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Podwojniak A, Tan IJ, Sauer J, Parikh A, Cohen BA, Heath C. Updates on Topical Dyad and Triple Combination Therapies Approved for Acne Vulgaris. Cureus 2024; 16:e61413. [PMID: 38947674 PMCID: PMC11214703 DOI: 10.7759/cureus.61413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Acne vulgaris is a multifaceted disease characterized by inflammatory and noninflammatory lesions. Topical combination therapies offer a multifaceted approach to acne treatment, with synergistic effects and a broad spectrum of action against multiple factors in acne pathogenesis in one single formulation. Clindamycin phosphate/benzoyl peroxide/adapalene, a combination therapy consisting of clindamycin phosphate 1.2%, benzoyl peroxide (BPO) 3.1%, and adapalene 0.15%, is a novel treatment, the only FDA-approved triple combination drug that offers effective treatment of acne vulgaris. This review aims to provide information on clindamycin phosphate/benzoyl peroxide/adapalene and review the literature on combination topical acne medications approved in the United States. This search was conducted on topical combination therapies for acne, their efficacy, adverse effects, and impacts on quality of life with a specific focus on the newly approved clindamycin phosphate/benzoyl peroxide/adapalene and its sub-component dyads, along with other combinations. PubMed, SCOPUS, Embase, Cochrane, and Web of Science databases were searched for publications in 2018-2023. Primary sources were given priority, and secondary sources such as other reviews were considered to supplement any missing information. It was found that various topical dyad and triad combinations exist for acne vulgaris, including adapalene/BPO, tazarotene/clindamycin, clindamycin/BPO, adapalene/clindamycin, topical tretinoin/azelaic acid, topical tretinoin/BPO, and clindamycin phosphate/benzoyl peroxide/adapalene. Dyad and triple combinations represent a promising, convenient solution for acne management, potentially improving patient adherence due to its single formulation. Clindamycin phosphate/benzoyl peroxide/adapalene exhibited significantly high efficacy in treating both inflammatory and noninflammatory lesions, a minimal side effect profile, although no significant changes in quality-of-life measures. Further research is indicated to assess its long-term efficacy and impact on other acne metrics such as cost, scarring, psychosocial implications, and impact on diverse patient populations.
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Affiliation(s)
- Alicia Podwojniak
- Dermatology, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Isabella J Tan
- Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - John Sauer
- Dermatology, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Aarushi Parikh
- Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | | | - Candrice Heath
- Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
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Rai S, Gupta GN, Singh S, Michael J, Misra P, Gupta B, Singh S, Prakash A, Tomar M, Sadhukhan S, Koley M, Saha S. Efficacy of Individualized Homeopathic Medicines in Treatment of Acne Vulgaris: A Double-Blind, Randomized, Placebo-Controlled Trial. HOMEOPATHY 2022; 111:240-251. [PMID: 35299272 DOI: 10.1055/s-0041-1739397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acne is estimated to affect 9.4% of the global population, making it the 8th most prevalent disease worldwide. Acne vulgaris (AV) is among the diseases that directly affect quality of life. This trial evaluated the efficacy of individualized homeopathic medicines (IHM) against placebo in AV. METHODS In this double-blind, randomized, placebo-controlled trial conducted at the National Institute of Homoeopathy, India, 126 patients suffering from AV were randomized in a 1:1 ratio to receive either IHM (verum) in centesimal potencies or identical-looking placebo (control). The primary outcome measure was the Global Acne Grading System score; secondary outcomes were the Cardiff Acne Disability Index and Dermatology Life Quality Index questionnaires - all measured at baseline and 3 months after the intervention. Group differences and effect sizes (Cohen's d) were calculated on the intention-to-treat sample. RESULTS Overall, improvements were greater in the IHM group than placebo, with small to medium effect sizes after 3 months of intervention; however, the inter-group differences were statistically non-significant. Sulphur (17.5%), Natrum muriaticum (15.1%), Calcarea phosphorica (14.3%), Pulsatilla nigricans (10.3%), and Antimonium crudum (7.1%) were the most frequently prescribed medicines; Pulsatilla nigricans, Tuberculinum bovinum and Natrum muriaticum were the most effective of those used. No harms, unintended effects, homeopathic aggravations or any serious adverse events were reported from either group. CONCLUSION There was non-significant direction of effect favoring homeopathy against placebo in the treatment of AV. TRIAL REGISTRATION CTRI/2018/11/016248; UTN: U1111-1221-8164.
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Affiliation(s)
- Shruti Rai
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Gobind Narayan Gupta
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Subhas Singh
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - James Michael
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Pankhuri Misra
- Department of Materia Medica, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Bharti Gupta
- Department of Paediatrics, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Suman Singh
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Akshaya Prakash
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Maneela Tomar
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Satarupa Sadhukhan
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Munmun Koley
- East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, South 24 Parganas, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, India
| | - Subhranil Saha
- Department of Repertory, D.N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Tangra, Kolkata, West Bengal, India
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Lu YT, Hu ZL, Shao FX, Song M, Hang TJ. Simultaneous determination of tazarotene, clindamycin phosphate and their active metabolites in Bama mini-pig skin by LC-MS/MS: Application to the development of a tazarotene/clindamycin phosphate cream. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1162:122455. [PMID: 33360677 DOI: 10.1016/j.jchromb.2020.122455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
Topical tazarotene combined with clindamycin phosphate can significantly improve the adherence and outcomes for the treatment of acne vulgaris than monotherapy, a novel tazarotene (0.05%)/clindamycin phosphate (1.2%) cream is thus developed. However, the pharmacokinetics and potential interaction of tazarotene and clindamycin phosphate in skin when formulated together remain unknown, which should be investigated to assess this novel cream. In the present work, a sensitive and rapid LC-MS/MS method for simultaneous determination of tazarotene, clindamycin phosphate and their active metabolites tazarotenic acid, clindamycin in Bama mini-pig skin was developed and reported for the first time. After pretreatment of the skin samples, the analytes were well separated on a Hypersil BDS C8 column (4.6 × 100 mm, 2.4 μm) using 0.2% (v/v) formic acid-0.1% (w/v) ammonium acetate water solution and acetonitrile as mobile phase in linear gradient elution. Quantification of tazarotene, clindamycin phosphate and their active metabolites tazarotenic acid, clindamycin was conducted under positive electrospray ionization mode using multiple reactions monitoring detection. The LC-MS/MS method was fully validated and then applied to the dermal pharmacokinetic study of the tazarotene/clindamycin phosphate cream. According to the obtained results, tazarotene and clindamycin phosphate did not have any drug-drug interaction when they were formulated together in the cream for topical application. Their absorption and metabolism features in the skin were also characterized, which can support the clinical medication regimen of tazarotene/clindamycin phosphate cream.
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Affiliation(s)
- Yu-Ting Lu
- Key Laboratory of Drug Quality Control and Pharmacovigilance (China Pharmaceutical University), Ministry of Education, Nanjing, China; Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Zhao-Liang Hu
- Key Laboratory of Drug Quality Control and Pharmacovigilance (China Pharmaceutical University), Ministry of Education, Nanjing, China; Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Fang-Xian Shao
- Key Laboratory of Drug Quality Control and Pharmacovigilance (China Pharmaceutical University), Ministry of Education, Nanjing, China; Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Min Song
- Key Laboratory of Drug Quality Control and Pharmacovigilance (China Pharmaceutical University), Ministry of Education, Nanjing, China; Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Tai-Jun Hang
- Key Laboratory of Drug Quality Control and Pharmacovigilance (China Pharmaceutical University), Ministry of Education, Nanjing, China; Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China.
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Li L, Zhang XF, Yang GP, Huang J, Yang XY, Ye L, Guo C, Yang S, Wang XM. Safety, Tolerability, and Pharmacokinetics of Tazarotene Clindamycin Cream: A Single-Dose, 3-Period Crossover Study. Clin Pharmacol Drug Dev 2020; 10:598-606. [PMID: 33241616 DOI: 10.1002/cpdd.890] [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: 07/15/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022]
Abstract
The current study compared the safety, tolerability, and pharmacokinetics of the new compound pharmaceutical preparation tazarotene clindamycin cream, and 2 single pharmaceutical preparations, tazarotene cream and clindamycin phosphate gel. Twelve healthy volunteers were enrolled in this single-center, single-blind, 3-treatment, 3-period crossover, single-dose randomized study. An 800-cm2 area on volunteers' backs was evenly smeared with 1.6 g of the test preparation to form a film. Blood samples were collected at predetermined time points for pharmacokinetic analysis. Safety and tolerability were assessed via skin reaction evaluation and clinical laboratory tests. The incidences of skin reactions were 18.2% for tazarotene clindamycin cream, 25.0% for tazarotene cream, and 18.2% for clindamycin phosphate gel. There were no significant differences in safety or tolerability among the 3 groups. Erythema, desquamation, and pruritus occurred in 7 volunteers, but no burning or tingling occurred. All adverse events were mild and resolved spontaneously, and there were no severe adverse events. The respective maximum plasma concentrations of tazarotenic acid after local administration of tazarotene clindamycin cream and tazarotene cream were 11 ± 5 pg/mL and 18 ± 12 pg/mL, and the areas under the curve within 72 hours were 444 ± 341 pg · h/mL and 692 ± 462 pg · h/mL.
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Affiliation(s)
- Lei Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,XiangYa School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, China
| | - Xing-Fei Zhang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Center of Drug Clinical Evaluation of Central South University, Changsha, Hunan, China
| | - Guo-Ping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,XiangYa School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, China.,Research Center of Drug Clinical Evaluation of Central South University, Changsha, Hunan, China.,Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,National-Local Joint Engineering Laboratory of Drug Clinical Evaluation Technology, Changsha, Hunan, China
| | - Jie Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Center of Drug Clinical Evaluation of Central South University, Changsha, Hunan, China.,Hunan Key Laboratory Cultivation Base of the Research and Development of Novel Pharmaceutical Preparations, Changsha, Hunan, China
| | - Xiao-Yan Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Ye
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Can Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuang Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Min Wang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Research Center of Drug Clinical Evaluation of Central South University, Changsha, Hunan, China
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Abstract
BACKGROUND Topical retinoids are a first-line treatment for acne vulgaris. OBJECTIVE This systematic review aims to evaluate the efficacy, safety, and tolerability of topical retinoids approved in the United States for the treatment of acne vulgaris. METHODS A PubMed and Embase search was conducted using the search terms 'adapalene,' 'tretinoin,' 'tazarotene,' and 'acne vulgaris.' Selection of articles fit the following inclusion criteria: clinical trials evaluating both efficacy and safety/tolerability of topical retinoids approved in the United States for the treatment of acne vulgaris and published between January 1, 2008 and September 1, 2018. Exclusion criteria included clinical trials involving 20 subjects or fewer, subjects under 12 years of age, and topical retinoid combination therapies with moisturizers or aloe vera. Of 424 search results found, a total of 54 clinical trials were chosen based on selection criteria. RESULTS Topical retinoids are superior to vehicle in improving Investigator Global Assessment and Investigator's Static Global Assessment (24.1-28.8% and 13.3-17.3%, respectively; p < 0.001). A topical retinoid combined with benzoyl peroxide led to IGA improvement compared with vehicle (26.1-34.9% vs 7-11.8%; p < 0.001) at Week 12. Topical retinoid plus an oral antibiotic was superior to vehicle in reducing lesion counts (64-78.9% vs 41-56.8%, p < 0.001). There was no significant difference in efficacy between tretinoin and tazarotene. Tretinoin 0.05% resulted in 62% of patients experiencing AEs compared with adapalene 0.1% (19%) and adapalene 0.3% (40%). More patients receiving adapalene were tolerant of the AEs compared with tazarotene (55.4% vs 24.4%; p < 0.0012). CONCLUSIONS Topical retinoids are safe and efficacious for the treatment of acne vulgaris. They should be used in combination with benzoyl peroxide to optimize results in patients. The differences in efficacy of topical retinoids appears minor; therefore, the type of topical retinoid is not as important as choosing a particular strength of topical retinoid and combining it with an antimicrobial agent. Adapalene has a superior tolerability profile amongst topical retinoids.
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Burleigh A, Yousefi M, Humphrey S. Skin Confident: A skin health and acne educational intervention to improve the Acne Quality of Life measures in adolescents. J Am Acad Dermatol 2018; 79:978-980. [PMID: 29981389 DOI: 10.1016/j.jaad.2018.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/13/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Angela Burleigh
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia.
| | - Masoud Yousefi
- Brain Research Centre, University of British Columbia, Vancouver, British Columbia
| | - Shannon Humphrey
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia
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