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Măgerușan ȘE, Hancu G, Rusu A. A Comprehensive Bibliographic Review Concerning the Efficacy of Organic Acids for Chemical Peels Treating Acne Vulgaris. Molecules 2023; 28:7219. [PMID: 37894698 PMCID: PMC10608815 DOI: 10.3390/molecules28207219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Acne vulgaris stands out as the most prevalent skin disorder among teenagers and young adults, causing physical discomfort and considerable economic and psychological burdens on individuals and society. A wide range of topical and systemic therapies are available in acne treatment. Chemical peeling is a skin resurfacing technique designed to rebuild healthy skin using exfoliating substances, a simple and affordable process with various dermatological uses. Chemical peels, classified as superficial, medium, and deep, have been utilized for acne vulgaris and multiple other skin issues. In these chemical peels, a diverse range of chemical substances is employed, each with its unique mode of action. Among these, α-hydroxy and β-hydroxy acids have gathered attention for their efficacy in reducing acne lesions and enhancing overall skin appearance. Acids, such as salicylic acid, glycolic acid, or lactic acid, are commonly used in chemical peels due to their exfoliating and sebum-regulating properties. Despite the widespread use of these acids, there exists a lack of consensus regarding the most effective acid type and concentration for treating acne-prone skin. This review aims to bridge this knowledge gap by evaluating the effectiveness and safety of various organic acids used in chemical peels specifically for acne-prone skin. The findings of this comprehensive bibliographic review indicate that organic acid-based chemical peels represent effective and safe treatment options for individuals with acne-prone skin. Their adaptability sets these treatments apart; the choice of organic acid can be tailored to meet individual patient needs and tolerability levels. This personalized approach ensures that patients receive optimal care while minimizing the risks associated with the treatment. As research in this field progresses, it is anticipated that a more nuanced understanding of the ideal acid type and concentration will emerge, further enhancing the efficacy and safety of chemical peels for acne-prone skin.
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Affiliation(s)
| | - Gabriel Hancu
- Department of Pharmaceutical and Therapeutic Chemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mureș, 540142 Târgu Mureș, Romania; (Ș.E.M.); (A.R.)
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2
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Huang Q, Chen D, Pan S, Hu M, Wang P, Wang H, Fan W, Yang X, He Y. Efficacy of alpha hydroxy acid combined with intense pulsed light in the treatment of acne vulgaris: A meta-analysis. J Cosmet Dermatol 2022; 21:5642-5650. [PMID: 35763391 DOI: 10.1111/jocd.15186] [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: 04/14/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acne patients frequently receive combination therapy. However, there has been no rigorous review of the efficacy of combining alpha hydroxy acid with IPL for acne vulgaris treatment. OBJECTIVE Assessing the effectiveness and safeness of alpha hydroxy acids in combination with IPL in the treatment of people with acne vulgaris. METHODS A computer search of common biomedical databases, including PubMed, Web of Science, Cochrane Library, Embase, Wanfang, CNKI, SinoMed, and VIP, was extensively conducted to identify previous studies on randomized controlled trials of alpha hydroxy acid combined with IPL in the management of acne vulgaris. RESULTS A total of 18 publications were included (1435 patients with common acne met the inclusion criteria). The meta-analysis showed that alpha hydroxy acid (AHA) combined with IPL had higher overall efficacy than the control group (OR = 4.24; 95% CI 2.66 ~ 6.74; p < 0.01). In the case of acne vulgaris, AHA combined with IPL and the AHA alone showed a remarkable difference in total efficiency (OR = 4.10; 95% CI 2.12 ~ 7.91; p < 0.01), and AHA combined with IPL were more effective than IPL alone (OR = 4.02; 95% CI 2.25 ~ 7.16; p < 0.01). In addition, the occurrence of adverse reactions that occurred in AHA combined with IPL and control groups did not differ (OR = 0.86; 95% CI 0.46 ~ 1.60; p = 0.64). CONCLUSION AHA combined with IPL therapy was superior to other therapies. Although it was slightly more expensive, it was effective and had a wide range of applications.
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Affiliation(s)
- Qiao Huang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Dongyu Chen
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Suyue Pan
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Min Hu
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Pu Wang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Hongxin Wang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Wenlong Fan
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Xiaoyu Yang
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China
| | - Yuqing He
- Department of Epidemiology and Medical Statistics, Institute of Medical Systems Biology, Guangdong Medical University, Dongguan, Guangdong, China.,Guangdong Medical University Liaobu Hospital, Dongguan, Guangdong, China
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Szymańska A, Budzisz E, Erkiert-Polguj A. The Anti-Acne Effect of Near-Infrared Low-Level Laser Therapy. Clin Cosmet Investig Dermatol 2021; 14:1045-1051. [PMID: 34471368 PMCID: PMC8403573 DOI: 10.2147/ccid.s323132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/16/2021] [Indexed: 12/11/2022]
Abstract
Background Acne vulgaris is a skin problem affecting many people of different ages. Phototherapy is one of the acne treatment options. The aim of the study was to assess the effect of near-infrared low-level laser therapy on acne lesions. Materials and Methods The prospective study involved a total number of 27 women, aged 18 to 45 years, with mild to severe acne. All the participants underwent a series of six treatments with the use of a 785 nm low-level laser with the power density 80mW/cm2, performed every two weeks. The analysis of the effectiveness of the performed procedures was based on sebumetric examination, photographic documentation and assessment of the change in the number of acne lesions. Results Significant improvements in acne lesions (assessed as non-inflammatory and inflammatory lesion counts) and a significant decrease in skin sebum excretion were observed after the treatment. No adverse effects were reported. Conclusion A series of six treatments using a near-infrared low-level laser represents a safe and effective non-invasive therapy option for acne vulgaris.
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Affiliation(s)
- Anna Szymańska
- Department of Cosmetic Raw Materials Chemistry, Faculty of Pharmacy, Medical University of Lodz, Lodz, Poland
| | - Elzbieta Budzisz
- Department of Cosmetic Raw Materials Chemistry, Faculty of Pharmacy, Medical University of Lodz, Lodz, Poland
| | - Anna Erkiert-Polguj
- Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Medical University of Lodz, Lodz, Poland
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Afarideh M, Rodriguez Baisi KE, Davis DMR, Hand JL, Tollefson MM. Trends in utilization of non-first-line topical acne medications among children, adolescents, and adults in the United States, 2012-2016. Pediatr Dermatol 2021; 38:1066-1073. [PMID: 34595751 DOI: 10.1111/pde.14733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE Current knowledge about usage of effective, but non-first-line topical acne medications in the United States is limited. We aimed to investigate utilization patterns and temporal trends for such acne medications in the US ambulatory care. METHODS Pediatric (≤18 years old) and adult (>18 years old) data from the 2012 to 2016 (inclusive) cycles of the US National Ambulatory Medical Care Survey were extracted. Utilization patterns of six non-first-line topical acne medications (ie, azelaic acid, salicylic acid, glycolic acid, sulfur, resorcinol, and zinc) were compared and followed over time. RESULTS Data from 218 410 US office-based sampled visits during 2012-2016 were included in the analysis. Across all acne visits (n = 1542), salicylic acid (1.58%), azelaic acid (1.22%), and glycolic acid (0.52%) were the most frequently used agents, while zinc and resorcinol were not used. Sulfur (0.52%) and salicylic acid (0.33%) were the only medications used in preadolescents, and none of these medications were used in the neonatal or infantile group. Temporal trends for using at least one of these medications were insignificant among both pediatric and adult age groups (P = .825 and .136, respectively). CONCLUSIONS Salicylic acid and azelaic acid are the most frequently used of the studied second-line medications to treat acne, although the use of these and the other non-first-line topical medications overall is uncommon, especially among younger groups of US pediatric patients.
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Affiliation(s)
| | | | - Dawn M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Hand
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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de Vries F, Welbie M, Tjin E, Driessen R, van de Kerkhof P. Reallocations in acne healthcare: exploring the possible roles and added value of non-physicians by a mixed-methods study design. BMC Health Serv Res 2021; 21:746. [PMID: 34315450 PMCID: PMC8317412 DOI: 10.1186/s12913-021-06744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background A highly promoted opportunity for optimizing healthcare services is to expand the role of non-physician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to non-physicians and identify drivers for and barriers to reallocation. Methods A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06744-2.
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Affiliation(s)
- Femke de Vries
- Research group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands. .,Department of Dermatology, Radboud university medical centre, Nijmegen, The Netherlands.
| | - Marlies Welbie
- Research Group Methodology of Practice-Based Research, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Esther Tjin
- Research group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Rieke Driessen
- Department of Dermatology, Radboud university medical centre, Nijmegen, The Netherlands
| | - Peter van de Kerkhof
- Department of Dermatology, Radboud university medical centre, Nijmegen, The Netherlands
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de Vries F, Tjin E, Driessen R, Vehof H, van de Kerkhof P. Exploring patient journeys through acne healthcare: a patient perspective. J DERMATOL TREAT 2021; 33:2209-2216. [PMID: 34192987 DOI: 10.1080/09546634.2021.1940808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the large availability of caregivers, there are no standardized care pathways for patients with acne. This increases the risk of ineffective care and unnecessary medicalizing. To better understand how to provide effective, efficient, and patient-satisfying care, it is necessary to gain insights into the patient journey through acne healthcare services. OBJECTIVE To explore the patient journeys, assessed by a series of consecutive steps through acne healthcare. METHODS A cross-sectional survey was conducted among Dutch individuals with acne. RESULTS A total of 371 respondents completed the questionnaire. Data revealed 58 different pathways through acne healthcare services. Patient with severe acne had a stronger tendency to seek professional care than those with mild acne (p< .05). The highest proportion of clinically relevant improvement was found in patients treated by dermatologists, compared to respondents treated by beauticians, p = .023 and dermal therapists, p = .018. CONCLUSIONS Mapping the patient journeys contributed to a better understanding of the gap between professional guidelines and the experiences of patients. Identifying these areas of care implies that there is potential to bring acne care services more in line with the patients' needs. Further research is recommended; for example by comparing the clinical treatment outcomes of multiple sequences of caregivers.
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Affiliation(s)
- Femke de Vries
- Research Group Innovations in Pharmaceutical Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Tjin
- Research Group Innovations in Pharmaceutical Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Rieke Driessen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Vehof
- Research Group Innovations in Pharmaceutical Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Peter van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Ex Vivo Live Full-Thickness Porcine Skin Model as a Versatile In Vitro Testing Method for Skin Barrier Research. Int J Mol Sci 2021; 22:ijms22020657. [PMID: 33440780 PMCID: PMC7827261 DOI: 10.3390/ijms22020657] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
Since the European Union (EU) announced their animal testing ban in 2013, all animal experiments related to cosmetics have been prohibited, creating a demand for alternatives to animal experiments for skin studies. Here, we investigated whether an ex vivo live porcine skin model can be employed to study the safety and skin barrier-improving effects of hydroxyacids widely used in cosmetics for keratolytic peels. Glycolic acid (1–10%), salicylic acid (0.2–2%), and lactobionic acid (1.2–12%) were used as representative substances for α-hydroxyacid (AHA), β-hydroxyacid (BHA), and polyhydroxyacid (PHA), respectively. When hydroxyacids were applied at high concentrations on the porcine skin every other day for 6 days, tissue viability was reduced to 50–80%, suggesting that the toxicity of cosmetic ingredients can be evaluated with this model. Based on tissue viability, the treatment scheme was changed to a single exposure for 20 min. The protective effects of a single exposure of hydroxyacids on skin barrier function were evaluated by examining rhodamine permeability and epidermal structural components of barrier function using immunohistochemistry (IHC) and immunofluorescence (IF) staining. Lactobionic acid (PHAs) improved skin barrier function most compared to other AHAs and BHAs. Most importantly, trans-epidermal water loss (TEWL), an important functional marker of skin barrier function, could be measured with this model, which confirmed the significant skin barrier-protective effects of PHAs. Collectively, we demonstrated that the ex vivo live full-thickness porcine skin model can be an excellent alternative to animal experiments for skin studies on the safety and efficacy of cosmetic ingredients.
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Zdrada J, Odrzywołek W, Deda A, Wilczyński S. A split-face comparative study to evaluate the efficacy of 50% pyruvic acid against a mixture of glycolic and salicylic acids in the treatment of acne vulgaris. J Cosmet Dermatol 2020; 19:2352-2358. [PMID: 31922347 DOI: 10.1111/jocd.13288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/19/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND One of the ways to treat acne is by using chemical peels. Salicylic, glycolic and pyruvic acids due to their keratolytic and antibacterial properties are often recommended for acne patients. AIMS The aim of the study was to compare the effect of a preparation containing glycolic and salicylic acids with pyruvic acid. PATIENTS/METHODS 14 women diagnosed with acne took part in the study. The facial treatment area was divided into two parts: right (a preparation containing 50% pyruvic acid) and left side ( a preparation containing glycolic and salicylic acids). A series of four treatments was performed at 2-week intervals. Skin parameters, namely hydration, sebum secretion and skin colour were measured. RESULTS As a result of using 50% pyruvic acid, the hydration of the right side of the face increased statistically and there was a decrease in the amount of melanin in the epidermis. On the left side of the face, there was an increase in skin hydration after using a mixture of glycolic and salicylic acids. The increase in skin hydration on the left side of the chin and nose was not statistically significant. The use of the mixture of glycolic and salicylic acids affected the skin colour on the left side of the face, on the forehead, cheek and nose. CONCLUSION Chemical peels affect a wide range of pathological factors of acne. A mixture of acids yields fewer side effects than a single acid used in high concentration, but the therapeutic effects are comparable.
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Affiliation(s)
- Julita Zdrada
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Wiktoria Odrzywołek
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Anna Deda
- Department of Cosmetology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
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Dreno B, Bagatin E, Blume-Peytavi U, Rocha M, Gollnick H. Akne bei erwachsenen Frauen: Physiologische und psychologische Erwägungen und Management. J Dtsch Dermatol Ges 2019; 16:1185-1196. [PMID: 30300500 DOI: 10.1111/ddg.13664_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/06/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Brigitte Dreno
- Department of Dermatology, University of Nantes, Frankreich
| | - Edileia Bagatin
- Department of Dermatology, Federal University of São Paulo - UNIFESP, São Paulo, Brasilien
| | - Ulrike Blume-Peytavi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Marco Rocha
- Department of Dermatology, Federal University of São Paulo - UNIFESP, São Paulo, Brasilien
| | - Harald Gollnick
- Klinik für Dermatologie und Venerologie, Otto-von-Guericke-Universität, Magdeburg
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Szymańska A, Budzisz E, Erkiert-Polguj A. Efficacy of 30% azelaic acid peel in the nonpharmacological treatment of facial acne. J DERMATOL TREAT 2019; 32:291-296. [DOI: 10.1080/09546634.2019.1657222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Anna Szymańska
- Department of Cosmetic Raw Materials Chemistry, Medical University of Lodz, Lodz, Poland
| | - Elzbieta Budzisz
- Department of Cosmetic Raw Materials Chemistry, Medical University of Lodz, Lodz, Poland
| | - Anna Erkiert-Polguj
- Department of Cosmetology and Aesthetic Dermatology, Medical University of Lodz, Lodz, Poland
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Abdel Hay R, Hegazy R, Abdel Hady M, Saleh N. Clinical and dermoscopic evaluation of combined (salicylic acid 20% and azelaic acid 20%) versus trichloroacetic acid 25% chemical peel in acne: an RCT. J DERMATOL TREAT 2019; 30:572-577. [PMID: 29862871 DOI: 10.1080/09546634.2018.1484876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Combined azelaic acid (AA) and salicylic acid (SA) have not been previously used for acne. Objective: To compare the efficacy of this combination versus trichloroacetic acid (TCA) 25% peel in acne. Methods: Thirty-four patients were included in this trial. Patients received four sessions 2 weeks apart. The combined solution was applied to one side of the face, while TCA was applied to the other. Our outcomes were physician-reported clinical improvement, dermoscopic assessment of the erythema and patient's satisfaction. Results: After two sessions, a significant clinical improvement was observed in non-inflammatory lesions in the TCA-treated side-treated TCA and in inflammatory lesions in the SA/AA-treated side. At the end, both modalities led to significant improvement, with no significant difference in between. Patients reported more discomfort with the TCA-treated side. There was no significant different clinical improvement in both treated sides as regards SPT. Erythema improved in both sides. Patients were more satisfied by the SA/AA-treated side. Conclusion: Chemical peeling is effective in controlling mild-moderate acne in SPT III-IV. Combined SA 20% and AA 20% are recommended at early stage of treatment if patients have more inflammatory lesions, while TCA is recommended if patients have more non-inflammatory lesions.
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Affiliation(s)
- Rania Abdel Hay
- a Dermatology Department, Faculty of Medicine, Cairo University , Cairo , Egypt
| | - Rehab Hegazy
- a Dermatology Department, Faculty of Medicine, Cairo University , Cairo , Egypt
| | - Mohamed Abdel Hady
- a Dermatology Department, Faculty of Medicine, Cairo University , Cairo , Egypt
| | - Noha Saleh
- a Dermatology Department, Faculty of Medicine, Cairo University , Cairo , Egypt
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Dreno B, Bagatin E, Blume-Peytavi U, Rocha M, Gollnick H. Female type of adult acne: Physiological and psychological considerations and management. J Dtsch Dermatol Ges 2018; 16:1185-1194. [PMID: 30248242 DOI: 10.1111/ddg.13664] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
Today we see more cases of acne after adolescence, with a greater prevalence in females than males. Adult female acne has a distinct clinical presentation and is associated with a number of specific pathophysiological features and gender-specific triggers. The psychological impact of acne is generally significant and largely underestimated; stress during professional and private life, anxiety and sleep quality, in particular, have a reciprocal relationship with disease susceptibility and severity. It is essential to compare with males. Acne in females often causes greater distress in adults than in adolescents. The impact of disease may therefore be greater for female patients, triggering higher levels of psychosocial anguish and increasing the likelihood of sequelae such as skin picking and the risks of cutaneous superinfection, scarring and PIH and acne recurrence. The management of adult female acne should encompass not just medical treatment of the symptoms, but also a comprehensive, holistic approach to the patient as a whole, her individual lifestyle factors and the impact of acne on her quality of life. Future management of this disease should aim to improve patient adherence to therapy and to develop validated outcomes of treatment regarding overall skin appearance and quality of life.
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Affiliation(s)
| | - Edileia Bagatin
- Department of Dermatology, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Marco Rocha
- Department of Dermatology, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Harald Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke Universität, Magdeburg, Germany
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Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics and management of Asian skin. Int J Dermatol 2018; 58:131-143. [DOI: 10.1111/ijd.14153] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- I. Lym Chan
- Faculdade de Medicina do ABC; Santo André São Paulo Brazil
| | - Simão Cohen
- Faculdade de Medicina do ABC; Santo André São Paulo Brazil
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Castillo DE, Keri JE. Chemical peels in the treatment of acne: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018; 11:365-372. [PMID: 30038512 PMCID: PMC6053170 DOI: 10.2147/ccid.s137788] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acne vulgaris is the most common skin disorder in adolescents and young adults. It carries a significant psychological and economic burden to patients and society. A wide range of therapeutic options are available, including topicals and systemic therapies. Chemical peeling is a skin resurfacing procedure intended to regenerate normal skin from the application of exfoliative agents. It has been used for the treatment of acne vulgaris and other skin disorders for decades. There are several chemical agents with variable mechanisms of action, usually classified as superficial, medium, and deep peels. When selecting the patient and the appropriate peel, the dermatologist individualizes therapy, and performs an extensive interview, including past medical history and physical exam. Several host factors can affect the outcome of this procedure, including current psychological state, medications, history of surgery, and immune system, among others. The physician must also be confident that the peel is safe and effective for the target patient. The Fitzpatrick skin type scale is a useful tool to classify patients based on skin color and ability to tan, but also can be used to evaluate preoperative risk of postpeel response and complications. Dark-skinned patients (Fitzpatrick skin type IV-VI), including blacks, Asian, and Hispanic/Latino, are at higher risk of postinflammatory/postpeel hyperpigmentation. When treating these populations, deep chemical peels should be avoided, and preoperative preparation emphasized. There are many studies available in the literature supporting the use of superficial to medium depth peels as adjuvant therapy for acne vulgaris. This review article aims to present the most important factors when selecting a patient for a chemical peel, the evidence behind its safety and efficacy, and special considerations when choosing a specific agent.
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Affiliation(s)
- David E Castillo
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Jonette E Keri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA, .,Dermatology Service, Miami VA Hospital, Miami, FL, USA,
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15
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de Vries FMC, Meulendijks AM, Driessen RJB, van Dooren AA, Tjin EPM, van de Kerkhof PCM. The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis. J Eur Acad Dermatol Venereol 2018; 32:1195-1203. [PMID: 29444375 DOI: 10.1111/jdv.14881] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence-based support in the efficacy and safety of non-pharmacological therapies is lacking. OBJECTIVE To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris. METHODS A systematic literature review, including a best-evidence synthesis, was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017. RESULTS Thirty-three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified laser- and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction in acne lesions. However, only seven studies had a high methodologic quality. Based on these seven trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), intense pulsed light (400-700 and 870-1200 nm) and the diode laser (1450 nm). Initially, conflicting evidence was found for pulsed dye laser (585-595 nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient. CONCLUSION Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.
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Affiliation(s)
- F M C de Vries
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A M Meulendijks
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - R J B Driessen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A van Dooren
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - E P M Tjin
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Abstract
OBJECTIVE We evaluated current evidence from randomised controlled trials (RCTs) regarding the effectiveness of chemical peeling for treating acne vulgaris. METHODS Standard Cochrane methodological procedures were used. We searched MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE via OvidSP through April 2017. Reviewers independently assessed eligibility, risk of bias and extracted data. RESULTS Twelve RCTs (387 participants) were included. Effectiveness was not significantly different: trichloroacetic acid versus salicylic acid (SA) (percentage of total improvement: risk ratio (RR) 0.89; 95% CI 0.73 to 1.10), glycolic acid (GA) versus amino fruit acid (the reduction of inflammatory lesions: mean difference (MD), 0.20; 95% CI -3.03 to 3.43), SA versus pyruvic acid (excellent or good improvement: RR 1.11; 95% CI 0.73 to 1.69), GA versus SA (good or fair improvement: RR 1.00; 95% CI 0.85 to 1.18), GA versus Jessner's solution (JS) (self-reported improvements: RR 1.00; 95% CI 0.44 to 2.26), and lipohydroxy acid versus SA (reduction of non-inflammatory lesions: 55.6%vs48.5%, p=0.878). Combined SA and mandelic acid peeling was superior to GA peeling (percentage of improvement in total acne score: 85.3%vs68.5%, p<0.001). GA peeling was superior to placebo (excellent or good improvement: RR 2.30; 95% CI 1.40 to 3.77). SA peeling may be superior to JS peeling for comedones (reduction of comedones: 53.4%vs26.3%, p=0.001) but less effective than phototherapy for pustules (number of pustules: MD -7.00; 95% CI -10.84 to -3.16). LIMITATIONS The methodological quality of the included RCTs was very low to moderate. Meta-analysis was not possible due to the significant clinical heterogeneity across studies. CONCLUSION Commonly used chemical peels appear to be similarly effective for mild-to-moderate acne vulgaris and well tolerated. However, based on current limited evidence, a robust conclusion cannot be drawn regarding any definitive superiority or equality among the currently used chemical peels. Well-designed RCTs are needed to identify optimal regimens.
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Affiliation(s)
- Xiaomei Chen
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheng Wang
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Li
- Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, China
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17
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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: 85] [Impact Index Per Article: 12.1] [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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18
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In Jae J, Dong Ju H, Dong Hyun K, Yoon MS, Lee HJ. Comparative study of buffered 50% glycolic acid (pH 3.0) + 0.5% salicylic acid solution vs Jessner's solution in patients with acne vulgaris. J Cosmet Dermatol 2017; 17:797-801. [DOI: 10.1111/jocd.12445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jeong In Jae
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Hyun Dong Ju
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Kim Dong Hyun
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Moon Soo Yoon
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - Hee Jung Lee
- Department of Dermatology; CHA Bundang Medical Center; CHA University; Seongnam Korea
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19
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Al-Talib H, Al-Khateeb A, Hameed A, Murugaiah C. Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris. An Bras Dermatol 2017; 92:212-216. [PMID: 28538881 PMCID: PMC5429107 DOI: 10.1590/abd1806-4841.20175273] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/10/2016] [Indexed: 01/29/2023] Open
Abstract
Acne vulgaris is an extremely common condition affecting the pilosebaceous unit
of the skin and characterized by presence of comedones, papules, pustules,
nodules, cysts, which might result in permanent scars. Acne vulgaris commonly
involve adolescents and young age groups. Active acne vulgaris is usually
associated with several complications like hyper or hypopigmentation, scar
formation and skin disfigurement. Previous studies have targeted the efficiency
and safety of local and systemic agents in the treatment of active acne
vulgaris. Superficial chemical peeling is a skin-wounding procedure which might
cause some potentially undesirable adverse events. This study was conducted to
review the efficacy and safety of superficial chemical peeling in the treatment
of active acne vulgaris. It is a structured review of an earlier seven articles
meeting the inclusion and exclusion criteria. The clinical assessments were
based on pretreatment and post-treatment comparisons and the role of superficial
chemical peeling in reduction of papules, pustules and comedones in active acne
vulgaris. This study showed that almost all patients tolerated well the chemical
peeling procedures despite a mild discomfort, burning, irritation and erythema
have been reported; also the incidence of major adverse events was very low and
easily manageable. In conclusion, chemical peeling with glycolic acid is a
well-tolerated and safe treatment modality in active acne vulgaris while
salicylic acid peels is a more convenient for treatment of darker skin patients
and it showed significant and earlier improvement than glycolic acid
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Affiliation(s)
- Hassanain Al-Talib
- Laboratory Medical Science Cluster, Faculty of Medicine, Universiti Teknologi MARA (UiTM) - Sungai Buloh, Malaysia
| | - Alyaa Al-Khateeb
- Biochemistry and Molecular Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA (UiTM) - Sungai Buloh, Malaysia
| | - Ayad Hameed
- Faculty of Medicine and Health Sciences, Ucsi University - Kuala Lumpur, Malaysia
| | - Chandrika Murugaiah
- Department of Biomedical Sciences and Therapeutics, Faculty of Medicine and Health Sciences, University Malaysia Sabah - Sabah, Malaysia
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20
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Vera N, Patel N, Cardwell LA, Saleem M, Feldman SR. Chemical pharmacotherapy options for managing adult acne. Expert Opin Pharmacother 2017; 18:263-273. [PMID: 28081648 DOI: 10.1080/14656566.2017.1282460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The incidence of adult acne is increasing worldwide. Despite clinical overlap with conventional acne, it has distinct features. Areas covered: A literature search of English-language review articles, randomized control studies and retrospective studies conducted over the past 30 years was performed using PubMed and Google Scholar. Search terms included acne, adult, topical medication, oral medication and skin of color. We highlight important clinical features and treatment modalities pertinent to the evaluation and management of adult acne. Given the relative dearth of literature detailing treatment options specific to adult acne, we offer expert opinion regarding management of the condition especially in special populations such as skin of color and pregnancy. Expert Opinion: It is unclear whether adult acne represents a distinct entity or a continuum of adolescent disease. Providers may opt to use topical medication as first-line, but should have a low threshold for switching to systemic therapy given the magnitude of psychosocial and emotional burden associated with the condition.
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Affiliation(s)
- Nora Vera
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Nupur Patel
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Leah A Cardwell
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Mohammed Saleem
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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21
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Abstract
Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. The most frequently used peeling agents are salicylic acid, glycolic acid, pyruvic acid, lactic acid, mandelic acid, Jessner solution, trichloroacetic acid, and phenol. The appropriate peel is chosen based on the patient's skin type, acne activity, and type of acne scars. Combination peels minimize side effects. In acne scars, chemical peels may be combined with other procedures to achieve better clinical results. A series of chemical peels can lead to significant improvement over a short period, leading to patient satisfaction and maintenance of clinical results. © 2016 Elsevier Inc. All rights reserved.
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Affiliation(s)
| | - Eftychia Platsidaki
- Department of Dermatology and Venereology, Andreas Sygros Skin Hospital, Athens, Greece.
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22
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Canavan TN, Chen E, Elewski BE. Optimizing Non-Antibiotic Treatments for Patients with Acne: A Review. Dermatol Ther (Heidelb) 2016; 6:555-578. [PMID: 27541148 PMCID: PMC5120627 DOI: 10.1007/s13555-016-0138-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Indexed: 12/22/2022] Open
Abstract
Acne is a very common non-infectious skin condition that is frequently treated in dermatological practices. Because acne is often chronic and may persist for years, safe and effective long-term maintenance therapy is often required. Given the increasing frequency of antibiotic-resistant bacteria and the gravity of the consequences of this trend, it behooves dermatologists to maximize use of non-antimicrobial therapy when treating acne. In this review of the literature we present data regarding the efficacy and appropriate use of non-antimicrobial treatments for acne. A variety of topical and oral treatment options exist that can be used in a step-wise manner according to the patients’ severity and therapeutic response. Non-antimicrobial treatments can be highly efficacious at controlling acne, especially when used as maintenance therapy. While antibiotics have a role in acne treatment, they should not be used as monotherapy, and lengthy courses of antibiotic use are discouraged.
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Affiliation(s)
- Theresa N Canavan
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Edward Chen
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Boni E Elewski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA.
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23
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Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016; 74:945-73.e33. [PMID: 26897386 DOI: 10.1016/j.jaad.2015.12.037] [Citation(s) in RCA: 691] [Impact Index Per Article: 86.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.
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Affiliation(s)
| | | | | | | | | | - Diane S Berson
- Weill Cornell Medical College, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Whitney P Bowe
- SUNY Down State Medical Center-Brooklyn, New York, New York
| | - Emmy M Graber
- Boston University School of Medicine, Boston, Massachusetts; Boston Medical Center, Boston, Massachusetts
| | | | - Sewon Kang
- Johns Hopkins Medicine, Baltimore, Maryland
| | - Jonette E Keri
- University of Miami Health System, Miami, Florida; Miami VA Hospital, Miami, Florida
| | | | - Rachel V Reynolds
- Harvard Medical Faculty Physicians, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nanette B Silverberg
- Mount Sinai Health System-Beth Israel, New York, New York; St. Lukes-Roosevelt, New York, New York
| | | | | | | | | | | | | | - Kevin M Boyer
- American Academy of Dermatology, Schaumburg, Illinois
| | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois.
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24
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Oudenhoven MD, Kinney MA, McShane DB, Burkhart CN, Morrell DS. Adverse effects of acne medications: recognition and management. Am J Clin Dermatol 2015; 16:231-242. [PMID: 25896771 DOI: 10.1007/s40257-015-0127-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acne vulgaris is a very common chronic inflammatory disease of the skin. The clinical features of acne range from non-inflammatory comedones to inflammatory nodules. While often perceived as an adolescent disease, the prevalence remains high into adulthood, and the manifestations can have detrimental psychosocial effects. It is therefore not surprising that many patients are motivated to seek treatment. The existing treatment strategies for acne are complex due to the multifactorial pathogenesis of the disease. Although it is difficult to cure, four categories of medications have proved efficacious in reducing acne lesions: topical agents, systemic antibiotics, systemic retinoids, and hormonal agents. Unfortunately, these medications can cause adverse effects that may limit their use. Typically, these adverse effects are mild and transient and can be remedied by altering the dose or frequency of the offending agent. However, more serious adverse effects can occur that pose a significant health risk to the patient. Understanding how to recognize and manage the adverse effects of common acne therapies is imperative to providing the safest and most appropriate treatment for each patient. This article focuses on the recognition and management of adverse effects associated with current acne medications.
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Affiliation(s)
- Mollie D Oudenhoven
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Megan A Kinney
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Diana B McShane
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Craig N Burkhart
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Dean S Morrell
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA.
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25
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Sánchez Viera M. Management of acne scars: fulfilling our duty of care for patients. Br J Dermatol 2015; 172 Suppl 1:47-51. [DOI: 10.1111/bjd.13650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Sánchez Viera
- Instituto De Dermatologia Integral; Avda. Menéndez Pelayo 67-28009 Madrid Spain
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26
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Bhate K, Williams HC. What's new in acne? An analysis of systematic reviews published in 2011-2012. Clin Exp Dermatol 2015; 39:273-7; quiz 277-8. [PMID: 24635060 DOI: 10.1111/ced.12270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 11/26/2022]
Abstract
This review summarizes important clinical developments in acne vulgaris identified from 17 systematic reviews published between February 2011 and August 2012. Regarding causes, Demodex mites have been shown to be associated with both acne vulgaris and rosacea, although it is unclear if their eradication improves either disease. Some weak evidence has emerged that suggests a possible link between dairy produce and acne, which warrants further research. With reference to the effects of acne, there is good evidence that acne negatively affects quality of life, self-esteem and mood in adolescents. Acne is also associated with an increased risk of anxiety, depression and suicidal ideation, highlighting the importance of asking patients with acne directly about psychological issues in order to identify those who might benefit from early psychiatric support. Regarding treatment, there seems to be no additional benefit to using higher strengths of benzoyl peroxide, and lower strengths such as 2.5% have fewer side effects. Despite earlier concerns of increased mortality in those using topical tretinoin for skin cancer prevention, a systematic review on this topic has not found any convincing evidence of a link between such non-cutaneous events and once-daily application of 0.02-0.05% tretinoin. Combined oral contraceptives are of benefit in both inflammatory and non-inflammatory acne. Current surveys suggest that implementation of the pregnancy prevention programme for isotretinoin may not be stringent, and a high level of monitoring and audit is recommended. Ablative and non-ablative laser resurfacing for the treatment of acne scars may be beneficial, but further studies with a longer follow-up period are required.
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Affiliation(s)
- K Bhate
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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27
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Kaminaka C, Uede M, Matsunaka H, Furukawa F, Yamomoto Y. Clinical Evaluation of Glycolic Acid Chemical Peeling in Patients with Acne Vulgaris: A Randomized, Double-Blind, Placebo-Controlled, Split-Face Comparative Study. Dermatol Surg 2014; 40:314-22. [DOI: 10.1111/dsu.12417] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Abstract
Acne vulgaris is a disorder of the sebaceous follicle. The cause is multifactorial, and both adolescents and adults can be affected. Acne is associated with a significant financial burden and considerable psychological distress. Treatment options are reviewed, including over-the-counter medications, prescription medications, and in-office procedures.
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Affiliation(s)
- Danielle Well
- Danielle Well is a nurse practitioner specializing in dermatology at Rockville Dermatology, P.C. Rockville Centre, N.Y., and Dr. Stuart R. Levine Dermatology and Dermatologic Surgery, Brooklyn, N.Y
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29
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Rzany B, Nast A. Acne treatment in the field: how guidelines and other sources can be included in daily practice. J Eur Acad Dermatol Venereol 2013; 27 Suppl 2:2-5. [PMID: 23731194 DOI: 10.1111/jdv.12167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acne is a complex disease ranging from mild to very severe. Quality of life can be considerably affected although the impact on the quality of life does not necessarily correlate with the severity of the disease. AIM To show how good external evidence can be used in individual treatment decisions. METHODS Description of four typical case secenarios usining the recommendation of the recent evidence based guidelines and other sources. RESULTS The four quite typical patients presented here (i) a young boy with comedonal acne; (ii) a young black girl with papulopustular acne; (iii) an older boy with conglobate acne; and (iv) a young women with postadolescent papulopustular acne give a range of the possible challenges a dermatologist may face. CONCLUSION How can the best treatment be selected for our patients? By keeping a clear mind, using the available best evidence and taking of course into account individual factors.
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Affiliation(s)
- Berthold Rzany
- RZANY & HUND, Kurfürstendamm 183, Berlin, D-10707, Germany.
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30
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Raone B, Veraldi S, Raboni R, Ardigò M, Patrizi A, Micali G. Salicylic acid peel incorporating triethyl citrate and ethyl linoleate in the treatment of moderate acne: a new therapeutic approach. Dermatol Surg 2013; 39:1243-51. [PMID: 23627892 DOI: 10.1111/dsu.12215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acne affects many adolescents. Conventional therapy often results in side effects and poor adherence, and the treatment does not consider the psychological effect of acne on patients, which is comparable with that of disabling diseases. OBJECTIVES To evaluate the efficacy and tolerability of a peel (30% salicylic acid, triethyl citrate and ethyl linoleate) combined with a home therapy with three topical agents (triethyl citrate, ethyl linoleate and salicylic acid 0.5% cream, lotion) in moderate acne of the face. DESIGN Prospective, observational, multicenter, open-label, postmarketing, phase IV study. METHODS Patients were assessed by comparing Global Acne Grading System (GAGS) score and total lesion count from 15 days before the first peel (T-15 ), after four salicylic peels (every 10 ± 2 days (T0 , T10 , T20 , T30 ), and 20 days after of the end of the study (T50 ). This treatment was associated to a home therapy. RESULTS Fifty-three patients completed the study. The average GAGS score fell 49% between T-15 and T50 (p < .001). No patient withdrew for adverse events. CONCLUSIONS This therapy was effective and well-tolerated in all cases. Chemo-exfoliation sessions ensured the continuous monitoring of clinical results and improved patient quality of life.
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Affiliation(s)
- Beatrice Raone
- Division of Dermatology, Department of Internal Medicine, Aging, and Nephrologic Diseases, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
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31
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Handog EB, Datuin MSL, Singzon IA. Chemical peels for acne and acne scars in asians: evidence based review. J Cutan Aesthet Surg 2013; 5:239-46. [PMID: 23378705 PMCID: PMC3560163 DOI: 10.4103/0974-2077.104911] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Chemical peeling is a widely used procedure in the management of acne and acne scars, but there are very few studies on Asian populations who are more prone to develop hyper pigmentation. This article aims to summarize and evaluate the existing studies on the role of chemical peels in the treatment of acne and acne scars among Asians. An online search was conducted to identify prospective studies published in English that evaluated the use of chemical peels in active acne and acne scars in Asian populations. There were six studies for acne and eight studies for acne scars that were identified using our search parameters. Most were single-centre, open label and with small sample sizes. Acne severity was not uniformly reported and the objective outcome measures of some studies were not explicitly reported as well. The general trend of the results of the studies support the safety and efficacy of chemical peels for acne and acne scars including those of darker skin types. The existing studies support the use of chemical peels in the treatment of acne and acne scars in Asians. Further clinical trials with better study design and more subjects are needed to further establish the role of chemical peels in Asian acne patients.
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Affiliation(s)
- Evangeline B Handog
- Department of Dermatology, Asian Hospital and Medical Center, Muntinlupa, Philippines
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Dréno B, Layton A, Zouboulis C, López-Estebaranz J, Zalewska-Janowska A, Bagatin E, Zampeli V, Yutskovskaya Y, Harper J. Adult female acne: a new paradigm. J Eur Acad Dermatol Venereol 2013; 27:1063-70. [DOI: 10.1111/jdv.12061] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The multifactorial etiology of acne vulgaris makes it challenging to treat. Current treatments include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, azelaic acid, and systemic isotretinoin. Adjunctive and/or emerging approaches include topical dapsone, taurine bromamine, resveratrol, chemical peels, optical treatments, as well as complementary and alternative medications. The purpose of this paper is to discuss the therapies available for acne and their latest developments, including new treatment strategies (i.e. re-evaluation of the use of oral antibiotics and avoidance of topical antibiotic monotherapy, use of subantimicrobial antibiotic dosing, use of low-dose isotretinoin, optical treatments), new formulations (microsponges, liposomes, nanoemulsions, aerosol foams), new combinations (fixed-combination products of topical retinoids and topical antibiotics [essentially clindamycin] or benzoyl peroxide), new agents (topical dapsone, taurine bromamine, resveratrol) and their rationale and likely place in treatment. Acne vaccines, topical natural antimicrobial peptides, and lauric acid represent other promising therapies.
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