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


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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


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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)



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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)


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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.