This week in aesthetics, Anna Waśkiel-Burnat, MD, PhD, discusses trichoscopy to diagnose hair disorders, Michael Kluska, MD, and Chad Deal, MD, review the Joule X platform and compare Renuvion (J-Plasma) vs Bodytite by InMode, Angelo Landriscina, MD, FAAD, highlights how to care for LGBTQ+ patients, a study examines laser-assisted delivery of vitamin C with growth factor, while a different study points to oxytocin anti-aging benefits.

According to one expert at the 29th EADV Virtual Congress, trichoscopy not only helps diagnose hair disorders and monitor treatment but also predicts treatment efficacy.

In this monthly technology review, Michael Kluska, MD, and Chad Deal, MD, discuss the Sciton Joule X laser and light platform, which includes multiple applications in one system.

Angelo Landriscina, MD, FAAD, discusses how to care for your LGBTQ+ patients while also effectively addressing their different dermatologic needs.

Laser-Assisted Delivery of Vitamin C with Growth Factor

Laser-assisted drug delivery helps the skin absorb exogenous macromolecules and improve treatment for wrinkles; however, more research is needed to determine patient safety.

Device Review: Renuvion (J-Plasma) vs. Bodytite

In this monthly technology review, Dr. Michael Kluska and Dr. Chad Deal revisit Renuvion (J-Plasma) versus Bodytite by InMode, and how to choose which to use on a case-to-case basis.

Clinical Study Points to Oxytocin’s Anti-Aging Benefits

Patients with high oxytocin levels had significantly lower (more youthful-looking) skin age scores than expected, even with strong histories of lifetime sun exposure, according to a recent study.

Articles

This week in aesthetics, Michael Kluska, MD, and Chad Deal, MD, discuss the Sciton Joule X laser and light platform, a study examines laser-assisted delivery of vitamin C with growth factor, and more.

This Week in Aesthetics: March 1-5

Trichoscopy (a dermoscopy-based diagnostic method) not only helps diagnose hair disorders and monitor treatment but also predicts treatment efficacy, Anna Waśkiel-Burnat, MD, PhD, a dermatologist at Medical University of Warsaw in Poland, said at the 29th European Academy of Dermatology and Venereology Virtual Congress (EADV).

“There are numerous hair and scalp diseases that share similar clinical features,” Waśkiel-Burnat said in her presentation. “Trichoscopy is an easy-to-perform diagnostic method that may help identify subtle details and establish the correct diagnosis. For example, it is difficult to distinguish between female androgenetic alopecia (FAGA) and fibrosing alopecia in a pattern distribution (FAPD) based only on the clinical picture. In these conditions, trichoscopy is useful to avoid misdiagnosis.”

Features of FAGA include increased numbers of vellus hairs and single-hair follicular units, along with anisotrichosis and yellow dots. For a diagnosis of FAGA, patients must meet 2 of the following major criteria

More than 4 yellow dots in 4 images at 70-fold magnification in the frontal area

Lower average hair thickness in the frontal area compared with the occiput (calculated from at least 50 hairs from each area).

More than 10% thin hairs (< 0.03 mm) in the frontal area

Alternatively, dermatologists can establish a diagnosis of FAGA using 1 major criterion and 2 of the following minor criteria (all comparing frontal area with occiput):

3.1 ratio of hair follicles with perifollicular discoloration

“Another condition that is difficult to diagnose, even with trichoscopy, is alopecia areata [AA] incognita,” Waśkiel-Burnat said. Because this entity is frequently misdiagnosed as telogen effluvium, histopathological examination is important, she said.

Because it is challenging to identify patients with AA who are at risk of rapid disease progression and to determine which patients are likely to respond well to immunosuppressive therapy, Waśkiel-Burnat and colleagues developed the Alopecia Areata Predictive Score.

In a study of 65 patients with patchy AA, the authors conducted trichoscopic examinations at baseline and 2 months after treatment initiation. After 6 months of treatment, investigators classified 27 patients as responders and 38 as nonresponders. Positive predictive trichoscopic factors (observed in control trichoscopy) for hair regrowth in patchy AA included upright regrowing hairs and pigtail hairs.

 Negative predictive markers for hair regrowth included black dots, broken hairs, exclamation mark hairs, and tapered hairs. Probability of regrowth ranged from 98.3% for patients with the highest AA predictive score to 0% for patients with the lowest score.

For alopecia totalis or alopecia universalis, Waśkiel-Burnat said, she recommends trichoscopic examination 6 weeks after starting treatment and clinical assessment of hair regrowth after 4 months’ treatment. Positive predictive factors (observed in control trichoscopy) for regrowth in patients include pigmented vellus hairs and pigmented upright regrowing hairs. No negative predictive markers are associated with these conditions, she added.

Findings in a recent analysis showed lichen planopilaris accounted for 7.6% of visits to 22 specialist hair clinics.

 This condition is characterized by perifollicular scaling and erythema, as well as white dots and milky red and white areas on the scalp.

Trichoscopy can be performed with or without immersion fluid (wet vs dry trichoscopy). “It is important to start the trichoscopy examination using the dry method, as it allows one to better visualize scaling and features of blond and gray hairs,” Waśkiel-Burnat said. She suggests performing trichoscopy after hair dyeing for light tones since dark hair is more easily.

“In the future, I believe that trichoscopy will focus on general medicine and its usefulness in diagnosis of nondermatological conditions such as connective tissue disorders and hematological diseases,” she said.

Waśkiel-Burnatreports no relevant disclosures or financial interests.

1. Waśkiel-Burnat A. Trichoscopy in hair. 29th European Academy of Dermatology and Venereology Virtual Congress; October 29-31, 2020.

2. Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Rudnicka L. Dermoscopy in female androgenic alopecia: method standardization and diagnostic criteria. 

. 2009;1(2):123-130. doi:10.4103/0974-7753.58555

3. Waśkiel-Burnat A, Rakowska A, Kurzeja M, et al. The value of dermoscopy in diagnosing eyebrow loss in patients with alopecia areata and frontal fibrosing alopecia. 

. 2019;33(1):213-219. doi:10.1111/jdv.15279

4. Waśkiel-Burnat A, Rakowska A, Sikora M, Olszewska M, Rudnicka L. Alopecia areata predictive score: a new trichoscopy-based tool to predict treatment outcome in patients with patchy alopecia areata. 

. 2020;19(3):746-751. doi:10.1111/jocd.13064

5. Vañó-Galván S, Saceda-Corralo D, Blume-Peytavi U, et al. Frequency of the types of alopecia at twenty-two specialist hair clinics: a multicenter study. 

. 2019;5(5):309-315. doi:10.1159/000496708

Trichoscopy Aids Diagnosis, Prognosis

In this monthly review series, Michael Kluska, MD, describes and examines devices and technologies to help other physicians choose the right piece of equipment for their practice.

This month, Kluska and Chad Deal, MD, of Southern Surgical Arts, Chattanooga, Tennessee, discuss the Sciton Joule X laser and light platform, which includes Halo, Forever BBL, diVa, Allura, and resurfacing all in one system. With dual wavelengths and the incorporation of dynamic thermal optimization (DTO) technology, the system detects skin temperature and adjusts the power of the laser accordingly.

In the video, Kluska and Deal highlight the Joule X platform’s use of optical navigation to lessen the risk of inconsistent treatment and stamp patterns, patient outcomes, and procedure downtimes.

Opinions expressed are that of Kluska and Deal and do not express the views or opinions of 

Videos

Device Review: Joule X Platform

 most recent Cutaneous Connection podcast, Angelo Landriscina, MD, FAAD, discusses how to care for your LGBTQ+ patients while also effectively addressing their different and specific dermatologic needs.

For the full catalog of past Cutaneous Connection Episodes, click 

Caring for LGBTQ+ Patients

Laser-assisted drug delivery (LADD) helps the skin absorb exogenous macromolecules and improve treatment for wrinkles.

Research published by Barbara Helena Barcaro Machado, MD, of the Pharmaceutical Research Group at the School of Allied Health, Faculty of Health, Education, Medicine and Social Care at Anglia Ruskin University in Chelmsford, UK and colleagues, in 

examined the efficacy of using LADD to improve vitamin C delivery, concluding that while the use of LADD improved the delivery of vitamin C and vitamin C plus growth factor (GF), vitamin C plus GF showed the best results for wrinkle reduction.

Machado et al say it is established knowledge that lasers can affect drug delivery and bio-distribution, and this study builds on that initial research. However, LADD is not an established therapy. Current evidence mostly relies on laboratory tests, animal experiments, and cadaver skin for published data.

The study authors conducted a randomized, double-blind, prospective clinical trial that enrolled 149 women, aged 43 to 70 years, with periorbital wrinkles. Divided into 2 groups, the control group of 74 women received vitamin C only (R-C), while 75 women in the experimental group received vitamin C with a GF cosmeceutical (R-CGF).

Investigators examined the effects of topical drug application immediately after laser skin resurfacing of wrinkles, with the R-C group receiving vitamin C alone (Vitasantisa) and the R-CGF grouping receiving both Vitasantisa and the patented cosmeceutical TNS Recovery Complex (SkinMedica; Allergan)

 that contained added growth factor. Both groups’ treatment areas were kept under occlusion for 30 minutes, according to study authors.

Researchers used a 3D stereophotogrammetry digital camera system (LifeViz Micro; QuantifiCare)

 that provided software readouts (DermaPix; QantifiCare)

 to provide statistical analysis for effectiveness of treatments. Patients were evaluated before treatment and at a 3-month follow-up. Machado and colleagues examined pre- and post procedure results for significant changes in average wrinkle depth and in the roughness of skin.

Patients were given a single round of treatment. Investigators reported any skin crusting that lasted 5 to 8 days, and all patients were noted to have early moderate periorbital swelling that was gone by the third day. After the seventh day, post laser erythema was reported, and had disappeared by day 20, investigators said.

“There was a significant reduction in both skin roughness and average depth of the wrinkles in the group treated with vitamin C and growth factors (

 < .01) than those treated with LADD followed by topical application of vitamin C alone,” Machado and colleagues reported, in the study, continuing that there were no adverse systemic or cutaneous reactions in patients.

Despite promising results, study authors emphasize that more research is needed to examine the “theoretical risk of systemic toxicity” based on prior studies.

They noted it was difficult to determine how the skin absorbs drugs only using molecular properties due to a variety of factors: dietary intake, endogenous production of substances, blood flow variations, and “the complex, new surface area and geometry created by the laser-induced microchannels.”

This raises concerns about approval and “has limited further objective research and restricted the commercialization of active delivery products,” according to the authors and but continue to say that “to date, no adverse toxicity has ever actually been linked to LADD.”

Machado BHB, Frame J, Zhang J, Najlah M. Comparative study on the outcome of periorbital wrinkles treated with laser-assisted delivery of vitamin C or vitamin C plus growth factors: a randomized, double-blind, clinical trial. 

 2020;10.1007/s00266-020-02035-z. doi:10.1007/s00266-020-02035-z

TNS Recovery Complex. SkinMedica. Accessed February 25, 2021. 

https://www.skinmedica.com/products/correct/tnsrecoverycomplex

LifeViz Micro: a portable 3D system for skin microstructure analysis. Quantificare. Accessed February 25, 2021. 

https://www.quantificare.com/3d-photography-systems/lifeviz-micro/

DermaPix. Quantificare. Accessed February 25, 2021. 

https://www.quantificare.com/mobile-technology/

In this monthly review series, Dr. Michael Kluska describes and examines devices and technologies to help other physicians choose the right piece of equipment for their practice.

This month, Dr. Kluska and Dr. Chad Deal compare Renuvion Helium Plasma Technology (Apyx Medical), a combination of helium-based plasma with radiofrequency energy, FDA-cleared for cutting, coagulation, and ablation of soft tissue, versus Bodytite (InMode), a radiofrequency-assisted lipolysis (RFAL) system FDA-cleared for fat coagulation.

In the video, Dr. Kluska and Deal talk similarities and differences between the two technologies, study comparisons, and which one each physician reaches for most often.

Opinions expressed are that of Dr. Deal and Dr. Kluska and do not express the views or opinions of 