Tolerability of clindamycin/tretinoin gel vs. tretinoin microsphere gel and adapalene gel.
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.
Electronic e-isotretinoin prescription chart: improving physicians' adherence to isotretinoin prescription guidelines.
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.
Fractional Resurfacing for the Treatment of Atrophic Facial Acne Scars in Asian Skin.
Dermatol Surg. 2009 Apr 6; Hu S, Chen MC, Lee MC, Yang LC, Keoprasom NBACKGROUND Atrophic facial acne scars is one of the most common problems in patients with inflammatory acne. Ablative laser resurfacing has unpleasant complications and a long recovery peroid. Nonablative therapies yield less improvement and satisfaction. The introduction of fractional photothermolysis (FP) is an alternative treatment for atrophic acne scars. OBJECTIVE To evaluate the effectiveness and safety of a nonablative 1,550-nm erbium-doped fiber laser in the FP of atrophic facial acne scars in one treatment session. METHODS Forty-five patients (skin type III-IV, mean age 29) with atrophic facial acne scars were enrolled in the study. Each patient received one treatment of FP. Comparative photographs were taken using specific complexion analysis to identify and quantify depressed scars and texture. Physician evaluations and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit. RESULTS The improvement in atrophic scars and texture after a FP treatment were significant. Twenty-seven (60%) of the patients had good to excellent results after 1 month. CONCLUSION The FP of atrophic facial acne scars resulted in significant improvement even in a single treatment, with good satisfaction and unremarkable side effects. The authors have indicated no significant interest with commercial supporters.
FGFR2 Abnormalities Underlie a Spectrum of Bone, Skin, and Cancer Pathologies.
J Invest Dermatol. 2009 Apr 23; Katoh MFibroblast growth factor receptor (FGFR)2 is regulated on the basis of the balance of FGFs, heparan-sulfate proteoglycans, FGFR2 isoforms, endogenous inhibitors, and microRNAs. FGFR2 signals cross-talk with hedgehog, bone morphogenetic protein, and other regulatory networks. Some cases of congenital skeletal disorders with an FGFR2 mutation show skin phenotypes, including acne, cutis gyrata, and acanthosis nigricans. Gain-of-function mutations or variations of human FGFR2 occur in estrogen receptor-positive breast cancer, diffuse-type gastric cancer, and endometrial uterine cancer. Oral administration of AZD2171 or Ki23057 inhibits in vivo proliferation of cancer cells with aberrant FGFR2 activation in rodent therapeutic models. However, loss-of-function mutations of FGFR2 are reported in human melanoma. Conditional Fgfr2b knockout in the rodent epidermis leads to increased macrophage infiltration to the dermis and adipose tissue, epidermal thickening accompanied by basal-layer dysplasia and parakeratosis, and the promotion of chemically induced squamous-cell carcinoma. Dysregulation of FGFR2 results in a spectrum of bone and skin pathologies and several types of cancer.Journal of Investigative Dermatology advance online publication, 23 April 2009; doi:10.1038/jid.2009.97.
