Topical retinoids in acne--an evidence-based overview
Journal der Deutschen Dermatologischen Gesellschaft (Impact Factor: 1.4). 01/2008; 6(12):1023-1031. DOI: 10.1111/j.1610-0387.2008.06741.x
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ABSTRACT: Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.American Journal of Clinical Dermatology 10/2012; 13(5):331-40. · 2.52 Impact Factor
Article: Adult female acne: a new paradigm.[Show abstract] [Hide abstract]
ABSTRACT: In the adult female, acne is a chronic condition with a substantial negative psychological, social and emotional impact. Based on time of onset, two subtypes of adult female acne are recognized: 'persistent acne' is a continuation of the disease from adolescence, while 'late-onset acne' first presents in adulthood. The morphological characteristics of adult female acne are often distinct from adolescent acne. In adults, inflammatory lesions (particularly papules, pustules and nodules) are generally more prominent on the lower chin, jawline and neck, and comedones are more often closed comedones (micro cysts). Adult acne is mainly mild-to-moderate in severity and may be refractory to treatment. A holistic approach to acne therapy should be taken in adult females, which combines standard treatments with adjunctive therapy and cosmetic use. A number of factors specific to the adult female influence choice of treatment, including the predisposition of older skin to irritation, a possible slow response to treatment, a high likelihood of good adherence, whether of child-bearing age, and the psychosocial impact of the disease. Adherence to therapy should be encouraged through further patient education and a simplified regimen that is tailored to suit the individual patient's needs and lifestyle. This article reviews the specific characteristics of adult female acne, and provides recommendations for acne therapy in this patient group.Journal of the European Academy of Dermatology and Venereology 01/2013; · 2.69 Impact Factor
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ABSTRACT: Retinoids are compounds, which show the activity of vitamin A. Both naturally occurred (retinol, ratinaldehyde, retinoic acid) and synthetic (eg. acitretin, adapalene, tazarotene, bexarotene) compounds belong to this group. They show their activity through nuclear receptors which bind to DNA in promoter regions of genes regulated by retinoids. Some of them are ligands of the receptors while other need to be metabolized to active derivatives. Naturally occurred in the organism retinoids take part in such processes as proliferation and differentiation of cells, reproduction, maintenance of epithelial tissue, immune function and vision (retinaldehyde). Considering their mechanism of action they are used in the therapy of various disorders like acne, psoriasis or neoplasms. They can be administered orally (acitretin) or topically (alitretinoin, motretinide, adapalene, tazatorene) and some of them both routes (tretinoin, isotretinoin, bexarotene). They are also active constituents of cosmeceuticals. The usage of retinoids is limited by adverse effects caused by them to which belong teratogenicity, mucocutaneous and skeletal toxicity.Farmacja polska 07/2014; 66(3):187-192.
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