What treatments improve physical appearance, excluding acne?

From the Guidelines

To improve physical appearance beyond acne concerns, a comprehensive approach that includes proper skincare, nutrition, exercise, and lifestyle habits is essential. This approach should start with a consistent skincare routine using a gentle cleanser twice daily, followed by a moisturizer appropriate for your skin type and broad-spectrum sunscreen (SPF 30+) during the day. For enhanced results, incorporate products with active ingredients like vitamin C for brightness, retinol for texture and anti-aging (start with 0.25-0.5% concentration, using 2-3 times weekly), and hyaluronic acid for hydration 1.

Some key considerations for improving physical appearance include:

• Maintaining a balanced diet rich in fruits, vegetables, lean proteins, and omega-3 fatty acids while staying hydrated with 8-10 glasses of water daily
• Regular exercise (aim for 150 minutes weekly of moderate activity) to improve circulation and skin tone while reducing stress
• Ensuring 7-9 hours of quality sleep nightly, as this is when skin repairs itself
• Avoiding smoking and limiting alcohol consumption, as these can accelerate aging and damage skin
• Proper posture and grooming habits, including regular haircuts and dental care, also significantly contribute to overall appearance

In terms of specific treatments, laser therapy can be an effective option for improving skin appearance, particularly for actinic keratosis. A good-quality, prospective, randomized study demonstrated significantly fewer recurrences in the laser group at 6 and 12 months, but more erythema and hypopigmentation in the long term 1. Other options like dermabrasion, chemical peels, and cryosurgery may also be considered, but it's essential to weigh the potential benefits against the risks of long-term side effects like hypopigmentation and scarring.

Physical interventions, such as therapeutic or conditioning exercise, physical or occupational therapy, acupuncture, and acupressure, heat therapy, massage, and use of cold or hot compresses, can also play a role in improving physical appearance by reducing stress and promoting overall well-being 1. Ultimately, a holistic approach that addresses skin health from both inside and outside, while enhancing overall physical wellness, is crucial for achieving optimal physical appearance.

From the FDA Drug Label

Two randomized, multi-center, double-blind, placebo-controlled trials (EV-001 [NCT02334423] and EV-002 [NCT02334436]) of identical design were conducted to evaluate JEUVEAU for use in the temporary improvement of the appearance of moderate to severe glabellar facial lines The primary efficacy endpoint was measured at Day 30 and was defined as the proportion of subjects achieving ≥2-grade improvement from baseline at maximum frown, as assessed independently by both the investigator and the subject using the Glabellar Line Scale (GLS). Table 3 Trials EV-001 and EV-002: Composite Investigator and Subject Assessment of Glabellar Line Severity at Maximum Frown at Day 30 – Responder Rates (% of Subjects Achieving ≥ 2-Grade Improvement from Baseline) Trial JEUVEAU Placebo Trial EV-001 N=246 68% N=84 1% Trial EV-002 N=246 70% N=78 1%

Treatments that improve physical appearance, excluding acne, are:

• Botulinum toxin (IM): specifically JEUVEAU, which has been shown to temporarily improve the appearance of moderate to severe glabellar facial lines, with responder rates of 68% and 70% in two clinical trials 2 2. Key benefits:
• Temporary improvement of glabellar facial lines
• Significant responder rates in clinical trials Note: The FDA drug label only discusses the improvement of glabellar facial lines and does not provide information on other physical appearance improvements.

From the Research

Treatments for Improving Physical Appearance

• Botulinum toxin type A is used to treat facial wrinkles, with studies showing its effectiveness in reducing wrinkles and improving participant-assessed and physician-assessed success rates 3
• The use of vitamins and supplements, such as carotenoids, vitamins C, E, and D, collagen, ceramides, and mixed supplements, may also improve skin appearance 4
• Botulinum toxins have various utilities in dermatology and cosmetology, including scar prevention, hyperhidrosis, rhytides, and eccrine nevus treatment 5

Specific Treatments and Their Effects

• OnabotulinumtoxinA-20 U probably has a higher success rate when assessed by participants and physicians compared to placebo 3
• AbobotulinumtoxinA-50 U has a higher participant-assessed success rate at week four compared to placebo 3
• IncobotulinumtoxinA-20 U probably has a higher participant-assessed and physician-assessed success rate at week four compared to placebo 3
• DaxibotulinumtoxinA-40 U probably has a higher participant-assessed and physician-assessed success rate at week four compared to placebo 3

Limitations and Future Research

• There is a lack of evidence about the effects of multiple cycles of botulinum toxin type A, frequency of major adverse events, duration of effect, efficacy of recently-approved botulinum toxin type A, and comparisons with other treatments 3
• Future research should consider pooled analysis of data on new emerging drugs for acne treatment and focus more on acne complications 6