Acne vulgaris is a chronic inflammatory disease of pilosebaceous follicles commonly affecting adolescents and young adults. This disease has a profound psychological impact on affected individuals and treatment has been shown to significantly improve both self-esteem and quality of life. Isotretinoin is an effective medication used primarily in severe cystic acne patients. Over the past 30 years, this medication has revolutionized the treatment of acne. However, despite its popularity there are numerous side effects associated with its use. Most of its side effects are predictable and dose dependent, which has led to the development of variable dose regimens. Unfortunately, rare but significant side effects (e.g., depression, inflammatory bowel disease) do occur and necessitate careful monitoring to improve clinical outcomes and minimize potential adverse events.

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A majority of patients preferred same-day preoperative consultation and surgery. Tumor size and prior complications should be considered in preoperative planning for dermatologic surgery.

BackgroundIngenol mebutate gel is a topical field treatment for actinic keratosis (AK). The treatment elicits application-site reactions in most patients. This analysis evaluated the relationship between the severity of reactions and the speed of their resolution.MethodsPatients in Phase III studies were treated for AKs on the face (n=218), scalp (n=56), and trunk and extremities (n=209). All of the patients were treated with either ingenol mebutate gel 0.015% once daily for three consecutive days (face/scalp) or ingenol mebutate gel 0.05% once daily for two consecutive days (trunk/extremities). Local skin reactions (LSRs) were assessed on a 5-point scale from 0 to 4 in six categories, yielding composite scores in the range of 0 to 24.ResultsThe composite LSR score on the day after the last application of ingenol mebutate gel was an important predictor of the speed of resolution of LSRs. The rate of resolution was greatest for AKs treated on the face, followed by the scalp, and then the trunk and extremities. All patients were expected to have minimal LSR scores for the face and scalp at 2 weeks, and for the trunk and extremities at 4 weeks.ConclusionThe absolute reduction in LSR scores was proportional to the composite LSR score on the day after the last application of ingenol mebutate gel treatment. The rate of resolution for LSRs was dependent on the anatomic site treated as well as the day 4 composite score.

Psoriasis is a chronic, multisystem autoimmune disease that has affected over 7.5 million Americans to date. The annual cost of psoriasis in the United States is $5,508/patient per year. These patients typically incur greater health care costs compared to the general population, especially those patients with more extensive disease. This rise in health care costs is largely due to the increasing expense of new therapies such as biologics. Biologics have revolutionized psoriasis treatment, but the lack of generic alternatives has made this medication very expensive. Further limiting the accessibility of biologics is the overwhelmingly restrictive nature of health insurance policies. Practices such as tiered cost-sharing, high out-of-pocket costs, step-therapy, coverage gaps, rigid preauthorization policies, and burdensome re-authorization policies have obstructed access to biologic therapies. These barriers have not only made biologic therapy unattainable for most patients but have delayed treatment resulting in inadequate care.