Cosmetic Self Care and prescription products (3)

Question 1

What is photoaging

Answer 1

Photoaging is the premature aging of skin caused by repeated exposure to ultraviolet radiation (UV) - from the sun or from artificial sources

This is different from natural skin aging process which occurs over time - the UV rays have damaging effects

Characteristics:
-premature wrinkles and loss of firmness
-thickening of epidermis in irregular pattern
-uneven skin pigmentation
-age spots
-dilated “spider” blood vessels on skin
-possible development of skin tumors (both benign and malignant)

Question 2

Management of photoaging (goal and 5 options)

Answer 2

The goal is to reduce visible effects of sun induced skin damage and protect the skin from further damage

Options:
-non pharmacological prevention
-topical retinoids (OTC: retinol, retinyl palmitate, RX: retinoic acid (isotretinoin), tretinoin, tazarotene)
-keratolytics (AHAs, BHAs, polyhydroxy acid)
-antioxidants (vitamin C, vitamin E, coenzyme q10)
-hydroquinone

Question 3

Non pharmacologic photoaging prevention strategies

Answer 3

Daily sun protection
-avoid exposure, use SPF 30+

Physical and emotional healthy lifestyle
-physical activity, sufficient sleep, balanced diet, adequate hydration, healthy mental and emotional state

Skin care
-cleansing, hydration, moisturizer

Things to avoid…
-sleeping on back
-excessive exaggerated facial expressions
-abrupt changes in weight
-smoking

Question 4

Topical retinoids counseling points

Answer 4

They require regular use - the effects are gradual and may take several months

Initially cause dryness and slight scaling (2 weeks-3 months)
-less with cream formulation vs gel
-use daily moisturizer to help
-if intolerable use every other night alternating with moisturizer

Initial redness and mild stinging may also occur…
-can decrease frequency if intolerable

Phototoxicity (increased risk of sunburn with these agents)
-must use sunscreen SPF 30+

Teratogenic - cannot be used in pregnancy

Question 5

What to topical retinoids do/how do they work?

Answer 5

These boost cell turnover - improve signs of photoaging and chronological aging
-Make skin smoother and thicker, lighten age spots

Question 6

What do keratolytic agents do/how do they work?

Answer 6

These exfoliate (peel off) the top layer of dead skin - results in smoother, non scaly skin - lessening fine lines and normalizing pigmentation

(BHAs, AHAs, polyhydroxy acid)

Question 7

Alpha hydroxy acids (AHAs) (products and ADRs)

Answer 7

common forms in cosmetic products: glycolic acid, lactic acid, citric acid, malic acid

ADRs: dryness and skin irritation (which is worse if used with other topicals like retinoids)

Question 8

Beta hydroxy acids (BHAs)

Answer 8

Common product: salicylic acid

More lipid soluble than AHAs so they can penetrate deeper into the skin and have a greater keratolytic effect

ADR - skin irritation - start slow (every other night) and gradually increase frequency as tolerated

Question 9

Polyhydroxy acid (use)

Answer 9

Similar to AHAs, but they cause less irritation, so they may be useful as mild exfoliants

(lactobionic acid, galactose, and gluconolactone)

Question 10

Vitamin C

Answer 10

Antioxidant protects against photoaging
Mild adrs (redness, itching, irritation, tingling) - good recommendation for someone just starting off or for prevention

Question 11

Hydroquinone

Answer 11

Depigmenting agent
-used for people with vitiligo and age spots (“liver spots”)
-can be used alone or with retinoic acid

Spots may gradually fade over several months of use

Works by suppressing melanocyte metabolic processes

●AEs: Allergic skin reaction, dermatitis, erythema, inflammation, stinging of the skin, xeroderma

Question 12

Androgenetic alopecia

Answer 12

most common form of gradual onset gender specific hair loss
(aka male pattern baldness in men)

In AGA the hair follicle undergoes a stepwise change in growth - the anagen phase (active growth phase) becomes shorter and the telogen phase (resting phase) becomes longer
-telogen hairs undergo increased shedding and are replaced by shorter, finer hairs
-catagen phase (when hair stops growing and becomes detached) lengthens - decreasing number of hairs

Question 13

Which product is the only FDA approved product for self treatment of AGA?

Answer 13

Minoxidil (Rogaine)

(MOA: increases cutaneous blood flow, promotes and maintains vascularization of hair follicles, directly stimulates follicular hypertrophy, and prolongs the anagen phase.)

Question 14

Minoxidil (Rogaine) patient education

Answer 14

Hair loss may continue during first few weeks of use
May take up to 4-6 months to see results
Must be used continuously and indefinitely to maintain regrowth

AEs: localy erythema, pruritus
Rare - chest pain, dizziness, changes in vision

Question 15

Exclusions for hair loss self care

Answer 15

-Under 18
-Pregnant, breastfeeding, or post partum hair loss
-Hair loss with no family history of it
-Hair loss with positive hair-pull test
-Hair loss related to history of endocrine dysfunction, medical treatments, and dietary deficiencies
-sudden or patchy hair loss
-evidence of fever/inflammation (3-6 months before hair loss begins)
-skin lesions that indicate autoimmune disorder or infection
-scaling, sunburn, or other damage to scalp
-broken off hair shafts that resemble fungal infection
-loss of eyebrows/eyelashes
-nail abnormalities
-women with sudden or severe hair loss

Question 16

What is onychoschizia

Answer 16

Splitting of the finger nails (brittle nails)
Common problem especially in women

Question 17

Onychoschizia treatment

Answer 17

Best treatment is to apply lotions containing alpha hydroxy acids or lanolin

Some patients may take Biotin vitamins (but there is no proven data for efficacy with these)

Nuvail (polyureaurethane 16%) - prescription product for nail dystrophy - clear liquid painted onto nails once daily at bedtime
(mild adrs - irritation, stinging)

Question 18

What is the only FDA approved product for thinning eyelashes?

Answer 18

Bimatoprost (Latisse)
-decreases intraocular pressure and increases the percent and duration of eyelash hairs
(used for glaucoma since it decreases IOP under different brand)

Question 19

Bimatoprost (Latisse) counseling points

Answer 19

Remove makeup and contact lenses before applying

Place 1 drop on applicator and apply along eyelid above upper eyelashes. Use new applicator for each eye.

Blot excess solution away with tissue

Use constituently once daily.
Full results seen in 16 weeks.

ADRs: Conjunctival hyperemia, erythema of eyelid, itching, hypertrichosis of eyelid, and other ophthalmic adverse effects,

Question 20

What is the only FDA approved prescription treatment for wrinkles?

Answer 20

Botox (onabotulinumtoxin A)

Question 21

Botox use/administration points

Answer 21

Injected into facial muscles
Temporarily and reversibly relaxes the signals that cause facial muscles to contract (so results don’t last long)

Takes 30 days to see full effect, and lasts up to 4 months

In some states pharmacists can administer this injection (not in PA)

●AEs: pain or swelling at injection site, droopy eyelids, crooked smile, flu-like symptoms

Question 22

Skin cancer considerations

Answer 22

If we see signs of skin cancer - the patient must be referred

3 types;

Squamous cell carcinoma
-firm flesh colored or red papules or plaques
-can occur in elderly

Basal cell carcinoma
-pigmented nodule on head and neck
-very common

Malignant melanoma
-presents as changing mole (asymmetric, irregular borders, variegated colors and size)
-Can produce systemic metastases unless detected early and excised