Integrating Cosmeceuticals into a Procedural Practice

Zoe Diana Draelos, MD

How can we integrate cosmeceuticals into procedural practices? Dr Draelos provides us with some important clinical pearls:

  • Cosmeceuticals that are relevant post-procedure are: barrier repair moisturizers, growth factors, antioxidants, and skin lighteners
  • Procedure induced barrier repair can be accomplished with:
    • Occlusive substances that reduce TEWL: Petrolatum=99%, Mineral oil=50%, vegetable oils=40%
    • Humectant substances that hold water: Hyaluronic acid, glycerin, proteins, vitamins, sodium PCA, lactic acid, urea
  • Growth factors, found in some post procedure cosmeceuticals, function as humectants to hold water and proteins can form a protective film over wounded skin
  • Growth factors are multifunctional peptides active in the picogram rang; they act as signaling molecules between cells by binding to cell surface receptors
  • Antioxidants are able to donate an electron to reactive oxygen species (ROS)
  • Wounding induces ROS, but antioxidants have never been shown to reduce post-procedural inflammation
  • Antioxidant vitamins A, D, and E used in healing products; but function as vitamin humectants or product preservatives
  •  Skin lightening ingredients include: kojic acid, licorice extract, arbutin, soy, lignin peroxidase, ellagic acid, hydroxyphenoxy propionic acid, niacinamide, and resorcinol


Contact Dermatitis: Clinical Pearls

Matthew J. Zirwas, MD

What do you need to know about contact dermatitis?

  • Add 10 allergens to the TRUE Test to dramatically improve diagnostic accuracy
  • Lip dermatitis is much more likely to be contact dermatitis if it extends beyond the vermillion border
  • Shampoo and conditioner are a very common cause of eyelid dermatitis
  • You can prepare allergens for patch testing 24 hours ahead of time, except two types: fragrance and acrylates
  • You can patch test patients on prednisone
  • Giving too much information about allergens is as bad as not giving enough
  • Use videos to make patient education easier, faster, and more effective

TNF-a Inhibition and the Treatment of Hidradenitis Suppurativa: Clinical Pearls

Bruce Strober, MD, PhD

What’s new with the treatment of hidradenitis suppurativa and TNF-a inhibition? Dr Strober provides us with his clinical pearls…

  • Both adalimumab and infliximab effectively treat many features of hidradenitis suppurativa.
  • Adalimumab has been evaluated in the most rigorous studies ever conducted on a potential treatment for hidradenitis suppurativa.
  • Adalimumab requires weekly dosing at 40 mg to be consistently effective.
  • TNF-a levels are elevated in lesional and perilesional skin from patients with hidradenitis suppurativa.
  • TNF-a inhibitors such as adalimumab and infliximab reduce not only lesion counts but also pain.
  • AbbVie will seek FDA-approval for the treatment of hidradenitis suppurativa with adalimumab.
  • Etanercept is not effective for the treatment of hidradenitis suppurativa.

The Aesthetic Consult: Clinical Pearls

B. Kent Remington, MD

What is the “real reason” our patients want to look better? Dr Remington provides key takeaway points on his aesthetic consult…

  • Aesthetic physicians are essentially “Image Enhancers” as the patients self image, self esteem and self concept have a direct impact on how they feel about themselves. A youthful appearance is the best thing you can wear. It is therefore paramount at some time in the consult to find and point out the patients positive facial features.
  • The main purpose of all Facial Aesthetic consults is to find the “Real Reason” why your patient wants to look better – it is almost always very little to do with the initial stated reason.
  • It is important to focus on the aesthetic patient that has a great interest and desire to look more youthful. This patient may not have the winning ticket for the best genetic lottery pool or be on a unlimited budget. It’s not their hormone level or the size of their wallet. It’s the wiring of their DNA some patients are just wired for aesthetics.
  • We –like are patients look with our eyes, but we see with our brains. The eye also sees what it wants to see. Most patients have severe selective monofocus. The patient’s perception of reality and reality are often not the same. Our focus is the whole face and converting patients to looking at the whole face and starting a renovation project is like restoring a painting – step at a time.
  • Aging and getting older is not a choice – looking younger is a choice – doing nothing is also a choice,
  • Faces are all about genetics, genetics are all about biology, biology is about physiology, physiology is about physics, physics is all about mathematics – therefore faces are all about Math — this is not left brain math but right brain math. Creating the extraordinary out of the ordinary are all fruits of good mathematics combined with art.
  • Aesthetic clues are like fish in the water – the fish are not aware of the water – they don’t see it or feel it. This is the same with many Aesthetic Physicians during the consult they do not connect with the patient and engage the patient – two essentials to a high consult to treatment percentage.
  • Photography – if possible a dedicated room with the same consistent light and background and camera settings. It cannot be understated the importance of a “baseline pretreatment” photos front view – ¾ views and profiles repose and animated.
  • Have all your aesthetic consults being in a good resolution facial photo in their 20’s to scan with their current photos taken in your clinic– not trying to make them look 20, but the importance of comparing past balance proportion harmony and symmetry to the present– or lack of. This whole exercise helps patients understand why we look at and treat the whole face.

Genetics: Clinical Pearls

James Treat, MD

  • Accurately describing skin disease can help diagnose Genetic diseases
  • There are fantastic searchable resources available to aid in diagnose
  • Capillary malformations can be associated with CNS arteriovenous malformations

Atopic Dermatitis

James Treat, MD

Clinical Pearls from Dr Treat..

  • Atopic dermatitis is caused in part by a defective skin barrier
  • Inmunodeficiency, nutritional deficiency, environmental and food allergies also play a role
  • Look for patterns of atopic dermatitis to help you differentiate.
  • There are multiple systemic agents that have shown efficacy in atopic dermatitis