Extraderm Plus Exfoliant 4 Skin Care
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This study was supported by OMP, Inc. Pariser received a grant from Obagi Medical Products, Inc. Spencer also received a research grant from Obagi Medical Products, Inc. Bruce has received honoraria from Obagi Medical Products, Inc. Parr is an employee of and owns stock in Obagi Medical Products, Inc. Gross has a clinical research facility within his private practice and was paid to do the research for this study. Multicenter, investigator-masked, randomized, parallel-group study.
Patients attending academic, institutional, and private dermatology clinics. The primary efficacy outcome was the incidence of treatment success for scar cosmesis, defined as a global assessment of excellent or good wound appearance on a scale of excellent, good, fair, and pooras evaluated by the investigators. After the end of the study, seven expert masked graders dermatologists or plastic surgeons reviewed the photographs from all of the lesions and extraderm plus exfoliant 4 evaluated global assessment.
Electrodesiccation and curettage EDC is commonly used to treat superficial basal cell carcinomas BCCsbut the resulting scars can be aesthetically unpleasing and a major disadvantage of this procedure. Each lesion was required to be at least 10cm away from any other lesion.
Patients were required to use a sunscreen on the wound site each day and be willing to refrain from using any other topical products on the wound site. Women of childbearing potential were required to use a reliable method of birth control for one month before starting the study and continue use throughout the study. Exclusion criteria included an allergy to hydroquinone, tretinoin, sunscreen, or other ingredients in the treatment regimens; a history or family history of vitiligo, or keloidal or hypertrophic scarring; uncontrolled systemic disease or insulin-dependent diabetes; immunological disorders; pregnancy, breastfeeding, or trying to become pregnant; or participation in an investigational study in the preceding 30 days.
The following washout periods were required: The study was approved by the relevant institutional review boards and was conducted in accordance with the Declaration of Helsinki and its amendments. All patients gave signed informed consent. Patients were randomly assigned 1: Each regimen was used for three weeks before and after EDC, with the post-EDC therapy beginning only once a lesion had reached greater than or equal to 75 percent re-epithelialization. For at least two weeks after EDC, until such time as greater than or equal to 75 percent reepithelialization was achieved, lesions in both groups received only twice-daily applications of cleanser and healing ointment.
Patients were extraderm plus exfoliant 4 to apply sufficient amounts of the study products to fully cover each lesion plus an additional 0. To maintain blinding, the investigators were not involved in dispensing or collecting the study products.
After the end of the study, seven expert graders dermatologists or plastic surgeons reviewed the photographs from all the lesions, while masked as to treatment identity, and evaluated global assessment using the same extraderm plus exfoliant 4 as the investigators. An a-level of 0. Both discontinuations were unrelated to study treatment and occurred in the group receiving standard treatment—malaise 1 patient and voluntary withdrawal 1 patient.
The patients were a mean of 56 years old and 55 percent were male. Both groups were comparable in terms of demographic details at baseline. The results from five of the seven expert graders showed a significant between-group difference in the incidence of treatment success with the P value ranging between 0.
With this overall analysis, the between-group difference was not statistically significant. All lesions for which extraderm plus exfoliant 4 were available immediately post-EDC and three weeks after the post-EDC resumption of treatment are shown in Figure 4. At three weeks post-resumption of treatment, the percent of lesions that had no or mild distortion i.
The mean lesion diameter three weeks after the post-EDC resumption of treatment was greater than before EDC in both groups. Both treatment regimens were similarly well tolerated with no significant extraderm plus exfoliant 4 differences in the incidence of adverse events overall or in the incidence of individual adverse events.
There was some variability in the scores reported by the different expert graders extraderm plus exfoliant 4 though they each reviewed an identical set of photographs. This is likely to be at least partly attributable to differences in clinical judgment and perhaps to difficulties in making an accurate assessment from a two-dimensional image.
The provision of standardized photographic guides depicting each grade on the global assessment scale, together with pre-evaluation training of the graders, might be considered in extraderm plus exfoliant 4 studies extraderm plus exfoliant 4 one extraderm plus exfoliant 4 to potentially improve between-grader scoring consistency.
With both regimens, the incidences of treatment success extraderm plus exfoliant 4 by the investigators, and by the individual expert graders, were higher than those calculated in the overall analysis of expert grader results on an individual lesion basis. This is because the overall analysis effectively sets a higher threshold for treatment extraderm plus exfoliant 4 than the extraderm plus exfoliant 4 evaluations.
In contrast, in the overall analysis, each individual lesion is considered to have achieved treatment success only if the mean scores from all the expert graders were excellent or good. The overall analysis therefore offers an alternative means of analyzing the results, which takes into account the variability in scoring between the expert graders.
The appearance of the lesions at the end of the study varied greatly between different lesions. While some of this is likely due to inevitable inter-individual differences, some of the variation might also have been attributable to differences in surgical technique between the study sites. Distortion results from a puckering of the skin around the edge of the wound—as if a purse string is being tightened around it—and may result in a less-than-perfect aesthetic outcome.
Wound elevation is generally believed to contribute to poor cosmetic outcomes of scars as well as hypertrophic scarring. To evaluate this further, it may be extraderm plus exfoliant 4 in future research to include an assessment of wound-edge elevation.
In addition, longer-term evaluations might be considered to evaluate how the improvements in scar cosmesis observed in this study progress over the ensuing weeks and months. The major limitation of EDC is commonly held to be wound cosmesis. Similarly, any treatment that is effective in improving post-EDC wound cosmesis might also have clinical utility in improving the appearance of lesser wounds from other treatment modalities—so any approach that helps avoid scar formation post-EDC could have wider applications beyond EDC.
Nevertheless, there is ample evidence available to support the scientific rationale of using tretinoin and hydroquinone to ameliorate hyperpigmentation. A potential benefit of the treatment they received, or could elect to continue to receive, is the possibility of improved cosmesis of their biopsy scar.
It is likely that tretinoin and hydroquinone both play a role in this—as tretinoin enhances wound healing and reduces dyspigmentation, and hydroquinone extraderm plus exfoliant 4 skin coloration and minimizes dyspigmentation. Accessed January 14, A clinical, prospective, randomized, double-blind trial comparing skin whitening complex with hydroquinone vs.
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Flattening of atrophic acne scars by using tretinoin by iontophoresis. Tretinoin in the preoperative and postoperative management of dermabrasion. J Am Acad Dermatol. Tretinoin accelerates healing after trichloroacetic acid chemical peel. Pretreatment of photoaged forearm skin with topical tretinoin accelerates healing of full-thickness wounds.
New quantitative scale for clinical scar assessment. Novel opportunities in the treatment and prevention of scarring. J Cutan Med Surg. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Topical treatments for hypertrophic scars. Tretinoin microsphere gel 0. Etiologic and therapeutic considerations. Enhancement of the depigmenting effect of hydroquinone and 4-hydroxyanisole by all-trans-retinoic acid tretinoin: Management of facial hyperpigmentation.
Usefulness of retinoic acid in the treatment of melasma. Ackowledgments We gratefully acknowledge the participation of the late Robert Loss, MD, as an investigator in this study. We also thank the masked extraderm plus exfoliant 4 graders who evaluated the photographs: Click here to access. September MauiDerm Supplement: Updates on Psoriasis and Cutaneous Oncology. Subscribe If you enjoyed this article, subscribe to receive more just like it. We never share your info.
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