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Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Stein Gold LF, Tan JKL, Tollefson MM, Weiss JS, Wu PA, Zaenglein AL, Han JM, Barbieri JS. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024; 90:1006.e1-1006.e30. [PMID: 38300170 DOI: 10.1016/j.jaad.2023.12.017] [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: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS These guidelines provide evidence-based recommendations for the management of acne vulgaris.
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Affiliation(s)
- Rachel V Reynolds
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fran Cook-Bolden
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Seemal R Desai
- Innovative Dermatology, Plano, Texas; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kelly M Druby
- Penn State Health Hampden Medical Center, Enola, Pennsylvania
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonette E Keri
- University of Miami, Miller School of Medicine, Miami, Florida; Miami VA Medical Center, Miami, Florida
| | | | - Jerry K L Tan
- Western University, London, Ontario, Canada; Windsor Clinical Research Inc., Windsor, Ontario, Canada
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Jonathan S Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Georgia Dermatology Partners, Snellville, Georgia
| | - Peggy A Wu
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State/Hershey Medical Center, Hershey, Pennsylvania
| | - Jung Min Han
- American Academy of Dermatology, Rosemont, Illinois.
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Chan PA, Le Brazidec DL, Becasen JS, Martin H, Kapadia J, Reno H, Bachmann L, Barbee LA. Safety of Longer-Term Doxycycline Use: A Systematic Review and Meta-Analysis With Implications for Bacterial Sexually Transmitted Infection Chemoprophylaxis. Sex Transm Dis 2023; 50:701-712. [PMID: 37732844 PMCID: PMC10592014 DOI: 10.1097/olq.0000000000001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have significantly increased over the past decade in the United States. Doxycycline as chemoprophylaxis (i.e., postexposure prophylaxis) offers promise for addressing bacterial STIs. The goal of the current study was to evaluate the safety of longer-term doxycycline use (defined as 8 or more weeks) in the context of potential use as STI chemoprophylaxis through a systematic literature review and meta-analysis. METHODS This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to search MEDLINE/PubMed for clinical studies published from August 2003 to January 2023 that reported on adverse events with doxycycline use with a focus on side effects and metabolic effects of long-term use. RESULTS A total of 67 studies were included in the systematic review. Overall, studies on longer-term doxycycline use reported 0% to greater than 50% adverse events ranging from mild to severe. Most common adverse events included gastrointestinal symptoms (i.e., nausea, vomiting, and abdominal pain), dermatologic (i.e., rash), and neurological (i.e., headache and dizziness) symptoms. Discontinuation of doxycycline due to adverse events was relatively uncommon in most studies. A meta-analysis of placebo controlled clinical trials (N = 18) revealed that gastrointestinal and dermatological adverse events were more likely to occur in the doxycycline group. CONCLUSIONS Longer-term (8+ weeks) doxycycline use is generally safe and may be associated with minor side effects. Further research is needed on the potential metabolic impact of longer-term doxycycline use.
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Affiliation(s)
- Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island, USA
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jeffrey S. Becasen
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Harrison Martin
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jhanavi Kapadia
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Hilary Reno
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura Bachmann
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lindley A. Barbee
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Forloni G, Roiter I, Artuso V, Marcon M, Colesso W, Luban E, Lucca U, Tettamanti M, Pupillo E, Redaelli V, Mariuzzo F, Boscolo Buleghin G, Mariuzzo A, Tagliavini F, Chiesa R, Ambrosini A. Preventive pharmacological treatment in subjects at risk for fatal familial insomnia: science and public engagement. Prion 2022; 16:66-77. [PMID: 35737759 PMCID: PMC9235883 DOI: 10.1080/19336896.2022.2083435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Engaging patients as partners in biomedical research has gradually gained consensus over the last two decades. They provide a different perspective on health priorities and help to improve design and outcomes of clinical studies. This paper describes the relationship established between scientists and members of a large family at genetic risk of very rare lethal disease, fatal familial insomnia (FFI). This interaction led to a clinical trial based on the repurposing of doxycycline - an antibiotic with a known safety profile and optimal blood-brain barrier passage - which in numerous preclinical and clinical studies had given evidence of its potential therapeutic effect in neurodegenerative disorders, including prion diseases like FFI. The design of this trial posed several challenges, which were addressed jointly by the scientists and the FFI family. Potential participants excluded the possibility of being informed of their own FFI genotype; thus, the trial design had to include both carriers of the FFI mutation (10 subjects), and non-carriers (15 subjects), who were given placebo. Periodic clinical controls were performed on both groups by blinded examiners. The lack of surrogate outcome measures of treatment efficacy has required to compare the incidence of the disease in the treated group with a historical dataset during 10 years of observation. The trial is expected to end in 2023. Regardless of the clinical outcome, it will provide worthwhile knowledge on the disease. It also offers an important example of public engagement and collaboration to improve the quality of clinical science.
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Affiliation(s)
- Gianluigi Forloni
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy,CONTACT Gianluigi Forloni Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milano20156, Italy
| | - Ignazio Roiter
- Ulss 2 Marca Trevigiana Ca’ Foncello Hospital, Treviso, Italy
| | | | | | | | | | - Ugo Lucca
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elisabetta Pupillo
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | | | | | | | | | | - Roberto Chiesa
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Ly S, Miller J, Tong L, Blake L, Mostaghimi A, Barbieri JS. Use of Patient-Reported Outcomes in Acne Vulgaris and Rosacea Clinical Trials From 2011 to 2021: A Systematic Review. JAMA Dermatol 2022; 158:1419-1428. [PMID: 36287541 DOI: 10.1001/jamadermatol.2022.3911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Acne and rosacea have substantial implications for quality of life, and it is therefore important to ensure the patient's voice is being captured in pivotal randomized clinical trials (RCTs). Although patient-reported outcome measures (PROMs) are a valuable tool to capture the patient perspective, little is known about use of PROMs in RCTs on acne and rosacea. Objective To characterize the use of PROMs in RCTs on acne and rosacea. Evidence Review A systematic literature search was conducted using the search terms acne vulgaris and rosacea in the following databases: MEDLINE through PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. A modified search hedge for RCTs from the McGill Library was applied. All phase 2, 3, and 4 RCTs published between December 31, 2011, through December 31, 2021, that evaluated the efficacy and safety of therapies for acne and rosacea vs any comparator were eligible for inclusion. Findings A total of 2461 publications describing RCTs were identified, of which 206 RCTs met the inclusion criteria (163 trials [79%] on acne and 43 [21%] on rosacea). At least 1 PROM was used in 53% of trials (110) included; PROM use was more common in rosacea RCTs (67% [n = 29]) compared with acne RCTs (50% [n = 81]). At least 1 dermatology-specific (13% [n = 27]) or disease-specific (14% [n = 28]) PROM was included in the RCTs analyzed. Only 7% of trials (14) included a PROM as a primary outcome measure. There was no statistically significant increase in PROM inclusion over the study period (11 of 21 trials in 2011 vs 5 of 12 trials in 2021). Conclusions and Relevance In this systematic review, PROMs were included in approximately one-half of acne and rosacea RCTs performed over the study period. In addition, PROMs were rarely used as a primary outcome measure, and inclusion of PROMs has not increased substantially over the past 10 years. Increasing use of PROMs in RCTs can ensure that the patient's perspective is captured during the development of new treatments for acne and rosacea.
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Affiliation(s)
- Sophia Ly
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - John Miller
- College of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Lauren Tong
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Lindsay Blake
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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5
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Chen SH, Lin YJ, Wang LC, Tsai HY, Yang CH, Teng YT, Hsu SM. Doxycycline Ameliorates the Severity of Experimental Proliferative Vitreoretinopathy in Mice. Int J Mol Sci 2021; 22:11670. [PMID: 34769100 PMCID: PMC8584209 DOI: 10.3390/ijms222111670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022] Open
Abstract
After successful surgeries for patients with rhegmatogenous retinal detachment, the most common cause of retinal redetachment is proliferative vitreoretinopathy (PVR), which causes severe vision impairment and even blindness worldwide. Until now, the major treatment for PVR is surgical removal of the epiretinal membrane, while effective treatment to prevent PVR is still unavailable. Therefore, we investigated the potential of doxycycline, an antibiotic in the tetracycline class, to treat PVR using a mouse model. We used the human retinal pigment epithelial cell line, ARPE-19, for in vitro and in vivo studies to test doxycycline for PVR treatment. We found that doxycycline suppressed the migration, proliferation, and contraction of ARPE-19 cells with reduced p38 MAPK activation and total MMP activity. Intravitreal doxycycline and topical tetracycline treatment significantly ameliorated the PVR severity induced by ARPE-19 cells in mice. PVR increased the expression of MMP-9 and IL-4 and p38 MAPK phosphorylation and modestly decreased IL-10. These effects were reversed by doxycycline and tetracycline treatment in the mouse retina. These results suggest that doxycycline will be a potential treatment for PVR in the future.
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Affiliation(s)
- Shun-Hua Chen
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (S.-H.C.); (Y.-J.L.)
| | - Yu-Jheng Lin
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (S.-H.C.); (Y.-J.L.)
| | - Li-Chiu Wang
- School of Medicine, I-Shou University, Kaohsiung 824, Taiwan;
| | - Hsien-Yang Tsai
- Department of Ophthalmology, Tzu Chi Hospital, Taichung 427, Taiwan;
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Yu-Ti Teng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
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Kardeh S, Saki N, Jowkar F, Kardeh B, Moein SA, Khorraminejad-Shirazi MH. Efficacy of Azithromycin in Treatment of Acne Vulgaris: A Mini Review. World J Plast Surg 2019; 8:127-134. [PMID: 31309049 PMCID: PMC6620802 DOI: 10.29252/wjps.8.2.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Antibiotics are commonly used in the treatment of acne vulgaris. Considering the rise of antibiotic resistance, alternative medications may be used in the main anti-acne armamentarium. The aim of this study was to investigate the efficacy of oral azithromycin in the treatment of acne vulgaris. METHODS Database searches were performed in PubMed and Scopus using the keywords “azithromycin” and “acne”. RESULTS Azithromycin 500 mg once daily for 3 days per week or in cycles of 10 days for 12 weeks are the most commonly used regimens. CONCLUSION Available experimental data suggest that oral azithromycin is an effective and well-tolerated option for treatment of acne vulgaris.
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Affiliation(s)
- Sina Kardeh
- Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Burn and Wound Healing Research Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Saki
- Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farideh Jowkar
- Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Kardeh
- Bone and Joint Diseases Research Center, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Arman Moein
- Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Khorraminejad-Shirazi
- Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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Kim JE, Park AY, Lee SY, Park YL, Whang KU, Kim HJ. Comparison of the Efficacy of Azithromycin Versus Doxycycline in Acne Vulgaris: A Meta-Analysis of Randomized Controlled Trials. Ann Dermatol 2018; 30:417-426. [PMID: 30065581 PMCID: PMC6029975 DOI: 10.5021/ad.2018.30.4.417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/13/2023] Open
Abstract
Background Acne vulgaris is one of the most common disorders of the pilosebaceous unit. Although doxycycline is considered to be a first-line anti-acne antibiotic, various other antibiotics have been tried due to its adverse effects and contraindications. We performed a meta-analysis of randomized controlled trials (RCTs) that compared the efficacy of oral azithromycin pulse therapy with that of oral daily doxycycline in the management of moderate to severe acne vulgaris. Methods Five scientific databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched to identify relevant studies. A review of 1,341 publications produced six RCTs that met our predefined inclusion criteria. The clinical outcome measures were remaining acne lesion counts, patients' self-assessment of treatment, and the investigators' assessment of treatment after 12 weeks. Results We included six studies assessing 906 patients with moderate to severe acne vulgaris. Meta-analyses of clinical outcome measures revealed no significant difference between the two groups regarding remaining acne lesion counts (p=0.27), patients' self-assessment of treatment (p=0.67), and the investigators' assessment of treatment (p=0.32). The incidence of severe adverse events leading to the discontinuation of therapy was higher in the doxycycline daily therapy group when compared with the azithromycin pulse therapy group. Conclusion This study indicates that azithromycin pulse therapy is equivalent to doxycycline at 12 weeks in the efficacy of the treatment for moderate to severe acne vulgaris Therefore, oral azithromycin pulse therapy may be a good alternative to doxycycline in the management of acne for those unable to tolerate doxycycline.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - A Young Park
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung Yul Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Kyu Uang Whang
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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8
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Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol 2017; 4:56-71. [PMID: 29872679 PMCID: PMC5986265 DOI: 10.1016/j.ijwd.2017.10.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the treatment options for adult female patients with acne. Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. Acne has various psychosocial effects that impact patients’ quality of life. Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. Treatments vary widely and treatment should be tailored specifically for each individual woman. We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.
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Affiliation(s)
- A U Tan
- Northwestern University, Department of Dermatology, Chicago, IL
| | - B J Schlosser
- Northwestern University, Department of Dermatology, Chicago, IL
| | - A S Paller
- Northwestern University, Department of Dermatology, Chicago, IL
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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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Sacchidanand SA, Lahiri K, Godse K, Patwardhan NG, Ganjoo A, Kharkar R, Narayanan V, Borade D, D’souza L. Synchronizing Pharmacotherapy in Acne with Review of Clinical Care. Indian J Dermatol 2017; 62:341-357. [PMID: 28794543 PMCID: PMC5527713 DOI: 10.4103/ijd.ijd_41_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.
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Affiliation(s)
| | - Koushik Lahiri
- Consultant Dermatologist, Wizderm Speciality Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Kiran Godse
- Shree Skin Centre and Pathology Laboratory, Navi Mumbai, Maharashtra, India
| | | | - Anil Ganjoo
- Dr. Ganjoo's Skin and Cosmetology Centre, New Delhi, India
| | - Rajendra Kharkar
- Consultant Dermatologist, Dr. Kharkar's Skin Clinic, Mumbai, Maharashtra, India
| | - Varsha Narayanan
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Dhammraj Borade
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Lyndon D’souza
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
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Poureisa M, Daghighi MH, Yousefi J, Hagigi A. Correlation of Axial Vertebral Rotation with Nerve Root Involvement: The First Clinical Study in Literature. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.235.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Talghini S, Shenasi R, Fouladi DF, Hagigi A. Demodex folliculorum and Skin Disease: A Case-Control Study. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.229.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Shokouhi B, Halimi M, Hagigi A. Risk Factors of Coronary Artery Disease in Affected Patients With and Without Psoriasis: The First Case-control Study in the Literature. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.223.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Halimi M, Shokouhi B, Hagigi A. Abnormal Serum Lipid Profile and Smoking are Associated with Plaque-type Psoriasi: A Case Control Study. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.217.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Khryanin AA, Reshetnikov OV. Efficacy of subantimicrobial dose of doxycycline in the treatment of acne of moderate severity: a review of international studie. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-3-134-139] [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 article analyzes the recent data concerning the new trends in the treatment of acne vulgaris of moderate severity using tetracyclines. Low-dose regimen of doxycycline is highly effective against inflammatory and noninflammatory lesions in patients with moderate acne on the face with a minority of side effects.
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M. Forest J, Rafikhah N. Oral Aqueous Green Tea Extract and Acne Vulgaris: A Placebo-Controlled Study. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajcn.2014.41.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Esmaeili H, Halimi M, Hagigi A. Gastrointestinal Dysfunction Symptoms and Lipids Profile in Patients with Various Severities of Acne Vulgaris. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.130.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Johnson M, Rafikhah N. Berberis vulgaris Juice and Acne Vulgaris: A Placebo-Controlled Study. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajcn.2014.47.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Acne is a common skin condition in adolescents. It is not uncommon in childhood and it persists into adulthood. A broad range of acne treatments are available and have been shown to be safe and effective in adolescents and adults. However, there is limited literature regarding acne treatment in childhood and its available therapeutic options. It seems reasonable to extrapolate findings of the various studies reported on treatment of acne in the adolescent and adult age group, with the exclusion of the use of tetracycline derivatives. As clinicians, we must be more familiar with the clinical presentation of acne and available treatment options in our younger patients. Early recognition of acne with prompt and appropriate initiation of therapy in childhood will help prevent severe scarring in children.
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Khodaeinai E, Babaeineja S, Amirnia M, Shokry J, Karimi ER, Fouladi DF, Sedaghat K. Efficacy of 10% Azelaic Acid Gel with Hydro-alcoholic or Alcohol-free Bases
in Mild to Moderate Acne Vulgaris; the First Clinical Trial. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.87.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khodaeiani E, . SB, . MJA, . ERK, . DFF, . MG. Changes of Hair Diameter after Treatment of Androgenic Alopecia; the First Case-control Study. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.97.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khodaeiani E, Halimi M, . AH. Severe Acne Vulgaris is Associated with Helicobacter pylori Infection:
First Report in the Literature. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2014.92.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Poureisa M, Daghighi MH, Navali AM, Shafaeian M. “Floating Meniscus” a Specific Indicator of Anterior Cruciate Ligament Rupture. JOURNAL OF MEDICAL SCIENCES 2013. [DOI: 10.3923/jms.2014.36.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sandoval LF, Hartel JK, Feldman SR. Current and future evidence-based acne treatment: a review. Expert Opin Pharmacother 2013; 15:173-92. [PMID: 24283604 DOI: 10.1517/14656566.2014.860965] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Current acne treatment guidelines, as well as, treatment efficacy, safety, tolerability and patient preferences must all be considered in determining appropriate treatment regimes. Literature can assist physicians' evidence-based recommendations according to these factors. AREAS COVERED To determine the current and future direction of pharmacotherapy for treatment of acne, a PubMed search was conducted to identify all clinical trials involving the treatment of acne from 2009 to 2012. A total of 65 publications met inclusion criteria and were reviewed. Literature was heavily focused on the efficacy and tolerability of topical combination therapies and supported their use compared with monotherapy. A few studies on topical antiandrogens and antioxidants showed an alternative approach to targeting acne. Studies on oral monotherapy provided some evidence for the use of pulsed azithromycin for acne in adolescents. Literature also supports the use of low-dose isotretinoin for moderate acne, which was comparable in efficacy to high-dose regimes and better tolerated. EXPERT OPINION Combination acne therapy, whether it be combination topical therapy or combination oral and topical therapy, is well supported by recent studies. Given the multifactorial pathogenesis of acne and the hurdles of adherence to treatment, we anticipate greater development of and reliance on combination acne products in the future.
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Affiliation(s)
- Laura F Sandoval
- Wake Forest School of Medicine, Center for Dermatology Research, Departments of Dermatology , Winston-Salem, North Carolina , USA +1 760 217 1457 ; +1 336 716 7732 ;
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Sabeti S, Malekzad F, Ashayer M, Fouladi RF, Hesari KK, Toutkaboni MP, Younespour S. The rate and pattern of bcl-2 and cytokeratin 15 expression in trichoepithelioma and nodular Basal cell carcinoma: a comparative study. Indian J Dermatol 2013; 58:331-6. [PMID: 24082173 PMCID: PMC3778768 DOI: 10.4103/0019-5154.117291] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Histopathological evaluations can differentiate between clinically resembling trichoepithelioma (TE) and basal cell carcinoma (BCC) unless the biopsy specimens are small or superficial. Previous studies used immunohistochemical evaluation for Bcl-2 and cytokeratin 15 (CK15), in attempts to differentiate between these two entities, with heterogeneous findings. Aims: This study intended to compare the rate and patterns of Bcl-2 and CK15 expressions between specimens of TE and nodular BCC. Settings and Design: Case-series including formalin-fixed, paraffin-embedded cutaneous biopsies. Subjects and Methods: Twenty-two BCC and 12 TE specimens were stained for Bcl-2 and CK15 and examined microscopically. The rate and patterns of expressions were compared between the two groups. Statistical Analysis Used: Statistical analysis was performed using the statistical software (SPSS version 16.0; SPSS Inc., Chicago, IL, USA), Pearson Chi-square, or Fisher's exact tests, wherever appropriate. Results: The two groups were comparable for the expression rate and patterns of Bcl-2 (86.4%: 5 central, 14 diffuse in BCC vs. 83.3%: 2 central, 8 diffuse in TE; P = 0.59 and 0.54 for rate and pattern, respectively). The rate of CK15 expression was significantly higher in TE specimens (66.7%: 4 central, 3 diffuse, 1 peripheral vs. 4.5%: 1 central; P < 0.001). The positive likelihood ratio in distinguishing the two neoplasms was 14.7 (95% confidence interval: 2.1-103.7). Conclusions: CK15 but not Bcl-2 staining may help in differentiating between BCC and TE even in BCCs with follicular differentiation.
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Affiliation(s)
- Shahram Sabeti
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khodaeiani E, Fouladi RF, Amirnia M, Saeidi M, Karimi ER. Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris. Int J Dermatol 2013; 52:999-1004. [DOI: 10.1111/ijd.12002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Mehdi Amirnia
- Department of Dermatology; Sina Hospital; Tabriz; Iran
| | - Majid Saeidi
- Faculty of Pharmacy; Sari University of Medical Sciences; Sari; Iran
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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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Fouladi RF. Aqueous Extract of Dried Fruit ofBerberis vulgaris L.in Acne vulgaris, a Clinical Trial. J Diet Suppl 2012; 9:253-61. [DOI: 10.3109/19390211.2012.726702] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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