Evaluation of the efficacy of maintenance therapy for acne vulgaris using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel for 24 weeks and assessment of atrophic acne scars using three-dimensional image analysis.

Maintenance therapy after remission of inflammation is strongly recommended in the guideline for the treatment of acne vulgaris published by the Japanese Dermatological Association. One advantage of continuing maintenance therapy is the alleviation of atrophic scarring. This study investigated the efficacy of maintenance therapy using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel, and its effects on atrophic scarring. Overall, 126 patients were randomized to the adapalene/benzoyl peroxide group (n = 40), benzoyl peroxide group (n = 44), and control group (without maintenance treatment drugs; n = 42), and 111 of these completed a trial lasting 24 weeks. As the primary endpoint, the treatment success rate (the percentage of patients in whom the number of inflammatory lesions was maintained at ≤10) was 89.2% in the adapalene/benzoyl peroxide group, 87.5% in the benzoyl peroxide group, and 47.4% in the control group. Compared with the control group, the success rates were significantly higher in the adapalene/benzoyl peroxide and benzoyl peroxide groups (P = 0.0006 for both). As one of the secondary endpoints, the rate of change in the number of atrophic scars showed significant improvement from the baseline in the adapalene/benzoyl peroxide and benzoyl peroxide groups at week 24 (P = 0.0004 and P < 0.0001, respectively). Although the three-dimensional image analysis parameters did not change significantly from the baseline in the adapalene/benzoyl peroxide and benzoyl peroxide groups at week 24, significant worsening was noted in the control group (P = 0.0276 for affected area, P = 0.0445 for volume, and P = 0.0182 for maximum depth). Adverse drug reactions were noted in three patients in the adapalene/benzoyl peroxide group (7.5%) but not in the benzoyl peroxide group. These findings suggest that maintenance therapy using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel is effective in preventing the worsening of scars in Japanese patients with acne vulgaris.

Preliminary study on the skin lightening practice and health symptoms among female students in Malaysia.

Many cases of dermatologic complication were reported with the use of skin lightening products. This study assessed the skin lightening practice and health symptoms among female students. Self-administered questionnaire was distributed to 104 female students (56 undergraduates and 48 postgraduates) aged 24 ± 2 years in Universiti Putra Malaysia. A total of 60.6% (N = 63) of the female students used skin lightening products (61.9% of undergraduates and 38.1% of postgraduates). Reasonable price (N = 35, 55.6%) and ingredients (N = 29, 46%) were considered the most important factors in the product selection. Most respondents purchased the product from drugstores (N = 39, 61.9%). Twenty-two respondents (34.9%) in this study experienced skin problem from the products they used. Skin peeling (N = 13, 12.5%) and acne (N = 9, 8.7%) were the most frequent symptoms experienced. Most of the respondents have the perception that lighter skin provides high self-esteem (N = 56, 53.8%) and looks beautiful and healthier (N = 54, 51.9%). The use of skin lightening products is common among female students in this study and some of these products can cause skin problems such as skin peeling, acne, and itching.

Preferences for new and existing contraceptive products.

New contraceptive methods provide greater choice in terms of effectiveness, management of side-effects, convenience and frequency of administration and flexibility, but make the decisions about contraception more complex. There are limited data on the factors that determine women's choices among these alternatives, to inform providers about the factors which are most important to women, or to predict uptake of new products. This paper reports on a choice experiment designed to elicit women's preferences in relation to prescribed contraception and to forecast the impact of the introduction of two new products into the Australian market. A generalised multinomial logit model is estimated and used in the simulation exercise. The model forecasts that the hormonal patch would be well received among women, achieving a greater market share than current non-pill products, but the vaginal ring would have limited appeal.

EGFR inhibitor-associated acneiform folliculitis: assessment and management.

Treatment with epidermal growth factor receptor (EGFR) inhibitors is associated with cutaneous adverse events, including acneiform folliculitis, dry skin, and nail disorders. Acneiform folliculitis is a class effect of EGFR inhibitors that is thought to be a direct result of EGFR blockade in the hair follicle. The folliculitis is typically mild to moderate in severity and reversible without scarring upon treatment completion. Dose modification or treatment discontinuation is rarely necessary, except in severe cases. Standard acne treatments (e.g. benzoyl peroxide, oral or topical antibacterials, retinoic acid) may provide some benefit, based on anecdotal reports. Clinicians should be aware of the possibility of superinfection with Staphylococcus aureus, in some cases involving meticillin-resistant strains, which may require treatment with oral antibacterials. Further study is needed to determine how the presence and severity of acneiform folliculitis are related to clinical outcomes, and which patients taking EGFR inhibitors are more likely to develop this disorder.

Treatment of endometriosis with depot medroxyprogesterone acetate: a preliminary experience.

The efficacy of depot medroxyprogesterone acetate in the treatment of endometriosis was assessed in 19 patients with severe diseases. Assessment was based on changes in subjective symptoms and signs at 4 weekly interval during treatment and after 52 weeks follow up, and changes in visible deposits and adhesions at laparoscopy before and after treatment. There were significant reductions in mean total subjective and symptoms scores, mean total R-AFS adhesions and implants scores, and mean additive diameter of implant scores at the end of treatment and follow up. Treatment success occurred in 75% of the patients, majority (66%) of whom had complete resolution of deposits. Side effects encountered include menorrhagia, break through bleeding, excessive weight gain, myalgia, breast pain, acne and delay in return of menses. It was concluded that DMPA an effective, cheap and readily available medication which is worth using in patients who can not afford the expensive alternatives.

Severe halogen acne due to a trifluoromethylpyrazole derivative and its resistance to isotretinoin.

We report a case of severe chloracne, with systemic involvement, following occupational exposure to dihydrotrifluoromethylphenyl benzothiopyranopyrazolone, which, to our knowledge, has not been previously reported as a cause of chloracne. Aggressive drug treatment, including high-dose oral isotretinoin was of limited benefit in suppressing the disease activity.

The mechanism of dioxin toxicity: relationship to risk assessment.

Risk characterization involves hazard identification, determination of dose-response relationships, and exposure assessment. Improvement of the risk assessment process requires inclusion of the best available science. Recent findings in the area of dioxin toxicity have led to a major effort to reassess its risk. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), commonly referred to as "dioxin," is the most toxic member of a class of related chemicals including the polyhalogenated dibenzo-p-dioxins, dibenzofurans, biphenyls, naphthalenes, azo- and azoxy-benzenes, whose toxicities can be expressed as fractional equivalencies of TCDD. These chemicals exert their effects through interaction with a specific intracellular protein, the Ah receptor. While binding to the receptor is necessary, it is not sufficient to bring about a chain of events leading to various responses including enzyme induction, immunotoxicity, reproductive and endocrine effects, developmental toxicity, chloracne, tumor promotion, etc. Some of these responses appear to be linear at low doses. Immunotoxicity and effects on the reproductive system appear to be among the most sensitive responses. The Ah receptor functions as a transcriptional enhancer, interacting with a number of other regulatory proteins (heat shock proteins, kinases, translocases, DNA binding species). Interaction with specific base sequences in the DNA appear to be modulated by the presence of other growth factors, hormones and their receptors as well as other regulatory proteins. Thus, dioxin appears to function as a hormone, initiating a cascade of events that is dependent upon the environment of each cell and tissue. While Ah receptor variants exist, all vertebrates examined have demonstrated such a protein with similar numbers of receptors and binding affinity for TCDD. Most species respond similarly to dioxin and related compounds. While a given species may be an outlier for a given response, it will behave like other animals for other responses. For both in vivo and in vitro end points where animal and human data exist, such as enzyme induction, chloracne, immunotoxicity, developmental toxicity, and cancer, the sensitivity of humans appears similar to that of experimental animals. Current levels of environmental exposure to this class of chemicals may be resulting in subtle responses in populations at special risk such as subsistence fisherman and the developing infant, as well as in the general population. Increased understanding of the mechanism of dioxin's effects as well as elucidation of exposure-dose relationships is leading to the development of a biologically based dose-response model in the ongoing process of incorporating the best science into the risk assessment of TCDD and related compounds.

Assessment of past occupational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin using blood lipid analyses.

Current 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) concentrations were determined in blood samples for 138 persons who had been involved in assessment, clean-up and demolition activities after the 1953 BASF trichlorophenol reactor accident. From these data and detailed descriptions of the circumstances and duration of individual exposure, a regression model was developed for describing the relationships between various exposure situations and TCDD concentration. The model explained 65% of the variability in log (TCDD) concentration. Using half-life assumptions and the regression model parameters we estimated cumulative TCDD concentrations back-calculated to the time of exposure for all 254 members of the accident cohort. The geometric mean cumulative TCDD concentration for all cohort members averaged 137.7 ppt. Estimated cumulative TCDD concentrations correlated well with chloracne severity. The mean TCDD concentrations were 38.4 ppt for the no chloracne subgroup (n = 139), 420.8 ppt for the moderate chloracne subgroup (n = 59) and 1008 ppt for the severe chloracne subgroup (n = 56). The estimation procedure should be helpful in assessing the relationships between various health outcomes and TCDD exposure in this cohort.

Problems in the assessment of human exposure to tetrachlorodibenzodioxin (TCDD): the marker chloracne.

An epidemiological study, aiming to assess the extent of the exposure to tetrachlorodibenzodioxin (TCDD) of the population involved in the Seveso accident, needs an effective information system, able to answer the questions usually asked--such as: why? what? who? where? when? how long?--and therefore concerning the wide range of the expected events, from the early cases till the ones expected in the long term. The paper is concerned with evaluation of possible use of chloracne as indicator of human exposure to TCDD, taking into account from one hand chloracne itself (i.e. its latency period, sensitivity, specificity, predictive value of diagnosis, etc) and, from the other, the development of the observational process. Moreover, the paper points out the role of the dermatological findings as representative--more than and before the other clinical findings--of the exposure conditions in the polluted area. The group of subjects classified as "chloracne" by the end of the second screening (May, 1977) included 187 cases, 164 of which were children 0-14 yrs old by the 10th of July 1976; 34 out of 164 were diagnosed in September-December 1976, the other 130 were diagnosed within the screening program. The results of a survey concerning their exposure data, clinical and laboratory findings are detailed. Finally, some remarks are made related to the quality of data. The authors emphasize that the reliability of assessment of health status of the exposed population depends not only upon a comprehensive a posteriori analysis of the different sets of clinical findings, but also upon the degree of integration of the professional staffs involved at operational levels.(ABSTRACT TRUNCATED AT 250 WORDS)