Digital Assessment of Facial Acne Vulgaris

Acne is chronic disorder of the pilosebaceous units with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes (P acnes) activity. Dermatologists use manual methods such as direct visual assessment and ordinary flash photography to assess the acne. However, these manual methods are very time consuming and may result in intra-observer and inter-observer variations, even by experienced dermatologists. To address these issues, there have been a number of research conducted using computational imaging methods for aiding in the acne diagnosis but they fail while solving more complex classification problems, cannot be used for real-time analysis, are semi-automated methods and they lack flexibilit

Digital Assessment of Facial Acne Vulgaris

Acne is chronic disorder of the pilosebaceous units with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes (P acnes) activity. Dermatologists use manual methods such as direct visual assessment and ordinary flash photography to assess the acne. However, these manual methods are very time consuming and may result in intra-observer and inter-observer variations, even by experienced dermatologists. To address these issues, there have been a number of research conducted using computational imaging methods for aiding in the acne diagnosis but they fail while solving more complex classification problems, cannot be used for real-time analysis, are semi-automated methods and they lack flexibilit

Randomized phase 3 evaluation of trifarotene 50 μg/g cream treatment of moderate facial and truncal acne.

BACKGROUND: Acne vulgaris often affects the face, shoulders, chest, and back, but treatment of nonfacial acne has not been rigorously studied. OBJECTIVES: Assess the safety and efficacy of trifarotene 50 μg/g cream, a novel topical retinoid, in moderate facial and truncal acne. METHODS: Two phase III double-blind, randomized, vehicle-controlled, 12-week studies of once-daily trifarotene cream versus vehicle in subjects aged 9 years or older. The primary end points were rate of success on the face, as determined by the Investigator\u27s Global Assessment (clear or almost clear and ≥2-grade improvement), and absolute change from baseline in inflammatory and noninflammatory counts from baseline to week 12. The secondary end points were rate of success on the trunk (clear or almost clear and ≥2-grade improvement) and absolute change in truncal inflammatory and noninflammatory counts from baseline to week 12. Safety was assessed through adverse events, local tolerability, vital signs, and routine laboratory testing results. RESULTS: In both studies, at week 12 the facial success rates according to the Investigator\u27s Global Assessment and truncal Physician\u27s Global Assessment and change in inflammatory and noninflammatory lesion counts (both absolute and percentage) were all highly significant (P \u3c .001) in favor of trifarotene when compared with the vehicle. LIMITATIONS: Adjunctive topical or systemic treatments were not studied. CONCLUSION: These studies demonstrate that trifarotene appears to be safe, effective, and well tolerated in treatment of both facial and truncal acne

Long-term safety and efficacy of trifarotene 50 μg/g cream, a first-in-class RAR-γ selective topical retinoid, in patients with moderate facial and truncal acne.

BackgroundTreatment for both facial and truncal acne has not sufficiently been studied.ObjectivesTo evaluate the long-term safety and efficacy of trifarotene in both facial and truncal acne.MethodsIn a multicentre, open-label, 52-week study, patients with moderate facial and truncal acne received trifarotene 50 μg/g cream (trifarotene). Assessments included local tolerability, safety, investigator and physician's global assessments (IGA, PGA) and quality of life (QOL). A validated QOL questionnaire was completed by the patient at Baseline, Week 12, 26 and 52/ET.ResultsOf 453 patients enrolled, 342 (75.5%) completed the study. Trifarotene-related treatment-emergent adverse events (TEAEs) were reported in 12.6% of patients, and none was serious. Most related TEAEs were cutaneous and occurred during the first 3 months. Signs and symptoms of local tolerability were mostly mild or moderate and severe signs, and symptoms were reported for 2.2% to 7.1% of patients for the face and 2.5% to 5.4% for the trunk. Local irritation increased during the first week of treatment on the face and up to Weeks 2 to 4 on the trunk with both decreasing thereafter. At Week 12, IGA and PGA success rates were 26.6% and 38.6%, respectively. Success rates increased to 65.1% and 66.9%, respectively at Week 52. Overall success (both IGA and PGA success in the same patient) was 57.9% at Week 52. At Week 52 visit, 92/171 (53.8%) patients who had completed their assessments had scores from 0 to 1 (i.e. no effect of acne on their QOL) vs. 47/208 (22.6%) patients at Baseline visit.ConclusionIn this 52-week study, trifarotene was safe, well tolerated and effective in moderate facial and truncal acne

Profile of clindamycin phosphate 1.2%/benzoyl peroxide 3.75% aqueous gel for the treatment of acne vulgaris.

Acne vulgaris is a common and chronic skin disease, and is a frequent source of morbidity for affected patients. Treatment of acne vulgaris is often difficult due to the multifactorial nature of this disease. Combination therapy, such as that containing clindamycin and benzoyl peroxide, has become the standard of care. Several fixed formulations of clindamycin 1% and benzoyl peroxide of varying concentrations are available and have been used with considerable success. The major limitation is irritation and dryness from higher concentrations of benzoyl peroxide, and a combination providing optimal efficacy and tolerability has yet to be determined. Recently, a clindamycin and benzoyl peroxide 3.75% fixed combination formulation was developed. Studies have suggested that this formulation may be a safe and effective treatment regimen for patients with acne vulgaris. Here, we provide a brief review of acne pathogenesis, benzoyl peroxide and clindamycin, and profile a new Clindamycin-BP 3.75% fixed combination gel for the treatment of moderate-to-severe acne vulgaris

The role of hypothalamus-pituitary-adrenal (HPA)-like axis in inflammatory pilosebaceous disorders

Skin is the largest peripheral endocrine organ and functions as a hormone target and endocrine gland. A cutaneous hypothalamus-pituitary-adrenal (HPA)-like axis enables the skin to respond to stress and regulates its steroidogenic activity. The pilosebaceous unit is a site for production and metabolism of a number of steroid hormones, including stress and sex hormones. This is an overview of the important role that the cutaneous HPA-like-axis plays in the pathogenesis and treatment of inflammatory pilosebaceous disorders, including acne, rosacea, seborrheic dermatitis, and hidradenitis suppurativa

Erythema-directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris.

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İzotretinoin tedavisi sonrası yüzde hipertrikoz: Yan etki mi tesadüf mü?

Background and Design: Excessive hair growth after isotretinoin treatment for acne vulgaris is not common, but may be one of the most undesirable side effects of the drug. The aim of this study is to investigate the relationship between systemic isotretinoin use and facial hypertrichosis. Materials and Methods: Female acne patients in premenopausal age were included in this prospective study. Laboratory tests [beta-human chorionic gonadotropin, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase, alanine aminotransferase] were evaluated initially and monthly during the study period. Hormone levels [luteinizing hormone, follicle stimulating hormone, total testosterone, free testosterone, dehydroepiandrosterone-sulfate (DHEAS), prolactin, 17-hydroxyprogesterone, glucose, and insulin] and abdominopelvic/transvaginal ultrasonography were also evaluated when there was a complaint or clinical findings of excessive hair growth. Body mass index (BMI) was calculated at the beginning of the study. Severity of the acne was assessed with Global Evaluation Acne Scale (GEAS). Hirsutism scores were calculated with Modified Ferriman-Gallwey score (m-FGS). Baseline and monthly taken digital dermoscopic photographs from the chin and cheeks were transferred to the Image., program to count the hair. Hair increases of >5% at the end of the treatment according to the basal hair count was accepted as hypertrichosis. Results: Thirty patients aged between 18-34 (median: 21.5) participated in the study. Mean duration of the therapy was 6.2 +/- 0.6 months. Facial hair growth was detected in three (10%) patients. One patient had an elevated DHEAS level with normal abdominal ultrasonography findings. Without the cessation of isotretinoin therapy, DHEAS level decreased to normal limits after two months. There was no statistically significant difference found between the mean GEAS (p=0.52), basal m-FGS (13=0.42), and BMI (p=0.71) of three patients with facial hypertrichosis, and in the remaining 27 patients. Facial hypertrichosis disappeared spontaneously 2 months (1-3 month) after the treatment courses were completed. Conclusion: The patho-mechanism of isotretinoin induced facial hair growth is not fully clarified. Since the facial hypertrichosis disappeared spontaneously when the treatment was ended, we think that this may be due to a temporary drug induced hormonal imbalance in susceptible individuals.Amaç: İzotretinoin tedavisi sonrası görülen kıl artışı sık olmamasına rağmen ilacın en rahatsız edici yan etkilerinden biri olabilir. Bu çalışmanın amacı, sistemik izotretinoin kullanımı ile yüzde gelişen hipertrikoz arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Bu prospektif çalışmaya premenapozal dönemdeki kadın akne vulgaris hastaları dahil edildi. Laboratuvar testleri (beta-insan koryonik gonadotropin, total kolesterol, trigliserid, düşük yoğunluklu lipoprotein, yüksek yoğunluklu lipoprotein, aspartat aminotransferaz, alanin aminotransferaz) tedavi başında ve çalışma boyunca aylık olarak değerlendirildi. Çalışmanın başında vücut kitle indeksi (VKİ) hesaplandı. Hastaların kıl artışı şikayeti olduğunda veya artış hekim tarafından gözlendiğinde ek olarak hormon [lüteinleştirici hormon, folikül uyarıcı hormon, total testosteron, serbest-testosteron, dehidroepiandrosteron-sülfat (DHEAS), prolaktin, 17-hidroksiprogesteron, glikoz, insülin] seviyeleri ve abdominopelvik/transvajinal ultrasonografi değerlendirildi. Akne şiddeti Global Akne Değerlendirme Ölçeği (GADÖ) ile, hirsutizm skoru modifiye Ferriman-Gallwey (m-FGS) skoru ile hesaplandı. Çene ve yanakların bazal ve aylık çekilen dijital dermoskopik fotoğrafları kıl sayımı için ImageJ programına aktarıldı. Bazal kıl sayısına göre tedavi sonunda %5’ten fazla kıl artışı hipertrikoz olarak kabul edildi. Bulgular: Çalışmaya 18-34 (ortanca: 21,5) yaş arasındaki 30 hasta katıldı. Ortalama tedavi süresi 6,2±0,6 aydı. Yüzde kıl artışı 3 (%10) hastada tespit edildi. Bir hastada DHEAS seviyesi yüksek olup bu hastanın abdominal ultrasonografisi normaldi. İzotretinoin tedavisi kesilmeden DHEAS seviyesi 2 ay sonra normale döndü. Yüzde kıllanma artışı olan 3 hasta ile diğer 27 hastanın ortalama GADÖ (p=0,52), bazal m-FGS (p=0,42) ve VKİ (p=0,71) değerleri karşılaştırıldığında istatiksel olarak anlamlı fark bulunmadı. Tedavi kürleri tamamlandıktan ortalama 2 (1-3) ay sonra hipertrikozun spontan olarak kaybolduğu gözlendi. Sonuç: İzotretinoinle indüklenen yüzde kıl artışının patomekanizması tam olarak aydınlatılamamıştır. Tedavi tamamlandıktan sonra kıllanmanın spontan olarak düzelmesi, bu durumun duyarlı kişilerde ilaca bağlı geçici bir hormonal dengesizlik sonucu oluşabileceğini düşündürmektedir