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Chang Q, Liu X, Wang P, Yang Y, Zhang L, Wang B, Wang X. IPL-PDT as an effective treatment for mild-to-moderate acne vulgaris: A prospective, single-center, self-controlled study. Photodiagnosis Photodyn Ther 2024; 46:103999. [PMID: 38336151 DOI: 10.1016/j.pdpdt.2024.103999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND High recurrence rate of mild-to-moderate acne vulgaris following traditional therapy poses a significant challenge. 5-Aminolaevulinic acid photodynamic therapy (ALA-PDT) with intense pulsed light (IPL) has emerged as a promising intervention. OBJECTIVES This study aimed to evaluate the efficacy and safety of IPL-PDT for the treatment of mild-to-moderate acne vulgaris. METHODS In this prospective, self-controlled study, eligible patients aged from 18 to 45 years old with Pillsbury grade Ⅰ-III facial acne were included. Patients were treated with three sessions of IPL-PDT at three-week interval, with follow-ups at 3 weeks and 2 months after the final treatment. RESULTS A total of 31 patients were enrolled. At 3 weeks post-treatment, the mean count of acne lesions decreased significantly (P < 0.001), with 87.1 % of patients achieving treatment success (defined as ≥ 75 % clearance rate of acne lesions). Recurrence rate at 2-month follow-up was 9.68 %. No severe adverse reactions were observed. LIMITATIONS This study is a single-center, self-controlled study. Multi-center study designed as randomize controlled trials involving a larger patient cohort is necessary. CONCLUSIONS IPL-PDT is a promising therapy for mild-to-moderate acne vulgaris, exhibiting high efficacy, minimal adverse effects, and a low recurrence rate.
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Affiliation(s)
- Qihang Chang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, P R China
| | - Xiaojing Liu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, P R China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, P R China
| | - Yutong Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, P R China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, P R China.
| | - Bo Wang
- Department of Dermatology, University of Michigan, 1500 E Medical Center DR SPC 5314, Ann Arbor, Michigan 48109, United States; Department of Dermatology, Avera Medical Group Dermatology Aberdeen, Aberdeen, South Dakota, United States.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai 200092, P R China.
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Cui H, Guo C, Wang Q, Feng C, Duan Z. A pilot study on the efficacy of topical lotion containing anti-acne postbiotic in subjects with mild -to -moderate acne. Front Med (Lausanne) 2022; 9:1064460. [PMID: 36569166 PMCID: PMC9780477 DOI: 10.3389/fmed.2022.1064460] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Acne can compromise facial esthetics and become a mental burden, especially when it occurs in puberty. Skincare cosmetics with anti-acne efficiency is more convenient than other treatment modalities, such as dietary supplements, in certain circumstances. The purpose of this study was to investigate the efficacy of an anti-acne lotion in alleviating acne. Methods In our study, an anti-acne lotion containing ferment lysate produced by Lactiplantibacillus plantarum VHProbi® E15 were applied to subjects with mild -to -moderate acne over 4 weeks. The efficacy was evaluated based on instrumental measurements using Visia®-CR and CK-MPA® system. Results and discussion The anti-acne lotion exhibited favorable safety, meeting the stringent criteria for the detection of microbes, heavy metals, toxicity, and irritation. After 2 weeks of treatment, a statistically significant improvement in acne lesions was observed compared to baseline (P < 0.01), and this continued to the end of the study. After 4 weeks of treatment, the transepidermal water loss (P < 0.05) and sebum production (P < 0.05) were significantly decreased in subjects compared to baseline. In addition, the pore/area of interest (AOI) and stratum corneum hydration displayed slightly positive changes throughout treatment. Thus, we conclude that applying topical anti-acne lotion may be safe and confer effective benefits in people with mild -to -moderate acne and represents a promising therapeutic option for acne.
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Costa CS, Bagatin E, Yang Z, Pacheco RL, Magin P, de Sá Urtiga Santos L, Pereira T, Riera R. Systemic pharmacological treatments for acne: an overview of systematic reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd014917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Caroline S Costa
- Department of Specialised Medicine, Discipline of Dermatology; Universidade Federal do Piaui; Teresina Brazil
| | - Ediléia Bagatin
- Department of Dermatology; Universidade Federal de São Paulo; São Paulo Brazil
| | - Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care; School of Clinical Medicine, University of Cambridge; Cambridge UK
| | - Rafael L Pacheco
- Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde (NEP-SBEATS); Universidade Federal de São Paulo; São Paulo Brazil
| | - Parker Magin
- Discipline of General Practice, School of Medicine and Public Health; The University of Newcastle; Newcastle Australia
| | | | - Tiago Pereira
- International Research Center HAOC. Health Technology Assessment Unit; São Paulo Brazil
| | - Rachel Riera
- Cochrane Brazil Rio de Janeiro; Cochrane; Petrópolis Brazil
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4
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Bagatin E, Rocha MADD, Freitas THP, Costa CS. Treatment challenges in adult female acne and future directions. Expert Rev Clin Pharmacol 2021; 14:687-701. [PMID: 33957838 DOI: 10.1080/17512433.2021.1917376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Acne is a chronic, inflammatory, and immune-mediated disease of the pilosebaceous unit, highly prevalent in adolescents. However, an increasing number of adults over 25 years old with facial acne, particularly women, have been observed. It is considered a different disease when compared to acne vulgaris. Face is the mainly involved area with inflammatory lesions and more sensitive skin, pointing out the need of a holistic approach.Areas covered: We performed a comprehensive literature search on PubMed database, up to January 2021, regarding adult female acne. We synthesized data about pathogenesis; differences compared to acne vulgaris; and treatment, with focus in the management challenges and perspectives.Expert opinion: It is essential to value the negative impact on quality of life of adult female acne, independently of severity. The disease has prolonged evolution, and patient might be resilient once the improvement, regardless of the treatment option, will just be noticeable after 3 months. Aggravating factors should be clearly discussed, such as the need of changing many habits, especially lesions manipulation. The therapeutic regimen includes make-up and tailored skin care (considering proneness to sensitivity), while anti-acne drugs should be chosen in accordance with desire to be pregnant, presence of pregnancy or breastfeeding.
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Affiliation(s)
| | | | | | - Caroline Sousa Costa
- Department of Specialized Medicine, Discipline of Dermatology - Universidade Federal Do Piauí, Teresina, Brazil
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5
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Karadag AS, Aslan Kayıran M, Wu CY, Chen W, Parish LC. Antibiotic resistance in acne: changes, consequences and concerns. J Eur Acad Dermatol Venereol 2020; 35:73-78. [PMID: 32474948 DOI: 10.1111/jdv.16686] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
Antibiotic resistance in acne was first observed in the 1970s and has been a major concern in dermatology since the 1980s. The resistance rates and types of antimicrobials have subsequently shown great variations in regions and countries. Illustrative of this is the resistance to topical erythromycin and clindamycin which continues to be a problem worldwide, while resistance to systemic treatment with tetracyclines has remained low during the past decade. The resistance for the newer macrolides like azithromycin and clarithromycin has been increasing. The results of antibiotic resistance may include treatment failure of acne, disturbance of skin microbiota, induction of opportunistic pathogens locally and systemically, and dissemination of resistant strains to both healthcare personnel and the general population. The ensuing complications, such as aggravated opportunistic infections caused by Propionibacterium acnes and the emergence of multiresistant superbugs, have not yet been confirmed.
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Affiliation(s)
- A S Karadag
- Department of Dermatology and Venereology, School of Medicine, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - M Aslan Kayıran
- Department of Dermatology and Venereology, School of Medicine, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - C-Y Wu
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - W Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - L C Parish
- Department of Dermatology and Cutaneous Biology and Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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6
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An update on formulation strategies of benzoyl peroxide in efficient acne therapy with special focus on minimizing undesired effects. Int J Pharm 2020; 578:119074. [PMID: 31982561 DOI: 10.1016/j.ijpharm.2020.119074] [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: 12/08/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/22/2022]
Abstract
Benzoyl peroxide (BPO) in the form of over the counter monotherapeutics or prescription-only combinations is a key component of topical acne therapy, but its unfavourable side effect profile reduces the therapeutic value of this compound. Various galenic approaches have been pursued to resolve this ambivalence, but only a few have managed to enter the market. This article aims to give a comprehensive overview of the published experimental vehicle systems and to identify the fundamental rationales. With regard to the formulation, an increase in the tolerability of BPO can essentially be achieved by combining BPO with re-fattening and moisturizing substances, by incorporating it and controlling its release, as well as by targeted deposition of the active ingredient at the site of action, i.e. drug targeting. Recently, novel particulate formulations have been proposed that combine several of these design principles and are expected to bring new developments in this dynamic field of research.
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7
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Asadi A, Abdi M, Kouhsari E, Panahi P, Sholeh M, Sadeghifard N, Amiriani T, Ahmadi A, Maleki A, Gholami M. Minocycline, focus on mechanisms of resistance, antibacterial activity, and clinical effectiveness: Back to the future. J Glob Antimicrob Resist 2020; 22:161-174. [PMID: 32061815 DOI: 10.1016/j.jgar.2020.01.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/17/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The increasing crisis regarding multidrug-resistant (MDR) and extensively drug-resistant microorganisms leads to appealing therapeutic options. METHODS During the last 30 years, minocycline, a wide-spectrum antimicrobial agent, has been effective against MDR Gram-positive and Gram-negative bacterial infections. As with other tetracyclines, the mechanism of action of minocycline involves attaching to the bacterial 30S ribosomal subunit and preventing protein synthesis. RESULTS This antimicrobial agent has been approved for the treatment of acne vulgaris, some sexually transmitted diseases and rheumatoid arthritis. Although many reports have been published, there remains limited information regarding the prevalence, mechanism of resistance and clinical effectiveness of minocycline. CONCLUSION Thus, we summarize here the currently available data concerning pharmacokinetics and pharmacodynamics, mechanism of action and resistance, antibacterial activity and clinical effectiveness of minocycline.
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Affiliation(s)
- Arezoo Asadi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Abdi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Pegah Panahi
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Ahmadi
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abbas Maleki
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehrdad Gholami
- Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Affiliation(s)
- Ulrich P Wehry
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Deutschland.
| | - Norman-Philipp Hoff
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Deutschland
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9
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Balato A, Cacciapuoti S, Di Caprio R, Marasca C, Masarà A, Raimondo A, Fabbrocini G. Human Microbiome: Composition and Role in Inflammatory Skin Diseases. Arch Immunol Ther Exp (Warsz) 2018; 67:1-18. [PMID: 30302512 DOI: 10.1007/s00005-018-0528-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022]
Abstract
This review focuses on recent evidences about human microbiome composition and functions, exploring the potential implication of its impairment in some diffuse and invalidating inflammatory skin diseases, such as atopic dermatitis, psoriasis, hidradenitis suppurativa and acne. We analysed current scientific literature, focusing on the current evidences about gut and skin microbiome composition and the complex dialogue between microbes and the host. Finally, we examined the consequences of this dialogue for health and skin diseases. This review highlights how human microbes interact with different anatomic niches modifying the state of immune activation, skin barrier status, microbe-host and microbe-microbe interactions. It also shows as most of the factors affecting gut and skin microorganisms' activity have demonstrated to be effective also in modulating chronic inflammatory skin diseases. More and more evidences demonstrate that human microbiome plays a key role in human health and diseases. It is to be expected that these new insights will translate into diagnostic, therapeutic and preventive measures in the context of personalized/precision medicine.
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Affiliation(s)
- Anna Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, NA, Italy
| | - Sara Cacciapuoti
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, NA, Italy.
| | - Roberta Di Caprio
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, NA, Italy
| | - Claudio Marasca
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, NA, Italy
| | - Anna Masarà
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, NA, Italy
| | - Annunziata Raimondo
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, NA, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, NA, Italy
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10
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Gollnick H, Abanmi A, Al-Enezi M, Al Hammadi A, Galadari I, Kibbi AG, Zimmo S. Managing acne in the Middle East: consensus recommendations. J Eur Acad Dermatol Venereol 2017; 31 Suppl 7:4-35. [DOI: 10.1111/jdv.14491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- H. Gollnick
- Universitätsklinik für Dermatologie und Venerologie; Otto-von-Guericke Universität; Magdeburg Germany
| | - A.A. Abanmi
- Dr Sulaiman Al Habib Hospital; Riyadh Saudi Arabia
| | | | | | - I. Galadari
- Faculty of Medicine; United Arab Emirates University; Dubai UAE
| | - A.-G. Kibbi
- American University of Beirut Medical Center; Beirut Lebanon
| | - S. Zimmo
- King Abdulaziz University; Jeddah Saudi Arabia
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11
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Abstract
BACKGROUND To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences. OBJECTIVE The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne. METHODS A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study. RESULTS Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone. CONCLUSION This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.
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12
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Ryan-Kewley AE, Williams DR, Hepburn N, Dixon RA. Non-antibiotic Isotretinoin Treatment Differentially Controls Propionibacterium acnes on Skin of Acne Patients. Front Microbiol 2017; 8:1381. [PMID: 28790988 PMCID: PMC5524737 DOI: 10.3389/fmicb.2017.01381] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/07/2017] [Indexed: 02/04/2023] Open
Abstract
Emergence and potential transfer of antibiotic resistance in skin microorganisms is of current concern in medicine especially in dermatology contexts where long term treatment with antibiotics is common. Remarkably, non-antibiotic therapy in the form of isotretinoin – a non-antimicrobial retinoid is effective at reducing or eradicating the anaerobe Propionibacterium acnes which is causally involved in the complex pathogenesis of Acne vulgaris. This study measured the extent of colonization of P. acnes in patients with primary cystic or severe acne from three defined skin sites in ‘non-lesion’ areas before, during and after treatment with isotretinoin. Patients attending acne clinics were investigated using standardized skin sampling techniques and the recovery of anaerobic P. acnes from 56 patients comprising 24 females and 32 males (mean age 22 years, age range 15–46 years) who were given a standard course of isotretinoin (1 mg/kg/day) are reported. P. acnes cultured from the external cheek surface of patients following treatment showed a significant reduction (1–2 orders of magnitude) compared with their pre-treatment status. Interestingly, other distinct sites (nares and toe web) failed to show this reduction. In addition, high levels of antibiotic-resistant P. acnes were recorded in each patients’ skin microbiota before, during and after treatment. In this study, microbial composition of the skin appears substantially altered by isotretinoin treatment, which clearly has differential antimicrobial effects on each anatomically distinct site. Our study confirmed that orally administered isotretinoin shows good efficacy in the resolution of moderate to severe acne that correlates with reductions in the number of P. acnes on the skin, including resistant isolates potentially acquired from previous treatments with antibiotics. Our study suggests that the role of tetracycline’s and macrolides, which are currently first line treatments in dermatology, might be reserved for severe or life-threatening infections since current antibiotic stewardship guidelines from medical departments no longer prescribe these antibiotics for routine use.
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Affiliation(s)
- Angela E Ryan-Kewley
- School of Health Sciences, Manchester Metropolitan UniversityManchester, United Kingdom.,Joseph Banks Laboratories, School of Life Sciences, University of LincolnLincoln, United Kingdom
| | - David R Williams
- Joseph Banks Laboratories, School of Life Sciences, University of LincolnLincoln, United Kingdom
| | - Neill Hepburn
- Dermatology Department, Lincoln County HospitalLincoln, United Kingdom
| | - Ronald A Dixon
- Joseph Banks Laboratories, School of Life Sciences, University of LincolnLincoln, United Kingdom
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13
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Santer M, Chandler D, Lown M, Francis NA, Muller I. Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums. Br J Dermatol 2017; 177:751-757. [PMID: 28218972 DOI: 10.1111/bjd.15398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acne vulgaris is common and can significantly impair quality of life, yet little is known about patients' understanding of acne and its treatments. Oral antibiotics are widely used for acne despite concerns about antibiotic resistance. People are increasingly turning to online discussion forums for advice, and information on these sites may influence health beliefs and treatment adherence. OBJECTIVES To explore understandings about the use of oral antibiotics for acne and advice shared among messages posted on online forums. METHODS We systematically searched for online forums and identified four where acne was frequently discussed. Discussion threads relating to oral antibiotics were analysed thematically. RESULTS We extracted 136 pages of data comprising 65 discussions among 294 participants. We found a wide range of perceptions around effectiveness of antibiotics for acne and concerns about adverse effects. The delayed onset of action of antibiotics was a source of frustration and compounded dissatisfaction with healthcare providers, who were perceived by people as 'fobbing them off' with prolonged courses of ineffective treatment. Advice ranged from when to ask for or insist on referral to use of costly cleansers. Forum posts related to a wide range of severities, from 'spots' to severe acne, which may make it confusing for users to assess appropriateness of information. CONCLUSIONS Online forums offer opinions that could confuse patients, or lead to early abandonment of treatments, challenging consultations and patient dissatisfaction. Users expressed frustration about the delayed onset of action of antibiotics for acne, perceptions of only temporary effectiveness and adverse effects.
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Affiliation(s)
- M Santer
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - D Chandler
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - M Lown
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - N A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, U.K
| | - I Muller
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
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14
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Harris VR, Cooper AJ. Modern management of acne. Med J Aust 2017; 206:41-45. [DOI: 10.5694/mja16.00516] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
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15
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Del Rosso JQ, Zeichner JA. The Clinical Relevance of Antibiotic Resistance: Thirteen Principles That Every Dermatologist Needs to Consider When Prescribing Antibiotic Therapy. Dermatol Clin 2017; 34:167-73. [PMID: 27015776 DOI: 10.1016/j.det.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antibiotics are commonly used by dermatologists in clinical practice, primarily because of the overall track record of favorable efficacy and safety with the most commonly used agents. During the past decade, increased attention has been given to the problems associated with antibiotic resistance. This article summarizes important principles gleaned from the continued efforts of the Scientific Panel on Antibiotic Use in Dermatology; other groups working diligently in this area, such as the Centers for Disease Control and Prevention and the Canadian Antimicrobial Resistance Alliance; and from the published literature.
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Affiliation(s)
- James Q Del Rosso
- Dermatology, Touro University Nevada, 874 American Pacific Drive, Henderson, NV 89014, USA.
| | - Joshua A Zeichner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98 Street, 5th Floor, New York, NY 10029, USA
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16
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Kuhn KG, Laursen M, Hammerum AM, Skov RL. High consumption of tetracyclines for acne treatment among young Danish adults. Infect Dis (Lond) 2016; 48:808-12. [PMID: 27385460 DOI: 10.1080/23744235.2016.1205214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Tetracyclines are used as acne treatment in adolescents worldwide. A large increase in the consumption of antimicrobial agents in Danish primary health care was recently linked to high levels of tetracycline use in adolescents. METHODS Here we closely examine how demographic factors influenced tetracycline use from 2005 to 2014 using consumption data from primary health care expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID) and number of persons treated per 1000 inhabitants. RESULTS From 2005 to 2013, tetracycline consumption increased by 54% followed by a decrease of 14% in 2014. Increases were especially pronounced in persons aged 15-39 years where nearly 9000 additional persons were treated with tetracyclines. CONCLUSIONS This study shows a long-lasting high consumption of tetracyclines in young Danes with a notable recent decrease breaking the otherwise worrying trend. To obtain a further decrease, focus on public awareness and suitable acne treatment guidelines are highly important.
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Affiliation(s)
- Katrin Gaardbo Kuhn
- a Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology & Infection Control , Statens Serum Institut , Copenhagen , Denmark ;,b Department of Infectious Disease Epidemiology , Statens Serum Institut , Copenhagen , Denmark
| | - Maja Laursen
- c Data Communication and Research Services, Danish Health Data Authority , Copenhagen , Denmark
| | - Anette M Hammerum
- a Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology & Infection Control , Statens Serum Institut , Copenhagen , Denmark
| | - Robert L Skov
- a Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology & Infection Control , Statens Serum Institut , Copenhagen , Denmark
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17
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Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. THE LANCET. INFECTIOUS DISEASES 2016; 16:e23-33. [PMID: 26852728 DOI: 10.1016/s1473-3099(15)00527-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
Abstract
Topical and oral antibiotics are routinely used to treat acne. However, antibiotic resistance is increasing, with many countries reporting that more than 50% of Propionibacterium acnes strains are resistant to topical macrolides, making them less effective. We reviewed the current scientific literature to enable proposal of recommendations for antibiotic use in acne treatment. References were identified through PubMed searches for articles published from January, 1954, to March 7, 2015, using four multiword searches. Ideally, benzoyl peroxide in combination with a topical retinoid should be used instead of a topical antibiotic to minimise the impact of resistance. Oral antibiotics still have a role in the treatment of moderate-to-severe acne, but only with a topical retinoid, benzoyl peroxide, or their combination, and ideally for no longer than 3 months. To limit resistance, it is recommended that benzoyl peroxide should always be added when long-term oral antibiotic use is deemed necessary. The benefit-to-risk ratio of long-term antibiotic use should be carefully considered and, in particular, use alone avoided where possible. There is a need to treat acne with effective alternatives to antibiotics to reduce the likelihood of resistance.
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Affiliation(s)
- Timothy R Walsh
- Department of Medical Microbiology and Infectious Diseases, Heath Hospital, Cardiff, UK.
| | | | - Brigitte Dréno
- Department of Dermatology, Nantes University Hospital, Nantes, France
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Fan Y, Hao F, Wang W, Lu Y, He L, Wang G, Chen W. Multicenter cross-sectional observational study of antibiotic resistance and the genotypes of Propionibacterium acnes isolated from Chinese patients with acne vulgaris. J Dermatol 2015; 43:406-13. [PMID: 26508505 DOI: 10.1111/1346-8138.13149] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
Abstract
Antibiotics are widely applied in management of acne vulgaris, which raises the issue of antibiotic resistance. Due to improper application and supervision of antibiotics, antibiotic resistance has become a serious problem in China. So, the efficacy of antimicrobial therapy in acne is unclear without an objective monitor of antibiotic resistance of Propionibacterium acnes. This cross-sectional, multicenter observational study is aimed at understanding the status of antibiotic resistance in P. acnes, investigating the measures of acne management in China and analyzing the genotypes of antibiotic-resistant strains of P. acnes. Altogether, 312 strains of P. acnes were collected from patients in five medical centers across central China after reviewing the corresponding medical history in detail. The samples underwent antibiotic susceptibility assays by agar dilution method with a total of 11 classes of antibiotics being tested. The antibiotic-resistant strains were screened and further analyzed by investigation of the genotypes regarding 23S rRNA, 16S rRNA and erm(X). The predominant resistance occurred in macrolides and lincomycin with an overall resistance rate of 47.8%. The resistance to tetracyclines was scarce with only two cases identified. The emergence of minimum inhibitory concentration elevation for tetracyclines is associated with its application history (P < 0.005). The genotypes of the reported macrolide-lincosamide-streptogramin B resistance strains were also spotted in Chinese subjects while other resistance determinants may also exist. The tetracyclines have been proved to be vastly susceptible while macrolides and lincomycin face a serious resistance status in China.
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Affiliation(s)
- Yukun Fan
- Department of Dermatology and Venereology, Southwest Hospital Affiliated to The Third Military Medical University, Chongqing, China
| | - Fei Hao
- Department of Dermatology and Venereology, Southwest Hospital Affiliated to The Third Military Medical University, Chongqing, China
| | - Weizhen Wang
- Department of Dermatology, The First Hospital of Wuhan, Tongji Medical College, Wuhan, China
| | - Yonghong Lu
- Department of Dermatology and Venereology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Li He
- Department of Dermatology and Venereology, The First Hospital Affiliated to The Kunming Medical University, Kunming, China
| | - Gang Wang
- Department of Dermatology and Venereology, Xijing Hospital Affiliated to The Fourth Military Medical University, Xi'an, China
| | - Wenchieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
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Sardana K, Gupta T, Garg VK, Ghunawat S. Antibiotic resistance toPropionobacterium acnes: worldwide scenario, diagnosis and management. Expert Rev Anti Infect Ther 2015; 13:883-96. [DOI: 10.1586/14787210.2015.1040765] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sparavigna A, Tenconi B, De Ponti I, La Penna L. An innovative approach to the topical treatment of acne. Clin Cosmet Investig Dermatol 2015; 8:179-85. [PMID: 25914552 PMCID: PMC4399783 DOI: 10.2147/ccid.s82859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acne is characterized by primary lesions on the face, chest, and back, and by a variety of other signs and symptoms. In particular, acne inflammatory lesions result from Propionibacterium acnes colonization and are of particular relevance as they can cause permanent scarring. Acne also causes significant psychological morbidity in affected patients. Products currently available for the treatment of acne include systemic and topical treatments. As these products can cause severe side effects, new, innovative therapies are needed. Farmaka Acne Cream (FAC) is a novel, film-forming cream developed to treat mild and moderate acne. In vitro studies have demonstrated that FAC is as effective as 5% benzoyl peroxide in inhibiting growth of P. acnes. In 32 subjects with mild or moderate acne, FAC reduced all the major signs and symptoms of the disease. These included itching, erythema, and scaling, as well as reductions in the numbers of papules, pustules, and open and closed comedones. Acne severity improved in 38% of subjects, while none worsened. FAC was found to be effective in controlling sebum secretion, and was non-comedogenic. Most subjects (90%) reported tolerability as good or very good, while clinical efficacy and cosmetic acceptability were judged as good. For assessment of contact sensitization and photosensitization, FAC was applied daily to the backs of 29 subjects in two symmetric areas for 10 days. Using a solar stimulator, one minimal erythema dose was delivered to one side of the back from days 11 to 13. The four different subareas of treated/untreated and irradiated/nonirradiated and combinations thereof were compared. No cases of contact sensitization or photosensitization were observed, and FAC is considered safe for use in intense sunlight. In vitro and in vivo studies provide evidence for the safety and clinical benefits of FAC, a promising candidate for the treatment of mild and moderate acne.
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Affiliation(s)
- Adele Sparavigna
- DermIng srl, Clinical Research and Bioengineering Institute, Monza, MB, Italy
| | - Beatrice Tenconi
- DermIng srl, Clinical Research and Bioengineering Institute, Monza, MB, Italy
| | - Ileana De Ponti
- DermIng srl, Clinical Research and Bioengineering Institute, Monza, MB, Italy
| | - Laura La Penna
- DermIng srl, Clinical Research and Bioengineering Institute, Monza, MB, Italy
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Kwon PS. Antimicrobial Effects of Photodynamic Therapy Using Blue Light Emitting Diode with Photofrin and Radachlorine against Propionibacterium acnes. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2015. [DOI: 10.15324/kjcls.2015.47.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Pil-Seung Kwon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan 570-750, Korea
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Smirnova IO, Karachevtseva MA, Mikhailov SM, Kulikova YA, Kolova IS, Smirnova TS, Dudko VY, Petunova YG, Shin NV. Rendering medical aid to acne patients. Results of an expert examination of the quality of medical aid. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-1-76-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Goal. To obtain information on typical errors in medical aid rendered to acne patients in dermatovenerology dispensaries in St. Petersburg in order to develop measures to improve the quality of medical aid rendered to this group of patients. Materials and methods. The authors conducted a special expert examination of 55 patients with acne who received treatment at St. Petersburg dermatovenerology dispensaries in 2013. The quality of medical aid was assessed using the Automated Expert Examination Technique (hereinafter referred to as AEET). Major results. The percentage of cases when medical aid of due quality was rendered to acne patients was 49%. Treatment and diagnostics errors prevailed in the structure of errors in medical aid. Errors in treatment were mainly a wrong combination of drugs, simultaneous administration of external and systemic antibacterial drugs, delayed comedolytic therapy and pathogenically infeasible therapy. Errors in diagnostics included absence of indications of the form and/or severity of acne. The most important error in the collection of information was absence of gynecology examinations for women to determine whether peroral contraceptives were necessary including in case of the administration of isotretinoin. Conclusion. The similarity of errors in medical aid rendered for acne as well as high percentage of errors relating to medical aid rendered to patients demand the development of consistent measures to improve the quality of medical aid rendered to such patients and repeated expert examination using preliminary (prompt) control of the quality of medical aid.
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Kawashima M, Hashimoto H, Alió Sáenz A, Ono M, Yamada M. Clindamycin phosphate 1·2%-benzoyl peroxide 3·0% fixed-dose combination gel has an effective and acceptable safety and tolerability profile for the treatment of acne vulgaris in Japanese patients: a phase III, multicentre, randomised, single-blinded, acti. Br J Dermatol 2015; 172:494-503. [DOI: 10.1111/bjd.13265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 12/19/2022]
Affiliation(s)
- M. Kawashima
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
| | - H. Hashimoto
- Biomedical Data Science; Japan Development and Medical Affairs; GlaxoSmithKline K.K.; Tokyo Japan
| | - A.B. Alió Sáenz
- Medicines Development R&D; Stiefel, A GSK Company, Research Triangle Park; NC U.S.A
| | - M. Ono
- Business Innovation; GlaxoSmithKline K.K.; Tokyo Japan
| | - M. Yamada
- Medicines Development; Japan Development and Medical Affairs; GlaxoSmithKline K.K.; Tokyo Japan
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Li C, Yuan K, Schluesener H. Impact of minocycline on neurodegenerative diseases in rodents: a meta-analysis. Rev Neurosci 2014; 24:553-62. [PMID: 24077620 DOI: 10.1515/revneuro-2013-0040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/09/2013] [Indexed: 11/15/2022]
Abstract
Minocycline is a semisynthetic second-generation tetracycline derivative, and many publications provide evidence of its successful neuroprotection in a variety of animal models. We searched PubMed and Chinese CNKI databases from January 1992 to May 2012 for studies on minocycline in neurodegenerative diseases in rodents. A meta-analysis that adopted weighted Cohen's d effect sizes, percent overlap, Fail-Safe N statistics, and confidence intervals was conducted. In total, 16 English and 3 Chinese articles with high or medium quality were included in this meta-analysis. The treatment benefits for rodents from low-dose (5 mg/kg/day), moderate-dose (45, 50, or 55 mg/kg/day), and high-dose (90 mg/kg/day) minocycline were larger in Huntington's disease, Alzheimer's disease, and stroke mouse models, respectively. In rats, a moderate dose (45 mg/kg/day) of minocycline was most effective. In conclusion, minocycline exerts neuroprotective effects in rodent models of neurodegenerative diseases. Anti-inflammatory, antiapoptotic, and antioxidant activities are discussed as the basis of this effect. However, there is insufficient information from these animal models on side effects of minocycline therapy.
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KUBANOVA AA, ARAVIYSKAYA YER, SOKOLOVSKY YEV, DVOROVA YEK, FADEYEVA YEI. Systemic treatment of severe forms of acne: experience of using Isotretinoin in the Russian Federation. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the results of a large-scale Russian program of the follow-up and treatment of acne patients with Isotretinoin (Roaccutane). The analysis of the results included information about 1,349 acne patients. In 71% of patients, the therapy was initiated at the dose of 0.5-1.0 mg/kg of the body weight. The average duration of treatment was 21.5±0.16 weeks while the average course dose was 119.9±0.8 mg/kg of the body weight. As many as 96% of patients achieved a positive result; women demonstrated a higher improvement rate than men. On the whole, Roaccutane was well-tolerated while adverse effects included dry lips (43.4%), dry skin in different areas (12.45%), retinoid dermatitis (6.45%), epistaxis (2.45%), conjunctivitis (1.41%) and hoarseness (0.22%). The Russian experience of using Roaccutane confirmed high efficacy of the systemic therapy for severe forms of acne.
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Abstract
Among the current treatments available for acne vulgaris, many widely practiced options lack support from studies at the best level of scientific evidence. The aim of this narrative review was to present the very latest information on topical and systemic treatments for acne vulgaris. Information from systematic reviews and well-designed clinical trials, obtained through a systematic search of the major medical databases, is emphasized. There are important issues regarding the clinical management of acne that still lack consistent grounding in scientific evidence. Among these are the optimum dose and duration of treatment with oral antibiotics that can be given without inducing bacterial resistance, and the safety of oral isotretinoin.
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Abdel Fattah NSA, Darwish YW. In vitro antibiotic susceptibility patterns of Propionibacterium acnes isolated from acne patients: an Egyptian university hospital-based study. J Eur Acad Dermatol Venereol 2012; 27:1546-51. [PMID: 23279041 DOI: 10.1111/jdv.12057] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antibiotics have been used for more than 40 years against Propionibacterium acnes (P. acnes), the most common agent of acne. Antibiotic resistance to this bacterium becomes a worldwide problem in recent years. No studies are available on antibiotic susceptibility patterns of P. acnes among Egyptian acne patients. OBJECTIVE To determine antibiotic susceptibility patterns of P. acnes isolated from acne patients attending the Dermatology outpatient clinic of an Egyptian university hospital to the most commonly prescribed antibiotics and to determine the difference in relation to age of patients, disease duration and previous antibiotic therapy for acne. METHODS Cutaneous samples were obtained from pustular acne lesions on the face of 115 patients, which were cultured in anaerobic media to demonstrate the presence of P. acnes. Antibiotic susceptibility tests of isolated P. acnes were then performed to clindamycin, erythromycin, azithromycin, oxytetracycline and doxycycline by disk diffusion method. RESULTS Propionibacterium acnes was isolated from 98 patients. Eighty-nine isolates were susceptible to azithromycin, followed by doxycycline and oxytetracycline isolated from 82 and 72 patients respectively. Resistance of P. acnes to clindamycin was detected in 65 patients, followed by erythromycin in 48 patients. Comparing the antibiotic susceptibility patterns of P. acnes isolated from patients with and without previous antibiotic therapy for acne revealed statistically non-significant differences as regards any of the antibiotics tested except for clindamycin and erythromycin. Statistically non-significant differences existed between antibiotic susceptibility patterns of P. acnes to all tested antibiotics regarding age of patients (< or ≥ 20 years) and disease duration (< or ≥ 2 years). CONCLUSION Propionibacterium acnes in vitro susceptibility patterns differed among Egyptian patients to the commonly prescribed antibiotics with the highest to lowest resistance to clindamycin, erythromycin, oxytetracycline, doxycycline and azithromycin.
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Affiliation(s)
- N S A Abdel Fattah
- Departments of Dermatology & VenereologyClinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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28
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Gamble R, Dunn J, Dawson A, Petersen B, McLaughlin L, Small A, Kindle S, Dellavalle RP. Topical antimicrobial treatment of acne vulgaris: an evidence-based review. Am J Clin Dermatol 2012; 13:141-52. [PMID: 22268388 DOI: 10.2165/11597880-000000000-00000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Topical antimicrobial treatment is indicated for mild to moderate acne vulgaris. Our literature review includes searches of Ovid, MEDLINE, EMBASE, and the databases of the Cochrane Library. A detailed search strategy is included. All searches were limited to controlled trials and systematic reviews. No year limits were applied to the searches, but we focused on trials, guidelines, and reviews published since 2004, the year that the last review of topical antimicrobials was published in this journal. Several controlled trials demonstrate that benzoyl peroxide, topical antibiotics, and topical retinoids used in combination provide the greatest efficacy and safety profile for the treatment of mild to moderate acne, but there are few trials directly comparing different combinations of these topical therapies with one another. Additionally, robust studies comparing cost and efficacy of generic combinations of the above agents with proprietary fixed-dose combination therapies that may increase compliance are also lacking. Although they have not been extensively studied, alternative agents including dapsone, salicylic acid, azelaic acid, and zinc are safe and efficacious when combined with traditional therapies.
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29
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Toyne H, Webber C, Collignon P, Dwan K, Kljakovic M. Propionibacterium acnes (P. acnes) resistance and antibiotic use in patients attending Australian general practice. Australas J Dermatol 2012; 53:106-11. [PMID: 22571557 DOI: 10.1111/j.1440-0960.2011.00867.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Antibiotic resistance in the community, including transfer between bacteria, is a growing concern for clinicians. Acne is commonly treated in general practice, sometimes with antibiotics. The aim of this study is to measure the rate of carriage of antibiotic resistant Propionibacterium acnes 10 years apart in general practice and the relationship of resistance to type of treatment, as well potential effects on other flora. METHODS Patients (N = 215) with acne presenting to Australian Capital Territory and south-eastern New South Wales general practices were swabbed for P. acnes in 1997-1998 and 2007. Clinical details were collected with questionnaires. In 2007 swabs were also taken for Staphylococcus aureus and Streptococcus pneumoniae. GP's diagnostic classification of acne was tested using a set of standard photographs. RESULTS Resistant P. acnes was isolated from 20 patients (9%) and the proportion that was resistant was the same in 1997-1998 and in 2007. Antibiotic use, particularly topical, was associated with P. acnes resistance. Resistance rates declined with the time elapsed since ceasing antibiotics. Use of retinoids was associated with a decreased chance of growing P. acnes (P = 0.008) but not with decreased resistance. Simultaneous resistance with S. aureus was not detected, but only in 30 patients was S. aureus isolated. CONCLUSIONS P. acnes resistance was similar in 1997-1998 and in 2007.The chance of a patient carrying a resistant strain of P. acnes is significantly greater with recent exposure to antibiotics, and clinicians should limit prescribing where possible. Resistance disappears rapidly after ceasing antibiotics. Cross resistance with other organisms was not detected in this study.
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Affiliation(s)
- Helen Toyne
- Academic Unit of General Practice and Community Health, Australian Capital Territory Health Directorate and Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
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Abstract
Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.
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Affiliation(s)
- Hywel C Williams
- Centre of Evidence-Based Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Luk NMT, Hui M, Lee HCS, Fu LH, Liu ZH, Lam LY, Eastel M, Chan YKA, Tang LSN, Cheng TS, Siu FYC, Ng SC, Lai YKD, Ho KM. Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong. J Eur Acad Dermatol Venereol 2011; 27:31-6. [PMID: 22103749 DOI: 10.1111/j.1468-3083.2011.04351.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been no study on antibiotic-resistant Propionibacterium acnes in Hong Kong. OBJECTIVE We investigated the prevalence and pattern of antibiotic-resistant P. acnes and to identify any associated factors for harbouring the resistant strains. METHODS Culture and sensitivity testing of P. acnes to commonly used antibiotics were performed. Resistance to tetracycline was defined at a minimal inhibitory concentration (MIC) of 2 μg/mL or more; erythromycin at an MIC of 0.5 μg/mL or more; clindamycin at an MIC of 0.25 μg/mL or more according to EUCAST. For breakpoints of doxycycline and minocycline, those with an MIC of 1 μg/mL or more were defined as resistant strains. RESULTS Among the 111 specimens collected from 111 patients, 86 strains of P. acnes were recovered, one from each specimen. Twenty-five specimens had no growth. Forty-seven (54.8%) strains were found to be resistant to one or more antibiotics. Forty-six (53.5%), 18 (20.9%), 14 (16.3%), 14(16.3%) and 14 (16.3%) strains were resistant to clindamycin (CL), erythromycin (EM), tetracycline (TET), doxycycline (DOX) and minocycline (MR) respectively. Ten strains (11.6%) had cross resistance between the MLS antibiotics (erythromycin or clindamycin), one strain (1.2%) had cross resistance among the cyclines and 14 strains (16.4%) had cross resistance between the MLS and cycline antibiotics. Binary logistic regression showed an association between MLS antibiotic resistance with an increased age whereas cycline resistance was associated with the duration of treatment. CONCLUSION Antibiotic-resistant P. acnes is prevalent in Hong Kong. Dermatologists should be more vigilant in prescribing antibiotics for acne patients.
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Affiliation(s)
- N-M T Luk
- Dermatology Research Centre Department of Microbiology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong.
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Yan AC, Baldwin HE, Eichenfield LF, Friedlander SF, Mancini AJ. Approach to pediatric acne treatment: an update. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2011; 30:S16-S21. [PMID: 21943563 DOI: 10.1016/j.sder.2011.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
By late adolescence, almost all individuals have experienced some degree of acne. A broad range of acne treatments has been shown to be safe and effective in adults. While still sparse, emerging data now also document similar safety and efficacy of these agents for children >12 years of age. For younger children with preadolescent acne, where data are more limited or unavailable, it seems reasonable to extrapolate from the findings of studies involving older children >12 years of age. This article reviews the latest evidence and current expert opinions on acne therapies in the pediatric age group.
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Affiliation(s)
- Albert C Yan
- Pediatric Dermatology, Children's Hospital of Philadelphia, Pediatrics and Dermatology Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
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Tzellos T, Zampeli V, Makrantonaki E, Zouboulis CC. Treating acne with antibiotic-resistant bacterial colonization. Expert Opin Pharmacother 2011; 12:1233-47. [PMID: 21355786 DOI: 10.1517/14656566.2011.553192] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Acne is a chronic skin disorder of the pilosebaceous unit; it has a multifactorial pathogenesis. Propionibacterium acnes within the follicle is considered to be a triggering factor of inflammation in acne. Antibiotics have been the primary treatment against P. acnes for more than 40 years. However, a gradual increase in the prevalence of antibiotic-resistant strains of P. acnes has been observed. AREAS COVERED This review discusses the pathophysiology of antibiotic-resistant acne development. It focuses on strategies to minimize the development of resistance and, most importantly, confront the development of antibiotic-resistant acne. The literature search was conducted up to August 2010, using the search terms 'acne', 'antibiotic-resistant acne' and 'bacterial resistance'. EXPERT OPINION Antibiotic-resistant acne is a real phenomenon. Strategies to prevent and confront it should include not only the use of certain treatment regimens but also rational prescribing policies, combination therapies, use of antibacterial non-antibiotic agents and treatment options targeting all the pathogenetic components of acne. Benzoyl-peroxide-based treatment is the most evidence-based approach. Oral isotretinoin remains the most efficacious option for severe acne.
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Affiliation(s)
- Thrasivoulos Tzellos
- Dessau Medical Center, Departments of Dermatology, Venereology, Allergology and Immunology, Auenweg Dessau, Germany.
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Affiliation(s)
- John Kraft
- Division of Dermatology, University of Toronto, Toronto, Ont
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Delgado S, Suárez A, Mayo B. Identification, typing and characterisation of Propionibacterium strains from healthy mucosa of the human stomach. Int J Food Microbiol 2011; 149:65-72. [PMID: 21329995 DOI: 10.1016/j.ijfoodmicro.2011.01.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 01/18/2011] [Accepted: 01/20/2011] [Indexed: 12/21/2022]
Abstract
Forty two Propionibacterium isolates were recovered from biopsy samples of the gastric mucosa of eight out of 12 healthy people. Of these, 41 were identified as belonging to Propionibacterium acnes; the remaining isolate was identified as belonging to Propionibacterium granulosum. Repetitive extragenic palindromic (REP)-PCR typing suggested that up to four strains might be present in the mucosa of the same individual. Sequence analysis of either recA, tly or camp5 genes of P. acnes isolates revealed two distinct phylogenetic lineages. As per the recA, most isolates belonged to type I, while the remainder of the isolates belonged to type II. Phenotypic analyses of representative isolates showed the different strains to have diverse biochemical properties. For example, large differences were seen in carbohydrate fermentation patterns, the results of qualitative and quantitative enzymatic profiling, and survival at acidic pH. In contrast, the patterns of resistance/susceptibility to a series of 16 antibiotics were rather similar, with no atypical resistances observed. The examined strains showed limited-if any-enzymatic activities that could be ultimately related to pathogenicity (lipolytic, proteolytic or haemolytic activity). This suggests that, in the gastric ecosystem, some Propionibacterium spp. genotypes and/or phenotypes can be considered true commensals.
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Affiliation(s)
- Susana Delgado
- Departamento de Microbiología y Bioquímica, Instituto de Productos Lácteos de Asturias (IPLA), Consejo Superior de Investigaciones Científicas (CSIC), Carretera de Infiesto, s/n, 33300-Villaviciosa, Asturias, Spain
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Song M, Seo SH, Ko HC, Oh CK, Kwon KS, Chang CL, Kim MB. Antibiotic susceptibility of Propionibacterium acnes isolated from acne vulgaris in Korea. J Dermatol 2010; 38:667-73. [PMID: 21352337 DOI: 10.1111/j.1346-8138.2010.01109.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.
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Affiliation(s)
- Margaret Song
- Department of Dermatology , Pusan National University, Busan, Korea
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Tunca M, Akar A, Ozmen I, Erbil H. Topical nadifloxacin 1% cream vs. topical erythromycin 4% gel in the treatment of mild to moderate acne. Int J Dermatol 2010; 49:1440-4. [DOI: 10.1111/j.1365-4632.2010.04601.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Choi MS, Yun SJ, Beom HJ, Park HR, Lee JB. Comparative study of the bactericidal effects of 5-aminolevulinic acid with blue and red light on Propionibacterium acnes. J Dermatol 2010; 38:661-6. [PMID: 21352326 DOI: 10.1111/j.1346-8138.2010.01094.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Propionibacterium acnes naturally produces endogenous porphyrins that are composed of coproporphyrin III (CPIII) and protoporphyrin IX (PpIX). Red light alone and photodynamic therapy (PDT) improve acne vulgaris clinically, but there remains a paucity of quantitative data that directly examine the bactericidal effects that result from PDT on P. acnes itself in vitro. The purpose of this study was to measure the difference of bactericidal effects of 5-aminolevulinic acid (ALA)-PDT with red and blue light on P. acnes. P. acnes were cultured under anaerobic conditions and divided into two groups (ALA-treated group and control group), and were then illuminated with blue (415 nm) and red (635 nm) lights using a light-emitting diode (LED). The cultured P. acnes were killed with both blue and red LED light illumination. The efficacy increased with larger doses of light and a greater number of consecutive illuminations. We demonstrated that red light phototherapy was less effective for the eradication of P. acnes than blue light phototherapy without the addition of ALA. However, pretreatment with ALA could enhance markedly the efficacy of red light phototherapy.
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Affiliation(s)
- Myoung-Soon Choi
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Abstract
Minocycline is a semi-synthetic, second-generation tetracycline. It was introduced in 1972 and has both antibacterial and anti-inflammatory properties. Minocycline is used for a variety of infectious diseases and in acne. Even today, new indications beyond the antibacterial indications are being investigated such as its use in neurologic diseases. Formerly, minocycline was thought to have a superior efficacy in the treatment of inflammatory acne, especially with respect to antibacterial-resistant Propionibacterium acnes. A thorough review of the literature, however, shows that minocycline is not more effective in acne than other tetracyclines. Compared with first-generation tetracyclines, minocycline has a better pharmacokinetic profile, and compared with doxycycline it is not phototoxic. However, minocycline has an increased risk of severe adverse effects compared with other tetracyclines. It may induce hypersensitivity reactions affecting the liver, lung, kidneys, or multiple organs (Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS] syndrome) in the first weeks of treatment and, with long-term treatment, may cause autoimmune reactions (systemic lupus erythematosus, autoimmune hepatitis). In addition, CNS symptoms, such as dizziness, are more frequent compared with other tetracyclines. Long-term treatment may induce hyperpigmentation of the skin or other organs. Resistance of P. acnes to minocycline also occurs, dependent on the prescribing behavior. Considering the aspects of efficacy, its adverse effect profile, resistance, price, and alternatives, minocycline is no longer considered the first-line antibacterial in the treatment of acne.
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Affiliation(s)
- Falk Ochsendorf
- Department of Dermatology and Venereology, University of Frankfurt, Germany.
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Bel'kova YA, Petrunin DD, Belkova YA, Petrunin DD. About local administration of antibacterial drugs for acne therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv857] [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 systematizes data accumulated in the world research literature, which are related to the role of P. acnes in the pathogenesis of acne, its microbiology and antibacterial resistance; it also examines antibacterial drugs for the external therapy of acne and recommendations for their use.
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Uçkay I, Dinh A, Vauthey L, Asseray N, Passuti N, Rottman M, Biziragusenyuka J, Riché A, Rohner P, Wendling D, Mammou S, Stern R, Hoffmeyer P, Bernard L. Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature. Clin Microbiol Infect 2010; 16:353-8. [DOI: 10.1111/j.1469-0691.2009.02801.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Cox LAT, Popken DA. Assessing potential human health hazards and benefits from subtherapeutic antibiotics in the United States: tetracyclines as a case study. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2010; 30:432-457. [PMID: 20136749 DOI: 10.1111/j.1539-6924.2009.01340.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Many scientists, activists, regulators, and politicians have expressed urgent concern that using antibiotics in food animals selects for resistant strains of bacteria that harm human health and bring nearer a "postantibiotic era" of multidrug resistant "super-bugs." Proposed political solutions, such as the Preservation of Antibiotics for Medical Treatment Act (PAMTA), would ban entire classes of subtherapeutic antibiotics (STAs) now used for disease prevention and growth promotion in food animals. The proposed bans are not driven by formal quantitative risk assessment (QRA), but by a perceived need for immediate action to prevent potential catastrophe. Similar fears led to STA phase-outs in Europe a decade ago. However, QRA and empirical data indicate that continued use of STAs in the United States has not harmed human health, and bans in Europe have not helped human health. The fears motivating PAMTA contrast with QRA estimates of vanishingly small risks. As a case study, examining specific tetracycline uses and resistance patterns suggests that there is no significant human health hazard from continued use of tetracycline in food animals. Simple hypothetical calculations suggest an unobservably small risk (between 0 and 1.75E-11 excess lifetime risk of a tetracycline-resistant infection), based on the long history of tetracycline use in the United States without resistance-related treatment failures. QRAs for other STA uses in food animals also find that human health risks are vanishingly small. Whether such QRA calculations will guide risk management policy for animal antibiotics in the United States remains to be seen.
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Abstract
Early acne can be defined as the occurrence of acne at its onset, primarily in preteens, or as acne at its earliest severity (ie, mild to moderate). Although the majority of patients with acne are treated by dermatologists, most, particularly mild to moderate cases, could be successfully managed by primary care physicians. Therefore, it is important for physicians to understand the benefits of treating all types of acne, not just the most severe. Awareness of the emotional impact of acne, particularly in adolescence, as well as recognition of possible scarring are important considerations. To achieve optimal results, physicians should be familiar with classification and severity grading of acne. Also, in-depth knowledge of available acne medications will streamline and optimize treatment regimens. Recognizing, treating, and monitoring the progress of early acne may lead to quicker, better clinical outcomes and improved quality of life.
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Affiliation(s)
- Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, 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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Alexis AF. Clinical considerations on the use of concomitant therapy in the treatment of acne. J DERMATOL TREAT 2009; 19:199-209. [DOI: 10.1080/09546630802132635] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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: 374] [Impact Index Per Article: 24.9] [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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48
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Abstract
Oral antibiotics are commonly used to treat acne vulgaris, primarily in patients presenting with moderate to severe facial or truncal disease severity. These agents are most appropriately used in combination with a topical regimen containing benzoyl peroxide and a topical retinoid. The most common oral antibiotics for treating acne vulgaris are the tetracycline derivatives, although macrolide agents such as erythromycin have also been used extensively. Over the past 4 decades, as the sensitivity of Propionibacterium acnes to several oral and topical antibiotics has decreased, the efficacy of oral tetracycline and erythromycin has markedly diminished, leading to increased use of doxycycline, minocycline, and other agents, such as trimethoprim/sulfamethoxazole.
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Affiliation(s)
- James Q Del Rosso
- Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV 89106, USA.
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49
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Ko HC, Song M, Seo SH, Oh CK, Kwon KS, Kim MB. Prospective, open-label, comparative study of clindamycin 1%/benzoyl peroxide 5% gel with adapalene 0.1% gel in Asian acne patients: efficacy and tolerability. J Eur Acad Dermatol Venereol 2009; 23:245-50. [DOI: 10.1111/j.1468-3083.2008.02920.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Fraser K. 67th annual meeting of the American Academy of Dermatology: San Francisco, California, USA, 6-10 March 2009. Am J Clin Dermatol 2009; 10:205-10. [PMID: 19354337 DOI: 10.2165/00128071-200910030-00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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