In her lecture on controversies in cosmetics, Heather Woodworth Goff, MD, MPH, said diseases dermatologists treat are rare and for which there are few, if any, FDA approved treatments for patients. She believes these circumstances perhaps allow those who practice dermatology to be more comfortable exploring and discovering new options for treatments for patients. Dr. Goff listed numerous “rules” dermatology providers have been given for their practice noting that you can break most of these so-called “rules.”
The first “rule” Dr. Goff approached was that filler cannot be used in patients with connective tissue disease. She points out that this is controversial and based on the idea that inflamed tissue may propagate an inflammatory response in these patients. She used an example of a patient with morphea on the face. This patient was treated with hyaluronic acid (HA) filler in the areas of morphea without any adverse effect. When treating morphea patients with fillers, she recommended using a standard first-generation HA filler. As this is off label treatment, these patients need to be properly educated, counseled and consent needs to be obtained. Dr. Goff also highlighted the use of onabotulinumtoxinA in use with scleroderma patients. In a study which is soon to be published in JAAD, injection of onabotulinumtoxinA in scleroderma patients helped with the oral aperture of these patients. She also reviewed use of autologous fat grafting for the digits in a scleroderma patient.
Another controversial rule Dr. Groff discussed was the avoidance of resurfacing in patients taking isotretinoin within the past six months. In researching this subject, she noted the majority of the information on the subject was based on studies from lasers used in the 1980s and 1990s. These lasers were much more destructive than lasers used now. A new consensus article in JAMA DERM revealed there is insufficient evidence to delay laser hair removal, fractional ablation and nonablative laser procedures in patients with use of isotretinoin within the last six months. The avoidance of retinoids in patients with rosacea was the next rule Dr. Goff debunked. These patients can use retinoids, they are not contraindicated, though patients should be counseled that their rosacea may flare in the beginning of treatment and they must use sun protection. Dr. Goff is a big supporter of retinoids as a tool for patients and encourages that if a patient doesn’t respond well to one retinoid, to try an alternate formulation. Additional topics of discussion included the use of different modalities for the treatment of striae.
Byline: Sarah B.W. Patton, MSHS, PA-C
Pictured: Heather Woodworth Goff, MD, MPH