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Abstract
IMPORTANCE Acne vulgaris is an inflammatory disease of the pilosebaceous unit of the skin that primarily involves the face and trunk and affects approximately 9% of the population worldwide (approximately 85% of individuals aged 12-24 years, and approximately 50% of patients aged 20-29 years). Acne vulgaris can cause permanent physical scarring, negatively affect quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation. OBSERVATIONS Acne vulgaris is classified based on patient age, lesion morphology (comedonal, inflammatory, mixed, nodulocystic), distribution (location on face, trunk, or both), and severity (extent, presence or absence of scarring, postinflammatory erythema, or hyperpigmentation). Although most acne does not require specific medical evaluation, medical workup is sometimes warranted. Topical therapies such as retinoids (eg, tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments. When prescribed as a single therapy in a randomized trial of 207 patients, treatment with tretinoin 0.025% gel reduced acne lesion counts at 12 weeks by 63% compared with baseline. Combinations of topical agents with systemic agents (oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception [COC] or spironolactone, or isotretinoin) are recommended for more severe disease. In a meta-analysis of 32 randomized clinical trials, COC was associated with reductions in inflammatory lesions by 62%, placebo was associated with a 26% reduction, and oral antibiotics were associated with a 58% reduction at 6-month follow-up. Isotretinoin is approved by the US Food and Drug Administration for treating severe recalcitrant nodular acne but is often used to treat resistant or persistent moderate to severe acne, as well as acne that produces scarring or significant psychosocial distress. CONCLUSIONS AND RELEVANCE Acne vulgaris affects approximately 9% of the population worldwide and approximately 85% of those aged 12 to 24 years. First-line therapies are topical retinoids, benzoyl peroxide, azelaic acid, or combinations of topicals. For more severe disease, oral antibiotics such as doxycycline or minocycline, hormonal therapies such as combination oral conceptive agents or spironolactone, or isotretinoin are most effective.
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Affiliation(s)
- Dawn Z Eichenfield
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Jessica Sprague
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego School of Medicine, La Jolla
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
- Department of Pediatrics, University of California San Diego School of Medicine, La Jolla
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2
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Affiliation(s)
- Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
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3
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Ferreira R, Napoli J, Enver T, Bernardino L, Ferreira L. Advances and challenges in retinoid delivery systems in regenerative and therapeutic medicine. Nat Commun 2020; 11:4265. [PMID: 32848154 PMCID: PMC7450074 DOI: 10.1038/s41467-020-18042-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/01/2020] [Indexed: 12/19/2022] Open
Abstract
Retinoids regulate a wide spectrum of cellular functions from the embryo throughout adulthood, including cell differentiation, metabolic regulation, and inflammation. These traits make retinoids very attractive molecules for medical purposes. In light of some of the physicochemical limitations of retinoids, the development of drug delivery systems offers several advantages for clinical translation of retinoid-based therapies, including improved solubilization, prolonged circulation, reduced toxicity, sustained release, and improved efficacy. In this Review, we discuss advances in preclinical and clinical tests regarding retinoid formulations, specifically the ones based in natural retinoids, evaluated in the context of regenerative medicine, brain, cancer, skin, and immune diseases. Advantages and limitations of retinoid formulations, as well as prospects to push the field forward, will be presented.
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Grants
- MC_U137973817 Medical Research Council
- MR/N000838/1 Medical Research Council
- The authors would like to thank Andreia Vilaça for the illustrations and the financial support of ERA Chair project (ERA@UC, ref:669088) through EU Horizon 2020 program, the POCI-01-0145-FEDER-016390 (acronym: CANCEL STEM) and POCI-01-0145-FEDER-029414 (acronym: LIghtBRARY) projects through Compete 2020 and FCT programs, projects 2IQBIONEURO (reference: 0624_2IQBIONEURO_6_E) and NEUROATLANTIC (reference: EAPA_791/2018) co-funded by INTERREG (Atlantic program or V-A Spain-Portugal) and European fund for Regional Development (FEDER), FCT (Portugal, SFRH/BPD/102103/2014), National Funds by Foundation for Science and Technology (UID/Multi/00709/2013), “Programa Operacional do Centro, Centro 2020” through the funding of the ICON project (Interdisciplinary Challenges On Neurodegeneration; CENTRO-01-0145-FEDER-000013), EXPL/BIM-MED/0822/2013 (LB), (SFRH/BPD/94228/2013, IF/00178/2015) (RF), Cerebrovascular Disease Grant and L’Oréal-UNESCO Portugal for Women in Science for supporting this work. Authors declare there are no conflict of interests.
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Affiliation(s)
- Raquel Ferreira
- Health Sciences Research Centre (CICS-UBI), Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Joseph Napoli
- Nutritional Sciences and Toxicology, University of California, 231 Morgan Hall, MC#3104, Berkeley, CA, 94720, USA
| | - Tariq Enver
- UCL Cancer Institute, University College London, London, UK
| | - Liliana Bernardino
- Health Sciences Research Centre (CICS-UBI), Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
| | - Lino Ferreira
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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4
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Liao AH, Cai YL, Chuang HC, Lee CY, Lin YC, Chiang CP. Application of ultrasound-mediated adapalene-coated lysozyme-shelled microbubbles in UVA-induced skin photoaging. PLoS One 2020; 15:e0232617. [PMID: 32438389 PMCID: PMC7242023 DOI: 10.1371/journal.pone.0232617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/18/2020] [Indexed: 01/30/2023] Open
Abstract
Photoaging, the premature aging of skin induced by ultraviolet rays, is characterized by wrinkling, roughness, laxity, and pigmentary changes. Various natural and synthetic retinoids have been explored for the treatment of aging. Among retinoids, adapalene (Ada, 0.3%) is one of the most potent and widely used drugs to treat photoaging. However, it causes irritant reactions that limit its acceptance by patients. Several studies have shown the applicability of Lysozyme (Lys)-shelled microbubbles (MBs) for drug delivery through sonophoresis, and recently we have shown its efficiency to treat inflammatory skin disease. Here, we report the construction of novel Ada-LysMBs based on opposite electric charges for combined effects to treat photoaging. The Ada-LysMBs were self-assembled and had a mean diameter of 2857 nm. The maximum loading efficiency of Ada onto LysMBs was 13.99 ± 0.59%. An acoustic power density of 3 W/cm2 for 1 min revealing maximum penetration depth of LysMBs was optimized for further in vitro and in vivo studies of Ada-LysMBs. It was observed that in vitro Ada release from Ada-LysMBs at 6 h after ultrasound (US) treatment was more rapid at pH 7.4 (82%) than at pH 5.5 (73%). Franz diffusion experiments on isolated porcine skin indicated that US approximately doubled Ada delivery by Ada-LysMBs and Ada + LysMBs at 12 h and six-fold Lys permeation by LysMBs at 6 h, compared to these treatments alone. A 5-week in vivo study in mice identified significant wrinkle reduction in animals treated with US plus Ada-LysMBs. Our findings indicate that US may be used with Ada-LysMBs in the water phase to treat photoaging by normalizing hyperkeratinization and promoting collagen synthesis.
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Affiliation(s)
- Ai-Ho Liao
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
- Department of Medical Engineering, National Defense Medical Center, Taipei, Taiwan
| | - You-Lin Cai
- Graduate Institute of Manufacturing Technology, National Taipei University of Technology, Taipei, Taiwan
| | - Ho-Chaio Chuang
- Graduate Institute of Manufacturing Technology, National Taipei University of Technology, Taipei, Taiwan
| | - Cheng-Ying Lee
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (YL); (CC)
| | - Chien-Ping Chiang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (YL); (CC)
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5
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Gupta AK, Bruce A, Abramovits W, Vincent KD. AKLIEF (Trifarotene 0.005% [50 μg/g] Cream) for Topical Treatment of Acne Vulgaris. Skinmed 2020; 18:160-163. [PMID: 32790612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada;
- Mediprobe Research Inc., London, Ontario, Canada
| | | | - William Abramovits
- Department of Medicine, Baylor University Medical Center, Dallas, TX
- Dermatology Treatment and Research Center, Dallas, TX
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6
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Tan J, Miklas M. A Novel Topical Retinoid for Acne: Trifarotene 50 μg/g Cream. Skin Therapy Lett 2020; 25:1-2. [PMID: 32196146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Trifarotene 50 μg/g cream is a fourth generation topical retinoid with retinoic acid receptor gamma selectivity. It was recently approved by the US FDA and Health Canada for the topical treatment of facial and truncal acne for those aged 9 and older based on two identically designed phase 3 trials demonstrating superiority in lesion count reduction and global acne improvement compared to vehicle. These studies and a 1 year study also demonstrated safety and tolerability with cutaneous adverse events developing in an anticipated timeframe (1 week) for the face. These were of lesser degree and tended to develop later at the trunk. Future studies will be required to evaluate the comparative efficacy of trifarotene 50 μg/g cream against other treatments for acne.
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Affiliation(s)
- Jerry Tan
- Windsor Clinical Research Inc., Windsor, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, Windsor Campus, ON, Canada
| | - Maegan Miklas
- Schulich School of Medicine and Dentistry, Western University, Windsor Campus, ON, Canada
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7
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Limmer AL, Nwannunu CE, Patel RR, Mui UN, Tyring SK. Management of Ichthyosis: A Brief Review. Skin Therapy Lett 2020; 25:5-7. [PMID: 32023022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ichthyoses, also termed the disorders of keratinization, are a heterogenous group of skin diseases in which a distinctive horny layer arises secondary to excessive transepidermal water loss. Although occasionally acquired, the majority of ichthyoses are inherited and can be pinpointed to characteristic genetic mutations. Management depends on disease severity and includes topical agents and lifestyle modifications with or without oral retinoids. Genetic counseling is also an important consideration. This review aims to highlight advances in our understanding of disease pathogenesis as well as the holistic approach necessary to adequately manage ichthyosis patients.
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Affiliation(s)
- Allison L Limmer
- Department of Dermatology, McGovern Medical School at The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Crystal E Nwannunu
- Department of Dermatology, McGovern Medical School at The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | | | - Uyen N Mui
- Center for Clinical Studies, Houston, TX, USA
| | - Stephen K Tyring
- Department of Dermatology, McGovern Medical School at The University of Texas Health Sciences Center at Houston, Houston, TX, USA
- Center for Clinical Studies, Houston, TX, USA
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8
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Trifarotene (Aklief) - a new topical retinoid for acne. Med Lett Drugs Ther 2019; 61:195-7. [PMID: 31999666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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9
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Abstract
Topical trifarotene (Aklief®) is a first-in-class, fourth-generation retinoid [selective retinoic acid receptor (RAR)-γ agonist] being developed by Galderma Research and Development LLC for the treatment of acne vulgaris. In October 2019 trifarotene received its first global approval in the USA for the topical treatment of acne vulgaris in patients 9 years of age and older. This article summarizes the milestones in the development of trifarotene leading to its first global approval for acne vulgaris.
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Affiliation(s)
- Lesley J Scott
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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10
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Gupta AK, Love RP, Abramovits W, Vincent KD. DUOBRII™ (Halobetasol Propionate and Tazarotene) Lotion for Topical Use: A Newly Approved Combination Corticosteroid and Retinoid Topical Treatment of Plaque Psoriasis in Adults. Skinmed 2019; 17:181-183. [PMID: 31496472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada;
- Mediprobe Research Inc., London, Ontario, Canada
| | - Robin P Love
- Mediprobe Research Inc., London, Ontario, Canada
| | - William Abramovits
- Department of Medicine, Baylor University Medical Center, University of Texas Southwestern Medical School, and Dermatology Treatment and Research Center, Dallas, TX
- Department of Dermatology, University of Texas Southwestern Medical School, and Dermatology Treatment and Research Center, Dallas, TX
- Department of Family Practice, University of Texas Southwestern Medical School, and Dermatology Treatment and Research Center, Dallas, TX
- University of Texas Southwestern Medical School, and Dermatology Treatment and Research Center, Dallas, TX
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11
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Chlebus E, Chlebus M. The role of adolescent acne treatment in formation of scars Among patients with persistent adult acne: evidence from an observational study. Cutis 2019; 104:57-61. [PMID: 31487338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Persistent adult acne is one of the most difficult types of acne to treat. It is a long-lasting disease with uncontrolled exacerbations that often result in scarring. The aim of this study was to analyze the influence of acne therapy used in adolescence on patients who later developed persistent adult acne. The use of oral antibiotics, isotretinoin, and topical retinoids in adolescence and their role in diminishing scar formation during adult acne was analyzed. This population-based study included 111 patients, 91 of whom had persistent adult acne. Results indicated that the use of isotretinoin or topical retinoids for adolescent acne decreased the risk for scar occurrence in adulthood.
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Affiliation(s)
- Ewa Chlebus
- Nova Derm Dermatology Centre, Warsaw, Poland
| | - Marcin Chlebus
- Department of Quantitative Finance, Faculty of Economic Sciences, University of Warsaw, Poland
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12
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Grimes PE, McDaniel DH, Wortzman M, Nelson D. In Vitro and In Vivo Efficacy and Tolerability of a Non-Hydroquinone, Multi-Action Skin Tone Correcting Cream. J Drugs Dermatol 2019; 18:642-648. [PMID: 31329402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Pigmentation disorders are therapeutically challenging to treat, requiring complicated regimens. Objectives: Alternatives to hydroquinone (HQ) are desired. We evaluated the efficacy and tolerability of a non-HQ multi-action skin tone corrector (ETCS) developed to inhibit melanin production and improve skin quality. Design and Methods: Twice-daily use of ETCS and ETCS + AHA-Ret, a retinoid-based alpha hydroxy acid cream, was evaluated in subjects with mild to severe dyschromia. Digital images were obtained at baseline, 4, 8, and 12 weeks and included assessment of dyschromia, erythema, fine lines/wrinkles, pores, texture, and global improvement. Melanin Index (MI) measurements were obtained at baseline, 4, 8, and 12 weeks. Subject self-assessments were obtained over the course of the study. Adverse Events (AEs) were collected throughout the study. An extension study evaluated use over 16-weeks. Results: Significant mean reductions from baseline occurred in dyschromia for ETCS (n=42) and ETCS + AHA-Ret (n=10) over 12 weeks (P<0.0001, each). Significant mean reductions from baseline in MI were achieved in both groups at every timepoint (ETCS: P<0.0001; ETCS + AHA-Ret: P<0.02, 4 weeks; P<0.0001, 8 and 12 weeks). Substantial improvements were demonstrated in global improvement, fine lines/wrinkles, erythema, pores, and texture at 12 weeks. Reductions from baseline occurred in dyschromia and MI (P<0.0001, each) at 16 weeks. High levels of subject satisfaction were reported with nearly all subjects reporting reduced appearance of uneven skin tone/discoloration and lightened darker patches, and improvement in overall skin tone. Mild, transient AEs were reported with no discontinuations due to an AE. Conclusions: Twice daily use of ETCS led to early, significant reductions in dyschromia and melanin index. Combination use with a retinoid-based, AHA cream in the evening demonstrated enhanced reductions. ETCS effectively reduced hyperpigmentation, improved overall skin appearance, and was highly tolerable. J Drugs Dermatol. 2019;18(7):642-648.
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13
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Tchero H, Herlin C, Bekara F, Fluieraru S, Teot L. Hidradenitis Suppurativa: A Systematic Review and Meta-analysis of Therapeutic Interventions. Indian J Dermatol Venereol Leprol 2019; 85:248-257. [PMID: 30924446 DOI: 10.4103/ijdvl.ijdvl_69_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analysis. Meta-analysis was conducted using the comprehensive meta-analysis software to generate pooled standardized mean differences or risk ratios. Numerous medical treatments are available for hidradenitis suppurativa such as antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents and radiotherapy for early lesions. Adalimumab, an anti-tumor necrosis factor antibody, was superior to placebo in reducing Sartorius score (standardized mean difference = -0.32, confidence interval [-0.46, -0.18], P < 0.0001) and pain (risk ratio = 1.42, confidence interval [1.07, 1.9], P = 0.02), when given weekly (not every other week). Combination therapies (such as antibiotics and hyperbaric oxygen therapy) have been tested, which have shown promising results that are yet to be confirmed. Based on the quality of evidence, the most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy. Surgery (either by simple excision or complete local excision followed by skin graft) is the first choice for intractable disease presenting in the late stages. However, the evidence on most of these treatments is deficient and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management.
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Affiliation(s)
- Huidi Tchero
- Unit of Wounds and Healing, Department of Trauma and Orthopaedic Surgery, Centre Hospitalier Louis Constant Fleming Saint Martin, Saint Martin, Guadeloupe, France
| | - Christian Herlin
- Department of Trauma and Orthopaedic Surgery, Montpellier University Hospital, Montpellier, France
| | - Farid Bekara
- Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier, France
| | - Sergiu Fluieraru
- Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier, France
| | - Luc Teot
- Department of Trauma and Orthopaedic Surgery, Montpellier University Hospital, Montpellier, France
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Tan J, Tanghetti E, Baldwin H, Stein Gold L, Lain E. The Role of Topical Retinoids in Prevention and Treatment of Atrophic Acne Scarring: Understanding the Importance of Early Effective Treatment. J Drugs Dermatol 2019; 18:255-260. [PMID: 30909329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Atrophic acne scarring is a frequent occurrence among acne patients. These facial marks are often very emotionally distressing for the patient and can result in adverse impact to quality of life. While most clinicians consider scarring as a sequela of moderate to severe acne, recent studies have found that scars are also associated with mild acne. Risk factors include time to effective treatment, severity of acne, family history, and excoriations. New data shows that early and effective acne treatment can reduce the development of new scars, confirming the widespread perception of this approach in prevention. It is also becoming clear that the inflammatory process drives both the development of acne lesions and atrophic scars. This implies that inhibiting activation of inflammatory pathways early is key to preventing scars. Data also suggests a useful role for adapalene for the treatment of well-established acne scars with scar remodeling accompanied by the production of new collagen and elastic tissue. Acne guidelines and recommendations continue to highlight the central role of retinoids, with fixed-dose combination retinoids being particularly important due to targeting of multiple inflammatory pathophysiologic factors and for patient convenience. Higher concentrations of retinoids such as adapalene 0.3%/benzoyl peroxide 2.5% (A0.3/BPO2.5) have shown increased efficacy, particularly among patients with moderately severe and severe acne – a population at high risk for scarring. Further, controlled study of A0.3/BPO2.5 in patients with moderate acne (mean, 40 acne lesions per half face) and mild-moderate scarring demonstrated A0.3/BPO2.5 was significantly superior to vehicle in reducing scar counts from baseline over 24 weeks. While scar counts lessened on the A0.3/BPO2.5 side, counts increased on the vehicle side during the study. This occurred in the setting of active acne, where the efficacy of A/BPO is well known, emphasizing the dual actions of A0.3/BPO2.5 in both treatment and prevention. J Drugs Dermatol. 2019;18(3):255-260.
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15
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Chien A. Retinoids in Acne Management: Review of Current Understanding, Future Considerations, and Focus on Topical Treatments. J Drugs Dermatol 2018; 17:s51-s55. [PMID: 30586482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Acne vulgaris is the most common skin condition affecting adolescents and young adults with a tremendous psychosocial impact. Its pathogenic hallmarks include follicular dyskeratosis, increased sebum production, and inflammation induced by Cutibacterium (formerly Propionibacterium) acnes within the follicle. Retinoids, derived from vitamin A, are the mainstays of acne treatment given they address the key pathogenic pathways of acne. Retinoids exert their effects through the binding of their nuclear receptors leading to downstream biological effects. The understanding of retinoid pharmacology has increased the diversity of retinoids with now both natural and synthetic retinoids available for use. For acne, retinoids can be administered both topically in a variety of formulations and combinations as well as systemically. With judicious use, this class of medication is well tolerated and very efficacious in managing acne. Furthermore, there is evidence showing its role in improving and preventing one of the most challenging post-acne changes, atrophic acne scarring. With a promising topical retinoid, trifarotene, on the horizon, the acne armamentarium will be further broadened to better manage acne and its related sequelae. J Drugs Dermatol. 2018;17(12 Suppl):s51-55
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16
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Gooderham MJ. Alitretinoin: An Update of Real-World Evidence in The Management of Chronic Hand Dermatitis. Skin Therapy Lett 2018; 23:1-4. [PMID: 30086182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chronic hand dermatitis is a debilitating inflammatory dermatosis that has a significant impact on the quality of life of those affected. Alitretinoin is an oral retinoid which has proven efficacy and safety in the treatment of chronic hand dermatitis through randomized controlled trials. Real-world evidence, information gathered in the clinic or community setting, as opposed to a research environment, can complement knowledge gained from clinical trials. Herein, real-world evidence supporting the safety and effectiveness of alitretinoin in the management of chronic hand dermatitis will be reviewed.
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Affiliation(s)
- M J Gooderham
- Skin Centre for Dermatology, Peterborough, ON, Canada; Probity Medical Research, Waterloo, ON, Canada; Queen's University, Kingston, ON, Canada
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17
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Hoffman LK, Bhatia N, Zeichner J, Kircik LH. Topical Vehicle Formulations in the Treatment of Acne. J Drugs Dermatol 2018; 17:s6-s10. [PMID: 29879262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Topical treatment is the mainstay of acne therapy. The most commonly prescribed topical medications for acne include benzoyl peroxide, clindamycin, and retinoids. Despite their effectiveness in treating mild to moderate acne vulgaris, these topical medications are found to be irritating, and are historically associated with poor tolerability and diminished patient adherence. Thus, choosing the right formulation that will be effective and well tolerated is essential. Novel formulations that optimize drug concentration and utilize improved delivery vehicles have helped to enhance the tolerability and efficacy, and allow for less frequent application or co-application of drugs that were previously considered incompatible. This article will review the goals of topical therapy for the treatment of acne, in addition to common therapies and their challenges. Advanced formulations and combination formulations of benzoyl peroxide, clindamycin, and tretinoin will also be discussed. J Drugs Dermatol. 2018;17(6 Suppl):s6-10.
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Ogawa H, Luxardi G, Kirane A, Kulkarni R, Monjazeb AM, Cheng MY, Ma C, Maverakis E. T Cells Dominate the Local Immune Response Induced by Intralesional IL-2 in Combination with Imiquimod and Retinoid for In-Transit Metastatic Melanoma. J Invest Dermatol 2017; 138:1442-1445. [PMID: 29291382 DOI: 10.1016/j.jid.2017.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Hiromi Ogawa
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA; Department of Dermatology, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
| | - Guillaume Luxardi
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Amanda Kirane
- Department of Surgery, University of California, Davis, School of Medicine, Los Angeles, California, USA
| | - Rajan Kulkarni
- Department of Dermatology, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
| | - Arta M Monjazeb
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Michelle Y Cheng
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Chelsea Ma
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA.
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Christman MP, Belkin D, Geronemus RG, Brauer JA. An Anatomical Approach to Evaluating and Treating Cellulite. J Drugs Dermatol 2017; 16:58-61. [PMID: 28095534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cellulite is the common rippling or dimpling of skin of the thighs and buttocks of women, formed from a confluence of skin laxity, tethering fibrous septa, and fat herniation. We describe an anatomical approach to evaluating the cellulite patient and selecting the best treatment from among available non-invasive, minimally invasive, and invasive therapies. It is crucial to consider the anatomy of the patient and the morphology of cellulite while choosing a treatment. Diffuse rippling represents increased adiposity and/or increased skin laxity which may stand to benefit from lipolytic and skin tightening modalities. Dimpling represents tethering by fibrous septa which may stand to improve from subcision by minimally invasive devices such as Cell na. Patients with both morphologies may be treated with a combination of treatments or Cellulaze. Careful evaluation of the patient can help identify the best therapeutic strategy. <em>J Drugs Dermatol. 2017;16(1):58-61.</em>.
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Veraldi S, Rossi LC, Barbareschi M. Are topical retinoids teratogenic? GIORN ITAL DERMAT V 2016; 151:700-705. [PMID: 27598619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Retinoic acid is a physiological compound of human blood. Blood levels range from 1000 to 7000 pg/mL (usually 1500-5000 pg/mL). Results of studies on absorption of topical retinoic acid in laboratory animals, although rather conflicting, demonstrate that it induces plasma concentrations which are well below concentrations caused by non-teratogenic oral doses. In humans, minimal percutaneous absorption of tretinoin was observed after topical applications. Neither single dose nor long-term treatment with topical tretinoin affect the endogenous levels of retinoic acid or its metabolites. Topical application of tretinoin at doses used in acne unlikely induces systemic effects. Although some clinical cases of suspected tretinoin-related embryotoxicity have been described, three prospective cohort studies clearly demonstrated the safety of topical tretinoin as an embryotoxic agent.
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Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy -
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21
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Jordan L, Baldwin HE. Stratum Corneum Abnormalities and Disease-Affected Skin: Strategies for Successful Outcomes in Inflammatory Acne. J Drugs Dermatol 2016; 15:1170-1173. [PMID: 27741332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Stratum corneum (SC) abnormalities are associated with disease-affected skin conditions such as inflammatory acne. Current topical acne treatment options including benzoyl peroxide and retinoids can worsen the barrier dysfunctions by increasing transepidermal water loss, depleting SC vitamin E levels, and relatively decreasing SC thickness. However, strategies exist to employ these treatments in a more effective manner and lessen barrier function disruption including use of less irritating vehicles or concomitant application of moisturizers. Patients also play a role in the outcome of their skin barrier function based on their compliance and administration technique. By increasing patient compliance and proper application of treatments, patient skin barrier function can improve. Additionally, future treatments are on the horizon that may customize acne therapy at a molecular level. <br /><br /> <em>J Drugs Dermatol.</em> 2016;15(10):1170-1173.
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In brief: An over-the-counter retinoid for acne. Med Lett Drugs Ther 2016; 58:126. [PMID: 27649343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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23
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Ghate VM, Lewis SA, Prabhu P, Dubey A, Patel N. Nanostructured lipid carriers for the topical delivery of tretinoin. Eur J Pharm Biopharm 2016; 108:253-261. [PMID: 27519827 DOI: 10.1016/j.ejpb.2016.07.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/23/2016] [Accepted: 07/31/2016] [Indexed: 11/20/2022]
Abstract
Cosmetic skin care products currently in the market demonstrate an increasing trend toward antiaging products. Selection of the right formulation approach is the key to successful consumer acceptance. Nanostructured lipid carriers (NLCs) for dermal application can render added benefits to the formulation. Tretinoin a derivative of vitamin A, is a retinoid with anti-aging and anti-acne potential. The present study was aimed at formulating NLCs of tretinoin for reducing the skin irritation potential, increasing the drug loading capacity and prolonging the duration of action. The NLCs were optimized using the response surface methodology based on the particle size. Preliminary study, suggested the use of stearic acid, oleic acid, Tween 80 and Span 60 as solid lipid, liquid lipid and surfactants respectively formed a stable dispersion. NLCs of tretinoin were prepared by hot melt microemulsion and hot melt probe sonication methods. The properties of the optimized NLCs such as morphology, size, Zeta potential, stability and in vitro drug release were investigated. Tretinoin loaded NLCs in carbopol gel showed a sustained release pattern with isopropyl alcohol as the receptor fluid compared to the marketed gel using Franz diffusion cells. Eight prepared gel formulations tested were found to follow the Higuchi model of drug release. Stability studies indicated that the formulations stored at refrigeration and room temperature showed no noticeable differences in the drug content and release profiles in vitro, after a period of 4 weeks. In vivo skin irritation test on male Wister rats indicated no irritation or erythema after application of the NLCs loaded gel repeated for a period of 7 days compared to the application of marketed tretinoin gel which showed irritation and slight erythema within 3 days. The results showed that the irritation potential of tretinoin was reduced, the drug loading was increased and the drug release was prolonged by the incorporation into the NLCs.
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Affiliation(s)
- Vivek M Ghate
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal 576104, Karnataka, India.
| | - Shaila A Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal 576104, Karnataka, India
| | - Prabhakara Prabhu
- Department of Pharmaceutics, Shree Devi College of Pharmacy, Kenjar, Mangalore 570142, Karnataka, India
| | - Akhilesh Dubey
- Department of Pharmaceutics, Shree Devi College of Pharmacy, Kenjar, Mangalore 570142, Karnataka, India
| | - Nilkumar Patel
- Department of Pharmaceutics, Shree Devi College of Pharmacy, Kenjar, Mangalore 570142, Karnataka, India
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Chung SSW, Wang X, Wolgemuth DJ. Prolonged Oral Administration of a Pan-Retinoic Acid Receptor Antagonist Inhibits Spermatogenesis in Mice With a Rapid Recovery and Changes in the Expression of Influx and Efflux Transporters. Endocrinology 2016; 157:1601-12. [PMID: 26812157 PMCID: PMC4816726 DOI: 10.1210/en.2015-1675] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have previously shown that oral administration of a pan-retinoic acid receptor antagonist in mice daily at 2.5 mg/kg for 4 weeks reversibly inhibited spermatogenesis, with no detectable side effects. To elucidate the lowest dose and the longest dosing regimen that inhibits spermatogenesis but results in complete restoration of fertility upon cessation of administration of the drug, we examined the effects of daily doses as low as 1.0 mg/kg with dosing periods of 4, 8, and 16 weeks. We observed 100% sterility in all regimens, with restoration of fertility upon cessation of the drug treatment even for as long as 16 weeks. There was no change in testosterone levels in these males and the progeny examined from 2 of the recovered males were healthy and fertile, with normal testicular weight and testicular histology. Strikingly, a more rapid recovery, as assessed by mating studies, was observed at the lower dose and longer dosing periods. Insight into possible mechanisms underlying this rapid recovery was obtained at 2 levels. First, histological examination revealed that spermatogenesis was not as severely disrupted at the lower dose and with the longer treatment regimens. Second, gene expression analysis revealed that the more rapid recovery may involve the interplay of ATP-binding cassette efflux and solute carrier influx transporters in the testes.
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Affiliation(s)
- Sanny S W Chung
- Departments of Genetics and Development (S.S.W.C., X.W., D.J.W.) and Obstetrics and Gynecology (D.J.W.), The Institute of Human Nutrition (D.J.W.), and The Herbert Irving Comprehensive Cancer Center (D.J.W.), Columbia University Medical Center, New York, New York 10032
| | - Xiangyuan Wang
- Departments of Genetics and Development (S.S.W.C., X.W., D.J.W.) and Obstetrics and Gynecology (D.J.W.), The Institute of Human Nutrition (D.J.W.), and The Herbert Irving Comprehensive Cancer Center (D.J.W.), Columbia University Medical Center, New York, New York 10032
| | - Debra J Wolgemuth
- Departments of Genetics and Development (S.S.W.C., X.W., D.J.W.) and Obstetrics and Gynecology (D.J.W.), The Institute of Human Nutrition (D.J.W.), and The Herbert Irving Comprehensive Cancer Center (D.J.W.), Columbia University Medical Center, New York, New York 10032
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25
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Kligman DE, Draelos ZD. Combination Superficial Peels With Salicylic Acid and Post-Peel Retinoids. J Drugs Dermatol 2016; 15:442-450. [PMID: 27050699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Salicylic acid (SA) and retinoids, tretinoin (all-trans retinoic acid [ATRA]), and retinol (all-trans retinol) are widely used as topical agents for the improvement of photodamage and acne vulgaris. They can be used in daily take-home products or as part of an in-office procedure, combining the benefits of a keratolytic (SA) and a retinoid. OBJECTIVE The objective of this research was to compare the efficacy for ameliorating photodamage of topical tretinoin (0.25%) and retinol (0.25%) to baseline and with each other when applied after a 30% salicylic acid peel on human facial skin. METHODS Twenty female subjects received a full face 30% SA peel followed by the overnight application of tretinoin to a 1 randomized half-face and retinol to the opposite side (split-face study). The identical procedure was repeated at week 2. Double-blinded subject and investigator assessments of the results were captured at weeks 2 and 4. RESULTS By investigator evaluation, both peeling regimens were effective in improving photodamage parameters compared to baseline. (ATRA P-values at week 4 were: P=.00008 texture, P=.00013 roughness, P=.00221 pores, P=.00098 dryness, P=.02770 erythema, and P=.00008 overall appearance. Retinol P-values at week 4 were: P=.00019 texture, P=.00053 roughness, P=.00221 pores, P=.00147 dryness, P=.02770 erythema, and P=.0043 overall appearance.) By subject self-assessment compared with baseline, both tretinoin and retinol were effective in improving overall appearance (ATRA P=.0229 and retinol P=.0190). By investigator evaluation comparing tretinoin with retinol, tretinoin was slightly better than retinol at week 4 in improving texture P=.00506, roughness P=.01171, and overall appearance P=.00506. By subject self-assessment comparing tretinoin with retinol, there was no difference in overall appearance (ATRA P=.2367 and retinol P=.3613). CONCLUSION Either topical tretinoin (0.25%) or retinol (0.25%) can be used safely and effectively when applied in office immediately after SA peeling to ameliorate signs of photoaging.
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Abstract
Epidermal growth factor receptor inhibition is a good target for the treatment of lung, colon, pancreatic and head and neck cancers. Epidermal growth factor receptor-tyrosine kinase inhibitor was first approved for the treatment of advanced lung cancer in 2002. Epidermal growth factor receptor-tyrosine kinase inhibitor plays an essential role in the treatment of cancer, especially for patients harbouring epidermal growth factor receptor activating mutation. Hence, skin toxicity is the most concerning issue for the epidermal growth factor receptor-tyrosine kinase inhibitor treatment. Skin toxicity is bothersome and sometimes affects the quality of life and treatment compliance. Thus, it is important for physicians to understand the background and how to manage epidermal growth factor receptor-tyrosine kinase inhibitor-associated skin toxicity. Here, the author reviewed the mechanism and upfront preventive and reactive treatments for epidermal growth factor receptor inhibitor-associated skin toxicities.
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Affiliation(s)
- Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
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27
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Drugs for rosacea. Med Lett Drugs Ther 2016; 58:16-7. [PMID: 26812123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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28
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Drugs for acne. Med Lett Drugs Ther 2016; 58:13-5. [PMID: 26812122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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29
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Shi VY, Tran K, Patel F, Leventhal J, Konia T, Fung MA, Wilken R, Garcia MS, Fitzmaurice SD, Joo J, Monjazeb AM, Burrall BA, King B, Martinez S, Christensen SD, Maverakis E. 100% Complete response rate in patients with cutaneous metastatic melanoma treated with intralesional interleukin (IL)-2, imiquimod, and topical retinoid combination therapy: results of a case series. J Am Acad Dermatol 2015; 73:645-54. [PMID: 26259990 DOI: 10.1016/j.jaad.2015.06.060] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with cutaneous melanoma metastases have experienced excellent responses to intralesional interleukin (IL)-2. This has led to its recent inclusion into the US National Comprehensive Cancer Network guidelines for management of cutaneous melanoma metastases. Despite this, intralesional IL-2 has not been highlighted in the US literature nor have US physicians adopted it. OBJECTIVE We sought to evaluate the effectiveness of intralesional IL-2 combined with topical imiquimod and retinoid for treatment of cutaneous metastatic melanoma. METHODS A retrospective case series of 11 patients with cutaneous metastatic melanoma were treated with intralesional IL-2 combined with topical imiquimod and retinoid. RESULTS A 100% complete local response rate with long-term follow-up (average of 24 months) was seen in all 11 patients treated with this proposed regimen. Biopsy specimens of treated sites confirmed absence of malignant cells. The most common treatment-related adverse event was rigors. LIMITATIONS Small number of patients, retrospective review of charts, and lack of a comparison group were limitations. CONCLUSION Intralesional IL-2 administered concomitantly with topical imiquimod and a retinoid cream is a promising therapeutic option for managing cutaneous melanoma metastases. The regimen was well tolerated and should be considered as a reasonable alternative to surgical excision.
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Affiliation(s)
- Vivian Y Shi
- Department of Dermatology, University of California, Davis, California
| | - Khiem Tran
- Department of Dermatology, University of California, Davis, California
| | - Forum Patel
- Department of Dermatology, University of California, Davis, California
| | - Jonathan Leventhal
- Department of Dermatology, Yale-New Haven Medical Center, New Haven, Connecticut
| | - Thomas Konia
- Department of Dermatology, University of California, Davis, California
| | - Maxwell A Fung
- Department of Dermatology, University of California, Davis, California
| | - Reason Wilken
- Department of Dermatology, University of California, Davis, California
| | | | | | - Jayne Joo
- Department of Dermatology, University of California, Davis, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California, Davis, California
| | - Barbara A Burrall
- Department of Dermatology, University of California, Davis, California
| | - Brett King
- Department of Dermatology, Yale-New Haven Medical Center, New Haven, Connecticut
| | - Steve Martinez
- Department of Surgical Oncology, University of California, Davis, California
| | - Scott D Christensen
- Department of Internal Medicine, Division of Hematology/Oncology, University of California Davis Medical Center, Davis, California
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, California.
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Kebe M, Cheikh OS, Yahya S, Ould N, Baba M, Ball M. [Xeroderma pigmentosum. About 2 Mauritanian cases]. Tunis Med 2015; 93:400-402. [PMID: 26644113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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31
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Orfanos CE, Stadler R, Gollnick H, Tsambaos D. Current developments of oral retinoid therapy with three generations of drugs. Non-aromatic, monoaromatic and polyaromatic retinoids (arotinoids). Curr Probl Dermatol 2015; 13:33-49. [PMID: 3156022 DOI: 10.1159/000410143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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32
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Veraldi S, Barbareschi M, Guanziroli E, Bettoli V, Minghetti S, Capitanio B, Sinagra JL, Sedona P, Schianchi R. Treatment of mild to moderate acne with a fixed combination of hydroxypinacolone retinoate, retinol glycospheres and papain glycospheres. GIORN ITAL DERMAT V 2015; 150:143-147. [PMID: 25876142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM A fixed combination of 0.1% hydroxypinacolone retinoate (synthetic esther of 9-cis-retinoic acid), 1% retinol in glycospheres and 2% papain in glycospheres in aqueous gel has been recently introduced into the Italian market in order to reduce the incidence and severity of irritant contact dermatitis caused by topical retinoids, without compromising their efficacy. Primary objectives of this sponsor-free, pilot, open, multicenter study were to evaluate the efficacy and tolerability of this gel in patients with comedonal-papular, mild to moderate acne of the face. METHODS Ninety-eight Caucasian patients (28 males and 70 females), with an age ranging from 15 to 40 years, were treated with the gel once daily for 12 weeks. Acne severity and treatment efficacy were evaluated by means of the Global Acne Grading System (GAGS) and lesions count. RESULTS Ninety-four patients were considered evaluable. A 41% mean reduction in the GAGS score was observed; a 40.8% mean reduction of total lesions was recorded; 15.3% of patients experienced mild to moderate local side effects (dryness, peeling, erythema, burning). No patients stopped the treatment because of these side effects. CONCLUSION This study, based on a high number of evaluable patients, demonstrates that this fixed combination is an effective and safe option for the treatment of comedonal-papular, mild to moderate acne of the face. A controlled clinical study is necessary to confirm these data.
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Affiliation(s)
- S Veraldi
- Department of Pathophysiology and Transplantation, University of Milan, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy -
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Feely MA, Smith BL, Weinberg JM. Novel psoriasis therapies and patient outcomes, part 1: topical medications. Cutis 2015; 95:164-170. [PMID: 25844785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, advances in our understanding of inflammatory mediators and the underlying pathogenesis of psoriasis and psoriatic arthritis have shed light on potential therapeutic targets, which has led to the development of several new promising treatments. In this article, key clinical trials, mechanisms of action, patient outcomes, and relevant safety information for these novel topical medications will be evaluated. This article is the first in a 3-part series on treatments presently in the pipeline for the management of psoriasis and psoriatic arthritis including topical agents, biologic treatments, and systemic therapies in phase 2 and phase 3 clinical trials. With novel approaches to the disease process, these therapies may afford more targeted individualized treatment regimens and offer hope to patients with psoriasis and psoriatic arthritis who have reported a suboptimal therapeutic response to conventional therapies.
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Affiliation(s)
- Meghan A Feely
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, Mount Sinai St. Luke's-Roosevelt, 1090 Amsterdam Ave, Ste 11B, New York, NY 10025, USA.
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Di Bella G, Toscano R, Ricchi A, Colori B. Congenital fibrosarcoma in complete remission with Somatostatin, Bromocriptine, Retinoids, Vitamin D3, Vitamin E, Vitamin C, Melatonin, Calcium, Chondroitin sulfate associated with low doses of Cyclophosphamide in a 14-year Follow up. Neuro Endocrinol Lett 2015; 36:725-733. [PMID: 26921571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
At birth, a male child presented a 6 cm tumour in the right leg. The tumour was partially removed after just 12 days. Histology showed a congenital fibrosarcoma associated with reactive lymphadenitis. A first cycle of adjuvant chemotherapy did not prevent the rapid progression of the disease. Subsequent evaluation for surgical removal raised serious concerns due to the need for a major operation involving total amputation of the right leg and hemipelvectomy. Since surgery could not exclude the possibility of disease recurrence and since the traditional cycles of chemotherapy did not offer any possibility of a cure, the parents opted for the Di Bella Method. The combined use of Somatostatin, Melatonin, Retinoids solubilized in Vit. E, Vit. C, Vit. D3, Calcium, and Chondroitin sulfate associated with low doses of Cyclophosphamide resulted in a complete objective response, still present 14 years later, with no toxicity and without the need for hospitalization, allowing a normal quality of life and perfectly normal adolescent psycho-physical development.
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Affiliation(s)
| | | | | | - Biagio Colori
- Rizzoli Scientific Research and Care Institute, Via Giulio Cesare Pupill, 40136 Bologna, Italy
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35
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Aires D, Shaath T, Fraga G, Rajpara A, Fischer R, Liu D. Safe and efficacious use of a topical retinoid under occlusion for the treatment of mycosis fungoides. J Drugs Dermatol 2014; 13:1479-1480. [PMID: 25607792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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36
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Forchetti G, Suppa M, Del Marmol V. Overview on non-melanoma skin cancers in solid organ transplant recipients. GIORN ITAL DERMAT V 2014; 149:383-387. [PMID: 25068224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The risk of non-melanoma skin cancer (NMSC) is significantly increased in solid organ transplant recipients (SOTRs) due to the long-term immunosuppressive treatment. NMSCs can be more aggressive in SOTRs than in the general population, resulting in significantly higher morbidity and mortality. In contrast to the immunocompetent population, skin cancers in SOTRs are dominated by squamous cell carcinoma, followed by basal cell carcinoma. Life-long radiation exposure, male sex, fair skin, history of prior NMSC, genetic factors, age at transplant along with duration and extent of the immunosuppression therapy have been identified as risk factors for NMSC in SOTRs. Photo-protection, skin self-examination, early diagnosis and treatment of skin lesions, reduction of immunotherapy, switch to mammalian target-of-rapamycin inhibitors and chemoprevention with oral retinoids are effective measures for the reduction of the incidence of NMSC in such patients.
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Affiliation(s)
- G Forchetti
- Department of Dermatology University of Padua, Padua, Italy -
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Shaw MK, Davis SA, Feldman SR, Fleischer AB. Trends in systemic psoriasis treatment therapies from 1993 through 2010. J Drugs Dermatol 2014; 13:917-920. [PMID: 25116968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Moderate-to-severe psoriasis generally requires systemic therapy, and is often undertreated. OBJECTIVE To determine and analyze what courses of treatment and in what frequency are being utilized to combat psoriasis in the United States. METHODS Analysis of data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) of the National Center for Health Statistics. Data were analyzed to examine the prevalence of different therapy techniques to combat psoriasis from 1993 through 2010. The trends for phototherapy, methotrexate (MTX), retinoids, cyclosporine A (CSA), systemic steroids, and biologics were all analyzed over the entire 18-year period and independently before and after the introduction of biologics in 2002. RESULTS From 1993 to 2010, the trend for total systemic treatments has not significantly increased (P=0.5). Frequency of phototherapy treatments significantly decreased from 1993 to 2010 (P<0.001). Since the introduction of biologics in 2002, their frequency has significantly increased, becoming the most frequently used treatment from 2008-2010 (P<0.0001). LIMITATIONS Severity of psoriasis was not recorded in the NAMCS and NHAMCS. CONCLUSIONS The frequency of systemic treatments to treat psoriasis has not significantly increased from 1993 to 2010. Despite the introduction of biologics, it appears that little progress has been made in reducing under-treatment of moderate-to-severe psoriasis.
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Ribeiro MPC, Santos AE, Custódio JBA. Interplay between estrogen and retinoid signaling in breast cancer--current and future perspectives. Cancer Lett 2014; 353:17-24. [PMID: 25042865 DOI: 10.1016/j.canlet.2014.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/17/2014] [Accepted: 07/08/2014] [Indexed: 01/11/2023]
Abstract
All-trans-retinoic acid (RA) is a promising agent for breast cancer treatment, but it induces several adverse effects and the few clinical trials performed up to now in breast cancer patients have provided disappointing results. The combination of RA and antiestrogenic compounds, such as tamoxifen, synergistically decreases the proliferation of breast cancer cells and an interplay between retinoid and estrogen signaling has begun to be unraveled, turning these combinations into an appealing strategy for breast cancer treatment. This review focus on the current knowledge regarding the interplay between retinoid and estrogen signaling in breast cancer and the combinations of RA with antiestrogens, aiming their future utilization in cancer therapy.
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Affiliation(s)
- Mariana P C Ribeiro
- Center for Neuroscience and Cell Biology, University of Coimbra, 3000-354 Coimbra, Portugal; Laboratory of Biochemistry, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Armanda E Santos
- Center for Neuroscience and Cell Biology, University of Coimbra, 3000-354 Coimbra, Portugal; Laboratory of Biochemistry, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - José B A Custódio
- Center for Neuroscience and Cell Biology, University of Coimbra, 3000-354 Coimbra, Portugal; Laboratory of Biochemistry, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
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Serna-Tamayo C, Janniger CK, Micali G, Schwartz RA. Neonatal and infantile acne vulgaris: an update. Cutis 2014; 94:13-16. [PMID: 25101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Acne may present in neonates, infants, and small children. Neonatal and infantile acne vulgaris are not considered to be rare. The presentation of acne in this patient population sometimes represents virilization and may portend later development of severe adolescent acne. Neonatal and infantile acne vulgaris must be distinguished from other cutaneous disorders seen in newborns and infants. Infantile acne tends to be more pleomorphic and inflammatory, thus requiring more vigorous therapy than neonatal acne.
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Affiliation(s)
| | - Camila K Janniger
- Dermatology and Pediatrics, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103, USA.
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Tang XH, Osei-Sarfo K, Urvalek AM, Zhang T, Scognamiglio T, Gudas LJ. Combination of bexarotene and the retinoid CD1530 reduces murine oral-cavity carcinogenesis induced by the carcinogen 4-nitroquinoline 1-oxide. Proc Natl Acad Sci U S A 2014; 111:8907-12. [PMID: 24927566 PMCID: PMC4066471 DOI: 10.1073/pnas.1404828111] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We investigated the effects of bexarotene (a retinoid X receptor agonist), CD1530 (a retinoic acid receptor γ selective agonist), and the combination of these two drugs for the prevention of oral carcinogenesis induced by the carcinogen 4-nitroquinoline 1-oxide (4-NQO) in a mouse model of human oral-cavity and esophageal squamous-cell carcinoma previously generated in our laboratory. We observed decreased numbers of neoplastic tongue lesions and reduced lesion severity in the 4-NQO plus CD1530 (4N+C) and 4-NQO plus bexarotene plus CD1530 (4N+B+C) groups compared with the 4-NQO group. RNA-Seq analyses showed increases in transcripts in cell proliferation/cell cycle progression pathways in the 4-NQO vs. the untreated group. In addition, β-catenin and matrix metallopeptidase 9 (MMP9) protein levels and reactive oxygen species (ROS), as assessed by 4-hydroxynonenal (4-HNE) staining, were elevated in tongue tissues 17 wk after the termination of the 4-NQO treatment. The 4N+B, 4N+C, and 4N+B+C groups showed dramatically lower levels of β-catenin, MMP9, and 4-HNE staining compared with the 4-NQO group. The major reduction in 4-HNE staining in the retinoid treatment groups suggests a novel mechanism of action, reduction of ROS, by which bexarotene and CD1530 inhibit carcinogenesis.
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Affiliation(s)
| | | | | | - Tuo Zhang
- Genomics Resources Core Facility, and
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Bowe WP. Antibiotic resistance and acne: where we stand and what the future holds. J Drugs Dermatol 2014; 13:s66-s70. [PMID: 24918574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Antibiotic resistance is described as "a global public health challenge" and a "major health security challenge of the 21st century" by global health authorities,1 and there is a growing need for dermatologists to counteract it in their treatments of acne.3,4 Antibiotic limiting regimens, such as a combination of topical retinoids and benzoyl peroxide, have shown effectiveness in the treatment of acne; and topical probiotics could also play a needed role.
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Bertelsen M, Rosenberg T, Larsen M. [New treatments of hereditary blindness]. Ugeskr Laeger 2013; 175:2038-2042. [PMID: 23992912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ongoing clinical trials are targeting several previously intractable hereditary causes of blindness of congenital, childhood or early adulthood onset, mainly in the optic nerve and retina. The intended stage of initiation of the new therapeutic approaches ranges from neonatal life and a structurally intact retinal tissue to adult life with a complete loss of photoreceptors. It must be assumed that some of the trials will succeed in producing new therapies and action must be taken to refine and accelerate diagnostics and to preserve therapeutic potential in blind people.
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Affiliation(s)
- Mette Bertelsen
- Øjenklinikken, Kennedy Centret, Gammel Landevej 7, Glostrup.
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Weiss JS. Messages from molecules: deciphering the code. J Drugs Dermatol 2013; 12:s70-s72. [PMID: 23839204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acne therapy should be based on pathogenesis. Current mainstays of therapy include topical retinoids, antibiotics, and benzoyl peroxide. Newer research has shown that inflammation may precede comedo formation. Gene array analysis of acne lesions has elucidated newer inflammatory mediators that may become future targets for therapeutic development.
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Shapiro SS, Seiberg M, Cole CA. Vitamin A and its derivatives in experimental photocarcinogenesis: preventive effects and relevance to humans. J Drugs Dermatol 2013; 12:458-463. [PMID: 23652895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The 1925 classical observation that vitamin A deficiency leads to squamous metaplasia and epithelial keratinization, coupled with the later finding that excess vitamin A inhibits keratinization of chick embryo skin, set the foundation for the potential therapeutic use of retinoids in cutaneous conditions of keratinization. Significant progress has since been made understanding the molecular biology, biochemistry, pharmacology, and toxicology of vitamin A and its derivatives, collectively named retinoids. Natural and synthetic retinoids are now routinely used to treat acne, psoriasis, skin keratinization disorders, and photodamage. Retinoids also inhibit tumor formation and skin cancer development in experimental systems and in humans. Retinol and retinyl palmitate (RP) are found in cosmetic products and in foods and dietary supplements, which are all considered safe, by inclusion in the Generally Recognized as Safe Substances Database. However, the safety of topical retinoids was questioned in one publication and in a recent National Toxicology Program report of RP-containing topical preparations, suggesting the possible earlier onset of ultraviolet-induced squamous cell carcinomas in the hairless mouse photocarcinogenesis model. This suggestion contradicts a large body of data indicating that topical retinoids are chemoprotective in humans, and it was immediately challenged by new reviews on the safety of RP in general and within sunscreens. This paper will review the preclinical and clinical data supporting the safety and chemopreventive activity of retinoids, with an emphasis on RP, and will examine the experimental systems used to evaluate the safety of topical vitamin A preparations in order to provide perspective relative to human skin.
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Fett N, Nevas J. Multiple eruptive milia. Cutis 2013; 91:191-192. [PMID: 23763079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multiple eruptive milia (MEM) is a rare skin condition characterized by sudden onset of multiple milia occurring mainly on the head, neck, and trunk. Milia are small, benign, 1- to 4-mm, white keratinous cysts. The lesions generally are asymptomatic and may arise spontaneously or secondary to a number of processes. Multiple eruptive milia are cosmetically troublesome and difficult to treat. We report the case of a 40-year-old man with an abrupt onset of MEM on the face.
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Affiliation(s)
- Nicole Fett
- Philadelphia VA Medical Center, Pennsylvania, USA.
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Abstract
BACKGROUND Psoriasis is a chronic, systemic, inflammatory condition for which a variety of treatment modalities exist. Combinations of therapies are used often in clinical practice to enhance efficacy and reduce drug toxicities. PURPOSE The purpose of this review is to assess the literature on the efficacy and safety of combination therapy in the treatment of psoriasis. METHODS MEDLINE was reviewed to identify English-language publications from 1966 to 2011 examining combination therapy in psoriasis. Fifty-three articles met inclusion criteria and were included in this review. Randomized controlled trials addressing various combinations of treatment modalities for psoriasis were included. Data from these clinical studies were summarized and the outcomes were discussed. RESULTS Large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis are limited. The strongest data support the use of combinations of vitamin D derivatives and corticosteroids as topical combinations and, to a lesser extent, the combination of other topical agents. Phototherapy and topical vitamin D derivatives as well as phototherapy in combination with oral retinoids are well supported in the literature. Combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety. LIMITATIONS Our data were limited by the small number of clinical trials examining the multiple available combinations that are used in clinical practice. CONCLUSIONS The use of combination treatments falls within the standard of care for psoriasis, even if these combinations have not been extensively studied in clinical trials.
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Affiliation(s)
- Cheryl J Gustafson
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA
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Di Bella G, Mascia F, Colori B. The Di Bella Method (DBM) in the treatment of prostate cancer: a preliminary retrospective study of 16 patients and a review of the literature. Neuro Endocrinol Lett 2013; 34:523-528. [PMID: 24378460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the objective clinical response and the safety of the combined administration of somatostatin, melatonin, retinoids, vitamin D3, dopamine subtype 2 receptor (D2R) agonists and low doses of cyclophosphamide, associated with androgen ablation, in patients with a histological diagnosis of prostate adenocarcinoma (Pac). MATERIALS AND METHODS The clinical data of 30 patients with non-invasive and metastatic prostate cancer, who attended our institution over a period of more than 5 years, were retrospectively reviewed. RESULTS 16 patients satisfied the evaluation criteria. Median age: 64 years. Disease stages: 8 patients (50%) were in Stage II. For advanced stages (Stage IV), secondary lesions were located in the bones and lymph nodes. Taken together, an overall objective response (OR) [Complete response (CR) + Partial Response (PR)] was achieved in 69% of the patients, with 88% of objective clinical benefit [CR+PR+SD]. For local Prostate Cancer group, an OR was achieved in 87.5% of patients (7 cases; 53-98; 95% CI), with CR in 62.5% (5 cases, 31-86; 95% CI). In metastatic disease, the OR was 50% (4 cases; 21-78; 95% CI), with a 20% of CR (2 cases; 7-59; 95% CI) and 75% of clinical benefit. CONCLUSIONS This preliminary study shows that patients with early and advanced forms of prostate cancer, not previously treated by surgery and/or chemo-radiotherapy, can achieve a more than positive clinical benefit with the protocol foreseen by the Di Bella Method. Further clinical investigations are strongly recommended.
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Affiliation(s)
| | - Fabrizio Mascia
- Di Bella Foundation, Via G. Marconi 51, Bologna 40122, Italy
| | - Biagio Colori
- Rizzoli Scientific Research and Care Institute, Via Giulio Cesare Pupill, 40136 Bologna, Italy
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Di Bella G, Mascia F, Ricchi A, Colori B. Evaluation of the safety and efficacy of the first-line treatment with somatostatin combined with melatonin, retinoids, vitamin D3, and low doses of cyclophosphamide in 20 cases of breast cancer: a preliminary report. Neuro Endocrinol Lett 2013; 34:660-668. [PMID: 24464005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The current strategies for the treatment of breast cancer are essentially based on surgery, preceded and/or followed by chemotherapy often supplemented by radiotherapy and/or the administration of hormonal therapy and monoclonal antibodies. Their combined use has made it possible to increase an overall survival but they are still penalized by adverse effects and toxicity. The marked anti-cancer effects of biological molecule such as somatostatin, melatonin, retinoid, vitamin D3 and prolactin inhibitors have been studied and documented for several decades. Their integrated and synergic action have been demonstrated, but only a few studies have as yet been carried out on their combined application in humans. The aim of the present investigation was to evaluate both the objective clinical response and toxicity of the biological multimodal treatment named Di Bella Method (DBM). MATERIAL AND METHODS The clinical data from a total of 20 women with a certified diagnosis of breast cancer,defined disease stage, and who independently decided to follow the DBM as first-line treatment, were retrospectively reviewed. RESULTS The mean age of the patients was 51 years (min 30; max 73). Twelve (12) patients (60%) presented an early stage disease, while the other 40% had a locally advanced/metastatic stage. An overall clinical benefit was achieved in 75% of cases, with 55% of complete response and 20% of partial response. For metastatic patients, the overall survival rate was 71%. The main toxicity effects included leukopenia, gastrointestinal phenomena and drowsiness. CONCLUSIONS The preliminary results of this report confirm the positive action of the biological treatment in terms of efficacy and survival, showing a more than favorable profile of tolerability.
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Affiliation(s)
| | - Fabrizio Mascia
- Di Bella Foundation, Via G. Marconi 51, Bologna 40122, Italy
| | | | - Biagio Colori
- Rizzoli Institute, Scientific Research and Care Institute, Bologna, Italy
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Youssef SM, Teng JMC. Effective topical combination therapy for treatment of lichen striatus in children: a case series and review. J Drugs Dermatol 2012; 11:872-875. [PMID: 22777233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lichen striatus (LS) is an uncommon linear dermatosis that is primarily seen in children from 4 months to 15 years of age. While some of these eruptions are asymptomatic, others can be quite pruritic. In darker-skinned individuals, post-inflammatory hypopigmentation can be significant and may provide a cause for concern for the patients and/or their parents. In our case series of 4 patients, we observed rapid resolution of LS by combining a topical retinoid with a topical steroid. To our knowledge, this is the first report of successful treatment with this kind of combination therapy in the English literature. The patients not only achieved satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of topical tazarotene is localized irritation at treatment sites, but the patients in this particular series tolerated the treatment well.
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Affiliation(s)
- Sherry M Youssef
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI 53715, USA
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