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1.
Int J Dermatol ; 63(6): 704-713, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38643368

RESUMEN

Acne, a highly prevalent skin disease, can be particularly bothersome for patients of Asian background because of its impact on self-confidence and social interactions. In addition to active acne lesions, some patients may develop sequelae such as scarring, macular/postinflammatory hyperpigmentation, or erythema. The tendency of Asian skin to develop sequelae because of its increased susceptibility to irritation, cultural preferences for lighter skin phototypes, and differences in skincare regimens may all contribute to the increased burden of acne. Moreover, many Asia-Pacific countries do not have their own guidelines for acne management, and those that do often have no schedule in place for regular updates. In this article, we provide a critical review of the published guidance for the management of acne and its sequelae in the Asia-Pacific region, identifying gaps in current recommendations that could be addressed to enhance standards of acne care in Asia-Pacific countries. Along with highlighting the importance of a comprehensive skincare regimen to increase treatment efficacy and adherence, we discuss topical retinoids and retinoid combination options in the acne armamentarium that may be beneficial for sequelae prevention and management, such as adapalene 0.3% ± benzoyl peroxide 2.5%, tretinoin 0.05%, tazarotene 0.1%, and trifarotene 0.005%. In particular, trifarotene 0.005% has been observed to significantly reduce acne scar counts in a Phase 4 study. The recent data highlight the need to establish up-to-date guidance for acne and acne sequelae management in Asia-Pacific countries to provide optimal care to Asian patients.


Asunto(s)
Acné Vulgar , Fármacos Dermatológicos , Retinoides , Humanos , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/complicaciones , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Fármacos Dermatológicos/efectos adversos , Retinoides/administración & dosificación , Retinoides/uso terapéutico , Retinoides/efectos adversos , Asia , Hiperpigmentación/etiología , Hiperpigmentación/tratamiento farmacológico , Administración Cutánea , Cicatriz/etiología , Cicatriz/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Cuidados de la Piel/métodos , Eritema/tratamiento farmacológico , Eritema/etiología
3.
JAAD Int ; 12: 60-69, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37274381

RESUMEN

Background: Acne, a commonly treated skin disease, requires patient-centered management due to its varying presentations, chronicity, and impact on health-related quality of life. Despite this, evidence-based clinical guidelines focus primarily on clinical severity of facial acne, omitting important patient- and disease-related factors, including ongoing management. Objectives: To generate recommendations to support patient-centered acne management, which incorporate priority and prognostic factors beyond conventional clinical severity, traditionally defined by grading the appearance and extent of visible lesions. Methods: The Personalizing Acne: Consensus of Experts consisted of 17 dermatologists who used a modified Delphi approach to reach consensus on statements regarding patient- and treatment-related factors pertaining to patient-centered acne management. Consensus was defined as ≥75% voting "agree" or "strongly agree." Results: Recommendations based on factors such as acne sequelae, location of acne, high burden of disease, and individual patient features were generated and incorporated into the Personalized Acne Treatment Tool. Limitations: Recommendations are based on expert opinion, which may differ from patients' perspectives. Regional variations in healthcare systems may not be represented. Conclusions: The Personalizing Acne: Consensus of Experts panel provided practical recommendations to facilitate individualized management of acne, based on patient features, which can be implemented to improve treatment outcomes, adherence, and patient satisfaction.

4.
JAMA Dermatol ; 158(8): 942-948, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-35704293

RESUMEN

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.


Asunto(s)
Acné Vulgar , Fármacos Dermatológicos , Acné Vulgar/inducido químicamente , Acné Vulgar/tratamiento farmacológico , Técnica Delphi , Fármacos Dermatológicos/efectos adversos , Humanos , Isotretinoína/efectos adversos , Triglicéridos
5.
Aust J Gen Pract ; 48(1-2): 48-52, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31256457

RESUMEN

METHOD: A qualitative descriptive study collected data via telephone interviews with 20 purposively sampled GPs working in New South Wales. A thematic analysis guided by the study objectives was undertaken. RESULTS: The participating GPs had divergent management approaches to acne treatment, infrequently provided acne patients with written resources, and would value additional dermatological support. Furthermore, the GPs recognised psychosocial ramifications and patient distress as drivers for treatment and expedited referral to dermatologists. DISCUSSION: Avenues for improved patient outcomes include explicit attention to psychological morbidity beyond treatment of the acne itself and improved use of patient educational materials, along with consistent collaboration between GPs and dermatologists.


Asunto(s)
Acné Vulgar/terapia , Médicos Generales/psicología , Pautas de la Práctica en Medicina/normas , Acné Vulgar/fisiopatología , Adulto , Actitud del Personal de Salud , Femenino , Medicina General/métodos , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Pautas de la Práctica en Medicina/tendencias , Investigación Cualitativa
6.
J Dermatol ; 45(5): 522-528, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29611225

RESUMEN

Acne vulgaris is a common disease among people in Asia. International guidelines and treatment recommendations emphasize the central role of topical retinoids in the management of acne. However, topical retinoids remain underutilized in clinical practise, which may be in part due to fear of retinoid-associated dermatitis/lack of experience, particularly in Asian patients. There is a perception that Asian skin has a greater tendency toward sensitivity compared with Caucasian skin. In our clinical experience, topical retinoid therapy can be used with excellent effect to treat Asians with acne. This article discusses available published work regarding the use of topical retinoids in Asian populations, and presents tips for utilizing these important agents in daily practise. Optimizing use of topical retinoids may improve adherence and, in turn, therapeutic outcomes and patient satisfaction.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antiinfecciosos/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Erupciones por Medicamentos/etiología , Retinoides/uso terapéutico , Acné Vulgar/etnología , Administración Cutánea , Antiinfecciosos/normas , Pueblo Asiatico , Clima , Fármacos Dermatológicos/normas , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Humanos , Cumplimiento de la Medicación , Satisfacción del Paciente , Guías de Práctica Clínica como Asunto , Retinoides/normas , Índice de Severidad de la Enfermedad , Piel/efectos de los fármacos , Pigmentación de la Piel/fisiología , Resultado del Tratamiento
7.
J Am Acad Dermatol ; 78(2 Suppl 1): S1-S23.e1, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29127053

RESUMEN

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.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Dermatólogos/normas , Manejo de la Enfermedad , Guías de Práctica Clínica como Asunto , Acné Vulgar/diagnóstico , Administración Oral , Administración Tópica , Antibacterianos/administración & dosificación , Consenso , Quimioterapia Combinada , Femenino , Humanos , Internacionalidad , Masculino , Mejoramiento de la Calidad , Retinoides/uso terapéutico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
8.
Dermatol Ther (Heidelb) ; 7(4): 525-533, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28905294

RESUMEN

INTRODUCTION: Actinic keratoses (AK) are treated to reduce the risk of progression to squamous cell carcinoma and for symptomatic and cosmetic benefits. The objective of this observational study was to generate real-life data on the use of daylight photodynamic therapy with methyl aminolevulinate cream (MAL DL-PDT) in treating mild to moderate facial/scalp AK. METHODS: A multicenter, prospective, observational study was conducted in Australia in patients receiving a single treatment of MAL DL-PDT for mild to moderate AK. Efficacy was assessed 3 months after treatment by investigator-assessed improvement and patient- and physician-completed satisfaction questionnaires. Adverse events were recorded throughout the study. RESULTS: Overall, 81 patients were enrolled of mean age 62.7 years, mostly men (76.5%) with skin phototype I (64.2%) or II (35.8%) and a long history of AK (mean duration 16.8 years). Most had multiple lesions (82.7% had >10 lesions) of predominantly grade I (75.3%). At 3 months after treatment, almost half the patients (46.8%) required no further treatment. The proportions of patients and physicians satisfied to very satisfied with the MAL DL-PDT treatment were 79.7% and 83.3%, respectively. After receiving the treatment, 74.1% of patients indicated via the questionnaire that they were not bothered at all by the pain. Related AEs were reported in 48.1% of patients, mainly mild erythema (44.4%). CONCLUSIONS: In clinical practice in Australia, the use of MAL DL-PDT in treating multiple mild to moderate non-hyperkeratotic AK of the face and/or scalp results in high levels of patient and physician satisfaction reflecting the good efficacy and tolerability of this almost painless, convenient procedure. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02674048. FUNDING: Galderma R&D.

9.
Australas J Dermatol ; 57(1): 24-8, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25827200

RESUMEN

BACKGROUND/OBJECTIVES: Solar (actinic) keratosis (AK) is an emergent concern worldwide and is associated with an increased risk of development of non-melanoma skin cancer, especially squamous cell carcinoma. Daylight-mediated photodynamic therapy (DL-PDT) using methyl aminolaevulinate cream has proved to be an effective, nearly painless, and more convenient alternative to conventional PDT for the treatment of AK. In a phase III, randomised, controlled trial performed in Australia, the mean irradiance (light intensity) received by patients during DL-PDT treatment, assessed via a spectroradiometer, was 305 W/m(2) (min. 40 to max. 585 W/m(2) ) with similar efficacy irrespective of intensity or dose. The objective of the present meteorological study was to assess the suitability of natural daylight to perform DL-PDT for the treatment of face and scalp AK during different periods of the year and different geographical locations and latitudes across Australia. METHODS: To determine daylight irradiance during a complete year in eight different geographical locations throughout Australia, we used meteorological software (Meteonorm, Meteotest, Bern, Switzerland), and available solar radiation and weather data from 1986-2005. RESULTS: The average daily irradiance remained within the levels (40-585 W/m(2) ) measured during the clinical DL-PDT study in Australia, throughout the year and in all geographical locations investigated (yearly average from Darwin 548 W/m(2) to Hobart 366 W/m(2) ). CONCLUSIONS: DL-PDT for the treatment of face and scalp AK in Australia can be performed effectively throughout the entire year as long as weather conditions permit daylight exposure and allow participants to remain under direct light for 2 h.


Asunto(s)
Dermatosis Facial/tratamiento farmacológico , Queratosis Actínica/tratamiento farmacológico , Fotoquimioterapia , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Luz Solar , Ácido Aminolevulínico/uso terapéutico , Australia , Humanos , Meteorología/estadística & datos numéricos , Fármacos Fotosensibilizantes/uso terapéutico , Factores de Tiempo
10.
Australas J Dermatol ; 57(3): 167-74, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26033230

RESUMEN

Australia has the highest prevalence of actinic keratoses (AK) worldwide. Because of the risk of transformation of AK to invasive squamous cell carcinomas, consensus guidelines recommend that AK are removed using appropriate therapies to prevent progression to invasive disease. Daylight photodynamic therapy (PDT) is emerging as an efficacious treatment for AK, particularly for patients who require treatment of large areas of chronic actinic damage that can be exposed easily to daylight. Daylight PDT with methyl aminolevulinate (MAL) cream is a simple treatment for AK, almost painless, well tolerated and convenient, requiring minimal time in the clinic. Randomised controlled studies from northern Europe and Australia support the use of daylight PDT as an effective therapy for grade I and II AK on the face and scalp. There is sufficient daylight to conduct daylight PDT in Australia at any time of the year and during most weather conditions. Hence, daylight PDT with MAL can be included as an effective and well-tolerated new treatment option for the treatment of AK in Australia. These consensus recommendations provide guidelines for Australian clinicians on the use of daylight PDT in the treatment of diagnosed AK.


Asunto(s)
Ácido Aminolevulínico/análogos & derivados , Queratosis Actínica/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Guías de Práctica Clínica como Asunto , Luz Solar , Ácido Aminolevulínico/uso terapéutico , Australia , Consenso , Dermatosis Facial/diagnóstico , Dermatosis Facial/tratamiento farmacológico , Femenino , Humanos , Queratosis Actínica/diagnóstico , Masculino , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
11.
J Am Acad Dermatol ; 60(5 Suppl): S1-50, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19376456

RESUMEN

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.


Asunto(s)
Acné Vulgar/terapia , Acné Vulgar/etiología , Administración Oral , Administración Tópica , Algoritmos , Antibacterianos/administración & dosificación , Enfermedad Crónica , Farmacorresistencia Microbiana , Quimioterapia Combinada , Medicina Basada en la Evidencia , Humanos , Queloide/terapia , Fototerapia , Retinoides/administración & dosificación
12.
Australas J Dermatol ; 46(3): 144-9, 2005 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16008643

RESUMEN

From January 2001 to January 2002, Broken Hill, New South Wales, served as a trial site for teledermatology as one method of access to dermatologists. Fourteen participating general practitioners referred 46 patients making up 48 teledermatology cases. The mean diagnostic agreement between general practitioners and dermatologists was 35% and 50% for primary and differential diagnoses, respectively. Teledermatology patients formed 12% of the collectively referred dermatology patients (outpatients and teledermatology). In this project, high patient and general practitioner acceptability and positive medical outcomes confirm the value of rural teledermatology. However, this project also revealed unexpected barriers and pitfalls in the effective operation of rural teledermatology. Lack of education of participants, inertia among potential users and patient inconvenience are issues that may adversely affect the effective implementation of rural teledermatology.


Asunto(s)
Dermatología/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Dermatología/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Medicina Familiar y Comunitaria/estadística & datos numéricos , Humanos , Nueva Gales del Sur , Ubicación de la Práctica Profesional/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta/estadística & datos numéricos , Servicios de Salud Rural/organización & administración , Telemedicina/métodos
13.
Australas J Dermatol ; 43(3): 186-9, 2002 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12121395

RESUMEN

The differences between topical corticosteroids are based mainly on their potency, safety and patient acceptability. The aim of this study was to evaluate a mild- to mid-potent topical corticosteroid, desonide 0.05%, on these three parameters in an Australian cohort of patients with facial seborrhoeic or atopic dermatitis. Eighty-one adult patients were randomized to receive desonide 0.05% lotion or its vehicle, applied twice daily for 3 weeks under double-blind conditions. In the active treatment group, 88% of patients had their skin condition cleared or almost cleared and only two patients experienced cutaneous adverse events (rash and pruritus). The acceptability of the lotion was high; 95% of patients stated they would use this topical corticosteroid again. These data support the short-term use of desonide 0.05% lotion as a suitable agent for the short-term treatment of facial dermatitis.


Asunto(s)
Antiinflamatorios/uso terapéutico , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Seborreica/tratamiento farmacológico , Desonida/uso terapéutico , Administración Tópica , Adolescente , Adulto , Antiinflamatorios/efectos adversos , Australia , Dermatitis Atópica/diagnóstico , Dermatitis Seborreica/diagnóstico , Desonida/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Emulsiones , Estética , Dermatosis Facial/diagnóstico , Dermatosis Facial/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Glucocorticoides , Humanos , Masculino , Persona de Mediana Edad , Probabilidad , Valores de Referencia , Resultado del Tratamiento
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