Acne Medications

Curr Opin HIV AIDS. 2008 Jul; 3(4): 453-60Huiras E, Preda V, Maurer T, Whitfeld MPURPOSE OF REVIEW: The introduction of highly active antiretroviral therapy (HAART) has altered the pattern of dermatologic disease among HIV-infected patients. While the majority benefit substantially from highly active antiretroviral therapy-induced immune recovery, a subset of patients experience unmasking of new skin disease or paradoxical worsening of existing dermatologic conditions, attributable to immune reconstitution inflammatory syndrome. We review the current literature regarding the dermatologic manifestations of immune reconstitution inflammatory syndrome. RECENT FINDINGS: Cutaneous immune reconstitution inflammatory syndrome is described in association with a range of infectious, inflammatory, neoplastic, and autoimmune disorders. The list of skin manifestations of immune reconstitution inflammatory syndrome continues to grow, with current literature highlighting the emergence of tropical skin diseases, such as leishmaniasis and leprosy, presenting in the context of immune recovery. Increasingly, we are recognizing common skin eruptions such as acne may be associated with immune reconstitution inflammatory syndrome. There are also recent descriptions of previously unreported presentations of well established immune reconstitution inflammatory syndrome-related conditions. These include Mycobacterium avium presenting as cutaneous ulceration and an epidermodysplasia verruciformis-like eruption of warts. Additionally, authors are attempting to define the unique immunopathology associated with immune reconstitution inflammatory syndrome in the context of specific cutaneous diseases. SUMMARY: Optimal management depends on recognition of immune reconstitution inflammatory syndrome as a unique syndrome by healthcare providers, rather than a failure of highly active antiretroviral therapy or an adverse drug reaction. Our understanding of dermatologic immune reconstitution inflammatory syndrome continues to evolve as the diversity of reported cutaneous immune reconstitution inflammatory syndrome-associated disorders expands.

Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. The most common cause is by increased production of male sex hormones (androgens). It is also affected by increased sensitivity to androgens in the hair follicles, and secretory glands around hair follicles (sebaceous glands). Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism.

OBJECTIVES:
The objective was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.

SEARCH STRATEGY:
The Cochrane Menstrual Disorders and Subfertility Group (MDSG) trials register was searched (April 2008). The Cochrane MDSG register is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.

SELECTION CRITERIA:
All randomised controlled comparisons of spironolactone versus: placebo, steroids (oral contraceptive pill included), spironolactone of varying dosages, or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.

DATA COLLECTION AND ANALYSIS:
Nine trials were included in the review, eight trials were excluded. Two other trials are awaiting assessment. Only one trial studied acne as an outcome, the remainder were concerned with hirsutism. Major outcome measures include the following: subjective observations, Ferriman and Gallwey hair scores, hormonal and biochemical parameters, side effects, sebum production measurement.

MAIN RESULTS:
In the two trials that compared 100 mg of spironolactone with placebo significant differences were reported for subjective improvements in hair growth (OR 7.18, 95% CI 1.96 to 26.28), although not the Ferriman-Galwey score (WMD 7.20, 95% CI -10.98 to -3.42)). Data could not be otherwise pooled as only one trial reported an outcome.

AUTHORS' CONCLUSIONS:
From the studies included in this review, there is some evidence to show that spironolactone is an effective treatment to decrease the degree of hirsutism but there was no evidence for effectiveness for the treatment of acne vulgaris. Studies in this area are scarce and small. Individual study data indicates some superiority of spironolactone over other drugs but results cannot be generalised.

"Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne."