Acne Vulgaris and the Epidermal Barrier: Is Acne Vulgaris Associated with Inherent Epidermal Abnormalities that Cause Impairment of Barrier Functions? Do Any Topical Acne Therapies Alter the Structural and/or Functional Integrity of the Epidermal Barrier?

Acne vulgaris is a common dermatological disorder that predominantly affects teenagers, but can also affect preadolescents and post-teen individuals. Despite the fact that acne vulgaris is the most common skin disorder encountered in ambulatory dermatology practice in the United States, there has been limited research on the epidermal permeability barrier in untreated skin of people with acne vulgaris and also after use of acne therapies. This article reviews the research results and discusses the available literature on this subject area. The importance of proper skin care as a component of the management of acne vulgaris is supported by the information that is currently available.     

The Role of Skin Care as an Integral Component in the Management of Acne Vulgaris: Part 1: The Importance of Cleanser and Moisturizer Ingredients,Design, and Product Selection

Acne vulgaris is a very common facial skin disorder accounting for approximately 10 percent of all visits to ambulatory dermatology practices across the United States annually. Over time, greater attention has been directed to the roles of multiple epidermal barrier functions in various dermatological disorders, especially the stratum corneum permeability barrier and antimicrobial barrier. As a result, it has become readily apparent that professional direction of skin care is very important in the overall management of acne vulgaris. This article discusses several reasons that support the importance of incorporating specified skin care recommendations and instructions into the overall management plan for acne vulgaris. In addition, the article reviews formulation characteristics and some of the scientific data on two commercially available products that are recommended for use as a skin care regimen in patients with acne-prone and acne-affected skin, a foam wash and a moisturizer with a sun protection factor 30 broad spectrum photoprotection rating. The rationale for inclusion of specific ingredients are discussed along with an overview of research results including use in patients with acne vulgaris.Acne vulgaris (AV) has long been considered the most common skin disorder overall, and has been reported to affect nearly 70 percent of adolescents.1 Although well known as a common disorder affecting the facial and truncal skin of many teenagers, AV also commonly affects pre-teens and post-teens, with the latter group inclusive of women with persistent AV and late-onset AV.2-4 Many clinicians including pediatric dermatologists have observed that pediatric acne is starting earlier in many patients, primarily due to earlier onset of adrenarche. Preadolescent AV, currently defined as between 7 and 11 years of age, is not often associated with an underlying endocrinopathy.5 Many preadolescent girls present with multiple facial comedonal lesions, often with forehead predominance, and in many cases also exhibit some superficial papules/pustules (Figure 1). In a five-year longitudinal study of preadolescent-premenstrual girls with AV as just described (N=871), higher serum levels of dihydroepiandrosterone sulfate (DHEA-S) and testosterone (free and total) were noted, which correlated with persistence of severe comedonal AV and also increased severity of inflammatory AV over time.6 The “extra androgen drive” present in this subset of young girls serves as a good predictor that a greater severity of AV will emerge over time and is associated with pilosebaceous enlargement and increased sebum production (“oily skin”).6,7 Ultimately, the age range of patients who commonly present with AV has broadened to include more pre-teen and post-teen patients. This change requires that dermatologists address the specific questions, concerns, and clinical challenges that commonly affect these subsets of AV patients, with obvious emphasis on efficacy and safety considerations, but also the potential psychosocial impact on different patient subsets.8 Additionally, education about fundamental skin care recommendations for patients with AV is appreciated by patients and has been shown to reduce signs and symptoms of cutaneous irritation.9-13 AV is an equal opportunity disease, affecting individuals of all ethnicities and skin colors. Open in a separate windowFigure 1Pre-adolescent acne vulgaris. An 11-year-old girl presented with multiple closed comedones and scattered superficial inflammatory papules/pustules with a marked predominance of forehead involvement.Photograph courtesy of James Q. Del Rosso, DO, FAOCDBased on representative data from the National Ambulatory Medical Care Survey (NAMCS) that assesses leading diagnoses in patient visits to dermatologists from 1993 to 2009, AV ranks among the top five dermatological diagnoses most commonly encountered in dermatology practices in the United States.14,15 In 2009, AV accounted for 10.2 percent of all visits to US dermatologists in outpatient practices.16In the review of NAMCS data from 1993 to 2009, AV was found to be the leading diagnosis in African American, Asian Pacific Islander, and Hispanic patients and was second only to actinic keratosis in the Caucasian patient population.14 Another study aimed to define the prevalence and clinical presentations of AV in 2,895 female patients of different races. It was found among the entire group of female patients included in the study that African Americans had the highest prevalence of AV (37%), followed by Hispanics (32%), Asians (30%), Caucasians (24%), and Continental Indians (23%).15AV is a common, chronic, inflammatory, facial skin disorder that can affect individuals from any race, ethnicity, or cultural background. The onset of AV is usually shortly before or during early adolescence; however, some cases start in latter childhood with the subset of preadolescent acne defined within the ages of 7 and 11 years.17 In addition, many adult women with post-teen acne are encountered in clinical practice, with some presenting in their mid-to-late 20s or in their 30s with AV similar to what they experienced as teens (persistent AV), or AV that they are first experiencing with little to no prior history of AV (late-onset AV).3,4 As AV involves the face in 97 percent of cases with or without truncal involvement, the visibility of AV is psychologically problematic for many affected individuals.18 Scarring and dyschromia are unfortunate physical sequelae after resolution of AV lesions that prolong the adverse psychosocial effects of AV for many people. However, what is not always fully appreciated during the limitations of an office visit is that many patients are affected from a psychosocial perspective, with adverse consequences reported that alter both overall quality of life and mental health status.8,19 Ultimately, AV is overall the most common dermatological disorder seen in office-based dermatology practices, affecting many teenagers, preadolescents, and post-teenage adults, and almost always affects facial skin with or without truncal involvement. As acne is not curable, it has a protracted course over several years in most affected individuals even with treatment, and can be late in onset, especially in adult women. Prolonged dyschromias are a common sequelae of acne, which also causes various forms of scarring in some cases. Acne can be managed effectively; however, this requires consistent adherence with long-term therapy and timely adjustments in the treatment regimen when the character and severity change over time. It is also common for acne to impart adverse psychosocial effects that can significantly impair quality of life and in some cases cause profound anxiety and/or depression. Therefore, it is important for dermatology practices to incorporate a well-organized and comprehensive approach to the evaluation and management of patients with AV.     

Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

Journal of Neurology - Compression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS...     

Open-label Extension Study Evaluating Long-term Safety and Efficacy of FMX103 1.5% Minocycline Topical Foam for the Treatment of Moderate-to-Severe Papulopustular Rosacea

BACKGROUND: Efficacy and safety of FMX103 1.5% for papulopustular rosacea were previously demonstrated in two 12-week, Phase 3 studies. OBJECTIVE: We sought to evaluate the safety and efficacy of FMX103 1.5% foam for up to 52 weeks of treatment. METHODS: Following the completion of two 12-week, double-blind, vehicle-controlled, Phase 3 studies, subjects were invited to enter a 40-week open-label extension study in which all subjects applied FMX103 1.5% once daily. Efficacy endpoints were the reduction in inflammatory lesions and the rate of IGA treatment success from the double-blind baseline. Safety assessments included adverse events, vital signs, laboratory tests, and facial tolerability signs and symptoms. RESULTS: The favorable safety profile of FMX103 1.5% observed in the double-blind studies was maintained over extended treatment lasting up to one year. There were no serious treatment-related adverse events. Long-term treatment with FMX103 1.5% was associated with a greater than 82-percent reduction in inflammatory lesions from baseline and with over 79 percent of subjects achieving treatment success. At the end of the open-label treatment period, over 82 percent of subjects indicated they were overall “satisfied” or “very satisfied” with FMX103 1.5%. All facial local tolerability symptoms improved through Week 52. LIMITATIONS: Due to the nature of the open-label study, lacking a vehicle-treated control, no statistical comparisons can be made. CONCLUSION: FMX103 1.5% demonstrated a favorable safety and tolerability profile for up to 52 weeks. Long-term efficacy was demonstrated by progressive reductions in inflammatory lesions and increasing IGA treatment success, suggesting that FMX103 1.5% may be a suitable option for the treatment for papulopustular rosacea.     

Chest Trauma Outcomes: Public Versus Private Level I Trauma Centers

World Journal of Surgery - The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma...     

Perioperative identifications of non-palpable pulmonary nodules: a narrative review

Early detection of lung cancer is the key to improving treatment and prognosis of this disease, and the advent of advances in computed tomography (CT) imaging and national screening programs have improved the detection rate of very small pulmonary lesions. As such, the management of this sub-centimetric and often sub-solid lesions has become quite challenging for clinicians, especially for choosing the most suitable diagnostic method. In clinical practice, to fulfill this diagnostic yield, transthoracic needle biopsy (TTNB) is often the first choice especially for peripheral nodules. For lesions for which TTNB could present technical difficulties or failed, other diagnostic strategies are needed. In this case, video-assisted thoracic surgery (VATS) is the gold standard to reach the diagnosis of lung nodules suspect of being malignant. Nonetheless it’s often not easy the identification of such lesions during VATS because of their little dimensions, non-firm consistency, deep localization. In literature various marking techniques have been described, in order to improve intraoperative nodules detection and to reduce conversion rate to thoracotomy: CT-guided hookwire positioning, methylene blue staining, intra-operative ultrasound and electromagnetic navigation bronchoscopy are the most used. The scientific evidence on this matter is weak because there are no randomized clinical trials but only case series on single techniques with no comparison on efficacy, so there are no guidelines to refer. From this standing, in this article we conducted a narrative review of the existing literature on the subject, with the aim of outlining a framework as complete as possible. We analyzed strengths and weaknesses of the main techniques reported, so as to allow the clinician to orient himself with greater ease.