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Pelet Del Toro NM, Strunk A, Wu JJ, Stein Gold L, Del Rosso JQ, Brodell RT, Han G. Topical clindamycin for acne vulgaris: analysis of gastrointestinal events. J DERMATOL TREAT 2024; 35:2325603. [PMID: 38568005 DOI: 10.1080/09546634.2024.2325603] [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: 12/19/2023] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Abstract
Purpose: Topical clindamycin, a lincosamide antibiotic, is commonly combined with benzoyl peroxide or a retinoid for acne vulgaris (AV) treatment. While oral and topical clindamycin carry warnings/contraindications regarding gastrointestinal (GI) adverse events (AEs), real-world incidence of GI AEs with topical clindamycin is unknown. This review provides background information and an overview of safety data of topical clindamycin for treating AV.Materials and Methods: Available safety data from published literature, previously unpublished worldwide pharmacovigilance data, and two retrospective cohort studies were reviewed.Results and Conclusions: According to pharmacovigilance data, the rate of GI adverse drug reactions with topical clindamycin-containing products was 0.000045% (64/141,084,533). Results from two retrospective medical record studies of patients with AV indicated that physicians prescribe topical clindamycin equally to patients with or without inflammatory bowel disease history, and that rates of pseudomembranous colitis in these patients were low. In 8 published pivotal clinical trials of topical clindamycin for AV, GI AEs were reported in 1.4% of participants. Limitations include under/inaccurate reporting of AEs or prescription data and limited generalizability. This review of published case reports, worldwide pharmacovigilance data, retrospective US prescription data, and clinical trials safety data demonstrates that the incidence of colitis in patients exposed to topical clindamycin is extremely low.
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Affiliation(s)
- Natalia M Pelet Del Toro
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Linda Stein Gold
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - James Q Del Rosso
- JDR Dermatology Research/Thomas Dermatology, Las Vegas, NV, USA
- Advanced Dermatology and Cosmetic Surgery, Maitland, FL, USA
- Department of Dermatology, Touro University Nevada, Henderson, NV, USA
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - George Han
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Guertler A, Neu K, Lill D, Clanner-Engelshofen B, French LE, Reinholz M. Exploring the potential of omega-3 fatty acids in acne patients: A prospective intervention study. J Cosmet Dermatol 2024. [PMID: 38982829 DOI: 10.1111/jocd.16434] [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: 03/26/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Omega-3 fatty acids (ω-3 FA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), are essential nutrients known for their anti-inflammatory properties, which involve reducing pro-inflammatory cytokines, eicosanoids, and insulin-like growth factor-1. This suggests their potential to alleviate acne severity, especially when deficits are present. AIMS To elevate EPA/DHA levels in acne patients through dietary intervention and supplementation, observing subsequent clinical effects. METHODS Over 16 weeks, 60 patients without prescription medication (n = 23 acne comedonica [AC], n = 37 acne papulopustulosa [AP]) adhered to a Mediterranean diet, incorporating oral algae-derived ω-3 FA supplementation (600 mg DHA/300 mg EPA week 1-8, 800 mg DHA/400 mg EPA week 8-16). At four visits (V1-V4), blood EPA/DHA levels were tracked using the HS-omega 3 index® (EPA/DHA (%) of total identified fatty acids in erythrocytes; target 8%-11%, deficit <8%, severe deficit <4%), alongside clinical assessments and standardized questionnaires. RESULTS At baseline, 98.3% of patients had an EPA/DHA deficit, with the mean HS-omega 3 index® rising from 4.9% at V1 to 8.3% at V4 (p < 0.001). AC showed significantly higher indices than AP at V4 (p = 0.035). Objective improvements in both inflammatory and non-inflammatory lesions were observed (p < 0.001). While self-reported appearance worsened in four patients, overall quality of life improved (p < 0.001), particularly in AP. Dietary triggers were more clearly defined than beneficial foods. Intake of cow's milk and dairy products reduced (p < 0.001). Compliance was good; no adverse events were reported. CONCLUSION Many acne patients have a ω-3 FA deficit. The HS-omega 3 index® can be increased by a Mediterranean diet and oral supplementation with algae-derived ω-3 FA. Acne severity improved significantly in patients with target ω-3 FA levels.
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Affiliation(s)
- Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Neu
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Diana Lill
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | | | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, USA
| | - Markus Reinholz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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Tang L, Zhou X, Su G. Successful treatment of a lactating women with severe acne through the combination of fire needle and photodynamic therapy: A case report. Photodiagnosis Photodyn Ther 2024; 48:104234. [PMID: 38848882 DOI: 10.1016/j.pdpdt.2024.104234] [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: 05/02/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
Severe acne, characterized by cysts and nodules, can significantly impact a patient's self-image and quality of life [1]. In China, first-line treatments for severe acne typically include oral isotretinoin, topical benzoyl peroxide, and oral or topical antibiotics [2]. However, due to concerns about safety, oral isotretinoin and antibiotics are not recommended for lactating women, posing challenges in treating acne in this population and often leading to emotional distress. While photodynamic therapy has shown effectiveness in patients unwilling to take oral medications [3], treating severe acne during lactation remains a complex issue with limited research available. In this unique case, fire needle combined with photodynamic therapy was successfully utilized to address severe acne in a lactating patient. Following treatment, the patient experienced clearance of cysts, nodules, and pustules, as well as an improvement in depressive symptoms, yielding significant outcomes. Nevertheless, the efficacy and safety of this combined approach warrant further investigation through clinical trials.
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Affiliation(s)
- Lei Tang
- Department of Dermatology and Cosmetology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Xun Zhou
- Department of Dermatology and Cosmetology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Ge Su
- Department of Dermatology and Cosmetology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
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Du L, Cao Z, Wei J, Li M, Han C, Zhang C. Fire needle pretreatment with 5-aminolevulinic acid photodynamic therapy combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne. Photodiagnosis Photodyn Ther 2024; 47:104215. [PMID: 38735352 DOI: 10.1016/j.pdpdt.2024.104215] [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: 03/09/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Nodulocystic acne is a severe form of acne, which is commonly treated with oral isotretinoin, hormones, or antibiotics. However, drug therapy often has some side effects and poor compliance. Fire needle combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a simple, effective, short-term treatment with few adverse reactions, which is expected to be an effective physiotherapy for nodulocystic acne. Moreover, the combination with isotretinoin can reduce the dosage of the drug, thereby reducing the side effects of isotretinoin. OBJECTIVES To evaluate the safety and efficacy of fire-needle pretreated ALA-PDT combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne. METHODS This study reported 10 patients with refractory nodulocystic acne who received combined treatment. During the treatment period, all patients received a low dose of oral isotretinoin capsules daily. The acne lesions were pretreated with fire needle before ALA-PDT treatment. The number of acne lesions, including papules, pustules, and nodular cysts, was documented at weeks 0, 2, 4, 8, and 12 to assess the therapeutic efficacy. Concurrently, adverse reactions such as pain, pruritus, and pigmentation changes were recorded and evaluated throughout the treatment course. RESULTS After combined treatment, all patients achieved good therapeutic effects, with an overall effective rate of 90 % at week 12. After treatment, skin lesions such as nodules, and cysts subsided significantly. The combination therapy has no serious adverse effects and has a favorable safety profile. CONCLUSION Fire needle pretreatment ALA-PDT combined with low-dose isotretinoin is effective and safe in the treatment of severe refractory nodular cystic acne, which is worthy of clinical promotion and research.
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Affiliation(s)
- Lingyun Du
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Zhiqiang Cao
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, PR China
| | - Jingjing Wei
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Mingming Li
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Changyu Han
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Chunhong Zhang
- Department of Dermato-Venereology, The Second Hospital of Shandong University, Jinan 250033, PR China.
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Zhang J, Liu S, Guo W, Li N. The synergistic effects of Guaiacum officinale and Rhodomyrtus tomentosa extracts in the treatment of acne vulgaris on sensitive skin. J Cosmet Dermatol 2024. [PMID: 38790116 DOI: 10.1111/jocd.16394] [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: 01/26/2024] [Revised: 04/09/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Acne vulgaris, a common chronic dermatological condition worldwide, is associated with inflammatory response and Cutibacterium acnes. Individuals with acne vulgaris and sensitive skin have limited suitable treatments due to the skin irritation and side effects exhibited by current hydroxy acidic medications. AIMS This study aimed to evaluate the synergistic effects of Guaiacum officinale (GO) and Rhodomyrtus Tomentosa (RT) extracts for treating acne vulgaris on sensitive skin by inhibiting inflammation. METHODS The phytochemical constituents and antioxidant activity of GO and RT extracts were determined in vitro. The anti-inflammatory effects were investigated in peptidoglycan (PGN)-induced HaCaT cells. Further, a 28-day clinical trial was conducted involving 30 subjects with both sensitive skin and acne to evaluate the efficacy and subjects' satisfaction. RESULTS Total phenolics and flavonoids were detected in GO and RT extracts, the IC50 values for DPPH radical scavenging were 6.15 wt% and 0.76 wt%, respectively. The combination of GO and RT extracts at a 1:1 (v/v) ratio significantly decreased the expression of TLR-2 and TLR-4, as well as the secretion of IL-1α, IL-8, and TNF-α in PGN-induced HaCaT cells, by 2.30-7.93 times compared to GO extract alone (p < 0.05). Moreover, the cream containing 5 wt% the combination significantly improved facial acne and redness (p < 0.05). The number of comedones decreased by 50.00% and papules by 30.65% after 28 days of application. No adverse events were reported and 96.67% of the subjects were satisfied with the treatment. CONCLUSION The efficacy of the GO and RT extracts in synergistically suppressing inflammation, improving acne vulgaris, and reducing redness. The study offers an effective and non-irritant treatment for acne vulgaris in individuals with sensitive skin.
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Affiliation(s)
- Jianhua Zhang
- N.O.D topia (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
- Simpcare (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
| | - Shichao Liu
- N.O.D topia (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
- Simpcare (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
| | - Wenjiao Guo
- N.O.D topia (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
- Simpcare (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
| | - Na Li
- N.O.D topia (GuangZhou) Biotechnology Co., Ltd., Guangzhou, China
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Kim HJ, Kim YH. Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies. Int J Mol Sci 2024; 25:5302. [PMID: 38791344 PMCID: PMC11121268 DOI: 10.3390/ijms25105302] [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: 03/22/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.
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Affiliation(s)
- Hyun Jee Kim
- Department of Dermatology, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea;
| | - Yeong Ho Kim
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Guertler A, Fiedler T, Lill D, Kuna AC, Volsky A, Wallmichrath J, Kämmerer T, French LE, Reinholz M. Deficit of Omega-3 Fatty Acids in Acne Patients-A Cross-Sectional Pilot Study in a German Cohort. Life (Basel) 2024; 14:519. [PMID: 38672789 PMCID: PMC11050840 DOI: 10.3390/life14040519] [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: 02/03/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Omega-3 fatty acids (ω-3 FAs) exert anti-inflammatory effects, including the downregulation of pro-inflammatory cytokines, eicosanoids, and insulin-like growth factor-1. Therefore, they may improve acne severity as an adjunct treatment. However, there is a paucity of data regarding patients' existing deficits. The aim of this study was to determine ω-3 FA levels in acne patients in correlation with self-reported dietary preferences and clinical severity. A single-center, cross-sectional study of 100 acne patients was conducted. Patients' blood parameters, including ω-3 FAs levels, were assessed using the HS-omega-3 Index® in erythrocytes (Omegametrix® GmbH, Martinsried, Germany). Dietary preferences were assessed using a standardized food frequency questionnaire. Clinical dermatologic evaluation was performed using the Investigator Global Assessment (IGA) of acne. The values of the HS-omega-3 Index® were outside the recommended range of 8-11% in 96 patients (mean 5.15%), independent of the clinical severity or affected anatomic sites. A severe deficit (HS-omega-3 Index® < 4%) was seen more commonly in men than in women (p = 0.021). The regular consumption of legumes was significantly associated with higher ω-3 FA levels (p = 0.003), as was oral ω-3 FA supplementation (p = 0.006) and the lack of sunflower oil intake (p = 0.008). This pilot study demonstrated a deficit of ω-3 FAs in a German acne cohort. Higher ω-3 FAs levels were observed in patients with regular legume intake and oral ω-3 FAs supplementation. Further prospective studies are needed to investigate whether the clinical severity of acne improves in patients with normal HS-omega-3 Index®.
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Affiliation(s)
- Anne Guertler
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Tobias Fiedler
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Diana Lill
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Anne-Charlotte Kuna
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Arina Volsky
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Jens Wallmichrath
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Till Kämmerer
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
| | - Lars E. French
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Markus Reinholz
- Department of Dermatology and Allergy, LMU University Hospital, 80539 Munich, Germany (M.R.)
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Althwanay A, AlEdani EM, Kaur H, Kasapoglu M, Yadavalli R, Nawaz S, Nath TS. Efficacy of Topical Treatments in the Management of Mild-to-Moderate Acne Vulgaris: A Systematic Review. Cureus 2024; 16:e57909. [PMID: 38725769 PMCID: PMC11081083 DOI: 10.7759/cureus.57909] [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] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Acne vulgaris, commonly called acne, is a skin condition affecting many individuals globally. It is a chronic condition characterized by developing pimples, blackheads (open comedones), whiteheads (closed comedones), and other skin lesions. Acne usually appears on the face, neck, chest, and back. It is commonly associated with puberty and adolescence but can also affect adults of all ages. Acne can be very frustrating and embarrassing, leading to low self-esteem and social isolation. The condition arises from various factors, including clogged pores, excessive sebum production, bacteria, and inflammation. This systematic review assesses the effectiveness of topical antibiotics, retinoids, niacinamide, azelaic acid, and clascoterone in treating mild-to-moderate acne vulgaris. A comprehensive search across PubMed, PubMed Central, and Google Scholar yielded 10 articles focused on topical antibiotics, with findings from 198 subjects indicating the efficacy of doxycycline against inflammatory lesions. Retinoids, such as tretinoin and adapalene, significantly improved both lesion types (open and closed comedones). Niacinamide, examined in a randomized controlled trial involving 41 participants, reduced sebum production. Another study with 60 patients revealed that azelaic acid effectively reduced both inflammatory and non-inflammatory lesions. Clascoterone emerged as a promising antiandrogenic treatment, supported by a randomized controlled trial involving 4,440 patients. It is essential that individualized therapy, incorporating patient preferences and considering adverse effects, is emphasized for optimizing acne management.
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Affiliation(s)
- Abdulaziz Althwanay
- Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Dermatology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Esraa M AlEdani
- Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Harleen Kaur
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | - Malik Kasapoglu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajesh Yadavalli
- Internal Medicine, Rajiv Gandhi Institute of Medical Sciences, Adilabad, IND
| | - Sarosh Nawaz
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Ullah A, Muhammad A, Mehmood F, Farooq H, Ahmad B, Bin Haq A, Khan N, Naz S, Khan A, Saeed A. Comparing the Efficacy of Topical 4% Benzoyl Peroxide Versus Topical 0.1% Adapalene for Treatment of Acne Vulgaris in Skin of Color Population: A South Asian Perspective. Cureus 2024; 16:e55555. [PMID: 38576696 PMCID: PMC10993754 DOI: 10.7759/cureus.55555] [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: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Acne vulgaris is one of the most common skin problems encountered in the dermatology department. It is a chronic, inflammatory disease of the pilosebaceous unit, clinically presenting with comedones, papules, pustules, nodules, and cysts. With its particularly high prevalence in the younger population, it has significant adverse sequelae on patient's quality of life. At present, due to an enhanced understanding of the pathogenesis of acne, various therapeutic modalities are available. The current management strategies generally follow a systematic treatment escalation based on disease severity and treatment response. However meticulous choice of appropriate anti-acne medicine for the acne type is the key to the management plan. Starting with mild to moderate types of acne as per the Leeds photometric grading scale, the most useful topical agents include topical retinoids, benzoyl peroxide, and topical antibiotics while systemic therapies such as oral antibiotics or isotretinoin are generally reserved for moderate to severe acne treatment. The skin of color (SOC) population is a relatively neglected group concerning the optimum and safe management strategies in different dermatological conditions and acne is no different, where there remains a need for comparing the available topical modalities for appropriate drug selection in the treatment of mild to moderate acne in SOC population. Objective The objective of this study was to compare the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalene in the treatment of acne vulgaris in the SOC population. Methods The participants were divided into two groups, groups A and B. A total of 64 patients of both genders, with acne vulgaris (duration > three months) were included in the study. In group A, 32 patients were administered topical 0.1% adapalene whereas, in group B, 32 patients were given topical 4% benzoyl peroxide. Both medicines were applied at night daily. Patients were called for follow-up after 12 weeks. In both groups, the final efficacy evaluation was done using the Global Acne Grading System (GAGS) score after 12 weeks of treatment period. Results In group A, the age ranged from 15 to 40 years with a mean age of 25.781±3.93 years while the duration of complaint was 5.843±1.27 months. GAGS score was 25.281±2.65 and mean BMI was 23.092±3.51 kg/m2. In group B, the mean age was 25.187± 4.06 years, the duration of complaint was 7.375±2.25 months, the GAGS score was 23.906± 2.60 while the mean BMI was 21.485±3.88 kg/m2. Efficacy in group A was noted in 25 (78.1%) patients as compared to 24 (75%) patients in group B (p =0.768). Conclusion The present study showed that the safety and efficacy of 0.1% adapalene the traditional drug 4% benzoyl peroxide in the SOC population was comparable.
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Affiliation(s)
- Asmat Ullah
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Anjum Muhammad
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Farman Mehmood
- Plastic Surgery, Combined Military Hospital, Rawalpindi, PAK
| | - Hina Farooq
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Bilal Ahmad
- Endocrinology and Diabetes, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Afnan Bin Haq
- Dermatology, Combined Military Hospital, Gujranwala, PAK
| | - Naseem Khan
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Syeda Naz
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
| | - Asghar Khan
- Medicine, Khyber Medical University, Peshawar, PAK
| | - Afshan Saeed
- Dermatology, Pak-Emirates Military Hospital, Rawalpindi, PAK
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Hingtgen GM, Solberg LB. Prescribing Teratogenic Medications Post- Dobbs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:49-51. [PMID: 38295238 DOI: 10.1080/15265161.2023.2296410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
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11
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Manuskiatti W, Wongdama S, Viriyaskultorn N, Li JB, Kulthanan K, Techapichetvanich T. Long-term efficacy and safety of nonablative monopolar radiofrequency in the treatment of moderate to severe acne vulgaris. Lasers Surg Med 2024; 56:133-141. [PMID: 38221810 DOI: 10.1002/lsm.23757] [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: 11/12/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Acne vulgaris (AV) is a prevalent skin condition known for its potential to cause scarring and psychological distress, often leading to diminished self-esteem. While topical and oral treatments are commonly prescribed, some patients experience treatment failure, adverse effects, or contraindications to conventional therapies. In response to these challenges, laser and energy-based device therapies have emerged as promising alternatives for individuals who fall into these categories, showing considerable potential in the treatment of AV. OBJECTIVE This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) in treatment of moderate to severe AV. METHODS Twenty-four patients with moderate to severe AV underwent a series of two NMRF treatment sessions, spaced 4 weeks apart. To evaluate treatment outcomes, live in-person lesion counts and measurements of pore size and volume, and sebum production were quantified using Antera® 3D imaging system, and Sebumeter®, respectively. Patients' self-assessment data regarding degree of improvement and facial oiliness were gathered. Dermatology life quality index (DLQI) questionnaire was utilized to assess the impact of AV on their quality of life. All objective and subjective evaluations were conducted at the baseline, 1 month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment sessions. Adverse effects were also recorded during each visit. RESULTS Twenty out of the 24 subjects completed the study protocol. The mean inflammatory lesion counts significantly reduced by 42.86% and 45.71% from the baseline at 3 (p = 0.027) and 6 months (p = 0.032) after the second treatment. Sebum excretion likewise significantly decreased from baseline by 11.62% (p = 0.012), 13.37% (p < 0.001), and 21.51% (p = 0.004), 1 month after the first treatment, 1 and 6 months after the second treatment, respectively. The pore volume continued to decrease by 35% (p = 0.003) and 41.5% (p < 0.001) at 1 and 6 months following the final treatment, respectively. The DLQI significantly decreased from 10.00 (interquartile range [IQR]: 6.50-15.00) to 2.00 (IQR: 1.00-4.75), corresponding to 80% improvement of the index, 1 month after the last treatment and was sustained up to the last follow-up visit. Patients' self-assessments on degree of improvement and facial oiliness also significantly improved following NMRF treatments. The treatments were well-tolerated without significant adverse effects. CONCLUSION NMRF appears to be an effective and safe treatment for inflammatory AV, with therapeutic outcomes persisting up to 6 months after two treatment sessions.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Noldtawat Viriyaskultorn
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jayne Bernadeth Li
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thanya Techapichetvanich
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Patel HA, Guo L, Feldman SR. The impact of current investigational drugs for acne on future treatment strategies. Expert Opin Investig Drugs 2024; 33:127-132. [PMID: 38369920 DOI: 10.1080/13543784.2024.2313091] [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: 06/01/2023] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Acne vulgaris is one of the most prevalent diseases worldwide with a considerably high cost and a burden on quality of life. There are currently many topical and systemic therapies for acne; however, many are limited by their local adverse event profile. This review provides an update on current, novel Phase I and II trials for acne vulgaris. AREAS COVERED This review searched the National Institutes of Health US National Library of Medicine online database of clinical trials (ClinicalTrials.gov) for ongoing Phase I and II trials. Only papers discussing novel therapies were discussed, and combinations of previously FDA-approved drugs were excluded. EXPERT OPINION The current investigational approaches to acne treatment reflect an attempt to mitigate the underlying cause of acne pathogenesis. By targeting key mechanisms involved, studies aim to show long-term improvement with less frequent treatment use. This provides potential for more tolerable treatments with better patient adherence, in turn leading to increased efficacy.
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Affiliation(s)
- Heli A Patel
- Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lily Guo
- Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL, USA
| | - Steven R Feldman
- Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Dermatology, Pathology, and Public Health Sciences, Winston-Salem, NC, USA
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13
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Huang F, Fu Q, Tang L, Zhao M, Huang M, Zhou X. Trends in photodynamic therapy for dermatology in recent 20 years: A scientometric review based on CiteSpace. J Cosmet Dermatol 2024; 23:391-402. [PMID: 37815144 DOI: 10.1111/jocd.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Analyze the research state and development trend of photodynamic therapy for dermatology using visual knowledge graphs derived from the Web of Science Core Collection database. METHODS The Web of Science Core Collection database was utilized as the search data source for the bibliometric analysis, and the associated articles published between January 1, 2000, and December 31, 2022, were obtained using the search terms "photodynamic therapy" and "dermatology". CiteSpace, VOSviewer, and additional tools were utilized for bibliometric analysis, and visual knowledge graphs were created. RESULTS Eight hundred and thirty two articles were retrieved in total, and 747 were included following de-duplication and transformation. The country with the greatest number of publications is the United States; the primary research institution was University of Copenhagen; and the references with the highest centrality were primarily concerned with the selection of photosensitizers; High frequency keywords primarily comprised 5 aminolevulinic acid and basal cell carcinoma; and the clustering graph revealed that all keywords fell into 11 categories. CONCLUSION In numerous areas of dermatology, photodynamic treatment is commonly employed. Current research focuses on nonneoplastic skin diseases and the choice of photosensitizers. Nonetheless, its specific mechanism and other applications merit further investigation.
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Affiliation(s)
- Fujun Huang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Qiang Fu
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Lei Tang
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Mingdan Zhao
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Mengya Huang
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xun Zhou
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
- Department of Cosmetic Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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14
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Xie L, Hamblin MR, Zheng D, Wen X. Die Bedeutung von Mikrokomedonen bei der Akne: Von der Beschreibung bis zum Behandlungsansatz?: The role of microcomedones in acne: Moving from a description to treatment target? J Dtsch Dermatol Ges 2024; 22:9-17. [PMID: 38212912 DOI: 10.1111/ddg.15272_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/11/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungEin wichtiger Faktor in der Pathogenese der Akne vulgaris ist die duktale Hyperproliferation der Talgdrüsen. Diese beginnt mit der Bildung unsichtbarer Mikrokomedonen und führt im weiteren Verlauf zur Ausbildung sowohl entzündlicher als auch nicht‐entzündlicher klinischer Läsionen. Die Mikrokomedonen stehen am Anfang der zyklischen Entwicklung einer Akne, die als Komedogenese bezeichnet wird. Mikrokomedonen können mithilfe von Cyanoacrylat‐Hautablösungen, Elektronenmikroskopie, konfokaler Reflexionsmikroskopie und anderen Techniken nachgewiesen werden. Es wird angenommen, dass die Dichte und Größe von Mikrokomedonen positiv mit dem Schweregrad der Akne korreliert. Ziel dieser Übersichtsarbeit ist es, die Ursachen der Akne zusammenzufassen und darauf hinzuweisen, dass die Behandlung von Mikrokomedonen zumindest teilweise Akneläsionen beseitigen und Rückfälle verhindern könnte.
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Affiliation(s)
- Li Xie
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, Südafrika
| | - DanLing Zheng
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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15
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Magin P, Prentice S. Isotretinoin and Adverse Psychiatric Effects. JAMA Dermatol 2024; 160:19-20. [PMID: 38019559 DOI: 10.1001/jamadermatol.2023.4577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Shaun Prentice
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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16
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Xie L, Hamblin MR, Zheng D, Wen X. The role of microcomedones in acne: Moving from a description to treatment target? J Dtsch Dermatol Ges 2024; 22:9-16. [PMID: 38123894 DOI: 10.1111/ddg.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023]
Abstract
A major factor in the pathogenesis of acne is ductal hyperproliferation in the pilosebaceous glands. This takes the form of invisible microcomedones and leads to the subsequent formation of both inflammatory and non-inflammatory clinical lesions. Microcomedones are the initial stage in the cyclical development of acne, so called comedogenesis. Microcomedones can be detected using cyanoacrylate skin surface stripping, electron microscopy, reflection confocal microscopy and other techniques. It has been proposed that the density and the size of microcomedones are positively correlated with acne severity. Thus, the purpose of this review is to summarize the root causes of acne, and suggest that treatment of microcomedones could, at least in part, resolve acne lesions and prevent relapse.
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Affiliation(s)
- Li Xie
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - DanLing Zheng
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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17
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Santer M, Burden-Teh E, Ravenscroft J. Managing acne vulgaris: an update. Drug Ther Bull 2023; 62:6-10. [PMID: 38154809 PMCID: PMC10803966 DOI: 10.1136/dtb.2023.000051] [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] [Indexed: 12/30/2023]
Abstract
Acne vulgaris is very common and can have significant negative impact on people. While sometimes a transient problem, acne may persist for many years and often leads to permanent scars or pigment changes. Guidelines unanimously advise topical treatments as first-line, although differ in recommending either topical benzoyl peroxide or topical retinoid (mainly adapalene) alone or in combination. Guidance published by the National Institute for Health and Care Excellence advises counselling patients regarding avoidance of skin irritation when starting topical treatments and promoting adherence (treatments take 6-8 weeks to work). Oral antibiotics are currently overprescribed for acne but have a role when coprescribed with a non-antibiotic topical treatment. Hormonal treatments, such as the combined contraceptive pill, are also effective and there is growing evidence for the use of spironolactone for women with persistent acne. Recent guidance from the Medicines and Healthcare products Regulatory Agency regarding isotretinoin has implications for specialist prescribing and monitoring, and increasing public awareness of potential risks of mental health problems and sexual dysfunction. Although acne is associated with psychiatric disorder, the mental health effects of isotretinoin remain controversial.
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Affiliation(s)
- Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
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18
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How KN, Ho WC, Sundaran M, Wan Ahmal Kammal WSL, Lim PY, Chew W. Efficacy and Tolerability of a Sunscreen Containing Licochalcone a and L-Carnitine as an Adjunct to Retinoids in the Management of Acne and Post-Acne Pigmentation Among Malaysian Patients. Clin Cosmet Investig Dermatol 2023; 16:3719-3729. [PMID: 38152154 PMCID: PMC10752021 DOI: 10.2147/ccid.s422898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/08/2023] [Indexed: 12/29/2023]
Abstract
Purpose We aim to evaluate the effectiveness and tolerability of a sunscreen formulation containing licochalcone A (LicA) and L-carnitine (LC) as an adjuvant to adapalene in the management of acne and post-acne pigmentation (PAH). Patients and Methods A randomized, double-blind, active comparator-controlled trial of 51 patients aged 18 years or older with a clinical diagnosis of mild-to-moderate acne vulgaris was conducted at the Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. The efficacy and tolerability of once-daily adapalene 1.0% were assessed during the 2-week run-in period. Subsequently, patients were randomized to receive either an add-on investigational LicA-containing sunscreen or niacinamide-containing comparator sunscreen every 4 hourly during daytime for 4 weeks. Patients were followed up at Weeks 2 and 4 to assess for improvement in acne severity, PAH, calorimetric parameters and cutaneous tolerability. Results Two weeks of adapalene usage significantly improved acne severity; however, up to 52% of patients experienced dryness, burning and stinging. Adding LicA-containing or comparator sunscreens was associated with further improvement in acne severity, PAH and calorimetric parameters at the study endpoint. No significant differences in the cutaneous tolerability profiles were observed between treatment groups. Notably, significantly fewer patients receiving LicA-containing sunscreen developed scaliness at Week 4 compared with those in the comparator group. In addition, more patients receiving LicA-containing sunscreen reported less dryness, burning and stinging reactions than the comparator group. Importantly, more patients receiving LicA-containing sunscreen agreed that their treatment led to excellent improvement than the comparator group; of note, one patient reported that their condition worsened with the receipt of the comparator product. Conclusion The concurrent use of LicA-containing sunscreen with adapalene may improve the cutaneous tolerance to adapalene among Malaysian patients.
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Affiliation(s)
- Kang Nien How
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Wen Chung Ho
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Meroshini Sundaran
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Wan Syazween Lyana Wan Ahmal Kammal
- Dermatology Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Wilson Chew
- Beiersdorf (Malaysia) Sdn Bhd, Petaling Jaya, Selangor, Malaysia
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19
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Pyne S, Sach TH, Lawrence M, Renz S, Eminton Z, Stuart B, Thomas KS, Francis N, Soulsby I, Thomas K, Permyakova NV, Ridd MJ, Little P, Muller I, Nuttall J, Griffiths G, Layton AM, Santer M. Cost-effectiveness of Spironolactone for Adult Female Acne (SAFA): economic evaluation alongside a randomised controlled trial. BMJ Open 2023; 13:e073245. [PMID: 38081673 PMCID: PMC10729081 DOI: 10.1136/bmjopen-2023-073245] [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: 02/28/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aims to estimate the cost-effectiveness of oral spironolactone plus routine topical treatment compared with routine topical treatment alone for persistent acne in adult women from a British NHS perspective over 24 weeks. DESIGN Economic evaluation undertaken alongside a pragmatic, parallel, double-blind, randomised trial. SETTING Primary and secondary healthcare, community and social media advertising. PARTICIPANTS Women ≥18 years with persistent facial acne judged to warrant oral antibiotic treatment. INTERVENTIONS Participants were randomised 1:1 to 50 mg/day spironolactone (increasing to 100 mg/day after 6 weeks) or matched placebo until week 24. Participants in both groups could continue topical treatment. MAIN OUTCOME MEASURES Cost-utility analysis assessed incremental cost per quality-adjusted life year (QALY) using the EQ-5D-5L. Cost-effectiveness analysis estimated incremental cost per unit change on the Acne-QoL symptom subscale. Adjusted analysis included randomisation stratification variables (centre, baseline severity (investigator's global assessment, IGA <3 vs ≥3)) and baseline variables (Acne-QoL symptom subscale score, resource use costs, EQ-5D score and use of topical treatments). RESULTS Spironolactone did not appear cost-effective in the complete case analysis (n=126 spironolactone, n=109 control), compared with no active systemic treatment (adjusted incremental cost per QALY £67 191; unadjusted £34 770). Incremental cost per QALY was £27 879 (adjusted), just below the upper National Institute for Health and Care Excellence's threshold value of £30 000, where multiple imputation took account of missing data. Incremental cost per QALY for other sensitivity analyses varied around the base-case, highlighting the degree of uncertainty. The adjusted incremental cost per point change on the Acne-QoL symptom subscale for spironolactone compared with no active systemic treatment was £38.21 (complete case analysis). CONCLUSIONS The results demonstrate a high level of uncertainty, particularly with respect to estimates of incremental QALYs. Compared with no active systemic treatment, spironolactone was estimated to be marginally cost-effective where multiple imputation was performed but was not cost-effective in complete case analysis. TRIAL REGISTRATION NUMBER ISRCTN registry (ISRCTN12892056).
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Affiliation(s)
- Sarah Pyne
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Megan Lawrence
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Susanne Renz
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
- Centre for Evaluation and Methods Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kim S Thomas
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nick Francis
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Irene Soulsby
- Public Contributor, Primary Care Research Centre, University of Southampton, Southampton, Hampshire, UK
| | - Karen Thomas
- Public Contributor, Primary Care Research Centre, University of Southampton, Southampton, Hampshire, UK
| | - Natalia V Permyakova
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison M Layton
- Skin Research Centre, Hull York Medical School, University of York, York, North Yorkshire, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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Cao Y, Liang J, Wang C, Bao X, Li S, Liu Q, Zeng B, Lopez DH, Yu R. Investigating material basis and molecular mechanism of Qing Cuo formula in the treatment of acne based on animal experiments, UPLC-LTQ-Orbitrap-MS and network pharmacology. PHARMACEUTICAL BIOLOGY 2023; 61:973-985. [PMID: 37390845 DOI: 10.1080/13880209.2023.2225546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/19/2023] [Accepted: 06/11/2023] [Indexed: 07/02/2023]
Abstract
CONTEXT Qing Cuo Formula (QCF) is a traditional Chinese medicine for treating acne, but its active compounds and molecular mechanisms are unclear. OBJECTIVE To investigate the material basis and molecular mechanism of QCF. MATERIALS AND METHODS In vivo experiments were conducted on 60 male golden hamsters with damp-heat acne, with a blank group, a spironolactone group and 3 QCF administration groups (given high, medium and low doses) over a 30-day period. Serum androgen and inflammatory cytokine levels were tested by ELISA. In vitro, chemical compositions of QCF were investigated by UPLC-LTQ-Orbitrap-MS. Network pharmacology approaches were used to analyse the protein-protein interaction (PPI) network and QCF active compounds-intersection targets-acne network. GO enrichment and KEGG pathway analysis was conducted subsequently. RESULTS Low-dose QCF group (11.4 g/kg/day) showed significantly reduced levels of serum T (4.94 ± 0.36; 5.51 ± 0.36 ng/mL), DHT (6.67 ± 0.61; 8.09 ± 0.59 nmol/L), E2 (209.01 ± 20.92; 237.08 ± 13.94 pg/mL), IL-1α (36.84 ± 3.23; 44.07 ± 4.00 pg/mL) and FFA (128.32 ± 10.94; 148.00 ± 12.12 µmol/L) compared to the blank group (p < 0.05). In vitro experiments identified 75 compounds in QCF decoction, with 27 active compounds absorbed in serum. Network pharmacology identified 6 active components connecting 17 targets. GO enrichment and KEGG pathway analysis indicated that QCF's anti-acne targets mainly regulate extracellular matrix function, inflammatory processes, immune response and endocrine function. CONCLUSIONS This study provides evidence of the molecular mechanism and material basis of QCF in treating androgen-related damp-heat acne, paving the way for further research on its potential in treating other conditions related to damp-heat constitution.
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Affiliation(s)
- Yanqi Cao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jinfeng Liang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chunguo Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xuejie Bao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Siqi Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Zeng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - David Humberto Lopez
- Department of Chemical and Environmental Engineering & Arizona Laboratory for Emerging Contaminants, University of Arizona, Tucson, AZ, USA
| | - Ruoxi Yu
- National Institute of Traditional Chinese Medicine Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China
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21
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Zhang L, Yang Y, Wang B, Zhao Y, Wang P, Liu J, Yang J, Wu Y, Lv T, Wei Z, Liu X, Wang R, Wong H, Ju Q, Shi L, Wang X. Modified red light 5-aminolevulinic acid photodynamic therapy versus low-dose isotretinoin therapy for moderate to severe acne vulgaris: A prospective, randomized, multicenter study. J Am Acad Dermatol 2023; 89:1141-1148. [PMID: 37558093 DOI: 10.1016/j.jaad.2023.07.1023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Modified 5-aminolevulinic acid photodynamic therapy (M-PDT) and isotretinoin (ISO) are effective treatments for moderate to severe acne vulgaris. OBJECTIVE To evaluate the efficacy and adverse effects of M-PDT and ISO for moderate to severe acne vulgaris. METHODS A multicenter, randomized clinical trial was conducted with participants randomly assigned to the M-PDT group (up to 5 weekly sessions following manual comedone extraction) or the ISO group (oral ISO, 0.5 mg/kg/d for 6 months) and followed up to 6-months after therapy. RESULTS A total of 152 patients were allocated. The overall effective rates in the M-PDT group were significantly higher than the ISO group at 1 month (67.74% vs 10.26%), whereas the opposite was the case 1 month after treatment (75.81% vs 97.44%). Time to achieve 50% lesion improvement in the M-PDT group was significantly less than the ISO group (1 vs 8 weeks). Overall, 70.67% of the ISO group patients experienced systemic side effects such as hepatotoxicity, whereas side effects were skin-limited in the M-PDT group. LIMITATIONS Limitations of this study included relatively low numbers of participants and high withdrawal rate. CONCLUSION M-PDT offers a more rapid onset of improvement, comparable overall efficacy, good tolerability, and comparable durability of response compared with ISO.
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Affiliation(s)
- Linglin Zhang
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Yutong Yang
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Bo Wang
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan; Department of Dermatology, Avera Medical Group Dermatology Aberdeen, Aberdeen, South Dakota
| | - Yan Zhao
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Peiru Wang
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Jia Liu
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Jiayi Yang
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Yun Wu
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Ting Lv
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Ziyu Wei
- Department of Dermatology, Renji Hospital, School of Medicine, Shanghai, Jiaotong University, Shanghai, China
| | - Xiaojing Liu
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Disease Hospital, Tongji University, Shanghai, China
| | - Harrison Wong
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Qiang Ju
- Department of Dermatology, Renji Hospital, School of Medicine, Shanghai, Jiaotong University, Shanghai, China.
| | - Lei Shi
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China.
| | - Xiuli Wang
- Department of Phototherapy, Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, China.
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22
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Cruz S, Vecerek N, Elbuluk N. Targeting Inflammation in Acne: Current Treatments and Future Prospects. Am J Clin Dermatol 2023; 24:681-694. [PMID: 37328614 PMCID: PMC10460329 DOI: 10.1007/s40257-023-00789-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/18/2023]
Abstract
Acne is a common, chronic inflammatory condition affecting millions of people worldwide, with significant negative impact on quality of life and mental health. Acne is characterized by comedones, inflammatory papules, pustules, and nodulocystic lesions, with long-lasting sequelae including scarring and dyspigmentation, the latter of which is more common in skin of color. The four main pillars of acne pathophysiology include alteration of sebum production and concentration, hyperkeratinization of the follicular unit, Cutibacterium acnes strains, and an inflammatory immune response. Newer research has provided greater insight into these pathophysiologic categories. This greater understanding of acne pathogenesis has led to numerous new and emerging treatment modalities. These modalities include combinations of existing treatments, repurposing of existing agents historically used for other conditions, new topical treatments, novel antibiotics, topical and oral probiotics, and various procedural devices. This article will provide an overview of emerging treatments of acne and their link to our current and improved understanding of acne pathogenesis.
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Affiliation(s)
- Sebastian Cruz
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Natalia Vecerek
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, 830 S Flower St Ste 100, Los Angeles, CA, 90017, USA.
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23
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Dehghani A, Kargar S, Faghihi G, Adibi N, Noorshargh P, Dehghani S, Pourazizi M, Abtahi-Naeini B. Systemic isotretinoin therapy and central macular and choroidal thicknesses in acne vulgaris: is there any association? Cutan Ocul Toxicol 2023; 42:174-178. [PMID: 37399081 DOI: 10.1080/15569527.2023.2227895] [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: 08/22/2022] [Revised: 11/29/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To investigate the effect of oral isotretinoin therapy on central macular thickness (CMT) thickness and choroidal thickness (CT) using optical coherence tomography (OCT). METHODS CT and CMT thickness of 43 eyes were evaluated at baseline, the third, and sixth month of isotretinoin therapy by spectral-domain OCT. For assessment of CT, OCT measurements were obtained at the fovea with six additional measurements at adjacent locations (at 500-1000 µm temporal to the fovea and 500-1000 µm nasal to the fovea). RESULTS Forty-three eyes from 43 patients with acne vulgaris, including 33 females (76.7%), who had a mean age of 24.81 ± 6.60 years, completed the study. The mean CMT was 231.49 ± 19.52 at the baseline and significantly decreased to 229.0 ± 19.57 (p = 0.02) and 229.28 ± 18.83 after three and six months, respectively (p < 0.03). The change in the macular thicknesses measured at four quadrants and choroidal thicknesses were not statistically significant during the study (p > 0.05). CONCLUSION The result of our study demonstrated choroidal thickness change is not significant in patients with acne vulgaris after systemic isotretinoin therapy during six months of follow-up. The decreased CMT amount was 2.2 microns; even if statistically significant, this amount is clinically insignificant.
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Affiliation(s)
- Alireza Dehghani
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Saeed Kargar
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Gita Faghihi
- Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Neda Adibi
- Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Pegah Noorshargh
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Shakiba Dehghani
- Farabi Eye Hospital, Department of Ophthalmology, Tehran University of Medical Science, Tehran, Iran
| | - Mohsen Pourazizi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Bahareh Abtahi-Naeini
- Skin Diseases and Leishmaniosis Research Center, Isfahan University of Medical Science, Isfahan, Iran
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24
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Bougault V, Schiano-Lomoriello S, Castanier C, Buisson C, Ericsson M, Teulier C, Collomp K. Physical activity and combined hormonal contraception: association with female students' perception of menstrual symptoms. Front Physiol 2023; 14:1185343. [PMID: 37265844 PMCID: PMC10230043 DOI: 10.3389/fphys.2023.1185343] [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] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023] Open
Abstract
Aim: The aim of this study was to examine the association between physical activity (PA) and combined hormonal contraceptive (CHC) on female students' self perceptio of their menstrual cycle symptoms. Methods: Healthy French female students (n = 834) completed an online questionnaire to assess their PA level (Group 1: non-active; Group 2: moderate physical activity; Group 3: high physical activity; Group 4: very high physical activity), menstrual status or contraception use, self-reported diet and medication, impact on engagement in some social activities, and self-assessment of perceived mental and physical symptoms during the week prior to menses (PM) for students with a normal menstrual cycle (NMC), and the week of menses (ME) for normal menstrual cycle students and those using combined hormonal contraception. Results: Whatever the conditions (PM and ME, NMC and CHC), fewer self-perceived symptoms and self-reported alteration in fat intake were reported by the students in Group 4, and more analgesic and anti-inflammatory medication use was reported by Group 1. Fewer self-perceived symptoms were also found in CHC vs NMC female students for all physical activity levels, but in a more marked way when associated with very high physical activity. In addition, less university and sports practice absenteeism was observed with high and very high physical activity. Conclusion: In conclusion, the perception of menstrual cycle symptoms was lower with very high physical activity, as with combined hormonal contraception. Moreover, female students training more than 5 h/week also reported less university absenteeism and impairment in physical activities. Further studies are necessary to establish the causal link of physical activity and combined hormonal contraception on menstrual symptoms.
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Affiliation(s)
| | - Sandrine Schiano-Lomoriello
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
- Sport, Physical Activity, Rehabilitation and Movement for Performance and Health Research Group, Orléans, France
| | - Carole Castanier
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
| | - Corinne Buisson
- Laboratoire Anti-Dopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
| | - Magnus Ericsson
- Laboratoire Anti-Dopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
| | - Caroline Teulier
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
| | - Katia Collomp
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
- Sport, Physical Activity, Rehabilitation and Movement for Performance and Health Research Group, Orléans, France
- Laboratoire Anti-Dopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
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25
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Xue H, Ye D, Huang S, He S, Li Y, Liu J, Hu D, Zhu Y, Hu G, Dong Y, Shen H, Zeng WH, Wang Z. Efficacy and safety of low-dose oral isotretinoin monotherapy versus combined therapy with picosecond laser for the treatment of acne scars in Asian population. Lasers Surg Med 2023; 55:359-371. [PMID: 36856028 DOI: 10.1002/lsm.23646] [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: 11/01/2022] [Revised: 01/12/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Acne scars are common in patients with moderate to severe acne. Isotretinoin is the first-line treatment for those patients, but whether oral isotretinoin can improve acne scar is not clear. Picosecond lasers (FxPico) has been reported to improve acne scars. In the present study, we evaluated the clinical efficacy of low-dose isotretinoin with or without FxPico treatment for acne scars. MATERIALS AND METHODS A total of 48 patients with acne scars were enrolled and were randomly assigned to receive low dose oral isotretinoin or not. For all the patients in both treatment groups, one side of face were randomly assigned to be treated with picosecond laser. Assessments, including photos, échelle d'évaluation clinique des cicatrices d'acné (ECCA) and Global Acne Grading System (GAGS) score, the number of lesions, melanin and erythema indexes, transepidermal water loss were assessed at 0, 1, 2, and 3 month. Side effects, Dermatology Life Quality Index (DLQI) and satisfaction were recorded before and after the study. RESULTS A total of 44 patients completed the study (24 received oral low dose isotretinoin and 20 did not). Low dose oral isotretinoin treated group showed significant improvement on ECCA (from 112.5 [50-180] to 105 [50-160]), GAGS score (from 12.6 ± 3.3 to 10.1 ± 3.0), the count of papules (from 4.3 ± 3.7 to 1.0 ± 1.5) than the blank group, and higher improvement were noticed after isotretinoin combined with FxPico. All the side effects were temporary and tolerable, no adverse effects were observed. Higher DLQI and patients' satisfaction were achieved by oral isotretinoin alone and isotretinoin combined with FxPico. CONCLUSIONS This is the first paper showing the improvement of scars by early low dose-isotretinoin intervention with or without the combination of picosecond laser. Early intervention with oral low-dose isotretinoin is effective for the treatment and prevention of acne scars, the combined therapy with FxPico can achieve better outcome.
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Affiliation(s)
- Huan Xue
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dan Ye
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shiliu Huang
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shujuan He
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Youbao Li
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Liu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Die Hu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yu Zhu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guanglei Hu
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Dong
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Editorial Department of Chinese Journal of Dermatovenereology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hua Shen
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Xi'an Asia-Pacific Medical Beauty Hospital, Xi'an, Shaanxi, China
| | - Wei-Hui Zeng
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhao Wang
- Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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26
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Sun HY, Sebaratnam DF. Assessment of disutility in cost-effectiveness analyses in acne. Clin Exp Dermatol 2023; 48:242-243. [PMID: 36763726 DOI: 10.1093/ced/llac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Helen Y Sun
- School of Clinical Medicine, UNSW Medicine & Health, South West Sydney Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, NSW, Australia
| | - Deshan F Sebaratnam
- School of Clinical Medicine, UNSW Medicine & Health, South West Sydney Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, NSW, Australia
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27
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Wang P, Wang B, Zhang L, Liu X, Shi L, Kang X, Lei X, Chen K, Chen Z, Li C, Zhang C, Tu P, Pan M, Ju Q, Man X, Lu Y, Yu N, Li Y, Zhu H, Zhang R, Su J, Tao S, Qiao J, Mu Q, Zeng W, Li Z, Gao Y, Gu H, Wang X. Clinical practice Guidelines for 5-Aminolevulinic acid photodynamic therapy for acne vulgaris in China. Photodiagnosis Photodyn Ther 2022; 41:103261. [PMID: 36587863 DOI: 10.1016/j.pdpdt.2022.103261] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
A variety of evidence suggest that 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) is clinically effective in management of acne vulgaris. Several clinical guidelines for acne recommend PDT as an alternative treatment modality for severe acne. However, there is a lack of detailed clinical guideline for PDT in acne treatment. To propose up-to-date, evidence-based and practical recommendations on application of ALA-PDT for acne vulgaris, dermatologists and PDT experts from the Photodynamic Therapy Research Center of the CMA and Photodynamic Therapy Rehabilitation Training Center of CARD achieved consensus and guidelines based on careful evaluation of published literature, expert opinions and experience. ALA-PDT plays a therapeutic role in all four major pathogenesis of acne, and is suitable for moderate to severe acne and scar-prone acne, especially for patients who cannot tolerate or refused systemic antibiotics and isotretinoin. The efficacy and adverse reactions of ALA-PDT are closely related to therapeutic parameters including ALA concentration, incubation time, light source and dosage. Proper pretreatment helps to improve transdermal absorption of ALA and enhances its efficacy. We reviewed and proposed recommended protocols for four PDT procedures including conventional PDT (C-PDT), modified painless PDT (M-PDT), intense pulsed light PDT (IPL-PDT) and daylight PDT (DL-PDT). M-PDT with lower ALA concentration (3-5%), shorter incubation time (30 mins), and lower dose but prolonged illumination (630nm, 40-60 mW/cm2, 150 J/cm2) can improve lesions of moderate to severe acne vulgaris effectively with minimal pain and easier manipulation, and thus was recommended by Chinese dermatologists. Lastly, management of adverse reactions were addressed.
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Affiliation(s)
- Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Wang
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, United States
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaojing Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Shi
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Xiaojing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang China
| | - Xia Lei
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing, China
| | - Kun Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Zhou Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Chengxin Li
- Department of Dermatology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Ju
- Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Shanghai, China
| | - Xiaoyong Man
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang China
| | - Yan Lu
- Dermatology Department, 1st Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Nan Yu
- Department of Dermatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yuzhen Li
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huilan Zhu
- Guangzhou Institute of Dermatology, Guangzhou, China
| | - Ruzhi Zhang
- Department of Dermatology, The Third Affiliated Hospital of Suzhou University, Suzhou, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Shiqin Tao
- Department of Dermatology, Wuxi No.2 People's Hospital, Wuxi Jiangsu, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiri Mu
- Department of Dermatology, International Mongolian Hospital of Inner Mongolia, Inner Mongolia, China
| | - Weihui Zeng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an , China
| | - Zhiming Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Gao
- Department of Dermatology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Gu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.
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Mavranezouli I, Welton NJ, Daly CH, Wilcock J, Bromham N, Berg L, Xu J, Wood D, Ravenscroft JC, Dworzynski K, Healy E. Cost-effectiveness of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Clin Exp Dermatol 2022; 47:2176-2187. [PMID: 36258288 PMCID: PMC10091701 DOI: 10.1111/ced.15356] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acne vulgaris is a common skin condition that may cause psychosocial distress. There is evidence that topical treatment combinations, chemical peels and photochemical therapy (combined blue/red light) are effective for mild-to-moderate acne, while topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy are most effective for moderate-to-severe acne. Effective treatments have varying costs. The National Institute for Health and Care Excellence (NICE) in England considers cost-effectiveness when producing national clinical, public health and social care guidance. AIM To assess the cost-effectiveness of treatments for mild-to-moderate and moderate-to-severe acne to inform relevant NICE guidance. METHODS A decision-analytical model compared costs and quality-adjusted life-years (QALYs) of effective topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, from the perspective of the National Health Service in England. Effectiveness data were derived from a network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion. RESULTS All of the assessed treatments were more cost-effective than treatment with placebo (general practitioner visits without active treatment). For mild-to-moderate acne, topical treatment combinations and photochemical therapy (combined blue/red light) were most cost-effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, and oral isotretinoin were the most cost-effective. Results showed uncertainty, as reflected in the wide confidence intervals around mean treatment rankings. CONCLUSION A range of treatments are cost-effective for the management of acne. Well-conducted studies are needed to examine the long-term clinical efficacy and cost-effectiveness of the full range of acne treatments.
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Affiliation(s)
- Ifigeneia Mavranezouli
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
- National Guideline AllianceRoyal College of Obstetricians and GynaecologistsLondonUK
| | - Nicky J. Welton
- Department of Population Health SciencesBristol Medical School, University of BristolBristolUK
| | - Caitlin H. Daly
- Department of Population Health SciencesBristol Medical School, University of BristolBristolUK
| | - Jane Wilcock
- Silverdale Medical PracticePendlebury Health CentreSalfordUK
| | - Nathan Bromham
- National Guideline AllianceRoyal College of Obstetricians and GynaecologistsLondonUK
- National Institute for Health and Care ExcellenceManchesterUK
| | - Laura Berg
- National Guideline AllianceRoyal College of Obstetricians and GynaecologistsLondonUK
- National Institute for Health and Care ExcellenceManchesterUK
| | - Jingyuan Xu
- National Guideline AllianceRoyal College of Obstetricians and GynaecologistsLondonUK
- Department of DermatopharmacologyUniversity of ManchesterManchesterUK
| | - Damian Wood
- Department of PaediatricsNottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical CentreNottinghamUK
| | | | - Katharina Dworzynski
- National Guideline AllianceRoyal College of Obstetricians and GynaecologistsLondonUK
- National Institute for Health and Care ExcellenceManchesterUK
| | - Eugene Healy
- Dermatopharmacology, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Department of DermatologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
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29
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Tang L, Fu Q, Zhou ZW, Liu L, Huang M, Zheng Q, Huang F, Zhang M, Zhou X. A systematic review and meta-analysis of randomized clinical trials of fire needle combined with ALA-PDT for the treatment of moderate-to- severe acne. Photodiagnosis Photodyn Ther 2022; 42:103200. [PMID: 36384211 DOI: 10.1016/j.pdpdt.2022.103200] [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: 08/07/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moderate-to-severe acne affects people's health and quality of life. As first-line therapeutic medications, isotretinoin and antibiotics are used to treat moderate-to-severe acne, but outcomes can be improved. The combination of fire needle and ALA-PDT may be one option. This study evaluated the safety and effectiveness in the treatment of moderate-to-severe acne by the combination with fire needle and ALA-PDT. METHODS By July 2022, search PubMed, the Chinese Biomedical Literature dababase, the Cochrane Library, the Chinese Scientific Journal Database, the China National Knowledge Infrastructure, the Web of Science Datebase, Embase Datebase,VIP Database and WanFang Database. To gather RCTs of the combination of fire needle and ALA-PDT for the treatment of moderate-to-severe acne. A meta-analysis was performed according to the Handbook guidelines of Cochrane. Study selection, data extraction, and risk of bias evaluation were all governed by two reviewers, with the help of a third reviewer if necessary. The meta-analysis was carried out with Review Manager Software 5.4. RESULTS There were a total of 9 RCTs with 862 participants. Clinical efficacy was recorded in nine trials, GAGS score was published in three studies, adverse events were documented in five studies, and the recurrence rate was reported in two studies. Treatment lasted between four and twelve weeks. Combination therapy outperformed monotherapy in terms of clinical efficacy (OR:3.73; 95% CI:2.51, 5.53; p < 0.00001). Additional subgroup analysis revealed that the combination therapy outperformed ALA-PDT alone in terms of clinical effect (OR: 3.20; 95% CI: 2.05, 4.99; p < 0.00001). Additionally, combination therapy outperformed fire needle alone in terms of clinical efficacy (OR:5.66; 95% CI: 2.66, 12.08; p < 0.00001). Studies have also indicated that combination therapy has a stronger benefit in lowering the GAGS score (MD:-3.35; 95% CI:-4.62, -2.09; p < 0.00001). Additionally, there was no discernible difference in the occurrence of adverse events between the combined treatments and monotherapy (OR:1.43; 95% CI: 0.76, 2.69; p = 0.26), and the combined treatment was able to control the recurrence rate (OR:0.18; 95% CI: 0.07, 0.45; P = 0.0002). CONCLUSIONS The efficacy of fire needle combined with ALA-PDT in the treatment of moderate-to-severe acne appears superior to that of ALA-PDT or fire needle alone. However, the conclusions of this study must be interpreted carefully due to the high risk and ambiguity of bias of the included trials.
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Affiliation(s)
- Lei Tang
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qiang Fu
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | | | - Lin Liu
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Mengya Huang
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qi Zheng
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Fujun Huang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Miao Zhang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Xun Zhou
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
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Evrenoglou T. Stratification according to disease severity can better reveal the relative effectiveness of treatments for acne vulgaris. Br J Dermatol 2022; 187:637-638. [PMID: 36065489 DOI: 10.1111/bjd.21849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Theodoros Evrenoglou
- Université Paris Cité, Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Paris, France
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