Case of acne conglobata successfully treated by CO(2) laser combined with topical tretinoin therapy

Acne conglobata is an uncommon disorder characterized by the presence of nodulocystic lesions. Conservative therapy with oral and topical antibiotics is of limited efficacy in many cases, and surgical excision is often needed for removal of the cystic lesions. Treatment is particularly difficult in cases with lesions located in aesthetically sensitive areas, such as the face. We successfully treated a case of acne conglobata by CO(2) laser ablation to remove the top of the sinuses and their tracts. In addition, topical tretinoin therapy was also initiated simultaneously to prevent the appearance of new acne lesions. Based on the results, we propose that the use of CO(2) laser for opening the cysts, combined with topical tretinoin therapy to prevent the appearance of new lesions, is a powerful treatment option for acne conglobata.     

外用噻吗洛尔在皮肤科的临床应用进展

 噻吗洛尔是一种有效的非选择性β受体阻滞剂,可引起血管收缩、促进创面修复。外用噻吗洛尔不仅已成为浅表性婴儿血管瘤的一线治疗方法,近年来还在慢性溃疡和其他血管性皮肤病等方面显示出广阔的应用前景,具有良好的美容效果。本文对其在皮肤科的临床应用进展作一综述,为更多皮肤病的治疗提供新思路与选择。     

Pyogenic granuloma, port-wine stain and pregnancy

We present a novel case of pyogenic granuloma occurring within a port-wine stain in two sequential pregnancies at different sites. There was no history of precipitating events such as trauma. We discuss why a pyogenic granuloma may occur within a port-wine stain and how pregnancy may increase the likelihood of this occurring.     

Pyogenic granuloma over the venous component of a mixed vascular malformation

A 52‐year‐old man presented with a rapidly growing red tumor on the central neckline. It had appeared over a congenital flat and pinkish vascular lesion that involved the shoulder and the upper anterior area of his chest. Intermingled with the pinkish stain, there were also some blue nodules several millimeters in diameter. Histopathologic examination revealed that the full lesion was a mixed venous‐capillary malformation. The red tumor was excised and diagnosed as a pyogenic granuloma developing over the venous component of the vascular malformation. To our knowledge, a pyogenic granuloma growing over a venous malformation has not been previously described.     

Pyogenic granuloma-like lesions in a patient using topical tretinoin

A 16-year-old male developed numerous pyogenic granuloma like-lesions across his neck, chest and back after 6 weeks isotretinoin therapy for cystic acne. The isotretinoin was ceased and he was commenced on oral steroids. After 6 weeks, the lesions were almost completely healed. However, due to worsening comedonal acne, the patient was commenced on topical tretinoin cream 0.03% twice daily to his chest. He was reviewed 2 weeks later and, surprisingly, 2 new pyogenic granuloma-like lesions had developed on his chest. These lesions persisted until the topical tretinoin was ceased 3 months later.     

A pilot methodology study for the photographic assessment of post‐inflammatory hyperpigmentation in patients treated with tretinoin

Background Post‐inflammatory hyperpigmentation (PIH) is a common occurrence in patients with acne vulgaris, particularly in those with skin of colour. Aims A previous study has demonstrated the benefit of tretinoin (retinoic acid) in the treatment of PIH; however, there is currently no standard protocol to evaluate change in PIH following treatment. Based on these findings, we performed a pilot, exploratory, blinded, intraindividual‐controlled methodology study that consisted of a photographic assessment protocol with facial mapping. Materials and methods The study was based on a secondary analysis of a phase 4, community‐based trial of 544 acne patients who were treated with tretinoin gel microsphere 0.04% or 0.1%. Only patients with Fitzpatrick types III–V (skin of colour) were included in the study; subjects with Fitzpatrick skin type VI were excluded because the photographic assessment did not allow for proper evaluation. Results Despite the small number of subjects evaluated (n = 25), the results revealed consistent assessment of improvement in PIH between two independent graders (weighted κ = 0.84). Conclusion Further study with a larger population is recommended to validate the accuracy of this method.     

维胺酯胶囊和全反式维A酸霜治疗寻常痤疮临床疗效观察

目的:观察维胺酯胶囊和全反式维A酸霜(商品名:迪维霜)治疗寻常痤疮的疗效。方法:将寻常痤疮患者随机分成3组,A组口服维胺酯胶囊,外用0.025%迪维霜;B组外用0.025%迪维霜;C组口服多西环素(商品名:强力霉素),外用硫磺炉甘石洗剂。均各治疗6周。结果:A组对丘疹和脂溢的疗效优于B组和C组(P<0.05),对粉刺的疗效优于C组(P<0.001),对脓疱的疗效优于B组(P<0.05),对结节囊肿的疗效3组差异无显著性;综合疗效A组优于B组和C组(P<0.05);A组中中度痤疮患者的效果优于B组和C组(P<0.05),但对轻度痤疮3组差异无显著性。结论:口服维胺酯胶囊联合外用迪维霜治疗轻、中度痤疮疗效较好。     

A multicentre, single-blind, randomized comparison of a fixed clindamycin phosphate/tretinoin gel formulation (Velac) applied once daily and a clindamycin lotion formulation (Dalacin T) applied twice daily in the topical treatment of acne vulgaris

BACKGROUND: A successful phase III pilot study compared the efficacy and safety of a fixed clindamycin 1%/tretinoin 0.025% gel formulation (CTG; Velac gel) applied once daily and a clindamycin 1% lotion formulation (CLN; Dalacin T lotion) applied twice daily in the treatment of moderate to severe acne vulgaris. OBJECTIVES: We aimed to follow up this study. METHODS: The two treatment regimens were compared in a multicentre, single-blind, randomized 12-week investigation of patients with moderate to severe acne vulgaris. RESULTS: At week 12, the mean percentage reduction in non-inflamed lesions (open and closed comedones) was greater in the CTG group compared with the CLN group (P = 0.05). Absolute reductions in open and closed comedones were also greater in the CTG group, consistent with the comedolytic activity of tretinoin. There was a significantly greater absolute reduction in inflamed lesions (pustules, papules and nodules) from baseline to both end-point (last observed efficacy outcome; P = 0.043) and week 12 (P = 0.018) in the CTG group compared with the CLN group. Evaluation of the calculated overall acne severity score, considering all five lesion subtypes, demonstrated a significantly greater mean percentage reduction in the CTG group compared with the CLN group, both at end-point (P = 0.01) and at week 12 (P < 0.01). The more subjective assessment of overall acne severity according to the Cook scale also demonstrated a significantly greater mean reduction in the CTG group than the CLN group after 12 weeks of therapy (P = 0.007). CTG had a more rapid effect on the onset of improvement compared with CLN; a 50% reduction in total lesion counts by day 60 was found in 77% of patients on CTG compared with 56% receiving CLN (P = 0.003). This was largely due to the reduction in open comedone counts (P = 0. 0006). For all other variables, CTG was at least as effective as CLN. Both treatments were well tolerated. CONCLUSIONS: A single daily topical application of Velac gel was superior to Dalacin T lotion applied twice daily in reducing overall acne scores, and was faster acting. The simpler dosing regimen of Velac gel and its rapid effect are likely to have a positive effect on both patient compliance and cost.     

A case of extensive linear porokeratosis with evaluation of topical tretinoin versus 5-flourouracil as treatment modalities

A 19-year-old male presented with linear raised lesions over extensive areas of his body that followed Blaschko's lines. The lesions were asymptomatic with ridged borders. Histopathology confirmed a diagnosis of porokeratosis. He was given topical tretinoin and topical flourouracil for local application on specified areas. The cosmetic acceptability and the safety profile of tretinoin were found to be better than those of flourouracil. However, both the agents were equally efficacious. A rare case of extensive porokeratosis with comparative evaluation of two treatment modalities is hereby presented.     

Comparison of tretinoin 0.05% cream and 3% alcohol‐based salicylic acid preparation in the treatment of acne vulgaris

Background  No single effective topical treatment is available for treating all pathogenic factors causing acne vulgaris (AV). Salicylic acid (SA), tretinoin (all‐TRA) and clindamycin phosphate (CDP) are known to to be effective agents depending on their comedolytic and anti‐inflammatory properties. Objective  To compare the efficacy and tolerability of SA and CDP combination (SA + CDP) with all‐TRA and CDP (all‐TRA + CDP) in patients with mild to moderate facial AV. Methods  Forty‐six patients aged between 18 and 35 years were enrolled in a 12‐week prospective, single‐blind, randomized and comparative clinical study. Efficacy was assessed by lesion counts, global improvement, quality of life index and measurement of skin barrier functions. Local side effects were also evaluated. Results  Both combinations were effective in reducing total lesion (TL), inflammatory lesion (IL) and non‐inflammatory lesion (NIL) counts and showed significant global improvement as evaluated by the investigator. At the end of the study, there was no significant difference between the two groups in terms of all lesion counts. In addition, TL counts decreased faster in the all‐TRA + CDP group compared with those in the SA + CDP group, with a significant difference between the two groups occurring as early as 2 weeks. Safety evaluations demonstrated that the incidence of mild to moderate side effects generally peaked at week 2 and declined gradually thereafter. Both combinations did not have an effect on stratum corneum hydration, although skin sebum values decreased with SA + CDP treatment. Conclusions  Combination of SA + CDP and all‐TRA + CDP was effective in decreasing lesion counts and well tolerated with minimal local cutaneous reactions in patients with mild to moderate AV.     

Effectiveness of topical propranolol 4% gel in the treatment of pyogenic granuloma in children

Pyogenic granuloma is a benign acquired vascular tumor that affects the skin and mucous membranes, occurring more often in children and young adults. Treatment is often required due to the associated risk of ulceration and bleeding. There are several publications reporting the use of beta‐blockers for the treatment of pyogenic granuloma. The aim of the present study was to evaluate the clinical effectiveness and safety profile of topical propranolol 4% gel for the treatment of pyogenic granuloma. A retrospective study of all cases of pyogenic granuloma treated with topical propranolol 4% gel between 2014 and 2015 was performed. Epidemiological, clinical and treatment data, including effectiveness score and safety, were reviewed. Of a total of 18 patients with pyogenic granuloma, 11 (61.1%) showed complete resolution of the lesion while two (11.1%) had an almost complete response. In three cases (16.6%), the treatment was discontinued due to bleeding, and the lesions were removed by curettage. Local irritation and lack of compliance led to treatment discontinuation in two cases. Altogether, 13 out of 18 patients (72%) had complete or almost complete response to treatment. There was a correlation between treatment duration and response to treatment. One patient only reported local side‐effects including irritation, redness and scaling of the treated area leading to discontinuation of the treatment and curettage of the pyogenic granuloma. No systemic adverse effects were reported. This is an uncontrolled retrospective study. Propranolol 4% gel may be considered as a safe and efficient topical therapy for pyogenic granuloma.     

Erythema‐directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris

Background

Erythema‐directed digital photography is a novel method for evaluating the efficacy and tolerability of topical acne treatments. Here, we describe three case reports in which erythema‐directed digital photography was used to evaluate acne before and after up to 12 weeks of treatment with clindamycin 1%/tretinoin 0.025% (Clin‐RA).

Materials and methods

Erythema‐directed digital photography was used to evaluate acne in three patients with mild‐to‐moderate facial acne, two of whom had refused to continue previous topical acne treatment (benzoyl peroxide 5% and clindamycin 1%/benzoyl peroxide 5%) due to persistent irritation. Acne lesions and erythema were evaluated using standard clinical photography and erythema‐directed digital photography (VISIA‐CR^™ system) before and after 8‐12 weeks of treatment with Clin‐RA.

Results

Erythema‐directed digital photography revealed background erythema from previous topical acne treatments that was not evident from standard clinical photographs and allowed a better visualization of both inflammatory and non‐inflammatory lesions. In all patients, there was a clear improvement in background erythema and a reduction in acne lesions following treatment with Clin‐RA.

Conclusion

This study has demonstrated for the first time that erythema‐directed digital photography can enhance the evaluation of the efficacy and tolerability of topical acne treatments. These cases show that Clin‐RA was associated with improved efficacy and tolerability vs previous treatments with topical monotherapy (benzoyl peroxide 5%) or a topical fixed‐dose combination (clindamycin 1%/benzoyl peroxide 5%).

     

当归苦参丸联合红蓝光和维A酸乳膏治疗中度痤疮疗效评价

目的:评价当归苦参丸联合红蓝光、维A酸乳膏治疗中度痤疮的临床疗效和安全性。方法:将入选的118例中度痤疮患者随机分成2组,治疗组(60例)给予当归苦参丸联合红蓝光、维A酸乳膏治疗,对照组(58例)给予红蓝光联合维A酸乳膏治疗,2组患者疗程均为4周。治疗结束时评价两组患者的临床疗效。结果:治疗组与对照组有效率分别为81.60%和55.17%,差异有统计学意义(P0.05)。结论:当归苦参丸联合红蓝光及维A酸乳膏治疗中度痤疮安全有效。     

Tolerability of high-dose topical tretinoin: the Veterans Affairs Topical Tretinoin Chemoprevention Trial

Background Topical tretinoin is a medication commonly used for acne that has potential application in the long‐term treatment of photodamaged skin. However, there are few published data regarding the tolerability of high‐dose tretinoin with long‐term use. Objectives To assess the long‐term tolerability of tretinoin 0·1% cream. Methods A randomized, multicentre, double‐blind, controlled trial for chemoprevention of keratinocyte carcinomas (i.e. basal cell or squamous cell carcinomas) using topical tretinoin cream to the face and ears was conducted. All participants were veterans and had a history of two or more keratinocyte carcinomas over the previous 5 years. Participants were examined (by a study dermatologist) and interviewed every 6 months (for up to 5·5 years to May 2004). Treatment comprised tretinoin 0·1% cream or vehicle control cream once daily, then twice daily as tolerated. Participants were instructed to step down application frequency to once daily or less if twice daily was not tolerated. The main outcome measures were reported side‐effects, frequency of cream application and attendance at study visits. Appropriate data were available for four of the six clinical sites of this trial. Results Data from 736 randomized participants (mean age 71 years; 97% men) from four clinical sites were analysed. The tretinoin group more commonly reported one or more side‐effects at the 6‐month follow‐up than the control group (61% vs. 42%, P < 0·0001). Side‐effects decreased over time in both groups, but to a greater extent in the tretinoin group, and the difference became nonsignificant at 30 months. Burning was the most common side‐effect (39% tretinoin vs. 17% control, P < 0·0001). There was no difference in severity of side‐effects among those affected. Of the participants who reported burning in either group, most reported mild burning; only 11% of those with burning in the tretinoin group reported it as severe (mild 62% tretinoin vs. 70% placebo; severe 11% vs. 5%; P = 0·4). Itching (24% vs. 16%, P = 0·01) and other local cutaneous reactions (12% vs. 6%, P = 0·01) were also more commonly reported by the tretinoin group at 6 months. There was no difference in numbness (2% vs. 2%, P = 0·9). Participants in the tretinoin group were less likely to apply cream twice daily at 6 months (29% vs. 43%, P = 0·0002). This difference persisted over the entire duration of follow‐up. There was little difference between groups in attendance at study visits or completion of telephone interviews (92% vs. 95%, P = 0·06). No unexpected adverse events were reported. Conclusions Overall, the tolerability level of topical tretinoin was high in this study population, with almost 40% of the tretinoin group reporting no side‐effects, and the majority (67%) tolerating at least once‐daily dosing at 6‐month follow‐up. High‐dose topical tretinoin is feasible for long‐term use in this population.