A randomized, controlled comparative study of the wrinkle reduction benefits of a cosmetic niacinamide/peptide/retinyl propionate product regimen vs. a prescription 0.02% tretinoin product regimen.

BACKGROUND: Tretinoin is considered the benchmark prescription topical therapy for improving fine facial wrinkles, but skin tolerance issues can affect patient compliance. In contrast, cosmetic antiwrinkle products are well tolerated but are generally presumed to be less efficacious than tretinoin. OBJECTIVES: To compare the efficacy of a cosmetic moisturizer regimen vs. a prescription regimen with 0.02% tretinoin for improving the appearance of facial wrinkles. METHODS: An 8-week, randomized, parallel-group study was conducted in 196 women with moderate to moderately severe periorbital wrinkles. Following 2 weeks washout, subjects on the cosmetic regimen (n = 99) used a sun protection factor (SPF) 30 moisturizing lotion containing 5% niacinamide, peptides and antioxidants, a moisturizing cream containing niacinamide and peptides, and a targeted wrinkle product containing niacinamide, peptides and 0.3% retinyl propionate. Subjects on the prescription regimen (n = 97) used 0.02% tretinoin plus moisturizing SPF 30 sunscreen. Subject cohorts (n = 25) continued treatment for an additional 16 weeks. Changes in facial wrinkling were assessed by both expert grading and image analysis of digital images of subjects' faces and by self-assessment questionnaire. Product tolerance was assessed via clinical erythema and dryness grading, subject self-assessment, and determinations of skin barrier integrity (transepidermal water loss) and stratum corneum protein changes. RESULTS: The cosmetic regimen significantly improved wrinkle appearance after 8 weeks relative to tretinoin, with comparable benefits after 24 weeks. The cosmetic regimen was significantly better tolerated than tretinoin through 8 weeks by all measures. CONCLUSIONS: An appropriately designed cosmetic regimen can improve facial wrinkle appearance comparably with the benchmark prescription treatment, with improved tolerability.

Dermabrasion.

Dermabrasion is a mechanical, "cold steel" method of removing the epidermis and creating an upper to mid-dermal wound. The subsequent restructuring of collagen and a freshly resurfaced epidermis yields excellent results in actinically damaged, aged, and scarred skin. Preoperative and postoperative management to optimize wound healing are well established and predictable, and morbidity and complications are infrequently encountered.

Dermabrasion for prophylaxis and treatment of actinic keratoses.

BACKGROUND: After dermabrasion, patients with actinic keratoses remain free of new lesions for many years. This clinical effect has been alluded to for 40 years in the dermatologic literature. However, there has been no consensus on how long this clinical benefit actually lasts. OBJECTIVE: To ascertain the longevity of the beneficial effect of dermabrasion, clinical records of patients who underwent this procedure for treatment of actinic keratosis were reviewed. METHOD: Retrospective review. RESULTS: A total of 23 such patients with at least 2 years good clinical follow-up were identified. Their ages ranged from 33 to 76 years. One year after dermabrasion, 96% remained free of new actinic keratoses. The benefits of dermabrasion gradually diminished with 83% clear at 2 years, 79% at 3 years, 64% at 4 years, and 54% at 5 years. The average time after dermabrasion before the appearance of one actinic keratoses was 4 years (median, 4.5 years). Dermabrasion, however did not prevent the appearance of basal cell carcinomas in the perinasal area. CONCLUSION: Dermabrasion provides long-term effective prophylaxis against actinic keratoses and presumably squamous cell carcinomas. The benefits last for an average of 4 years before even one new actinic keratosis reappears. Cryosurgery, 5-Fluorouracil, and chemical peels result in much shorter prophylaxis. Dermabrasion is the most effective modality for prevention of new actinic keratoses.

Adjuncts to scalp reduction surgery. Intraoperative tissue expanders and hyaluronidase.

Scalp reduction has become an important part of the cosmetic surgeon's armamentarium in the treatment of male pattern alopecia. Recently, the use of two-stage tissue expansion has been advocated for scalp reduction. Intraoperative tissue expansion obviates many of the disadvantages of delayed expansion and increases the yield of excised scalp by 20-30% over standard reduction techniques in the 20 patients studied. The addition of hyaluronidase to the local anesthetic facilitates its diffusion, enhancing anesthesia and the ease of dissection. Therefore, the use of intraoperative tissue expansion and the addition of hyaluronidase to the local anesthetic are two separate adjuncts to scalp reduction surgery.

Tretinoin in the preoperative and postoperative management of dermabrasion.

Full-face or half-face dermabrasions for acne scarring were performed in 123 patients, 88 of whom received pretreatment for at least 2 weeks with 0.05% tretinoin cream. In the group that received tretinoin, healing, as evidenced by reepithelialization, was complete by 7 days; most of these patients completely healed in 5 days. All patients who did not receive tretinoin healed by 11 days, but none healed sooner than 7 days. No milia or postinflammatory hyperpigmentation was experienced by patients treated with tretinoin when the drug was resumed within 1 week after dermabrasion. In the group that received no tretinoin, milia and postinflammatory hyperpigmentation occurred in 28% of patients postoperatively.

Evaluation of a new povidone-iodine-impregnated polyethylene oxide gel occlusive dressing.

Forty-five surgical wounds were closed by suture technic and then treated with either a polyethylene oxide gel (POG) dressing or a povidone-iodine-impregnated polyethylene oxide gel (PVPI-POG) dressing. In the control group with the POG dressing alone, three wound infections, representing 25% of those patients, were encountered. In the PVPI-POG dressing group no wound infections were encountered. Wound healing, in terms of reduced inflammation and faster epidermal approximation, appeared better in the PVPI-POG dressing group.

A new primary wound dressing made of polyethylene oxide gel.

Vigilon is a new primary wound dressing consisting of 96% water and polyethylene oxide. This moisture-containing, occlusive dressing absorbs its own weight in wound exudate and allows free transfer of oxygen. It is non-adherent and appears to promote better wound healing than that reported by other occlusive dressings, making it an ideal dressing for a wide variety of dermatologic surgery.

The practical use of Z-plasty.

Properly employed, Z-plasty is a valuable way of avoiding complications of tension and contracture that may result in hypertrophic scars, and for repairing such scars if they occur. Careful preoperative planning to place the limbs of the Z in the lines of least tension and to make limbs of equal length at 60 degree angles to the central limb are essential to success. Cautious handling of the flaps and attention to hemostasis helps to ensure that success. Occasionally, Z-plasty has to be resorted to unplanned when it is found that an excision will result in tension exceeding expectations if primary closure were to be done.