New tricks revive old hands

Key Points

New York - Patients seeking skincare advice and cosmetic treatments to improve the appearance of an aging face are likely to be very grateful if offered treatments to rejuvenate aging hands, says Kimberly J. Butterwick, M.D.

Resurfacing

However, because this site is more prone to slower healing and complications, it is important to be more conservative than when performing chemical peeling on the face.

"I would particularly advise against combining treatments. One published report described scarring after trichloroacetic acid (TCA) peeling combined with fat grafting in the hands," Dr. Butterwick tells Dermatology Times.

Patients should also be told that a series of peels will be necessary, and that they will see improvement relatively slowly. The peels used are generally superficial, such as TCA 10 percent to 25 percent or up to a single coat of TCA 35 percent, Jessner's solution, salicylic acid, alpha hydroxy acids, tretinoin solution or modified Unna's resorcinol paste.

Microdermabrasion can also be performed, and Dr. Butterwick notes she offers it as a "gift" to patients undergoing facial microdermabrasion. The effect is modest, but the treatment does not take long and results in temporary increased smoothness.

"Perhaps one of the greatest benefits is that it reminds patients to pay attention to skincare for their hands. Whatever they are using to prevent or reverse photoaging of the face, I encourage them to use on their hands," Dr. Butterwick says.

Ablative lasers can be used for resurfacing the hands, but relative to treatment of the face, they need to be used with greater caution, and they involve a longer healing period of two to three weeks.

The available literature, which is minimal, suggests resurfacing with an erbium: YAG laser or a single-pass ultrapulse CO₂ laser with the debris left in place.

However, the newer, less invasive lasers are probably best for resurfacing the backs of the hands compared with either of those ablative technologies, Dr. Butterwick says.

"Observations from experienced laser surgeons show moderately good results can be achieved with fractional photothermolysis (Fraxel, Reliant) or plasma resurfacing with excited nitrogen gas. Healing occurs rapidly, although multiple treatments are required. Still more research is needed to better define the benefits, duration of effect and the optimal treatment parameters," she says.

Lentigines

Use of any Q-switch pigmented laser is Dr. Butterwick's preferred modality for clearing solar lentigines, as the treatment can provide excellent results after only one or two sessions. Light cryosurgery, however, should not be forgotten as a viable option.

"Some of the lentigines are actually slightly palpable, thin seborrheic keratoses that will not respond to pigmented lasers," Dr. Butterwick says.

Topical bleaching agents are not very effective as monotherapy for lentigines on the hands. Combination products or a combined treatment approach using light cryotherapy and a topical agent appear to be better.

Nevertheless, once the topical agent is discontinued, the lentigines tend to darken again.

When there are multiple lentigines, Dr. Butterwick says she prefers using an intense pulsed light (IPL) source with or without a photosensitizer. The lentigines respond readily, and good global improvement can generally be obtained after two or three treatments. Because the treatment may also stimulate collagen synthesis, it appears to be helpful for resolving senile purpura as well.