Acne Medications

Arch Dis Child. 2009 May 21; Perera E, Massie J, Phillips RJBACKGROUND: Theoretical concerns about liver disease and vitamin A deficiency have limited the use of oral isotretinoin for troublesome acne in adolescents with cystic fibrosis. METHODS: We administered oral isotretinoin to 9 patients with cystic fibrosis who had troublesome acne unresponsive to antibiotics. All patients were followed for 1-4 years after cessation of treatment. RESULTS: Isotretinoin treatment cleared active acne lesions in all patients. It was well tolerated and no patient had significant side effects. All nine patients were pleased or delighted with the improvement in their skin. CONCLUSIONS: Adolescents with cystic fibrosis and acne can be treated with oral isotretinoin. Oral isotretinoin should be considered for adolescents with cystic fibrosis who have acne associated with scarring, acne not clearing with topical and antibiotic treatment, acne associated with depression, or severe cystic acne.

J Dtsch Dermatol Ges. 2009 Apr 21; Degitz KModern acne therapy uses anticomedogenic, antimicrobial, antiinflammatory, and antiandrogenic substances. As an additional approach in recent years, treatments have been developed based on the application of electromagnetic radiation. Visible light or infrared wave lengths are utilized by most techniques, including blue light lamps, intense pulsed light, photodynamic therapy and lasers. This review evaluates the various methods with regard to efficacy and their current role in the management of acne. Although UV radiation has been frequently used to treat acne, it is now regarded as obsolete due to the unfavorable risk-benefit ratio. Visible light, especially of blue wavelengths, appears to be suitable for the treatment of mild to moderate inflammatory acne. Photodynamic therapy is effective, but, due to considerable immediate side effects, it is best reserved for selected situations. Despite promising observations, intense pulsed light and lasers have to be evaluated in further studies, before they can be recommended.

Pol J Microbiol. 2009; 58(1): 61-8Yoon WJ, Kim SS, Oh TH, Lee NH, Hyun CGIn this study, the chemical composition of Cryptomeria japonica essential oil (CJE) was analyzed and its biological activities were tested. CJE was obtained by steam distillation from leaves collected from Jeju Island and analyzed by gas chromatography (GC)-flame ionization detection (FID) and GC-MS. Kaurene (17.20%), elemol (10.88%), gamma-eudesmol (9.41%), and sabinene (8.86%) were the major components in CJE. The antibacterial and anti-inflammatory activities of CJE against drug-susceptible and -resistant skin pathogens have been not reported previously. Thus, we determined the anti-bacterial activities of CJE using the disk diffusion method and minimum inhibitory concentration (MIC) values. CJE showed excellent antibacterial activities against Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. The MIC of CJE against drug-susceptible and -resistant P. acens and S. epidermidis ranged from 0.16 to 10.0 microl/ml. In addition, the effects of CJE on nitric oxide (NO), prostaglandin E2 (PGE2), tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. Pro-inflammatory cytokine and mediator tests indicated that CJE has excellent dose-dependent inhibitory activities. Therefore, based on these results, we propose that CJE is an attractive acne-mitigating candidate for skin health.

Clin Evid (Online). 2009; 2009: Cahill DJINTRODUCTION: Polycystic ovary syndrome (PCOS) is diagnosed in up to 10% of women attending gynaecology clinics, but the prevalence in the population as a whole is unclear. PCOS has been associated with hirsutism, infertility, acne, weight gain, type 2 diabetes, cardiovascular disease (CVD), and endometrial hyperplasia. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: finasteride, flutamide, metformin, spironolactone, cyproterone acetate-ethinylestradiol (co-cyprindiol), interventions to achieve weight loss, ketoconazole, and mechanical hair removal.

Br J Dermatol. 2009 May 21; Gollnick HP, Draelos Z, Glenn MJ, Rosoph LA, Kaszuba A, Cornelison R, Gore B, Liu Y, Graeber M, Summary Background Combination therapy utilizing agents with complementary mechanisms of action is recommended by acne guidelines to help simultaneously target multiple pathogenic factors. A unique, topical, fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has recently been developed for the once-daily treatment of acne. Objectives To evaluate the efficacy and safety of adapalene 0.1%-BPO 2.5% fixed-dose combination gel (adapalene-BPO) relative to adapalene 0.1% monotherapy (adapalene), BPO 2.5% monotherapy (BPO), and the gel vehicle (vehicle) in a large population for the treatment of acne vulgaris. Methods In total, 1670 subjects were randomized in a double-blind controlled trial to receive adapalene-BPO, adapalene, BPO or vehicle for 12 weeks (1 : 1 : 1 : 1 randomization). Evaluations included success rate (subjects 'clear' or 'almost clear'), percentage change in lesion count from baseline, cutaneous tolerability and adverse events. Results Adapalene-BPO was significantly more effective than corresponding monotherapies, with significant differences in percentage lesion count change observed as early as 1 week. Cutaneous tolerability profile was similar to adapalene. Adverse events were more frequent with the combination therapy (mainly due to an increase in mild-to-moderate dry skin), occurred early in the study, and were transient. Conclusions Adapalene-BPO provides significantly greater and synergistic efficacy and a faster onset of action with an acceptable safety profile in the treatment of acne vulgaris when compared with the corresponding vehicle and the adapalene and BPO monotherapies.

J Dermatolog Treat. 2009 Jan 1; 1-4Tirado-Sanchez A, Maria Ponce-Olivera RIntroduction: Superoxidized solution (SOS) is an electrochemically processed aqueous solution manufactured from pure water and sodium chloride. Inflammatory skin disorders have all improved their outcomes with the use of SOS. These indications suggest that SOS could be useful in acne. Methods: A total of 89 patients were enrolled in this double blinded, clinical trial. Patients presented with 10--50 inflammatory lesions (papules and pustules) and an absence of nodulocystic lesions. Results: Improvement was excellent in nine patients (23%) using SOS, compared with five patients (21%) using benzoyl peroxide (BP) (p = 0.378); good in 21 patients (54%) using SOS and 12 patients (50%) using BP (p = 0.794), compared with four patients (18%) taking placebo (p = 0.001); and fair in six patients (15%) using SOS and five patients (21%) using BP (p = 0.415), compared with 12 patients taking placebo (55%) (p = 0.014). In three patients using SOS (8%) the response was poor, compared with two patients (8%) using BP (p = 0.725) and six patients (27%) taking placebo (p = 0.075). We did not need to change a dose during the study period and no systemic effect was observed. Conclusions: We found that SOS is an important choice to treat inflammatory acne, comparable with benzoyl peroxide; however, a larger sample is needed.

Peptides. 2009 Jun; 30(6): 1058-1068Pan CY, Chen JY, Lin TL, Lin CHThe synthetic epinecidin-1(22-42) peptide was derived from positions 22-42 of Epinephelus coioides epinecidin-1. The synthetic SALF(55-76) cyclic peptide (csSALF(55-76)) and SALF(55-76) linear peptide (lsSALF(55-76)) contained sequences from positions 55 to 76 of the Penaeus monodon anti-lipopolysaccharide factor (ALF), respectively. We studied the in vitro activities of epinecidin-1(22-42), csSALF(55-76), and lsSALF(55-76) against Propionibacterium acnes, Candida albicans, and Trichomonas vaginalis. The minimum inhibitory concentrations (MICs) of epinecidin-1(22-42) for the test pathogen strains ranged 12.5-200mug/ml, those of csSALF(55-76) ranged 100-200mug/ml, and those of lsSALF(55-76) ranged 25-200mug/ml. epinecidin-1(22-42) exhibited cytotoxicity towards P. acnes, C. albicans, and T. vaginalis (one strain of which was a metronidazole-resistant strain, while the other strain was not), suggesting that epinecidin-1 functions like a lytic peptide. Similar cytotoxicity was identified against T. vaginalis treated with the csSALF(55-76) and lsSALF(55-76) peptides. The antimicrobial activities of these peptides were confirmed by scanning electron microscopy (SEM), transmission electron microscopy (TEM), a viable cell count assay, and flow cytometric analysis. TEM and SEM examinations of T. vaginalis treated with these three peptides showed that severe swelling preceded cell death and breakage of the outer membrane, and the intracellular inclusion was found to have effluxed extracellularly. This phenomenon was also found with epinecidin-1(22-42) treatment of P. acnes and C. albicans. Our results suggest that the epinecidin-1(22-42), csSALF(55-76), and lsSALF(55-76) peptides may be good candidates for treating trichomoniasis, and epinecidin-1(22-42) may have potential as a drug supporting therapy for acne and candidiasis.

Tidsskr Nor Laegeforen. 2009 May 14; 129(10): 992-996Tolaas E, Knudsen CW, Sviland L, Tønseth KABACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by recurrent tender nodules and boils, usually in the armpits and groins. Draining fistulas and hypertrophic scarring are hallmarks of more severe disease. The objective of this article is to review the clinical presentation, diagnostic considerations and treatment of the disease. MATERIAL AND METHODS:. The article is based on a non-systematic literature search in PubMed, review of dermatology textbooks and the author's personal clinical experience. RESULTS: Hidradenitis suppurativa, also known as acne inversa, is a follicular occlusion disease that can severely reduce quality of life. Staphylococci and other pathogenic bacteria frequently colonize the lesions, but the disease is not primarily a bacterial infection. Smoking and obesity can worsen disease activity. Moderate and severe disease is usually treated with excisional surgery. Antibiotics, often tetracyclines, are indicated for mild disease and as an adjunct to surgery in more severe disease. Antibiotics, however, are not curative. New treatment options, such as TNF-α inhibitors and zinc gluconate should still be considered experimental. INTERPRETATION: Hidradenitis suppurativa is probably underdiagnosed. The disease is often recalcitrant to treatment. The effect of medical treatment is not supported by high quality evidence.

Dermatol Surg. 2009 Apr 27; Kim S, Cho KHBACKGROUND Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that has been proposed. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced. OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers. METHODS A series of 20 patients (skin phototypes IV-V) with atrophic facial acne scars were randomly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high (group A) and low (group B) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half. Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively. Clinical assessment scores were determined at each treatment session and follow-up visit. RESULTS Although the use of the ablative fractional laser with high energy resulted in an improvement in patients' acne scars, the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results, as assessed in photographs as well as by the overall appearance of the acne scars. With the combination method, fewer complications were observed. The authors have indicated no significant interest with commercial supporters.

J Eur Acad Dermatol Venereol. 2009 Apr 24; Kalkan G, Karadag AS, Astarcı HM, Akbay G, Ustun H, Eksioglu MAbstract Background Papulopustular lesions (PPL) are commonly seen cutaneous lesions in Behçet's disease (BD). Some authorities do not recommend using cutaneous lesions for diagnostic criteria because these lesions are confused with acne vulgaris. Objective To understand if PPL have diagnostic value in BD. Methods Biopsy was performed on papulopustular lesions of Behçet's patients for histopathological examination to compare with the control group composed of patients with acne vulgaris. Forty two patients with BD and 21 control patients with acne vulgaris were enrolled in the study. Histopathological findings were classified as leukocytoclastic vasculitis, lymphocytic vasculitis, superficial and/or deep perivascular infiltration, and folliculitis and/or perifolliculitis. Results Of the specimens from 42 Behçet's disease patients, 7 (16.7%) revealed leukocytoclastic vasculitis and 3 (7.1%) had lymphocytic vasculitis, 15 (35.7%) had superficial perivascular and/or interstitial infiltration, 12 (28.6%) had superficial and deep perivascular and/or interstitial infiltration, 5 (11.9%) had folliculitis or perifolliculitis. Of the control group patients, 9 (42.9%) had folliculitis or perifolliculitis, 8 (38.1%) revealed superficial perivascular inflammation and 4 (19.0%) revealed mixed superficial and deep perivascular inflammation. Vasculitis was not encountered in any control group specimens. Vasculitis ratio was statistically higher in Behcet's disease patients (P = 0.016). Conclusions We evaluated more patients than previous related studies reported in the literature. Histopathological findings of vasculitis were encountered only in BD group. Non-vasculitis histopathological findings were also encountered in the control group patients. In conclusion, PPL can be used as a diagnostic criterion of BD subsequent to finding vasculitis in histopathological examination of the biopsy specimen of the PPL. Conflicts of interest None declared.

Arch Gynecol Obstet. 2009 May 22; Siddiqui IA, Tamimi W, Tamim H, Aleisa N, Adham MBACKGROUND: Polycystic ovary syndrome (PCOS) is an endocrine metabolic dysfunction closely associated with obesity, which predisposes to pregnancy complications. PCOS is a common endocrine disorder affecting 5-10% of the population. It is characterized by chronic anovulation and hyperandrogenism with clinical manifestations of oligomenorrhea, hirsutism and acne. Obese females are at higher risk for metabolic syndrome due to severe hyperandrogenemia, which also leads to high blood pressure. OBJECTIVES: To determine, among patients with PCOS, the correlation of body mass index (BMI) with (1) the clinical manifestations of PCOS and (2) blood pressure. METHOD: We performed a cross-sectional study of 62 women of reproductive age (29-43 years), who attended the Obstetrics and Gynecology Clinic at King Fahd National Guard Hospital in Riyadh, Kingdom of Saudi Arabia, with the confirmed diagnosis of PCOS. These patients were divided into two BMI groups: nonobese (BMI less than 25 kg/m(2)) and obese (BMI more than 25 kg/m(2)). Patients' waist to hip ratio, acne, hirsutism, and systolic and diastolic blood pressures were also recorded as clinical manifestations in PCOS and compared between the two BMI groups. RESULTS: The mean age of the patients was 35.85 +/- 5.03 years, BMI was 31.91 +/- 6.40 kg/m(2), waist-hip ratio was 0.82 +/- 0.067, Ferriman and Gallway's score for hirsutism was 3.63 +/- 4.35, systolic blood pressure was 113.02 +/- 16.10 mmHg, diastolic blood pressure was 71.79 +/- 10.04 mmHg, and acne was present in 24 cases (38.7%). When the groups were compared according to BMI, a significant increase in systolic and diastolic blood pressures (p = 0.001 and 0.003, respectively) was seen in obese patients, but there was no significant rise in the waist-hip ratio and hirsutism score. CONCLUSION: We observed a significant and progressive effect of BMI on clinical manifestations and blood pressure levels in patients with PCOS.

Braz J Med Biol Res. 2009 Jun; 42(6): 501-5Abulnaja KOAcne vulgaris is a multifactorial disease affecting a majority of the adolescent population. The objective of this study was to test for a correlation between fasting serum lipid profiles and levels of testosterone, insulin, leptin, and interleukin 1-beta (IL-1beta) and the incidence of severe acne vulgaris in obese adolescent females. Four groups of adolescent females were studied: obese with acne, obese without acne, non-obese with acne, and non-obese without acne. Obese females with acne, compared to obese females without acne and non-obese subjects, had significantly higher serum triglycerides, low-density lipoprotein cholesterol and apolipoprotein-B (apo-B) (mean +/- SD: 197 +/- 13.7 vs 171 +/- 11.5, 128 +/- 8.3 vs 116 +/- 7.7, 96 +/- 13.7 vs 85 +/- 10.3 mg/dL, respectively) but significantly lower high-density lipoprotein cholesterol and apo-A1 levels (40 +/- 3.3 vs 33 +/- 3.5 and 126 +/- 12 vs 147 +/- 13 mg/dL). Serum testosterone, insulin and leptin levels were significantly higher in obese subjects with or without acne compared to non-obese females with or without acne (3 +/- 0.5 vs 2.1 +/- 0.47, 15.5 +/- 3.3 vs 11.6 +/- 3, 0.9 +/- 0.2 vs 0.6 +/- 0.15 nmol/mL, respectively). Serum IL-1b was significantly elevated in obese and non-obese subjects with acne compared to subjects without acne; in those without acne, these levels were higher in obese than non-obese subjects (2.4 +/- 0.2, 1.4 +/- 0.1 vs 1.8 +/- 0.12 and 1.3 +/- 0.11 pg/mL, respectively). Our results indicate that there is a relationship between obesity (BMI >27) and acne. By early recognition, the etiology and treatment protocol of acne may prevent unwanted conditions.

J Eur Acad Dermatol Venereol. 2009 Mar; 23(3): 245-50Ko HC, Song M, Seo SH, Oh CK, Kwon KS, Kim MBBACKGROUND: Used as individual agents, topical antibiotics and benzoyl peroxide are known to be effective in treatment of acne. Clindamycin phosphate 1% with benzoyl peroxide 5% (CDP/BPO) is a new combination gel, made by rationale, in that combination drug is more effective than either ingredients used alone. Adapalene 0.1% (ADA) is the third-generation retinoid, shown to be as effective as other topical retinoid with well tolerability. OBJECTIVES: To compare the efficacy and tolerability in combination of CDP/BPO in comparison with ADA in Asian patients with mild to moderate acne vulgaris. METHODS: Total of 69 patients, including 31 patients for CDP/BPO group and 38 for ADA group, with mild to moderate acne vulgaris were enrolled for a 12-week prospective, randomized, open-label comparative study of topical agents. Efficacy was assessed by lesion counts, acne grading system, and global improvement. Adverse events were also evaluated in scale of 0 (none) to 3 (severe). RESULTS: Both CDP/BPO and ADA were effective in reducing lesion counts and acne severity scale and showed significant global improvement. However, CDP/BPO offered greater efficacy against inflammatory lesions than ADA. Both drugs were well tolerated with minimal adverse drug reactions. CONCLUSION: Combination formulation of CDP/BPO and ADA were shown to be both effective in decreasing total, inflammatory, and non-inflammatory lesion counts along with well tolerability in Asian patients with mild to moderate acne vulgaris.

Indian J Dermatol Venereol Leprol. 2009 May-Jun; 75(3): 279-82NilFroushzadeh MA, Siadat AH, Baradaran EH, Moradi SBACKGROUND: Acne vulgaris is a common skin disease that affects 85% to 100% of people at some time during their lives. It is characterized by noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. AIMS: To compare the efficacy of combination treatment of clindamycin+salicylic acid, versus clindamycin+tretinoin versus clindamycin alone in the treatment of the mild-to-moderate acne vulgaris. METHODS: This was a single-blinded, randomized clinical trial.Forty-two female patients (age range: 15-25 years) with mild-to-moderate acne vulgaris were selected randomly and subsequently randomized to 3 groups. Group A patients were treated with 1% clindamycin lotion (C lotion) twice daily. Group B patients were treated with 1% clindamycin+0.025% tretinoin lotion once nightly (CT lotion). Group C patients were treated with 1% clindamycin+2% salicylic acid lotion twice daily (CS lotion) for 12 weeks. For comparison of efficacy of these treatments, and regarding the skewed distribution of the data, Kruskal-Wallis Test and Mann-Whitney U test were used. SPSS software was used for statistical analysis. RESULTS: There was a significant difference between 3 types of treatment in the respect of the total lesion count (TLC) improvement (P = 0.039). The efficacy of treatment on Acne Severity Index (ASI) was maximum for CS lotion (81.80% reduction in ASI). CT lotion reduced ASI by as much as 73.73% during 12 weeks of treatment. The efficacy of C lotion was calculated to be 37.87% in the reduction of ASI. CONCLUSIONS: Our data suggested that the efficacy of CS lotion was significantly more than C lotion with respect to the TLC and ASI, although there was no significant difference between CS and CT lotion.

Indian J Dermatol Venereol Leprol. 2009 May-Jun; 75(3): 272-8Adityan B, Thappa DMBACKGROUND: Acne vulgaris is believed to be the most common disease of the skin. There is no Indian study on the profile of acne vulgaris, markers of severe forms of acne vulgaris and a possible correlation between acne vulgaris and markers of androgenicity in females. AIM: To study the profile of acne vulgaris, its seasonal variation, relationship with smoking and possible correlation between acne vulgaris and markers of androgenicity in females. METHODS: The study was conducted between August 2006 and June 2008. All patients with acne vulgaris who consented to participate in the study were included. The parameters evaluated included age, gender, age of onset, duration of lesions, site of lesions, grade, relation with menstrual cycle, markers of androgenicity, number of acne lesions such as comedones, papules pustules and nodules, number and site of post-acne scarring, post-acne hyperpigmentation, seasonal variation and history of smoking. RESULTS: A total of 309 patients with acne vulgaris were included in the study. The frequency of acne vulgaris in our study was 1.068%. Mean age of the study group was 19.78 years. Male to female ratio was 1.25:1. The most common age group involved was 16 to 20 years (59.8%). Mean age of onset was 15.97 years. Face was involved in all the patients, followed by back (28.2%), chest (20.1%), neck (9.4%) and arms (10%). In the older age groups, women were more likely to report having acne vulgaris than men (P = 0.01). The closed comedones outnumbered open comedones by a factor of 4.9:1. A total of 186 patients (60.2%) had grade 1 acne vulgaris, 85 (27.5%) had grade 2 acne, 8 (2.6%) had grade 3 acne and 30 (9.7%) had grade 4 acne vulgaris. There was a higher incidence of scarring (39.5%) and post-acne hyperpigmentation (24.6%) in our study. In female patients, 57.7% had premenstrual flare and 12.4% had cutaneous markers of androgenicity. There was no association between severity of acne vulgaris and other markers of androgenicity (P = 0.108). Seborrheic dermatitis (21.35%) was the most common disease associated. Seasonal variation was observed only in 80 patients (25.9%); 71 patients (23%) exacerbated in summer and 9 patients (2.9%) in winter. Smokers had more severe grade of acne vulgaris compared to nonsmokers (P = 0.001). CONCLUSION: This study brings out the clinical profile of acne vulgaris in a tertiary care hospital in South India.

Paediatr Child Health. 2008 Jul; 13(6): 507-9Savlov D, O'Gorman C, Urbach S, Pope E

Internist (Berl). 2009 May 13; Lamprecht P, Gross WLIn its strict sense, the term "autoinflammatory syndromes" comprises the hereditary periodic fever syndromes (HPF), which are caused by mutations of pattern-recognition receptors (PRR) and perturbations of the cytokine balance. These include the crypyrinopathies, familial Mediterranean fever, TNF-receptor associated periodic fever syndrome (TRAPS), hyper-IgD and periodic syndrome (HIDS), pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, NALP12-HPF, and the Blau syndrome. The diseases are characterized by spontaneous activation of cells of the innate immunity in the absence of ligands. Autoantibodies are usually not found. HPF clinically present with recurrent fever episodes and inflammation, especially of serosal and synovial interfaces and the skin. Intriguingly, PRR-mediated autoinflammtory mechanisms also play a role in a number of chronic inflammatory and autoimmune diseases.

Hautarzt. 2009 May; 60(5): 402-8Lehmann PAcne is the most common disease in teens, with a prevalence of about 80-90%. The severity of acne varies greatly among individuals, and genetic background plays an important role. Pathogenetic factors include androgen-induced seborrhea, follicular hyperkeratosis, microbial population, and immunological and inflammatory processes. These factors influence each other, leading to the acne phenotype. Classical acne forms must be differentiated from special acne entities. Among those, acne induced by self-administered anabolic steroids ("bodybuilding acne") has especially become a widespread problem. Psychological effects induced by the disfiguring appearance of severe acne manifestations in pubertal adolescents should not be underestimated. Acne juvenilis may be well controlled by a variety of pathogenesis-oriented antiacne treatment strategies. Because the treatment is always longstanding, and success is achieved only after a prolonged period of time, a very good patient-doctor relationship is required.

BMC Cancer. 2009 May 11; 9(1): 141Pahwa P, Karunanayake CP, Spinelli JJ, Dosman JA, McDuffie HHABSTRACT: BACKGROUND: Research has shown that ethnicity is a significant predictor of Hodgkin lymphoma (HL). Variations in cancer incidence among ethnic groups in the same country can lead to important information in the search for etiological factors. Other risk factors important in the etiology of HL are medical history and exposure to pesticides. In this report we investigated the association between ethnicity and HL in the presence of medical history, and exposure to pesticides. METHODS: The data resulting from a matched population-based case-control study conducted in six provinces of Canada (Ontario, Quebec, Manitoba, Saskatchewan, Alberta, and British Columbia) was analyzed to determine whether or not there was any association between ethnicity and incidence of HL when adjusted for personal medical history and pesticide exposure. Information on ethnicity, personal medical history, and pesticide exposure was collected by questionnaires via mail on 316 men diagnosed with HL; and on 1506 controls. A conditional logistic regression was utilized and results were presented as odds ratios and 95% confidence intervals. RESULTS: In our study population, the distribution of ethnic groups was: 38.5% North American, 15% British, 8.4% Western European, 8.2% Eastern European, 1.7% Asian, 1.4% Scandinavian and 27% of other ethnic origin. Compared to North Americans (i) the risk of HL was greater among the Eastern European descendents (Odds Ratio (ORadj): 1.82; 95% confidence interval (CI): 1.02, 3.25) and Western European (ORadj: 1.62; 95% CI: 0.95-2.76) descent population (borderline significance at 5% level); and (ii) the risk of HL was lower in Asian descents. Diagnosis with measles (ORadj: 0.72, 95% C.I.: 0.53-0.98) and/or positive history of allergy desensitization shots (ORadj: 0.55, 95% C.I.: 0.30-0.99) were negatively associated with the incidence of HL, while diagnosis with acne (ORadj: 2.12, 95% C.I.: 1.19-3.78), shingles (ORadj: 2.41, 95% C.I.: 1.38-4.22) and positive family history of cancer (ORadj: 1.93, 95% C.I.: 1.40-2.65) increased the risk of HL. Exposure to individual herbicide dichlorprop showed an increased risk of HL (ORadj: 6.35, 95% C.I.: 1.56-25.92). CONCLUSIONS: In Canada, compared to North Americans descendents, the risk of HL was significantly greater among the Eastern European and Western European descent population. Our results related to association between ethnicity and HL support the findings reported by other researchers. Our data showed that subjects who were diagnosed with measles or had allergy desensitization shots negatively associated with the incidence of HL; and other medical conditions, ever diagnosed with acne, and positive family history of cancer were positively associated with the incidence of HL.

J Cutan Med Surg. 2009 May-Jun; 13(3): 164-8Bleiziffer O, Dragu A, Kneser U, Horch REBACKGROUND:Acne inversa is a progressive chronic inflammatory disease associated with abscess and fistula formation and subsequent scarring. In recent years, an increasing number of reports have been published about acne inversa and concomitantly occurring Crohn disease. Extensive anogenitoperineal soft tissue defects represent an enormous challenge to therapy. Common treatment strategies of reconstructive surgery such as local flaps, free flaps, or split-thickness skin grafts are frequently problematic and associated with poor outcomes.OBJECTIVE:The aim of this case report is to demonstrate the clinical problem of extensive anogenitoperineal soft tissue defects and to present a surgical technique that can be successfully used in such difficult cases.METHODS:In both cases, extensive excision of the affected areas was carried out down to the gluteal muscles followed by intramuscular grafting of buried skin chip grafts.RESULTS:In both cases, the final postoperative results after numerous surgeries were very good, with complete wound closure resulting in complete recovery and social reintegration.CONCLUSION:The technique of buried skin chip grafting has long been ignored since split-thickness skin grafting and different techniques of flap coverage evolved, but it may constitute a highly efficient treatment strategy in challenging reconstructive situations.

Curr Opin Investig Drugs. 2009 May; 10(5): 474-81Scheinfeld NAllergen Inc has launched Aczone, a topical gel formulation of the antibacterial, anti-inflammatory agent dapsone, for the potential treatment of acne vulgaris. Oral dapsone has demonstrated efficacy in acne, but was associated with severe side effects such as anemia, which was particularly serious in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Aczone was developed to overcome this limitation, and is formulated using solvent-microparticle technology for improved absorption and action and for fewer side effects. In a phase I clinical trial, systemic exposure to dapsone was 126-fold lower following treatment with Aczone compared with oral dapsone. Aczone significantly reduced lesion counts in patients with acne in phase III trials, and was particularly effective in reducing inflammatory lesions. In a phase IV trial, Aczone was safely applied to patients with G6PD deficiency without inducing anemia. Phase IV trials in patients with acne were ongoing at the time of publication to assess safety and to compare Aczone monotherapy with combinations of Aczone and other anti-acne therapeutics. At the time of publication, Allergen was also developing Aczone for the treatment of rosacea; the drug was undergoing phase II trials for this indication. Aczone appears to be a novel promising anti-acne therapeutic option, particularly for patients with inflammatory acne.

Sirolimus (SRL) allows to minimize the use of cyclosporine (CsA), but de novo administration after transplantation is associated with various complications. We report a prospective, open-label, multicenter randomized study to evaluate conversion from a CsA-based regimen to a SRL-based regimen 3 months after transplantation.

One hundred ninety-two of a total of 237 patients were eligible at 3 months to be converted to SRL (n = 95) or to continue CsA (n = 97). All patients were also given mycophenolate mofetil (MMF) and oral steroids, planned to be discontinued at month 8.

The primary endpoint, the clearance estimated according to Cockcroft and Gault at week 52, was significantly better in the SRL group (68.9 vs. 64.4 mL/min, p = 0.017). Patient and graft survival were not statistically different.

The incidence of acute rejection episodes, mainly occurring after withdrawal of steroids, was numerically but not statistically higher in the SRL group (17% vs. 8%, p = 0.071).

Sixteen patients discontinued SRL, mainly for adverse events (n = 11), and seven patients discontinued CsA for renal failure or acute rejection. Significantly, more patients in the SRL group reported aphthous, diarrhea, acne scar medications and high triglyceride levels.

Conversion CsA to SRL 3 months after transplantation combined with MMF is associated with improvement in renal function.


"Efficacy on renal function of early conversion from cyclosporine to sirolimus 3 months after renal transplantation: concept study."
Am J Transplant. 2009 May; 9(5): 1115-23Lebranchu Y, Thierry A, Toupance O, Westeel PF, Etienne I, Thervet E, Moulin B, Frouget T, Le Meur Y, Glotz D, Heng AE, Onno C, Buchler M, Girardot-Seguin S, Hurault de Ligny B

In this study we aim to document the use of animal species in traditional medicine and healing practices in the semi-arid region of Northeastern Brazil. While widespread and of great importance to large population that has limited access to contemporary medicine, such practices are poorly understood and the potential value of medicinal animal species largely unknown.

MATERIALS AND METHODS:
Based on interviews with merchants of medicinal animals, we calculated the Informant Consensus Factor (ICF) to determine the consensus over which species are effective for particular ailments, as well as the species relative importance to determine the extent of potential utilization of each species.

RESULTS:
We describe the therapeutic effects of 36 animal species used medicinally. The zootherapeutical products sold commercially are used to treat 40 health problems that were classified into 10 broad categories. We also highlight those species valued for their effectiveness against a range of ailments. The highest ICF value (0.91) was cited for diseases of the skin and subcutaneous tissue, which include relief of symptoms such as topical acne scar medications and furuncles.

DISCUSSION AND CONCLUSION:
This study demonstrates that many animal species play an important role in healing practices. Animals provide the raw materials for remedies prescribed clinically and are also used in the form of amulets and charms in magic-religious rituals and ceremonies. The medicinal value of animal species depends on the local knowledge that exists within user communities and therefore the conservation of animal species is imperative to the preservation of local medicinal knowledge and culture.


Commercialization of animal-derived remedies as complementary medicine in the semi-arid region of northeastern Brazil.
J Ethnopharmacol. 2009 May 4; Alves RR, Neto NA, Brooks SE, Albuquerque UPAIM OF THE STUDY

Expert Opin Drug Deliv. 2009 May; 6(5): 465-83Trapasso E, Cosco D, Celia C, Fresta M, Paolino DBACKGROUND: Retinoids represent an old class of bioactives used in the treatment of different skin pathologies (such as acne and psoriasis) and in the treatment of many tumors. Unfortunately, they present several side effects, i.e., burning of skin and general malaise after systemic administration and they are very unstable after exposition to light. METHODS: One of the most promising new approaches for reducing the side effects of retinoids while improving their pharmacological effect is the use of drug-delivery devices. This review explains the current status of retinoid drug transport, which has been developing over the last few years, explaining the modification of their biopharmaceutical properties in detail after encapsulation/inclusion in vesicular and polymeric systems. RESULTS/CONCLUSION: Different colloidal and micellar systems containing retinoid drugs have been realized furnishing important potential advancements in traditional therapy.

Int J Dermatol. 2009 May; 48(5): 498-505Yahya HBACKGROUND: Community-based studies of acne vulgaris conducted in many parts of the world show that it is very common in adolescents but little is known from Africa. METHODS: In a cross-sectional study, 539 randomly selected students aged 11-19 years in a secondary school in Kaduna, Nigeria were administered a questionnaire to assess self-report of acne, its severity and impact; beliefs and perceptions of causes, and treatments used. 418 students were later examined to detect and grade acne severity. RESULTS: 274 (50.8%) were male while 265 (49.2%) were female. Mean age for respondents was 16 years. 320 students (59.4%) self-reported acne. Of 418 students examined, 379 had acne giving a prevalence of 90.7%. There was no significant gender difference in prevalence at all ages of adolescence. Prevalence of acne increased with age (76.7% at age 10-13 years; 88.2% at age 14-16 years; 97.1% at age 17-19 years). 353 of 379 (93.1%) had mild acne while 26 of 379 (6.9%) had moderate acne. The severity of acne was similar in boys and girls. 47.7% of students reported feeling "very sad/unhappy" about their acne although in more than 70% of those who self-reported, this did not interfere with relationship with family, friends or school work. Diet was the commonest factor believed to cause acne. Cleansing agents were the most commonly used treatments. CONCLUSIONS: Acne vulgaris is very common in Nigerian adolescents, although it is mild acne in most.

Lancet. 2009 May 2; 373(9674): 1525-31Pirker R, Pereira JR, Szczesna A, von Pawel J, Krzakowski M, Ramlau R, Vynnychenko I, Park K, Yu CT, Ganul V, Roh JK, Bajetta E, O'Byrne K, de Marinis F, Eberhardt W, Goddemeier T, Emig M, Gatzemeier U, BACKGROUND: Use of cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), has the potential to increase survival in patients with advanced non-small-cell lung cancer. We therefore compared chemotherapy plus cetuximab with chemotherapy alone in patients with advanced EGFR-positive non-small-cell lung cancer. METHODS: In a multinational, multicentre, open-label, phase III trial, chemotherapy-naive patients (>or=18 years) with advanced EGFR-expressing histologically or cytologically proven stage wet IIIB or stage IV non-small-cell lung cancer were randomly assigned in a 1:1 ratio to chemotherapy plus cetuximab or just chemotherapy. Chemotherapy was cisplatin 80 mg/m(2) intravenous infusion on day 1, and vinorelbine 25 mg/m(2) intravenous infusion on days 1 and 8 of every 3-week cycle) for up to six cycles. Cetuximab-at a starting dose of 400 mg/m(2) intravenous infusion over 2 h on day 1, and from day 8 onwards at 250 mg/m(2) over 1 h per week-was continued after the end of chemotherapy until disease progression or unacceptable toxicity had occurred. The primary endpoint was overall survival. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00148798. FINDINGS: Between October, 2004, and January, 2006, 1125 patients were randomly assigned to chemotherapy plus cetuximab (n=557) or chemotherapy alone (n=568). Patients given chemotherapy plus cetuximab survived longer than those in the chemotherapy-alone group (median 11.3 months vs 10.1 months; hazard ratio for death 0.871 [95% CI 0.762-0.996]; p=0.044). The main cetuximab-related adverse event was acne-like rash (57 [10%] of 548, grade 3). INTERPRETATION: Addition of cetuximab to platinum-based chemotherapy represents a new treatment option for patients with advanced non-small-cell lung cancer. FUNDING: Merck KGaA.

We report one case of very severe acne-like lesions associated with amineptine (Survector). They were most prominent on the face and back, but were also observed on sites not affected by acne vulgaris, such as perineum, arms and legs.

The lesions appeared after long-term self-medication of high doses. Keratoacanthoma-like lesions were also present, and the small ones were successfully treated with topical imiquimod. The case is significant since the disease is quite rare.

"Acne Induced By Amineptine"
An Bras Dermatol. 2009 Jan-Feb; 84(1): 71-4Guedes AC, Bentes AA, Machado-Pinto J, Carvalho Mde L

Many innovations in acne therapy have evolved since the discovery in 1949 that vitamin A derivatives affected epidermal proliferation.

Approval of topical tretinoin solution in 1971 was followed by modifications in the formulation to improve tolerability and provide flexibility in dosing. Identification of retinoid receptors led to research that resulted in 2 receptor-selective synthetic retinoids: adapalene and tazarotene.

Today, topical retinoids are one of the cornerstones of acne therapy and are recommended as first-line therapy for all but the most severe forms of acne.

They are used as monotherapy in mild comedonal acne; for inflammatory acne, topical retinoids are used in combination with benzoyl peroxide (BPO) and antibiotics (topical or oral) and/or hormonal therapy for females.

Because of the high prevalence of antibiotic-resistant strains of Propionibacterium acnes, topical antibiotics should no longer be used as monotherapy. Topical retinoid monotherapy is recommended for maintenance because it prevents formation of microcomedones, the precursor lesions in acne.

Combination topical retinoid/antimicrobial therapy has become the current recommended standard of care for the management of patients with acne. Combination therapy can target multiple pathogenic factors: abnormal follicular keratinization, P acnes proliferation, inflammation, and increased sebum production. A number of fixed-combination products are available.

These products are effective, generally well-tolerated, and more convenient for patients than multiple individual agents. By reducing the number of medications and applications, fixed-combination products have the potential to improve patient adherence, thereby improving treatment outcomes.

"Changing the face of acne therapy"
Cutis. 2009 Feb; 83(2 Suppl): 4-15Ghali F, Kang S, Leyden J, Shalita AR, Thiboutot DM

Arch Pharm Res. 2009 Apr; 32(4): 489-94Cho SC, Sultan MZ, Moon SSQuinone type compound, pulsaquinone 1, isolated from the aqueous ethanol extract of the roots of Pulsatilla koreana exhibited antimicrobial activities against an anaerobic non-spore-forming gram-positive bacillus, Propionibacterium acnes, which is related with the pathogenesis of the inflamed lesions in a common skin disease, acne vulgaris. Compound 1 was unstable on standing and thus converted to more stable compound 2, namely hydropulsaquinone by hydrogenation, whose activity was comparable to mother compound 1 (MIC for 1 and 2 against P. acnes: 2.0 and 4.0 mug/mL, respectively). Other structurally-related quinone derivatives (3-13) were also tested for structure-activity relationship against anaerobic and aerobic bacteria, and fungi. The antimicrobial activity was fairly good when the quinone moiety was fused with a nonpolar 6- or 7-membered ring on the right side whether or not conjugated (1,4-naphtoquinone derivatives 3-5), while simple quinone compounds 6-9 showed poor activity. It seems that the methoxy groups at the left side of the quinone function deliver no considerable antimicrobial effect.

Retinoids (RA) have been used as therapeutic agents for numerous skin diseases, from psoriasis to acne and wrinkles.

While RA is known to inhibit keratinocyte differentiation, the molecular effects of RA in epidermis have not been comprehensively defined. To identify the transcriptional targets of RA in primary human epidermal keratinocytes, we compared the transcriptional profiles of cells grown in the presence or absence of all-trans retinoic acid for 1, 4, 24, 48, and 72 h, using large DNA microarrays.

As expected, RA suppresses the protein markers of cornification; however the genes responsible for biosynthesis of epidermal lipids, long-chain fatty acids, cholesterol, and sphingolipids, are also suppressed.

Importantly, the pathways of RA synthesis, esterification and metabolism are activated by RA; therefore, RA regulates its own bioavailability. Unexpectedly, RA regulates many genes associated with the cell cycle and programmed cell death. This led us to reveal novel effects of RA on keratinocyte proliferation and apoptosis.

The response to RA is very fast: 315 genes were regulated already after 1 h. More than one-third of RA-regulated genes function in signal transduction and regulation of transcription. Using in silico analysis, we identified a set of over-represented transcription factor binding sites in the RA-regulated genes.

Many psoriasis-related genes are regulated by RA, some induced, others suppressed. These results comprehensively document the transcriptional changes caused by RA in keratinocytes, add new insights into the molecular mechanism influenced by RA in the epidermis and demonstrate the hypothesis-generating power of DNA microarray analysis. J. Cell. Physiol. (c) 2009 Wiley-Liss, Inc.

"Retinoid-responsive transcriptional changes in epidermal keratinocytes"
J Cell Physiol. 2009 Apr 22; Lee DD, Stojadinovic O, Krzyzanowska A, Vouthounis C, Blumenberg M, Tomic-Canic M

J Am Acad Dermatol. 2009 Apr 28; Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, Poli F, Faye O, Bastuji-Garin SBACKGROUND: Factors associated with the severity of hidradenitis suppurativa (HS) are not known. OBJECTIVE: We sought to identify factors associated with the severity of HS. METHODOLOGY: The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. RESULTS: Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). LIMITATIONS: The referral center base of the study may have biased recruitment. CONCLUSION: Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.

J Dermatolog Treat. 2009 Jan 1; 1-2Passeron T, Khemis A, Ortonne JPThe relapses and the chronicity of acne inversa cause a significant impact on the quality of life of the affected patients and urge for a search of more effective treatments. We report the treatment of four consecutive acne inversa patients with pulse dye laser-mediated photodynamic therapy (PDL-PDT). Three months after the end of the treatment there was no improvement in comparison with opposite control sites. Intense pain during treatment was reported by all the patients. These cases do not support the use of PDL-PDT for treating acne inversa.

Lipids. 2009 Apr 7; Yoon WJ, Kim SS, Oh TH, Lee NH, Hyun CGSince acne vulgaris is the combined result of a bacterial infection and the inflammatory response to that infection, we examined whether Abies koreana essential oil (AKE) possessed anti-inflammatory and antibacterial activities against skin pathogens. In this study, AKE showed excellent antibacterial activities against drug-susceptible and -resistant Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. In addition, AKE reduced the LPS-induced secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, NO and PGE(2) in RAW 264.7 cells, indicating that it has anti-inflammatory effects. Therefore, we suggest that AKE may be an attractive candidate for promoting skin health.

Cutis. 2009 Mar; 83(3): 146-54Webster G, Cargill DI, Quiring J, Vogelson CT, Slade HBAcne vulgaris is a widely prevalent skin disorder primarily treated with retinoids, which have been shown to cause skin irritation. This report describes the combined analysis of 2 similar phase 3 studies designed to evaluate the efficacy and safety of an aqueous gel formulation of tretinoin relative to its vehicle (both studies) and a marketed microsphere formulation of tretinoin (one study) for once-daily topical treatment of acne. Randomized participants 10 years and older with mild to moderate acne (N=1537) received tretinoin gel 0.05% (n=674), tretinoin gel microsphere 0.1% (n=376), or vehicle (n=487) once daily for 12 weeks. Tretinoin gel was more effective than vehicle in reducing inflammatory (P

Altern Med Rev. 2009 Mar; 14(1): 67-71Vitex agnus-castus (chaste tree) is a deciduous shrub that is native to Europe and Asia. Medicinally, the berries have been used for centuries for conditions such as acne, constipation, infertility, lactation support, and libido control. Current clinical uses for chaste tree are menstrual irregularities, premenstrual syndrome, and mastalgia. These indications are supported by the German Commission E reports and a recent survey of practitioners. Recent clinical research identified a dopaminergic effect of chaste tree on the pituitary, with central prolactin inhibition. Hormone modulation by Vitex is seen through dopamine antagonism, not by stimulation of FSH and LH, as was originally reported by early clinical studies. Due to its high degree of safety and efficacy, Vitex is widely used by German physicians, herbalists, and naturopathic physicians for many gynecological conditions.

Zhongguo Zhen Jiu. 2009 Mar; 29(3): 247-51Li B, Chai H, Du YH, Xiao L, Xiong JOBJECTIVE: To evaluate the therapeutic effect and safety of acupuncture and moxibustion for treatment of acne, and to analyze the current situation of clinical studies at present. METHODS: Retrieve PubMed, Cochrane library, CBM databank, CNKI databank, etc., and collect the randomized and controlled trials of treatment of acne with acupuncture and moxibustion, and select clinical trials conforming with the enrolled criteria, and conduct evaluation of quality with Cochrane systematic manual 5.0, and RevMan 4.2.8 was used for statistical analysis. RESULTS: Seventeen papers, including 1,613 cases, conformed with the enrolled criteria. Seventeen studies adopted the cured rate as the evaluation index, Meta-analysis showed treatment of acne by acupuncture and moxibustion with routine western medicine as control, significant difference for inter-group comparison [combined RR (random efficacy model) = 2.96, 95% CI (1.63, 4.91), Z=4.08. P

J Drugs Dermatol. 2009 Apr; 8(4): 383-8Leyden J, Wortzman M, Baldwin EKBACKGROUND: Newer agents and formulations seek to improve the tolerability of topical retinoid therapy. Recently, a gel containing crystalline clindamycin 1.2% and tretinoin 0.025% (CLIN/RA) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of treating mild-to-moderate acne. OBJECTIVE: This single-center, randomized, evaluator-blind phase 1 study compared the tolerability of CLIN/RA to 0.1% tretinoin gel or 0.1% adapalene gel. RESULTS: Forty-five patients applied CLIN/RA once daily to one side of their face every day for 21 days. Patients were randomized to either tretinoin 0.1% (n = 23) or adapalene 0.1% (n = 22) on the contralateral side. A clinical evaluator assessed degree of erythema and scaling; patients provided subjective evaluations of burning, stinging, and itching. CONCLUSION: CLIN/RA was significantly better tolerated than was 0.1% tretinoin gel, as evidenced by significantly reduced erythema (P < 0.04), scaling (P < 0.03), itching (P < 0.02), burning (P < 0.03) and stinging (P < 0.04). A trend for greater erythema, scaling, and subjective discomfort for 0.1% adapalene gel compared to CLIN/RA was also evident.

Australas J Dermatol. 2009 May; 50(2): 107-12Tang MB, Tan ES, Tian EA, Loo SC, Chua SHOral isotretinoin is a highly effective treatment for refractory nodulocystic acne. However, it can be associated with serious adverse effects such as teratogenicity and hepatitis. Inadequate cumulative dosing may also result in reduced therapeutic efficacy and higher disease relapse. A preliminary audit had previously revealed a poor and inconsistent adherence to local isotretinoin prescribing guidelines by physicians. To achieve greater than 90% adherence to isotretinoin guidelines for all acne patients prescribed systemic isotretinoin at the National Skin Centre, Singapore, key areas and the reasons for non-adherence were identified. A specifically designed 'one-stop' electronic isotretinoin chart was launched within the electronic medical records (EMR) system to address important safety areas; namely, informed patient consent, pregnancy testing, baseline laboratory tests, and automatic calculation of cumulative and target doses of isotretinoin. Physician adherence to prescribing guidelines improved from a baseline of 50-60% to greater than 90% (range 95-100%) for 30 consecutive months post intervention. The e-isotretinoin chart has resulted in significant improvement in physicians' adherence to isotretinoin prescription guidelines and highlights the utility of EMR technology in influencing safe prescribing behaviour among doctors.