Orlando Dermatology Aesthetic and Clinical (ODAC) Conference

ORLANDO – When it comes to preventing alopecia, it may be best to advise patients against certain trendy hairstyles that can cause early hair loss.

At the Orlando Dermatology Aesthetic and Clinical Conference, Dr. Wendy Roberts, a dermatologist practicing in Rancho Mirage, Calif., spoke about the risks of traction alopecia associated with some hairstyles and why it’s in patients’ best interest to avoid them if they don’t want to experience premature hair loss.

Dr. Roberts brings up the topic of hair loss with patients during the full-body exam. Full-body skin exams are “opportunities for us, as the skin and hair experts, to speak to our patients about hair loss, [but] it’s rarely asked about,” she said. “Typically, what I do is start my full-body skin exam from the head and I always ask the question right away ‘How’s your hair? Are you having any problems with your hair? How’s your scalp?’ And about 50% of the time, there’s a positive answer or an interest in learning more about it.”

To avoid traction alopecia, caused frequently by intense pulling or pressure on the hair follicles, patients should be advised against braiding their hair or, for male patients, styling their hair in a “man bun.” For braids, the tightness of the braid and pulling along the hairlines will cause intense pressure on follicles over time that can lead to hair loss. For the man bun, Dr. Roberts noted that dermatologists will likely see an uptick in male patients with traction alopecia as this hairstyle becomes more popular.

In the evaluation and treatment of traction alopecia – as with any form of alopecia – clinical presentation, ethnicity, and the age of the patient should be considered, Dr. Roberts said. Additionally, collection of evidence – hair pulls, biopsy, dermoscopy, and lab work should be obtained.

Labs will check for iron levels and anemia, thyroid disease, vitamin D deficiency, and perhaps signs of a connective tissue disorder, she noted. “It’s staggering the amount of African-American women who are deficient in vitamin D, [and] there is some soft evidence that perhaps vitamin D deficiency may be a culprit in some of the clinical signs of discoid lupus erythematosus, [so] check the vitamin D and zinc levels.”

After making a diagnosis, it is important to quickly begin rigorous treatment of the alopecia. Aggressive treatment is “the bottom line,” Dr. Roberts emphasized, “because people are losing their hair and when they come to you, they’ve really had enough.”

She did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – When it comes to preventing alopecia, it may be best to advise patients against certain trendy hairstyles that can cause early hair loss.

At the Orlando Dermatology Aesthetic and Clinical Conference, Dr. Wendy Roberts, a dermatologist practicing in Rancho Mirage, Calif., spoke about the risks of traction alopecia associated with some hairstyles and why it’s in patients’ best interest to avoid them if they don’t want to experience premature hair loss.

Dr. Roberts brings up the topic of hair loss with patients during the full-body exam. Full-body skin exams are “opportunities for us, as the skin and hair experts, to speak to our patients about hair loss, [but] it’s rarely asked about,” she said. “Typically, what I do is start my full-body skin exam from the head and I always ask the question right away ‘How’s your hair? Are you having any problems with your hair? How’s your scalp?’ And about 50% of the time, there’s a positive answer or an interest in learning more about it.”

To avoid traction alopecia, caused frequently by intense pulling or pressure on the hair follicles, patients should be advised against braiding their hair or, for male patients, styling their hair in a “man bun.” For braids, the tightness of the braid and pulling along the hairlines will cause intense pressure on follicles over time that can lead to hair loss. For the man bun, Dr. Roberts noted that dermatologists will likely see an uptick in male patients with traction alopecia as this hairstyle becomes more popular.

In the evaluation and treatment of traction alopecia – as with any form of alopecia – clinical presentation, ethnicity, and the age of the patient should be considered, Dr. Roberts said. Additionally, collection of evidence – hair pulls, biopsy, dermoscopy, and lab work should be obtained.

Labs will check for iron levels and anemia, thyroid disease, vitamin D deficiency, and perhaps signs of a connective tissue disorder, she noted. “It’s staggering the amount of African-American women who are deficient in vitamin D, [and] there is some soft evidence that perhaps vitamin D deficiency may be a culprit in some of the clinical signs of discoid lupus erythematosus, [so] check the vitamin D and zinc levels.”

After making a diagnosis, it is important to quickly begin rigorous treatment of the alopecia. Aggressive treatment is “the bottom line,” Dr. Roberts emphasized, “because people are losing their hair and when they come to you, they’ve really had enough.”

She did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – When it comes to preventing alopecia, it may be best to advise patients against certain trendy hairstyles that can cause early hair loss.

At the Orlando Dermatology Aesthetic and Clinical Conference, Dr. Wendy Roberts, a dermatologist practicing in Rancho Mirage, Calif., spoke about the risks of traction alopecia associated with some hairstyles and why it’s in patients’ best interest to avoid them if they don’t want to experience premature hair loss.

Dr. Roberts brings up the topic of hair loss with patients during the full-body exam. Full-body skin exams are “opportunities for us, as the skin and hair experts, to speak to our patients about hair loss, [but] it’s rarely asked about,” she said. “Typically, what I do is start my full-body skin exam from the head and I always ask the question right away ‘How’s your hair? Are you having any problems with your hair? How’s your scalp?’ And about 50% of the time, there’s a positive answer or an interest in learning more about it.”

To avoid traction alopecia, caused frequently by intense pulling or pressure on the hair follicles, patients should be advised against braiding their hair or, for male patients, styling their hair in a “man bun.” For braids, the tightness of the braid and pulling along the hairlines will cause intense pressure on follicles over time that can lead to hair loss. For the man bun, Dr. Roberts noted that dermatologists will likely see an uptick in male patients with traction alopecia as this hairstyle becomes more popular.

In the evaluation and treatment of traction alopecia – as with any form of alopecia – clinical presentation, ethnicity, and the age of the patient should be considered, Dr. Roberts said. Additionally, collection of evidence – hair pulls, biopsy, dermoscopy, and lab work should be obtained.

Labs will check for iron levels and anemia, thyroid disease, vitamin D deficiency, and perhaps signs of a connective tissue disorder, she noted. “It’s staggering the amount of African-American women who are deficient in vitamin D, [and] there is some soft evidence that perhaps vitamin D deficiency may be a culprit in some of the clinical signs of discoid lupus erythematosus, [so] check the vitamin D and zinc levels.”

After making a diagnosis, it is important to quickly begin rigorous treatment of the alopecia. Aggressive treatment is “the bottom line,” Dr. Roberts emphasized, “because people are losing their hair and when they come to you, they’ve really had enough.”

She did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – When treating rosacea, consider adding cosmeceuticals to more conventional prescriptions and over-the-counter treatments to improve the management of symptoms and patient satisfaction.

The recommendation comes from Dr. Julie Harper, a dermatologist at the University of Alabama-Birmingham, who spoke about the benefits of cosmeceuticals for rosacea at the Orlando Dermatology Aesthetic and Clinical Conference.

“I see about 40 people a day on my regular dermatology days [and] it’s easy to just write a prescription and hand it to that rosacea patient, but you do them a big disservice when you do that,” explained Dr. Harper. “We’ve got to talk about triggers, about skin care, about sun protection, [and] start that discussion from there.”

The most-important point for patients to understand is the main triggers of their rosacea, which can include ultraviolet light, spices, stress, exercise, heat, barrier disruption, and Demodex. Since sunlight is the No. 1 trigger for rosacea, treatment strategies often need to start there and revolve around how to avoid or manage the condition based on sun exposure.

As for cosmeceuticals, Dr. Harper focused on three types that have been shown to be effective against rosacea: niacinamide, licorice, and green tea.

The available data on niacinamide for rosacea are primarily from the 2006 Nicomide Improvement in Clinical Outcomes Study (NICOS), an open-label, multicenter, prospective cohort study that recruited people with acne vulgaris and acne rosacea from 100 centers and administered 750 mg of niacinamide with zinc and copper, while some got niacinamide plus oral antibiotics. The 49 people with rosacea who were enrolled received baseline assessments in the clinic, but 4-week and 8-week follow-ups were done via self-reported surveys (Cutis. 2006 Jan;77[1 Suppl]:17-28).

At 8 weeks, “75% of the rosacea group reported that appearance of their rosacea was moderately or much better [and] that there was also significant reduction in inflammatory lesions,” Dr. Harper said. “There was not a big difference in the group that had an oral antibiotic and niacinamide, versus niacinamide without the oral antibiotic,” although the design of the study leaves the findings somewhat questionable, she noted.

Topical niacinamide also has the potential to benefit certain rosacea patients, she said, referring to a 2005 study examining the effects of a niacinamide-containing moisturizer on the face and one forearm of 50 patients over 4 weeks. The primary outcome of the trial was barrier function, as measured by a dimethyl sulfoxide (DMSO) chemical probe (Cutis. 2005 Aug;76[2]:135-41).

While the results of this trial are “difficult” to interpret – due largely to the lack of any real measurement of facial improvement in barrier function and the confusion over whether any improvement on the forearm can be attributed to the niacinamide specifically or to the moisturizer itself – “long story short, niacinamide did seem to help the barrier function in this particular study,” Dr. Harper said. The takeaway, therefore, is that topical niacinamide treatments may offer some value to certain patients.

Moving on to licorice, Dr. Harper discussed an open label study recently published online in the Journal of the European Academy of Dermatology and Venereology, in which subjects were given a complete skin care system – which contained a cleanser, a day cream, a night cream, and a concealer product containing licochalcone A (licorice extract). They were evaluated over a period of 8 weeks for improvement in erythema, burning, stinging, tingling, and tightness, all of which were measured at baseline (J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:21-7).

Results showed “improvement of statistical significance,” Dr. Harper said. “All groups had improvement over time, and did better at 8 weeks than at 4 weeks [although] the rosacea group did not reach statistical significance until week 8.”

Finally, with green tea, Dr. Harper pointed to a 2010 randomized double-blind split-face study of just four healthy individuals with erythema and telangiectasia of the face, treated for 6 weeks with a cream containing epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, on one side of their face; a vehicle cream was applied to the other side and punch biopsies were performed to determine improvements (Int J Clin Exp Pathol. 2010;3[7]:705-9). EGCG cream was used because of its “antioxidant, immunomodulatory, photoprotective, antiangiogenic – that’s the standout here, that’s what we really need – and anti-inflammatory properties,” Dr. Harper said.

While biopsies did not reveal any changes to facial vasculature, there “was a significant reduction in hypoxia-inducible factor-1 and VEGF [vascular endothelial growth factor],” which are both markers of angiogenesis – indicating some degree of usefulness against rosacea, Dr. Harper said. However, a longer, more definitive study would be needed to substantiate these findings, she added.

Dr. Harper did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – When treating rosacea, consider adding cosmeceuticals to more conventional prescriptions and over-the-counter treatments to improve the management of symptoms and patient satisfaction.

The recommendation comes from Dr. Julie Harper, a dermatologist at the University of Alabama-Birmingham, who spoke about the benefits of cosmeceuticals for rosacea at the Orlando Dermatology Aesthetic and Clinical Conference.

“I see about 40 people a day on my regular dermatology days [and] it’s easy to just write a prescription and hand it to that rosacea patient, but you do them a big disservice when you do that,” explained Dr. Harper. “We’ve got to talk about triggers, about skin care, about sun protection, [and] start that discussion from there.”

The most-important point for patients to understand is the main triggers of their rosacea, which can include ultraviolet light, spices, stress, exercise, heat, barrier disruption, and Demodex. Since sunlight is the No. 1 trigger for rosacea, treatment strategies often need to start there and revolve around how to avoid or manage the condition based on sun exposure.

As for cosmeceuticals, Dr. Harper focused on three types that have been shown to be effective against rosacea: niacinamide, licorice, and green tea.

The available data on niacinamide for rosacea are primarily from the 2006 Nicomide Improvement in Clinical Outcomes Study (NICOS), an open-label, multicenter, prospective cohort study that recruited people with acne vulgaris and acne rosacea from 100 centers and administered 750 mg of niacinamide with zinc and copper, while some got niacinamide plus oral antibiotics. The 49 people with rosacea who were enrolled received baseline assessments in the clinic, but 4-week and 8-week follow-ups were done via self-reported surveys (Cutis. 2006 Jan;77[1 Suppl]:17-28).

At 8 weeks, “75% of the rosacea group reported that appearance of their rosacea was moderately or much better [and] that there was also significant reduction in inflammatory lesions,” Dr. Harper said. “There was not a big difference in the group that had an oral antibiotic and niacinamide, versus niacinamide without the oral antibiotic,” although the design of the study leaves the findings somewhat questionable, she noted.

Topical niacinamide also has the potential to benefit certain rosacea patients, she said, referring to a 2005 study examining the effects of a niacinamide-containing moisturizer on the face and one forearm of 50 patients over 4 weeks. The primary outcome of the trial was barrier function, as measured by a dimethyl sulfoxide (DMSO) chemical probe (Cutis. 2005 Aug;76[2]:135-41).

While the results of this trial are “difficult” to interpret – due largely to the lack of any real measurement of facial improvement in barrier function and the confusion over whether any improvement on the forearm can be attributed to the niacinamide specifically or to the moisturizer itself – “long story short, niacinamide did seem to help the barrier function in this particular study,” Dr. Harper said. The takeaway, therefore, is that topical niacinamide treatments may offer some value to certain patients.

Moving on to licorice, Dr. Harper discussed an open label study recently published online in the Journal of the European Academy of Dermatology and Venereology, in which subjects were given a complete skin care system – which contained a cleanser, a day cream, a night cream, and a concealer product containing licochalcone A (licorice extract). They were evaluated over a period of 8 weeks for improvement in erythema, burning, stinging, tingling, and tightness, all of which were measured at baseline (J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:21-7).

Results showed “improvement of statistical significance,” Dr. Harper said. “All groups had improvement over time, and did better at 8 weeks than at 4 weeks [although] the rosacea group did not reach statistical significance until week 8.”

Finally, with green tea, Dr. Harper pointed to a 2010 randomized double-blind split-face study of just four healthy individuals with erythema and telangiectasia of the face, treated for 6 weeks with a cream containing epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, on one side of their face; a vehicle cream was applied to the other side and punch biopsies were performed to determine improvements (Int J Clin Exp Pathol. 2010;3[7]:705-9). EGCG cream was used because of its “antioxidant, immunomodulatory, photoprotective, antiangiogenic – that’s the standout here, that’s what we really need – and anti-inflammatory properties,” Dr. Harper said.

While biopsies did not reveal any changes to facial vasculature, there “was a significant reduction in hypoxia-inducible factor-1 and VEGF [vascular endothelial growth factor],” which are both markers of angiogenesis – indicating some degree of usefulness against rosacea, Dr. Harper said. However, a longer, more definitive study would be needed to substantiate these findings, she added.

Dr. Harper did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – When treating rosacea, consider adding cosmeceuticals to more conventional prescriptions and over-the-counter treatments to improve the management of symptoms and patient satisfaction.

The recommendation comes from Dr. Julie Harper, a dermatologist at the University of Alabama-Birmingham, who spoke about the benefits of cosmeceuticals for rosacea at the Orlando Dermatology Aesthetic and Clinical Conference.

“I see about 40 people a day on my regular dermatology days [and] it’s easy to just write a prescription and hand it to that rosacea patient, but you do them a big disservice when you do that,” explained Dr. Harper. “We’ve got to talk about triggers, about skin care, about sun protection, [and] start that discussion from there.”

The most-important point for patients to understand is the main triggers of their rosacea, which can include ultraviolet light, spices, stress, exercise, heat, barrier disruption, and Demodex. Since sunlight is the No. 1 trigger for rosacea, treatment strategies often need to start there and revolve around how to avoid or manage the condition based on sun exposure.

As for cosmeceuticals, Dr. Harper focused on three types that have been shown to be effective against rosacea: niacinamide, licorice, and green tea.

The available data on niacinamide for rosacea are primarily from the 2006 Nicomide Improvement in Clinical Outcomes Study (NICOS), an open-label, multicenter, prospective cohort study that recruited people with acne vulgaris and acne rosacea from 100 centers and administered 750 mg of niacinamide with zinc and copper, while some got niacinamide plus oral antibiotics. The 49 people with rosacea who were enrolled received baseline assessments in the clinic, but 4-week and 8-week follow-ups were done via self-reported surveys (Cutis. 2006 Jan;77[1 Suppl]:17-28).

At 8 weeks, “75% of the rosacea group reported that appearance of their rosacea was moderately or much better [and] that there was also significant reduction in inflammatory lesions,” Dr. Harper said. “There was not a big difference in the group that had an oral antibiotic and niacinamide, versus niacinamide without the oral antibiotic,” although the design of the study leaves the findings somewhat questionable, she noted.

Topical niacinamide also has the potential to benefit certain rosacea patients, she said, referring to a 2005 study examining the effects of a niacinamide-containing moisturizer on the face and one forearm of 50 patients over 4 weeks. The primary outcome of the trial was barrier function, as measured by a dimethyl sulfoxide (DMSO) chemical probe (Cutis. 2005 Aug;76[2]:135-41).

While the results of this trial are “difficult” to interpret – due largely to the lack of any real measurement of facial improvement in barrier function and the confusion over whether any improvement on the forearm can be attributed to the niacinamide specifically or to the moisturizer itself – “long story short, niacinamide did seem to help the barrier function in this particular study,” Dr. Harper said. The takeaway, therefore, is that topical niacinamide treatments may offer some value to certain patients.

Moving on to licorice, Dr. Harper discussed an open label study recently published online in the Journal of the European Academy of Dermatology and Venereology, in which subjects were given a complete skin care system – which contained a cleanser, a day cream, a night cream, and a concealer product containing licochalcone A (licorice extract). They were evaluated over a period of 8 weeks for improvement in erythema, burning, stinging, tingling, and tightness, all of which were measured at baseline (J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:21-7).

Results showed “improvement of statistical significance,” Dr. Harper said. “All groups had improvement over time, and did better at 8 weeks than at 4 weeks [although] the rosacea group did not reach statistical significance until week 8.”

Finally, with green tea, Dr. Harper pointed to a 2010 randomized double-blind split-face study of just four healthy individuals with erythema and telangiectasia of the face, treated for 6 weeks with a cream containing epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, on one side of their face; a vehicle cream was applied to the other side and punch biopsies were performed to determine improvements (Int J Clin Exp Pathol. 2010;3[7]:705-9). EGCG cream was used because of its “antioxidant, immunomodulatory, photoprotective, antiangiogenic – that’s the standout here, that’s what we really need – and anti-inflammatory properties,” Dr. Harper said.

While biopsies did not reveal any changes to facial vasculature, there “was a significant reduction in hypoxia-inducible factor-1 and VEGF [vascular endothelial growth factor],” which are both markers of angiogenesis – indicating some degree of usefulness against rosacea, Dr. Harper said. However, a longer, more definitive study would be needed to substantiate these findings, she added.

Dr. Harper did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.

This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.

While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”

The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.

For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.

“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”

There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.

For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).

Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.

“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.

Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.

Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.

She did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.

This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.

While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”

The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.

For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.

“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”

There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.

For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).

Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.

“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.

Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.

Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.

She did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.

This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.

While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”

The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.

For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.

“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”

There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.

For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).

Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.

“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.

Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.

Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.

She did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – New diagnostic and treatment options are at the forefront of what’s new and exciting in the area of superficial cutaneous fungal infections, according to Dr. Adam Friedman.

“Although superficial cutaneous mycoses [are] extremely common, they can be quite a challenge for several reasons,” explained Dr. Friedman of the George Washington University in Washington, at the Orlando Dermatology Aesthetic and Clinical annual meeting, adding that “many of the common skin diseases are often confused for tineum, and vice versa.”

In this video interview, Dr. Friedman discusses what dermatologists should look for in terms of diagnosing and treating dermatophytes and onychomycosis, two of most common and increasingly treatable fungal infections patients are likely to present with.

Dr. Friedman did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – New diagnostic and treatment options are at the forefront of what’s new and exciting in the area of superficial cutaneous fungal infections, according to Dr. Adam Friedman.

“Although superficial cutaneous mycoses [are] extremely common, they can be quite a challenge for several reasons,” explained Dr. Friedman of the George Washington University in Washington, at the Orlando Dermatology Aesthetic and Clinical annual meeting, adding that “many of the common skin diseases are often confused for tineum, and vice versa.”

In this video interview, Dr. Friedman discusses what dermatologists should look for in terms of diagnosing and treating dermatophytes and onychomycosis, two of most common and increasingly treatable fungal infections patients are likely to present with.

Dr. Friedman did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – New diagnostic and treatment options are at the forefront of what’s new and exciting in the area of superficial cutaneous fungal infections, according to Dr. Adam Friedman.

“Although superficial cutaneous mycoses [are] extremely common, they can be quite a challenge for several reasons,” explained Dr. Friedman of the George Washington University in Washington, at the Orlando Dermatology Aesthetic and Clinical annual meeting, adding that “many of the common skin diseases are often confused for tineum, and vice versa.”

In this video interview, Dr. Friedman discusses what dermatologists should look for in terms of diagnosing and treating dermatophytes and onychomycosis, two of most common and increasingly treatable fungal infections patients are likely to present with.

Dr. Friedman did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – Dermatologists with the right patient population should consider incorporating photodynamic therapy (PDT) into their practices, as it is becoming an increasingly popular and effective.

Although most dermatologists know about PDT, “They’re not as comfortable setting up the office” and often don’t know the best ways to use PDT to achieve optimal treatment outcomes, explained Dr. Neal Bhatia, director of clinical dermatology at Therapeutics Clinical Research in San Diego, during his session at the Orlando Dermatology Aesthetic and Clinical annual meeting.

In this video interview, Dr. Bhatia, explains the benefits of PDT, what type of patient would be best suited for this treatment, and why it’s increasingly important for dermatologists to offer this treatment to their patients – even if they’ve never considered doing so before.

Dr. Bhatia is a clinical investigator and consultant with Dusa Pharmaceuticals and Biofrontera. He did not report any other relevant disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – Dermatologists with the right patient population should consider incorporating photodynamic therapy (PDT) into their practices, as it is becoming an increasingly popular and effective.

Although most dermatologists know about PDT, “They’re not as comfortable setting up the office” and often don’t know the best ways to use PDT to achieve optimal treatment outcomes, explained Dr. Neal Bhatia, director of clinical dermatology at Therapeutics Clinical Research in San Diego, during his session at the Orlando Dermatology Aesthetic and Clinical annual meeting.

In this video interview, Dr. Bhatia, explains the benefits of PDT, what type of patient would be best suited for this treatment, and why it’s increasingly important for dermatologists to offer this treatment to their patients – even if they’ve never considered doing so before.

Dr. Bhatia is a clinical investigator and consultant with Dusa Pharmaceuticals and Biofrontera. He did not report any other relevant disclosures.

dchitnis@frontlinemedcom.com

ORLANDO – Dermatologists with the right patient population should consider incorporating photodynamic therapy (PDT) into their practices, as it is becoming an increasingly popular and effective.

Although most dermatologists know about PDT, “They’re not as comfortable setting up the office” and often don’t know the best ways to use PDT to achieve optimal treatment outcomes, explained Dr. Neal Bhatia, director of clinical dermatology at Therapeutics Clinical Research in San Diego, during his session at the Orlando Dermatology Aesthetic and Clinical annual meeting.

In this video interview, Dr. Bhatia, explains the benefits of PDT, what type of patient would be best suited for this treatment, and why it’s increasingly important for dermatologists to offer this treatment to their patients – even if they’ve never considered doing so before.

Dr. Bhatia is a clinical investigator and consultant with Dusa Pharmaceuticals and Biofrontera. He did not report any other relevant disclosures.

dchitnis@frontlinemedcom.com