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Sea Buckthorn
A member of the Elaeagnaceae family, Hippophae rhamnoides, better known as sea buckthorn, is a high-altitude wild shrub endemic to Europe and Asia with edible fruits and a lengthy record of use in traditional Chinese medicine.1-6 Used as a health supplement and consumed in the diet throughout the world,5 sea buckthorn berries, seeds, and leaves have been used in traditional medicine to treat burns/injuries, edema, hypertension, inflammation, skin grafts, ulcers, and wounds.4,7
This hardy plant is associated with a wide range of biologic activities, including anti-atherogenic, anti-atopic dermatitis, antibacterial, anticancer, antifungal, anti-inflammatory, antimicrobial, antioxidant, anti-psoriasis, anti-sebum, anti-stress, anti-tumor, cytoprotective, hepatoprotective, immunomodulatory, neuroprotective, radioprotective, and tissue regenerative functions.4,5,8-11
Key Constituents
Functional constituents identified in sea buckthorn include alkaloids, carotenoids, flavonoids, lignans, organic acids, phenolic acids, proanthocyanidins, polyunsaturated acids (including omega-3, -6, -7, and -9), steroids, tannins, terpenoids, and volatile oils, as well as nutritional compounds such as minerals, proteins, and vitamins.4,5,11 Sea buckthorn pericarp oil contains copious amounts of saturated palmitic acid (29%-36%) and omega-7 unsaturated palmitoleic acid (36%-48%), which fosters cutaneous and mucosal epithelialization, as well as linoleic (10%-12%) and oleic (4%-6%) acids.12,6 Significant amounts of carotenoids as well as alpha‐linolenic fatty acid (38%), linoleic (36%), oleic (13%), and palmitic (7%) acids are present in sea buckthorn seed oil.6
Polysaccharides
In an expansive review on the pharmacological activities of sea buckthorn polysaccharides, Teng and colleagues reported in April 2024 that 20 diverse polysaccharides have been culled from sea buckthorn and exhibited various healthy activities, including antioxidant, anti-fatigue, anti-inflammatory, anti-obesity, anti-tumor, hepatoprotective, hypoglycemic, and immunoregulation, and regulation of intestinal flora activities.1
Proanthocyanidins and Anti-Aging
In 2023, Liu and colleagues investigated the anti–skin aging impact of sea buckthorn proanthocyanidins in D-galactose-induced aging in mice given the known free radical scavenging activity of these compounds. They found the proanthocyanidins mitigated D-galactose-induced aging and can augment the total antioxidant capacity of the body. Sea buckthorn proanthocyanidins can further attenuate the effects of skin aging by regulating the TGF-beta1/Smads pathway and MMPs/TIMP system, thus amplifying collagen I and tropoelastin content.13
A year earlier, many of the same investigators assessed the possible protective activity of sea buckthorn proanthocyanidins against cutaneous aging engendered by oxidative stress from hydrogen peroxide. The compounds amplified superoxide dismutase and glutathione antioxidant functions. The extracts also fostered collagen I production in aging human skin fibroblasts via the TGF-beta1/Smads pathway and hindered collagen I degradation by regulating the MMPs/TIMPs system, which maintained extracellular matrix integrity. Senescent cell migration was also promoted with 100 mcg/mL of sea buckthorn proanthocyanidins. The researchers concluded that this sets the stage for investigating how sea buckthorn proanthocyanidins can be incorporated in cosmetic formulations.14 In a separate study, Liu and colleagues demonstrated that sea buckthorn proanthocyanidins can attenuate oxidative damage and protect mitochondrial function.9
Acne and Barrier Functions
The extracts of H rhamnoides and Cassia fistula in a combined formulation were found to be effective in lowering skin sebum content in humans with grade I and grade II acne vulgaris in a 2014 single-blind, randomized, placebo-controlled, split-face study with two groups of 25 patients each (aged 18-37 years).15 Khan and colleagues have also reported that a sea buckthorn oil-in-water emulsion improved barrier function in human skin as tested by a tewameter and corneometer (noninvasive probes) in 13 healthy males with a mean age of 27 ± 4.8 years.16
Anti-Aging, Antioxidant, Antibacterial, Skin-Whitening Activity
Zaman and colleagues reported in 2011 that results from an in vivo study of the effects of a sea buckthorn fruit extract topical cream on stratum corneum water content and transepidermal water loss indicated that the formulation enhanced cell surface integrin expression thus facilitating collagen contraction.17
In 2012, Khan and colleagues reported amelioration in skin elasticity, thus achieving an anti-aging result, from the use of a water-in-oil–based hydroalcoholic cream loaded with fruit extract of H rhamnoides, as measured with a Cutometer.18 The previous year, some of the same researchers reported that the antioxidants and flavonoids found in a topical sea buckthorn formulation could decrease cutaneous melanin and erythema levels.
More recently, Gęgotek and colleagues found that sea buckthorn seed oil prevented redox balance and lipid metabolism disturbances in skin fibroblasts and keratinocytes caused by UVA or UVB. They suggested that such findings point to the potential of this natural agent to confer anti-inflammatory properties and photoprotection to the skin.19
In 2020, Ivanišová and colleagues investigated the antioxidant and antimicrobial activities of H rhamnoides 100% oil, 100% juice, dry berries, and tea (dry berries, leaves, and twigs). They found that all of the studied sea buckthorn products displayed high antioxidant activity (identified through DPPH radical scavenging and molybdenum reducing antioxidant power tests). Sea buckthorn juice contained the highest total content of polyphenols, flavonoids, and carotenoids. All of the tested products also exhibited substantial antibacterial activity against the tested microbes.20
Burns and Wound Healing
In a preclinical study of the effects of sea buckthorn leaf extracts on wound healing in albino rats using an excision-punch wound model in 2005, Gupta and colleagues found that twice daily topical application of the aqueous leaf extract fostered wound healing. This was indicated by higher hydroxyproline and protein levels, a diminished wound area, and lower lipid peroxide levels. The investigators suggested that sea buckthorn may facilitate wound healing at least in part because of elevated antioxidant activity in the granulation tissue.3
A year later, Wang and colleagues reported on observations of using H rhamnoides oil, a traditional Chinese herbal medicine derived from sea buckthorn fruit, as a burn treatment. In the study, 151 burn patients received an H rhamnoides oil dressing (changed every other day until wound healing) that was covered with a disinfecting dressing. The dressing reduced swelling and effusion, and alleviated pain, with patients receiving the sea buckthorn dressing experiencing greater apparent exudation reduction, pain reduction, and more rapid epithelial cell growth and wound healing than controls (treated only with Vaseline gauze). The difference between the two groups was statistically significant.21
Conclusion
Sea buckthorn has been used for hundreds if not thousands of years in traditional medical applications, including for dermatologic purposes. Emerging data appear to support the use of this dynamic plant for consideration in dermatologic applications. As is often the case, much more work is necessary in the form of randomized controlled trials to determine the effectiveness of sea buckthorn formulations as well as the most appropriate avenues of research or uses for dermatologic application of this traditionally used botanical agent.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur in Miami. She founded the division of cosmetic dermatology at the University of Miami in 1997. The third edition of her bestselling textbook, “Cosmetic Dermatology,” was published in 2022. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Galderma, Johnson & Johnson, and Burt’s Bees. She is the CEO of Skin Type Solutions, a SaaS company used to generate skin care routines in office and as a e-commerce solution. Write to her at [email protected].
References
1. Teng H et al. J Ethnopharmacol. 2024 Apr 24;324:117809. doi: 10.1016/j.jep.2024.117809.
2. Wang Z et al. Int J Biol Macromol. 2024 Apr;263(Pt 1):130206. doi: 10.1016/j.ijbiomac.2024.130206.
3. Gupta A et al. Int J Low Extrem Wounds. 2005 Jun;4(2):88-92. doi: 10.1177/1534734605277401.
4. Pundir S et al. J Ethnopharmacol. 2021 Feb 10;266:113434. doi: 10.1016/j.jep.2020.113434.
5. Ma QG et al. J Agric Food Chem. 2023 Mar 29;71(12):4769-4788. doi: 10.1021/acs.jafc.2c06916.
6. Poljšak N et al. Phytother Res. 2020 Feb;34(2):254-269. doi: 10.1002/ptr.6524. doi: 10.1002/ptr.6524.
7. Upadhyay NK et al. Evid Based Complement Alternat Med. 2011;2011:659705. doi: 10.1093/ecam/nep189.
8. Suryakumar G, Gupta A. J Ethnopharmacol. 2011 Nov 18;138(2):268-78. doi: 10.1016/j.jep.2011.09.024.
9. Liu K et al. Front Pharmacol. 2022 Jul 8;13:914146. doi: 10.3389/fphar.2022.914146.
10. Akhtar N et al. J Pharm Bioallied Sci. 2010 Jan;2(1):13-7. doi: 10.4103/0975-7406.62698.
11. Ren R et al. RSC Adv. 2020 Dec 17;10(73):44654-44671. doi: 10.1039/d0ra06488b.
12. Ito H et al. Burns. 2014 May;40(3):511-9. doi: 10.1016/j.burns.2013.08.011.
13. Liu X et al. Food Sci Nutr. 2023 Dec 7;12(2):1082-1094. doi: 10.1002/fsn3.3823.
14. Liu X at al. Antioxidants (Basel). 2022 Sep 25;11(10):1900. doi: 10.3390/antiox11101900.
15. Khan BA, Akhtar N. Postepy Dermatol Alergol. 2014 Aug;31(4):229-234. doi: 10.5114/pdia.2014.40934.
16. Khan BA, Akhtar N. Pak J Pharm Sci. 2014 Nov;27(6):1919-22.
17. Khan AB et al. African J Pharm Pharmacol. 2011 Aug;5(8):1092-5.
18. Khan BA, Akhtar N, Braga VA. Trop J Pharm Res. 2012;11(6):955-62.
19. Gęgotek A et al. Antioxidants (Basel). 2018 Aug 23;7(9):110. doi: 10.3390/antiox7090110.
20. Ivanišová E et al. Acta Sci Pol Technol Aliment. 2020 Apr-Jun;19(2):195-205. doi: 10.17306/J.AFS.0809.
21. Wang ZY, Luo XL, He CP. Nan Fang Yi Ke Da Xue Xue Bao. 2006 Jan;26(1):124-5.
A member of the Elaeagnaceae family, Hippophae rhamnoides, better known as sea buckthorn, is a high-altitude wild shrub endemic to Europe and Asia with edible fruits and a lengthy record of use in traditional Chinese medicine.1-6 Used as a health supplement and consumed in the diet throughout the world,5 sea buckthorn berries, seeds, and leaves have been used in traditional medicine to treat burns/injuries, edema, hypertension, inflammation, skin grafts, ulcers, and wounds.4,7
This hardy plant is associated with a wide range of biologic activities, including anti-atherogenic, anti-atopic dermatitis, antibacterial, anticancer, antifungal, anti-inflammatory, antimicrobial, antioxidant, anti-psoriasis, anti-sebum, anti-stress, anti-tumor, cytoprotective, hepatoprotective, immunomodulatory, neuroprotective, radioprotective, and tissue regenerative functions.4,5,8-11
Key Constituents
Functional constituents identified in sea buckthorn include alkaloids, carotenoids, flavonoids, lignans, organic acids, phenolic acids, proanthocyanidins, polyunsaturated acids (including omega-3, -6, -7, and -9), steroids, tannins, terpenoids, and volatile oils, as well as nutritional compounds such as minerals, proteins, and vitamins.4,5,11 Sea buckthorn pericarp oil contains copious amounts of saturated palmitic acid (29%-36%) and omega-7 unsaturated palmitoleic acid (36%-48%), which fosters cutaneous and mucosal epithelialization, as well as linoleic (10%-12%) and oleic (4%-6%) acids.12,6 Significant amounts of carotenoids as well as alpha‐linolenic fatty acid (38%), linoleic (36%), oleic (13%), and palmitic (7%) acids are present in sea buckthorn seed oil.6
Polysaccharides
In an expansive review on the pharmacological activities of sea buckthorn polysaccharides, Teng and colleagues reported in April 2024 that 20 diverse polysaccharides have been culled from sea buckthorn and exhibited various healthy activities, including antioxidant, anti-fatigue, anti-inflammatory, anti-obesity, anti-tumor, hepatoprotective, hypoglycemic, and immunoregulation, and regulation of intestinal flora activities.1
Proanthocyanidins and Anti-Aging
In 2023, Liu and colleagues investigated the anti–skin aging impact of sea buckthorn proanthocyanidins in D-galactose-induced aging in mice given the known free radical scavenging activity of these compounds. They found the proanthocyanidins mitigated D-galactose-induced aging and can augment the total antioxidant capacity of the body. Sea buckthorn proanthocyanidins can further attenuate the effects of skin aging by regulating the TGF-beta1/Smads pathway and MMPs/TIMP system, thus amplifying collagen I and tropoelastin content.13
A year earlier, many of the same investigators assessed the possible protective activity of sea buckthorn proanthocyanidins against cutaneous aging engendered by oxidative stress from hydrogen peroxide. The compounds amplified superoxide dismutase and glutathione antioxidant functions. The extracts also fostered collagen I production in aging human skin fibroblasts via the TGF-beta1/Smads pathway and hindered collagen I degradation by regulating the MMPs/TIMPs system, which maintained extracellular matrix integrity. Senescent cell migration was also promoted with 100 mcg/mL of sea buckthorn proanthocyanidins. The researchers concluded that this sets the stage for investigating how sea buckthorn proanthocyanidins can be incorporated in cosmetic formulations.14 In a separate study, Liu and colleagues demonstrated that sea buckthorn proanthocyanidins can attenuate oxidative damage and protect mitochondrial function.9
Acne and Barrier Functions
The extracts of H rhamnoides and Cassia fistula in a combined formulation were found to be effective in lowering skin sebum content in humans with grade I and grade II acne vulgaris in a 2014 single-blind, randomized, placebo-controlled, split-face study with two groups of 25 patients each (aged 18-37 years).15 Khan and colleagues have also reported that a sea buckthorn oil-in-water emulsion improved barrier function in human skin as tested by a tewameter and corneometer (noninvasive probes) in 13 healthy males with a mean age of 27 ± 4.8 years.16
Anti-Aging, Antioxidant, Antibacterial, Skin-Whitening Activity
Zaman and colleagues reported in 2011 that results from an in vivo study of the effects of a sea buckthorn fruit extract topical cream on stratum corneum water content and transepidermal water loss indicated that the formulation enhanced cell surface integrin expression thus facilitating collagen contraction.17
In 2012, Khan and colleagues reported amelioration in skin elasticity, thus achieving an anti-aging result, from the use of a water-in-oil–based hydroalcoholic cream loaded with fruit extract of H rhamnoides, as measured with a Cutometer.18 The previous year, some of the same researchers reported that the antioxidants and flavonoids found in a topical sea buckthorn formulation could decrease cutaneous melanin and erythema levels.
More recently, Gęgotek and colleagues found that sea buckthorn seed oil prevented redox balance and lipid metabolism disturbances in skin fibroblasts and keratinocytes caused by UVA or UVB. They suggested that such findings point to the potential of this natural agent to confer anti-inflammatory properties and photoprotection to the skin.19
In 2020, Ivanišová and colleagues investigated the antioxidant and antimicrobial activities of H rhamnoides 100% oil, 100% juice, dry berries, and tea (dry berries, leaves, and twigs). They found that all of the studied sea buckthorn products displayed high antioxidant activity (identified through DPPH radical scavenging and molybdenum reducing antioxidant power tests). Sea buckthorn juice contained the highest total content of polyphenols, flavonoids, and carotenoids. All of the tested products also exhibited substantial antibacterial activity against the tested microbes.20
Burns and Wound Healing
In a preclinical study of the effects of sea buckthorn leaf extracts on wound healing in albino rats using an excision-punch wound model in 2005, Gupta and colleagues found that twice daily topical application of the aqueous leaf extract fostered wound healing. This was indicated by higher hydroxyproline and protein levels, a diminished wound area, and lower lipid peroxide levels. The investigators suggested that sea buckthorn may facilitate wound healing at least in part because of elevated antioxidant activity in the granulation tissue.3
A year later, Wang and colleagues reported on observations of using H rhamnoides oil, a traditional Chinese herbal medicine derived from sea buckthorn fruit, as a burn treatment. In the study, 151 burn patients received an H rhamnoides oil dressing (changed every other day until wound healing) that was covered with a disinfecting dressing. The dressing reduced swelling and effusion, and alleviated pain, with patients receiving the sea buckthorn dressing experiencing greater apparent exudation reduction, pain reduction, and more rapid epithelial cell growth and wound healing than controls (treated only with Vaseline gauze). The difference between the two groups was statistically significant.21
Conclusion
Sea buckthorn has been used for hundreds if not thousands of years in traditional medical applications, including for dermatologic purposes. Emerging data appear to support the use of this dynamic plant for consideration in dermatologic applications. As is often the case, much more work is necessary in the form of randomized controlled trials to determine the effectiveness of sea buckthorn formulations as well as the most appropriate avenues of research or uses for dermatologic application of this traditionally used botanical agent.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur in Miami. She founded the division of cosmetic dermatology at the University of Miami in 1997. The third edition of her bestselling textbook, “Cosmetic Dermatology,” was published in 2022. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Galderma, Johnson & Johnson, and Burt’s Bees. She is the CEO of Skin Type Solutions, a SaaS company used to generate skin care routines in office and as a e-commerce solution. Write to her at [email protected].
References
1. Teng H et al. J Ethnopharmacol. 2024 Apr 24;324:117809. doi: 10.1016/j.jep.2024.117809.
2. Wang Z et al. Int J Biol Macromol. 2024 Apr;263(Pt 1):130206. doi: 10.1016/j.ijbiomac.2024.130206.
3. Gupta A et al. Int J Low Extrem Wounds. 2005 Jun;4(2):88-92. doi: 10.1177/1534734605277401.
4. Pundir S et al. J Ethnopharmacol. 2021 Feb 10;266:113434. doi: 10.1016/j.jep.2020.113434.
5. Ma QG et al. J Agric Food Chem. 2023 Mar 29;71(12):4769-4788. doi: 10.1021/acs.jafc.2c06916.
6. Poljšak N et al. Phytother Res. 2020 Feb;34(2):254-269. doi: 10.1002/ptr.6524. doi: 10.1002/ptr.6524.
7. Upadhyay NK et al. Evid Based Complement Alternat Med. 2011;2011:659705. doi: 10.1093/ecam/nep189.
8. Suryakumar G, Gupta A. J Ethnopharmacol. 2011 Nov 18;138(2):268-78. doi: 10.1016/j.jep.2011.09.024.
9. Liu K et al. Front Pharmacol. 2022 Jul 8;13:914146. doi: 10.3389/fphar.2022.914146.
10. Akhtar N et al. J Pharm Bioallied Sci. 2010 Jan;2(1):13-7. doi: 10.4103/0975-7406.62698.
11. Ren R et al. RSC Adv. 2020 Dec 17;10(73):44654-44671. doi: 10.1039/d0ra06488b.
12. Ito H et al. Burns. 2014 May;40(3):511-9. doi: 10.1016/j.burns.2013.08.011.
13. Liu X et al. Food Sci Nutr. 2023 Dec 7;12(2):1082-1094. doi: 10.1002/fsn3.3823.
14. Liu X at al. Antioxidants (Basel). 2022 Sep 25;11(10):1900. doi: 10.3390/antiox11101900.
15. Khan BA, Akhtar N. Postepy Dermatol Alergol. 2014 Aug;31(4):229-234. doi: 10.5114/pdia.2014.40934.
16. Khan BA, Akhtar N. Pak J Pharm Sci. 2014 Nov;27(6):1919-22.
17. Khan AB et al. African J Pharm Pharmacol. 2011 Aug;5(8):1092-5.
18. Khan BA, Akhtar N, Braga VA. Trop J Pharm Res. 2012;11(6):955-62.
19. Gęgotek A et al. Antioxidants (Basel). 2018 Aug 23;7(9):110. doi: 10.3390/antiox7090110.
20. Ivanišová E et al. Acta Sci Pol Technol Aliment. 2020 Apr-Jun;19(2):195-205. doi: 10.17306/J.AFS.0809.
21. Wang ZY, Luo XL, He CP. Nan Fang Yi Ke Da Xue Xue Bao. 2006 Jan;26(1):124-5.
A member of the Elaeagnaceae family, Hippophae rhamnoides, better known as sea buckthorn, is a high-altitude wild shrub endemic to Europe and Asia with edible fruits and a lengthy record of use in traditional Chinese medicine.1-6 Used as a health supplement and consumed in the diet throughout the world,5 sea buckthorn berries, seeds, and leaves have been used in traditional medicine to treat burns/injuries, edema, hypertension, inflammation, skin grafts, ulcers, and wounds.4,7
This hardy plant is associated with a wide range of biologic activities, including anti-atherogenic, anti-atopic dermatitis, antibacterial, anticancer, antifungal, anti-inflammatory, antimicrobial, antioxidant, anti-psoriasis, anti-sebum, anti-stress, anti-tumor, cytoprotective, hepatoprotective, immunomodulatory, neuroprotective, radioprotective, and tissue regenerative functions.4,5,8-11
Key Constituents
Functional constituents identified in sea buckthorn include alkaloids, carotenoids, flavonoids, lignans, organic acids, phenolic acids, proanthocyanidins, polyunsaturated acids (including omega-3, -6, -7, and -9), steroids, tannins, terpenoids, and volatile oils, as well as nutritional compounds such as minerals, proteins, and vitamins.4,5,11 Sea buckthorn pericarp oil contains copious amounts of saturated palmitic acid (29%-36%) and omega-7 unsaturated palmitoleic acid (36%-48%), which fosters cutaneous and mucosal epithelialization, as well as linoleic (10%-12%) and oleic (4%-6%) acids.12,6 Significant amounts of carotenoids as well as alpha‐linolenic fatty acid (38%), linoleic (36%), oleic (13%), and palmitic (7%) acids are present in sea buckthorn seed oil.6
Polysaccharides
In an expansive review on the pharmacological activities of sea buckthorn polysaccharides, Teng and colleagues reported in April 2024 that 20 diverse polysaccharides have been culled from sea buckthorn and exhibited various healthy activities, including antioxidant, anti-fatigue, anti-inflammatory, anti-obesity, anti-tumor, hepatoprotective, hypoglycemic, and immunoregulation, and regulation of intestinal flora activities.1
Proanthocyanidins and Anti-Aging
In 2023, Liu and colleagues investigated the anti–skin aging impact of sea buckthorn proanthocyanidins in D-galactose-induced aging in mice given the known free radical scavenging activity of these compounds. They found the proanthocyanidins mitigated D-galactose-induced aging and can augment the total antioxidant capacity of the body. Sea buckthorn proanthocyanidins can further attenuate the effects of skin aging by regulating the TGF-beta1/Smads pathway and MMPs/TIMP system, thus amplifying collagen I and tropoelastin content.13
A year earlier, many of the same investigators assessed the possible protective activity of sea buckthorn proanthocyanidins against cutaneous aging engendered by oxidative stress from hydrogen peroxide. The compounds amplified superoxide dismutase and glutathione antioxidant functions. The extracts also fostered collagen I production in aging human skin fibroblasts via the TGF-beta1/Smads pathway and hindered collagen I degradation by regulating the MMPs/TIMPs system, which maintained extracellular matrix integrity. Senescent cell migration was also promoted with 100 mcg/mL of sea buckthorn proanthocyanidins. The researchers concluded that this sets the stage for investigating how sea buckthorn proanthocyanidins can be incorporated in cosmetic formulations.14 In a separate study, Liu and colleagues demonstrated that sea buckthorn proanthocyanidins can attenuate oxidative damage and protect mitochondrial function.9
Acne and Barrier Functions
The extracts of H rhamnoides and Cassia fistula in a combined formulation were found to be effective in lowering skin sebum content in humans with grade I and grade II acne vulgaris in a 2014 single-blind, randomized, placebo-controlled, split-face study with two groups of 25 patients each (aged 18-37 years).15 Khan and colleagues have also reported that a sea buckthorn oil-in-water emulsion improved barrier function in human skin as tested by a tewameter and corneometer (noninvasive probes) in 13 healthy males with a mean age of 27 ± 4.8 years.16
Anti-Aging, Antioxidant, Antibacterial, Skin-Whitening Activity
Zaman and colleagues reported in 2011 that results from an in vivo study of the effects of a sea buckthorn fruit extract topical cream on stratum corneum water content and transepidermal water loss indicated that the formulation enhanced cell surface integrin expression thus facilitating collagen contraction.17
In 2012, Khan and colleagues reported amelioration in skin elasticity, thus achieving an anti-aging result, from the use of a water-in-oil–based hydroalcoholic cream loaded with fruit extract of H rhamnoides, as measured with a Cutometer.18 The previous year, some of the same researchers reported that the antioxidants and flavonoids found in a topical sea buckthorn formulation could decrease cutaneous melanin and erythema levels.
More recently, Gęgotek and colleagues found that sea buckthorn seed oil prevented redox balance and lipid metabolism disturbances in skin fibroblasts and keratinocytes caused by UVA or UVB. They suggested that such findings point to the potential of this natural agent to confer anti-inflammatory properties and photoprotection to the skin.19
In 2020, Ivanišová and colleagues investigated the antioxidant and antimicrobial activities of H rhamnoides 100% oil, 100% juice, dry berries, and tea (dry berries, leaves, and twigs). They found that all of the studied sea buckthorn products displayed high antioxidant activity (identified through DPPH radical scavenging and molybdenum reducing antioxidant power tests). Sea buckthorn juice contained the highest total content of polyphenols, flavonoids, and carotenoids. All of the tested products also exhibited substantial antibacterial activity against the tested microbes.20
Burns and Wound Healing
In a preclinical study of the effects of sea buckthorn leaf extracts on wound healing in albino rats using an excision-punch wound model in 2005, Gupta and colleagues found that twice daily topical application of the aqueous leaf extract fostered wound healing. This was indicated by higher hydroxyproline and protein levels, a diminished wound area, and lower lipid peroxide levels. The investigators suggested that sea buckthorn may facilitate wound healing at least in part because of elevated antioxidant activity in the granulation tissue.3
A year later, Wang and colleagues reported on observations of using H rhamnoides oil, a traditional Chinese herbal medicine derived from sea buckthorn fruit, as a burn treatment. In the study, 151 burn patients received an H rhamnoides oil dressing (changed every other day until wound healing) that was covered with a disinfecting dressing. The dressing reduced swelling and effusion, and alleviated pain, with patients receiving the sea buckthorn dressing experiencing greater apparent exudation reduction, pain reduction, and more rapid epithelial cell growth and wound healing than controls (treated only with Vaseline gauze). The difference between the two groups was statistically significant.21
Conclusion
Sea buckthorn has been used for hundreds if not thousands of years in traditional medical applications, including for dermatologic purposes. Emerging data appear to support the use of this dynamic plant for consideration in dermatologic applications. As is often the case, much more work is necessary in the form of randomized controlled trials to determine the effectiveness of sea buckthorn formulations as well as the most appropriate avenues of research or uses for dermatologic application of this traditionally used botanical agent.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur in Miami. She founded the division of cosmetic dermatology at the University of Miami in 1997. The third edition of her bestselling textbook, “Cosmetic Dermatology,” was published in 2022. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Galderma, Johnson & Johnson, and Burt’s Bees. She is the CEO of Skin Type Solutions, a SaaS company used to generate skin care routines in office and as a e-commerce solution. Write to her at [email protected].
References
1. Teng H et al. J Ethnopharmacol. 2024 Apr 24;324:117809. doi: 10.1016/j.jep.2024.117809.
2. Wang Z et al. Int J Biol Macromol. 2024 Apr;263(Pt 1):130206. doi: 10.1016/j.ijbiomac.2024.130206.
3. Gupta A et al. Int J Low Extrem Wounds. 2005 Jun;4(2):88-92. doi: 10.1177/1534734605277401.
4. Pundir S et al. J Ethnopharmacol. 2021 Feb 10;266:113434. doi: 10.1016/j.jep.2020.113434.
5. Ma QG et al. J Agric Food Chem. 2023 Mar 29;71(12):4769-4788. doi: 10.1021/acs.jafc.2c06916.
6. Poljšak N et al. Phytother Res. 2020 Feb;34(2):254-269. doi: 10.1002/ptr.6524. doi: 10.1002/ptr.6524.
7. Upadhyay NK et al. Evid Based Complement Alternat Med. 2011;2011:659705. doi: 10.1093/ecam/nep189.
8. Suryakumar G, Gupta A. J Ethnopharmacol. 2011 Nov 18;138(2):268-78. doi: 10.1016/j.jep.2011.09.024.
9. Liu K et al. Front Pharmacol. 2022 Jul 8;13:914146. doi: 10.3389/fphar.2022.914146.
10. Akhtar N et al. J Pharm Bioallied Sci. 2010 Jan;2(1):13-7. doi: 10.4103/0975-7406.62698.
11. Ren R et al. RSC Adv. 2020 Dec 17;10(73):44654-44671. doi: 10.1039/d0ra06488b.
12. Ito H et al. Burns. 2014 May;40(3):511-9. doi: 10.1016/j.burns.2013.08.011.
13. Liu X et al. Food Sci Nutr. 2023 Dec 7;12(2):1082-1094. doi: 10.1002/fsn3.3823.
14. Liu X at al. Antioxidants (Basel). 2022 Sep 25;11(10):1900. doi: 10.3390/antiox11101900.
15. Khan BA, Akhtar N. Postepy Dermatol Alergol. 2014 Aug;31(4):229-234. doi: 10.5114/pdia.2014.40934.
16. Khan BA, Akhtar N. Pak J Pharm Sci. 2014 Nov;27(6):1919-22.
17. Khan AB et al. African J Pharm Pharmacol. 2011 Aug;5(8):1092-5.
18. Khan BA, Akhtar N, Braga VA. Trop J Pharm Res. 2012;11(6):955-62.
19. Gęgotek A et al. Antioxidants (Basel). 2018 Aug 23;7(9):110. doi: 10.3390/antiox7090110.
20. Ivanišová E et al. Acta Sci Pol Technol Aliment. 2020 Apr-Jun;19(2):195-205. doi: 10.17306/J.AFS.0809.
21. Wang ZY, Luo XL, He CP. Nan Fang Yi Ke Da Xue Xue Bao. 2006 Jan;26(1):124-5.
Cosmetic Dermatology Product Recalls Still Common, Analysis Finds
TOPLINE:
Between 2011 and 2023, the US Food and Drug Administration (FDA) reported recalls of 334 cosmetic dermatology products in the United States, affecting over 77 million units, predominantly due to bacterial contamination.
METHODOLOGY:
- Researchers conducted a cross-sectional analysis of the FDA Enforcement Report database for cosmetic dermatology products from 2011 to 2023.
- Cosmetic products are any article “intended for body cleaning or beauty enhancement,” as defined by the FDA.
- Recalls were categorized by product type, reason for the recall, microbial contaminant, inorganic contaminant, distribution, and risk classification.
TAKEAWAY:
- During the study period, 334 voluntary and manufacturer-initiated recalls of cosmetic products were reported, affecting 77,135,700 units.
- A total of 297 recalls (88.9%) were categorized as Class II, indicating that they caused “medically reversible health consequences.” The median recall duration was 307 days.
- Hygiene and cleaning products accounted for most of the recalls (51.5%). Makeup gels, soaps, shampoos, tattoo ink, wipes, and lotions were the most recalled product categories. Nearly 51% of the products were distributed internationally.
- Microbial and inorganic contamination accounted for 76.8% and 10.2% of the recalls (the two most common reasons for the recall), respectively, with bacteria (80%) the most common contaminating pathogen (primarily Pseudomonas and Burkholderia species).
IN PRACTICE:
With 77 million units recalled by the FDA over 12 years, cosmetic recalls have remained common, the authors concluded, adding that “dermatologists should be key voices in pharmacovigilance given scientific expertise and frontline experience managing products and associated concerns.” Dermatologists, they added, “should also be aware of FDA enforcement reports for recall updates given that average recall termination took approximately 1 year.”
SOURCE:
The study was led by Kaushik P. Venkatesh, MBA, MPH, Harvard Medical School, Boston, and was published online on October 29 in the Journal of the American Academy of Dermatology.
LIMITATIONS:
The study’s limitations include the potential underreporting of Class III recalls (products that are unlikely to cause any adverse health reaction but violate FDA labeling or manufacturing laws) and lack of complete information on contaminants.
DISCLOSURES:
No information on funding was provided in the study. No conflicts of interest were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Between 2011 and 2023, the US Food and Drug Administration (FDA) reported recalls of 334 cosmetic dermatology products in the United States, affecting over 77 million units, predominantly due to bacterial contamination.
METHODOLOGY:
- Researchers conducted a cross-sectional analysis of the FDA Enforcement Report database for cosmetic dermatology products from 2011 to 2023.
- Cosmetic products are any article “intended for body cleaning or beauty enhancement,” as defined by the FDA.
- Recalls were categorized by product type, reason for the recall, microbial contaminant, inorganic contaminant, distribution, and risk classification.
TAKEAWAY:
- During the study period, 334 voluntary and manufacturer-initiated recalls of cosmetic products were reported, affecting 77,135,700 units.
- A total of 297 recalls (88.9%) were categorized as Class II, indicating that they caused “medically reversible health consequences.” The median recall duration was 307 days.
- Hygiene and cleaning products accounted for most of the recalls (51.5%). Makeup gels, soaps, shampoos, tattoo ink, wipes, and lotions were the most recalled product categories. Nearly 51% of the products were distributed internationally.
- Microbial and inorganic contamination accounted for 76.8% and 10.2% of the recalls (the two most common reasons for the recall), respectively, with bacteria (80%) the most common contaminating pathogen (primarily Pseudomonas and Burkholderia species).
IN PRACTICE:
With 77 million units recalled by the FDA over 12 years, cosmetic recalls have remained common, the authors concluded, adding that “dermatologists should be key voices in pharmacovigilance given scientific expertise and frontline experience managing products and associated concerns.” Dermatologists, they added, “should also be aware of FDA enforcement reports for recall updates given that average recall termination took approximately 1 year.”
SOURCE:
The study was led by Kaushik P. Venkatesh, MBA, MPH, Harvard Medical School, Boston, and was published online on October 29 in the Journal of the American Academy of Dermatology.
LIMITATIONS:
The study’s limitations include the potential underreporting of Class III recalls (products that are unlikely to cause any adverse health reaction but violate FDA labeling or manufacturing laws) and lack of complete information on contaminants.
DISCLOSURES:
No information on funding was provided in the study. No conflicts of interest were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Between 2011 and 2023, the US Food and Drug Administration (FDA) reported recalls of 334 cosmetic dermatology products in the United States, affecting over 77 million units, predominantly due to bacterial contamination.
METHODOLOGY:
- Researchers conducted a cross-sectional analysis of the FDA Enforcement Report database for cosmetic dermatology products from 2011 to 2023.
- Cosmetic products are any article “intended for body cleaning or beauty enhancement,” as defined by the FDA.
- Recalls were categorized by product type, reason for the recall, microbial contaminant, inorganic contaminant, distribution, and risk classification.
TAKEAWAY:
- During the study period, 334 voluntary and manufacturer-initiated recalls of cosmetic products were reported, affecting 77,135,700 units.
- A total of 297 recalls (88.9%) were categorized as Class II, indicating that they caused “medically reversible health consequences.” The median recall duration was 307 days.
- Hygiene and cleaning products accounted for most of the recalls (51.5%). Makeup gels, soaps, shampoos, tattoo ink, wipes, and lotions were the most recalled product categories. Nearly 51% of the products were distributed internationally.
- Microbial and inorganic contamination accounted for 76.8% and 10.2% of the recalls (the two most common reasons for the recall), respectively, with bacteria (80%) the most common contaminating pathogen (primarily Pseudomonas and Burkholderia species).
IN PRACTICE:
With 77 million units recalled by the FDA over 12 years, cosmetic recalls have remained common, the authors concluded, adding that “dermatologists should be key voices in pharmacovigilance given scientific expertise and frontline experience managing products and associated concerns.” Dermatologists, they added, “should also be aware of FDA enforcement reports for recall updates given that average recall termination took approximately 1 year.”
SOURCE:
The study was led by Kaushik P. Venkatesh, MBA, MPH, Harvard Medical School, Boston, and was published online on October 29 in the Journal of the American Academy of Dermatology.
LIMITATIONS:
The study’s limitations include the potential underreporting of Class III recalls (products that are unlikely to cause any adverse health reaction but violate FDA labeling or manufacturing laws) and lack of complete information on contaminants.
DISCLOSURES:
No information on funding was provided in the study. No conflicts of interest were reported.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
FDA Approves OnabotulinumtoxinA for Improving Platysma Bands
The in adults.
According to a press release from Allergan Aesthetics, which developed onabotulinumtoxinA, by injecting along the jawline and the vertical bands connecting the jaw and neck with one of the FDA-approved doses of the product based on severity, onabotulinumtoxinA temporarily reduces underlying muscle activity.
The company cited results from phase 3 clinical studies, which demonstrated statistical significance for the improvement in appearance of platysma bands from baseline with onabotulinumtoxinA compared with placebo on both investigator and patient assessment (P < .0001).
All secondary endpoints were also met, as measured by multiple validated, proprietary patient-reported outcome instruments. In two of the clinical studies, for example, 65% and 62% of patients reported being “very satisfied” or “satisfied,” respectively, with their neck and jawline definition 14 days after treatment with a dose of 26, 31, or 36 units of onabotulinumtoxinA, compared with 12% with placebo in both studies.
The development marks the fourth indication for onabotulinumtoxinA. The others are for moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity, moderate to severe lateral canthal lines associated with orbicularis oculi activity, and moderate to severe forehead lines associated with frontalis activity.
A version of this article appeared on Medscape.com.
The in adults.
According to a press release from Allergan Aesthetics, which developed onabotulinumtoxinA, by injecting along the jawline and the vertical bands connecting the jaw and neck with one of the FDA-approved doses of the product based on severity, onabotulinumtoxinA temporarily reduces underlying muscle activity.
The company cited results from phase 3 clinical studies, which demonstrated statistical significance for the improvement in appearance of platysma bands from baseline with onabotulinumtoxinA compared with placebo on both investigator and patient assessment (P < .0001).
All secondary endpoints were also met, as measured by multiple validated, proprietary patient-reported outcome instruments. In two of the clinical studies, for example, 65% and 62% of patients reported being “very satisfied” or “satisfied,” respectively, with their neck and jawline definition 14 days after treatment with a dose of 26, 31, or 36 units of onabotulinumtoxinA, compared with 12% with placebo in both studies.
The development marks the fourth indication for onabotulinumtoxinA. The others are for moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity, moderate to severe lateral canthal lines associated with orbicularis oculi activity, and moderate to severe forehead lines associated with frontalis activity.
A version of this article appeared on Medscape.com.
The in adults.
According to a press release from Allergan Aesthetics, which developed onabotulinumtoxinA, by injecting along the jawline and the vertical bands connecting the jaw and neck with one of the FDA-approved doses of the product based on severity, onabotulinumtoxinA temporarily reduces underlying muscle activity.
The company cited results from phase 3 clinical studies, which demonstrated statistical significance for the improvement in appearance of platysma bands from baseline with onabotulinumtoxinA compared with placebo on both investigator and patient assessment (P < .0001).
All secondary endpoints were also met, as measured by multiple validated, proprietary patient-reported outcome instruments. In two of the clinical studies, for example, 65% and 62% of patients reported being “very satisfied” or “satisfied,” respectively, with their neck and jawline definition 14 days after treatment with a dose of 26, 31, or 36 units of onabotulinumtoxinA, compared with 12% with placebo in both studies.
The development marks the fourth indication for onabotulinumtoxinA. The others are for moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity, moderate to severe lateral canthal lines associated with orbicularis oculi activity, and moderate to severe forehead lines associated with frontalis activity.
A version of this article appeared on Medscape.com.
Wrinkles, Dyspigmentation Improve with PDT, in Small Study
.
“Our study helps capture and quantify a phenomenon that clinicians who use PDT in their practice have already noticed: Patients experience a visible improvement across several cosmetically important metrics including but not limited to fine lines, wrinkles, and skin tightness following PDT,” one of the study authors, Luke Horton, MD, a fourth-year dermatology resident at the University of California, Irvine, said in an interview following the annual meeting of the American Society for Dermatologic Surgery, where he presented the results during an oral abstract session.
For the study, 11 patients underwent a 120-minute incubation period with 17% 5-aminolevulinic acid over the face, followed by visible blue light PDT exposure for 16 minutes, to reduce rhytides. The researchers used a Vectra imaging system to capture three-dimensional images of the patients before the procedure and during the follow-up. Three dermatologists analyzed the pre-procedure and post-procedure images and used a validated five-point Merz wrinkle severity scale to grade various regions of the face including the forehead, glabella, lateral canthal rhytides, melolabial folds, nasolabial folds, and perioral rhytides.
They also used a five-point solar lentigines scale to evaluate the change in degree of pigmentation and quantity of age spots as well as the change in rhytid severity before and after PDT and the change in the seven-point Global Aesthetic Improvement Scale (GAIS) to gauge overall improvement of fine lines and wrinkles.
After a mean follow-up of 4.25 months, rhytid severity among the 11 patients was reduced by an average of 0.65 points on the Merz scale, with an SD of 0.20. Broken down by region, rhytid severity scores decreased by 0.2 points (SD, 0.42) for the forehead, 0.7 points (SD, 0.48) for the glabella and lateral canthal rhytides, 0.88 points (SD, 0.35) for the melolabial folds and perioral rhytides, and 0.8 points (SD, 0.42) for the nasolabial folds. (The researchers excluded ratings for the melolabial folds and perioral rhytides in two patients with beards.)
In other findings, solar lentigines grading showed an average reduction of 1 point (SD, 0.45), while the GAIS score improved by 1 or more for every patient, with an average of score of 1.45 (SD, 0.52), showing that some degree of improvement in facial rhytides was noted for all patients following PDT.
“The degree of improvement as measured by our independent physician graders was impressive and not far off from those reported with CO2 ablative laser,” Horton said. “Further, the effect was not isolated to actinic keratoses but extended to improved appearance of fine lines, some deep lines, and lentigines. Although we are not implying that PDT is superior to and should replace lasers or other energy-based devices, it does provide a real, measurable cosmetic benefit.”
Clinicians, he added, can use these findings “to counsel their patients when discussing field cancerization treatment options, especially for patients who may be hesitant to undergo PDT as it can be a painful therapy with a considerable downtime for some.”
Lawrence J. Green, MD, clinical professor of dermatology, The George Washington University, Washington, DC, who was asked to comment on the study results, said that the findings “shine more light on the long-standing off-label use of PDT for lessening signs of photoaging. Like studies done before it, I think this adds an additional benefit to discuss for those who are considering PDT treatment for their actinic keratoses.”
Horton acknowledged certain limitations of the study including its small sample size and the fact that physician graders were not blinded to which images were pre- and post-treatment, “which could introduce an element of bias in the data,” he said. “But this being an unfunded project born out of clinical observation, we hope to later expand its size. Furthermore, we invite other physicians to join us to better study these effects and to design protocols that minimize adverse effects and maximize clinical outcomes.”
His co-authors were Milan Hirpara; Sarah Choe; Joel Cohen, MD; and Natasha A. Mesinkovska, MD, PhD.
No relevant disclosures were reported. Green had no relevant disclosures.
A version of this article appeared on Medscape.com.
.
“Our study helps capture and quantify a phenomenon that clinicians who use PDT in their practice have already noticed: Patients experience a visible improvement across several cosmetically important metrics including but not limited to fine lines, wrinkles, and skin tightness following PDT,” one of the study authors, Luke Horton, MD, a fourth-year dermatology resident at the University of California, Irvine, said in an interview following the annual meeting of the American Society for Dermatologic Surgery, where he presented the results during an oral abstract session.
For the study, 11 patients underwent a 120-minute incubation period with 17% 5-aminolevulinic acid over the face, followed by visible blue light PDT exposure for 16 minutes, to reduce rhytides. The researchers used a Vectra imaging system to capture three-dimensional images of the patients before the procedure and during the follow-up. Three dermatologists analyzed the pre-procedure and post-procedure images and used a validated five-point Merz wrinkle severity scale to grade various regions of the face including the forehead, glabella, lateral canthal rhytides, melolabial folds, nasolabial folds, and perioral rhytides.
They also used a five-point solar lentigines scale to evaluate the change in degree of pigmentation and quantity of age spots as well as the change in rhytid severity before and after PDT and the change in the seven-point Global Aesthetic Improvement Scale (GAIS) to gauge overall improvement of fine lines and wrinkles.
After a mean follow-up of 4.25 months, rhytid severity among the 11 patients was reduced by an average of 0.65 points on the Merz scale, with an SD of 0.20. Broken down by region, rhytid severity scores decreased by 0.2 points (SD, 0.42) for the forehead, 0.7 points (SD, 0.48) for the glabella and lateral canthal rhytides, 0.88 points (SD, 0.35) for the melolabial folds and perioral rhytides, and 0.8 points (SD, 0.42) for the nasolabial folds. (The researchers excluded ratings for the melolabial folds and perioral rhytides in two patients with beards.)
In other findings, solar lentigines grading showed an average reduction of 1 point (SD, 0.45), while the GAIS score improved by 1 or more for every patient, with an average of score of 1.45 (SD, 0.52), showing that some degree of improvement in facial rhytides was noted for all patients following PDT.
“The degree of improvement as measured by our independent physician graders was impressive and not far off from those reported with CO2 ablative laser,” Horton said. “Further, the effect was not isolated to actinic keratoses but extended to improved appearance of fine lines, some deep lines, and lentigines. Although we are not implying that PDT is superior to and should replace lasers or other energy-based devices, it does provide a real, measurable cosmetic benefit.”
Clinicians, he added, can use these findings “to counsel their patients when discussing field cancerization treatment options, especially for patients who may be hesitant to undergo PDT as it can be a painful therapy with a considerable downtime for some.”
Lawrence J. Green, MD, clinical professor of dermatology, The George Washington University, Washington, DC, who was asked to comment on the study results, said that the findings “shine more light on the long-standing off-label use of PDT for lessening signs of photoaging. Like studies done before it, I think this adds an additional benefit to discuss for those who are considering PDT treatment for their actinic keratoses.”
Horton acknowledged certain limitations of the study including its small sample size and the fact that physician graders were not blinded to which images were pre- and post-treatment, “which could introduce an element of bias in the data,” he said. “But this being an unfunded project born out of clinical observation, we hope to later expand its size. Furthermore, we invite other physicians to join us to better study these effects and to design protocols that minimize adverse effects and maximize clinical outcomes.”
His co-authors were Milan Hirpara; Sarah Choe; Joel Cohen, MD; and Natasha A. Mesinkovska, MD, PhD.
No relevant disclosures were reported. Green had no relevant disclosures.
A version of this article appeared on Medscape.com.
.
“Our study helps capture and quantify a phenomenon that clinicians who use PDT in their practice have already noticed: Patients experience a visible improvement across several cosmetically important metrics including but not limited to fine lines, wrinkles, and skin tightness following PDT,” one of the study authors, Luke Horton, MD, a fourth-year dermatology resident at the University of California, Irvine, said in an interview following the annual meeting of the American Society for Dermatologic Surgery, where he presented the results during an oral abstract session.
For the study, 11 patients underwent a 120-minute incubation period with 17% 5-aminolevulinic acid over the face, followed by visible blue light PDT exposure for 16 minutes, to reduce rhytides. The researchers used a Vectra imaging system to capture three-dimensional images of the patients before the procedure and during the follow-up. Three dermatologists analyzed the pre-procedure and post-procedure images and used a validated five-point Merz wrinkle severity scale to grade various regions of the face including the forehead, glabella, lateral canthal rhytides, melolabial folds, nasolabial folds, and perioral rhytides.
They also used a five-point solar lentigines scale to evaluate the change in degree of pigmentation and quantity of age spots as well as the change in rhytid severity before and after PDT and the change in the seven-point Global Aesthetic Improvement Scale (GAIS) to gauge overall improvement of fine lines and wrinkles.
After a mean follow-up of 4.25 months, rhytid severity among the 11 patients was reduced by an average of 0.65 points on the Merz scale, with an SD of 0.20. Broken down by region, rhytid severity scores decreased by 0.2 points (SD, 0.42) for the forehead, 0.7 points (SD, 0.48) for the glabella and lateral canthal rhytides, 0.88 points (SD, 0.35) for the melolabial folds and perioral rhytides, and 0.8 points (SD, 0.42) for the nasolabial folds. (The researchers excluded ratings for the melolabial folds and perioral rhytides in two patients with beards.)
In other findings, solar lentigines grading showed an average reduction of 1 point (SD, 0.45), while the GAIS score improved by 1 or more for every patient, with an average of score of 1.45 (SD, 0.52), showing that some degree of improvement in facial rhytides was noted for all patients following PDT.
“The degree of improvement as measured by our independent physician graders was impressive and not far off from those reported with CO2 ablative laser,” Horton said. “Further, the effect was not isolated to actinic keratoses but extended to improved appearance of fine lines, some deep lines, and lentigines. Although we are not implying that PDT is superior to and should replace lasers or other energy-based devices, it does provide a real, measurable cosmetic benefit.”
Clinicians, he added, can use these findings “to counsel their patients when discussing field cancerization treatment options, especially for patients who may be hesitant to undergo PDT as it can be a painful therapy with a considerable downtime for some.”
Lawrence J. Green, MD, clinical professor of dermatology, The George Washington University, Washington, DC, who was asked to comment on the study results, said that the findings “shine more light on the long-standing off-label use of PDT for lessening signs of photoaging. Like studies done before it, I think this adds an additional benefit to discuss for those who are considering PDT treatment for their actinic keratoses.”
Horton acknowledged certain limitations of the study including its small sample size and the fact that physician graders were not blinded to which images were pre- and post-treatment, “which could introduce an element of bias in the data,” he said. “But this being an unfunded project born out of clinical observation, we hope to later expand its size. Furthermore, we invite other physicians to join us to better study these effects and to design protocols that minimize adverse effects and maximize clinical outcomes.”
His co-authors were Milan Hirpara; Sarah Choe; Joel Cohen, MD; and Natasha A. Mesinkovska, MD, PhD.
No relevant disclosures were reported. Green had no relevant disclosures.
A version of this article appeared on Medscape.com.
New Cosmeceutical as Effective as Cysteamine for Facial Melasma
A presented at the European Academy of Dermatology and Venereology (EADV) 2024 Congress.
“Melasyl is a new potent melanogenesis inhibitor that exhibits a unique mode of action while preserving melanocyte integrity,” Mukta Sachdev, MD, head of the Department of Dermatology at Manipal Hospital in Bangalore, India, said at a late-breaking news session.
Both the serum and the cysteamine cream lightened participants’ skin to a similar extent, according to the modified Melasma Area and Severity Index (mMASI), with respective reductions of 4.19 and 3.81 points over a period of 4 months from baseline values of 11.15 and 10.93. 
The mMASI score ranges from 0 to 24, with the lowest score representing the least and the highest score the most severe hyperpigmentation of the skin.
But the serum performed better than the cream by another measure. Judged by investigators blinded to which preparation study participants had been using, there was a significantly higher reduction in the Investigator Global Assessment (IGA) score from baseline among those treated with the serum than among those treated with the cream (−51.85% vs −39.06%; P = .0163).
Moreover, after 4 months of treatment, there were significantly more participants with clear or almost clear skin with the serum than with the cream (17.46% vs 7.81%; P = .0163), Sachdev reported.
Other skin parameters relative to melasma, such as the brightness of skin tone and evenness of the improvement, improved more in the participants using the serum vs cream, she said.
With “no side effects, no local skin reactions,” Sachdev said, “quality of life improved significantly and similarly, and almost all subjects in both groups were very satisfied with their treatment options.”
Active Ingredients
Margarida Gonçalo, MD, PhD, professor of dermatology at the University of Coimbra, in Portugal, who co-chaired the late-breaking news session, commented: “It’s really nice to have new products to treat such a devastating disease.”
Session co-chair, Lidia Rudnicka, MD, head of the Department of Dermatology, Medical University of Warsaw, in Poland, and president of the Polish Dermatological Society, wanted to know more about the active ingredients of the serum and the study’s design.
Sachdev replied that the serum also contains other ingredients that provide “antioxidant protection” and moisturization. These include retinyl palmitate, which works on the dermal-epidermal junction, and hyaluronic acid, as well as “soothing agents,” such as the medicinal herb Centella asiatica, she said.
Study Design
Conducted at a single center in India, the study involved 127 adults aged 20-50 years with melasma. For inclusion, the participants had to have facial epidermal or mixed melasma (phototypes III-V) for more than 1 year; those with dermal melasma were excluded.
Participants were randomly allocated to receive either the serum, which was applied topically to the areas of interest twice a day in the morning and then at bedtime (n = 63), or cysteamine cream (n = 64), which was applied once a day in addition to a neutral moisturizer. Treatment was for 4 months, with an on-site visit every month.
All participants were supplied with the same sunscreen/ultraviolet protector applied twice a day (once in the morning and again at midday) and a neutral hydrating cleanser that was used in the morning and evening.
Practical Implications
Over 4 months, both products showed significant improvement in melasma without reaching a plateau, Sachdev reported, with the serum demonstrating superior efficacy and tolerability, as judged by the investigators.
The study suggests that the serum is a promising non-hydroquinone treatment for melasma, she said. Hydroquinone-containing topical preparations are used to depigment the skin, but their long-term use can be limited for safety reasons.
“When products like this demonstrate improvement, it is something for the dermatologist to think about because we now have newer ingredients, which are safer and well tolerated,” she continued, noting that there appeared to be no risk for exogenous ochronosis, which can occur with long-term application of hydroquinone.
“So, I think the armamentarium of non-hydroquinone products for the treatment of melasma is rapidly expanding, and there are studies now with clinically proven efficacy,” Sachdev concluded.
The study was supported by L’Oréal France La Roche-Posay, which launched Melasyl in March 2024. Sachdev reported receipt of research support and honoraria from the company. Gonçalo and Rudnicka were not involved in the study and had no relevant conflicts of interest to report.
A version of this article appeared on Medscape.com.
A presented at the European Academy of Dermatology and Venereology (EADV) 2024 Congress.
“Melasyl is a new potent melanogenesis inhibitor that exhibits a unique mode of action while preserving melanocyte integrity,” Mukta Sachdev, MD, head of the Department of Dermatology at Manipal Hospital in Bangalore, India, said at a late-breaking news session.
Both the serum and the cysteamine cream lightened participants’ skin to a similar extent, according to the modified Melasma Area and Severity Index (mMASI), with respective reductions of 4.19 and 3.81 points over a period of 4 months from baseline values of 11.15 and 10.93.
The mMASI score ranges from 0 to 24, with the lowest score representing the least and the highest score the most severe hyperpigmentation of the skin.
But the serum performed better than the cream by another measure. Judged by investigators blinded to which preparation study participants had been using, there was a significantly higher reduction in the Investigator Global Assessment (IGA) score from baseline among those treated with the serum than among those treated with the cream (−51.85% vs −39.06%; P = .0163).
Moreover, after 4 months of treatment, there were significantly more participants with clear or almost clear skin with the serum than with the cream (17.46% vs 7.81%; P = .0163), Sachdev reported.
Other skin parameters relative to melasma, such as the brightness of skin tone and evenness of the improvement, improved more in the participants using the serum vs cream, she said.
With “no side effects, no local skin reactions,” Sachdev said, “quality of life improved significantly and similarly, and almost all subjects in both groups were very satisfied with their treatment options.”
Active Ingredients
Margarida Gonçalo, MD, PhD, professor of dermatology at the University of Coimbra, in Portugal, who co-chaired the late-breaking news session, commented: “It’s really nice to have new products to treat such a devastating disease.”
Session co-chair, Lidia Rudnicka, MD, head of the Department of Dermatology, Medical University of Warsaw, in Poland, and president of the Polish Dermatological Society, wanted to know more about the active ingredients of the serum and the study’s design.
Sachdev replied that the serum also contains other ingredients that provide “antioxidant protection” and moisturization. These include retinyl palmitate, which works on the dermal-epidermal junction, and hyaluronic acid, as well as “soothing agents,” such as the medicinal herb Centella asiatica, she said.
Study Design
Conducted at a single center in India, the study involved 127 adults aged 20-50 years with melasma. For inclusion, the participants had to have facial epidermal or mixed melasma (phototypes III-V) for more than 1 year; those with dermal melasma were excluded.
Participants were randomly allocated to receive either the serum, which was applied topically to the areas of interest twice a day in the morning and then at bedtime (n = 63), or cysteamine cream (n = 64), which was applied once a day in addition to a neutral moisturizer. Treatment was for 4 months, with an on-site visit every month.
All participants were supplied with the same sunscreen/ultraviolet protector applied twice a day (once in the morning and again at midday) and a neutral hydrating cleanser that was used in the morning and evening.
Practical Implications
Over 4 months, both products showed significant improvement in melasma without reaching a plateau, Sachdev reported, with the serum demonstrating superior efficacy and tolerability, as judged by the investigators.
The study suggests that the serum is a promising non-hydroquinone treatment for melasma, she said. Hydroquinone-containing topical preparations are used to depigment the skin, but their long-term use can be limited for safety reasons.
“When products like this demonstrate improvement, it is something for the dermatologist to think about because we now have newer ingredients, which are safer and well tolerated,” she continued, noting that there appeared to be no risk for exogenous ochronosis, which can occur with long-term application of hydroquinone.
“So, I think the armamentarium of non-hydroquinone products for the treatment of melasma is rapidly expanding, and there are studies now with clinically proven efficacy,” Sachdev concluded.
The study was supported by L’Oréal France La Roche-Posay, which launched Melasyl in March 2024. Sachdev reported receipt of research support and honoraria from the company. Gonçalo and Rudnicka were not involved in the study and had no relevant conflicts of interest to report.
A version of this article appeared on Medscape.com.
A presented at the European Academy of Dermatology and Venereology (EADV) 2024 Congress.
“Melasyl is a new potent melanogenesis inhibitor that exhibits a unique mode of action while preserving melanocyte integrity,” Mukta Sachdev, MD, head of the Department of Dermatology at Manipal Hospital in Bangalore, India, said at a late-breaking news session.
Both the serum and the cysteamine cream lightened participants’ skin to a similar extent, according to the modified Melasma Area and Severity Index (mMASI), with respective reductions of 4.19 and 3.81 points over a period of 4 months from baseline values of 11.15 and 10.93.
The mMASI score ranges from 0 to 24, with the lowest score representing the least and the highest score the most severe hyperpigmentation of the skin.
But the serum performed better than the cream by another measure. Judged by investigators blinded to which preparation study participants had been using, there was a significantly higher reduction in the Investigator Global Assessment (IGA) score from baseline among those treated with the serum than among those treated with the cream (−51.85% vs −39.06%; P = .0163).
Moreover, after 4 months of treatment, there were significantly more participants with clear or almost clear skin with the serum than with the cream (17.46% vs 7.81%; P = .0163), Sachdev reported.
Other skin parameters relative to melasma, such as the brightness of skin tone and evenness of the improvement, improved more in the participants using the serum vs cream, she said.
With “no side effects, no local skin reactions,” Sachdev said, “quality of life improved significantly and similarly, and almost all subjects in both groups were very satisfied with their treatment options.”
Active Ingredients
Margarida Gonçalo, MD, PhD, professor of dermatology at the University of Coimbra, in Portugal, who co-chaired the late-breaking news session, commented: “It’s really nice to have new products to treat such a devastating disease.”
Session co-chair, Lidia Rudnicka, MD, head of the Department of Dermatology, Medical University of Warsaw, in Poland, and president of the Polish Dermatological Society, wanted to know more about the active ingredients of the serum and the study’s design.
Sachdev replied that the serum also contains other ingredients that provide “antioxidant protection” and moisturization. These include retinyl palmitate, which works on the dermal-epidermal junction, and hyaluronic acid, as well as “soothing agents,” such as the medicinal herb Centella asiatica, she said.
Study Design
Conducted at a single center in India, the study involved 127 adults aged 20-50 years with melasma. For inclusion, the participants had to have facial epidermal or mixed melasma (phototypes III-V) for more than 1 year; those with dermal melasma were excluded.
Participants were randomly allocated to receive either the serum, which was applied topically to the areas of interest twice a day in the morning and then at bedtime (n = 63), or cysteamine cream (n = 64), which was applied once a day in addition to a neutral moisturizer. Treatment was for 4 months, with an on-site visit every month.
All participants were supplied with the same sunscreen/ultraviolet protector applied twice a day (once in the morning and again at midday) and a neutral hydrating cleanser that was used in the morning and evening.
Practical Implications
Over 4 months, both products showed significant improvement in melasma without reaching a plateau, Sachdev reported, with the serum demonstrating superior efficacy and tolerability, as judged by the investigators.
The study suggests that the serum is a promising non-hydroquinone treatment for melasma, she said. Hydroquinone-containing topical preparations are used to depigment the skin, but their long-term use can be limited for safety reasons.
“When products like this demonstrate improvement, it is something for the dermatologist to think about because we now have newer ingredients, which are safer and well tolerated,” she continued, noting that there appeared to be no risk for exogenous ochronosis, which can occur with long-term application of hydroquinone.
“So, I think the armamentarium of non-hydroquinone products for the treatment of melasma is rapidly expanding, and there are studies now with clinically proven efficacy,” Sachdev concluded.
The study was supported by L’Oréal France La Roche-Posay, which launched Melasyl in March 2024. Sachdev reported receipt of research support and honoraria from the company. Gonçalo and Rudnicka were not involved in the study and had no relevant conflicts of interest to report.
A version of this article appeared on Medscape.com.
FROM EADV 2024
What We Know About Salmon Sperm in Dermatology
It may not have an aesthetic-sounding appeal to most people, but salmon sperm is indeed one of the novel ingredients featured in products for human skin. These products also reportedly enhance and promote skin regeneration.1 This column will focus on the innovative approach to skin care involving purified polynucleotides derived from salmon sperm.
The Properties and Activities of PDRNs, PNs
PDRNs contain DNA fragments primarily derived from Pacific or chum salmon (Oncorhynchus keta), and salmon trout (Oncorhynchus mykiss) sperm cells.2 Through preclinical and clinical trials, PDRN has demonstrated a wide range of salutary functions, including antiallodynic, antiapoptotic, anti-inflammatory, antimelanogenetic, antiosteonecrotic, antiosteoporotic, antiulcerative, bone-regenerative, tissue damage–preventive, and wound-healing activities through adenosine A2A receptor and salvage pathways activation. Indeed, PDRNs have been shown in vitro to spur the proliferation of preadipocytes and, in vivo, to be effective in treating wounds and ulcers.3,4 In particular, atrophic, hypertrophic, surgical, and various acne scars have been treated with such injections.2,5,6 PDRN is thought to affect cutaneous health more directly by facilitating angiogenesis, cellular functions, especially fibroblast stimulation, collagen production, soft-tissue regeneration, and skin revitalization. Further, it has been used successfully to treat hyperpigmentation.7
PNs, derived from the same fish species as PDRNs, have been used effectively to ameliorate skin elasticity, hydration, pore size, thickness, wrinkles, as well as pigmentation and, specifically, in treating periorbital rhytides and postsurgical scars.5,6,8 Beyond skin rejuvenation, PNs have been recognized for effectiveness in treating stretch marks and achieving vulvovaginal revitalization; guidelines for its use have been established and implemented in recent years.6,9,10 In South Korea, PNs have become a popular treatment for facial erythema even though preclinical and clinical data are sparse.11 Nevertheless, the use of these novel substances is thought to foster tissue regeneration and a more natural rejuvenation than achieved through more traditional fillers.6
Skin Rejuvenation
Park and colleagues conducted a small study with five patients in 2016 in which long-chain polynucleotide filler was used for skin rejuvenation. Over a 2-week period, five Korean women received four injections of the filler (0.05 mL) on one side of the face. No adverse side effects were reported. In the patients in their 30s, pore and skin thickness significantly improved with treatment. For patients in their 40s, observable improvements were noted in melanin, sagging, skin tone, and wrinkles. Despite the small study size, the investigators concluded that this intradermal injection material is a safe and effective product for skin rejuvenation therapy.1 The product is also available in Europe and reportedly spurs the regeneration of damaged tissues and yields a more natural appearance.1
A Hybrid HA-PN Filler
Given that the most common filling agent, hyaluronic acid (HA), is associated with multiple side effects, JH Kim and colleagues set out in 2020 to compare HA with a new HA-PN dermal filler that has displayed notable biocompatibility and promoted tissue regeneration. The investigators observed that the combination filler provoked greater cell migration in a wound healing assay and was more effective in promoting collagen production in human and mouse fibroblasts. To their knowledge, this was the first study showing the efficacy, safety, and durability of a hybrid HA-PN filler. They concluded that fillers containing both HA and PN were more effective than HA alone in suppressing cutaneous aging and may represent the next step in the evolution of dermal filling agents.12
Most Recent Findings
In August 2023, MJ Kim and colleagues became the first to report on the successful use of PNs derived from fish sperm as a volumizing treatment for fat atrophy in vivo (in the temple in one case, and the cheek in the other). Injections were made into the subcutaneous layer to treat iatrogenic volume loss resulting from lipolysis injections. In one case, a depression in the left temple of a 53-year-old female lipolysis patient was treated with a series of 1 cc PN injections in a 20 mg/mL concentration. At 1 month after the final series of injections (four treatments), significant clinical improvement was observed, with the result (barely visible depression) maintained at 11 months and 21 months after the last treatment. The second patient, a 34-year-old female, presented with two depressed areas on the left cheek 2 months after steroid injections for two acne lesions. A series of PN filler injections also with a concentration of 20 mg/mL was administered (four treatments) at 1-month intervals. Significant improvement was seen 2 months after the last treatment, with maintenance of complete healing noted at 5 months and 12 months after the final treatment. No adverse effects were reported in either case. The investigators concluded that long-chain PN fillers appear to be effective in treating depressions in the skin, but more data, particularly from controlled studies, is necessary to determine the safety and efficacy as a lone therapeutic approach for soft-tissue depression.6
A month later, Lee and colleagues reported on the results of their survey of clinicians in South Korea who use PNs in clinical practice. The goal was to understand current practices and perceptions of effectiveness in treating facial erythema. Of the 557 physicians who participated, 84.4% used PNs for facial erythema provoked by inflammatory facial dermatosis, 66.4% for facial erythema induced by repeated laser/microneedle radiofrequency, and 47.4% for facial erythema caused by steroid overuse. In these same classifications, 88.1%, 90%, and 83.7%, respectively, found PNs to be “highly effective” or “effective.” Survey respondents also characterized PNs as imparting wound healing/regeneration (95.8%), skin barrier protection (92.2%), hydration (90.5%), vascular stabilization (81.0%), and anti-inflammatory activity (79.5%).11
Conclusion
The use of salmon sperm cells is an example of the recent trend toward a cellular approach in which cutaneous components are activated with the intention of stimulating tissue regeneration. It is commonly used in Brazil and my Brazilian patients seem to know all about it. This innovative outlook is intriguing as are a spate of recently reported results. Nevertheless, much more evidence is required to ascertain safety and effectiveness in large sample sizes and, ideally, to establish maintenance of corrections over longer periods whether these ingredients are used in filling agents or topical formulations.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur in Miami. She founded the division of cosmetic dermatology at the University of Miami in 1997. The third edition of her bestselling textbook, “Cosmetic Dermatology,” was published in 2022. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Galderma, Johnson & Johnson, and Burt’s Bees. She is the CEO of Skin Type Solutions, a SaaS company used to generate skin care routines in office and as a e-commerce solution. Write to her at [email protected].
References
1. Park KY et al. Dermatol Ther. 2016 Jan;29(1):37-40. .
2. Kim TH et al. Mar Drugs. 2021 May 22;19(6):296.
3. Raposio E et al. Cell Prolif. 2008 Oct;41(5):739-54.
4. Veronesi F et al. J Cell Physiol. 2017 Sep;232(9):2299-2307.
5. Kim JH et al. Lasers Surg Med. 2018 Mar 25.
6. Kim MJ et al. Skin Res Technol. 2023 Aug;29(8):e13439.
7. Khan A et al. Chinese Journal of Plastic and Reconstructive Surgery. 2022 Dec;4(4):187-193.
8. Lee YJ et al. J Dermatolog Treat. 2022 Feb;33(1):254-260.
9. De Caridi G et al. Int Wound J. 2016 Oct;13(5):754-8.
10. Cavallini M et al. J Cosmet Dermatol. 2021 Mar;20(3):922-928.
11. Lee D. Skin Res Technol. 2023 Sep;29(9):e13466. doi: 10.1111/srt.13466.
12. Kim JH et al. Sci Rep. 2020 Mar 20;10(1):5127. .
It may not have an aesthetic-sounding appeal to most people, but salmon sperm is indeed one of the novel ingredients featured in products for human skin. These products also reportedly enhance and promote skin regeneration.1 This column will focus on the innovative approach to skin care involving purified polynucleotides derived from salmon sperm.
The Properties and Activities of PDRNs, PNs
PDRNs contain DNA fragments primarily derived from Pacific or chum salmon (Oncorhynchus keta), and salmon trout (Oncorhynchus mykiss) sperm cells.2 Through preclinical and clinical trials, PDRN has demonstrated a wide range of salutary functions, including antiallodynic, antiapoptotic, anti-inflammatory, antimelanogenetic, antiosteonecrotic, antiosteoporotic, antiulcerative, bone-regenerative, tissue damage–preventive, and wound-healing activities through adenosine A2A receptor and salvage pathways activation. Indeed, PDRNs have been shown in vitro to spur the proliferation of preadipocytes and, in vivo, to be effective in treating wounds and ulcers.3,4 In particular, atrophic, hypertrophic, surgical, and various acne scars have been treated with such injections.2,5,6 PDRN is thought to affect cutaneous health more directly by facilitating angiogenesis, cellular functions, especially fibroblast stimulation, collagen production, soft-tissue regeneration, and skin revitalization. Further, it has been used successfully to treat hyperpigmentation.7
PNs, derived from the same fish species as PDRNs, have been used effectively to ameliorate skin elasticity, hydration, pore size, thickness, wrinkles, as well as pigmentation and, specifically, in treating periorbital rhytides and postsurgical scars.5,6,8 Beyond skin rejuvenation, PNs have been recognized for effectiveness in treating stretch marks and achieving vulvovaginal revitalization; guidelines for its use have been established and implemented in recent years.6,9,10 In South Korea, PNs have become a popular treatment for facial erythema even though preclinical and clinical data are sparse.11 Nevertheless, the use of these novel substances is thought to foster tissue regeneration and a more natural rejuvenation than achieved through more traditional fillers.6
Skin Rejuvenation
Park and colleagues conducted a small study with five patients in 2016 in which long-chain polynucleotide filler was used for skin rejuvenation. Over a 2-week period, five Korean women received four injections of the filler (0.05 mL) on one side of the face. No adverse side effects were reported. In the patients in their 30s, pore and skin thickness significantly improved with treatment. For patients in their 40s, observable improvements were noted in melanin, sagging, skin tone, and wrinkles. Despite the small study size, the investigators concluded that this intradermal injection material is a safe and effective product for skin rejuvenation therapy.1 The product is also available in Europe and reportedly spurs the regeneration of damaged tissues and yields a more natural appearance.1
A Hybrid HA-PN Filler
Given that the most common filling agent, hyaluronic acid (HA), is associated with multiple side effects, JH Kim and colleagues set out in 2020 to compare HA with a new HA-PN dermal filler that has displayed notable biocompatibility and promoted tissue regeneration. The investigators observed that the combination filler provoked greater cell migration in a wound healing assay and was more effective in promoting collagen production in human and mouse fibroblasts. To their knowledge, this was the first study showing the efficacy, safety, and durability of a hybrid HA-PN filler. They concluded that fillers containing both HA and PN were more effective than HA alone in suppressing cutaneous aging and may represent the next step in the evolution of dermal filling agents.12
Most Recent Findings
In August 2023, MJ Kim and colleagues became the first to report on the successful use of PNs derived from fish sperm as a volumizing treatment for fat atrophy in vivo (in the temple in one case, and the cheek in the other). Injections were made into the subcutaneous layer to treat iatrogenic volume loss resulting from lipolysis injections. In one case, a depression in the left temple of a 53-year-old female lipolysis patient was treated with a series of 1 cc PN injections in a 20 mg/mL concentration. At 1 month after the final series of injections (four treatments), significant clinical improvement was observed, with the result (barely visible depression) maintained at 11 months and 21 months after the last treatment. The second patient, a 34-year-old female, presented with two depressed areas on the left cheek 2 months after steroid injections for two acne lesions. A series of PN filler injections also with a concentration of 20 mg/mL was administered (four treatments) at 1-month intervals. Significant improvement was seen 2 months after the last treatment, with maintenance of complete healing noted at 5 months and 12 months after the final treatment. No adverse effects were reported in either case. The investigators concluded that long-chain PN fillers appear to be effective in treating depressions in the skin, but more data, particularly from controlled studies, is necessary to determine the safety and efficacy as a lone therapeutic approach for soft-tissue depression.6
A month later, Lee and colleagues reported on the results of their survey of clinicians in South Korea who use PNs in clinical practice. The goal was to understand current practices and perceptions of effectiveness in treating facial erythema. Of the 557 physicians who participated, 84.4% used PNs for facial erythema provoked by inflammatory facial dermatosis, 66.4% for facial erythema induced by repeated laser/microneedle radiofrequency, and 47.4% for facial erythema caused by steroid overuse. In these same classifications, 88.1%, 90%, and 83.7%, respectively, found PNs to be “highly effective” or “effective.” Survey respondents also characterized PNs as imparting wound healing/regeneration (95.8%), skin barrier protection (92.2%), hydration (90.5%), vascular stabilization (81.0%), and anti-inflammatory activity (79.5%).11
Conclusion
The use of salmon sperm cells is an example of the recent trend toward a cellular approach in which cutaneous components are activated with the intention of stimulating tissue regeneration. It is commonly used in Brazil and my Brazilian patients seem to know all about it. This innovative outlook is intriguing as are a spate of recently reported results. Nevertheless, much more evidence is required to ascertain safety and effectiveness in large sample sizes and, ideally, to establish maintenance of corrections over longer periods whether these ingredients are used in filling agents or topical formulations.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur in Miami. She founded the division of cosmetic dermatology at the University of Miami in 1997. The third edition of her bestselling textbook, “Cosmetic Dermatology,” was published in 2022. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Galderma, Johnson & Johnson, and Burt’s Bees. She is the CEO of Skin Type Solutions, a SaaS company used to generate skin care routines in office and as a e-commerce solution. Write to her at [email protected].
References
1. Park KY et al. Dermatol Ther. 2016 Jan;29(1):37-40. .
2. Kim TH et al. Mar Drugs. 2021 May 22;19(6):296.
3. Raposio E et al. Cell Prolif. 2008 Oct;41(5):739-54.
4. Veronesi F et al. J Cell Physiol. 2017 Sep;232(9):2299-2307.
5. Kim JH et al. Lasers Surg Med. 2018 Mar 25.
6. Kim MJ et al. Skin Res Technol. 2023 Aug;29(8):e13439.
7. Khan A et al. Chinese Journal of Plastic and Reconstructive Surgery. 2022 Dec;4(4):187-193.
8. Lee YJ et al. J Dermatolog Treat. 2022 Feb;33(1):254-260.
9. De Caridi G et al. Int Wound J. 2016 Oct;13(5):754-8.
10. Cavallini M et al. J Cosmet Dermatol. 2021 Mar;20(3):922-928.
11. Lee D. Skin Res Technol. 2023 Sep;29(9):e13466. doi: 10.1111/srt.13466.
12. Kim JH et al. Sci Rep. 2020 Mar 20;10(1):5127. .
It may not have an aesthetic-sounding appeal to most people, but salmon sperm is indeed one of the novel ingredients featured in products for human skin. These products also reportedly enhance and promote skin regeneration.1 This column will focus on the innovative approach to skin care involving purified polynucleotides derived from salmon sperm.
The Properties and Activities of PDRNs, PNs
PDRNs contain DNA fragments primarily derived from Pacific or chum salmon (Oncorhynchus keta), and salmon trout (Oncorhynchus mykiss) sperm cells.2 Through preclinical and clinical trials, PDRN has demonstrated a wide range of salutary functions, including antiallodynic, antiapoptotic, anti-inflammatory, antimelanogenetic, antiosteonecrotic, antiosteoporotic, antiulcerative, bone-regenerative, tissue damage–preventive, and wound-healing activities through adenosine A2A receptor and salvage pathways activation. Indeed, PDRNs have been shown in vitro to spur the proliferation of preadipocytes and, in vivo, to be effective in treating wounds and ulcers.3,4 In particular, atrophic, hypertrophic, surgical, and various acne scars have been treated with such injections.2,5,6 PDRN is thought to affect cutaneous health more directly by facilitating angiogenesis, cellular functions, especially fibroblast stimulation, collagen production, soft-tissue regeneration, and skin revitalization. Further, it has been used successfully to treat hyperpigmentation.7
PNs, derived from the same fish species as PDRNs, have been used effectively to ameliorate skin elasticity, hydration, pore size, thickness, wrinkles, as well as pigmentation and, specifically, in treating periorbital rhytides and postsurgical scars.5,6,8 Beyond skin rejuvenation, PNs have been recognized for effectiveness in treating stretch marks and achieving vulvovaginal revitalization; guidelines for its use have been established and implemented in recent years.6,9,10 In South Korea, PNs have become a popular treatment for facial erythema even though preclinical and clinical data are sparse.11 Nevertheless, the use of these novel substances is thought to foster tissue regeneration and a more natural rejuvenation than achieved through more traditional fillers.6
Skin Rejuvenation
Park and colleagues conducted a small study with five patients in 2016 in which long-chain polynucleotide filler was used for skin rejuvenation. Over a 2-week period, five Korean women received four injections of the filler (0.05 mL) on one side of the face. No adverse side effects were reported. In the patients in their 30s, pore and skin thickness significantly improved with treatment. For patients in their 40s, observable improvements were noted in melanin, sagging, skin tone, and wrinkles. Despite the small study size, the investigators concluded that this intradermal injection material is a safe and effective product for skin rejuvenation therapy.1 The product is also available in Europe and reportedly spurs the regeneration of damaged tissues and yields a more natural appearance.1
A Hybrid HA-PN Filler
Given that the most common filling agent, hyaluronic acid (HA), is associated with multiple side effects, JH Kim and colleagues set out in 2020 to compare HA with a new HA-PN dermal filler that has displayed notable biocompatibility and promoted tissue regeneration. The investigators observed that the combination filler provoked greater cell migration in a wound healing assay and was more effective in promoting collagen production in human and mouse fibroblasts. To their knowledge, this was the first study showing the efficacy, safety, and durability of a hybrid HA-PN filler. They concluded that fillers containing both HA and PN were more effective than HA alone in suppressing cutaneous aging and may represent the next step in the evolution of dermal filling agents.12
Most Recent Findings
In August 2023, MJ Kim and colleagues became the first to report on the successful use of PNs derived from fish sperm as a volumizing treatment for fat atrophy in vivo (in the temple in one case, and the cheek in the other). Injections were made into the subcutaneous layer to treat iatrogenic volume loss resulting from lipolysis injections. In one case, a depression in the left temple of a 53-year-old female lipolysis patient was treated with a series of 1 cc PN injections in a 20 mg/mL concentration. At 1 month after the final series of injections (four treatments), significant clinical improvement was observed, with the result (barely visible depression) maintained at 11 months and 21 months after the last treatment. The second patient, a 34-year-old female, presented with two depressed areas on the left cheek 2 months after steroid injections for two acne lesions. A series of PN filler injections also with a concentration of 20 mg/mL was administered (four treatments) at 1-month intervals. Significant improvement was seen 2 months after the last treatment, with maintenance of complete healing noted at 5 months and 12 months after the final treatment. No adverse effects were reported in either case. The investigators concluded that long-chain PN fillers appear to be effective in treating depressions in the skin, but more data, particularly from controlled studies, is necessary to determine the safety and efficacy as a lone therapeutic approach for soft-tissue depression.6
A month later, Lee and colleagues reported on the results of their survey of clinicians in South Korea who use PNs in clinical practice. The goal was to understand current practices and perceptions of effectiveness in treating facial erythema. Of the 557 physicians who participated, 84.4% used PNs for facial erythema provoked by inflammatory facial dermatosis, 66.4% for facial erythema induced by repeated laser/microneedle radiofrequency, and 47.4% for facial erythema caused by steroid overuse. In these same classifications, 88.1%, 90%, and 83.7%, respectively, found PNs to be “highly effective” or “effective.” Survey respondents also characterized PNs as imparting wound healing/regeneration (95.8%), skin barrier protection (92.2%), hydration (90.5%), vascular stabilization (81.0%), and anti-inflammatory activity (79.5%).11
Conclusion
The use of salmon sperm cells is an example of the recent trend toward a cellular approach in which cutaneous components are activated with the intention of stimulating tissue regeneration. It is commonly used in Brazil and my Brazilian patients seem to know all about it. This innovative outlook is intriguing as are a spate of recently reported results. Nevertheless, much more evidence is required to ascertain safety and effectiveness in large sample sizes and, ideally, to establish maintenance of corrections over longer periods whether these ingredients are used in filling agents or topical formulations.
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur in Miami. She founded the division of cosmetic dermatology at the University of Miami in 1997. The third edition of her bestselling textbook, “Cosmetic Dermatology,” was published in 2022. Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Galderma, Johnson & Johnson, and Burt’s Bees. She is the CEO of Skin Type Solutions, a SaaS company used to generate skin care routines in office and as a e-commerce solution. Write to her at [email protected].
References
1. Park KY et al. Dermatol Ther. 2016 Jan;29(1):37-40. .
2. Kim TH et al. Mar Drugs. 2021 May 22;19(6):296.
3. Raposio E et al. Cell Prolif. 2008 Oct;41(5):739-54.
4. Veronesi F et al. J Cell Physiol. 2017 Sep;232(9):2299-2307.
5. Kim JH et al. Lasers Surg Med. 2018 Mar 25.
6. Kim MJ et al. Skin Res Technol. 2023 Aug;29(8):e13439.
7. Khan A et al. Chinese Journal of Plastic and Reconstructive Surgery. 2022 Dec;4(4):187-193.
8. Lee YJ et al. J Dermatolog Treat. 2022 Feb;33(1):254-260.
9. De Caridi G et al. Int Wound J. 2016 Oct;13(5):754-8.
10. Cavallini M et al. J Cosmet Dermatol. 2021 Mar;20(3):922-928.
11. Lee D. Skin Res Technol. 2023 Sep;29(9):e13466. doi: 10.1111/srt.13466.
12. Kim JH et al. Sci Rep. 2020 Mar 20;10(1):5127. .
FDA Approves IL-13 inhibitor for Atopic Dermatitis
The that is not well controlled, despite treatment with topical prescription therapies.
The recommended initial starting dose of lebrikizumab consists of 500 mg (two 250 mg injections) at baseline and week 2, followed by 250 mg every 2 weeks until week 16 or later when adequate clinical response is achieved. Then, maintenance dosing is recommended with one monthly injection (250 mg every 4 weeks). Children aged 12-17 years must weigh at least 88 pounds (40 kg) to be eligible for lebrikizumab treatment.
According to a press release from Lilly, which has been developing lebrikizumab, approval was based on results from the ADvocate 1, ADvocate 2, and ADhere studies, which included over 1000 adults and children aged 12 and older with moderate to severe AD. The primary endpoint for these studies was evaluated at 16 weeks and measured clear or almost clear skin (IGA score of 0 or 1).
According to Lilly, 38% of people in ADvocate 1 and 2 who took lebrikizumab achieved clear or almost-clear skin at 16 weeks, compared with 12% of those in the placebo arm, and 10% experienced these results as early as 4 weeks. Of those treated with lebrikizumab who experienced clear or almost-clear skin at week 16, 77% maintained those results at 1 year on the once-monthly dose. In addition, on average, 43% of those on lebrikizumab experienced relief of itch at 16 weeks, compared with 12% of those on placebo, according to the press release.
The most common side effects of lebrikizumab observed in the clinical trials include eye and eyelid inflammation, such as redness, swelling, and itching; injection-site reactions; and herpes zoster (shingles).
Lebrikizumab was approved in Japan in January 2024, and by the European Commission in 2023.
A version of this article first appeared on Medscape.com.
The that is not well controlled, despite treatment with topical prescription therapies.
The recommended initial starting dose of lebrikizumab consists of 500 mg (two 250 mg injections) at baseline and week 2, followed by 250 mg every 2 weeks until week 16 or later when adequate clinical response is achieved. Then, maintenance dosing is recommended with one monthly injection (250 mg every 4 weeks). Children aged 12-17 years must weigh at least 88 pounds (40 kg) to be eligible for lebrikizumab treatment.
According to a press release from Lilly, which has been developing lebrikizumab, approval was based on results from the ADvocate 1, ADvocate 2, and ADhere studies, which included over 1000 adults and children aged 12 and older with moderate to severe AD. The primary endpoint for these studies was evaluated at 16 weeks and measured clear or almost clear skin (IGA score of 0 or 1).
According to Lilly, 38% of people in ADvocate 1 and 2 who took lebrikizumab achieved clear or almost-clear skin at 16 weeks, compared with 12% of those in the placebo arm, and 10% experienced these results as early as 4 weeks. Of those treated with lebrikizumab who experienced clear or almost-clear skin at week 16, 77% maintained those results at 1 year on the once-monthly dose. In addition, on average, 43% of those on lebrikizumab experienced relief of itch at 16 weeks, compared with 12% of those on placebo, according to the press release.
The most common side effects of lebrikizumab observed in the clinical trials include eye and eyelid inflammation, such as redness, swelling, and itching; injection-site reactions; and herpes zoster (shingles).
Lebrikizumab was approved in Japan in January 2024, and by the European Commission in 2023.
A version of this article first appeared on Medscape.com.
The that is not well controlled, despite treatment with topical prescription therapies.
The recommended initial starting dose of lebrikizumab consists of 500 mg (two 250 mg injections) at baseline and week 2, followed by 250 mg every 2 weeks until week 16 or later when adequate clinical response is achieved. Then, maintenance dosing is recommended with one monthly injection (250 mg every 4 weeks). Children aged 12-17 years must weigh at least 88 pounds (40 kg) to be eligible for lebrikizumab treatment.
According to a press release from Lilly, which has been developing lebrikizumab, approval was based on results from the ADvocate 1, ADvocate 2, and ADhere studies, which included over 1000 adults and children aged 12 and older with moderate to severe AD. The primary endpoint for these studies was evaluated at 16 weeks and measured clear or almost clear skin (IGA score of 0 or 1).
According to Lilly, 38% of people in ADvocate 1 and 2 who took lebrikizumab achieved clear or almost-clear skin at 16 weeks, compared with 12% of those in the placebo arm, and 10% experienced these results as early as 4 weeks. Of those treated with lebrikizumab who experienced clear or almost-clear skin at week 16, 77% maintained those results at 1 year on the once-monthly dose. In addition, on average, 43% of those on lebrikizumab experienced relief of itch at 16 weeks, compared with 12% of those on placebo, according to the press release.
The most common side effects of lebrikizumab observed in the clinical trials include eye and eyelid inflammation, such as redness, swelling, and itching; injection-site reactions; and herpes zoster (shingles).
Lebrikizumab was approved in Japan in January 2024, and by the European Commission in 2023.
A version of this article first appeared on Medscape.com.
Who’s Behind Cosmetic Procedures at MedSpas?
CARLSBAD, CALIFORNIA — according to Sara Hogan, MD.
“I’m not anti-MedSpa; I’m pro-patient safety,” Dr. Hogan, clinical assistant professor of dermatology at George Washington University, Washington, DC, said at the Controversies & Conversations in Laser & Cosmetic Surgery symposium. “The MedSpa industry is booming; it brought in $17 billion in 2023. There are as many MedSpas in the United States as there are practicing dermatologists, and that number is set to exceed the number of dermatologists.”
According to industry data from the American Med Spa Association, 63% of member MedSpas have non-MD ownership. Among MedSpas owned by physicians, 80% are of a non–core specialty, meaning a specialty other than dermatology, plastic surgery, otorhinolaryngology, or ophthalmology. Of MedSpa medical directors, 69% are from non–core physician specialties. “There’s an increasing amount of data that shows a relatively higher incidence of complications from cosmetic procedures that are delivered at MedSpas,” Dr. Hogan said. “A 2020 study suggested that this is likely due to improper training, improper technique, and/or improper device settings.”
Dr. Hogan also cited adverse effects linked to counterfeit or mishandled botulinum toxin injections that prompted the Centers for Disease Control and Prevention to issue an alert to clinicians in April 2024. Clusters of 22 people in 11 states reported adverse effects after receiving injections with counterfeit botulinum toxin or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas.
To better understand who performs cosmetic procedures, provides medical supervision, and follows safety protocols at MedSpas, Dr. Hogan and colleagues conducted a “truth in advertising” study of 127 MedSpas in the greater Chicago area. They chose this geographic location because an analysis published in 2021 identified Chicago as having the third highest number of aesthetic physicians and the fifth highest number of MedSpas in the United States. The researchers enlisted help from “secret shoppers” who contacted the MedSpas by telephone to ask about the level of training, if patients underwent a review of medical history, the level of on-site physician supervision, and the protocol for complications.
The top five cosmetic procedures offered by the 127 surveyed MedSpas were facials (85.0%), hair removal (85.0%), botulinum toxin injections (83.5%), dermal fillers (82.7%), and chemical peels (76.4%). About two thirds of cosmetic procedures were performed by aestheticians (66.9%), followed by registered nurses or licensed practical nurses (52.8%), board-certified physicians (48.8%, mostly plastic and reconstructive surgeons), nurse practitioners (27.6%), and physician assistants (9.4%).
In the realm of supervision, 16.5% of MedSpas surveyed reported that a medical director or supervising physician is always on site. “If not located on site, when asked where the physicians are, the majority of the time they were at the physician’s primary practice, clinic, or hospital,” Dr. Hogan said. “Only 65% of the MedSpas surveyed stated that they informed the patient that the supervising physician is not on site. In addition, a patient’s medical history is reviewed at only 40% of the MedSpas. To give context, in Illinois, a physician can only deliver care after a physician-patient relationship has been established, meaning that a good faith exam has been performed. And if they are to delegate any type of service, they must always be on site to provide assistance.”
Dr. Hogan noted that there are no federal statutes or agencies that regulate or oversee MedSpas. “Regulation and oversight are often delegated to state licensing agencies that are overwhelmed and often stretched thin regarding personnel and budgets,” she said. To raise awareness of this issue, the American Society for Dermatologic Surgery Association (ASDSA) launched the Medical Spa Safety Coalition, which aims to promote model legislation for states known as the Medical Spa Safety Act. Highlights of the bill include clear definitions of medical spa and medical director, as well as the requirement of an on-site medical director who must be a physician trained in all procedures performed at the MedSpa. Coalition members include 16 state dermatology boards as well as the ASDSA, the American Academy of Dermatology Association, the American Society for Laser Medicine & Surgery, and the American Society of Plastic Surgeons.
The ASDSA provided funding to support the published study. Dr. Hogan reported having no financial disclosures.
A version of this article appeared on Medscape.com.
CARLSBAD, CALIFORNIA — according to Sara Hogan, MD.
“I’m not anti-MedSpa; I’m pro-patient safety,” Dr. Hogan, clinical assistant professor of dermatology at George Washington University, Washington, DC, said at the Controversies & Conversations in Laser & Cosmetic Surgery symposium. “The MedSpa industry is booming; it brought in $17 billion in 2023. There are as many MedSpas in the United States as there are practicing dermatologists, and that number is set to exceed the number of dermatologists.”
According to industry data from the American Med Spa Association, 63% of member MedSpas have non-MD ownership. Among MedSpas owned by physicians, 80% are of a non–core specialty, meaning a specialty other than dermatology, plastic surgery, otorhinolaryngology, or ophthalmology. Of MedSpa medical directors, 69% are from non–core physician specialties. “There’s an increasing amount of data that shows a relatively higher incidence of complications from cosmetic procedures that are delivered at MedSpas,” Dr. Hogan said. “A 2020 study suggested that this is likely due to improper training, improper technique, and/or improper device settings.”
Dr. Hogan also cited adverse effects linked to counterfeit or mishandled botulinum toxin injections that prompted the Centers for Disease Control and Prevention to issue an alert to clinicians in April 2024. Clusters of 22 people in 11 states reported adverse effects after receiving injections with counterfeit botulinum toxin or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas.
To better understand who performs cosmetic procedures, provides medical supervision, and follows safety protocols at MedSpas, Dr. Hogan and colleagues conducted a “truth in advertising” study of 127 MedSpas in the greater Chicago area. They chose this geographic location because an analysis published in 2021 identified Chicago as having the third highest number of aesthetic physicians and the fifth highest number of MedSpas in the United States. The researchers enlisted help from “secret shoppers” who contacted the MedSpas by telephone to ask about the level of training, if patients underwent a review of medical history, the level of on-site physician supervision, and the protocol for complications.
The top five cosmetic procedures offered by the 127 surveyed MedSpas were facials (85.0%), hair removal (85.0%), botulinum toxin injections (83.5%), dermal fillers (82.7%), and chemical peels (76.4%). About two thirds of cosmetic procedures were performed by aestheticians (66.9%), followed by registered nurses or licensed practical nurses (52.8%), board-certified physicians (48.8%, mostly plastic and reconstructive surgeons), nurse practitioners (27.6%), and physician assistants (9.4%).
In the realm of supervision, 16.5% of MedSpas surveyed reported that a medical director or supervising physician is always on site. “If not located on site, when asked where the physicians are, the majority of the time they were at the physician’s primary practice, clinic, or hospital,” Dr. Hogan said. “Only 65% of the MedSpas surveyed stated that they informed the patient that the supervising physician is not on site. In addition, a patient’s medical history is reviewed at only 40% of the MedSpas. To give context, in Illinois, a physician can only deliver care after a physician-patient relationship has been established, meaning that a good faith exam has been performed. And if they are to delegate any type of service, they must always be on site to provide assistance.”
Dr. Hogan noted that there are no federal statutes or agencies that regulate or oversee MedSpas. “Regulation and oversight are often delegated to state licensing agencies that are overwhelmed and often stretched thin regarding personnel and budgets,” she said. To raise awareness of this issue, the American Society for Dermatologic Surgery Association (ASDSA) launched the Medical Spa Safety Coalition, which aims to promote model legislation for states known as the Medical Spa Safety Act. Highlights of the bill include clear definitions of medical spa and medical director, as well as the requirement of an on-site medical director who must be a physician trained in all procedures performed at the MedSpa. Coalition members include 16 state dermatology boards as well as the ASDSA, the American Academy of Dermatology Association, the American Society for Laser Medicine & Surgery, and the American Society of Plastic Surgeons.
The ASDSA provided funding to support the published study. Dr. Hogan reported having no financial disclosures.
A version of this article appeared on Medscape.com.
CARLSBAD, CALIFORNIA — according to Sara Hogan, MD.
“I’m not anti-MedSpa; I’m pro-patient safety,” Dr. Hogan, clinical assistant professor of dermatology at George Washington University, Washington, DC, said at the Controversies & Conversations in Laser & Cosmetic Surgery symposium. “The MedSpa industry is booming; it brought in $17 billion in 2023. There are as many MedSpas in the United States as there are practicing dermatologists, and that number is set to exceed the number of dermatologists.”
According to industry data from the American Med Spa Association, 63% of member MedSpas have non-MD ownership. Among MedSpas owned by physicians, 80% are of a non–core specialty, meaning a specialty other than dermatology, plastic surgery, otorhinolaryngology, or ophthalmology. Of MedSpa medical directors, 69% are from non–core physician specialties. “There’s an increasing amount of data that shows a relatively higher incidence of complications from cosmetic procedures that are delivered at MedSpas,” Dr. Hogan said. “A 2020 study suggested that this is likely due to improper training, improper technique, and/or improper device settings.”
Dr. Hogan also cited adverse effects linked to counterfeit or mishandled botulinum toxin injections that prompted the Centers for Disease Control and Prevention to issue an alert to clinicians in April 2024. Clusters of 22 people in 11 states reported adverse effects after receiving injections with counterfeit botulinum toxin or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas.
To better understand who performs cosmetic procedures, provides medical supervision, and follows safety protocols at MedSpas, Dr. Hogan and colleagues conducted a “truth in advertising” study of 127 MedSpas in the greater Chicago area. They chose this geographic location because an analysis published in 2021 identified Chicago as having the third highest number of aesthetic physicians and the fifth highest number of MedSpas in the United States. The researchers enlisted help from “secret shoppers” who contacted the MedSpas by telephone to ask about the level of training, if patients underwent a review of medical history, the level of on-site physician supervision, and the protocol for complications.
The top five cosmetic procedures offered by the 127 surveyed MedSpas were facials (85.0%), hair removal (85.0%), botulinum toxin injections (83.5%), dermal fillers (82.7%), and chemical peels (76.4%). About two thirds of cosmetic procedures were performed by aestheticians (66.9%), followed by registered nurses or licensed practical nurses (52.8%), board-certified physicians (48.8%, mostly plastic and reconstructive surgeons), nurse practitioners (27.6%), and physician assistants (9.4%).
In the realm of supervision, 16.5% of MedSpas surveyed reported that a medical director or supervising physician is always on site. “If not located on site, when asked where the physicians are, the majority of the time they were at the physician’s primary practice, clinic, or hospital,” Dr. Hogan said. “Only 65% of the MedSpas surveyed stated that they informed the patient that the supervising physician is not on site. In addition, a patient’s medical history is reviewed at only 40% of the MedSpas. To give context, in Illinois, a physician can only deliver care after a physician-patient relationship has been established, meaning that a good faith exam has been performed. And if they are to delegate any type of service, they must always be on site to provide assistance.”
Dr. Hogan noted that there are no federal statutes or agencies that regulate or oversee MedSpas. “Regulation and oversight are often delegated to state licensing agencies that are overwhelmed and often stretched thin regarding personnel and budgets,” she said. To raise awareness of this issue, the American Society for Dermatologic Surgery Association (ASDSA) launched the Medical Spa Safety Coalition, which aims to promote model legislation for states known as the Medical Spa Safety Act. Highlights of the bill include clear definitions of medical spa and medical director, as well as the requirement of an on-site medical director who must be a physician trained in all procedures performed at the MedSpa. Coalition members include 16 state dermatology boards as well as the ASDSA, the American Academy of Dermatology Association, the American Society for Laser Medicine & Surgery, and the American Society of Plastic Surgeons.
The ASDSA provided funding to support the published study. Dr. Hogan reported having no financial disclosures.
A version of this article appeared on Medscape.com.
Fillers, Hyaluronidase Relieve Orofacial Changes in Patients with Scleroderma
CARLSBAD, CALIFORNIA — In 2003, researchers asked 303 patients with systemic sclerosis (scleroderma) what bothered them most about their disease from an aesthetic standpoint: Orofacial features, such as thin lips and mouth furrows, or non-facial features, such as fingertip ulceration and waxy changes to the skin.
Respondents expressed significant concern about specific orofacial features, including thin lips (73%), mouth furrows (80%), loss of facial lines (68%), and a smaller, tighter mouth (77%).
“Patients with systemic sclerosis may have loss of vermilion lip, microstomia, and perioral rhytids,” Kathleen Cook Suozzi, MD, who directs the Aesthetic Dermatology Program at Yale University School of Medicine, New Haven, Connecticut, said at the Controversies and Conversations in Laser and Cosmetic Surgery annual symposium. “How can we address these changes for our patients?”
Recent research has shown that hyaluronidase injections can help improve orofacial changes commonly experienced by patients with scleroderma. In 2019, researchers in Alabama reported the case of a 53-year-old woman treated with hyaluronidase for scleroderma-induced microstomia. After four visits over 7 months and a total hyaluronidase dose of 470 IU, the patient reported an improved Mouth Handicap in Systemic Sclerosis (MHISS) score (38 of 48); subjective improvement of symptoms, including greater ease in eating and undergoing dental treatment; and improved mouth closure.
In 2023, researchers published a cohort study of four women between the ages of 43 and 61 with autoimmune sclerosing conditions that resulted in oral microstomia. Following hyaluronidase injections, all improved in mouth opening capacity and MHISS, with change stabilizing between three and five treatments. More recently, in a study pending publication in JAAD Case Reports, Dr. Suozzi and colleagues retrospectively evaluated 12 women with scleroderma who received between 150 and 300 units of hyaluronic acid (HA) filler for microstomia between 2020 and 2023. Of the 12 women, 58% had diffuse disease, and 42% had limited disease. Overall, oral aperture width increased by 0.65 cm (P = .0027) and oral aperture height increased by 0.88 cm (P < .0001). “In general, patients needed three to four treatments to reach peak effect, and then they reached a plateau,” Dr. Suozzi said. “It wasn’t that the treatment wasn’t working anymore, but it was because their oral aperture had gotten to a size of around 5 cm, which is clinically normal. Interestingly, we found that if the patient’s disease flared and their microstomia started to return, when you rechallenged them, they continued to respond. So, patients can continue to use this treatment over time.”
In a separate case series of seven patients, Dr. Suozzi and colleagues prospectively evaluated the effect of HA soft tissue filler with Restylane Silk for lip augmentation. Study participants experienced statistically significant increases in the difference between pre- and postinjection fullness in both upper and lower lips. Also, the mean posttreatment score fell between “much improved” (2) and “improved” (3) on both the Investigator Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale.
Dr. Suozzi recommends using nerve blocks for injecting HA filler or hyaluronidase in patients with scleroderma and minimizing the injection points. “Initially, we were using 30% lidocaine preparations around the mouth for an hour before the procedure, and patients were still having pain, so now we use nerve blocks,” she said. “For hyaluronidase, we do perform a test dose of 75-100 units, usually in the commissure. It’s amazing how well it works; people will usually come back after their test dose and have improvements in their measurements. This is a really easy treatment to perform, and I think it can be done in the office of a general dermatologist. There is concern about cross-reactivity with bee venom, so you want to ask patients about that.”
Dr. Suozzi reported having no relevant financial relationships.
A version of this article first appeared on Medscape.com.
CARLSBAD, CALIFORNIA — In 2003, researchers asked 303 patients with systemic sclerosis (scleroderma) what bothered them most about their disease from an aesthetic standpoint: Orofacial features, such as thin lips and mouth furrows, or non-facial features, such as fingertip ulceration and waxy changes to the skin.
Respondents expressed significant concern about specific orofacial features, including thin lips (73%), mouth furrows (80%), loss of facial lines (68%), and a smaller, tighter mouth (77%).
“Patients with systemic sclerosis may have loss of vermilion lip, microstomia, and perioral rhytids,” Kathleen Cook Suozzi, MD, who directs the Aesthetic Dermatology Program at Yale University School of Medicine, New Haven, Connecticut, said at the Controversies and Conversations in Laser and Cosmetic Surgery annual symposium. “How can we address these changes for our patients?”
Recent research has shown that hyaluronidase injections can help improve orofacial changes commonly experienced by patients with scleroderma. In 2019, researchers in Alabama reported the case of a 53-year-old woman treated with hyaluronidase for scleroderma-induced microstomia. After four visits over 7 months and a total hyaluronidase dose of 470 IU, the patient reported an improved Mouth Handicap in Systemic Sclerosis (MHISS) score (38 of 48); subjective improvement of symptoms, including greater ease in eating and undergoing dental treatment; and improved mouth closure.
In 2023, researchers published a cohort study of four women between the ages of 43 and 61 with autoimmune sclerosing conditions that resulted in oral microstomia. Following hyaluronidase injections, all improved in mouth opening capacity and MHISS, with change stabilizing between three and five treatments. More recently, in a study pending publication in JAAD Case Reports, Dr. Suozzi and colleagues retrospectively evaluated 12 women with scleroderma who received between 150 and 300 units of hyaluronic acid (HA) filler for microstomia between 2020 and 2023. Of the 12 women, 58% had diffuse disease, and 42% had limited disease. Overall, oral aperture width increased by 0.65 cm (P = .0027) and oral aperture height increased by 0.88 cm (P < .0001). “In general, patients needed three to four treatments to reach peak effect, and then they reached a plateau,” Dr. Suozzi said. “It wasn’t that the treatment wasn’t working anymore, but it was because their oral aperture had gotten to a size of around 5 cm, which is clinically normal. Interestingly, we found that if the patient’s disease flared and their microstomia started to return, when you rechallenged them, they continued to respond. So, patients can continue to use this treatment over time.”
In a separate case series of seven patients, Dr. Suozzi and colleagues prospectively evaluated the effect of HA soft tissue filler with Restylane Silk for lip augmentation. Study participants experienced statistically significant increases in the difference between pre- and postinjection fullness in both upper and lower lips. Also, the mean posttreatment score fell between “much improved” (2) and “improved” (3) on both the Investigator Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale.
Dr. Suozzi recommends using nerve blocks for injecting HA filler or hyaluronidase in patients with scleroderma and minimizing the injection points. “Initially, we were using 30% lidocaine preparations around the mouth for an hour before the procedure, and patients were still having pain, so now we use nerve blocks,” she said. “For hyaluronidase, we do perform a test dose of 75-100 units, usually in the commissure. It’s amazing how well it works; people will usually come back after their test dose and have improvements in their measurements. This is a really easy treatment to perform, and I think it can be done in the office of a general dermatologist. There is concern about cross-reactivity with bee venom, so you want to ask patients about that.”
Dr. Suozzi reported having no relevant financial relationships.
A version of this article first appeared on Medscape.com.
CARLSBAD, CALIFORNIA — In 2003, researchers asked 303 patients with systemic sclerosis (scleroderma) what bothered them most about their disease from an aesthetic standpoint: Orofacial features, such as thin lips and mouth furrows, or non-facial features, such as fingertip ulceration and waxy changes to the skin.
Respondents expressed significant concern about specific orofacial features, including thin lips (73%), mouth furrows (80%), loss of facial lines (68%), and a smaller, tighter mouth (77%).
“Patients with systemic sclerosis may have loss of vermilion lip, microstomia, and perioral rhytids,” Kathleen Cook Suozzi, MD, who directs the Aesthetic Dermatology Program at Yale University School of Medicine, New Haven, Connecticut, said at the Controversies and Conversations in Laser and Cosmetic Surgery annual symposium. “How can we address these changes for our patients?”
Recent research has shown that hyaluronidase injections can help improve orofacial changes commonly experienced by patients with scleroderma. In 2019, researchers in Alabama reported the case of a 53-year-old woman treated with hyaluronidase for scleroderma-induced microstomia. After four visits over 7 months and a total hyaluronidase dose of 470 IU, the patient reported an improved Mouth Handicap in Systemic Sclerosis (MHISS) score (38 of 48); subjective improvement of symptoms, including greater ease in eating and undergoing dental treatment; and improved mouth closure.
In 2023, researchers published a cohort study of four women between the ages of 43 and 61 with autoimmune sclerosing conditions that resulted in oral microstomia. Following hyaluronidase injections, all improved in mouth opening capacity and MHISS, with change stabilizing between three and five treatments. More recently, in a study pending publication in JAAD Case Reports, Dr. Suozzi and colleagues retrospectively evaluated 12 women with scleroderma who received between 150 and 300 units of hyaluronic acid (HA) filler for microstomia between 2020 and 2023. Of the 12 women, 58% had diffuse disease, and 42% had limited disease. Overall, oral aperture width increased by 0.65 cm (P = .0027) and oral aperture height increased by 0.88 cm (P < .0001). “In general, patients needed three to four treatments to reach peak effect, and then they reached a plateau,” Dr. Suozzi said. “It wasn’t that the treatment wasn’t working anymore, but it was because their oral aperture had gotten to a size of around 5 cm, which is clinically normal. Interestingly, we found that if the patient’s disease flared and their microstomia started to return, when you rechallenged them, they continued to respond. So, patients can continue to use this treatment over time.”
In a separate case series of seven patients, Dr. Suozzi and colleagues prospectively evaluated the effect of HA soft tissue filler with Restylane Silk for lip augmentation. Study participants experienced statistically significant increases in the difference between pre- and postinjection fullness in both upper and lower lips. Also, the mean posttreatment score fell between “much improved” (2) and “improved” (3) on both the Investigator Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale.
Dr. Suozzi recommends using nerve blocks for injecting HA filler or hyaluronidase in patients with scleroderma and minimizing the injection points. “Initially, we were using 30% lidocaine preparations around the mouth for an hour before the procedure, and patients were still having pain, so now we use nerve blocks,” she said. “For hyaluronidase, we do perform a test dose of 75-100 units, usually in the commissure. It’s amazing how well it works; people will usually come back after their test dose and have improvements in their measurements. This is a really easy treatment to perform, and I think it can be done in the office of a general dermatologist. There is concern about cross-reactivity with bee venom, so you want to ask patients about that.”
Dr. Suozzi reported having no relevant financial relationships.
A version of this article first appeared on Medscape.com.
Lipedema: Current Diagnostic and Treatment Evidence
Lipedema affects about 11% of cisgender women, according to the Brazilian Society of Angiology and Vascular Surgery. Yet the condition remains wrapped in uncertainties. Despite significant advancements in understanding its physiology, diagnosis, and treatment, more clarity is needed as awareness and diagnoses increase.
At the latest International Congress on Obesity (ICO) in São Paulo, Brazil, Philipp Scherer, PhD, director of the Touchstone Diabetes Center, discussed the complexities of lipedema. “It is an extremely frustrating condition for someone like me, who has spent a lifetime studying functional and dysfunctional adipose tissue. We are trying to understand the physiology of this pathology, but it is challenging, and so far, we have not been able to find a concrete answer,” he noted.
Lipedema is characterized by the abnormal accumulation of subcutaneous adipose tissue, especially in the lower limbs, and almost exclusively affects cisgender women. The reason for this gender disparity is unclear. It could be an intrinsic characteristic of the disease or a result from clinicians’ lack of familiarity with lipedema, which often leads to misdiagnosis as obesity. This misdiagnosis results in fewer men seeking treatment.
Research has predominantly focused on women, and evidence suggests that hormones play a crucial role in the disease’s pathophysiology. Lipedema typically manifests during periods of hormonal changes, such as puberty, pregnancy, menopause, and hormone replacement therapies, reinforcing the idea that hormones significantly influence the condition’s development and progression.
Main Symptoms
Jonathan Kartt, CEO of the Lipedema Foundation, emphasized that intense pain in the areas of adipose tissue accumulation is a hallmark symptom of lipedema, setting it apart from obesity. Pain levels can vary widely among patients, ranging from moderate to severe, with unbearable peaks on certain days. Mr. Kartt stressed the importance of recognizing and addressing this often underestimated symptom.
Lipedema is characterized by a bilateral, symmetrical increase in mass compared with the rest of the body. This is commonly distinguished by the “cuff sign,” a separation between normal tissue in the feet and abnormal tissue from the ankle upward. Other frequent symptoms include a feeling of heaviness, discomfort, fatigue, frequent bruising, and tiredness. A notable sign is the presence of subcutaneous nodules with a texture similar to that of rice grains, which are crucial for differentiating lipedema from other conditions. Palpation during anamnesis is essential to identify these nodules and confirm the diagnosis.
“It is crucial to investigate the family history for genetic predisposition. Additionally, it is fundamental to ask whether, even with weight loss, the affected areas retain accumulated fat. Hormonal changes, pain symptoms, and impact on quality of life should also be carefully evaluated,” advised Mr. Kartt.
Diagnostic Tools
André Murad, MD, a clinical consultant at the Instituto Lipedema Brazil, has been exploring new diagnostic approaches for lipedema beyond traditional anamnesis. During his presentation at the ICO, he shared studies on the efficacy of imaging exams such as ultrasound, tomography, and MRI in diagnosing the characteristic lipedema-associated increase in subcutaneous tissue.
He also discussed lymphangiography and lymphoscintigraphy, highlighting the use of magnetic resonance lymphangiography to evaluate dilated lymphatic vessels often observed in patients with lipedema. “By injecting contrast into the feet, this technique allows the evaluation of vessels, which are usually dilated, indicating characteristic lymphatic system overload in lipedema. Lymphoscintigraphy is crucial for detecting associated lymphedema, revealing delayed lymphatic flow and asymmetry between limbs in cases of lipedema without lymphedema,” he explained.
Despite the various diagnostic options, Dr. Murad highlighted two highly effective studies. A Brazilian study used ultrasound to establish a cutoff point of 11.7 mm in the pretibial subcutaneous tissue thickness, achieving 96% specificity for diagnosis. Another study emphasized the value of dual-energy x-ray absorptiometry (DXA), which demonstrated 95% sensitivity. This method assesses fat distribution by correlating the amount present in the legs with the total body, providing a cost-effective and accessible option for specialists.
“DXA allows for a precise mathematical evaluation of fat distribution relative to the total body. A ratio of 0.38 in the leg-to-body relationship is a significant indicator of high suspicion of lipedema,” highlighted Dr. Murad. “In clinical practice, many patients self-diagnose with lipedema, but the clinical exam often reveals no disproportion, with the leg-to-body ratio below 0.38 being common in these cases,” he added.
Treatment Approaches
Treatments for lipedema are still evolving, with considerable debate about the best approach. While some specialists advocate exclusively for conservative treatment, others recommend combining these methods with surgical interventions, depending on the stage of the disease. The relative novelty of lipedema and the scarcity of robust, long-term studies contribute to the uncertainty around treatment efficacy.
Conservative treatment typically includes compression, lymphatic drainage techniques, and pressure therapy. An active lifestyle and a healthy diet are also recommended. Although these measures do not prevent the accumulation of adipose tissue, they help reduce inflammation and improve quality of life. “Even though the causes of lipedema are not fully known, lifestyle management is essential for controlling symptoms, starting with an anti-inflammatory diet,” emphasized Dr. Murad.
Because insulin promotes lipogenesis, a diet that avoids spikes in glycemic and insulin levels is advisable. Insulin resistance can exacerbate edema formation, so a Mediterranean diet may be beneficial. This diet limits fast-absorbing carbohydrates, such as added sugar, refined grains, and ultraprocessed foods, while promoting complex carbohydrates from whole grains and legumes.
Dr. Murad also presented a study evaluating the potential benefits of a low-carbohydrate, high-fat diet for patients with lipedema. The study demonstrated weight loss, reduced body fat, controlled leg volume, and, notably, pain relief.
For more advanced stages of lipedema, plastic surgery is often considered when conservative approaches do not yield satisfactory results. Some specialists advocate for surgery as an effective way to remove diseased adipose cells and reduce excess fat accumulation, which can improve physical appearance and associated pain. There is a growing consensus that surgical intervention should be performed early, ideally in stage I of IV, to maximize efficacy and prevent disease progression.
Fábio Masato Kamamoto, MD, a plastic surgeon and director of the Instituto Lipedema Brazil, shared insights into surgical treatments for lipedema. He discussed techniques from liposuction to advanced skin retraction and dermolipectomy, crucial for addressing more advanced stages of the condition. “It’s a complex process that demands precision to protect the lymphatic system, especially considering the characteristic nodules of lipedema,” he noted.
Dr. Kamamoto discussed a former patient with stage III lipedema. In the initial stage, he performed liposuction, removing 8 L of fat and 3.4 kg of skin. After 6 months, a follow-up procedure resulted in a total removal of 15 kg. Complementary procedures, such as microneedling, were performed to stimulate collagen production and reduce skin sagging. In addition to cosmetic improvements, the procedure also removed the distinctive lipedema nodules, which Mr. Kartt described as feeling like “rice grains.” Removing these nodules significantly alleviates pain, according to Dr. Kamamoto.
The benefits of surgical treatment for lipedema can be long lasting. Dr. Kamamoto noted that fat tends not to reaccumulate in treated areas, with patients often experiencing lower weight, reduced edema, and decreased pain over time. “While we hope that patients do not regain weight, the benefits of surgery persist even if weight is regained. Therefore, combining conservative and surgical treatments remains a valid and effective approach,” he concluded.
Dr. Scherer highlighted that despite various approaches, there is still no definitive “magic signature” that fully explains lipedema. This lack of clarity directly affects the effectiveness of diagnoses and treatments. He expressed hope that future integration of data from different studies and approaches will lead to the identification of a clinically useful molecular signature. “The true cause of lipedema remains unknown, requiring more speculation, hypothesis formulation, and testing for significant discoveries. This situation is frustrating, as the disease affects many women who lack a clear diagnosis that differentiates them from patients with obesity, as well as evidence-based recommendations,” he concluded.
This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Lipedema affects about 11% of cisgender women, according to the Brazilian Society of Angiology and Vascular Surgery. Yet the condition remains wrapped in uncertainties. Despite significant advancements in understanding its physiology, diagnosis, and treatment, more clarity is needed as awareness and diagnoses increase.
At the latest International Congress on Obesity (ICO) in São Paulo, Brazil, Philipp Scherer, PhD, director of the Touchstone Diabetes Center, discussed the complexities of lipedema. “It is an extremely frustrating condition for someone like me, who has spent a lifetime studying functional and dysfunctional adipose tissue. We are trying to understand the physiology of this pathology, but it is challenging, and so far, we have not been able to find a concrete answer,” he noted.
Lipedema is characterized by the abnormal accumulation of subcutaneous adipose tissue, especially in the lower limbs, and almost exclusively affects cisgender women. The reason for this gender disparity is unclear. It could be an intrinsic characteristic of the disease or a result from clinicians’ lack of familiarity with lipedema, which often leads to misdiagnosis as obesity. This misdiagnosis results in fewer men seeking treatment.
Research has predominantly focused on women, and evidence suggests that hormones play a crucial role in the disease’s pathophysiology. Lipedema typically manifests during periods of hormonal changes, such as puberty, pregnancy, menopause, and hormone replacement therapies, reinforcing the idea that hormones significantly influence the condition’s development and progression.
Main Symptoms
Jonathan Kartt, CEO of the Lipedema Foundation, emphasized that intense pain in the areas of adipose tissue accumulation is a hallmark symptom of lipedema, setting it apart from obesity. Pain levels can vary widely among patients, ranging from moderate to severe, with unbearable peaks on certain days. Mr. Kartt stressed the importance of recognizing and addressing this often underestimated symptom.
Lipedema is characterized by a bilateral, symmetrical increase in mass compared with the rest of the body. This is commonly distinguished by the “cuff sign,” a separation between normal tissue in the feet and abnormal tissue from the ankle upward. Other frequent symptoms include a feeling of heaviness, discomfort, fatigue, frequent bruising, and tiredness. A notable sign is the presence of subcutaneous nodules with a texture similar to that of rice grains, which are crucial for differentiating lipedema from other conditions. Palpation during anamnesis is essential to identify these nodules and confirm the diagnosis.
“It is crucial to investigate the family history for genetic predisposition. Additionally, it is fundamental to ask whether, even with weight loss, the affected areas retain accumulated fat. Hormonal changes, pain symptoms, and impact on quality of life should also be carefully evaluated,” advised Mr. Kartt.
Diagnostic Tools
André Murad, MD, a clinical consultant at the Instituto Lipedema Brazil, has been exploring new diagnostic approaches for lipedema beyond traditional anamnesis. During his presentation at the ICO, he shared studies on the efficacy of imaging exams such as ultrasound, tomography, and MRI in diagnosing the characteristic lipedema-associated increase in subcutaneous tissue.
He also discussed lymphangiography and lymphoscintigraphy, highlighting the use of magnetic resonance lymphangiography to evaluate dilated lymphatic vessels often observed in patients with lipedema. “By injecting contrast into the feet, this technique allows the evaluation of vessels, which are usually dilated, indicating characteristic lymphatic system overload in lipedema. Lymphoscintigraphy is crucial for detecting associated lymphedema, revealing delayed lymphatic flow and asymmetry between limbs in cases of lipedema without lymphedema,” he explained.
Despite the various diagnostic options, Dr. Murad highlighted two highly effective studies. A Brazilian study used ultrasound to establish a cutoff point of 11.7 mm in the pretibial subcutaneous tissue thickness, achieving 96% specificity for diagnosis. Another study emphasized the value of dual-energy x-ray absorptiometry (DXA), which demonstrated 95% sensitivity. This method assesses fat distribution by correlating the amount present in the legs with the total body, providing a cost-effective and accessible option for specialists.
“DXA allows for a precise mathematical evaluation of fat distribution relative to the total body. A ratio of 0.38 in the leg-to-body relationship is a significant indicator of high suspicion of lipedema,” highlighted Dr. Murad. “In clinical practice, many patients self-diagnose with lipedema, but the clinical exam often reveals no disproportion, with the leg-to-body ratio below 0.38 being common in these cases,” he added.
Treatment Approaches
Treatments for lipedema are still evolving, with considerable debate about the best approach. While some specialists advocate exclusively for conservative treatment, others recommend combining these methods with surgical interventions, depending on the stage of the disease. The relative novelty of lipedema and the scarcity of robust, long-term studies contribute to the uncertainty around treatment efficacy.
Conservative treatment typically includes compression, lymphatic drainage techniques, and pressure therapy. An active lifestyle and a healthy diet are also recommended. Although these measures do not prevent the accumulation of adipose tissue, they help reduce inflammation and improve quality of life. “Even though the causes of lipedema are not fully known, lifestyle management is essential for controlling symptoms, starting with an anti-inflammatory diet,” emphasized Dr. Murad.
Because insulin promotes lipogenesis, a diet that avoids spikes in glycemic and insulin levels is advisable. Insulin resistance can exacerbate edema formation, so a Mediterranean diet may be beneficial. This diet limits fast-absorbing carbohydrates, such as added sugar, refined grains, and ultraprocessed foods, while promoting complex carbohydrates from whole grains and legumes.
Dr. Murad also presented a study evaluating the potential benefits of a low-carbohydrate, high-fat diet for patients with lipedema. The study demonstrated weight loss, reduced body fat, controlled leg volume, and, notably, pain relief.
For more advanced stages of lipedema, plastic surgery is often considered when conservative approaches do not yield satisfactory results. Some specialists advocate for surgery as an effective way to remove diseased adipose cells and reduce excess fat accumulation, which can improve physical appearance and associated pain. There is a growing consensus that surgical intervention should be performed early, ideally in stage I of IV, to maximize efficacy and prevent disease progression.
Fábio Masato Kamamoto, MD, a plastic surgeon and director of the Instituto Lipedema Brazil, shared insights into surgical treatments for lipedema. He discussed techniques from liposuction to advanced skin retraction and dermolipectomy, crucial for addressing more advanced stages of the condition. “It’s a complex process that demands precision to protect the lymphatic system, especially considering the characteristic nodules of lipedema,” he noted.
Dr. Kamamoto discussed a former patient with stage III lipedema. In the initial stage, he performed liposuction, removing 8 L of fat and 3.4 kg of skin. After 6 months, a follow-up procedure resulted in a total removal of 15 kg. Complementary procedures, such as microneedling, were performed to stimulate collagen production and reduce skin sagging. In addition to cosmetic improvements, the procedure also removed the distinctive lipedema nodules, which Mr. Kartt described as feeling like “rice grains.” Removing these nodules significantly alleviates pain, according to Dr. Kamamoto.
The benefits of surgical treatment for lipedema can be long lasting. Dr. Kamamoto noted that fat tends not to reaccumulate in treated areas, with patients often experiencing lower weight, reduced edema, and decreased pain over time. “While we hope that patients do not regain weight, the benefits of surgery persist even if weight is regained. Therefore, combining conservative and surgical treatments remains a valid and effective approach,” he concluded.
Dr. Scherer highlighted that despite various approaches, there is still no definitive “magic signature” that fully explains lipedema. This lack of clarity directly affects the effectiveness of diagnoses and treatments. He expressed hope that future integration of data from different studies and approaches will lead to the identification of a clinically useful molecular signature. “The true cause of lipedema remains unknown, requiring more speculation, hypothesis formulation, and testing for significant discoveries. This situation is frustrating, as the disease affects many women who lack a clear diagnosis that differentiates them from patients with obesity, as well as evidence-based recommendations,” he concluded.
This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Lipedema affects about 11% of cisgender women, according to the Brazilian Society of Angiology and Vascular Surgery. Yet the condition remains wrapped in uncertainties. Despite significant advancements in understanding its physiology, diagnosis, and treatment, more clarity is needed as awareness and diagnoses increase.
At the latest International Congress on Obesity (ICO) in São Paulo, Brazil, Philipp Scherer, PhD, director of the Touchstone Diabetes Center, discussed the complexities of lipedema. “It is an extremely frustrating condition for someone like me, who has spent a lifetime studying functional and dysfunctional adipose tissue. We are trying to understand the physiology of this pathology, but it is challenging, and so far, we have not been able to find a concrete answer,” he noted.
Lipedema is characterized by the abnormal accumulation of subcutaneous adipose tissue, especially in the lower limbs, and almost exclusively affects cisgender women. The reason for this gender disparity is unclear. It could be an intrinsic characteristic of the disease or a result from clinicians’ lack of familiarity with lipedema, which often leads to misdiagnosis as obesity. This misdiagnosis results in fewer men seeking treatment.
Research has predominantly focused on women, and evidence suggests that hormones play a crucial role in the disease’s pathophysiology. Lipedema typically manifests during periods of hormonal changes, such as puberty, pregnancy, menopause, and hormone replacement therapies, reinforcing the idea that hormones significantly influence the condition’s development and progression.
Main Symptoms
Jonathan Kartt, CEO of the Lipedema Foundation, emphasized that intense pain in the areas of adipose tissue accumulation is a hallmark symptom of lipedema, setting it apart from obesity. Pain levels can vary widely among patients, ranging from moderate to severe, with unbearable peaks on certain days. Mr. Kartt stressed the importance of recognizing and addressing this often underestimated symptom.
Lipedema is characterized by a bilateral, symmetrical increase in mass compared with the rest of the body. This is commonly distinguished by the “cuff sign,” a separation between normal tissue in the feet and abnormal tissue from the ankle upward. Other frequent symptoms include a feeling of heaviness, discomfort, fatigue, frequent bruising, and tiredness. A notable sign is the presence of subcutaneous nodules with a texture similar to that of rice grains, which are crucial for differentiating lipedema from other conditions. Palpation during anamnesis is essential to identify these nodules and confirm the diagnosis.
“It is crucial to investigate the family history for genetic predisposition. Additionally, it is fundamental to ask whether, even with weight loss, the affected areas retain accumulated fat. Hormonal changes, pain symptoms, and impact on quality of life should also be carefully evaluated,” advised Mr. Kartt.
Diagnostic Tools
André Murad, MD, a clinical consultant at the Instituto Lipedema Brazil, has been exploring new diagnostic approaches for lipedema beyond traditional anamnesis. During his presentation at the ICO, he shared studies on the efficacy of imaging exams such as ultrasound, tomography, and MRI in diagnosing the characteristic lipedema-associated increase in subcutaneous tissue.
He also discussed lymphangiography and lymphoscintigraphy, highlighting the use of magnetic resonance lymphangiography to evaluate dilated lymphatic vessels often observed in patients with lipedema. “By injecting contrast into the feet, this technique allows the evaluation of vessels, which are usually dilated, indicating characteristic lymphatic system overload in lipedema. Lymphoscintigraphy is crucial for detecting associated lymphedema, revealing delayed lymphatic flow and asymmetry between limbs in cases of lipedema without lymphedema,” he explained.
Despite the various diagnostic options, Dr. Murad highlighted two highly effective studies. A Brazilian study used ultrasound to establish a cutoff point of 11.7 mm in the pretibial subcutaneous tissue thickness, achieving 96% specificity for diagnosis. Another study emphasized the value of dual-energy x-ray absorptiometry (DXA), which demonstrated 95% sensitivity. This method assesses fat distribution by correlating the amount present in the legs with the total body, providing a cost-effective and accessible option for specialists.
“DXA allows for a precise mathematical evaluation of fat distribution relative to the total body. A ratio of 0.38 in the leg-to-body relationship is a significant indicator of high suspicion of lipedema,” highlighted Dr. Murad. “In clinical practice, many patients self-diagnose with lipedema, but the clinical exam often reveals no disproportion, with the leg-to-body ratio below 0.38 being common in these cases,” he added.
Treatment Approaches
Treatments for lipedema are still evolving, with considerable debate about the best approach. While some specialists advocate exclusively for conservative treatment, others recommend combining these methods with surgical interventions, depending on the stage of the disease. The relative novelty of lipedema and the scarcity of robust, long-term studies contribute to the uncertainty around treatment efficacy.
Conservative treatment typically includes compression, lymphatic drainage techniques, and pressure therapy. An active lifestyle and a healthy diet are also recommended. Although these measures do not prevent the accumulation of adipose tissue, they help reduce inflammation and improve quality of life. “Even though the causes of lipedema are not fully known, lifestyle management is essential for controlling symptoms, starting with an anti-inflammatory diet,” emphasized Dr. Murad.
Because insulin promotes lipogenesis, a diet that avoids spikes in glycemic and insulin levels is advisable. Insulin resistance can exacerbate edema formation, so a Mediterranean diet may be beneficial. This diet limits fast-absorbing carbohydrates, such as added sugar, refined grains, and ultraprocessed foods, while promoting complex carbohydrates from whole grains and legumes.
Dr. Murad also presented a study evaluating the potential benefits of a low-carbohydrate, high-fat diet for patients with lipedema. The study demonstrated weight loss, reduced body fat, controlled leg volume, and, notably, pain relief.
For more advanced stages of lipedema, plastic surgery is often considered when conservative approaches do not yield satisfactory results. Some specialists advocate for surgery as an effective way to remove diseased adipose cells and reduce excess fat accumulation, which can improve physical appearance and associated pain. There is a growing consensus that surgical intervention should be performed early, ideally in stage I of IV, to maximize efficacy and prevent disease progression.
Fábio Masato Kamamoto, MD, a plastic surgeon and director of the Instituto Lipedema Brazil, shared insights into surgical treatments for lipedema. He discussed techniques from liposuction to advanced skin retraction and dermolipectomy, crucial for addressing more advanced stages of the condition. “It’s a complex process that demands precision to protect the lymphatic system, especially considering the characteristic nodules of lipedema,” he noted.
Dr. Kamamoto discussed a former patient with stage III lipedema. In the initial stage, he performed liposuction, removing 8 L of fat and 3.4 kg of skin. After 6 months, a follow-up procedure resulted in a total removal of 15 kg. Complementary procedures, such as microneedling, were performed to stimulate collagen production and reduce skin sagging. In addition to cosmetic improvements, the procedure also removed the distinctive lipedema nodules, which Mr. Kartt described as feeling like “rice grains.” Removing these nodules significantly alleviates pain, according to Dr. Kamamoto.
The benefits of surgical treatment for lipedema can be long lasting. Dr. Kamamoto noted that fat tends not to reaccumulate in treated areas, with patients often experiencing lower weight, reduced edema, and decreased pain over time. “While we hope that patients do not regain weight, the benefits of surgery persist even if weight is regained. Therefore, combining conservative and surgical treatments remains a valid and effective approach,” he concluded.
Dr. Scherer highlighted that despite various approaches, there is still no definitive “magic signature” that fully explains lipedema. This lack of clarity directly affects the effectiveness of diagnoses and treatments. He expressed hope that future integration of data from different studies and approaches will lead to the identification of a clinically useful molecular signature. “The true cause of lipedema remains unknown, requiring more speculation, hypothesis formulation, and testing for significant discoveries. This situation is frustrating, as the disease affects many women who lack a clear diagnosis that differentiates them from patients with obesity, as well as evidence-based recommendations,” he concluded.
This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.