Physicians can give patients the best of all worlds by combining therapeutic modalities like light sources, pharmacological therapies, and cosmeceuticals – and occasionally all three. Combination therapy treats a variety of ailments.
The goal of combination therapy, according to Mark S. Nestor, M.D., Ph.D., director of the Center for Cosmetic Enhancement and clinical associate professor of dermatology and cutaneous surgery at the University of Miami School of Medicine in Miami, is to maximize patient improvement, depending on the indication, both clinically and cosmetically.
To treat disorders like rosacea and melasma, Dr. Nestor usually combines medicines and cosmeceuticals with lasers or light sources.
Dr. Nestor informs Cosmetic Surgery Times that there are three distinct types of rosacea: rhinophymatous, telangiectatic, and papular-pustular, and they commonly overlap. For combination therapy, we combine topical medications like metronidazole (Galderma), MetroGel (metronidazole, Galderma), or MetroLotion (metronidazole, Galderma), sunblock, and (recommend) some dietary and lifestyle adjustments with gadgets like the Lumenis One (Lumenis), intense pulsed light (IPL), or photorejuvenation gadgets. Some factors, like sun exposure and spicy or hot foods, might make rosacea worse. By combining the operation, medicine, lifestyle changes, and topical treatments, we provide remarkable results.
Dr. Nestor frequently emphasizes photorejuvenation treatments for telangiectatic rosacea since they can considerably diminish telangiectasias. Moreover, he uses pulsed-dye lasers and 532 nm lasers for this purpose.
“Drug treatments don’t have as big of an impact on these patients. Nevertheless, telangiectatic rosacea individuals can also develop pustular and papular rosacea, both of which respond to medication. Although it is specifically linked to the telangiectatic portion of rosacea, flushing is usually associated with papular and pustular rosacea “He claims.
Rhinophymatous For rhinophymatous alterations, which include a small thickening of the sebaceous skin, Dr. Nestor frequently utilizes pulsed-dye laser treatments and photodynamic therapy (PDT) with Levulan (aminolevulinic acid/ALA, Dusa Pharmaceuticals).
He continues, “Patients with thicker rhinophymatous alterations can also gain the most from a procedure like an ablative CO2 laser or erbium laser.
Melasma In a similar vein, photorejuvenation and microdermabrasion are excellent mixes of nonablative and ablative laser therapies for melasma.
Dr. Nestor asserts that “triple combination treatments,” such as the Tri Luma cream (fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%), as well as widespread application of broad-spectrum sunblocks, as well as patient education regarding sun avoidance, are also effective.
On the other hand, lentigines and other hyper-pigmented conditions like sun damage can benefit from the Q-switched ruby laser. For post-inflammatory hyperpigmentation, Dr. Nestor advises combining photorejuvenation with topical medications and cosmeceuticals like kojic acid (PIH).
Acne “Our approach to treating acne has significantly changed as a result of the way we now use combination therapy. “Comedonal acne responds to combinations like significant cleansers and retinoids like adapalene (Differin, Galderma) and devices like the new Clarisonic (Pacific Biosciences Laboratories), a cleansing device that helps get rid of the comedones,” he says.
For papular-pustular acne, topical medications such as retinoids and antibiotics (both topical and oral) are effective. But today, in addition to those therapies, Dr. Nestor says, “we’re using 420 nm blue light to get some substantial changes.” Some patients occasionally additionally receive photodynamic treatment (PDT).”
Oral antibiotics, accutane, and cleansers (ideally non-irritating) are effective therapies for cystic acne.