MY APPROACH to Acne Scarring | PracticeUpdate. Contraception-Update. FRM F008 Harper 13674 10925. Acne Vulgaris. A disease of pilosebaceous units, especially infundibula, that may manifest itself as noninflammatory lesions, i.e., comedones and intact cysts, or as inflammatory lesions, i.e., papules, nodules, and pustules. The process may resolve without residua, or alternatively, with scars of different types, e.g., keloidal or atrophic, boxcar, pitted, or in rarely encountered acne necrotica, cribriform. The condition usually affects adolescents on the face (99% of cases), back (60% of cases), and chest (15% of cases). At times, the condition may be seen much earlier in neonates, infants, mid-childhood (1-7 years old), and pre-adolescents (7-12 years old).
Signs of androgen excess in pediatric patients age 12 or younger should prompt a systemic workup for endocrine dysfunction. References Nast A, Dréno B, Bettoli V, et al. European evidence-based (S3) guidelines for the treatment of acne. Eichenfield LF, Krakowski AC, Piggott C, et al. Cumulative dosing of isotretinoin should not follow strict range. Clinicians should "ignore the numbers" when treating patients with acne and be guided by the principle to treat to clear, says Jerry Tan M.D., F.R.C.P.C., medical director at Windsor Clinical Research Inc. and an adjunct professor at Western University in London, Ontario, Canada.
Dr. Tan told colleagues during a session at Dermatology Update 2015 (Toronto) that the optimal dosing of oral isotretinoin, a drug that was introduced more than three decades ago, has long been debated in the dermatologic community internationally. Publications in the 1990s and various guidelines subsequently on management of acne put forth that cumulative dosing of isotretinoin should be in the range of 120 to 150 mg/kg to decrease recurrence of acne. "This range of 120 to 150 mg/kg is probably incorrect," Dr. Tan says. A total of 20 studies were included in the systematic review. In addition, the studies did not use standardized definitions of terms like relapse and remission, Dr. Disclosure: Dr. Reference: Global Dermatology » Topical Retinoids Apparently Safe to use during Pregnancy. Pregnancy Outcomes Following First Trimester Exposure to Topical Retinoids : A Systematic Review and Meta-analysis.Kaplan YC, Ozsarfati J, Etwel F, Nickel C, Nulman I, Koren G.
Br J Dermatol. 2015 Jul 26. doi: 10.1111/bjd.14053. [Epub ahead of print] Topical retinoids are use in the treatment of acne vulgaris, mainly on the retionnal lesions (blackheads and whiteheads). They are also used in the treatment of wrinkles (rhytids) [along with many other indications (pigmentation, off label uses (keratinization disorders)…] Oral retinoids (isotretinoin, acitretin, etretinate) are absolutely contraindicated because of their malformative (teratogenic) effects on the fetus. In this study: -the data was retrospectively collected on MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases from inception to December 4th 2014. 654 pregnant women were exposed to topical retinoids during the first trimester and they were matched with 1375 unexposed pregnant women. Practiceupdate. Five Keys to Winter Training and Racing.
Regardless, we runners will continue to run. We have to. You want to run a good half in March, a strong Boston in April? You can't afford to wait until Presidents' Day weekend to start training. And while a couple of weeks off from running every so often can be beneficial—and the middle of January is a better time than most—do you really want to be sucking wind in April, regretting the loss of all that hard-won fitness you had back in November? There are plenty of serious runners, in some of the coldest climates in the U.S., who find ways to train through the dead of winter. They get their mileage, maintain their fitness and emerge race-ready in spring. You can, too. For many in the Northeast, last winter meant roads covered in ice and snow. New York, like many other cities, also has a winter run series.
In early April, Fernandez ran the Greenwich (Connecticut] Half Marathon in a PR of 1:27:17. “I hate the treadmill.” It's a common refrain among serious runners. The Workout: REPEAT 8 times. Should you wait after isotretinoin to treat acne with laser? Dermatology Times editorial advisor, Dr. Elaine Siegfried continues the discussion on isotretinoin with Jim Leyden, M.D., emeritus professor of dermatology at the University of Pennsylvania.
In this final segment, the two discuss whether a waiting period is necessary before treating acne scars and the questionable existence of pityrosporum folliculitis. Elaine Siegfried, M.D.Dr. Siegfried: A topic that is getting more publication recently and is relevant for my patients is the issue about patients who have had their acne clear but have residual scarring. READ: Isotretinoin’s discovery and development Jim Leyden, M.D.Dr. ALSO READ: Isotretinoin dosing decisions Dr. Dr. Dr. Dr. Dr. Dr. READ: How to recognize sinus tracts, keratinous cysts I saw a couple of patients there at a meeting that had interesting pustules on their upper chest and back. It was the late Peyton Weary who first proposed this condition back in the ’70s.
LISTEN: Isotretinoin audio recordings Dr. Dr. Dr. Dr. Isotretinoin dosing decisions. Side effect issues Dr. Siegfried: There is a trend to push the dose higher, which I think is being fostered by people who did not live through the era in which that was already done and in which there were horrendous side effects. Dr. Leyden: There are other side effects, but they are clearly dose influenced. For example, if somebody takes their shirt off and you see blood on the T-shirt or you see hemorrhagic crusting lesions, I have always strongly urged dermatologists, do not start with anything more than 0.1 mg/kg.
Isotretinoin, like other retinoids, has a profound stimulus to granulation tissue, and you can make those hemorrhagic crusted lesions much worse. Likewise, there are patients who, when they are put on 1 mg/kg, they suddenly get much worse. READ: How to recognize sinus tracts, keratinous cysts We now know from the work of the Diane Thiboutot group that this drug induces apoptosis of sebocytes. Dr. Dr. Dr. Dr. None of those things should happen, in my opinion, but they do. Practiceupdate. Practiceupdate. Photodynamic Therapy With Methyl Aminoaevulinate May be Effective for Severe Facial Acne Vulgaris.