Skincare News

Tazarotene Offers Proven Results In Combo Therapies

Tazarotene, the topical retinoid gel frequently prescribed for the treatment of psoriasis and more moderate cases of acne, has been shown to offer stronger results when used in combination with other therapies such as potent steroids and UVB phototherapy.

In a double-blind study, Alan Menter, M.D., chief of dermatology, Baylor University Medical Center, Dallas, compared Tazarotene (Tazorac) with and without clobetasol propionate in a maintenance therapy. One group received Tazarotene 0.1 percent gel plus clobetasol propionate 0.05 percent ointment daily for two weeks, followed by four weeks of doses which were tapered to Tazarotene three mornings per week and clobetasol two evenings per week.

End result was a reduction from moderate-to-severe levels of  psoriasis to mild levels with an overall severity score reduced from a mean of 5 at baseline to 2 at six weeks.

Over the next five months, patients maintained some benefit, regardless of the variation of combination treatments.

"I think the benefit of the combination is that you have a very quick effect by using the potent steroid," stated Dr. Menter, "...and by introducing the Tazarotene you get longer remissions."

In a second study,  Dr. Menter found that use of Tazarotene in conjunction with UVB phototherapy for patients with bilaterally-symmetrical, moderately-elevated plaques had their initial treatment success time reduced from 53 days, with exclusively UVB therapy, to 25 days when a retinoid regimen was added. Median cumulative UVB exposure was also successfully reduced from 1644 mJ/cm2 to 390mJ/cm2 when used with a Tazarotene regimen.

Dr. Menter concluded that the addition of Tazarotene was responsible for the significantly greater reductions in plaque elevation and scaling throughout his UVB study. He also noted that the drug was tolerated well.

Vancouver Study
Sunscreen May Lower The Risk Factor For Melanoma In Children

Because 80% of your lifetime sun exposure occurs before you are 18, researchers have always assumed that sun protection begun in childhood should decrease the number of skin cancers in adulthood. There is a just-concluded study, in the elementary schools of Vancouver, that proves just that. Sunscreen use in children prevents the development of large numbers of moles, a risk factor for melanoma.

Considering the sunburns in childhood can lead to melanomas in adulthood, Dr. David McLean, Professor of Dermatology at the University of British Columbia, selected a total of 458 first and fourth graders from six local schools and divided them at random into two groups, one to receive sunscreen protection and the other to get none.

Parents of the treatment group children were given a supply of SPF 30 broad-spectrum sunscreen and wereadvised to apply it to exposed skin when a child was expected to be outdoors in the sun for 30 minutes or more. 

The SPF 30 provides protection against both the shorter wavelengths of sunlight, Ultraviolet B (UVB), and the longer wavelengths, Ultraviolet A (UVA).

Parents in the non-treatment group received neither sunscreen nor advice on sun protection, but were free to use sun protection as was their usual practice.

Prior to the 3-year study, moles on each child's body were counted, exclusive of the scalp, genital area, buttocks, and breasts (in girls). Mole counts in first graders averaged 41 and in the fourth graders, 68. The group of children receiving sunscreen developed significantly fewer moles than those who did not. A few children actually had a lower number of moles at the end of the study than at the beginning.

Every July, parents were sent a second bottle of sunscreen. They were requested to mark what remained in the first bottle. The greater the amount of sunscreen used, the smaller the number of new moles.

"Sunscreen...is especially necessary for children with freckles," concluded Dr. McLean. "They would develop 30% to 40% fewer moles than freckled children who were not protected."

Sclerotherapy Still #1 Treatment Choice

When it comes to treating leg veins, sclerotherapy is still the number one treatment of choice.

"Compared with sclerotherapy, lasers are less effective overall, hurt more and cost more. The failure rate using lasers to treat leg veins is so high that these devices are simply not a first choice and doctors who continue to advocate a laser approach are at risk for losing their credibility," stated David M. Duffy, M.D., Assistant Clinical Professor of Medicine at UCLA.

Most shorter wavelength lasers are marginally effective for small telangiectasia and cannot be used at all in treating darker skinned or tanned patients. The YAG laser is more effective, but is quite painful and its efficacy is dependent on vessel size. While best laser results are achieved in treatment of larger vessels, sclerotherapy eradicates them just as well, usually in one session.

NAIL NEWS

Recalcitrant trachyonychia in children treated with oral biotin.

Oral biotin, in doses of 2.5 mg per day for 180 days, resulted in a reduction in nail plate thinning and longitudinal ridging in two children with idiopathic trachyonychia. Both the shiny and opaque forms of trachyonychia improved, along with reduced distal notching of affected nail plates. The clinical improvement noted in both cases was maintained or improved further when both patients were evaluated at an additional six months after discontinuation of oral biotin. No adverse events were observed.

Argyria found to cause bluish pigmentation.

Patients with Argyria typically present with a bluish pigmentation of the sun-exposed skin and proximal nail bed of fingernails. This is due to deposition of silver granules in the dermis. Differential diagnoses include azure lunulac of Wilson's Disease and blue discoloration of the nails occurring after phenolphthalbin or minocyline treatment. A skin biopsy demonstrates the presence of tiny brownish granules in the dermis.

Onycholysis: a common side effect of systemic chemotherapy.

Systemic chemotherapy is frequently responsible for nail changes. New drugs that have been associated with nail changes include docetaxel and paclitaxel. Onycholysis occurred in 25% of patients who received more than six courses of paclitaxel. All these patients developed onycholysis during the summer months suggesting that sunlight may precipitate this side effect. Docetaxel is reported to induce nail abnormalities in up to 41% of the patients with onycholysis, often associated with subungual hemorrhages, in 19% of the cases. Subungual abscesses due to bacterial superinfection can be a severe complication.

Antibiotic Therapy for Acne Facing Resistance

Decades ago, there were two antibiotics used to treat acne; oral tetracycline and oral erythromycin. Today, clinicians have a much larger menu of topical and systemic drugs available. "However, the choice among them is becoming more complicated as microbial resistance appears to have a problem gathering steam," reports James J. Leyden, M.D., professor of dermatology, University of Pennsylvania, Philadelphia.

The clinical use of antibiotics is being impacted by the increasingly important role of Propionibacterium acnes resistance. Topical and systemic antibiotics that reach the target site in levels strong enough to eradicate the P. acnes population, do so through another mechanism involving anti-inflammatory activity secondary to wounding of the organism and interference with its ability to produce chemotactic factors and other pro-inflammatory molecules.

Over a period of time, Dr. Leyden has seen an increasing number of acne patients with resistant strains of P. acnes insensitive to multiple antibiotics. Currently, about 60 percent of his referral population was affected with resistant P. acnes, including many with multi-resistant strains.

The proportion of P. acnes that is antibiotic resistant varies from patient to patient and change may show intrapatient during the course of therapy. To increase the likelihood of a satisfactory therapeutic  outcome while minimizing the chance of resistance emerging during therapy. Leyden suggests (1) avoiding systemic or topical erythromycin monotherapy and  topical clindamycin; (2) using minocycline or doxycycline as agents of choice for patients requiring systemic therapy; (3) always treating topically with benzoyl peroxide alone or in combination with erythromycin; (4) minimizing duration of antibiotic use.

Ask Doctor Hecker

Q. What kinds of improvement can I expect with a peel treatment?

A. I prefer discussing improvements individually and setting realistic expectations, as improvements will vary from patient to patient. However, you may expect: Smoother skin texture and tone, a lessening of fine lines and wrinkles, reduction of age spots, better control of excess oils, restored skin vitality and reduced acne blemishes.

Q. How do glycolic acid and skin peels affect people of color?

A. While special considerations are necessary for people of color, Glytone is safe for all races. I will work personally with you to determine your proper regimen.

Q. Should men consider skin peels?

A. Definitely. Glytone provides the same exfoliation benefits for men as it does for women, helping to slough away the superficial top layer of dead skin cells to reveal the fresher skin beneath, reducing the appearance of fine lines and wrinkles. In addition, the glycolic acid may minimize razor bumps and shaving irritation.