Neuromodulators in skin of colour
New review of safety, efficacy, patient concerns, and preferences for botulinum toxin A in varied populations (Issue #215, 1,600 words, 8 minutes)
A comprehensive literature review on the safety and efficacy of botulinum toxin A (BTX-A) in skin of colour (SOC) populations has identified variations in aging patterns, skin properties, and aesthetic concerns in these populations.
For the review, published in Dermatologic Surgery (Sept. 2024; 50(9S):S73-S79), researchers searched the PubMed and MEDLINE databases from 2004 to 2024 and identified 23 articles that examined the use of BTX-A in SOC populations for several aesthetic concerns including glabellar frown lines, crow's feet lines, masseter hypertrophy, forehead rhytides, full face BTX-A treatment, and gummy smile. Twelve studies were from East Asia, five from the United States or Canada, three from South or Southeast Asia, two from South America, and one from the Middle East. Overall, the eligible studies encompassed 6,158 individuals.
Some findings from the review include:
Among SOC populations of African descent, facial aging concerns may be more focused on changes in soft tissue volume and pigmentary alterations and less on the development of fine and coarse rhytides
Differences in the efficacy of BTX-A between patients of African descent with SOC and non-SOC have been observed. Some studies show more significant improvement among SOC patients, while others show less improvement in these patients compared to non-SOC patients
In populations with thicker, heavier skin, such as in SOC populations of Latin America, aging can cause increased prominence of nasolabial folds and eyelid hooding, along with a heavier appearance of the skin of the neck. A U.S. survey investigating facial aesthetic concerns in patients with SOC of Latin American descent found that facial wrinkles and dark undereye circles were the leading facial concerns reported
A study involving 19 women in Brazil comparing treatment response, muscle activity, and sweat gland activity between abobotulinumtoxinA and onabotulinumtoxinA in the treatment of forehead rhytides found that the two formulations had similar 4-point Wrinkle Severity Scale grading and evoked compound muscle action potentials, while sweat gland activity significantly differed.
Studies that examined Middle Eastern beauty standards reported an oval-shaped face with a well-defined jawline and chin, a straight nose, full lips, and large almond-shaped eyes are favoured. Among women who wear head coverings, the periorbital region is a facial area favoured for cosmetic enhancement
One prospective study involving 108 patients with SOC from Iran that investigated the efficacy and treatment duration of abobotulinumtoxinA for treating glabellar lines, crow’s feet, and forehead rhytides reported 97% of patients achieved significant or moderate improvement by the 4-point Wrinkle Improvement Scale at the one-month mark. Approximately half of the patients had treatment effects lasting longer than four months
When treating the periorbital region in patients with SOC of Asian descent, lower dosages of BTX-A are often used to achieve the desired treatment response. This practice of lower doses may be in part due to smaller facial muscles in these populations and may also help to preserve aesthetic preferences that favour a more natural cosmetic appearance
A meta-analysis of nine studies investigating onabotulinumtoxinA for glabellar lines and crow’s feet found higher rates of eyelid sensory disorder, eyelid ptosis, and eyelid edema in patients with SOC of Asian descent in comparison to patients with non-SOC.
The authors conclude that greater SOC representation in clinical trials may guide the development of tailored treatment approaches to optimize aesthetic outcomes for patients with SOC. They write that a comprehensive knowledge of the variations in aging patterns, skin properties, and aesthetic concerns across these populations is essential for providing culturally sensitive cosmetic dermatologic care.
From the literature on dermatology in skin of colour
755-nm picosecond laser with diffractive lens array for acne scars in Fitzpatrick skin types V and VI
In this prospective clinical study, researchers assessed the utility of a 755 nm picosecond laser with fractionated lens array in improving the clinical appearance of acne scars in patients with Fitzpatrick skin types V and VI.
Of 24 enrolled subjects, 17 completed a three-month follow-up. The mean age of the subjects was 33.9 years, and 95.8% were women.
Each patient received up to five monthly laser treatments. Three blinded reviewers compared scar appearance between baseline and three-month follow-up.
Two of the blinded reviewers agreed to identify pretreatment and posttreatment photographs for 82.4% of the cases. The physician Global Aesthetic Improvement Scale assessed all subjects with clinical improvement. Overall, 94.1% of subjects were satisfied with their treatment. No severe or unanticipated adverse events occurred.
A clinical and novel dermoscopic investigation of combined peels as a hand aging treatment
Researchers assessed the effectiveness of a chemical peeling combination in retarding hand aging in patients with Fitzpatrick skin types III to IV. They also evaluated the utility of the Dermoscopy Photoaging Scale (DPAS) in this process.
This study involved 69 volunteers aged 20 to 69. Researchers treated one hand of each participant with 20% glycolic acid (GA), while the other received a combination of peels consisting of 20% GA and 15% trichloroacetic acid (TCA). Investigators clinically examined the hands before and after the treatments and performed dermoscopic examinations using a modified DPAS.
The researchers observed four treatments improved clinical and dermoscopic characteristics in both hands. The combined peeling considerably improved pigmentation intensity on the dorsal hand compared to the GA peel (p<0.001). Patient satisfaction increased significantly post-peeling.
The researchers conclude that this modified version of the DPAS is a valuable instrument for assessing the signs of hand aging. They write that the combination of GA and TCA effectively improves hand skin aging and offers an accessible and economical option for addressing skin aging.
Clinical efficacy and safety of a thermomechanical fractional injury device for neck rejuvenation
Researchers assessed the efficacy and safety of a novel fractional thermomechanical skin rejuvenation system in subjects with Fitzpatrick skin types I through IV.
Researchers recruited 26 women with moderate to severe neck rhytides in this prospective clinical trial. Their mean age was 58.4 years. Each patient underwent four monthly treatments with the new device, developed to create dermal coagulation through direct heat transfer with subsequent neocollagenesis.
The mean baseline score on the Fitzpatrick Wrinkle Classification System (FWCS) was 6.3. Investigators recorded a mean 1.5-grade improvement in FWCS at the one-month follow-up (p<0.00001) and a 1.4-grade improvement in FWCS at the three-month follow-up (p<0.00001). All subjects had improvement in physician Global Aesthetic Improvement Scale scores at both the one- and three-month follow-up visits. There were no severe adverse events, and subjects experienced minimal pain.
At the intersection of skin and society
The city of Halifax is paying tribute to Dr. Alfred Waddell, one of the first Black physicians in Canada, by naming a street in his honour, reports CBC News.
According to the news outlet, Dr. Alfred Waddell Street will be part of the new Cogswell District, a region of Halifax that encompasses the area where Dr. Waddell worked, lived, and volunteered from the 1930s until his death in 1953.
CBC News interviewed Ron Milne, MD, Waddell's grandson, who said he thought the dedication was “great.”
“I think it's overdue that the city and the province should recognize him because of all the work he did in civil rights and advocacy as well as in medicine.”
Waddell, born in 1896 in Trinidad and Tobago, moved to Halifax to study at Dalhousie University, where he became one of the first Black doctors to graduate in 1933.
The street in his name will be off Brunswick Street, where Proctor Street is now. It is a few blocks from where Waddell established his first practice in what is now the Black Educators Association.
“I think this is a fitting way to honour him,” said Dr. Milne. “He made a big difference. He's an unsung hero.”
Dr. Milne said Waddell was credited as one of the only physicians during his time who provided house calls to historically Black communities such as the Prestons, Africville, and Beechville.
Registration is still open for the Indigenous Skin Spectrum Summit and Skin Spectrum Summit
There is still time to take advantage of Early Bird discounts for the 4th annual Indigenous Skin Spectrum Summit and the 10th annual Skin Spectrum Summit. The conferences are hosted at the Art Gallery of Ontario (317 Dundas St. W, Toronto, Ontario) on October 4 and 5, 2024.
The Skin Spectrum Summit is a landmark educational congress of healthcare professionals dedicated to providing better dermatologic care for Canada's diverse population.
This full-day event provides education on treating patients across all six Fitzpatrick skin types, emphasizing care for Types IV to VI.
The Indigenous Skin Spectrum Summit is dedicated to improving the cultural competence of Canadian healthcare providers and giving practical advice on providing dermatologic care to Indigenous patients.
Faculty for this year’s Indigenous Skin Spectrum Summit include:
Conference chair Dr. Rachel Asiniwasis (Regina): Founder of Origins Dermatology Centre, a combined multidisciplinary model that services both the general population and provides outreach clinics (in-person and virtual care) for underserviced remote and rural Indigenous (First Nations and Metis) communities.
Dr. Reetesh Bose (Ottawa): Director of the Skin of Colour dermatology clinic at the Ottawa Hospital.
Dr. Carolyn Jack (Montreal): Founder of the McGill University Hospital Network Center of Excellence for Atopic Dermatitis, Canada's first tertiary care centre dedicated to adult atopic dermatitis.
Sierra Fremont, BSc (Toronto): A researcher examining the barriers faced by members of the Nisichawayasihk Cree Nation in accessing healthcare. Fremont also investigates the role of Indigenous traditional medicines and the integration of traditional practices into mainstream healthcare.
Jonah W. Perlmutter, BSc (Toronto): A medical student researching inflammatory skin conditions and Indigenous health to help identify and address barriers to skin care in Northern communities. He is also developing a “Rural Skin Guide” for primary care providers in rural communities.
Skin Spectrum Weekly readers still have time to register using the button below to take advantage of a 50% early-bird discount for either or both days.
This week
September is National Sickle Cell Awareness Month in the U.S.
Sept. 15 to Oct. 15 is National Hispanic Heritage Month in the U.S.
Sept. 26 is World Contraception Day
Something to think about in the week ahead . . .
—Donald Norman, researcher and author of The Design of Everyday Things (1935 to present)
Next week
Using data collected from two pediatric dermatology clinics at two urban Aboriginal Community Controlled Health Organisations, researchers describe the skin health of urban-living Aboriginal children in Australia, including disease frequencies and associations.
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Dr. Geeta Yadav (Toronto) advises on managing melasma using fractionated lasers.
Drs. Andrei Metelitsa (Calgary), Lisa Kellett (Toronto), and Vince Bertucci (Woodbridge, Ont.) review new and upcoming soft tissue filler products that may benefit Canadian practitioners.
Dr. Zaki Taher (Edmonton) shares his thoughts on the importance of lasers, radiofrequency microneedling, and platelet-rich plasma treatments in a cosmetic dermatology practice.
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