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Acne, topical antibiotics for [keywords]
- [Acne vulgaris]. [English Abstract, Journal Article]
- Hautarzt 2014 Aug; 65(8):733-50.
Acne vulgaris is worldwide the most common skin disease. Acne is an inflammatory disorder in whose emergence androgens, PPAR ligands, the IGF-1 signaling pathway, regulating neuropeptides and environmental factors are probably involved. These factors interrupt the natural cycling process in the sebaceous gland follicle and support the transition of microcomedones to comedones and inflammatory lesions. Proinflammatory lipids and cytokines are mediators for the development of acne lesions. Bacterial antigens can potentate the inflammatory phenomena. Acne is predominantly treated with combination therapy. Selecting a treatment regimen depends on the exact classification of acne type and severity. The development of scars is the main criterion for the choice of systemic therapy. Retinoids for mild comedonal acne and the combination of retinoids with antibiotics and/or benzoyl peroxide for mild to moderate papulopustular acne are the drugs of first choice for topical treatment. The use of topical antibiotics is not recommended any more because of the development of resistant bacterial strains. Systemic antibiotics, in combination with topical retinoids and/or benzoyl peroxide, for moderate papular/nodular acne and isotretinoin for severe nodular/conglobate acne are the columns of systemic acne treatment. Systemic anti-androgens are used in women against moderate papulopustular acne. Due to advances in the understanding of the underlying inflammatory mechanisms in recent years the development of new therapeutic agents with good efficacy and better side effect profile should be expected in the future.
- Common Use of Prescription Off-Label Acne Therapy in Children Younger Than 12 Years Old. [JOURNAL ARTICLE]
- Pediatr Dermatol 2014 Jun 13.
Acne is occurring more frequently in younger age groups, but most available treatments are considered off-label in young children. As the epidemiology of acne has changed to include younger children over the past 20 years, neither regulators, pharmaceutical companies, nor clinicians have understood the need or value of obtaining regulatory sanctions for problems physicians have managed using clinical judgment. The objective of this study was to analyze the frequency of off-label acne treatment according to age and other demographic factors. We searched the National Ambulatory Medical Care Survey from 1993 to 2010 for visits in children younger than 12 years of age for the diagnosis of International Classification of Diseases, Ninth Revision, code 706.1. We tabulated leading acne treatments and assessed factors associated with off-label prescribing. Off-label but appropriate acne treatments were used in 29% of acne visits for children younger than 12 years of age. Dermatologists were more likely than pediatricians to prescribe off-label treatment (p < 0.001). The most frequently used off-label treatments were topical retinoids, followed by oral antibiotics. There was no significant trend in the rate of off-label prescribing over time (p = 0.40). Off-label treatment is well within the standard of care for young children with acne. More data on the use of topical retinoids in young children will improve our understanding of their use, which may help optimize treatment outcomes for children with acne.
- Novel pharmacological approaches for the treatment of acne vulgaris. [JOURNAL ARTICLE]
- Expert Opin Investig Drugs 2014 Jun 2.:1-22.
Introduction: Acne vulgaris is the most common skin disease worldwide; yet, current treatment options, although effective, are associated with unwanted side effects, chronicity, relapses and recurrences. The adequate control of the four pathogenic mechanisms, involved in the appearance of acne lesions, is paramount to treatment success. Areas covered: The authors discuss and evaluate the pathogenic pathways related to the mechanisms of action of novel molecules, which are currently under investigation for the treatment of acne vulgaris. The manuscript is based on comprehensive searches made through PubMed, GoogleScholar and ClinicalTrial.gov, using different combination of key words, which include acne vulgaris, pathogenesis, treatment, sebogenesis and Propionibacterium acnes. Expert opinion: In the near future, more effective treatments with fewer side effects are expected. The use of topical antiandrogens, acetylcholine inhibitors and PPAR modulators seem to be promising options for controlling sebum production. Retinoic acid metabolism-blocking agents and IL-1α inhibitors have the potential to become legitimate alternative options to retinoid therapy in the management of infundibular dyskeratosis. Indeed, the authors believe that there will likely be a decline in the use of antibiotics for controlling P. acnes colonization and targeting the inflammation cascade.
- Moisturizers for Acne: What are their Constituents? [REVIEW]
- J Clin Aesthet Dermatol 2014 May; 7(5):36-44.
Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers. Different treatments offer different modes of action, but aim to target acne pathology. Topical therapies, such as benzoyl peroxide, retinoids, antibiotics with alcohol-based preparations, and salicylic acid, can cause skin irritation resulting in a lack of patient adherence. Some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical benzoyl peroxide or a retinoid is prescribed. Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne. Moisturizers contain three main properties, which are occlusive, humectant, and emollient effects. Currently, many moisturizers claim to be suitable for acne treatment. This article aims to provide a review of the active ingredients and properties of those moisturizers. Fifty-two moisturizers for acne were included for analysis. Most of the products (92%) have anti-inflammatory properties apart from occlusive, humectant, and emollient effects. Anti-acne medications, including salicylic acid, benzoyl peroxide, and retinol, were found respectively in 35, 10, and 8 percent of the moisturizer products containing anti-inflammatory properties. More than half of the products contain dimethicone and/or glycerin for its moisturizer property. Aloe vera and witch hazel are botanical anti-inflammatories that were commonly found in this study. Scientific data regarding some ingredients are discussed to provide a guide for physicians in selecting moisturizers for acne patients.
- A retrospective analysis of the duration of oral antibiotic therapy for the treatment of acne among adolescents: Investigating practice gaps and potential cost-savings. [JOURNAL ARTICLE]
- J Am Acad Dermatol 2014 Apr 8.
Duration of oral antibiotic therapy in acne has not been widely studied. Recent guidelines suggest it should be limited to 3 to 6 months.We sought to compare the duration of oral antibiotic use with recent guidelines and determine the potential cost-savings related to shortened durations.This is a retrospective cohort study from the MarketScan Commercial Claims and Encounters database. Claims data were used to determine duration and costs of antibiotic therapy.The mean course duration was 129 days. The majority (93%) of courses were less than 9 months. Among the 31,634 courses, 18,280 (57.8%) did not include concomitant topical retinoid therapy. The mean (95% confidence interval) duration with and without topical retinoid use was 133 (131.5-134.7) days and 127 (125.4-127.9) days, respectively. The mean excess direct cost of antibiotic treatment for longer than 6 months was $580.99/person.Claims cannot be attributed to a specific diagnosis or provider. The database does not provide information on acne severity.Duration of antibiotic use is decreasing when compared with previous data. However, 5547 (17.53%) courses exceeded 6 months, highlighting an opportunity for reduced antibiotic use. If courses greater than 6 months were shortened to 6 months, savings would be $580.99/person.
- Antibiotic stewardship in dermatology: limiting antibiotic use in acne. [JOURNAL ARTICLE]
- Eur J Dermatol 2014 Apr 11.
Background/Objectives: Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for long durations; thus, acne therapy results in extensive antibiotic exposure. This article discusses the role of antibiotic therapy in acne from the perspective of how clinicians can best preserve the utility of these important drugs while providing efficacious and safe therapy for acne patients. Methods: Review of literature augmented by expert opinion when literature was sparse. Results: Antibiotic monotherapy (topical or oral) is not recommended due to the availability of clinically superior regimens. Systemic antibiotics are important for managing moderate to severe acne and should be used for a limited duration of time (3-4 months). Topical antibiotics should be paired with benzoyl peroxide to limit potential for resistance. Information gained in recent years about the pathophysiology of acne has shed light on the role of Propionibacterium acnes as well as other key pathogenic pathways such as inflammation. Conclusions: The improved understanding of acne pathogenic mechanisms can and should be applied to develop modern therapeutic approaches that are efficacious and mesh with current public health concerns.
- Cohort study on the treatment with dapsone 5% gel of mild to moderate inflammatory acne of the face in women. [Journal Article]
- Skinmed 2014 Jan-Feb; 12(1):15-21.
Topical dapsone 5% gel for the treatment of mild to moderate acne has been shown to be effective in randomized controlled studies. A total of 101 adult women with mild to moderate facial inflammatory acne participated in a 12-week cohort study to evaluate the efficacy, tolerability, and safety of dapsone gel 5% in this specific group who often complain of sensitive skin. The women were instructed to apply dapsone 5% gel twice daily after washing their face with a standard noncomedogenic soap-free cleanser. Treatment outcome was evaluated using physician-scored Global Acne Assessment Scale (GAAS) and patient-reported facial skin condition. Ninety-three women completed the study (6 were lost to follow-up and 2 had mild skin irritation). At 12 weeks, significant physician GAAS scores (t55 = 8.85, P = .001) and patient-reported lesion reductions were shown. Treatment success (GAAS 0 or 1) at 12 weeks was achieved in 69.4% (n = 75) of women (t94 = 4.17, P = .001), improving patient-reported quality-of-life aspects. Topical dapsone gel 5% was shown to be safe, minimally irritating, and effective in the treatment of mild to moderate inflammatory facial acne in adult women with sensitive skin.
- Therapeutic update: acne. [Journal Article]
- J Drugs Dermatol 2014 Mar; 13(3):235-8.
Acne vulgaris is a multi-factorial disease affecting a significant proportion of the population. A patient-centered approach is most effective for the treatment of acne, focusing both on life style interventions as well as pharmacologic therapy. Lifestyle modifications include dietary counseling, as a link between dietary choices and acne continues to grow. Pharmacologic regimens must account for the severity of disease, emergence of resistant bacterial strains and ease of patient compliance. Combination topical therapy is often required for patients with mixed inflammatory and comedonal acne, while oral medications are frequently needed for severe cases or those involving large surface areas such as the chest or back. With or without a photosensitizer, light based treatments present an alternative or adjuvant to traditional pharmacologic therapy. Novel formulations of existing medications in addition to original compounds continue in development, expanding therapeutic possibilities for the future. With the emergence of antibiotic resistance, we are forced to prescribe antibiotics more responsibly, while exploring alternatives to this longstanding standard of care. This article discusses current and emerging therapies for the treatment of acne.
- Spironolactone and topical retinoids in adult female cyclical acne. [Journal Article]
- J Drugs Dermatol 2014 Feb; 13(2):126-9.
To access the efficacy of spironolactone and topical retinoids in the treatment of female cyclical acne.A retrospective chart review on 41 female patients age 19-57 years old with cyclical acne was performed. Patients were examined over the course of 2 to 102 months while taking 50 to 200 mg of spironolactone and topical tretinoin 0.025% or adapalene 0.1% cream. All were diagnosed with acne rated mild to severe, prior to treatment, and were started on an initial dose of 50 mg po daily. If significant improvement was not seen within the first 3-6 months, the dose was either held or increased in 25 mg increments every 3 months. Patients on oral and topical antibiotics, as well as patients on photodynamic therapy were excluded from the study. The response to treatment was rated on a 0-4 scale with 0 being no response and 4 corresponding to clear skin.One patient (2.4%) had no response to treatment. This patient was only on 50 mg po daily for only 2 months. Only 5 (12.2%) patients had minimal response to treatment and 9 (22.0%), 12 (29.3%), and 14 (34.1%) had a good, excellent, or clear response respectively. The study showed 26 (63.4%) women on treatment with spironolactone and topical retinoids had an excellent or clear outcome, and 35 (85.4%) were considered to have a good, excellent, or clear response.The addition of spironolactone to topical retinoid treatment suggests a superior response to retinoids alone in clearance of female adult cyclical acne.
- Acneiform eruptions: A common cutaneous toxicity of the MEK inhibitor trametinib. [JOURNAL ARTICLE]
- Australas J Dermatol 2013 Dec 9.
The MEK inhibitor trametinib is currently undergoing clinical trials as the treatment of metastatic melanoma both alone and in combination with the BRAF inhibitor dabrafenib. One of the most frequent side-effects associated with its use as a single agent is the development of acneiform eruptions. These eruptions seem to be reduced when dosed in combination with dabrafenib.To investigate the prevalence of acneiform eruptions in patients taking the MEK inhibitor trametinib, both alone and in combination with dabrafenib.All patients enrolled in the trametinib alone (n = 13) or trametinib and dabrafenib combination (n = 30) clinical trials at a single site underwent a retrospective file review. The development and management of acne or acneiform eruptions was noted.In total, 77% of the trametinib group developed an acneiform eruption on the trial, while only 10% developed acneiform lesions in the combination trial. The patients were treated with oral doxycycline, topical antibiotics or topical antiseptic washes, with a good response. However the condition recurred if these treatments were ceased and the patient was still on trametinib therapy.The MEK inhibitor trametinib is associated with the development of acneiform eruptions. When combined with dabrafenib the frequency of this side-effect is reduced.