Rosacea

WASHINGTON – The autologous cellular product azficel-T produced significant improvement in acne scarring compared with placebo, according to new study results reported at the annual meeting of the American Society for Dermatologic Surgery.

The product, Laviv (Fibrocell Science), was recently approved by the Food and Drug Administration for the treatment of moderate to severe nasolabial folds. It is the first FDA-approved personalized cell therapy for aesthetic use, according to Dr. Girish Munavalli of the dermatology department at Wake Forest University, Winston-Salem, N.C.

In the multicenter, randomized, double-blind, placebo-controlled study, skin biopsies were collected from 119 patients with moderate-to-severe depressed acne scarring of at least 9 cm² for at least 3 years. The biopsies were used to produce individual fibroblasts for each patient. Up to three injections of 2 mL of autologous fibroblasts (10-20 million cells/mL) were given on one cheek and placebo on the other at 14-day intervals in 99 of the patients. Treatment was administered at a dose of 0.1 mL/cm² into areas of acne scarring. Adverse events were recorded for each cheek.

At 4 months after completion of the treatment, a statistically significant higher percentage of patients had responded to treatment with azficel-T than to treatment with placebo, as rated by both the study investigators (58.7% vs. 42.2%, respectively) and patients (43.1% vs. 18.3%). Patient and evaluator assessments at earlier time points during the study also showed a significantly higher proportion of responses with azficel-T than with placebo at all but one assessment, reported Dr. Munavalli.

The study successfully met its two prospectively defined end points: a 2-point or greater improvement on a 5-point Subject Live Acne Scarring assessment scale, and a 1-point or greater reduction in cheek acne severity on a physician-assessed, validated 5-point Evaluator Live Acne Scar assessment scale.

All reported adverse events were mild or moderate in severity. No subjects experienced serious adverse events, discontinued treatment, or withdrew from the study. The incidence of adverse events occurring in the treatment areas was comparable between azficel-T and placebo. The most commonly reported adverse events were treatment-area erythema (occurring in 11.1%) and swelling (10.1%). In the azficel-T-treated area, erythema was moderate in 5 of the 12 subjects who reported it, and swelling was moderate in 5 of the 11 who reported it. In contrast, all treatment-related adverse events in the placebo-treated areas were mild.

Other adverse events with a possible relationship to study treatment included bruising, rash, irritation, nodules, pain, acne, induration, and headache, Dr. Munavalli reported.

"Our findings show that using a person's own collagen-producing cells in the form of Laviv may provide a promising new alternative to improve acne scarring with minimal downtime and an excellent safety profile," he noted.

Dr. Munavalli received research funding from Fibrocell Science.

WASHINGTON – The autologous cellular product azficel-T produced significant improvement in acne scarring compared with placebo, according to new study results reported at the annual meeting of the American Society for Dermatologic Surgery.

The product, Laviv (Fibrocell Science), was recently approved by the Food and Drug Administration for the treatment of moderate to severe nasolabial folds. It is the first FDA-approved personalized cell therapy for aesthetic use, according to Dr. Girish Munavalli of the dermatology department at Wake Forest University, Winston-Salem, N.C.

In the multicenter, randomized, double-blind, placebo-controlled study, skin biopsies were collected from 119 patients with moderate-to-severe depressed acne scarring of at least 9 cm² for at least 3 years. The biopsies were used to produce individual fibroblasts for each patient. Up to three injections of 2 mL of autologous fibroblasts (10-20 million cells/mL) were given on one cheek and placebo on the other at 14-day intervals in 99 of the patients. Treatment was administered at a dose of 0.1 mL/cm² into areas of acne scarring. Adverse events were recorded for each cheek.

At 4 months after completion of the treatment, a statistically significant higher percentage of patients had responded to treatment with azficel-T than to treatment with placebo, as rated by both the study investigators (58.7% vs. 42.2%, respectively) and patients (43.1% vs. 18.3%). Patient and evaluator assessments at earlier time points during the study also showed a significantly higher proportion of responses with azficel-T than with placebo at all but one assessment, reported Dr. Munavalli.

The study successfully met its two prospectively defined end points: a 2-point or greater improvement on a 5-point Subject Live Acne Scarring assessment scale, and a 1-point or greater reduction in cheek acne severity on a physician-assessed, validated 5-point Evaluator Live Acne Scar assessment scale.

All reported adverse events were mild or moderate in severity. No subjects experienced serious adverse events, discontinued treatment, or withdrew from the study. The incidence of adverse events occurring in the treatment areas was comparable between azficel-T and placebo. The most commonly reported adverse events were treatment-area erythema (occurring in 11.1%) and swelling (10.1%). In the azficel-T-treated area, erythema was moderate in 5 of the 12 subjects who reported it, and swelling was moderate in 5 of the 11 who reported it. In contrast, all treatment-related adverse events in the placebo-treated areas were mild.

Other adverse events with a possible relationship to study treatment included bruising, rash, irritation, nodules, pain, acne, induration, and headache, Dr. Munavalli reported.

"Our findings show that using a person's own collagen-producing cells in the form of Laviv may provide a promising new alternative to improve acne scarring with minimal downtime and an excellent safety profile," he noted.

Dr. Munavalli received research funding from Fibrocell Science.

WASHINGTON – The autologous cellular product azficel-T produced significant improvement in acne scarring compared with placebo, according to new study results reported at the annual meeting of the American Society for Dermatologic Surgery.

The product, Laviv (Fibrocell Science), was recently approved by the Food and Drug Administration for the treatment of moderate to severe nasolabial folds. It is the first FDA-approved personalized cell therapy for aesthetic use, according to Dr. Girish Munavalli of the dermatology department at Wake Forest University, Winston-Salem, N.C.

In the multicenter, randomized, double-blind, placebo-controlled study, skin biopsies were collected from 119 patients with moderate-to-severe depressed acne scarring of at least 9 cm² for at least 3 years. The biopsies were used to produce individual fibroblasts for each patient. Up to three injections of 2 mL of autologous fibroblasts (10-20 million cells/mL) were given on one cheek and placebo on the other at 14-day intervals in 99 of the patients. Treatment was administered at a dose of 0.1 mL/cm² into areas of acne scarring. Adverse events were recorded for each cheek.

At 4 months after completion of the treatment, a statistically significant higher percentage of patients had responded to treatment with azficel-T than to treatment with placebo, as rated by both the study investigators (58.7% vs. 42.2%, respectively) and patients (43.1% vs. 18.3%). Patient and evaluator assessments at earlier time points during the study also showed a significantly higher proportion of responses with azficel-T than with placebo at all but one assessment, reported Dr. Munavalli.

The study successfully met its two prospectively defined end points: a 2-point or greater improvement on a 5-point Subject Live Acne Scarring assessment scale, and a 1-point or greater reduction in cheek acne severity on a physician-assessed, validated 5-point Evaluator Live Acne Scar assessment scale.

All reported adverse events were mild or moderate in severity. No subjects experienced serious adverse events, discontinued treatment, or withdrew from the study. The incidence of adverse events occurring in the treatment areas was comparable between azficel-T and placebo. The most commonly reported adverse events were treatment-area erythema (occurring in 11.1%) and swelling (10.1%). In the azficel-T-treated area, erythema was moderate in 5 of the 12 subjects who reported it, and swelling was moderate in 5 of the 11 who reported it. In contrast, all treatment-related adverse events in the placebo-treated areas were mild.

Other adverse events with a possible relationship to study treatment included bruising, rash, irritation, nodules, pain, acne, induration, and headache, Dr. Munavalli reported.

"Our findings show that using a person's own collagen-producing cells in the form of Laviv may provide a promising new alternative to improve acne scarring with minimal downtime and an excellent safety profile," he noted.

Dr. Munavalli received research funding from Fibrocell Science.

LISBON – Overweight or obesity is independently associated with a twofold increased prevalence of moderate to severe acne in adolescent girls, according to a large population-based Norwegian study.

No such association was apparent in adolescent boys, Dr. Jon A. Halvorsen reported at the annual congress of the European Academy of Dermatology and Venereology.

He presented a cross-sectional questionnaire study of 3,774 Oslo teenagers aged 18-19 years. He and his coworkers undertook the study because the relationship between acne and body mass index has seldom been examined. The only prior study addressing the issue dates back to 1956; it found no association between acne and overweight in a group of young male soldiers (Br. Med. J. 1956;1:1268-70).

In the new Oslo study, overweight or obesity marked by a body mass index (BMI) of at least 25 kg/m² was present in 9.5% of girls and 15.4% of boys. Self-reported moderate or severe acne, as defined using validated criteria, was present in 13.1% of girls and 14% of boys.

In the multivariate logistic regression analysis adjusted for mental health issues, sociodemographic factors, and diet, the prevalence of moderate or severe acne in overweight or obese girls was 18.5%, compared with less than 12% in the normal-weight comparison group of girls with a BMI of 18.5 to less than 23, reported Dr. Halvorsen of the University of Oslo. Girls with a BMI of 23 to less than 25 were 30% more likely than the comparison group to have significant acne, a trend that didn’t reach significance.

The situation was quite different in boys. The highest prevalence of moderate or severe acne (18%) occurred in underweight boys having a BMI less than 18.5. Normal-weight boys had less than a 12% prevalence of significant acne, while in overweight or obese boys the prevalence was slightly greater than 13%.

Dr. Halvorsen stressed that since these findings come from a cross-sectional study, they don’t establish a causal relationship between acne and BMI. But the data do raise questions worthy of further investigation.

"Can overweight cause acne? How important is inflammation in the pathogenesis of acne? How important are hormonal factors in adolescent acne? What about physical activity: Is it related to acne prevalence? How important are lifestyle factors?" he asked.

A lack of hormonal measurements is an important limitation of the Norwegian study. It’s an issue because polycystic ovary syndrome is known to be a risk factor for both overweight and acne, he noted.

The dietary variables incorporated in the analysis included rates of consumption of soft drinks, fatty junk foods, and raw vegetables. An audience member observed that milk consumption has previously been linked to acne; however, milk intake wasn’t recorded in the study.

Dr. Halvorsen reported having no financial conflicts of interest.

LISBON – Overweight or obesity is independently associated with a twofold increased prevalence of moderate to severe acne in adolescent girls, according to a large population-based Norwegian study.

No such association was apparent in adolescent boys, Dr. Jon A. Halvorsen reported at the annual congress of the European Academy of Dermatology and Venereology.

He presented a cross-sectional questionnaire study of 3,774 Oslo teenagers aged 18-19 years. He and his coworkers undertook the study because the relationship between acne and body mass index has seldom been examined. The only prior study addressing the issue dates back to 1956; it found no association between acne and overweight in a group of young male soldiers (Br. Med. J. 1956;1:1268-70).

In the new Oslo study, overweight or obesity marked by a body mass index (BMI) of at least 25 kg/m² was present in 9.5% of girls and 15.4% of boys. Self-reported moderate or severe acne, as defined using validated criteria, was present in 13.1% of girls and 14% of boys.

In the multivariate logistic regression analysis adjusted for mental health issues, sociodemographic factors, and diet, the prevalence of moderate or severe acne in overweight or obese girls was 18.5%, compared with less than 12% in the normal-weight comparison group of girls with a BMI of 18.5 to less than 23, reported Dr. Halvorsen of the University of Oslo. Girls with a BMI of 23 to less than 25 were 30% more likely than the comparison group to have significant acne, a trend that didn’t reach significance.

The situation was quite different in boys. The highest prevalence of moderate or severe acne (18%) occurred in underweight boys having a BMI less than 18.5. Normal-weight boys had less than a 12% prevalence of significant acne, while in overweight or obese boys the prevalence was slightly greater than 13%.

Dr. Halvorsen stressed that since these findings come from a cross-sectional study, they don’t establish a causal relationship between acne and BMI. But the data do raise questions worthy of further investigation.

"Can overweight cause acne? How important is inflammation in the pathogenesis of acne? How important are hormonal factors in adolescent acne? What about physical activity: Is it related to acne prevalence? How important are lifestyle factors?" he asked.

A lack of hormonal measurements is an important limitation of the Norwegian study. It’s an issue because polycystic ovary syndrome is known to be a risk factor for both overweight and acne, he noted.

The dietary variables incorporated in the analysis included rates of consumption of soft drinks, fatty junk foods, and raw vegetables. An audience member observed that milk consumption has previously been linked to acne; however, milk intake wasn’t recorded in the study.

Dr. Halvorsen reported having no financial conflicts of interest.

LISBON – Overweight or obesity is independently associated with a twofold increased prevalence of moderate to severe acne in adolescent girls, according to a large population-based Norwegian study.

No such association was apparent in adolescent boys, Dr. Jon A. Halvorsen reported at the annual congress of the European Academy of Dermatology and Venereology.

He presented a cross-sectional questionnaire study of 3,774 Oslo teenagers aged 18-19 years. He and his coworkers undertook the study because the relationship between acne and body mass index has seldom been examined. The only prior study addressing the issue dates back to 1956; it found no association between acne and overweight in a group of young male soldiers (Br. Med. J. 1956;1:1268-70).

In the new Oslo study, overweight or obesity marked by a body mass index (BMI) of at least 25 kg/m² was present in 9.5% of girls and 15.4% of boys. Self-reported moderate or severe acne, as defined using validated criteria, was present in 13.1% of girls and 14% of boys.

In the multivariate logistic regression analysis adjusted for mental health issues, sociodemographic factors, and diet, the prevalence of moderate or severe acne in overweight or obese girls was 18.5%, compared with less than 12% in the normal-weight comparison group of girls with a BMI of 18.5 to less than 23, reported Dr. Halvorsen of the University of Oslo. Girls with a BMI of 23 to less than 25 were 30% more likely than the comparison group to have significant acne, a trend that didn’t reach significance.

The situation was quite different in boys. The highest prevalence of moderate or severe acne (18%) occurred in underweight boys having a BMI less than 18.5. Normal-weight boys had less than a 12% prevalence of significant acne, while in overweight or obese boys the prevalence was slightly greater than 13%.

Dr. Halvorsen stressed that since these findings come from a cross-sectional study, they don’t establish a causal relationship between acne and BMI. But the data do raise questions worthy of further investigation.

"Can overweight cause acne? How important is inflammation in the pathogenesis of acne? How important are hormonal factors in adolescent acne? What about physical activity: Is it related to acne prevalence? How important are lifestyle factors?" he asked.

A lack of hormonal measurements is an important limitation of the Norwegian study. It’s an issue because polycystic ovary syndrome is known to be a risk factor for both overweight and acne, he noted.

The dietary variables incorporated in the analysis included rates of consumption of soft drinks, fatty junk foods, and raw vegetables. An audience member observed that milk consumption has previously been linked to acne; however, milk intake wasn’t recorded in the study.

Dr. Halvorsen reported having no financial conflicts of interest.

The Federal Trade Commissions says no, definitely not.  On Sept. 8, the agency announced that it had reached settlements with two companies that were claiming their apps could cure acne. It is the first time the FTC has pursued any company making a health claim for an app.

"AcneApp" and "Acne Pwner" both claimed to be able to treat acne with colored lights that come out of the phone when the app is activated. Purchasers were told to hold the screen next to the affected area of skin for a few minutes daily.

But the FTC is having none of it. "Smartphones make our lives easier in countless ways, but unfortunately when it comes to curing acne, there's no app for that," said FTC Chairman Jon Leibowitz, in a statement.

According to the FTC, there were 3,300 downloads of AcnePwner, which was for sale in the Android Marketplace for .99 cents. AcneApp was downloaded 11,600 times from the iTunes store at a cost of $1.99. 

The AcneApp makers claimed that the app was developed by a dermatologist and that its technology was backed by a study in the British Journal of Dermatology. Nope, not true, said the FTC.

The settlements bar the app makers from making acne-treatment claims and they were ordered to pay nominal fines. Koby Brown and Gregory W. Pearson, doing business as DermApps, have to pay $14,294, and Andrew N. Finkle, doing business as Acne Pwner, was ordered to pay $1,700.

The trade journal mobihealthnews reported that both apps had been removed from retail earlier this year or late last year. Mobihealthnews also noted that the New York Times gave the AcneApp some press in late 2009. Gregory Pearson is identified in that story as a Houston-area dermatologist.

But there are likely to be plenty more apps to scrutinize in the future.

A quick check of the Android marketplace from my smartphone found, "Acne Clear," from United Holdings Group, being sold at .99 cents.  It supposedly "uses a specific sound frequency and a blue color wavelength from the Lapis Lazuli gemstone to help clear and detox the skin."  United also markets a "Skin Cleanser" app that supposedly uses a sound frequency and "a yellow color wavelength from the Imperial Topaz gemstone to help clean the skin of dark spots, sun spots, and acne scars."  It's also .99 cents.

There's also "SkinApp" from M&R Selected, which is free. It claims to allow users to do "color light therapy on the go." It is listed as having 10,000 to 50,000 downloads. The reviews are full of testimonials that it works, but also that it is just plain "bad."

What kind of review would you give these apps?

— Alicia Ault (on Twitter @aliciaault)

The Federal Trade Commissions says no, definitely not.  On Sept. 8, the agency announced that it had reached settlements with two companies that were claiming their apps could cure acne. It is the first time the FTC has pursued any company making a health claim for an app.

"AcneApp" and "Acne Pwner" both claimed to be able to treat acne with colored lights that come out of the phone when the app is activated. Purchasers were told to hold the screen next to the affected area of skin for a few minutes daily.

But the FTC is having none of it. "Smartphones make our lives easier in countless ways, but unfortunately when it comes to curing acne, there's no app for that," said FTC Chairman Jon Leibowitz, in a statement.

According to the FTC, there were 3,300 downloads of AcnePwner, which was for sale in the Android Marketplace for .99 cents. AcneApp was downloaded 11,600 times from the iTunes store at a cost of $1.99. 

The AcneApp makers claimed that the app was developed by a dermatologist and that its technology was backed by a study in the British Journal of Dermatology. Nope, not true, said the FTC.

The settlements bar the app makers from making acne-treatment claims and they were ordered to pay nominal fines. Koby Brown and Gregory W. Pearson, doing business as DermApps, have to pay $14,294, and Andrew N. Finkle, doing business as Acne Pwner, was ordered to pay $1,700.

The trade journal mobihealthnews reported that both apps had been removed from retail earlier this year or late last year. Mobihealthnews also noted that the New York Times gave the AcneApp some press in late 2009. Gregory Pearson is identified in that story as a Houston-area dermatologist.

But there are likely to be plenty more apps to scrutinize in the future.

A quick check of the Android marketplace from my smartphone found, "Acne Clear," from United Holdings Group, being sold at .99 cents.  It supposedly "uses a specific sound frequency and a blue color wavelength from the Lapis Lazuli gemstone to help clear and detox the skin."  United also markets a "Skin Cleanser" app that supposedly uses a sound frequency and "a yellow color wavelength from the Imperial Topaz gemstone to help clean the skin of dark spots, sun spots, and acne scars."  It's also .99 cents.

There's also "SkinApp" from M&R Selected, which is free. It claims to allow users to do "color light therapy on the go." It is listed as having 10,000 to 50,000 downloads. The reviews are full of testimonials that it works, but also that it is just plain "bad."

What kind of review would you give these apps?

— Alicia Ault (on Twitter @aliciaault)

The Federal Trade Commissions says no, definitely not.  On Sept. 8, the agency announced that it had reached settlements with two companies that were claiming their apps could cure acne. It is the first time the FTC has pursued any company making a health claim for an app.

"AcneApp" and "Acne Pwner" both claimed to be able to treat acne with colored lights that come out of the phone when the app is activated. Purchasers were told to hold the screen next to the affected area of skin for a few minutes daily.

But the FTC is having none of it. "Smartphones make our lives easier in countless ways, but unfortunately when it comes to curing acne, there's no app for that," said FTC Chairman Jon Leibowitz, in a statement.

According to the FTC, there were 3,300 downloads of AcnePwner, which was for sale in the Android Marketplace for .99 cents. AcneApp was downloaded 11,600 times from the iTunes store at a cost of $1.99. 

The AcneApp makers claimed that the app was developed by a dermatologist and that its technology was backed by a study in the British Journal of Dermatology. Nope, not true, said the FTC.

The settlements bar the app makers from making acne-treatment claims and they were ordered to pay nominal fines. Koby Brown and Gregory W. Pearson, doing business as DermApps, have to pay $14,294, and Andrew N. Finkle, doing business as Acne Pwner, was ordered to pay $1,700.

The trade journal mobihealthnews reported that both apps had been removed from retail earlier this year or late last year. Mobihealthnews also noted that the New York Times gave the AcneApp some press in late 2009. Gregory Pearson is identified in that story as a Houston-area dermatologist.

But there are likely to be plenty more apps to scrutinize in the future.

A quick check of the Android marketplace from my smartphone found, "Acne Clear," from United Holdings Group, being sold at .99 cents.  It supposedly "uses a specific sound frequency and a blue color wavelength from the Lapis Lazuli gemstone to help clear and detox the skin."  United also markets a "Skin Cleanser" app that supposedly uses a sound frequency and "a yellow color wavelength from the Imperial Topaz gemstone to help clean the skin of dark spots, sun spots, and acne scars."  It's also .99 cents.

There's also "SkinApp" from M&R Selected, which is free. It claims to allow users to do "color light therapy on the go." It is listed as having 10,000 to 50,000 downloads. The reviews are full of testimonials that it works, but also that it is just plain "bad."

What kind of review would you give these apps?

— Alicia Ault (on Twitter @aliciaault)

Jason Emer, MD, Heidi Waldorf, MD, and Diane Berson, MD

Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here.

*For a PDF of the full article, click on the link to the left of this introduction.

Jason Emer, MD, Heidi Waldorf, MD, and Diane Berson, MD

Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here.

*For a PDF of the full article, click on the link to the left of this introduction.

Jason Emer, MD, Heidi Waldorf, MD, and Diane Berson, MD

Rosacea is a chronic inflammatory skin condition characterized by cutaneous hypersensitivity. There are many therapeutic options available for the treatment of rosacea, but none are curative. Since the pathogenesis of rosacea remains elusive, it is not surprising that no single treatment is paramount and that many patients find therapies unsatisfactory or even exacerbating. Treatments are prescribed to work in concert with each other in order to ameliorate the common clinical manifestations, which include: papules and pustules, telangiectasias, erythema, gland hypertrophy, and ocular disease. The most validated topical therapies include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Many other topical therapies, such as calcineurin inhibitors, benzoyl peroxide, clindamycin, retinoids, topical corticosteroids, and permethrin have demonstrated varying degrees of success. Due to the inconsistent results of the aforementioned therapies patients are increasingly turning to alternative products containing natural ingredients or botanicals to ease inflammation and remit disease. Additional research is needed to elucidate the benefits of these ingredients in the management of rosacea, but some important considerations regarding the natural ingredients with clinical data will be discussed here.

*For a PDF of the full article, click on the link to the left of this introduction.

The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.

The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.

When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)

For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.

Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.

Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.

A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).

The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.

The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.

When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)

For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.

Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.

Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.

A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).

The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.

The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.

When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)

For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.

Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.

Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.

A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).

In this month's episode reporters discuss a possible cure for acne based on research being conducted by Dr. R. Rox Anderson.

Photo credit: Naseem Miller

Dr. Albert C. Yan goes head to head with lice. He talks about a regimen that uses Cetaphil to suffocate the bugs.

Tips for reducing infection rates during nail surgery are given by Dr. Nathaniel Jellinek.

Dr. Lily Talakoub talks all things sunscreen.

And, last but not least, Dr. Alan Rockoff closes this month's episode with a story about a patient with very strong opinions, and he does a little singing too.

In this month's episode reporters discuss a possible cure for acne based on research being conducted by Dr. R. Rox Anderson.

Photo credit: Naseem Miller

Dr. Albert C. Yan goes head to head with lice. He talks about a regimen that uses Cetaphil to suffocate the bugs.

Tips for reducing infection rates during nail surgery are given by Dr. Nathaniel Jellinek.

Dr. Lily Talakoub talks all things sunscreen.

And, last but not least, Dr. Alan Rockoff closes this month's episode with a story about a patient with very strong opinions, and he does a little singing too.

In this month's episode reporters discuss a possible cure for acne based on research being conducted by Dr. R. Rox Anderson.

Photo credit: Naseem Miller

Dr. Albert C. Yan goes head to head with lice. He talks about a regimen that uses Cetaphil to suffocate the bugs.

Tips for reducing infection rates during nail surgery are given by Dr. Nathaniel Jellinek.

Dr. Lily Talakoub talks all things sunscreen.

And, last but not least, Dr. Alan Rockoff closes this month's episode with a story about a patient with very strong opinions, and he does a little singing too.

While often considered a problem in white skin, rosacea is also a common concern in skin of color patients.

The clinical signs of rosacea are often hard to diagnose in Fitzpatrick skin types III-VI, and are often not associated with clinical signs and symptoms of flushing or telangiectasias. Trigger factors associated with rosacea flares – hot beverages, spicy foods, caffeine, alcoholic drinks, heat, and exercise – are often completely absent in skin of color.

Rosacea occurs mainly on the central malar cheeks, forehead, chin, and nose.  Erythema and red/brown papules are common and are often confused with acne. As the condition progresses, the skin becomes persistently red and can feel uneven or even thicker. Hyper or hypopigmentation may develop in areas with inflammation. Perioral or periorficial papules, a form of rosacea commonly seen in skin of color, is also often misdiagnosed.

It has been my experience that rosacea in skin of color is often refractory to traditional topical medications and patients will often need a short course of oral antibiotics. Sulfur/sodium sulfacetamide topicals, in addition to azelaic acid, are a great adjunct to oral treatment. Topical steroids may initially improve symptoms, but will actually make the disease progress when the steroids are stopped, so they should be avoided. Strict photo protection should be encouraged.

For years, the cause of rosacea was unknown. However a team of researchers, led by Dr. Richard L. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California San Diego, found that overproduction of two interactive inflammatory proteins results in excessive levels of a third protein that cause rosacea symptoms. His team found skin antimicrobial peptides, cathelicidins, were altered and overproduced in patients with rosacea (Nat. Med. 2007;13:975-80).

Approximately 14 million people in the United States have rosacea. Early diagnosis and management with combination oral and topical medications are effective at controlling this highly prevalent yet often misdiagnosed disease. Future research into the underlying cause of rosacea will offer targeted therapies aimed at the abnormally processed antimicrobial peptides present in the skin of rosacea patients.

While often considered a problem in white skin, rosacea is also a common concern in skin of color patients.

The clinical signs of rosacea are often hard to diagnose in Fitzpatrick skin types III-VI, and are often not associated with clinical signs and symptoms of flushing or telangiectasias. Trigger factors associated with rosacea flares – hot beverages, spicy foods, caffeine, alcoholic drinks, heat, and exercise – are often completely absent in skin of color.

Rosacea occurs mainly on the central malar cheeks, forehead, chin, and nose.  Erythema and red/brown papules are common and are often confused with acne. As the condition progresses, the skin becomes persistently red and can feel uneven or even thicker. Hyper or hypopigmentation may develop in areas with inflammation. Perioral or periorficial papules, a form of rosacea commonly seen in skin of color, is also often misdiagnosed.

It has been my experience that rosacea in skin of color is often refractory to traditional topical medications and patients will often need a short course of oral antibiotics. Sulfur/sodium sulfacetamide topicals, in addition to azelaic acid, are a great adjunct to oral treatment. Topical steroids may initially improve symptoms, but will actually make the disease progress when the steroids are stopped, so they should be avoided. Strict photo protection should be encouraged.

For years, the cause of rosacea was unknown. However a team of researchers, led by Dr. Richard L. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California San Diego, found that overproduction of two interactive inflammatory proteins results in excessive levels of a third protein that cause rosacea symptoms. His team found skin antimicrobial peptides, cathelicidins, were altered and overproduced in patients with rosacea (Nat. Med. 2007;13:975-80).

Approximately 14 million people in the United States have rosacea. Early diagnosis and management with combination oral and topical medications are effective at controlling this highly prevalent yet often misdiagnosed disease. Future research into the underlying cause of rosacea will offer targeted therapies aimed at the abnormally processed antimicrobial peptides present in the skin of rosacea patients.

While often considered a problem in white skin, rosacea is also a common concern in skin of color patients.

The clinical signs of rosacea are often hard to diagnose in Fitzpatrick skin types III-VI, and are often not associated with clinical signs and symptoms of flushing or telangiectasias. Trigger factors associated with rosacea flares – hot beverages, spicy foods, caffeine, alcoholic drinks, heat, and exercise – are often completely absent in skin of color.

Rosacea occurs mainly on the central malar cheeks, forehead, chin, and nose.  Erythema and red/brown papules are common and are often confused with acne. As the condition progresses, the skin becomes persistently red and can feel uneven or even thicker. Hyper or hypopigmentation may develop in areas with inflammation. Perioral or periorficial papules, a form of rosacea commonly seen in skin of color, is also often misdiagnosed.

It has been my experience that rosacea in skin of color is often refractory to traditional topical medications and patients will often need a short course of oral antibiotics. Sulfur/sodium sulfacetamide topicals, in addition to azelaic acid, are a great adjunct to oral treatment. Topical steroids may initially improve symptoms, but will actually make the disease progress when the steroids are stopped, so they should be avoided. Strict photo protection should be encouraged.

For years, the cause of rosacea was unknown. However a team of researchers, led by Dr. Richard L. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California San Diego, found that overproduction of two interactive inflammatory proteins results in excessive levels of a third protein that cause rosacea symptoms. His team found skin antimicrobial peptides, cathelicidins, were altered and overproduced in patients with rosacea (Nat. Med. 2007;13:975-80).

Approximately 14 million people in the United States have rosacea. Early diagnosis and management with combination oral and topical medications are effective at controlling this highly prevalent yet often misdiagnosed disease. Future research into the underlying cause of rosacea will offer targeted therapies aimed at the abnormally processed antimicrobial peptides present in the skin of rosacea patients.