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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

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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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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.
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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

| Acne, Featured Articles, The Latest | No Comments
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…

Recommendations for Preparing a Disaster Response Plan

| Aesthetics, COVID 19, Featured Articles, The Latest | No Comments
In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year. In a paper recently published by…
Dermatologist looking at skin

What’s New in Dermatology – January 2021

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In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care…

Recommendations for Preparing a Disaster Response Plan

By Aesthetics, COVID 19, Featured Articles, The Latest No Comments

Featured Article

Featured Article

In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year.

In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year.

Heather Onorati

The  suddenness with which offices closed as the COVID-19 pandemic escalated created many questions for practices. The uncertainty and inconsistencies around staffing procedures and reopening protocols added to the anxiety and emphasized the need to have proactive strategies in place for emergency situations.

In a paper recently published by JDD, Aesthetic Office Disaster Preparedness and Response Plan, several experts developed a guide based on their own experiences navigating the challenges of this past year.

“This advisory guide is meant to provide aesthetic physicians and their staff with a practical approach for practice management, staffing, supplies and inventory, and patient management,” the authors write in their paper titled “Aesthetic Office Disaster Preparedness and Response Plan.” They add that the paper does not set a standard of practice, but rather offers recommendations for various office procedures to have in place before a disaster-related event.

The experts classified their recommendations into four general areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies.

Among their many recommendations, they suggest creating several lists to serve as references in the event of an emergency. These include:

  • Site access lists — log-in information and passwords to social media sites and other web-based office accounts
  • Contact lists — staff contact details; office insurance policy contacts; financial institutions; colleagues who can be reached for assistance or guidance; state and national agencies like the Centers for Disease Control and Prevention, Federal emergency Management Agency, Department of Public Health), Department of Labor, etc.
  • Supply lists — office-related items in staff possession, inventory of general medical supplies including quantities and expiration dates

Additionally, the authors suggest pre-planning protocols for emergency staffing and office-hours as well as methods for communicating these to both staff and patients at the onset of a disaster.

“In situations of office closure or limited patient accessibility, the staff should be prepared to quickly switch to virtual access patient management tools such as telemedicine appointments,” the authors write.

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.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
Articles Cited in this Post

 

Aesthetic Office Disaster Preparedness and Response Plan

The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the “lessons learned” with the COVID-19 pandemic.
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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

| Acne, Featured Articles, The Latest | No Comments
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…

Recommendations for Preparing a Disaster Response Plan

| Aesthetics, COVID 19, Featured Articles, The Latest | No Comments
In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year. In a paper recently published by…
Dermatologist looking at skin

What’s New in Dermatology – January 2021

| Featured Articles, The Latest | No Comments
In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care…
Dermatologist looking at skin

What’s New in Dermatology – January 2021

By Featured Articles, The Latest No Comments

Featured Article

Featured Article

Dermatologist looking at skin

In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

 

Heather Onorati

January always represents new beginnings. It’s the time of year we tend to reflect on the past, extract insight from experience and look toward the future with new hope and understanding. It is with this in mind that our January issue couples articles based in foresight and advances.

Groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

In Aesthetic Office Disaster Preparedness and Response Plan, authors look to their shared experiences to provide suggestions for a proactive approach to manage possible future disaster-related events that could affect aesthetic practice operations and financial viability. Leveraging Virtual Boot Camp to Alleviate First Year Dermatology Resident Anxiety illustrates compelling levels of anxiety among incoming first-year dermatology residents and suggests that formally addressing the tenets of the specialty at the onset of PGY-2 can strengthen the foundation and boost the confidence of trainees. And, in Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations, authors discuss how the field of dermatology must remain on the leading edge of patient safety and advocacy issues and remain compassionate and adaptable when facing new patient care issues.

In the spirit of advancing understanding, other articles look to build the knowledge well around therapeutic techniques and disease treatment. As we continue toward a better understanding COVID-19, New York and Brazilian researchers examine the cutaneous presentations that could be clues to diagnosis in Presentation and Management of Cutaneous Manifestations of COVID-19. In the article Aesthetic ONE21 Technique for Injecting IncobotulinumtoxinA into the Forehead: Initial Experience With 86 Patients, authors report safety and efficacy from a single-center, retrospective study. Researchers present a clinical evaluation of a drug-device combination product for the topical treatment of molluscum contagiosum in A Phase 2 Open-Label Study to Evaluate VP-102 for the Treatment of Molluscum Contagiosum.

In addition, experts examine the impact of psychosocial stress on skin health, investigate efficacy of a nutraceutical supplement for promoting hair growth, discuss recommendations for absorbable suspension sutures in nonsurgical facial rejuvenation, and much more.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
January 2021 JDD 

 

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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

| Acne, Featured Articles, The Latest | No Comments
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…

Recommendations for Preparing a Disaster Response Plan

| Aesthetics, COVID 19, Featured Articles, The Latest | No Comments
In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year. In a paper recently published by…
Dermatologist looking at skin

What’s New in Dermatology – January 2021

| Featured Articles, The Latest | No Comments
In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care…

Top 10 Most Talked About Articles of 2020

By Featured Articles, The Latest No Comments

Featured Article

Featured Article

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year.  

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year.  

 

Heather Onorati

The second half of 2020 has seen the world still trying to navigate and overcome the COVID-19 pandemic, and the practice of dermatology has been no exception. However, while still an area of focus, dermatologists have been reading, sharing and discussing studies about a variety of other conditions and treatments relevant to their patients.  

In our year-end topten list, we’re sharing the case studies, reviews and investigations published by the Journal of Drugs in Dermatology that have been downloaded and read the most in the past 12 months.  

 

As the world sought to understand the emerging Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), or coronavirus disease 2019 (COVID-19), many potential signs and symptoms were investigated in connection with the virus, leading dermatologists to also grapple with identifying potentially afflicted patients. In a case study published early in the pandemic, authors in Cairo, Egypt, looked at whether a reported case of a pityriasis rosea-like rash could be connected with COVID-19. 

While COVID-19 remains a topic of interest, other issues like the use of neutraceuticals, approaches to treating melasma and hyperpigmentation, countering hair loss, and calming dermatitis have drawn attention.   

Nutrition and supplementation are topics of interest across medicine for their potential roles in overall health and wellness, including skincare. A literature review published in early 2019 examined the benefits of collagen supplementation in skin healing and anti-aging. The authors reported on a total of 11 studies that included 805 patients being treated for a range of issues from decubitus ulcers to anti-aging. In their analysis, the authors noted that collagen supplementation appeared to be promising with potential improvements in elasticity, hydration and dermal collagen density; however not all supplements are created equal and patients should be counselled with regard to ingredients and expectations, they noted. Another study that explored the use of a neutraceutical supplement for the treatment of hair loss highlighted botanical ingredients that may mitigate triggers for hair loss and help to restore balance to the follicle.   

In line with patient interest in “natural” treatments, investigators examined the mechanism of action for observed dermatologic benefits of colloidal oatmeal and found that extracts of colloidal oatmeal decreased pro-inflammatory cytokines in vitro. 

 

“Clinical evaluations showed that the colloidal oatmeal skin protectant lotion significantly improved dryness, scaling and roughness as early as 1 day after use, and these improvements were maintained over the duration of the study with continued use of the lotion,” the authors wrote. 

Among the investigations into treatments for common but challenging conditions, authors from the University of Kansas Medical Center, Kansas City, KS, reported on a case of chronic bilateral nasolabial fold seborrheic dermatitis. They hypothesized that Crisaborole 2% ointment, a PDE4 inhibitor would reduce the inflammation. After 2 treatments per week for 4 weeks, the investigators observed a notable reduction in scaling and erythema on the treatment site.  

Another commonly seen condition, xanthelasma palpebrae, can be a significant cosmetic concern for patients. In a case study published in 2016, researchers report on a case in which they used a hyfrecator for superficial tissue destruction resulting in excellent cosmetic results, the authors showed. 

Melasma and hyperpigmentation are among the challenging conditions dermatologists see. One study still garnering attention is an investigation into the benefit of Vitamin C plus iontophoresis. Investigators observed a mean 73% improvement in abnormal pigmentation after treatment combining Vitamin C with a full-face iontophoresis mask. A mean improvement of 15.7 on the Melasma Area and Severity Index was also noted.  

A review of 10 studies examining the efficacy of retinoids and azelaic acid for the treatment of acne and subsequent post-inflammatory hyperpigmentation in skin of color reported growing evidence that retinoids are well-tolerated and could be considered as first-line therapies to treat acne people with skin of color. In addition, azelaic acid may offer improvement in both acne and hyperpigmentation, the authors noted.  

Finally, a more recent review evaluated 35 randomized controlled trials of topical agents for the treatment of melasma found strong evidence for the recommendation of cysteamine, triple combination therapy, and tranexamic acid. 

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year. 

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
Read the top 10 most discussed articles in 2020: 

 

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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

| Acne, Featured Articles, The Latest | No Comments
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…

Recommendations for Preparing a Disaster Response Plan

| Aesthetics, COVID 19, Featured Articles, The Latest | No Comments
In a paper recently published by JDD, several experts developed a guide based on their own experiences navigating the challenges of this past year. In a paper recently published by…
Dermatologist looking at skin

What’s New in Dermatology – January 2021

| Featured Articles, The Latest | No Comments
In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care…

Safely Reopening Derm Practices – Best Practices & Practical Pearls

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Dermatology News

Video Pearls

Join Dr. Jeffrey S. Dover, Director of SkinCare Physicians in Chestnut Hill, Massachusetts as he discusses how the COVID-19 pandemic has affected dermatology practices across the country and around the world.

View Video Series Now

Safely Reopening Derm Practices

Best Practices & Practical Pearls

Join Dr. Jeffrey S. Dover, Director of SkinCare Physicians in Chestnut Hill, Massachusetts as he discusses how the COVID-19 pandemic has affected dermatology practices across the country and around the world.  In the face of a change that no one was really prepared for, Dr. Dover and an esteemed panel of experts from the fields of Infectious Disease, Immunology, Public Health Policy, Dermatology, Plastic Surgery, and Facial Plastic Surgery, came together to render their opinions and guidance on how to safely reopen dermatology practices across the country.

This collaborative effort resulted in the publication of Project AesCert Guidance, which represents a consensus of studied principles that combines learnings from major hospital systems on the frontlines of treating COVID-19 patients¹.

In an effort to expand the reach of these and other guidelines and best practices being used by dermatology practices across the country, Dr. Dover, in partnership with the Journal of Drugs in Dermatology, invited a panel of dermatology Key Opinion Leaders to share their experience as they reopen their practices. During this 5-part video series, you will hear immediately useful pearls and best practices from Jeffrey S. Dover, MD, Nazanin Saedi, MD, Kavita Mariwalla, MD, Terrence Keaney, MD, and Thomas E. Rohrer, MD.

Watch Part I

We kick off the series with Dr. Jeffrey S. Dover. Watch as he shares pearls and best practices on:

  • Medical Office Preparedness
  • Managing the Office Environment
  • General Guidance
  • Cleaning & Disinfecting Practices
  • PPE and Medical Supplies

View the entire video series on JDDonline.com , featuring Drs. Nazanin Saedi, MD, Kavita Mariwalla, MD, Terrence Keaney, MD, and Thomas E. Rohrer, MD.

View Video Series Now
References

1. Dover, J. S., Moran, M. L., Figueroa, J. F., Furnas, H., Vyas, J. M., Wiviott, L. D., & Karchmer, A. W. (2020). A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement—Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak. Facial plastic surgery & aesthetic medicine, 22(3), 125-151.

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Oral Tetracyclines and Acne: A Systematic Review for Dermatologists

| Acne, Featured Articles, The Latest | No Comments
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…

Sign Up To Attend Free ODAC Virtual Workshops

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Sign up now to attend Free ODAC Virtual 2021 Workshops Sign up now to attend Free ODAC Virtual 2021 Workshops The virtual ODAC conference, taking place January 14 – 17,…

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