Treatment Of Acne In Patients Research Articles

Trifarotene: a new chapter in the treatment of acne. An overview of the data on efficacy and safety profile of a fourth-generation retinoid

Vulgar acne is a chronic inflammatory skin disease that has a significant impact on patients' quality of life. The search for new highly effective and treatments with favorable safety profile remains relevant due to the high incidence in the population. The launch of a 4th generation retinoid, trifarotene, which has a selective mechanism of action on RAR-γ (γ-retinoic acid receptors agonist), represents a new era in topical therapy of acne vulgaris and is of particular interest to practical healthcare. A systematic literature overview in PubMed, Google Scholar, and ClinicalTrials.Gov databases was conducted to evaluate the mechanism of action, efficacy, and safety profile of the selective 4th generation retinoid, trifarotene 50 µg/g (0,005%) in dosage form topical cream. In a systematic overview, 12 contemporary studies (2015–2023) were selected confirming the high efficacy of trifarotene in protocols for the treatment of acne vulgaris with localization on both facial and truncal skin. The drug demonstrates a unique ability to modulate cell adhesion, optimize transepidermal water loss and reduce the activity of membrane metalloendopeptidases, which determines its proven efficacy. Trifarotene, an innovative 4th generation topical retinoid approved by the FDA in 2019 for the treatment of acne in patients over 9 years of age, opens new possibilities in the treatment of acne vulgaris. Its selective activity to RAR-γ receptors, proven efficacy and favorable safety profile make it a promising agent in therapeutic practice.

Unmet Needs in the Management of Acne Vulgaris: A Consensus Statement.

Acne vulgaris is the most common skin condition in the US, affecting up to 50 million Americans. The American Academy of Dermatology (AAD) guidelines on acne treatment were developed to provide recommendations for the diagnosis, grading, and treatment of acne in adolescents and adults to support clinicians in their therapeutic decision-making process. The most recent acne guidelines were published in 2016, and the approach to care and the therapeutic landscape of acne have evolved since that time. The Acne Management Consensus Roundtable was convened in 2022 to discuss unmet needs in the management of acne. The main focus of the meeting was the role of androgens in acne pathology; the evaluation of clascoterone, the first topical anti-androgen that specifically addresses sebum production in acne; and the identification of the place of clascoterone in therapy. Clascoterone was approved by the US Food and Drug Administration for the treatment of acne in patients 12 years and older in 2020. This report aims to highlight important limitations of the 2016 AAD treatment guidelines and to familiarize practitioners with clascoterone and its indication, efficacy and safety profile, and potential use across diverse patient populations. With its new mechanism of action, clascoterone may be able to fulfill important unmet needs in acne treatment. Baldwin H, Farberg AS, Frey C, et al. Unmet needs in the management of acne vulgaris: a consensus statement. J Drugs Dermatol. 2023;22(6):582-587. doi:10.36849/JDD.7587.

Clear solution for clearer skin

Clear solution for clearer skin

How safe and effective is prescribing oral isotretinoin to treat acne in patients on renal dialysis? A systematic review.

Patients on renal dialysis often develop severe acne. In spite of this, the literature remains scarce about the use of isotretinoin for the treatment of acne in this group of patients, and many clinicians remain apprehensive and hesitant to use it. To systematically review the literature surrounding the safety and efficacy of isotretinoin for the treatment of acne in patients on renal dialysis. Four electronic databases (MEDLINE, Embase, CINAHL, Emcare) were systematically searched in March 2021. The search strategy incorporated the terms 'isotretinoin', 'renal', 'kidney', 'dialysis' and 'acne', along with terms closely related to these. Studies were considered eligible if they reported the use of isotretinoin for treatment of acne in patients with renal impairment or on renal dialysis, and if they had relevant implications to this topic. The search resulted in a total of 63 results. Using the PRISMA approach, 11 articles were deemed relevant to this review: 1 randomized single-blinded placebo-controlled trial, 2 case series, 2 retrospective studies and 6 case reports. Hence the level of evidence was mostly low (Grading of Recommendations, Assessment, Development and Evaluations level 3). This review of the literature suggests that low-dose isotretinoin (10-20 mg) can safely and successfully be used to treat severe acne in patients on renal dialysis, leading to a significant improvement in their quality of life. As the current literature on this topic is scarce, more studies would be beneficial to further establish the safe use of isotretinoin in patients on renal dialysis.

Clascoterone cream (1%) topical androgen receptor inhibitor for the treatment of acne in patients 12 years and older

ABSTRACT Introduction The efficacy of clascoterone cream was demonstrated in two phase three vehicle-controlled clinical trials that enrolled over 1,400 subjects. Its safety profile allowed it to be approved for treating patients as young as 12 years old. During clinical trials, the occurrence of local skin reactions (edema, erythema, pruritus, dryness) was similar to treatment with vehicle alone. Areas covered All publications describing the clinical development of clascoterone cream (cortexolone 17α-propionate) are reviewed and discussed in relation to with existing topical and systemic therapies for acne vulgaris. Expert opinion Clascoterone 1% cream is a novel first-in-class topical androgen receptor inhibitor for the treatment of acne vulgaris. Topical clascoterone 1% cream represents the first new type of therapy for acne treatment in almost 40 years and may become first-line therapy.

13674 Eligibility criteria related to hormone therapy in acne clinical trials

Despite multiple guidelines on acne management, there is a paucity of high-quality data on the treatment of acne among patients receiving hormone therapy. In the United States, this potentially impacts the treatment of acne among 9.1 million women using oral contraceptive pills in 2015-2017 and 2.3 million cisgender and transgender men receiving testosterone replacement therapy. We examined exclusion criteria of acne clinical trials to identify potential barriers to the enrollment of patients receiving hormone therapy. We searched clinicaltrials.gov using the term “acne” from 1/1/2009 to 5/16/2019 for exclusion criteria of acne interventions. Of the 115 studies included, 33% had exclusion criteria related to hormone therapy, including recent changes in therapies such as oral contraceptives, estrogens and anti-androgenic medications within specified time ranges (4 weeks to 1 year). Patients with medication-induced acne or a hormone disorder were excluded in 8.7% and 2.6% of trials, respectively. Other exclusion criteria included current use of oral contraceptives (2.6%), androgen blockers (3.5%), hormone-replacement therapy (1.7%), or any medication (5.2%). Findings were limited to the interventions posted on clinicaltrials.gov. Acne is the most common dermatologic condition in the United States, yet robust evidence guiding the optimal treatment of acne in patients receiving hormone therapy remains scarce. These data highlighted limitations in generalizability of many existing acne clinical trials, as well as the need to expand the eligibility criteria to improve real-world effectiveness of acne treatment across large and diverse populations receiving hormone therapies.

Assessment of Hematological and Inflammatory Parameters in Patients Receiving Isotretinoin Therapy for Acne Vulgaris

Objectives:Isotretinoin (ISO) is a synthetic analog of vitamin A used at the doses of 0.5–2 mg/kg for four to five months in the treatment of moderate to severe acne vulgaris. In the present study, both hematological and inflammatory parameters were retrospectively assessed in patients receiving ISO therapy for acne vulgaris.Method: This study included 352 patients who were admitted to the Dermatology Clinic and received oral ISO for the treatment of acne vulgaris were included in the study. Each patient’s hematological and inflammatory parameters (hemoglobin, hematocrit, thrombocyte, mean platelet volume, leukocyte, erythrocyte, neutrophil, lymphocyte, monocyte, eosinophil, basophil, neutrophil/basophil, thrombocyte/lymphocyte, RDW, PCT and PDW) were evaluated before the treatment and retrospectively evaluated four months after the onset of treatment. Results: After treatment, a significant decrease was detected in the levels of leukocyte, neutrophil and neutrophil to lymphocyte ratio (NLR) (an indicator of inflammation), and a significant increase was detected in the levels of thrombocyte and procalcitonin (PCT).Conclusion: In our study, isotretinoin inhibited the anti-inflammatory effect of isotretinoin treatment of acne in patients with NLR decline after treatment with inflammatory markers. Patients with markedly elevated platelet counts or low leukocyte counts should be closely monitored.

Isotretinoin therapy for the treatment of acne in patients with cystic fibrosis: a case series and review of the literature

Cystic fibrosis (CF) is the most common severe autosomal recessive disorder inCaucasians. Viscous secretionstypically obstruct the lungs, pancreas, and gastrointestinal tract. As disease management improves,patients will increasingly seek care for conditions such as acne. Isotretinoin therapy for acne inpatients with CF is controversial owing to concerns that the medication may exacerbate CF-relatedhepatic, pulmonary, and ocular complications. We describe two patients with CF treated with isotretinoin from our clinic and alsoprovide a literature review of 11 similar cases. We describe patient outcomes, commoncomplications, and the risks for severe adverse effects. The clinical courses of two patients with CF who were treated withisotretinoin for moderate-severe acne are presented. Using PubMed, we analyzed previous casereports of patients with CF who were prescribed isotretinoin and review complications associatedwith systemic retinoids. Based on a synthesis of the literature and our own experience, it appears thatisotretinoin therapy for CF patients with moderate-severe acne may be an appropriate option whenclinically indi ated. If dermatologists monitor lab values and adverseeffects carefully, patients with CF can benefit from isotretinoin therapy.

Take specific considerations into account when treating acne in patients with skin of colour

Treatment of acne in patients with skin of colour can be challenging, mainly due to their propensity to develop cosmetic complications. Topical retinoids are first-line therapy, with alternative topical treatments including antimicrobials, azelaic acid and dapsone. Hydroquinone can be used as a specific treatment for post-inflammatory hyperpigmentation. Oral antibacterials and isotretinoin are effective in the treatment of more severe acne. The early promise shown by lasers and phototherapies as adjunctive therapy for acne requires validation.

Topical Liposomal Gel of Tretinoin for the Treatment of Acne: Research and Clinical Implications

An attempt was made to pharmaceutically develop a topical liposomal tretinoin (TRE) gel and clinically evaluate the developed formulation for the treatment of acne in patients. Liposomes of TRE were prepared using the lipid film hydration technique and the entrapment efficiency of TRE in liposomes was optimized to 79.96%. The drug retention in liposomes and in liposomal TRE gel (Carbopol 934 gel base) studied at three storage conditions indicated maximum drug retention at refrigeration temperature. For liposomal TRE gel, reduced drug leakage was observed as compared to that of liposomes at all three storage conditions. Diffusion studies of plain TRE gel and liposomal TRE gel suggested prolongation (3.4 times reduction in flux value) of drug diffusion and almost two- fold increase in skin drug retention after liposomal encapsulation of drug. A comparative double-blind clinical study of the developed liposomal TRE gel, carried out on 30 acne patients over a period of 3 months, demonstrated significant enhancement (about 1.5-fold) in drug efficacy. More remarkable improvement was observed in the treatment of comedones, where the mean percent reduction in lesions increased from 62.36% for plain TRE gel to 94.17% for liposomal TRE gel. Erythema and irritation associated with the use of plain TRE gel was reduced considerably with the use of liposomal TRE gel. The findings of this investigation therefore underscore potential utility of commercialization of liposomal TRE gel in the treatment of acne.

In-vivo activity of retinoid esters in skin is related to in-vitro hydrolysis rate.

BMS-181163 (4-acetamidophenyl retinoate, previously reported as BMY-30123), the acetamidophenyl ester of all-trans-retinoic acid (tRA), is topically active in various retinoid-sensitive animal models, but was recently shown to be ineffective for the treatment of acne in patients. To determine whether BMS-181163 functions as a prodrug of tRA in mice but not in man, the relative rates of ester hydrolysis in mouse and human skin homogenates were determined. In-vitro hydrolysis assays showed that BMS-181163 was substantially hydrolysed in mouse skin homogenates and minimally in human skin preparations. In addition, a series of phenyl esters of tRA and several known active synthetic retinoids (Ch-80: (E)-4-[3-oxo-3-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthalenyl)-1 - propenyl] benzoic acid; CD-271: 6-[3-(1-adamantyl)-4-methyoxyphenyl]-2-naphthoic acid; and TTNPB: (E)-4-[2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthalenyl)-1- propenyl] benzoic acid) was prepared and hydrolysis rates and in-vivo (rhino mouse utriculi reduction) activities were compared. The hydrolysis rates of the six test retinoid phenyl esters, ranging from 0.06 to 2.0 h-1 were found to correlate with the in-vivo activity. Those esters (BMS-181163 and acetamidophenyl esters of Ch-80 and TTNPB) with a higher hydrolysis rate exhibited in-vivo activity only slightly lower than their parent free acid retinoids. In contrast, the three phenyl esters with a hydrolysis rate less than 0.3 h-1 were inactive in-vivo.(ABSTRACT TRUNCATED AT 250 WORDS)