Vibrating system enhances treatment of Aks, acne

National report - A new dermabrasion and infusion system enhances drug absorption to improve results of treatments for conditions including actinic keratoses (AKs), psoriasis, acne and rosacea, according to dermatologists who have used the technology.

The Vibraderm system uses handheld plastic paddles both to dermabrade and to deliver topical anesthetics and other medications deeply and efficiently into the skin, according to the product's manufacturer.

"The best advantage of the Vibraderm is that it does a very complete and uniform removal of the stratum corneum and enhances penetration," says Nate Trookman, M.D., director of the Rocky Mountain Laser Center in Colorado Springs, Colo.

For cosmetic procedures, he says the Vibraderm system can cut drug-absorption times in half for topical EMLA or the topical anesthetic of one's choice.

"When using Vibradermabrasion with aminolevulinic acid," Dr. Trookman tells Dermatology Times, "One gets a much more even removal of the stratum corneum, far better than with microdermabrasion. It's painless, and we get better results when we use the aminolevulinic acid for whatever entity we're treating."

Treating AKs

Most commonly, Dr. Trookman says his practice uses aminolevulinic acid, in combination with blue light or pulsed light, for treating AKs.

He explains, "Our classic regimen is that we cleanse the skin with alcohol. Then we Vibraderm the epidermis for about 10 minutes, passing the paddle over each facial zone for about two minutes according to the manufacturer's instructions. Then we immediately apply the aminolevulinic acid" with a separate Vibrafusion paddle.

"To minimize discomfort with pulsed dye treatments, we even put topical anesthetic on top of the aminolevulinic acid. So we would put the Levulan (Levulan Kerastick, DUSA) on for 15 minutes, then apply a topical anesthetic for 15 more minutes, plus the (original) topical anesthetic in an emollient base. Then we have patients wash twice with soap and water," Dr. Trookman says.

For blue light treatments, which don't require the additional anesthetic, he adds, Vibraderm has cut incubation times from 60 minutes to 30 while achieving much more even peeling.

Dr. Trookman and his colleagues call their protocol a power photofacial. This method, with minor revisions, also works for disseminated superficial actinic porokeratosis (DSAP).

Better, faster treatment

"This condition is notoriously difficult to treat. We've used freezing, peels, curettage and other treatments trying to remove the keratoses. We've finally had some luck with Vibraderm on the top layer, then applying the aminolevulinic acid, letting it soak in for three hours or more before putting patients under the BLU-U (DUSA)."

"Our big issue is incubation time," he says. "If we're doing power photofacials on the cosmetic side, we could only do three a day with microdermabrasion. Now we're able to schedule four or five a day, because before, one had to prep the skin, let patients sit for 60 or 90 minutes, then perform the procedure."

After the IPL or blue light treatment, Dr. Trookman says, "We have patients wash their faces again and apply an SPF 30 zinc sunscreen. We also prescribe strict sun avoidance."

Dr. Trookman also uses the Vibraderm system for keratosis pilaris (KP).

"One or two Vibraderm treatments planes those bumps down," he says.

Additionally, he says his practice's microdermabrasion business has doubled since purchasing the device. The only potential drawback to the Vibraderm is that rarely, patients dislike its vibrating sensation on their noses, Dr. Trookman notes.

Acne, psoriasis, rosacea

Conversely, Alex De Souza, M.D., uses the Vibraderm for conditions including acne vulgaris, psoriasis and rosacea.