Management of acne: Canadian clinical practice guideline

Asai, Yuka; Baibergenova, Akerke; Dutil, Maha; Humphrey, Shannon; Hull, Peter; Lynde, Charles; Poulin, Yves; Shear, Neil H.; Tan, Jerry; Toole, John; Zip, Catherine

doi:10.1503/cmaj.140665

Cited by 75 publications

(86 citation statements)

References 35 publications

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“…This last time point was chosen for reporting treatment efficacy to ensure that comparisons were made only during periods of active treatment. Based on this point of comparison, all trials reported clinically relevant (> 10%) reductions in lesion counts with use of isotretinoin (Table ). In addition, superior treatment efficacy of isotretinoin vs. control (> 10% difference, Table ) was found in all trials, with seven of 11 trials showing statistical significance.…”

Section: Resultsmentioning

confidence: 99%

“…χ 2 ‐Tests were used to compare percentage changes in primary outcome measures between isotretinoin and control groups (α = 0·05). To establish the clinical relevance of statistical tests, the recommendation from the Canadian clinical practice guideline on acne was used, where clinical relevance is defined as a reduction in acne lesion counts by > 10% …”

Section: Methodsmentioning

confidence: 99%

“…In cases of severe nodulocystic and papulopustular acne, oral isotretinoin is often prescribed as a first‐line treatment, potentially resulting in cure of disease . Recent Canadian, American and European clinical practice guidelines have suggested that isotretinoin should be used for management of moderate‐to‐severe acne …”

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confidence: 99%

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Efficacy and adverse events of oral isotretinoin for acne: a systematic review

et al. 2017

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SummaryDespite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking. We searched MED-LINE, Embase, Cochrane Central, relevant web pages and bibliographies for randomized controlled trials in acne evaluating isotretinoin vs. control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total 760 patients randomized), containing mostly men. Mean treatment ages ranged from 18 to 47Á9 years and participants generally had moderate-to-severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which was either placebo (two studies), oral antibiotics (seven studies) or other control (two studies). Across trials with an overall low risk of bias, two of three demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (751 events) than with control (388 events). More than half of all adverse events were dermatological and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (12 patients) included Stevens-Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. This study was registered with PROSPERO number CRD42015025080.What's already known about this topic?• Isotretinoin is used for management of moderate-to-severe acne.• It is considered effective and generally safe, although a comprehensive review of evidence from randomized controlled trials has not been performed. What does this study add?• This study reviewed evidence from randomized controlled trials to assess the efficacy and safety profile of isotretinoin for treatment of acne.• It was found that isotretinoin was superior to placebo and other therapies in reducing acne lesion counts; however, isotretinoin also had far more adverse events.• While these adverse events were generally mild and dryness related, severe adverse events requiring participant withdrawal occurred in 3Á2% of patients randomized to isotretinoin.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Efficacy and adverse events of oral isotretinoin for acne: a systematic review

et al. 2017

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“…Both types of medications are widely used to treat acne vulgaris and other skin conditions . Isotretinoin (13‐ cis ‐retinoic acid) is the first‐line treatment for intransigent and debilitating acne vulgaris . The caveat to using isotretinoin is that it is known to trigger depressive symptoms, psychosis, suicidal ideation, and suicide, but there are conflicting views on this matter .…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman

et al. 2018

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This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.

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“…41 Isotretinoin (13-cis-retinoic acid) is the first-line treatment for intransigent and debilitating acne vulgaris. 42 The caveat to using isotretinoin is that it is known to trigger depressive symptoms, psychosis, suicidal ideation, and suicide, 43 but there are conflicting views on this matter. [44][45][46] Despite these contradicting viewpoints, the possible iatrogenic effect of isotretinoin has been noted in the present study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Depressive Symptoms Among Attendees of a Tertiary Care Dermatology Clinic in Muscat, Oman

Al‐Alawi¹

2018

Preprint

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Background Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations.Objectives The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinicaldemographic factors associated with depressive symptoms.Methods A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs).Results A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27-39.05, P = 0.002; OR = 2.0, 95% CI: 1.2-3.21, P = 0.05; OR = 2.28, 95% CI: 1.09-4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08-7.19, P = 0.035, respectively).Conclusion This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression. for Ethical Human Research, which included confidentiality and data management. 26 The local internal review board (IRB), the research committee of Al Nahdha Hospital, approved this study (MH/ANH/RC/12/2016). Declaration of Helsinki

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Management of acne: Canadian clinical practice guideline

Cited by 75 publications

References 35 publications

Efficacy and adverse events of oral isotretinoin for acne: a systematic review

Efficacy and adverse events of oral isotretinoin for acne: a systematic review

Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman

Prevalence and Predictors of Depressive Symptoms Among Attendees of a Tertiary Care Dermatology Clinic in Muscat, Oman

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