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RMD Open Dec 2023Synovitis acne pustulosis hyperostosis osteitis (SAPHO) is a rare heterogeneous disease of unknown aetiopathology. Externally validated and internationally agreed... (Review)
Review
BACKGROUND AND OBJECTIVES
Synovitis acne pustulosis hyperostosis osteitis (SAPHO) is a rare heterogeneous disease of unknown aetiopathology. Externally validated and internationally agreed diagnostic criteria or outcomes and, as a result, prospective randomised controlled trials in SAPHO are absent. Consequently, there is no agreed treatment standard. This study aimed to systematically collate and discuss treatment options in SAPHO.
METHODS
Following 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' guidance, a systematic literature search was conducted using PubMed, Scopus and Web of Science databases. Prospective clinical studies and retrospective case collections discussing management and outcomes in SAPHO involving five or more participants were included. Articles not published in English, studies not reporting defined outcomes, and studies solely relying on patient-reported outcomes were excluded.
RESULTS
A total of 28 studies (20 observational, 8 open-label clinical studies) reporting 796 patients of predominantly European ethnicity were included. Reported therapies varied greatly, with many centres using multiple treatments in parallel. Most patients (37.1%) received non-steroidal anti-inflammatory drugs alone or in combination. Bisphosphonates (22.1%), conventional (21.7%) and biological (11.3%) disease-modifying antirheumatic drugs were the next most frequently reported treatments. Reported outcomes varied and delivered mixed results, which complicates comparisons. Bisphosphonates demonstrated the most consistent improvement of osteoarticular symptoms and were associated with transient influenza-like symptoms. Paradoxical skin reactions were reported in patients treated with TNF inhibitors, but no serious adverse events were recorded. Most treatments had limited or mixed effects on cutaneous involvement. A recent study investigating the Janus kinase inhibitor tofacitinib delivered promising results in relation to skin and nail involvement.
CONCLUSIONS
No single currently available treatment option sufficiently addresses all SAPHO-associated symptoms. Variable, sometimes descriptive outcomes and the use of treatment combinations complicate conclusions and treatment recommendations. Randomised clinical trials are necessary to generate reliable evidence.
Topics: Humans; Acquired Hyperostosis Syndrome; Osteitis; Retrospective Studies; Prospective Studies; Synovitis; Hyperostosis; Acne Vulgaris; Diphosphonates
PubMed: 38151265
DOI: 10.1136/rmdopen-2023-003688 -
Antioxidants (Basel, Switzerland) Jul 2023Skin conditions are a significant cause of fatal and nonfatal disease burdens globally, ranging from mild irritations to debilitating diseases. Oxidative stress, which... (Review)
Review
Skin conditions are a significant cause of fatal and nonfatal disease burdens globally, ranging from mild irritations to debilitating diseases. Oxidative stress, which is an imbalance between reactive oxygen species and the cells' ability to repair damage, is implicated in various skin diseases. Antioxidants have been studied for their potential benefits in dermatologic health, but the evidence is limited and conflicting. Herein, we conducted a systematic review of controlled trials, meta-analyses, and Cochrane review articles to evaluate the current evidence on the utility of antioxidant supplementation for adjunct prevention and treatment of skin disease and to provide a comprehensive assessment of their role in promoting dermatologic health. The Cochrane Library, PubMed, EMBASE, and Epistemonikos databases were queried. Eligibility criteria included (1) primary focus on nanoparticle utility for skin cancer; (2) includes measurable outcomes data with robust comparators; (3) includes a number of human subjects or cell-line types, where applicable; (4) English language; and (5) archived as full-text journal articles. A total of 55 articles met the eligibility criteria for the present review. Qualitative analysis revealed that topical and oral antioxidant supplementation has demonstrated preliminary efficacy in reducing sunburns, depigmentation, and photoaging. Dietary exogenous antioxidants (namely vitamins A, C, and E) have shown chemopreventive effects against skin cancer. Antioxidant supplementation has also shown efficacy in treating non-cancer dermatoses, including rosacea, psoriasis, atopic dermatitis, and acne vulgaris. While further studies are needed to validate these findings on a larger scale, antioxidant supplementation holds promise for improving skin health and preventing skin diseases.
PubMed: 37627498
DOI: 10.3390/antiox12081503 -
Skin Health and Disease Aug 2023Acne is very common, can cause considerable negative impact on quality of life and there is increasing concern over the use of long courses of oral antibiotics for this...
BACKGROUND
Acne is very common, can cause considerable negative impact on quality of life and there is increasing concern over the use of long courses of oral antibiotics for this condition.
OBJECTIVES
(1) To critically appraise reporting in acne guidelines and compare this with previous systematic review of acne guidelines. (2) Examine acne treatment guidance on pre-specified acne treatments of interest and compare between acne guidelines.
METHODS
Searches for new or updated guidelines were carried out in MEDLINE, Embase, Google Scholar, LILACS from 1 January 2017 to 31 July 2021, supplemented by searching a guideline-specific depository and checking for updates to guidelines included in previous review. We included guidelines, consensus statements or care protocols on the medical treatment of acne vulgaris in adults and/or children and excluded those that focused on a single intervention or subgroup of acne, regional adaptations of guidelines or guidelines included in previous review. AGREE II checklist was applied to critically appraise reporting of guidelines. Results were synthesised narratively.
RESULTS
Of 807 abstracts identified nine guidelines were identified that were eligible for inclusion. All guidelines had AGREE II scores above average in at least one domain and reporting was substantially improved compared to the systematic review of acne carried out 5 years previously. There was consensus between guidelines on the key role of topical treatments as first-line acne treatment and most recommended continuing topical treatments as maintenance therapy. There was considerable variation between guidelines on classification of severity, indications for commencing oral antibiotics and on maximum duration of oral antibiotics. However, there was consensus on the need for co-prescription of a non-antibiotic topical treatment when using oral antibiotics. There were notable differences on recommendations regarding provision of information for patients on how to use topical treatments or how to mitigate against side effects.
CONCLUSIONS
Substantial differences in classification of acne severity hampered comparisons between guidelines. Although development and reporting of guidelines has improved over the past 5 years, differences in key recommendations remain, possibly reflecting uncertainties in the underlying evidence base. Differences between guidelines could have substantial implications for prevalence of antibiotic prescribing for acne.
PubMed: 37538340
DOI: 10.1002/ski2.240 -
The Journal of Dermatological Treatment Dec 2023Acne vulgaris (AV) is a common skin disease. Fire needle is a method of quickly piercing the local skin lesions with red-hot needles for AV. This work aimed to evaluate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acne vulgaris (AV) is a common skin disease. Fire needle is a method of quickly piercing the local skin lesions with red-hot needles for AV. This work aimed to evaluate the efficacy and safety of fire needle combined with chemical peels for AV.
METHODS
Eight databases including PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed, and VIP databases were searched to enrolled randomized controlled trials (RCTs) comparing fire needle therapy combined with chemical peels with chemical peels alone. The risk of bias was evaluated by the Cochrane Collaboration's tool. Statistical analysis was completed by RevMan 5.3 and Stata 14.0.
RESULTS
Altogether 18 studies including 1213 patients were enrolled. Compared with chemical peels alone, fire needle adjuvant chemical peels therapy improved the total effective rate (RR = 1.37,95% CI [1.26,1.48], < 0.00001) and skin lesions (MD = -2.11, 95% CI [-2.74, -1.47], < 0.00001), and reduced the recurrence rate (RR = 0.50,95% CI [0.33,0.76], = 0.0009).The application of fire needle was associated with few adverse reactions, all of which were well tolerated and transient.
CONCLUSION
Fire needle adjuvant chemical peels therapy is effective and safe for AV. Nevertheless, more large-scale, well-designed clinical studies are warranted to provide evidence-based medical support.
Topics: Humans; Needles; Acne Vulgaris; Chemexfoliation; Cosmetic Techniques; Research Design
PubMed: 37503565
DOI: 10.1080/09546634.2023.2240455 -
Skin Research and Technology : Official... Jun 2023Acne scar is a persistent complication of acne vulgaris. However, the prevalence and risk factors are still unclear. This study aimed to assess the global prevalence and...
BACKGROUND
Acne scar is a persistent complication of acne vulgaris. However, the prevalence and risk factors are still unclear. This study aimed to assess the global prevalence and risk factors of acne scars in patients with acne.
MATERIALS AND METHODS
A systematic search of published studies in three databases was performed and the meta-analyses were conducted.
RESULTS
Finally, we included 37 studies involving 24 649 acne patients. And, the pooled prevalence of acne scars in these patients was 47% (95% confidence interval [CI]: 38-56%). Besides, the differences in prevalence were observed based on the subgroup analysis for age, gender, acne severity, source of patients, and so on. Subsequently, we quantified the relationship of three risk factors with acne scars: male gender (odds ratio [OR]: 1.58, 95% CI: 1.19-2.09), positive family history of acne (OR: 2.73, 95% CI: 1.26-5.91), and acne severity (OR for moderate acne: 2.34, 95% CI: 1.54-3.57; OR for severe acne: 5.51, 95% CI: 2.45-12.41).
CONCLUSION
Herein, we found that 47% of acne patients suffered from acne scars and identified three risk factors: male gender, positive family history of acne, and acne severity. In order to reduce acne scarring, attention and effective therapy early in the course of acne is important.
Topics: Humans; Male; Acne Vulgaris; Cicatrix; Prevalence; Risk Factors; Treatment Outcome
PubMed: 37357642
DOI: 10.1111/srt.13386 -
The Journal of Dermatological Treatment Dec 2023Isotretinoin is frequently used for treatment of severe nodulocystic and papulopustular acne, however use is limited by mucocutaneous, ocular, and systemic side... (Meta-Analysis)
Meta-Analysis
Isotretinoin is frequently used for treatment of severe nodulocystic and papulopustular acne, however use is limited by mucocutaneous, ocular, and systemic side effects. (1) provide a systematic meta-analysis of ocular side effects during isotretinoin use and their corresponding incidences; (2) provide a narrative summary of ocular side effects during isotretinoin use reported in case reports. A systematic database search using predefined search terms was performed in PubMed, EMBASE, and Scopus from inception to 5 March, 2021. Predetermined inclusion and exclusion criteria were used to select included studies. In total, 53 original studies qualified for meta-analysis, and 41 case reports/series qualified for narrative results. The studies included in the meta-analysis reported incidences of various ocular side effects including dry eye, eye sensitivity, vision changes, and ocular inflammatory conditions. Incidences across studies did vary, leading to considerable heterogeneity. The narrative results summarize more uncommon, but equally important, ocular side effects. Dry eye is the most commonly reported ocular side effect. Other less common, but more serious, ocular side effects including vision changes can occur. We recommend that isotretinoin prescribers monitor for dry eye. Limitations include the heterogeneity of reported incidences of ocular side effects between studies.
Topics: Humans; Acne Vulgaris; Dermatologic Agents; Drug-Related Side Effects and Adverse Reactions; Dry Eye Syndromes; Eye; Face; Isotretinoin
PubMed: 37248700
DOI: 10.1080/09546634.2023.2213364 -
Dermatology (Basel, Switzerland) 2023Topical drugs are often used as first-line treatment for dermatological conditions. A within-person design may then be well adapted: it consists of randomizing...
BACKGROUND
Topical drugs are often used as first-line treatment for dermatological conditions. A within-person design may then be well adapted: it consists of randomizing lesions/body sites rather than patients, which are then concomitantly treated by the different drugs compared, reducing inter-group variability and therefore requiring fewer patients than the classical parallel-group trial.
OBJECTIVES
The aim of this review was to provide a methodological overview of within-person randomized trials (WP-RCTs) in dermatology.
METHODS
We searched for eligible trials published between 2017 and 2021 in MEDLINE, Embase, and Central in dermatology journals and the 6 highest-impact-factor general medical journals. Two authors selected publications and extracted data independently.
RESULTS
From 1,034 articles identified, we included 54 WP-RCTs, mainly for acne vulgaris, psoriasis, actinic keratosis, and atopic dermatitis. In most of the trials, patients had only 2 lesions/body sites. In none of the trials, did we detect a potential carry-across effect (known to be the major methodological problem in WP-RCTs). Twelve studies reported a care provider applying the treatment, and in 26 studies, the patients themselves applied the treatment. Finally, we also highlight statistical issues for the statistical analysis: overall, 14 (26.9%) studies used a test for independent observations, thus ignoring the between-lesion correlation.
CONCLUSION
Our systematic review highlights that despite the publication of the CONSORT checklist extension for WP-RCTs in 2017, this design is rarely used, and when it is, there are methodological and reporting concerns.
Topics: Humans; Randomized Controlled Trials as Topic; Acne Vulgaris; Dermatitis, Atopic; Checklist
PubMed: 36990057
DOI: 10.1159/000530149 -
JAMA Dermatology May 2023Tumor necrosis factor-α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are...
IMPORTANCE
Tumor necrosis factor-α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are refractory to conventional therapies. However, use of TNFis can also be followed by acne occurrence, suggesting an association between TNFis and acne. Most of the literature on the topic comprises case reports and series that have not been reviewed in a systematic manner.
OBJECTIVE
To characterize the demographic characteristics, clinical presentations, treatments, and outcomes of patients receiving TNFis to treat acne and patients who develop acne following treatment of other conditions with TNFis.
EVIDENCE REVIEW
A systematic literature review was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. PubMed and Web of Science were searched from inception through October 17, 2022. Included studies reported on patients of any sex or age who received TNFis whose treatment was followed by resolution or occurrence of acne. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined.
FINDINGS
A total of 53 studies reporting on 64 patients who received TNFis for the treatment of acne (n = 47) or who experienced acne after treatment with TNFis for a different condition (n = 17) (mean age, 28.7 years; range, 12-64 years; 6 female individuals [8.8%]) were included. The TNFis used included adalimumab, infliximab, and etanercept. Among the 47 patients treated for acne with TNFis, most had previously received antibiotics (31 [66.0%]) or isotretinoin (32 [68.1%]). Most (44 [93.6%]) experienced partial improvement (25 [53.2%]) or clearance (19 [40.4%]) with very few adverse effects reported (3 [6.4%]). Acne manifested as part of an inflammatory syndrome for 30 patients (63.8%). Among the 17 patients treated TNFis for a different condition followed by the occurrence of acne, only 1 patient (5.9%) reported having a history of acne. Therapy with TNFis was either discontinued (8 [47.1%]) or altered (6 [35.3%]) in most patients due to acne occurrence, typically with improvement in symptoms.
CONCLUSIONS AND RELEVANCE
The results of this systematic review suggest that TNFis can be effective in treating refractory acne but can also be associated with the occurrence of acne in certain instances. Further studies elucidating the role that TNF plays in treating and inducing acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding clinical care of patients with acne treated or induced by TNFis.
Topics: Adult; Female; Humans; Acne Vulgaris; Adalimumab; Etanercept; Immunologic Factors; Infliximab; Tumor Necrosis Factor-alpha; Male; Child; Adolescent; Young Adult; Middle Aged
PubMed: 36930143
DOI: 10.1001/jamadermatol.2023.0269 -
Drug Delivery and Translational Research Jun 2023Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and... (Review)
Review
Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and safety of these treatments has not been published. The objectives of this study are to evaluate the efficacy and safety of needle-free jet injections for dermatological indications and to provide evidence-based treatment recommendations. An electronic literature search was conducted in April 2022. Two reviewers independently selected studies based on predefined criteria and performed a methodological quality assessment using the Cochrane Collaborations risk-of-bias 2.0 assessment tool and Newcastle-Ottawa Scale. Thirty-seven articles were included, involving 1911 participants. Dermatological indications included scars, alopecia areata, hyperhidrosis, nail diseases, non-melanoma skin cancer, common warts, local anesthesia, and aesthetic indications. Keloids and other types of scars (hypertrophic, atrophic, and burn scars) were investigated most frequently (n = 7). The included studies reported favorable efficacy and safety outcomes for intralesional jet injector-assisted treatment with triamcinolone acetonide/hexacetonide, 5-fluorouracil, bleomycin, or hyaluronic acid. Two high-quality studies showed good efficacy and tolerability of intralesional jet injections with a combination of 5-fluorouracil and triamcinolone acetonide in hypertrophic scars and with saline in boxcar and rolling acne scars. No serious adverse reactions and good tolerability were reported in the included studies. Overall, the methodological quality of the included studies was low. Limited evidence suggests that needle-free jet injector-assisted intralesional treatment is efficacious and safe for hypertrophic and atrophic acne scars. More well-powered RCTs investigating the efficacy and safety of jet injector treatment in dermatology are warranted to make further evidence-based recommendations.
Topics: Humans; Triamcinolone Acetonide; Dermatology; Keloid; Fluorouracil; Acne Vulgaris; Treatment Outcome
PubMed: 36884194
DOI: 10.1007/s13346-023-01295-x -
Cureus Jan 2023Acne vulgaris usually affects the dermal layer of the skin and is revealed frequently in young adulthood and adolescence. It has serious psychosocial comorbidities. We... (Review)
Review
Evaluation of Psychiatric Comorbidities and Quality of Life As Well As Brain-Derived Neurotrophic Factor (BDNF) Concentrations Among Patients Suffering From Acne Vulgaris: A Systematic Review and Meta-Analysis.
Acne vulgaris usually affects the dermal layer of the skin and is revealed frequently in young adulthood and adolescence. It has serious psychosocial comorbidities. We conducted the present systematic review and meta-analysis to elucidate the association of acne vulgaris with psychiatric comorbidities and quality of life as well as the brain-derived neurotrophic factor (BDNF) level. A systematic review and meta-analysis of the published articles were carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We investigated diverse databases: Web of Science, PubMed, the Cochrane Library, Embase, PsycINFO, and CINAHL to search for articles reporting the prevalence of psychosocial comorbidities among patients with acne vulgaris from database inception through June 2022. The outcomes were depression, anxiety, symptom checklist-90-R (SCL-90-R), quality of life, self-esteem, stress, loneliness, and BDNF concentrations. Of 3647 articles identified, 23 met the inclusion criteria. Patients with acne vulgaris have a significantly higher level of anxiety, depression, and stress (P<0.05). Yet, the reported findings of the SCL-90-R, self-esteem, loneliness, and BDNF scores among patients suffering from acne vulgaris were variable and did not differ significantly compared to healthy participants (P>0.05), hampering any conclusive findings on absolute prevalence. Subgroup analysis and comparison showed that heterogeneity between studies was likely due to factors, including country, study design, and assessment tools. This comprehensive review and meta-analysis revealed that anxiety, depression, and stress are significantly more frequent among patients suffering from acne vulgaris. These findings confirm that acne vulgaris has both psychiatric and medical characteristics and requires a multidisciplinary approach.
PubMed: 36751189
DOI: 10.7759/cureus.33357