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1.
Medicine (Baltimore) ; 100(3): e23732, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545938

RESUMO

BACKGROUND: This study is to assess the effectiveness of CO2 laser therapy (COLT) in treating patients with acne depressed scar (ADS). METHODS: Relevant randomized controlled trials will be checked by search the electronic databases of Cochrane Library, PUBEMD, EMBASE, Web of Science, Allied and Complementary Medicine Database, VIP Database, CBM database, and China National Knowledge Infrastructure. All potential randomized controlled trials of COLT for patients with ADS will be identified by 2 independent authors by searching all sources from inception to present. Two authors will independently undertake literature selection, data collection and study quality assessment. Any divergences between 2 authors will be settled down by a third author through discussion. RevMan 5.3 software will be used for statistical analysis. RESULTS: This study will assess the effectiveness of COLT for patients with ADS. CONCLUSIONS: This study may provide helpful evidence to determine whether COLT is an effective intervention for patients with ADS. STUDY REGISTRATION: OSF (osf.io/m9ghv).


Assuntos
Acne Vulgar/radioterapia , Humanos , Terapia a Laser , Lasers de Gás , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto
2.
Ann Pharmacother ; 55(1): 105-110, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618475

RESUMO

OBJECTIVE: To review the safety and efficacy of minocycline 4% topical foam for the treatment of moderate to severe acne vulgaris in adults and pediatric patients aged 9 years and older. DATA SOURCES: A literature search through PubMed and EMBASE was conducted using the following keywords: FMX101, minocycline, foam, and acne. STUDY SELECTION AND DATA EXTRACTION: Articles selected included those describing preclinical and clinical studies of pharmacokinetics, efficacy, or safety of topical minocycline foam. DATA SYNTHESIS: Minocycline 4% topical foam was shown in a preclinical study to effectively deliver minocycline to the pilosebaceous unit, with little penetration beyond the stratum corneum. This was consistent with a phase 1 pharmacokinetic study of the foam, which yielded a significantly reduced systemic exposure of minocycline compared with oral minocycline. In phase 2 and phase 3 clinical trials, the foam significantly reduced acne lesion counts and Investigator's Global Assessment scores of acne severity compared with placebo. The foam has a good safety profile, with headache, mild erythema, hyperpigmentation, and mild dryness among the most common adverse effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Topical antibiotics have been a mainstay of acne therapy with the benefit of less systemic exposure compared with oral antibiotics. However, the development of bacterial resistance has reduced their use, thereby reducing options for many patients with acne. Minocycline 4% topical foam is a safe and effective alternative, which may help restore this important therapeutic approach for treating acne vulgaris.


Assuntos
Acne Vulgar/tratamento farmacológico , Antibacterianos/uso terapêutico , Minociclina/uso terapêutico , Administração Cutânea , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Criança , Ensaios Clínicos como Assunto , Feminino , Humanos , Hiperpigmentação/induzido quimicamente , Masculino , Minociclina/administração & dosagem , Minociclina/efeitos adversos , Resultado do Tratamento
3.
J Dermatolog Treat ; 32(1): 73-77, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31172821

RESUMO

Background: It is anticipated that the combined treatments of ablative laser and human stem cell-conditioned media produce the synergistic effects.Objectives: To investigated the effects of human stem cell-conditioned media (HSCM) as a post-procedural agent after fractional CO2 laser procedure in patients with atrophic acne scars and skin pores. Method: Both cheeks of 15 subjects were treated with a fractional CO2 laser. HSCM was randomly applied to one of the resurfacing sites (T) and normal saline was applied to the other site as a control (C). During the next six days, a solution containing 80% HSCM and hyaluronic acid (HA) was applied on the treated side (T) and HA alone was applied to the control side (C). Scar volume and erythema were objectively evaluated using an Antera 3D® CS. Result: After two months, the scar volume was reduced by 23.5% (T) versus 15.0% (C) (p = .143) and the volume of the skin pores was reduced by 37.6% (T) versus 15.9% (C) (p = .006), while the erythema was increased by 2.8% (T) versus 3.1% (C) (p = .934). Atrophic scar and the skin pores in the HSCM-applied area improved by at least 15.0% after a single treatment session, suggesting better results compared with the control side.Conclusion: HSCM may augment the regenerative effects of fractional CO2 laser.


Assuntos
Cicatriz/radioterapia , Meios de Cultivo Condicionados/farmacologia , Lasers de Gás/uso terapêutico , Pele/efeitos dos fármacos , Acne Vulgar/complicações , Adulto , Idoso , Cicatriz/etiologia , Eritema/etiologia , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Lasers de Gás/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Pessoa de Meia-Idade , Pele/patologia , Células-Tronco/citologia , Células-Tronco/metabolismo , Resultado do Tratamento , Adulto Jovem
4.
J Dermatolog Treat ; 32(1): 64-69, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31076012

RESUMO

Background: Acne Vulgaris is a chronic inflammatory disease that requires long-term treatment. Adherence to treatment is a problem in chronic diseases and may affect treatment outcomes.Objective: We aim to investigate treatment adherence and satisfaction of patients with acne and identify independent factors that affect them.Methods: Five hundred patients with acne were included in this cross-sectional study. Demographic and clinical characteristics of the patients were recorded. Severity of acne was assessed using the Investigator Global Assessment (IGA) scale, and a five-point Likert scale was used to assess patients' satisfaction and adherence.Results: Adherence to treatment was poor in 64.4% of the patients. Multivariate logistic regression analysis showed that using oral isotretinoin (OR: 4.1, 95% CI 2.44-6.92, p < .001) and satisfaction with treatment (OR: 2.1, 95% CI 1.31-3.43, p = .002) were independent factors that affect adherence in patients. 51.8% of the patients were satisfied with their treatments and treatment satisfaction was higher in females (OR: 2.2, 95% CI 1.3-3.8, p = .004) and patients using oral isotretinoin (OR: 14.8, 95% CI 9.4-23.2, p < .001).Conclusions: Treatment adherence is poor among patients with acne. Identifying the factor that affects adherence may help the dermatologist recognize non-adherent patients and develop strategies to improve adherence.


Assuntos
Acne Vulgar/psicologia , Satisfação do Paciente , Cooperação e Adesão ao Tratamento , Acne Vulgar/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Isotretinoína/uso terapêutico , Modelos Logísticos , Masculino , Razão de Chances , Fatores Sexuais , Adulto Jovem
5.
J Dermatolog Treat ; 32(1): 3-10, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31211609

RESUMO

Introduction: Dermocosmetics are increasingly being recognized as an integral part of acne management. Dermocosmetics may minimize the side effects of acne medications, provide synergistic effects by improving the efficacy of other treatments, and limit exposure to environmental factors such as ultraviolet radiation. We aimed to provide an overview of the active ingredients and different types of preparations used in dermocosmetics for acne, and highlight supporting evidence for their use in clinical practice.Methods: A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertize.Results and discussion: The different types of active ingredients in dermocosmetics for acne can be classified as: sebum-controlling, antimicrobial, anti-inflammatory, anti-oxidant and/or keratolytic. Such agents may modulate the pathogenic pathways in acne. Dermocosmetics can be formulated as emulsions/creams, cleansers or camouflaging make-up. Dermocosmetics are useful treatment adjuncts for acne and have been shown to improve the clinical signs of acne, reduce transepidermal water loss and modify sebum production. Dermocosmetics have also been associated with reducing side effects of pharmacological treatments, high levels of patient satisfaction and increased adherence to treatment regimens. Together this evidence supports the use of dermocosmetics in clinical practice.


Assuntos
Acne Vulgar/tratamento farmacológico , Cosméticos/uso terapêutico , Acne Vulgar/radioterapia , Antibacterianos/química , Antibacterianos/uso terapêutico , Anti-Inflamatórios/química , Anti-Inflamatórios/uso terapêutico , Antioxidantes/química , Cosméticos/química , Emulsões/química , Humanos , Ceratolíticos/química , Ceratolíticos/uso terapêutico , Sebo/química , Raios Ultravioleta
6.
Ann Pharmacother ; 55(1): 111-116, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32567361

RESUMO

OBJECTIVE: This article reviews clinical trials to assess the efficacy, safety, and clinical application of trifarotene 0.005% cream (Aklief). DATA SOURCES: A systematic review of the literature was performed using the terms trifarotene OR Aklief OR CD5789 in MEDLINE (PubMed) and EMBASE databases. Articles prior to May 2020 were considered for inclusion. Bibliographies and ClinicalTrials.gov were also searched to identify further studies. STUDY SELECTION AND DATA EXTRACTION: Relevant English language and human studies related to pharmacology, clinical trials, and safety were considered. DATA SYNTHESIS: In the 52-week phase III trial, treatment success rates for facial acne (Investigator Global Assessment [IGA] rating of no or almost no acne) and truncal acne (Physician's Global Assessment [PGA] rating of no or almost no acne) were 65.1% and 66.9%, respectively. Overall success rates (IGA and PGA success in the same patient) were 57.9%; 52.8% of patients had a Dermatology Quality of Life Index score of 0 or 1, compared with 22.6% at baseline. Trifarotene was well tolerated, with pruritus, irritation, and sunburn as the most common adverse effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Trifarotene is a newly Food and Drug Administration-labeled fourth-generation topical retinoid that shows particular promise in the treatment of facial and truncal acne vulgaris. It is an effective and safe addition to currently available retinoids. CONCLUSION: Trifarotene is effective and safe for treatment of facial and truncal acne. Future trials should compare its efficacy and tolerability with that of the older, clinically established retinoids. Despite efficacy, cost may be a prohibitive factor.


Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Retinoides/uso terapêutico , Administração Cutânea , Adolescente , Adulto , Ensaios Clínicos Fase III como Assunto , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Feminino , Humanos , Prurido/induzido quimicamente , Qualidade de Vida , Retinoides/administração & dosagem , Retinoides/efeitos adversos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(44): e22983, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126372

RESUMO

To investigate the incidence of skin diseases, the factors affecting the life quality, anxiety, and depression of patients with skin diseases and the correlation among the 3.A total of 1127 patients with skin diseases were selected online from March 2018 to June 2018. Logistic regression was used to analyze the factors influencing life quality, anxiety, and depression. Spearman rank correlation was used to analyze the correction among the life quality, anxiety, and depression.There was no significant difference in ethnicity, education, and time of question among patients (P > .05). Sex ratio, age, marital status, and occupation were statistically significant difference among patients with different skin diseases (P < .05). The life quality index of patients with psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia were 11.96 ±â€Š6.74, 9.84 ±â€Š6.99, 11.57 ±â€Š6.85, 13.86 ±â€Š6.31, 7.86 ±â€Š6.82, respectively. The differences were statistically significant (P < .05). The main factors affecting quality of life included age, family history, and types of skin diseases. The age, ethnicity, education, and family history of skin diseases were the main factors affecting anxiety of patients with different skin diseases. Additionally, sex, marital status, education, and family history of skin diseases were the main factors influencing depression. Spearman rank correlation analysis showed that the life quality, anxiety, and depression were positively correlated.Psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia have a certain impact on the life quality of most patients, and may cause different degrees of anxiety and depression.


Assuntos
Ansiedade ao Tratamento Odontológico/etiologia , Depressão/etiologia , Qualidade de Vida , Dermatopatias/psicologia , Acne Vulgar/complicações , Acne Vulgar/psicologia , Adulto , Alopecia/complicações , Alopecia/psicologia , Dermatite/complicações , Dermatite/psicologia , Dermatite Atópica/complicações , Dermatite Atópica/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Psoríase/complicações , Psoríase/psicologia , Qualidade de Vida/psicologia , Dermatopatias/complicações , Inquéritos e Questionários
11.
Nat Commun ; 11(1): 5067, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082341

RESUMO

Although acne is the most common human inflammatory skin disease, its pathogenic mechanisms remain incompletely understood. Here we show that GATA6, which is expressed in the upper pilosebaceous unit of normal human skin, is down-regulated in acne. GATA6 controls keratinocyte proliferation and differentiation to prevent hyperkeratinisation of the infundibulum, which is the primary pathological event in acne. When overexpressed in immortalised human sebocytes, GATA6 triggers a junctional zone and sebaceous differentiation program whilst limiting lipid production and cell proliferation. It modulates the immunological repertoire of sebocytes, notably by upregulating PD-L1 and IL10. GATA6 expression contributes to the therapeutic effect of retinoic acid, the main treatment for acne. In a human sebaceous organoid model GATA6-mediated down-regulation of the infundibular differentiation program is mediated by induction of TGFß signalling. We conclude that GATA6 is involved in regulation of the upper pilosebaceous unit and may be an actionable target in the treatment of acne.


Assuntos
Acne Vulgar/metabolismo , Fator de Transcrição GATA6/metabolismo , Glândulas Sebáceas/metabolismo , Acne Vulgar/genética , Acne Vulgar/patologia , Acne Vulgar/fisiopatologia , Antígeno B7-H1/genética , Antígeno B7-H1/metabolismo , Diferenciação Celular , Fator de Transcrição GATA6/genética , Homeostase , Humanos , Interleucina-10/genética , Interleucina-10/metabolismo , Queratinócitos/citologia , Queratinócitos/metabolismo , Queratinócitos/patologia , Glândulas Sebáceas/citologia , Glândulas Sebáceas/patologia , Pele/citologia , Pele/metabolismo , Pele/patologia
12.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(8): 639-649, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197150

RESUMO

La espironolactona es un diurético ahorrador de potasio con efecto antiandrogénico, de bajo coste y con un buen perfil de seguridad. Hemos observado en nuestra experiencia que es un fármaco infrautilizado en dermatología, pese a que existe evidencia de su uso en diversas patologías dermatológicas, especialmente en el acné femenino (nivel de evidencia II-III, fuerza de recomendación B), donde podría disminuir el uso de antibióticos y probablemente de isotretinoína. Otras enfermedades en las cuales puede ser útil son la hidrosadenitis supurativa y la alopecia androgenética femenina. Discutimos las indicaciones de la espironolactona, su dosificación en la práctica dermatológica, las precauciones que deben tener en cuenta y sus efectos secundarios. Además, presentamos nueva evidencia que avala su uso en dermatología sin necesidad de indicar pruebas complementarias en mujeres jóvenes y enfatiza su seguridad a largo plazo. Consideramos que la espironolactona debería estar entre los agentes comúnmente utilizados en la práctica clínica habitual


Spironolactone is an economical potassium-sparing diuretic with an anti-androgenic effect and a good safety profile. Our experience suggests that this diuretic is underexploited in dermatology even though there is evidence supporting its use in several skin conditions. When prescribed for acne in female patients (level 1-2 evidence; strength of recommendation, B), for example, it can reduce the need for antibiotics and possibly isotretinoin. Other diseases in which spironolactone is potentially useful are hidradenitis suppurativa and female androgenetic alopecia. We discuss the indications for spironolactone, dosing in dermatology, precautions to consider, and adverse effects. We also review new evidence that stresses the safety of long-term therapy and supports the use of this drug without the need for complementary testing in young women. We think that spironolactone merits a place among the medications commonly used in routine clinical practice


Assuntos
Humanos , Feminino , Espironolactona/farmacologia , Antagonistas de Androgênios/farmacologia , Acne Vulgar/tratamento farmacológico , Hidradenite Supurativa/tratamento farmacológico , Alopecia/tratamento farmacológico , Hirsutismo/tratamento farmacológico , Resultado do Tratamento
13.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 449-455, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879071

RESUMO

By searching the database of CNKI, Wanfang and PubMed, the prevalence and risk factors of atopic dermatitis, psoriasis, acne, and urticaria were relatively more investigated, which were the skin diseases of more concern in the current epidemiological study of skin diseases. Three national epidemiologic surveys reported that the prevalence of atopic dermatitis increased from 0.69% in 1998, to 3.07% in 2002, and 12.94% in 2014, respectively. The prevalence of psoriasis increased from 0.123% in 1984 to 0.47% in 2009 according to 2 national surveys. The prevalence of acne was 8.1% in a national investigation in 2008. Representative national prevalence data of urticaria is not available. Risk factors for these skin diseases are distinct. Atopic dermatitis, psoriasis, and urticaria are more related to environment and mental stress, while acne is more related to skin type and dietary factors. Owing to the heterogeneities in diagnostic methods used in the dermatoepidemiologic surveys (some of the diagnoses were self-reported) and a lack of follow ups, the reliability of data remained questionable, and the comparability across the surveys was difficult. As a result, it is necessary to conduct population-based cohort studies on skin diseases in China.


Assuntos
Acne Vulgar/epidemiologia , Dermatite Atópica , Psoríase/epidemiologia , Urticária , China/epidemiologia , Humanos , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(4): 559-561, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895111

RESUMO

Acne vulgaris is an inflammatory disease of hair follicle sebaceous gland units,with an incidence of up to 85% in adolescents.The pathogenesis is closely related to androgen,sebum secretion,lipophilic microbial infection,and immune-inflammatory reaction.This article reviews the signaling pathways related to acne from the aspects of inflammatory signaling pathways and sebum secretion pathways.


Assuntos
Acne Vulgar , Adolescente , Humanos , Glândulas Sebáceas , Sebo , Transdução de Sinais
15.
Niger J Clin Pract ; 23(9): 1289-1294, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913170

RESUMO

Backround: Internalized stigma, adoption of negative attitudes, and societal stereotypes regarding acne vulgaris (AV) have not been previously studied. Objective: To investigate the internalized stigma state in AV and determine its association with quality of life, perceived health, body image, and depression. Methods: A total of 77 AV patients (43 female, 34 male; aged 19.7 ± 2.3 years) were enrolled in this cross-sectional study. The scales used in the study were Acne Internalized Stigma Scale (AISS), Acne Quality of Life scale (AQOL), FDA Global score, Perceived Health Status (PHS), Body Image Scale (BIS), and Beck Depression Inventory (BDI). Results: Mean AISS scores (53.68 ± 13.6) were significantly higher in males than in females (57.41 ± 14.37, 50.39 ± 12.25, P = 0.042). There was a significant positive correlation between mean values of AISS and AQOL (r = 0.816, P < 0.001), FDA Global grade (r = 0.391, P = 0.002) and BDI (r = 0.440, P < 0.001). Lower PHS (P = 0.027) was another determinant of high AISS scores. The mean AISS score of patients with a family history was significantly lower than those without a family history (P = 0.007). VAS was also found to be correlated with mean values of AISS and AQOL. Linear regression analysis revealed that the most important determinant of internalized stigma was AQOL (ß = 0,632; P < 0.001), followed by gender (ß = -0,229; P = 0.001), FDA Global score (ß = 0,193; P = 0.007), and BDI (ß = 0,177; P = 0.024). Discussion: Significant and independent predictive factors for high internalized stigma state were the negative quality of life, male gender, the severity of the illness, and depression. Therefore, internalized stigma may be one of the major factors responsible for the psychosocial burden of AV.


Assuntos
Acne Vulgar/psicologia , Imagem Corporal/psicologia , Depressão/psicologia , Qualidade de Vida/psicologia , Estigma Social , Estereotipagem , Adolescente , Adulto , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Adulto Jovem
16.
J Biosci Bioeng ; 130(5): 457-463, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32747300

RESUMO

Inflammatory responses stimulated by Propionibacterium acnes have been shown to be major etiological factors in the pathogenesis of acne. Scutellaria baicalensis, a popular traditional Chinese medicine, has been widely shown to have anti-inflammatory effects. In this study, primary component analysis and primary effective component analysis were conducted. The results showed that wogonin (1.15 mg/g S. baicalensis extract) possessed better anti-acne effects than wogonoside (8.71 mg/g S. baicalensis extract) in inhibiting the up-regulation of IL-1ß and IL-8 level caused by P. acnes via inactivation of the MAPK and NF-κB signaling pathways. To enhance the anti-acne effects of S. baicalensis extract, an environmentally friendly and healthy plant fermentation strategy was used to efficiently convert glycoside-type constituents into bioactive aglycone. S. baicalensis extract was fermented by symbiotic fungus Penicillium decumbens f3-1 to transform wogonoside into wogonin with a conversion rate of 91.0% after 4 days. Fermented S. baicalensis extract (FSE) showed higher potential anti-acne effects than non-fermented S. baicalensis extract (NSE) by inhibiting the up-regulation of IL-1ß and IL-8. Thus, P. decumbens-fermented S. baicalensis Extract may be used for developing new anti-acne cosmetic ingredients.


Assuntos
Acne Vulgar/tratamento farmacológico , Acne Vulgar/microbiologia , Fermentação , Penicillium/fisiologia , Extratos Vegetais/farmacologia , Simbiose , Acne Vulgar/metabolismo , Acne Vulgar/patologia , Regulação da Expressão Gênica/efeitos dos fármacos , Interleucina-1beta/metabolismo , Interleucina-8/metabolismo , NF-kappa B/metabolismo , Extratos Vegetais/uso terapêutico , Transdução de Sinais/efeitos dos fármacos
17.
Hautarzt ; 71(10): 752-761, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32857168

RESUMO

Hyperandrogenism or hyperandrogenemia are medical conditions characterized by excessive levels of androgens in the periphery or systemically. Clinical manifestations of hyperandrogenism include hirsutism, seborrhea, acne, androgenetic alopecia, and virilization. Hirsutism, defined as excessive growth of terminal hair in women in a male-like pattern, is the most commonly used clinical diagnostic criterion of hyperandrogenism and is determined by using a standardized scoring system of hair growth. Acne and alopecia are further common androgenic skin changes and might be observed without hirsutism in some women. Clitoris hypertrophy, increase of muscle mass, irregular menstrual cycle, and metabolic syndrome can also accompany this condition. Among others polycystic ovary syndrome (PCOS), Cushing disease, and late-onset adrenogenital syndrome belong to the most frequent causes of hyperandrogenemia. Virilization is a relatively uncommon feature of hyperandrogenemia and its presence often suggests an androgen-producing tumor. Management of symptoms include the use of antiandrogens such as cyproterone acetate, spironolactone, and flutamide. A thorough history, a focused clinical examination and an interdisciplinary approach together with gynecologists and endocrinologists are extremely helpful in the diagnostic evaluation and therapy of patients with suspected hyperandrogenism.


Assuntos
Acne Vulgar , Hirsutismo , Hiperandrogenismo , Alopecia , Androgênios , Feminino , Humanos , Síndrome do Ovário Policístico
18.
Cochrane Database Syst Rev ; 8: CD005552, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32794179

RESUMO

BACKGROUND: Metformin has been proposed as possibly a safer and more effective long-term treatment than the oral contraceptive pill (OCP) in women with polycystic ovary syndrome (PCOS). It is important to directly compare the efficacy and safety of metformin versus OCP in the long-term treatment of women with PCOS. This is an update of a Cochrane Review comparing insulin sensitising agents with the OCP and only includes studies on metformin. OBJECTIVES: To assess the effectiveness and safety of metformin versus the OCP (alone or in combination) in improving clinical, hormonal, and metabolic features of PCOS. SEARCH METHODS: In August 2019 we searched the Cochrane Gynaecology and Fertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL, the trial registers, handsearched references of the identified articles, and contacted experts in the field to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of the use of metformin versus the OCP (alone or in combination) for women with PCOS. DATA COLLECTION AND ANALYSIS: We used standard methods recommended by Cochrane. The primary review outcomes were the clinical parameters of hirsutism and adverse events, both severe (requiring stopping of medication), and minor. In the presence of substantial heterogeneity (I2 statistic > 50), which could be explained by pre-specified subgroup analyses on the basis of BMI, we reported the subgroups separately. MAIN RESULTS: This is a substantive update. We identified 38 additional studies. We included 44 RCTs (2253 women), which comprised 39 RCTs on adult women (2047 women) and five RCTs on adolescent women (206 women). Evidence quality ranged from very low to low. The main limitations were risk of bias, imprecision and inconsistency. Metformin versus the OCP In adult women, we are uncertain of the effect of metformin compared to the OCP on hirsutism in subgroup body mass index (BMI) < 25 kg/m2 (mean difference (MD) 0.38, 95% confidence interval (CI) -0.44 to 1.19, 3 RCTs, n = 134, I2 = 50%, very low-quality evidence) and subgroup BMI > 30 kg/m2 (MD -0.38, 95% CI -1.93 to 1.17; 2 RCTs, n = 85, I2 = 34%, low-quality evidence). Metformin may be less effective in improving hirsutism compared to the OCP in the subgroup BMI 25 kg/m2 to 30 kg/m2 (MD 1.92, 95% CI 1.21 to 2.64, 5 RCTs, n = 254, I2 = 0%, low-quality evidence). Metformin may increase severe gastro-intestinal adverse events rate compared to the OCP (Peto odds ratio (OR) 6.42, 95% CI 2.98 to 13.84, 11 RCTs, n = 602, I2 = 0%, low-quality evidence). Metformin may decrease the incidence of severe other adverse events compared to the OCP (Peto OR 0.20, 95% CI 0.09 to 0.44, 8 RCTs, n = 363, I2 = 0%, low-quality evidence). There were no trials reporting on minor adverse events. In adolescents, we are uncertain whether there is a difference between Metformin and the OCP, on hirsutism and adverse events. Metformin versus metformin combined with the OCP In adult women, metformin may be less effective in improving hirsutism compared to Metformin combined with the OCP (MD 1.36, 95% CI 0.62 to 2.11, 3 RCTs, n = 135, I2= 9%, low-quality evidence). We are uncertain if there was a difference between metformin and metformin combined with the OCP for severe gastro-intestinal adverse events (OR 0.74, 95% CI 0.21 to 2.53, 3 RCTs, n = 171, I2 = 0%, low-quality evidence), or for severe other adverse events (OR 0.56, 95% CI 0.11 to 2.82, 2 RCTs, n = 109, I2 = 44%, low-quality evidence). There were no trials reporting on minor adverse events. In adolescents, there were no trials for this comparison. The OCP versus metformin combined with the OCP In adult women, the OCP may be less effective in improving hirsutism compared to metformin combined with the OCP (MD 0.54, 95% CI 0.20 to 0.89, 6 RCTs, n = 389, I2= 1%, low-quality evidence). The OCP may decrease the incidence of severe gastro-intestinal adverse events compared to metformin combined with the OCP (OR 0.20, 95% CI 0.06 to 0.72, 5 RCTs, n = 228, I2 = 0%, low-quality evidence). We are uncertain if there is a difference between the OCP and metformin combined with the OCP for severe other adverse events (OR 1.61, 95% CI 0.49 to 5.37, 4 RCTs, n = 159, I2 = 12%, low-quality evidence). The OCP may decrease the incidence of minor (gastro-intestinal) adverse events compared to metformin combined with the OCP (OR 0.06, 95% CI 0.01 to 0.44, 2 RCTs, n = 98, I2 = 0%, low-quality evidence). In adolescents, we are uncertain whether there is a difference between the OCP, compared to metformin combined with the OCP, on hirsutism or adverse events. AUTHORS' CONCLUSIONS: In adult women with PCOS, metformin may be less effective in improving hirsutism compared to the OCP in the subgroup BMI 25 kg/m2 to 30 kg/m2 but we are uncertain if there was a difference between metformin and the OCP in subgroups BMI < 25 kg/m2 and BMI > 30kg/m2. Compared to the OCP, metformin may increase the incidence of severe gastro-intestinal adverse events and decrease the incidence of severe other adverse events with no trials reporting on minor adverse events. Either metformin alone or the OCP alone may be less effective in improving hirsutism compared to metformin combined with the OCP. We are uncertain whether there is a difference between the OCP alone and metformin alone compared to metformin combined with the OCP for severe or minor adverse events except for the OCP versus metformin combined with the OCP where the OCP may decrease the incidence of severe and minor gastro-intestinal adverse events. In adolescent women with PCOS, we are uncertain whether there is a difference between any of the comparisons for hirsutism and adverse events due to either no evidence or very low-quality evidence. Further large well-designed RCTs that stratify for BMI are needed to evaluate metformin versus the OCP and combinations in women with PCOS, in particular adolescent women.


Assuntos
Anticoncepcionais Orais Combinados/uso terapêutico , Hirsutismo/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Distúrbios Menstruais/tratamento farmacológico , Metformina/uso terapêutico , Síndrome do Ovário Policístico/tratamento farmacológico , Acne Vulgar/tratamento farmacológico , Adolescente , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/prevenção & controle , Anticoncepcionais Orais Combinados/efeitos adversos , Quimioterapia Combinada , Neoplasias do Endométrio/prevenção & controle , Feminino , Humanos , Metformina/efeitos adversos , Síndrome do Ovário Policístico/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
19.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32765835

RESUMO

Multidisciplinary investigations into the pathogenesis of acne have significantly progressed over the past three years. Studies of the etiology of acne from the perspectives, for example, of sebaceous gland biology, sebum, genetics, keratinization, differentiation, hair cycles, immunology, bacteriology, and wound healing have elucidated its pathogenesis. This has led to the development of new therapies and paved the way for advanced studies that will enable the further evolution of acne treatment.


Assuntos
Acne Vulgar , Acne Vulgar/terapia , Diferenciação Celular , Humanos , Glândulas Sebáceas , Sebo
20.
Dermatol Online J ; 26(4)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621674

RESUMO

The application of teledermatology for evaluating acne patients has yielded comparable therapeutic outcomes with traditional face-to-face evaluation, but follow-up compliance between these modalities is not well-studied. Our objective is to compare the rate and duration of follow-up between acne patients initially evaluated by teledermatology versus in-person outpatient consultation. Electronic medical review of acne patients, 18-35 years-old seen via teledermatology and face-to-face evaluation at the University of Pittsburgh Medical Center between 2010-2018 was performed. Teledermatology patients were less likely to follow-up in the first 90 days (13.0% versus 31.0%, P<0.001) compared to patients seen face-to-face with overall follow-up rates of 22% among both modalities. The median time to follow-up was 45.5 days (IQR: 13/57) in the teledermatology group compared to 64 days (IQR: 56/77) in the face-to-face group (P<0.001). Teledermatology patients were more likely to be treated with oral antibiotics (43.0% versus 28.5%) or oral spironolactone (18.5% versus 12.5%) compared to patients seen face-to-face (P<0.001). Teledermatology poses a promising solution to extend dermatologic care with earlier access to follow-up. Our data demonstrates a need to improve teledermatology follow-up education to improve follow-up care.


Assuntos
Acne Vulgar/terapia , Assistência Ambulatorial , Dermatologia/métodos , Telemedicina , Adulto , Assistência ao Convalescente/métodos , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Estudos Retrospectivos , Adulto Jovem
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