Investigators evaluated the effect of ixekizumab withdrawal and retreatment in Japanese patients with plaque psoriasis in this single-arm open-label phase 3 study.

In a cohort of Japanese patients with plaque psoriasis who exhibited an initial response to ixekizumab, approximately half of the patients relapsed within 5 months of treatment withdrawal. Most of these patients subsequently recaptured their responses within 12 weeks, and that response was maintained for up to 120 weeks of retreatment. The results of the single-arm open-label phase 3 study (UNCOVER-J; ClinicalTrials.gov identifier: NCT01624233) were published in the Journal of the European Academy of Dermatology and Venereology.

The investigators sought to evaluate the clinical course after ixekizumab treatment withdrawal and retreatment and the efficacy of retreatment with ixekizumab in Japanese patients with plaque psoriasis. Efficacy measures included the percentage of patients attaining baseline reduction in the Psoriasis Area and Safety Index of 75% (PASI 75), 90% (PASI 90) and 100% (PASI 100); percentage of patients achieving Static Physician Global Assessment 0, 1, and 0; time to relapse (ie, loss of response: PASI ≤50) after ixekizumab withdrawal in patients with a PASI 75 response at week 52; change from baseline in PASI scores; Dermatology Life Quality Index; and Psoriasis Scalp Psoriasis Index (in patients with scalp psoriasis at baseline).

Safety measures included drug-free emergent adverse events (AEs), treatment-emergent AEs, AEs of special interest, serious AEs, AEs that led to treatment discontinuation, and immunogenicity.

A total of 78 patients with plaque psoriasis were enrolled in the study. After ixekizumab treatment (ie, 160-mg loading dose, 80 mg every 2 weeks for the first 12 weeks, and then 80 mg every 4 weeks until week 52), 70 participants attained a PASI 75 response at week 52. These 70 patients were then withdrawn from ixekizumab therapy from week 52 through week 100. The participants who relapsed (PASI ≤50) during the treatment withdrawal period were retreated with 80 mg of ixekizumab every 4 weeks for 192 weeks.

At weeks 52, 76, and 100, PASI 75 response rates were 100%, 26%, and 7%, respectively; PASI 90 response rates were 87%, 11%, and 3%, respectively; and PASI 100 response rates were 53%, 0%, and 0%, respectively. After treatment withdrawal, 87% of patients relapsed, with a median time to relapse of 143 days.

After12 weeks of retreatment with 80 mg of ixekizumab every 4 weeks, 83% of relapsed patients attained PASI 75, 68% attained PASI 90, and 25% attained PASI 100. The improvements were maintained for up to 120 weeks of retreatment.

Treatment-emergent AEs and serious AEs were reported in 56% and 4% of patients, respectively, during the treatment withdrawal period and in 88% and 14% of patients, respectively, during the retreatment period.

The investigators concluded that in patients who were withdrawn from ixekizumab after attaining PASI 75, approximately half relapse within 5 months of withdrawal. Most of these patients recaptured their response within 12 weeks, though, and that response was maintained for up to 120 weeks of retreatment. Interrupted ixekizumab treatment was well tolerated.

The main limitations of this study included the lack of a control group, its open-label design, and that the analysis was conducted in Japanese patients only, with a relatively small sample size.

Follow @DermAdvisor

Reference

Umezawa Y, Torisu-Itakura H, Morisaki Y, et al; Japanese Ixekizumab Study Group. Long-term efficacy and safety results from an open-label phase III study (UNCOVER-J) in Japanese plaque psoriasis patients: impact of treatment withdrawal and retreatment of ixekizumab [published online October 16, 2018]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15292

Wikipedia is frequently used as a starting point for health-focused research.

With the proliferation of online medical information, educators and students alike struggle to discern the legitimacy of “e-health” sources.¹ Wikipedia, a crowdsourced online encyclopedia, is frequently utilized as a “starting [point] for locating information” despite its perceived lower quality and reliability compared with peer-reviewed sources.² In fact, 94% of medical students surveyed in 2012 reported using Wikipedia, describing its articles as “easy to access…and understand.”³

Addressing concerns from health professors less familiar with digital resources, Jennifer Meka, PhD, of the Penn State College of Medicine in Hershey, Pennsylvania, developed a framework for incorporating online content into medical education.⁴

Marc Prensky coined the terms “digital natives” and “digital immigrants” to describe individuals who were born into the “digital era” and individuals who were not, respectively.⁵ To properly educate, Mr Prensky asserts, educators must “learn to communicate [with] their students” who are digital natives.⁵ That is, educators must accommodate and regulate students’ use of online materials.

Wikipedia, as a crowdsourced website, is vulnerable to serious errors and thus should be navigated with care. Several studies have investigated the accuracy of Wikipedia. A 2005 study published in Nature compared the accuracy of scientific articles in Wikipedia with those in Encyclopedia Birtannica.⁶ However, an additional review conducted in 2011 found “mixed results.”⁶ 

Even so, medical entries on Wikipedia remain a leading resource, amassing 4.88 billion crowdsourced pageviews in 2013 alone.⁷ In addition, 1 study even suggested that Wikipedia “[complements]…the traditional journal system,” in that scientific articles referenced by Wikipedia receive more citations.⁸ It is clear that despite reservations about scientific accuracy, Wikipedia is frequently utilized by medical students and may even influence the medical research community itself.

As such, researchers developed the Technological Pedagogical Content Knowledge (TPACK) framework to guide educators in “[teaching] effectively with technology.”⁹ TPACK expands on the teachings of Lee Shulman, who emphasized the necessity of “contextual understanding”¹⁰ for educators; in this case, medical professors must be aware that medical learning now occurs in the digital era.

Per TPACK, educators must demonstrate 3 primary forms of knowledge: content knowledge, pedagogical knowledge, and technological knowledge. Through effective utilization of the TPACK framework, educators provide an “optimal learning experience” for digital natives by teaching students to be discerning about online resources. Under TPACK, content knowledge and pedagogical knowledge each reflect standard tenets of teaching; content knowledge comprises understanding of “concepts, theories, ideas” and understanding of their acquisition.¹¹ In a  similar fashion, pedagogical knowledge refers to the understanding of the “materials, programs, and resources” that comprise the curriculum.¹¹ As an addendum, the investigators have added technological knowledge, an understanding of how to productively utilize information technology.⁹ Educators must understand their students’ preferences and needs, specifically the widespread use of Wikipedia and similar sources. By becoming educated on the same online resources utilized by students, educators can effectively provide guidelines and assistance.

Educators must teach students to effectively weigh evidence and make educated decisions, be they in the clinic or performing a resource scan on Wikipedia. Open communication regarding the reliability of these sources is paramount to a proper medical education in the digital era.

Follow @DermAdvisor

References

1. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):e20.
2. Judd T, Kennedy G. Expediency-based practice? Medical students’ reliance on Google and Wikipedia for biomedical inquiries. Br J Educ Technol. 2011;42(2):351-360.
3. Allahwala UK, Nadkarni A, Sebaratnam DF. Wikipedia use amongst medical students—new insights into the digital revolution. Med Teach. 2012:35(4):337.
4. Meka J, Vigliotti A. Should crowdsourced, unvetted content on Wikipedia be used in health sciences teaching and learning? AMA J Ethics. 2018;20(11):E1033-1040
5. Prensky M. Digital natives, digital immigrants. On Horiz. 2001;9(5):1-6.
6. Giles J. Internet encyclopaedias go head to head. Nature. 2005;438(7070):900-901.
7. Heilman JM, West AG. Wikipedia and medicine: quantifying readership, editors, and the significance of natural language. J Med Internet Res. 2015;17(3):e62.
8. Thompson N, Douglas H. Science is shaped by Wikipedia: evidence from a randomized control trial. MIT Sloan School of Management research paper 5238-17. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3039505. Published September 20, 2017. Updated February 19, 2018. Accessed December 3, 2018.
9. Koehler M. TPACK explained [What is TPACK? tab on TPACK website]. http://tpack.org/. Published September 24, 2012. Accessed December 3, 2018.
10. Shulman LS. Knowledge and teaching: foundations of the new reform. Harv Educ Rev. 1987;57(1):1-21.
11. Koehler MJ, Mishra P. What is technological pedagogical content knowledge? Contemp Issues Technol Teach Educ. 2009;9(1):60-70.

There was a 2.53-fold increased risk for developing Crohn disease and a 1.71-fold increased risk for developing ulcerative colitis.

Psoriasis is significantly associated with inflammatory bowel disease (IBD), according to a study recently published in JAMA Dermatology.

To investigate the association between psoriasis and IBD, researchers conducted a systematic review and meta-analysis using studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between inception and January 17, 2018. Investigators included studies that were case-control, cross-sectional, or cohort studies and examined either the odds or risk of IBD in patients with psoriasis. The studies were neither limited geographically nor linguistically. Analyses for Crohn disease and ulcerative colitis were performed separately, and a subgroup analysis on psoriatic arthritis was conducted.

Five case-control or cross-sectional studies and 4 cohort studies with a total of 7,794,087 participants were included. Investigators discovered a significant association between psoriasis and Crohn disease (odds ratio [OR]=1.70, 95% CI, 1.20-2.40) and between psoriasis and ulcerative colitis (OR= 1.75, 95% CI, 1.49-2.05).

Additionally, investigators found an increased risk for Crohn disease and ulcerative colitis in patients with psoriasis (risk ratio=2.53; 95% CI, 1.65-3.89 and risk ratio=1.71; 95% CI, 1.55-1.89, respectively).

Only one cohort study analyzed the relationship between severity of psoriasis and IBD. Due to the variation in sample size across the studies included, the weight of the different studies varied in subgroup analyses. Despite this limitation, the direction of effects was consistent across the analyzed studies. 

The results of this meta-analysis indicate that patients with psoriasis are prone to comorbid Crohn disease and ulcerative colitis. Gastroenterology consultation may be advisable for patients with psoriasis who present with bowel symptoms.

Follow @DermAdvisor

Reference

Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis [published online October 24, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.3631

The guidelines include a strong recommendation against smoking

A new treatment guideline for psoriatic arthritis (PsA) recommends a treat-to-target approach and the use of tumor necrosis factor inhibitors (TNFi) as a first-line therapy option in patients with active PsA. 

The guideline is jointly authored by the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). It is the first guideline that specifically recommends trying TNFi biologics in treatment-naïve patients first, before using oral small molecule drugs (OSM). 

“The available evidence suggested that in the absence of certain conditions, many treatment-naïve patients would benefit from trying a TNFi biologic first,” said Dafna Gladman, MD, University of Toronto and member of the NPF Medical Board who served as a content expert for the guidelines. She went on to say that OSMs can continue to be used as a first-line option for patients who have contraindications to TNFi treatment or in patients with severe PsA or psoriasis that prefer an oral treatment. 

The guidelines also include a strong recommendation against smoking, as the literature suggests it reduces the efficacy of biologics. 

The authors developed the guidelines using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology; most of the recommendations were “conditional” because of low or very low quality evidence available in some areas. Principle investigator Jasvinder Singh, MD, called for more head-to-head trials of “various treatments and comparative effectiveness studies in both trial populations and PsA populations with comorbidities.”

Follow @DermAdvisor

Fore more information visit Rheumatology.org. 

The US Food and Drug Administration approved Ipilimumab in 2011.

Increased melanoma care costs as part of skin cancer-related care (SCRC), which includes both skin cancer screening and treatment, were largely due to the increased use and cost of the skin cancer drug ipilimumab at an academic center between 2 time points, according to a recent study published in the Journal of the American Academy of Dermatology.

Researchers determined the costs of SCRC using data from the Dana-Farber/Brigham and Women’s Cancer Center in Boston, Massachusetts in 2008 and 2013. Both insurance and patient payment data were analyzed using the International Classification of Diseases, Ninth Revision. Screening costs were analyzed using Current Procedural Terminology codes. Possible non-normal distribution of the cost data was assessed using Wilcoxon rank sum tests, and chi-square and t tests determined the difference between patient characteristics in 2008 and 2013.

The authors examined data for 9309 patients and 13,514 patients who received SCRC in 2008 and 2013, respectively. There was a 45% increase in skin cancer patient volume. Total treatment cost for melanoma increased by 171% from 3,999,091 to $10,826,138 in 2008 and 2013, respectively).

A t test determined the mean annual cost per skin cancer patient increased by 13% ($1533 to $1731 in 2008 and 2013, respectively [P =.03]). Wilcoxon rank sum tests showed increased melanoma costs at $4405 and $8085 in 2008 and 2013, respectively (84% increase; P <.001).  

In 2013, 48 melanoma patients (4% of total 13,514 patients) were treated with ipilimumab, which costs an average of $95,603 per melanoma patient since the medication was approved by the US Food and Drug Administration (FDA) in 2011. The cost of ipilimumab accounted for 42% of the total costs of melanoma treatment and 20% of the costs of SCRC in 2013. Respective ipilimumab costs were absent in 2008 since the drug was approved for commercial use by the FDA in 2011.

The authors explained that an overall increase in SCRC costs is expected as more skin cancer patients are treated; however, the mean cost per melanoma patient increased significantly and the most among all skin cancers per diagnosis. The authors further explained that despite its high cost, ipilimumab has improved melanoma patients’ overall survival relative to previous standards of care.

Study limitations include the fact that outpatient skin cancer patient prescription costs were unavailable, reimbursement data lacked clinical data (eg, cancer stages and outcomes), and single sum hospital structure payments prevented a broken-down assessment of costs by treatment modality.

The authors stated national studies to monitor the cost-effectiveness SCRC are needed.

Disclosures: Belen Fraile, MD, has received speaker honoraria from Novartis. Patrick A. Ott, MD, has served on the advisory boards of Bristol-Myers Squibb and Merck.

Follow @DermAdvisor

Reference

Morgan FC, Duran J, Fraile B, et al. A comparison of skin cancer screening and treatment costs at a Massachusetts cancer center, 2008 versus 2013. J Am Acad Dermatol. 2018; 79:921-928.

Nearly 50% of dermatology residents and dermatologists indicate that they have received inadequate training on skin conditions in people of color.

According to the United States Census Bureau, people of color will comprise an estimated 50% of the US population by the year 2050.¹ This ever-increasing diversity underscores the need for healthcare providers to be educated about differences in clinical presentation and outcomes of conditions in people of color compared with white patients. In a US survey published in 2011, 47% of dermatologists and dermatology residents indicated that they had received inadequate training on skin conditions in people of color.²

“Skin of color, also known as ethnic skin, traditionally refers to that of persons of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. These skin types are usually categorized as Fitzpatrick types III to VI, and are more richly pigmented,” as stated in a 2013 paper published in American Family Physician.¹ “There are notable differences in skin disease incidence, presentation, and treatment based on skin type…. due to structural and functional differences in the skin and hair, as well as the influence of cultural practices.”

Andrew F. Alexis, MD, MPH, chair of the department of dermatology and director of the Skin of Color Center at Mount Sinai St Luke’s and Mount Sinai West in New York and associate professor at the Icahn School of Medicine at Mount Sinai, highlighted 5 conditions that affect people of color with greater frequency compared with other populations.

Central Centrifugal Cicatricial Alopecia (CCCA)

CCCA is a common cause of permanent, scarring hair loss that predominantly affects black women. It is diagnosed by in-office examination and biopsy of the scalp.³Clinically, there is a centrally located patch of diminished hair growth with a reduction of follicular ostia. Bogginess may be appreciated on palpation.

CCCA is treated with anti-inflammatory medications including oral doxycycline, intralesional triamcinolone, and topical corticosteroids; growth stimulating agents such as minoxidil 5% foam; and haircare modifications including avoidance of traction-associated styles and minimization of scalp exposure to heat and chemical relaxers. The goal of treatment is to reduce inflammation and further hair loss.

Dr Alexis and colleagues at Mount Sinai West are currently enrolling participants for an open-label pilot study investigating the efficacy of apremilast in the treatment of CCCA.

Melasma

Women comprise approximately 90% of those with melasma, which most commonly affects people of color.⁴ In a recent study, the most frequently reported triggers were pregnancy (40%), sun exposure (37%), and hormonal oral contraception use (22%).⁵Melasma is typically characterized by symmetric tan brown patches that may involve the cheeks, forehead, and upper lip. Wood’s light can be helpful in distinguishing predominantly epidermal vs dermal melasma.

The condition is treated with combination therapy, including a hydroquinone- and nonhydroquinone-based topical bleaching agent; in-office procedures such as chemical peels and low-density nonablative fractional lasers; and vigilant photoprotection.

Pseudofolliculitis Barbae

The highest prevalence of this disorder is found among men of African descent, with a reported prevalence of 45% to 85%, followed by Hispanic men.⁶ Characteristic clinical features include perifollicular inflamed papules or pustules in areas of shaving — for example, the male beard or the underside of the female chin, and evidence of coarse hair shafts reentering the skin may also be seen on close examination. Associated hyperpigmentation is common.

Treatment consists of the use of topical retinoids and clindamycin lotion. In-office procedures such as chemical peels and laser hair removal are also useful — the latter being associated with long-term remission.

Atopic Dermatitis

This condition is more common in African Americans and Asian Americans/Pacific Islanders (with 2-fold and 6-fold greater number of related doctor’s visits) compared with whites and is often more severe at the time of diagnosis in people of color.^2,7

Erythema may be more challenging to detect in darker skin types. Lesions are typically “hyperchromic” rather than red and may appear to be red-brown, dark brown, or grayish in color depending on the skin type and severity of the condition.

Early and efficacious treatment is important given the higher risk for long-term sequelae such as postinflammatory hyperpigmentation and hypopigmentation, as well as permanent depigmentation in areas of longstanding severe disease that have been excoriated for many years.

Multisystem Disorders

Certain multisystem disorders are more prevalent in skin of color, including sarcoidosis, discoid lupus erythematosus, and scleroderma.

According to conservative estimates, there is a 3-fold incidence of sarcoidosis in individuals of African vs European descent.⁸ The disease can present in myriad ways. One common presentation in African Americans is dermal flesh-colored papules on the face — especially periorificially. This variant usually responds to oral minocycline.

Studies suggest that the prevalence of systemic lupus erythematosus is 2-fold to 3-fold higher in people of color of various ethnicities compared with people of European origin.⁸ People with discoid lupus erythematosus frequently have oval-shaped patches or plaques on the scalp or face. Hyperpigmentation or hypopigmentation can be seen within lesions. Treatment consists of topical or intralesional corticosteroids with or without hydroxychloroquine, depending on the severity of disease.

The highest prevalence of scleroderma is observed in Choctaw Indians, and rates are 1.5 to 3.5 times greater among people of African vs European descent.⁸ The disease may present with “salt-and-pepper”-like dyspigmentation, especially on the upper trunk. These involved areas are indurated and, when found, warrant examination of the digits and screening for systemic signs and symptoms.

Follow @DermAdvisor

References

1. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part I. Special considerations for common skin disorders. Am Fam Physician. 2013;87(12):850-856.

2. Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30(1):53-59.

3. Heath CR, Robinson CN, Kundu RV. Central centrifugal cicatricial alopecia (CCCA). http://skinofcolorsociety.org/dermatology-education/central-centrifugal-cicatricial-alopecia-ccca/. Accessed November 16, 2018.

4. Pandya AG. Melasma. http://skinofcolorsociety.org/dermatology-education/1406-2/. Accessed November 16, 2018.

5. D’Elia MPB, Brandão MC, de Andrade Ramos BR, et al. African ancestry is associated with facial melasma in women: a cross-sectional study. BMC Med Genet. 2017;18(1):17.

6. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color. Am Fam Physician. 2013;87(12):859-865.

7. Janumpally SR, Feldman SR, Gupta AK, Fleischer AB Jr. In the United States, blacks and Asian/Pacific Islanders are more likely than whites to seek medical care for atopic dermatitis. Arch Dermatol. 2002;138(5):634-637.

8. Petit A, Dadzie OE. Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease. Br J Dermatol. 2013;169(Suppl 3):1-10.

Skin cancer is quite common today. Melanoma the most serious form of skin cancer, is a cancer of the skin pigment cells, which are called melanocytes. Melanomas can occur anywhere on the skin, but they are most likely to develop on the chest and back in men and on the legs in women. Other common sites for melanomas include the neck and face. Melanomas can occur anywhere on the skin, but they are most likely to develop on the chest and back in men and on the legs in women. Melanoma only accounts for around 1 percent of all skin cancers, yet it is responsible for most skin cancer-related deaths.

Early detection of melanoma, is critical to effectively treat this potentially fatal disease. Dermatologists universally recommend regular skin exams followed by closely monitoring your skin in between exams. It is important to catch skin cancer earlier as the cure rate is around 90% if caught early. Remember to schedule your skin exams regularly!

Learn more about skin cancer detection, prevention and treatments.

During our daily routine, the skin is submitted to a lot of conditions and situations that have an impact on how healthy it is and how it looks. Some examples are sun exposure, air pollution, unhealthy diet, the stress of a busy routine or even just normal ageing. Because of this, cosmetic procedures such as facials are becoming more popular each day.

Microdermabrasion is one of these procedures that are “in” lately and you probably heard of it at some point, but it is also very likely that you don’t know much about it. There is a reason for the “hype” and the reason is that this procedure can be very useful for several conditions described below.

What is microdermabrasion and why does it work?

Starting with a short definition of microdermabrasion, it is a procedure that consists of using an abrasive yet gentle instrument to remove the outer and uneven layer of the skin. This procedure is non-chemical and non-invasive, which makes it even more attractive. In fact, microdermabrasion uses microcrystals to do the whole exfoliation process.

The microdermabrasion works in two ways:

1. Removes the dead skin cells, revealing the younger looking and healthier cells underneath it.
2. It stimulates the production of collagen and elastin, which also improves the skin elasticity and appearance.

Although the skin might feel a bit red after the procedure, the microdermabrasion is not painful.

Indications

Microdermabrasion is non-invasive and a very versatile technique that can be used for several skin conditions, from the ones that affect mostly teenagers (such as acne), to conditions that are more related to ageing (such as wrinkles and age spots). Here are some examples of conditions that can be treated or at least improved by microdermabrasion:

• Acne
• Wrinkles
• Age Spots
• Uneven skin tone or texture
• Melasma
• Sun damage
• Clogged Pores

Counter-indications

To avoid damages to the skin, the patient should not do many “potentially aggressive” procedures in a short amount of time. So, this is not indicated for patients that had recent skin procedures such as chemical peel or collagen injections or even waxing. Microdermabrasion is also not indicated for people with deep scars and/or active keloids.

Contact our office today to learn more about Microdermabrasion!

Aging is a natural part of our life which may take a toll on our skin especially on our face. Our skin loses firmness and elasticity as we age causing one of the most common skin problem – wrinkles. Facial aging is the result of both genetics and outside factors such as exposure to sun, stress and smoking. Fortunately, there are several treatments available to slow the aging process. Restylane is a clinically proven treatment that provides a fast and minimally invasive solution to smooth fine lines and wrinkles.

Restylane products use hyaluronic acid, a naturally occurring compound that is found in our body, to help provide elasticity in our skin. This compound decreases gradually as we age causing our skin to sag and develop wrinkles. Restylane treatment restores the hyaluronic acid in our skin to help reduce wrinkles by up to 80%.

The Restylane line of products includes Restylane Silk for subtle lip enhancement, Restylane  Lyft to provide volume in the cheek area, and Restylane Refyne & Restylane Defyne to smooth laugh lines around the lips, brow and eyes. The treatments will provide you with a natural looking skin and facial features while giving you the flexibility to maintain your natural facial expressions.

One thing that sets Restylane apart is the ability reduce and eliminate deep wrinkles without requiring the need for surgery. Another advantage of this procedure is that it can be accomplished in 30 minutes or less which means you can easily defy the signs of aging and achieve the natural looking results that you want. Effects will also be full evident within one week from treatment and you can perform immediately your daily normal routine. The long-lasting results of these treatments can be enjoyed for 6 months or more. Contact our office today to learn more about Restylane family of cosmetic products. Learn more about Restylane!