Dermalogica Skin Care, The Science Of Skin Care

Skin Inc. magazine Information | News | Dermalogica's New Headquarters and More

2006-04-02T01:34:00.000-08:00

Skin Inc. magazine Information | News | Dermalogica's New Headquarters and More: "Dermalogica's New Headquarters and More

(2006-02-13)

Dermalogica's new 145,000-square-foot Carson, CA-based facility places a collective corporate emphasis on education. In other news, CoolBrands, a publication in the United Kingdom, included the company in its directory of international brands that have earned popular public perception. 800-831-5150, feedback@dermalogica.com"

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2006-04-02T01:20:00.000-08:00

Effortless chic: beauty director Mikki Taylor is swept away by skin-renewing treats and perfect curls

2006-03-22T05:32:00.000-08:00

My Checklist

Out with the old, in with the new! Now's the time to:

[check] 1. Work hairstylist Ted Gibson's captivating curls (seen at Ellen Tracy's spring 2006 fashion show). All you need is a small-barrel curling iron and Aveda's Air Control Hair Spray ($23, aveda.com). Just wrap the hair around the iron, release, then spray for hold. These fabulous ringlets last for days.

[check] 2. Radiate! You can beat the complexion-dulling side effects of winter with Nivea Visage Simply Glowing Moisturizer ($9, drugstores nationwide).

[check] 3. Play up your eyes in clean, neutral shadows like Bobbi Brown Eye Shadow., ($19) in Banana, Cocoa, Taupe or Rich Brown. And don't forget the Bobbi Brow Eye Blender Brush ($24, bobbibrown.com), which perfects the look every time.

[check] 4. Go for whisper-soft blushes infused with a subtle bit of shimmer. I love Bourjois Blush in Brun Illusion ($14, bourjois.com).

GETTING PERSONAL

Maintaining shiny, health hair is no small feat. What works for me? Design Essentials Reflections Liquid Shine ($14.50, at designessentials.com).

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FAB GOODS

* Smooth Operators

Serve great face with Dermalogica Daily Resurfacer ($65 for a 35-day supply, dermalogica.com). It effortlessly exfoliates and evens out your skin's texture and tone.

* Dream Escape

Recently I did myself a favor. I pushed the pause button on my hectic schedule and headed straight to Willow Stream, the spa at Arizona's Fairmont Scottsdale Princess. Nestled in the heart of the Sonoran Desert, the spa specializes in healing treatments that promote energy and well-being--just what a hardworking girl needs! And given the hotel's gorgeous rooms that start at $149 a night (from June to September) and its soothing rooftop pool facing the majestic McDowell Mountains, I'm all ready to book my next trip. Until then, I'm enjoying the spa's Avocado Energy Wrap ($23.95, willowstream.com), which moisturizes and invigorates my skin.

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Q Mikki, how can I keep my locks from drying out this winter?.

--Heather, Baltimore

Heather, help is on the way. Try this at-home regimen recommended by Anu Prestonia of the Khamit Kinks salon in New York City. After you shampoo, apply a deep conditioner to the hair. Cover your hair with a plastic cap and leave on for 20 minutes. Rinse, then follow with a light nourishing oil like Khamit Kinks Herbal Hair Oil ($10 for 4 ounces, khamitkinks.com). Massage a small amount from scalp to ends, and then style as usual.

mikki@essence.com

COPYRIGHT 2006 Essence Communications, Inc.
COPYRIGHT 2005 Gale Group

Professional Skin Care Look

2006-03-10T05:25:00.000-08:00

When you walk in a room, have people notice your Beauty not your make-up!

The place to start for skin care that looks professional is clear healthy skin, it's a must. Whereas many women simply wash their face, cleansing the skin is important to the final finish. To effectively cleanse the skin, NEVER, EVER use soap off the shelf of the drugstore or grocery mart. A professional cleansing product that is specifically developed for your skin type is mandatory. World-class products, supplied by IH Distribution, include Cleansing Cream for dry skin, Cleansing Lotion for oily skin, hydrating wash with anti-aging properties for mature skin. More information about these products can be obtained from www.ihdistribution.com. Next, NEVER scrub your face with a washcloth, always use the fingertips. Rinse with lukewarm water and pat dry with a towel.

A critical step often missed is the use of a toner or freshener, which is also directly tailored to your skin type; this is important because it will remove any remaining oil, debris, or remnants the cleanser left behind. Then, using the proper moisturizer (again, tailored to your skin type) is paramount.

The foundation used is vitally important because where eye shadow, blush and lipstick may accent your facial features; the foundation sets the tone for a woman's visual appearance. Find a shade that disappears into your skin, which will be the correct shade for your complexion. IH Distribution has 15 different shades for which one perfectly matches everyone's skin. The About Face Line Defiance Makeup is SPF8, which smoothes the look of fine lines and wrinkles. The new line of liquid makeup is blended with vitamins A & E to protect against the invisible enemy - Time.

When using a blush to accent facial features, use a slightly darker shade to provide a contour to your face and provide cheekbones that "lift" from your face. Start at the earlobe down towards the cheek so a "glob" isn't left on the cheek. Use a blush that is lighter in color to bring out the highlights.

Eye makeup - use shadows to effectively reflect your moods! Take time to practice and you can apply eye shadow accurately and easily. Keep in mind that light colors highlight features and dark colors diminish. Use either 2 or 3 different shades, start with the lightest first on the entire eye lid, medium lower only and the darkest on the outer corner which provides a perception of depth.

Eyeliner should be applied with short strokes and remember to start at the center and work outside to the corners.

To complete the look and the mood, quality mascara finishes your eye make-up --- with dark eyes use navy, black, or dark brown.

Nail color - Use a polish that compliments the overall tones of your make-up. For example, if you were using natural shades on your lips and cheeks, stay with a natural color for nails.

Finally, lip color adds the striking appearance that makes a woman stand out and appear desirable. A professional skin care tip is to try to use a lip pencil to outline the lips prior to lipstick application; it's a personal thing but very defining on some women. Also, try a small brush from tube lipstick to help define the contours of the mouth but, more importantly, really control the amount of color that's applied. Another professional skin care tip is to lightly apply powder over the lips before applying the lipstick which helps it stay on longer. For effective lipstick stain removal, apply a dab of glycerin and wash as usual.

Check IH Distribution's 10 About Face Lip Pencils and 28 About Face Lipsticks. Virtually a rainbow of colors, one is sure to fit and shade your lips with beautiful color, moistures, and antioxidant protection. Favorite colors are Mysterious, Smolder, Whisper, and Celebrity. The products are available online at www.ihdistribution.com.

© IH Distribution LLC, 2004
No material to be used without the expressed permission of IH Distribution LLC

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Pure. Natural. Beautiful
from IH Distribution.
IH Distribution specializes in health areas such as acne skin care, anti-aging cream, anti-wrinkle cream, hormones and natural hormone replacement therapy, natural progesterone cream and skin care cream. We offer beauty care products such as natural cosmetics, facial products, skin care products, eye make up and dermatologist approved cleansing products.

Woman-to-Woman, a Skin Care Guide

2006-03-10T05:07:00.000-08:00

Due to the cycles in a woman's lifespan, her skin is different than a man's skin. Specifically, women have thinner skin than men which makes exposure to the sun critically more important to a woman. Always use skin care products that have sunscreen at least SPF8 level. The skin on the arms, back, and legs should be protected whenever the skin is exposed to the sun. Typically, the critical hours are 10am until 4pm, however, the closer to the Equator, the more critical the SPF level and exposure time.

It is said that women are said to age more quickly than men and the sun exposure issue is a major factor. The sun's penetrating UVA rays on under protected skin allow the sun's penetrating UVA rays to more quickly and deeply damage a woman's thinner skin. As a result of western women's dress, melanoma develops on different body areas than men. Because fashion dictates, women often wear skirts, the most common site for serious skin issues is the lower legs. In men, melanoma is most commonly found on the back. To protect yourself from skin cancer, remember to cover all exposed skin at all times.

A woman's skin also tends to change color and texture with age; while sun exposure is responsible for many of these changes, others are caused by the dynamic hormonal variations that occur around and during menopause. The hormone estrogen is responsible for maintaining the bony framework beneath the skin and helps keep the skin soft and resilient and works to keep a vibrant, healthy facial complexion. The issue of hormone replacement therapy is front and center in the news today. The use of all-natural progesterone creams provides many or all of the benefits hormone replacement therapy does, however, with natural products and without many of the side effects. More information about natural progesterone replacement can be found at www.realprogesterone.com.

A woman's skin is the largest organ of the body. It functions as a barrier to prevent the intrusion of toxic substance, provides a first line of defense against bacterial, viral, and fungal organisms, acts as a thermostat in regulating body temperature and acts as a sensor for stimuli through touch. Great looking skin begins early in childhood but requires careful attention throughout life to guarantee beautiful, healthy skin as an adult. IH Distribution provides a complete, all-natural skin care line including makeup and sun screen with products that are developed in Switzerland for the spa industry and can be ordered at www.ihdistribution.com.

© IH Distribution LLC, 2004
No material to be used without the expressed permission of IH Distribution LLC

--------------------------------------------------------------------------------

Pure. Natural. Beautiful
from IH Distribution.
IH Distribution specializes in health areas such as acne skin care, anti-aging cream, anti-wrinkle cream, hormones and natural hormone replacement therapy, natural progesterone cream and skin care cream. We offer beauty care products such as natural cosmetics, facial products, skin care products, eye make up and dermatologist approved cleansing products.

The use of photodynamic therapy in dermatology: results of a consensus conference

2006-03-09T15:19:00.000-08:00

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pre-treatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.

Introduction and Objectives

Photodynamic therapy (PDT) using topical 5-aminolevulinic acid (ALA) has significant promise in improving the clinical and cosmetic outcomes of patients with a variety of cutaneous conditions. (1,2) Although ALA PDT has been explored and expanded by some practitioners, the technique has not been widely adopted by most dermatologists because (1) the 1999 FDA clearance of ALA (as Levulan[R] Kerastick[R], Dusa Pharmaceuticals, Inc.) is limited to the treatment of nonhypertrophic actinic keratoses (AK) of the face and scalp, (2) patient "downtime" and photosensitivity are concerns, (3) reimbursement for the ALA PDT treatment of AK is poor, (4) the ALA PDT treatment of acne and other conditions are not covered by insurance, and (5) clinical guidelines have not been established.

To address these issues, a group of experts in ALA PDT met to (1) discuss the history, principles, and clinical benefits of ALA PDT; (2) establish an economic ; (3) define indications, patient types, and classifications; (4) establish consensus statements for pretreatment, ALA contact time, light sources (preferred and alternative), posttreatment, and number of treatments; (6) suggest future applications of the technique; and (7) prepare a consensus statement. The information in this report is intended for dermatologists and other physician specialists seeking treatment alternatives to skin diseases that we believe can be treated successfully with ALA PDT.

History of Photodynamic Therapy

In 1900, Raab reported that although acridine orange or light was not toxic to paramecia, the cells died in less than 2 hours when exposed to both at the same time. Von Tappeimer and Jesionek later used topical eosin (5%) and light together to treat skin cancer, lupus vulgaris, and condylomata lata. (2,3) In these cases, acridine and eosin acted as "photosensitizers," (1) compounds which, when inside cells, could participate in cytotoxic chemical reactions when activated by light. Von Tappeiner and Jodlbauer later reported that oxygen must be present for these photosensitizing reactions to occur. (3)

Subsequent interest in photosensitization focused on porphyrins. In 1911, Hausman described the ability of light-activated hematoporphyrin to photosensitize guinea pigs and mice. In 1913 Meyer-Betz showed that hematoporphyrin could photosensitize humans by injecting himself with hematoporphyrin and noting swelling and pain in parts of his body exposed to light. (Meyer-Betz also endured skin phototoxicity for 2 months, a major drawback in the use of hematoporphyrin as a photosensitizer.) In 1942, Auler and Banzer showed conclusively that hematoporphyrin was taken up and retained more in tumors than in surrounding tissue. They also found that fluorescent tumors were necrotic, and this was the first observation of the photodynamic action of hematoporphyrin. (3)

At this stage, the principles of the photodynamic process had been established. Porphyrin-based photosensitizing agents could selectively concentrate in human cancerous tissue and be activated by light in the presence of oxygen to initiate cytotoxic chemical reactions. Hematoporphyrin derivative (HPD), a complex mixture of porphyrin subunits resulting from attempts to purify hematoporphyrin (4) became the standard photosensitizer for studies of photodynamic therapy. (2,5) The development of photodynamic therapy with systemic HPD in various cancers is largely due to the work of Dougherty (6) and others. (7)

Because skin is accessible to light-based therapy, dermatologists have explored the use of PDT for cutaneous conditions. (8) A major drawback of HPD, however, is that it accumulates in skin and may take several months to clear. During this time, phototoxic reactions may occur in patients. (4)

To overcome the prolonged risk of phototoxicity, Kennedy and colleagues (4) introduced topically applied ALA, a new photosensitizing "prodrug" that can penetrate the stratum corneum of actinically damaged cells, solar keratoses, basal cell carcinomas, squamous cell carcinomas, and pilosebaceous units. (2,9) When ALA enters epidermal cells, it is converted to protoporphyrin IX (PpIX) because ALA is the natural precursor of PpIX in the biosynthesis of heme (Figure 1). ALA is a photosensitizing agent while PpIX is a photosensitizer which can be activated by either blue or red light. (2)

[FIGURE 1 OMITTED]

Under ordinary circumstances, heme biosynthesis is under close feedback control, so heme precursors, including PpIX, do not accumulate in most tissues. (10) The clinical consequence of this is that PpIX from exogenous ALA is cleared rapidly from skin, much more so than HPD. Patients with ALA-induced PpIX are at risk for phototoxic reactions for only a few days rather than several months. Another advantage is that aqueous ALA penetrates abnormal but not normal keratin, so PpIX synthesis is confined to abnormal tissue, thus increasing the specificity of photodynamic therapy. (1,11,12)

Subsequent research culminated in the 1999 U.S. Food and Administration (FDA) clearance of Levulan Kerastick ([delta]-aminolevulinic acid HCl, 20%, Dusa Pharmaceuticals, Inc) for the treatment of nonhyperkeratotic AKs on the head and scalp with a 14- to 18-hour skin contact time and activation of ALA-induced PpIX with a blue light source, (2) the FDA clearance of the BLU-U[R] Blue Light Photodynamic Therapy Illuminator for the AK indication in 2000.

Although the original protocol suggests 14- to 18-hour ALA contact time with the treated areas before exposure to light, recent reports show that shorter ALA contact (incubation) times--30 minutes to 1 hour in most cases--are generally sufficient for the treatment of photodamage, acne, and other skin conditions. (2,13)

Treatment variables that affect PDT results include the ALA concentration, volume of ALA applied per unit of skin area, ALA incubation time, time between application of ALA and light treatment, delivery vehicle for ALA into tissue, temperature of the area being treated, wavelength(s) of light used in treatment, light dose (fluence in J/[cm.sup.2]), rate at which light is delivered (mW/[cm.sup.2]), and the availability of molecular oxygen at the treatment site. (14) The accumulation and clearance of PpIX in tissue as well as photobleaching also affects outcomes.

Methyl Aminolevulinate

Due to its low lipophilicity, ALA diffuses slowly through cell membranes. A large amount of ALA must therefore be applied to skin to ensure that enough ALA accumulates in diseased tissue.

To enhance diffusion rate, researchers have prepared ALA derivatives of higher lipophilicity. They hypothesized that these ALA prodrugs would enter cells more rapidly and be enzymatically hydrolyzed to ALA, leading to the formation of PpIX. (15,16) This theory was explored by Fritsch and colleagues, (17) who compared porphyrin accumulation (in both solar keratoses and adjacent normal skin) due to topically applied ALA with accumulation due to its methyl ester, methyl aminolevulinate (MAOP). With both ALA and MAOP, porphyrin levels were higher in solar keratoses than in the adjacent normal skin. Results also indicated that MAOP was a more specific sensitizer of keratotic cells than ALA.

These early studies led to prospective randomized trials (18-20) of the use of MAOP PDT for the treatment of AK (Table 1). Two (18,20) showed that clinical responses and tolerability with MAOP PDT were comparable to those of cryotherapy and all 3 trials showed that cosmetic outcome and patient satisfaction were high with MAOP PDT. In a prospective, randomized trial comparing MAOP PDT with surgery for 97 patients with nodular basal cell carcinoma (BCC), Rhodes and colleagues (21) obtained 91% and 98% response rates (3 months after treatment) for MAOP PDT and surgery, respectively.

MAOP PDT has also been used successfully in the treatment of actinic cheilitis, (22) erythroplasia of Queyrat, (23) "difficult to treat" BCC, (24) and AKs in transplant recipients. (25) Details of MAOP use and applications have been reviewed. (26,27)

Research led to the European approval of MAOP cream (Metvix[TM], PhotoCure ASA, Norway) for the treatment of AKs of the face and scalp and basal cell carcinoma unsuitable for conventional therapy in 2001, and the FDA clearance of Metvix for the treatment of AKs in 2004. Metvix is not available in the US at the time of this writing.

Although clinical responses and cosmetic outcomes have been favorable, MAOP has drawbacks. Before applying MAOP cream, the authors of 5 large studies (18-21,24) had to (1) use a dermal curette to remove loose crusts, scales, and other debris from lesions to be treated and (2) roughen lesional surfaces to enhance access of the cream and red light. They also had to allow MAOP to incubate 3 hours under occlusion before activation with red light.

Allergies to ALA (28) and MAOP, (29) though rare, have been reported.

Mechanism of Photodynamic Therapy

With ALA PDT, (1) photosensitizing agent (ALA) must penetrate the stratum corneum of the target area and (2) ALA-induced PpIX must accumulate in sufficient quantity to have a therapeutic effect.

Since PpIX fluoresces when exposed to UV light (Wood's lamp), the penetrating ability of ALA can be studied by observing the fluorescence of ALA-induced PpIX. Fluorescence studies show that ALA penetration decreases with skin thickness and increases in the presence of photo-damage, AKs, psoriasis, BCC, or other skin abnormalities. Once inside, ALA diffuses through the epidermis to the dermis, but very little PpIX fluorescence is found in the dermis. As a result, ALA PDT can eradicate epidermal cancers without seriously damaging the dermis, thus avoiding scarring. (11) The time for ALA to diffuse to 2.5 to 3.0 mm has been estimated at 3 to 15 hours. (30)

When enough PpIX has accumulated, the treatment area is exposed to wavelength(s) of light absorbed by PpIX (Figure 2). In general, the longer the wavelength (up to 850 nm), (8) the deeper its penetration into tissue. (5) Depending on the type of tissue, the optical penetration depth is less than 1 mm at 400 nm, 0.5 to 2 mm at 514 nm, 1 to 6 mm at 630 nm, and maximal at 700 to 800 nm. (31)

In PDT, activation of photosensitizer generates products that can destroy cells. The primary cytotoxic agent is believed to be singlet oxygen, a metastable intermediate produced when photosensitizer is activated. (32,33) The cytotoxic process occurs in 3 steps: (1) ALA diffuses through the stratum corneum to the epidermis and dermis, (2) tissues synthesize PpIX, and (3) optical radiation of PpIX generates singlet oxygen (or possibly radicals). (34) of actinic keratotic cells after ALA PDT has been shown to involve an apoptotic mechanism. (35)

The first direct evidence that PDT-induced skin damage is related to the production of singlet oxygen was reported by Niedre and colleagues. (33) Using a method to detect singlet oxygen in vitro, these researchers exposed hairless mouse skin photosensitized with ALA to 635-nm laser radiation. They found that skin damage was related to cumulative oxygen production. Although other reactive intermediates are produced, most phototoxicity in ALA PDT was attributable to singlet oxygen.

Actinic Keratoses

Actinic keratosis is considered by some to be an in situ cancer that may regress, remain stable, or progress. (36) Although the natural history of a specific lesion is unpredictable, all AKs should be treated to avoid progression to invasive SCC and more expensive treatment. (37) Destructive and topical treatments of AK are shown in Table 2.

Photodynamic Therapy with 5-Aminolevulinic Acid

In 1990 Kennedy and colleagues (4) introduced topical ALA as a photosensitizing agent. This report stimulated researchers to experiment with a variety of light sources to activate ALA-induced PpIX. (1) ALA incubation times ranged from 3 to 24 hours. In most cases, CR rates for AK lesions exceeded 75% with a single treatment. Adverse effects included localized edema and erythema as well as mild stinging and burning during light treatment. A large-field source of incoherent light (38) and the long-pulse pulsed dye laser (39) have been shown to provide efficacy and safety with minimal discomfort in the ALA PDT treatment of AK (39) as well as certain superficial BCCs. (38)

Clinical Trials

The encouraging results of early studies led to phase 1, (40) 2, (41) and 3 (42) trials. Treatment parameters and results are presented in Table 3.

In phase 3 trials, 94% of patients considered their cosmetic outcome as good to excellent. (43) No noncutaneous effects were associated with treatment. A variety of temporary local side effects were found in both the ALA and vehicle groups. (2) Cosmetic results were rated good or excellent by 92% of investigators and by 94% of patients.

The efficacy and recurrence rate of AK lesions treated with ALA PDT has been studied by Fowler and colleagues. (44) These investigators reported that 4 years after treatment, 69% of 32 lesions in 4 patients were still clear, 9% recurred, and 22% were "uncertain."

Short Incubation

Having established the safety and efficacy of ALA PDT, researchers (12,13,45,47) turned their attention to making the procedure more practical for patients seen in the dermatology practice (Table 4). These studies collectively showed that short-contact and/or wide field ALA PDT provides efficacy and safety in the treatment of nonhyperkeratotic AKs.

Large-Surface Application

Early studies on the use of ALA PDT for the treatment of extensive AKs of the scalp, (48) multiple AKs, (49) photodamage, (12,47,50) and acne, (51,52) suggested that ALA PDT might be effective over large skin surfaces. Smith and colleagues (46) reported that ALA PDT with 1-hour ALA incubation and blue light activation cleared AK lesions as effectively as topical 5-fluorouracil (5-FU), the standard treatment of AK over large surfaces, and was better tolerated. At the same time, encouraged by an early report (53) that ALA PDT delayed UV-induced skin tumors in hairless mice, Bissonette and colleagues (54) reported that skin tumors did not develop for up to 10 months in hairless mice treated weekly with ALA alone, blue light alone, or ALA PDT with blue light. Liu and colleagues (55) reported that weekly ALA PDT with blue light delayed induction of skin tumors in hairless mice exposed daily to UV radiation. These studies collectively showed that ALA PDT might be an alternative to 5-FU for the treatment of multiple AKs over large skin surfaces. In human patients, Touma and colleagues (13) reported significant AK reduction over broad skin areas treated by ALA PDT.

In a recent study, (56) 14 of 15 patients with multiple diffuse AKs maintained 90% lesion clearance 1 year after receiving 5-FU for 5 days followed by a single session of ALA PDT with IPL (Table 4). The rationale of this approach was to substitute ALA PDT for 5-FU before the appearance of skin irritation associated with 5-FU treatment.

Photorejuvenation

By a mechanism not well understood, photoaging occurs when UV radiation triggers the production of reactive oxygen species (ROS) which alter DNA, proteins, lipids, and other cellular components in skin by oxidation. (57,58) The clinical symptoms of prolonged sun exposure--telangiectases, dyschromias, lentigines, rhytids, and rough elastotic skin--are collectively known as chronic actinic damage. (59) Shielding skin from solar radiation by clothing, UV-blocking sunscreen, or other agents are effective in the treatment and prevention of photoaging. (60,61) Topical treatments include retinoic acid, alpha-hydroxy acids, antioxidants, and estrogens.

Regarding procedures, initial studies showed that (1) IPL improves wrinkling, coarse skin texture, pigmentation changes, and telangiectasia with epidermal ablation (62,63) and (2) ALA PDT with red light is effective against AKs and nonmelanoma skin cancers. (8,17) Encouraged by these results, Ruiz-Rodriguez and colleagues (64) used compounded ALA PDT with IPL at a 615-nm cutoff filter to treat skin with both photodamage and AK lesions. After 2 treatments, 34 of 38 AK lesions had been removed and cosmetic results were excellent. Avram (47) confirmed these findings with the use of Levulan ALA PDT and standard IPL settings. The treatment, coined "photodynamic photorejuvenation," (65) was well-tolerated.

Other investigators evaluated the efficacy and safety of PDT with blue light. Gold (37) reported (1) reductions of skin thickening and inelasticity in areas of multiple nonhyperkeratotic AKs, (2) complete healing of the treatment area, and (3) additional improvement over time in 2 patients with AKs and moderate to severe photodamage. Touma and colleagues (13) showed that at 1 and 5 months after treatment, (1) improvement in photodamage (and AK clearance) with 1-hour ALA incubation was comparable to that obtained with 14- to 18-hour ALA incubation and (2) broad-area treatment was effective against multiple AKs and significantly reduced wrinkles, sallowness, and dyspigmentation. More than 80% of patients reported good to excellent satisfaction with results, despite moderate phototoxicity for 1 week.

The results of subsequent reports using ALA PDT with IPL or blue light are shown in Table 5. In the split face studies, (66-68) results on the ALA PDT with IPL are generally superior to those on the IPL alone side, indicating that ALA enhances the effects of IPL. Side effects were mild and temporary. Avram and colleagues (47) showed clearly that ALA PDT with IPL was effective against both AK and symptoms of photodamage.

In a recent pilot study, (69) Lowe and colleague activated ALA-induced PpIX with a 633-nm light-emitting diode device (Omnilux revive, Photo Therapeutics Ltd. Manchester, UK) in 6 patients with photodamaged skin. In this study, 5% ALA in Unguentum M was applied to the periorbital areas and incubated under occlusion for 30 minutes before irradiation. (The 5% concentration was chosen to minimize erythema, ulceration, scaling, pigmentation, roughness, and phototoxic reactions.) The authors noted a reduction in fine lines in 4 patients and improved skin softness in all patients. The treatment was well-tolerated with no adverse effects.

Recent work by Hall and colleagues (70) suggests that ALA/PDT may also be used in conjunction with radiofrequency (RF) energy to enhance photorejuvenation and treat both dermal and epidermal actinic changes.

To provide guidelines for the treatment of photoaging, investigators have categorized photoaging as type A, type B, and type C (Table 6) and treatment techniques as type I, type II, and type III (Table 7). (65)

ALA PDT (type III) is the preferred treatment for type C photodamage. IPL is more appropriate for patients with skin types I-III because it acts on brown and red pigment. For patients with skin types IV-VI, blue light is appropriate because tissue effects are minimal.

Consensus panel members recommend a minimum of 3 ALA PDT treatments at 2- to 4-week intervals. ALA PDT can also be part of a standard 5-treatment IPL regime for photorejuvenation.

Acne

Determining an appropriate course of treatment of acne vulgaris depends on the severity, extent, and duration of the acne; the nature of the lesions; and psychological factors. (72) Current medical therapies include topical, (73) systemic, (74) and hormonal (75) agents. Numerous light- and laser-based treatments--blue light, red and blue light, diode lasers, pulsed-dye laser, and ALA PDT--have been explored, (76) and radiofrequency has been introduced. (77) Blue light (420 nm) alone or in combination with topical agents is effective against mild to moderate acne, (78) but not against severe acne. (59) The Global Alliance to Improve Outcomes in Acne has developed recommendations for acne management. (79)

Acne is a rapidly emerging application for ALA PDT. (1,9,45,52,80-82) The ALA PDT approach is based on (1) the proven efficacy of light- and laser-based therapies against acne, (76) (2) uptake of ALA by pilosebaceous units and its conversion to PpIX, (11,83,84) and (3) photoexcitation of endogenous bacterial porphyrins to produce cytotoxic singlet oxygen. (84,85)

The first major evaluation of ALA PDT for acne was reported by Hongcharu and colleagues in 2000. (9) In this landmark study, investigators treated 22 subjects (with acne of the back) at 4 sites with (1) ALA (20%) and red light (550-700 nm), (2) ALA alone, (3) red light alone, and (4) no treatment. ALA was incubated for 3 hours under occlusion before treatment. Eleven subjects were treated once and the remaining 11 were treated 4 times. The authors studied changes in sebum excretion rate and auto-fluorescence from bacteria in follicles, protoporphyrin synthesis in pilosebaceous units, and histologic changes associated with treatment. They found that with ALA PDT, (1) multiple treatments were associated with reduced sebum excretion rates, (2) porphyrin fluorescence was suppressed in bacteria, (3) sebaceous glands were damaged, and (4) inflammatory acne was cleared for 10 weeks and 20 weeks after a single treatment and multiple treatments, respectively. Side effects with ALA PDT included transient hyperpigmentation, superficial exfoliation, and crusting, all of which cleared without scar formation.

The results of subsequent studies are summarized in the Table 8. In these studies, acne ranging from mild to severe was treated by ALA PDT. Improvement was measurable and visible and adverse effects were minimal and temporary, showing that ALA PDT with a variety of light sources is a safe and effective treatment of acne with disease-free periods of up to 13 months. (82)

In the experience of one author (Dr. Nestor), clearance of moderate to severe acne has been achieved and maintained for more than 2 years in 50% to 60% of patients receiving 3 ALA PDT treatments. (59)

Consensus panel members agreed that ALA PDT provides (1) the best results when used to treat inflammatory and cystic acne and (2) modest clearance when used to treat comedonal acne, although recent data shows that ALA PDT was effective against comedonal acne (82) when the long-pulsed pulsed dye laser is used. They also agreed that (1) acneiform flares may occur after any treatment, including ALA PDT, and (2) although not supported by extensive documentation, PDL activation provides the best results in ALA PDT for acne. One member (Dr. Nestor) stated that only PDL with ALA PDT has maintained clearance of acne lesions for up to 2 years, even in patients resistant to other treatments.

Sebaceous Skin

Traditional treatments of sebaceous skin (SS) include cauterization, cryotherapy, topical medications, oral tretinoin, surgical excision, and ablative laser vaporization. With these treatments, the risks of dyspigmentation, scar formation, intra- and postoperative bleeding, and lesion recurrence are substantial. (89,90) In addition, recovery times may be long and the number of lesions treated in one session is limited. (90) A pulsed dye laser (PDL) (89) and a 1450-nm diode laser (91) have shown encouraging results.

The efficacy and safety of ALA PDT in the treatment of SS has been evaluated (2,90,92,93) and the results of 5 reports are shown in Table 9.

ALA PDT with a halogen slide projector, PDL, IPL, and blue light appear to be safe and effective treatments of SS without the adverse effects and long recovery times of traditional treatments. ALA PDT with PDL appears to require the fewest treatments to clear SS lesions. Focal crusting may be needed to destroy lesions completely. (90)

Consensus panel members agreed that (1) ALA should be incubated at least 1 hour before irradiation and (2) PDL with multiple stacked pulses provides the best results in ALA PDT for SS.

Emerging Applications

Hidradenitis suppurativa (HS) and molluscum contagiosum are 2 of many other applications of ALA PDT. (95-97) In one study, (95) 4 patients with chronic HS unresponsive to standard treatments received 3 to 4 ALA PDT sessions at 1- to 2-week intervals. ALA remained in contact with skin for 15 to 30 minutes before irradiation with blue light. All patients showed 75% to 100% clearance 3 months after the final treatment. Adverse effects were not observed.

Other conditions responsive to ALA PDT are shown in Table 10.

Treatment Algorithms

Consensus panel members agreed to the following algorithms (pretreatment, light sources, posttreatment) for the use of ALA PDT. Light sources, number of treatments, treatment intervals, and comments are presented in the Table 11.

Pretreatment

1. Continue topical or systemic medications.

2. For patients with severe actinic damage and hypertropic actinic keratosis consider treating individual lesions or areas with a short course of imiquimod or 5-fluorouracil.

3. Wash area to be treated with soap and water or alcohol swab.

4. Perform either microdermabrasion, single pass, and/or scrub area with acetone. Microdermabrasion removes the keratin layer and increases the even penetration of ALA.

5. Prepare 20% ALA by crushing ampoules with the fingers and shaking the Kerastick for 3 minutes.

6. Apply ALA liberally with extra pressure to lesions; avoid mucous membranes.

7. Allow ALA to incubate for at least 30 to 60 minutes.

8. Remove ALA with soap and water, wipe with alcohol.

Light Source

* Preferred: Most significant response for lesion type; may cause response without ALA (ie, IPL for photodamage, PDL for acne).

* Alternate: Substantial effectiveness against lesion type.

* Other: Unproven effectiveness against lesion type (ie, 532 nm light for acne).

* Blue light (5-8 min): (15 min): as a single light source or (5-8 min): when used in addition to IPL or laser for activation of remaining ALA (photobleaching).

Posttreatment

* Apply titanium dioxide-zinc oxide to block UVA and UVB light.

* Instruct patient to avoid direct sun exposure for 24 to 48 hours.

* Tell patient to expect desquamation and sunburn-like reaction with mild to moderate redness and erythema for 48 to 72 hours.

* Apply moisturizers as needed.

Number and Timing of Treatments

* Since number of treatments and timing depend upon indication, give 2 to 5 treatments, 2 to 4 weeks apart as a general rule.

* Vary incubation time(s) and light source energy/time to achieve desired clinical response in second and subsequent ALA PDT treatments.

Erythema

Panel members agreed that results of ALA PDT improve with the amount of posttreatment redness and peeling. Although responses vary among patients, the absence of redness for 24 to 48 hours after treatment generally indicates that the ALA incubation time was not long enough to achieve a therapeutic effect, and that the ALA incubation time should be increased in the next session. Alternatively, this suggests that skin preparation may not have been vigorous, implying that a stronger acetone scrub and/or microdermabreasion is necessary. With more aggressive treatment (ie, longer ALA incubation times), fewer treatment sessions may be required to achieve the clinical endpoint of 48 to 72 hours of redness and peeling after treatment. ALA incubation time may be gradually increased to 60 to 90 minutes, depending on patient tolerance. (59) Some patients may prefer more treatments with less redness and swelling.

[FIGURE 3 OMITTED]

Panelists agreed that physicians should tell patients to expect mild to moderate redness, swelling, and desquamation after treatment.

Carcinogenic Potential of ALA PDT

In 1997, Stender and colleagues (53) reported that topical ALA delayed UV photocarcinogenesis in hairless mice, an early indication that repetitive ALA PDT might be used to prevent skin cancer. Other studies of the potential roles of blue light (121,122) and ALA (123) in carcinogenesis led Bissonette and colleagues (54) to search deeper for possible carcinogenic effects of multiple ALA PDT sessions with blue light activation in hairless mice. Eighty mice were divided into 4 treatment groups: (1) ALA, (2) blue light, (3) ALA PDT with blue light activation, and (4) no treatment. Each group was treated once weekly for 10 months. Skin tumors were not observed in any of the treatment groups, indicating the ALA, blue light, and ALA PDT with blue light activation can be used safely in human patients. The low risk of ALA PDT-induced skin cancer has been reviewed in detail. (124)

Prevention of Non-Melanoma Skin Cancer

One author (Dr. Nestor) has tracked the occurrence rate of active facial non-melanoma skin cancer (NMSC) in 5 patients followed since 2001 (Figure 3). Five or six new NMSCs developed in these patients each year. When these patients received ALA PDT with IPL activation at the end of 2003, the occurrence rate dropped to 1 NMSC per patient, suggesting that ALA PDT with IPL activation has a photochemoprotective effect in patients with active facial NMSC.

Research Goals

ALA PDT parameters--ALA incubation times, light source settings, multiple treatments, and treatment intervals--should be continually refined to ensure maximum efficacy, safety, and patient comfort during the treatment of acne (including moderate to severe), photodamage, nonmelanoma skin cancers, actinic cheilitis, and new applications. The use of ALA PDT in combination with other treatment modalities has shown encouraging results in the treatment of photodamaged skin and acne. The technique has been explored in structural skin smoothing, (125) onychomycosis, and hair removal and may ultimately reduce the risk of skin cancers. (59)

Conclusions

ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in a dermatology practice. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. The combined effect of light and activation of ALA-induced PpIX results in clinical and cosmetic improvement exceeding that of either modality alone and with little risk of pigmentary alterations. Visible light, lasers, and pulsed light can be used to activate photosensitizer with the added benefit of improvement in the quality of treated skin. Appropriate light sources are already available in many dermatology offices. If not, the expanding clinical and financial benefits of ALA PDT justify the purchase of an appropriate light source.

Disclaimer

Due to the variability of responses among patients, the ASPDT does not guarantee that the consensus recommendations for ALA PDT will apply to all patients.

Disclosure

This statement was drafted, reviewed, and revised by the ASPDT chair and has been carefully reviewed by the participants as well as the governing board of directors of the American Society of Photodynamic Therapy (ASPDT). Funding to ASPDT was provided by an unrestricted educational grant from DUSA Pharmaceuticals, Inc.

The following disclosures refer to relationships with Dusa Pharmaceuticals, Inc. Dr. Nestor has received research support and is a funded speaker, consultant, and physician advisory board member. Drs. Gold, Goldman, and Taub have received research support and are funded speakers, consultants, physician advisory board members, and shareholders. Drs. Geronemus and Pariser have received research support. Dr. Gilbert is a funded speaker and shareholder. Dr. Alster is a member of the physician advisor board. Dr. Hanke is a member of the physician advisor board, has received research support, and owns stock. Dr. Zelickson is a shareholder and has active research grants. Dr. Robins is a consultant. Dr. Ritvo is a funded speaker. Drs. Anderson, Bank, A. Carruthers, J. Carruthers, Lowe, Richey, Spencer, Kauvar, and Goldberg have no financial relationships.

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114. Yim YC, Lee ES, Chung PS, et al. Recalcitrant palmoplantar pustular psoriasis successfully treated with topical 5-aminolaevulinic acid photodynamic therapy. Clin Exp Dermatol. 2005;30:723-724.

115. Radakovic-Fijan S, Blecha-Thalhammer U, Schleyer V, et al. Topical aminolaevulinic acid-based photodynamic therapy as a treatment option for psoriasis? Results of a randomized, observer-blinded study. Br J Dermatol. 2005;152:279-283.

116. Amari N, Ando I, Wakugawa M. Photodynamic therapy for rhinophyma. J Dermatol. 2004;31:771-772.

117. Karrer S, Abels C, Landthaler M, et al. Topical photodynamic therapy for localized scleroderma. Acta Derm Venereol. 2000;80:26-27.

118. Wang X, Wang H, Wang H, et al. Topical 5-aminolaevulinic acid-photodynamic therapy for the treatment of urethral condylomata acuminata. Br J Dermatol. 2004;151:880-885.

119. Smucler R, Jatsova E. Comparative study of aminolevulic acid photodynamic therapy plus pulsed dye laser versus pulsed dye laser alone in treatment of viral warts. Photomed Laser Surg. 2005;23:202-205.

120. Schroeter CA, Pleunis J, van Nispen tot Pannerden C, et al. Photodynamic therapy: new treatment for therapy-resistant plantar warts. Dermatol Surg. 2005;31:71-5.

121. Setlow RB, Grist E, Thompson K, et al. Wavelengths effective in induction of malignant melanoma. Proc Natl Acad Sci U S A. 1993;90:6666-6670.

122. Ohara M, Kawashima Y, Kitajima S, et al. Blue light inhibits the growth of skin tumors in the v-Ha-ras transgenic mouse. Cancer Sci. 2003;94:205-209.

123. Fiedler DM, Eckl PM, Krammer B. Does delta-aminolaevulinic acid induce genotoxic effects? J Photochem Photobiol B. 1996;33:39-44.

124. Morton CA, Brown SB, Collins S, et al. Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group. Br J Dermatol. 2002;146:552-567.

125. Marmur ES, Phelps R, Goldberg DJ. Ultrastructural changes seen after ALA-IPL photorejuvenation: a pilot study. J Cosmet Laser Ther. 2005;7:21-24.

Address for Correspondence

Mark S. Nestor MD PhD

2925 Aventura Blvd, Ste. 205

Aventura, FL 33180-3108

e-mail: nestormd@admcorp.com

Mark S. Nestor MD PhD (chair), (a) Michael H. Gold MD (co-chair), (b) Arielle N. B. Kauvar MD, (c) Amy F. Taub MD, (d) Roy G. Geronemus MD, (c) Eva C. Ritvo MD, (e) Mitchel P. Goldman MD, (f) Dore J. Gilbert MD, (g) Donald F. Richey MD (h) (Consensus Panel)

a. Center for Cosmetic Advancement, Aventura, FL.

b. Gold Skin Care Center, Nashville, TN

c. New York Laser & Skin Care, New York, NY

d. Advanced Dermatology, Lincolnshire, IL

e. Department of Psychiatry and Behavioral Science, University of Miami, Miami, FL

f. La Jolla Spa MD, La Jolla, CA

g. Newport Dermatology and Laser Associates, Newport Beach, CA

h. North Valley Dermatology Center, Chico, CA

Tina S. Alster MD, (i) R. Rox Anderson MD, (j) David E. Bank MD, (k) Alastair Carruthers MD, (l) Jean Carruthers MD, (l) David J. Goldberg MD JD, (m) C. William Hanke MD, (n) Nicholas J. Lowe MD, (o) David M. Pariser MD, (p) Darrell S. Rigel MD, (q) Perry Robins MD, (q) James M. Spencer MD, (r) Brian D. Zelickson MD (s) (American Society of Photodynamic Therapy Board Members)

i. Washington Institute of Dermatologic Laser Surgery, Washington DC

j. Harvard Medical School, Boston, MA

k. The Center for Dermatology, Cosmetic and Laser Surgery, Mount Kisco, NY

l. University of British Columbia, Vancouver, Canada

m. Skin Laser & Surgery Specialists of New York & New Jersey, Westwood, NJ

n. Laser and Skin Surgery Center of Indiana, Carmel, IN

o. UCLA School of Medicine, Santa Monica, CA

p. Eastern Virginia Medical School Norfolk, VA

q. NYU Medical Center, New York, NY

r. Mt. Sinai School of Medicine, New York, NY

s. Center for Cosmetic Care Minneapolis, MN

Table 1. Treatment of actinic keratoses (AK) by photodynamic therapy
with topical methyl aminolevulinate (MAOP) and red light (570-670 nm)
activation.

No of Patients/ MAOP Contact No. of
Reference Lesions Time (hr) Treatments

Szeimies et al (18) 193/699 3 1*
Freeman et al (20) 204/-- 3 2
Pariser et al (19) 80/502 3 2

Reference Complete Follow-Up
Response Rate (%) (mo.)

Szeimies et al (18) 69 3
Freeman et al (20) 91 3
Pariser et al (19) 89 3

*Two treatments for areas not on face or scalp.
CR=Complete response

Table 2. Destructive and topical treatments of actinic keratosis.

Destructive
Cryosurgery
Curettage
Electrosurgery
Excisional surgery
Photodynamic therapy
Topical
5-fluorouracil
Imiquimod
Diclofenac
Tretinoin
Adalpene
Tazarotene

Table 3. Clinical trial data for the treatment of nonhyperkeratotic
actinic keratosis by photodynamic therapy (PDT) with topical 5-
aminolevulinic acid (ALA).

No. of Patients/ Treatment
Reference Lesions Parameters

Jeffes et al (40) 40/218 Argon pumped dye laser
(Phase 1, single (630 nm); 10-150 J/[cm.sup.2];
treatment) up to 150 m W/[cm.sup.2]; ALA
(10%, 20%, 30%) incubation 3 hr
Jeffes et al (41) 36/70 Blue light (417 nm); 2-10
(Phase 2, single J/[cm.sup.2]; 3-10
treatment) mW/[cm.sup.2]; ALA (20%)
incubation 14-18 hr.
Piacquadio et al (42) 243/1909 Blue light (417 nm); 10
(Phase 3, single mW/[cm.sup.2]; ALA (20%)
treatment) incubation 14-18 hr.

Side Effects
Reference Results (Temporary) Comment

Jeffes et al (40) 91% CR rate Erythema, edema Clinical
(Phase 1, single for face, scalp; (localized), responses
treatment) 45% CR rate trunk, mild stinging, with 10%,
extremities; 8-wk burning during 20%, 30%
follow-up light exposure ALA similar;
best
response
with
non-
hypertrophic
AKs; well-
tolerated
Jeffes et al (41) CR 66%, Burning/ re-treatment
(Phase 2, single 8-wk follow-up stinging during increased CR
treatment) light exposure; rate from
itching, pain; 66% to 88%;
erythema, well-
edema, tolerated
vesiculation
Piacquadio et al (42) CR 83%, 8-wk Burning/ re-treatment
(Phase 3, single follow-up stinging during increased CR
treatment) light exposure; rate from
erythema, edema 83% to 91%;
safe and
effective

*Levulan Kerastick, Dusa Pharmaceuticals.
CR = complete response.

Table 4. Single treatment of actinic keratoses by photodynamic therapy
with short-incubation 5-aminolevulinic acid (ALA).

ALA Contact Light Clearance Follow-Up
Reference Time (hr) Source (%) (mo.)

Goldman et al (12) 1 Blue light 90 (6 mo.) 6
Gold (45) 0.5-1 IPL >85* 3
Smith et al (46) 1 Blue light 50 1
Avram et al (47) 1 IPL 68 3
Touma et al (13) 1 Blue light 90 5
Gilbert (56)([dagger]) 0.5-0.75 IPL 90 12

*Three treatments.
([dagger]) Patients received 5-fluorouracil for 5 days, followed by a
single treatment of ALA PDT.
IPL = intense pulsed light.

Table 5. Results of ALA PDT with IPL or blue light for the treatment of
photoaging.

ALA Contact Light No. of
Reference Time (hr) Source Treatments

Gold (45) 1 IPL 3
Goldman et al (12) Short- Blue 1
contact light
Avram et al (47) 1 IPL 1
Bhatia et al (66) -- IPL 3*, 2 ([dagger])
Gold et al (67) -- IPL 3*
Alster et al (71) 1 IPL 2*
Dover et al (68) ([section]) 0.5-1 IPL 3*, 2 ([dagger])

Improvement or Follow-
Reference Clearance Up (mo.)

Gold (45) 90 (crow's feet); 100 (tactile 3
skin roughness); 90 (mottled
hyperpigmentation); 70 (facial
erythema); 83 (AK)
Goldman et al (12) 90 (AK); 72 (skin texture); 59 --
(skin pigmentation)
Avram et al (47) 68 (AK); 55 (telangiectasias); 1,3
48 (pigment irregularities); 25
(skin texture)
Bhatia et al (66) 80 (ALA-PDT-IPL) vs. 50 (IPL) 1
photoaging; 95 vs. 65 (mottled
hyperpigmentation); 55 vs. 20
(fine lines)
Gold et al (67) 80 (ALA-PDT-IPL) vs. 50 (IPL) 3
crow's feet; 55 vs. 29.5
(tactile skin roughness); 60.3
vs. 37.2 (mottled
hyperpigmentation); 84.6 vs.
53.8 (facial erythema); 78 vs.
53.6 (AK)
Alster et al (71) 1.65 ([double dagger]) (ALA PDT 6
IPL) vs. 1.28[double dagger]
(IPL)
Dover et al (68) ([section]) 80 (ALA-PDT-IPL) vs. 45 (IPL) 1
global score; 95 vs. 60 (mottled
hyperpigmentation); 80 vs. 80
(fine lines); 95 vs. 90 (tactile
roughness); 75 vs. 75
sallowness)

*Split face, ALA PDT-IPL vs IPL.
([dagger]) Full face, IPL alone.
([double dagger]) Mean clinical grade (1=<25% improvement, 2=25%-50%;
3=51%-75%; 4=76%-100%).
([section]) Prospective, randomized, controlled split-face study.
IPL = intense pulsed light; AK=actinic keratosis; RF=radiofrequency.

Table 6. Characteristics of types A, B, C skin damage.

Photodamage Treatment
Type Characteristics Type

A Superficial changes in complexion, including I
vascular and pigmentary changes, lentigines,
telangiectasias, erythema, symptoms of rosacea
and melasma
B Structural changes in the dermis and epidermis II
resulting in rhytides, large pores, lax and
actinically damaged skin
C Severe elastosis associated with AK, early skin III
cancer, type A damage, type B damage

ALA=5-aminolevulinic acid; PDT=photodynamic therapy; AK=actinic
keratosis; IPL=intense pulsed light.

Table 7. Characteristics of types I, II, III treatment modalities.

Treatment Type Applications

I (IPL alone or in combination with Pigmentary changes, posttreatment
topical treatments*) (laser) dyschromia, vascular
changes
II (IPL in combination with 1064-nm, Elastosis, enlarged pores,
1320-nm Nd:YAG laser) rhytides
III (ALA PDT with IPL) AK, severe acne, rosacea

*Metronidazole topical cream, fluocinolone acetonide 0.01%,
hydroquinone 4%, tretinoin 0.05%.

Table 8. Studies on the use of ALA PDT for acne vulgaris.

ALA Incubation No. of Light
Reference Time (hr) Treatments Source

(intractable
acne)
Itoh et al (80) 4 1 Pulsed
case study excimer-dye
Itoh et al (81) 4 1 Halogen
(intractable (600-700 nm)
acne)
Gold et al (86) 1 4 IPL
(moderate to
severe)
Goldman et al (52) 2 Blue
(mild to moderate)
Gold (87) 0.5-1 4 Blue
(moderate to
severe)
Taub (88) 0.25-0.5 2-4 Blue or 580-1000
(moderate to nm with RF (ELOS)
severe)
Alexiades- 0.75 Mean 2.9, LP PDL
Armenakas (82) range 1-6 (595 nm)
(mild to severe)

Follow-up
Reference Results (mo.)

laser (635 nm)
Itoh et al (80) Treated areas clear for 8 mo.; temporary 8
case study edematous erythema, crusting
Itoh et al (81) New lesions reduced 1, 3, 6 mo. after 6
(intractable treatment; improved facial appearance;
acne) temporary edematous erythema, epidermal
exfoliation; acne lesions returned in 6
months
Gold et al (86) 50% reduction in lesions at end of final 1,3
(moderate to treatment; 68% reduction 4 weeks after
severe) final treatment, 72% reduction at 12
weeks; no adverse events or recurrences
Goldman et al (52) 32% (ALA PDT) vs 25% (light only) 0.5
(mild to moderate) improvement; 68% (ALA PDT) vs 40% (light
only) reduction in papule counts; no
significant adverse effects
Gold (87) 58% reduction in inflammatory lesions, 1,3
(moderate to 55% with >75% improvement in global
severe) severity score; no adverse reactions
Taub (88) 1.75 average improvement*; 11 of 12 4
(moderate to patients with improvement had 50%
severe) improvement and 5 had 75% or more;
temporary erythema, peeling
Alexiades- Clearance in all patients Mean 6.4,
Armenakas (82) range
(mild to severe) 1-13

*Acne improvement graded on a scale of 0 to 4.
ALA=5-aminolevulinic acid; PDT=photodynamic therapy; IPL-intense pulsed
light; RF=radiofrequency; ELOS=Electro-Optical Synergy, Syneron Medical
Ltd., Yokneam, Israel; LP PDL=long pulsed, pulsed dye laser.

Table 9. Studies on the use of ALA PDT for sebaceous skin.

ALA Incubation No. of Light
Reference Time (hr) Treatments Source

Horio et al (92) 4 3 Halogen,
>620 nm
Alster et al (90) 1 1,2 PDL
(595 nm)
Goldman (94) 0.25 2-4 IPL or
blue
Richey et al (93) 0.75-1 3-6 Blue
Gold et al (86) 0.5-1 4 Blue, IPL

Follow-up
Reference Results (mo.)

Horio et al (92) Small and large lesions decreased in size 12
and reduced sizes persisted for 12 months;
temporary erythema, edema,
hyperpigmentation
Alster et al (90) 7 of 10 patients cleared with 1 treatment, 3
3 patients cleared after 2 treatments;
transient erythema, edema, focal crusting
Goldman (94) Acne and SS lesions cleared after 2-4 --
treatments
Richey et al (93) 70% lesion clearance after 6 mo.; 10%-20% 6
recurrence 3-4 months after final
treatment; temporary erythema, edema,
hyperpigmentation
Gold et al (86) 55% reduction in lesions with blue light, 1,3
53% with IPL; temporary mild erythema and
blisters

Table 10. Emerging applications of ALA PDT.

Dermatologic Condition Reference

Cutaneous T-cell lymphoma Coors et al, (98) Umegaki et al (99)
Cutaneous leishmaniasis Gardlo et al, (100) Enk et al, (101) El-On
et al (102)
Extramammary Paget's disease Shieh et al, (103) Mikasa et al (104)
Hailey-Hailey disease Ruiz-Rodriguez et al (105)
Hidradenitis suppurativa Gold et al, (95) Strauss et al (106)
Keratoacanthoma Radakovic-Fijan et al (107)
Keratosis pilaris Clark et al (108)
Molluscum contagiosum Moiin, (97) Gold et al (96)
Mycosis fungoides Edstrom et al, (109) Markham et al (110)
Nevus sebaceus Dierickx et al (111)
Perioral dermatitis Richey et al (112)
Psoriasis Bissonnette et al, (113) Yim et al, (114)
Radakovic-Fijan et al (115)
Rhinophyma Amari et al (116)
Scleroderma (localized) Karrer et al (117)
Warts Wang et al, (118) Smucler et al, (119)
Schroeter et al (120)

ALA-5-aminolevulinic acid; PDT=photodynamic therapy

Table 11. Consensus recommendations for light sources, number of
treatments, and treatment intervals for photodynamic therapy with
5-aminolevulinic acid.

Light Source
Dermatologic (Preferred/ No. of Treatments
Condition Alternate/Other) (interval)

Actinic keratoses, Blue/PDL,* IPL ([dagger])/ 1-2 (3-5 or 2
superficial basal green, yellow, red wk) ([double dagger])
cell carcinoma
Photodamage/cosmetic IPL ([dagger]) At least 2 (2-4 or 1
enhancement (blue for skin type wk), ([double dagger])
VI)/Blue, PDL*/green, depending on severity
yellow ([section]) of damage
Acne PDL [right arrow] blue (5 1-3 (2-3 wk)||
min)/blue (8 min)/green,
red, IPL, yellow
Sebaceous skin, PDL, (#) blue/ 1-2 (3-5 or 2
rosacea, IPL ([dagger]) wk) ([double dagger])
rhinophyma green, (#) yellow, red

Dermatologic
Condition Comment

Actinic keratoses,
superficial basal
cell carcinoma
Photodamage/cosmetic Typically 5 treatments at 2-3 wk intervals; 3
enhancement treatments include ALA (59)
Acne Treat flares immediately; 6-12 mo. clearance
typical
Sebaceous skin,
rosacea, rhinophyma

* Fluences that avoid bruising.
([dagger]) Standard photorejuvenation settings by patient type.
([double dagger]) Increase ALA incubation time if necessary in second
and subsequent treatments.
([section]) Optimum is IPL, PDL, or green (532 nm) followed by blue
light for 5 minutes.
|| For skin types IV-VI, ALA incubated 30 min. for first treatment.
# Double or triple pulsing on lesion recommended.
PDL=pulsed dye laser; IPL=intense pulsed light.

COPYRIGHT 2006 Journal of in Dermatology, Inc.
COPYRIGHT 2006 Gale Group

Asian Skin Pigmentation

2006-03-07T10:25:00.000-08:00

Those whose Ethnic background are from South Asia i.e. Indian, Pakistan, Bangladesh, etc; have much darker skin than their northern caucasian counterpart because they have an increased amount of melanin in the skin. Melanin is specifically the pigment in the skin and it protects the skin from sunlight. This actually helps to keep Asian people looking younger than people with white skin. The melanin pigment also slows down the aging process. However as Asian peple age their skin can conceive unbalanced pigmented. This can be seen as darker patches. Unbalanced pigmentation can also be caused by swelling or irratation. If a part of the skin becomes inflamed or red due to being bit by an insect or from an acne pimple, once the redness or inflammation subsides a brown area can be left behind.

Asians although in general are no more oily than caucasian skin but according to dermatologists, Asian women tend to have more oilier skin than recent Asian immigrants. Some dermatologists contribute this on the grounds that there is higher fat content in the diet. There is a theory that diet does not directly affect skin condition, except when it is poor enough to affect one's overall health.

However leading Skin Therapist refute this theory that the internal workings on the human body does contribute to what goes on externally and this will result in unexpected pimples signaling stress, hormonal imbalance, or internal health problems.

And that too much unhealthy food consumption can appear to affect acne breakouts by contributing to an overall physiological imbalance which in turn will cause an increase in the skin's oil production which can cause acne breakouts.

Dear Friend,

Within my 6 years as a Beauty Therapist I have had countless number of clients asking about the best solution for their skin. So I have gone ahead and created http://www.dermaology.com to provide the best skin product available!

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dermalogica diversion

2006-03-03T10:45:00.000-08:00

The health of your skin is at stake.

The health of your skin is at stake, and it’s due to diverted skin care products that are currently sitting on your bathroom counter, in your shower and within hands reach of all your family members – including your children.

The truly disturbing fact is that you may have purchased diverted products without even knowing it. Often times, they are found on the Internet or even in your local grocery or drug store.

Products are classified as “diverted” when they have been purchased by an unauthorized retailer from an authorized Dermalogica skin treatment center or spa for resale. These products are often sold for a measurable savings/discount.

They’re putting you at risk.

The actions of businesses that divert products are putting consumers worldwide at risk.

Based upon independent lab testing, diverted products have been proven to be expired, stolen, counterfeit, and/or contaminated. “That means consumers everywhere are putting something that’s potentially harmful, unsafe and definitely less effective on their skin,” says Dermalogica founder Jane Wurwand. “The availability of product that’s lacking integrity concerns me not only as a manufacturer but as a consumer.”

The efficacy of Dermalogica products is only guaranteed when purchased from an authorized Dermalogica skin treatment center and/or a Dermalogica trained skin therapist. This same Dermalogica guarantee won’t be found when purchasing from a retailer who’s selling diverted products.

What can I do?

Dermalogica has launched a strong campaign to put a stop to diversion by encouraging spas, salons and skin treatment centers to take an active role in reporting those who participate in diversion.

As a consumer, the only way you can be secure and confident in your skin care product purchases is when you buy from an authorized retailer. Keep in mind that Dermalogica only sells to skin care professionals – never to discount Internet websites, drug stores or mass retail outlets. To find an authorized Dermalogica retailer nearest you, visit dermalogica.com and click on the “get dermalogica” link.

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Dermalogica review

2006-02-28T15:55:00.000-08:00

Check Out the reviews for Dermalogica products:

Great acne fightining cleanser!, October 13, 2005

I have always struggled with acne most of my life. And I don't mean one or two zits every once and a while. Now that I am pregnant and under alot of stress I have been breaking out more than ever. I discovered this product recently when I got a facial done at a high end salon. I must say this stuff works and leaves your skin feeling fabulous, not too dry or oily. It is a little pricey but it is all well worth it because the bottle is big and all you need is a pea size amount to cleanse your face. Even the big pores on my nose has shrunk by at least half its size. If you think you have tried it all and nothing has worked, try this product, you will love it!

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centre on the iNet.

Dermalogica establishes new world headquarters

2006-02-20T14:38:00.000-08:00

US-based Dermalogica is moving to new corporate headquarters incorporating both research and development as well as training facilities.

The skin care specialists is making the step to move from its existing premises in Los Angeles to a new facility at the nearby Dominguez Technology Centre. The company has signed a ten year lease at a value of $10 million ( for a total working area that exceeds 35,000 square metres.

According to Dermalogica president Raymond Wurwand, the premises were chosen because of the carefully planning and design of the facilities that were in line with the high standards the company was looking for.

"The building design enables us to operate our business with ease and convenience," Wurwand said.

Dermalogica was founded in Los Angeles in 1986 and is currently among the world's largest professional skin-care companies. Known for its innovative ingredients, animal-free testing and results-driven products, it has an international following with consumers as well as make-up and skin-care specialists.

The new facilities are set to be completed by mid-2005 and will have an architecturally distinctive appearance that includes an abundance of natural light. Likewise the interior design emphasises natural lighting and space.

Dermalogica will bring its Los Angeles-based staff of more than 200 to the new Legacy BuildingSM in the Dominguez Technology Center mid-year 2005.

The move has been bought about due to significant expansion in the company, particularly in its international markets. This has bought about the need for bigger premises, with more of an emphasis on new product development.

Dermalogica produces a skin care system researched and developed by The International Dermal Institute. Widely used by professional skin care experts, Dermalogica markets and sells a complete range of skincare products, from facial scrubs to ant-wrinkle treatments and sun care products in over 40 countries.

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Dermalogica Bites the Big Apple

2006-02-20T14:35:00.000-08:00

At the same time are the planned Los Angeles opening of the brand's first flagship store at the end of 2003, Dermalogica has created a new regional marketing arm based in Manhatten.

Brand marketing specialist Christine Smith Banks has recently relocated from the company's Torrance, California, headquarters to work as point-person in the new strategic effort. Bank played an instrumental role in new product branding and marketing and her new mission is to locate and maximize branding opportunities in New York City and other eastern seaboard markets.

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Banish Acne With Dermalogica

2006-02-19T01:48:00.000-08:00

If you have noticed a blemish or two, you are not alone. Acne affects around 50% of s 20-40 years of age, which makes acne one of the most common diseases in the world.

If you have noticed a blemish or two, you are not alone. Acne affects around 50% of s 20-40 years of age, which makes acne one of the most common diseases in the world.

People often try to treat acne by "de-oiling" and "drying" the skin with products that include harsh soaps, strong scrubs and mass-market medicated (drying) cosmetics. This approach to acne can cause intense drying of the skin, and provides only short-term benefits.

While drying out blemishes can make skin appear satisfactory for a few weeks, over-drying can cause oil glands to compensate by working harder, resulting in clogged pores and more "breakouts" a few weeks later. This often causes the user to resort back to drying products, which are causing the problem. In addition, treating acne harshly can create problems such as redness or broken capillaries.

When blemishes add to wrinkles, you should take a double caution when treating blemishes with conventional methods. Your best bet is to switch to the mildest possible skin care routine which is based on natural effective products that work with minimal irritation. Clearing and preventing breakouts is now possible without irritation and over-drying the skin.

No matter how vigorously we try to get rid of acne it always hits back, which is why acne-prone skin requires constant upkeep. We were lucky to come across a Dermalogica line which comprised of professional-strength products free of mineral oil, lanolin, SD alcohol, artificial colors and fragrances. Dermalogica also uses food-grade preservatives instead of commonly used harsh ones.

Dermalogica requires a serious approach, and the best way to benefit from this line is to give it a honest run for at least a month. Here is the Dermalogica lineup for acne-prone skin:

1. Cleansing: Dermal Clay Cleanser formulated with super-absorbent kaolin, menthol and watercress. Works wonders on t-zone, but not suitable for use around eyes.
2. Conditioning: Multi-Active Toner created with Aloe, Lavender, non-stingy Balm Mint and Arnica.
3. Moisturizing: Active Moist at night, Sheer Moisture at day.

Dermalogica creator L.A.-based Jane Wurwand believes that the skin should be cleansed with double lathering twice a day, and that a hydrating mist does skin more good than a thick layer of heavy moisturizer. We followed the advice, and by the end of the trial month we didn't get a usual array of blemishes, plus, the spots from the old ones were noticeably lighter.

None of the Dermalogica products, most of which were created back in 1986 and constantly improved since, are labeled according to certain skin types. Instead, Dermalogica dermatologists prescribe products based on Skin Mapping – a technique which defines 14 problem zones and assigns specific products for them. For instance, my face map revealed breakout activity where I would normally least expect it and assigned me not one but two conditioners for my problem areas – a light hydrating Multi-Active Toner and a spectacular Daily Microfoliant, a sushi-smelling rice-based powder packed with exfoliating enzymes and salicylic acid.

Adult skin, especially aging one, cannot be stripped of moisture, and Dermalogica products offer just the right amount of moisturizing. Active Moist – a lightweight oil-free lotion packed with silk amino acids, lavender essential oil and natural astringents such as lemon and burdock, - should be used at night, while Sheer Moisture with SPF15 should be used daily – even in winter to combat elements.

This winter Dermalogica launched a true Holy Grail moisturizer for drier skins and inhospitable weather conditions. Aptly called Super Rich Repair, this cream is formulated with palmitoyl tetrapeptides-3, palmitoyl oligopeptides and hyaluronic acid in the base of shea butter and evening primrose oil. Concentrated and naturally fragrant, Super Rich Repair cocoons dry dehydrated skin with protecting repairing emollient shield.

When it comes to treating problem skin, many dermatologists admit that when a product does not appeal to the person, he or she will never use it, no matter how effective it might be. Sleek, subtly fragrant, concentrated Dermalogica products will satisfy even the most adept metrosexual. Sadly thought, they are available only through trained skin therapists, but hey, at least you always have a chance to fine-tune your beauty regimen!

In Toronto Dermalogica skin care line is available at Stillwater Spa at Part Hyatt hotel and Glow Spa.
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Julie GABRIEL, Fashion Monitor

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