MDNews - Minnesota

Educating the nursing staff Teaching U of MN dermatology residents exciting and effective than ever before." Dr. Crutchfield sat down with MD News to discuss some of the new treatments and products his clinic is using to achieve skin outcomes that make a difference in his patients' lives. Narrow band UVB phototherapy remains a gold standard for treating inflammatory skin diseases including psoriasis and vitiligo, but recent psoriasis research indicates that systemic medications, called biologic treatments, also contribute to good results. "With the advent of biologics," explains Dr. Crutchfield, "we are able to design a custom program for our psoriasis patients, incorporating a combination of topical medicines, phototherapy treatments, biologic treatments and traditional treatments that work together synergistically. This individual customization enables us to respond to the location of the psoriasis, effectively address localized or generalized conditions and adjust for other medical conditions or medications the patient might be taking." Frequent physician referrals of acne patients are a testament to Dr. Crutchfield's success with problem acne. "There are a lot of myths about acne," Dr. Crutchfield says. "Acne is a sophisticated and challenging problem caused by genetics and oil glands down deep in the skin. You can't clear it up by washing your skin or avoiding pizza. If there was a simple solution you could spray on your face to make acne go away, that's all everybody would use. But it doesn't work that way. There are great treatments for acne, but it's a matter of attacking the problem in a medical, physiologic way." Advanced acne treatment options incorporate new cosmetic procedures, including alphahydroxy acid peels, laser treatments and skin programs. Lasers can effectively address both active acne and residual scarring. For patients with active acne, Dr. Crutchfield uses the Aramis laser to treat acne and control oil. This painless procedure is designed to heat the dermis, stimulating the natural formation of new collagen. After acne has been cleared up, he uses the ablative Pixel laser to treat any residual scarring. "The Pixel laser makes a microscopic hole in the skin to stimulate collagen remodeling to fill in acne scars. I also use it for superficial lines and wrinkles," Dr. Crutchfield explains. "There's no quick, easy fix for acne, but with aggressive, appropriate treatment, I usually have patients clear in four to six months and can keep them clear with a minor maintenance program adjusted based on patient response." Dr. Crutchfield has also incorporated laser procedures into the treatment of pediatric hemangiomas. "By age 5, about half these birthmarks resolve without any treatment," notes Dr. Crutchfield. "However, the location of the hemangioma may preclude a wait-and-see approach. Hemangiomas around the eyes may interfere with vision or visual development; around the mouth, they can interfere with eating and cause a child to fall off the growth chart. Large bleed- ing hemangiomas raise concerns about infection and blood loss. "As a resident," recalls Dr. Crutchfield, "I was trained to treat hemangioma patients with systemic corticosteroids, but steroids are fraught with complications and problems, and I was not satisfied with clinical results. New research has shown that laser treatment in combination with propranolol, a beta blocker usually used as a blood pressure medication, can help hemangiomas resolve more quickly. I've found this combination very successful." Within the last year, two new cosmetic treatments, CoolSculpting and Selphyl, have garnered media attention and patient interest. Crutchfield Dermatology offers both. Dr. Crutchfield discussed the evolution and advantages of each treatment. "When I was at the Mayo Clinic, my mentor, Michael Getz, Ph.D., told me that every once in a while in life, people stumble over the truth. Unfortunately, most people pick themselves up and keep on going," Dr. Crutchfield says, chuckling. "The develop- ment of CoolSculpting is a bit like that. Years ago, The New England Journal of Medicine published an article about children who developed dimples from their habit of holding the frozen, rounded tips of popsicles against the insides of their cheeks as they ate them. Over several months, lipolysis, or little dimples,

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