There are many hair changes attributable to anticancer therapies. In approximately 65% of patients treated with chemotherapy and in up to 100% of areas treated with radiotherapy can lead to hair changes.

These can manifest as hair loss (alopecia), pigment changes, textural changes, and changes in hair cycle.

Hair Loss

Chemotherapy induced hair loss typically begins weeks after the first dose of chemotherapy and represents what is called an anagen effluvium, predominantly in areas of increased friction on the scalp. Eyebrows and eyelashes may also be affected. Usually asymptomatic, it can be associated with itch or pain. Two to six months after the chemotherapy has finished, the hair typically begins to regrow, although the hair loss can be persistent.

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For this holiday season, our clinic will be closed from December 24, 2020 to December 31, 2021, although we will continue to answer phones to book appointments during regular office hours.

The office will be completely closed from January 1 to January 3, 2021, and we will not be answering phones on those days. We will also be closed all statutory holidays and including Easter Monday. Thank you and have a great holiday season! See you in 2021!

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We have used oral minocycline for rosacea for decades. However, there are risks associated with oral minocycline, even though they are rare. A topical formulation of minocycline is being investigated for the management of rosacea by a company called Vyne Therapeutics. Two studies with a total of 1521 patients compared 1.5% topical minocycline foam versus vehicle and the foam appears to be effective, safe, and well-tolerated. This may provide a good alternative for rosacea sufferers looking to avoid oral medications.

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A phase 2b study  by Asana Biosciences regarding a novel new medication for moderate to severe chronic hand eczema has shown some encouraging results. The medication is called gusacitinib and is a dual JAK/SYK inhibitor. The study showed statistically significant improvements in chronic hand eczema severity compared to placebo. It had an acceptable safety profile and was well tolerated. The most common side effects were headache, nausea, nasopharyngitis, and upper respiratory tract infection. A phase 3 trial is being finalized.

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Cryomodulation and nanosecond pulsed electric field treatment are two new technologies for the treatment of benign lesions like seborrheic keratoses. Cryomodulation is a technique using cooling technology to treat sunspots and seborrheic keratoses. The first to market device is Glacial RX by R2 Technologies.

Another new technology is nanosecond pulsed electric field treatment, which is a nonthermal, energy based technology used to treat seborrheic keratoses and other conditions. It will be interesting to see how effective these two new technologies will be.

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A recent article in Dermatologic Surgery suggests that injectors (and patients) should be aware of the effects of needle size on the properties of fillers. Various types of fillers (monophasic and biphasic) were injected through 30G needles and the size and properties of the fillers were analyzed after they had been injected through the needles.  

Both monophasic (e.g. Juvederm products) and biphasic (e.g. Restylane) fillers were affected by the smaller needle size. They were affected in terms of the size of the extruded particles and in the properties (G’) of the extruded particles. Interestingly, biphasic fillers seemed to be affected more than monophasic fillers. In addition, larger particles seemed to be affected more than smaller particles as we would intuitively expect. 

Injectors should consider the size of the needle being used to inject fillers (especially biphasic fillers and fillers of larger particle size) as this might affect the performance and durability of the filler.

Reference: 

Soft Tissue Filler Properties Can Be Altered by a Small-Diameter Needle. Dermatol Surg 2020 Sep;46(9):1155-1162.

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Nuceiva is the newest neuromodulator on the market for the treatment of glabellar frown lines. Whereas Botox is referred to as abobotulinumtoxin A, Nuceiva is referred to as prabotulinumtoxin A.

Similar to other brands such as Botox, Xeomin, and Dysport, Nuceiva™ works to smooth out creases in the face by decreasing muscle contraction.

It has been approved by Health Canada and the FDA.

Marketed as Jeuveau by a company called Evolus in the United States, it originated with a South Korean company called Daewoong. Nuceiva™ was authorized for sale by Health Canada in August of 2019 and was subsequently officially brought to the Canadian market by Clarion Medical Technologies in October 2019. It is also available in the European Union.

Nuceiva™ usually lasts about 3 to 4 months although this varies from person to person. A study published in Dermatologic Surgery in 2019 showed similar efficacy to Botox.

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Bleach baths are a controversial therapy for patient with atopic eczema, also known as atopic dermatitis (AD). In recent years, there has been an increase in the use of bleach baths to decrease the severity of the eczema. However, a recent review showed that while bleach baths did seem to decrease the severity of atopic eczema, it was no more effective than water baths alone. There has been a lot of research into the effect of bleach baths on Staphylococcus bacteria and it seems like the concentration of bleach used in bleach baths may not be high enough to kill bacteria. There may be other anti-inflammatory properties that have yet to be discovered.

With all of the conflicting data out there, the best summation is probably what was stated in the latest Canadian consensus statement on pediatric atopic eczema: “bleach baths have not been consistently shown to improve outcomes in AD and may be used at the discretion of the treating health care provider.”

Reference:
Lansang P et al, Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis.

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Pulsed dye laser (PDL) is a very effective treatment for redness of the face due to enlarged blood vessels. It has proven to be very safe and effective. However, there is some discomfort from the laser pulses and while most patients have no difficulty tolerating treatment without any anesthetic, some patients do find it difficult to tolerate. Topical anesthetic can be used to decrease the discomfort of laser treatments but there has always been the question of whether the vasoconstrictive properties (i.e. constriction of blood vessels) of the anesthetic might have an adverse effect on outcome if you are trying to get rid of blood vessels.

A recent study by Chunharas et al in April of 2020 (Lasers Surg Med. 2020 Apr;52(4):307-314) demonstrates that topical anesthesia with lidocaine and tetracaine do not interfere with the efficacy of pulsed dye lasers. This is great news for those who want to receive treatments with pulsed dye lasers.

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Thank you for your patience! As Phase 2 is set to open on June 12, 2020, we are happy to announce that we are reopening as well! We have been following the Chief Medical Officer of Health instructions and have therefore not been able to see any of our patients since March 16, 2020, except for skin cancer patients and those with urgent needs.

We are happy to announce that we will be booking appointments for all those we had to cancel over the last few months, as well as accommodate those on our wait list. We look forward to see you back again! We thank you for your patience and understanding as we ourselves need to go through our phased approach to booking.

Sincerely,

Dr. Nakatsui

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Prabotulinumtoxin A

In 2002, Botox (onabotulinumtoxin A) was the first botulinum toxin to gain FDA approval for the “temporary treatment of glabellar lines in adults.”  A recent study published in Dermatologic Surgery reviewed two Phase 2 randomized, multicenter, double-blind, placebo controlled trials with 2100 patients showed that a new version called prabotulinumtoxin A had a similar onset of action, duration of action, and adverse event profile as compared to Botox. On the market currently, we have Botox, Dysport, and Xeomin for the treatment of lines and wrinkles. We may see another agent available soon.

 

References:

1. Dermatol Surg. 2019 Dec;45(12):1610-1619

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Temporary Closure

On Monday, March 16, 2020, the Nakatsui DermaSurgery Centre decided to take a leading initiative and temporarily close operations to help mitigate the spread of COVID-19. This was not an easy decision. In the end, we are confident that this was the best decision to protect our patients, our staff, and our community. We have stopped all non-essential services and are in the process of contacting patients who were scheduled to see us in the next two weeks to let them know what is happening. We will do our best to reschedule everyone as soon as possible once the situation improves. For our current patients who have more urgent medical needs, Dr. Nakatsui will make himself available to see you.

It is important to remember we should not panic as this infection will be well managed for the vast majority of those affected. However, we must assist our health care system by “flattening the curve” and preventing the exponential rise in COVID-19 and reducing the number of serious cases.

We will still be answering our phones and responding to emails for the time being. If you have any questions and concerns, please feel free to contact us at 780-482-1414 or via email at info@nakatsuiderm.com.

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