PracticalDermatology

Practice pearls and new research, technologies, and treatment options for a variety of conditions were the focus of the 65th Annual Meeting of the Noah Worcester Dermatological Society in sunny Isle of Palms, South Carolina, from April 30 to May 4.

Practical Dermatology® Editorial Board members Anisha Patel, MD, and Natasha Atanaskova Mesinkovska, MD, PhD, served as the co-chairs of the Scientific Committee, compiling a program with more than 30 presenters. Members of the Practical Dermatology team were in attendance, with some highlights summarized below. Further coverage, including video interviews, will be available at PracticalDermatology.com.

NEW UPDATES ON BOTULINUM TOXINS – COSMETIC AND MEDICAL USES

Michael Gold, MD, FAAD, covered the always-hot topic of botulinum toxins, including research indicating that utilizing a constant injection volume of 0.05 mL per injection across all botulinum toxin doses achieved the primary effectiveness endpoint.

Gold reported on a new liquid botulinum toxin type A available only in Europe currently, RelaBoNT-A, for treatment to temporarily improve the appearance of moderate to severe globular lines.

“What is really important here is the onset of actions in clinical studies,” Gold said, referring to phase IIIb trials in which 40% of patients rated themselves as “improved” or better on the Global Aesthetic Improvement Scale as early as day one. He also mentioned another liquid toxin being developed, nivobotulinumtoxinA, that appears promising.

Gold also discussed daxibotulinumtoxinA and the in vitro data suggesting that its positively charged peptide increases the affinity of the toxin for neuronal membranes, potentially increasing the opportunity for toxin entry into the neuron. “I do not tell my patients they are going to get 6 months in every case,” Gold said of the drug. “I tell them it is dependent on a lot of things.”

Another potentially groundbreaking product covered in this lecture was an anticholinesterase agent that can resolve adverse events caused by botulinum toxins, reversing undesirable paralysis in problem areas while maintaining intended therapy in other areas. Gold said this will improve outcomes and increase patient safety, in turn reducing hesitancy for the treatment. “Every pencil needs an eraser,” Gold said. “With hyaluronic acid fillers, we have an eraser. Now, we will have one for toxins.”

Finally, Gold noted nontraditional dermatologic uses of botulinum toxins, including treating hair loss, Raynaud’s disease, facial flushing, pore/sebum reduction, post-herpetic neuralgia/neuropathic pain, Hailey-Hailey disease, dyshidrotic eczema, hidradenitis suppurativa, and hypertrophic scars.

Source: Gold M. New Updates on Botulinum Toxins – Cosmetic and Medical Uses. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.

PLATELET RICH PLASMA AND BEYOND

In the Alfred L. Weiner MD Lecture, Reena Jogi, MD, presented an overview of platelet rich plasma (PRP) applications and went into greater depth on its follicular effects, based on activation of extracellular signal-related kinase (ERK pathway) and protein kinase B (AKT) signaling and increased expression of B-cell lymphoma-2 and B-catenin.

Jogi also discussed the implications of single- and double-spin prepared PRP injection, and the conflicting data as to whether activation is necessary. She mentioned porcine bladder, exosomes, and vitamins as additives to PRP treatment, specifically cautioning about exosomes: “They still have an FDA warning,” she said. “You are setting yourself up for trouble.”

Jogi concluded that PRP is a strong option for treating hair loss. “If you do it correctly,” she said, “there is a pretty high patient satisfaction rate.”

Source: Jogi R. Platelet Rich Plasma and Beyond. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.

PERI-ORAL COMBINATION REJUVENATION

Treatment strategies to rejuvenate the peri-oral area were the topic of discussion for Joel L. Cohen, MD, FAAD, who covered botulinum agents, fillers, and laser resurfacing.

“We don’t just use one modality,” Cohen said, explaining that he typically prefers to try fillers and neuromodulation before laser resurfacing. When heavier ablative resurfacing is necessary to achieve the desired results, patients should be made aware of the recovery time, and they must be agreeable to severe skin discoloration during that time, especially in the days immediately following treatment, Cohen said. Compliance with wound care and preventive measures was another element that was stressed.

Cohen added that multiple sessions could be necessary. “I don’t overpromise that it’s going to be one treatment,” he said.

Source: Cohen JL. Peri-Oral Combination Rejuvenation. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.

UPDATES FROM THE MAYO MELANOMA LAB

Alexander Meves, MD, MBA, presented on Mayo Clinic research into CP-GEP—a model combining clinicopathologic and gene expression variables to identify primary cutaneous melanoma patients who may safely forgo sentinel lymph node biopsy due to their low risk for nodal metastasis.

“This test is mostly risk stratification,” Meves said. CP-GEP can be performed on primary melanoma diagnostic biopsy tissue, and the research has confirmed its potential to reduce negative SLNB in all relevant age groups.

Source: Meves A. Updates From the Mayo Melanoma Lab. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.

THE USE OF LASERS AND NON-ENERGY DEVICES IN PEDIATRICS AND SKIN OF COLOR

Jeannette Jakus, MD, MBA, discussed the increasing demand for dermatologic procedures for both medical and cosmetic indications at a time when the US population is becoming increasingly ethnically and racially diverse. Technology continues to develop, she said, and with it comes a need to ensure safe practices across all skin types and ages.

Risks of these devices include burns, scars, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation. To avoid complications specific to darker skin, Jakus suggested assessing the patient’s individualized risk, pretreating and/or discontinuing topicals when necessary, performing test spots in less conspicuous locations, and using longer wavelengths, lower fluences, and longer pulse durations. For pediatric patients, she recommended understanding age-specific physical, emotional, and cognitive development; acknowledging and managing caregiver anxiety; maximizing patient and parent comfort; using age-specific techniques for non-anesthesia pain control; and age-appropriate use of anesthesia.

“These are subtle changes,” Jakus said of the procedures for which she uses these devices. “We don’t want to be too aggressive with these patients because we want to avoid side effects.”

Source: Jakus J. The Use of Lasers and Non-Energy Devices in Pediatrics and Skin of Color. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.

HOW BONE CHANGES OVER TIME SIGNIFICANTLY AFFECT FACIAL AGING

The significant changes in facial bone shape later in adulthood were the focus for Howard Steinman, MD. These changes significantly affect the position of the facial fat, muscle, and skin that exemplify the aging face. Knowledge of these bond changes are important to understand for correct cosmetic use of deep filler treatments and surgical interventions.

Facial skeletal aging, Steinman noted, involves orbital enlargement, pyriform aperture enlargement, maxilla retraction, and mandible thinning. “Think of your midface rotating [clockwise],” Steinman said. “As your facial bones move, your muscle, fat, and skin—everything attached to that—is going to move.”

Steinman noted that these factors are particularly important to understand when performing cosmetic procedures. “You’ve got to think about that when you are doing fillers and volumetric changes,” he added.

Source: Steinman H. How Bone Changes Over Time Significantly Affect Facial Aging. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.

MAGICAL METFORMIN APPLICATIONS TO DERMATOLOGY & BEYOND

In one of the program’s Resident Lectures, Nicole Ufkes, MD, discussed the use of metformin for various dermatological conditions. A drug used to treat diabetes since the 1950s, metformin now has been shown in studies to be effective in treating or preventing acne, hidradenitis suppurativa, psoriasis, and other inflammatory skin diseases. It has demonstrated immunomodulating, anti-fibrotic, anti-aging, and anti-tumoral effects. In one study, a topical application of metformin showed potential for treating hyperpigmentation disorders by turning a mouse’s tail from brown to white.

Ufkes noted that metformin is versatile, effective, well-tolerated, affordable, and safe in pregnancy and breastfeeding.

“I would say it is a wonder drug,” Ufkes said.

Source: Ufkes N. Magical Metformin Applications to Dermatology & Beyond. Presented at: Noah Worcester Dermatological Society 65th Annual Meeting. April 30-May 4, 2024; Isle of Palms, S.C.