Aesthetics

Gaithersburg, Md. - The FDA General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee meeting on March 25 unanimously recommended approval of Sculptra for reconstructive purposes with lipoatrophy associated with HIV infection and treatment. However, because of limited clinical data and fear of off-label use, the panel recommended attaching five conditions to that approval.

Moderator: What is ringworm, and do you find it to be seasonalin nature?

Q&A/ROSACEAAlbert Kligman, M.D., Ph.D., is a pioneer who continues to break new ground in dermatology. Dialogue with a Mentor is brought to you by an unrestricted educational grant from Galderma Laboratories, LP.

The Smoothbeam diode laser was given expanded FDA clearance for treatment of facial acne.

Akron, Ohio - Maggot debridement therapy (MDT), a controversial, but reportedly effective wound-healing technique, has attracted a following abroad in recent years, and is now gaining interest in the United States, as well. MDT is the medical use of live maggots or fly larvae for cleaning non-healing wounds. "MDT has been around for centuries -- so it's certainly not new, but there has been a resurgence of interest," said dermatologist and wound-care specialist Elliot N. Mostow, M.D., of Wound Care Associates of Akron (Ohio).

National report -- In a study that could have implications for faster wound healing in the future, Australian researchers have dispelled the belief that only epidermal stem cells are capable of tissue regeneration; short term and long term. They report in the February 2004 issue of The Journal of Clinical Investigation that significant proliferative and tissue-regenerative capacity resides in the more mature progeny of keratinocyte stem cells - including early differentiating cells.

Amsterdam - Cell culture techniques have been developed that allow in vitro reconstruction of skin, based on three different techniques developed 25 years ago at MIT in three independent laboratories (those of Howard Green, Ioannis Yannas and Eugene Bell). The use of these techniques has given rise to a variety of tissue substitutes that can serve not only as permanent covering, used in the repair of large skin defects, but also as temporary biological dressings to promote wound healing.

Waikoloa, Hawaii - Bexarotene 1 percent gel (Targretin) is a useful alternative modality, offering advantages to other therapies, for the treatment of mycosis fungoides (MF), according to Joan Guitart, M.D., at the annual Hawaii Dermatology Seminar in January.

Waikoloa, Hawaii - Nearly two decades after bovine collagen hit the market, several new allergy-free, long-lasting dermal fillers are available for soft tissue augmentation. "Every new filler is a step closer to perfection with no reactivity and good longevity for filling wrinkles and folds," said Mark G. Rubin, M.D., at the annual Hawaii Dermatology Seminar.

Miami, Fla. - Dermatologists face extraordinary difficulties in their efforts to heal the wounds of epidermolysis bullosa (EB) patients because of the genetic absence of anchoring structures, such as anchoring fibrils and hemidesmosomes. While there has been significant progress in the science of identifying the structural defects and genetic sites of damage that lead to this disease, wound healing remains a great challenge, according to Lawrence Schachner, M.D., professor of dermatology, professor of pediatrics and interim chair at the University of Miami School of Medicine, Miami, Fla.

At a recent social event, I was asked, "What do you do?" Before I responded, I thought, should I say dermatologic surgery, laser skin surgery, cosmetic surgery, dermsurgery or dermatology?

La Jolla, Calif. - Melanoma vaccine approaches are making headway in treating intermediate-risk patients.

Washington - New N-Acetylamino (N-A) sugars are building a data trail in order to square off with acids for space in moisturizing creams and other anti-aging products. Said Barbara Green R.Ph., director of technical and consumer affairs for NeoStrata Company, Inc., "N-Acetyl offers a new therapeutic skin care alternative with anti-aging benefits, specifically improved for skin plumping and thickness."

The technical exhibit hall at the 62nd annual meeting of the AmericanAcademy of Dermatology was abuzz yesterday with new products and treatmentadvancements. Dermatology Times checked in with few exhibitors to see whatwas cooking.

Recent regulatory decisions about hyaluronic acids and hyaluronic gelshave brought facial wrinkle fillers even further into the fold of the impulsepurchase. "This changes everything," said Florida and New Yorkdermatolgist and filler expert Frederic S. Brandt, M.D., "because thesefillers don't require skin testing, which means that as soon someone comesin, they can get treatment."

Dermatologists and their patients have numerous cosmeceutical productsfrom which to choose. Doctors who categorize the agents can better helptheir patients understand how the novel therapies fit into skincare regimens.According to Zoe Diana Draelos, M.D., clinical associate professor ofdermatology, Wake Forest University School of Medicine, Winston Salem, N.C.,key cosmeceutical categories include: barrier-enhancing vitamins, receptor-mediatedvitamins, regulators of collagen breakdown, anti-inflammatories, exfoliates,and botanicals.

February 10 - Intradermal botulinum toxin has a durable effect in thetreatment of primary axillary hyperhidrosis, with nearly half of treatmentresponders requiring only one injection over a 52-week period, said DeeAnna Glaser, M.D., associate professor, department of dermatology, St. LouisUniversity.

Zein Obagi, M.D., a pioneer in the anti-aging movement, checked in withDermatology Times yesterday at the 62nd annual meeting of the American Academyof Dermatology. The Obagi Nu-Derm System of skin health remains a top-sellerfor those wishing to stem the aging process and retain young, vibrant features.

As dermatologists accumulate knowledge about the injection of botulinumtoxin Type A, the safer the procedure is becoming, according to AlastairCarruthers, M.D.With reports of rare side effects, such as extreme fatigue and headaches,surfacing from sources across the United States, dermatologists might bequestioning the safety of a drug that continues to grow in popularity anddemand. But these concerns should be eased with sound evidence supportingthe contrary.

Experts in the art of facial rejuvenation are now able to restore orenhance the "pillars" of the face - chins, cheekbones, and jawlines - for many patients who have lost the strength of these characteristicsat midlife. As a result, more and more patients are enjoying the permanentyet reversible changes that can be made to the face using a variety of volumetricimplants.

Who can deny the progression of cosmetic dermatology? Most sources saythat an impressive amount of dermatologists now call aesthetics an importantof their practice despite it being a topic debated among clinical dermatologists.

When it comes to photoprotection, people expect too much from sunscreens.In a perfect world - if people would put on enough to get full protection,reapply it as often as necessary, use a high enough SPF and a sunscreenwith the best protective ingredients, and start early enough in life protectingtheir skin from the sun - sunscreens might offer powerful protection againstmalignant melanoma and other skin conditions related to the sun. However,ours is not a perfect world and dermatologists should arm patients withthe reality that sunscreens alone are not the end-all solution in sun protection.

When it comes to complications from laser resurfacing, prevention isthe best medicine. For patients, this means picking the most qualified doctoravailable. For doctors, it's sometimes a matter of knowing your limitations.

Washington - Botulinum toxin, the wildly popular dewrinkling treatment,is not just for women anymore. Men are favoring the easy defurrowing injectionsmore and more, according to dermatologist Christopher B. Zachary, M.D.,clinical professor of dermatology, University of California, San Francisco.He discussed how men are turning to botulinum rejuvenation in order to diminishwrinkles around their eyebrows, forehead region, and mouth, he said yesterdayat the AAD annual meeting.

Despite the growing popularity of new modalities, the CO2 laser remainsthe gold standard for tissue tightening and contraction of the skin, saidSue Ellen Cox, M.D. However, the choice of therapy largely depends on theage and mindset of the patient, she added.

Laser and light therapies, while still controversial, are dramatically changing acne treatment. Rosacea patients also benefit from the more patient-friendly nondrug options. And drug therapies, including hormonal options, provide a strong hope that patients will have alternatives in treatment aimed at tackling severe acne in the future.

Many of the modern therapies that evolved during the last 25 years are new, more patient-friendly twists on old therapies. Harsh treatments with unpleasant odors that fail to diminish the most severe forms of acne and rosacea are no longer the main tools in the dermatologists' arsenal.

National report - Cosmetic dermatology is relatively new, and while no one can be expected to predict the future with certainty, it is destined to continue to grow based on consumer demand, ongoing research, and advances in science, techniques, and technology.

National report - Cosmetic treatments and modalities to prevent and reverse skin aging are relatively new realms in the field of dermatology. Looking back 25 years ago, there was much less concern among the populace about the appearance of aging skin, and limited attention was being directed by dermatologists in practice or in research to elucidate its pathophysiology or modalities for treatment and prevention.

David McDaniel grew up with a family full of role models - parents and aunts and uncles who set an example by never limiting themselves because of what other people said they could or could not do.