Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial.

OBJECTIVE: To assess the effectiveness of oral spironolactone for acne vulgaris in adult women. DESIGN: Pragmatic, multicentre, phase 3, double blind, randomised controlled trial. SETTING: Primary and secondary healthcare, and advertising in the community and on social media in England and Wales. PARTICIPANTS: Women (≥18 years) with facial acne for at least six months, judged to warrant oral antibiotics. INTERVENTIONS: Participants were randomly assigned (1:1) to either 50 mg/day spironolactone or matched placebo until week six, increasing to 100 mg/day spironolactone or placebo until week 24. Participants could continue using topical treatment. MAIN OUTCOME MEASURES: Primary outcome was Acne-Specific Quality of Life (Acne-QoL) symptom subscale score at week 12 (range 0-30, where higher scores reflect improved QoL). Secondary outcomes were Acne-QoL at week 24, participant self-assessed improvement; investigator's global assessment (IGA) for treatment success; and adverse reactions. RESULTS: From 5 June 2019 to 31 August 2021, 1267 women were assessed for eligibility, 410 were randomly assigned to the intervention (n=201) or control group (n=209) and 342 were included in the primary analysis (n=176 in the intervention group and n=166 in the control group). Baseline mean age was 29.2 years (standard deviation 7.2), 28 (7%) of 389 were from ethnicities other than white, with 46% mild, 40% moderate, and 13% severe acne. Mean Acne-QoL symptom scores at baseline were 13.2 (standard deviation 4.9) and at week 12 were 19.2 (6.1) for spironolactone and 12.9 (4.5) and 17.8 (5.6) for placebo (difference favouring spironolactone 1.27 (95% confidence interval 0.07 to 2.46), adjusted for baseline variables). Scores at week 24 were 21.2 (5.9) for spironolactone and 17.4 (5.8) for placebo (difference 3.45 (95% confidence interval 2.16 to 4.75), adjusted). More participants in the spironolactone group reported acne improvement than in the placebo group: no significant difference was reported at week 12 (72% v 68%, odds ratio 1.16 (95% confidence interval 0.70 to 1.91)) but significant difference was noted at week 24 (82% v 63%, 2.72 (1.50 to 4.93)). Treatment success (IGA classified) at week 12 was 31 (19%) of 168 given spironolactone and nine (6%) of 160 given placebo (5.18 (2.18 to 12.28)). Adverse reactions were slightly more common in the spironolactone group with more headaches reported (20% v 12%; p=0.02). No serious adverse reactions were reported. CONCLUSIONS: Spironolactone improved outcomes compared with placebo, with greater differences at week 24 than week 12. Spironolactone is a useful alternative to oral antibiotics for women with acne. TRIAL REGISTRATION: ISRCTN12892056.

Mask-related adverse skin reactions in orientals during COVID-19: Prevalence, social-psychological impacts and risk factors for acne exacerbation.

BACKGROUND: COVID-19 pandemic has caused mask-related skin problems on health-care professions, yet very few studies have investigated the prevalence in oriental general population. OBJECTIVE: To investigate the prevalence of mask-related adverse skin reactions in Orientals, to explore psychological influence, to identify risk factors for mask-related acne exacerbation. METHODS: We performed a survey through social media. Participant demographics, skin condition before and after COVID-19, and the influence of adverse skin on social-psychological conditions were collected. We compared characteristics between individuals with or without acne exacerbation, and we performed a logistic regression to identify risk factors. RESULTS: Six hundred and six participants (62.3%) responded the survey and 23.3% complained their facial acnes become exacerbated since COVID-19. The social-psychological impact of acnes is more prevalent in women. Risk factors for mask-related acne exacerbation were occupation as health-care workers (OR = 1.861, p = 0.027), prolonged wearing of N95 masks (OR = 3.167, p = 0.001), and touching of acnes (OR = 2.65, p = 0.002). Sex, pre-existed acnes, and prolonged wearing time per day are also associated with acne exacerbation. CONCLUSIONS: Mask-related adverse skin reactions are common in Orientals, and could lead to negative social-psychological effects.

Factors aggravating acne vulgaris during the COVID-19 pandemic in China: a web-based cross-sectional survey.

OBJECTIVE: Acne vulgaris is a common skin disease worldwide. Throughout the COVID-19 pandemic, many patients with acne complained of worsening symptoms. This investigation was designed to survey the impact of COVID-19 regulations on acne and guide patients with acne on symptom management during the pandemic. MATERIALS AND METHODS: From April 7th to April 21st, 2020, an anonymous, self-completed, web-based questionnaire was distributed to patients previously diagnosed with acne (via the Chinese internet medical software). Information collected included patients' mask-wearing routines and behavioral factors including dietary habits, sleep habits, facial hygiene, and make-up use habits. RESULTS: 508 qualified questionnaire responses were collected. During the COVID-19 outbreak in China, there was an overall worsening of patients' acne symptoms (152, 29.9%). Behaviors including intake of sweets (34.9% vs. 16.0%, p<0.01), dairy consumption (32.9% vs. 23.3%, p<0.05), greasy (19.1% vs. 11.2%, p<0.05) and spicy food intake (30.3% vs. 14.3%, p<0.01) and mask-wearing frequency (>28 hours per week) (25.0% vs. 15.3%, p<0.05) presented a statistically significant difference between the acne aggravated and non-aggravated groups. Longtime mask-wearing (>28 hours per week), rather than the mask type, was significantly associated with acne symptom deterioration during the COVID-19 outbreak (odds ratio [OR]: 2.164; 95% confidence interval [CI]: 1.232-3.801). CONCLUSIONS: Besides the well-known risk factors, such as sweets intake, dairy consumption, and greasy and spicy food intake, wearing masks appears to trigger or aggravate acne during the COVID-19 pandemic. Limiting overall mask-wearing time may help to manage acne.

Teledermatology in South Dakota: Uses and Patient Centered Improvement in a Rural Setting.

Dermatologic conditions account for a large proportion of healthcare visits in the United States, yet there continues to be barriers to dermatologic care particularly among the rural and underserved populations. Patients among these populations are particularly vulnerable to poor outcomes and increased morbidity. Teledermatology offers a potential solution to increase access to high-quality dermatologic care. Studies have previously examined the convenience, cost-effectiveness, and clinical efficacy of teledermatology compared to in-person dermatology visits. There is a need to assess which populations are appropriate and in what settings teledermatology can be most effective. We surveyed patients of a South Dakota dermatology practice to assess perceptions and experiences with teledermatology visits in the context of the COVID-19 pandemic. Significant factors leading patients to prefer in-person visits compared to teledermatology were being over the age 65 (OR 2.9 95 percent CI 1.9,3.8 and p-value 0.036) or experiencing technical difficulties during the visit (OR 2.9 95 percent CI 1.9,3.9 and p-value 0.048). We found the chief complaint played an important role in patient preference for visit modality. Patients with acne or acne follow up compared to all other chief complaints had a strong preference for teledermatologic visits (OR 4.7 95 percent CI 4.0,5.4 and p-value 0.000018) whereas patients with possible malignant lesions strongly preferred having an in-person visit (OR 6.6 95 percent CI 5.5,7.8 and p-value 0.0004). Based on these results, we suggest a targeted use of teledermatology with pre-visit screening measures to maintain a patient center approach and avoid redundant visits.

Prevalence of dermatological manifestations due to face mask use and its associated factors during COVID-19 among the general population of Bangladesh: A nationwide cross-sectional survey.

Following the worldwide COVID-19 pandemic, individuals have begun to take preventive measures to avoid exposure. Among the precautionary measures, facemask was mostly emphasized. This study aimed to determine the prevalence of dermatological symptoms linked with face mask usage and explore other associated factors. This cross-sectional survey was conducted throughout all eight divisions of Bangladesh. 1297 people were approached using a fixed-step procedure on a random route sample where 803 fulfilled the inclusion criteria. The overall prevalence of dermatological manifestation in this study was 40.85%. The common dermatological manifestations due to facemasks use were acne (26%), allergy symptoms (24%), traumatic symptoms (24%), and other symptoms (26%). Two important frequently reported risk factors were previous history of skin diseases and obesity. Females were more likely to have acne (CI: 1.199, 3.098; p = .007) and allergy issues (CI: 1.042, 2.359; p = .031). N95 and KN95 masks were more likely to produce allergic symptoms, while surgical mask users were more likely to develop acne. Acne was prevalent more than twice (CI: 1.42, 4.26; p = 0.001) in persons with a COVID-19 infection history. Further exploration is required to find out the reason. Surgical mask users reported more complaints than other types of masks, and prolonged use caused more skin symptoms. Modifications in the pattern of facemask usage and planning for work recesses might also be advised to provide for a pause from uninterrupted facemask use.

Impact of prolonged PPE use on Canadian health professionals.

AIM: To explore the impact that prolonged use of personal protective equipment (PPE) has on the skin integrity of Canadian health professionals. METHOD: A descriptive, pan-Canadian, cross-sectional, online survey was carried out to explore the type and prevalence of PPE-related skin injury among Canadian health professionals. Convenience sampling was used to disseminate the online survey link to health professionals. RESULTS: There were responses from 757 health professionals. Masks worn included surgical masks (90%), a combination of surgical or N95/KN95 masks (7.7%) and an N95/KN95 mask alone (2.7%). Responses showed 84.6% of providers always wear a mask while at work with 38.5% wearing the same mask all shift; 90% of participants wore protective eye wear. Complications included soreness or pressure injuries behind the ears (70%), new or worsening acne (52%), a runny nose or sneezing (45%), itching (39%), and dry skin (37%). Hand issues included dry skin (53%), red skin (30%), itching (26%), broken skin (20%), rash (16%), and dermatitis (11%) - 51% of respondents did not moisturise their hands. Complications related to gown use included itching (6%), moisture-associated skin damage (5.5%), feeling claustrophobic (4.5%), and new or worsening acne (3%). Increased perspiration due to PPE was experienced in 87.5% of respondents. Some 43% of respondents noted their mental health became worse due to wearing PPE for prolonged periods. CONCLUSION: These findings should be used in the development of guidelines to prevent and manage PPE-related skin injuries among health professionals. Education for professionals should focus on skin protection, prevention of PPE-related skin complications and support for mental health issues.

Acne care in health care providers during the COVID-19 pandemic: A national survey.

The medical face mask, widely used by health care providers (HCPs) during the COVID-19 pandemic, is reported to be associated with adverse reactions, among which acne is one of the most common. This study aims to evaluate treatment strategies employed by HCPs affected by acne in association with prolonged medical face mask use, their openness towards accessing telemedicine as a patient, and other lifestyle factors with potential influence on the evolution of their acne. Our online-based cross-sectional survey was distributed between December 17, 2020, and February 17, 2021, and targeted HCPs from different medical centers in Romania. From the n = 134 respondents, 50% reported current acne lesions and 56.7% required treatment. Of the latter, 65.8% self-medicated and 34.2% sought medical advice. The most common treatment associations between anti-acne topical products were: retinoids and salicylic acid (18.18%; n = 8), retinoids and benzoyl peroxide (13.64%; n = 6), salicylic acid and benzoyl peroxide (13.64%; n = 6), and azelaic acid together with salicylic acid (9.09%; n = 4). The health care provider responders were reluctant to use telemedicine, as only 14.2% participants were open to telemedicine. Our results suggest inadequate management of acne in HCPs using medical face masks. As with other occupational hazards and proper usage of personal protective equipment, HCPs should receive adequate screening, training, and treatment for this condition.

[Occupational Dermatoses in Healthcare Workers during the COVID-19 Pandemic: A Narrative Review]. / Dermatoses Ocupacionais em Profissionais de Saúde durante a Pandemia de COVID-19: Revisão Narrativa.

INTRODUCTION: On the 11th March 2020, the World Health Organization declared the novel coronavirus outbreak as a pandemic. Preventive measures such as the appropriate use of personal protective equipment and proper hand hygiene are essential in decreasing transmissibility. Healthcare workers have been required to wear personal protective equipment and to wash their hands even more frequently. These preventive measures are associated with an increased risk of skin conditions, namely, contact dermatitis and exacerbation of pre-existing skin lesions such as acne and seborrheic dermatitis. The aim of this article is to provide an overview of the main skin lesions, and highlighting the role in occupational dermatology and preventive measures. METHODS: A search was conducted on PubMed and some guidelines from organizations like World Health Organization and Portuguese General Directorate of Health were included. RESULTS: Most skin conditions seen in healthcare professionals throughout the pandemic were associated with hand hygiene and the use of personal protective equipment and comprised hand eczema, mask-induced contact dermatitis, personal protective equipment related irritant contact dermatitis, cheilitis and exacerbation of pre-existing conditions such as acne and seborrheic dermatitis. Prevention and early recognition of dermatitis associated with personal protective equipment and hand hygiene are essential to maximize work performance, healthcare workers' safety and the adherence to preventive measures. CONCLUSION: Protection of healthcare workers' health and safety is an essential measure in the fight against the pandemic. Occupational Health has a fundamental role, acting in terms of disease prevention and health promotion, for example, through educational sessions and orientation of skin conditions associated with work, thus maximizing workers' well-being.

Introdução: A 11 de março de 2020, a Organização Mundial da Saúde declarou a doença provocada pelo novo coronavírus uma pandemia. As medidas de prevenção, nomeadamente, o uso apropriado de equipamento de proteção individual e a higienização das mãos, são essenciais na diminuição da transmissibilidade. Os profissionais de saúde têm particular indicação para o seu uso e para o aumento da frequência e duração da lavagem e desinfeção das mãos. Estas medidas estão associadas a um maior risco de desenvolvimento de patologias cutâneas como a dermatite de contacto e a exacerbação de lesões cutâneas pré-existentes, tais como a acne e a dermatite seborreica. O objetivo deste artigo é apresentar uma descrição das principais lesões cutâneas, e salientar o papel da dermatologia ocupacional e medidas preventivas.Métodos: Foi realizada uma pesquisa na PubMed e incluídas orientações de organizações como a Direção-Geral da Saúde e a Organização Mundial da Saúde.Resultados: As principais patologias cutâneas observadas nos profissionais de saúde ao longo da pandemia associam-se à higienização das mãos e à utilização de equipamentos de proteção individual, consistindo, sucintamente, em eczema das mãos, dermatite de contacto induzida por máscaras, dermatite de contacto irritativa por traumatismo do equipamento de proteção individual, queilite e exacerbação de condições pré-existentes como acne e dermatite seborreica. A prevenção e o reconhecimento atempado das dermatites associadas ao uso de equipamento de proteção individual e ao reforço da higiene das mãos são fundamentais para otimizar o desempenho laboral e a segurança dos profissionais de saúde e maximizar a adesão às medidas preventivas.Conclusão: A proteção da saúde e da segurança dos profissionais de saúde constitui uma medida essencial no combate da pandemia, pelo que a Medicina do Trabalho assume um papel fundamental, atuando a nível da prevenção da doença e promoção da saúde, por exemplo, através da realização de sessões de educação e orientação das várias patologias cutâneas associadas ao trabalho, maximizando o bem-estar do trabalhador.

An epidemiological study on face masks and acne in a Nigerian population.

BACKGROUND: Acne vulgaris is a skin disorder that affects males and females with significant impact on quality of life. The onset of the COVID-19 pandemic led to a series of non-pharmaceutical interventions globally to reduce the spread of the virus particularly since there have been no known cures or definitive treatment for the disease. One key non-pharmaceutical intervention was recommendation on wearing of face masks. There are reports of discomfort associated with wearing face mask including complaints of various skin rashes, acne and headaches which could hinder appropriate use of face masks. While the dermatological problems associated with face mask use have been comprehensively explored in high income countries, the data is sparse in sub-Saharan Africa. We aimed to determine the association between face mask use and development of acne vulgaris in our developing country setting. We subsequently determined risk factors for development of acne vulgaris such as duration of wearing face masks, type of face mask, and prior dermatological skin condition history. We aimed to also determine the potential of acne development secondary to face mask use to reducing predisposition to wearing face masks. METHODS: This was an observational cross-sectional study conducted in within two local government areas of the Federal Capital Territory, Abuja. Trained interviewers administered pre-tested questionnaires to 1316 consecutive consenting adult participants randomly approached for informed consent at various public locations. Information was inputted into MS Excel and analyzed using Epi-info. RESULTS: A total number of 1316 persons participated in this study with mean age 34.4 ±12.3 years and median age 35.5years. Male: female ratio was 1:1.41. New onset acne or worsening of acne following consistent wearing of face masks was reported by 323 (24.5%) of the 1316 participants in this study. The surgical face mask was the least likely to predispose to acne p<0.05. Compared with the surgical mask, persons using N95 face mask and cloth mask were 1.89 and 1.41 times more likely to have acne respectively. Persons with prior history of acne were more likely to develop new acne or experience worsening of acne following wearing of face mask OR 3.89, 95% CI 2.85, 5.33; p <0.05). The length of time of daily mask wearing was not significantly associated with occurrence of new onset acne or worsening of acne. Persons reporting prior histories of allergy were more likely to develop acne in this study (OR 2.01, 95% CI 1.50, 2.88; p<0.05). In this study, 192 (59.4%) of those who reported having acne following face masks use responded they have a negative predisposition to wearing masks. CONCLUSION: Our finding of greater predisposition to development or worsening of acne following consistent use of face masks could have implications for the control strategy of COVID-19. The finding that the N95 face mask was more significantly associated with acne is of concern as this is the preferred face mask in healthcare settings. It is important for the medical community to investigate feasible and safe recommendations to help alleviate this condition.

Efficacy and safety of a facial serum containing snail secretion filtrate, Calendula officinalis, and Glycyrrhiza glaba root extract in the treatment of maskne: A randomized placebo-controlled study.

INTRODUCTION: During the ongoing COVID-19 outbreak, face mask use has increased and became a part of our daily lives. While wearing, prolonged contact time and microenvironmental change profoundly lead to an acne flare-up, defined as "maskne." AIMS: We aimed to assess the efficacy and safety of snail secretion filtrate, Calendula officinalis, and Glycyrrhiza glaba root extract combination serum (SCGS) in treating the maskne. METHODS: This was a randomized, double-blind, placebo-controlled trial study. This study enrolled 66 participants with mild-to-moderate maskne. The SCGS and placebo were randomly assigned for participants to use twice daily for 12 weeks. Percentage change of acne lesion count, acne severity by Investigator Global Evaluation Acne (IGEA), sebum levels, corneometry levels, transepidermal water loss (TEWL), erythema score by Visia®, and adverse events were evaluated 4-weekly at baseline to Week 12. At Week 12, all participants evaluated their satisfaction scores using a 10-point visual analog scale (VAS). RESULTS: In the mask-covered area, the percent reduction in inflammatory acne lesions from the treatment group was significantly greater than the placebo group at all time points (coefficient of percentage change of inflammatory lesions = -33.89 [95% CI -65.24, -2.53]; p = 0.03). Also, a subgroup analysis with participants using concurrent acne treatments revealed similar results (12 participants, coefficient = -50.30 [95% -88.65, -11.95]; p = 0.01). However, there were no significant differences in non-inflammatory lesions, all skin biophysics, and VAS between groups. Adverse events were mild and occurred in a few cases in both groups. CONCLUSIONS: The SCGS could significantly improve inflammatory acne lesions and had a favorable tolerability profile, suggesting its role as an adjunctive treatment in maskne.

Types and prevalence of adverse skin reactions associated with prolonged N95 and simple mask usage during the COVID-19 pandemic.

BACKGROUND: As the coronavirus 2019 (COVID-19) pandemic persists on a global level, the chronic daily use of face masks within the healthcare system remains an important component of disease prevention and transmission. Increased use of personal protective equipment (PPE) may result in increased rates of occupational dermatoses and adverse skin reactions. OBJECTIVES: The purpose of this study is to explore how chronic, prolonged use of N95 masks or simple surgical masks affects the prevalence of adverse skin reactions in Healthcare Workers (HCWs). METHODS: An optional, quantitative, web-based survey was administered to patient-facing HCWs across six network hospitals in a large metropolitan city. Data were analysed to assess the types and sites of adverse skin reactions, and to evaluate correlations between single mask use duration and adverse skin reactions. RESULTS: A total of 230 HCWs responded with 192 endorsing occupational dermatoses. Among the healthcare responders, (n = 192, 83.5%) experienced at least one adverse skin reaction. The most common occupational adverse skin reactions were acne (n = 133, 57.8%), dryness (n = 108, 47.0%) and redness (n = 105, 45.7%). Anatomical areas most commonly affected included the nasal bridge (n = 92, 40.0%), cheeks (n = 92, 40.0%) and chin (n = 91, 39.6%). Acne (P = 0.002), dryness/scaling (P = 0.002), increased pore size (0.003), itch (P = 0.003), nasal bridge scarring (P < 0.001), redness (P < 0.001), frictional erosions (P = 0.001) and ulcerations (P = 0.002) showed a positive correlation to duration of mask use. CONCLUSIONS: Prolonged, daily usage of PPE is associated with numerous adverse skin reactions among HCWs with acne being the most commonly seen adverse reaction. Many adverse reactions are associated with prolonged use of single mask.

Adverse Events in Isotretinoin Therapy: A Single-Arm Meta-Analysis.

Isotretinoin (ISO) is an oral prescription-only retinoid, well known for its acne-treating effect. However, it affects a substantial number of human cell types, causing a broad spectrum of adverse effects. The purpose of this study is to establish the isotretinoin therapy adverse events among human clinical trials and their prevalence. Two authors (J.K., J.L.) systematically performed the literature review and assessment from December 2021-February 2022. Three databases (PubMed, ClinicalTrials, and Cochrane Library) were searched using the following terms: "isotretinoin acne vulgaris" for published studies in English from 1980-2021. Finally, 25 randomized controlled clinical trials (RCTs) and five open-label clinical trials provided 3274 acne vulgaris suffering patients. Isotretinoin therapy affects almost all of the systems in the human body, causing numerous adverse events. However, they mainly concern mild mucocutaneous conditions (severe cases are rare) and represent individual responses to a drug. In addition, all adverse events are reversible and can be avoided by specific preparations.

Upadacitinib as induction and maintenance therapy for moderately to severely active ulcerative colitis: results from three phase 3, multicentre, double-blind, randomised trials.

BACKGROUND: There is a great unmet need for advanced therapies that provide rapid, robust, and sustained disease control for patients with ulcerative colitis. We assessed the efficacy and safety of upadacitinib, an oral selective Janus kinase 1 inhibitor, as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis. METHODS: This phase 3, multicentre, randomised, double-blind, placebo-controlled clinical programme consisted of two replicate induction studies (U-ACHIEVE induction [UC1] and U-ACCOMPLISH [UC2]) and a single maintenance study (U-ACHIEVE maintenance [UC3]). The studies were conducted across Europe, North and South America, Australasia, Africa, and the Asia-Pacific region at 199 clinical centres in 39 countries (UC1), 204 clinical centres in 40 countries (UC2), and 195 clinical centres in 35 countries (UC3). Patients aged 16-75 years with moderately to severely active ulcerative colitis (Adapted Mayo score 5-9; endoscopic subscore 2 or 3) for at least 90 days were randomly assigned (2:1) to oral upadacitinib 45 mg once daily or placebo for 8 weeks (induction studies). Patients who achieved clinical response following 8-week upadacitinib induction were re-randomly assigned (1:1:1) to upadacitinib 15 mg, upadacitinib 30 mg, or placebo for 52 weeks (maintenance study). All patients were randomly assigned using web-based interactive response technology. The primary endpoints were clinical remission per Adapted Mayo score at week 8 (induction) and week 52 (maintenance). The efficacy analyses in the two induction studies were based on the intent-to-treat population, which included all randomised patients who received at least one dose of treatment. In the maintenance study, the primary efficacy analyses reported in this manuscript were based on the first 450 (planned) clinical responders to 8-week induction therapy with upadacitinib 45 mg once daily. The safety analysis population in the induction studies consisted of all randomised patients who received at least one dose of treatment; in the maintenance study, this population included all patients who received at least one dose of treatment as part of the primary analysis population. These studies are registered at ClinicalTrials.gov, NCT02819635 (U-ACHIEVE) and NCT03653026 (U-ACCOMPLISH). FINDINGS: Between Oct 23, 2018, and Sept 7, 2020, 474 patients were randomly assigned to upadacitinib 45 mg once daily (n=319) or placebo (n=155) in UC1. Between Dec 6, 2018, and Jan 14, 2021, 522 patients were randomly assigned to upadacitinib 45 mg once daily (n=345) or placebo (n=177) in UC2. In UC3, a total of 451 patients (21 from the phase 2b study, 278 from UC1, and 152 from UC2) who achieved a clinical response after 8 weeks of upadacitinib induction treatment were randomly assigned again to upadacitinib 15 mg (n=148), upadacitinib 30 mg (n=154), and placebo (n=149) in the primary analysis population. Statistically significantly more patients achieved clinical remission with upadacitinib 45 mg (83 [26%] of 319 patients in UC1 and 114 [34%] of 341 patients in UC2) than in the placebo group (seven [5%] of 154 patients in UC1 and seven [4%] of 174 patients; p<0·0001; adjusted treatment difference 21·6% [95% CI 15·8-27·4] for UC1 and 29·0% [23·2-34·7] for UC2). In the maintenance study, clinical remission was achieved by statistically significantly more patients receiving upadacitinib (15 mg 63 [42%] of 148; 30 mg 80 [52%] of 154) than those receiving placebo (18 [12%] of 149; p<0·0001; adjusted treatment difference 30·7% [21·7-39·8] for upadacitinib 15 mg vs placebo and 39·0% [29·7-48·2] for upadacitinib 30 mg vs placebo). The most commonly reported adverse events in UC1 were nasopharyngitis (15 [5%] of 319 in the upadacitinib 45 mg group vs six [4%] of 155 in the placebo group), creatine phosphokinase elevation (15 [4%] vs three [2%]), and acne (15 [5%] vs one [1%]). In UC2, the most frequently reported adverse event was acne (24 [7%] of 344 in the upadacitinib 45 mg group vs three [2%] of 177 in the placebo group). In both induction studies, serious adverse events and adverse events leading to discontinuation of treatment were less frequent in the upadacitinib 45 mg group than in the placebo group (serious adverse events eight [3%] vs nine (6%) in UC1 and 11 [3%] vs eight [5%] in UC2; adverse events leading to discontinuation six [2%] vs 14 [9%] in UC1 and six [2%] vs nine [5%] in UC2). In UC3, the most frequently reported adverse events (≥5%) were worsening of ulcerative colitis (19 [13%] of 148 in the upadacitinib 15 mg group vs 11 [7%] of 154 in the upadacitinib 30 mg group vs 45 [30%] of 149 in the placebo group), nasopharyngitis (18 [12%] vs 22 [14%] vs 15 [10%]), creatine phosphokinase elevation (nine [6%] vs 13 [8%] vs three [2%]), arthralgia (nine [6%] vs five [3%] vs 15 [10%]), and upper respiratory tract infection (seven [5%] vs nine [6%] vs six [4%]). The proportion of serious adverse events (ten [7%] vs nine [6%] vs 19 [13%]) and adverse events leading to discontinuation (six [4%] vs ten [6%] vs 17 [11%]) was lower in both upadacitinib groups than in the placebo group. Events of cancer, adjudicated major adverse cardiac events, or venous thromboembolism were reported infrequently. There were no treatment-related deaths. INTERPRETATION: Upadacitinib demonstrated a positive efficacy and safety profile and could be an effective treatment option for patients with moderately to severely active ulcerative colitis. FUNDING: AbbVie.

The change in the frequency and severity of facial dermatoses and complaints in healthcare workers during the COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in the use of personal protective equipment (PPE). However, the increased use of PPEs may lead to facial skin complaints. AIMS: This survey study aims to evaluate the effect of the COVID-19 pandemic on facial dermatoses and complaints. METHODS: A total of 1017 volunteers (age 18-60 years), consisting of healthcare workers, participated in the study. In the present study, healthcare professionals were screened for facial dermatoses and complaints between 1 and 15 April 2021 with an online survey. RESULTS: The vast majority of the survey were women (82.4%) and between 26 and 35 years old (49.2%). The most new-onset facial complaints were acne (25.3%) and lip dryness (29.2%). Along with the pandemic, 50.9% of patients with seborrheic dermatitis had an increase in lesions. Another remarkable result was a 60.5% increase in acne complaints. Moreover, the rate of exacerbations of rosacea, melasma, and lip dryness was increased after the COVID-19 pandemic (39.1%, 22.0%, and 42.7%, respectively). Exacerbations of seborrheic dermatitis, acne, and lip dryness have occurred more frequently in females when compared to males (p < 0.001). CONCLUSIONS: The current pandemic has had serious impacts on facial dermatoses which had to be managed carefully. Compared to the pre-pandemic period, there was a significant increase in the frequency and severity of complaints in facial dermatoses related to PPE. If the complaints that may develop due to PPE are known in advance, their development can be prevented by taking precautions against them.

C. acnes qPCR-Based Antibiotics Resistance Assay (ACQUIRE) Reveals Widespread Macrolide Resistance in Acne Patients and Can Eliminate Macrolide Misuse in Acne Treatment.

Background: Macrolides have been widely used to treat moderate-to-severe acne for more than 50 years. However, the prevalent antibiotic resistance of Propionibacterium acnes, along with the absence of clinically available resistance tests, has made macrolide misuse a frequent occurrence around the globe, with serious consequences. Objective: We developed Cutibacterium acnes quantitative PCR (qPCR)-based antibiotics resistance assay (ACQUIRE) to enable fast and accurate detection of C. acnes macrolide resistance in clinical settings, representing an opportunity to administer antibiotics more wisely and improve the quality of care. Methods: A cross-sectional observational study (n = 915) was conducted to probe into the macrolide resistance of C. acnes in patients with acne. Results: The high sensitivity of ACQUIRE enabled us to reveal a much higher C. acnes 23S recombinant DNA (rDNA) point mutation rate (52%) and thus a higher macrolide resistance (75.5%) compared to previous reports. Carriage of ermX gene was discovered on 472 (53%) subjects, which concurs with previous studies. Conclusion: The macrolide resistance of C. acnes is much higher than previously reported. Integrating ACQUIRE into acne treatment modalities may eliminate macrolide misuse and achieve better clinical improvements.