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Aggio D, Dixon C, Law EH, Randall R, Price T, Lloyd A. Estimation of health utility values for alopecia areata. Qual Life Res 2024; 33:1581-1592. [PMID: 38551802 PMCID: PMC11116246 DOI: 10.1007/s11136-024-03645-9] [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] [Accepted: 03/01/2024] [Indexed: 05/24/2024]
Abstract
PURPOSE Alopecia areata (AA) is an autoimmune-mediated inflammatory dermatological disease characterised by non-scarring hair loss affecting the scalp and sometimes other hair-bearing sites. This study aimed to elicit health state utility values (HSUVs) from the UK general population for AA using time trade off (TTO) interviews. METHODS Vignette descriptions of health states defined by the extent of hair loss were developed (as well as one describing caregiver burden). These were developed using data from standardised patient reported outcome (PRO) measures, a literature review and qualitative interviews. Health states were defined based on the severity of alopecia tool (SALT), which assesses extensiveness of scalp hair loss. HSUVs were then elicited for each health state in TTO interviews with the UK public. RESULTS One caregiver and five patient health states were developed based on the literature review findings, clinical trial PRO (Hospital Anxiety and Depression Scale and Alopecia Areata Patient Priority Outcomes Questionnaire) data and qualitative interviews with patients (N = 11), clinical experts (N = 4) and caregivers of adolescents with AA (N = 10). These data showed a more severe impact among patients with more extensive hair loss. One hundred and twenty participants evaluated the vignettes in TTO interviews. Patient HSUVs ranged from 0.502 for the most extensive hair loss health state (SALT 50-100 + eyebrow and eyelash loss) to 0.919 (SALT 0-10) for the mildest health state. The caregiver HSUV was 0.882. CONCLUSION Quantitative and qualitative data sources were used to develop and validate vignettes describing different AA health states. Patient and caregiver HSUVs demonstrate a large impact associated with AA, especially for states defined by more extensive hair loss.
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Affiliation(s)
- Daniel Aggio
- Acaster Lloyd Consulting Ltd, 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK.
| | - Caleb Dixon
- Acaster Lloyd Consulting Ltd, 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | | | | | | | - Andrew Lloyd
- Acaster Lloyd Consulting Ltd, 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
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2
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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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3
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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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4
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Layton AM, Alexis A, Baldwin H, Bettoli V, Del Rosso J, Dirschka T, Dréno B, Gold LS, Harper J, Ko JY, Al Nuaimi K, Oon HH, Rajagopalan M, Rocha M, See JA, Weiss J, Tan J. The Personalized Acne Treatment Tool - Recommendations to facilitate a patient-centered approach to acne management from the Personalizing Acne: Consensus of Experts. JAAD Int 2023; 12:60-69. [PMID: 37274381 PMCID: PMC10236180 DOI: 10.1016/j.jdin.2023.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/06/2023] Open
Abstract
Background Acne, a commonly treated skin disease, requires patient-centered management due to its varying presentations, chronicity, and impact on health-related quality of life. Despite this, evidence-based clinical guidelines focus primarily on clinical severity of facial acne, omitting important patient- and disease-related factors, including ongoing management. Objectives To generate recommendations to support patient-centered acne management, which incorporate priority and prognostic factors beyond conventional clinical severity, traditionally defined by grading the appearance and extent of visible lesions. Methods The Personalizing Acne: Consensus of Experts consisted of 17 dermatologists who used a modified Delphi approach to reach consensus on statements regarding patient- and treatment-related factors pertaining to patient-centered acne management. Consensus was defined as ≥75% voting "agree" or "strongly agree." Results Recommendations based on factors such as acne sequelae, location of acne, high burden of disease, and individual patient features were generated and incorporated into the Personalized Acne Treatment Tool. Limitations Recommendations are based on expert opinion, which may differ from patients' perspectives. Regional variations in healthcare systems may not be represented. Conclusions The Personalizing Acne: Consensus of Experts panel provided practical recommendations to facilitate individualized management of acne, based on patient features, which can be implemented to improve treatment outcomes, adherence, and patient satisfaction.
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Affiliation(s)
- Alison M. Layton
- Skin Research Centre, York University, York, UK
- Harrogate and District NHS Foundation Trust, Harrogate, UK
| | | | - Hilary Baldwin
- Robert Wood Johnson Medical Center, New Brunswick, New Jersey
- The Acne Treatment and Research Center, Brooklyn, New York
| | - Vincenzo Bettoli
- Dermatology Unit – Teaching Hospital, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | - James Del Rosso
- Advanced Dermatology and Cosmetic Surgery, Maitland, Florida
- JDR Dermatology Research, Las Vegas, Nevada
| | | | | | | | - Julie Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, Alabama
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Khaled Al Nuaimi
- Faculty of Medicine, Sharjah University, Sharjah, United Arab Emirates
| | - Hazel H. Oon
- Division of Dermatology, National Skin Centre, Singapore
| | | | - Marco Rocha
- Federal University of São Paulo, São Paulo, Brazil
| | - Jo-Ann See
- Central Sydney Dermatology, Sydney, New South Wales, Australia
| | | | - Jerry Tan
- Windsor Clinical Research Inc, Windsor, Ontario, Canada
- Department of Medicine, University of Western Ontario, Windsor, Ontario, Canada
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5
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Shields A, Barbieri JS. From Breakouts to Bargains: Strategies for Patient-Centered, Cost-effective Acne Care. Cutis 2023; 112:E24-E29. [PMID: 37820334 PMCID: PMC10951614 DOI: 10.12788/cutis.0844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
A range of treatment options are available for both mild to moderate and moderate to severe acne, and these options vary widely in their clinical uses, effectiveness, and costs. With the continued rise of dermatologic drug prices and increased cost-sharing due to high-deductible health plans, the importance of cost-effective treatment continues to grow. Failure to consider cost-effective, patient-centered care may lead to increased financial toxicity, reduced adherence, and ultimately worse outcomes and patient satisfaction. Combination topical products offer improved efficacy and convenience, which are associated with better adherence and outcomes. Generic fixed-dose adapalene-benzoyl peroxide (BPO) and fixed-dose clindamycin-BPO can be highly cost-effective options for patients with mild to moderate acne. Hormonal agents such as combined oral contraceptives (COCs) and spironolactone are inexpensive and likely reflect a highly cost-effective option that could reduce reliance on oral antibiotics in patients with moderate to severe acne. Doxycycline and isotretinoin also are cost-effective options for more severe acne. Frequent laboratory monitoring for spironolactone and isotretinoin continues to be prevalent despite little evidence to support its clinical utility, and it is associated with a major cost burden to the patient and health care system. The reduction of laboratory monitoring is an opportunity to provide higher-value care.
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Affiliation(s)
- Ali Shields
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts. Dr. Barbieri also is from Harvard Medical School, Boston
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts. Dr. Barbieri also is from Harvard Medical School, Boston
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6
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Nicholas-Haizelden K, Murphy B, Hoptroff M, Horsburgh MJ. Bioprospecting the Skin Microbiome: Advances in Therapeutics and Personal Care Products. Microorganisms 2023; 11:1899. [PMID: 37630459 PMCID: PMC10456854 DOI: 10.3390/microorganisms11081899] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Bioprospecting is the discovery and exploration of biological diversity found within organisms, genetic elements or produced compounds with prospective commercial or therapeutic applications. The human skin is an ecological niche which harbours a rich and compositional diversity microbiome stemming from the multifactorial interactions between the host and microbiota facilitated by exploitable effector compounds. Advances in the understanding of microbial colonisation mechanisms alongside species and strain interactions have revealed a novel chemical and biological understanding which displays applicative potential. Studies elucidating the organismal interfaces and concomitant understanding of the central processes of skin biology have begun to unravel a potential wealth of molecules which can exploited for their proposed functions. A variety of skin-microbiome-derived compounds display prospective therapeutic applications, ranging from antioncogenic agents relevant in skin cancer therapy to treatment strategies for antimicrobial-resistant bacterial and fungal infections. Considerable opportunities have emerged for the translation to personal care products, such as topical agents to mitigate various skin conditions such as acne and eczema. Adjacent compound developments have focused on cosmetic applications such as reducing skin ageing and its associated changes to skin properties and the microbiome. The skin microbiome contains a wealth of prospective compounds with therapeutic and commercial applications; however, considerable work is required for the translation of in vitro findings to relevant in vivo models to ensure translatability.
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Affiliation(s)
- Keir Nicholas-Haizelden
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK;
| | - Barry Murphy
- Unilever Research & Development, Port Sunlight, Wirral CH63 3JW, UK; (B.M.); (M.H.)
| | - Michael Hoptroff
- Unilever Research & Development, Port Sunlight, Wirral CH63 3JW, UK; (B.M.); (M.H.)
| | - Malcolm J. Horsburgh
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK;
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7
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Lotfi E, Kaveh R, Nezhad NZ, Iranmanesh B, Hosseini SA, Ahramiyanpour N. Endo-radiofrequency subcision in the treatment of acne scars: a pilot investigative study. Lasers Med Sci 2023; 38:154. [PMID: 37400740 DOI: 10.1007/s10103-023-03819-w] [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: 12/03/2022] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Acne vulgaris is a common condition, mostly involving teenagers. Post-acne scarring can cause many psychosocial problems. Treatments include topical agents, chemical peels, ablative lasers, fractional lasers, and more invasive approaches like subcision and surgery. We aimed to build on data regarding the efficacy and safety of endo-radiofrequency subcision in treating acne scars. This trial involved 30 patients (26 females and 4 males) suffering from acne scars. Patients were treated with endo-radiofrequency subcision. Outcomes were measured by Goodman and Baron scores (GBA), Patient's Global Assessment (PGA), and Investigator's Global Assessment (IGA). All 30 patients completed the trial. The mean baseline quantitative Goodman and Baron score was 13.2 ± 4.31, which improved to 5.37 ± 2.83 by the end of the study (P < 0.001). A significant improvement was also noted in the Goodman and Baron qualitative assessment of acne scars (P < 0.001). According to the PGA, the improvement rate was 25-50% in most patients (60%), while according to the IGA, the improvement rate was 25-49% in most patients (50%). Eleven patients (36.7%) were satisfied with the treatment process, while the other 19 patients (63.3%) were very satisfied. Side effects were minimal and transient. A single session of endo-radiofrequency subcision is a fairly safe and effective treatment, with a high satisfaction rate among treated patients.
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Affiliation(s)
| | - Roxana Kaveh
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Behzad Iranmanesh
- Department of Dermatology, Afzalipour Faculty of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | | | - Najmeh Ahramiyanpour
- Department of Dermatology, Bushehr University Of Medical Sciences, Bushehr, Iran.
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8
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Alrabiah Z, Wajid S, Babelghaith SD, Al Arifi MN. Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Saudi Arabia. Front Med (Lausanne) 2023; 10:1133765. [PMID: 37457577 PMCID: PMC10345154 DOI: 10.3389/fmed.2023.1133765] [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: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background and objectives In Saudi Arabia, Acne vulgaris is a very predominant ailment and Pharmacists currently have standardized protocols at their disposal for the treatment of acne. Pharmacists often prescribe medications for minor cases of acne. Therefore, this study aimed to explore community pharmacists (CPs)' knowledge, attitudes, and practice toward acne management in Riyadh, Saudi Arabia. Methods An online cross-sectional study was conducted among CPs working in Riyadh, Saudi Arabia from January and April 2021, using a self-administered, questionnaire, was divided into four sections that collected information from the CP's Knowledge, attitudes, and practices and the management of acne vulgaris. The data were analyzed using the Statistical Package for the Social Sciences version 26 (SPSS). Result A total of 313 CPs were enrolled in the study who successfully returned the questionnaire. The mean score of knowledge on etiology, pathophysiology, and therapy for AV was 5.3 ± (SD = 1.5). However, the majority of CPs had a moderate level of knowledge (80.8%), followed by mild to moderate (12.8%). This study showed that CPs had an insufficient level of knowledge about ace management, about 6% of CPs have a high level of knowledge. Inadequate knowledge was revealed in their management practice, only 0.3% of CPs treated patients with acne on their own without a referral. In addition, CPs showed a positive attitude toward acne management. Conclusion There is a need to improve CPs' understanding of acne care and to contribute to participating in organized training sessions on the management of AV.
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9
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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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10
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Mavranezouli I, Daly CH, Welton NJ, Deshpande S, Berg L, Bromham N, Arnold S, Phillippo DM, Wilcock J, Xu J, Ravenscroft JC, Wood D, Rafiq M, Fou L, Dworzynski K, Healy E. A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Br J Dermatol 2022; 187:639-649. [PMID: 35789996 PMCID: PMC9804728 DOI: 10.1111/bjd.21739] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Various treatments for acne vulgaris exist, but little is known about their comparative effectiveness in relation to acne severity. OBJECTIVES To identify best treatments for mild-to-moderate and moderate-to-severe acne, as determined by clinician-assessed morphological features. METHODS We undertook a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, published up to May 2020. Outcomes included percentage change in total lesion count from baseline, treatment discontinuation for any reason, and discontinuation owing to side-effects. Risk of bias was assessed using the Cochrane risk-of-bias tool and bias adjustment models. Effects for treatments with ≥ 50 observations each compared with placebo are reported below. RESULTS We included 179 RCTs with approximately 35 000 observations across 49 treatment classes. For mild-to-moderate acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with benzoyl peroxide (BPO) [mean difference 26·16%, 95% credible interval (CrI) 16·75-35·36%]; physical - chemical peels, e.g. salicylic or mandelic acid (39·70%, 95% CrI 12·54-66·78%) and photochemical therapy (combined blue/red light) (35·36%, 95% CrI 17·75-53·08%). Oral pharmacological treatments (e.g. antibiotics, hormonal contraceptives) did not appear to be effective after bias adjustment. BPO and topical retinoids were less well tolerated than placebo. For moderate-to-severe acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with lincosamide (clindamycin) (44·43%, 95% CrI 29·20-60·02%); oral pharmacological - isotretinoin of total cumulative dose ≥ 120 mg kg-1 per single course (58·09%, 95% CrI 36·99-79·29%); physical - photodynamic therapy (light therapy enhanced by a photosensitizing chemical) (40·45%, 95% CrI 26·17-54·11%); combined - BPO with topical retinoid and oral tetracycline (43·53%, 95% CrI 29·49-57·70%). Topical retinoids and oral tetracyclines were less well tolerated than placebo. The quality of included RCTs was moderate to very low, with evidence of inconsistency between direct and indirect evidence. Uncertainty in findings was high, in particular for chemical peels, photochemical therapy and photodynamic therapy. However, conclusions were robust to potential bias in the evidence. CONCLUSIONS Topical pharmacological treatment combinations, chemical peels and photochemical therapy were most effective for mild-to-moderate acne. Topical pharmacological treatment combinations, oral antibiotics combined with topical pharmacological treatments, oral isotretinoin and photodynamic therapy were most effective for moderate-to-severe acne. Further research is warranted for chemical peels, photochemical therapy and photodynamic therapy for which evidence was more limited. What is already known about this topic? Acne vulgaris is the eighth most common disease globally. Several topical, oral, physical and combined treatments for acne vulgaris exist. Network meta-analysis (NMA) synthesizes direct and indirect evidence and allows simultaneous inference for all treatments forming an evidence network. Previous NMAs have assessed a limited range of treatments for acne vulgaris and have not evaluated effectiveness of treatments for moderate-to-severe acne. What does this study add? For mild-to-moderate acne, topical treatment combinations, chemical peels, and photochemical therapy (combined blue/red light; blue light) are most effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy (light therapy enhanced by a photosensitizing chemical) are most effective. Based on these findings, along with further clinical and cost-effectiveness considerations, National Institute for Health and Care Excellence (NICE) guidance recommends, as first-line treatments, fixed topical treatment combinations for mild-to-moderate acne and fixed topical treatment combinations, or oral tetracyclines combined with topical treatments, for moderate-to-severe acne.
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Affiliation(s)
- Ifigeneia Mavranezouli
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.,National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Caitlin H Daly
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Shalmali Deshpande
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,National Institute for Health and Care Excellence, Level 1A, Piccadilly Plaza, Manchester, M1 4BT, UK
| | - Laura Berg
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,National Institute for Health and Care Excellence, Level 1A, Piccadilly Plaza, Manchester, M1 4BT, UK
| | - Nathan Bromham
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,National Institute for Health and Care Excellence, Level 1A, Piccadilly Plaza, Manchester, M1 4BT, UK
| | - Stephanie Arnold
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,National Institute for Health and Care Excellence, Level 1A, Piccadilly Plaza, Manchester, M1 4BT, UK
| | - David M Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jane Wilcock
- Silverdale Medical Practice, Pendlebury Health Centre, 659 Bolton Road, Swinton, Salford, M27 8HP, UK
| | - Jingyuan Xu
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,Department of Dermatopharmacology, University of Manchester, Manchester, M13 9PT, UK
| | | | - Damian Wood
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, UK
| | | | - Linyun Fou
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Katharina Dworzynski
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,National Institute for Health and Care Excellence, Level 1A, Piccadilly Plaza, Manchester, M1 4BT, UK
| | - Eugene Healy
- Department of Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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