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American Family Physician Oct 2019Acne vulgaris is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people per year, mostly adolescents and young adults....
Acne vulgaris is the most prevalent chronic skin disease in the United States, affecting nearly 50 million people per year, mostly adolescents and young adults. Potential sequelae of acne, such as scarring, dyspigmentation, and low self-esteem, may result in significant morbidity. Typical acne lesions involve the pilosebaceous follicles and the interrelated processes of sebum production, Cutibacterium acnes (previously called Propionibacterium acnes) colonization, and inflammation. Acne may be classified as mild, moderate, or severe based on the number and type of skin lesions. Multiple treatment agents and formulations are available, with each agent targeting a specific area within acne pathogenesis. Treatment selection is based on disease severity, patient preference, and tolerability. Topical retinoids are indicated for acne of any severity and for maintenance therapy. Systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks. Isotretinoin is used for severe, recalcitrant acne. Because of the risk of teratogenicity, patients, pharmacists, and prescribers must register with the U.S. Food and Drug Administration-mandated risk management program, iPledge, before implementing isotretinoin therapy. There is limited evidence for physical modalities (e.g., laser therapy, light therapy, chemical peels) and complementary therapies (e.g., purified bee venom, low-glycemic-load diet, tea tree oil); therefore, further study is required.
Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Chronic Disease; Complementary Therapies; Curriculum; Dermatologic Agents; Education, Medical, Continuing; Female; Humans; Isotretinoin; Laser Therapy; Male; Phototherapy; United States; Young Adult
PubMed: 31613567
DOI: No ID Found -
American Family Physician Oct 2012Acne is a chronic inflammatory skin disease that is the most common skin disorder in the United States. Therapy targets the four factors responsible for lesion... (Review)
Review
Acne is a chronic inflammatory skin disease that is the most common skin disorder in the United States. Therapy targets the four factors responsible for lesion formation: increased sebum production, hyperkeratinization, colonization by Propionibacterium acnes, and the resultant inflammatory reaction. Treatment goals include scar prevention, reduction of psychological morbidity, and resolution of lesions. Grading acne based on lesion type and severity can help guide treatment. Topical retinoids are effective in treating inflammatory and noninflammatory lesions by preventing comedones, reducing existing comedones, and targeting inflammation. Benzoyl peroxide is an over-the-counter bactericidal agent that does not lead to bacterial resistance. Topical and oral antibiotics are effective as monotherapy, but are more effective when combined with topical retinoids. The addition of benzoyl peroxide to antibiotic therapy reduces the risk of bacterial resistance. Oral isotretinoin is approved for the treatment of severe recalcitrant acne and can be safely administered using the iPLEDGE program. After treatment goals are reached, maintenance therapy should be initiated. There is insufficient evidence to recommend the use of laser and light therapies. Referral to a dermatologist should be considered if treatment goals are not met.
Topics: Acne Vulgaris; Administration, Topical; Anti-Bacterial Agents; Dermatologic Agents; Diagnosis, Differential; Humans; Phototherapy
PubMed: 23062156
DOI: No ID Found -
Dermatology Online Journal Feb 2019Patients with psoriasis have a growing interest in managing their disease through diet. (Review)
Review
BACKGROUND
Patients with psoriasis have a growing interest in managing their disease through diet.
OBJECTIVE
This review paper aims to analyze dietary interventions for psoriasis and their outcome.
METHODS
Terms "psoriasis AND diet" were used to search PubMed database and 63 articles describing dietary changes influencing psoriasis were selected.
RESULTS
Low calorie diet (LCD) improves Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) in conjunction with topical or systemic therapy, although LCD was unsuccessful in maintaining disease remission when patients discontinued concomitant cyclosporine or methotrexate therapy. A fish oil diet improved baseline PASI of 7.7 to 5.3 at three months and 2.6 at 6 months compared to control (PASI: 8.9, 7.8, and 7.8, respectively). A randomized, double-blind, placebo-controlled study investigating selenium supplementation in psoriasis provided no PASI improvement. Zinc supplementation with concomitant betamethasone valerate 0.0025% ointment in a randomized, double-blind, placebo-controlled study provided a mean PASI of 11.2 in the intervention group and 8.0 in the control group with no significant difference between both arms. Gluten free diet and vitamin D supplementation were also efficacious dietary changes although results were mixed.
CONCLUSIONS
Dietary changes alone do not cause a large effect in psoriasis but may become an important adjunct to current first line treatments.
Topics: Anti-Inflammatory Agents; Caloric Restriction; Dermatologic Agents; Diet, Gluten-Free; Dietary Supplements; Fish Oils; Humans; Psoriasis; Quality of Life; Selenium; Severity of Illness Index; Zinc
PubMed: 30865402
DOI: No ID Found -
Dermatology Online Journal Oct 2019Melasma is an acquired hyperpigmentation disorder most commonly affecting females with darker skin types. It is triggered by several factors including sun exposure,... (Review)
Review
Melasma is an acquired hyperpigmentation disorder most commonly affecting females with darker skin types. It is triggered by several factors including sun exposure, genetic influences, and female sex hormones. The pathology of melasma extends beyond melanocytes and recent literature points to interactions between keratinocytes, mast cells, gene regulation abnormalities, neovascularization, and disruption of basement membrane. This complex pathogenesis makes melasma difficult to target and likely to recur post treatment. A better understanding of the latest pathological findings is key to developing novel and successful treatment options. This review aims to provide a summary of the more novel pathological findings and latest investigational therapies.
Topics: Administration, Cutaneous; Dermatologic Agents; Face; Female; Humans; Keratinocytes; Mast Cells; Melanocytes; Melanosis; Skin; Sunlight; Sunscreening Agents
PubMed: 31735001
DOI: No ID Found -
Journal of the European Academy of... Nov 2022The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four...
The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.
Topics: Adolescent; Anti-Infective Agents; Anti-Inflammatory Agents; Antipruritics; Biological Products; Child; Dermatitis, Atopic; Dermatologic Agents; Eczema; Emollients; Female; Humans; Janus Kinases
PubMed: 36056736
DOI: 10.1111/jdv.18429 -
Nutrients Sep 2019Curcumin is a compound isolated from turmeric, a plant known for its medicinal use. Recently, there is a growing interest in the medical community in identifying novel,... (Review)
Review
Curcumin is a compound isolated from turmeric, a plant known for its medicinal use. Recently, there is a growing interest in the medical community in identifying novel, low-cost, safe molecules that may be used in the treatment of inflammatory and neoplastic diseases. An increasing amount of evidence suggests that curcumin may represent an effective agent in the treatment of several skin conditions. We examined the most relevant in vitro and in vivo studies published to date regarding the use of curcumin in inflammatory, neoplastic, and infectious skin diseases, providing information on its bioavailability and safety profile. Moreover, we performed a computational analysis about curcumin's interaction towards the major enzymatic targets identified in the literature. Our results suggest that curcumin may represent a low-cost, well-tolerated, effective agent in the treatment of skin diseases. However, bypass of limitations of its in vivo use (low oral bioavailability, metabolism) is essential in order to conduct larger clinical trials that could confirm these observations. The possible use of curcumin in combination with traditional drugs and the formulations of novel delivery systems represent a very promising field for future applicative research.
Topics: Animals; Curcumin; Dermatologic Agents; Humans; Skin; Skin Diseases; Treatment Outcome
PubMed: 31509968
DOI: 10.3390/nu11092169 -
Aging Nov 2020Radiation-induced skin injury (RSI) refers to a frequently occurring complication of radiation therapy. Nearly 90% of patients having received radiation therapy... (Review)
Review
Radiation-induced skin injury (RSI) refers to a frequently occurring complication of radiation therapy. Nearly 90% of patients having received radiation therapy underwent moderate-to-severe skin reactions, severely reducing patients' quality of life and adversely affecting their disease treatment. No gold standard has been formulated for RSIs. In the present study, the mechanism of RSI and topical medications was discussed. Besides, this study can be referenced for clinicians to treat RSIs to guide subsequent clinical medicine.
Topics: Administration, Cutaneous; Animals; Apoptosis; Dermatologic Agents; Fibrosis; Humans; Occupational Exposure; Radiation Exposure; Radiodermatitis; Radiotherapy; Severity of Illness Index; Skin; Treatment Outcome
PubMed: 33202382
DOI: 10.18632/aging.103932 -
Journal of the American Board of Family... 2016Acne vulgaris is a common disease of the pilosebaceous unit and affects adolescents and adults. Because high-quality guidelines regarding treatment of acne in pregnancy... (Review)
Review
Acne vulgaris is a common disease of the pilosebaceous unit and affects adolescents and adults. Because high-quality guidelines regarding treatment of acne in pregnancy are scarce, management of this condition can be challenging. We describe the safety profile of common therapies and outline approaches based on available evidence. Topical azelaic acid or benzoyl peroxide can be recommended as baseline therapy. A combination of topical erythromycin or clindamycin with benzoyl peroxide is recommended for inflammatory acne. Oral erythromycin or cephalexin is generally considered safe for moderate to severe inflammatory acne when used for a few weeks. A short course of oral prednisolone may be useful for treating fulminant nodular cystic acne after the first trimester. In general, topical and oral antibiotics should not be used as monotherapy, but combined with topical benzoyl peroxide to decrease bacterial resistance. Oral retinoids are teratogenic and absolutely contraindicated for women who are pregnant or considering pregnancy. Although some complementary therapies including micronutrients and nonpharmacologic treatments seem to be well tolerated, limited data exist regarding their safety and efficacy, and they are not currently recommended during pregnancy. The risk-to-benefit ratio, efficacy, acceptability, and costs are considerations when choosing a treatment for acne in pregnancy.
Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Adolescent; Adult; Aminolevulinic Acid; Anti-Bacterial Agents; Contraindications; Dermatologic Agents; Female; Glucocorticoids; Humans; Photochemotherapy; Pregnancy; Pregnancy Complications; Retinoids; Zinc
PubMed: 26957383
DOI: 10.3122/jabfm.2016.02.150165 -
Acta Dermato-venereologica Jan 2020The management of psoriasis has evolved considerably over the past 100 years. This has occurred in parallel with our understanding of the pathogenesis of this common,... (Review)
Review
The management of psoriasis has evolved considerably over the past 100 years. This has occurred in parallel with our understanding of the pathogenesis of this common, complex and enigmatic disease. It should be celebrated as an outstanding example of successful translational research. With precise targeting of immune pathways for the treatment of psoriasis with new biologics and small molecules has come the realisation that the most effective approach to patient management is a holistic one which encompasses the biopsychosocial nature of the disease. This involves a stratified medicine approach to identifying the best drug for an individual allied to patient education, screening for comorbidity, and regular review as both the clinical presentation and the patient's needs will change over time. Al-though there is not yet a cure for psoriasis - the whole person, systems approach to patient management, that is in part dependent on early intervention, should help to ensure an optimal outcome.
Topics: Adrenal Cortex Hormones; Biological Products; Dermatologic Agents; Disease Management; Drug Development; Furocoumarins; History, 20th Century; History, 21st Century; Holistic Health; Humans; Life Style; Molecular Targeted Therapy; PUVA Therapy; Patient Education as Topic; Psoriasis
PubMed: 31971601
DOI: 10.2340/00015555-3386 -
American Family Physician Jun 2017Urticaria commonly presents with intensely pruritic wheals, sometimes with edema of the subcutaneous or interstitial tissue. It has a lifetime prevalence of about 20%.... (Review)
Review
Urticaria commonly presents with intensely pruritic wheals, sometimes with edema of the subcutaneous or interstitial tissue. It has a lifetime prevalence of about 20%. Although often self-limited and benign, it can cause significant discomfort, continue for months to years, and uncommonly represent a serious systemic disease or life-threatening allergic reaction. Urticaria is caused by immunoglobulin E- and non-immunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. Diagnosis is made clinically; anaphylaxis must be ruled out. Chronic urticaria is idiopathic in 80% to 90% of cases. Only a limited nonspecific laboratory workup should be considered unless elements of the history or physical examination suggest specific underlying conditions. The mainstay of treatment is avoidance of triggers, if identified. The first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses. First-generation H1 antihistamines, H2 antihistamines, leukotriene receptor antagonists, high-potency antihistamines, and brief corticosteroid bursts may be used as adjunctive treatment. In refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine. More than one-half of patients with chronic urticaria will have resolution or improvement of symptoms within a year.
Topics: Cyclosporine; Dermatologic Agents; Diagnosis, Differential; Histamine H1 Antagonists; Humans; Omalizumab; Urticaria
PubMed: 28671445
DOI: No ID Found