Rosacea

Patients with rosacea are more likely than others to have dyslipidemia and hypertension, and they are at increased risk for coronary artery disease independently of cardiovascular risk factors, according to a report published in the Journal of the American Academy of Dermatology.

Rosacea, characterized by central facial erythema, visible blood vessels, papules, and pustules, is considered to be a chronic inflammatory disease even though its precise pathophysiology is not yet understood. A recent small study suggested that patients with rosacea might be at higher than average risk for cardiovascular diseases. To investigate this possibility, researchers in Taiwan performed a nationwide population-based case-control study using information from a health insurance database covering virtually 100% of the country’s population.

The investigators identified all 33,553 adults in Taiwan diagnosed as having rosacea in 1997-2010, and matched them for age and gender with 67,106 control subjects who did not have the disease. Patients were significantly more likely than controls to have dyslipidemia (OR, 1.41) and hypertension (OR, 1.17). After the data were adjusted to control for these and other cardiovascular risk factors, rosacea patients still were at significantly increased risk for CAD (OR, 1.20), said Dr. Tuan-Chun Hua, of the department of dermatology, National Taiwan University Hospital, National Yang-Ming University, and Taipei Medical University, all in Taipei, and associates.

Men with rosacea also were at significantly increased risk for diabetes, peripheral artery occlusive disease, and cerebral infarction, but women were not, Dr. Hua and associates said (J. Amer. Acad. Dermatol. 2015; [http://dx.doi.org/10.1016/j.jaad.2015.04.028]).

“The inflammatory nature of rosacea may be the reason for these associations, they wrote. “Clinicians should be alert to cardiovascular comorbidities in patients with rosacea.”

This study was supported by the Taipei Veterans General Hospital. Dr. Hua and associates reported having no financial conflicts of interest.

Patients with rosacea are more likely than others to have dyslipidemia and hypertension, and they are at increased risk for coronary artery disease independently of cardiovascular risk factors, according to a report published in the Journal of the American Academy of Dermatology.

Rosacea, characterized by central facial erythema, visible blood vessels, papules, and pustules, is considered to be a chronic inflammatory disease even though its precise pathophysiology is not yet understood. A recent small study suggested that patients with rosacea might be at higher than average risk for cardiovascular diseases. To investigate this possibility, researchers in Taiwan performed a nationwide population-based case-control study using information from a health insurance database covering virtually 100% of the country’s population.

The investigators identified all 33,553 adults in Taiwan diagnosed as having rosacea in 1997-2010, and matched them for age and gender with 67,106 control subjects who did not have the disease. Patients were significantly more likely than controls to have dyslipidemia (OR, 1.41) and hypertension (OR, 1.17). After the data were adjusted to control for these and other cardiovascular risk factors, rosacea patients still were at significantly increased risk for CAD (OR, 1.20), said Dr. Tuan-Chun Hua, of the department of dermatology, National Taiwan University Hospital, National Yang-Ming University, and Taipei Medical University, all in Taipei, and associates.

Men with rosacea also were at significantly increased risk for diabetes, peripheral artery occlusive disease, and cerebral infarction, but women were not, Dr. Hua and associates said (J. Amer. Acad. Dermatol. 2015; [http://dx.doi.org/10.1016/j.jaad.2015.04.028]).

“The inflammatory nature of rosacea may be the reason for these associations, they wrote. “Clinicians should be alert to cardiovascular comorbidities in patients with rosacea.”

This study was supported by the Taipei Veterans General Hospital. Dr. Hua and associates reported having no financial conflicts of interest.

Patients with rosacea are more likely than others to have dyslipidemia and hypertension, and they are at increased risk for coronary artery disease independently of cardiovascular risk factors, according to a report published in the Journal of the American Academy of Dermatology.

Rosacea, characterized by central facial erythema, visible blood vessels, papules, and pustules, is considered to be a chronic inflammatory disease even though its precise pathophysiology is not yet understood. A recent small study suggested that patients with rosacea might be at higher than average risk for cardiovascular diseases. To investigate this possibility, researchers in Taiwan performed a nationwide population-based case-control study using information from a health insurance database covering virtually 100% of the country’s population.

The investigators identified all 33,553 adults in Taiwan diagnosed as having rosacea in 1997-2010, and matched them for age and gender with 67,106 control subjects who did not have the disease. Patients were significantly more likely than controls to have dyslipidemia (OR, 1.41) and hypertension (OR, 1.17). After the data were adjusted to control for these and other cardiovascular risk factors, rosacea patients still were at significantly increased risk for CAD (OR, 1.20), said Dr. Tuan-Chun Hua, of the department of dermatology, National Taiwan University Hospital, National Yang-Ming University, and Taipei Medical University, all in Taipei, and associates.

Men with rosacea also were at significantly increased risk for diabetes, peripheral artery occlusive disease, and cerebral infarction, but women were not, Dr. Hua and associates said (J. Amer. Acad. Dermatol. 2015; [http://dx.doi.org/10.1016/j.jaad.2015.04.028]).

“The inflammatory nature of rosacea may be the reason for these associations, they wrote. “Clinicians should be alert to cardiovascular comorbidities in patients with rosacea.”

This study was supported by the Taipei Veterans General Hospital. Dr. Hua and associates reported having no financial conflicts of interest.

VANCOUVER, B.C. – A persuasive case can be made for ivermectin 1% cream as the new treatment of choice for papulopustular rosacea, Dr. Leon Kircik asserted at the World Congress of Dermatology.

He cited the results of a large recent head-to-head randomized trial in which ivermectin 1% cream (Soolantra), approved last December by the Food and Drug Administration, proved superior to metronidazole 0.75% cream (Metrocream), which is the market leader and until now the topical agent most physicians have considered their first-line treatment for papulopustular rosacea.

Bruce Jancin/Frontline Medical News

The study, known as ATTRACT (Assessment of a Topical Treatment in Rosacea: Activity, Compliance, Tolerability), was a 962-patient, phase III, single-blind, European randomized trial. Ivermectin demonstrated faster onset of action, a greater clinical success rate, delayed time to relapse following treatment discontinuation, a lower relapse rate, and better tolerability (Br. J. Dermatol. 2015;172:1103-10).

Dr. Kircik, a Louisville dermatologist in private practice, and a clinical trialist, was not involved in the ATTRACT study but was impressed that it was undertaken by Galderma, which markets both drugs.

“We don’t get many head-to-head studies in dermatology. Those are typically studies no one wants to sponsor. And most of what few head-to-head studies are done are designed as noninferiority studies. In this case, ATTRACT was designed as a superiority study. That’s a higher bar to reach,” noted Dr. Kircik, a consultant to, and member of the speakers bureau for, Galderma and other pharmaceutical companies.

ATTRACT was a two-part study. In part A, 962 patients with moderate to severe rosacea were randomized to ivermectin 1% cream once daily or metronidazole 0.75% cream b.i.d. for 16 weeks. As early as the first assessment at 3 weeks, a significant difference in favor of ivermectin was evident in terms of reduction in inflammatory lesion count. At week 16, the ivermectin group showed an 83% reduction from baseline in inflammatory lesions, significantly better than the 73.7% reduction with metronidazole. Moreover, 84.9% of the ivermectin group was rated clear or almost clear by Investigator’s Global Assessment (IGA) compared with 75.4% of the metronidazole group.

In addition, 34.9% of ivermectin-treated patients achieved an IGA of 0 by 16 weeks, meaning they were totally lesion free, compared with 21.7% of the metronidazole group. That “completely clear” status is really important psychosocially to a significant proportion of patients, said Dr. Kircik.

“How many times have you had a patient come in asking for an intralesional steroid injection for their single remaining lesion after months of topical treatment?” he asked rhetorically.

Ivermectin was better tolerated than was metronidazole. The rate of treatment-related adverse events leading to discontinuation – typically for skin irritation, redness, or itching – was 0.6% in the ivermectin group compared with 2.1% with metronidazole.

Part B of the ATTRACT study was an unusually designed 36-week extension study.

“In my mind, part B is much more important and much more relevant because rosacea is a chronic disease. It doesn’t last for just 16 weeks. Part B asks what happens after we stop therapy. This is the rare clinical trial that actually mimics real life,” Dr. Kircik said.

Despite physicians’ standard advice to continue with maintenance therapy after clearing, the reality is that most patients stop treatment once they clear, figuring they’ll resume if they relapse, he asserted. Part B of ATTRACT reflected that approach. Seven hundred fifty-seven patients who were clear/almost clear as defined by an IGA of 0/1 at the end of 16 weeks enrolled in the 36-week extension study. They surrendered their medication and returned to their physician monthly. If they had relapsed during that month, meaning they showed up with an IGA of 2 or more, they got their medication back; if they were still IGA 0/1, they did not.

The median time to relapse off treatment in the ivermectin group was 115 days, a full month later than the 85 days for the metronidazole group. Also, the relapse rate in the ivermectin group was significantly lower: 62.7% compared with 68.4% in the metronidazole group.

“The impact on both clinical practice and pharmacoeconomic practice is huge here. It makes sense to switch from metronidazole to ivermectin as first-line therapy because you know that your patients will do better and will relapse later and less,” Dr. Kircik declared.

He was a coinvestigator in the twin pivotal phase III randomized Galderma-funded trials that led to FDA approval of ivermectin for papulopustular rosacea. Although those studies have been published (J. Drugs Dermatol. 2014;13:1380-6), Dr. Kircik highlighted a couple of findings he said haven’t drawn the attention they deserve. Both came from the long-term 40-week extension that followed the initial 12-week, double-blind stage.

One of these underappreciated findings concerned safety. The rate of treatment-related dermatologic adverse events during the double-blind first 3 months of the study was 2.5% in the ivermectin group compared with 6.3% in vehicle-treated controls.

“That’s pretty impressive. That the active treatment arm of the study had less treatment-related dermatologic adverse events than placebo has never been seen before in any other topical study. It tells you something: The assumption here is that the potent inherent anti-inflammatory activity of ivermectin is overwhelming,” the dermatologist said.

The other particularly noteworthy finding came in the long-term, 40-week extension study that followed the initial 12-week, double-blind stage. What was impressive here was the way the proportion of patients who were IGA clear/almost clear rose steadily throughout, he noted. At the end of the initial 3-month phase of the two studies, 38%-40% of ivermectin-treated patients were clear/almost clear. At 12 months, nearly 70% were.

“In most studies, efficacy sort of plateaus at some point. Here it keeps going up through 12 months. So if somebody comes to your office after 3 months using ivermectin and says, ‘Eh, I’m okay, but I’m not clear or almost clear,’ there’s no reason to switch to another medication, because if they continue you know there’s a high chance they will become clear/almost clear,” Dr. Kircik said.

On the other hand, study participants who were still IGA ‘severe’ after 3 months remained severe after 12 months on the drug. So the message here is if a patient still has severe rosacea after 3 months on ivermectin it’s time to change drugs, he added.

[email protected]

VANCOUVER, B.C. – A persuasive case can be made for ivermectin 1% cream as the new treatment of choice for papulopustular rosacea, Dr. Leon Kircik asserted at the World Congress of Dermatology.

He cited the results of a large recent head-to-head randomized trial in which ivermectin 1% cream (Soolantra), approved last December by the Food and Drug Administration, proved superior to metronidazole 0.75% cream (Metrocream), which is the market leader and until now the topical agent most physicians have considered their first-line treatment for papulopustular rosacea.

Bruce Jancin/Frontline Medical News

The study, known as ATTRACT (Assessment of a Topical Treatment in Rosacea: Activity, Compliance, Tolerability), was a 962-patient, phase III, single-blind, European randomized trial. Ivermectin demonstrated faster onset of action, a greater clinical success rate, delayed time to relapse following treatment discontinuation, a lower relapse rate, and better tolerability (Br. J. Dermatol. 2015;172:1103-10).

Dr. Kircik, a Louisville dermatologist in private practice, and a clinical trialist, was not involved in the ATTRACT study but was impressed that it was undertaken by Galderma, which markets both drugs.

“We don’t get many head-to-head studies in dermatology. Those are typically studies no one wants to sponsor. And most of what few head-to-head studies are done are designed as noninferiority studies. In this case, ATTRACT was designed as a superiority study. That’s a higher bar to reach,” noted Dr. Kircik, a consultant to, and member of the speakers bureau for, Galderma and other pharmaceutical companies.

ATTRACT was a two-part study. In part A, 962 patients with moderate to severe rosacea were randomized to ivermectin 1% cream once daily or metronidazole 0.75% cream b.i.d. for 16 weeks. As early as the first assessment at 3 weeks, a significant difference in favor of ivermectin was evident in terms of reduction in inflammatory lesion count. At week 16, the ivermectin group showed an 83% reduction from baseline in inflammatory lesions, significantly better than the 73.7% reduction with metronidazole. Moreover, 84.9% of the ivermectin group was rated clear or almost clear by Investigator’s Global Assessment (IGA) compared with 75.4% of the metronidazole group.

In addition, 34.9% of ivermectin-treated patients achieved an IGA of 0 by 16 weeks, meaning they were totally lesion free, compared with 21.7% of the metronidazole group. That “completely clear” status is really important psychosocially to a significant proportion of patients, said Dr. Kircik.

“How many times have you had a patient come in asking for an intralesional steroid injection for their single remaining lesion after months of topical treatment?” he asked rhetorically.

Ivermectin was better tolerated than was metronidazole. The rate of treatment-related adverse events leading to discontinuation – typically for skin irritation, redness, or itching – was 0.6% in the ivermectin group compared with 2.1% with metronidazole.

Part B of the ATTRACT study was an unusually designed 36-week extension study.

“In my mind, part B is much more important and much more relevant because rosacea is a chronic disease. It doesn’t last for just 16 weeks. Part B asks what happens after we stop therapy. This is the rare clinical trial that actually mimics real life,” Dr. Kircik said.

Despite physicians’ standard advice to continue with maintenance therapy after clearing, the reality is that most patients stop treatment once they clear, figuring they’ll resume if they relapse, he asserted. Part B of ATTRACT reflected that approach. Seven hundred fifty-seven patients who were clear/almost clear as defined by an IGA of 0/1 at the end of 16 weeks enrolled in the 36-week extension study. They surrendered their medication and returned to their physician monthly. If they had relapsed during that month, meaning they showed up with an IGA of 2 or more, they got their medication back; if they were still IGA 0/1, they did not.

The median time to relapse off treatment in the ivermectin group was 115 days, a full month later than the 85 days for the metronidazole group. Also, the relapse rate in the ivermectin group was significantly lower: 62.7% compared with 68.4% in the metronidazole group.

“The impact on both clinical practice and pharmacoeconomic practice is huge here. It makes sense to switch from metronidazole to ivermectin as first-line therapy because you know that your patients will do better and will relapse later and less,” Dr. Kircik declared.

He was a coinvestigator in the twin pivotal phase III randomized Galderma-funded trials that led to FDA approval of ivermectin for papulopustular rosacea. Although those studies have been published (J. Drugs Dermatol. 2014;13:1380-6), Dr. Kircik highlighted a couple of findings he said haven’t drawn the attention they deserve. Both came from the long-term 40-week extension that followed the initial 12-week, double-blind stage.

One of these underappreciated findings concerned safety. The rate of treatment-related dermatologic adverse events during the double-blind first 3 months of the study was 2.5% in the ivermectin group compared with 6.3% in vehicle-treated controls.

“That’s pretty impressive. That the active treatment arm of the study had less treatment-related dermatologic adverse events than placebo has never been seen before in any other topical study. It tells you something: The assumption here is that the potent inherent anti-inflammatory activity of ivermectin is overwhelming,” the dermatologist said.

The other particularly noteworthy finding came in the long-term, 40-week extension study that followed the initial 12-week, double-blind stage. What was impressive here was the way the proportion of patients who were IGA clear/almost clear rose steadily throughout, he noted. At the end of the initial 3-month phase of the two studies, 38%-40% of ivermectin-treated patients were clear/almost clear. At 12 months, nearly 70% were.

“In most studies, efficacy sort of plateaus at some point. Here it keeps going up through 12 months. So if somebody comes to your office after 3 months using ivermectin and says, ‘Eh, I’m okay, but I’m not clear or almost clear,’ there’s no reason to switch to another medication, because if they continue you know there’s a high chance they will become clear/almost clear,” Dr. Kircik said.

On the other hand, study participants who were still IGA ‘severe’ after 3 months remained severe after 12 months on the drug. So the message here is if a patient still has severe rosacea after 3 months on ivermectin it’s time to change drugs, he added.

[email protected]

VANCOUVER, B.C. – A persuasive case can be made for ivermectin 1% cream as the new treatment of choice for papulopustular rosacea, Dr. Leon Kircik asserted at the World Congress of Dermatology.

He cited the results of a large recent head-to-head randomized trial in which ivermectin 1% cream (Soolantra), approved last December by the Food and Drug Administration, proved superior to metronidazole 0.75% cream (Metrocream), which is the market leader and until now the topical agent most physicians have considered their first-line treatment for papulopustular rosacea.

Bruce Jancin/Frontline Medical News

The study, known as ATTRACT (Assessment of a Topical Treatment in Rosacea: Activity, Compliance, Tolerability), was a 962-patient, phase III, single-blind, European randomized trial. Ivermectin demonstrated faster onset of action, a greater clinical success rate, delayed time to relapse following treatment discontinuation, a lower relapse rate, and better tolerability (Br. J. Dermatol. 2015;172:1103-10).

Dr. Kircik, a Louisville dermatologist in private practice, and a clinical trialist, was not involved in the ATTRACT study but was impressed that it was undertaken by Galderma, which markets both drugs.

“We don’t get many head-to-head studies in dermatology. Those are typically studies no one wants to sponsor. And most of what few head-to-head studies are done are designed as noninferiority studies. In this case, ATTRACT was designed as a superiority study. That’s a higher bar to reach,” noted Dr. Kircik, a consultant to, and member of the speakers bureau for, Galderma and other pharmaceutical companies.

ATTRACT was a two-part study. In part A, 962 patients with moderate to severe rosacea were randomized to ivermectin 1% cream once daily or metronidazole 0.75% cream b.i.d. for 16 weeks. As early as the first assessment at 3 weeks, a significant difference in favor of ivermectin was evident in terms of reduction in inflammatory lesion count. At week 16, the ivermectin group showed an 83% reduction from baseline in inflammatory lesions, significantly better than the 73.7% reduction with metronidazole. Moreover, 84.9% of the ivermectin group was rated clear or almost clear by Investigator’s Global Assessment (IGA) compared with 75.4% of the metronidazole group.

In addition, 34.9% of ivermectin-treated patients achieved an IGA of 0 by 16 weeks, meaning they were totally lesion free, compared with 21.7% of the metronidazole group. That “completely clear” status is really important psychosocially to a significant proportion of patients, said Dr. Kircik.

“How many times have you had a patient come in asking for an intralesional steroid injection for their single remaining lesion after months of topical treatment?” he asked rhetorically.

Ivermectin was better tolerated than was metronidazole. The rate of treatment-related adverse events leading to discontinuation – typically for skin irritation, redness, or itching – was 0.6% in the ivermectin group compared with 2.1% with metronidazole.

Part B of the ATTRACT study was an unusually designed 36-week extension study.

“In my mind, part B is much more important and much more relevant because rosacea is a chronic disease. It doesn’t last for just 16 weeks. Part B asks what happens after we stop therapy. This is the rare clinical trial that actually mimics real life,” Dr. Kircik said.

Despite physicians’ standard advice to continue with maintenance therapy after clearing, the reality is that most patients stop treatment once they clear, figuring they’ll resume if they relapse, he asserted. Part B of ATTRACT reflected that approach. Seven hundred fifty-seven patients who were clear/almost clear as defined by an IGA of 0/1 at the end of 16 weeks enrolled in the 36-week extension study. They surrendered their medication and returned to their physician monthly. If they had relapsed during that month, meaning they showed up with an IGA of 2 or more, they got their medication back; if they were still IGA 0/1, they did not.

The median time to relapse off treatment in the ivermectin group was 115 days, a full month later than the 85 days for the metronidazole group. Also, the relapse rate in the ivermectin group was significantly lower: 62.7% compared with 68.4% in the metronidazole group.

“The impact on both clinical practice and pharmacoeconomic practice is huge here. It makes sense to switch from metronidazole to ivermectin as first-line therapy because you know that your patients will do better and will relapse later and less,” Dr. Kircik declared.

He was a coinvestigator in the twin pivotal phase III randomized Galderma-funded trials that led to FDA approval of ivermectin for papulopustular rosacea. Although those studies have been published (J. Drugs Dermatol. 2014;13:1380-6), Dr. Kircik highlighted a couple of findings he said haven’t drawn the attention they deserve. Both came from the long-term 40-week extension that followed the initial 12-week, double-blind stage.

One of these underappreciated findings concerned safety. The rate of treatment-related dermatologic adverse events during the double-blind first 3 months of the study was 2.5% in the ivermectin group compared with 6.3% in vehicle-treated controls.

“That’s pretty impressive. That the active treatment arm of the study had less treatment-related dermatologic adverse events than placebo has never been seen before in any other topical study. It tells you something: The assumption here is that the potent inherent anti-inflammatory activity of ivermectin is overwhelming,” the dermatologist said.

The other particularly noteworthy finding came in the long-term, 40-week extension study that followed the initial 12-week, double-blind stage. What was impressive here was the way the proportion of patients who were IGA clear/almost clear rose steadily throughout, he noted. At the end of the initial 3-month phase of the two studies, 38%-40% of ivermectin-treated patients were clear/almost clear. At 12 months, nearly 70% were.

“In most studies, efficacy sort of plateaus at some point. Here it keeps going up through 12 months. So if somebody comes to your office after 3 months using ivermectin and says, ‘Eh, I’m okay, but I’m not clear or almost clear,’ there’s no reason to switch to another medication, because if they continue you know there’s a high chance they will become clear/almost clear,” Dr. Kircik said.

On the other hand, study participants who were still IGA ‘severe’ after 3 months remained severe after 12 months on the drug. So the message here is if a patient still has severe rosacea after 3 months on ivermectin it’s time to change drugs, he added.

[email protected]

VANCOUVER, B.C. – Mounting evidence suggests that consuming a low glycemic index diet can substantially improve acne, according to Dr. Hyuck Hoon Kwon.

The approach has held up in several small-scale randomized clinical trials, earning it a grade of 1B last year from the American Academy of Dermatology, noted Dr. Kwon of Seoul National University in South Korea.

“Dermatologists can recommend dietary modification to patients, and can advise them to avoid foods that they believe worsen their acne,” Dr. Kwon said at the World Congress of Dermatology. He said he has seen clinically meaningful reductions in acne lesions as soon as 4 weeks after patients cut their intake of refined carbohydrates and other high glycemic index (GI) foods, although results can take up to 12 weeks, and more studies of time to effect are needed.

Scientists and clinicians have long debated the role of diet in the pathogenesis of acne, and until recently, there were no randomized, controlled trials or meta-analyses of the topic. But observational studies have repeatedly documented “astonishingly” low rates of acne in cultures with “traditional” diets that are lower in refined carbohydrates and fat than typical Western fare, said Dr. Kwon.

pedphoto36pm/Thinkstock.com

In one study of 1,285 individuals in Korea, those who did not have acne reported consuming significantly higher amounts of fish and yellow, leafy green, and cruciferous vegetables, while those with acne ate significantly more instant noodles, processed cheeses, and “junk” foods, he noted (Eur. J. Dermatol. 2010;20:768-72).

In another trial, Dr. Kwon and colleagues randomized 32 individuals with mild to moderate acne to either a low-GI diet that emphasized beans, barley, vegetables, fish, and whole-grain breads, or to a high-GI control diet (Acta Derm. Venereol. 2012;92:241-6). The low-GI group ate more protein to replace calories lost from cutting carbohydrates. At 10 weeks, the groups had similar mean calorie intakes and body mass indices, but the low-GI group had reduced its dietary glycemic load from baseline and had significantly fewer inflammatory and noninflammatory acne lesions compared with baseline and with the high-GI group, Dr. Kwon said. The low-GI group also had significant decreases in total average area of sebaceous glands, and decreased expression of sterol response element-binding protein-1 (SREBP-1), which stimulates lipogenesis in sebocytes.

Most recently, scientists have explored the molecular mechanisms linking diet to acne, Dr. Kwon noted. High GI diets trigger chronic hyperinsulinemia, which impairs the ability of FoxO1 transcription factor to mediate androgen receptor signaling, oxidative stress, lipogenesis, and sebaceous gland homeostasis. Importantly, FoxO1 inhibition also is associated with activation of mTORC1, which promotes lipid and protein synthesis, sebaceous gland hyperplasia, and sebaceous lipogenesis, he said.

Dr. Kwon reported having no relevant conflicts of interest.

VANCOUVER, B.C. – Mounting evidence suggests that consuming a low glycemic index diet can substantially improve acne, according to Dr. Hyuck Hoon Kwon.

The approach has held up in several small-scale randomized clinical trials, earning it a grade of 1B last year from the American Academy of Dermatology, noted Dr. Kwon of Seoul National University in South Korea.

“Dermatologists can recommend dietary modification to patients, and can advise them to avoid foods that they believe worsen their acne,” Dr. Kwon said at the World Congress of Dermatology. He said he has seen clinically meaningful reductions in acne lesions as soon as 4 weeks after patients cut their intake of refined carbohydrates and other high glycemic index (GI) foods, although results can take up to 12 weeks, and more studies of time to effect are needed.

Scientists and clinicians have long debated the role of diet in the pathogenesis of acne, and until recently, there were no randomized, controlled trials or meta-analyses of the topic. But observational studies have repeatedly documented “astonishingly” low rates of acne in cultures with “traditional” diets that are lower in refined carbohydrates and fat than typical Western fare, said Dr. Kwon.

pedphoto36pm/Thinkstock.com

In one study of 1,285 individuals in Korea, those who did not have acne reported consuming significantly higher amounts of fish and yellow, leafy green, and cruciferous vegetables, while those with acne ate significantly more instant noodles, processed cheeses, and “junk” foods, he noted (Eur. J. Dermatol. 2010;20:768-72).

In another trial, Dr. Kwon and colleagues randomized 32 individuals with mild to moderate acne to either a low-GI diet that emphasized beans, barley, vegetables, fish, and whole-grain breads, or to a high-GI control diet (Acta Derm. Venereol. 2012;92:241-6). The low-GI group ate more protein to replace calories lost from cutting carbohydrates. At 10 weeks, the groups had similar mean calorie intakes and body mass indices, but the low-GI group had reduced its dietary glycemic load from baseline and had significantly fewer inflammatory and noninflammatory acne lesions compared with baseline and with the high-GI group, Dr. Kwon said. The low-GI group also had significant decreases in total average area of sebaceous glands, and decreased expression of sterol response element-binding protein-1 (SREBP-1), which stimulates lipogenesis in sebocytes.

Most recently, scientists have explored the molecular mechanisms linking diet to acne, Dr. Kwon noted. High GI diets trigger chronic hyperinsulinemia, which impairs the ability of FoxO1 transcription factor to mediate androgen receptor signaling, oxidative stress, lipogenesis, and sebaceous gland homeostasis. Importantly, FoxO1 inhibition also is associated with activation of mTORC1, which promotes lipid and protein synthesis, sebaceous gland hyperplasia, and sebaceous lipogenesis, he said.

Dr. Kwon reported having no relevant conflicts of interest.

VANCOUVER, B.C. – Mounting evidence suggests that consuming a low glycemic index diet can substantially improve acne, according to Dr. Hyuck Hoon Kwon.

The approach has held up in several small-scale randomized clinical trials, earning it a grade of 1B last year from the American Academy of Dermatology, noted Dr. Kwon of Seoul National University in South Korea.

“Dermatologists can recommend dietary modification to patients, and can advise them to avoid foods that they believe worsen their acne,” Dr. Kwon said at the World Congress of Dermatology. He said he has seen clinically meaningful reductions in acne lesions as soon as 4 weeks after patients cut their intake of refined carbohydrates and other high glycemic index (GI) foods, although results can take up to 12 weeks, and more studies of time to effect are needed.

Scientists and clinicians have long debated the role of diet in the pathogenesis of acne, and until recently, there were no randomized, controlled trials or meta-analyses of the topic. But observational studies have repeatedly documented “astonishingly” low rates of acne in cultures with “traditional” diets that are lower in refined carbohydrates and fat than typical Western fare, said Dr. Kwon.

pedphoto36pm/Thinkstock.com

In one study of 1,285 individuals in Korea, those who did not have acne reported consuming significantly higher amounts of fish and yellow, leafy green, and cruciferous vegetables, while those with acne ate significantly more instant noodles, processed cheeses, and “junk” foods, he noted (Eur. J. Dermatol. 2010;20:768-72).

In another trial, Dr. Kwon and colleagues randomized 32 individuals with mild to moderate acne to either a low-GI diet that emphasized beans, barley, vegetables, fish, and whole-grain breads, or to a high-GI control diet (Acta Derm. Venereol. 2012;92:241-6). The low-GI group ate more protein to replace calories lost from cutting carbohydrates. At 10 weeks, the groups had similar mean calorie intakes and body mass indices, but the low-GI group had reduced its dietary glycemic load from baseline and had significantly fewer inflammatory and noninflammatory acne lesions compared with baseline and with the high-GI group, Dr. Kwon said. The low-GI group also had significant decreases in total average area of sebaceous glands, and decreased expression of sterol response element-binding protein-1 (SREBP-1), which stimulates lipogenesis in sebocytes.

Most recently, scientists have explored the molecular mechanisms linking diet to acne, Dr. Kwon noted. High GI diets trigger chronic hyperinsulinemia, which impairs the ability of FoxO1 transcription factor to mediate androgen receptor signaling, oxidative stress, lipogenesis, and sebaceous gland homeostasis. Importantly, FoxO1 inhibition also is associated with activation of mTORC1, which promotes lipid and protein synthesis, sebaceous gland hyperplasia, and sebaceous lipogenesis, he said.

Dr. Kwon reported having no relevant conflicts of interest.

A family physician was the first to notice possible signs of rosacea in approximately one-quarter of rosacea patients, according to a recent survey from the National Rosacea Society (NRS). Other health care professionals making the initial observation included ophthalmologists, internists, optometrists, nurse practitioners, physician assistants, allergists, gynecologists, and dentists. However, dermatologists made the definitive diagnosis of rosacea in the majority of cases (85%).

The spring 2015 edition of Rosacea Review, the NRS newsletter, reported on the results of a survey of 774 rosacea patients. Other health care professionals who diagnosed rosacea included family physicians (9%), ophthalmologists (4%), and internists and allergists (1% each).

Survey results from NRS also indicated that dermatologists were the most likely to provide ongoing care to rosacea patients. In fact, 80% of respondents said they were under the care of a dermatologist, while 24% received treatment from a family physician, 10% from an ophthalmologist, 3% from an internist, and 0.5% from an allergist. Many patients indicated that they received care from more than one physician.

A December 2014 Cutis article “Most Common Dermatologic Conditions Encountered by Dermatologists and Nondermatologists” also indicated that nondermatologists are seeing patients for skin conditions. Wilmer et al analyzed data from the National Ambulatory Medical Care Survey and reported that rosacea ranked ninth in the top dermatologic conditions seen by dermatologists. Although rosacea did not rank in the top 20 dermatologic conditions seen by nondermatologists, it did rank 10th in the top referrals to dermatologists by nondermatologists. Of nondermatologist specialties evaluated, including emergency medicine, family practice, general surgery, internal medicine, otolaryngology, and pediatrics, rosacea was within the top 20 dermatologic conditions encountered by otolaryngologists only. These findings suggest that nondermatologists may benefit from education efforts targeted toward the common skin diseases to improve diagnostic accuracy and patient outcomes.

A January 2015 Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” revealed that rosacea patients may seek care of a health care professional after experiencing persistent facial flushing, an intolerable burning sensation, or too much pain and embarrassment associated with their symptoms. Ultimately patients should seek the care of a dermatologist to ensure their condition is not misdiagnosed. However, issues of access to dermatologic care and receiving the correct diagnosis come into play, as patients may experience long wait times for appointments with a dermatologist.

“When we think of the rosacea journey or ways we can improve the journey, coming up with ways to facilitate patient’s access to dermatologists would be something that would come to mind, not just changing the available medications,” said Dr. Steven Feldman, one of the authors of the rosacea patient journey article, in a recent audiocast. “I think it’s likely that many of the people with rosacea are being seen by primary care doctors but their rosacea may never even come up in their discussions.”

Improved awareness of the signs and symptoms of rosacea among health care professionals is beneficial to patients, and dermatologists can be leaders in expanding education efforts.

A family physician was the first to notice possible signs of rosacea in approximately one-quarter of rosacea patients, according to a recent survey from the National Rosacea Society (NRS). Other health care professionals making the initial observation included ophthalmologists, internists, optometrists, nurse practitioners, physician assistants, allergists, gynecologists, and dentists. However, dermatologists made the definitive diagnosis of rosacea in the majority of cases (85%).

The spring 2015 edition of Rosacea Review, the NRS newsletter, reported on the results of a survey of 774 rosacea patients. Other health care professionals who diagnosed rosacea included family physicians (9%), ophthalmologists (4%), and internists and allergists (1% each).

Survey results from NRS also indicated that dermatologists were the most likely to provide ongoing care to rosacea patients. In fact, 80% of respondents said they were under the care of a dermatologist, while 24% received treatment from a family physician, 10% from an ophthalmologist, 3% from an internist, and 0.5% from an allergist. Many patients indicated that they received care from more than one physician.

A December 2014 Cutis article “Most Common Dermatologic Conditions Encountered by Dermatologists and Nondermatologists” also indicated that nondermatologists are seeing patients for skin conditions. Wilmer et al analyzed data from the National Ambulatory Medical Care Survey and reported that rosacea ranked ninth in the top dermatologic conditions seen by dermatologists. Although rosacea did not rank in the top 20 dermatologic conditions seen by nondermatologists, it did rank 10th in the top referrals to dermatologists by nondermatologists. Of nondermatologist specialties evaluated, including emergency medicine, family practice, general surgery, internal medicine, otolaryngology, and pediatrics, rosacea was within the top 20 dermatologic conditions encountered by otolaryngologists only. These findings suggest that nondermatologists may benefit from education efforts targeted toward the common skin diseases to improve diagnostic accuracy and patient outcomes.

A January 2015 Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” revealed that rosacea patients may seek care of a health care professional after experiencing persistent facial flushing, an intolerable burning sensation, or too much pain and embarrassment associated with their symptoms. Ultimately patients should seek the care of a dermatologist to ensure their condition is not misdiagnosed. However, issues of access to dermatologic care and receiving the correct diagnosis come into play, as patients may experience long wait times for appointments with a dermatologist.

“When we think of the rosacea journey or ways we can improve the journey, coming up with ways to facilitate patient’s access to dermatologists would be something that would come to mind, not just changing the available medications,” said Dr. Steven Feldman, one of the authors of the rosacea patient journey article, in a recent audiocast. “I think it’s likely that many of the people with rosacea are being seen by primary care doctors but their rosacea may never even come up in their discussions.”

Improved awareness of the signs and symptoms of rosacea among health care professionals is beneficial to patients, and dermatologists can be leaders in expanding education efforts.

A family physician was the first to notice possible signs of rosacea in approximately one-quarter of rosacea patients, according to a recent survey from the National Rosacea Society (NRS). Other health care professionals making the initial observation included ophthalmologists, internists, optometrists, nurse practitioners, physician assistants, allergists, gynecologists, and dentists. However, dermatologists made the definitive diagnosis of rosacea in the majority of cases (85%).

The spring 2015 edition of Rosacea Review, the NRS newsletter, reported on the results of a survey of 774 rosacea patients. Other health care professionals who diagnosed rosacea included family physicians (9%), ophthalmologists (4%), and internists and allergists (1% each).

Survey results from NRS also indicated that dermatologists were the most likely to provide ongoing care to rosacea patients. In fact, 80% of respondents said they were under the care of a dermatologist, while 24% received treatment from a family physician, 10% from an ophthalmologist, 3% from an internist, and 0.5% from an allergist. Many patients indicated that they received care from more than one physician.

A December 2014 Cutis article “Most Common Dermatologic Conditions Encountered by Dermatologists and Nondermatologists” also indicated that nondermatologists are seeing patients for skin conditions. Wilmer et al analyzed data from the National Ambulatory Medical Care Survey and reported that rosacea ranked ninth in the top dermatologic conditions seen by dermatologists. Although rosacea did not rank in the top 20 dermatologic conditions seen by nondermatologists, it did rank 10th in the top referrals to dermatologists by nondermatologists. Of nondermatologist specialties evaluated, including emergency medicine, family practice, general surgery, internal medicine, otolaryngology, and pediatrics, rosacea was within the top 20 dermatologic conditions encountered by otolaryngologists only. These findings suggest that nondermatologists may benefit from education efforts targeted toward the common skin diseases to improve diagnostic accuracy and patient outcomes.

A January 2015 Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” revealed that rosacea patients may seek care of a health care professional after experiencing persistent facial flushing, an intolerable burning sensation, or too much pain and embarrassment associated with their symptoms. Ultimately patients should seek the care of a dermatologist to ensure their condition is not misdiagnosed. However, issues of access to dermatologic care and receiving the correct diagnosis come into play, as patients may experience long wait times for appointments with a dermatologist.

“When we think of the rosacea journey or ways we can improve the journey, coming up with ways to facilitate patient’s access to dermatologists would be something that would come to mind, not just changing the available medications,” said Dr. Steven Feldman, one of the authors of the rosacea patient journey article, in a recent audiocast. “I think it’s likely that many of the people with rosacea are being seen by primary care doctors but their rosacea may never even come up in their discussions.”

Improved awareness of the signs and symptoms of rosacea among health care professionals is beneficial to patients, and dermatologists can be leaders in expanding education efforts.

Skin cancer treatments ranked as the most-performed procedures (3.08 million total procedures) for the fourth year in a row, according to survey results released by the American Society for Dermatologic Surgery (ASDS). Of them, 2.8 million procedures were for nonmelanoma skin cancers, and 206,000 were for melanomas. This finding confirms the growing incidence of skin cancer and the expertise of dermatologic surgeons in diagnosis and treatment.

Data were collected for the 2014 experience from 826 practicing members of the ASDS, with nearly 9.5 million medically necessary and cosmetic procedures performed.

Dermatologic surgeons performed 6.4 million cosmetic treatments in 2014. The top 5 cosmetic treatments were:

• Laser and light/energy-based devices: 2.06 million total procedures
• Wrinkle-relaxing injections (injectable neuromodulators): 1.74 million total procedures
• Soft-tissue fillers: 1.01 million total procedures
• Laser hair removal: 633,000 total procedures
• Chemical peels: 564,000 total procedures

Most laser and light/energy-based device treatments were reported for facial redness, followed by photorejuvenation, phototherapy, age spots, tissue tightening, laser resurfacing, acne scars, surgical scars, tattoo removal, and birthmarks.

Of the injectable neuromodulators used, nearly 1.2 million procedures were reported for onabotulinumtoxinA, followed by abobotulinumtoxinA (382,000) and incobotulinumtoxinA (175,000). The highest percentage of neuromodulator injections was reported in patients aged 46 to 50 years. Also, females (87%) received more injections than males (13%).

Soft-tissue fillers were performed the most in patients older than 55 years. Females (91%) received more treatments than males (9%).

The number of laser hair removal procedures performed in 2014 increased 27% from 2013 and 51% from 2012, emphasizing the role of dermatologists in providing safe and effective treatment.

Body sculpting procedures accounted for 208,000 total procedures, a 53% increase since 2012. The top treatments were cryolipolysis (79,000) and radiofrequency therapy (49,600).

View the full results of this survey on the ASDS Web site.

Skin cancer treatments ranked as the most-performed procedures (3.08 million total procedures) for the fourth year in a row, according to survey results released by the American Society for Dermatologic Surgery (ASDS). Of them, 2.8 million procedures were for nonmelanoma skin cancers, and 206,000 were for melanomas. This finding confirms the growing incidence of skin cancer and the expertise of dermatologic surgeons in diagnosis and treatment.

Data were collected for the 2014 experience from 826 practicing members of the ASDS, with nearly 9.5 million medically necessary and cosmetic procedures performed.

Dermatologic surgeons performed 6.4 million cosmetic treatments in 2014. The top 5 cosmetic treatments were:

• Laser and light/energy-based devices: 2.06 million total procedures
• Wrinkle-relaxing injections (injectable neuromodulators): 1.74 million total procedures
• Soft-tissue fillers: 1.01 million total procedures
• Laser hair removal: 633,000 total procedures
• Chemical peels: 564,000 total procedures

Most laser and light/energy-based device treatments were reported for facial redness, followed by photorejuvenation, phototherapy, age spots, tissue tightening, laser resurfacing, acne scars, surgical scars, tattoo removal, and birthmarks.

Of the injectable neuromodulators used, nearly 1.2 million procedures were reported for onabotulinumtoxinA, followed by abobotulinumtoxinA (382,000) and incobotulinumtoxinA (175,000). The highest percentage of neuromodulator injections was reported in patients aged 46 to 50 years. Also, females (87%) received more injections than males (13%).

Soft-tissue fillers were performed the most in patients older than 55 years. Females (91%) received more treatments than males (9%).

The number of laser hair removal procedures performed in 2014 increased 27% from 2013 and 51% from 2012, emphasizing the role of dermatologists in providing safe and effective treatment.

Body sculpting procedures accounted for 208,000 total procedures, a 53% increase since 2012. The top treatments were cryolipolysis (79,000) and radiofrequency therapy (49,600).

View the full results of this survey on the ASDS Web site.

Skin cancer treatments ranked as the most-performed procedures (3.08 million total procedures) for the fourth year in a row, according to survey results released by the American Society for Dermatologic Surgery (ASDS). Of them, 2.8 million procedures were for nonmelanoma skin cancers, and 206,000 were for melanomas. This finding confirms the growing incidence of skin cancer and the expertise of dermatologic surgeons in diagnosis and treatment.

Data were collected for the 2014 experience from 826 practicing members of the ASDS, with nearly 9.5 million medically necessary and cosmetic procedures performed.

Dermatologic surgeons performed 6.4 million cosmetic treatments in 2014. The top 5 cosmetic treatments were:

• Laser and light/energy-based devices: 2.06 million total procedures
• Wrinkle-relaxing injections (injectable neuromodulators): 1.74 million total procedures
• Soft-tissue fillers: 1.01 million total procedures
• Laser hair removal: 633,000 total procedures
• Chemical peels: 564,000 total procedures

Most laser and light/energy-based device treatments were reported for facial redness, followed by photorejuvenation, phototherapy, age spots, tissue tightening, laser resurfacing, acne scars, surgical scars, tattoo removal, and birthmarks.

Of the injectable neuromodulators used, nearly 1.2 million procedures were reported for onabotulinumtoxinA, followed by abobotulinumtoxinA (382,000) and incobotulinumtoxinA (175,000). The highest percentage of neuromodulator injections was reported in patients aged 46 to 50 years. Also, females (87%) received more injections than males (13%).

Soft-tissue fillers were performed the most in patients older than 55 years. Females (91%) received more treatments than males (9%).

The number of laser hair removal procedures performed in 2014 increased 27% from 2013 and 51% from 2012, emphasizing the role of dermatologists in providing safe and effective treatment.

Body sculpting procedures accounted for 208,000 total procedures, a 53% increase since 2012. The top treatments were cryolipolysis (79,000) and radiofrequency therapy (49,600).

View the full results of this survey on the ASDS Web site.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top OTC cleansers for rosacea patients. Consideration must be given to:

• Avène Antirougeurs Redness Relief Dermo-Cleansing Milk
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Avène Extremely Gentle Cleanser Lotion
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Cetaphil Gentle Skin Cleanser
  Galderma Laboratories, LP
  “I always recommend for all of my rosacea patients a strict regimen of cleansing and sun protection with Cetaphil cleanser and moisturizing sunscreen.”—Wm. Philip Werschler, MD, Seattle, Washington
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Toleriane Dermo-Cleanser
  La Roche-Posay Laboratoire Dermatologique
  “Excellent for rosacea because it doesn’t contain any surfactants. This product has a very hydrated formula that helps repair the skin barrier.”—Whitney Bowe, MD, Brooklyn, New York
  Recommended by Gary Goldenberg, MD, New York, New York

Cutis invites readers to send us their recommendations. Face washes and products for babies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to [email protected].

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top OTC cleansers for rosacea patients. Consideration must be given to:

• Avène Antirougeurs Redness Relief Dermo-Cleansing Milk
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Avène Extremely Gentle Cleanser Lotion
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Cetaphil Gentle Skin Cleanser
  Galderma Laboratories, LP
  “I always recommend for all of my rosacea patients a strict regimen of cleansing and sun protection with Cetaphil cleanser and moisturizing sunscreen.”—Wm. Philip Werschler, MD, Seattle, Washington
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Toleriane Dermo-Cleanser
  La Roche-Posay Laboratoire Dermatologique
  “Excellent for rosacea because it doesn’t contain any surfactants. This product has a very hydrated formula that helps repair the skin barrier.”—Whitney Bowe, MD, Brooklyn, New York
  Recommended by Gary Goldenberg, MD, New York, New York

Cutis invites readers to send us their recommendations. Face washes and products for babies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to [email protected].

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

To improve patient care and outcomes, leading dermatologists offered their recommendations on the top OTC cleansers for rosacea patients. Consideration must be given to:

• Avène Antirougeurs Redness Relief Dermo-Cleansing Milk
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Avène Extremely Gentle Cleanser Lotion
  Pierre Fabre Dermo-Cosmétique USA
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Cetaphil Gentle Skin Cleanser
  Galderma Laboratories, LP
  “I always recommend for all of my rosacea patients a strict regimen of cleansing and sun protection with Cetaphil cleanser and moisturizing sunscreen.”—Wm. Philip Werschler, MD, Seattle, Washington
  Recommended by Julie Woodward, MD, Durham, North Carolina

• Toleriane Dermo-Cleanser
  La Roche-Posay Laboratoire Dermatologique
  “Excellent for rosacea because it doesn’t contain any surfactants. This product has a very hydrated formula that helps repair the skin barrier.”—Whitney Bowe, MD, Brooklyn, New York
  Recommended by Gary Goldenberg, MD, New York, New York

Cutis invites readers to send us their recommendations. Face washes and products for babies will be featured in upcoming editions of Cosmetic Corner. Please e-mail your recommendation(s) to [email protected].

Disclaimer: Opinions expressed herein do not necessarily reflect those of Cutis or Frontline Medical Communications Inc and shall not be used for product endorsement purposes. Any reference made to a specific commercial product does not indicate or imply that Cutis or Frontline Medical Communications Inc endorses, recommends, or favors the product mentioned. No guarantee is given to the effects of recommended products.

Individuals undergoing a transition from female to male (trans men) may be prone to severe acne in response to the testosterone therapy associated with that process, according to data from case reports presented in a research letter in JAMA Dermatology.

Data on the impact of testosterone therapy on the skin of trans men are limited, and previous studies suggested that the therapy did not promote acne, but Dr. Lucia Turrion-Merino of Ramón y Cajal Hospital, Madrid, and colleagues reported otherwise.

© Ocskay Bence /Fotolia.com

“Our 2 patients developed severe inflammatory acne with scarring, even with physiological male T [testosterone] levels,” they said.

Both patients were in their 20s, with no history of severe acne, but they presented with, in one case, inflammatory acne and scarring on the face and chest, and in the second case, seborrhea and severe acne on the face and trunk. In both cases, the acne arose within 6 months of starting testosterone therapy. Both patients improved on isotretinoin but have required ongoing treatment, as the acne returned when the isotretinoin was discontinued.

“In our opinion, it is reasonable to think that if the patient keeps receiving masculinizing doses of T, virilizing characteristics such as acne will persist,” the researchers wrote.

The findings were published online May 20 (JAMA Dermatol. 2015 [doi:10.1001/jamadermatol.2015.0761]). Find the full study here.

Individuals undergoing a transition from female to male (trans men) may be prone to severe acne in response to the testosterone therapy associated with that process, according to data from case reports presented in a research letter in JAMA Dermatology.

Data on the impact of testosterone therapy on the skin of trans men are limited, and previous studies suggested that the therapy did not promote acne, but Dr. Lucia Turrion-Merino of Ramón y Cajal Hospital, Madrid, and colleagues reported otherwise.

© Ocskay Bence /Fotolia.com

“Our 2 patients developed severe inflammatory acne with scarring, even with physiological male T [testosterone] levels,” they said.

Both patients were in their 20s, with no history of severe acne, but they presented with, in one case, inflammatory acne and scarring on the face and chest, and in the second case, seborrhea and severe acne on the face and trunk. In both cases, the acne arose within 6 months of starting testosterone therapy. Both patients improved on isotretinoin but have required ongoing treatment, as the acne returned when the isotretinoin was discontinued.

“In our opinion, it is reasonable to think that if the patient keeps receiving masculinizing doses of T, virilizing characteristics such as acne will persist,” the researchers wrote.

The findings were published online May 20 (JAMA Dermatol. 2015 [doi:10.1001/jamadermatol.2015.0761]). Find the full study here.

Individuals undergoing a transition from female to male (trans men) may be prone to severe acne in response to the testosterone therapy associated with that process, according to data from case reports presented in a research letter in JAMA Dermatology.

Data on the impact of testosterone therapy on the skin of trans men are limited, and previous studies suggested that the therapy did not promote acne, but Dr. Lucia Turrion-Merino of Ramón y Cajal Hospital, Madrid, and colleagues reported otherwise.

© Ocskay Bence /Fotolia.com

“Our 2 patients developed severe inflammatory acne with scarring, even with physiological male T [testosterone] levels,” they said.

Both patients were in their 20s, with no history of severe acne, but they presented with, in one case, inflammatory acne and scarring on the face and chest, and in the second case, seborrhea and severe acne on the face and trunk. In both cases, the acne arose within 6 months of starting testosterone therapy. Both patients improved on isotretinoin but have required ongoing treatment, as the acne returned when the isotretinoin was discontinued.

“In our opinion, it is reasonable to think that if the patient keeps receiving masculinizing doses of T, virilizing characteristics such as acne will persist,” the researchers wrote.

The findings were published online May 20 (JAMA Dermatol. 2015 [doi:10.1001/jamadermatol.2015.0761]). Find the full study here.

The distribution of acne lesions in adults is similar to that in adolescents, based on data from a prospective study of 374 women aged 25 years and older.

“The stereotype of adult female acne being due to hormonal disturbances presenting as inflammatory acne localized only to the mandibular area was not found in the majority of this large group,” noted Dr. Brigitte Dreno of Nantes (France) University and colleagues.

Courtesy Wikimedia Commons/Kinan Ayu/ Creative Commons license

Approximately 90% of the women demonstrated facial acne severity typical to that seen in adolescents, with involvement of the cheeks, forehead, temples, and mandibular area, the researchers noted. The most common presentation was mixed facial acne, with both inflammatory and noninflammatory lesions. A total of 6% of women had inflammatory acne only, with no reported noninflammatory lesions, and 17% had comedonal acne and no reported inflammatory lesions.

“We recommend that the general treatment approach for adult acne should include agents that target each of the acne lesion subtypes,” the researchers wrote.

The findings were published in the Journal of the European Academy of Dermatology and Venereology (2015;29:1096-106 [doi:10.1111/jdv.12757]).

The distribution of acne lesions in adults is similar to that in adolescents, based on data from a prospective study of 374 women aged 25 years and older.

“The stereotype of adult female acne being due to hormonal disturbances presenting as inflammatory acne localized only to the mandibular area was not found in the majority of this large group,” noted Dr. Brigitte Dreno of Nantes (France) University and colleagues.

Courtesy Wikimedia Commons/Kinan Ayu/ Creative Commons license

Approximately 90% of the women demonstrated facial acne severity typical to that seen in adolescents, with involvement of the cheeks, forehead, temples, and mandibular area, the researchers noted. The most common presentation was mixed facial acne, with both inflammatory and noninflammatory lesions. A total of 6% of women had inflammatory acne only, with no reported noninflammatory lesions, and 17% had comedonal acne and no reported inflammatory lesions.

“We recommend that the general treatment approach for adult acne should include agents that target each of the acne lesion subtypes,” the researchers wrote.

The findings were published in the Journal of the European Academy of Dermatology and Venereology (2015;29:1096-106 [doi:10.1111/jdv.12757]).

The distribution of acne lesions in adults is similar to that in adolescents, based on data from a prospective study of 374 women aged 25 years and older.

“The stereotype of adult female acne being due to hormonal disturbances presenting as inflammatory acne localized only to the mandibular area was not found in the majority of this large group,” noted Dr. Brigitte Dreno of Nantes (France) University and colleagues.

Courtesy Wikimedia Commons/Kinan Ayu/ Creative Commons license

Approximately 90% of the women demonstrated facial acne severity typical to that seen in adolescents, with involvement of the cheeks, forehead, temples, and mandibular area, the researchers noted. The most common presentation was mixed facial acne, with both inflammatory and noninflammatory lesions. A total of 6% of women had inflammatory acne only, with no reported noninflammatory lesions, and 17% had comedonal acne and no reported inflammatory lesions.

“We recommend that the general treatment approach for adult acne should include agents that target each of the acne lesion subtypes,” the researchers wrote.

The findings were published in the Journal of the European Academy of Dermatology and Venereology (2015;29:1096-106 [doi:10.1111/jdv.12757]).

Adding automated counseling to an acne education website had no impact on improving acne severity and quality of life, but it did encourage more patients to begin or maintain an antiacne skin care routine, based on data from a randomized trial published online May 27 in JAMA Dermatology.

Patient education is the key to successful acne management, but the effects of patient education programs on clinical outcomes have not been well studied, wrote William Tuong of the University of California, Davis, and his colleagues. Mr. Tuong and his colleagues designed an educational acne website that included virtual counselors to take the place of an in-person visit with a doctor. They randomized 98 high school students aged 14-29 years with mild to moderate acne to this website or a second similar website without the virtual counseling component (JAMA Dermatology 2015 [doi:10.1001/jamadermatol.2015.0859]).

©Stephen Strathdee/iStockphoto.com

The primary outcome of the study was the difference in acne lesion counts at baseline vs. 12 weeks after patients completed the online education program. At 12 weeks, the change in acne lesion counts was not significantly different between the automated counseling and control groups, and the total lesion count at 12 weeks was approximately 21 for both groups. In addition, the average improvement in quality of life scores was not significantly different between the groups.

However, significantly more participants in the automated counseling website group vs. the standard website group reported having “maintained or adopted a skin care regimen” at 12 weeks’ follow-up, the researchers noted.

“For some participants in this study, this alliance [with the virtual counselor] may have provided effective counseling on skin care or positive feedback that reinforced current behaviors,” they wrote.

The results were limited by the lower-than-expected use of the study websites, the researchers noted. However, the findings suggest that “interactive, Internet-based education may still carry the potential to improve long-term clinical factors, such as acne severity and quality of life,” and these factors can be explored in future studies, the investigators said.

The study was supported in part by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.

[email protected]

Adding automated counseling to an acne education website had no impact on improving acne severity and quality of life, but it did encourage more patients to begin or maintain an antiacne skin care routine, based on data from a randomized trial published online May 27 in JAMA Dermatology.

Patient education is the key to successful acne management, but the effects of patient education programs on clinical outcomes have not been well studied, wrote William Tuong of the University of California, Davis, and his colleagues. Mr. Tuong and his colleagues designed an educational acne website that included virtual counselors to take the place of an in-person visit with a doctor. They randomized 98 high school students aged 14-29 years with mild to moderate acne to this website or a second similar website without the virtual counseling component (JAMA Dermatology 2015 [doi:10.1001/jamadermatol.2015.0859]).

©Stephen Strathdee/iStockphoto.com

The primary outcome of the study was the difference in acne lesion counts at baseline vs. 12 weeks after patients completed the online education program. At 12 weeks, the change in acne lesion counts was not significantly different between the automated counseling and control groups, and the total lesion count at 12 weeks was approximately 21 for both groups. In addition, the average improvement in quality of life scores was not significantly different between the groups.

However, significantly more participants in the automated counseling website group vs. the standard website group reported having “maintained or adopted a skin care regimen” at 12 weeks’ follow-up, the researchers noted.

“For some participants in this study, this alliance [with the virtual counselor] may have provided effective counseling on skin care or positive feedback that reinforced current behaviors,” they wrote.

The results were limited by the lower-than-expected use of the study websites, the researchers noted. However, the findings suggest that “interactive, Internet-based education may still carry the potential to improve long-term clinical factors, such as acne severity and quality of life,” and these factors can be explored in future studies, the investigators said.

The study was supported in part by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.

[email protected]

Adding automated counseling to an acne education website had no impact on improving acne severity and quality of life, but it did encourage more patients to begin or maintain an antiacne skin care routine, based on data from a randomized trial published online May 27 in JAMA Dermatology.

Patient education is the key to successful acne management, but the effects of patient education programs on clinical outcomes have not been well studied, wrote William Tuong of the University of California, Davis, and his colleagues. Mr. Tuong and his colleagues designed an educational acne website that included virtual counselors to take the place of an in-person visit with a doctor. They randomized 98 high school students aged 14-29 years with mild to moderate acne to this website or a second similar website without the virtual counseling component (JAMA Dermatology 2015 [doi:10.1001/jamadermatol.2015.0859]).

©Stephen Strathdee/iStockphoto.com

The primary outcome of the study was the difference in acne lesion counts at baseline vs. 12 weeks after patients completed the online education program. At 12 weeks, the change in acne lesion counts was not significantly different between the automated counseling and control groups, and the total lesion count at 12 weeks was approximately 21 for both groups. In addition, the average improvement in quality of life scores was not significantly different between the groups.

However, significantly more participants in the automated counseling website group vs. the standard website group reported having “maintained or adopted a skin care regimen” at 12 weeks’ follow-up, the researchers noted.

“For some participants in this study, this alliance [with the virtual counselor] may have provided effective counseling on skin care or positive feedback that reinforced current behaviors,” they wrote.

The results were limited by the lower-than-expected use of the study websites, the researchers noted. However, the findings suggest that “interactive, Internet-based education may still carry the potential to improve long-term clinical factors, such as acne severity and quality of life,” and these factors can be explored in future studies, the investigators said.

The study was supported in part by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.

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