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Retinoids 101

What Are Retinoids?

A Retinoid is an umbrella term used to describe Vitamin A derivatives. Retinoids are powerful enough to improve overall skin texture, acne marks, discoloration, fine lines and wrinkles, as well as decrease oil production leading to less acne.

How Do Retinoids Work?

In simple terms, retinoids stimulate rapid cell renewal and turn over while also keeping pores free from blockage.

They slow the breakdown of collagen and thicken the deeper layer of skin where wrinkles start.

Retinoids also help improve uneven skin tones and brown spots.  It does this by sloughing them off and reducing melanin production.

Prescription vs Non-Prescription

What’s the difference between retinols you can buy in a department store and prescription Retin A?

Medical providers can prescribe Tretinoin (Retin A) which contains Retinoic Acid.  These formulations are only available by prescription and contain active ingredients.

Non-prescription “over the counter” products usually contain vitamin A derivatives such as retinol, retinyl palmitate, retinyl acetate, or retinyl linoleate.  The biggest difference between the two types are how they work at the cellular level.  Retinols are not active products and need to be converted into retinoic acid at the cellular level before they can work. The more steps that the Vitamin A derivative needs to take before it becomes the active retinoic acid, the less potent it becomes.  With any non-prescription strength product, it’s important to know what ingredient is being used, and how far it is from being activated.

The active Retinoic Acid product works quickly, but can be associated with more side effects.  At the end of the day, Retinols and Retinoic Acids are able to do the same thing, but it may take a lot longer to see results with retinols.

Lloyd Dermatology Center now offers more options of your topical medications available within our office.

Skin Basic offers medical grade cosmeceuticals (non-prescription retinol products)

How To Get Started?

If you are a newbie to Retinols/Retinoids, the trick is to start out slow! Your skin will tolerate the medication if you start out slow and build up your frequency of use.

Retinoids can cause some redness, dryness, and irritation in all skin types, regardless of being dry or oily.

*Only use your retinoid at night as they are deactivated by the sun.

Start out by using a small “Pea Size” amount, once or twice a week. (Monday, Thursday) If you are using it twice a week, space out your days. The goal is to work your way up to nightly usage, but it takes time to get there with prescription strength medications.

If you need to moisturize your skin with the use of retinoids

  1. Wash your face
  2. Apply your moisturizer
  3. Apply your topical retinoid.

*Lloyd Dermatology Center now dispenses more retinoid medications in office.

Retinols are often easier to tolerate on sensitive skin, and an individual can build up their frequency of use quicker with this non-prescription product. Retinols can still cause drying and irritation, so it is just as important to start out slow with usage and build up to every night.

*If you are not a patient at our office and want to find a retinol product that is right for your skin type, visit Skin Basic to discuss our non-prescription products.


FemiLift (FDA) – Dr. Madeline Tarrillion

U.S. Food and Drug Administration (FDA) Clearance of CO2 lasers:

Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy (VVA), is a condition affecting postmenopausal women, which usually includes vaginal dryness, burning, itching, irritation, urinary incontinence, dysuria (pain with urination) and dyspareunia (pain with sexual activity). Standard therapies include vaginal moisturizers, low dose topical estrogen, and selective estrogen receptor modulators. Patient compliance can be low due to numerous factors: cost, inconvenience, method of application, safety concerns, etc. Topical estrogen is currently considered the gold standard therapy for GSM; however, patients and providers are seeking out more affordable, convenient, durable, effective, non-hormonal management options.

For years the CO2 laser has been broadly used in the field of dermatology for the treatment of skin. The CO2 laser fractional micro-ablative technology has been shown to remodel the vaginal connective tissue with the production of new collagen and elastic fibers without tissue damage, which can improve the symptoms of GSM.

On July 30th, 2018, the FDA sent out a warning against the use of energy devices (laser therapy) to perform “vaginal rejuvenation” because of worries about adverse events. Typically, the term “vaginal rejuvenation” applies to procedures that are primarily for cosmetic purposes. “Vaginal Rejuvenation” procedures are elective without a clearly defined medical purpose.

The FemiLift/Pixel CO2 laser system along with the Focusing and Pixel handpieces are cleared by the FDA under K103501 for laser “ablation, vaporization, excision, incision, and coagulation of soft tissue in medical specialties including: aesthetic surgery (dermatology and plastic surgery), podiatry, gynecology, neurosurgery, orthopedics (soft tissue), arthroscopy (knee).”

CO2 lasers are FDA-cleared as safe to use; however, they are not specifically FDA-cleared for treatment of GSM. Throughout the medical literature, therapy using CO2 lasers has been documented as an appropriate and efficacious treatment for GSM; therefore, this is currently an “off-label” use of a device. Within medicine, there are many drugs and devices that have shown to have medical benefit for “off-label” uses. More than 20% of pharmaceutical prescriptions are filled for “off-label” conditions. In addition, “off-label” use of medications and devices has often led to FDA-approval of new therapies (including the most popular class of erectile dysfunction drugs, which were initially studied as a treatment for high blood pressure and chest pain).

In a large case series by Filippini et al, 386 menopausal women with GSM were treated with 3 sessions of fractional micro-ablative CO2 laser. There was resolution of dryness in 60%, vaginal burning in 56%, dyspareunia in 49%, itching in 56%, soreness in 73%, and vaginal introital pain in 49%. These effects were reported after the first session and continued for 1 year after the final session. Most studies report only “minimal” risks, and the procedure is performed in an outpatient setting. The articles mention that most women report some slight redness, swelling, and/or “some discomfort” that disappears within 1 to 2 days. Currently on RealSelf.com, the FemiLift CO2 Pixel laser has a “Worth It” rating of 93%.

Unlike vaginal estrogen, the CO2 laser has additional benefits such as treating lichen sclerosus, potentially removing the need for chronic high-potency topical steroid use. In addition, the CO2 laser has shown promise in the treatment of overactive bladder symptoms and stress urinary incontinence. CO2 laser could create a low-risk alternative to surgery for women seeking other treatment options.

A few additional factors to consider are the specific laser and the type of provider. CO2 lasers should not be confused with radiofrequency (RF) devices, in which the energy waves are less focused and can cause more collateral damage and potential side effects. Also, seek out treatment by a board-certified physician, who can provide a thorough consultation about the risks, benefits, and side effects of this procedure. Adverse events are more likely to occur if the procedure is done in a non-medical setting by providers without enough experience in laser use.

It is important to note that the criteria for FDA device clearance are much less stringent than for drug approval, and that the clearance for the CO2 laser was as described above and not specifically indicated for use in GSM. FDA device clearance does not require the large, double-blind, randomized, placebo-controlled trials with established efficacy and safety endpoints required for the approval of new drugs. We agree with the FDA that these devices need continuing/longitudinal studies, development of clear indications, appropriately informed patients, and skilled and ethical physicians to be used safely.

This is an important time for women’s health, which has been hindered in the past by hesitance to openly address women’s reproductive and sexual health concerns. We do not want this FDA statement to limit the availability of innovative therapies, which when used correctly may benefit women’s reproductive health.

The FDA should not equate “vaginal rejuvenation” cosmetic procedures with innovative therapies that may improve women’s quality of life. The FDA was right to be looking out for women’s health, but we hope that the warning does not scare or deter women from seeking information about alternative therapies that could potentially help.

https://www.health.harvard.edu/blog/fda-warning-on-vaginal-laser-procedures-should-emphasize-informed-choices-not-fear-2018080214405
https://www.npr.org/sections/health-shots/2018/08/13/638348014/despite-fda-caution-doctors-say-lasers-may-help-with-vaginal-pain-and-dryness
http://www.poynorhealthnewyork.com/laser-rejunvenation/
https://www.realself.com/femilift
https://www.medscape.com/viewarticle/846960
https://urology.stanford.edu/content/dam/sm/urology/JJimages/publications/CO2-Laser-Treatment-is-Effective-for-Symptoms-of-Vaginal-Atrophy-No.pdf
https://www.syracuse.com/health/index.ssf/2018/08/syracuse_docs_who_provide_vaginal_rejuvenation_say_treatment_safe_despite_fdas_w.html


Expanded In-Office Medications

What Is In-Office Dispensing? In-office dispensing is a convenient solution that allows our patients to fill their topical medications in our office, no need to go to the pharmacy or hassle with insurance. It allows our patients to obtain the appropriate medication that was requested by their provider immediately, without a substitution required by their insurance.

Why Are We Offering This Program? This program has been established first and foremost for our patient’s benefit and convenience. Due to insurance constraints, patients frequently cannot get the medication we prescribe for their dermatological conditions. Often our patient’s insurance will not cover the prescription at all, or it will require prior authorization for the patient to receive the medication at an extremely high cost. These issues often keep our patient from obtaining the medications they need to get better.

Our Medications: We’ve contracted with a FDA inspected U.S. based 503B facility to design customized medications.  All medications are produced using FDA approved National Drug Code ingredients.  They prepare these customized medications specifically for your skin condition.

How Do I Pick Up My Medication? The medication order will be sent electronically by your provider and will be sent to our “503B area” in Skin Basic.  There it will be filled immediately after your appointment. Payment for your medication will be separate from your office visit.

How Do I Pay For My Medication? Payment is accepted immediately following your appointment at check out.  This program does not allow us to bill the cost of the medication to your insurance; however, the cost is generally less than your copay. You may be able to submit the cost to your Health Savings Account for reimbursement or use your Flexible Spending Account (FSA).

Do I Have To Use This Service?  If the patient prefers, prescriptions can still be sent to your pharmacy and billed through your insurance. As always, you have the right tho choose where you wish to have us send your prescriptions.

What Times Can I Pick Up My Medications? Your medications can be picked up Monday through Friday from 8:00 AM to 5:00 PM.

 


Alternative Ways To Get That Healthy Glow!

Many people seem to want to maintain a “healthy glow,” especially during the summer months. Sunbathing and the use of indoor tanning beds not only significantly increase changes of skin cancer, but also accelerates the aging process. Damage to your skin cannot be undone, so here are some alternatives if you love the bronze look.

1. Spray Tanning: Spray tanning has come a long way from the days when it was one shade of orange. Now you have different options.
Spray tanning booths have different levels of colors with skin enhancing additives like moisturizers and fragrances. Personal airbrushing is performed by a technician and gives you a customized color, with expert level application.  The technician can help you choose your desired shade and can customize your solution based how fast you would like your tan to appear. Typically spray tans will last about one week and cost on average $20-$40.  This is a great option if you have an event or are going away for a few days.

There are also micro mist options “spray tan in a can” that can be applied at home on your own.  These products do not require rubbing in and have a much easier application process than most lotions.

 

 

2. Sunless Tanning Lotions: These lotions come in a variety of shades with different application options. Sunless lotions now range from personal foams, gels, lotions, and even in shower options.  If you want a more gradual tan try Jergen’s Natural Glow.  This is a daily moisturizer that will give you natural looking color over time. If you are looking for a natural 100% lotion, Skin Basic offers Jane Iredale Tantasia.

Jane Iredale Tantasia available at Skin Basic

Tantasia is a self tanner and bronzer with a light citrus scent that retails for $37.

 

 

 

Jane Iredale Bronzers and Golden Shimmer. 100% mineral makeup available at Skin Basic

3. Cosmetics: Bronzer and blush are two great ways to get a Sun-kissed glow daily. Depending on your skin tone, turning to a warm or cool toned palette will enhance your natural features. Warm pallets should be used on golden undertones, while cool pallets work best with pink undertones. Many companies also make enhancing drops, which can be added to your moisturizer or foundation to give you a Luminous glow, whether you are looking for a shimmer or a bronze glow.

Jane Iredale contour kits come in two shades. Each include a luminizer, bronzer, and blush ideal for a warm/cool skin tone. Contour kits retail at Skin Basic for $49.

 

 

 

 

 

 

Just as a friendly reminder…

With any of these options, you should still be applying sunscreen daily.  Having the appearance of darker skin will not protect you from the sun’s damaging rays.


Our Office

Lloyd Dermatology Center

8060 Market Street
Youngstown, OH 44512

Phone: 330.758.9189Fax: 330.758.4487

Office Hours:

Monday, Wednesday
8:00 a.m. – 5:00 p.m.

Tuesday
7:00 a.m. – 5:00 p.m

Thursday
7:00 a.m. – 5:45 p.m

Friday
7:00 a.m. – 5:00 p.m