Do you have rosacea? Botox!

Botox treatments make a noticeable difference in the redness of the skin in a patient suffering from rosacea

Yet another use for Botox:

Rosacea is an extremely common and frequently frustrating skin condition. For all those that suffer from the redness and flushing that accompanies rosacea, also called erythematotelangiectatic rosacea, a novel and impressively effective therapy is again in the news, Botox.

In a recent study published in Dermatologic Surgery. Intradermal injections of Botox were found to be safe and effective in treating the facial redness of rosacea.

In the study multiple injections were performed “intradermally” and the amount used ranged from 15-45 total units. Unquestionably, patients noticed decreased flushing, erythema (redness), and inflammation within one week. The results persisted 3-6 months.

Even though the injections of Botox were placed into the cheeks, none of the study patients experienced any weakness or relaxing of the smile or cheek muscles. This may be secondary to the amount and, more likely, the location in which the product was placed. Botox when used to treat wrinkles is not injected intra-dermally, but deeper, either sub-dermally or intramuscularly.

Botox blocks the release of the neurotransmitter acetylcholine, which plays a role in local vascular control. It should be noted however that neurovascular regulation is much more complex than simple acetylcholine release. Thus, there have also been case reports of this treatment approach being ineffective in some patients. This illustrates the complexity of the condition.

For those of you that suffer from rosacea, you know that there are very few treatment options to truly target the redness that accompanies rosacea. A newer topical medication called Mirvaso, targets the redness by constricting the superficial blood vessel in the skin and can do a great job in a temporary fashion, but I have seen mixed results in practice and have my own concerns about the product. And then of course there are lasers.

Laser therapy remains the gold standard for the treatment of erythematotelangiectatic rosacea. They just work. Unfortunately since they are not covered by insurance in the vast majority of cases, these options may not be talked about enough with patients suffering from the disease.

Botox for rosacea represents a new and interesting application of a surprisingly complex medication. And it is always nice to have options in medicine.  If you suffer from rosacea, consider laser or Botox. You will be pleased.


Taking care of your skin with topical retinoids

retin AThere are a few simple recommendations and practices that should be included in any basic skin care regimen.  Appropriate
moisturization and exfoliation, protection from harmful UV radiation, and avoiding the significant damage caused by harsh toxins such as those found in cigarette smoke are a few such recommendations.  And certainly, in patients with
lighter skin tone, the use of topical retinoids (a class of chemical compounds long used in cosmetic creams and in the treatment of various skin disorders) could be included in this list.

A study published in the Journal of Drugs in Dermatology explores the efficacy and tolerability of two topical treatments for
photoaging, photodamage, and fine lines/wrinkles on the face.  The study compares two commonly used vitamin A derivatives, retinol and tretinoin.

Retinol is an over the counter compound found in many cosmetic creams marketed to treat wrinkles and to rejuvenate the skin.  Tretinoin is a similar more potent compound available by prescription, and is most commonly found in topical acne therapies.  Tretinoin has been used to effectively treat acne for many years, but has also long been used as a prescription strength anti-wrinkle cream.

The study enlisted patients with photodamage (blotchy skin coloring from sun damage) to use retinol on one side of the face and tretinoin on the other for a period of 12 weeks.  And the results from the study were undeniable.  The regular daily use of topical retinoids produced noticeable improvement in photodamage.  Meaning It helped to even tone and texture by lightening brown spots, smoothening rough patches, and fading fine lines.

retinol before and after
Before and after 12 weeks of daily use retinol 5% cream. Notice the subtle improvement in fine lines and dark spots.

Confirmation is always nice, but the fact that topical retinoids help with fine lines is not news.  What I found more interesting however, is that there seemed to be little to no difference in improvement between the retinol and the tretinoin treated sides.  Meaning that both sides of the face improved to similar degrees. The results of this study support the notion that over the counter cosmetic products containing retinol might be similarly effective as the prescription tretinoin formulations. Another reason why this may be good news is that tretinoin creams tend to be more irritating to the skin, causing occasional dryness, flaking, redness, and burning sensation.

It should be noted that there are multiple shortcomings and potential confounding variables in the study, including an obvious conflict of interest as the study was designed, executed, and paid for by a cosmetic skin care company that produces over the counter retinol creams.  As an aside, this particular company makes products that I really like and have found to work well in my own practice.  But I think the take home message for me from this study is unhindered by these questionable detractors. Skin care is important and has an appreciable effect on skin health and appearance weather you use over the counter products
or prescription strength medication.  You only get one face. Take care of it.

Botox for depression

Can botox help patients suffering from depression? Dermatologists and scientific research are finding this is a viable treatment for patients suffering from depression. Dr. Smart of The University of Utah advises patients that botox could be the missing treatment in their struggle with depression.

Positive effects on mood have been seen in patients who’ve had Botox
treatment for the glabella and frown lines (the area above the nose
and between the eyebrows).  And a randomized, double-blinded, placebo controlled trial recently published in the Journal of Clinical Psychiatry adds further evidence to support the use of botox as an adjunctive therapy to treat depression.

In this study a total of 30 patients with high levels of chronic and
treatment-resistant depression were enrolled in the study. Patients
were randomly assigned to receive a single injection of Botox or a
single injection of saline (placebo). Six weeks after a single
treatment, the Botox group had an average 47.1% reduction in
depression symptoms vs. 9.2% in the placebo group.

Why would this work?  Our emotions are expressed by facial muscles,
which in turn send feedback signals to the brain to reinforce those
emotions. Treating facial muscles with botulinum toxin to prevent the
facial muscles from expressing a frown or brooding scowl seems to
interrupt this cycle.

Neither this concept nor the evidence presented here are particularly new, but I never fail to find the link between the physical and the emotional fascinating. Or maybe people are just happy when their wrinkles get better.