® & Prescription Renova
In a controlled clinical study, an Epionce regimen produced similar results in improving the appearance of photoaging parameters com-
Epionce (% Change) Renova (% Change)
pared to the gold standard Renova (prescription 0.05% tretinoin).
Using a split-face methodology, an Epionce regimen was compared
with prescription Renova (0.05% cream) in a six-month double-blind, prospective, controlled clinical trial during the winter and spring
months. The study consisted of 25 panelists who used no sunscreen
during the study period. The regimen consisted of Epionce Renewal
Facial Cream applied twice daily and Epionce Lytic Tx applied nightly,
Epionce appears to be the first nonprescription (cosmeceutical)
7-15 minutes prior to Renewal Facial Cream application. The Renova
product line to directly compare itself to Renova, the prescription gold
regimen consisted of Renova (0.05%) nightly and Johnson & Johnson
standard to treat visible signs of skin aging. This data clearly thrusts
Softlotion™ 24 Hour Moisture, applied twice daily. The latter has a
Epionce to the forefront of non-prescription amelioration of extrinsic
consistency similar to that of Epionce Renewal Facial Cream. Most of
aging. Most importantly, it validates this new concept for reversing/
the middle-aged population living in the region where the study was
preventing visible photoaging by optimizing stratum corneum bar-
conducted, who use Renova, also use a moisturizer twice daily (during
rier function while safely reversing/preventing activation of chronic
inflammatory factors. This breakthrough concept is intuitively based upon increasingly published cutaneous pathobiology discussed in the
following paragraphs. A compromised stratum corneum permeability
Board-certified dermatologists performed the clinical assessment for
barrier results in the activation of chronic cutaneous inflammation
both regimens. The clinical results showed no statistical difference
by releasing and stimulating synthesis of proinflammatory biologic
between the two regimens, although the Epionce regimen was numeri-
response modifiers. With as many as fifty percent of women having
cally superior in 5 of 7 parameters, as in Table 1.
sensitive skin, including individuals exhibiting signs of extrinsic skin aging, a large segment of the population has a documented incompe-
tent permeability barrier with accompanying chronic inflammation.2,3
Epionce (% Change) Renova (% Change)
Barrier disruption releases pre-formed interleukins (IL-1 alpha and
beta, IL-8, IL-12), tumor necrosis factor alpha, growth factors (epider-
mal platelet derived, fibroblast and transforming growth factors and granulocyte colony stimulating factor), substance P, and calcium,
among others.3 These biologic response modifiers activate nuclear
receptors (activating protein-1 and nuclear factor kappa beta) which
encode for gene transcription of other biologically active compounds
including adhesion molecules, chemokines, selectins, defensins and
proteinases. One group of these end products, matrix metallopro-
*Skin was cleansed prior to application of leave-on products
teinases, destroys collagen, elastin and ground substances thereby producing microscars, which progress to the visible fine lines and wrinkles of extrinsic aging. It follows that chronic exfoliation, unlike
In Table 2, the histologic parameters were mixed with comparable
the reports in lay literature, is actually destructive, producing visible
results with reduction of epidermal and papillary dermal thickness.
The Epionce regimen was statistically significantly superior (p<0.05) in increasing epidermal glycosaminoglycans 13.3% vs. 7.4% with Renova
The gold standard for photoaging therapy is prescription retinoids.
regimen. Dermal density measured by ultrasound also was statistically
Renova was the first retinoid therapy approved by the FDA. Retinoids
superior (p<0.05) of Epionce, with an increase in dermal density by
are known to induce exfoliation, contact irritant and photoirritant
20.8% vs 10.3% with Renova. Renova induced a statistically significant
reactions.1,4 The frequency of local skin irritation, desquamation, burn-
increase (p<0.05) of stratum corneum compaction of 44.4% vs. 20% for
ing sensation, erythema, pruritis and dry skin reaches up to 59% in pa-
Epionce. The Epionce regimen induced a highly statistically significant
tients using the product. Most reactions were mild, but the incidence
(p<0.001) lower incidence of eyelid mild erythema and scaling than
of severe reactions was 5% with 0.05% tretinoin cream.5 In a study of
Renova. Nonprescription Epionce, with unique mechanisms of action,
people with acne and sensitive skin, 23% withdrew by day 29 of treat-
is the first cosmeceutical with clinical and histologic results compara-
ment.6 The documented incidence of photoirritation to UVB in humans
Comparing Epionce & Prescription Renova, cont.
and prevention of visible extrinsic aging. They provide a safe and
The FDA has made cautionary recommendations regarding exfoliat-
effective over-the-counter therapy that results in healthy, optimally
ing compounds due to concerns of increasing chronic inflammation,
inducing tumorigenesis.7 Furthermore, the disruption of the perme-ability barrier allows a significantly increased ingress of environ-
1. Nyirady J, Grossman R. Evaluation of Tretinoin Cream 0.05% as a potential cause of phototoxicity
mental insults, including proinflammatory molecules, inducing even
and photoallergy. Cosmet Dermatol. 2003;16 (4 Suppl) 14-17.
more destructive chronic cutaneous inflammation. The difference
2. Johnson AW. Population perspectives of sensitive skin. Making sense of sensitive skin. Maibach
in the mechanisms of action for Epionce from traditional anti-aging
HI (chair). Supplement to Skin and Allergy News. Elsevier. 2003;2:6.
3. Elias PM, Feingold KR. Does the tail wag the dog? Role of the barrier in the pathogenesis of
therapies does not preclude combining them. In fact, using Epionce
inflammatory dermatoses and therapeutic implications. Arch Dermatol. 2001;137: 1079-1081.
Renewal Facial Cream with Renova and Tazorac® eliminated irritant
4. Kligman AM. Topical retinoic acid (Tretinoin) for photoaging: Conceptions and misconceptions.
reactions (pending publication). Anecdotal observations suggest clini-
Cosmet Dermatol. 2003;16: (4 Suppl) 3-6.
5. Kang S, Leyden JJ, Lowe NJ, Ortonne JP, Phillips TJ, Weinstein GD, Bhawan J, Lewkaya DA,
cal efficacy is improved by combining Epionce and retinoids. Retinoid
Matsumoto RM, Sefton J, Walker PS, Gibson JR. Tazarotene Cream for the treatment of facial
delivery appears enhanced after Epionce use because retinoids were
photodamage. Arch Dermatol. 2001;137:1597-1603.
originally developed for teenagers afflicted with acne who have much
6. Leyden JJ, Grove GL. Randomized facial tolerability studies comparing gel formulations of retinoids used to treat acne vulgaris. Cutis. 2001;67 (6 Suppl) 17-27.
higher lipid content in their skin than more mature patients. It follows
7. Kraeling ME, Bronaugh RL. In vitro percutaneous absorption of alpha hydroxy acids in human
that the infusion of Epionce lipids into photoaged skin would be ex-
skin. J Soc Cos Chem. 1997; 48;187-197.
pected to maximize retinoid efficacy and minimize adverse reactions.
Epionce products are a significant advance in the pursuit for reversal
NITRATE TREATMENT FOR TENDONS (source: injuryupdate.com) What are nitrate patches? Used primarily for improving blood supply to the heart, nitrate patches havebeen recently shown to improve healing in chronic tendoninjuries. Please refer to the abstracts below. Using nitratepatches for tendon injuries is currently "off-label" but isbacked by strong scientific evidence. Are the
PEDIATRICS CME Clinical Considerations assessed various nebulizer/compressor combi- Jet Nebulizer Types. Jet nebulizers vary wide-nations in models simulating pediatric inspira-ly in their design, ability to be reused and drugtory and expiratory flows, budesonide inhala-delivery profiles. Table 3 provides an overviewtion suspension was nebulized in amounts sim-of the three primar