 talks tranexamic acid for dark spots and filler questions to ask a dermatologist, while 

 highlights retinol, reef-safe sunscreen effectiveness, and hyperhidrosis treatment.

Why Tranexamic Acid Is the New Secret to Fading Dark Spots

Here's What Dermatologists Want You to Know About Retinol

Hold Up, Is 'Reef-Safe Sunscreen' Actually Just BS?

12 Questions to Ask Your Dermatologist When Considering Fillers

Can You Permanently Reduce Sweating? Here's What Dermatologists Say

Articles

This week, consumer magazines highlight hyperhidrosis, filler questions to ask a dermatologist, and more.

Is Your Sweating Problem Actually Hyperhidrosis?

This week in aesthetics, a study highlights baricitinib for hair regrowth in alopecia areata patients, Will Kirby, DO, FAOCD, interviews Amy Spizuoco, DO, FAOCD, FAAD, in the April “Meet the Aesthetic Expert” column, a study examines the role of vitamin D in keloid scar treatment, and Michael Kluska, DO, discusses Evolve by InMode in his monthly device review.

Baricitinib Shows Hair Regrowth in Phase 3 Study for AA

Eli Lilly and Incyte announce results from its phase 3 study evaluating baricitinib 2 mg and 4 mg for the treatment of alopecia areata, making it the first phase 3 study with top-line results in patients with the hair disorder.

The Role of Vitamin D in Keloid Scar Treatment

A recent study in the Journal of Cosmetic Dermatology examines the safety and efficacy of using vitamin D intralesional injection for the treatment of keloid scars.

Meet the Aesthetic Expert With Dr Will Kirby: Amy Spizuoco, DO, FAOCD, FAAD

In this month’s "Meet the Aesthetic Expert" column, Will Kirby, DO, FAOCD, talks with dual board-certified dermatologist and dermatopathologist Amy Spizuoco, DO, FAOCD, FAAD, about her new role as president-elect of AOCD, the coveted millennial patient population, and how to leverage health and beauty for a more holistic approach to aesthetics.

In this monthly technology review, Michael Kluska, DO, discusses Evolve by InMode, including device overview, cost, ROI, patient perceptions, and candidate considerations.

This week in aesthetics, we highlight baricitinib for hair regrowth in alopecia areata patients, the April “Meet the Aesthetic Expert” column, and more.

This Week in Aesthetics: April 12-16

In this monthly review series, Michael Kluska, DO, of Southern Surgical Arts, Chattanooga, Tennessee, describes and examines devices and technologies to help other physicians choose the right piece of equipment for their practice.

This month, Kluska discusses Evolve by InMode, a hands-free system that utilizes multiple technologies to remodel skin, target adipose tissue, and tone muscles. The 3 technologies on the platform include Evolve Tite, Evolve Trim, and Evolve Tone.

Evolve Tite uses radiofrequency (RF) energy to remodel skin and improve its appearance with 8 hands-free applicators. The applicators deliver uniform and volumetric heating to the skin and subdermal layer.

Evolve Trim offers 6 hands-free applicators to deliver RF and a tissue vacuum to the deepest layers of subcutaneous fat.

Evolve Tone uses 4 hands-free applicators to emit electrical muscle stimulation to simulate involuntary muscle contractions. The applicators target specific muscle groups to improve appearance and strengthen muscle.

In the video, Kluska highlights system specifics, cost, ROI, patient perceptions, and candidate considerations.

Opinions expressed are that of Kluska and do not express the views or opinions of Aesthetic Authority®.

Videos

Device Review: Evolve 

Welcome to “Meet the Aesthetic Expert,” where, each month,

of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.

 is a Manhattan-based, dual board-certified dermatologist and dermatopathologist who has specialized in aesthetic and surgical dermatology for the past decade.

She offers customized injectables, lasers, and aesthetic threads at her clinic, True Dermatology, and serves as the New York regional medical director for LaserAway.

She is an associate clinical instructor in the department of dermatology at The Icahn School of Medicine at Mount Sinai Hospital and is honored to serve as the new president-elect of the American Osteopathic College of Dermatology, the largest organization of osteopathic dermatologists in the nation.

 Dr Spizuoco, thanks so much for agreeing to step into the spotlight and allowing me to grill you! Let’s jump right into it. Can you please tell us a little more about your backstory?

I grew up in a small Long Island town to divorced parents and an identical twin sister. There are no dermatologists in my family, let alone doctors. My father was a high school science teacher and my mother elementary education teacher. I loved biology, the study of life, specifically the human body. My parents emphasized a strong educational foundation but it was my relationship with my sister that taught me something extraordinary. See, as identical twins, we were constantly being compared, rather contrasted, to each other. So, I recognized very early on that I wanted to establish my own identity by carving out a meaningful, unique career path to make it clear to the world exactly who I was!

 What led you to an aesthetic career path?

 I’ve always been a very visual, creative person — I took several art and photography classes in school, always wanting to create shapes and designs. However, I gravitated towards science as well. I eventually realized that I wanted to become a doctor. In medical school, I learned that I loved how an individual’s face can tell us so much about their health and personality. Eventually, I knew I’d have to become an aesthetic dermatologist to take part in the process of helping define who patients are and how they present themselves to the world. Even better, as an osteopathic physician, I am trained to see the big picture and how health and beauty are intertwined. I see the whole body, how the structure and function are related, and how that creates a meaningful aesthetic outcome.

 Please let me congratulate you on your new role, you are the president-elect of the American Osteopathic College of Dermatology (AOCD)! I know you are humble, but let’s be honest, this is an immensely powerful position. What do you hope to accomplish in this role?

 As president-elect of the AOCD, I’d like to position myself as an advocate for the osteopathic dermatology (DO) profession. Many organizations, including the Veterans Association (VA), do not recognize osteopathic dermatologists as providers to our nation’s veterans. I hope to show health care providers and patients alike that DO’s are equal to our MD counterparts.

 Well said! Now, as the president of the AOCD, you are going to have to play politics as well. Are you ready for that challenge?

 If I’ve learned anything during my service to dermatology organizations, it is how to present both sides of the picture to get the advantage. So yes, I am ready!

Did you have an aesthetic mentor you revered? How did this individual influence you?

 I’ve been fortunate to attend many conferences and learn from the best in the industry. Many aesthetic providers have shown me their personal approach and how they manage patients. The dermatologists that have influenced me the most are the ones that can see the big picture. Being honest and setting realistic patient expectations are key. There are two people I feel I have a close relationship and that have taught me a ton.

First is a New York aesthetic dermatologist, Dr Doris Day. She has always been extremely available and encouraging in all my aesthetic endeavors.

The second is, well, you Dr. Kirby! You gave me the opportunity to showcase myself as a leader in the aesthetic industry by naming me the New York Regional Medical Director of LaserAway. You’ve shown me, by example, how to manage patient expectations, how to ensure patient contentment, and how to delegate effective treatments. But above all, your emphasis on safety is second-to-none. The policies, procedures, and protocols that you created are exemplary to all aesthetic practices. It’s been a dream come true to work with you.

 Thank you! That's very kind of you to say. What’s the best piece of aesthetic career advice you have received?

 “Take the initiative to think outside the box” and to “find your niche and go with it”.

 What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?

Traditionally the most coveted patients were women in their 50s and 60s. These individuals were looking for makeovers, and to remove their past from their present appearance. 

Right now, it’s all about millennials. This group of patients are forward thinkers. They are obsessed with future and preventative care. They will be our patients for life and do a wonderful job referring their friends.

 What aesthetic patient population is the most challenging and why?

 Once again, I have to say millennials. They are a group of patients that have been taught to challenge tradition, not to take no for an answer, and that they deserve perfection. These patients have always had the internet, cell phones, and now Tiktok to answer all of their questions. On one hand, they are the most coveted, but they can be a challenge as well.

 Is telehealth here to stay? What role will it have in aesthetics moving forward?

 Telehealth is absolutely here to stay. The millennial population will see to that. This patient population has grown up on technology, instant gratification, and everything in real time. I am certain aesthetic consults via telehealth will be the norm, as patients can shop around more easily without making a commitment to treatment. Technological platforms to show aesthetic outcomes will be the norm as well.

 What will the aesthetic industry look like 10 years from now?

 I’m predicting that patients will apply filters via technology platforms to portray how they want to look. We are really only starting to see that now. In the future, your online appearance might look very different from your in person one. 

 What is the biggest myth in the aesthetic industry?

The biggest myth in the aesthetic industry is that anyone can do it. I truly believe aesthetic providers need to have an excellent command of hand and eye coordination. It can be trained, so you have to practice, but there needs to be a kinetic quotient to ultimately be a great aesthetic provider. 

 What part of the aesthetic industry is ripe for disruption?

 Many clinicians think they can make a huge profit by running lasers but they lack true understanding of the technology, of the correct treatment parameters, and of ideal patient selection. This leads to unwanted patient outcomes and the public perception that some providers are inept or even corrupt. Aesthetic laser therapies are ripe for disruption because so many people do it poorly.

 What steps should the aesthetic industry take to increase market penetration?

 The industry needs to advocate for proper patient care and uniform, standard treatment protocols. 

 Many traditional leaders in the aesthetic space use the phrase physician advocacy as a veil to try to prevent allied health care professionals form working in the aesthetic arena. What’s your stance on this advocacy?

 I think the aesthetic industry will minimize its relationship with traditional leaders. The use of technology and specifically social media is accelerating this already. 

 What role do allied healthcare professionals (RNs, NPs, PAs) play currently in aesthetics and what role will they play 5 years from now?

 I believe that the implementation of aesthetic treatments are a team effort right now and will continue to be in the future. Like any successful endeavor, it often takes a village.

 What advice do you have for aesthetic providers to avoid burnout?

 Hire help and delegate. Also, vacation, vacation, VACATION! 

 I wanted to be a professional surfer. One problem, I’m not good at surfing so I went into aesthetics. If you weren’t an aesthetic expert, what would you do for a living?

 Easy question, I’m obsessed with the National Football League. I would become an NFL sideline reporter in a heartbeat! I live for Sundays in the fall, checking player stats, injury reports, and predicting the wins. 

 What is your personal favorite aesthetic treatment to implement?

 Everyone needs a little oomph under the eyes,so I love tear trough filler injections, especially with the strain of the pandemic. Not to mention all the zoom calls. Proper tear trough filler gives patients an awake, refreshed, and rejuvenated look when they need a pick-me-up.

 What is your favorite aesthetic treatment to personally receive?

 I personally love to get microneedling. This procedure is great for rejuvenation, stimulating collagen, tightening, removing sunspots, and acne scars. 

 What is your favorite quote (mantra, etc.) that is applicable to the aesthetic industry?

 Rome wasn’t built in a day (I’m Italian!)

 Dr Spizuoco, you are far too humble and kind. I know you are busy, and your time is immensely valuable, so I’ll stop pestering you. How can our readers get more aesthetic expert information from you?

 Please follow me on Instagram at @dramyspiz, on Facebook atTrue Dermatology PLLC and on Tiktok at @dramyspiz.

Treating keloid scars continue to be a particular challenge for those in the aesthetic specialty due to the scar's oversized nature, continued growth, and difficult treatment.

While intralesional corticosteroid injection is considered first-line treatment for keloids, a recent study in the 

 (JCD) examined vitamin D efficacy in treating keloids using intralesional injection. Vitamin D slows the progression of tissue fibrosis by keloid fibroblasts and inhibits collagen synthesis in dermal fibrosis, according to the study, making the vitamin a key player in cell proliferation and differentiation.

The study, which evaluated the efficacy of intralesional injection of vitamin D in the treatment of keloids, both clinically and ultrasonically, included 40 patients with keloids. Patients were injected weekly with intralesional vitamin D at a dose of 0.2 ml (200,000 IU) per 1 cm lesion.

The keloid scars were evaluated before and after treatment with the Vancouver Scar Scale (VSS) and by a high-resolution ultrasound using B mode. Study patients received 3 to 4 sessions.

Results showed a statistically significant reduction in VSS after treatment with the vitamin injection (

 value ≤0.001) along with a highly significant improvement in ultrasonic keloid scar thickness post-treatment (

 value ≤0.001). From this data, study investigators concluded that intralesional vitamin D is a safe and effective treatment of keloid scars. Additionally, ultrasound is useful in assessing keloid improvement after treatment.

Mamdouh M, Omar GA, Hafiz HSA, Ali SM. Role of vitamin D in treatment of keloid. 

. Published online March 26, 2021:jocd.14070. 

A recent study in the Journal of Cosmetic Dermatology examines the safety and efficacy of using vitamin D intralesional injection for the treatment of keloid scars. 

Eli Lilly and Company and Incyte Corporation announced positive results from its phase 3 study evaluating the safety and efficacy of baricitinib (Olumiant) 2 mg and 4 mg in adult patients with severe alopecia areata (AA).

"For patients who suffer from alopecia areata, it is not a cosmetic condition, it is a devastating autoimmune disease that can have significant psychological effects. They lose much more than just hair," said Lotus Mallbris, MD, PhD, vice president of immunology development at Eli Lilly. "We are looking forward to sharing the totality of data from the overall clinical development program for baricitinib as a potential first-in-disease treatment for alopecia areata."

Baricitinib is a once-daily, oral JAK inhibitor approved in the United States and over 70 countries as treatment for adults with moderate to severe rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies. The medication was also recently approved in the European Union and Japan for the treatment of moderate to severe atopic dermatitis (AD) in adult patients who are candidates for systemic therapy, according to a press release.

Most recently, the FDA granted baricitinib Breakthrough Therapy designation for the treatment of AA.

 Currently, there are no FDA-approved treatments for AA.

The study (BRAVE-AA2), is a multicenter, randomized, double-blind, placebo-controlled study enrolled 546 adults with a Severity of Alopecia Tool (SALT) score ≥ 50 and a current episode of severe AA lasting at least 6 months but no more than 8 years. The patient population included participants from Argentina, Australia, Brazil, China, Israel, Japan, South Korea, Taiwan, and the U.S.

Investigators evaluated the safety and efficacy of baricitinib 2 mg and 4 mg in study patients. Both doses met the primary efficacy endpoint of demonstrating a statistically significant improvement in scalp hair regrowth compared to placebo at Week 36.

The safety profile of baricitinib in BRAVE-AA2 was consistent with previous safety profiles in patients with RA and AD. The study reported no deaths, major adverse cardiovascular events (MACE), or venous thromboembolic events (VTEs).

According to the release, BRAVE-AA2 is the first phase 3 study with top-line results in patients with AA.

"These positive results are very promising and suggest that baricitinib has the potential to address the urgent needs of people living with alopecia areata," said Brett King, MD, PhD, associate professor of dermatology at Yale School of Medicine. "This level of high-quality research is needed to advance our understanding and the treatment of this frequently devastating disease."

Additional data from BRAVE-AA2 will be available in the first half of 2021, with detailed results from the BRAVE program expected to be presented at a future medical conference, as well as published in a peer-reviewed journal.

"Significant unmet need exists in the treatment of alopecia areata," said Abby Ellison, research director at the National Alopecia Areata Foundation (NAAF). "We appreciate Lilly's important work in this area and are excited that these data could bring us closer to a potential new treatment option for patients."

Baricitinib is first jak-inhibitor to demonstrate hair regrowth in phase 3 alopecia areata (Aa) trial | Eli Lilly and company. Accessed April 9, 2021. https://investor.lilly.com/news-releases/news-release-details/baricitinib-first-jak-inhibitor-demonstrate-hair-regrowth-phase