Aesthetic Dermatology

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

 

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

 

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Live video demonstrations of several novel laser and laserlike devices generated mixed reviews from a panel of dermatologists.

Panelists at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation disagreed about the safety and efficacy of several of the devices, although they came to a meeting of the minds on some points, such as the "feel-good" potential of microdermabrasion devices.

What follows is a recap of many of the thumbs-up, thumbs-down impressions aired at the meeting.

Portrait Plasma

"I have to say I'm truly impressed with this device," said Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine.

"I'm not sure why it hasn't caught on."

The Portrait Plasma device, manufactured by Rhytec, derives its heat energy from nitrogen plasma rather than from a laser.

Treatment of photodamage, including fine lines and wrinkles, is attained by using a variety of energy levels up to 5–6 J, a setting that leaves behind significant erythema.

At about 4 J, the epidermis appears bronzed, with the skin remaining intact for several days "like a natural dressing," Dr. Zachary said.

Dr. Mitchel P. Goldman, a dermatologist in private practice in La Jolla, Calif., expressed concern about the variability of the energy delivery.

"I've seen profound scarring with this device," he said. "I prefer a laser where I know exactly how much heat is going to be built up between each pass."

Dr. Zachary agreed that "there is no free lunch" with the Portrait Plasma. Double passes at 3.5–4 J could definitely produce scarring, although the device also has the potential for significant improvement in the skin, he said.

"Share [the potential of side effects] with the patient," he suggested. "Let them be part of the decision."

VariLite Laser

Dr. Bill H. Halmi, a Phoenix-based dermatologist, demonstrated the use of the VariLite dual wavelength (532 nm or 940 nm) laser, manufactured by Iridex, as a "spot welding device" that can target unsightly perinasal vessels by creating a dotted line of damage, leaving untreated millimeters of tissue between the spots.

"Go for little gaps" in the visible vessel line, Dr. Zachary said during the live video presentation.

As visual evidence of the vein disappeared under the beam of the laser, Dr. Zachary marveled, "Oh, that's very nice. It's better than sex!"

Dr. Zachary stressed the need for wearing protective goggles, preferably polarized for better visualization, when using the device.

Dr. Goldman offered a less rosy opinion. "This is the single most dangerous procedure to do. It puts holes in peoples' faces," he said.

Whitened skin evident in the video close-ups represents destruction of the epidermis. He also expressed concern that the laser has no epidermal cooling system to prevent permanent heat damage.

Beyond the safety concerns, Dr. Goldman questioned the permanence of the VariLite treatment. Red telangiectasias seen at the nasal alar area originate from the nasolabial artery and "will always come back," he pointed out. "[I would] never, ever tell a patient it's permanent, and I don't think it's better than sex."

DermaSweep

One of a wide variety of dermabrasion devices, DermaSweep (developed by CosMedic) requires no anesthesia and is becoming a popular modality among physicians, said Dr. Zachary.

This particular unit uses suction to draw the skin close to a variety of different bristles that range from "a silky, superficial … polisher to aggressive bristles," he said.

The device is said to enhance penetration of infusions of hyaluronic acid, vitamin C preparations, and Levulan (DUSA Pharmaceuticals Inc.).

"There is no way an infusion of hyaluronic acid is going to do a darned thing beyond 1–2 days," said Dr. Goldman. He also questioned its use in patients with a propensity to develop telangiectasias, such as those with rosacea.

Physicians should understand that if they use it prior to a light peel, the peel will become a deep peel with all of the associated side effects.

This said, Dr. Goldman acknowledged that the DermaSweep is an "outstanding machine" and that he uses it in his spa and on patients receiving photodynamic therapy.

All of the panelists commented on the immediate smoothing created by the low-impact device.

"It feels good for a day," said Dr. Margaret Mann, who is with the department of dermatology at the University of California, Irvine. "You get what you pay for."

She said, however, that she also uses the device to enhance penetration of aminolevulinic acid before photodynamic therapy, and she sees it as a nice introductory procedure. "It's great for the patient who comes in and just wants to know what an aesthetic procedure is like," Dr. Mann said.

 

Once such a patient feels comfortable, he or she "might move on to something more aggressive," she suggested.

Dr. Zachary disclosed that he has received equipment loans from Rhytec, Iridex, and CosMedic.

Dr. Goldman, Dr. Mann, and Dr. Halmi had no disclosures relating to the products mentioned in this article.

Skin Disease Education Foundation and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — Don't bother leafing through the pages of glossy, upscale San Diego magazines to find advertisements for Dr. Mitchel P. Goldman's successful, 6-year-old medical spa.

Magazine marketing recruits mostly "looky-loos," said Dr. Goldman at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

Most of the marketing for La Jolla (Calif.) Spa MD occurs only after a patient enters the column-framed, wood-and-glass doors and is greeted by one of 92 staff members for a dermatology, cosmetic surgery, or cosmetic dentistry procedure; wellness/longevity consultation; spa service, or a trip to the retail center.

Then, "it's all marketing," from the videos playing in the waiting room and the artfully displayed brochures to the up-close (and sometimes alarming) computer analysis of patients' faces and flaws, with a scorecard and list of recommended procedures.

The patient who arrives for a simple $150 massage—the least profitable service in the spa—might also be informed that a cancellation has left a Botox appointment available, for 10% off.

Spa aestheticians, massage therapists, and make-up specialists receive incentives when their clients sign up for cosmetic medical procedures.

Established patients, whose names go into the computer database, receive discount coupons, specials, and gift cards. Birthday and anniversary cards arrive each year, with $50-off coupons. The spa newsletter features special promotions.

Upward of 10,000 Web site visitors a month, often drawn to the site by word-of-mouth, learn about spa and medical services, schedule spa "packages"—(the 3-hour, four-treatment "anti-cellulite sampler" goes for $620), and purchase products once they establish an online account, thus entering the database to receive e-mail blast offers for discount services.

Although he is not big on print and broadcast advertising, Dr. Goldman said he is generous with his time for interviews with journalists. He also promotes the spa by making generous charitable donations. At any given time, the practice may be conducting 20 active clinical trials, any of which may draw a newcomer who will then return as a paying customer.

Dr. Goldman's unconventional, upscale marketing efforts seem to be paying off. In the past 3 years, the number of new patients rose from 5,600 to 5,700, to 6,000, respectively, he said.

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Document

70565_fx1.sml

Dr. Mitchel P. Goldman's upscale marketing efforts are paying off. ©Marty Mann

What's Hot and What's Not at An Upscale California MediSpa

Dr. Goldman, founder of the La Jolla Spa MD medical spa, recently shared his observations about which treatments are "in," which are "out," and which aren't worth the trouble.

Ubiquitous Botox procedures, always a draw, and requests for other facial fillers have been up 25% in recent months at his spa, as a down economy induces penny-pinching socialites to seek out temporary, relatively affordable alternatives to big-ticket cosmetic surgery procedures, according to Dr. Goldman.

As a whole, aesthetic surgery procedures declined 10% last year, while appointments for plastic surgery took a 50% dive, said Dr. Goldman. Adding that breast implants, facelifts, and blepharoplasty procedures have seen a decline "all over California."

He predicted the popularity of these procedures will rebound with "pent-up demand" once the economy improves.

Leg vein procedures, hair removal, photodynamic therapy for acne, and intense pulsed light treatments are all holding their own, and cosmetic dentistry has proved to be "very profitable," he said.

The spa's retail center, which features a variety of skin products, has shown 133% growth in 5 years, now generating $1.5 million/year in sales.

Dr. Goldman doesn't recommend catering to patients requesting laser tattoo removal.

"They're the worst patients in the world," who may have paid $100 while drunk to get a tattoo and are irritated at the notion of paying thousands for 5-50 treatments to have them removed, he said.

SANTA MONICA, CALIF. — Don't bother leafing through the pages of glossy, upscale San Diego magazines to find advertisements for Dr. Mitchel P. Goldman's successful, 6-year-old medical spa.

Magazine marketing recruits mostly "looky-loos," said Dr. Goldman at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

Most of the marketing for La Jolla (Calif.) Spa MD occurs only after a patient enters the column-framed, wood-and-glass doors and is greeted by one of 92 staff members for a dermatology, cosmetic surgery, or cosmetic dentistry procedure; wellness/longevity consultation; spa service, or a trip to the retail center.

Then, "it's all marketing," from the videos playing in the waiting room and the artfully displayed brochures to the up-close (and sometimes alarming) computer analysis of patients' faces and flaws, with a scorecard and list of recommended procedures.

The patient who arrives for a simple $150 massage—the least profitable service in the spa—might also be informed that a cancellation has left a Botox appointment available, for 10% off.

Spa aestheticians, massage therapists, and make-up specialists receive incentives when their clients sign up for cosmetic medical procedures.

Established patients, whose names go into the computer database, receive discount coupons, specials, and gift cards. Birthday and anniversary cards arrive each year, with $50-off coupons. The spa newsletter features special promotions.

Upward of 10,000 Web site visitors a month, often drawn to the site by word-of-mouth, learn about spa and medical services, schedule spa "packages"—(the 3-hour, four-treatment "anti-cellulite sampler" goes for $620), and purchase products once they establish an online account, thus entering the database to receive e-mail blast offers for discount services.

Although he is not big on print and broadcast advertising, Dr. Goldman said he is generous with his time for interviews with journalists. He also promotes the spa by making generous charitable donations. At any given time, the practice may be conducting 20 active clinical trials, any of which may draw a newcomer who will then return as a paying customer.

Dr. Goldman's unconventional, upscale marketing efforts seem to be paying off. In the past 3 years, the number of new patients rose from 5,600 to 5,700, to 6,000, respectively, he said.

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Document

70565_fx1.sml

Dr. Mitchel P. Goldman's upscale marketing efforts are paying off. ©Marty Mann

What's Hot and What's Not at An Upscale California MediSpa

Dr. Goldman, founder of the La Jolla Spa MD medical spa, recently shared his observations about which treatments are "in," which are "out," and which aren't worth the trouble.

Ubiquitous Botox procedures, always a draw, and requests for other facial fillers have been up 25% in recent months at his spa, as a down economy induces penny-pinching socialites to seek out temporary, relatively affordable alternatives to big-ticket cosmetic surgery procedures, according to Dr. Goldman.

As a whole, aesthetic surgery procedures declined 10% last year, while appointments for plastic surgery took a 50% dive, said Dr. Goldman. Adding that breast implants, facelifts, and blepharoplasty procedures have seen a decline "all over California."

He predicted the popularity of these procedures will rebound with "pent-up demand" once the economy improves.

Leg vein procedures, hair removal, photodynamic therapy for acne, and intense pulsed light treatments are all holding their own, and cosmetic dentistry has proved to be "very profitable," he said.

The spa's retail center, which features a variety of skin products, has shown 133% growth in 5 years, now generating $1.5 million/year in sales.

Dr. Goldman doesn't recommend catering to patients requesting laser tattoo removal.

"They're the worst patients in the world," who may have paid $100 while drunk to get a tattoo and are irritated at the notion of paying thousands for 5-50 treatments to have them removed, he said.

SANTA MONICA, CALIF. — Don't bother leafing through the pages of glossy, upscale San Diego magazines to find advertisements for Dr. Mitchel P. Goldman's successful, 6-year-old medical spa.

Magazine marketing recruits mostly "looky-loos," said Dr. Goldman at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

Most of the marketing for La Jolla (Calif.) Spa MD occurs only after a patient enters the column-framed, wood-and-glass doors and is greeted by one of 92 staff members for a dermatology, cosmetic surgery, or cosmetic dentistry procedure; wellness/longevity consultation; spa service, or a trip to the retail center.

Then, "it's all marketing," from the videos playing in the waiting room and the artfully displayed brochures to the up-close (and sometimes alarming) computer analysis of patients' faces and flaws, with a scorecard and list of recommended procedures.

The patient who arrives for a simple $150 massage—the least profitable service in the spa—might also be informed that a cancellation has left a Botox appointment available, for 10% off.

Spa aestheticians, massage therapists, and make-up specialists receive incentives when their clients sign up for cosmetic medical procedures.

Established patients, whose names go into the computer database, receive discount coupons, specials, and gift cards. Birthday and anniversary cards arrive each year, with $50-off coupons. The spa newsletter features special promotions.

Upward of 10,000 Web site visitors a month, often drawn to the site by word-of-mouth, learn about spa and medical services, schedule spa "packages"—(the 3-hour, four-treatment "anti-cellulite sampler" goes for $620), and purchase products once they establish an online account, thus entering the database to receive e-mail blast offers for discount services.

Although he is not big on print and broadcast advertising, Dr. Goldman said he is generous with his time for interviews with journalists. He also promotes the spa by making generous charitable donations. At any given time, the practice may be conducting 20 active clinical trials, any of which may draw a newcomer who will then return as a paying customer.

Dr. Goldman's unconventional, upscale marketing efforts seem to be paying off. In the past 3 years, the number of new patients rose from 5,600 to 5,700, to 6,000, respectively, he said.

SDEF and this newspaper are wholly owned subsidiaries of Elsevier.

Document

70565_fx1.sml

Dr. Mitchel P. Goldman's upscale marketing efforts are paying off. ©Marty Mann

What's Hot and What's Not at An Upscale California MediSpa

Dr. Goldman, founder of the La Jolla Spa MD medical spa, recently shared his observations about which treatments are "in," which are "out," and which aren't worth the trouble.

Ubiquitous Botox procedures, always a draw, and requests for other facial fillers have been up 25% in recent months at his spa, as a down economy induces penny-pinching socialites to seek out temporary, relatively affordable alternatives to big-ticket cosmetic surgery procedures, according to Dr. Goldman.

As a whole, aesthetic surgery procedures declined 10% last year, while appointments for plastic surgery took a 50% dive, said Dr. Goldman. Adding that breast implants, facelifts, and blepharoplasty procedures have seen a decline "all over California."

He predicted the popularity of these procedures will rebound with "pent-up demand" once the economy improves.

Leg vein procedures, hair removal, photodynamic therapy for acne, and intense pulsed light treatments are all holding their own, and cosmetic dentistry has proved to be "very profitable," he said.

The spa's retail center, which features a variety of skin products, has shown 133% growth in 5 years, now generating $1.5 million/year in sales.

Dr. Goldman doesn't recommend catering to patients requesting laser tattoo removal.

"They're the worst patients in the world," who may have paid $100 while drunk to get a tattoo and are irritated at the notion of paying thousands for 5-50 treatments to have them removed, he said.

SANTA MONICA, CALIF. — When state coffers get low, legislators go hunting for cash.

Lately, in states such as Maryland and New York, lawmakers have been considering taxes on "luxury" items from upscale cars to aesthetic surgery offices, Dr. Ron Wheeland said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"This is not a new idea," he said, citing longstanding sales taxes on cosmetic surgery procedures in New Jersey and Minnesota.

In New Jersey, in fact, a Senate bill seeks to repeal the 2004 sales tax on cosmetic procedures because it generated far less money than expected.

But that experience hasn't stopped other states from trying.

In Tennessee, it's the same tune with different lyrics, as legislators consider a tax on devices and equipment used in cosmetic procedures, rather than targeting the consumers who pay for laser procedures and facelifts, he said.

Aesthetic procedures are also in the legislative spotlight with regard to safety and oversight, Dr. Wheeland said during a talk on the "new truths" in dermatology.

Restricting procedures and imposing tighter oversight measures are seen as "white hat" moves for legislators, who like to be seen protecting constituents, even in cases when not all the facts are in, said Dr. Wheeland, director of dermatologic surgery at the University of Missouri-Columbia.

In Virginia, House Bill 1399 would establish as a professional entity "laser light technicians" who would report not to the state boards that oversee physicians or nurses but to the board that oversees barbers and cosmetologists.

"I can only hope that that bill is defeated," he said.

In Georgia, Illinois, and California, proposed legislation would require preoperative examinations prior to laser or cosmetic surgical procedures. In Arizona, a bill is being considered that would allow nonphysicians to perform aesthetic procedures with lasers or light devices without physician supervision if they pass a 40-hour course.

Another bill in Illinois, which was referred to the rules committee in April, would permit only board-certified plastic surgeons to inject Botox, perform chemical peels, or perform aesthetic laser procedures.

"This one bothers me the most," said Dr. Wheeland. "When you think of these three procedures in particular, the first thing that ought to pop into your mind is that all three were developed by dermatologists."

It behooves dermatologists to be alert to themes and patterns in legislative proposals and to become involved when their own states are considering laws that would have a direct impact on the practice of dermatology, Dr. Wheeland said.

SDEF and this publication are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — When state coffers get low, legislators go hunting for cash.

Lately, in states such as Maryland and New York, lawmakers have been considering taxes on "luxury" items from upscale cars to aesthetic surgery offices, Dr. Ron Wheeland said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"This is not a new idea," he said, citing longstanding sales taxes on cosmetic surgery procedures in New Jersey and Minnesota.

In New Jersey, in fact, a Senate bill seeks to repeal the 2004 sales tax on cosmetic procedures because it generated far less money than expected.

But that experience hasn't stopped other states from trying.

In Tennessee, it's the same tune with different lyrics, as legislators consider a tax on devices and equipment used in cosmetic procedures, rather than targeting the consumers who pay for laser procedures and facelifts, he said.

Aesthetic procedures are also in the legislative spotlight with regard to safety and oversight, Dr. Wheeland said during a talk on the "new truths" in dermatology.

Restricting procedures and imposing tighter oversight measures are seen as "white hat" moves for legislators, who like to be seen protecting constituents, even in cases when not all the facts are in, said Dr. Wheeland, director of dermatologic surgery at the University of Missouri-Columbia.

In Virginia, House Bill 1399 would establish as a professional entity "laser light technicians" who would report not to the state boards that oversee physicians or nurses but to the board that oversees barbers and cosmetologists.

"I can only hope that that bill is defeated," he said.

In Georgia, Illinois, and California, proposed legislation would require preoperative examinations prior to laser or cosmetic surgical procedures. In Arizona, a bill is being considered that would allow nonphysicians to perform aesthetic procedures with lasers or light devices without physician supervision if they pass a 40-hour course.

Another bill in Illinois, which was referred to the rules committee in April, would permit only board-certified plastic surgeons to inject Botox, perform chemical peels, or perform aesthetic laser procedures.

"This one bothers me the most," said Dr. Wheeland. "When you think of these three procedures in particular, the first thing that ought to pop into your mind is that all three were developed by dermatologists."

It behooves dermatologists to be alert to themes and patterns in legislative proposals and to become involved when their own states are considering laws that would have a direct impact on the practice of dermatology, Dr. Wheeland said.

SDEF and this publication are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — When state coffers get low, legislators go hunting for cash.

Lately, in states such as Maryland and New York, lawmakers have been considering taxes on "luxury" items from upscale cars to aesthetic surgery offices, Dr. Ron Wheeland said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation.

"This is not a new idea," he said, citing longstanding sales taxes on cosmetic surgery procedures in New Jersey and Minnesota.

In New Jersey, in fact, a Senate bill seeks to repeal the 2004 sales tax on cosmetic procedures because it generated far less money than expected.

But that experience hasn't stopped other states from trying.

In Tennessee, it's the same tune with different lyrics, as legislators consider a tax on devices and equipment used in cosmetic procedures, rather than targeting the consumers who pay for laser procedures and facelifts, he said.

Aesthetic procedures are also in the legislative spotlight with regard to safety and oversight, Dr. Wheeland said during a talk on the "new truths" in dermatology.

Restricting procedures and imposing tighter oversight measures are seen as "white hat" moves for legislators, who like to be seen protecting constituents, even in cases when not all the facts are in, said Dr. Wheeland, director of dermatologic surgery at the University of Missouri-Columbia.

In Virginia, House Bill 1399 would establish as a professional entity "laser light technicians" who would report not to the state boards that oversee physicians or nurses but to the board that oversees barbers and cosmetologists.

"I can only hope that that bill is defeated," he said.

In Georgia, Illinois, and California, proposed legislation would require preoperative examinations prior to laser or cosmetic surgical procedures. In Arizona, a bill is being considered that would allow nonphysicians to perform aesthetic procedures with lasers or light devices without physician supervision if they pass a 40-hour course.

Another bill in Illinois, which was referred to the rules committee in April, would permit only board-certified plastic surgeons to inject Botox, perform chemical peels, or perform aesthetic laser procedures.

"This one bothers me the most," said Dr. Wheeland. "When you think of these three procedures in particular, the first thing that ought to pop into your mind is that all three were developed by dermatologists."

It behooves dermatologists to be alert to themes and patterns in legislative proposals and to become involved when their own states are considering laws that would have a direct impact on the practice of dermatology, Dr. Wheeland said.

SDEF and this publication are wholly owned subsidiaries of Elsevier.

KYOTO, JAPAN — Facial sagging has been found to be a function not only of aging, gravity, and environmental and lifestyle factors, but also of genetics.

Melanocortin 1 receptor (MC1R) and elastin proved to be significantly associated with the sagging of facial skin in a genetic study of 530 white women age 44-70 years, Christiane Guinot, Ph.D., said at an international investigative dermatology meeting.

The MC1R gene plays a major role in skin pigmentation and sensitivity to sunlight. Elastin figures prominently in arterial wall elasticity. Neither gene had previously been linked to sagging of facial skin, said Dr. Guinot of the Chanel Epidermal and Sensory Research and Investigation Center and the University of Tours (France).

Dr. Guinot, who is president of the French Statistical Association, reported that 121 of the 530 women had severe sagging of the facial skin based upon a structured 0-10 rating scale. Nongenetic factors that proved significantly associated with severe facial sagging were age, being overweight or obese, and being menopausal and not on hormone replacement therapy (HRT).

An analysis that adjusted for these factors revealed that women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging, compared with those with the wt/wt (wild type) genotype. Women with the Ser422Gly polymorphism of the elastin gene were at a 1.8-fold increased risk.

Overweight women were 1.7 times more likely to have severe facial sagging than normal-weight women; obese women were at 2.3-fold increased risk. Menopausal women not on HRT were an adjusted 2.1-fold more likely to have severe facial skin sagging than those on HRT.

Neither smoking status nor skin color was significantly associated with severity of facial skin sagging, although the spectrum of skin colors in this all-Caucasian study was limited, Dr. Guinot noted at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology. The study was sponsored by Chanel.

Document

70563_fx1.sml

Women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging. DR. GUINOT

KYOTO, JAPAN — Facial sagging has been found to be a function not only of aging, gravity, and environmental and lifestyle factors, but also of genetics.

Melanocortin 1 receptor (MC1R) and elastin proved to be significantly associated with the sagging of facial skin in a genetic study of 530 white women age 44-70 years, Christiane Guinot, Ph.D., said at an international investigative dermatology meeting.

The MC1R gene plays a major role in skin pigmentation and sensitivity to sunlight. Elastin figures prominently in arterial wall elasticity. Neither gene had previously been linked to sagging of facial skin, said Dr. Guinot of the Chanel Epidermal and Sensory Research and Investigation Center and the University of Tours (France).

Dr. Guinot, who is president of the French Statistical Association, reported that 121 of the 530 women had severe sagging of the facial skin based upon a structured 0-10 rating scale. Nongenetic factors that proved significantly associated with severe facial sagging were age, being overweight or obese, and being menopausal and not on hormone replacement therapy (HRT).

An analysis that adjusted for these factors revealed that women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging, compared with those with the wt/wt (wild type) genotype. Women with the Ser422Gly polymorphism of the elastin gene were at a 1.8-fold increased risk.

Overweight women were 1.7 times more likely to have severe facial sagging than normal-weight women; obese women were at 2.3-fold increased risk. Menopausal women not on HRT were an adjusted 2.1-fold more likely to have severe facial skin sagging than those on HRT.

Neither smoking status nor skin color was significantly associated with severity of facial skin sagging, although the spectrum of skin colors in this all-Caucasian study was limited, Dr. Guinot noted at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology. The study was sponsored by Chanel.

Document

70563_fx1.sml

Women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging. DR. GUINOT

KYOTO, JAPAN — Facial sagging has been found to be a function not only of aging, gravity, and environmental and lifestyle factors, but also of genetics.

Melanocortin 1 receptor (MC1R) and elastin proved to be significantly associated with the sagging of facial skin in a genetic study of 530 white women age 44-70 years, Christiane Guinot, Ph.D., said at an international investigative dermatology meeting.

The MC1R gene plays a major role in skin pigmentation and sensitivity to sunlight. Elastin figures prominently in arterial wall elasticity. Neither gene had previously been linked to sagging of facial skin, said Dr. Guinot of the Chanel Epidermal and Sensory Research and Investigation Center and the University of Tours (France).

Dr. Guinot, who is president of the French Statistical Association, reported that 121 of the 530 women had severe sagging of the facial skin based upon a structured 0-10 rating scale. Nongenetic factors that proved significantly associated with severe facial sagging were age, being overweight or obese, and being menopausal and not on hormone replacement therapy (HRT).

An analysis that adjusted for these factors revealed that women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging, compared with those with the wt/wt (wild type) genotype. Women with the Ser422Gly polymorphism of the elastin gene were at a 1.8-fold increased risk.

Overweight women were 1.7 times more likely to have severe facial sagging than normal-weight women; obese women were at 2.3-fold increased risk. Menopausal women not on HRT were an adjusted 2.1-fold more likely to have severe facial skin sagging than those on HRT.

Neither smoking status nor skin color was significantly associated with severity of facial skin sagging, although the spectrum of skin colors in this all-Caucasian study was limited, Dr. Guinot noted at the meeting of the European Society for Dermatological Research, the Japanese Society for Investigative Dermatology, and the Society for Investigative Dermatology. The study was sponsored by Chanel.

Document

70563_fx1.sml

Women carrying two variants of the MC1R gene were at a 2.3-fold increased risk of severe sagging. DR. GUINOT

Angelica sinensis, better known as dong quai, is a fragrant perennial plant that has been used for medicinal purposes for more than a thousand years in China, Japan, and Korea. A. sinensis is best known as a traditional treatment for dysmenorrhea, amenorrhea, menopause, and related conditions in women.

The herb is used throughout the world, including the United States, as an unregulated oral supplement and in some topical multibotanical formulations.

The dried root of A. sinensis is included in several herbal formulations, typically for amenorrhea, endometriosis and premenstrual syndrome, and as a hormone replacement therapy alternative, even though Western medicine has not established whether such indications are appropriate or justified (Integrative Cancer Therapies 2003;2:120-38; Nurse Pract. 1997;22:55-6, 61-6).

Despite numerous anecdotal reports of its effectiveness in exerting estrogenic effects, a study of 71 postmenopausal women showed that A. sinensis alone failed to produce estrogenic effects on endometrial thickness or vaginal maturation. In addition, the herb eased menopause symptoms no better than placebo (Fertil. Steril. 1997;68:981-6).

Although the reported effects of this reputed “women's herb” remain dubious in the West, evidence is increasing that A. sinensis possesses anticarcinogenic properties, which are often associated with antioxidant potential and implications for dermatologic use.

In this vein, the potent antioxidant ferulic acid, which was featured in this column in October 2005, has been identified as a major active component of A. sinensis, along with ligustilide (J. Pharm. Biomed. Anal. 2005;38:664-9).

Antitumor Action

Investigators assessing the antitumor effects, in vitro and in vivo, of a chloroform extract of A. sinensis on glioblastoma multiforme brain tumors reported that the herb strongly inhibits the growth of malignant brain tumor cells, via cell cycle arrest and apoptosis induction, without damaging fibroblasts.

In vitro, angelica spurred p53-dependent and -independent pathways, resulting in apoptosis. In human DBTRG-05MG and rat RG2 glioblastoma multiforme tumor cells, angelica suppressed malignant growth and reduced tumor volume. Researchers concluded that A. sinensis merits more research and consideration as a potential brain tumor therapeutic agent (Clin. Cancer Res. 2005;11:3475-84).

In a study that assessed the antioxidant activities of three herbs used frequently in traditional Chinese medicine—A. sinensis, Lycium barbarum, and Poria cocos—aqueous extracts of these herbs concentration-dependently displayed antioxidant activities. L. barbarum extract was the strongest, but all the extracts inhibited ferric chloride-ascorbic acid-induced lipid peroxidation in rat liver homogenate in vitro, and demonstrated significant superoxide anion-scavenging activity as well as antisuperoxide formation activity (Phytother. Res. 2004;18:1008-12).

Another study revealed that the total polysaccharide from A. sinensis confers antitumor effects on in vivo murine models and, in vitro, inhibits invasion and metastasis of hepatocellular cancer cells (World J. Gastroenterol. 2003;9:1963-7).

In a study of the effects of 14 commonly used herbs on cellular proliferation and apoptosis of a hepatic stellate cell line in rats, A. sinensis was among five herbs that exhibited both antiproliferative and proapoptotic properties in association with upregulation of Fas and Bax and downregulation of Bcl-xL. Investigators suggested that further research is warranted into the antifibrotic potential of these herbs to promote apoptosis in hepatic stellate cells, which are integral in hepatic fibrosis and are known to possess antifibrotic activity (J. Ethnopharmacol. 2005;100:180-6).

Action in the Skin

Perhaps the evidence providing the most direct link to dermatologic application comes from a study of the effects of A. sinensis on melanocytes and tyrosinase activity. The potent herb was noted for significantly promoting melanocytic proliferation, which substantially increased cell counts, and fostering melanin synthesis and melanocytic tyrosinase activity. Such actions, the investigators concluded, suggest a mechanism that may justify the use of this fragrant botanical in the treatment of skin dyschromias (Di Yi Jun Yi Da Xue Xue Bao 2003;23:239-41).

In addition, A. sinensis is an ingredient in Si-Wu-Tang, a traditional Chinese formula used to treat pruritus, chronic skin inflammation, and other conditions (Biol. Pharm. Bull. 2002;25:1175-8).

Gastrointestinal Protection

Polysaccharides isolated from the root of A. sinensis have been found to impart an ulcer-protective effect.

Specifically, angelica extract dose-dependently inhibited various neutrophil-dependent gastrointestinal lesions induced in rats by orally administered ethanol or indomethacin. The investigators concluded that angelica exhibits anti-inflammatory action, and might be effective in preventing neutrophil-dependent gastrointestinal damage (Planta Med. 2000;66:348-51).

Some of the same researchers followed up by demonstrating that A. sinensis extract has a direct wound-healing effect on gastric epithelial cells. The herb significantly promoted epithelial cell migration over an artificial wound, and dose-dependently stimulated DNA synthesis as well as concurrent epithelial growth factor mRNA expression (Life Sci. 2001;68:961-8).

Subsequent research confirmed that A. sinensis crude extract does dose-dependently confer a direct healing effect on gastric mucosal lesions in rats, and it also promotes wound repair in culture (Biochem. Pharmacol. 2001;61:1439-48).

 

Other Actions

An evaluation of the therapeutic activity of A. sinensis on focal ischemic injury in rats showed reduced volume of cerebral infarction, reduced Bax protein expression, and significant decreases in the number of neuronal apoptosis cells (Clin. Hemorheol. Microcirc. 2005;32:209-15). Improvement in microcirculation, with obvious implications for various organs, was achieved by the intravenous injection of A. sinensis in a study examining the mechanism of microcirculation disorder in the tongue in the common oral disease glossodynia (Hua Xi Kou Qiang Yi Xue Za Zhi 2000;18:101-2, 108).

Aqueous extract of A. sinensis has been shown in a rabbit model to impart myocardial protective effects caused by ischemia reperfusion (Zhongguo Zhong Xi Yi Jie He Za Zhi 1995;15:486-8).

A study of the effects of two herbs used in traditional Chinese medicine to treat bleomycin-induced pulmonary fibrosis in rats revealed that ligustrazini and, to a lesser extent, A. sinensis, lessened the severity of alveolitis symptomatic of pulmonary fibrosis (Zhonghua Jie He He Hu Xi Za Zhi 1996;19:26-8).

Similarly, a traditional Chinese medicinal decoction containing A. sinensis and Astragalus membranaceus, which is used for stimulating production of red blood cells and bolstering cardiovascular function, was shown in a rat model to confer myocardial protection against ischemia-reperfusion injury (Phytother. Res. 2000;14:195-9).

Injection of Qi-Xue, another Chinese herb combination containing A. sinensis, Panax ginseng, and Astragalus monogholicus, is thought to prevent severe hypoxic pulmonary hypertension by enhancing heart function (Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1990;12:51-5).

In high doses, A. sinensis may increase susceptibility to photosensitivity reactions, so sun exposure should be curtailed. It also is contraindicated for patients taking warfarin (Lancet 2000; 355:134-8; J. Am. Med. Womens Assoc. 1999;54:191-2, 195).

Conclusions

A. sinensis is one of the oldest and most popular herbs used in traditional Chinese medicine. While there is an expanding body of research on the broad medical applications of this botanical product, and it is being used in multibotanical formulations, there is minimal evidence as yet to warrant its use for dermatologic purposes.

Recent studies, however, do seem to indicate that A. sinensis has antioxidant and antitumorigenic activity and that it warrants further investigation, including for its potential benefit to the skin. Research associating angelica with melanocytic, anti-inflammatory, and antipruritic properties also deserves attention and further study.

Although little dermatologic research has been done, the Angelica sinensis plant, also known as dong quai, appears to have antioxidant and antitumorigenic activity.

Photo ©adisa/iStockphoto, Inc.

Angelica sinensis, better known as dong quai, is a fragrant perennial plant that has been used for medicinal purposes for more than a thousand years in China, Japan, and Korea. A. sinensis is best known as a traditional treatment for dysmenorrhea, amenorrhea, menopause, and related conditions in women.

The herb is used throughout the world, including the United States, as an unregulated oral supplement and in some topical multibotanical formulations.

The dried root of A. sinensis is included in several herbal formulations, typically for amenorrhea, endometriosis and premenstrual syndrome, and as a hormone replacement therapy alternative, even though Western medicine has not established whether such indications are appropriate or justified (Integrative Cancer Therapies 2003;2:120-38; Nurse Pract. 1997;22:55-6, 61-6).

Despite numerous anecdotal reports of its effectiveness in exerting estrogenic effects, a study of 71 postmenopausal women showed that A. sinensis alone failed to produce estrogenic effects on endometrial thickness or vaginal maturation. In addition, the herb eased menopause symptoms no better than placebo (Fertil. Steril. 1997;68:981-6).

Although the reported effects of this reputed “women's herb” remain dubious in the West, evidence is increasing that A. sinensis possesses anticarcinogenic properties, which are often associated with antioxidant potential and implications for dermatologic use.

In this vein, the potent antioxidant ferulic acid, which was featured in this column in October 2005, has been identified as a major active component of A. sinensis, along with ligustilide (J. Pharm. Biomed. Anal. 2005;38:664-9).

Antitumor Action

Investigators assessing the antitumor effects, in vitro and in vivo, of a chloroform extract of A. sinensis on glioblastoma multiforme brain tumors reported that the herb strongly inhibits the growth of malignant brain tumor cells, via cell cycle arrest and apoptosis induction, without damaging fibroblasts.

In vitro, angelica spurred p53-dependent and -independent pathways, resulting in apoptosis. In human DBTRG-05MG and rat RG2 glioblastoma multiforme tumor cells, angelica suppressed malignant growth and reduced tumor volume. Researchers concluded that A. sinensis merits more research and consideration as a potential brain tumor therapeutic agent (Clin. Cancer Res. 2005;11:3475-84).

In a study that assessed the antioxidant activities of three herbs used frequently in traditional Chinese medicine—A. sinensis, Lycium barbarum, and Poria cocos—aqueous extracts of these herbs concentration-dependently displayed antioxidant activities. L. barbarum extract was the strongest, but all the extracts inhibited ferric chloride-ascorbic acid-induced lipid peroxidation in rat liver homogenate in vitro, and demonstrated significant superoxide anion-scavenging activity as well as antisuperoxide formation activity (Phytother. Res. 2004;18:1008-12).

Another study revealed that the total polysaccharide from A. sinensis confers antitumor effects on in vivo murine models and, in vitro, inhibits invasion and metastasis of hepatocellular cancer cells (World J. Gastroenterol. 2003;9:1963-7).

In a study of the effects of 14 commonly used herbs on cellular proliferation and apoptosis of a hepatic stellate cell line in rats, A. sinensis was among five herbs that exhibited both antiproliferative and proapoptotic properties in association with upregulation of Fas and Bax and downregulation of Bcl-xL. Investigators suggested that further research is warranted into the antifibrotic potential of these herbs to promote apoptosis in hepatic stellate cells, which are integral in hepatic fibrosis and are known to possess antifibrotic activity (J. Ethnopharmacol. 2005;100:180-6).

Action in the Skin

Perhaps the evidence providing the most direct link to dermatologic application comes from a study of the effects of A. sinensis on melanocytes and tyrosinase activity. The potent herb was noted for significantly promoting melanocytic proliferation, which substantially increased cell counts, and fostering melanin synthesis and melanocytic tyrosinase activity. Such actions, the investigators concluded, suggest a mechanism that may justify the use of this fragrant botanical in the treatment of skin dyschromias (Di Yi Jun Yi Da Xue Xue Bao 2003;23:239-41).

In addition, A. sinensis is an ingredient in Si-Wu-Tang, a traditional Chinese formula used to treat pruritus, chronic skin inflammation, and other conditions (Biol. Pharm. Bull. 2002;25:1175-8).

Gastrointestinal Protection

Polysaccharides isolated from the root of A. sinensis have been found to impart an ulcer-protective effect.

Specifically, angelica extract dose-dependently inhibited various neutrophil-dependent gastrointestinal lesions induced in rats by orally administered ethanol or indomethacin. The investigators concluded that angelica exhibits anti-inflammatory action, and might be effective in preventing neutrophil-dependent gastrointestinal damage (Planta Med. 2000;66:348-51).

Some of the same researchers followed up by demonstrating that A. sinensis extract has a direct wound-healing effect on gastric epithelial cells. The herb significantly promoted epithelial cell migration over an artificial wound, and dose-dependently stimulated DNA synthesis as well as concurrent epithelial growth factor mRNA expression (Life Sci. 2001;68:961-8).

Subsequent research confirmed that A. sinensis crude extract does dose-dependently confer a direct healing effect on gastric mucosal lesions in rats, and it also promotes wound repair in culture (Biochem. Pharmacol. 2001;61:1439-48).

 

Other Actions

An evaluation of the therapeutic activity of A. sinensis on focal ischemic injury in rats showed reduced volume of cerebral infarction, reduced Bax protein expression, and significant decreases in the number of neuronal apoptosis cells (Clin. Hemorheol. Microcirc. 2005;32:209-15). Improvement in microcirculation, with obvious implications for various organs, was achieved by the intravenous injection of A. sinensis in a study examining the mechanism of microcirculation disorder in the tongue in the common oral disease glossodynia (Hua Xi Kou Qiang Yi Xue Za Zhi 2000;18:101-2, 108).

Aqueous extract of A. sinensis has been shown in a rabbit model to impart myocardial protective effects caused by ischemia reperfusion (Zhongguo Zhong Xi Yi Jie He Za Zhi 1995;15:486-8).

A study of the effects of two herbs used in traditional Chinese medicine to treat bleomycin-induced pulmonary fibrosis in rats revealed that ligustrazini and, to a lesser extent, A. sinensis, lessened the severity of alveolitis symptomatic of pulmonary fibrosis (Zhonghua Jie He He Hu Xi Za Zhi 1996;19:26-8).

Similarly, a traditional Chinese medicinal decoction containing A. sinensis and Astragalus membranaceus, which is used for stimulating production of red blood cells and bolstering cardiovascular function, was shown in a rat model to confer myocardial protection against ischemia-reperfusion injury (Phytother. Res. 2000;14:195-9).

Injection of Qi-Xue, another Chinese herb combination containing A. sinensis, Panax ginseng, and Astragalus monogholicus, is thought to prevent severe hypoxic pulmonary hypertension by enhancing heart function (Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1990;12:51-5).

In high doses, A. sinensis may increase susceptibility to photosensitivity reactions, so sun exposure should be curtailed. It also is contraindicated for patients taking warfarin (Lancet 2000; 355:134-8; J. Am. Med. Womens Assoc. 1999;54:191-2, 195).

Conclusions

A. sinensis is one of the oldest and most popular herbs used in traditional Chinese medicine. While there is an expanding body of research on the broad medical applications of this botanical product, and it is being used in multibotanical formulations, there is minimal evidence as yet to warrant its use for dermatologic purposes.

Recent studies, however, do seem to indicate that A. sinensis has antioxidant and antitumorigenic activity and that it warrants further investigation, including for its potential benefit to the skin. Research associating angelica with melanocytic, anti-inflammatory, and antipruritic properties also deserves attention and further study.

Although little dermatologic research has been done, the Angelica sinensis plant, also known as dong quai, appears to have antioxidant and antitumorigenic activity.

Photo ©adisa/iStockphoto, Inc.

Angelica sinensis, better known as dong quai, is a fragrant perennial plant that has been used for medicinal purposes for more than a thousand years in China, Japan, and Korea. A. sinensis is best known as a traditional treatment for dysmenorrhea, amenorrhea, menopause, and related conditions in women.

The herb is used throughout the world, including the United States, as an unregulated oral supplement and in some topical multibotanical formulations.

The dried root of A. sinensis is included in several herbal formulations, typically for amenorrhea, endometriosis and premenstrual syndrome, and as a hormone replacement therapy alternative, even though Western medicine has not established whether such indications are appropriate or justified (Integrative Cancer Therapies 2003;2:120-38; Nurse Pract. 1997;22:55-6, 61-6).

Despite numerous anecdotal reports of its effectiveness in exerting estrogenic effects, a study of 71 postmenopausal women showed that A. sinensis alone failed to produce estrogenic effects on endometrial thickness or vaginal maturation. In addition, the herb eased menopause symptoms no better than placebo (Fertil. Steril. 1997;68:981-6).

Although the reported effects of this reputed “women's herb” remain dubious in the West, evidence is increasing that A. sinensis possesses anticarcinogenic properties, which are often associated with antioxidant potential and implications for dermatologic use.

In this vein, the potent antioxidant ferulic acid, which was featured in this column in October 2005, has been identified as a major active component of A. sinensis, along with ligustilide (J. Pharm. Biomed. Anal. 2005;38:664-9).

Antitumor Action

Investigators assessing the antitumor effects, in vitro and in vivo, of a chloroform extract of A. sinensis on glioblastoma multiforme brain tumors reported that the herb strongly inhibits the growth of malignant brain tumor cells, via cell cycle arrest and apoptosis induction, without damaging fibroblasts.

In vitro, angelica spurred p53-dependent and -independent pathways, resulting in apoptosis. In human DBTRG-05MG and rat RG2 glioblastoma multiforme tumor cells, angelica suppressed malignant growth and reduced tumor volume. Researchers concluded that A. sinensis merits more research and consideration as a potential brain tumor therapeutic agent (Clin. Cancer Res. 2005;11:3475-84).

In a study that assessed the antioxidant activities of three herbs used frequently in traditional Chinese medicine—A. sinensis, Lycium barbarum, and Poria cocos—aqueous extracts of these herbs concentration-dependently displayed antioxidant activities. L. barbarum extract was the strongest, but all the extracts inhibited ferric chloride-ascorbic acid-induced lipid peroxidation in rat liver homogenate in vitro, and demonstrated significant superoxide anion-scavenging activity as well as antisuperoxide formation activity (Phytother. Res. 2004;18:1008-12).

Another study revealed that the total polysaccharide from A. sinensis confers antitumor effects on in vivo murine models and, in vitro, inhibits invasion and metastasis of hepatocellular cancer cells (World J. Gastroenterol. 2003;9:1963-7).

In a study of the effects of 14 commonly used herbs on cellular proliferation and apoptosis of a hepatic stellate cell line in rats, A. sinensis was among five herbs that exhibited both antiproliferative and proapoptotic properties in association with upregulation of Fas and Bax and downregulation of Bcl-xL. Investigators suggested that further research is warranted into the antifibrotic potential of these herbs to promote apoptosis in hepatic stellate cells, which are integral in hepatic fibrosis and are known to possess antifibrotic activity (J. Ethnopharmacol. 2005;100:180-6).

Action in the Skin

Perhaps the evidence providing the most direct link to dermatologic application comes from a study of the effects of A. sinensis on melanocytes and tyrosinase activity. The potent herb was noted for significantly promoting melanocytic proliferation, which substantially increased cell counts, and fostering melanin synthesis and melanocytic tyrosinase activity. Such actions, the investigators concluded, suggest a mechanism that may justify the use of this fragrant botanical in the treatment of skin dyschromias (Di Yi Jun Yi Da Xue Xue Bao 2003;23:239-41).

In addition, A. sinensis is an ingredient in Si-Wu-Tang, a traditional Chinese formula used to treat pruritus, chronic skin inflammation, and other conditions (Biol. Pharm. Bull. 2002;25:1175-8).

Gastrointestinal Protection

Polysaccharides isolated from the root of A. sinensis have been found to impart an ulcer-protective effect.

Specifically, angelica extract dose-dependently inhibited various neutrophil-dependent gastrointestinal lesions induced in rats by orally administered ethanol or indomethacin. The investigators concluded that angelica exhibits anti-inflammatory action, and might be effective in preventing neutrophil-dependent gastrointestinal damage (Planta Med. 2000;66:348-51).

Some of the same researchers followed up by demonstrating that A. sinensis extract has a direct wound-healing effect on gastric epithelial cells. The herb significantly promoted epithelial cell migration over an artificial wound, and dose-dependently stimulated DNA synthesis as well as concurrent epithelial growth factor mRNA expression (Life Sci. 2001;68:961-8).

Subsequent research confirmed that A. sinensis crude extract does dose-dependently confer a direct healing effect on gastric mucosal lesions in rats, and it also promotes wound repair in culture (Biochem. Pharmacol. 2001;61:1439-48).

 

Other Actions

An evaluation of the therapeutic activity of A. sinensis on focal ischemic injury in rats showed reduced volume of cerebral infarction, reduced Bax protein expression, and significant decreases in the number of neuronal apoptosis cells (Clin. Hemorheol. Microcirc. 2005;32:209-15). Improvement in microcirculation, with obvious implications for various organs, was achieved by the intravenous injection of A. sinensis in a study examining the mechanism of microcirculation disorder in the tongue in the common oral disease glossodynia (Hua Xi Kou Qiang Yi Xue Za Zhi 2000;18:101-2, 108).

Aqueous extract of A. sinensis has been shown in a rabbit model to impart myocardial protective effects caused by ischemia reperfusion (Zhongguo Zhong Xi Yi Jie He Za Zhi 1995;15:486-8).

A study of the effects of two herbs used in traditional Chinese medicine to treat bleomycin-induced pulmonary fibrosis in rats revealed that ligustrazini and, to a lesser extent, A. sinensis, lessened the severity of alveolitis symptomatic of pulmonary fibrosis (Zhonghua Jie He He Hu Xi Za Zhi 1996;19:26-8).

Similarly, a traditional Chinese medicinal decoction containing A. sinensis and Astragalus membranaceus, which is used for stimulating production of red blood cells and bolstering cardiovascular function, was shown in a rat model to confer myocardial protection against ischemia-reperfusion injury (Phytother. Res. 2000;14:195-9).

Injection of Qi-Xue, another Chinese herb combination containing A. sinensis, Panax ginseng, and Astragalus monogholicus, is thought to prevent severe hypoxic pulmonary hypertension by enhancing heart function (Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1990;12:51-5).

In high doses, A. sinensis may increase susceptibility to photosensitivity reactions, so sun exposure should be curtailed. It also is contraindicated for patients taking warfarin (Lancet 2000; 355:134-8; J. Am. Med. Womens Assoc. 1999;54:191-2, 195).

Conclusions

A. sinensis is one of the oldest and most popular herbs used in traditional Chinese medicine. While there is an expanding body of research on the broad medical applications of this botanical product, and it is being used in multibotanical formulations, there is minimal evidence as yet to warrant its use for dermatologic purposes.

Recent studies, however, do seem to indicate that A. sinensis has antioxidant and antitumorigenic activity and that it warrants further investigation, including for its potential benefit to the skin. Research associating angelica with melanocytic, anti-inflammatory, and antipruritic properties also deserves attention and further study.

Although little dermatologic research has been done, the Angelica sinensis plant, also known as dong quai, appears to have antioxidant and antitumorigenic activity.

Photo ©adisa/iStockphoto, Inc.

SANTA MONICA, CALIF. — In the world of cosmetic skin rejuvenation, what's old is new again.

Ablative laser resurfacing with CO₂ lasers—using fractionalized laser energy this time around to reduce healing time—dominated a recent cosmetic dermatology seminar sponsored by Skin Disease Educational Foundation.

"It's almost like we're rediscovering the wheel," said Dr. Mitchel Goldman, who is a dermatologist in private practice in La Jolla, Calif.

Dr. Goldman explained that he has 32 lasers in his office, but the only ones that truly smooth wrinkles and tighten the skin are the CO₂ and erbium:YAG lasers.

The others, he said, mainly address pigmentation issues and vascular changes. They demand multiple visits, multiple passes, and generate multiple complaints from patients who see little improvement in their overall appearance.

The drawback with CO₂ lasers is the downtime to allow for healing, even with fractional ablative resurfacing. "No matter what anyone says, there is some downtime," now averaging approximately 4-5 days, compared with the 1-4 weeks for first-generation CO₂ lasers, he said.

The lure of fractional CO₂ resurfacing is its reliability in producing meaningful cosmetic skin changes with less damage by creating pinpoint "drill holes" linked by tissue bridges.

Among 356 patients who have undergone fractionalized CO₂ laser procedures in his practice in the past 3 years, "we have seen virtually no complications," he said. A 1% incidence of herpes was eliminated by the addition of antiviral prophylaxis in every case. There has been a 2% rate of erythema lasting for more than 4 days.

"That was it," he said, detailing his experience with Lumenis systems.

The three big players in ablative fractional resurfacing, according to Dr. Goldman, are the Fraxel Re:pair by Reliant, and the ActiveFX and DeepFX by Lumenis.

Speakers discussed their experiences with each, coming to the conclusion that the devices induce significant nonspecific thermal damage that induces collagen remodeling, yet invite far fewer complications than traditional CO₂ lasers, including burns and pigmentation abnormalities.

"I think there's been a quantum shift back toward CO₂. The reason is, CO₂ works," said Dr. John Fezza of Sarasota, Fla.

"There's no question, there is some redness," acknowledged Dr. Fezza, who performed a real-time video laser resurfacing procedure on a 42-year-old woman with sun damage during the meeting.

Still, in more than 2 years, he has seen no lasting hyper- or hypopigmentation—common side effects associated with traditional CO₂ laser resurfacing.

Patients with realistic expectations know that if they have a fractionated CO₂ laser procedure on a Friday, they'll be ready to go out with makeup by Monday.

"They don't mind house arrest for 3 days," he said.

Dr. Goldman said he considers fractionated CO₂ lasers "safe if you go within the [recommended] parameters," but they require care and caution just like their prototypes.

Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine, said he believes the reason fractionated CO₂ lasers have a measurable impact on wrinkling and skin tightening is that "they have the ability to induce a defect that is deeper than it is wide."

Dr. David Goldberg agreed. For photo damage and superficial rhytids, the key is density, but depth is what matters if the goal is skin tightening, he said.

"I'm pretty convinced," Dr. Goldberg said.

All speakers at the session disclosed grant support, laser equipment loans, and/or speakers bureau ties to companies that manufacture lasers, including Reliant and Lumenis.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — In the world of cosmetic skin rejuvenation, what's old is new again.

Ablative laser resurfacing with CO₂ lasers—using fractionalized laser energy this time around to reduce healing time—dominated a recent cosmetic dermatology seminar sponsored by Skin Disease Educational Foundation.

"It's almost like we're rediscovering the wheel," said Dr. Mitchel Goldman, who is a dermatologist in private practice in La Jolla, Calif.

Dr. Goldman explained that he has 32 lasers in his office, but the only ones that truly smooth wrinkles and tighten the skin are the CO₂ and erbium:YAG lasers.

The others, he said, mainly address pigmentation issues and vascular changes. They demand multiple visits, multiple passes, and generate multiple complaints from patients who see little improvement in their overall appearance.

The drawback with CO₂ lasers is the downtime to allow for healing, even with fractional ablative resurfacing. "No matter what anyone says, there is some downtime," now averaging approximately 4-5 days, compared with the 1-4 weeks for first-generation CO₂ lasers, he said.

The lure of fractional CO₂ resurfacing is its reliability in producing meaningful cosmetic skin changes with less damage by creating pinpoint "drill holes" linked by tissue bridges.

Among 356 patients who have undergone fractionalized CO₂ laser procedures in his practice in the past 3 years, "we have seen virtually no complications," he said. A 1% incidence of herpes was eliminated by the addition of antiviral prophylaxis in every case. There has been a 2% rate of erythema lasting for more than 4 days.

"That was it," he said, detailing his experience with Lumenis systems.

The three big players in ablative fractional resurfacing, according to Dr. Goldman, are the Fraxel Re:pair by Reliant, and the ActiveFX and DeepFX by Lumenis.

Speakers discussed their experiences with each, coming to the conclusion that the devices induce significant nonspecific thermal damage that induces collagen remodeling, yet invite far fewer complications than traditional CO₂ lasers, including burns and pigmentation abnormalities.

"I think there's been a quantum shift back toward CO₂. The reason is, CO₂ works," said Dr. John Fezza of Sarasota, Fla.

"There's no question, there is some redness," acknowledged Dr. Fezza, who performed a real-time video laser resurfacing procedure on a 42-year-old woman with sun damage during the meeting.

Still, in more than 2 years, he has seen no lasting hyper- or hypopigmentation—common side effects associated with traditional CO₂ laser resurfacing.

Patients with realistic expectations know that if they have a fractionated CO₂ laser procedure on a Friday, they'll be ready to go out with makeup by Monday.

"They don't mind house arrest for 3 days," he said.

Dr. Goldman said he considers fractionated CO₂ lasers "safe if you go within the [recommended] parameters," but they require care and caution just like their prototypes.

Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine, said he believes the reason fractionated CO₂ lasers have a measurable impact on wrinkling and skin tightening is that "they have the ability to induce a defect that is deeper than it is wide."

Dr. David Goldberg agreed. For photo damage and superficial rhytids, the key is density, but depth is what matters if the goal is skin tightening, he said.

"I'm pretty convinced," Dr. Goldberg said.

All speakers at the session disclosed grant support, laser equipment loans, and/or speakers bureau ties to companies that manufacture lasers, including Reliant and Lumenis.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

SANTA MONICA, CALIF. — In the world of cosmetic skin rejuvenation, what's old is new again.

Ablative laser resurfacing with CO₂ lasers—using fractionalized laser energy this time around to reduce healing time—dominated a recent cosmetic dermatology seminar sponsored by Skin Disease Educational Foundation.

"It's almost like we're rediscovering the wheel," said Dr. Mitchel Goldman, who is a dermatologist in private practice in La Jolla, Calif.

Dr. Goldman explained that he has 32 lasers in his office, but the only ones that truly smooth wrinkles and tighten the skin are the CO₂ and erbium:YAG lasers.

The others, he said, mainly address pigmentation issues and vascular changes. They demand multiple visits, multiple passes, and generate multiple complaints from patients who see little improvement in their overall appearance.

The drawback with CO₂ lasers is the downtime to allow for healing, even with fractional ablative resurfacing. "No matter what anyone says, there is some downtime," now averaging approximately 4-5 days, compared with the 1-4 weeks for first-generation CO₂ lasers, he said.

The lure of fractional CO₂ resurfacing is its reliability in producing meaningful cosmetic skin changes with less damage by creating pinpoint "drill holes" linked by tissue bridges.

Among 356 patients who have undergone fractionalized CO₂ laser procedures in his practice in the past 3 years, "we have seen virtually no complications," he said. A 1% incidence of herpes was eliminated by the addition of antiviral prophylaxis in every case. There has been a 2% rate of erythema lasting for more than 4 days.

"That was it," he said, detailing his experience with Lumenis systems.

The three big players in ablative fractional resurfacing, according to Dr. Goldman, are the Fraxel Re:pair by Reliant, and the ActiveFX and DeepFX by Lumenis.

Speakers discussed their experiences with each, coming to the conclusion that the devices induce significant nonspecific thermal damage that induces collagen remodeling, yet invite far fewer complications than traditional CO₂ lasers, including burns and pigmentation abnormalities.

"I think there's been a quantum shift back toward CO₂. The reason is, CO₂ works," said Dr. John Fezza of Sarasota, Fla.

"There's no question, there is some redness," acknowledged Dr. Fezza, who performed a real-time video laser resurfacing procedure on a 42-year-old woman with sun damage during the meeting.

Still, in more than 2 years, he has seen no lasting hyper- or hypopigmentation—common side effects associated with traditional CO₂ laser resurfacing.

Patients with realistic expectations know that if they have a fractionated CO₂ laser procedure on a Friday, they'll be ready to go out with makeup by Monday.

"They don't mind house arrest for 3 days," he said.

Dr. Goldman said he considers fractionated CO₂ lasers "safe if you go within the [recommended] parameters," but they require care and caution just like their prototypes.

Dr. Christopher Zachary, professor and chair of dermatology at the University of California, Irvine, said he believes the reason fractionated CO₂ lasers have a measurable impact on wrinkling and skin tightening is that "they have the ability to induce a defect that is deeper than it is wide."

Dr. David Goldberg agreed. For photo damage and superficial rhytids, the key is density, but depth is what matters if the goal is skin tightening, he said.

"I'm pretty convinced," Dr. Goldberg said.

All speakers at the session disclosed grant support, laser equipment loans, and/or speakers bureau ties to companies that manufacture lasers, including Reliant and Lumenis.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.