Combination therapy in female pattern hair loss.

Patterned hair loss is a common type of non-scarring alopecia, characterized by miniaturization of hair follicles. The etiology of female pattern hair loss (FPHL) is not clearly linked to androgens or other hormones thereby making it a challenging condition to treat. Various treatment modalities, like minoxidil (topical or oral), spironolactone, finasteride, have been tried alone or in combination with variable results. Combination therapy is superior to the monotherapy, since these multiple treatment modalities act by targeting different pathogenetic pathways, making the treatment aggressive and more effective.

Laser treatment for facial acne scars: A review.

BACKGROUND AND OBJECTIVES: Acne scarring is a widely prevalent condition that can have a negative impact on a patient's quality of life and is often worsened by aging. A number of options are available for the treatment of acne scarring, including retinoids, microdermabrasion, dermal fillers, and surgical techniques such as subcision. The aim of this review is to evaluate the different laser modalities that have been used in peer-reviewed clinical studies for treatment of atrophic acne scars, and summarize current clinical approaches. MATERIALS AND METHODS: A Medline search spanning from 1990 to 2016 was performed on acne scarring. Search terms included "atrophic acne scars," "ablative'', "nonablative," "fractional," "nonfractional," "neodymium," "alexandrite," "pulsed dye" lasers, and results are summarized. RESULTS: Various types of lasers have been evaluated for the treatment of atrophic acne scars. While they are efficacious overall, they differ in terms of side effects and clinical outcomes, depending on patients skin and acne scar type. A new emerging trend is to combine lasers with other energy-based devices and/or topicals. CONCLUSION: Evaluation of the literature examining acne scar treatment with lasers, revealed that clinical outcomes are dependent on various patient factors, including atrophic acne scar subtype, patient skin type, treatment modality, and side-effect profile.

Photobiomodulation therapy for androgenetic alopecia: A clinician's guide to home-use devices cleared by the Federal Drug Administration.

The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium. ABBREVIATIONS: AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.

New-Generation Therapies for the Treatment of Hair Loss in Men.

Hair loss affects millions of people worldwide and can have devastating effects on an individual's psychoemotional well-being. Today hair restoration technologies through hair transplantation have advanced with the use of robots and follicular unit extraction/grafting that can offer patients excellent clinical results. Adjuvant modalities, such as platelet-rich plasma injections, lasers, and stem cells, can further enhance durability, health, and appearance of hair transplants.

Efficacy of multipolar radiofrequency with pulsed magnetic field therapy for the treatment of abdominal cellulite.

INTRODUCTION: Cellulite is a metabolic condition, predominately seen in females, that affects the subcutaneous tissue of the posterolateral thighs, buttocks, pelvic region, and abdomen. It is characterized by skin dimpling and lumpiness resembling an orange peel. Despite the wide range of treatment options for patients with cellulite, there is a paucity of empirical data supporting their efficacy. The objective of this study was to evaluate the efficacy of a new-generation multipolar radiofrequency (RF) device for the treatment of cellulite. METHODS: A multipolar RF device with pulsed magnetic fields was used to treat abdominal cellulite. Twenty-five healthy adult females with stage II or stage III abdominal cellulite underwent 8 weekly treatments. Assessments were performed at baseline and at weeks 1, 4, and 12 following the final treatment. RESULTS: Reduction in subcutaneous thickness in the axial and sagittal plane of the abdomen was observed at 1 week following treatment initiation. Results from self-reported questionnaires revealed a significantly high level of patient satisfaction (60%). Assessments by a blinded investigator at one, four, and twelve weeks after the final treatment demonstrated a significant improvement in cellulite appearance. No adverse effects were reported and the treatment was well tolerated. CONCLUSION: This study demonstrates the safety, efficacy, and subject satisfaction of multipolar RF with pulsed magnetic field therapy in the treatment of abdominal cellulite.

A novel approach to structural facial volume replacement.

UNLABELLED: Improved understanding of the anatomy and physiology of the aging face has laid the foundation for adopting an earlier and more comprehensive approach to facial rejuvenation, shifting the focus from individual wrinkle treatment and lift procedures to a holistic paradigm that considers the entire face and its structural framework. This article presents an overview of a comprehensive method to address facial aging. The key components to the reported strategy for improving facial cosmesis include, in addition to augmentation of volume loss, protection with sunscreens and antioxidants; promotion of epidermal cell turnover with techniques such as superficial chemical peels; microlaser peels and microdermabrasion; collagen stimulation and remodeling via light, ultrasound, or radiofrequency (RF)-based methods; and muscle control with botulinum toxin. For the treatment of wrinkles and for the augmentation of pan-facial dermal lipoatrophy, several types of fillers and volumizers including hyaluronic acid (HA), autologous fat, and calcium hydroxylapatite (CaHA) or injectable poly-L-lactic acid (PLLA) are available. A novel bimodal, trivector technique to restore structural facial volume loss that combines supraperiosteal depot injections of volume-depleted fat pads and dermal/subcutaneous injections for panfacial lipoatrophy with PLLA is presented. The combination of treatments with fillers; toxins; light-, sound-, and RF-based technologies; and surgical procedures may help to forestall the facial aging process and provide more natural results than are possible with any of these techniques alone. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of mild-to-moderate acne vulgaris using a combined light and heat energy device: home-use clinical study.

INTRODUCTION: Light and heat devices have become widely used for the treatment of mild-to-moderate inflammatory acne as an alternative to retinoids and antibiotics. The purpose of this study was to examine whether a hand-held device that emits both light and heat energy can safely and effectively be applied at home to shorten the time to improvement and time to resolution of acne papules and pustules. METHODS: A two-center, randomized, placebo-controlled, double-blind study was conducted on 63 subjects with at least four inflamed, facial, acne lesions. Treatments were self-administered twice a day for 4 days. All lesions were photographed on a daily basis. Treatment results were assessed by two blinded evaluators, based on the macro photographs, using a 4-point visual analogue scale (VAS) and a photographic lesion reference scale (PLRS), as well as by the subjects. Safety was assessed based on evaluators and subjects' reported side effects and adverse events. RESULTS: Twenty-nine subjects in the treatment arm and 32 subjects in the placebo arm, with skin types II-VI, successfully completed the study. Based on blinded VAS scores, 92.24% of the lesions treated with an active device improved within a median time of 1 day versus 75.78% and a median time of 2 days for the placebo arm. At 24 hours the improvement rate was 76.72% for the active arm versus 15.63% for the placebo arm. Based on blinded PLRS scores, 87.07% of the lesions treated with an active device improved within a median time of 2 days versus 64.8% and 3 days for the placebo. A total of 51.7% of the active arm lesions resolved within a median time of 4 days versus 36% (no median) for the placebo arm lesions. No device-related adverse events occurred throughout the study. CONCLUSION: This study demonstrates the safety and effectiveness of the hand-held, combined light and heat energy device for at-home treatment of individual mild-to-moderate inflammatory acne lesions. Statistically significant shorter lesion improvement and lesion resolution rates were found.

New clinical outcomes utilizing a 1064-nm Nd:YAG laser for lipolysis of the torso oblique region.

OBJECTIVES: The safety and efficacy of a 1064-nm Nd:YAG laser (Cynosure, Westford, USA) utilizing a 300-microm optical fiber and a 1-mm diameter micro-cannula were evaluated as a treatment for reduction in the appearance or elimination of unwanted fat in the lower back/flanks ('love handles'). In addition, the use of the laser for tightening the skin and collagen regeneration in the area of lipolysis was assessed through biopsies. METHODS: Ten subjects with unwanted flaccidity and fat deposits in the oblique region of the torso were enrolled in the study. Subjects underwent a single laser lipolysis treatment followed by aspiration of the treatment area. The total tumescence used, laser energy delivered, and tissue removed was recorded for each subject. All subjects had baseline photographs taken and their weight recorded prior to treatment. Pregnancy tests (if applicable) were performed prior to treatment as well. Three subjects had 4-mm biopsies taken at baseline and 6 months to evaluate collagen regeneration. Collagen and elastic tissue fibers were evaluated using special routine stains and histochemical stains designed to highlight these dermal components. Follow-up visits were conducted at 1 week, 1 month, 3 months and 6 months following treatment to evaluate side effects, weight loss and laxity. Additionally, patients kept an evaluation log for each of the first 7 days following treatment. At the 6-month conclusion, patient satisfaction was recorded. RESULTS: Laser lipolysis procedures with subsequent aspiration were performed bilaterally on the flanks of 10 subjects. At 1-week post-treatment, 80% of the subjects demonstrated reduction in laxity. Similarly, 100% of patients showed visible skin improvement at 1 month, with 70% recording a score of 2 (good improvement). Three-month evaluations yielded one patient (10%) with a score of 3 (excellent improvement) and seven patients (70%) with a score of 2. Histology reports confirmed the visual clinical outcomes, describing thicker collagen bundles at 6 months, as well as coagulation of blood vessels and adipocytes. Side effects were mild and transient in nature, and the majority of discomfort, redness, bruising, swelling, and tingling experienced was resolved within 1 week post-procedure. The treatment was well tolerated and efficacious, with 90% of patients rating their results as good or excellent and 100% of patients reporting that they would recommend the procedure. CONCLUSION: The use of the 1064-nm Nd:YAG laser with a 300-microm fiber demonstrated the ability to treat adipose tissue in the highly vascular flank area with favorable efficacy and safety. Patients exhibited a quick recovery time and excellent tolerance, as well as visually improved skin.

Treatment of cellulite: Part II. Advances and controversies.

Treatments for localized adiposities range from topical creams to liposuction. Most treatments lack a substantial proof of efficacy. The unpredictable treatment outcome can be related to the fact that cellulite adipose tissue is physiologically and biochemically different from subcutaneous tissue found elsewhere in the body. Part II of this two-part series on cellulite reviews the various treatment options that are currently available for human adipose tissue including, but not limited to, cellulite. It also focuses on newer techniques that can be potentially useful in the future for the treatment of cellulite.

Ablative skin resurfacing with a novel microablative CO2 laser.

Carbon dioxide (CO2) laser skin resurfacing has been a mainstay of facial rejuvenation since its introduction in the mid 1990s. Recently, a new generation of fractional or microablative CO2 lasers has been introduced to the marketplace. According to the concept of fractional photothermolysis, these lasers ablate only a fraction of the epidermal and dermal architecture in the treatment area. An array of microscopic thermal wounds is created that ablates the epidermis and dermis within very tiny zones; adjacent to these areas, the epidermis and dermis are spared. This microablative process of laser skin resurfacing has proven safe and effective not only for facial rejuvenation, but elsewhere on the body as well. It is capable of improving wrinkles, acne scars, and other types of atrophic scars and benign pigmented lesions associated with elastotic, sun-damaged skin. Because of the areas of spared epidermis and dermis inherent in a procedure that employs fractional photothermolysis, healing is more rapid compared to fully ablative CO2 laser skin resurfacing and downtime is proportionately reduced. A series of 32 consecutive patients underwent a single laser resurfacing procedure with the a new microablative CO2 laser. All patients were followed for a minimum of 6 months and were asked to complete patient satisfaction questionnaires; a 6 month postoperative photographic evaluation by an independent physician, not involved in the treatment, was also performed. Both sets of data were graded and reported on a quartile scale. Results demonstrated greater than 50% improvement in almost all patients with those undergoing treatment for wrinkles, epidermal pigment or solar elastosis deriving the greatest change for the better (>75%).

Effects of cellulite treatment with RF, IR light, mechanical massage and suction treating one buttock with the contralateral as a control.

BACKGROUND AND OBJECTIVES: A system that combines bipolar radio frequency (RF) and intense infrared light (IR) together with mechanical massage and suction has recently been reported as being efficient for cellulite treatment. The present split study was designed to evaluate the efficacy of such a system through various treatments of cellulite located on the buttocks. METHODS: Ten patients were enrolled for 12 sessions of 30 minutes each performed over one buttock, the other buttock serving as an untreated control. Sessions were conducted twice a week for a period of 12 weeks. Clinical photography and profilometry were carried out to assess textural changes before (baseline) and 2 months after the final treatment. Histopathology was performed at baseline, 2 hours after the first session, and just before the 12th session and 2 months thereafter. RESULTS: All patients noted improvement in the treated buttock before the final session, which was maintained at the 2-month assessment. Improved skin appearance was noticed after the first session and was maintained throughout the study. All patients were satisfied with the results and requested further treatment in order to balance the results in both buttocks. Random histological analyses suggested dermal firmness, fibre compaction and tightening of skin layers, including the subcutis, as possible reasons for the effects achieved. The authors recognize that the small number of participants limits the statistical power of the study. CONCLUSIONS: Treatment sessions with the combined RF, IR light and mechanical massage and suction system were complication free, produced improvements in the overall cellulite appearance and skin condition, suggesting that further treatment sessions for maintenance could sustain patient satisfaction index (SI) and lead to lasting results. Based on the good results in the limited trial population, further studies with larger patient populations are warranted.

Medical spa marketing.

Medical spas are different. We are not just selling medical and dermatology services; we are offering clients viable new solutions to their skin care, body care, and hair care challenges. Traditional medical marketing becomes blurred today, as the expansion and acceptance of medical spas helps you to effectively compete with traditional skin care clinics, salons, and spas, while offering more therapeutic treatments from professionally licensed doctors, nurses, aestheticians, massage therapists, spa professionals, and medical practitioners. We recommend that you make the choice to successfully and competitively become a market-driven medical spa with an annual strategic plan, rather than an operationally driven business.

Handheld LED array device in the treatment of acne vulgaris.

The successful treatment of acne still remains problematic. Conventional therapies often prove inconsistent with unacceptable side effects and recurrence rates, leading to patient noncompliance. A thermal phototherapy treatment using a combination of blue light and red light has recently attracted much attention and seems to offer an effective alternative. The objective of this study was to evaluate the efficacy of blue light (415 nm) in combination with red light (633 nm) in the reduction of inflammatory lesions on the face of subjects (n=21) with mild to moderate acne vulgaris after a course of 8 20-minute (blue) or 30-minute (red) alternated light treatments, self-administered by a handheld unit over a period of 4 weeks. Lesion counts progressively reduced throughout the 4-week light therapy period and continued to reduce up to 8 weeks posttherapy, with a final average reduction of 69% seen 8 weeks after the treatment course (P>.001). This pattern is similar to previously reported studies.

A study to determine the efficacy of a novel handheld light-emitting diode device in the treatment of photoaged skin.

The use of visible or near-infrared spectral light alone for the purpose of skin rejuvenation has been previously reported in the literature. These devices use large arrays of diodes to deliver light to the skin. In this study, a novel method of light-emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths delivered from a small handheld unit is proposed. Twenty-two subjects with facial rhytides received eight light therapy treatments over a course of 4 weeks, using the Omnilux handheld LED system. Assessment of global skin grading was evaluated at weeks 6, 9, and 12 by a dermatologist. Additional outcome measures included assessments of clinical photography and patient satisfaction scores. Seventy-four percent of the subjects reported a visible improvement in fine lines and wrinkles at 8 weeks posttreatment. Combination red and near-infrared LED therapy delivered from a small portable handheld unit represents an effective and acceptable method of photo rejuvenation. Further studies to optimize the parameters of treatment are required.

In vivo skin antioxidant effect of a new combination based on a specific Vitis vinifera shoot extract and a biotechnological extract.

BACKGROUND AND OBJECTIVES: Ultraviolet (UV) light produces reactive oxygen species (ROS) in skin, which accelerate aging by damaging DNA, proteins, lipids, and other cellular constituents. The aims of this study were to 1) evaluate the antioxidant properties of a Vitis vinifera shoot extract on cultured normal human keratinocytes, 2) compare the in vivo antioxidant of this extract in combination with a biotechnological extract (Ronacare Hydroine), and 3) evaluate the efficacy on photoaging skin of a serum based on a combination (Vitis vinifera shoot extract in hydroglycolic solution, or Sarmentine, and Ronacare Hydroine) after a 4-week application, and to quantify the additional improvement given by applying a cream with the serum. METHODS/STUDY DESIGN: An in vitro study was conducted to evaluate the antioxidant properties of Vitis vinifera shoot extract added to cultured normal human keratinocytes. A fluorescent probe was used to quantify cytoplasmic endogenous species formed in response to oxidative stress induced by H2O2. The antioxidant activity of Vitis vinifera shoot extract was compared to that of a solvent control and 2 positive controls, vitamin E and vitamin C. In the first in vivo study, 2 test products were included in a comparative, randomized, single-blind trial in which 27 subjects acted as their own (untreated) controls. Products were applied 4 times to randomized areas of the inner surface of the forearm for one day. The following day, treated and untreated (control) areas of stratum corneum were sampled for fluorimetric analysis. A decrease in fluorescence compared with untreated control reflected a decrease in the level of ROS, in which case the product had a scavenging effect. The 2 products contained a combination of Sarmentine and Ronacare Hydroine, whose antioxidant properties were under investigation. Other products were known antioxidants. In the second in vivo study, 60 female subjects applied either serum or serum plus cream twice daily for 28 days for clinical evaluation. Overall improvement was rated on a quartile scale (0%-25%, 26%-50%, 51%-75%, 76%-100%) and changes in firmness, radiant glow, evenness, smoothness, wrinkles, fine lines, hydration, texture, and softness were rated on a negative to positive scale (-5=worse to +5=greatly improved). RESULTS AND CONCLUSIONS: Vitis vinifera shoot extract appears to have significantly stronger in vitro antioxidant capacity than vitamin C or vitamin E. In the same vehicle (placebo emulsion), ascorbic acid (0.5%), Sarmentine (1%), and the Sarmentine (1%) plus Ronacare Hydroine (1%) combination had a significant in vivo antioxidant effect versus a nontreated area. The combination Sarmentine (1%) plus Ronacare Hydroine (1%) showed a higher efficacy than Sarmentine alone. The dermatologic evaluation showed that a 4-week twice-daily application of a serum containing the combination improved the main clinical signs of photoaged skin. The addition of the cream with the serum appears to enhance the serum-induced improvement of most of the skin characteristics.

Modulation of gene expression as a new skin anti-aging strategy.

BACKGROUND/OBJECTIVES: [corrected] The signs of aging may originate from natural processes or from exposure to the sun, wind, or other environmental factors. To evaluate the anti-aging effects of potential agents researchers must first identify and be able to quantify epidermal markers that change with aging. This paper summarizes the results of studies conducted to evaluate the transcriptional effects of an Aframomum angustifolium seed extract and Malva Sylvestris extract, and the antiaging efficacy of a skin care product containing the Aframomum angustifolium seed extract. METHODS: The transcriptional effect of an Aframomum angustifolium seed extract on normal human keratinocytes (NHKs) and normal human fibroblasts (NHF) was evaluated in vitro with the use of a low-density DNA array technology. The Malva Sylvestris extract was studied with a commercial DNA macroarray and by a real-time quantitative reverse transcriptase-polymerase chain reaction. The in vitro anti-aging activities of the Malva sylvestris extract were compared with those of all-trans retinoic acid (RA), a well-established topical therapy for photodamage and wrinkles. The genes studied were known to be modified by RA. The anti-aging efficacy of a facial skin care product containing Aframomum angustifolium seed extract was evaluated in a single-center study using image processing analysis and in a 2-center study by evaluation of the photographs by the investigator, independent evaluators, and subjects. RESULTS: In general, the Aframomum angustifolium seed extract strongly modified the gene expression profiles of NHKs and weakly modified the gene expression profiles of NHFs. After incubation with Aframomum angustifolium seed extract, the expressions of 3 antioxidant genes (metallothionein 1, metallothionein 2, and thioredoxin) were increased in NHKs, while expressions of 1 antioxidant gene (glutathione peroxidase) was increased in NHFs. Concerning the Malva sylvestris extract, a cDNA macro-array technology experiment with the reconstructed human epidermis model showed that some genes modulated by treatment with the Malva sylvestris extract are also regulated by RA treatment indicating a similar activity at the mRNA level. In the single-center study, a facial skin care product containing the Aframomum angustifolium seed extract significantly improved the homogeneity of the skin. The areas of the detected objects (skin imperfections) decreased significantly on each studied area of the face and the variance decreased significantly over the entire face. In the 2-center study, 28% percent of the subjects reported a greater than 50% overall global improvement in their skin by the end of the study compared to 11% of the subjects after 4 weeks of treatment. Seventy-six percent of subjects said they would purchase the cream. CONCLUSIONS: The authors developed a low-density DNA chip method that permitted the study of the transcriptional effect of Malva Sylvestris extract and of Aframomum angustrifolium seed extract. The gene expression profiles obtained demonstrate the anti-aging properties of these compounds. An in vivo single-center study, performed and analyzed with an assay based on image processing analysis, demonstrated the antiwrinkle activity of a formulation containing the Aframomum angustifolium seed extract. The data obtained in the 2-center study suggests that the cosmeceutical containing Aframomum angustifolium seed extract produces a global rejuvenation effect in terms of redness, pigmentation, and fine lines similar to that noted utilizing an intense pulse light source.

Hydrating skin by stimulating biosynthesis of aquaporins.

Aquaporins (AQPs) are proteins that facilitate the transport of water across cell membranes. AQP3 expression is related to the expressions of other epidermal proteins involved in water maintenance (ie, CD44, claudin-1, and filaggrin). The expressions of AQP3 water channels are strongly affected by age and chronic sun exposure, and a defective osmotic equilibrium could occur in the epidermis, which would account for the skin dryness observed in older people and skin areas most exposed to sunlight. We investigated active ingredients that are able to increase AQP3 levels in order to improve hydration in human skin keratinocytes. We selected an ethanolic/water (70/30 v/v) extract of Ajuga turkestanica, a plant from Central Asia, as the hydrating agent. After 17 days of treatment every 2 days with this extract (2.5 microg/mL) in vitro, AQP3 expression measured at the protein level in human reconstructed epidermis was significantly increased. Water transport through both aquaporins and aquaglyceroporins and glycerol transport through aquaglyceroporins alone are important to skin hydration. The distribution and the variability of aquaporins in human skin cells suggest that these channels may have important roles in skin physiology. AQPs appear to be key protein targets to improve the resistance and quality of the skin surface as well as to improve aging and sun exposure-induced dryness as shown by their roles in 1) hydrating the living layers of the epidermis where the keratinocyte differentiation takes place and 2) barrier formation and recovery.

Laser and light treatments for pilonidal cysts.

Pilonidal (nest of hair) cysts are foreign body reactions accompanied by chronic inflammation. Current accepted treatments include the traditional conservative treatments or aggressive surgery. However, these modalities exhibit a high rate of disease recurrence, especially in patients with hirsutism; therefore, affected patients often are subjected to repeated surgical interventions. This report describes 5 patients treated with either a diode laser or intense pulsed light (IPL), which produced results leaving the patients recurrence free. Four of 5 patients remained recurrence free for 7 months to more than 36 months; one patient experienced a recurrence after 36 months, which was longer than his previous remission. These results suggest laser and IPL technologies are alternatives to traditional surgical intervention, providing potentially longer disease-free intervals and fewer recurrences.