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"

test

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).

[ILLUSTRATION OMITTED]

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.

[ILLUSTRATIONS OMITTED]

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

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

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.

References

1. Taub A. Photodynamic therapy in dermatology: history and horizons. J Dermatol. 2004;3(Suppl):S8-S25.

2. Gold MH, Goldman MP. 5-aminolevulinic acid photodynamic therapy: where we have been and where we are going. Dermatol Surg. 2004;30:1077-1083

3. Daniell MD, Hill JS. A history of photodynamic therapy. Aust N Z J Surg. 1991;61:340-348.

4. Kennedy JC, Pottier RH, Pross DC. Photodynamic therapy with endogenous protoporphyrin IX: basic principles and present clinical experience. J Photochem Photobiol B. 1990;6:143-148.

5. Wilson BC, Patterson MS. The physics of photodynamic therapy. Phys Med Biol. 1986;31:327-360.

6. Dougherty TJ, Kaufman JE, Goldfarb A, et al. Photoradiation therapy for the treatment of malignant tumors. Cancer Res. 1978;38:2628-2635.

7. Pass HI. Photodynamic therapy in oncology: mechanisms and clinical use. J Natl Cancer Inst. 1993;85:443-456.

8. Kalka K, Merk H, Mukhtar H. Photodynamic therapy in dermatology. J Am Acad Dermatol. 2000;42:389-413.

9. Hongcharu W, Taylor C, Chang Y, et al. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. J Invest Dermatol. 2000;115:183-192.

10. Kennedy JC, Marcus SL, Pottier RH. Photodynamic therapy (PDT) and photodiagnosis (PD) using endogenous photosensitization induced by 5-aminolevulinic acid (ALA): mechanisms and clinical results. J Clin Laser Med Surg. 1996;14:289-304.

11. Kennedy J, Pottier R. Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy. J Photochem Photobiol B: Biol. 1992;14:275-292.

12. Goldman MP, Atkin D, Kincad S. PDT/ALA in the treatment of actinic damage: real world experience. J Lasers Med Surg. 2002;14(Suppl):24.

13. Touma D, Yaar M, Whitehead S, et al. A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage. Arch Dermatol. 2004;140:33-40.

14. Marcus S, McIntyre W. Photodynamic therapy systems and applications. Expert Opin Emerging . 2002;7:321-334.

15. Kloek J, Beijersbergen van Henegouwen GMJ. Prodrugs of 5-aminolevulinic acid for photodynamic therapy. Photochem Photobiol. 1996;64:994-1000.

16. Uehlinger P, Zellweger M, Wagnieres G, et al. 5-Aminolevulinic acid and its derivatives: physical chemical properties and protoporphyrin IX formation in cultured cells. J Photochem Photobiol B. 2000;54:72-80.

17. Fritsch C, Homey B, Stahl W, et al. Preferential relative porphyrin enrichment in solar keratoses upon topical application of delta-aminolevulinic acid methylester. Photochem Photobiol. 1998;68:218-221.

18. Szeimies RM, Karrer S, Radakovic-Fijan S, et al. Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: A prospective, randomized study. J Am Acad Dermatol. 2002;47:258-262.

19. Pariser DM, Lowe NJ, Stewart DM, et al. Photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: results of a prospective randomized multicenter trial. J Am Acad Dermatol. 2003;48:227-232.

20. Freeman M, Vinciullo C, Francis D, et al. A comparison of photodynamic therapy using topical methyl aminolevulinate (Metvix) with single cycle cryotherapy in patients with actinic keratosis: a prospective, randomized study. J Dermatolog Treat. 2003;14:99-106.

21. Rhodes LE, de Rie M, Enstrom Y, et al. Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial. Arch Dermatol. 2004;140:17-23.

22. Hauschild A, Lischner S, Lange-Asschenfeldt B, et al. Treatment of actinic cheilitis using photodynamic therapy with methylaminolevulinate: report of three cases. Dermatol Surg. 2005;31:1344-1347.

23. Lee MR, Ryman W. Erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy. Australas J Dermatol. 2005;46:196-198.

24. Vinciullo C, Elliott T, Francis D, et al. Photodynamic therapy with topical methyl aminolaevulinate for 'difficult-to-treat' basal cell carcinoma. Br J Dermatol. 2005;152:765-772.

25. Dragieva G, Prinz BM, Hafner J, et al. A randomized controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients. Br J Dermatol. 2004;151:196-200.

26. Morton CA. Methyl aminolevulinate (Metvix) photodynamic therapy--practical pearls. J Dermatolog Treat. 2003;14(Suppl 3):23-26.

27. Foley P. Clinical efficacy of methyl aminolevulinate (Metvix) photodynamic therapy. J Dermatolog Treat. 2003;14(Suppl 3):15-22.

28. Gniazdowska B, Rueff F, Hillemanns P. et al. Allergic contact dermatitis from delta-aminolevulinic acid used for photodynamic therapy. Contact Dermatitis. 1998;38:348-349.

29. Wulf HC, Philipsen P. Allergic contact dermatitis to 5-aminolaevulinic acid methylester but not to 5-aminolaevulinic acid after photodynamic therapy. Br J Dermatol. 2004;150:143-145.

30. Svaasand LO, Tromberg BJ, Wyss P, et al. Light and distribution with topically administered photosensitizers. Lasers Med Sci. 1996;11:261-265.

31. Henderson BW. Photodynamic therapy--coming of age. Photodermatol. 1989;6:200-211.

32. Weishaupt KR, Gomer CJ, Dougherty TJ. Identification of singlet oxygen as the cytotoxic agent in photoinactivation of a murine tumor. Cancer Res. 1976;36(7 pt 1):2326-2329.

33. Niedre MJ, Yu CS, Patterson MS, et al. Singlet oxygen luminescence as an in vivo photodynamic therapy dose metric: validation in normal mouse skin with topical amino-levulinic acid. Br J Cancer. 2005;92:298-304.

34. Svaasand LO, Wyss P, Wyss MT, et al. Dosimetry for photodynamic therapy with topically administered photosensitizers. Lasers Surg Med. 1996;18:139-149.

35. Nakaseko H, Kobayashi M, Akita Y, et al. Histological changes and involvement of apoptosis after photodynamic therapy for actinic keratoses. Br J Dermatol. 2003;148:122-127.

36. erell CJ, Wharton JR. New histopathological classification of actinic keratosis (incipient intraepidermal squamous cell carcinoma). J Dermatol. 2005;4:462-467.

37. Gold MH. The evolving role of aminolevulinic acid hydrochloride with photodynamic therapy in photoaging. Cutis. 2002;69(6 Suppl):S8-S13.

38. Varma S, Wilson H, Kurwa HA, et al. Bowen's disease, solar keratoses and superficial basal cell carcinomas treated by photodynamic therapy using a large-field incoherent light source. Br J Dermatol. 2001;144:567-574.

39. Alexiades-Armenakas MR, Geronemus RG. Laser-mediated photodynamic therapy of actinic keratoses. Arch Dermatol. 2003;139:1313-1320.

40. Jeffes EW, McCullough JL, Weinstein GD, et al. Photodynamic therapy of actinic keratosis with topical 5-aminolevulinic acid. A pilot dose-ranging study. Arch Dermatol. 1997; 133:727-732.

41. Jeffes EW, McCullough JL, Weinstein GD, et al. Photodynamic therapy of actinic keratoses with topical aminolevulinic acid hydrochloride and fluorescent blue light. J Am Acad Dermatol. 2001;45:96-104.

42. Piacquadio DJ, Chen DM, Farber HF, et al. Photodynamic therapy with aminolevulinic acid topical solution and visible blue light in the treatment of multiple actinic keratoses of the face and scalp: investigator-blinded, phase 3, multicenter trials. Arch Dermatol. 2004;140:41-46.

43. Data on file, Levulan[R] Kerastick[R] (aminolevulinic acid HCI) for topical solution, 20%, Dusa Pharmaceuticals, Inc., Wilmington, Mass.

44. Fowler JF Jr, Zax RH. Aminolevulinic acid hydrochloride with photodynamic therapy: efficacy outcomes and recurrence 4 years after treatment. Cutis. 2002;69(6 Suppl):2-7.

45. Gold MH. Intense pulsed light therapy for photorejuvenation enhanced with 20% aminolevulinic acid photodynamic therapy. J Lasers Med Surg. 2003;15(Suppl):47.

46. Smith S, Piacquadio D, Morhenn V, et al. Short incubation PDT versus 5-FU in treating actinic keratoses. J Dermatol. 2003;2:629-635.

47. Avram DK, Goldman MP. Effectiveness and safety of ALA-IPL in treating actinic keratoses and photodamage. J Dermatol. 2004;3(1 Suppl):S36-S39.

48. Markham T, Collins P. Topical 5-aminolaevulinic acid photodynamic therapy for extensive scalp actinic keratoses. Br J Dermatol. 2001;145:502-504.

49. Weinstein GD, Taylor JR, Glazer SD, et al. A dose-ranging study of photodynamic therapy with topical 5-aminolevulinic acid for treatment of actinic keratoses. Poster presented at: 61st Annual Meeting of the American Academy of Dermatology, San Francisco, 2003.

50. Gold MH. A single-center, open-label investigatory study of photodynamic therapy in the treatment of photoaging with aminolevulinic acid topical solution 20% and intense pulsed light. Poster presented at: 61st Annual Meeting of the American Academy of Dermatology, San Francisco, 2003.

51. Gold MH. A single-center, open-label investigatory study of photodynamic therapy in the treatment of moderate to severe acne vulgaris with aminolevulinic acid topical solution 20% and visible blue light. Poster presented at: 61st Annual Meeting of the American Academy of Dermatology, San Francisco, 2003.

52. Goldman MP, Boyce SM. A Single Center Study of 5-Aminolevulinic Acid and 417 nm Photodynamic Therapy in the Treatment of Moderate to Severe Acne Vulgaris. J Dermatol. 2003;2:393-396.

53. Stender IM, Bech-Thomsen N, Poulsen T, et al. Photodynamic therapy with topical delta-aminolevulinic acid delays UV photocarcinogenesis in hairless mice. Photochem Photobiol. 1997;66:493-496.

54. Bissonette R, Bergeron A, Liu Y. Large surface photodynamic therapy with aminolevulinic acid: treatment of actinic keratoses and beyond. J Dermatol. 2004;3(1 Suppl):S26-S31.

55. Liu Y, Viau G, Bissonnette R. Multiple large-surface photodynamic therapy sessions with topical or systemic aminolevulinic acid and blue light in UV-exposed hairless mice. J Cutan Med Surg. 2004;8:131-139.

56. Gilbert DJ. Treatment of actinic keratoses with sequential combination of 5-fluorouracil and photodynamic therapy. J Dermatol. 2005;4:161-163.

57. Fisher GJ, Kang S, Varani J, et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol. 2002;138:1462-1470.

58. Kang S, Fisher GJ, Voorhees JJ. Photoaging: pathogenesis, prevention, and treatment. Clin Geriatr Med. 2001;17:643-59.

59. Nestor MS. Evolving use of 5-aminolevulinic acid (ALA) topical photodynamic therapy clinically and cosmetically: a clinician's perspective. Cosmetic Dermatol. 2005;18:2-8.

60. Kligman LH, Akin FJ, Kligman AM. Prevention of ultraviolet damage to the dermis of hairless mice by sunscreens. J Invest Dermatol. 1982;78:181-189.

61. Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993;329:1147-1151.

62. Bitter PH. Noninvasive rejuvenation of photodamaged skin using serial, full-face intense pulsed light treatments. Dermatol Surg. 2000;26:835-842.

63. Negisht K. Tezuka Y, Kushikata N, et al. Photorejuvenation for Asian skin by intense pulsed light. Dermatol Surg. 2001,27:627-631.

64. Ruiz-Rodriguez R, Sanz-Sanchez T, Cordoba S. Photodynamic rejuvenation. Dermatol Surg. 2002;28:742-744.

65. Nestor MS, Goldbert DJ, Goldman MP, et al. New Perspectives on Photorejuvenation. Skin & Aging. 2003;11:68-74.

66. Bhatia AC, Dover JS, et al. Adjunctive use of topical aminolevulinic acid with intense pulsed light in the treatment of photoaging. Paper presented at: Controversies and Conversations in Cutaneous Laser Surgery, Mt. Tremblant, Canada, August 2004.

67. Gold MH, Bradshaw VL, Boring MM, et al. A split-face comparison study of ALA-PDT with intense pulsed light versus intense pulse light alone for photodamage/photorejuvenation. Dermatol Surg. In press.

68. Dover JS, Bhatia AC, Stewart B, et al. Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Arch Dermatol. 2005;141:1247-1252.

69. Lowe NJ, Lowe PL. A pilot study to determine the efficacy of ALA-PDT photorejuvenation for the treatment of facial aging. J Cos Laser Ther. Dec. 2005.

70. Hall J, Keller P, Keller G. Dose response of combination photorejuvenation using intense pulsed light-Activated photodynamic therapy and radiofrequency energy. Arch Facial Plast Surg. 2004;6:374-378.

71. Alster TS, Tanzi EL, Welsh EC. Photorejuvenation of facial skin with topical 20% 5-aminolevulinic acid and intense pulsed light treatment: A split-face comparison study. J Dermatol. 2005;4:35-38.

72. Leyden JJ. Therapy for acne vulgaris. N Engl J Med. 1997;336:1156-1162.

73. Gollnick HP, Krautheim A. Topical treatment in acne: current status and future aspects. Dermatology. 2003;206:29-36.

74. Zouboulis CC, Piquero-Martin J. Update and future of systemic acne treatment. Dermatology. 2003;206:37-53.

75. Thiboutot D, Chen W. Update and future of hormonal therapy in acne. Dermatology. 2003;206:57-67.

76. Elman M, Lebzelter J. Light therapy in the treatment of acne vulgaris. Dermatol Surg. 2004;30(2 Pt 1):139-146.

77. Ruiz-Esparza J, Gomez JB. Nonablative radiofrequency for active acne vulgaris: the use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy): a report of 22 patients. Dermatol Surg. 2003;29:333-339.

78. Omi T, Bjerring P, Sato S, et al. 420 nm intense continuous light therapy for acne. J Cosmet Laser Ther. 2004;6:156-162.

79. Gollnick H, Cunliffe W, Berson D, et al. Global Alliance to Improve Outcomes in Acne. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003;49(1 Suppl):S1-S37.

80. Itoh Y, Ninomiya Y, Tajima S, et al. Photodynamic Therapy for Acne Vulgaris With Topical 5-Aminolevunic Acid. Arch Dermatol. 2000:136;1093-1095.

81. Itoh Y, Ninomiya Y, Tajima S, et al. Photodynamic therapy of acne vulgaris with topical delta-aminolevulinic acid and incoherent light in Japanese patients. Br J Dermatol. 2001;144:575-579.

82. Alexiades-Armenakas M. Long-Pulsed Dye Laser-Mediated Photodynamic Therapy Combinded with Topical Therapy for Mild to Severe Comedonal, Inflammatory, or Cystic Acne. J Dermatol. 2006;5(1):45.

83. Divaris DX, Kennedy JC, Pottier RH. Phototoxic damage to sebaceous glands and hair follicles of mice after systemic administration of 5-aminolevulinic acid correlates with localized protoporphyrin IX fluorescence. Am J Pathol. 1990;136:891-897.

84. Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris. Br J Dermatol. 2000;142:855-856.

85. Arakane K, Ryu A, Hayashi C, et al. Singlet oxygen (1 delta g) generation from coproporphyrin in Propionibacterium acnes on irradiation. Biochem Biophys Res Commun. 1996;223:578-582.

86. Gold MH, Bradshaw VL, Boring MM, et al. Treatment of sebaceous gland hyperplasia by photodynamic therapy with 5-aminolevulinic acid and a blue light source or intense pulsed light source. J Dermatol. 2004;3(6 Suppl):S6-S9.

87. Gold MH. The utilization of ALA PDT and a new photoclearing device for the treatment of severe inflammatory acne vulgaris--results of an initial clinical trial. J Lasers Surg Med. 2003;15(Suppl):S46.

88. Taub A. Photodynamic therapy for the treatment of acne: A pilot study. J Dermatol. 2004;3(Suppl):S10-S14.

89. Schonermark MP, Schmidt C, Raulin C. Treatment of sebaceous gland hyperplasia with the pulsed dye laser. Lasers Surg Med. 1997;21:313-310.

90. Alster TS, Tanzi EL. Photodynamic therapy with topical aminolevulinic acid and pulsed dye laser irradiation for sebaceous hyperplasia. J Dermatol. 2003;2:501-504.

91. No D, McClaren M, Chotzen V, et al. Sebaceous hyperplasia treated with a 1450-nm diode laser. Dermatol Surg. 2004;30:382-384.

92. Horio T, Horio O, Miyauchi-Hashimoto H, et al. Photodynamic therapy of sebaceous hyperplasia with topical 5-aminolaevulinic acid and slide projector. Br J Dermatol. 2003; 148:1274-1276.

93. Richey DF, Hopson B. Treatment of sebaceous hyperplasia by photodynamic therapy. Cosmetic Dermatol. 2004;17:525-529.

94. Goldman MP. Using 5-aminolevulinic acid to treat acne and sebaceous hyperplasia. Cosmetic Dermatol. 2003;16:57-58.

95. Gold M, Bridges TM, Bradshaw VL, et al. ALA-PDT and blue light therapy for hidradenitis suppurativa. J Dermatol. 2004;3(1 Suppl):S32-S35.

96. Gold MH, Boring MM, Bridges TM, et al. The successful use of ALA-PDT in the treatment of recalcitrant molluscum contagiosum. J Dermatol. 2004;3:187-190.

97. Moiin A. Photodynamic therapy for molluscum contagiosum infection in HIV-coinfected patients: review of 6 patients. J Dermatol. 2003;2:637-639.

98. Coors E, von den Driesch P. Topical photodynamic therapy for patients with therapy-resistant lesions of cutaneous T-cell lymphoma. J Am Acad Dermatol. 2004;50:363-367.

99. Umegaki N, Moritsugu R, Katoh S, et al. Photodynamic therapy may be useful in debulking cutaneous lymphoma prior to radiotherapy. Clin Exp Dermatol. 2004;29:42-45.

100. Gardlo K, Horska Z, Enk CD, et al. Treatment of cutaneous leishmaniasis by photodynamic therapy. J Am Acad Dermatol. 2003;48:893-896.

101. Enk CD, Fritsch C, Jonas F, et al. Treatment of cutaneous leishmaniasis with photodynamic therapy. Arch Dermatol. 2003;139:432-434.

102. El-On J, Katz M, Weinrauch L. Treatment of cutaneous leishmaniasis by photodynamic therapy. J Am Acad Dermatol. 2004;50:e12; author reply e13.

103. Shieh S, Dee AS, Cheney RT, et al. Photodynamic therapy for the treatment of extramammary Paget's disease. Br J Dermatol. 2002;146:1000-1005.

104. Mikasa K, Watanabe D, Kondo C, et al. 5-Aminolevulinic acid-based photodynamic therapy for the treatment of two patients with extramammary Paget's disease. J Dermatol. 2005;32:97-101.

105. Ruiz-Rodriguez R, Alvarez JG, Jaen P, et al. Photodynamic therapy with 5-aminolevulinic acid for recalcitrant familial benign pemphigus (Hailey-Hailey disease). J Am Acad Dermatol. 2002;47:740-742.

106. Strauss RM, Pollock B, Stables GI, et al. Photodynamic therapy using aminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa. Br J Dermatol. 2005;152:803-804.

107. Radakovic-Fijan S, Honigsmann H, Tanew A. Efficacy of topical photodynamic therapy of a giant keratoacanthoma demonstrated by partial irradiation. Br J Dermatol. 1999;141:936-938.

108. Clark SM, Mills CM, Lanigan SW. Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser. J Cutan Laser Ther. 2000;2:151-156.

109. Edstrom D, Porwit A, Ros A-M. Photodynamic therapy with topical 5-aminolevulinic acid for mycosis fungoides: Clinical and histological response. J Eur Acad Dermatol Venereol. 2001;81:184-188.

110. Markham T, Sheahan K, Collins P. Topical 5-aminolevulinic acid photodynamic therapy for tumour-stage mycosis fungoides. Br J Dermatol. 2001;144:1262-1295.

111. Dierickx CC, Goldenhersh M, Dwyer P, et al. Photodynamic therapy for nevus sebaceus with topical delta-aminolevulinic acid. Arch Dermatol. 1999;135:637-640.

112. Richey DF, Hopson B. Treatment of perioral dermatitis by photodynamic therapy. J Dermatol. 2006;5(suppl 1).

113. Bissonnette R, Tremblay J, Juzenas P, et al. Systemic photodynamic therapy with aminolevulinic acid induces apoptosis in lesional T lymphocytes of psoriatic plaques. J Invest Dermatol. 2002;119:77-83.

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!

Yours Amina

Find the best products and solutions at the best centre on the iNet!
# dermalogica skin care

Article Source: http://EzineArticles.com/?expert=Amina_Sheikh

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.

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

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!

Find the best products and solutions at the best

dermalogica skin care

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.

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

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.

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

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.
______________________________
Julie GABRIEL, Fashion Monitor

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

Clean and Heal the Natural Way with Toxin & Chemical free Products

2006-02-19T01:27:00.000-08:00

From the desk of Clayton, Tedeton of Monroe, La., creator of Miracle Soap :

We would like to take the opportunity to introduce you to what may be the single most important concept in healthcare to come about in the past several decades. What you are about to discover is fact. The facts behind how a few, simple common sense product changes incorporated in one's daily hygiene regimen can have a profound and lasting impact on one's health.

The simple changes to one's regimen include substituting Miracle Soap for your shampoo and bath products, substituting Miracle Soap Neutralizer for your toothpaste and as an additive to your drinking water, consuming at least 2 liters of pure water a day. The substitution of a Miracle Soap Deodorant Stone for your antiperspirant. Additionally, we ask that you wash your clothes and linens with a Miracle Soap laundry product. The cost to you may be pennies more than you already spend, and then again it may be less. In the long run it will be substantially less. We challenge you to try the products and see the results for yourself. However corny you may think this sounds, the truth is you cannot afford not to try it.

THE SCIENCE BEHIND THE CHALLENGE:

The quotation below is an excerpt from the March 8, 1999 issue of Chemical Engineering News, a weekly publication serving the chemical industry.

"Sandia National Laboratories chemist Maher E. Tadros, in protective gear, sprays a foam that he and Sandia chemist Mark D. Tucker have developed to decontaminate chemical and biological warfare agents. The foam is a combination of a mild nucleophile such as hydrogen peroxide carbonates commonly found in toothpaste, a positively charged non-toxic surfactant often found in hair conditioners, and hydrotopes found in detergents. Hydrotopes found in detergents solubilize and catalyze the neutralization of the agents.

The foam reacts rapidly with the agents, is non-toxic and non-corrosive and could be produced at a cost of 15 cents per pound. Testing the foam against the nerve gases VX and Soman and against mustard gas was conducted by Illinois Institute of Technology (IIT) in Chicago because Sandia can only use simulants. The half-life of the reaction 'is in the neighborhood of 2-10 minutes, Soman being neutralized very quickly and mustard gas reacting much more slowly,' Tadros explains. The foam has been shown by NMR to cleave the P-S bond in the agents.

Using a simulant for the biological warfare agent anthrax, the foam achieved a 7-log kill, meaning only one anthrax spore of 10 million is alive after one hour. IIT will test live anthrax next month.

How the spores are killed is not known. Researchers speculate that the surfactants damage the spore's protective protein wall and all the nucleophiles -- oxidizing agents -- to attack the genetic material inside. The foam's development is part of the Department of Energy's Chemical & Biological Nonproliferation Program."

The article discloses a product developed by Sandia Labs for the Biological and Chemical Warfare Division of the US Military under the auspices of the DOE. The product is a combination of a peroxide gel surfactant commonly found in shampoo, conditioners and different food stuffs and hydrotopes found in detergents. Obviously the product neutralizes the most potent nerve toxins and airborne pathogens known to man. The product acts to neutralize these agents and cleanse them from the skin like an antibacterial soap, but it is not soap. We spoke with one of the product developers, Dr. Mark Tucker. His explanation was that the peroxide gel, an oxidizing agent in conjunction with the surfactant and hydrotope, surrounds the organism or chemical agent, oxidizes it and will not allow it to interact with it's environment, effectively neutralizing the toxic agent. The surfactant-hydrotope combination is apparently very selective in seeking out only toxins and gram positive pathogens. This is not an antioxidant reaction, quite the opposite, if peroxide is present. Likewise, it appears we are looking at the missing ingredients in peroxide and ozone therapy that would keep these strong oxidizers from harming the body after they have oxidized pathogens and oxygenated the body -- the surfactant and hydrotope. Surfactants have been used in fuel cells in lieu of salt to catalyze the electronic reaction and could do the same for ozone therapy machines. We know that the body's T-cells dispatch pathogens with peroxide and we know that the body and cells manufacture and use surfactants in places like the lungs to regulate oxygen-carbon dioxide exchange and at the surface of the cell wall to reduce surface tension in the water layer surrounding the cell membrane. This is necessary for cellular functioning and communications. Could it be that the surfactant in the lungs has an anti-microbial and anti-toxin function that has eluded science to date? It would appear that biochemists as well as the medical community may have missed these connections in terms of a surfactant-hydrotope role in human health.

SURFACTANTS, HYDROTOPES AND HUMAN HEALTH

We are reminded of the discovery of penicillin and how doctors lamented about not having seen the relation between the substance's known anti-microbial properties and human health earlier. Iodine based anti-microbial soaps have been used in hospitals and clinics for years. Even in use in surgery on patient's insides before closing them up to lessen the chance of infection and neutralize toxins. Why didn't one of these practitioners ever think about creating a soap-like product for internal use capable of neutralizing toxins and pathogens while facilitating elimination? We now have this product available : Miracle Soap and Neutralizer. These products have been on the market for the last 18 years, quietly used by thousands of people with virtually nothing but positive benefits to their health. Benefits that can only be attributed to the product's use as directed. What we are witnessing is a totally new paradigm in healthcare and preventive maintenance. A paradigm that is both inexpensive and effective. We do not believe in "magic bullets" or panaceas. We do believe in accessories or adjuncts that aid and restore body functioning to design, thus allowing the body to approach optimal health on its own.

Can the road to health and longevity be as simple as proper hydration coupled with a product capable of sequestering toxins and pathogens in such a manner that they can be washed from the body internally as easily as they can be washed from the skin with soap? Is there something that can do this with no adverse side effects, no associated healing crisis and do this with no other form of intervention?

We believe the Miracle Soap and Neutralizer capable of doing just that. This in reality is not intervention at all, it is personal hygiene, internal hygiene like drinking plenty of water, taking a bath or brushing your teeth! This is a very uncomplicated procedure. You simply replace all of your shampoos, soaps, toothpaste and laundry detergents with Miracle products and witness the difference it makes in your life. If you are a health conscious individual compare the cost of Miracle monthly expense to the complex vitamins, antioxidants, amino acids, enzymes, trace minerals and various chelates (some chelating agents are surfactants) you are currently consuming in an attempt to remedy health concerns minus the cost of toiletries and detergents, then see where you stand. Basically for slightly more than the replacement cost of your current personal hygiene items and detergents you can have Miracle products plus health. How much is your health worth to you? Are you really getting your money's worth from what you are spending when most of what you are consuming is eliminated from the body prior to use?

We are not advocating that a person stop using neutraceuticals, they do have a positive effect on a person's health. But, consider that the very best antioxidants available including pycnogenol (grape seed and microhydrin) contain surfactant properties and you will see why they work so much better than the rest. They are also the most expensive. Surfactants have the ability to extend products and reduce surface tension to the point that they can be carried into the cell. It also means you don't have to use as much of them when the surfactant is present.

Free Radical Theory May Be Incomplete

We hear a lot about the Free Radical Theory of Disease and Aging these days. Touted as an explanation for everything that ails us. In view of the above, we feel the current Free Radical Theory may be incomplete. The Free Radical Theory concerns itself only with harm done by sub-atomic particles called protons via ionic oxidation to the cell wall and internal portion of a cell. The remedy to this perceived threat is supplying the body with surplus free electrons donated from ionic compounds we must consume to balance out electrical charges strictly from a chemical standpoint, thus freeing the body from this imbalance. The free radical is the bad guy and the antioxidant is the good guy and the whole current marketing scenario is about declaring war on free radicals. We reel that getting on a bandwagon and declaring war on free radicals may not be the only answer. We accept that it is about achieving a balance. A review of basic human physiology tells us that without free radicals you would not be alive! Almost all of the acid based metabolic functions of the body as well as your immune system work by means of free radicals. If the body could adequately cleanse itself of a radical after it performed its function it would not be necessary to perform the added energy inefficient step of neutralizing radicals with antioxidants prior to eliminating them from the body. The big culprit is dehydration. Most of us are dehydrated. Antioxidants don't cure dehydration, water does! If we had enough pure water available within the body we could eliminate radicals before they became a problem. A review of the theory in practice demonstrates that most antioxidants are large organic molecules that have only a single electron to donate. Once they have donated that electron they themselves become a free radical that in turn needs an antioxidant to neutralize it. This continues for about five additional antioxidant demand steps before it is finally balanced simply because there are very few broad spectrum antioxidants capable of donating more than one free electron and quenching the free radical in one step. Each additional step equates to another energy demand for waste removal from the body.

Furthermore, there has been an ongoing debate among scientists who know that the atmosphere contains free electrons and negatively charged ions capable of quenching free radicals through the skin as well as through the lungs. They imply that the quenching process proceeds at electronic speeds, near light velocity and never is it at a mechanistic chemical approach standstill. Basically a free radical is always hunting an electron to balance itself out; consequently it steals one from a healthy cell's double electric ion-water layer surrounding the cell. The theft of this ion is automatically adjusted for in a series of steps that take place from the atmosphere inward to the deficient cell at near instantaneous speeds. If this is true, then there is a limited need for consumption of additional large organic antioxidant molecules.
The last and foremost difficulty with the Free Radical Theory is that it is based only on electrical charge satisfaction. Once an electrical charge has been satisfied there is no flow of current, the body depends on a flow of electrical current to live. Where there is a flow of current there is something else going on. The other vector of electromagnetism which is totally neglected by this theory-magnetism and the role it plays in cellular functioning and health. Some years ago Swedish radiologist Bjorn Nordstrom proposed a working theory based on his observations which stated that the components of our circulatory system carried an electrical charge. The observed charge geometry was opposite charges on the inner walls versus the outer walls of arteries and veins. This is not surprising as flow containing iron rich hemoglobin would generate an electrical charge as long as it was flowing. The charges on the walls themselves were moving in opposite directions. A moving charge generates a magnetic field transverse to the direction of movement. When this process slows or breaks down the charge density decreases. The magnetic field collapses and diseases like cancer ensue. Cancerous masses exhibit an electropositive charge radiating outward from the mass. By changing the electro-potential of the mass from positive to negative Nordenstrom in many cases was able to make the mass dissipate and return to normal cell growth. Hemoglobin is of course the oxygen carrier for the body. Oxygen-carbon dioxide exchange is an electromagnetic process involving a surfactant as well. Oxygen is strongly paramagnetic. When oxygen levels to the tissue drop, chemically reducing conditions predominate. Cancer is a condition that depends on reducing conditions and low electromagnetic current flow to manifest. This information gives strong credence to direct electrification technologies. We now know that the body produces the magnetic mineral magnetite and that magnetite is present in small quantities in virtually every cell in the body, playing roles ranging from shielding mechanisms. Sensory mechanisms trigger mechanisms of enzymatic reactions. And these roles are not just tied to ferromagnetic materials like magnetite. Every non-ferromagnetic substance exhibits paramagnetic or diamagnetic qualities measured as minute differences in their magnetic susceptibility (measured behavioral response to a magnetic field). Biochemistry has paid absolutely no attention to this or the ability of applied magnetic or electrical fields to influence chemistry. The free radical theory" 'will remain incomplete until it adequately addresses these issues. The issue is not just electrical charges found in chemistry. It must include polar magnetic effects--- not just electrical induction, but magnetic induction and the effects it has on a substances magnetic susceptibility. Last year one of the journals of chemistry published an article stating it was looking more and more like it was the fields surrounding a substance C field resonance) that were doing the work and not the chemical substance itself. The gross physical substance appeared to be contributing only to the side effects! And medicine is still saying that there is nothing to Homeopathy. They haven't studied the magnetic susceptibility relationships! Chemistry is only now getting around to studying the electrotheology interactions of compounds in water. It will be a while before they study the magnetotheology relationships in terms of the magnetic susceptibility of substances in aqueous mediums like those found in the body. Another area of study that is about to unfold in relation to human health in terms of minerals and elemental transformations is plasma discharge charge cluster dynamics (quantum biology).

Surfactant Chemistry

First, what is a surfactant? A surfactant is a surface-active agent or wetting agent organic or hydryl-carbyl-silane molecule that contains hydrophylic (water loving), and hydrophobic (water hating) respective parts that allows the molecule to act with both properties - in other words the molecule is non-polar on one end and polar on the other. They are coupling agents normally functioning at the interface between bulk materials (for example; oil and water) such that what would not normally mix does so in the form of a suspension or colloid. The hydrophobic non-polar end attaches to dirtv pathogens and oils while the hydrophylic end attaches to water. Surfactants are thus used to create micelles (micro-container for substances like oils) and reduce the surface or interfacial tension between the affected water and it's bulk substance. In this manner the water and a substance are bound to one another and can then be transported more effectively by the water because the water is now wetter and more slippery. This is how detergents remove oils, dirt, grime, odors, and microbes from your clothes. Surfactants are usually manufactured from natural organic substances like fatty alcohols found in plant material. The creator or Miracle Products was guided to use a particular coconut derived surfactant (NO, not Cocomide DEA that has been demonstrated to cause cancer in mice or unreformed sodium laurel sulfate that is suspected of being a carcinogen-most surfactants are not beneficial to humans or animals). They must be transformed before they are acceptable for human consumption. This particular non-harmful transformed surfactant specifically targets and cleanses gram-positive pathogens and substances toxic to humans out of the body after it has been subjected to the manufacturers process. Which surfactant is it? That's the manufacturer's trade secret. It is non-harmful to begin with and becomes very beneficial after it has been treated. This is why the bio- and chemical warfare people still do not have anything consumable- they were unable to back-engineer the manufacturer's process. When you try to analyze a surfactant chemically, it is very difficult and one that is diluted in water is nearly impossible. Now consider one that has been transformed by a trade secret electronic process. This should give you some inkling of how and why the product works. More on that later after you have had time to digest this.
A clue as to how the manufacturers multi-phase plasma arc and electronic process transforms the properties of the surfactant is on the bottle: stabilized oxygen and ash of dodecyl sulfate (a surfactant) Those of you who follow the Edgar Cayce health readings will recall that Cayce had a cancer remedy based on something he called "animated ash." Animated ash was a form of bamboo that was reduced to activated charcoal by means of a partial vacuum electrical carbon arc process. The resulting ash was taken internally. Coconut husk derived activated charcoal is the preferred form of charcoal for water and air filtration. Miracle products all contain an electrically treated coconut based surfactant in addition to the ash of dodecyl sulfate. Basically the manufacturers multiphase plasma arc process carbonizes and reforms the surfactant into an activated form through elemental transformational charge cluster dynamics. We carbonized some doceyl sulphate in our lab and lo and behold when we added it into some water it still had surfactant properties and was still able to reduce the surface tension of water! So what is this Carbon Ash? It is a form of dielectric (electrical insulator) carbon capable of affixing copious quantities of oxygen to its structure in a form usable by the body. It is a strong oxygenator that when diluted in water possessing reduced surface tension, allows it reach all parts of the body very quickly. This hydrated-charge clustered form of paramagnetic oxygen is electronegative and as such when attached to hemoglobin is dispersed and diffused to the body faster and in greater quantities due to the action of the reduced surface tension water! Thus Miracle II products have a distinct advantage over the older Cayce preparation. Some of you may be familiar with Dr. Willard's CAW water. Dr. Willard was a chemist who formulated a castor oil and coal (carbon) based soap that had been electrically treated and is reported to have remarkable health benefits when diluted in water and taken internally. Sound familiar? The difference is that Willard's product does not exhibit reduced surface tension in water. In fact it raises the surface tension of water. This tells us that it will not be as active or effective in the body as Miracle Neutralizer. When viewing the reconstituted Neutralizer in solid form, it has a curious pale blue color, like the atmosphere. We surmise that this is the life (giving oxygen locked into the mix. It is, in addition, evidence of the Eloptic (subtle) energy the same as Reich's Orgone energy, which is reported to be pale blue in color).

"The Spiritual Thing"

Connection of Reduced Surface Tension and Coherence of Vacuum State "Zero Point Energy"
It is accepted scientific fact that living cells produce coherent light, just like a laser, by means of an electronic relationship between the cell membrane, a sugar based surfactant and water. The cell produces the sugar surfactant that in turn alters the two to three molecule thick double electric ion layer buffer between the cell membrane and the water interface. The surface or interfacial tension of water within this thin layer is maintained by the cell at about 45 dynes/cm as compared to the bulk interstitial water measurement of 72.3 dynes/cm tension when cohering light. By regulating the surface tension of this layer the cell can cohere, decohere and change the frequency of light within this layer. This means that the cell can produce light over a broad bandwidth of the EM spectrum. Present measurements range from UV through IR down on into the X- band. This spectral manipulation involves changing the thickness of the double electric layer. The resulting coherent light is said to possess a signal quality ten times that of our best lasers. Additionally, it has only been within the last year that engineers have been able to build a laser capable of cohering light of two separate frequencies simultaneously. Wonders of Mother Nature never cease; the cell has been doing it since God willed it into existence! This high signal quality is what has allowed German researchers to separate cellular signal content from the signal to noise domain. Coherent light signal information is how cells control cellular function and communicate with each other at light velocity. The cellular photographic field equivalent of the nervous system, responds much more quickly than die physical nervous system. This system allows cells to utilize tools like fine level spectroscopy and interferometry to obtain information on identifying and spatially referencing anything in its environment. It is this holographic light field extending beyond the body that we term the Aura. This system is so speedy that the chemical matter part of our body has a time delay before it can process the information for our brains. This delay between cellular sensing and slower nervous system-brain sensing is what is called time-ratio signaling or phase-modulated signals. Basically the brain is the last information processor to receive the parallel processed information. The cellular sensory system could be termed a holographic, parallel processing quantum computer. The holographic nature of the cellular system is derived from the fact that the coherent light travels around the cell membrane creating self referencing phase conjugated constructive interference and atomic spin alignment which is what amplifies and increases the oscillator signal quality while at the same time sensing all the different possibilities and probabilities for an event occurrence in order to select the right one for it's specific dimensional and time reference frame. Once the amplitude of coherent light has built up or lased it is able to discharge its signal content to other cells. The receiver cells as a whole, or individual cellular systems, can either resonate in harmony and identify with each other or sense receive and cross collate the information for better resolution. This identity is a systems-regulating mechanism, sensitive to many cyclic rhythms.

Friction, surface coherence and surface tension are related to one another. We all know that when we rub two surfaces together it produces heat and resistance. The most recent work on friction shows that this is related to electron drag across a surface that produces phonons (Standing waves of mechanical energy -sound or heat) and that when we put a lubricant between the two surfaces it reduces the fiction by dampening the standing waves (the interfering noise levels). That is what a surfactant in water does. It is a self-orienting lubricant that allows the water and the cell membrane to come closer together without touching while increasing the amount of available surface energy between the two substances. It allows the two dissimilar substances to interact without merging. It regulates the quantities of heat, light and sound and determines the specific wavelengths of light that can exist within the buffered zone. The closer the two substances come together the higher the coherence and frequency generated between the two until a coherence match occurs and lasing begins. This characteristic is likened to what in radio electronics is called an impedance match between a dipole transmitter antenna and a receiver. The two opposing surfaces and corresponding double electric layers constitute a capacitor-resistor oscillator circuit around the cell and on structures within the interior of the cell. These structures act as resonant cavity oscillators that amplify the signal and probably aid in stepping the signal frequency down. Since the cell membrane and water interface is elastic, this allows for not only coherent light production but high frequency transverse electromagnetic (other than light) and acoustic wave transmission. The double electric layer buffer zone coherence is what quantum physicists refer to as an interface for the Lamb shift and the Casimir Effect. Then the distance between two non-charged surfaces is sufficiently small or in dimensional accord with the energy filled space matrix vacuum potential, coherence will occur and draw energy from the vacuum potential. This is what is called Zero Point Energy extraction from the vacuum. This phenomenon would explain how humans constantly use more energy than they can extract from the food. Water and air intakes and burns during the metabolic process for healthy human functioning. This energy is very high frequency. Consequently the gross matter of our bodies can only extract a small portion of it - basically the lower harmonics that is in tune with matter. Some researcher's calculations indicate the convened amount is as little as 100 watts of power a day. We presently do not know the body's step down mechanism for making more of this energy available to lower order systems except for transverse EM and sound waves mentioned earlier. This system represents one of the highest, if not the highest types of energy generating and sensory Systems found in the living human organism. As an aside we had made mention of the new research on quantum state computers and the possible link with this cellular mechanism and parallel processing quantum computing. Quantum computing makes use of single atoms axial spin alignment as an on-off type switch. The atomic computer is theorized to have access to or contains all the possibilities and probabilities for an event occurrence within the universe and all parallel universes and can make the one and only correct decision referenced to it's present phased time frame. Additionally, once two atoms have made a coherent connection, the memory of that connection and shared information is retained throughout the two atoms lifetimes. Even when separated by great distances this connection is maintained, meaning that there is communication between the two at speeds greater than light velocity. So, present Quantum Mechanics has finally gotten around to explaining action at a distance greater than previously allowed by inverse square law mechanics or quantized field theory and at speeds greater than that of light! This realization opens the door for explaining all paranormal phenomena, teleportation, mass translation, and the connectedness of all things in the universe via vacuum state harmonic resonance. This has been one of God's most cherished secrets that he has now graced science with. The human race must be doing something right for a change. What does this have to do with Miracle products and human functioning? Think about it. If you have a transformed material capable of interfacing with a human at the right frequencies and cohering energy of the spirit, light and wisdom directly into human beings in usable form then there is no negative force in this universe that a human cannot overcome!

When our nutrition is poor, our water and mineral intake low, and we are exposed to environmental toxins, our energy levels drop to the point that our immune Systems can no longer fight off pathogens. How does this work from an electronics aspect? Once the energy level drops. Not only is the body incapable of producing the necessary quantity of chemicals to sustain peak functioning, the resonance of the chemical toxins and pathogens is higher than that of the cells and begins to drive the cellular oscillators at the foreign chemical's and organisms disharmonious resonance. Since the correct amount of sugar surfactant is no longer being produce& the oscillator circuit either resonates at the wrong frequencies or fails. Consequently, the holographic regulation function collapses. The body now must rely on its back-up systems. Ill health, premature aging, and ensue.

Now this is pure conjecture, but based on the beneficial effects and energy increases observed in individuals on the Miracle program, plus how the product amplifies radionics signals, we would have to assume that the product's creator was given a way to manufacture a surfactant that can either supplement or replace the sugar surfactant with a more resistant and elastic surfactant capable of forming a thinner membrane. The Miracle Product surface active ingredient must help form the correct thickness double electric layer around a cell to cohere the correct frequencies for energy extraction from the vacuum - this may well be the clue to the most important activity of Miracle Products in the body.

The other half of this energy producing mechanisms within the body involving Miracle Products that is not currently recognized by western physiology and biochemistry is plasma discharge charge cluster dynamics. The human body is largely composed of water. The body fluids contain quantities of electrolyte and soluble trace minerals. We know that water can be used as a fuel when water is split into hydrogen and oxygen and recombined to yield heat, light and water once again. Water is usually split by electrolysis in a fuel cell. Science is now realizing that plasma charge cluster dynamics and elemental transformations are taking place in minerals in the water and in the cell electrodes. Literally forming highly energetic transformed mineral charge clusters. We know that chemical electrolysis takes place in the body all the time. Many fuel cells use surfactants in the water to help with the reaction. As an experiment we placed some Miracle Neutralizer in an open 9V electrolysis cell to see what happened. The electrolytic reaction increased by a power of 10 over a normal cation and pH matched alkaline electrolyte! We don't know if what was out-gassing off the electrodes was only hydrogen and oxygen and we do not know if this electrochemical reaction is going on in the body. We do know that the manufacturer's process involves charge clustering and reformation of the surfactant and minerals in the water. It could very well be that when the body's chemical electrolysis process is combined with the charge clustered reformed surfactant, efficiencies may increase several fold. This would also explain the detoxification effects. Toxic chemicals would literally be broken down and transformed into benign or usable beneficial byproducts by the action of the charge clusters. We do know that in the agriculture of very healthy desert plants that the plants have been observed to give off water even during the hottest (high solar radiation capable of generating charge clusters within the plant thus increasing chemical electrolysis) and most dry part of the day. Science now knows that most of the energy that drives these charge cluster plasmoids comes from outside the system. Their field and spin dynamics polarize the vacuum and pull energy in from the space matrix. Consequently they become self-regenerative charge structures that pick up and hold mineral ions in their centers. At a finer level this is the way that subatomic particles and atoms are formed from the space matrix vacuum---zero point energy. Biophysicists now recognize that the classical explanation of the mechanics of cellular sodium-potassium pump energy production is incorrect. This mechanism was never more than a theory, but was always presented as fact. The problem was, no one could figure out how sodium always went into the cell and potassium always came out The classical explanation of the materials balance replenishment cycle is not feasible. A mechanism is readily available, if we look to research results stemming from cold fusion experiments. It is through an electrostatic trans-membrane potential difference known as electro-insertion. The only way this could happen is if the sodium were transformed into potassium by charge cluster dynamics within the cell and consequently kicked out of the cell, thus drawing in another sodium ion in the process!
If this were not happening, we would be , , !
--THE LIVING CELL IS A MINIATURE COLD FUSION NUCLEAR REACTOR CAPABLE OF ELEMENTAL TRANSFORMATlONS THAT NET EXCESS ENERGY BACK TO THE LIVING SYSTEM! ONLY GOD COULD HAVE ENGINEERED THIS AND ONLY GOD CAN IMPROVE ON IT!

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

Grease be gone! - personal beauty -

2006-02-19T01:26:00.000-08:00

We know you want to shine this year...just not on your face. Five readers tested these leading grease-busters so you can put your best face forward this fall!

Jane Good Skin Light Energy Oil Control Moisturizer ($6) Light Energy smells really good, and it's very refreshing. But it makes a way better moisturizer than oil controller. --Hannah, 13

Dermalogica Oil control Lotion ($30)

I really like Dermalogica Oil Control Lotion. It keeps shine off my face during the day and removes oil. And it doesn't stink, so you don't have to worry about holding your nose while you apply it. --Rebecca, 13

Clean & Clear Instant Oil-absorbing Sheets ($5)

Clean & Clear Instant Oil-absorbing Sheets really works well for me! My mom says my face looks clearer and I notice it, too. I'm surprised at how much oil is on the sheet after I use it. And it's in a small compact package, so you can take it anywhere! --Katie, 13

Origins Oil Refiner ($16)

Origins Oil Refiner doesn't make my face break out like some other lotions, but I also don't really notice much of a difference in the amount of oil on my face. The smell is pretty strong, and it tingles when you put it on. Don't forget to shake it every time you use it. --Camille, 13

Clinique Sheer Matteness T-zone Control ($12.50)

The Clinique Sheer Matteness helps my face a lot! I don't get any new pimples, and my face doesn't feel greasy at all. I had been using different brands of oil reducers, and they all made my face feel slimy--yuck! But the T-zone Oil Control feels smooth when I put it on, and it's 100-percent fragrance-free. --Sarah, 13

COPYRIGHT 2001 Monarch Avalon, Inc.
COPYRIGHT 2001 Gale Group

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

A Sweet Way to Keep Your Skin Young

2006-02-18T11:02:00.000-08:00

We’re all wrapped in skin. It is the largest organ in our body. It stretches, heals and renews trillions of cells each day. As the years go by, this process begins to decline and our skin starts looking dull, wrinkled and less vibrant.

Beauty spas offer expensive solutions to help us buy back what God gave us for free when we were younger. These solutions include chemical peels, dermabrasion, laser resurfacing and expensive alpha hydroxyl acid (AHA) products and a host of moisturizing products.

You don’t need to go to expensive and potentially dangerous lengths to get back the vibrant glow to your skin. Your skin can be renewed through careful skin care and intelligently using beauty solutions that come from nature.

God has made provision for all of our needs in creation. Honey is one of the best examples of a God-given substance that provides for health, healing and even beauty! Here are just a few benefits of honey:

• Honey is a natural humectant - that means it naturally attracts and retains moisture. This makes honey an important ingredient in many moisturizing products, cleansers, shampoos and conditioners.

• Honey is also well known for its healing properties and has been used to keep wounds clean and infection-free for generations.

• Honey acts like hydrogen peroxide when it teams up with propolis (a compound in nectar) to fight infection and bacteria and to act as a natural bandage. These nourishing and protecting properties extend beyond broken skin, acting as a gentle moisturizing cleanser for all skin types.

Honey is a Sweet Treat for Your Skin!

The cosmetic industry has noticed that health conscious women are looking for safer and better ways to care for their skin. You now see honey in products found at your cosmetic counter. But, why settle for a little honey combined with things you may not need?

To get the best result, use pure honey straight from the container. There is nothing better than the real thing. Until we know the true cause of disease and dreaded cancers, we should stay as close to natural as possible.

For healthy, younger-looking skin, try these beauty recipes using the God-given power of honey. Use only Pure Organic Honey in these recipes if you can.

Honey Facials

For normal to oily skin:

1. Beat one egg white (from a medium size egg) until frothy
2. Add 1 Tablespoon Pure organic honey
3. Mix the honey and beaten egg white together to form a paste. Apply to your face and throat using an upward motion only!
4. Sit back, put your feet up and relax for 10-15 minutes
5. Rinse your face with warm water followed by a cold water splash
6. Your face will be refreshed and well nourished

For dry skin:

1. Mix 2 Tablespoons honey and 1 teaspoon olive oil until well blended
2. Apply to your face and throat using and upward motion only

Use this treatment once a day for two weeks and you will see a softening of fine lines and wrinkles.

Lemon and Honey Hydrating Mask

This mask is great for very dehydrated skin. You only need:

2 tablespoons of honey
1 tablespoon of diary cream and
1 tablespoon of lemon juice.

After mixing all of the ingredients well:

1. apply by patting with your fingers
2. leave it on for 20 minutes and rinse off with bottled or spring water and cotton pads.

After just one facial treatment, your skin will be hydrated, smooth and nourished.

You don’t have to be a casualty in the war against aging. The same creator who gave us the feminine desire to seek beauty and vibrancy has also given us natural sources to remain youthful and beautiful for many years.

Linda Gaston is an advocate for natural beauty solutions for the mature Christian Woman. She has written a book "Born Again Beautiful" that provides all natural solutions for beautiful hair, skin and body for the woman over forty. To learn more visit http://www.bornagainbeautiful.com

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.

Dry skin 911: is your skin still weathering winter's elements? Here's how to bring back the glow, just in time for spring

2006-02-18T06:34:00.000-08:00

BODY GLOW

Winter-weary skin needs a little buffing in order to shine. According to Annet King. director of training and development of the International Dermal Institute in Torrance, California. the way to get and keep a healthy glow is to step up your exfoliating program with these smooth moves:

* Once a week, brush your entire body with a dry body brush like Dermalogica The Ultimate Buffing Cloth. Pay special attention to rough areas.

* When you've got a little time on your hands, mix a salt scrub and a massage oil into a paste and rub it all over. Rinse well with warm water.

* Before you leave the shower, put on Olay Moisturerinse In Shower Body Lotion, which adds an extra layer of conditioning to your normal routine. Shopping tip: When choosing a moisturizer, check the label for ultrahydrating ingredients like glycolipids, shea butter and urea.

HANDS DOWN

Apply a rich cream like de-luxe Shea Butter Hand Creme (right) while your hands are still damp. Before you snooze, slather on a cream with alpha hydroxy acids. (They exfoliate and smooth.) Try Eucerin Plus Intensive Repair Hand Creme.

Face Time

* Always wash dry skin with a soap-free facial cleanser such as ROC Age Diminishing Facial Cleanser with conditioning soy extracts.

* Exfoliate at least twice a week, If you're a fan of chemical exfoliants like glycolic peels and microdermabrasion kits, do use them sparingly: They can be drying.

* Follow up with rich creams containing humectants that draw moisture from the air, like Chanel Precision Hydramax + Creme Source d'Hydratation Moisture Boost Cream and Clinique Superdefense Triple Action Moisturizer SPF 25.

Smooth Feet

Shed the rough stuff by giving yourself a perfect pedi. Remove cells and sea in moisture using Creative Nail Design Raw Earth Spa Pedicure. This complete at-home system allows you to cleanse, exfoliate we love the water-activated warming action of Footbuff, shown at right), treat Calluses, and hydrate with the ultra-moisturizing mask.

LIP SERVICE

* When your lips are ed, and peeling, treat them with a lip aid like DDF Therapeutic Lip Treatment.

* Protect, condition and give lips great color with Bobbi Brown Lip Tint SPF 15.

* Before going to bed, sea in moisture with Neutrogena Overnight Lip Treatment.

[ILLUSTRATIONS oMITTED]

COPYRIGHT 2005 Essence Communications, Inc.
COPYRIGHT 2005 Gale Group

We believe your skin is best taken care by dermalogica so we ask you to take

care dermalogica skin by visiting

by visiting dermaology.com

Your best makeup moves luminous skin: fresh, flawless makeup is all in the details.

2006-02-18T06:33:00.000-08:00

In your daily quest for ideal makeup, keep it soft and easy. Your foundation and concealer should be so well blended, folks will be wondering if that flawless skin is naturally yours.

Smooth the surface. You can't have an impeccable finish with a rough complexion, so take care of your skin's texture. Make exfoliation part of your routine. We like Bobbi Brown Exfoliating Cream Wash and Dermalogica Daily Resurfacer (dermalogica.com).

Meet your match. If the undertones in your foundation aren't right, the look won't be either. For most women of color, products with pink or red undertones are off the mark. Most of us fall into the yellow-undertone category, but if you have any doubts, visit department-store cosmetics counters like Prescriptives or Clinique for an analysis and foundation samples. More great lines to try: Becca (sephora.com), Black Opal. Black Radiance and Iman. Look at your foundation color in natural light to get the best match. It should blend seamlessly into your skin. To get maximum results from your foundation, make sure it complements your skin type. Dry skin calls for rich, creamy formulations, while oilier skin types should use oil-free formulas.

Look for the light. "Without luminosity, foundation can leave your complexion looking dull," says celebrity makeup artist Paul Innis. "You can get radiance from shimmer sticks, bronzing powders or liquid makeup with shimmery finishes." Deeper complexions need only a touch of shimmer; lighter complexions require both shimmer and warmth to shine. But keep away from shimmers with a silvery or pink-colored base--they can leave you looking ashy.

Keep shine in check. "There are good and bad shine areas," says Innis. Keep the cheekbones and jawline dewy and radiant, but take down the shine factor at the top of the forehead, tip of the nose, and anywhere around the laugh lines. Use blotting papers and powder to minimize the effect.

Warm your cheeks. To further enhance your makeup, try a kiss of color. Just don't overdo it with a severe "racer stripe" up the cheekbone. "Try a gel or a sheer cream blush," advises celebrity makeup artist Monifa Mortis. Dab the apples of the cheeks and blend in a circular motion. Formulations that do our complexions right include tarte Cheek Stain, Stila color pushups and Sonia Kashuk Cheek Sheers.

wake up those eyes

When you skip zzz's, it's written all over your face. Erase dark circles and puffiness with these eye-opening tricks

Line the lower rim of your eyes with an eyeliner that's close to your skin tone, preferably one with gold flecks. "This is a modern way to brighten says makeup pro Bianca Alexander of MAC Cosmetics. "It makes them look larger." Her favorite liners include Tendered, Bountiful Brown and PowerSurge, all by MAC.

Apply concealer around the entire eye and blend well with s. Concealer not only covers dark circles, but also helps your shadow to stay longer and brightens the area between your crease and brow.

Well-groomed brows open up the eyes. Pluck an, strays below four natural arch. Then using a fine-tip brow pencil, fill in any sparse areas with short, light strokes along your arch line. Skip heavy black pencils and stick to more natural-looking deep browns. Finish by brushing on a prow gel It further softens pencil marks, hobos brows in place, and brings in a bit of shine.

To fully showcase eyes, finish with two coats of mascara, on both upper and lower lashes. Let mascara dry between applications. To clean up smudges, dip a cotton swab into your foundation for easy touch-ups.

fresh and lovely lips

The lip du jour is unlined. Here's how to get the look

Begin with a balm; it smooths and preps lips for color. Try SCO Lip Balm or Blistex Pro Care.

Sheer, flesh-tone neutrals are the look of season. If your natural lip color is a bit uneven (most are), use foundation on your lips first to even the tone, then apply your lip color with a brush. Our favorite neutrals this spring include Bobbi Brown Lip Color in Raisin, Fashion Fair Lip Color in Sheer Bronze Clinique Glosswear for Lips Cream Shines in Rich Raisin and MAC Viva Glam V.

If you're just not feeling a neutral or unlined lip, you can add more definition with a lip pencil that's slightly darker than your lip color. Use the liner only at the corners of the mouth. Fade the color into the lip with a sponge. Put on your lipstick with a brush, then purse your lips together to soften the effect.

shadow and sculpt

Wish you could soften a double chin or chisel out some cheekbones? We'll show you how. Contouring can be like a face-lift without surgery

THE TECHNIQUE Contouring tapers the face to add or take away depth. All you need is a powder shadow one shade darker than your complexion and a contour brush. (Be careful not to use too much color.) And always remember to tap off the excess powder onto a tissue first. Makeup pro llana Harkavi, creator of the II Makiage makeup line, offers these technique tips.

To pick up droopy eyelids, add color to the lids from the outer corner to the center, then blend over the bone. Don't go higher than the crease.

To narrow the nose, apply color along the sides of the nose. but not directly onto the center

To lift cheekbones, use your fingers to locate your cheekbones, then brush on a few sweeps of shadow in a diagonal direction toward the tip of the ear at the hollow of your cheeks. The result is softer if you apply in light layers.

To camouflage a double chin, shade the area just below the chin, right under the jawline, but not on the neck. Move the brush from left to right.

To define the jawline, brush the color directly under me bone from the ear to the chin.

Bonus: The 5-Minute Face

When you're pressed for time (and most of us are), start with moisturizer. Then apply makeup with a sponge where needed. If you nave an uneven skin tone, use a compact foundation with a cream-to-powder finish to conceal problem spots. For a bit of high-pro glow, add a touch of bronzer like Nars Bronzer in Casino. Apply two sweeps around the perimeter of the face, then on the apples of the cheeks. Now add a coat of mascara to your lashes, and finish with your favorite lip color. Total time: 4 minutes, 30 seconds. Okay, you've got 30 seconds left to find your keys and be out the door.

For all your

dermalogica

needs visit dermaology.com, the provider for your skin care solutions.

COPYRIGHT 2005 Essence Communications, Inc.
COPYRIGHT 2005 Gale Group

Combination skin - Beauty - skin care - Brief Article

2006-02-18T06:30:00.000-08:00

Oily T-zone--nose, forehead and chin--with dry patches on the cheeks. In the summer, expect an even oilier T-zone. Sebaceous glands step up their oil production when it's hot.

what's new

At-home infusions that give skin a dose of vitamin C. We like Dr. Howard Murad Vitamin C Infusion System, a patented treatment that warms up the skin so the vessels dilate, allowing hydrating, anti-inflammatory and antioxidant properties to be absorbed better.

try ...

* Skin-care products especially designed for combination skin: Sundari Neem and Burdock Balancing Cream-Gel Cleanser and Neutrogena Anti-Wrinkle Anti-Blemish Lotion With SPF 15. Even some makeup products can help keep skin in balance, like Elizabeth Arden Skin Balancing Foundation.

* Spending a bit more time washing your T-zone. Don't scrub; make light circular motions with your fingers.

* Exfoliation, but using gentle formulations like Dermalogica Daily Microfoliant.
Using a light-to-medium-weight moisturizer.

* Using a water-based sunblock.

avoid ...

* Leaving cleanser on the face, which can strip both the oily and dry areas. Rinse at least twice after cleansing.

* Using rich and creamy sunblocks.

PROFESSIONAL TREATMENT

Claude Arty, a registered nurse and skin practitioner at Skinklinic in New York City, balances combination-skin types by alternating between beta-hydroxy acid peels and microdermabrasion treatments. The former lifts oil and debris from pores, while the latter removes -skin cells.

COPYRIGHT 2003 Essence Communications, Inc.
COPYRIGHT 2003 Gale Group

Find the best products and solutions at the best

dermalogica skin care

centre on the iNet.