Acne vulgaris

Tuchayi, Sara Moradi; Makrantonaki, Evgenia; Gancevičienė, Rūta; Dessinioti, Clio; Feldman, Steven R.; Zouboulis, Christos C.

doi:10.1038/nrdp.2015.29

Cited by 328 publications

(289 citation statements)

References 232 publications

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“…2 Low strength of recommendation. 3 The recommendation for comedonal acne passed with vote of 60% agreement only. 4 Adapalene rather than tretinoin/isotretinoin.…”

Section: Patient Managementmentioning

confidence: 99%

“…In vitro, propionibacteria are mitogenic for T lymphocytes. They induce the release of IL-17A and interferon-γ from CD4-positive T lymphocytes, and thus promote the infl ammatory process in acne lesions [ 3 ] .…”

Section: Pathogenesismentioning

confidence: 99%

“…In addition, various physiological and exogenous factors act as triggers or modulators (Figure 3 ), including androgens, growth factors such as IGF-1, neuroendocrine mediators, propionibacteria, drugs, and Western dietary habits (foods with a high glycemic load, dairy products) [ 2,3,12 ] .…”

Section: Pathogenesismentioning

confidence: 99%

“…Modulators of sebocyte activity include peroxisome proliferator-activated receptors, IGF-1, or neuropeptides such as corticotropin-releasing hormone and alpha-melanocortin [ 3 ] . Neuropeptides provide an explanation for psychological infl uences on disease activity.…”

Section: Pathogenesismentioning

confidence: 99%

“…Acne is a chronic infl ammatory disease of sebaceous follicles [ 1 ] , resulting from a complex interaction of various pathogenetic factors [ 2,3 ] . In Germany and other Western industrialized nations, a majority of the adolescent population is affected.…”

Section: Introductionmentioning

confidence: 99%

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Acne

Degitz

Ochsendorf

2017

J Deutsche Derma Gesell

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Summary Acne is a chronic disease with a high prevalence among adolescents. Key pathogenetic factors (and their clinical correlates) are increased sebum production (seborrhea), follicular hyperkeratosis (comedones), and perifollicular inflammation (papules and pustules). The disease is modulated by a variety of endogenous (androgens, IGF‐1, neuroendocrine factors) and exogenous (Propionibacterium acnes, diet, friction, ingredients of medical or cosmetic topical products) triggers. Acne is associated with high morbidity, and even mild manifestations may potentially cause considerable impairment in quality of life. Effective topical and systemic treatments are available. Optimal therapeutic results require continuous patient management over the course of the entire treatment period as well as adjustment of treatment modalities based on symptoms and disease severity.

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“…2 Low strength of recommendation. 3 The recommendation for comedonal acne passed with vote of 60% agreement only. 4 Adapalene rather than tretinoin/isotretinoin.…”

Section: Patient Managementmentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Acne

Degitz

Ochsendorf

2017

J Deutsche Derma Gesell

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Evaluation of Point-of-Care Decision Support for Adult Acne Treatment by Primary Care Clinicians

Pournamdari

Liu

et al. 2020

JAMA Dermatol

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cne is a chronic inflammatory skin disease that affects more than 85% of adolescents and frequently continues to adulthood. [1][2][3][4] Although there is a high diagnostic concordance for acne between dermatologists and primary care clinicians, acne continues to be a common indication for referral to a dermatologist. 5,6 Although referrals to dermatologists for acne are not discouraged, there are consequences of immediate referral by primary care clinicians who do not provide treatment, including delayed treatment and loss to follow-up. 7 Previous studies have demonstrated the potential of education and treatment algorithms to reduce unnecessary referrals to specialty care in nondermatological disease areas. [8][9][10][11][12] Importantly, these studies support the use of real-time decision-support tools to modify physician behavior and reduce unnecessary referrals, specifically for patients with pediatric scoliosis or constipation being referred to specialists by primary care clinicians. 9,10 Meanwhile, decision-support tools have also been used to improve rates of health screening questions for preventative health and laboratory test orders for monitoring of adverse drug events. 11,12 In dermatology, stepwise treatment algorithms for acne have been proposed, although implementation has been a challenge. [13][14][15] In a previous study, 7 we modeled the effect of algorithm-based acne treatment by primary care clinicians, and demonstrated shared acne care had the potential to decrease the rates of unnecessary appointments, wait time for treatment, no-show rates, and downstream costs associated with acne. Despite these predictions, prospective evaluation of algorithm-based care for acne is lacking. From a societal standpoint, shared care may reduce unnecessary referrals for acne while reallocating resources to improve access to dermato-IMPORTANCE Acne is a common reason for referral to dermatologists from primary care clinicians. We previously modeled the impact of algorithm-based acne care in reducing dermatology referrals, missed appointments, and treatment delays. OBJECTIVE To prospectively evaluate the downstream outcomes following a real-time, algorithm-based electronic decision-support tool on the treatment of patients referred for acne. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study included 260 treatment-naive patients referred to a dermatologist for the chief concern of acne, as well as the referring primary care clinicians, at 33 primary care sites affiliated with Brigham and Women's Hospital from March 2017 to March 2018. INTERVENTIONSWe developed and implemented a decision-support tool into the electronic medical record system at an academic medical center. The algorithm identified patients referred to a dermatologist who had not previously been treated for acne and offered guideline-based recommendations for treatment via a real-time notification. MAIN OUTCOMES AND MEASURES Treatment modification by referring clinicians.RESULTS Of 260 patients referred for acne, 209 (80.4%) were wome...

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Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne

et al. 2020

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IMPORTANCE Acne is a common, multifactorial skin condition, and treatments with novel mechanisms have been elusive. OBJECTIVE To assess the safety and efficacy of clascoterone cream, 1%, a novel topical androgen receptor inhibitor, in 2 phase 3 randomized clinical trials (CB-03-01/25 and CB-03-01/26). DESIGN, SETTING, AND PARTICIPANTS Two identical, multicenter, randomized, vehicle-controlled, double-blind, phase 3 studies conducted from November 2015 to April 2018 evaluated the efficacy and safety of use of clascoterone cream, 1%, in males and nonpregnant females 9 years and older with moderate or severe facial acne as scored on the Investigator's Global Assessment scale. Participants were enrolled if they had 30 to 75 inflammatory lesions and 30 to 100 noninflammatory lesions. INTERVENTIONS Patients were randomized to treatment with clascoterone cream, 1%, or vehicle cream and applied approximately 1 g to the whole face twice daily for 12 weeks. MAIN OUTCOMES AND MEASURES Treatment success was defined as an Investigator's Global Assessment score of 0 (clear) or 1 (almost clear), and a 2-grade or greater improvement from baseline and absolute change from baseline in noninflammatory and inflammatory lesion counts at week 12. Safety measures included adverse event frequency and severity. RESULTS A total of 1440 patients were randomzied in 2 studies. In CB-03-01/25, 353 participants were randomized to treatment with clascoterone cream, 1% (median [range] age, 18.0 [10-58] years; 221 [62.6%] female), and 355 participants were randomized to treatment with vehicle cream (median [range] age, 18.0 [9-50] years; 215 (60.6%) female); in CB-03-01/26, 369 participants were randomized to treatment with clascoterone cream, 1% (median [range] age, 18.0 [10-50] years; 243 [65.9%] female), and 363 participants were randomized to treatment with vehicle cream (median [range] age, 18.0 [range, 11-42] years; 221 [60.9%] female). At week 12, treatment success rates in CB-03-01/25 and CB-03-01/26 with clascoterone cream, 1%, were 18.4% (point estimate, 2.3; 95% CI, 1.4-3.8; P < .001) and 20.3% (point estimate, 3.7; 95% CI, 2.2-6.3; P < .001) vs 9.0% and 6.5% with vehicle, respectively. At week 12, in both CB-03-01/25 and CB-03-01/26, treatment with clascoterone cream, 1%, resulted in a significant reduction in absolute noninflammatory lesions from baseline to −19.4 (point estimate difference, −6.4; 95% CI, −10.3 to −2.6; P < .001) and −19.4 (point estimate difference, −8.6; 95% CI, −12.3 to −4.9; P < .001) vs −13.0 and −10.8 with vehicle, respectively, as well as a reduction in inflammatory lesions from baseline to −19.3 (point estimate difference, −3.8; 95% CI, −6.4 to −1.3; P < .001) and −20.0 (point estimate difference, −7.4; 95% CI, −9.8 to −5.1; P < .001) vs −15.5 and −12.6 with vehicle, respectively. Adverse events rates were low and mostly mild; the predominant local skin reaction was trace or mild erythema. CONCLUSIONS AND RELEVANCE Use of clascoterone cream, 1%, for acne treatment appears to demonstrate favorable efficacy and...

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Acne vulgaris

Cited by 328 publications

References 232 publications

Acne

Acne

Evaluation of Point-of-Care Decision Support for Adult Acne Treatment by Primary Care Clinicians

Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne

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