Journal of Clinical and Aesthetic Dermatology

MauiDerm 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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JCAD S12 journal of clinical and aesthetic dermatology JCAD journal of clinical and aesthetic dermatology May 2017 • Volume 10 • Number 5 (Supplement 1) p <0.03, and p<0.012). Tretinoin d emonstrated negative changes in hydration. Subjects reported significant improvement in hydration with AHA- Ret (p<0.02) and reported experiencing less side effects with AHA-Ret vs. tretinoin or retinol (9.7%, 12.6%, and 47.3%, respectively). Six subjects in the r etinol group switched to AlphaRet due to irritation, and one subject required a rest period. Conclusion: Treatment with a double conjugate retinoid cream demonstrated early, significant reductions in photodamage skin and improvement in hydration over 12 weeks. AHA-Ret induced significantly less erythema vs. 1.0% retinol and was more tolerable than 1.0% retinol and 0.025% tretinoin. Imiquimod 2.5% and 3.75% for the Treatment of Photodamage: Meta- Analysis of Efficacy and Tolerability in 969 Randomized Patients Presenters: James Del Rosso, DO, 1 Neil Swanson, MD, 2 Brian Berman, MD, PhD, 3 Ted Rosen, MD 4 Affiliations: 1 Las Vegas Skin & Cancer Clinic, Las Vegas, NV; 2 Department of Dermatology, Oregon Health and Science University, Portland, OR; 3 Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, FL, and Center for Clinical and Cosmetic Research, Aventura, FL; 4 Department of Dermatology at Baylor College of Medicine, Houston, TX Background: In clinical studies of imiquimod for the treatment of actinic keratosis (AKs), there have been ad hoc reports that imiquimod may improve skin texture and also improve overall symptoms of photodamage. Objective: To assess the efficacy and tolerability of imiquimod 3.75% and 2 .5% cream for the treatment of p hotodamage in patients being treated for AK of the full face or balding scalp. Methods: Meta-analysis of four identical multicenter, randomized, double-blind, placebo-controlled studies in 969 adult subjects (aged 33–91 years) with 5 to 20 visible l esions, or palpable AKs in an area exceeding 25cm 2 on either the face or balding scalp, randomized to imiquimod 3.75%, 2.5%, or vehicle cream (1:1:1). Up to two packets (250mg each) were applied per dose once daily for two two-week treatment cycles, separated by a two-week, no- treatment interval. Photodamage improvement (including an integrated assessment of fine wrinkling, coarse wrinkling, mottled pigmentation, roughness, sallowness, skin laxity, and telangiectasias) was assessed at study end based on subject's baseline assessment using a 7-point scale (where +3=significantly improved and - 3=significantly worse than baseline). Local skin reactions (LSRs) were recorded throughout the study. Results: Combined Investigator's Global Integrated Photodamage (IGIP) score was "significantly" or "much" improved in 57.6 percent (N=175) of patients treated with imiquimod 2.5% cream and 69.6 percent (N=208) of patients treated with imiquimod 3.37% cream, compared with 25.7 percent (N=76) of patients treated with placebo. Mean IGIP scores at end of study (EOS) were 1.62, 1.93, and 1.01, respectively. Only six patients (2.0%) treated with imiquimod 2.5% cream and five patients (1.7%) treated with imiquimod 3.75% cream reported worse photodamage at the end of the study. LSRs were similar in all four studies. Erythema was the most common LSR, with severe erythema being dose- dependent. Mean LSR sum scores r eturned to baseline at the end of the s tudy. Limitations: Photodamage was a tertiary endpoint in the studies and assessment made four months' post- baseline (8 weeks following conclusion of treatment). No assessment was made as to which aspects of p hotodamage were improved. It was not clear whether LSRs were at the site of the AKs or in treated skin between visible AKs. Conclusion: In four well-controlled Phase 3 studies, both imiquimod 2.5% and 3.75% creams have shown a positive effect on photodamage when compared with placebo that would warrant further study to elucidate which aspects of photodamage benefit the most and the source of LSRs. Effectiveness and Tolerability of a Novel Large Molecule, Injectable- grade Hyaluronic Acid Cream in Subjects with Moderate Photoaging Presenters: David H. McDaniel, 1 Chris Mazur, 1 Diane B. Nelson, 2 Mitch Wortzman 2 Affiliations: 1 McDaniel Institute of Anti-Aging Research; 2 Skinbetter Science, LLC Synopsis: The moisture-binding properties of hyaluronic acid (HA) in improving skin hydration are widely recognized. Applied topically, HA is an excellent hydrator. However, due to the large size of the HA molecule, challenges exist in delivery through the skin in maximizing efficacy. Herein, we describe the efficacy and tolerability of a large molecule, injectable-grade HA cream in photoaging skin using an advanced formulation delivery platform. Objective: To evaluate the clinical effectiveness and tolerability of a large molecular HA-containing cream in improvement in the appearance of

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