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A split face study on the effect of an anti-acne product containing fermentation products of Enterococcus faecalis CBT SL-5 on skin microbiome modification and acne improvement. J Microbiol 2022; 60:488-495. [DOI: 10.1007/s12275-022-1520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
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Valente Duarte de Sousa IC. Guidance for the pharmacological management of acne vulgaris. Expert Opin Pharmacother 2021; 23:49-62. [PMID: 34686076 DOI: 10.1080/14656566.2021.1990263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne. AREAS COVERED Herein, the author discusses the treatment of comedonal, papulopustular, and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases. EXPERT OPINION The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.
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Emmerich VK, Purvis CG, Feldman SR. An overview of adapalene and benzoyl peroxide once-daily topical gel as a therapeutic option for acne. Expert Opin Pharmacother 2021; 22:1661-1667. [PMID: 34086519 DOI: 10.1080/14656566.2021.1939678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Acne vulgaris is the most common skin condition worldwide, and it is associated with substantial psychological comorbidity. Topical therapies - including retinoids, antibiotics, and benzoyl peroxide - are the cornerstones of treatment for patients with acne. The main barriers to care in the treatment of acne are poor adherence to therapy and lack of tolerability. AREAS COVERED Herein, the authors review the safety and efficacy of adapalene/benzoyl peroxide combination gel (0.1%/2.5% and 0.3%/2.5%), as well as its specific mechanisms of action that target acne vulgaris. The authors also offer an expert opinion on the use of adapalene/benzoyl peroxide gel compared with other topical therapies. EXPERT OPINION Adapalene/benzoyl peroxide gel is safe and highly effective in the treatment of acne vulgaris. Its efficacy, tolerability, and ease-of-use are superior to other topical acne therapies, and its use does not contribute to antibiotic resistance. However, the cost of adapalene/benzoyl peroxide gel and lack of available generics may prohibit its use.
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Affiliation(s)
- Veronica K Emmerich
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caitlin G Purvis
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston- Salem, North Carolina.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND Acne is a common, economically burdensome condition that can cause psychological harm and, potentially, scarring. Topical benzoyl peroxide (BPO) is a widely used acne treatment; however, its efficacy and safety have not been clearly evaluated. OBJECTIVES To assess the effects of BPO for acne. SEARCH METHODS We searched the following databases up to February 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of relevant randomised controlled trials (RCTs) and systematic reviews. SELECTION CRITERIA We included RCTs that compared topical BPO used alone (including different formulations and concentrations of BPO) or as part of combination treatment against placebo, no treatment, or other active topical medications for clinically diagnosed acne (used alone or in combination with other topical drugs not containing BPO) on the face or trunk. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. Primary outcome measures were 'participant global self-assessment of acne improvement' and 'withdrawal due to adverse events in the whole course of a trial'. 'Percentage of participants experiencing any adverse event in the whole course of a trial' was a key secondary outcome. MAIN RESULTS We included 120 trials (29,592 participants randomised in 116 trials; in four trials the number of randomised participants was unclear). Ninety-one studies included males and females. When reported, 72 trials included participants with mild to moderate acne, 26 included participants with severe acne, and the mean age of participants ranged from 18 to 30 years. Our included trials assessed BPO as monotherapy, as add-on treatment, or combined with other active treatments, as well as BPO of different concentrations and BPO delivered through different vehicles. Comparators included different concentrations or formulations of BPO, placebo, no treatment, or other active treatments given alone or combined. Treatment duration in 80 trials was longer than eight weeks and was only up to 12 weeks in 108 trials. Industry funded 50 trials; 63 trials did not report funding. We commonly found high or unclear risk of performance, detection, or attrition bias. Trial setting was under-reported but included hospitals, medical centres/departments, clinics, general practices, and student health centres. We reported on outcomes assessed at the end of treatment, and we classified treatment periods as short-term (two to four weeks), medium-term (five to eight weeks), or long-term (longer than eight weeks). For 'participant-reported acne improvement', BPO may be more effective than placebo or no treatment (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.12 to 1.45; 3 RCTs; 2234 participants; treatment for 10 to 12 weeks; low-certainty evidence). Based on low-certainty evidence, there may be little to no difference between BPO and adapalene (RR 0.99, 95% CI 0.90 to 1.10; 5 RCTs; 1472 participants; treatment for 11 to 12 weeks) or between BPO and clindamycin (RR 0.95, 95% CI 0.68 to 1.34; 1 RCT; 240 participants; treatment for 10 weeks) (outcome not reported for BPO versus erythromycin or salicylic acid). For 'withdrawal due to adverse effects', risk of treatment discontinuation may be higher with BPO compared with placebo or no treatment (RR 2.13, 95% CI 1.55 to 2.93; 24 RCTs; 13,744 participants; treatment for 10 to 12 weeks; low-certainty evidence); the most common causes of withdrawal were erythema, pruritus, and skin burning. Only very low-certainty evidence was available for the following comparisons: BPO versus adapalene (RR 1.85, 95% CI 0.94 to 3.64; 11 RCTs; 3295 participants; treatment for 11 to 24 weeks; causes of withdrawal not clear), BPO versus clindamycin (RR 1.93, 95% CI 0.90 to 4.11; 8 RCTs; 3330 participants; treatment for 10 to 12 weeks; causes of withdrawal included local hypersensitivity, pruritus, erythema, face oedema, rash, and skin burning), erythromycin (RR 1.00, 95% CI 0.07 to 15.26; 1 RCT; 60 participants; treatment for 8 weeks; withdrawal due to dermatitis), and salicylic acid (no participants had adverse event-related withdrawal; 1 RCT; 59 participants; treatment for 12 weeks). There may be little to no difference between these groups in terms of withdrawal; however, we are unsure of the results because the evidence is of very low certainty. For 'proportion of participants experiencing any adverse event', very low-certainty evidence leaves us uncertain about whether BPO increased adverse events when compared with placebo or no treatment (RR 1.40, 95% CI 1.15 to 1.70; 21 RCTs; 11,028 participants; treatment for 10 to 12 weeks), with adapalene (RR 0.71, 95% CI 0.50 to 1.00; 7 RCTs; 2120 participants; treatment for 11 to 24 weeks), with erythromycin (no participants reported any adverse events; 1 RCT; 89 participants; treatment for 10 weeks), or with salicylic acid (RR 4.77, 95% CI 0.24 to 93.67; 1 RCT; 41 participants; treatment for 6 weeks). Moderate-certainty evidence shows that the risk of adverse events may be increased for BPO versus clindamycin (RR 1.24, 95% CI 0.97 to 1.58; 6 RCTs; 3018 participants; treatment for 10 to 12 weeks); however, the 95% CI indicates that BPO might make little to no difference. Most reported adverse events were mild to moderate, and local dryness, irritation, dermatitis, erythema, application site pain, and pruritus were the most common. AUTHORS' CONCLUSIONS Current evidence suggests that BPO as monotherapy or add-on treatment may be more effective than placebo or no treatment for improving acne, and there may be little to no difference between BPO and either adapalene or clindamycin. Our key efficacy evidence is based on participant self-assessment; trials of BPO versus erythromycin or salicylic acid did not report this outcome. For adverse effects, the evidence is very uncertain regarding BPO compared with adapalene, erythromycin, or salicylic acid. However, risk of treatment discontinuation may be higher with BPO compared with placebo or no treatment. Withdrawal may be linked to tolerability rather than to safety. Risk of mild to moderate adverse events may be higher with BPO compared with clindamycin. Further trials should assess the comparative effects of different preparations or concentrations of BPO and combination BPO versus monotherapy. These trials should fully assess and report adverse effects and patient-reported outcomes measured on a standardised scale.
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Affiliation(s)
- Zhirong Yang
- School of Clinical Medicine, University of CambridgePrimary Care Unit, Department of Public Health and Primary CareStrangeways Research Laboratory, 2 Worts’ CausewayCambridgeUKCB1 8RN
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and BiostatisticsBeijingChina100191
| | - Yuan Zhang
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonONCanadaL8S 4K1
| | - Elvira Lazic Mosler
- Catholic University of CroatiaDepartment of NursingIlica 242ZagrebCroatia10000
- General Hospital "Dr. Ivo Pedišić"Department for Dermatology and VenereologyJ.J. Strossmayera 59SisakCroatia44000
| | - Jing Hu
- School of Public Health, Peking UniversityCentre for Evidence Based Medicine and Clinical Research, Department of Epidemiology and BiostatisticsBeijingChina100191
| | - Hang Li
- Peking University First HospitalDepartment of Dermatology and Venereology8 Xishiku Main StreetBeijingXicheng DistrictChina100034
- Beijing Key Laboratory of Molecular Diagnosis on DermatosesBeijingChina
- National Clinical Research Center for Skin and Immune DiseasesBeijingChina
| | - Yanchang Zhang
- Yale School of Public HealthDepartment of Chronic Disease Epidemiology367 Cedar ST RM 704New HavenConnecticutUSA06510
| | - Jia Liu
- Xuanwu Hospital, Capital Medical UniversityDepartment of NeurologyChangchun Street 45BeijingChina100053
| | - Qian Zhang
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
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Abstract
BACKGROUND Topical retinoids are a first-line treatment for acne vulgaris. OBJECTIVE This systematic review aims to evaluate the efficacy, safety, and tolerability of topical retinoids approved in the United States for the treatment of acne vulgaris. METHODS A PubMed and Embase search was conducted using the search terms 'adapalene,' 'tretinoin,' 'tazarotene,' and 'acne vulgaris.' Selection of articles fit the following inclusion criteria: clinical trials evaluating both efficacy and safety/tolerability of topical retinoids approved in the United States for the treatment of acne vulgaris and published between January 1, 2008 and September 1, 2018. Exclusion criteria included clinical trials involving 20 subjects or fewer, subjects under 12 years of age, and topical retinoid combination therapies with moisturizers or aloe vera. Of 424 search results found, a total of 54 clinical trials were chosen based on selection criteria. RESULTS Topical retinoids are superior to vehicle in improving Investigator Global Assessment and Investigator's Static Global Assessment (24.1-28.8% and 13.3-17.3%, respectively; p < 0.001). A topical retinoid combined with benzoyl peroxide led to IGA improvement compared with vehicle (26.1-34.9% vs 7-11.8%; p < 0.001) at Week 12. Topical retinoid plus an oral antibiotic was superior to vehicle in reducing lesion counts (64-78.9% vs 41-56.8%, p < 0.001). There was no significant difference in efficacy between tretinoin and tazarotene. Tretinoin 0.05% resulted in 62% of patients experiencing AEs compared with adapalene 0.1% (19%) and adapalene 0.3% (40%). More patients receiving adapalene were tolerant of the AEs compared with tazarotene (55.4% vs 24.4%; p < 0.0012). CONCLUSIONS Topical retinoids are safe and efficacious for the treatment of acne vulgaris. They should be used in combination with benzoyl peroxide to optimize results in patients. The differences in efficacy of topical retinoids appears minor; therefore, the type of topical retinoid is not as important as choosing a particular strength of topical retinoid and combining it with an antimicrobial agent. Adapalene has a superior tolerability profile amongst topical retinoids.
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Hayashi N, Akamatsu H, Iwatsuki K, Shimada-Omori R, Kaminaka C, Kurokawa I, Kono T, Kobayashi M, Tanioka M, Furukawa F, Furumura M, Yamasaki O, Yamasaki K, Yamamoto Y, Miyachi Y, Kawashima M. Japanese Dermatological Association Guidelines: Guidelines for the treatment of acne vulgaris 2017. J Dermatol 2018; 45:898-935. [DOI: 10.1111/1346-8138.14355] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 01/23/2023]
Affiliation(s)
| | - Hirohiko Akamatsu
- Applied Cell and Regenerative Medicine; Fujita Health University School of Medicine; Aichi Japan
| | - Keiji Iwatsuki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Ryoko Shimada-Omori
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Chikako Kaminaka
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
| | - Ichiro Kurokawa
- Department of Dermatology; Meiwa Hospital; Nishinomiya Japan
| | - Takeshi Kono
- Department of Dermatology; Chiba Hokusoh Hospital; Nippon Medical School; Inba-gun Japan
| | | | | | | | - Minao Furumura
- Section of Dermatology; Department of Medicine; Fukuoka Dental College; Fukuoka Japan
| | - Osamu Yamasaki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Kenshi Yamasaki
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yuki Yamamoto
- Department of Dermatology; Wakayama Medical University; Wakayama Japan
| | - Yoshiki Miyachi
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Makoto Kawashima
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
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Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2017; 78:S1-S23.e1. [PMID: 29127053 DOI: 10.1016/j.jaad.2017.09.078] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.
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Abstract
BACKGROUND To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences. OBJECTIVE The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne. METHODS A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study. RESULTS Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone. CONCLUSION This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.
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Kim SY, Ochsendorf FR. New developments in acne treatment: role of combination adapalene-benzoylperoxide. Ther Clin Risk Manag 2016; 12:1497-1506. [PMID: 27757036 PMCID: PMC5055040 DOI: 10.2147/tcrm.s94062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The fixed-dose combination adapalene 0.1%/benzoylperoxide 2.5% (A/BPO) was introduced as an acne vulgaris therapeutic in 2007. It combines anti-inflammatory, keratolytic, comedolytic, and antibacterial properties. Thus, it addresses several pathophysiological factors involved in the pathophysiology of acne. This review highlights the rationale for the use of this fixed-dose combination product, its therapeutic efficacy including effects on adherence and quality of life, its use for different forms of acne, and the side-effect profile. In summary, the fixed-dose combination of A/BPO gel can be regarded as a highly effective and safe formulation. It is not associated with antibiotic resistance. It reduces factors that cause nonadherence and has positive effects on the quality of life of affected patients. The tolerance is good. The initial mild irritation potential can be addressed by adequate counseling. A/BPO can be used for all forms of inflammatory acne, including severe forms, as part of a combination with systemic antibiotics. Finally, it can also be used for the long-term treatment of chronic acne. Thus, it is a very valuable therapeutic option in daily practice, which is reflected by its strong recommendation in the “European S3-guidelines”.
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Affiliation(s)
- Su Youn Kim
- Clinic for Dermatology, Venereology, and Allergology, University Hospital, Frankfurt/M, Germany
| | - Falk R Ochsendorf
- Clinic for Dermatology, Venereology, and Allergology, University Hospital, Frankfurt/M, Germany
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Al-Hammadi A, Al-Ismaily A, Al-Ali S, Ramadurai R, Jain R, McKinley-Grant L, Mughal TI. Topical, Biological and Clinical Challenges in the Management of Patients with Acne Vulgaris. Sultan Qaboos Univ Med J 2016; 16:e152-60. [PMID: 27226905 DOI: 10.18295/squmj.2016.16.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 07/02/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Acne vulgaris is one of the most common chronic inflammatory skin disorders among adolescents and young adults. It is associated with substantial morbidity and, rarely, with mortality. The exact worldwide incidence and prevalence are currently unknown. Current challenges involve improving understanding of the underlying pathophysiology of acne vulgaris and developing a practical treatment consensus. Expert panel discussions were held in 2013 and 2014 among a group of scientists and clinicians from the Omani and United Arab Emirate Dermatology Societies to ascertain the current optimal management of acne vulgaris, identify clinically relevant end-points and construct suitable methodology for future clinical trial designs. This article reviews the discussions of these sessions and recent literature on this topic.
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Affiliation(s)
- Anwar Al-Hammadi
- Department of Dermatology, Rashid Hospital, Dubai, United Arab Emirates
| | | | - Sameer Al-Ali
- Department of Dermatology, Abu Dhabi Dermatology Clinic, Abu Dhabi, United Arab Emirates
| | - Rajesh Ramadurai
- Department of Clinical & Medical Affairs, Glenmark Pharmaceuticals Private Ltd., Mumbai, India
| | - Rishi Jain
- Department of Clinical & Medical Affairs, Glenmark Pharmaceuticals Private Ltd., Mumbai, India
| | - Lynn McKinley-Grant
- Department of Dermatology, George Washington University Hospital, Washington D.C., USA
| | - Tariq I Mughal
- Department of Hematology & Oncology, Tufts University Medical Center, Boston, Massachusetts, USA
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Gollnick HP, Bettoli V, Lambert J, Araviiskaia E, Binic I, Dessinioti C, Galadari I, Ganceviciene R, Ilter N, Kaegi M, Kemeny L, López-Estebaranz JL, Massa A, Oprica C, Sinclair W, Szepietowski JC, Dréno B. A consensus-based practical and daily guide for the treatment of acne patients. J Eur Acad Dermatol Venereol 2016; 30:1480-90. [PMID: 27177989 DOI: 10.1111/jdv.13675] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many current guidelines provide detailed evidence-based recommendations for acne treatment. OBJECTIVE To create consensus-based, simple, easy-to-use algorithms for clinical acne treatment in daily office-based practice and to provide checklists to assist in determining why a patient may not have responded to treatment and what action to take. METHODS Existing treatment guidelines and consensus papers were reviewed. The information in them was extracted and simplified according to daily clinical practice needs using a consensus-based approach and based on the authors' clinical expertise. RESULTS As outcomes, separate simple algorithms are presented for the treatment of predominant comedonal, predominant papulopustular and nodular/conglobate acne. Patients with predominant comedonal acne should initially be treated with a topical retinoid, azelaic acid or salicylic acid. Fixed combination topicals are recommended for patients with predominant papulopustular acne with treatment tailored according to the severity of disease. Treatment recommendations for nodular/conglobate acne include oral isotretinoin or fixed combinations plus oral antibiotics in men, and these options may be supplemented with oral anti-androgenic hormonal therapy in women. Further decisions regarding treatment responses should be evaluated 8 weeks after treatment initiation in patients with predominant comedonal or papulopustular acne and 12 weeks after in those with nodular/conglobate acne. Maintenance therapy with a topical retinoid or azelaic acid should be commenced once a patient is clear or almost clear of their acne to prevent the disease from recurring. The principal explanations for lack of treatment response fall into 5 main categories: disease progression, non-drug-related reasons, drug-related reasons, poor adherence, and adverse events. CONCLUSION This practical guide provides dermatologists with treatment algorithms adapted to different clinical features of acne which are simple and easy to use in daily clinical practice. The checklists to establish the causes for a lack of treatment response and subsequent action to take will facilitate successful acne management.
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Affiliation(s)
- H P Gollnick
- Department of Dermatology & Venereology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - V Bettoli
- Department of Clinical and Experimental Medicine, O.U. of Dermatology, Azienda Ospedaliero-Universitaria, University of Ferrara, Ferrara, Italy
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, University of Antwerp, Edegem, Belgium
| | - E Araviiskaia
- Department of Dermatology and Venereal Diseases, First I. P. Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - I Binic
- Department of Dermatovenerology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - C Dessinioti
- Department of Dermatology, A. Syggros Hospital, University of Athens, Athens, Greece
| | - I Galadari
- School of Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - R Ganceviciene
- Clinic of Infectious, Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Vilnius, Lithuania
| | - N Ilter
- Department of Dermatology, Gazi University Medical School, Ankara, Turkey
| | - M Kaegi
- Hautzentrum Zürich, Zürich, Switzerland
| | - L Kemeny
- Department of Dermatology and Allergology University of Szeged, Szeged, Hungary
| | | | - A Massa
- Clínica Dermatológica Dr António Massa, Porto, Portugal
| | - C Oprica
- Department of Laboratory Medicine, Karolinska Institutet Karolinska University Hospital Huddinge, Stockholm, Sweden.,Diagnostiskt Centrum Hud, Stockholm, Sweden
| | - W Sinclair
- Department of Dermatology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - B Dréno
- Department of Dermato-Cancerology, University of Nantes, Nantes, France
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Leyden J. Recent advances in the use of adapalene 0.1%/benzoyl peroxide 2.5% to treat patients with moderate to severe acne. J DERMATOL TREAT 2016; 27 Suppl 1:S4-13. [DOI: 10.3109/09546634.2016.1145338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Lee YH, Liu G, Thiboutot DM, Leslie DL, Kirby JS. A retrospective analysis of the duration of oral antibiotic therapy for the treatment of acne among adolescents: Investigating practice gaps and potential cost-savings. J Am Acad Dermatol 2014; 71:70-6. [DOI: 10.1016/j.jaad.2014.02.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
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Acne subject preference for pump over tube for dispensing fixed-dose combination adapalene 0.1%-benzoyl peroxide 2.5% gel. Dermatol Ther (Heidelb) 2014; 4:61-70. [PMID: 24919432 PMCID: PMC4065281 DOI: 10.1007/s13555-014-0054-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Acne is a chronic inflammatory disease. Key to a patient’s success on fixed-dose adapalene–benzoyl peroxide (BPO) gel is ensuring adherence. Use of a pump system to deliver a pre-measured amount of gel with each pressure enables application of a more consistent dose vs. the tube, which should improve adherence. In the present study, we evaluate patient preference for two different containers for dispensing adapalene–BPO gel. Methods In this 15-day, open-label study, 300 subjects were asked to treat their acne using fixed-dose adapalene 0.1%–BPO 2.5% gel dispensed in either a tube or a pump once-daily for up to 7 days. At week 1, subjects switched to the alternative packaging design for the same timeframe. At the end of the treatment period, subjects were asked to complete a subject preference survey. Results Among subjects completing the survey (n = 291), 79.0% (n = 230) preferred the pump for dispensing adapalene–BPO gel and 21.0% (n = 61) preferred the tube (p < 0.001). The top three characteristics of the pump were that it was easy to use (89.0%; n = 259/291), clean (73.2%; n = 213/291) and convenient (69.4%; n = 202/291). When asked to rate their experience with using the pump, 91.8% (n = 267/291; p < 0.001) of subjects reported being satisfied on a self-assessment scale. The majority of subjects stated they would tell their doctor about their preference for the pump next time adapalene–BPO gel was prescribed (76.6%; n = 223/291; p < 0.001) and would prefer the pump if both containers cost the same amount (80.1%; n = 233/291; p < 0.001). Conclusion Patients prefer using a pump instead of a tube to dispense adapalene–BPO gel. This delivery mechanism helps to ensure consistent application and thus may improve patient adherence to the prescribed acne treatment regimen. Electronic supplementary material The online version of this article (doi:10.1007/s13555-014-0054-1) contains supplementary material, which is available to authorized users.
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Zhou R, Jiang X. Effects of adapalene-benzoyl peroxide combination gel in treatment or maintenance therapy of moderate or severe acne vulgaris: a meta-analysis. Ann Dermatol 2014; 26:43-52. [PMID: 24648685 PMCID: PMC3956794 DOI: 10.5021/ad.2014.26.1.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/04/2013] [Accepted: 01/05/2013] [Indexed: 02/05/2023] Open
Abstract
Background An antibiotic-free, fixed-dose combination gel with adapalene (A) 0.1% and benzoyl peroxide (BPO) 2.5% has been developed for treatment of acne vulgaris. Objective To compare the clinical outcomes of A-BPO combination gel with vehicle gel for treatment or maintenance therapy of patients with acne vulgaris. Methods An electronic search of the database PubMed (1966 to September 2012), Embase (1984 to September 2012), and Cochrane Controlled Trials Register (CENTRAL; 3rd Quarter, 2012) was undertaken to identify relevant studies. Main clinical outcomes were success rate, treatment-related adverse events (AEs), AEs leading to discontinuation, satisfaction with the effectiveness, and overall satisfaction. Results Six studies were finally included in this meta-analysis. The A-BPO group yielded better clinical outcomes regarding the success rate (p<0.00001), satisfaction with the effectiveness of treatment (p=0.005), and overall satisfaction (p=0.005) compared to the vehicle group. The incidence of treatment-related AEs in the A-BPO group was comparable with that of vehicle group (p=0.09), while the A-BPO group was associated with a slightly increase in the incidence of AEs leading to discontinuation when compared with the vehicle group (p=0.02). Conclusion A-BPO combination gel yields better clinical outcomes including success rate, satisfaction with the effectiveness, and overall satisfaction compared to vehicle gel, despite an increased incidence of AEs leading to discontinuation. The A-BPO combination agent most likely contributes to the treatment of moderate acne vulgaris rather than severe acne vulgaris, but it may be useful in maintenance therapy of patients with severe acne vulgaris.
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Affiliation(s)
- Rongying Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
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Zhou R, Jiang X. Effects of Adapalene-Benzoyl Peroxide Combination Gel in Treatment or Maintenance Therapy of Moderate or Severe Acne Vulgaris: A Meta-Analysis. Ann Dermatol 2014. [DOI: 10.5021/ad.2014.26.1.43 free pmc article] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Affiliation(s)
- Rongying Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
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Sandoval LF, Hartel JK, Feldman SR. Current and future evidence-based acne treatment: a review. Expert Opin Pharmacother 2013; 15:173-92. [PMID: 24283604 DOI: 10.1517/14656566.2014.860965] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Current acne treatment guidelines, as well as, treatment efficacy, safety, tolerability and patient preferences must all be considered in determining appropriate treatment regimes. Literature can assist physicians' evidence-based recommendations according to these factors. AREAS COVERED To determine the current and future direction of pharmacotherapy for treatment of acne, a PubMed search was conducted to identify all clinical trials involving the treatment of acne from 2009 to 2012. A total of 65 publications met inclusion criteria and were reviewed. Literature was heavily focused on the efficacy and tolerability of topical combination therapies and supported their use compared with monotherapy. A few studies on topical antiandrogens and antioxidants showed an alternative approach to targeting acne. Studies on oral monotherapy provided some evidence for the use of pulsed azithromycin for acne in adolescents. Literature also supports the use of low-dose isotretinoin for moderate acne, which was comparable in efficacy to high-dose regimes and better tolerated. EXPERT OPINION Combination acne therapy, whether it be combination topical therapy or combination oral and topical therapy, is well supported by recent studies. Given the multifactorial pathogenesis of acne and the hurdles of adherence to treatment, we anticipate greater development of and reliance on combination acne products in the future.
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Affiliation(s)
- Laura F Sandoval
- Wake Forest School of Medicine, Center for Dermatology Research, Departments of Dermatology , Winston-Salem, North Carolina , USA +1 760 217 1457 ; +1 336 716 7732 ;
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Keating GM. Adapalene 0.1%/benzoyl peroxide 2.5% gel: a review of its use in the treatment of acne vulgaris in patients aged ≥ 12 years. Am J Clin Dermatol 2011; 12:407-20. [PMID: 21967116 DOI: 10.2165/11208170-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Adapalene 0.1%/benzoyl peroxide 2.5% gel (Epiduo™, Tactuo™) is the only fixed-dose combination product available that combines a topical retinoid with benzoyl peroxide; it targets three of the four main pathophysiologic factors in acne. This article reviews the therapeutic efficacy and tolerability of topical adapalene 0.1%/benzoyl peroxide 2.5% gel in the treatment of patients aged ≥ 12 years with acne vulgaris, as well as summarizing its pharmacologic properties. In three 12-week trials in patients aged ≥ 12 years with moderate acne, success rates were significantly higher with adapalene 0.1%/benzoyl peroxide 2.5% gel than with adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone, and combination therapy had an earlier onset of action. In addition, significantly greater reductions in total, inflammatory, and noninflammatory lesion counts were seen in patients receiving adapalene 0.1%/benzoyl peroxide 2.5% gel than in those receiving adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone. Adapalene 0.1%/benzoyl peroxide 2.5% gel did not significantly differ from clindamycin 1%/benzoyl peroxide 5% gel in terms of the reduction in the inflammatory, noninflammatory, or total lesion counts in patients with mild to moderate acne, according to the results of a 12-week trial. Twelve-week studies showed that topical adapalene 0.1%/benzoyl peroxide 2.5% gel in combination with oral lymecycline was more effective than oral lymecycline alone in patients with moderate to severe acne, and topical adapalene 0.1%/benzoyl peroxide 2.5% gel in combination with oral doxycycline hyclate was more effective than oral doxycycline hyclate alone in patients with severe acne. In patients with severe acne who responded to 12 weeks' therapy with topical adapalene 0.1%/benzoyl peroxide 2.5% gel plus oral doxycycline hyclate or oral doxycycline hyclate alone, an additional 6 months' therapy with adapalene 0.1%/benzoyl peroxide 2.5% gel was more effective than vehicle gel at maintaining response, with further improvement seen in adapalene 0.1%/benzoyl peroxide 2.5% gel recipients. A noncomparative study also demonstrated the efficacy of 12 months' therapy with adapalene 0.1%/benzoyl peroxide 2.5% gel in patients with acne vulgaris. Topical adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in patients with acne. In 12-week trials, the most commonly occurring treatment-related adverse events included erythema, scaling, dryness, and stinging/burning; these dermatologic treatment-related adverse events were usually of mild to moderate severity, occurred early in the course of treatment, and resolved without residual effects. Topical adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in the longer term, with dry skin being the most commonly occurring treatment-related adverse event over 12 months of treatment. In conclusion, adapalene 0.1%/benzoyl peroxide 2.5% gel is a valuable agent for the first-line treatment of acne vulgaris.
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