Optimizing Non-Antibiotic Treatments for Patients with Acne: A Review

Theresa N Canavan, Edward Chen, Boni E Elewski, Theresa N Canavan, Edward Chen, Boni E Elewski

Abstract

Acne is a very common non-infectious skin condition that is frequently treated in dermatological practices. Because acne is often chronic and may persist for years, safe and effective long-term maintenance therapy is often required. Given the increasing frequency of antibiotic-resistant bacteria and the gravity of the consequences of this trend, it behooves dermatologists to maximize use of non-antimicrobial therapy when treating acne. In this review of the literature we present data regarding the efficacy and appropriate use of non-antimicrobial treatments for acne. A variety of topical and oral treatment options exist that can be used in a step-wise manner according to the patients' severity and therapeutic response. Non-antimicrobial treatments can be highly efficacious at controlling acne, especially when used as maintenance therapy. While antibiotics have a role in acne treatment, they should not be used as monotherapy, and lengthy courses of antibiotic use are discouraged.

Keywords: Acne; Antibiotics; Azelaic acid; Isotretinoin; Light therapy; Retinoids; Spironolactone; Subantimicrobial.

Figures

Fig. 1
Fig. 1
Comparison of efficacy of first-line mild to moderate acne treatments in reducing total acne lesion count. BPO benzoyl peroxide. Clindamycin 1% + BPO 3% gel: Schaller et al. [20], Eichenfield et al. [21]; clindamycin 1% + BPO 5% gel BID: Langner et al. [30], Jackson et al. [38]; clindamycin 1% + tretinoin 0.025% lotion: Jackson et al. [38], NilFroushzadeh et al. [39]; clindamycin 1% + BPO 5% gel: Langner et al. [30]; clindamycin 1% lotion + adapalene 0.1% gel: Wolf et al. [40]. BPO 3% gel: Eichenfield et al. [28]; BPO 2.5% gel: Gollnick et al. [22], Babaeinejad and Fouladi [29]. Tretinoin 0.1% cream: Webster et al. [36]; tretinoin 0.025% gel: Cunliffe et al. [35], Webster [36]; tretinoin 0.025% cream: Webster [36]; tretinoin 0.1% gel: Webster et al. [36]; tretinoin 0.05% gel: Webster et al. [31], Tirado-Sánchez and Ponce-Olivera [33]; tretinoin 0.04% microsphere gel: Berger et al. [32]; adapalene 0.1% + BPO 2.5% combo gel: Gollnick et al. [22]; adapalene 0.3% gel: Thiboutot et al. [23], Pariser et al. [24], Tanghetti et al. [25], Tirado-Sánchez and Ponce-Olivera [33]; adapalene 0.1% lotion: Eichenfield et al. [28]; adapalene 0.1% gel: Gollnick et al. [22], Thiboutot et al. [23], Pariser et al. [24], Babaeinejad and Fouladi [29], Langner et al. [30], Tirado-Sánchez and Ponce-Olivera [33], Cunliffe et al. [35]; adapalene 0.1% cream: Shalita et al. [26], Lucky et al. [34]; tazarotene 1% cream: Tanghetti et al. [25], Shalita et al. [26]; tazarotene 1% foam: Feldman et al. [27]; tazarotene 0.1% gel: Shalita et al. [37]; tazarotene 0.05% gel: Shalita et al. [37]. Asterisk Treatment length varied from 12 weeks to 16 weeks. Double dagger symbol Treatment length varied from 8 to 12 weeks. Dagger symbol Treatment length varied from 12 weeks to 90 days

References

    1. CDC. Get Smart about Antibiotics Week [Internet]. Centers for Disease Control and Prevention. 2015 [cited 2016 Feb 28]. Available from: .
    1. McGann P, Snesrud E, Maybank R, Corey B, Ong AC, Clifford R, et al. Escherichia coli harboring MCR-1 and blaCTX-M on a novel IncF plasmid: first report of MCR-1 in the United States. Antimicrob Agents Chemother. 2016;60(7):4420–4421.
    1. Bowe WP. Antibiotic resistance and acne: where we stand and what the future holds. J Drugs Dermatol. 2014;13(6):s66–s70.
    1. White GM. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. J Am Acad Dermatol. 1998;39(2 Pt 3):S34–S37.
    1. Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol. 1999;41(4):577–580.
    1. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474–485.
    1. Rosen T. Antibiotic resistance: an editorial review with recommendations. J Drugs Dermatol. 2011;10(7):724–733.
    1. Leyden JJ. In vivo antibacterial effects of tretinoin-clindamycin and clindamycin alone on Propionibacterium acnes with varying clindamycin minimum inhibitory. J Drugs Dermatol. 2012;11(12):1434–1438.
    1. Leyden JJ, Preston N, Osborn C, Gottschalk RW. In-vivo effectiveness of adapalene 0.1%/benzoyl peroxide 2.5% gel on antibiotic-sensitive and resistant Propionibacterium acnes. J Clin Aesthet Dermatol. 2011;4(5):22–26.
    1. Vowels BR, Feingold DS, Sloughfy C, Foglia AN, Konnikov N, Ordoukhanian E, et al. Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora. Antimicrob Agents Chemother. 1996;40(11):2598–2604.
    1. Mills O, Thornsberry C, Cardin CW, Smiles KA, Leyden JJ. Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Acta Derm Venereol. 2002;82(4):260–265.
    1. Gallo RL, Nakatsuji T. Microbial symbiosis with the innate immune defense system of the skin. J Invest Dermatol. 2011;131(10):1974–1980.
    1. Marples RR, Fulton JE, Leyden J, McGinley KJ. Effect of antibiotics on the nasal flora in acne patients. Arch Dermatol. 1969;99(6):647–651.
    1. Leyden JJ, Marples RR, Mills OH, Kligman AM. Gram-negative folliculitis—a complication of antibiotic therapy in acne vulgaris. Br J Dermatol. 1973;88(6):533–538.
    1. Levy RM, Huang EY, Roling D, Leyden JJ, Margolis DJ. Effect of antibiotics on the oropharyngeal flora in patients with acne. Arch Dermatol. 2003;139(4):467–471.
    1. Margolis DJ, Fanelli M, Kupperman E, Papadopoulos M, Metlay JP, Xie SX, et al. Association of pharyngitis with oral antibiotic use for the treatment of acne: a cross-sectional and prospective cohort study. Arch Dermatol. 2012;148(3):326–332.
    1. Margolis DJ, Bowe WP, Hoffstad O, Berlin JA. Antibiotic treatment of acne may be associated with upper respiratory tract infections. Arch Dermatol. 2005;141(9):1132–1136.
    1. Adams SJ, Cunliffe WJ, Cooke EM. Long-term antibiotic therapy for acne vulgaris: effects on the bowel flora of patients and their relatives. J Invest Dermatol. 1985;85(1):35–37.
    1. Work Group, Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–73.e33.
    1. Schaller M, Sebastian M, Ress C, Seidel D, Hennig M. A multicentre, randomized, single-blind, parallel-group study comparing the efficacy and tolerability of benzoyl peroxide 3%/clindamycin 1% with azelaic acid 20% in the topical treatment of mild-to-moderate acne vulgaris. J Eur Acad Dermatol Venereol. 2016;30(6):966–973.
    1. Eichenfield LF, Alió Sáenz AB. Safety and efficacy of clindamycin phosphate 1.2%-benzoyl peroxide 3% fixed-dose combination gel for the treatment of acne vulgaris: a phase 3, multicenter, randomized, double-blind, active- and vehicle-controlled study. J Drugs Dermatol. 2011;10(12):1382–1396.
    1. Gollnick HPM, Draelos Z, Glenn MJ, Rosoph LA, Kaszuba A, Cornelison R, et al. Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients. Br J Dermatol. 2009;161(5):1180–1189.
    1. Thiboutot D, Pariser DM, Egan N, Flores J, Herndon JH, Kanof NB, et al. Adapalene gel 0.3% for the treatment of acne vulgaris: a multicenter, randomized, double-blind, controlled, phase III trial. J Am Acad Dermatol. 2006;54(2):242–250.
    1. Pariser DM, Thiboutot DM, Clark SD, Jones TM, Liu Y, Graeber M, et al. The efficacy and safety of adapalene gel 0.3% in the treatment of acne vulgaris: a randomized, multicenter, investigator-blinded, controlled comparison study versus adapalene gel 0.1% and vehicle. Cutis. 2005;76(2):145–151.
    1. Tanghetti E, Dhawan S, Green L, Del Rosso J, Draelos Z, Leyden J, et al. Randomized comparison of the safety and efficacy of tazarotene 0.1% cream and adapalene 0.3% gel in the treatment of patients with at least moderate facial acne vulgaris. J Drugs Dermatol. 2010;9(5):549–558.
    1. Shalita A, Miller B, Menter A, Abramovits W, Loven K, Kakita L. Tazarotene cream versus adapalene cream in the treatment of facial acne vulgaris: a multicenter, double-blind, randomized, parallel-group study. J Drugs Dermatol. 2005;4(2):153–158.
    1. Feldman SR, Werner CP, Alió Saenz AB. The efficacy and tolerability of tazarotene foam, 0.1%, in the treatment of acne vulgaris in 2 multicenter, randomized, vehicle-controlled, double-blind studies. J Drugs Dermatol. 2013;12(4):438–446.
    1. Eichenfield LF, Jarratt M, Schlessinger J, Kempers S, Manna V, Hwa J, et al. Adapalene 0.1% lotion in the treatment of acne vulgaris: results from two placebo-controlled, multicenter, randomized double-blind, clinical studies. J Drugs Dermatol. 2010;9(6):639–646.
    1. Babaeinejad SH, Fouladi RF. The efficacy, safety, and tolerability of adapalene versus benzoyl peroxide in the treatment of mild acne vulgaris: a randomized trial. J Drugs Dermatol. 2013;12(7):790–794.
    1. Langner A, Chu A, Goulden V, Ambroziak M. A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide and adapalene in the treatment of mild to moderate facial acne vulgaris. Br J Dermatol. 2008;158(1):122–129.
    1. Webster G, Cargill DI, Quiring J, Vogelson CT, Slade HB. A combined analysis of 2 randomized clinical studies of tretinoin gel 0.05% for the treatment of acne. Cutis. 2009;83(3):146–154.
    1. Berger R, Barba A, Fleischer A, Leyden JJ, Lucky A, Pariser D, et al. A double-blinded, randomized, vehicle-controlled, multicenter, parallel-group study to assess the safety and efficacy of tretinoin gel microsphere 0.04% in the treatment of acne vulgaris in adults. Cutis. 2007;80(2):152–157.
    1. Tirado-Sánchez A, Ponce-Olivera RM. Efficacy and tolerance of superoxidized solution in the treatment of mild to moderate inflammatory acne. A double-blinded, placebo-controlled, parallel-group, randomized, clinical trial. J Dermatol Treat. 2009;20(5):289–292.
    1. Lucky A, Jorizzo JL, Rodriguez D, Jones TM, Stewart DM, Tschen EH, et al. Efficacy and tolerance of adapalene cream 0.1% compared with its cream vehicle for the treatment of acne vulgaris. Cutis. 2001;68(4 Suppl):34–40.
    1. Cunliffe WJ, Poncet M, Loesche C, Verschoore M. A comparison of the efficacy and tolerability of adapalene 0.1% gel versus tretinoin 0.025% gel in patients with acne vulgaris: a meta-analysis of five randomized trials. Br J Dermatol. 1998;139(Suppl 52):48–56.
    1. Webster GF. Safety and efficacy of Tretin-X compared with Retin-A in patients with mild-to-severe acne vulgaris. Skinmed. 2006;5(3):114–118.
    1. Shalita AR, Chalker DK, Griffith RF, Herbert AA, Hickman JG, Maloney JM, et al. Tazarotene gel is safe and effective in the treatment of acne vulgaris: a multicenter, double-blind, vehicle-controlled study. Cutis. 1999;63(6):349–354.
    1. Jackson JM, Fu J-JJ, Almekinder JL. A randomized, investigator-blinded trial to assess the antimicrobial efficacy of a benzoyl peroxide 5%/clindamycin phosphate 1% gel compared with a clindamycin phosphate 1.2%/tretinoin 0.025% gel in the topical treatment of acne vulgaris. J Drugs Dermatol. 2010;9(2):131–136.
    1. NilFroushzadeh MA, Siadat AH, Baradaran EH, Moradi S. Clindamycin lotion alone versus combination lotion of clindamycin phosphate plus tretinoin versus combination lotion of clindamycin phosphate plus salicylic acid in the topical treatment of mild to moderate acne vulgaris: a randomized control trial. Indian J Dermatol Venereol Leprol. 2009;75(3):279–282.
    1. Wolf JE, Kaplan D, Kraus SJ, Loven KH, Rist T, Swinyer LJ, et al. Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: a multicenter, randomized, investigator-blinded study. J Am Acad Dermatol. 2003;49(3 Suppl):S211–S217.
    1. Bhavsar B, Choksi B, Sanmukhani J, Dogra A, Haq R, Mehta S, et al. Clindamycin 1% nano-emulsion gel formulation for the treatment of acne vulgaris: results of a randomized, active controlled, multicentre, phase IV clinical trial. J Clin Diagn Res. 2014;8(8):YC05–YC09.
    1. Draelos ZD, Carter E, Maloney JM, Elewski B, Poulin Y, Lynde C, et al. Two randomized studies demonstrate the efficacy and safety of dapsone gel, 5% for the treatment of acne vulgaris. J Am Acad Dermatol. 2007;56(3):439.e1-10.
    1. Fleischer AB, Shalita A, Eichenfield LF, Abramovits W, Lucky A, Garrett S, et al. Dapsone gel 5% in combination with adapalene gel 0.1%, benzoyl peroxide gel 4% or moisturizer for the treatment of acne vulgaris: a 12-week, randomized, double-blind study. J Drugs Dermatol. 2010;9(1):33–40.
    1. Langner A, Sheehan-Dare R, Layton A. A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide (Duac) and erythromycin + zinc acetate (Zineryt) in the treatment of mild to moderate facial acne vulgaris. J Eur Acad Dermatol Venereol. 2007;21(3):311–319.
    1. Capitanio B, Sinagra JL, Weller RB, Brown C, Berardesca E. Randomized controlled study of a cosmetic treatment for mild acne. Clin Exp Dermatol. 2012;37(4):346–349.
    1. Lee JW, Yoo KH, Park KY, Han TY, Li K, Seo SJ, et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study. Br J Dermatol. 2011;164(6):1369–1375.
    1. Weimar VM, Puhl SC, Smith WH, tenBroeke JE. Zinc sulfate in acne vulgaris. Arch Dermatol. 1978;114(12):1776–1778.
    1. Tan J, Humphrey S, Vender R, Barankin B, Gooderham M, Kerrouche N, et al. A treatment for severe nodular acne: a randomized investigator-blinded, controlled, noninferiority trial comparing fixed-dose adapalene/benzoyl peroxide plus doxycycline vs. oral isotretinoin. Br J Dermatol. 2014;171(6):1508–1516.
    1. Kar BR, Tripathy S, Panda M. Comparative study of oral isotretinoin versus oral isotretinoin + 20% salicylic acid peel in the treatment of active acne. J Cutan Aesthet Surg. 2013;6(4):204–208.
    1. Moore A, Ling M, Bucko A, Manna V, Rueda M-J. Efficacy and safety of subantimicrobial dose, modified-release doxycycline 40 mg versus doxycycline 100 mg versus placebo for the treatment of inflammatory lesions in moderate and severe acne: a randomized, double-blinded, controlled study. J Drugs Dermatol. 2015;14(6):581–586.
    1. Skidmore R, Kovach R, Walker C, Thomas J, Bradshaw M, Leyden J, et al. Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Arch Dermatol. 2003;139(4):459–464.
    1. Fowler JF. Anti-inflammatory dose doxycycline for the treatment of rosacea. Expert Rev Dermatol. 2007;2(5):523–531.
    1. Leyden J, Shalita A, Hordinsky M, Swinyer L, Stanczyk FZ, Weber ME. Efficacy of a low-dose oral contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel for the treatment of moderate acne: a randomized, placebo-controlled trial. J Am Acad Dermatol. 2002;47(3):399–409.
    1. Thiboutot D, Archer DF, Lemay A, Washenik K, Roberts J, Harrison DD. A randomized, controlled trial of a low-dose contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel for acne treatment. Fertil Steril. 2001;76(3):461–468.
    1. Maloney JM, Dietze P, Watson D, Niknian M, Lee-Rugh S, Sampson-Landers C, et al. A randomized controlled trial of a low-dose combined oral contraceptive containing 3 mg drospirenone plus 20 microg ethinylestradiol in the treatment of acne vulgaris: lesion counts, investigator ratings and subject self-assessment. J Drugs Dermatol. 2009;8(9):837–844.
    1. Palli MBA, Reyes-Habito CM, Lima XT, Kimball AB. A single-center, randomized double-blind, parallel-group study to examine the safety and efficacy of 3 mg drospirenone/0.02 mg ethinyl estradiol compared with placebo in the treatment of moderate truncal acne vulgaris. J Drugs Dermatol. 2013;12(6):633–637.
    1. Shamban AT, Enokibori M, Narurkar V, Wilson D. Photopneumatic technology for the treatment of acne vulgaris. J Drugs Dermatol. 2008;7(2):139–145.
    1. Liu L-H, Fan X, An Y-X, Zhang J, Wang C-M, Yang R-Y. Randomized trial of three phototherapy methods for the treatment of acne vulgaris in Chinese patients. Photodermatol Photoimmunol Photomed. 2014;30(5):246–253.
    1. Gold MH, Biron J. Efficacy of a novel combination of pneumatic energy and broadband light for the treatment of acne. J Drugs Dermatol. 2008;7(7):639–642.
    1. Wanitphakdeedecha R, Tanzi EL, Alster TS. Photopneumatic therapy for the treatment of acne. J Drugs Dermatol. 2009;8(3):239–241.
    1. Elman M, Lask G. The role of pulsed light and heat energy (LHE) in acne clearance. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol. 2004;6(2):91–95.
    1. Yeung CK, Shek SY, Bjerring P, Yu CS, Kono T, Chan HH. A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Lasers Surg Med. 2007;39(1):1–6.
    1. Moftah NH, Ibrahim SM, Wahba NH. Intense pulsed light versus photodynamic therapy using liposomal methylene blue gel for the treatment of truncal acne vulgaris: a comparative randomized split body study. Arch Dermatol Res. 2016;308(4):263–268.
    1. Hong JS, Jung JY, Yoon JY, Suh DH. Acne treatment by methyl aminolevulinate photodynamic therapy with red light vs. intense pulsed light. Int J Dermatol. 2013;52(5):614–619.
    1. Oh SH, Ryu DJ, Han EC, Lee KH, Lee JH. A comparative study of topical 5-aminolevulinic acid incubation times in photodynamic therapy with intense pulsed light for the treatment of inflammatory acne. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2009;35(12):1918–1926.
    1. Taub AF. A comparison of intense pulsed light, combination radiofrequency and intense pulsed light, and blue light in photodynamic therapy for acne vulgaris. J Drugs Dermatol. 2007;6(10):1010–1016.
    1. Ma Y, Liu Y, Wang Q, Ren J, Xiang L. Prospective study of topical 5-aminolevulinic acid photodynamic therapy for the treatment of severe adolescent acne in Chinese patients. J Dermatol. 2015;42(5):504–507.
    1. Mei X, Shi W, Piao Y. Effectiveness of photodynamic therapy with topical 5-aminolevulinic acid and intense pulsed light in Chinese acne vulgaris patients. Photodermatol Photoimmunol Photomed. 2013;29(2):90–96.
    1. Paithankar DY, Sakamoto FH, Farinelli WA, Kositratna G, Blomgren RD, Meyer TJ, et al. Acne treatment based on selective photothermolysis of sebaceous follicles with topically delivered light-absorbing gold microparticles. J Invest Dermatol. 2015;135(7):1727–1734.
    1. Haedersdal M, Togsverd-Bo K, Wiegell SR, Wulf HC. Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: a randomized controlled trial. J Am Acad Dermatol. 2008;58(3):387–394.
    1. Alexiades-Armenakas M. Long-pulsed dye laser-mediated photodynamic therapy combined with topical therapy for mild to severe comedonal, inflammatory, or cystic acne. J Drugs Dermatol. 2006;5(1):45–55.
    1. Gold MH, Sensing W, Biron JA. Clinical efficacy of home-use blue-light therapy for mild-to moderate acne. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol. 2011;13(6):308–314.
    1. Handler MZ, Bloom BS, Goldberg DJ. Energy-based devices in treatment of acne vulgaris. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2016;42(5):573–585.
    1. Na JI, Suh DH. Red light phototherapy alone is effective for acne vulgaris: randomized, single-blinded clinical trial. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2007;33(10):1228–1233.
    1. Aziz-Jalali MH, Tabaie SM, Djavid GE. Comparison of red and infrared low-level laser therapy in the treatment of acne vulgaris. Indian J Dermatol. 2012;57(2):128–130.
    1. de Arruda LHF, Kodani V, Bastos Filho A, Mazzaro CB. A prospective, randomized, open and comparative study to evaluate the safety and efficacy of blue light treatment versus a topical benzoyl peroxide 5% formulation in patients with acne grade II and III. An Bras Dermatol. 2009;84(5):463–468.
    1. Pollock B, Turner D, Stringer MR, Bojar RA, Goulden V, Stables GI, et al. Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Br J Dermatol. 2004;151(3):616–622.
    1. Taub AF. Photodynamic therapy for the treatment of acne: a pilot study. J Drugs Dermatol. 2004;3(6 Suppl):S10–S14.
    1. Akaraphanth R, Kanjanawanitchkul W, Gritiyarangsan P. Efficacy of ALA-PDT vs blue light in the treatment of acne. Photodermatol Photoimmunol Photomed. 2007;23(5):186–190.
    1. Bissonnette R, Maari C, Nigen S, Provost N, Bolduc C. Photodynamic therapy with methylaminolevulinate 80 mg/g without occlusion improves acne vulgaris. J Drugs Dermatol. 2010;9(11):1347–1352.
    1. Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. J Am Acad Dermatol. 2006;54(4):647–651.
    1. Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Br J Dermatol. 2006;154(5):969–976.
    1. Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br J Dermatol. 2000;142(5):973–978.
    1. Lee SY, You CE, Park MY. Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV. Lasers Surg Med. 2007;39(2):180–188.
    1. Kwon HH, Lee JB, Yoon JY, Park SY, Ryu HH, Park BM, et al. The clinical and histological effect of home-use, combination blue-red LED phototherapy for mild-to-moderate acne vulgaris in Korean patients: a double-blind, randomized controlled trial. Br J Dermatol. 2013;168(5):1088–1094.
    1. Ilknur T, Demirtaşoğlu M, Biçak MU, Ozkan S. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol. 2010;12(5):242–245.
    1. Levesque A, Hamzavi I, Seite S, Rougier A, Bissonnette R. Randomized trial comparing a chemical peel containing a lipophilic hydroxy acid derivative of salicylic acid with a salicylic acid peel in subjects with comedonal acne. J Cosmet Dermatol. 2011;10(3):174–178.
    1. Leyden JJ. New understandings of the pathogenesis of acne. J Am Acad Dermatol. 1995;32(5, Part 3):S15–S25.
    1. Lavker RM, Leyden JJ, McGinley KJ. The relationship between bacteria and the abnormal follicular keratinization in acne vulgaris. J Invest Dermatol. 1981;77(3):325–330.
    1. Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009;60(5 Suppl):S1–S50.
    1. Ioannides D, Rigopoulos D, Katsambas A. Topical adapalene gel 0.1% vs. isotretinoin gel 0.05% in the treatment of acne vulgaris: a randomized open-label clinical trial. Br J Dermatol. 2002;147(3):523–527.
    1. Leyden JJ, Tanghetti EA, Miller B, Ung M, Berson D, Lee J. Once-daily tazarotene 0.1% gel versus once-daily tretinoin 0.1% microsponge gel for the treatment of facial acne vulgaris: a double-blind randomized trial. Cutis. 2002;69(2 Suppl):12–19.
    1. Kircik LH. Microsphere technology: hype or help? J Clin Aesthet Dermatol. 2011;4(5):27–31.
    1. Poulin Y, Sanchez NP, Bucko A, Fowler J, Jarratt M, Kempers S, et al. A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuously improves efficacy among patients with severe acne vulgaris: results of a randomized controlled trial. Br J Dermatol. 2011;164(6):1376–1382.
    1. Seidler EM, Kimball AB. Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne. J Am Acad Dermatol. 2010;63(1):52–62.
    1. Ozolins M, Eady EA, Avery AJ, Cunliffe WJ, Po ALW, O’Neill C, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet Lond Engl. 2004;364(9452):2188–2195.
    1. Del Rosso JQ, Kircik L, Gallagher CJ. Comparative efficacy and tolerability of dapsone 5% gel in adult versus adolescent females with acne vulgaris. J Clin Aesthet Dermatol. 2015;8(1):31–37.
    1. Lucky AW, Maloney JM, Roberts J, Taylor S, Jones T, Ling M, et al. Dapsone gel 5% for the treatment of acne vulgaris: safety and efficacy of long-term (1 year) treatment. J Drugs Dermatol. 2007;6(10):981–987.
    1. Skinoren Cream—Summary of Product Characteristics (SPC)-(eMC) [Internet]. (cited 2016 Jun 11). Available from: .
    1. Sieber MA, Hegel JKE. Azelaic acid: properties and mode of action. Skin Pharmacol Physiol. 2014;27(Suppl 1):9–17.
    1. Mastrofrancesco A, Ottaviani M, Aspite N, Cardinali G, Izzo E, Graupe K, et al. Azelaic acid modulates the inflammatory response in normal human keratinocytes through PPARgamma activation. Exp Dermatol. 2010;19(9):813–820.
    1. Briganti S, Flori E, Mastrofrancesco A, Kovacs D, Camera E, Ludovici M, et al. Azelaic acid reduced senescence-like phenotype in photo-irradiated human dermal fibroblasts: possible implication of PPARγ. Exp Dermatol. 2013;22(1):41–47.
    1. Akamatsu H, Komura J, Asada Y, Miyachi Y, Niwa Y. Inhibitory effect of azelaic acid on neutrophil functions: a possible cause for its efficacy in treating pathogenetically unrelated diseases. Arch Dermatol Res. 1991;283(3):162–166.
    1. Passi S, Picardo M, De Luca C, Breathnach AS, Nazzaro-Porro M. Scavenging activity of azelaic acid on hydroxyl radicals “in vitro”. Free Radic Res Commun. 1991;11(6):329–338.
    1. Draelos ZD. The rationale for advancing the formulation of azelaic acid vehicles. Cutis. 2006;77(2 Suppl):7–11.
    1. Draelos ZD, Elewski BE, Harper JC, Sand M, Staedtler G, Nkulikiyinka R, et al. A phase 3 randomized, double-blind, vehicle-controlled trial of azelaic acid foam 15% in the treatment of papulopustular rosacea. Cutis. 2015;96(1):54–61.
    1. Finacea (azelaic acid) Foam [Internet]. (cited 2016 Jun 29). Available from: .
    1. Gollnick HPM, Graupe K, Zaumseil R-P. Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies. J Dtsch Dermatol Ges J Ger Soc Dermatol. 2004;2(10):841–847.
    1. Novan Therapeutics:: Novan’s Phase 2b Results to be Presented at AAD [Internet]. (cited 2016 Jun 12). Available from: .
    1. PowerPoint Presentation - Novan_Phase_2b_AAD_2016.pdf [Internet]. (cited 2016 Jun 12). Available from: .
    1. DRM01: Dermira [Internet]. (cited 2016 Jun 12). Available from: .
    1. Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. Lancet Infect Dis. 2016;16(3):e23–e33.
    1. Elewski BE, Lamb BA, Sams WM, Gammon WR. In vivo suppression of neutrophil chemotaxis by systemically and topically administered tetracycline. J Am Acad Dermatol. 1983;8(6):807–812.
    1. Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742–750.
    1. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273(3):214–219.
    1. Watson RL, Dowell SF, Jayaraman M, Keyserling H, Kolczak M, Schwartz B. Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics. 1999;104(6):1251–1257.
    1. Meeker D, Linder JA, Fox CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA. 2016;315(6):562–570.
    1. Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003;49(1 Suppl):S1–S37.
    1. Dréno B. Bacteriological resistance in acne: A call to action. Eur J Dermatol EJD. 2015.
    1. Dréno B, Bettoli V, Ochsendorf F, Layton A, Mobacken H, Degreef H, et al. European recommendations on the use of oral antibiotics for acne. Eur J Dermatol. 2004;14(6):391–399.
    1. Nast A, Dréno B, Bettoli V, Degitz K, Erdmann R, Finlay AY, et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol. 2012;26(Suppl 1):1–29.
    1. Thiboutot D. Rethinking treatment of acne in the severe patient. J Drugs Dermatol. 2011;10(6):s8–s12.
    1. Nagler AR, Milam EC, Orlow SJ. The use of oral antibiotics before isotretinoin therapy in patients with acne. J Am Acad Dermatol. 2016;74(2):273–279.
    1. Peck GL, Olsen TG, Butkus D, Pandya M, Arnaud-Battandier J, Gross EG, et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. J Am Acad Dermatol. 1982;6(4 Pt 2 Suppl):735–745.
    1. Goldsmith LA, Bolognia JL, Callen JP, Chen SC, Feldman SR, Lim HW, et al. American Academy of Dermatology Consensus Conference on the safe and optimal use of isotretinoin: summary and recommendations. J Am Acad Dermatol. 2004;50(6):900–906.
    1. Lehucher-Ceyrac D, de La Salmonière P, Chastang C, Morel P. Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients. Dermatol Basel Switz. 1999;198(3):278–283.
    1. Blasiak RC, Stamey CR, Burkhart CN, Lugo-Somolinos A, Morrell DS. High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol. 2013;149(12):1392–1398.
    1. Rubinow DR, Peck GL, Squillace KM, Gantt GG. Reduced anxiety and depression in cystic acne patients after successful treatment with oral isotretinoin. J Am Acad Dermatol. 1987;17(1):25–32.
    1. Etminan M, Bird ST, Delaney JA, Bressler B, Brophy JM. Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data. JAMA Dermatol. 2013;149(2):216–220.
    1. Chia CY, Lane W, Chibnall J, Allen A, Siegfried E. Isotretinoin therapy and mood changes in adolescents with moderate to severe acne: a cohort study. Arch Dermatol. 2005;141(5):557–560.
    1. Cohen J, Adams S, Patten S. No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort. Can J Clin Pharmacol. 2007;14(2):e227–e233.
    1. Yentzer BA, Hick J, Reese EL, Uhas A, Feldman SR, Balkrishnan R. Acne vulgaris in the United States: a descriptive epidemiology. Cutis. 2010;86(2):94–99.
    1. Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. Br J Dermatol. 1997;136(1):66–70.
    1. Till AE, Goulden V, Cunliffe WJ, Holland KT. The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ. Br J Dermatol. 2000;142(5):885–892.
    1. Imperato-McGinley J, Gautier T, Cai LQ, Yee B, Epstein J, Pochi P. The androgen control of sebum production. Studies of subjects with dihydrotestosterone deficiency and complete androgen insensitivity. J Clin Endocrinol Metab. 1993;76(2):524–528.
    1. Lolis MS, Bowe WP, Shalita AR. Acne and systemic disease. Med Clin North Am. 2009;93(6):1161–1181.
    1. Thiboutot D, Chen W. Update and future of hormonal therapy in acne. Dermatol Basel Switz. 2003;206(1):57–67.
    1. Lucky AW, Koltun W, Thiboutot D, Niknian M, Sampson-Landers C, Korner P, et al. A combined oral contraceptive containing 3-mg drospirenone/20-microg ethinyl estradiol in the treatment of acne vulgaris: a randomized, double-blind, placebo-controlled study evaluating lesion counts and participant self-assessment. Cutis. 2008;82(2):143–150.
    1. Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115(2):227–232.
    1. Kim GK, Del Rosso JQ. Oral spironolactone in post-teenage female patients with acne vulgaris: practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012;5(3):37–50.
    1. Plovanich M, Weng QY, Mostaghimi A. Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne. JAMA Dermatol. 2015;151(9):941–944.
    1. Trifu V, Tiplica G-S, Naumescu E, Zalupca L, Moro L, Celasco G. Cortexolone 17α-propionate 1% cream, a new potent antiandrogen for topical treatment of acne vulgaris. A pilot randomized, double-blind comparative study vs. placebo and tretinoin 0.05% cream. Br J Dermatol. 2011;165(1):177–183.
    1. Afzali BM, Yaghoobi E, Yaghoobi R, Bagherani N, Dabbagh MA. Comparison of the efficacy of 5% topical spironolactone gel and placebo in the treatment of mild and moderate acne vulgaris: a randomized controlled trial. J Dermatol Treat. 2012;23(1):21–25.
    1. Dréno B, Fischer TC, Perosino E, Poli F, Viera MS, Rendon MI, et al. Expert opinion: efficacy of superficial chemical peels in active acne management—what can we learn from the literature today? Evidence-based recommendations. J Eur Acad Dermatol Venereol. 2011;25(6):695–704.
    1. Lee H-S, Kim I-H. Salicylic acid peels for the treatment of acne vulgaris in Asian patients. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2003;29(12):1196–1199.
    1. Pariser DM, Eichenfield LF, Bukhalo M, Waterman G, Jarratt M. PDT Study Group. Photodynamic therapy with methyl aminolaevulinate 80 mg g(−1) for severe facial acne vulgaris: a randomized vehicle-controlled study. Br J Dermatol. 2016;174(4):770–777.
    1. Potter RA. Intralesional triamcinolone and adrenal suppression in acne vulgaris. J Invest Dermatol. 1971;57(6):364–370.
    1. Karimipour DJ, Karimipour G, Orringer JS. Microdermabrasion: an evidence-based review. Plast Reconstr Surg. 2010;125(1):372–377.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅