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CHICAGO, I.L. -- May 19, 2006 -- Infants who develop rashes on their arms and over their joints appear most likely to acquire the skin ...
Effects of Acne Treatment / 05/19/2006 »
CHICAGO, I.L. -- May 19, 2006 -- Patients who were first treated with an oral antibiotic and topical gel for acne were often able to ...
New Strengths of Antibiotic Keflex(R) / 05/15/2006 »
GERMANTOWN, M.D. -- May 15, 2006 -- Advancis Pharmaceutical Corporation today announced that the U.S. Food and Drug ...
Fuente del Material: PSLGroup
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Topical Therapies Alone May Maintain Positive Effects of Acne Treatment
CHICAGO, I.L. -- May 19, 2006 -- Patients who were first treated with an oral antibiotic and topical gel for acne were often able to maintain their clearer skin by using topical agents alone, according to two studies in the May issue of Archives of Dermatology, one of the JAMA/Archives journals.

Acne is a common, recurring disease, according to background information in the article. Acne treatment can be complex, often requiring aggressive combination therapy of oral antibiotics and medication applied directly to the skin (topical), as well as a long-term strategy.

Because acne can return after successful treatment, maintenance therapy is necessary for many patients. However, due to reduced sensitivity of acne to some antibiotics, it has been recommended that antibiotic use be limited to three months. Topical retinoids, medications derived from vitamin A, have been identified as a choice for maintenance therapy.

Diane M. Thiboutot, MD, of the Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, and colleagues studied the efficacy of a gel containing adapalene, a retinoid-like compound, in maintaining the effects of successful acne treatment.

Patients from a previous study were included if they had shown at least moderate improvement in their acne when treated with either adapalene gel and 100 mg of doxycycline (an oral antibiotic) or doxycycline and an unmedicated gel. A total of 253 patients aged 12 to 30 years were randomly assigned to receive either adapalene gel or unmedicated gel once daily for 16 weeks. Patients' acne was evaluated at the beginning of the study and after four, eight, 12 and 16 weeks.

The group that continued treatment with adapalene gel had significantly higher rates of maintaining previous treatment success, defined as at least 50% improvement since beginning therapy, than the unmedicated gel group, 75% vs. 54%.

During the study, the number of breakouts gradually increased in the unmedicated gel group, while remaining stable or decreasing in the adapalene gel group. In a survey, a significantly larger percentage of patients treated with adapalene gel were "very satisfied" or "satisfied" with the overall treatment, compared with patients treated with unmedicated gel (75% vs. 58%).

"The present 16-week and previous 12-week studies provide data to support regimens, such as those recommended in the recent acne treatment guidelines, wherein oral antibiotics can be used initially in combination with topical retinoids to gain control over the acne, and maintenance with adapalene can delay the recurrence of acne," the authors write.

At the time this study was conducted, three of the authors were employees of Galderma (Mss. Dawson and Arsonnaud and Mr. Kerrouche). Drs. Thiboutot, Shalita and Kang have served as consultants and conducted clinical trials for Galderma Laboratories and Allergan, Inc. Dr. Yamauchi has conducted clinical trials for Galderma Laboratories and Allergan, Inc. Drs. Thiboutot and Shalita have served as consultants for Connetics, Inc., and Dermik Laboratories. Dr. Shalita has served as a consultant for Medicis and Steifel and owns stock in Allergan, Medicis and Johnson & Johnson.
Retinoid Gel and Antibiotics Alone or Together
In a related article, James Leyden, MD, of the Skin Study Center, Broomall, Penn., and colleagues studied the effectiveness of three different maintenance therapies in patients whose acne had also improved using an oral antibiotic and tazarotene, a topical retinoid gel.

Patients with moderately severe to severe acne were originally treated with a gel containing 0.1% of the tazarotene (nightly) and 100-mg capsules of the antibiotic minocycline hydrochloride (twice daily) for up to 12 weeks. Those who experienced at least a 75% improvement in their acne were randomly assigned to 12 weeks of one of three maintenance therapies: retinoid gel plus placebo capsules, unmedicated gel plus antibiotic capsules or retinoid gel plus antibiotic capsules. Ninety patients (average age, 22 years) completed the maintenance phase of the study.

The researchers found that all three regimens were effective in sustaining acne improvement. After 12 weeks of therapy, average reductions in noninflammatory (blackheads, whiteheads and mild pimples) and inflammatory breakouts (reddened pimples) were, respectively, 60% and 54% with retinoid gel alone, 52% and 66% with antibiotic capsule alone, and 64% and 66% with retinoid gel plus antibiotic.

more than 80% of patients in each group had sustained a 50% or greater improvement From initial combination treatment through the end of maintenance therapy (at week 24).

"Initial treatment with tazarotene plus minocycline is effective in improving moderately severe to severe acne," the researchers write. "Furthermore, the improvements can be well maintained even with the topical retinoid as a single agent. Monotherapy with the topical retinoid has clinical advantages for ongoing maintenance therapy compared with the topical retinoid plus minocycline or minocycline alone; obviating the need for long-term treatment with oral antibiotics helps prevent potential problems such as the development of Propionibacterium acnes resistance," or insensitivity of the bacteria that cause acne to antibiotics.
This study was funded by Allergan Inc. Please see the article for full financial disclosure.

Editorial: Expanding the Role of Topical Retinoids
In an accompanying editorial, Lee T. Zane, MD, MAS, of University of California, San Francisco, writes that, "For many dermatologists, the concept that topical retinoids alone may be effective in the maintenance phase of therapy for inflammatory acne may represent a substantial departure from their traditional thinking about the role of this class of medications."

"These studies demonstrate that a substantial proportion of patients can continue to do well for several months following discontinuation of oral antibiotic therapy, likely owing to a class effect of topical retinoids," Dr. Zane writes. "That we are conscious of reducing antibiotic overuse and actively exploring therapeutic options to long-term oral antibiotic therapy is truly a step in the right direction."

Arch Dermatol. 2006; 142: 597 - 602.
Arch Dermatol. 2006; 142: 605 - 612.
American Medical Association
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