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1.
J Drugs Dermatol ; 20(4): 432-435, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33852240

RESUMO

Telemedicine, defined as practicing medicine at a distance, has grown in popularity over the past ten years, as advances in consumer technology have permitted its expansion. Dermatology is a field that especially lends itself to this method of care, as many common dermatological diagnoses can be made upon visual inspection. With social distancing becoming the new standard in this age of COVID-19, telemedicine emerges as a key tool in continuing patient care without interruption. In this pilot study, we examine the reliability of acne vulgaris diagnostic assessments made via patient-taken photos compared to in-office assessments in patients between the ages of 16 and 23 with mild to moderate acne. Fourteen patient encounters were clinically examined for three outcomes: inflammatory lesions, noninflammatory acne lesions, and facial nodules. On the same day patient outcomes were counted and recorded in-person, patients were instructed to photograph their faces. These images were reviewed 8–12 weeks later by investigators for the same assessment. Initial findings suggest strong concordance between in-person and digital diagnosis, with a Spearman’s correlation coefficient of 0.96 across all lesion and nodule scores. These data support further research on the expansion and implementation of telemedicine for dermatology. J Drugs Dermatol. 20(4):432-435. doi:10.36849/JDD.5688.


Assuntos
Acne Vulgar/diagnóstico , Acne Vulgar/terapia , Dermatologia/métodos , Telemedicina/métodos , Adolescente , COVID-19 , Face , Feminino , Humanos , Masculino , Pandemias , Distanciamento Físico , Projetos Piloto , Smartphone , Resultado do Tratamento , Adulto Jovem
2.
Nutrients ; 13(4)2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33921829

RESUMO

Lactobacillus plantarum CJLP55 has anti-pathogenic bacterial and anti-inflammatory activities in vitro. We investigated the dietary effect of CJLP55 supplement in patients with acne vulgaris, a prevalent inflammatory skin condition. Subjects ingested CJLP55 or placebo (n = 14 per group) supplements for 12 weeks in this double-blind, placebo-controlled randomized study. Acne lesion count and grade, skin sebum, hydration, pH and surface lipids were assessed. Metagenomic DNA analysis was performed on urine extracellular vesicles (EV), which indirectly reflect systemic bacterial flora. Compared to the placebo supplement, CJLP55 supplement improved acne lesion count and grade, decreased sebum triglycerides (TG), and increased hydration and ceramide 2, the major ceramide species that maintains the epidermal lipid barrier for hydration. In addition, CJLP55 supplement decreased the prevalence of Proteobacteria and increased Firmicutes, which were correlated with decreased TG, the major skin surface lipid of sebum origin. CJLP55 supplement further decreased the Bacteroidetes:Firmicutes ratio, a relevant marker of bacterial dysbiosis. No differences in skin pH, other skin surface lipids or urine bacterial EV phylum were noted between CJLP55 and placebo supplements. Dietary Lactobacillus plantarum CJLP55 was beneficial to clinical state, skin sebum, and hydration and urine bacterial EV phylum flora in patients with acne vulgaris.


Assuntos
Acne Vulgar/microbiologia , Acne Vulgar/terapia , Suplementos Nutricionais , Vesículas Extracelulares/microbiologia , Lactobacillus plantarum , Método Duplo-Cego , Disbiose/microbiologia , Disbiose/terapia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Sebo/química , Pele/química , Pele/microbiologia , Resultado do Tratamento , Triglicerídeos/metabolismo , Urina/microbiologia , Adulto Jovem
3.
J Dermatolog Treat ; 32(3): 269-276, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33754925

RESUMO

Background: Despite the wide range of available treatment modalities a delay between the first outbreak of acne vulgaris and an effective treatment outcome is experienced by many patients. Considering the growing incentives to improve patient satisfaction and quality of care while reducing healthcare costs, insights into the structure, quality and accessibility of acne healthcare services beyond guidelines are therefore needed.Objective: To provide insights into the structure, quality and accessibility of acne healthcare services.Methods: A qualitative study was conducted according to the principles of 'situational analysis'. The Dutch acne healthcare system was taken as an illustrative example. Twenty-four semi-structured interviews were conducted among representatives of the 4 main Dutch professions providing acne care. All interviews were audiotaped, transcribed verbatim and analyzed.Results: Multiple facilitators and barriers emerged from the interviews. Identified facilitators were care providers delivering personalized patient care and having a positive attitude toward formalized multidisciplinary care delivery. A lack of streamlined referral pathways and standardization in acne severity-assessment, financial aspects and unfamiliarity with the content and added value of other acne care professionals were identified as barriers. Further research is recommended to investigate how de-medicalisation, the gatekeepers role, and the impact of location and work setting influence the quality of and accessibility to care.Conclusions: Identified facilitators and barriers and an overall positive attitude of care providers toward multidisciplinary care provision provides opportunities for the utilization of future guidelines involving streamlined referral pathways and good working arrangements between all acne care providing professions.


Assuntos
Acne Vulgar/terapia , Atenção à Saúde , Médicos/psicologia , Adulto , Feminino , Custos de Cuidados de Saúde , Humanos , Entrevistas como Assunto , Masculino , Medicina de Precisão , Encaminhamento e Consulta
4.
BMJ Open ; 11(2): e041794, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526498

RESUMO

OBJECTIVES: The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs). DESIGN: Systematic review and synthesis of qualitative papers. METHODS: Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings. RESULTS: A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people's experience of acne and HCPs' attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was 'trivialised' by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others. CONCLUSIONS: People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use. PROSPERO REGISTRATION NUMBER: CRD42016050525.


Assuntos
Acne Vulgar , Pessoal de Saúde , Acne Vulgar/terapia , Adolescente , Atitude do Pessoal de Saúde , Cuidadores , Humanos , Pesquisa Qualitativa
7.
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
8.
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
11.
Pediatrics ; 145(Suppl 2): S225-S230, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32358215

RESUMO

Acne vulgaris is an extraordinarily common skin condition in adolescents. The mainstays of acne treatment have remained largely unchanged over recent years. In the context of increasing antibiotic resistance worldwide, there is a global movement away from antibiotic monotherapy toward their more restrictive use. Classically reserved for nodulocystic acne, isotretinoin has become the drug of choice by dermatologists for moderate to severe acne. Given the virtually ubiquitous nature of acne in teenagers, there remains an appreciable need for novel therapies. In this article, we will cover the currently used acne treatments, evaluate the issues and data supporting their use, explore the issues of compliance and the mental health implications of acne care, and recommend directions for the field of acne management in adolescents in the years ahead.


Assuntos
Acne Vulgar/terapia , Acne Vulgar/epidemiologia , Acne Vulgar/psicologia , Adolescente , Antibacterianos/uso terapêutico , Feminino , Humanos , Isotretinoína/uso terapêutico , Masculino , Saúde Mental , Cooperação do Paciente/psicologia , Pediatria , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(18): e19764, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358349

RESUMO

INTRODUCTION: Acne vulgaris is a chronic inflammatory disease of the sebaceous glands that occurs in adolescent men and women. In recent years, the incidence of acne has increased year by year, so it is of great significance to find a precise and effective treatment and further explore its possible mechanism of action. The purpose of this study will be to explore a treatment method that has both traditional Chinese medicine characteristics and significant effects, and provides a higher level of evidence for acupuncture for acne vulgaris. It also provides patients with more treatment options. METHODS/DESIGN: The study will be a randomized controlled trial divided into 2 parallel groups. This pragmatic randomized controlled trial will recruit 66 patients who are diagnosed with acne vulgaris. 30-minutes acupuncture sessions will be provided to patients assigned to the intervention group. All participants will continue to receive conventional treatment. The selection of outcomes will be evaluated by the skin lesions score scale. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with acne vulgaris. TRIAL REGISTRATION NUMBER: CTR2000030427.


Assuntos
Acne Vulgar/terapia , Terapia por Acupuntura/métodos , Medicina Tradicional Chinesa/métodos , Creme para a Pele/administração & dosagem , Vitamina A/administração & dosagem , Administração Tópica , Adolescente , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
15.
Pediatr Ann ; 49(3): e109-e115, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32155276

RESUMO

Acne is the most common skin condition observed in adolescent and preadolescent patients. Pediatric providers are on the forefront of managing the disease, often as a secondary concern in a busy practice. Therefore, every provider needs to have an acne treatment plan that is effective, easy to communicate, and simple to follow. This article provides treatment rationale and guidelines-based recommendations for the initial treatment of acne, tips for troubleshooting any side effects, and a plan for subsequent follow-up to maintain good control. [Pediatr Ann. 2020;49(3):e109-e115.].


Assuntos
Acne Vulgar , Acne Vulgar/diagnóstico , Acne Vulgar/terapia , Adolescente , Criança , Humanos , Pediatria , Médicos de Atenção Primária , Guias de Prática Clínica como Assunto
17.
JAMA Dermatol ; 156(3): 296-302, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31995147

RESUMO

Importance: The qualitative grading of acne is important for routine clinical care and clinical trials, and although many useful systems exist, no single acne global grading system has had universal acceptance. In addition, many current instruments focus primarily on evaluating primary lesions (eg, comedones, papules, and nodules) or exclusively on signs of secondary change (eg, postinflammatory hyperpigmentation, scarring). Objectives: To develop and validate an acne global grading system that provides a comprehensive evaluation of primary lesions and secondary changes due to acne. Design, Setting, and Participants: This diagnostic study created a multidimensional acne severity feature space by analyzing decision patterns of pediatric dermatologists evaluating acne. Modeling acne severity patterns based on visual image features was then performed to reduce dimensionality of the feature space to a novel 2-dimensional grading system, in which severity levels are functions of multidimensional acne cues. The system was validated by 6 clinicians on a new set of images. All images used in this study were taken from a retrospective, longitudinal data set of 150 patients diagnosed with acne, ranging across the entire pediatric population (aged 0-21 years), excluding images with any disagreement on their diagnosis, and selected to adequately span the range of acne types encountered in the clinic. Data were collected from July 1, 2001, through June 30, 2013, and analyzed from March 1, 2015, through December 31, 2016. Main Outcomes and Measures: Prediction performance was evaluated as the mean square error (MSE) with the clinicians' scores. Results: The scale was constructed using acne visual features and treatment decisions of 6 pediatric dermatologists evaluating 145 images of patients with acne ranging in age from 0 to 21 years. Using the proposed scale to predict the severity scores on a new set of 40 images achieved an overall MSE of 0.821, which is smaller than the mean within-clinician differences (MSE of 0.998). Conclusions and Relevance: By integrating primary lesions and secondary changes, this novel acne global grading scale provides a more clinically relevant evaluation of acne that may be used for routine clinical care and clinical trials. Because the severity scores are based on actual clinical practice, this scoring system is also highly correlated with appropriate treatment choices.


Assuntos
Acne Vulgar/diagnóstico , Tomada de Decisões , Padrões de Prática Médica , Acne Vulgar/patologia , Acne Vulgar/terapia , Adolescente , Criança , Pré-Escolar , Dermatologistas/estatística & dados numéricos , Dermatologia , Humanos , Lactente , Estudos Longitudinais , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
18.
Dermatol Ther ; 33(1): e13189, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31837243

RESUMO

Acne vulgaris, a common and chronic disorder of the pilosebaceous unit, affects up to 85% of adolescent and young adults. Although the current treatment options are effective, they are associated with unwanted side effects, chronicity, relapses, and recurrences. Recently, the Food and Drug Administration approved topical application of gold microparticles for selective photothermolysis to treat acne vulgaris. Here, we report two cases showing the efficacy of gold nanoshell-mediated photothermal therapy for recurrent acne that were refractory to previous treatments. In both cases, three sessions of photothermal therapy prevented the development of new lesions during a follow-up period of 3-4 months without causing any adverse effects. The two cases reported here demonstrate the possibility of gold nanoshell-mediated photothermal therapy as a safe and effective treatment for recurrent acne vulgaris in Asian patients.


Assuntos
Acne Vulgar/terapia , Nanoconchas , Fototerapia/métodos , Seguimentos , Ouro , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
19.
J Cosmet Dermatol ; 19(2): 393-399, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31553119

RESUMO

BACKGROUND: Chemical peels have become a popular modality in the treatment of acne vulgaris (AV). Mandelic acid (MA) is a new emerging peeling agent for AV owing to its antibacterial and anti-inflammatory properties. Hence, it is worthwhile to evaluate the effectiveness and safety profile of this newer agent and to compare it with an older established peeling agent, salicylic acid (SA) in the treatment of AV. OBJECTIVE: Comparison between therapeutic efficacy and safety of 45% MA peel with 30% SA peel in Indian patients suffering from mild-to-moderate facial AV. METHODS: A total of 50 patients suffering from mild-to-moderate AV were randomly divided into two groups, with one receiving 30% SA peels and the other receiving 45% MA peels at an interval of 2 weeks for six sessions. Total duration of the study was 12 weeks. Michaelsson acne scores (MAS) and clinical photographs were used to evaluate the efficacy of therapy objectively. Adverse effects of both the agents were also noted at each visit. RESULTS: Both agents showed almost equal efficacy in improving mild-to-moderate AV. Salicylic acid was found better in treating noninflammatory lesions, while MA had an upper hand in treating inflammatory lesions. Overall, there was no significant difference between the two peels in improving MAS and percentage decrease in MAS. However, adverse effects were lesser with MA peels. CONCLUSION: About 45% MA peel was found to be equally effective as 30% SA peel in mild-to-moderate facial AV. However, safety and tolerability of MA peel were better than SA peel.


Assuntos
Acne Vulgar/terapia , Abrasão Química/métodos , Ceratolíticos/administração & dosagem , Ácidos Mandélicos/administração & dosagem , Ácido Salicílico/administração & dosagem , Acne Vulgar/diagnóstico , Adolescente , Abrasão Química/efeitos adversos , Relação Dose-Resposta a Droga , Face , Feminino , Humanos , Ceratolíticos/efeitos adversos , Masculino , Ácidos Mandélicos/efeitos adversos , Estudos Prospectivos , Ácido Salicílico/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
20.
Dermatol Surg ; 46(1): 86-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31356435

RESUMO

BACKGROUND: Microneedling is a popular, minimally invasive skin rejuvenation modality for acne scarring. Recent reports have evaluated the efficacy and safety of microneedling monotherapy and combination treatment for scarring. OBJECTIVE: This review aims to systematically analyze the current literature on microneedling techniques used for acne scarring. METHODS: A PubMed search (2009-current) was used to identify literature on microneedling treatment for acne. All randomized and nonrandomized clinical trials, case cohorts, case reports, and case series were included with the exception of 2 studies, which were excluded due to unavailability. RESULTS: All 33 articles evaluated showed improvement of acne scar appearance after microneedling treatment. Evidence was inconsistent when comparing microneedling monotherapy to dual therapy or to fractional laser treatment. CONCLUSION: Microneedling improves acne scarring, and further studies are needed to compare microneedling with other minimally invasive treatments.


Assuntos
Acne Vulgar/complicações , Acne Vulgar/terapia , Cicatriz/etiologia , Cicatriz/terapia , Técnicas Cosméticas , Humanos , Agulhas , Resultado do Tratamento
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