Eucrisa Approved for Eczema

The U.S. Food and Drug Administration recently approved Eucrisa (crisaborole) ointment to treat mild to moderate eczema (atopic dermatitis) in patients two years of age and older. This is the first major new treatment option in atopic dermatitis in quite some time, and will be a welcome addition to the typical steroid options. Eucrisa, applied topically twice daily, is a phosphodiesterase 4 (PDE-4) inhibitor, although its specific mechanism of action in atopic dermatitis is not known.

The safety and efficacy of Eucrisa were established in two placebo-controlled trials with a total of 1,522 participants ranging in age from two years of age to 79 years of age, with mild to moderate atopic dermatitis. Overall, participants receiving Eucrisa achieved greater response with clear or almost clear skin after 28 days of treatment.

Serious side effects of Eucrisa include hypersensitivity reactions. Eucrisa should not be used in patients who have had a hypersensitivity reaction to Eucrisa’s active ingredient, crisaborole. The most common side effect of Eucrisa is application site pain, including burning or stinging.

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HUMIRA (adalimumab) Approved for Hidradinitis Supparitiva

Recently the biologic HUMIRA (adalimumab) was approved by the FDA for the treatment of moderate to severe hidradenitis supparativa (HS), an often debilitating disease with inflammatory papules, cysts and sinuses in the groin, axilla, inframammary and buttocks areas. This is an exciting new addition to the armamentarium of treatments, which typically include topical and oral antibiotics, as well as surgical approaches. In two clinical studies, PIONEER I and PIONEER II, it was demonstrated that at 12 weeks, patients with moderate-to-severe HS treated with HUMIRA  achieved a statistically significant greater response compared to those on placebo on the Hidradenitis Suppurativa Clinical Response (HiSCR) measure.

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Hair Transplantation

Hair transplantation is a surgical technique that moves hair follicles from the stable area of of the scalp (typically posterior portion) to the thinning or balding portion of the scalp (typically crown, temples, or frontal portion). It can be used for management of pattern alopecia, traction alopecia, and  in special cases burned out scarring alopecia in men and women. The basic procedure was started in the 1930s.  Over the last  century the procedure has been refined and now individual follicular units are transferred with less invasive incisions made on the balding scalp.

The strip harvesting technique is the most common type of hair transplantation procedure.  It involves excision of a strip of skin from the stable portion of the scalp.  Individual 1-4 follicular units are then dissected from this strip and transferred to tiny slits on the balding scalp.

Follicular unit extraction is a newer technique that is growing in popularity.  It involves removal and dissection of individual 1-4  follicular units (FU) directly from the stable portion of the scalp. The FUs are transferred to tiny slits on the balding scalp.  Smaller scars can be expected from this procedure.  Recently, robotic devices have been able to automate the process.

With any technique, more than one procedure may be necessary to obtain the desired result. It is important to make sure medical therapy is continued in order to obtain maximal results.

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Platelet Rich Plasma for Hair Loss

Platelet Rich Plasma (PRP), the use of a person’s own blood platelets,  has been used in many areas of medicine including orthopedics, ophthalmology and cardiology to improve wound healing and tissue repair. PRP can be used to enhance hair growth as a stand-alone treatment or to improve the recovery and results of hair transplant surgery. PRP has been studied in pattern baldness and alopecia areata.  Although there has been no randomized controlled long term study on the efficacy of PRP in alopecia, there are many studies with positive results.

During the procedure, a small sample of your  blood is taken.  This sample is processed in an FDA-cleared device to separate the platelets from other components of the blood. Under local anesthesia, activated platelets containing a powerful cocktail of growth factors, cytokines and other proteins are injected into the area of scalp where weak hair follicles exist.  Microneedling of the skin is also performed prior to PRP injection for enhanced effect  One to three treatments many be required over the course of a year. Treatment may need to be repeated depending on the patient’s response to therapy, hair loss condition and goals. In order to determine if you are a good candidate for PRP,  schedule an appointment for a consultation.

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Hair Loss Consultation Now Available

SOMA Skin & Laser is now offering consultations for hair loss for men and women.  In addition to a medical evaluation includes assessment for hair transplantation and innovative procedures such as platelet rich plasma (PRP) and Acell Hair Regrowth Therapy (Please note that these procedures are not covered by insurance).

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New Topical Therapies for Onychomycosis

For more than 15 years the only available topical therapy for onychomycosis was ciclopirox, which offered rather low cure rates. In 2014 two new topical agents were approved: eficonazole (Jublia) and tavaborole (Kerydin).

Ciclopirox

Ciclopirox, available as an 8% nail lacquer, is indicated for treatment of mild to moderate onychomycosis. It is available as an 8% topical solution formulated as a nail lacquer. Ciclopirox is applied daily and then removed with alcohol weekly. Nail trimming is advised along with its use.

Two clinical studies evaluated the efficacy and safety of ciclopirox in more than 450 patients with onychomycosis of the great toenails.  After 48 weeks of application and monthly debridement of free nail, complete cure rates were 5.5% (vs 0.9% with vehicle) and 8.5% (vs 0% with vehicle) in the two studies, respectively. Mycological cure rates (i.e. negative fungal cultures) were 29% with ciclopirox vs 11% with vehicle and 36% with ciclopirox vs 9% with vehicle in the two studies, respectively. The most common adverse effects were application site reactions.

Efinaconazole (Jublia)

Efinaconazole, a triazole, was approved by the FDA in June 2014 for the treatment of onychomycosis of the toenails caused byT rubrum or T mentagrophytes. Efinaconazole is applied topically once daily for 48 weeks. Nail debridement is not required.

Clinical studies evaluated the efficacy of efinaconazole in more than 1600 patients with onychomycosis. Complete cure rates after 52 weeks 18.5% vs 4.7% with vehicle in data combined from two studies. Mycological cure rates at week 52 were  56.3% vs 16.6% with vehicle. Application site dermatitis and vesicles were the most commonly reported adverse events.

Tavaborole (Kerydin)

In July 2014 tavaborole, an oxaborole antifungal, was approved by the FDA for the treatment of onychomycosis of the toenails caused by T rubrum or T mentagrophytes. Tavaborole is applied once daily for 48 weeks. Debridement is not required.

The efficacy of tavaborole was evaluated in two clinical trials in almost 1200 patients. In the two studies, complete cure rates were 6.5% with tavaborole vs 0.5% with vehicle and 9.1% with tavaborole vs 1.5% vehicle, respectively. in the two studies, mycological cure rates were 31.1% with tavaborole vs 7.2% with vehicle and 35.9% with tavaborole vs 12.2% with vehicle, respectively.

Overall, the cure rates with these new vehicles is an advance over prior care. These topical treatments are an option for those unable to take oral antifungal medications, or may be useful adjuncts to oral or laser therapy.

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Resources for Allergic Contact Dermatitis

There are several tools available to facilitate avoidance of specific allergens in personal care products. Once you have been patch tested by your dermatologist and the relevant allergens determined, consulting these databases may be helpful.

Contact Allergen Management Program from American Contact Dermatitis Society

Contact Allergen Replacement Database (CARD) from Mayo Clinic

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miraDry for Underarm Hyperhidrosis Now in New Jersey

SOMA Skin & Laser has added miraDry, the latest non-invasive treatment for axillary hyperhidrosis. miraDry is an FDA-cleared device for significantly reducing underarm sweat. It is a non-invasive outpatient procedure performed in our office. miraDry delivers electromagnetic energy to the underarm area, eliminating the underarm sweat glands.

Two procedures are typically recommended, 3 months apart, to maximize the quality and duration of results. Each appointment generally lasts about an hour. miraDry costs $1,500 per treatment.

The miraDry system eliminates the underarm sweat glands.  This results in a dramatic and lasting reduction of underarm sweat. In a clinical study, patients experienced an average of 82% reduction in underarm sweat. You should notice a reduction in sweat immediately after treatment. As with any medical procedure, results will vary by person.

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First Topical Agent for Facial Erythema of Rosacea Approved

Brimonidine topical gel 0.33% (Mirvaso, Galderma Laboratories) has been approved by the FDA for facial redness resulting from rosacea in adults aged 18 years or older

In clinical testing, the alpha 2 adrenergic agonist brimonidine topical gel yielded significantly greater improvement in the facial redness of rosacea than vehicle gel, according to the company sponsor of the clinical trial. Testing included 2 phase 3 clinical trials involving more than 550 patients, each lasting 1 month, and a long-term trial with 276 patients lasting up to 12 months.

Brimonidine topical gel is thought to work by constricting dilated facial blood vessels to reduce the redness of rosacea. It is intended to be applied in a pea-sized amount once daily to the forehead, chin, nose, and each cheek.

The most common adverse reactions (incidence ≥ 1%) seen in the short-term trials were erythema, flushing, skin burning sensation, and contact dermatitis.

In the long-term study, the most common adverse events (≥4% of subjects) included flushing (10%), erythema (8%), rosacea (5%), nasopharyngitis (5%), skin burning sensation (4%), increased intraocular pressure (4%), and headache (4%).

Galderma expects Mirvaso to be available in pharmacies in September 2013.

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Pharos Excimer Laser in New Jersey for Vitiligo and Psoriasis

We offer treatments with the Pharos excimer laser, a 308nm laser for the treatment of psoriasis, vitiligo, and other skin disorders.

Vitiligo. The Pharos utilizes a specific wavelength of ultraviolet light which stimulates the repigmentation of the skin in patients with vitiligo. Although there is no cure, vitiligo can be treated. Clinical studies with the Pharos have shown that, in some patients with vitiligo, repigmentation can begin within 6 to 12 treatments, and successful repigmentation can often be obtained in 30 treatments or less. The number of treatments needed can vary from person to person based on a variety of factors.

Psoriasis. The Pharos excimer laser can treat scaly skin plaques quickly and effectively often in just 6 to 10 brief treatment sessions.  This can provide long-lasting relief, typically several months free of symptoms.

Other skin conditions. Numerous other skin conditions are responsive to the excimer 308 nm laser., including:

  • atopic dermatitis
  • alopecia areata
  • pityriasis rosea
  • parapsoriasis
  • cutaneous T-cell lymphoma (CTCL)
  • polymorphous light eruption and other photodermatoses;
  • lichen planus;
  • pruritus; and
  • pityriasis lichenoides
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