Many people think of combination therapy in our field as it relates to skin rejuvenation and cosmetic enhancements. Most of the inquiries and searches we get at The Tennessee Society for Laser Medicine and Surgery are around the latest, greatest, and most cutting edge procedures that can be used to take years off of someone’s appearance or help to maintain their youthful good looks. However, there a whole slew of medical issues that people face that cause everything from blemishes to skin and feature disfigurement. From acne to cancer, combination therapies have the potential to offer better results than that of single, stand-alone medications or treatments. This installment of our blog series talks about just that.
What is Combination Therapy
Combination therapy is a broad term used to indicate that more than one treatment, or medication, is being used for a single purpose. We previously published a piece on The Most Effective Use of Combination Therapies, in which we outlined several of the most interesting combination therapies, or polymedicine, providing examples that included treatment regimens that involved administering several separate pills, each containing a particular drug, or single pills that contained several drugs.
Combination therapies exist in almost every medical field, and are no exception in the practices of dermatologists, plastic surgeons, oculoplastic surgeons, aesthetic physicians and aestheticians. The most common type of polymedicine in our field is when non-invasive procedures are ‘stacked’ to treat signs of aged skin and also help to rejuvenate that same area of skin. There are dozens, if not hundreds, of known ways we can help our patients and clients become their most beautiful using this method.
In the case of oncology, skin related or otherwise, combination therapies are frequently focused around the use of multiple medications. With melanoma in particular, this is the gold standard. According to the Melanoma Research Alliance:
Cancer experts have found that combining two drugs may treat advanced melanoma more effectively than either medication on its own, for certain patients. Since 2014, the U.S. Food and Drug Administration (FDA) has approved several combinations of medications to treat advanced melanoma. Some combination therapies are composed of two targeted therapies, and some are composed of two immunotherapies.
This is frequently combined with surgical procedures to remove lesions and growths. There are many other medical cases where a procedure alone will not solve the problem. Oftentimes it requires both medication and surgery, or a non-invasive procedure or procedures, to help.
When Procedures Alone Just Don’t Cut It
There are many examples where combination therapy is most effective as a medication + procedure. The following are a few conditions that can be treated using this type of therapy, including some that are new and cutting edge. For more information on these, and other ways combination therapy works in the cosmetic, dermatologic, and aesthetic industries, follow our blog and attend SCALE 2019 Music City in May.
Hidradenitis Suppurativa (HS)
This is an interesting disease that causes pimple-like bumps on the skin in places that pimples do not generally occur, such as under the arms and on the groin. As noted by the American Academy of Dermatology:
Early diagnosis and treatment can prevent HS from worsening.If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking blood stained pus onto clothing. This fluid often has a foul odor. As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to heal and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because HS can look a lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis. To a dermatologist’s trained eye, the differences between HS and other skin diseases are subtle but obvious. Proper treatment depends on an accurate diagnosis.
Oral antibiotics, combined with surgery, will both treat and manage this disease. As noted by the HS Foundation, “Tetracyclines, lincosamides, fluoroquinolones, carbapenems, rifampin, dapsone, and metronidazole are some of the most commonly used antibiotics or classes of antibiotics which are frequently used in mono or combination therapy for HS.” While those help to manage the disease, surgery remains the “cornerstone” of treatment.
For almost a decade we have seen great success in treating acne vulgaris with a combination of drugs and phototherapy, combined with skin rejuvenation and skin tightening. This approach first made dermatologic headlines when a study was published in 2011 in the Journal Laser Therapy.
The summary of that study is as follows:
Over a 2 years of clinical experience using a combination of drugs with LHE™ phototherapy on moderate to severe acne patients, patients first underwent a series of 8–10 bi-weekly LHE treatments to reduce their dermal inflammatory process. These treatments were combined with keratolytic agents which are not contraindicated with phototherapy. The combined LHE/drug treatment regimen was followed by a series of LHE skin rejuvenation procedures to treat post acne symptoms of localized erythema, post inflammatory hyperpigmentation and scars. This double phototherapy protocol appears to offer excellent clinical and aesthetic results with no side effects or complications and may be repeated if relapse occurs.
Combination Therapy for Dark Skin
One of the biggest challenges that dermatologists, cosmetic surgeons, and aestheticians face is treating skin tone. This has not been lost on researchers, publishing in medical journals.
With the rapid increase in patients seeking cosmetic treatments, the variation in responses of lightly pigmented skin versus darkly pigmented skin has become increasingly apparent. Despite extensive treatment options in patients with skin of color, there is a paucity of well-designed studies performed on this patient population. The lack of research is concerning, as it is well documented that patients with darker skin types are at an increased risk of adverse events when treated with many of the available modalities used in cosmetic procedures. Fortunately, by combining a variety of treatments, these risks may be abrogated, and combination treatments may be a promising regimen for a wide variety of cosmetic complaints. (Source).
Medications combined with other procedures are making it possible to effectively treat patients of all skin tones.