Why We Should Consider Evidence-Based Treatment Options for Truncal Acne.
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ABSTRACT:
SUBMITTER: Stein Gold L
PROVIDER: S-EPMC8163923 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Acne is a relatively common disease of the pilosebaceous units. Many aspects of facial acne have been studied. However, there is limited evidence regarding truncal acne. Truncal acne is also observed in a significant number of patients, but it is often ignored by patients and clinicians. Although the pathogenesis of facial and trunk acne is considered to be similar, the characteristics of the skin on the trunk and face are thought to be different. As truncal acne can cause scars on large areas of the body and adversely affect the quality of life of patients, more attention should be given to patients with truncal acne. Although only a few studies have been published to date, the epidemiology, etiology, severity assessment tool, assessments of the quality of life, and new treatments targeting truncal acne are currently being studied. Therefore, in this review, the latest knowledge on truncal acne will be discussed.
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Project description:Acne vulgaris is a ubiquitous problem affecting 80 percent of people ages 11 to 30 years, with many patients experiencing some degree of scarring. This review focuses on atrophic scars, the most common type of acne scar. We briefly address the cellular sequelae that lead to scar formation and the initial evaluation of patients with acne scars. We then discuss an algorithmic approach to the treatment of acne scarring based on the classification of scars into erythematous and atrophic types. Lastly, we discuss the future treatment of acne scars and ongoing clinical trials.
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Project description:BackgroundMore than half of acne patients have truncal acne on their chest, back, and shoulders. However, since most studies on acne have focused on the face, data on clinical characteristics and proper management for truncal acne are insufficient.ObjectiveTo establish a Korean Acne Rosacea Society (KARS) consensus for experts' perception and treatment patterns of truncal acne.MethodsWe conducted two rounds of the Dephi technique to gather expert opinion and reach a consensus on truncal acne. The first round comprised 48 questionnaires focusing on various aspects such as epidemiology, clinical features, diagnosis, treatment, prognosis and more, while second rounds consisted of 26 questionnaires.ResultsA total of 36 dermatologists (36/38 KARS members, 94.7%) completed this survey. In the first-round survey, consensus was reached on 20 out of the 48 questions (41.7%). In the second-round questionnaire, consensus was achieved on 9 of the 26 questions (34.6%). The most unresponsive lesion to truncal acne treatment was scars (atrophic/hypertrophic). The most commonly used treatments for each non-inflammatory and inflammatory truncal acne lesions were selected to use topical retinoids (78.1% of the responders) and oral antibiotics (93.8% of the responders).ConclusionOur study has yielded valuable insights into the epidemiology, clinical manifestations, diagnosis, treatment, and quality of life of patients with truncal acne. We anticipate that this study will inspire further comprehensive research for individuals with truncal acne.
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Project description:No epidemiological information about truncal acne is available. This study assessed the self-reported impact of truncal acne in adolescents and young adults, using an internet survey in France in 1,001 adolescents and young adults with truncal acne. Participants' mean age was 18.6 ± 4.3 years, 75.7% were females, 52.9% reported severe and 16.0% very severe truncal acne; 90.0% of participants with truncal acne also reported past or ongoing facial acne. Stress (46.3%), a diet high in lipids (33.2%), and sleeplessness (27.0%) were considered to be triggers of truncal acne; 44.7% consulted at least 1 healthcare professional and 28.1% searched the internet or social network for information about truncal acne. Of subjects with truncal acne, 68.4% thought constantly about their condition. Overall, 79.9% of the participants with severe acne vs 41.8% with mild or moderate acne: 41.8% thought about their acne all the time (p < 0.0001). Truncal acne heavily or very heavily impacted quality of life of 38.7% of participants. It impacted females significantly more than males (p < 0.0001). Significantly (p < 0.001) more females than males reported facial acne. A significant (p = 0.0067) association was observed between the severities of facial and truncal acne. The self-perceived impact of truncal acne in adolescents and young adults highlights the need for information as well as reinforced medical and psychological care.
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Project description:The 2019 novel coronavirus (COVID-19) has quickly become one of the most dire international pandemic crises since the 1918 Spanish flu. Evidence for COVID-19 pharmacological therapies has shown rapid growth and a diverse array of results, but an assessment of the value of each piece of evidence must be reinforced. This article aims to review utilized therapies, the evidence level supporting these therapies, as well as drugs under investigation for the treatment of COVID-19. Primary scrutinized therapies include antiviral regimens, such as remdesivir, hydroxychloroquine/chloroquine, lopinavir/ritonavir, immunomodulating drugs, such as corticosteroids and interleukin (IL) inhibitors, and other therapies including convalescent plasma. Only one therapy, dexamethasone, has shown a mortality benefit in randomized controlled trials and summarized evidence for other therapies show limited positive results. Reviewing these therapies in a historical way shows how limited evidence can drive therapy decisions. A broad summary of available evidence can assist clinicians in a return to hierarchical assessments of evidence which can lead to safer patient outcomes, improved distribution of resources, and better targets for appropriate therapy decisions.
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Project description:Acne scars are the reason for significant morbidity among dermatology outpatients. With more modalities being introduced every year, it is important to choose the best one suited for a particular type of scar for each patient to obtain an optimum result. Guidelines on acne scar management in the skin of color are not available where the therapeutic effect and side effect profile of the modalities can vary significantly. This narrative review looked at critical evaluation of the available modalities to find the level of evidence and therapeutic ladder of management of different types of acne scars. Treatment options for different types of scars have been described. Evidence level for each type of modality for the individual type of scar was calculated using the Strength of Recommendation Taxonomy (SORT) developed by editors of the US family medicine and primary care journals. In addition, various newer and emerging treatment options, such as dermal cell suspension, jet volumetric remodeling, and radiofrequency subcision, have been discussed. The highest level of evidence is available for microneedling, fractional radiofrequency, fractional CO2, and erbium:yttrium aluminum garnet laser for mild to moderate grade scars. Trichloroacetic acid chemical reconstruction of skin scars showed efficacy in ice pick scars. Grade 4 scars improve poorly with resurfacing procedures, where punch excision and punch elevation can be tried. Platelet-rich plasma therapy was effective in combination with lasers and microneedling. Overall there is lack of high-quality data in the management of post acne scars. Combination treatment has shown better efficacy compared to single modalities.
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Project description:BACKGROUND: The historic use of full-dose ritonavir as part of an unboosted protease inhibitor (PI)-based antiretroviral therapy regimen in some South African children contributes to the frequent accumulation of major PI resistance mutations. METHODS: In order to describe the prevalence of major PI resistance in children failing antiretroviral therapy and to investigate the clinical, immunological and virological outcomes in children with PI resistance, we conducted a cross-sectional study, with a nested case series, following up those children with major PI resistance. The setting was public health sector antiretroviral clinics in the Western Cape province of South Africa, and the subjects were children failing antiretroviral therapy. The following outcome measures were investigated: CD4 count, viral load and resistance mutations. RESULTS: Fourteen (17%) of 82 patients, referred from tertiary hospitals, had major PI resistance. All these patients were exposed to regimens that included ritonavir as a single PI. Immune reconstitution and clinical benefit were achieved when using a lopinavir/ritonavir-based treatment regimen in these children with prior PI resistance. At first HIV-1 viral load follow up after initial resistance testing (n = 11), only one patient had a viral load of less than 400 copies/ml; at a subsequent follow up (n = 9), the viral loads of five patients were less than 400 copies/ml. Patients retained on LPV/r had lower viral loads than those switched to a non-nucleoside reverse transcriptase inhibitor (NNRTI). However, two of three patients with follow-up resistance tests accumulated additional PI resistance. CONCLUSIONS: In children with pre-existing PI resistance, although initially effective, the long-term durability of a lopinavir/ritonavir-based treatment regimen can be compromised by the accumulation of resistance mutations. Furthermore, a second-line NNRTI regimen is often not durable in these patients. As genotypic resistance testing and third-line treatment regimens are costly and limited in availability, we propose eligibility criteria to identify patients with high risk for resistance and guidance on drug selection for children who would benefit from third-line therapy.
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