Volume 11 | Issue 12
Ronald L. Moy MD|No abstract details for the moment.
Alan R. Shalita MD and Whitney P. Bowe MD|No abstract details for the moment.
New Inhibitors of Polo-like Kinase 1 Function and Their Emerging Role in Attenuating Tumor Growth in Systemic Malignancies
Shailendra Kapoor MD|No abstract details for the moment.
Actinic keratoses (AKs) are cutaneous areas of atypical squamous transformation that are considered to be an early step in the continuum of transformation from normal skin to invasive and metastatic cutaneous squamous cell carcinoma (SCC). Enhanced understanding of the pathophysiologic changes leading from AK to malignancy, combined with an increasing global prevalence of AK, has led to a new focus on the importance of combining local tretments that remove individual lesions with topical or procedural field therapies that treat the entire actinically damaged field — also known as field cancerization — which is important because it is impossible to predict which AK lesions will progress to SCC. Currently available topical field therapies include 5-fluorouracil cream (5%, 1%, 0.5%), imiquimod cream (5% and 3.75%), diclofenac sodium gel 3% with 2.5% hyaluronic gel, and ingenol mebutate gel (0.05% and 0.015%). Photodynamic therapy is a procedural field therapy. Important considerations when developing a comprehensive treatment plan include patient risk factors; the number and location of AK lesions; strategies for minimizing sun exposure; and the mechanism of action, clearance rate, adverse effect profile, and application of local and topical therapies.
J Drugs Dermatol 2012;11(12):1462-1467.
Single-Center, Open-Label Study of a Proprietary Topical 0.5% Salicylic Acid-Based Treatment Regimen Containing Sandalwood Oil in Adolescents and Adults With Mild to Moderate AcneBackground: A proprietary topical blend of salicylic acid and highly puri!ed sandalwood oil from Australia was used in this open-label study in adolescents and adults with mild to moderate facial acne.
Methods: The investigational regimen consisted of a foaming cleanser, an acne serum, a spot treatment, and a mask. Patients applied the treatment regimen as directed for 8 weeks. The primary ef!cacy measure was the percentage of patients assessed as improved, much improved, or very much improved according to the Global Aesthetic Improvement Scale (GAIS) ratings at week 8. Severity was rated using the Evaluato's Global Severity Scores (EGSS) at baseline and weeks 2, 4, and 8. Tolerability was assessed at baseline and weeks 2, 4, and 8 by asking patients to rate the severity of itching, scaling, erythema, burning, dryness, and stinging. Patients were also asked to complete an acne questionnaire.
Results: 89.4% (42/47) met the primary end point determined by the GAIS of improved (66%), much improved (19%), or very much improved (4%). Notable reductions in lesion counts were observed in patients with more severe or in"amed lesions. Tolerability was queried at all visits. No itching, scaling, or erythema was reported after initial application. Symptoms of intolerability peaked at week 2; however, most events were mild to moderate and were typically reported with use of the mask component. Intolerance decreased by week 4 and by week 8. The treatment regimen was well tolerated by patients.
Conclusions: Results from this study support the use of a proprietary investigational regimen in patients with mild to moderate acne and warrant further investigation to determine whether longer-term therapy (ie, beyond 8 weeks) results in enhanced efficacy with minimal side effects, leading to continued patient compliance and skin improvement.
J Drugs Dermatol. 2012;11(12):1403-1408.
Clindamycin Phosphate 1.2% and Tretinoin 0.025% Gel for Rosacea: Summary of a Placebo-Controlled, Double-Blind TrialRosacea is a common, chronic, and poorly understood dermatological condition characterized by an inflammatory component composed of papules and pustules and a vascular component composed of flushing and erythema. Current treatment options include topical, systemic, and light-based methods, each of which focuses on either the inflammatory or the vascular component. Retinoids are not routinely indicated as treatment because of the common conception that they would be too inflammatory for the sensitive rosacea patient. However, photodamage may play a role in rosacea and tretinoin is well-known to repair photodamage. Thirty rosacea subjects were enrolled to assess their response to the use of clindamycin phosphate 1.2% and tretinoin 0.025% gel (ZIANA; Medicis Pharmaceutical Corporation, Scottsdale, AZ) for a period of 12 weeks. The results showed a dramatic decrease in pustules and papules without any significant inflammation or overall intolerance. No improvement in facial redness was achieved. Based on our results, more investigation of topical retinoids for rosacea treatment is prudent.
J Drugs Dermatol. 2012;11(12):1410-1414.
The Efficacy and Tolerability of Dapsone 5% Gel in Female vs Male PatientsWith Facial Acne Vulgaris: Gender as a Clinically Relevant Outcome VariableBackground: Gender differences in skin and acne have been reported.
Objective: To evaluate the effect of gender on the efficacy and tolerability of dapsone 5% gel.
Methods: This was a pooled analysis of data from 2 identical phase 3 randomized, double-blind, and vehicle-controlled trials (DAP0203 and DAP0204) of dapsone 5% gel conducted in the United States and Canada between November 2002 and September 2003. A total of 2,898 patients with acne vulgaris were included in the pooled analysis. Of these, 1,453 patients (753 female, 700 male) received dapsone 5% gel twice daily, and 1,445 patients (767 female, 678 male) received vehicle twice daily. End points included the mean percentage reduction from baseline in acne lesion counts and the proportion of patients achieving clinical success (Global Acne Assessment Scale score of 0, clear skin, or 1, almost clear skin). Assessments were performed at baseline and at weeks 2, 4, 6, 8, and 12.
Results: The mean percentage reduction in acne lesion counts at 12 weeks was significantly greater in females than males in both treatment groups. The mean reduction in total lesion counts in dapsone-treated females and males was, respectively, 46.6% vs 35.8% (P<.0001). Reductions in papulopustular and comedonal lesion counts were likewise significantly higher in female than male patients (each P<.0001). Significantly more dapsone-treated females than males achieved clinical success (48.6% vs 34.4%; P=.0003).
Conclusion: The response to dapsone 5% gel appears to be influenced by gender, with female patients experiencing a significantly greater reduction in acne lesion counts and a significantly higher clinical success rate following 12 weeks of treatment. These data suggest that gender is a novel predictor of outcome that should be considered in acne clinical trial design and analysis.
J Drugs Dermatol. 2012;11(12):1417-1421.
A Double-Blind, Randomized, Bilateral Comparison of Skin Irritancy Following Application of the Combination Acne Products Clindamycin/Tretinoin and Benzoyl Peroxide/Adapalene
Renato Goreshi MD, Aman Samrao MD, and Benjamin D. Ehst MD PhD|
Background: The use of topical medications for acne vulgaris is often limited by their irritant properties. Newer combination preparations are available and offer convenience, but irritant potential may still be a hindrance, perhaps more so with the combination of 2 agents. Few studies have compared these formulations directly for tolerability.
Objective: We sought to compare the tolerability of 2 combination topical acne products, clindamycin 1.2%-tretinoin 0.025% (CLIN/RA) gel and benzoyl peroxide 2.5%-adapalene 0.1% (BPO/ADA) gel.
Methods: CLIN/RA and BPO/ADA were applied daily to opposite sides of a subject's face for 21 days in a double-blinded fashion. Investigators' Global Assessments and study subject self-assessments of burning/stinging, itching, erythema, and dryness/scaling were collected. Transepidermal water loss (TEWL) was also measured as an objective measure of skin irritation. A mixed model analysis and repeated-measures analysis of variance were used to compare outcomes for both acne formulations.
Results: CLIN/RA produced significantly less burning/stinging than BPO/ADA (P<.001) as well as significantly less pruritus than BPO/ADA (P<.001). BPO/ADA caused significantly more TEWL than CLIN/RA (P=.005). There was no significant difference in the amount of erythema or the amount of dryness/scaling caused by either formulation.
Conclusion: CLIN/RA produced significantly less skin irritancy and TEWL than BPO/ADA.
J Drugs Dermatol. 2012;11(12):1422-1426.
Alan R. Shalita MD,a Ronald Falcon MD,b Alan Olansky MD,c Patricia Iannotta MD,d Arash Akhavan MD,e Doris Day MD,f, Anthony Janiga MD,g Prashant Singri MD,h and John E. Kallal PhDi|Background: Inflammatory acne, particularly in postadolescent women, is increasing in incidence. The most effective therapeutic modality for treatment of this type of acne has been the administration of oral tetracyclines. Long-term acne treatment with such drugs, however, is frequently accompanied by undesirable adverse reactions, including gastrointestinal disturbances, antianabolic effects, headaches, tinnitus, and photosensitivity.
Objective: To assess the usefulness of a novel dietary supplement in the overall management of patients with inflammatory acne vulgaris.
Methods: 235 patients with inflammatory acne vulgaris were enrolled by dermatologists in a multicenter, open-label, 8-week, prospective study evaluating the effects of adding NicAzel, 1 to 4 tablets daily, to their current acne treatment regimen.
Results: A statistically significant (P<.0001) number of patients demonstrated improvement over their previous acne treatment regimens after both 4 and 8 weeks of NicAzel (nicotinamide, azelaic acid, zinc, pyridoxine, copper, folic acid; Elorac Inc, Vernon Hills, IL) use. At week 8, 88% of the patients experienced a visible reduction in inflammatory lesions, and 81% of the patients rated their appearance as much or moderately better compared with baseline. Three-quarters (76%) of the patients thought NicAzel was at least as effective as previous treatment with oral antibiotics.
Conclusion: Patients with inflammatory acne showed significant improvement in acne severity and overall appearance when NicAzel was added to their existing treatment regimen.
J Drugs Dermatol. 2012;11(12):1428-1433.
In Vivo Antibacterial Effects of Tretinoin-Clindamycin and Clindamycin Aloneon Propionibacterium acnes With Varying Clindamycin Minimum InhibitoryConcentration Levels
James J. Leyden MD|
Department of Dermatology, University of Pennsylvania, Philadelphia, PA
Objective: To quantify the antimicrobial effect of clindamycin phosphate 1.2% and tretinoin 0.025% gel and 1% clindamycin phosphate gel in patients with Propionibacterium acnes of varying sensitivity to clindamycin.
Design: Study 1 was an initial range-finding study that was neither blinded nor randomized. Study 2 was an open-label, randomized, splitface, single-center study. Both studies were conducted in Pennsylvania.
Patients: Study 1 (n=20) and study 2 (n=22) involved healthy patients aged 18 years or older with initial P acnes levels ≥104/cm2 and minimum inhibitory concentrations (MICs) ≥8 µg/mL for clindamycin.
Interventions: Study 1, clindamycin gel applied twice daily for 6 weeks. Study 2; once-daily application with the combination gel to one cheek and clindamycin gel to the other side for 6 weeks.
Main Outcome Measure: The comparative effectiveness of each product vs P acnes of varying sensitivity to clindamycin at 3 and 6 weeks posttreatment.
Results: For study 1, at 3 and 6 weeks, clindamycin-treated patients with MICs of ≤256 µg/mL showed greater reductions than those with MICs ≥512 µg/mL (P=.0001). Study 2 showed a significant reduction in P acnes for both products, with no differences found. Clindamycin alone was more effective in vivo in patients with MIC levels of ≤256 µg/mL than patients with higher MIC levels. The combination product produced a greater reduction than clindamycin alone after 6 weeks in patients with high MICs >512 µg/mL (P=.0047).
Conclusion: These studies suggest that 1% clindamycin alone produces a varying in vivo antimicrobial effect, with a breakpoint at ≤256 µg/mL. Use of clindamycin phosphate 1.2% and tretinoin 0.025% gel resulted in a significantly greater in vivo antimicrobial effect than clindamycin alone in patients carrying P acnes with MICs of ≥512 µg/mL (P=.0047).
J Drugs Dermatol. 2012;11(12):1434-1438.
Gender as a Clinically Relevant Outcome Variable in Acne: Benefits of a FixedCombination Clindamycin Phosphate (1.2%) and Benzoyl Peroxide (2.5%)Aqueous Gel
Julie C. Harper MD|
The Dermatology and Skin Care Center of Birmingham, Birmingham, ALObjective: There is an increasing interest in gender differences both in the pathogenesis and treatment of skin diseases. We investigate whether there were any treatment differences in male and female subjects treated with clindamycin phosphate 1.2%/benzoyl peroxide (BPO) 2.5% gel as monotherapy for moderate to severe acne.
Methods: We performed a post hoc analysis of the efficacy and cutaneous tolerability in 797 subjects receiving clindamycin phosphate 1.2%/BPO 2.5% gel from two 12-week, multicenter studies that enrolled 2,813 subjects with moderate to severe acne. Efficacy and tolerability were compared with both male and female subjects, overall and stratified by age (12-18 years and ≥18 years).
Results: Absolute mean reductions in lesion counts with clindamycin phosphate 1.2%/BPO 2.5% gel were comparable and not significantly different across gender and age groups. Net reductions were greater in the adolescent groups. Treatment success in the older males was significantly greater (P=.046) compared with the adolescent males, and the difference between the male and female adolescent groups was significant in favor of the female subjects (P=.046). Cutaneous tolerability was comparable across all groups and between clindamycin phosphate 1.2%/BPO 2.5% gel and vehicle.
Conclusions: Clindamycin phosphate 1.2%/BPO 2.5% gel provided comparable reductions in lesion counts across all 4 groups; however, the impact was greater in those subjects with more severe acne (the older males and adolescent females), and net benefit was greater in the adolescent subjects.
J Drugs Dermatol. 2012;11(12):1440-1445.
A High-Potency, Multimechanism Skin Care Regimen Provides SignificantAntiaging Effects: Results From a Double-Blind, Vehicle-Controlled Clinical Trial
Patricia K. Farris MD, Brenda L. Edison BA, Irina Brouda MA, Ronni L. Weinkauf PhD, andBarbara A. Green RPh MSPatricia K. Farris MD,a Brenda L. Edison BA,b Irina Brouda MA,b Ronni L. Weinkauf PhD,b and Barbara A. Green RPh MSb|Skin aging is a multifaceted biological process characterized by the appearance of wrinkles, pigmentation irregularities, and loss of firmness. These symptoms cannot be fully addressed by any single skin care ingredient or noninvasive cosmetic procedure. A comprehensive treatment approach, including the use of clinically proven topical skin care formulations, provides optimal antiaging effects. A high-strength skin care regimen (NeoStrata Skin Active; NeoStrata Company, Inc, Princeton, NJ) was developed to deliver a combination of more than 35% active bene!t ingredients, including the a-hydroxy acid glycolic acid, the polyhydroxy acid gluconolactone, maltobionic acid, N-acetylglucosamine, retinol, peptides, antioxidants, and apple stem cell extract. The products (cleanser, day cream, night cream, eye cream) were formulated to provide antiaging bene!ts across all skin layers via multiple mechanisms of action. The regimen was evaluated in a randomized, double-blind, vehicle-controlled clinical trial over 16 weeks, with a subset continuing to 30 weeks. Sixty-nine Caucasian women (active group, n=44; vehicle group, n=25) completed 16 weeks of twice-daily treatment. Results showed the active group improved significantly better than the vehicle group for: all clinician-graded aging symptoms beginning as early as 2 weeks; pinch recoil as a measure of firmness/elasticity; dermal density, which was measured using ultrasound; and total skin thickness, which was measured using digital calipers. Clinical photography revealed younger-looking skin. Seventeen subjects from the active group continued to receive the active regimen until week 30. Improvement in all parameters of aging was shown to be significantly greater at week 30 than at week 16, and dermal density continued to increase. The comprehensive benefits observed in this study over the cosmetic vehicles are believed to have been achieved through the synergistic actions of the benefit ingredients in the active regimen.
J Drugs Dermatol 2012;11(12):1447-1454.
Improvement in Signs and Symptoms of Plaque Psoriasis After 1 Week of Treatment With Clobetasol Propionate 0.05% Spray
Robert Brodell MDa,b and Norman Preston PhDc
aDivision of Dermatology, University of Mississippi Medical Center, Jackson, MS bDepartment of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY cGalderma Laboratories, L.P., Fort Worth, TX|Clobetasol propionate 0.05% spray (CPS) is a topical, super-high-potent corticosteroid indicated for the treatment of moderate to severe plaque psoriasis. Two pivotal trials of CPS investigated the efficacy and safety of treatment in subjects with moderate to severe plaque psoriasis. Overall disease severity (ODS), erythema, plaque elevation, scaling, and pruritus were assessed on a 5-point scale of 0 (clear) to 4 (severe/very severe). Overall disease severity treatment success was defined as achieving a score of ≤2 at week 2 and a score of ≤1 at week 4. Treatment success for all other parameters was defined as achieving a score of ≤1 at all time points. Based on Cochran-Mantel-Haenszel analysis, treatment success was achieved in the CPS group in both studies compared with vehicle after 2 weeks, but not after 1 week. Only subjects who achieved treatment success were considered for analysis. Thus, subjects who did not meet the criteria for treatment success were not examined for improvement. A post hoc analysis was conducted using all the data and the median as the measure of central tendency. It was shown that ODS, erythema, plaque elevation, scaling, and pruritus improved by 1 grade from baseline at week 1 in subjects given CPS. The data presented here suggest CPS is effective in improving the signs and symptoms of plaque psoriasis 1 week after initiating treatment.
J Drugs Dermatol. 2012;11(12):1455-1459.
Nitrosoglutathione Generating Nitric Oxide Nanoparticles as an ImprovedStrategy for Combating Pseudomonas aeruginosa - Infected Wounds
Jason Chouake BA,a* David Schairer BA,a* Allison Kutner BA,a David A. Sanchez BS,b Joy Makdisi BS,a Karin Blecher-Paz MD,a Parimala Nacharaju PhD,c Chaim Tuckman-Vernon BS,cPhil Gialanella MS BS,d Joel M. Friedman MD PhD,c Joshua D. Nosanchuk MD,a,b and Adam J. Friedman MDa,cPseudomonas aeruginosa is a community-acquired, nosocomial pathogen that is an important cause of human morbidity and mortality; it is intrinsically resistant to several antibiotics and is capable of developing resistance to newly developed drugs via a variety of mechanisms. P aeruginosa's ubiquity and multidrug resistance (MDR) warrants the development of innovative methods that overcome its ability to develop resistance. We have previously described a nitric oxide-releasing nanoparticle (NO-np) platform that effectively kills gram-positive and gram-negative organisms in vitro and accelerates clinical recovery in vivo in murine wound and abscess infection models. We have also demonstrated that when glutathione (GSH) is added to NO-np, the nitroso intermediate S-nitrosoglutathione (GSNO) is formed, which has greater activity against P aeruginosa and other gram-negative organisms compared with NO-np alone. In the current study, we evaluate the potential of NO-np to generate GSNO both in vitro and in vivo in a murine excisional wound model infected with an MDR clinical isolate of P aeruginosa. Whereas NO-np alone inhibited P aeruginosa growth in vitro for up to 8 hours, NO-np+GSH completely inhibited P aeruginosa growth for 24 hours. Percent survival in the NO-np+GSH-treated isolates was significantly lower than in the NO-np (36.1% vs 8.3%; P=.004). In addition, NO-np+GSH accelerated wound closure in P aeruginosa - infected wounds, and NO-np+GSH-treated wounds had significantly lower bacterial burden when compared to NO-np-treated wounds (P<.001). We conclude that GSNO is easily generated from our NO-np platform and has the potential to be used as an antimicrobial agent against MDR organisms such as P aeruginosa.
J Drugs Dermatol. 2012;11(12):1471-1477.
Clinical Efficacy and Safety of a Multimodality Skin Brightener CompositionCompared With 4% Hydroquinone
Elizabeth T. Makino BS MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa|
aSkinMedica, Inc, Carlsbad, CA bThomas J. Stephens & Associates, Inc, Carrollton, TX cProPharmaCon, LLC, Carlsbad, CAThere are numerous common skin disorders involving hyperpigmentation, including solar lentigines, postinflammatory hyperpigmentation, melasma, freckles, and dyschromia from photoaging. While these conditions are of an aesthetic nature, there is great interest in newer, safer, and more effective treatment modalities. Topical hydroquinone (HQ) has been the gold standard of skin lighteners for many years. However, regulatory authorities around the world are now questioning its safety. A randomized, double-blind, half-face study was conducted in females having moderate to severe facial hyperpigmentation to assess the efficacy and tolerability of 3 new skin brightener formulations containing SMA-432, a prostaglandin E2 inhibitor, compared with 4% HQ. Each subject was assigned 2 of the 4 test materials and was instructed to apply the product on the assigned side of the face twice daily for 12 weeks. Evaluation visits were conducted at baseline and at 4, 8, and 12 weeks. At each visit, subjects were evaluated by a blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photography and Chroma Meter assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. Sixty-eight Caucasian subjects (136 half faces) completed the study. All test materials significantly reduced Overall Hyperpigmentation and improved the Investigator's Global Hyperpigmentation Improvement rating at weeks 4, 8, and 12 compared with baseline. SMA-432 exhibited a dose-dependent improvement in hyperpigmentation. There were no major tolerability issues with any of the test materials. Self-assessments were generally favorable for all test materials. At the completion of the trial, subjects rated one of the tested multimodality brightener compositions as the most favorable product and 4% HQ as the least favorable. This study demonstrated that the new non-HQ-containing skin brightener formulations were as effective and equally well tolerated as the gold standard, 4% HQ, in females with facial hyperpigmentation.
J Drugs Dermatol. 2012;11(12):1478-1482.
A Multicenter, Randomized, Vehicle-Controlled Phase 2 Study of Blue Light Photodynamic Therapy With Aminolevulinic Acid HCl 20% Topical Solution for the Treatment of Actinic Keratoses on the Upper Extremities: The Effect of Occlusion During the Drug Incubation Period
George J. Schmieder DO,a Eugene Y. Huang MD PhD,b and Michael Jarratt MDc|Background: Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be safe and effective in the treatment of actinic keratoses (AKs) of the face and scalp. A recent small study has suggested that ALA-PDT can be effective for AKs of the dorsal hands/forearms. However, studies designed to provide sufficient statistical power to test this hypothesis are lacking in the literature.
Objectives: To determine and compare the safety and ef!cacy of blue light ALA-PDT vs blue light placebo vehicle (VEH) in the treatment of AKs of the upper extremities and to evaluate the effect of occlusion after application of ALA vs VEH.
Methods: ALA or VEH was applied to both dorsal hands/forearms for the 3-hour incubation period before blue light treatment (10 J/ cm2). One extremity of each subject was covered with occlusive dressing during the incubation period. Treatment was repeated at week 8 if any AK lesions remained.
Results: The median AK lesion clearance rate at week 12 was 88.7% for extremities treated with occluded ALA (ALA+OCC), 70.0% for extremities treated with nonoccluded ALA, 16.7% for extremities treated with occluded VEH (VEH+OCC), and 5.6% for extremities treated with nonoccluded VEH (P<.0001). ALA+OCC resulted in a significantly higher clearance rate compared with the nonoccluded extremity at weeks 8 (P=.0006) and 12 (P=.0029). Thirty-four percent (12/35) of extremities treated with ALA+OCC had complete clearance of lesions at week 12 compared with 0% (0/35) of extremities treated with VEH+OCC (P=.0002). The safety pro!le in this study is consistent with previously reported side effects of the therapy.
Conclusion: Blue light ALA-PDT following a 3-hour incubation appears efficacious for AK clearance of the upper extremities. Incubation using an occlusive dressing significantly increases the efficacy of the procedure and also increases the incidence and severity of some acute inflammatory side effects of PDT.
J Drugs Dermatol. 2012;11(12):1483-1489.
Elizabeth M. Grossman MD MBA,a Shivani Nanda BS,a Jennifer R.S. Gordon MD,a Meghan Dubina MD,aAlfred W. Rademaker PhD,b Dennis P. West PhD,a and Peter A. Lio MDa|
aDepartment of Dermatology and bDepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, ILBackground: The prevalence of Staphylococcus aureus colonization of healthcare workers is reported at 30%, with colonization rates for methicillin-resistant S aureus (MRSA) reported between 2.0% and 8.5% among industrialized nations. The anterior nares are the most frequent colonization site. Mupirocin is the standard of care for nasal S aureus decolonization, with decolonization rates as high as 90%. Staphyloccocal resistance to mupirocin has been described, requiring additional management strategies. In certain situations, triple antibiotic ointment (TAO) may be a suitable alternative for elimination of nasal S aureus colonization.
Observations: Adult healthcare workers within an academic-centered hospital (n=216) were screened via nasal swab with culture for S aureus colonization. Forty-five subjects (20.8%) screened positive for S aureus; of these subjects, 3 (1.4%) were positive for MRSA. Of the 45 subjects with positive cultures, 30 completed 5 days of twice-daily intranasal TAO application. One week after treatment, all 30 subjects were reswabbed; 16 (53.3%) showed evidence of decolonization on repeat culture.
Conclusions: The rate of S aureus colonization of healthcare workers in our study is lower than published rates in industrialized nations. Intranasal application of TAO may be a viable option for eradication of nasal colonization by methicillin-susceptible S aureus in environments where mupirocin-resistant bacterial strains become more prevalent.
J Drugs Dermatol. 2012;11(12):1490-1492.
Steven H. Dayan MD,a Rachel N. Pritzker MD,b and John P. Arkins BSc|
aClinical Assistant Professor, University of Illinios Department of Otolaryngology, Chicago, IL bDepartment of Medicine, Division of Dermatology, John H.Stroger Jr. Hospital of Cook Country, Chicago, IL cDeNova Research, Chicago, ILRosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different treatment modalities for each of the physical findings associated with this disease, and all have varying results. As the use of onabotulinumtoxinA rises, its benefit in the treatment of a growing number of medical diseases increases. The authors report anecdotal evidence of patients with rosacea experiencing improved symptoms of erythema and flushing after treatment with intradermal, microdroplets of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a likely neurogenic component to vascular dysfunction, inflammation, and hypersebaceous activity is reviewed.
J Drugs Dermatol. 2012;11(12):e76-e79.
M. Shane Hamman MD,a Sabrina G. Fabi MD,b and Mitchel P. Goldman MDb|
aDepartment of Dermatology, University of California San Diego, San Diego, CAbGoldman Butterwick Fitzpatrick Groff & Fabi, Cosmetic Laser Dermatology, San Diego, CA
Background: Hyaluronic acid (HA) can be used to correct volume loss associated with periorbital aging.
Objective: To report and compare the efficacy and safety of HA used to treat tear trough deformities with two different injection techniques.
Materials and Methods: This is a retrospective, single-center study of 81 patients comparing the two injection techniques used for the treatment of tear trough deformities from 2003 to 2011. Hyaluronic acid was administered either in a single depot in the nasojugal groove and massaged into position or in multiple small aliquots along the inferior orbital rim and massaged into position. Patient satisfaction and the incidence of adverse reactions were evaluated.
Results: Of the 194 patients treated during the study period, 81 (42%) were successfully contacted. The overall patient satisfaction with the correction was similar for both techniques. Two patients treated with a single depot of HA were later given hyaluronidase, but otherwise, there was no statistically significant difference in the incidence and severity of side effects.
Conclusions: We describe and compare an alternative technique for the correction of tear trough deformity using a single deposition of HA in the nasojugal groove with favorable outcomes.
J Drugs Dermatol. 2012;11(12):e80-e84.
Kenneth Beer MDa-c|
aDepartment of Dermatology, University of Miami, Miami, FL bDepartment of Medicine, Duke University, Durham, NC
cDepartment of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PAEruptions from drugs are among the most frequently reported adverse events. The most frequent etiologic agents include antibiotics and nonsteroidal anti-inflammatory agents. These eruptions are also a frequent source of visits to dermatology offices. Many of the inciting agents are known and have been well described. Frequently implicated drugs include antibiotics, nonsteroidal anti-inflammatory medications, and anticonvulsants. This case report reviews a drug eruption that has not yet been noted, despite years of experience with the class of drug involved in this case, and the literature associated with it.
J Drugs Dermatol. 2012;11(12):1494-1495.
Daniel Opel MA,a Afrodite Economidi MD,b Daphne Chan PhD,c Yasmine Wasfi MD PhD,cSameer Mistry BSc MB ChB MRCS,d Theognosia Vergou MD,b Christina Antoniou MD PhD,band Howard Sofen MDe|
aLoyola University Chicago Stritch School of Medicine, Chicago, IL bPsoriasis Clinic, Department of Dermatology, University of Athens, A. Sygros Hospital, Athens, Greece cDepartment of Immunology, Janssen Research & Development, LLC, Spring House, PA dDepartment of Medical A7airs, Janssen-Cilag Ltd, Buckinghamshire, UK eDermatology Research Associates, Los Angeles, CABackground: Patients with psoriasis who are treated with systemic and biologic therapies may have an increased risk of infections, including hepatitis B virus (HBV). Cytokines that modulate CD4+ T cell subsets, including interleukin (IL)-12 and IL-23, have been suggested to play a role in the pathogenesis of HBV infection.
Objective: To report the first known cases of acute HBV infection in 2 ustekinumab-treated patients with psoriasis from a phase 3 (PHOENIX 1) and a phase 4 (TRANSIT) study.
Results: Both ustekinumab-treated patients generated an immune response toward HBV and experienced typical courses of infection, without progression to chronic HBV infection.
Conclusion: Continued monitoring of liver-related adverse events in clinical trials, registries, and spontaneous reporting from the postmarketing setting will further contribute to understanding the role of ustekinumab in viral hepatitis.
J Drugs Dermatol. 2012;11(12):1498-1501.
Successful Treatment of Patients Previously Labeled as Having Delusions of Parasitosis With Antidepressant Therapy
Ashley Delacerda MD, Jason S. Reichenberg MD, and Michelle Magid MD|
Department of Dermatology, University of Texas Southwestern, Austin, TXDelusions of parasitosis (DOP) is a somatic subtype of delusional disorder, also known as monosymptomatic hypochondriacal psychosis. The management of DOP has been discussed extensively in the medical literature. Patients with suspected DOP have a broad differential diagnosis, including skin-based or systemic medical conditions and several kinds of psychiatric disease. However, there are many patients who have been labeled with DOP but do not meet the diagnostic criteria or who present with additional somatic complaints. These cases are a unique therapeutic challenge for dermatologists and psychiatrists alike and have not been thoroughly studied or reported. We present a patient referred for DOP who benefited substantially with antidepressant therapy.
J Drugs Dermatol. 2012;11(12):1506-1507.
Giuseppe Ricci MD, Monica Martinelli BS, Stefania Luppi PhD, Leila Lo Bello MD, Michela De Santis MD,Kristina Skerk MD, and Gabriella Zito MD|Although millions of men have taken or are taking finasteride, there are no documented cases of successful pregnancy in the literature after discontinuation of the drug. Early studies did not show significant influence of finasteride on semen parameters, whereas some recent observations have suggested that in subfertile patients, the effects of the drug might be amplified. Therefore, counseling is particularly difficult for men taking finasteride and planning pregnancy. We report the case of a couple whose male partner had used finasteride for approximately 10 years and who presented for primary infertility. The first semen analysis, carried out 3 months after finasteride cessation, revealed severe oligospermia. One month later, sperm concentration increased, and the following month, the couple spontaneously conceived. A healthy baby was delivered at full term. To the best of our knowledge, this is the first case of successful full-term pregnancy and live birth after long-term use of finasteride, which suggests that treatment with finasteride, even after several years, does not prevent normal conception. However, caution should be advised with the use of finasteride in male partners of couples who are attempting to become pregnant.
J Drugs Dermatol. 2012;11(12):1511-1513.
James D. Brodell Jr,a Jonathan D. Cannella MD,b and Stephen E. Helms MDc|Although acanthosis nigricans (AN) may be associated with internal malignancies, a benign form is more common, and a subset of these is drug-induced. In this case, a solitary, hyperpigmented, acanthotic plaque developed on the right abdomen after daily, samesite injections of insulin over a six-month period. The lesion completely resolved eight months after insulin injections were rotated to other locations. Acanthosis nigricans recurred, however, at the original location two months after the patient resumed serial same-site insulin injections, against medical advice. This provides direct evidence that localized hyperinsulinism is causally related to AN through its effect on insulin-like growth factor receptors.
J Drugs Dermatol. 2012;11(12):e85-e87.
Heather Kiraly Orkwis DO and Daniel M. Stewart DO|Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the St. Joseph Mercy Health System Dermatology Residency Program. The editor of Resident Rounds is Omar A. Ibrahimi MD PhD. He is currently the Founding and Medical Director of the Connecticut Skin Institute. Dr. Ibrahimi is also a Visiting Assistant Professor of Dermatology Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com.
Dunnett Durando DO|
St. Joseph Mercy Health System, Ann Arbor, MI
No abstract details for the moment.
Heather Kiraly Orkwis DO, Craig Cattell MD, and Jessica Ghaferi MD|No abstract details for the moment.
No abstract details for the moment.
Pipeline Previews brings to you information on the newest drugs and medical products as they become available to the dermatologic community. This department may include additional information from the manufacturers, plus reports from physicians who wish to share their clinical experience with these new products. In addition, we will inform our readers about the latest drugs receiving Food and Drug Administration (FDA) approval.
Clinical Trial Review is a JDD department designed to provide physicians with information on drugs and devices undergoing clinical testing. It is our goal to inform the reader of the status of select drug and device studies relevant to the practice of dermatology before this information is available through standard channels. To participate in or learn more about these and additional trials, visit www.clinicaltrials.gov.
Leon H. Kircik MD, James Q. Del Rosso DO, FAOCD, Matthew Zirwas MD|Taro Pharmaceuticals Solves a Puzzling Enigma for Dermatologists
FDA regulations require that generic topical steroids match the active ingredients, concentration, and dosage of brand topical steroids, but the generic formulations do not have to match the bioequivalence of branded formulations. Vasoconstrictor assays have found large differences in bioequivalence between generic and trade name topical steroid formulations containing the same steroid in the same concentration in both cream and ointment vehicles. However, Taro Pharmaceuticals desoximetasone 0.05% and desoximetasone 0.25% ointments are a notable exception. Both branded and generic desoximetasone 0.05% and desoximetasone 0.25% ointments are produced by Taro Pharmaceuticals and contain the same excipients in the vehicle. Consequently, physicians do not have to be concerned about differences in therapeutic effectiveness between Taro's generic and brand desoximetasone ointments.