The "A" Train

A New Acne Medication

Thanks to the folks a Galderma, they have now released a new acne treatment called Epiduo. What makes this gel  unique is that it has combined .1%  adapalene (the gentlest of the prescription retinoids) and 2.5% benzoyl peroxide.

Here is my take on this new drug.

PROS     - it is a gel formulation which will lessen irritation and increase bio availability.
             - two active ingredients combined into one treatment which will save you money

CONS     - I couldn't find it in their literature, but I am sure they are using micro-encapsulation to protect the two actives from each other. This does a great job of suspending the active, but does not do the best job of delivering into the skin.

            -though retinoid treatment combined with benzoyl peroxide is the preferred topical treatment   protocol for dermatologists, you typically apply the retinoid at night and the benzoyl peroxide in the morning. By seperating the application of the actives, you tend to lessen irritation which can only help patient compliance.

The reality is, that if you can get a teenager to brush their teeth, you have made a major accomplishment as a parent. Therefore, combining two proven acne treatments into one is a great thing...if their skin can tolerate it. If irritation and adaptation is an issue, I would recommend that you stick with the retinoid at night and the benzoyl peroxide in the morning routine for a couple of months. After a period of time you may can move to the Epiduo treatment for convenience and cost.

Facials: The Debate

Facials are promoted as a  simple massaging of the skin to miracle "at the touch of a hand". But, at any level are they worth the $40 to $200 a session? Here's what the experts say:

Pro: Aesthetician, Rowena Woo: (I'm paraphrasing) Facials can be beneficial if you stick to the basics like cleaning, extraction and exfoliation.

Con: From dermatologist, Dr. Leslie Bauman: aestheticians “often don’t know which products are right for the skin of each client” and that facials cause breakouts most of the time.

Reality: There are many aestheticians that are very well trained and know their business better than some of doctors. However, most expensive facials are a waste of money and time and you can pretty much bet the farm that it has no anti-aging benefits. However, a facial can be a great luxury if you can afford it. Just understand that the benefits from a physical standpoint are small such as light exfoliation, blemish extracting (which is really good for clogged pores) and cleansing. The meta physical benefits can be significant, a time to be caressed and pampered is a great thing. Again, if you can afford it.

My advise is find an aesthetician that has experience and doesn't push alot of unneeded products and services. Also, if they don't lead with a retinoid as their first line of defense for healthy skin, then I would keep looking (this goes for the docs too!).

Want to read more on the subject? A New York Times Article and Dr. Baumann's Blog Posting

Lasers for Acne

As much as the laser community wants us to believe that lasers treat acne. The fact is the cost does not justify the result....However, that may change in the future.

http://www3.interscience.wiley.com/cgi-bin/fulltext/119408075/PDFSTART?CRETRY=1&SRETRY=0

Topical and oral treatments remain the best protocols for acne

http://atrain.typepad.com/atrain/2009/03/acne-now-classified-as-a-chronic-disease.html

Acne: Now Classified as a Chronic Disease

According to The Acne Global Alliance, acne is not classified as a chronic disease that needs appropriate diagnosis and long term strategies to effectively treat.

The Alliance says that acne effects 85% of the World's Population in the age of 12 to 24.

So how do you treat this disease? The Alliance recommends the following (and I am paraphrasing).

Mild Acne     - 1st Choice - Topical retinoid
                   - 2nd Choice - Azelaic acid, salicyclic acid, physical extraction
                   - Alternative for women - see 1st choice
                   - Maintenance - Topical retinoid

Moderate Acne     - 1st Choice - Topical retinoid + topical antimicrobial
                           - 2nd Choice - Azaelaic acid, physical extraction
                           - Alternative for women - see 1st choice
                           - Maintenance - Topical retinoid

Severe Acne     - 1st Choice - Oral antibiotic + topical retinoid and/or benzoyl peroxide
                       - 2nd Choice - No consensus among experts so they default to first choice and azelaic
                       - Alternative for women - Oral antiandrogen + Topical retinoid and/or topical                                                                           antimicrobial
                       -Maintenance - Topical retinoid and/or benzoyl peroxide

Disfiguring Acne  - 1st Choice - oral isotretinoin
                          - 2nd Choice - high dose oral antibiotic + topical retinoid and/or benzoyl peroxide
                          - Alternative for women - High dose oral antiandrogen + topical retinoid and/or                                                                            topical antimicrobial
                          - Maintenance - Topical retinoid and/or benzoyl peroxide

This is alot of information to digest, but the bottom line is that a topical retinoid is your best weapon when fighting acne.

Please do not use this information to self diagnose and treat your acne. But, use this information to talk to your dermatologist as the best ways to treat your condition.

I often hear from frusterated people that lament they have tried man of these therapies and are not getting results or that they cannot tolerate the retinoid. There is no one best way to treat everyone's acne, but requires a trial by fire mentality to best approach your condition. Your doctor has the insight and training to help your search for the best path to treatment....so, don't lose faith after a couple of visits!

Cell Receptors are the Key To Understanding Retinoids

At the American Academy of Dermatology Annual Meeting in San Francisco, Dr. Sewon Kang presented some of his prolific research on retinoids. The thing that I liked the most about his speech was his definition of a topical retinoid:

"any molecule that, by itself or through metabolic conversion, binds to and activates the retinoic acid receptors, thereby eliciting transcriptional activation of retinoic acid-responsive genes that results in specific biologic responses (Kang & Voorhees. Fitzpatrick's Dermatology in General Medicine [7th Ed.]. 2008)."

He went on to further explain that Vitamin A enters the skin where it is stored and esterfied. It is then oxidized into retinoic acid where it is received in the nucleas of the cell. (For a visual representation of this event click here).

He went on to point out that keratinocytes are divided faster in retinoid treated skin which is the main reason to use a retinoid.

There is also a general misconception that retinoids thin the skin. In a study that was conducted by Dr. Kang, skin biopsies show that the skin doubled in thickness.

The last thing he pointed out was, "Topical retinol elicits a retinoic acid-like epidermal histology (hyperplasia and spongiosis), but, unlike retinoic acid, it doesn’t cause significant erythema."

Therefore, it is my hope that we can get doctors to think about carrying an over the counter retinol as a great alternative to prescription strength retinoids.

You can read the full Dermatology Times article here.

Another Good Reason Not To Use A Tanning Bed

Yikes! http://www.newsobserver.com/front/story/1436088.html :)

Green Cream Gets a "favorite" Plug

One of our favorite bloggers/beauty writers, Nadine Haobsh http://www.jolienadine.com, has just plugged Green Cream as one of her favorite products in a St. Paul Newspaper http://www.twincities.com/ci_11637368.

We have never supported her financially, but, have sent her a free bottle to evaluate. Therefore, you can take her comments as unbiased. You may want to check out her other products she likes.

Nadine first blogged about Green Cream http://jolienadine.com/blog/2008/04/02/green-cream/

Skin-Lightening 101

One of my favorite researchers, Dr. Zoe Draelos,  has published an article on Skin Lightening products in Skin Inc. magazine (A magazine for skin care professionals).

The main points from the article

• All OTC skin-lightening treatments should include using a sunscreen daily.
• Hydroquinone remains the gold standard in skin lightening, but OTC products may be banned by the FDA.
• Mequinol a prescritpion based product that does not damage the melanocyte like hydroquionone does.
• RETINOIDS are typically combined with other skin lightening agents to enhance penetration. Retioids do an effective job of lightening freckles. OTC retinol has been thought ot provide similar effects that prescription strength retinoids.
• Vitamin C when used by itself is a poor skin lightener.
• Licorice extract is low on the irritation scale, but must be used in high concentrations over a long period of time. 
• Alpha Lipoic Acid's ability to lighten skin is doubtful 
• Kojic acid is effective but has a hard time penetrating the skin and needs to be used with penetration enhancers like a retinoid. 
• Aleosin & Arbutin are not very effective but need to be mixed together to be effective.

  You can read the whole article here http://www.skininc.com/skinscience/ingredients/37222599.html?page=1

FDA Warning: Topical Anesthetic

After two young females died after applying topical lidocaine in preparation of a laser hair removal have died of a heart attacks recently.

The FDA recommends:

• use a topical anesthetic that contains the lowest amount possible of medication that will relieve the pain; 
• apply the topical anesthetic sparingly and only to the area where pain exists or is expected to occur;
• not apply the topical anesthetic to broken or irritated skin.
• ask their doctor what side effects are possible and how to lower their chance of having life-threatening side effects from anesthetic drugs.
• be aware that if wrapping or covering the skin with any type of material or dressing is recommended or considered, this can increase the chance of serious side effects, as can applying heat to the treated area while the medication is still present.

Some possible topical anesthetics are

• lidocaine
• benzocaine
• tetrocaine
• prilocaine

Some of the possible side effects are:

• Irregular Heartbeat
• Seizures
• Breathing Difficulties
• Coma
• Death

http://www.fda.gov/cder/drug/advisory/topical_anesthetics2009.htm

Study Resumes: Topical Retinoids in The Prevention of Skin Cancer

There was a study that started back in early 2000 regarding the use of tretinoin (the main ingredient in Retin A) as a skin cancer inhibitor. It has been shown that topical retinoids could prevent certain skin cancers like basal cells and squamous cells.

However, in 2004, the study was halted due to concerns of increased mortality rates of using topical tretinoin. I think most dermatologists knew that something was wrong with the study. After 3 years of re-examining the data, the VA Medical Center has resumed the study because there was no causal link between the use of topical tretinoin and death.

This is great news and, once approved by the FDA, you will start seeing Retin A marketed as prevention of some skin cancers. This is particularly important for people who have had skin cancer in the past, or have a family history of skin cancer.

The full article can be viewed here.