Topical Treatment of Truncal Acne with Tretinoin Lotion 0.05% and Azelaic Acid Foam.

Truncal acne is present in approximately half of all patients with facial acne but is also occasionally seen in isolation. Important considerations when selecting treatment options for adult female acne, whether on the face, back, chest, or shoulders, include patient compliance, treatment response time, tolerability of the treatment, and psychosocial impact of the disease. Oral antibiotics are widely prescribed for truncal acne due to the challenges of applying topical therapy to such an extensive body surface area. In cases of severe inflammatory and nodular acne vulgaris, this may be a reasonable consideration; however, oral antibiotics should only be used for short durations. Overprescription contributes to microbial resistance and may cause disruption of the gastrointestinal microbiome. In many cases of mild, moderate, or even severe truncal acne, combinations of topical therapies may be valid alternatives. The introduction of foam formulations with enhanced percutaneous absorption and tretinoin lotion formulations that incorporate moisturizing/hydrating agents challenges the previously held idea that effective and tolerable treatment of truncal acne requires oral treatment. This case series describes four female African-American patients with truncal acne successfully treated with a combination of tretinoin lotion 0.05% and azelaic acid 15% foam.

Novel Tretinoin 0.05% Lotion for the Once-daily Treatment of Moderate-to-severe Acne Vulgaris in a Preadolescent and Adolescent Population.

Background: The efficacy of tretinoin is well documented in adolescent acne, with limited data available in preadolescents. A novel tretinoin 0.05% lotion formulation has been shown to be effective and well tolerated in moderate-to-severe acne. Objective: We sought to evaluate the safety and efficacy of tretinoin 0.05% lotion in preadolescent (≤13 years) and adolescent (14-17 years) subjects with acne. Methods: This study involved the post-hoc analysis of two multicenter, randomized, double-blind, vehicle-controlled Phase III studies. Preadolescent (n=154) and adolescent (n=575) subjects were randomized (1:1) to tretinoin 0.05% lotion or vehicle used once daily for 12 weeks. Efficacy assessments included lesion count reductions, treatment success (at least a two-grade reduction in the Evaluator's Global Severity Score and clear/almost clear). Safety, adverse events (AEs), and cutaneous tolerability were evaluated. Results: At Week 12, mean percent reductions in inflammatory and noninflammatory lesion counts were 49.5% and 44.0% in preadolescents and 50.5% and 41.2% in adolescents, compared to 31.4%, 18.8%, 35.9%, and 23.8% for the vehicle, respectively (all p≤0.001). Treatment success was achieved by 23.7% (preadolescent) and 17.5% (adolescent) of subjects by Week 12, compared to 7.2% (p=0.009) and 8.8% (P=0.004) with the vehicle. The majority of AEs were mild and transient; the most frequent occurrences were application site pain and dryness in 5.6% and 2.8% of preadolescents and 3.2% and 3.6% of adolescents. Local cutaneous safety and tolerability assessments were generally mild-to-moderate, with slight transient increases in mean scores at Week 4. Conclusions: Tretinoin 0.05% lotion was significantly more effective than the vehicle in achieving treatment success and reducing inflammatory and noninflammatory lesions in preadolescent and adolescent acne. It was well tolerated, and all treatment-related AEs were mild or moderate.

Pili annulati associated with hair fragility: cause or coincidence?

Pili annulati is a disorder that produces a spangled appearance to the hair, caused by alternating light and dark banding of hair shafts. This phenomenon is created by abnormal cavities in the cortex of the hair shaft, which produces lighter bands seen on clinical examination. Complications of pili annulati are limited; the most noteworthy complication is increased breakage secondary to weathering of the abnormal hair shafts. We report a case of a 14-year-old adolescent girl with pili annulati and progressive hair loss of 2 months' duration. Most of her hairs were notably short, spangled, and lusterless with light and dark banding observed with handheld magnification. Light microscopy demonstrated alternating light and dark bands, and the dark bands had the typical appearance of air-filled spaces. Gentler hair grooming practices were recommended, and at a follow-up visit, the appearance of the hair had improved with darker and longer shafts. This case should alert clinicians to look for pili annulati when hair fragility is present.

Postinflammatory hyperpigmentation: etiologic and therapeutic considerations.

Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis and sequela of a variety of inflammatory skin conditions. PIH can have a negative impact on a patient's quality of life, particularly for darker-skinned patients. Studies show that dyschromias, including PIH, are one of the most common presenting complaints of darker-skinned racial ethnic groups when visiting a dermatologist. This is likely due to an increased production or deposition of melanin into the epidermis or dermis by labile melanocytes. A variety of endogenous or exogenous inflammatory conditions can culminate in PIH and typically most epidermal lesions will appear tan, brown, or dark brown while dermal hypermelanosis has a blue-gray discoloration. Depigmenting agents target different steps in the production of melanin, most commonly inhibiting tyrosinase. These agents include hydroquinone, azelaic acid, kojic acid, arbutin, and certain licorice (glycyrrhiza) extracts. Other agents include retinoids, mequinol, ascorbic acid (vitamin C), niacinamide, N-acetyl glucosamine, and soy, and these products depigment by different mechanisms. Certain procedures can also be effective in the treatment of PIH including chemical peeling and laser therapy. It is important to note that these same therapeutic modalities may also play a role in causing PIH. Lastly, those lesions that are not amenable to medical or surgical therapy may experience some improvement with cosmetic camouflage.