101
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Gold MH, Goldberg DJ, Nestor MS. Current treatments of acne: Medications, lights, lasers, and a novel 650-μs 1064-nm Nd: YAG laser. J Cosmet Dermatol 2017; 16:303-318. [PMID: 28703382 DOI: 10.1111/jocd.12367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
Abstract
The treatment of acne, especially severe acne, remains a challenge to dermatologists. Therapies include retinoids, antibiotics, hormones, lights, lasers, and various combinations of these modalities. Acne is currently considered a chronic rather than an adolescent condition. The appropriate treatment depends on the patient and the severity of disease. The purpose of this study was to review current therapies for acne of all severities and to introduce the 650-μs 1064-nm laser for the treatment of acne.
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Affiliation(s)
| | - David J Goldberg
- Skin Laser and Surgery Specialists of NY and NJ, Hackensack, NJ, USA
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102
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Barbieri JS, James WD, Margolis DJ. Trends in prescribing behavior of systemic agents used in the treatment of acne among dermatologists and nondermatologists: A retrospective analysis, 2004-2013. J Am Acad Dermatol 2017; 77:456-463.e4. [PMID: 28676330 DOI: 10.1016/j.jaad.2017.04.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite recommendations to limit the use of oral antibiotics and increasing support for hormonal agents in the treatment of acne, it is unclear whether there have been any significant changes in practice patterns. OBJECTIVE To characterize changes in prescribing behavior for systemic agents in the treatment of acne in the United States between 2004 and 2013. METHODS We conducted a retrospective analysis using the OptumInsight Clinformatics DataMart (Optum, Eden Prairie, MN). RESULTS The number of courses of spironolactone prescribed per 100 female patients being managed for acne by dermatologists and nondermatologists increased from 2.08 to 8.13 and from 1.43 to 4.09, respectively. The median duration of therapy with oral antibiotics was 126 and 129 days among patients managed by dermatologists and nondermatologists, respectively, and did not change significantly over the study period. LIMITATIONS The OptumInsight Clinformatics DataMart lacks information on acne severity and clinical outcomes. CONCLUSIONS Additional work to identify patients who would benefit most from alternative therapies such as spironolactone, oral contraceptives, or isotretinoin represents a potential opportunity to improve the care of patients with acne.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - William D James
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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103
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Sacchidanand SA, Lahiri K, Godse K, Patwardhan NG, Ganjoo A, Kharkar R, Narayanan V, Borade D, D’souza L. Synchronizing Pharmacotherapy in Acne with Review of Clinical Care. Indian J Dermatol 2017; 62:341-357. [PMID: 28794543 PMCID: PMC5527713 DOI: 10.4103/ijd.ijd_41_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.
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Affiliation(s)
| | - Koushik Lahiri
- Consultant Dermatologist, Wizderm Speciality Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Kiran Godse
- Shree Skin Centre and Pathology Laboratory, Navi Mumbai, Maharashtra, India
| | | | - Anil Ganjoo
- Dr. Ganjoo's Skin and Cosmetology Centre, New Delhi, India
| | - Rajendra Kharkar
- Consultant Dermatologist, Dr. Kharkar's Skin Clinic, Mumbai, Maharashtra, India
| | - Varsha Narayanan
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Dhammraj Borade
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Lyndon D’souza
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
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104
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Kawashima M, Sato S, Furukawa F, Matsunaga K, Akamatsu H, Igarashi A, Tsunemi Y, Hayashi N, Yamamoto Y, Nagare T, Katsuramaki T. Twelve-week, multicenter, placebo-controlled, randomized, double-blind, parallel-group, comparative phase II/III study of benzoyl peroxide gel in patients with acne vulgaris: A secondary publication. J Dermatol 2017; 44:774-782. [PMID: 28295516 PMCID: PMC5516201 DOI: 10.1111/1346-8138.13798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
A placebo-controlled, randomized, double-blind, parallel-group, comparative, multicenter study was conducted to investigate the efficacy and safety of benzoyl peroxide (BPO) gel, administrated once daily for 12 weeks to Japanese patients with acne vulgaris. Efficacy was evaluated by counting all inflammatory and non-inflammatory lesions. Safety was evaluated based on adverse events, local skin tolerability scores and laboratory test values. All 609 subjects were randomly assigned to receive the study products (2.5% and 5% BPO and placebo), and 607 subjects were included in the full analysis set, 544 in the per protocol set and 609 in the safety analyses. The median rates of reduction from baseline to the last evaluation of the inflammatory lesion counts, the primary end-point, in the 2.5% and 5% BPO groups were 72.7% and 75.0%, respectively, and were significantly higher than that in the placebo group (41.7%). No deaths or other serious adverse events were observed. The incidences of adverse events in the 2.5% and 5% BPO groups were 56.4% and 58.8%, respectively; a higher incidence than in the placebo group, but there was no obvious difference between the 2.5% and 5% BPO groups. All adverse events were mild or moderate in severity. Most adverse events did not lead to study product discontinuation. The results suggested that both 2.5% and 5% BPO are useful for the treatment of acne vulgaris.
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Affiliation(s)
- Makoto Kawashima
- Department of DermatologyTokyo Women's Medical UniversityTokyoJapan
| | - Shinichi Sato
- Department of DermatologyGraduate School of Medicine and Faculty of MedicineThe University of TokyoTokyoJapan
| | - Fukumi Furukawa
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Kayoko Matsunaga
- Departments of Integrative Medical Science for Allergic DiseaseFujita Health University School of MedicineAichiJapan
| | - Hirohiko Akamatsu
- Department of Applied Cell and Regenerative MedicineFujita Health University School of MedicineAichiJapan
| | | | - Yuichiro Tsunemi
- Department of DermatologyTokyo Women's Medical UniversityTokyoJapan
| | | | - Yuki Yamamoto
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Toshitaka Nagare
- Medical Writing GroupData Science DepartmentMaruho Co. LtdKyotoJapan
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105
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Zouboulis CC, Dessinioti C, Tsatsou F, Gollnick HPM. Anti-acne drugs in phase 1 and 2 clinical trials. Expert Opin Investig Drugs 2017. [PMID: 28627277 DOI: 10.1080/13543784.2017.1337745] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite the impressive increase of knowledge on acne etiology accumulated during the last 20 years, few efforts have been overtaken to introduce new therapeutic regiments targeting the ideal treatment of acne. The increasing emergence of microbial resistance associated with antibiotics, teratogenicity, particularly associated with systemic isotretinoin, and the need for an adverse drug profile, which can be tolerated by the patient, make the need of new pathogenesis relevant anti-acne agents an emerging issue. Areas covered: A search for phase 1 and 2 acne treatment trials in the US National Institutes of Health database of clinical trials and the European Medicines Agency database with the key words 'acne' and 'treatment' was carried out, on 6 January 2017. Expert opinion: The detected trials mostly investigate topical agents that may act via sebosuppressive effects, antimicrobial properties or anti-inflammatory actions. The compounds under investigation include olumacostat glasaretil, cortexolone 17α-propionate, stearoyl-CoA desaturase 1 inhibitors, agents affecting the melanocortin system, omiganan, and minocycline. Systemic studied anti-acne drugs include finasteride, biologics, low dose anti-inflammatory antibiotics, and leukotriene B4 inhibitors.
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Affiliation(s)
- Christos C Zouboulis
- a Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center , Theodore Fontane Medical University of Brandenburg , Dessau , Germany
| | - Clio Dessinioti
- b Department of Dermatology , Andreas Sygros Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Fragkiski Tsatsou
- a Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center , Theodore Fontane Medical University of Brandenburg , Dessau , Germany
| | - Harald P M Gollnick
- c Department of Venerology and Dermatology , Otto von Guericke University Magdeburg , Magdeburg , Germany
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106
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Leyden J, Stein-Gold L, Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb) 2017; 7:293-304. [PMID: 28585191 PMCID: PMC5574737 DOI: 10.1007/s13555-017-0185-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Indexed: 12/16/2022] Open
Abstract
Acne-focused dermatology expert groups have consistently recommended that most patients with acne be treated with a combination of topical retinoid and antimicrobial therapy. This is based on clinical data as well as evidence that these drug classes have different and complementary mechanisms of action that target multiple aspects of acne's complex pathophysiology. Recent evidence-based guidelines for acne, including those from the American Academy of Dermatology (AAD) and the European Dermatology Forum (EDF), have agreed that retinoids have an essential role in this widespread disease. The AAD states "retinoids are the core of topical therapy for acne because they are comedolytic, resolve the precursor microcomedone lesion, and are anti-inflammatory;" further, they "allow for maintenance of clearance." Despite uniform recommendation for use of topical retinoids, a recent study of prescribing practices from 2012 to 2014 indicated that dermatologists prescribed retinoids just 58.8% of the time while non-dermatologists prescribed them for only 32.4% of cases. In this article, we review the reasons supporting retinoids as the mainstay of acne therapy and discuss some of the perceived barriers that may be limiting use of this important drug class. Further, we discuss how and when titrating retinoid concentrations may be utilized in clinical practice. FUNDING Galderma International.
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Affiliation(s)
- James Leyden
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Linda Stein-Gold
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Jonathan Weiss
- Gwinnett Dermatology, PC, and Gwinnett Clinical Research Center, Inc., Snellville, GA, USA
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107
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Boen M, Brownell J, Patel P, Tsoukas MM. The Role of Photodynamic Therapy in Acne: An Evidence-Based Review. Am J Clin Dermatol 2017; 18:311-321. [PMID: 28276005 DOI: 10.1007/s40257-017-0255-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acne vulgaris is a highly prevalent skin disorder that affects almost all adolescents and can persist into adulthood. Photodynamic therapy (PDT) is an emerging treatment for acne that involves the use of a photosensitizer in combination with a light source and oxygen. METHODS We performed a systematic review of the literature and critically evaluated the studies. Sixty-nine clinical trials, four case reports, and two retrospective studies met the inclusion criteria, and seven of the studies were high quality. RESULTS The most common photosensitizers used were 5-aminolevulinic acid and methyl aminolevulinate, and both showed similar response. Red light was the most frequently used light source, followed by intense pulsed light, and showed comparable results. Inflammatory and non-inflammatory lesions both responded to treatment, with inflammatory lesions showing greater clearance in most studies. Adverse events associated with PDT for acne were mild and included pain on illumination and post-procedural erythema and edema. PDT has been safely used in higher Fitzpatrick skin types (III-IV), although these patients had a higher risk of transient hyperpigmentation. CONCLUSION This review supports PDT as an efficacious treatment for acne and a good adjunctive treatment for mild to severe acne, especially in patients who have not responded to topical therapy and oral antibacterials, and are not great candidates for isotretinoin. Further studies are warranted to evaluate the optimal photosensitizers, light sources, incubation times, and number of treatments for PDT use in acne.
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Affiliation(s)
- Monica Boen
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA.
| | - Joshua Brownell
- College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Room 130, Chicago, IL, 60612, USA
| | - Priyanka Patel
- College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Room 130, Chicago, IL, 60612, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St., Suite 380, Chicago, IL, 60612, USA.
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108
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Chlebus E, Chlebus M. Factors affecting the course and severity of adult acne. Observational cohort study. J DERMATOL TREAT 2017; 28:737-744. [DOI: 10.1080/09546634.2017.1329500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ewa Chlebus
- Nova Derm Dermatology Centre, Warsaw, Poland
| | - Marcin Chlebus
- Department of Quantitative Finance, Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
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109
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Borgonjen R, de Lange J, van de Kerkhof P. Guideline-based clinical decision support in acne patients receiving isotretinoin: improving adherence and cost-effectiveness. J Eur Acad Dermatol Venereol 2017; 31:e440-e442. [DOI: 10.1111/jdv.14247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R.J. Borgonjen
- Department of Dermatology; Radboud university medical center; 6500 HB Nijmegen The Netherlands
| | - J.A. de Lange
- Department of Dermatology; Radboud university medical center; 6500 HB Nijmegen The Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud university medical center; 6500 HB Nijmegen The Netherlands
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110
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111
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Nast A, Rosumeck S, Erdmann R, Alsharif U, Dressler C, Werner RN. Methods report on the development of the European evidence-based (S3) guideline for the treatment of acne - update 2016. J Eur Acad Dermatol Venereol 2017; 30:e1-e28. [PMID: 27514933 DOI: 10.1111/jdv.13783] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A Nast
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Rosumeck
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Erdmann
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - U Alsharif
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Dressler
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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112
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Bactericidal activity and post-antibiotic effect of ozenoxacin against Propionibacterium acnes. J Infect Chemother 2017; 23:374-380. [PMID: 28389164 DOI: 10.1016/j.jiac.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 01/20/2023]
Abstract
Ozenoxacin, a novel non-fluorinated topical quinolone, is used for the treatment of acne vulgaris in Japan. We investigated bactericidal activity and post-antibiotic effect (PAE) of ozenoxacin against Propionibacterium acnes, a major causative bacterium of acne vulgaris. The minimum inhibitory concentrations (MICs) of ozenoxacin against 3 levofloxacin-susceptible strains (MIC of levofloxacin; ≤4 μg/mL) and 3 levofloxacin-resistant strains (MIC of levofloxacin; ≥8 μg/mL) ranged from 0.03 to 0.06 μg/mL and from 0.25 to 0.5 μg/mL, respectively. These MICs of ozenoxacin were almost the same or lower than nadifloxacin and clindamycin. The minimum bactericidal concentrations (MBCs) of ozenoxacin against the levofloxacin-susceptible and -resistant strains were from 0.06 to 8 μg/mL and from 0.5 to 4 μg/mL, respectively. These MBCs were lower than those of nadifloxacin and clindamycin. In time-kill assay, ozenoxacin at 1/4, 1 and 4 times the respective MIC against both levofloxacin-susceptible and -resistant strains showed a concentration-dependent bactericidal activity. Ozenoxacin at 4 times the MICs against the levofloxacin-susceptible strains showed more potent and more rapid onset of bactericidal activity compared to nadifloxacin and clindamycin at 4 times the respective MICs. The PAEs of ozenoxacin at 4 times the MICs against the levofloxacin-susceptible strains were from 3.3 to 17.1 h, which were almost the same or longer than nadifloxacin and clindamycin. In contrast, the PAEs were hardly induced by any antimicrobial agents against the levofloxacin-resistant strains. The present findings suggest that ozenoxacin has a potent bactericidal activity against both levofloxacin-susceptible and -resistant P. acnes, and a long-lasting PAE against levofloxacin-susceptible P. acnes.
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113
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Abstract
The article highlights different educational and practice gaps in infectious diseases as they pertain to dermatology. These gaps include the use of antibiotics in relation to atopic dermatitis and acne vulgaris, treatment of skin and soft tissue infection, and diagnosis and treatment of onychomycosis. In addition, practice gaps related to use of imiquimod for molluscum contagiosum, risk of infections related to immunosuppressive medications and rates of vaccination, and the use of bedside diagnostics for diagnosing common infections were discussed.
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Affiliation(s)
- Shelby Hopp
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Tyler L Quest
- Department of Dermatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Karolyn A Wanat
- Department of Dermatology, Pathology and Infectious Disease, University of Iowa Hospitals and Clinics, and VA Medical Center, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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114
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McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal 2017; 3:2059513116689805. [PMID: 29799579 PMCID: PMC5965340 DOI: 10.1177/2059513116689805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.
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Affiliation(s)
- Rory Boyd McGoldrick
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | - Evgenia Theodorakopoulou
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | | | - Maxwell Murison
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
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115
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López-Estebaranz J, Herranz-Pinto P, Dréno B. Consensus-Based Acne Classification System and Treatment Algorithm for Spain. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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116
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117
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118
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Patwardhan SV, Richter C, Vogt A, Blume-Peytavi U, Canfield D, Kottner J. Measuring acne using Coproporphyrin III, Protoporphyrin IX, and lesion-specific inflammation: an exploratory study. Arch Dermatol Res 2017; 309:159-167. [PMID: 28180934 PMCID: PMC5348552 DOI: 10.1007/s00403-017-1718-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/06/2017] [Accepted: 01/17/2017] [Indexed: 01/20/2023]
Abstract
Propionibacterium acnes: (P. acnes) produce Porphyrins; however, fluorescence measurement of Porphyrins from Ultraviolet-A (UVA) images has failed to establish a correlation. Acne clinical research and imaging has ignored the spectral excitation-emission characteristics and the exact pattern of the Porphyrins synthesized by P. acnes. In this exploratory study, for the first time, the possible relationships of Coproporphyrin III (CpIII) and Protoporphyrin IX (PpIX) fluorescence as well as acne lesion-specific inflammation measurements with clinical signs of acne are investigated. Furthermore, the sensitivity of these measurements in tracking and differentiating the known treatment effects of Benzoyl Peroxide (BPO) 5%, and combination of Clindamycin + BPO are also evaluated. Comedonal and papulopustular lesions identified by investigators during a live assessment of 24 mild-to-severe acne subjects were compared with fluorescence and inflammation measurements obtained from analysis of VISIA®-CR images. CpIII fluorescence spots showed a strong correlation (r = 0.69-0.83), while PpIX fluorescence spots showed a weak correlation (r = 0.19-0.27) with the investigators' comedonal lesion counts. A strong correlation was also observed between the investigators' papulopustular lesion counts and acne lesion-specific inflammation (r = 0.76). Our results suggest that CpIII fluorescence and acne lesion-specific-inflammation measurement can provide objective indication of comedonal and papulopustular acne severity, respectively. Furthermore, these measurements may be more sensitive and specific in evaluating treatment effects and early signs of acne lesion progression compared to investigators' lesion counts.
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Affiliation(s)
| | - C Richter
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Vogt
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - U Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - D Canfield
- Canfield Scientific Inc., 4 Wood Hollow Road, Parsippany, NJ, 07054, USA
| | - J Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
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119
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Kawashima M, Nagare T, Katsuramaki T. Open-label, randomized, multicenter, phase III study to evaluate the safety and efficacy of benzoyl peroxide gel in long-term use in patients with acne vulgaris: A secondary publication. J Dermatol 2017; 44:635-643. [PMID: 28150367 PMCID: PMC5484293 DOI: 10.1111/1346-8138.13741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/21/2016] [Indexed: 11/06/2022]
Abstract
An open‐label, randomized, multicenter study was conducted to evaluate the safety and efficacy of long‐term use of 2.5% and 5% benzoyl peroxide (BPO) gels administrated once daily for 52 weeks to Japanese patients with acne vulgaris. The efficacy of the study drugs was evaluated by counting inflammatory lesions and non‐inflammatory lesions. Safety was evaluated based on adverse events, local skin tolerability scores and laboratory test values. In total, 458 subjects were included in the efficacy and safety analyses. The total lesion count, the efficacy end‐point, was similarly changed both in the 2.5% and 5% BPO groups over the course of the study. The median rates of reduction from baseline to week 12 were approximately 65%. Thereafter, the counts were maintained at a reduced level without increasing until week 52. The median rates at week 52 were approximately 80%. Similar trends were observed for inflammatory and non‐inflammatory lesion counts. Bacteriological evaluation indicated similar distribution of the minimum inhibitory concentration of each of the antibacterial drugs against Propionibacterium acnes between the values at baseline and at week 52, suggesting that long‐term use did not result in changes in the drug sensitivity. The incidence of adverse events was 84.0% in the 2.5% BPO group and 87.2% in the 5% BPO group. Many of the adverse events occurred within the first month and were mild or moderate in severity and transient. The results suggest that both 2.5% and 5% BPO gels are effective and safe for long‐term treatment of patients with acne vulgaris.
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Affiliation(s)
- Makoto Kawashima
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshitaka Nagare
- Medical Writing Group, Data Science Department, Maruho Co. Ltd, Kyoto, Japan
| | - Tsuneo Katsuramaki
- Medical Writing Group, Data Science Department, Maruho Co. Ltd, Kyoto, Japan
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Abstract
Acne, one of the most common skin diseases, affects approximately 85% of the adolescent population, and occurs most prominently at skin sites with a high density of sebaceous glands such as the face, back, and chest. Although often considered a disease of teenagers, acne is occurring at an increasingly early age. Rosacea is a chronic facial inflammatory dermatosis characterized by flushing (or transient facial erythema), persistent central facial erythema, inflammatory papules/pustules, and telangiectasia. Both acne and rosacea have a multifactorial pathology that is incompletely understood. Increased sebum production, keratinocyte hyper-proliferation, inflammation, and altered bacterial colonization with Propionibacterium acnes are considered to be the underlying disease mechanisms in acne, while the multifactorial pathology of rosacea is thought to involve both vasoactive and neurocutaneous mechanisms. Several advances have taken place in the past decade in the research field of acne and rosacea, encompassing pathogenesis and epidemiology, as well as the development of new therapeutic interventions. In this article, we provide an overview of current perspectives on the pathogenesis and treatment of acne and rosacea, including a summary of findings from recent landmark pathophysiology studies considered to have important implications for future clinical practice. The advancement of our knowledge of the different pathways and regulatory mechanisms underlying acne and rosacea is thought to lead to further advances in the therapeutic pipeline for both conditions, ultimately providing a greater array of treatments to address gaps in current management practices.
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Affiliation(s)
| | | | - Jerry Tan
- University of Western Ontario, Windsor, ON, Canada
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121
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Harris VR, Cooper AJ. Modern management of acne. Med J Aust 2017; 206:41-45. [DOI: 10.5694/mja16.00516] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
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122
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Bissonnette R, Poulin Y, Drew J, Hofland H, Tan J. Olumacostat glasaretil, a novel topical sebum inhibitor, in the treatment of acne vulgaris: A phase IIa, multicenter, randomized, vehicle-controlled study. J Am Acad Dermatol 2017; 76:33-39. [DOI: 10.1016/j.jaad.2016.08.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022]
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123
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Richter C, Trojahn C, Hillmann K, Dobos G, Kanti V, Vogt A, Blume-Peytavi U, Kottner J. Sensitivity to change of the Dermatology Life Quality Index in adult females with facial acne vulgaris: a validation study. J Eur Acad Dermatol Venereol 2017; 31:169-174. [PMID: 27393576 DOI: 10.1111/jdv.13757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/30/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The postadolescent form of acne papulopustulosa, also referred to as 'acne tarda' can have substantial negative impact on Quality of Life, especially in adult female patients. OBJECTIVE Although the Dermatology Life Quality Index (DLQI) is widely used, empirical evidence about its performance in adult female acne patients is lacking. METHODS In this prospective cohort study, we have investigated the sensitivity to change of the DLQI in 53 female adult acne patients with mild to moderate facial acne treated with azelaic acid (AzA) 15% gel twice daily over 24 weeks. RESULTS Mean Investigator Static Global Assessment (ISGA) score was 2.3 (SD 0.5) at baseline and ranged from 0.9 (SD 0.3) to 2.1 (SD 0.4) at the end of the study in the 'Highly Improved' and 'Unchanged' responder groups respectively. The mean baseline DLQI score was 5.1 (SD 4.2). The Effect Size in the responder group 'Highly Improved' was 0.66; in group 'Improved' 0.62 and 0.23 in group 'Unchanged'. At the end of study, the mean DLQI score ranged from 1.1 (SD 1.5) in the 'Highly Improved' group to 3.7 (SD 6.0) in the 'Unchanged' group. CONCLUSION The results support the sensitivity to change of the DLQI in this population.
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Affiliation(s)
- C Richter
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - C Trojahn
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - K Hillmann
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - G Dobos
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - V Kanti
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - A Vogt
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - U Blume-Peytavi
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - J Kottner
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Clinical Research Center for Hair and Skin Science, Berlin, Germany
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Kainz JT, Berghammer G, Auer-Grumbach P, Lackner V, Perl-Convalexius S, Popa R, Wolfesberger B. Azelainsäure 20 % Creme: Auswirkung auf Lebensqualität und Krankheitsaktivität bei erwachsenen Patientinnen mit Acne vulgaris. J Dtsch Dermatol Ges 2016; 14:1249-1260. [PMID: 27992138 DOI: 10.1111/ddg.12889_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/19/2015] [Indexed: 11/30/2022]
Abstract
HINTERGRUND Zur Wirksamkeit von Aknetherapien und deren Auswirkungen auf die Lebensqualität erwachsener Patienten liegen kaum Daten vor. ZIEL: Erhebung der Wirkung von Azelainsäure 20 % Creme (Skinoren® ) auf Akne-Schweregrad und krankheitsbedingte Lebensqualität. PATIENTEN UND METHODIK Nichtinterventionelle Studie bei erwachsenen Patientinnen mit leichter bis mittelschwerer Akne. Wirksamkeitsparameter waren DLQI sowie Akne-Schweregrad im Gesicht, am Dekolleté sowie am Rücken im Gesamturteil des Prüfarztes (IGA-Skala: Grad 1 = annähernd reine Haut; 2 = leichte Akne; 3 = mittelschwere Akne). Visiten waren zu Studienbeginn sowie nach 4-8 und zwölf Wochen geplant. ERGEBNISSE Von den 251 eingeschlossenen Patientinnen lag zu Studienbeginn bei 59 %, 31 % bzw. 10 % ein IGA-Grad von 1, 2 bzw. 3 vor; die am häufigsten betroffene Hautpartie war das Gesicht (IGA-Grad 2 oder 3: 79 %). Nach zwölf Behandlungswochen war eine signifikante Besserung der Acne vulgaris im Gesicht (IGA-Grad 0 oder 1: 82 %) sowie auf Dekolleté und Rücken feststellbar. Der mediane DLQI-Wert sank von neun zu Studienbeginn auf fünf nach zwölf Behandlungswochen. Neunzig Prozent der behandelnden Ärzte und Patientinnen beurteilten die Verträglichkeit der Behandlung als sehr gut oder gut. SCHLUSSFOLGERUNGEN Die Anwendung von 20%iger Azelainsäure-Creme führt bei erwachsenen Frauen zu einer signifikanten Besserung der Acne vulgaris und der krankheitsbedingten Lebensqualität.
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Affiliation(s)
| | | | | | | | | | - Rodica Popa
- Hautarztpraxis, 8490, Bad Radkersburg, Österreich
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125
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Barbieri JS, Hoffstad O, Margolis DJ. Duration of oral tetracycline-class antibiotic therapy and use of topical retinoids for the treatment of acne among general practitioners (GP): A retrospective cohort study. J Am Acad Dermatol 2016; 75:1142-1150.e1. [DOI: 10.1016/j.jaad.2016.06.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 01/30/2023]
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126
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Kainz JT, Berghammer G, Auer-Grumbach P, Lackner V, Perl-Convalexius S, Popa R, Wolfesberger B. Azelaic acid 20 % cream: effects on quality of life and disease severity in adult female acne patients. J Dtsch Dermatol Ges 2016; 14:1249-1259. [PMID: 27897372 DOI: 10.1111/ddg.12889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/19/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Data on the efficacy of acne treatments and their impact on quality of life (QoL) in adult patients is sketchy. OBJECTIVE Assessment of the efficacy of azelaic acid 20 % cream (Skinoren® ) on acne severity and disease-related QoL. PATIENTS AND METHODS Noninterventional study in adult female patients with mild to moderate acne. Efficacy variables included DLQI and acne severity on the face, chest, and back using the Investigator's Global Assessment (IGA) scale (grade 1 = nearly clear skin; 2 = mild acne; 3 = moderate acne). Visits were scheduled at baseline, at 4-8 weeks, and at twelve weeks. RESULTS Of the 251 women enrolled, 59 % had grade 1 acne at baseline; 31 %, grade 2; and 10 %, grade 3; the most commonly affected area of the body was the face (IGA grades 2 or 3: 79 %). After twelve weeks, there was significant improvement of acne on the face (IGA grades 0 or 1: 82 %), chest, and back. Median DLQI decreased from nine at baseline to five after twelve weeks. Ninety percent of physicians and patients rated the tolerability of the treatment as very good or good. CONCLUSIONS Treatment with azelaic acid 20 % cream significantly improves acne severity and disease-related QoL in adult women.
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Affiliation(s)
| | | | | | | | | | - Rodica Popa
- Dermatology Practice, 8490, Bad Radkersburg, Austria
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127
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López-Estebaranz JL, Herranz-Pinto P, Dréno B. Consensus-Based Acne Classification System and Treatment Algorithm for Spain. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:120-131. [PMID: 27816123 DOI: 10.1016/j.ad.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/14/2016] [Accepted: 10/02/2016] [Indexed: 01/24/2023] Open
Abstract
Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered.
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Affiliation(s)
| | | | - B Dréno
- Hospital Universitario de Nantes, Nantes, Francia
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128
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Lizneva D, Gavrilova-Jordan L, Walker W, Azziz R. Androgen excess: Investigations and management. Best Pract Res Clin Obstet Gynaecol 2016; 37:98-118. [DOI: 10.1016/j.bpobgyn.2016.05.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 01/25/2023]
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129
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Abstract
Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. The most frequently used peeling agents are salicylic acid, glycolic acid, pyruvic acid, lactic acid, mandelic acid, Jessner solution, trichloroacetic acid, and phenol. The appropriate peel is chosen based on the patient's skin type, acne activity, and type of acne scars. Combination peels minimize side effects. In acne scars, chemical peels may be combined with other procedures to achieve better clinical results. A series of chemical peels can lead to significant improvement over a short period, leading to patient satisfaction and maintenance of clinical results. © 2016 Elsevier Inc. All rights reserved.
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Affiliation(s)
| | - Eftychia Platsidaki
- Department of Dermatology and Venereology, Andreas Sygros Skin Hospital, Athens, Greece.
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130
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Quick Evidence Synopsis. Dermatol Clin 2016. [DOI: 10.1016/j.det.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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131
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Barbaric J, Abbott R, Posadzki P, Car M, Gunn LH, Layton AM, Majeed A, Car J. Light therapies for acne. Cochrane Database Syst Rev 2016; 9:CD007917. [PMID: 27670126 PMCID: PMC6457763 DOI: 10.1002/14651858.cd007917.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acne vulgaris is a very common skin problem that presents with blackheads, whiteheads, and inflamed spots. It frequently results in physical scarring and may cause psychological distress. The use of oral and topical treatments can be limited in some people due to ineffectiveness, inconvenience, poor tolerability or side-effects. Some studies have suggested promising results for light therapies. OBJECTIVES To explore the effects of light treatment of different wavelengths for acne. SEARCH METHODS We searched the following databases up to September 2015: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and LILACS. We searched ISI Web of Science and Dissertation Abstracts International (from inception). We also searched five trials registers, and grey literature sources. We checked the reference lists of studies and reviews and consulted study authors and other experts in the field to identify further references to relevant randomised controlled trials (RCTs). We updated these searches in July 2016 but these results have not yet been incorporated into the review. SELECTION CRITERIA We included RCTs of light for treatment of acne vulgaris, regardless of language or publication status. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 71 studies, randomising a total of 4211 participants.Most studies were small (median 31 participants) and included participants with mild to moderate acne of both sexes and with a mean age of 20 to 30 years. Light interventions differed greatly in wavelength, dose, active substances used in photodynamic therapy (PDT), and comparator interventions (most commonly no treatment, placebo, another light intervention, or various topical treatments). Numbers of light sessions varied from one to 112 (most commonly two to four). Frequency of application varied from twice daily to once monthly.Selection and performance bias were unclear in the majority of studies. Detection bias was unclear for participant-assessed outcomes and low for investigator-assessed outcomes in the majority of studies. Attrition and reporting bias were low in over half of the studies and unclear or high in the rest. Two thirds of studies were industry-sponsored; study authors either reported conflict of interest, or such information was not declared, so we judged the risk of bias as unclear.Comparisons of most interventions for our first primary outcome 'Participant's global assessment of improvement' were not possible due to the variation in the interventions and the way the studies' outcomes were measured. We did not combine the effect estimates but rated the quality of the evidence as very low for the comparison of light therapies, including PDT to placebo, no treatment, topical treatment or other comparators for this outcome. One study which included 266 participants with moderate to severe acne showed little or no difference in effectiveness for this outcome between 20% aminolevulinic acid (ALA)-PDT (activated by blue light) versus vehicle plus blue light (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.04, low-quality evidence). A study (n = 180) of a comparison of ALA-PDT (activated by red light) concentrations showed 20% ALA was no more effective than 15% (RR 1.05, 95% CI 0.96 to 1.15) but better than 10% ALA (RR 1.22, 95% CI 1.05 to 1.42) and 5% ALA (RR 1.47, 95% CI 1.19 to 1.81). The number needed to treat for an additional beneficial outcome (NNTB) was 6 (95% CI 3 to 19) and 4 (95% CI 2 to 6) for the comparison of 20% ALA with 10% and 5% ALA, respectively.For our second primary outcome 'Investigator-assessed changes in lesion counts', we combined three RCTs, with 360 participants with moderate to severe acne and found methyl aminolevulinate (MAL) PDT (activated by red light) was no different to placebo cream plus red light with regard to change in inflamed lesions (ILs) (mean difference (MD) -2.85, 95% CI -7.51 to 1.81), percentage change in ILs (MD -10.09, 95% CI -20.25 to 0.06), change in non-inflamed lesions (NILs) (MD -2.01, 95% CI -7.07 to 3.05), or in percentage change in NILs (MD -8.09, 95% CI -21.51 to 5.32). We assessed the evidence as moderate quality for these outcomes meaning that there is little or no clinical difference between these two interventions for lesion counts.Studies comparing the effects of other interventions were inconsistent or had small samples and high risk of bias. We performed only narrative synthesis for the results of the remaining trials, due to great variation in many aspects of the studies, poor reporting, and failure to obtain necessary data. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold microparticle suspension to vehicle, and clindamycin/benzoyl peroxide combined with pulsed dye laser to clindamycin/benzoyl peroxide alone. There were also several other studies comparing MAL-PDT to light-only treatment, to adapalene and in combination with long-pulsed dye laser to long-pulsed dye laser alone. None of these showed any clinically significant effects.Our third primary outcome was 'Investigator-assessed severe adverse effects'. Most studies reported adverse effects, but not adequately with scarring reported as absent, and blistering reported only in studies on intense pulsed light, infrared light and photodynamic therapies. We rated the quality of the evidence as very low, meaning we were uncertain of the adverse effects of the light therapies.Although our primary endpoint was long-term outcomes, less than half of the studies performed assessments later than eight weeks after final treatment. Only a few studies assessed outcomes at more than three months after final treatment, and longer-term assessments are mostly not covered in this review. AUTHORS' CONCLUSIONS High-quality evidence on the use of light therapies for people with acne is lacking. There is low certainty of the usefulness of MAL-PDT (red light) or ALA-PDT (blue light) as standard therapies for people with moderate to severe acne.Carefully planned studies, using standardised outcome measures, comparing the effectiveness of common acne treatments with light therapies would be welcomed, together with adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.
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Affiliation(s)
- Jelena Barbaric
- School of Medicine, University of ZagrebAndrija Stampar School of Public HealthRockefellerova 4ZagrebCroatia10000
| | - Rachel Abbott
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Mate Car
- Imperial College LondonDepartment of Primary Care and Public HealthSt Dunstan's RoadLondonUKW6 8RP
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Alison M Layton
- Harrogate and District NHS Foundation TrustDepartment of DermatologyHarrogateUK
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthSt Dunstan's RoadLondonUKW6 8RP
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthReynolds BuildingSt Dunstans RoadLondonUKW6 8RP
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132
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Abstract
Acne vulgaris is a common skin condition associated with multiple factors. Although mostly presenting alone, it can likewise present with features of hyperandrogenism and hormonal discrepancies. Of note, hormonal therapies are indicated in severe, resistant-to-treatment cases and in those with monthly flare-ups and when standard therapeutic options are inappropriate. This article serves as an update to hormonal pathogenesis of acne, discusses the basics of endocrinal evaluation for patients with suspected hormonal acne, and provides an overview of the current hormonal treatment options in women.
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Affiliation(s)
- Mohamed L Elsaie
- Department of Dermatology and Venereology, National Research Centre, Cairo, Egypt
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133
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Topical Ivermectin 10 mg/g and Oral Doxycycline 40 mg Modified-Release: Current Evidence on the Complementary Use of Anti-Inflammatory Rosacea Treatments. Adv Ther 2016; 33:1481-501. [PMID: 27432381 PMCID: PMC5020118 DOI: 10.1007/s12325-016-0380-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Indexed: 12/21/2022]
Abstract
Rosacea is a common, chronic inflammatory skin disease that can present with a variety of signs and symptoms. The potentially simultaneous occurrence of different signs and symptoms is due to different underlying inflammatory pathways, emphasizing the need for complementary treatment approaches. Topical ivermectin cream (10 mg/g) and systemic, oral anti-inflammatory doxycycline (40 mg modified-release) are both approved for the treatment of papulopustular rosacea (PPR). Whether or not a combined therapeutic approach may be more beneficial than monotherapy for patients with PPR remains to be tested. Here, we summarize underlying inflammatory pathways implicated in rosacea and clarify the impact of these two agents on selective pathways during inflammation, due to specific characteristics of their individual mechanisms of action (MoA). Based on the complementary MoA of doxycycline modified-release and ivermectin, a scientific rationale for a combined therapy targeting inflammatory lesions in rosacea is given. We propose that topical ivermectin cream is a promising new candidate as first-line treatment to target the inflammatory lesions of rosacea, which can be used in combination with systemic doxycycline modified-release to provide an optimal treatment approach considering all inflammatory pathways involved in PPR. Funding Galderma.
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134
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Antoniou C, Dessinioti C, Sotiriadis D, Kalokasidis K, Kontochristopoulos G, Petridis A, Rigopoulos D, Vezina D, Nikolis A. A multicenter, randomized, split-face clinical trial evaluating the efficacy and safety of chromophore gel-assisted blue light phototherapy for the treatment of acne. Int J Dermatol 2016; 55:1321-1328. [DOI: 10.1111/ijd.13349] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/28/2016] [Accepted: 03/20/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Christina Antoniou
- 1st Department of Dermatology; University of Athens; Andreas Sygros Hospital; Athens Greece
| | - Clio Dessinioti
- 1st Department of Dermatology; University of Athens; Andreas Sygros Hospital; Athens Greece
| | - Dimitrios Sotiriadis
- Department of Dermatology; Aristotle University of Thessaloniki Medical School; Papageorgiou General Hospital; Thessaloniki Greece
| | - Konstantinos Kalokasidis
- Department of Dermatology; Aristotle University of Thessaloniki Medical School; Papageorgiou General Hospital; Thessaloniki Greece
| | | | | | - Dimitrios Rigopoulos
- University of Athens; Attikon University General Hospital of Athens; Athens Greece
| | | | - Andreas Nikolis
- Division of Plastic Surgery; University of Montreal; Montreal Canada
- Victoria Park Research Centre; Plastic Surgery Section; Montreal Canada
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135
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Khairutdinov VR, Statsenco AV, Samtsov AV. Topical formulations used in the treatment of acne. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-4-75-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents 2 clinical observations of patients with papules-pustular form of acne of moderate severity. In both cases the use of combined topical therapy - topical clindamycin and azelaic acid. The therapeutic effect of clindamycin is faster than other topical preparations. Azelaic acid strengthens the anti-bacterial action of clindamycin, prevents the development of resistance. The results indicate the feasibility of the combined use of these drugs in the treatment of acne.
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136
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Canavan TN, Chen E, Elewski BE. Optimizing Non-Antibiotic Treatments for Patients with Acne: A Review. Dermatol Ther (Heidelb) 2016; 6:555-578. [PMID: 27541148 PMCID: PMC5120627 DOI: 10.1007/s13555-016-0138-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Indexed: 12/22/2022] Open
Abstract
Acne is a very common non-infectious skin condition that is frequently treated in dermatological practices. Because acne is often chronic and may persist for years, safe and effective long-term maintenance therapy is often required. Given the increasing frequency of antibiotic-resistant bacteria and the gravity of the consequences of this trend, it behooves dermatologists to maximize use of non-antimicrobial therapy when treating acne. In this review of the literature we present data regarding the efficacy and appropriate use of non-antimicrobial treatments for acne. A variety of topical and oral treatment options exist that can be used in a step-wise manner according to the patients’ severity and therapeutic response. Non-antimicrobial treatments can be highly efficacious at controlling acne, especially when used as maintenance therapy. While antibiotics have a role in acne treatment, they should not be used as monotherapy, and lengthy courses of antibiotic use are discouraged.
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Affiliation(s)
- Theresa N Canavan
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Edward Chen
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Boni E Elewski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA.
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Can Acne Affect Prognosis of Breast Augmentation? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e754. [PMID: 27482493 PMCID: PMC4956866 DOI: 10.1097/gox.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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138
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Nakajima A, Ikeda F, Kanayama S, Okamoto K, Matsumoto T, Ishii R, Fujikawa A, Takei K, Kawashima M. Antimicrobial activities of ozenoxacin against isolates of propionibacteria and staphylococci from Japanese patients with acne vulgaris. J Med Microbiol 2016; 65:745-750. [DOI: 10.1099/jmm.0.000293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Akiko Nakajima
- Strategic Research Planning & Management Department, Drug Development Laboratories, Kyoto R&D Center, Maruho Co., Ltd., 93 Awata-cho, Chudoji, Shimogyo-ku, Kyoto 600-8815, Japan
| | - Fumiaki Ikeda
- Strategic Research Planning & Management Department, Drug Development Laboratories, Kyoto R&D Center, Maruho Co., Ltd., 93 Awata-cho, Chudoji, Shimogyo-ku, Kyoto 600-8815, Japan
| | - Shoji Kanayama
- Strategic Research Planning & Management Department, Drug Development Laboratories, Kyoto R&D Center, Maruho Co., Ltd., 93 Awata-cho, Chudoji, Shimogyo-ku, Kyoto 600-8815, Japan
| | - Kazuaki Okamoto
- Strategic Research Planning & Management Department, Drug Development Laboratories, Kyoto R&D Center, Maruho Co., Ltd., 93 Awata-cho, Chudoji, Shimogyo-ku, Kyoto 600-8815, Japan
| | - Tatsumi Matsumoto
- Strategic Research Planning & Management Department, Drug Development Laboratories, Kyoto R&D Center, Maruho Co., Ltd., 93 Awata-cho, Chudoji, Shimogyo-ku, Kyoto 600-8815, Japan
| | - Ritsuko Ishii
- Strategic Research Planning & Management Department, Drug Development Laboratories, Kyoto R&D Center, Maruho Co., Ltd., 93 Awata-cho, Chudoji, Shimogyo-ku, Kyoto 600-8815, Japan
| | - Akira Fujikawa
- Clinical Development Department, Kyoto R&D Center, Maruho Co., Ltd., Kyoto, Japan
| | | | - Makoto Kawashima
- Department of Dermatology, Tokyo Women’s Medical University, Tokyo, Japan
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139
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Sadhasivam S, Sinha M, Saini S, Kaur SP, Gupta T, Sengupta S, Ghosh S, Sardana K. Heterogeneity and antibiotic resistance in Propionibacterium acnes
isolates and its therapeutic implications: blurring the lines between commensal and pathogenic phylotypes. Dermatol Ther 2016; 29:451-454. [DOI: 10.1111/dth.12391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Suresh Sadhasivam
- Vyome Biosciences Pvt. Ltd; Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area Delhi 110092 India
- Research Scholar, Research and Development Centre; Bharathiar University; Coimbatore 641046 India
| | - Mau Sinha
- Vyome Biosciences Pvt. Ltd; Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area Delhi 110092 India
| | - Swamini Saini
- Vyome Biosciences Pvt. Ltd; Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area Delhi 110092 India
| | - Simar Preet Kaur
- Vyome Biosciences Pvt. Ltd; Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area Delhi 110092 India
| | - Tanvi Gupta
- Maulana Azad Medical College & Lok Nayak Hospital; Bahadur Shah Zafar Marg; New Delhi 110002 India
| | - Shiladitya Sengupta
- Department of Medicine, Brigham and Women's Hospital; Boston; Massachusetts USA
- Harvard-MIT Division of Health Sciences and Technology; Harvard Medical School; Boston Massachusetts USA
| | - Shamik Ghosh
- Vyome Biosciences Pvt. Ltd; Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area Delhi 110092 India
| | - Kabir Sardana
- Maulana Azad Medical College & Lok Nayak Hospital; Bahadur Shah Zafar Marg; New Delhi 110002 India
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140
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Kuhn KG, Laursen M, Hammerum AM, Skov RL. High consumption of tetracyclines for acne treatment among young Danish adults. Infect Dis (Lond) 2016; 48:808-12. [PMID: 27385460 DOI: 10.1080/23744235.2016.1205214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Tetracyclines are used as acne treatment in adolescents worldwide. A large increase in the consumption of antimicrobial agents in Danish primary health care was recently linked to high levels of tetracycline use in adolescents. METHODS Here we closely examine how demographic factors influenced tetracycline use from 2005 to 2014 using consumption data from primary health care expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID) and number of persons treated per 1000 inhabitants. RESULTS From 2005 to 2013, tetracycline consumption increased by 54% followed by a decrease of 14% in 2014. Increases were especially pronounced in persons aged 15-39 years where nearly 9000 additional persons were treated with tetracyclines. CONCLUSIONS This study shows a long-lasting high consumption of tetracyclines in young Danes with a notable recent decrease breaking the otherwise worrying trend. To obtain a further decrease, focus on public awareness and suitable acne treatment guidelines are highly important.
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Affiliation(s)
- Katrin Gaardbo Kuhn
- a Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology & Infection Control , Statens Serum Institut , Copenhagen , Denmark ;,b Department of Infectious Disease Epidemiology , Statens Serum Institut , Copenhagen , Denmark
| | - Maja Laursen
- c Data Communication and Research Services, Danish Health Data Authority , Copenhagen , Denmark
| | - Anette M Hammerum
- a Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology & Infection Control , Statens Serum Institut , Copenhagen , Denmark
| | - Robert L Skov
- a Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology & Infection Control , Statens Serum Institut , Copenhagen , Denmark
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141
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Czilli T, Tan J, Knezevic S, Peters C. Cost of Medications Recommended by Canadian Acne Clinical Practice Guidelines. J Cutan Med Surg 2016; 20:542-545. [DOI: 10.1177/1203475416653735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Acne affects a large proportion of the Canadian population and has psychosocial and financial consequences. Objective: We provide cost information for treatments recommended by the Canadian acne guidelines. Methods: Highest level recommendations were selected for 3-month usage cost. Results: Three-month estimated treatment costs were as follows: topical retinoids ($14.40-$73.80), benzoyl peroxide (BPO; $6.75), fixed-dose BPO-clindamycin ($40.95-$44.10) and BPO-adapalene ($73.80), oral antibiotics ($25.20 for tetracycline 250 mg qid; $52.20 and $52.74 for doxycycline 50 mg bid and 100 mg od, respectively), and hormonal therapy ($26.46-$37.80 for ethinyl estradiol [EE] 0.030 mg/drospirenone 3mg and $75.60-108.99 for EE 0.035 mg/cyproterone acetate 2 mg). Oral isotretinoin 3-month costs ranged from $393.96 to $478.80. Conclusions: Awareness of costs of recommended treatments may facilitate improved outcomes by increasing procurement and adherence.
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Affiliation(s)
| | - Jerry Tan
- Schulich School of Medicine and Dentistry, Windsor Campus, University of Western Ontario, Windsor, ON, Canada
- Windsor Clinical Research, Ontario, Windsor, ON, Canada
| | - Sanja Knezevic
- Schulich School of Medicine and Dentistry, Windsor Campus, University of Western Ontario, Windsor, ON, Canada
| | - Colin Peters
- Independent pharmacist, Wellington Apothecary, Windsor, ON, Canada
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142
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Lazic Mosler E, Leitner C, Gouda MA, Carter B, Layton AM, KhalafAllah MT. Topical antibiotics for acne. Hippokratia 2016. [DOI: 10.1002/14651858.cd012263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elvira Lazic Mosler
- General Hospital "Dr. Ivo Pedišić"; Department for Dermatology and Venereology; J.J. Strossmayera 59 Sisak Croatia 44000
- University of Zagreb School of Medicine; Department of Anatomy; Zagreb Croatia
- Catholic University of Croatia; Zagreb Croatia
| | - Christina Leitner
- University Hospitals Coventry and Warwickshire NHS Trust; Department of Dermatology; Clifford Bridge Road Coventry UK
| | - Mohamed A Gouda
- Menoufia University; Faculty of Medicine; Shebin Al-Kom Menoufia Egypt
| | - Ben Carter
- Cardiff University School of Medicine; Institute of Primary Care & Public Health; 3rd Floor, Neuadd Meirionnydd, Heath Park Cardiff UK CF14 4YS
| | - Alison M Layton
- Harrogate and District NHS Foundation Trust; Department of Dermatology; Harrogate UK
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143
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Farrah G, Tan E. The use of oral antibiotics in treating acne vulgaris: a new approach. Dermatol Ther 2016; 29:377-384. [DOI: 10.1111/dth.12370] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Georgia Farrah
- Resident Medical Officer, Sir Charles Gairdner Hospital; Perth Western Australia
| | - Ernest Tan
- Consultant Dermatologist, Dermatology Department; Sir Charles Gairdner Hospital; Perth Western Australia
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144
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Manfredini M, Greco M, Farnetani F, Mazzaglia G, Ciardo S, Bettoli V, Virgili A, Pellacani G. In vivomonitoring of topical therapy for acne with reflectance confocal microscopy. Skin Res Technol 2016; 23:36-40. [DOI: 10.1111/srt.12298] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M. Manfredini
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - M. Greco
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Mazzaglia
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - V. Bettoli
- Department of Dermatology; University of Ferrara; Ferrara Italy
| | - A. Virgili
- Department of Dermatology; University of Ferrara; Ferrara Italy
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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145
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Social Anxiety and Quality of Life in Vitiligo and Acne Patients with Facial Involvement: A Cross-Sectional Controlled Study. Am J Clin Dermatol 2016; 17:305-11. [PMID: 26818062 DOI: 10.1007/s40257-016-0172-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vitiligo and acne vulgaris, commonly affecting the face, have significant psychological effects and impair the quality of life of the affected individuals. Because of their negative effect on physical appearance, these conditions may act as a potential barrier to social relationships and cause social anxiety. OBJECTIVE The objective of the study was to investigate the social anxiety, quality of life, anxiety, and depression levels of acne and vitiligo patients with facial involvement and compare these levels with healthy controls. METHODS Thirty-seven vitiligo and 37 acne patients, aged older than 18 years, with facial involvement and 74 age- and sex-matched healthy control subjects were included in the study. The patients and healthy controls were asked to complete the Liebowitz Social Anxiety Scale, the Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. Disease severity was evaluated both objectively by the physician and subjectively by the patients using a visual analog scale. RESULTS Social anxiety, depression, and anxiety levels of vitiligo and acne patients were significantly higher than healthy controls (p < 0.05). Quality of life was impaired in both patient groups (Dermatology Life Quality Index scores for vitiligo: 5.6 ± 5.1; acne: 6.4 ± 6.2). There was no correlation between psychiatric scale scores and disease severity. Quality of life was negatively correlated with social anxiety and depression levels in both patient groups in our study. CONCLUSION Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.
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146
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Gollnick HP, Bettoli V, Lambert J, Araviiskaia E, Binic I, Dessinioti C, Galadari I, Ganceviciene R, Ilter N, Kaegi M, Kemeny L, López-Estebaranz JL, Massa A, Oprica C, Sinclair W, Szepietowski JC, Dréno B. A consensus-based practical and daily guide for the treatment of acne patients. J Eur Acad Dermatol Venereol 2016; 30:1480-90. [PMID: 27177989 DOI: 10.1111/jdv.13675] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many current guidelines provide detailed evidence-based recommendations for acne treatment. OBJECTIVE To create consensus-based, simple, easy-to-use algorithms for clinical acne treatment in daily office-based practice and to provide checklists to assist in determining why a patient may not have responded to treatment and what action to take. METHODS Existing treatment guidelines and consensus papers were reviewed. The information in them was extracted and simplified according to daily clinical practice needs using a consensus-based approach and based on the authors' clinical expertise. RESULTS As outcomes, separate simple algorithms are presented for the treatment of predominant comedonal, predominant papulopustular and nodular/conglobate acne. Patients with predominant comedonal acne should initially be treated with a topical retinoid, azelaic acid or salicylic acid. Fixed combination topicals are recommended for patients with predominant papulopustular acne with treatment tailored according to the severity of disease. Treatment recommendations for nodular/conglobate acne include oral isotretinoin or fixed combinations plus oral antibiotics in men, and these options may be supplemented with oral anti-androgenic hormonal therapy in women. Further decisions regarding treatment responses should be evaluated 8 weeks after treatment initiation in patients with predominant comedonal or papulopustular acne and 12 weeks after in those with nodular/conglobate acne. Maintenance therapy with a topical retinoid or azelaic acid should be commenced once a patient is clear or almost clear of their acne to prevent the disease from recurring. The principal explanations for lack of treatment response fall into 5 main categories: disease progression, non-drug-related reasons, drug-related reasons, poor adherence, and adverse events. CONCLUSION This practical guide provides dermatologists with treatment algorithms adapted to different clinical features of acne which are simple and easy to use in daily clinical practice. The checklists to establish the causes for a lack of treatment response and subsequent action to take will facilitate successful acne management.
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Affiliation(s)
- H P Gollnick
- Department of Dermatology & Venereology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - V Bettoli
- Department of Clinical and Experimental Medicine, O.U. of Dermatology, Azienda Ospedaliero-Universitaria, University of Ferrara, Ferrara, Italy
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, University of Antwerp, Edegem, Belgium
| | - E Araviiskaia
- Department of Dermatology and Venereal Diseases, First I. P. Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - I Binic
- Department of Dermatovenerology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - C Dessinioti
- Department of Dermatology, A. Syggros Hospital, University of Athens, Athens, Greece
| | - I Galadari
- School of Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - R Ganceviciene
- Clinic of Infectious, Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Vilnius, Lithuania
| | - N Ilter
- Department of Dermatology, Gazi University Medical School, Ankara, Turkey
| | - M Kaegi
- Hautzentrum Zürich, Zürich, Switzerland
| | - L Kemeny
- Department of Dermatology and Allergology University of Szeged, Szeged, Hungary
| | | | - A Massa
- Clínica Dermatológica Dr António Massa, Porto, Portugal
| | - C Oprica
- Department of Laboratory Medicine, Karolinska Institutet Karolinska University Hospital Huddinge, Stockholm, Sweden.,Diagnostiskt Centrum Hud, Stockholm, Sweden
| | - W Sinclair
- Department of Dermatology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - B Dréno
- Department of Dermato-Cancerology, University of Nantes, Nantes, France
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147
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Affiliation(s)
- M. Taylor
- Department of Dermatology; Neath Port Talbot Hospital; Baglan Way Port Talbot SA12 7BX Wales U.K
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148
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Kokhan MM, Keniksfest YUV, Polishchuk AI. Reasonable selection of a topical therapy for different forms of acne. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-2-81-86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Modern data of the acne pathogenesis, including the role of Propionibacterium acnes in the early stages of the acne formation and their provocative role in the development of the inflammatory process are presented. Priority importance of topical retinoids and combination products containing fixed combinations adapalene with benzoyl peroxide or antibiotic clindamycin in the acne treatment are shown. There are presented the facts of the effectiveness of Clenzit gel (adapalene 0.1%) and Clenzit-C (adapalene 0.1% and clindamycin phosphate 1.0%) and an algorithm for the choice of drug depending on clinical and morphological features of the skin process that allows to optimize the treatment of patients with various forms of acne.
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149
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Dessinioti C, Masouri S, Drakaki E, Katsambas A, Antoniou C. Short-contact, low-dose methyl aminolaevulinate photodynamic therapy for acne vulgaris. Br J Dermatol 2016; 175:215. [PMID: 26854014 DOI: 10.1111/bjd.14460] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - S Masouri
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - E Drakaki
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - A Katsambas
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - C Antoniou
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
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150
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Xu J, Lu Q, Huang J, Hao F, Sun Q, Fang H, Gu J, Dong X, Zheng J, Luo D, Li F, Wang G, Gu H, Tian H, Yang H, Xi L, Li M, Zheng M, Wu Y, Tu Y, He Y, Zhao G, Sheng W, Li J, Hamedani A. A multicentre, randomized, single‐blind comparison of topical clindamycin 1%/benzoyl peroxide 5% once‐daily gel versus clindamycin 1% twice‐daily gel in the treatment of mild to moderate acne vulgaris in Chinese patients. J Eur Acad Dermatol Venereol 2016; 30:1176-82. [PMID: 27075705 DOI: 10.1111/jdv.13622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J.H. Xu
- Department of Dermatology Huashan Hospital Fudan University Shanghai China
| | - Q.J. Lu
- Hunan Key Laboratory of Medical Epigenomics Department of Dermatology Second Xiangya Hospital Central South University Changsha China
| | - J.H. Huang
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
| | - F. Hao
- Department of Dermatology Southwest Hospital Third Military Medical University Chongqing China
| | - Q.N. Sun
- Department of Dermatology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - H. Fang
- Department of Dermatology The First Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - J. Gu
- Department of Dermatology Changhai Hospital Second Military Medical University Shanghai China
| | - X.Q. Dong
- Department of Dermatology Guangdong General Hospital Guangzhou China
| | - J. Zheng
- Department of Dermatology Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - D. Luo
- Department of Dermatology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - F.Q. Li
- Department of Dermatology The Second Hospital of Jilin University Changchun China
| | - G. Wang
- Department of Dermatology Xijing Hospital Fourth Military Medical University Xi'an China
| | - H. Gu
- Institute of Dermatology Chinese Academy of Medical Science and Peking Union Medical College Nanjing China
| | - H.Q. Tian
- Shandong Provincial Institute of Dermatology and Venereology Provincial Academy of Medical Science Jinan Shandong China
| | - H.L. Yang
- Department of Dermatology General Hospital of Guangzhou Military Command of PLA Guangzhou China
| | - L.Y. Xi
- Department of Dermatology Sun Yat‐sen Memorial Hospital Guangzhou China
| | - M. Li
- Department of Dermatology Zhongshan Hospital Fudan University Shanghai China
| | - M. Zheng
- Department of Dermatology The Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Y. Wu
- Department of Dermatology Peking University First Hospital Beijing China
| | - Y.T. Tu
- Department of Dermatology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Y.L. He
- Department of Dermatology Beijing Chao‐Yang Hospital Capital Medical University Beijing China
| | - G. Zhao
- Department of Dermatology Air Force General Hospital Beijing China
| | - W.X. Sheng
- Department of Dermatology Zhongnan Hospital Wuhan University Wuhan China
| | - J. Li
- GlaxoSmithKline Pudong Shanghai China
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