Acne Therapy Research Articles

Activation of Janus kinase signaling pathway in acne lesions.

The Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway has been linked to the pathogenesis of many inflammatory skin diseases; however, the role of JAKs in the pathogenesis of acne vulgaris has not been previously elucidated. We aimed to analyze the cutaneous expression of JAK1/2/3 proteins in acne vulgaris and investigate the possible role of JAK signaling in acne pathogenesis. This case-control study was carried out on 28 patients with inflammatory acne vulgaris vs 20 age- and sex-matched healthy volunteers. Acne severity was assessed using Global acne severity grading system (GAGS). Skin biopsies were collected from lesional and non-lesional skin of patients and from control group. The expression of JAK1/2/3 proteins was examined by real-time quantitative polymerase chain reaction. JAK1 and JAK3 were overexpressed in acne lesions, compared to non-lesional skin and the control group. No significant difference was found in JAK2 expression between patients and controls. JAK1 and JAK3 showed no significant relation with the patients' age, sex, family history, duration of acne, or GAGS score. Our results suggest the activation of JAK pathway in acne lesions, indicating that it may play a pivotal role in the inflammatory disease process. JAK1 and JAK3 may be possible new targets for acne therapy.

17980 Severe nodulocystic acne in a renal dialysis patient managed successfully with low-dose isotretinoin

A 31-year-old woman with a background of a previous simultaneous pancreas-kidney (SPK) transplant with failed kidney, on long-term dialysis, was referred to our dermatology service for management of severe nodulocystic acne. She had type 1 diabetes, with secondary retinopathy, nephropathy and gastroparesis. Examination revealed severe nodulocystic acne affecting her face and neck, with evidence of scarring. Previous treatments included conventional topical treatments, as well as oral oxytetracycline. Her regular medications were mycophenolate mofetil, prednisolone, isoniazid, and paroxetine. Six months of low dose isotretinoin treatment (20 mg daily) resulted in complete resolution of her acne and there have been no adverse side effects reported thus far. Nodulocystic acne is not uncommon in renal dialysis patients. The mechanism of this whilst still largely unknown, has previously been postulated to be related to the toxic effect of uraemia. Nodulocystic acne often has a significantly negative impact on a patient’s quality of life and often fails to respond to conventional acne therapy. The use of low dose isotretinoin to treat acne in haemodialysis patients has been scarcely reported with only Lin et al’s prospective study in 1999 showing significant efficacy and minimal side effects. Renal elimination of isotretinoin and its metabolites is known to be negligible, and isotretinoin is protected from haemodialysis removal through its protein binding. Our case adds to the evidence that low-dose isotretinoin can safely and successfully be used to treat severe nodulocystic acne in renal dialysis patients, leading to a significant improvement in patients’ quality of life.

Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions.

While isotretinoin has been the gold-standard of therapy for severe acne since its approval in 1982, its anti-inflammatory properties makes it a potentially applicable and versatile therapy for a wide variety of dermatologic conditions yet to be explored. This systematic review comprehensively recounts the success of oral isotretinoin in non-acne cutaneous diseases and provide insight into future directions of isotretinoin utility. A systematic literature review was performed using PubMed. Search terms included "isotretinoin" OR "accutane" AND "skin" OR "dermatology" OR "hair" OR "nails" OR "rosacea" OR "psoriasis" OR "pityriasis rubra pilaris" OR "condyloma acuminata" OR "granuloma annulare" OR "darier's disease" OR "non-melanoma skin cancer" OR "frontal fibrosing alopecia" OR "cutaneous lupus erythematosus" OR "hidradenitis suppurativa" OR "photodamaged skin" OR "skin aging" OR "wart" OR "flat warts" OR "plane warts" OR "lichen planus" OR "dissecting cellulitis" OR "folliculitis decalvans" OR "sebaceous hyperplasia" OR "cutaneous t-cell lymphoma" OR "mycosis fungoides." A total of 169 studies discuss the use of oral isotretinoin for 16 non-acne dermatologic conditions, the most common being non-melanoma skin cancers (0.2-8.2mg/kg/day), cutaneous T-cell lymphomas (0.5-2mg/kg/day), and rosacea (0.22-1mg/kg/day). Inflammatory conditions such as rosacea, granuloma annulare, and hidradenitis suppurativa benefit from lower oral isotretinoin dosage of 0.3-1mg/kg/day, whereas, hyperkeratotic diseases such as psoriasis and pityriasis rubra pilaris, consistently respond better to higher dosages of up to 2-4mg/kg/day for lesion clearance. Recurrence of disease following discontinuation of isotretinoin have been reported for rosacea, psoriasis, granuloma annulare, Darier's disease, dissecting cellulitis, and non-melanoma skin cancers. Disease exacerbation was reported in some patients with hidradenitis suppurativa. Off-label isotretinoin is an effective treatment choice for dermatological conditions beyond acne. Further prospective, randomized human trials are needed to clarify when and how to prescribe off-label isotretinoin for maximum efficacy and safety.

Formulation of Creams Containing Spirulina Platensis Powder with Different Nonionic Surfactants for the Treatment of Acne Vulgaris.

Natural products used in the treatment of acne vulgaris may be promising alternative therapies with fewer side effects and without antibiotic resistance. The objective of this study was to formulate creams containing Spirulina (Arthrospira) platensis to be used in acne therapy. Spirulina platensis belongs to the group of micro algae and contains valuable active ingredients. The aim was to select the appropriate nonionic surfactants for the formulations in order to enhance the diffusion of the active substance and to certify the antioxidant and antibacterial activity of Spirulina platensis-containing creams. Lyophilized Spirulina platensis powder (SPP) was dissolved in Transcutol HP (TC) and different types of nonionic surfactants (Polysorbate 60 (P60), Cremophor A6:A25 (CR) (1:1), Tefose 63 (TFS), or sucrose ester SP 70 (SP70)) were incorporated in creams as emulsifying agents. The drug release was evaluated by the Franz diffusion method and biocompatibility was tested on HaCaT cells. In vitro antioxidant assays were also performed, and superoxide dismutase (SOD) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays were executed. Antimicrobial activities of the selected compositions were checked against Staphylococcus aureus (S. aureus) and Cutibacterium acnes (C. acnes) (formerly Propionibacterium acnes) with the broth microdilution method. Formulations containing SP 70 surfactant with TC showed the most favorable dissolution profiles and were found to be nontoxic. This composition also showed significant increase in free radical scavenger activity compared to the blank sample and the highest SOD enzyme activity was also detected after treatment with the cream samples. In antibacterial studies, significant differences were observed between the treated and control groups after an incubation time of 6 h.

Utilization of Asynchronous and Synchronous Teledermatology in a Large Health Care System During the COVID-19 Pandemic.

Background: Teledermatology offers an opportunity to continually deliver care during the coronavirus disease 2019 pandemic. Objective: To provide quantitative data about the use of teledermatology. Methods: Retrospective analysis of teledermatology consultations was performed from March 16 to May 1, 2020. The number/type of encounters, differences in diagnoses, and prescriptions between asynchronous and synchronous teledermatology visits were analyzed. Results: A total of 951 visits (36.2%) were asynchronous whereas 1,672 visits (63.8%) were synchronous. Only 131 (<5%) visits required an acute in-person follow-up. The diagnosis of acne was more frequent with asynchronous visits (p < 0.002, Bonferroni corrected). Antibiotics and nonretinoid acne medications were prescribed more with asynchronous visits, whereas immunomodulators and biologics were more commonly prescribed with synchronous visits (p < 0.02, Bonferroni corrected). Providers at our institution were split on preferred mode (54.2% synchronous, 45.8% asynchronous); however, synchronous visits were preferred for complex medical dermatology patients and return patients (p < 0.05). Limitations: This study is limited by being a single-center study. Conclusions: Asynchronous teledermatology was used more for acne management, whereas synchronous teledermatology was preferable to providers for complex medical dermatology. Postanalysis of the data collected led us to institute a hybridization of our asynchronous and synchronous teledermatology.

Azelaic Acid: A Promising Agent for Dermatological Applications

Azelaic Acid (AA) is a naturally occurring 9-carbon straight-chain saturated dicarboxylic acid widely found in wheat, rye, and barley. It has been shown to possess numerous biochemical activities, such as anti-inflammatory, anti-microbial, antioxidant, anticomedolytic and anticancer. This therapeutic agent has been approved by US food Drug Administration for the treatment of mild to moderate acne and rosacea. Further, azelaic acid has been reported for the management of skin hyperpigmentation, melasma and alopecia. In this review article, several studies on azelaic acid that pointed out its bioactivities and pharmacology along with its drug delivery systems are reviewed. Additionally, an outlook on its mechanism of action is also given. Azelaic acid is an important moiety for the management of acne owing to its benefits in addressing follicular excess sebum, inflammatory action, hyperproliferation and activity against Propionibacterium acne. The commercially available topical formulations normally contain 15 to 20% AA. In the future, a broadspectrum antibacterial agent, azelaic acid can act as a pillar in acne therapy minimizing the potential risk of emergence of resistance. This review will definitely provide a new perspective for research involving this bioactive molecule.

Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis.

Acne is one of the cutaneous manifestations of polycystic ovary syndrome (PCOS). There is limited evidence on metformin use for treatment of acne in PCOS patients. Our aim was to conduct a systematic review and meta-analysis to evaluate the efficacy of metformin for treatment of PCOS-related acne. On November 23, 2019, we searched PubMed, the Cochrane Library, and Embase databases for human clinical studies in any language. The keywords included 'acne' and 'polycystic ovary syndrome' combined with 'metformin,' 'biguanide,' or 'glucophage.' We included randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and open-label studies on patients with PCOS treated with metformin. We calculated standardized mean differences (SMDs) for acne scores and odds ratios (ORs) for presence of acne, with 95% confidence intervals (CIs). Quality assessment was performed using the Cochrane Collaboration risk of bias instrument for RCTs. NRCTs and open-label studies were assessed using the adapted methodological index for nonrandomized studies (MINORS). We included 51 studies on 2405 PCOS patients. Metformin as adjuvant therapy led to greater improvement of acne scores than the same therapy without metformin (SMD - 0.256; 95% CI - 0.439 to - 0.074). Pooling pre- and post-metformin therapy data showed significant decrease of acne scores after metformin use (SMD - 0.712; 95% CI - 0.949 to - 0.476). Presence of acne decreased significantly after metformin treatment (OR 0.362; 95% CI 0.271 to 0.485). There was heterogeneity across some studies due to different acne assessment scales, metformin dosages, and treatment durations. For PCOS patients, metformin as stand-alone or adjuvant therapy was associated with improvement of acne. More randomized controlled trials are needed to validate these results. PROSPERO registration number CRD42020159656.

Development of novel topical formulation from fullerene with antibacterial activity against Propionibacterium acnes

Acne vulgaris is a chronic skin disease of the pilosebaceous unit. Several pathophysiological associations have been identified in which Propionibacterium acnes plays a major role. Although there are a number of antibiotic therapies suggested for acne, many of them have limitations in their safety and efficacy. Therefore, there is a high demand to develop a safe alternative therapy for acne. Fullerene is an emerging nanomaterial believed to be a potential candidate for the treatment of acne due to its antibacterial and antioxidant activities. The low water solubility of fullerene limits its application in the cosmeceutical products. In the present study, a water soluble derivative of fullerene, glycine-fullerene conjugate (Gly-Ful), was developed and optimized using Design expert® software. As the positively charged molecules could act directly on the negatively charged bacterial cellular membranes, chitosan surface modified glycine-fullerene conjugate nanoparticles (Chi-Gly-Ful NPs) were prepared and Chi-Gly-Ful NPs gel was formulated for topical use in acne treatment. In vitro susceptibility of Propionibacterium acnes to Chi-Gly-Ful NPs formulation and comparator drug (streptomycin) was evaluated. The results showed that Chi-Gly-Ful NPs formulation inhibited effectively the growth of P. acnes and showed comparable antibacterial activity to streptomycin. The minimum bactericidal concentration (MIC) for Chi-Gly-Ful NPs was 8 µg/ml. Chi-Gly-Ful NPs at the concentrations of 25–400 µM showed no cytotoxicity on L929 fibroblast cells. Conclusively, our present work showed for the first time that Chi-Gly-Ful NPs has antimicrobial effects against P. acnes with no cytotoxic effect, suggesting Chi-Gly-Ful NPs as a promising novel therapeutic agent for the treatment of acne.

New technologies in topical acne therapy

The article is of an overview nature, it outlines the current understanding of the pathophysiology of acne, provides data on the role of retinoids in the treatment of dermatosis, discusses the advantages of combination therapy and new technologies in the treatment of acne.

Formulation development and evaluation of antiacne activity of ethosomal gel prepared using Plumbago zeylanica root extract

The objective of present research work is, to develop an ethosome, as a carrier system for Plumbago root extract, its incorporation into gel formulations and to characterize the developed gel formulations by estimation of plumbagin content and study of antiacne activity. Roots of Plumbago zeylanica L (Plumbaginaceae) contains Plumbagin and is used for skin infections and intestinal worms. Topical therapy for acne includes comedolytic agents, antibiotics and anti-inflammatory drugs. The excessive use of antibiotics has led to the increased resistance of acne-causing bacteria. In this research work, plumbago roots have been screened for their potential use for the treatment of acne and hydroalcoholic extract of the roots was found to be effective. Seven batches (EF1-EF7) of ethosomes were prepared using soya lecithin (1-3%) and ethanol (10-45%) and the hydroalcoholic extract. The range of entrapment efficiency varied from 17.12 to 80.82%. The ethosomes EF6 having highest entrapment efficiency was incorporated into gel formulation. Carbopol 934P (0.5 -2%) was used to prepare ethosomal gel and evaluated for physicochemical properties, drug content and diffusion characteristics. The pH of the gel was in the range of 6.87 to 7.03. Viscosity was between 5600 - 9800 centipoises. The % drug content was in the range of 95.91% to 100.7%. The ethosome, in their gel formulation, showed good physicochemical properties, drug content and diffusion pattern. The anti-acne activity of F3 showed good zones of inhibition comparable with standard Clindamycin. The present study suggested ethosomal gel as an efficient carrier for plumbago root extract for antiacne activity.

Adverse effects of systemic retinoids in treatment of acne: what are doctor and patient afraid of?

Since 1982, oral isotretinoin has been indicated for the treatment of severe nodular-cystic acne, but indications for its use have expanded significantly in recent decades. Dermatologists around the world have begun to actively use isotretinoin for moderate and even mild forms of acne, for acne that is resistant to standard treatment methods, as well as if the patient has a tendency to scar formation, which indirectly confirms that most often the benefits obtained from the use of the drug are significantly higher than the possible risk of side effects. Despite 38 years of experience with isotretinoin, currently some dermatologists unreasonably avoid prescribing the drug. Analysis of the literature and our own experience show that this attitude to acne therapy with systemic isotretinoin is usually associated with insufficient or inadequate awareness of doctors and patients. The most common reason why systemic isotretinoin therapy is not prescribed is fear of the risk of side effects during treatment.Therefore, the aim of the work was to determine the profile and frequency of side effects in acne treatment with systemic isotretinoin. For this purpose, we retrospectively analyzed 76 outpatient records of patients receiving systemic isotretinoin in the complex therapy of acne. Among the patients there were 51 women aged 13 to 42 years and 25 men aged 14 to 39 years. Roaccutane (F. Hoffmann-La Roche Ltd, Switzerland) was used as a systemic therapy for acne. The regimen of therapy with Roaccutane was as follows: for the first 2 months — 0.3—0.4 mg per 1 kg of body weight per day, then with normal biochemical parameters of liver, kidney function, lipid and carbohydrate metabolism, the daily dose increased to 0.5—0.7 mg per 1 kg of the patient’s body weight until a cumulative dose of 120 mg per kg of body weight is reached. In all patients who received Roaccutane for the treatment of acne, side effects were well tolerated, easily corrected and sometimes required only a temporary reduction in its daily dose. Changes in the biochemical blood test were transient: the indicators were restored to normal values after the end of the course of therapy.

The Skin Microbiome: A New Actor in Inflammatory Acne.

Our understanding of the role of Cutibacterium acnes in the pathophysiology of acne has recently undergone a paradigm shift: rather than C. acnes hyperproliferation, it is the loss of balance between the different C. acnes phylotypes, together with a dysbiosis of the skin microbiome, which results in acne development. The loss of diversity of C. acnes phylotypes acts as a trigger for innate immune system activation, leading to cutaneous inflammation. A predominance of C. acnes phylotype IA1 has been observed, with a more virulent profile in acne than in normal skin. Other bacteria, mainly Staphylococcus epidermis, are also implicated in acne. S. epidermidis and C. acnes interact and are critical for the regulation of skin homeostasis. Recent studies also showed that the gut microbiome is involved in acne, through interactions with the skin microbiome. As commonly used topical and systemic antibiotics induce cutaneous dysbiosis, our new understanding of acne pathophysiology has prompted a change in direction for acne treatment. In the future, the development of individualized acne therapies will allow targeting of the pathogenic strains, leaving the commensal strains intact. Such alternative treatments, involving modifications of the microbiome, will form the next generation of ‘ecobiological’ anti-inflammatory treatments.

Efficacy and tolerability of low-dose spironolactone and topical benzoyl peroxide in adult female acne: A randomized, double-blind, placebo-controlled trial.

Effective therapies for adult female acne (AFA) are limited. Oral spironolactone (SPL), 100-200mg/day, is currently used off-label to treat AFA. However, high-dose SPL results in clinically significant side-effects which prevent widespread use in clinical practice. The efficacy of low-dose spironolactone in AFA is unknown. We examined the efficacy and tolerability of low-dose (25-50mg/day) oral SPL in Thai women with moderate AFA. A randomized, double-blind, placebo-controlled trial was conducted for 12weeks. Moderate AFA patients aged between 25 and 45years received a combination of daily topical benzoyl peroxide (BP) 2.5% plus either SPL 25mg (SPL25 group), SPL 50mg (SPL50 group) or placebo. We performed total acne counts and Adult Female Acne Scoring Tool (AFAST) grading at 4-week intervals. The success rate, defined as the proportion of participants achieving a "clear/almost clear" AFAST grade by the end of week 12, was considered as the main outcome. Treatment-related adverse events (TRAE) were recorded. We enrolled 63 participants in the study. The total acne counts decreased significantly in all three groups (P<0.05) as compared with baseline. Participants in the SPL50 group had a significantly higher success rate than those in the placebo group (P<0.05). Serum potassium and creatinine levels showed no significant changes with treatment or between groups. A small number of participants in SPL25 and SPL50 reported mild and temporary TRAE, such as menstrual irregularities, breast tenderness and dizziness. The combination of SPL 50mg/day and topical BP proved effective in improving moderate AFA in Thai women, with an acceptable side-effect profile. We propose this regimen as an option for treating moderate AFA.

Combination of surgery and photodynamic therapy for the treatment of cystic acne of the scalp.

Cystic acne of the scalp is relatively resistant to conventional treatment because of its thick wall and deep cavity. This study was conducted as a comparative analysis of clinical outcomes of single surgery and those of surgery combined with photodynamic therapy for cystic acne of the scalp. Ten patients were treated only with surgical incisions and drainage of pus and necrotic tissues, and another ten patients were treated with photodynamic therapy immediately after surgery, followed by two weekly cycles thereafter. The combination treatment group reported better outcomes than the single surgery group in terms of duration of wound healing, the number of dressing changes, pain score at the time of dressing change, and recurrence rate. Our study demonstrateds that the combination of surgery and photodynamic therapy may have pronounced effects on the treatment for cystic acne of the scalp.

Commentary on 'Sebocyte differentiation as a new target for acne therapy: an in vivo experience'.

Linked article: M. Ottaviani et al. J Eur Acad Dermatol Venereol 2020; 34: 1803–1814. https://doi.org/10.1111/jdv.16252.

Anti-Inflammatory and Antibacterial Activity Constituents from the Stem of Cinnamomum validinerve.

One new dibenzocycloheptene, validinol (1), and one butanolide firstly isolated from the natural source, validinolide (2), together with 17 known compounds were isolated from the stem of Cinnamomum validinerve. Among the isolates, lincomolide A (3), secosubamolide (7), and cinnamtannin B1 (19) exhibited potent inhibition on both superoxide anion generation (IC50 values of 2.98 ± 0.3 µM, 4.37 ± 0.38 µM, and 2.20 ± 0.3 µM, respectively) and elastase release (IC50 values of 3.96 ± 0.31 µM, 3.04 ± 0.23 µM, and 4.64 ± 0.71 µM, respectively) by human neutrophils. In addition, isophilippinolide A (6), secosubamolide (7), and cinnamtannin B1 (19) showed bacteriostatic effects against Propionibacterium acnes in in vitro study, with minimal inhibitory concentration (MIC) values at 16 μg/mL, 16 μg/mL, and 500 μg/mL, respectively. Further investigations using the in vivo ear P. acnes infection model showed that the intraperitoneal administration of the major component cinnamtannin B1 (19) reduced immune cell infiltration and pro-inflammatory cytokines TNF-α and IL-6 at the infection sites. The results demonstrated the potential of cinnamtannin B1 (19) for acne therapy. In summary, these results demonstrated the anti-inflammatory potentials of Formosan C. validinerve during bacterial infections.

Ion Pair Strategy in Solid Lipid Nanoparticles: a Targeted Approach to Improve Epidermal Targeting with Controlled Adapalene Release, Resulting Reduced Skin Irritation.

Adapalene (AD) is one of the main retinoids used in the topical therapy of acne, an extremely common skin disease usually associated with psychological morbidity. However, like other retinoids, AD is frequently associated with skin irritation. To overcome the skin irritation, we proposed the encapsulation of AD in solid lipid nanoparticles (SLNs) using the ion pair strategy. The developed SLN-AD was characterized by high-performance liquid chromatography, differential scanning calorimetry, X-ray diffraction, synchrotron small-angle X-ray scattering, and transmission electron microscopy. In vitro permeation tests using porcine skin and in vivo mice skin irritation test were performed to evaluate, respectively, the drug's skin distribution and the skin irritation. The characterization studies were able to demonstrate that the proposed strategy effectively provided high AD encapsulation in SLNs and its incorporation into a hydrophilic gel. Sustained release, epidermal targeting, and less skin irritation were observed for SLN-AD gel in comparison to the marketed AD gel. The studies demonstrated that the encapsulation of AD in SLNs through the formation of an ion pair is a valuable alternative to diminish the adverse skin reactions caused by AD and can optimize patient adherence to treatment.

Treatment experience of late acne in active reproductive aged women

Current guidelines of acne treatment are not effective in different women. Dissatisfaction with the esthetic results of treatment creates the need to optimize the treatment of late acne in active reproductive aged women.Objective of the study: to evaluate the effectiveness of developed comprehensive method for the treatment of late acne in active reproductive aged women.Materials and methods. 32 patients with acne tarda aged 25–40 years were examined and treated, including women with acne of I degree of severity – 18.8%, II degree – 30.6%, III degree – 46.8%. Biophysical parameters of skin (fat, moisture, elasticity and erythema degree) were determined before treatment, after 3 and 6 months and expressed in arbitrary units. The control group consisted of 8 conditionally healthy women of the corresponding age without acne. Treatment efficacy was evaluated in 3 comparison groups: group 1 – 10 patients who received conventional therapy; group 2 – 12 patients in whom traditional therapy was combined with combined oral contraceptive (COC) Belara, group 3 – 10 patients in whom traditional therapy was combined with COC Belara and Richter CycloBalance.Results. A comparative analysis of the inflammatory dynamics (papules, pustules, nodes, cysts) and non-inflammatory rash elements (open and closed comedones), skin biophysical parameters (fat, porosity, hydration, erythema, elasticity) before treatment, after 3 and 6 months of therapy showed the advantage of combined use COC Belara and Richter CycloBalance in the complex treatment of late acne in active reproductive aged women.Conclusion. Complex therapy of late acne in active reproductive aged women with COC Belar and Richter CycloBalance increases the effectiveness of therapy and aesthetic skin status.

Racial and Ethnic Disparities in Access to Emerging and Frontline Therapies in Common Dermatological Conditions: A Cross-Sectional Study

ObjectiveThis study investigates possible race- and ethnicity-related disparities in the treatment of acne, atopic dermatitis, and psoriasis of newly approved treatments as well as existing therapies. MethodsAggregate level data was collected from patient medical records between 2013 and 2018. The odds ratio of patients who had been prescribed treatments for acne, atopic dermatitis, and psoriasis per racial and ethnic group were calculated using a 95% confidence interval after applying Bonferroni correction to account for multiple comparisons. ResultsBlack patients with acne had statistically significant (p < 0.001) lower odds of receiving isotretinoin 0.26 [0.22–0.30], adapalene 0.72 [0.67–0.78], tazarotene 0.74 [0.64–0.86], and dapsone 0.39 [0.34–0.45] than white patients. The exceptions were tretinoin 1.28 [1.23–1.34] and benzoyl peroxide 3.00 [2.79–3.23] (p < 0.001). Hispanic patients with acne had statistically lower odds of receiving tretinoin 0.86 [0.79–0.95] (p < 0.001) compared to non-Hispanics. Black patients with atopic dermatitis were less likely to receive desonide 0.90 [0.78–0.93], tacrolimus 0.75 [0.68–0.83], pimecrolimus 0.71 [0.60–0.84], crisaborole 0.39 [0.26–0.57], dupilumab 0.42 [0.27–0.65]. The exception was hydrocortisone 2.50 [2.34–2.65] (p < 0.001). There was no statistically significant difference for Hispanics compared to non-Hispanics. Black patients with psoriasis had a lower likelihood of receiving cyclosporine 0.54 [0.35–0.83] and etanercept 0.65 [0.49–0.87]. ConclusionsThis study demonstrates a racial and ethnic disparity in accessing newly approved and standard of care medical therapies for acne, atopic dermatitis, and psoriasis within the past three years.

Minocycline Topical Foam: A New Drug for the Treatment of Acne.

To review the safety and efficacy of minocycline 4% topical foam for the treatment of moderate to severe acne vulgaris in adults and pediatric patients aged 9 years and older. A literature search through PubMed and EMBASE was conducted using the following keywords: FMX101, minocycline, foam, and acne. Articles selected included those describing preclinical and clinical studies of pharmacokinetics, efficacy, or safety of topical minocycline foam. Minocycline 4% topical foam was shown in a preclinical study to effectively deliver minocycline to the pilosebaceous unit, with little penetration beyond the stratum corneum. This was consistent with a phase 1 pharmacokinetic study of the foam, which yielded a significantly reduced systemic exposure of minocycline compared with oral minocycline. In phase 2 and phase 3 clinical trials, the foam significantly reduced acne lesion counts and Investigator's Global Assessment scores of acne severity compared with placebo. The foam has a good safety profile, with headache, mild erythema, hyperpigmentation, and mild dryness among the most common adverse effects. Topical antibiotics have been a mainstay of acne therapy with the benefit of less systemic exposure compared with oral antibiotics. However, the development of bacterial resistance has reduced their use, thereby reducing options for many patients with acne. Minocycline 4% topical foam is a safe and effective alternative, which may help restore this important therapeutic approach for treating acne vulgaris.