Recent Advances in Medical and Aesthetic Dermatology
Several exciting recent advances in medical and aesthetic dermatology include innovations in pioneering botanical blends for hair care, a new device to treat solar lentigines and superficial skin lesions to enhance aesthetics, scientific breakthroughs for oral sun protection, and new frontiers in red light photodynamic therapy (PDT). This article will discuss how these discoveries and new technologies can be integrated into your practice for patient benefit.
Why go beyond biotin for hair loss? Because there are many new advances in hair health nutraceuticals. When I am providing care to men and women who are seeking nonpharmacologic treatment to maintain their full head of hair, approximately 50% of my patients are proactive and taking the preventive approach to hair care, and the other half of patients who present are men and women who have started to experience thinning and loss.
With patients who present seeking hair care, I discuss a variety of preventive measures and treatment options that include pharmacologic, supplemental, procedural, and natural approaches.
Oftentimes, the conversation starts with pharmacologic therapeutics, extends to a regimen that includes biotin, then expands to hair cover up and thickening methods, and concludes with procedural options such as platelet-rich plasma (PRP), and hair transplantation. For the increasing number of patients who desire a natural, noninvasive approach, our discussion often includes a detailed regimen that is complex with some inherent challenges and limitations related to medication side effect concerns and/or procedure-related cost and downtime.
For patients who are searching for a comprehensive solution to hair loss and thinning, emerging research is suggesting that blocking a single receptor is not enough, as the pathophysiology of hair thinning and loss is multifactorial.
Therefore, the approach to a solution must be multipronged. Hair loss is increasingly seen as a multifactorial etiology, with stress, aging, and inflammation playing prominent roles, while not being currently addressed by monotherapeutic options on the market.
Until recently, especially for women, the only supplemental therapy, in addition to the limited pharmaceutical options, that we had available in our arsenal was biotin. This begs the question: Why do we use biotin in practice and is there any data that it really works for hair loss?
Biotin is a B vitamin that acts as a cofactor of the carboxylase group of enzymes. Historically, it was noted a long time ago that infants born with a genetic biotin deficiency had alopecia. The correction of this deficiency re-grew hair.
However, it is difficult to develop an acquired deficiency of biotin as an adult, as plenty of biotin is present in our diet and the bacteria in our gastrointestinal tract continuously synthesize even more. In fact, medical literature contains very little information on biotin for hair loss. An older study documented women treated with biotin for hair loss and showed no effect, though they did document improvement in nails. Limited clinical evidence exists that supports use of biotin for hair loss.1,2
The advent of nutraceuticals and advances in biotechnology are helping fill the patient desire for natural products that aid hair beauty. Simple hair vitamins, minerals, and marine collagen only provide nutritional support in some cases of hair loss related to nutritional deficiencies. However, certain botanicals and their components have clinical efficacy against the primary causes underlying hair loss—dihydrotestosterone (DHT), inflammation, stress, oxidative damage, and aging—providing efficacy against factors that contribute to hair loss not currently addressed by anything on the market.
Not all botanical products are created equal due to the lack of oversight, standardization, and clinical testing in the nutraceutical supplement space. Therefore, it is hard to say how much of the phytoactives are present in each batch and whether their integrity is preserved post-extraction.
A new nutraceutical supplement (Nutrafol) is taking a leading role in hair health, as it takes these key factors into consideration (Figure 2). By selectively using clinically efficacious dosages of patented, bio-optimized botanical ingredients that have clinical data on absorption and efficacy, ingredients are standardized to contain consistent fractions of bioactive components.
Nutrafol’s Synergen Complex is composed of bio-optimized curcumin (an anti-inflammatory extract of turmeric that has been shown to lower inflammatory biomarkers), a patented ashwagandha (clinically shown to rebalance the stress response and lower cortisol levels in chronically stressed adults), a dual-patented form of saw palmetto that exceeds USP monograph standards—a recognized DHT inhibitor, and a tocotrienol-rich complex that was shown to counter lipid peroxidation and improve hair growth.
Several case studies have demonstrated efficacy, in addition to substantial ingredient clinical data. Three placebo-controlled trials are in progress. The supplement is gaining traction with numerous dermatologists as we are incorporating it in our clinical practice either as monotherapy or adjunct therapy to PRP and other procedures such as hair transplantation.
Removal of Cosmetic Lesions
As dermatologists, we know that cryotherapy is a valuable approach to treating actinic keratosis and other superficial cutaneous lesions. Liquid nitrogen (LN) is the most commonly used cryogen and is widely considered a very effective and inexpensive method of lesion removal, but one key drawback to LN-based cryotherapy is the cosmetic side effect profile. LN can result in significant and permanent hypopigmentation, blistering, and scarring.
Cryo-necrosis occurs in human tissue between -4°F and -22° F. LN freezes tissue at -321°F (-196°C) compared with carbon dioxide (CO2) which freezes skin at -108°F (-78°C). This temperature differential allows for a softer, more comfortable freeze that is ideal for shallow cosmetic lesions, especially on highly visible areas like the face. The milder freeze produces an effective aesthetic improvement of cosmetic lesions and is less likely to damage surrounding tissue, and in my experience typically does not result in blister formation.
A single-center clinical trial was performed to assess the efficacy and tolerability of the CryoCorrect Precision treatment in 75 patients aged 35 to 65, with Fitzpatrick I to III skin types. The study demonstrated efficacy in treatment of solar lentigines, mild actinic keratosis, and skin tags. A single treatment demonstrated a statistically significant decrease in the intensity and size of treated lesions at weeks 2, 4, and 6 compared with baseline; and at week 6, dark spots were improved in greater than 85% in both size and intensity (Figure 3). Furthermore, 66% of all study participants experienced complete removal of their treated lesion.3
For skin tags, one treatment demonstrated a statistically significant decrease in the length and width of skin tags at weeks 1, 2, and 4—with 96% of patients demonstrating complete removal of their treated skin tag by week 4.
Based upon my clinical experience with the device, a single skin tag treated resolved within 1 week with full removal of the skin tag without any blistering. This represents a true advance, as we know that LN cryotherapy often requires blister formation to be effective.