Facial rejuvenation: combining cosmeceuticals with cosmetic procedures.

Cosmetic patients are looking for a more youthful appearance without spending a lot of money, feeling any pain, or experiencing any postprocedure downtime. New cosmeceutical therapies can be used adjuvant to chemical peels, lasers, and injectables, making antiaging regimens less painful and requiring less postprocedural healing time. Adjunctive agents can be used to enhance chemical peels and decrease postinflammatory hyperpigmentation (PIH). Topical retinoids used prior to ablative laser treatments can aid in faster postprocedure healing and reepithelialization. Cosmeceuticals that contain both antioxidants and anti-inflammatories can help reduce postprocedure inflammation. Acetyl hexapeptide-3 is an effective topical agent for decreasing wrinkles and can be used as an adjunct to intramuscular botulinum neurotoxin, which may reduce the number of injections needed. Topical hyaluronic acid also would help patients who are averse to needles or are just starting to get wrinkles and are looking for noninvasive therapy. This article reviews combinations of cosmeceuticals with cosmetic procedures that dermatologists may want to consider discussing with their cosmetic patients.

Treatment of refractory necrobiotic xanthogranulomas with extracorporeal photopheresis and intravenous immunoglobulin.

Necrobiotic xanthogranuloma (NXG) is a disease of fibrotic or telangiectatic granulomatous papules and nodules that can ultimately progress into ulcerated plaques. Although the exact cause of NXG is unknown, it most often occurs in patients with paraproteinemia secondary to a hematologic disease. Consequently, therapy for NXG is targeted at treating the underlying hematologic disease, and subsequent paraproteinemia, with alkylating agents, antimetabolites, radiation, and/or immunosuppressive agents. Cases refractory to these therapies often have poor outcomes. We report the successful treatment of two patients with refractory NXG with two different modalities: extracorporeal photopheresis (ECP) and intravenous immunoglobulin (IVIG). The first case shows a patient without paraproteinemia who had success with ECP and IVIG, and the second is a patient with paraproteinemia treated effectively with IVIG. The beneficial response of our patients to IVIG, as well as ECP, shows that they may be an effective treatment option for refractory NXG.