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Conservative approach benefits nonsurgical rejuvenation


National report - When dealing with topical treatments, dermal fillers and botulinum toxin, an expert advises sticking to products backed by rigorous science and minimizing patients' risks wherever possible.

When it comes to daily regimens, "Dermatologists need to know there are a broad range of cleansers," says Marsha Lynn Gordon, M.D., clinical professor of dermatology, Mount Sinai School of Medicine, New York. For example, extremely mild formulations that don't even require rinsing are well-suited to patients with very dry skin, she says. Conversely, Dr. Gordon says patients with normal skin can use foaming cleansers, while those with oily skin benefit from cleansers that offer added exfoliative benefits.

"Exfoliative scrubs are very popular right now," she says. These over-the-counter products contain tiny particles that physically exfoliate the skin. Using these products is "almost like doing a mini microdermabrasion every time one scrubs the face because they take off a few cells of the stratum corneum and leave the skin feeling smoother," Dr. Gordon says.

"The other thing we know improves the appearance of photodamaged skin is tazarotene (Tazorac, Avage; Allergan Medical). Tretinoin and tazarotene are derived from vitamin A, and we have studies good enough for the FDA to approve these ingredients as drugs that improve the appearance of the skin," although they may cause drying and irritation in some patients, Dr. Gordon says.

"It's important for dermatologists who are constantly being barraged by new products on the market to remember that we really do have agents that have undergone strict scientific studies and proven to be useful," she says.

Sun protection offers similar utility, Dr. Gordon adds.

"A fantastic amount of what we're treating could have been prevented if patients would just protect their skin from the damaging rays of the sun."

She notes that in a recent study, researchers found that chronic low-dose UVA radiation insufficient to cause tanning or burning can still damage skin (Kambayashi H et al. J Dermatol Sci. 2001 Aug;27 Suppl 1:S19-25.).

However, she says that although both UVA and UVB can damage the skin - and UVA penetrates more deeply - the sun protection factor (SPF) number used stateside primarily measures UVB protection.

To make sure patients are getting adequate UVA protection, Dr. Gordon says, "We must educate our patients to look in the active ingredient section for any of the following: zinc, titanium or avobenzone (Parsol 1789). Any one of those three FDA-approved ingredients is excellent at blocking UVA."

It's also extremely important that patients know sunscreen alone isn't sun protection, she adds.

"Every study that's ever looked at this has shown that we don't put enough on," Dr. Gordon explains.


Conversely, she says many other topicals might work, but they lack sufficient scientific studies to prove their efficacy, perhaps because manufacturers hesitate to spend money on tests whose results could mean their products are classified as prescription drugs. Such topicals include:

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