The genome of Propionibacterium acnes, the microbe presumed to be at least partially etiologic for the development of acne,
has recently been decoded. The genome supports long-standing concepts regarding acne pathogenesis, but also demonstrates
heretofore unknown and/or unsuspected bacterial properties, which might play a role in disease occurrence. In turn,
understanding the genome may lead to new therapeutic avenues, as summarized in this manuscript.
Andrew C. Krakowski MD,a Lawrence F. Eichenfield, MDb
Acne vulgaris can be easy to diagnose yet difficult to evaluate and manage, especially when it presents in infancy and
childhood. The differential diagnosis of acne varies by age and, in some cases, may warrant a work-up in order to rule out
underlying systemic abnormalities. Likewise, treatment strategies can be influenced by the patient’s age. In this article,
we present an overview of the clinical presentations of acne by age, an approach to patient evaluation, and a general strategy
for management of this common and important disease.
Data is very limited on the demographics, epidemiology, grading, and management of truncal acne vulgaris. In this study
completed in 5 cities across the US, 696 patients were assessed to evaluate the frequency and severity of truncal acne vulgaris.
Approximately 50% of patients who presented with acne vulgaris demonstrated involvement on the chest and/or
back, with more than 3% presenting with truncal acne lesions alone. Interestingly, approximately 1 out of 4 patients who
presented with both facial and truncal acne involvement did not voluntarily mention the presence of truncal acne as part
of their presenting complaint. In such cases, the presence of truncal acne lesions was detected by clinical examination.
A grading system for truncal acne vulgaris is also presented. The majority of patients presenting with truncal acne vulgaris exhibited mild to moderate severity and more than 75% were interested in treatment for truncal acne lesions
Joel Schlessinger MD, Alan Menter MD, Michael Gold MD, Craig Leonardi MD, Lawrence F. Eichenfield MD, R. Todd Plott PhD, James J. Leyden MD (ZIANA™ Study Group)
Clindamycin phosphate 1.2% and tretinoin 0.025% gel (CLIN/RA gel [ZIANA™ Gel]) is a novel topical combination
agent approved by the FDA for the treatment of acne vulgaris in patients 12 years of age or older. A solution of clindamycin
phosphate 1.2% combined with partially solubilized and crystalline tretinoin 0.025% suspended in an aqueous-based,
alcohol-free gel formulation, CLIN/RA gel was studied in 2 randomized, vehicle-controlled trials involving more than
4,500 patients. Efficacy results from these studies showed that treatment with the combination significantly reduced lesion counts and improved patients overall appearance to a greater extent than the individual components. Individual ingredients and the combination were well-tolerated. Among those treated with the combination formulation, discontinuation rates due to adverse events were 1% or less.
James Q. Del Rosso DO FAOCD
Combination therapy is the standard of care in the management of acne vulgaris. It is essential to treat as many aspects
of acne pathogenesis as possible. Due to increasing insensitivity of Propionibacterium acnes to antibiotics, the concomitant
use of other topical agents that exhibit other modes of antibacterial and anti-inflammatory activity is integral to the
successful treatment of acne. The combination of topical benzoyl peroxide and clindamycin gel has been shown to be
more effective than either agent alone. The addition of a topical retinoid may further enhance therapeutic results. This
12-week study evaluated the safety and efficacy of initial topical benzoyl peroxide 5%/clindamycin 1% gel as monotherapy
and in combination with adapalene gel versus adapalene gel monotherapy in the management of acne.
James L. Campbell Jr. MD MS
Many physicians regularly prescribe combination therapy involving a retinoid for their acne patients. The most common
retinoid-containing regimens include either oral antibiotics or topical benzoyl peroxide and antibiotic products. A fair number
of studies have been conducted to evaluate the efficacy of these combination therapies, but there is a lack of comparative
studies examining different regimens head-to-head. Also, many of the noncomparative studies have very similar trial
designs. A review of these studies was conducted in order to organize the available data side by side from the different regimens.
Although not derived from comparative studies, this presentation of data is expected to provide dermatologists with
valuable information from which they can easily make their own comparisons among similarly designed trials.
Jonathan S. Dosik MD, Lori A. Johnson PhD
Background: Topical retinoids, including adapalene and tazarotene, are a primary treatment choice for patients with acne.
Adapalene is currently marketed in a 0.1% concentration in gel and cream formulation. A new gel containing a higher
concentration (0.3%) of adapalene has been developed. In clinical studies, adapalene 0.1% concentration has proven
to be better tolerated than other retinoids in skin treatment. However, the tolerability of adapalene gel 0.3% has yet to
be compared to other topical retinoids.
Purpose: The purpose of this study was to compare the local cutaneous tolerability of adapalene gel 0.3% once daily versus
tazarotene cream 0.05% once daily.
Methods: Subjects reported to the investigative site each day Monday through Friday, cleansed the faced and then applied
adapalene 0.3% gel to one side of the face and tazarotene 0.05% cream to the other in the presence of study personnel.
For the weekends, subjects were instructed to apply the treatment at home according to the same procedure.
Tolerability was assessed during each weekday visit. The study lasted for 3 weeks.
Result: Tolerability results for adapalene 0.3% gel and tazarotene 0.05% cream were statistically similar throughout the study. Investigator-assessed overall tolerability was in favor of adapalene at days 19 and 22 (P=.043). A cosmetic acceptability survey also showed results were better for adapalene 0.3% gel.
Conclusion: Adapalene gel 0.3% is very well-tolerated with good cosmetic acceptability.
Joseph F. Fowler Jr. MD
Research into the pathophysiology of rosacea suggests a central role for inflammatory mediators such as nitric oxide
(NO), reactive oxygen species (ROS), and matrix metalloproteinases (MMPs). Effective treatments for rosacea,
including topical metronidazole and systemic antibiotics, have anti-inflammatory activity, which may be more important
than their antimicrobial activity in this setting. Phase III studies have substantiated the efficacy of anti-inflammatory
dose doxycycline (40-mg doxycycline monohydrate controlled-release capsules) administered once daily for the
treatment of inflammatory lesions of rosacea. Results of a 16-week, randomized, double-blind, placebo-controlled study
of anti-inflammatory dose doxycycline plus topical metronidazole gel 1% for mild to moderate rosacea are presented here.
At week 12, metronidazole was discontinued and patients continued on either placebo or doxycycline. Combination
therapy significantly reduced inflammatory lesion counts as early as week 4 and through week 12 compared to topical
metronidazole 1% gel monotherapy. The combined therapy appeared effective and well-tolerated.