Medesthetics Special

AR Supplement

Surgical Aesthetics and Acne & Rosacea are special editions of Medesthetics. To see Surgical Aesthetics, go to

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Prescribing Topicals Smoothing the Surface Continued from page 8 Continued from page 14 Galderma ( recently completed Phase 3 clinical trials of a new topical bimonidine tartrate gel 0.5% (CD07805/47) to reduce the inflammatory erythema and telangiectasia of rosacea. "Nothing is going to completely abolish the telangiectasia permanently other than a laser or IPL device, but as far as shrinking the vessels while the drug is active, it seems to have some effect on that as well as affecting the inflammatory erythema," says Joseph F. Fowler, MD, lead author of two Phase 3 clinical studies that were published in the British Journal of Dermatology in March 2012. In study A, 122 subjects were randomized to receive a once-daily application of bimonidine tartrate gel 0.07%, bimonidine tartrate gel 0.18%, bimonidine tartrate gel 0.5% or vehicle. Study B followed 269 subjects randomized to receive bimonidine tartrate gel 0.5% once daily, bimonidine tartrate gel 0.18% once daily, vehicle once daily, bimonidine tartrate gel 0.18% twice daily or vehicle twice daily. The patients were treated for four weeks and observed for an additional four With pulse stacking, he achieved almost 2mm in depth with less erythema, less pain and improved response in fewer treatments when compared to traditional fractional ablative resurfacing. He postulates that the device may be effective in the treatment of striae and acne scars. Most patients require a combination of treatment modalities to achieve satisfactory results. For example, treatment may start with a TCA-based CROSS procedure to help break down the collagen core in icepick scars, followed by punch incisions for very small icepick scars. "After all of that, I may do a fractional CO2 laser or radiofrequency treatment," says Dr. Wasserman. Kevin C. Smith MD FRCPC, often starts with lasers and, if there are residual scars, he touches up the site with an injectable HA filler such as Juvederm (Allergan, juvederm. com). For Dr. Sarnoff, a common treatment combination involves "some subcision and fillers, topped off at the end with a fractional ablative laser treatment," she says. "It's going to be a great addition since we haven't had anything previously to help with the erythema of rosacea. A common treatment combination involves "some subcision and fillers, topped off at the end with a fractional ablative laser treatment." weeks of followup. The researchers reported that bimonidine tartrate gel at all dose levels was well-tolerated and effective in reducing erythema for 12 hours after a single application. The four-week followup noted no rebound erythema or aggravation of telangiectasia compared with baseline. The greatest efficacy was observed in the 0.5% dosage, followed by 0.18%. The researchers used a scale of 0 for normal to 4 for severe redness, and the FDA mandated a two-grade improvement for approval. "With the topicals, like metrodinazole and azelaic acid and with the oral medications like the doxycycline, we can do a pretty darn good job of getting rid of most of the papules in most patients," says Dr. Fowler. "But none of the that really gets rid of the background erythema, and that is a significant component of rosacea. It won't replace any of the previous medications. But it's going to a great addition since we haven't had anything previously to help with the erythema of rosacea." Based on previous approvals, the new topical will be approved in mid-2013 at the earliest. z Inga Hansen is the executive editor of MedEsthetics. Patient Education and Home Care Acne scarring treatment doesn't end with the office visit. Home care is a key component of successful therapy. There are "a lot of new products out there that provide growth factors for some good wound healing after a laser procedure," says Dr. Wasserman. "I instruct patients to use them because the procedure allows the skin to absorb the growth factor product more readily." Dr. Sarnoff notes that "there is a simple homecare therapy called 'needling.' If done frequently enough and under a physician's direction, it can be hugely effective." Another useful home treatment is light therapy. "Red light stimulates collagen, and blue light kills the bacteria that cause acne in the first place," she says. Patients must also be educated that scarred skin is more susceptible to sun damage and pigmentation irregularities, so be sure to recommend diligent use of a sunscreen. z Russell A. Jackson is a West Hollywood, CA-based freelance writer who specializes in healthcare and small business. | July/August 2012 23

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