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Cosmeceutical Botanicals

Summary and Key Features There are 1100 herbal ingredients used in topically applied products Secondary metabolites are small molecules from herbs that produce clinical activity Product development of herbal containing formulations is complex with less predictable functionality due to variations of environmental and processing factors Twenty-four herbs applied topically have induced fatalities The five largest selling herbs in the United States are Gingko biloba , St…

Physiologic Lipids for Barrier Repair

Summary and Key Features Many skin diseases are accompanied by abnormal skin barrier function Epidermal lipids are required for normal skin barrier function Physiologic lipids contribute to the pool of lipids delivered to the stratum corneum; nonphysiologic lipids do not penetrate beneath the stratum corneum, instead fully infiltrating the extracellular domains of the stratum corneum Both physiologic and nonphysiologic lipids, alone and in combination, can be…

Cosmeceutical Vitamins: Vitamin B

Summary and Key Features Niacinamide is a water-soluble, stable, low molecular weight vitamin that readily penetrates the stratum corneum. Niacinamide has been used topically in prevention of photodamage, reduction in acne, improvement in bullous pemphigoid, and treatment of rosacea and atopy. Panthenol or provitamin B5 is also known as pantothenol and pantothenyl alcohol. Panthenol has been used topically to treat wounds, bruises, scars, pressure and dermal…

Cosmeceutical Vitamins: Vitamin C

Summary and Key Features L-ascorbic acid is a water soluble antioxidant Vitamin C serves as a co-factor for the enzymes that synthesize collagen Topically applied vitamin C confers photoprotection Vitamin C inhibits tyrosinase and is an effective skin lightener Topical vitamin C rejuvenates photoaged skin Introduction Vitamin C is a naturally occurring antioxidant incorporated into cosmeceuticals for the purpose of preventing and treating sun-damaged skin. Most…

Retinoids

Summary and Key Features Retinoids are naturally occurring derivatives of betacarotene ascribed as vitamin A and its direct metabolites. Retinol has been studied extensively for topical treatment of photodamage and acne with currently marketed cosmetic products containing relatively low levels of retinol to a maximum of 0.08%. Oxidation of the alcohol group on retinol yields retinaldehyde, an intermediate form during the conversion of retinol to retinoic…

Evaluating Cosmeceutical Efficacy

Summary and Key Features Cosmeceutical formulations are tested through noninvasive techniques to insure consumer efficacy. Photography and image analysis are use to analyze surface texture and wrinkle improvement through the use of cosmeceuticals. Transepidermal water loss is a measure of the water leaving the skin to the atmosphere and can quantitated through the use of 2 humidity meters. Laser Doppler velocimetry can be used to assess…

Cosmeceutical Formulation Considerations

Summary and Key Features Delivery systems are intended to maximize performance and provide consumer-perceivable benefits with excellent aesthetic attributes to provide a unique feel and form. Successful delivery systems must consider pH, solubility, compatibility, stability, and preservation. Emulsions are the major delivery system and can be divided into two major forms to include oil-in-water and water-in-oil. Serums are thin liquids that can be clear, translucent or…

Cosmeceuticals : Function and the Skin Barrier

Summary and Key Features Stratum corneum (SC) is one of the largest organs of the body, protecting us against external environmental stresses to regulating water and heat and also serving as an immunological barrier While there is a host of different processes and functions that occur in skin, there are broadly five key processes for the formation and functioning of the SC SC structures range in…

The Future

Introduction This chapter is our vision for the way forward from gaps to goals . We first summarize the major gaps that exist in order to provide optimal care for HS patients. We then outline the journey to address these gaps and the programs and initiatives required to do this ( Fig. 35.1 ). Major Gaps to Address Now for Optimal Care of HS Patients in…

Pipeline Therapeutics

Introduction Since early 2000, there has been a dramatic increase in the number of publications and clinical trials devoted to moderate to severe hidradenitis suppurativa (HS). HS is a complex disease process in which a complete mechanism is still unknown. Recent data on pathogenesis are presented in earlier chapters, and a currently proposed model is presented in Fig. 34.1 . Drugs currently in the therapeutic pipeline…

Support Groups in Hidradenitis Suppurativa—Building a Community

Introduction Support groups are an invaluable tool to help individuals cope with a multitude of diseases, conditions, and phases in life. They are beneficial to patients as well as to family members and caregivers. Support groups can be in-person with scheduled meeting times for members to attend or online in the form of social media without time or geographic constraints. For a disease like hidradenitis suppurativa…

Building a Multidisciplinary Hidradenitis Suppurativa Clinic

Introduction Successful treatment of a patient with hidradenitis suppurativa (HS) requires a multidisciplinary approach. As such, establishing a multidisciplinary HS clinic is crucial to address this multifaceted disease. Having a basic treatment algorithm, expertise in the field, access to other specialties for referral, knowledge and access to the latest research, and quality improvement initiatives are all important in establishing a successful HS clinic. Treatment Algorithm Every…

Hidradenitis Suppurativa in Women

Introduction In many epidemiologic studies, hidradenitis suppurativa (HS) has been found to disproportionately affect women of childbearing age. Nearly three-quarters of new diagnoses are in women, with the highest incidence in female patients aged 30 to 39. Furthermore, the reported average annual incidence in the United States is 12.1 per 100,000 for women, which is more than twice that of men (5.1 per 100,000). Women may…

Skin of Color

Abbreviations used HS hidradenitis suppurativa IL interleukin Nd:YAG neodymium-doped yttrium-aluminum-garnet laser MetS metabolic syndrome IBD inflammatory bowel disease OR odds ratio SIR standardized incidence ratios QOL quality of life SD standard deviation SES socioeconomic status NAMCS National Ambulatory Medical Care NHAMCS National Hospital Ambulatory Medical Care Survey IPV intimate partner violence CD Crohn’s disease UC ulcerative colitis SCC squamous cell carcinoma US United States Prevalence of…

Pediatric Hidradenitis Suppurativa

Introduction Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle which affects apocrine gland-rich areas of the body. The disease usually presents after puberty, but it can, although uncommonly, also affect adolescents (onset after initiation of puberty, older than 10 to 12 years) and children. Typical clinical symptoms include painful, deep-seated, inflamed lesions (nodules, abscesses), tunnels, and scarring. In…

Complementary and Alternative Medicine

Introduction Hidradenitis suppurativa (HS) poses many challenges to patients, including delays in diagnosis, recurring pain, discomfort, and inadequate symptom coverage with conventional therapies. A survey study of 303 HS patients reported that half of HS patients using conventional therapies reported these methods as “not very successful.” As a result, many patients resort to complementary and alternative medicine (CAM) methods to treat and optimize their symptoms. The…

Lifestyle Modifications

Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with a profoundly negative impact on quality of life in patients with active disease. Many lifestyle factors are associated with disease incidence, severity, and exacerbation. This chapter addresses potentially modifiable lifestyle factors that may affect disease activity, including diet, obesity, tobacco use, and psychological stress. Diet Emerging evidence indicates that dietary modifications may be a viable adjunctive…

Hidradenitis Suppurativa—Other Procedural Treatments

Introduction The treatments for hidradenitis suppurativa (HS) can generally be divided into those with pharmacologic focus, and those that are procedural. For milder Hurley stage I disease, management is usually medication-focused, and designed to control or prevent the inflammatory events. For more severe disease, the physical signs of scars, acute or persistent abscesses, nodules, and sinus tracts may be accompanied by symptoms of ongoing or acute…

Laser and Light Treatments for Hidradenitis Suppurativa

Abbreviations: hidradenitis suppurativa (HS) carbon dioxide (CO 2 ) neodymium-doped yttrium aluminum garnet (Nd:YAG) Hidradenitis Suppurativa Clinical Response (HiSCR) Dermatology Life Quality Index (DLQI) photodynamic therapy (PDT) methyl aminolevulinate (MAL) 5-aminolevulinic acid (ALA) methylene blue (MB) Introduction In additional to traditional topical, medical, and surgical modalities, hidradenitis suppurativa (HS) can also be managed with laser and light-based treatments. These methods have the advantage of targeting affected…

Office-Based Excision for Hidradenitis Suppurativa: A Surgeon’s Decades-Long Experience

Introduction Every patient with hidradenitis suppurativa (HS) has a unique story to tell. All too often this story is a long one that includes numerous treatments, frustration, pain, and social embarrassment. By the time I see the patient, he or she has a skeptical feeling toward–if not frank distrust of–physicians. Fortunately for most patients, HS can be regionally cured if an adequate surgical excision is performed.…