No abstract details for the moment.
James Q. Del Rosso DO, Hilary Baldwin MD, Guy Webster MD
Objectives:The objectives of these Guidelines are to provide an overview of the fundamental disease state of rosacea and quality of
life implications and outline available pharmacological treatments for rosacea with reference to supporting research and
literature. The pharmacological agents discussed are inclusive of those that are FDA-approved based on phase 3 pivotal
trials, commonly used agents based on extensive clinical experience, and less commonly used alternatives reported in peerreviewed
Emil Tanghetti MD, Leon Kircik MD, David Wilson MD, Sunil Dhawan MD
Background: Benzoyl peroxide (BPO) is poorly soluble. A solubilized formulation of BPO has been developed to maximize
its bioavailability and enhance follicular penetration.
Methods: Patients with acne vulgaris were randomly assigned to receive solubilized BPO 5% gel on one side of the face
and a BPO 5%/clindamycin 1% combination product on the contralateral side, twice daily for 4 weeks.
Results: Of 23 patients enrolled, 100% completed the study. Reductions in lesion count with the solubilized BPO gel were
at least as great as with BPO/clindamycin—and significantly greater (P≤.05) for noninflammatory lesions at week 1 and
inflammatory lesions at week 4. Both regimens were generally well tolerated and patient satisfaction was comparable.
Conclusions: Solubilized BPO 5% gel monotherapy offers significantly greater efficacy, and comparable patient satisfaction,
compared with BPO/clindamycin. The early reduction in lesion counts observed with the solubilized BPO gel in
the absence of an antibiotic is clinically relevant.
Diane M. Thiboutot MD, Alan B. Fleischer Jr MD, James Q. Del Rosso DO, Klaus Graupe PhD
Background: Twice-daily azelaic acid (AzA) is the conventional regimen for papulopustular rosacea, but once-daily AzA
may be equally effective, with greater convenience and dosing flexibility. In order to test this hypothesis, an exploratory
study was conducted.
Methods: The evaluable efficacy population of this 12-week double-blind, parallel-group study included 72 patients and
the population that was used to report safety results included 92 patients. Baseline characteristics were comparable between
the once-daily and twice-daily study groups. Evaluations were performed at baseline and at weeks 4, 8, and 12.
Results: No significant difference was found between the once-daily and twice-daily groups at the end of study therapy
in mean investigator global assessment (IGA) scores, treatment success, or treatment response. The mean number of inflammatory
lesions, the intensity of erythema intensity, and the intensity of telangiectasia at treatment end were likewise
not significantly different (P>.205 for all). More than 90% of subjects in each group rated cosmetic acceptability of
this AzA gel as satisfactory or better.
Conclusion: Based on these findings and those of prior studies, once-daily AzA 15% gel can therefore be utilized as a safe,
effective, and economical dosing option for the treatment of mild-to-moderate papulopustular rosacea. Once-daily dosing
of AzA 15% gel was well accepted by patients
Steven L. Harlan MD FAAD
Background: There have been many reports of topical steroids treatment for the face causing perioral dermatitis, steroid
acne, and steroid rebound phenomenon.
Objective: To assess patient reported outcomes in patients receiving compounded topical (hydrocortisone 0.75% and precipitated
sulfur 0.5%) lotion for up to 15 years for common dermatological conditions of the face.
Methods: In a retrospective study, 300 patients were randomly sampled from the dermatology clinic who had used, or were
continuing to use, a lotion based, pharmacy-compounded topical preparation for the face. The topical compound was used
in therapies for seborrheic dermatitis and combination with prescription topical therapy for patients with acne and rosacea
with tolerability problems.
Results: None of the 300 patients experienced steroid acne, rebound phenomenon, or perioral dermatitis associated with
use of hydrocortisone 0.75% and precipitated sulfur 0.5% on the face.
Conclusion: There was no evidence found that perioral dermatitis, steroid acne, or rebound phenomenon occurs when
sulfur is compounded with topical hydrocortisone 0.75%.
Jerry K. L. Tan MD FRCPC, Jing Tang MSc, Karen Fung PhD, Aditya K. Gupta MD PhD FRCPC, D. RichardThomas MD FRCPC, Sheetal Sapra MD FRCPC, Charles Lynde MD FRCPC, Yves Poulin MD FRCPC,Wayne Gulliver MD FRCPC, Rolf J. Sebaldt MD CM FRCPC
Background: There is a paucity of information on the prevalence and severity of acne of the face, chest, and back.
Purpose: This study was designed to examine the prevalence and severity of acne on the face, chest, and back in a referral
cohort of patients with acne using a validated global acne severity scale.
Methods: Acne patients referred to dermatologists were evaluated at the face, chest, and back. Chi-square testing was
performed to assess consistency between patient and physician assessments of each region. The correlation of acne severity
between regions was evaluated by Spearman’s rank correlation.
Results: In 965 patients, the prevalence of acne on the face, chest, and back was 92%, 45%, and 61%, respectively. Acne
severity was significantly correlated for all regional pairs (P<.001): face and back (r=0.11); face and chest (r=0.12); and
chest and back (r=0.67). The consistency of patient reporting and clinical evaluation for the presence of acne varied by
region: face=92%, chest=69%, and back=74%. The proportions of patients reporting no occurrence of acne when clinical
acne was indeed absent (negative predictive value) were 67% and 65% for the chest and back, respectively.
Limitations: The operational threshold for clinical acne (>mild) may underestimate the total proportion of affected
patients. These patients were referred to dermatologists for care and may represent a more severe cohort.
Conclusion: Acne affected the face in 92% and the trunk in just over 60% (with the back more frequently and severely
affected than the chest). Acne severity was observed to have a much higher correlation between chest and back than
face and back or face and chest. Patient-reporting evaluations of absence of acne on the chest and back are frequently
erroneous, mandating clinical evaluations of these sites for assessment of overall extent.
Amrollah Ahmadi MD, Babak Barikbin MD, Mohsen Naseri MD PhD, Mohammadali Mohagheghi MD
Background: Psoriasis vulgaris is one of the most common chronic skin disorders without any curative treatment. Theaim of this study was to investigate the efficacy and safety of HESA-A in the treatment of psoriasis.
Methods: In a randomized, double-blind clinical trial, 28 patients (11 male, 17 female) with chronic plaque-type psoriasis
were randomly assigned to treatment and placebo groups. Patients in treatment group received HESA-A tablet 25
mg/kg twice a day orally and control group received placebo with the same method for 6 months and were followed clinically
during the study.
Results: At the end of study, in the treatment group psoriatic plaques were absent (no evidence of psoriasis or complete
remission) in 9 cases (64.2%) and was very mild (controlled, but not entirely cleared) in 5 cases (35.8%). Disease relief
was observed in 10 (71.4%) patients after 4 months, in 2 cases (14.3%) after 5 months and in 2 (14.3%) other patients
after 6 months while none of the controls showed disease improvement.
Conclusion: This study showed rapid and good efficacy and safety of HESA-A in the treatment of plaque-type psoriasis.
Alice B. Gottlieb MD PhD, Frank Dann MD, Alan Menter MD
Psoriasis is a chronic immune-inflammatory–mediated disease that can predispose patients to other inflammatory conditions.
For example, individuals with psoriasis are at increased risk for insulin resistance, obesity, dyslipidemia, and hypertension—
components that characterize the metabolic syndrome. The metabolic syndrome is an important driver of
adverse cardiovascular outcomes. Proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), and other
factors that are overproduced in patients with psoriasis likely contribute to the increased risk for development of metabolic
syndrome. This article reviews the association of psoriasis with metabolic syndrome, as well as the impact of biologic
agents that are currently used to treat psoriasis (ie, TNF antagonists) on risk factors for metabolic syndrome.
James Q. Del Rosso DO, Joel Schlessinger MD, Philip Werschler MD
No abstract details for the moment.