PracticalDermatology

The Women’s Dermatologic Society (WDS) treated members of the media to lunch and a lively discussion about a wide range of cosmetic and medical dermatology topics at the Gansevoort Hotel in downtown Manhattan this fall. The program featured established dermatologists along with up-and-comers who shared the latest thinking about pigmentation disorders, acne, and much more.

At-Home Technology Update

Susan C. Taylor, MD, an Associate Professor of Dermatology at the Hospital of the University of Pennsylvania in Philadelphia and Mara C. Weinstein Velez, MD, FAAD, a dermatologist at Schweiger Dermatology Group in New York City, discussed the ever-expanding category of at-home beauty devices. One such device marketed by Neutrogena is cleared by the FDA for the treatment of mild to moderate acne. It emits 420nm blue and 660nm red light and may reduce sebaceous gland size, sebum production, and bacteria. The mask is worn once daily for 15 minutes and shuts off automatically. Each mask has a lifespan of 30 treatments. A randomized controlled trial of 41 adults with mild to moderate acne showed that participants who used the mask saw a 50 percent reduction in inflammatory lesions compared to a two percent increase seen among controls after 12 weeks. Findings appear in a 2015 issue of the Journal of Cosmetic and Laser Therapy. The changes occurred as early as three weeks, with maximum benefit seen between seven and 12 weeks. “Patients need to consult a dermatologist first because it’s important that acne be accurately evaluated and severity determined as severity will dictate treatment,” Dr. Taylor says.

Another home-use device that patients may be asking about or using is a low-energy IPL for hair removal called Silk’n SensEpil. The device emits 475-1200nm wavelength, spot size 20x30mm, with one pulse delivered every 3.5 seconds. This device only fires when in complete contact with the surface of the skin, and it is smart enough to determine skin color before treatment. If skin color is deemed appropriate, the IPL will flash and proceed to deliver light therapy. If skin is too dark, it won’t fire, as risks of scarring are too great in such patients. The device should be used once every two weeks for the first four to five sessions, then once monthly or as needed. Full hair removal takes up to six months. “Patients who are looking for instant gratification will be disappointed,” Dr. Taylor says.

Perfectio Zero Gravity is an FDA-cleared Class II Medical Device that uses LED lights for facial rejuvenation. One study showed a 32 percent improvement in all key signs of aging after seven weeks, and 100 percent of subjects agreed that their skin looked younger as a result of treatment with this device, says Dr. Velez. It’s safe for all skin types with no downtime, she adds.

The bottom line on home devices: “There are a range of quality devices, but safety is an ever-present concern and FDA clearances and well-designed studies are needed,” Dr. Velez says.

Beyond HQ: Treating Pigment Disorders

New York City dermatologist Neil Sadick, MD, along with Nada Elbuluk, MD an assistant professor at the NYU Langone Medical Center’s Ronald O. Perelman Department of Dermatology, discussed advances in treating pigmentation disorders including post-inflammatory pigmentation, melasma, ephelides, lentigines, and photodamage.

“Pigmentary conditions, especially hyperpigmentation, get worse without sun protection,” says Dr. Elbuluk. Judicious use of broad-spectrum sunscreens that block ultraviolet and visible light, such as those that contain zinc, titanium, or iron oxide are among the best ways to stave off such damage.

When it comes to treating hyperpigmentation, there are many new non-hydroquinone (HQ) options including Vitamin C, soy, arbutin, licorice, bearberry extract, and niacinamide. Another new potential way to address melasma is tranexamic acid. “This was originally a medication for heavy bleeding, but it also has a strong effect on pigmentation,” Dr. Elbuluk says. “The topical benefit is not as strong as when it is taken orally, and it can’t be used if a patient is at risk of clotting or with certain medications.”

There is also a risk of gastrointestinal side effects. “We need more studies done in the US, but this may prove to be a nice option particularly for our melasma patients.”

In-office treatments such as microneedling, chemical peels, lasers, and energy-based devices still play a role in treating pigment disorders.

The bottom line on treating pigment disorders today: “Retinol peels, tranexamic acid (orally), and pico second lasers, like Enlighten, are the most exciting things happening in the treatment of pigmentation disorders today,” says Dr. Sadick.

Treating Today’s Female Pattern Hair Loss Patient

Past WDS President Valerie D. Callender, MD, FAAD, a dermatologist in Glenn Dale, MD, and Shari R. Lipner, MD, PhD, FAAD, an assistant professor of dermatology at Weill Cornell Medicine in New York, took on the still somewhat taboo topic of female pattern hair loss. They began by pointing out that 40 percent of hair loss patients are women.

Nutritional treatment for female hair loss such as Biotin, Viviscal, and Nutrafol can be useful adjuncts to therapy, Dr. Callender says. Other options include in-office and at-home laser therapy, platelet-rich plasma injections and hair restoration surgeries. Hair prosthesis and hair extensions are also still commonly used.

Many patients are concerned about hair loss in the eyebrows and eyelashes. For them, microblading, bimatoprost, and eyebrow and eyelash transplantation are options.

The bottom line on treating female hair loss: Despite some common misperceptions, treatment of female pattern hair loss is highly effective.

The Next Big Things

Emerging technology for the treatment of acne and other concerns was the focus for Washington, DC dermatologists Cheryl M. Burgess, MD and Kachiu C. Lee, MD, MPH. The duo are enthusiastic about Sebacia. With this experimental acne treatment, gold-coated silicone microparticles are massaged into pores and oil glands. Next they can be activated via laser to injure the sebaceous glands. There are currently three trials taking place in the US looking at the safety and efficacy of Sebacia with and without a laser. A European trial documented a 50 percent reduction in acne lesions at four months with Sebacia.

“There is minimal redness after the procedure and no systemic toxicity because this is a topical,” Dr. Burgess says.

She and Dr. Lee also commented on the popularity of Brazilian butt lifts and highlighted a growing role for Sculptra in buttock augmentation. “Buttock is just the beginning for Sculptra,” Dr. Sadick added.

Other potential uses for Sculptra may include post-partum treatment of skin laxity of the abdomen, arms and legs and cellulite reduction, he says.

The bottom line: The future is looking bright.