Isotretinoin Laboratory Monitoring in Acne Treatment: A Delphi Consensus Study.

Importance: Although isotretinoin may rarely be associated with laboratory abnormalities such as hypertriglyceridemia, the optimal approach to laboratory monitoring is uncertain, and there is wide variation in clinical practice. Objective: To establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne. Design, Setting, and Participants: Using a modified electronic Delphi process, 4 rounds of anonymous electronic surveys were administered from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, questions regarding more time-specific monitoring throughout isotretinoin therapy were asked in subsequent rounds. The participants were international board-certified dermatologist acne experts who were selected on a voluntary basis based on involvement in acne-related professional organizations and research. Main Outcomes and Measures: The primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters. Results: The 22 participants from 5 continents had a mean (SD) time in practice of 23.7 (11.6) years and represented a variety of practice settings. Throughout the 4-round study, participation rates ranged from 90% to 100%. Consensus was achieved for the following: check alanine aminotransferase within a month prior to initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); check triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%); do not check complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all >70%); do not check gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%). Conclusions and Relevance: This Delphi study identified a core set of laboratory tests that should be evaluated prior to and during treatment with isotretinoin. These results provide valuable data to guide clinical practice and clinical guideline development to optimize laboratory monitoring in patients treated with isotretinoin.

Guía clínica chilena para el estudio y tratamiento de hidradenitis supurativa. Resumen ejecutivo

Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle characterized by recurrent painful and inflamed lesions, predominantly affecting intertriginous regions. Due to its physical sequelae and impact on quality of life, we should be familiarized with this disease to make an appropriate diagnosis and implement an early treatment. This executive summary of the clinical guideline, elaborated by the hidradenitis suppurativa workgroup of the Chilean Society of Dermatology and Venereology (SOCHIDERM), reviews its definition, epidemiology, pathophysiology, risk factors, comorbidities, psycho-emotional impact, clinical presentation, diagnosis, classifications, ultrasonographic evaluation, and its medical and surgical treatments. Finally, a therapeutic approach algorithm is proposed.

[Chilean clinical guideline for the management of hidradenitis suppurativa - executive summary]. / Guía clínica chilena para el estudio y tratamiento de hidradenitis supurativa. Resumen ejecutivo.

Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle characterized by recurrent painful and inflamed lesions, predominantly affecting intertriginous regions. Due to its physical sequelae and impact on quality of life, we should be familiarized with this disease to make an appropriate diagnosis and implement an early treatment. This executive summary of the clinical guideline, elaborated by the hidradenitis suppurativa workgroup of the Chilean Society of Dermatology and Venereology (SOCHIDERM), reviews its definition, epidemiology, pathophysiology, risk factors, comorbidities, psycho-emotional impact, clinical presentation, diagnosis, classifications, ultrasonographic evaluation, and its medical and surgical treatments. Finally, a therapeutic approach algorithm is proposed.

Guía clínica chilena para el manejo de hidradenitis supurativa / Chilean clinical guidelines for the management of hidradenitis suppurativa

La hidradenitis supurativa es una enfermedad inflamatoria crónica del folículo piloso que se caracteriza por la aparición recurrente de lesiones inflamatorias dolorosas y profundas predominantemente en pliegues. Debido a sus secuelas físicas y en la calidad de vida, debemos estar familiarizados con esta enfermedad, a fin de poder realizar un diagnóstico oportuno e implementar un tratamiento precoz. Esta guía clínica, elaborada por el grupo de trabajo de hidradenitis supurativa de la Sociedad Chilena de Dermatología y Venereología (SOCHIDERM), revisa su definición, epidemiología, fisiopatogenia, factores de riesgo, comorbilidades, impacto psicoemocional, presentación clínica, diagnóstico, clasificaciones, evaluación ecográfica, y tratamientos médico y quirúrgico. Finalmente se propone un algoritmo de enfrentamiento terapéutico.

Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle characterized by recurrent painful and inflamed lesions, predominantly affecting intertriginous regions. Due to its physical sequelae and impact on life quality, we should be familiarized with this disease to make an appropriate diagnosis and implement an early treatment. This clinical guideline, elaborated by the hidradenitis suppurativa workgroup of the Chilean Society of Dermatology and Venereology (SOCHIDERM), review its definition, epidemiology, pathophysiology, risk factors, comorbidities, psycho-emotional impact, clinical presentation, diagnosis, classifications, ultrasonographic evaluation, and its medical and surgical treatments. Finally, a therapeutic approach algorithm is proposed.

Challenges and Solutions in Oral Isotretinoin in Acne: Reflections on 35 Years of Experience.

Acne vulgaris affects more than 80% of adolescents and young adults and forms a substantial proportion of the dermatologist's and general practitioner's caseload. Severity of symptoms varies but may result in facial scarring and psychological repercussions. Oral isotretinoin is highly effective but can only be prescribed by specialists. Side effects are recognized and mostly predictable, ranging from cosmetic effects to teratogenicity. These can affect patients' quality of life and treatment adherence. This article provides a commentary on 4 key areas: the use of oral isotretinoin vs oral antibiotics, including the importance of early recognition of nonresponse to treatment, the psychological effects of acne and isotretinoin treatment, the side effects of isotretinoin therapy, and cosmetic treatment options that can help alleviate predictable side effects. The authors, who have all participated in various international expert groups, draw on relevant literature and their extensive professional experience with oral isotretinoin in the treatment of acne. The aim of this article is to provide an informative and practical approach to managing oral isotretinoin treatment in patients with acne, to help optimize treatment of this skin disease.

Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne.

Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.

Refining the ideas of "ethnic" skin.

Skin disease occur worldwide, affecting people of all nationalities and all skin types. These diseases may have a genetic component and may manifest differently in specific population groups; however, there has been little study on this aspect. If population-based differences exist, it is reasonable to assume that understanding these differences may optimize treatment. While there is a relative paucity of information about similarities and differences in skin diseases around the world, the knowledge-base is expanding. One challenge in understanding population-based variations is posed by terminology used in the literature: including ethnic skin, Hispanic skin, Asian skin, and skin of color. As will be discussed in this article, we recommend that the first three descriptors are no longer used in dermatology because they refer to nonspecific groups of people. In contrast, "skin of color" may be used - perhaps with further refinements in the future - as a term that relates to skin biology and provides relevant information to dermatologists.

Refining the ideas of "ethnic" skin

Abstract: Skin disease occur worldwide, affecting people of all nationalities and all skin types. These diseases may have a genetic component and may manifest differently in specific population groups; however, there has been little study on this aspect. If population-based differences exist, it is reasonable to assume that understanding these differences may optimize treatment. While there is a relative paucity of information about similarities and differences in skin diseases around the world, the knowledge-base is expanding. One challenge in understanding population-based variations is posed by terminology used in the literature: including ethnic skin, Hispanic skin, Asian skin, and skin of color. As will be discussed in this article, we recommend that the first three descriptors are no longer used in dermatology because they refer to nonspecific groups of people. In contrast, "skin of color" may be used - perhaps with further refinements in the future - as a term that relates to skin biology and provides relevant information to dermatologists.

Clinical efficacy of adapalene (differin(®)) 0.3% gel in Chilean women with cutaneous photoaging.

Skin photoaging is a concern for many patients today, and it is important for dermatologists to evaluate new therapeutic approaches. This 6-month open-label study evaluated the effectiveness and safety of adapalene 0.3% gel in 40 Latin American women with signs of facial photoaging. Assessments at baseline, week 12, and week 24 included clinical severity grading, measurement of transepidermal water loss, hydration, and elasticity (Cutometer MPA 850®), evaluation of general skin tone and number of wrinkles (VISIA(®) Complexion Analysis System), and ultrasonography to measure changes in skin thickness. There were significant improvements in clinical grading of wrinkles (p < 0.01) with a reduction in mean severity score of 40% in forehead wrinkles, 52% in periorbital wrinkles, and 29% in perioral wrinkles. Melanin, transepidermal water loss, and hydration were improved, as were general skin tone and the number of wrinkles (p < 0.05). Measurement of skin thickness showed a non-significant improvement in the epidermis and dermis and a significant decrease of the elastosis band (11.6% at week 12 and 15.1% at week 24). Adapalene was well tolerated overall, although three patients discontinued the study due to skin irritation in the first month. We conclude that adapalene 0.3% gel is a new safe and effective approach to photoaging.

[Cross sectional search for skin lesions in 118 diabetic patients]. / Manifestaciones cutáneas de diabetes mellitus.

BACKGROUND: Thirty percent of patients with diabetes mellitus have some skin lesion that is directly related to the disease or caused by infections, complications or treatments used. AIM: To determine the frequency and type of skin lesions in diabetic patients. MATERIAL AND METHODS: Cross sectional examination of 26 patients with type 1 diabetes, 75 patients with type 2 diabetes and 17 patients with gestational diabetes. A complete skin physical examination and a direct mycological examination and culture when Onychomycosis was suspected, were performed. RESULTS: In 56% of patients, diabetes lasted more than 10 years and 52% had some complication of the disease. A mean of 1.4+/-0.1 skin lesions per patient was found among subjects with type 1 or 2 diabetes. No skin lesion was found in patients with gestational diabetes. The lesions found were Onychomycosis in 27%, diabetic dermatopathy in 17%, macroangiopathy in 15%, tine a corporis in 14% and neurosis in 14%. CONCLUSIONS: Onychomycosis is the most commonly found skin lesion in diabetic patient.

Specific gel-cream as adjuvant to oral isotretinoin improved hydration and prevented TEWL increase--a double-blind, randomized, placebo-controlled study.

BACKGROUND: Hydrating and emollient products are often recommended to patients under isotretinoin therapy to control the most frequent mucocutaneous side effects and to improve adherence to treatment. AIMS: To assess, using noninvasive biophysical tests, the clinical and instrumental effectiveness of a hydrating gel-cream compared with placebo as an adjuvant to isotretinoin for treatment of facial skin in patients with inflammatory acne. METHODS: Prospective, double-blind, randomized study, using MULTI SKIN MC750, on the adjuvant effect of a hydrating gel-cream for acne (active product) vs. a gel-cream without active substances (placebo). Follow-up lasted 3 months. RESULTS: Sixty-six patients were included. Thirty-four were administered the active product, and 32 placebo. Though the number of lesions fell significantly in both groups, the mean number of papules on day 30 was significantly lower in the active product group. The active product group showed a significant increase in hydration, while the placebo group showed a significant increase in transepidermal water loss (TEWL). Seborrhoea decreased significantly in both groups; there were no differences between them. CONCLUSIONS: Compared with placebo, the specific gel-cream with active products as an adjuvant to oral isotretinoin improved hydration, prevented TEWL increase, and reduced inflammatory acne lesions after 30 days.

Manifestaciones cutáneas de diabetes mellitus / Cross sectional search for skin lesions in 118 diabetic patients

Background: Thirty percent of patients with diabetes mellitus have some skin lesion that is directly related to the disease or caused by infections, complications or treatments used. Aim: To determine the frequency and type of skin lesions in diabetic patients. Material and methods: Cross sectional examination of 26 patients with type 1 diabetes, 75 patients with type 2 diabetes and 17 patients with gestational diabetes. A complete skin physical examination and a direct mycological examination and culture when Onychomycosis was suspected, were performed. Results: In 56 percent of patients, diabetes lasted more than 10 years and 52 percent had some complication of the disease. A mean of 1.4±0.1 skin lesions per patient was found among subjects with type 1 or 2 diabetes. No skin lesion was found in patients with gestational diabetes. The lesions found were Onychomycosis in 27 percent, diabetic dermatopathy in 17 percent, macroangiopathy in 15 percent, tine a corporis in 14 percent and neurosis in 14 percent. Conclusions: Onychomycosis is the most commonly found skin lesion in diabetic patient.

New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group.

The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.

Lipoatrophia semicircularis: a compressive lipoatrophy consecutive to persistent mechanical pressure.

Lipoatrophia semicircularis is an infrequent condition characterized by semicircular depressions of the anterolateral aspects of the thighs. The origin of this peculiar variant of lipoatrophy is unknown, although repeated mechanical trauma on the affected thighs has been advocated in many cases. A 57-year-old woman presented with a 1-year history of two bilateral, parallel, symmetric, asymptomatic depressions on the anterolateral aspect of her thighs. The patient worked as a cashier, permanently seated and almost always wearing trousers. The localization of lesions and their linear artifactual appearance perfectly matched with the strangling folds formed by trousers while being sat. Echotomographic examination revealed a loss of the normal echogenic pattern in the subcutaneous tissue of the affected areas. We believe that the anatomical adipose constitution of women's thighs predisposes that a persistent mechanical pressure induced by wearing trousers while being sat for long periods of time, originates a relative impaired circulation on a tenuous perfused tissue, and induces the development of lipoatrophia semicircularis.

Evaluación clínica de dos cremas formuladas en base a esfingolípido, en piel seca y muy seca / Clinical evaluation of 2 formulated creams based in sphyngolipids in dry and very dry skin

Las ceramidas naturales son lípidos constituyentes esenciales de la capa lipídica del estrato córneo. Su importancia en funciones de barrera del estrato córneo, en el proceso de retención de agua y en procesos de diferenciación y proliferación celular es conocida. Una nueva molécula de síntesis, el Esfingolípido©, ha sido recientemente desarrollada. Su acción principal es promover la síntesis de ceramidas endógenas, introduciéndose en la cadena de biosíntesis de estas ceramidas. El objetivo de este estudio ha sido evaluar la respuesta clínica de dos cremas formuladas en base a esfigolípidos en el manejo de la piel facial seca y muy seca