TeleCondutas: acne / TeleGuides: acne

Acne é a dermatose mais comum, acometendo cerca de 80% dos adolescentes e adultos jovens. É caracterizada por lesões não-inflamatórias (comedões abertos e/ou fechados) e por lesões inflamatórias (pápulas, pústulas, cistos ou nódulos) tipicamente localizados na face, pescoço, dorso, tórax e braços. A etiologia da acne vulgar resulta da associação dos seguintes fatores: hiperqueratinização e obstrução do infundíulo folicular, devido à descamação anormal do epitélio folicular; aumento da produção de sebo estimulada pelos andrógenos; colonização do folículo pelo Propionibacterium acnes, gerando inflamação. Esta guia apresenta informação que orienta a conduta para casos de acne no contexto da Atenção Primária à Saúde, incluindo: classificação da acne vulgar, Características da acne vulgar, Erupção acneiforme, Diagnóstico da acne vulgar, Tratamento - Orientações gerais, Tratamento - Medicamentos, Terapia tópica, Antibióticos sistêmicos, Terapia antiandrogênica, Acne na Gestante, Acompanhamento, Encaminhamento para serviço especializado.

Twice-per-week Application of an Adapalene-benzoyl Peroxide Fixed-dose Combination Gel as Maintenance Treatment for Acne Vulgaris in Adults / 대한피부과학회지

BACKGROUND: The efficacy and safety of daily maintenance treatment with an adapalene-benzoyl peroxide (adapalene-BPO) fixed-dose combination gel is established in acne vulgaris in adults. OBJECTIVE: This study evaluated the efficacy and tolerability of twice-per-week maintenance therapy with an adapalene-BPO combination gel for acne vulgaris in adults. METHODS: All patients applied the adapalene-BPO combination gel once daily during the initial 8 weeks. Subsequently, the patients were randomized into two groups. The maintenance group applied the ointment twice-per-week for 12 weeks of maintenance treatment, while the control group discontinued treatment after the initial 8 weeks active treatment. The changes in the mean numbers of total, inflammatory, and non-inflammatory lesions were assessed. RESULTS: During maintenance treatment, the changes in the average numbers of total and inflammatory lesions in the maintenance group differed significantly from the control group. CONCLUSION: Twice-per-week application of an adapalene-BPO combination gel after active treatment appears to be a good option for the maintenance therapy of acne vulgaris in adults.

Evaluation of the Efficacy, Safety, and Treatment-Related Skin Irritation of Adapalene-Benzoyl Peroxide Combination Gel and Adapalene Gel in Acne Patients: A Randomized Comparative Study / 대한피부과학회지

BACKGROUND: While adapalene and benzoyl peroxide have both been demonstrated to be effective for the treatment of acne vulgaris, they can also cause skin irritation, resulting in patient incompliance. In addition, the irritation may be severe when adapalene is co-administered with benzoyl peroxide. OBJECTIVE: The intention of this study was to evaluate the efficacy and safety of adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel, and adapalene 0.1% gel monotherapy, for the treatment of mild to moderate acne. Any changes in the skin barrier function were also measured. METHODS: A total of 52 patients applied adapalene-benzoyl peroxide gel or adapalene gel once daily. The changes in lesion counts, investigator's global assessment, patient satisfaction, and adverse events were recorded for 6 weeks. The biophysical profiles of the skin, including transepidermal water loss and redness, were measured for 3 weeks. RESULTS: Both agents were effective for the treatment of acne lesions. Adapalene-benzoyl peroxide showed a faster onset of action than adapalene, especially on inflammatory lesions. However, at week 6, both agents showed a similar effect in reducing lesion counts. While most patients in both groups experienced skin irritation from week 1, this gradually reduced. Likewise, the changes in transepidermal water loss and redness showed peak rates at week 1 and 2, but decreased over time. CONCLUSION: Adapalene-benzoyl peroxide gel is effective for the treatment of acne with a safety profile comparable to adapalene gel. The skin irritation experienced may be associated with the changes in skin barrier disruption, which lasts for 1~2 weeks.

Effects of Adapalene-Benzoyl Peroxide Combination Gel in Treatment or Maintenance Therapy of Moderate or Severe Acne Vulgaris: A Meta-Analysis

BACKGROUND: An antibiotic-free, fixed-dose combination gel with adapalene (A) 0.1% and benzoyl peroxide (BPO) 2.5% has been developed for treatment of acne vulgaris. OBJECTIVE: To compare the clinical outcomes of A-BPO combination gel with vehicle gel for treatment or maintenance therapy of patients with acne vulgaris. METHODS: An electronic search of the database PubMed (1966 to September 2012), Embase (1984 to September 2012), and Cochrane Controlled Trials Register (CENTRAL; 3rd Quarter, 2012) was undertaken to identify relevant studies. Main clinical outcomes were success rate, treatment-related adverse events (AEs), AEs leading to discontinuation, satisfaction with the effectiveness, and overall satisfaction. RESULTS: Six studies were finally included in this meta-analysis. The A-BPO group yielded better clinical outcomes regarding the success rate (p<0.00001), satisfaction with the effectiveness of treatment (p=0.005), and overall satisfaction (p=0.005) compared to the vehicle group. The incidence of treatment-related AEs in the A-BPO group was comparable with that of vehicle group (p=0.09), while the A-BPO group was associated with a slightly increase in the incidence of AEs leading to discontinuation when compared with the vehicle group (p=0.02). CONCLUSION: A-BPO combination gel yields better clinical outcomes including success rate, satisfaction with the effectiveness, and overall satisfaction compared to vehicle gel, despite an increased incidence of AEs leading to discontinuation. The A-BPO combination agent most likely contributes to the treatment of moderate acne vulgaris rather than severe acne vulgaris, but it may be useful in maintenance therapy of patients with severe acne vulgaris.

Comparative study between topical clindamycin solution [1%] versus combination of clindamycin [1%] /adapalene [0.1%] gel in the treatment of mild to moderate acne vulgaris

Acne vulgaris is a common skin disorder. Combination therapy with topical retinoid and antibiotic is recognized as an effective treatment of acne vulgaris. The aim of this study was to compare the efficacy and tolerability of topical clindamycin solution as a rnonotherapy with the combination gel of clindamycin/adapalene for the treatment of mild to moderate acne of the face. This comparative therapeutic trial was conducted at the out patient department of Dermatology and Venereology at Rizgari Teaching Hospital in Erbil City from November 2008. Hundred patients with mild to moderate acne of the face were enrolled in the study and were divided in to two groups; group I [n=50]; apply clindamycin phosphate solution 1%, and group II [n=50]; apply a combination gel of clindamycin1% /adapalene 0.1%; once daily at night for 12 weeks. Of 100 patients, 89 patients completed their treatment as per protocol, 45 patients in group I, and 44 patients in group II. At the end of the 12 weeks; the mean percent reductions of noninflammatory, inflammatory, and total lesion count were greater in group II than in group I. A significantly greater reduction of total [P = 0.008], and noninflammatory lesions [P = 0.002] were seen in group II than in group I. Both treatments were well tolerated, and few side effects were reported. This study demonstrates that the combination of topical clindamycin and adapalene is more effective than clindamycin solution alone, and provides faster benefit in treatment of mild to moderate acne

A Study of the Effectiveness in the Treatment of Mild to Moderate Severity Acne with Adapalene-benzoyl Peroxide Fixed-dose Combination Gel (Epiduo(R)) / 대한피부과학회지

BACKGROUND: A fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has been developed for once-daily treatment of acne. It is known to be effective to reduce inflammatory and non-inflammatory lesions, but there have been no study in Korean yet. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of adapalene 0.1%-BPO 2.5% fixed-dose combination gel (adapalene-BPO) for the treatment of mild to moderate severity acne in Korean. METHODS: In total, 64 patients with mild to moderate severity acne were enrolled. Adapalene-BPO was applied to face once daily at night. The efficacy assessment was performed at baseline and monthly for 3 months: inflammatory lesions (IL), non-inflammatory lesions (NIL), total lesions (TL) were counted and median percentage changes of each lesion were measured for 3 months with patient satisfaction and adverse events questionnaire. RESULTS: Of the 64 patients enrolled, 58 have completed 3-month treatments. Adapalene-BPO showed early onset of action with significant reduction in inflammatory, non-inflammatory, and total lesion counts. The median percentage reduction of mild group from baseline to 3rd month was greater than moderate group in IL, NIL, and TL counts (71.1% vs 65%/61.4% vs 56.4%/67.7% vs 62% reduction). Also, patient satisfaction score improved and significant reduction of Korea Acne Grading System (KAGS) was noted in both groups. All the reported adverse events were mild. CONCLUSION: This study shows that adapalene-BPO is an effective and safe treatment regimen for both mild and moderate acne. It has a better effect for treating mild severity acne than moderate acne with reduction of the IL, NIL, and TL counts and greater patient satisfaction.

A Case of Infantile Acne / 대한피부과학회지

Infantile acne is a much less common disease than adolescent and postadolescent acne. It occurs in children approximately at 3 to 6 months of age. An 8 month-old male infant, accompanied by his mother, visited our clinic with a history of erythematous skin lesions on both cheeks, which started 5 months ago. Physical examination revealed closed comedones, several relatively well demarcated, erythematous papules, nodules and pustules. Inflammatory lesions left scars scattered over the face. For further evaluation of endocrinologic abnormalities or other systemic diseases, an additional abdominal ultrasound was done after a visit to the pediatrician. A skin biopsy revealed findings compatible with acne. Skin lesions were improved by treatment with oral and topical antibiotics, adapalene and isotretinoin. We report herein a case of infantile acne which has not been reported in Korean dermatological literature.

A Case of Dariers Disease Treated with Adapalene / 대한피부과학회지

Dariers disease is inherited as an autosomal dominant trait and characterized by follicular pruritic hyperkeratotic papules. The onset is usually in late childhood and the course of the disease is chronic and slowly progressive in most cases. Dariers disease is refractory to treatment with most conventional keratolytics and anti-inflammatory agents. To date, oral and topical retinoid products have been the mainstay therapy for this population, but local as well as systemic side effects often limit their effectiveness. We present a case of localized Dariers disease which responded promptly to the topical application of adapalene 0.1% gel without side effects. A review of treatment for Dariers disease also is presented.