AAD Annual Meeting 2016

WASHINGTON – Antivirals, rest, and pain management are the Big Three of shingles treatment, and they should be employed early and consistently.

There are ways to tweak response, such as augmenting pain management with antidepressants or anticonvulsants. And a corticosteroid may have a place in the mix for some patients. But the importance of the Big Three can’t be overstressed, Dr. Kenneth Tomecki said at the annual meeting of the American Academy of Dermatology.

“You want to halt the progression of disease and decrease viral shedding,” said Dr. Tomecki of the Cleveland Clinic in Ohio. “But the key to successful treatment is to decrease the severity of pain. It is a strong attendant feature. There will be pain and we need to try hard to keep it as brief as possible. Some patients are stoic and will tell you they don’t need anything for pain. Don’t believe them.”

Managing pain also makes it easier to get patients to relax and slow down. “Rest, rest, rest, and more rest. Rest leads the list. These patients need to slow down and cool it. They have a viral illness and systemic disease. Rest is mandatory.”

Antiviral therapy is a key part of treatment, but only if it’s timely. “If you can get it on board in the first 72 hours, you can increase the likelihood of the rash resolving quickly, limit the pain, and reduce the risk of postherpetic neuralgia by 50%.”

The mainstay of antiviral therapy has been acyclovir, which is effective and inexpensive – about $30 for a 7-10 day course. But its bioavailability is not great, which means patients need to take it five times a day.

Famciclovir and valacyclovir possess more efficient pharmacokinetic profiles, and are just as safe and well-tolerated. Their thrice-daily dosing schedules make them a little more manageable for most patients. They are more expensive (about $100 for a week-long course), but not prohibitively so, Dr. Tomecki said. And both of them are effective, with evidence from a randomized, double-blind, controlled trial showing a similar benefit for acute pain and postherpetic neuralgia (Arch Fam Med. 2000;9:863-9).

“I would say both of the newer drugs work a little bit better than acyclovir, but they are similar to each other,” he said. “My go-to treatment for uncomplicated zoster is 1 gram of valacyclovir three times a day for 7-10 days, and I throw in either gabapentin or pregabalin.”

In an open-label study of 166 patients (Arch Dermatol. 2011;147[8]:901-7), this combination resulted in less than a 10% incidence of postherpetic neuralgia at 6 months, Dr. Tomecki added.

Mild pain during the acute phase can be handled with acetaminophen or nonsteroidal anti-inflammatories. But lots of patients need a bigger bullet for their discomfort. Tramadol at 50 mg/day or a weak opioid will work for moderate pain. With severe pain, start thinking about oxycodone.

A tapered dose of corticosteroid can be included, especially if cellulitis is involved in the clinical picture. “It does help patients feel better, and there’s no real detriment to it,” Dr. Tomecki said.

Patients who have postherpetic pain may need longer-term pain management. Lidocaine patches and capsaicin cream are both effective, and they work best if used consistently. The recommended dosing frequency for capsaicin is three or four times a day, “But to be really effective I find you need to apply it more like five or six times a day.”

Patients with persistent postherpetic pain should probably be referred to a neurologist or pain management specialist. In the meantime, though, tricyclic antidepressants aren’t out of the question, but they take a while to kick in and must be used very, very carefully in elderly patients. “Don’t jump in initially with these. Start with good derm care and rest.”

The anticonvulsants gabapentin or pregabalin can also be helpful. “If you do start any of these, start low, go slow and refer for pain management.”

A 2014 meta-analysis of seven studies, however, showed a mixed bag of benefits and tradeoffs (Minerva Anestesiol. 2014 May;80[5]:556-67). Gabapentin improved sleep quality and significantly reduce pain, but patients who took it were likely to report dizziness, sleepiness, edema, ataxia, and diarrhea.

Antidepressants and anticonvulsants may be out of the purview of many dermatologists, but other pain management strategies are not, Dr. Tomecki said. Among them is cryotherapy.

“I’m not talking about freezing as in truly freezing like with do with actinic keratosis. I’m talking about just a gentle brushing of the area.”

A small study of 47 patients employed a 30-second pass of liquid nitrogen over the affected sensory nerve dermatome, making sure not to freeze the skin (Int J Dermatol. 2011 Jun;50[6]:746-50). The treatment consisted of three passes per session on a weekly basis. Most of the patients (94%) experienced good or excellent improvements by week 6. For 19%, one session was enough to eliminate pain, and 17% had complete pain relief in two sessions.

Narrow-band ultraviolet light is another easy and inexpensive option, Dr. Tomecki said. ”We only have a small study on this, but more than 50% of patients in it did very well.”

The 17 patients had three weekly sessions of light therapy for 15 weeks or until pain disappeared. About half reported at least a 50% improvement in pain by the end of 3 months (Indian J Dermatol. 2011 Jan-Feb;56[1]:44–47).

“These are both interventions that are easily available, inexpensive, and well within our reach as dermatologists,” he said.

He had no financial disclosures.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Antivirals, rest, and pain management are the Big Three of shingles treatment, and they should be employed early and consistently.

There are ways to tweak response, such as augmenting pain management with antidepressants or anticonvulsants. And a corticosteroid may have a place in the mix for some patients. But the importance of the Big Three can’t be overstressed, Dr. Kenneth Tomecki said at the annual meeting of the American Academy of Dermatology.

“You want to halt the progression of disease and decrease viral shedding,” said Dr. Tomecki of the Cleveland Clinic in Ohio. “But the key to successful treatment is to decrease the severity of pain. It is a strong attendant feature. There will be pain and we need to try hard to keep it as brief as possible. Some patients are stoic and will tell you they don’t need anything for pain. Don’t believe them.”

Managing pain also makes it easier to get patients to relax and slow down. “Rest, rest, rest, and more rest. Rest leads the list. These patients need to slow down and cool it. They have a viral illness and systemic disease. Rest is mandatory.”

Antiviral therapy is a key part of treatment, but only if it’s timely. “If you can get it on board in the first 72 hours, you can increase the likelihood of the rash resolving quickly, limit the pain, and reduce the risk of postherpetic neuralgia by 50%.”

The mainstay of antiviral therapy has been acyclovir, which is effective and inexpensive – about $30 for a 7-10 day course. But its bioavailability is not great, which means patients need to take it five times a day.

Famciclovir and valacyclovir possess more efficient pharmacokinetic profiles, and are just as safe and well-tolerated. Their thrice-daily dosing schedules make them a little more manageable for most patients. They are more expensive (about $100 for a week-long course), but not prohibitively so, Dr. Tomecki said. And both of them are effective, with evidence from a randomized, double-blind, controlled trial showing a similar benefit for acute pain and postherpetic neuralgia (Arch Fam Med. 2000;9:863-9).

“I would say both of the newer drugs work a little bit better than acyclovir, but they are similar to each other,” he said. “My go-to treatment for uncomplicated zoster is 1 gram of valacyclovir three times a day for 7-10 days, and I throw in either gabapentin or pregabalin.”

In an open-label study of 166 patients (Arch Dermatol. 2011;147[8]:901-7), this combination resulted in less than a 10% incidence of postherpetic neuralgia at 6 months, Dr. Tomecki added.

Mild pain during the acute phase can be handled with acetaminophen or nonsteroidal anti-inflammatories. But lots of patients need a bigger bullet for their discomfort. Tramadol at 50 mg/day or a weak opioid will work for moderate pain. With severe pain, start thinking about oxycodone.

A tapered dose of corticosteroid can be included, especially if cellulitis is involved in the clinical picture. “It does help patients feel better, and there’s no real detriment to it,” Dr. Tomecki said.

Patients who have postherpetic pain may need longer-term pain management. Lidocaine patches and capsaicin cream are both effective, and they work best if used consistently. The recommended dosing frequency for capsaicin is three or four times a day, “But to be really effective I find you need to apply it more like five or six times a day.”

Patients with persistent postherpetic pain should probably be referred to a neurologist or pain management specialist. In the meantime, though, tricyclic antidepressants aren’t out of the question, but they take a while to kick in and must be used very, very carefully in elderly patients. “Don’t jump in initially with these. Start with good derm care and rest.”

The anticonvulsants gabapentin or pregabalin can also be helpful. “If you do start any of these, start low, go slow and refer for pain management.”

A 2014 meta-analysis of seven studies, however, showed a mixed bag of benefits and tradeoffs (Minerva Anestesiol. 2014 May;80[5]:556-67). Gabapentin improved sleep quality and significantly reduce pain, but patients who took it were likely to report dizziness, sleepiness, edema, ataxia, and diarrhea.

Antidepressants and anticonvulsants may be out of the purview of many dermatologists, but other pain management strategies are not, Dr. Tomecki said. Among them is cryotherapy.

“I’m not talking about freezing as in truly freezing like with do with actinic keratosis. I’m talking about just a gentle brushing of the area.”

A small study of 47 patients employed a 30-second pass of liquid nitrogen over the affected sensory nerve dermatome, making sure not to freeze the skin (Int J Dermatol. 2011 Jun;50[6]:746-50). The treatment consisted of three passes per session on a weekly basis. Most of the patients (94%) experienced good or excellent improvements by week 6. For 19%, one session was enough to eliminate pain, and 17% had complete pain relief in two sessions.

Narrow-band ultraviolet light is another easy and inexpensive option, Dr. Tomecki said. ”We only have a small study on this, but more than 50% of patients in it did very well.”

The 17 patients had three weekly sessions of light therapy for 15 weeks or until pain disappeared. About half reported at least a 50% improvement in pain by the end of 3 months (Indian J Dermatol. 2011 Jan-Feb;56[1]:44–47).

“These are both interventions that are easily available, inexpensive, and well within our reach as dermatologists,” he said.

He had no financial disclosures.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Antivirals, rest, and pain management are the Big Three of shingles treatment, and they should be employed early and consistently.

There are ways to tweak response, such as augmenting pain management with antidepressants or anticonvulsants. And a corticosteroid may have a place in the mix for some patients. But the importance of the Big Three can’t be overstressed, Dr. Kenneth Tomecki said at the annual meeting of the American Academy of Dermatology.

“You want to halt the progression of disease and decrease viral shedding,” said Dr. Tomecki of the Cleveland Clinic in Ohio. “But the key to successful treatment is to decrease the severity of pain. It is a strong attendant feature. There will be pain and we need to try hard to keep it as brief as possible. Some patients are stoic and will tell you they don’t need anything for pain. Don’t believe them.”

Managing pain also makes it easier to get patients to relax and slow down. “Rest, rest, rest, and more rest. Rest leads the list. These patients need to slow down and cool it. They have a viral illness and systemic disease. Rest is mandatory.”

Antiviral therapy is a key part of treatment, but only if it’s timely. “If you can get it on board in the first 72 hours, you can increase the likelihood of the rash resolving quickly, limit the pain, and reduce the risk of postherpetic neuralgia by 50%.”

The mainstay of antiviral therapy has been acyclovir, which is effective and inexpensive – about $30 for a 7-10 day course. But its bioavailability is not great, which means patients need to take it five times a day.

Famciclovir and valacyclovir possess more efficient pharmacokinetic profiles, and are just as safe and well-tolerated. Their thrice-daily dosing schedules make them a little more manageable for most patients. They are more expensive (about $100 for a week-long course), but not prohibitively so, Dr. Tomecki said. And both of them are effective, with evidence from a randomized, double-blind, controlled trial showing a similar benefit for acute pain and postherpetic neuralgia (Arch Fam Med. 2000;9:863-9).

“I would say both of the newer drugs work a little bit better than acyclovir, but they are similar to each other,” he said. “My go-to treatment for uncomplicated zoster is 1 gram of valacyclovir three times a day for 7-10 days, and I throw in either gabapentin or pregabalin.”

In an open-label study of 166 patients (Arch Dermatol. 2011;147[8]:901-7), this combination resulted in less than a 10% incidence of postherpetic neuralgia at 6 months, Dr. Tomecki added.

Mild pain during the acute phase can be handled with acetaminophen or nonsteroidal anti-inflammatories. But lots of patients need a bigger bullet for their discomfort. Tramadol at 50 mg/day or a weak opioid will work for moderate pain. With severe pain, start thinking about oxycodone.

A tapered dose of corticosteroid can be included, especially if cellulitis is involved in the clinical picture. “It does help patients feel better, and there’s no real detriment to it,” Dr. Tomecki said.

Patients who have postherpetic pain may need longer-term pain management. Lidocaine patches and capsaicin cream are both effective, and they work best if used consistently. The recommended dosing frequency for capsaicin is three or four times a day, “But to be really effective I find you need to apply it more like five or six times a day.”

Patients with persistent postherpetic pain should probably be referred to a neurologist or pain management specialist. In the meantime, though, tricyclic antidepressants aren’t out of the question, but they take a while to kick in and must be used very, very carefully in elderly patients. “Don’t jump in initially with these. Start with good derm care and rest.”

The anticonvulsants gabapentin or pregabalin can also be helpful. “If you do start any of these, start low, go slow and refer for pain management.”

A 2014 meta-analysis of seven studies, however, showed a mixed bag of benefits and tradeoffs (Minerva Anestesiol. 2014 May;80[5]:556-67). Gabapentin improved sleep quality and significantly reduce pain, but patients who took it were likely to report dizziness, sleepiness, edema, ataxia, and diarrhea.

Antidepressants and anticonvulsants may be out of the purview of many dermatologists, but other pain management strategies are not, Dr. Tomecki said. Among them is cryotherapy.

“I’m not talking about freezing as in truly freezing like with do with actinic keratosis. I’m talking about just a gentle brushing of the area.”

A small study of 47 patients employed a 30-second pass of liquid nitrogen over the affected sensory nerve dermatome, making sure not to freeze the skin (Int J Dermatol. 2011 Jun;50[6]:746-50). The treatment consisted of three passes per session on a weekly basis. Most of the patients (94%) experienced good or excellent improvements by week 6. For 19%, one session was enough to eliminate pain, and 17% had complete pain relief in two sessions.

Narrow-band ultraviolet light is another easy and inexpensive option, Dr. Tomecki said. ”We only have a small study on this, but more than 50% of patients in it did very well.”

The 17 patients had three weekly sessions of light therapy for 15 weeks or until pain disappeared. About half reported at least a 50% improvement in pain by the end of 3 months (Indian J Dermatol. 2011 Jan-Feb;56[1]:44–47).

“These are both interventions that are easily available, inexpensive, and well within our reach as dermatologists,” he said.

He had no financial disclosures.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Nemolizumab, an anti-interleukin-31 receptor A monoclonal antibody, was shown to rapidly and consistently improve pruritus, dermatitis, and sleep disturbance in patients with previously uncontrolled moderate-to-severe atopic dermatitis in a phase II, randomized, double-blind, placebo-controlled trial.

“The patients notice that the itch is gone very quickly, sometimes within days, even before their dermatitis starts to heal,” said Dr. Jon M. Hanifin, one of the treatment’s investigators. “It’s very exciting.”

jancin

Dr. Hanifin, a researcher at Oregon Health & Science University, Portland, made his comments while presenting the data during the late-breaking clinical research session at this year’s annual meeting of the American Academy of Dermatology.

The novel treatment, currently known as CIM331 (Chugai) targets elevated levels of interleukin-31, a cytokine that has been implicated in the pathophysiology of atopic dermatitis (AD) and pruritus.

The multicenter, multi-dose study assigned 264 patients, primarily in their mid-30s, with moderate-to-severe AD, uncontrolled by topical treatments, to either placebo or 0.1 mg/kg, 0.5 mg/kg, or 2.0 mg/kg CIM331 every 4 weeks. The study completion rate was 82%.

Using a visual analog scale of 0 to 10, with 10 characterized as “the worst imaginable,” at week 12, patients in the three study groups reported −41.5%, −61.2%, and −60.5% reductions in pruritus vs. −20.1% for placebo (P less than .01 for all).

The “significant reductions” in itch began as early as week 1, particularly in the group treated with the 2-mg/kg dose. Dr. Hanifin said that the patients had a very high mean pruritis score, and some had as much as half of their body surface area affected by AD.

Rescue medications such as topical corticosteroids were not permitted until after at least 1 month of treatment. Patients given rescue therapies were required to have both itch and dermatitis. “This was kind of a tough thing to get through, but [patients] did okay,” Dr. Hanifin said.

Patients treated with the 0.5-mg/kg dose showed the most improvement from baseline in Eczema Area and Severity Index scores at week 12 at −44.6%, compared with −20.9% for placebo. Across the study arms, the proportion of static Investigator’s Global Assessment of 1 or less was 20.9% vs. 4.7% for placebo. Additionally, Dr. Hanifin said sleep latency in the study groups was improved by half and there was an increase in total overall sleep time.

CIM331 was well tolerated, with the most common adverse events being exacerbation of AD and nasopharyngitis. “The risk of immune suppression seemed to be low,” Dr. Hanifin said.

WASHINGTON – Nemolizumab, an anti-interleukin-31 receptor A monoclonal antibody, was shown to rapidly and consistently improve pruritus, dermatitis, and sleep disturbance in patients with previously uncontrolled moderate-to-severe atopic dermatitis in a phase II, randomized, double-blind, placebo-controlled trial.

“The patients notice that the itch is gone very quickly, sometimes within days, even before their dermatitis starts to heal,” said Dr. Jon M. Hanifin, one of the treatment’s investigators. “It’s very exciting.”

jancin

Dr. Hanifin, a researcher at Oregon Health & Science University, Portland, made his comments while presenting the data during the late-breaking clinical research session at this year’s annual meeting of the American Academy of Dermatology.

The novel treatment, currently known as CIM331 (Chugai) targets elevated levels of interleukin-31, a cytokine that has been implicated in the pathophysiology of atopic dermatitis (AD) and pruritus.

The multicenter, multi-dose study assigned 264 patients, primarily in their mid-30s, with moderate-to-severe AD, uncontrolled by topical treatments, to either placebo or 0.1 mg/kg, 0.5 mg/kg, or 2.0 mg/kg CIM331 every 4 weeks. The study completion rate was 82%.

Using a visual analog scale of 0 to 10, with 10 characterized as “the worst imaginable,” at week 12, patients in the three study groups reported −41.5%, −61.2%, and −60.5% reductions in pruritus vs. −20.1% for placebo (P less than .01 for all).

The “significant reductions” in itch began as early as week 1, particularly in the group treated with the 2-mg/kg dose. Dr. Hanifin said that the patients had a very high mean pruritis score, and some had as much as half of their body surface area affected by AD.

Rescue medications such as topical corticosteroids were not permitted until after at least 1 month of treatment. Patients given rescue therapies were required to have both itch and dermatitis. “This was kind of a tough thing to get through, but [patients] did okay,” Dr. Hanifin said.

Patients treated with the 0.5-mg/kg dose showed the most improvement from baseline in Eczema Area and Severity Index scores at week 12 at −44.6%, compared with −20.9% for placebo. Across the study arms, the proportion of static Investigator’s Global Assessment of 1 or less was 20.9% vs. 4.7% for placebo. Additionally, Dr. Hanifin said sleep latency in the study groups was improved by half and there was an increase in total overall sleep time.

CIM331 was well tolerated, with the most common adverse events being exacerbation of AD and nasopharyngitis. “The risk of immune suppression seemed to be low,” Dr. Hanifin said.

WASHINGTON – Nemolizumab, an anti-interleukin-31 receptor A monoclonal antibody, was shown to rapidly and consistently improve pruritus, dermatitis, and sleep disturbance in patients with previously uncontrolled moderate-to-severe atopic dermatitis in a phase II, randomized, double-blind, placebo-controlled trial.

“The patients notice that the itch is gone very quickly, sometimes within days, even before their dermatitis starts to heal,” said Dr. Jon M. Hanifin, one of the treatment’s investigators. “It’s very exciting.”

jancin

Dr. Hanifin, a researcher at Oregon Health & Science University, Portland, made his comments while presenting the data during the late-breaking clinical research session at this year’s annual meeting of the American Academy of Dermatology.

The novel treatment, currently known as CIM331 (Chugai) targets elevated levels of interleukin-31, a cytokine that has been implicated in the pathophysiology of atopic dermatitis (AD) and pruritus.

The multicenter, multi-dose study assigned 264 patients, primarily in their mid-30s, with moderate-to-severe AD, uncontrolled by topical treatments, to either placebo or 0.1 mg/kg, 0.5 mg/kg, or 2.0 mg/kg CIM331 every 4 weeks. The study completion rate was 82%.

Using a visual analog scale of 0 to 10, with 10 characterized as “the worst imaginable,” at week 12, patients in the three study groups reported −41.5%, −61.2%, and −60.5% reductions in pruritus vs. −20.1% for placebo (P less than .01 for all).

The “significant reductions” in itch began as early as week 1, particularly in the group treated with the 2-mg/kg dose. Dr. Hanifin said that the patients had a very high mean pruritis score, and some had as much as half of their body surface area affected by AD.

Rescue medications such as topical corticosteroids were not permitted until after at least 1 month of treatment. Patients given rescue therapies were required to have both itch and dermatitis. “This was kind of a tough thing to get through, but [patients] did okay,” Dr. Hanifin said.

Patients treated with the 0.5-mg/kg dose showed the most improvement from baseline in Eczema Area and Severity Index scores at week 12 at −44.6%, compared with −20.9% for placebo. Across the study arms, the proportion of static Investigator’s Global Assessment of 1 or less was 20.9% vs. 4.7% for placebo. Additionally, Dr. Hanifin said sleep latency in the study groups was improved by half and there was an increase in total overall sleep time.

CIM331 was well tolerated, with the most common adverse events being exacerbation of AD and nasopharyngitis. “The risk of immune suppression seemed to be low,” Dr. Hanifin said.

WASHINGTON – After 60 weeks of continuous therapy with the investigational drug ixekizumab, 722 patients who initially had moderate to severe plaque psoriasis had Psoriasis Area Severity Index (PASI) 75, 90, and 100 response rates of 87%, 78%, and 57%, respectively, based on study results presented by Dr. Andrew Blauvelt at the annual meeting of the American Academy of Dermatology.

Additionally, the rate of complete clearance or mild severity of plaque psoriasis based on the Physician Global Assessment measure was 79% in the study patients. Dr. Blauvelt said “these were tremendous results over time.”

The findings come from the open-label continuation study of ixekizumab in UNCOVER-3. At week 12 of that study, 722 ixekizumab-treated patients were continued on or converted to a regimen of 80 mg ixekizumab every 4 weeks.

In UNCOVER-3, all study participants initially received induction therapy with ixekizumab and then were randomized to placebo (193 patients), etanercept 50 mg twice weekly (382 patients), 80 mg ixekizumab every 4 weeks (386 patients) after a 160 mg starting dose, or 80 mg ixekizumab every 2 weeks (385 patients) after an initial 160 mg starting dose. After 12 weeks, patients entered open-label treatment with the study drug once every 4 weeks.

The long-term safety and tolerability profile was similar to the one seen during the induction period and cited in previously published data. Dr. Blauvelt, President of the Oregon Medical Research Center, said the finding was “good news, in that there were no unexpected safety signals [not already] seen with initial therapy.”

Ixekizumab is an IgG4 monoclonal antibody that selectively binds with interleukin 17A (IL-17A) cytokines, inhibiting interaction with the IL-17 receptor.

According to a spokesperson from Eli Lilly, sponsor of the UNCOVER trial and maker of ixekizumab, a decision from the U.S. Food and Drug Administration on whether to approve ixekizumab for use in psoriasis is expected during the first quarter of 2016.

Dr. Blauvelt is an advisor or consultant for and has received research grants from a wide variety of drug companies including Eli Lilly.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – After 60 weeks of continuous therapy with the investigational drug ixekizumab, 722 patients who initially had moderate to severe plaque psoriasis had Psoriasis Area Severity Index (PASI) 75, 90, and 100 response rates of 87%, 78%, and 57%, respectively, based on study results presented by Dr. Andrew Blauvelt at the annual meeting of the American Academy of Dermatology.

Additionally, the rate of complete clearance or mild severity of plaque psoriasis based on the Physician Global Assessment measure was 79% in the study patients. Dr. Blauvelt said “these were tremendous results over time.”

The findings come from the open-label continuation study of ixekizumab in UNCOVER-3. At week 12 of that study, 722 ixekizumab-treated patients were continued on or converted to a regimen of 80 mg ixekizumab every 4 weeks.

In UNCOVER-3, all study participants initially received induction therapy with ixekizumab and then were randomized to placebo (193 patients), etanercept 50 mg twice weekly (382 patients), 80 mg ixekizumab every 4 weeks (386 patients) after a 160 mg starting dose, or 80 mg ixekizumab every 2 weeks (385 patients) after an initial 160 mg starting dose. After 12 weeks, patients entered open-label treatment with the study drug once every 4 weeks.

The long-term safety and tolerability profile was similar to the one seen during the induction period and cited in previously published data. Dr. Blauvelt, President of the Oregon Medical Research Center, said the finding was “good news, in that there were no unexpected safety signals [not already] seen with initial therapy.”

Ixekizumab is an IgG4 monoclonal antibody that selectively binds with interleukin 17A (IL-17A) cytokines, inhibiting interaction with the IL-17 receptor.

According to a spokesperson from Eli Lilly, sponsor of the UNCOVER trial and maker of ixekizumab, a decision from the U.S. Food and Drug Administration on whether to approve ixekizumab for use in psoriasis is expected during the first quarter of 2016.

Dr. Blauvelt is an advisor or consultant for and has received research grants from a wide variety of drug companies including Eli Lilly.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – After 60 weeks of continuous therapy with the investigational drug ixekizumab, 722 patients who initially had moderate to severe plaque psoriasis had Psoriasis Area Severity Index (PASI) 75, 90, and 100 response rates of 87%, 78%, and 57%, respectively, based on study results presented by Dr. Andrew Blauvelt at the annual meeting of the American Academy of Dermatology.

Additionally, the rate of complete clearance or mild severity of plaque psoriasis based on the Physician Global Assessment measure was 79% in the study patients. Dr. Blauvelt said “these were tremendous results over time.”

The findings come from the open-label continuation study of ixekizumab in UNCOVER-3. At week 12 of that study, 722 ixekizumab-treated patients were continued on or converted to a regimen of 80 mg ixekizumab every 4 weeks.

In UNCOVER-3, all study participants initially received induction therapy with ixekizumab and then were randomized to placebo (193 patients), etanercept 50 mg twice weekly (382 patients), 80 mg ixekizumab every 4 weeks (386 patients) after a 160 mg starting dose, or 80 mg ixekizumab every 2 weeks (385 patients) after an initial 160 mg starting dose. After 12 weeks, patients entered open-label treatment with the study drug once every 4 weeks.

The long-term safety and tolerability profile was similar to the one seen during the induction period and cited in previously published data. Dr. Blauvelt, President of the Oregon Medical Research Center, said the finding was “good news, in that there were no unexpected safety signals [not already] seen with initial therapy.”

Ixekizumab is an IgG4 monoclonal antibody that selectively binds with interleukin 17A (IL-17A) cytokines, inhibiting interaction with the IL-17 receptor.

According to a spokesperson from Eli Lilly, sponsor of the UNCOVER trial and maker of ixekizumab, a decision from the U.S. Food and Drug Administration on whether to approve ixekizumab for use in psoriasis is expected during the first quarter of 2016.

Dr. Blauvelt is an advisor or consultant for and has received research grants from a wide variety of drug companies including Eli Lilly.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

WASHINGTON – Now is the time to work toward defining alternative payment models that are effective for dermatology in terms of both outcomes and payment, Dr. Marta J. VanBeek said at the annual meeting of the American Academy of Dermatology.

Alternative payment models (APMs) will steadily displace fee-for-service models in the shift to paying for value over volume. Regulations formally defining APMs, which were created to replace the sustainable growth rate formula in the Medicare Access and CHIP Reauthorization Act, are expected in the coming months.

The key is to make sure that APMs accommodate the complexities of treating a variety of patients, Dr. VanBeek, a professor at the University of Iowa, Iowa City, said. A one-size-fits-all patients approach can disincentivize caring for complex patients and severe disease.

The start of designing and supporting a proposed APM is good data, she said. The AAD’s recently launched DataDerm tool is an important piece for measuring the quality aspects of care, and its use could be an active part of designing high-quality APMs.

If approached the right way, and led by physicians rather than payers, APMs could result in “a sea change in the way we deliver medicine and may bring the joy back,” rather than have the focus on worrying about what was put in the EMR and what was billed.

The key to designing and properly applying an APM is to understand and manage risk. If not accurately accounted for as it is under the current fee-for-service system, risk could put doctors out of business.

“In an alternative payment model, you’d be paid a fixed amount and ... you would still be paid the same amount regardless of whether more care was sought or required by the patients you serve ... so all the financial risk is on you,” Dr. VanBeek said.

Under this scenario, a single outlier patient could be a financial disaster for a solo practitioner seeing only a few thousand patients a year. Consider the wide difference in the costs of treating a patient with severe psoriasis versus one with mild psoriasis. The disparity is risk adjusted for today’s fee-for-service environment, but those differences could get lost in a bundled payment that regards all psoriasis patients as having identical needs.

Part of the challenge ahead is “to correct misconceptions that people may have and ... to design [the APMs] to prevent a potential disaster,” Dr. VanBeek said.

To illustrate her point, she referenced a payment bundle, a form of alternative payment model, that was developed for joint replacement surgery by orthopedic surgeons at her university hospital. The surgeons designed the bundle and negotiated the price. They found a win-win solution for surgeons, patients, and payers; and the “orthopedics department is further in the black than it’s ever been in decades.”

At certain hospitals around the country, though, CMS is now mandating Medicare-developed joint replacement payment bundles. “Those hospitals are panicking because they know that [the CMS payment bundle] is not financially viable,” Dr. VanBeek said.

The lesson to be learned: Do your homework and define your APM or a model that is unlikely to work may be forced upon you. “One hospital has an APM for joint replacement that was developed by doctors. The other has a model that was developed by CMS. One works really, really well. One does not,” she said. “And that’s my caveat in saying that [dermatologists] really need to get involved” in creating specialty-appropriate APMs.

Dr. VanBeek said she had no financial disclosures.

gtwachtman@frontlinemedcom.com

WASHINGTON – Now is the time to work toward defining alternative payment models that are effective for dermatology in terms of both outcomes and payment, Dr. Marta J. VanBeek said at the annual meeting of the American Academy of Dermatology.

Alternative payment models (APMs) will steadily displace fee-for-service models in the shift to paying for value over volume. Regulations formally defining APMs, which were created to replace the sustainable growth rate formula in the Medicare Access and CHIP Reauthorization Act, are expected in the coming months.

The key is to make sure that APMs accommodate the complexities of treating a variety of patients, Dr. VanBeek, a professor at the University of Iowa, Iowa City, said. A one-size-fits-all patients approach can disincentivize caring for complex patients and severe disease.

The start of designing and supporting a proposed APM is good data, she said. The AAD’s recently launched DataDerm tool is an important piece for measuring the quality aspects of care, and its use could be an active part of designing high-quality APMs.

If approached the right way, and led by physicians rather than payers, APMs could result in “a sea change in the way we deliver medicine and may bring the joy back,” rather than have the focus on worrying about what was put in the EMR and what was billed.

The key to designing and properly applying an APM is to understand and manage risk. If not accurately accounted for as it is under the current fee-for-service system, risk could put doctors out of business.

“In an alternative payment model, you’d be paid a fixed amount and ... you would still be paid the same amount regardless of whether more care was sought or required by the patients you serve ... so all the financial risk is on you,” Dr. VanBeek said.

Under this scenario, a single outlier patient could be a financial disaster for a solo practitioner seeing only a few thousand patients a year. Consider the wide difference in the costs of treating a patient with severe psoriasis versus one with mild psoriasis. The disparity is risk adjusted for today’s fee-for-service environment, but those differences could get lost in a bundled payment that regards all psoriasis patients as having identical needs.

Part of the challenge ahead is “to correct misconceptions that people may have and ... to design [the APMs] to prevent a potential disaster,” Dr. VanBeek said.

To illustrate her point, she referenced a payment bundle, a form of alternative payment model, that was developed for joint replacement surgery by orthopedic surgeons at her university hospital. The surgeons designed the bundle and negotiated the price. They found a win-win solution for surgeons, patients, and payers; and the “orthopedics department is further in the black than it’s ever been in decades.”

At certain hospitals around the country, though, CMS is now mandating Medicare-developed joint replacement payment bundles. “Those hospitals are panicking because they know that [the CMS payment bundle] is not financially viable,” Dr. VanBeek said.

The lesson to be learned: Do your homework and define your APM or a model that is unlikely to work may be forced upon you. “One hospital has an APM for joint replacement that was developed by doctors. The other has a model that was developed by CMS. One works really, really well. One does not,” she said. “And that’s my caveat in saying that [dermatologists] really need to get involved” in creating specialty-appropriate APMs.

Dr. VanBeek said she had no financial disclosures.

gtwachtman@frontlinemedcom.com

WASHINGTON – Now is the time to work toward defining alternative payment models that are effective for dermatology in terms of both outcomes and payment, Dr. Marta J. VanBeek said at the annual meeting of the American Academy of Dermatology.

Alternative payment models (APMs) will steadily displace fee-for-service models in the shift to paying for value over volume. Regulations formally defining APMs, which were created to replace the sustainable growth rate formula in the Medicare Access and CHIP Reauthorization Act, are expected in the coming months.

The key is to make sure that APMs accommodate the complexities of treating a variety of patients, Dr. VanBeek, a professor at the University of Iowa, Iowa City, said. A one-size-fits-all patients approach can disincentivize caring for complex patients and severe disease.

The start of designing and supporting a proposed APM is good data, she said. The AAD’s recently launched DataDerm tool is an important piece for measuring the quality aspects of care, and its use could be an active part of designing high-quality APMs.

If approached the right way, and led by physicians rather than payers, APMs could result in “a sea change in the way we deliver medicine and may bring the joy back,” rather than have the focus on worrying about what was put in the EMR and what was billed.

The key to designing and properly applying an APM is to understand and manage risk. If not accurately accounted for as it is under the current fee-for-service system, risk could put doctors out of business.

“In an alternative payment model, you’d be paid a fixed amount and ... you would still be paid the same amount regardless of whether more care was sought or required by the patients you serve ... so all the financial risk is on you,” Dr. VanBeek said.

Under this scenario, a single outlier patient could be a financial disaster for a solo practitioner seeing only a few thousand patients a year. Consider the wide difference in the costs of treating a patient with severe psoriasis versus one with mild psoriasis. The disparity is risk adjusted for today’s fee-for-service environment, but those differences could get lost in a bundled payment that regards all psoriasis patients as having identical needs.

Part of the challenge ahead is “to correct misconceptions that people may have and ... to design [the APMs] to prevent a potential disaster,” Dr. VanBeek said.

To illustrate her point, she referenced a payment bundle, a form of alternative payment model, that was developed for joint replacement surgery by orthopedic surgeons at her university hospital. The surgeons designed the bundle and negotiated the price. They found a win-win solution for surgeons, patients, and payers; and the “orthopedics department is further in the black than it’s ever been in decades.”

At certain hospitals around the country, though, CMS is now mandating Medicare-developed joint replacement payment bundles. “Those hospitals are panicking because they know that [the CMS payment bundle] is not financially viable,” Dr. VanBeek said.

The lesson to be learned: Do your homework and define your APM or a model that is unlikely to work may be forced upon you. “One hospital has an APM for joint replacement that was developed by doctors. The other has a model that was developed by CMS. One works really, really well. One does not,” she said. “And that’s my caveat in saying that [dermatologists] really need to get involved” in creating specialty-appropriate APMs.

Dr. VanBeek said she had no financial disclosures.

gtwachtman@frontlinemedcom.com

WASHINGTON – The key to treating cellulite may be as simple as cutting a tiny tether.

Vertical bundles of fibrous septae that run through subdermal fat and anchor the skin seem to cause the dimples and bulges that annoy up to 95% of women. Releasing those fibers with a minimally invasive instrument causes an immediate smoothing of the skin – an improvement that appears to last for at least 3 years, according to data presented at the annual meeting of the American Academy of Dermatology.

“At 3 years, the data are remarkably consistent,” said Dr. Michael Kaminer of Yale University, New Haven, Conn. “No one was unsatisfied with the result, and in fact, 93% of the patients were still satisfied or very satisfied. So I would say this meets the criteria of something that is reasonable to offer to our patients.

The Cellfina system can treat up to 30 dimples in a single hour-long session, according to Dr. Kaminer, who discussed the procedure in a video interview. The procedure costs anywhere from $2,500-$6,000 per session, depending on how many dimples are treated.

The device consists of a circular area that provides enough suction to elevate the skin over each dimple. One disposable click-in module contains a 22-gauge multibore needle that delivers local anesthetic. After the anesthetic is delivered, a second module clicks into place. This contains an 18-gauge probe tipped with a very small triangular blade. Inserted 5-6 mm below the skin, the probe can be pivoted back and forth, cutting the septae under the dimple. This releases their constricting effect on the skin, which immediately rebounds and appears smooth. The system does not remove any fat.

Cellfina’s earlier data earned it a 2-year Food and Drug Administration clearance for cellulite treatment. The data presented at the meeting confirm its effect at 3 years, Dr. Kaminer said, and form the basis of an application for a 3-year clearance.

The follow-up study comprised 45 women who had undergone the procedure and were reevaluated by several means: a blinded physician rating of before and after pictures, and a 1- 5 point patient self-evaluation scale, with a change of at least 1 point rated as “satisfactory.”

These women represented all six Fitzpatrick skin types. They were a mean of 40 years old at baseline and had a mean body mass index of 25 kg/m².

Independent, blinded physicians were given before-and-after photos of all patients and asked to identify which photo showed change. All of the physicians correctly identified all of the “after” photos.

“This was not a subtle change they were seeing in the pictures,” Dr. Kaminer said. “It’s a very, very noticeable improvement that a physician who doesn’t treat cellulite would recognize as something having been done.”

At the 1-year follow-up, patients reported an average improvement of 2 points on the severity scale. This was largely maintained at 3 years; 42 patients (93%) remained satisfied. Of the entire group, 19 patients said they were very satisfied, 23 were “satisfied,” and the rest were neutral. No one was unsatisfied, he noted.

“What this means is that about half of patients had an amazing result and the rest had a very good result,” Dr. Kaminer said. He added that none of the women had requested any retreatment. “Most felt like the improvement they experienced was good enough not to need more.”

In fact, he said, the 3-year follow-up photos seem to show that the contours of the treated areas continued to improve. “It certainly looks that way. We have no idea why this would be,” he said but suggested that once women feel better about the appearance of their legs and rear, they may be more motivated to make such beneficial lifestyle changes as improved diet and regular exercise.

The system has mostly been used for buttock cellulite, but that’s expanding. Dr. Kaminer said. “We are treating a lot of outer thighs now, and we’re starting to move into anterior thighs and seeing excellent results.”

He added that the procedure is very safe and quite easy for patients to tolerate. Postprocedural pain is minimal and managed with nonprescription acetaminophen. Aftercare consists only of wearing a light compression garment – like a body shaper – for a week after the procedure. Adverse events included slight ecchymosis that cleared rapidly; one patient experienced scratching for pruritus.

Some women, however, will experience a residual firmness in treated areas. It’s not clear what this is, Dr. Kaminer said, but it recedes spontaneously over 6-12 months. “If it’s really bothering them, you can inject a little steroid into it. It can sometimes go away with massage.”

Informing patients about the possibility is key, he added. “If you tell them they might experience it, it’s really not a big deal to them.”

Dr. Kaminer received financial benefits during the initial development and deployment of Cellfina, but said he has no financial ties to the company now.

msullivan@frontlinemedcom.com

WASHINGTON – The key to treating cellulite may be as simple as cutting a tiny tether.

Vertical bundles of fibrous septae that run through subdermal fat and anchor the skin seem to cause the dimples and bulges that annoy up to 95% of women. Releasing those fibers with a minimally invasive instrument causes an immediate smoothing of the skin – an improvement that appears to last for at least 3 years, according to data presented at the annual meeting of the American Academy of Dermatology.

“At 3 years, the data are remarkably consistent,” said Dr. Michael Kaminer of Yale University, New Haven, Conn. “No one was unsatisfied with the result, and in fact, 93% of the patients were still satisfied or very satisfied. So I would say this meets the criteria of something that is reasonable to offer to our patients.

The Cellfina system can treat up to 30 dimples in a single hour-long session, according to Dr. Kaminer, who discussed the procedure in a video interview. The procedure costs anywhere from $2,500-$6,000 per session, depending on how many dimples are treated.

The device consists of a circular area that provides enough suction to elevate the skin over each dimple. One disposable click-in module contains a 22-gauge multibore needle that delivers local anesthetic. After the anesthetic is delivered, a second module clicks into place. This contains an 18-gauge probe tipped with a very small triangular blade. Inserted 5-6 mm below the skin, the probe can be pivoted back and forth, cutting the septae under the dimple. This releases their constricting effect on the skin, which immediately rebounds and appears smooth. The system does not remove any fat.

Cellfina’s earlier data earned it a 2-year Food and Drug Administration clearance for cellulite treatment. The data presented at the meeting confirm its effect at 3 years, Dr. Kaminer said, and form the basis of an application for a 3-year clearance.

The follow-up study comprised 45 women who had undergone the procedure and were reevaluated by several means: a blinded physician rating of before and after pictures, and a 1- 5 point patient self-evaluation scale, with a change of at least 1 point rated as “satisfactory.”

These women represented all six Fitzpatrick skin types. They were a mean of 40 years old at baseline and had a mean body mass index of 25 kg/m².

Independent, blinded physicians were given before-and-after photos of all patients and asked to identify which photo showed change. All of the physicians correctly identified all of the “after” photos.

“This was not a subtle change they were seeing in the pictures,” Dr. Kaminer said. “It’s a very, very noticeable improvement that a physician who doesn’t treat cellulite would recognize as something having been done.”

At the 1-year follow-up, patients reported an average improvement of 2 points on the severity scale. This was largely maintained at 3 years; 42 patients (93%) remained satisfied. Of the entire group, 19 patients said they were very satisfied, 23 were “satisfied,” and the rest were neutral. No one was unsatisfied, he noted.

“What this means is that about half of patients had an amazing result and the rest had a very good result,” Dr. Kaminer said. He added that none of the women had requested any retreatment. “Most felt like the improvement they experienced was good enough not to need more.”

In fact, he said, the 3-year follow-up photos seem to show that the contours of the treated areas continued to improve. “It certainly looks that way. We have no idea why this would be,” he said but suggested that once women feel better about the appearance of their legs and rear, they may be more motivated to make such beneficial lifestyle changes as improved diet and regular exercise.

The system has mostly been used for buttock cellulite, but that’s expanding. Dr. Kaminer said. “We are treating a lot of outer thighs now, and we’re starting to move into anterior thighs and seeing excellent results.”

He added that the procedure is very safe and quite easy for patients to tolerate. Postprocedural pain is minimal and managed with nonprescription acetaminophen. Aftercare consists only of wearing a light compression garment – like a body shaper – for a week after the procedure. Adverse events included slight ecchymosis that cleared rapidly; one patient experienced scratching for pruritus.

Some women, however, will experience a residual firmness in treated areas. It’s not clear what this is, Dr. Kaminer said, but it recedes spontaneously over 6-12 months. “If it’s really bothering them, you can inject a little steroid into it. It can sometimes go away with massage.”

Informing patients about the possibility is key, he added. “If you tell them they might experience it, it’s really not a big deal to them.”

Dr. Kaminer received financial benefits during the initial development and deployment of Cellfina, but said he has no financial ties to the company now.

msullivan@frontlinemedcom.com

WASHINGTON – The key to treating cellulite may be as simple as cutting a tiny tether.

Vertical bundles of fibrous septae that run through subdermal fat and anchor the skin seem to cause the dimples and bulges that annoy up to 95% of women. Releasing those fibers with a minimally invasive instrument causes an immediate smoothing of the skin – an improvement that appears to last for at least 3 years, according to data presented at the annual meeting of the American Academy of Dermatology.

“At 3 years, the data are remarkably consistent,” said Dr. Michael Kaminer of Yale University, New Haven, Conn. “No one was unsatisfied with the result, and in fact, 93% of the patients were still satisfied or very satisfied. So I would say this meets the criteria of something that is reasonable to offer to our patients.

The Cellfina system can treat up to 30 dimples in a single hour-long session, according to Dr. Kaminer, who discussed the procedure in a video interview. The procedure costs anywhere from $2,500-$6,000 per session, depending on how many dimples are treated.

The device consists of a circular area that provides enough suction to elevate the skin over each dimple. One disposable click-in module contains a 22-gauge multibore needle that delivers local anesthetic. After the anesthetic is delivered, a second module clicks into place. This contains an 18-gauge probe tipped with a very small triangular blade. Inserted 5-6 mm below the skin, the probe can be pivoted back and forth, cutting the septae under the dimple. This releases their constricting effect on the skin, which immediately rebounds and appears smooth. The system does not remove any fat.

Cellfina’s earlier data earned it a 2-year Food and Drug Administration clearance for cellulite treatment. The data presented at the meeting confirm its effect at 3 years, Dr. Kaminer said, and form the basis of an application for a 3-year clearance.

The follow-up study comprised 45 women who had undergone the procedure and were reevaluated by several means: a blinded physician rating of before and after pictures, and a 1- 5 point patient self-evaluation scale, with a change of at least 1 point rated as “satisfactory.”

These women represented all six Fitzpatrick skin types. They were a mean of 40 years old at baseline and had a mean body mass index of 25 kg/m².

Independent, blinded physicians were given before-and-after photos of all patients and asked to identify which photo showed change. All of the physicians correctly identified all of the “after” photos.

“This was not a subtle change they were seeing in the pictures,” Dr. Kaminer said. “It’s a very, very noticeable improvement that a physician who doesn’t treat cellulite would recognize as something having been done.”

At the 1-year follow-up, patients reported an average improvement of 2 points on the severity scale. This was largely maintained at 3 years; 42 patients (93%) remained satisfied. Of the entire group, 19 patients said they were very satisfied, 23 were “satisfied,” and the rest were neutral. No one was unsatisfied, he noted.

“What this means is that about half of patients had an amazing result and the rest had a very good result,” Dr. Kaminer said. He added that none of the women had requested any retreatment. “Most felt like the improvement they experienced was good enough not to need more.”

In fact, he said, the 3-year follow-up photos seem to show that the contours of the treated areas continued to improve. “It certainly looks that way. We have no idea why this would be,” he said but suggested that once women feel better about the appearance of their legs and rear, they may be more motivated to make such beneficial lifestyle changes as improved diet and regular exercise.

The system has mostly been used for buttock cellulite, but that’s expanding. Dr. Kaminer said. “We are treating a lot of outer thighs now, and we’re starting to move into anterior thighs and seeing excellent results.”

He added that the procedure is very safe and quite easy for patients to tolerate. Postprocedural pain is minimal and managed with nonprescription acetaminophen. Aftercare consists only of wearing a light compression garment – like a body shaper – for a week after the procedure. Adverse events included slight ecchymosis that cleared rapidly; one patient experienced scratching for pruritus.

Some women, however, will experience a residual firmness in treated areas. It’s not clear what this is, Dr. Kaminer said, but it recedes spontaneously over 6-12 months. “If it’s really bothering them, you can inject a little steroid into it. It can sometimes go away with massage.”

Informing patients about the possibility is key, he added. “If you tell them they might experience it, it’s really not a big deal to them.”

Dr. Kaminer received financial benefits during the initial development and deployment of Cellfina, but said he has no financial ties to the company now.

msullivan@frontlinemedcom.com

WASHINGTON – Microneedling is one of the hottest new trends in aesthetic dermatology and is easy to incorporate into any practice, according to Washington dermatologist Dr. Tina Alster.

Microneedling involves using an updated microneedle device to create small wounds on a patient’s area of concern. Perioral wrinkles, large pores on the nose, certain scars, and stretch marks all respond well to the procedure, Dr. Alster said at the annual meeting of the American Academy of Dermatology.

“I’ve been blown away by the fact that microneedling works as well as it does,” Dr. Alster added, noting that it’s not hard to do, it’s not hard to heal from, and it offers good results.

In this video interview, Dr. Alster explains how to do this microneedling procedures and how to incorporate the device into practice.

dfulton@frontlinemedcom.com

On Twitter @denisefulton

WASHINGTON – Microneedling is one of the hottest new trends in aesthetic dermatology and is easy to incorporate into any practice, according to Washington dermatologist Dr. Tina Alster.

Microneedling involves using an updated microneedle device to create small wounds on a patient’s area of concern. Perioral wrinkles, large pores on the nose, certain scars, and stretch marks all respond well to the procedure, Dr. Alster said at the annual meeting of the American Academy of Dermatology.

“I’ve been blown away by the fact that microneedling works as well as it does,” Dr. Alster added, noting that it’s not hard to do, it’s not hard to heal from, and it offers good results.

In this video interview, Dr. Alster explains how to do this microneedling procedures and how to incorporate the device into practice.

dfulton@frontlinemedcom.com

On Twitter @denisefulton

WASHINGTON – Microneedling is one of the hottest new trends in aesthetic dermatology and is easy to incorporate into any practice, according to Washington dermatologist Dr. Tina Alster.

Microneedling involves using an updated microneedle device to create small wounds on a patient’s area of concern. Perioral wrinkles, large pores on the nose, certain scars, and stretch marks all respond well to the procedure, Dr. Alster said at the annual meeting of the American Academy of Dermatology.

“I’ve been blown away by the fact that microneedling works as well as it does,” Dr. Alster added, noting that it’s not hard to do, it’s not hard to heal from, and it offers good results.

In this video interview, Dr. Alster explains how to do this microneedling procedures and how to incorporate the device into practice.

dfulton@frontlinemedcom.com

On Twitter @denisefulton