1-7-10 Therapeutics and cosmetic dermatology Sunscreen UV damages DNA by exciting adjacent thymine bases into a thyminde dimer

r or a pyrimidine-pyrimidine 6,4-photoproduct Sunblock acts as either a physical or chemical blocker Chem. Sunscreens absorb UV and convert the energy into lower energy wavelengths UVA blockers: benzohones, dibenzoylmethane, methyl anthranilate, red veterinary protein UVB: PABA, padimate O, cinnamates, salicylate Physical blockers reflect both UVA and UVB: titanium dioxide and zinc oxide SPF only reflects efficacy in blocking UVB. Any sunscreen with SPF>30 usually contains both chem. And physical agents. Water resistant means 40 minutes of water contact, while waterproof means 80 minutes of water Most people put on a layer that only gives the actual SPF rating Retinoids Vitamin A alcohol is retinol Vitamin A aldehyde is retinal Vitamin A acid is retinoic acid Retinoids induce direct and indirect effects on transcription Direct effects are mediated by binding of hormone response element RARE to mediate skin differentiation and normalization Drugs such as tretinoin, adapalene, and tarazotene affect different retinoic acid receptors and retinoid X receptors. Retinoic acid helps prevent photoaging by Increasing the number of anchoring fibrils Making effaced epidermal junctions more undulating Dispersing clumped melanin Improving fine wrinkling (Rhytids) Botulinum Toxin Botulinum toxin A is one of seven serotypes of Ach-blocking neurotoxins produced by C. botulinum It exerts its activity via a multistep process that inhibits Ca-dependent neurotransmitter release The first use of BTX-A was to weaken eye muscles to treat strabismus. The drug was called Oculinum. It was first used cosmetically in the 1990s to temporarily reduce or eliminate active wrinkles Can be used to address glabellar lines (frown lines between eyebrows), hyperhidrosis (perspiration), and as an adjunct to surgery BTX-A is contraindicated for patients with neuromuscular disorders (like myasthenia gravis or Lambert-Eaton syndrome) and pregnant individuals

Fillers

Soft-tissue augmentation Wide variety of materials available, with different levels of implantation, biodegradability, allergenicity and durability Regions where fillers are placed: lips, melolabial (nasolabial) folds, marionette lines (lines around mouth), glabella (space between eyebrows), cheeks Indicated for atrophic scarring, static wrinkles, contour defects due to soft tissue loss (i.e. HIV lipodystrophy) The purpose of fillers is to augment skin to look more youthful or normal without the risks, recovery time and expense of surgery Caveats: Contraindicated for patients w/ bleeding disorders or on NSAIDs, and in people with bovine collagen hypersensitivity; can cause glabellar necrosis, granulomatous foreign body reactions, risk of toxic shock syndrome

Chemical peels Application of exfoliating agens to the skin to produce a controlled partial-thickness injury (a burn) The partial-thickness wound will heal via replacement of the epidermis (and maybe the dermis). This is skin rejuvenation. Result: skin color and textor are improved, while sun-related growths are removed Three levels of chemical peel types: Superficial peel: penetrates to epidermis/papillary dermis Use Jessners solution, salicylic acid, trichloroacetic acid, glycolic acid Medium peel: penetrates to the dermis/upper reticular dermis Use Jessners solution, TCA, glycolytic acid Deep peel: mid-reticular dermis Use phenol The deeper the peel the more impressive the rejuvenation! Many superficial peels does not equal one deep peel, because all you keep removing is the stratum corneum. With deep peels, you need IV sedatio, IV fluids and cardiac monitoring since the peel itself is cardiotoxic, nephrotoxic and hepatotoxic. In ethnic individuals, peels may cause post-inflammatory hyperpigmentation. Lasers

Light Amplification by the Stimulated Emission of Radiation Longer wavelengths of laser penetrate deeper into the skin Chromophores are what absorb the light energy. When light is absorbed by a chromophore, heat is produced and contained within it. Chromophores include hemoglobin, melanin, and water. Lasers that target hemoglobin help eliminate vessels Lasers that target melanin help eliminate hair roots Lasers that target water are used for skin resurfacing

Mohs Method of excision that provides complete microscopic control of tumor margins and offers superior cure rates. The main benefits of Mohs are a high cure rate of almost 100% and tissue sparing where almost all normal tissue is left untouched. Horizontal frozen histological sections of the surgical margins are evaluated to achieve complete microsocopic examination

Conclusions: Healthy lifestyle, sunscreen, retinoid are the foundations for aging gracefully A number of non-invasive/minimally invasive cosmetic surgeries can help mediate the aging process and help with dermatological problems. Different branches of dermatology: Dermatopathology: read slides Medical dermatology: work with patients with horrendous skin disorders and utilize drugs like methotrexate, TNF-alpha inhibitors, and plaquenil Mohs: skin cancer removal and reconstruction