Category

Acne

Treating Acne in Adolescents and Young Adults

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JDD Multimedia

JDD Webinars

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Treating Acne in Adolescents and Young Adults

Featuring Leon H. Kircik, MD, Anthony J. Mancini, MD, FAAP, FAAD, Adelaide A. Hebert, MD

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Join Drs. Leon H. Kirick, Anthony Mancini, and Adelaide Hebert, as they  explore the categorization and grading of acne by age of onset in children and adolescents. They will also review and discuss new and evolving acne treatment strategies that offer optimal outcomes in children and young adults presenting with acne.

Upon completion of this live, internet-based CE activity, participants should be able to:

  • Appreciate the updated pediatric care classification, including appropriate evaluations and treatment, when needed 
  • Review acne treatment strategies offering optimal outcomes for pre-adolescents and adolescents with acne.

Faculty

Leon Kircik, MD
Clinical Professor of Dermatology
Icahn School of Medicine at Mount Sinai, New York, NY
Indiana University Medical Center, Indianapolis, IN
Medical Director
Physicians Skin Care, PLLC, Louisville, KY
DermResearch, PLLC, Louisville, KY
Skin Sciences, PLLC, Louisville, KY

Anthony J. Mancini, MD, FAAP, FAAD
Head, Division of Dermatology, Ann & Robert H. Lurie Children’s Hospital of Chicago
Professor of Pediatrics and Dermatology, Northwestern University Feinberg School of Medicine
Chicago, Illinois
Adelaide A. Hebert, MD
Chief of Pediatric Dermatology
McGovern School of Medicine
Childrens’ Memorial Hermann Hospital
Houston, Texas
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Recognizing Nuances in the Diagnosis & Management of Acne in Skin of Color Patients

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JDD Multimedia

JDD Webinars

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Recognizing Nuances in the Diagnosis & Management of Acne in Skin of Color Patients

Featuring Leon Kircik, MD & Andrew Alexis, MD, MPH

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Sign Up Now!

Earn 1.0 CE Credit:

Join Dr. Leon H. Kircik and Andrew Alexis, MD, MPH as they discuss they nuances in the diagnosis and management of acne in skin of color patients.

Upon completion of this enduring, internet-based webinar, participants should be able to:

  • Summarize the role of androgen and androgen receptors in the development and management of acne in skin of color patients
  • Recognize clinical nuances in acne grade and severity in skin of color patients
  • Differentiate therapeutic approaches in treating acne in patients with darker skin vs. lighter skin
  • Discuss new therapies in development for the management of acne

Faculty

Leon Kircik, MD
Clinical Professor of Dermatology
Icahn School of Medicine at Mount Sinai, New York, NY
Indiana University Medical Center, Indianapolis, IN
Medical Director
Physicians Skin Care, PLLC, Louisville, KY
DermResearch, PLLC, Louisville, KY
Skin Sciences, PLLC, Louisville, KY

Andrew Alexis, MD, MPH
Chair, Department of Dermatology
Mount Sinai West and Mount Sinai Morningside
Professor, Icahn School of Medicine at Mount Sinai
New York, New York
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February issue highlights new perspectives in chronic skin conditions

By Acne, Aesthetics, Featured Articles, JDD Highlights No Comments

Dermatology News

JDD Highlights

It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like acne as well as anti-aging.

Read the February JDD Now

Acne, Anti-Aging, Aesthetics, Psoriasis, and more

by Heather Onorati

February marks a transition period from the month of new beginnings (January) to a month of advancement (March). In many ways our collective focus is shifting. With new vaccines now rolling out, there has been a shift in the pandemic; our national leadership has shifted; our seasons are transitioning (with many on the East Coast looking forward to warmer days ahead). It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like acne as well as anti-aging. Here’s a glimpse into the findings reported this month:

Article Highlights

  • As we age, the body’s ability to manage inflammation decreases due to a gradual increase in pro-inflammatory systemic cytokines that result in chronic, low-grade inflammation, termed “inflammaging”. This is thought to play a role in many age-related chronic conditions like cardiovascular disease, diabetes, certain cancers and Alzehiemr’s disease. Other studies suggest the human microbiome also may play a role in inflammaging. In “Inflammaging in Dermatology: A New Frontier for Research,” researchers examine inflammaging within the context of the skin microbiome and its impact on chronic disease. The authors write that the skin, our largest organ, may be responsible for a larger role in promoting or preventing inflammaging.

  • Psoriasis is a condition continually studied as it has such a significant impact on patients and their quality of life. While many advances have been made, researchers continue to exam ways in which clinicians can improve treatment and disease management for these patients. In “Hospitalization in Patients With Psoriasis: Impact of Biological Therapies on Temporal Evolution,” researchers recognized the need to improve understanding of the impact of biological therapies on hospitalization. They retrospectively collected data on patients diagnosed with psoriasis within one institution who had at least one hospital admission during the study period. They established methods to compare hospitalizations at specified time periods since the evolution of biological therapies. While their data point to a gradual decrease in average hospitalization rate since 2004, they advise that there have been no extensive data to evaluate the impact of biological therapies on patient hospitalization.

  • In another recently published study, “Dermatologists’ Perspectives on Defining Moderate Psoriasis: The Canadian Moderate Psoriasis Survey,” researchers noted that there is a need to more fully define what constitutes “moderate plaque psoriasis” in order to improve care. In their survey of 69 responding Canadian dermatologists, the authors found that body surface area was used most commonly by respondents to describe disease severity. And, many consider disease location to be an indicator of severity.

  • Another skin condition that causes significant social and psychosocial distress is acne. As oral antibiotics are among the most commonly used systemic treatment, their use may be limited by potential side effects, according to the authors of “Differences in Depression and Distress Between Acne Patients on Isotretinoin vs Oral Antibiotics”. While isotretinoin is one of the most effective therapies, the authors note its potential side effects as well as controversy around its association with depression and suicidal ideation.

    “A critical knowledge gap exists in defining the association between systemic anti-acne treatments and mental health outcomes,” the authors write. To explore this further, they examined the differences in mental health outcomes between patients treated with isotretinoin vs oral antibiotics and found that patients treated with isotretinoin experiences less psychosocial distress and symptoms related to depression compared with those patients treated with oral antibiotics.

  • And, since antimicrobial resistance continues to be a concern, physicians need to weigh this risk when considering treatments for patients with various skin infections. In “Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo,” a group of experts used a modified Delphi technique to develop a treatment algorithm to guide clinicians in the treatment of children and adults with impetigo.

    The authors conducted a systematic literature review of recommendations for the current practice of impetigo treatment, which included research studies, clinical guidelines, consensus papers, and reviews published between 2014 and February 2020.  They developed a step-by-step method to standardize and support clinical decision making, they write, which includes guidance for education and prevention, diagnosis and classification, treatment measures and follow-up. In addition, they discuss a newer topical antibiotic that appears to be safe and effective.

    “The panel recognized that doctors need education in antibiotic stewardship principles, as, for some of them, it is an unknown field,” the authors write.

  • And finally, in an ongoing effort to better understand the impact of COVID-19 in the dermatology setting, researchers in one study reported that patients found teledermatology appointments to be a convenient and effective alternative to in-person visits during the pandemic. While the lack of physical touch and inability to provide close inspection can be frustrating for patients, this can be overcome by appropriate patient selection, the authors report in Patient Perceptions and Satisfaction With Teledermatology During the COVID-19 Pandemic: A Survey-Based Study.

  • Another impact of pandemic restrictions on the dermatology setting is the interaction between dermatologists and pharmaceutical company representatives, who often provide clinicians with educational information on drugs as well as samples for patients. In “The Impact of the COVID-19 Pandemic on Physician-Pharmaceutical Office-Based Interactions,” researchers examined the changing dynamic in the format of visits with and access to physicians by pharmaceutical representatives.

Editor's Picks

These articles and more make up this month’s February issue. Read more on aging, melasma and skin cancer in these articles also included:

  • Efficacy and Tolerability of a Novel Topical Treatment for the Neck: A Randomized, Double-Blind, Regimen-Controlled Study
  • New Protocol for Long-Term Results With a Multi-Pulse Nd:YAG Laser for Melasma Treatment: A Descriptive Cohort Study
  • A Review of Hedgehog Inhibitors Sonidegib and Vismodegib for Treatment of Advanced Basal Cell Carcinoma
  • Ingenol Mebutate as Treatment of Squamous Cell Carcinoma In Situ: A Case Series
  • Intralesional 5-Fluorouracil for Treatment of Non-Melanoma Skin Cancer: A Systematic Review
 
 

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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

By Acne, Featured Articles, The Latest No Comments

Featured Article

Featured Article

Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. The authors conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment.

Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. The authors conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment.

April W. Armstrong MD MPH, Joshua Hekmatjah BS, Leon H. Kircik MD

Acne vulgaris is a common skin disease affecting up to 70% of the population during their lifetime.  Cutibacterium acnes is the primary target of acne pathogenesis, and oral antibiotics, namely oral tetracyclines, have been the mainstay of systemic acne treatment for decades. In addition, oral tetracyclines possess an indirect anti-inflammatory effect against acne. Oral tetracyclines are an important part of the acne treatment regimen, and substantial evidence exists for their efficacy and safety for use in inflammatory acne.

Oral tetracyclines demonstrate bacteriostatic (inhibiting bacterial growth) effects against C. acnes; however, some tetracyclines also exhibit bacteriostatic effects on beneficial commensal organisms of the gut. This broad-spectrum effect can lead to a less diverse gut microbiome. Disruptions in the symbiotic relationship between the gut microbiome and the host have been associated with chronic diseases, such as obesity and inflammatory bowel disease (IBD).  Although a compositional definition of an ideal gut microbiome does not exist, greater microbial diversity is important for protection from pathogens, nutrient supply, and vitamin production.

While oral tetracyclines are widely prescribed for acne, a gap exists in synthesizing the most recent data on the efficacy and safety of these agents. We conducted a systematic review of the efficacy and safety of common oral tetracyclines (sarecycline, doxycycline, minocycline, and tetracycline) used for acne.

To determine the efficacy and safety of oral tetracyclines for acne, we followed the Preferred Reporting Items for Systematic Reviews guidelines and performed a systematic review using PubMed and Embase. Our search included published articles from January 1960 to April 2020, and our search criteria included the following: (“Acne”[MeSH] OR “Acne Vulgaris”[MeSH]) OR “acne vulgaris/drug therapy”[MeSH Major Topic]) AND tetracyclines [MeSH Terms].

Among their many additional suggestions, the authors offer insight into financial considerations, office medical record policies and procedures, how much to stock of various emergency supplies and more.

“We are hopeful that this provides at least a template of items for consideration and implementation across the various practice situations and emergencies and mitigates the reoccurrence of difficult lessons learned from the COVID-19 pandemic,” they write.

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Articles Cited in this Post

 

Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

Oral tetracyclines are the most widely prescribed systemic antibiotic for acne. Synthesis of efficacy and safety of traditional and novel oral tetracyclines is highly informative to clinical practice. We conducted a systematic search of PubMed to identify large interventional and observational studies utilizing oral tetracyclines as an acne treatment. We identified 13 articles meeting inclusion for this review, which represented 226,019 pediatric and adult acne patients. Oral tetracyclines that were included in this systematic review were sarecycline (a novel narrow-spectrum tetracycline), doxycycline, minocycline, and tetracycline. Based on shared and divergent outcome measures, different oral tetracyclines were variably effective against facial acne. Sarecycline also demonstrated efficacy in truncal acne. Members of the oral tetracycline class also differed in their ability to minimize antibiotic resistance and gut dysbiosis.
Read More

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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Systemic Antibiotics in the Management of Acne: Issues and Considerations for Optimal Care

By Acne, Podcast Highlights No Comments

JDD Multimedia

JDD Podcast

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How to Listen

"Systemic Antibiotics in the Management of Acne: Issues and Considerations for Optimal Care"

Drs. Joslyn Kirby and Adam Friedman

 

WEEEEEEERE BACK! Join host Dr. Adam Friedman for lively and learned discussion with Dr. Joslyn Kirby on one of the most common, chronic, soul-crushing complaints… Acne Vulgaris. It is, from a pathophysiological standpoint, a biological sh*t show, but you need to understand it to develop the best treatment plans. We talk inflammation, first line approaches, setting patient expectations and compliance. We dive deep into the differences between broad-spectrum and narrow-spectrum antibiotics, when to use them, and for how long. (Spoiler alert: NOT TOO LONG!). In our efforts to be stewards of meaningful antibiotic use and adversaries of antimicrobial resistance, narrow-spectrum antibiotics are the future!

This enduring activity is supported by an independent medical education grant provided by Almirall, LLC.

Upon completion of this enduring, internet-based educational activity, participants should be able to:

  • Review current scientific understanding of pathophysiology of acne
  • Summarize acne treatment strategies utilizing systemic antibiotics
  • Differentiate safety and efficacy of broad and narrow spectrum antibiotics indicated for acne treatment
  • Cite the benefits of narrow spectrum antibiotic use in acne therapy
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Disclosures:
  • Adam Friedman, MD, FAAD – Grant/Research: Aclaris, CPN, Almirall. Consultant: SanovaWorks, Oakstone Institute, L’oreal, La Roche Posay, Galderma, Aveeno, Valeant, Microcures, Biogen, Pfizer, G&W Laboratories, Novartis, Occulus, Intraderm, Encore, Exeltis, Menlo, Lilly, Aclaris, Dermira, Berg, Allergan, Zylo Therapeutics, Hoth. Speaker’s Bureau: Regeneron, Dermira, Janssen, AbbVie. Major Stock Shareholder: Zylo, Minorcures.
  • Joslyn R. Sciacca Kirby, MD – No relevant disclosures.

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Acne, OCPs, and a Side Order of Practical Pearls for the Adolescent Patient

By Acne, Podcast Highlights No Comments

JDD Multimedia

JDD Podcast

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"Acne, OCPs, and a Side Order of Practical Pearls for the Adolescent Patient"

Dr. Adam Friedman and Dr. Lawrence Eichenfield

JDD Podcast host Dr. Adam Friedman gets first-hand insight from internationally acclaimed pediatric dermatologist Dr. Lawrence Eichenfield on his recent study entitled “Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients” published in the June 2016 edition of the Journal of Drugs of Dermatology.

Want a refresher on the use of OCPs in Acne? Interested in learning how to initiate a patient based survey study? Just curious how a leader in the field gets an uninterested adolescent to be compliant and engaged in his/her acne care? These are just a few of the practical pearls provided.

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The Latest Research & Discoveries in Acne, Rosacea, Anti-Aging, and Medical Dermatology

By Acne, JDD Highlights, Rosacea No Comments

Dermatology News

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The June issue of the Journal of Drugs in Dermatology is available now. This month, we focus on Acne and Rosacea, with special features on Public Health, Anti-aging, Aesthetic, and Medical Dermatology.

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Acne, Rosacea, Public Health, Anti-Aging, Aesthetic, and Medical Dermatology

The June issue of the Journal of Drugs in Dermatology is available now. This month, we focus on Acne and Rosacea, with special features on Public Health, Anti-aging, Aesthetic, and Medical Dermatology.

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