Aesthetic Dermatology

What is it?

The Mohs Appropriate Use Criteria (AUC) app is a decision support tool based on the Mohs micrographic surgery AUC published in 2012.¹ The app helps to determine if Mohs surgery is appropriate for your patients at the point of care.

How does it work?

The app walks you through a short series of selections based on tumor and patient characteristics (ie, cancer type, location, recurrent or primary, histologic features, tumor size, if the patient has immunocompromise or a genetic syndrome) and returns a rating on the appropriateness of Mohs surgery using a scale of 1 to 9. The rating indicates if Mohs surgery is appropriate; not appropriate; or uncertain, meaning that there is not enough published evidence to support if Mohs surgery is appropriate. The whole process takes seconds to complete.

How can it help me?

Compared to the 20-page Mohs surgery AUC publication,¹ this application is extremely easy to use at the point of care. It frees me from having to memorize the Mohs AUC or having to wade through an extensive report when I only want to know if Mohs surgery is appropriate. It also will be useful in educating patients who believe every skin cancer requires Mohs surgery.

How can I get it?

Because Mohs AUC is free, every dermatologist should use this mobile app. It can be downloaded from the Apple App Store. It is not available for Android devices at this time.

What is it?

The Mohs Appropriate Use Criteria (AUC) app is a decision support tool based on the Mohs micrographic surgery AUC published in 2012.¹ The app helps to determine if Mohs surgery is appropriate for your patients at the point of care.

How does it work?

The app walks you through a short series of selections based on tumor and patient characteristics (ie, cancer type, location, recurrent or primary, histologic features, tumor size, if the patient has immunocompromise or a genetic syndrome) and returns a rating on the appropriateness of Mohs surgery using a scale of 1 to 9. The rating indicates if Mohs surgery is appropriate; not appropriate; or uncertain, meaning that there is not enough published evidence to support if Mohs surgery is appropriate. The whole process takes seconds to complete.

How can it help me?

Compared to the 20-page Mohs surgery AUC publication,¹ this application is extremely easy to use at the point of care. It frees me from having to memorize the Mohs AUC or having to wade through an extensive report when I only want to know if Mohs surgery is appropriate. It also will be useful in educating patients who believe every skin cancer requires Mohs surgery.

How can I get it?

Because Mohs AUC is free, every dermatologist should use this mobile app. It can be downloaded from the Apple App Store. It is not available for Android devices at this time.

What is it?

The Mohs Appropriate Use Criteria (AUC) app is a decision support tool based on the Mohs micrographic surgery AUC published in 2012.¹ The app helps to determine if Mohs surgery is appropriate for your patients at the point of care.

How does it work?

The app walks you through a short series of selections based on tumor and patient characteristics (ie, cancer type, location, recurrent or primary, histologic features, tumor size, if the patient has immunocompromise or a genetic syndrome) and returns a rating on the appropriateness of Mohs surgery using a scale of 1 to 9. The rating indicates if Mohs surgery is appropriate; not appropriate; or uncertain, meaning that there is not enough published evidence to support if Mohs surgery is appropriate. The whole process takes seconds to complete.

How can it help me?

Compared to the 20-page Mohs surgery AUC publication,¹ this application is extremely easy to use at the point of care. It frees me from having to memorize the Mohs AUC or having to wade through an extensive report when I only want to know if Mohs surgery is appropriate. It also will be useful in educating patients who believe every skin cancer requires Mohs surgery.

How can I get it?

Because Mohs AUC is free, every dermatologist should use this mobile app. It can be downloaded from the Apple App Store. It is not available for Android devices at this time.

SAN FRANCISCO – Dermatologists and dermatologic surgeons risk a decreased reimbursement value for Mohs surgery if they don’t review the published criteria on its appropriate use, according to Dr. Sumaira Aasi.

Although it can be difficult, it is worth the effort to convince some patients that electrodessication, a curettage procedure, or some other management strategy is appropriate for their skin lesions, she said at the annual meeting of the Pacific Dermatologic Association.

"The reason is, at the end of the day, we might be killing the goose that laid the golden egg ourselves" if too many Mohs surgeries are done for inappropriate reasons, said Dr. Aasi of Stanford (Calif.) University.

SDr. Aasi urged the audience at the meeting to study criteria published in 2012 for the appropriate use of Mohs surgery, and to pay particular attention to scenarios deemed inappropriate for the procedure (J. Am. Acad. Dermatol. 2012;67:531-50).

There are an estimated 4 million nonmelanoma skin cancers in the United States each year, and the use of Mohs surgery increased by 400% from 1995 to 2009, Dr. Aasi said (Dermatol. Clin. 2012;30:167-75).

Some experts argue that the increase is a response to the increase in skin cancer cases, and others say the increasing number of Mohs surgeons is driving the rising rate of the procedure. "Regardless, it’s a problem," Dr. Aasi said.

Federal reimbursement programs don’t care if there is an epidemic of skin cancer, she said. If a surgery is being "overused," it is considered overvalued, and reimbursement rates are subject to change, she explained.

The top two CPT codes flagged by the federal government as potentially misvalued in the July 19, 2013, Federal Register were codes 17311 for Mohs surgery on the face, head, and neck and 17313 for Mohs surgery on the trunk and extremities, Dr. Aasi noted.

The 2012 appropriate-use criteria were created to help maintain the value of Mohs surgery in Medicare reimbursements, Dr. Aasi said. The American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, and the American Society of Mohs Surgery convened a consensus panel of eight Mohs surgeons and nine non-Mohs surgeons. The panel considered 270 clinical scenarios and rated 74% appropriate for Mohs surgery, 17% inappropriate, and 9% uncertain, meaning there were conflicting data in the literature or not enough information to make a determination of the appropriateness of Mohs surgery in that scenario.

"I still think that Mohs surgeons in this panel were a little highly represented," Dr. Aasi said. Overall, the indications the panel deemed appropriate for Mohs surgery were "pretty generous," she added.

The consensus panel was asked to implicitly consider cost in deciding on the appropriateness of Mohs surgery for each scenario. "It’s an implicit consideration but a very important consideration," said Dr. Aasi.

Invasive melanoma was not included in the scenarios because if its complexity, but some scenarios did include melanoma in situ or lentigo maligna melanoma. The scenarios included different body areas, aggressive or nonaggressive skin cancers, tumor size, and the patient’s immune status. Agreement by at least 12 panel members was considered a consensus on the use of Mohs surgery.

Examples of scenarios that were considered inappropriate for Mohs surgery included nonaggressive basal cell or squamous cell carcinomas smaller than 2 cm on the trunk or extremities. Other lesions deemed inappropriate for Mohs included primary actinic keratosis (AK) with focal squamous cell cancer in situ, bowenoid AK, or squamous cell carcinoma in situ AK-type, labels that Dr. Aasi found "worrisome" because their definitions are unclear.

"As a Mohs surgeon, I found it a little surprising that they had to consider scenarios where actinic keratoses were being considered a possibility for Mohs surgery," she said.

Physicians can use the appropriate-use criteria to talk with other health care providers, third-party payers, and patients, said Dr. Aasi. Talking with patients can be most difficult, because if they’ve heard of Mohs surgery, they often want "the technique where I [the patient] know right away that I’m going to be clear," she said.

When Mohs surgery is inappropriate, "I try to convince them that, no, you don’t need it. It’s like an atomic bomb being used to kill a flea," she said.

The appropriate-use criteria do not compare different treatment modalities with Mohs surgery, Dr. Aasi emphasized, but they aim to state simply whether or not Mohs surgery would be appropriate in selected scenarios.

"I urge everyone to read" the criteria, she said.

Dr. Aasi reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

SAN FRANCISCO – Dermatologists and dermatologic surgeons risk a decreased reimbursement value for Mohs surgery if they don’t review the published criteria on its appropriate use, according to Dr. Sumaira Aasi.

Although it can be difficult, it is worth the effort to convince some patients that electrodessication, a curettage procedure, or some other management strategy is appropriate for their skin lesions, she said at the annual meeting of the Pacific Dermatologic Association.

"The reason is, at the end of the day, we might be killing the goose that laid the golden egg ourselves" if too many Mohs surgeries are done for inappropriate reasons, said Dr. Aasi of Stanford (Calif.) University.

SDr. Aasi urged the audience at the meeting to study criteria published in 2012 for the appropriate use of Mohs surgery, and to pay particular attention to scenarios deemed inappropriate for the procedure (J. Am. Acad. Dermatol. 2012;67:531-50).

There are an estimated 4 million nonmelanoma skin cancers in the United States each year, and the use of Mohs surgery increased by 400% from 1995 to 2009, Dr. Aasi said (Dermatol. Clin. 2012;30:167-75).

Some experts argue that the increase is a response to the increase in skin cancer cases, and others say the increasing number of Mohs surgeons is driving the rising rate of the procedure. "Regardless, it’s a problem," Dr. Aasi said.

Federal reimbursement programs don’t care if there is an epidemic of skin cancer, she said. If a surgery is being "overused," it is considered overvalued, and reimbursement rates are subject to change, she explained.

The top two CPT codes flagged by the federal government as potentially misvalued in the July 19, 2013, Federal Register were codes 17311 for Mohs surgery on the face, head, and neck and 17313 for Mohs surgery on the trunk and extremities, Dr. Aasi noted.

The 2012 appropriate-use criteria were created to help maintain the value of Mohs surgery in Medicare reimbursements, Dr. Aasi said. The American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, and the American Society of Mohs Surgery convened a consensus panel of eight Mohs surgeons and nine non-Mohs surgeons. The panel considered 270 clinical scenarios and rated 74% appropriate for Mohs surgery, 17% inappropriate, and 9% uncertain, meaning there were conflicting data in the literature or not enough information to make a determination of the appropriateness of Mohs surgery in that scenario.

"I still think that Mohs surgeons in this panel were a little highly represented," Dr. Aasi said. Overall, the indications the panel deemed appropriate for Mohs surgery were "pretty generous," she added.

The consensus panel was asked to implicitly consider cost in deciding on the appropriateness of Mohs surgery for each scenario. "It’s an implicit consideration but a very important consideration," said Dr. Aasi.

Invasive melanoma was not included in the scenarios because if its complexity, but some scenarios did include melanoma in situ or lentigo maligna melanoma. The scenarios included different body areas, aggressive or nonaggressive skin cancers, tumor size, and the patient’s immune status. Agreement by at least 12 panel members was considered a consensus on the use of Mohs surgery.

Examples of scenarios that were considered inappropriate for Mohs surgery included nonaggressive basal cell or squamous cell carcinomas smaller than 2 cm on the trunk or extremities. Other lesions deemed inappropriate for Mohs included primary actinic keratosis (AK) with focal squamous cell cancer in situ, bowenoid AK, or squamous cell carcinoma in situ AK-type, labels that Dr. Aasi found "worrisome" because their definitions are unclear.

"As a Mohs surgeon, I found it a little surprising that they had to consider scenarios where actinic keratoses were being considered a possibility for Mohs surgery," she said.

Physicians can use the appropriate-use criteria to talk with other health care providers, third-party payers, and patients, said Dr. Aasi. Talking with patients can be most difficult, because if they’ve heard of Mohs surgery, they often want "the technique where I [the patient] know right away that I’m going to be clear," she said.

When Mohs surgery is inappropriate, "I try to convince them that, no, you don’t need it. It’s like an atomic bomb being used to kill a flea," she said.

The appropriate-use criteria do not compare different treatment modalities with Mohs surgery, Dr. Aasi emphasized, but they aim to state simply whether or not Mohs surgery would be appropriate in selected scenarios.

"I urge everyone to read" the criteria, she said.

Dr. Aasi reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

SAN FRANCISCO – Dermatologists and dermatologic surgeons risk a decreased reimbursement value for Mohs surgery if they don’t review the published criteria on its appropriate use, according to Dr. Sumaira Aasi.

Although it can be difficult, it is worth the effort to convince some patients that electrodessication, a curettage procedure, or some other management strategy is appropriate for their skin lesions, she said at the annual meeting of the Pacific Dermatologic Association.

"The reason is, at the end of the day, we might be killing the goose that laid the golden egg ourselves" if too many Mohs surgeries are done for inappropriate reasons, said Dr. Aasi of Stanford (Calif.) University.

SDr. Aasi urged the audience at the meeting to study criteria published in 2012 for the appropriate use of Mohs surgery, and to pay particular attention to scenarios deemed inappropriate for the procedure (J. Am. Acad. Dermatol. 2012;67:531-50).

There are an estimated 4 million nonmelanoma skin cancers in the United States each year, and the use of Mohs surgery increased by 400% from 1995 to 2009, Dr. Aasi said (Dermatol. Clin. 2012;30:167-75).

Some experts argue that the increase is a response to the increase in skin cancer cases, and others say the increasing number of Mohs surgeons is driving the rising rate of the procedure. "Regardless, it’s a problem," Dr. Aasi said.

Federal reimbursement programs don’t care if there is an epidemic of skin cancer, she said. If a surgery is being "overused," it is considered overvalued, and reimbursement rates are subject to change, she explained.

The top two CPT codes flagged by the federal government as potentially misvalued in the July 19, 2013, Federal Register were codes 17311 for Mohs surgery on the face, head, and neck and 17313 for Mohs surgery on the trunk and extremities, Dr. Aasi noted.

The 2012 appropriate-use criteria were created to help maintain the value of Mohs surgery in Medicare reimbursements, Dr. Aasi said. The American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, and the American Society of Mohs Surgery convened a consensus panel of eight Mohs surgeons and nine non-Mohs surgeons. The panel considered 270 clinical scenarios and rated 74% appropriate for Mohs surgery, 17% inappropriate, and 9% uncertain, meaning there were conflicting data in the literature or not enough information to make a determination of the appropriateness of Mohs surgery in that scenario.

"I still think that Mohs surgeons in this panel were a little highly represented," Dr. Aasi said. Overall, the indications the panel deemed appropriate for Mohs surgery were "pretty generous," she added.

The consensus panel was asked to implicitly consider cost in deciding on the appropriateness of Mohs surgery for each scenario. "It’s an implicit consideration but a very important consideration," said Dr. Aasi.

Invasive melanoma was not included in the scenarios because if its complexity, but some scenarios did include melanoma in situ or lentigo maligna melanoma. The scenarios included different body areas, aggressive or nonaggressive skin cancers, tumor size, and the patient’s immune status. Agreement by at least 12 panel members was considered a consensus on the use of Mohs surgery.

Examples of scenarios that were considered inappropriate for Mohs surgery included nonaggressive basal cell or squamous cell carcinomas smaller than 2 cm on the trunk or extremities. Other lesions deemed inappropriate for Mohs included primary actinic keratosis (AK) with focal squamous cell cancer in situ, bowenoid AK, or squamous cell carcinoma in situ AK-type, labels that Dr. Aasi found "worrisome" because their definitions are unclear.

"As a Mohs surgeon, I found it a little surprising that they had to consider scenarios where actinic keratoses were being considered a possibility for Mohs surgery," she said.

Physicians can use the appropriate-use criteria to talk with other health care providers, third-party payers, and patients, said Dr. Aasi. Talking with patients can be most difficult, because if they’ve heard of Mohs surgery, they often want "the technique where I [the patient] know right away that I’m going to be clear," she said.

When Mohs surgery is inappropriate, "I try to convince them that, no, you don’t need it. It’s like an atomic bomb being used to kill a flea," she said.

The appropriate-use criteria do not compare different treatment modalities with Mohs surgery, Dr. Aasi emphasized, but they aim to state simply whether or not Mohs surgery would be appropriate in selected scenarios.

"I urge everyone to read" the criteria, she said.

Dr. Aasi reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

Callan et al (Clin Cosmet Investig Dermatol. 2013;6:81-89) reported on the efficacy and safety profile of Juvéderm Voluma (Allergan, Inc) for midface volume deficiency in 103 participants over 24 months. Study participants received treatment with the hyaluronic acid filler to the malar area in 1 or 2 sessions over a 4-week period. An additional treatment was administered at week 78 of the study. At least a 1-point improvement on the midface volume deficit scale (MFVDS) and on the global aesthetic improvement scale (GAIS) was defined as clinically meaningful improvement. Of the 103 participants enrolled, 84% had moderate or significant volume deficiency at baseline. At week 8, 96% were reported to be responders on the MFVDS and 98% deemed themselves responders on the GAIS.

Seventy-two participants completed 24 months of treatment; 45 of these participants did not receive supplementary filler at week 78. Forty-three of the 45 (95.6%) participants were deemed responders on the MFVDS. At end of the study (n=72), 66 participants were either satisfied or very satisfied with the product, with 70 participants indicating that they would recommend the product to others. Adverse events included bruising, swelling, pain/tenderness, erythema, eyelid edema, and vasovagal syncope. Injection-site bruising and swelling were the most commonly reported adverse events. There was a single case of swelling in the left tear trough area, which occurred approximately 17 weeks after the week 4 treatment with the study product and 2 months after bilateral administration of Juvéderm Ultra (Allergan, Inc) to the tear troughs (done outside the study), which was speculated to have led to bilateral hardening of the Juvéderm Voluma implant. Oral prednisolone 5 mg daily was administered over 5 days and Hyalase (sanofi-aventis Australia)(100–150 U) was injected 3 times over a 3-week period. The swelling completely resolved approximately 1 month after the third Hyalase session.

What’s the issue?

Juvéderm Voluma currently is not available in the United States. It differs from other hyaluronic acid fillers in that it has a lower cohesivity but higher gel hardness that results in a more viscous solution. These properties are purported to be more suited for deeper injection in the skin at the deep dermal/subcutaneous level and submuscular/supraperiosteal level, which would allow for higher lift of tissue and volume restoration, while still being injected via a small-diameter needle. Although this filler has been used outside the United States, it will be interesting to see the adaptation and adoption in the US filler market. Is it the future of fillers or another one to add to the toolbox?

We want to know your views! Tell us what you think.

Callan et al (Clin Cosmet Investig Dermatol. 2013;6:81-89) reported on the efficacy and safety profile of Juvéderm Voluma (Allergan, Inc) for midface volume deficiency in 103 participants over 24 months. Study participants received treatment with the hyaluronic acid filler to the malar area in 1 or 2 sessions over a 4-week period. An additional treatment was administered at week 78 of the study. At least a 1-point improvement on the midface volume deficit scale (MFVDS) and on the global aesthetic improvement scale (GAIS) was defined as clinically meaningful improvement. Of the 103 participants enrolled, 84% had moderate or significant volume deficiency at baseline. At week 8, 96% were reported to be responders on the MFVDS and 98% deemed themselves responders on the GAIS.

Seventy-two participants completed 24 months of treatment; 45 of these participants did not receive supplementary filler at week 78. Forty-three of the 45 (95.6%) participants were deemed responders on the MFVDS. At end of the study (n=72), 66 participants were either satisfied or very satisfied with the product, with 70 participants indicating that they would recommend the product to others. Adverse events included bruising, swelling, pain/tenderness, erythema, eyelid edema, and vasovagal syncope. Injection-site bruising and swelling were the most commonly reported adverse events. There was a single case of swelling in the left tear trough area, which occurred approximately 17 weeks after the week 4 treatment with the study product and 2 months after bilateral administration of Juvéderm Ultra (Allergan, Inc) to the tear troughs (done outside the study), which was speculated to have led to bilateral hardening of the Juvéderm Voluma implant. Oral prednisolone 5 mg daily was administered over 5 days and Hyalase (sanofi-aventis Australia)(100–150 U) was injected 3 times over a 3-week period. The swelling completely resolved approximately 1 month after the third Hyalase session.

What’s the issue?

Juvéderm Voluma currently is not available in the United States. It differs from other hyaluronic acid fillers in that it has a lower cohesivity but higher gel hardness that results in a more viscous solution. These properties are purported to be more suited for deeper injection in the skin at the deep dermal/subcutaneous level and submuscular/supraperiosteal level, which would allow for higher lift of tissue and volume restoration, while still being injected via a small-diameter needle. Although this filler has been used outside the United States, it will be interesting to see the adaptation and adoption in the US filler market. Is it the future of fillers or another one to add to the toolbox?

We want to know your views! Tell us what you think.

Callan et al (Clin Cosmet Investig Dermatol. 2013;6:81-89) reported on the efficacy and safety profile of Juvéderm Voluma (Allergan, Inc) for midface volume deficiency in 103 participants over 24 months. Study participants received treatment with the hyaluronic acid filler to the malar area in 1 or 2 sessions over a 4-week period. An additional treatment was administered at week 78 of the study. At least a 1-point improvement on the midface volume deficit scale (MFVDS) and on the global aesthetic improvement scale (GAIS) was defined as clinically meaningful improvement. Of the 103 participants enrolled, 84% had moderate or significant volume deficiency at baseline. At week 8, 96% were reported to be responders on the MFVDS and 98% deemed themselves responders on the GAIS.

Seventy-two participants completed 24 months of treatment; 45 of these participants did not receive supplementary filler at week 78. Forty-three of the 45 (95.6%) participants were deemed responders on the MFVDS. At end of the study (n=72), 66 participants were either satisfied or very satisfied with the product, with 70 participants indicating that they would recommend the product to others. Adverse events included bruising, swelling, pain/tenderness, erythema, eyelid edema, and vasovagal syncope. Injection-site bruising and swelling were the most commonly reported adverse events. There was a single case of swelling in the left tear trough area, which occurred approximately 17 weeks after the week 4 treatment with the study product and 2 months after bilateral administration of Juvéderm Ultra (Allergan, Inc) to the tear troughs (done outside the study), which was speculated to have led to bilateral hardening of the Juvéderm Voluma implant. Oral prednisolone 5 mg daily was administered over 5 days and Hyalase (sanofi-aventis Australia)(100–150 U) was injected 3 times over a 3-week period. The swelling completely resolved approximately 1 month after the third Hyalase session.

What’s the issue?

Juvéderm Voluma currently is not available in the United States. It differs from other hyaluronic acid fillers in that it has a lower cohesivity but higher gel hardness that results in a more viscous solution. These properties are purported to be more suited for deeper injection in the skin at the deep dermal/subcutaneous level and submuscular/supraperiosteal level, which would allow for higher lift of tissue and volume restoration, while still being injected via a small-diameter needle. Although this filler has been used outside the United States, it will be interesting to see the adaptation and adoption in the US filler market. Is it the future of fillers or another one to add to the toolbox?

We want to know your views! Tell us what you think.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top men’s cosmetics. Consideration must be given to:

Cutis invites readers to send us their recommendations. Facial moisturizers, shampoos, and scar therapies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to msteiger@frontlinemedcom.com.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc. and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc. endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top men’s cosmetics. Consideration must be given to:

Cutis invites readers to send us their recommendations. Facial moisturizers, shampoos, and scar therapies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to msteiger@frontlinemedcom.com.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc. and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc. endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top men’s cosmetics. Consideration must be given to:

Cutis invites readers to send us their recommendations. Facial moisturizers, shampoos, and scar therapies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to msteiger@frontlinemedcom.com.

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc. and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc. endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

Botox Cosmetic

Allergan, Inc, obtains US Food and Drug Administration approval of Botox Cosmetic (onabotulinumtoxinA) for temporary improvement of moderate to severe lateral canthal lines (crow’s-feet) in adults. It blocks nerve impulses and reduces muscle movements around the eyes. This indication will allow physicians to treat both crow’s-feet and frown lines (approved in 2002 for this latter indication) with little downtime for patients. For more information, visit www.allergan.com.

Fabior Foam 0.1%

Stiefel, a GSK company, receives US Food and Drug Administration approval of Fabior (tazarotene) Foam 0.1% for the treatment of acne vulgaris in patients 12 years and older. Fabior Foam is applied once daily before bedtime. For more information, visit www.fabiorfoam.com.

NIA24 Intensive Retinol Repair

Niadyne, Inc, introduces NIA24 Intensive Retinol Repair for photodamage. It targets the major signs of UV damage including wrinkles, hyperpigmentation, lack of firmness, and uneven texture and tone. Formulated with ProNiacin and retinol, NIA24 Intensive Retinol Repair strengthens the skin barrier and increases collagen. It is an alternative for patients who cannot tolerate retinoic acid or traditional retinol treatments. A prescription is not required, and it can be applied daily. For more information, visit www.NIA24.com.

Stelara

Janssen Biotech Inc obtains US Food and Drug Administration approval of Stelara (ustekinumab) to treat patients with active psoriatic arthritis, alone or in combination with methotrexate. Stelara targets the cytokines IL-12 and IL-23 to control joint pain, swelling, and stiffness associated with psoriatic arthritis, in addition to psoriasis plaque thickness, scaling, and redness. Stelara is administered every 12 weeks after 2 starter doses for the treatment of psoriatic arthritis. For more information, visit www.stelarainfo.com.

XTRAC Velocity 7

PhotoMedex Inc introduces XTRAC Velocity 7 with an advanced user interface for psoriasis and vitiligo. Using UVB light, the XTRAC excimer laser treats areas of the skin affected by psoriasis or vitiligo without harming the surrounding tissue. XTRAC Velocity 7 offers increased efficiency, with the rate of output increasing the speed for delivery of treatment. Treatment guidelines and suggestions based on body area are provided using the touch screen. It can be used on hard-to-reach areas such as the elbows, knees, and scalp. Before and after photographs can be stored to show progression of resolution, enhancing patient compliance. The manufacturer also offers a patient advocacy program for patients to call and obtain answers to product and insurance questions from a live operator; patients also can book appointments with a participating physician faster using the XTRAC TeleCare Center. For more information, visit www.xtracnow.com

Botox Cosmetic

Allergan, Inc, obtains US Food and Drug Administration approval of Botox Cosmetic (onabotulinumtoxinA) for temporary improvement of moderate to severe lateral canthal lines (crow’s-feet) in adults. It blocks nerve impulses and reduces muscle movements around the eyes. This indication will allow physicians to treat both crow’s-feet and frown lines (approved in 2002 for this latter indication) with little downtime for patients. For more information, visit www.allergan.com.

Fabior Foam 0.1%

Stiefel, a GSK company, receives US Food and Drug Administration approval of Fabior (tazarotene) Foam 0.1% for the treatment of acne vulgaris in patients 12 years and older. Fabior Foam is applied once daily before bedtime. For more information, visit www.fabiorfoam.com.

NIA24 Intensive Retinol Repair

Niadyne, Inc, introduces NIA24 Intensive Retinol Repair for photodamage. It targets the major signs of UV damage including wrinkles, hyperpigmentation, lack of firmness, and uneven texture and tone. Formulated with ProNiacin and retinol, NIA24 Intensive Retinol Repair strengthens the skin barrier and increases collagen. It is an alternative for patients who cannot tolerate retinoic acid or traditional retinol treatments. A prescription is not required, and it can be applied daily. For more information, visit www.NIA24.com.

Stelara

Janssen Biotech Inc obtains US Food and Drug Administration approval of Stelara (ustekinumab) to treat patients with active psoriatic arthritis, alone or in combination with methotrexate. Stelara targets the cytokines IL-12 and IL-23 to control joint pain, swelling, and stiffness associated with psoriatic arthritis, in addition to psoriasis plaque thickness, scaling, and redness. Stelara is administered every 12 weeks after 2 starter doses for the treatment of psoriatic arthritis. For more information, visit www.stelarainfo.com.

XTRAC Velocity 7

PhotoMedex Inc introduces XTRAC Velocity 7 with an advanced user interface for psoriasis and vitiligo. Using UVB light, the XTRAC excimer laser treats areas of the skin affected by psoriasis or vitiligo without harming the surrounding tissue. XTRAC Velocity 7 offers increased efficiency, with the rate of output increasing the speed for delivery of treatment. Treatment guidelines and suggestions based on body area are provided using the touch screen. It can be used on hard-to-reach areas such as the elbows, knees, and scalp. Before and after photographs can be stored to show progression of resolution, enhancing patient compliance. The manufacturer also offers a patient advocacy program for patients to call and obtain answers to product and insurance questions from a live operator; patients also can book appointments with a participating physician faster using the XTRAC TeleCare Center. For more information, visit www.xtracnow.com

Botox Cosmetic

Allergan, Inc, obtains US Food and Drug Administration approval of Botox Cosmetic (onabotulinumtoxinA) for temporary improvement of moderate to severe lateral canthal lines (crow’s-feet) in adults. It blocks nerve impulses and reduces muscle movements around the eyes. This indication will allow physicians to treat both crow’s-feet and frown lines (approved in 2002 for this latter indication) with little downtime for patients. For more information, visit www.allergan.com.

Fabior Foam 0.1%

Stiefel, a GSK company, receives US Food and Drug Administration approval of Fabior (tazarotene) Foam 0.1% for the treatment of acne vulgaris in patients 12 years and older. Fabior Foam is applied once daily before bedtime. For more information, visit www.fabiorfoam.com.

NIA24 Intensive Retinol Repair

Niadyne, Inc, introduces NIA24 Intensive Retinol Repair for photodamage. It targets the major signs of UV damage including wrinkles, hyperpigmentation, lack of firmness, and uneven texture and tone. Formulated with ProNiacin and retinol, NIA24 Intensive Retinol Repair strengthens the skin barrier and increases collagen. It is an alternative for patients who cannot tolerate retinoic acid or traditional retinol treatments. A prescription is not required, and it can be applied daily. For more information, visit www.NIA24.com.

Stelara

Janssen Biotech Inc obtains US Food and Drug Administration approval of Stelara (ustekinumab) to treat patients with active psoriatic arthritis, alone or in combination with methotrexate. Stelara targets the cytokines IL-12 and IL-23 to control joint pain, swelling, and stiffness associated with psoriatic arthritis, in addition to psoriasis plaque thickness, scaling, and redness. Stelara is administered every 12 weeks after 2 starter doses for the treatment of psoriatic arthritis. For more information, visit www.stelarainfo.com.

XTRAC Velocity 7

PhotoMedex Inc introduces XTRAC Velocity 7 with an advanced user interface for psoriasis and vitiligo. Using UVB light, the XTRAC excimer laser treats areas of the skin affected by psoriasis or vitiligo without harming the surrounding tissue. XTRAC Velocity 7 offers increased efficiency, with the rate of output increasing the speed for delivery of treatment. Treatment guidelines and suggestions based on body area are provided using the touch screen. It can be used on hard-to-reach areas such as the elbows, knees, and scalp. Before and after photographs can be stored to show progression of resolution, enhancing patient compliance. The manufacturer also offers a patient advocacy program for patients to call and obtain answers to product and insurance questions from a live operator; patients also can book appointments with a participating physician faster using the XTRAC TeleCare Center. For more information, visit www.xtracnow.com

DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. (IMNG) – It may seem counterintuitive, but fractional ablative lasers have become a mainstay for treating all types of scars.

At a meeting sponsored by SkinCare Physicians and Northwestern University, Dr. Jill Waibel said that fractional lasers provide symptomatic relief, functional improvement, and rehabilitation to the target scars. "Lasers are emerging as the standard of care for scars," said Dr. Waibel, a dermatologic surgeon with the Miami Dermatology and Laser Institute.

"If you’re not using these on your scars, your patients may be missing out," she said. The effects are "permanent, powerful, and they can change the lives of your patients."

She favors a multimodal approach to scar treatment that she likened to a three-course meal. For the "appetizer," she’ll use one of several lasers to remove color from the scar. "I’ll use a vascular laser if it’s red; I’ll use a thulium or Q-switched laser if it’s hyperpigmented. I’ll use a nonablative fractional laser if it’s an atrophic scar."

The "main course" involves same-day treatment of the scar with a fractional ablative device such as the fractional ablative carbon dioxide or fractional ablative erbium laser. She uses a low density of 10% and recommends matching the depth of the laser to the depth of the scar, which typically amounts to 600-800 mcm.

For "dessert," she’ll use adjunctive therapies such as triamcinolone acetonide, 5-fluorouracil, hyaluronidase, Z-plasty, punch biopsies, compression, or subcision. "If you do these procedures together you are really going to increase your results," Dr. Waibel said. "The more procedures, the better. You don’t hit a wall like you often do treating port-wine stains. If you want to get 70%-90% improvement, you’re looking at between seven and nine treatments."

Clinicians are also using lasers to assist in the delivery of certain agents to enhance scar healing. For example, Dr. Waibel and her associates found that combination same-session therapy with laser-assisted delivery of triamcinolone acetonide offered efficient, safe, and effective treatment of challenging scars (Lasers Surg. Med. 2013;45:135-40). She has also conducted similar studies that involve the laser-assisted delivery of 5-fluorouracil to the scar site, which inhibits cell proliferation of fibroblasts.

Currently, Dr. Waibel and her colleagues at the University of Miami are working on a pilot study supported by the Department of Defense to test the hypothesis that ablative fractional lasers could deliver mesenchymal stem cells to skin using a porcine full-thickness wound model. So far, "we have shown that the stem cell can be delivered either autologously or allogeneically," she said. "It creates a woundless scar and re-creates the epidermal ridges. Fractional lasers are one of our greatest discoveries."

Dr. Waibel disclosed that she is a speaker for and has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.

"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."

Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.

On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."

Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.

Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."

He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.

Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.

"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."

Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.

On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."

Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.

Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."

He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.

Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.

dbrunk@frontlinemedcom.com

DANA POINT, CALIF. – For skin tightening, there’s no comparison between surgical and nonsurgical approaches as far as quality, predictability, and longevity, according to Dr. A. Jay Burns.

"Anyone who suggests to patients that nonsurgical contouring and rejuvenation share comparable results is either self-serving, dishonest, grossly naive, or misinformed," said Dr. Burns of the Dallas Plastic Surgery Institute. "In my opinion, surgical treatments are extremely reliable and nonsurgical treatments are extremely variable. But I’m not in an ivory tower. I realize that [surgical approaches result in] more complications and that they’re more expensive."

Surgical skin tightening involves total elevation, full repositioning, centimeter changes, and control, with predictable, clear results, he said at the meeting, sponsored by SkinCare Physicians and Northwestern University.

On the other hand, nonsurgical skin tightening involves no elevation, no repositioning, millimeter changes, and no control. This leads to results that he characterized as "unpredictable and subtle."

Dr. Burns acknowledged certain advantages of nonsurgical skin tightening approaches, such as the fact that they’re typically less expensive (except for brow dynamic line elimination), they eliminate the risk of nerve damage, and they require less downtime. He said he advises clinicians to recommend nonsurgical skin tightening for patients who prioritize downtime, cost, and risk over results. Surgical skin tightening is for those who want optimal results, maximum quality and predictability, and elegance, he said.

Dr. Burns said that there is "a clear place for" nonsurgical skin tightening techniques in his practice, and he emphasized the importance of fostering integrity during patient consultations. This includes informed consent, representing the technology honestly, and being honest with patients about expectations from procedures that you offer. Such practice "shows character and aids your reputation," he said. "It also prioritizes patient care over revenue."

He noted that the ThermiRF, developed by Southlake, Tex.–based ThermiAesthetics, represents a promising advance in noninvasive skin technology because it features a continuous temperature monitor on its internal probe. This radiofrequency device enables the user to administer the precise amount of heat for the collagen layer, Dr. Burns said. "There are some really nice results on the skin and neck," he said.

Dr. Burns disclosed that he has received equipment loans or discounts on equipment from Cynosure, Zeltiq Aesthetics, and other companies. He has held stock or stock options with Skin Medica and Zeltiq and has received honoraria from Solta Medical and Ulthera. He is an advisory board member for Cynosure, Ulthera, and Zeltiq.

dbrunk@frontlinemedcom.com