SUPPLEMENT INDIVIDUAL ARTICLE: Optimizing Skin Care in Acne Treatment - Evaluation of a Designated Cleanser and Moisturizer Regimen With Improvement in Clinical Outcomes.

Acne vulgaris (AV) is one of the most common skin disorders encountered in outpatient dermatology practice worldwide, commonly affecting adolescents, but also pre-teens and postadolescent adults of any race, ethnicity, and skin color.1.

Applications of Topical Oak Bark Extract in Dermatology: Clinical Examples and Discussion

The versatility of wound healing and anti-inflammatory agents can be assets to dermatologists when other therapies lack appropriate mechanisms of action, or when the risk to benefit ratio may be in question. Bensal HP ointment is a broad-spectrum antimicrobial agent with in vitro activity against important pathogens such as MRSA and gram-negative bacteria, some fungal strains, and yeasts.1 Based on the physiochemical composition of Bensal HP ointment, and its impact after application to skin, there are many potentially benefits derived from the formulation stability. While there have been several animal and human studies characterizing the antibacterial, wound healing, and anti-inflammatory properties of Bensal HP, they do not provide real world clinical experience and guidance on potential utilization in dermatology. The goal of this article is to present a variety of clinical cases for which Bensal HP was utilized as a means of translating the pre-clinical and trial data. J Drugs Dermatol. 2019;18(2):203-206.

Polypodium leucotomos extract: a status report on clinical efficacy and safety.

Various extracts of polypodium leucotomos (PLE) applied topically or taken orally have been shown to have several beneficial antioxidant, photoprotectant, antimutagenic, and immunoregulatory effects. Modern studies have evaluated the efficacy of PLE orally as a photoprotective agent and for use in several photo-aggravated dermatologic disorders such as polymorphous light eruption, other photodermatoses, and melasma. No articles have been published evaluating the safety of PLE. We performed a PUBMED search for any randomized clinical trials related to PLE, or anapsos, a synonym. The primary safety endpoint of the review was any mention of an adverse event, side effect, or toxicity. Overall, 19 human and 6 basic science studies were included spanning over 40 years of research. Oral PLE was administered at daily doses ranging from 120 mg to 1080 mg. No adverse effects were reported in laboratory studies. In humans, side effects (gastrointestinal complaints and pruritus) were mild to moderate and found only in very small numbers of patients overall (16/1016 [2%]). This review concludes PLE is well tolerated at all doses administered and associated with a negligible risk of side effects.

Calcipotriene-betamethasone dipropionate topical suspension in the management of psoriasis: a status report on available data with an overview of practical clinical application.

Psoriasis is a multifactorial process associated with immunologic dysregulation. Chronic plaque psoriasis (PP) is the most common clinical presentation. Plaque psoriasis is characteristically a chronic disease associated with periods of persistence and episodes of flaring; therefore, intermittent use of topical corticosteroid (TC) therapy along with concurrent or sequential use of a nonsteroidal topical agent is commonly employed to achieve and sustain control of the disorder. Calcipotriene 0.005%-betamethasone dipropionate 0.064% topical suspension (C/Bd-TS) is a rational option for the treatment of PP in patients with localized disease or in patients treated systemically or with phototherapy for more extensive disease who exhibit persistence or recurrence of scattered areas of PP. This article provides a review of a patented topical suspension combination formulation of C/Bd-TS, including formulation characteristics, perspectives on modes of action, outcomes from pivotal trials, and efficacy and safety data reported from additional studies.

Consensus recommendations from the American acne & rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices.

The fourth article in this 5-part series reviews physical modalities and devices used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The major therapeutic uses of physical modalities and devices, especially laser and light-based systems, are for treatment of telangiectases and persistent facial erythema (background erythema). Phymas, especially rhinophyma, also are treated with physical modalities such as ablative lasers or surgical devices (eg, electrosurgical loop). Appropriately selected and properly used lasers and intense pulsed light (IPL) devices can successfully address specific clinical manifestations of rosacea that exhibit limited or no response to available medical therapies, such as telangiectases and background centrofacial erythema. Rosacea-associated symptoms also may improve. In most cases, treatment will need to be repeated intermittently to sustain improvement.

An evaluation of potential correlations between pathophysiologic mechanisms, clinical manifestations, and management of rosacea.

This article discusses rosacea, a common facial dermatosis of uncertain etiology and recent investigations that have begun to shed considerable light on the sequence of events leading to clinical manifestations of rosacea. The article content is based on a dedicated meeting about rosacea sanctioned by the American Acne & Rosacea Society (AARS) and represents the consensus of the authors and AARS Board of Directors.

Optimizing topical therapies for treating psoriasis: a consensus conference.

In 2010, an expert committee of physicians and researchers in the field of dermatology working together as the Psoriasis Process of Care Consensus Panel developed consensus guidelines for the treatment of psoriasis. As much as possible, the guidelines were evidence based but also included the extensive clinical experience of the dermatologists. Psoriasis is a lifelong disease that requires long-term treatment and 80% of psoriasis patients have mild to moderate disease. Topical therapies play an important role in the treatment of psoriasis, especially in patients with mild to moderate disease. Patients usually start with monotherapy; however, in more severe cases (> 10% body surface area [BSA], severely impaired quality of life [QOL], or recalcitrant psoriatic lesions), multiple treatment modalities may be used as part of combination, sequential, or rotational therapeutic regimens. Main treatment options include topical steroids, systemic therapies, topical vitamin D treatments such as vitamin D3 ointment, retinoids, phototherapy, and biologic therapies. Other topical therapies include the following steroid-sparing agents: coal tar, anthralin, calcineurin inhibitors, keratolytics, and emollients. Therapeutic considerations also should focus on adherence, improving QOL, and promoting a good patient-physician relationship.

Laser and light-based therapies for acne vulgaris: a current guide based on available data.

There are some patients that, despite their continued use of optimized topical and systemic medication and skin care regimens, exhibit at least partial persistence of acne vulgaris (AV) lesions that is bothersome and treatment-resistant to pharmacologic approaches. Additionally, professional, public and governmental concern regarding "antibiotic resistance" has led to interest in therapeutic alternatives other than antibiotics. These challenges drive research into non-pharmacologic approaches to AV treatment, including laser and light-based approaches.

Anti-TNF agents for the treatment of psoriasis.

INTRODUCTION: Psoriasis is one of several systemic diseases that presents chiefly with cutaneous symptoms and has the potential to negatively impact patients' overall health and quality of life. Physicians who treat patients with psoriasis must be cognizant of the chronic, lifelong character of the disease and of the potential for multisystem pathology. According to the National Institutes of Health (NIH), between 5.8 and 7.5 million persons in the U.S.--approximately 2.2% of the population--have psoriasis; worldwide, it affects an estimated 125 million people. The annual cost of treating psoriasis may exceed $3 billion annually. Immunologic mechanisms are now accepted as the pathophysiologic basis for the development of psoriatic disease. Treatment strategies--which include topical treatment, phototherapy, methtrexate, cyclosporine and acitretin--also encompass several biologic agents that target immune mediators associated with the condition. DISCUSSION: Patients with mild disease may obtain symptomatic relief with topical agents and targeted phototherapy. Patients with moderate-to-severe disease are likely to benefit from systemic therapy. Shortcomings of the traditional agents, particularly their adverse event profiles, have motivated research and development of biologic agents. Currently three anti-TNF agents--etanercept, infliximab and adalimumab--are FDA-approved for treatment of psoriasis. Differences exist among study designs and, therefore, in interpretation of data; however, the improvements observed in the psoriasis study populations participating in clinical trials are dramatic. Long-term clinical data continue to accumulate and demonstrate sustained benefits with anti-TNF agents. Safety data also continue to be collected over the long-term; key safety considerations are infection, cytopenia, demyelinating disease, lupus-like syndromes, congestive heart failure and malignancies. Combination therapy should also be considered when managing psoriasis for such reasons as augmenting an inadequate response to monotherapy or improving tolerability. Combination therapy with an anti-TNF agent and phototherapy has shown considerably higher rates of response compared with either intervention alone. OBJECTIVE: The objective of this paper is to critically examine the anti-TNF studies to assess the efficacy and safety of the agents in patients with psoriasis and determine applicability of the data in clinical practice. In light of the chronic nature of this disease, the emphasis will be on the longest-term data available. CONCLUSION: The treatment of plaque psoriasis with TNF-alpha antagonists is still a relatively recent addition to the pharmacologic armamentarium available to clinicians. The collection of long-term data is, therefore, small but growing as results from newer studies emerge. From the data reviewed here, the clinician can attempt to arrive at a satisfactory assessment of the benefits and risks of treatment with these agents.

Oral antibiotic drug interactions of clinical significance to dermatologists.

Oral antibiotics are commonly prescribed by dermatologists in clinical practice. When prescribing an oral antibiotic, as with other systemic medications, it is important to consider potential interactions with other drugs, including over-the-counter medications. The most common drug interaction mechanisms that may lead to clinically significant sequelae are inhibition of GI drug absorption and alterations in drug metabolism. Tetracycline and quinolones undergo chelation interactions with many metal ions found in antacids and mineral supplements. Some macrolides, such as erythromycin, inhibit the hepatic metabolism of many other drugs, increasing the risk for toxicity. Rifampin increases the metabolism of many other drugs, thus predisposing to treatment failure. Drug interactions can only be averted if their potential is understood and recognized in advance.

Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: focus on antibiotic resistance.

Propionibacterium acnes is an anaerobic bacterium that plays an important role in the pathogenesis of acne. Certain antibiotics that can inhibit P acnes colonization also have demonstrated anti-inflammatory activities in the treatment of acne, rosacea, and other noninfectious diseases. Decreased sensitivity of P acnes to antibiotics, such as erythromycin and tetracycline, has developed and may be associated with therapeutic failure. Benzoyl peroxide (BPO) is a nonantibiotic antibacterial agent that is highly effective against P acnes and for which no resistance against it has been detected to date. Retinoids are important components in combination therapy for acne, including use with antibiotics, and can serve as an alternative to these agents in maintenance therapy. By increasing our understanding of the multifaceted actions of antibiotics and the known clinical implications of antibiotic resistance, physicians can improve their decision making in prescribing these agents.

The treatment of rosacea.

The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physicians better diagnose and manage these subtypes. A lively discussion centered on treatment options for the various subtypes of rosacea ensued.

New and emerging topical approaches for actinic keratoses.

Actinic keratoses (AKs) are intraepidermal foci of malignancy and represent the earliest clinical stage in the continuum of squamous cell carcinoma (SCC). A variety of topical, physical, and surgical modalities are available for treatment. Until recently, topical 5-fluorouracil was the only topical agent approved by the US Food and Drug Administration (FDA) for the treatment of AK. Topical diclofenac 3% gel, an inhibitor of arachidonic acid, is the second topical approved for the treatment of AK. Although not currently approved in the United States, multiple studies have substantiated the efficacy of topical imiquimod for AKs. This article reviews the efficacy and safety of topical diclofenac and topical imiquimod for the treatment of AKs.