Why Are Dermatologists Still Talking About Acne? Because So Many People Have It… and We Are Always Seeking Better Ways to Manage It

June 2011 | Volume 10 | Issue 6 | Editorials | 575 | Copyright © June 2011

James Q. Del Rosso, DO

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On behalf of the Editors, and also the support staff of the Journal of Drugs in Dermatology, I want to invite all of you to dig into what is a very robust Journal issue encompassing several "faces" of both acne and rosacea. It is an honor to once again serve as the Guest Editor of the annual Acne and Rosacea issue of the JDD, a responsibility that I approach with dedicated passion and with very strong interest in both of these disease states. I want to thank Editor-in-Chief Perry Robins MD, Co-Editor-in-Chief James Spencer MD and the editorial leadership at JDD for allowing me to continue in this capacity each year. Along with the assistance of Mr. James Gormley, Ms. Elza Tamazashvili and the rest of the excellent JDD staff, I try to produce a special issue that includes a diverse collection of peer-reviewed articles covering relevant basic science findings, timely reviews of the disease states and/or their management, data from new clinical research, applicable information on physical modalities and clinical information that can be adapted to "real world" practice. This year, I think we have achieved one of our best issues in terms of covering all of these important objectives. In some cases, I ask specific authors to cover topics where there appears to be a void, either in new data or with clinical "pearls." Other articles are submitted based on new clinical research or reviews of topics that the authors have chosen to delve into in detail and bring forward to the literature.
The article by Bellew et al. reviews what is new, interesting and clinically relevant regarding the pathogenesis of acne. New information which challenges the recycled dogma of acne lesion development is included, along with discussions of newer information on the possible diverse roles played by Propionibacterium acnes in acne development, biofilm formation and P. acnes, matrix metalloproteinases (MMPs) present in acne, MMP changes with acne lesion improvement, innate immunity and relationship to toll-like receptors (TLRs), and sebaceous gland activity and factors modifying sebum production.
In his respective article, which addresses inflammation in acne and rosacea, Fleischer provides a current status report on the array of inflammatory processes associated with acne and rosacea. He discusses how these mechanisms may be set into motion from a pathophysiologic perspective. Importantly, the author differentiates acne and rosacea regarding which mechanisms may be exclusive to one of the disorders, and which may be operative in both. A major focus of this article is to update the reader on the apparent roles of specific inflammatory mechanisms and how individual topical and oral therapies appear to correlate with therapeutic benefit. Information is also included on how antimicrobial peptides, especially cathelicidins, may play important roles in both acne and rosacea.
The influence of vehicle formulation with topical therapies for rosacea is reviewed in detail by Jackson, with emphasis on factors that may influence efficacy, tolerability and adherence. The author discusses details of product formulation with both brand and generic products, and reviews many of the specific inert ingredients that are components of specific vehicles and their clinical implications. Data from clinical trials are also discussed. Importantly, the author stresses that available topical agents for rosacea have been evaluated almost exclusively in patients with the papulopustular subtype.
The article by Feldman addresses an important clinical concern, that is, how patients experience and manage cutaneous side effects to prescribed topical acne therapy, such as dryness and irritation. The type of topical acne therapy addressed by this study included only the two available benzoyl peroxide 5%/clindamycin 1% gel formulations. The study used an internet-based survey methodology, seeking input from both teenage and post-teenage patients with acne. The author identified that many patients on their own will reduce the frequency of application, apply medication only as "spot" treatment, apply medication