Severe Acne Research Articles

A Systematic Literature Review and Network Meta-Analysis of Comparative Efficacy of Topical Fixed-Dose Combination Treatments for Moderate to Severe Acne Vulgaris

INTRODUCTION: Several topical and oral monotherapies/combination treatments are available for treating patients with moderate to severe acne vulgaris and a few are currently under review with the United States (US) Food and Drug Administration (FDA). Among these treatments, topical fixed-dose combinations (FDCs) are widely used in the US. No study has assessed the comparative efficacy of topical FDCs based on the treatment success endpoint of the proportion of patients achieving ≥2 grade reduction AND "Clear" or "Almost clear” status by week 12 on an Investigator's Global Assessment (IGA) or equivalent scales. The objective of this study was to conduct a systematic literature review (SLR) and network meta-analysis (NMA) to compare the efficacy of topical FDCs for the treatment of moderate to severe acne.
 STUDY DESCRIPTION: An SLR was conducted for identifying randomized controlled trials (RCTs), that included at least one topical FDC (currently approved/under review with FDA) arm, in academic (MEDLINE, Embase, Cochrane CENTRAL, PEDE, and NHS EED) and non-academic databases (HTA databases, conference abstracts databases, and trial registries). The search was conducted in May 2022, based on a pre-specified inclusion/exclusion criterion. RCTs included in the analysis evaluated acne severity using IGA or equivalent (Evaluator's Global Severity Score, Investigator’s Static Global Assessment) scales. A Bayesian network meta-regression was conducted, using the proportion of patients with moderate acne, inflammatory and non-inflammatory lesion counts at baseline as covariates to account for acne severity.
 RESULTS: Twelve Phase II/III/IV RCTs were identified from 5,159 citations comprising 8,349 patients across 8 treatment groups. The odds ratio for treatment success with topical FDC of clindamycin phosphate 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1% (first triple agent FDC) gel was estimated to be 7.61 (95% Credible Interval: 4.44 –13.20) in comparison to Vehicle gel. Comparative effectiveness ranking demonstrated that the topical triple agent FDC gel was the most effective treatment with surface under cumulative ranking of 100%.
 CONCLUSION: Based on this SLR/NMA, the topical triple agent FDC of clindamycin phosphate 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1% gel, which is currently under FDA review (PDUFA date 10/20/2023), was clinically superior to all other topical FDC treatments for moderate to severe acne vulgaris.

Efficacy and safety of isotretinoin Lidose®

Introduction. Acne is a common chronic inflammatory disease, which is accompanied by severe social stress and reduces the quality of life of patients. Isotretinoin is the gold standard for the treatment of severe and moderate forms of acne, and is also used when there is a risk of developing a post-acne symptom complex and when previous treatment methods are ineffective.Purpose of the study. To determine the effectiveness and safety of various isotretinoin regimens at a dose of 0.4–0.8 mg/kg in patients with moderate to severe acne vulgaris and in patients with adult acne.Materials and methods. A single-center, prospective, parallel, controlled study involved 139 patients with acne vulgaris and adult acne, who were divided into 3 groups. 72 patients with acne vulgaris of moderate severity according to the IGA scale (group A1) and 37 patients with adult acne (group B) received isotretinoin (Accutane) at a dose of 0.4 mg/kg/day (cumulative dose 100 mg/kg) for 8 months. 30 patients with severe forms of acne vulgaris (group A1) received Accutane at a dose of 0.8 mg/kg/day (cumulative dose 120 mg/kg) for 8 months. The study lasted 24 months. and consisted of 4 visits (1st visit, 4, 8 and 24 months), at each visit photocontrol was performed, the number of inflammatory and non-inflammatory elements was calculated, the DAI index and the degree on the IGA scale were determined.Results. All 139 patients achieved ‘clear’ or almost ‘clear’ skin according to the IGA scale after 8 months of therapy. There was also a statistically significant decrease in non-inflammatory and inflammatory elements in all groups after 4 and 8 months. (p < 0.001). The total DIA score after 8 months was reduced in group A1 by 89.2%, in group A2 by 83.78% and in group B by 80.3%. Acne recurrence after 24 months was determined in five patients.Conclusions. Various regimens of Accutane for moderate and severe acne vulgaris, as well as adult acne, have demonstrated high efficacy and a favorable safety profile.

ACNE AND INSULIN RESISTANCE: A SYSTEMATIC REVIEW

Acne is a skin disorder that is characterized by persistent inflammation and involves the folliculopilosebaceous unit. It has an impact on a sizeable portion of the general population. Acne affects a disproportionate number of females and teenagers, especially those between the ages of 15 and 24, who are most susceptible to the condition. In recent times, there has been seen to be a growing interest in the possible connection between acne and insulin resistance (IR). This attention has been seen, and it is appreciated. It would appear that IR has a strong connection to acne, which is a persistent skin condition that can lead to inflammation. Research has been conducted on a wide variety of etiopathological factors that have been associated with the progression of IR. It would appear that obesity is one of the most common. Additionally, it would appear that factors such as chronic inflammation, hypertriglyceridemia, low HDL serum concentration, mitochondrial dysfunction, gut microbiota, and the excess activity of antagonistic hormones such as cortisol, glucagon, and thyroid hormones all play a significant role in the development of this condition. We identified a linkage between insulin resistance and severe acne vulgaris, which was reported to have a positive link with insulin resistance. On the basis of these findings, it is a legitimate assumption to hypothesize that medications that are now utilized for the treatment of insulin resistance would also be helpful for the treatment of severe acne vulgaris.

The efficiency and safety of low-dosage isotretinoin therapy for Chinese acne vulgaris patients.

Acne vulgaris is one of the most common skin conditions in dermatology clinics. Accumulating evidence has implicated oral low-dosage isotretinoin was an effective treatment for acne with fewer side effects. Currently, the data on low-dosage isotretinoin use in Chinese is limited. To investigate the efficiency and safety of low-dosage isotretinoin therapy for Chinese acne patients. Three hundred and eighty-eight patients treated with low-dosage isotretinoin (0.2-0.4 mg/kg/d) and who completed the course (120 mg/kg) were enrolled. Medical information on the severity, duration, adverse effects, and outcome of acne was reviewed. The majority (90.2%, n = 350) of patients achieved complete remission, and on average, patients received 13.5 months of treatment. The time between isotretinoin start and the clear date between the mild and moderate groups was not significantly different (74 ± 24 vs. 84 ± 24 days). However, it took longer to resolve for the severe acne group (112 ± 25 days). Follow-up 1 year after completion of the isotretinoin course, 37/350 (10.6%) patients relapsed, but there was no difference in the severity of acne. There were 133 (34.3%), 40 (10.3%), and 14 (2.6%) patients who developed hypercholesterolemia, hypertriglyceridemia, and high LDL, respectively. Thirty-two (8.2%) and 28 patients (7.2%) had elevated serum levels of alanine and aspartate aminotransferases. No values above grade 2 were detected. This study reaffirms the efficacy and safety of low-dosage oral isotretinoin in Chinese patients with acne vulgaris. Lab investigation could be performed after 2 months of therapy in healthy patients with normal baseline liver function and lipid panel tests.

Prévalence et impact psychologique de l’acné en milieu scolaire de Kinshasa, République Démocratique du Congo

Context and objective: Acne affects approximately 80% of adolescents and impacts their quality of life. Our Objective was to: describe the quality of life of acne-prone schoolchildren in Kinshasa. Materials and method: This were a descriptive cross-sectional study conducted in schools in Kinshasa for 2 months. Every student aged from 10 to 19 years, regularly enrolled, who gave their verbal consent and for whom parental consent was obtained, were included. Sampling was random at 4 degrees. The ECLA and CADI grids were used to assess acne severity and quality of life. Data were analyzed using SPSS 21.0 software. Associations between variables were assessed using Pearson’s chi-square test. A value of p < 0.05 was considered as the threshold of statistical significance. Results: The prevalence of acne was of 58%, with a female predominance (54%) and a sex ratio of 1.2. The average age was 15.3±2.2 years, with extremes ranging from 11 to 19 years. 53.4% of the students had a heredofamilial history of acne. The mean age at onset was 13.1±1.9 years. The mean age at menarche was 11.5±3.3 years. Inflammatory lesions were numerous on the face (96.6%). 10.3% of students had severe acne. The total score of the ECLA grid varied from 2 – 19, with an average of 7.3 and a median of 7. The quality of life was slightly impaired in 87.7% of the cases without being linked to sex but associated with acne severity (p = 0.022). The high frequency of severe acne was observed in students with a moderate quality of life (27.8%). Conclusion: The alteration of the quality of life of a student with acne is effective in schools in Kinshasa, without proportionality with the seriousness of the pathology. The dermatologist to resort to the use of the ECLA and CADI grids for a comprehensive management of juvenile acne.

Evaluation of the Effect of Oral Isotretinoin on the Level of Serum YKL40 in Acne Vulgaris Patients: A Cross-Sectional Case-Control.

In the entire world, acne vulgaris (AV) is the most prevalent skin condition. Approximately 9.4% of people worldwide have acne vulgaris. This study compared the blood levels of chitinase 3-like protein 1 (YKL-40) in acne vulgaris patients before and after oral isotretinoin therapy. The design of the study was cross-sectional case-control. Forty patients with moderate to severe acne vulgaris and twenty healthy participants participated in this study. Using the Global Acne Grading System (GAGS) score, patients with acne vulgaris were evaluated both before and after concluding their treatment. Using the enzyme-linked immunosorbent assay (ELISA), the serum levels of YKL-40 were measured before and after oral isotretinoin therapy in healthy controls and acne patients. Patients with acne vulgaris had considerably greater serum levels of YKL-40 than healthy control subjects (p 0.001) did. After three months of oral isotretinoin medication, the GAGS score and blood levels of YKL-40 in acne vulgaris patients both significantly decreased. The conclusion of this study was that reducing the blood levels of YKL-40 and the GAGS score in patients with acne vulgaris who took oral isotretinoin for three months was a crucial strategy.

Adapalene Gel Therapy in Patients with Moderate to Severe Acne Vulgaris

Acne is a chronic inflammatory disease of pilosebaceous units. Topical Adapalene is the most effective despite the availability of various treatments. Abnormalities in plasma lipids are recognized side effects of Adapalene therapy. Minimal reports compare the lipid changes in intermittent and continuous Adapalene treatment. To evaluate the alteration in lipid profile before, during, and after constant/ intermittent topical Adapalene therapy. One hundred patients with moderate to severe acne were randomly assigned to two treatment regimens. Serum levels of lipids were measured at baseline, 4wk, 8wk, 12wk, 16wk, and at the end of the treatment. A significant increase in cholesterol, triglyceride, and LDL concentration and a decrease in HDL levels in a continuous regimen beyond the normal range but not requiring any treatment interruption compared to intermittent therapy. In intermittent therapy, the cholesterol, triglyceride, and LDL concentration increase was within the normal range. Intermittent Adapalene therapy was clinically equally effective, with lesser effects on serum lipid levels and cost than continuous Adapalene therapy.

Analysis of correlation between insulin resistance and severity of acne vulgaris

Blood glucose levels in the disease activate the free IGF-1 which promotes lipogenesis of sebaceous glands thus leading to acne formation. The study was aimed to analyze the correlation between insulin resistance and the severity of acne vulgaris. A total of 100 patients clinically diagnosed with acne vulgaris were enrolled in the study. The severity of the acne was evaluated using the GAGS system. The HOMA-IR index was used for the analysis of insulin resistance. The mean age of the patients was 22.13 years with a predominance of females i.e., 76%. GAGS score revealed 89% of patients had mild acne, 9% of patients had moderate acne and 2% of patients had severe acne. As per the HOMA-IR index cutoff value of 2.5, 35% of patients in our study had insulin resistance. A significant positive correlation was observed between the acne vulgaris and insulin resistance. Early treatment of insulin resistance can help evaluate a patient’s metabolic aspects that should be helpful in the diagnosis and treatment of various other skin conditions associated with it apart from acne vulgaris such as acanthosis nigricans, acrochordons, etc., and improving the health and the quality of care for these patients.

Artificial intelligence analysis of over a million Chinese men and women reveals level of dark circle in the facial skin aging process.

To better compare the progression of dark circles and the aging process in Chinese skin. A total of 100589 Chinese males and 1838997 Chinese females aged 18 to 85, without facial skin conditions, and who had access to a smartphone with a high-resolution camera all took selfies. Using a smartphone application with a built-in artificial intelligence algorithm, facial skin diagnostic evaluated the selfies and score the severity of the dark circles with four other facial indicators (including skin type, Pores, Acne vulgaris, and Blackheads). Basic information was collected with online questionnaire, including their age, gender, skin sensitivity, and dietary habits. In users between the age of 18 and 59, the prevalence of comprehensive, pigmented, and structural type of dark circles all rose with age. However, between the age of 60 and 85, the intensity of all types of dark circles diminished. Besides, vascular dark circles progressively worsen from the age of 18 to their peak at 39, and then gradually decline with age. Females typically have more pronounced black circles under their eyes than males in China. Bad eating habits, urbanization, regular cosmetics use, and sensitive skin positively correlate with severe dark circles. Vascular, comprehensive dark circles were worse in spring. Both pigmented and structural dark circles were worse in the summer. The results indicated that the intensity of dark circles was influenced by oily skin, wide pores, severe blackheads, and severe acne. Chinese men and women differed noticeably in the prevalence of each face aging indicator and the appearance of aging dark circles. Selfies could be automatically graded and examined by artificial intelligence, which is a quick and private method for quantifying signs of facial aging and identifying major problems for different populations. Artificial intelligence would assist in the development of individualized preventive and therapeutic interventions.

Analysis of the effectiveness of PDT with 5-aminolevulinic acid in comparison to blue/red light combined with intralesional triamcinolone injection in treatment of severe inflammatory acne: A retrospective study.

In this study, the therapeutic effect of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in comparison to blue/red light combined with intralesional triamcinolone injection for severe inflammatory acne was evaluated and analyzed. One hundred and four cases of severe inflammatory acne were analyzed in this study. They were divided into two groups as control and observation groups, 52 cases in each group. The control group (group A) received red and blue light combined with triamcinolone injection and lidocaine injection (1:4), while the observation group (Group B) was treated with ALA-PDT. Finally, the therapeutic effect and the occurrence of adverse reactions were compared between the two groups. After 2, 4 and 6 weeks, the effectiveness rates of group B was 28.85%, 75.00%, and 86.54%, respectively while it was 9.62%, 51.92%, and 69.23%, respectively in group A. The difference between A and B was statistically remarkable (χ2 = 6.1905, 5.9713, 4.5217, p = 0.0128, 0.0145, 0.0335 at p < 0.05). In addition, the incidence of adverse reactions in B was 5.77%, lower than A (32.69%). This difference between A and B was statistically remarkable (χ2 = 12.1333, p = 0.0005). After 2, 4, and 6 weeks of treatment, the number of residual lesions in the group B group was remarkably lower than group A (p < 0.01). There was remarkable difference in the incidence of pain, burning sensation, pigmentation and erythema between the two groups. The therapeutic effect of ALA-PDT in the treatment of severe acne is better than red blue light combined with triamcinolone injection and lidocaine injection. In addition, ALA-PDT has an ideal effect in the treatment of severe acne.

Effect of interleukin-12 gene expression on insulin resistance in patients with acne vulgaris.

Insulin resistance (IR) is a condition where cells become resistant to insulin, causing impaired glucose uptake and increased blood glucose levels. Interleukin-12 (IL-12), a cytokine, regulates the immune system. High levels of IL-12 can lead to chronic inflammation, exacerbate resistance to insulin, and contribute to type 2 diabetes. Also, link IR to acne vulgaris (AV), as it reduces tissue sensitivity to insulin, causing increased insulin levels and sebum production, which can contribute to acne development. To explore the role of IL-12 gene expression on IR in AV patients and to study the role of IL-12 gene in the development of AV. A case-control study was performed on 68 AV patients and 68 healthy controls. The biochemical analysis included fasting glucose, fasting insulin, (HOMA-IR), and serum IL-12 level. IL-12 gene expression was performed by quantitative real-time PCR for both two groups. In addition, folding change was calculated by using the standard 2-(∆∆Ct) method. IL-12 level, IL-12 folding change, fasting insulin, and IR were all increased in acne patients. A highly significant linear correlation was found between IL-12 folding change and both IL-12 levels and IR. There is a substantial positive significant simple linear association between IL-12 level and IL-12 folding change, as well as IR and IL-12 folding change, in moderate and severe acne. IL-12 gene has an important role in IR and the development of acne in AV patients.

QUALITY OF LIFE IN ACNE PATIENTS USING ISOTRETINOIN AT CAN THO HOSPITAL OF DERMATO- VENEREOLOGY IN 2023

Background: Acne vulgaris is a common chronic skin disease that mainly occurs during puberty. Although acne vulgaris is not life-threatening, it has physical symptoms such as a rash, pain, and stinging. It also affects patients psychologically (such as friendship issues, workplace trouble, bad appearance, self-deprecation, shame, anger, anxiety, emotional burden, etc.), socially (dislike, feeling stigmatized, etc.), and mentally (anxiety, depression, and suicidal thoughts). All of these problems severely reduce the patient's quality of life. In Vietnam in general and at Can Tho Dermato-Venereology Hospital in particular, acne is one of the leading causes of patients coming for examination and treatment. However, few studies on the quality of life of acne patients have been done. Objectives: To determine the rate of impact on quality of life and some related factors in patients with moderate to severe acne at Can Tho Dermato-Venereology Hospital in 2021-2023. Materials and methods: A cross-sectional descriptive study analyzed 92 patients with acne at Can Tho Dermato-Venereology Hospital. Results: In our study, 43.5% of patients were female, 53.7% were male; and the majority of patients (55.4%) were aged 19 years old and over, compared to 44.6% aged under 19. The disease duration under 1 year was 33.7% and from 1 year or more 66.3%. Severe and very severe acne accounted for 73.9%, and moderate acne was 26.1%. For acne-induced QoL impairment by CADI score, there was no impairment (CADI=0) in 4 (4,3%), mild impairment (CADI=1-5) in 12 (13%), moderate impairment (CADI=6-10) in 48 (52,2%) and severe impairment (CADI=11-15) in 28 (30,4%). The severity of impairment was associated with acne grade (p=0,038). In view of acne grade, the level of QoF impairment among severe and very severe acne (97,1%) outgrew it in moderate acne (83,3%). The severity of impairment was associated with occupation (p=0,033) and the duration of acne (p=0,016). Conclusions: There was no impairment in 4 (4,3%), mild impairment in 12 (13%), moderate impairment in 48 (52,2%) and severe impairment in 28 (30,4%). The severity of impairment was associated with occupation (p=0,033), duration of acne (p=0,016), and acne grade (p=0,038).

Durability of the improvement of collagen I and collagen III with the use of oral isotretinoin in the treatment of photoaging.

Oral isotretinoin (ISO) is the drug of choice for the treatment of severe acne. For photoaging treatment, ISO has been proved to be effective in some controlled and noncontrolled trials and is an alternative to topical retinoic acid (RA) therapy, which causes an expected skin irritation. To evaluate and compare the skin remodeling in patients taking ISO 20 mg 3 times a week for 12 weeks and 12 weeks after the end of the treatment to quantify collagen I and collagen III augmentation. Immunohistochemical studies were performed to evaluate the expression of collagen I and collagen III, metalloproteinases (MMPs) -1, -3, -7, -9, -12, and the tissue inhibitor of MMP type-1 (TIMP-1) of the skin of 20 45 to 50-year-old women through morphometry in a semiquantitative method. The inclusion criteria were facial aging 2 and 3 of Glogau's classification, with phototypes between II and V who had not entered menopause. Biopsies of the skin of the left preauricular region were performed at three different times: pre-treatment (T0), end of 12-week treatment (T1), and 12 weeks posttreatment (T2). Collagen fibers I and III increased with statistical significance in T1 (50.7%; P = 0.012) but not in T2 (49.7%), which in turn was higher than in T0 (47.2%) for collagen I and T1 (33.3%; P = 0.002) but not in T2 (32.7%), and also was higher than T0 (32.0%) for collagen III. MMP-9 presented a decreased activity with statistical significance in T1 (P = 0.047) and T2 (P = 0.058). MMP-1 showed a reduction in T2 only (P = 0.015). MMPs -3, -7, -12, and TIMP-1 did not present significant modification in their expressions during or after the treatment. Low-dose ISO is effective in remodeling the extracellular matrix (ECM). This study found that the increase of collagen occurs through the augmentation of both collagen I and collagen III fibers. With originality, it was possible to verify the durability of these fibers for at least 12 weeks. This may be related to the decrease in MMP-9 expression verified at the end of the treatment and 12 weeks posttreatment.

Retrospective analysis of the results of systemic therapy of moderate to severe papulo-pustular acne

Background: Systemic isotretinoin is an effective treatment for acne, but the significant relapse rate requires a search for optimal daily doses to prolong disease remission.&#x0D; Purpose: To compare the results of systemic therapy of moderate-to-severe resistant and severe papulopustular pustular acne with isotretinoin at daily doses of 0.5; 0.7 and 1.0 mg/kg body weight.&#x0D; Methods: In a retrospective study, data from outpatient records and facial skin corneometry results of 125 individuals (95 acne patients, 30 healthy individuals) were analyzed. Patients with acne received isotretinoin (Sotret)at a daily dose of0.5; 0.7 or 1.0 mg/kg body weight, with a cumulative dose of 120 mg/kg body weight in all patients. The duration of follow-up of patients, according to outpatient records, was 18 months.&#x0D; Results: Isotretinoin systemic therapy was effective in patients in all compared groups. The resolution of inflammatory elements was faster (p0.001) in those who received doses of isotretinoin 0.7 and 1.0 mg/kg body weight. After treatment, elevated values of sebumetry, skin relief, pore size, and pigmentation were normalized in all groups. There was a significant difference in the incidence of adverse events depending on the dose of isotretinoin. The number of patients with relapses registered at 18-week follow-up after therapy in Group I was 6 (18.75%); in Group II, 4 (12.5%); in Group III, 1 (3.2%), the differences between the groups being significant (p=0.003).&#x0D; Conclusion: Therapy of moderate-to-severe resistant and severe papulopustular acne with systemic isotretinoin (Sotret) at daily doses of 0.5; 0.7 and 1.0 mg/kg at a cumulative dose of 120 mg/kg body weight demonstrates comparable clinical efficacy. However, recurrence rates during the 18-month follow-up period correlated with the daily dose of the drug.

P20 Thoracic outlet obstruction – first presentation of a rheumatological disorder

P20 Thoracic outlet obstruction – first presentation of a rheumatological disorder

The use of a combination drug with adapalene/metronidazole for acne

The latest advances in the research of the effect of skin microbiome on the occurrence of acne raised the need for the development of new effective treatments for the long-term use in persistent or recurrent disease. The review presents an analysis of foreign and domestic studies on the issues of pathogenesis and treatment of acne. The latest data on the role of skin microbiome imbalance in the occurrence of acne are presented. The Cutibacterium acnes phylotypes diversity loss acts as a trigger for innate immunity activation and chronic inflammation in acne. We show the main directions in the treatment of acne based on international and Russian clinical guidelines. Today, a new solution in acne therapy lies in a multimodal approach to the impact on various links in the pathogenesis of acne to increase therapeutic efficacy, safety, and patient adherence to therapy. The place of topical fixed-dose combination drugs in the treatment of mild to moderate acne has been determined. Due to the growing resistance to antibiotics and their more limited use, it was observed that there is a need to develop new effective treatments for the long-term use. The studies showed that the fixed combination of adapalene/metronidazole is a highly effective treatment for moderate to moderately severe papulopustular acne. The comparative analysis of the use of fixed-dose combinations of adapalene/metronidazole and adapalene/clindamycin in the treatment of patients with acne revealed the comparable efficacy and good tolerability of both combinations. The findings of foreign and domestic studies have proved that the adapalene/metronidazole combination is an effective and safe drug to treat mild to moderate acne.

Burden of treatment in severe acne vulgaris

AbstractBackgroundAcne is associated with a significant burden of disease related to the visual impact of facial lesions, symptoms such as pain, and sequelae such as scarring. However, little research has been performed on the acne‐specific burden of treatment (BOT), defined as the workload of healthcare as well as its impact on functioning and well‐being.ObjectivesThe aim of this study was to examine the BOT of moderate‐severe acne.MethodsA prospective study was performed in our tertiary dermatology department. Patients attending the dermatology department with moderate‐severe acne (defined as an Investigator's Global Assessment of acne severity of 3 or 4) were invited to complete a validated BOT questionnaire, modified for use in acne, with additional qualitative components.ResultsOf 50 patients, 68% were female, with a mean age of 22.6 years (range 16‐45 years). Most (82%, n = 41) patients were on isotretinoin, with 18% (n = 9) on oral antibiotics. The average BOT was 4.2/10 (range 0–8.2) for topical therapies, 4.5/10 (range 2.7–6.8) for oral antibiotics, and 3.8/10 (range 0.69–6.9) for isotretinoin. From qualitative statements, the greatest burdens reported with topical treatment were unpleasant sensations, skin sensitivity, skin dryness, and lack of efficacy; with antibiotic therapy were the requirement for long‐term treatment, limited efficacy, and side‐effects including gastrointestinal upset; and with isotretinoin therapy were cheilitis and xerosis, cost, and need for blood tests. However, 58% (n = 29) of patients believed their overall BOT was decreased with isotretinoin, and 18% (n = 9) felt that it was unchanged with isotretinoin, with statements such as “the side effects can be tough, but the result is definitely worth it.”ConclusionsThe BOT associated with oral isotretinoin is similar or lower to topical therapies and oral antibiotics. This should be taken into consideration when optimizing the care of patients with acne.

Efficacy and Safety of Topical Versus Systemic Isotretinoin for Acne Vulgaris Treatment: A Systematic Review

Introduction: Oral Isotretinoin has been used for years to successfully treat and manage severe acne. Topical isotretinoin has also been used to manage acne. However there exist very few studies that assess the safety and efficacy of topical isotretinoin. The aim of this systematic review is to evaluate available literature that report on the safety and efficacy of topical isotretinoin particularly in the management of acne. Methods: A systematic review of existing literature. Online searches were conducted on various databases including PubMed, PubMed Central, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, Web of Knowledge, PsycINFO and Scopus. Studies were assessed for eligibility using the specified inclusion and exclusion criteria. The researchers independently reviewed the abstracts and differences were settled by a consensus. Relevant data was extracted from eligible studies, including author and year of publication, study type, research design, number of participants, study aim and main findings from each study. Results: Out of the 274 studies identified through search of databases and registers, 11 studies met the criteria for inclusion in the systematic review. A total of 1129 patients were included in the systematic review. The studies were from different geographical regions and countries. The studies found that topical isotretinoin was used in the management of acne and other dermatological conditions. Conclusion: Topical isotretinoin is comparatively effective for the treatment of acne vulgaris of various degrees of severity, with minimal side effects. Further research is needed to understand its long-term safety, especially for high-risk populations. With appropriate monitoring, primary care clinicians should consider it for moderate to severe acne, especially in high-risk populations for whom the use of oral isotretinoin could be problematic or is contraindicated.

Efficacy of Isotretinoin in The Management of Enlarged Facial Pores in Moderate and Severe Acne Vulgaris Patients

Efficacy of Isotretinoin in The Management of Enlarged Facial Pores in Moderate and Severe Acne Vulgaris Patients

44255 Impact of acne on social functioning, emotional functioning, and activities of daily living(ADL) among patients with moderate to severe non-nodular Acne Vulgaris (AV) administered sarecycline in community practices across the U.S: Race stratified analysis

44255 Impact of acne on social functioning, emotional functioning, and activities of daily living(ADL) among patients with moderate to severe non-nodular Acne Vulgaris (AV) administered sarecycline in community practices across the U.S: Race stratified analysis