My SkinCeuticals rep asked me today if I was worried about the FDA talking about taking Obagi's Nu-Derm off the market. Apparently there is concern about all the 4% hydroquinone. My patients really love Obagi, especially in conjunction with procedures like IPL fotofacials, Blue peels, etc. So I usually limit there use of the hydroquinone to the recommended 4 months. But what about the people who use it for years on end? Does anyone have any commentary?

Please ask the Obaji rep to send you the clincal data that backs up safety of hydroquinone. And NO FDA obaji ??? where did this rumor come from?

I work for a skin care clinic in georgia... MY skin ceutical rep said the same thing to me today and offered to trade her products for ALL of my obagi products WHATS GOING ON!!!

I have been hearing the same thing, but my information is that it will only affect the 2% OTC formulations and not the 'prescription' strength 4%+ available in Obagi products and by prescription. I may be wrong, but check with your Obagi rep before you dump all your product on a competitor's word

I know Skinceauticals is using this opportunity to advocate the use of their product 'Phyto Corrective' which uses Kojic Acid, Licorice, and, I believe, Bearberry as it's 'lighteners'. What I have personally found, through both personal and patient use, is that it works...but it takes about 3 months of contiual use. Plus, it's a somewhat runny product that takes 5 plus minutes to adequately dry and does not sit well under makeup.

I just think hydro-q 4% is a superior product and science. The ony thing that concerns me is that patients are prey to the 'too much of a good thing' paradox. They attempt to stay on the product for too long instead of cycling the product and being diligent about maintaining their spf protection.

I was wondering if anyone has been using Epicuin Micro, Skin Medica's pharmaceautical product? They recommend only a 4 week cycle to see substantial results. Would love anyone's feedback on this product.

I have been prescribing Obagi for about 2 years now and I am not overly concerned. If you look at the reasoning it is that it possible can lead to cancer but it has not been shown to occur in humans and in the studies it was extremely high doses in mice.

Secondly, they have seen something called ochranosis. It is a staining of the deeper tissues with a dark pigment. It is mostly in darker sinned individuals and most were using OTC hydroquinone and simply overusing it. Some were using it up to 12 times per day.

I do not have much worry here where I am at as about 90% of clients are Fitz 1 to 3. I do agree that it is worth cycling off of the Obagi intermittently. I have tried some of the other prescription hydroquinones and have not seen nearly the same resuts as with the Obagi system.

What about the proliferation of 4% hydroquinon product available online without a prescriptioon? This is mainly Obagi product- where is it coming from if Obagi only sells to Physician's offices?

Consumer,

I have asked the same question of Obagi. First, in the US it is actually illegal for these to be given out without a prescription.

Some are being sold by physicians over the internet. This is even illegal in my mind.

Some are outdated and have been pulled from the market and being sold by unscrupulous individuals usually at a significant price reduction.

Some are stolen.

Some are knock offs just like the fake Gucci bag.

So when you buy over the internet you need to be very careful. Again, it is illegal. If you have seen some of this then you can contact Obagi with the website and they will investigate. Obagi is not the only company that has people ripping them off.

I have been looking for something that is less expensive and fewer steps that works as well as Obagi.

Does anyone have suggestions?

Does anyone have experience with the Nia24 system?

Has anyone out there tried SkinTx? It is a new product line and the results are great, better than Obagi less redness and irritation with superior results. this is the newest technology of skin retoration. Try it out I really reccomend it. Hydroquinone is extremely safe at 4% there are no none cases of cancer or ocronosis where we run into trouble is high concentrations of 8%+ that are compounded with many other ingredients.

I have been using obaji for atleast 3 years now. The results are fantastic but if I stop using the product I notice my pigmentation re-appearing again. I really want to stop using obaji and try something with no hydroquinone. Any suggestions will be greatly appreciated. Thank you!

As far as I have read, there are no cases of human cancer from hydroquinone. The only association is in mice that were given oral doses 400 times the normal amount.

Also, there are no documented cases of ochranosis in the US that I could find but I have not looked for a while. The other thing is that the ochranosis was only in darker skinned individuals. The documented cases are all outside the US and in places where the hydroquinone was OTC and the person was putting it on up to 12 times per day.

My pts are mostly fitz 1-3 and there are no documented cases of ochranosis in fitz 1-3. I have also not founf any cases of ochranosis from Obagi.

We use Remergent's HQ (4%) with success

The center where I am planning my first Profractional procedure told me I need to prep my face with AT LEAST 2 months of the Obagi products. They said no if and or buts about it. They want me to purchase a 4 month treatment for $450+ Is this a commen avenue or are these guys just trying to push a product for their Obagi reps? In fact, should anyone prep their face before a profractional session to begin with?

Your professional thoughts and opinions are appreciated.

AC,

It depends on your skintype. Darker skin has a higher risk of post inflammatory hyperpigmentation. Some feel that it is best to pre-treat darker/ethnic skin to prevent PIH. Studies do not necessarily support this. There is some support in the literature for treating after the laser treatment.

LH,

Thanks for the info. My skin is a type 4 and I was recommended by another center to prep for at least one moth for sure. I plan to do so. Thanks!

I do have another quick question to ask of your opinion/expertise- The center has me scheduled to perform four Profractional sessions in one month intervals at 1000microns in depth each. I do have some ice pick type acne scarring and I am told these four sessions will give me an 80-90% improvement. I was thrilled for to me a 40-50% improvement is great but are four sessions at 1000micron in depth per month safe seeing that I am first more concerned about safety and second obviously of final results?

AC,

If you have true ice pick scars, they likely will not benefit much from the laser therapy. The best way to get rid of these is to remove them with a scalpel or to do punch grafts. Other acne scars should do very well. I never promise a patient 80 to 90% improvement but always hope for it. Your 40 to 50% is very realistic.

As far as the safety, it depends on the coverage which is given in percent. In reality, the doc can do a full depth laser resurfacing to 1000 microns on your cheeks but you would have increased down time and increased risks.

I do think it is probably worth the pretreatment with the obagi due to your skin-type.

LH,

Is there a way to identify a "true ice pick"? I've read dozens of web sites, and many of the definitions for scar types seem to overlap or even conflict.

Some sites say ice picks must be hard and "fibrotic", and list a different name for "soft" scarring. Others say ice picks could be either.If all atrophic scars aren't "ice pick", what is the distinction? I'm a little lost and hope you have some insight into this.

A true ice pick scar is the scar that looks like you stuck an ice pick in the skin pulled it out and it left a hole. They are only 1 to 2 mm with very defined edges and look like a small hole in the skin.

I agree with LH, 80-90% is awfully high to promise a patient. The profractional also is not flexible with regards to the depth, but also the percent to fractionate. 4 treatments is within current recommendations, but this is new techology, and I wonder if an initially slower approach would not be prudent. 1000 microns deep may elicit quite a bit of down time. Especially if a large percent of area is chosen.

Sorry, Saw error in my last post. I meant to say not only flexible with regards to depth, but also with the percent to fractionate.

I have been utilizing Obagi for the past year and I have had marginal results with them. Can anyone suggest other products which they have had good success with?

Use Skinceuticals Pigment Regulator if you don't want to worry about cancer...check out their clinical trials, it really works...

Use Skinceuticals Pigment Regulator if you don't want to worry about cancer...check out their clinical trials, it really works...

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How is Nu-Derm kit costs in USA?
I am asking, cause one of my patient ordered it on-line from USA for 185$.

The kits run 350-455. None of the kits are cheap. Also, they are only supposed to be sold in a medical office. I cant see how she would have the real thing. Especially since they cost more then that to the medical staff to purchase!

DocRokky,

I currently carry Obagi and have been very frustrated with the company and internet sales. They say it is not suppose to be sold on the internet but do nothing about it. I am thinking about dropping their line because they do not do anything about internet sales. They have promised to do somethng about it but nothing changes.

In my clinic we probably spend at least 1 hour of time with the patient to get them started and go through each piece of the NuDerm and then we see them back in 2 weeks. My staff and I do all the work and then patients start buying it off the internet. So we do all the hard work and take all the follow up phone calls and then some internet sales company reaps most of the rewards.

We are currently working to add our own line that will take the place of Obagi. This way patients will only be able to get it from us.

Also, because many of the products are prescription they can not be sold without a prescription from a physican. This makes it illegal to sell without a prescription but somehow the FDA does nothing about it. I have tried to get a straight answer from Obagi but they could care less.

Lornell E. Hansen II, M.D.
LazaDerm Skincare Centre
www.LazaDerm.com

LH
I stopped carrying them about 3 years ago. Not so much from lost sales- I have the patients on an automatic reordering system similar to ProActive- but because of Obagi's arrogant attitude towards their providers.

I have been doing some consulting with a plasti in NYC- she has customized her own line- (which any derm or plasti has the knowledge to do) Lauder approached her about somehow taking the line public and selling to just MD's. So there are alternatives- do it yourself and put your own label on it. Hire a savvy esti with a strong knowledge of peels/Jessner etc... You give the initial consult and write script- and then let her run with the follow through, keeping you informed.

When you look at what your paying to stock the Obagi and what your profit is- and if you look at your lost profit from the internet- it will more than pay for your dedicated esti and your supplies to formulate your own customized treatments.

Plus you're not going to be stuck with dog products that don't sell.

BetterOffNow,

Well said. I am working on a self labeled product line at this time.

I had never thought of automatic re-ordering. That is a very smart way to go. What do the clients think of it?

We make it a part of the seamless presentation that we believe in the products so much, that we don't want them to miss any of the benefits by running out. We have them fill out an automatic bill pay form ( I think it was provided by Visa?) that authorizes us to charge them, take down their CC # and CID # and then give them the incentive of free shipping.

SPF is not negotiable and will be included in any package even if we have to strap them on the bed to apply it. LOL

Typically either myself or an esti does a "Care Call" 2 weeks into their regime to see how it's working and at that time uncover what there future needs are. Some patients go through cleansers like it's water, some try and conserve their products therefore not getting the best benefit- so it's an opportunity for further product education as well as up selling. We also remind them they will see a charge when the next batch of products are shipped in two weeks, and call if you have questions or concerns blah blah blah.

Then their products get shipped- and it's a beautiful thing to walk in the door on a Monday morning at 10:00 and already have 3-4 K in the register as their products get rung through the register.

I also find it is an effective inventory management tool as well. If you know that 36 patients need 2 glyco cleansers in 2 weeks time, you're never scrambling to get the product shipped to your office in time.

We also started a new sampling program that is sorta in a beta trial right now. We ship 3-4 deluxe samples of products they AREN'T purchasing, note it in their records and then do a Care Call on those samples to see if they want those products added to their order.
those are usually "fluffy" products like moisturizing masks- smell pretty scrubs etc. but hey- every little dollar counts. I will evaluate these results in 90 days.

My estis are very gung ho to add cosmetics like Jane Iredale or Mineral makeup. We may do some foundations with a sunscreen- but I really don't want to cheapen our branding by adding a color line so we'll see.

Personally- I would look at the % of gross revenue each product line is selling from the Total gross, and then look at the % of net compared to the Total net.

That's why I made the decision to switch- the gross % was much greater than the net % and I really thought it should be about the same. So total product gross from obagi was 12-14% of total monthly gross- but it was something like 6- 7% of net. That's b.s. I would rather pay an esti the extra $$$, and utilize her to be a liason to upsell products and services and to make the products than give away the profit to obagi.

plus the free shipping is a tax write off ;-)

BTW- just for sh*ts and giggles- there are almost 1000 obagi products for sale on eBay TODAY

http://shop.ebay.com/i.html?_trkparms=65%253A12%257C66%253A2%257C39%253A1%257C72%253A4026&rt=nc&_nkw=obagi&_dmpt=US_Skin_Care&_sticky=1&_trksid=p3286.c0.m14&_sop=10&_sc=1

BetterOffNow,

Great post, I have already discussed some of this with my business manager.

LH

For Sumi and whoever else wants an alternative to Obagi,
We have found the Epionce Melano Corrective System to be a great alternative for people who want to cycle off hydroquinone. The company did do a full clinical study in a head-to-head against the Obagi Nu Derm too, but a lot of patients just want hydroquinone or Obagi specifically because of name recognition. That's fine. We start them with the Obagi (or Cosmelan) and then cycle off and onto the Melano Corrective System which can be used daily, no irritation, no rebound, etc. so the patients have great long-term results.

As we all know, hyperpigmentation is inherently hard to treat and takes a long time. Part of our job is to manage the patient's expectations so they realize it can never be a quick fix. We will have to work together over time as a team for them to see the best results.

Insight re: HQ..I am not a huge fan of it in general for several reasons. #1. It's bleach AKA a free radical. Think about all of the attention given to adding antioxidants to products to prevent oxidation and it's contradictory. #2. The bleach molecule is rather large and usually needs some sort of 'suspending' ingredient, steroid/resourcinol to allow it to penetrate deep enough to do anything. Precisely why it's not recommended for long term use. #3 It offers only marginal results and is not appropriate for all skin types. I have had great success with the NIA24 line and its main ingredient, VitB3/Nicotinic Acid. Similar to the retinA molecule, it is small enough to penetrate the skin where it is critically needed to eliminate inflammation in the cellular DNA, shattering pigment and reversing discoloration. Truly remarkable results. Since there are no AHA's in any of the products, they are compatible/complimentary with RetinA use. That particular combination is very effective for brightening the skin and even preventing AKeratosis. More importantly it consists of a very SIMPLE routine and patients can benefit from even using only one of the products in their line. There will always be stubborn discoloration that needs laser attention but I strongly suggest you research NIA24. I know you will be as impressed as I with the results.