1
|
Abstract
A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.
Collapse
Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Health Care Sciences, University College, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK.
| | | |
Collapse
|
2
|
Zouboulis CC, Bettoli V. Management of severe acne. Br J Dermatol 2016; 172 Suppl 1:27-36. [PMID: 25597508 DOI: 10.1111/bjd.13639] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 12/28/2022]
Abstract
Acne is the most common skin disease, affecting up to 95% of adolescents. Severe episodes of acne can cause considerable physical and psychological scarring, and overexpression of transforming growth factor-β can lead to formation of hypertrophic scars and keloids. The severity of acne in adolescence is associated with a positive history of severe acne in first-degree relatives, especially the mother. In most cases acne is a chronic disease, and it is often a component of systemic diseases or syndromes. All forms of severe acne require systemic treatment. The available options include oral antibiotics, hormonal antiandrogens for female patients and oral isotretinoin, as well as other combination treatments. Oral isotretinoin is the only drug available that affects all four pathogenic factors of acne. However, due to possible serious side-effects, a European directive states that oral isotretinoin should be used only as a second-line therapy in cases of severe, nodular and conglobate acne. The pharmaceutical quality of generic isotretinoin products and the obtainability of isotretinoin through e-pharmacies without prescription raise new therapeutic problems. New anti-inflammatory compounds, such as the 5-lipoxygenase inhibitor zileuton, may replace systemic antibiotics in the future, especially under the scope of antibiotic resistance prevention. This review looks into the various options and latest approaches, and factors to consider, when combating severe acne.
Collapse
Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany
| | - V Bettoli
- Department of Clinical and Experimental Medicine, Section of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, University of Ferrara, via Aldo Moro 8, Località Cona-44100, Ferrara, Italy
| |
Collapse
|
3
|
Tan J, Knezevic S, Boyal S, Waterman B, Janik T. Evaluation of Evidence for Acne Remission With Oral Isotretinoin Cumulative Dosing of 120-150 mg/kg. J Cutan Med Surg 2015; 20:13-20. [DOI: 10.1177/1203475415595776] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Oral isotretinoin (ISO) is the standard of care for severe inflammatory acne and a threshold dose of 120-150 mg/kg is widely regarded as increasing remission potential. Objective: Our objective was to evaluate the evidence underlying ISO dosing of 120-150 mg/kg in acne remission. Methods: A systematic literature search was performed using keywords “acne,” “isotretinoin,” “efficacy,” “dosing,” “relapse,” and “remission.” Results: Definitions for acne clearance, relapse/remission, and treatment endpoint vary widely across studies. Only 2 studies explicitly evaluated the cumulative dose of 120-150 mg/kg for induction of acne remission—both low grade. Conclusion: The threshold dose of 120-150 mg/kg for oral ISO is based on past parameters of treatment duration and prior studies used vague or inconsistent definitions of clearance and remission. Optimal cumulative doses of ISO required to induce remission appears to vary with severity.
Collapse
Affiliation(s)
- Jerry Tan
- Department of Medicine, University of Western Ontario, London, ON, Canada
- Windsor Clinical Research Inc, Windsor, ON, Canada
| | - Sanja Knezevic
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | | | - Brad Waterman
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Toni Janik
- Windsor Regional Hospital, Windsor, ON, Canada
| |
Collapse
|
4
|
Gollnick HP, Zouboulis CC. Not all acne is acne vulgaris. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:301-12. [PMID: 24828100 PMCID: PMC4098044 DOI: 10.3238/arztebl.2014.0301] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acne is the most common skin disease in adolescence, with a prevalence of nearly 100%. About 60% of affected adolescents have mild acne for which they use non-prescription preparations without consulting a physician. The remaining 40% constitute the population of acne patients seen in medical practice. The course of acne can be either acute or chronic; its manifestations can appear in waves, sometimes with dramatically severe inflammation leading rapidly to scarring. Acne often has adverse emotional consequences. Its treatment is markedly better than in the past because of new pharmacological and physicochemical approaches and because evidence-based guidelines are now available. METHOD This article is based on a selective review of the literature and also incorporates the authors' own clinical and scientific experience. RESULTS Acne vulgaris of grade I or II in an adolescent is generally not hard to treat. In contrast, the more severe grades III and IV and conglobate acne often present a therapeutic challenge, as they are associated with varying constellations of acute lesions, scarring, inflammation, and emotional disturbances. These conditions often require systemic treatment with tetracyclines, which are especially useful because of their para-antibiotic antiinflammatory effect. Severe cases must be treated with isotretinoin. Women can benefit from anti-androgenic contraceptive drugs. Retinoids or azelaic acid are used in maintenance therapy to suppress the formation of microcomedones, the precursor stage of acne lesions. CONCLUSION A variety of effective treatments for acne are available, depending on the severity of the condition.
Collapse
Affiliation(s)
- Harald P Gollnick
- Department of Venerology and Dermatology, Otto von Guericke University Magdeburg
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center
| |
Collapse
|
5
|
KUBANOVA AA, ARAVIYSKAYA YER, SOKOLOVSKY YEV, DVOROVA YEK, FADEYEVA YEI. Systemic treatment of severe forms of acne: experience of using Isotretinoin in the Russian Federation. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the results of a large-scale Russian program of the follow-up and treatment of acne patients with Isotretinoin (Roaccutane). The analysis of the results included information about 1,349 acne patients. In 71% of patients, the therapy was initiated at the dose of 0.5-1.0 mg/kg of the body weight. The average duration of treatment was 21.5±0.16 weeks while the average course dose was 119.9±0.8 mg/kg of the body weight. As many as 96% of patients achieved a positive result; women demonstrated a higher improvement rate than men. On the whole, Roaccutane was well-tolerated while adverse effects included dry lips (43.4%), dry skin in different areas (12.45%), retinoid dermatitis (6.45%), epistaxis (2.45%), conjunctivitis (1.41%) and hoarseness (0.22%). The Russian experience of using Roaccutane confirmed high efficacy of the systemic therapy for severe forms of acne.
Collapse
|
6
|
|
7
|
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
|
8
|
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
|
9
|
Ruamrak C, Lourith N, Natakankitkul S. Comparison of clinical efficacies of sodium ascorbyl phosphate, retinol and their combination in acne treatment. Int J Cosmet Sci 2009; 31:41-6. [PMID: 19134126 DOI: 10.1111/j.1468-2494.2008.00479.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acne vulgaris impairs the appearance of an individual and causes psychological irritation. Inflammatory acne lesion is caused by multifactor incorporates in each step of acne pathogenesis. In an attempt to archive inflammatory lesion treatment with the promise of prevention of acne vulgaris, randomized and double-blind studies on the comparison of the efficacies of topical formulations containing 5% sodium ascorbyl phosphate (SAP) and 0.2% retinol, separately as well as in combination application, were conducted. The resulting data showed that SAP reduced the inflammatory lesion by 20.14% and 48.82% within 4 and 8 weeks respectively. Application of the formulation containing retinol slightly improved the treatment efficacy as the lesion reduced by 21.79% and 49.50% after 4 and 8 weeks respectively. The combination treatment significantly reduced the inflammatory lesion by 29.28% after 4 weeks and 63.10% after 8 weeks of application. The most effective treatment was by using the combination of 5% SAP and 0.2% retinol, which incorporated the synergistic effects on lipid peroxidation and sebaceous gland function in addition to the enhancement of SAP permeability by the desquamation of stratum corneum influenced by retinol, keratin plug removal and anti-inflammatory effect of retinol. This study promises for the development of cosmetic products to overcome aesthetic and psychological problems caused by acne vulgaris.
Collapse
Affiliation(s)
- C Ruamrak
- Ramida Clinic, Nakornpathom, Thailand
| | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE To identify drugs associated with the complaint of dry mouth. MATERIALS AND METHODS MEDLINE was searched for papers 1980-2002 using keywords, oral, mouth, salivary, drugs, dry mouth and xerostomia, and relevant secondary references were hand-searched. RESULTS Evidence was forthcoming for a number of xerogenic drugs, especially antimuscarinic agents, some sympathomimetic agents, and agents affecting serotonin and noradrenaline uptake, as well as a miscellany of other drugs such as appetite suppressants, protease inhibitors and cytokines. CONCLUSION Dry mouth has a variety of possible causes but drugs--especially those with anticholinergic activity against the M3 muscarinic receptor--are the most common cause of reduced salivation.
Collapse
Affiliation(s)
- C Scully
- International Centres for Excellence in Dentistry and Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, London, UK.
| |
Collapse
|
11
|
Seukeran D, Cunliffe W. Oral isotretinoin is not associated with increased side-effects when prescribed to patients with less severe acne. J DERMATOL TREAT 1998. [DOI: 10.3109/09546639809160697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dc Seukeran
- The Skin Research Centre, Department of Dermatology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Wj Cunliffe
- The Skin Research Centre, Department of Dermatology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| |
Collapse
|
12
|
Wozel G, Chang A, Zultak M, Czarnetzki BM, Happle R, Barth J, van de Kerkhof PC. The effect of topical retinoids on the leukotriene-B4-induced migration of polymorphonuclear leukocytes into human skin. Arch Dermatol Res 1991; 283:158-61. [PMID: 1651071 DOI: 10.1007/bf00372055] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic retinoids are effective in a variety of inflammatory dermatoses. Disorders in which polymorphonuclear leukocytes (PMN) are involved, such as psoriasis and acne, respond particularly well to various retinoids. However, side-effects restrict the use of systemic retinoids to severe manifestations. Topical application might provide the possibility of avoiding the systemic side-effects of these compounds. In this communication we report on the modulation of transepidermal migration of PMN by topical application of all-trans-retinoic acid, 13-cis-retinoic acid, arotinoid methyl sulphone and arotinoid ethyl sulphone. Test areas of healthy volunteers were pretreated with these retinoids in a cream base and with corresponding placebo creams, and intraepidermal accumulation of PMN was quantified 24 h after epicutaneous challenge with leukotriene B4 (LTB4), using elastase as a marker enzyme. Topical treatment with 13-cis-retinoic acid resulted in a marked and statistically significant inhibition of the LTB4-induced migration of PMN. All-trans-retinoic acid, arotinoid methyl sulphone and arotinoid ethyl sulphone reduced the accumulation of PMN slightly, but not statistically significantly. Topical treatment with arotinoid methyl sulphone had no effect.
Collapse
Affiliation(s)
- G Wozel
- Department of Dermatology, University Hospital Nijmegen, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Abstract
A multicenter trial of isotretinoin in severe papulopustular rosacea in adult patients was undertaken to evaluate the efficacy and safety of this treatment. A 20-week course of therapy was instituted in 92 patients from 11 dermatology departments. At the end of the study period, isotretinoin was found to be highly effective in the clearing of refractory rosacea lesions.
Collapse
|
15
|
Fraunfelder FT, LaBraico JM, Meyer SM. Adverse ocular reactions possibly associated with isotretinoin. Am J Ophthalmol 1985; 100:534-7. [PMID: 2931989 DOI: 10.1016/0002-9394(85)90676-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A total of 261 adverse ocular reactions occurred in 237 patients who received isotretinoin, a commonly used drug in the treatment of severe cystic acne. Blepharoconjunctivitis, subjective complaints of dry eyes, blurred vision, contact lens intolerance, and photodermatitis are reversible side effects. More serious ocular adverse reactions include papilledema, pseudotumor cerebri, and white or gray subepithelial corneal opacities; all of these are reversible if the drug is discontinued. Reported cases of decreased dark adaptation are under investigation. Isotretinoin is contraindicated in pregnancy because of the many reported congenital abnormalities after maternal use (including microphthalmos, orbital hypertelorism, and optic nerve hypoplasia).
Collapse
|