Glabella lines, often referred to as the dreaded “11s,” are the short parallel vertical lines found between the eyebrows and extending up the central forehead for a centimeter or so. They are often the first lines to appear on the forehead, even as early as one’s mid- 20s.
Initially glabella lines are intermittent, appearing only when a person frowns. These lines are considered “dynamic” and are evident when someone makes the angry face that furrows the brow. As time goes on and with repeated movement, the glabella lines become deeper and more permanent.
Glabella lines can look quite deep because the skin in this area is comparatively thick. These “11” lines are created by the dynamic action of the underlying muscles of the glabella (the part of the forehead between the eyebrows), the corrugator supercilii (the muscle above the eyebrow), the procerus (the triangular muscle between your eyes) and the depressor supercilii (the muscle near your inner eyebrow located near the eye). Together they pull the central areas of the eyebrows inward and downward, causing those lovely 11’s to form.
Other external factors that can worsen the glabella lines include sunlight (of course because we squint!), smoking, and exposure to pollution. Patients with thyroid disease who have exophthalmos can have deeper central glabella lines. Individuals with eye sensitivity, contact lens wearers, and those with other eye issues may use the glabella area of the forehead more frequently and consequently have more lines.
We know too that mood can worsen glabella lines: A truly angry person or someone who is constantly frowning can have deeper glabella lines. In fact we have become so habituated to “reading” glabella lines this way that even if the individual is not angry or unhappy, the presence of deep “11” lines can give false signals that this person is always in a bad mood! No wonder many people wear bangs to camouflage their wrinkles on the forehead and glabella.
Making that “mad face” can also contribute to headaches and a feeling of central forehead heaviness. Aesthetically, glabella lines can make an upper face look heavy and tired: the muscles can bunch up instead of looking open and relaxed. An open appearance is more attractive to the eye.
The treatment of the “11” lines is aimed at softening and reducing them. Botox® (botulinum toxin A) is a neurotoxin that temporarily paralyzes muscle activity in the area that is treated. This toxin is produced by the microbe clostridium botulinum and is purified, which makes it safe to be used in small doses. Botulinum toxin A stops the muscles of the glabella from contracting and forming furrows. Injection of Botox into the glabella muscle paralyzes the downward and inward muscle action which produces the angry-looking lines.
The Botox injection takes about 5 to 8 days for the effect to kick in; it peaks within about 10 days and continues to render the muscle inactive for 3 to 6 months. Eventually, the treatment wears off and the muscle begins to move again, at which point the treatment can be repeated. There are other neurotoxins available-be sure to check with your provider to see which one is best for you.
Neurotoxins like Botox are the best treatment tend to and prevent lines and wrinkles of the forehead and around the eyes. They can also help soften the lines on the forehead if they are not too deep to start with. Eventually with continued treatment those lines can virtually disappear.
Injections of neurotoxins are given in 2-5 small injections into the particular muscle that is being treated. The pattern is determined when a dermatologic practitioner examines the individual’s musculature. Care is taken to avoid the frozen “Spock” look...unless, of course, you want that! The goal is to avoid changing the shape of the eyebrow and to try to maintain the eyebrow arch. A successful treatment is when you cannot move your glabella lines—in other words, when you try to make a mad face but have difficulty doing so!
From time to time when you treat the glabella, patients start to notice other lines on their face including the forehead, eye corners and lower face. For this reason I often recommend treating the forehead, eye corners and glabella together, as an aesthetic whole.
If the glabella lines are kept relaxed over a period of time with regular injections, those deep vertical lines will become less noticeable, and fewer new ones will form. Don’t forget, treatment is aimed at softening or reducing the lines—not at giving a frozen look. It is always best to begin with a smaller dose and increasing the dose progressively if necessary.
For numerous patients with acne, it becomes more than a skin disease that affects just the skin. Acne can most definitely have a profound effect on a person’s emotional health. There have been countless studies on the psychosocial effects of acne. These effects include: a decrease in quality of life, depression, low self-esteem, depression and anxiety. Every day, dermatologic practitioners see how acne can be devastating to a patient. Acne can simply make your life, well…difficult.
Kids can be bullied because of acne. I am sure you have heard the term “crater face”—an incredibly hurtful term when referring to a person with widespread acne. Bullying itself can cause teenagers to feel miserable and upset. They can become socially withdrawn. In studies on patients with acne, many participants have said that their skin makes them feel ugly and unattractive, embarrassed or insecure. This can prevent someone from participating in their lives; they can become stressed and incredibly anxious. Even when acne is mild, patients can become affected psychologically.
As experts in dermatology, we know that the longer acne lasts, the more likely it affects a person’s psychological health. I have had an adult patient who had severe acne as a teenager and is well into her 60’s now. She told me that every time she looks in the mirror she sees “that kid with acne”. This is proof that the scars of acne are more than just on the skin’s surface and they can last long into someone’s life.
When you delay or go without treatment, acne can exacerbate and cause further scarring. Early and effective treatment of acne is key. It is important to prevent worsening of the disease, stop the scarring process and help a patient avoid many of the psychosocial consequences that occur as a result. Successful management of acne can make a patient feel more comfortable in their own skin. When you take care of acne, skin can become more clear and a person feels better about themselves. A patient can become more confident and less self-conscious.
When faced with a condition like acne, prompt treatment is important. Acne is not a frivolous disease. Although it is not associated with severe illness or physical disability, it can have substantial and long-standing psychosocial effects. Our goal as clinicians, in addition to treating your acne, is to reduce the emotional and social impact on your life.
If your acne is interfering in your life, especially if it is causing any of the difficulties above, seek help immediately. It is important to tell your practitioner all of your worries. Most cases of acne can be controlled with treatments. It can often times be cured. Over-the-counter topical acne creams, lotions or gels are great for mild cases of acne. Clinique’s Acne Solutions line is a fantastic option. Prescription medications, both topical and oral are also obtainable when you see your practitioner.
Depression is a disease that is almost always treated successfully. See your family practitioner or internist for information and guidance and if needed, you could be directed to a mental professional. There are lots of treatments for depression. They include antidepressant medications, counseling and psychological treatments for negative thinking, obsessing and anxiety, which often go together with depression.
Overall it is particularly important to manage your anxiety or depression with your acne. All of this can improve the destructive thoughts, nervousness and worry about your acne and help build up your self-assurance, confidence and self-esteem.
Cryolipolysis, a.k.a "fat freezing" or CoolSculpting®, is an office-based procedure that targets and freezes fat cells through a distinct cooling technology. This entails cooling the body fat in a specific area causing fat cells to break down, leading to a decrease in the fat while not harming the skin or other tissue. The results of the procedure usually takes a few months to be realized.
There is lots of scientific evidence surrounding Cryolipolysis--a non-invasive body contouring treatment used to reduce fat cell volume by freezing. The method involves precise application of a cooling technology within the temperature range of +5 to -11 °C which lessens localized fat deposits. In doing so it reshapes and contours the body. Studies have found that cryolipolysis decreases treated fat by as much as 25%. When an area is treated and the fat cells have undergone the process, they are then eliminated from the body through the metabolic processes of apoptosis (death of cells) and phagocytosis (ingestion of the cells) via the liver. There is no injury or damage to the surrounding tissues. CoolSculpting can reduce fat on the abdomen, thighs, upper arms, flanks, back, and underneath the chin or buttocks. It is non-invasive—there are no needles or surgical excisions.
Prior to the treatment, a practitioner evaluates the patient to see if they are good candidate as well as reviews their medical history. During this time we talk about the patient’s expectations as well as the possible risks and anticipated results. This therapy is suitable for pinchable excess fat. If a patient is not in good general physical and mental health, they may not be suitable candidate for the procedure. Other patients who should not try CoolSculpting include those with the following medical conditions:
The procedure is done by placing a vacuum applicator on the skin, which suctions the pinchable fat into two cooling panels. The device delivers exactly the right amount of cooling directed at the particular area and freezes the fat cells. The fat is cooled to a freezing temperature, which sets off a method of natural fat removal in the body. Patients feel a cold sensation for a couple of minutes, and then it brings about an anesthetic effect—the treatment area starts to feel numb. The fat is cooled for up to an hour. During the procedure you can read, listen to music or watch television. After a treatment, most patients return to their normal activities.
Common side effects of CoolSculpting include soreness, stinging, pain and an achey feeling at the treatment area which can last 2-4 weeks after. Additionally, there can be redness, swelling, bruising or skin sensitivity. Overall, the procedure really has no down time—patients can restart their usual activities the same day. Rarely, cryolipolysis causes an increase in the volume of fat cells in the treated area called paradoxical adipose hyperplasia. This occurs in less than 1% of patients.
What is important to remember is that cryolipolysis usually needs multiple treatment sessions and results are seen in about two to four months. Moreover, it is not a substitute for diet and exercise, nor is it a therapy for obesity. Alternately, cryolipolysis is a method for taking away unwelcome fat that sticks around after other attempts at weight loss.
The best news about CoolSculpting is that the results last forever (yes forever!) because the fat cells are destroyed and they do not return! However, if you gain weight, you may gain fat back in the treatment area or in other areas of the body. The procedure is also non-invasive and non-surgical without long-term or notable side effects; and anesthesia and pain medication are not needed. Overall, CoolSculpting is an innovative treatment option for unwanted stubborn fat and who doesn’t love that?
Are your smile lines causing you to frown? Are you worried about your hollowed or drooping cheeks giving away your age?
You might be interested Sculptra Aesthetic, a different kind of injectable, to give these areas a boost.
Sculptra is an FDA-approved injectable that assists in slowly replacing collagen, which is the fundamental cause of facial aging. Clinical results can last over two years. This type of synthetic facial injectible, generically known as poly-L-lactic acid (PLLA), has been used for decades in dissolvable stitches and soft tissue implants. This material may trigger the proliferation of collagen which, in turn, helps bring back facial volume, fill wrinkles and improve folds over time.
The effects of Sculptra progressively materialize over the prescribed course of treatment, which usually is about one treatment every 4-6 weeks over 3 or 4 months. Remember, individual results vary and your practitioner would have to determine how many treatments are appropriate for you.
How is Sculptra different than other injectibles?
Sculptra is a poly-L-lactic acid (PLLA) collagen stimulator, so it is different from other injectables, like those containing hyaluronic acid. Sculptra works with your body's own dermis, to support and reinvigorate collagen building, bringing back your skin’s inner matrix, which improves and replaces lost facial volume. When the microparticles are soaked up by the body, the body produces collagen. This renovated collagen starts to slowly bring back youthful facial volume and makes wrinkles and folds appear full.
Sculptra acts as an irritant, causing your body to respond by depositing collagen in the area injected. Since Sculptra stimulates your body to build its own collagen, it does not actually “fill” hollow areas and lines and wrinkles immediately. The results are not instantaneous, instead it works over time, which my patients say makes the procedure less noticeable and makes for a more natural outcome. The desired effects of Sculptra can take anywhere from 4-6 months.
Where do we use Sculptra?
- Deep folds between the nose and the mouth which are most commonly known as your “smile lines”
- The lines around your mouth that look like parentheses, known as “marionette lines”
- Lines and wrinkles under your lip and on your chin
- Hollowing or sagging under your cheekbones
We do not use Sculptra around the eye area to help with crows feet or to help with under eye hollows because in these areas little lumps and granulomas may form which we find unacceptable to successful treatment.
What’s the procedure for injecting Sculptra?
Most patients need 2 to 3 injection sessions over a few months. The number of injection sessions and the number of injections per session vary depending on the patient and area(s) in need.
On the day of injection, we apply a topical numbing cream for 20-30 minutes prior to any injections in addition to mixing Sculptra with a pain-reducing local anesthetic to make treatment as pain-free as possible. Ice may be applied before and after each injection site to reduce any possible bruising and slight redness that may result that day or the next few days.
Once the initial series of injections is completed, results may be seen in 4-6 months while effects may last up to 2 years.
Some DOs and DON'Ts I recommend for success with Sculptra injections
- DO discuss with your practitioner if you are on any blood thinners, aspirin, fish oil or vitamin E, as these medications may increase your chances of bruising.
- DON’T have Sculptra injections on the same day as other procedures, like lasers or radiofrequency.
- DO use ice before and after the injections to reduce any bleeding, swelling and bruising.
- DON’T have Sculptra injections right before a big event. It is not meant as a quick fix and bruising can result.
- DO gently massage the area of the injections for an even distribution under the skin.
Lots of patients who may not be candidates for a face lift prefer Sculptra because it is so much less invasive. The results improve subtly so its not such as drastic and noticeable a change with a lot of downtime.
Have you been considering Sculptra?
Everybody ages differently. Regardless of your gender, eventually you’re going to notice lines and wrinkles in different areas of the face. Some individuals find that their jowls are sagging or they discover their skin is not so clear anymore—spots and areas of discoloration can appear. Sometimes you may notice that your cheeks are shrinking and becoming flatter, which can make your face look thinner, droopier, and (we hate to say it) older!
If you think that your face is beginning to sag and your cheeks are becoming hollow and drawn, we may have a good option for you.
JUVÉDERM VOLUMA® XC, one of the newer injectable fillers for volume replacement, is used for the purpose of adding volume beneath the skin’s surface to lift and contour the cheek area. By improving that hollowed-out appearance, the face appears younger, more rounded and firm. Not only has JUVÉDERM VOLUMA® XC received FDA approval for restoring that lost volume around your cheek area, it is by far the easiest, most precise and longest-lasting injectable there is to rectify age-related volume depletion in the cheeks. By raising sunken cheeks, laxity along the jawline is improved, helping you look fresh-faced and sprightly.
JUVÉDERM VOLUMA® XC is part of Allergan's arsenal of other injectable gel fillers for minimizing lines and wrinkles and for adding lip volume, All of them are formulated from hyaluronic acid (HA), which is a natural component of healthy, young and plump skin. JUVÉDERM VOLUMA® XC, however, is different from other HA fillers in that it was formulated to add volume to a larger area, such as the cheeks, and it does so by staying in place for a longer period of time. This gives you a subtle, natural-looking lift that lasts longer. As with other HA injectable fillers, you can see the results immediately.
The new HA formulation in JUVÉDERM VOLUMA® XC maintains the effects of the treatment and lasts up to twice as long-- up to 2 years-- compared to other injectable fillers, which last between 6 to 12 months for the average patient. I have found that JUVÉDERM VOLUMA® XC doesn’t entirely disappear after the two years either, allowing for possibly less product to be used for subsequent treatment of sunken cheeks.
Depending on your desired degree of correction, most patients require a couple of syringes when treated, but it’s worth the expense. JUVÉDERM VOLUMA® XC is long-lasting and natural-looking, and it can bring back your youthful look. That’s why it’s one of my most favorite fillers to use!
The most important thing I like to impress upon all of my patients is that most skin cancer is 100% preventable because it is simply caused by repeated exposure to the sun’s UV rays over time. Even though a tan fades, the damage to your skin cells is done, and not only does this make you more prone to developing skin cancer but also skin that is aged, leathery, blotchy, wrinkly and sagging. The second thing I like all my patients to know is that at least 90% of all skin cancers are completely curable, especially if those cancers are detected early.
What is skin cancer?
Skin cancer begins with excessive growth of abnormal cells in the skin. If it is allowed to continue growing uncontrolled, a tumor will form and you will notice some type of change to the skin. The vast majority of skin cancers are basal cell carcinomas and squamous cell carcinomas. Although they are malignant, they are unlikely to spread to other parts of the body if discovered early. However, they can be locally disfiguring if not treated promptly.
Will I get skin cancer?
Basal cell carcinoma (BCC) is the most common form of non-melanoma skin cancer and is so called because it begins in the deepest layer of the epidermis, the skin’s basal cells. This cancer often looks like an open sore, red patch, pink growth or shiny bump; is very slow-growing and most often caused by cumulative (building up over time) and intense exposure to the sun. Basal cell carcinomas rarely metastasize (spread) beyond the borders, so these skin cancers are very treatable.
A squamous cell carcinoma (SCC) is caused by uncontrolled growth of abnormal cells in the squamous cells, which comprise the skin’s upper layers (epidermis). SCCs often look like scaly red patches, open sores or elevated growths with a central depression. They may crust or bleed and may become disfiguring and sometimes deadly if allowed to grow.
The most dangerous form of skin cancer is malignant melanoma, which forms in the melanocytes of the skin (those cells which turn your skin tan to protect the deeper layers of the skin when exposed to the sun). These cancerous growths are caused by damage to the DNA of skin cells, often by ultraviolet radiation from the sun or even from tanning beds. Intense, occasional UV exposure frequently leads to sunburn, especially in those who are genetically predisposed. UV can trigger changes or defects that lead to those skin cells rapidly multiplying and creating malignant tumors. Melanomas can develop from pre-existing moles and the majority are black or brown, but they can also be skin colored, pink, red, purple, blue or white. If melanoma is recognized and treated immediately, it is almost always curable, but if it is not addressed, the cancer can spread to other parts of the body, where it becomes hard to treat and can be fatal. Although it is not the most common skin cancer, it causes the most deaths.
Anyone can get skin cancer, especially those who spend or have spent a lot of time in the sun. However, having fair skin and freckles, light eyes and blonde, red or light-brown hair means your skin burns more easily in the sun and also makes you more susceptible to skin cancer. Additionally, people who have a family history of skin cancer are also more likely to develop skin cancer.
How do I know if I have skin cancer?
Check your own skin regularly and have a dermatologist do so once a year. If you notice any difference in your skin including any raised patches, redness, scaliness, a sore that does not heal or strange moles, head to the dermatologist to have it checked out. Any skin lesion that lingers longer than a month warrants a trip to the dermatologist. Here are the ABC’s of skin changes you should look out for:
•Asymmetry: Any mole that has irregular shape and jagged edges.
•Bleeding: Any mole that bleeds and does not heal.
•Color: Any mole with a variety of colors in the one mole.
•Diameter: Any mole that is larger than the size of a pencil eraser.
•Evolving: Any mole that changes in some way, whether in size, shape, or color.
When you come in for a skin check we will examine your skin and any growths or skin changes in question. If we suspect any type of cancerous lesion, we will take a biopsy (a small piece of the skin) to test it in the laboratory to determine if the growth is benign, pre-cancerous or cancerous.
How to protect yourself from the sun’s damaging rays
Never go into the sun without protecting yourself with a broad-spectrum sunscreen (these protect against both UVA and UVB rays). UVA rays penetrate deep into the dermis, the skin's thickest layer and unprotected exposure can lead to premature aging and wrinkling. UVB rays will usually burn the superficial layers of your skin. It plays a key role in the development of skin cancer.
The Skin Cancer Foundation grants its Seal of Recommendation to sunscreen products greater than SPF 15, so you know they meet the highest safety and effectiveness standards. You can also look for this seal when purchasing UV-protective automobile and residential window film, sunglasses, UV-protective laundry additives and sun-protective clothing and hats.
One last reminder: Did you realize that water, snow, or ice can reflect as much as 90% of the sun’s rays upwards and sideways, which greatly increases your exposure? Don’t ignore the need for sunscreen when working or playing on these surfaces, even on cloudy days as 70% to 80% of the sun’s damaging rays can penetrate through the clouds and haze.
It seems as if the universe is conspiring against us to make us look older and more tired than we are, doesn't it? As we age, many changes occur that lead to thinning facial skin, sagging wrinkles and hollowing where there used to be plump, firm skin. If you're interested in using facial fillers to solve these problems, you've probably heard about Juvéderm Vollure XC and that's because treatment with this injectable facial filler lasts up to 50% longer than any dermal filler before.
Part of the problem with using injectable fillers is that you have to repeat the treatment at regular intervals; some every 6 months and some every year or so, to keep up the desired results. Last month, however, Allergan, the company that makes Juvéderm announced that Juvéderm Vollure XC has been approved by the U.S. Food and Drug Administration (FDA) to correct facial lines and wrinkles such as those folds between your nose and mouth (called nasolabial folds) that can sink into the moderate to severe category.
The exciting news is that in the Juvéderm Vollure XC clinical trial, nearly 60% of patients experienced improvement in nasolabial folds for up to 18 months. This formula was studied and tested for treatment of the nasolabial folds because that is the most common treatment area for wrinkles. The majority of patients (82%) in the trial said they were satisfied with their results at 6 months and 68% were still satisfied at 18 months. Now that's long lasting!
How does Juvéderm Vollure XC work differently than other fillers?
Most facial fillers today rely on a substance called hyaluronic acid, or HA for short, which is naturally occurring in our own connective tissues and cartilage. Since hyaluronic acid is not derived from animal sources or a synthetic compound, it is compatible with the human body, which makes it a filler of choice. It's the viscosity of the filler that determines where it is best used. Soft, thin fillers are best for small areas where precision is very important, such as lips and tear troughs (the under eye area). Thicker fillers fill in hollowness or can add volume and enhance cheekbones. We use a variety of fillers to achieve many different results for our patients, including diminishing the depressed area under your eyes and improve the appearance of deep or sagging wrinkles around the mouth. Fillers can also plump your thin lips or your sunken cheeks and can even facial inconsistencies.
Juvéderm Vollure XC features new Vycross technology, which means it is a much smoother and natural looking hyaluronic acid filler. It has a a more stable consistency and provides longer lasting results and we are using it to treat those nasolabial folds, the marionette lines and the corners of the mouth. The clinical study was based on an average of 1.8 syringes per treatment, so we've found 1-2 syringes treats most patient's nasolabial folds. One of the best things about Juvéderm Vollure XC is the new cohesive gel makes it more malleable than other fillers making it soft enough to move with facial expressions which gives the patient a natural look.
The most common side effects are temporary responses at the injection site such as tenderness, bruising and redness; most of these resolve within a week.
Overall, Juvéderm Vollure XC is a great addition to our filler arsenal giving us long lasting results to correct facial lines and wrinkles with minimal swelling and downtime. Give it a try!
If you’ve got a “double chin” or are concerned about fat or fullness directly under your chin, you’ll be thrilled to hear about Kybella®, an injectable treatment that actually dissolves fat cells under your chin permanently. You may have heard of it as ATX-101 when it was in clinical trials, but now it is FDA approved to treat submental fullness.
This procedure is a God-send to both men and women who may have a hereditary disposition towards under-chin fullness which does not respond to any fat-reducing diet or exercise. It’s the perfect treatment for patients who want a discreet, quick, non-surgical alternative to liposuction. Now you can finally lose that beard, go scarfless and throw out your turtle neck sweaters!
How does Kybella work?
The active ingredient in Kybella® is called deoxycholic acid which naturally occurs in the body to help dissolve fat from your diet. When it’s injected in the fat under your chin, it destroys those the fat cells completely. Once destroyed, they cannot grow back, which is how these injections provide a permanent fat-shrinking effect in the under-chin area. Even if you gain weight, you will usually not gain it where you have had Kybella injections because you will have less fat cells there after treatment.
What does Kybella treatment entail?
You will need anywhere from 1 to 4 treatment sessions consisting of multiple injections throughout the area of the under-chin fat or fullness.
For comfort, ice is applied 10-15 minutes before the injections are administered. Swelling is an expected side effect and can last anywhere from just two days to as long as a few weeks depending on the amount of fat treated and the dose we administered.
The other common side effects of Kybella® include bruising, pain, numbness, redness and possibly small areas of hardness in the treated area. Older patients with loose skin may notice swelling takes a bit longer to resolve than younger patients with firmer skin.
Once the swelling subsides, you should notice a skin tightening effect along with the fat dissolving.
I usually recommend the treatments be repeated every 4-6 weeks until the desired result is achieved.
For all subsequent treatments, you will notice less injections because there is less fat to treat.
Who does Kybella® work best for?
I’ve had men lining up for it, but it works equally well for both men and women who are concerned specifically with the small amount of fat directly under their chin. Although some skin tightening can be seen as a result of treatment, it does work best in younger patients with firmer skin that is not already sagging.
Kybella® does not help the “turkey neck” or sagging jowls (we have other treatments for that!) so chin, neck and jowl sagging would still be noticeable and need to be treated with other methods.
Is Kybella® expensive?
You may have heard that Kybella® is almost as expensive as liposuction for ridding the under-chin area of fat and fullness. However, it has it's advantages, which include being a non-invasive, non-surgical alternative to liposuction surgery or its after-effects which include pain, swelling and incision-site scarring.
It is definitely the more discreet and the less invasive of the options.
I’m excited to be able to treat my patients who have hated their lifelong double-chin...the difference it makes is amazing!
Just remember, your chin is attached to the rest of your face and your neck, so we have to take all of that into consideration when choosing the best treatment to achieve the look you want.
What I love about being involved in dermatological research is when new disease pathways are found and existing drugs can be applied to them. This is true for a new drug called Soolantra® for treating rosacea. There have been many theories about what caused the redness, large pustules, papules and broken blood vessels that characterize rosacea.
We typically treat rosacea with topical medications including drugs such as metronidazole, azelaic acid and sulfacetamide. Often, we add an oral course of antibiotics including doxycycline, tetracycline, minocycline and clarithromycin to kick start a faster response from the inside out. If that doesn't work, we moved on to topical retinoids such as Retin-A® and for really stubborn, disfiguring rosacea we try isotretinoin. We found that another topical gel formulation of the alpha2 agonist brimonidine called Mirvaso® helps decrease the facial swelling and redness, but doesn't help with the pustules and papules that are so disturbing to patients. Further, we often have to rely on lasers and light treatments to treat any broken blood vessels (we call telangiectasia) that often accompany the pimples and pustules of rosacea. After all is said and done, none of these drugs are perfect, so it is nice to have another option to add to anti-rosacea arsenal.
What can Soolantra® do that is different?
The FDA has approved a 1% cream of the anti-parasitic drug ivermectin (Soolantra®) for the topical treatment of rosacea. You may have heard of this drug as an anti-parasitic medication primarily used in the treatment of onchocerciasis (river blindness) in humans. It is also used in some epidermal parasitic skin infections, such as scabies. Researchers have now determined that Demodex, a microscopic mite that is a normal inhabitant of human facial skin is a powerful culprit in rosacea.
The results of the clinical studies may have you running to the dermatologist to try Soolantra® if you have rosacea:
Two 12-week, randomized, double-blind trials compared a once-daily application of ivermectin cream compared to a similar cream without ivermectin in a total of 1371 patients. In both trials, a complete or almost complete clearing of lesions occurred in significantly more patients treated with ivermectin cream (38.4% and 40.1%) than without the ivermectin (11.6% and 18.8%).
The ivermectin cream decreased the number of inflammatory lesions from the baseline by 76% and 75% compared to reductions of 50% using the cream without ivermectin alone.
Both trials were extended to 40 weeks of treatment with ivermectin cream which significantly boosted the percentages of patients with complete or almost complete clearing of lesions from 38.4% and 40.1% in the initial trial to 71.1% and 76% respectively in the extended trial. That's some increase.
Another 16-week randomized trial in 962 patients with moderate to severe papulopustular rosacea showed that using ivermectin 1% cream once per day was significantly more effective than metronidazole 0.75% twice a day in decreasing the number of inflammatory lesions from baseline (83% versus 73.7%) and in clearing or almost clearing lesions (84.9% versus. 75.4%).
This is such great, exciting news for those suffering rosacea
The treatment is simple, apply a pea-sized amount of prescription Soolantra® in a thin layer to any affected area of the face once a day. I would suggest my patients stay on Soolantra® until lesions have cleared which might be anywhere from 16-40 weeks (because there were virtually no side effects in the trials) depending on your specific rosacea condition.
I can't wait to see these results in my patients with rosacea...
Recently, the United States surgeon general issued a call to action to prevent skin cancer, calling it a major public health problem that requires immediate action.
Nearly 5 million people are treated for skin cancer each year. According to the American Cancer Society, more cases of skin cancer are diagnosed annually than breast, prostate, lung and colon cancer cases combined and skin cancer rates are increasing.
“We all need to take an active role to prevent skin cancer by protecting our skin outdoors and avoiding intentional sun exposure and indoor tanning,” said acting Surgeon General Boris D. Lushniak, MD, MPH.
I say this all the time, but it bears repeating as often as possible:
“Most skin cancer is 100 percent preventable.”
Most cases of melanoma – as many as 90 percent – are believed to be caused by cumulative exposure to UV rays. UV rays are also a major risk factor for the most common curable forms of skin cancer, basal and squamous cell skin cancers. Exposure to UV rays comes from the sun and other sources like tanning beds and sunlamps. The U.S. Food and Drug Administration (FDA) now requires that tanning beds and sunlamps carry a warning stating people under 18 should not use them. Lushniak said there is a flawed perception in the US that tanned skin looks healthy, and that needs to change. I always say,
“Tanned skin is damaged skin.”
According to the Melanoma Education Foundation, One blistering sunburn before age 20 doubles your lifetime risk of melanoma. Three or more blistering sunburns before age 20 multiplies your lifetime risk by five.
Reduce your risk of skin cancer for yourself and your children:
- Whenever spending time in the sun, always wear a sunscreen that blocks both UVA and UVB rays of SPF 30 or higher.
- Reapply sunscreen to dry skin every time you come out of the water and reapply at least every 2 hours regardless of SPF.
- Use a full 1 ounce of sunscreen (that’s a shot glass full) to cover your body. Don't forget to apply sunscreen to your neck and ears, face and tops of feet. If you have thinning hair, be sure to apply sunscreen to your scalp!
- Wear a hat to protect eyes and face by wearing sunglasses and a hat-seek shade often.
- Remember, babies under 6 months old should never spend any prolonged time in the sun.
-Jodi, proud owner of a lily white complexion.