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Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Stein Gold LF, Tan JKL, Tollefson MM, Weiss JS, Wu PA, Zaenglein AL, Han JM, Barbieri JS. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024; 90:1006.e1-1006.e30. [PMID: 38300170 DOI: 10.1016/j.jaad.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS These guidelines provide evidence-based recommendations for the management of acne vulgaris.
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Affiliation(s)
- Rachel V Reynolds
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fran Cook-Bolden
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Seemal R Desai
- Innovative Dermatology, Plano, Texas; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kelly M Druby
- Penn State Health Hampden Medical Center, Enola, Pennsylvania
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonette E Keri
- University of Miami, Miller School of Medicine, Miami, Florida; Miami VA Medical Center, Miami, Florida
| | | | - Jerry K L Tan
- Western University, London, Ontario, Canada; Windsor Clinical Research Inc., Windsor, Ontario, Canada
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Jonathan S Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Georgia Dermatology Partners, Snellville, Georgia
| | - Peggy A Wu
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State/Hershey Medical Center, Hershey, Pennsylvania
| | - Jung Min Han
- American Academy of Dermatology, Rosemont, Illinois.
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Harper JC, Baldwin H, Choudhury SP, Rai D, Ghosh B, Aman MS, Choudhury AR, Dutta SK, Dey D, Bhattacharyya S, Lin T, Joseph G, Dashputre AA, Tan JKL. Treatments for Moderate-to-Severe Acne Vulgaris: A Systematic Review and Network Meta-analysis. J Drugs Dermatol 2024; 23:216-226. [PMID: 38564399 DOI: 10.36849/jdd.8148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Multiple treatment options exist for the management of moderate-to-severe acne. However, the comparative effectiveness (efficacy/safety) of moderate-to-severe acne treatments has not been systematically examined. METHODS A systematic literature review (SLR) was conducted to identify randomized controlled trials of ≥4 weeks of treatment (topical, oral, physical, or combinations) for moderate-to-severe facial acne in patients aged ≥9 years. Efficacy outcomes included: percentage of patients achieving ≥2-grade reduction from baseline and “clear” or “almost clear” for global severity score (treatment success); absolute change in inflammatory (ILs reduction); and noninflammatory lesion counts (NILs reduction). A random-effects network meta-analysis (NMA) was conducted for the efficacy outcomes. Treatments were ranked with posterior rank plots and surface under cumulative ranking values. Results: Eighty-five studies were included in the SLR/NMA. Topical triple-agent fixed-dose combination (FDC) gel (clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1%) and combinations of double-agent fixed-dose topical treatments with oral antibiotics (TOA3) consistently ranked in the top 3 treatments. Topical triple-agent FDC gel was numerically superior to TOA3 for treatment success (log-odds ratios: 1.84 [95% credible interval (CrI) 1.36 to 2.29]) and 1.69 (95% CrI: 1.01 to 2.32) vs placebo/vehicle). TOA3 was numerically superior to topical triple-agent FDC gel for reduction of ILs (mean difference: -8.21 [-10.33 to -6.13]) and -10.40 [-13.44 to -7.14] vs placebo/vehicle) and NILs (mean difference: -13.41 [-16.69 to -10.32] and -17.74 [-22.56 to -12.85] vs placebo/vehicle). CONCLUSIONS Based on this SLR/NMA, topical triple-agent FDC gel was the most efficacious and safe treatment for moderate-to-severe acne. J Drugs Dermatol. 2024;23(4): doi:10.36849/JDD.8148.
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Paller AS, Tan JKL, Bagel J, Rossi AB, Shumel B, Zhang H, Abramova A. IGAxBSA composite for assessing disease severity and response in patients with atopic dermatitis. Br J Dermatol 2021; 186:496-507. [PMID: 34726270 PMCID: PMC9303952 DOI: 10.1111/bjd.20872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate assessment of atopic dermatitis (AD) severity is critical when initiating and monitoring therapy. Use of existing research tools such as the Eczema Area and Severity Index (EASI) and the SCORing Atopic Dermatitis (SCORAD) is complex and time-consuming in clinical practice. A previous analysis found the product of validated Investigator Global Assessment (vIGA) and affected body surface area (BSA) to be an accurate and practical tool for routine assessment of paediatric AD. OBJECTIVE To evaluate IGAxBSA composite as an alternative to EASI or SCORAD for assessment of AD disease severity and disease responsiveness. METHODS The relationship between IGAxBSA, EASI, and SCORAD was assessed in a post-hoc analysis of pooled data from the dupilumab clinical trial programme in adult and paediatric patients with moderate-to-severe AD who had received dupilumab or placebo (with/without topical corticosteroids [TCS]). RESULTS Using datapoints from pooled dupilumab randomized controlled trials (n = 3473) and open-label extension (OLE) trials (n = 3045), we found that IGAxBSA correlated well with EASI and SCORAD, irrespective of treatment group and race (White/Asian/Black). IGAxBSA correlated better with objective measures (EASI, SCORAD) than with patient/caregiver-reported subjective measures. IGAxBSA correlated strongly with EASI and SCORAD in assessing disease change over time (r = 0.8973; r = 0.7649, respectively; P < 0.0001) and concordance between IGAxBSA-50/75/90 and EASI-50/75/90 was excellent (88-94%). CONCLUSIONS IGAxBSA is a valid alternative for assessment of AD disease severity and response over time, compared with EASI or SCORAD in patients with AD, irrespective of race.
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Affiliation(s)
- A S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J K L Tan
- Windsor Clinical Research, Windsor, ON, Canada
| | - J Bagel
- Eczema Center of New Jersey, East Windsor, NJ, USA
| | | | - B Shumel
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
| | - H Zhang
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
| | - A Abramova
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
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Thyssen JP, Lio P, Ball S, Pierce E, Sun L, Chen Y, Tan JKL, Augustin M. Improvement in symptoms of anxiety and depression in patients with atopic dermatitis after treatment with baricitinib. J Eur Acad Dermatol Venereol 2021; 36:e147-e150. [PMID: 34553429 DOI: 10.1111/jdv.17704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - P Lio
- Medical Dermatology Associates of Chicago, Chicago, IL, USA
| | - S Ball
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - E Pierce
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - L Sun
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Y Chen
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - J K L Tan
- University of Western Ontario and Windsor Clinical Research Inc., Windsor, ON, Canada
| | - M Augustin
- University Medical Centre Hamburg, Hamburg, Germany
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5
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Kohn AH, Alavi A, Armstrong AW, Babalola F, Garg A, Gottlieb AB, Grilli L, Jemec GBE, Latella J, Marcus K, Merola JF, Ortega-Loayza AG, Siegel DM, Strand V, Tan JKL, Perez-Chada LM. International Dermatology Outcome Measures (IDEOM): Report from the 2020 Annual Meeting. Dermatology 2021; 238:430-437. [PMID: 34537770 DOI: 10.1159/000518966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The International Dermatology Outcome Measures (IDEOM) initiative is a non-profit organization that aims to develop evidence-based outcome measurements to evaluate the impact of treatments for patients with dermatological disease. IDEOM includes all key stakeholders in dermatology (patient, physician, industry, insurer, and government) during the process of developing such outcome measurements. SUMMARY Here, we provide an update of IDEOM activities that were presented at the 2020 IDEOM Virtual Annual Meeting (October 23-24, 2020). During the meeting, multiple IDEOM workgroups (psoriasis, psoriatic arthritis, hidradenitis suppurativa, acne, pyoderma gangrenosum, and actinic keratosis) shared their progress to date, as well as future directions in developing and validating Patient-Reported Outcome Measures. Updates on demonstrating efficacy in clinicals trials by the US Food and Drug Administration are also summarized. Key Messages: In this report, we summarize the work presented by each IDEOM workgroup (psoriasis, psoriatic arthritis, hidradenitis suppurativa, acne, pyoderma gangrenosum, and actinic keratosis) at the 2020 IDEOM Virtual Annual Meeting.
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Affiliation(s)
- Alison H Kohn
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,
| | - Folawiyo Babalola
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lesley Grilli
- Patient Research Partner, International Dermatology Outcome Measures (IDEOM), Cohasset, Massachusetts, USA
| | | | - John Latella
- Patient Research Partner, International Dermatology Outcome Measures (IDEOM), Windsor, Connecticut, USA
| | - Kendall Marcus
- Division of Dermatology and Dental Products, Office of New Drugs, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Joseph F Merola
- Department of Dermatology and Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel M Siegel
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jerry K L Tan
- Faculty of Medicine, Western University, London, Ontario, Canada
| | - Lourdes M Perez-Chada
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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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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Affiliation(s)
- John S Barbieri
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jerry K L Tan
- Schulich School of Medicine and Dentistry, Western University, Windsor, Ontario, Canada
| | - Adewole S Adamson
- Division of Dermatology, Department of Internal Medicine, University of Texas at Austin, USA
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Abstract
Acne is a disease of pilosebaceous inflammation. Pivotal in pathogenesis are the roles of hormones (insulin, insulin-like growth factor-1, androgens), Propionibacterium acnes, lipogenesis, and a proinflammatory lipid profile. Innate immune responses are induced through interaction with toll-like receptors and inflammasome activation initially and subsequently through adaptive immune activation. These insights into pathogenic inflammatory pathways can translate into novel therapeutic approaches for acne. Semin Cutan Med Surg 37(supp3):S60-S62 ©2018 published by Frontline Medical Communication.
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Affiliation(s)
- Jerry K L Tan
- Adjunct Professor Schulich School of Medicine and Dentistry Western University Windsor, Ontario, Canada
| | - Linda F Stein Gold
- Director of Dermatology Clinical Research Division Head of Dermatology Henry Ford Hospital Detroit, Michigan
| | - Andrew F Alexis
- Chair, Department of Dermatology Director of The Skin of Color Center Mount Sinai St. Luke's and Mount Sinai West Associate Professor of Dermatology Icahn School of Medicine at Mount Sinai New York, New York
| | - Julie C Harper
- Clinical Associate Professor of Dermatology University of Alabama at Birmingham Dermatology and Skin Care Center of Birmingham Birmingham, Alabama
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9
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Abstract
Patients with skin of color are more likely to develop acne and postinflammatory hyperpigmentation (PIH). Many therapies for acne have demonstrated efficacy in darker skin types and in the treatment of PIH. Semin Cutan Med Surg 37(supp3):S71-S73 © 2018 published by Frontline Medical Communications.
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Affiliation(s)
- Andrew F Alexis
- Chair, Department of Dermatology Director of The Skin of Color Center Mount Sinai St. Luke's and Mount Sinai West Associate Professor of Dermatology Icahn School of Medicine at Mount Sinai New York, New York
| | - Julie C Harper
- Clinical Associate Professor of Dermatology University of Alabama at Birmingham Dermatology and Skin Care Center of Birmingham Birmingham, Alabama
| | - Linda F Stein Gold
- Director of Dermatology Clinical Research Division Head of Dermatology Henry Ford Hospital Detroit, Michigan
| | - Jerry K L Tan
- Adjunct Professor Schulich School of Medicine and Dentistry Western University Windsor, Ontario, Canada
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10
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Abstract
New topical therapies have demonstrated efficacy in patients with moderate or severe acne who might otherwise have required therapy with systemic antibiotics or isotretinoin. Increasing knowledge about the pathogenesis of acne has facilitated the development of therapies with novel modes of action. New and investigational therapies also are available or in development for the treatment of both the papulopustular and erythematous manifestations of rosacea. Semin Cutan Med Surg 37(supp3):S63-S66 © 2018 published by Frontline Medical Communications.
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Affiliation(s)
- Linda F Stein Gold
- Director of Dermatology Clinical Research Division Head of Dermatology Henry Ford Hospital Detroit, Michigan
| | - Andrew F Alexis
- Chair, Department of Dermatology Director of The Skin of Color Center Mount Sinai St. Luke's and Mount Sinai West Associate Professor of Dermatology Icahn School of Medicine at Mount Sinai New York, New York
| | - Julie C Harper
- Clinical Associate Professor of Dermatology University of Alabama at Birmingham Dermatology and Skin Care Center of Birmingham Birmingham, Alabama
| | - Jerry K L Tan
- Adjunct Professor Schulich School of Medicine and Dentistry Western University Windsor, Ontario, Canada
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Eichenfield LF, Del Rosso JQ, Tan JKL, Hebert AA, Webster GF, Harper J, Baldwin HE, Kircik LH, Stein-Gold L, Kaoukhov A, Alvandi N. Use of an alternative method to evaluate erythema severity in a clinical trial: difference in vehicle response with evaluation of baseline and postdose photographs for effect of oxymetazoline cream 1·0% for persistent erythema of rosacea in a phase IV study. Br J Dermatol 2019; 180:1050-1057. [PMID: 30500065 PMCID: PMC6850476 DOI: 10.1111/bjd.17462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 12/01/2022]
Abstract
Background Once‐daily topical oxymetazoline cream 1·0% significantly reduced persistent facial erythema of rosacea in trials requiring live, static patient assessments. Objectives To evaluate critically the methodology of clinical trials that require live, static patient assessments by determining whether assessment of erythema is different when reference to the baseline photograph is allowed. Methods In two identically designed, randomized, phase III trials, adults with persistent facial erythema of rosacea applied oxymetazoline or vehicle once daily. This phase IV study evaluated standardized digital facial photographs from the phase III trials to record ≥ 1‐grade Clinician Erythema Assessment (CEA) improvement at 1, 3, 6, 9 and 12 h postdose. Results Among 835 patients (oxymetazoline n = 415, vehicle n = 420), significantly greater proportions of patients treated with oxymetazoline vs. vehicle achieved ≥ 1‐grade CEA improvement. For the comparison between phase IV study results and the original phase III analysis, when reference to baseline photographs was allowed while evaluating post‐treatment photographs, the results for oxymetazoline were similar to results of the phase III trials (up to 85.7%), but a significantly lower proportion of vehicle recipients achieved ≥ 1‐grade CEA improvement (up to 29.7% [phase 4] vs. 52.3% [phase 3]; P<0.001). In the phase IV study, up to 80·2% of patients treated with oxymetazoline achieved at least moderate erythema improvement vs. up to 22·9% of patients treated with vehicle. The association between patients’ satisfaction with facial skin redness and percentage of erythema improvement was statistically significant. Conclusions Assessment of study photographs, with comparison to baseline, confirmed significant erythema reduction with oxymetazoline on the first day of application. Compared with the phase III trial results, significantly fewer vehicle recipients attained ≥ 1‐grade CEA improvement, suggesting a mitigated vehicle effect. This methodology may improve the accuracy of clinical trials evaluating erythema severity. What's already known about this topic? Phase III studies that evaluate the effects of medications on persistent facial erythema associated with rosacea require investigator assessments without allowing comparison with baseline images.
What does this study add? Grading of facial erythema of rosacea that utilized baseline photographs compared with post‐treatment photographs enhanced the accuracy of persistent facial erythema assessments. Furthermore, this method more accurately differentiated active treatment with oxymetazoline cream 1·0% from vehicle compared with live, static assessments. Methodology that allows for comparison to baseline photographs may improve the accuracy of clinical trials that evaluate erythema severity.
Linked Comment: https://doi.org/10.1111/bjd.17725. https://www.bjdonline.com/article/
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Affiliation(s)
- L F Eichenfield
- University of California, San Diego, CA, U.S.A.,Rady Children's Hospital, San Diego, CA, U.S.A
| | - J Q Del Rosso
- JDR Dermatology Research/Thomas Dermatology, Las Vegas, NV, U.S.A
| | - J K L Tan
- Windsor Clinical Research Inc., Windsor, ON, Canada
| | - A A Hebert
- UTHealth McGovern Medical School, Department of Dermatology, Houston, TX, U.S.A
| | - G F Webster
- Webster Dermatology, P.A., Hockessin, DE, U.S.A
| | - J Harper
- Dermatology and Skin Care Center of Birmingham, Birmingham, AL, U.S.A
| | - H E Baldwin
- The Acne Treatment and Research Center, Morristown, NJ, U.S.A
| | - L H Kircik
- DermResearch, PLLC, Louisville, KY, U.S.A.,Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - L Stein-Gold
- Henry Ford Health System, West Bloomfield, MI, U.S.A
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Harper JC, Stein Gold LF, Alexis AF, Tan JKL. Treating Acne in Adult Women. ACTA ACUST UNITED AC 2018; 37:S67-S70. [PMID: 30192345 DOI: 10.12788/j.sder.2018.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 11/20/2022]
Abstract
Acne can persist into adulthood or erupt de novo at any point after adolescence. Adult acne is more common in women than in men. Considerations for treating acne in adult women include childbearing potential, pregnancy, lactation, and concomitant skin conditions. Semin Cutan Med Surg 37(supp3):S67-S70 © 2018 published by Frontline Medical Communications.
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Affiliation(s)
- Julie C Harper
- Clinical Associate Professor of Dermatology University of Alabama at Birmingham Dermatology and Skin Care Center of Birmingham Birmingham, Alabama
| | - Linda F Stein Gold
- Director of Dermatology Clinical Research Division Head of Dermatology Henry Ford Hospital Detroit, Michigan
| | - Andrew F Alexis
- Chair, Department of Dermatology Director of The Skin of Color Center Mount Sinai St. Luke's and Mount Sinai West Associate Professor of Dermatology Icahn School of Medicine at Mount Sinai New York, New York
| | - Jerry K L Tan
- Adjunct Professor Schulich School of Medicine and Dentistry Western University Windsor, Ontario, Canada
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13
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Affiliation(s)
- Jerry K L Tan
- Dermatologist, Faculty of Medicine, Western University, London, Ont
| | - Neil Shear
- Professor, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ont
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Tan JKL, Vasey K, Fung KY. Attitudes of Female Patients regarding Oral Contraceptives for Treatment of Acne. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Two hormonal agents with contraceptive properties are currently indicated in Canada for treatment of acne. Objective: The purpose of this study was to determine the attitudes and concerns of female patients regarding the use of hormonal agents and oral contraceptives in treatment of acne. Methods: A self-completed questionnaire was administered to all female acne patients of a community-based dermatologist over a 10-week period between June and August 1999. Statistical analysis was performed by chi-square testing at the 5% significance level. Results: Eighty-six percent recognized that oral contraceptives (“birth control pills”) were also used as a treatment for acne and 60% were willing to use this form of treatment. The most common concern regarding the use of oral contraceptives were side effects (80%). Younger patients were seven times more likely to be concerned about potential disapproval or misunderstanding on the part of others regarding the use of these medications ( p ∼ 0.01). Conclusion: Female acne patients recognize that oral contraceptives are useful in treatment of acne. Although side effects of these medications are of general concern, social disapproval is of particular concern to younger patients.
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Affiliation(s)
- Jerry K. L. Tan
- Dermatology and Consulting Staff, Windsor Regional Hospital, Windsor, Ontario, Canada
| | | | - Karen Y. Fung
- Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada
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Abstract
Background: There is a paucity of data on the reliability of dermatologists in acne lesion counting and global severity assessments. The effects of training and practice on reliability are also uncertain. The objective of this study was to determine the reliability of these outcome measurements when performed by trained dermatologists. Methods: Eleven dermatologists were divided into two groups that evaluated the same six acne subjects twice on the same day. A training session was provided either after (group A) or before (group B) the first patient evaluation sessions. Reliability of raters in lesion counting and global severity assessment was determined by calculation of intraclass correlation coefficients (ICCs). ICC values close to 1.0 indicate excellent reliability, whereas values less than 0.75 are considered unacceptable. Results: Intrarater ICCs ranged from 0.37 to 0.99 for noninflammatory lesions, 0.26 to 0.97 for inflammatory lesions, and 0.56 to 0.83 for global assessments for group A (trained after); corresponding values for group B (trained before) were 0.84 to 0.98, 0.61 to 0.95, and 0.43 to 0.91. ICC values ≥ 0.75 for all three outcome parameters were observed in one of six group A and three of five group B raters. Interrater ICCs for groups A and B after the first evaluation session were 0.17 versus 0.68 for noninflammatory counts, 0.84 versus 0.72 for inflammatory counts, and 0.71 versus 0.65 for global assessments, respectively. Corresponding values after session 2 were 0.79 and 0.77 for noninflammatory, 0.81 and 0.90 for inflammatory, and 0.61 and 0.77 for global assessments. Conclusion: Dermatologists tended to be reliable in acne lesion counting but somewhat less so in global assessments. Training tended to improve group reliability in noninflammatory lesion counts and increased the proportion of raters with good reliability in all three outcome measures. Practice enhanced reliability in all outcome measurements.
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Abstract
Acne is estimated to affect 9.4% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, with boys most frequently affected, particularly with more severe forms of the disease. This paper aims to provide an update on the epidemiology of acne worldwide. Recent general and institutional studies from around the world have shown that the prevalence of acne is broadly consistent globally (with the exception of specific populations, which are discussed). However, this review highlights that there is a wide range of disparate outcome measures being applied in epidemiology studies, and we emphasize the need to develop a widely accepted, credible, standard assessment scale to address this in the future. In addition we discuss special populations, such as those devoid of acne, as well as the impact of potential determinants of acne on disease epidemiology.
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Affiliation(s)
- J K L Tan
- Windsor Clinical Research Inc. and Western University, London, ON, Canada
| | - K Bhate
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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Tan JKL, Wolfe BJ, Bulatovic R, Jones EB, Lo AY. Critical appraisal of quality of clinical practice guidelines for treatment of psoriasis vulgaris, 2006-2009. J Invest Dermatol 2010; 130:2389-95. [PMID: 20555354 DOI: 10.1038/jid.2010.164] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Numerous international clinical guidelines for management of psoriasis have recently been published. We evaluated the quality of guidelines published between 2006 and December 2009 using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Eight guidelines from five separate working groups fulfilled inclusion criteria and were evaluated. Four used the standards established by the AGREE instrument in the process of development of their guidelines. Each of the guidelines uniformly received high domain scores (i.e., > 90%) for scope and purpose (range of 94-100%), and clarity and presentation (range of 92-100%). Nevertheless, each of the eight guidelines had important shortcomings (item scores < or = 2/4, in which 4 indicates strongly agree and 1 indicates strongly disagree that specific items have been adequately addressed) in at least one item including: stakeholder involvement (by lack of piloting and inadequate determination of patient views), development rigor (inadequate procedure for updating), applicability (by lack of discussion on organizational barriers), and editorial independence (from funding body). Despite the use of predefined standards in their development, important deficiencies exist in the most recent clinical treatment guidelines for psoriasis.
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Affiliation(s)
- Jerry K L Tan
- Department of Medicine, University of Western Ontario, London, Ontario, Canada.
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Tan JKL, Tang J. Three-dimensional, Full-sized, Silicone-based, Facial Replicas for Teaching Outcome Measures in Acne. J Clin Aesthet Dermatol 2010; 3:35-38. [PMID: 20725549 PMCID: PMC2921752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The scientific integrity of outcome measurements is dependent upon reproducibility and accuracy. In acne assessments, there is no current gold standard for accuracy in lesion counting and global grading. PURPOSE The purpose of this study was to create facial acne replicas for use in acne training and for evaluation of rater accuracy. METHODS Two full-sized, three-dimensional, silicone-based, facial replicas with predetermined acne lesion type and number were created. Their teaching value was evaluated by dermatologists and clinical coordinators undergoing training in acne evaluations. A questionnaire after the training session addressed realism, preferences, and ease of assessments with the facial replicas compared to live subjects. RESULTS Of 55 potential respondents, 32 questionnaires were completed and analyzable. Of these, 23 were from dermatologists and nine were from clinical research coordinators performing acne assessments. The facial replicas were considered sufficiently realistic for acne lesion counting by 91 percent (29/32) and for global grading by 94 percent (30/32). Of these, 66 percent preferred to have both real subjects and replicas for training (21/32), 31 percent preferred real subjects only (9/32), and one preferred replicas only. Replicas were considered easier to evaluate for noninflammatory and inflammatory lesions (p=0.002 and p=0.013, respectively) and equivalent to live models for global grading (p=0.001). LIMITATIONS Shortcomings include the limited spectrum of acne that could be represented due to production of only two prototypes, the relative paucity of secondary lesions, and production time and cost. CONCLUSION These facial replicas provide a realistic and practical method for teaching and evaluating raters in acne outcome measures as they provide a gold standard for acne lesion counts. Furthermore, their use may obviate some of the shortcomings inherent in recruitment of human acne volunteers for acne training sessions.
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Roberts JL, Ortonne JP, Tan JKL, Jaracz E, Frankel E. The safety profile and sustained remission associated with response to multiple courses of intramuscular alefacept for treatment of chronic plaque psoriasis. J Am Acad Dermatol 2010; 62:968-78. [PMID: 20392521 DOI: 10.1016/j.jaad.2009.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 07/01/2009] [Accepted: 07/18/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Safety and efficacy of up to 3 courses of alefacept intramuscular (IM) in the treatment of chronic plaque psoriasis have been demonstrated in earlier trials. OBJECTIVE We sought to determine the safety and efficacy of up to 5 courses of alefacept IM in treating plaque psoriasis. METHODS A standard treatment course was defined as 15 mg of alefacept IM once weekly for 12 weeks, followed by 12 weeks of treatment-free observation. Patients with chronic plaque psoriasis, who had previously received alefacept IM, received up to 3 additional courses (A, B, and C). Efficacy was evaluated by Physician Global Assessment. RESULTS Safety profiles were similar to those for a single course of treatment. There were no cumulative adverse effects. At 2 weeks postdosing, 16%, 22%, and 19% of patients were rated clear or almost clear by Physician Global Assessment in courses A, B, and C, respectively, with 35%, 42%, and 42% achieving this response at any time during these courses. Patients who achieved clear or almost clear at 2 weeks postdosing remained so for a median duration of 214 and 126 days after courses A and B, respectively. LIMITATIONS This was an extension study and therefore contained no control group. CONCLUSIONS Up to 5 courses of alefacept IM may provide extended treatment-free, symptom-free periods in responders while maintaining the safety profile.
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Affiliation(s)
- Janet L Roberts
- Northwest Dermatology and Research Center, Portland, Oregon, USA.
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Tan JKL. Adapalene 0.1% and benzoyl peroxide 2.5%: a novel combination for treatment of acne vulgaris. Skin Therapy Lett 2009; 14:4-5. [PMID: 19609474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Topical products commonly used to treat acne include retinoids and antimicrobials, due to their effects on different components of pathogenesis. Accordingly, a fixed combination of adapalene 0.1% and benzoyl peroxide (BPO) 2.5% was developed (Epiduo, Galderma) and was approved by the US FDA in December 2008 for the treatment of acne. The superior efficacy of this combination was demonstrated in 2 large randomized controlled trials. This paper reviews the evidence for efficacy and tolerability of the combination of the retinoid adapalene 0.1% and BPO 2.5%, a once-daily gel formulation for the treatment of acne.
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Affiliation(s)
- J K L Tan
- Department of Medicine, University of Western Ontario, London, ON, Canada
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Tan JKL, Tang J, Fung K, Gupta AK, Thomas DR, Sapra S, Lynde C, Poulin Y, Gulliver W, Sebaldt RJ. Prevalence and severity of facial and truncal acne in a referral cohort. J Drugs Dermatol 2008; 7:551-556. [PMID: 18561586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is a paucity of information on the prevalence and severity of acne of the face, chest, and back. PURPOSE This study was designed to examine the prevalence and severity of acne on the face, chest, and back in a referral cohort of patients with acne using a validated global acne severity scale. METHODS Acne patients referred to dermatologists were evaluated at the face, chest, and back. Chi-square testing was performed to assess consistency between patient and physician assessments of each region. The correlation of acne severity between regions was evaluated by Spearman's rank correlation. RESULTS In 965 patients, the prevalence of acne on the face, chest, and back was 92%, 45%, and 61%, respectively. Acne severity was significantly correlated for all regional pairs (P<.001): face and back (r=0.11); face and chest (r=0.12); and chest and back (r=0.67). The consistency of patient reporting and clinical evaluation for the presence of acne varied by region: face=92%, chest=69%, and back=74%. The proportions of patients reporting no occurrence of acne when clinical acne was indeed absent (negative predictive value) were 67% and 65% for the chest and back, respectively. LIMITATIONS The operational threshold for clinical acne (>mild) may underestimate the total proportion of affected patients. These patients were referred to dermatologists for care and may represent a more severe cohort. CONCLUSION Acne affected the face in 92% and the trunk in just over 60% (with the back more frequently and severely affected than the chest). Acne severity was observed to have a much higher correlation between chest and back than face and back or face and chest. Patient-reporting evaluations of absence of acne on the chest and back are frequently erroneous, mandating clinical evaluations of these sites for assessment of overall extent.
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Affiliation(s)
- Jerry K L Tan
- University of Western Ontario, Windsor, Ontario, Canada.
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Tan JKL. New developments in hormonal therapy for acne. Skin Therapy Lett 2007; 12:1-3. [PMID: 17940710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Oral contraceptives (OCs) are a valuable option for the treatment of women with acne. The use of OCs can be considered across the spectrum of acne disease severity in women. In Canada, three preparations are approved for mild-to-moderate acne, and a fourth is indicated for severe acne. These formulations contain estrogen in the form of ethinyl estradiol and a progestin. In Canada, the most recently approved OC is ethinyl estradiol 0.03 mg and drospirenone 3mg (Yasmin, Bayer). With the accumulating evidence on the efficacy and safety of drospirenone-containing hormonal preparations, this formulation provides dermatologists with a new treatment option for acne and other hyperandrogenic disorders.
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Affiliation(s)
- J K L Tan
- Department of Medicine, University of Western Ontario, London, ON, Canada Windsor Clinical Research Inc, Windsor, ON, Canada
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Tan JKL. Psychosocial impact of acne vulgaris: evaluating the evidence. Skin Therapy Lett 2004; 9:1-3, 9. [PMID: 15334275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
This paper reviews current evidence presented by recent studies on the impact of acne on psychosocial health. Study methodologies, including case-control and cross-sectional surveys, have demonstrated psychological abnormalities including depression, suicidal ideation, anxiety, psychosomatic symptoms, including pain and discomfort, embarrassment and social inhibition. Effective treatment of acne was accompanied by improvement in self-esteem, affect, obsessive-compulsiveness, shame, embarrassment, body image, social assertiveness and self-confidence. Acne is associated with a greater psychological burden than a variety of other disparate chronic disorders. Future studies with a longitudinal cohort design may provide further validation of the causal inference between acne and psychosocial disability provided by the current literature.
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Affiliation(s)
- J K L Tan
- Department of Medicine, University of Western Ontario, Acne Research and Treatment Center, Windsor, ON, Canada
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Tan JKL, Girard C, Krol A, Murray HE, Papp KA, Poulin Y, Chin DA, Jeandupeux D. Randomized placebo-controlled trial of metronidazole 1% cream with sunscreen SPF 15 in treatment of rosacea. J Cutan Med Surg 2002; 6:529-34. [PMID: 12001006 DOI: 10.1007/s10227-001-0144-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rosacea is a photoaggravated dermatosis responsive to treatment with topical and oral antibiotics. A formulation combining metronidazole 1% cream with sunscreen SPF 15 was developed for the treatment of rosacea. OBJECTIVE The objective of this study was to determine the safety and efficacy of a formulation combining metronidazole 1% cream with sunscreen SPF 15 in the treatment of moderate to severe rosacea. METHODS One hundred and twenty patients with moderate to severe rosacea were enrolled for a randomized, placebo-controlled (vehicle containing sunscreen with SPF 15), double-blind study. Study cream was applied twice daily to the entire face over a 12-week period. RESULTS Treatment with metronidazole 1% cream with sunscreen SPF 15 resulted in significant improvement (p <0.05) in inflammatory lesion count, erythema and telangiectasiae scores, and investigator and patient global assessment scores compared with baseline and placebo. Adverse reactions related to study medication were typically mild, occurred at the site of application, and were reversible. There was no difference between the safety profiles of metronidazole 1% cream with sunscreen SPF 15 and placebo. CONCLUSIONS The combined topical formulation of metronidazole 1% cream with sunscreen SPF 15 was an effective, well-tolerated topical agent for the treatment of moderate to severe rosacea.
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Tan JKL. Clindoxyl gel for the treatment of acne vulgaris. Skin Therapy Lett 2002; 7:1-2. [PMID: 12223978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Clindoxyl Gel (Stiefel) is a combination of 1% clindamycin phosphate and 5% benzoyl peroxide in a gel vehicle that is well tolerated and more efficacious than either active agent alone or the vehicle in reducing lesion counts and improving global scores in patients with moderate acne. It was approved for once daily use in Canada in November 2001.
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Affiliation(s)
- J K L Tan
- University of Western Ontario, Windsor, Ontario, Canada
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Tan JKL. (11d) Pustular Psoriasis and Hepatotoxicity associated with use of Skin Cap. Dermatol Online J 1997. [DOI: 10.5070/d336091431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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