Increasing absorption by abrasion

National report - A new technology that superficially abrades the stratum corneum is enhancing results of commonly performed procedures for facial rejuvenation, actinic keratosis, acne and more by increasing the skin's ability to absorb topical agents, including anesthesia.

Nathan Trookman, M.D., a dermatologist in Colorado Springs, Colo., has, for the most part, replaced the use of microdermabrasion with Vibraderm (Vibraderm). Like microdermabrasion, Vibraderm mechanically exfoliates the skin. The newer device, however, uses an exfoliating paddle with small, sharp blades. With high vibration frequency, the device polishes the top layer of the stratum corneum.

"It vibrates very quickly to help exfoliate, and the vibration helps reduce pain," Dr. Trookman says.

"Vibraderm is equal to two or three microdermabrasions for histologic depth, and that correlates to what we see clinically. From what I have seen, it is the best technology that we have available for removing the stratum corneum completely. It also avoids the mess of the crystals that get into people's eyes, ears, etc.," Dr. Trookman explains.

Absorption advantages

Vibraderm creates a vigorous exfoliation of the top layer of skin, resulting in an increased potential for the penetration and absorption of anesthetic and skin treatment compounds, Dr. Trookman says.

"When performing pulsed light, photofacials or acne treatments, we remove the top layer of stratum corneum, which allows the anesthesia to penetrate better and work faster and more efficiently," he says.

Dr. Trookman traditionally would have had photofacial patients sit for 30 minutes to an hour to allow for topical anesthetic absorption. The incubation period with the Vibraderm is less than half that time - at 10 minutes to 20 minutes.

"A setting on the Vibraderm, which is a diffusion paddle, allows us to push the anesthesia in deeper," he tells Dermatology Times.

The dermatologist also uses Vibraderm to aid in the absorption of Levulan (5-aminolevulinic acid, Dusa Pharmaceuticals) and says that he has cut incubation times in half using mechanical exfoliation.

"We increase our penetration of Levulan to accentuate and speed up our Levulan-pulsed light treatments or laser treatments for acne and rejuvenation," Dr. Trookman says.

He first takes off the top layer of the stratum corneum with Vibraderm, then applies the Levulan Kerastick, adding anesthesia on top to help with penetration and pain control. Dr. Trookman lets patients sit for about 20 minutes and then washes their skin to prepare for pulsed light or laser treatment.

Chemical peels net variable results

Dr. Trookman says that, while superficial chemical peels can also help increase penetration of topical medications, the approach is more technique-dependent than with mechanical exfoliation.

"When you put an acid on someone's face, you get different levels of exfoliation," he says.

Analyzing treatment approaches

In addition to using the technology for facial rejuvenation, Dr. Trookman says Vibraderm has significantly improved results from treatment of actinic keratoses and disseminated superficial actinic porokeratosis (DSAP).

He uses Vibraderm before applying Levulan, then uses blue light treatment.

While acne treatment is more efficient with Vibraderm, Dr. Trookman says young acne patients often get too much penetration of the Levulan, putting them at high risk for phototoxic reaction.

"Acne is one indication where we limit our Vibraderm usage," he says.

Dr. Trookman offers facial rejuvenation patients what he calls a power photofacial, where he exfoliates the skin with Vibraderm, then applies Levulan. Fifteen minutes after applying the Levulan and without taking it off, he applies a topical anesthetic. Another 15 minutes later, he removes both before performing IPL treatment.

Dr. Trookman says Vibraderm is ideal for patients coming in for repeat treatments. If the target is pigmentation, he might use the diffusion paddle to enhance the effects of hydroquinone. Alternatively, he might use a topical vitamin C for skin rejuvenation.