Newer topical therapies for the treatment of acne vulgaris

Newer topical therapies approved by the US Food and Drug Administration (FDA) for the treatment of acne vulgaris are dapsone gel 5% and clindamycin phosphate 1.2% and tretinoin 0.025% combination gel. Both are formulated in aqueous-based gel vehicles. These newer topical acne products have been shown to be effective and safe in pivotal 12-week phase 3 trials and long-term studies completed over 12 months. This article reviews applicable pharmacokinetic, efficacy, and safety data reported with both products.     

Benzoylperoxide versus topical erythromycin in the treatment of acne vulgaris

In a double-blind clinical study in ninety-four subjects a 1.5% (w/v) erythromycin lotion was as effective as 5% (w/v) benzoyl peroxide gel in significantly reducing the number of small inflamed lesions and the overall acne severity. However, benzoyl peroxide also significantly reduced the number of non-inflamed lesions whereas erythromycin had no effect on these lesions. This study supports the view that, although topical erythromycin is of value in the treatment of mild or moderate acne vulgaris, long established, safe and effective remedies should not be replaced by topical antibiotics until more comparative studies and investigations on bacterial resistance have been completed.     

Topical isotretinoin vs. topical retinoic acid in the treatment of acne vulgaris

This is a clinical, prospective, and longitudinal study comparing the efficacy and incidence of averse effects of topical isotretinoin against those of topical retinoic acid in the treatment of acne vulgaris. The 30 participants were recruited from the patients attending the outpatient clinic of the Department of Dermatology of “Dr Manuel Gea González” General Hospital in Mexico City. They belonged to either sex and any race, their ages ranged between 13 and 30 years, and they presented with 15 to 100 facial inflammatory lesions (papulo-pustules) and/or 15 to 100 noninflammatory lesions (comedones) and no more than three nodulo-cystic lesions. The criteria of exclusion were as follows: pregnancy or lactation, systemic treatment with steroids, antibiotics, antiandrogens, or oral retinoids in the preceding 24 months, treatment with ultraviolet radiation, hypersensitivity to retinoids, or a severe systemic illness. From 44 interviewed patients, 14 were excluded. A detailed clinical history was obtained from the remaining individuals, the degree of seborrhea was recorded, and acne lesions were counted. Each patient received either isotretinoin gel 0.05% or retinoic acid cream 0.05%. The patients were instructed to wash their faces in the mornings and evenings with a neutral soap, and to apply the product after the evening cleansing. The patients were examined again after 2, 4, 8, and 12 weeks of treatment and, at each appointment, the number of lesions was recorded and the severity of acne was graded according to the classification of Plewig and Kligman.¹ The seriousness of the adverse effects, such as stinging, pruritus, erythema, xerosis, and desquamation, was evaluated blindly by an investigator who did not know what group the patient belonged to, and graded as 1=mild, 2=moderate, and 3=severe. The efficacy of each drug was determined by the reduction in the number of lesions between weeks 0 and 12 of treatment. An excellent response corresponded to a 76%–100% reduction of the lesions, a good response to a 51%–75% reduction, a fair response to a 26%–50% reduction, and a poor response to a 0%–25% reduction. The results were analyzed statistically using the chi-square test, the exact test of Fisher and the test of Wilcoxon–Mann–Whitney. The changes in the numbers of lesions between weeks 0 and 12 were analyzed separately for each group of treatment, and the level of statistical significance was fixed at 0.05. The analysis was performed with the aid of a Stat program, version 4.0. Results The patients were assigned randomly to either Group I (isotretinoin) or Group II (retinoic acid). Each group was composed of 15 individuals and, as a coincidence, in each group there were nine women and six men. The clinical differences between the groups at the first visit were not statistically significant. In both groups, there was, in general, a good response to treatment (Fig. 1). Both drugs had a similar degree of efficacy on inflammatory lesions. At the first visit, grades III and IV predominated, whereas, after 12 weeks of treatment, most patients were classified in grades I or II (Fig. 2). Similar results were observed regarding noninflammatory lesions (Fig. 3). Ten of the patients of Group II complained of stinging associated with the treatment, especially at weeks 8 and 12, as well as erythema and desquamation at the 12th week. Erythema and stinging lasted for minutes or hours, whereas desquamation persisted for several days. Seven individuals receiving isotretinoin mentioned irritation, which was of a mild degree.     

The role of topical dermocosmetics in acne vulgaris

Acne is a common chronic inflammatory disease and treatment modalities based on acne severity are well established. The role of dermocosmetics in dermatology, and in particular acne, is becoming more important as more research elucidates the mechanisms of action of products in the pathogenesis of acne. Dermocosmetics have the potential to be used as monotherapy or in combination with medical treatment. Therefore, it has become important for dermatologists to understand dermocosmetics to effectively and appropriately advise patients on their use. The objective of this review was to provide new insights into the role of traditional and novel ingredients in dermocosmetics for the treatment of acne, based on the authors’ objective assessment of the published literature. The type of products discussed include: those which have a sebostatic effect, such as topical antioxidants and niacinamide; agents targeting abnormal keratinization, such as salicylic acid, lipo‐hydroxy acid, alpha‐hydroxy acids, retinol‐based products and linoleic acid; agents targeting Propionibacterium acnes, such as lauric acid; and anti‐inflammatory agents such as nicotinamide, alpha‐linolenic acid and zinc salts. Despite the scientific advances in understanding these cosmetic ingredients, there still remains a lack of rigorous controlled studies in this area.     

治疗寻常痤疮几种常用外用制剂安全性评价

局部外用药物是治疗轻度寻常痤疮的首选方案,本文比较了采用药物局部斑贴实验进行了常用的外用药物局部刺激性的评价。结果所有药物均有不同程度的皮肤刺激性,就局部刺激性来说,1%克林霉素凝胶是较优秀的,0.1%阿达帕林凝胶以及0.05%维A酸霜均是有较弱的刺激性,程度基本一致,1%克林霉素&0.025%维A酸霜也具有很好的耐受性,5%过氧化苯甲酰刺激性较明显,但当加入3%红霉素时可减少其局部刺激性。     

Efficacy and safety of CD 271 alcoholic gels in the topical treatment of acne vulgaris

CD 271, a naphthoic acid, is a powerful modulator of epidermal differentiation. This double-blind, randomized study compared the efficacy and safety of two concentrations (0.03% w/w and 0.1% w/w) of CD 271 alcoholic gel, with 0.025% w/w tretinoin gel in 72 male patients with acne vulgaris over a period of 12 weeks. Efficacy was measured by counting facial inflammatory and non-inflammatory lesions and by grading the severity of the acne at each visit. Skin tolerance was assessed with subjective symptoms, such as burning and pruritus, as well as clinical assessment of erythema, dryness and scaling on the treated areas. The alcoholic 0.1% CD 271 gel was as effective as 0.025% tretinoin gel in reducing total comedone counts (83% reduction for both products after 12 weeks' treatment). The reduction in the number of inflammatory lesions and the total number of acne lesions were significantly greater with 0.1% CD 271 gel than with tretinoin gel (69% and 79% for 0.1% CD 271, 50% and 73% for tretinoin gel, respectively, P less than 0.05). All three treatments were well tolerated and there were no changes in any major blood parameters. No CD 271 could be detected in blood plasma at the end of the study (detection limit = 1 ng/ml).     

A double-blind comparison of topical clindamycin and oral minocycline in the treatment of acne vulgaris

Sixty-six patients with moderate to severe facial acne vulgaris were entered in a 12-week double-blind study to compare the efficacy of topical clindamycin phosphate 1% twice daily and oral minocycline 50 mg twice daily. Both treatments gave significant overall improvements from baseline observations in acne grade and inflamed lesion counts, but not in noninflamed lesion counts. There were no significant differences between the two treatment groups in respect of acne grade, inflamed or non-inflamed lesion counts. Both treatment regimes were well tolerated. This study has shown that topical clindamycin twice daily is an effective alternative to oral minocycline 50 mg twice daily in the treatment of moderate to severe facial acne vulgaris.     

Cosmetics in the treatment of acne vulgaris

This article describes scenarios of patients who have acne vulgaris have tried over-the-counter products and cosmetics and are disheartened by the persistence of their disease and the resulting scars. They may have seen an aesthetician, plastic surgeon, or even a general practitioner before seeing a well-informed skin specialist. Patients perceive the dermatologist to be the skin care expert and seek guidance to obtain otherwise unobtainable results. Therefore, practicing dermatologists should take advantage of the available tools to treat patients aggressively and completely. Appropriately applied cosmetics can play a role in achieving this goal. This article describes scenarios that integrate cosmetics into an anti-acne treatment regimen that is effective and safe for all ethnic groups and is well tolerated by both male and female patients.     

Comparison of efficacy of topical clindamycin and nicotinamide combination with plain clindamycin for the treatment of acne vulgaris and acne resistant to topical antibiotics

A total of 75 patients with inflammatory acne vulgaris were divided into three groups. Group A was treated with combination of 4% nicotinamide and 1% clindamycin combination, Group B was treated with plain 1% clindamycin and Group C which was considered to have resistance to local antibiotics due to no response to treatment was treated with the combination. At the end of 8 weeks the results were compared. It was concluded that addition of nicotinamide was of not much value in treating inflammatory acne and results were some as for plain clindamycin and also the combination did not offer much relief in treatment of resistant acne.     

安体舒通治疗寻常痤疮疗效观察

本文通过103例寻常痤疮病人随机地分成三组,分别用四环素,每天1.0克;安体舒通,每天60毫克;和安体舒通与四环素并用进行观察,结果示:安体舒通疗效明显优于四环素,安体舒通与四环素并用效果极佳。治疗期间未出现任何明显的副作用。因此,安体舒通作为一种雄激素拮抗剂,短期治疗寻常痤疮是完全可靠的。     

寻常痤疮及痤疮瘢痕的物理疗法

痤疮是一种有着极其复杂发病机制且十分常见的皮肤疾病。人群发病率非常高,特别是青少年。痤疮主要发生于面部,可形成粉刺、丘疹、脓疱、囊肿、结节、瘢痕等损害。活动性痤疮及其后遗症,特别是持久性瘢痕,对患者的生理和心理都会造成很大的影响。因此,痤疮和痤疮瘢痕的治疗显得非常重要。目前越来越多的物理疗法应用于临床,并取得很好的疗效。本文主要对寻常痤疮及痤疮瘢痕的物理治疗方面的有关进展做一综述。     

A comparison of clindamycin phosphate 1 percent topical lotion and placebo in the treatment of acne vulgaris

The efficacy and skin tolerance of 1 percent clindamycin phosphate lotion were compared with those of the placebo for the lotion in a randomized, double-blind, 12-week study in forty-six patients with moderate to severe acne vulgaris. Patients using the 1 percent clindamycin lotion experienced reductions in numbers of pustules, papules, open comedones, and nodulocystic lesions. Papule counts were also reduced in placebo-treated patients. The group using clindamycin lotion had significantly greater reductions in pustule counts at week 12 and papule counts at week 3 than the placebo-treated group. Nearly 90 percent of the evaluable patients at week 12 experienced improvement or marked improvement in their acne according to the physician's evaluation, regardless of treatment group. Both regimens were well tolerated. Although diarrhea was reported by eight patients (three taking clindamycin, five receiving placebo), no patients discontinued the protocol because of diarrhea. This study demonstrated the efficacy of 1 percent clindamycin topical lotion in the treatment of moderate to severe acne vulgaris.     

Topical retinoids in the treatment of acne vulgaris

Topical retinoids are highly effective in the treatment of both comedonal and inflammatory lesions of acne and are a vital part of almost any acne regimen. A better understanding of the structure and function of this class of medications has led to better outcomes in treatments of patients with acne. In this article, the structure and function of retinoids is first reviewed. Then, the clinical effectiveness and tolerability of each of the available topical retinoid formulations is summarized.     

Tretinoin-sunscreen mixture in the treatment of acne vulgaris

In an open design study of fifty-four patients with grade I or grade II acne vulgaris, the combination of 0.1 percent tretinoin cream (Retin-A) and a sunscreen with sun protection factor 15 (Sundown) was evaluated. Overall study results of the forty-six patients who could be evaluated demonstrated a decrease in papule count of 25.9 percent, a decrease in closed comedones of 49.1 percent, and a decrease in open comedones of 36.3 percent by the end of the eight-week study period. These results indicate that the addition of a noncomedogenic sunscreen to tretinoin did not compromise its effectiveness and successfully prevented photoaccentuation reactions.