Pigmentary problems are common and include post-inflammatory hyperpigmentation, hipopigmentation, dyschromia and melasma. Yet the threat of a ban from the FDA in 2006 put a cloud over the agent widely considered in the U.S. to be the gold standard for treatment of these skin problems — hydroquinone.

The proposed ban of its over-the-counter sales was based on controversial murine models suggesting that hydroquinone could act as a carcinogen, along with reports, also controversial, linking the product with exogenous ochronosis. The FDA’s action was met with strong opposition from the largest user of hydroquinone, the aesthetic dermatologic community, which was adamant in its assertion of the product’s safety, and, after the four-month period of public comment, no regulatory action was taken.

But the issue was never officially put to bed, and with hydroquinone bans currently on in the European Union, Japan and Australia, doctors and patients alike may be justified in wondering if hydroquinone remains on borrowed time in the U.S.

These bans on hydroquinone have prompted research into botanicals and other agents, including kojic acid, arbutin, mequinol and azelaic acid, as alternatives for treating skin pigmentation. So far, however, no blockbuster treatments have emerged.

Laser treatments offer a very good alternative to the drug solution. Many pigmented lesions can be safely and successfully removed even on dark-skin individuals. It is also important to realize that some of the pigmentation complications after a laser surgery or laser treatment may have been avoided if the right laser modality was used in the first place.

Cynosure has a new machine for the American Academy of Dermatology’s 67th Annual Meeting in San Francisco – Elite MPX for its Smartlipo MPX laser lipolysis workstation.

Through the company’s patented MultiPlex(TM) technology, Elite MPX combines two wavelengths — 755nm Alexandrite and 1064 nmNd:YAG – along with Xenon Pulsed Light (XPL2) technology to create one of the industry’s most powerful workstations for vascular treatment, hair removal and skin rejuvenation. In addition, Cynosure is introducing two new intelligent delivery systems for the Smartlipo MPX workstation for laser lipolysis: SmartSense with ThermaGuide and ThermaView, the world’s first subcutaneous temperature sensing technology and thermal imaging system for Laser Body Contouring.

Elite MPX incorporates Cynosure’s proprietary MultiPlex technology, which sequentially fires two wavelengths for more effective treatments than single-wavelength systems. A completely new software system runs the graphically enhanced Graphic User Interface, which makes its operation simple and easy.

The workstation also features a built-in Zimmer SmartCool(R) skin cooling system that is exclusive to Cynosure. Rather than requiring a separate SmartCool device, Zimmer technology is integrated into a single compact module, saving precious office space and reducing treatment time. In addition, the Elite MPX includes eight different spot sizes, including an 18mm spot size that results in 44% more treatment area per pulse than standard spot sizes.

“Cynosure’s Elite MPX is a powerful and versatile system that enables clinicians to customize treatments for a broad range of skin types and conditions, including sun-damaged skin, pigmented lesions, dyschromia and rosacea,” said Emil Tanghetti, M.D., Clinical Professor of Dermatology at the University of California, Davis and Director of The Center for Dermatology and Laser Surgery, Sacramento, California. “As practitioners, we are seeing a growing cultural diversity within our patient base, and I expect the Elite MPX will provide benefits across the spectrum of applications for these patients.”

According to InMedica, the worldwide demand for hair removal, pigmented lesion removal and vascular lesion removal is expected to increase from $650 million in 2007 to $750 million by 2010.

SmartSense with ThermaGuideis equipped with a thermal sensing cannula for measuring temperatures in the subcutaneous areas of the body. This technology allows the practitioner to set temperature thresholds to achieve targeted and controlled energy delivery for a safe and optimal clinical endpoint.

The ThermaView thermal camera system measures skin surface temperature and provides a visual map of temperatures within the treatment area in order to provide a homogeneous delivery of thermal energy. This intelligence is integrated into the Smartlipo MPX system. As a result, thermal energy is delivered to a targeted temperature setting, helping to ensure the safe and effective treatment of the superficial layer of the surface area.

LaserOffers.com comment

Many people will call these advances bells and whistles. We disagree. Cynosure has come up with a lot of real technological advances rolling out this system. High capacity, large volume clinics will benefit from it, if they can afford it. All it takes to get your money back is a few hundred patients a month. Every month.

Photoaging could be induced by accumulated DNA damage on skin cells. Photoaged skin has such characteristics as a nodular leathery surface with fine and coarse wrinkles, blotches and yellowing, dryness, teleangiectasia, and skin cancer formation. For this condition, chemical peeling, iontophoresis, laser and phototherapy are used with some improvement, especially in wrinkles and pigmentary uniformity.

The actual mechanisms of these treatments on photoaging continue to be actively studied. Glycolic acid may act on skin cells via keratinocytes and activate the cytokine network, which results in the remodeling of tissue construct and elimination of pigment. Heat generated by non-ablative laser or phototherapy might induce heat shock proteins which induce new collagen formation, and eliminate oxidized abnormal materials. This type of research is expected to disclose the cellular and molecular mechanisms of photoaging, and to lead to the establishment of further effective photoaging treatment.

Keywords: photoaging, cosmetic dermatology, chemical peeling, glycolic acid, skin rejuvenation, non-ablative laser, Intense pulsed light (IPL), heat shock protein (hsp), matrix metalloproteinase (MMP), thermal stimulation, advanced glycation end products (AGE), oxidative stress

Source: International Journal of Cosmetic Science, Volume 31, Number 1, February 2009 , pp. 75-75(1)