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Associating surfactant to hydrophobically modified polymers reduces the surfactant dynamics and reduces the aggressiveness of a cleanser
P1621 Efficacy and tolerability of antioxidant complex treatment in fine lines, wrinkles, and photodamaged skin Fred McCall-Perez, PhD, Valeant Pharmaceuticals North America, Redwood City, CA, United States; James Herndon, Jr, MD, Dermatology Center of Dallas, Dallas, TX, United States; Thomas Stephens, PhD, Stephens and Associates, Carrolton, TX, United States Background: Dermatology visits for the prevention and treatment of aging skin are increasing as patients live longer. The clinical sequelae of photodamage, including wrinkling, pigmentary changes, roughness, laxity, and telangiectasia, can all result in the appearance of aged skin. Antioxidant complex treatment has been formulated with ingredients known to improve the appearance of fine lines, wrinkles, and skin barrier function. Objective: To assess the efficacy and tolerability of antioxidant complex treatment in fine lines, wrinkles, and signs of photodamage. Methods: Thirty-four female subjects (Fitzpatrick classification I-IV) completed a 12week controlled clinical usage study. Antioxidant complex treatment was applied to the face, neck, and decolletage each morning. Efficacy was assessed using visual grading of facial and periocular skin, cutometry, and digital photography. Clinical evaluations and subject self-assessments were conducted at baseline and weeks 4, 8, and 12 using 10-point scales and skin condition assessment. Cutaneous tolerability was evaluated clinically and subjectively using a 4-point scale. Results: Significant improvements in all parameters and skin condition were seen as early as week 4 (P # .05). There was an 18% improvement in overall appearance by week 12 (P # .05) compared to baseline. Mean scores for fine lines and coarse winkles improved by 27% and 15% respectively (both P # .05 vs baseline). Significant improvements were also seen in uneven pigmentation, firmness/elasticity, toned/resiliency, skin radiance, tone, and tactile roughness/smoothness (10%, 11%, 18%, 21%, 16%, and 47%, respectively; all P # .05 vs baseline). By week 12, subjects reported a 43% improvement in overall facial skin appearance and 24% reduction in mean scores for facial lines and wrinkles (both P # .05 vs baseline). Improvements were also reported in overall skin tone, firmness, dryness, appearance of pores, appearance of brown spots/facial discoloration, skin radiance, and texture (37%, 35%, 35%, 28%, 24%, 39%, and 38%, respectively; all P # .05 vs baseline). There was a 71% reduction in erythema and 94% reduction in skin dryness by week 12 (both P # .05 vs baseline). Conclusion: Antioxidant complex treatment is effective and well-tolerated when treating photodamage and improves the appearance of fine lines and wrinkles.
DIGITAL/ELECTRONIC TECHNOLOGY P1700 Dermoscopic structural changes of nevi during pregnancy related to location Alin Luarentiu Tatu, MD, PhD, private practice and the Faculty of Medicine, University Dunarea de Jos, Galati, Romania Background: The objective is to determine if there is a relationship between localization and the dimensions of nevi during pregnancy and the dermoscopic changes of nevi. Some nevi may change in aspect, shape, margins, color, and dimension during pregnancy. Some nevi change in size during pregnancy related to their location and some of them suffer dermoscopic structural changes. Methods: This was a prospective comparative open-label trial. I studied and compared, from both clinical and dermoscopic points of view, the dimensions of two cohorts of nevi during pregnancy: one situated on distended cutaneous areas (the abdomen and breasts) and the other on nondistended cutaneous areas. I followed-up with 420 pregnant women with 1642 nevi in the first and third trimesters. I measured the nevi clinically and with the dermoscopic scale and followed-up the dermoscopic structural changes. Results: From 357 nevi situated on distended areas, 49 (13.72%) were enlarged in diameter between the first and third trimesters (2.9% of all 1642 nevi). Nineteen of them also had dermoscopic changes: 13 with a reticular pattern, showing the enlargement of the holes of pigmentary network (broadened network), and six of those with a globular pattern, showing new dots and globules. From 1285 nevi situated in areas without cutaneous distension, just 28 (2.18%) of nevi are enlarged between first and the third trimesters (1.7% of all 1642 nevi). Seven of them had also dermoscopic changes; four had thickened lines of pigmentary network and three with a globular pattern had new globules and dots. Conclusion: In pregnancy, a small number of nevi (4.6%) are enlarged between first and the third trimesters. When they are situated on distended areas, a larger proportion of nevi (13.72%) are enlarged comparative to the nevi situated on nonexpanded skin areas (2.18%). The distended skin could thin the deep of the nevus under the pressure of the nevocitic nests to the basal membrane. On distended areas from 49 nevi that are enlarged, 38.77% had dermoscopic structural changes compared to the enlargement of 28 nevi from nondistended skin areas: 25% of them have dermoscopic structural changes. Commercial support: None identified.
Commercial support: 100% sponsored by Valeant Pharmaceuticals North America.
P1701
P1622 Associating surfactant to hydrophobically modified polymers reduces the surfactant dynamics and reduces the aggressiveness of a cleanser Russel Walters, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Huda Jerri, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Katharine Martin, MS, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Lisa Gandolfi, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Michael Fevola, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States In addition to their desired beneficial effects, cleansing products can cause unwanted damage to the skin. There are many ways in which a cleanser interacts with the stratum corneum, including removing skin components, such as lipids and NMF, and remaining in the skin after rinsing and disrupting the lipid order. Previously it was thought that creating mild cleansing systems required reduced surfactant monomer concentrations, and reduced total surfactant concentrations. In this study, we show a new approach to creating skin compatible cleansers and from this gain new insight into how surfactant-based cleansers interact with the skin. We observe that low molecular weight hydrophobically modified polymers (HMPs) are particularly efficient at associating surfactants because of the strong propensity for aggregation of surfactant hydrophobic tail groups with the hydrophobic domains of the HMP. With surface tensionometry, we quantify the critical micelle concentration (CMC) of the surfactant solution, which is related to the amount of surfactant that is associated to these HMPs. Surfactant associated to the HMP lowers the effective concentration of free surfactant micelles in solution and creates polymeresurfactant complexes that are less aggressive. This study shows the important role that surfactant dynamics plays in creating mild cleansing systems. The addition of HMP to the surfactant solution results in a decrease in the surfactant dynamics, as measured with bubble pressure tensiometry and pendant drop tensiometry. The surfactant/HMP solutions require longer times to achieve equivalent surface tensions than surfactant only solutions. These slower dynamics with HMP suggest that the surfactant associated to the polymer is less dynamic than surfactant that exists in micelles. In HMP/surfactant systems, we observe a reduction in surfactant aggressiveness to tissue as measured by the fluorescein leakage test. We also observe clinical benefits from this less dynamic HMP/surfactant complex. With these results, we have developed a new understanding of the surfactant-based cleanser aggressiveness; by reducing the dynamics of the surfactant system, skin compatibility is improved. Commercial support: Sponsored by Johnson and Johnson Consumer and Personal Products Worldwide/
FEBRUARY 2011
Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: A challenge for melanoma diagnosis Pantea Hashemi, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Allan C. Halpern, MD, Memorial Sloan-kettering Cancer Center, New York, NY, United States; Alon Scope, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Ashfaq A. Marghoob, MD, Memorial Sloankettering Cancer Center, New York, NY, United States; Melissa P. Pulitzer, MD, Memorial Sloan-Kettering Cancer Center, New york, NY, United States Background: Intraepidermal Langerhans cells (ILC) can be difficult to differentiate from melanocytes under reflectance confocal microscopy (RCM), and their presence may simulate pagetoid spread of melanocytes on RCM images. Objective: To correlate bright round and dendritic cells in a pagetoid pattern identified on RCM with findings of conventional histopathology and immunohistochemistry for lesions that were falsely diagnosed as melanoma by RCM. Methods: Before excision, melanocytic lesions with clinical and dermoscopic features suspicious for melanoma were imaged by RCM. Cases selected for this retrospective study included all histopathologically proven nevi that had been imaged by RCM between 2005 and 2009 and displayed numerous bright round or dendritic cells in a pagetoid pattern under RCM, resulting in the incorrect RCM diagnosis of melanoma. For comparison, we also selected histopathologically proven melanomas displaying bright cells in a pagetoid pattern on RCM and biopsy-proven nevi that did not display such cells on RCM. To help characterize RCM-indentified pagetoid cells, we analyzed the histopathologic findings on hematoxylineeosin stained slides and on slides stained by immunohistochemistry with Melan-A and CD1a. Results: We identified 24 nevi that were falsely diagnosed as melanoma by RCM because of numerous bright cells in a pagetoid pattern. ILC were observed on histopathologic analysis in all the cases, with some cases showing distinct dense aggregates of ILC (‘‘high density’’). Bright cells in a pagetoid pattern on RCM corresponded on histopathology to ILC with a high density in 23 of the 24 nevi (95%) and to melanocytes in seven of the 24 nevi (29%). Among six melanomas displaying cells in a pagetoid pattern on RCM, ILC with high density were observed on histopathologic analysis in five of the six cases (83%) and pagetoid melanocytes were seen in all six cases (100%). The cells in the pagetoid pattern were most frequently pleomorphic (both roundish and dendritic) in the two groups of melanoma and nevi, followed by roundish cells, and less commonly dendritic cells. Numerous bright cells in pagetoid pattern (ie, $ 20 cells/mm2) were the most helpful RCM parameter in distinction of melanoma from nevi. Conclusion: Although the finding of bright cells in a pagetoid pattern is a useful RCM feature for the diagnosis of melanoma, it does not always imply the presence of pagetoid melanocytes but may, at times, represent ILC. Commercial support: None identified.
J AM ACAD DERMATOL
AB75
DIGITAL/ELECTRONIC TECHNOLOGY P1700 Dermoscopic structural changes of nevi during pregnancy related to location Alin Luarentiu Tatu, MD, PhD, private practice and the Faculty of Medicine, University Dunarea de Jos, Galati, Romania Background: The objective is to determine if there is a relationship between localization and the dimensions of nevi during pregnancy and the dermoscopic changes of nevi. Some nevi may change in aspect, shape, margins, color, and dimension during pregnancy. Some nevi change in size during pregnancy related to their location and some of them suffer dermoscopic structural changes. Methods: This was a prospective comparative open-label trial. I studied and compared, from both clinical and dermoscopic points of view, the dimensions of two cohorts of nevi during pregnancy: one situated on distended cutaneous areas (the abdomen and breasts) and the other on nondistended cutaneous areas. I followed-up with 420 pregnant women with 1642 nevi in the first and third trimesters. I measured the nevi clinically and with the dermoscopic scale and followed-up the dermoscopic structural changes. Results: From 357 nevi situated on distended areas, 49 (13.72%) were enlarged in diameter between the first and third trimesters (2.9% of all 1642 nevi). Nineteen of them also had dermoscopic changes: 13 with a reticular pattern, showing the enlargement of the holes of pigmentary network (broadened network), and six of those with a globular pattern, showing new dots and globules. From 1285 nevi situated in areas without cutaneous distension, just 28 (2.18%) of nevi are enlarged between first and the third trimesters (1.7% of all 1642 nevi). Seven of them had also dermoscopic changes; four had thickened lines of pigmentary network and three with a globular pattern had new globules and dots. Conclusion: In pregnancy, a small number of nevi (4.6%) are enlarged between first and the third trimesters. When they are situated on distended areas, a larger proportion of nevi (13.72%) are enlarged comparative to the nevi situated on nonexpanded skin areas (2.18%). The distended skin could thin the deep of the nevus under the pressure of the nevocitic nests to the basal membrane. On distended areas from 49 nevi that are enlarged, 38.77% had dermoscopic structural changes compared to the enlargement of 28 nevi from nondistended skin areas: 25% of them have dermoscopic structural changes. Commercial support: None identified.
Commercial support: 100% sponsored by Valeant Pharmaceuticals North America.
P1701
P1622 Associating surfactant to hydrophobically modified polymers reduces the surfactant dynamics and reduces the aggressiveness of a cleanser Russel Walters, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Huda Jerri, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Katharine Martin, MS, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Lisa Gandolfi, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States; Michael Fevola, PhD, Johnson and Johnson Consumer and Personal Products Worldwide, Skillman, NJ, United States In addition to their desired beneficial effects, cleansing products can cause unwanted damage to the skin. There are many ways in which a cleanser interacts with the stratum corneum, including removing skin components, such as lipids and NMF, and remaining in the skin after rinsing and disrupting the lipid order. Previously it was thought that creating mild cleansing systems required reduced surfactant monomer concentrations, and reduced total surfactant concentrations. In this study, we show a new approach to creating skin compatible cleansers and from this gain new insight into how surfactant-based cleansers interact with the skin. We observe that low molecular weight hydrophobically modified polymers (HMPs) are particularly efficient at associating surfactants because of the strong propensity for aggregation of surfactant hydrophobic tail groups with the hydrophobic domains of the HMP. With surface tensionometry, we quantify the critical micelle concentration (CMC) of the surfactant solution, which is related to the amount of surfactant that is associated to these HMPs. Surfactant associated to the HMP lowers the effective concentration of free surfactant micelles in solution and creates polymeresurfactant complexes that are less aggressive. This study shows the important role that surfactant dynamics plays in creating mild cleansing systems. The addition of HMP to the surfactant solution results in a decrease in the surfactant dynamics, as measured with bubble pressure tensiometry and pendant drop tensiometry. The surfactant/HMP solutions require longer times to achieve equivalent surface tensions than surfactant only solutions. These slower dynamics with HMP suggest that the surfactant associated to the polymer is less dynamic than surfactant that exists in micelles. In HMP/surfactant systems, we observe a reduction in surfactant aggressiveness to tissue as measured by the fluorescein leakage test. We also observe clinical benefits from this less dynamic HMP/surfactant complex. With these results, we have developed a new understanding of the surfactant-based cleanser aggressiveness; by reducing the dynamics of the surfactant system, skin compatibility is improved. Commercial support: Sponsored by Johnson and Johnson Consumer and Personal Products Worldwide/
FEBRUARY 2011
Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: A challenge for melanoma diagnosis Pantea Hashemi, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Allan C. Halpern, MD, Memorial Sloan-kettering Cancer Center, New York, NY, United States; Alon Scope, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Ashfaq A. Marghoob, MD, Memorial Sloankettering Cancer Center, New York, NY, United States; Melissa P. Pulitzer, MD, Memorial Sloan-Kettering Cancer Center, New york, NY, United States Background: Intraepidermal Langerhans cells (ILC) can be difficult to differentiate from melanocytes under reflectance confocal microscopy (RCM), and their presence may simulate pagetoid spread of melanocytes on RCM images. Objective: To correlate bright round and dendritic cells in a pagetoid pattern identified on RCM with findings of conventional histopathology and immunohistochemistry for lesions that were falsely diagnosed as melanoma by RCM. Methods: Before excision, melanocytic lesions with clinical and dermoscopic features suspicious for melanoma were imaged by RCM. Cases selected for this retrospective study included all histopathologically proven nevi that had been imaged by RCM between 2005 and 2009 and displayed numerous bright round or dendritic cells in a pagetoid pattern under RCM, resulting in the incorrect RCM diagnosis of melanoma. For comparison, we also selected histopathologically proven melanomas displaying bright cells in a pagetoid pattern on RCM and biopsy-proven nevi that did not display such cells on RCM. To help characterize RCM-indentified pagetoid cells, we analyzed the histopathologic findings on hematoxylineeosin stained slides and on slides stained by immunohistochemistry with Melan-A and CD1a. Results: We identified 24 nevi that were falsely diagnosed as melanoma by RCM because of numerous bright cells in a pagetoid pattern. ILC were observed on histopathologic analysis in all the cases, with some cases showing distinct dense aggregates of ILC (‘‘high density’’). Bright cells in a pagetoid pattern on RCM corresponded on histopathology to ILC with a high density in 23 of the 24 nevi (95%) and to melanocytes in seven of the 24 nevi (29%). Among six melanomas displaying cells in a pagetoid pattern on RCM, ILC with high density were observed on histopathologic analysis in five of the six cases (83%) and pagetoid melanocytes were seen in all six cases (100%). The cells in the pagetoid pattern were most frequently pleomorphic (both roundish and dendritic) in the two groups of melanoma and nevi, followed by roundish cells, and less commonly dendritic cells. Numerous bright cells in pagetoid pattern (ie, $ 20 cells/mm2) were the most helpful RCM parameter in distinction of melanoma from nevi. Conclusion: Although the finding of bright cells in a pagetoid pattern is a useful RCM feature for the diagnosis of melanoma, it does not always imply the presence of pagetoid melanocytes but may, at times, represent ILC. Commercial support: None identified.
J AM ACAD DERMATOL
AB75