Dermatology Times - November 2011 - (Page 31)
Experimental oral medication clears skin of unsightly lesions
Restarting ustekinumab effective for psoriasis therapy
Strategies for scars
Toxins, fillers and lasers can improve appearance of postsurgical marks
By Ilya Petrou, M.D. Senior Staff Correspondent
Denver — Botulinum toxins, fillers and lasers are all powerful aesthetic tools commonly used for rejuvenation. These modalities may also have use in some cases where reconstruction of postsurgical scarring is desired, according to a Denver dermatologist. Using botulinum toxin prior to certain closures (whether before Mohs or reconstruction surgery or even facelifts) can help to immobilize the targeted musculature and lead to less tension across wounds in specific regions. “By limiting the mobility of the area, you are able to decrease tension vectors across the wound,” says Joel L. Cohen, M.D., director of AboutSkin Dermatology and DermSurgery P.C., Denver. “Decreasing mechanical stress on a wound can lead to less scar separation and a better looking scar,” he says. “Moreover, it is thought that by decreasing the mechanical stress across the wound, there could be less metabolic requirements, which may also benefit wound healing,” In one study performed at the Mayo Clinic, patients with facial lacerations (traumatic forehead lacerations or elective excisions of forehead masses) were randomized to receive either botulinum
toxin or placebo injections into the musculature adjacent to the wound within 24 hours after wound closure. Investigators found that botulinum toxin-induced immobilization of forehead wounds enhanced the healing of the wounds and that in selected patients, this approach could be useful in improving the eventual appearance of the scar (Gassner HG, Brissett AE, Otley CC, et al. Mayo Clin Proc. 2006;81(8):1023-1028). In another study, the utility of intraoperative botulinum toxin for scar cosmesis was assessed in patients undergoing surgical reconstruction after Mohs surgery for treatment of skin cancer. Results showed that the use of botulinum toxin could help the healing of wounds (Flynn TC. Dermatol Surg. 2009;35(2):182-188). “I have been using this technique for several years in my patients where I think immobilization of the musculature could assist wound healing. Such an approach is very important to consider in those areas where there is both a lot of expected facial animation movement as well as consistent aesthetic efficacy of botulinum toxin itself — such as the forehead, glabella, lateral canthal and perioral regions,” Dr. Cohen says. “Presurgical botulinum toxin can be
very useful in those patients who are particularly cosmetically minded and articulate great concern regarding the degree regarding the degree of expected scarring.” Cosmetic patients will typically receive botulinum toxin rejuvenation treatments in the forehead, the glabella and lateral canthus areas. These are also regions of increased muscle movement, and, according to Dr. Cohen, patients undergoing excisional surgery in these areas may not only benefit from adjunct botulinum toxin treatment to improve scar quality, but also appreciate the rejuvenation effect on the region as a whole. “The critical time for a scar in terms of avoiding signifDr. Cohen icant mobility in the area is the first couple of months after the surgery, which is also as long as botulinum toxin will last. Often, patients like the technique and the rejuvenation effect of botulinum toxin and request further treatments long after the surgery. The use of this technique originally for the purpose of improving Scars see page 34
DT Extra At-home wart therapy effective
Above: Getty Images/Photodisc/ Darren Robb; Right: Getty Images/ Digital Vision/James Darell
Self-treatment of verrucae with salicylic acid may be as effective as cryotherapy performed by healthcare professionals, Medical News Today reports. In a study of 240 participants, researchers with University of York, England, evaluated results of treatment to 117 patients receiving cryotherapy and 123 patients treating themselves with salicylic acid. At 12 weeks and at six months after enrollment, researchers found no differential evidence in the clearance rates between the two groups.
Source: Medical News Today
“This novel supplement can actually help treat and prevent SP from occurring.”
Joshua M. Berlin, M.D. Boynton Beach, Fla.
On using an oral drug to treat senile purpura See story, page 37
Table of Contents for the Digital Edition of Dermatology Times - November 2011
Dermatology Times - November 2011
Special Report - the Aging Patient
Dermatology Times - November 2011
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