Aesthetic Dermatology

In this month's Skinny Podcast, we catch up with Dr. Richard Carvajal for the latest on the FDA's recent approval of vemurafenib for advanced-stage melanoma.

We also talk to Dr. Henry Lim about why the thinks adults and children (starting at age 1) should be taking regular vitamin D supplements.

Dr. Ronald Rapini discusses the northward march of the fire ant. His stories are sure to make your skin crawl.

In this month's Cosmetic Counter segment, Dr. Lily Talakoub lays out the facts about cleansers and offers tips that you can share with your patients.

And last but not least, Dr. Alan Rockoff entertains us with a story about a bath tub and an angry mother-in-law.

In this month's Skinny Podcast, we catch up with Dr. Richard Carvajal for the latest on the FDA's recent approval of vemurafenib for advanced-stage melanoma.

We also talk to Dr. Henry Lim about why the thinks adults and children (starting at age 1) should be taking regular vitamin D supplements.

Dr. Ronald Rapini discusses the northward march of the fire ant. His stories are sure to make your skin crawl.

In this month's Cosmetic Counter segment, Dr. Lily Talakoub lays out the facts about cleansers and offers tips that you can share with your patients.

And last but not least, Dr. Alan Rockoff entertains us with a story about a bath tub and an angry mother-in-law.

In this month's Skinny Podcast, we catch up with Dr. Richard Carvajal for the latest on the FDA's recent approval of vemurafenib for advanced-stage melanoma.

We also talk to Dr. Henry Lim about why the thinks adults and children (starting at age 1) should be taking regular vitamin D supplements.

Dr. Ronald Rapini discusses the northward march of the fire ant. His stories are sure to make your skin crawl.

In this month's Cosmetic Counter segment, Dr. Lily Talakoub lays out the facts about cleansers and offers tips that you can share with your patients.

And last but not least, Dr. Alan Rockoff entertains us with a story about a bath tub and an angry mother-in-law.

Fredric S. Brandt, MD, Alex Cazzaniga, MBA, and Michael Hann, MSc

The desire to maintain a youthful image combined with an emerging global market with disposable income has driven the development of many new industries. The cosmeceutical industry is based on the development and marketing of products that lie between cosmetics and pharmaceuticals. Today, there are over 400 suppliers and manufacturers of cosmeceutical products, and the industry is estimated to grow by 7.4% by 2012. Although a number of products advertise predictable outcomes, the industry is largely unregulated and any consumers of cosmeceutical products should consult a dermatologist prior to use. This review will provide a snapshot of the current trends of this industry and provide an analysis of this multi-billion dollar market.

*For a PDF of the full article, click on the link to the left of this introduction.

Fredric S. Brandt, MD, Alex Cazzaniga, MBA, and Michael Hann, MSc

The desire to maintain a youthful image combined with an emerging global market with disposable income has driven the development of many new industries. The cosmeceutical industry is based on the development and marketing of products that lie between cosmetics and pharmaceuticals. Today, there are over 400 suppliers and manufacturers of cosmeceutical products, and the industry is estimated to grow by 7.4% by 2012. Although a number of products advertise predictable outcomes, the industry is largely unregulated and any consumers of cosmeceutical products should consult a dermatologist prior to use. This review will provide a snapshot of the current trends of this industry and provide an analysis of this multi-billion dollar market.

*For a PDF of the full article, click on the link to the left of this introduction.

Fredric S. Brandt, MD, Alex Cazzaniga, MBA, and Michael Hann, MSc

The desire to maintain a youthful image combined with an emerging global market with disposable income has driven the development of many new industries. The cosmeceutical industry is based on the development and marketing of products that lie between cosmetics and pharmaceuticals. Today, there are over 400 suppliers and manufacturers of cosmeceutical products, and the industry is estimated to grow by 7.4% by 2012. Although a number of products advertise predictable outcomes, the industry is largely unregulated and any consumers of cosmeceutical products should consult a dermatologist prior to use. This review will provide a snapshot of the current trends of this industry and provide an analysis of this multi-billion dollar market.

*For a PDF of the full article, click on the link to the left of this introduction.

Jason Emer, MD, Heidi Waldorf, MD, and Diane Berson, MD

Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here.

*For a PDF of the full article, click on the link to the left of this introduction.

Jason Emer, MD, Heidi Waldorf, MD, and Diane Berson, MD

Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here.

*For a PDF of the full article, click on the link to the left of this introduction.

Jason Emer, MD, Heidi Waldorf, MD, and Diane Berson, MD

Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here.

*For a PDF of the full article, click on the link to the left of this introduction.

Mary Lupo, MD, and Leah Jacob, MD

The use of laser resurfacing for cutaneous rejuvenation has become an important tool in the modern dermatologist’s armamentarium. To ensure a successful outcome, proper preoperative and postoperative skin care is essential. Incorporating cosmeceuticals into the perioperative skin care regimen can promote a better overall patient experience by hastening postoperative healing, reducing common side effects, and enhancing overall rejuvenation. This article aims to explore the use of various cosmeceuticals in conjunction with laser resurfacing procedures. In particular, the overall mechanisms of action behind each selected therapy will be discussed, followed by a brief discussion of the existing literature on each agent’s use with laser resurfacing. Theoretical considerations and a limited body of evidence suggest a potential benefit for the use of these agents in conjunction with laser resurfacing procedures; however, further placebo-controlled studies are needed to truly confirm these benefits.

*For a PDF of the full article, click on the link to the left of this introduction.

Mary Lupo, MD, and Leah Jacob, MD

The use of laser resurfacing for cutaneous rejuvenation has become an important tool in the modern dermatologist’s armamentarium. To ensure a successful outcome, proper preoperative and postoperative skin care is essential. Incorporating cosmeceuticals into the perioperative skin care regimen can promote a better overall patient experience by hastening postoperative healing, reducing common side effects, and enhancing overall rejuvenation. This article aims to explore the use of various cosmeceuticals in conjunction with laser resurfacing procedures. In particular, the overall mechanisms of action behind each selected therapy will be discussed, followed by a brief discussion of the existing literature on each agent’s use with laser resurfacing. Theoretical considerations and a limited body of evidence suggest a potential benefit for the use of these agents in conjunction with laser resurfacing procedures; however, further placebo-controlled studies are needed to truly confirm these benefits.

*For a PDF of the full article, click on the link to the left of this introduction.

Mary Lupo, MD, and Leah Jacob, MD

The use of laser resurfacing for cutaneous rejuvenation has become an important tool in the modern dermatologist’s armamentarium. To ensure a successful outcome, proper preoperative and postoperative skin care is essential. Incorporating cosmeceuticals into the perioperative skin care regimen can promote a better overall patient experience by hastening postoperative healing, reducing common side effects, and enhancing overall rejuvenation. This article aims to explore the use of various cosmeceuticals in conjunction with laser resurfacing procedures. In particular, the overall mechanisms of action behind each selected therapy will be discussed, followed by a brief discussion of the existing literature on each agent’s use with laser resurfacing. Theoretical considerations and a limited body of evidence suggest a potential benefit for the use of these agents in conjunction with laser resurfacing procedures; however, further placebo-controlled studies are needed to truly confirm these benefits.

*For a PDF of the full article, click on the link to the left of this introduction.

Patricia K. Farris, MD

Skin aging is a combination of natural aging with superimposed photoaging. Naturally aged skin is thin, fragile and finely wrinkled whereas photoaged skin is rough and thickened with deep coarse wrinkles. In addition photoaging is characterized by mottled pigmentation, solar lentigines, telangectasias and a loss of elasticity. The science behind skin aging has exploded in the past decade. Skin aging has now been defined on both a cellular and molecular level. The study of genomics in aging skin provides us with potential targets as points for intervention. In this regard, the science behind skin aging becomes a platform for the development of new anti-aging strategies and products. In this paper two new and emerging approaches to treat aging skin will be discussed. Sirtuin activating and antiglycation products are already being marketed by cosmetic and pharmaceutical companies. These anti-aging approaches are backed by basic science research and the ingredients used are supported by proof of concept studies although clinical trials are often lacking. It is this bench to beauty counter approach to cosmeceuticals that remains an industry standard today.

*For a PDF of the full article, click on the link to the left of this introduction.

Patricia K. Farris, MD

Skin aging is a combination of natural aging with superimposed photoaging. Naturally aged skin is thin, fragile and finely wrinkled whereas photoaged skin is rough and thickened with deep coarse wrinkles. In addition photoaging is characterized by mottled pigmentation, solar lentigines, telangectasias and a loss of elasticity. The science behind skin aging has exploded in the past decade. Skin aging has now been defined on both a cellular and molecular level. The study of genomics in aging skin provides us with potential targets as points for intervention. In this regard, the science behind skin aging becomes a platform for the development of new anti-aging strategies and products. In this paper two new and emerging approaches to treat aging skin will be discussed. Sirtuin activating and antiglycation products are already being marketed by cosmetic and pharmaceutical companies. These anti-aging approaches are backed by basic science research and the ingredients used are supported by proof of concept studies although clinical trials are often lacking. It is this bench to beauty counter approach to cosmeceuticals that remains an industry standard today.

*For a PDF of the full article, click on the link to the left of this introduction.

Patricia K. Farris, MD

Skin aging is a combination of natural aging with superimposed photoaging. Naturally aged skin is thin, fragile and finely wrinkled whereas photoaged skin is rough and thickened with deep coarse wrinkles. In addition photoaging is characterized by mottled pigmentation, solar lentigines, telangectasias and a loss of elasticity. The science behind skin aging has exploded in the past decade. Skin aging has now been defined on both a cellular and molecular level. The study of genomics in aging skin provides us with potential targets as points for intervention. In this regard, the science behind skin aging becomes a platform for the development of new anti-aging strategies and products. In this paper two new and emerging approaches to treat aging skin will be discussed. Sirtuin activating and antiglycation products are already being marketed by cosmetic and pharmaceutical companies. These anti-aging approaches are backed by basic science research and the ingredients used are supported by proof of concept studies although clinical trials are often lacking. It is this bench to beauty counter approach to cosmeceuticals that remains an industry standard today.

*For a PDF of the full article, click on the link to the left of this introduction.

Doris Hexsel, MD, and Mariana Soirefmann, MD, MSc

Cellulite is characterized by alterations to the skin surface, presenting as dimpled or puckered skin of the buttocks and posterior and lateral thighs. It mainly affects women. Cellulite occurrence is believed to be due to structural, inflammatory, morphological and biochemical alterations of the subcutaneous tissue. However, its pathogenesis is not completely understood. Topical treatments for cellulite include many agents, such those that increase the microcirculation flow, agents that reduce lipogenesis and promote lipolysis, agents that restore the normal structure of dermis and subcutaneous tissue, and agents that scavenge free radicals or prevent their formation. There are many cosmetic and medical treatments for cellulite. However, there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. The successful treatment of cellulite will ultimately depend upon our understanding of the physiopathology of cellulite adipose tissue.

*For a PDF of the full article, click on the link to the left of this introduction.

Doris Hexsel, MD, and Mariana Soirefmann, MD, MSc

Cellulite is characterized by alterations to the skin surface, presenting as dimpled or puckered skin of the buttocks and posterior and lateral thighs. It mainly affects women. Cellulite occurrence is believed to be due to structural, inflammatory, morphological and biochemical alterations of the subcutaneous tissue. However, its pathogenesis is not completely understood. Topical treatments for cellulite include many agents, such those that increase the microcirculation flow, agents that reduce lipogenesis and promote lipolysis, agents that restore the normal structure of dermis and subcutaneous tissue, and agents that scavenge free radicals or prevent their formation. There are many cosmetic and medical treatments for cellulite. However, there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. The successful treatment of cellulite will ultimately depend upon our understanding of the physiopathology of cellulite adipose tissue.

*For a PDF of the full article, click on the link to the left of this introduction.

Doris Hexsel, MD, and Mariana Soirefmann, MD, MSc

Cellulite is characterized by alterations to the skin surface, presenting as dimpled or puckered skin of the buttocks and posterior and lateral thighs. It mainly affects women. Cellulite occurrence is believed to be due to structural, inflammatory, morphological and biochemical alterations of the subcutaneous tissue. However, its pathogenesis is not completely understood. Topical treatments for cellulite include many agents, such those that increase the microcirculation flow, agents that reduce lipogenesis and promote lipolysis, agents that restore the normal structure of dermis and subcutaneous tissue, and agents that scavenge free radicals or prevent their formation. There are many cosmetic and medical treatments for cellulite. However, there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. The successful treatment of cellulite will ultimately depend upon our understanding of the physiopathology of cellulite adipose tissue.

*For a PDF of the full article, click on the link to the left of this introduction.

Heather Woolery-Lloyd, MD, and Jenna N. Kammer, BA

Hyperpigmentation is a common dermatologic condition that is seen in all skin types but is most prominent in skin of color. In skin of color, any inflammation or injury to skin can almost immediately be accompanied by alterations in pigmentation, either hyperpigmentation or hypopigmentation. Post-inflammatory hyperpigmentation can be observed in many skin conditions including acne, eczema, and contact dermatitis and treatment can be challenging. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding area. This review will discuss current research on treatments for hyperpigmentation and approaches to treating this condition.

*For a PDF of the full article, click on the link to the left of this introduction.

Heather Woolery-Lloyd, MD, and Jenna N. Kammer, BA

Hyperpigmentation is a common dermatologic condition that is seen in all skin types but is most prominent in skin of color. In skin of color, any inflammation or injury to skin can almost immediately be accompanied by alterations in pigmentation, either hyperpigmentation or hypopigmentation. Post-inflammatory hyperpigmentation can be observed in many skin conditions including acne, eczema, and contact dermatitis and treatment can be challenging. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding area. This review will discuss current research on treatments for hyperpigmentation and approaches to treating this condition.

*For a PDF of the full article, click on the link to the left of this introduction.

Heather Woolery-Lloyd, MD, and Jenna N. Kammer, BA

Hyperpigmentation is a common dermatologic condition that is seen in all skin types but is most prominent in skin of color. In skin of color, any inflammation or injury to skin can almost immediately be accompanied by alterations in pigmentation, either hyperpigmentation or hypopigmentation. Post-inflammatory hyperpigmentation can be observed in many skin conditions including acne, eczema, and contact dermatitis and treatment can be challenging. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding area. This review will discuss current research on treatments for hyperpigmentation and approaches to treating this condition.

*For a PDF of the full article, click on the link to the left of this introduction.

Nevenka Golubovic-Liakopoulos, PhD, Sanford R. Simon, PhD, and Bhavdeep Shah, PhD

The skin is a complex organ and its aging is a complex process. Cutaneous aging is influenced by factors such as sun exposure, genetics, stress and the environment. While skin laxity, rhytides, and dyschromia appear on the surface, these processes originate in deeper layers including the dermis and subcutaneous tissues. Until recently, most topical skin treatments were applied to, and consequently only affected the skin surface. Skin care has evolved to be scientifically based, and as knowledge increases about the physiology of the skin, novel methods of maintaining its health and appearance are developed. New generation skin care products are targeting multiple aging mechanisms by utilizing functional active ingredients in combination with innovative delivery systems.

*For a PDF of the full article, click on the link to the left of this introduction.

Nevenka Golubovic-Liakopoulos, PhD, Sanford R. Simon, PhD, and Bhavdeep Shah, PhD

The skin is a complex organ and its aging is a complex process. Cutaneous aging is influenced by factors such as sun exposure, genetics, stress and the environment. While skin laxity, rhytides, and dyschromia appear on the surface, these processes originate in deeper layers including the dermis and subcutaneous tissues. Until recently, most topical skin treatments were applied to, and consequently only affected the skin surface. Skin care has evolved to be scientifically based, and as knowledge increases about the physiology of the skin, novel methods of maintaining its health and appearance are developed. New generation skin care products are targeting multiple aging mechanisms by utilizing functional active ingredients in combination with innovative delivery systems.

*For a PDF of the full article, click on the link to the left of this introduction.

Nevenka Golubovic-Liakopoulos, PhD, Sanford R. Simon, PhD, and Bhavdeep Shah, PhD

The skin is a complex organ and its aging is a complex process. Cutaneous aging is influenced by factors such as sun exposure, genetics, stress and the environment. While skin laxity, rhytides, and dyschromia appear on the surface, these processes originate in deeper layers including the dermis and subcutaneous tissues. Until recently, most topical skin treatments were applied to, and consequently only affected the skin surface. Skin care has evolved to be scientifically based, and as knowledge increases about the physiology of the skin, novel methods of maintaining its health and appearance are developed. New generation skin care products are targeting multiple aging mechanisms by utilizing functional active ingredients in combination with innovative delivery systems.

*For a PDF of the full article, click on the link to the left of this introduction.

While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.

Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.

The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot­­ be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.

Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.

Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.

The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.  

Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.

Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.

Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.

We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.

While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.

Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.

The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot­­ be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.

Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.

Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.

The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.  

Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.

Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.

Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.

We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.

While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.

Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.

The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot­­ be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.

Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.

Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.

The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.  

Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.

Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.

Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.

We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.

Women seeking genital surgery to reduce the size of their labia minora do not have large or misshapen labia, and also tend to be relatively young, a small U.K. study has found.

Of the 33 women in the prospective study, published Aug. 24 in BJOG, 30 had labia with dimensions within the normal published limits, yet sought surgery anyway. The women’s average age was 23 years, although a quarter were 16 years or younger, with the youngest being 11 years old.

This points to the psychological or cultural appeal of cosmetic genital surgery among young women and girls, the study’s authors say, which may be influenced by grooming trends that expose the vulva – two-thirds of women in the study had removed their pubic hair – and by widespread advertising of the surgical procedures using before-and-after photos, which about one-third of subjects reported having consulted (BJOG 2011 Aug. 24 [doi:10.1111/j.1471-0528.2011.03088.x]).

"We noticed that more young women were coming in saying, ‘we’re not normal,’ " said Dr. Sarah Creighton, a gynecologist at University College London’s Elizabeth Garrett Anderson Institute of Women’s Health and the corresponding author of the study, in an interview. "And yet there is little information about what is normal."

For their research, Dr. Creighton and colleagues at a London hospital clinic (which performs the surgeries on women whose genitalia are outside normal measures) interviewed women referred to them by primary care physicians. Two-thirds of the women seeking surgery identified themselves as students, only 15% had given birth, and two-thirds reported being single. Most (84%) were white.

The women did not appear to be guided by sexual concerns, as a majority (61%) reported having never been sexually active.

Dr. Creighton and colleagues interviewed the women on their reasons for seeking surgery, and found that most (78%) were motivated by concerns about the appearance of their genitals. Although discomfort, such as that caused by rubbing or chafing, was reported by 57% of them, only 18% said that they thought surgery would help.

The investigators also measured the women’s labia, finding all but three to be within normal published limits, with a mean (SD) of 26.9 (12.8) mm on the right side, and 24.8 (13.1) mm on the left. Surgeries were offered only to those women whose labia were outside that range.

The investigators were surprised, they wrote, to find "that all of the study participants and their referring doctors should have felt that surgery was an appropriate treatment," when the women’s labia were normal. Moreover, 40% of the 30 participants who were denied surgery by the clinic "remained keen to pursue surgery by any other available route."

About 2,000 women now receive the surgeries every year through NHS clinics, a fivefold increase from a decade ago, Dr. Creighton and colleagues noted, with privately performed procedures likely accounting for a far greater number. Yet despite the expanding availability of the procedure, a U.K. law prohibits female genital surgeries for cultural or nontherapeutic reasons, even on adult women.

Thus far, Dr. Creighton said, no lawsuit has challenged the legality of the procedure, which some NHS trusts offer on the grounds of alleviating psychological distress.

"There are no guidelines. The NHS is not publicly discussing it," Dr. Creighton said, adding that professional surgical associations have not issued clear guidelines for treating women seeking labial surgery, leaving clinician discretion as the norm.

"National care standards are urgently needed," Dr. Creighton and colleagues wrote in their analysis. The investigators also urged the publication of data on normal labial measurements "based on a large adult general population sample stratified according to age, ethnicity and parity."

The study was funded by the Elizabeth Garrett Anderson Institute of Women’s Health at University College London. None of its authors declared conflicts of interest.

Women seeking genital surgery to reduce the size of their labia minora do not have large or misshapen labia, and also tend to be relatively young, a small U.K. study has found.

Of the 33 women in the prospective study, published Aug. 24 in BJOG, 30 had labia with dimensions within the normal published limits, yet sought surgery anyway. The women’s average age was 23 years, although a quarter were 16 years or younger, with the youngest being 11 years old.

This points to the psychological or cultural appeal of cosmetic genital surgery among young women and girls, the study’s authors say, which may be influenced by grooming trends that expose the vulva – two-thirds of women in the study had removed their pubic hair – and by widespread advertising of the surgical procedures using before-and-after photos, which about one-third of subjects reported having consulted (BJOG 2011 Aug. 24 [doi:10.1111/j.1471-0528.2011.03088.x]).

"We noticed that more young women were coming in saying, ‘we’re not normal,’ " said Dr. Sarah Creighton, a gynecologist at University College London’s Elizabeth Garrett Anderson Institute of Women’s Health and the corresponding author of the study, in an interview. "And yet there is little information about what is normal."

For their research, Dr. Creighton and colleagues at a London hospital clinic (which performs the surgeries on women whose genitalia are outside normal measures) interviewed women referred to them by primary care physicians. Two-thirds of the women seeking surgery identified themselves as students, only 15% had given birth, and two-thirds reported being single. Most (84%) were white.

The women did not appear to be guided by sexual concerns, as a majority (61%) reported having never been sexually active.

Dr. Creighton and colleagues interviewed the women on their reasons for seeking surgery, and found that most (78%) were motivated by concerns about the appearance of their genitals. Although discomfort, such as that caused by rubbing or chafing, was reported by 57% of them, only 18% said that they thought surgery would help.

The investigators also measured the women’s labia, finding all but three to be within normal published limits, with a mean (SD) of 26.9 (12.8) mm on the right side, and 24.8 (13.1) mm on the left. Surgeries were offered only to those women whose labia were outside that range.

The investigators were surprised, they wrote, to find "that all of the study participants and their referring doctors should have felt that surgery was an appropriate treatment," when the women’s labia were normal. Moreover, 40% of the 30 participants who were denied surgery by the clinic "remained keen to pursue surgery by any other available route."

About 2,000 women now receive the surgeries every year through NHS clinics, a fivefold increase from a decade ago, Dr. Creighton and colleagues noted, with privately performed procedures likely accounting for a far greater number. Yet despite the expanding availability of the procedure, a U.K. law prohibits female genital surgeries for cultural or nontherapeutic reasons, even on adult women.

Thus far, Dr. Creighton said, no lawsuit has challenged the legality of the procedure, which some NHS trusts offer on the grounds of alleviating psychological distress.

"There are no guidelines. The NHS is not publicly discussing it," Dr. Creighton said, adding that professional surgical associations have not issued clear guidelines for treating women seeking labial surgery, leaving clinician discretion as the norm.

"National care standards are urgently needed," Dr. Creighton and colleagues wrote in their analysis. The investigators also urged the publication of data on normal labial measurements "based on a large adult general population sample stratified according to age, ethnicity and parity."

The study was funded by the Elizabeth Garrett Anderson Institute of Women’s Health at University College London. None of its authors declared conflicts of interest.

Women seeking genital surgery to reduce the size of their labia minora do not have large or misshapen labia, and also tend to be relatively young, a small U.K. study has found.

Of the 33 women in the prospective study, published Aug. 24 in BJOG, 30 had labia with dimensions within the normal published limits, yet sought surgery anyway. The women’s average age was 23 years, although a quarter were 16 years or younger, with the youngest being 11 years old.

This points to the psychological or cultural appeal of cosmetic genital surgery among young women and girls, the study’s authors say, which may be influenced by grooming trends that expose the vulva – two-thirds of women in the study had removed their pubic hair – and by widespread advertising of the surgical procedures using before-and-after photos, which about one-third of subjects reported having consulted (BJOG 2011 Aug. 24 [doi:10.1111/j.1471-0528.2011.03088.x]).

"We noticed that more young women were coming in saying, ‘we’re not normal,’ " said Dr. Sarah Creighton, a gynecologist at University College London’s Elizabeth Garrett Anderson Institute of Women’s Health and the corresponding author of the study, in an interview. "And yet there is little information about what is normal."

For their research, Dr. Creighton and colleagues at a London hospital clinic (which performs the surgeries on women whose genitalia are outside normal measures) interviewed women referred to them by primary care physicians. Two-thirds of the women seeking surgery identified themselves as students, only 15% had given birth, and two-thirds reported being single. Most (84%) were white.

The women did not appear to be guided by sexual concerns, as a majority (61%) reported having never been sexually active.

Dr. Creighton and colleagues interviewed the women on their reasons for seeking surgery, and found that most (78%) were motivated by concerns about the appearance of their genitals. Although discomfort, such as that caused by rubbing or chafing, was reported by 57% of them, only 18% said that they thought surgery would help.

The investigators also measured the women’s labia, finding all but three to be within normal published limits, with a mean (SD) of 26.9 (12.8) mm on the right side, and 24.8 (13.1) mm on the left. Surgeries were offered only to those women whose labia were outside that range.

The investigators were surprised, they wrote, to find "that all of the study participants and their referring doctors should have felt that surgery was an appropriate treatment," when the women’s labia were normal. Moreover, 40% of the 30 participants who were denied surgery by the clinic "remained keen to pursue surgery by any other available route."

About 2,000 women now receive the surgeries every year through NHS clinics, a fivefold increase from a decade ago, Dr. Creighton and colleagues noted, with privately performed procedures likely accounting for a far greater number. Yet despite the expanding availability of the procedure, a U.K. law prohibits female genital surgeries for cultural or nontherapeutic reasons, even on adult women.

Thus far, Dr. Creighton said, no lawsuit has challenged the legality of the procedure, which some NHS trusts offer on the grounds of alleviating psychological distress.

"There are no guidelines. The NHS is not publicly discussing it," Dr. Creighton said, adding that professional surgical associations have not issued clear guidelines for treating women seeking labial surgery, leaving clinician discretion as the norm.

"National care standards are urgently needed," Dr. Creighton and colleagues wrote in their analysis. The investigators also urged the publication of data on normal labial measurements "based on a large adult general population sample stratified according to age, ethnicity and parity."

The study was funded by the Elizabeth Garrett Anderson Institute of Women’s Health at University College London. None of its authors declared conflicts of interest.