American Dermatology Annual Meeting highlights key innovations

The American Academy of Dermatology held its 2009 Annual Meeting in San Francisco, from March 6 to 10, 2009. Around 17,000 attended the meeting which featured world-renowned leaders in the field of dermatology and presentations on the latest research in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions.

Dr Adrian Lim, Sydney-based cosmetic dermatologist and phlebologist, said key cosmetic papers from the meeting focused on familiar and novel topics. “Even in the midst of the global financial crisis, the field of cosmetic medicine continues to trade robustly with significant Wall Street presence. Partnerships are being forged between medical device corporations and multinational cosmetics and toiletries giants like Proctor & Gamble, Johnson and Johnson and L’Oreal. The advent of over-the-counter (and web-based) cosmetic home-devices has added another dimension to the increasingly popular world of self-rejuvenation,” Dr Lim explained.

Dr Lim also highlighted some of the key innovations from the event:

“The rise and rise of fractional resurfacing was not unexpected although there is a definite shift in emphasis from non-ablative to ablative methods of fractional laser devices. It appears that the current crop of ablative fractional devices such as CO2 fractional resurfacing may be more effective and require fewer treatment sessions than non-ablative fractional devices. However a word of caution: practitioners are also starting to encounter unwanted complications such as permanent pigment loss and scarring that not-so-long-ago burst the bubble of ‘old-fashioned’ contiguous laser skin resurfacing.”

Dr Lim said the existing classes of ablative fractional devices include:

• Erbium (2940nm)
• CO2 (10600nm)
• YSGG (2790nm)

He said non-laser and relatively novel devices such as plasma resurfacing devices also rated mention and can produce laser-like resurfacing results. “Likewise, there is ongoing interest in non-ablative skin tightening devices generating tissue heating via infrared, radiofrequency and ultrasonic waves,” Dr Lim explained. “In general, there is fair acknowledgement of the efficacy limitation of these non-ablative no-downtime devices. An interesting development in the radiofrequency arena is a unipolar radiofrequency intradermal needle that is inserted into the dermis to directly stimulate collagen heating and remodelling. Hype or hope – only time will tell!”

Dr Lim said that non-invasive body (fat) contouring is another red-hot topic. The myriad of non-invasive fat dissolving devices based on clever ways of disrupting adipose cells include:

• Ultrasonic (mechanical)
• Ultrasonic (thermal)
• Light based (thermal)
• Radiofrequency (mechanical/ thermal)
• Cooling (thermal)

“Fat-loss through cooling? Yes, ‘cryo-lipolysis’ is a novel method of controlled and localised skin cooling to freeze fat cells to death,” he explained. “Sounds too good to be true? Well, it is an accepted fact that fat cells can undergo cellular suicide (apoptosis) when exposed to cold – termed ‘cold panniculitis’ in dermatological parlance. Porcine studies have confirmed the efficacy of cryo-lipolysis. But does it work in humans? According to a US-based research team, this novel method of fat reduction has already been tested in over 120 human subjects with evidence of up to 25 per cent fat reduction within four months post-treatment.”

According to Dr Lim, other hot topics emerging at the meeting were:

• Pneumatic-suction assisted IPL in hair removal and acne treatments.
• Fractional skin preparation as a method of trans-cutaneous drug delivery.
• ALA photosensitiser to enhance IPL treatments.
• Easy-to-remove ‘permanent’ tattoo ink using a bio-absorbable pigment in microsphere that is easily ruptured with conventional Q-switch lasers. This is currently available in tattoo parlours across the US.
• Suture-less wound closure (nano-suturing) using rose bengal as a natural instant adhesive when exposed to IPL.
• Home devices. “Yes, they do work (somewhat) and will have a role in maintenance. IPLs, lasers and LEDs have all been incorporated into battery-powered home devices. To put it in perspective, like DIY hair colouring, these home kits are not expected to replace professional services,” he said.

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