South Beach Symposium

MIAMI BEACH – Two of the newest treatments available for psoriasis – apremilast and secukinumab – are true “game-changers,” according to Dr. David M. Pariser.

Apremilast (Otezla), a recently approved oral phosphodiesterase 4 inhibitor, will be a particularly attractive treatment option for many dermatologists and patients, he said at the South Beach Symposium.

Apremilast has a very limited effect on the immune system, and it’s an oral therapy and thus requires no needles. It is very safe – with “strikingly few” serious adverse events – and no laboratory monitoring is required, he explained.

Efficacy results with apremilast are modest. In the phase III ESTEEM trial, for example, 33% of patients achieved at least 75% improvement (PASI-75), compared with 5% of patients who received placebo, said Dr. Pariser of Eastern Virginia Medical School, Norfolk, and an investigator for the trial.

Further, the drug can be used for almost any patient and type of psoriasis; it is an option for those who want systemic therapy, but who don’t want to go on a biologic or methotrexate, and its use is not precluded by a history of cancer or infections, as is the case with biologics, he added.

Apremilast also will be attractive for dermatologists who do not currently prescribe systemic therapy for psoriasis, or who don’t use aggressive systemic therapy for psoriasis, he said.

“If a prescriber feels safety is more important than efficacy, this might be a good choice,” he said.

Secukinumab (Cosentyx), on the other hand, is a “big gun,” Dr. Pariser said of the biologic, which was approved in January 2015 for the treatment of adults with moderate to severe plaque psoriasis.

“It’s the biggest gun we’ve got now … and it really has a safety profile similar to existing biologics so far,” he said.

The fully human monoclonal antibody inhibits interleukin-17A and is administered by subcutaneous injection. Its safety and efficacy were demonstrated in numerous of studies involving about 4,500 patients. Treatment was associated with significant improvement, compared with placebo, said Dr. Pariser, who also was an investigator on secukinumab trials.

Of note, while the PASI-75 findings for secukinumab are “a nice number but not dramatically higher than things we have had in the past,” the PASI-90 and PASI-100 scores are remarkable, he said.

At the highest dose studied (300 mg given at weeks 1, 2, 3, 4, and 8, and monthly thereafter), PASI-90 was achieved by 59% of patients in one study, and PASI-100 was achieved in 28%.

“That’s significant. We haven’t had that before, and that is really, really, really nice,” he said.

Further, the primary efficacy endpoint of the study was outcome at 12 weeks, but patients continued to improve at least until 16 weeks.

PASI-100 – no psoriasis whatsoever – was 40% at 16 weeks, he said.

In another phase III trial, secukinumab was again shown to be superior to placebo, but it also compared favorably with etanercept, he noted.

Safety was reasonable in the secukinumab trials. No deaths occurred, but there were more serious adverse events and discontinuations in the active treatment group. Nasopharyngitis was the most common serious adverse events, and it occurred in all groups. Upper respiratory tract infections appeared to be more common in the secukinumab patients, he noted.

An important consideration with secukinumab, however, is the need for continuous treatment, he said.

“The bottom line, really, is that patients should stay on it. They will lose effectiveness if they go off of it or take it on an as-needed basis,” he said.

Dr. Pariser is a consultant and/or researcher for Amgen, AbbVie, Celgene, Eli Lilly, Janssen Pharmaceuticals, Merck, and Pfizer.

MIAMI BEACH – Two of the newest treatments available for psoriasis – apremilast and secukinumab – are true “game-changers,” according to Dr. David M. Pariser.

Apremilast (Otezla), a recently approved oral phosphodiesterase 4 inhibitor, will be a particularly attractive treatment option for many dermatologists and patients, he said at the South Beach Symposium.

Apremilast has a very limited effect on the immune system, and it’s an oral therapy and thus requires no needles. It is very safe – with “strikingly few” serious adverse events – and no laboratory monitoring is required, he explained.

Efficacy results with apremilast are modest. In the phase III ESTEEM trial, for example, 33% of patients achieved at least 75% improvement (PASI-75), compared with 5% of patients who received placebo, said Dr. Pariser of Eastern Virginia Medical School, Norfolk, and an investigator for the trial.

Further, the drug can be used for almost any patient and type of psoriasis; it is an option for those who want systemic therapy, but who don’t want to go on a biologic or methotrexate, and its use is not precluded by a history of cancer or infections, as is the case with biologics, he added.

Apremilast also will be attractive for dermatologists who do not currently prescribe systemic therapy for psoriasis, or who don’t use aggressive systemic therapy for psoriasis, he said.

“If a prescriber feels safety is more important than efficacy, this might be a good choice,” he said.

Secukinumab (Cosentyx), on the other hand, is a “big gun,” Dr. Pariser said of the biologic, which was approved in January 2015 for the treatment of adults with moderate to severe plaque psoriasis.

“It’s the biggest gun we’ve got now … and it really has a safety profile similar to existing biologics so far,” he said.

The fully human monoclonal antibody inhibits interleukin-17A and is administered by subcutaneous injection. Its safety and efficacy were demonstrated in numerous of studies involving about 4,500 patients. Treatment was associated with significant improvement, compared with placebo, said Dr. Pariser, who also was an investigator on secukinumab trials.

Of note, while the PASI-75 findings for secukinumab are “a nice number but not dramatically higher than things we have had in the past,” the PASI-90 and PASI-100 scores are remarkable, he said.

At the highest dose studied (300 mg given at weeks 1, 2, 3, 4, and 8, and monthly thereafter), PASI-90 was achieved by 59% of patients in one study, and PASI-100 was achieved in 28%.

“That’s significant. We haven’t had that before, and that is really, really, really nice,” he said.

Further, the primary efficacy endpoint of the study was outcome at 12 weeks, but patients continued to improve at least until 16 weeks.

PASI-100 – no psoriasis whatsoever – was 40% at 16 weeks, he said.

In another phase III trial, secukinumab was again shown to be superior to placebo, but it also compared favorably with etanercept, he noted.

Safety was reasonable in the secukinumab trials. No deaths occurred, but there were more serious adverse events and discontinuations in the active treatment group. Nasopharyngitis was the most common serious adverse events, and it occurred in all groups. Upper respiratory tract infections appeared to be more common in the secukinumab patients, he noted.

An important consideration with secukinumab, however, is the need for continuous treatment, he said.

“The bottom line, really, is that patients should stay on it. They will lose effectiveness if they go off of it or take it on an as-needed basis,” he said.

Dr. Pariser is a consultant and/or researcher for Amgen, AbbVie, Celgene, Eli Lilly, Janssen Pharmaceuticals, Merck, and Pfizer.

MIAMI BEACH – Two of the newest treatments available for psoriasis – apremilast and secukinumab – are true “game-changers,” according to Dr. David M. Pariser.

Apremilast (Otezla), a recently approved oral phosphodiesterase 4 inhibitor, will be a particularly attractive treatment option for many dermatologists and patients, he said at the South Beach Symposium.

Apremilast has a very limited effect on the immune system, and it’s an oral therapy and thus requires no needles. It is very safe – with “strikingly few” serious adverse events – and no laboratory monitoring is required, he explained.

Efficacy results with apremilast are modest. In the phase III ESTEEM trial, for example, 33% of patients achieved at least 75% improvement (PASI-75), compared with 5% of patients who received placebo, said Dr. Pariser of Eastern Virginia Medical School, Norfolk, and an investigator for the trial.

Further, the drug can be used for almost any patient and type of psoriasis; it is an option for those who want systemic therapy, but who don’t want to go on a biologic or methotrexate, and its use is not precluded by a history of cancer or infections, as is the case with biologics, he added.

Apremilast also will be attractive for dermatologists who do not currently prescribe systemic therapy for psoriasis, or who don’t use aggressive systemic therapy for psoriasis, he said.

“If a prescriber feels safety is more important than efficacy, this might be a good choice,” he said.

Secukinumab (Cosentyx), on the other hand, is a “big gun,” Dr. Pariser said of the biologic, which was approved in January 2015 for the treatment of adults with moderate to severe plaque psoriasis.

“It’s the biggest gun we’ve got now … and it really has a safety profile similar to existing biologics so far,” he said.

The fully human monoclonal antibody inhibits interleukin-17A and is administered by subcutaneous injection. Its safety and efficacy were demonstrated in numerous of studies involving about 4,500 patients. Treatment was associated with significant improvement, compared with placebo, said Dr. Pariser, who also was an investigator on secukinumab trials.

Of note, while the PASI-75 findings for secukinumab are “a nice number but not dramatically higher than things we have had in the past,” the PASI-90 and PASI-100 scores are remarkable, he said.

At the highest dose studied (300 mg given at weeks 1, 2, 3, 4, and 8, and monthly thereafter), PASI-90 was achieved by 59% of patients in one study, and PASI-100 was achieved in 28%.

“That’s significant. We haven’t had that before, and that is really, really, really nice,” he said.

Further, the primary efficacy endpoint of the study was outcome at 12 weeks, but patients continued to improve at least until 16 weeks.

PASI-100 – no psoriasis whatsoever – was 40% at 16 weeks, he said.

In another phase III trial, secukinumab was again shown to be superior to placebo, but it also compared favorably with etanercept, he noted.

Safety was reasonable in the secukinumab trials. No deaths occurred, but there were more serious adverse events and discontinuations in the active treatment group. Nasopharyngitis was the most common serious adverse events, and it occurred in all groups. Upper respiratory tract infections appeared to be more common in the secukinumab patients, he noted.

An important consideration with secukinumab, however, is the need for continuous treatment, he said.

“The bottom line, really, is that patients should stay on it. They will lose effectiveness if they go off of it or take it on an as-needed basis,” he said.

Dr. Pariser is a consultant and/or researcher for Amgen, AbbVie, Celgene, Eli Lilly, Janssen Pharmaceuticals, Merck, and Pfizer.

MIAMI BEACH – The value of specific instructions for general skin care in acne patients is often underestimated, but clear guidance can improve outcomes, according to Dr. James Q. Del Rosso.

“Skin care is very important. It sounds trivial, but it is extremely important to tell patients exactly what they should be using as far as skin care,” he said at the South Beach Symposium.

Courtesy Wikimedia Commons/Kinan Ayu/Creative Commons license

Using the wrong products can reduce the efficacy of acne treatment, he said. Patients may use products that damage the stratum corneum and cause excess water loss, thereby increasing the likelihood of irritation. This sets their skin up for additional irritation or sensitization from prescribed topical medications, he explained.

“If you controlled the skin care, you wouldn’t have that problem at all,” said Dr. Del Rosso of Touro University in Henderson, Nev.

Additionally, patients may be engaging in procedures at home, such as microdermabrasion, that can increase transepidermal water loss and promote inflammation as part of the skin’s self-repair mechanism, he noted.

Such inflammation can increase skin sensitivity to medications.

“So controlling the skin care has a lot to do with what the therapeutic outcome will be,” he said.

Dr. Del Russo and colleagues found that a specific regimen consisting of a foam moisturizer and an SPF 30 moisturizer formulated with a lower dose of sunscreen (DermaControl) to reduce the potential for irritation was safe, effective, and well liked by patients when used in conjunction with daily application of a topical gel containing adapalene 1% and benzoyl peroxide 2.5% (Epiduo). Their findings appeared earlier this year (J. Clin. Aesthet. Dermatol. 2015; 8:22-30).

Further, a review of the types of patients included in the original pivotal trials for Epiduo and those in Dr. Del Rosso’s study suggests that use of the DermaControl skin care regimen lessened skin irritation caused by the prescription treatment. The same types of patients were included in both studies, and the same treatment regimen was used, he said.

Additional studies comparing various treatments used with and without specific skin care regimens are needed, and are likely in the future, he said.

Dr. Del Rosso has served as a consultant, researcher, and/or speaker for multiple companies including Allergan, Anacor Pharmaceuticals, Aqua Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Celgene, Dermira, Ferndale Pharmaceuticals, Galderma, Genentech, Innocutis, LEO Pharmaceuticals, Promius Pharma, PuraCap Pharmaceutical, Quinnova Pharmaceuticals, Ranbaxy Pharmaceuticals, Sebacia, Suneva Medical, Taro Pharmaceutical Industries, Unilever, and Valeant. His spouse is employed by Novartis.

MIAMI BEACH – The value of specific instructions for general skin care in acne patients is often underestimated, but clear guidance can improve outcomes, according to Dr. James Q. Del Rosso.

“Skin care is very important. It sounds trivial, but it is extremely important to tell patients exactly what they should be using as far as skin care,” he said at the South Beach Symposium.

Courtesy Wikimedia Commons/Kinan Ayu/Creative Commons license

Using the wrong products can reduce the efficacy of acne treatment, he said. Patients may use products that damage the stratum corneum and cause excess water loss, thereby increasing the likelihood of irritation. This sets their skin up for additional irritation or sensitization from prescribed topical medications, he explained.

“If you controlled the skin care, you wouldn’t have that problem at all,” said Dr. Del Rosso of Touro University in Henderson, Nev.

Additionally, patients may be engaging in procedures at home, such as microdermabrasion, that can increase transepidermal water loss and promote inflammation as part of the skin’s self-repair mechanism, he noted.

Such inflammation can increase skin sensitivity to medications.

“So controlling the skin care has a lot to do with what the therapeutic outcome will be,” he said.

Dr. Del Russo and colleagues found that a specific regimen consisting of a foam moisturizer and an SPF 30 moisturizer formulated with a lower dose of sunscreen (DermaControl) to reduce the potential for irritation was safe, effective, and well liked by patients when used in conjunction with daily application of a topical gel containing adapalene 1% and benzoyl peroxide 2.5% (Epiduo). Their findings appeared earlier this year (J. Clin. Aesthet. Dermatol. 2015; 8:22-30).

Further, a review of the types of patients included in the original pivotal trials for Epiduo and those in Dr. Del Rosso’s study suggests that use of the DermaControl skin care regimen lessened skin irritation caused by the prescription treatment. The same types of patients were included in both studies, and the same treatment regimen was used, he said.

Additional studies comparing various treatments used with and without specific skin care regimens are needed, and are likely in the future, he said.

Dr. Del Rosso has served as a consultant, researcher, and/or speaker for multiple companies including Allergan, Anacor Pharmaceuticals, Aqua Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Celgene, Dermira, Ferndale Pharmaceuticals, Galderma, Genentech, Innocutis, LEO Pharmaceuticals, Promius Pharma, PuraCap Pharmaceutical, Quinnova Pharmaceuticals, Ranbaxy Pharmaceuticals, Sebacia, Suneva Medical, Taro Pharmaceutical Industries, Unilever, and Valeant. His spouse is employed by Novartis.

MIAMI BEACH – The value of specific instructions for general skin care in acne patients is often underestimated, but clear guidance can improve outcomes, according to Dr. James Q. Del Rosso.

“Skin care is very important. It sounds trivial, but it is extremely important to tell patients exactly what they should be using as far as skin care,” he said at the South Beach Symposium.

Courtesy Wikimedia Commons/Kinan Ayu/Creative Commons license

Using the wrong products can reduce the efficacy of acne treatment, he said. Patients may use products that damage the stratum corneum and cause excess water loss, thereby increasing the likelihood of irritation. This sets their skin up for additional irritation or sensitization from prescribed topical medications, he explained.

“If you controlled the skin care, you wouldn’t have that problem at all,” said Dr. Del Rosso of Touro University in Henderson, Nev.

Additionally, patients may be engaging in procedures at home, such as microdermabrasion, that can increase transepidermal water loss and promote inflammation as part of the skin’s self-repair mechanism, he noted.

Such inflammation can increase skin sensitivity to medications.

“So controlling the skin care has a lot to do with what the therapeutic outcome will be,” he said.

Dr. Del Russo and colleagues found that a specific regimen consisting of a foam moisturizer and an SPF 30 moisturizer formulated with a lower dose of sunscreen (DermaControl) to reduce the potential for irritation was safe, effective, and well liked by patients when used in conjunction with daily application of a topical gel containing adapalene 1% and benzoyl peroxide 2.5% (Epiduo). Their findings appeared earlier this year (J. Clin. Aesthet. Dermatol. 2015; 8:22-30).

Further, a review of the types of patients included in the original pivotal trials for Epiduo and those in Dr. Del Rosso’s study suggests that use of the DermaControl skin care regimen lessened skin irritation caused by the prescription treatment. The same types of patients were included in both studies, and the same treatment regimen was used, he said.

Additional studies comparing various treatments used with and without specific skin care regimens are needed, and are likely in the future, he said.

Dr. Del Rosso has served as a consultant, researcher, and/or speaker for multiple companies including Allergan, Anacor Pharmaceuticals, Aqua Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Celgene, Dermira, Ferndale Pharmaceuticals, Galderma, Genentech, Innocutis, LEO Pharmaceuticals, Promius Pharma, PuraCap Pharmaceutical, Quinnova Pharmaceuticals, Ranbaxy Pharmaceuticals, Sebacia, Suneva Medical, Taro Pharmaceutical Industries, Unilever, and Valeant. His spouse is employed by Novartis.

MIAMI BEACH – A fixed-dose adapalene/benzoyl peroxide gel is a suitable treatment for acne in adult women, according to a meta-analysis of data from three randomized, vehicle-controlled multicenter studies.

The median percent change in total lesions at 12 weeks in 130 women who were treated with the 0.1% adapalene/2.5% benzoyl peroxide gel (A-BPO) was –71%, compared with –45% in 124 treated with vehicle gel, Dr. Linda Stein Gold of Henry Ford Medical Center, Detroit, reported in a poster at the annual South Beach Symposium.

Similarly, the median percent change in inflammatory lesions was –73% vs. –41%, and the median percent change in noninflammatory lesions was –70% vs. –45% in the groups, respectively.

Response to the A-BPO treatment was rapid, with significant improvements seen at 1 week, compared with vehicle. Treatment was also well tolerated; adverse events occurring in at least 3% of those in the A-BPO treatment group were dry skin, contact dermatitis, and application site irritation, but all were mild, Dr. Gold noted.

Study participants were women aged 25 years and older. Data increasingly demonstrate that the prevalence of acne in women in this age group is increasing, with up to 54% of women affected, she said.

“Furthermore, recent data show that the mandibular form of acne traditionally associated with adult women is less prevalent than previously thought and that most acne in adult women more closely resembles adolescent acne,” she wrote.

Treatment with benzoyl peroxide in combination with a retinoid has been recommended as a first-line treatment for women with acne, and the fixed-dose A-BPO combination used in this study has been shown to be safe in patients as young as age 9 years.

The findings of this meta-analysis suggest that it is also effective and safe – with quick onset of action – in adult women, she concluded.

This study was funded by Galderma Research and Development and Galderma Laboratories.

MIAMI BEACH – A fixed-dose adapalene/benzoyl peroxide gel is a suitable treatment for acne in adult women, according to a meta-analysis of data from three randomized, vehicle-controlled multicenter studies.

The median percent change in total lesions at 12 weeks in 130 women who were treated with the 0.1% adapalene/2.5% benzoyl peroxide gel (A-BPO) was –71%, compared with –45% in 124 treated with vehicle gel, Dr. Linda Stein Gold of Henry Ford Medical Center, Detroit, reported in a poster at the annual South Beach Symposium.

Similarly, the median percent change in inflammatory lesions was –73% vs. –41%, and the median percent change in noninflammatory lesions was –70% vs. –45% in the groups, respectively.

Response to the A-BPO treatment was rapid, with significant improvements seen at 1 week, compared with vehicle. Treatment was also well tolerated; adverse events occurring in at least 3% of those in the A-BPO treatment group were dry skin, contact dermatitis, and application site irritation, but all were mild, Dr. Gold noted.

Study participants were women aged 25 years and older. Data increasingly demonstrate that the prevalence of acne in women in this age group is increasing, with up to 54% of women affected, she said.

“Furthermore, recent data show that the mandibular form of acne traditionally associated with adult women is less prevalent than previously thought and that most acne in adult women more closely resembles adolescent acne,” she wrote.

Treatment with benzoyl peroxide in combination with a retinoid has been recommended as a first-line treatment for women with acne, and the fixed-dose A-BPO combination used in this study has been shown to be safe in patients as young as age 9 years.

The findings of this meta-analysis suggest that it is also effective and safe – with quick onset of action – in adult women, she concluded.

This study was funded by Galderma Research and Development and Galderma Laboratories.

MIAMI BEACH – A fixed-dose adapalene/benzoyl peroxide gel is a suitable treatment for acne in adult women, according to a meta-analysis of data from three randomized, vehicle-controlled multicenter studies.

The median percent change in total lesions at 12 weeks in 130 women who were treated with the 0.1% adapalene/2.5% benzoyl peroxide gel (A-BPO) was –71%, compared with –45% in 124 treated with vehicle gel, Dr. Linda Stein Gold of Henry Ford Medical Center, Detroit, reported in a poster at the annual South Beach Symposium.

Similarly, the median percent change in inflammatory lesions was –73% vs. –41%, and the median percent change in noninflammatory lesions was –70% vs. –45% in the groups, respectively.

Response to the A-BPO treatment was rapid, with significant improvements seen at 1 week, compared with vehicle. Treatment was also well tolerated; adverse events occurring in at least 3% of those in the A-BPO treatment group were dry skin, contact dermatitis, and application site irritation, but all were mild, Dr. Gold noted.

Study participants were women aged 25 years and older. Data increasingly demonstrate that the prevalence of acne in women in this age group is increasing, with up to 54% of women affected, she said.

“Furthermore, recent data show that the mandibular form of acne traditionally associated with adult women is less prevalent than previously thought and that most acne in adult women more closely resembles adolescent acne,” she wrote.

Treatment with benzoyl peroxide in combination with a retinoid has been recommended as a first-line treatment for women with acne, and the fixed-dose A-BPO combination used in this study has been shown to be safe in patients as young as age 9 years.

The findings of this meta-analysis suggest that it is also effective and safe – with quick onset of action – in adult women, she concluded.

This study was funded by Galderma Research and Development and Galderma Laboratories.

MIAMI BEACH – A fixed-dose adapalene/benzoyl peroxide gel is a suitable treatment for acne in adult women, according to a meta-analysis of data from three randomized, vehicle-controlled multicenter studies.

The median percent change in total lesions at 12 weeks in 130 women who were treated with the 0.1% adapalene/2.5% benzoyl peroxide gel (A-BPO) was –71%, compared with –45% in 124 treated with vehicle gel, Dr. Linda Stein Gold of Henry Ford Medical Center, Detroit, reported in a poster at the annual South Beach Symposium.

Similarly, the median percent change in inflammatory lesions was –73% vs. –41%, and the median percent change in noninflammatory lesions was –70% vs. –45% in the groups, respectively.

Response to the A-BPO treatment was rapid, with significant improvements seen at 1 week, compared with vehicle. Treatment was also well tolerated; adverse events occurring in at least 3% of those in the A-BPO treatment group were dry skin, contact dermatitis, and application site irritation, but all were mild, Dr. Gold noted.

Study participants were women aged 25 years and older. Data increasingly demonstrate that the prevalence of acne in women in this age group is increasing, with up to 54% of women affected, she said.

“Furthermore, recent data show that the mandibular form of acne traditionally associated with adult women is less prevalent than previously thought and that most acne in adult women more closely resembles adolescent acne,” she wrote.

Treatment with benzoyl peroxide in combination with a retinoid has been recommended as a first-line treatment for women with acne, and the fixed-dose A-BPO combination used in this study has been shown to be safe in patients as young as age 9 years.

The findings of this meta-analysis suggest that it is also effective and safe – with quick onset of action – in adult women, she concluded.

This study was funded by Galderma Research and Development and Galderma Laboratories.

MIAMI BEACH – A fixed-dose adapalene/benzoyl peroxide gel is a suitable treatment for acne in adult women, according to a meta-analysis of data from three randomized, vehicle-controlled multicenter studies.

The median percent change in total lesions at 12 weeks in 130 women who were treated with the 0.1% adapalene/2.5% benzoyl peroxide gel (A-BPO) was –71%, compared with –45% in 124 treated with vehicle gel, Dr. Linda Stein Gold of Henry Ford Medical Center, Detroit, reported in a poster at the annual South Beach Symposium.

Similarly, the median percent change in inflammatory lesions was –73% vs. –41%, and the median percent change in noninflammatory lesions was –70% vs. –45% in the groups, respectively.

Response to the A-BPO treatment was rapid, with significant improvements seen at 1 week, compared with vehicle. Treatment was also well tolerated; adverse events occurring in at least 3% of those in the A-BPO treatment group were dry skin, contact dermatitis, and application site irritation, but all were mild, Dr. Gold noted.

Study participants were women aged 25 years and older. Data increasingly demonstrate that the prevalence of acne in women in this age group is increasing, with up to 54% of women affected, she said.

“Furthermore, recent data show that the mandibular form of acne traditionally associated with adult women is less prevalent than previously thought and that most acne in adult women more closely resembles adolescent acne,” she wrote.

Treatment with benzoyl peroxide in combination with a retinoid has been recommended as a first-line treatment for women with acne, and the fixed-dose A-BPO combination used in this study has been shown to be safe in patients as young as age 9 years.

The findings of this meta-analysis suggest that it is also effective and safe – with quick onset of action – in adult women, she concluded.

This study was funded by Galderma Research and Development and Galderma Laboratories.

MIAMI BEACH – A fixed-dose adapalene/benzoyl peroxide gel is a suitable treatment for acne in adult women, according to a meta-analysis of data from three randomized, vehicle-controlled multicenter studies.

The median percent change in total lesions at 12 weeks in 130 women who were treated with the 0.1% adapalene/2.5% benzoyl peroxide gel (A-BPO) was –71%, compared with –45% in 124 treated with vehicle gel, Dr. Linda Stein Gold of Henry Ford Medical Center, Detroit, reported in a poster at the annual South Beach Symposium.

Similarly, the median percent change in inflammatory lesions was –73% vs. –41%, and the median percent change in noninflammatory lesions was –70% vs. –45% in the groups, respectively.

Response to the A-BPO treatment was rapid, with significant improvements seen at 1 week, compared with vehicle. Treatment was also well tolerated; adverse events occurring in at least 3% of those in the A-BPO treatment group were dry skin, contact dermatitis, and application site irritation, but all were mild, Dr. Gold noted.

Study participants were women aged 25 years and older. Data increasingly demonstrate that the prevalence of acne in women in this age group is increasing, with up to 54% of women affected, she said.

“Furthermore, recent data show that the mandibular form of acne traditionally associated with adult women is less prevalent than previously thought and that most acne in adult women more closely resembles adolescent acne,” she wrote.

Treatment with benzoyl peroxide in combination with a retinoid has been recommended as a first-line treatment for women with acne, and the fixed-dose A-BPO combination used in this study has been shown to be safe in patients as young as age 9 years.

The findings of this meta-analysis suggest that it is also effective and safe – with quick onset of action – in adult women, she concluded.

This study was funded by Galderma Research and Development and Galderma Laboratories.

MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.

“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.

The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.

Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.

Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.

In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).

The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.

“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.

Dr. Rosen reported having no relevant financial disclosures.

MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.

“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.

The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.

Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.

Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.

In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).

The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.

“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.

Dr. Rosen reported having no relevant financial disclosures.

MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.

“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.

The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.

Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.

Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.

In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).

The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.

“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.

Dr. Rosen reported having no relevant financial disclosures.

MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.

“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.

The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.

Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.

Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.

In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).

The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.

“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.

Dr. Rosen reported having no relevant financial disclosures.

MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.

“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.

The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.

Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.

Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.

In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).

The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.

“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.

Dr. Rosen reported having no relevant financial disclosures.

MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.

“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.

The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.

Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.

Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.

In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).

The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.

“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.

Dr. Rosen reported having no relevant financial disclosures.

MIAMI BEACH – Acne on the face and trunk in adolescents could be associated with the use of whey protein supplements, according to Dr. Jonette E. Keri.

Teenage boys, especially, may use whey protein supplements in an effort to increase muscle mass or gain weight, Dr. Keri of the University of Miami said at the South Beach Symposium.

She cited a 2012 case series of five male teenage athletes aged 14-18 years who were using whey protein shakes or reconstituted powder. The teens presented with moderate to severe acne that responded poorly to standard treatment, but four of the five experienced clearing of the acne upon discontinuation of the whey protein supplement.

All five had been treated unsuccessfully with traditional therapies, including oral antibiotics, topical retinoids, and benzoyl peroxide. One teen stopped using the whey protein immediately after being counseled to do so, and he experienced improvement. Two teens didn’t stop using whey protein immediately but experienced improvement in their acne when they did discontinue it. Another teen experienced clearing after discontinuing the whey protein during a second course of isotretinoin therapy, and the fifth was lost to follow-up (Cutis 2012;90:70-2).

One of the teens who cleared after discontinuing the whey protein experienced a flare of the acne when he reinitiated supplementation, Dr. Keri said.

Three of the boys were trying to build muscle for football and two were trying to gain weight, which underscores the importance of asking teens about supplement use, she noted, adding that, importantly, it’s not just boys who are affected.

Continue for another study >>

In fact, a Brazilian study of 30 patients showed a very strong association between the onset or exacerbation of acne and initiation of whey protein use – and the finding was more pronounced among women than men, and among those without a personal or family history of acne (An. Bras. Dermatol. 2013;88:907-12).

In that study, subjects were examined on three occasions and followed for 60 days.

“They went the gym, wanted to work out a little bit and get bigger, took some whey, and broke out in acne,” Dr. Keri said.

Although acne breakouts won’t happen to everyone who uses whey protein, it’s something worth considering in teens, particularly if they fail to respond to standard therapies, she said.

Although the reason for the association hasn’t yet been “teased out,” whey protein is derived from cow’s milk, and it appears to be related to activation of the insulin cascade, explained Dr. Keri.

Dr. Nanette B. Silverberg of the Mount Sinai Health System, New York, author of the case series involving the five male athletes, noted that milk is known to be associated with acne and suggested that whey protein may be the fraction of dairy products that promote acne formation.

Similarly, based on findings from a study of five adult male bodybuilders who developed moderate to severe facial or truncal acne after consuming whey protein, Dr. Thierry Simonart of Brussels noted that the observations are “in line with biochemical and epidemiological data supporting the effects of milk and dairy products as enhancers of insulin/insulin-like growth factor 1 signaling and acne aggravation” (Dermatology 2012;225:256-8).

Dr. Kerri reported having no relevant disclosures.

MIAMI BEACH – Acne on the face and trunk in adolescents could be associated with the use of whey protein supplements, according to Dr. Jonette E. Keri.

Teenage boys, especially, may use whey protein supplements in an effort to increase muscle mass or gain weight, Dr. Keri of the University of Miami said at the South Beach Symposium.

She cited a 2012 case series of five male teenage athletes aged 14-18 years who were using whey protein shakes or reconstituted powder. The teens presented with moderate to severe acne that responded poorly to standard treatment, but four of the five experienced clearing of the acne upon discontinuation of the whey protein supplement.

All five had been treated unsuccessfully with traditional therapies, including oral antibiotics, topical retinoids, and benzoyl peroxide. One teen stopped using the whey protein immediately after being counseled to do so, and he experienced improvement. Two teens didn’t stop using whey protein immediately but experienced improvement in their acne when they did discontinue it. Another teen experienced clearing after discontinuing the whey protein during a second course of isotretinoin therapy, and the fifth was lost to follow-up (Cutis 2012;90:70-2).

One of the teens who cleared after discontinuing the whey protein experienced a flare of the acne when he reinitiated supplementation, Dr. Keri said.

Three of the boys were trying to build muscle for football and two were trying to gain weight, which underscores the importance of asking teens about supplement use, she noted, adding that, importantly, it’s not just boys who are affected.

Continue for another study >>

In fact, a Brazilian study of 30 patients showed a very strong association between the onset or exacerbation of acne and initiation of whey protein use – and the finding was more pronounced among women than men, and among those without a personal or family history of acne (An. Bras. Dermatol. 2013;88:907-12).

In that study, subjects were examined on three occasions and followed for 60 days.

“They went the gym, wanted to work out a little bit and get bigger, took some whey, and broke out in acne,” Dr. Keri said.

Although acne breakouts won’t happen to everyone who uses whey protein, it’s something worth considering in teens, particularly if they fail to respond to standard therapies, she said.

Although the reason for the association hasn’t yet been “teased out,” whey protein is derived from cow’s milk, and it appears to be related to activation of the insulin cascade, explained Dr. Keri.

Dr. Nanette B. Silverberg of the Mount Sinai Health System, New York, author of the case series involving the five male athletes, noted that milk is known to be associated with acne and suggested that whey protein may be the fraction of dairy products that promote acne formation.

Similarly, based on findings from a study of five adult male bodybuilders who developed moderate to severe facial or truncal acne after consuming whey protein, Dr. Thierry Simonart of Brussels noted that the observations are “in line with biochemical and epidemiological data supporting the effects of milk and dairy products as enhancers of insulin/insulin-like growth factor 1 signaling and acne aggravation” (Dermatology 2012;225:256-8).

Dr. Kerri reported having no relevant disclosures.

MIAMI BEACH – Acne on the face and trunk in adolescents could be associated with the use of whey protein supplements, according to Dr. Jonette E. Keri.

Teenage boys, especially, may use whey protein supplements in an effort to increase muscle mass or gain weight, Dr. Keri of the University of Miami said at the South Beach Symposium.

She cited a 2012 case series of five male teenage athletes aged 14-18 years who were using whey protein shakes or reconstituted powder. The teens presented with moderate to severe acne that responded poorly to standard treatment, but four of the five experienced clearing of the acne upon discontinuation of the whey protein supplement.

All five had been treated unsuccessfully with traditional therapies, including oral antibiotics, topical retinoids, and benzoyl peroxide. One teen stopped using the whey protein immediately after being counseled to do so, and he experienced improvement. Two teens didn’t stop using whey protein immediately but experienced improvement in their acne when they did discontinue it. Another teen experienced clearing after discontinuing the whey protein during a second course of isotretinoin therapy, and the fifth was lost to follow-up (Cutis 2012;90:70-2).

One of the teens who cleared after discontinuing the whey protein experienced a flare of the acne when he reinitiated supplementation, Dr. Keri said.

Three of the boys were trying to build muscle for football and two were trying to gain weight, which underscores the importance of asking teens about supplement use, she noted, adding that, importantly, it’s not just boys who are affected.

Continue for another study >>

In fact, a Brazilian study of 30 patients showed a very strong association between the onset or exacerbation of acne and initiation of whey protein use – and the finding was more pronounced among women than men, and among those without a personal or family history of acne (An. Bras. Dermatol. 2013;88:907-12).

In that study, subjects were examined on three occasions and followed for 60 days.

“They went the gym, wanted to work out a little bit and get bigger, took some whey, and broke out in acne,” Dr. Keri said.

Although acne breakouts won’t happen to everyone who uses whey protein, it’s something worth considering in teens, particularly if they fail to respond to standard therapies, she said.

Although the reason for the association hasn’t yet been “teased out,” whey protein is derived from cow’s milk, and it appears to be related to activation of the insulin cascade, explained Dr. Keri.

Dr. Nanette B. Silverberg of the Mount Sinai Health System, New York, author of the case series involving the five male athletes, noted that milk is known to be associated with acne and suggested that whey protein may be the fraction of dairy products that promote acne formation.

Similarly, based on findings from a study of five adult male bodybuilders who developed moderate to severe facial or truncal acne after consuming whey protein, Dr. Thierry Simonart of Brussels noted that the observations are “in line with biochemical and epidemiological data supporting the effects of milk and dairy products as enhancers of insulin/insulin-like growth factor 1 signaling and acne aggravation” (Dermatology 2012;225:256-8).

Dr. Kerri reported having no relevant disclosures.

MIAMI BEACH – Acne on the face and trunk in adolescents could be associated with the use of whey protein supplements, according to Dr. Jonette E. Keri.

Teenage boys, especially, may use whey protein supplements in an effort to increase muscle mass or gain weight, Dr. Keri of the University of Miami said at the South Beach Symposium.

She cited a 2012 case series of five male teenage athletes aged 14-18 years who were using whey protein shakes or reconstituted powder. The teens presented with moderate to severe acne that responded poorly to standard treatment, but four of the five experienced clearing of the acne upon discontinuation of the whey protein supplement.

marekuliasz/Thinkstock.com

All five had been treated unsuccessfully with traditional therapies, including oral antibiotics, topical retinoids, and benzoyl peroxide. One teen stopped using the whey protein immediately after being counseled to do so, and he experienced improvement. Two teens didn’t stop using whey protein immediately but experienced improvement in their acne when they did discontinue it. Another teen experienced clearing after discontinuing the whey protein during a second course of isotretinoin therapy, and the fifth was lost to follow-up (Cutis 2012;90:70-2).

One of the teens who cleared after discontinuing the whey protein experienced a flare of the acne when he reinitiated supplementation, Dr. Keri said.

Three of the boys were trying to build muscle for football and two were trying to gain weight, which underscores the importance of asking teens about supplement use, she noted, adding that, importantly, it’s not just boys who are affected.

In fact, a Brazilian study of 30 patients showed a very strong association between the onset or exacerbation of acne and initiation of whey protein use – and the finding was more pronounced among women than men, and among those without a personal or family history of acne (An. Bras. Dermatol. 2013;88:907-12).

In that study, subjects were examined on three occasions and followed for 60 days.

“They went the gym, wanted to work out a little bit and get bigger, took some whey, and broke out in acne,” Dr. Keri said.

Although acne breakouts won’t happen to everyone who uses whey protein, it’s something worth considering in teens, particularly if they fail to respond to standard therapies, she said.

Although the reason for the association hasn’t yet been “teased out,” whey protein is derived from cow’s milk, and it appears to be related to activation of the insulin cascade, explained Dr. Keri.

Dr. Nanette B. Silverberg of the Mount Sinai Health System, New York, author of the case series involving the five male athletes, noted that milk is known to be associated with acne and suggested that whey protein may be the fraction of dairy products that promote acne formation.

Similarly, based on findings from a study of five adult male bodybuilders who developed moderate to severe facial or truncal acne after consuming whey protein, Dr. Thierry Simonart of Brussels noted that the observations are “in line with biochemical and epidemiological data supporting the effects of milk and dairy products as enhancers of insulin/insulin-like growth factor 1 signaling and acne aggravation” (Dermatology 2012;225:256-8).

Dr. Kerri reported having no relevant disclosures.

MIAMI BEACH – Acne on the face and trunk in adolescents could be associated with the use of whey protein supplements, according to Dr. Jonette E. Keri.

Teenage boys, especially, may use whey protein supplements in an effort to increase muscle mass or gain weight, Dr. Keri of the University of Miami said at the South Beach Symposium.

She cited a 2012 case series of five male teenage athletes aged 14-18 years who were using whey protein shakes or reconstituted powder. The teens presented with moderate to severe acne that responded poorly to standard treatment, but four of the five experienced clearing of the acne upon discontinuation of the whey protein supplement.

marekuliasz/Thinkstock.com

All five had been treated unsuccessfully with traditional therapies, including oral antibiotics, topical retinoids, and benzoyl peroxide. One teen stopped using the whey protein immediately after being counseled to do so, and he experienced improvement. Two teens didn’t stop using whey protein immediately but experienced improvement in their acne when they did discontinue it. Another teen experienced clearing after discontinuing the whey protein during a second course of isotretinoin therapy, and the fifth was lost to follow-up (Cutis 2012;90:70-2).

One of the teens who cleared after discontinuing the whey protein experienced a flare of the acne when he reinitiated supplementation, Dr. Keri said.

Three of the boys were trying to build muscle for football and two were trying to gain weight, which underscores the importance of asking teens about supplement use, she noted, adding that, importantly, it’s not just boys who are affected.

In fact, a Brazilian study of 30 patients showed a very strong association between the onset or exacerbation of acne and initiation of whey protein use – and the finding was more pronounced among women than men, and among those without a personal or family history of acne (An. Bras. Dermatol. 2013;88:907-12).

In that study, subjects were examined on three occasions and followed for 60 days.

“They went the gym, wanted to work out a little bit and get bigger, took some whey, and broke out in acne,” Dr. Keri said.

Although acne breakouts won’t happen to everyone who uses whey protein, it’s something worth considering in teens, particularly if they fail to respond to standard therapies, she said.

Although the reason for the association hasn’t yet been “teased out,” whey protein is derived from cow’s milk, and it appears to be related to activation of the insulin cascade, explained Dr. Keri.

Dr. Nanette B. Silverberg of the Mount Sinai Health System, New York, author of the case series involving the five male athletes, noted that milk is known to be associated with acne and suggested that whey protein may be the fraction of dairy products that promote acne formation.

Similarly, based on findings from a study of five adult male bodybuilders who developed moderate to severe facial or truncal acne after consuming whey protein, Dr. Thierry Simonart of Brussels noted that the observations are “in line with biochemical and epidemiological data supporting the effects of milk and dairy products as enhancers of insulin/insulin-like growth factor 1 signaling and acne aggravation” (Dermatology 2012;225:256-8).

Dr. Kerri reported having no relevant disclosures.

MIAMI BEACH – Acne on the face and trunk in adolescents could be associated with the use of whey protein supplements, according to Dr. Jonette E. Keri.

Teenage boys, especially, may use whey protein supplements in an effort to increase muscle mass or gain weight, Dr. Keri of the University of Miami said at the South Beach Symposium.

She cited a 2012 case series of five male teenage athletes aged 14-18 years who were using whey protein shakes or reconstituted powder. The teens presented with moderate to severe acne that responded poorly to standard treatment, but four of the five experienced clearing of the acne upon discontinuation of the whey protein supplement.

marekuliasz/Thinkstock.com

All five had been treated unsuccessfully with traditional therapies, including oral antibiotics, topical retinoids, and benzoyl peroxide. One teen stopped using the whey protein immediately after being counseled to do so, and he experienced improvement. Two teens didn’t stop using whey protein immediately but experienced improvement in their acne when they did discontinue it. Another teen experienced clearing after discontinuing the whey protein during a second course of isotretinoin therapy, and the fifth was lost to follow-up (Cutis 2012;90:70-2).

One of the teens who cleared after discontinuing the whey protein experienced a flare of the acne when he reinitiated supplementation, Dr. Keri said.

Three of the boys were trying to build muscle for football and two were trying to gain weight, which underscores the importance of asking teens about supplement use, she noted, adding that, importantly, it’s not just boys who are affected.

In fact, a Brazilian study of 30 patients showed a very strong association between the onset or exacerbation of acne and initiation of whey protein use – and the finding was more pronounced among women than men, and among those without a personal or family history of acne (An. Bras. Dermatol. 2013;88:907-12).

In that study, subjects were examined on three occasions and followed for 60 days.

“They went the gym, wanted to work out a little bit and get bigger, took some whey, and broke out in acne,” Dr. Keri said.

Although acne breakouts won’t happen to everyone who uses whey protein, it’s something worth considering in teens, particularly if they fail to respond to standard therapies, she said.

Although the reason for the association hasn’t yet been “teased out,” whey protein is derived from cow’s milk, and it appears to be related to activation of the insulin cascade, explained Dr. Keri.

Dr. Nanette B. Silverberg of the Mount Sinai Health System, New York, author of the case series involving the five male athletes, noted that milk is known to be associated with acne and suggested that whey protein may be the fraction of dairy products that promote acne formation.

Similarly, based on findings from a study of five adult male bodybuilders who developed moderate to severe facial or truncal acne after consuming whey protein, Dr. Thierry Simonart of Brussels noted that the observations are “in line with biochemical and epidemiological data supporting the effects of milk and dairy products as enhancers of insulin/insulin-like growth factor 1 signaling and acne aggravation” (Dermatology 2012;225:256-8).

Dr. Kerri reported having no relevant disclosures.

MIAMI BEACH – Worry less about reactions, and more about counseling patients on what to expect following actinic keratosis treatments, according to Dr. Neal Bhatia.

“I just want to take everyone’s finger off the panic button when it comes to managing reactions of actinic keratoses,” he said at the South Beach Symposium.

© Dr-Strangelove / ThinkStockPhotos.com

It’s easy to get hung up on side effects and redness, as well as other issues related to treatment, said Dr. Bhatia of Therapeutics Dermatology in San Diego.

“Let’s not forget we’re treating something that could cause skin cancer if left alone,” he added.

AKs are “no longer a Medicare disease,” he said, explaining that AKs are increasingly common in 30- and 40-year-old patients, and the focus of their care should be on outcomes, not reactions.

“The reactions, more often than not, are anticipated,” Dr. Bhatia said.

Patients should be counseled in advance about possible side effects from AK treatments, as well as about anticipated responses, and they should be advised about how to modify symptoms, he said.

“More importantly, we want to give them something that’s going to keep them adherent to the program … we tell them ‘these are things that are going to happen. Be prepared. If you have a problem, you can call the office,’ ” he said.

A patient who doesn’t know what to expect will run to a primary care doctor and post negative reviews on every rating site out there, he cautioned, but that can be prevented by counseling in advance and by choosing the correct therapy with a duration that is a good fit for the patient. He noted that clinicians who suspect a patient won’t be compliant should choose a 2-day treatment, and if they think the patient can handle it – choose a 90-day treatment.

There are numerous treatment choices that will have some benefit for the right patient, Dr. Bhatia added.

When it comes to managing an aggressive treatment response, consider the mechanism of the response. Antibiotics can be used to reduce inflammation without changing the immune process, while steroids can undo the immune response that some therapies are trying to recruit.

“We can emphasize keeping the lesion calmed down while reducing symptoms that are going to be dose limiting,” he said.

Dr. Bhatia advised prescribing medications to be filled only on Monday-Thursday to avoid substitutions being given on Friday-Sunday when “we can’t defend them.” He recommends that patients start treatment on Sunday, so any reactions occur mid-week and can be addressed by the office.

To further reduce the chance of reactions, be sure to avoid office procedures in the 4-7 days before or after AK treatment. Also, when starting any AK drugs, advise the patient to use as many adjunctive therapies as possible, including topical anesthetics, moisturizers, sunblock – “anything to reduce the potential for going overboard,” he said.

Dr Bhatia has been a consultant, researcher, and/or speaker for companies including Allergan, Aqua Pharmaceuticals, Bayer Healthcare Pharmaceuticals, DUSA Pharmaceuticals, Exeltis, Ferndale Pharma, Galderma Laboratories, Genentech, LEO Pharmaceuticals, Nerium Novartis, Promius Pharma, Sandoz, Novartis, and Valeant.

MIAMI BEACH – Worry less about reactions, and more about counseling patients on what to expect following actinic keratosis treatments, according to Dr. Neal Bhatia.

“I just want to take everyone’s finger off the panic button when it comes to managing reactions of actinic keratoses,” he said at the South Beach Symposium.

© Dr-Strangelove / ThinkStockPhotos.com

It’s easy to get hung up on side effects and redness, as well as other issues related to treatment, said Dr. Bhatia of Therapeutics Dermatology in San Diego.

“Let’s not forget we’re treating something that could cause skin cancer if left alone,” he added.

AKs are “no longer a Medicare disease,” he said, explaining that AKs are increasingly common in 30- and 40-year-old patients, and the focus of their care should be on outcomes, not reactions.

“The reactions, more often than not, are anticipated,” Dr. Bhatia said.

Patients should be counseled in advance about possible side effects from AK treatments, as well as about anticipated responses, and they should be advised about how to modify symptoms, he said.

“More importantly, we want to give them something that’s going to keep them adherent to the program … we tell them ‘these are things that are going to happen. Be prepared. If you have a problem, you can call the office,’ ” he said.

A patient who doesn’t know what to expect will run to a primary care doctor and post negative reviews on every rating site out there, he cautioned, but that can be prevented by counseling in advance and by choosing the correct therapy with a duration that is a good fit for the patient. He noted that clinicians who suspect a patient won’t be compliant should choose a 2-day treatment, and if they think the patient can handle it – choose a 90-day treatment.

There are numerous treatment choices that will have some benefit for the right patient, Dr. Bhatia added.

When it comes to managing an aggressive treatment response, consider the mechanism of the response. Antibiotics can be used to reduce inflammation without changing the immune process, while steroids can undo the immune response that some therapies are trying to recruit.

“We can emphasize keeping the lesion calmed down while reducing symptoms that are going to be dose limiting,” he said.

Dr. Bhatia advised prescribing medications to be filled only on Monday-Thursday to avoid substitutions being given on Friday-Sunday when “we can’t defend them.” He recommends that patients start treatment on Sunday, so any reactions occur mid-week and can be addressed by the office.

To further reduce the chance of reactions, be sure to avoid office procedures in the 4-7 days before or after AK treatment. Also, when starting any AK drugs, advise the patient to use as many adjunctive therapies as possible, including topical anesthetics, moisturizers, sunblock – “anything to reduce the potential for going overboard,” he said.

Dr Bhatia has been a consultant, researcher, and/or speaker for companies including Allergan, Aqua Pharmaceuticals, Bayer Healthcare Pharmaceuticals, DUSA Pharmaceuticals, Exeltis, Ferndale Pharma, Galderma Laboratories, Genentech, LEO Pharmaceuticals, Nerium Novartis, Promius Pharma, Sandoz, Novartis, and Valeant.

MIAMI BEACH – Worry less about reactions, and more about counseling patients on what to expect following actinic keratosis treatments, according to Dr. Neal Bhatia.

“I just want to take everyone’s finger off the panic button when it comes to managing reactions of actinic keratoses,” he said at the South Beach Symposium.

© Dr-Strangelove / ThinkStockPhotos.com

It’s easy to get hung up on side effects and redness, as well as other issues related to treatment, said Dr. Bhatia of Therapeutics Dermatology in San Diego.

“Let’s not forget we’re treating something that could cause skin cancer if left alone,” he added.

AKs are “no longer a Medicare disease,” he said, explaining that AKs are increasingly common in 30- and 40-year-old patients, and the focus of their care should be on outcomes, not reactions.

“The reactions, more often than not, are anticipated,” Dr. Bhatia said.

Patients should be counseled in advance about possible side effects from AK treatments, as well as about anticipated responses, and they should be advised about how to modify symptoms, he said.

“More importantly, we want to give them something that’s going to keep them adherent to the program … we tell them ‘these are things that are going to happen. Be prepared. If you have a problem, you can call the office,’ ” he said.

A patient who doesn’t know what to expect will run to a primary care doctor and post negative reviews on every rating site out there, he cautioned, but that can be prevented by counseling in advance and by choosing the correct therapy with a duration that is a good fit for the patient. He noted that clinicians who suspect a patient won’t be compliant should choose a 2-day treatment, and if they think the patient can handle it – choose a 90-day treatment.

There are numerous treatment choices that will have some benefit for the right patient, Dr. Bhatia added.

When it comes to managing an aggressive treatment response, consider the mechanism of the response. Antibiotics can be used to reduce inflammation without changing the immune process, while steroids can undo the immune response that some therapies are trying to recruit.

“We can emphasize keeping the lesion calmed down while reducing symptoms that are going to be dose limiting,” he said.

Dr. Bhatia advised prescribing medications to be filled only on Monday-Thursday to avoid substitutions being given on Friday-Sunday when “we can’t defend them.” He recommends that patients start treatment on Sunday, so any reactions occur mid-week and can be addressed by the office.

To further reduce the chance of reactions, be sure to avoid office procedures in the 4-7 days before or after AK treatment. Also, when starting any AK drugs, advise the patient to use as many adjunctive therapies as possible, including topical anesthetics, moisturizers, sunblock – “anything to reduce the potential for going overboard,” he said.

Dr Bhatia has been a consultant, researcher, and/or speaker for companies including Allergan, Aqua Pharmaceuticals, Bayer Healthcare Pharmaceuticals, DUSA Pharmaceuticals, Exeltis, Ferndale Pharma, Galderma Laboratories, Genentech, LEO Pharmaceuticals, Nerium Novartis, Promius Pharma, Sandoz, Novartis, and Valeant.

MIAMI BEACH – Acne flares on the chin can usually be managed in women with oral contraceptive therapy and spironolactone, according to Dr. Diane Berson.

These acne breakouts may be just a few pimples and are often related to the menstrual cycle, Dr. Berson of Cornell University and New York Presbyterian Hospital, both in New York, said at the South Beach Symposium.

“We know that women do develop premenstrual acne,” she said, citing a 2014 survey in which 65% of 105 respondents reported worsening of acne with their menstrual cycles, and 56% of those women reported acne in the week preceding menses (J. Clin. Aesthet. Dermatol. 2014;7:30-4).

Stress also seems to play a role, with another recent study showing that various stress factors including noise, socioeconomic pressures, light stimuli, and sleep deprivation also contribute to acne breakouts – again, often on the chin, she noted.

Oral contraceptives decrease testosterone, thereby reducing sebum production and, hopefully, acne breakouts, she said. With the traditional 21-day active/7-day inactive oral contraceptives, women tend to have acne flares during the 7-day inactive part of the treatment cycle, so increasing the active treatment cycle to 24 days of active therapy and 4 days of “blanks” can limit premenstrual syndrome and acne breakouts.

Contraceptive patches and rings provide a more continuous release of estrogen, so these products may also be helpful for women with hormonally induced acne, she added.

“Spironolactone is a great adjunct,” she said, noting that “it is inexpensive, really has minimal side effects, and women notice they get fewer hormonal breakouts when they are on it.”

A dose of 25-50 mg of spironolactone is usually sufficient, she said. “I have gone up to 100 mg, but my average patient is on 50 mg.” Patients also taking a drospirenone-containing oral contraceptive such as Yaz or Yasmin, get 25 mg of spironolactone, because they are already getting the equivalent of 25 mg in the oral contraceptive.

In another study, adding spironolactone to topical retinoid treatment led to a superior response to retinoids alone in the treatment of female adult cyclical acne (J. Drugs Dermatol. 2014;13:126-9), she noted.

“For our women patients with acne, a big part of our management is maintenance therapy,” she concluded. With hormonal flares, “I find that the best maintenance is a topical retinoid paired with either an oral contraceptive pill or spironolactone. That way you are giving them a topical comedolytic to decrease their clogging, and the hormonal treatment to decrease their hormonally induced flares.”

Dr. Berson is a consultant for Allergan, Galderma, Kythera Biopharmaceuticals, La Roche-Posay, Procter & Gamble, and Valeant Pharmaceuticals International.

MIAMI BEACH – Acne flares on the chin can usually be managed in women with oral contraceptive therapy and spironolactone, according to Dr. Diane Berson.

These acne breakouts may be just a few pimples and are often related to the menstrual cycle, Dr. Berson of Cornell University and New York Presbyterian Hospital, both in New York, said at the South Beach Symposium.

“We know that women do develop premenstrual acne,” she said, citing a 2014 survey in which 65% of 105 respondents reported worsening of acne with their menstrual cycles, and 56% of those women reported acne in the week preceding menses (J. Clin. Aesthet. Dermatol. 2014;7:30-4).

Stress also seems to play a role, with another recent study showing that various stress factors including noise, socioeconomic pressures, light stimuli, and sleep deprivation also contribute to acne breakouts – again, often on the chin, she noted.

Oral contraceptives decrease testosterone, thereby reducing sebum production and, hopefully, acne breakouts, she said. With the traditional 21-day active/7-day inactive oral contraceptives, women tend to have acne flares during the 7-day inactive part of the treatment cycle, so increasing the active treatment cycle to 24 days of active therapy and 4 days of “blanks” can limit premenstrual syndrome and acne breakouts.

Contraceptive patches and rings provide a more continuous release of estrogen, so these products may also be helpful for women with hormonally induced acne, she added.

“Spironolactone is a great adjunct,” she said, noting that “it is inexpensive, really has minimal side effects, and women notice they get fewer hormonal breakouts when they are on it.”

A dose of 25-50 mg of spironolactone is usually sufficient, she said. “I have gone up to 100 mg, but my average patient is on 50 mg.” Patients also taking a drospirenone-containing oral contraceptive such as Yaz or Yasmin, get 25 mg of spironolactone, because they are already getting the equivalent of 25 mg in the oral contraceptive.

In another study, adding spironolactone to topical retinoid treatment led to a superior response to retinoids alone in the treatment of female adult cyclical acne (J. Drugs Dermatol. 2014;13:126-9), she noted.

“For our women patients with acne, a big part of our management is maintenance therapy,” she concluded. With hormonal flares, “I find that the best maintenance is a topical retinoid paired with either an oral contraceptive pill or spironolactone. That way you are giving them a topical comedolytic to decrease their clogging, and the hormonal treatment to decrease their hormonally induced flares.”

Dr. Berson is a consultant for Allergan, Galderma, Kythera Biopharmaceuticals, La Roche-Posay, Procter & Gamble, and Valeant Pharmaceuticals International.

MIAMI BEACH – Acne flares on the chin can usually be managed in women with oral contraceptive therapy and spironolactone, according to Dr. Diane Berson.

These acne breakouts may be just a few pimples and are often related to the menstrual cycle, Dr. Berson of Cornell University and New York Presbyterian Hospital, both in New York, said at the South Beach Symposium.

“We know that women do develop premenstrual acne,” she said, citing a 2014 survey in which 65% of 105 respondents reported worsening of acne with their menstrual cycles, and 56% of those women reported acne in the week preceding menses (J. Clin. Aesthet. Dermatol. 2014;7:30-4).

Stress also seems to play a role, with another recent study showing that various stress factors including noise, socioeconomic pressures, light stimuli, and sleep deprivation also contribute to acne breakouts – again, often on the chin, she noted.

Oral contraceptives decrease testosterone, thereby reducing sebum production and, hopefully, acne breakouts, she said. With the traditional 21-day active/7-day inactive oral contraceptives, women tend to have acne flares during the 7-day inactive part of the treatment cycle, so increasing the active treatment cycle to 24 days of active therapy and 4 days of “blanks” can limit premenstrual syndrome and acne breakouts.

Contraceptive patches and rings provide a more continuous release of estrogen, so these products may also be helpful for women with hormonally induced acne, she added.

“Spironolactone is a great adjunct,” she said, noting that “it is inexpensive, really has minimal side effects, and women notice they get fewer hormonal breakouts when they are on it.”

A dose of 25-50 mg of spironolactone is usually sufficient, she said. “I have gone up to 100 mg, but my average patient is on 50 mg.” Patients also taking a drospirenone-containing oral contraceptive such as Yaz or Yasmin, get 25 mg of spironolactone, because they are already getting the equivalent of 25 mg in the oral contraceptive.

In another study, adding spironolactone to topical retinoid treatment led to a superior response to retinoids alone in the treatment of female adult cyclical acne (J. Drugs Dermatol. 2014;13:126-9), she noted.

“For our women patients with acne, a big part of our management is maintenance therapy,” she concluded. With hormonal flares, “I find that the best maintenance is a topical retinoid paired with either an oral contraceptive pill or spironolactone. That way you are giving them a topical comedolytic to decrease their clogging, and the hormonal treatment to decrease their hormonally induced flares.”

Dr. Berson is a consultant for Allergan, Galderma, Kythera Biopharmaceuticals, La Roche-Posay, Procter & Gamble, and Valeant Pharmaceuticals International.