VIRGINIA BEACH DERMATOLOGY ASSOCIATES, PLLC.

BETTER BOTOX
We are inundated with claims of products that are Better than Botox? Smarter than Botox? More Effective than Botox? Is it possible that there may be a Botox better than Botox? How about a topical Botox? Researchers have recently published the results of a study which showed that a special topical formulation of Botox was about 70% as effective as the injectable form of the miracle substance. Investigators injected Botox in one armpit and used a liquid form in the other. The side where the liquid was applied stopped sweating 70% as well as the Botox side.

This sounds pretty exciting. However, I hate to be a wet blanket on the study, but there seems to me to be a major stumbling block in extrapolating this study to the use of a liquid to relax facial muscles. First, liquids can utilize the sweat ducts to travel to their intended target, the sweat gland and the area near the sweat gland. For facial muscles Botox must reach their muscular target. Further, the muscles lie deeper than the sweat duct so there is a longer distance to travel. Finally, it might be easier to effect the sweat duct than it is to effect muscle paralysis. Still, a topical form of Botox, even if it attains only a fraction of the injectable form, would be a welcome addition to the anti-aging armamentarium.

MORE ON HYALURONIC ACID
In my last article I touted the benefits of hyaluronic acid. While those words are still true, I would like to clarify why I was recommending two products in particular: Hylira and Bionect. The reason that these two products were recommended is that they are what is termed nano-hyaluronic acid. While hyaluronic acid is a strong humectant(draws in water) and therefore an excellent moisturizer, its usual form is a large molecule 3,000-20,000 nanometers. It therefore sits on top of the skin and fails to replace the natural stores of hyaluronic acid we lose in the aging process. Special forms of it, using nanotechnology, are low molecular weight, more like 5 nanometers. Low-molecular weight hyaluronic acid can easily pass through the epidermal crevices and reach the dermis.

This form of hyaluronic acid dispersed throughout our cutaneous tissue, replenishing our hyaluronic acid levels similar to the skin we enjoyed in our youth, and providing deep moisturization and a healthy, smooth appearance to our skin.

Besides the two products mentioned above, which are prescription only, Derm-Advance offers a nono-hyaluronic acid formulation in its Hyalogy P-effect line. Your dermatologist may know of others.

LINOLEIC ACID FIGHTS AGING AND ECZEMA
Researchers at Unilever, the makers of Dove soap, are working on a special form of linoleic acid for possible treatment of photoaging. Early results indicate that linoleic acid increases fillaggrin production. Filaggrin is a protein which binds to and strengthens the keratin fibers of your skin cells. In studies this product was as effective as the application of tretinoin (Retin A) with virtually no irritation.

A fascinating thing about fillaggin is that when the gene coding for its expression is mutated, the result is severe eczema or ichthyosis. Ichthyosis is marked by fish-scale like, extremely dry skin. It has been shown that at least 50% of severe eczema cases have a copy of this mutated gene.

If linoleic acid sounds familiar to you, linoleic acid and its brother gamma linoleic acid are long chain fatty acids which coat the surface of the skin and help it retain moisture. You eat linoleic acid daily as it is an Omega 6 fatty acid and is found in safflower oil, sunflower oil, palm oil, walnuts olive oil, and soybeans. If you take flaxseed oil supplements, as you should if you have dry skin or eczema, you are consuming a healthy amount of linoleic acid. In fact we get our word linen from the Greek word linon (or flax).

DNA SUNSCREEN
Dimericine, a new compound, has joined the parade for youthful skin. Its approach is a unique one. Dermatologists know that photoaging and skin cancers are caused by solar damage to the DNA of our skin cells.

Dimericine contains something called T4endonuclease V, a substance important to DNA repair. Studies in cell cultures and animal models indicate T4N5 liposomes (the balls containing this stuff) increased repair of DNA damage caused by ultraviolet light.

In clinical testing in xeroderma pigmentosum, a genetic disorder predisposing to skin cancer, Dimericine reduced the incidence of pre-malignant actinic keratosis and basal cell carcinoma. By repairing DNA efficiently after sun exposure, we should have fewer mutations in our DNA and a lower skin cancer rate. Since the damage done to DNA can cause photoaging, we can keep our skin younger.

BOTOX DISGRACE
I was very disturbed by a recent article that showed dermatologists offer a significantly shorter wait time to patients seeking cosmetic boulinum toxin injections that to those seeking urgent consultations for a changing mole.

In this study researchers made scripted telephone calls to 900 dermatologists in 12 metropolitan areas requesting Botox injections. The median wait time was eight days, six if there was a so-called physician extender. The wait time to see a dermatologist for a changing mole was a depressing 26 days. Since obtaining a dermatology residency is intensely competitive, it makes me wonder if the criteria used in selecting residents should be changed.

This article was written by Dr. Arnold Oppenheim, M.D. for the Tidewater Women – June 2008 Edition.