Clinical efficacy and safety of a topical combination of retinaldehyde 0.1% with erythromycin 4% in acne vulgaris.

The objective of this randomized, controlled, multicentre study was to assess the efficacy and safety of a topically applied retinaldehyde 0.1% gel in combination with a topical erythromycin 4% lotion for the treatment of acne vulgaris. Treatment consisted of applying either retinaldehyde or its vehicle every morning and erythromycin every evening for 8 weeks. Efficacy parameters were sequential lesion counts for papules and pustules, and a 6-point semiquantitative scale for comedones and microcysts. Safety parameters were local tolerance and adverse events. Of 74 recruited patients, 73 were appraisable for efficacy and safety. In both treatment groups, papules and pustules were reduced significantly at the end of treatment (P < 0.001), and no statistical difference was observed between the groups. Comedones and microcysts were significantly improved with retinaldehyde combined with erythromycin (P = 0.005), but not with erythromycin alone. However, no statistical difference between the groups could be demonstrated (test power, 50%). Local tolerance of the combined treatment group was very satisfactory, as only a few patients experienced local irritation. In conclusion, retinaldehyde combined with erythromycin appears to be a valuable topical therapy in polymorphic acne.

Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients.

BACKGROUND: The efficacy of oral isotretinoin in acne has been established, though the role of the mean daily dose (MDD) is still unclear. OBJECTIVE: To determine the predictive factors of resistance to oral isotretinoin and the role of the MDD of isotretinoin on relapse of acne while taking into account patient characteristics and the total cumulative dose (TCD). METHODS: Two hundred and thirty-seven patients treated with oral isotretinoin for the first time were enrolled by a single dermatologist. Patients with closed comedonal acne and with hyperandrogenism received adequate therapy prior to isotretinoin. RESULTS: Closed comedonal acne was the only predictive factor of resistance to isotretinoin with an adjusted OR = 2.7 (95% CI: 1.0-7.3). The estimated rates of relapse at 1, 3 and 5 years were 14, 40 and 48%, respectively. Age and grade of facial acne were the only predictive factors for relapse with adjusted relative risks of 0.6 (95% CI: 0.4-0.8) for age >/= 20 and 1.5 (95% CI: 1.0-2.2) for grade > 3. CONCLUSION: MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.

[Acne in the male resistant to isotretinoin and responsibility of androgens: 9 cases, therapeutic implications]. / Acné de l'homme résistant à l'isotrétinoïne et responsabilité des androgènes: 9 cas, implications thérapeutiques.

INTRODUCTION: Treatment failures with isotretinoin in female patients are frequently related to endocrinological dysfunctions. Such a concept has never been discussed in male patients. CASE REPORTS: An extensive endocrinological work-up has been performed in nine male patients who presented with an acne refractory to conventional treatment and to isotretinoin. Adrenal dysfunction was found in four patients and isolated 5-alpha reductase hyperactivity in 2 cases. Three work-ups were normal. A suppressive treatment in three patients with adrenal dysfunction provided immediate efficacy. COMMENTS: These results would provide insight into the mechanism of refractory acne in men.

[Aggravation of acne by isotretinoin. 6 cases, predictive factors]. / Aggravation de l'acné sous isotrétinoïne. 6 cas, facteurs prédictifs.

OBJECTIVE: Acne flare-ups are frequent in the early phase of isotretinoin treatment. Severity varies from one patient to another. Clinical factors favoring a potentially severe course were assessed on the basis of 6 cases. CASE REPORTS: Six male patients, mean age 16.5 years, with inflammatory acne with a major retentional component were studied. Isotretinoin administered at a daily dose 0.5 mg/kg led to explosive development of massive nodulocystic lesions or pyogenic granulomas within two months. The lesions healed at withdrawal of isotretinoin and administration of antibiotics and antiinflammatory drugs. There was important scar sequellae. DISCUSSION: Four concomitant factors were identified which contribute to the development of acne flare-ups: sex (male), young age, retentional form of acne and daily isotretinoin dose 0.5 mg/kg.

[Acne, hyperandrogenism and oral isotretinoin resistance. 23 cases. Therapeutic implications]. / Acné, hyperandrogénie et résistance à l'isotrétinoïne orale. 23 cas. Implications thérapeutiques.

BACKGROUND: We earlier demonstrated that oral isotretinoin can be associated with hyperandrogenism in women with acne. The aim of this study was to evaluate the causal relationships of the different etiologies in case of unsuccessful treatment. PATIENTS AND METHODS: The study group included 120 patients with late-onset acne resistant to different treatment and signs of hyperandrogenism. A complete hormone work-up was obtained in all patients. There was a group of 23 patients who failed to respond to isotretinoin and 97 patients in the control group. Unsuccessful treatment was defined as persistance of grade 2 lesions after a mean cumulative dose of 166 mg/kg isotretinoin. RESULTS: In the non-responders to isotretinoin, hyperandrogenism was observed in 22 out of 23 cases: pituitary (n = 2), adrenal (n = 5), ovarian (n = 13), peripheral (n = 2). In the control group, hyperandrogenism was found in 89 out of 97 patients: pituitary (n = 6), adrenal (n = 45), ovarian (n = 33), peripheral (n = 5). The distribution of two etiologies, ovary and adrenal, demonstrated a significant difference between isotretinoin non-responders and controls, the former having a higher frequency of ovarian hyperandrogenism. DISCUSSION: These findings confirm that untreated hyperandrogenism, particularly ovarian hyperandrogenism, is a source of unsuccessful treatment with oral isotretinoin.

Isotretinoin and acne in practice: a prospective analysis of 188 cases over 9 years.

A total of 188 acne patients (113 male and 75 female) with a mean age of 25 years (range 15-42 years) were treated with isotretinoin in doses ranging from 0.5 to 1 mg/kg. The study lasted 9 years. The treatment was not terminated until 2 months after total healing. The patients were then re-examined at regular intervals. In the event of a recurrence greater than grade 2 (pre-nodular threshold grade), they underwent a new course of treatment. At the end of the study, three groups were distinguished: (1) immediate, long-term, stable remissions following one single course of isotretinoin (111 patients with an average follow-up period of 27 months); (2) stable remissions following 2 or 3 courses of isotretinoin (54 patients with an average follow-up period of 16 months); (3) immediate partial remissions or partial remissions following several courses of treatment in 23 patients who continued to present with at least grade 3 acne. There was no significant statistical difference between the first two groups with respect to the age and sex of the patients and the grade and prior duration of the acne. The third group differed from the other two in having a greater proportion of patients with microcystic acne (p < 0.05) and women with endocrinological problems ((p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Retinoids and contraception.

The main side effect of the retinoids is teratogenicity. Every dermatologist has a moral obligation to ensure that this effect is avoided, and the present publication is aimed at helping prescribe these drugs. After a review of the key properties of each of the retinoids on the market, the different forms of contraception available and their indication in young patients undergoing retinoid treatment are discussed. Unless otherwise contraindicated, oral contraception with an estrogen-progestogen formulation is the contraceptive method of choice for women undergoing retinoid treatment. The intrauterine device (IUD) is of little or almost no relevance for young women undergoing treatment with a retinoid. IUDs are indicated in older multiparae who have practised this form of contraception before starting retinoid treatment and who refuse to take the pill. Natural and local methods of contraception are totally unsuitable for women undergoing treatment with retinoids. However, they may be used as an additional precautionary measure by IUD users.

[Hair loss during treatment with oral contraceptives]. / Chute des cheveux sous pilule.

Oral contraceptives with a dominant androgen component can cause or worsen androgen-dependent alopecia in women. This diagnosis can only be made if other causes of alopecia (which can occur at the same time as treatment with oral contraceptives) have been excluded. The patient's endocrine profile must be investigated sometimes, this being in order to detect any excess production of androgens. These types of alopecia call for the stopping of the oral contraceptive and sometimes also calls for oral anti-antigen treatment.

[Decrease of the sebum excretion rate and improvement of acne in acneic women treated with the association: cyproterone acetate-ethinyl estradiol (author's transl)]. / Réduction de l'excrétion sébacée et amélioration de l'acné chez des patientes traitées par l'association : acétate de cyprotérone - éthinyl oestradiol.

37 women have received during a total of 429 cycles (mean 12 cycles/patients) an association containing cyproterone acetate 2 mg and ethinyl estradiol 0.05 mg. A marked improvement in the clinical symptoms (acne 35 cases) has been observed. The sequential determination of the sebum excretion rate has been made in the same time (150 measurements) and revealed an important, early and durable decrease in the sebum excretion rate. The respective role of the CA and EE has been analysed in a second trial. It seems that the antiandrogen might play a role in the clinical improvement and in the reduction of the sebaceous flow.