Developments in topical retinoid therapy for acne.

Topical retinoic acid was introduced for acne treatment three decades ago. Since that time, researchers have discovered thousands of retinoids, originally defined as chemical analogs of vitamin A. After the identification of nuclear retinoid receptors in 1987, the definition of this class expanded to include molecules that bind to and activate such receptors. The receptor-selective retinoid agents, adapalene and tazarotene, were developed in the 1990s. Other innovations of the past decade include retinoid formulations and methods aimed at limiting retinoid absorption. Cutaneous irritation may be reduced without losing retinoid efficacy by inhibiting retinoid penetration into the deep epidermis and dermis. Examples include tretinoin in slow-release vehicles and the short-contact method of tazarotene gel therapy. Only trace amounts of adapalene are absorbed after topical application, perhaps explaining its relatively low irritancy. New formulations of existing agents, such as additional concentrations of tretinoin in microsphere gel and cream formulations of tazarotene, are now under investigation for acne. Current research focused on receptor selectivity holds the promise of yielding new retinoid molecules with improved benefits and safety.

The modern age of acne therapy: a review of current treatment options.

This review of current acne treatments begins with the crucial discovery in 1979 of isotretinoin treatment for nodulocystic acne. This drug s approval in 1982 revolutionized therapy, since it was the first oral acne-specific drug, and it provided prolonged remissions. In addition, it may prevent the emergence of resistant bacteria, a problem linked to the traditional use of antibiotics for acne. Patients who are not candidates for isotretinoin therapy may benefit from one of the other drugs or drug combinations reviewed, including the third-generation topical retinoids adapalene and tazarotene, retinoic acid reformulated in new vehicles, azelaic acid, and topical antibiotics. Proper selection and education of patients are essential, since serious consequences may result from poorly monitored use of antibiotics and retinoid.

Changes in plasma lipids and lipoproteins during isotretinoin therapy for acne.

Abnormalities in plasma lipids are a recognized side effect of isotretinoin therapy for nodulocystic acne. We studied 60 patients during 20 weeks of isotretinoin therapy, to measure changes in plasma lipids and lipoproteins, to compare plasma lipid responses in men and women, and to determine whether there are alterations in levels of lipoprotein lipase or hepatic triglyceride lipase that could explain the development of isotretinoin-induced hypertriglyceridemia. Mean triglyceride levels rose in men and women, with maximum mean increases of 46.3 mg per deciliter (P less than 0.0001) and 52.3 mg per deciliter (P less than 0.002), respectively. The maximum level was reached by 4 weeks of therapy in men but not until the 12th week in women. Nine of 53 patients (17 per cent) completing 20 weeks of isotretinoin therapy acquired hypertriglyceridemia, with values of 200 to 600 mg per deciliter. Both men and women had significant increases in mean plasma levels of cholesterol and low-density-lipoprotein cholesterol and decreases in mean levels of high-density-lipoprotein cholesterol. There were no significant changes in mean levels of lipoprotein lipase or hepatic triglyceride lipase. Plasma lipid and lipoprotein levels returned to base line by eight weeks after discontinuation of the drug. If sustained over a long period, the change in the ratio of low-density-lipoprotein cholesterol to high-density-lipoprotein cholesterol that we observed, from 2.4 to 3.0 (P less than 0.0001), would predict an increased risk of cardiovascular disease.

Dermatoglyphic patterns in patients with atopic dermatitis.

Fingertip dermatoglyphic patterns of forty-five patients with atopic dermatitis were compared to those of sixty nonatopic dermatologic patients, twenty-one of whom had hand dermatitis. The average number of digits in which linear grooves were detected was significantly higher in the atopic group than in the nonatopic controls (p less than 0.005). Three or more digits with linear grooves were found in 95.2% of atopic patients with hand dermatitis and in 61.9% of controls with hand dermatitis (p less than 0.005). A greater number of digits displaying linear grooves was found in control patients with hand dermatitis than in control patients without hand dermatitis. However, atopic patients with hand dermatitis had, on the average, an even greater number of digits with linear grooves than did control patients with hand dermatitis (p less than 0.005). These findings suggest that linear grooves, although associated with hand dermatitis in general, are more commonly found in patients with atopic hand dermatitis. Although a significant increase in the whorl pattern was detected in female, but not in male, atopic patients when compared to sex-matched control groups (p less than 0.0025), this increase was significant only in Caucasian females when compared to sex- and race-matched controls (p less than 0.0005).