2MCosD_Spring4_13.qxd 4/13/2006 1:50 PM Page 1 A Supplement to ® Skin Disease Skin & Allergy News Education Foundation Roundup on Cosmetic Dermatology SPRING 2006 TOPIC HIGHLIGHTS: New Options Spur Interest in Combination Treatment Preventive Skin Care Forms Basis for Battle Against Sun and Aging For Quick Results, Think Nonablative Resurfacing Plasma Energy Harnessed for Damaged, Aging Skin Horse Chestnut New Laser System Offers Another GUEST EDITORS: Skin Tx Option David J. Goldberg, M.D., J.D. Clinical Professor of Dermatology Director, Laser Research and Mohs Surgery Maintaining Safety, Integrity of Mount Sinai School of Medicine Botulinum Toxin A Adjunct Professor of Law Fordham Law School New York, N.Y. Director, Skin Laser & Surgery Specialists of New York/New Jersey New York, N.Y. Christopher B. Zachary, F.R.C.P. Chair and Clinical Professor Department of Dermatology Co-Director, Dermatologic Surgery and Laser Center University of California at Irvine Produced in affiliation with the 30th Hawaii Dermatology Seminar and the Cosmetic Dermatology Seminar. 2MCOSD_S.QXD 4/7/2006 8:06 PM Page 2 2MCosD_Spring4_13.qxd 4/13/2006 1:50 PM Page 3 Skin & Allergy News® Roundup on Cosmetic Dermatology SPRING 2006 TOPIC HIGHLIGHTS: 4 New Options Spur Interest in Combination Treatment 5 Preventive Skin Care Forms Basis for Battle Against Sun and Aging 6 For Quick Results, Think Nonablative Resurfacing 9 Plasma Energy Harnessed for Damaged, Aging Skin 10 Horse Chestnut 12 New Laser System Offers Another Skin Tx Option 15 Maintaining Safety, Integrity of Botulinum Toxin A GUEST EDITORS: David J. Goldberg, M.D., J.D. Christopher B. Zachary, F.R.C.P. Clinical Professor of Dermatology Chair and Clinical Professor Director, Laser Research and Mohs Surgery Department of Dermatology Mount Sinai School of Medicine Co-Director, Dermatologic Adjunct Professor of Law Surgery and Laser Center Fordham Law School University of California at Irvine New York, N.Y. Director, Skin Laser & Surgery Specialists of New York/New Jersey New York, N.Y. President, Elsevier/IMNG Alan J. Imhoff Vice President, Medical Education & Business Development Sylvia H. Reitman, M.B.A. Contributing Writer Charles Bankhead Program Manager, Medical Education Sara M. Hagan National Account Manager Cheryl J. Gromann Art Director Elizabeth Lobdell Director of Production and Manufacturing Yvonne Evans Roundup on Cosmetic Dermatology was produced by the medical education department of International Medical News Group. Neither the Editor of SKIN & ALLERGY NEWS, the Editorial Advisory Board, nor the reporting staff reviewed or contributed to its contents. The ideas and opinions expressed in this supplement are those of the faculty and do not necessarily reflect the views of the supporter or the Publisher. Copyright © 2006 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of the Publisher. Elsevier Inc. will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. INTERNATIONAL MEDICAL NEWS GROUP 2MCosD_Spring4_13.qxd 4/17/2006 8:38 PM Page 4 New Options Spur Interest in Combination Treatment he emergence of new options for cosmetic tually will demonstrate whether LED devices have a dermatology procedures has created a great place as sole therapy for dermatologic conditions or as potential for combining different modalities an adjunct to other technologies and treatments. T to achieve the best possible result. “In the real world of dermatology practice for acne, for Two of the newest technologic developments are example, we often use a laser to shrink the oil glands by light-emitting diode (LED) treatment and topical anti- heating them and combine that with red LED light, which aging agents that contain growth factors. These new decreases the bacteria involved in acne,” said Dr. Goldberg. treatment modalities can be combined with lasers, “For rosacea, we might use intense pulsed light, which pro- intense pulsed light, or other technologies to achieve cos- duces heat, and combine it with yellow LED light, which metic results that are more tailored to individual patient also is used to treat rosacea.” needs. Future experience also will define the “The general trend in cosmetic derma- role of new-generation topical agents, but tology is to have a synergistic approach in- the growth factor–containing creams have volving a variety of different agents,” said several advantages over conventional topi- David J. Goldberg, M.D., J.D., Clinical cal treatments. Conventional lotions and Professor of Dermatology and Director of creams either fail to penetrate the skin or Laser Research and Mohs Surgery at achieve concentrations that are too low to Mount Sinai School of Medicine in New produce any meaningful effects. In some York. “The synergy might come from com- cases, exposure to air and light causes a bining lasers with LED technology or, per- cream or lotion to oxidize in its container haps, with botulinum toxin, fillers, or ef- and lose whatever therapeutic potential it fective new topical creams.” might have had. The evolution of LED technology has David J. The newest additions to the topical arma- given rise to a unique new approach to skin Goldberg, M.D., J.D. mentarium contain multiple types of growth treatment. In contrast to lasers, LED devices do not heat factors developed by means of stem-cell technology. Orig- the skin and, as a result, do not cause any pain. inally developed to aid healing of burns and other wounds, Instead, the devices achieve cosmetic benefits by mod- the new agents have found a role in cosmetic dermatology ulating biologic activity inside various types of cells in because of their antiaging effects. the skin. “These new topical agents are sort of like fertilizer for Within the field of cosmetic dermatology, LED tech- the skin,” said Dr. Goldberg. “They differ from other top- nology currently comprises four wavelengths, each of ical agents in that they can actually get into the skin, they which has different effects on the skin and can be used for are packed with growth factors, and they can achieve very different cosmetic applications. Blue light and red light are nice improvement in the skin.” both used to treat acne. Red and near-infrared light are used Cosmetic dermatologists have already begun to use the to achieve antiaging effects. Yellow light has found a niche growth-factor agents in combination with other technolo- in the treatment of rosacea. gies that can achieve antiaging effects in the skin. The ex- “Each type of light has a different mechanism of ac- perience to date suggests that combination treatment offers tion, but they have in common the fact that they do not the potential to achieve better cosmetic results than does create any heat,” said Dr. Goldberg. “Generally, a treat- single-agent treatment. ■ ment can last anywhere from half a minute to 20 min- utes. The treatments do not take very long, and there is DR. GOLDBERG has received funding for clinical studies no wound.” from Photo Therapeutics, Cynosure, Inc., Neocutis Swiss The ultimate role of LED technology in cosmetic der- Technology, Inamed Corporation, Thermage, Inc., and matology remains to be determined, Dr. Goldberg added. Cutera, Inc. He is also a consultant to Bioform Medical, Continued clinical experience with the technology even- Inc., Lumenis Ltd., and Juva Medical Inc. 4 Roundup on Cosmetic Dermatology Spring 2006 2MCosD_Spring4_13.qxd 4/17/2006 8:39 PM Page 5 Preventive Skin Care Forms Basis for Battle Against Sun and Aging dvances in skin rejuvenation techniques have matic improvement in the color, texture, and tone of the not lessened the importance of good pre- skin,” said Dr. Zachary, “although I am not so impressed ventive care to ward off the effects of sun ex- with its effects on early wrinkling.” A posure, climate, and aging. Prominent among lasers developed for skin rejuvenation “An ounce of prevention is worth a lot,” said Christo- procedures are the CoolTouch (CoolTouch, Roseville, pher B. Zachary, F.R.C.P., Chair and Clinical Professor of Calif.) and Smoothbeam (Candela Corp., Wayland, Mass.) Dermatology at the University of California, Irvine. “Good devices. Both have demonstrated the ability to improve preventive skin care can delay aging and reduce the risk wrinkling and acne scarring. of keratoses, cancer, and wrinkling. In fact, a good com- The latest addition to dermatologic laser technology is bined skin care regimen can provide as much benefit in fractional resurfacing, represented by the Fraxel, 1,550-nm terms of appearance as do many of the new laser (Reliant Technologies, Inc., Palo Alto, nonablative lasers.” Calif.). Fractional resurfacing represents a Good skin care comprises four principal new approach to laser skin treatment. Where- components: sun block, moisturizer, retinoid, as traditional lasers penetrate the skin in a hor- and bleaching agent, such as hydroquinone. izontal layer, fractional resurfacing creates Among those components, a good moistur- multiple tiny cylinders of penetration that ex- izer often is overlooked, thereby depriving tend to a depth of 200 to 500 microns in an the skin of a treatment that can prevent a sig- orientation at right angles to the skin surface. nificant degree of wrinkling, according to “The key to the success of this technology Dr. Zachary. is that it treats only about 15% to 20% of the Providing a “California perspective” on skin,” said Dr. Zachary. “There is no exuda- skin aging, the Irvine cosmetic dermatology tion and very little chance of scarring. The specialist said geographically defined dif- Christopher B. treatment results in an internal structure of ferences in climate can have a profound im- Zachary, F.R.C.P. damage that heals by laying down new col- pact on the speed and extent of skin aging.