Medication adherence among acne patients: a review

Background Acne is a chronic disease often requiring the use of medications for extended periods of time. In general, adherence decreases over time in patients with chronic diseases, and adherence to topical medications is poor compared to adherence to oral medications, placing individuals using topical medications at increased risk for nonadherence and treatment failure. Poor adherence may also be a common cause of treatment failure in teens with acne. Purpose We reviewed the current literature on medication adherence in teenagers with acne to assess adherence levels and predictors of adherence. We hope to provide a foundation for further research into medication adherence in acne patients. Methods A Medline search was conducted using the key words “acne” and “adherence” or “compliance.” Studies reporting adherence were included in the analysis. Results A positive correlation was found between quality of life of patients with acne and medication adherence. Weaker predictors of adherence include increased age, female gender, and employment. The most commonly reported reason for nonadherence was inadequate time to use the treatment medication. Patients taking medications requiring less frequent dosing had better adherence, and medication adherence correlated with better health status among acne patients. A longer duration between office visits may be associated with decreased compliance. Limitations Few studies investigating the prevalence and causes of nonadherence in acne patients were identified. Conclusions Adherence to medications is difficult to measure and rates reported by patients often overestimate actual adherence. Patients cite lack of time as a common reason for nonadherence to topical medications.     

Alternative treatments for atopic dermatitis: a selected review

Atopic dermatitis (AD) is a chronic itchy, inflammatory skin disease that is extremely difficult to treat. Effective therapeutic agents are limited in number, and may have long-term toxic side-effects. Frustrated by these realities, many patients stop seeking help from conventional physicians and turn to alternative medical approaches. These can include so-called natural products, herbal products and over-the-counter (OTC) treatments. Herbs and medications share a common history, as most of our well-known medications were derived from plants. However, herbal remedies are largely unregulated. Many may have scientific merit and clinical benefit, but they are still scientifically invalid and inadequately monitored. Dermatologists need information about the effects of herbal remedies in order to better serve their patients.     

Requirements in cosmetics for black skin

As large, well-funded cosmetics houses are taking more interest in the needs of black consumers, so should the dermatologist. The dermatologist should be able to discuss intelligently with patients those products that are intended for black skin and hair. Patients also appreciate a referral to a hair stylist or cosmetologist that the doctor is familiar with. As outlined in this article, the most common cosmetics problems encountered by black consumers include the lack of selection of appropriate shades of cosmetics; greasy and irritating "black" make-up; irritant or allergic reactions to fragrance and other cosmetic ingredients; acne from "oil-free" products; and a shortage of effective products to treat "ashiness." It is hoped that this review will help the reader understand what black patients may expect from their skin and hair cosmetics.     

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.     

Variability of over-the-counter spending on acne treatment across race and demographic characteristics

Acne is a common skin condition that is associated with long-term dermatologic and psychologic morbidities if left untreated. In this study, a survey was distributed via Amazon Mechanical Turk to evaluate for out-of-pocket costs associated with over-the-counter (OTC) acne treatment. A total of 515 respondents with acne were included, of whom 84% used OTC products, spending on average $121.99 ± $115.69 in the past year. Additionally, on average, Black respondents spent more on OTC products than those of other races, and there was a positive correlation between income and expenditure on OTC products. Consistent with the literature, we found that many patients self-treat with multiple OTC products and out-of-pocket costs are significant.     

Klinische Formen der Akne

Acne is a very common dermatosis with characteristic clinical features. It is a polymorphic disease. The clinical expression ranges from non-inflammatory closed and open comedones to inflammatory papules, pustules, and nodules. Most patients have a mixture of non-inflammatory and inflammatory lesions, although some have predominantly one or the other. Acne varies in severity from a very distressing, socially disabling disorder to a state that has been regarded as physiological by some authors. The most severe forms of acne are acne fulminans and acne inversa. Although acne may occur in all age groups, it is most prevalent during adolescence. It is not known why acne subsides in most patients but persists into adulthood in some. Certain medications may be associated with provocation, perpetuation, or exacerbation of pre-existing acne or with acneiform eruptions. Acne-like disorders include rosacea, pseudofolliculitis barbae, and other conditions that share clinical features with acne.     

Dermo-cosmetic approach to acne by the dermatologist

Cosmetics contribute to the success of anti-acne treatments, by providing optimal hygiene, compensating the irritation and dryness induced by medications, and allowing use of adapted cosmetics and sun protection. The most contemporary products can contribute directly to obtaining a therapeutic benefit, either alone or with medications. The dermatologist's advice is essential. The choices are guided by information from laboratories and the efficacy and tolerance tested by use. Overall, cosmetology is considered by the dermatologist as part of the management of acne devoid of notable side effects. In day-to-day medical practice, the dermatologist prescribes medications and dermo-cosmetics together, an approach that is also found in managing other disorders such as atopic dermatitis. This mode of operation is part of a true healthcare protocol in which each part has its importance, from daily hygiene to isotretinoin, to ensure complete and individualized management.     

The new age of acne therapy: Light,lasers, and radiofrequency

BACKGROUND: Current treatments for acne vulgaris include topical and oral medications that counteract microcomedone formation, sebum production, Propionibacterium acnes, and inflammation. Concerns about the short‐ and long‐term consequences of these medications, along with technological advancements, have to significant progress in the management of acne. These developments include light, laser, and radio frequency, which may offer faster onset of action, equal or greater efficacy, and greater convenience than traditional approaches. CONCLUSION: Research emphasizing long‐term follow‐up and comparative, randomized trials is necessary to determine whether these emerging technologies will become a viable alternative to standard therapies such as antibiotics.     

Ingredients and safety of cellulite creams

There is virtually no knowledge of the ingredients of cellulite creams in the dermatological literature. In the present study, the ingredients of cellulite creams, the frequency of their use and whether the ingredients have been reported to cause allergy were investigated. In the 32 products tested, 263 ingredients were used. On average each product contained 22 ingredients (range 4 to 31). Botanicals and emollients predominated; altogether 44 different botanicals and 39 different emollients were used in the 32 products. Caffeine, present in 14 products was the most common additive, apparently representing an "active" ingredient. In other respects the compositions of the products were similar to those of skin creams. All products contained fragrance. The creams were microbiologically pure. Concentrations of preservatives did not exceed limit values in the regulations. No formaldehyde was present (detection limit 10 ppm). The well-known allergens isothiazolinones or dibromoglutaronitril were declared only in a few products. In spite of the large number of substances used in cellulite creams, their safety seems acceptable for most users. Because, however, one fourth of the substances used have been shown to cause allergy, the risk of adverse effects should be taken into account when using cellulite creams.     

Update in retinoid therapy of acne

The pathogenesis of acne, the most common skin disease, is complex and multifactorial. Clinical experience has demonstrated that parallel targeting of various pathogenetic factors, achieved either by mono- or combination therapy with appropriate drugs, represents the most effective approach to treating acne. Topical retinoids have been shown to expulse mature comedones, reduce microcomedone formation, and exert immunomodulatory effects. They have broad anti-acne activity without the risk of inducing bacterial resistance, which justifies their use as first-line treatment in most types of noninflammatory and inflammatory acne and makes them uniquely suitable as long-term medication to maintain remission after cessation of initial combination therapy. Systemic isotretinoin as a monotherapeutic agent strongly affects all four major pathogenetic factors and has been, in the hand of experienced dermatologists, a potent and safe agent for the treatment of severe and recalcitrant acne forms for more that 20 years. However, patient counseling, careful monitoring, and evaluation and management of adverse events are necessary. The use of isotretinoin has experienced a drawback now that its indication has been lowered from a first-line to a second-line medication.     

Dermatologic treatment during pregnancy: practical overview

BACKGROUND: This article provides a practical overview of dermatologic medication use in pregnancy. OBJECTIVE: The therapeutics of the following common dermatoses are reviewed: acne, psoriasis, and bacterial, fungal, viral, and parasitic infections. Antipruritic, analgesic, and topical anesthetic use in pregnancy is reviewed as well. CONCLUSIONS: At the end, the reader is challenged with a series of applied clinical scenarios that highlight the presented material and provide information on additional important medications.