8% and 83% mean improvement, although the reviewers questioned the appropriateness of using mean values rather than medians, given that "the properties of the ordinal scales were unknown and points on the scale were not necessarily equidistant."
The nonablative studies reported an improvement range of 26% to 50%.
Only four studies were split-face randomized controlled trials, and most had follow-up criteria of just 1 to 6 months; only one study included a 2-year follow-up. Moreover, the methods and rating scales for measuring improvement varied widely.
Only five studies analyzed the histological degree of scar improvement, but in these, new collagen formation was noted with both ablative and nonablative fractional photothermolysis.
In one of the nonablative studies included in the review, an increase in elastic fibers framework in the papillary dermis, as well as the upper and mid dermis, was noted 12 weeks after final treatment (Photodermatol. Photoimmunol. Photomed. 2009;25:138-42).
Similarly, using 3D optical profiling, a study of ablative laser resurfacing showed a marked, statistically significant improvement in skin smoothness and scar volume 1 month after treatment. "However, there were no further improvements of skin smoothness or scar volume at 3- and 6-months follow-up," wrote the authors (J. Am. Acad. Dermatol. 2010;63:274-83).
Looking at side effects, "A higher proportion of patients (up to 92.3%) who undertake ablative FP [fractional photothermolysis] experience post inflammatory hyperpigmentation (PIH) than those who have nonablative FP (up to 13%)," wrote the reviewers, with a maximum duration of PIH of up to 6 months in ablative FP, vs. 1 week in nonablative treatment.
Pain ratings for nonablative procedures were also lower, compared with ablative procedures. "The mean pain score reported across ablative FP studies ranged from 5.9-8.1 (scale of 10)," reported the authors. In contrast, the mean pain scores for nonablative FP procedures were rated 3.9-5.7.
The authors pointed out that they found no evidence regarding the effects of FP lasers on patients’ psychological status and quality of life. "This information can be useful and should be obtained before and after treatment," they wrote.
Limitations of the review included the fact that none of the methods of assessing clinical outcome had had its validity or reliability investigated, wrote the reviewers. For the most part, however, the results were promising.
"Most studies had clinicians/dermatologists to assess overall scar improvement, and there were some studies which had patient assessment," they wrote. In many cases the evaluators were blinded, but at least three studies used evaluators who were not.
Fractional photothermolysis laser resurfacing improves facial acne scarring, despite dramatic methodological variability in efficacy studies. Nevertheless, more studies are needed, especially split-face, randomized controlled trials using objective assessment measures of improvement, like histological or 3D optical profiling, they concluded.
The review authors reported having no outside funding and stated that they had no conflicts of interest to declare.
Ablative fractional laser resurfacing is more effective than nonablative therapy for the treatment of acne scaring, albeit, with greater side effects and pain, according to a new review.
Ms. Michal Wen Sheue Ong and Dr. Saquib Bashir, of King’s College Hospital NHS Foundation Trust in London, conducted literature searches using the PubMed and Scopus databases for English-language articles published between 2003 and January 2011 that reported on "acne scars" and "fractional photothermolysis."
A total of 26 papers, published between 2008 and 2011, met the criteria – 13 papers on ablative fractional lasers and an equal number on nonablative fractional lasers (Br. J. Dermatol. 2012 Feb. 1 [doi: 10.1111/j.1365-2133.2012.10870.x]).
"Most ablative studies reported a percentage of improvement within the range of 26% to 75%," they wrote. In two cases, studies claimed 79.8% and 83% mean improvement, although the reviewers questioned the appropriateness of using mean values rather than medians, given that "the properties of the ordinal scales were unknown and points on the scale were not necessarily equidistant."
The nonablative studies reported an improvement range of 26% to 50%.
Only four studies were split-face randomized controlled trials, and most had follow-up criteria of just 1 to 6 months; only one study included a 2-year follow-up. Moreover, the methods and rating scales for measuring improvement varied widely.
Only five studies analyzed the histological degree of scar improvement, but in these, new collagen formation was noted with both ablative and nonablative fractional photothermolysis.
In one of the nonablative studies included in the review, an increase in elastic fibers framework in the papillary dermis, as well as the upper and mid dermis, was noted 12 weeks after final treatment (Photodermatol. Photoimmunol. Photomed. 2009;25:138-42).
Similarly, using 3D optical profiling, a study of ablative laser resurfacing showed a marked, statistically significant improvement in skin smoothness and scar volume 1 month after treatment. "However, there were no further improvements of skin smoothness or scar volume at 3- and 6-months follow-up," wrote the authors (J. Am. Acad. Dermatol. 2010;63:274-83).
Looking at side effects, "A higher proportion of patients (up to 92.3%) who undertake ablative FP [fractional photothermolysis] experience post inflammatory hyperpigmentation (PIH) than those who have nonablative FP (up to 13%)," wrote the reviewers, with a maximum duration of PIH of up to 6 months in ablative FP, vs. 1 week in nonablative treatment.
Pain ratings for nonablative procedures were also lower, compared with ablative procedures. "The mean pain score reported across ablative FP studies ranged from 5.9-8.1 (scale of 10)," reported the authors. In contrast, the mean pain scores for nonablative FP procedures were rated 3.9-5.7.
The authors pointed out that they found no evidence regarding the effects of FP lasers on patients’ psychological status and quality of life. "This information can be useful and should be obtained before and after treatment," they wrote.
Limitations of the review included the fact that none of the methods of assessing clinical outcome had had its validity or reliability investigated, wrote the reviewers. For the most part, however, the results were promising.
"Most studies had clinicians/dermatologists to assess overall scar improvement, and there were some studies which had patient assessment," they wrote. In many cases the evaluators were blinded, but at least three studies used evaluators who were not.
Fractional photothermolysis laser resurfacing improves facial acne scarring, despite dramatic methodological variability in efficacy studies. Nevertheless, more studies are needed, especially split-face, randomized controlled trials using objective assessment measures of improvement, like histological or 3D optical profiling, they concluded.
The review authors reported having no outside funding and stated that they had no conflicts of interest to declare.
Ablative fractional laser resurfacing is more effective than nonablative therapy for the treatment of acne scaring, albeit, with greater side effects and pain, according to a new review.
Ms. Michal Wen Sheue Ong and Dr. Saquib Bashir, of King’s College Hospital NHS Foundation Trust in London, conducted literature searches using the PubMed and Scopus databases for English-language articles published between 2003 and January 2011 that reported on "acne scars" and "fractional photothermolysis."
A total of 26 papers, published between 2008 and 2011, met the criteria – 13 papers on ablative fractional lasers and an equal number on nonablative fractional lasers (Br. J. Dermatol. 2012 Feb. 1 [doi: 10.1111/j.1365-2133.2012.10870.x]).
"Most ablative studies reported a percentage of improvement within the range of 26% to 75%," they wrote. In two cases, studies claimed 79.8% and 83% mean improvement, although the reviewers questioned the appropriateness of using mean values rather than medians, given that "the properties of the ordinal scales were unknown and points on the scale were not necessarily equidistant."
The nonablative studies reported an improvement range of 26% to 50%.
Only four studies were split-face randomized controlled trials, and most had follow-up criteria of just 1 to 6 months; only one study included a 2-year follow-up. Moreover, the methods and rating scales for measuring improvement varied widely.
Only five studies analyzed the histological degree of scar improvement, but in these, new collagen formation was noted with both ablative and nonablative fractional photothermolysis.
In one of the nonablative studies included in the review, an increase in elastic fibers framework in the papillary dermis, as well as the upper and mid dermis, was noted 12 weeks after final treatment (Photodermatol. Photoimmunol. Photomed. 2009;25:138-42).
Similarly, using 3D optical profiling, a study of ablative laser resurfacing showed a marked, statistically significant improvement in skin smoothness and scar volume 1 month after treatment. "However, there were no further improvements of skin smoothness or scar volume at 3- and 6-months follow-up," wrote the authors (J. Am. Acad. Dermatol. 2010;63:274-83).
Looking at side effects, "A higher proportion of patients (up to 92.3%) who undertake ablative FP [fractional photothermolysis] experience post inflammatory hyperpigmentation (PIH) than those who have nonablative FP (up to 13%)," wrote the reviewers, with a maximum duration of PIH of up to 6 months in ablative FP, vs. 1 week in nonablative treatment.
Pain ratings for nonablative procedures were also lower, compared with ablative procedures. "The mean pain score reported across ablative FP studies ranged from 5.9-8.1 (scale of 10)," reported the authors. In contrast, the mean pain scores for nonablative FP procedures were rated 3.9-5.7.
The authors pointed out that they found no evidence regarding the effects of FP lasers on patients’ psychological status and quality of life. "This information can be useful and should be obtained before and after treatment," they wrote.
Limitations of the review included the fact that none of the methods of assessing clinical outcome had had its validity or reliability investigated, wrote the reviewers. For the most part, however, the results were promising.
"Most studies had clinicians/dermatologists to assess overall scar improvement, and there were some studies which had patient assessment," they wrote. In many cases the evaluators were blinded, but at least three studies used evaluators who were not.
Fractional photothermolysis laser resurfacing improves facial acne scarring, despite dramatic methodological variability in efficacy studies. Nevertheless, more studies are needed, especially split-face, randomized controlled trials using objective assessment measures of improvement, like histological or 3D optical profiling, they concluded.
The review authors reported having no outside funding and stated that they had no conflicts of interest to declare.
FROM THE BRITISH JOURNAL OF DERMATOLOGY
Major Finding: Most ablative studies reported a percentage of improvement within the range of 26% to 75%, compared with a reported range of improvement of 26% to 50% for the nonablative studies.
Data Source: A review of 26 studies on ablative and nonablative fractional photothermolysis for facial acne scars.
Disclosures: The review authors reported having no outside funding and stated that they had no conflicts of interest to declare.
Skin of Color: Microskin Camouflages Imperfections
As a follow-up to our recent blog on using skin camouflage to cover skin disorders, a technology called Microskin is also available to mask skin imperfections.
Microskin, also known as simulated second skin, is a topical skin camouflage that is individually tailored to match a person's skin color and cover conditions such as birthmarks, vitiligo, burns, scars, striae, pigmentary disorders, rosacea, and photodamage.
Unlike traditional make-up, Microskin is an alcohol-based liquid that won't wipe off on clothing. It is waterproof and adheres to the epidermis forming a simulated second skin over the affected area.
One application typically lasts for 1-2 days on the face and several days longer on the body. Small areas are treated with a sponge, whereas larger areas may be airbrushed.
Microskin was developed in Australia, where it was studied at a pediatric burn center to assess the product's impact on burn patients. The U.S. headquarters are located in New York, but consultations are often set up at various cities around the country throughout the year.
Microskin is is not a treatment or medication for skin conditions, but it can be another acceptable option for helping patients achieve cosmetic improvement.
More information may be found at microskincenter.com.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
As a follow-up to our recent blog on using skin camouflage to cover skin disorders, a technology called Microskin is also available to mask skin imperfections.
Microskin, also known as simulated second skin, is a topical skin camouflage that is individually tailored to match a person's skin color and cover conditions such as birthmarks, vitiligo, burns, scars, striae, pigmentary disorders, rosacea, and photodamage.
Unlike traditional make-up, Microskin is an alcohol-based liquid that won't wipe off on clothing. It is waterproof and adheres to the epidermis forming a simulated second skin over the affected area.
One application typically lasts for 1-2 days on the face and several days longer on the body. Small areas are treated with a sponge, whereas larger areas may be airbrushed.
Microskin was developed in Australia, where it was studied at a pediatric burn center to assess the product's impact on burn patients. The U.S. headquarters are located in New York, but consultations are often set up at various cities around the country throughout the year.
Microskin is is not a treatment or medication for skin conditions, but it can be another acceptable option for helping patients achieve cosmetic improvement.
More information may be found at microskincenter.com.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
As a follow-up to our recent blog on using skin camouflage to cover skin disorders, a technology called Microskin is also available to mask skin imperfections.
Microskin, also known as simulated second skin, is a topical skin camouflage that is individually tailored to match a person's skin color and cover conditions such as birthmarks, vitiligo, burns, scars, striae, pigmentary disorders, rosacea, and photodamage.
Unlike traditional make-up, Microskin is an alcohol-based liquid that won't wipe off on clothing. It is waterproof and adheres to the epidermis forming a simulated second skin over the affected area.
One application typically lasts for 1-2 days on the face and several days longer on the body. Small areas are treated with a sponge, whereas larger areas may be airbrushed.
Microskin was developed in Australia, where it was studied at a pediatric burn center to assess the product's impact on burn patients. The U.S. headquarters are located in New York, but consultations are often set up at various cities around the country throughout the year.
Microskin is is not a treatment or medication for skin conditions, but it can be another acceptable option for helping patients achieve cosmetic improvement.
More information may be found at microskincenter.com.
- Naissan Wesley, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Skin of Color: Hair Practices and Scarring Alopecia
Scarring alopecia is a common and devastating disease in skin of color patients. Although many controversial studies have looked at the effects of styling techniques and chemical treatments on hair loss, no direct relationships have been found.
A recent study published in the Journal of Cosmetic Dermatology found that there was an increased baseline level of the profibrotic cytokine IL-1 alpha and the IL-1 receptor antagonist in the scalp sebum of afro-textured hair. The study also highlighted the increased susceptibility to scarring alopecia in black patients.
Interestingly, the levels of the profibrotic cytokines increased with chemical treatments and decreased with shampooing, which is also a feature unique to black patients.
When evaluating patients with scarring alopecia, I often inquire about shampooing frequency and chemical treatments. The frequency, type of treatment, chemical used, color used, and relaxing techniques are factors I document in order to evaluate hair loss for every patient.
This study sheds light on the increased risk of scarring alopecia in black patients; and it should alert dermatologists to elucidate hair practices in all patients with hair loss.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Scarring alopecia is a common and devastating disease in skin of color patients. Although many controversial studies have looked at the effects of styling techniques and chemical treatments on hair loss, no direct relationships have been found.
A recent study published in the Journal of Cosmetic Dermatology found that there was an increased baseline level of the profibrotic cytokine IL-1 alpha and the IL-1 receptor antagonist in the scalp sebum of afro-textured hair. The study also highlighted the increased susceptibility to scarring alopecia in black patients.
Interestingly, the levels of the profibrotic cytokines increased with chemical treatments and decreased with shampooing, which is also a feature unique to black patients.
When evaluating patients with scarring alopecia, I often inquire about shampooing frequency and chemical treatments. The frequency, type of treatment, chemical used, color used, and relaxing techniques are factors I document in order to evaluate hair loss for every patient.
This study sheds light on the increased risk of scarring alopecia in black patients; and it should alert dermatologists to elucidate hair practices in all patients with hair loss.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].
Scarring alopecia is a common and devastating disease in skin of color patients. Although many controversial studies have looked at the effects of styling techniques and chemical treatments on hair loss, no direct relationships have been found.
A recent study published in the Journal of Cosmetic Dermatology found that there was an increased baseline level of the profibrotic cytokine IL-1 alpha and the IL-1 receptor antagonist in the scalp sebum of afro-textured hair. The study also highlighted the increased susceptibility to scarring alopecia in black patients.
Interestingly, the levels of the profibrotic cytokines increased with chemical treatments and decreased with shampooing, which is also a feature unique to black patients.
When evaluating patients with scarring alopecia, I often inquire about shampooing frequency and chemical treatments. The frequency, type of treatment, chemical used, color used, and relaxing techniques are factors I document in order to evaluate hair loss for every patient.
This study sheds light on the increased risk of scarring alopecia in black patients; and it should alert dermatologists to elucidate hair practices in all patients with hair loss.
- Lily Talakoub, M.D.
Do you have questions about treating patients with darker skin? If so, send them to [email protected].