Combination approach moving from trend to norm

July 1, 2006

National report - Over recent years, the combining of various laser and other light-based therapies with existing topical treatments and systemics has become a trend in dermatologic practices - and one that's likely to continue.

That's largely due to the fact that today's patients are increasingly seeking cosmetic and clinical procedures that require minimal downtime from their busy schedules but that are optimally effective and long-lasting, yet affordable.

Examples of currently favored, non-ablative technologies include intense pulsed light (IPL), pulsed dye laser (PDL), long-pulsed erbium substituted: yttrium aluminum garnet (Er:YAG), radiofrequency (RF), light-emitting diodes (LED) and photodynamic therapy (PDT) using light of varying wavelengths.

Pharmaceutical treatments that are being used in conjunction with these devices include topical metronidazole and oral metronidazole for rosacea, and various retinoids for acne and actinic damage. In recent months, newer agents, such as the topical mequinol/tretinoin solution for solar lentigines, as well as Botox (Allergan) and an increasing variety of other fillers have gained favor for use combined with state-of-the-art treatment devices. Another relatively recent development is the combination of vitamin D creams, topical anti-inflammatory creams and other topicals with laser and light-source devices to more effectively treat psoriasis.

Dermatology Times asked two veteran dermatologists - David J. Goldberg, M.D., and Tina Alster, M.D. - to offer their opinions and insights regarding what they're seeing as the most popular and effective creative approaches that combine the latest technological devices with topical treatments and systemics.

A look at the here and now

"There is now, and will be, more of an emphasis on combining modalities that work in different manners and by different mechanisms," says Dr. Goldberg, director of the Skin Laser & Surgery Specialists of New York and New Jersey and clinical professor and director of laser research in the department of dermatology at New York's Mount Sinai School of Medicine.

"Combined modalities for anti-aging approaches and acne are currently being used in my practice. In our practice, for anti-aging treatments we will combine one laser that improves skin tone by increasing new collagen formation with an LED device that will photomodulate and protect collagen from further breakdown, and in turn combine that with home topical products that provide growth factors to the skin. For the treatment of acne, we are using a laser that shrinks sebaceous glands and improves acne scars in combination with an FDA-approved acne take-home device."

The old, the new, the overhyped

Dr. Alster, founding director of the Washington Institute of Dermatologic Laser Surgery in Washington, and clinical professor of dermatology at Georgetown University Medical Center, says she sees two major trends in this kind of combination therapy.

"The combination of Fraxel (Reliant Technologies) laser skin-resurfacing with fillers, such as Restylane (Medicis) and Botox for facial rejuvenation, appears to be very popular and effective," she says.

"I am using a lot of this combination - Fraxel with fillers and Botox. In fact, I no longer perform ablative laser skin resurfacing such as CO2 and erbium laser, chiefly because of the success of the combination treatment, which is very effective, generates excellent results and does not require prolonged postoperative recovery.