Acne Medications

The etiology of acne is a complex process, and acne is one of the most common skin disorders affecting millions of people. The pathogenesis of acne is closely associated with the bacterium, Propionibacterium acnes which was previously known as Corynebacterium parvum.

Both viable and non-viable P. acnes/C. parvum have been shown to induce an immunostimulatory effect in vivo, suggesting that even dead bacteria continue to activate an inflammatory response. Acne treatments with lasers or devices, induce a bactericidal effect through heat generation which may not address the immunogenic activity of P. acnes and the resulting acne inflammation.

Therefore, we sought to determine whether killed P. acnes is capable of inducing an inflammatory response and therefore could be a contributing factor in acne. Direct heat treatment of P. acnes cultures with temperatures ranging from 50 degrees C to 80 degrees C reduced P. acnes viability. Both viable and heat-killed P. acnes activated the p38 MAP kinase and its downstream substrate Hsp27. Stimulating keratinocytes with normal and heat-inactivated P. acnes resulted in an induction of proinflammatory nitric oxide and IL-8 production.

Thus killed P. acnes is capable of inducing inflammation in skin suggesting that therapies that have both bactericidal and anti-inflammatory effects may result in a more effective treatment of patients with acne than treatments that are bactericidal alone.


"Heat-killed Propionibacterium acnes is capable of inducing inflammatory responses in skin"
Exp Dermatol. 2009 Jul 14; Lyte P, Sur R, Nigam A, Southall MD


Highlight:
Comparative efficacy and safety results of two topical combination ...
Quality of medical care of patients with acne vulgaris in Germany ...
Sulfur Acne Medications for Severe Acne
Profile of acne vulgaris--a hospital-based study from South India.
Phototherapy, photodynamic therapy and lasers in the treatment of ...
Scoring systems in acne vulgaris.
Zeno Anti-Acne Medications And Treatment


Related:
Acne Drug Accutane No Longer Sold
Pembalut Wanita: Acne Medicine For Pregnant Mother
Homemade Acne Treatments | Acne Treatment
Acne Diet Development: Creating the Diet that is Right for Your ...
Excoriated Acne | Home Remedies For Acne

Dehydroepiandrosterone (DHEA) and its sulfate DHEAS, which are the most abundant steroids in women, decline with age. We have shown association between low sexual function and low circulating DHEAS levels in women.

The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young individuals improves sexual function. Methods.

Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week randomized, double-blind, placebo controlled trial and received either DHEA 50 mg or placebo (PL) daily.

Main Outcome Measures. Efficacy was assessed through 26 weeks. The main outcome measures were the change in total satisfying sexual events (SSE) and the change in the Sabbatsberg Sexual Self-Rating Scale (SSS) total score. Secondary measures were the Psychological General Well-Being Questionnaire (PGWB), and the Menopause-Specific Quality of Life Questionnaire (MENQOL).

Hormonal levels, adverse events (AEs), serious adverse events (SAEs) and clinical labs were evaluated over 52 weeks. Results. Eighty-five participants (91%) were included in the 26-week efficacy analysis. There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS, PGWB, and MENQOL change scores.

Overall AE reports and number of withdrawals as a result of AEs were similar in both groups; however more women in the DHEA group experienced androgenic effects of acne and increased hair growth. Conclusions. In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA resulted in no significant improvements in sexual function over PL therapy over 26 weeks.



A Randomized Trial of Oral DHEA Treatment for Sexual Function, Well-Being, and Menopausal Symptoms in Postmenopausal Women with Low Libido.
J Sex Med. 2009 Jul 10; Panjari M, Bell RJ, Jane F, Wolfe R, Adams J, Morrow C, Davis S (Hubmed)



Highlight:
Acne Scar Medications | Adult Acne Medications | Sulfur Acne Medications | Oral Acne Medications

Acne vulgaris is a prevalent skin condition that can cause disfiguring residual scarring. While the complete removal of acne scars is unlikely, several treatments exist that can improve the appearance of acne scars.

Dermal fillers offer a simple, nonsurgical corrective procedure that can provide improved skin texture. Dermicol-P35 (Evolence [Ortho Dermatologics, Skillman, NJ]) is a new, highly purified, ribose cross-linked, porcine collagen-based dermal filler that has demonstrated low immunogenicity and results that persist for at least 12 months.

This article presents the aesthetic results of a male patient treated with Dermicol-P35 for severe facial acne scars.


Repair of acne scars with Dermicol-P35.
Aesthet Surg J. 2009 May-Jun; 29(3 Suppl): S16-8Smith KC (Hubmed)


Highlight:
Acne Scar Medications | Adult Acne Medications | Sulfur Acne Medications | Oral Acne Medications

Minocycline is a commonly used antibiotic for long-term treatment of acne vulgaris. A well-documented and cosmetically displeasing side effect is skin pigmentation.

Three distinct types occur: Type I, blue-black/grey pigment on the face in areas of scarring or inflammation associated with acne; type II, blue-grey pigment on normal skin on the shins and forearms; type III, diffuse muddy-brown discoloration in areas of sun exposure.

Types I and II stain for iron and melanin extracellularly and within macrophages in the dermis. Type III shows nonspecific increased melanin in basal keratinocytes and dermal melanophages staining for melanin only.

The etiology of this pigmentation is unknown, but may be related to polymerized reactive metabolites, insoluble chelation products, and lengthy treatment durations of minocycline compared to other tetracyclines.

Types I and II tend to resolve slowly over time, whereas type III persists indefinitely. Treatment involves early recognition, discontinuation of the drug, sun protection, and laser for persistent pigmentation.


Minocycline-induced skin pigmentation
Acta Dermatovenerol Croat. 2009; 17(2): 123-6Geria AN, Tajirian AL, Kihiczak G, Schwartz RA(Hubmed)

Fixed combination products of clindamycin 1% (as 1.2% clindamycin phosphate) and benzoyl peroxide (BPO) 5% are commonly used in the treatment of acne vulgaris. Although any given topical acne product may be therapeutically effective, signs and symptoms of cutaneous tolerability may lead to missed applications by the patient, thus limiting adherence to therapy.

BPO and other formulation components such as surfactants, preservatives and high levels of organic solvents can cause cutaneous irritation and dryness.

BPO irritation is dose-dependent. An approach to optimizing the BPO concentration was undertaken to develop a surfactant- and preservative-free, clindamycin and low concentration


The development and optimization of a fixed combination of clindamycin and benzoyl peroxide aqueous gel.
J Drugs Dermatol. 2009 Jul; 8(7): 634-8Bucks D, Sarpotdar P, Yu K, Angel A, Del Rosso J (Hubmed)


Highlight:
Acne Scar Medications | Adult Acne Medications | Sulfur Acne Medications | Oral Acne Medications

J Drugs Dermatol. 2009 Jul; 8(7): 615-8Bhambri S, Del Rosso JQ, Bhambri AAcne vulgaris is the most common disorder seen in ambulatory dermatology practice. Acne causes significant morbidity and the direct costs associated with it exceed $2.2 billion per year in the United States (U.S.). The pathogenesis is multifactorial, and our understanding of the mechanisms involved in the development of acne lesions has improved with time. Follicular hyperkeratinization, sebum production, presence of Propionibacterium acnes (P. acnes), inflammatory mediators, and androgens have been identified as key components of acne pathophysiology. Recent advances have been made in this area with the discovery of P. acnes interaction with Toll-like receptors (TLRs), vaccines targeting P. acnes or its components, antimicrobial peptides and the role of hormones.

J Drugs Dermatol. 2009 Jul; 8(7): 624-30Kircik LHCombination therapy has become the standard for the management of acne, particularly for moderate-to-severe cases. Among these combinations, those regimens containing benzoyl peroxide (BPO), clindamycin and a retinoid have been used frequently as they address most aspects of acne pathogenesis. This study compares the efficacy and safety of two common topical treatment regimens in the treatment of a moderate to severe facial acne vulgaris: fixed-combination gel containing BPO 5% and clindamycin 1% (BPO/C) plus tretinoin microsphere gel 0.04% (RAM) versus a regimen of a fixed-combination gel containing clindamycin phosphate 1.2% and tretinoin 0.025% (CPT) plus a once-daily BPO 5% wash. While both regimens were safe and effective, regimen BPO/C+RAM yielded a more rapid onset of effect versus regimen CPT+BPO against both non-inflammatory and inflammatory lesions. Both treatment regimens were well-tolerated.

J Drugs Dermatol. 2009 Jul; 8(7): 650-4Kircik LHThis 12-week, single-center, investigator-blinded, randomized, parallel-design study assessed the safety and efficacy of tretinoin microsphere gel 0.04% delivered by pump (TMG PUMP) to tazarotene cream 0.05% (TAZ) in mild-to-moderate facial acne vulgaris. Efficacy measurements included investigator global assessment (IGA), lesion counts, and subject self-assessment of acne signs and symptoms. Efficacy was generally comparable between treatment groups, although TMG PUMP provided more rapid results in several parameters. IGA showed a more rapid mean change from baseline at week 4 in the TMG PUMP group (-0.18 versus -0.05 in the TAZ subjects). TMG PUMP yielded more rapid improvement in papules. At week 4, the mean percentage change from baseline in open comedones was statistically significant at -64% in the TMG PUMP group (P=0.0039, within group) versus -19% in the TAZ group (not statistically significant within the group; P=0.1875). Skin dryness, peeling and pruritus were significantly less in the TMG PUMP group as early as week 4. Adverse events related to study treatment were rare in both groups and all resolved upon discontinuation of study medication.

J Drugs Dermatol. 2009 Jul; 8(7): 657-61Fakhouri T, Yentzer BA, Feldman SRBACKGROUND: Antibiotic resistance of Propionibacterium acnes (P. acnes) is a growing phenomenon in the wake of widespread use of topical and systemic antibiotics for acne vulgaris. Benzoyl peroxide has a proven track record of safety and efficacy, and can decrease reliance on antibiotics in the treatment of acne. PURPOSE: To review the literature for methods to increase the efficacy and tolerability of benzoyl peroxide (BPO). METHODS: A PubMed literature search was done using the terms "benzoyl peroxide," "vehicle," "mechanism," and "delivery system." Relevant papers were reviewed for methods of increasing BPO efficacy and tolerability. RESULTS: BPO in concentrations of 2.5%, 5% and 10% are equally effective at treating inflammatory acne. However, higher concentrations are associated with more adverse effects. The efficacy of BPO may be enhanced by the presence of Vitamin E and tertiary amines. BPO is also more efficacious if used in combination with topical retinoids than as a monotherapy. Novel vehicles including a microparticle delivery system and those with a hydrophase or urea base increase the tolerability of BPO without sacrificing efficacy. CONCLUSION: Benzoyl peroxide has a proven track record of safety and efficacy for the treatment of acne. Recent discoveries have provided new methods of increasing the efficacy and tolerability of topical BPO, making it useful as monotherapy for mild acne or as an adjunct in the treatment of moderate to severe acne vulgaris.

J Drugs Dermatol. 2009 Jul; 8(7): 669-71Terrell S, Aires D, Schweiger ESBACKGROUND: Studies indicate photodynamic therapy is an effective treatment of inflammatory acne lesions on patients with Fitzpatrick skin types 1-3. There is a lack of evidence in the literature regarding the use of photodynamic therapy to treat acne vulgaris in African American patients. This article reports the first case of blue light photodynamic therapy to treat moderate inflammatory facial acne on an African American patient with type 5 skin. OBSERVATIONS: This article describes a 26-year-old African American woman with moderate inflammatory facial acne vulgaris. On examination, she had over 15 inflammatory papules on her face and post-inflammatory hyperpigmentation. The patient had a history of treatment failure with the following therapies: topical benzoyl peroxide, topical antibiotics, topical retinoids and oral antibiotics. At presentation, the patient was using a combination topical benzoyl peroxide/clindamycin product in the morning and tazoratene gel in the evening without success. The patient was treated with 20% aminolevulinic acid/blue-light photodynamic therapy spaced monthly for a total of four treatments, a once-daily application of hydroquinone 4% cream and her existing topical regimen. The patient reported significant improvement of inflammatory acne lesions and post-inflammatory hyperpigmentation following two treatments with photodynamic therapy and was virtually clear of all acne lesions after the third treatment. CONCLUSION: Photodynamic therapy is an emerging remedy for patients with acne vulgaris resistant to standard treatment, particularly in patients with skin of color who are more sensitive to post-inflammatory hyperpigmentation. In this African-American patient, 20% aminolevulinic acid/blue-light photodynamic therapy was effective in treating facial acne vulgaris.

J Dermatol. 2009 Jul; 36(7): 383-91Kobayashi M, Kabashima K, Nakamura M, Tokura YMacrolides are effective for inflammatory acne, but there are not many studies on roxithromycin. In this study, patients with acne were surveyed for improvement of their quality of life after treatment with roxithromycin. Patients were orally given roxithromycin 300 mg daily for 2-4 weeks. At the time of pre- and post-treatment, the dermatologists graded the severity of acne symptoms, and the patients answered questionnaires. In 123 half faces of 76 patients, 80 half faces were improved, 42 half faces were not changed, and one half face was deteriorated. The score of "symptom and feeling" and "leisure" in DLQI-J and "emotions" and "symptoms" in Skindex-29-J were significantly decreased after roxithromycin treatment. Roxithromycin has a therapeutic effect on inflammatory acne and leads to improvement of quality of life in the patients.

Cochrane Database Syst Rev. 2009; CD004425Arowojolu AO, Gallo MF, Lopez LM, Grimes DA, Garner SEBACKGROUND: Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women. OBJECTIVES: To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies. SEARCH STRATEGY: We searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We wrote to authors of identified trials to seek any unpublished or published trials that we might have missed. SELECTION CRITERIA: All randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placebo or another active therapy for acne in women were eligible. DATA COLLECTION AND ANALYSIS: We extracted data on total and specific (i.e., open or closed comedones, papules, pustules and nodules) facial lesion counts; acne severity grades; global assessments by the clinician or the participant and discontinuation due to adverse events. Data were entered and analyzed in RevMan. MAIN RESULTS: The search yielded 25 trials: 7 placebo-controlled trials made 4 different comparisons, 17 trials made 13 comparisons between 2 different COC regimens, and 1 additional trial compared a COC to an antibiotic. COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. Differences in the comparative effectiveness of COCs containing varying progestin types and dosages, though, were less clear. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel, although this apparent advantage was based on limited data. A COC with cyproterone acetate might result in better acne outcomes than one with desogestrel; however, the three studies comparing these COCs produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes in one trial, but a second trial found the COC groups were similar. AUTHORS' CONCLUSIONS: The four COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few important differences were found between COC types in their effectiveness for treating acne. How COCs compare to alternative acne treatments is unknown since limited data were available regarding this question.

PLoS One. 2009; 4(7): e6147Waite AL, Schaner P, Richards N, Balci-Peynircioglu B, Masters SL, Brydges SD, Fox M, Hong A, Yilmaz E, Kastner DL, Reinherz EL, Gumucio DLPSTPIP1 is a cytoskeleton-associated adaptor protein that links PEST-type phosphatases to their substrates. Mutations in PSTPIP1 cause PAPA syndrome (Pyogenic sterile Arthritis, Pyoderma gangrenosum, and Acne), an autoinflammatory disease. PSTPIP1 binds to pyrin and mutations in pyrin result in familial Mediterranean fever (FMF), a related autoinflammatory disorder. Since disease-associated mutations in PSTPIP1 enhance pyrin binding, PAPA syndrome and FMF are thought to share a common pathoetiology. The studies outlined here describe several new aspects of PSTPIP1 and pyrin biology. We document that PSTPIP1, which has homology to membrane-deforming BAR proteins, forms homodimers and generates membrane-associated filaments in native and transfected cells. An extended FCH (Fes-Cip4 homology) domain in PSTPIP1 is necessary and sufficient for its self-aggregation. We further show that the PSTPIP1 filament network is dependent upon an intact tubulin cytoskeleton and that the distribution of this network can be modulated by pyrin, indicating that this is a dynamic structure. Finally, we demonstrate that pyrin can recruit PSTPIP1 into aggregations (specks) of ASC, another pyrin binding protein. ASC specks are associated with inflammasome activity. PSTPIP1 molecules with PAPA-associated mutations are recruited by pyrin to ASC specks with particularly high efficiency, suggesting a unique mechanism underlying the robust inflammatory phenotype of PAPA syndrome.

Int J Gynaecol Obstet. 2009 Jul 2; Tamimi W, Siddiqui IA, Tamim H, Aleisa N, Adham MOBJECTIVE: To determine whether there is a correlation between body mass index (BMI) and blood pressure or clinical features such as hirsutism in women with polycystic ovary syndrome (PCOS). METHOD: In this cross-sectional study, 62 women with PCOS were allocated to one of 3 groups according to a BMI range defining normal weight, overweight, or obesity. Blood pressure, waist-to-hip ratio, Ferriman and Gallwey hirsutism score, and presence of acne were recorded for each participant and the means were compared among groups. RESULTS: The overall mean age was 35.85+/-5.03 years; BMI, 31.91+/-6.40; systolic and diastolic blood pressure, 113.02+/-16.10 mm Hg and 71.79+/-10.04 mm Hg; waist-to-hip ratio, 0.82+/-0.07; and hirsutism score, 3.63+/-4.35. Acne was present in 24 participants. Of these, 8 (33.3%) were overweight and 13 (54.2%) obese. When groups were compared, a progressive and significant increase in systolic and diastolic blood pressure was observed from the normal weight to the obese group. CONCLUSION: We observed a significant and progressive correlation between BMI and both blood pressure and clinical features in women with PCOS.

J Dtsch Dermatol Ges. 2009 Jul 1; Franzke N, Zimmer L, Schäfer I, Radermacher C, Kresken J, Augustin MBackground: No empirical "real world" data on the health care of patients with acne vulgaris in Germany currently exist. The objective of this study was to get an informative basis of health care of patients with acne vulgaris in Germany, taking into account both doctor-prescribed medication and self-medication. Patients and Methods: Surveying both medically and self-treated patients, n = 504 patients with acne vulgaris were interviewed in 48 pharmacies nationwide. In addition to socio-demographic data, the duration of illness, localization and therapy as well as patient-relevant outcomes such as patient benefit, psychological strain and markers of compliance were evaluated. The participation and significance of individual treatment providers were also evaluated. Results: A large percentage of the patients found acne vulgaris to be burdensome. Despite the longstanding necessity of treatment and the chronic course of the illness, the treatment of acne vulgaris was deemed a rather satisfactory experience by most of those affected. Dermatologists were most frequently consulted for treatment. A great number of medicinal products were further acquired through self-medication or after consulting with a pharmacist. The medically regulated therapies predominantly complied with the latest guidelines. Conclusions: Acne vulgaris is a burdensome, socio-economically relevant illness, and dermatologists treat most cases in Germany. Surveying across a network of pharmacies offers a unique access to relevant treatment data. Selection effects, particularly by choice of doctors and self-medication, were minimized.

Dermatol Surg. 2009 Jun 22; Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, Chen TMBACKGROUND Treatment of acne scars remains a challenge, especially in dark-skinned individuals. Treatment parameters may be optimized by selecting appropriate pulse width and laser energy that enhance tissue thermal response with limited morbidity. OBJECTIVE To determine the efficacy and side effects of variable square pulse (VSP) erbium:yttrium-aluminum-garnet (Er:YAG) laser resurfacing for treatment of punched-out atrophic and rolling acne scars. METHODS Twenty-four subjects with acne scars were treated monthly for 2 months with four passes of VSP Er:YAG laser resurfacing using a 7-mm spot size and a fluence of 0.4 J/cm(2). Subjects were divided into two groups and treated with two different pulse widths: 300 mus (short pulse, SP) and 1,500 mus (extra-long pulse, XLP). Objective and subjective assessments were obtained at baseline and 1, 2, and 4 months after treatment. RESULTS In the SP group, skin smoothness improved significantly (p

Rheumatol Int. 2009 Jun 24; Siau K, Laversuch CJSynovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare group of sterile, inflammatory osteoarticular disorders classically associated with skin lesions. It is occasionally associated with enteropathic disease such as ulcerative colitis. We present a 39-year-old patient with chronic ulcerative colitis who developed enteropathic SAPHO and responded well to pamidronate. We discuss the clinicopathological features with particular attention to bone pathology, and perform a literature review of this fascinating syndrome.

J Eur Acad Dermatol Venereol. 2009 Jun 23; Magin P, Pond C, Smith W, Goode SAbstract Background There is a considerable number of studies linking acne with psychological and psychiatric morbidities, although this literature is not entirely consistent and is largely cross-sectional in methodology. Objective This study aims to establish the relationship of acne and psychological and psychiatric morbidity in adolescents in a community setting and, via a longitudinal methodology, provide evidence for causality in the relationship. Methods The study was a 12-month cohort study. Two hundred and forty-four students in Years 8, 9 and 11 (ages 14-17) at four Australian high schools were assessed at baseline 6 months and 12 months. Presence and severity of acne were assessed, along with a number of psychological and psychiatric morbidities and personality traits (depression, anxiety, overall psychiatric morbidity, self-consciousness, neuroticism and introversion/extraversion) and other demographic variables. Results Of the 244 participating students, 209 (86%) completed all three rounds of data collection. A further 26 (11%) completed two rounds. The study failed to demonstrate an association of the presence of acne or of acne severity with the examined measures of psychological and psychiatric morbidity, and no evidence for an effect of acne in their causation. Conclusion The relationship of acne and psychological morbidities found in previous health care settings was not found in this community sample. This may be due to differences between community and clinical acne populations. Other possible reasons for this finding are attenuation of psychological morbidity in subjects in this study by successful acne treatment, and the role of personality traits in the complex relationship between acne and psychological morbidities. It is suggested that this relationship would be best investigated by means of longer-term cohort studies enlisting subjects at an early age, prior to the onset of acne. Conflicts of interest None declared.

Exp Dermatol. 2009 Jun 23; Kurokawa I, Danby FW, Ju Q, Wang X, Xiang LF, Xia L, Chen W, Nagy I, Picardo M, Suh DH, Ganceviciene R, Schagen S, Tsatsou F, Zouboulis CCPlease cite this paper as: New developments in our understanding of acne pathogenesis and treatment. Experimental Dermatology 2009.Abstract: Interest in sebaceous gland physiology and its diseases is rapidly increasing. We provide a summarized update of the current knowledge of the pathobiology of acne vulgaris and new treatment concepts that have emerged in the last 3 years (2005-2008). We have tried to answer questions arising from the exploration of sebaceous gland biology, hormonal factors, hyperkeratinization, role of bacteria, sebum, nutrition, cytokines and toll-like receptors (TLRs). Sebaceous glands play an important role as active participants in the innate immunity of the skin. They produce neuropeptides, excrete antimicrobial peptides and exhibit characteristics of stem cells. Androgens affect sebocytes and infundibular keratinocytes in a complex manner influencing cellular differentiation, proliferation, lipogenesis and comedogenesis. Retention hyperkeratosis in closed comedones and inflammatory papules is attributable to a disorder of terminal keratinocyte differentiation. Propionibacterium acnes, by acting on TLR-2, may stimulate the secretion of cytokines, such as interleukin (IL)-6 and IL-8 by follicular keratinocytes and IL-8 and -12 in macrophages, giving rise to inflammation. Certain P. acnes species may induce an immunological reaction by stimulating the production of sebocyte and keratinocyte antimicrobial peptides, which play an important role in the innate immunity of the follicle. Qualitative changes of sebum lipids induce alteration of keratinocyte differentiation and induce IL-1 secretion, contributing to the development of follicular hyperkeratosis. High glycemic load food and milk may induce increased tissue levels of 5alpha-dihydrotestosterone. These new aspects of acne pathogenesis lead to the considerations of possible customized therapeutic regimens. Current research is expected to lead to innovative treatments in the near future.

Ginekol Pol. 2009 May; 80(5): 374-8Bumbuliene Z, Alisauskas JClinical manifestations of androgen excess which are skin and hair related (hirsutism, acne, alopecia) are common and distressing symptoms for an adolescent girls. During puberty and at the time of the first menstruation cycles, physiological hyperandrogenism can be observed. The causes of hirsutism can be various, including familial, idiopathic, and those, caused by excess androgen secretion by the ovary (PCOS, tumors), or by adrenal glands (congenital adrenal hyperplasia, tumor), or exogenous pharmacologic sources of androgens. The diagnosis and treatment of hirsutism remains quite problematic due to innumerous endocrinologic aspects and unsatisfactory treatment results. Androgen excess during puberty must be appropriately recognized, clinically evaluated and treated. Pharmacologic and cosmetic treatments may have beneficial effect. Oral contraceptives and antiadrogens combinations may be recommended as the treatment of choice in adolescents.

J Eur Acad Dermatol Venereol. 2009 Jun 22; Adışen E, Yüksek J, Erdem O, Aksakal F, Aksakal ABackground In acne vulgaris patients, the presence of a dysregulation of the production of innate and specific antimicrobial peptides has been postulated. Objective This study aims to determine whether human neutrophil proteins (HNP) 1-3 are expressed in acne patients. Materials and methods HNP 1-3 expression was investigated in 35 acne patients treated with isotretinoin and in 25 healthy subjects. At the beginning of the study, two skin biopsies were taken from acne patients; one biopsy was taken from an established pustule and one from uninvolved skin, and the biopsies were repeated after treatment. Only one biopsy was obtained from controls. Results The statistical analysis showed that pustular lesions of acne patients had significantly higher levels of perivascular and interstitial HNP 1-3 expression when compared with the biopsy of uninvolved skin of these patients (P = 0.003, P = 0.001, respectively) and with that of healthy controls (P = 0.007, P = 0.014, respectively). Isotretinoin treatment achieved a decrease in the perivascular and interstitial HNP 1-3 expression of pustular lesions (P = 0.01, P = 0.001, respectively). Conclusion Our current study demonstrates the novel observation that a recently identified antimicrobial peptide, HNP 1-3, is expressed in neutrophils of acne inflammation but not in uninvolved skin of these patients. These results suggest that HNP 1-3 may contribute to the development of inflammatory lesions of acne. Conflicts of interest None declared.

Clin Exp Dermatol. 2009 Jun 22; Madan V, August PJ, Chalmers RJSummary Background. Despite a range of available topical and systemic therapies, treatment of cutaneous lupus erythematosus (CLE) can be challenging. Objectives. To evaluate the efficacy of a specially formulated preparation of tacrolimus 0.3% in clobetasol propionate 0.05% ointment (TCPO) in the treatment of CLE. Methods. Case notes of 13 patients with treatment-resistant CLE (11 discoid LE, 1 systemic LE and 1 subacute cutaneous LE) who had used twice-daily TCPO (TCPO group) were reviewed. These were compared with five similar patients with resistant CLE who had been given 0.1% tacrolimus ointment alone (TO group). Results. In the TCPO group (mean treatment duration 20 months, range 1-72), a good or excellent response was seen in five and six patients, respectively; one patient showed slight improvement. Telangiectasia and acne were observed in two patients. No systemic side-effects were noted. In the TO group (mean treatment duration 6 months, range 1-24), one patient showed good improvement and two showed slight improvement. Conclusion. The results of our small retrospective study suggest that TCPO may be more effective than either 0.1% tacrolimus or clobetasol propionate 0.05% ointment monotherapy in the treatment of recalcitrant CLE. Randomized controlled trials are needed to confirm these preliminary findings.

Gynecol Endocrinol. 2009 Jun 23; 1-6Zacche MM, Caputo L, Filippis S, Zacche G, Dindelli M, Ferrari ABackground. Polycystic ovary syndrome (PCOS) is the most common endocrine cause of hirsutism, acne and pattern alopecia, often characterised by ovulation disorders (usually manifested as oligo- or amenorrhea). In addition, 30-40% of women with PCOS have impaired glucose tolerance, and a defect in the insulin signalling pathway seems to be implicated in the pathogenesis of insulin resistance. For this reason, insulin-lowering medications represent novel approach in women with PCOS. The aim of this study was to evaluate the effects of myo-inositol (MYO), an isoform of inositol, belonging to the vitamin B complex, in the treatment of cutaneous disorders like hirsutism and acne. Methods. Fifty patients with PCOS were enrolled in the study. BMI, LH, FSH, insulin, HOMA index, androstenedione, testosterone, free testosterone, hirsutism and acne were evaluated at the baseline and after receiving MYO therapy for 6 months. Results. After 3 months of MYO administration, plasma LH, testosterone, free testosterone, insulin and HOMA index resulted significantly reduced; no significant changes were observed in plasma FSH and androstenedione levels. Both hirsutism and acne decreased after 6 months of therapy. Discussion. MYO administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne.

Clin Exp Dermatol. 2009 Jun 22; Law MP, Chuh AA, Molinari N, Lee ASummary Background. The association between diet and acne vulgaris has long been suggested but remains unproven in western medicine. In contrast, the diet-acne relationship is considered important in traditional Chinese medicine (TCM). Aim. To investigate the association between diet and acne, using a TCM approach. Methods. Using a cross-sectional study of 322 entrants to a university in Hong Kong, China, we examined the participants' clinical severity of acne using the Global Acne Grading System and the participants' yin and yang scores using a quantitative method. We then divided them into two groups, a yin-predominant group (yin-PG) and a yang-predominant group (yang-PG) before the diet-acne relationship was investigated. Results. In total, 82 (25.2%) participants were in the clinical acne group and 240 (74.5%) were in the reference group. There were 155 (48.1%) participants in the yin-PG and 167 (51.9%) in the yang-PG group. No association of diet and acne was found when the participants were considered as a homogenous group. In yin-PG, intake of foods from street stalls (P = 0.04) was significantly associated with a lower incidence of acne. In yang-PG, the intake of desserts (P = 0.04) and fresh fruit juices (P = 0.02) was significantly associated with a higher incidence of acne, whereas the intake of dairy and soy products (P = 0.04) was significantly associated with a lower incidence of acne. Conclusions. The application of a TCM approach led to the detection of significant associations between diet and the incidence of acne.

Telemed J E Health. 2009 Jun; 15(5): 426-30Bergman H, Tsai KY, Seo SJ, Kvedar JC, Watson AJDigital imaging of dermatology patients is a novel approach to remote data collection. A number of assessment tools have been developed to grade acne severity and to track clinical progress over time. Although these tools have been validated when used in a face-to-face setting, their efficacy and reliability when used to assess digital images have not been examined. The main purpose of this study was to determine whether specific assessment tools designed to grade acne during face-to-face visits can be applied to the evaluation of digital images. The secondary purpose was to ascertain whether images obtained by subjects are of adequate quality to allow such assessments to be made. Three hundred (300) digital images of patients with mild to moderate facial inflammatory acne from an ongoing randomized-controlled study were included in this analysis. These images were obtained from 20 patients and consisted of sets of 3 images taken over time. Of these images, 120 images were captured by subjects themselves and 180 were taken by study staff. Subjects were asked to retake their photographs if the initial images were deemed of poor quality by study staff. Images were evaluated by two dermatologists-in-training using validated acne assessment measures: Total Inflammatory Lesion Count, Leeds technique, and the Investigator's Global Assessment. Reliability of raters was evaluated using correlation coefficients and kappa statistics. Of the different acne assessment measures tested, the inter-rater reliability was highest for the total inflammatory lesion count (r = 0.871), but low for the Leeds technique (kappa = 0.381) and global assessment (kappa = 0.3119). Raters were able to evaluate over 89% of all images using each type of acne assessment measure despite the fact that images obtained by study staff were of higher quality than those obtained by patients (p < 0.001). Several existing clinical assessment measures can be used to evaluate digital images obtained from subjects with inflammatory acne lesions. The level of inter-rater agreement is highly variable across assessment measures, and we found the Total Inflammatory Lesion Count to be the most reliable. This measure could be used to allow a dermatologist to remotely track a patient's progress over time.

Br J Dermatol. 2009 May 26; Hogewoning AA, Koelemij I, Amoah AS, Bouwes Bavinck JN, Aryeetey Y, Hartgers F, Yazdanbakhsh M, Willemze R, Boakye DA, Lavrijsen AP

J Drugs Dermatol. 2009 Jun; 8(6): 562-8Serrano G, Lorente M, Reyes M, Millán F, Lloret A, Melendez J, Navarro M, Navarro MTopical aminolevulinic acid (ALA) photodynamic therapy (PDT) is currently being used for the treatment of actinic keratosis of the face and scalp. This study reports the results obtained after three to four treatments with ALA-PDT in patients with acne (n=12), photoaging (n=8) and vitiligo (n=6). ALA was applied on large areas (e.g., full face) and at very low strengths (1-2%). Side effects were minimal and self-limited.

J Drugs Dermatol. 2009 Jun; 8(6): 577-9Park KK, Tung RC, de Luzuriaga ARIn eating disorders, such as bulimia nervosa, body image disturbance often extends beyond the realm of weight and shape into the dermatologic spectrum. While commonly associated conditions due to binging and self-induced vomiting include cutaneous entities (e.g., Russell's sign, acne, alopecia and hypertrichosis) and oral pathologies (e.g., enamel erosion, caries and mild parotid hypertrophy), a rare but troubling manifestation is disfiguring parotid enlargement (sialoadenomegaly). This article presents a case of painful sialoadenomegaly associated with hyperamylasemia in a bulimic patient successfully managed with pilocarpine.

J Am Acad Dermatol. 2009 Jul; 61(1): 123-5Galadari H, Bishop AG, Venna SS, Sultan E, Do D, Zeltser RSynovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a clinically heterogeneous entity, encompassing a variety of debilitating conditions that have in common inflammation of the skeletal system and skin. To date, there is a paucity of documented efficacious treatment options. We report a 48-year-old man with skeletal and cutaneous signs and symptoms who improved dramatically after treatment with a combination of isotretinoin and pamidronate. This report provides an alternative treatment regimen for SAPHO that addresses the possible underlying pathophysiology of this likely underdiagnosed syndrome.

Cutis. 2009 May; 83(5): 265-72Dhawan SSCombination therapy for the topical treatment of acne vulgaris using benzoyl peroxide (BPO) and an antibiotic is more efficacious and better tolerated than treatment with either component alone. Moreover, the addition of BPO to antibiotic therapy is recommended as a means of preventing the development of Propionibacterium acnes antibiotic resistance. However, BPO is an irritant, and the dryness and irritation experienced by some patients using topical therapy containing BPO can negatively impact compliance. Historically, once-daily treatment application has enhanced compliance versus twice daily. The current 12-week study aimed to compare the efficacy of a clindamycin 1%-BPO 5% topical gel with the hydrating excipients dimethicone and glycerin (C/BPO HE) and a clindamycin 1%-BPO 5% topical gel that does not contain hydrating excipients (C/BPO) applied once daily for the treatment of 20 participants with facial acne vulgaris and to determine if there were differences in product preference and participant acceptability between the treatments. Both C/BPO HE and C/BPO were effective in the treatment of acne, with substantive reductions (-60.8% and -61.3%, respectively) in total inflammatory lesions at week 4 in both treatment groups. Participants receiving C/BPO HE demonstrated a more consistent treatment response than with C/BPO, with incremental reductions in total inflammatory lesions at each time point, whereas the response to C/BPO waned at week 8. As a result, greater percentage reductions in inflammatory and noninflammatory lesions were observed with C/BPO HE treatment than C/BPO treatment at week 8 (papules: -71.9% vs -49.4%, P=.053; pustules: -64.8% vs -28.0%, P=.134; open comedones: -44.5% vs 2.6%, P=.480; closed comedones: -35.5% vs -26.3%, P=.501). With the exception of papules, greater reductions in all lesion subtypes also were observed at week 12. None of the between-group differences reached statistical significance. Both treatment groups displayed similar disease signs and symptoms throughout the study period. However, scaling, erythema, dryness, and pruritus occurred more frequently in participants using C/BPO. Treatment satisfaction was greatest with C/BPO HE; participants reported that this formulation was easy to apply and 100% (9/9) of participants reported that they would continue using C/BPO HE compared with 80% (8/10) of participants using C/BPO. Both treatments were well-tolerated. In this pilot study, both formulations were effective in the treatment of inflammatory and noninflammatory acne lesions, but C/BPO HE produced a more consistent reduction in total inflammatory lesions over 12 weeks. The addition of hydrating excipients in the C/BPO HE formulation appears to improve patient tolerance and acceptance, which will likely help patients to comply with therapy.

Eur J Dermatol. 2009 Jun 15; Cesko E, Körber A, Dissemond JAcne inversa is a chronic, recurring acneiform skin disease with inflammation of the follicular epithelium of the sebaceous glands and the terminal hair follicle. It primarily manifests in the intertriginous areas. So far, the aetiology of acne inversa is unknown. Smoking, amongst others, is being discussed and should be evaluated as a possible aetiological factor. In this study a retrospective investigation was carried out in 100 patients with acne inversa. The parameters; age, BMI, sex, weight, height, location of acne inversa, quantity of smoking, smoking behaviour and the date of initial diagnosis of acne inversa were considered. In most cases, the acne inversa is located in the axillary and inguinal areas. Overall, 96% of the 100 patients had a positive, long standing, on average almost 20-year, smoking history. On average, over 20 cigarettes are smoked daily. Over 50% of the patients are overweight. Merely 26.1% fall into the normal weight category. Our results suggest that especially smoking, but also obesity, may present an aetiologically relevant factor in the origin of acne inversa.

J Cosmet Dermatol. 2009 Jun; 8(2): 152-8Tochio T, Tanaka H, Nakata S, Ikeno HBackground Previous studies reported that lipid peroxide (LPO) caused by oxidation of sebum is associated with the progression of acne vulgaris, and that therapy with antioxidative ingredients is efficacious for treatment. In this study, we hypothesized that lipid accumulation in comedones induces progression of comedogenesis and inflammatory changes in comedones, and investigated the possible role of accumulated LPO in comedogenesis and its inflammatory changes. Methods We first sampled comedones and the stratum corneum from patients with acne vulgaris. The quantities of LPO, interleukin-1-alpha (IL-1alpha), and NF-kappa-B (NF-kappaB) in comedones and in the stratum corneum from each patient were measured for comparison. Next, comedones were sampled again from the same patients and classified into five groups: microcomedo (MC), noninflammatory open comedo (NIOC), noninflammatory closed comedo (NICC), inflammatory open comedo (IOC), and inflammatory closed comedo (ICC). We measured quantities of LPO in each group. Results The quantities of LPO, IL-1alpha, and NF-kappaB were significantly higher in the content of comedones than those in the stratum corneum. The quantities of LPO in the content of IOC and ICC were significantly higher than those of MC, NIOC, and NICC; however, there were no significant differences in quantities of LPO between the content of MC, NIOC, and NICC. Conclusions We conclude that the accumulation of a certain amount of LPO in the content of comedones may play an important role in the progression of comedogenesis and the excessive accumulation of LPO may be involved in inflammatory changes in comedones.

Fitoterapia. 2009 Jun 11; Pothitirat W, Chomnawang MT, Supabphol R, Gritsanapan WContents of bioactive components, free radical scavenging and anti-acne producing bacteria activities of young and mature fruit rind extracts of mangosteen were compared. The young fruit rind extract contained significantly higher contents of phenolics and tannins and promoted higher free radical scavenging activity than the mature fruit rind extract, while the later extract contained higher contents of flavonoids and alpha-mangostin xanthone and gave higher anti-acne producing bacteria activity than the young fruit rind extract. Thus, the young and mature stages of mangosteen fruit rind should be beneficial for further development of antioxidant and anti-acne pharmaceutical preparations, respectively.

J Eur Acad Dermatol Venereol. 2009 Jun 11; Rehn L, Meririnne E, Höök-Nikanne J, Isometsä E, Henriksson MObjective To investigate the putative association between isotretinoin treatment and depressive symptoms or suicidal ideation among Finnish male military conscripts. Methods Consecutive acne patients were enrolled into an uncontrolled, prospective 12-week follow-up study conducted at the Central Military Hospital, Helsinki, Finland. Of the 135 patients prescribed isotretinoin, 126 (93.3%) completed the follow-up. Depression and suicidal ideation were investigated with the Beck Depression Inventory (BDI) at baseline, weeks 4-6, and weeks 10-12. Results BDI mean score was low at baseline and declined further significantly (p < 0.001) during the follow-up from 3.0 (SD 3.948) to 1.8 (SD 3.783) among patients on isotretinoin. Moreover, the proportion of patients with clinically significant depressive symptoms (BDI >/= 10) declined non-significantly from 7.1 % to 3.2 %. Suicidal ideation was reported by 17 (13.5 %) patients at baseline and 9 (7.1%) patients at the end of the follow-up (NS). During the follow-up, one non-depressed patient attempted suicide while intoxicated by alcohol. Conclusion On group level, isotretinoin seems not to be typically associated with treatment-emergent depression or suicidal ideation among young men. However, the possibility that individual patients may be susceptible for mood effects of isotretinoin as a rare idiosyncratic reaction can not be excluded. Conflicts of interest None declared.

J Am Acad Dermatol. 2009 Jun 12; Wang F, Kwak HS, Elbuluk N, Kaczmarek AL, Hamilton T, Voorhees JJ, Fisher GJ, Kang SBACKGROUND: The cytochrome P450 (CYP) enzyme CYP26 (retinoic acid [RA] 4-hydroxylase) initiates the catabolism of all-trans RA (tRA) and limits the effects of tRA. The CYP26 enzyme acts specifically on tRA, but not 13-cis RA (isotretinoin), a retinoid used to treat severe acne. However, 13-cis RA can isomerize to tRA, which can then be metabolized by CYP26. OBJECTIVE: In healthy individuals, we assessed the variability of CYP26 enzymatic activity. We then investigated whether response to oral 13-cis RA among patients with acne correlates with variability in CYP26 expression. METHODS: In healthy individuals, we isolated microsomal fractions from the epidermis of keratome biopsy specimens and measured CYP26 enzymatic activity in untreated skin and skin treated with tRA. Enzymatic activity was determined based on rate of formation of 4-hydroxy RA (pg/min/mg microsomal protein). Using real-time polymerase chain reaction we quantified CYP26 messenger RNA induction after tRA application in patients with acne who responded or did not respond to one course of 13-cis RA. RESULTS: In normal-appearing skin (N = 118), CYP26 enzymatic activity was widely variable (1-180 pg/min/mg microsomal fraction; mean 42.7 +/- 3.5). Furthermore, CYP26 enzymatic activity was inducible in a dose-dependent manner in normal-appearing skin after tRA application, but not correlated with age or sex (N = 29). In patients with acne, CYP26 messenger RNA induction after 0.1% tRA application did not differ (P > .05) between patients who responded (N = 8, 587 +/- 325-fold) or did not respond (N = 8, 657 +/- 227-fold) to one course of 13-cis RA. LIMITATIONS: The small number of patients with acne treated with 13-cis RA was a major limitation. CONCLUSION: Factors other than CYP26 activity may determine response to isotretinoin in acne.

Cutan Ocul Toxicol. 2009; 28(2): 90-2Bilaç C, Müezzinoğlu T, Ermertcan AT, Kayhan TC, Temeltaş G, Oztürkcan S, Temiz PSorafenib is a new therapeutic agent being used in metastatic renal cell carcinoma, hepatocellular carcinoma, and malignant melanoma. The most frequently seen cutaneous side effects due to sorafenib are erythema, exfoliative dermatitis, acne vulgaris, and flushing. Folliculitis, eczema, and erythema multiforme are other, rare side effects of sorafenib. A 59-year-old man underwent left radical nephrectomy due to renal cell carcinoma 8 months ago, and after the operation he received immunochemotherapy and then sorafenib. On the third day of sorafenib therapy his lesions occurred. His dermatologic examination revealed multiple erythematous papules on his neck, arms, and legs and bullae and iris lesions on his palms and soles. He was diagnosed as having erythema multiforme. In the literature we found only 1 other erythema multiforme case due to sorafenib. We present this interesting case to show and discuss cutaneous side effects of sorafenib, especially erythema multiforme as a very rare cutaneous side effect.

Cutan Ocul Toxicol. 2009; 28(1): 41-4Waris W, Naik S, Idrees I, Taha H, Camosino L, Mehrishi A, Saif MWBACKGROUND: The management of locally advanced head and neck cancer remains a challenge to most oncologists and their patients. Treatment with epithelial growth factor receptor inhibitors (EGFRIs) is associated with a good response. Cetuximab, a chimeric monoclonal antibody directed against epithelial growth factor receptor (EGFR), in combination with radiation therapy is indicated for the treatment of locally advanced squamous cell carcinoma of the head and neck. Although a mild acneiform skin rash (Grade 1, 2) is very common in these patients, severe rash (Grade 3) is uncommon. CASE REPORT: A 61-year-old African American man with locally advanced oropharyngeal cancer was treated with cetuximab and radiation. He developed a sudden flare-up of a skin rash after the 5th cycle of cetuximab following use of over-the-counter (OTC) skin care remedies. The rash manifested with severe maculopapular eruption and erythematous rash, along with desquamation and exfoliation of the skin, mainly on the face and neck area. The patient denied any extraordinary sun exposure. Cetuximab and radiation therapy were held for 1 week and the rash was treated with doxycycline, diphenhydramine, and continued use of natural emollient (Vaseline petroleum jelly). After 1 week, a dramatic improvement of the facial rash was noticed. DISCUSSION: Our report describes a sudden flare-up of a skin rash (Grade 3) after the 5th cycle of cetuximab following use of OTC skin care remedies, which was unusual for this patient, suggesting a possible relation to the therapy. Skin crucially depends on EGFR for its normal function and becomes extremely sensitive during cetuximab therapy. Topical OTC acne and dry skin remedies can suddenly change the mild acneiform rash into severe skin toxicity associated with marked desquamation and exfoliation. Avoidance of further skin damage caused by topical applications and the use of doxycycline and diphenhydramine show a significant success in the management of skin toxicity.

Clin Exp Dermatol. 2009 Mar 14; Chua SL, Angus JE, Ravenscroft J, Perkins W

Dermatol Nurs. 2009 Mar-Apr; 21(2): 63-8; quiz 69Ramos-e-Silva M, Carneiro SCAcne is a chronic disease of the pilosebaceous follicle that affects mainly adolescents. It causes polymorph cutaneous lesions that may leave scars after regression. It is characterized by alternation of periods of exacerbation and stability. Spontaneous regression usually occurs after age 20, but some patients may continue suffering during adult life. Diagnosis is clinical and based on the patient's age at the time that the lesions first appear, and on its polymorphism and type of lesions and location. Some patients also need a hormonal and, sometimes, psychological evaluation. The right treatment for the right patient is key to treating acne safely.

Value Health. 2009 Mar 10; Arbuckle R, Clark M, Harness J, Bonner N, Scott J, Draelos Z, Rizer R, Yeh Y, Copley-Merriman KABSTRACT Introduction: Developed using focus groups, the Oily Skin Self Assessment Scale (OSSAS) and Oily Skin Impact Scale (OSIS) are patient-reported outcome measures of oily facial skin. Objective: The aim of this study was to finalize the item-scale structure of the instruments and perform psychometric validation in adults with self-reported oily facial skin. Methods: The OSSAS and OSIS were administered to 202 adult subjects with oily facial skin in the United States. A subgroup of 152 subjects returned, 4 to 10 days later, for test-retest reliability evaluation. Results: Of the 202 participants, 72.8% were female; 64.4% had self-reported nonsevere acne. Item reduction resulted in a 14-item OSSAS with Sensation (five items), Tactile (four items) and Visual (four items) domains, a single blotting item, and an overall oiliness item. The OSIS was reduced to two three-item domains assessing Annoyance and Self-Image. Confirmatory factor analysis supported the construct validity of the final item-scale structures. The OSSAS and OSIS scales had acceptable item convergent validity (item-scale correlations >0.40) and floor and ceiling effects (

Expert Opin Pharmacother. 2009 Jun; 10(9): 1515-21Pickert A, Raimer SBACKGROUND: Oral dapsone has been available for over 60 years. Its first clinical use was discovered in 1945, when it was found to be efficacious in inhibiting the progression of leprosy. The combined antibacterial and anti-inflammatory pharmacologic activities of dapsone have made it a widely investigated drug, particularly for use in refractory and unusual dermatologic conditions. However, the possibility of significant hematological side effects, even at low doses, has limited its use. Currently, oral dapsone has FDA approval for the treatment of leprosy and dermatitis herpetiformis. The potential of oral dapsone to treat acne vulgaris is well established, but the risks of serious side effects have made it an undesirable drug for use in the relatively healthy acne population. Recently, a topical formulation of dapsone (Aczone, Allergan, Inc., Irvine, CA, USA) has been approved by the FDA for the treatment of acne vulgaris. OBJECTIVE/METHODS: The aims of this study were to review the published literature on dapsone pharmacology and pharmacokinetics, and to evaluate the gel's efficacy and safety in treating acne vulgaris, and finally to provide personal insight into its future as a topical agent for acne vulgaris. RESULTS/CONCLUSIONS: Clinical studies indicate dapsone gel 5% is effective in treating mild to moderately severe acne. It is well tolerated, with pharmacokinetic evidence indicating topical dosing in comparison to oral administration significantly reduces systemic concentrations of the drug, and therefore risk of serious side effects. Data suggests that dapsone gel 5% has the potential to become an established topical drug for the treatment of acne vulgaris. However, studies comparing the clinical effectiveness of the dapsone gel 5% to other available topical antiacne drugs are needed as are studies accessing its usefulness and safety when combined with other acne pharmaceuticals.

BMJ. 2009; 338: a2738Hamilton F, Car J, Layton A

Contraception. 2009 Jul; 80(1): 25-33Plewig G, Cunliffe WJ, Binder N, Höschen KBACKGROUND: The study was conducted to assess the effects of the monophasic combined oral contraceptive containing ethinyl estradiol (EE) 0.03 mg and chlormadinone acetate (CMA) 2 mg (EE/CMA) on papulopustular acne of the face, décolleté (low neck) and back; on moderate comedonal acne of the face; and on seborrhea, alopecia and hirsutism. STUDY DESIGN: Three hundred seventy-seven women were randomized (2:1) to receive EE/CMA (n=251) or placebo (n=126) for six medication cycles. Due to the placebo-controlled, double-blind design of the trial, condoms were supplied for contraception. The primary efficacy end point was defined as a reduction of at least 50% in the number of papules and/or pustules of the face from admission to Medication Cycle 6. RESULTS: In total, 64.1% (161/251) of subjects treated with EE/CMA responded compared with 43.7% (55/126) of those taking placebo (p=.0001). The median reduction in papules/pustules on the face at Cycle 6 compared with admission was 63.6% (EE/CMA) compared with 45.3% (placebo group). For comedonal lesions of the face, the reduction in lesion numbers was 54.8% (EE/CMA) compared with 32.4% (placebo). Moderate papulopustular acne of the décolleté decreased by 92.9% (EE/CMA) vs. 50% (placebo group) and of the back by 86.0% and 58.3%, respectively. For these skin conditions, the p values for the relative difference between groups vs. baseline were