A multicentre, randomized, double-masked, parallel group, vehicle-controlled phase IIb study to evaluate the safety and efficacy of 1% and 3% topical minocycline gel in patients with papulopustular rosacea.

BACKGROUND: Papulopustular rosacea is characterized by chronic facial erythema and inflammatory facial lesions. Minocycline has anti-inflammatory properties which may be effective in the treatment of rosacea inflammatory lesions. OBJECTIVES: To assess the safety and efficacy of once-daily topical minocycline gel 1% and 3% in patients with papulopustular rosacea. METHODS: This was a prospective, 12-week, double-blinded study conducted at 26 sites in the United States; 270 patients with papulopustular rosacea and 12-40 inflammatory lesions were randomized to minocycline 1%, minocycline 3% or vehicle. The primary endpoint was the mean change in inflammatory lesions at week 12. Key secondary endpoints included success on an Investigator's Global Assessment (IGA). RESULTS: Baseline mean lesion counts were 24·6, 25·1 and 24·3 in the minocycline 1%, minocycline 3% and vehicle groups, respectively; at week 12, the counts had decreased by 12·6, 13·1 and 7·9, respectively. Minocycline significantly decreased lesions, compared with the vehicle [P = 0·01, 95% confidence interval (CI) 7·9 to 0·9, for minocycline 1%; P = 0·007, 95% CI 8·3 to 1·3, for minocycline 3%]. The proportion of patients achieving IGA success was 39% in the minocycline 1% arm [P = 0·34, odds ratio (OR) 1·396 and OR 95% CI 0·71 to 2·75 vs. vehicle], 46% in the minocycline 3% arm (P = 0·04, OR 2·03 and OR 95% CI 1·04 to 3·95 vs. vehicle) and 31% in the vehicle arm. CONCLUSIONS: Minocycline topical gel appears to be safe and tolerable at concentrations of 1% and 3%, and both concentrations significantly decreased inflammatory lesion counts, with a significantly larger proportion of patients achieving IGA success at week 12 in the minocycline 3% arm. These findings support further evaluation of minocycline gel for treating inflammatory lesions associated with papulopustular rosacea. Linked Comment: Hampton. Br J Dermatol 2020; 183:412-413.

Efficacy and safety of the Janus kinase 1 inhibitor PF-04965842 in patients with moderate-to-severe psoriasis: phase II, randomized, double-blind, placebo-controlled study.

BACKGROUND: PF-04965842 is an oral Janus kinase 1 inhibitor being investigated for the treatment of plaque psoriasis. OBJECTIVES: To evaluate the efficacy, safety and tolerability of PF-04965842 in patients with moderate-to-severe plaque psoriasis. METHODS: Patients in this phase II, placebo-controlled study (NCT02201524) were randomized to receive placebo, 200 mg once daily (OD), 400 mg OD or 200 mg twice daily (TD) PF-04965842 for 4 weeks. The primary endpoint was change from baseline in Psoriasis Area Severity Index (PASI) at week 4. Study enrolment was discontinued on 25 June 2015 due to changes in the sponsor's development priorities. RESULTS: Fifty-nine patients were randomized and received at least one dose of PF-04965842 or placebo. The estimated treatment effect (active -placebo PASI change from baseline) and 90% confidence interval at week 4 was -5·1 (-9·2 to -1·0), -5·6 (-9·6 to -1·6) and -10·0 (-14·2 to -5·8) for the 200 mg OD, 400 mg OD and 200 mg TD groups, respectively. At week 4, the proportion of patients achieving PASI 75 was 17% for the placebo and 200 mg OD groups, 50% for the 400 mg OD group and 60% for the 200 mg TD group. There were more abnormal laboratory test results of clinical interest (low neutrophil, reticulocyte and platelet counts) in the 200 mg TD group compared with the OD treatment groups. No serious infections or bleeding events related to neutropenia or thrombocytopenia, respectively, were reported. CONCLUSIONS: These results suggest that treatment with PF-04965842 improves symptoms and is well tolerated in patients with moderate-to-severe psoriasis.

Male skin and ingredients relevant to male skin care.

Male skin care needs are heavily influenced by the need to remove facial hair on a regular basis. Facial skin issues associated with poor hair removal approaches are common and include razor burn and irritation. This paper evaluates current research on shaving technology and how careful ingredient selection can contribute to male skin health. The importance of maintaining hair softness during the shave and restoring facial hydration post-shave is discussed. Data are presented on how post-shave moisturizers containing glycerine and emollients can create an environment for improved barrier function which can be further improved by incorporating specific ingredients such as niacinamide.

The dermatology dispensing debate.

The in-office dispensing of topical skin care products by dermatologists is a source of frequent debate. Guidelines for proper dispensing have been penned by various medical organizations, yet the controversy continues. With the increasing number of physician-dispensed lines available for sale, combined with mounting medical financial issues, the ongoing debate surrounding in-office dispensing will continue.

Concepts in a multiprong approach to photoaging.

Photoaging is a multisystem degenerative process that involves the skin and the skin support systems, including the bone, cartilage, and subcutaneous compartments. These structures provide the architectural support for the dermis, epidermis, and stratum corneum. A multiprong approach to photoaging involves reversing the undesirable changes in each of these structures. Dermatologists should become adept at treating all of the visible manifestations of photoaging.

Cosmetics in acne and rosacea.

Cosmetics that are appropriate for use in patients with rosacea and acne must be noncomedogenic, nonacnegenic, nonirritating, and hypoallergenic. This requires a basic understanding of cosmetic fromulation and the selection of products that meet guidelines for sensitive skin.

Degradation and migration of facial foundations.

The surface characteristics of a facial foundation on the skin affect not only photoprotection, but also aesthetic appearance. A 400x video microscope was used to study the movement of facial foundation on the face of 12 female subjects with oily, dry, and normal skin in a controlled environment over 8 hours. This evaluation revealed gradual degradation of the cosmetic film and accumulation of facial foundation pigment particles in the follicular ostia. This cosmetic migration decreases photoprotection and may explain the perifollicular nature of some cutaneous reactions to facial foundations.

Physicians' and patients' perspectives on office-based dispensing: the central role of the physician-patient relationship.

OBJECTIVE: To describe physicians' and patients' reasons for participating in office-based sales of dermatologic products. DESIGN: Survey data on the attitudes, opinions, and beliefs of dermatologists and their patients were analyzed. SETTING: A market research study of office-based selling. PARTICIPANTS: Thirty dermatologists involved in direct selling from the office, 20 dermatologists not involved in direct selling, 22 patients who purchase products from their dermatologists' offices, and 25 office managers. MAIN OUTCOME MEASURE: The hypotheses of this study were formulated after the market research study had been done. The main outcome measure was the physicians' and patients' reported reasons for patients purchasing skin care products from dermatologists rather than from retail stores. RESULTS: "Trust" was the most frequent reason cited by physicians for patient purchases, while "physician knowledge" was the most frequent reason cited by the purchasing patients. The most common location to display the products was the waiting room (20 [67%] of the physicians). The most common types of products sold included glycolic acid products (15 [50%]), moisturizers (13 [43%]), sunscreens (12 [40%]), and alpha-hydroxy acid products other than glycolic acid (9 [30%]). CONCLUSION: The interaction between physicians who sell products in their offices and their patients is highlighted by 2 key elements of the physician-patient relationship: trust and physician knowledge.

A dermatologist's perspective on the final sunscreen monograph.

The final sunscreen monograph, released on May 21, 1999, defined the upper limit for sun protection factor rating to 30+, revised the list of accepted active agents allowed in sunscreens, and changed the permissible wording of product labeling. These changes are important to the dermatologist who uses sunscreens as part of skin cancer prevention.

Hydrogel barrier/repair creams and contact dermatitis.

BACKGROUND: Barrier creams are important to protect the skin in occupations with chemical exposure. The value of hydrogels in barrier creams has never been studied. OBJECTIVE: The purpose of this study was to evaluate the current technology in barrier cream formulation and explore the utility of hygrogels in skin protection. METHODS: A total of 80 men, women, and children between the ages of newborn to 80 years >were studied with the following dermatologic conditions: household hand dermatitis (21), occupational hand dermatitis (18), latex glove irritant contact dermatitis (9), diaper dermatitis (5), cutaneous wounds (17), and allergic contact dermatitis (ACD) (10). In this study, the investigators used a split body approach, in a double-blind randomized fashion, where one body site was treated with a traditional petrolatum-based cream while the other body site was treated with a hydrogel-based barrier/repair cream. Both subject and investigator assessments were recorded by questionnaire. RESULTS: The hydrogel barrier/repair cream showed better skin improvement than the petrolatum-based cream in both subject assessment (62%, P =.0048) and investigator assessment (75%, P =.0000003). CONCLUSION: Hydrogel barrier/repair creams might represent a new, effective approach to skin protection.

Cosmetics and skin care products. A historical perspective.

The history of cosmetics and skin care products parallels many important technologic developments in chemistry, materials, and packaging innovations. Much is revealed about ancient civilizations by the cosmetics that are uncovered in archaeologic excavations. Much can also be said about modern-day health and adornment practices based on products in the current marketplace.

Therapeutic moisturizers.

Moisturizers have been adapted to perform many important roles on the skin surface. Simple moisturizers combine occlusives and humectants to enhance the water-holding capacity of the skin. The addition of carefully selected emollients can influence the esthetic properties of the moisturizer and the stability of the active ingredients. The addition of sunscreens to moisturizers has created a new product category with an added skin function. Further diversity in moisturizer formulation is created through the addition of specialty ingredients, designed to enhance the functioning of the skin. Moisturizers are an important part of the dermatologist's armamentarium.

Colored facial cosmetics.

Colored cosmetics are an important part of the dermatologic armamentarium. They can camouflage contour and pigment abnormalities, provide moisturization, enhance oil control, add sun protection, deliver barrier-enhancing agents, increase acne treatment, and create a sense of personal well-being. Familiarity with these products allows the dermatologist to provide better patient care.

The biology of hair care.

Most hair damage occurs as a result of grooming habits and chemical exposure for cosmetic purposes. An evaluation of hair structure and biology points to the need for better protective mechanisms from cuticular damage and UV damage to maintain the cosmetic value of the hair. Through the cooperative efforts of dermatologists and cosmetic chemists, better hair care products can be developed. The dermatologist needs to elucidate the mechanism through which products can enhance hair shaft functioning, whereas the cosmetic chemist needs to identify substances and develop formulations to accomplish the desired end.

Nail cosmetic issues.

Nail cosmetics are a part of good hygiene and self adornment. These cosmetics can provide solutions to problems involving the nail plate and also can create disease. This article provides a diagnosis and treatment-oriented approach to nail cosmetic issues.

Treating the patient with multiple cosmetic product allergies. A problem-oriented approach to sensitive skin.

Treating patients with multiple allergies to cosmetic products is a difficult proposition. Many of these patients may simply be experiencing irritant contact dermatitis. Others may have defective barrier function caused by a dermatitis that requires treatment. And some patients with sensitive skin need to exercise care in choosing which products they use on their skin. For many of these patients, products with the fewest ingredients work best because they contain the least or no sensitizers, irritants, or cutaneous sensory stimulants.

Topical agents used in association with cosmetic surgery.

Effective cosmetic surgery depends on proper preparation of the skin prior to the procedure, excellent wound care, and an appropriate postoperative skin maintenance program. Accomplishing this goal requires a thorough understanding of topical agents. Substances applied to the skin can alter barrier function, permeability, transepidermal water loss, immune response, wound repair, vasostability, collagen deposition, epidermal turnover, and melanin formation, to name a few. Each of these skin characteristics can affect the quality of the end surgical result. This article discusses topical agents used in association with cosmetic surgery.