Alan R. Shalita's research while affiliated with State University of New York and other places

Publications (90)

Article
Background/objectives: Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for...
Article
Background: Inflammatory acne, particularly in post-adolescent women, is increasing in incidence. The most effective therapeutic modality for treatment of this type of acne has been the administration of oral tetracyclines. Long-term acne treatment with such drugs, however, is frequently accompanied by undesirable adverse reactions, including gast...
Article
Acne treatment regimens have changed due to the recent over-the-counter (OTC) switch of all prescription benzoyl peroxide (BPO) topical preparations. The elimination of prescription single-agent BPO products means that dermatologists must select from a variety of OTC formulations to utilize the time-tested efficacy of BPO in the treatment of mild t...
Article
There are many proposed non-antimicrobial actions of tetracyclines. Pathways affected by these medications are often overexpressed in various dermatologic conditions. Matrix metalloproteinases (MMPs) are enzymes best known for breaking down connective tissue proteins and are upregulated in conditions involving dermal destruction. Inhibition of MMPs...
Article
Acne vulgaris can cause both physical and emotional scarring. Effective treatment requires an understanding of acne pathogenesis and the key elements of keratinocyte differentiation and comedone formation, sebum production, colonization with Propionibacterium acnes (P. acnes) and subsequent inflammation. Addressing issues of compliance is critical...
Article
This 16-week study evaluated once-daily tazarotene 0.1% cream and adapalene 0.3% gel in patients with moderate-to-severe acne. Patients treated with tazarotene 0.1% cream performed better in many acne efficacy measures (reduction in lesion counts, percentage of patients achieving a 50 percent lesion count reduction, overall disease severity, invest...
Article
To evaluate the safety and efficacy of dapsone gel 5% in the treatment of acne when used in combination with adapalene gel 0.1%, benzoyl peroxide gel 4% or moisturizer. This was a twelve-week, randomized, double-blind study. Patients aged 12 years and older (n=301) applied dapsone gel twice daily and were randomly assigned (1:1:1) to one of three a...
Article
Full-text available
Objective. To evaluate the clinical benefit in adolescents of a three-step acne system containing solubilized benzoyl peroxide. Design. Patients in this multicenter, investigator-blind trial were randomly assigned to receive 10 weeks of treatment with either the three-step acne system for normal-to-oily skin (proprietary 2% salicylic acid cleanser...
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Full-text available
A 3-step acne system has been developed to enhance the bioavailability and follicular penetration of benzoyl peroxide (BPO). Participants with mild to moderate facial acne vulgaris were randomly assigned to 10 weeks' facial treatment with the 3-step acne system (proprietary salicylic acid cleanser 2% twice daily, proprietary salicylic acid toner 2%...
Article
Topical clindamycin has been accepted as being effective, safe and well tolerated in the treatment of acne for decades. Topical clindamycin comes in various vehicles, including gel, lotion, solution and foam. Choosing the proper vehicle is dependent on patient preference, tolerability and application site. Widespread usage of topical antibiotics ha...
Article
CONCLUSIONS The 3-step acne system is an effective antibiotic-free approach to the treatment of acne. Compared with a combination BPO/clindamycin product, the acne system is at least as effective in reducing the non- inflammatory lesion count and may enhance the speed at which these lesions are reduced. The acne system also demonstrates comparable...
Chapter
Retinoids that include the natural and synthetic derivatives/metabolites of vitamin A as well as its functional analogs [i.e., chemicals that bind to retinoic acid receptors (RARs)], have been shown to exert multiple and profound effects on diverse bio logical systems (see Chapters 1 and 4). The effects of synthetic retinoids on epithelial cell pro...
Article
Topical retinoids offer highly effective treatment for both inflammatory and non-inflammatory acne, with tazarotene demonstrating greater efficacy than other topical retinoids. A multicenter, double-blind, randomized, parallel-group trial has been performed to evaluate whether the adjunctive use of clindamycin/benzoyl peroxide could enhance the eff...
Article
A multicenter, double-blind, randomized, parallel-group trial compared tazarotene 0.1% cream with adapalene 0.1% cream, once daily for 12 weeks, in 173 patients with facial acne vulgaris. Tazarotene was associated with a significantly greater incidence of patients achieving 50% or greater global improvement (77% vs. 55%, P < or = .01), and a signif...
Article
Despite published data showing the efficacy of topical retinoids in treating inflammatory acne, in clinical practice topical retinoids tend to be used most commonly for noninflammatory acne. The goal of this study was to assess the efficacy of topical retinoids as monotherapy in inflammatory acne. This retrospective, investigator-blinded,vehicle-co...
Article
Results of clinical trials have shown that tazarotene cream used as monotherapy effectively reduces the number of both inflammatory and noninflammatory lesions in patients with acne vulgaris. The efficacy of tazarotene cream in clinical practice, however, has not been reported. To evaluate the benefits of tazarotene cream in everyday clinical pract...
Article
A photographic analysis was conducted of results from a randomized, double-blind, vehicle-controlled, 12-week study that assessed the efficacy of topical benzoyl peroxide 5%/clindamycin 1% (BP/C) gel (BenzaClin) versus vehicle in the treatment of rosacea. The objective was to compare the baseline and end-of-treatment photographs of patients treated...
Article
Excessive sebum production is a central aspect of the pathophysiology of acne vulgaris. Sebaceous gland function is under androgen control and it is hypothesized that dihydrotestosterone is formed by the action of 5 alpha-reductase. Type I is the controlling isoenzyme. This study describes a 3-month, multicenter, randomized, placebo-controlled clin...
Article
The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physic...
Article
All effective agents used to treat rosacea have a common mechanism of action: anti-inflammatory effects. Concomitant with this, many of these agents also show antioxidant effects. Both anti-inflammatory and antioxidant effects may address the proposed underlying pathophysiology of rosacea. Future topical formulations may involve the combination of...
Article
Acne is a multifactorial disease in which androgens appear to play an important role. A low-dose oral contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel (EE/LNG) has been shown to improve biochemical markers of androgenicity. Lowering bioavailable androgens may improve acne. The aim of this study was to evaluat...
Article
This article will review the rationale for early use of topical retinoids alone or in combination with topical antimicrobials in light of the pathogenesis of microcomedones and later lesions. Knowledge of the pathogenic processes in acne vulgaris has risen dramatically over the last three decades. It is now widely accepted that acne is the result o...
Article
Retinoids reverse the abnormal pattern of keratinization seen in acne vulgaris. Tazarotene is the first of a novel family of topical receptor-selective acetylenic retinoids. This study evaluates the safety and efficacy of topical tazarotene 0.1% and 0.05% gels, in comparison to vehicle gel, applied once daily for 12 weeks, in the treatment of mild-...
Article
Finasteride, a specific inhibitor of type II 5alpha-reductase, decreases serum and scalp dihydrotestosterone and has been shown to be effective in men with vertex male pattern hair loss. This study evaluated the efficacy of finasteride 1 mg/day in men with frontal (anterior/mid) scalp hair thinning. This was a 1-year, double-blind, placebo-controll...
Article
Adapalene is a new chemical entity that exhibits tretinoin-like activities in the terminal differentiation process. We evaluated a dose range effect of two concentrations of adapalene gel as acne treatment and compared adapalene 0.1% gel with tretinoin 0.025% gel in the treatment of acne patients in two large multicenter studies. Multicenter, inves...
Article
Full-text available
Background: Oral isotretinoin (Roaccutane) revolutionized the treatment of acne when it was introduced in 1982. Methods: Twelve dermatologists from several countries with a special interest in acne treatment met to formally review the survey of their last 100 acne patients treated with oral isotretinoin. The primary purpose of the survey was to...
Article
Adapalene is a new synthetic retinoid analogue developed for the topical treatment of acne vulgaris. The study was designed to compare the efficacy and safety and adapalene gel 0.1% with tretinoin gel 0.025% in the treatment of grade II to II facial acne vulgaris. Three hundred twenty-three patients were enrolled in this investigator-masked, random...
Article
Effective methods of fungal treatment involve reduction in fungal infections and host inflammatory responses. Naftifine (NF), a topical antifungal agent, is highly active in vitro and in vivo against a wide range of pathogenic fungi. Additionally NF has been shown to inhibit polymorphonuclear leukocyte (PMN) chemotaxis and respiratory burst activit...
Article
Terbinafme (TB, SF86-327), a synthetic allylamine, is a broad-spectrum, orally active antifungal. Cytospin data showed that TB-treated (10-50 ug/ml for 30 min at 37 °C) human polymorphonuclear leukocytes (PMNs) displayed nuclear rounding with loss of lobulations and a reduction in the cytoplasmic to nuclear ratio. Similar cytoplasmic to nuclear rat...
Article
Systemic and topical antimicrobials are effective in the treatment of inflammatory acne vulgaris; however, widespread use of these agents is becoming increasingly associated with the emergence of resistant pathogens raising concerns about microorganism resistance and highlighting the need for alternative nonantimicrobial agents for the treatment of...
Article
Neonatal lupus erythematosus (NLE) is an uncommon disease that is manifested by cutaneous lesions, cardiac conduction defects, or both, that appear in utero or shortly after birth. In approximately 95% of patients, anti-Ro antibody (Ro[SS-A]) has been identified and has become the serologic marker for NLE. Since 1987 there have been four reported c...
Article
Scabies is a common infestation for patients of all ages throughout the world. One of the standard therapies for scabies is 1% lindane lotion. Lindane has been associated with neurotoxic reactions, specifically seizures. We describe a case of a middle-aged adult man with human immunodeficiency virus (HIV) infection who was found to have typical sca...
Article
Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. The present study utilized a new questionnaire designed to assess the type and degree o...
Article
Background. Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. Methods. The present study utilized a new questionnaire designed to assess...
Article
Naftifine (NF), a topical antimycotic agent, is highly active in vitro and in vivo against a wide range of pathogenic fungi. NF inhibits human polymorphonuclear leucocyte (PMN) chemotaxis. Following stimulation with zymosan-activated serum, 85-97% of the PMNs exhibited detectable membrane ruffling and polarity. In contrast, NF-treated PMNs did not...
Article
Topical retinoids have been employed in dermatology since the 1960s to treat a wide variety of cutaneous disorders. This review focuses on three areas in which retinoids have had their greatest impact: acne vulgaris, photoaging and cutaneous neoplasia. The pharmacology of the available topical retinoids, their mechanism of action and the history of...
Article
Summary Antibiotic resistance of the resident cutaneous bacterial flora is a well recognized consequence of systemic antibiotic therapy. In this study, we followed the development of antibiotic resistance of coagulase-negative staphylococci (CNS), the most numerous aerobic bacteria found on the skin surface, during treatment with three topical anti...
Article
Relatively few persons with obsessive-compulsive disorder (OCD) come to psychiatric clinics for treatment. Our hypothesis was that patients with a form of OCD that involves compulsive hand and body washing might initially seek treatment from a dermatologist. Our purpose was to screen patients attending a dermatology clinic to determine the frequenc...
Article
Acne vulgaris is a multifactorial disease involving abnormalities in follicular keratinization, sebum production, proliferation of Propionibacterium acnes, and inflammation. Treatment is directed toward reversing these underlying pathogenic factors. Therapeutic options include topical comedolytics, topical and systemic antibiotics, hormonal manipul...
Article
Isotretinoin (13-cis-retinoic acid) remains the drug of choice for treatment of severe, recalcitrant nodulocystic acne that is unresponsive to conventional therapy, including oral antibiotics. The drug has been shown to produce dramatic clearing of lesions and prolonged remissions. The length of remission may be dependent on both the dosage used an...
Article
Isotretinoin, a drug used for the treatment of acne, has been shown to have teratogenic effects. We report an additional case of isotretinoin teratogenicity in which the patient had agenesis of the cerebellar vermis, multiple leptomeningeal neuroglial heterotopias, hydrocephalus, and abnormalities of the corticospinal tracts. These findings are rel...
Article
One hundred two patients with mild to moderate facial acne vulgaris completed a 12-week, investigator-masked, randomized, parallel-group comparison of a gel formation of erythromycin (2%) with clindamycin phosphate 1% solution. Patients were evaluated at a baseline visit and after 4, 8, and 12 weeks of twice-daily treatment. Both medications signif...
Article
Acne vulgaris is a disorder of sebaceous follicles that usually begins at the time of the sharp increase in androgen production that occurs in adolescence. This disease is most prevalent among teenagers, but it does occur in patients in their twenties and thirties. Three major areas of pathophysiology have been identified in acne: hyperkeratinizati...
Article
The effect of isotretinoin on the chemotaxis of human monocytes was studied in an in vitro system using a Nucleopore chamber. The chemoattractant used was zymosan-activated serum. Inhibition of monocyte chemotaxis was achieved with isotretinoin in concentrations of 1 X 10(-3) M and 5 X 10(-4) M. It is felt that the improvement seen in patients with...
Article
Full-text available
The immunological adjuvant, Propionibacterium acnes (formerly classified as Corynebacterium parvum) is believed to be the major factor in the etiology of inflammatory acne (IA). We have previously reported defective phagocytosis of P. acnes by neutrophils in some patients with IA. In attempting to elucidate this phenomenon we undertook the present...
Article
Two hundred eight patients completed a 12-week, multicenter, double-blind, controlled study comparing a 2% erythromycin ointment to its vehicle. Patients were evaluated by inflammatory lesion counts and Cook acne severity grade at the initial visit and at weeks 2, 4, 8, 10, and 12. The 2% erythromycin ointment proved to be statistically more effect...
Article
One hundred fifty patients with treatment-resistant nodulocystic acne were entered into a double-blind clinical study. Three different dosing levels (0.1, 0.5, 1.0 mg/kg/day) were used in equal-sized groups. In addition to the clinical response, the clinical side effects, the laboratory abnormalities, and the duration of the induced remissions were...
Article
One hundred sixty-five subjects completed a 10-week, double-blind controlled study comparing the following: (1) a combination of 3% erythromycin and 5% benzoyl peroxide in a gel, (2) 5% benzoyl peroxide gel, (3) 3% erythromycin gel, and (4) the gel vehicle. The benzoyl peroxide gel and the erythromycin gel were superior to the control gel; however,...
Chapter
The introduction of isotretinoin for the treatment of severe, recalcitrant nodulocystic acne has dramatically altered the management of this troublesome and disfiguring disease. Not only has one been able to achieve remarkable improvement in patients with severe inflammatory acne, but also prolonged remissions have been observed in patients treated...
Article
In the one year since isotretinoin has been available in the United States for the treatment of severe, recalcitrant, nodulocystic acne, there has been extensive clinical verification of the reports of its dramatic efficacy in the treatment of this troublesome disease. Proper selection of patients, as well as treatment with adequate doses of drug f...
Article
The skin manifestations associated with boric acid intoxication are particularly striking. We present a case report of a 44-year-old black woman who, following a suicide attempt, demonstrated the classic features of acute boric acid poisoning. She developed generalized erythema creating a "boiled lobster" appearance with massive areas of desquamati...
Article
Isotretinoin (13-cis-retinoic acid) was compared with the aromatic retinoid, etretinate, in patients with severe nodulocystic acne. Evaluation of fifty-six such men receiving 1 mg/kg of one or the other of these two drugs was performed with regard to clinical improvement and change in sebum production. Lesion counting demonstrated a significant imp...
Article
The chemoattraction of Propionibacterium acnes lipase for neutrophils and the effect of lipase inhibitor and two antibiotic agents on the chemotaxis were evaluated. Of the various fractions tested, partially purified lipase (fraction 2c) was the most active cytotaxin produced by P. acnes. Serum mediators were not required for the generation of chem...
Article
We evaluated the effectiveness of 2% erythromycin and its alcohol/propylene glycol vehicle in the treatment of three hundred forty-eight patients with inflammatory acne vulgaris. A significantly greater reduction was noted in the papulopustule count for the erythromycin-treated group compared to the vehicle-treated group. Additionally, clinical imp...
Article
The contents of acne lesions from 30 men with inflammatory acne vulgaris, obtained before and at the conclusion of 4 weeks of topical 2% erythromycin therapy, were cultured on aerobic and anaerobic plates. Sensitivity testing of cultures was performed with discs containing 50 mg erythromycin, in order to ascertain the prevalence of erythromycin-res...
Article
Thin-layer chromatography and infrared reflectance spectroscopy were compared as methods for measuring sebum composition. Solutions of varying known concentrations of free fatty acids and triglycerides were analyzed by both methods. Skin surface lipid samples were similarly analyzed. Infrared spectroscopy produced more variable data than thin-layer...
Article
Porphyrin production by Propionibacterium acnes and that by Propionibacterium granulosum were compared. Porphyrin synthesized by both organisms was identified as coproporphyrin III on the bases of absorption and fluorescence spectra and behavior on paper chromatography and thin-layer chromatography. Quantitative, rather than qualitative, difference...