By Louise Gagnon – Correspondent, The Chronicle
New anti-aging topical treatments, energy devices with new features, as well as new fillers are rounding out the portfolio of modalities that Canadian dermatologists are offering patients for rejuvenation and to improve the appearance of scars resulting from injuries such as burns.
“We have made great strides in treating both the colour and textural components of scars,” said Dr. Jaggi Rao, a dermatologist in Edmonton, and clinical professor of medicine and program director for the Dermatology Residency Program at the University of Alberta. “There are newer laser delivery systems that cause blood vessels to contract and pigment to be destroyed, both of which can restore the colour of a scar to normal. For scar texture, there are excellent lasers which can smooth out elevated scars, thicken the skin below indented scars, and normalize the skin in general.”
In addition, Dr. Rao uses soft fillers to enhance the cosmetic appearance of scars, particularly for acne scars which often leave indentations in the skin surface. Collagen-stimulating fillers can be effective in elevating depressed scars, he added.
Dr. Marnie Fisher, a Toronto dermatologist, noted that it is timely, with warmer months ahead where Canadians will be exposing their feet by wearing open-toed shoes and sandals, that patients now have an alternative to systemic antibiotics to treat nail fungus with the emergence of efinaconazole 10% topical solution.
Efinaconazole 10% nail solution administered once a day for 36 or 48 weeks to treat mild to moderate toenail onychomycosis caused by dermatophytes resulted in complete and mycologic cure rates of 15 to 25% and 53 to 87%, respectively (Journal of Cutaneous Medicine and Surgery 2014; 18(3):151-155).
“It [efinaconazole] has evidence that it is much, more efficacious than the existing topical agents available, and it is a lot easier to use,” Dr. Fisher said in an interview with The Chronicle of Skin & Allergy. “It is less burdensome to use than nail lacquers for managing fungal infections, and more effective.”
While oral antifungal agents are effective, a disadvantage to them is that they can interact with other systemic agents that patients may be taking, according to Dr. Fisher.
“People get nail fungus infections in their third, fourth, and fifth decade of life, and if they are already taking a cholesterol-lowering agent or anti-hypertensive medication, it may make it very difficult to take an oral antifungal agent,” she said. “You would have to strongly consider a possible drug-drug interaction.”
Laser treatment for nail fungal infections has not to date shown that can produce a high rate of clearance, said Dr. Fisher.
Dr. Fisher now offers patients with rosacea brimonidine topical gel to treat the facial redness associated with rosacea. “It can treat any facial flushing or redness,” she said. “There does not appear to be a risk of increased sensitivity linked to its use, and if you use it and reduce the vessels and the blood flow, you may actually get less sensitivity [down the road].”
Dr. Lisa Kellett, a Toronto dermatologist, looks to an array of modalities including filling agents, topical agents, and lasers to make her patients look fresher and more rejuvenated.
The M22 laser is a multi-application platform that Dr. Kellett can employ to treat acne scars when acne is still active, as well as acne scars that have formed and when acne is inactive. The laser can also make wrinkles less visible.
“The settings are modified [different from a CO2 laser], so there’s more rapid healing, less downtime for patients, and less risk for infection,” said Dr. Kellett.
Scars that lie over joints, as a result of a trauma such as a burn, are more challenging to treat, but success in employing a laser to treat a scar in such a location can offer a functional as well as cosmetic improvement, according to Dr. Kellett.
“It can make a huge difference,” she said. “The laser can soften the scar to such a degree, that the patient is able to move the limb.”
While they are called fillers or filling agents, Dr. Kellett observes a movement to use the products more to “lift than fill the face.”
“The filler is used more to lift the jaw line than fill the face,” said Dr. Kellett. “We are also injecting Botox and fillers to erase lines in the neck and for lift. Thermage is still a good option to reduce skin laxity.”
A radiofrequency application, Thermage is also being used to treat skin laxity of the triceps, particularly in women, noted Dr. Kellett. “There is noticeable tightening [of the triceps] that lasts about two to three years,” said Dr. Kellett, explaining the device heats up and tightens collagen in the skin.
Non-hydroquinone treatment options to treat melasma are becoming popular, said Dr. Kellett, noting that alternatives to hydroquinone for depigmenting have been explored because of safety issues associated with hydroquinone, she noted.
“We are using bleaching agents to target the melanocytes, which make pigment,” said Dr. Kellett. “The topical agents are inhibiting the production of melanin.”
Dr. Sean Rice uses Precision TX, an Nd: YAG laser with a 1,440 nm wavelength, to ablate sweat glands under the skin, and studies have shown that patients have about 80 to 90% reduction in underarm sweating almost two years after the treatment.
“The 1,440 wavelength has a high affinity for water, so it’s a good fit for the sweat glands,” said Dr. Rice, adding that the 1,440 nm wavelength is also used to reduce the appearance of cellulite.
Smart Xide DOT Skin Resurfacing uses a CO2 laser and addresses fine lines, sun damage, as well as deeper scarring, including scars that may result due to burns, noted Dr. Rice. “It is a very quick procedure, and a topical anesthetic can be used,” he said.
“You can alter the parameters of the laser and control depths,” said Dr. Rice. “In this way, you can obtain more superficial skin resurfacing or obtain more skin tightening depending what is desired.”
Toronto dermatologist Dr. Martie Gidon, director of Gidon Aesthetics & MediSpa, is looking forward to Canadian cosmetic innovation LumiCleanse, which uses a proprietary gel formulation that involves light-emitting diode light to treat acne, and LumiBel, a photorejuvenation treatment, in her practice.
“The research [on LumiCleanse] shows 12-week follow-up of patients with excellent results,” said Dr. Gidon. “It can be used with a topical treatment or an oral antibiotic.” Other new offerings include topical products known as Processed Skin Cell Proteins, made by Neocutis Inc. Now available in Canada, the anti-aging products will come in vehicles like serum, gel, and cream, explained Dr. Gidon.
Micro-needling is not a new skin procedure, but it has been modified with the adjunctive use of a fractionated device known as Dermapen™. The needle depth can be adjusted for different treatment areas, explained Dr. Gidon.
“It is much less aggressive than laser treatment and less costly for patients,” said Dr. Gidon. “The damage to the skin causes stimulation of new collagen. If it is used with hyaluronic acid serum or anti-oxidants, there is the benefit of deeper penetration and better overall results. It is appropriate for treating small specific areas, like one scar on the face or crow’s feet.”
The Permea handpiece is being used in conjunction with the Clear + Brilliant Laser. Permea treatment is designed to brighten skin and even skin tone, and used together with anti-oxidant serum, the result is optimal, explained Dr. Gidon.