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Journal of Drugs in Dermatology : JDD May 2013This article reviews the published literature about the efficacy of oral and topical zinc as treatments for acne vulgaris. The medical literature was systematically... (Review)
Review
This article reviews the published literature about the efficacy of oral and topical zinc as treatments for acne vulgaris. The medical literature was systematically reviewed to identify relevant articles. Each published study was assessed for pathophysiologic results and the quality of the clinical evidence the study provided based on Strength of Recommendation Taxonomy (SORT) criteria. Finally, the body of evidence for using oral or topical zinc in the treatment of acne was assessed, again using SORT criteria. A SORT strength of recommendation of B (inconsistent or limited-quality patient-oriented evidence) appears to be appropriate for both oral and topical zinc. The preponderance of evidence suggests zinc has antibacterial and anti-inflammatory effects and that it may decrease sebum production.
Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Anti-Inflammatory Agents; Dermatologic Agents; Humans; Sebum; Zinc
PubMed: 23652948
DOI: No ID Found -
Expert Review of Clinical Pharmacology Jan 2012Seborrheic dermatitis is a common, chronic, relapsing inflammatory skin disorder that manifests as erythema, scaling and pruritus in sebum gland-rich areas of the skin.... (Review)
Review
Seborrheic dermatitis is a common, chronic, relapsing inflammatory skin disorder that manifests as erythema, scaling and pruritus in sebum gland-rich areas of the skin. The objective of this article is to evaluate the clinical efficacy of pimecrolimus 1% cream in the treatment of seborrheic dermatitis compared with corticosteroids, antimycotics, placebo or no intervention. Pimecrolimus 1% cream appears to be a well-tolerated and effective treatment for seborrheic dermatitis. It has comparable efficacy, in terms of decreasing severity of erythema, scaling and pruritus, to the standard treatments: topical corticosteroids and antimycotics. However, future studies with more standardized measures of treatment outcome are recommended. More studies may also be conducted to further evaluate pimecrolimus 1% cream as a long-term maintenance therapy for seborrheic dermatitis.
Topics: Administration, Cutaneous; Animals; Calcineurin Inhibitors; Chemistry, Pharmaceutical; Dermatitis, Seborrheic; Dermatologic Agents; Humans; Randomized Controlled Trials as Topic; Tacrolimus; Treatment Outcome
PubMed: 22142161
DOI: 10.1586/ecp.11.68 -
The Cochrane Database of Systematic... Apr 2009Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. The most common cause is by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. The most common cause is by increased production of male sex hormones (androgens). It is also affected by increased sensitivity to androgens in the hair follicles, and secretory glands around hair follicles (sebaceous glands). Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism.
OBJECTIVES
The objective was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.
SEARCH STRATEGY
The Cochrane Menstrual Disorders and Subfertility Group (MDSG) trials register was searched (April 2008). The Cochrane MDSG register is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.
SELECTION CRITERIA
All randomised controlled comparisons of spironolactone versus: placebo, steroids (oral contraceptive pill included), spironolactone of varying dosages, or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.
DATA COLLECTION AND ANALYSIS
Nine trials were included in the review, eight trials were excluded. Two other trials are awaiting assessment. Only one trial studied acne as an outcome, the remainder were concerned with hirsutism. Major outcome measures include the following: subjective observations, Ferriman and Gallwey hair scores, hormonal and biochemical parameters, side effects, sebum production measurement.
MAIN RESULTS
In the two trials that compared 100 mg of spironolactone with placebo significant differences were reported for subjective improvements in hair growth (OR 7.18, 95% CI 1.96 to 26.28), although not the Ferriman-Galwey score (WMD 7.20, 95% CI -10.98 to -3.42)). Data could not be otherwise pooled as only one trial reported an outcome.
AUTHORS' CONCLUSIONS
From the studies included in this review, there is some evidence to show that spironolactone is an effective treatment to decrease the degree of hirsutism but there was no evidence for effectiveness for the treatment of acne vulgaris. Studies in this area are scarce and small. Individual study data indicates some superiority of spironolactone over other drugs but results cannot be generalised.
Topics: Acne Vulgaris; Androgen Antagonists; Drug Therapy, Combination; Female; Hirsutism; Humans; Randomized Controlled Trials as Topic; Spironolactone
PubMed: 19370553
DOI: 10.1002/14651858.CD000194.pub2 -
The Cochrane Database of Systematic... 2003Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by... (Review)
Review
BACKGROUND
Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by increased production of male sex hormones also known as androgens. It is also affected by increased sensitivity to androgens in the hair follicles, and the secretory glands around the hair follicles, called sebaceous glands. Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism.
OBJECTIVES
The objective of this review was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.
SEARCH STRATEGY
We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 12 June 2003). The Cochrane Menstrual Disorders and Subfertility Group register is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, the handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.
SELECTION CRITERIA
All randomised controlled comparisons of spironolactone versus: placebo, steroids (oral contraceptive pill included), spironolactone of varying dosages, or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.
DATA COLLECTION AND ANALYSIS
Seven trials were included in the review, eight trials were excluded. Two other trials are awaiting assessment. All included trials were small (no more than 41 participants) randomised and controlled. Only one trial studied acne as an outcome, the remainder were concerned with hirsutism. Two trials investigated spironolactone versus placebo; one trial was a dosage studies of spironolactone; one trial compared spironolactone with spironolactone in combination with dexamethasone; one trial used topical spironolactone for the treatment of acne, one trial compared three treatments; spironolactone, finasteride, cyproterone acetate. Major outcome measures include the following: subjective observations, Ferriman and Gallwey hair scores, hormonal and biochemical parameters, side effects, sebum production measurement.
MAIN RESULTS
All sample populations were small and confidence intervals were wide. In the two trials that compared 100 mg of spironolactone with placebo significant differences were reported for subjective improvements in hair growth (OR 7.18, 95% CI 1.96 to 26.28), Ferriman-Galwey score (WMD 7.20, 95% CI -10.98 to -3.42)). The remaining comparisons were not statistically significant. There were statistically significant improvements in Ferriman-Galwey scores 12 months after the end of treatment in those women who received 100mg/day spironolactone compared to 12.5 mg/day cyproterone acetate (first 10 days of cycle) (WMD -1.18, 95% CI -2.1 to -0.26) and 5mg/day finasteride (WMD -2.34, 95% CI -3.23 to -1.45).
REVIEWER'S CONCLUSIONS
Six months treatment with 100 mg/day spironolactone compared with placebo was associated with a statistically significant subjective improvement in hair growth and a decrease in Ferriman-Galwey scores. Spironolactone 100mg/day is superior to finasteride 5 mg/day and low dose cyproterone acetate 12.5 mg/day (first 10 days of cycle) up to 12 months after the end of treatment. The effectiveness of treatment for acne vulgaris cannot be determined due to the small sample populations involved in the trials. Its value in clinical practice is difficult to assess from currently available research.
Topics: Acne Vulgaris; Drug Therapy, Combination; Female; Glucocorticoids; Hirsutism; Humans; Male; Mineralocorticoid Receptor Antagonists; Randomized Controlled Trials as Topic; Spironolactone
PubMed: 14583916
DOI: 10.1002/14651858.CD000194 -
The Cochrane Database of Systematic... 2001Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by... (Review)
Review
BACKGROUND
Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by increased production of male sex hormones also known as androgens. It is also affected by increased sensitivity to androgens in the hair follicles, and the secretory glands around the hair follicles, called sebaceous glands. Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism. Since 1978, many studies have been conducted to determine its effectiveness.
OBJECTIVES
The objective of this review was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.
SEARCH STRATEGY
All publications of randomised controlled trials of spironolactone versus placebo and/or in combination with steroids (oral contraceptive pill included) were identified. Search strategy was developed by the Menstrual Disorder Group. All accessible electronic databases were searched. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.
SELECTION CRITERIA
All randomised controlled comparisons of spironolactone versus: placebo, steroids (oral contraceptive pill included), spironolactone of varying dosages, or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.
DATA COLLECTION AND ANALYSIS
Six trials were included in the review, seven trials were excluded. Two other trials are awaiting assessment. All included trials were small (no more than 40 participants) randomised and controlled. Only one trial studied acne as an outcome, the remainder were concerned with hirsutism. Two trials investigated spironolactone versus placebo; one trial was a dosage studies of spironolactone; one trial compared spironolactone with spironolactone in combination with dexamethasone; the remaining trial used topical spironolactone for the treatment of acne. Major outcome measures include the following: - subjective observations - Ferriman and Gallwey hair scores - hormonal and biochemical parameters - side effects - sebum production measurement
MAIN RESULTS
All sample populations were small and confidence intervals were wide. In the two trials that compared 100 mg of spironolactone with placebo significant differences were reported for subjective improvements in hair growth (OR 7.18, 95%CI 1.96, 26.28), Ferriman-Galwey score (WMD 7.20, 95%CI -10.98, -3.42)). The remaining comparisons were not statistically significant.
REVIEWER'S CONCLUSIONS
Six months treatment with 100 mg spironolactone compared with placebo was associated with a statistically significant subjective improvement in hair growth and a decrease in Ferriman-Galwey scores. The effectiveness of treatment for acne vulgaris cannot be determined due to the small sample populations involved in the trials. Its value in clinical practice is difficult to assess from currently available research.
Topics: Acne Vulgaris; Drug Therapy, Combination; Female; Glucocorticoids; Hirsutism; Humans; Male; Mineralocorticoid Receptor Antagonists; Randomized Controlled Trials as Topic; Spironolactone
PubMed: 11687072
DOI: 10.1002/14651858.CD000194 -
The Cochrane Database of Systematic... 2000Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by... (Review)
Review
BACKGROUND
Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by increased production of male sex hormones also known as androgens. It is also affected by increased sensitivity to androgens in the hair follicles, and the secretory glands around the hair follicles, called sebaceous glands. Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism. Since 1978, many studies have been conducted to determine its effectiveness.
OBJECTIVES
The objective of this review was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.
SEARCH STRATEGY
All publications of randomised controlled trials of spironolactone versus placebo and/or in combination with steroids (oral contraceptive pill included) were identified. Search strategy was developed by the Menstrual Disorder Group. All accessable electronic databases were searched. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.
SELECTION CRITERIA
All randomised controlled comparisons of spironolactone versus: placebo steroids (oral contraceptive pill included)) spironolactone of varying dosages or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.
DATA COLLECTION AND ANALYSIS
Four trials were included in the review, seven trials were excluded. Two other trials are awaiting assessment. All included trials were small (no more than 31 participants) randomised and controlled. Only one trial studied acne as an outcome, the remaining three were concerned with hirsutism. One trial investigated spironolactone versus placebo; one trial was a dosage studies of spironolactone; one trial compared spironolactone with spironolactone in combination with dexamethasone; the remaining trial used topical spironolactone for the treatment of acne. Major outcome measures include the following: - subjective observations - Ferriman and Gallwey hair scores - hormonal and biochemical parameters - side effects - sebum production measurement
MAIN RESULTS
All sample populations were small and confidence intervals were wide. There was no significant difference between treatments for any of the observed outcomes.
REVIEWER'S CONCLUSIONS
The effectiveness of treatment for either acne vulgaris or hirsutism cannot be determined due to the small sample populations involved in the trials. Its value in clinical practice is difficult to assess from currently available research.
Topics: Acne Vulgaris; Drug Therapy, Combination; Female; Glucocorticoids; Hirsutism; Humans; Male; Mineralocorticoid Receptor Antagonists; Spironolactone
PubMed: 10796700
DOI: 10.1002/14651858.CD000194