Hawaii Bans Sunscreen in an Effort to Protect Coral Reefs

Written By: Jamee Bonner

In an effort to protect its marine environment, Hawaii becomes the first state in the nation to ban synthetic sunscreen that is harmful to the coral reefs. The law specifically prohibits the sale and distribution of sunscreen containing oxybenzone and octinoxate, which will take effect in 2021.

“At first this may seem like a shocking decision that leaves tourists choosing between sunburns, skin cancer, or injuring our coral reefs, but it is crucial to realize only sunscreens containing two specific ingredients are included under the ban,” explained dermatology physician assistant Lindsey Smith. “There are still plenty of sun protective options to consider when visiting Hawaii including many sunscreens.”

The two additives included in the ban — oxybenzone and octinoxate – are said to cause, “mortality in developing coral; increase coral bleaching that indicates extreme stress, even at temperatures below 87.8 degrees Fahrenheit; and cause genetic damage to coral and other marine organisms.” A study published in the journal Archives of Environmental Contamination and Toxicology from 2015, found that 14,000 tons of sunscreen end up in and around coral reefs each year in Hawaii and in the Caribbean.

Sunscreens containing oxybenzone and octinoxate are known as synthetic sunscreens and soak into the top layers of our skin. Synthetic sunscreens protect us by absorbing UV rays, and then converting them into infrared rays. While they make up a large portion of sunscreens on the market due to their more cost effective price point they are not the only options available. Sunscreens containing titanium dioxide and zinc oxide are known as mineral sunscreen and are not affected by Hawaii’s recent legislation. It works by forming a protective layer on the skin and physically reflecting UV rays.

“All sunscreens, including chemical sunscreens, have safe ingredients that have not been scientifically proven to be toxic or hazardous to humans. The effect of chemical sunscreens on the coral reef does warrant more research and exploring other options when traveling. Mineral sunscreens are the types of sunscreen I recommend anyway, so it does not make a really significant change in my opinion, “ said Smith.

Which one should I be using?

Most dermatologist would agree that the best sunscreen is the one that you will use. Both types of sunscreens are effective and it all comes down to your circumstance and situation. What matters most in ensuring broad-spectrum protection from UVA and UVB rays, and diligently using whatever type you choose.

The American Academy of Dermatology Association has expressed concern that the restrictions could lead to an increase in skin cancer, particularly melanoma, which the organization says is already 30% higher in Hawaii than the national average. Nevertheless, doctors see this as an opportunity to increase their efforts in educating the public on the importance of sun protection.

“When visiting Hawaii consider investing in a mineral sunscreen or if all else fails use additional sun safety practices such as seeking shade, wearing protective clothing, and limiting time in the sun between 10am and 4pm,” said Smith.

As far as sunscreen usage in Utah no changes need to be made. Continue to wear SPF 30 sunscreen of any brand and type, reapply every 1-2 hours, and remain aware of how much time you are spending in the sun.

Written by Jamee Bonner

I AM GOING BALD

I am going through some major hair loss right now and each time I shower and brush my hair I feel like this lady below, seriously though!

hair loss

My baby is now almost four months old and I am currently going through a type of hair loss called Telogen Effluvium. I was hopeful I would not get it this time around because the delivery and first three months were much less traumatic, but it is here and I hope it is at the peak and will start to slow down.

There are many types of hair loss, but I will be talking about this one since it is pretty common and I am currently experiencing it:) Did you know that is can be normal to lose up to 100 hairs a day due to the normal hair cycle? I don’t know about you, but 100 hairs seemed like a ton to me. What is a normal hair cycle?  The hair growth cycle can be divided into three cycles: 1. Anagen – actively growing hair 2. Catagen – Transition phase lasting 2-3 weeks where growth stops and follicle shrinks and 3. Telogen – Resting phase for 1-4 months (up to 10% of hairs in a normal scalp).

Now think about this, if there is a shock to your system, such as child birth, your hair cycle can reverse the ratio and your Anagen (growing) hairs can be triggered into Telogen (resting) phase.

Telogen Effluvium is a non-scarring type of hair loss where over-shedding occurs 2 to 6 months after an inciting event that stops active hair growth.

It is commonly caused by the following stressors:

  1. Fever, weight loss, pregnancy/childbirth
  2. Illness, psychological stress (Accident, death, divorce, etc..)
  3. Surgical operations, medications and others

 

You will not go bald with Telogen effluvium, even though you will feel like it! It is self-correcting and rarely influenced by any treatment that can be given. The biggest thing in treatment of this condition is fixing the inciting event.

Now I want to mention one thing about hair vitamins that seem to be all the rage right now. If you have some sort of social media account I am sure you have seen celebrities and bloggers push Sugar Bear Hair vitamins. These blue gummy candies look cute but they are not going to help your hair grow! They contain vitamin A and C and a couple different B vitamins and Biotin. Biotin is not the holy grail when it comes to hair loss and there are actually very weak studies to suggest that Biotin improves hair, unless you have a Biotin deficiency which is really rare. I am not saying it won’t help, the power of placebo is real, and it won’t hurt so you can give it a try. However, a deficiency in Iron, Ferritin, vitamin B12, folic acid can slow hair growth. In short, my opinion is eating a healthy diet high in protein, fruits and vegetables is probably better for your hair than blue gummy bears:)

 

 

 

Moisturizers, not all are created equal

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I think that winter finally decided to show up just in time for the Holidays. And with winter comes lots of dry, cracked skin that can lead to rashes.

I have a lot of patients at my Park City clinic that are from the East Coast and they always tell me similar stories, ever since living here their skin is very different. It is very dry and gets irritated easily or they have never had eczema in their life until moving here.

We do live in the 2nd driest state in the country and our skin takes a beating, especially in the winter. Consequently, we have to be extra vigilant in taking care of it.

Xerosis is the medical term that means dry skin and it usually has a very dry, rough and scaly texture to it. It can develop little tears that can lead to some serious rashes and infections.

You may not have “eczema”, but we all deal with dry skin at some point or another, especially here. I don’t have particularly dry sensitive skin, but my hands sure do get hammered in the winter because I wash them 100 times a day to try and keep the winter bugs away from my baby.

Regardless of how mild or severe your dry skin may be, it is a sign of barrier dysfunction. There are different factors that can play a role in barrier dysfunction, but in short it doesn’t keep water in and allergens and irritants out!

How do we repair our barrier and keep our skin healthy and soft? Applying a good moisturizer frequently is critical.

However, the term moisturizer is a marketing term and not all moisturizers are created equal.

I have patients tell me all the time, well I apply my Bath and Body works hand lotion daily and then we go on to have the discussion that the term moisturizer is a marketing ploy and they are not all created equal.

 

Step 1 ; picking a good moisturizer

  • Ointments are better than creams, and creams are better than lotions. This comes with a caveat, you have to like the feel of what you put on or else you won’t use it frequently enough. Don’t smear Vaseline all over your body and dread it, just remember in general the thicker (higher oil content than water and alcohol content) the better.
  • Look for the terms, emollient and humectant
  • Products should contain ceramides
  • Products should not contain fragrances and soaps
  • Good ingredients include; Urea, petrolatum, dimethicone, etc..

 

There are many different brands you can find at your grocery store with these tips in mind. If you do have very sensitive skin that is prone to eczema then my favorite is the Vanicream line of products because it is in my opinion the most hypoallergenic product out there.

There are also some prescriptions medications that repair and protect the skin barrier that many patients have had less eczema flares with and you can talk with your doctor about those.

 

Step 2; Frequency of application

            –The more you use it the better. Your moisturizer should be applied at least twice a day with one of the applications being immediately following showering when your skin has highest absorption.

 

Other tips to avoid further drying out your skin this winter

  • Frequent washing, especially in really hot water
  • Hard water, which increases skin pH
  • Soaps and antiseptics
  • Extreme temperatures
  • Excessive chlorine in pools and hot tubs

 

Basically, if you want your skin silky smooth at all times, move to Hawaii and avoid the low humidity, wind and cold that comes with Utah winters!

Lindsey Smart Smith PA-C

Should you rub that fruit on your face?

 

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No, don’t rub fruit on your face.   I’ve seen several posts and articles about the benefits of certain foods and about applying them topically on your face to get the benefits of these ingredients.  Why don’t I agree with this?  I’ll tell you, and I’ll start with a metaphor I heard and really like for this.   Imagine walking into a critically acclaimed restaurant run by a celebrated and highly educated chef, barging back into the kitchen, and saying, “Oh, chocolate soufflé? Well, I’ve got an oven and a bar of chocolate right here, I don’t need your fancy kitchen shenanigans.”

Sure, you can make a chocolate soufflé on your own.  And yes, you don’t need to get it from an expensive restaurant for it to be good.   But if you have had no training or even practice in this area, it’s a bit unreasonable to suggest that you’re going to out-cook someone who’s devoted years of their life to the culinary arts.

The same can be said of beauty products. Cosmetic chemists go to school for years so that they can understand the science and make expert products that are effective, safe, and long-lasting.

Home made products are especially not worth it in the case of vitamin C, and vitamin C is the main reason why so many beauty blogs will suggest rubbing these things directly on your skin.  Here’s a just a couple of reasons why:

  1. Instability: L-ascorbic acid is very unstable. It’s one of the most effective forms of vitamin C, but it degrades in heat, light, and air.  Stabilizing vitamin C is not always an easy or cheap process.
  2. The wrong pH: The skin is slightly acidic, with a pH around 5.5 or 6.5, and mildly acidic products do the best on the skin.  Specifically, Vitamin C penetrates the skin best at an acidic pH and in order to effectively enter the skin, it must be formulated at a pH lower than 3.5. However, a pH too low is going to cause irritation, sun sensitization, and dry skin.

So, these products are formulated by professionals who spend their time researching and developing the coming up with the most effective methods. While something in your kitchen might be readily available and safe, it’s still not likely to work as you intend it to.  When it comes to vitamin C, irritation will probably be the biggest issue, but even if its not.  Without the right pH, a stabilized formulation, and additional ingredients, it won’t even work.

My advice? Let’s be more demanding. Demand more and better research from our cosmeceutical companies.  Require products that have solid scientific evidence to support their efficacy.  And when it comes to home remedies, consider sticking to professionally formulated products that work and won’t be irritating to your skin.

 

Metaphor and content drawn from several sources. Principally see Futurederm.com Skincare by Natalie Bell.

 

Smoother than a Baby’s Bottom

Baby-Skin-Care

We are all born with skin, the largest organ, and it plays many vital roles. Most importantly it serves as the physical barrier between the outside world and us. It provides protection against harmful UV rays; it prevents water loss, regulates body temperature and plays a major role in sensory perception.

Infant skin is different than adult skin and it undergoes a significant maturing process the moment after delivery through the first year of life. The development of the skin barrier increases with gestational age, meaning that preterm infant skin is even more fragile. Newborn skin is more susceptible to infections, heat loss, damage from chemicals and heat, and isn’t as effective at keeping things out that are supposed to stay out. I think it is most helpful to think of Infant skin as having a slightly impaired barrier.

How do we care for such fragile skin as it is still developing? Are there products we should use and ones we should avoid? How often should we bathe our babies? Can we prevent our children from having dry or diseased skin in the future?

One thing that I noticed that was different when I gave birth from when my mom delivered me in the hospital is that they do not immediately bathe the baby anymore. This is because of the special coating brand new babies have on their skin called the vernix caseosa. It is a protective coating that develops during the last trimester of gestation. It is composed of water, proteins, sebum lipids and antimicrobial peptides. The coating on the skin surface contributes to a higher skin hydration, a lower skin pH and relates to a reduced heat loss after birth. Basically I wish that protective coating were on their skin forever!

One of the most common diseases in young skin is Eczema, a disease of dry skin. This condition tends to run in families and these kids can also develop two other closely related conditions, asthma and seasonal allergies. While there is no cure for this disease, a recent study performed in the United States and the United Kingdom provides evidence that might be able to help prevent it. The study took hundreds of infants at high risk of developing eczema and showed that that daily full-body moisturizing from birth can prevent eczema.

The exact way that it prevents the disease is not fully understood, but the study proposes that emollients, moisturizing creams and ointments, correct the skin barrier and the early inflammation in at-risk infants by improving skin hydration and reducing skin permeability. This in turn leads to preventing skin dryness and cracking, as well as reducing irritation and allergic reactions. It also stops some infants from developing eczema.

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Some skin cleansing tips for babies

  • Use Emollient based liquid cleansers that are pH neutral or mildly acidic.
  • Avoid cleansing bars or scrubbing brushes that can further damage a fragile skin barrier.
  • Although they smell nice, avoid the fragranced body washes. Lavender oil can be allergenic and can further irritate dry skin.
  • Limit baths to no more than every other day and bathe in luke warm water.
  • Immediately following bath time, apply an emollient based, fragrance free thick moisturizer from head to toe. Moisturizers in pump bottles tend to have more preservatives in them so they will spread easier, but have less of an occlusive effect making them less effective. The thicker the better!!
  • Avoid products with excessive ingredients and preservatives like formaldehydes and parabens.
  • Some great products are; Cetaphil Baby, Aveeno Baby, Vanicream is one of my favorites and believe it or not good old Vaseline or Aquaphor! For those babies that already have eczema give Robathol bath oil a try.

 

 

 

 

 

 

 

 

 

 

Vitamin C: For Younger, Brighter Skin

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Vitamin C really can make your skin look younger and brighter.

While vitamin C is most commonly thought of as a citrusy supplement that boosts the immune system, there are several more benefits to this vitamin.  When applied topically vitamin C is a powerful addition to an anti-aging skin care regimen.

Vitamin C is an essential water soluble vitamin that also lightens and brightens the skin, is an impressive antioxidant, and is essential in collagen synthesis.

This rather versatile and tasty vitamin smoothens the tone of aging and damaged skin by lightening and brightening the skin. The blotchy coloring that appears on the skin over time, and with sun damage, is due in part to the uneven production of brown pigment in the skin cells.  This brown pigment comes from a molecule called melanin.  Over time, some areas or cells start making more melanin.  Vitamin C smoothens out the tone by causing those overproducing areas to start making less melanin and start matching the rest of the skin.

For those wanting a slightly more scientific explanation of this, read this paragraph:  Tyrosinase is the enzyme that makes melanin.  Vitamin C interacts with copper at the tyrosinase-active site and inhibits action of the enzyme, thereby decreasing the melanin formation.

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Vitamin C is also a powerful antioxidant.  An antioxidant is a molecule that inhibits the oxidation of other molecules. Oxidation is a chemical reaction that can produce free radicals, which are atoms or molecules with an unpaired electron.  When a free radical then steals an electron from one of the proteins in a strand of collagen, it creates damage or a break in that strand. The more breaks you get, the more damage you see, such as sagging and wrinkles. Since vitamin C is an effective electron donor, it helps reverse and prevent signs of aging.

Essentially what this means is that Vitamin C can effectively protect the skin from damaging chemical reactions caused by sun exposure, pollution, and time.

Finally, vitamin C is a necessary component in the building of new collagen, and new healthy collagen is the building block of young vibrant skin.

These three functions of vitamin C have several applications when it comes to skin health. And solid, reproducible and reliable studies have also shown the following benefits of using topical vitamin C preparations:

  • Improve skin appearance by reducing fine lines and wrinkles.
  • Improved skin health and wound healing as it aids in stabilizing collagen.
  • Increased protection and/or lessening the severity of sunburns.

Ok, now keep reading because this next bit is the most important part.

It is important to note that vitamin C is an unstable compound, and not all formulations are created equal.

A correctly formulated topical vitamin C preparation is a difficult and costly process. Many formulations on the market, or made at home, are manufactured cheaply and are basically ineffective. The problems lies in the fact that vitamin C is most commonly found in the form L-ascorbic acid. This is highly unstable when exposed to oxygen, which renders the vitamin essentially useless topically. In addition, many of the currently available topical vitamin C preparations do not penetrate the skin sufficiently to make any difference. Research is continually underway to optimize stable and effective topical vitamin C formulations.

If you are considering using topical vitamin C you should consult your pharmacist, doctor or dermatologist before starting.

Kybella! Liposuction in a needle

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

This is really cool stuff! It literally lends credibility to the title of this post, liposuction in a needle. The product is called Kybella (deoxycholic acid) and with it, a sharper jaw line may be just a few injections away.

The FDA recently approved Kybella for treatment of adults with moderate-to-severe fat below the chin, known as submental fat. This is fairly groundbreaking as kybella is a first-in-class medication. There is literally nothing else on the drug market that is FDA approved to dissolve fat in this manner.

A bit of history:
Compounds like kybella have been injected into the body for many years to try and tighten skin and destroy fat, but this is the first time that a medication like this has successfully undergone the rigorous study and clinical trials to obtain FDA approval.

Kybella is deoxycholic acid, a secondary bile salt, found naturally in the body. Its job in the body is to emulsify or surround fat and help the body absorb dietary intake. When Injected directly into fatty tissue the deoxycholic acid ruptures cell membranes and causes destruction of the fat cells. Once destroyed, those cells can no longer store or accumulate fat.

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

What is treatment with kybella like?

First, we will clean the skin and mark out the area to be treated under the chin. The area is then typically numbed with either topical or injected numbing medicine such as lidocaine. Kybella is then injected directly into the submental fat pad under the chin. The entire treatment lasts for about 15 min.

In the Kybella studies approximately 70% of patients were getting their desired results in 2-4 treatment sessions, but the treatment can be repeated as necessary to achieve the desired outcome. Treatments in the study were spaced out every 4 weeks, but I think we will find that this is too close together and that waiting closer to 8 weeks in-between treatments will give a more accurate perspective on results.

Since fat cells do not regenerate, once the desired aesthetic outcome is obtained, the need for retreatment at any time is not expected. Even if weight is subsequently gained.

Expected side effects from the treatment include redness, bruising, and swelling. Discomfort, as would be expected from the sensation associated with a bruise, is also common. These last anywhere from 3-7 days on average. Rare side effects noted in the study were all temporary but included difficulty swallowing or nerve injury resulting in an uneven smile for a few weeks.

Overall, I’m very excited about this therapy. It’s new, it’s safe, and it works.

See some before and after pictures below:

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

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kybella fat destruction double chin treatment at University of Utah dermatology David Smart

kybella fat destruction double chin treatment at University of Utah dermatology David Smart

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Tight Skin! ThermiTight

Over time the effects of gravity and aging slowly take their toll on us all. And for several reasons certain areas on the face and body unfortunately start to droop and sag, and the skin loses its youthful rebound and tension.

In short, life happens. Skin gets loose. And people want to keep it tight.

thermi-tight

Skin tightening is a popular request in a dermatologist’s office, and the world of aesthetic medicine and technology continues to try to meet the increasing demand with new approaches and treatments. A relatively new treatment modality of an already proven technology is ThermiTight.

ThermiTight is an application of the ThermiAesthetics system that uses radiofrequency (RF) technology to safely rejuvenate the skin. It is also one of the most effective “non-surgical” skin-tightening treatments I’ve seen. We’ve had great results.

There are many different devices in this non-surgical skin-tightening realm. Some work well, some less so, but none that I have yet seen work better or as reliably as the TermiTight. This is not to say that I don’t like, use, and recommend other methods. I do. But I’ve recently been quite impressed with the results of this treatment method.

ThermiTight’s RF energy induces the reduction of wrinkles, tightens skin and helps contour the body by heating underneath the skin, the hypodermis, and the layer of adipose tissue found there. It causes the release of liquid fat from fat cells and induces fat cells to shrink in the treatment area while also stimulating new collagen formation and contraction.

This procedure may be administered on several areas:

  • Lower face and neck
  • Arms
  • Legs
  • Stomach
  • Breasts
  • Hips
  • Back

It is also frequently combined with other procedures such as liposuction or laser resurfacing which reduces fine lines and wrinkles on the surface of the skin.

The fact that the RF energy is applied directly to the hypodermal layer is what makes it stand out. A fact that likely accounts for increased efficacy, but does make it minimally invasive. Unlike ultrasound or laser techniques, in which energy is placed on the surface of the skin and directed internally, RF energy stimulates the skin from within. The use an internal probe to apply energy below the surface of the skin directly targets the collagen.

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The treatment begins by administering local anesthetic to the treatment site. Tumescent anesthesia is used, which means that a diluted lidocaine mixure is used to flood the target area.   A thin, specialized probe is then inserted through a very small incision (2-3mm) to reach the subdermis. The probe is then slowly moved back and forth to evenly heat the treatment area. The continuous temperature monitor on the probe is set to the desired level required to tighten the skin, while an infrared camera is used to monitor the skin surface temperature and ensure the heat energy is maintained at an effective and safe level. The treatment lasts for less than 60 minutes, with results that develop gradually over 3-6 months. After the procedure, the patients are free to resume normal activities the next day. There is very little recovery time, with temporary bruising or swelling being the most common side effects.

For patients with skin that is drooping naturally from aging or significant weight loss ThermiTight might just be exactly what they are looking for.

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Stretch Marks

Stretch marks are noticeably lighter and less visible after only five laser treatments from Dr. Smart at The University of Utah's Department of Dermatology
Before and after 5 treatments of the Fraxel laser

The Stretch Mark

Why do stretch marks form? Well…. from stretching right? Probably, but the precise cause of stretch marks, also known as striae, is not quite understood. While many believe that mechanical stretching of the connective tissue causes rupture and their subsequent appearance, there is more to it than that. And even normal growth associated with high levels of steroid hormone may be the cause.

Whatever the cause, many of us have a stretch mark or two. They are a very common cosmetic concern and more than twice as likely in women, compared to men.  But regardless of gender, they can be frustrating to us all.

Keep in mind, we divide striae into two groups, striae rubra (SR) and striae alba (SA). SR are a little bit pink, red, or purple, relatively new, and may be raised. SA are typically older, light colored and slightly atrophic or thinned. These categories are important because they are treated a little differently.

How to treat your stretch marks:

Treatment of stretch marks includes a variety of topical and injectable medications and laser therapy and resurfacing techniques.

Tretinoin and similar topical creams have shown to clinically improve the appearance of SR in clinical trials. Daily application over the period of 3-4 months may help exfoliate and tighten the mark. Other topical therapies that show benefit are glycolic acid and Trichloroacetic acid (10-35%) These are typically applied at monthly intervals.

Another proven therapy is microdermabrasion. By carefully and gently abrading the superficial layer of skin, deeper new collagen regeneration is stimulated and the texture of the striae can be smoothened and strengthened.

There are also a variety of laser and light devices that have been studied to treat these pesky stretch marks. By using a combination of different lasers, such as the V-beam and Fraxel lasers, Good to great results can be achieved in both newer red stretch marks and older white colored ones.

Personally, I like the results I get with laser resurfacing. Fractionated laser resurfacing will help tighten the skin and improve the appearance of stretch marks both new and old.

A few technical details:

 The PDL 585-595nm lasers have perhaps the most evidence and are able to achieve good results when treating the early SR. Their effect is less impressive on mature SA.   Though caution should be used on much darker skin types with this laser. And in darker skin types one might consider a different wavelength such as a 1064nm ND: YAG. This provides increased safety when treating dark skin types, while still provided collagen regeneration and targeting vasculature.

The treatment of SA is more difficult and less predictable.  Studies show conflicting results with various fractionated laser modalities. but both ablative and non-ablative fractionated lasers have shown improvement. And both should be considered options in patients with mature striae.

Another consideration in SA may be the 308nm excimer laser. Multiple studies have documented improvment and repigmentation in white or light colored areas with the excimer.

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.

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