Adverse events related to topical drug treatments for acne vulgaris.

Introduction: Acne vulgaris is a widespread skin disease. Topical therapy is a standard treatment for mild to moderate acne. Given the complex pathophysiology of acne, various agents with complementary action are nowadays frequently combined to increase the efficacy of therapy.Area covered: This review focus on safety profile of topical agents used for the treatment of acne vulgaris, including topical retinoids, benzyl peroxide, azelaic acid, topical antibiotic, and combined agents. Data from clinical trials but also metanalyses, systematic reviews, and other secondary analyses are presented.Expert opinion: In general, topical agents used for acne vulgaris have a favorable safety profile. The most commonly reported AEs were associated with local skin irritation, usually mild to moderate in intensity, intermittent, and rarely led to the cessation of therapy. Irritative potential seems to be highest for BPO and topical retinoids. Due to the possibility of development of Cutibacterium acnes resistance, topical antibiotics should not be used in monotherapy but as a part of combination therapy. In female adolescent and adults of childbearing potential, topical retinoids should be used with caution, because they are contraindicated in pregnant females (FDA Pregnancy category) C (adapalene, tretinoin) and X (tazarotene).

Folate supplementation reduces the side effects of methotrexate therapy for psoriasis.

INTRODUCTION: Methotrexate (MTX) is an effective treatment option for patients with moderate-to-severe psoriasis. As psoriasis is an incurable disease, the goal of the MTX treatment is to suppress psoriasis, achieving long-term remissions with minimal treatment-related adverse events (AEs). AREAS COVERED: Supplementation with folate - either folic acid (FA) or folinic acid - may reduce the side effects of MTX therapy. There are no consistent, evidence-based guidelines for folate supplementation in this clinical setting. We present data concerning the impact of folic supplementation on the safety and efficacy of MTX therapy for psoriasis. An extensive search (1960 - March 2014) identified few studies addressing with just one randomized controlled trial (RCT) and some case series. This meager yield underlines the need for further studies, especially RCTs, in this group of patients. EXPERT OPINION: FA may be effective in diminishing the severity of AEs in patients with psoriasis treated with MTX and should be recommended. Supplementation with too high doses of FA may influence the efficacy of treatment.