Mary P. Lupo

Antioxidants and vitamins in cosmetics.

Cosmetics are commercially available products that are used to improve the appearance of the skin. Since the late 1980s, consumer demand for more effective products that more substantively beautify the appearance has resulted in increased basic science research and product development in the cosmetics industry. The result has been more ingredients that may actually improve not just the appearance of the skin, but the health of the skin as well. We now have products that renew, restore, and rejuvenate—not just cleanse, protect, and moisturize. There is probably no greater focus of interest currently than the incorporation of vitamins and antioxidants in skin care products. There are considerable data to suggest the benefits of such ingredients in cosmetics. This article reviews the published data that support the usefulness of vitamins and antioxidants in cosmetics. Our job as dermatologists is to digest and assess the data so we can give knowledgeable recommendations to our patients. The ingestion and absorption of vitamins and antioxidants, most importantly through diet, and secondarily through intake of manufactured supplements, is critical to the health of human beings. The skin is the largest organ; as our primary external barrier, it is on the forefront of the battle with external causes of damaging free radicals. Ultraviolet light and environmental pollutants are known initiators of free radicals. Free radicals are highly reactive molecules with an unpaired electron that result in damage to surrounding molecules and tissues. The most significant damage by free radicals is to biomembranes and to DNA. It is thought that additional, topical use of vitamins and antioxidants in cosmetics can better protect and possibly correct the damage by neutralizing these free radicals. In addition, some vitamins may be beneficial to the skin because of other actions such as effects of suppression of pigmentation and bruising, stimulation of collagen production, refinement of keratinization, or anti-inflammatory effects. Vitamin A

Effectiveness of Juvéderm Ultra Plus dermal filler in the treatment of severe nasolabial folds.

Background: With the baby boomer generation firmly ensconced in middle age and the ubiquity of botulinum toxin type A, nonsurgical facial rejuvenation is becoming increasingly prevalent. As this generation continues to age, products with greater therapeutic power to correct aging changes will be in growing demand. Methods: A multicenter, double-blind, randomized, within-subject, controlled study was conducted comparing Juvéderm Ultra Plus hyaluronic acid filler with bovine collagen. A subset of subjects classified as having treatment for severe nasolabial folds is presented in this article. Subjects received Juvéderm Ultra Plus in one severe nasolabial fold and Zyplast collagen in the other nasolabial fold; up to two touch-up treatments were allowed at 2-week intervals. Nasolabial fold severity was evaluated every 4 weeks for 24 weeks using a five-point scale. Treatment site reactions and adverse events were also recorded. A complimentary treatment was offered at the end of the trial, with effectiveness evaluations just before retreatment and up to 48 weeks after repeated treatment for a subset of subjects. Results: Of the 87 subjects, most were female Caucasians, but all Fitzpatrick skin types were represented (36 percent types IV through VI). At 24 weeks, 96 percent of nasolabial folds treated with Juvéderm had maintained clinically significant correction, and 81 percent maintained the correction for 1 year or more. Results were similar for those subjects with follow-up through 48 weeks after repeated treatment. The median volume required for repeated treatment with Juvéderm was significantly less than that for initial treatment (0.7 ml versus 1.6 ml). Conclusion: Juvéderm Ultra Plus provides correction of severe nasolabial folds through 1 year or more.

Efficacy and safety of onabotulinumtoxinA for treating crow's feet lines alone or in combination with glabellar lines: a multicenter, randomized, controlled trial.

BACKGROUND This was the second study in a Phase 3 program treating crows feet lines (CFL) with onabotulinumtoxinA. OBJECTIVE To evaluate the efficacy and safety of onabotulinumtoxinA treatment of CFL alone or with glabellar lines (GL). METHODS This multicenter, double-blind, placebo-controlled, repeat treatment, 7-month study randomized subjects with moderate-to-severe CFL and GL (maximum contraction) to onabotulinumtoxinA 44 U (CFL: 24 U, GL: 20 U; n = 305), onabotulinumtoxinA 24 U (CFL: 24 U, GL: placebo; n = 306), or placebo (n = 306). Coprimary end points were investigator-assessed and subject-assessed proportion of subjects achieving a CFL Facial Wrinkle Scale Grade of 0 or 1 (maximum smile; Day 30, Cycle 1). Additional efficacy end points and safety/adverse events (AEs) were evaluated. RESULTS All primary and secondary end points were achieved; statistically significant differences favored onabotulinumtoxinA (p < .001, all comparisons vs placebo). Investigator and subject responder rates were: CFL, 54.9% and 45.8%; CFL + GL, 59.0% and 48.5%; and placebo, 3.3% (both), respectively. Responder rates on other end points also significantly favored onabotulinumtoxinA treatments. Most AEs were mild or moderate. Two subjects discontinued: 1 serious AE unrelated to treatment (myocardial infarction) and 1 treatment-related AE (injection site pain). CONCLUSION OnabotulinumtoxinA was effective and well tolerated for treating moderate-to-severe CFL alone or in combination with GL.

Cosmeceuticals used in conjunction with laser resurfacing.

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

Efficacy of hydroquinone-free skin-lightening cream for photoaging

Hyperpigmentation and solar damage remains a difficult problem to treat with topical agents.

Cosmeceuticals: Practical Applications

Cosmeceuticals are topically applied products that are more than merely cosmetic, yet are not true drugs that have undergone rigorous placebo controlled studies for safety and efficacy. There are many review articles that outline the theoretical biologic and clinical actions of these cosmeceuticals and their various ingredients. This article reviews how to incorporate various cosmeceuticals into the treatment regime of patients, depending on the diagnosis and therapies chosen. The practical application of when, why, and on whom to use different products will enable dermatologists to improve the methodology of product selection and, ultimately, improve patients clinical results.

Cosmeceutical Science in Clinical Practice

Cosmeceuticals – skin-care products that fall between a cosmetic and a pharmaceutical, with active ingredients that counter skin ageing and promote skin rejuvenation – are an invaluable adjunct to the cosmetic dermatologist or plastic surgeon performing minimally invasive aesthetic procedures. This guide from expert researchers and practitioners explains how best to integrate the potential of cosmeceutical products into the best international clinical practice.

Safety and efficacy of hydrogen peroxide topical solution, 40% (w/w), in patients with seborrheic keratoses: Results from 2 identical, randomized, double-blind, placebo-controlled, phase 3 studies (A-101-SEBK-301/302)

Background Approved topical treatments for seborrheic keratoses (SKs) are an unmet need. Objective To evaluate the safety and efficacy of 40% hydrogen peroxide topical solution (HP40) versus vehicle for the treatment of SKs (A‐101‐SEBK). Methods A total of 937 patients with 4 SKs each (≥1 lesion each on the face and on the trunk and/or an extremity) were randomized 1:1 to HP40 or vehicle. At each visit, SKs were graded using the Physicians Lesion Assessment (PLA) scale (0, clear; 1, nearly clear; 2, ≤1 mm thick; and 3, >1 mm thick). After 1 treatment, SKs with a PLA score higher than 0 were re‐treated 3 weeks later. Results At day 106, significantly more patients treated with HP40 than with vehicle achieved a PLA score of 0 on all 4 SKs (study 1, 4% vs 0%; study 2, 8% vs 0% [both P < .01]) and on 3 of 4 SKs (study 1, 13% vs 0%; study 2, 23% vs 0% [both P < .0001]). A higher mean per‐patient percentage of SKs were clear (study 1, 25% vs 2%; study 2, 34% vs 1%) and clear or nearly clear (study 1, 47% vs 10%; study 2, 54% vs 5%) with HP40 than with vehicle. Local skin reactions were largely mild and resolved by day 106. Limitations The optimal number of treatment sessions was not evaluated. Conclusion Application of HP40 was well tolerated and effective in the removal of SKs.

Abbreviations for Device Names: A Proposed Methodology With Specific Examples

BACKGROUND Many devices used in dermatology lack generic names. If investigators use commercial device names, they risk the appearance of bias. Alternatively, reliance on ad‐hoc names and abbreviations may confuse readers who do not recognize these. OBJECTIVE To develop a system for assigning abbreviations to denote devices commonly used in dermatology. Secondarily, to use this system to create abbreviations for FDA‐approved neurotoxins and prepackaged injectable soft‐tissue augmentation materials. METHODS The American Society for Dermatologic Surgery convened a Lexicon Task Force in March 2012. One charge of this Task Force was to develop criteria for assigning abbreviations to medical devices. A modified consensus process was used. RESULTS Abbreviations to denote devices were to be: based on a standardized approach; transparent to the casual reader; markedly brief; and in all cases, different than the commercial names. Three‐letter all caps abbreviations, some with subscripts, were assigned to denote each of the approved neurotoxins and fillers. CONCLUSION A common system of abbreviations for medical devices in dermatology may avoid the appearance of bias while ensuring effective communication. The proposed system may be expanded to name other devices, and the ensuing abbreviations may be suitable for journal articles, continuing medical education lectures, or other academic or clinical purposes.

Skin Rejuvenation Using Microdermabrasion

Publisher Summary This chapter reviews the trendy procedure of skin rejuvenation using microdermabrasion. Microdermabrasion is a popular noninvasive office procedure that is sought after by a public that is forever in a quest to improve their appearance with little time off from their day-to-day activities. Microdermabrasion is one of the procedures that have fueled that change. Extraordinarily safe, with high patient satisfaction levels, it has become the modern-day version of the facial that really does something to make the skin look and feel better. While many purists complain that microdermabrasion does not have enough science behind it, it is clear that microscopic and molecular changes can be proven, and that clinical responses, while variable, do occur. The Italians first presented the procedure dubbed microdermabrasion to the aesthetic medical community in the 1980s. The procedure known as microdermabrasion is performed by different types of equipment. The most well known is a closed loop system under negative pressure, dispensing aluminum oxide crystals out of a hand piece with a vacuum that sucks up the used particles along with skin surface impurities and pilosebaceous surface plugs. Other systems use different particles such as baking soda or sodium chloride, or positive rather than negative pressure. Suggestions by some of a danger of particulates to the eyes or respiratory system have prompted newer systems that abrade the skin without any particles.