A randomized, controlled comparative study of the wrinkle reduction benefits of a cosmetic niacinamide/peptide/retinyl propionate product regimen vs. a prescription 0.02% tretinoin product regimen.

BACKGROUND: Tretinoin is considered the benchmark prescription topical therapy for improving fine facial wrinkles, but skin tolerance issues can affect patient compliance. In contrast, cosmetic antiwrinkle products are well tolerated but are generally presumed to be less efficacious than tretinoin. OBJECTIVES: To compare the efficacy of a cosmetic moisturizer regimen vs. a prescription regimen with 0.02% tretinoin for improving the appearance of facial wrinkles. METHODS: An 8-week, randomized, parallel-group study was conducted in 196 women with moderate to moderately severe periorbital wrinkles. Following 2 weeks washout, subjects on the cosmetic regimen (n = 99) used a sun protection factor (SPF) 30 moisturizing lotion containing 5% niacinamide, peptides and antioxidants, a moisturizing cream containing niacinamide and peptides, and a targeted wrinkle product containing niacinamide, peptides and 0.3% retinyl propionate. Subjects on the prescription regimen (n = 97) used 0.02% tretinoin plus moisturizing SPF 30 sunscreen. Subject cohorts (n = 25) continued treatment for an additional 16 weeks. Changes in facial wrinkling were assessed by both expert grading and image analysis of digital images of subjects' faces and by self-assessment questionnaire. Product tolerance was assessed via clinical erythema and dryness grading, subject self-assessment, and determinations of skin barrier integrity (transepidermal water loss) and stratum corneum protein changes. RESULTS: The cosmetic regimen significantly improved wrinkle appearance after 8 weeks relative to tretinoin, with comparable benefits after 24 weeks. The cosmetic regimen was significantly better tolerated than tretinoin through 8 weeks by all measures. CONCLUSIONS: An appropriately designed cosmetic regimen can improve facial wrinkle appearance comparably with the benchmark prescription treatment, with improved tolerability.

New oral and topical approaches for the treatment of melasma.

Melasma is a common, therapeutically challenging, and universally relapsing disorder of hyperpigmentation that is most often observed in women and individuals with Fitzpatrick Skin Types III through VI. The pathogenesis of melasma is complex and protean. Contributing factors that are often implicated in the etiopathogenesis of this condition include a genetic predisposition, intense ultraviolet radiation exposure, and hormonal influences. Therapeutic interventions for melasma include a multimodality approach incorporating photoprotection agents, topical and oral skin lighteners, and resurfacing procedures. Given our expanding knowledge of the pathogenesis of melasma, new and effective treatments are expanding our therapeutic armamentarium. This article reviews new and emerging oral and topical treatments for melasma.

A closer look at the role of the dermatologist in championing total women's health through the dermatology gateway.

New data collected by the Women's Dermatologic Society (WDS) through a membership survey conducted in August 2018 reflect the key role of the dermatologist in championing the overall health of the total woman through the dermatology gateway. These meaningful results provide a first-ever metric glimpse into the myriad systemic/internal diseases, disorders, and conditions that WDS dermatologists detect and diagnose in female dermatology patients and the wide scope of our collaborations with other physician specialists to manage complex, underlying medical conditions. Insightful perspectives from medical and health experts outside of dermatology address the importance of teamwork, reaffirm the unique role that dermatologists play on the medical team, and underscore the vital importance of our proclivity toward collaboration, the latter of which is shown to be significant according to the WDS data. Given an apparent general lack of awareness about the role of the dermatologist in the health journey of the total woman, we have an important opportunity to advance this broadened perspective among our colleagues in and outside of dermatology, our patients, the media, and the public at-large. By raising awareness, we can elevate our specialty in the medical profession and in the public eye, increase the likelihood that people will consult a dermatologist (proactively and reactively), inspire mutual referrals and greater cross-specialty teamwork and communications to benefit patients, and positively affect public health.

Vitiligo: Patient stories, self-esteem, and the psychological burden of disease.

Vitiligo is a relatively common disorder that is characterized by depigmented patches of skin. Multiple studies characterize the overwhelming psychological burden that is experienced by many patients around the globe. This review examines personal patient stories and the impacts of age, culture, sex, race, and ethnicity in relationship to altered self-esteem and quality of life in patients who live with vitiligo.

Determination of trimethylpsoralen in blood, ophthalmic fluids, and skin.

Trimethylpsoralen (TMP) levels in the blood of vitiligo patients were determined through the use of a high-performance liquid chromatographic method. TMP was extracted from blood buffered at pH 9.0 with 95:5 (V/V) hexane-isopropanol mixture; evaporated to dryness, and reconstituted in 50 microliters of ethanol. A 10-microliters aliquot was injected into a Micropack MCH-10 column (Varian HPLC model #5000). The mobile phase consisted of a mixture of water and acetonitrile with a linear gradient. The retention time of TMP was 16.5 min. The calibration curve of the external standards was linear. Overall recovery of the internal stands was 75-92%, with the lower detection limit of TMP at 2 ng/ml. Peak blood levels as low as 140 ng/ml and as high as 800 ng/ml were obtained in vitiligo patients 1-2 hr following the oral administration of 30 mg of trioxsalen tablets (Paul B. Elder Co.). Blood TMP levels peaked consistently at 2 hr when patients were fasted for 8 hr prior to drug ingestion. These results are consistent with the clinical observation that maximum response due to phototherapy is obtained 1-2 hr after oral administration of the drug. Two hours after oral drug administration, TMP levels in the epidermis, dermis, and whole skin of the guinea pig (in ng per g tissue) were: epidermis, 226 +/- 15; dermis, 25 +/- 6; and whole skin 176 +/- 12. Also detected were TMP levels 244 +/- 17 ng/ml in aqueous humor and 63 +/- 6 mg/ml in vitreous humor. These results point to the fact that the eyes of patients must be protected from overexposure to sunlight after psoralen-ultraviolet treatment.

Sex differences in psychiatrists' practice patterns and incomes.

OBJECTIVE AND METHOD: Using data from the APA's 1988-1989 Professional Activities Survey, the authors compared male and female psychiatrists on demographic characteristics, training, practice patterns, and income. RESULTS: In keeping with previous studies' findings, female respondents on the average were younger than male respondents and more likely to have taken a residency or fellowship in child or adolescent psychiatry, worked fewer hours per week, allocated their working hours differently among types of activities, saw fewer patients per week, and worked in somewhat different settings. Multiple regression analysis showed that women had significantly lower mean net annual income than men after the effects of those predictors were statistically controlled. CONCLUSIONS: Differences in age, training, hours worked in specific settings, and numbers of patients do not completely account for the gender gap in psychiatrists' annual incomes.

Melasma. Etiologic and therapeutic considerations.

BACKGROUND: Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. OBSERVATIONS: Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established. CONCLUSIONS: In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.

Autoantibodies and their clinical significance in a black vitiligo population.

The frequency of autoantibodies was determined in 70 black vitiligo patients and controls. Both groups were screened for antithyroid, antinuclear, antigastric parietal cell, anti-smooth muscle cell, and antimitochondrial autoantibodies. The significance of autoantibodies was determined in vitiligo patients by correlating their presence or absence with various clinical features of the patients. The overall frequencies of autoimmune and endocrine diseases were also assessed in vitiligo patients, controls, and their respective families. Vitiligo patients had an increased frequency of antithyroid antibodies and an increased frequency of autoimmune and/or endocrine diseases. These diseases included, especially, hyperthyroidism, hypothyroidism, and alopecia areata. Autoantibody-positive vitiligo patients had an increased frequency of first- and second-degree relatives having autoimmune and/or endocrine diseases. These findings tend to support an autoimmune cause of vitiligo in black patients.

Vitiligo. An overview of therapeutic approaches.

Vitiligo often induces severe cosmetic disfigurement in patients. These patients must function in a society that places profound emphasis and social significance on appearance. Although physically healthy, many patients are greatly affected psychologically by the disease. Hence, concerted efforts should be made to treat these individuals. Despite the inherent difficulties in stimulating melanocytes to repigment vitiliginous lesions, a variety of medical, surgical, and adjunctive/alternative therapies benefit innumerable patients with vitiligo. These treatments may be used as monotherapies or combination therapies to achieve optimal results.

Skin and hair cosmetic issues in women of color.

Women of color comprise many phenotypically heterogeneous groups. Despite the general heterogeneity, however, there are unique skin and hair care issues and needs. These issues often present therapeutically challenging problems for the dermatologist and the skin and hair care industry.

Cosmetics in blacks.

Blacks comprise a phenotypically heterogeneous group with respect to skin and hair. They are uniquely multihued with at least 35 different possible shades of pigmentation, and there is considerable variability in hair texture. This accounts for many of the unique skin and hair cosmetic requirements and customs in the black race. These grooming practices may present perplexing problems for the dermatologist when viewed in the context of resultant skin disease; therefore, an awareness and understanding of skin and hair products used by blacks, grooming techniques, and their consequences are essential for clinicians caring for black patients.

Pigmentary disorders in blacks.

An awareness of pigmentary nuances and an understanding of the psychosocial impact of pigmentary disturbances in blacks is essential in rendering optimal dermatologic care to black patients.

Considerations for cosmetic surgery in the black population.

The availability of cosmetic surgical procedures to the general public, especially blacks, has become increasingly widespread. Aesthetic surgeons should not be deterred from performing these procedures in blacks. The myth that all black patients develop keloids or dyspigmentation after surgery should be dispelled; however, in those patients with a history of keloid formation or hypertrophic scarring, elective cosmetic procedures should be either withheld or performed with extreme caution. In general, the cosmetic surgeon can proceed with surgery in blacks and attain good aesthetic results if the procedures are slightly modified when indicated to minimize pigmentary changes and scarring and to maintain ethnic congruency.

Should vitiligo be treated?

Vitiligo patients may experience profound psychological despair secondary to this disease. Physicians at large have been insensitive to the psychological needs of the vitiligo patient and to the importance of treatment. Vitiligo can and should be treated, especially in those individuals whose life-style, self-esteem, and productivity have been dramatically altered by this disease. Therapeutic options for these patients are presented herein.

Cutaneous manifestations of sarcoidosis in blacks.

The diverse patterns of skin lesions occurring in black patients with sarcoidosis are described. Shiny, somewhat waxy papular lesions are the most frequent cutaneous manifestation of sarcoidosis in blacks. Erythema nodosum remains an infrequent finding when compared with the frequency of other cutaneous lesions. Because of its protean cutaneous manifestations, sarcoidosis should be included in the differential diagnosis of all chronic dermatoses in blacks.

How we treat vitiligo.

Because the therapy of vitiligo is long and tedious, often requiring twelve to eighteen months, one must first evaluate the intensity of the patient's desire for treatment. If a decision is made to treat the patient, the physician must then decide whether oral or topical therapy is indicated. If the area to be treated occupies less than 20 percent of the skin surface, topical therapy is best. If the afflicted area is greater than this, oral treatment is used. If 50 percent or more of the skin surface is vitiliginous, then depigmentation with monobenzone should be considered. Therapies and techniques available to the patient with vitiligo are presented herein.

Dermatosis papulosa nigra.

The incidence and natural history of dermatosis papulosa nigra was assessed in eighty-two black patients. The overall incidence in the study population was 77 percent, with a predominance in women of almost 2:1. Fifty-four percent of these patients reported that other members of their families were also affected. The peak incidence and number of lesions occurred in those patients in their sixties. Fair-complexioned blacks had the lowest frequency of involvement. These findings confirm those of other investigators; however, we report a higher than average incidence of involvement in the population we studied.

Incidence of common dermatoses in a predominantly black dermatologic practice.

A study was done to determine the frequency of common dermatoses seen in private dermatology practices composed of predominantly black patients. This was then compared to similar previous studies. New trends in common dermatoses in private black patients were found. The most common dermatosis noted was acne vulgaris, followed by eczema, pigmentary disorders, seborrheic dermatitis, and alopecias.