Clinical efficacy of adapalene (Differin®) 0.3% gel in Chilean women with cutaneous photoaging

One Acne™: A holistic management approach to improve overall skin quality and treatment outcomes in acne with or without sensitive skin

Acne and sensitive skin can take a profound toll on patients' well-being, which can be exacerbated if the conditions are experienced together. This narrative review aims to identify appropriate treatments to facilitate a holistic management approach to acne (One Acne™), sensitive skin, and acne-induced sequelae and describe the role of treatments in improving skin quality. Topical retinoids are considered the preferred first-line option for acne treatment by dermatologists, either as monotherapy or in combination with other treatments, because of their ability to target various aspects of the disease. Tretinoin, trifarotene, adapalene, and tazarotene have all been assessed in clinical studies for managing acne-associated scarring, with varying success, with the latter three reported to improve skin quality. Moreover, some corrective procedures, e.g., injectable non-animal stabilized hyaluronic acid (NASHA) fillers, have proven effective for treating acne scarring. Both treatment types may complement each other to provide optimal treatment outcomes and patient satisfaction, as observed in several patients receiving concomitant treatment with NASHA fillers/topical trifarotene. Adjunctive use of cleansers, moisturizers, and photoprotection-containing ingredients such as vitamin B3, glycerin, or pro-vitamin B3 may also complement drug/corrective treatments to reduce skin irritation and risk of scarring, as well as improve skin hydration, tone, and overall appearance. This narrative review highlights that comprehensive skincare regimens should be used throughout acne patients' journeys to reduce treatment-related irritation, improve treatment outcomes, adherence, and satisfaction, and enhance overall skin quality. Patients with sensitive skin should choose tailored skincare products to maintain skin barrier integrity and restore skin function.

Screening of Adapalene Microsponges Fabrication Parameters with Insight on the In vitro Biological Effectiveness

PURPOSE

The objective of the present study was to scrutinize the microsponges (MS) as a carrier system using Adapalene (ADA) as a model drug.

METHODS

Data modelling was implemented using Plackett-Burman design to identify the main variables affecting the formulation of ADA-MS. The adopted method of preparation for MS was quasi-emulsion solvent diffusion method. The nominated independent variables were volume of organic phase, sonication time, stirring speed, drug percent, polymer type, emulsifier concentration, and method of organic phase addition. As for the dependent variables, they included entrapment efficiency (E.E.%), production yield (P.Y.%), particle size (P.S.) and morphology. Furthermore, selected ADA loaded microsponges (ADA-MS) were in vitro assayed for their biological activities via cytotoxicity, UVA irradiation and cell viability, and antimicrobial activity.

RESULTS

The study indicated that the drug percent, polymer type and surfactant concentration have the key significant effect on E.E.% and P.Y.%, while, the drug percent, stirring speed and volume of organic phase have had a significant effect on P.S. and their morphology. Furthermore, ADA-MS had a momentous cytotoxic effect on A431 and M10 cell-lines with exceptional enrichment when the polymer Eudragit RS100 was used. Also, the ADA-MS increased the cell viability after UVA irradiation on HFB-4 cell-line by 14% to 43%, especially when using Ethyl Cellulose as a polymer. Lastly, the antimicrobial activity of ADA against Propionibacterium acnes was boosted when incorporated into MS.

CONCLUSION

The Plackett-Burman design proved its impact in discerning preparation variables affecting the quality of ADA-MS formulation, with heightening of the in vitro biological activities of ADA. Thus, MS was presumed to be an auspicious carrier system for ADA.

Synthetic Retinoids Beyond Cancer Therapy

While the uses of retinoids for cancer treatment continue to evolve, this review focuses on other therapeutic areas in which retinoids [retinol (vitamin A), all-trans retinoic acid (RA), and synthetic retinoic acid receptor (RAR)α-, β-, and γ-selective agonists] are being used and on promising new research that suggests additional uses for retinoids for the treatment of disorders of the kidneys, skeletal muscles, heart, pancreas, liver, nervous system, skin, and other organs. The most mature area, in terms of US Food and Drug Administration-approved, RAR-selective agonists, is for treatment of various skin diseases. Synthetic retinoid agonists have major advantages over endogenous RAR agonists such as RA. Because they act through a specific RAR, side effects may be minimized, and synthetic retinoids often have better pharmaceutical properties than does RA. Based on our increasing knowledge of the multiple roles of retinoids in development, epigenetic regulation, and tissue repair, other exciting therapeutic areas are emerging. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Questionnaire Modifications and Alternative Scoring Methods of the Dermatology Life Quality Index: A Systematic Review

OBJECTIVES

Dermatology Life Quality index (DLQI) is the most widely used health-related quality of life questionnaire in dermatology. Little is known about existing questionnaire or scoring modifications of the DLQI. We aimed to systematically review, identify, and categorize all modified questionnaire versions and scoring methods of the DLQI.

METHODS

We performed a systematic literature search in PubMed, Web of Science, CINAHL, and PsychINFO. Methodologic quality and evidence of psychometric properties were assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and Terwee checklists.

RESULTS

The included 81 articles reported on 77 studies using 59 DLQI modifications. Modifications were used for a combined sample of 25 509 patients with 47 different diagnoses and symptoms from 28 countries. The most frequently studied diseases were psoriasis, hirsutism, acne, alopecia, and bromhidrosis. The modifications were categorized into the following nonmutually exclusive groups: bolt-ons or bolt-offs (48%), disease, symptom, and body part specifications (42%), changes in existing items (34%), scoring modifications (27%), recall period changes (19%), response scale modifications (15%), and illustrations (3%). The evidence concerning the quality of measurement properties was heterogeneous: 4 of 13 studies were rated positive on internal consistency, 1 of 3 on reliability, 3 of 5 on content validity, 9 of 22 on construct validity, 6 of 6 on criterion validity, and 1 of 1 on responsiveness.

CONCLUSION

An exceptionally large number of DLQI modifications have been used that may indicate an unmet need for adequate health-related quality of life instruments in dermatology. The psychometric overview of most questionnaire modifications is currently incomplete, and additional efforts are needed for proper validation.

The Effect of Platelet-Rich Fibrin Matrix on Skin Rejuvenation: A Split-Face Comparison

BACKGROUND

Despite the increasingly popular use of platelet-rich fibrin matrix (PRFM) for facial rejuvenation, no studies have evaluated its effects on skin.

OBJECTIVES

The aim of this study was to determine the effect of PRFM on skin quality as measured by the Canfield VISIA Complexion Analysis System.

METHODS

This was a 12-week randomized, placebo-controlled trial conducted at a single center comparing 2 groups. Thirty patients received a PRFM injection in the mid-cheek region and nasolabial fold on one side of the face and saline on the contralateral side. The primary outcome measure was the difference between pre- and posttreatment total VISIA skin scores for each group at 6 and 12 weeks. The change in subscores for each skin parameter was also calculated.

RESULTS

There were 30 participants, with a mean [standard deviation] age of 49.9 [13.9] years. At 6 weeks, the median change in total VISIA score (interquartile range) was -1.77 (2.36) in the PRFM group and -0.73 (2.09) in the saline group (P = 0.003). The only skin parameter that had a significantly different change in score between the groups was texture (P = 0.004). At 12 weeks, the change in median score was -1.31 (3.26) in the PRFM cohort and -0.76 (2.21) in the saline cohort (P = 0.34). There was no statistical significance in the change in score for any of the individual skin parameters.

CONCLUSIONS

PRFM can objectively improve skin quality compared with placebo. Texture was the only skin parameter that significantly improved, which is consistent with PRFM's role as a filler agent. The results appear to persist for at least 6 weeks.

LEVEL OF EVIDENCE: 1

Cosmeceuticals: The Principles and Practice of Skin Rejuvenation by Nonprescription Topical Therapy

Background

Aesthetic practice relies on a harmonious relationship between medicine and commerce. Bridging the gap is a large number of skincare products that make therapeutic claims while avoiding the regulatory framework of pharmaceuticals. In this gray area, clinicians find themselves poorly disposed to counsel patients wisely as the industry is expanding faster than empirical evidence of efficacy and safety can be acquired. To serve our patients and engage with industry, we must understand the theoretical principles and evaluate the clinical evidence in practice.

Objectives

The purpose of this paper is to classify cosmeceuticals by method of action, explain how they work in principle with reference to skin aging, and evaluate the clinical evidence for them.

Methods

A literature and cosmetic clinic website search was conducted to establish a list of the most commonly advertised cosmeceuticals, and a peer-reviewed literature search was then conducted to establish the clinical evidence for them.

Results

A huge number of cosmeceuticals are marketed for skin rejuvenation but almost invariably they fall into 1 of 4 categories. These include the induction of tissue repair mechanisms, inflammatory modulation, scavenging of reactive oxygen species, or a combination of the 3. With the exception of retinol derivatives and hydroxy acids, the clinical evidence is limited, despite promising preclinical evidence for several cosmeceuticals.

Conclusions

Cosmeceuticals reside within a highly competitive ecosystem and are often brought to market based on preclinical, not clinical evidence. Success and failure will largely be governed by the establishment of clinical evidence in retrospect.

Recent Advances Regarding the Therapeutic Potential of Adapalene

Adapalene (ADP) is a representative of the third retinoids generation and successfully used in first-line acne treatment. ADP binds to retinoic acid nuclear receptors. The comedolytic, anti-inflammatory, antiproliferative, and immunomodulatory are the known ADP effects. Its safety profile is an advantage over other retinoids. ADP recently was found to be effective in the treatment of several dermatological diseases and photoaging besides the utility in the treatment of acne vulgaris. New biological effects of adapalene with therapeutic potential are highlighted in this review paper. Thus, adapalene could be a valuable therapeutic drug into the treatment of several types of cancer. Additionally, some neurodegenerative diseases could be treated with a suitable formulation for intravenous administration. The antibacterial activity against methicillin-resistant Staphylococcus aureus of an analogue of ADP has been proven. In different therapeutic schemes, ADP is more effective in combination with other active substances. New topical combinations with adapalene include ketoconazole (antifungal), mometasone furoate (anti-inflammatory corticosteroid), nadifloxacin (fluoroquinolone), and alfa and beta hydroxy acids. Combination with oral drugs is a new trend that enhances the properties of topical formulations with adapalene. Several studies have investigated the effects of ADP in co-administration with azithromycin, doxycycline, faropenem, isotretinoin, and valganciclovir. Innovative formulations of ADP also aim to achieve a better bioavailability, increased efficacy, and reduced side effects. In this review, we have highlighted the current studies on adapalene regarding biological effects useful in various treatment types. Adapalene has not been exploited yet to its full biological potential.

Application of ultrasound-mediated adapalene-coated lysozyme-shelled microbubbles in UVA-induced skin photoaging

Photoaging, the premature aging of skin induced by ultraviolet rays, is characterized by wrinkling, roughness, laxity, and pigmentary changes. Various natural and synthetic retinoids have been explored for the treatment of aging. Among retinoids, adapalene (Ada, 0.3%) is one of the most potent and widely used drugs to treat photoaging. However, it causes irritant reactions that limit its acceptance by patients. Several studies have shown the applicability of Lysozyme (Lys)-shelled microbubbles (MBs) for drug delivery through sonophoresis, and recently we have shown its efficiency to treat inflammatory skin disease. Here, we report the construction of novel Ada-LysMBs based on opposite electric charges for combined effects to treat photoaging. The Ada-LysMBs were self-assembled and had a mean diameter of 2857 nm. The maximum loading efficiency of Ada onto LysMBs was 13.99 ± 0.59%. An acoustic power density of 3 W/cm2 for 1 min revealing maximum penetration depth of LysMBs was optimized for further in vitro and in vivo studies of Ada-LysMBs. It was observed that in vitro Ada release from Ada-LysMBs at 6 h after ultrasound (US) treatment was more rapid at pH 7.4 (82%) than at pH 5.5 (73%). Franz diffusion experiments on isolated porcine skin indicated that US approximately doubled Ada delivery by Ada-LysMBs and Ada + LysMBs at 12 h and six-fold Lys permeation by LysMBs at 6 h, compared to these treatments alone. A 5-week in vivo study in mice identified significant wrinkle reduction in animals treated with US plus Ada-LysMBs. Our findings indicate that US may be used with Ada-LysMBs in the water phase to treat photoaging by normalizing hyperkeratinization and promoting collagen synthesis.

Topical Retinoids: Therapeutic Mechanisms in the Treatment of Photodamaged Skin

Retinoids are a group of substances comprising vitamin A and its natural and synthetic derivatives. Retinoids were first used in dermatology in 1943 by Straumfjord for acne vulgaris. Since that time, retinoids have been utilized in the management and treatment of various skin conditions, including photoaging. Photodamage of the skin occurs as a consequence of cumulative exposure to solar ultraviolet radiation (UVR) and is characterized by deep wrinkles, easy bruising, inelasticity, mottled pigmentation, roughness, and telangiectasias. The mechanism of UVR-induced photodamage is multifactorial. Retinoids have demonstrated efficacy in the treatment of photoaged skin. Indeed, understanding the pathophysiology of photoaging and the molecular mechanism of retinoids can not only provide insight into the effects retinoids can exert in treating photoaging but also provide the rationale for their use in the treatment of other dermatologic diseases.

Objective assessment of facial skin aging and the associated environmental factors in Japanese monozygotic twins

Twin studies, especially those involving monozygotic (MZ) twins, facilitate the analysis of factors affecting skin aging while controlling for age, gender, and genetic susceptibility. The purpose of this study was to objectively assess various features of facial skin and analyze the effects of environmental factors on these features in MZ twins. At the Osaka Twin Research Center, 67 pairs of MZ twins underwent medical interviews and photographic assessments, using the VISIA(®) Complexion Analysis System. First, the average scores of the right and left cheek skin spots, wrinkles, pores, texture, and erythema were calculated; the differences between the scores were then compared in each pair of twins. Next, using the results of medical interviews and VISIA data, we investigated the effects of environmental factors on skin aging. The data were analyzed using Pearson's correlation coefficient test and the Wilcoxon signed-rank test. The intrapair differences in facial texture scores significantly increased as the age of the twins increased (P = 0.03). Among the twin pairs who provided answers to the questions regarding history differences in medical interviews, the twins who smoked or did not use skin protection showed significantly higher facial texture or wrinkle scores compared with the twins not exposed to cigarettes or protectants (P = 0.04 and 0.03, respectively). The study demonstrated that skin aging among Japanese MZ twins, especially in terms of facial texture, was significantly influenced by environmental factors. In addition, smoking and skin protectant use were important environmental factors influencing skin aging.

Mechanisms and treatments of photoaging

Photoaging is frequently encountered in a dermatologic practice. This systematic literature review aims to explore the etiology of photoaging and address the evidence behind its current management. A comprehensive search of MEDLINE, EMBASE, UpToDate, and the Cochrane Library was conducted. Articles were limited to those relating to photoaging. There are two major approaches in the current management of photoaging. This includes strategies to prevent against ultraviolet damage (e.g. sunscreen) and medications that attempt to reverse existing skin damage (topical retinoids and 5-fluorouracil). There has been a large growth in the variety of treatment options in recent years. While it is important for such growth to continue, prevention via sensible photoprotection methods still remains the best current management option.