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Frühauf J, Kröck S, Quehenberger F, Kopera D, Fink-Puches R, Komericki P, Pucher S, Arzberger E, Hofmann-Wellenhof R. Mobile teledermatology helping patients control high-need acne: a randomized controlled trial. J Eur Acad Dermatol Venereol 2014; 29:919-24. [PMID: 25258175 DOI: 10.1111/jdv.12723] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acne is an important health issue with a major psychological impact in addition to the physical problems it causes. OBJECTIVES To investigate the superiority of mobile teledermatology in the care of patients with high-need facial acne in comparison to outpatient services with particular attention to treatment efficacy, safety, and patient compliance. Further, patient satisfaction with remote care was evaluated. METHODS Sixty-nine consecutive patients (f: 25, m: 44, median age: 19 years, range: 13-37 years) were randomly allocated to either the teleconsultation (TCA) or the outpatient consultation (OCA) arm of the trial to receive isotretinoin treatment in weight and severity-dependent dosages over 24 weeks. Acne grading was performed by one examiner using the Global Acne Severity Scale (GEA) and the total lesion counting (TLC). RESULTS Due to noncompliance issues, 17 of 69 (24.6%) patients were excluded from the study, of who 10 had been assigned to the TCA (10/34; 29.4%) and 7 to the OCA (7/35; 20%). Both, in the TCA (GEA-score: ∆ = 2.25; TLC: ∆ = 89.08) and in the OCA (GEA-score: ∆ = 2.0; TLC: ∆ = 91.21) excellent and almost equivalent therapeutic outcomes were achieved. In the TCA, however, less patients experienced adverse reactions (P = 0.55). Even though additional live supervision would have been appreciated in some teledermatology cases, patients were satisfied with the mobile service and no consultation request was created. CONCLUSION Mobile teledermatology is an efficient, safe and well-accepted tool among patients with high-need acne constituting at least a valuable adjunct to outpatient care services. Further larger studies would be useful to confirm our findings.
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Affiliation(s)
- J Frühauf
- JF Private Dermatology Practice, Maria Enzersdorf, Lower Austria, Austria; Department of Dermatology, Medical University of Graz, Graz, Austria
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Rao PK, Bhat RM, Nandakishore B, Dandakeri S, Martis J, Kamath GH. Safety and efficacy of low-dose isotretinoin in the treatment of moderate to severe acne vulgaris. Indian J Dermatol 2014; 59:316. [PMID: 24891681 PMCID: PMC4037971 DOI: 10.4103/0019-5154.131455] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Isotretinoin is indicated for moderate to severe cases of acne which are unresponsive to conventional therapy. The classical recommended dose is 0.5 to 1.0 mg/kg/day. As the side effects are dose related, low-dose isotretinoin therapy for acne is an attractive option; however, but little data exists on the safety and efficacy of this strategy. Materials and Methods: In this prospective, non-comparative study, 50 participants, both male and female, having moderate to severe acne vulgaris were enrolled and treated with isotretinoin at a dose of 20 mg/day (approximately 0.3-0.4 mg/kg/day), for a period of 3 months. Participants were evaluated by means of clinical and laboratory investigations before starting isotretinoin. Investigations were repeated at the end of the first and third months following completion of treatment, and participants were followed up for 6 months to look for any relapse. Results: At the end of the treatment, very good results were observed in 90% of participants. Cheilitis was the most common among the side effects observed and was seen in 98% of the participants. One participant developed vitiligo as a side effect, which is a new finding, and has not reported in literature before. Elevated serum lipid levels were observed in 6% of the participants, and relapse occurred in 4% of the participants over a 6 month follow up period. Conclusion: Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris, with a low incidence of serious side effects. This dose also was more economical than the higher doses.
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Affiliation(s)
- Parinitha K Rao
- Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Ramesh M Bhat
- Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
| | - B Nandakishore
- Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Sukumar Dandakeri
- Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Jacintha Martis
- Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Ganesh H Kamath
- Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India
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Abstract
Acne vulgaris is a chronic inflammatory disease of pilosebaceous follicles commonly affecting adolescents and young adults. This disease has a profound psychological impact on affected individuals and treatment has been shown to significantly improve both self-esteem and quality of life. Isotretinoin is an effective medication used primarily in severe cystic acne patients. Over the past 30 years, this medication has revolutionized the treatment of acne. However, despite its popularity there are numerous side effects associated with its use. Most of its side effects are predictable and dose dependent, which has led to the development of variable dose regimens. Unfortunately, rare but significant side effects (e.g., depression, inflammatory bowel disease) do occur and necessitate careful monitoring to improve clinical outcomes and minimize potential adverse events.
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Affiliation(s)
- Shelbi C Jim On
- Department of Dermatology, The Mount Sinai School of Medicine, New York, New York, USA
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Lee HE, Chang IK, Lee Y, Kim CD, Seo YJ, Lee JH, Im M. Effect of antihistamine as an adjuvant treatment of isotretinoin in acne: a randomized, controlled comparative study. J Eur Acad Dermatol Venereol 2014; 28:1654-60. [PMID: 25081735 DOI: 10.1111/jdv.12403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Isotretinoin has been frequently used for acne therapy. However, it has limitation in acceptance because of its adverse effects. Although antihistamine recently revealed to decrease the lipogenesis, evidence is lacking regarding the clinical relevance of antihistamine in the treatment of acne. OBJECTIVES To evaluate the clinical efficacy and tolerability of antihistamine as an adjuvant treatment of isotretinoin. METHODS Forty patients with moderate acne were included in this randomized, controlled comparative study. Twenty patients were treated with isotretinoin and 20 patients were treated with additional antihistamine, desloratadine. Assessment was made at baseline, after 2, 4, 8 and 12 weeks of treatment. RESULTS At week 12, compared with isotretinoin only group, isotretinoin with additional antihistamine group showed more statistically significant decrease in acne lesion counts (non-inflammatory lesions: 44.8% vs. 17.8%; inflammatory lesions: 55.8% vs. 22.9%; total lesions: 45.6% vs. 18.7%; all P < 0.05). Significant decrease was also observed in the score of global acne grading system and the measured value of sebum and erythema. Moreover, acne flare during the treatment occurred less frequently and adverse events of isotretinoin were more tolerable in additional antihistamine group. CONCLUSIONS This results provide early evidence that antihistamine has a synergic effect with minimizing the side-effect of isotretinoin, and may be used as an adjuvant treatment of moderate acne.
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Affiliation(s)
- H E Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
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Rowe C, Spelman L, Oziemski M, Ryan A, Manoharan S, Wilson P, Daubney M, Scott J. Isotretinoin and mental health in adolescents: Australian consensus. Australas J Dermatol 2013; 55:162-7. [PMID: 24283385 DOI: 10.1111/ajd.12117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/21/2013] [Indexed: 12/14/2022]
Abstract
Acne is a common condition among adolescents and has the potential to negatively impact on the psychological well-being of those who suffer from it. In particular, depression and suicidal ideation are more common in adolescents with acne. Successful treatment of acne can improve the quality of life and reduce levels of anxiety and depression in these individuals. The current treatment of choice for severe or refractive acne is isotretinoin, a retinoid. While the possible causal association between isotretinoin and mental illness remains a controversial topic, a recent systematic review has presented evidence to support this relationship. In light of this evidence, a group of dermatologists and psychiatrists have collaborated to develop these recommendations to aid the safe prescribing of isotretinoin in adolescents. These clinical suggestions are aimed at practitioners in both disciplines to increase awareness of the current evidence in support of the association between isotretinoin and adolescent depression.
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Affiliation(s)
- Casey Rowe
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
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Sandoval LF, Hartel JK, Feldman SR. Current and future evidence-based acne treatment: a review. Expert Opin Pharmacother 2013; 15:173-92. [PMID: 24283604 DOI: 10.1517/14656566.2014.860965] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Current acne treatment guidelines, as well as, treatment efficacy, safety, tolerability and patient preferences must all be considered in determining appropriate treatment regimes. Literature can assist physicians' evidence-based recommendations according to these factors. AREAS COVERED To determine the current and future direction of pharmacotherapy for treatment of acne, a PubMed search was conducted to identify all clinical trials involving the treatment of acne from 2009 to 2012. A total of 65 publications met inclusion criteria and were reviewed. Literature was heavily focused on the efficacy and tolerability of topical combination therapies and supported their use compared with monotherapy. A few studies on topical antiandrogens and antioxidants showed an alternative approach to targeting acne. Studies on oral monotherapy provided some evidence for the use of pulsed azithromycin for acne in adolescents. Literature also supports the use of low-dose isotretinoin for moderate acne, which was comparable in efficacy to high-dose regimes and better tolerated. EXPERT OPINION Combination acne therapy, whether it be combination topical therapy or combination oral and topical therapy, is well supported by recent studies. Given the multifactorial pathogenesis of acne and the hurdles of adherence to treatment, we anticipate greater development of and reliance on combination acne products in the future.
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Affiliation(s)
- Laura F Sandoval
- Wake Forest School of Medicine, Center for Dermatology Research, Departments of Dermatology , Winston-Salem, North Carolina , USA +1 760 217 1457 ; +1 336 716 7732 ;
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Bagatin E, Guadanhim LRS, Enokihara MMSS, Sanudo A, Talarico S, Miot HA, Gibson L. Low-dose oral isotretinoin versus topical retinoic acid for photoaging: a randomized, comparative study. Int J Dermatol 2013; 53:114-22. [DOI: 10.1111/ijd.12191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Edileia Bagatin
- Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); SN Botucatu SP Brazil
| | - Lilia R. S. Guadanhim
- Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); SN Botucatu SP Brazil
| | | | - Adriana Sanudo
- Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); SN Botucatu SP Brazil
| | - Sérgio Talarico
- Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); SN Botucatu SP Brazil
| | - Helio A. Miot
- Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); SN Botucatu SP Brazil
| | - Lawrence Gibson
- Department of Dermatology; Universidade Federal de São Paulo (UNIFESP); SN Botucatu SP Brazil
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Yoon JH, Park EJ, Kwon IH, Kim CW, Lee GS, Hann SK, Kim KH, Kim KJ. Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars. J DERMATOL TREAT 2013; 25:142-6. [DOI: 10.3109/09546634.2013.768758] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jong Hyun Yoon
- Department of Dermatology, College of Medicine, Hallym University,
Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, College of Medicine, Hallym University,
Anyang, Korea
| | - In Ho Kwon
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine,
Hwaseong, Korea
| | - Chul Woo Kim
- Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine,
Seoul, Korea
| | | | | | - Kwang Ho Kim
- Department of Dermatology, College of Medicine, Hallym University,
Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, College of Medicine, Hallym University,
Anyang, Korea
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Rademaker M, Wishart J, Birchall N. Isotretinoin 5 mg daily for low-grade adult acne vulgaris - a placebo-controlled, randomized double-blind study. J Eur Acad Dermatol Venereol 2013; 28:747-54. [DOI: 10.1111/jdv.12170] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/25/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Rademaker
- Dermatology Department; Waikato Hospital; Hamilton New Zealand
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Morales-Cardona C, Sánchez-Vanegas G. Tasa de recaída y factores pronóstico de recaída después del tratamiento con isotretinoína oral en pacientes con acné quístico. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:61-6. [DOI: 10.1016/j.ad.2012.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/30/2012] [Accepted: 05/01/2012] [Indexed: 11/30/2022] Open
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Acne Relapse Rate and Predictors of Relapse Following Treatment with Oral Isotretinoin. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
The multifactorial etiology of acne vulgaris makes it challenging to treat. Current treatments include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, azelaic acid, and systemic isotretinoin. Adjunctive and/or emerging approaches include topical dapsone, taurine bromamine, resveratrol, chemical peels, optical treatments, as well as complementary and alternative medications. The purpose of this paper is to discuss the therapies available for acne and their latest developments, including new treatment strategies (i.e. re-evaluation of the use of oral antibiotics and avoidance of topical antibiotic monotherapy, use of subantimicrobial antibiotic dosing, use of low-dose isotretinoin, optical treatments), new formulations (microsponges, liposomes, nanoemulsions, aerosol foams), new combinations (fixed-combination products of topical retinoids and topical antibiotics [essentially clindamycin] or benzoyl peroxide), new agents (topical dapsone, taurine bromamine, resveratrol) and their rationale and likely place in treatment. Acne vaccines, topical natural antimicrobial peptides, and lauric acid represent other promising therapies.
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Abstract
This article briefly reviews some of the most common skin lesions in the head and neck of a child. Benign "lumps and bumps" are very common in children and it is prudent for the pediatric maxillofacial surgeon to be familiar with their presentation, workup (including radiographic studies), and definitive surgical management. Inflammatory and infectious lesions require prompt treatment to avoid more serious sequelae of progressive infection and scarring.
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Affiliation(s)
- Joli C Chou
- Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Schattner Building, 240 South, 40th Street, Philadelphia, PA 19104, USA.
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Dupuy A. Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2011; 138 Suppl 4:S263-72. [DOI: 10.1016/s0151-9638(11)70100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Simpson RC, Grindlay DJ, Williams HC. What’s new in acne? An analysis of systematic reviews and clinically significant trials published in 2010-11. Clin Exp Dermatol 2011; 36:840-3; quiz 843-4. [DOI: 10.1111/j.1365-2230.2011.04218.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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