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Histology of fractionated CO2 laser wrinkle reduction and skin resurfacing in an animal model
Histologic improvement in photodamage after 12 months of treatment with tretinoin emollient cream (0.02%)
Hydroquinone-free brightening complex: A multicenter study for skin aging
(Poster reference number 4806)
(Poster reference number 5295)
Leon H. Kircik, MD, Mount Sinai Medical Center, New York, NY, United States
Zoe D. Draelos, MD, Clinical Dermatology Center, North Point, NC, United States; Mary L. Puissegur Lupo, MD, The Lupo Center for Aesthetic & General Dermatology, New Orleans, LA, United States; Michael H. Gold, MD, Tennessee Clinical Research Center, Nashville, TN, United States; Mitchel P. Goldman, MD, Goldman Butterwick Fitzpatrick, Groff Cosmetic Laser Dermatology, San Diego, CA, United States
Background: Topical retinoids are effective in improving the appearance of photodamaged skin. Histologic analyses show that tretinoin can act to reduce collagen loss, augment collagen formation, and mitigate signs of solar elastosis. Objective: The aim of this pilot investigation was to evaluate histologic changes after 12 months of applying tretinoin 0.02% emollient cream to treat moderate to severe facial photodamage. Methods: This pilot report assessed 3 of 19 subjects who were enrolled in a singlecenter, open-label, single-group observational study designed to evaluate the safety and efficacy of tretinoin 0.02% cream for treating adults with facial photodamage. Subjects aged 18 years or older with moderate to severe photodamage (as classified by the investigator on the Glogau Photodamage Classification Scale) applied tretinoin emollient cream 0.02% each evening to treatment areas for 12 months. Facial photographs and 2-mm punch biopsy specimens of the lateral canthus area were obtained at baseline and 12 months. Biopsy samples were stained for collagen, elastin, and melanin, and stratum corneum morphology was examined. Results: At baseline, 2 of the 3 subjects had extensive solar elastosis, with moderate elastosis in the third subject. There was also evidence of abnormal elastin and collagen fiber orientation and distribution at baseline. After 12 months of tretinoin treatment, all 3 subjects showed histologic improvements in photodamage, including smoothing of the epidermis, a slightly thinner keratin layer, and thin, comparatively straight elastic and collagen fibers in the mid- to deep-dermal layer. The histologic changes in all subjects were attributed to a remodeling process that affected the elastic and connective tissue fibers in the mid to deep dermis induced by tretinoin treatment. Conclusion: These results suggest that 12 months of tretinoin 0.02% cream treatment is associated with histologic improvements in photodamaged skin. Additional evaluation using a larger sample size is warranted. Commercial support: 80% of expenses related to development and production of abstract and poster would be sponsored by J&J.
Background: Along with wrinkles and elastosis, aged skin manifests in pigment changes such as mottled hyperpigmentation and lentigines. Whereas hydroquinone at prescription strength is considered the gold standard for skin whitening, alternatives to hydroquinone are available. This study describes the use of a novel skin brightening complex for photoaged skin. The complex comprises four actives targeting several key processes of melanogenesis. Objective: The skin brightening complex consists of leucine, disodium glycerophosphate, phenylethyl resorcinol and undecylenoyl phenylalanine. Leucine competes with tyrosine transport into the melanocyte-melanosome complex and may limit availability of tyrosine needed for melanin formation. Disodium glycerophosphate binds calcium to potentially influence calcium dependent processes in melanogenesis including phenylalanine uptake into melanosomes, and melanosome transfer. Phenylethyl resorcinol strongly inhibits tyrosinase; about 10 times more efficiently than Kojic acid. In vitro data indicates that undecylenoyl phenylalanine acts as an antagonist of alfa-MSH. Safety and efficacy of an oil-in-water emulsion containing the skin brightening complex (Neocutis, San Francisco, CA) was studied in 80 females between 35 to 65 years of age of skin types I to III with at least mild mottled hyperpigmentation on face. Methods: Subjects applied the skin brightening complex cream twice daily in conjunction with a SPF30+ sunscreen during day time for 12 weeks after a 4-week wash-out period with the sunscreen use only. Evaluations for mottled hyperpigmentation, irregular depigmentation, lentigines, skin tone, and brightness were performed before and after washout, and after 4, 8, and 12 weeks by the respective investigator using a simple 4- to 5-point visual severity scale. Results: Whereas improvement in skin aging measured parameters after the washout period were insignificant, visible signs for mottled hyperpigmentation, irregular depigmentation, lentigines, skin tone and brightness improved by 36%, 23%, 26%, 18%, and 32%, respectively, after 12 weeks of use. The cream was well tolerated. Conclusion: This study demonstrated that a cream with a novel hydroquinone-free skin brightening complex is effective in improving the appearance of aged skin. Commercial support: 100% sponsored by NEOCUTIS, Inc.
Histology of fractionated CO2 laser wrinkle reduction and skin resurfacing in an animal model
(Poster reference number 5516)
Robert Tucker, PhD, MD, University of Iowa College of Medicine, Iowa City, IA, United States Background: The study examines histologic effects of wrinkle reduction/skin tightening and skin resurfacing with a table-top 15-watt fractionated CO2 laser with a unique fiber optic output cable system. Typical clinical power settings, 6 and 12 watts were employed in the two procedures. The depth and extent of thermal damage was quantified both as necrotic and thermally damaged tissue. Methods: A female Sus scrofia pig was preanesthetized and the surgical plane was maintained by inhalation of isoflurane. The pig was connected to heart rate monitor, oxygen monitor, and ventilator; the skin was cleaned and shaved. The laser was employed at: (1) 12 watts with a dwell of 7 ms and varying densities for the wrinkle reduction; and (2) 6 watts with a dwell of 2 ms for skin resurfacing. Seventeen areas were treated, removed, and placed in 10% buffered formalin. Four micron sections were taken perpendicular to the skin and stained with H&E. As a single section had a large uncertainty with respect to their spatial location to the laser spot application, additional slides from each treatment area were examined to insure a complete histological picture of the tissue effect. Therefore, 10 step sections from a treatment area were recut from the paraffin blocks with each step separated by 100 microns.
Improvement of deep seated eyes and medial eyelid height using combination of hyaluronic acid filler and botulinum toxin type A
(Poster reference number 5699)
Fariba Ghalamkarpour, MD, Skin Research Center, Shohada and Tajrish Hospital, Shahid Beheshti Medical University, Tehran, Iran Background: A combination therapy of botulinum toxin type A and hyaluronic acid fillers has been proposed by experts in order to achieve tridimensional facial rejuvenation. The central role of eyebrows and eyes is continuously emphasized as the marks of facial beauty. The aim of aesthetic treatment is to help patients have a more satisfying look and therefore greater self e esteem. Augmenting the exposure of deep seated eyes and lid elevation thereby reducing lid sagging is of a crucial importance to the many patients who suffer from this. Objectives: In this study, we have tried to evaluate the effect of hyaluronic acid filler injections at a naso-frontal angle and medial eyebrow position to improve the conspicuousness of the deep-seated eyes and the height of the medial brow two weeks subsequent to BTX-A treatment of the upper face.
Conclusion: Histology demonstrated that higher power settings can thermally modify collagen in the dermis for skin tightening. This effect was observed at 12 watts and may be accomplished with lower settings. Low power settings of 6 watts yielded superficial damage confined mostly to the epidermis as is desirable for skin resurfacing.
Method: Ten patients with age range of 45 to 65 were selected. We treated the patients with BTX -A in the upper facial area. Two weeks posttreatment, 0.2-0.3 mL hyaluronic acid filler was injected under the medial eyebrow head and 0.2-0.4 mL at the nasal base. We measured the distance between the medial canthus and the upper border of the medial brow before and after filler injection. Photography was done before and after treatment. Results: These were interpreted based on the following criteria: elevation of the eyebrow height, 2-3 mm was classified as excellent; 2-1.5 as good; 1.5-2 moderate; and less than 1.5 poor. The interpretation of the extent to which an improvement to sunken eyes was perceived was based on patient satisfaction and ab unbiased, qualified assessor. Responses were as follows: 70 % of the patients show a very positive reaction, 20% good, 10 % unsatisfying. Elevation less than 1.5 mm was not observed. Conclusion: Filler injection at a naso-frontal angle and medial brow head after a BTX-A treatment of the upper lid results in an improvement for deep seated eyes, an increase of medial brow height and consecutively a reduction of medial lid sagging.
Commercial support: 50% sponsored by Ellman International, Inc.
Commercial support: None identified.
Results: (1) In the 12 watt procedure, two tissue effects were seen: a necrotic area with a complete loss of normal architecture; and an area that had a more normal appearing architecture but eosinophilic cytoplasm, nuclei that were hyperchromic and pyknotic, and vascular congestion which probably would necrose over time. Ablated holes had a typical depth of about 450 ms and an additional thermal damage that extended about 80 m into the reticular dermis. (2) In the 6 watt procedure, little necrosis was seen and normal architecture was present. The thermal effect was usually confined to the epidermis with an average depth of 40 to 80 m and a maximum of 160 m.
APRIL 2012
J AM ACAD DERMATOL
AB27
Hydroquinone-free brightening complex: A multicenter study for skin aging
(Poster reference number 4806)
(Poster reference number 5295)
Leon H. Kircik, MD, Mount Sinai Medical Center, New York, NY, United States
Zoe D. Draelos, MD, Clinical Dermatology Center, North Point, NC, United States; Mary L. Puissegur Lupo, MD, The Lupo Center for Aesthetic & General Dermatology, New Orleans, LA, United States; Michael H. Gold, MD, Tennessee Clinical Research Center, Nashville, TN, United States; Mitchel P. Goldman, MD, Goldman Butterwick Fitzpatrick, Groff Cosmetic Laser Dermatology, San Diego, CA, United States
Background: Topical retinoids are effective in improving the appearance of photodamaged skin. Histologic analyses show that tretinoin can act to reduce collagen loss, augment collagen formation, and mitigate signs of solar elastosis. Objective: The aim of this pilot investigation was to evaluate histologic changes after 12 months of applying tretinoin 0.02% emollient cream to treat moderate to severe facial photodamage. Methods: This pilot report assessed 3 of 19 subjects who were enrolled in a singlecenter, open-label, single-group observational study designed to evaluate the safety and efficacy of tretinoin 0.02% cream for treating adults with facial photodamage. Subjects aged 18 years or older with moderate to severe photodamage (as classified by the investigator on the Glogau Photodamage Classification Scale) applied tretinoin emollient cream 0.02% each evening to treatment areas for 12 months. Facial photographs and 2-mm punch biopsy specimens of the lateral canthus area were obtained at baseline and 12 months. Biopsy samples were stained for collagen, elastin, and melanin, and stratum corneum morphology was examined. Results: At baseline, 2 of the 3 subjects had extensive solar elastosis, with moderate elastosis in the third subject. There was also evidence of abnormal elastin and collagen fiber orientation and distribution at baseline. After 12 months of tretinoin treatment, all 3 subjects showed histologic improvements in photodamage, including smoothing of the epidermis, a slightly thinner keratin layer, and thin, comparatively straight elastic and collagen fibers in the mid- to deep-dermal layer. The histologic changes in all subjects were attributed to a remodeling process that affected the elastic and connective tissue fibers in the mid to deep dermis induced by tretinoin treatment. Conclusion: These results suggest that 12 months of tretinoin 0.02% cream treatment is associated with histologic improvements in photodamaged skin. Additional evaluation using a larger sample size is warranted. Commercial support: 80% of expenses related to development and production of abstract and poster would be sponsored by J&J.
Background: Along with wrinkles and elastosis, aged skin manifests in pigment changes such as mottled hyperpigmentation and lentigines. Whereas hydroquinone at prescription strength is considered the gold standard for skin whitening, alternatives to hydroquinone are available. This study describes the use of a novel skin brightening complex for photoaged skin. The complex comprises four actives targeting several key processes of melanogenesis. Objective: The skin brightening complex consists of leucine, disodium glycerophosphate, phenylethyl resorcinol and undecylenoyl phenylalanine. Leucine competes with tyrosine transport into the melanocyte-melanosome complex and may limit availability of tyrosine needed for melanin formation. Disodium glycerophosphate binds calcium to potentially influence calcium dependent processes in melanogenesis including phenylalanine uptake into melanosomes, and melanosome transfer. Phenylethyl resorcinol strongly inhibits tyrosinase; about 10 times more efficiently than Kojic acid. In vitro data indicates that undecylenoyl phenylalanine acts as an antagonist of alfa-MSH. Safety and efficacy of an oil-in-water emulsion containing the skin brightening complex (Neocutis, San Francisco, CA) was studied in 80 females between 35 to 65 years of age of skin types I to III with at least mild mottled hyperpigmentation on face. Methods: Subjects applied the skin brightening complex cream twice daily in conjunction with a SPF30+ sunscreen during day time for 12 weeks after a 4-week wash-out period with the sunscreen use only. Evaluations for mottled hyperpigmentation, irregular depigmentation, lentigines, skin tone, and brightness were performed before and after washout, and after 4, 8, and 12 weeks by the respective investigator using a simple 4- to 5-point visual severity scale. Results: Whereas improvement in skin aging measured parameters after the washout period were insignificant, visible signs for mottled hyperpigmentation, irregular depigmentation, lentigines, skin tone and brightness improved by 36%, 23%, 26%, 18%, and 32%, respectively, after 12 weeks of use. The cream was well tolerated. Conclusion: This study demonstrated that a cream with a novel hydroquinone-free skin brightening complex is effective in improving the appearance of aged skin. Commercial support: 100% sponsored by NEOCUTIS, Inc.
Histology of fractionated CO2 laser wrinkle reduction and skin resurfacing in an animal model
(Poster reference number 5516)
Robert Tucker, PhD, MD, University of Iowa College of Medicine, Iowa City, IA, United States Background: The study examines histologic effects of wrinkle reduction/skin tightening and skin resurfacing with a table-top 15-watt fractionated CO2 laser with a unique fiber optic output cable system. Typical clinical power settings, 6 and 12 watts were employed in the two procedures. The depth and extent of thermal damage was quantified both as necrotic and thermally damaged tissue. Methods: A female Sus scrofia pig was preanesthetized and the surgical plane was maintained by inhalation of isoflurane. The pig was connected to heart rate monitor, oxygen monitor, and ventilator; the skin was cleaned and shaved. The laser was employed at: (1) 12 watts with a dwell of 7 ms and varying densities for the wrinkle reduction; and (2) 6 watts with a dwell of 2 ms for skin resurfacing. Seventeen areas were treated, removed, and placed in 10% buffered formalin. Four micron sections were taken perpendicular to the skin and stained with H&E. As a single section had a large uncertainty with respect to their spatial location to the laser spot application, additional slides from each treatment area were examined to insure a complete histological picture of the tissue effect. Therefore, 10 step sections from a treatment area were recut from the paraffin blocks with each step separated by 100 microns.
Improvement of deep seated eyes and medial eyelid height using combination of hyaluronic acid filler and botulinum toxin type A
(Poster reference number 5699)
Fariba Ghalamkarpour, MD, Skin Research Center, Shohada and Tajrish Hospital, Shahid Beheshti Medical University, Tehran, Iran Background: A combination therapy of botulinum toxin type A and hyaluronic acid fillers has been proposed by experts in order to achieve tridimensional facial rejuvenation. The central role of eyebrows and eyes is continuously emphasized as the marks of facial beauty. The aim of aesthetic treatment is to help patients have a more satisfying look and therefore greater self e esteem. Augmenting the exposure of deep seated eyes and lid elevation thereby reducing lid sagging is of a crucial importance to the many patients who suffer from this. Objectives: In this study, we have tried to evaluate the effect of hyaluronic acid filler injections at a naso-frontal angle and medial eyebrow position to improve the conspicuousness of the deep-seated eyes and the height of the medial brow two weeks subsequent to BTX-A treatment of the upper face.
Conclusion: Histology demonstrated that higher power settings can thermally modify collagen in the dermis for skin tightening. This effect was observed at 12 watts and may be accomplished with lower settings. Low power settings of 6 watts yielded superficial damage confined mostly to the epidermis as is desirable for skin resurfacing.
Method: Ten patients with age range of 45 to 65 were selected. We treated the patients with BTX -A in the upper facial area. Two weeks posttreatment, 0.2-0.3 mL hyaluronic acid filler was injected under the medial eyebrow head and 0.2-0.4 mL at the nasal base. We measured the distance between the medial canthus and the upper border of the medial brow before and after filler injection. Photography was done before and after treatment. Results: These were interpreted based on the following criteria: elevation of the eyebrow height, 2-3 mm was classified as excellent; 2-1.5 as good; 1.5-2 moderate; and less than 1.5 poor. The interpretation of the extent to which an improvement to sunken eyes was perceived was based on patient satisfaction and ab unbiased, qualified assessor. Responses were as follows: 70 % of the patients show a very positive reaction, 20% good, 10 % unsatisfying. Elevation less than 1.5 mm was not observed. Conclusion: Filler injection at a naso-frontal angle and medial brow head after a BTX-A treatment of the upper lid results in an improvement for deep seated eyes, an increase of medial brow height and consecutively a reduction of medial lid sagging.
Commercial support: 50% sponsored by Ellman International, Inc.
Commercial support: None identified.
Results: (1) In the 12 watt procedure, two tissue effects were seen: a necrotic area with a complete loss of normal architecture; and an area that had a more normal appearing architecture but eosinophilic cytoplasm, nuclei that were hyperchromic and pyknotic, and vascular congestion which probably would necrose over time. Ablated holes had a typical depth of about 450 ms and an additional thermal damage that extended about 80 m into the reticular dermis. (2) In the 6 watt procedure, little necrosis was seen and normal architecture was present. The thermal effect was usually confined to the epidermis with an average depth of 40 to 80 m and a maximum of 160 m.
APRIL 2012
J AM ACAD DERMATOL
AB27