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King A, Tan MG, Kirshen C, Tolkachjov SN. Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024. [PMID: 39239956 DOI: 10.1111/jdv.20315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Rosacea is a chronic, relapsing inflammatory dermatosis predominantly affecting the central face and can result in significant psychosocial impacts. Isotretinoin has been studied for rosacea due to its anti-inflammatory and sebum reduction properties, but its use remains limited likely due to its off-label use and potential adverse events. OBJECTIVE This systematic review and meta-analysis investigated the efficacy and safety of low-dose isotretinoin (LDI; ≤0.5 mg/kg/day) for the four main types of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea. METHODS Randomized and non-randomized studies evaluating LDI for rosacea were included. Incomplete studies, non-English studies and case reports were excluded. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation scale. RESULTS Of 435 studies, and 16 studies involving 1445 patients were included. LDI decreased lesion count (p = 0.03) and erythema (p = 0.01) with large effect [standardized mean difference (SMD) > 0.8]. Compared to topical retinoids and topical antimicrobials, isotretinoin had larger reductions in lesion count (p = 0.03) with moderate effect (SMD > 0.5). Mean lesion count and erythema remained reduced by 70% and 47%, respectively, at 16 weeks after LDI cessation. Relapse rate was 35% at 5.5 months post-isotretinoin, and three patients (0.4%) experienced worsening of rosacea. Three patients (0.4%) experienced serious adverse events. CONCLUSIONS Study design heterogeneity limited more comprehensive comparisons. Overall, low-dose isotretinoin may serve as an effective treatment for rosacea with good tolerability and safety.
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Affiliation(s)
- Aliyah King
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marcus G Tan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carly Kirshen
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, Texas, USA
- Baylor University Medical Center, Dallas, Texas, USA
- Department of Dermatology, University of Texas at Southwestern, Dallas, Texas, USA
- Texas A&M College of Medicine, Dallas, Texas, USA
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Narayanan D, Rogge M. Cheilitis: A Diagnostic Algorithm and Review of Underlying Etiologies. Dermatitis 2024; 35:431-442. [PMID: 38422211 DOI: 10.1089/derm.2023.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Cheilitis, or inflammation of the lips, is a common reason for dermatologic consultation. The inflammation can include the vermillion lip, vermillion border, and surrounding skin, and can present with an acute or chronic course. There are many etiologies, including irritant and allergic contact dermatitis, atopic cheilitis, actinic cheilitis, infectious etiologies, nutritional deficiencies, drug-induced cheilitis, and rare etiologies, including granulomatous cheilitis, cheilitis glandularis, plasma cell cheilitis, lupus cheilitis, and exfoliative cheilitis. Distinguishing among the various etiologies of cheilitis is clinically difficult, as many causes may produce similar erythema and superficial desquamation of mucosal skin. In addition, patients report dryness, redness, irritation, burning, fissuring, and itch in many of the underlying causes. Thus, the specific etiology of cheilitis is often difficult to diagnose, requiring extensive testing and treatment trials. In this review, we summarize the various types of cheilitis, synthesizing novel cases, clinical presentations, histopathology, epidemiology, and advancements in diagnostic methods and therapeutics. We provide a diagnostic algorithm aimed to assist clinicians in the management of cheilitis.
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Affiliation(s)
- Deepika Narayanan
- From the Department of Dermatology, John P. and Kathrine G. McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Megan Rogge
- From the Department of Dermatology, John P. and Kathrine G. McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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3
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Kapetanovic I, Zivanovic D, Mijuskovic M, Minic S. The unknown silent drug reaction in acne patients: rare case of isotretinoin-induced haematuria. Fam Pract 2024; 41:615-617. [PMID: 37602648 DOI: 10.1093/fampra/cmad043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Acne vulgaris is one of the most frequent visits to primary care physicians and dermatologists alike. Isotretinoin is the backbone of acne treatment. In most countries, depending on the health care system, isotretinoin is prescribed by dermatologists but primary care physicians are a part of the follow-up and interpreting analysis. Adverse effects of isotretinoin on the kidney and urinary system are mostly limited to sparse case reports. Specifically, gross and microscopic haematuria is not mentioned to be associated with isotretinoin. Lack of data regarding these adverse effects can lead to doubt regarding further patient management not only with dermatologists but also primary care physicians. OBJECTIVE We report a 16-year-old male patient with isotretinoin-induced haematuria with multiple episodes and subsequent challenge and de-challenge. No personal or familial history of nephrological disease was present. Ultrasound imaging and nephrology workup was within normal limits. Other aetiologies were excluded. Nephrology consult stated there was no contraindication for isotretinoin use and was reinstated at 0.6 m/kg/day. More frequent observation was indicated until completion of isotretinoin. CONCLUSION Our case raises awareness to other dermatologists and primary care physicians that haematuria can be secondary to isotretinoin but not a contraindication for further use if asymptomatic and microscopic. More extensive evaluation and monitoring should be done if the patient is symptomatic with other abnormalities and symptoms. Urinalysis should be a part of routine follow-up monitoring in patients on isotretinoin. Furthermore, delineating and differentiating when to refer to a nephrologist is essential for physicians, patients, and the health care system overall.
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Affiliation(s)
- Igor Kapetanovic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dubravka Zivanovic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Margita Mijuskovic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Minic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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4
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Xu D, Yang X, Wu W, Yang J. Identification of Novel Protein Biomarkers and Drug Targets for Acne Vulgaris by Integrating Human Plasma Proteome with Genome-Wide Association Data. J Inflamm Res 2024; 17:4431-4441. [PMID: 39006495 PMCID: PMC11246077 DOI: 10.2147/jir.s463450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Background Despite the availability of numerous therapies, the treatment of acne vulgaris remains challenging. Novel drug targets for acne vulgaris are still needed. Methods We conducted a Mendelian randomization analysis to explore possible drug targets for acne vulgaris. We utilized summary statistics obtained from the dataset of acne vulgaris, including 399,413 individuals of European ancestry. We gathered genetic instruments for 566 plasma proteins from genome-wide association studies. In order to strengthen the findings from Mendelian randomization, various methods were employed, including bidirectional Mendelian randomization analysis, Bayesian co-localization, phenotype scanning, and single-cell analysis. These methods facilitated the identification of reverse causality, the search for reported variant-trait associations, and the determination of the cell types that is the primary source of protein. Furthermore, using the plasma proteins in the deCODE cohort, we conducted a replication of the Mendelian randomization analysis as an external validation. Results At the significance level of Bonferroni (P < 8.83×10-5), a protein-acne pair was discovered through Mendelian randomization analysis. In plasma, increasing TIMP4 (OR = 1.15; 95% CI, 1.09-1.21; P = 1.01×10-7) increased the risk of acne vulgaris. The absence of reverse causality was observed in the TIMP4 protein. According to Bayesian co-localization analysis, TIMP4 shared the same variant with acne vulgaris (PPH4 = 0.93). TIMP4 was replicated in deCODE cohort (OR = 1.17; 95% CI, 1.10-1.24; P = 1.48×10-7). Single-cell analysis revealed that TIMP4 was predominantly detected in myeloid cells in blood, and was detected in almost all cell types in skin tissue. Conclusion The integrative analysis revealed that the level of plasma TIMP4 has a direct influence on the risk of developing acne vulgaris. This implies that TIMP4 protein could serve as a potential target for the development of drugs aimed at treating acne vulgaris.
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Affiliation(s)
- Dongrui Xu
- School of Basic Medical Sciences, Dali University, Dali, Yunnan, People’s Republic of China
| | - Xiaoyi Yang
- School of Basic Medical Sciences, Dali University, Dali, Yunnan, People’s Republic of China
| | - Wenjuan Wu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Jiankang Yang
- School of Basic Medical Sciences, Dali University, Dali, Yunnan, People’s Republic of China
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Assiri A, Hobani AH, AlKaabi HA, Mojiri ME, Daghriri SA, Suwaid OA, Alameer MI, Akkam MM, Alamir MA, Albarr AA, Alshaikh MR, Sumayli AM, Akkam FM, Hakami HA. Efficacy of Low-Dose Isotretinoin in the Treatment of Rosacea: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e57085. [PMID: 38681262 PMCID: PMC11052926 DOI: 10.7759/cureus.57085] [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: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Rosacea is a common cutaneous condition caused by persistent, recurring lesions in facial skin vessels. It is a chronic skin condition with a variety of clinical symptoms and an unknown cause. Rosacea begins with the widening of capillaries and a flushed appearance. Following that, telangiectasia appears, and reddened patches persist, particularly on the cheeks and nose. Erythema persists due to repeated vasodilation and telangiectasia. In addition, skin inflammation manifests as papules, pustules, lymphedema, and fibrosis. Despite recent advances in treatment, rosacea, a chronic inflammatory relapsing central facial dermatosis, can be extremely difficult to manage. The purpose of this meta-analysis and systematic review was to evaluate the effectiveness of low-dose isotretinoin in the treatment of rosacea. Following the guidelines set forth by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), the researcher employed the following search terms in the EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar databases to provide a therapeutic update relevant to clinical practice: "low dose isotretinoin," "isotretinoin and rosacea," "isotretinoin treatment of rosacea," and "effectiveness of isotretinoin in treating rosacea". The search was carried out by the researcher for articles published from February 2019 to February 2024. The articles included were all published in the English language. The overall frequency of patients with adverse events differed significantly between the groups treated with low-dose isotretinoin and the comparators (minocycline, pulsed dye laser, evening primrose oil, Lactobacillus plantarum, doxycycline, combined dose or placebo) (0.80, 95% CI 0.73 to 0.88, p = 0.0001). Sub-group analysis indicated that there was a difference between the interventions used in the treatments all in favor of low-dose isotretinoin treatment. The results showed that the moderate group had RR: 0.76, 95% CI: 0.44-1.30, I2 = 0%; the mild group had RR: 0.94, 95% CI: 0.56-1.57, I2 = 0%; and the group with severe rosacea had RR: 0.73, 95% CI: 0.47-1.13, I2 = 0%. According to this study, rosacea can be treated effectively with low-dose isotretinoin even in patients at severe stages of the disease by using the recommended dose once a week. Further, the intervention has also been shown to have fewer side effects on the patients. Therefore, this study recommends randomized controlled trials to be done to fully investigate the best combination options for isotretinoin on mild to severe rosacea based on the fact that some of the treatments combined have shown to be effective on treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ali A Albarr
- College of Medicine, Jazan University, Jazan, SAU
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Liang L, Qi X, Jiang X, Chen T, Dong L. Lactobacillus plantarum MH-301 as an effective adjuvant to isotretinoin in the treatment of acne vulgaris: a randomized and open-label trail. Front Med (Lausanne) 2024; 10:1340068. [PMID: 38264057 PMCID: PMC10803606 DOI: 10.3389/fmed.2023.1340068] [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: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Acne vulgaris is a common chronic inflammatory skin disease originating in the sebaceous gland units of the skin follicles. Isotretinoin is presently the primary choice for the treatment of acne vulgaris. However, it could induce several adverse reactions like diarrhea, cheilitis, headache, elevated triglyceride levels and risk of inflammatory bowel disease and depression. Hence, it is imperative to seek an alternative therapy. Methods One hundred five patients were randomly divided into 3 groups, and received a baseline treatment of oral doxycycline for the initial 4 weeks. Group I received isotretinoin oral for 12 weeks; Group P received oral Lactobacillus plantarum MH-301 treatment for 12 weeks; Group IP received combined treatment with oral probiotics and oral isotretinoin for 12 weeks. The number of skin lesions was recorded at 0, 4, 8, and 12 weeks during the treatment to compare the efficacy of each intervention, and skin and fecal samples were collected from patients at 12 weeks for high-throughput sequencing to explore the microbiota differences between various groups. Results Our results revealed that the combination of L. plantarum MH-301 with isotretinoin significantly reduced the number of skin lesions in patients compared to using L. plantarum MH-301 and isotretinoin alone (p < 0.001). Additionally, skin microbiome High-throughput analysis indicated the restorative effects of L. plantarum MH-301 on skin microbial diversity while also observing a reduction in the main microbiota of skin lesions, Propionibacterium and Corynebacterium. Meanwhile, gut microbiome High-throughput analysis showed that it could regulate disorders of the intestinal microbiota and increased the abundance of probiotics such as Lactobacillus, Bifidobacterium, Coprococcus and Bacteroides genera. Conclusion In conclusion, L. plantarum MH-301 could be used in combination with isotretinoin for optimal results in the treatment of acne vulgaris. The research conducted provides theoretical and data support for the adjuvant effect of L. plantarum in the treatment of acne vulgaris. Clinical Trial Registration [ClinicalTrials.gov], identifier (ChiCTR2200063499).
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Affiliation(s)
- Lili Liang
- Department of Dermatology, Shanxi Provincial People’s Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, China
| | - Xinyue Qi
- Institute of Life Science, Nanchang University, Nanchang, China
- National Engineering Research Center for Bioengineering Drugs and the Technologies, Institution of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiaoke Jiang
- Department of Dermatology, Shanxi Provincial People’s Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, China
| | - Tingtao Chen
- National Engineering Research Center for Bioengineering Drugs and the Technologies, Institution of Translational Medicine, Jiangxi Medical College, Nanchang University, Nanchang, China
- School of Pharmacy, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Lina Dong
- Core Laboratory, Shanxi Provincial People’s Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, China
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7
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Olguín‐García MG, Peralta‐Pedrero ML, Jurado‐Santa Cruz F, Vega‐Memije E, Morales‐Sánchez MA. Low-dose oral isotretinoin in the treatment of recalcitrant facial flat warts: A clinical case and review of literature. Health Sci Rep 2023; 6:e1633. [PMID: 37885463 PMCID: PMC10599275 DOI: 10.1002/hsr2.1633] [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: 08/26/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Background and Aims The treatment of recalcitrant facial flat warts has always been challenging for dermatologists. The pain related to the application of the different treatments, side effects and costs are determining factors in the choice of therapy. To date, it is known that oral isotretinoin administered at a dose of 0.5 mg/kg/day is effective and safe; However, the different adverse effects reported have a dose-dependent behavior and they could limit their use. Our aim is to assess the effect of low-doses of oral isotretinoin to reducing side effects in the complete removal of recalcitrant facial flat warts and the current evidence in this regard. Methods An extensive literature review was conducted to identify articles relating to low doses of oral isotretinoin for recalcitrant flat warts treatment, regardless of design up to May 2023. Results The literature search yielded eight articles of 324 reviewed meeting criteria. Isotretinoin was administered in doses of 0.1-0.5 mg/kg/day. Complete elimination of the lesions occurred in 65.13% of the patients and a partial response in 19.26%. Four relapses were documented at the 4-month follow-up. The most frequent adverse effect was cheilitis. Conclusion We might consider low doses of oral isotretinoin for the treatment of recalcitrant facial flat warts in which side effects need to be reduced. However, current published works have several limitations, including small sample sizes, lack of control group and follow-up periods. Larger, randomized, controlled studies are needed to verify the efficacy and safety of different doses of isotretinoin.
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Affiliation(s)
- María Guadalupe Olguín‐García
- Universidad Nacional Autónoma de México “Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud”Mexico CityMexico
- Education and Research DepartmentCentro Dermatológico Dr. Ladislao de la Pascua (CDP) Secretaría de Salud de la Ciudad de MéxicoMexico CityMexico
- Internal Medicine DepartmentHospital General Dr. Darío Fernández Fierro, ISSSTEMexico CityMexico
| | - María Luisa Peralta‐Pedrero
- Universidad Nacional Autónoma de México “Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud”Mexico CityMexico
- Education and Research DepartmentCentro Dermatológico Dr. Ladislao de la Pascua (CDP) Secretaría de Salud de la Ciudad de MéxicoMexico CityMexico
| | - Fermín Jurado‐Santa Cruz
- Education and Research DepartmentCentro Dermatológico Dr. Ladislao de la Pascua (CDP) Secretaría de Salud de la Ciudad de MéxicoMexico CityMexico
| | - Elisa Vega‐Memije
- Dermatology DepartmentHospital General Dr. Manuel Gea González Secretaria de SaludMexico CityMexico
| | - Martha Alejandra Morales‐Sánchez
- Education and Research DepartmentCentro Dermatológico Dr. Ladislao de la Pascua (CDP) Secretaría de Salud de la Ciudad de MéxicoMexico CityMexico
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8
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Alabadallah RY, Hijazi BM, Altawalbeh SM, Oqal M, Almomani BA. Clinical pharmacist role in improving the knowledge and outcomes in patients using isotretinoin: A randomized, controlled study. Heliyon 2023; 9:e20102. [PMID: 37809575 PMCID: PMC10559846 DOI: 10.1016/j.heliyon.2023.e20102] [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: 03/23/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To evaluate the role of a clinical pharmacist in improving knowledge and outcomes among isotretinoin users. Methods Patients were randomly assigned to an intervention group (received education about isotretinoin by a clinical pharmacist in addition to the physician) and a control group (received routine education by the physician), then followed for three months. Patients' knowledge about isotretinoin optimal use, and side effects and their management and other outcomes were measured in both groups at baseline and at follow up after three months using a validated questionnaire. Results Two-hundred and three patients completed the study; 103 were in the intervention group and 100 in the control group. The knowledge improvement between baseline score and follow-up score was greater in the intervention group (mean = 2.835 ± 1.329) compared to the control group (mean = 0.530 ± 0.784) with mean differences = -2.30495, P < 0.001. Conclusion Implementing clinical pharmacy services in dermatology clinics can positively increase patients' level of knowledge about isotretinoin, which could reduce the severity of its side effects. Therefore, improving patients' quality of life, and improvement in acne. Practice implications Implementing clinical pharmacist services to patients using isotretinoin is feasible in an outpatient setting. Clinical pharmacist counseling and education improve the medication knowledge among patients who use isotretinoin.
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Affiliation(s)
- Ruba Y. Alabadallah
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Bushra M. Hijazi
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Muna Oqal
- Faculty of Pharmaceutical Sciences, Hashemite University, Zarqa, Jordan
| | - Basima A. Almomani
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Soutou B, Sleiman J, Tomb R, Kechichian E, Helou J. Prevalence of adverse events varies with the different oral isotretinoin brands in acne treatment: a retrospective observational study. Arch Dermatol Res 2023; 315:1533-1539. [PMID: 36656385 DOI: 10.1007/s00403-023-02532-6] [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: 07/26/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
Oral isotretinoin remains the most effective treatment for acne. The aim of this retrospective single-center cohort study was to estimate the prevalence of adverse events with the different oral isotretinoin brands used in acne treatment. The population consisted of all patients who consulted for acne between January 2015 and January 2020. The inclusion criterion was the initiation of treatment with oral isotretinoin. The exclusion criteria were the use of two or more brands during the same course of treatment and previous treatment with oral isotretinoin. Statistical analysis was carried out using Chi-square and Mann-Whitney tests. We analyzed 468 patients of whom 68.6% were female. The median age was 21 years. The median weight was 65 kg. The treatment was Roaccutane®, Curacné®, Acnotren®, Isosupra®, Contracné®, or Acnogen® in 44.2%, 28%, 14.5%, 10.5%, 1.7% and 0.4% of cases, respectively. Xerosis was the most frequently reported side effect regardless of the brand. The highest frequencies of hypercholesterolemia (25.6%) and eczema (13%) were noted with Roaccutane®; hypertriglyceridemia (16.8%), epistaxis (9.9%) and fatigue (3.1%) with Curacné®; excessive sweating (4.1%) and headache (4.1%) with Isosupra®; and abnormal liver function tests (11%) with Acnotren®. We found a significant correlation mainly between abnormal ASAT and Acnotren® (p = 0.009), hypercholesterolemia and Roaccutane® [OR = 1.652 (95% CI 1.056-2.585)], hypertriglyceridemia and higher body weight (p = 0.004). Factors related to the drug brand and to characteristics of acne patients could explain the variability in the prevalence of some adverse events.
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Affiliation(s)
- Boutros Soutou
- Dermatology Department, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon.
- Dermatology Department, Hôtel-Dieu de France University Hospital, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon.
| | - Joelle Sleiman
- Dermatology Department, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
- Dermatology Department, Hôtel-Dieu de France University Hospital, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
| | - Roland Tomb
- Dermatology Department, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
- Dermatology Department, Hôtel-Dieu de France University Hospital, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
| | - Elio Kechichian
- Dermatology Department, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
- Dermatology Department, Hôtel-Dieu de France University Hospital, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
| | - Josiane Helou
- Dermatology Department, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
- Dermatology Department, Hôtel-Dieu de France University Hospital, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
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10
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Ding RL, Zheng Y, Bu J. Physiological and Psychological Effects of Isotretinoin in the Treatment of Patients with Acne: A Narrative Review. Clin Cosmet Investig Dermatol 2023; 16:1843-1854. [PMID: 37483471 PMCID: PMC10362870 DOI: 10.2147/ccid.s416267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
Isotretinoin (ISO) is a powerful vitamin A derivative that offers the potential for treatment of permanent remission of acne; however, its potential side effects on both physiological and psychological aspects limit its application. This article reviews the side effects of ISO from physiological and psychological aspects in detail, to better screen the suitable population of ISO and improve the efficiency of clinical treatment. Our findings indicate that ISO may cause teratogenicity, skin reactions, ocular reactions, changes in blood indicators, and occasional acne fulminans. To optimize clinical treatment, more attention should be paid to identifying the specific conditions under which these reactions occur, how severe they are, and how they subside to alleviate patient concerns. Regarding the controversial issue of psychological side effects caused by ISO, researchers should shift their focus to the psychological problems that acne itself may cause.
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Affiliation(s)
- Rui-Lian Ding
- Hospital for Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, People’s Republic of China
| | - Yu Zheng
- Hospital for Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, People’s Republic of China
| | - Jin Bu
- Hospital for Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, People’s Republic of China
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Aktas H, Bahçe ZŞ. Evaluation of the Incidence of Anal Fissures in Patients who Systemic Isotretinoin Therapy for Acne. Dermatol Pract Concept 2023; 13:e2023133. [PMID: 37557107 PMCID: PMC10412088 DOI: 10.5826/dpc.1303a133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Isotretinoin is an effective drug widely used in the treatment of severe acne. In this study, we tried to evaluate the incidence of anal fissures with clinical and laboratory side effects associated with isotretinoin. METHODS The study evaluated 210 patients who received systemic isotretinoin treatment. Especially patients with constipation and anal bleeding were evaluated by the General Surgery clinic to arrange appropriate treatments. RESULTS Of 210 patients included in the study, 138 (65.7%) were female and 72 (34.3%) were male, with a mean age of 23.7 years. The most common adverse event was dry lips in 206 (98.1%) patients. The mucocutaneous side effects were constipation 36 (17.1%), anal bleeding 18 (8.6%), mucosal erosion 10 (4.7%), anal fissure 7 (3.3%). Treatment was discontinued due to elevated liver function tests in 5 patients (2.3%), and because anal bleeding could not be controlled in 1 patient. CONCLUSIONS Isotretinoin is the most effective acne medicine used today. Clarification of the patients about the rarely seen side effects such as dryness, erosion, fissure and bleeding in the anal mucosa in addition to the common mucocutaneous side effects will ensure that patients are more cautious and increase their tolerance to the treatment.
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Affiliation(s)
- Hamza Aktas
- Private Memorial Hospital, Department of Dermatology, Diyarbakır, Turkey
| | - Zeynep Şener Bahçe
- Private Memorial Hospital, Department of General Surgery, Diyarbakır, Turkey
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Gradwohl K, Verghese M, Rosenblatt AE. Mood changes and clinical decision making in adolescent patients on isotretinoin therapy for acne vulgaris. Pediatr Dermatol 2023; 40:494-496. [PMID: 37037198 DOI: 10.1111/pde.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
Although numerous studies have demonstrated no causal relationship between isotretinoin and depression or suicide, subtle mood changes and idiosyncratic mood symptoms have been reported in patients on isotretinoin treatment for acne vulgaris, and few studies have described the full range of mood symptoms and clinical course after a mood change arises. We reviewed 247 patients, ages 10-25 years, with acne vulgaris on isotretinoin and found that 26/247 (10.5%) patients experienced mood changes, the most common being depressive symptoms, anxiety, aggression, and emotional lability. Regardless of treatment management, 22/25 (88%) patients experienced improvement of mood symptoms to baseline, and 22/25 (88%) were able to complete their isotretinoin course without symptom recurrence. Our findings highlight the importance of monitoring for a broad range of mood changes in patients on isotretinoin, especially those related to a pre-existing mood disorder and including those which do not meet formal criteria for a psychiatric disorder.
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Affiliation(s)
- Kelsey Gradwohl
- Transitional Year Program, Ascension Resurrection Medical Center, Chicago, Illinois, USA
- Section of Dermatology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Michelle Verghese
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Adena E Rosenblatt
- Section of Dermatology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
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Xiang Y, Lu J, Mao C, Zhu Y, Wang C, Wu J, Liu X, Wu S, Kwan KY, Cheung KM, Yeung KW. Ultrasound-triggered interfacial engineering-based microneedle for bacterial infection acne treatment. SCIENCE ADVANCES 2023; 9:eadf0854. [PMID: 36888703 PMCID: PMC9995069 DOI: 10.1126/sciadv.adf0854] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Acne is an inflammatory skin disease mainly caused by Propionibacterium acnes, which can cause local inflammatory reactions and develop into chronic inflammatory diseases in severe cases. To avoid the use of antibiotics and to effectively treat the site of acne, we report a sodium hyaluronate microneedle patch that mediates the transdermal delivery of ultrasound-responsive nanoparticles for the effective treatment of acne. The patch contains nanoparticles formed by zinc porphyrin-based metal-organic framework and zinc oxide (ZnTCPP@ZnO). We demonstrated activated oxygen-mediated killing of P. acnes with an antibacterial efficiency of 99.73% under 15 min of ultrasound irradiation, resulting in a decrease in levels of acne-related factors, including tumor necrosis factor-α, interleukins, and matrix metalloproteinases. The zinc ions up-regulated DNA replication-related genes, promoting the proliferation of fibroblasts and, consequently, skin repair. This research leads to a highly effective strategy for acne treatment through the interface engineering of ultrasound response.
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Affiliation(s)
- Yiming Xiang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
- Biomedical Materials Engineering Research Center, Collaborative Innovation Center for Advanced Organic Chemical Materials Co-constructed by the Province and Ministry, Hubei University, Wuhan 430062, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Jiali Lu
- Biomedical Materials Engineering Research Center, Collaborative Innovation Center for Advanced Organic Chemical Materials Co-constructed by the Province and Ministry, Hubei University, Wuhan 430062, China
| | - Congyang Mao
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
- Biomedical Materials Engineering Research Center, Collaborative Innovation Center for Advanced Organic Chemical Materials Co-constructed by the Province and Ministry, Hubei University, Wuhan 430062, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Yizhou Zhu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
- Biomedical Materials Engineering Research Center, Collaborative Innovation Center for Advanced Organic Chemical Materials Co-constructed by the Province and Ministry, Hubei University, Wuhan 430062, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Chaofeng Wang
- School of Life Science and Health Engineering, Hebei University of Technology, Tianjin 300401, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Xiangmei Liu
- Biomedical Materials Engineering Research Center, Collaborative Innovation Center for Advanced Organic Chemical Materials Co-constructed by the Province and Ministry, Hubei University, Wuhan 430062, China
- School of Life Science and Health Engineering, Hebei University of Technology, Tianjin 300401, China
| | - Shuilin Wu
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Kenny Y. H. Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Kelvin W. K. Yeung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
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Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management. Am J Clin Dermatol 2023; 24:199-223. [PMID: 36539678 DOI: 10.1007/s40257-022-00746-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
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Turan Ç, Öner Ü. Lip Mesotherapy with Dexpanthenol as a Novel Approach to Prevent Isotretinoin-Associated Cheilitis. Dermatol Pract Concept 2023; 13:dpc.1301a12. [PMID: 36892384 PMCID: PMC9946106 DOI: 10.5826/dpc.1301a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Isotretinoin (ISO)-associated cheilitis is the most common side effect and the most common reason for discontinuation of ongoing therapy. So, various lip balms are also routinely recommended for all patients. OBJECTIVES We aimed to investigate the effectiveness of local intradermal injections (mesotherapy) of dexpanthenol into the lips to prevent ISO-associated cheilitis. METHODS This pilot study was conducted on patients over the age of 18 using ISO (about 0.5 mg/kg/day). All patients were prescribed only hamamelis virginiana distillate in ointment form as a lip balm. In the mesotherapy group (n=28), 0.1 ml of dexpanthenol was injected into each lip tubercle (4 points total) to the submucosal level. The patients in the control group (n=26) used only the ointment. "ISO cheilitis grading scale (ICGS)" was used in the evaluation of ISO-associated cheilitis. The patients were followed for 2 months. RESULTS Although there was an increase in ICGS scores in the mesotherapy group compared to the baseline, no statistically significant change was observed after treatment (p=0.545). However, in the control group, there was a statistically significant increase in ICGS scores in the 1st and 2nd months compared to the baseline (p<0.001). Lip balms were needed significantly less frequently in the mesotherapy group compared to the control, both in the 1st and 2nd months (p=0.006, p=0.045; respectively). CONCLUSIONS Lip mesotherapy with dexpanthenol will be a useful option for preventing ISO-associated cheilitis because of its easy application, cost-effectiveness, low complication risk, and high patient satisfaction.
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Affiliation(s)
- Çağrı Turan
- Department of Dermatology and Venereology, Medical Park Ankara Hospital, Ankara, Turkey
| | - Ümran Öner
- Department of Dermatology and Venereology, Kastamonu University School of Medicine, Kastamonu, Turkey
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Kumar B, Pandey M, Aggarwal R, Sahoo PK. A comprehensive review on invasomal carriers incorporating natural terpenes for augmented transdermal delivery. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2022. [DOI: 10.1186/s43094-022-00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
Transdermal drug delivery is one of the most widely used drug administration routes, which offer several advantages over other routes of drug delivery. The apical layer of the skin called the stratum corneum is the most dominant obstacle in the transdermal drug delivery, which restricts the passage of drugs across the skin. Considerable strategies have been applied to enhance the rate of permeation across the epithelial cells; however, the most widely used strategy is the use of sorption boosters, also known as permeation enhancers.
Main body
Terpenes were considered as efficient skin permeation enhancers and are generally recognized as safe as per Food and Drug Administration. Terpenes improve the permeability of drugs either by destructing the stratum corneum’s tightly packed lipid framework, excessive diffusivity of drug in cell membrane or by rampant drug partitioning into epithelial cells. Various vesicular systems have been developed and utilized for the transdermal delivery of many drugs. Invasomes are one such novel vesicular system developed which are composed of phospholipids, ethanol and terpenes. The combined presence of ethanol and terpenes provides exceptional flexibility to the vesicles and improves the permeation across the barrier offered due to the stratum corneum as both ethanol and terpenes act as permeation enhancers. Therefore, utilization of invasomes as carriers to facilitate higher rate of drug permeation through the skin can be a very useful approach to improve transdermal drug delivery of a drug.
Conclusion
The paper focuses on a broad updated view of terpenes as effective permeation enhancers and invasomes along with their applications in the pharmaceutical formulations.
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The use of isotretinoin in acne therapy in early childhood and its effect on the occurrence of acne symptoms later in life. Eight-year follow-up. Postepy Dermatol Alergol 2022; 39:682-687. [PMID: 36090714 PMCID: PMC9454369 DOI: 10.5114/ada.2022.118921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Acne vulgaris is a chronic inflammatory skin disease of the pilosebaceous follicles that affects patients of all ages. Aim Use of isotretinoin in the early stages of the disease to prevent subsequent lesions of acne, including prolonged treatment and acne scars at a later age. Material and methods A retrospective, comparative study was carried between January 2010 and November 2018. The study population consisted of 90 children aged 9-18 years with acne. During treatment by isotretinoin the clinical evaluation was done every month. Patients were divided into three groups according to age. One of the qualification criteria was follow-up visits. Results A total of 90 children (67.8% females; mean age: 13.5 years) were enrolled. In group A (30 individuals - aged 9-11) and B (30 individuals - aged 12-13), treatment was terminated 2 months after clinical improvement (mean: 3 months). In control group C (30 individuals - aged 14-18), treatment was carried out using average cumulative dose 135 mg/kg bw/day. All groups showed up for follow-up. after 1 to 8 years. In groups A and B, 13 people underwent a second acne treatment; in 3.33% oral isotretinoin was used, in 18.33% topical treatment. In group C, 30 (100%) individuals underwent a second acne treatment; in 20% oral isotretinoin was used, and 80% required a topical treatment. Acne scars and post acne hyperpigmentation have been documented in 73.33% in group C. Conclusions Early, reasonable and short-term use of isotretinoin can reduce the incidence of acne in the future and reduce the occurrence of secondary acne symptoms.
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Lytvyn Y, McDonald K, Mufti A, Beecker J. Comparing the frequency of isotretinoin-induced hair loss at <0.5-mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review. JAAD Int 2022; 6:125-142. [PMID: 35199047 PMCID: PMC8841364 DOI: 10.1016/j.jdin.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin. An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities. Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible. Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.
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Chen L, Lu L, Tu S, Zhang T, Du X, Chen L, Zhang M, Li L, Lin H. Efficacy and Safety of 5% Glycolic Acid-based Gel Essence in the Treatment of Mild to Moderate Acne. J Cosmet Dermatol 2022; 21:4482-4489. [PMID: 35182003 DOI: 10.1111/jocd.14865] [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: 12/31/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
The efficacy and safety of commercial low-concentration glycolic acid products on acne were evaluated by recruiting volunteers accompanying mild to moderate acne of different ages and genders, which is a clinical practice for acne. We recruited a total of 30 volunteers according to the inclusion criteria, conducting clinical evaluation and skin physiological index testing, VISIA skin analysis, distributing products, and informing the trial method. Clinical testing and assessment will be carried out in weeks 0, 1, 2, and 4. 27 acne volunteers finished the entire trial. After 4 weeks of using low-concentration glycolic acid products, most subjects experienced significant improvement in their skin lesions and the GAGS score. At the same time, the VISIA test showed that the subjects had an obvious amelioration in facial porphyrins, which was statistically significant, and there was a slight improvement in residual spots and erythema. The skin physiological indexes showed that the skin hydration value increased from 236.2 ± 98.05 to 278.2 ± 90.26 after 14 days. At the end of the test, the skin hydration value dropped to 234.6 ± 81.88. Regarding the melanin and erythema, the value decreased in the 4th week significantly. Repeated use of 5% low-concentration glycolic acid improves the appearance and chromaticity of the treatment site. It increases the brightness L* and reduces the redness a*. This study shows that low concentrations of glycolic acids have a good effect on the treatment of mild to moderate acne. It may pay the way to carry out further large-scale clinical research.
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Affiliation(s)
- Linjiao Chen
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Lingling Lu
- Henan University of Chinese Medicine, Zhengzhou, 450000, P.R.China
| | - Shaozhong Tu
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Tao Zhang
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Xianni Du
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Lifen Chen
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Milin Zhang
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Lihao Li
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
| | - Huaner Lin
- Shenzhen Hospital, Beijing University of Chinese Medicine (Longgang), Shenzhen, 518100, P.R.China
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Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6. [PMID: 37168254 PMCID: PMC10168661 DOI: 10.1016/j.jadr.2021.100230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Isotretinoin (13-cis-retinoic acid, marketed under the names Accutane, Roaccutane, and others) is an effective treatment for acne that has been on the market for over 30 years, although reports of neuropsychiatric side effects continue to be reported. Isotretinoin is an isomer of the active form of Vitamin A, 13-trans-retinoic acid, which has known psychiatric side effects when given in excessive doses, and is part of the family of compounds called retinoids, which have multiple functions in the central nervous system. Methods The literature was reviewed in pubmed and psychinfo for research related to isotretinoin and neuropsychiatric side effects including depression, suicidal thoughts, suicide, mania, anxiety, impulsivity, emotional lability, violence, aggression, and psychosis. Results Multiple case series have shown that successful treatment of acne with isotretinoin results in improvements in measures of quality of life and self esteem However, studies show individual cases of clinically significant depression and other neuropsychiatric events that, although not common, are persistent in the literature. Since the original cases of depression were reported to the United States Food and Drug Administration, numerous cases have been reported to regulatory agencies in the United Kingdom, France, Ireland, Denmark, Australia, Canada, and other countries, making isotretinoin one of the top five medications in the world associated with depression and other neuropsychiatric side effects. Clinicians are advised to warn patients of the risks of neuropsychiatric side effects with isotretinoin which may arise from the medication itself, and not just as a side effect of acne or youth.
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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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Diogo MLG, Campos TM, Fonseca ESR, Pavani C, Horliana ACRT, Fernandes KPS, Bussadori SK, Fantin FGMM, Leite DPV, Yamamoto ÂTA, Navarro RS, Motta LJ. Effect of Blue Light on Acne Vulgaris: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:6943. [PMID: 34696155 PMCID: PMC8537635 DOI: 10.3390/s21206943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/05/2023]
Abstract
Acne is a dermatosis that affects almost 90% of the adolescent population worldwide and its treatment is performed with retinoids, antimicrobials, acids, and topical or systemic antibiotics. Side effects such as skin irritation in addition to microbial resistance to antibiotics are the main side effects found. Phototherapy with blue light is being used as an alternative treatment. Our objective was to analyze the use of blue light to treat inflammatory acne. We conducted a systematic literature review, following the recommendation PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses), including in the sample randomized clinical trial studies that compared blue light with another intervention as control. The research was carried out in the PUBMED and WEB of SCIENCE databases and the methodological quality of the studies evaluated were made by the Cochrane Collaboration Bias Risk Scale. After the exclusion of duplicates, the titles and abstracts of 81 articles were evaluated, and 50 articles were selected for full reading, including in the review at the end 8 articles. Studies have shown significant improvements in the overall picture of acne. It is concluded that despite the great potential in its use in the treatment of acne, there is a need for more detailed trials on the effect of blue light on the treatment of inflammatory acne.
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Affiliation(s)
- Mara Lúcia Gonçalves Diogo
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
| | - Thalita Molinos Campos
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
| | | | - Christiane Pavani
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
| | - Anna Carolina Ratto Tempestini Horliana
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
| | - Kristianne Porta Santos Fernandes
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
| | - Sandra Kalil Bussadori
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
| | | | - Diego Portes Vieira Leite
- Department of Bioengineering, Universidade Brasil, São Paulo 08230-030, Brazil; (F.G.M.M.F.); (D.P.V.L.); (R.S.N.)
| | | | - Ricardo Scarparo Navarro
- Department of Bioengineering, Universidade Brasil, São Paulo 08230-030, Brazil; (F.G.M.M.F.); (D.P.V.L.); (R.S.N.)
| | - Lara Jansiski Motta
- Biophotonics Applied to Health Sciences Department, Nove de Julho University (UNINOVE), Vergueiro 245, São Paulo 01504-001, Brazil; (M.L.G.D.); (T.M.C.); (C.P.); (A.C.R.T.H.); (K.P.S.F.); (S.K.B.)
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Fallah H, Rademaker M. Isotretinoin for acne vulgaris - an update on adverse effects and laboratory monitoring. J DERMATOL TREAT 2021; 33:2414-2424. [PMID: 34379039 DOI: 10.1080/09546634.2021.1967269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A significant barrier to the usage of isotretinoin has been concerns regarding its adverse effect profile. The dose-dependent mucocutaneous side effects of isotretinoin are well recognised and easily managed, particularly if a lower dose is used. A possible association with depression has gained widespread media attention and is a source of concern for many patients and their carers, but data from prospective studies and recent meta-analyses has been reassuring. Furthermore, there has been much confusion amongst both patients and physicians regarding a possible association with inflammatory bowel disease, as well the ocular and rheumatological adverse effects of isotretinoin. We provide an update on the evidence surrounding the adverse effects of isotretinoin, and discuss practical strategies to prevent and manage these adverse effects. We also discuss appropriate laboratory monitoring for patients taking isotretinoin.
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Affiliation(s)
- Haady Fallah
- The University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,The Skin Hospital, Sydney, Australia
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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24
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AlAmari A, AlSaif F, AlDakhil A, AlSyefi N, AlAmari A, AlSaif F, AlOtaibi H, Balbeesi A, AlBabtain N. Oral isotretinoin therapy and milia formation in patients with acne vulgaris: A prospective study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2021. [DOI: 10.4103/jdds.jdds_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Landis MN. Optimizing Isotretinoin Treatment of Acne: Update on Current Recommendations for Monitoring, Dosing, Safety, Adverse Effects, Compliance, and Outcomes. Am J Clin Dermatol 2020; 21:411-419. [PMID: 32107726 DOI: 10.1007/s40257-020-00508-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acne vulgaris is the most common skin disease treated by dermatologists. It can be severe and result in permanent scars. Isotretinoin is the most effective treatment for acne and has the potential for long-term clearance. Prescribing and monitoring protocols can vary widely among prescribers. Recent studies, reports, and consensus statements help shed light on optimizing the use of isotretinoin for acne. A recent literature review is summarized in this article to help the practitioner optimize isotretinoin use for acne. The article outlines the advantages and disadvantages of standard, high-dose, and low-dose isotretinoin regimens; discusses the current status of controversies surrounding isotretinoin (including depression/suicide, pregnancy, and inflammatory bowel disease); reviews monitoring recommendations and treatment for hypertriglyceridemia and elevated transaminase levels; and discusses common adverse effects seen with isotretinoin, along with their treatment and prevention.
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Affiliation(s)
- Megan N Landis
- Department of Medicine (Dermatology), University of Louisville School of Medicine, Louisville, KY, USA.
- The Dermatology and Skin Cancer Center of Southern Indiana, Corydon, IN, USA.
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26
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Rabdomiolisis grave asociada al tratamiento con bajas dosis de isotretinoína. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:333-335. [DOI: 10.1016/j.ad.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022] Open
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27
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Morgado-Carrasco D, del Rosario A, Fustà-Novell X, Giavedoni P. Severe Rhabdomyolysis Associated With Low-Dose Isotretinoin Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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28
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İşlek A, Yıldız MG. Evaluation of Nasal Mucociliary Clearance, Nasal Obstruction Symptom Evaluation, and Epistaxis Severity Score in Isotretinoin Treatment. EAR, NOSE & THROAT JOURNAL 2020; 100:566-569. [PMID: 32283974 DOI: 10.1177/0145561320920425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The study aims to investigate the possible side effects of isotretinoin use on the nasal mucosa with objective methods in the treatment of acne vulgaris. METHODS Before the treatment, nasal mucociliary clearance time (MCT) was measured in all patients. Also all patients were asked to complete the questionnaires about the nasal dryness (visual analog scale [VAS]), nasal obstruction (Nasal Obstruction Symptom Evaluation [NOSE]), and presence of epistaxis (Epistaxis Severity Score [ESS]). Both MCT and questionnaires were reevaluated in patients who completed the treatment. RESULTS The results of 101 patients were evaluated. Before treatment, mean duration of nasal mucociliary clearance (NMC) was 9.55 ± 1.30 minutes, nasal dryness (VAS) value was 2.7 ± 0.7, NOSE score was 2.1 ± 1.1, and ESS score was 1.2 ± 0.7; after treatment, the duration of NMC was 13.80 ± 2.29 minutes, VAS value was 3.3 ± 1.1, NOSE score was 3.2 ± 1.3, and ESS score was 2.1 ± 1.2 (P = .018, .150, .027, .011, respectively). CONCLUSION The nasal mucosa is adversely affected in patients due to regular use of isotretinoin in the acne treatment, anamnesis should be checked in all nasal surgeries, and routine ear nose throat control should be recommended for these patients.
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Affiliation(s)
- Akif İşlek
- Nusaybin State Hospital, Otolaryngology-Head and Neck Surgery Clinic, Mardin, Turkey
| | - Muhammed Gazi Yıldız
- Nusaybin State Hospital, Otolaryngology-Head and Neck Surgery Clinic, Mardin, Turkey
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29
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STAR particles for enhanced topical drug and vaccine delivery. Nat Med 2020; 26:341-347. [PMID: 32152581 DOI: 10.1038/s41591-020-0787-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/03/2020] [Indexed: 11/08/2022]
Abstract
Drug delivery to the skin is highly constrained by the stratum corneum barrier layer1. Here, we developed star-shaped particles, termed STAR particles, to dramatically increase skin permeability. STAR particles are millimeter-scale particles made of aluminum oxide or stainless steel with micron-scale projections designed to create microscopic pores across the stratum corneum. After gentle topical application for 10 s to porcine skin ex vivo, delivery of dermatological drugs and macromolecules, including those that cannot be given topically, was increased by 1 to 2 orders of magnitude. In mice treated with topical 5-fluorouracil, use of STAR particles increased the efficacy of the drug in suppressing the growth of subcutaneous melanoma tumors and prolonging survival. Moreover, topical delivery of tetanus toxoid vaccine to mice using STAR particles generated immune responses that were at least as strong as delivery of the vaccine by intramuscular injection, albeit at a higher dose for topical than intramuscular vaccine administration. STAR particles were well tolerated and effective at creating micropores when applied to the skin of human participants. Use of STAR particles provides a simple, low-cost and well-tolerated method for increasing drug and vaccine delivery to the skin and could widen the range of compounds that can be topically administered.
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30
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Abdelmaksoud A, Lotti T, Anadolu R, Goldust M, Ayhan E, Dave DD, Vestita M, Ebik B, Gupta M. Low dose of isotretinoin: A comprehensive review. Dermatol Ther 2020; 33:e13251. [PMID: 32022958 DOI: 10.1111/dth.13251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/04/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Isotretinoin is a first-generation retinoid initially approved for the treatment of severe cases of acne vulgaris (nodulocystic acne). Because of its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited PubMed search, from inception till December 2019, using the following search terms: "low-dose isotretinoin" and "dermatology," "isotretinoin and safety," "isotretinoin, off-label uses," "isotretinoin and male fertility," "isotretinoin, iPLEDGE system," aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low-dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology. We also highlight on the safety profile of the drug and experts' recommendations to enhance safety measures to decrease fetal risk while on isotretinoin.
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Affiliation(s)
- Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
| | - Torello Lotti
- Department of Dermatology, University of Rome "G.Marconi", Rome, Italy
| | - Rana Anadolu
- Department of Dermatology, Venerology and Dermatopathology, International Dermatology, Dermatopathology, Esthetics and Anti-aging Academy (IDEA), Istanbul, Turkey.,Dermatology Clinic, Ankara, Turkey.,Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | - Mohamed Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Erhan Ayhan
- Department of Dermatology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Michelangelo Vestita
- Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Berat Ebik
- Division of Gastroenterology Diyarbakir, Dicle University Faculty of Medicine, Kıtılbıl, Turkey
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31
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Mülkoğlu C, Karaosmanoğlu N. Effect of Serum 25 Hydroxy Vitamin D Level on Isotretinoin-Induced Musculoskeletal Symptoms: A Cross-Sectional Study. Sci Rep 2020; 10:2245. [PMID: 32042004 PMCID: PMC7010655 DOI: 10.1038/s41598-020-59167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022] Open
Abstract
Isotretinoin (ISO) is a drug which is used for the treatment of severe and refractory acne vulgaris (AV), over the last few decades. The drug has various musculoskeletal side effects. The aim of this study was to investigate relationship between serum 25 hydroxy (OH) vitamin D levels and the ISO-induced musculoskeletal side effects in patients with AV. We included 87 patients receiving ISO and had musculoskeletal symptoms as adverse effect (AE) group. Another 90 patients receiving ISO for AV and had any musculoskeletal complaints were recruited as control (C) group. Locomotor system examination of the patients was performed by the same clinician. Serum 25 OH vitamin D levels of the all participants were measured. Patients in the AE group were divided into three subgroups by serum 25 OH vitamin D levels. Patients with serum 25 OH vitamin D level lower than 10 ng/ml was classified as Group I, the ones between 10-20 ng/ml as Group II and those higher than 20 ng/ml were classified as Group III. AE and C groups were similar in terms of age and sex (p > 0.05). There was no statistically significant difference in the mean serum vitamin D levels between two groups (p = 0.17). Also, there was no significant difference in number of arthralgia (p = 0.30), myalgia (p = 0.29), low back pain (p = 0.10) and sacroiliitis (p = 0.17) between three subgroups in AE group. In addition, we found no statistically significant correlation between the serum vitamin D levels and age, cumulative dose of ISO, arthralgia, myalgia and sacroiliitis parameters in AE group (p > 0.05). Serum 25 OH vitamin D levels between the AE and C groups were similar. We also found that no significant difference in musculoskeletal adverse events between AE subgroups. Therefore, it can be concluded that vitamin D deficiency has no effect on the musculoskeletal adverse events in patients receiving ISO.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey.
| | - Nermin Karaosmanoğlu
- Department of Dermatology, Health Sciences University Ankara Training and Research Hospital, Ankara, Turkey
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32
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Lugović-Mihić L, Blagec T, Japundžić I, Skroza N, Delaš Adžajić M, Mravak-Stipetić M. Diagnostic management of cheilitis: an approach based on a recent proposal for cheilitis classification. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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33
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Maria Alexandra Stanescu A, Totan A, Mircescu D, Diaconescu S, Gabriel Bratu O, Fekete L, László Fekete G, Boda D, Cristina Diaconu C. Assessment of suicidal behavior in dermatology (Review). Exp Ther Med 2019; 20:73-77. [PMID: 32508997 DOI: 10.3892/etm.2019.8145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/21/2019] [Indexed: 12/21/2022] Open
Abstract
Many diseases that affect physical health can also affect mental health. Many of these diseases are studied in terms of quality of life, depression and suicidal behavior. Dermatological disorders, although having a strong impact on the individual's life, are less studied with regard to suicidal behavior. There is a need to approach several dermatological diseases from the perspective of suicidal behavior in order to intervene early with specific treatment or to prevent suicide. Psoriasis, acne, melanoma, atopic dermatitis and urticaria are scarcely studied from the point of view of suicidal behavior. In addition to these diseases, there are others that require attention in terms of suicidal behavior, such as vitiligo or oculocutaneous albinism, most probably due to a small number of people suffering from these diseases, research is almost non-existent in these cases. We want to draw attention to the importance of early detection of suicidal behavior in dermatological practice and to highlight the need for several studies on this subject.
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Affiliation(s)
| | - Alexandra Totan
- University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania
| | - Daniela Mircescu
- University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania
| | - Smaranda Diaconescu
- II Pediatric Surgery Clinic, 'St. Mary' Children Emergency Hospital, 700309 Iasi, Romania
| | - Ovidiu Gabriel Bratu
- University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.,Urology Department, Emergency University Central Military Hospital, 010825 Bucharest, Romania
| | | | - Gyula László Fekete
- University of Medicine and Pharmacy, Dermatology Clinic, 530136 Targu Mures, Romania
| | - Daniel Boda
- University of Medicine and Pharmacy 'Carol Davila', Department of Dermatology, 050474 Bucharest, Romania
| | - Camelia Cristina Diaconu
- University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.,Clinical Emergency Hospital of Bucharest, 020322 Bucharest, Romania
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34
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Ahn GR, Kim JM, Park SJ, Li K, Kim BJ. Selective Sebaceous Gland Electrothermolysis Using a Single Microneedle Radiofrequency Device for Acne Patients: A Prospective Randomized Controlled Study. Lasers Surg Med 2019; 52:396-401. [PMID: 31502662 DOI: 10.1002/lsm.23152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES The selective electrothermolysis of the sebaceous glands was suggested as a novel therapeutic option for facial acne. However, there has been no randomized controlled trial to evaluate the effectiveness and safety of the monopolar radiofrequency (RF) device using single microneedle with proximal insulation. The objective of the study was to evaluate the efficacy and tolerability of intralesional electrothermolysis using monopolar RF device and proximally-insulated single microneedle in acne patients. STUDY DESIGN/MATERIALS AND METHODS The prospective randomized controlled clinical trial was performed to treat moderate-to-severe facial acne. Subjects randomized to the treatment group received three treatments at 4-week intervals with an RF device, whereas the control group received micro-needling and extraction. For efficacy evaluation, reduction rate of acne lesions were evaluated by two independent physicians. RESULTS Sixty-three patients completed the study and the results showed statistically significant improvement of inflammatory acne at 12 weeks. The number of inflammatory lesions was significantly reduced at 12 weeks (20.86 vs. -5.13; P = 0.03) compared with controls. CONCLUSIONS Selective sebaceous gland electrothermolysis can be a safe and effective method of achieving consistent improvement in acne. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Ga Ram Ahn
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Min Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Jung Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kapsok Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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35
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Aktas H, Ertugrul G, Parlak M, Unal M. Long‐term isotretinoin use does not cause parenchymal liver change: Ultrasonographic study in 50 patients. Dermatol Ther 2019; 32:e13012. [DOI: 10.1111/dth.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Habibullah Aktas
- Faculty of Medicine, Department of DermatologyKarabuk University Karabuk Turkey
| | - Goksen Ertugrul
- Faculty of Medicine, Department of DermatologyKarabuk University Karabuk Turkey
| | - Muharrem Parlak
- Faculty of Medicine, Department of RadiologyKarabuk University Karabuk Turkey
| | - Mehmet Unal
- Faculty of Medicine, Department of DermatologySelçuk University Konya Turkey
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36
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Propionibacterium acnessusceptibility to low‐level 449 nm blue light photobiomodulation. Lasers Surg Med 2019; 51:727-734. [DOI: 10.1002/lsm.23087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
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37
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Tugrul Ayanoglu B, Demirdag HG, Yalici Armagan B, Bezirgan O. Perceptions about oral isotretinoin treatment. Dermatol Ther 2019; 32:e12873. [PMID: 30868702 DOI: 10.1111/dth.12873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 01/20/2023]
Abstract
There are some studies on the knowledge, beliefs, and perceptions of patients about acne vulgaris, however, there is no sufficient data on patients' beliefs about oral isotretinoin treatment (OIT). The aim of this study was to assess the knowledge, beliefs, and perceptions of the patients with acne vulgaris about the therapy of OIT and its side effects. A total of 214 patients with acne vulgaris in our outpatient clinic were included. Patients who were planned to treat with OIT were asked whether they had information about the treatment and its side effects. It was noted whether the patients accepted treatment after being informed both verbally and written about the OIT details. The study consisted of 133 female and 81 male aged 12-57 years. Most of the patients (78%) stated that they had heard of OIT. The most common source of the information on isotretinoin therapy was friends (57.6%). The dryness was the best-known side effect. While 86.4% of patients (n: 185) accepted OIT, the group (14.4%) stated that "I have knowledge about side effects." And refused to use the treatment. Most of the patients agreed to the treatment after explanation of dermatologist. Patients may be educated and informed via reliable medical sources to prevent bias and improve compliance to the treatment.
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Affiliation(s)
- Burcu Tugrul Ayanoglu
- Department of Dermatology, Health Science University, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hatice G Demirdag
- Department of Dermatology, Health Science University, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Basak Yalici Armagan
- Faculty of Medicine, Department of Dermatology, Hacettepe University, Ankara, Turkey
| | - Osman Bezirgan
- Department of Dermatology, Health Science University, Ankara Oncology Training and Research Hospital, Ankara, Turkey
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38
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Effects of Intradermal Radiofrequency Treatment and Intense Pulsed Light Therapy in an Acne-induced Rabbit Ear Model. Sci Rep 2019; 9:5056. [PMID: 30911021 PMCID: PMC6434013 DOI: 10.1038/s41598-019-41322-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 03/01/2019] [Indexed: 11/25/2022] Open
Abstract
Acne vulgaris is a common condition that can have psychologically deleterious effects. Since current treatments carry the risks of antibiotic resistance or teratogenicity, novel treatment modalities are under investigation. Our study investigated the efficacy of intradermal radiofrequency treatment (RF) and intense pulsed light (IPL) in the treatment of acne vulgaris in a rabbit ear model. We evaluated the effectiveness of IPL, RF, and a combination treatment on cultured Cuticobacterium acnes strains in an induced rabbit ear model, according to clinical outcomes as well as histological and immunological approaches. We found that RF treatment markedly decreases papule volume, while IPL appears to have an immunomodulatory effect. In combination, the two have an additive effect in treatment. These findings suggest that combination of RF and IPL may be an effective therapeutic option for the treatment of acne vulgaris.
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39
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Barbieri JS, Spaccarelli N, Margolis DJ, James WD. Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments. J Am Acad Dermatol 2019; 80:538-549. [PMID: 30296534 PMCID: PMC6333507 DOI: 10.1016/j.jaad.2018.09.055] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022]
Abstract
Acne is one of the most common diseases worldwide and affects ∼50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use might be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications, such as spironolactone, combined oral contraceptives, and oral isotretinoin.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Natalie Spaccarelli
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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40
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Bagatin E, de Freitas THP, Machado MCR, Ribeiro BM, Nunes S, da Rocha MAD. Adult female acne: a guide to clinical practice. An Bras Dermatol 2019; 94:62-75. [PMID: 30726466 PMCID: PMC6360964 DOI: 10.1590/abd1806-4841.20198203] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/10/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. OBJECTIVE To develop a guide for the clinical practice of adult female acne. METHODS A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. RESULTS The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. CONCLUSION Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.
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Affiliation(s)
- Edileia Bagatin
- Department of Dermatology, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo (SP), Brazil
- Program of Post-Graduation in Translational Medicine, Escola
Paulista de Medicina, Universidade Federal de São Paulo, São Paulo
(SP), Brazil
| | - Thais Helena Proença de Freitas
- Dermatology Service, Hospital da Santa Casa de São Paulo,
Brazil
- Dermatology Clinic, Departamento de Clínica Médica,
Santa Casa de São Paulo, São Paulo (SP), Brazil
| | - Maria Cecilia Rivitti Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
- Discipline of Dermatology, Faculdade de Medicina, Universidade
Metropolitana de Santos, Santos (SP), Brazil
| | - Beatriz Medeiros Ribeiro
- Dermatology Service, Hospital Regional da Asa Norte, Secretaria de
Saúde do Distrito Federal, Brasília (DF), Brazil
| | | | - Marco Alexandre Dias da Rocha
- Service of Cosmiatry, Department of Dermatology, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo (SP),
Brazil
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Tasli H, Yurekli A, Gokgoz MC, Karakoc O. Effects of oral isotretinoin therapy on the nasal cavities. Braz J Otorhinolaryngol 2018; 86:99-104. [PMID: 30472003 PMCID: PMC9422455 DOI: 10.1016/j.bjorl.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/31/2018] [Accepted: 10/20/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure. Objective The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy. Methods Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints. Results The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47 ± 1.48 (0–5); 0.35 ± 1.30 (0–5) at admission, 3.57 ± 4.45 (0–10); 2.26 ± 4.71 (0–20) at the first month, and 4.28 ± 6 (0–20); 2.26 ± 4.71 (0–20) at the third month of the treatment respectively. Total nasal resistance of 0.195 ± 0.079 (0.12–0.56) Pa/cm3/s at admission, 0.21 ± 0.084 (0.12–0.54) Pa/cm3/s at the first month, and 0.216 ± 0.081 (0.14–0.54) Pa/cm3/s at the third month. Conclusion Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.
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Affiliation(s)
- Hamdi Tasli
- Birecik State Hospital, Department of Otolaryngology, Head and Neck Surgery, Sanliurfa, Turkey.
| | - Aslan Yurekli
- Bayburt State Hospital, Department of Dermatology, Bayburt, Turkey
| | - Mert Cemal Gokgoz
- Siirt State Hospital, Department of Otolaryngology, Head and Neck Surgery, Siirt, Turkey
| | - Omer Karakoc
- Gulhane Medical School, Department of Otolaryngology, Head and Neck Surgery, Ankara, Turkey
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42
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İslamoğlu ZGK, Altınyazar HC. Effects of isotretinoin on the hair cycle. J Cosmet Dermatol 2018; 18:647-651. [DOI: 10.1111/jocd.12800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 07/19/2018] [Accepted: 09/07/2018] [Indexed: 12/28/2022]
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43
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Affiliation(s)
- Andrea L Zaenglein
- From the Departments of Dermatology and Pediatrics, Penn State Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey
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44
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Vitiligo Appearing after Oral Isotretinoin Therapy for Acne. Case Rep Dermatol Med 2018; 2018:3697260. [PMID: 30112221 PMCID: PMC6077457 DOI: 10.1155/2018/3697260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/30/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022] Open
Abstract
Isotretinoin is an effective treatment for severe and scarring acne. In this report, we describe a case developing vitiligo after isotretinoin therapy for scarring acne. It is not known whether this was a coincidence or might be precipitated by the treatment.
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45
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Amitay-Laish I, Reiter O, Prag-Naveh H, Kershenovich R, Hodak E. Retinoic acid receptor agonist as monotherapy for early-stage mycosis fungoides: does it work? J DERMATOL TREAT 2018; 30:258-263. [PMID: 29889596 DOI: 10.1080/09546634.2018.1487525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Retinoids exert their biologic effects by binding to intracellular retinoic-acid receptors (RARs) and/or retinoid X receptors (RXRs). Early-stage mycosis fungoides (MF) has been effectively treated with bexarotene, an RXR-agonist, with overall response (OR) rates 54-67% and complete response (CR) rates 7-27%. Data on RAR-agonist monotherapy are limited. OBJECTIVE To analyze the effectiveness of RAR-agonist monotherapy for early-stage MF. METHODS Data on patients with early-stage MF treated with acitretin/isotretinoin monotherapy at a tertiary cutaneous lymphoma clinic in 2010-2017 were collected retrospectively from the medical files. RESULTS Thirty-five patients (26 males) of median age 50 years (range 8-83) with early-stage MF (IA 9, IB 26) underwent 37 treatment events: 25 acitretin and 12 isotretinoin at a median dosages of 0.3 mg/kg (range 0.2-0.9) and 0.2 mg/kg (range 0.1-0.7), respectively. Median time to maximal response was 6 months for both (range 1-10 for acitretin, 3-16 for isotretinoin); median treatment duration was 10 months (range 3-46) for acitretin, and 9 months (range 3-55) for isotretinoin. OR was 64% for acitretin and 80% for isotretinoin, and CR, 4% and 8%, respectively. Side-effect profiles were as previously reported for retinoids. CONCLUSIONS Early-stage MF patients may benefit from low dose RAR-agonist monotherapy, although the CR rate is low.
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Affiliation(s)
- Iris Amitay-Laish
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ofer Reiter
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Hadas Prag-Naveh
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel
| | - Ruben Kershenovich
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel
| | - Emmilia Hodak
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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46
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Zhang Y, Feng P, Yu J, Yang J, Zhao J, Wang J, Shen Q, Gu Z. ROS-Responsive Microneedle Patch for Acne Vulgaris Treatment. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800035] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Yuqi Zhang
- Joint Department of Biomedical Engineering; University of North Carolina at Chapel Hill and North; Carolina State University; Raleigh NC 27695 USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics; UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill NC 27599 USA
| | - Peijian Feng
- Department of Polymer Science and Engineering; Key Laboratory of High Performance Polymer Materials and Technology of MOE; Collaborative Innovation Center of Chemistry for Life Sciences; School of Chemistry and Chemical Engineering; Nanjing University; Nanjing 210023 P. R. China
| | - Jicheng Yu
- Joint Department of Biomedical Engineering; University of North Carolina at Chapel Hill and North; Carolina State University; Raleigh NC 27695 USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics; UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill NC 27599 USA
| | - Jia Yang
- Department of Polymer Science and Engineering; Key Laboratory of High Performance Polymer Materials and Technology of MOE; Collaborative Innovation Center of Chemistry for Life Sciences; School of Chemistry and Chemical Engineering; Nanjing University; Nanjing 210023 P. R. China
| | - Jiacheng Zhao
- Department of Polymer Science and Engineering; Key Laboratory of High Performance Polymer Materials and Technology of MOE; Collaborative Innovation Center of Chemistry for Life Sciences; School of Chemistry and Chemical Engineering; Nanjing University; Nanjing 210023 P. R. China
| | - Jinqiang Wang
- Joint Department of Biomedical Engineering; University of North Carolina at Chapel Hill and North; Carolina State University; Raleigh NC 27695 USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics; UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill NC 27599 USA
| | - Qundong Shen
- Department of Polymer Science and Engineering; Key Laboratory of High Performance Polymer Materials and Technology of MOE; Collaborative Innovation Center of Chemistry for Life Sciences; School of Chemistry and Chemical Engineering; Nanjing University; Nanjing 210023 P. R. China
| | - Zhen Gu
- Joint Department of Biomedical Engineering; University of North Carolina at Chapel Hill and North; Carolina State University; Raleigh NC 27695 USA
- Center for Nanotechnology in Drug Delivery and Division of Molecular Pharmaceutics; UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill NC 27599 USA
- Department of Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC 27599 USA
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47
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Kovitwanichkanont T, Driscoll T. A comparative review of the isotretinoin pregnancy risk management programs across four continents. Int J Dermatol 2018; 57:1035-1046. [DOI: 10.1111/ijd.13950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/06/2018] [Accepted: 01/28/2018] [Indexed: 12/30/2022]
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48
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Mansouri P, Azizian Z, Hejazi S, Chalangari R, Chalangari KM. Evaluation the efficacy of trichloroacetic acid (TCA) 33% in treatment of oral retinoid-induced cheilitis compared with placebo (Vaseline): a randomized pilot study. J DERMATOL TREAT 2018; 29:694-697. [PMID: 29464980 DOI: 10.1080/09546634.2018.1441489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Oral Isotretinoin (13-cis-retinoic acid) is a gold standardtreatment for severe forms of acne with cheilitis as a most frequent complication. We designed this novel study to investigate the therapeutic effect of trichloroacetic acid (TCA) 33% as compared with placebo to treat cheilitis. METHODS In this pilot study, 90 acne vulgaris patients between 18 and 50 years, who referred dermatologic clinic with cheilitis, were assigned to either case (TCA) or control (Vaseline) group using permuted-block randomization from 2013 to 2015 with data analysis in 2016. Patients had follow-up visits after 2 and 6 weeks, at which their lesions were photographed. Two blinded expert dermatologists recorded physician International global score for each image. RESULTS Ninety eligible patients were randomly allocated into two groups. This included 45 patients in each group. At the end of follow-up, 44 patients in the intervention group and 37 patients in control group completed the final assessment. Compared to the control group, the TCA group had a greater reduction in the mean ICGS value from baseline to Week 6 (mean difference 2.59 points, p < .0001). CONCLUSIONS TCA can be considered as a good strategy in improvement of cheilitis to isotretinoin therapy.
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Affiliation(s)
- Parvin Mansouri
- a Skin and Stem Cell Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Zahra Azizian
- a Skin and Stem Cell Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Somayeh Hejazi
- a Skin and Stem Cell Research Center, Tehran University of Medical Sciences , Tehran , Iran
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49
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Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol 2017; 4:56-71. [PMID: 29872679 PMCID: PMC5986265 DOI: 10.1016/j.ijwd.2017.10.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the treatment options for adult female patients with acne. Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. Acne has various psychosocial effects that impact patients’ quality of life. Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. Treatments vary widely and treatment should be tailored specifically for each individual woman. We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.
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Affiliation(s)
- A U Tan
- Northwestern University, Department of Dermatology, Chicago, IL
| | - B J Schlosser
- Northwestern University, Department of Dermatology, Chicago, IL
| | - A S Paller
- Northwestern University, Department of Dermatology, Chicago, IL
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50
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Vallerand IA, Lewinson RT, Farris MS, Sibley CD, Ramien ML, Bulloch AGM, Patten SB. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol 2017; 178:76-85. [PMID: 28542914 DOI: 10.1111/bjd.15668] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/01/2023]
Abstract
Despite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking. We searched MEDLINE, Embase, Cochrane Central, relevant web pages and bibliographies for randomized controlled trials in acne evaluating isotretinoin vs. control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total 760 patients randomized), containing mostly men. Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate-to-severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which was either placebo (two studies), oral antibiotics (seven studies) or other control (two studies). Across trials with an overall low risk of bias, two of three demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (751 events) than with control (388 events). More than half of all adverse events were dermatological and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (12 patients) included Stevens-Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. This study was registered with PROSPERO number CRD42015025080.
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Affiliation(s)
- I A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M S Farris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - C D Sibley
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M L Ramien
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - A G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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