Pathogenesis of acne vulgaris: recent advances.

Acne vulgaris is the most common disorder seen in ambulatory dermatology practice. Acne causes significant morbidity and the direct costs associated with it exceed $2.2 billion per year in the United States (U.S.). The pathogenesis is multifactorial, and our understanding of the mechanisms involved in the development of acne lesions has improved with time. Follicular hyperkeratinization, sebum production, presence of Propionibacterium acnes (P. acnes), inflammatory mediators, and androgens have been identified as key components of acne pathophysiology. Recent advances have been made in this area with the discovery of P. acnes interaction with Toll-like receptors (TLRs), vaccines targeting P. acnes or its components, antimicrobial peptides and the role of hormones.

Daily application of fluocinonide 0.1% cream for the treatment of atopic dermatitis.

OBJECTIVE: To assess the efficacy and safety of topical fluocinonide 0.1% cream for the treatment of atopic dermatitis. DESIGN: In this double-blind, vehicle-controlled study, patients were randomized to receive treatment with fluocinonide 0.1% cream applied once (n=109) or twice daily (n=102) or vehicle applied once (n=50) or twice daily (n=52) for two weeks. SETTING: Multicenter, outpatient. PARTICIPANTS: Patients aged 18 years or older with atopic dermatitis affecting at least two percent but less than 10 percent of body surface area. MEASUREMENTS: Efficacy and safety measures included lesion severity, pruritus, hypothalamic-pituitary-adrenal axis suppression, and adverse events. RESULTS: Fluocinonide 0.1% cream applied once or twice daily was more effective than cream vehicle. Both regimens were similarly efficacious after two weeks of treatment. At the end of treatment, lesions were cleared or almost cleared in 59 percent of subjects treated once daily and 57 percent of subjects treated twice daily with fluocinonide 0.1% cream. Further, considerable residual benefit remained after cessation of twice-daily versus once-daily treatment. Skin safety evaluations showed no significant adverse effects of treatment on signs or symptoms of skin atrophy. Fluocinonide 0.1% cream and vehicle treatments did not differ significantly in their suppression of the hypothalamic-pituitary-adrenal axis, nor did hypothalamic-pituitary-adrenal axis suppression differ significantly following once- or twice-daily treatment with fluocinonide 0.1% cream. Fluocinonide 0.1% cream was well tolerated. CONCLUSION: Once- or twice-daily topical application of fluocinonide 0.1% cream for 14 days was safe and effective for treating atopic dermatitis in this adult patient population. The efficacy of once-daily application was comparable to twice-daily application.

Atypical mycobacterial cutaneous infections.

Atypical mycobacterial infections have been a cause of steadily growing infections over the past decades, especially in immunocompromised patients. They are classified by their ability to produce pigment, growth rate, and optimal temperature. Mycobacterium marinum, M. kansasii, and M. avium-intracellulare are examples of slow-growing mycobacteria. M. fortuitum, M. chelonei, and M. abscessus are examples of rapidly growing mycobacteria. Atypical mycobacteria are ubiquitous in the environment. No specific treatment guidelines exist but a multidrug regimen combined with surgical modalities is often used for therapy.

Clindamycin phosphate 1.2%- tretinoin 0.025% gel: vehicle characteristics, stability, and tolerability.

An aqueous gel formulation containing solubilized clindamycin phosphate 1.2% and a stable combination of both solubilized and crystalline tretinoin 0.025% (clin/tret) has been evaluated in 3 pivotal phase 3 studies, among other studies including a 52-week trial. The pivotal studies enrolled 4550 participants 12 years and older with mild, moderate, and severe acne vulgaris. The combination clin/tret gel was effective in reducing both inflammatory and noninflammatory lesions and was well-tolerated. This article reviews important vehicle characteristics of the combination gel as well as formulation stability and tolerability data that are potentially clinically relevant.

Dermatofibrosarcoma protuberans: a case report and review of the literature.

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing fibrohistiocytic neoplasm that commonly favors young to middle-aged adults. It is most commonly seen on the trunk and frequently recurs locally after an incomplete excision, but distant metastasis is rare. Mohs micrographic surgery (MMS) is the treatment of choice for DFSP.

An Aluminum Magnesium Hydroxide Stearate-based Skin Barrier Protection Cream Used for the Management of Eczematous Dermatitis: A Summary of Completed Studies.

Eczematous dermatoses can often be very difficult to treat. An aluminum magnesium hydroxide stearate-based cream has recently become available for clinical use. Aluminum magnesium hydroxide stearate-based cream provides an alternative option in treating these dermatoses while providing barrier protection against external allergens and irritants. This article reviews various studies evaluating aluminum magnesium hydroxide stearate-based cream.

Oral trimethoprim/sulfamethoxazole in the treatment of acne vulgaris.

Oral trimethoprim/sulfamethoxazole (TMP-SMX) is approved by the US Food and Drug Administration for the treatment of urinary tract infections, shigellosis, acute otitis media in pediatric patients, and Pneumocystis carinii pneumonia. TMP-SMX has been used off label in dermatology to treat various skin conditions, including acne vulgaris and other skin and soft tissue infections, especially those infections caused by methicillin-resistant Staphylococcus aureus.