What’s New On Rosacea Front

Rosacea is a genetically determined, long-lasting skin condition that causes inflammation and redness of the face. Rosacea usually progresses through four stages.
1.    Erythema and flushing
2.    Persistent redness on the cheeks, nose, chin or forehead marked by telangiectasia
3.    Papular and pustular acne form eruption with increase telangiectasia
4.    Rhinophyma – Knobby bumps on nose with thickening of the skin of nose and redness and grittiness in eyes.

These skin symptoms causes much distress and social withdrawal for the people who suffer from it. According to surveys around 60% of individuals with stage 1 and 85% of those with stage 3 report an influence in social functioning – refusal of food and drinks is quite common (as these are triggers of flares).

Common triggers include hot drinks, alcohol, spicy foods, stress, sunlight and extreme heat or cold. These triggers increase blood flow and cause the small blood vessels in the face to dilate.

Also, being careful while selecting your daily skincare can help keep skin calm and clear.
·      Select facial cleansers and moisturizers that do not burn, sting, irritate or cause redness when you apply them.
·      Wash your face with lukewarm water and a mild soap. Don’t use too hot or cold water.
·      Avoid toners, astringents, scrubs, exfoliating agents and products that contain alcohol or acetone.
·      Hydroxy acids and tretinoin (for example, Retin-A) are very helpful for other skin conditions, but can worsen rosacea.
·      Finally, use sunscreens and sun blockers regularly and liberally to protect your face.

Treatment Options: The good news is that treatments can improve the appearance of rosacea. They may even stop, or reverse, its progress. Depending on your specific symptoms, your doctor may prescribe:

Conventional treatments include topical antibiotics (metronidazole), topical azelaic acid (Finacea), oral antibiotics (cyclines) and Beta-Blockers / Alpha Antagonists to reduce flushing through their effect on blood vessels.

Laser treatments with pulse-dye and Nd-Yag lasers to reduce blood vessels on the affected skin also have proven to be useful in controlling and keeping the symptoms at bay.

Estrogen the female hormone is used when rosacea is aggravated by the hot flashes of menopause, since estrogen treatment reduces the number and severity of hot flashes.

Recent studies have introduced brimonidine tartrate, a vasoconstrictor with acts selectively action on the alpha2 adrenergic receptor. It is being used at a concentration of 0.5% applied topically once a day. Reduction of redness can be seen after 30 minutes of application and studies suggest a maximum effect somewhere between 6 and 12 hours after application.


Mesotherapy — Youth By Thousand Pricks

#Mesotherapy, #MesoFace
The origins of mesotherapy take us to the aesthetic capitol of the world  —France, where Dr. Michel Pistor laid the foundation of meso-therapeutical research until it was adopted as a specialized field of medicine in 1987. In the last decade or so mesotherapy has received more global attention and has gradually become an increasingly popular cosmetic injectable procedure.  The science behind mesotherapy focuses on delivering multiple pharmaceuticals, vitamins, plant extracts etc. directly into the different layers of skin to target different needs — in aesthetic medicine we use it to promote healthy shiny youthful skin, tackling hair fall/loss, and to combat cellulite or fat reduction.

Today we are going to focus on mesotherapy for face, as I have received tons of queries and questions demanding an elaborate feature on MesoFace — How is it done, what entails, who is a good candidate, what are the side effects, and what are the results?

MesoFace All You Need To Soak Up

MesoFace sessions are aim specifically at skin rejuvenation, brightening and hydration as well as on face/neck contouring. The procedure itself is a unique combination of art and science utilizing almost painless microinjections, which deliver skin boosting and enhancing formulations into the epidermis, dermis and sub cutaneous space (top, mid and under the skin).

MesoFace Logic

The natural hyaluronic acid found in our skin contributes to skin elasticity and firmness by maintaining a high level of hydration in the skin. As we age, the level of naturally occurring hyaluronic acid in our skin decreases considerably, leading to the appearance of sagging & aged skin highlighted with fine lines and wrinkles.

#MesoTherapy,  #MesoFace

MesoFace formulations are carefully chosen to improve and maintain skin tone by promoting collagen production by the skin fibroblasts (natural factories of collagen), plus anti-oxidants utilized in MesoFace formulations promote free radical scavenging activities thus preserving the natural collagen. By using combination formulas containing hyaluronic acid along with valuable vitamins mesotherapy helps to nourish and hydrate skin putting spot light on an instant youthful glow and radiance.

For skin revitalization and brightening multivitamin injections coupled with hyaluronic acid are applied by superficial nappage (by hand, pen or machine) or by papule method in the sub dermal plane. This process ensures efficient delivery of active substances into the skin to help rejuvenate the epidermal and dermal cells, making them more active, and thereby stimulating the production of collagen and elastin. The active formulations also help plump up and rejuvenate the skin with use of non-cross linked hyaluronic acid. Results become obvious 2-3 days post treatment, showcasing a visible improvement in the tone, hydration and texture of skin.

For face and neck contouring specialized formulations containing caffeine and Sodium deoxycholate are injected into the fat layers under the skin that lead to fat break down and shrinkage of double chin, puffy cheeks or bulky jowls. Additional skin tightening agents are then injected into the dermis to promote skin tightening to trot out a more slimmer and lifted silhouette.

MesoFace With A Derma-Roller

Derma roller is a hand-held small, narrow device (rather like a tiny paint roller) studded with almost 200 fine surgical steel micro-needles (common lengths are 0.5 millimeter, 1 millimeter and 1.5 millimeters). Smaller lengths are designed for thinner skin areas (eyes, neck) and longer lengths are used for the thicker skin areas like forehead and cheeks.)  As the device is rolled over the skin it produces multiple pinpricks and punctures.

Mesotherapy, Dermaroller

The science behind needle plowing the skin aims at stimulating collagen production by injuring the skin with thousands of micro punctures. Theoretically, any injury to the skin should instigate a process of wound healing by attracting cytokines and growth factors to the area as well as stimulating the fibroblasts to produce more collagen. More collagen literally means smoother & plumper skin. Applying vitamins and hyaluronic acid on skin stimulated by needle punctures leads to additional beneficial effects in the form of instantaneous glow and shine for the skin.

No Needle MesoFacials

There are also many trans-dermal delivery devices available in the market that utilize micro current or ultrasound waves to deliver skin enhancing active formulation more efficiently into the skin bypassing the sharp pricks from a needle, but for me the good old-fashioned skin stimulation and nutrients delivery package with a sharp needle point holds precedence.
Mesotherapy, Transdermal delivery system

Though over time I have become a big fan of using the meso-cocktails coupled with fractionated lasers & radiofrequency (RF) devices. Utilizing these technologies the micro-holes into the skin are drilled by lasers or RF instead of stainless steel needles and the end results become much more satisfactory compared to using only one module. Coupled treatments also result in less downtime and faster recovery post fractionated sessions — literally the best of both worlds.

Who’s A Good Candidate For MesoFace?

If you suffer from dull, dry, lack-luster skin and are looking for a quick megawatt-radiance fix — mesotherapy might be godsend to you. With few swipes from the needle tips meso-cocktails deliver mega doses of vitamins, nutrients and hyaluronic acid into your skin and you get an instantaneously glowing and beautiful skin.

Finally Let’s Talk Side Effects

Using mesotherapy practices under unhygienic conditions can lead to introduction of bacteria into the skin resulting in infections and related side effects. Word to the wise if you’re planning to use derma-roller at home, make sure you learn how to do the procedure with proper anti-septic protocol. Even while selecting a derma clinic to do the procedure look for places that maintain high standards of care with strong emphasis on sterilized clinical practices.

Mesotherapy has been the hidden secret behind “The Red Carpet Star Glow” for ages. In my practice it is the fastest & quickest way to get red-carpet worthy radiant skin in a jiffy.


Looking At Biological Medication For Psoriasis

Psoriasis treatments
Psoriasis — an autoimmune condition that causes itchy, scaly red patches on the skin — can be tough to treat, and your treatment needs can change over time. When psoriasis doesn’t respond to topical ointments and light therapy, your condition may need a different type of medication. That’s when it's likely time to talk to your doctor about effective prescription treatment options for moderate to severe psoriasis. The two main types of drugs for psoriasis are called systemic and biologic.

Systemic drugs affect the entire immune system, hence the name “systemic.” You typically take them in liquid or pill form, although some may be given by injection. If you haven't had success with topical medications or light therapy, or if you have psoriatic arthritis, you're a potential candidate for systemic drugs. Systemic medications work by suppressing the immune system to reduce or stop the inflammation that causes psoriasis. Different types of systemic drugs perform in different ways. Acitretin, for example, works by slowing down how quickly skin cells multiply. Methotrexate works by interfering with DNA, slowing down the production of new cells.

Biologic drugs are made from living cells in a laboratory, meaning they are genetically engineered. Instead of affecting the entire immune system, biologic medications target specific proteins or cells, such as tumor necrosis factor alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23 that have a direct connection to psoriasis. This class of drugs is typically prescribed when other treatments have failed.

“Biologic” Treatment Indications:
·      If no response to classical systemic treatments is seen or their usage is contraindicated.
·      The PASI (psoriasis area severity index) of at least 15.

Here’s A Concise Review Of Short Term Response Rates From Literature Review

70% of treated individuals achieve an improvement of PASI 70
45% of treated individuals achieve an improvement of PASI 90
In both cases, the dosage is of 40mg every 2 weeks, after an induction dose of 80mg

35% of treated individuals achieve an improvement of PASI 70 and 10% have an improvement of PASI 90 after a dosage of 2 times 25mg per week.
50% of treated individuals achieve an improvement of PASI 70 and 20% have an improvemnet of PASI 90 after a dosage of 2 times 50mg per week.

With a dosage of 0.5mg/Kg at weeks 2, 4 and 6
80% of treated individuals achieve an improvement of PASI 70.
40% of treated individuals achieve an improvement of PASI 90.

With a dosage of 45mg every three months:
70% of treated individuals achieve an improvement of PASI 70.
40% of treated individuals achieve an improvement of PASI 90.

To summarize, infliximab achieves the fastest results but it requires an intravenous infusion every 6 weeks. With ustekinumab, the improvement of PASI 90 is maintained 76 weeks after initiation of treatment in 63% of patients at a dosage of 90mg and in 45% of patients at a dosage of 45mg. Adalimumab also remains efficacous 2 years after initiation of treatment.

Which one to chose: adalimumab (anti-TNF), infliximab (anti-TNF), etanercept (anti-TNF), ustekinumab (anti IL-12): Actually no real guidelines exist. Personal experience is therefore a must.

New biologics recently entering the market:
With a dose of 300mg or 150mg given weekly for 5 weeks and then every 4 weeks at 12 weeks
81.5% of treated individuals with 300 mg achieve an improvement of PASI 75.
71.5% of treated individuals with 150 mg achieve an improvement of PASI 75.

Therapeutic advise according to the histological characteristics
·      Keratolytics for hyperkeratosis
·      2-5% salicylic acid (up to 20% concentration in palar and plantar locations)
·      Emollients for parakeratosis
·      Anthralin, topical steroids, vitamin D analogues and phototherapy for psoriasiform hyperplasia
·      Topical steroids, cyclosporin, fumaric acid and biologics for erythema.

The Right Psoriasis Treatment for You

Psoriasis treatment isn’t a one-size-fits-all approach. Various individual factors determine which treatment option may be best for you, including the severity of your psoriasis, if you have any other medical conditions, and your personal needs. Your doctor’s preference and your insurance coverage are likely to factor in as well. Some doctors may be more comfortable prescribing systemic drugs for psoriasis because they've been around much longer and insurance coverage for these medications is often better and easier to deal with.

In any medical decision-making process, the choice of treatment requires careful consideration of the benefits, risks, and alternatives of the treatments being considered. There are pros and cons to both psoriasis medication options that should be explored. Work with your doctor to determine the most effective psoriasis drug treatment for you.