[Bacterial resistance in acne? A meta-analysis of the controversy]. / ¿Resistencia en el acné? Un metaanálisis a propósito de la controversia.

BACKGROUND: Acne is one of the dermatological pathologies with the highest incidence around the world. It is a multifactorial disease and its treatment can be complex. Propionibacterium acnes play a key role in the inflammation of this dermatosis. Topical antibiotics, including mainly erythromycin and clindamycin, have been used, but there is controversy over their use due to the widely documented bacterial resistance. For this reason a meta-analysis of the publications over the past 10 years is presented in order to confirm this hypothesis. MATERIAL AND METHODS: A search was made of the publications over the past 10 years that included the results of antibiogams of patients with acne. MeSH type searches were performed with the terms "acne vulgaris", "Propionibacterium acnes", "topical administration", "treatment", "erythromycin", "clindamycin", "nadifloxacin", "antibacterial agent", "bacterial drug resistance" in PubMed, Ovid, EBSCO, Cochrane, ScienceDirect and ClinicalKey meta-searches. RESULTS: A total of 13 articles were found that met the inclusion criteria. The mean odds ratio (OR 1.24, 95% CI) of the articles showed a slight tendency toward resistance of Propionibacterium acnes. CONCLUSIONS: An increase in bacterial resistance to topical erythromycin and clindamycin can be confirmed, thus the use of these antibiotics is recommended in selective cases for short periods, and in combination with benzoyl peroxide for the best clinical outcome in patients with acne vulgaris.

The use of lymecycline and benzoyl peroxide for the treatment of progressive macular hypomelanosis: a prospective study.

Progressive macular hypomelanosis is a dermatosis of uncertain etiology. The participation of Propionibacterium acnes has been suggested in view of the response achieved following therapy with drugs that are active against this bacterium. This report describes a series of thirteen patients with progressive macular hypomelanosis who were treated with an association of lymecycline and benzoyl peroxide over a three-month period. Response to treatment was excellent and the positive results were maintained during the entire follow up period.

Uso da limeciclina associada com o peróxido de benzoíla no tratamento da hipomelanose macular progressiva: um estudo prospectivo / The use of lymecycline and benzoyl peroxide for the treatment of progressive macular hypomelanosis: a prospective study

A hipomelanose macular progressiva é uma dermatose de etiopatogenia pouco conhecida. A participação do Propionibacterium acnes e a resposta ao tratamento com medicamentos com atividade para essa bactéria têm sido sugeridas. Relata-se uma série de casos de 13 pacientes com hipomelanose macular progressiva tratados com limeciclina e peróxido de benzoíla durante três meses, que apresentaram excelente resposta ao tratamento e nele se mantêm durante o período de seguimento do estudo.

Progressive macular hypomelanosis is a dermatosis of uncertain etiology. The participation of Propionibacterium acnes has been suggested in view of the response achieved following therapy with drugs that are active against this bacterium. This report describes a series of thirteen patients with progressive macular hypomelanosis who were treated with an association of lymecycline and benzoyl peroxide over a three-month period. Response to treatment was excellent and the positive results were maintained during the entire follow up period.

Community study of fixed-combination adapalene 0.1% and benzoyl peroxide 2.5% in acne.

A new fixed-dose combination formulation of adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has shown excellent efficacy and safety in registration studies; however, it can be difficult to judge the real-world performance of a product using only the results from controlled clinical trials. This 12-week, open-label, community-based study evaluated adapalene/BPO in 91 patients with mild to moderate acne (20-50 inflammatory lesions and 30-100 noninflammatory lesions) who were treated at dermatology centers throughout Argentina. The study evaluated efficacy, described the most common side effects, determined tolerability, and assessed the level of patient satisfaction with treatment. By week 12, there were statistically significant reductions in both inflammatory and noninflammatory lesions (80.6% and 69.3% from baseline, respectively; P < .001); there were also significant improvements in the Investigator's Global Assessment scores (median score, 2.9 at baseline and 1.0 at week 12; P < .001). By week 12, 67% of patients were rated clear or almost clear by investigators. Local tolerability was good overall. When cutaneous irritation was present, it typically occurred in the first 2 weeks of treatment and improved or resolved with continuing therapy. Patients were highly satisfied with the results of treatment, and 74% of patients felt that they had marked or total improvement by week 12. Patient survey also revealed that 94% rated the efficacy as good or very good and 87.5% rated tolerability as good or very good. A significant majority (81%) felt that the treatment met expectations, and 62% perceived that improvement had been rapid during adapalene/BPO therapy. These results demonstrate that adapalene/BPO has good efficacy and tolerability in routine practice, resulting in continuous reductions in lesion counts throughout the study. Adapalene/BPO therapy is also associated with high patient satisfaction, which is important for therapeutic adherence and satisfaction with the physician's care.

Estudo clínico, prospectivo, aberto, randomizado e comparativo para avaliar a segurança e a eficácia da luz azul versus peróxido de benzoíla 5 por cento no tratamento da acne inflamatória graus II e III / A prospective, randomized, open and comparative study to evaluate the safety and efficacy of blue light treatment versus a topical benzoyl peroxide 5 percent formulation in patients with acne grade II and III

FUNDAMENTOS: Muitos pacientes relatam melhora da acne com a exposição à luz solar, e vários estudos demonstram que a luz azul é efetiva no tratamento da acne. OBJETIVOS: Verificar a segurança e a eficácia da luz azul (espectro eletromagnético de 407 a 420 nm) no tratamento da acne inflamatória graus II e III, comparada à terapêutica tópica com peróxido de benzoíla a 5 por cento. MÉTODOS: O estudo avaliou 60 pacientes em cinco visitas: uma de seleção, uma com 7, 14 e 28 dias de tratamento e uma última de seguimento, 14 dias após o término do tratamento. Trinta foram randomizados para luz azul (oito sessões, duas vezes por semana), e outros 30, para peróxido de benzoíla a 5 por cento, duas vezes ao dia, diariamente. A avaliação foi por meio da contagem das lesões e fotografias. RESULTADOS: A redução no número médio de lesões foi semelhante com os dois tratamentos, independente do tipo de lesão (p 0,05), porém o tratamento com a luz azul apresentou menos efeitos colaterais. CONCLUSÕES: A luz azul foi um tratamento tão eficaz quanto o peróxido de benzoíla a 5 por cento para o tratamento da acne graus II e III, mas com menos efeitos adversos.

BACKGROUND: Many acne patients improve after exposure to sunlight and there are many reports about the efficacy of blue light phototherapy on acne lesions. OBJECTIVES - The purpose of this study was to evaluate efficacy and safety of blue light treatment versus topical benzoyl peroxide 5 percent formulation in patients with acne grades II and III. METHODS - Sixty volunteers with facial acne were included and evaluated in 5 visits: the first one for screening, another 3 held on days 7, 14 and 28 of treatment, and the last one after 14 days of the end of treatment. Thirty of them were irradiated with Blue Light (8 times, twice a week) and the other thirty were treated with topical Benzoyl Peroxide 5 percent formulation, auto-applied twice a day, every day. We assessed the severity of acne by counting the lesions and analyzing the photographs. RESULTS - The improvement achieved by the blue light was the same as the one with benzoyl peroxide, regardless of the type of lesion (p 0.05). Otherwise, the side effects were less frequent in the group treated with blue light. CONCLUSIONS - Blue light irradiation was as effective as Benzoyl Peroxide in acne treatment grades II and III but there were fewer side effects.

A North American study of adapalene-benzoyl peroxide combination gel in the treatment of acne.

A fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% recently has been developed for the treatment of acne vulgaris. In this multicenter, randomized, double-blind, parallel-group, active- and vehicle-controlled study conducted at 60 centers in the United States, Puerto Rico, and Canada, we assessed the efficacy and safety of adapalene-BPO combination gel in comparison with adapalene and BPO monotherapies as well as the gel vehicle. Participants with moderate facial acne vulgaris (rated 3 on the 5-point investigator global assessment of acne severity scale) were recruited and randomized to receive once-daily treatment with adapalene-BPO combination gel, adapalene monotherapy, BPO monotherapy, or gel vehicle for 12 weeks. They were assessed for success rate (the percentage of participants with investigator global assessment of acne severity rated clear or almost clear) and percentage change in inflammatory lesion (IL), noninflammatory lesion (NIL), and total lesion counts. Of the 1668 participants enrolled, 1429 (85.7%) completed the study. At study end point, adapalene-BPO combination gel showed a significantly higher success rate (P < or = .006) and a greater percentage reduction in all acne lesion counts (P < or = .017) compared with the other treatment groups. A significant early treatment effect of adapalene-BPO combination gel at week 1 compared with adapalene monotherapy and vehicle also was observed for all lesion count reductions (P<.001). The safety of adapalene-BPO combination gel was comparable with adapalene and BPO monotherapies and vehicle. In a large clinical trial, the adapalene-BPO fixed-dose combination gel has shown superiority in efficacy compared with adapalene and BPO monotherapies and vehicle, with an early onset of efficacy and a good safety profile.

[A prospective, randomized, open and comparative study to evaluate the safety and efficacy of blue light treatment versus a topical benzoyl peroxide 5% formulation in patients with acne grade II and III]. / Estudo clínico, prospectivo, aberto, randomizado e comparativo para avaliar a segurança e a eficácia da luz azul versus peróxido de benzoíla 5% no tratamento da acne inflamatória graus II e III.

BACKGROUND: Many acne patients improve after exposure to sunlight and there are many reports about the efficacy of blue light phototherapy on acne lesions. OBJECTIVES: The purpose of this study was to evaluate efficacy and safety of blue light treatment versus topical benzoyl peroxide 5% formulation in patients with acne grades II and III. METHODS: Sixty volunteers with facial acne were included and evaluated in 5 visits: the first one for screening, another 3 held on days 7, 14 and 28 of treatment, and the last one after 14 days of the end of treatment. Thirty of them were irradiated with Blue Light (8 times, twice a week) and the other thirty were treated with topical Benzoyl Peroxide 5% formulation, auto-applied twice a day, every day. We assessed the severity of acne by counting the lesions and analyzing the photographs. RESULTS: The improvement achieved by the blue light was the same as the one with benzoyl peroxide, regardless of the type of lesion (p 0.05). Otherwise, the side effects were less frequent in the group treated with blue light. CONCLUSIONS: Blue light irradiation was as effective as benzoyl peroxide in acne treatment grades II and III but there were fewer side effects.

Novel vesicular and particulate drug delivery systems for topical treatment of acne.

BACKGROUND: The efficacy of the antiacne topical drugs is well established. The local side effects, however, mainly cutaneous irritation, erythema, dryness, peeling and scaling, remain major problems. Novel vesicular and particulate drug delivery systems have been proposed to reduce the side effects of drugs commonly used in the topical treatment of acne. OBJECTIVE: This review focuses on the development and evaluation of antiacne drug-loaded vesicular and particulate delivery systems (liposomes, polymeric microspheres and solid lipid nanoparticles) for topical treatment, their advantages and challenges. METHODS: All the literature available was reviewed to highlight the potential of these novel systems for the topical treatment of acne. CONCLUSION: The encapsulation of antiacne drugs in vesicular and particulate delivery systems represents an innovative alternative to minimize side effects, while preserving their efficacy. This can be obtained by the capacity of these systems to provide controlled release or to improve the drug penetration into skin or even into the pilosebaceous unit.

Rosacea: II. Therapy

Despite an incomplete understanding of the pathogenesis of rosacea, therapeutic modalities continue to expand. The principal subtypes of rosacea include erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea. These phenotypic expressions are probably caused by divergent pathogenic factors and consequently respond to different therapeutic regimens. A subtype-directed approach to therapy is discussed in part II of this review. We provide an overview of the available topical, oral, laser, and light therapies in the context of these cutaneous subtypes, review the evidence that supports their use, and outline their therapeutic approach. Suggestions for future areas of study also are provided

Single-blind and comparative clinical study of the efficacy and safety of benzoyl peroxide 4% gel (BID) and adapalene 0.1% Gel (QD) in the treatment of acne vulgaris for 11 weeks.

objectives: To compare the efficacy and tolerability of a gel containing benzoyl peroxide 4%, used twice daily, with a gel containing adapalene 0.1% used once daily, in the treatment of acne vulgaris for 11 weeks. methods: 178 patients bearing acne vulgaris, aged between 13 and 30 years, were studied in a comparative and single-blind clinical study. The 178 patients were divided into two groups: 89 patients treated with benzoyl peroxide 4% and 89 patients treated with adapalene 0.1%. The treatment duration was 11 weeks. The efficacy assessment was conducted through an accounting of both the inflammatory and non-inflammatory lesions in all visits. The safety assessment was conducted through reports regarding adverse reactions and local tolerance in all visits and an overall tolerance at the end of the study. conclusions: The results showed that both treatments were efficient in the reduction of acne lesions after 11 weeks treatment and were well tolerated, without any serious adverse event report. The benzoyl peroxide 4% was superior in the reduction of the number of inflammatory and non-inflammatory lesions at weeks 2 and 5, when compared to adapalene 0.1%.

Antimicrobianos tópicos en acné: novedades / Topical antimicrobials in acne: news

Los antimicrobianos y principalmente los antibióticos tópicos son un arma terapéutica eficaz y segura en el tratamiento del acné. Antiobióticos tópicos tales como Eritromicina, Clidamicina o Tetraciclina son eficaces en el acné inflamatorio leve a moderado. Su mecanismo de acción es por inhibición de la inflamación más que por un efecto bactericida. Su uso combinado con Peróxido de Benzoílo, Tretinoina o Zinc aumentan su eficacia. Los efectos adversos son leves siendo el de mayor relevancia el desarrollo de cepas resistentes de Propionibacterium Acnes. Nuevos antibióticos tópicos están en investigación siendo una promesa al futuro del tratamiento tópico del acné