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Clinical Tips: Enhancing Outcomes of Botox, Discussing Expectations for Hair Loss, and More

Clinical Tips: Enhancing Outcomes of Botox, Discussing Expectations for Hair Loss, and More


Tip 1: Sunscreen—What and How Much to Put on 

Would you go outside naked? Stepping outside without sunscreen is like going out naked. Without the proper sun protection, you are allowing yourself to be exposed and potentially sun damaged.

It is necessary to divide applications of sunscreen into smaller, more frequent portions. Putting too much rich moisturizing cream on the skin is like putting too much food on your plate since you have a limited amount of food you can eat in a single sitting. It is the same with skin—it can only absorb a certain amount per application and the rest will just stain the patient’s clothing. 

Sam Fayman, MD

Galesburg, IL


Tip 2: Bringing in Phototherapy

Dermatologists spend a lot of nonreimbursed personal and staff time treating patients with systemic and biologic therapies. If you are not already doing this, add a narrowband UV-B light box to your treatment options for psoriasis, atopic dermatitis, pruritus, mycosis fungoides, and vitiligo. Phototherapy usually does not require prior authorization and you will get reimbursed for the service supervised by your medical staff. There is very little maintenance for the light box, which needs to be recalibrated once a year. 

Wayne Fujita, MD

Aiea, HI  


Tip 3: Enhancing Outcomes and Botox Dosage

After 1 month, ask a patient who received Botox if they wish the treated area had less movement or was more frozen. If they say yes, then increase subsequent dosing for optimal response and a happier patient. Often patients will not mention this unless they are specifically asked.  

Benjamin Barakin, MD 

Toronto, Ontario, Canada


doctor and patient

Tip 4: Discussing Realistic Expectations for Hair Loss

For patients with hair loss, it is very important to set the right expectations for each disease state and treatment. Also, it is important to explain the time course of any possible improvement to patients.

For example, when I perform platelet-rich plasma injection for androgenetic alopecia, I discuss various clinical studies, types of results that I have seen in my practice, treatment protocol and expectations of the results, and when the results can be seen with my patients. 

Gary Goldenberg, MD 

New York, NY

Tip 5: Oral Pentoxifylline Uses

Oral pentoxifylline is not only good for vasculitis, but also for stubborn bronchial and upper respiratory signs and symptoms, such as after an infective episode of pharyngitis plus bronchitis that was adequately treated, including with antibiotics if needed, but the patient continues to experience coughing and spitting. I think this is due to the tumor necrosis factor (TNF) inhibition produced by pentoxifylline. Haines Ely, MD, insists on the anti-TNF properties of pentoxifylline, but I am not aware of whether he has proposed using it for respiratory conditions.  

Mauricio Goihman-Yahr, MD, PhD 

Caracas, Venezuela 

Dr Barankin

Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.

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