Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.

Purpose Combination intranasal corticosteroid and antihistamine sprays are a first-line treatment option for allergic rhinitis (AR), of which Azelastine Hydrochloride and Fluticasone Propionate nasal spray (AZE/FLU; Dymista ® ), and Olopatadine Hydrochloride and Mometasone Furoate Monohydrate nasal spray (OLO/MOM; Ryaltris ® ) are currently registered in Australia. As it is not known how patients value treatment attributes of current combination nasal sprays, this observational, real-world clinical study aimed to understand patients’ satisfaction with, and importance of, treatment attributes of OLO/MOM and AZE/FLU using an Anchored Best-Worst Scaling (ABWS) exercise. Participants and Methods Four hundred and twenty-six adults in Australia with moderate to severe AR using either OLO/MOM or AZE/FLU completed an online survey incorporating an ABWS with 11 domains: 7 sensory (immediate taste of medication, aftertaste of medication, smell of medication, irritation to your nose, urge to sneeze, dripping out your nose/down your throat, dryness of your nose/throat) and 4 treatment-related (convenience, fast acting, duration of effect, and AR symptom control). The ABWS involved rescaling individual BWS scores using anchored ratings (0–10) for most and least satisfied/important domains to create a total satisfaction index (TSI) (0–100) to be compared across groups. Statistical comparisons were completed using ANOVA (TSI) and MANOVA (individual domains). Results Participants using OLO/MOM ( M = 68.26, SE = 1.39) had significantly higher TSI than participants using AZE/FLU ( M =62.78, SE = 0.70) ( p < 0.001), significantly higher satisfaction on 7 of 11 domains and regarded 8 of 11 domains as significantly more important compared to participants using AZE/FLU (all p < 0.05). Preferred domains were predominantly sensory attributes. Conclusion Current findings showed that participants using OLO/MOM were more satisfied with their overall treatment compared to participants using AZE/FLU, particularly with sensory attributes, thus highlighting the suitability of OLO/MOM for people with AR who value sensory attributes. Prescribers of AR treatments are encouraged to discuss treatment attributes with patients to facilitate shared decision-making.

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BACKGROUND Acne vulgaris is a universal skin disease affecting both genders. Acne affects more than 85% of the teenagers as well as some adults and persists in large number of people in their 20s and 30s age. A single-center clinic-based study from a teaching hospital in India reported prevalence of acne among boys and girls between 12-17 years of age as 50.6% and 38.13%, respectively. Combination therapy is an effective approach in the management of acne as it can simultaneously act on several pathogenic mechanisms. The current (2016) European Dermatology Forum (EDF) guidelines recommend combination therapy for all grades of acne as initial treatment. The aim of the study is to evaluate efficacy, safety and patient satisfaction of a bioinnovative fixed-dose combination of adapalene (micronised) 0.1% plus benzoyl peroxide (microencapsulated) 2.5% gel in the treatment of acne. MATERIALS AND METHODS In this prospective survey, acne patients treated with adapalene (micronised) 0.1% plus benzoyl peroxide (microencapsulated) 2.5% for four weeks were enrolled. Grade of acne, investigator global assessment and patient satisfaction scores were noted at baseline, week 2 and week 4. Safety was assessed by recording adverse events and incidence of dryness, erythema or irritation. Global adverse event score was calculated by adding the number of adverse events at week 2 and 4. RESULTS A total of 412 patients with mean duration of acne was 6.98 (5.81) months were enrolled. Number of patients with grade 3 or 4 acne reduced from 202 (49%) at baseline to 73 (17.7%) at week 2 and 31 (7.5%) at week 4, whereas number of patients with grade 1 acne increased from 27 (6.6%) at baseline to 155 (37.6%) after 2 weeks and 277 (67.2%) at 4 weeks (p=0.001, both at 2 and 4 weeks). Number of patients with severe acne reduced from 47 (11.4%) at baseline to 17 (4.1%) after week 2 and 8 (1.9%) after 4 weeks. The improvement in investigator global assessment after treatment at 2 and 4 weeks was statistically significant (p=0.001). After 4 weeks of treatment, 374 (95.6%) patients were either satisfied or more than satisfied. Mean global adverse event score reduced from 2.35 (±2.27) at week 2 to 1.68 (±1.88) after 4 weeks with 28.5% in mean global adverse event score (p=0.001). CONCLUSION Technologically-enhanced formulation of adapalene (micronised) 0.1% plus benzoyl peroxide (microencapsulated) 2.5% is significantly effective and very well tolerated in patients with acne.