A clinical investigation on the improvement and apparent resolution of
Using a tretinoin/4% hydroquinone-based skin care system in conjunc-
keratosis pilaris with a novel photopneumatic therapy: A pilot study
Fredric Brandt, MD, Dermatology Research Institute, Coral Gables, FL, United
Jody Comstock, MD, Skin Spectrum, Tucson, AZ, United States; Roxanne Guy,
States; Alex Cazzaniga, MBA, Dermatology Research Institute, Coral Gables, FL,
MD, Brevard Plastic Surgery & Skin Treatment Center, Melbourne, FL, United
United States; Ana Caos, MSN, Dermatology Research Institute, Coral Gables, FL,
United States; Oscar Hevia, MD, Dermatology Research Institute, Coral Gables,
Introduction: A tretinoin/4% hydroquinone-based skin care system has been
available for several years to help correct premature photoaged skin and prevent
Background: Keratosis pilaris (KP) is a common benign skin disorder affecting
future skin damage. The system comprises several products (including cleanser,
approximately 40% to 50% of the adult population and 50% to 80% of all adolescents.
toner, 4% hydroquinone, exfoliant, tretinoin, sunscreen SPF 35, and moisturizer)
It occurs as the results of overproduction of keratin, which accumulates within the
whose order and frequency of application are carefully defined to create a 4-step
hair follicles forming keratotic follicular papules. There are several variants of KP and
process for improving and restoring overall skin quality. The first step is skin
severity ranges from mild to severe and it is more common in women than men.
preparation, the second step is skin correction, the third step is skin stimulation, and
There is currently no cure for KP. The available treatments only make the symptoms
the fourth step is skin protection. A study has been conducted to quantify the benefit
of using this system adjunctively with facial rejuvenation procedures, and to assess
Aim: To evaluate the clinical safety and efficacy of a novel photopneumatic therapy
patients’ overall facial improvement.
(PPx) for treating women of skin type I to III suffering from mild to moderate KP
Methods: Before and after treatment, physicians completed a 1-page evaluation
rubra on their posterolateral upper arms with regards to improvements in erythema
assessing the skin quality of their patients who used the tretinoin/hydroquinone
and skin roughness, treatment tolerability, and side effects.
system and who also received one or more facial rejuvenation procedures (eg,
Methods: Photopneumatic therapy uses a proprietary technology which combines
injection of botulinum toxin type A, injection of a filler, laser treatment, micro-
pneumatic energy and broadband light. For this study, the affected areas were
dermabrasion, chemical peel, or surgery). Skin quality was assessed in terms of
cleansed with a mild OTC soap before treatment. Patients received 4 to 5 treatments
hyperpigmentation, tactile roughness, sallowness, periocular fine wrinkles, and
3 weeks apart with the photopneumatic system. Treatment of all posterolateral
perioral fine wrinkles using a scale where 0 ¼ none, 1 ¼ mild/barely noticeable, 2 ¼
upper arm areas involved with KP rubra were performed with the photopneumatic
moderate/easily visible, and 3 ¼ severe/prominent.
system at power levels of 1 to 3 with 10 mm 3 20 mm spot size tips via two passes
Results: Data from more than 2500 patients show that use of this system with facial
under high/med vacuum levels. PPx therapy does not require any pretreatment with
rejuvenation procedures achieved incidences of $ 1-grade improvement (eg, from
moderate to mild, or mild to none) of 84% for hyperpigmentation, 83% for tactile
Results: Clinical improvement was noted in all patients with significant reduction in
roughness, 77% for sallowness, 64% for periocular fine wrinkles, and 57% for
erythema and skin roughness scores by PI and blinded evaluator. The treatment was
well tolerated by all the patients and no side effects were reported.
Conclusions: The tretinoin/4% hydroquinone system improves overall skin quality
Conclusion: This novel photopneumatic system appears to be a safe and effective
and is an effective adjunct to both nonsurgical and surgical facial rejuvenation
treatment for the treatment of KP rubra.
This study was supported by an unrestricted educational grant by Aesthera
P2808Flaccid skin in morbidly obese patients: A histopathologic studyCarolina Trabanino, MD, Instituto Nacional de Ciencias Medicas y Nutricion
Salvador Zubiran, Mexico, Mexico; Edgardo Reyes, MD, Instituto Nacional de
A comparison of commercially available polymethylmethacrylate-based
Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico; Carla Archer-
Dubon, MD, Instituto Nacional de Ciencias Medicas y Nutricion Salvador
Daniel Piacquadio, MD, Therapeutics Incorporated, San Diego, CA, United States;
Zubiran, Mexico, Mexico; Rocio Orozco-Topete, MD, Instituto Nacional de la
Russell Anderson, MBA, Artes Medical, San Diego, CA, United States; Adelbert
Nutricion Salvador Zubiran, Mexico, Mexico
Stagg, PhD, Artes Medical, San Diego, CA, United States
Background: Redundant tissue syndrome after bariatric surgery in morbidly obese
The number of soft tissue filler options available today is overwhelming compared to
patients is resolved by plastic surgeons. These patients require extensive resections
what it was just a few years ago. It is important to understand that all of these
of skin and subcutaneous tissue mainly of the abdomen, back, thighs, arms, and
products are not equivalent and that approval standards across the globe can be
breasts because their skin is flaccid, with null capacity of returning to its original
significantly different. In general, the United States has the most rigorous standards
state. Our patients develop early and exaggerated laxity within 6 months after
for these products, because they are approved as novel medical devices requiring
reconstructive surgery, when compared to otherwise healthy patients subject to
premarket approval (PMA), which requires data from well controlled clinical studies
abdominoplasties. This has been hypothetically attributed to a chronic and
to substantiate clinical safety and efficacy. In the European Union, such products
progressive stretching of elastic fibers and a rapid weight loss after bariatric surgery;
typically require only CE marking, which is more of a manufacturing conformity
however, microscopic studies are lacking.
requirement which may require only limited supportive clinical data depending on
Methods: Patients referred for body reconstruction after massive weight loss were
the product’s classification. In some other ex-US/EU markets, there can be minimal
included. Transoperative biopsies from resected flaps of clinically flaccid skin were
requirements or enforcement. Competitor products using alternate technology
taken. Biopsies were studied with routine light microscopy and one with electron
platforms (eg, hyaluronic acid, etc.) are now becoming available. Given this rapid
market expansion, physicians need to have a better understanding of the differencesamong these products. This need has become even more critical as physicians are
Results: Nine female patients aged 28 to 58 years (mean, 42 yrs) were included.
required to: (a) manage patients treated with products available outside the US; (b)
Their mean BMI before bariatric surgery was 59 and 32 at the moment of
interpret medical literature that deals with similar global products; and (c) deal with
reconstructive surgery. Mean weight loss was 70 kg. Seven patients were subject
patients treated with products imported into the United States from abroad (parallel
to abdominoplasties, one to thigh lift and one to both. Surgical procedures were belt
importing of non-FDA approved products). Apparently similar products can result in
lipectomy plus fleur de lis and thigh lift. Hiatus between bariatric and reconstructive
materially different outcomes with respect to both safety and efficacy because of
surgery was 24 months. A total of 12 biopsies from 9 patients were studied.
what some may consider small differences in composition, particle characteristics,
Hematoxyline eosin stain showed normal arrangement and distribution of dermal
or other features. With the advent of more permanent filler materials, the need to
collagen fibers. Verhoeffevan Gieson showed normal elastic and collagen fibers;
appreciate such differences has become even more important given the potential
Masson, PAS, alcian blue, and colloidal iron for mucopolysaccharides were normal.
long-term consequences to patients. Five commercially available PMMA-based filler
Electron microscopy was performed on one biopsy: no alterations were observed.
materials from different global markets were obtained and analyzed for key features;
Conclusions: There are no previous studies regarding the ultrastructure of flaccid
PMMA particle size distribution and surface characteristics, carrier ‘‘gel’’ matrix
skin in obese patients. The results we obtained at the histopathologic and structural
characteristics, and select impurities (eg, heavy metals). The results show a wide
level are unexpected given the clinical evidence of increased skin laxity in these
variety of differences between these ‘‘similar’’ products. Based upon the variability
patients. In healthy subjects, poor surgical results after abdominoplasties can usually
in particle size and topology alone, it is anticipated that such products will have
be attributed to an incomplete resection of the abdominal flap, which is not the case
markedly different tolerability (eg, implant accommodation reactions, phagocytosis,
of our patients. We believe there are changes in the skin of morbidly obese patients,
granuloma risk, etc) profiles in man. These findings will be reviewed and their
although our initial attempts to characterize them have been unsuccessful and
potential significance to patient management will be discussed.
further investigations are necessary.
This poster is sponsored by Artes Medical.
Commercial support: None identified.
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PROVINCIA DI SONDRIO ________________________________ PROCESSO VERBALE DI DELIBERAZIONE DELLA GIUNTA PROVINCIALE Oggetto: DETERMINAZIONE DELLE SPESE D’ISTRUTTORIA IN MATERIA DI ACQUE MINERALI, TERMALI, DI SORGENTE E IN MATERIA DI AUTORIZZAZIONI ALLO SCARICO L’anno 2004 (duemilaquattro), addì 6 (sei) del mese di dicembre, alle ore 14 (quattordici), nella sala delle