Rosacea

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

Fewer than 10% of Staphylococcus aureus isolates showed resistance to long-term use of tetracycline antibiotics in a cross-sectional study of 83 patients with acne. Furthermore, the patients on antibiotics for acne showed a lower prevalence of S. aureus than acne patients not on antibiotics.

Approximately 40% of the S. aureus isolates were resistant to clindamycin and 44.2% to erythromycin, but all other antibiotics tested (trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, and minocycline) showed resistance of less than 10%, reported Dr. Matthew Fanelli and his colleagues from the University of Pennsylvania (Arch. Dermatol. 2011 [doi:10.1001/archdermatol.2011.67]).

Thirty-six patients (43%) overall had S. aureus colonies: 5 of 23 (22%) in the oral antibiotics group, compared with 31 of 60 (52%) in the non-antibiotics group.

The colonies were found in the throat (56%), nose (25%), and in both (19%). Two had methicillin-resistant S. aureus (MRSA) in the throat.

Investigators took cultures from both the oropharynx and the anterior nares to assess the effect of the antibiotics on the development of S. aureus and MRSA in the throat and the nose. Across the board, antibiotic resistance was higher in the nasal area than in the throat.

They reported that "[l]ong-term use of antibiotics [to treat acne] decreased the prevalence of S. aureus colonization by nearly 70%."

Long-term use of antibiotics constituted 2 months, instead of the more commonly used 1 month measure, another study author, Dr. David J. Margolis, said in an interview.

Thirty-six patients were using oral or topical antibiotics for acne for at least 1 month before the study. Nine patients had used non-acne antibiotics in the last month.

Of the 51 female and 32 male patients, 63 were white, and median age was 24 years. The majority had an acne severity grade of 2 or 3. The investigators reported that age, sex, Hispanic ethnicity, race, and acne severity did not directly affect S. aureus colonization rates.

"I was surprised by the findings," Dr. Margolis said, noting that the patients were young and fairly healthy, yet they provided the "ideal" group of patients to study for antibiotic resistance.

Antibiotic resistance is a hot topic in the media, and Dr. Margolis expressed concern that media accounts would generalize the study for all antibiotics, instead of just those that address acne.

Study authors reported no relevant financial disclosures. Partial support for the study came from a National Institutes of Health grant.

WAILEA, HAWAII – Many dermatologists prescribe topical retinoids for preteen acne, but some are hesitant to do so because of the lack of an FDA-approved indication in this young age group.

For the same reason, many pediatricians and family physicians refrain from using topical retinoids off-label for preteen acne.

But now, for the first time, there is published evidence showing that a topical retinoid – 0.04% tretinoin microsphere gel (Retin-A Micro) – is safe, efficacious, and well tolerated in 8- to 12-year-olds with acne, Dr. Hilary E. Baldwin said at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

The efficacy and safety in the preteen study were the same as physicians have come to expect in using this agent in older children with acne, noted Dr. Baldwin, vice chair of dermatology at the State University of New York, Brooklyn.

The open-label exploratory study conducted by investigators at the University of California, San Diego, involved 40 patients (33 girls, 7 boys) aged 8-12 years with mild to moderate acne. They were treated for 12 weeks with 0.04% tretinoin microsphere gel administered through a pump dispenser. The participants’ mean age was 10.7 years, with a mean age at onset of acne of 9.1 years.

The coprimary end points in the study were change in Evaluator’s Global Severity Score and Alternative Evaluator's Global Severity Score from baseline through 12 weeks. Significant improvements were seen on both scores.

The mean Evaluator's Global Severity Score decreased from 2.6 to 2.1, with 75% of patients being graded "almost clear" or "mild." The mean Alternative Evaluator's Global Severity Score improved from 3.1 to 2.4; this modified 7-point scale was utilized because inflammatory lesions are less prominent in preteen acne than in older patients.

The total lesion count was reduced by 37.3%, with a mean 36.9% decrease in noninflammatory lesions by week 12 and a 39.1% reduction in the relatively limited number of inflammatory lesions. Overall, 32 of the 40 patients experienced improvement.

Subjects were instructed to apply two pumps of the retinoid gel once daily at night, use a gentle facial cleanser twice daily, and apply a moisturizer in the morning as needed. Nevertheless, 15 patients experienced treatment-related adverse effects. These consisted mostly of mild skin irritation, generally lasting less than a week, with a peak incidence occurring during weeks 1-2 of the 12-week study. No one discontinued the trial because of adverse events. The investigators advised using a slowly escalating regimen in preteens, with application of the retinoid every other day during the first several weeks in order to minimize the early irritation (Pediatrics 2010;125:e1316-23).

To put the study in perspective, Dr. Baldwin noted that Global Alliance to Improve Outcomes in Acne guidelines recommend topical retinoid therapy as first-line treatment of acne, with consideration being given to adding a systemic antibiotic in more severe cases. However, the guidelines do not specifically address the preteen population, because there have been no data – until now (J. Am. Acad. Dermatol. 2009;60:s1-50).

Topical retinoids approved for treatment of acne vulgaris are indicated only down to age 12 years, with the exception of tretinoin 0.05% gel (Atralin), which is approved for use in children as young as 10 years of age. But acne is a significant problem well before age 10, noted Dr. Baldwin.

Data show that 78% of 9- to 10-year-old girls have acne. The onset of acne is associated with adrenarche, not menarche. Adrenarche brings increased production of dehydroepiandrosterone and dehydroepiandrosterone sulfate, which activate the sebaceous glands. And adrenarche occurs at age 6-7 years in girls and 7-8 years in boys, she noted.

"These kids are getting acne younger and younger, and we have no FDA-approved drugs to effectively treat them, although we do anyway," she said.

Also of concern are data showing that the more comedones girls have at age 6-9, the more likely they are to have more severe acne later in adolescence.

"These kids need to get started on treatment very early on in order to perhaps interrupt that flow to more severe acne in adolescence, or at least get them used to having to put a product on because their acne is going to be worse when they reach adolescence," Dr. Baldwin said.

The study of 0.04% tretinoin microsphere gel in preteen acne was sponsored by Johnson & Johnson. Dr. Baldwin was not involved in the trial. She declared that she has received research funds from and/or serves as a consultant to Allergan, Coria, Galderma, GlaxoSmithKline, Graceway Pharmaceuticals, L’Oreal, Ortho Dermatologics, Medicis, and Sanofi-Aventis.

SDEF and this news organization are owned by Elsevier.

WAILEA, HAWAII – Many dermatologists prescribe topical retinoids for preteen acne, but some are hesitant to do so because of the lack of an FDA-approved indication in this young age group.

For the same reason, many pediatricians and family physicians refrain from using topical retinoids off-label for preteen acne.

But now, for the first time, there is published evidence showing that a topical retinoid – 0.04% tretinoin microsphere gel (Retin-A Micro) – is safe, efficacious, and well tolerated in 8- to 12-year-olds with acne, Dr. Hilary E. Baldwin said at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

The efficacy and safety in the preteen study were the same as physicians have come to expect in using this agent in older children with acne, noted Dr. Baldwin, vice chair of dermatology at the State University of New York, Brooklyn.

The open-label exploratory study conducted by investigators at the University of California, San Diego, involved 40 patients (33 girls, 7 boys) aged 8-12 years with mild to moderate acne. They were treated for 12 weeks with 0.04% tretinoin microsphere gel administered through a pump dispenser. The participants’ mean age was 10.7 years, with a mean age at onset of acne of 9.1 years.

The coprimary end points in the study were change in Evaluator’s Global Severity Score and Alternative Evaluator's Global Severity Score from baseline through 12 weeks. Significant improvements were seen on both scores.

The mean Evaluator's Global Severity Score decreased from 2.6 to 2.1, with 75% of patients being graded "almost clear" or "mild." The mean Alternative Evaluator's Global Severity Score improved from 3.1 to 2.4; this modified 7-point scale was utilized because inflammatory lesions are less prominent in preteen acne than in older patients.

The total lesion count was reduced by 37.3%, with a mean 36.9% decrease in noninflammatory lesions by week 12 and a 39.1% reduction in the relatively limited number of inflammatory lesions. Overall, 32 of the 40 patients experienced improvement.

Subjects were instructed to apply two pumps of the retinoid gel once daily at night, use a gentle facial cleanser twice daily, and apply a moisturizer in the morning as needed. Nevertheless, 15 patients experienced treatment-related adverse effects. These consisted mostly of mild skin irritation, generally lasting less than a week, with a peak incidence occurring during weeks 1-2 of the 12-week study. No one discontinued the trial because of adverse events. The investigators advised using a slowly escalating regimen in preteens, with application of the retinoid every other day during the first several weeks in order to minimize the early irritation (Pediatrics 2010;125:e1316-23).

To put the study in perspective, Dr. Baldwin noted that Global Alliance to Improve Outcomes in Acne guidelines recommend topical retinoid therapy as first-line treatment of acne, with consideration being given to adding a systemic antibiotic in more severe cases. However, the guidelines do not specifically address the preteen population, because there have been no data – until now (J. Am. Acad. Dermatol. 2009;60:s1-50).

Topical retinoids approved for treatment of acne vulgaris are indicated only down to age 12 years, with the exception of tretinoin 0.05% gel (Atralin), which is approved for use in children as young as 10 years of age. But acne is a significant problem well before age 10, noted Dr. Baldwin.

Data show that 78% of 9- to 10-year-old girls have acne. The onset of acne is associated with adrenarche, not menarche. Adrenarche brings increased production of dehydroepiandrosterone and dehydroepiandrosterone sulfate, which activate the sebaceous glands. And adrenarche occurs at age 6-7 years in girls and 7-8 years in boys, she noted.

"These kids are getting acne younger and younger, and we have no FDA-approved drugs to effectively treat them, although we do anyway," she said.

Also of concern are data showing that the more comedones girls have at age 6-9, the more likely they are to have more severe acne later in adolescence.

"These kids need to get started on treatment very early on in order to perhaps interrupt that flow to more severe acne in adolescence, or at least get them used to having to put a product on because their acne is going to be worse when they reach adolescence," Dr. Baldwin said.

The study of 0.04% tretinoin microsphere gel in preteen acne was sponsored by Johnson & Johnson. Dr. Baldwin was not involved in the trial. She declared that she has received research funds from and/or serves as a consultant to Allergan, Coria, Galderma, GlaxoSmithKline, Graceway Pharmaceuticals, L’Oreal, Ortho Dermatologics, Medicis, and Sanofi-Aventis.

SDEF and this news organization are owned by Elsevier.

WAILEA, HAWAII – Many dermatologists prescribe topical retinoids for preteen acne, but some are hesitant to do so because of the lack of an FDA-approved indication in this young age group.

For the same reason, many pediatricians and family physicians refrain from using topical retinoids off-label for preteen acne.

But now, for the first time, there is published evidence showing that a topical retinoid – 0.04% tretinoin microsphere gel (Retin-A Micro) – is safe, efficacious, and well tolerated in 8- to 12-year-olds with acne, Dr. Hilary E. Baldwin said at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

The efficacy and safety in the preteen study were the same as physicians have come to expect in using this agent in older children with acne, noted Dr. Baldwin, vice chair of dermatology at the State University of New York, Brooklyn.

The open-label exploratory study conducted by investigators at the University of California, San Diego, involved 40 patients (33 girls, 7 boys) aged 8-12 years with mild to moderate acne. They were treated for 12 weeks with 0.04% tretinoin microsphere gel administered through a pump dispenser. The participants’ mean age was 10.7 years, with a mean age at onset of acne of 9.1 years.

The coprimary end points in the study were change in Evaluator’s Global Severity Score and Alternative Evaluator's Global Severity Score from baseline through 12 weeks. Significant improvements were seen on both scores.

The mean Evaluator's Global Severity Score decreased from 2.6 to 2.1, with 75% of patients being graded "almost clear" or "mild." The mean Alternative Evaluator's Global Severity Score improved from 3.1 to 2.4; this modified 7-point scale was utilized because inflammatory lesions are less prominent in preteen acne than in older patients.

The total lesion count was reduced by 37.3%, with a mean 36.9% decrease in noninflammatory lesions by week 12 and a 39.1% reduction in the relatively limited number of inflammatory lesions. Overall, 32 of the 40 patients experienced improvement.

Subjects were instructed to apply two pumps of the retinoid gel once daily at night, use a gentle facial cleanser twice daily, and apply a moisturizer in the morning as needed. Nevertheless, 15 patients experienced treatment-related adverse effects. These consisted mostly of mild skin irritation, generally lasting less than a week, with a peak incidence occurring during weeks 1-2 of the 12-week study. No one discontinued the trial because of adverse events. The investigators advised using a slowly escalating regimen in preteens, with application of the retinoid every other day during the first several weeks in order to minimize the early irritation (Pediatrics 2010;125:e1316-23).

To put the study in perspective, Dr. Baldwin noted that Global Alliance to Improve Outcomes in Acne guidelines recommend topical retinoid therapy as first-line treatment of acne, with consideration being given to adding a systemic antibiotic in more severe cases. However, the guidelines do not specifically address the preteen population, because there have been no data – until now (J. Am. Acad. Dermatol. 2009;60:s1-50).

Topical retinoids approved for treatment of acne vulgaris are indicated only down to age 12 years, with the exception of tretinoin 0.05% gel (Atralin), which is approved for use in children as young as 10 years of age. But acne is a significant problem well before age 10, noted Dr. Baldwin.

Data show that 78% of 9- to 10-year-old girls have acne. The onset of acne is associated with adrenarche, not menarche. Adrenarche brings increased production of dehydroepiandrosterone and dehydroepiandrosterone sulfate, which activate the sebaceous glands. And adrenarche occurs at age 6-7 years in girls and 7-8 years in boys, she noted.

"These kids are getting acne younger and younger, and we have no FDA-approved drugs to effectively treat them, although we do anyway," she said.

Also of concern are data showing that the more comedones girls have at age 6-9, the more likely they are to have more severe acne later in adolescence.

"These kids need to get started on treatment very early on in order to perhaps interrupt that flow to more severe acne in adolescence, or at least get them used to having to put a product on because their acne is going to be worse when they reach adolescence," Dr. Baldwin said.

The study of 0.04% tretinoin microsphere gel in preteen acne was sponsored by Johnson & Johnson. Dr. Baldwin was not involved in the trial. She declared that she has received research funds from and/or serves as a consultant to Allergan, Coria, Galderma, GlaxoSmithKline, Graceway Pharmaceuticals, L’Oreal, Ortho Dermatologics, Medicis, and Sanofi-Aventis.

SDEF and this news organization are owned by Elsevier.

Combination adapalene-benzoyl peroxide for acne vulgaris is more effective than either therapy alone, according to the results of a new analysis.

The therapy reduced total lesion count after 12 weeks, regardless of a patient's initial number of lesions, according to Dr. Steven R. Feldman of the department of dermatology at Wake Forest University, Winston-Salem, N.C., and his colleagues.

The investigators pooled data from three multicenter, randomized clinical trials of similar design, totaling 3,853 patients. The three studies had four treatment groups (combination, adapalene only, benzoyl peroxide [BPO] only, and a gel vehicle).

The study investigators defined three subgroups based on lesion count: lowest 25%, middle 50%, and highest 25%. They found that efficacy of adapalene-benzoyl relative to its gel vehicle increased with number of lesions (J. Amer. Acad. Dermatol. 2011 [doi:10.1016/j.jaad.2010.03.036]).

Also, "adapalene-BPO was significantly more efficacious, compared with the monotherapies and vehicle in percent reduction of inflammatory, noninflammatory, and total lesions," the investigators wrote. "The superior efficacy of adapalene-BPO was also confirmed in all lesion count subgroups."

Total lesion counts in the three subgroups treated with combination therapy were reduced by 19%, 26%, and 29%, respectively.

The patients were aged 12 years or older and had 20-50 inflammatory lesions and 30-100 noninflammatory lesions on their face. Although 495 patients dropped out of the study, they were proportionally distributed among the three subgroups.

As for adverse events, tolerability was similar across all lesion count subgroups, with events being highest at week 1. The most common side effect was dry sin.

Dr. Feldman said in an interview that by subtracting the effect of the gel vehicle, he could more clearly determine the effect of the drug itself, since the study did not incorporate a placebo. However, he added, in clinical practice what is important is the full effect of the drug for the patient, aided by the gel vehicle.

He concluded that because the combination therapy showed similar overall improvement in the low- and high-lesion count groups, topical drugs are a viable first option even for severe acne cases. In addition, studies show that combination therapies simplify treatment for the patient and increase likelihood of adherence.

The study received funding from Galderma. Dr. Feldman disclosed receiving grant funding from Galderma, as well as serving as a speaker, investigator, and consultant for the pharmaceutical company. All of the other investigators for this study also disclosed relationships with Galderma.

Combination adapalene-benzoyl peroxide for acne vulgaris is more effective than either therapy alone, according to the results of a new analysis.

The therapy reduced total lesion count after 12 weeks, regardless of a patient's initial number of lesions, according to Dr. Steven R. Feldman of the department of dermatology at Wake Forest University, Winston-Salem, N.C., and his colleagues.

The investigators pooled data from three multicenter, randomized clinical trials of similar design, totaling 3,853 patients. The three studies had four treatment groups (combination, adapalene only, benzoyl peroxide [BPO] only, and a gel vehicle).

The study investigators defined three subgroups based on lesion count: lowest 25%, middle 50%, and highest 25%. They found that efficacy of adapalene-benzoyl relative to its gel vehicle increased with number of lesions (J. Amer. Acad. Dermatol. 2011 [doi:10.1016/j.jaad.2010.03.036]).

Also, "adapalene-BPO was significantly more efficacious, compared with the monotherapies and vehicle in percent reduction of inflammatory, noninflammatory, and total lesions," the investigators wrote. "The superior efficacy of adapalene-BPO was also confirmed in all lesion count subgroups."

Total lesion counts in the three subgroups treated with combination therapy were reduced by 19%, 26%, and 29%, respectively.

The patients were aged 12 years or older and had 20-50 inflammatory lesions and 30-100 noninflammatory lesions on their face. Although 495 patients dropped out of the study, they were proportionally distributed among the three subgroups.

As for adverse events, tolerability was similar across all lesion count subgroups, with events being highest at week 1. The most common side effect was dry sin.

Dr. Feldman said in an interview that by subtracting the effect of the gel vehicle, he could more clearly determine the effect of the drug itself, since the study did not incorporate a placebo. However, he added, in clinical practice what is important is the full effect of the drug for the patient, aided by the gel vehicle.

He concluded that because the combination therapy showed similar overall improvement in the low- and high-lesion count groups, topical drugs are a viable first option even for severe acne cases. In addition, studies show that combination therapies simplify treatment for the patient and increase likelihood of adherence.

The study received funding from Galderma. Dr. Feldman disclosed receiving grant funding from Galderma, as well as serving as a speaker, investigator, and consultant for the pharmaceutical company. All of the other investigators for this study also disclosed relationships with Galderma.

Combination adapalene-benzoyl peroxide for acne vulgaris is more effective than either therapy alone, according to the results of a new analysis.

The therapy reduced total lesion count after 12 weeks, regardless of a patient's initial number of lesions, according to Dr. Steven R. Feldman of the department of dermatology at Wake Forest University, Winston-Salem, N.C., and his colleagues.

The investigators pooled data from three multicenter, randomized clinical trials of similar design, totaling 3,853 patients. The three studies had four treatment groups (combination, adapalene only, benzoyl peroxide [BPO] only, and a gel vehicle).

The study investigators defined three subgroups based on lesion count: lowest 25%, middle 50%, and highest 25%. They found that efficacy of adapalene-benzoyl relative to its gel vehicle increased with number of lesions (J. Amer. Acad. Dermatol. 2011 [doi:10.1016/j.jaad.2010.03.036]).

Also, "adapalene-BPO was significantly more efficacious, compared with the monotherapies and vehicle in percent reduction of inflammatory, noninflammatory, and total lesions," the investigators wrote. "The superior efficacy of adapalene-BPO was also confirmed in all lesion count subgroups."

Total lesion counts in the three subgroups treated with combination therapy were reduced by 19%, 26%, and 29%, respectively.

The patients were aged 12 years or older and had 20-50 inflammatory lesions and 30-100 noninflammatory lesions on their face. Although 495 patients dropped out of the study, they were proportionally distributed among the three subgroups.

As for adverse events, tolerability was similar across all lesion count subgroups, with events being highest at week 1. The most common side effect was dry sin.

Dr. Feldman said in an interview that by subtracting the effect of the gel vehicle, he could more clearly determine the effect of the drug itself, since the study did not incorporate a placebo. However, he added, in clinical practice what is important is the full effect of the drug for the patient, aided by the gel vehicle.

He concluded that because the combination therapy showed similar overall improvement in the low- and high-lesion count groups, topical drugs are a viable first option even for severe acne cases. In addition, studies show that combination therapies simplify treatment for the patient and increase likelihood of adherence.

The study received funding from Galderma. Dr. Feldman disclosed receiving grant funding from Galderma, as well as serving as a speaker, investigator, and consultant for the pharmaceutical company. All of the other investigators for this study also disclosed relationships with Galderma.

WAILEA, HAWAII - Aggressively dosed red light photodynamic therapy effectively destroys sebaceous glands, resulting in prolonged inhibition of sebum output and la asting cure of moderate-to-severe acne, according to Dr. R. Rox Anderson said.

"I don't use the word 'cure' lightly. I think there really are patients you can cure with high-dose aggressive photodynamic therapy. In my experience, it's more effective than oral retinoids. It's something you want to reserve for patients who have more severe acne, though," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston, and director of the Wellman Center for Photomedicine at Massachusetts General Hospital.

High-dose red light PDT needs to be employed selectively because it is a time consuming office-based procedure with substantial side effects. These include marked pain, several days of erythema and edema, crusting, sterile pustules, and sensitivity to light that keeps patients indoors for 48 hours post treatment; because of their daunting appearance, they actually welcome being temporarily shut in. Complete healing is typical a week after treatment, he explained at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

This therapy is different from the low-dose version of PDT that improves acne temporarily via its anti-inflammatory effect. High-dose red light PDT is akin to a necrotizing folliculitis that results in histologically confirmed destruction of many of the deeply placed sebaceous glands.

Having first demonstrated that high-dose red light PDT is capable of curing acne in a small clinical trial 11 years ago (J. Invest. Dermatol. 2000;15:183-92), lately, Dr. Anderson has focused on optimizing the treatment. He is varying the topical photosensitizer agent and dose, contact time, light fluence, and other factors in an effort to make a faster therapy with fewer side effects, while preserving the unmatched effectiveness.

"We're not done with this yet. We're still tweaking," he said. "This work is not funded by any drug or device company. I'm doing it because I just want to help people with severe acne. It's still the number-one disease we face. We're losing Accutane [isotretinoin] because of medicolegal issues, and we need to come up with an alternative."

An important step has been the discovery in his laboratory that low-level blue light, shined on the skin during incubation with the photosensitizing agent, appears to inhibit porphyrin synthesis selectively in the epidermis. This turns off unwanted epidermal photosensitization and greatly lessens the epidermal inflammatory reaction responsible for many of the most florid treatment side effects. At the same time, the dim blue light, which cannot penetrate far into the skin, allows continued production of porphyrin deep into the sebaceous follicles, where the red light is aimed.

"Pain scores go from 7 or 8 on a 10-point scale down to 1 or 2 with blue light," according to Dr. Anderson.

The only Food and Drug Administration-approved dermatologic indication for the two topical PDT photosensitizing agents—aminolevulinic acid (Levulan) and methyl aminolevulinate (Metvixia)—is treatment of actinic keratoses.

For dermatologists interested in using high-dose red light PDT off-label to treat severe acne, Dr. Anderson provided several practical tips. First degrease the skin, then apply the photosensitizing agent under plastic wrap occlusion for 1-3 hours with low-level blue light, and apply 5%-7% topical lidocaine 30 minutes before putting on the red PDT light for 10-30 minutes. Use a red light LED array having a 635-nm wavelength and a fluence of at least 50 J/cm². The topical lidocaine has the side benefit of greatly enhancing the PDT response for reasons that are not understood.

Also, keep the treatment room warm. Porphyrin is the target in PDT, and porphyrin synthesis varies tremendously depending upon skin temperature. A chilly room will essentially shut it down. Dr. Anderson said he keeps the room warm and dimly lit with a low-level blue LED light source. The optimal features of the blue light in terms of wavelength and output level are still under study.

The two available photosensitizing agents appear to be essentially equivalent for this form of therapy, although methyl aminolevulinate tends to be more selective for the sebaceous glands.

The treatment course consists of four sessions at roughly 2-week intervals. The first two sessions elicit the big inflammatory reaction. The third and fourth generate only a mild sunburn-like reaction.

Asked if he is concerned about possible long-term adverse health consequences resulting from destroying sebaceous glands, Dr. Anderson said he used to be until he asked the late Dr. Albert Kligman for his thoughts.

"He said if you want to know what skin is like with no sebaceous gland function, look at any child. The glands are there but they're turned off because they haven't yet seen the androgen of puberty," recalled Dr. Anderson. "So, I think functionally, the sebaceous gland is just there as God's curse on teenagers."

A blinded, split-face comparative study of high-dose red light PDT testing various parameters is underway at Massachusetts General Hospital and should be completed in about 6 months.

Dr. Anderson has been awarded more than 60 patents and is responsible for numerous seminal advances in laser medicine. Many top laser experts have trained under him, a process they call "getting Roxified," in which they acquire a spirit of open-minded inquiry.

Dr. Anderson declared having no relevant financial interests. SDEF and this news organization are owned by Elsevier.

WAILEA, HAWAII - Aggressively dosed red light photodynamic therapy effectively destroys sebaceous glands, resulting in prolonged inhibition of sebum output and la asting cure of moderate-to-severe acne, according to Dr. R. Rox Anderson said.

"I don't use the word 'cure' lightly. I think there really are patients you can cure with high-dose aggressive photodynamic therapy. In my experience, it's more effective than oral retinoids. It's something you want to reserve for patients who have more severe acne, though," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston, and director of the Wellman Center for Photomedicine at Massachusetts General Hospital.

High-dose red light PDT needs to be employed selectively because it is a time consuming office-based procedure with substantial side effects. These include marked pain, several days of erythema and edema, crusting, sterile pustules, and sensitivity to light that keeps patients indoors for 48 hours post treatment; because of their daunting appearance, they actually welcome being temporarily shut in. Complete healing is typical a week after treatment, he explained at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

This therapy is different from the low-dose version of PDT that improves acne temporarily via its anti-inflammatory effect. High-dose red light PDT is akin to a necrotizing folliculitis that results in histologically confirmed destruction of many of the deeply placed sebaceous glands.

Having first demonstrated that high-dose red light PDT is capable of curing acne in a small clinical trial 11 years ago (J. Invest. Dermatol. 2000;15:183-92), lately, Dr. Anderson has focused on optimizing the treatment. He is varying the topical photosensitizer agent and dose, contact time, light fluence, and other factors in an effort to make a faster therapy with fewer side effects, while preserving the unmatched effectiveness.

"We're not done with this yet. We're still tweaking," he said. "This work is not funded by any drug or device company. I'm doing it because I just want to help people with severe acne. It's still the number-one disease we face. We're losing Accutane [isotretinoin] because of medicolegal issues, and we need to come up with an alternative."

An important step has been the discovery in his laboratory that low-level blue light, shined on the skin during incubation with the photosensitizing agent, appears to inhibit porphyrin synthesis selectively in the epidermis. This turns off unwanted epidermal photosensitization and greatly lessens the epidermal inflammatory reaction responsible for many of the most florid treatment side effects. At the same time, the dim blue light, which cannot penetrate far into the skin, allows continued production of porphyrin deep into the sebaceous follicles, where the red light is aimed.

"Pain scores go from 7 or 8 on a 10-point scale down to 1 or 2 with blue light," according to Dr. Anderson.

The only Food and Drug Administration-approved dermatologic indication for the two topical PDT photosensitizing agents—aminolevulinic acid (Levulan) and methyl aminolevulinate (Metvixia)—is treatment of actinic keratoses.

For dermatologists interested in using high-dose red light PDT off-label to treat severe acne, Dr. Anderson provided several practical tips. First degrease the skin, then apply the photosensitizing agent under plastic wrap occlusion for 1-3 hours with low-level blue light, and apply 5%-7% topical lidocaine 30 minutes before putting on the red PDT light for 10-30 minutes. Use a red light LED array having a 635-nm wavelength and a fluence of at least 50 J/cm². The topical lidocaine has the side benefit of greatly enhancing the PDT response for reasons that are not understood.

Also, keep the treatment room warm. Porphyrin is the target in PDT, and porphyrin synthesis varies tremendously depending upon skin temperature. A chilly room will essentially shut it down. Dr. Anderson said he keeps the room warm and dimly lit with a low-level blue LED light source. The optimal features of the blue light in terms of wavelength and output level are still under study.

The two available photosensitizing agents appear to be essentially equivalent for this form of therapy, although methyl aminolevulinate tends to be more selective for the sebaceous glands.

The treatment course consists of four sessions at roughly 2-week intervals. The first two sessions elicit the big inflammatory reaction. The third and fourth generate only a mild sunburn-like reaction.

Asked if he is concerned about possible long-term adverse health consequences resulting from destroying sebaceous glands, Dr. Anderson said he used to be until he asked the late Dr. Albert Kligman for his thoughts.

"He said if you want to know what skin is like with no sebaceous gland function, look at any child. The glands are there but they're turned off because they haven't yet seen the androgen of puberty," recalled Dr. Anderson. "So, I think functionally, the sebaceous gland is just there as God's curse on teenagers."

A blinded, split-face comparative study of high-dose red light PDT testing various parameters is underway at Massachusetts General Hospital and should be completed in about 6 months.

Dr. Anderson has been awarded more than 60 patents and is responsible for numerous seminal advances in laser medicine. Many top laser experts have trained under him, a process they call "getting Roxified," in which they acquire a spirit of open-minded inquiry.

Dr. Anderson declared having no relevant financial interests. SDEF and this news organization are owned by Elsevier.

WAILEA, HAWAII - Aggressively dosed red light photodynamic therapy effectively destroys sebaceous glands, resulting in prolonged inhibition of sebum output and la asting cure of moderate-to-severe acne, according to Dr. R. Rox Anderson said.

"I don't use the word 'cure' lightly. I think there really are patients you can cure with high-dose aggressive photodynamic therapy. In my experience, it's more effective than oral retinoids. It's something you want to reserve for patients who have more severe acne, though," said Dr. Anderson, professor of dermatology at Harvard Medical School, Boston, and director of the Wellman Center for Photomedicine at Massachusetts General Hospital.

High-dose red light PDT needs to be employed selectively because it is a time consuming office-based procedure with substantial side effects. These include marked pain, several days of erythema and edema, crusting, sterile pustules, and sensitivity to light that keeps patients indoors for 48 hours post treatment; because of their daunting appearance, they actually welcome being temporarily shut in. Complete healing is typical a week after treatment, he explained at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).

This therapy is different from the low-dose version of PDT that improves acne temporarily via its anti-inflammatory effect. High-dose red light PDT is akin to a necrotizing folliculitis that results in histologically confirmed destruction of many of the deeply placed sebaceous glands.

Having first demonstrated that high-dose red light PDT is capable of curing acne in a small clinical trial 11 years ago (J. Invest. Dermatol. 2000;15:183-92), lately, Dr. Anderson has focused on optimizing the treatment. He is varying the topical photosensitizer agent and dose, contact time, light fluence, and other factors in an effort to make a faster therapy with fewer side effects, while preserving the unmatched effectiveness.

"We're not done with this yet. We're still tweaking," he said. "This work is not funded by any drug or device company. I'm doing it because I just want to help people with severe acne. It's still the number-one disease we face. We're losing Accutane [isotretinoin] because of medicolegal issues, and we need to come up with an alternative."

An important step has been the discovery in his laboratory that low-level blue light, shined on the skin during incubation with the photosensitizing agent, appears to inhibit porphyrin synthesis selectively in the epidermis. This turns off unwanted epidermal photosensitization and greatly lessens the epidermal inflammatory reaction responsible for many of the most florid treatment side effects. At the same time, the dim blue light, which cannot penetrate far into the skin, allows continued production of porphyrin deep into the sebaceous follicles, where the red light is aimed.

"Pain scores go from 7 or 8 on a 10-point scale down to 1 or 2 with blue light," according to Dr. Anderson.

The only Food and Drug Administration-approved dermatologic indication for the two topical PDT photosensitizing agents—aminolevulinic acid (Levulan) and methyl aminolevulinate (Metvixia)—is treatment of actinic keratoses.

For dermatologists interested in using high-dose red light PDT off-label to treat severe acne, Dr. Anderson provided several practical tips. First degrease the skin, then apply the photosensitizing agent under plastic wrap occlusion for 1-3 hours with low-level blue light, and apply 5%-7% topical lidocaine 30 minutes before putting on the red PDT light for 10-30 minutes. Use a red light LED array having a 635-nm wavelength and a fluence of at least 50 J/cm². The topical lidocaine has the side benefit of greatly enhancing the PDT response for reasons that are not understood.

Also, keep the treatment room warm. Porphyrin is the target in PDT, and porphyrin synthesis varies tremendously depending upon skin temperature. A chilly room will essentially shut it down. Dr. Anderson said he keeps the room warm and dimly lit with a low-level blue LED light source. The optimal features of the blue light in terms of wavelength and output level are still under study.

The two available photosensitizing agents appear to be essentially equivalent for this form of therapy, although methyl aminolevulinate tends to be more selective for the sebaceous glands.

The treatment course consists of four sessions at roughly 2-week intervals. The first two sessions elicit the big inflammatory reaction. The third and fourth generate only a mild sunburn-like reaction.

Asked if he is concerned about possible long-term adverse health consequences resulting from destroying sebaceous glands, Dr. Anderson said he used to be until he asked the late Dr. Albert Kligman for his thoughts.

"He said if you want to know what skin is like with no sebaceous gland function, look at any child. The glands are there but they're turned off because they haven't yet seen the androgen of puberty," recalled Dr. Anderson. "So, I think functionally, the sebaceous gland is just there as God's curse on teenagers."

A blinded, split-face comparative study of high-dose red light PDT testing various parameters is underway at Massachusetts General Hospital and should be completed in about 6 months.

Dr. Anderson has been awarded more than 60 patents and is responsible for numerous seminal advances in laser medicine. Many top laser experts have trained under him, a process they call "getting Roxified," in which they acquire a spirit of open-minded inquiry.

Dr. Anderson declared having no relevant financial interests. SDEF and this news organization are owned by Elsevier.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Suicidal ideation is almost twice as common in adolescents aged 18-19 years with substantial acne, compared with those who have little or no acne, according to a large cross-sectional, questionnaire-based study.

The findings suggest that adverse mental health outcomes that have been attributed to acne therapies in later adolescence might actually be attributable to the burden of having substantial acne, Dr. Jon A. Halvorsen of the University of Oslo (Norway) and his colleagues reported.

Of 3,775 adolescents aged 18-19 years who participated in the study, 14% reported having either "a lot" or "very much" acne. The prevalence of suicidal ideation was nearly 11% in the whole sample, but was 24% in those reporting "very much" acne. Suicidal ideation was twice as likely in girls and three times as likely in boys who reported having "very much" acne, compared with those with little or no acne.

After adjusting for depression, ethnicity, and family income, the risk for suicidal ideation remained significantly increased in those with substantial acne (odds ratio, 1.80), the investigators found (J. Invest. Dermatol. 2011;131:363-70).

Numerous other mental and social difficulties were also associated with substantial acne in the multivariate mode, including mental health problems (OR, 2.25), failure to thrive at school (OR, 1.41), experiencing bullying (OR, 1.39), never having had a romantic relationship (OR, 1.35), and never having had sexual intercourse (OR, 1.51), the investigators reported.

Suicidal ideation, mental health problems, and social difficulties all increased significantly with increasing acne severity, and when the results were stratified by gender, substantial acne in boys was associated more with low attachment to family and friends and never having had sexual intercourse, and in girls it was associated with not thriving at school.

Study participants were part of the Youth 2004 study, which included a large representative community sample. Mental health problems were measured using the Strengths and Difficulties Questionnaire.

Since 10% to 20% of teens will develop moderate to severe acne, knowledge about the psychosocial effects of acne is important for determining optimal healthcare, the investigators wrote.

This is particularly true because some studies have suggested treatment with isotretinoin may lead to increased risk of depression, suicidal ideation, and suicide. The findings have been conflicting, however, and there is a dearth of controlled studies on the topic, the investigators noted.

Findings from the current study confirm those of prior studies showing an association between acne and mental health problems in adolescents aged 12-18 years, and they suggest that the higher rates of reported suicidal ideation and mental health problems among adolescents with substantial acne are more likely to be a result of the effect of acne than the effect of therapy for the acne.

In fact, several studies have demonstrated reduced depression symptoms following successful acne treatment with isotretinoin, providing further support for this premise.

Also providing support for the findings is that while psychiatric difficulties are the main risk factor for suicide, prior studies have also demonstrated a link between lack of attachment to friends and family and increased suicide risk.

"In our study, the separate introduction of social variables ... in the multivariate model did not change the association between acne and suicidal ideation. As such relationships are important for many adolescents, these findings further strengthen our suggestion that acne is an independent risk factor for suicidal ideation," they wrote.

Although limited by the cross-sectional design and self-reported data, this study provides important information for clinicians, as "subjective complaints are important when choosing treatment.

"Furthermore, these findings have public health implications because they underscore the need of appropriate health care for adolescent boys and girls in the community," they concluded.

Funding for this study was provided by the University of Oslo, the Norwegian Institute of Public Health, and The Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The investigators had no disclosures to report.

Acne severity, frequency, and beliefs about the effect of external factors, such as cleansing habits, all play a part in how likely adolescents are to seek help for their acne.

The findings come from a survey of more than 1,000 middle and high school–aged teens in New Jersey. The study was published online in the journal Pediatric Dermatology (2010 Aug. 26 [doi:10.1111/j.1525-1470.2010.01286.x]).

©Stephen Strathdee/iStockphoto.com

"Our study demonstrated that grade of acne, knowledge, and beliefs play a role in help-seeking behaviors, which vary to a significant extent by race and ethnicity," wrote Carol E. Cheng and her coinvestigators. Ms. Cheng is a medical student at Boston University. "Better education about how to manage their acne effectively, and guiding appropriate patients to health care providers, may be important ways to decrease the risk of racial disparities in acne morbidity."

Students at five middle schools and three high schools in New Jersey were asked to complete an anonymous survey, in which they were asked questions about their acne severity, frequency, treatment, beliefs about external factors affecting acne, and perception of the psychosocial impact of acne. Students self-reported demographic information on age, gender, grade, ethnicity (Hispanic, not Hispanic, don't know), and race (American Indian, Native Hawaiian, white, black/African American, more than one race, or unknown).

A total of 1,214 students in grades 6-12 completed the survey; their ages ranged from 10 to 18 years. Roughly half (52%) were male. Almost a quarter of the students (24%) were Hispanic, 40% were white, 14% were Asian, and 10% were black.

Students were asked to rate their acne frequency as never, rarely, sometimes, often, or always. Roughly three-quarters (76%) reported that they had acne of some frequency. They were also asked to rate the severity of their acne as none, mild, moderate, or severe. In all, 65% reported that they had acne of some severity.

"The largest differences appeared in the frequency and severity of black respondents, compared with other races, which suggest that this population may be less affected or may perceive themselves to be less affected," the investigators wrote. Black students were 14% less likely than nonblack students to report acne of any frequency. Similarly, black students were 18% less likely than white students to report acne of any severity.

Participants were also asked to report whether they visited a pediatrician, dermatologist, or another type of health professional, or had never seen a health professional for their acne. Most (83%) reported they had not seen a health professional for their acne. This value was similar across ethnicities and races.

Self-reported acne had an impact on the likelihood of respondents having seen a physician and also on the type of physician seen. Students who reported having acne of some severity were more likely to have seen a physician, compared with those who reported not having acne (21% vs. 8%, respectively). Increased acne severity corresponded with increased likelihood of seeing a dermatologist.

Black students with mild or moderate acne were more likely to have seen a health care professional for their acne, compared with white students (relative risk 3.63 and 3.06, respectively). In contrast, Hispanic students with mild or moderate acne were less likely to see a health professional for their acne, compared with non-Hispanic students (RR 0.56 and 0.47, respectively).

Students were also asked if they treated their own acne, followed a health professional's advice, did both, or did something else. There were no significant differences by race or ethnicity with regard to treatment advice.

The researchers asked the students to rate how much they believed that certain factors affected their acne. These included poor cleansing habits, poor dietary habits, decreased sleep, increased stress, increased exercise, increased drinking of water, increased face touching, increased face washing, increased tanning, and pimple popping.

A majority of students believed that the following factors worsened acne: poor cleansing habits (77%), poor dietary habits (56%), stress (60%), increased face touching (70%), and pimple popping (70%).

"Notably, black respondents in 6/10 cases were least likely to believe that a given factor worsened acne relative to other groups, whereas Asian respondents in 7/10 cases were more likely to believe that a given factor worsened acne relative to other groups," the researchers noted.

White students were more likely to have seen a health care professional and follow a treatment suggestion from a physician if they believed external factors affected acne. Black students who believed external factors affected acne were also more likely to follow a treatment suggestion from a physician. "Notably, Asian respondents did not attribute their help-seeking behavior or treatment decisions to any external factors," the investigators reported.

Disclosures: The investigators did not report whether they had any relevant financial relationships.

Acne severity, frequency, and beliefs about the effect of external factors, such as cleansing habits, all play a part in how likely adolescents are to seek help for their acne.

The findings come from a survey of more than 1,000 middle and high school–aged teens in New Jersey. The study was published online in the journal Pediatric Dermatology (2010 Aug. 26 [doi:10.1111/j.1525-1470.2010.01286.x]).

©Stephen Strathdee/iStockphoto.com

"Our study demonstrated that grade of acne, knowledge, and beliefs play a role in help-seeking behaviors, which vary to a significant extent by race and ethnicity," wrote Carol E. Cheng and her coinvestigators. Ms. Cheng is a medical student at Boston University. "Better education about how to manage their acne effectively, and guiding appropriate patients to health care providers, may be important ways to decrease the risk of racial disparities in acne morbidity."

Students at five middle schools and three high schools in New Jersey were asked to complete an anonymous survey, in which they were asked questions about their acne severity, frequency, treatment, beliefs about external factors affecting acne, and perception of the psychosocial impact of acne. Students self-reported demographic information on age, gender, grade, ethnicity (Hispanic, not Hispanic, don't know), and race (American Indian, Native Hawaiian, white, black/African American, more than one race, or unknown).

A total of 1,214 students in grades 6-12 completed the survey; their ages ranged from 10 to 18 years. Roughly half (52%) were male. Almost a quarter of the students (24%) were Hispanic, 40% were white, 14% were Asian, and 10% were black.

Students were asked to rate their acne frequency as never, rarely, sometimes, often, or always. Roughly three-quarters (76%) reported that they had acne of some frequency. They were also asked to rate the severity of their acne as none, mild, moderate, or severe. In all, 65% reported that they had acne of some severity.

"The largest differences appeared in the frequency and severity of black respondents, compared with other races, which suggest that this population may be less affected or may perceive themselves to be less affected," the investigators wrote. Black students were 14% less likely than nonblack students to report acne of any frequency. Similarly, black students were 18% less likely than white students to report acne of any severity.

Participants were also asked to report whether they visited a pediatrician, dermatologist, or another type of health professional, or had never seen a health professional for their acne. Most (83%) reported they had not seen a health professional for their acne. This value was similar across ethnicities and races.

Self-reported acne had an impact on the likelihood of respondents having seen a physician and also on the type of physician seen. Students who reported having acne of some severity were more likely to have seen a physician, compared with those who reported not having acne (21% vs. 8%, respectively). Increased acne severity corresponded with increased likelihood of seeing a dermatologist.

Black students with mild or moderate acne were more likely to have seen a health care professional for their acne, compared with white students (relative risk 3.63 and 3.06, respectively). In contrast, Hispanic students with mild or moderate acne were less likely to see a health professional for their acne, compared with non-Hispanic students (RR 0.56 and 0.47, respectively).

Students were also asked if they treated their own acne, followed a health professional's advice, did both, or did something else. There were no significant differences by race or ethnicity with regard to treatment advice.

The researchers asked the students to rate how much they believed that certain factors affected their acne. These included poor cleansing habits, poor dietary habits, decreased sleep, increased stress, increased exercise, increased drinking of water, increased face touching, increased face washing, increased tanning, and pimple popping.

A majority of students believed that the following factors worsened acne: poor cleansing habits (77%), poor dietary habits (56%), stress (60%), increased face touching (70%), and pimple popping (70%).

"Notably, black respondents in 6/10 cases were least likely to believe that a given factor worsened acne relative to other groups, whereas Asian respondents in 7/10 cases were more likely to believe that a given factor worsened acne relative to other groups," the researchers noted.

White students were more likely to have seen a health care professional and follow a treatment suggestion from a physician if they believed external factors affected acne. Black students who believed external factors affected acne were also more likely to follow a treatment suggestion from a physician. "Notably, Asian respondents did not attribute their help-seeking behavior or treatment decisions to any external factors," the investigators reported.

Disclosures: The investigators did not report whether they had any relevant financial relationships.

Acne severity, frequency, and beliefs about the effect of external factors, such as cleansing habits, all play a part in how likely adolescents are to seek help for their acne.

The findings come from a survey of more than 1,000 middle and high school–aged teens in New Jersey. The study was published online in the journal Pediatric Dermatology (2010 Aug. 26 [doi:10.1111/j.1525-1470.2010.01286.x]).

©Stephen Strathdee/iStockphoto.com

"Our study demonstrated that grade of acne, knowledge, and beliefs play a role in help-seeking behaviors, which vary to a significant extent by race and ethnicity," wrote Carol E. Cheng and her coinvestigators. Ms. Cheng is a medical student at Boston University. "Better education about how to manage their acne effectively, and guiding appropriate patients to health care providers, may be important ways to decrease the risk of racial disparities in acne morbidity."

Students at five middle schools and three high schools in New Jersey were asked to complete an anonymous survey, in which they were asked questions about their acne severity, frequency, treatment, beliefs about external factors affecting acne, and perception of the psychosocial impact of acne. Students self-reported demographic information on age, gender, grade, ethnicity (Hispanic, not Hispanic, don't know), and race (American Indian, Native Hawaiian, white, black/African American, more than one race, or unknown).

A total of 1,214 students in grades 6-12 completed the survey; their ages ranged from 10 to 18 years. Roughly half (52%) were male. Almost a quarter of the students (24%) were Hispanic, 40% were white, 14% were Asian, and 10% were black.

Students were asked to rate their acne frequency as never, rarely, sometimes, often, or always. Roughly three-quarters (76%) reported that they had acne of some frequency. They were also asked to rate the severity of their acne as none, mild, moderate, or severe. In all, 65% reported that they had acne of some severity.

"The largest differences appeared in the frequency and severity of black respondents, compared with other races, which suggest that this population may be less affected or may perceive themselves to be less affected," the investigators wrote. Black students were 14% less likely than nonblack students to report acne of any frequency. Similarly, black students were 18% less likely than white students to report acne of any severity.

Participants were also asked to report whether they visited a pediatrician, dermatologist, or another type of health professional, or had never seen a health professional for their acne. Most (83%) reported they had not seen a health professional for their acne. This value was similar across ethnicities and races.

Self-reported acne had an impact on the likelihood of respondents having seen a physician and also on the type of physician seen. Students who reported having acne of some severity were more likely to have seen a physician, compared with those who reported not having acne (21% vs. 8%, respectively). Increased acne severity corresponded with increased likelihood of seeing a dermatologist.

Black students with mild or moderate acne were more likely to have seen a health care professional for their acne, compared with white students (relative risk 3.63 and 3.06, respectively). In contrast, Hispanic students with mild or moderate acne were less likely to see a health professional for their acne, compared with non-Hispanic students (RR 0.56 and 0.47, respectively).

Students were also asked if they treated their own acne, followed a health professional's advice, did both, or did something else. There were no significant differences by race or ethnicity with regard to treatment advice.

The researchers asked the students to rate how much they believed that certain factors affected their acne. These included poor cleansing habits, poor dietary habits, decreased sleep, increased stress, increased exercise, increased drinking of water, increased face touching, increased face washing, increased tanning, and pimple popping.

A majority of students believed that the following factors worsened acne: poor cleansing habits (77%), poor dietary habits (56%), stress (60%), increased face touching (70%), and pimple popping (70%).

"Notably, black respondents in 6/10 cases were least likely to believe that a given factor worsened acne relative to other groups, whereas Asian respondents in 7/10 cases were more likely to believe that a given factor worsened acne relative to other groups," the researchers noted.

White students were more likely to have seen a health care professional and follow a treatment suggestion from a physician if they believed external factors affected acne. Black students who believed external factors affected acne were also more likely to follow a treatment suggestion from a physician. "Notably, Asian respondents did not attribute their help-seeking behavior or treatment decisions to any external factors," the investigators reported.

Disclosures: The investigators did not report whether they had any relevant financial relationships.