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See JA, Chavda R, Kon KM, Goodman GJ, Oblepias MS, Nadela RE, Oon HH, Aurangabadkar S, Suh DH, Chan HHL, Lahiri K. A review of the topical management of acne and its associated sequelae in the Asia-Pacific region with a spotlight on trifarotene. Int J Dermatol 2024; 63:704-713. [PMID: 38643368 DOI: 10.1111/ijd.17141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 04/22/2024]
Abstract
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.
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Affiliation(s)
- Jo-Ann See
- Central Sydney Dermatology, Sydney, NSW, Australia
| | | | - Khen M Kon
- Galderma ANZ, North Sydney, NSW, Australia
| | | | - Marie S Oblepias
- AcneCure Center, Parañaque, Philippines
- Medical Center Parañaque, Parañaque, Philippines
| | - Rosalina E Nadela
- Fatima University Medical Center, Antipolo City, Philippines
- The Holistic Dermatology Clinic, Quezon City, Philippines
| | - Hazel H Oon
- Division of Dermatology, National Skin Centre, Singapore, Singapore
| | | | - Dae H Suh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Henry H L Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Koushik Lahiri
- Apollo Multispeciality Hospitals, Kolkata, India
- Wizderm Speciality Skin and Hair Clinic, Kolkata, India
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Alexis A, Del Rosso JQ, Forman S, Martorell A, Browning J, Laquer V, Desai SR, York JP, Chavda R, Dhawan S, Moore AY, Stein-Gold L. Importance of treating acne sequelae in skin of color: 6-month phase IV study of trifarotene with an appropriate skincare routine including UV protection in acne-induced post-inflammatory hyperpigmentation. Int J Dermatol 2024; 63:806-815. [PMID: 38685118 DOI: 10.1111/ijd.17189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Acne-induced hyperpigmentation (AIH) may accompany acne vulgaris (AV) inflammation in all skin phototypes. Trifarotene has shown depigmenting properties in vivo. This study evaluated trifarotene plus skincare because it is increasingly recognized that holistic AV management should include skincare and treatments. METHODS This is a phase IV double-blind, parallel-group study of patients (13-35 years) with moderate AV and AIH treated with trifarotene (N = 60) or vehicle (N = 63) plus skincare regimen (moisturizer, cleanser, and sunscreen) for 24 weeks. Assessments included the AIH overall disease severity (ODS) score, post-AV hyperpigmentation index (PAHPI), exit interviews, photography, and acne assessments. Standard safety assessments were included. RESULTS Trifarotene 50 μg/g cream improved significantly from baseline in ODS score versus vehicle (-1.6 vs. -1.1, P = 0.03) at Week 12, but scores were comparable between groups at Week 24 (primary endpoint). Trifarotene had a better reduction in PAHPI score at Week 24 (-18.9% vs. -11.3% vehicle, P < 0.01). Lesion count reductions were higher with trifarotene at Week 12 versus vehicle (P < 0.001) and at Week 24 (P < 0.05), as were IGA success rates versus vehicle at Weeks 12 (P < 0.05) and 24 (P < 0.05). Patients agreed that the skincare regimen contributed to less irritation, making treatment adherence easier. Photography showed improvements in pigmentation and erythema across all skin types. AEs were more common in the vehicle group versus trifarotene (30.2 vs. 16.7%, respectively). CONCLUSIONS In all skin phototypes, there was more rapid improvement in the ODS and PAHPI scores with trifarotene by Weeks 12 and 24, respectively. The combination of trifarotene and skincare correlated with high patient satisfaction and adherence to the treatment protocol.
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Affiliation(s)
- Andrew Alexis
- Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | - Vivian Laquer
- First OC Dermatology Research Inc., Fountain Valley, CA, USA
| | - Seemal R Desai
- Innovative Dermatology, Plano, TX, USA
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Sunil Dhawan
- Center for Dermatology, Clinical Research, Inc., Fremont, CA, USA
| | - Angela Y Moore
- Baylor University Medical Center, Dallas, TX, USA
- Arlington Research Center, Arlington, TX, USA
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Ko JY, Song CH, Kim KJ, Kim NI, Kim JE, Kim HS, Ro YS, Park KY, Park MY, Suh DH, Shin K, Shin MK, Ahn HH, Lee WJ, Lee WJ, Lee JH, Lee JB, Lee HW, Lee HJ, Jang MS, Cheong SH, Cho S, Choi YS, Choi YW, Choi H, Lee MW. Consensus Report on Truncal Acne: The Korean Acne and Rosacea Society Experts Panel. Ann Dermatol 2024; 36:35-43. [PMID: 38325432 PMCID: PMC10861305 DOI: 10.5021/ad.23.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND More than half of acne patients have truncal acne on their chest, back, and shoulders. However, since most studies on acne have focused on the face, data on clinical characteristics and proper management for truncal acne are insufficient. OBJECTIVE To establish a Korean Acne Rosacea Society (KARS) consensus for experts' perception and treatment patterns of truncal acne. METHODS We conducted two rounds of the Dephi technique to gather expert opinion and reach a consensus on truncal acne. The first round comprised 48 questionnaires focusing on various aspects such as epidemiology, clinical features, diagnosis, treatment, prognosis and more, while second rounds consisted of 26 questionnaires. RESULTS A total of 36 dermatologists (36/38 KARS members, 94.7%) completed this survey. In the first-round survey, consensus was reached on 20 out of the 48 questions (41.7%). In the second-round questionnaire, consensus was achieved on 9 of the 26 questions (34.6%). The most unresponsive lesion to truncal acne treatment was scars (atrophic/hypertrophic). The most commonly used treatments for each non-inflammatory and inflammatory truncal acne lesions were selected to use topical retinoids (78.1% of the responders) and oral antibiotics (93.8% of the responders). CONCLUSION Our study has yielded valuable insights into the epidemiology, clinical manifestations, diagnosis, treatment, and quality of life of patients with truncal acne. We anticipate that this study will inspire further comprehensive research for individuals with truncal acne.
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Affiliation(s)
- Joo Yeon Ko
- Department of Dermatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Hwa Song
- Department of Dermatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Nack In Kim
- Kim Nack-In Dermatology Clinic, Seoul, Korea
| | - Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi-Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kihyuck Shin
- Department of Dermatology, Pusan National University Yangsan Hospital, Pusan University College of Medicine, Yangsan, Korea
| | - Min Kyung Shin
- Department of Dermatology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyo Hyun Ahn
- Department of Dermatology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ju Hee Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Bum Lee
- Department of Dermatology, Chonnam National University Hospital, Chonnam University College of Medicine, Gwangju, Korea
| | | | - Hee Jung Lee
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Min Soo Jang
- Department of Dermatology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seung Hyun Cheong
- Department of Dermatology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yu Sung Choi
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - You Won Choi
- Department of Dermatology, Ehwa Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hoon Choi
- Department of Dermatology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Tahir A, Khan S, Shah RR, Waqas N, Sharif S, Rao B. Efficacy of combined spironolactone and topical retinoids in South Asian women with acne. Clin Dermatol 2024; 42:89-90. [PMID: 38008366 DOI: 10.1016/j.clindermatol.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- Anam Tahir
- Department of Dermatology, Rawalpindi Medical Center, Rawalpindi, Pakistan
| | - Samavia Khan
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Newark, New Jersey, USA
| | - Rohan R Shah
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - Nadia Waqas
- Department of Dermatology, Rawalpindi Medical Center, Rawalpindi, Pakistan
| | - Shawana Sharif
- Department of Dermatology, Rawalpindi Medical Center, Rawalpindi, Pakistan
| | - Babar Rao
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Dessinioti C, Katsambas A. The Microbiome and Acne: Perspectives for Treatment. Dermatol Ther (Heidelb) 2024; 14:31-44. [PMID: 38183614 PMCID: PMC10828138 DOI: 10.1007/s13555-023-01079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024] Open
Abstract
The skin microbiome consists of the microorganisms populating the human skin. Cutibacterium acnes (C. acnes, formerly named Propionibacterium acnes) is recognized as a key factor in acne development, regulating inflammatory and immune pathways. Dysbiosis has been described as the imbalance in skin microbiome homeostasis and may play a role in acne pathogenesis. Microbial interference has been shown to be a contributor to healthy skin homeostasis and staphylococcal strains may exclude acne-associated C. acnes phylotypes. In this review we present an update on the skin microbiome in acne and discuss how current acne treatments such as benzoyl peroxide, orally administered isotretinoin, and antibiotics may affect the skin microbiome homeostasis. We highlight the collateral damage of acne antibiotics on the skin microbiome, including the risk of antimicrobial resistance and the dysregulation of the microbiome equilibrium that may occur even with short-term antibiotic courses. Consequently, the interest is shifting towards new non-antibiotic pharmacological acne treatments. Orally administered spironolactone is an emerging off-label treatment for adult female patients and topical peroxisome proliferator-activated receptor gamma (PPARγ) modulation is being studied for patients with acne. The potential application of topical or oral probiotics, bacteriotherapy, and phage therapy for acne are further promising areas of future research.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, 5, Dragoumi Str, 16 121, Athens, Greece.
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Schleicher S, Moore A, Rafal E, Gagne-Henley A, Johnson SM, Dhawan S, Chavda R, York JP, Sforzolini B, Holcomb K, Ablon G, Del Rosso J, Dreno B. Trifarotene Reduces Risk for Atrophic Acne Scars: Results from A Phase 4 Controlled Study. Dermatol Ther (Heidelb) 2023; 13:3085-3096. [PMID: 37838987 PMCID: PMC10689318 DOI: 10.1007/s13555-023-01042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Atrophic acne scarring often accompanies acne vulgaris. The efficacy of topical retinoids for treatment of acne is well documented; however, evidence for use in atrophic acne scars is limited. METHODS In this randomized, split-face, double-blind study, subjects (age: 17-34 years, N = 121) with moderate-to-severe facial acne, with acne scars present, were treated with either trifarotene 50 μg/g or vehicle once daily for 24 weeks. Efficacy was assessed by absolute and percent change from baseline in atrophic acne scar counts, Scar Global assessment (SGA), and IGA success rates as well as acne lesion counts. RESULTS At week 24, a statistically significantly greater reduction in the mean absolute change from baseline in the total atrophic scar count was noted in the trifarotene- vs vehicle-treated area (- 5.9 vs - 2.7; p < 0.0001) with differences between sides noted as early as week 2 (- 1.5 vs - 0.7; p = 0.0072). The SGA success rate was higher in the trifarotene side at week 12 (14.9% vs 5.0%, P < 0.05) and improved through week 24 (31.3% vs 8.1%, P < 0.001). Similarly, at week 24, the IGA success rate was higher with trifarotene (63.6% vs 31.3%, P < 0.0001) along with reductions in total (70% vs 45%) and inflammatory (76% vs 48%) lesion counts. The incidence of treatment-emergent adverse events was 5.8% (trifarotene) and 2.5% (vehicle); most common (> 1%) was skin tightness (1.7% vs 0.8%), and all events were mild to moderate in severity. CONCLUSIONS Trifarotene was effective and well tolerated in treating moderate-to-severe facial acne and reducing atrophic acne scars, with reduction of total atrophic scar count as early as week 2. TRIAL REGISTRATION Clinicaltrials.gov NCT04856904.
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Affiliation(s)
| | - Angela Moore
- Arlington Research Center, Inc, Arlington, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
| | - Elyse Rafal
- DermResearchCenter of New York, Inc, Stony Brook, NY, USA
| | | | | | - Sunil Dhawan
- Center for Dermatology Clinical Research, Inc, Fremont, CA, USA
| | | | - J P York
- Galderma Laboratories, Dallas, TX, USA
| | | | | | - Glynis Ablon
- Ablon Skin Institute & Research Center, University of California, Los Angeles, CA, USA
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Schachner LA, Alexis AF, Andriessen A, Berson D, Gold M, Goldberg DJ, Hu S, Keri J, Kircik L, Woolery-Lloyd H. Insights into acne and the skin barrier: Optimizing treatment regimens with ceramide-containing skincare. J Cosmet Dermatol 2023; 22:2902-2909. [PMID: 37605504 DOI: 10.1111/jocd.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Acne is a common, complex, multifactorial inflammatory skin disease associated with epidermal barrier dysfunction. Beginning in childhood, acne affects many adolescents and adults. Acne is associated with lower self-esteem, anxiety, and depression and may cause scars and pigmentary sequelae. The review explores the relationships between acne and the skin barrier function and discusses nuances in the prevention, treatment, and maintenance of acne and its impact on the skin barrier. METHODS The advisors' previous publications addressed prescription and nonprescription pediatric acne treatment and skincare using cleansers, moisturizers, and a practical algorithm for treatment and maintenance, including skincare recommendations for pediatric acne patients and an algorithm for skin of color patients with acne. Before the meeting, literature was culled on the relationship between the skin barrier and acne and current best practices in acne, addressing prescription and nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment. RESULTS After discussing 13 draft statements, the advisors applied the selected literature and drew from their clinical knowledge and experience, and agreed on five statements. The follicular epithelial barrier is directly involved with changes that occur during both comedogenesis and in stages of inflammation, especially with follicular rupture compromising the barrier's integrity. In acne-affected skin, sebaceous glands are larger, sebum excretion and filaggrin expression higher, and stratum corneum lipids are reduced. Educating patients and clinicians about inflammation's central role in acne and measures to reduce inflammation is essential. Skin irritation and xerosis from acne and treatments lead to poor treatment adherence. A skincare regimen should be included in the acne prevention, treatment, and maintenance care regimen and should be ongoing. Maintenance treatment with topical agents and skincare using gentle ceramide-containing cleansers and moisturizers is a recommended strategy after successfully controlling the disease. CONCLUSIONS Epidermal barrier dysfunction contributes to acne exacerbation. Using the appropriate treatment and skincare helps to minimize irritation and inflammation, enhance treatment adherence, and improve patient outcomes.
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Affiliation(s)
- Lawrence A Schachner
- Division of Pediatric Dermatology, Department of Dermatology and Cutaneous Surgery, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Anneke Andriessen
- Radboud UMC, Nijmegen and Andriessen Consultants, Malden, the Netherlands
| | - Diane Berson
- Weill Cornell Medical College, New York, New York, USA
- New York-Presbyterian Hospital, New York, New York, USA
| | - Michael Gold
- Gold Skin Care Center, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine and Nursing, Nashville, Tennessee, USA
| | - David J Goldberg
- Schweiger Dermatology Group, Hackensack, New Jersey, USA
- Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Shasa Hu
- Division of Pediatric Dermatology, Department of Dermatology and Cutaneous Surgery, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jonette Keri
- Division of Pediatric Dermatology, Department of Dermatology and Cutaneous Surgery, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Leon Kircik
- Icahn School of Medicine at Mt. Sinai, New York, New York, USA
- Dermatology, Indiana University Medical Center, Indianapolis, Indiana, USA
- Physicians Skin Care, PLLC, Louisville, Kentucky, USA
- DermResearch, PLLC, Louisville, Kentucky, USA
| | - Heather Woolery-Lloyd
- Skin of Color Division, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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da Rocha MAD, Fierro-Arias L, Cohen Sabban EN, Castillo RS, Chavda R, Almeida LM. Acne characteristics in Latin American patients and the potential role of trifarotene. Int J Dermatol 2023; 62:1176-1185. [PMID: 37340535 DOI: 10.1111/ijd.16754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Individualization of treatment based on acne type and severity, location, disease burden, and patient preference is required to maximize efficacy, safety, and adherence to therapy. Latin American populations have unique attributes that must be considered as part of this process to improve clinical success and achieve patient goals. Acne is more common among patients with darker skin phototypes, in whom it is often associated with postinflammatory hyperpigmentation and scarring-the most important acne sequelae-potentially due to more frequent and more severe underlying inflammatory processes in this population. DISCUSSION These data argue for an early and proactive approach to managing acne in these patients with agents that target the inflammatory processes that underlie acne and its sequelae. As a class, retinoids offer a spectrum of activity that may be useful in addressing the unique needs of Latin American populations. CONCLUSION Trifarotene, a novel, selective retinoid, has been evaluated in relevant patient populations.
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Affiliation(s)
| | | | - Emilia N Cohen Sabban
- Instituto de Investigaciones Médicas A. Lanari, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Rajeev Chavda
- Galderma Research & Development, Lausanne, Switzerland
| | - Luiz M Almeida
- Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil
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Dolivo DM, Rodrigues AE, Galiano RD, Mustoe TA, Hong SJ. Prediction and Demonstration of Retinoic Acid Receptor Agonist Ch55 as an Antifibrotic Agent in the Dermis. J Invest Dermatol 2023; 143:1724-1734.e15. [PMID: 36804965 PMCID: PMC10432574 DOI: 10.1016/j.jid.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
The prevalence of fibrotic diseases and the lack of pharmacologic modalities to effectively treat them impart particular importance to the discovery of novel antifibrotic therapies. The repurposing of drugs with existing mechanisms of action and/or clinical data is a promising approach for the treatment of fibrotic diseases. One paradigm that pervades all fibrotic diseases is the pathological myofibroblast, a collagen-secreting, contractile mesenchymal cell that is responsible for the deposition of fibrotic tissue. In this study, we use a gene expression paradigm characteristic of activated myofibroblasts in combination with the Connectivity Map to select compounds that are predicted to reverse the pathological gene expression signature associated with the myofibroblast and thus contain the potential for use as antifibrotic compounds. We tested a small list of these compounds in a first-pass screen, applying them to fibroblasts, and identified the retinoic acid receptor agonist Ch55 as a potential hit. Further investigation exhibited and elucidated the antifibrotic effects of Ch55 in vitro as well as showing antiscarring activity upon intradermal application in a preclinical rabbit ear hypertrophic scar model. We hope that similar predictions to uncover antiscarring compounds may yield further preclinical and ultimately clinical success.
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Affiliation(s)
- David M Dolivo
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Adrian E Rodrigues
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert D Galiano
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thomas A Mustoe
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Seok Jong Hong
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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Fabi SG, Beleznay K, Berson DS, Cohen JL, Lee S, Dayan SH. Treatment of acne in the aesthetic patient: A round table update. J Cosmet Dermatol 2023; 22:2391-2398. [PMID: 37403516 DOI: 10.1111/jocd.15913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The popularity of social media appears to be increasing the acceptance of cosmetic treatments, prompting more consumers to seek cosmetic treatments. As the estimated prevalence of acne vulgaris among adult women may be as high as 54%, acne is commonly observed among patients presenting for cosmetic treatments. Concomitant treatment of acne in the aesthetic patient population will improve overall clinical outcomes. AIMS The goal of this work was to deliver a high-quality ethical and evidence-based educational program to physicians and adjunctive health care providers to advance patient care. METHODS This paper is based on a webcam presentation with roundtable discussion by several notable experts in their field. RESULTS A range of topical medications, injectable products, chemical peels, and energy-based devices are available for treating acne vulgaris. In most instances, these are compatible with rejuvenation procedures in the aesthetic patient. CONCLUSION The growth of social media is raising awareness of aesthetic procedures and appears to be increasing the number of patients seeking aesthetic treatment. Educating patients about the importance of treating acne vulgaris can improve overall treatment outcomes. In most instances, the presence of acne is not a barrier to aesthetic care.
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Affiliation(s)
| | - Katie Beleznay
- Humphrey & Beleznay Cosmetic Dermatology, Vancouver, British Columbia, Canada
| | - Diane S Berson
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, USA
| | - Joel L Cohen
- AboutSkin Dermatology and DermSurgery, PC, Greenwood Village, Colorado, USA
| | - Sandra Lee
- Skin Physicians & Surgeons, Upland, California, USA
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Tan J, Chavda R, Baldwin H, Dreno B. Management of Acne Vulgaris With Trifarotene. J Cutan Med Surg 2023; 27:368-374. [PMID: 36927117 PMCID: PMC10486177 DOI: 10.1177/12034754231163542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
Topical retinoids have an essential role in treatment of acne. Trifarotene, a topical retinoid selective for retinoic acid receptor (RAR) γ, is the most recent retinoid approved for treatment of acne. RAR-γ is the most common isoform of RARs in skin, and the strong selectivity of trifarotene for RAR-γ translates to efficacy in low concentration. Trifarotene, like other topical retinoids, acts by increasing keratinocyte differentiation and decreasing proliferation, which reduces hyperkeratinization. Retinoids have also been shown to inhibit inflammatory pathways via effects on leukocyte migration, toll-like receptors, and Activator Protein (AP)-1. Large-scale randomized, controlled clinical trials have demonstrated trifarotene to be safe, well tolerated, and efficacious in reducing both comedones and papules/pustules of acne. However, unlike all other retinoids, trifarotene is the first topical retinoid with rigorous clinical data on safety and efficacy in truncal acne. Data supporting use of trifarotene to manage acne are reviewed in this publication.
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Affiliation(s)
- Jerry Tan
- Windsor Clinical Research Inc, Ontario, Canada
- Department of Medicine, University of Western Ontario, Windsor Campus, Canada
| | | | - Hilary Baldwin
- Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
- The Acne Treatment and Research Center, Brooklyn, New York, USA
| | - Brigitte Dreno
- Dermato-cancerology Department, CHU Nantes, University of Nantes, France
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12
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Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management. Am J Clin Dermatol 2023; 24:199-223. [PMID: 36539678 DOI: 10.1007/s40257-022-00746-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
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13
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Effect of Sarecycline on the Acne Symptom and Impact Scale and Concerns in Moderate-to-Severe Truncal Acne in Open-Label Pilot Study. Antibiotics (Basel) 2023; 12:antibiotics12010094. [PMID: 36671294 PMCID: PMC9854980 DOI: 10.3390/antibiotics12010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Truncal acne is common, and the psychosocial burden may be underestimated as patients most often complain of facial acne. The Acne Symptom and Impact Scale (ASIS) is a 17-item patient-reported outcome (PRO) measure designed to assess the signs and impacts of acne vulgaris. ASIS has previously been validated in a prospective, non-interventional study as a reliable PRO instrument for facial acne. In a pilot study, ASIS, and an additional 10 new questions that focused on the concerns of patients (ASIS-C), were given to 10 patients with moderate-to-severe truncal acne vulgaris who received 3 months of monotherapy with oral sarecycline, a narrow-spectrum tetracycline-class antibiotic. ASIS-C questionnaires were also given to 10 acne-free control subjects. Average ASIS-C answers decreased by 4% for Signs, 15% for Impact, and 16% for Concerns in the 10 patients, with greater decreases of 5% for Signs, 20% for Impact, and 19% for Concerns in the 60% of patients whose truncal acne was clear or almost clear after 12 weeks of sarecycline treatment. In this study, sarecycline was effective in reducing the psychosocial burden associated with truncal acne based on the ASIS-C PRO measures.
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14
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Tobiasz A, Nowicka D, Szepietowski JC. Acne Vulgaris-Novel Treatment Options and Factors Affecting Therapy Adherence: A Narrative Review. J Clin Med 2022; 11:jcm11247535. [PMID: 36556150 PMCID: PMC9788443 DOI: 10.3390/jcm11247535] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Acne vulgaris is an extremely common skin condition, affecting a large population of adolescents, but at the same time, remaining a quite common issue in the group of adult patients. Its complex pathogenesis includes increased sebum secretion, impaired follicular keratinization, colonization of sebaceous glands with Cutibacterium acne bacteria, and the development of inflammation in pilosebaceous units. Although there are many methods of treatment available targeting the mechanisms mentioned above, a large percentage of patients remain undertreated or non-compliant with treatment. Ineffective treatment results in the formation of acne scars, which has a major impact on the well-being and quality of life of the patients. The aim of this publication was a review of available evidence on widely used and novel methods of topical and systemic treatment of acne, additionally including current literature-based analysis of factors affecting patients' compliance. The strengths and limitations of novel substances for treating acne were discussed. We conclude that an effective acne treatment remains a challenge. A better understanding of current treatment options and factors affecting patients' compliance could be a helpful tool in choosing a proper treatment option.
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15
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Tan J, Del Rosso JQ, Weiss JS, Layton AM, Bhatia ND, Arekapudi KL, Hougeir FG, Desai SR. Prevalence and Demographics of Truncal Involvement Among Acne Patients: Survey Data and a Review of the Literature. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:62-67. [PMID: 36312821 PMCID: PMC9586532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Truncal acne is frequently underdiagnosed despite affecting around half of those with facial acne. The objective was to provide an overview of the literature on the incidence of truncal acne according to age, gender, and acne severity. METHODS A narrative review of data from recent large surveys and a literature search in PubMed on the incidence of truncal acne across subgroups of age, gender, and acne severity. RESULTS The prevalence of truncal acne alone was low, ranging from <1% to 14%, but approximately 30 to 60 percent of individuals with facial acne also had truncal acne depending on the population. In an online survey in the United States of 2,000 respondents aged between 14 -29 years with self-reported active facial and/or truncal acne, the incidence of truncal acne was lower in the 14-20 years subgroup than in the 21-29 years subgroup (49% vs 54%). The incidence of truncal acne was similar in both males and females, while 46 percent of respondents with self-declared clear and mild acne indicated having truncal involvement compared to 60 percent of those with moderate or severe acne. LIMITATIONS Online surveys have inherent limitations, such as self-reporting and potential confounders. CONCLUSION Data suggests that patients with both facial and truncal involvement have earlier onset of acne and more severe acne. Additional adverse psychological impact may arise from having the impression that the disease is spreading and becoming more severe. Raising awareness of truncal acne prevalence and demographics could improve its clinical management to reduce the negative psychological impact.
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Affiliation(s)
- Jerry Tan
- Dr. Tan is with Windsor Clinical Research Inc. in Windsor, Ontario, Canada, and the Department of Medicine at the University of Western Ontario, London, Ontario, Canada
| | - James Q Del Rosso
- Dr. Del Rosso is with JDR Dermatology Research and Thomas Dermatology in Las Vegas, Nevada and Advanced Dermatology and Cosmetic Surgery in Maitland, Florida
| | - Jonathan S Weiss
- Dr. Weiss is with Georgia Dermatology Partners and Gwinnett Clinical Research Center Inc. in Snellville, Georgia
| | - Alison M Layton
- Dr. Layton is with the Department of Dermatology at Harrogate and District NHS Foundation Trust in Harrogate, United Kingdom
| | - Neal D Bhatia
- Dr. Bhatia is with Therapeutics Clinical Research in San Diego, California
| | | | - Firas G Hougeir
- Dr. Hougeir is with Southeast Dermatology Specialists in Douglasville, Georgia
| | - Seemal R Desai
- Dr. Desai is with the Department of Dermatology at The University of Texas Southwestern Medical Center in Dallas, Texas.Dr. Desai is also with Innovative Dermatology in Plano, Texas
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16
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Del Rosso JQ, Lain E, York JP, Alexis A. Trifarotene 0.005% Cream in the Treatment of Facial and Truncal Acne Vulgaris in Patients with Skin of Color: a Case Series. Dermatol Ther (Heidelb) 2022; 12:2189-2200. [PMID: 35994159 PMCID: PMC9464295 DOI: 10.1007/s13555-022-00788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
The clinical appearance of acne vulgaris (AV) and the response to therapeutic agents may vary in people with skin of color (SoC) compared with those with lighter skin types. Given the heightened potential for postinflammatory hyperpigmentation and keloid development, effective and timely AV treatment in patients with SoC is especially important. However, these patients are frequently underrepresented in clinical trials, and SoC photographs are generally underrepresented in dermatology. Trifarotene 0.005% cream is a retinoid approved for the once-daily topical treatment of AV, and was studied in large-scale clinical trials that assessed the treatment of AV on both the face and trunk. For severe AV, a topical retinoid may be used in combination with an oral antibiotic, such as doxycycline. Five subjects covering Fitzpatrick skin phototypes III, IV, V, and VI were selected from two larger studies to visually demonstrate treatment of clinically diagnosed AV with trifarotene 0.005% cream. Two subjects received 24 weeks of treatment with trifarotene 0.005% cream for moderate AV on the face and trunk, while three subjects received 12 weeks of treatment with trifarotene 0.005% cream in association with 120 mg oral doxycycline with modified polymer coating for severe facial AV. This case series supports the favorable efficacy and safety of facial and truncal AV treatment with trifarotene 0.005% cream, with or without oral doxycycline, in subjects with SoC (phototypes III–VI).
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Affiliation(s)
- James Q Del Rosso
- JDR Dermatology Research/Thomas Dermatology, Las Vegas, NV, USA. .,Advanced Dermatology and Cosmetic Surgery, Maitland, FL, USA.
| | - Edward Lain
- Austin Institute for Clinical Research, Pflugerville, TX, USA
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17
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Mohsin N, Hernandez LE, Martin MR, Does AV, Nouri K. Acne Treatment Review and Future Perspectives. Dermatol Ther 2022; 35:e15719. [PMID: 35841269 DOI: 10.1111/dth.15719] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/25/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Acne affects approximately 9% of people worldwide and is the most common skin condition in the United States. There are abundant topical and oral treatment options available for patients with acne. First-line agents include topical retinoids, azelaic acid, benzoyl peroxide, and combinations of these agents. For recalcitrant or more severe acne, oral medications, including oral antibiotics, isotretinoin, or hormonal therapy, may be considered. This review will also discuss the many advances being made in the treatment of acne vulgaris, from the development of microencapsulated medications to targeted treatments. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Noreen Mohsin
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Loren E Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Ashley Vander Does
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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18
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Del Rosso JQ, Johnson SM, Schlesinger T, Green L, Sanchez N, Lain E, Draelos Z, York JP, Chavda R. A Randomized, Controlled Trial of Trifarotene Plus Doxycycline for Severe Acne Vulgaris. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:E53-E59. [PMID: 35942016 PMCID: PMC9345187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We evaluated the efficacy and safety of trifarotene plus oral doxycycline in acne. METHODS This was a randomized (2:1 ratio) 12-week, double-blind study of once-daily trifarotene cream 50µg/g plus enteric-coated doxycycline 120mg (T+D) versus trifarotene vehicle and doxycycline placebo (V+P). Patients were aged 12 years or older with severe facial acne (≥20 inflammatory lesions, 30 to 120 non-inflammatory lesions, and ≤4 nodules). Efficacy outcomes included change from baseline in lesion counts and success (score of 0/1 with ≥2 grade improvement) on investigator global assessment (IGA). Safety was assessed by adverse events and local tolerability. RESULTS The study enrolled 133 subjects in the T+D group and 69 subjects in the V+P group. The population was balanced, with an approximately even ratio of adolescent (12-17 years) and adult (≥18 years) subjects. The absolute change in lesion counts from baseline were: -69.1 T+D versus -48.1 V+P for total lesions, -29.4 T+D versus -19.5 V+P for inflammatory lesions, and -39.5 T+D versus -28.2 for non-inflammatory lesions (P<0.0001 for all). Success was achieved by 31.7 percent of subjects in the T+D group versus 15.8 percent in the V+P group (P=0.0107). The safety and tolerability profiles were comparable between the T+D and V+P arms. CONCLUSION T+D was demonstrated to be safe and efficacious as a treatment option for patients with severe acne.
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Affiliation(s)
- James Q Del Rosso
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada and Advanced Dermatology and Cosmetic Surgery Clinical Research in Maitland. Florida
| | | | - Todd Schlesinger
- Dr. Schlesinger is with the Clinical Research Center of the Carolinas in Charleston, South Carolina
| | - Lawrence Green
- Dr. Green is with the George Washington School of Medicine in Washington D.C
| | - Nestor Sanchez
- Dr. Sanchez is with Dermatology and Pathology, at Aibonito Hospital in Aibonito, Puerto Rico
| | - Edward Lain
- Dr. Lain is with the Austin Institute for Clinical Research in Austin, Texas
| | - Zoe Draelos
- Dr. Draelos is with Dermatology Consulting Services, PLLC in High Point, North Carolina
| | - Jean-Philippe York
- Dr. York is with Galderma Laboratories, LP in Fort Worth, Texas, and Galderma SA in Switzerland
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19
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Truncal Acne: An Overview. J Clin Med 2022; 11:jcm11133660. [PMID: 35806952 PMCID: PMC9267677 DOI: 10.3390/jcm11133660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Acne is a relatively common disease of the pilosebaceous units. Many aspects of facial acne have been studied. However, there is limited evidence regarding truncal acne. Truncal acne is also observed in a significant number of patients, but it is often ignored by patients and clinicians. Although the pathogenesis of facial and trunk acne is considered to be similar, the characteristics of the skin on the trunk and face are thought to be different. As truncal acne can cause scars on large areas of the body and adversely affect the quality of life of patients, more attention should be given to patients with truncal acne. Although only a few studies have been published to date, the epidemiology, etiology, severity assessment tool, assessments of the quality of life, and new treatments targeting truncal acne are currently being studied. Therefore, in this review, the latest knowledge on truncal acne will be discussed.
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20
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Baker NC, Pierro JD, Taylor LW, Knudsen TB. Identifying candidate reference chemicals for in vitro testing of the retinoid pathway for predictive developmental toxicity. ALTEX 2022; 40:217–236. [PMID: 35796328 PMCID: PMC10765368 DOI: 10.14573/altex.2202231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
Evaluating chemicals for potential in vivo toxicity based on their in vitro bioactivity profile is an important step toward animal- free testing. A compendium of reference chemicals and data describing their bioactivity on specific molecular targets, cellular pathways, and biological processes is needed to bolster confidence in the predictive value of in vitro hazard detection. Endogenous signaling by all-trans retinoic acid (ATRA) is an important pathway in developmental processes and toxicities. Employing data extraction methods and advanced literature extraction tools, we assembled a set of candidate reference chemicals with demonstrated activity on ten protein family targets in the retinoid system. The compendium was culled from Protein Data Bank, ChEMBL, ToxCast/Tox21, and the biomedical literature in PubMed. Finally, we performed a case study on one chemical in our collection, citral, an inhibitor of endogenous ATRA production, to determine whether the literature supports an adverse outcome pathway explaining the compound’s developmental toxicity initiated by disruption of the retinoid pathway. We also deliver an updated Abstract Sifter tool populated with these reference compounds and complex search terms designed to query the literature for the downstream consequences to support concordance with targeted retinoid pathway disruption.
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Affiliation(s)
| | - Jocylin D. Pierro
- Center for Computational Toxicology and Exposure, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Laura W. Taylor
- Center for Computational Toxicology and Exposure, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Thomas B. Knudsen
- Center for Computational Toxicology and Exposure, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
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21
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Trifarotene: A Novel Therapeutic Option for Acne. Dermatol Res Pract 2022; 2022:1504303. [PMID: 35668721 PMCID: PMC9166940 DOI: 10.1155/2022/1504303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/27/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Acne vulgaris, or acne, is a prevailing cutaneous predicament that customarily crops up on the face, neck, and trunk in the forms of comedones, papules, pustules, and nodules. According to epidemiologic explorations, acne affects 9.4% of the global population, making it the eighth most common disease globally. Acne perturbs up to 85% of adolescents, while it is periodically misconceived as an ailment that affects teenagers only; nonetheless, it also affects myriad adults. Acne has well-documented psychosocial ramifications, including adverse effects on self-perception, mental health, and social functioning. Trifarotene is basically a novel fourth-generation locally applied retinoid approved for the first time in the regimens of both face and truncal acnes. The exclusive topical retinoid that adheres precisely to RAR-gamma, the epidermis' most frequent isoform, is trifarotene, approved in October 2019. The current review evaluates the role of trifarotene in treating acne.
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22
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Dagnelie MA, Poinas A, Dréno B. What is new in adult acne for the last 2 years: focus on acne pathophysiology and treatments. Int J Dermatol 2022; 61:1205-1212. [PMID: 35521784 DOI: 10.1111/ijd.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/07/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
Acne affects more than 640 million people worldwide, including about 85% of adolescents. This inflammatory dermatosis affects the entire population, from teenagers to adults, which reinforces the need to investigate it. Furthermore, in adults, acne has serious consequences, including a psychological impact, low self-esteem, social isolation, and depression. Over the last years, the understanding of acne pathophysiology has improved, mainly thanks to the identification of the pivotal role of the microbiota. The aim of this review was to screen the most recent scientific literature on adult acne and the newly tested treatments. Clinically, therapeutic innovations for the treatment of acne have been recently developed, including pre/probiotics, new molecules, and innovative formulations associated, however, with fewer side effects. Moreover, clinical trials are underway to use off-label molecules that seem to be proving their value in the fight against adult acne.
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Affiliation(s)
- Marie-Ange Dagnelie
- Nantes Université, Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
| | - Alexandra Poinas
- Nantes Université, Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
| | - Brigitte Dréno
- Nantes Université, Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes, France
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23
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Drake L, Reyes-Hadsall S, Barbieri JS, Mostaghimi A. New Developments in Topical Acne Therapy. Am J Clin Dermatol 2022; 23:125-136. [PMID: 35041198 DOI: 10.1007/s40257-021-00666-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Acne vulgaris is a common chronic inflammatory disease with a multifactorial pathogenesis. Although myriad acne treatments are available, current options may not be sufficient because of a lack of efficacy, limited tolerability, or burden of cost to patients. In this review, we highlight recently approved topical acne treatments, as well as those currently in clinical trials. Novel formulations of tretinoin, tazarotene, and minocycline provide modifications of and improvements to existing products. Trifarotene, a novel fourth-generation retinoid, has demonstrated improved tolerability compared with existing topical retinoids. Clascoterone is a novel first-in-class antiandrogen that topically addresses the hormonal etiology of acne. The late-phase clinical trials pipeline consists of agents with bactericidal and anti-sebum mechanisms. Although it is evident that acne treatments continue to evolve, it is important to recognize the need for further comparative studies among new and existing agents to define optimal treatment algorithms that address not only safety and efficacy but also cost-effective care.
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Affiliation(s)
- Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Sophia Reyes-Hadsall
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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24
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Milosheska D, Roškar R. Use of Retinoids in Topical Antiaging Treatments: A Focused Review of Clinical Evidence for Conventional and Nanoformulations. Adv Ther 2022; 39:5351-5375. [PMID: 36220974 PMCID: PMC9618501 DOI: 10.1007/s12325-022-02319-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 01/30/2023]
Abstract
Nowadays, numerous skincare routines are used to rejuvenate aging skin. Retinoids are one of the most popular ingredients used in antiaging treatments. Among the representatives of retinoids, tretinoin is considered the most effective agent with proven antiaging effects on the skin and can be found in formulations approved as medicines for topical treatment of acne, facial wrinkles, and hyperpigmentation. Other retinoids present in topical medicines are used for various indications, but only tazarotene is also approved as adjunctive agent for treatment of facial fine wrinkling and pigmentation. The most commonly used retinoids such as retinol, retinaldehyde, and retinyl palmitate are contained in cosmeceuticals regulated as cosmetics. Since clinical efficacy studies are not required for marketing cosmetic formulations, there are concerns about the efficacy of these retinoids. From a formulation perspective, retinoids pose a challenge to researchers as a result of their proven instability, low penetration, and potential for skin irritation. Therefore, novel delivery systems based on nanotechnology are being developed to overcome the limitations of conventional formulations and improve user compliance. In this review, the clinical evidence for retinoids in conventional and nanoformulations for topical antiaging treatments was evaluated. In addition, an overview of the comparison clinical trials between tretinoin and other retinoids is presented. In general, there is a lack of evidence from properly designed clinical trials to support the claimed efficacy of the most commonly used retinoids as antiaging agents in cosmeceuticals. Of the other retinoids contained in medicines, tazarotene and adapalene have clinically evaluated antiaging effects compared to tretinoin and may be considered as potential alternatives for antiaging treatments. The promising potential of retinoid nanoformulations requires a more comprehensive evaluation with additional studies to support the preliminary findings.
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Affiliation(s)
| | - Robert Roškar
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, 1000, Ljubljana, Slovenia.
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25
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Tan J, Alexis A, Baldwin H, Beissert S, Bettoli V, Del Rosso J, Dréno B, Gold LS, Harper J, Lynde C, Thiboutot D, Weiss J, Layton AM. Gaps and recommendations for clinical management of truncal acne from the Personalising Acne: Consensus of Experts panel. JAAD Int 2021; 5:33-40. [PMID: 34816132 PMCID: PMC8593751 DOI: 10.1016/j.jdin.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Truncal acne is common and burdensome for patients; however, there is paucity of evidence and guidance for the management of truncal acne. Currently, clinical practice guidelines provide very little guidance on the assessment or management of truncal acne. Objectives To identify unmet needs in truncal acne and make recommendations to address clinical and management gaps using an international consensus. Methods The Personalising Acne: Consensus of Experts panel consisted of 13 dermatologists, who used a modified Delphi approach to reach a consensus on statements related to clinically relevant aspects of truncal acne evaluation and management. A consensus was defined as ≥75% of the panelists voting “agree” or “strongly agree.” The voting was electronic and blinded. Results The panel identified gaps and made recommendations related to truncal acne identification, assessment, and grading; the evaluation of the impact on patients; and treatment goals and factors to be considered for its management. Limitations The recommendations are based on expert opinion, in the absence of high-quality evidence. Conclusions We highlighted addressing not just facial acne but also truncal acne during patient consultations. The recommendations made herein may help facilitate the care of patients who present with truncal acne, with or without facial acne.
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Affiliation(s)
- Jerry Tan
- Windsor Clinical Research Inc, Windsor, Ontario, Canada
- Department of Medicine, University of Western Ontario, Windsor Campus, Windsor, Ontario, Canada
- Correspondence to: Jerry Tan, MD, Windsor Clinical Research Inc, 2224 Walker Rd, Suite 300, Windsor, Ontario, N8W 5L7, Canada.
| | | | - Hilary Baldwin
- Robert Wood Johnson Medical Center, New Brunswick, New Jersey
- The Acne Treatment and Research Center, Brooklyn, New York
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Vincenzo Bettoli
- Dermatology Unit – Teaching Hospital, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | - James Del Rosso
- Thomas Dermatology, Las Vegas, Nevada
- JDR Dermatology Research, Las Vegas, Nevada
| | - Brigitte Dréno
- Dermato-cancérology Department, CHU Nantes, University of Nantes, Nantes, France
| | | | - Julie Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, Alabama
| | - Charles Lynde
- Department of Medicine, University of Toronto, Markham, Ontario, Canada
- Lynderm Research Inc, Markham, Ontario, Canada
| | - Diane Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, Philadelphia
| | | | - Alison M. Layton
- Hull York Medical School, University of York, York, United Kingdom
- Harrogate and District NHS Foundation Trust, United Kingdom
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Guerra-Tapia A, González-Guerra E. A New Prospect in Retinoid Therapy: Trifarotene. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Trifarotene for acne. Aust Prescr 2021; 44:140-141. [PMID: 34421181 PMCID: PMC8377295 DOI: 10.18773/austprescr.2021.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Brumfiel CM, Patel MH, Bell KA, Cardis MA. Assessing the Safety and Efficacy of Trifarotene in the Treatment of Acne Vulgaris. Ther Clin Risk Manag 2021; 17:755-763. [PMID: 34345173 PMCID: PMC8324978 DOI: 10.2147/tcrm.s286953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
Acne vulgaris is a common skin condition of the face and trunk that negatively impacts quality of life. Trifarotene is a new first-in-class fourth-generation topical retinoid that has been uniquely studied in the treatment of both facial and truncal acne. Through selective agonism of retinoic acid receptor (RAR)-gamma, the most predominant RAR isotype in the epidermis, trifarotene exerts more targeted, skin-specific effects than earlier generation retinoids. This narrative review summarizes all currently available literature regarding the use of trifarotene in acne vulgaris. We focus on efficacy, safety, and tolerability data and highlight quality of life outcomes and patient-reported satisfaction. Future clinical trials and the clinical applicability of this novel medication in the treatment of acne are also discussed.
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Affiliation(s)
| | - Meera H Patel
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Katheryn A Bell
- Georgetown University School of Medicine, Washington, DC, USA
| | - Michael A Cardis
- MedStar Washington Hospital Center/Georgetown University Hospital Department of Dermatology, Washington, DC, USA
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Santhosh P, Kidangazhiathmana A. Trifarotene - The latest retinoid. Indian J Dermatol Venereol Leprol 2021; 87:742-745. [PMID: 34245524 DOI: 10.25259/ijdvl_741_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Parvathy Santhosh
- Department of Dermatology, Malabar Medical College Hospital and Research Centre, Kozhikode, India
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30
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Bagatin E, Rocha MADD, Freitas THP, Costa CS. Treatment challenges in adult female acne and future directions. Expert Rev Clin Pharmacol 2021; 14:687-701. [PMID: 33957838 DOI: 10.1080/17512433.2021.1917376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Acne is a chronic, inflammatory, and immune-mediated disease of the pilosebaceous unit, highly prevalent in adolescents. However, an increasing number of adults over 25 years old with facial acne, particularly women, have been observed. It is considered a different disease when compared to acne vulgaris. Face is the mainly involved area with inflammatory lesions and more sensitive skin, pointing out the need of a holistic approach.Areas covered: We performed a comprehensive literature search on PubMed database, up to January 2021, regarding adult female acne. We synthesized data about pathogenesis; differences compared to acne vulgaris; and treatment, with focus in the management challenges and perspectives.Expert opinion: It is essential to value the negative impact on quality of life of adult female acne, independently of severity. The disease has prolonged evolution, and patient might be resilient once the improvement, regardless of the treatment option, will just be noticeable after 3 months. Aggravating factors should be clearly discussed, such as the need of changing many habits, especially lesions manipulation. The therapeutic regimen includes make-up and tailored skin care (considering proneness to sensitivity), while anti-acne drugs should be chosen in accordance with desire to be pregnant, presence of pregnancy or breastfeeding.
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Affiliation(s)
| | | | | | - Caroline Sousa Costa
- Department of Specialized Medicine, Discipline of Dermatology - Universidade Federal Do Piauí, Teresina, Brazil
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31
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Guerra-Tapia A, González-Guerra E. A New Prospect in Retinoid Therapy: Trifarotene. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00175-7. [PMID: 33984312 DOI: 10.1016/j.ad.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Guerra-Tapia
- Clínica Dermatólogas Guerra, Madrid, España; Universidad Complutense de Madrid, Madrid, España.
| | - E González-Guerra
- Clínica Dermatólogas Guerra, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Hospital Clínico Universitario San Carlos, Madrid, España
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32
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Tan JKL, Dirschka T. A New Era for Truncal Acne: Emerging from a Legacy of Neglect. Dermatol Ther (Heidelb) 2021; 11:665-668. [PMID: 33877587 PMCID: PMC8163915 DOI: 10.1007/s13555-021-00529-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Jerry K L Tan
- Faculty of Medicine, Western University, London, ON, Canada.
- Windsor Clinical Research Inc., 2224 Walker Rd, Suite 300, Windsor, ON, N8W5L7, Canada.
| | - Thomas Dirschka
- CentroDerm Clinic, Wuppertal, Germany
- Faculty of Health, University of Witten-Herdecke, Witten, Germany
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Why We Should Consider Evidence-Based Treatment Options for Truncal Acne. Dermatol Ther (Heidelb) 2021; 11:661-664. [PMID: 33871801 PMCID: PMC8163923 DOI: 10.1007/s13555-021-00530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 10/31/2022] Open
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34
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Cosio T, Di Prete M, Gaziano R, Lanna C, Orlandi A, Di Francesco P, Bianchi L, Campione E. Trifarotene: A Current Review and Perspectives in Dermatology. Biomedicines 2021; 9:biomedicines9030237. [PMID: 33652835 PMCID: PMC7996910 DOI: 10.3390/biomedicines9030237] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Retinoids have numerous applications in inflammatory, dyskeratotic, and oncohematology diseases. Retinoids have now reached the fourth generation, progressively reducing toxicity whilst increasing their efficacy. Trifarotene is a new fourth-generation retinoid with a selective action on RAR-γ. In this review, we reported the trials—both concluded and in progress—including the use of trifarotene in dermatological diseases. Studies were identified by searching electronic databases (MEDLINE, EMBASE, PubMed, Cochrane, Trials.gov) from 2012 to today and reference lists of respective articles. Only articles published in English language were included. Randomized trials evaluating trifarotene tolerability, safety, and efficacy in congenital ichthyosis and acne have demonstrated great results and mild side effects, leading to the approval by the FDA of trifarotene for the treatment of lamellar ichthyosis in 2014, and of acne vulgaris in October 2019. No high-quality randomized clinical trials have evaluated the treatment of primary cutaneous lymphomas with trifarotene. Finally, we are hypothesizing future perspectives in the treatment of non-melanoma skin cancers, fungal infections, photoaging, and hand-foot skin reactions with trifarotene.
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Affiliation(s)
- Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
| | - Monia Di Prete
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.P.); (A.O.)
| | - Roberta Gaziano
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Caterina Lanna
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
| | - Augusto Orlandi
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (M.D.P.); (A.O.)
| | - Paolo Di Francesco
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (R.G.); (P.D.F.)
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (T.C.); (C.L.); (L.B.)
- Correspondence:
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Han JJ, Faletsky A, Barbieri JS, Mostaghimi A. New Acne Therapies and Updates on Use of Spironolactone and Isotretinoin: A Narrative Review. Dermatol Ther (Heidelb) 2021; 11:79-91. [PMID: 33409936 PMCID: PMC7859022 DOI: 10.1007/s13555-020-00481-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Acne vulgaris is a chronic inflammatory skin disease with a multifactorial pathogenesis. Although a variety of acne treatments are available, limitations of current therapies include tolerability, antimicrobial resistance, and costs and patient burden associated with monitoring. This narrative review focuses on emerging treatments and updates on the management of acne. Clascoterone, sarecycline, trifarotene, and novel lotion formulations of tretinoin and tazarotene have been evaluated in clinical trials and provide new options for treatment. Emerging data on the safety and efficacy of spironolactone and isotretinoin challenge current conventions and suggest a need to reconsider drug monitoring guidelines and risk prevention systems. Additional head-to-head data are needed to confirm these novel treatments' utility in treating acne.
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Affiliation(s)
- Jane J Han
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Adam Faletsky
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
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Talianu MT, Dinu-Pîrvu CE, Ghica MV, Anuţa V, Jinga V, Popa L. Foray into Concepts of Design and Evaluation of Microemulsions as a Modern Approach for Topical Applications in Acne Pathology. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E2292. [PMID: 33228156 PMCID: PMC7699607 DOI: 10.3390/nano10112292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Abstract
With a fascinating complexity, governed by multiple physiological processes, the skin is considered a mantle with protective functions which during lifetime are frequently impaired, triggering dermatologic disorders. As one of the most prevalent dermatologic conditions worldwide, characterized by a complex pathogenesis and a high recurrence, acne can affect the patient's quality of life. Smart topical vehicles represent a good option in the treatment of a versatile skin condition. By surpassing the stratum corneum known for diffusional resistance, a superior topical bioavailability can be obtained at the affected place. In this direction, the literature study presents microemulsions as a part of a condensed group of modern formulations. Microemulsions are appreciated for their superior profile in matters of drug delivery, especially for challenging substances with hydrophilic or lipophilic structures. Formulated as transparent and thermodynamically stable systems, using simplified methods of preparation, microemulsions have a simple and clear appearance. Their unique structures can be explained as a function of the formulation parameters which were found to be the mainstay of a targeted therapy.
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Affiliation(s)
- Marina-Theodora Talianu
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Cristina-Elena Dinu-Pîrvu
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Mihaela Violeta Ghica
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Valentina Anuţa
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
| | - Viorel Jinga
- Department of Clinical Sciences, no.3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Lăcrămioara Popa
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020950 Bucharest, Romania; (M.-T.T.); (C.-E.D.-P.); (V.A.); (L.P.)
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37
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Johnson SM, Chavda R, DuBois JC. Subject Satisfaction with Trifarotene 50 μg/g Cream in the Treatment of Facial and Truncal Acne Vulgaris: A Case Series. Dermatol Ther (Heidelb) 2020; 10:1165-1173. [PMID: 32623660 PMCID: PMC7477054 DOI: 10.1007/s13555-020-00417-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
There is a paucity of literature covering patient-reported outcomes of treatments for truncal acne. Trifarotene 50 μg/g cream is a novel retinoid molecule approved for once-daily topical treatment of facial and truncal acne vulgaris. As physicians are starting to gain real-world experience with this retinoid treatment, their access to reporting from the patient’s perspective provides a valuable adjunct to the pivotal studies. We report a case series of three subjects with moderate facial and truncal acne treated with trifarotene 50 μg/g cream on the face, shoulders, upper back and upper anterior chest for 12 weeks and evaluated by satisfaction questionnaires. This case series illustrating the treatment of facial and truncal acne with trifarotene 50 μg/g cream, in the form of real-world data, describes high overall satisfaction and excellent tolerability to support the use of this new retinoid molecule in the treatment of acne vulgaris on both the face and trunk.
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Bell KA, Brumfiel CM, Haidari W, Boger L. Trifarotene for the Treatment of Facial and Truncal Acne. Ann Pharmacother 2020; 55:111-116. [PMID: 32567361 DOI: 10.1177/1060028020934892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Katheryn A Bell
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Wasim Haidari
- Georgetown University School of Medicine, Washington, DC, USA
| | - Laura Boger
- MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, USA
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39
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Abstract
The terminal differentiation of the epidermis is a complex physiological process. During the past few decades, medical genetics has shown that defects in the stratum corneum (SC) permeability barrier cause a myriad of pathological conditions, ranging from common dry skin to lethal ichthyoses. Contrarily, molecular phylogenetics has revealed that amniotes have acquired a specialized form of cytoprotection cornification that provides mechanical resilience to the SC. This superior biochemical property, along with desiccation tolerance, is attributable to the proper formation of the macromolecular protein-lipid complex termed cornified cell envelopes (CE). Cornification largely depends on the peculiar biochemical and biophysical properties of loricrin, which is a major CE component. Despite its quantitative significance, loricrin knockout (LKO) mice have revealed it to be dispensable for the SC permeability barrier. Nevertheless, LKO mice have brought us valuable lessons. It is also becoming evident that absent loricrin affects skin homeostasis more profoundly in many more aspects than previously expected. Through an extensive review of aggregate evidence, we discuss herein the functional significance of the thiol-rich protein loricrin from a biochemical, genetic, pathological, metabolic, or immunological aspect with some theoretical and speculative perspectives.
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Affiliation(s)
- Yosuke Ishitsuka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Dennis R. Roop
- Department of Dermatology and Charles C. Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
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40
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Kassir M, Karagaiah P, Sonthalia S, Katsambas A, Galadari H, Gupta M, Lotti T, Wollina U, Abdelmaksoud A, Grabbe S, Goldust M. Selective RAR agonists for acne vulgaris: A narrative review. J Cosmet Dermatol 2020; 19:1278-1283. [PMID: 32100454 DOI: 10.1111/jocd.13340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acne vulgaris is a chronic disfiguring inflammatory disease of adolescents and adults affecting up to 90% of the population around the world. The sequence of etiopathogenesis in acne is not completely understood but involves abnormalities in sebum production, follicular plugging, proliferation of propionibacterium acnes, and chronic inflammation. AIMS This review aims to summarize the features of the topical selective RAR agonists in treating acne vulgaris with a special emphasis on the 4th generation topical retinoid trifarotene. METHODS Studies were identified by searching electronic databases (MEDLINE and PubMed) till August 2019 and reference lists of respective articles. Only articles published in English language were included. RESULTS Topical retinoids have been first line of treatment for more than 30 years now in treating mild to moderate acne vulgaris. Third generation retinoids like adapalene and tazarotene are selective RAR and γ agonists, having an additional anti-inflammatory action along with their comedolytic effects and work well in combinations with topical antibiotics, due to the stability of chemical composition. CONCLUSION Trifarotene is a new 4th generation retinoid with selective action on RAR-γ receptor alone, which is specific for skin, and it is safe for long-term maintenance therapy with good efficacy and tolerability.
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Affiliation(s)
| | - Priyanka Karagaiah
- Department of Dermatology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Sidharth Sonthalia
- Skinnocence: The Skin Clinic, Department of Dermatology & STD, Kalyani-Escorts Hospital, Gurgaon, India
| | | | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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41
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Abstract
Topical trifarotene (Aklief®) is a first-in-class, fourth-generation retinoid [selective retinoic acid receptor (RAR)-γ agonist] being developed by Galderma Research and Development LLC for the treatment of acne vulgaris. In October 2019 trifarotene received its first global approval in the USA for the topical treatment of acne vulgaris in patients 9 years of age and older. This article summarizes the milestones in the development of trifarotene leading to its first global approval for acne vulgaris.
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Affiliation(s)
- Lesley J Scott
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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