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Ko JY, Song CH, Kim KJ, Kim NI, Kim JE, Kim HS, Ro YS, Park KY, Park MY, Suh DH, Shin K, Shin MK, Ahn HH, Lee WJ, Lee WJ, Lee JH, Lee JB, Lee HW, Lee HJ, Jang MS, Cheong SH, Cho S, Choi YS, Choi YW, Choi H, Lee MW. Consensus Report on Truncal Acne: The Korean Acne and Rosacea Society Experts Panel. Ann Dermatol 2024; 36:35-43. [PMID: 38325432 PMCID: PMC10861305 DOI: 10.5021/ad.23.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND More than half of acne patients have truncal acne on their chest, back, and shoulders. However, since most studies on acne have focused on the face, data on clinical characteristics and proper management for truncal acne are insufficient. OBJECTIVE To establish a Korean Acne Rosacea Society (KARS) consensus for experts' perception and treatment patterns of truncal acne. METHODS We conducted two rounds of the Dephi technique to gather expert opinion and reach a consensus on truncal acne. The first round comprised 48 questionnaires focusing on various aspects such as epidemiology, clinical features, diagnosis, treatment, prognosis and more, while second rounds consisted of 26 questionnaires. RESULTS A total of 36 dermatologists (36/38 KARS members, 94.7%) completed this survey. In the first-round survey, consensus was reached on 20 out of the 48 questions (41.7%). In the second-round questionnaire, consensus was achieved on 9 of the 26 questions (34.6%). The most unresponsive lesion to truncal acne treatment was scars (atrophic/hypertrophic). The most commonly used treatments for each non-inflammatory and inflammatory truncal acne lesions were selected to use topical retinoids (78.1% of the responders) and oral antibiotics (93.8% of the responders). CONCLUSION Our study has yielded valuable insights into the epidemiology, clinical manifestations, diagnosis, treatment, and quality of life of patients with truncal acne. We anticipate that this study will inspire further comprehensive research for individuals with truncal acne.
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Affiliation(s)
- Joo Yeon Ko
- Department of Dermatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Hwa Song
- Department of Dermatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Nack In Kim
- Kim Nack-In Dermatology Clinic, Seoul, Korea
| | - Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi-Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kihyuck Shin
- Department of Dermatology, Pusan National University Yangsan Hospital, Pusan University College of Medicine, Yangsan, Korea
| | - Min Kyung Shin
- Department of Dermatology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyo Hyun Ahn
- Department of Dermatology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ju Hee Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Bum Lee
- Department of Dermatology, Chonnam National University Hospital, Chonnam University College of Medicine, Gwangju, Korea
| | | | - Hee Jung Lee
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Min Soo Jang
- Department of Dermatology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seung Hyun Cheong
- Department of Dermatology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yu Sung Choi
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - You Won Choi
- Department of Dermatology, Ehwa Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hoon Choi
- Department of Dermatology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Stan D, Ruta LL, Bocancia-Mateescu LA, Mirica AC, Stan D, Micutz M, Brincoveanu O, Enciu AM, Codrici E, Popescu ID, Popa ML, Rotaru F, Tanase C. Formulation and Comprehensive Evaluation of Biohybrid Hydrogel Membranes Containing Doxycycline or Silver Nanoparticles. Pharmaceutics 2023; 15:2696. [PMID: 38140037 PMCID: PMC10747233 DOI: 10.3390/pharmaceutics15122696] [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: 09/18/2023] [Revised: 10/31/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Complicated wounds often require specialized medical treatments, and hydrogels have emerged as a popular choice for wound dressings in such cases due to their unique properties and the ability to incorporate and release therapeutic agents. Our focus was to develop and characterize a new optimized formula for biohybrid hydrogel membranes, which combine natural and synthetic polymers, bioactive natural compounds, like collagen and hyaluronic acid, and pharmacologically active substances (doxycycline or npAg). Dynamic (oscillatory) rheometry confirmed the strong gel-like properties of the obtained hydrogel membranes. Samples containing low-dose DOXY showed a swelling index of 285.68 ± 6.99%, a degradation rate of 71.6 ± 0.91% at 20 h, and achieved a cumulative drug release of approximately 90% at pH 7.4 and 80% at pH 8.3 within 12 h. The addition of npAg influenced the physical properties of the hydrogel membranes. Furthermore, the samples containing DOXY demonstrated exceptional antimicrobial efficacy against seven selected bacterial strains commonly associated with wound infections and complications. Biocompatibility assessments revealed that the samples exhibited over 80% cell viability. However, the addition of smaller-sized nanoparticles led to decreased cellular viability. The obtained biohybrid hydrogel membranes show favorable properties that render them suitable for application as wound dressings.
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Affiliation(s)
- Diana Stan
- DDS Diagnostic, Segovia 1 Str., 031427 Bucharest, Romania; (L.L.R.); (L.-A.B.-M.); (A.-C.M.); (D.S.)
- Doctoral School of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Lavinia Liliana Ruta
- DDS Diagnostic, Segovia 1 Str., 031427 Bucharest, Romania; (L.L.R.); (L.-A.B.-M.); (A.-C.M.); (D.S.)
- Department of Inorganic, Organic Chemistry, Biochemistry and Catalysis, Faculty of Chemistry, University of Bucharest, 90–92 Panduri Str., 050663 Bucharest, Romania
| | | | - Andreea-Cristina Mirica
- DDS Diagnostic, Segovia 1 Str., 031427 Bucharest, Romania; (L.L.R.); (L.-A.B.-M.); (A.-C.M.); (D.S.)
| | - Dana Stan
- DDS Diagnostic, Segovia 1 Str., 031427 Bucharest, Romania; (L.L.R.); (L.-A.B.-M.); (A.-C.M.); (D.S.)
| | - Marin Micutz
- Department of Analytical and Physical Chemistry, University of Bucharest, 4-12 Regina Elisabeta Blvd., 030018 Bucharest, Romania;
| | - Oana Brincoveanu
- National Institute for R&D in Microtechnology, 077190 Bucharest, Romania;
- Research Institute, The University of Bucharest, 060102 Bucharest, Romania
| | - Ana-Maria Enciu
- Victor Babes National Institute of Pathology, 050096 Bucharest, Romania; (A.-M.E.); (E.C.); (I.D.P.); (C.T.)
- Department of Cell Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Elena Codrici
- Victor Babes National Institute of Pathology, 050096 Bucharest, Romania; (A.-M.E.); (E.C.); (I.D.P.); (C.T.)
| | - Ionela Daniela Popescu
- Victor Babes National Institute of Pathology, 050096 Bucharest, Romania; (A.-M.E.); (E.C.); (I.D.P.); (C.T.)
| | - Maria Linda Popa
- Department of Cell Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Flaviana Rotaru
- Polytechnic University of Bucharest, Splaiul Independenței 54, 030167 Bucharest, Romania;
- Rohealth—Health and Bioeconomy Cluster, Calea Griviţei 6-8, 010731 Bucharest, Romania
- Frontier Management Consulting, Calea Griviţei6-8, 010731 Bucharest, Romania
| | - Cristiana Tanase
- Victor Babes National Institute of Pathology, 050096 Bucharest, Romania; (A.-M.E.); (E.C.); (I.D.P.); (C.T.)
- Department of Cell Biology and Clinical Biochemistry, Titu Maiorescu University, 031593 Bucharest, Romania
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Zhu W, Hamblin MR, Wen X. Role of the skin microbiota and intestinal microbiome in rosacea. Front Microbiol 2023; 14:1108661. [PMID: 36846769 PMCID: PMC9950749 DOI: 10.3389/fmicb.2023.1108661] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 02/12/2023] Open
Abstract
Rosacea is a chronic inflammatory cutaneous disorder of uncertain etiology that mainly affects the centrofacial region, including cheeks, nose, chin, forehead, and eyes. The pathogenesis of rosacea remains unclear because it involves several complex factors. Additionally, the potential treatment methods need to be explored. We reviewed the common bacterial species in the skin microbiota and gut microbiota of rosacea patients such as Demodex folliculorum, Staphylococcus epidermidis, Bacillus oleronius, Cutibacterium acnes, and Helicobacter pylori and identified their role in the pathogenesis. Besides, we summarized the influence factors such as temperature and age on rosacea patients. We also systematically reviewed the commonly used clinical treatment methods, including antibiotics, probiotics. as well as their treatment mechanism and application precautions.
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Affiliation(s)
- Weitao Zhu
- Clinical Medicine (Eight-Year Program), West China School of Medicine, Sichuan University, Chengdu, China
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Xiang Wen, ✉
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Suárez-Rivero JM, Pastor-Maldonado CJ, Povea-Cabello S, Álvarez-Córdoba M, Villalón-García I, Talaverón-Rey M, Suárez-Carrillo A, Munuera-Cabeza M, Reche-López D, Cilleros-Holgado P, Piñero-Perez R, Sánchez-Alcázar JA. UPR mt activation improves pathological alterations in cellular models of mitochondrial diseases. Orphanet J Rare Dis 2022; 17:204. [PMID: 35581596 PMCID: PMC9115953 DOI: 10.1186/s13023-022-02331-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/26/2022] [Indexed: 12/23/2022] Open
Abstract
Background Mitochondrial diseases represent one of the most common groups of genetic diseases. With a prevalence greater than 1 in 5000 adults, such diseases still lack effective treatment. Current therapies are purely palliative and, in most cases, insufficient. Novel approaches to compensate and, if possible, revert mitochondrial dysfunction must be developed. Results In this study, we tackled the issue using as a model fibroblasts from a patient bearing a mutation in the GFM1 gene, which is involved in mitochondrial protein synthesis. Mutant GFM1 fibroblasts could not survive in galactose restrictive medium for more than 3 days, making them the perfect screening platform to test several compounds. Tetracycline enabled mutant GFM1 fibroblasts survival under nutritional stress. Here we demonstrate that tetracycline upregulates the mitochondrial Unfolded Protein Response (UPRmt), a compensatory pathway regulating mitochondrial proteostasis. We additionally report that activation of UPRmt improves mutant GFM1 cellular bioenergetics and partially restores mitochondrial protein expression. Conclusions Overall, we provide compelling evidence to propose the activation of intrinsic cellular compensatory mechanisms as promising therapeutic strategy for mitochondrial diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02331-8.
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Affiliation(s)
- Juan M Suárez-Rivero
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Carmen J Pastor-Maldonado
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Suleva Povea-Cabello
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Mónica Álvarez-Córdoba
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Irene Villalón-García
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Marta Talaverón-Rey
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Alejandra Suárez-Carrillo
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Manuel Munuera-Cabeza
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Diana Reche-López
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Paula Cilleros-Holgado
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - Rocío Piñero-Perez
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain
| | - José A Sánchez-Alcázar
- Centro Andaluz de Biología del Desarrollo (CABD), Consejo Superior de Investigaciones Científicas, Universidad Pablo de Olavide, Carretera de Utrera Km 1, 41013, Seville, Spain. .,Centro de Investigación Biomédica en Red: Enfermedades Raras, Instituto de Salud Carlos III, 41013, Seville, Spain.
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Martins AM, Marto JM, Johnson JL, Graber EM. A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea. Antibiotics (Basel) 2021; 10:antibiotics10070757. [PMID: 34206485 PMCID: PMC8300648 DOI: 10.3390/antibiotics10070757] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023] Open
Abstract
Resistance of Cutibacterium acnes to topical antibiotics historically used to treat acne (topical erythromycin and clindamycin and, more recently, topical azithromycin and clarithromycin) has been steadily increasing and new topical antibiotics are needed. Minocycline is a semisynthetic tetracycline-derived antibiotic currently used systemically to treat a wide range of infections caused by Gram-negative and Gram-positive bacteria. In addition to its antibiotic activity, minocycline possesses anti-inflammatory properties, such as the downregulation of proinflammatory cytokine production, suppression of neutrophil chemotaxis, activation of superoxide dismutase, and inhibition of phagocytosis, among others. These characteristics make minocycline a valuable agent for treatment of dermatological diseases such as acne vulgaris and papulopustular rosacea. However, more frequent or serious adverse effects have been observed upon the systemic administration of minocycline than with other tetracyclines. Examples of serious adverse effects include hypersensitivity syndrome reaction, drug-induced lupus, idiopathic intracranial hypertension, and other autoimmune syndromes that may cause death. Here, we review adverse effects and drug–drug interactions observed with oral administration of minocycline and contrast this with topical minocycline formulations recently approved or under development for effectively treating dermatological disorders with fewer adverse effects and less drug interaction.
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Affiliation(s)
- Ana M. Martins
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal; (A.M.M.); (J.M.M.)
| | - Joana M. Marto
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal; (A.M.M.); (J.M.M.)
| | - Jodi L. Johnson
- Departments of Pathology and Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Emmy M. Graber
- The Dermatology Institute, Boston, MA 02116, USA
- Northeastern University, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-857-317-2057
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Husein-ElAhmed H, Steinhoff M. Bewertung der Wirksamkeit sub‐antimikrobieller Dosierungen von Doxycyclin bei Rosacea: Systematische Auswertung von klinischen Studien und Metaanalyse. J Dtsch Dermatol Ges 2021; 19:7-18. [PMID: 33491888 DOI: 10.1111/ddg.14247_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Husein Husein-ElAhmed
- Abteilung Dermatologie und Venerologie, Granada, Spanien.,Translational Research Institute, Hamad Medical Corporation, Doha, Katar
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Katar.,Abteilung Dermatologie und Venerologie Hamad Medical Corporation, Doha, Katar.,Weill Cornell Medicine Katar, College of Medicine, Doha, Katar.,Universität Katar, Medizinische Fakultät, Doha, Katar.,Weill Cornell University, College of Medicine, New York, NY, USA
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Selective toxicity of antibacterial agents-still a valid concept or do we miss chances and ignore risks? Infection 2020; 49:29-56. [PMID: 33367978 PMCID: PMC7851017 DOI: 10.1007/s15010-020-01536-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Selective toxicity antibacteribiotics is considered to be due to interactions with targets either being unique to bacteria or being characterized by a dichotomy between pro- and eukaryotic pathways with high affinities of agents to bacterial- rather than eukaryotic targets. However, the theory of selective toxicity oversimplifies the complex modes of action of antibiotics in pro- and eukaryotes. METHODS AND OBJECTIVE This review summarizes data describing multiple modes of action of antibiotics in eukaryotes. RESULTS Aminoglycosides, macrolides, oxazolidinones, chloramphenicol, clindamycin, tetracyclines, glycylcyclines, fluoroquinolones, rifampicin, bedaquillin, ß-lactams inhibited mitochondrial translation either due to binding to mitosomes, inhibition of mitochondrial RNA-polymerase-, topoisomerase 2ß-, ATP-synthesis, transporter activities. Oxazolidinones, tetracyclines, vancomycin, ß-lactams, bacitracin, isoniazid, nitroxoline inhibited matrix-metalloproteinases (MMP) due to chelation with zinc and calcium, whereas fluoroquinols fluoroquinolones and chloramphenicol chelated with these cations, too, but increased MMP activities. MMP-inhibition supported clinical efficacies of ß-lactams and daptomycin in skin-infections, and of macrolides, tetracyclines in respiratory-diseases. Chelation may have contributed to neuroprotection by ß-lactams and fluoroquinolones. Aminoglycosides, macrolides, chloramphenicol, oxazolidins oxazolidinones, tetracyclines caused read-through of premature stop codons. Several additional targets for antibiotics in human cells have been identified like interaction of fluoroquinolones with DNA damage repair in eukaryotes, or inhibition of mucin overproduction by oxazolidinones. CONCLUSION The effects of antibiotics on eukaryotes are due to identical mechanisms as their antibacterial activities because of structural and functional homologies of pro- and eukaryotic targets, so that the effects of antibiotics on mammals are integral parts of their overall mechanisms of action.
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Husein-ElAhmed H, Steinhoff M. Evaluation of the efficacy of subantimicrobial dose doxycycline in rosacea: a systematic review of clinical trials and meta-analysis. J Dtsch Dermatol Ges 2020; 19:7-17. [PMID: 32989925 DOI: 10.1111/ddg.14247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/09/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Low-dose doxycycline (SDD) is an antimicrobial agent that appears to improve common inflammatory skin diseases. Few data are available regarding the overall effectiveness, appropriate length of treatment and optimal patient selection for rosacea. We therefore reviewed the efficacy of sub-antimicrobial doses of SDD in papulopustular rosacea (PPR) and aimed to determine the most suitable patients for this approach. METHODS From July to September 2019, we carried out a comprehensive search of literature from five databases, using a combination of "rosacea" AND "doxycycline". RESULTS Our search yielded 532 potentially relevant studies. Our meta-analysis showed no significant difference between SDD and a comparator (RR: 1.12, 95 % CI: 0.78-1.62, I2 = 86 %). Subgroup analysis of studies comparing doxycycline with placebo yielded a clear difference in favor of doxycycline (RR: 1.45, 95 % CI: 1.22-1.72, I2 = 31 %), while subgroup analysis of studies comparing active drugs revealed no difference between interventions (RR: 0.52, 95 % CI: 0.17-1.63, I2 = 90 %). CONCLUSIONS There is strong evidence that SDD is more effective than placebo. However, other drugs such as minocycline or isotretinoin have shown outcomes at least similar to that of SDD. We suggest that the anti-inflammatory properties of SDD may be of more value for mild cases of rosacea than for moderate to severe cases, for which higher (antimicrobial) doses of doxycycline may be a more suitable choice.
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Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar.,Qatar University, Medical School, Doha, Qatar.,Weill Cornell University, College of Medicine, New York, NY, USA
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Comparison of the efficacy of tea tree ( Melaleuca alternifolia) oil with other current pharmacological management in human demodicosis: A Systematic Review. Parasitology 2020; 147:1587-1613. [PMID: 32772960 DOI: 10.1017/s003118202000150x] [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] [Indexed: 12/12/2022]
Abstract
Various treatments are found to be moderately effective in managing Demodex-related diseases except tea tree oil (TTO) and terpinen-4-ol (T4O), which showed superior miticidal and anti-inflammatory effects in numerous clinical studies. Their possible effects include lowering mite counts, relieving Demodex-related symptoms, and modulating the immune system. This review summarizes the current clinical topical and oral treatments in human demodicosis, their possible mechanisms of action, side-effects and resistance in treating this condition. TTO (especially T4O) is found to be the most effective followed by metronidazole, ivermectin and permethrin in managing the disease. This is because TTO has anti-parasitic, anti-bacterial, anti-fungal, anti-inflammatory and wound-healing effects. Furthermore, nanoTTO can even release its contents into fungus and Pseudomonas biofilms. Combinations of different treatments are occasionally needed for refractory cases, especially for individuals with underlying genetic predisposal or are immuno-compromised. Although the current treatments show efficacy in controlling the Demodex mite population and the related symptoms, further research needs to be focused on the efficacy and drug delivery technology in order to develop alternative treatments with better side-effects profiles, less toxicity, lower risk of resistance and are more cost-effective.
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Safety of Combination Laser or Intense Pulsed Light Therapies and Doxycycline for the Treatment of Rosacea. Dermatol Surg 2020; 45:1401-1405. [PMID: 31658188 DOI: 10.1097/dss.0000000000002009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.
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Samartzis EP, Fink D, Stucki M, Imesch P. Doxycycline reduces MMP-2 activity and inhibits invasion of 12Z epithelial endometriotic cells as well as MMP-2 and -9 activity in primary endometriotic stromal cells in vitro. Reprod Biol Endocrinol 2019; 17:38. [PMID: 30981279 PMCID: PMC6462312 DOI: 10.1186/s12958-019-0481-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/04/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Matrix metalloproteinases (MMPs), especially the gelatinases MMP-2 and MMP-9, play a crucial role in the pathogenesis of endometriosis by enabling invasion. Doxycycline is a well-tolerated antibiotic and a potent MMP-inhibitor in subantimicrobial doses. METHODS Gelatin zymography and activity assays were used to detect latent and active MMP-2 and -9 in cell culture supernatants of immortalized epithelial (12Z) and two isolates of primary endometriotic stromal cells treated with doxycycline. The invasiveness of 12Z endometriotic cells treated with doxycycline was assessed in matrigel-coated invasion chambers. The effect on latent and active MMP-2 expression of the combination of progesterone and doxycycline was tested in 12Z. RESULTS Doxycycline significantly reduced the MMP-2 activity and pro-MMP-2 expression in 12Z and the MMP-2 and -9 activity as well as expression of pro-MMP-2 and -9 in primary endometriotic stromal cells. The percentage of 12Z cells invading through a matrigel-coated membrane was reduced to 65 and 22% of the control after treatment with doxycycline at doses of 1 μg/ml and 10 μg/ml, respectively. Furthermore, a combination of progesterone and doxycycline showed an additive effect in low doses on the reduction of MMP-2 activity and pro-MMP2 expression in 12Z endometriotic cells. CONCLUSIONS In conclusion, the MMP-inhibiting features of subantimicrobial-dose doxycycline may be further evaluated as a well-tolerable additional therapeutic approach, e.g. in combination with progestins such as dienogest, in patients with infiltrative endometriosis with insufficient response to current medical treatment options.
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Affiliation(s)
- Eleftherios P. Samartzis
- 0000 0004 0478 9977grid.412004.3Division of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
| | - Daniel Fink
- 0000 0004 0478 9977grid.412004.3Division of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
| | - Manuel Stucki
- 0000 0004 0478 9977grid.412004.3Division of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
| | - Patrick Imesch
- 0000 0004 0478 9977grid.412004.3Division of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
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12
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Abstract
Persistent centrofacial erythema is a predominant component of rosacea. The authors review the topical and systemic treatments for rosacea-related erythema and flushing to aid in treatment decision making in clinical practice. Databases were searched for literature pertaining to treatment options for erythema related to rosacea. The paucity of large-scale clinical trials in patients with the erythematotelangiectatic rosacea subtype makes it difficult to draw firm conclusions regarding treatment. Although certain topical and oral treatments appear to have modest benefit in reducing erythema, there is a need for high-quality, well-designed, and rigorously reported studies for the treatments for rosacea.
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Affiliation(s)
- Abigail Cline
- Augusta University Medical Center, Augusta, GA 30912, USA
| | - Sean P McGregor
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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13
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Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2017; 78:S1-S23.e1. [PMID: 29127053 DOI: 10.1016/j.jaad.2017.09.078] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.
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Yu M, Dong A, Chen C, Xu S, Cao Y, Liu S, Zhang Q, Qi R. Thermosensitive Hydrogel Containing Doxycycline Exerts Inhibitory Effects on Abdominal Aortic Aneurysm Induced By Pancreatic Elastase in Mice. Adv Healthc Mater 2017; 6. [PMID: 28885781 DOI: 10.1002/adhm.201700671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Indexed: 01/27/2023]
Abstract
Doxycycline (DOX) is reported to exert therapeutic effects against abdominal aortic aneurysm (AAA), a severe degenerative disease. In this study, a DOX hydrogel formulation of DOX/PECTgel is studied, and its phase transition behavior and in vitro release profiles are explored. In addition, the anti-AAA effects and bioavailability of DOX/PECTgel are evaluated in an elastase induced AAA mouse model. The results show that the phase transition temperature of 30% poly(e-caprolactone-co-1,4,8-trioxa[4.6]spiro-9-undecanone) (PECT) solution is above 34 °C. In vitro release profiles of DOX/PECTgel indicate a fast release of DOX at the first two days, followed by a slow and sustained release for 14 d. In vivo single-dose single subcutaneous injection of DOX/PECTgel containing 8.4 or 4.2 mg mL-1 DOX presents comparatively preventive effects on AAA, compared to intraperitoneal injections of DOX alone at a dose of 15 mg kg-1 for seven injections, while DOX bioavailability of the DOX/PECTgel treated groups is 1.39 times or 1.19 times of the DOX alone treated group, respectively.
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Affiliation(s)
- Maomao Yu
- Peking University Institute of Cardiovascular Sciences; Key Laboratory of Molecular Cardiovascular Sciences; Ministry of Education; Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems; Peking University Health Science Center; 38 Xueyuan Road Beijing 100191 China
| | - Anjie Dong
- School of Chemical Engineering and Technology; Tianjin University; Tianjin 300072 China
| | - Cong Chen
- Peking University Institute of Cardiovascular Sciences; Key Laboratory of Molecular Cardiovascular Sciences; Ministry of Education; Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems; Peking University Health Science Center; 38 Xueyuan Road Beijing 100191 China
| | - Shuxin Xu
- School of Chemical Engineering and Technology; Tianjin University; Tianjin 300072 China
| | - Yini Cao
- Peking University Institute of Cardiovascular Sciences; Key Laboratory of Molecular Cardiovascular Sciences; Ministry of Education; Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems; Peking University Health Science Center; 38 Xueyuan Road Beijing 100191 China
| | - Shu Liu
- Peking University Institute of Cardiovascular Sciences; Key Laboratory of Molecular Cardiovascular Sciences; Ministry of Education; Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems; Peking University Health Science Center; 38 Xueyuan Road Beijing 100191 China
- Shihezi University College of Pharmacy/Key Laboratory of Xinjiang Endemic Phytomedicine Resources Ministry of Education; Xinjiang 832003 China
| | - Qiang Zhang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems; School of Pharmaceutical Sciences; Peking University; 38 Xueyuan Road Beijing 100191 China
| | - Rong Qi
- Peking University Institute of Cardiovascular Sciences; Key Laboratory of Molecular Cardiovascular Sciences; Ministry of Education; Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems; Peking University Health Science Center; 38 Xueyuan Road Beijing 100191 China
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15
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Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. State of the art: systemic rosacea management. J Dtsch Dermatol Ges 2017; 14 Suppl 6:29-37. [PMID: 27869374 DOI: 10.1111/ddg.13141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 12/30/2022]
Abstract
Based on numerous trials, oral tetracyclines and most commonly their second-generation derivative doxycycline have become the main pillar in systemic rosacea treatment. However, the only preparation that has been approved so far in this setting is 40 mg doxycycline in an anti-inflammatory dosage and with a modified release formulation. With the introduction of this once-daily, non-antibiotic dosing of doxycycline, oral therapy is more commonly prescribed as first-line treatment in moderate to severe papulopustular rosacea. In addition, topical and oral strategies are often used in combination due to the more substantial improvements compared to monotherapy. Although several other non-approved oral agents like macrolides, isotretinoin, and carvedilol have been evaluated for systemic treatment and showed promising results, yet the experience with these drugs in rosacea is limited, and thus they should be reserved for special situations.
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Affiliation(s)
- M Schaller
- Department of Dermatology, Tübingen University Hospital, Tübingen, Germany
| | - H Schöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital, Goethe-University, Frankfurt/M, Germany
| | - B Homey
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - U Gieler
- Clinics for Dermatology and Allergology, Justus-Liebig-University, Giessen, Germany
| | - P Lehmann
- Department of Dermatology and Allergology, HELIOS Hospital Wuppertal, Witten/Herdecke University, Germany
| | - T A Luger
- Department of Dermatology, University Hospital Münster, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
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16
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Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Aktueller Stand der systemischen Rosazea-Therapie. J Dtsch Dermatol Ges 2016; 14 Suppl 6:29-37. [DOI: 10.1111/ddg.13141_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M Schaller
- Universitäts-Hautklinik; Klinikum der Universität Tübingen; Deutschland
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie; Johann Wolfgang Goethe-Universität; Frankfurt/Main Deutschland
| | - B Homey
- Klinik für Dermatologie; Universitätsklinikum Düsseldorf; Deutschland
| | - U Gieler
- Zentrum für Psychosomatische Medizin, Psychosomatische Dermatologie; Universitätsklinikum Gießen; Deutschland
| | - P Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie; Helios Kliniken Wuppertal, Universität Witten/Herdecke; Deutschland
| | - TA Luger
- Klinik für Hautkrankheiten, Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster; Deutschland
| | - T Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie; Ludwig-Maximilians-Universität München
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology; University Collge Dublin; Dublin Irland
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17
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Abstract
Rosacea represents a common and chronic inflammatory skin disorder. Clinical features include transient and permanent erythema, inflammatory papules and pustules, phymatous changes, and ocular signs and symptoms. Rosacea is generally classified into four subtypes and one variant. Subtype 1, erythematotelangiectatic rosacea, includes clinical features of flushing and persistent central facial erythema with or without telangiectasia. Subtype 2, papulopustular rosacea, is characterized by persistent central facial erythema with transient papules or pustules or both on the central face. Subtype 3, phymatous rosacea, includes thickening of the skin with irregular surface nodularities and enlargement. Subtype 4, ocular rosacea, includes inflammation of different parts of the eye and eyelid. A variant, granulomatous rosacea, is noninflammatory and is characterized by hard, brown, yellow, or red cutaneous papules or nodules of uniform size. Patients may present with more than one subtype, and each individual characteristic may fluctuate. There is debate whether rosacea progresses from one subtype over time or subtypes represent discreet entities. Defining clinical presentation and improved understanding of pathophysiology has resulted in identification of novel treatment approaches. This contribution outlines a rationale for treatment, highlights an evidence-based approach with approved treatments, and considers novel developments and off-license therapy available.
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Affiliation(s)
- Alison M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom.
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18
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Del Rosso JAMESQ. Cutaneous rosacea: a thorough overview of pathogenesis, clinical presentations, and current recommendations on management. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-2-32-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The review summarizes and systemizes available international data on the pathogenesis, clinical manifestations and current recommendations for the management of rosacea patients.
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19
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Del Rosso JAMESQ. Cutaneous rosacea: a thorough overview of pathogenesis, clinical presentations, and current recommendations on management. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-2-21-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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21
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Arman A, Demirseren DD, Takmaz T. Treatment of ocular rosacea: comparative study of topical cyclosporine and oral doxycycline. Int J Ophthalmol 2015; 8:544-9. [PMID: 26086005 DOI: 10.3980/j.issn.2222-3959.2015.03.19] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 10/09/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints. METHODS One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline. RESULTS Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05). CONCLUSION Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.
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Affiliation(s)
- Aysegul Arman
- Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey
| | | | - Tamer Takmaz
- Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey
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22
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Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some people. A range of treatment options are available but it is unclear which are most effective. OBJECTIVES To assess the efficacy and safety of treatments for rosacea. SEARCH METHODS We updated our searches, to July 2014, of: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974) and Science Citation Index (from 1988). We searched five trials registers and checked reference lists for further relevant studies. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. MAIN RESULTS We included 106 studies, comprising 13,631 participants. Sample sizes of 30-100 and study duration of two to three months were most common. More women than men were included, mean age of 48.6 years, and the majority had papulopustular rosacea, followed by erythematotelangiectatic rosacea.A wide range of comparisons (67) were evaluated. Topical interventions: metronidazole, azelaic acid, ivermectin, brimonidine or other topical treatments. Systemic interventions: oral antibiotics, combinations with topical treatments or other systemic treatments, i.e. isotretinoin. Several studies evaluated laser or light-based treatment.The majority of studies (57/106) were assessed as 'unclear risk of bias', 37 'high risk ' and 12 'low risk'. Twenty-two studies provided no usable or retrievable data i.e. none of our outcomes were addressed, no separate data reported for rosacea or limited data in abstracts.Eleven studies assessed our primary outcome 'change in quality of life', 52 studies participant-assessed changes in rosacea severity and almost all studies addressed adverse events, although often only limited data were provided. In most comparisons there were no statistically significant differences in number of adverse events, most were mild and transient. Physician assessments including investigators' global assessments, lesion counts and erythema were evaluated in three-quarters of the studies, but time needed for improvement and duration of remission were incompletely or not reported.The quality of the body of evidence was rated moderate to high for most outcomes, but for some outcomes low to very low.Data for several outcomes could only be pooled for topical metronidazole and azelaic acid. Both were shown to be more effective than placebo in papulopustular rosacea (moderate quality evidence for metronidazole and high for azelaic acid). Pooled data from physician assessments in three trials demonstrated that metronidazole was more effective compared to placebo (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.29 to 3.02). Four trials provided data on participants' assessments, illustrating that azelaic acid was more effective than placebo (RR 1.46, 95% CI 1.30 to 1.63). The results from three studies were contradictory on which of these two treatments was most effective.Two studies showed a statistically significant and clinically important improvement in favour of topical ivermectin when compared to placebo (high quality evidence). Participants' assessments in these studies showed a RR of 1.78 (95% CI 1.50 to 2.11) and RR of 1.92 (95% CI 1.59 to 2.32),which were supported by physicians' assessments. Topical ivermectin appeared to be slightly more effective than topical metronidazole for papulopustular rosacea, based on one study, for improving quality of life and participant and physician assessed outcomes (high quality evidence for these outcomes).Topical brimonidine in two studies was more effective than vehicle in reducing erythema in rosacea at all time points over 12 hours (high quality evidence). At three hours the participants' assessments had a RR of 2.21 (95% CI 1.52 to 3.22) and RR of 2.00 (95% CI 1.33 to 3.01) in favour of brimonidine. Physicians' assessments confirmed these data. There was no rebound or worsening of erythema after treatment cessation.Topical clindamycin phosphate combined with tretinoin was not considered to be effective compared to placebo (moderate quality evidence).Topical ciclosporin ophthalmic emulsion demonstrated effectiveness and improved quality of life for people with ocular rosacea (low quality evidence).Of the comparisons assessing oral treatments for papulopustular rosacea there was moderate quality evidence that tetracycline was effective but this was based on two old studies of short duration. Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99) (high quality evidence). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doxycycline, but there was evidence of fewer adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54) (low quality evidence). There was very low quality evidence from one study (assessed at high risk of bias) that doxycycline 100 mg was as effective as azithromycin. Low dose minocycline (45 mg) was effective for papulopustular rosacea (low quality evidence).Oral tetracycline was compared with topical metronidazole in four studies and showed no statistically significant difference between the two treatments for any outcome (low to moderate quality evidence).Low dose isotretinoin was considered by both the participants (RR 1.23, 95% CI 1.05 to 1.43) and physicians (RR 1.18, 95% CI 1.03 to 1.36) to be slightly more effective than doxycycline 50-100 mg (high quality evidence).Pulsed dye laser was more effective than yttrium-aluminium-garnet (Nd:YAG) laser based on one study, and it appeared to be as effective as intense pulsed light therapy (both low quality evidence). AUTHORS' CONCLUSIONS There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea. Moderate quality evidence was available for topical metronidazole and oral tetracycline. There was low quality evidence for low dose minocycline, laser and intense pulsed light therapy and ciclosporin ophthalmic emulsion for ocular rosacea. Time needed to response and response duration should be addressed more completely, with more rigorous reporting of adverse events. Further studies on treatment of ocular rosacea are warranted.
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Affiliation(s)
- Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | | | - Ben Carter
- King's College London; Institute of Psychiatry, Psychology & NeuroscienceBiostatistics and Health InformaticsDenmark HillLondonUK
| | | | - Lyn Charland
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
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Abstract
INTRODUCTION Acne is the most common skin condition in the US. The mainstay of acne therapy includes: topical retinoids, topical antibiotics, benzoyl peroxide (BP), and oral isotretinoin for severe cases. Although these treatment options are highly effective they do have certain drawbacks. Current acne treatment regimens often require patients to use multiple medications, some of which may have irritating side effects. Furthermore, Propionibacterium acnes resistance to antibiotics has become an increasing problem due to the rise in antibiotic use. AREAS COVERED New therapies that have either been released onto the market or that are being developed include: adapalene-BP combination agent, dapsone 5% gel, minocycline foam, topical nitric oxide-releasing agent, cortexolone 17 α-propionate, and CIP isotretinoin. Some of these new therapies address the challenges faced with existing treatment options. For instance, the relatively new combination therapy, adapalene-BP, limits antibiotic resistance and also helps simplify treatment regimens. The newly developed topical nitric oxide-releasing agent also holds potential in limiting antibiotic resistance. EXPERT OPINION Many of the new therapies discussed in this paper are still in early stages of testing so it is difficult to predict their outlook; however, based on preliminary findings, these therapies seem to be promising.
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Affiliation(s)
- Imran Aslam
- Wake Forest School of Medicine, Center for Dermatology Research, Department of Dermatology, Medical Center Boulevard , Winston-Salem, NC 27157-1071 , USA
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24
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Del Rosso JQ. Management of cutaneous rosacea: emphasis on new medical therapies. Expert Opin Pharmacother 2014; 15:2029-38. [DOI: 10.1517/14656566.2014.945423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shehwaro N, Langlois AL, Gueutin V, Gauthier M, Casenave M, Izzedine H. [Doxycycline or how to create new with the old?]. Therapie 2014; 69:129-41. [PMID: 24926631 DOI: 10.2515/therapie/2013069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/26/2013] [Indexed: 11/20/2022]
Abstract
Tetracyclines are broad-spectrum antibiotics that interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s in the treatment of acne. More recently, their biological actions on inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism were studied. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that degrade components of the extracellular matrix (ECM). MMPs have direct or indirect effects on the vascular endothelium and the vascular relaxation/contraction system. The therapeutic effects of tetracyclines and analogues were studied in rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis and autoimmune diseases autoimmune diseases such as rheumatoid arthritis and scleroderma. In addition, downregulation of MMP using doxycycline could be beneficial in reducing vascular dysfunction mediated by MMPs and progressive damage of the vascular wall. We review the nonantibiotic properties of doxycycline and its potential clinical applications.
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Perret LJ, Tait CP. Non-antibiotic properties of tetracyclines and their clinical application in dermatology. Australas J Dermatol 2013; 55:111-8. [PMID: 23808657 DOI: 10.1111/ajd.12075] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022]
Abstract
Dermatologists have used tetracyclines since the 1950s to treat disorders that do not necessarily have an infectious aetiology. Their anti-inflammatory and anti-collagenase properties contribute significantly to their success in treating diseases such as rosacea and acne. This article reviews the non-antibiotic properties of tetracyclines and their clinical application in dermatology.
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Affiliation(s)
- Leanna J Perret
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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28
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Dixit S, Bradford J, Fischer G. Management of nonsexually acquired genital ulceration using oral and topical corticosteroids followed by doxycycline prophylaxis. J Am Acad Dermatol 2013. [DOI: 10.1016/j.jaad.2012.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Abstract
Acne and rosacea compromise a substantial portion of the dermatology clinical practice. Over the past century, many treatment modalities have been introduced with antibiotics playing a major role. Today, both oral and topical antibiotics are used in the management of acne and rosacea, with several novel formulations and/or combination regimens recently introduced. The latest studies suggest anti-inflammatory actions to be the most likely mechanism of antibiotics in acne and rosacea, shifting the focus to subantimicrobial-dose oral antibiotics and/or topical antibiotic regimens as the preferred first-line agents. Here we will discuss the most recent oral and topical antibiotic therapies available for treatment of acne and rosacea, with special focus on efficacy data, indication, dosing, and mechanism of action.
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30
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Mathers JJ, Flick SC, Cox LA. Longer-duration uses of tetracyclines and penicillins in U.S. food-producing animals: Indications and microbiologic effects. ENVIRONMENT INTERNATIONAL 2011; 37:991-1004. [PMID: 21435723 DOI: 10.1016/j.envint.2011.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 05/12/2023]
Abstract
We review and analyze regulatory categories for longer duration of use (defined as ≥ 7 day) tetracyclines (TCs) and penicillins (PNs) approved for U.S. livestock and poultry, together with scientific studies, surveillance programs and risk assessments pertaining to antimicrobial resistance. Indications listed on a government database were grouped into three broad categories according to the terminology used to describe their use: disease control (C), treatment (T) and growth improvement (G). Consistent with mostly therapeutic uses, the majority (86%) of listed indications had C and/or T terms. Several studies showed interruption of early disease stages in animals and modulation of intestinal microflora. Longer-duration exposures are consistent with bacteriostatic modes of action, where adequate exposure time as well as concentration is needed for sufficient antimicrobial activity. Other effects identified included reduced animal pathogen prevalence, toxin formation, inflammation, environmental impacts, improved animal health, reproductive measures, nutrient utilization, and others. Several animal studies have shown a limited, dose-proportionate, selective increase in resistance prevalence among commensal animal bacteria following longer-duration exposures. Pathogen surveillance programs showed overall stable or declining resistance trends among sentinel bacteria. Quantitative, microbiologically detailed resistance risk assessments indicate small probabilities of human treatment failure due to resistance under current conditions. Evaluations of longer-duration uses of TCs, PNs, and other antimicrobial classes used in food-producing animals should consider mechanisms of activity, known individual- and population-level health and waste reduction effects in addition to resistance risks.
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Pfeffer I, Borelli C, Zierhut M, Schaller M. Treatment of ocular rosacea with 40 mg doxycycline in a slow release form. J Dtsch Dermatol Ges 2011; 9:904-7. [DOI: 10.1111/j.1610-0387.2011.07723.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some patients. A range of treatment options are available but it is unclear which are the most effective. OBJECTIVES To assess the evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY In February 2011 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea. DATA COLLECTION AND ANALYSIS Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors. MAIN RESULTS Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. Only two studies assessed our primary outcome 'quality of life'.Pooled data from physician assessments in three trials provided some evidence that metronidazole was more effective compared to placebo (RR 1.95, 95% CI 1.48 to 2.56). Three trials provided data, based on participants' assessments, illustrating azelaic acid was more effective than placebo (RR 1.52, 95% CI 1.32 to 1.76).Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doses of doxycycline, but there was evidence of less adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54).One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea (for all outcomes). AUTHORS' CONCLUSIONS Although the majority of included studies were assessed as being at high or unclear risk of bias there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.5% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
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Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, B1-Q, Leiden, Netherlands, 2300 RC
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Briest W, Cooper TK, Tae HJ, Krawczyk M, McDonnell NB, Talan MI. Doxycycline ameliorates the susceptibility to aortic lesions in a mouse model for the vascular type of Ehlers-Danlos syndrome. J Pharmacol Exp Ther 2011; 337:621-7. [PMID: 21363928 DOI: 10.1124/jpet.110.177782] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The vascular form of Ehlers-Danlos syndrome (vEDS), a rare disease with grave complications resulting from rupture of major arteries, is caused by mutations of collagen type III [α1 chain of collagen type III (COL3A1)]. The only, recently proven, preventive strategy consists of the reduction of arterial wall stress by β-adrenergic blockers. The heterozygous (HT) Col3a1 knockout mouse has reduced expression of collagen III and recapitulates features of a mild presentation of the disease. The objective of this study was to determine whether changing the balance between synthesis and degradation of collagen by chronic treatment with doxycycline, a nonspecific matrix metalloproteinase (MMP) inhibitor, could prevent the development of vascular pathology in HT mice. After 3 months of treatment with doxycycline or placebo, 9-month-old HT or wild-type (WT) mice were subjected to surgical stressing of the aorta. A 3-fold increase in stress-induced aortic lesions found in untreated HT mice 1 week after intervention (cumulative score 4.5 ± 0.87 versus 1.3 ± 0.34 in WT, p < 0.001) was fully prevented in the doxycycline-treated group (1.1 ± 0.56, p < 0.001). Untreated HT mice showed increased MMP-9 activity in the carotid artery and decreased collagen content in the aorta; however, in doxycycline-treated animals there was normalization to the levels observed in WT mice. Doxycycline treatment inhibits the activity of tissue MMP and attenuates the decrease in the collagen content in aortas of mice haploinsufficient for collagen III, as well as prevents the development of stress-induced vessel pathology. The results suggest that doxycycline merits clinical testing as a treatment for vEDS.
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Affiliation(s)
- Wilfried Briest
- Laboratory of Cardiovascular Sciences, National Institute on Aging, Baltimore, Maryland, USA.
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Gu Y, Lee HM, Sorsa T, Simon SR, Golub LM. Doxycycline [corrected] inhibits mononuclear cell-mediated connective tissue breakdown. ACTA ACUST UNITED AC 2009; 58:218-25. [PMID: 19909341 DOI: 10.1111/j.1574-695x.2009.00625.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic periodontitis is the most common chronic inflammatory disease and has been associated with an increased risk for serious medical conditions including cardiovascular disease (CVD). Endotoxin (lipopolysaccharide), derived from periodontopathogens, can induce the local accumulation of mononuclear cells in the inflammatory lesion, increasing proinflammatory cytokines and matrix metalloproteinases (MMPs), resulting in the destruction of periodontal connective tissues including bone. In this study, we show that doxycycline, originally developed as a broad-spectrum tetracycline antibiotic (and, more recently, as a nonantimicrobial therapy for chronic inflammatory periodontal and skin diseases), can inhibit extracellular matrix degradation in cell culture mediated by human peripheral blood-derived monocytes/macrophages. The mechanisms include downregulation of cytokines and MMP-9 protein levels and the inhibition of the activities of both collagenase and MMP-9. These pleiotropic, but nonantibiotic, effects of doxycycline explain, at least in part, its therapeutic potential for various chronic inflammatory diseases including periodontitis, and may reduce the risks of systemic diseases (e.g. CVDs, less manageable diabetes) associated with this and other local diseases.
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Affiliation(s)
- Ying Gu
- Department of General Dentistry, Stony Brook University, Stony Brook, NY, USA.
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Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clin Cosmet Investig Dermatol 2009; 2:129-40. [PMID: 21436975 PMCID: PMC3047926 DOI: 10.2147/ccid.s4296] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Rosacea is a common, chronic, skin condition characterized by recurrent episodes of facial flushing, transient or persistent erythema, papules, pustules, and telangiectasias, in a symmetrical facial distribution. The etiology of rosacea remains unknown and this condition represents a therapeutic challenge because of its chronic nature, progression, potential for disfigurement and psychological impact. Although there is no curative therapy for rosacea, the most widely used systemic agents are oral tetracycline derivatives, including tetracycline, doxycycline, and minocycline. This article reviews the available evidence for the use of doxycycline, a second-generation tetracycline, in the treatment or rosacea.
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Affiliation(s)
- Sheila Valentín
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Adisbeth Morales
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Jorge L Sánchez
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Abimael Rivera
- Department of Dermatology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
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Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, Shalita AR, Lozada VT, Berson D, Finlay A, Goh CL, Herane MI, Kaminsky A, Kubba R, Layton A, Miyachi Y, Perez M, Martin JP, Ramos-E-Silva M, See JA, Shear N, Wolf J. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60:S1-50. [PMID: 19376456 DOI: 10.1016/j.jaad.2009.01.019] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 01/06/2009] [Accepted: 01/10/2009] [Indexed: 12/13/2022]
Abstract
The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.
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Affiliation(s)
- Diane Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, USA.
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Preshaw PM, Novak MJ, Mellonig J, Magnusson I, Polson A, Giannobile WV, Rowland RW, Thomas J, Walker C, Dawson DR, Sharkey D, Bradshaw MH. Modified-Release Subantimicrobial Dose Doxycycline Enhances Scaling and Root Planing in Subjects With Periodontal Disease. J Periodontol 2008; 79:440-52. [DOI: 10.1902/jop.2008.070375] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Christy B Doherty
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77005, USA
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Submicrobial Doxycycline and Rosacea. ACTA ACUST UNITED AC 2007; 33:78-81. [DOI: 10.1007/s12019-007-8003-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 11/30/1999] [Accepted: 02/07/2007] [Indexed: 11/25/2022]
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40
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Del Rosso JQ, Webster GF, Jackson M, Rendon M, Rich P, Torok H, Bradshaw M. Two randomized phase III clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline, USP capsules) administered once daily for treatment of rosacea. J Am Acad Dermatol 2007; 56:791-802. [PMID: 17367893 DOI: 10.1016/j.jaad.2006.11.021] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 11/07/2006] [Accepted: 11/15/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Doxycycline monotherapy at antimicrobial doses has been shown to be effective for the treatment of rosacea. OBJECTIVE To evaluate the efficacy and safety of once-daily anti-inflammatory dose doxycycline for the treatment of rosacea. METHODS In two phase III, parallel-group, multicenter, randomized, double-blind, placebo-controlled studies (studies 301 and 302), patients received 40-mg of controlled-release doxycycline (n = 269) or placebo (n = 268) for 16 weeks. The primary efficacy end point was the mean change from baseline in facial inflammatory lesion count. RESULTS The mean lesion count at baseline was approximately 20 in each study arm. At week 16, the mean change from baseline in lesion count in the active-treatment groups was -11.8 in study 301 and -9.5 in study 302 compared with -5.9 and -4.3, respectively, in the placebo groups (P < .001 for both comparisons). Anti-inflammatory dose doxycycline was well tolerated; the most common adverse events were nasopharyngitis (4.8%), diarrhea (4.4%), and headache (4.4%). LIMITATIONS In both studies, the reduction of inflammatory lesion counts did not plateau within the 16-week time frame in either treatment group. Rosacea is often treated for a period of months or years. The duration of the studies did not allow for assessment of safety beyond 16 weeks or whether the progressive improvement seen with active treatment would continue beyond 16 weeks. Neither study assessed the effect of treatment in patients with only erythematotelangiectatic (subtype 1) rosacea. CONCLUSION Once-daily anti-inflammatory dose doxycycline appears to be effective and safe for the treatment of rosacea.
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Affiliation(s)
- James Q Del Rosso
- Department of Dermatology, University of Nevada School of Medicine, and Touro University College of Osteopathic Medicine, Las Vegas, NV, USA.
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van Zuuren EJ, Gupta AK, Gover MD, Graber M, Hollis S. Systematic review of rosacea treatments. J Am Acad Dermatol 2007; 56:107-15. [PMID: 17190628 DOI: 10.1016/j.jaad.2006.04.084] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 04/13/2006] [Accepted: 04/15/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rosacea is a common chronic skin and ocular condition. It is unclear which treatments are most effective. We have conducted a Cochrane review of rosacea therapies. This article is a distillation of that work. OBJECTIVE We sought to assess the evidence for the efficacy and safety of rosacea therapies. METHODS Multiple databases were systematically searched. Randomized controlled trials in people with moderate to severe rosacea were included. Study selection, assessment of methodologic quality, data extraction, and analysis were carried out by two independent researchers. RESULTS In all, 29 studies met inclusion criteria. Topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95-12.06). Azelaic acid is more effective than placebo (odds ratio 2.45, 95% confidence interval 1.82-3.28). Firm conclusions could not be drawn about other therapies. LIMITATIONS The quality of the studies was generally poor. CONCLUSIONS There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.
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Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology B1-Q, Leiden University Medical Center, The Netherlands.
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Badgwell C, Rosen T. Cutaneous sarcoidosis therapy updated. J Am Acad Dermatol 2007; 56:69-83. [PMID: 17190623 DOI: 10.1016/j.jaad.2006.06.019] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 04/14/2006] [Accepted: 06/19/2006] [Indexed: 11/30/2022]
Abstract
The widely accepted standard therapy for cutaneous sarcoidosis includes corticosteroids, antimalarials, and methotrexate. However, a better understanding of the basic immunopathogenic properties of sarcoidosis has elucidated a number of steps critical to the persistence and progression of disease that may be vulnerable to treatment by targeted therapy. This article reviews both standard and newer therapeutic options for cutaneous sarcoidosis.
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Affiliation(s)
- Christy Badgwell
- Dermatology Department, Baylor College of Medicine, and Houston Veterans Affairs Medical Center, Texas, USA
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Abstract
Rosacea presents an enigma to patients and physicians alike. Although new insights and a plethora of therapies provide hope, the underlying etiology remains unknown. This assures a certain amount of frustration as available treatments temporize rather than cure the disease. This article examines the current state of knowledge regarding this fascinating entity.
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Affiliation(s)
- Ken Landow
- Division of Dermatology, Department of Medicine, University of Southern California School of Medicine, Los Angeles, CA, USA.
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Abstract
BACKGROUND Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective. OBJECTIVES To assess the evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were searched. Relevant manufacturers and experts were contacted. SELECTION CRITERIA Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the authors to have seriously flawed methodology were excluded. DATA COLLECTION AND ANALYSIS Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent authors. Disagreements were resolved by discussion and consensus. MAIN RESULTS The evidence provided by twenty-nine included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea were included. Pooled data from two trials involving 174 participants indicated that according to the participants, topical metronidazole is more effective than placebo (odds ratio (OR) 5.96, 95% confidence interval (CI) 2.95 to 12.06). Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70 to 80% versus 50% to 55% (OR 2.45, 95% CI 1.82 to 3.28). A within-patient trial of azelaic cream versus placebo could not be pooled with the other three studies, but also showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians, tetracycline was effective (OR 6.06, 95% CI 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. AUTHORS' CONCLUSIONS The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. Good RCTs looking at these treatments are urgently needed.
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Affiliation(s)
- E J van Zuuren
- Dermatology department B1-Q, Leiden University Medical Centre, Albinus dreef 2, Leiden, Netherlands, 2333 ZA.
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Abstract
Due to the development and release of newer topical formulations, the diagnosis and treatment of rosacea has received renewed attention over the past 3-5 years both in the literature and at medical symposia. Rosacea is a very common facial dermatosis. In the US, rosacea is estimated to affect > 14 million people, predominantly adults with approximately 60% of cases diagnosed before the age of 50. A frustrating aspect of the disease is its inherent chronicity punctuated with periods of exacerbation and relative remission. A variety of subtypes have been identified which correlate with clinical presentation. Although the pathogenesis of rosacea is poorly understood, multiple topical agents are available. The efficacy of topical therapy for rosacea relates primarily to reduction in inflammatory lesions (papules, pustules), decreased intensity of erythema, a reduction in the number and intensity of flares and amelioration of symptoms, which may include stinging, pruritus and burning. The list of main topical agents utilised for the treatment of rosacea include metronidazole, sulfacetamide-sulfur, azelaic acid and topical antibiotics (clindamycin, erythromycin). Depending on the severity at initial presentation, topical therapy may be combined with systemic antibiotic therapy (e.g., oral tetracycline derivative). Newer therapeutic choices primarily involve improved vehicle formulations, which demonstrate favourable skin tolerability and cosmetic elegance.
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Affiliation(s)
- James Q Del Rosso
- Department of Dermatology, University of Nevada School of Medicine, Las Vegas, Nevada, USA.
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Abstract
Rosacea is a common skin disease that frequently involves the eye. Although the pathogenesis of the disease remains undefined, recent findings suggest that an altered inflammatory response plays an important role in both cutaneous and ocular rosacea. Ocular manifestations include lid and ocular surface alterations. Chronic inflammation can lead to corneal vascularization, which may compromise vision. Treatment of ocular rosacea is aimed at preventing irritation of the ocular surface (e.g., lubricants, lid hygiene) and controlling inflammation with topical and systemic anti-inflammatory drugs. Systemic tetracyclines are the mainstay of treatment. These drugs act multifactorially by decreasing bacterial flora and the expression of matrix metalloproteinases, altering meibum secretion, inhibiting the production of bacterial lipases, and providing an immunomodulatory effect.
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Affiliation(s)
- Lenio S Alvarenga
- Department of Ophthalmology, University of California, Davis, California, USA
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Abstract
Diverticular disease of the colon is very common in developed countries with its prevalence increasing with age, varying from < 10% in those < 40 years of age, to an estimated 50-66% of patients > 80 years of age. Diverticulitis, defined as inflammation and/or infection associated with diverticula, is the most common clinical complication of this disorder, affecting an estimated 10-25% of patients with colonic diverticula. The therapeutic measures aim at putting the intestine 'at rest', thus resolving the infection, the consequences of the inflammation and preventing or limiting complications. For patients with severe and complicated diverticulitis, ampicillin, gentamicin, metronidazole, piperacillin and tazobactam are the antibiotics successfully used in clinical practice, whereas ciprofloxacin, metronidazole and more recently, rifaximin, have been successfully used in the treatment of uncomplicated diverticular disease. Mesalazine (alone or in association with antibiotics) and probiotics are the two latest therapies for the treatment of diverticulitis which have been developed in the last few years. In fact, the combination of mesalazine and an antibiotic showed significant superiority in improving the severity of symptoms, bowel habits and in preventing symptomatic recurrence of diverticulitis than antibiotics alone, but probiotics also seem to be effective in preventing recurrence of the disease. In light of the excellent results obtained in the treatment of inflammatory bowel disease and irritable bowel syndrome, it is probable that probiotics may be the future best treatment also for mild-to-moderate uncomplicated attacks of acute diverticulitis, especially if used with salycilates.
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Affiliation(s)
- Antonio Tursi
- Digestive Endoscopy Unit, Lorenzo Bonomo Hospital, Galleria Pisani, 4 70031 Andria (BA), Italy.
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