AARS Hot Topics - September 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

  • BioPharmX Corporation (NYSE MKT: BPMX), a specialty pharmaceutical company focusing on dermatology, is announcing preliminary data from a feasibility study of BPX-01 to assess the safety and efficacy of topical minocycline gel at both the 1% and 2% doses for the treatment of rosacea. The preliminary data from the ongoing study suggest good tolerability and promising efficacy of BPX-01 in this indication and highlight the value of BioPharmX's dermatology delivery system.
  • The generic acne treatment adapalene and benzoyl peroxide (Epiduo) gel, 0.1%/2.5%, has launched in the United States, according to drug maker Teva Pharmaceutical Industries Ltd. Teva is the first company that filed a generic application for the branded treatment.

New Medical Research

  • A new study was to evaluate the outcome of a series of patients with erythematotelangiectatic rosacea (ETR) affected by persistent erythema and varying degree of telangiectasias being treated with brimonidine alone or combined with a vascular laser based on the type of vascular components preliminarily evaluated by clinical and instrumental observation. Ten patients affected by ETR were enrolled in a pilot, open study. Instrumental evaluation included erythema-directed digital photography by VISIA-CR™ system and X10 dermoscopy. In conclusion, a preliminary evaluation of the vascular component by erythema-directed digital photography and dermoscopy in ETR may be helpful to select the most appropriate therapeutic strategy.
  • The results or a recent study contribute to our understanding of the mechanisms underlying the effects of the three lignans on P. acnes-induced inflammation and suggest that schisandrins might be developed as pharmacological agents for acne therapy.
  • Recent results from a study which induced a physiological granulomatous reaction in response to different well-characterized clinical C. acnes isolates provides new evidence supporting the role of C. acnes in the development of sarcoidosis and new explanations concerning the mechanisms underlying PJI due to C. acnes.
  • A study was conducted to evaluate the synergistic effects of autologous PRP with fractional CO2 laser resurfacing in treatment of acne scars among Egyptian patients. It concluded that the combination of fractional CO2 laser resurfacing and intradermal PRP was superior to CO2 laser alone for acne scar treatment.
  • NAFL treatment for acne scarring appears to be well tolerated within 1 month of completing isotretinoin treatment. Dermatologists should reevaluate the current recommendation to wait 6 months after isotretinoin treatment for acne scar revision with lasers. Other larger studies are necessary to further challenge this dogma.

Clinical Reviews

  • SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare inflammatory condition describing the combination of skin, bone, and joint manifestations that has a heterogeneous presentation. We report a case of severe SAPHO syndrome in association with hidradenitis suppurativa and pyoderma gangrenosum in a 27-year-old male.
  • Just as an imbalance in the intestinal microbiota can disrupt gut function, dysbiosis of the facial skin can allow acne-causing bacteria to flourish. In acne, said Adam Friedman, MD, “we’ve always been talking about bacteria,” but now the thinking has shifted from just controlling Propionibacterium acnes to a subtler understanding of what’s happening on the skin of individuals with acne. Individuals may have their own unique skin microbiota – the community of organism residents on the skin – but dysbiosis characterized by a lack of diversity is increasingly understood as a common theme in many skin disorders, and acne is no exception.
  • In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea.
  • We applaud Kimball et al on their report that adalimumab demonstrated clinical improvement in patients with hidradenitis suppurativa (HS) versus placebo in 2 phase 3 trials. Hidradenitis suppurativa is a chronic relapsing condition with painful subcutaneous abscesses, malodorous drainage, sinus tract formation, and scarring that typically occurs in the axillae and anogenital region. Further understanding of the pathogenesis of HS may result in additional biologic treatments for HS. We encourage the manufacturers of other biologic therapies, such as infliximab, ustekinumab, anakinra, secukinumab, ixekizumab, and brodalumab, to consider conducting further clinical trials in HS to enhance the therapeutic options available for this debilitating disease.
  • The prevalence of acne in the adult population is increasing, particularly in women. This retrospective data analysis confirms that the use of low doses of spironolactone is a valuable alternative in women with acnein whom oral isotretinoin has failed. Moreover, the analysis shows that first and second-generation oral contraceptives decrease the efficacy of spironolactone, confirming the interest of using two third or fourth-generation oral contraceptives.
  • Having two parents with a history of acne was associated with an eightfold higher risk of acne during adolescence and young adulthood, in a European study that surveyed people aged 15-24 years in seven European countries. The results were published online on July 14. The overall prevalence of self-reported acne was 57.8%, with the highest prevalence – 65.8% – found in the 15- to 17-years age group, and the lowest being 52.6% in the 21- to 24-years age group. Individuals who reported having one parent with a history of acne had a threefold greater incidence of acne compared to those without a history of paternal or maternal acne.
  • A cross-sectional study of 64 adults in New York City with and without moderate/severe acne found a significant association between dietary carbohydrate consumption and acne, which the authors said merited further study. “Epidemiologic studies typically report a low incidence of acne in non-developed nations, suggesting that environmental factors, such as diet, can play a role in acne pathogenesis,” wrote Jennifer Burris, PhD, of the department of nutrition and food studies, at Steinhardt School of Culture, Education, and Human Development, New York University, and her coauthors.

Patient Counseling / Communication

  • Acne treatment options now extend beyond antibiotics, and hormonal therapy, particularly birth control pills (BCPs), may provide clearance of acne in women who may not respond to other therapies. "Challenge [yourselves] to learn how to safely use BCPs," said Dr. Julie Harper, Clinical Associate Professor of Dermatology at the University of Alabama in Birmingham, in the presentation, "Use of Hormonal Therapy for Acne," at the Summer Meeting of the American Academy of Dermatology. The use of BCPs for acne has a strength-of-recommendation grade of A (consistent, good-quality patient-oriented evidence). According to Dr. Harper, all combination BCPs should work for acne, except progestin-only BCPs, which will make acne worse. Currently, there are 4 BCPs approved by the US Food and Drug Administration for acne.
  • Rosacea is a skin condition mediated by a proinflammatory predisposition on the skin. A cosmeceutical approach supports the stable microbiome of the skin to maintain the health of the skin barrier. Herein, a regimen including cleansers, barrier repair creams, supplements, and antioxidants is provided, as well as alternative therapies. What do your patients need to know? Vascular instability associated with rosacea is exacerbated by triggers such as sunlight, hot drinks, spicy foods, stress, and rapid changing weather, which make patients flush and blush, increase the appearance of telangiectasia, and disrupt the normal skin barrier.
  • Isotretinoin may be a useful treatment for patients with severe acne. The physician, the pharmacy, and the patient must be registered with the iPLEDGE program (https://www.ipledgeprogram.com). These pearls provide guidance on managing acne with isotretinoin, discussing side effects and false information with patients and/or parents/guardians, and providing reliable resources to them. What does your patient need to know at the first visit? Most important is what you need to know before the first visit. As the prescribing physician, you must be familiar with the iPLEDGE program. Because of the complexity of the program, consider identifying a physician in your area to refer patients if you are not going to be a regular prescriber of the medication.