Phosphatidylcholine tx raises hopes, concerns

Atlanta - Mesotherapy includes a broad range of injections, including phosphatidylcholine and deoxycholate, the effects of which remain largely unknown, according to an expert.

"I try to warn people that we don't have a lot of data regarding these types of treatments," says Glynis R. Ablon, M.D., clinical assistant professor of dermatology at the University of California, Los Angeles, and director of the Ablon Skin Institute, Manhattan Beach, Calif. "For people to be randomly using these injections and putting them basically anywhere on the body without any studies behind them is going to create complications."

Dr. Ablon says she frequently gets calls from patients who have had mesotherapy treatments performed by other practitioners and subsequently suffer from problems such as increased swelling in treated areas such as the abdomen.

To date, Dr. Ablon says she's been surprised at drug companies' lack of interest in supporting further study of deoxycholate, as well as other mesotherapy compounds.

"Everyone has excuses. But there's enough of it being used without the funding that people aren't as excited about (funding) research," she says.

To help fill in this data gap, Dr. Ablon undertook and completed the first U.S.-based study of phosphatidylcholine after reading what she calls an intriguing prior publication on the subject (Rittes PG. Dermatol Surg. 2001;27:391-392).

"I read that with great interest and realized that we have no studies," Dr. Ablon says. "I understand that phosphatidylcholine is now banned in Brazil, which is where the original study took place."

Supplement in U.S.

In the United States, phosphatidylcholine is classified as a supplement in the Physician's Desk Reference and by the Food and Drug Administration. Accordingly, she says, "We're not having the kind of regulations we should have on this substance being injected into the skin."

However, one area of growing research interest is in using phosphatidylcholine intravenously to help lower cholesterol in heart disease patients, Dr. Ablon reports.

Research continues

At the same time, Dr. Ablon continues her research. As part of a soon-to-be-published study, she excised one lipoma that had been directly injected with deoxycholate and found the medicine had caused necrosis in the lipoma.

She says, "The question is, how do we ensure that this is localized necrosis? How does one make sure that if one injects (phosphatidylcholine) anywhere, it's only going to hit the fat and not the muscle underneath? That's the concern for physicians who are considering using this compound to treat lower eyelids and other areas of the body. If the injection were to cause digestion of some of the underlying muscle tissue, one could have serious complications," Dr. Ablon notes.

Useful area

One area where phosphatidylcholine might prove useful is in treating submental fat, she says.

In ongoing studies she is conducting with 0.8 percent phosphatidylcholine (in comparison with 1 percent deoxycholate), Dr. Ablon reports, "We're achieving amazing results, even better than the studies I did with the eyes, which achieved a 70 percent success rate (Ablon G, Rotunda AM. Dermatol Surg. 2004;30:422-427). We're having a 100 percent success rate."

With patients showing increasing interest in nonsurgical treatments to improve their appearance, excitement over mesotherapy is building, she says.

"The question is, does it work? Thousands of physicians are performing these treatments, many of whom aren't dermatologists but gynecologists, family practitioners and other physicians who aren't familiar with subjects including fatty deposits and liposuction. And they're making money," Dr. Ablon says.