Kathani Amin MD, Christy C. Riddle MD, Daniel J. Aires MD, Eric S. Schweiger MD
Acne vulgaris is an extremely common disorder affecting many adolescents and adults throughout their lifetimes. The
pathogenesis of acne is multifactorial and is thought to involve excess sebum, follicular hyperkeratinization, bacterial
colonization, and inflammation. Many therapeutic options exist for treating acne, including topical benzoyl peroxide, topical
and oral antibiotics, topical and oral retinoids, and oral contraceptives. Oral antibiotics have been a mainstay in the
treatment of acne for decades and function by exerting an antibacterial effect by reducing the follicular colonization of
Propionibacterium acnes. Systemic antibiotics also have anti-inflammatory and immunomodulatory properties. This article
reviews the English language literature on the efficacy of various systemic antibiotics for treating acne vulgaris, including
second-line and less historically used medications. We discuss the tetracyclines, including subantimicrobial dose
doxycycline, macrolides (notably azithromycin), trimethoprim-sulfamethoxazole, cephalosporins, and fluoroquinolones
as treatment options for acne vulgaris.
Kattie J. Allen MD, Stephen E. Wolverton MD
Rituximab is a chimeric murine-human monoclonal antibody that targets the CD20 antigen found on B cells and results
in rapid depletion of this cell population. It is indicated for patients with relapsed or refractory, low-grade or follicular,
CD20-positive, B cell non-Hodgkin’s lymphoma. In addition, rituximab has been used for many other diseases, including
refractory pemphigus. In this study, 42 case reports of patients with refractory pemphigus vulgaris, pemphigus foliaceus,
and paraneoplastic pemphigus treated with rituximab were reviewed for clinical efficacy and safety. Forty-one of the 42
patients had at least some improvement following the rituximab therapy, while 6 suffered infectious adverse events. Though
rituximab appears to be effective in the treatment of refractory pemphigus diseases, further studies are warranted to clarify
its overall safety, especially concerning the risk of infectious adverse events in this patient population.
Gianni Montesi MD, Stefano Calvieri MD, Alberto Balzani MD, Michael H. Gold MD
Background: Rapid progress in the technology for skin rejuvenation has allowed for shorter post-treatment times than
ever before. An example of such technology is the radiofrequency (RF) device, which offers nonablative skin rejuvenation,
particularly for skin tightening and wrinkle reduction.
Objective: Medical devices that emit RF energy produce a change in the electrical charges of the treated skin creating
an electron movement, and the resistance of the tissue to the electron movement generates heat. This article examines
the mechanism of action of a new bipolar RF device, which emits RF energy through a handpiece with a bipolar electrode
configuration, and assesses the clinical histological and immunohistochemical results on a sample group of patients
who underwent a cycle of sessions with this device.
Methods and Materials: Thirty patients affected with periocular wrinkles, glabellar wrinkles, slackness of the cheeks with
accentuation of the nasogenian furrow, striae distensae at the scapulohumeral joint, abdomen, and gluteal-trochanteric
areas, or acne scars were included. These patients underwent a cycle of 6 to 8 sessions with 2-week intervals with the new
bipolar RF device undergoing photographic monitoring before treatment and at the end of the cycle of sessions. In addition,
15 patients from the sample group were subjected to 2 biopsies, one at the start of treatment and the other 3 months
after the last treatment.
Results: All the patients showed improvement in treated imperfections from the second session onward, and they expressed
their satisfaction at the end of the treatment cycle. The most notable clinical, histological, and immunohistochemical
results were observed in the patients with abdominal striae distensae. In most cases, the temporary side effects
observed consisted of rashes and ecchymosis. Two patients reported the formation of blisters on the treated area caused
by excessively high RF settings.
Conclusion: The new bipolar RF device proved to be effective, noninvasive, and easy to use. The improvement in the
treated areas is progressive and continues to be apparent several months after the last session. The duration of the results
achieved still remains to be accurately determined.
David M. Pariser MD, Patricia Westmoreland MD, Amy Morris MD, Michael H. Gold MD, Yin Liu PhD, Michael Graeber MD
Background: A unique, once-daily, fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BP) 2.5%
has been developed for the treatment of acne vulgaris.
Objective: To evaluate the long-term (up to 12 months) safety and efficacy of the adapalene 0.1%/BP 2.5% fixed-dose
combination gel for the treatment of acne vulgaris.
Methods: A total of 452 subjects were enrolled in this 12-month study and received adapalene/BP once daily. Evaluations
included lesion count reduction, subject’s assessment of acne, adverse events, and cutaneous tolerability.
Results: Adverse events were mild to moderate, occurred early in the study, and decreased thereafter. Discontinuations
due to adverse events were low (2.0%) and no subjects discontinued due to lack of efficacy. Early and sustained reductions
in inflammatory and noninflammatory lesions were observed, with clinically significant lesion reductions as early
as week 1.
Conclusions: These findings are consistent with previous clinical findings and support the use of a once-daily adapalene/BP
fixed-dose combination as a safe and effective treatment in the long-term management of acne.
Julie A. Neville MD, Phillip M. Williford MD, Joseph L. Jorizzo MD
Background: Nodular basal cell carcinoma (nBCC) is the most common cutaneous malignancy and studies assessing the
use of topical imiquimod 5% cream as a monotherapy in the treatment of nBCC have resulted in less than optimal clearance
Objective: This pilot study was designed to evaluate the efficacy of imiquimod 5% cream on nodular basal cell carcinoma
lesions after initial treatment with curettage.
Methods: After obtaining informed consent, 17 nBCCs on 15 patients were included in this institutional review boardapproved,
open-label study with initial treatment using curettage without electrodesiccation followed by once-daily application
of imiquimod 5% cream 5 times per week for 6 weeks. The area was excised and examined histologically 6 weeks
after cessation of imiquimod cream.
Results: All 17 lesions (100%) showed no histologic evidence of residual tumor on the post-treatment excision. Local
site reactions necessitating a rest period from medication application were experienced by most patients (67%), but the
majority of patients stated that they would choose this treatment modality over excision if they developed a subsequent
Conclusion: Imiquimod 5% cream appears to be an effective treatment method for nodular basal cell carcinoma if combined
with curettage prior to application.
Warren Wallo, Judith Nebus, James J. Leyden MD
Serine protease inhibitors (soybean trypsin inhibitor [STI] and Bowman-Birk protease inhibitor [BBI]) found in soybeans
have been shown to inhibit melanosome phagocytosis by keratinocytes via protease-activated receptor 2 (PAR-2). Preclinical
studies have confirmed the skin lightening potential of these molecules. In this study, we investigated the efficacy
of a novel soy moisturizer containing nondenaturated STI and BBI for the improvement of skin tone, pigmentation, and
other photoaging attributes. Sixty-five women, with moderate facial photodamage, were enrolled in the 12-week,
parallel, vehicle-controlled study. Efficacy was monitored through clinical observation, self-assessment, colorimetric evaluations,
and digital photography. The results showed that the novel soy moisturizer was significantly more efficacious than
the vehicle in improving mottled pigmentation, blotchiness, dullness, fine lines, overall texture, overall skin tone, and
overall appearance. Differences were significant from week 2 to week 12 for all above parameters (except dullness which
started at week 4). In this study, we found that a moisturizer containing stabilized soy extracts is safe and effective, and
can be used to ameliorate overall skin tone and texture attributes of photoaging.
Barbara D. Garcia MD, Mitchel P. Goldman MD, Michael H. Gold MD
Photodynamic therapy (PDT) and intense pulsed light therapy (IPL) are commonly used in the setting of photorejuvenation.
Patient expectations for minimal to no downtime associated with these procedures has become an increasingly
important issue. In an attempt to define a topical skin care regimen that would reduce procedure-related symptoms and
possibly enhance therapeutic efficacy, 4 separate topical products were examined. Avène Thermal Spring Water (Laboratoires
Dermatologiques Avène, Les Cauquillous, France), NIA 24™ (Niadyne, Inc, Research Triangle Park, NC),
MimyX™ cream (Stiefel Laboratories, Coral Gables, FL), and Biafine® (OrthoNeutrogena, Los Angeles, CA) were studied
individually in the setting of either PDT or IPL treatments. The results of these studies indicate that a pre- and/or
postprocedure topical skin care regimen can be beneficial in reducing postprocedure symptoms.