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Evaluation of the SilkPeel™ system in treating erythematotelangiectatic and papulopustular rosacea
Abstract
We present a study designed to evaluate the efficacy of the SilkPeel system in the treatment of erythematotelangiectatic and papulopustular rosacea. The SilkPeel system is an innovative form of microdermabrasion that exfoliates uniformly and simultaneously allows surface penetration of topical infusion agents, which optimizes therapy while maintaining structural integrity. Thirty qualified patients with erythematotelangiectatic or papulopustular rosacea as defined by the National Rosacea Society underwent SilkPeel treatments bimonthly for 12 weeks. Significant clinical reductions in erythema, papules, and pustules were noted as early as week 4 for all patients (P<.03).
... Dermal infusion allows maximal delivery of the agents for treating acne, pigmentation, aging, and rosacea. 2 For optimum results, and depending on the patient's skin condition, four to six treatments can be performed every 2 weeks, followed by monthly maintenance treatments. The treatment is safe and painless, and results are visible immediately as well as over time. ...
Dermal infusion can be tailored to the individual patient and can be used when conventional microdermabrasion is contraindicated Although traditional particulate microdermabrasion is widely used, health risks, including pulmonary inhalation and eye irritation, are areas of concern. The skin is abraded with a stream of crystals, such as aluminum oxide sapphire, that are delivered under pressure across the face to remove the upper dermal layer. Studies have shown that microdermabrasion is a superficial peel that can be repeated at 2-week intervals because the skin recovers histologically within 1 to 4 days. 1 Microdermabrasion works for many skin ailments, but it has its limitations. It is contraindicated in patients with active skin infections, such as flat warts, impetigo, and herpes simplex. Patients with malignant skin tumors involving keratoses or other specific keratoses, or those who have used isotretinoin within the past year, also should not be treated with microdermabrasion. 2 Enter dermal infusion, or "wet microdermabrasion," an innovative procedure that provides noninvasive exfoliation and delivers skin-specific topical solutions under pressure to treat such concerns as rosacea, dehydration, acne, and postinflammatory hyperpigmentation.
Skin resurfacing and rejuvenation techniques have experienced significant advances in the last few decades, and new devices are continuously being introduced into the marketplace. The large number of available modalities such as fractional lasers, radiofrequency systems, microdermabrasion, laser-assisted lipolysis, and ultrasound provides practitioners with a wide array of choices to address the needs of cosmetic patients. Many of the newer technologies, such as devices that integrate a fractional delivery system, provide excellent results with few adverse side effects. However, proper perioperative management is essential to achieving the desired effects. Furthermore, practitioners must be fluent with the operation and expected complications of these new technologies. While there are many overlapping treatment indications for each of the devices mentioned above, some modalities offer distinct advantages making proper patient selection essential. In certain cases, utilizing various combinations of mechanical, optic, acoustic, and electrical energies may be necessary to achieve the desired outcomes. This review discusses the application of new and existing skin rejuvenation techniques to clinical practice. A particular emphasis is placed on the use of fractional, radiofrequency, microdermabrasion, laser-assisted lipolysis, and ultrasound devices.
Despite its prevalence, rosacea has not received the same attention of researchers as other dermatologic disorders. Nevertheless, new pharmacologic and nonpharmacologic therapies for the condition continue to be developed. The future of rosacea treatment will probably involve a combination of drugs and devices. Certain core therapies (ie, topical metronidazole, topical azelaic acid, oral tetracyclines, and topical sulfur/sodium sulfacetamide) are validated by the greatest amount of high-order clinical evidence and will undoubtedly remain first-line therapeutic choices. However, more research is necessary to validate the efficacy and safety of newer pharmacologic agents and light-based therapy. Because rosacea is a chronic condition, pharmacologic maintenance therapy is necessary to maintain remission.
The ideal skin-resurfacing modality needs to be efficacious, reliable, and technically easy to use and must have minimal morbidity, patient risk for complications, and operator risk for disease exposure. At this early stage, microdermabrasion seems to fulfill all these requirements, fast becoming an alternative to glycolic acid and other superficial chemical peeling treatments. The technique also seems capable of being an adjunct to deeper techniques such as laser and deep chemical peels. As a superficial resurfacing technique, microdermabrasion has limited efficacy in treating deep wrinkles and thick scars, emphasizing the fact that no single treatment modality is appropriate for every skin problem. Nevertheless, microdermabrasion seems to have already established a solid position in the armamentarium of skin-resurfacing techniques.
Particle-beam resurfacing is a tool that is useful in the management of epidermal abnormalities of the skin, including fine lines and wrinkles, actinic damage, clogged pores, comedonal acne, and mild acne scarring. For the procedure to be economically viable for the physician, it should be incorporated into a skin treatment program that can be managed safely and effectively by an appropriately trained nurse, aesthetician, or physician's assistant. This technique should be used to treat only the epidermis, because aluminum hydroxide crystals can be deposited into the dermis if the stratum basale is violated.
Microdermabrasion is widely performed in a number of clinical settings, including medical offices, salons, and spas. This procedure is generally regarded as safe and easy to perform.
To determine if latex exposure caused an acute urticarial response following microdermabrasion in a latex-allergic patient.
The patient was prick tested to saline and histamine controls, latex, and sterile medical grade 100 m aluminum oxide crystals that had been passed through the microdermabrader.
The strongly positive latex prick test confirmed latex allergy in our patient. Negative prick testing to aluminum oxide crystals that had passed through the microdermabrader make it unlikely that the patient was exposed to latex via this system.
Physicians need to carefully evaluate patients who are considering microdermabrasion and appreciate that unexpected serious complications can occur.
Microdermabrasion is a simple, safe, office cosmetic procedure in which aluminum oxide crystals or other abrasive substances are blown onto the face, then vacuumed off, using a single handpiece. This procedure has rapidly become widely utilized for a variety of cosmetic objectives, including the improvement of photoaging, hyperpigmentation, acne, scars and stretch marks. Despite its widespread use, little is known about its actual mechanism of action. The few published studies suggest that patients and physicians alike report a mild benefit when microdermabrasion is utilized for photoaging. Histologic evaluation reveals little actual abrasion of the skin with the procedure, yet changes are seen in the dermis. Given the safety, simplicity and patient satisfaction associated with microdermabrasion, it is likely to remain a popular treatment.
A number of topical and systemic pharmacologic therapies, some of which remain investigational, have been used to treat rosacea. The pathophysiology of rosacea appears to be inflammatory, and most of the interventions modulate the inflammatory process in some way. Topical agents include various formulations of sodium sulfacetamide and sulfur, metronidazole, azelaic acid, and benzoyl peroxide/clindamycin. Oral agents include antibiotics in conventional and subantimicrobial doses. A paradigm shift in progress in the management of rosacea encompasses the use of these and other agents either alone or, increasingly, in different combinations, based on the subtype of rosacea.
Certain skin characteristics, such as altered vascular reactivity, appear to be common among patients with rosacea. This may partly explain the observation that these patients appear to have increased sensitivity to certain components of commonly used topical agents. Accordingly, patients with rosacea should be educated regarding which general skin care products to use and to avoid. This review summarizes information regarding 3 classes of these products--cleansers, moisturizers, and photoprotectants--with emphasis on barrier function and skin irritation.