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Cosmetic Dermatology PRINCIPLES AND PRACTICE SECOND EDITION NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowl- edge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed...

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Cosmetic Dermatology PRINCIPLES AND PRACTICE SECOND EDITION Nompumelelo Zitha-Khoza

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Cosmetic Dermatology PRINCIPLES AND PRACTICE SECOND EDITION

NOTICE Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

Cosmetic Dermatology PRINCIPLES AND PRACTICE SECOND EDITION LESLIE BAUMANN, MD Author and Editor Director, University of Miami Cosmetic Medicine and Research Institute Professor of Dermatology University of Miami Miami Beach, FL

SOGOL SAGHARI, MD Associate Editor Department of Dermatology University of Miami Miami, FL Private Practice Los Angeles, CA

EDMUND WEISBERG, MS Managing Editor Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine Philadelphia, PA

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Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-164128-9 MHID: 0-07-164128-9 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-149062-7, MHID: 0-07-149062-0. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.

Dedication This book is dedicated to the three men in my life: Roger Alexander Baumann Thank you for encouraging me and being there to help me with all the technology and business aspects of my life. Your never- ending support has kept me sane over the years. Most of all, my thanks for dragging me out of the mud when times were tough like a good cutting horse does! You are an ideal husband, father, and friend. Here’s to another 20 years together! Robert Edward Baumann I am so proud of what a good person you are growing up to be. You are kind, have a great sense of humor, and have a love for others that is truly refreshing. You have many talents, one of which is making me feel very special and proud to have you as a son. Keep up the good work! Maximilian Carl Baumann When this book comes out, you will be 7 years old. It is hard to believe that you are growing up so fast; however, you will always be my baby. I am very proud of what a great student and person you are. I am so happy to have someone in the family who is so much like me and loves to read as much as I do. Never stop snuggling!

Roger, Robert and Max, You all brighten my life, remind me of what is important, and make it all worthwhile. Thank you for loving me!

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CONTENTS

Basic Science of the Epidermis Basic Science of the Dermis

3

......................

8

Leslie Baumann and Sogol Saghari

3

Fat and the Subcutaneous Layer

................

14

Voraphol Vejjabhinanta, Leslie Baumann, Suzan Obagi, and Anita Singh

4

Immunology of the Skin

........................

Hormones and Aging Skin

......................

......................

Nutrition and the Skin

..........................

16 Rosacea (Type 2 Sensitive Skin)

121

...............

128

Sogol Saghari, Jonette Keri, Stuart Shanler and Leslie Baumann

Leslie Baumann

Sharon E. Jacob

19 Wrinkled Skin

.................................

20 Chemical Peels

45

21 Prevention and Treatment of Bruising

Leslie Baumann

145

Sogol Saghari and Leslie Baumann

42

Leslie Baumann and Sogol Saghari

8

..................

Leslie Baumann and Jonette Keri

18 Contact Dermatitis (Type 4 Sensitive Skin) . . .136

Photoaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Cigarettes and Aging Skin

15 Acne (Type 1 Sensitive Skin)

29

Leslie Baumann and Sogol Saghari

7

Section 3. Specific Skin Problems

22

Larissa Zaulyanov-Scanlan

6

109

17 Burning and Stinging Skin (Type 3 Sensitive Skin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

H. Ray Jalian and Jenny Kim

5

..................................

Heather Woolery-Lloyd

...................

Leslie Baumann and Sogol Saghari

2

Leslie Baumann and Sogol Saghari

14 Skin of Color

Section 1. Basic Concepts of Skin Science 1

13 Skin Pigmentation and Pigmentation Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

CONTENTS

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

................................

148

Leslie Baumann and Sogol Saghari .........

163

Susan Schaffer, Sogol Saghari and Leslie Baumann

Section 4. Cosmetic Procedures Section 2. Skin Types 9

The Baumann Skin Typing System

22 Botulinum Toxin .............

69

.......................................

75

Leslie Baumann and Edmund Weisberg

10 Oily Skin

........................................

Leslie Baumann, Marianna Blyumin and Sogol Saghari

24 Lasers and Light Devices 83

Leslie Baumann

12 Sensitive Skin

169

23 Dermal Fillers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Mohamed L. Elsaie and Leslie Baumann

11 Dry Skin

..............................

Leslie Baumann, Mohamed L. Elsaie and Lisa Grunebaum

......................

212

Joely Kaufman

25 Sclerotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 ...................................

94

Larissa Zaulyanov-Scanlan

Leslie Baumann

vii

26 Facial Scar Revision . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Suzan Obagi and Angela S. Casey

Leslie Baumann and Inja Bogdan Allemann

35 Anti-inflammatory Agents . . . . . . . . . . . . . . . . . . . . . 312

Section 5. Skin Care 27 Starting a Skin Care Product Line

..............

237

Leslie Baumann

28 Cosmetic and Drug Regulation

................

241

Edmund Weisberg and Leslie Baumann

29 Sunscreens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

......................................

CONTENTS

..............................

...........................

273

Leslie Baumann

33 Depigmenting Agents

325

37 Preservatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Edmund Weisberg and Leslie Baumann

....................

335

Leslie Baumann and Mari Paz Castanedo-Tardan ...................

342

Mari Paz Castanedo-Tardan and Leslie Baumann

40 The Psychosocial Aspects of Cosmetic Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Edmund Weisberg

.........................

Leslie Baumann and Inja Bogdan Allemann

viii

......................................

Edmund Weisberg and Leslie Baumann

39 Scales Used to Classify Skin 263

Kumar Subramanyan and K.P. Ananth

32 Moisturizing Agents

36 Fragrance

38 Bioengineering of the Skin 256

Leslie Baumann and Sogol Saghari

31 Cleansing Agents

Mari Paz Castanedo-Tardan and Leslie Baumann

Section 6. Other

Leslie Baumann, Nidhi Avashia and Mari Paz Castanedo-Tardan

30 Retinoids

34 Antioxidants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

279 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357

CONTRIBUTORS

K. P. Ananth Chapter 31 Nidhi J. Avashia, BS Miller School of Medicine, University of Miami, Miami, Florida Chapter 29 Marianna L. Blyumin, MD Dermatology Resident, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida Chapter 23 Angela S. Casey, MD Assistant Professor, Dermatology and Mohs Surgery, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, Vermont Chapter 26 Maria Paz Castanedo-Tardan, MD Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami Miami, Florida Chapters 29, 35, 38, and 39

Mohamed L. Elsaie, MD, MBA Cosmetic Dermatology Fellow, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida; Department of Dermatology and Venereology, National Research Center, Cairo, Egypt Chapters 10 and 22 Lisa Danielle Grunebaum, MD Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Head and Neck Surgery, University of Miami, Miami, Florida Chapter 22 Sharon E. Jacob, MD Assistant Professor, Divisions of Medicine and Pediatrics (Dermatology), University of California, San Diego, San Diego, California Chapter 18 H. Ray Jalian, MD Resident Physician, Department of Medicine, Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California Chapter 4 Joely Kaufman, MD Assistant Professor, Department of Dermatology and Cutaneous Surgery and Director of Laser and Light Therapy, University of Miamia Cosmetic Medicine and Research Institute, Miami, Florida Chapter 24

Jonette Keri, MD, PhD Assistant Professor, Miller School of Medicine, University of Miami, Miami, Florida; Chief, Dermatology Service, Miami VA Hospital, Miami, Florida Chapters 15 and 16

CONTRIBUTORS

Inja Bogdan Allemann, MD Cosmetic Dermatology Fellow, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida; Dermatologic Clinic, University Hospital of Zurich Zurich, Switzerland Chapters 33 and 34

Jenny Kim, MD, PhD Associate Professor, Department of Medicine and Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California Chapter 4 Suzan Obagi, MD Assistant Professor of Dermatology, Director, The Cosmetic Surgery and Skin Health Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Chapters 3 and 26 Sogol Saghari, MD Department of Dermatology, University of Miami, Miami, Florida; Private Practice, Los Angeles, California Chapters 1, 2, 7, 13, 16, 19, 20, 21, 23, and 30 Susan Schaffer, RN University of Miami, Cosmetic Medicine and Research Institute, Miami Beach, Florida Chapter 21 Stuart Daniel Shanler, MD, FACMS Private Practice, New York, New York Chapter 16

ix

Anita Singh, MS Miller School of Medicine, University of Miami, Miami, Florida Chapter 3 Kumar Subramanyan, PhD Senior Manager, Consumer and Clinical Evaluation, Unilever Global Skin Research & Development Shanghai, China Chapter 31

CONTRIBUTORS x

Voraphol Vejjabhinanta, MD Postdoctoral Fellow, Mohs, Laser and, Dermatologic Surgery, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine,University of Miami, Miami, Florida; Clinical Instructor Suphannahong Dermatology Institute, Bangkok, Thailand Chapter 3

Edmund Weisberg, MS Managing Editor, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Chapters 9, 28, 36, 37, and 40 Heather Woolery-Lloyd, MD Assistant Professor, Department of Dermatology and Cutaneous Surgery, Director of Ethnic Skin Care University of Miami Cosmetic Medicine and Research Institute, Miami, Florida Chapter 14

Larissa Zaulyanov-Scanlan, MD Voluntary Faculty, University of Miami Cosmetic Medicine and Research Institute, Miami Beach, Florida; Private Practice, Delray Beach, Florida Chapters 5 and 25

P R E FA C E

and procedures. By working together in this way we can preserve the integrity of an exciting and rapidly developing field of study. Research in the field of cosmetic dermatology should be encouraged for many reasons. Obviously, it is vital to maintain the hard earned integrity of the field of dermatology. In addition, the discoveries made though cosmetic dermatology research will likely benefit other fields of dermatology. For example, research into the anti-aging effects of antioxidants may lead to enhanced knowledge of chemopreventive techniques to be used to prevent skin cancer. Advances in acne therapy, vitiligo and other disorders of pigmentation are also possible. In fact, it is interesting to note that the development of Vaniqa™, a cream designed to slow hair growth in women with facial hair, has led to the availability of an intravenous treatment for African Sleeping Sickness, a major cause of death in Africa. Without the financial incentive to develop Vaniqa, which is used for purely aesthetic purposes, this life-saving drug would not be available. For many reasons, all pharmaceutical, medical device, and cosmetic companies should be encouraged to research their products. Although there is much research performed by cosmetic companies on the effects of cosmetics on the skin, much of this data is proprietary and is not published nor shared with the rest of the scientific community. The reasons for this are numerous, but competition between companies and the desire to be the first to come out with a new “miracle product” are prominent among them. However, the issue is even more complex. The FDA has different definitions for drugs and cosmetics. Cosmetic prod-

ucts do not have to be researched in any standard way because FDA approval is not required. Instead, cosmetic products are voluntarily registered by the companies that develop them. However, drugs must undergo years of expensive trials establishing both safety and efficacy before receiving FDA approval (see Ch 28). This disparity means that a company is more reluctant to publish data that could cause their product to be labeled as a drug. The dearth of published data on cosmetic products has forced physicians, aestheticians, and lay people to rely on sales people and marketing departments to obtain information about cosmetic formulations. This has led to much misinformation that has diminished the credibility of cosmetic products and the cosmetic field in general. Because an ever-increasing number of dermatologists and other physicians are practicing “cosmetic dermatology,” it is imperative that the cosmetic dermatologist practice evidence-based medicine in order to distinguish efficacious treatments from mere marketing hype. This text sifts through the knowledge of the effects cosmetic products and procedures have on ...