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Excessive sebum production is a factor in acne development. Tazarotene 0.045% lotion has demonstrated reductions in acne lesions and acne-induced sequalae.Evaluate efficacy, changes in skin oiliness, and safety with tazarotene 0.045% lotion in participants with moderate-to-severe acne and oily skin.In two phase 3, double-blind, 12-week studies (NCT03168321; NCT03168334), participants aged ≥9 years with moderate-to-severe acne were randomized 1:1 to once-daily tazarotene 0.045% lotion or vehicle lotion (N = 1,614). This pooled, post hoc analysis included only participants self-categorized with oily skin at baseline on the Acne Quality of Life questionnaire item 19 (scores: 0 [extremely oily] to 6 [not at all oily]). Inflammatory/noninflammatory lesion counts, treatment success, skin oiliness, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability were evaluated.In all participants with oily skin (n = 793), tazarotene provided greater reductions in inflammatory/noninflammatory lesions (iP/i lt; 0.001, both) and greater treatment success rates versus vehicle (iP/i lt; 0.01) at week 12. Over two-thirds of polymeric lotion-treated participants had subjective skin oiliness reductions by week 12, with around a third reporting 'low/not' oily skin. Tazarotene TEAE rates were similar to the overall population.Once-daily treatment with tazarotene 0.045% polymeric emulsion lotion may help improve patient-perceived skin oiliness in those with moderate-to-severe acne.

Background The expanding number of potential treatment options for atopic dermatitis (AD) highlights the need to better understand the treatment preferences of individuals with AD. Objective This study identified attributes that most greatly influenced treatment preferences of adults/adolescents/caregivers of children with mild/moderate/severe AD. Methods Adults (≥18 years), adolescents (12-17 years), and caregivers of children (2-11 years) with mild, moderate, or severe AD in the United States (US) and United Kingdom (UK) participated in semistructured interviews. Thematic analysis was used to identify and generate themes across the interview results describing the treatment attributes of greatest importance to participants. Results Qualitative interviews were conducted with 35 adults, 35 caregivers, and 33 adolescent participants across both countries (n = 103; US =51; UK =52) and all severity groups (mild =43; moderate =47; severe =13). The most important treatment attributes included efficacy (96.1%; speed and duration of symptom relief), mode of administration (66.0%; route of administration, frequency, and convenience), and side effects (55.3%, short-term, long-term, and general). Conclusion Efficacy, mode of administration, and side effects were the most important attributes that influenced AD treatment preferences for patients and caregivers across different countries, ages, and disease severity. These results may assist patients/caregivers/clinicians in shared decision-making discussions to improve treatment adherence and outcomes.

Background Patients with sensitive skin find topical retinoid use for anti-aging purposes challenging due to irritation. Bakuchiol, a meroterpene from the Psoralea corylifolia seed, has retinol functionality through retinol-like regulation of gene expression. Objective This research examined the tolerability, efficacy, and barrier effects of a nature-based bakuchiol-containing cleanser and moisturizer in subjects with sensitive skin. Methods 60 female subjects Fitzpatrick skin types InV age 40n65 years with sensitive mild to moderate photodamaged skin were enrolled in this 12 week study. A sensitive skin panel was constructed: 1/3 eczema/atopic dermatitis, 1/3 rosacea, 1/3 cosmetic intolerance syndrome. Subjects used a nature-based cleanser and moisturizer twice daily and underwent transepidermal water loss (TEWL), corneometry, tolerability assessments, and efficacy assessments at baseline, 5n10 minutes post-application, and week 4. Results The skin care products were well tolerated and efficacious (Pl0.001) in terms of investigator assessed improvement in visual smoothness, tactile smoothness, clarity, radiance, overall appearance, and global anti-aging. Cheek corneometry measurements demonstrated a statistically significant 16% increase in skin moisture content (Pl0.001). Conclusion A bakuchiol nature-based anti-aging moisturizer is well tolerated and effective in individuals with sensitive skin.J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5522.

Background: Topical tretinoin’s role in acne has been established through evidence-based guidelines. Cutaneous irritation and potential to cause or exacerbate postinflammatory hyperpigmentation (PI...

OBJECTIVE: Despite common administration of intralesional triamcinolone to acne lesions, there is little published data or consensus on best practices. This study aimed to evaluate specific characteristics of intralesional triamcinolone for acne among various dermatology healthcare professionals. DESIGN: One hundred participants (82 attending physicians, 9 physician assistants, 8 other healthcare professionals, and 1 unidentified) from private practices and academic centers completed a 10-question survey to assess specific characteristics of intralesional triamcinolone injections, including frequency, indication, depth of injection, concentration, volume, as development of adverse events. RESULTS: The most common reported concentration of intralesional triamcinolone was 2.5mg/mL (52.5%). The most frequently used volume injected was 0.05mL (42.3%). In total, 61.6 percent of those surveyed answered that they inject into the center of the lesion. Additionally, 50.5 percent of respondents counsel patients on potential adverse effects of hypopigmentation and atrophy before every injection. The majority of respondents (88.8%) reported that less than one percent of their patients returned for adverse events resulting from triamcinolone usage, and 48.4 percent reported that atrophy lasted over six months (48.4%). CONCLUSION: The data collected from this study can offer guidance on best practices in administering intralesional kenalog to patients. While consistency exists for the concentration of triamcinolone used, there was significant discordance in the volumes and depth of triamcinolone injection. Observed skin atrophy rates are extremely low, but they are long lasting when it occurred. We can use these data to refine our treatment techniques as well as improve treatment outcomes and patient satisfaction.

Context: Skin sensitivity may be best defined as self-reported intolerance to application of skincare products. It is commonly believed that individuals with darker skin are generally less sensitive, while those lighter skin are more sensitive. However, there is little objective data correlating sensitivity with skin type or with objective measures of sensitivity. Objective: This study assessed Fitzpatrick skin type and self-reported perception of skin sensitivity. Design: A single-blinded, lactic acid sting test was performed on the medial cheeks, where patients were randomized to receive room temperature 10% lactic acid on the left or right cheek with water applied to the contralateral cheek as a control. Outcome Measures: Stinging was assessed 1 minute after application of test solution to one cheek using a visual analogue scale (VAS). Results: There was a statistically significant difference in self-reported skin sensitivity in patients with Fitzpatrick skin types 1-3 vs 4-6 (73.6% vs 46.5%; P= 0.006). Patients who had higher perceived sensitivity were more likely to have objectively measured sensitivity as well, across all skin types (P

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Antibiotics are commonly used by dermatologists in clinical practice, primarily because of the overall track record of favorable efficacy and safety with the most commonly used agents. During the past decade, increased attention has been given to the problems associated with antibiotic resistance. This article summarizes important principles gleaned from the continued efforts of the Scientific Panel on Antibiotic Use in Dermatology; other groups working diligently in this area, such as the Centers for Disease Control and Prevention and the Canadian Antimicrobial Resistance Alliance; and from the published literature.

Acne vulgaris (AV) is considered a straightforward diagnosis made clinically without specific diagnostic testing. However, certain disorders may simulate AV, such as multiple small epidermal cysts or deep milia, multiple osteoma cutis, multiple small adnexal neoplasms, and follicular and/or infections characterized by multiple small papules and/or pustules such as gram-positive folliculitis, gram-negative folliculitis, Malassezia folliculitis, keratosis pilaris, and flat warts. This can lead to an erroneous diagnosis and improper management. Acneiform eruptions, often associated with ingestion of certain drugs and chemicals, can confound the clinician regarding AV diagnosis. We present herein an interesting case that was originally misdiagnosed as AV.

The process of aging is associated with anticipated cutaneous changes such as epidermal thinning, dehydration, loss of barrier function, and decreased extracellular matrix components. These physiologic changes translate to clinical findings such as atrophy, pigmentary changes, and wrinkling. Over the past century, the role of decreased circulating estrogens in the process of cutaneous aging has been elucidated. Estrogen replacement, both systemic and topical, has been shown to have positive effects on aging skin by promoting fibroblast proliferation and increasing collagen density. However, despite these positive effects on skin health and appearance, estrogens also display a wide-range of actions on various other systems. Even topical estrogen application can result in unwanted systemic effects. Research into alternative substances such as soft estrogens—synthetic, non-hormonal molecules that produce local, cutaneous estrogenic effects and are then metabolized to inactive compounds prior to being absorbed into the systemic circulation— suggests that estrogenic-like benefits on aging skin could be harnessed safely, while avoiding the potential pitfalls associated with estrogen use.

Dapsone gel, 7.5% is a topical medication approved for acne in patients aged 12 years and older. Clinical trials have demonstrated the safety and efficacy of once-daily dapsone gel, 7.5% in patients with moderate acne.The objective of this report is to describe the clinical course of 8 patients who participated in a 12-week program using once-daily dapsone gel, 7.5% as monotherapy for acne in a real-world clinical setting.Male and female adults and adolescents with facial acne, representing a broad range of ages, skin phototypes, and ethnicities, and with no prior use of dapsone gel, 7.5% applied the product once daily for 12 weeks as monotherapy for acne. Photographs were taken at baseline and at 12 weeks. The treating dermatologists recorded observations of baseline disease, treatment tolerability, and outcomes. An independent rater assessed Global Acne Assessment Score (GAAS) at baseline and at 12 weeks based on photographs. Patients provided testimonials of their experience with treatment.Acne improvement was evident in the photographs of the 8 patients. Changes in GAAS at week 12 of treatment, as assessed by an independent rater, ranged from 1- to 3-grade improvement from baseline.Photographs, dermatologist reports, and patient commentary in an office-based practice demonstrated that 12 weeks of treatment with only topical dapsone gel, 7.5%, applied once daily, was effective and well tolerated as a stand-alone treatment in 8 patients with facial acne vulgaris, with results that are consistent with the phase 3 pivotal trials. J Drugs Dermatol. 2018;17(6):602-608.

OBJECTIVE: The objective of the study was to evaluate the impact of rosacea on self-perception, emotional, social, and overall well-being and quality of life in individuals with erythematotelangiectatic rosacea (ETR) and papulopustular rosacea (PPR). DESIGN: We distributed a cross-sectional email invitation for participants in the United States to fill out a web-based survey. PARTICIPANTS: We included adults who reported having previously received a diagnosis of erythematotelangiectatic rosacea or papulopustular rosacea. MEASUREMENTS: Questionnaires measured the psychosocial aspects of rosacea, including the Satisfaction With Appearance Scale and modified Satisfaction With Appearance Scale questionnaires, Impact Assessment for Rosacea Facial Redness, Rosacea-Specific Quality-of-Life questionnaire, and RAND 36-Item Short Form Health Survey. The Impact Assessment for Rosacea Facial Bumps or Pimples was administered to the papulopustular rosacea cohort. RESULTS: Six hundred participants enrolled and completed the survey, with most rating their rosacea as mild or moderate (ETR: 95.6%; PPR: 93.7%). In the erythematotelangiectatic rosacea and papulopustular rosacea cohorts, respectively, 45 and 53 percent disagreed/strongly disagreed that they were satisfied with their appearance due to rosacea; 42 and 27 percent agreed/strongly agreed that they “worry how people will react when they see my rosacea”; and 43 and 59 percent agreed/strongly agreed that they feel their rosacea is unattractive to others. Rosacea-Specific Quality-of-Life total and domain scores indicated negative impact of rosacea for both cohorts. Both cohorts reported worse 36-item Short Form Health Survey overall and domain scores than population norms in the United States. CONCLUSION: Rosacea had wide-ranging, negative effects on self-perceptions and emotional, social, and overall well-being as well as rosacea-specific quality of life. Overall, both erythematotelangiectatic rosacea and papulopustular rosacea cohorts reported a substantial negative impact of rosacea on quality of life on a range of instruments.

Hand dermatitis is estimated to affect greater than 15% of the general population. Childhood eczema, frequent hand washing, and occupational exposure to chemicals are predisposing factors. Hand dermatitis treatment involves both prevention of outbreaks and treatment of active disease. Moisturizers are essential to protect the skin from the environment, enhance hydration, and repair the skin barrier. They have been shown in large studies to prevent occupational related breakouts. Natural oils are commonly used in moisturizers for their moisturizing and emollient properties. Sweet almond oil is an oil that contains high levels of fatty acids and has been used for centuries to treat skin diseases such as eczema and psoriasis. In this study, a moisturizer with 7% sweet almond oil and 2% colloidal oatmeal was found to be both safe and effective in treating patients with moderate to severe hand dermatitis.pemJ Drugs Dermatol. 2018;17(1):78-82./em/p.

Lipohydroxy acid is a derivative of salicylic acid with unique properties that explain its clinical effects in the skin. Lipohydroxy acid has skin renewing, exfoliating, and acne treating properties and is a commonly used ingredient in personal skin care products. The slow penetration of lipohydroxy acid results in an individual cell-by-cell exfoliation that is associated with excellent tolerability. Lipohydroxy acid has been shown to induce dermal thickening by stimulating glycosaminoglycans, collagen, and elastin production. Finally, lipohydroxy acid has been demonstrated to possess comedolytic properties. This article reviews the available data on the use of lipohydroxy acid in treating aging skin and acne.

Acne vulgaris (acne) is a common affliction in adolescence and is a growing problem in adult women. Despite an increasing awareness of acne in the adult female population, there is a lack of good prospective studies assessing the severity, distribution, and differential response to treatment in this group. The long-held dogma that acne in adult women develops on the lower one-third of the face has been recently challenged, and here the authors critically review data from available literature. Moreover, while adult female acne has traditionally been defined as disease in women over age 25, it is the authors’ experience that this group is subdivided into women ages 25 to 44 years, separate from perimenopausal patients, ages 45 years and up. While there is no data specifically comparing these two groups, the authors will review the existing data and provide practical recommendations based on our experience in treating these groups of patients. Finally, while there is a lack of data on this subject, it is the group’s opinion that adherence to medication regimens is likely higher in women than men, which influences therapeutic outcomes.

not available.

Onychomycosis is defined as a fungal infection of the nail bed and/or nail plate. The prevalence of onychomycosis has increased dramatically as a worldwide condition in the twentieth century due to occlusive footwear, global wars and natural migration. Risk factors generally leading to onychomycosis development include bodily spread of dermatophyte and non-dermatophyte tinea pedis, peripheral vascular disease, damaged nails via sports and trauma, older age, genetics, immunodeficiency and diabetes. Many publications discuss prevalence, symptoms and treatment of the disease in individual cases, hospitals or specific locations, but few strongly link the cause of onychomycosis to living environments. This is a review of the current literature on the prevalence of onychomycosis and its relationship to surrounding living environments of those infected. A Pubmed search was performed with 'onychomycosis'. Articles were selected based on the relevance to close quarter living environments. All ages can be affected with onychomycosis, ranging from children in boarding schools to elderly in nursing homes. Although not directly linking living environments to transmission and infection in all articles reviewed, onychomycosis was very prevalent in many different close quarter living settings, including within families, boarding schools, military quarters and nursing homes. This review demonstrates that various close quarter living environments are highly associated with increased transmission and infection with onychomycosis.

Antibiotics are commonly used by dermatologists in clinical practice, primarily because of the overall track record of favorable efficacy and safety with the most commonly used agents. During the past decade, increased attention has been given to the problems associated with antibiotic resistance. This article summarizes important principles gleaned from the continued efforts of the Scientific Panel on Antibiotic Use in Dermatology; other groups working diligently in this area, such as the Centers for Disease Control and Prevention and the Canadian Antimicrobial Resistance Alliance; and from the published literature.

The Internet provides both education and miseducation for acne patients. Although some sites provide disease background information and objective treatment guidance, support networks, and research findings, others may seem to be objective on the surface, but are in reality run by untrained, self-proclaimed experts or are promotional in nature. Providers must be aware of the potential benefits and pitfalls the Internet provides for those suffering with acne.

With the rising incidence of diabetes mellitus (DM) in the US, it is of paramount importance that practitioners understand the complications of DM and how best to manage them. Diabetes affects every organ system and the skin is no exception. There are numerous cutaneous manifestations of DM that have similar etiologies and result from the same pathologic mechanisms as the internal complications of this disease state. In addition, skin manifestations may precede the diagnosis of diabetes. The present article reviews both the common and less common cutaneous manifestations of DM, including presenting lesions, pathogenesis, and management.

not available. Disclosures: Study sponsored by Ortho Dermatologics. Copyright 2018 SKIN

Streszczenie Przedmiot Analiza skuteczności i bezpieczenstwa kremu MAS063DP (Atopiclair) w leczeniu lagodnych i umiarkowanych form atopowego zapalenia skory u niemowląt i dzieci. Program badan Stu czterdziestu dwom pacjentom w wieku od 6 miesiecy do 12 lat podawano MAS063DP (n = 72) lub krem placebo (n = 70) 3 trzy razy dziennie na obszarach objetych atopowym zapaleniem skory i miejscach sklonnych do powstania atopowego zapalenia skory. Pierwszorzednym punktem koncowym oceny skuteczności byla ocena globalna przez badających w 22 dniu. Drugorzedne cele to ocena globalna badających w innych punktach czasu, ocene przez pacjentow/opiekunow świądu, początku, czasu trwania ulgi w swedzeniu, rozleglości stanu zapalnego i skali oceny nasilenia, ocena badanych/opiekunow odpowiedzi ogolnej, i zapotrzebowania na lek przynoszący ulge w przypadku zaostrzenia atopowego zapalenia skory. Wyniki Wyniki stosowania Krem MAS063DP byl statystycznie skuteczniejszy (P Wnioski Krem MAS063DP jest skuteczny i bezpieczny jako monoterapia w leczeniu objawow lagodnego i umiarkowanego nasilenia atopowego zapalenia skory u niemowląt i dzieci. (J Pediatr 2008; 152: 854–9).

Vitamin D receptor modulators have been used extensively for years in the treatment of psoriasis. These agents have demonstrated comparable efficacy to mid-potency corticosteroids and have a good safety profile. Vitamin D receptor modulators are useful as single agents and when used in combination, rotational or sequential therapy with other psoriasis treatments. Calcitriol ointment (1α,25-dihydroxyvitamin D3), the naturally occurring, endogenous, biologically active metabolite of vitamin D3, has recently been approved in the United States as the only Vitamin D3 ointment (Vectical™) available for the topical treatment of psoriasis. Two randomized, double-blind, placebo-controlled clinical trials demonstrated the application of calcitriol 3 μg/g ointment twice daily for eight weeks produced significantly greater improvement than did vehicle ointment on physician-rated and patient-rated scores of global psoriasis severity and improvement in psoriasis symptoms from baseline. Long-term clinical trials have demonstrated that twice-daily calcitriol was safe and well-tolerated for one year or longer and that calcium homeostasis was not significantly affected by continuous treatment up to 52 weeks. A direct comparison of calcitriol and calcipotriol [calcipotriene (Dovonex®)] in patients with chronic plaque psoriasis found that the two agents produced generally similar improvements in psoriasis severity but that calcitriol was associated with fewer cutaneous adverse events. A second comparative study that examined calcitriol and calcipotriene for the treatment of psoriasis in sensitive areas found that calcitriol produced significantly less perilesional edema, erythema and stinging/burning than did calcipotriene. Several clinical trials also support calcitriol as part of combination therapy. Topical calcitriol ointment is a new, safe, effective and well-tolerated treatment that offers considerable flexibility in psoriasis care.

Skin aging is a combination of multifactorial mechanisms that are not fully understood. Intrinsic and extrinsic factors modulate skin aging, activating distinctive processes that share similar molecular pathways. One of the main characteristics of youthful skin is its large capacity to retain water, and this decreases significantly as we age. A key molecule involved in maintaining skin hydration is hyaluronic acid (HA). Concentration of HA in the skin is determined by the complex balance between its synthesis, deposition, association with cellular structures, and degradation. HA bio-equivalency and bio-compatibility have been fundamental in keeping this macromolecule as the favorite of the skincare industry for decades. Scientific evidence now shows that topically applied HA is unable to penetrate the skin and is rapidly degraded on the skin surface. SkinMedica's HA5 Rejuvenating Hydrator (SkinMedica Inc., an Allergan company, Irvine, CA) promotes restoration of endogenous epidermal HA homeostasis and provides instant smoothing and hydration of the skin. These dual benefits are accomplished through the combination of 2 breakthrough technologies: 1) a unique blend of actives powered by SkinMedica proprietary flower-derived stem cell extract that restores the endogenous production of HA; and 2) a proprietary mix of 5 HA forms that plump the skin, decreasing the appearance of fine lines/wrinkles. Pre-clinical studies demonstrated that HA5 induces expression of key epidermal differentiation and barrier markers as well as epidermal HA synthases. A decrease expression of hyaluronidases was also observed upon HA5 application. Initial clinical studies showed that within 15 minutes of application, HA5 instantly improves the appearance of fine lines/wrinkles and skin hydration. Subjects that continue using HA5 (for 8 weeks) demonstrated significant improvements in fine lines/wrinkles, tactile roughness, and skin hydration. In summary, the blend of these 2 key technologies present in HA5 promotes restoration of endogenous epidermal HA while delivering instant smoothing effects.

Acne vulgaris (AV) is an inflammatory skin disease characterized by the presence of comedones, papules, pustules, and nodules. Consensus guidelines recommend the use of combination therapy using different drugs with complementary mechanisms of action to best address as many acne pathogenic factors as possible at the same time. Topical acne medications exist as individual agents that may be combined in physician-recommended regimens or as pre-formulated fixed-dose combination products. In addition, there are several new and promising topical therapies currently being developed that work by different mechanisms of action from traditionally used acne therapies. The following review will cover commonly used drugs, newcomers to the market, and what the future holds for the topical treatment of AV.

Onychomycosis is the most common fungal skin infection, and it is frequently seen in the setting of other concomitant fungal infections, the most common being tinea pedis. Infected nails become a reservoir of fungal organisms that may infect the skin, and vice versa. Early, effective treatment of the nails is necessary for preventing not only permanent structural damage but also the spread and superinfection of the surrounding skin and soft tissue. Moreover, treatment of the skin is important for preventing re-infection of the nails.

Dermatophyte infections of the skin and nails are common in the United States. These infections warrant treatment because they are symptomatic and progressive, and can predispose patients to superinfections. Topical drugs such as luliconazole, naftifine, efinaconazole, and tavaborole are newer options for treating these dermatophyte infections with proven safety, efficacy, and ease of use.

For more than a century, solar radiation has been known to contribute significantly to the extrinsic aging of skin. Until recently, this was almost exclusively attributed to the photodamage caused by ultraviolet (UV) light. However, a growing body of evidence now indicates that both infrared (IR) and visible light may also contribute to extrinsic skin aging. Infrared radiation, comprised of IR-A, IR-B, and IR-C, accounts for 54.3% of the total solar radiation reaching the skin. Studies have shown that IR radiation is also responsible for skin aging. Thus, IR-A radiation regulates hundreds of genes in skin, with roles in extracellular matrix (ECM) homeostasis regulation, apoptosis, cell growth, and stress responses. IR-B and IR-C radiation are primarily responsible for the increase in skin temperature associated with solar exposure, and are implicated in heat-related skin destruction of collagen and elastin, which is characterized by an increase in the expression of matrix metalloproteinases (MMPs). The contribution of visible light to photoaging is less well understood; however, some preliminary indication associates visible light with the upregulation of MMPs' expression, DNA damage, and keratinocyte proliferation. Interestingly, the common denominator that links skin damage to the different solar wavelengths is the enhanced production of reactive molecule species (RMS) and therewith increased oxidative stress. SkinMedica® Total Defense + Repair (TD+R; SkinMedica Inc., an Allergan company, Irvine, CA) is a "superscreen," which combines broad spectrum UV protection with a unique blend of antioxidants (SOL-IR Advanced Antioxidant Complex™) that provide protection from IR radiation while promoting skin repair. Preclinical studies have indicated that TD+R SPF34 prevents the formation of UV-induced sunburn cells and cyclobutane pyrimidine dimers while preserving or improving the expression of ECM genes. In addition, it prevents IR-A-triggered fragmentation of elastin fibers and expression of MMP-1. Initial clinical studies indicate that TDR+R SPF34 reduces the increase in surface temperature seen with IR radiation. A significant improvement in the appearance of lines and wrinkles was reported as early as week 2 in patients using TDR+R SPF34. In summary, we observed that the unique blend of antioxidants present in TD+R acts in harmony with SPF active ingredients, expanding solar protection beyond UV radiation and counterbalancing the deleterious effects of free radicals on skin cells by promoting endogenous repair.

Objective: To investigate the efficacy and tolerability of clindamycin phosphate 1.2%/benzoyl peroxide 3.75% gel or vehicle monotherapy in adult female acne patients. Methods: A post hoc analysis in 72 adult female patients (aged ≥25 years) with moderate-to-severe acne receiving clindamycin phosphate 1.2%/benzoyl peroxide 3.75% gel or vehicle for 12 weeks. Results: The efficacy of clindamycin phosphate 1.2%/benzoyl peroxide 3.75% gel was significantly greater than vehicle. The mean percent change from baseline in inflammatory and noninflammatory lesion counts and the percentage of patients who achieved a 2-grade reduction in the Evaluator’s Global Severity Score was 68.7%, 60.4, and 52.7 percent, respectively (P=0.019, 0.020 and 0.074 versus vehicle). In addition, 44 percent of patients reported their acne to be “clear” or “almost clear” at Week 12 (P=0.026 versus vehicle). No substantive differences were seen in cutaneous tolerability among treatment groups, and no patients discontinued treatment because of adverse events. Limitations: It is not possible to determine the contributions of the individual active ingredients, and this study was not set up specifically to investigate the treatment of adult female acne. Conclusion: Clindamycin phosphate 1.2%/benzoyl peroxide 3.75% gel provides statistically significant greater efficacy than vehicle in treating acne in adult female patients and has a favorable safety and tolerability profile.

Lipohydroxy acid is a derivative of salicylic acid with unique properties that explain its clinical effects in the skin. Lipohydroxy acid has skin renewing, exfoliating, and acne treating properties and is a commonly used ingredient in personal skin care products. The slow penetration of lipohydroxy acid results in an individual cell-by-cell exfoliation that is associated with excellent tolerability. Lipohydroxy acid has been shown to induce dermal thickening by stimulating glycosaminoglycans, collagen, and elastin production. Finally, lipohydroxy acid has been demonstrated to possess comedolytic properties. This article reviews the available data on the use of lipohydroxy acid in treating aging skin and acne.

Approximately 20-25% of the population worldwide is affected by superficial cutaneous mycoses (SCM). SCM are cutaneous fungal infections with a wide array of systemic and topical treatment options. However, successful therapeutic outcomes are limited by patient non-adherence, medication side effects, potential drug interactions, antifungal resistance and disease recurrence. Advances in formulation technology have allowed for the development of more effective and safer therapies. In this article we will review several new and emerging pharmacotherapeutics for onychomycosis and tinea pedis.

The human circadian clock ensures that biochemical and physiological processes occur at the optimal time of day. In addition to a central pacemaker in the body, recent evidence suggests that peripheral mammalian tissues also possess autonomous circadian oscillators, which are regulated by genes linked to distinct tissue-specific functions. The skin is situated in a position naturally exposed to diurnal environmental changes. The skin's chronobiological functioning influences skin aging, cell repair and development of skin cancers, as well as optimal timing of drug delivery to the skin. An understanding of circadian skin-related functions and the impact of their disruption allow clinicians to improve therapeutic decision-making and maximize the effectiveness of prescribed treatments.

Cervical cancer is a preventable health problem, yet is the second most common cancer of women worldwide. More than 80% of cases occur in developing countries, and this is expected to increase to 90% by the year 2020. The five-year survival rate of patients in developing countries is less than 50%, compared to 66% in developed nations. A worldwide HPV vaccine program would significantly reduce the spread of HPV 16 and 18 and lower the incidence of cervical cancer. Mathematical models have determined that vaccinating 66% of the population will decrease the incidence of cervical cancer by 80% over the next 40-60 years. For every five-year delay in a cervical cancer prevention/detection program, there will be an additional 1.5-2.0 million deaths. The introduction of a vaccination program will be a challenge due to high costs, unknown durability of the vaccine, and the potential for new oncogenic strains to emerge. A global effort will be required to eliminate cervical cancer from developing counties.

The Psoriasis Area and Severity Index (PASI) is a psoriasis severity measurement tool used by clinicians, which evaluates different regions of the body and rates the corresponding psoriatic lesions based on their level of erythema, induration and scaliness. It is a highly quantitative method that has been used by some insurance companies to establish minimum requirements for approval of the biologic therapeutics alefacept (Amevive), efalizumab (Raptiva) or etanercept (Enbrel) for psoriasis. A large insurance company proposed a minimum PASI score of 10 to justify reimbursement for biologic therapies. However, calculating the PASI score was burdensome. We hypothesized that the method of calculating percentage of body surface area (BSA) affected would be easier and more time-efficient, and thus could serve as a suitable proxy for the PASI score. We analyzed the BSA percentages and corresponding PASI scores in 96 patients whose psoriasis was prospectively graded in clinical trials. We hypothesized that BSAs of 10% to 15% correlated to a PASI of 10, the threshold score for the insurance company to authorize the use of the biologics. Our results show that with a minimum BSA involvement of 13%, only two out of 15 patients had PASI scores less than 10, and both of those patients had PASI scores greater than 9. Like the PASI score, BSA is an imperfect tool for the assessment of psoriasis severity, but it is much easier to use than the PASI score.

Acne vulgaris is a common disease of the pilosebacous unit that affects an estimated 40-50 million Americans. Greater than 95% of teenage boys and between 83% and 85% of teenage girls suffer from acne. The condition frequently continues into adulthood. While boys more commonly suffer from acne in the teenage years, greater numbers of women suffer into adulthood. It is unclear if the number of post-adolescent women with acne is rising as compared to the past, or whether women are now seeking out treatment more than in the past.(4) Post-adolescent acne is a significant problem for women. One survey-based United States study found that approximately 50% of women continue to suffer from acne in their twenties, 35% in their thirties, 26% in their forties, and 15% in their fifties. The prevalence of acne was shown to be higher in women than in men in each of these age groups.(7) A similar study from Europe showed that beyond the age of 23, acne is more prevalent in women than men. In their forties and fifties, 5% and 8% of women suffered from acne, respectively. Several other studies have provided similar data, showing that larger numbers of adult women suffer from acne as compared to age matched men. Acne is the number one reason that patients visit a dermatologist. While the mean age at which patients are seen for acne is 24 years old, 10% of visits occur in patients in their mid-thirties and forties. Approximately two thirds of dermatology visits for acne are made by women, and one-third of total acne office visits are made by women over 25 years old. Acne patients suffer from a significant psychological burden, which has been compared to that of patients with systemic diseases like diabetes, asthma, arthritis, or epilepsy. Up to 50% of adolescents with acne experience disturbances to their psyche, including issues with body image, anxiety, depression, poor self-esteem, social impairment, and thoughts of suicide. Moreover, acne treatment is expensive. The average total cost of care related to an acne patient's visit to the dermatologist is estimated to be $689.(14)

Brooke-Spiegler syndrome (BSS) is an autosomal dominant (AD) inherited syndrome predisposing those affected, to the development of multiple hamartomas/neoplasms derived from skin appendage structures. These tumors include cylindromas, trichoepitheliomas, and spiradenomas. In the setting of BSS, these lesions most often appear as multiple papules or nodules on the head and neck region during adolescence or early adulthood. BSS may be mistaken for the eruption of acne vulgaris [1, 2]. While BSS was initially described as a unique entity, it is now thought to exist as part of a spectrum of AD appendage tumor syndromes allelic for germline mutations within the Cylindromatosis (CYLD) gene. This group includes two other syndromes: familial cylindromatosis (FC) and multiple familial trichoepithelioma (MFT) [2]. As indicated by their name, MFT is characterized by trichoepitheliomas, while FC is characterized by cylindromas [3]. Therefore, MFT and FC represent two ends of a spectrum with BSS falling within the middle [4].

Muir-Torre syndrome (MTS) is a rare, autosomal dominant genodermatosis characterized by sebaceous neoplasms, keratoacanthomas, and visceral malignancies [1, 2]. MTS is a phenotypic subset of hereditary nonpolyposis colorectal cancer (HNPCC) caused by mutations in mismatch repair genes associated with microsatellite instability [3]. Due to the increased risk in developing visceral malignancies, it is important that the proper diagnosis to be made as early as possible and family members be evaluated for MTS and its associated cancers.