Rosacea

WASHINGTON – Acne patients are telling the truth when they describe feeling isolated, rejected, and stigmatized – and now there are data to prove it.

Dr. Alexa B. Kimball, professor of dermatology at Harvard Medical School, Boston, found that almost 70% of people surveyed believe that those with acne are unattractive and hesitate to be seen with them. Her survey of 56 people also found that they harbor fears that acne is infectious and can be transmitted, that it’s caused by poor hygiene and diet.

“The widespread misconceptions about acne contribute to negative perceptions, which can affect patients’ quality of life and social interaction,” Dr. Kimball said. “When our patients describe these feelings, they are describing their real, day-to-day life experiences.”

See more of her comments on treating patients with acne in this video.

[email protected]

WASHINGTON – Acne patients are telling the truth when they describe feeling isolated, rejected, and stigmatized – and now there are data to prove it.

Dr. Alexa B. Kimball, professor of dermatology at Harvard Medical School, Boston, found that almost 70% of people surveyed believe that those with acne are unattractive and hesitate to be seen with them. Her survey of 56 people also found that they harbor fears that acne is infectious and can be transmitted, that it’s caused by poor hygiene and diet.

“The widespread misconceptions about acne contribute to negative perceptions, which can affect patients’ quality of life and social interaction,” Dr. Kimball said. “When our patients describe these feelings, they are describing their real, day-to-day life experiences.”

See more of her comments on treating patients with acne in this video.

[email protected]

WASHINGTON – Acne patients are telling the truth when they describe feeling isolated, rejected, and stigmatized – and now there are data to prove it.

Dr. Alexa B. Kimball, professor of dermatology at Harvard Medical School, Boston, found that almost 70% of people surveyed believe that those with acne are unattractive and hesitate to be seen with them. Her survey of 56 people also found that they harbor fears that acne is infectious and can be transmitted, that it’s caused by poor hygiene and diet.

“The widespread misconceptions about acne contribute to negative perceptions, which can affect patients’ quality of life and social interaction,” Dr. Kimball said. “When our patients describe these feelings, they are describing their real, day-to-day life experiences.”

See more of her comments on treating patients with acne in this video.

[email protected]

WASHINGTON – Monotherapy is not recommended in treating moderate-severe acne, and antibiotics should always be coupled with topical therapy, according to the latest guidelines from the American Academy of Dermatology.

And although it may be hard – even nearly impossible – to discontinue antibiotics completely, patients should be reevaluated every 3-4 months to determine whether reducing the dosage may be possible while maintaining effectiveness, the document says.

AAD published the guideline on Feb 17. At the academy’s annual meeting, a panel met to discuss its practical application.

Topical therapy

Benzoyl peroxide is a first-line agent that not only effectively fights Propionibacterium acnes, but also discourages the development of antibiotic resistance. Topical antibiotics also decrease P. acnes populations and exert a mild anti-inflammatory effect; however, monotherapy with a topical antibiotic is strongly discouraged. These should be used in combination with another agent such as a retinoid, benzoyl peroxide, adapalene, azelaic acid, or dapsone. This approach decreases the chance of antibiotic resistance, attacks the acne on several fronts, and provides for a maintenance transition.

Systemic antibiotics

Tetracycline-class antibiotics are still the best option for moderate-severe acne. A Cochrane review found that minocycline and doxycycline are equally effective (Cochrane Skin Group Nov 2011. doi: 10.1002/14651858.CD002086.pub2).

The incidence of adverse events associated with each is low, although minocycline may be marginally more troublesome. Low doses seem to be as effective as traditional doses, but pulsed therapy is inadequate. To prevent antibiotic resistance, limit both dose and length of therapy as much as possible. This can best be accomplished by adding a topical agent – either benzoyl peroxide or a retinoid – to the regimen.

“This is critical,” Dr. Jonette E. Keri of the University of Miami said at the meeting. “When antibiotics are eventually discontinued, the retinoid will fulfill the need for maintenance therapy.”

Hormonal agents

Four combination oral contraceptives are Food and Drug Administration–approved for acne treatment. Each of them decreases androgens by interrupting the pathway of testosterone production. There are no data suggesting that one is better than the other; patient preferences and their individual clinical picture should drive choice. Because of the cardiovascular risks associated with these combination OCs, they should not be prescribed for anyone with a personal or family history of clotting disorders or thromboembolic events. Smoking should also be a contraindication.

Oral contraceptives can be tried alone or as part of a comprehensive treatment regimen, including one containing antibiotics. Rifampin and griseofulvin are the only antibiotics known to decrease the contraceptive effect of the medications.

The tincture of time is an important part of this therapy, said Dr. Diane M. Thiboutot, professor of dermatology at Pennsylvania State University, Hershey. “You can’t rush it. It may take three cycles to see any real improvement in acne, and patients should be aware of this.”

Isotretinoin

Oral isotretinoin is a highly effective treatment for severe, recalcitrant acne. It decreases sebum production, acne lesion count, and scarring. Despite concerns about depression and suicidality, isotretinoin treatment can actually improve mood in most patients, said Dr. Megha M. Tollefson of the Mayo Clinic, Rochester, Minn.

“A very well-done Swedish study published in 2010 in BMJ found a slightly increased risk of suicide in the first 6 months after treatment started, but that risk was already rising before treatment started, so it could [be unrelated] to the drug,” she said. “And, in those who got isotretinoin, the [suicide] rate after that was actually decreased, compared to the general population.”

Female patients need education on isotretinoin’s teratogenic potential. After discussions, they should sign the SMART or iPLEDGE agreements about using effective birth control while taking the drug. Unfortunately, Dr. Tollefson said, “We continue to see hundreds of isotretinoin-exposed pregnancies each year.”

A recent study found that up to 30% of women did not comply with the birth control measures they agreed to while taking the drug (J Am Acad Dermatol. 2011 Oct. doi: 10.1016/j.jaad.2013.08.034).

The link between isotretinoin and inflammatory bowel disease is not well founded, Dr. Tollefson said. Studies have been contradictory, and most evidence is based on case report and association studies. There is, however, some evidence suggesting an innate connection between acne and inflammatory bowel disease, she noted.

Diet

Emerging evidence suggests that high glycemic diets may be associated with acne, but these studies are small. However, those randomized to a low glycemic index diet showed decreased sebum production and inflammation.

A small case-control study in 2012 suggested a link between milk and acne. AAD makes no recommendation based on this. Milk remains an important source of calcium and vitamin D for Americans, especially children, the panel said.

Dr. Tollefson had no financial disclosures. Dr. Keri said she has been a consultant for Hoffmann-LaRoche.

[email protected]

WASHINGTON – Monotherapy is not recommended in treating moderate-severe acne, and antibiotics should always be coupled with topical therapy, according to the latest guidelines from the American Academy of Dermatology.

And although it may be hard – even nearly impossible – to discontinue antibiotics completely, patients should be reevaluated every 3-4 months to determine whether reducing the dosage may be possible while maintaining effectiveness, the document says.

AAD published the guideline on Feb 17. At the academy’s annual meeting, a panel met to discuss its practical application.

Topical therapy

Benzoyl peroxide is a first-line agent that not only effectively fights Propionibacterium acnes, but also discourages the development of antibiotic resistance. Topical antibiotics also decrease P. acnes populations and exert a mild anti-inflammatory effect; however, monotherapy with a topical antibiotic is strongly discouraged. These should be used in combination with another agent such as a retinoid, benzoyl peroxide, adapalene, azelaic acid, or dapsone. This approach decreases the chance of antibiotic resistance, attacks the acne on several fronts, and provides for a maintenance transition.

Systemic antibiotics

Tetracycline-class antibiotics are still the best option for moderate-severe acne. A Cochrane review found that minocycline and doxycycline are equally effective (Cochrane Skin Group Nov 2011. doi: 10.1002/14651858.CD002086.pub2).

The incidence of adverse events associated with each is low, although minocycline may be marginally more troublesome. Low doses seem to be as effective as traditional doses, but pulsed therapy is inadequate. To prevent antibiotic resistance, limit both dose and length of therapy as much as possible. This can best be accomplished by adding a topical agent – either benzoyl peroxide or a retinoid – to the regimen.

“This is critical,” Dr. Jonette E. Keri of the University of Miami said at the meeting. “When antibiotics are eventually discontinued, the retinoid will fulfill the need for maintenance therapy.”

Hormonal agents

Four combination oral contraceptives are Food and Drug Administration–approved for acne treatment. Each of them decreases androgens by interrupting the pathway of testosterone production. There are no data suggesting that one is better than the other; patient preferences and their individual clinical picture should drive choice. Because of the cardiovascular risks associated with these combination OCs, they should not be prescribed for anyone with a personal or family history of clotting disorders or thromboembolic events. Smoking should also be a contraindication.

Oral contraceptives can be tried alone or as part of a comprehensive treatment regimen, including one containing antibiotics. Rifampin and griseofulvin are the only antibiotics known to decrease the contraceptive effect of the medications.

The tincture of time is an important part of this therapy, said Dr. Diane M. Thiboutot, professor of dermatology at Pennsylvania State University, Hershey. “You can’t rush it. It may take three cycles to see any real improvement in acne, and patients should be aware of this.”

Isotretinoin

Oral isotretinoin is a highly effective treatment for severe, recalcitrant acne. It decreases sebum production, acne lesion count, and scarring. Despite concerns about depression and suicidality, isotretinoin treatment can actually improve mood in most patients, said Dr. Megha M. Tollefson of the Mayo Clinic, Rochester, Minn.

“A very well-done Swedish study published in 2010 in BMJ found a slightly increased risk of suicide in the first 6 months after treatment started, but that risk was already rising before treatment started, so it could [be unrelated] to the drug,” she said. “And, in those who got isotretinoin, the [suicide] rate after that was actually decreased, compared to the general population.”

Female patients need education on isotretinoin’s teratogenic potential. After discussions, they should sign the SMART or iPLEDGE agreements about using effective birth control while taking the drug. Unfortunately, Dr. Tollefson said, “We continue to see hundreds of isotretinoin-exposed pregnancies each year.”

A recent study found that up to 30% of women did not comply with the birth control measures they agreed to while taking the drug (J Am Acad Dermatol. 2011 Oct. doi: 10.1016/j.jaad.2013.08.034).

The link between isotretinoin and inflammatory bowel disease is not well founded, Dr. Tollefson said. Studies have been contradictory, and most evidence is based on case report and association studies. There is, however, some evidence suggesting an innate connection between acne and inflammatory bowel disease, she noted.

Diet

Emerging evidence suggests that high glycemic diets may be associated with acne, but these studies are small. However, those randomized to a low glycemic index diet showed decreased sebum production and inflammation.

A small case-control study in 2012 suggested a link between milk and acne. AAD makes no recommendation based on this. Milk remains an important source of calcium and vitamin D for Americans, especially children, the panel said.

Dr. Tollefson had no financial disclosures. Dr. Keri said she has been a consultant for Hoffmann-LaRoche.

[email protected]

WASHINGTON – Monotherapy is not recommended in treating moderate-severe acne, and antibiotics should always be coupled with topical therapy, according to the latest guidelines from the American Academy of Dermatology.

And although it may be hard – even nearly impossible – to discontinue antibiotics completely, patients should be reevaluated every 3-4 months to determine whether reducing the dosage may be possible while maintaining effectiveness, the document says.

AAD published the guideline on Feb 17. At the academy’s annual meeting, a panel met to discuss its practical application.

Topical therapy

Benzoyl peroxide is a first-line agent that not only effectively fights Propionibacterium acnes, but also discourages the development of antibiotic resistance. Topical antibiotics also decrease P. acnes populations and exert a mild anti-inflammatory effect; however, monotherapy with a topical antibiotic is strongly discouraged. These should be used in combination with another agent such as a retinoid, benzoyl peroxide, adapalene, azelaic acid, or dapsone. This approach decreases the chance of antibiotic resistance, attacks the acne on several fronts, and provides for a maintenance transition.

Systemic antibiotics

Tetracycline-class antibiotics are still the best option for moderate-severe acne. A Cochrane review found that minocycline and doxycycline are equally effective (Cochrane Skin Group Nov 2011. doi: 10.1002/14651858.CD002086.pub2).

The incidence of adverse events associated with each is low, although minocycline may be marginally more troublesome. Low doses seem to be as effective as traditional doses, but pulsed therapy is inadequate. To prevent antibiotic resistance, limit both dose and length of therapy as much as possible. This can best be accomplished by adding a topical agent – either benzoyl peroxide or a retinoid – to the regimen.

“This is critical,” Dr. Jonette E. Keri of the University of Miami said at the meeting. “When antibiotics are eventually discontinued, the retinoid will fulfill the need for maintenance therapy.”

Hormonal agents

Four combination oral contraceptives are Food and Drug Administration–approved for acne treatment. Each of them decreases androgens by interrupting the pathway of testosterone production. There are no data suggesting that one is better than the other; patient preferences and their individual clinical picture should drive choice. Because of the cardiovascular risks associated with these combination OCs, they should not be prescribed for anyone with a personal or family history of clotting disorders or thromboembolic events. Smoking should also be a contraindication.

Oral contraceptives can be tried alone or as part of a comprehensive treatment regimen, including one containing antibiotics. Rifampin and griseofulvin are the only antibiotics known to decrease the contraceptive effect of the medications.

The tincture of time is an important part of this therapy, said Dr. Diane M. Thiboutot, professor of dermatology at Pennsylvania State University, Hershey. “You can’t rush it. It may take three cycles to see any real improvement in acne, and patients should be aware of this.”

Isotretinoin

Oral isotretinoin is a highly effective treatment for severe, recalcitrant acne. It decreases sebum production, acne lesion count, and scarring. Despite concerns about depression and suicidality, isotretinoin treatment can actually improve mood in most patients, said Dr. Megha M. Tollefson of the Mayo Clinic, Rochester, Minn.

“A very well-done Swedish study published in 2010 in BMJ found a slightly increased risk of suicide in the first 6 months after treatment started, but that risk was already rising before treatment started, so it could [be unrelated] to the drug,” she said. “And, in those who got isotretinoin, the [suicide] rate after that was actually decreased, compared to the general population.”

Female patients need education on isotretinoin’s teratogenic potential. After discussions, they should sign the SMART or iPLEDGE agreements about using effective birth control while taking the drug. Unfortunately, Dr. Tollefson said, “We continue to see hundreds of isotretinoin-exposed pregnancies each year.”

A recent study found that up to 30% of women did not comply with the birth control measures they agreed to while taking the drug (J Am Acad Dermatol. 2011 Oct. doi: 10.1016/j.jaad.2013.08.034).

The link between isotretinoin and inflammatory bowel disease is not well founded, Dr. Tollefson said. Studies have been contradictory, and most evidence is based on case report and association studies. There is, however, some evidence suggesting an innate connection between acne and inflammatory bowel disease, she noted.

Diet

Emerging evidence suggests that high glycemic diets may be associated with acne, but these studies are small. However, those randomized to a low glycemic index diet showed decreased sebum production and inflammation.

A small case-control study in 2012 suggested a link between milk and acne. AAD makes no recommendation based on this. Milk remains an important source of calcium and vitamin D for Americans, especially children, the panel said.

Dr. Tollefson had no financial disclosures. Dr. Keri said she has been a consultant for Hoffmann-LaRoche.

[email protected]

WAIKOLOA, HAWAII – Three new approaches to topical treatment of acne are on the horizon, and they all share a common foe: sebum.

“One exciting new avenue for topical therapy are drugs that actually target the production of sebum,” explained Dr. Linda F. Stein Gold, director of dermatology research at Henry Ford Health System, Detroit. “For the first time, we have a drug that potentially targets sebum with a topical mechanism. In the past, we’ve only been able to do that with oral therapy.”

In an interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation, Dr. Stein Gold discussed three topical, sebum-focused drugs in clinical trials and outlined their differing mechanisms of action.

SDEF and this news organization are owned by the same parent company.

WAIKOLOA, HAWAII – Three new approaches to topical treatment of acne are on the horizon, and they all share a common foe: sebum.

“One exciting new avenue for topical therapy are drugs that actually target the production of sebum,” explained Dr. Linda F. Stein Gold, director of dermatology research at Henry Ford Health System, Detroit. “For the first time, we have a drug that potentially targets sebum with a topical mechanism. In the past, we’ve only been able to do that with oral therapy.”

In an interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation, Dr. Stein Gold discussed three topical, sebum-focused drugs in clinical trials and outlined their differing mechanisms of action.

SDEF and this news organization are owned by the same parent company.

WAIKOLOA, HAWAII – Three new approaches to topical treatment of acne are on the horizon, and they all share a common foe: sebum.

“One exciting new avenue for topical therapy are drugs that actually target the production of sebum,” explained Dr. Linda F. Stein Gold, director of dermatology research at Henry Ford Health System, Detroit. “For the first time, we have a drug that potentially targets sebum with a topical mechanism. In the past, we’ve only been able to do that with oral therapy.”

In an interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation, Dr. Stein Gold discussed three topical, sebum-focused drugs in clinical trials and outlined their differing mechanisms of action.

SDEF and this news organization are owned by the same parent company.

In recent years, resistance to antimicrobial drugs has become increasingly widespread, resulting in a health threat of epidemic proportions. The long list of drug-resistant bacteria continues to expand at an accelerated pace. What does this mean in the dermatology world? We are not the only problem but are certainly part of the problem, representing 5% of all antibiotic prescriptions annually even though we represent only 1% of all physicians in the United States. These prescriptions certainly do not just include skin and soft tissue functions, as a survey-based study by Chouake et al (J Drugs Dermatol. 2014;13:119-124.) showed that dermatologists are overusing antibiotics in the treatment of simple skin abscesses such as acne vulgaris, one of the most common inflammatory skin diseases.

Although the inappropriate utilization of antibiotics for acne has been a subject of great discourse for years, it recently reentered the limelight in a study by Nagler et al published online in October 2015 in the Journal of the American Academy of Dermatology. They showed that patients who ultimately were treated with isotretinoin had been receiving antibiotics for months without any sign of therapeutic life or course end in sight. This retrospective chart review evaluated the duration of systemic antibiotic use prior to starting isotretinoin in 137 patients with inflammatory/nodulocystic acne. Antibiotic use continued for a mean of 331.3 days (median, 238 days). Duration of antibiotic use was divided into categories: 3 months or less (15.3%), 6 months or more (64.2%), or 1 year or more (33.6%).

Let’s take a broad look at antimicrobial resistance. Bacterial drug resistance has numerous negative effects on medicine and society. Drug-resistant bacterial infections result in higher doses of drugs, the addition of treatments with higher toxicity, longer hospital stays, and increased mortality. In the United States, infections due to antibiotic-resistant bacteria add $20 billion to total health care costs plus $35 billion in costs to society.

Unfortunately, it is relatively easy for bacterium to develop drug resistance through 3 simple steps: acquisition by microbes of resistance genes, expression of those resistance genes, and selection for pathogens expressing those resistance genes. The selective pressure in favor of resistance occurs whenever microbes are exposed to a drug but not eradicated, either by the killing effects of the drug itself or by inhibitory effects of the drug followed by killing by the host’s immune system. In any setting that creates this selective pressure in favor of drug resistance, such as poor patient compliance (ie, infrequent dosing, taking an antibiotic for too long as we see with the use of antibiotics for the treatment of inflammatory skin diseases such as acne), the likelihood of that resistance actually developing is increased. In addition, drugs that inhibit but do not kill microbes are more likely to allow some microbial cells to live and therefore develop resistance when exposed to a drug, which accounts for the majority of antibiotics in our armament. Lastly, abuse of broad-spectrum antibiotics has further spurred the emergence of many antibiotic-resistant strains. For instance, Pseudomonas aeruginosa is one of many evolving multidrug-resistant microorganisms that have been collectively coined the “ESKAPE” pathogens (Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, P aeruginosa, Enterobacter species) to emphasize the fact that they “escape” the effects of many antibacterial agents.

All of the above does not take into account the environmental factors that play a role in this resistance. The close quarters, mass/public transportation, and stressful pace of life of urban living not only bring these organisms together to share resistance genes but also increase our susceptibility.

What’s the issue?

We can all do our part in the fight against microbial resistance and join the antimicrobial stewardship. Here are a couple tips for dermatologists:

1. Stop using over-the-counter antibiotic ointment for every biopsy or minor procedure, which is one of the recommendations of the American Academy of Dermatology based on the ABIM Foundation’s Choosing Wisely campaign.
2. Oral and topical antibiotics for inflammatory skin diseases such as acne, rosacea, and hidradenitis suppurativa should only be used temporarily or at subantimicrobial dosing. Always combine a benzoyl peroxide–containing wash with a topical or oral antibiotic to hit the bacteria with multiple mechanisms of antibacterial activity to limit resistance. Don’t use benzoyl peroxide stronger than 2.5% for the face; make sure to wash it off completely to avoid staining your towels, sheets, and clothing.

We can all play our part in the fight against antimicrobial resistance. How do you fight the resistance?

We want to know your views! Tell us what you think.

In recent years, resistance to antimicrobial drugs has become increasingly widespread, resulting in a health threat of epidemic proportions. The long list of drug-resistant bacteria continues to expand at an accelerated pace. What does this mean in the dermatology world? We are not the only problem but are certainly part of the problem, representing 5% of all antibiotic prescriptions annually even though we represent only 1% of all physicians in the United States. These prescriptions certainly do not just include skin and soft tissue functions, as a survey-based study by Chouake et al (J Drugs Dermatol. 2014;13:119-124.) showed that dermatologists are overusing antibiotics in the treatment of simple skin abscesses such as acne vulgaris, one of the most common inflammatory skin diseases.

Although the inappropriate utilization of antibiotics for acne has been a subject of great discourse for years, it recently reentered the limelight in a study by Nagler et al published online in October 2015 in the Journal of the American Academy of Dermatology. They showed that patients who ultimately were treated with isotretinoin had been receiving antibiotics for months without any sign of therapeutic life or course end in sight. This retrospective chart review evaluated the duration of systemic antibiotic use prior to starting isotretinoin in 137 patients with inflammatory/nodulocystic acne. Antibiotic use continued for a mean of 331.3 days (median, 238 days). Duration of antibiotic use was divided into categories: 3 months or less (15.3%), 6 months or more (64.2%), or 1 year or more (33.6%).

Let’s take a broad look at antimicrobial resistance. Bacterial drug resistance has numerous negative effects on medicine and society. Drug-resistant bacterial infections result in higher doses of drugs, the addition of treatments with higher toxicity, longer hospital stays, and increased mortality. In the United States, infections due to antibiotic-resistant bacteria add $20 billion to total health care costs plus $35 billion in costs to society.

Unfortunately, it is relatively easy for bacterium to develop drug resistance through 3 simple steps: acquisition by microbes of resistance genes, expression of those resistance genes, and selection for pathogens expressing those resistance genes. The selective pressure in favor of resistance occurs whenever microbes are exposed to a drug but not eradicated, either by the killing effects of the drug itself or by inhibitory effects of the drug followed by killing by the host’s immune system. In any setting that creates this selective pressure in favor of drug resistance, such as poor patient compliance (ie, infrequent dosing, taking an antibiotic for too long as we see with the use of antibiotics for the treatment of inflammatory skin diseases such as acne), the likelihood of that resistance actually developing is increased. In addition, drugs that inhibit but do not kill microbes are more likely to allow some microbial cells to live and therefore develop resistance when exposed to a drug, which accounts for the majority of antibiotics in our armament. Lastly, abuse of broad-spectrum antibiotics has further spurred the emergence of many antibiotic-resistant strains. For instance, Pseudomonas aeruginosa is one of many evolving multidrug-resistant microorganisms that have been collectively coined the “ESKAPE” pathogens (Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, P aeruginosa, Enterobacter species) to emphasize the fact that they “escape” the effects of many antibacterial agents.

All of the above does not take into account the environmental factors that play a role in this resistance. The close quarters, mass/public transportation, and stressful pace of life of urban living not only bring these organisms together to share resistance genes but also increase our susceptibility.

What’s the issue?

We can all do our part in the fight against microbial resistance and join the antimicrobial stewardship. Here are a couple tips for dermatologists:

1. Stop using over-the-counter antibiotic ointment for every biopsy or minor procedure, which is one of the recommendations of the American Academy of Dermatology based on the ABIM Foundation’s Choosing Wisely campaign.
2. Oral and topical antibiotics for inflammatory skin diseases such as acne, rosacea, and hidradenitis suppurativa should only be used temporarily or at subantimicrobial dosing. Always combine a benzoyl peroxide–containing wash with a topical or oral antibiotic to hit the bacteria with multiple mechanisms of antibacterial activity to limit resistance. Don’t use benzoyl peroxide stronger than 2.5% for the face; make sure to wash it off completely to avoid staining your towels, sheets, and clothing.

We can all play our part in the fight against antimicrobial resistance. How do you fight the resistance?

We want to know your views! Tell us what you think.

In recent years, resistance to antimicrobial drugs has become increasingly widespread, resulting in a health threat of epidemic proportions. The long list of drug-resistant bacteria continues to expand at an accelerated pace. What does this mean in the dermatology world? We are not the only problem but are certainly part of the problem, representing 5% of all antibiotic prescriptions annually even though we represent only 1% of all physicians in the United States. These prescriptions certainly do not just include skin and soft tissue functions, as a survey-based study by Chouake et al (J Drugs Dermatol. 2014;13:119-124.) showed that dermatologists are overusing antibiotics in the treatment of simple skin abscesses such as acne vulgaris, one of the most common inflammatory skin diseases.

Although the inappropriate utilization of antibiotics for acne has been a subject of great discourse for years, it recently reentered the limelight in a study by Nagler et al published online in October 2015 in the Journal of the American Academy of Dermatology. They showed that patients who ultimately were treated with isotretinoin had been receiving antibiotics for months without any sign of therapeutic life or course end in sight. This retrospective chart review evaluated the duration of systemic antibiotic use prior to starting isotretinoin in 137 patients with inflammatory/nodulocystic acne. Antibiotic use continued for a mean of 331.3 days (median, 238 days). Duration of antibiotic use was divided into categories: 3 months or less (15.3%), 6 months or more (64.2%), or 1 year or more (33.6%).

Let’s take a broad look at antimicrobial resistance. Bacterial drug resistance has numerous negative effects on medicine and society. Drug-resistant bacterial infections result in higher doses of drugs, the addition of treatments with higher toxicity, longer hospital stays, and increased mortality. In the United States, infections due to antibiotic-resistant bacteria add $20 billion to total health care costs plus $35 billion in costs to society.

Unfortunately, it is relatively easy for bacterium to develop drug resistance through 3 simple steps: acquisition by microbes of resistance genes, expression of those resistance genes, and selection for pathogens expressing those resistance genes. The selective pressure in favor of resistance occurs whenever microbes are exposed to a drug but not eradicated, either by the killing effects of the drug itself or by inhibitory effects of the drug followed by killing by the host’s immune system. In any setting that creates this selective pressure in favor of drug resistance, such as poor patient compliance (ie, infrequent dosing, taking an antibiotic for too long as we see with the use of antibiotics for the treatment of inflammatory skin diseases such as acne), the likelihood of that resistance actually developing is increased. In addition, drugs that inhibit but do not kill microbes are more likely to allow some microbial cells to live and therefore develop resistance when exposed to a drug, which accounts for the majority of antibiotics in our armament. Lastly, abuse of broad-spectrum antibiotics has further spurred the emergence of many antibiotic-resistant strains. For instance, Pseudomonas aeruginosa is one of many evolving multidrug-resistant microorganisms that have been collectively coined the “ESKAPE” pathogens (Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, P aeruginosa, Enterobacter species) to emphasize the fact that they “escape” the effects of many antibacterial agents.

All of the above does not take into account the environmental factors that play a role in this resistance. The close quarters, mass/public transportation, and stressful pace of life of urban living not only bring these organisms together to share resistance genes but also increase our susceptibility.

What’s the issue?

We can all do our part in the fight against microbial resistance and join the antimicrobial stewardship. Here are a couple tips for dermatologists:

1. Stop using over-the-counter antibiotic ointment for every biopsy or minor procedure, which is one of the recommendations of the American Academy of Dermatology based on the ABIM Foundation’s Choosing Wisely campaign.
2. Oral and topical antibiotics for inflammatory skin diseases such as acne, rosacea, and hidradenitis suppurativa should only be used temporarily or at subantimicrobial dosing. Always combine a benzoyl peroxide–containing wash with a topical or oral antibiotic to hit the bacteria with multiple mechanisms of antibacterial activity to limit resistance. Don’t use benzoyl peroxide stronger than 2.5% for the face; make sure to wash it off completely to avoid staining your towels, sheets, and clothing.

We can all play our part in the fight against antimicrobial resistance. How do you fight the resistance?

We want to know your views! Tell us what you think.

A convenient, once-daily fixed combination of 0.3% adapalene plus 2.5% benzoyl peroxide gel significantly improved lesion counts over the course of 12 weeks in patients aged 12 years and older with moderate or severe acne.

Investigators enrolled just over 500 patients from 31 sites in the United States and Canada. About half of patients were rated as having severe acne and half as having moderate acne on the investigator’s global assessment (IGA) scale, Dr. Linda F. Stein Gold said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Patients were randomized to three treatment groups: adapalene 0.3%/benzoyl peroxide 2.5% gel (A-BPO-0.3%), adapalene 0.1%/benzoyl peroxide 2.5% (A-BPO-0.1%), or vehicle. Patients in each group had approximately the same total lesion count, and about half in each group had truncal acne lesions, said Dr. Stein Gold, director of clinical research in the department of dermatology at Henry Ford Hospital, Detroit.

Patients were instructed to use their study medications once daily at night after washing with a provided cleanser. They were provided with a standardized moisturizer and cleaners.

Treatment with A-BPO-0.3% was judged as successful (IGA of 1 or almost clear) at 12 weeks in 31% of patients with severe acne. By contrast, 13.3% of patients with severe acne were judged as almost clear. In patients with severe acne, A-BPO-1% was not statistically superior to vehicle (J Drugs Dermatol. 2015 Dec 1;14[12]:1427-35).

“Topical treatment is still the cornerstone of acne therapy, and it is great to have additional options, especially for our more severe acne patients,” Dr. Stein Gold said.

Patients noted dryness, scaling, erythema, and stinging/burning with A-BPO-0.3%, especially between weeks 1 and 2.

Dr. Stein Gold disclosed that she serves as a consultant and scientific advisory board member to Galderma, which markets A-BPO-0.3% as Epiduo Forte.

SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @denisefulton

A convenient, once-daily fixed combination of 0.3% adapalene plus 2.5% benzoyl peroxide gel significantly improved lesion counts over the course of 12 weeks in patients aged 12 years and older with moderate or severe acne.

Investigators enrolled just over 500 patients from 31 sites in the United States and Canada. About half of patients were rated as having severe acne and half as having moderate acne on the investigator’s global assessment (IGA) scale, Dr. Linda F. Stein Gold said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Patients were randomized to three treatment groups: adapalene 0.3%/benzoyl peroxide 2.5% gel (A-BPO-0.3%), adapalene 0.1%/benzoyl peroxide 2.5% (A-BPO-0.1%), or vehicle. Patients in each group had approximately the same total lesion count, and about half in each group had truncal acne lesions, said Dr. Stein Gold, director of clinical research in the department of dermatology at Henry Ford Hospital, Detroit.

Patients were instructed to use their study medications once daily at night after washing with a provided cleanser. They were provided with a standardized moisturizer and cleaners.

Treatment with A-BPO-0.3% was judged as successful (IGA of 1 or almost clear) at 12 weeks in 31% of patients with severe acne. By contrast, 13.3% of patients with severe acne were judged as almost clear. In patients with severe acne, A-BPO-1% was not statistically superior to vehicle (J Drugs Dermatol. 2015 Dec 1;14[12]:1427-35).

“Topical treatment is still the cornerstone of acne therapy, and it is great to have additional options, especially for our more severe acne patients,” Dr. Stein Gold said.

Patients noted dryness, scaling, erythema, and stinging/burning with A-BPO-0.3%, especially between weeks 1 and 2.

Dr. Stein Gold disclosed that she serves as a consultant and scientific advisory board member to Galderma, which markets A-BPO-0.3% as Epiduo Forte.

SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @denisefulton

A convenient, once-daily fixed combination of 0.3% adapalene plus 2.5% benzoyl peroxide gel significantly improved lesion counts over the course of 12 weeks in patients aged 12 years and older with moderate or severe acne.

Investigators enrolled just over 500 patients from 31 sites in the United States and Canada. About half of patients were rated as having severe acne and half as having moderate acne on the investigator’s global assessment (IGA) scale, Dr. Linda F. Stein Gold said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Patients were randomized to three treatment groups: adapalene 0.3%/benzoyl peroxide 2.5% gel (A-BPO-0.3%), adapalene 0.1%/benzoyl peroxide 2.5% (A-BPO-0.1%), or vehicle. Patients in each group had approximately the same total lesion count, and about half in each group had truncal acne lesions, said Dr. Stein Gold, director of clinical research in the department of dermatology at Henry Ford Hospital, Detroit.

Patients were instructed to use their study medications once daily at night after washing with a provided cleanser. They were provided with a standardized moisturizer and cleaners.

Treatment with A-BPO-0.3% was judged as successful (IGA of 1 or almost clear) at 12 weeks in 31% of patients with severe acne. By contrast, 13.3% of patients with severe acne were judged as almost clear. In patients with severe acne, A-BPO-1% was not statistically superior to vehicle (J Drugs Dermatol. 2015 Dec 1;14[12]:1427-35).

“Topical treatment is still the cornerstone of acne therapy, and it is great to have additional options, especially for our more severe acne patients,” Dr. Stein Gold said.

Patients noted dryness, scaling, erythema, and stinging/burning with A-BPO-0.3%, especially between weeks 1 and 2.

Dr. Stein Gold disclosed that she serves as a consultant and scientific advisory board member to Galderma, which markets A-BPO-0.3% as Epiduo Forte.

SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @denisefulton

An increased focus on neurologic symptoms in patients with rosacea may be warranted, according to Danish researchers, who found a significantly increased risk of glioma associated with rosacea, in a nationwide study of Danish citizens.

The observational study followed 5,484,910 Danish adults from January 1997 through December 2011; 68,372 were diagnosed with rosacea, and the remaining 5,416,538 were the reference group. The incidence rate of glioma per 10,000 person-years (adjusted for age, sex, and socioeconomic status) was 3.34 in the reference population, but was 4.99 among those with rosacea, reported Dr. Alexander Egeberg of the department of dermatoallergology, Herlev and Gentofte University Hospital, University of Copenhagen, Hellerup, and his coauthors (JAMA Dermatol. 2016 Jan 27. doi: 10.1001/jamadermatol.2015.5549).

The adjusted incidence rate ratio (IRR) of glioma in patients with rosacea was 1.36 (P less than .001). When the researchers limited the analysis to patients who had been diagnosed by a hospital dermatologist, the adjusted IRR was 1.82. The results remained significant after sensitivity analyses and after adjustment for potential confounders.

M. Sand, et al/Head & face medicine/ISSN 1746-160X/CC BY 2.0

Among the patients with rosacea, men had an increased risk of glioma, compared with women (an incidence rate per 10,000 person-years of 6.45 vs. 4.30), although “gliomas and rosacea were generally more common among women,” the authors reported.

The association might be partially mediated by mechanisms dependent on matrix metalloproteinases (MMPs), the authors said, referring to studies indicating that MMPs, in particular MMP-9, “play a pivotal role in rosacea and regulation of the invasiveness of malignant glioma cells.” While speculative, “mechanisms dependent on MMPs may contribute to the link between rosacea and the risk for glioma,” the investigators added.

An increased focus on neurologic symptoms such as headaches, memory loss, visual symptoms, cognitive decline, and personality changes in patients with rosacea “and timely referral to relevant specialists may be warranted,” they concluded.

Limitations of the study included the observational design, which cannot establish causation, the authors noted. Dr. Egeberg reported being a former employee of Pfizer; one coauthor reported receiving consultancy and/or speaker honoraria from Galderma. The study was supported by an unrestricted grant from the LEO Foundation and the Lundbeck Foundation and an unrestricted research scholarship from the Novo Nordisk Foundation.

An increased focus on neurologic symptoms in patients with rosacea may be warranted, according to Danish researchers, who found a significantly increased risk of glioma associated with rosacea, in a nationwide study of Danish citizens.

The observational study followed 5,484,910 Danish adults from January 1997 through December 2011; 68,372 were diagnosed with rosacea, and the remaining 5,416,538 were the reference group. The incidence rate of glioma per 10,000 person-years (adjusted for age, sex, and socioeconomic status) was 3.34 in the reference population, but was 4.99 among those with rosacea, reported Dr. Alexander Egeberg of the department of dermatoallergology, Herlev and Gentofte University Hospital, University of Copenhagen, Hellerup, and his coauthors (JAMA Dermatol. 2016 Jan 27. doi: 10.1001/jamadermatol.2015.5549).

The adjusted incidence rate ratio (IRR) of glioma in patients with rosacea was 1.36 (P less than .001). When the researchers limited the analysis to patients who had been diagnosed by a hospital dermatologist, the adjusted IRR was 1.82. The results remained significant after sensitivity analyses and after adjustment for potential confounders.

M. Sand, et al/Head & face medicine/ISSN 1746-160X/CC BY 2.0

Among the patients with rosacea, men had an increased risk of glioma, compared with women (an incidence rate per 10,000 person-years of 6.45 vs. 4.30), although “gliomas and rosacea were generally more common among women,” the authors reported.

The association might be partially mediated by mechanisms dependent on matrix metalloproteinases (MMPs), the authors said, referring to studies indicating that MMPs, in particular MMP-9, “play a pivotal role in rosacea and regulation of the invasiveness of malignant glioma cells.” While speculative, “mechanisms dependent on MMPs may contribute to the link between rosacea and the risk for glioma,” the investigators added.

An increased focus on neurologic symptoms such as headaches, memory loss, visual symptoms, cognitive decline, and personality changes in patients with rosacea “and timely referral to relevant specialists may be warranted,” they concluded.

Limitations of the study included the observational design, which cannot establish causation, the authors noted. Dr. Egeberg reported being a former employee of Pfizer; one coauthor reported receiving consultancy and/or speaker honoraria from Galderma. The study was supported by an unrestricted grant from the LEO Foundation and the Lundbeck Foundation and an unrestricted research scholarship from the Novo Nordisk Foundation.

An increased focus on neurologic symptoms in patients with rosacea may be warranted, according to Danish researchers, who found a significantly increased risk of glioma associated with rosacea, in a nationwide study of Danish citizens.

The observational study followed 5,484,910 Danish adults from January 1997 through December 2011; 68,372 were diagnosed with rosacea, and the remaining 5,416,538 were the reference group. The incidence rate of glioma per 10,000 person-years (adjusted for age, sex, and socioeconomic status) was 3.34 in the reference population, but was 4.99 among those with rosacea, reported Dr. Alexander Egeberg of the department of dermatoallergology, Herlev and Gentofte University Hospital, University of Copenhagen, Hellerup, and his coauthors (JAMA Dermatol. 2016 Jan 27. doi: 10.1001/jamadermatol.2015.5549).

The adjusted incidence rate ratio (IRR) of glioma in patients with rosacea was 1.36 (P less than .001). When the researchers limited the analysis to patients who had been diagnosed by a hospital dermatologist, the adjusted IRR was 1.82. The results remained significant after sensitivity analyses and after adjustment for potential confounders.

M. Sand, et al/Head & face medicine/ISSN 1746-160X/CC BY 2.0

Among the patients with rosacea, men had an increased risk of glioma, compared with women (an incidence rate per 10,000 person-years of 6.45 vs. 4.30), although “gliomas and rosacea were generally more common among women,” the authors reported.

The association might be partially mediated by mechanisms dependent on matrix metalloproteinases (MMPs), the authors said, referring to studies indicating that MMPs, in particular MMP-9, “play a pivotal role in rosacea and regulation of the invasiveness of malignant glioma cells.” While speculative, “mechanisms dependent on MMPs may contribute to the link between rosacea and the risk for glioma,” the investigators added.

An increased focus on neurologic symptoms such as headaches, memory loss, visual symptoms, cognitive decline, and personality changes in patients with rosacea “and timely referral to relevant specialists may be warranted,” they concluded.

Limitations of the study included the observational design, which cannot establish causation, the authors noted. Dr. Egeberg reported being a former employee of Pfizer; one coauthor reported receiving consultancy and/or speaker honoraria from Galderma. The study was supported by an unrestricted grant from the LEO Foundation and the Lundbeck Foundation and an unrestricted research scholarship from the Novo Nordisk Foundation.

ORLANDO – When treating rosacea, consider adding cosmeceuticals to more conventional prescriptions and over-the-counter treatments to improve the management of symptoms and patient satisfaction.

The recommendation comes from Dr. Julie Harper, a dermatologist at the University of Alabama-Birmingham, who spoke about the benefits of cosmeceuticals for rosacea at the Orlando Dermatology Aesthetic and Clinical Conference.

“I see about 40 people a day on my regular dermatology days [and] it’s easy to just write a prescription and hand it to that rosacea patient, but you do them a big disservice when you do that,” explained Dr. Harper. “We’ve got to talk about triggers, about skin care, about sun protection, [and] start that discussion from there.”

The most-important point for patients to understand is the main triggers of their rosacea, which can include ultraviolet light, spices, stress, exercise, heat, barrier disruption, and Demodex. Since sunlight is the No. 1 trigger for rosacea, treatment strategies often need to start there and revolve around how to avoid or manage the condition based on sun exposure.

As for cosmeceuticals, Dr. Harper focused on three types that have been shown to be effective against rosacea: niacinamide, licorice, and green tea.

The available data on niacinamide for rosacea are primarily from the 2006 Nicomide Improvement in Clinical Outcomes Study (NICOS), an open-label, multicenter, prospective cohort study that recruited people with acne vulgaris and acne rosacea from 100 centers and administered 750 mg of niacinamide with zinc and copper, while some got niacinamide plus oral antibiotics. The 49 people with rosacea who were enrolled received baseline assessments in the clinic, but 4-week and 8-week follow-ups were done via self-reported surveys (Cutis. 2006 Jan;77[1 Suppl]:17-28).

At 8 weeks, “75% of the rosacea group reported that appearance of their rosacea was moderately or much better [and] that there was also significant reduction in inflammatory lesions,” Dr. Harper said. “There was not a big difference in the group that had an oral antibiotic and niacinamide, versus niacinamide without the oral antibiotic,” although the design of the study leaves the findings somewhat questionable, she noted.

Topical niacinamide also has the potential to benefit certain rosacea patients, she said, referring to a 2005 study examining the effects of a niacinamide-containing moisturizer on the face and one forearm of 50 patients over 4 weeks. The primary outcome of the trial was barrier function, as measured by a dimethyl sulfoxide (DMSO) chemical probe (Cutis. 2005 Aug;76[2]:135-41).

While the results of this trial are “difficult” to interpret – due largely to the lack of any real measurement of facial improvement in barrier function and the confusion over whether any improvement on the forearm can be attributed to the niacinamide specifically or to the moisturizer itself – “long story short, niacinamide did seem to help the barrier function in this particular study,” Dr. Harper said. The takeaway, therefore, is that topical niacinamide treatments may offer some value to certain patients.

Moving on to licorice, Dr. Harper discussed an open label study recently published online in the Journal of the European Academy of Dermatology and Venereology, in which subjects were given a complete skin care system – which contained a cleanser, a day cream, a night cream, and a concealer product containing licochalcone A (licorice extract). They were evaluated over a period of 8 weeks for improvement in erythema, burning, stinging, tingling, and tightness, all of which were measured at baseline (J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:21-7).

Results showed “improvement of statistical significance,” Dr. Harper said. “All groups had improvement over time, and did better at 8 weeks than at 4 weeks [although] the rosacea group did not reach statistical significance until week 8.”

Finally, with green tea, Dr. Harper pointed to a 2010 randomized double-blind split-face study of just four healthy individuals with erythema and telangiectasia of the face, treated for 6 weeks with a cream containing epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, on one side of their face; a vehicle cream was applied to the other side and punch biopsies were performed to determine improvements (Int J Clin Exp Pathol. 2010;3[7]:705-9). EGCG cream was used because of its “antioxidant, immunomodulatory, photoprotective, antiangiogenic – that’s the standout here, that’s what we really need – and anti-inflammatory properties,” Dr. Harper said.

While biopsies did not reveal any changes to facial vasculature, there “was a significant reduction in hypoxia-inducible factor-1 and VEGF [vascular endothelial growth factor],” which are both markers of angiogenesis – indicating some degree of usefulness against rosacea, Dr. Harper said. However, a longer, more definitive study would be needed to substantiate these findings, she added.

Dr. Harper did not report any relevant financial disclosures.

[email protected]

ORLANDO – When treating rosacea, consider adding cosmeceuticals to more conventional prescriptions and over-the-counter treatments to improve the management of symptoms and patient satisfaction.

The recommendation comes from Dr. Julie Harper, a dermatologist at the University of Alabama-Birmingham, who spoke about the benefits of cosmeceuticals for rosacea at the Orlando Dermatology Aesthetic and Clinical Conference.

“I see about 40 people a day on my regular dermatology days [and] it’s easy to just write a prescription and hand it to that rosacea patient, but you do them a big disservice when you do that,” explained Dr. Harper. “We’ve got to talk about triggers, about skin care, about sun protection, [and] start that discussion from there.”

The most-important point for patients to understand is the main triggers of their rosacea, which can include ultraviolet light, spices, stress, exercise, heat, barrier disruption, and Demodex. Since sunlight is the No. 1 trigger for rosacea, treatment strategies often need to start there and revolve around how to avoid or manage the condition based on sun exposure.

As for cosmeceuticals, Dr. Harper focused on three types that have been shown to be effective against rosacea: niacinamide, licorice, and green tea.

The available data on niacinamide for rosacea are primarily from the 2006 Nicomide Improvement in Clinical Outcomes Study (NICOS), an open-label, multicenter, prospective cohort study that recruited people with acne vulgaris and acne rosacea from 100 centers and administered 750 mg of niacinamide with zinc and copper, while some got niacinamide plus oral antibiotics. The 49 people with rosacea who were enrolled received baseline assessments in the clinic, but 4-week and 8-week follow-ups were done via self-reported surveys (Cutis. 2006 Jan;77[1 Suppl]:17-28).

At 8 weeks, “75% of the rosacea group reported that appearance of their rosacea was moderately or much better [and] that there was also significant reduction in inflammatory lesions,” Dr. Harper said. “There was not a big difference in the group that had an oral antibiotic and niacinamide, versus niacinamide without the oral antibiotic,” although the design of the study leaves the findings somewhat questionable, she noted.

Topical niacinamide also has the potential to benefit certain rosacea patients, she said, referring to a 2005 study examining the effects of a niacinamide-containing moisturizer on the face and one forearm of 50 patients over 4 weeks. The primary outcome of the trial was barrier function, as measured by a dimethyl sulfoxide (DMSO) chemical probe (Cutis. 2005 Aug;76[2]:135-41).

While the results of this trial are “difficult” to interpret – due largely to the lack of any real measurement of facial improvement in barrier function and the confusion over whether any improvement on the forearm can be attributed to the niacinamide specifically or to the moisturizer itself – “long story short, niacinamide did seem to help the barrier function in this particular study,” Dr. Harper said. The takeaway, therefore, is that topical niacinamide treatments may offer some value to certain patients.

Moving on to licorice, Dr. Harper discussed an open label study recently published online in the Journal of the European Academy of Dermatology and Venereology, in which subjects were given a complete skin care system – which contained a cleanser, a day cream, a night cream, and a concealer product containing licochalcone A (licorice extract). They were evaluated over a period of 8 weeks for improvement in erythema, burning, stinging, tingling, and tightness, all of which were measured at baseline (J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:21-7).

Results showed “improvement of statistical significance,” Dr. Harper said. “All groups had improvement over time, and did better at 8 weeks than at 4 weeks [although] the rosacea group did not reach statistical significance until week 8.”

Finally, with green tea, Dr. Harper pointed to a 2010 randomized double-blind split-face study of just four healthy individuals with erythema and telangiectasia of the face, treated for 6 weeks with a cream containing epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, on one side of their face; a vehicle cream was applied to the other side and punch biopsies were performed to determine improvements (Int J Clin Exp Pathol. 2010;3[7]:705-9). EGCG cream was used because of its “antioxidant, immunomodulatory, photoprotective, antiangiogenic – that’s the standout here, that’s what we really need – and anti-inflammatory properties,” Dr. Harper said.

While biopsies did not reveal any changes to facial vasculature, there “was a significant reduction in hypoxia-inducible factor-1 and VEGF [vascular endothelial growth factor],” which are both markers of angiogenesis – indicating some degree of usefulness against rosacea, Dr. Harper said. However, a longer, more definitive study would be needed to substantiate these findings, she added.

Dr. Harper did not report any relevant financial disclosures.

[email protected]

ORLANDO – When treating rosacea, consider adding cosmeceuticals to more conventional prescriptions and over-the-counter treatments to improve the management of symptoms and patient satisfaction.

The recommendation comes from Dr. Julie Harper, a dermatologist at the University of Alabama-Birmingham, who spoke about the benefits of cosmeceuticals for rosacea at the Orlando Dermatology Aesthetic and Clinical Conference.

“I see about 40 people a day on my regular dermatology days [and] it’s easy to just write a prescription and hand it to that rosacea patient, but you do them a big disservice when you do that,” explained Dr. Harper. “We’ve got to talk about triggers, about skin care, about sun protection, [and] start that discussion from there.”

The most-important point for patients to understand is the main triggers of their rosacea, which can include ultraviolet light, spices, stress, exercise, heat, barrier disruption, and Demodex. Since sunlight is the No. 1 trigger for rosacea, treatment strategies often need to start there and revolve around how to avoid or manage the condition based on sun exposure.

As for cosmeceuticals, Dr. Harper focused on three types that have been shown to be effective against rosacea: niacinamide, licorice, and green tea.

The available data on niacinamide for rosacea are primarily from the 2006 Nicomide Improvement in Clinical Outcomes Study (NICOS), an open-label, multicenter, prospective cohort study that recruited people with acne vulgaris and acne rosacea from 100 centers and administered 750 mg of niacinamide with zinc and copper, while some got niacinamide plus oral antibiotics. The 49 people with rosacea who were enrolled received baseline assessments in the clinic, but 4-week and 8-week follow-ups were done via self-reported surveys (Cutis. 2006 Jan;77[1 Suppl]:17-28).

At 8 weeks, “75% of the rosacea group reported that appearance of their rosacea was moderately or much better [and] that there was also significant reduction in inflammatory lesions,” Dr. Harper said. “There was not a big difference in the group that had an oral antibiotic and niacinamide, versus niacinamide without the oral antibiotic,” although the design of the study leaves the findings somewhat questionable, she noted.

Topical niacinamide also has the potential to benefit certain rosacea patients, she said, referring to a 2005 study examining the effects of a niacinamide-containing moisturizer on the face and one forearm of 50 patients over 4 weeks. The primary outcome of the trial was barrier function, as measured by a dimethyl sulfoxide (DMSO) chemical probe (Cutis. 2005 Aug;76[2]:135-41).

While the results of this trial are “difficult” to interpret – due largely to the lack of any real measurement of facial improvement in barrier function and the confusion over whether any improvement on the forearm can be attributed to the niacinamide specifically or to the moisturizer itself – “long story short, niacinamide did seem to help the barrier function in this particular study,” Dr. Harper said. The takeaway, therefore, is that topical niacinamide treatments may offer some value to certain patients.

Moving on to licorice, Dr. Harper discussed an open label study recently published online in the Journal of the European Academy of Dermatology and Venereology, in which subjects were given a complete skin care system – which contained a cleanser, a day cream, a night cream, and a concealer product containing licochalcone A (licorice extract). They were evaluated over a period of 8 weeks for improvement in erythema, burning, stinging, tingling, and tightness, all of which were measured at baseline (J Eur Acad Dermatol Venereol. 2016 Feb;30 Suppl 1:21-7).

Results showed “improvement of statistical significance,” Dr. Harper said. “All groups had improvement over time, and did better at 8 weeks than at 4 weeks [although] the rosacea group did not reach statistical significance until week 8.”

Finally, with green tea, Dr. Harper pointed to a 2010 randomized double-blind split-face study of just four healthy individuals with erythema and telangiectasia of the face, treated for 6 weeks with a cream containing epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, on one side of their face; a vehicle cream was applied to the other side and punch biopsies were performed to determine improvements (Int J Clin Exp Pathol. 2010;3[7]:705-9). EGCG cream was used because of its “antioxidant, immunomodulatory, photoprotective, antiangiogenic – that’s the standout here, that’s what we really need – and anti-inflammatory properties,” Dr. Harper said.

While biopsies did not reveal any changes to facial vasculature, there “was a significant reduction in hypoxia-inducible factor-1 and VEGF [vascular endothelial growth factor],” which are both markers of angiogenesis – indicating some degree of usefulness against rosacea, Dr. Harper said. However, a longer, more definitive study would be needed to substantiate these findings, she added.

Dr. Harper did not report any relevant financial disclosures.

[email protected]

ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.

This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.

While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”

The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.

For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.

“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”

There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.

For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).

Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.

“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.

Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.

Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.

She did not report any relevant financial disclosures.

[email protected]

ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.

This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.

While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”

The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.

For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.

“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”

There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.

For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).

Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.

“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.

Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.

Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.

She did not report any relevant financial disclosures.

[email protected]

ORLANDO – The increasingly popular role of cosmeceuticals in treating acne has created some confusion among both dermatologists and their patients as to what’s really effective and worth recommending.

This was the focus of a presentation at the Orlando Dermatology Aesthetic and Clinical Conference by Dr. Hilary E. Baldwin, who reviewed the cosmeceuticals most likely to make a clinical impact on patients with acne.

While there are no definitive data that prove that cosmeceuticals are the most effective means of managing acne, “sometimes cosmeceuticals may actually be helpful as adjunctive therapy,” said Dr. Baldwin, vice chair of dermatology at the State University of New York at Brooklyn. “Compared to prescription medications, I think these are just a drop in the bucket, but they’re a drop in the right direction.”

The main benefit of using cosmeceuticals for acne is to improve the barrier function of the skin. With increasing evidence that acne either causes or is caused by barrier defects, cosmeceuticals can be used, at the very least, as “extraordinarily well-made moisturizers,” according to Dr. Baldwin. In addition, because moisturizers are anti-inflammatory, they can improve the tolerability of other topical treatments dermatologists recommend to their patients, both prescription and over-the-counter.

For reducing Propionibacterium acnes, consider tea tree oil and lily leaf oil, both of which have a small but promising amount of clinical data behind them. For tea tree oil, Dr. Baldwin referred to a randomized study of 124 patients, which compared 5% tea tree oil gel with 5% benzoyl peroxide for treatment of mild to moderate acne (Med J Aust. 1990 Oct 15;153[8]:455-8). The study found that although the onset of action was slower for tea tree oil, overall it had a significant effect in improving acne in the patients, by reducing the number of inflamed and non-inflamed lesions.

“Both of them worked, but benzoyl peroxide was statistically better,” Dr. Baldwin said. “There were fewer side effects in the tea tree oil group, with less people complaining about skin discomfort.”

There are less data regarding lily leaf extract, however, with only one study she said was worth mentioning: a 4-week trial comparing lily leaf extract and 5% benzoyl peroxide that was “so complicated, and had so many arms, that they ended up having only 4-5 patients in each arm, so I don’t think they can conclude anything,” she remarked.

For management of acne-related inflammation, there is good evidence to suggest botanicals are an effective treatment. A double-blind, randomized, 12-week study coauthored by Dr. Baldwin found that in a cohort of 80 patients, benzoyl peroxide and salicylic acid were more effective when combined with botanical extracts than when used on their own (Semin Cutan Med Surg. 2015 Sep;34[5S]:S82-S85).

Furthermore, explained Dr. Baldwin, “evidence suggests that patients were also using [the botanical extract treatment] more because there was a preference for that,” indicating the increasing desire for more natural, cosmeceutical approaches to treating skin ailments by the general public.

“[Cosmeceuticals] appeal to this increasingly mature and demanding acne patient population,” she said. “[Patients] have a preference for a natural approach to skin disease, they believe that strengthening the host is more important than killing a pathogen, they think [cosmeceuticals] have less of a potential for side effects, and it also gives [patients] a sense of control, which attenuates some of the psychological sequelae of acne.

Dr. Baldwin also recommended oatmeal-based cosmeceuticals for their potential benefit in barrier repair, licorice-based cosmeceuticals for their ability to reduce both postinflammatory hyperpigmentation and post inflammatory erythema, and niacinamide. Niacinamide has been shown to reduce postinflammatory hyperpigmentation when used with other treatment options.

Dr. Baldwin emphasized, however, that cosmeceuticals should always be considered as a supplement to other, ongoing treatments, not the main treatment for acne.

She did not report any relevant financial disclosures.

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GRAND CAYMAN – What impact do treatments for gastroesophageal reflux disease (GERD), hypertension, hyperlipidemia, and menopausal flushing have in patients with erythematotelangiectatic and papulopustular rosacea?

In a video interview at the Caribbean Dermatology Symposium, Dr. Jonathan K. Wilkin, who is in private practice in Grand Cayman and is a former director of the Food and Drug Administration’s Division of Dermatologic and Dental Drug Products, refers to recent studies that have linked rosacea to these and other comorbidities. He shares his insights into how addressing these four comorbidities into your treatment calculus can improve outcomes in patients who have rosacea with flushing.

The meeting is provided by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN – What impact do treatments for gastroesophageal reflux disease (GERD), hypertension, hyperlipidemia, and menopausal flushing have in patients with erythematotelangiectatic and papulopustular rosacea?

In a video interview at the Caribbean Dermatology Symposium, Dr. Jonathan K. Wilkin, who is in private practice in Grand Cayman and is a former director of the Food and Drug Administration’s Division of Dermatologic and Dental Drug Products, refers to recent studies that have linked rosacea to these and other comorbidities. He shares his insights into how addressing these four comorbidities into your treatment calculus can improve outcomes in patients who have rosacea with flushing.

The meeting is provided by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN – What impact do treatments for gastroesophageal reflux disease (GERD), hypertension, hyperlipidemia, and menopausal flushing have in patients with erythematotelangiectatic and papulopustular rosacea?

In a video interview at the Caribbean Dermatology Symposium, Dr. Jonathan K. Wilkin, who is in private practice in Grand Cayman and is a former director of the Food and Drug Administration’s Division of Dermatologic and Dental Drug Products, refers to recent studies that have linked rosacea to these and other comorbidities. He shares his insights into how addressing these four comorbidities into your treatment calculus can improve outcomes in patients who have rosacea with flushing.

The meeting is provided by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

A new survey from the National Rosacea Society of 794 rosacea patients revealed that the majority of respondents indicated the disease had affected interactions with others in the workplace. More than 82% of respondents said they would notice people staring when they were experiencing a flare-up, and nearly 54% reported hearing rude or inappropriate comments about their facial appearance. More than 66% of the survey respondents said rosacea had negatively impacted interactions with customers or coworkers. Twenty-nine percent of patients with mild symptoms and 43% of those with severe symptoms reported they had missed work because of the condition.

Although rosacea may impact workplace interactions, 76.5% of respondents did not feel their appearance had cost them a promotion or new responsibilities, and 77.5% indicated that it had not kept them from landing a new job. Most respondents indicated that workplace problems were resolved when medical therapy was started, with nearly 67% reporting that effective treatment had improved their interactions with others at work.

In a January 2015 Cutis article, “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences,” Kuo and colleagues discussed how patients can be educated to prepare for the rosacea patient experience. “Rosacea patients are faced with confusing and aggravating symptoms that can cause anxiety and may lead them to seek treatment from a physician,” the authors said. Rosacea can be a socially stigmatizing disease because the facial flushing and phymatous changes may be mistaken for alcohol abuse. It can also disrupt social and professional interactions, leading to quality-of-life effects such as difficulty functioning on a day-to-day basis.

Because there is no cure for rosacea, the patient and dermatologist must work together to devise a treatment plan that will help control the symptoms of rosacea. “Ultimately, with the alleviation of visible symptoms, the patient’s quality of life also can improve,” Kuo and colleagues reported. “Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.”

Share a copy of the Cutis rosacea patient journey guide with your patients today. 

A new survey from the National Rosacea Society of 794 rosacea patients revealed that the majority of respondents indicated the disease had affected interactions with others in the workplace. More than 82% of respondents said they would notice people staring when they were experiencing a flare-up, and nearly 54% reported hearing rude or inappropriate comments about their facial appearance. More than 66% of the survey respondents said rosacea had negatively impacted interactions with customers or coworkers. Twenty-nine percent of patients with mild symptoms and 43% of those with severe symptoms reported they had missed work because of the condition.

Although rosacea may impact workplace interactions, 76.5% of respondents did not feel their appearance had cost them a promotion or new responsibilities, and 77.5% indicated that it had not kept them from landing a new job. Most respondents indicated that workplace problems were resolved when medical therapy was started, with nearly 67% reporting that effective treatment had improved their interactions with others at work.

In a January 2015 Cutis article, “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences,” Kuo and colleagues discussed how patients can be educated to prepare for the rosacea patient experience. “Rosacea patients are faced with confusing and aggravating symptoms that can cause anxiety and may lead them to seek treatment from a physician,” the authors said. Rosacea can be a socially stigmatizing disease because the facial flushing and phymatous changes may be mistaken for alcohol abuse. It can also disrupt social and professional interactions, leading to quality-of-life effects such as difficulty functioning on a day-to-day basis.

Because there is no cure for rosacea, the patient and dermatologist must work together to devise a treatment plan that will help control the symptoms of rosacea. “Ultimately, with the alleviation of visible symptoms, the patient’s quality of life also can improve,” Kuo and colleagues reported. “Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.”

Share a copy of the Cutis rosacea patient journey guide with your patients today. 

A new survey from the National Rosacea Society of 794 rosacea patients revealed that the majority of respondents indicated the disease had affected interactions with others in the workplace. More than 82% of respondents said they would notice people staring when they were experiencing a flare-up, and nearly 54% reported hearing rude or inappropriate comments about their facial appearance. More than 66% of the survey respondents said rosacea had negatively impacted interactions with customers or coworkers. Twenty-nine percent of patients with mild symptoms and 43% of those with severe symptoms reported they had missed work because of the condition.

Although rosacea may impact workplace interactions, 76.5% of respondents did not feel their appearance had cost them a promotion or new responsibilities, and 77.5% indicated that it had not kept them from landing a new job. Most respondents indicated that workplace problems were resolved when medical therapy was started, with nearly 67% reporting that effective treatment had improved their interactions with others at work.

In a January 2015 Cutis article, “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences,” Kuo and colleagues discussed how patients can be educated to prepare for the rosacea patient experience. “Rosacea patients are faced with confusing and aggravating symptoms that can cause anxiety and may lead them to seek treatment from a physician,” the authors said. Rosacea can be a socially stigmatizing disease because the facial flushing and phymatous changes may be mistaken for alcohol abuse. It can also disrupt social and professional interactions, leading to quality-of-life effects such as difficulty functioning on a day-to-day basis.

Because there is no cure for rosacea, the patient and dermatologist must work together to devise a treatment plan that will help control the symptoms of rosacea. “Ultimately, with the alleviation of visible symptoms, the patient’s quality of life also can improve,” Kuo and colleagues reported. “Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.”

Share a copy of the Cutis rosacea patient journey guide with your patients today.