Innovative Dermatologist

MD NewsBy Marian Deegan
(click here for PDF version MDNews)

Thirty seconds. According to social psychologists, that’s how long it takes to form a lasting impression about someone. These few seconds can determine the outcome of a job interview or a first date. Beauty may be only skin deep, but when a confident appearance can make or break opportunities in a person’s career and personal life, clear skin takes on an importance that encompasses more than physical health.

For 10 years, Crutchfield Dermatology has been helping patients make the most of those 30 seconds– treating psoriasis, acne, vitiligo, pediatric and cosmetic dermatology issues, and ethnic skin conditions. Clinic founder Charles Crutchfield III, M.D., has seen firsthand the trans-formative power of healthy skin.

“Skin issues have a powerful impact on our personal and professional lives,” he explains. “I can’t tell you how many patients report that their self-esteem has completely turned around after we resolved an issue like acne or psoriasis. Other patients are concerned about staying in the workforce longer or re-entering the workforce after an absence; their professional success can depend on how they look and how they are perceived. They want to look competitive and feel confident about their appearances.”

Dr. Crutchfield treats an active base of more than 40,000 patients, ranging from newborns to grandparents. He is team dermatologist for the Minnesota Twins and Minnesota Vikings and a clinical professor of dermatology at the University of Minnesota Medical School. Seventy-five percent to 80% of his practice is focused on medical dermatology, with the remainder in cosmetic dermatology.

“There are about 4,000 different dermatological diagnoses.” he says. “A sign advertising skin care does not mean that treatment will be handled by a board-certified dermatologist. A board-certified dermatologist cannot only design the best treatment plan for your skin, but more importantly, he or she is the most skilled and qualified to handle any complications that can arise from a variety of skin and laser treatments. Successfully evaluating, diagnosing and designing a treatment plan is a matter of rigorous training, thorough knowledge of the anatomy and physiology of the skin, and years of clinical experience. My custom programs incorporate dermatology treatment options at the forefront of medicine that are more 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 systematic 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 or medications the patient may 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 alpahydroxy 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 hear 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 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 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 bleeding 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., tols me that every once in a while in life, people stumble over a truth. Unfortunately, most people pick themselves up and keep on going,” Dr. Crutchfield says, chuckling. “The development 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, rounded tips of popsicles against the insides of their cheeks as they ate them. Over several months, lipolysis, or little dimples, developed because the constant cold had dissolved the fat. I read the article, found it interesting, and kept on going. But somebody else read that article and was inspired to develop a machine to chill fat in the body to melt is away.”

During the first few minutes of a Coolsculpting treatment, patients report a tingly sensation that dissipates after six or seven minutes; the rest of the hour-long treatment is painless. After the procedure, the body gradually eliminates the treated fat over two to three months. Coolsculpting works for 80% to 90% of patients, and 75% of successfully treated patients need only one treatment.

Currently, CoolSculpting units have been designed to treat love handles, the upper and lower abdomen, and fat rolls on the back, but components are under development to treat the area under the chin, the backs of the arms and thighs.

A nonsurgical liquid face lift is a new cosmetic treatment available to patients, thanks to the emergence of advanced dermal filler products like BOTOX, Dysport, JUVEDERM and Restylane. the latest of these products, Selphyl, was adapted from the use of platelet-rich plasma in sports medicine to rebuild collagen in joints by centrifuging patients’ blood to concentrate growth factos and platelets. This concentrated plasma is injected into joints to repair them. An FDA study successfully confirmed that the same treatment could repair damage in the skin by stimulating collagen production.

“The plasma injections stimulate the patient’s own cell growth and collagen production to fill in the skin,” explains Dr. Crutchfield. “The effect is gradual. We begin to see results around week two after the injections, and response continues to build, peaking at about three months. There’s no possibility of an allergic reaction because we are using the patients own growth factors. Not only does Selphyl fill in lines and wrinkles, but it also makes skin look fresher and younger. We’ve found it particularly effective to treat fine wrinkles under the eyes and acne scars.”

The disadvantage of Selphyl, compared to other filling agents, is that it can take a months to work; the other agents correct immediately. With Selphyl, however the response is very durable and can last several years. Dr. Crutchfield cautions that patient response to Selphyl varies.

“A third of the time,” he explains, “we have a tremendous response. Another third of the time, its a very good response. Another third of the times, the response is so-so. The difference in response not age-related; I suspect it may be a matter of individual genetics.”

Dr. Crutchfield often combines several nonsurgical cosmetic techniques to give patients a customized liquid facelift.

New procedures and treatments may grab media attention, but Dr. Crutchfield points out that skin care basics are also advancing, albeit more quietly. “I’ve used the NeoStrata customizable skin care program for my patients since 1994,” he says. “They’ve just introduces a new formulation that has been in development for five years. The new topical treatment contains alpha hydroxy acids, antiocidants, anti-inflammatories, stem-cell extracts, sunscreen and retinols. It works unlike any other skin care program I’ve seen. Patient skin tone changes and evens out; dark skin areas and sun freckles fade; wrinkles soften; overall skin texture smooths; and pore size diminishes. Twenty years ago, cold creams like Ponds were good at gentle cleansing and moisturization, but today’s NeoStrata products have evolved with components that deliver dramatic results beyond moisturization. They are doing a fantastic job at skin correction, rejuvenation and repair.”

A lasting impression may be formed in 30 seconds, but Dr. Crutchfield is committed to working as long as it takes to ensure his patients have beautiful, healthy skin when their moments come.

“I treat each patient personally, and I do my absolute best to five the highest-quality skin care possible,” he says. “If you have a skin care problem and come to me, or are referred to me for help, I promise I will not stop working until your problem is solved. I will not give up. My staff and I are dedicated to treating our patients with courtesy, dignity and respect, and delivering quality skin results to make them look their best and feel wonderful.

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