VIRGINIA BEACH DERMATOLOGY ASSOCIATES, PLLC.

Here are a few recent developments in skin care.

ENDOMETRIOSIS AND MELANOMA
A large French study recently demonstrated a substantial correlation between endometriosis and melanoma. Endometriosis is the existence of normal endometrium, the tissue that lines the uterus, in abnormal places such as the muscle of the uterus, ovaries, and various other regions of the human anatomy. As a pathology resident, I remember my astonishment upon seeing that the lung tissue I was sampling harbored a piece of endometrium.

It is felt that this link may be of a genetic nature, that the same genes that cause endometriosis may affect women and predispose them to melanoma. With this in mind, if you have been diagnosed with endometriosis, it would be prudent for you and your gynecologist to examine your skin with the utmost care.

NEW UNIQUE TOPICA ANESTHEETIC
In the continual quest to make skin procedures less painful, a new topical anesthetic has been introduced. Its name is Pliaglis, and it is administered in a unique manner. This cream is applied on the intended target and the patient is asked to wait fifteen minutes. After this time has elapsed, the cream, containing the anesthetics topicaine and benzocaine, hardens and is peeled off. The anesthesia obtained is comparable to an injected anesthetic (needles!!).
I tested this on myself before my blood was being drawn. It worked. I barely felt the needle. I find Pliaglis especially helpful as an anesthetic prior to lip augmentation and for use in placing fillers in the naso-labial folds, regions of the face known to be particularly sensitive. In most cases Pliaglis circumvents the need for a dental block. Some physicians are charging a supplemental fee when they use this cream, but from my experience, it is worth it.

COLLAGEN – A SCAM?
Collagen is wonderful—and half the goal of skin anti-aging is to build up or keep the precious stuff.  But if you see collagen as a main ingredient in an anti-aging skin care product, don’t buy it.

Collagen is a big molecule and can’t penetrate the epidermis. It is like asking a mouse to fit through a keyhole. No matter how hard it tries, it can’t squeek through.

HYALURONIC ACID ON TOP
By now most of you are familiar with the wonders hyaluronic acid can wrought as a filler. Restylane and Juvederm have dramatically changed the complexion of cosmetic dermatology. Do they help when placed on top of the skin as opposed to being injected into the skin? The answer is a dramatic yes. Unlike collagen, hyaluronic acid is a small molecule and can wend its say through the wall-like structure of the epidermis into the dermis. There it takes its place among its fellow hyaluronic acid molecules, making the dermis richer and fuller. An even further benefit is that while it lies on the epidermis, it serves as a powerful anti-inflammatory agent. Like the ill- fated Vioxx, it blocks COX-2 and therefore decreases inflammation.

A tip for those using products which are causing redness or irritation: get yourself prescription grade hyaluronic acid topical. My favorites are Hyluria and Bionect. These are especially useful for people whose skin has been retinized with Retinoids such as Retin A (and Renova), Tazarac, or Differin. Your skin can generally tolerate a stronger Retinoid with Bionect or Hyluria. A higher Retinoid means a more potent anti-aging regimen.

For those using Effudex, Carac, or Aldara, used to treat actinic keratoses (pre-skin cancers), the irritation these cause can be greatly relieved with hyaluronic acid. These products are also great after procedures, be it IPL, laser, peels, or microdermabrsioins.

BOTOX RIVAL DERAILED
Reloxin (Dysport in Europe) was supposed to be the major league competitor for BOTOX. Since it has been used successfully in Europe for many years, it was assumed that the FDA would pretty much rubber stamp its approval here in the US. But in the words of Lee Corso, former Indiana head football coach, “Not so fast my friend.” The FDA told Medicis, the American company with marketing rights in the United States, that they would like more complete data before granting approval. So there will be at least a six-month delay.

When it does get approved, there may not be the price break we have been anticipating. I certainly am hoping Reloxin will be sold cheaper. The price of BOTOX for physicians has skyrocketed. When I first ordered it a few years ago, its cost was $385 a vial. In my last order, a vial cost $525 for the same product.

Physicians will find Reloxin a bit trickier to use since it diffuses more readily than BOTOX. This may be an advantage in places like the forehead and a disadvantage in the eye and mouth areas.

MIGHTY MATRIXYL
One of the hottest anti-aging skin ingredients is matrixyl. The active ingredient in mastrixyl is a pentapeptide composed of five amino acids. The developers of Matrixyl, Sederma and Procter and Gamble, hooked it up with the fatty acid palmitoyl to enhance skin penetration. Being a small molecule, matrixyl does get into the dermis pretty well.

What it does when it gets there is to stimulate collagen and fibronectin (a sugar-protein that helps bind collagen). What’s more, matrixyl increases hyaluronic synthesis. It also decreases the production of collagenase, a protein that breaks up your precious collagen.

This amazing lipoprotein reduced deep wrinkles by half and sometimes faded smaller wrinkles and fine lines even better. I feel that it is at least as effective as retinols without the irritation and should be part of most people’s skin care regimen.

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