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 cases, I would do combination treatment with a topical and oral antibiotic along with a retinoid. One subset of patients that deserves special attention is skin of color patients. They may require combination therapy with oral antibiotics due to the propensity to find inflammation even in mild comedonal acne and their increased incidence of post-inflammatory hyperpigmentation." Dr. Downie offers two combination clindamycin and tretinoin products in her practice, Veltin Gel (Stiefel, and Ziana (Medicis Pharmaceutical, "Some patients are really dry so I recommend an oil-free moisturizer," she says. "I also recommend dotting on a fade cream to the darker areas. The fade cream of the moment is Sledgehammer from MyBody. It's very gentle yet very effective." The Right Product for Each Patient "A foam is better tolerated in hair-bearing areas—such as the scalp—while oily skin may require a gel base." In addition to a variety of actives, topical treatments are offering a range of vehicles, from creams to gels and even foam formulations for more targeted prescriptive care. "Choosing vehicles is very important as it effects compliance," says Dr. Badreshia-Bansai. "A foam is better tolerated in hair-bearing areas—such as the scalp—while oily skin may require a gel base and dry skin requires more of a moisturizing cream vehicle." Patients in climates with dry winter seasons may also require a moisturizing, cream-based product, while patients in more humid climates are best treated with lightweight, gel-based formulations. Dr. Badreshia-Bansai finds that teens generally prefer "the simplest regimens possible, as do many adults. This is where dual therapy is excellent. Benzoyl peroxide/clindamycin gel 6 July/August 2012 | ACNE & ROSACEA and benzoyl peroxide/adapalene are more effective and easier to use and requires fewer steps, which increases compliance and treatment results." Working with a skin condition that largely affects young people inevitably leads to questions of pregnancy. "That changes everything," says Dr. Downie. "I take the patient off retinoids immediately. She has to come off oral antibiotics and all topicals except Finacea. Finacea is the only safe acne drug in the pregnancy category. I will still peel them with chemical peels and I let them use glycolic-acid based cleansers at home." Homecare Advances Taking a cue from prescription-based topicals, homecare regimens are boosting efficacy and patient compliance with a combination of active ingredients. Retinol—based on its ability to be converted into retinoic acid in the skin—and benzoyl peroxide are two of the most widely used acne-fighting homecare ingredients. But even at lower, over-the-counter strengths, they bring concerns of dryness and irritation. PCA Skin offers a benzoyl peroxide cleanser and cream that has been reformulated with arnica to reduce redness and polyhydroxy acid gluconolatone. "This is an alpha hydroxy acid and also a polyhydroxy acid. It has a well-known usage in skin care as an antioxidant, and it also has a UV protective component," says Ivana Veljkovic, PhD, manager of research and development and international regulatory compliance, PCA Skin ( "Gluconolactone is a milder exfoliant compared to glycolic acid, for example, so it causes less skin irritation and erythema. It seems to be a great addition to benzoyl peroxide because it synergistically increases the overall efficacy of the products, but it also brings a moisturizer and anti-inflammatory component." © Though choosing the best active ingredient or combination of ingredients is largely based on skin type, the severity of acne and a patient's age, gender and region may also play a role in prescription choices. Dr. Downie notes that ACZONE is a popular choice for women because it comes in a lightweight gel that absorbs right into the skin. "They can put on their sunblock and their makeup and walk right out the door," she says. "Tazorac comes in a cream formulation, but it also absorbs very well."

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