The toxic edge—A novel treatment for refractory erythema and flushing of rosacea

Friedman, Or; Koren, Amir; Niv, Roni; Mehrabi, Joseph N; Artzi, Ofir

doi:10.1002/lsm.23023

Cited by 37 publications

(68 citation statements)

References 49 publications

(73 reference statements)

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“…These effects allow the penetration of topically applied Botulinium toxin into the skin through the stratum corneum. This system has already been demonstrated to significantly increase the permeability of a couple of topically applied medications including, lidocaine (Sintov & Brandys‐Sitton, ) and as proved by Friedman et al also Botulinium toxin (which was used in severe cases of rosacea; Friedman et al, ).…”

Section: Discussionmentioning

confidence: 92%

“…This effect and the subsequent decrease of microorganism colonization might serve as one explanation for its efficacy in the treatment of Hailey–Hailey disease (Benohanian, ). Botulinum toxin cannot cross the stratum corneum, therefore, its injection is required for both the treatment of hyperhidrosis (de Almeida & Montagner, ; Glaser & Galperin, ) and for the treatment of Hailey–Hailey disease (Charlton et al, ; Friedman et al, ; Kothapalli & Caccetta, ; Lapiere et al, ). It is an effective treatment but a painful, expensive, and the duration effects is for several months only.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with botulinum toxin was first described in 2000 (Lapiere, Hirsh, Gordon, Cook, & Montalvo, ) with promising, several months lasting, results (Charlton, Stewart, & Rosen, ; Friedman, Koren, Niv, Mehrabi, & Artzi, ; Kothapalli & Caccetta, ). The main disadvantages of this treatment are the high cost of the toxin and the excruciating pain as well as the risk of infections due to the numerous needle punctures.…”

Section: Introductionmentioning

confidence: 99%

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An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey–Hailey disease

Bar‐Ilan

Koren

Shehadeh

et al. 2019

Dermatologic Therapy

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Successful treatment of Hailey-Hailey disease with intradermal botulinum toxininjections has been previously reported. The main disadvantages of this treatment are the excruciating pain and the risk of infections due to the numerous injections.We sought to evaluate the clinical effectiveness and safety profile of a novel approach using an energy-based device (Tixel, Novoxel, and Israel), followed by the topical application of botulinum toxin Type A for the treatment of Hailey-Hailey disease. A retrospective study of all cases of histologically diagnosed cases of Hailey-Hailey disease treated with Tixel device followed by topical application of botulinum toxin between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. The study included eight patients, of whom seven patients (87.5%) showed good or partial response. No systemic or local adverse effects were reported. There was no difference in effectivity between different body areas. Response to treatment ranged between patients with an average duration of 7.125 months after the second treatment. Tixel treatment followed by topical application of botulinum toxin can be considered in the treatment of Hailey-Hailey disease. This approach is less invasive, less painful, and yet effective as well as safe.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey–Hailey disease

Bar‐Ilan

Koren

Shehadeh

et al. 2019

Dermatologic Therapy

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“…Besides skin ablation, TMA causing a low‐energy thermal decomposition of the stratum corneum can enhance the transepidermal penetration of substances 6; recently proved for botulinum toxin and 5‐amino‐levulinic‐acid 12,13. These findings, showing an increased permeability of the epidermis after TMA, could maybe be extrapolated for aesthetic applications, like platelet‐rich‐plasma treatments.…”

Section: Discussionmentioning

confidence: 93%

Wound Healing Process After Thermomechanical Skin Ablation

Kokolakis

Grawert

Ulrich³

et al. 2020

Lasers Surg Med

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Background and Objectives Energy‐based devices have been widely applied for skin ablation. A novel ablation technique based on thermomechanical principles (Tixel©) has been recently developed. The aim of this study was to examine the wound‐healing process and clinical aspects after thermomechanical skin ablation. Study Design/Materials and Methods Six female participants were treated with Tixel© on healthy skin of the dorsal side of the right forearm in a single session with a 600 µm protrusion and 12 milliseconds pulse. The treated area was examined with confocal laser scanning microscopy on day 1, 2, 7, and 14 after treatment. Clinical symptoms were evaluated at the same time‐points. Results All patients developed erythema and mild edema on the treated areas, which completely disappeared within 14 days. No post‐inflammatory hyperpigmentation or scarring was observed. Thermomechanical skin ablation resulted in the formation of homogeneous micro‐ablation zones. Two weeks after ablation, the honeycomb patterns of the epidermis in all examined layers was thoroughly restored. Thus, wound‐healing was completed. Conclusions Wound healing after thermomechanical skin ablation is much faster compared with other fractionated ablation methods. Treatment intervals of 2–4 weeks could be recommended. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

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“…This study further substantiates the evidence introduced by earlier studies of low‐energy TMFI pretreatments for PDD. Friedman et al reported treatment of rosacea with botulinum toxin following TMFI pretreatment, and Sintov et al described the permeation of several hydrophilic molecules after TMFI pretreatment in an ex vivo study.…”

Section: Discussionmentioning

confidence: 99%

A New Method for Percutaneous Drug Delivery by Thermo‐Mechanical Fractional Injury

Shavit¹,

Dierickx²

2019

Lasers Surg Med

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Background and Objectives: Percutaneous drug delivery (PDD) is a means of increasing the uptake of topically applied agents into the skin. Successful delivery of a photosensitizer into the skin is an important factor for effective photodynamic therapy. To evaluate the efficacy of pretreatment by thermomechanical fractional injury (TMFI) (Tixel ® , Novoxel ® , Israel) at low-energy settings in increasing the permeability of the skin to a known hydrophilic-photosensitizer medication, 5-amino-levulinic-acid hydrochloride (ALA) in compounded 20% ALA gel. To compare the effect of TMFI on ALA permeation into the skin in compounded gel to three commercial photosensitizing medications in different vehicles: ALA microemulsion gel, methyl-amino-levulinic-acid hydrochloride (MAL) cream, and ALA hydroalcoholic solution. Study Design/Materials and Methods: Five healthy subjects were treated in two separate experiments and on a total of 136 test sites, with four topical photosensitizer preparations as follows: compounded 20% ALA gel prepared in a good manufacturing practice (GMP)certified pharmacy (Super-Pharm Professional, Israel), 10% ALA microemulsion gel (Ameluz ® , Biofrontera Bioscience GmbH, Leverkusen, Germany), 16.8% MAL cream (Metvix ® , Galderma, Lausanne, Switzerland), and 20% ALA hydroalcoholic solution (Levulan Kerastick ® , DUSA Pharmaceuticals, Inc., Wilmington, MA, USA). The dermal sites were pretreated by Tixel ® (Novoxel ® Ltd., Israel) prior to topical drug application. One site was untreated to serve as control. Protoporphyrin IX (PpIX) fluorescence intensity readouts were taken immediately and 1, 2, 3, 4, and 5 hours posttreatment. Results: The highest average PpIX fluorescence intensity measurements were obtained for the compounded 20% ALA gel following pre-treatment by TMFI at 6 milliseconds pulse duration. After 2 and 3 hours, TMFI-treated sites exhibited an increased hourly rate in readouts of FluoDerm units, which were 156-176% higher than the control rates (P ≤ 0.004). TMFI pre-treatment did not enhance the percutaneous permeation of either ALA or MAL following the microemulsion gel, hydroalcoholic solution, and cream applications. Conclusions: Pretreatment with low-energy TMFI at a pulse duration of 6 milliseconds increased the percutaneous permeation of ALA linearly over the first 5 hours from application when the compounded 20% ALA gel was used. Formulation characteristics have substantial influence on the ability of TMFI pretreatment to significantly increase the percutaneous permeation of ALA and MAL. Lasers Surg. Med.

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The toxic edge—A novel treatment for refractory erythema and flushing of rosacea

Cited by 37 publications

References 49 publications

An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey–Hailey disease

An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey–Hailey disease

Wound Healing Process After Thermomechanical Skin Ablation

A New Method for Percutaneous Drug Delivery by Thermo‐Mechanical Fractional Injury

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