Innovations in Neuromodulators

In an interview with Dermatology Times®, Seth Matarasso, MD, clinical professor of dermatology at the University of California San Francisco School of Medicine, and president-elect of the American Society for Dermatologic Surgery (ASDS), gave an overview of his presentation, “Neuromodulators: The Cutting Edge,” presented at the Annual ASDS meeting last month. Matarasso began by stressing that treating patients with neuromodulators needs a much more custom-tailored plan than it used to.

Seth Matarasso, MD

“It’s no longer a cookbook in terms of ‘these are the precise amounts of units’ and ‘these are the precise injection sites.’ Throw away the cookbook and look at the patient to individualize the toxin in terms of how much you need and where to place it,” said Matarasso.

Previously, many dermatologists may have followed standard measurements of units and injection site locations to treat glabellar lines, such as 5 injection sites and 25 units, but this is no longer the case. Now, standard units and injection sites will not be universal for all patients, and personalized measurements should be used to achieve maximum efficacy.

Another important discussion that came from Matarasso’s presentation was about the neurotoxin pipeline. There is no longer just one neurotoxin option. OnabotulinumtoxinA (Botox) used to be the gold standard of neurotoxin treatment, but the landscape has changed with the now 5 FDA-approved neurotoxins in the United States. Additionally, 3-4 new neurotoxins are coming down the pipeline in Europe.

“There are about 4 neurotoxins coming out from Europe, which one of my concerns is that we're going to start to cannibalize the market. This is such a uniformly effective procedure. Historically, patients are so happy. I just am concerned that we're going to dilute the market,” said Matarasso.

Matarasso also pointed out that the discussion of diffusion versus the spread of the toxin was popular during his presentation. The difference between the two is contingent upon volume and dilution and should be handled responsibly.

One neurotoxin for physicians to keep their eye on is botulinum neurotoxin serotype E (BoNT/E)from Allergan Aesthetics.

“I think there is potential here. Allergan is marketing BoNT/E as a very fast-acting neurotoxin. It goes into effect within 24 hours. Conversely, it only lasts 2 weeks. So, one of the points of discussion is whether you can mix a toxin with a quick onset of action with a toxin that has a longer onset of action, and we hope to get the best of both worlds. I don't know if that's going to be universally accepted, but it did generate a fair amount of discussion,” said Matarasso.

A hot topic currently discussed in the aesthetic dermatology space is the incidence of neurotoxin complications due to ill-trained practitioners. Using neurotoxins to treat glabellar lines or the frontalis muscle is an incredibly safe procedure when performed by the right physician. Dermatologists, plastic surgeons, ophthalmologists, and other core group members are noticing more and more complications when injections are performed by those with improper training.

To end a thoughtful discussion, Matarasso explained why he believes the annual ASDS conference is important to attend.

“What I really enjoy about this meeting and what makes it stand out more than any other meeting is the camaraderie. It is big enough that you have so many different courses from which to choose. There are live courses and video courses, and then you step out in the hallway and you see a colleague and you can ask about a problem or situation that you might be dealing with in the office. There is that personal touch which I think is remarkable,” said Matarasso.

Reference

Matarasso S. Neuromodulators: The Cutting Edge. American Society for Dermatologic Surgery. October 7-10. Denver, Colorado.