Journal of Clinical and Aesthetic Dermatology

OCT 2017

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

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O R I G I N a L R E S E a R C H 12 JCAD joURnAL oF CLiniCAL And AesTHeTiC deRMAToLogy October 2017 • Volume 10 • Number 10 a Background: Fractionated, ablative lasers are usually associated with post-treatment erythema, edema, and crusting, which can last from 5 to 14 days. Conjugated linolenic acid, an omega-5 fatty acid, has significant antioxidant and anti-inVammatory properties, and has been shown to stimulate keratinocyte proliferation and epidermal regeneration. by modulating the early inVammatory milieu and directly aSecting skin structure and function, conjugated linolenic acid might therefore shorten downtime following fractionated ablative laser resurfacing of the face. Objective: To evaluate the eTcacy and subject satisfaction of a topical regimen containing conjugated linolenic acid derived from pomegranate seed extract in accelerating wound healing and improving skin quality following fractionated ablative laser resurfacing of the face. Materials and Methods: Thirty-four subjects were enrolled and received fractionated CO 2 laser resurfacing. Subjects were randomized to use the test healing regimen (n=24) or 1% dimethicone ointment (n=10) post-procedure. The primary endpoint was the degree of erythema, edema, crusting, and exudation evaluated by a blinded clinician at post-treatment Days 1, 3, 7, 10, 14, and 30. Secondary endpoints included a blinded evaluator assessment of the degree of wrinkling and elastosis using the Fitzpatrick-Goldman Wrinkle and Elastosis Scale; subject-assessed degree of pain, itching, tightness, oozing, and crusting; and subject overall satisfaction. Results: Subjects who applied the topical conjugated linolenic acid healing regimen experienced significantly reduced edema on post-procedure Day 3 (p=0.04), and itching on Days 1 and 3 (p=0.03 and p=0.04). both regimens produced significant improvements in wrinkling and elastosis at Days 14 and 30 post-treatment, with conjugated linolenic acid outperforming placebo in improvements in wrinkling at Day 14. both regimens were well tolerated with no statistical diSerences in adverse events or subject satisfaction. Conclusion: The topical conjugated linolenic acid formulation outperformed placebo by decreasing acute pruritus and edema, and enabling a faster positive outcome in wrinkle improvement. additionally, topical conjugated linolenic acid does not raise any safety or tolerability issues as compared to current standard of care. Keywords: Conjugated linolenic acid, ablative resurfacing, CO 2 laser, wound healing, post-laser healing a b S T R a C T by douglas C. Wu, Phd, Md, and Mitchel P. goldman, Md Drs. Wu and Goldman are with Cosmetic Laser Dermatology in San Diego, California. J Clin Aesthet Dermatol. 2017;10(10):12–17 FUnding: No funding was provided. disCLosURes: Drs. Wu and Goldman have no conVicts of interest relevant to the content of this article. AUTHoR CoRResPondenCe: Douglas C. Wu, PhD, MD; Email: A Topical Anti-in:ammatory Healing Regimen Utilizing Conjugated Linolenic Acid for Use Post-ablative Laser Resurfacing of the Face: a Randomized, Controlled Trial ablative resurfacing remains the gold standard for improving the appearance of rhytides, textural irregularities, dyspigmentation and sallowness of the skin. ConVuent ablative techniques have proven to be very eSective but are associated with prolonged healing and subsequent downtime. 1–3 Fractionated ablative lasers oSer eTcacy with less downtime, but discovering improved healing regimens is important. Cutaneous wound healing progresses through five continuous phases: coagulation, inVammation, cellular proliferation, remodeling and maturation. although this cycle might take a year or longer to complete, 4 the early inVammatory phase, which typically occurs within the first one to two weeks, plays a significant role in determining the final outcome. Excessive or prolonged inVammatory stimuli result in a poorer quality of wound healing and increased risk for adverse scarring. 5 In order to optimize the wound healing response, appropriate inVammatory modulation combined with adequate moisture balance are essential. 6, 7 Conjugated linolenic acid (CLa) is an 18 carbon fatty acid possessing three double bonds, with the first double bond located between the fifth and sixth carbons. as an omega-5 fatty acid, it has significant antioxidant and anti-inVammatory properties. 8–11 additionally, experimental models have demonstrated the ability of CLa to reduce keratinocyte production of inVammatory mediators, such as arachidonic acid, prostaglandin, and histamine, resulting in a reduction of pruritus in the setting of atopic dermatitis. 1 2–14 When used as a dietary supplement, CLa induces significant changes in skin composition by altering the adipocyte composition of the subcutaneous layer. 15–16 Taken together, these data suggest that CLa might have a positive impact on cutaneous wound healing by modulating the early inVammatory milieu and directly aSecting skin structure and function. However, due to the CLa molecule being highly unstable, it has not been available in a product for topical administration that could deliver the compound to the skin in its active form. Recent technological innovations have now led to the development of a topical CLa formulation that doubles as both a delivery system and a highly stable preservative system that lacks the conventional chemical-based preservative deck (Pomega Inc., San anselmo, California). In this prospective, randomized, standard- controlled, evaluator-blind study, we assessed the safety and eTcacy of a topical healing regimen containing CLa derived from the extract of the pomegranate seed (Pomega MDTM, Pomega Inc., San anselmo, California) in the setting of fractionated ablative laser resurfacing of the face.

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