AARS Hot Topics - August 15, 2017 Issue


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This is a semi-monthly compilation of peer-review literature and online updates in acne and rosacea covering industry press, new medical research and what patients and your peers are talking about in patient counseling tips.

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Industry News

  • TopMD, the parent company of CLn Skin Care, announced it has appointed Kristin A. Romine, MD, to its medical advisory board. Romine is founder of Camelback Dermatology & Skin Surgery in Phoenix, Arizona, and specializes in surgical, cosmetic and laser dermatology. She also is an adjunct faculty member at Midwestern University, Glendale, Arizona
  • Foamix Pharmaceuticals announced that the first patient has been dosed in its third phase 3 study to measure the efficacy and safety of FMX101, its topical minocycline foam 4%, in patients with moderate-to-severe acne. "During a recent Type B meeting, the FDA confirmed that statistically significant findings from a third study would constitute replication of the Study FX2014-05 results, and would be sufficient to establish an efficacy claim," David Domzalski, CEO of Foamix, stated in a news release.
  • Cutanea Life Sciences announced the introduction a new mobile application for patients who are prescribed Aktipak (erythromycin and benzoyl peroxide) Gel, 3%/5%, a combination erythromycin and benzoyl peroxide therapy indicated for the topical treatment of acne vulgaris. "Most teens today have three things in common: they have acne, they're always on the go, and they're into digital technology.”

New Medical Research

  • Findings from a recent case studs demonstrate facial flushing and persistent erythema can be effectively treated by carvedilol long-term with a fast onset of improvement in a dose well tolerated.
  • Increased facial skin pH in patients with acne at basal conditions mirrors a chronic state of stratum corneum instability, which could be predisposing individuals to acne occurrence and/or recurrences. It could possibly be a common domain via which the classical pathomechanisms might be acting in acne. Integrating measures that maintain stratum corneum pH during therapy might prove worthwhile.
  • Isotretinoin significantly affected salivary flow, buffer capacity, caries lesion activity scores for 6 months. However, salivary parameters and caries lesion activity scores had no significant correlations.
  • The results of two randomized, vehicle-controlled, phase 2 studies indicated that clindamycin cream 0.3% and 1% and clindamycin gel 1% were no more effective than the vehicle in the treatment of moderate to severe rosacea, suggesting clindamycin has no intrinsic anti-inflammatory activity in rosacea.
  • Improvement in acne symptoms was observed for both treatment procedures without significant differences and with minimal side effects. Salicylic acid 30% peel and PBBL were well tolerated in our study, and both clinical procedures were efficacious and well-tolerated by the patients.
  • Overexpression of cytokines/chemokines, along with genetic changes, supports the hypothesis that PG and its syndromic form, PASH, are a spectrum of polygenic autoinflammatory conditions.
  • This study suggests that biofilm formation is associated with inflammation of chronic HS lesions. The aggregates most likely occur as a secondary event, possibly due to predisposing local anatomical changes such as sinus tracts (tunnels), keratinous detritus and dilated hair follicles.

Clinical Reviews

  • The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used.
  • Brimonidine topical gel 0.33% is a safe, effective, and patient-accepted treatment for facial erythema of rosacea. This was concluded in a review of current literature regarding the safety, efficacy, and patient acceptability of brimonidine 0.33% gel.
  • To review the current literature regarding the safety, efficacy, and patient acceptability of brimonidine 0.33% gel. These guidelines better characterize acne fulminans and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants.
  • The presence of vasoactivity in rosacea-affected skin led to the development of two topical alpha-adrenergic receptor agonists, brimonidine tartrate 0.5% gel and oxymetazoline hydrochloride 1% cream, both approved by the United States Food and Drug Administration for treatment of persistent facial erythema of rosacea. In this article, the author discusses challenges related to the treatment of persistent facial erythema of rosacea and the use of alpha-agonist therapy. The author also discusses cases of worsening of facial erythema after the application of brimonidine, as well as briefly reviews recently reported clinical data on oxymetazoline. Finally, the author attempts to differentiate some potential mechanistic differences between these two agents.
  • We used a retrospective cohort analysis, including incident HS cases identified using electronic health records data for a demographically heterogeneous population-based sample of >48 million unique patients across all 4 census regions. HS incidence has increased over the past decade and disproportionately involves women, young adults, and African Americans.
  • Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women. The following review will outline current management strategies for HS and their compatibility with pregnancy and lactation.
  • Health-related quality of life (HRQOL) has become one of the most relevant patient-reported outcomes, especially for nonlife- threatening chronic diseases. Today not only the objective severity of a disease but also its (subjective) impact on the HRQOL of the patient often guides health–economic and clinical decisions. It is known that the objective physician’s rating of disease severity is only poorly to moderately correlate with HRQOL as a subjective measure of disease impact.
  • Acne is a common, worldwide problem that is usually multifactorial in etiology, but androgens may play a pivotal role in the development and severity of acne. Endocrinopathies, such as polycystic ovarian syndrome, ovarian tumors, or adrenal hyperplasia or tumors, may be detected in some patients with acne, especially if acne is sudden in onset, associated with hirsutism or menstrual irregularities, or associated with cushingoid facies, acanthosis nigricans, patterned hair loss, or deepened voice.
  • Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. A series of chemical peels can lead to significant improvement over a short period, leading to patient satisfaction and maintenance of clinical results.
  • Topical drugs have been used successfully to treat acne for decades. This review discusses the use, efficacy, and safety of options available via prescription. Topical antibiotics, dapsone, benzyl peroxide, azelaic acid, and topical retinoids are included. Topical antibiotics should not be used as monotherapy but rather be combined with other agents to avoid resistant Propionibacterium acnes strains.

Patient Counseling / Communication

  • The cost of medication is important to each patient because multiple studies have shown that higher costs are associated with lower medication adherence, as in the case of this patient. We were taught to prescribe generic medication when available, rather than brand name medication, to give patients a similar outcome with a lower cost.
  • In a comparison of clinical study results, it was concluded that there are no significant differences in the efficacy and safety of BPO between these patient populations. The efficacy and safety of long-term use in Japanese patients are also expected to be applicable to those in Western patients.
  • Dermatologists’ reluctance to prescribe is likely multifactorial including OCPs’ “primary” indication for the prevention of pregnancy and the requirement for a conversation about sexual activity when prescribing OCPs. Additionally, dermatologists face ambiguities in consent laws governing minors specifically with respect to OCPs. In many states, due to the role of OCPs in sexual health, their prescription to minors does not require parental consent. Dermatologists need clarity on whether they can prescribe OCPs to minors absent parental consent.
  • The use of cosmeceuticals by patients with acne is common; however, their role is unclear and confusing, with many asking, "Do they really help acne?" Cosmeceuticals are intermediate products between prescription medications and cosmetics, available to consumers over the counter. These products are popular and may be used without the direct supervision of a dermatologist, creating a practice gap in educating patients. Herein, a variety of cosmeceuticals are discussed, including retinoids, niacinamide, and glycolic acid. The evidence for and against cosmeceutical use in patients with acne is reviewed.