Axillary Hyperhidrosis: The Old is New Again

The standard treatment for increased sweating of the armpits (axillary hyperhidrosis) has been the use of aluminum hexahydrate in either prescription or nonprescription strengths. If that fails the next step has generally been the injection of Botox, although other methods such as iontophoresis (the patient uses a battery powered device to deliver an electric current to the skin while the skin is immersed in water) have sometimes been used. All of these methods have disadvantages. Botox is expensive and lasts 4 months to a year. Topical antiperspirants can be irritating and can loose their effectiveness. Iontophoresis can be painful, time consuming and of limited effectiveness.
In a recent letter to the editor of the journal Dermatologic Surgery, Dr. James Swinhart, of Denver Colorado, reminds of a technique that he described in 2000.

Melasma: The Mask of Pregnancy

Melasma is probably the most common pigmentary abnormality in women. The average age of onset is in the early 30s. Almost half the sufferers from melasma have family members who also have melasma. This condition most commonly starts during pregnancy, but it may also start before or after pregnancy. Much less commonly, it can be seen in males. Melasma is more common in women with darker skin types, and more time spent outdoors during pregnancy is associated with an increased risk of melasma. Inreased maternal age at first pregnancy and multiple pregnancies both increase the risk of melasma. Birth control pill use is another factor that has been associated with the onset of melasma.

Botulinum Toxin Wars

Now that Dysport, which was going to be named Reloxin, has been approved by the FDA, you can expect to see extensive advertising by Allergan (Botox) and Medicis (Dysport) implying that theirs is the better product. Dysport has been used for years in Europe and Canada, and the differences between the products are less than the differences between fillers. Although they both have Botulinum Toxin A as their active ingredient, they are manufactured differently and there are some differences in their makeup and action.

Laser Assisted Liposuction: Cholesterol Reduction?

There are a number of laser assisted liposuction machines on the market. None of them have demonstrated any clear advantage over traditional liposuction, although the claim is that they produce more skin tightening than traditional liposuction. When one researcher proposed looking at this scientifically, the laser company he was working with refused to let him proceed.
Now a company studying another low level laser liposuction device has seen reduction in serum cholesterol and triglyceride levels two weeks after treatment with their device (LipoLaser). In a group of 19 patients the mean cholesterol level fell by 19 mg/dL, with the mean LDL (bad) cholesterol reduction of 14 mg/dL.

LED Phototherapy: Hype or Hope

The use of light emitting diodes (LEDs) to improve skin tone and texture has gained prominence in some offices and spas. Previous studies were performed by manufacturers and suggested some improvement in fine lines. Recently there was an independant study evaluating the effectiveness of Gentlewaves, one of the most commonly used units.

Botulinum Toxin Alert: New Labeling for Botox and Others

The FDA has recently released additions to the labeling requirements for all Botulinum Type A Products. These actions are a result of adverse events that have occurred in both approved and unapproved uses where the toxin has spread beyond the injection site causing symptoms of botulism (difficulty breathing, difficulty swallowing, muscular weakness, drooping eyelids, constipation, aspiration pneumonia, speech disorder, facial drooping, double vision, or respiratory depression). The postmarketing case reports of these adverse events occurred primarily in children being treated for muscle spasticity due to cerebral palsy, and in adults being treated for spasticity or cervical dystonia.
It is important to note that, according to the FDA, “Definitive serious adverse event reports of distant spread of toxin effect associated with dermatologic use of Botox at the labeled dose... have NOT been identified."

The FDA also has informed the manufacturers that development of a Risk  Evaluation and Mitigation System is necessary. The System would include a Communication Plan to provide more information regarding the risk for distant spread of botulinum toxin effects after local injection, as well as information to explain that botulinum toxin products cannot be interchanged. The System also would include a Medication Guide that explains the risks to patients. Once it is developed, dermatologists will distribute the Medication Guide to patients at the time of injection.

The bottom line is that this is an administrative change, but it does not indicate that there is any new information or that there has been any change in the previously understood potential side effects of Botulinum A Toxin. It is likely that the release of these guidelines will hasten the approval of Reloxin, one of several new Botulinum A Toxins in the pipeline, and the one that is closest to release. The appearance of competitors to Botox will almost certainly bring lower prices to consumers.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA

Reloxin: When?

The FDA had previously delayed the release of Reloxin, a Botox analog, because of administrative issues. Medicis, the US company that will be distributing Reloxin, had filed additional paperwork with the FDA detailing its plan for follow up of adverse events. The FDA was supposed to give Medicis an answer this month, but there has been no announcement forthcoming. The reasons are unclear, at this point.

Silhouette: Threadlift Revisited?

For many people it has long been a goal to achieve at least some of the benefits of a face-lift without sognificant surgery or downtime. The tightening of tissues in a face-lift or MACS-lift is achieved by using sutures to elevate the deeper tissues (SMAS) and the skin comes along for the ride. For a number of years surgeons have explored the idea of inserting a suture through the skin, hooking and tightening the deeper tissues and burying the tied ends of the sutures under the skin.

CO2 Fractional Lasers: Home Run or Hype?

The first of the fractional lasers was the Fraxel 750 which has evolved into the Fraxel Restore. This laser was clearly a significant advance over previous lasers, particularly in treating skin discoloration and acne scarring. It also helped lines, wrinkles and skin texture, but the improvement was not nearly so dramatic. The next advance, which was supposed to improve wrinkling as well as do everything that the Fraxel Restore could do, was the fractional CO2 laser, the application of the fractionated concept to the CO2 laser. The original CO2 laser was the most effective resurfacing laser, but one that, at times, produced unwanted side effects.

Evolence: The New Filler in Town

Evolence was approved by the Food & Drug administration in late June 2008, and is now being rolled out across the nation. It is a porcine (pig) collagen based product which has been available in Canada and Europe for about 2 years. It is much longer lasting than the original bovine (cow) collagen or the human based collagen that is now available as well. It has a number of advantages and at least one significant disadvantage.