Aesthetic Dermatology

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.

She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.

Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.

Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.

Be mindful of trends, and use Leonardo's classic proportions as a guide.

Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.

To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.

She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:

• Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
• Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
• Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.

"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.

During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.

When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.

Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.

Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.

The Zerona laser looks a little bit like the villainous martian tripods in “War of the Worlds,” but rather than blasting your entire body into charbroiled atoms, its four laser arms melt away excess fat.

And instead of a strong-armed surgeon and his trusty cannula removing the leftovers, macrophages do the dirty work, sucking down a liquid lipid orgy of burgers and fries. 
 
Company-sponsored data supports the notion that it works, according to Ryan Maloney, Ph.D. Dr. Maloney is a patent holder on the 635-nm laser and medical director of Erchonia, manufacturer of the laser.  He presented the recently published data at the annual meeting of the American Association of Cosmetic Surgery.
 
The sham-controlled study included 67 patients, none of which were obese. Many were just right at the overweight line, with a mean body mass index of 26 kg/m2. Still, after six 40-minute treatments, 22 of the 35 active patients met the criteria for success (a mean combined loss of at least 3 inches in circumference from the waist, hip, and thighs). Only two patients in the sham group had comparable results (Laser Surg. Med. 2009;799-809). 

The program didn’t include any special diet or exercise recommendations. Dr. Maloney, and the representatives at the Zerona exhibit booth, claimed the weight lost was a direct result of laser exposure. They showed photo micrographs of its effect on human fat cells. Before treatment, the round little globules were taught and tightly filled with lipids. After exposure, they looked like popped party balloons, wrinkled and collapsed, all their fatty filling leaked away.
 
How was this accomplished? In vivo studies show that the short wavelength laser creates a transient pore in the cell membrane. The contents disperse outward into the interstitial space and the immune system takes over, Dr. Maloney said. None of the patients have shown any related increase in blood lipids, he added.
 
The concept might not be as far-fetched as it seems. Laser-assisted liposuction (LAL) has been around for a few years now. The dual-headed instrument slips under and over the skin, with a laser above and a suction cannula below. The laser deposits its heat energy in the adipose layer—sparing the skin—and the cannula pierces and sucks out the liquified fat. The difference here is that LAL destroys the adipocyte. Zerona supposedly leaves it alive and, thus, the cells are capable of reinflating if patients tank up on goodies (or decline the repeat treatments urged on the Zerona Web site).
 
What’s the bottom line? Zerona is the first treatment to claim total noninvasive weight loss—other than shutting your mouth to that second piece of pie.
 
Michele G. Sullivan
Mid-Atlantic Bureau

_{Photo courtesy Zerona via www.myzerona.com}

The Zerona laser looks a little bit like the villainous martian tripods in “War of the Worlds,” but rather than blasting your entire body into charbroiled atoms, its four laser arms melt away excess fat.

And instead of a strong-armed surgeon and his trusty cannula removing the leftovers, macrophages do the dirty work, sucking down a liquid lipid orgy of burgers and fries. 
 
Company-sponsored data supports the notion that it works, according to Ryan Maloney, Ph.D. Dr. Maloney is a patent holder on the 635-nm laser and medical director of Erchonia, manufacturer of the laser.  He presented the recently published data at the annual meeting of the American Association of Cosmetic Surgery.
 
The sham-controlled study included 67 patients, none of which were obese. Many were just right at the overweight line, with a mean body mass index of 26 kg/m2. Still, after six 40-minute treatments, 22 of the 35 active patients met the criteria for success (a mean combined loss of at least 3 inches in circumference from the waist, hip, and thighs). Only two patients in the sham group had comparable results (Laser Surg. Med. 2009;799-809). 

The program didn’t include any special diet or exercise recommendations. Dr. Maloney, and the representatives at the Zerona exhibit booth, claimed the weight lost was a direct result of laser exposure. They showed photo micrographs of its effect on human fat cells. Before treatment, the round little globules were taught and tightly filled with lipids. After exposure, they looked like popped party balloons, wrinkled and collapsed, all their fatty filling leaked away.
 
How was this accomplished? In vivo studies show that the short wavelength laser creates a transient pore in the cell membrane. The contents disperse outward into the interstitial space and the immune system takes over, Dr. Maloney said. None of the patients have shown any related increase in blood lipids, he added.
 
The concept might not be as far-fetched as it seems. Laser-assisted liposuction (LAL) has been around for a few years now. The dual-headed instrument slips under and over the skin, with a laser above and a suction cannula below. The laser deposits its heat energy in the adipose layer—sparing the skin—and the cannula pierces and sucks out the liquified fat. The difference here is that LAL destroys the adipocyte. Zerona supposedly leaves it alive and, thus, the cells are capable of reinflating if patients tank up on goodies (or decline the repeat treatments urged on the Zerona Web site).
 
What’s the bottom line? Zerona is the first treatment to claim total noninvasive weight loss—other than shutting your mouth to that second piece of pie.
 
Michele G. Sullivan
Mid-Atlantic Bureau

_{Photo courtesy Zerona via www.myzerona.com}

The Zerona laser looks a little bit like the villainous martian tripods in “War of the Worlds,” but rather than blasting your entire body into charbroiled atoms, its four laser arms melt away excess fat.

And instead of a strong-armed surgeon and his trusty cannula removing the leftovers, macrophages do the dirty work, sucking down a liquid lipid orgy of burgers and fries. 
 
Company-sponsored data supports the notion that it works, according to Ryan Maloney, Ph.D. Dr. Maloney is a patent holder on the 635-nm laser and medical director of Erchonia, manufacturer of the laser.  He presented the recently published data at the annual meeting of the American Association of Cosmetic Surgery.
 
The sham-controlled study included 67 patients, none of which were obese. Many were just right at the overweight line, with a mean body mass index of 26 kg/m2. Still, after six 40-minute treatments, 22 of the 35 active patients met the criteria for success (a mean combined loss of at least 3 inches in circumference from the waist, hip, and thighs). Only two patients in the sham group had comparable results (Laser Surg. Med. 2009;799-809). 

The program didn’t include any special diet or exercise recommendations. Dr. Maloney, and the representatives at the Zerona exhibit booth, claimed the weight lost was a direct result of laser exposure. They showed photo micrographs of its effect on human fat cells. Before treatment, the round little globules were taught and tightly filled with lipids. After exposure, they looked like popped party balloons, wrinkled and collapsed, all their fatty filling leaked away.
 
How was this accomplished? In vivo studies show that the short wavelength laser creates a transient pore in the cell membrane. The contents disperse outward into the interstitial space and the immune system takes over, Dr. Maloney said. None of the patients have shown any related increase in blood lipids, he added.
 
The concept might not be as far-fetched as it seems. Laser-assisted liposuction (LAL) has been around for a few years now. The dual-headed instrument slips under and over the skin, with a laser above and a suction cannula below. The laser deposits its heat energy in the adipose layer—sparing the skin—and the cannula pierces and sucks out the liquified fat. The difference here is that LAL destroys the adipocyte. Zerona supposedly leaves it alive and, thus, the cells are capable of reinflating if patients tank up on goodies (or decline the repeat treatments urged on the Zerona Web site).
 
What’s the bottom line? Zerona is the first treatment to claim total noninvasive weight loss—other than shutting your mouth to that second piece of pie.
 
Michele G. Sullivan
Mid-Atlantic Bureau

_{Photo courtesy Zerona via www.myzerona.com}

Injectable silicone has taken a public beating recently, blamed for everything from “trout pout” to death.

But the compound—and using it off label for cosmetic purposes—shouldn’t be sliding down a slippery slope into oblivion, Dr. Jay G. Barnett told a packed audience yesterday at the annual meeting of the American Academy of Cosmetic Surgery, in Orlando.

Liquid silicone is an enormously effective facial filler, he said, with the ability to permanently smooth out wrinkles, normalize the look of disease-related facial atrophy, and virtually erase scarring.

“As a physician, using silicone to treat scars is my reason d’etre,” said Dr. Barnett, showing immediate post-procedure photos of a patient with tears of gratitude in her eyes. “I get a lot of hugs and kisses.”

A dermatologist in New York City, Dr. Barnett claimed to have treated thousands of patients with microdroplet injections—usually less than a single cc—with not a single complication. Photos showed scars and other defects smoothed in minutes, and patients still looking good after 30 years.

His presentation obviously struck a chord. As soon as he stepped off the platform, Dr. Barnett was handing out cards to a dozen eager fans. But he apparently didn’t win all hearts and minds. During the panel discussion, Dr. Barnett fielded several hardballs from physicians whose silicone stories didn’t have quite so rosy an ending.

One said she had used the compound on two patients, both of whom developed granulomas that had to be surgically excised. Another told of desperate women coming to her with “plum-sized lumps” after attending parties where quasi-health professionals injected them with what they claimed to be medical-grade liquid silicone.

Dr. Barnett was apparently no stranger to their angst—or his own.  “For years, I’ve felt responsible and guilty over every negative story about silicone,” he said. “I can only go by what has happened to me. I’ve done 15,000-20,000 of these over 40 years with no complications, and I cannot be responsible for the rest of the world.”

What do you think? Can liquid silicone be safely used as facial filler? Or should dermatologists stick to the products that have been specifically approved for this purpose?

Michele G. Sullivan
Mid-Atlantic Bureau

Injectable silicone has taken a public beating recently, blamed for everything from “trout pout” to death.

But the compound—and using it off label for cosmetic purposes—shouldn’t be sliding down a slippery slope into oblivion, Dr. Jay G. Barnett told a packed audience yesterday at the annual meeting of the American Academy of Cosmetic Surgery, in Orlando.

Liquid silicone is an enormously effective facial filler, he said, with the ability to permanently smooth out wrinkles, normalize the look of disease-related facial atrophy, and virtually erase scarring.

“As a physician, using silicone to treat scars is my reason d’etre,” said Dr. Barnett, showing immediate post-procedure photos of a patient with tears of gratitude in her eyes. “I get a lot of hugs and kisses.”

A dermatologist in New York City, Dr. Barnett claimed to have treated thousands of patients with microdroplet injections—usually less than a single cc—with not a single complication. Photos showed scars and other defects smoothed in minutes, and patients still looking good after 30 years.

His presentation obviously struck a chord. As soon as he stepped off the platform, Dr. Barnett was handing out cards to a dozen eager fans. But he apparently didn’t win all hearts and minds. During the panel discussion, Dr. Barnett fielded several hardballs from physicians whose silicone stories didn’t have quite so rosy an ending.

One said she had used the compound on two patients, both of whom developed granulomas that had to be surgically excised. Another told of desperate women coming to her with “plum-sized lumps” after attending parties where quasi-health professionals injected them with what they claimed to be medical-grade liquid silicone.

Dr. Barnett was apparently no stranger to their angst—or his own.  “For years, I’ve felt responsible and guilty over every negative story about silicone,” he said. “I can only go by what has happened to me. I’ve done 15,000-20,000 of these over 40 years with no complications, and I cannot be responsible for the rest of the world.”

What do you think? Can liquid silicone be safely used as facial filler? Or should dermatologists stick to the products that have been specifically approved for this purpose?

Michele G. Sullivan
Mid-Atlantic Bureau

Injectable silicone has taken a public beating recently, blamed for everything from “trout pout” to death.

But the compound—and using it off label for cosmetic purposes—shouldn’t be sliding down a slippery slope into oblivion, Dr. Jay G. Barnett told a packed audience yesterday at the annual meeting of the American Academy of Cosmetic Surgery, in Orlando.

Liquid silicone is an enormously effective facial filler, he said, with the ability to permanently smooth out wrinkles, normalize the look of disease-related facial atrophy, and virtually erase scarring.

“As a physician, using silicone to treat scars is my reason d’etre,” said Dr. Barnett, showing immediate post-procedure photos of a patient with tears of gratitude in her eyes. “I get a lot of hugs and kisses.”

A dermatologist in New York City, Dr. Barnett claimed to have treated thousands of patients with microdroplet injections—usually less than a single cc—with not a single complication. Photos showed scars and other defects smoothed in minutes, and patients still looking good after 30 years.

His presentation obviously struck a chord. As soon as he stepped off the platform, Dr. Barnett was handing out cards to a dozen eager fans. But he apparently didn’t win all hearts and minds. During the panel discussion, Dr. Barnett fielded several hardballs from physicians whose silicone stories didn’t have quite so rosy an ending.

One said she had used the compound on two patients, both of whom developed granulomas that had to be surgically excised. Another told of desperate women coming to her with “plum-sized lumps” after attending parties where quasi-health professionals injected them with what they claimed to be medical-grade liquid silicone.

Dr. Barnett was apparently no stranger to their angst—or his own.  “For years, I’ve felt responsible and guilty over every negative story about silicone,” he said. “I can only go by what has happened to me. I’ve done 15,000-20,000 of these over 40 years with no complications, and I cannot be responsible for the rest of the world.”

What do you think? Can liquid silicone be safely used as facial filler? Or should dermatologists stick to the products that have been specifically approved for this purpose?

Michele G. Sullivan
Mid-Atlantic Bureau

Whether it be botulinum toxin, a new drug, or a miracle wrinkle cream, we've all heard clinical investigators tout "their" investigational product as the next best thing since penicillin at medical meetings--usually with full disclosure. I'll also bet that you can recall a number of instances where you've turned on the T.V. or radio to hear physicians promoting an investigational drug or device they are intimately connected to.
 
So does the Jan. 11 Division of Drug Marketing, Advertising, and Communications' letter to Dr. Leslie S. Baumann signify an FDA crackdown? 
 
The agency cited Dr. Baumann for suggesting that Ipsen's Dysport (abobotulinumA) is superior to Allergan's Botox (onabotulinumtoxinA) in Allure and Elle magazine, and on the "Today Show" on NBC before the approval of Dysport. The letter said that Dr. Baumann suggested that Dysport was "safe and effective before it was approved, and that it was in fact superior to the approved product Botox." According to the FDA, no head-to-head trials of Botox to Dysport have been conducted to assess this.
 
Dr. Baumann became a clinical investigator for Dysport in July 2006, according to the FDA letter. While she was a trial investigator, she made one such comment to Allure: "Reloxin, the new Botox, will likely come out later this year. Early data show it may last longer and kick in faster than Botox."
 
This, according to the FDA, was a promotion of an unapproved drug, and against regulations that state "A sponsor or investigator ... shall not represent in a promotional context that an investigational new drug is safe and effective for the purposes for which it is under investigation or otherwise promote the drug."
 
Dr. Baumann was given 10 business days from the receipt of the letter to inform the FDA of the actions she plans to take to "prevent similar violations in the future."
 
I spoke with Dr. Baumann, a Skin & Allergy News editorial advisory board member and columnist, today about this matter, but she was unable to comment for now. UPDATE: Dr. Baumann addressed the FDA letter on her blog at Skin Type Solutions on Feb. 1.

She is in private practice in Miami, but was with the University of Miami when she conducted the clinical trials for Medicis. (Ipsen granted Medicis Pharma the rights to develop, distribute, and commercialize Dysport.)
 
This is another example of why clinical trial investigators should disclose, disclose, disclose! The bottom line: don't promote until approved!

Whether it be botulinum toxin, a new drug, or a miracle wrinkle cream, we've all heard clinical investigators tout "their" investigational product as the next best thing since penicillin at medical meetings--usually with full disclosure. I'll also bet that you can recall a number of instances where you've turned on the T.V. or radio to hear physicians promoting an investigational drug or device they are intimately connected to.
 
So does the Jan. 11 Division of Drug Marketing, Advertising, and Communications' letter to Dr. Leslie S. Baumann signify an FDA crackdown? 
 
The agency cited Dr. Baumann for suggesting that Ipsen's Dysport (abobotulinumA) is superior to Allergan's Botox (onabotulinumtoxinA) in Allure and Elle magazine, and on the "Today Show" on NBC before the approval of Dysport. The letter said that Dr. Baumann suggested that Dysport was "safe and effective before it was approved, and that it was in fact superior to the approved product Botox." According to the FDA, no head-to-head trials of Botox to Dysport have been conducted to assess this.
 
Dr. Baumann became a clinical investigator for Dysport in July 2006, according to the FDA letter. While she was a trial investigator, she made one such comment to Allure: "Reloxin, the new Botox, will likely come out later this year. Early data show it may last longer and kick in faster than Botox."
 
This, according to the FDA, was a promotion of an unapproved drug, and against regulations that state "A sponsor or investigator ... shall not represent in a promotional context that an investigational new drug is safe and effective for the purposes for which it is under investigation or otherwise promote the drug."
 
Dr. Baumann was given 10 business days from the receipt of the letter to inform the FDA of the actions she plans to take to "prevent similar violations in the future."
 
I spoke with Dr. Baumann, a Skin & Allergy News editorial advisory board member and columnist, today about this matter, but she was unable to comment for now. UPDATE: Dr. Baumann addressed the FDA letter on her blog at Skin Type Solutions on Feb. 1.

She is in private practice in Miami, but was with the University of Miami when she conducted the clinical trials for Medicis. (Ipsen granted Medicis Pharma the rights to develop, distribute, and commercialize Dysport.)
 
This is another example of why clinical trial investigators should disclose, disclose, disclose! The bottom line: don't promote until approved!

Whether it be botulinum toxin, a new drug, or a miracle wrinkle cream, we've all heard clinical investigators tout "their" investigational product as the next best thing since penicillin at medical meetings--usually with full disclosure. I'll also bet that you can recall a number of instances where you've turned on the T.V. or radio to hear physicians promoting an investigational drug or device they are intimately connected to.
 
So does the Jan. 11 Division of Drug Marketing, Advertising, and Communications' letter to Dr. Leslie S. Baumann signify an FDA crackdown? 
 
The agency cited Dr. Baumann for suggesting that Ipsen's Dysport (abobotulinumA) is superior to Allergan's Botox (onabotulinumtoxinA) in Allure and Elle magazine, and on the "Today Show" on NBC before the approval of Dysport. The letter said that Dr. Baumann suggested that Dysport was "safe and effective before it was approved, and that it was in fact superior to the approved product Botox." According to the FDA, no head-to-head trials of Botox to Dysport have been conducted to assess this.
 
Dr. Baumann became a clinical investigator for Dysport in July 2006, according to the FDA letter. While she was a trial investigator, she made one such comment to Allure: "Reloxin, the new Botox, will likely come out later this year. Early data show it may last longer and kick in faster than Botox."
 
This, according to the FDA, was a promotion of an unapproved drug, and against regulations that state "A sponsor or investigator ... shall not represent in a promotional context that an investigational new drug is safe and effective for the purposes for which it is under investigation or otherwise promote the drug."
 
Dr. Baumann was given 10 business days from the receipt of the letter to inform the FDA of the actions she plans to take to "prevent similar violations in the future."
 
I spoke with Dr. Baumann, a Skin & Allergy News editorial advisory board member and columnist, today about this matter, but she was unable to comment for now. UPDATE: Dr. Baumann addressed the FDA letter on her blog at Skin Type Solutions on Feb. 1.

She is in private practice in Miami, but was with the University of Miami when she conducted the clinical trials for Medicis. (Ipsen granted Medicis Pharma the rights to develop, distribute, and commercialize Dysport.)
 
This is another example of why clinical trial investigators should disclose, disclose, disclose! The bottom line: don't promote until approved!

 Before I arrived at the ODAC, I blogged about how and whether the current recession might impact aesthetic dermatology. I’m not sure I have an answer, but based on the attendance at this meeting, dermatologists’ interest in aesthetic procedures is booming.

The speakers are playing to a packed ballroom—even the front row was full! Some attendees were sitting in extra chairs lined up along the wall, and some were sitting on the floor. I haven’t confirmed these numbers, but I heard that the conference organizers were originally expecting between 200 and 300 attendees, and the total is closer to 400.

Even at the end of a long day that was running late, I’d say at least two-thirds of the crowd resisted going to the happy hour in the exhibit hall (just on the other side of the curtain, so you could hear the glasses clinking) to watch the live demonstration on facial shaping with fillers. One of the presenters actually had to tell us to go and visit the exhibitors as they finished up with the volunteer patient onstage.

Are more dermatologists looking to add aesthetics to their practices to boost business during a recession? Or, as I suggested in my previous post, are they getting more demand for aesthetic procedures from job-hunting patients?

Whether either or both of these things are true, interest in aesthetic dermatology looks healthy from where I sat. (I felt lucky to get a chair)

Heidi Splete (on Twitter @hsplete)
Senior Writer

 Before I arrived at the ODAC, I blogged about how and whether the current recession might impact aesthetic dermatology. I’m not sure I have an answer, but based on the attendance at this meeting, dermatologists’ interest in aesthetic procedures is booming.

The speakers are playing to a packed ballroom—even the front row was full! Some attendees were sitting in extra chairs lined up along the wall, and some were sitting on the floor. I haven’t confirmed these numbers, but I heard that the conference organizers were originally expecting between 200 and 300 attendees, and the total is closer to 400.

Even at the end of a long day that was running late, I’d say at least two-thirds of the crowd resisted going to the happy hour in the exhibit hall (just on the other side of the curtain, so you could hear the glasses clinking) to watch the live demonstration on facial shaping with fillers. One of the presenters actually had to tell us to go and visit the exhibitors as they finished up with the volunteer patient onstage.

Are more dermatologists looking to add aesthetics to their practices to boost business during a recession? Or, as I suggested in my previous post, are they getting more demand for aesthetic procedures from job-hunting patients?

Whether either or both of these things are true, interest in aesthetic dermatology looks healthy from where I sat. (I felt lucky to get a chair)

Heidi Splete (on Twitter @hsplete)
Senior Writer

 Before I arrived at the ODAC, I blogged about how and whether the current recession might impact aesthetic dermatology. I’m not sure I have an answer, but based on the attendance at this meeting, dermatologists’ interest in aesthetic procedures is booming.

The speakers are playing to a packed ballroom—even the front row was full! Some attendees were sitting in extra chairs lined up along the wall, and some were sitting on the floor. I haven’t confirmed these numbers, but I heard that the conference organizers were originally expecting between 200 and 300 attendees, and the total is closer to 400.

Even at the end of a long day that was running late, I’d say at least two-thirds of the crowd resisted going to the happy hour in the exhibit hall (just on the other side of the curtain, so you could hear the glasses clinking) to watch the live demonstration on facial shaping with fillers. One of the presenters actually had to tell us to go and visit the exhibitors as they finished up with the volunteer patient onstage.

Are more dermatologists looking to add aesthetics to their practices to boost business during a recession? Or, as I suggested in my previous post, are they getting more demand for aesthetic procedures from job-hunting patients?

Whether either or both of these things are true, interest in aesthetic dermatology looks healthy from where I sat. (I felt lucky to get a chair)

Heidi Splete (on Twitter @hsplete)
Senior Writer

Many products that tout antioxidant activity include antioxidant ingredients that contain polyphenols. There are numerous classes of polyphenols, which are the largest group of phytochemicals and the most broadly disseminated among plants (J. Am. Diet. Assoc. 1999;99:213-8). They are secondary plant metabolites represented by more than 8,000 naturally occurring compounds.

These widely divergent substances, which exhibit various levels of antioxidant activity, share a common structural component: a phenol or an aromatic ring, usually two, with at least one hydroxyl group, that are linked via a three-carbon bond to form a six-unit heterocyclic ring (J. Nutr. 2003;133:3248S-54S).

Attention has been increasingly focused on polyphenols, as they are known to be an important part of, and the most abundant source of antioxidants in, the human diet. They are present in many vegetables, fruits, herbs, grains, teas, and beans, as well as coffee, propolis, and red wine (Biomed. Pap. Med. Fac. Univ. Palacky Olomouc. Czech Repub. 2003;147:137-45; J. Nutr. 2000;130:2073S-85S; Annu. Rev. Nutr. 2002;22:19-34; Pharmacol. Ther. 2001;90:157-77; Free Radic. Biol. Med. 2001;30:1213-22).

The most prevalent and frequently studied polyphenols are known as flavonoids. Based on the connection of an aromatic ring to the heterocyclic ring, as well as the oxidation state and functional groups of the heterocyclic ring, flavonoids are further divided into flavones (based on the 2-phenylchromen-4-one skeleton, e.g., apigenin and luteolin); flavonols (based on the 3-hydroxy-2-phenylchromen-4-one skeleton and functional group, e.g., quercetin, kaempferol, myricetin, and fisetin); flavanones (based on the 2,3-dihydro-2-phenylchromen-4-one skeleton and functional group, e.g., naringenin, hesperetin, and eriodictyol); isoflavones (based on the 3-phenylchromen-4-one skeleton, e.g., genistein and daidzein); flavanols or catechins (based on the 2-phenyl-3,4-dihydro-2H-chromen-3-ol skeleton and functional groups, e.g., epicatechin, epicatechin 3-gallate, epigallocatechin, epigallocatechin 3-gallate (EGCG), catechin, gallocatechin); anthocyanins (based on the 2-phenylchromenylium ion skeleton, e.g., cyanidin and pelargonidin); and proanthocyanidins or condensed tannins (which are polymer chains of flavanols, such as catechins, and include pycnogenol, leukocyanidin, and leucoanthocyanidin) (Annu. Rev. Nutr. 2002;22:19-34; Asia Pac. J. Clin. Nutr. 2004;13:S72; J. Nutr. 2000;130:2073S-85S; J. Nutr. 2003;133:3248S-54S).
Tannins, phenolic polymers of high molecular weight, are divided into three classes: hydrolyzable tannins (e.g., ellagic acid, found in pomegranates, raspberries, strawberries, cranberries, and walnuts), derived tannins (created during food handling and processing and present in black and oolong teas), and condensed tannins, described above (J. Am. Diet. Assoc. 1999;99:213-8; J. Nutr. 2003;133:3248S-54S).

Some specific flavonoids can be found in the following food sources: flavonols in apples with skin, broccoli, olives, onions, and green and black tea; flavones in celery and parsley; flavonones in grapefruit, oranges, and their juices; and catechins (flavanols) in apples with or without skin, dark chocolate, cocoa, red wine, and green and black tea (Asia Pac. J. Clin. Nutr. 2004;13:S72).

There are a plethora of other polyphenols, many of which confer health benefits, including stilbenes (e.g., resveratrol, found in red wine), lignans (e.g., enterodiol, found in flaxseed and flaxseed oil), and phenolic acids, such as hydroxybenzoic and hydroxycinnamic acids, among which caffeic and ferulic acids are often present in foods.

Broad health benefits have been associated with hundreds of polyphenolic substances. Notably, some of the best known research results on polyphenols have reported on the success of various topical applications of green tea catechins, ferulic acid, resveratrol, and other related compounds (many of which have been addressed in this column). The rest of this discussion focuses on new information regarding systemic efficacy, topical delivery, or applications of a representative from several subclasses of these compounds.

Flavonols: Quercetin
A water-in-oil microemulsion containing quercetin has been shown, in porcine skin in vitro and hairless mouse skin in vivo, to enhance the penetration of the flavonol into the stratum corneum, epidermis, and dermis. The preparation also was found to significantly inhibit ultraviolet B (UVB)-induced metalloproteinase activity and glutathione reduction (Eur. J. Pharm. Biopharm. 2008;69:948-57).

Flavones: Apigenin
The topical application of 4',5,7-trihydroxyflavone (apigenin) on mouse skin has been shown to decrease skin tumor size and incidence induced by UVB exposure (Cancer Res. 2008:68:3057-65). In a different study, the apigenin glycosides 7-O-glucuronide, 7-O-methylglucuronide, and pectolinarin also have been demonstrated to induce collagen type I synthesis in fibroblasts. The investigators found that all tested compounds promoted the activity of prolidase, which initiates the last stage of collagen degradation and is integral to collagen production (Int. J. Mol. Med. 2007;20:889-95).

Flavonones: Naringenin
The citrus flavonone naringenin shows promise as a preventive agent against cutaneous aging as well as carcinogenesis. Naringenin has been demonstrated to exert an antiapoptotic effect in UVB-damaged cells, significantly extending long-term cellular survival, and to facilitate the removal of cyclobutane pyrimidine dimers from the genome (Photochem. Photobiol. 2008;84:307-16).

 

Isoflavones: Red Clover, Genistein, and Daidzein
Recently, red clover, whose isoflavones had previously been shown to contribute to a low incidence of osteoporosis and menopausal symptoms in high dietary concentrations, was examined for anti-aging effects. Investigators orally administered red clover extract containing 11% isoflavones to ovariectomized rats for 14 weeks, and found that collagen levels increased significantly in the treatment group as compared to the control group. Epidermal thickness and keratinization were normal in the treated group, but were reduced in the control group. The authors concluded that the regular dietary consumption of red clover isoflavones can alleviate cutaneous aging brought on by declines in estrogen (Phytother. Res. 2006;20:1096-9).

In a recent study evaluating the feasibility of skin absorption of the soy isoflavones genistein, daidzein, and glycitein, both genistein and daidzein inhibited UVB-induced hydrogen peroxide synthesis in keratinocytes. Analysis of vehicle effects on in vitro topical delivery revealed that genistein showed better skin absorption than daidzein. The investigators concluded that the topical application of soy isoflavones shows promise as a treatment for photoaging and photodamage (Int. J. Pharm. 2008;364:36-44).

Indeed, the topical application of isoflavones, including genistein and daidzein, has been shown to protect pig skin from photodamage caused by solar-simulated ultraviolet irradiation. Notably, the isoflavone compounds tested were less effective than a topical antioxidant formulation containing vitamins C and E and the phenolic acid ferulic acid (Photodermatol. Photoimmunol. Photomed. 2008;24:61-6).

Catechins (Flavanols): Epigallocatechin 3-gallate
Already considered a potent antioxidant, EGCG continues to receive attention for conferring an expanding range of health benefits. This compound, the most abundant and potent catechin in green tea, has been shown to hinder UVB-induced collagen-degrading matrix metalloproteinases (Food Chem. Toxicol. 2008;46:1298-307).

A different study of EGCG indicated that it hampered the proliferation and migration of keloid fibroblasts in vitro, and also curbed in vivo signs of keloids, by interrupting the signal transducer and activator of the transcription-3 signaling pathway. As a result of these findings, the investigators proposed EGCG as a preventive and therapeutic agent for keloids (J. Invest. Dermatol. 2008;128:2429-41). EGCG also has been suggested as a potential therapeutic approach to atopic dermatitis, given its success against AD-like skin lesions in a murine model (Int. Immunopharmacol. 2008;8:1172-82).

Anthocyanins: Cyanidin
Clearly, all flavonoids are not equal. In a recent study, methanol extracts of black raspberries, strawberries, and blueberries were tested for their capacity to inhibit UV-induced activation of nuclear transcription factor-kappa B (NF-kappaB) and activator protein-1 (AP-1) in mouse epidermal cells. The methanol fractions of black raspberries, which contain the anthocyanin cyanidin 3-rutinoside, were found to time- and dose-dependently inhibit the effects of UV on NF-kappaB and AP-1, unlike the other berries, which do not contain cyanidin 3-rutinoside (Nutr. Cancer 2007;58:205-12).

Another form of cyanidin has also been shown to impart cutaneous benefits. Specifically, pretreatment of human keratinocytes with the anthocyanin cyanidin 3-O-glucoside has been demonstrated to protect against a wide array of UVB-induced damage (J. Agric. Food Chem. 2006;54:4041-7).

Proanthocyanidins: Pycnogenol
Investigators studied pycnogenol in an antioxidant mixture that also included evening primrose and vitamins C and E. After 10 weeks of oral administration to female SKH-1 hairless mice exposed to UVB irradiation three times weekly, the mixture was found to significantly inhibit wrinkle formation by suppressing UVB-induced matrix metalloproteinase activity while promoting collagen production (Photodermatol. Photoimmunol. Photomed. 2007;23:155-62).

Tannins: Ellagic Acid
In a double-blind, placebo-controlled, 4-week trial, investigators assessed the effects of orally administered ellagic acid-rich pomegranate extract on the pigmentation of 13 women after UV exposure. Healthy volunteers were randomly assigned to high-dose, low-dose, and control groups. The results showed that luminance values decreased by 1.73% in the high-dose group and 1.35% in the low-dose group, compared with the control group, and stains and freckles also were diminished (J. Nutr. Sci. Vitaminol. (Tokyo) 2006;52:383-8).

Stilbenes: Resveratrol
The antioxidant potency of resveratrol has been cited for conferring a wide range of salutary effects, including antitumorigenic and antiaging activity. Recently, a resveratrol-based skin care formulation intended to combat photoaging was reported to exhibit 17-fold greater antioxidant activity than idebenone (J. Cosmet. Dermatol. 2008;7:2-7). In a different study, resveratrol, the primary active polyphenolic constituent in red wine, was assessed in terms of topical/transdermal delivery viability, given the previously established benefits shown via systemic administration. Several hydrogel systems used as resveratrol vehicles were shown to be safe and effective methods for cutaneously delivering the therapeutic effects of this antioxidant (Biol. Pharm. Bull. 2008;31:955-62).

Phenolic Acids: Ferulic Acid
In a small study, a stable formulation of 15% L-corbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid was applied topically to normal-appearing human skin for 4 days, and was found to confer significant photoprotection against solar-simulated UV radiation. The preparation was especially effective at diminishing thymine dimer mutations, which are linked to skin cancer. The authors also noted that the mechanism of action of this antioxidant formulation differs from that of sunscreens and, therefore, may serve as a supplement to such products (J. Am. Acad. Dermatol. 2008;59:418-25). It is worth noting that ferulic acid has been approved as a sunscreen agent in Japan (J. Pharm. Biomed. Anal. 2008;46:645-52).

 

Conclusion
A brief survey of the polyphenolic landscape obviously cannot do the subject justice. That said, from the dermatologic perspective, it is simply worth noting how often this diverse family of compounds factors occur in to the skin care formulations that are becoming more prevalent in the established armamentarium as well as the direct-to-consumer market.

Given the increasing attention paid here and elsewhere to the impact of diet on the skin, the status of the diverse class of polyphenolic compounds found in a wide array of plants, which includes several antioxidants, appears to be well deserved and warrants much more research.

Many products that tout antioxidant activity include antioxidant ingredients that contain polyphenols. There are numerous classes of polyphenols, which are the largest group of phytochemicals and the most broadly disseminated among plants (J. Am. Diet. Assoc. 1999;99:213-8). They are secondary plant metabolites represented by more than 8,000 naturally occurring compounds.

These widely divergent substances, which exhibit various levels of antioxidant activity, share a common structural component: a phenol or an aromatic ring, usually two, with at least one hydroxyl group, that are linked via a three-carbon bond to form a six-unit heterocyclic ring (J. Nutr. 2003;133:3248S-54S).

Attention has been increasingly focused on polyphenols, as they are known to be an important part of, and the most abundant source of antioxidants in, the human diet. They are present in many vegetables, fruits, herbs, grains, teas, and beans, as well as coffee, propolis, and red wine (Biomed. Pap. Med. Fac. Univ. Palacky Olomouc. Czech Repub. 2003;147:137-45; J. Nutr. 2000;130:2073S-85S; Annu. Rev. Nutr. 2002;22:19-34; Pharmacol. Ther. 2001;90:157-77; Free Radic. Biol. Med. 2001;30:1213-22).

The most prevalent and frequently studied polyphenols are known as flavonoids. Based on the connection of an aromatic ring to the heterocyclic ring, as well as the oxidation state and functional groups of the heterocyclic ring, flavonoids are further divided into flavones (based on the 2-phenylchromen-4-one skeleton, e.g., apigenin and luteolin); flavonols (based on the 3-hydroxy-2-phenylchromen-4-one skeleton and functional group, e.g., quercetin, kaempferol, myricetin, and fisetin); flavanones (based on the 2,3-dihydro-2-phenylchromen-4-one skeleton and functional group, e.g., naringenin, hesperetin, and eriodictyol); isoflavones (based on the 3-phenylchromen-4-one skeleton, e.g., genistein and daidzein); flavanols or catechins (based on the 2-phenyl-3,4-dihydro-2H-chromen-3-ol skeleton and functional groups, e.g., epicatechin, epicatechin 3-gallate, epigallocatechin, epigallocatechin 3-gallate (EGCG), catechin, gallocatechin); anthocyanins (based on the 2-phenylchromenylium ion skeleton, e.g., cyanidin and pelargonidin); and proanthocyanidins or condensed tannins (which are polymer chains of flavanols, such as catechins, and include pycnogenol, leukocyanidin, and leucoanthocyanidin) (Annu. Rev. Nutr. 2002;22:19-34; Asia Pac. J. Clin. Nutr. 2004;13:S72; J. Nutr. 2000;130:2073S-85S; J. Nutr. 2003;133:3248S-54S).
Tannins, phenolic polymers of high molecular weight, are divided into three classes: hydrolyzable tannins (e.g., ellagic acid, found in pomegranates, raspberries, strawberries, cranberries, and walnuts), derived tannins (created during food handling and processing and present in black and oolong teas), and condensed tannins, described above (J. Am. Diet. Assoc. 1999;99:213-8; J. Nutr. 2003;133:3248S-54S).

Some specific flavonoids can be found in the following food sources: flavonols in apples with skin, broccoli, olives, onions, and green and black tea; flavones in celery and parsley; flavonones in grapefruit, oranges, and their juices; and catechins (flavanols) in apples with or without skin, dark chocolate, cocoa, red wine, and green and black tea (Asia Pac. J. Clin. Nutr. 2004;13:S72).

There are a plethora of other polyphenols, many of which confer health benefits, including stilbenes (e.g., resveratrol, found in red wine), lignans (e.g., enterodiol, found in flaxseed and flaxseed oil), and phenolic acids, such as hydroxybenzoic and hydroxycinnamic acids, among which caffeic and ferulic acids are often present in foods.

Broad health benefits have been associated with hundreds of polyphenolic substances. Notably, some of the best known research results on polyphenols have reported on the success of various topical applications of green tea catechins, ferulic acid, resveratrol, and other related compounds (many of which have been addressed in this column). The rest of this discussion focuses on new information regarding systemic efficacy, topical delivery, or applications of a representative from several subclasses of these compounds.

Flavonols: Quercetin
A water-in-oil microemulsion containing quercetin has been shown, in porcine skin in vitro and hairless mouse skin in vivo, to enhance the penetration of the flavonol into the stratum corneum, epidermis, and dermis. The preparation also was found to significantly inhibit ultraviolet B (UVB)-induced metalloproteinase activity and glutathione reduction (Eur. J. Pharm. Biopharm. 2008;69:948-57).

Flavones: Apigenin
The topical application of 4',5,7-trihydroxyflavone (apigenin) on mouse skin has been shown to decrease skin tumor size and incidence induced by UVB exposure (Cancer Res. 2008:68:3057-65). In a different study, the apigenin glycosides 7-O-glucuronide, 7-O-methylglucuronide, and pectolinarin also have been demonstrated to induce collagen type I synthesis in fibroblasts. The investigators found that all tested compounds promoted the activity of prolidase, which initiates the last stage of collagen degradation and is integral to collagen production (Int. J. Mol. Med. 2007;20:889-95).

Flavonones: Naringenin
The citrus flavonone naringenin shows promise as a preventive agent against cutaneous aging as well as carcinogenesis. Naringenin has been demonstrated to exert an antiapoptotic effect in UVB-damaged cells, significantly extending long-term cellular survival, and to facilitate the removal of cyclobutane pyrimidine dimers from the genome (Photochem. Photobiol. 2008;84:307-16).

 

Isoflavones: Red Clover, Genistein, and Daidzein
Recently, red clover, whose isoflavones had previously been shown to contribute to a low incidence of osteoporosis and menopausal symptoms in high dietary concentrations, was examined for anti-aging effects. Investigators orally administered red clover extract containing 11% isoflavones to ovariectomized rats for 14 weeks, and found that collagen levels increased significantly in the treatment group as compared to the control group. Epidermal thickness and keratinization were normal in the treated group, but were reduced in the control group. The authors concluded that the regular dietary consumption of red clover isoflavones can alleviate cutaneous aging brought on by declines in estrogen (Phytother. Res. 2006;20:1096-9).

In a recent study evaluating the feasibility of skin absorption of the soy isoflavones genistein, daidzein, and glycitein, both genistein and daidzein inhibited UVB-induced hydrogen peroxide synthesis in keratinocytes. Analysis of vehicle effects on in vitro topical delivery revealed that genistein showed better skin absorption than daidzein. The investigators concluded that the topical application of soy isoflavones shows promise as a treatment for photoaging and photodamage (Int. J. Pharm. 2008;364:36-44).

Indeed, the topical application of isoflavones, including genistein and daidzein, has been shown to protect pig skin from photodamage caused by solar-simulated ultraviolet irradiation. Notably, the isoflavone compounds tested were less effective than a topical antioxidant formulation containing vitamins C and E and the phenolic acid ferulic acid (Photodermatol. Photoimmunol. Photomed. 2008;24:61-6).

Catechins (Flavanols): Epigallocatechin 3-gallate
Already considered a potent antioxidant, EGCG continues to receive attention for conferring an expanding range of health benefits. This compound, the most abundant and potent catechin in green tea, has been shown to hinder UVB-induced collagen-degrading matrix metalloproteinases (Food Chem. Toxicol. 2008;46:1298-307).

A different study of EGCG indicated that it hampered the proliferation and migration of keloid fibroblasts in vitro, and also curbed in vivo signs of keloids, by interrupting the signal transducer and activator of the transcription-3 signaling pathway. As a result of these findings, the investigators proposed EGCG as a preventive and therapeutic agent for keloids (J. Invest. Dermatol. 2008;128:2429-41). EGCG also has been suggested as a potential therapeutic approach to atopic dermatitis, given its success against AD-like skin lesions in a murine model (Int. Immunopharmacol. 2008;8:1172-82).

Anthocyanins: Cyanidin
Clearly, all flavonoids are not equal. In a recent study, methanol extracts of black raspberries, strawberries, and blueberries were tested for their capacity to inhibit UV-induced activation of nuclear transcription factor-kappa B (NF-kappaB) and activator protein-1 (AP-1) in mouse epidermal cells. The methanol fractions of black raspberries, which contain the anthocyanin cyanidin 3-rutinoside, were found to time- and dose-dependently inhibit the effects of UV on NF-kappaB and AP-1, unlike the other berries, which do not contain cyanidin 3-rutinoside (Nutr. Cancer 2007;58:205-12).

Another form of cyanidin has also been shown to impart cutaneous benefits. Specifically, pretreatment of human keratinocytes with the anthocyanin cyanidin 3-O-glucoside has been demonstrated to protect against a wide array of UVB-induced damage (J. Agric. Food Chem. 2006;54:4041-7).

Proanthocyanidins: Pycnogenol
Investigators studied pycnogenol in an antioxidant mixture that also included evening primrose and vitamins C and E. After 10 weeks of oral administration to female SKH-1 hairless mice exposed to UVB irradiation three times weekly, the mixture was found to significantly inhibit wrinkle formation by suppressing UVB-induced matrix metalloproteinase activity while promoting collagen production (Photodermatol. Photoimmunol. Photomed. 2007;23:155-62).

Tannins: Ellagic Acid
In a double-blind, placebo-controlled, 4-week trial, investigators assessed the effects of orally administered ellagic acid-rich pomegranate extract on the pigmentation of 13 women after UV exposure. Healthy volunteers were randomly assigned to high-dose, low-dose, and control groups. The results showed that luminance values decreased by 1.73% in the high-dose group and 1.35% in the low-dose group, compared with the control group, and stains and freckles also were diminished (J. Nutr. Sci. Vitaminol. (Tokyo) 2006;52:383-8).

Stilbenes: Resveratrol
The antioxidant potency of resveratrol has been cited for conferring a wide range of salutary effects, including antitumorigenic and antiaging activity. Recently, a resveratrol-based skin care formulation intended to combat photoaging was reported to exhibit 17-fold greater antioxidant activity than idebenone (J. Cosmet. Dermatol. 2008;7:2-7). In a different study, resveratrol, the primary active polyphenolic constituent in red wine, was assessed in terms of topical/transdermal delivery viability, given the previously established benefits shown via systemic administration. Several hydrogel systems used as resveratrol vehicles were shown to be safe and effective methods for cutaneously delivering the therapeutic effects of this antioxidant (Biol. Pharm. Bull. 2008;31:955-62).

Phenolic Acids: Ferulic Acid
In a small study, a stable formulation of 15% L-corbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid was applied topically to normal-appearing human skin for 4 days, and was found to confer significant photoprotection against solar-simulated UV radiation. The preparation was especially effective at diminishing thymine dimer mutations, which are linked to skin cancer. The authors also noted that the mechanism of action of this antioxidant formulation differs from that of sunscreens and, therefore, may serve as a supplement to such products (J. Am. Acad. Dermatol. 2008;59:418-25). It is worth noting that ferulic acid has been approved as a sunscreen agent in Japan (J. Pharm. Biomed. Anal. 2008;46:645-52).

 

Conclusion
A brief survey of the polyphenolic landscape obviously cannot do the subject justice. That said, from the dermatologic perspective, it is simply worth noting how often this diverse family of compounds factors occur in to the skin care formulations that are becoming more prevalent in the established armamentarium as well as the direct-to-consumer market.

Given the increasing attention paid here and elsewhere to the impact of diet on the skin, the status of the diverse class of polyphenolic compounds found in a wide array of plants, which includes several antioxidants, appears to be well deserved and warrants much more research.

Many products that tout antioxidant activity include antioxidant ingredients that contain polyphenols. There are numerous classes of polyphenols, which are the largest group of phytochemicals and the most broadly disseminated among plants (J. Am. Diet. Assoc. 1999;99:213-8). They are secondary plant metabolites represented by more than 8,000 naturally occurring compounds.

These widely divergent substances, which exhibit various levels of antioxidant activity, share a common structural component: a phenol or an aromatic ring, usually two, with at least one hydroxyl group, that are linked via a three-carbon bond to form a six-unit heterocyclic ring (J. Nutr. 2003;133:3248S-54S).

Attention has been increasingly focused on polyphenols, as they are known to be an important part of, and the most abundant source of antioxidants in, the human diet. They are present in many vegetables, fruits, herbs, grains, teas, and beans, as well as coffee, propolis, and red wine (Biomed. Pap. Med. Fac. Univ. Palacky Olomouc. Czech Repub. 2003;147:137-45; J. Nutr. 2000;130:2073S-85S; Annu. Rev. Nutr. 2002;22:19-34; Pharmacol. Ther. 2001;90:157-77; Free Radic. Biol. Med. 2001;30:1213-22).

The most prevalent and frequently studied polyphenols are known as flavonoids. Based on the connection of an aromatic ring to the heterocyclic ring, as well as the oxidation state and functional groups of the heterocyclic ring, flavonoids are further divided into flavones (based on the 2-phenylchromen-4-one skeleton, e.g., apigenin and luteolin); flavonols (based on the 3-hydroxy-2-phenylchromen-4-one skeleton and functional group, e.g., quercetin, kaempferol, myricetin, and fisetin); flavanones (based on the 2,3-dihydro-2-phenylchromen-4-one skeleton and functional group, e.g., naringenin, hesperetin, and eriodictyol); isoflavones (based on the 3-phenylchromen-4-one skeleton, e.g., genistein and daidzein); flavanols or catechins (based on the 2-phenyl-3,4-dihydro-2H-chromen-3-ol skeleton and functional groups, e.g., epicatechin, epicatechin 3-gallate, epigallocatechin, epigallocatechin 3-gallate (EGCG), catechin, gallocatechin); anthocyanins (based on the 2-phenylchromenylium ion skeleton, e.g., cyanidin and pelargonidin); and proanthocyanidins or condensed tannins (which are polymer chains of flavanols, such as catechins, and include pycnogenol, leukocyanidin, and leucoanthocyanidin) (Annu. Rev. Nutr. 2002;22:19-34; Asia Pac. J. Clin. Nutr. 2004;13:S72; J. Nutr. 2000;130:2073S-85S; J. Nutr. 2003;133:3248S-54S).
Tannins, phenolic polymers of high molecular weight, are divided into three classes: hydrolyzable tannins (e.g., ellagic acid, found in pomegranates, raspberries, strawberries, cranberries, and walnuts), derived tannins (created during food handling and processing and present in black and oolong teas), and condensed tannins, described above (J. Am. Diet. Assoc. 1999;99:213-8; J. Nutr. 2003;133:3248S-54S).

Some specific flavonoids can be found in the following food sources: flavonols in apples with skin, broccoli, olives, onions, and green and black tea; flavones in celery and parsley; flavonones in grapefruit, oranges, and their juices; and catechins (flavanols) in apples with or without skin, dark chocolate, cocoa, red wine, and green and black tea (Asia Pac. J. Clin. Nutr. 2004;13:S72).

There are a plethora of other polyphenols, many of which confer health benefits, including stilbenes (e.g., resveratrol, found in red wine), lignans (e.g., enterodiol, found in flaxseed and flaxseed oil), and phenolic acids, such as hydroxybenzoic and hydroxycinnamic acids, among which caffeic and ferulic acids are often present in foods.

Broad health benefits have been associated with hundreds of polyphenolic substances. Notably, some of the best known research results on polyphenols have reported on the success of various topical applications of green tea catechins, ferulic acid, resveratrol, and other related compounds (many of which have been addressed in this column). The rest of this discussion focuses on new information regarding systemic efficacy, topical delivery, or applications of a representative from several subclasses of these compounds.

Flavonols: Quercetin
A water-in-oil microemulsion containing quercetin has been shown, in porcine skin in vitro and hairless mouse skin in vivo, to enhance the penetration of the flavonol into the stratum corneum, epidermis, and dermis. The preparation also was found to significantly inhibit ultraviolet B (UVB)-induced metalloproteinase activity and glutathione reduction (Eur. J. Pharm. Biopharm. 2008;69:948-57).

Flavones: Apigenin
The topical application of 4',5,7-trihydroxyflavone (apigenin) on mouse skin has been shown to decrease skin tumor size and incidence induced by UVB exposure (Cancer Res. 2008:68:3057-65). In a different study, the apigenin glycosides 7-O-glucuronide, 7-O-methylglucuronide, and pectolinarin also have been demonstrated to induce collagen type I synthesis in fibroblasts. The investigators found that all tested compounds promoted the activity of prolidase, which initiates the last stage of collagen degradation and is integral to collagen production (Int. J. Mol. Med. 2007;20:889-95).

Flavonones: Naringenin
The citrus flavonone naringenin shows promise as a preventive agent against cutaneous aging as well as carcinogenesis. Naringenin has been demonstrated to exert an antiapoptotic effect in UVB-damaged cells, significantly extending long-term cellular survival, and to facilitate the removal of cyclobutane pyrimidine dimers from the genome (Photochem. Photobiol. 2008;84:307-16).

 

Isoflavones: Red Clover, Genistein, and Daidzein
Recently, red clover, whose isoflavones had previously been shown to contribute to a low incidence of osteoporosis and menopausal symptoms in high dietary concentrations, was examined for anti-aging effects. Investigators orally administered red clover extract containing 11% isoflavones to ovariectomized rats for 14 weeks, and found that collagen levels increased significantly in the treatment group as compared to the control group. Epidermal thickness and keratinization were normal in the treated group, but were reduced in the control group. The authors concluded that the regular dietary consumption of red clover isoflavones can alleviate cutaneous aging brought on by declines in estrogen (Phytother. Res. 2006;20:1096-9).

In a recent study evaluating the feasibility of skin absorption of the soy isoflavones genistein, daidzein, and glycitein, both genistein and daidzein inhibited UVB-induced hydrogen peroxide synthesis in keratinocytes. Analysis of vehicle effects on in vitro topical delivery revealed that genistein showed better skin absorption than daidzein. The investigators concluded that the topical application of soy isoflavones shows promise as a treatment for photoaging and photodamage (Int. J. Pharm. 2008;364:36-44).

Indeed, the topical application of isoflavones, including genistein and daidzein, has been shown to protect pig skin from photodamage caused by solar-simulated ultraviolet irradiation. Notably, the isoflavone compounds tested were less effective than a topical antioxidant formulation containing vitamins C and E and the phenolic acid ferulic acid (Photodermatol. Photoimmunol. Photomed. 2008;24:61-6).

Catechins (Flavanols): Epigallocatechin 3-gallate
Already considered a potent antioxidant, EGCG continues to receive attention for conferring an expanding range of health benefits. This compound, the most abundant and potent catechin in green tea, has been shown to hinder UVB-induced collagen-degrading matrix metalloproteinases (Food Chem. Toxicol. 2008;46:1298-307).

A different study of EGCG indicated that it hampered the proliferation and migration of keloid fibroblasts in vitro, and also curbed in vivo signs of keloids, by interrupting the signal transducer and activator of the transcription-3 signaling pathway. As a result of these findings, the investigators proposed EGCG as a preventive and therapeutic agent for keloids (J. Invest. Dermatol. 2008;128:2429-41). EGCG also has been suggested as a potential therapeutic approach to atopic dermatitis, given its success against AD-like skin lesions in a murine model (Int. Immunopharmacol. 2008;8:1172-82).

Anthocyanins: Cyanidin
Clearly, all flavonoids are not equal. In a recent study, methanol extracts of black raspberries, strawberries, and blueberries were tested for their capacity to inhibit UV-induced activation of nuclear transcription factor-kappa B (NF-kappaB) and activator protein-1 (AP-1) in mouse epidermal cells. The methanol fractions of black raspberries, which contain the anthocyanin cyanidin 3-rutinoside, were found to time- and dose-dependently inhibit the effects of UV on NF-kappaB and AP-1, unlike the other berries, which do not contain cyanidin 3-rutinoside (Nutr. Cancer 2007;58:205-12).

Another form of cyanidin has also been shown to impart cutaneous benefits. Specifically, pretreatment of human keratinocytes with the anthocyanin cyanidin 3-O-glucoside has been demonstrated to protect against a wide array of UVB-induced damage (J. Agric. Food Chem. 2006;54:4041-7).

Proanthocyanidins: Pycnogenol
Investigators studied pycnogenol in an antioxidant mixture that also included evening primrose and vitamins C and E. After 10 weeks of oral administration to female SKH-1 hairless mice exposed to UVB irradiation three times weekly, the mixture was found to significantly inhibit wrinkle formation by suppressing UVB-induced matrix metalloproteinase activity while promoting collagen production (Photodermatol. Photoimmunol. Photomed. 2007;23:155-62).

Tannins: Ellagic Acid
In a double-blind, placebo-controlled, 4-week trial, investigators assessed the effects of orally administered ellagic acid-rich pomegranate extract on the pigmentation of 13 women after UV exposure. Healthy volunteers were randomly assigned to high-dose, low-dose, and control groups. The results showed that luminance values decreased by 1.73% in the high-dose group and 1.35% in the low-dose group, compared with the control group, and stains and freckles also were diminished (J. Nutr. Sci. Vitaminol. (Tokyo) 2006;52:383-8).

Stilbenes: Resveratrol
The antioxidant potency of resveratrol has been cited for conferring a wide range of salutary effects, including antitumorigenic and antiaging activity. Recently, a resveratrol-based skin care formulation intended to combat photoaging was reported to exhibit 17-fold greater antioxidant activity than idebenone (J. Cosmet. Dermatol. 2008;7:2-7). In a different study, resveratrol, the primary active polyphenolic constituent in red wine, was assessed in terms of topical/transdermal delivery viability, given the previously established benefits shown via systemic administration. Several hydrogel systems used as resveratrol vehicles were shown to be safe and effective methods for cutaneously delivering the therapeutic effects of this antioxidant (Biol. Pharm. Bull. 2008;31:955-62).

Phenolic Acids: Ferulic Acid
In a small study, a stable formulation of 15% L-corbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid was applied topically to normal-appearing human skin for 4 days, and was found to confer significant photoprotection against solar-simulated UV radiation. The preparation was especially effective at diminishing thymine dimer mutations, which are linked to skin cancer. The authors also noted that the mechanism of action of this antioxidant formulation differs from that of sunscreens and, therefore, may serve as a supplement to such products (J. Am. Acad. Dermatol. 2008;59:418-25). It is worth noting that ferulic acid has been approved as a sunscreen agent in Japan (J. Pharm. Biomed. Anal. 2008;46:645-52).

 

Conclusion
A brief survey of the polyphenolic landscape obviously cannot do the subject justice. That said, from the dermatologic perspective, it is simply worth noting how often this diverse family of compounds factors occur in to the skin care formulations that are becoming more prevalent in the established armamentarium as well as the direct-to-consumer market.

Given the increasing attention paid here and elsewhere to the impact of diet on the skin, the status of the diverse class of polyphenolic compounds found in a wide array of plants, which includes several antioxidants, appears to be well deserved and warrants much more research.

PHOENIX — Dermatologists may be under the clinical impression that botulinum toxin is better suited for the upper face, while fillers are the treatment of choice for the lower face.

However, as demonstrated in a previous upper-face study, the combined use of toxin and filler gave not only a superior aesthetic result but virtually doubled the duration of aesthetic response (Dermatol. Surg. 2003;29:802-9).

To elucidate these findings, Dr. Jean Carruthers and her husband Dr. Alastair Carruthers designed a lower-face study at three clinical sites. Along with Dr. Gary D. Monheit, they recruited 30 women from each site, for a total of 90, for the parallel group study.

They randomized 30 patients to receive onabotulinumtoxinA (Botox, Allergan), 30 to Juvéderm Ultra and/or Juvéderm Ultra Plus (hyaluronic acid, Allergen), and the remaining 30 patients to a combination of both treatments.

They first assessed the 35- to 55-year-old patients at baseline. Each patient was treated once and allowed one touch-up session of filler, but as many treatments with lower-face botulinum toxin as they felt they needed. A blinded rater and a principal investigator followed clinical outcomes over 6 months.

Lip fullness was rated superior in the combination group, Dr. Monheit said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery. Juvéderm alone was found more effective than botulinum toxin alone at increasing ratings on the lip-fullness scale. Photographic analysis confirmed the investigator evaluation.

In terms of oral commissure improvements, the combination outperformed both of the single treatments, although the “filler almost matched it in most aspects,” said Dr. Monheit of the departments of dermatology and ophthalmology at the University of Alabama at Birmingham.

Dr. Jean Carruthers is clinical professor of ophthalmology at the University of British Columbia, Vancouver. Dr. Alastair Carruthers is clinical professor in the department of dermatology at the same university. Investigators asked participants to purse their lips at each assessment. “We took smooch-pose photos to look at perioral lines,” Dr. Monheit said. “We also took grimace photos to show the power of the [depressor anguli oris] muscle.” At maximal contraction, the combination yielded better results again.

The investigators and patients also completed satisfaction questionnaires. They rated multiple areas. “Botox alone pretty well lagged behind [on the] investigator's lip satisfaction questionnaire,” the investigators noted. “The patient questionnaire had pretty much the same results: The combination and filler did best, and the toxin lagged behind.”

At the conclusion of the study, the combination treatment group fared better than the filler or the toxin groups alone on most outcome measures, including lip fullness, oral commissure severity, and perioral line improvement. In addition, subjective patient satisfaction and objective investigator satisfaction rankings were highest in the combined group. Overall, the results in the combined group were better, and the longevity of response was longer. “This is a confirmation of what we do on an everyday basis,” Dr. Monheit said.

Swelling, bruising, asymmetry, and lumps were adverse events recorded in patient diaries and reported by investigators, but these “minor adverse events were rarely noted in subjects with combination treatment,” Dr. Monheit said.

Disclosures: This investigator-initiated study was funded by Allergan. The company had no input on study design or outcome, according to the investigators. Dr. Jean and Alastair Carruthers are both consultants and researchers for Allergan, Merz Pharmaceuticals, and BioForm Medical. Dr. Monheit is a researcher and consultant for Allergan, Genzyme, and Johnson & Johnson, as well as a researcher for Dermik Laboratories, Inamed Aesthetics, and ColBar LifeScience.

PHOENIX — Dermatologists may be under the clinical impression that botulinum toxin is better suited for the upper face, while fillers are the treatment of choice for the lower face.

However, as demonstrated in a previous upper-face study, the combined use of toxin and filler gave not only a superior aesthetic result but virtually doubled the duration of aesthetic response (Dermatol. Surg. 2003;29:802-9).

To elucidate these findings, Dr. Jean Carruthers and her husband Dr. Alastair Carruthers designed a lower-face study at three clinical sites. Along with Dr. Gary D. Monheit, they recruited 30 women from each site, for a total of 90, for the parallel group study.

They randomized 30 patients to receive onabotulinumtoxinA (Botox, Allergan), 30 to Juvéderm Ultra and/or Juvéderm Ultra Plus (hyaluronic acid, Allergen), and the remaining 30 patients to a combination of both treatments.

They first assessed the 35- to 55-year-old patients at baseline. Each patient was treated once and allowed one touch-up session of filler, but as many treatments with lower-face botulinum toxin as they felt they needed. A blinded rater and a principal investigator followed clinical outcomes over 6 months.

Lip fullness was rated superior in the combination group, Dr. Monheit said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery. Juvéderm alone was found more effective than botulinum toxin alone at increasing ratings on the lip-fullness scale. Photographic analysis confirmed the investigator evaluation.

In terms of oral commissure improvements, the combination outperformed both of the single treatments, although the “filler almost matched it in most aspects,” said Dr. Monheit of the departments of dermatology and ophthalmology at the University of Alabama at Birmingham.

Dr. Jean Carruthers is clinical professor of ophthalmology at the University of British Columbia, Vancouver. Dr. Alastair Carruthers is clinical professor in the department of dermatology at the same university. Investigators asked participants to purse their lips at each assessment. “We took smooch-pose photos to look at perioral lines,” Dr. Monheit said. “We also took grimace photos to show the power of the [depressor anguli oris] muscle.” At maximal contraction, the combination yielded better results again.

The investigators and patients also completed satisfaction questionnaires. They rated multiple areas. “Botox alone pretty well lagged behind [on the] investigator's lip satisfaction questionnaire,” the investigators noted. “The patient questionnaire had pretty much the same results: The combination and filler did best, and the toxin lagged behind.”

At the conclusion of the study, the combination treatment group fared better than the filler or the toxin groups alone on most outcome measures, including lip fullness, oral commissure severity, and perioral line improvement. In addition, subjective patient satisfaction and objective investigator satisfaction rankings were highest in the combined group. Overall, the results in the combined group were better, and the longevity of response was longer. “This is a confirmation of what we do on an everyday basis,” Dr. Monheit said.

Swelling, bruising, asymmetry, and lumps were adverse events recorded in patient diaries and reported by investigators, but these “minor adverse events were rarely noted in subjects with combination treatment,” Dr. Monheit said.

Disclosures: This investigator-initiated study was funded by Allergan. The company had no input on study design or outcome, according to the investigators. Dr. Jean and Alastair Carruthers are both consultants and researchers for Allergan, Merz Pharmaceuticals, and BioForm Medical. Dr. Monheit is a researcher and consultant for Allergan, Genzyme, and Johnson & Johnson, as well as a researcher for Dermik Laboratories, Inamed Aesthetics, and ColBar LifeScience.

PHOENIX — Dermatologists may be under the clinical impression that botulinum toxin is better suited for the upper face, while fillers are the treatment of choice for the lower face.

However, as demonstrated in a previous upper-face study, the combined use of toxin and filler gave not only a superior aesthetic result but virtually doubled the duration of aesthetic response (Dermatol. Surg. 2003;29:802-9).

To elucidate these findings, Dr. Jean Carruthers and her husband Dr. Alastair Carruthers designed a lower-face study at three clinical sites. Along with Dr. Gary D. Monheit, they recruited 30 women from each site, for a total of 90, for the parallel group study.

They randomized 30 patients to receive onabotulinumtoxinA (Botox, Allergan), 30 to Juvéderm Ultra and/or Juvéderm Ultra Plus (hyaluronic acid, Allergen), and the remaining 30 patients to a combination of both treatments.

They first assessed the 35- to 55-year-old patients at baseline. Each patient was treated once and allowed one touch-up session of filler, but as many treatments with lower-face botulinum toxin as they felt they needed. A blinded rater and a principal investigator followed clinical outcomes over 6 months.

Lip fullness was rated superior in the combination group, Dr. Monheit said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery. Juvéderm alone was found more effective than botulinum toxin alone at increasing ratings on the lip-fullness scale. Photographic analysis confirmed the investigator evaluation.

In terms of oral commissure improvements, the combination outperformed both of the single treatments, although the “filler almost matched it in most aspects,” said Dr. Monheit of the departments of dermatology and ophthalmology at the University of Alabama at Birmingham.

Dr. Jean Carruthers is clinical professor of ophthalmology at the University of British Columbia, Vancouver. Dr. Alastair Carruthers is clinical professor in the department of dermatology at the same university. Investigators asked participants to purse their lips at each assessment. “We took smooch-pose photos to look at perioral lines,” Dr. Monheit said. “We also took grimace photos to show the power of the [depressor anguli oris] muscle.” At maximal contraction, the combination yielded better results again.

The investigators and patients also completed satisfaction questionnaires. They rated multiple areas. “Botox alone pretty well lagged behind [on the] investigator's lip satisfaction questionnaire,” the investigators noted. “The patient questionnaire had pretty much the same results: The combination and filler did best, and the toxin lagged behind.”

At the conclusion of the study, the combination treatment group fared better than the filler or the toxin groups alone on most outcome measures, including lip fullness, oral commissure severity, and perioral line improvement. In addition, subjective patient satisfaction and objective investigator satisfaction rankings were highest in the combined group. Overall, the results in the combined group were better, and the longevity of response was longer. “This is a confirmation of what we do on an everyday basis,” Dr. Monheit said.

Swelling, bruising, asymmetry, and lumps were adverse events recorded in patient diaries and reported by investigators, but these “minor adverse events were rarely noted in subjects with combination treatment,” Dr. Monheit said.

Disclosures: This investigator-initiated study was funded by Allergan. The company had no input on study design or outcome, according to the investigators. Dr. Jean and Alastair Carruthers are both consultants and researchers for Allergan, Merz Pharmaceuticals, and BioForm Medical. Dr. Monheit is a researcher and consultant for Allergan, Genzyme, and Johnson & Johnson, as well as a researcher for Dermik Laboratories, Inamed Aesthetics, and ColBar LifeScience.

PHOENIX — Some devices commonly touted for skin tightening are supported by evidence-based medicine, although few have data at the randomized, controlled-trial level, according to Dr. E. Victor Ross.

“We have a lot of skin-tightening devices … and I applaud those companies who have spent money trying to do good, controlled studies,” Dr. Ross said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery.

Thermage (Solta Medical Inc., Hayward, Calif.) leads in the literature in terms of strong evidence to support its use for skin tightening, Dr. Ross said. For example, 8 of 60 published studies are “good randomized, controlled trials,” meaning they provide level 1 evidence of clinical benefit. Level 2 evidence is a nonrandomized study, whereas level 3 evidence is anecdotal or case reports showing benefit of a device.

Thermage is included in the greatest number of published studies because it has been marketed the longest, said Dr. Ross, director of the Scripps Clinic Laser and Cosmetic Dermatology Center in Carmel Valley, Calif.

Other skin-tightening devices are supported by less evidence. For example, there are no published, peer-reviewed studies about the ultrasound-focusing Ulthera system (Ulthera, Mesa, Ariz.). “But at least … you can see changes on routine histology,” he said. The Food and Drug Administration cleared marketing of the Ulthera system in September for noninvasive eyebrow lifts.

Although many manufacturers promote the “real-time temperature rise” of their devices, this may not be a fair basis for comparison because different devices heat to different levels of the skin, he said.

Another option in the skin-tightening market is the UltraShape device (UltraShape, San Ramon, Calif.). “UltraShape does have some good papers—at least two of nine are level 1, prospective randomized studies,” Dr. Ross said.

In contrast, none of the six published studies on the Accent laser system (Alma Lasers, Buffalo Grove, Ill.) are designed to provide level 1 evidence. “My interpretation of the six studies so far … is they are level 2 or 3. Also, clinical photos were not blinded as to which ones were 'before' and 'after,'” Dr. Ross said.

A promising device not yet available in the United States is the high-intensity, focused, ultrasound LipoSonix system (Medicis Technologies, Bothell, Wash.), he said. It is approved for use in Europe and Canada. Foamy macrophages—suggesting lipid uptake—are seen on histology after use of the LipoSonix device, suggesting a true clinical effect.

Disclosures: Dr. Ross is a researcher and/or consultant for Palomar Medical Technologies Inc., Lumenis Ltd., Cutera Inc., Candela Corp., Alma Lasers Ltd., Iridex Corp., Laserscope, Ulthera Inc., and Sciton Inc.

PHOENIX — Some devices commonly touted for skin tightening are supported by evidence-based medicine, although few have data at the randomized, controlled-trial level, according to Dr. E. Victor Ross.

“We have a lot of skin-tightening devices … and I applaud those companies who have spent money trying to do good, controlled studies,” Dr. Ross said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery.

Thermage (Solta Medical Inc., Hayward, Calif.) leads in the literature in terms of strong evidence to support its use for skin tightening, Dr. Ross said. For example, 8 of 60 published studies are “good randomized, controlled trials,” meaning they provide level 1 evidence of clinical benefit. Level 2 evidence is a nonrandomized study, whereas level 3 evidence is anecdotal or case reports showing benefit of a device.

Thermage is included in the greatest number of published studies because it has been marketed the longest, said Dr. Ross, director of the Scripps Clinic Laser and Cosmetic Dermatology Center in Carmel Valley, Calif.

Other skin-tightening devices are supported by less evidence. For example, there are no published, peer-reviewed studies about the ultrasound-focusing Ulthera system (Ulthera, Mesa, Ariz.). “But at least … you can see changes on routine histology,” he said. The Food and Drug Administration cleared marketing of the Ulthera system in September for noninvasive eyebrow lifts.

Although many manufacturers promote the “real-time temperature rise” of their devices, this may not be a fair basis for comparison because different devices heat to different levels of the skin, he said.

Another option in the skin-tightening market is the UltraShape device (UltraShape, San Ramon, Calif.). “UltraShape does have some good papers—at least two of nine are level 1, prospective randomized studies,” Dr. Ross said.

In contrast, none of the six published studies on the Accent laser system (Alma Lasers, Buffalo Grove, Ill.) are designed to provide level 1 evidence. “My interpretation of the six studies so far … is they are level 2 or 3. Also, clinical photos were not blinded as to which ones were 'before' and 'after,'” Dr. Ross said.

A promising device not yet available in the United States is the high-intensity, focused, ultrasound LipoSonix system (Medicis Technologies, Bothell, Wash.), he said. It is approved for use in Europe and Canada. Foamy macrophages—suggesting lipid uptake—are seen on histology after use of the LipoSonix device, suggesting a true clinical effect.

Disclosures: Dr. Ross is a researcher and/or consultant for Palomar Medical Technologies Inc., Lumenis Ltd., Cutera Inc., Candela Corp., Alma Lasers Ltd., Iridex Corp., Laserscope, Ulthera Inc., and Sciton Inc.

PHOENIX — Some devices commonly touted for skin tightening are supported by evidence-based medicine, although few have data at the randomized, controlled-trial level, according to Dr. E. Victor Ross.

“We have a lot of skin-tightening devices … and I applaud those companies who have spent money trying to do good, controlled studies,” Dr. Ross said at the joint annual meeting of the American Society for Dermatologic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery.

Thermage (Solta Medical Inc., Hayward, Calif.) leads in the literature in terms of strong evidence to support its use for skin tightening, Dr. Ross said. For example, 8 of 60 published studies are “good randomized, controlled trials,” meaning they provide level 1 evidence of clinical benefit. Level 2 evidence is a nonrandomized study, whereas level 3 evidence is anecdotal or case reports showing benefit of a device.

Thermage is included in the greatest number of published studies because it has been marketed the longest, said Dr. Ross, director of the Scripps Clinic Laser and Cosmetic Dermatology Center in Carmel Valley, Calif.

Other skin-tightening devices are supported by less evidence. For example, there are no published, peer-reviewed studies about the ultrasound-focusing Ulthera system (Ulthera, Mesa, Ariz.). “But at least … you can see changes on routine histology,” he said. The Food and Drug Administration cleared marketing of the Ulthera system in September for noninvasive eyebrow lifts.

Although many manufacturers promote the “real-time temperature rise” of their devices, this may not be a fair basis for comparison because different devices heat to different levels of the skin, he said.

Another option in the skin-tightening market is the UltraShape device (UltraShape, San Ramon, Calif.). “UltraShape does have some good papers—at least two of nine are level 1, prospective randomized studies,” Dr. Ross said.

In contrast, none of the six published studies on the Accent laser system (Alma Lasers, Buffalo Grove, Ill.) are designed to provide level 1 evidence. “My interpretation of the six studies so far … is they are level 2 or 3. Also, clinical photos were not blinded as to which ones were 'before' and 'after,'” Dr. Ross said.

A promising device not yet available in the United States is the high-intensity, focused, ultrasound LipoSonix system (Medicis Technologies, Bothell, Wash.), he said. It is approved for use in Europe and Canada. Foamy macrophages—suggesting lipid uptake—are seen on histology after use of the LipoSonix device, suggesting a true clinical effect.

Disclosures: Dr. Ross is a researcher and/or consultant for Palomar Medical Technologies Inc., Lumenis Ltd., Cutera Inc., Candela Corp., Alma Lasers Ltd., Iridex Corp., Laserscope, Ulthera Inc., and Sciton Inc.

As the Senate continued to debate the Democrats' health reform proposal, it was not clear whether a proposed 5% tax on elective cosmetic surgery, including injectables, would survive the floor fight and the eventual conference committee to reconcile the House and Senate bills.

Physician groups—not just dermatologists—have united in opposition to the tax, saying that it is discriminatory, and, they point out, it has proven to be an inefficient means of collecting revenue in the only state with such a tax.

Even so, the American Academy of Dermatology expects more states to look at a cosmetic tax as a potential revenue source this year, Dr. David Pariser, president of the AAD, said in an interview.

New Jersey has taxed elective cosmetic procedures since 2004, levying a 6% fee at the point of sale—the physician's office—but the state has had a 59% shortfall based on projected revenue estimates, according to the Stop Medical Taxes Coalition. The newly formed group, which is sponsored by Botox maker Allergan Inc., represents 22 medical organizations, the AAD, the American Society for Aesthetic Plastic Surgery (ASAPS), the American Society for Dermatologic Surgery Association, the American Association of Neurologic Surgeons, and the American Society of Breast Surgeons.

The American Medical Association also came out in opposition to the tax. In a letter to Senate Majority Leader Harry Reid of Nevada, the AMA said that it “strongly opposes taxes on physician services to fund health care programs or to accomplish health system reform.” The organization said that it was concerned that the exceptions outlined in the bill weren't clear enough or broad enough.

And, said the AMA, the tax could be expanded in the future to cover other health care items or services that might not be considered medically necessary.

The Stop Medical Taxes Coalition wrote to all 50 Senators in late November, outlining its objections. A chief argument: The tax would fall disproportionately on working women.

According to survey data collected by the American Society of Plastic Surgeons in 2005, about one-fourth of the women planning to have surgery in the next 2 years reported income of $30,000–$60,000 a year, suggesting that the tax would hit middle earners, not high-income women.

“This tax is effectively a 'Soccer Mom' tax that will adversely impact mainstream American wives and mothers, who are the majority of plastic surgery patients,” Dr. Renato Saltz, president of the ASAPS, said in a statement.

In a separate letter, the AAD said that the proposed tax would insert the government into the physician-patient relationship “in a new way,” partly because it would be in charge of determining what was medically necessary. Under the proposal's language, an HIV-infected patient with lipoatrophy might be taxed for seeking treatment for what is arguably a disfiguring condition, the AAD wrote.

Rather than tax these patients, the AAD suggests that the federal government levy tanning bed users.

“A federal tax on indoor tanning could deter individuals, especially young people, from the practice,” Dr. Pariser said.

In New Jersey, the tax has led to patients choosing not to have procedures, and it has driven them to seek treatments in neighboring states, said Dr. David Goldberg, a dermatologist with practices in both New Jersey and New York. He said that he had New Jersey patients who went to his New York office to avoid the tax.

Also, “it is not a cost-effective tax,” said Dr. Goldberg, because the administrative costs for the program outweigh the revenue. In an interview, he predicted that state legislators would probably succeed in repealing the tax, especially since there is a new Republican governor friendly to the anti-tax effort and the state is seeking to enhance revenues and bolster savings.

For that same reason, Dr. Pariser said that he expects many states in the coming year to look at a cosmetic tax as a source of revenue. It is especially likely in Connecticut and New York, he said.

The AAD is calling on state societies to help mobilize dermatologists against such tax efforts, Dr. Pariser said.

As the Senate continued to debate the Democrats' health reform proposal, it was not clear whether a proposed 5% tax on elective cosmetic surgery, including injectables, would survive the floor fight and the eventual conference committee to reconcile the House and Senate bills.

Physician groups—not just dermatologists—have united in opposition to the tax, saying that it is discriminatory, and, they point out, it has proven to be an inefficient means of collecting revenue in the only state with such a tax.

Even so, the American Academy of Dermatology expects more states to look at a cosmetic tax as a potential revenue source this year, Dr. David Pariser, president of the AAD, said in an interview.

New Jersey has taxed elective cosmetic procedures since 2004, levying a 6% fee at the point of sale—the physician's office—but the state has had a 59% shortfall based on projected revenue estimates, according to the Stop Medical Taxes Coalition. The newly formed group, which is sponsored by Botox maker Allergan Inc., represents 22 medical organizations, the AAD, the American Society for Aesthetic Plastic Surgery (ASAPS), the American Society for Dermatologic Surgery Association, the American Association of Neurologic Surgeons, and the American Society of Breast Surgeons.

The American Medical Association also came out in opposition to the tax. In a letter to Senate Majority Leader Harry Reid of Nevada, the AMA said that it “strongly opposes taxes on physician services to fund health care programs or to accomplish health system reform.” The organization said that it was concerned that the exceptions outlined in the bill weren't clear enough or broad enough.

And, said the AMA, the tax could be expanded in the future to cover other health care items or services that might not be considered medically necessary.

The Stop Medical Taxes Coalition wrote to all 50 Senators in late November, outlining its objections. A chief argument: The tax would fall disproportionately on working women.

According to survey data collected by the American Society of Plastic Surgeons in 2005, about one-fourth of the women planning to have surgery in the next 2 years reported income of $30,000–$60,000 a year, suggesting that the tax would hit middle earners, not high-income women.

“This tax is effectively a 'Soccer Mom' tax that will adversely impact mainstream American wives and mothers, who are the majority of plastic surgery patients,” Dr. Renato Saltz, president of the ASAPS, said in a statement.

In a separate letter, the AAD said that the proposed tax would insert the government into the physician-patient relationship “in a new way,” partly because it would be in charge of determining what was medically necessary. Under the proposal's language, an HIV-infected patient with lipoatrophy might be taxed for seeking treatment for what is arguably a disfiguring condition, the AAD wrote.

Rather than tax these patients, the AAD suggests that the federal government levy tanning bed users.

“A federal tax on indoor tanning could deter individuals, especially young people, from the practice,” Dr. Pariser said.

In New Jersey, the tax has led to patients choosing not to have procedures, and it has driven them to seek treatments in neighboring states, said Dr. David Goldberg, a dermatologist with practices in both New Jersey and New York. He said that he had New Jersey patients who went to his New York office to avoid the tax.

Also, “it is not a cost-effective tax,” said Dr. Goldberg, because the administrative costs for the program outweigh the revenue. In an interview, he predicted that state legislators would probably succeed in repealing the tax, especially since there is a new Republican governor friendly to the anti-tax effort and the state is seeking to enhance revenues and bolster savings.

For that same reason, Dr. Pariser said that he expects many states in the coming year to look at a cosmetic tax as a source of revenue. It is especially likely in Connecticut and New York, he said.

The AAD is calling on state societies to help mobilize dermatologists against such tax efforts, Dr. Pariser said.

As the Senate continued to debate the Democrats' health reform proposal, it was not clear whether a proposed 5% tax on elective cosmetic surgery, including injectables, would survive the floor fight and the eventual conference committee to reconcile the House and Senate bills.

Physician groups—not just dermatologists—have united in opposition to the tax, saying that it is discriminatory, and, they point out, it has proven to be an inefficient means of collecting revenue in the only state with such a tax.

Even so, the American Academy of Dermatology expects more states to look at a cosmetic tax as a potential revenue source this year, Dr. David Pariser, president of the AAD, said in an interview.

New Jersey has taxed elective cosmetic procedures since 2004, levying a 6% fee at the point of sale—the physician's office—but the state has had a 59% shortfall based on projected revenue estimates, according to the Stop Medical Taxes Coalition. The newly formed group, which is sponsored by Botox maker Allergan Inc., represents 22 medical organizations, the AAD, the American Society for Aesthetic Plastic Surgery (ASAPS), the American Society for Dermatologic Surgery Association, the American Association of Neurologic Surgeons, and the American Society of Breast Surgeons.

The American Medical Association also came out in opposition to the tax. In a letter to Senate Majority Leader Harry Reid of Nevada, the AMA said that it “strongly opposes taxes on physician services to fund health care programs or to accomplish health system reform.” The organization said that it was concerned that the exceptions outlined in the bill weren't clear enough or broad enough.

And, said the AMA, the tax could be expanded in the future to cover other health care items or services that might not be considered medically necessary.

The Stop Medical Taxes Coalition wrote to all 50 Senators in late November, outlining its objections. A chief argument: The tax would fall disproportionately on working women.

According to survey data collected by the American Society of Plastic Surgeons in 2005, about one-fourth of the women planning to have surgery in the next 2 years reported income of $30,000–$60,000 a year, suggesting that the tax would hit middle earners, not high-income women.

“This tax is effectively a 'Soccer Mom' tax that will adversely impact mainstream American wives and mothers, who are the majority of plastic surgery patients,” Dr. Renato Saltz, president of the ASAPS, said in a statement.

In a separate letter, the AAD said that the proposed tax would insert the government into the physician-patient relationship “in a new way,” partly because it would be in charge of determining what was medically necessary. Under the proposal's language, an HIV-infected patient with lipoatrophy might be taxed for seeking treatment for what is arguably a disfiguring condition, the AAD wrote.

Rather than tax these patients, the AAD suggests that the federal government levy tanning bed users.

“A federal tax on indoor tanning could deter individuals, especially young people, from the practice,” Dr. Pariser said.

In New Jersey, the tax has led to patients choosing not to have procedures, and it has driven them to seek treatments in neighboring states, said Dr. David Goldberg, a dermatologist with practices in both New Jersey and New York. He said that he had New Jersey patients who went to his New York office to avoid the tax.

Also, “it is not a cost-effective tax,” said Dr. Goldberg, because the administrative costs for the program outweigh the revenue. In an interview, he predicted that state legislators would probably succeed in repealing the tax, especially since there is a new Republican governor friendly to the anti-tax effort and the state is seeking to enhance revenues and bolster savings.

For that same reason, Dr. Pariser said that he expects many states in the coming year to look at a cosmetic tax as a source of revenue. It is especially likely in Connecticut and New York, he said.

The AAD is calling on state societies to help mobilize dermatologists against such tax efforts, Dr. Pariser said.

Welcome to our first post for our new blog, "Skin of Color" for Skin & Allergy News Digital Network.

During the past several years, dermatologic issues pertaining to people of color have become more pervasive in the literature and in the media. Research has shown that differences in skin properties and pathophysiology do exist among people of different ethnicities. It is likely that these differences attribute to an increased prevalence of certain skin conditions in darker skinned people, as well as differences in disease presentation and response to treatment. Because there is a general lack of awareness of exactly what these differences are, clinicians are often less confident in the diagnosis and management of skin conditions seen in their darker skinned patients.

The goal of our blog is to inform clinicians on advances in the management of patients of color. We invite you to make our blog the place where you find the most current information and trends that will be applicable to your daily practice. Please share with us your own experiences and together we will further the understanding and delineate the unique qualities of skin of color patients.


Special Invitation from Dr. Naissan Wesley:
I had the privilege to serve as the Guest Editor of the June 2009 issue of Seminars in Cutaneous Medicine and Surgery entitled "Dermatologic Issues in People of Color." This issue was the first of its kind, and was dedicated to providing the most up-to-date information about dermatologic conditions that affect people of color. Each article was written by authors who are leading authorities on pigmented skin, many of whom are also pioneers in the research and education of their respected topics.

***************
A free subscription to upcoming issues of Seminars in Cutaneous Medicine and Surgery is available to qualified dermatologists. Simply click here and complete the registration form to receive your subscription.
***************

This special issue is divided into the most clinically relevant topics pertaining to skin of color, including management of common skin disorders, pigmentary disorders, skin cancer, diseases affecting hair, and cosmetic considerations. "Dermatologic Issues in People of Color" begins with a comprehensive update on managing common disorders in darker skin types led by Dr Andrew Alexis, Director of the Skin of Color Center at St. Luke's-Roosevelt Hospital Center. Dr A. Paul Kelly, pioneer in skin of color education and research and Chairman of Dermatology at King-Drew Medical Center, provides an update on the pathogenesis of another common condition, keloids, and a practical approach to their management.

Disorders of pigmentation can be devastating for patients both socially and psychologically, and unfortunately preferentially affect people with darker skin. Dr Pearl Grimes, leader of dyschromia research, Clinical Professor of Dermatology at the University of California Los Angeles and Director of the Vitiligo and Pigmentation Institute of Southern California, provides a comprehensive review of the pathogenesis and most ground-breaking treatments for post-inflammatory hyperpigmentation and melasma. Dr Rebat Halder, dyschromia expert and Professor and Chairman of the department of dermatology at Howard University College of Medicine, reviews the latest advances in the etiology and pathogenesis of vitiligo and provides an evidence-based approach to the management of the vitiligo patient.

Although skin cancer is a well-described subject within the field of dermatology, the etiopathogenesis in people of color is not as clear. The next two articles focus on skin cancer in people of color, as Dr Brooke Jackson, Mohs surgeon and Director of the Skin Wellness Center of Chicago, reviews nonmelanoma skin cancer, and Dr Mohammed Kashani-Sabet, Director of the Melanoma Center at the University of California San Francisco, leads a discussion of recent melanoma trends among African-, Asian-, Latin-, and Native-American people.

Other than pigmentary disorders, diseases affecting hair are one of the most common complaints among those with skin of color and especially African-American patients. Hair care practices among African-American women are often poorly understood by non-African-American clinicians, yet important for dermatologists to understand given the propensity for some of these practices to lead to hair disorders. Dr Amy McMichael, Professor of Dermatology at Wake Forest University School of Medicine and editor of Hair and Scalp Diseases: Medical, Surgical, and Cosmetic Treatments, provides an in-depth review of common hair care practices in African-American patients and their consequences. Professor of Dermatology at the University of California San Francisco and hair authority, Dr Vera Price, addresses the diagnostic challenges that clinicians face when presented with hair loss and provides a practical approach to diagnosing and managing hair loss in women of color.

Finally, with ethnic patients now accounting for approximately 24% of cosmetic patients, an 11% increase since 2007, cosmetic considerations in skin of color are addressed. Dr Eliot Battle, laser authority in darker skin types and director of Cultura Medical Spa, reviews the indications, benefits, potential risks, and treatment of complications associated with the use of lasers in darker skin.

Dr. Talakoub and I reviewed differences in perception of beauty and cosmetic procedures performed in people of different ethnic backgrounds. As a special opportunity for our online readers at the Skin of Color blog, we are making our article, Differences in Perceptions of Beauty and Cosmetic Procedures Performed in Ethnic Patients, available to you

We hope you enjoy our article and invite you to register to receive your free subscription to Seminars in Cutaneous Medicine and Surgery


Organizations with a Special Interest in Disorders of Skin of Color

Skin of Color Society
http://skinofcolorsociety.org
Upcoming meeting: March 2010, Miami, Fl

Cicatricial Alopecia Research Foundation (CARF)
P.O. Box 64158
Los Angeles, CA 90064
TEL (310) 475-2419
FAX: (310) 475-4883
www.carfintl.org
Upcoming meeting: CARF’s International Patient/Doctor Conference
Fall 2010
Los Angeles, CA
Please email: [email protected]

National Vitiligo Foundation
P.O. Box 23226
Cincinnati, OH 45223
TEL: 513-541-3903
FAX: 513-558-0198
http://www.nvfi.org/

Welcome to our first post for our new blog, "Skin of Color" for Skin & Allergy News Digital Network.

During the past several years, dermatologic issues pertaining to people of color have become more pervasive in the literature and in the media. Research has shown that differences in skin properties and pathophysiology do exist among people of different ethnicities. It is likely that these differences attribute to an increased prevalence of certain skin conditions in darker skinned people, as well as differences in disease presentation and response to treatment. Because there is a general lack of awareness of exactly what these differences are, clinicians are often less confident in the diagnosis and management of skin conditions seen in their darker skinned patients.

The goal of our blog is to inform clinicians on advances in the management of patients of color. We invite you to make our blog the place where you find the most current information and trends that will be applicable to your daily practice. Please share with us your own experiences and together we will further the understanding and delineate the unique qualities of skin of color patients.


Special Invitation from Dr. Naissan Wesley:
I had the privilege to serve as the Guest Editor of the June 2009 issue of Seminars in Cutaneous Medicine and Surgery entitled "Dermatologic Issues in People of Color." This issue was the first of its kind, and was dedicated to providing the most up-to-date information about dermatologic conditions that affect people of color. Each article was written by authors who are leading authorities on pigmented skin, many of whom are also pioneers in the research and education of their respected topics.

***************
A free subscription to upcoming issues of Seminars in Cutaneous Medicine and Surgery is available to qualified dermatologists. Simply click here and complete the registration form to receive your subscription.
***************

This special issue is divided into the most clinically relevant topics pertaining to skin of color, including management of common skin disorders, pigmentary disorders, skin cancer, diseases affecting hair, and cosmetic considerations. "Dermatologic Issues in People of Color" begins with a comprehensive update on managing common disorders in darker skin types led by Dr Andrew Alexis, Director of the Skin of Color Center at St. Luke's-Roosevelt Hospital Center. Dr A. Paul Kelly, pioneer in skin of color education and research and Chairman of Dermatology at King-Drew Medical Center, provides an update on the pathogenesis of another common condition, keloids, and a practical approach to their management.

Disorders of pigmentation can be devastating for patients both socially and psychologically, and unfortunately preferentially affect people with darker skin. Dr Pearl Grimes, leader of dyschromia research, Clinical Professor of Dermatology at the University of California Los Angeles and Director of the Vitiligo and Pigmentation Institute of Southern California, provides a comprehensive review of the pathogenesis and most ground-breaking treatments for post-inflammatory hyperpigmentation and melasma. Dr Rebat Halder, dyschromia expert and Professor and Chairman of the department of dermatology at Howard University College of Medicine, reviews the latest advances in the etiology and pathogenesis of vitiligo and provides an evidence-based approach to the management of the vitiligo patient.

Although skin cancer is a well-described subject within the field of dermatology, the etiopathogenesis in people of color is not as clear. The next two articles focus on skin cancer in people of color, as Dr Brooke Jackson, Mohs surgeon and Director of the Skin Wellness Center of Chicago, reviews nonmelanoma skin cancer, and Dr Mohammed Kashani-Sabet, Director of the Melanoma Center at the University of California San Francisco, leads a discussion of recent melanoma trends among African-, Asian-, Latin-, and Native-American people.

Other than pigmentary disorders, diseases affecting hair are one of the most common complaints among those with skin of color and especially African-American patients. Hair care practices among African-American women are often poorly understood by non-African-American clinicians, yet important for dermatologists to understand given the propensity for some of these practices to lead to hair disorders. Dr Amy McMichael, Professor of Dermatology at Wake Forest University School of Medicine and editor of Hair and Scalp Diseases: Medical, Surgical, and Cosmetic Treatments, provides an in-depth review of common hair care practices in African-American patients and their consequences. Professor of Dermatology at the University of California San Francisco and hair authority, Dr Vera Price, addresses the diagnostic challenges that clinicians face when presented with hair loss and provides a practical approach to diagnosing and managing hair loss in women of color.

Finally, with ethnic patients now accounting for approximately 24% of cosmetic patients, an 11% increase since 2007, cosmetic considerations in skin of color are addressed. Dr Eliot Battle, laser authority in darker skin types and director of Cultura Medical Spa, reviews the indications, benefits, potential risks, and treatment of complications associated with the use of lasers in darker skin.

Dr. Talakoub and I reviewed differences in perception of beauty and cosmetic procedures performed in people of different ethnic backgrounds. As a special opportunity for our online readers at the Skin of Color blog, we are making our article, Differences in Perceptions of Beauty and Cosmetic Procedures Performed in Ethnic Patients, available to you

We hope you enjoy our article and invite you to register to receive your free subscription to Seminars in Cutaneous Medicine and Surgery


Organizations with a Special Interest in Disorders of Skin of Color

Skin of Color Society
http://skinofcolorsociety.org
Upcoming meeting: March 2010, Miami, Fl

Cicatricial Alopecia Research Foundation (CARF)
P.O. Box 64158
Los Angeles, CA 90064
TEL (310) 475-2419
FAX: (310) 475-4883
www.carfintl.org
Upcoming meeting: CARF’s International Patient/Doctor Conference
Fall 2010
Los Angeles, CA
Please email: [email protected]

National Vitiligo Foundation
P.O. Box 23226
Cincinnati, OH 45223
TEL: 513-541-3903
FAX: 513-558-0198
http://www.nvfi.org/

Welcome to our first post for our new blog, "Skin of Color" for Skin & Allergy News Digital Network.

During the past several years, dermatologic issues pertaining to people of color have become more pervasive in the literature and in the media. Research has shown that differences in skin properties and pathophysiology do exist among people of different ethnicities. It is likely that these differences attribute to an increased prevalence of certain skin conditions in darker skinned people, as well as differences in disease presentation and response to treatment. Because there is a general lack of awareness of exactly what these differences are, clinicians are often less confident in the diagnosis and management of skin conditions seen in their darker skinned patients.

The goal of our blog is to inform clinicians on advances in the management of patients of color. We invite you to make our blog the place where you find the most current information and trends that will be applicable to your daily practice. Please share with us your own experiences and together we will further the understanding and delineate the unique qualities of skin of color patients.


Special Invitation from Dr. Naissan Wesley:
I had the privilege to serve as the Guest Editor of the June 2009 issue of Seminars in Cutaneous Medicine and Surgery entitled "Dermatologic Issues in People of Color." This issue was the first of its kind, and was dedicated to providing the most up-to-date information about dermatologic conditions that affect people of color. Each article was written by authors who are leading authorities on pigmented skin, many of whom are also pioneers in the research and education of their respected topics.

***************
A free subscription to upcoming issues of Seminars in Cutaneous Medicine and Surgery is available to qualified dermatologists. Simply click here and complete the registration form to receive your subscription.
***************

This special issue is divided into the most clinically relevant topics pertaining to skin of color, including management of common skin disorders, pigmentary disorders, skin cancer, diseases affecting hair, and cosmetic considerations. "Dermatologic Issues in People of Color" begins with a comprehensive update on managing common disorders in darker skin types led by Dr Andrew Alexis, Director of the Skin of Color Center at St. Luke's-Roosevelt Hospital Center. Dr A. Paul Kelly, pioneer in skin of color education and research and Chairman of Dermatology at King-Drew Medical Center, provides an update on the pathogenesis of another common condition, keloids, and a practical approach to their management.

Disorders of pigmentation can be devastating for patients both socially and psychologically, and unfortunately preferentially affect people with darker skin. Dr Pearl Grimes, leader of dyschromia research, Clinical Professor of Dermatology at the University of California Los Angeles and Director of the Vitiligo and Pigmentation Institute of Southern California, provides a comprehensive review of the pathogenesis and most ground-breaking treatments for post-inflammatory hyperpigmentation and melasma. Dr Rebat Halder, dyschromia expert and Professor and Chairman of the department of dermatology at Howard University College of Medicine, reviews the latest advances in the etiology and pathogenesis of vitiligo and provides an evidence-based approach to the management of the vitiligo patient.

Although skin cancer is a well-described subject within the field of dermatology, the etiopathogenesis in people of color is not as clear. The next two articles focus on skin cancer in people of color, as Dr Brooke Jackson, Mohs surgeon and Director of the Skin Wellness Center of Chicago, reviews nonmelanoma skin cancer, and Dr Mohammed Kashani-Sabet, Director of the Melanoma Center at the University of California San Francisco, leads a discussion of recent melanoma trends among African-, Asian-, Latin-, and Native-American people.

Other than pigmentary disorders, diseases affecting hair are one of the most common complaints among those with skin of color and especially African-American patients. Hair care practices among African-American women are often poorly understood by non-African-American clinicians, yet important for dermatologists to understand given the propensity for some of these practices to lead to hair disorders. Dr Amy McMichael, Professor of Dermatology at Wake Forest University School of Medicine and editor of Hair and Scalp Diseases: Medical, Surgical, and Cosmetic Treatments, provides an in-depth review of common hair care practices in African-American patients and their consequences. Professor of Dermatology at the University of California San Francisco and hair authority, Dr Vera Price, addresses the diagnostic challenges that clinicians face when presented with hair loss and provides a practical approach to diagnosing and managing hair loss in women of color.

Finally, with ethnic patients now accounting for approximately 24% of cosmetic patients, an 11% increase since 2007, cosmetic considerations in skin of color are addressed. Dr Eliot Battle, laser authority in darker skin types and director of Cultura Medical Spa, reviews the indications, benefits, potential risks, and treatment of complications associated with the use of lasers in darker skin.

Dr. Talakoub and I reviewed differences in perception of beauty and cosmetic procedures performed in people of different ethnic backgrounds. As a special opportunity for our online readers at the Skin of Color blog, we are making our article, Differences in Perceptions of Beauty and Cosmetic Procedures Performed in Ethnic Patients, available to you

We hope you enjoy our article and invite you to register to receive your free subscription to Seminars in Cutaneous Medicine and Surgery


Organizations with a Special Interest in Disorders of Skin of Color

Skin of Color Society
http://skinofcolorsociety.org
Upcoming meeting: March 2010, Miami, Fl

Cicatricial Alopecia Research Foundation (CARF)
P.O. Box 64158
Los Angeles, CA 90064
TEL (310) 475-2419
FAX: (310) 475-4883
www.carfintl.org
Upcoming meeting: CARF’s International Patient/Doctor Conference
Fall 2010
Los Angeles, CA
Please email: [email protected]

National Vitiligo Foundation
P.O. Box 23226
Cincinnati, OH 45223
TEL: 513-541-3903
FAX: 513-558-0198
http://www.nvfi.org/