Aesthetic Dermatology

A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force.

The protocol consists of a history, general examination, and an assessment of dermatologic, musculoskeletal, neurologic, and vascular factors. Details of the protocol were issued by the American Diabetes Association, with the endorsement of the American Association of Clinical Endocrinologists, in a report by Dr. Andrew J. M. Boulton and his colleagues in a task force of the ADA's Foot Care Interest Group.

The history should explore previous foot ulceration or amputation, neuropathic or peripheral vascular symptoms, impaired vision, renal replacement therapy, and tobacco use.

Key components of the diabetic foot exam include dermatologic inspection for skin status, sweating, infection, ulceration, and calluses, as well as musculoskeletal inspection for deformity (claw toes, prominent metatarsal heads, Charcot's joint) or muscle wasting.

Neurologic assessment for loss of protective sensation (LOPS) should include the use of a 10-g monofilament test, with the device placed at specific points on the bottom of the foot while the patient's eyes are closed, as well as one of these additional tests:

▸ Vibration with 128-Hz tuning fork.

▸ Pinprick sensation.

▸ Ankle reflexes.

▸ Vibration perception threshold testing.

Vascular assessment using ankle brachial pressure index testing should be performed to determine the presence of peripheral arterial disease (PAD) in two groups of patients: those who are symptomatic (claudication, rest pain, or nonhealing ulcer) and those who have absent posterior tibial or dorsalis pedis pulses (Diabetes Care 2008;31:1679–85).

Patients assessed using the protocol should be assigned to a foot risk category from 0 to 3, with 0 being no LOPS, no PAD, and no deformity, 1 being LOPS with or without deformity, 2 being PAD with or without LOPS, and 3 being a history of ulcer or amputation.

Subsequent therapy and follow-up care should be provided according to the category: Primary care monitoring is appropriate for risk categories 0 and 1, and specialist care is indicated for risk categories 2 and 3.

A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force.

The protocol consists of a history, general examination, and an assessment of dermatologic, musculoskeletal, neurologic, and vascular factors. Details of the protocol were issued by the American Diabetes Association, with the endorsement of the American Association of Clinical Endocrinologists, in a report by Dr. Andrew J. M. Boulton and his colleagues in a task force of the ADA's Foot Care Interest Group.

The history should explore previous foot ulceration or amputation, neuropathic or peripheral vascular symptoms, impaired vision, renal replacement therapy, and tobacco use.

Key components of the diabetic foot exam include dermatologic inspection for skin status, sweating, infection, ulceration, and calluses, as well as musculoskeletal inspection for deformity (claw toes, prominent metatarsal heads, Charcot's joint) or muscle wasting.

Neurologic assessment for loss of protective sensation (LOPS) should include the use of a 10-g monofilament test, with the device placed at specific points on the bottom of the foot while the patient's eyes are closed, as well as one of these additional tests:

▸ Vibration with 128-Hz tuning fork.

▸ Pinprick sensation.

▸ Ankle reflexes.

▸ Vibration perception threshold testing.

Vascular assessment using ankle brachial pressure index testing should be performed to determine the presence of peripheral arterial disease (PAD) in two groups of patients: those who are symptomatic (claudication, rest pain, or nonhealing ulcer) and those who have absent posterior tibial or dorsalis pedis pulses (Diabetes Care 2008;31:1679–85).

Patients assessed using the protocol should be assigned to a foot risk category from 0 to 3, with 0 being no LOPS, no PAD, and no deformity, 1 being LOPS with or without deformity, 2 being PAD with or without LOPS, and 3 being a history of ulcer or amputation.

Subsequent therapy and follow-up care should be provided according to the category: Primary care monitoring is appropriate for risk categories 0 and 1, and specialist care is indicated for risk categories 2 and 3.

A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force.

The protocol consists of a history, general examination, and an assessment of dermatologic, musculoskeletal, neurologic, and vascular factors. Details of the protocol were issued by the American Diabetes Association, with the endorsement of the American Association of Clinical Endocrinologists, in a report by Dr. Andrew J. M. Boulton and his colleagues in a task force of the ADA's Foot Care Interest Group.

The history should explore previous foot ulceration or amputation, neuropathic or peripheral vascular symptoms, impaired vision, renal replacement therapy, and tobacco use.

Key components of the diabetic foot exam include dermatologic inspection for skin status, sweating, infection, ulceration, and calluses, as well as musculoskeletal inspection for deformity (claw toes, prominent metatarsal heads, Charcot's joint) or muscle wasting.

Neurologic assessment for loss of protective sensation (LOPS) should include the use of a 10-g monofilament test, with the device placed at specific points on the bottom of the foot while the patient's eyes are closed, as well as one of these additional tests:

▸ Vibration with 128-Hz tuning fork.

▸ Pinprick sensation.

▸ Ankle reflexes.

▸ Vibration perception threshold testing.

Vascular assessment using ankle brachial pressure index testing should be performed to determine the presence of peripheral arterial disease (PAD) in two groups of patients: those who are symptomatic (claudication, rest pain, or nonhealing ulcer) and those who have absent posterior tibial or dorsalis pedis pulses (Diabetes Care 2008;31:1679–85).

Patients assessed using the protocol should be assigned to a foot risk category from 0 to 3, with 0 being no LOPS, no PAD, and no deformity, 1 being LOPS with or without deformity, 2 being PAD with or without LOPS, and 3 being a history of ulcer or amputation.

Subsequent therapy and follow-up care should be provided according to the category: Primary care monitoring is appropriate for risk categories 0 and 1, and specialist care is indicated for risk categories 2 and 3.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. Using univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, "confirming that vascular involvement in diabetic patients with foot ulcers is particularly important," the authors stated (Diabetes Care 2008;31:1288–92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. Using univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, "confirming that vascular involvement in diabetic patients with foot ulcers is particularly important," the authors stated (Diabetes Care 2008;31:1288–92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. Using univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, "confirming that vascular involvement in diabetic patients with foot ulcers is particularly important," the authors stated (Diabetes Care 2008;31:1288–92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

CHICAGO — The novel skin substitutes Suprathel and Matriderm resulted in complete healing and excellent functionality in patients with deep burns in two studies.

By using Suprathel, complete epithelialization was achieved in 14–20 days for 38 of 40 patients with deep dermal burns. Regrafting was necessary in only two patients, said Dr. David Lumenta, who presented the results on behalf of Dr. Lars-Peter Kamolz at the annual meeting of the American Burn Association. Both are with the division of plastic and reconstructive surgery at the Medical University of Vienna.

Average total body surface area burned (TBSA) was 35%, although the team has used Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany) in patients with burns up to 90% TBSA.

Suprathel is a resorbable skin substitute produced from a fully synthetic copolymer with a porous membrane, based largely (greater than 70%) on poly-DL-lactide. It is available in various pore and surface sizes and is indicated mainly for use on donor sites and partial-thickness burns.

Its main advantages are reduced pain, accelerated epithelialization, and employment in functionally stressed regions and joints. It is more easily handled than other biologic dressings, and there is no biological risk, Dr. Lumenta said. No signs of local or systemic allergic reaction were observed in the 40 patients.

In a poster at the same meeting, Dr. Kamolz reported their experience with Matriderm in 10 patients with severe hand burns.

Matriderm (Dr. Suwelack Skin & Health Care AG, Billerbeck, Germany) is a thin, porous membrane consisting of a native bovine type I, II, and V collagen-fiber template coated with elastin hydrolysate, which is converted into native host collagen within weeks of application, Dr. Kamolz said in an interview.

The matrix serves as a support structure for new cell growth while the collagen improves the stability and elasticity of the regenerating tissue. As healing progresses, fibroblasts produce their own extracellular matrix and Matriderm is resorbed. The main indications for this matrix are full-thickness burns in functionally and aesthetically important regions, he said.

A two-step repair is recommended for Matriderm sheets 2 mm or greater in thickness, with a 7-day interval between matrix application and transplantation of split-thickness skin grafts to allow for vascularization of the matrix. A single operation is feasible in the acute phase after burn trauma using a 1-mm-thick sheet.

The take-rate using Matriderm does not differ significantly, compared with traditional split-thickness skin grafts, and the quality of the resulting scar has been superior, Dr. Kamolz said.

The take-rate was 97% at 3 months' follow-up among 10 patients, mean age 45 years, with severe, full-thickness hand burns (TBSA 23%) who underwent early debridement and immediate grafting with Matriderm and an unmeshed skin graft in a single operation.

The pliability of the grafted area was excellent, with a mean Vancouver Scar Scale score of 3.2. Full range of motion was achieved in all hands, he said.

No blisters and no unstable or hypertrophic scars were observed. In comparison with conventional skin grafts, the color of the skin grafts over the matrix appeared pale during the first few days, but no difference was observed after 2 weeks.

"These good functional and aesthetic results remain stable, even 12 months postoperatively," he reported.

The study was supported by the Medical University of Vienna. The investigators disclosed no relevant conflicts of interest. Neither product has been approved for use in the United States.

A patient whose severe hand burns (left) were treated with Matriderm grafting showed free range of motion and good function at 1 year. Photos courtesy Dr. Lars-Peter Kamolz

CHICAGO — The novel skin substitutes Suprathel and Matriderm resulted in complete healing and excellent functionality in patients with deep burns in two studies.

By using Suprathel, complete epithelialization was achieved in 14–20 days for 38 of 40 patients with deep dermal burns. Regrafting was necessary in only two patients, said Dr. David Lumenta, who presented the results on behalf of Dr. Lars-Peter Kamolz at the annual meeting of the American Burn Association. Both are with the division of plastic and reconstructive surgery at the Medical University of Vienna.

Average total body surface area burned (TBSA) was 35%, although the team has used Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany) in patients with burns up to 90% TBSA.

Suprathel is a resorbable skin substitute produced from a fully synthetic copolymer with a porous membrane, based largely (greater than 70%) on poly-DL-lactide. It is available in various pore and surface sizes and is indicated mainly for use on donor sites and partial-thickness burns.

Its main advantages are reduced pain, accelerated epithelialization, and employment in functionally stressed regions and joints. It is more easily handled than other biologic dressings, and there is no biological risk, Dr. Lumenta said. No signs of local or systemic allergic reaction were observed in the 40 patients.

In a poster at the same meeting, Dr. Kamolz reported their experience with Matriderm in 10 patients with severe hand burns.

Matriderm (Dr. Suwelack Skin & Health Care AG, Billerbeck, Germany) is a thin, porous membrane consisting of a native bovine type I, II, and V collagen-fiber template coated with elastin hydrolysate, which is converted into native host collagen within weeks of application, Dr. Kamolz said in an interview.

The matrix serves as a support structure for new cell growth while the collagen improves the stability and elasticity of the regenerating tissue. As healing progresses, fibroblasts produce their own extracellular matrix and Matriderm is resorbed. The main indications for this matrix are full-thickness burns in functionally and aesthetically important regions, he said.

A two-step repair is recommended for Matriderm sheets 2 mm or greater in thickness, with a 7-day interval between matrix application and transplantation of split-thickness skin grafts to allow for vascularization of the matrix. A single operation is feasible in the acute phase after burn trauma using a 1-mm-thick sheet.

The take-rate using Matriderm does not differ significantly, compared with traditional split-thickness skin grafts, and the quality of the resulting scar has been superior, Dr. Kamolz said.

The take-rate was 97% at 3 months' follow-up among 10 patients, mean age 45 years, with severe, full-thickness hand burns (TBSA 23%) who underwent early debridement and immediate grafting with Matriderm and an unmeshed skin graft in a single operation.

The pliability of the grafted area was excellent, with a mean Vancouver Scar Scale score of 3.2. Full range of motion was achieved in all hands, he said.

No blisters and no unstable or hypertrophic scars were observed. In comparison with conventional skin grafts, the color of the skin grafts over the matrix appeared pale during the first few days, but no difference was observed after 2 weeks.

"These good functional and aesthetic results remain stable, even 12 months postoperatively," he reported.

The study was supported by the Medical University of Vienna. The investigators disclosed no relevant conflicts of interest. Neither product has been approved for use in the United States.

A patient whose severe hand burns (left) were treated with Matriderm grafting showed free range of motion and good function at 1 year. Photos courtesy Dr. Lars-Peter Kamolz

CHICAGO — The novel skin substitutes Suprathel and Matriderm resulted in complete healing and excellent functionality in patients with deep burns in two studies.

By using Suprathel, complete epithelialization was achieved in 14–20 days for 38 of 40 patients with deep dermal burns. Regrafting was necessary in only two patients, said Dr. David Lumenta, who presented the results on behalf of Dr. Lars-Peter Kamolz at the annual meeting of the American Burn Association. Both are with the division of plastic and reconstructive surgery at the Medical University of Vienna.

Average total body surface area burned (TBSA) was 35%, although the team has used Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany) in patients with burns up to 90% TBSA.

Suprathel is a resorbable skin substitute produced from a fully synthetic copolymer with a porous membrane, based largely (greater than 70%) on poly-DL-lactide. It is available in various pore and surface sizes and is indicated mainly for use on donor sites and partial-thickness burns.

Its main advantages are reduced pain, accelerated epithelialization, and employment in functionally stressed regions and joints. It is more easily handled than other biologic dressings, and there is no biological risk, Dr. Lumenta said. No signs of local or systemic allergic reaction were observed in the 40 patients.

In a poster at the same meeting, Dr. Kamolz reported their experience with Matriderm in 10 patients with severe hand burns.

Matriderm (Dr. Suwelack Skin & Health Care AG, Billerbeck, Germany) is a thin, porous membrane consisting of a native bovine type I, II, and V collagen-fiber template coated with elastin hydrolysate, which is converted into native host collagen within weeks of application, Dr. Kamolz said in an interview.

The matrix serves as a support structure for new cell growth while the collagen improves the stability and elasticity of the regenerating tissue. As healing progresses, fibroblasts produce their own extracellular matrix and Matriderm is resorbed. The main indications for this matrix are full-thickness burns in functionally and aesthetically important regions, he said.

A two-step repair is recommended for Matriderm sheets 2 mm or greater in thickness, with a 7-day interval between matrix application and transplantation of split-thickness skin grafts to allow for vascularization of the matrix. A single operation is feasible in the acute phase after burn trauma using a 1-mm-thick sheet.

The take-rate using Matriderm does not differ significantly, compared with traditional split-thickness skin grafts, and the quality of the resulting scar has been superior, Dr. Kamolz said.

The take-rate was 97% at 3 months' follow-up among 10 patients, mean age 45 years, with severe, full-thickness hand burns (TBSA 23%) who underwent early debridement and immediate grafting with Matriderm and an unmeshed skin graft in a single operation.

The pliability of the grafted area was excellent, with a mean Vancouver Scar Scale score of 3.2. Full range of motion was achieved in all hands, he said.

No blisters and no unstable or hypertrophic scars were observed. In comparison with conventional skin grafts, the color of the skin grafts over the matrix appeared pale during the first few days, but no difference was observed after 2 weeks.

"These good functional and aesthetic results remain stable, even 12 months postoperatively," he reported.

The study was supported by the Medical University of Vienna. The investigators disclosed no relevant conflicts of interest. Neither product has been approved for use in the United States.

A patient whose severe hand burns (left) were treated with Matriderm grafting showed free range of motion and good function at 1 year. Photos courtesy Dr. Lars-Peter Kamolz

SANTA MONICA, CALIF. — In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet.

The faculty at a recent cosmetic dermatology seminar sponsored by Skin Disease Education Foundation helped to put some of these myths to rest.

▸ Botox is deadly. Among 28 deaths reported to the Food and Drug Administration from December 1989 to May 2003, none involved cosmetic use of Botox (J. Am. Acad. Dermatol. 2005;53:407–15). Indeed, of 16 deaths recently highlighted by citizens' groups, all involved serious disorders treated with huge volumes of Botox, said Dr. Allan Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif.

Among the potentially deadly uses of Botox is treatment of severe cervical dystonia, which can lead to spread of the toxin to the esophagus, prompting dysphagia or aspiration pneumonia.

▸ Book prewedding Botox sessions on Friday afternoons. Disappointed brides and furious mothers-in-law will blame you for the wedding pictures if you schedule cosmetic procedures too close to the ceremony, said Dr. Mitchell Goldman, a dermatologist in private practice in La Jolla, Calif. Botox's full effect takes 5–6 days, and unexpected bruising may need time to heal.

▸ Avoid freezing. The refrigerator is the place for Botox, but Dr. Richard Glogau, a dermatologist in San Francisco, may have chipped away at the myth that freezing "will degrade the molecule," when Botox that was frozen by mistake worked just fine on his patients, Dr. Goldman said.

▸ Save the paralysis for the muscles. There was a day when patients were told to sit perfectly upright, avoid exercise, and cancel air travel plans for hours after Botox injections. These precautions are "just old wives' tales—such ridiculous stuff," said Dr. Goldman.

Dr. Wirtzer has served as a consultant for Medicis, distributor of Reloxin (botulinum toxin type A, not approved in the United States). Dr. Goldman has received grant support from, and served as a consultant and speaker for, Allergan Inc., maker of Botox.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet.

The faculty at a recent cosmetic dermatology seminar sponsored by Skin Disease Education Foundation helped to put some of these myths to rest.

▸ Botox is deadly. Among 28 deaths reported to the Food and Drug Administration from December 1989 to May 2003, none involved cosmetic use of Botox (J. Am. Acad. Dermatol. 2005;53:407–15). Indeed, of 16 deaths recently highlighted by citizens' groups, all involved serious disorders treated with huge volumes of Botox, said Dr. Allan Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif.

Among the potentially deadly uses of Botox is treatment of severe cervical dystonia, which can lead to spread of the toxin to the esophagus, prompting dysphagia or aspiration pneumonia.

▸ Book prewedding Botox sessions on Friday afternoons. Disappointed brides and furious mothers-in-law will blame you for the wedding pictures if you schedule cosmetic procedures too close to the ceremony, said Dr. Mitchell Goldman, a dermatologist in private practice in La Jolla, Calif. Botox's full effect takes 5–6 days, and unexpected bruising may need time to heal.

▸ Avoid freezing. The refrigerator is the place for Botox, but Dr. Richard Glogau, a dermatologist in San Francisco, may have chipped away at the myth that freezing "will degrade the molecule," when Botox that was frozen by mistake worked just fine on his patients, Dr. Goldman said.

▸ Save the paralysis for the muscles. There was a day when patients were told to sit perfectly upright, avoid exercise, and cancel air travel plans for hours after Botox injections. These precautions are "just old wives' tales—such ridiculous stuff," said Dr. Goldman.

Dr. Wirtzer has served as a consultant for Medicis, distributor of Reloxin (botulinum toxin type A, not approved in the United States). Dr. Goldman has received grant support from, and served as a consultant and speaker for, Allergan Inc., maker of Botox.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — In the early days of cosmetic botulinum toxin type A therapy, rumors greatly outnumbered scientific facts about its safety, storage, and storied effect on furrowed brows and deep crow's feet.

The faculty at a recent cosmetic dermatology seminar sponsored by Skin Disease Education Foundation helped to put some of these myths to rest.

▸ Botox is deadly. Among 28 deaths reported to the Food and Drug Administration from December 1989 to May 2003, none involved cosmetic use of Botox (J. Am. Acad. Dermatol. 2005;53:407–15). Indeed, of 16 deaths recently highlighted by citizens' groups, all involved serious disorders treated with huge volumes of Botox, said Dr. Allan Wirtzer, a dermatologist in private practice in Sherman Oaks, Calif.

Among the potentially deadly uses of Botox is treatment of severe cervical dystonia, which can lead to spread of the toxin to the esophagus, prompting dysphagia or aspiration pneumonia.

▸ Book prewedding Botox sessions on Friday afternoons. Disappointed brides and furious mothers-in-law will blame you for the wedding pictures if you schedule cosmetic procedures too close to the ceremony, said Dr. Mitchell Goldman, a dermatologist in private practice in La Jolla, Calif. Botox's full effect takes 5–6 days, and unexpected bruising may need time to heal.

▸ Avoid freezing. The refrigerator is the place for Botox, but Dr. Richard Glogau, a dermatologist in San Francisco, may have chipped away at the myth that freezing "will degrade the molecule," when Botox that was frozen by mistake worked just fine on his patients, Dr. Goldman said.

▸ Save the paralysis for the muscles. There was a day when patients were told to sit perfectly upright, avoid exercise, and cancel air travel plans for hours after Botox injections. These precautions are "just old wives' tales—such ridiculous stuff," said Dr. Goldman.

Dr. Wirtzer has served as a consultant for Medicis, distributor of Reloxin (botulinum toxin type A, not approved in the United States). Dr. Goldman has received grant support from, and served as a consultant and speaker for, Allergan Inc., maker of Botox.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations.

Antitumor Activity

In a 2005 study, mice with highly metastatic drug-resistant tumors were used to test the effects of various herbal compounds on tumor growth and metastasis. Although the focus of the study was stilbene compounds, investigators found that two chalcone derivatives from Angelica keiskei roots inhibited tumor growth and metastasis. The chalcone derivatives worked by suppressing tumor-induced neovascularization and/or reducing the immune suppression brought on by tumors (In Vivo 2005;19:37–60).

Chalcone extracts of A. keiskei root, also known as ashitaba, which is consumed as a vegetable in Japan, also exhibited antitumorigenic activity in the two-phase mouse skin cancer model, in which carcinogenesis is induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA) (Planta Med. 1991;57:242–6).

In another study, xanthoangelol, a major chalcone constituent of A. keiskei, was found to dose-dependently decrease the survival rates of human neuroblastoma (IMR-32) and leukemia (Jurkat) cell lines. The findings indicated that the angelica component induced apoptosis by activating caspase-3 in neuroblastoma and leukemia cells without involving Bax/Bcl-2 proteins. The investigators concluded that xanthoangelol has potential as an agent against these cancers (Biol. Pharm. Bull. 2005;28:1404–7).

Other Angelica species besides keiskei and sinensis have shown antitumorigenic activity. Constituents of the Japanese drug shi-un-kou, which contains A. acutiloba, have been evaluated in assays. A. acutiloba alone and in combination with another constituent, Macrotomia euchroma, exhibited inhibitory effects, including reduced cytotoxicity, on Epstein-Barr virus activation induced by the tumor promoter TPA. The authors reported that a subsequent in vivo study in mice showed that shi-un-kou significantly inhibited skin tumor formation induced by TPA (Yakugaku Zasshi 1989;109:843–6).

In other research, investigators isolated the coumarin compound decursin from Korean angelica (A. gigantis, also known as A. gigas) root. They observed that decursin treatment for 24–96 hours strongly inhibited growth and dose-dependently induced apoptosis in human prostate carcinoma cells (Urol. Oncol. 2005;23:379–80).

In addition, another Angelica species, A. archangelica, exhibits antitumorigenic properties. Investigators evaluated the in vitro and in vivo effects of A. archangelica leaf extract on the growth of Crl mouse breast cancer cells. In vitro, the extract was found to be mildly antiproliferative. In the in vivo segment of the study, 11 of 20 mice were injected with A. archangelica leaf extract, and 9 of them developed no or small tumors, whereas control mice developed tumors that were significantly larger. The antitumor properties of A. archangelica extract could not be attributed to the antiproliferative characteristics of the furanocoumarins in the extract (In Vivo 2005;19:191–4).

Significant antiproliferative activity has also been identified in the tincture of A. archangelica, using the human pancreas cancer cell line PANC-1 as a model. Investigators ascribed most of the antiproliferative activity to imperatorin and xanthotoxin, the two furanocoumarins most prevalent in the A. archangelica tincture (Z. Naturforsch. [C] 2004;59:523–7).

Dermatologic Potential

In addition to antitumorigenic activity, several Angelica species have exhibited properties pertinent to clinical dermatology. Hwaotang, a traditional Korean formulation that combines seven herbs, including A. gigas, exerts anti-inflammatory effects related to the inhibition of human neutrophil functions and of nitric oxide and prostaglandin E2 production (Immunopharmacol. Immunotoxicol. 2004;26:53–73).

In a study of the anti-inflammatory activity of a new formulation containing Synurus deltoides and A. gigas extracts, along with glucosamine sulfate, the medication (SAG) dose dependently inhibited ear edema in mice induced by arachidonic acid and TPA. Prostaglandin E2 production associated with mouse skin lesions was also significantly reduced by SAG, as well as by treatment with S. deltoides extract alone. The authors acknowledged that although SAG is not as potent as anti-inflammatory products in widespread use, this A. gigas-containing preparation has potential benefits as a neutraceutical therapy for inflammatory conditions (Arch. Pharm. Res. 2005;28:848–53).

A study of herbs used in traditional Chinese and Japanese medicine to treat acne revealed that the ethanol extract (0.01%) of Angelica dahurica substantially inhibited neutrophil chemotaxis, at a level comparable to that of erythromycin (0.01%). In the same study, Rhizoma coptidis displayed a stronger antilipogenic effect than did retinoic acid (0.01%), and Glycyrrhiza glabra (licorice) showed significant antibacterial activity against P. acnes. These results led the researchers to conclude that a formulation containing all three herbs would have potential in the prevention and treatment of acne (Skin Pharmacol. Appl. Skin Physiol. 2003;16:84–90). A. dahurica, which also contains lactones and psoralen, and has been used traditionally to treat psoriasis and for its reputed antihistamine effects.

In a study evaluating extracts from 15 plants used in traditional Chinese medicine to treat topical inflammations, investigators focused on the inhibitory effects on enzymes that are therapeutic targets in cutaneous conditions, specifically 5-lipoxygenase, cyclooxygenase, and elastase. Four plant species, including A. dahurica and A. pubescens, inhibited elastase in intact leukocytes and platelets (J. Pharm. Pharmacol. 2003;55:1275–82; Planta Med. 1998;64:525–9). In addition, A. pubescens has been found to confer analgesic and anti-inflammatory effects (Planta Med. 1995;61:2–8). One of the main active components isolated from A. pubescens, osthole, a coumarin compound, has also been shown to exert a nonspecific relaxant effect on the trachea of guinea pigs (Naunyn Schmiedebergs Arch. Pharmacol. 1994;349:202–8).

At the Store

Zestra Feminine Arousal Fluid (Zestra Laboratories Inc.) is a topical botanical formulation containing A. archangelica along with borage seed oil, evening primrose oil, ascorbyl palmitate, and alpha tocopherol. The product is intended to enhance female sexual pleasure and arousal.

Investigators conducted a randomized, double-blind, crossover study to assess the efficacy and safety of Zestra in 10 women with and 10 women without female sexual arousal disorder. Using questionnaires, participants reported on a range of sexual functions pertaining to home use of the formulation. The results indicated statistically significant overall improvements in sexual function in both test groups, compared with placebo (J. Sex Marital Ther. 2003;29 [Suppl 1]:33–44).

Conclusions

A wide range of Angelica species possess properties found to be of medical, including dermatologic, benefit. In addition to A. sinensis (discussed in this column in August), A. archangelica, A. dahurica, and A. gigas have been used successfully in traditional herbal medicines, and research is ongoing on these and other species, including A. keiskei, A. pubescens, and A. acutiloba.

While the overall body of research is slim on the efficacy of these herbs, the extant evidence supports further investigation and provides reasons for optimism. In the meantime, as is typical in the case of myriad botanic ingredients, there are several unproven formulations available to consumers that contain botanical cocktails including the biologically active Angelica species.

Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations.

Antitumor Activity

In a 2005 study, mice with highly metastatic drug-resistant tumors were used to test the effects of various herbal compounds on tumor growth and metastasis. Although the focus of the study was stilbene compounds, investigators found that two chalcone derivatives from Angelica keiskei roots inhibited tumor growth and metastasis. The chalcone derivatives worked by suppressing tumor-induced neovascularization and/or reducing the immune suppression brought on by tumors (In Vivo 2005;19:37–60).

Chalcone extracts of A. keiskei root, also known as ashitaba, which is consumed as a vegetable in Japan, also exhibited antitumorigenic activity in the two-phase mouse skin cancer model, in which carcinogenesis is induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA) (Planta Med. 1991;57:242–6).

In another study, xanthoangelol, a major chalcone constituent of A. keiskei, was found to dose-dependently decrease the survival rates of human neuroblastoma (IMR-32) and leukemia (Jurkat) cell lines. The findings indicated that the angelica component induced apoptosis by activating caspase-3 in neuroblastoma and leukemia cells without involving Bax/Bcl-2 proteins. The investigators concluded that xanthoangelol has potential as an agent against these cancers (Biol. Pharm. Bull. 2005;28:1404–7).

Other Angelica species besides keiskei and sinensis have shown antitumorigenic activity. Constituents of the Japanese drug shi-un-kou, which contains A. acutiloba, have been evaluated in assays. A. acutiloba alone and in combination with another constituent, Macrotomia euchroma, exhibited inhibitory effects, including reduced cytotoxicity, on Epstein-Barr virus activation induced by the tumor promoter TPA. The authors reported that a subsequent in vivo study in mice showed that shi-un-kou significantly inhibited skin tumor formation induced by TPA (Yakugaku Zasshi 1989;109:843–6).

In other research, investigators isolated the coumarin compound decursin from Korean angelica (A. gigantis, also known as A. gigas) root. They observed that decursin treatment for 24–96 hours strongly inhibited growth and dose-dependently induced apoptosis in human prostate carcinoma cells (Urol. Oncol. 2005;23:379–80).

In addition, another Angelica species, A. archangelica, exhibits antitumorigenic properties. Investigators evaluated the in vitro and in vivo effects of A. archangelica leaf extract on the growth of Crl mouse breast cancer cells. In vitro, the extract was found to be mildly antiproliferative. In the in vivo segment of the study, 11 of 20 mice were injected with A. archangelica leaf extract, and 9 of them developed no or small tumors, whereas control mice developed tumors that were significantly larger. The antitumor properties of A. archangelica extract could not be attributed to the antiproliferative characteristics of the furanocoumarins in the extract (In Vivo 2005;19:191–4).

Significant antiproliferative activity has also been identified in the tincture of A. archangelica, using the human pancreas cancer cell line PANC-1 as a model. Investigators ascribed most of the antiproliferative activity to imperatorin and xanthotoxin, the two furanocoumarins most prevalent in the A. archangelica tincture (Z. Naturforsch. [C] 2004;59:523–7).

Dermatologic Potential

In addition to antitumorigenic activity, several Angelica species have exhibited properties pertinent to clinical dermatology. Hwaotang, a traditional Korean formulation that combines seven herbs, including A. gigas, exerts anti-inflammatory effects related to the inhibition of human neutrophil functions and of nitric oxide and prostaglandin E2 production (Immunopharmacol. Immunotoxicol. 2004;26:53–73).

In a study of the anti-inflammatory activity of a new formulation containing Synurus deltoides and A. gigas extracts, along with glucosamine sulfate, the medication (SAG) dose dependently inhibited ear edema in mice induced by arachidonic acid and TPA. Prostaglandin E2 production associated with mouse skin lesions was also significantly reduced by SAG, as well as by treatment with S. deltoides extract alone. The authors acknowledged that although SAG is not as potent as anti-inflammatory products in widespread use, this A. gigas-containing preparation has potential benefits as a neutraceutical therapy for inflammatory conditions (Arch. Pharm. Res. 2005;28:848–53).

A study of herbs used in traditional Chinese and Japanese medicine to treat acne revealed that the ethanol extract (0.01%) of Angelica dahurica substantially inhibited neutrophil chemotaxis, at a level comparable to that of erythromycin (0.01%). In the same study, Rhizoma coptidis displayed a stronger antilipogenic effect than did retinoic acid (0.01%), and Glycyrrhiza glabra (licorice) showed significant antibacterial activity against P. acnes. These results led the researchers to conclude that a formulation containing all three herbs would have potential in the prevention and treatment of acne (Skin Pharmacol. Appl. Skin Physiol. 2003;16:84–90). A. dahurica, which also contains lactones and psoralen, and has been used traditionally to treat psoriasis and for its reputed antihistamine effects.

In a study evaluating extracts from 15 plants used in traditional Chinese medicine to treat topical inflammations, investigators focused on the inhibitory effects on enzymes that are therapeutic targets in cutaneous conditions, specifically 5-lipoxygenase, cyclooxygenase, and elastase. Four plant species, including A. dahurica and A. pubescens, inhibited elastase in intact leukocytes and platelets (J. Pharm. Pharmacol. 2003;55:1275–82; Planta Med. 1998;64:525–9). In addition, A. pubescens has been found to confer analgesic and anti-inflammatory effects (Planta Med. 1995;61:2–8). One of the main active components isolated from A. pubescens, osthole, a coumarin compound, has also been shown to exert a nonspecific relaxant effect on the trachea of guinea pigs (Naunyn Schmiedebergs Arch. Pharmacol. 1994;349:202–8).

At the Store

Zestra Feminine Arousal Fluid (Zestra Laboratories Inc.) is a topical botanical formulation containing A. archangelica along with borage seed oil, evening primrose oil, ascorbyl palmitate, and alpha tocopherol. The product is intended to enhance female sexual pleasure and arousal.

Investigators conducted a randomized, double-blind, crossover study to assess the efficacy and safety of Zestra in 10 women with and 10 women without female sexual arousal disorder. Using questionnaires, participants reported on a range of sexual functions pertaining to home use of the formulation. The results indicated statistically significant overall improvements in sexual function in both test groups, compared with placebo (J. Sex Marital Ther. 2003;29 [Suppl 1]:33–44).

Conclusions

A wide range of Angelica species possess properties found to be of medical, including dermatologic, benefit. In addition to A. sinensis (discussed in this column in August), A. archangelica, A. dahurica, and A. gigas have been used successfully in traditional herbal medicines, and research is ongoing on these and other species, including A. keiskei, A. pubescens, and A. acutiloba.

While the overall body of research is slim on the efficacy of these herbs, the extant evidence supports further investigation and provides reasons for optimism. In the meantime, as is typical in the case of myriad botanic ingredients, there are several unproven formulations available to consumers that contain botanical cocktails including the biologically active Angelica species.

Besides Angelica sinensis, discussed last month, other species of Angelica have been studied for their medicinal potential, and, gradually, these species have been introduced into topical formulations.

Antitumor Activity

In a 2005 study, mice with highly metastatic drug-resistant tumors were used to test the effects of various herbal compounds on tumor growth and metastasis. Although the focus of the study was stilbene compounds, investigators found that two chalcone derivatives from Angelica keiskei roots inhibited tumor growth and metastasis. The chalcone derivatives worked by suppressing tumor-induced neovascularization and/or reducing the immune suppression brought on by tumors (In Vivo 2005;19:37–60).

Chalcone extracts of A. keiskei root, also known as ashitaba, which is consumed as a vegetable in Japan, also exhibited antitumorigenic activity in the two-phase mouse skin cancer model, in which carcinogenesis is induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA) (Planta Med. 1991;57:242–6).

In another study, xanthoangelol, a major chalcone constituent of A. keiskei, was found to dose-dependently decrease the survival rates of human neuroblastoma (IMR-32) and leukemia (Jurkat) cell lines. The findings indicated that the angelica component induced apoptosis by activating caspase-3 in neuroblastoma and leukemia cells without involving Bax/Bcl-2 proteins. The investigators concluded that xanthoangelol has potential as an agent against these cancers (Biol. Pharm. Bull. 2005;28:1404–7).

Other Angelica species besides keiskei and sinensis have shown antitumorigenic activity. Constituents of the Japanese drug shi-un-kou, which contains A. acutiloba, have been evaluated in assays. A. acutiloba alone and in combination with another constituent, Macrotomia euchroma, exhibited inhibitory effects, including reduced cytotoxicity, on Epstein-Barr virus activation induced by the tumor promoter TPA. The authors reported that a subsequent in vivo study in mice showed that shi-un-kou significantly inhibited skin tumor formation induced by TPA (Yakugaku Zasshi 1989;109:843–6).

In other research, investigators isolated the coumarin compound decursin from Korean angelica (A. gigantis, also known as A. gigas) root. They observed that decursin treatment for 24–96 hours strongly inhibited growth and dose-dependently induced apoptosis in human prostate carcinoma cells (Urol. Oncol. 2005;23:379–80).

In addition, another Angelica species, A. archangelica, exhibits antitumorigenic properties. Investigators evaluated the in vitro and in vivo effects of A. archangelica leaf extract on the growth of Crl mouse breast cancer cells. In vitro, the extract was found to be mildly antiproliferative. In the in vivo segment of the study, 11 of 20 mice were injected with A. archangelica leaf extract, and 9 of them developed no or small tumors, whereas control mice developed tumors that were significantly larger. The antitumor properties of A. archangelica extract could not be attributed to the antiproliferative characteristics of the furanocoumarins in the extract (In Vivo 2005;19:191–4).

Significant antiproliferative activity has also been identified in the tincture of A. archangelica, using the human pancreas cancer cell line PANC-1 as a model. Investigators ascribed most of the antiproliferative activity to imperatorin and xanthotoxin, the two furanocoumarins most prevalent in the A. archangelica tincture (Z. Naturforsch. [C] 2004;59:523–7).

Dermatologic Potential

In addition to antitumorigenic activity, several Angelica species have exhibited properties pertinent to clinical dermatology. Hwaotang, a traditional Korean formulation that combines seven herbs, including A. gigas, exerts anti-inflammatory effects related to the inhibition of human neutrophil functions and of nitric oxide and prostaglandin E2 production (Immunopharmacol. Immunotoxicol. 2004;26:53–73).

In a study of the anti-inflammatory activity of a new formulation containing Synurus deltoides and A. gigas extracts, along with glucosamine sulfate, the medication (SAG) dose dependently inhibited ear edema in mice induced by arachidonic acid and TPA. Prostaglandin E2 production associated with mouse skin lesions was also significantly reduced by SAG, as well as by treatment with S. deltoides extract alone. The authors acknowledged that although SAG is not as potent as anti-inflammatory products in widespread use, this A. gigas-containing preparation has potential benefits as a neutraceutical therapy for inflammatory conditions (Arch. Pharm. Res. 2005;28:848–53).

A study of herbs used in traditional Chinese and Japanese medicine to treat acne revealed that the ethanol extract (0.01%) of Angelica dahurica substantially inhibited neutrophil chemotaxis, at a level comparable to that of erythromycin (0.01%). In the same study, Rhizoma coptidis displayed a stronger antilipogenic effect than did retinoic acid (0.01%), and Glycyrrhiza glabra (licorice) showed significant antibacterial activity against P. acnes. These results led the researchers to conclude that a formulation containing all three herbs would have potential in the prevention and treatment of acne (Skin Pharmacol. Appl. Skin Physiol. 2003;16:84–90). A. dahurica, which also contains lactones and psoralen, and has been used traditionally to treat psoriasis and for its reputed antihistamine effects.

In a study evaluating extracts from 15 plants used in traditional Chinese medicine to treat topical inflammations, investigators focused on the inhibitory effects on enzymes that are therapeutic targets in cutaneous conditions, specifically 5-lipoxygenase, cyclooxygenase, and elastase. Four plant species, including A. dahurica and A. pubescens, inhibited elastase in intact leukocytes and platelets (J. Pharm. Pharmacol. 2003;55:1275–82; Planta Med. 1998;64:525–9). In addition, A. pubescens has been found to confer analgesic and anti-inflammatory effects (Planta Med. 1995;61:2–8). One of the main active components isolated from A. pubescens, osthole, a coumarin compound, has also been shown to exert a nonspecific relaxant effect on the trachea of guinea pigs (Naunyn Schmiedebergs Arch. Pharmacol. 1994;349:202–8).

At the Store

Zestra Feminine Arousal Fluid (Zestra Laboratories Inc.) is a topical botanical formulation containing A. archangelica along with borage seed oil, evening primrose oil, ascorbyl palmitate, and alpha tocopherol. The product is intended to enhance female sexual pleasure and arousal.

Investigators conducted a randomized, double-blind, crossover study to assess the efficacy and safety of Zestra in 10 women with and 10 women without female sexual arousal disorder. Using questionnaires, participants reported on a range of sexual functions pertaining to home use of the formulation. The results indicated statistically significant overall improvements in sexual function in both test groups, compared with placebo (J. Sex Marital Ther. 2003;29 [Suppl 1]:33–44).

Conclusions

A wide range of Angelica species possess properties found to be of medical, including dermatologic, benefit. In addition to A. sinensis (discussed in this column in August), A. archangelica, A. dahurica, and A. gigas have been used successfully in traditional herbal medicines, and research is ongoing on these and other species, including A. keiskei, A. pubescens, and A. acutiloba.

While the overall body of research is slim on the efficacy of these herbs, the extant evidence supports further investigation and provides reasons for optimism. In the meantime, as is typical in the case of myriad botanic ingredients, there are several unproven formulations available to consumers that contain botanical cocktails including the biologically active Angelica species.

The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and other skin conditions. For more information, visit www.dermatologyfoundation.org

The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and other skin conditions. For more information, visit www.dermatologyfoundation.org

The Dermatology Foundation has awarded its prestigious Discovery Award to Dr. John A. Parrish and Dr. R. Rox Anderson. The award acknowledges their landmark development of the use of selective photothermolysis in the treatment of birthmarks and other skin conditions. For more information, visit www.dermatologyfoundation.org

More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology.

Today, women report receiving significantly more negative comments and having more problems with "stigma" regarding their tattoos than do men. Women with tattoos are more likely to report embarrassment and "more societal fallout" than men with tattoos, according to Myrna L. Armstrong, Ed.D., of Texas Tech University Health Sciences Center, Marble Falls, and her associates.

The researchers studied the issue because "dermatologists are increasingly hearing stories of regrets and requests for tattoo removal. Estimated prevalence rates of dissatisfied tattoo wearers hover around 20%, with a smaller number who actually seek removal (6%)," they noted.

Dr. Armstrong and her colleagues assessed present-day tattoo removal using an anonymous survey of 196 clients aged 14–73 years who were attending four dermatology clinics in Arizona, Colorado, Massachusetts, and Texas. They compared the results with those from a similar survey conducted in 1996.

Although most of these subjects had been pleased with their tattoos when they first got them, they reported feeling dissatisfied with the tattoos for an average of 10 years before finally seeking removal. Most people who wanted to remove tattoos in 1996 were men, whereas most of those seeking removal in the present day were women, especially "career-minded" women.

Women reported receiving significantly more negative comments and suffering significantly more embarrassment regarding their tattoos than did men. In particular, women reported their tattoos interfered with their job or career and that they elicited negative comments in the workplace, in public, and in school settings, as wells as from significant others.

Currently, women also reported having to hide their tattoos with cosmetics or bandages and being unable to wear certain clothing because of their tattoos more often than men did. These findings correspond with reports in the literature that tattoo wearers are perceived as having lower credibility, competence, and sociability, particularly in the workplace, Dr. Armstrong and her associates said (Arch. Dermatol. 2008;144:879–84).

"For women, their tattoo procurement may be a way to break out of the gender norms and take some social risk by visually displaying their assertive identity. Yet, there still may be many members of society who consider tattoos on women to be a 'transgression of gender boundaries,'" the researchers wrote.

The major reason cited for getting a tattoo among both men and women who later sought removal was that it "helped me feel unique." Most of these subjects grew "disillusioned because their unique product had lost its luster and excitement." Some also said they were actively dissociating from their past or shifting their identity focus in order to "move on."

Dr. Armstrong is an education consultant for Freedom

More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology.

Today, women report receiving significantly more negative comments and having more problems with "stigma" regarding their tattoos than do men. Women with tattoos are more likely to report embarrassment and "more societal fallout" than men with tattoos, according to Myrna L. Armstrong, Ed.D., of Texas Tech University Health Sciences Center, Marble Falls, and her associates.

The researchers studied the issue because "dermatologists are increasingly hearing stories of regrets and requests for tattoo removal. Estimated prevalence rates of dissatisfied tattoo wearers hover around 20%, with a smaller number who actually seek removal (6%)," they noted.

Dr. Armstrong and her colleagues assessed present-day tattoo removal using an anonymous survey of 196 clients aged 14–73 years who were attending four dermatology clinics in Arizona, Colorado, Massachusetts, and Texas. They compared the results with those from a similar survey conducted in 1996.

Although most of these subjects had been pleased with their tattoos when they first got them, they reported feeling dissatisfied with the tattoos for an average of 10 years before finally seeking removal. Most people who wanted to remove tattoos in 1996 were men, whereas most of those seeking removal in the present day were women, especially "career-minded" women.

Women reported receiving significantly more negative comments and suffering significantly more embarrassment regarding their tattoos than did men. In particular, women reported their tattoos interfered with their job or career and that they elicited negative comments in the workplace, in public, and in school settings, as wells as from significant others.

Currently, women also reported having to hide their tattoos with cosmetics or bandages and being unable to wear certain clothing because of their tattoos more often than men did. These findings correspond with reports in the literature that tattoo wearers are perceived as having lower credibility, competence, and sociability, particularly in the workplace, Dr. Armstrong and her associates said (Arch. Dermatol. 2008;144:879–84).

"For women, their tattoo procurement may be a way to break out of the gender norms and take some social risk by visually displaying their assertive identity. Yet, there still may be many members of society who consider tattoos on women to be a 'transgression of gender boundaries,'" the researchers wrote.

The major reason cited for getting a tattoo among both men and women who later sought removal was that it "helped me feel unique." Most of these subjects grew "disillusioned because their unique product had lost its luster and excitement." Some also said they were actively dissociating from their past or shifting their identity focus in order to "move on."

Dr. Armstrong is an education consultant for Freedom

More women than men have sought tattoo removal in recent years, a reversal of the pattern that prevailed 10 years earlier, according to a report in the Archives of Dermatology.

Today, women report receiving significantly more negative comments and having more problems with "stigma" regarding their tattoos than do men. Women with tattoos are more likely to report embarrassment and "more societal fallout" than men with tattoos, according to Myrna L. Armstrong, Ed.D., of Texas Tech University Health Sciences Center, Marble Falls, and her associates.

The researchers studied the issue because "dermatologists are increasingly hearing stories of regrets and requests for tattoo removal. Estimated prevalence rates of dissatisfied tattoo wearers hover around 20%, with a smaller number who actually seek removal (6%)," they noted.

Dr. Armstrong and her colleagues assessed present-day tattoo removal using an anonymous survey of 196 clients aged 14–73 years who were attending four dermatology clinics in Arizona, Colorado, Massachusetts, and Texas. They compared the results with those from a similar survey conducted in 1996.

Although most of these subjects had been pleased with their tattoos when they first got them, they reported feeling dissatisfied with the tattoos for an average of 10 years before finally seeking removal. Most people who wanted to remove tattoos in 1996 were men, whereas most of those seeking removal in the present day were women, especially "career-minded" women.

Women reported receiving significantly more negative comments and suffering significantly more embarrassment regarding their tattoos than did men. In particular, women reported their tattoos interfered with their job or career and that they elicited negative comments in the workplace, in public, and in school settings, as wells as from significant others.

Currently, women also reported having to hide their tattoos with cosmetics or bandages and being unable to wear certain clothing because of their tattoos more often than men did. These findings correspond with reports in the literature that tattoo wearers are perceived as having lower credibility, competence, and sociability, particularly in the workplace, Dr. Armstrong and her associates said (Arch. Dermatol. 2008;144:879–84).

"For women, their tattoo procurement may be a way to break out of the gender norms and take some social risk by visually displaying their assertive identity. Yet, there still may be many members of society who consider tattoos on women to be a 'transgression of gender boundaries,'" the researchers wrote.

The major reason cited for getting a tattoo among both men and women who later sought removal was that it "helped me feel unique." Most of these subjects grew "disillusioned because their unique product had lost its luster and excitement." Some also said they were actively dissociating from their past or shifting their identity focus in order to "move on."

Dr. Armstrong is an education consultant for Freedom

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

Facial resurfacing using a CO₂ laser is a safe and effective treatment for rhytids demonstrating long-term results, according to a retrospective study of 47 patients who underwent an entire facial resurfacing procedure.

Dr. Shan R. Baker of the department of otolaryngology-head and neck surgery at the University of Michigan, Ann Arbor, performed the procedure from December 1996 to December 2004 using a commercially available CO₂ laser to assess long-term effects and complications of full-face CO₂ laser resurfacing. Particular attention was given to the incidence of hypopigmentation that was evident by photographic review, according to Dr. Baker and Dr. P. Daniel Ward, also of the university (Arch. Facial Plast. Surg. 2008;10:238–43).

Sixty-two patients who underwent entire facial laser resurfacing initially were identified. Complete data were available in 46 patients with Fitzpatrick skin types I, II, or III and 1 with skin type IV. The mean follow-up was 2.3 years. Many of the patients had other procedures at the time of the resurfacing, including dermabrasion, blepharoplasty, brow lift, and rhytidectomy.

The mean improvement in facial rhytid score was 45%, according to the researchers.

Reported complications included milia or acne in 14 cases (30%), hyperpigmentation in 8 cases (17%), hypopigmentation in 6 cases (13%), infection in 1 case (2%), and ectropion in 1 case (2%). The only complications present after 1 year of follow-up were six cases of hypopigmentation and one case of hyperpigmentation. Postprocedure hyperpigmentation was treated with topical hydroquinone. The case of persistent hyperpigmentation at the 1-year follow-up had resolution within 2 years of the procedure.

Patient response to treatment was assessed by comparing the mean improvement in rhytid scores with and without hypopigmentation. The researchers noted that patients with hypopigmentation had a greater response to treatment, with 73.9% mean improvement, than did patients who did not develop hypopigmentation (41.8% mean improvement), a statistically significant difference.

The researchers, who had no conflicts to report, said the results confirm previous studies that found CO₂ laser resurfacing leads to long-term improvement in facial rhytidosis.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.