Rosacea

An estimated 16 million Americans have rosacea, but research shows that many of them do not know the signs or symptoms of rosacea or they wait to seek treatment. Dermatologists can play a key role in patient education, and a better understanding of the patient journey can aid in patient-physician interactions.

In a survey conducted by the National Rosacea Society (NRS), 47% of 1459 respondents reported they had never heard of rosacea prior to receiving their diagnosis and 95% indicated they knew little or nothing about the signs and symptoms of rosacea prior to their diagnosis. Rosacea treatment also is a challenge for patients, with 77% of respondents saying they knew nothing about rosacea treatment prior to being diagnosed, 21% said they knew a little about treatment, and only 2% said they knew a lot. Patient outreach from the NRS has made the term rosacea more widely known, but more education is needed on the common warning signs and symptoms of rosacea so that patients can seek treatment.

In a January 2015 article published in Cutis, Kuo and colleagues presented the patient journey model for rosacea so that dermatologists can have a better understanding of the key issues in rosacea management, including barriers to successful treatment outcomes. Similar to the NRS survey, Kuo et al reported that only a small proportion of patients with rosacea seek conventional medical treatment and symptomatic patients may wait on average 7 months to 5 years before receiving a diagnosis. The delay can be attributed to patients dismissing their symptoms as either acne vulgaris or sunburn or patients thinking their symptoms will resolve. More patients also are turning to over-the-counter products before seeking medical attention, and the difficulty obtaining an appointment with a dermatologist has prompted patients to seek care from a primary care physician or internist, which may lead to misdiagnosis or incorrect treatment.

Kuo et al suggest that treatment of rosacea is multifactorial and behavioral, with patients not only adhering to oral and topical therapies but also avoiding lifestyle and environmental triggers. They recommend an early follow-up visit to evaluate newly prescribed treatments, which can positively influence disease management. Because rosacea is a chronic condition, continuation of treatment is critical.

“As the patient and dermatologist work together to find an appropriate treatment plan, identify certain triggers, and modify the skin care routine, the patient can become disciplined in controlling rosacea symptoms,” the authors report. “Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.”

Access the Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” for more information on the patient perspective so that dermatologists can better aid patients with rosacea.

An estimated 16 million Americans have rosacea, but research shows that many of them do not know the signs or symptoms of rosacea or they wait to seek treatment. Dermatologists can play a key role in patient education, and a better understanding of the patient journey can aid in patient-physician interactions.

In a survey conducted by the National Rosacea Society (NRS), 47% of 1459 respondents reported they had never heard of rosacea prior to receiving their diagnosis and 95% indicated they knew little or nothing about the signs and symptoms of rosacea prior to their diagnosis. Rosacea treatment also is a challenge for patients, with 77% of respondents saying they knew nothing about rosacea treatment prior to being diagnosed, 21% said they knew a little about treatment, and only 2% said they knew a lot. Patient outreach from the NRS has made the term rosacea more widely known, but more education is needed on the common warning signs and symptoms of rosacea so that patients can seek treatment.

In a January 2015 article published in Cutis, Kuo and colleagues presented the patient journey model for rosacea so that dermatologists can have a better understanding of the key issues in rosacea management, including barriers to successful treatment outcomes. Similar to the NRS survey, Kuo et al reported that only a small proportion of patients with rosacea seek conventional medical treatment and symptomatic patients may wait on average 7 months to 5 years before receiving a diagnosis. The delay can be attributed to patients dismissing their symptoms as either acne vulgaris or sunburn or patients thinking their symptoms will resolve. More patients also are turning to over-the-counter products before seeking medical attention, and the difficulty obtaining an appointment with a dermatologist has prompted patients to seek care from a primary care physician or internist, which may lead to misdiagnosis or incorrect treatment.

Kuo et al suggest that treatment of rosacea is multifactorial and behavioral, with patients not only adhering to oral and topical therapies but also avoiding lifestyle and environmental triggers. They recommend an early follow-up visit to evaluate newly prescribed treatments, which can positively influence disease management. Because rosacea is a chronic condition, continuation of treatment is critical.

“As the patient and dermatologist work together to find an appropriate treatment plan, identify certain triggers, and modify the skin care routine, the patient can become disciplined in controlling rosacea symptoms,” the authors report. “Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.”

Access the Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” for more information on the patient perspective so that dermatologists can better aid patients with rosacea.

An estimated 16 million Americans have rosacea, but research shows that many of them do not know the signs or symptoms of rosacea or they wait to seek treatment. Dermatologists can play a key role in patient education, and a better understanding of the patient journey can aid in patient-physician interactions.

In a survey conducted by the National Rosacea Society (NRS), 47% of 1459 respondents reported they had never heard of rosacea prior to receiving their diagnosis and 95% indicated they knew little or nothing about the signs and symptoms of rosacea prior to their diagnosis. Rosacea treatment also is a challenge for patients, with 77% of respondents saying they knew nothing about rosacea treatment prior to being diagnosed, 21% said they knew a little about treatment, and only 2% said they knew a lot. Patient outreach from the NRS has made the term rosacea more widely known, but more education is needed on the common warning signs and symptoms of rosacea so that patients can seek treatment.

In a January 2015 article published in Cutis, Kuo and colleagues presented the patient journey model for rosacea so that dermatologists can have a better understanding of the key issues in rosacea management, including barriers to successful treatment outcomes. Similar to the NRS survey, Kuo et al reported that only a small proportion of patients with rosacea seek conventional medical treatment and symptomatic patients may wait on average 7 months to 5 years before receiving a diagnosis. The delay can be attributed to patients dismissing their symptoms as either acne vulgaris or sunburn or patients thinking their symptoms will resolve. More patients also are turning to over-the-counter products before seeking medical attention, and the difficulty obtaining an appointment with a dermatologist has prompted patients to seek care from a primary care physician or internist, which may lead to misdiagnosis or incorrect treatment.

Kuo et al suggest that treatment of rosacea is multifactorial and behavioral, with patients not only adhering to oral and topical therapies but also avoiding lifestyle and environmental triggers. They recommend an early follow-up visit to evaluate newly prescribed treatments, which can positively influence disease management. Because rosacea is a chronic condition, continuation of treatment is critical.

“As the patient and dermatologist work together to find an appropriate treatment plan, identify certain triggers, and modify the skin care routine, the patient can become disciplined in controlling rosacea symptoms,” the authors report. “Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.”

Access the Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” for more information on the patient perspective so that dermatologists can better aid patients with rosacea.

The majority of antibiotic courses for adult acne line up with recommended guidelines for treatment duration, according to results of a retrospective cohort study of 17,448 courses of antibiotics in adults aged 21 years and older.

Chelsey E. Straight, a student at Penn State College of Medicine in Hershey, Pa., and her colleagues reviewed data from the MarketScan Commercial Claims and Encounters database and determined that about 85% of the courses of antibiotics for adult acne matched guidelines for treatment duration. The most common course duration was 90-179 days, and the mean costs of generic and branded medications were $103.77 and $1,421.61, respectively.

Courtesy Wikimedia Commons/Kinan Ayu/ Creative Commons license

The study was limited by several factors, including a lack of information about acne severity, patient characteristics, and clinical outcomes, the researchers noted.

However, a “mean savings of $592.26 per person could result if prolonged courses met guidelines,” they wrote.

Find the study online in the Journal of the American Academy of Dermatology (2015;72:822-27).

The majority of antibiotic courses for adult acne line up with recommended guidelines for treatment duration, according to results of a retrospective cohort study of 17,448 courses of antibiotics in adults aged 21 years and older.

Chelsey E. Straight, a student at Penn State College of Medicine in Hershey, Pa., and her colleagues reviewed data from the MarketScan Commercial Claims and Encounters database and determined that about 85% of the courses of antibiotics for adult acne matched guidelines for treatment duration. The most common course duration was 90-179 days, and the mean costs of generic and branded medications were $103.77 and $1,421.61, respectively.

Courtesy Wikimedia Commons/Kinan Ayu/ Creative Commons license

The study was limited by several factors, including a lack of information about acne severity, patient characteristics, and clinical outcomes, the researchers noted.

However, a “mean savings of $592.26 per person could result if prolonged courses met guidelines,” they wrote.

Find the study online in the Journal of the American Academy of Dermatology (2015;72:822-27).

The majority of antibiotic courses for adult acne line up with recommended guidelines for treatment duration, according to results of a retrospective cohort study of 17,448 courses of antibiotics in adults aged 21 years and older.

Chelsey E. Straight, a student at Penn State College of Medicine in Hershey, Pa., and her colleagues reviewed data from the MarketScan Commercial Claims and Encounters database and determined that about 85% of the courses of antibiotics for adult acne matched guidelines for treatment duration. The most common course duration was 90-179 days, and the mean costs of generic and branded medications were $103.77 and $1,421.61, respectively.

Courtesy Wikimedia Commons/Kinan Ayu/ Creative Commons license

The study was limited by several factors, including a lack of information about acne severity, patient characteristics, and clinical outcomes, the researchers noted.

However, a “mean savings of $592.26 per person could result if prolonged courses met guidelines,” they wrote.

Find the study online in the Journal of the American Academy of Dermatology (2015;72:822-27).

Women with isolated postadolescent severe acne do not have increased levels of adrenal androgens, either basally or in response to corticotropin stimulation, reported Dr. N. Cinar of Hacettepe University in Ankara, Turkey, and colleagues. However, women with severe acne have secretion patterns of serum 17-hydroxyprogesterone similar to those of polycystic ovary syndrome patients, suggesting the two may have an unexplored connection.

To investigate the role of androgens in the pathogenesis of acne, the researchers compared 32 women with postadolescent severe acne and 32 women with polycystic ovary syndrome (PCOS) with 32 age- and body mass index–matched healthy controls (aged 17-34 years; BMI, 20.8 ± 1.9 kg/m²). They found basal testosterone, free androgen index, and dehydroepiandrosterone sulphate levels for androstenedione (used as metrics for determining adrenocortical production) were significantly higher in the PCOS group than in the women with acne and the controls (P < .05 for all).

In addition, women with PCOS and those with severe acne had significantly and similarly higher area under the curve values of serum 17-hydroxyprogesterone, compared with controls (P < .05), the investigators noted.

Read the entire article here: Journal of the European Academy of Dermatology and Venereology, (2015;29: 875-880 ([doi:10.1111/jdv.12696]).

Women with isolated postadolescent severe acne do not have increased levels of adrenal androgens, either basally or in response to corticotropin stimulation, reported Dr. N. Cinar of Hacettepe University in Ankara, Turkey, and colleagues. However, women with severe acne have secretion patterns of serum 17-hydroxyprogesterone similar to those of polycystic ovary syndrome patients, suggesting the two may have an unexplored connection.

To investigate the role of androgens in the pathogenesis of acne, the researchers compared 32 women with postadolescent severe acne and 32 women with polycystic ovary syndrome (PCOS) with 32 age- and body mass index–matched healthy controls (aged 17-34 years; BMI, 20.8 ± 1.9 kg/m²). They found basal testosterone, free androgen index, and dehydroepiandrosterone sulphate levels for androstenedione (used as metrics for determining adrenocortical production) were significantly higher in the PCOS group than in the women with acne and the controls (P < .05 for all).

In addition, women with PCOS and those with severe acne had significantly and similarly higher area under the curve values of serum 17-hydroxyprogesterone, compared with controls (P < .05), the investigators noted.

Read the entire article here: Journal of the European Academy of Dermatology and Venereology, (2015;29: 875-880 ([doi:10.1111/jdv.12696]).

Women with isolated postadolescent severe acne do not have increased levels of adrenal androgens, either basally or in response to corticotropin stimulation, reported Dr. N. Cinar of Hacettepe University in Ankara, Turkey, and colleagues. However, women with severe acne have secretion patterns of serum 17-hydroxyprogesterone similar to those of polycystic ovary syndrome patients, suggesting the two may have an unexplored connection.

To investigate the role of androgens in the pathogenesis of acne, the researchers compared 32 women with postadolescent severe acne and 32 women with polycystic ovary syndrome (PCOS) with 32 age- and body mass index–matched healthy controls (aged 17-34 years; BMI, 20.8 ± 1.9 kg/m²). They found basal testosterone, free androgen index, and dehydroepiandrosterone sulphate levels for androstenedione (used as metrics for determining adrenocortical production) were significantly higher in the PCOS group than in the women with acne and the controls (P < .05 for all).

In addition, women with PCOS and those with severe acne had significantly and similarly higher area under the curve values of serum 17-hydroxyprogesterone, compared with controls (P < .05), the investigators noted.

Read the entire article here: Journal of the European Academy of Dermatology and Venereology, (2015;29: 875-880 ([doi:10.1111/jdv.12696]).

A gel combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% was significantly more effective against acne vulgaris than a vehicle gel, and lesion count reductions were greater in women, based on data from a study of nearly 500 adults with moderate to severe acne.

In the post hoc analysis, the mean percent change in both inflammatory and noninflammatory lesions from baseline to 12 weeks was greater among women than men. The findings were published by Dr. Julie C. Harper, a dermatologist in Birmingham, Ala., in the April issue of the Journal of Drugs in Dermatology. However, the results were limited by the inability to determine the contributions of the individual ingredients, she noted.

Read the article here (J. Drugs Dermatol. 2015;14:381-4).

A gel combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% was significantly more effective against acne vulgaris than a vehicle gel, and lesion count reductions were greater in women, based on data from a study of nearly 500 adults with moderate to severe acne.

In the post hoc analysis, the mean percent change in both inflammatory and noninflammatory lesions from baseline to 12 weeks was greater among women than men. The findings were published by Dr. Julie C. Harper, a dermatologist in Birmingham, Ala., in the April issue of the Journal of Drugs in Dermatology. However, the results were limited by the inability to determine the contributions of the individual ingredients, she noted.

Read the article here (J. Drugs Dermatol. 2015;14:381-4).

A gel combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% was significantly more effective against acne vulgaris than a vehicle gel, and lesion count reductions were greater in women, based on data from a study of nearly 500 adults with moderate to severe acne.

In the post hoc analysis, the mean percent change in both inflammatory and noninflammatory lesions from baseline to 12 weeks was greater among women than men. The findings were published by Dr. Julie C. Harper, a dermatologist in Birmingham, Ala., in the April issue of the Journal of Drugs in Dermatology. However, the results were limited by the inability to determine the contributions of the individual ingredients, she noted.

Read the article here (J. Drugs Dermatol. 2015;14:381-4).

SAN FRANCISCO – An investigational topical sebum inhibitor met its primary endpoints in a phase IIa trial, significantly reducing inflammatory and noninflammatory lesions in patients with facial acne vulgaris, researchers reported at the annual meeting of the American Academy of Dermatology.

“This study demonstrated that DRM01, belonging to a novel class of topical acne therapeutic agents, is well tolerated and shows evidence of efficacy for treatment of facial acne vulgaris,” said Dr. Robert Bissonnette of Innovaderm Research. Patients had no serious adverse events related to treatment, although the topical product caused erythema at the application site, he said.

The DRM01 agent inhibits sebum production by competing with acetyl coenzyme A carboxylase, which facilitates the first and rate-limiting step in fatty acid synthesis. “It has shown pronounced impact on triacylglycerols, which are considered the most important component of sebum in acne vulgaris,” said Dr. Bissonnette.

The researchers randomized 108 patients with moderate to severe facial acne to 12 weeks of twice-daily treatment with either 7.5% DRM01 or the vehicle gel. On average, patients had 29 inflammatory lesions and 40 noninflammatory lesions at baseline, and approximately two-thirds were women.

At week 12, the DRM01 group had an average 63.9% reduction in inflammatory lesions, compared with 45.9% for the vehicle control group (P < .001), Dr. Bissonnette said. The DRM01 group also had a 48.1% reduction in non-inflammatory lesions, compared with 28.8% for the control group (P =.003). Furthermore, 24.5% of patients who received DRM01 improved by at least two grades on the Investigator’s Global Assessment score, compared with only 7.3% of the control group (P = .007).

Most adverse events were mild or moderate and affected similar proportions of patients in each group, said Dr. Bissonnette. More than 5% of patients in both groups experienced application site dryness, burning, and stinging, but only patients in the treatment group reported application site erythema, he said. Nasopharyngitis affected 24.5% of patients treated with DRM01 and 12.7% of those treated with the vehicle, but was considered unrelated to treatment.

Researchers do not know how or whether DRM01 reduces inflammation, Dr. Bissonnette said in response to a question from an audience member. The study also was not able to show that DRM01 significantly reduced sebum production compared with the gel vehicle. “It could be a data quality problem, as the sites had not all been fully trained in doing those measurements,” he said.

Dermira manufactures DRM01 and sponsored the study. Dr. Bissonnette reported having served as a researcher for Dermira.

SAN FRANCISCO – An investigational topical sebum inhibitor met its primary endpoints in a phase IIa trial, significantly reducing inflammatory and noninflammatory lesions in patients with facial acne vulgaris, researchers reported at the annual meeting of the American Academy of Dermatology.

“This study demonstrated that DRM01, belonging to a novel class of topical acne therapeutic agents, is well tolerated and shows evidence of efficacy for treatment of facial acne vulgaris,” said Dr. Robert Bissonnette of Innovaderm Research. Patients had no serious adverse events related to treatment, although the topical product caused erythema at the application site, he said.

The DRM01 agent inhibits sebum production by competing with acetyl coenzyme A carboxylase, which facilitates the first and rate-limiting step in fatty acid synthesis. “It has shown pronounced impact on triacylglycerols, which are considered the most important component of sebum in acne vulgaris,” said Dr. Bissonnette.

The researchers randomized 108 patients with moderate to severe facial acne to 12 weeks of twice-daily treatment with either 7.5% DRM01 or the vehicle gel. On average, patients had 29 inflammatory lesions and 40 noninflammatory lesions at baseline, and approximately two-thirds were women.

At week 12, the DRM01 group had an average 63.9% reduction in inflammatory lesions, compared with 45.9% for the vehicle control group (P < .001), Dr. Bissonnette said. The DRM01 group also had a 48.1% reduction in non-inflammatory lesions, compared with 28.8% for the control group (P =.003). Furthermore, 24.5% of patients who received DRM01 improved by at least two grades on the Investigator’s Global Assessment score, compared with only 7.3% of the control group (P = .007).

Most adverse events were mild or moderate and affected similar proportions of patients in each group, said Dr. Bissonnette. More than 5% of patients in both groups experienced application site dryness, burning, and stinging, but only patients in the treatment group reported application site erythema, he said. Nasopharyngitis affected 24.5% of patients treated with DRM01 and 12.7% of those treated with the vehicle, but was considered unrelated to treatment.

Researchers do not know how or whether DRM01 reduces inflammation, Dr. Bissonnette said in response to a question from an audience member. The study also was not able to show that DRM01 significantly reduced sebum production compared with the gel vehicle. “It could be a data quality problem, as the sites had not all been fully trained in doing those measurements,” he said.

Dermira manufactures DRM01 and sponsored the study. Dr. Bissonnette reported having served as a researcher for Dermira.

SAN FRANCISCO – An investigational topical sebum inhibitor met its primary endpoints in a phase IIa trial, significantly reducing inflammatory and noninflammatory lesions in patients with facial acne vulgaris, researchers reported at the annual meeting of the American Academy of Dermatology.

“This study demonstrated that DRM01, belonging to a novel class of topical acne therapeutic agents, is well tolerated and shows evidence of efficacy for treatment of facial acne vulgaris,” said Dr. Robert Bissonnette of Innovaderm Research. Patients had no serious adverse events related to treatment, although the topical product caused erythema at the application site, he said.

The DRM01 agent inhibits sebum production by competing with acetyl coenzyme A carboxylase, which facilitates the first and rate-limiting step in fatty acid synthesis. “It has shown pronounced impact on triacylglycerols, which are considered the most important component of sebum in acne vulgaris,” said Dr. Bissonnette.

The researchers randomized 108 patients with moderate to severe facial acne to 12 weeks of twice-daily treatment with either 7.5% DRM01 or the vehicle gel. On average, patients had 29 inflammatory lesions and 40 noninflammatory lesions at baseline, and approximately two-thirds were women.

At week 12, the DRM01 group had an average 63.9% reduction in inflammatory lesions, compared with 45.9% for the vehicle control group (P < .001), Dr. Bissonnette said. The DRM01 group also had a 48.1% reduction in non-inflammatory lesions, compared with 28.8% for the control group (P =.003). Furthermore, 24.5% of patients who received DRM01 improved by at least two grades on the Investigator’s Global Assessment score, compared with only 7.3% of the control group (P = .007).

Most adverse events were mild or moderate and affected similar proportions of patients in each group, said Dr. Bissonnette. More than 5% of patients in both groups experienced application site dryness, burning, and stinging, but only patients in the treatment group reported application site erythema, he said. Nasopharyngitis affected 24.5% of patients treated with DRM01 and 12.7% of those treated with the vehicle, but was considered unrelated to treatment.

Researchers do not know how or whether DRM01 reduces inflammation, Dr. Bissonnette said in response to a question from an audience member. The study also was not able to show that DRM01 significantly reduced sebum production compared with the gel vehicle. “It could be a data quality problem, as the sites had not all been fully trained in doing those measurements,” he said.

Dermira manufactures DRM01 and sponsored the study. Dr. Bissonnette reported having served as a researcher for Dermira.

SAN FRANCISCO – The room was packed for a talk about spironolactone and acne at the annual meeting of the American Academy of Dermatology.

Several dozen people were turned away at the door because there weren’t any seats left. Dermatologists have heard that the drug is a good option for adult women, but they’ve also heard about potential problems with spironolactone, and – as the turnout shows – they want to know the bottom line.

One of the speakers, Dr. Julie Harper of the University of Alabama in Birmingham, explained when and how to use spironolactone in an interview after the session.

 [email protected]

SAN FRANCISCO – The room was packed for a talk about spironolactone and acne at the annual meeting of the American Academy of Dermatology.

Several dozen people were turned away at the door because there weren’t any seats left. Dermatologists have heard that the drug is a good option for adult women, but they’ve also heard about potential problems with spironolactone, and – as the turnout shows – they want to know the bottom line.

One of the speakers, Dr. Julie Harper of the University of Alabama in Birmingham, explained when and how to use spironolactone in an interview after the session.

 [email protected]

SAN FRANCISCO – The room was packed for a talk about spironolactone and acne at the annual meeting of the American Academy of Dermatology.

Several dozen people were turned away at the door because there weren’t any seats left. Dermatologists have heard that the drug is a good option for adult women, but they’ve also heard about potential problems with spironolactone, and – as the turnout shows – they want to know the bottom line.

One of the speakers, Dr. Julie Harper of the University of Alabama in Birmingham, explained when and how to use spironolactone in an interview after the session.

 [email protected]

Young women taking spironolactone for hormonally mediated acne do not need to be monitored for hyperkalemia, say the authors of a study that showed no significant increase in the risk of the condition.

The retrospective study in 974 otherwise healthy women taking spironolactone found the rate of hyperkalemia was 0.72%, compared with 0.76% in women not taking spironolactone, according to data published online March 22 in JAMA Dermatology.

A subset of 13 patients were found to have elevated serum potassium but upon repeat testing in 6, these measurements had all returned to normal, suggesting either incorrect first measurements or that the mild hyperkalemia was transient (JAMA Dermatology 2015 [doi:10.1001/jamadermatol.2015.34].

“The low rate of hyperkalemia may encourage more health care professionals to consider the use of this highly effective drug in their clinical practice,” wrote Dr. Molly Plovanich and her coauthors from Brigham and Women’s Hospital and Harvard Medical School, both in Boston.

Young women taking spironolactone for hormonally mediated acne do not need to be monitored for hyperkalemia, say the authors of a study that showed no significant increase in the risk of the condition.

The retrospective study in 974 otherwise healthy women taking spironolactone found the rate of hyperkalemia was 0.72%, compared with 0.76% in women not taking spironolactone, according to data published online March 22 in JAMA Dermatology.

A subset of 13 patients were found to have elevated serum potassium but upon repeat testing in 6, these measurements had all returned to normal, suggesting either incorrect first measurements or that the mild hyperkalemia was transient (JAMA Dermatology 2015 [doi:10.1001/jamadermatol.2015.34].

“The low rate of hyperkalemia may encourage more health care professionals to consider the use of this highly effective drug in their clinical practice,” wrote Dr. Molly Plovanich and her coauthors from Brigham and Women’s Hospital and Harvard Medical School, both in Boston.

Young women taking spironolactone for hormonally mediated acne do not need to be monitored for hyperkalemia, say the authors of a study that showed no significant increase in the risk of the condition.

The retrospective study in 974 otherwise healthy women taking spironolactone found the rate of hyperkalemia was 0.72%, compared with 0.76% in women not taking spironolactone, according to data published online March 22 in JAMA Dermatology.

A subset of 13 patients were found to have elevated serum potassium but upon repeat testing in 6, these measurements had all returned to normal, suggesting either incorrect first measurements or that the mild hyperkalemia was transient (JAMA Dermatology 2015 [doi:10.1001/jamadermatol.2015.34].

“The low rate of hyperkalemia may encourage more health care professionals to consider the use of this highly effective drug in their clinical practice,” wrote Dr. Molly Plovanich and her coauthors from Brigham and Women’s Hospital and Harvard Medical School, both in Boston.

More than one-quarter of patients prescribed treatments for acne do not fill all their prescriptions, particularly those prescribed more than one treatment, research suggests.

A telephone survey of 143 individuals prescribed treatments for acne showed that 27% of patients did not fill all their prescriptions, and primary nonadherence was higher in those prescribed topical retinoid or over-the-counter products, according to data published online March 20 in JAMA Dermatology.

Nine percent of patients who were prescribed one medication did not fill all their prescriptions, 40% of those prescribed two treatments and 31% of those prescribed three treatments did not fill all their prescriptions (JAMA Dermatol. 2015, March 20 [doi:10.1001/jamadermatol.2014.5254]).

“Common justifications [for not filling prescriptions] included cost, forgetfulness, similar treatments already on hand, not agreeing with the prescribed regimen, and improvement of skin condition before obtaining the prescriptions,” wrote Kathryn L. Anderson and colleagues of Wake Forest University, Winston-Salem, N.C.

The study center is supported by a grant from Galderma Laboratories. One author reported speaker fees, grants, advisory board positions, and stock ownership for a range of pharmaceutical companies.

More than one-quarter of patients prescribed treatments for acne do not fill all their prescriptions, particularly those prescribed more than one treatment, research suggests.

A telephone survey of 143 individuals prescribed treatments for acne showed that 27% of patients did not fill all their prescriptions, and primary nonadherence was higher in those prescribed topical retinoid or over-the-counter products, according to data published online March 20 in JAMA Dermatology.

Nine percent of patients who were prescribed one medication did not fill all their prescriptions, 40% of those prescribed two treatments and 31% of those prescribed three treatments did not fill all their prescriptions (JAMA Dermatol. 2015, March 20 [doi:10.1001/jamadermatol.2014.5254]).

“Common justifications [for not filling prescriptions] included cost, forgetfulness, similar treatments already on hand, not agreeing with the prescribed regimen, and improvement of skin condition before obtaining the prescriptions,” wrote Kathryn L. Anderson and colleagues of Wake Forest University, Winston-Salem, N.C.

The study center is supported by a grant from Galderma Laboratories. One author reported speaker fees, grants, advisory board positions, and stock ownership for a range of pharmaceutical companies.

More than one-quarter of patients prescribed treatments for acne do not fill all their prescriptions, particularly those prescribed more than one treatment, research suggests.

A telephone survey of 143 individuals prescribed treatments for acne showed that 27% of patients did not fill all their prescriptions, and primary nonadherence was higher in those prescribed topical retinoid or over-the-counter products, according to data published online March 20 in JAMA Dermatology.

Nine percent of patients who were prescribed one medication did not fill all their prescriptions, 40% of those prescribed two treatments and 31% of those prescribed three treatments did not fill all their prescriptions (JAMA Dermatol. 2015, March 20 [doi:10.1001/jamadermatol.2014.5254]).

“Common justifications [for not filling prescriptions] included cost, forgetfulness, similar treatments already on hand, not agreeing with the prescribed regimen, and improvement of skin condition before obtaining the prescriptions,” wrote Kathryn L. Anderson and colleagues of Wake Forest University, Winston-Salem, N.C.

The study center is supported by a grant from Galderma Laboratories. One author reported speaker fees, grants, advisory board positions, and stock ownership for a range of pharmaceutical companies.

In December 2014, the US Food and Drug Administration approved ivermectin cream 1% (Soolantra) for the treatment of inflammatory lesions of rosacea. This approval follows several safety and efficacy trials, particularly a phase 3 investigator-blinded, parallel-group study, published online in the British Journal of Dermatology on September 16, 2014, comparing once-daily application of ivermectin cream 1% and twice-daily metronidazole cream 0.75% in 962 patients with papulopustular rosacea over 16 weeks. Ivermectin showed more favorable local tolerability and significant reduction in lesion count versus metronidazole (83% vs 73.7%; P<.001) starting at week 3 and persisting throughout the study.

What’s the issue?

How many patients do you encounter each week who apply metronidazole topical treatments for years with little objective evidence of rosacea improvement? These data suggest that topical ivermectin may be a slightly more effective and tolerable alternative for papulopustular rosacea than the long-standing but modestly efficacious gold standard. With the recent approval of brimonidine gel for the erythematous component of rosacea, it is groundbreaking to introduce novel topical mechanisms into our rosacea prescription armamentarium as we attempt to elucidate the disease’s complex pathophysiology. What is your experience with this topical, and how do you think it will fit into your prescribing routines for rosacea?

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

In December 2014, the US Food and Drug Administration approved ivermectin cream 1% (Soolantra) for the treatment of inflammatory lesions of rosacea. This approval follows several safety and efficacy trials, particularly a phase 3 investigator-blinded, parallel-group study, published online in the British Journal of Dermatology on September 16, 2014, comparing once-daily application of ivermectin cream 1% and twice-daily metronidazole cream 0.75% in 962 patients with papulopustular rosacea over 16 weeks. Ivermectin showed more favorable local tolerability and significant reduction in lesion count versus metronidazole (83% vs 73.7%; P<.001) starting at week 3 and persisting throughout the study.

What’s the issue?

How many patients do you encounter each week who apply metronidazole topical treatments for years with little objective evidence of rosacea improvement? These data suggest that topical ivermectin may be a slightly more effective and tolerable alternative for papulopustular rosacea than the long-standing but modestly efficacious gold standard. With the recent approval of brimonidine gel for the erythematous component of rosacea, it is groundbreaking to introduce novel topical mechanisms into our rosacea prescription armamentarium as we attempt to elucidate the disease’s complex pathophysiology. What is your experience with this topical, and how do you think it will fit into your prescribing routines for rosacea?

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

In December 2014, the US Food and Drug Administration approved ivermectin cream 1% (Soolantra) for the treatment of inflammatory lesions of rosacea. This approval follows several safety and efficacy trials, particularly a phase 3 investigator-blinded, parallel-group study, published online in the British Journal of Dermatology on September 16, 2014, comparing once-daily application of ivermectin cream 1% and twice-daily metronidazole cream 0.75% in 962 patients with papulopustular rosacea over 16 weeks. Ivermectin showed more favorable local tolerability and significant reduction in lesion count versus metronidazole (83% vs 73.7%; P<.001) starting at week 3 and persisting throughout the study.

What’s the issue?

How many patients do you encounter each week who apply metronidazole topical treatments for years with little objective evidence of rosacea improvement? These data suggest that topical ivermectin may be a slightly more effective and tolerable alternative for papulopustular rosacea than the long-standing but modestly efficacious gold standard. With the recent approval of brimonidine gel for the erythematous component of rosacea, it is groundbreaking to introduce novel topical mechanisms into our rosacea prescription armamentarium as we attempt to elucidate the disease’s complex pathophysiology. What is your experience with this topical, and how do you think it will fit into your prescribing routines for rosacea?

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

MIAMI BEACH – Do you cringe when a patient comes in wanting treatment for acne scars? Fear not; such patients are usually very motivated, and effective treatment options exist, according to Dr. Gary Monheit.

It’s true that you can’t perfect their skin, that there is a need to deal with the psychology of what their scarring has meant for them, and that it may take a significant amount of time to temper expectations, he said at the South Beach Symposium.

“But once you win them over, they can be some of the most grateful patients you have. … Don’t turn them away,” he said.

There’s not a lot of training available for treating acne scars, but using existing skill, good judgment, and a combination of tools and techniques can lead to excellent results, said Dr. Monheit, who is in private practice in Birmingham, Ala.

Leveling patient expectations comes down to educating patients about the different kinds of scars and the fact that each type requires different tools.

For example, fillers can be useful – but only for distensible scars. If the scar rises up when the skin is stretched, that’s a distensible scar that will respond to a filler, he explained.

Conversely, if injectable fillers are used in scars with bands that hold them down in deeper tissue, the filler will migrate, surround the scar, and exaggerate its appearance.

A classification system described by Dr. Greg Goodman (Int. J. Dermatol. 2011;50:1179-94]) is useful for determining the best treatment approach based on scar type, he said.

Dr. Goodman described level 1 scars as flat with red, white, or brown marks. Level 2 scars are mild scars visible primarily at close distance, such as while looking in the mirror. Level 3 scars are visible at a conversational distance, but are distensible. Level 4 scars are more severe and are nondistensible.

Peels, cosmeceuticals, and light resurfacing techniques such as the V-beam laser or intense pulsed light, are best for mild scars like level 1 scars, as they typically are erythematous and involve color change, Dr. Monheit said.

For hyperpigmented level 1 scars, consider using topical treatments such as salicylic acid or bleaching agents. For hypopigmented scars, there is a need to blend skin color.

The main thing with these types of scars is to address the color and texture, he said.

Level 2 scars are atrophic, and involve textural and color change. Other resurfacing techniques, including deeper peels, dermabrasion, and laser resurfacing such as with a fractional laser or an ablative laser are particularly useful for these, he said, noting that the treatments can be combined as necessary to achieve the desired results.

Dermarolling also can be helpful for deeper scars.

“As you get into the dermis and deeper, you are breaking collagen bonds and letting skin rise to the surface, and you can also use [dermarolling] as a conduit for whatever you are doing,” he explained.

Needling is another approach that is relatively safe, inexpensive, and involves minimal down time. However, the treatment can be bloody and painful with the depths typically needed for treating scars, he noted.

Moderate scars that are distensible, like level 3 scars, generally need lifting. Fillers are good for these types of scars, and often there is very little more that needs to be done.

Nondistensible scars that are more severe typically require a combination approach. One of the best tools for these types of scars is subcision to loosen them, which creates a pocket that then can be either allowed to fill with blood to raise the scar up or treated with an injectable filler. This is followed by resurfacing to smooth the surface of the skin.

Dr. Monheit described one patient in whom he subcised the nondistensible scars and injected a very small amount – just enough for a surface lift – of Radiesse filler. Significant improvement was seen after two treatment sessions, and then resurfacing was performed.

In another patient with nondistensible scars, he excised a little bit of skin at the scar and performed what amounted to a collagen graft by “chopping it into little pieces – making little pellets – and essentially stuffing those pellets into the pockets with a tiny little needle, giving it lift and stability.” This was followed by resurfacing.

“It really does give a nice result,” he said, noting that subcision may cause some red bumps at first, but these will settle down and the scar will smooth out.

A different approach is needed for other types of scars, such as ice pick scars.

One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.

Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.

Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.

Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.

“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.

Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.

MIAMI BEACH – Do you cringe when a patient comes in wanting treatment for acne scars? Fear not; such patients are usually very motivated, and effective treatment options exist, according to Dr. Gary Monheit.

It’s true that you can’t perfect their skin, that there is a need to deal with the psychology of what their scarring has meant for them, and that it may take a significant amount of time to temper expectations, he said at the South Beach Symposium.

“But once you win them over, they can be some of the most grateful patients you have. … Don’t turn them away,” he said.

There’s not a lot of training available for treating acne scars, but using existing skill, good judgment, and a combination of tools and techniques can lead to excellent results, said Dr. Monheit, who is in private practice in Birmingham, Ala.

Leveling patient expectations comes down to educating patients about the different kinds of scars and the fact that each type requires different tools.

For example, fillers can be useful – but only for distensible scars. If the scar rises up when the skin is stretched, that’s a distensible scar that will respond to a filler, he explained.

Conversely, if injectable fillers are used in scars with bands that hold them down in deeper tissue, the filler will migrate, surround the scar, and exaggerate its appearance.

A classification system described by Dr. Greg Goodman (Int. J. Dermatol. 2011;50:1179-94]) is useful for determining the best treatment approach based on scar type, he said.

Dr. Goodman described level 1 scars as flat with red, white, or brown marks. Level 2 scars are mild scars visible primarily at close distance, such as while looking in the mirror. Level 3 scars are visible at a conversational distance, but are distensible. Level 4 scars are more severe and are nondistensible.

Peels, cosmeceuticals, and light resurfacing techniques such as the V-beam laser or intense pulsed light, are best for mild scars like level 1 scars, as they typically are erythematous and involve color change, Dr. Monheit said.

For hyperpigmented level 1 scars, consider using topical treatments such as salicylic acid or bleaching agents. For hypopigmented scars, there is a need to blend skin color.

The main thing with these types of scars is to address the color and texture, he said.

Level 2 scars are atrophic, and involve textural and color change. Other resurfacing techniques, including deeper peels, dermabrasion, and laser resurfacing such as with a fractional laser or an ablative laser are particularly useful for these, he said, noting that the treatments can be combined as necessary to achieve the desired results.

Dermarolling also can be helpful for deeper scars.

“As you get into the dermis and deeper, you are breaking collagen bonds and letting skin rise to the surface, and you can also use [dermarolling] as a conduit for whatever you are doing,” he explained.

Needling is another approach that is relatively safe, inexpensive, and involves minimal down time. However, the treatment can be bloody and painful with the depths typically needed for treating scars, he noted.

Moderate scars that are distensible, like level 3 scars, generally need lifting. Fillers are good for these types of scars, and often there is very little more that needs to be done.

Nondistensible scars that are more severe typically require a combination approach. One of the best tools for these types of scars is subcision to loosen them, which creates a pocket that then can be either allowed to fill with blood to raise the scar up or treated with an injectable filler. This is followed by resurfacing to smooth the surface of the skin.

Dr. Monheit described one patient in whom he subcised the nondistensible scars and injected a very small amount – just enough for a surface lift – of Radiesse filler. Significant improvement was seen after two treatment sessions, and then resurfacing was performed.

In another patient with nondistensible scars, he excised a little bit of skin at the scar and performed what amounted to a collagen graft by “chopping it into little pieces – making little pellets – and essentially stuffing those pellets into the pockets with a tiny little needle, giving it lift and stability.” This was followed by resurfacing.

“It really does give a nice result,” he said, noting that subcision may cause some red bumps at first, but these will settle down and the scar will smooth out.

A different approach is needed for other types of scars, such as ice pick scars.

One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.

Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.

Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.

Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.

“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.

Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.

MIAMI BEACH – Do you cringe when a patient comes in wanting treatment for acne scars? Fear not; such patients are usually very motivated, and effective treatment options exist, according to Dr. Gary Monheit.

It’s true that you can’t perfect their skin, that there is a need to deal with the psychology of what their scarring has meant for them, and that it may take a significant amount of time to temper expectations, he said at the South Beach Symposium.

“But once you win them over, they can be some of the most grateful patients you have. … Don’t turn them away,” he said.

There’s not a lot of training available for treating acne scars, but using existing skill, good judgment, and a combination of tools and techniques can lead to excellent results, said Dr. Monheit, who is in private practice in Birmingham, Ala.

Leveling patient expectations comes down to educating patients about the different kinds of scars and the fact that each type requires different tools.

For example, fillers can be useful – but only for distensible scars. If the scar rises up when the skin is stretched, that’s a distensible scar that will respond to a filler, he explained.

Conversely, if injectable fillers are used in scars with bands that hold them down in deeper tissue, the filler will migrate, surround the scar, and exaggerate its appearance.

A classification system described by Dr. Greg Goodman (Int. J. Dermatol. 2011;50:1179-94]) is useful for determining the best treatment approach based on scar type, he said.

Dr. Goodman described level 1 scars as flat with red, white, or brown marks. Level 2 scars are mild scars visible primarily at close distance, such as while looking in the mirror. Level 3 scars are visible at a conversational distance, but are distensible. Level 4 scars are more severe and are nondistensible.

Peels, cosmeceuticals, and light resurfacing techniques such as the V-beam laser or intense pulsed light, are best for mild scars like level 1 scars, as they typically are erythematous and involve color change, Dr. Monheit said.

For hyperpigmented level 1 scars, consider using topical treatments such as salicylic acid or bleaching agents. For hypopigmented scars, there is a need to blend skin color.

The main thing with these types of scars is to address the color and texture, he said.

Level 2 scars are atrophic, and involve textural and color change. Other resurfacing techniques, including deeper peels, dermabrasion, and laser resurfacing such as with a fractional laser or an ablative laser are particularly useful for these, he said, noting that the treatments can be combined as necessary to achieve the desired results.

Dermarolling also can be helpful for deeper scars.

“As you get into the dermis and deeper, you are breaking collagen bonds and letting skin rise to the surface, and you can also use [dermarolling] as a conduit for whatever you are doing,” he explained.

Needling is another approach that is relatively safe, inexpensive, and involves minimal down time. However, the treatment can be bloody and painful with the depths typically needed for treating scars, he noted.

Moderate scars that are distensible, like level 3 scars, generally need lifting. Fillers are good for these types of scars, and often there is very little more that needs to be done.

Nondistensible scars that are more severe typically require a combination approach. One of the best tools for these types of scars is subcision to loosen them, which creates a pocket that then can be either allowed to fill with blood to raise the scar up or treated with an injectable filler. This is followed by resurfacing to smooth the surface of the skin.

Dr. Monheit described one patient in whom he subcised the nondistensible scars and injected a very small amount – just enough for a surface lift – of Radiesse filler. Significant improvement was seen after two treatment sessions, and then resurfacing was performed.

In another patient with nondistensible scars, he excised a little bit of skin at the scar and performed what amounted to a collagen graft by “chopping it into little pieces – making little pellets – and essentially stuffing those pellets into the pockets with a tiny little needle, giving it lift and stability.” This was followed by resurfacing.

“It really does give a nice result,” he said, noting that subcision may cause some red bumps at first, but these will settle down and the scar will smooth out.

A different approach is needed for other types of scars, such as ice pick scars.

One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.

Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.

Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.

Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.

“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.

Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.