Light therapies for acne: abridged Cochrane systematic review including
            <scp>GRADE</scp>
            assessments

Barbarić, Jelena; Abbott, Rachel; Posadzki, Paul; Car, Mate; Gunn, Laura H; Layton, Alison; Majeed, Azeem; Car, Josip

doi:10.1111/bjd.15495

Cited by 33 publications

(14 citation statements)

References 54 publications

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“…Long-term improvements up to 1 year have been documented with laser treatments and they need to be explored further in menopausal acne, which is predominantly inflammatory, as they cause minimal side effects 70. However, a recent Cochrane review on light therapies for acne concluded that there is a need for larger studies of better quality to provide evidence of the utility and long-term benefits in acne, particularly considering the cost of laser therapies 71…”

Section: Methodsmentioning

confidence: 99%

<p>Menopausal Acne – Challenges And Solutions</p>

Khunger¹,

Mehrotra²

2019

IJWH

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Although acne is a disease predominant in adolescence, it is being increasingly observed in adult life, including the menopausal period. The etiology of menopausal acne is multifactorial, with hormonal imbalance being the major culprit. There is a relative increase of androgens in the menopausal female that leads to clinical hyperandrogenism manifesting as acne, hirsutism and androgenetic alopecia. Other endocrine disorders including thyroid abnormalities, hyperprolactinemia and insulin resistance also play a role. Genetics, stress, dietary changes, lack of sleep and exercise and other lifestyle changes are implicated as trigger factors. Most menopausal women with isolated few acne lesions have normoandrogenic serum levels and do not require extensive investigations. However, baseline investigations including total testosterone are useful. Patients must also be evaluated for associated comorbidities such as obesity, diabetes, hypertension and dyslipidemia. A detailed history can help to exclude polycystic ovarian syndrome, late-onset congenital adrenal hyperplasia or medications as a cause of acne. The evaluation of menopausal acne and the approach to treatment depend on the severity of acne and associated features. In patients with mild acne without virilization, prolonged topical therapy is the mainstay of treatment. Though combined oral contraceptives are effective, they are relatively contraindicated in the postmenopausal period. Spironolactone is the first choice of therapy in the subset of patients that require oral anti-androgen therapy. Procedural treatment can be useful as it can also help in the treatment of associated acne scars and concomitant skin aging. It is also important to focus on lifestyle changes such as reducing stress, controlling obesity, having a healthy diet, exercise and proper skin care routine to reduce acne. The focus of this article is on the clinical presentation and management challenges of menopausal acne, which represents a special subtype of acne.

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Section: Methodsmentioning

confidence: 99%

<p>Menopausal Acne – Challenges And Solutions</p>

Khunger¹,

Mehrotra²

2019

IJWH

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“…A review of randomized, controlled studies of light-based therapies for acne treatment concluded that none of the studies demonstrated efficacy; it is necessary to carry out well-designed studies that employ standardized outcome measures as well as comparison with usual drug treatments. 114…”

Section: Systemic Treatmentmentioning

confidence: 99%

Adult female acne: a guide to clinical practice

Bagatin

Freitas

Machado

et al. 2019

An. Bras. Dermatol.

113

124

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BackgroundAcne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution.ObjectiveTo develop a guide for the clinical practice of adult female acne.MethodsA team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne.ResultsThe group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne.ConclusionDifferent from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.

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“…Although well-designed studies evaluating the effectiveness of non-pharmacological interventions are lacking, circumstantial evidence suggests that the e cacy of these types of therapy are promising. (11)(12)(13) In addition, Waldman et al (2017) reported an expert consensus on the safety of non-pharmacological treatment modalities in the setting of isotretinoin use.…”

Section: Discussionmentioning

confidence: 99%

Reallocations in Acne Healthcare: Exploring the Possible Roles and Added Value of Non-physicians by a Mixed-Methods Study Design

Vries

Welbie

Tjin

et al. 2021

Preprint

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Background A highly promoted opportunity for optimizing healthcare services is to expand the role of non-physician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to non-physicians and identify drivers for and barriers to reallocation. Methods A mixed-method design was used combining quantitative and qualitative data. 224 questionnaires were completed and 24 semi-structured interviews were conducted.Results A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusion Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.

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Light therapies for acne: abridged Cochrane systematic review including GRADE assessments

Cited by 33 publications

References 54 publications

<p>Menopausal Acne – Challenges And Solutions</p>

<p>Menopausal Acne – Challenges And Solutions</p>

Adult female acne: a guide to clinical practice

Reallocations in Acne Healthcare: Exploring the Possible Roles and Added Value of Non-physicians by a Mixed-Methods Study Design

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