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See JA, Chavda R, Kon KM, Goodman GJ, Oblepias MS, Nadela RE, Oon HH, Aurangabadkar S, Suh DH, Chan HHL, Lahiri K. A review of the topical management of acne and its associated sequelae in the Asia-Pacific region with a spotlight on trifarotene. Int J Dermatol 2024; 63:704-713. [PMID: 38643368 DOI: 10.1111/ijd.17141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 04/22/2024]
Abstract
Acne, a highly prevalent skin disease, can be particularly bothersome for patients of Asian background because of its impact on self-confidence and social interactions. In addition to active acne lesions, some patients may develop sequelae such as scarring, macular/postinflammatory hyperpigmentation, or erythema. The tendency of Asian skin to develop sequelae because of its increased susceptibility to irritation, cultural preferences for lighter skin phototypes, and differences in skincare regimens may all contribute to the increased burden of acne. Moreover, many Asia-Pacific countries do not have their own guidelines for acne management, and those that do often have no schedule in place for regular updates. In this article, we provide a critical review of the published guidance for the management of acne and its sequelae in the Asia-Pacific region, identifying gaps in current recommendations that could be addressed to enhance standards of acne care in Asia-Pacific countries. Along with highlighting the importance of a comprehensive skincare regimen to increase treatment efficacy and adherence, we discuss topical retinoids and retinoid combination options in the acne armamentarium that may be beneficial for sequelae prevention and management, such as adapalene 0.3% ± benzoyl peroxide 2.5%, tretinoin 0.05%, tazarotene 0.1%, and trifarotene 0.005%. In particular, trifarotene 0.005% has been observed to significantly reduce acne scar counts in a Phase 4 study. The recent data highlight the need to establish up-to-date guidance for acne and acne sequelae management in Asia-Pacific countries to provide optimal care to Asian patients.
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Affiliation(s)
- Jo-Ann See
- Central Sydney Dermatology, Sydney, NSW, Australia
| | | | - Khen M Kon
- Galderma ANZ, North Sydney, NSW, Australia
| | | | - Marie S Oblepias
- AcneCure Center, Parañaque, Philippines
- Medical Center Parañaque, Parañaque, Philippines
| | - Rosalina E Nadela
- Fatima University Medical Center, Antipolo City, Philippines
- The Holistic Dermatology Clinic, Quezon City, Philippines
| | - Hazel H Oon
- Division of Dermatology, National Skin Centre, Singapore, Singapore
| | | | - Dae H Suh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Henry H L Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Koushik Lahiri
- Apollo Multispeciality Hospitals, Kolkata, India
- Wizderm Speciality Skin and Hair Clinic, Kolkata, India
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Munavalli G. Advancing precision acne therapy using a novel photopneumatic device. J COSMET LASER THER 2024; 26:77-80. [PMID: 38989548 DOI: 10.1080/14764172.2024.2376704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/18/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
Photopneumatic therapy (PPT) combines vacuum and pulsed, broadband light to extract debris and bacteria from the pilosebaceous units; monotherapy is unexplored. Facial acne lesions and skin texture were evaluated after up to six PPT treatments, 1-2 weeks apart for 15-20 minutes per treatment using customized energy settings, in seven female patients with inflammatory, comedonal and pustular lesions. Lesion and redness reduction with improvement in skin texture and pore size were observed after 1-3 treatments; adverse effects were infrequent. PPT may optimize lesion clearance as monotherapy and/or as an adjuvant. The ability to change pulse structure, pulse duration, vacuum pressure and fluence allow for treatment that best matches skin type and acne severity.
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Affiliation(s)
- Gilly Munavalli
- Dermatology, Laser & Vein Specialists of the Carolinas, PLLC, Charlotte, NC, USA
- Department of Dermatology, Wake Forest School of Medicine, Winston Salem, NC, USA
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Almeida LMC, Ianhez M, Dal'Forno T, Picosse FR, Ravelli F, Kamamoto C, Sarlos P, Gold LFS. Long-term maintenance treatment of rosacea: experts' opinion. Int J Dermatol 2024; 63:94-101. [PMID: 38013632 DOI: 10.1111/ijd.16920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Rosacea is a chronic inflammatory dermatosis characterized by remissions and flares. Although the rosacea active treatment phase is well established, the long-term maintenance phase is still challenging. OBJECTIVE To discuss and make recommendations on how to treat patients during the long-term maintenance phase for the main rosacea phenotypes. METHODS A panel of six board-certified Brazilian dermatologists and one American dermatologist gathered to compose a consensus based upon an initial statement on how to treat rosacea during the long-term maintenance phase based on the methodology Nominal Group Technique. The experts discussed each factor based upon an initial statement on how to treat rosacea patients in the long-term maintenance phase. A sequence of comprehensive narrative reviews was performed; a questionnaire preparation about the definition of the maintenance phase and its management was presented; an interpersonal discussion and ranking of the ideas were conducted. Recommendations were made if the specialists had 75% agreement. RESULTS The maintenance treatment phase, which starts by achieving IGA 0 or 1 grades at the active phase, should be considered at least during the 9-month period after remission. The recommendations of all treatments target this period. Daily skincare regimen and sunscreen are crucial. Active treatment phase should be recommended if signs or symptoms reappear or worsen. CONCLUSION Maintenance phase success depends on patient's adherence to daily skin care, appropriate treatments, continued follow-up with dermatologist, and self-assessment to identify new signs and symptoms indicating disease relapse.
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Affiliation(s)
- Luiz M C Almeida
- Department of Dermatology, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | - Mayra Ianhez
- Hospital of Tropical Diseases, Universidade Federal de Goiás Faculdade de Medicina, Goiânia, Brazil
| | - Taciana Dal'Forno
- Dermatology Residency Program, Pontificia Universidade Catolica do Rio Grande do Sul Porto Alegre, Private Practice, Porto Alegre, Brazil
| | - Fabíola R Picosse
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Linda F S Gold
- Department of Dermatology, Henry Ford Medical Centre, Detroit, MI, USA
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da Rocha MAD, Fierro-Arias L, Cohen Sabban EN, Castillo RS, Chavda R, Almeida LM. Acne characteristics in Latin American patients and the potential role of trifarotene. Int J Dermatol 2023; 62:1176-1185. [PMID: 37340535 DOI: 10.1111/ijd.16754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Individualization of treatment based on acne type and severity, location, disease burden, and patient preference is required to maximize efficacy, safety, and adherence to therapy. Latin American populations have unique attributes that must be considered as part of this process to improve clinical success and achieve patient goals. Acne is more common among patients with darker skin phototypes, in whom it is often associated with postinflammatory hyperpigmentation and scarring-the most important acne sequelae-potentially due to more frequent and more severe underlying inflammatory processes in this population. DISCUSSION These data argue for an early and proactive approach to managing acne in these patients with agents that target the inflammatory processes that underlie acne and its sequelae. As a class, retinoids offer a spectrum of activity that may be useful in addressing the unique needs of Latin American populations. CONCLUSION Trifarotene, a novel, selective retinoid, has been evaluated in relevant patient populations.
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Affiliation(s)
| | | | - Emilia N Cohen Sabban
- Instituto de Investigaciones Médicas A. Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Rajeev Chavda
- Galderma Research & Development, Lausanne, Switzerland
| | - Luiz M Almeida
- Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil
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Layton AM, Alexis A, Baldwin H, Bettoli V, Del Rosso J, Dirschka T, Dréno B, Gold LS, Harper J, Ko JY, Al Nuaimi K, Oon HH, Rajagopalan M, Rocha M, See JA, Weiss J, Tan J. The Personalized Acne Treatment Tool - Recommendations to facilitate a patient-centered approach to acne management from the Personalizing Acne: Consensus of Experts. JAAD Int 2023; 12:60-69. [PMID: 37274381 PMCID: PMC10236180 DOI: 10.1016/j.jdin.2023.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/06/2023] Open
Abstract
Background Acne, a commonly treated skin disease, requires patient-centered management due to its varying presentations, chronicity, and impact on health-related quality of life. Despite this, evidence-based clinical guidelines focus primarily on clinical severity of facial acne, omitting important patient- and disease-related factors, including ongoing management. Objectives To generate recommendations to support patient-centered acne management, which incorporate priority and prognostic factors beyond conventional clinical severity, traditionally defined by grading the appearance and extent of visible lesions. Methods The Personalizing Acne: Consensus of Experts consisted of 17 dermatologists who used a modified Delphi approach to reach consensus on statements regarding patient- and treatment-related factors pertaining to patient-centered acne management. Consensus was defined as ≥75% voting "agree" or "strongly agree." Results Recommendations based on factors such as acne sequelae, location of acne, high burden of disease, and individual patient features were generated and incorporated into the Personalized Acne Treatment Tool. Limitations Recommendations are based on expert opinion, which may differ from patients' perspectives. Regional variations in healthcare systems may not be represented. Conclusions The Personalizing Acne: Consensus of Experts panel provided practical recommendations to facilitate individualized management of acne, based on patient features, which can be implemented to improve treatment outcomes, adherence, and patient satisfaction.
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Affiliation(s)
- Alison M. Layton
- Skin Research Centre, York University, York, UK
- Harrogate and District NHS Foundation Trust, Harrogate, UK
| | | | - Hilary Baldwin
- Robert Wood Johnson Medical Center, New Brunswick, New Jersey
- The Acne Treatment and Research Center, Brooklyn, New York
| | - Vincenzo Bettoli
- Dermatology Unit – Teaching Hospital, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | - James Del Rosso
- Advanced Dermatology and Cosmetic Surgery, Maitland, Florida
- JDR Dermatology Research, Las Vegas, Nevada
| | | | | | | | - Julie Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, Alabama
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Khaled Al Nuaimi
- Faculty of Medicine, Sharjah University, Sharjah, United Arab Emirates
| | - Hazel H. Oon
- Division of Dermatology, National Skin Centre, Singapore
| | | | - Marco Rocha
- Federal University of São Paulo, São Paulo, Brazil
| | - Jo-Ann See
- Central Sydney Dermatology, Sydney, New South Wales, Australia
| | | | - Jerry Tan
- Windsor Clinical Research Inc, Windsor, Ontario, Canada
- Department of Medicine, University of Western Ontario, Windsor, Ontario, Canada
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Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, Boyle J, Teede HJ. Polycystic ovary syndrome. Lancet Diabetes Endocrinol 2022; 10:668-680. [PMID: 35934017 DOI: 10.1016/s2213-8587(22)00163-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects 5-18% of women, and is a reproductive, metabolic, and psychological condition with impacts across the lifespan. The cause is complex, and includes genetic and epigenetic susceptibility, hypothalamic and ovarian dysfunction, excess androgen exposure, insulin resistance, and adiposity-related mechanisms. Diagnosis is recommended based on the 2003 Rotterdam criteria and confirmed with two of three criteria: hyperandrogenism (clinical or biochemical), irregular cycles, and polycystic ovary morphology. In adolescents, both the criteria of hyperandrogenism and irregular cycles are needed, and ovarian morphology is not included due to poor specificity. The diagnostic criteria generates four phenotypes, and clinical features are heterogeneous, with manifestations typically arising in childhood and then evolving across adolescent and adult life. Treatment involves a combination of lifestyle alterations and medical management. Lifestyle optimisation includes a healthy balanced diet and regular exercise to prevent excess weight gain, limit PCOS complications and target weight reduction when needed. Medical management options include metformin to improve insulin resistance and metabolic features, combined oral contraceptive pill for menstrual cycle regulation and hyperandrogenism, and if needed, anti-androgens for refractory hyperandrogenism. In this Review, we provide an update on the pathophysiology, diagnosis, and clinical features of PCOS, and discuss the needs and priorities of those with PCOS, including lifestyle, and medical and infertility treatment. Further we discuss the status of international evidence-based guidelines (EBG) and translation, to support patient self management, healthcare provision, and to set research priorities.
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Affiliation(s)
- Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia.
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