Photodynamic Therapy Enhancement Using Clarisonic Brushes
By Michael H. Gold, M.D.
Prior to its release in early 2005, my practice was involved in evaluating the Clarisonic for its ability to cleanse the skin, particularly as an adjunct to prescription therapies for various skin conditions, such as acne and oily skin, but additionally for the cosmetic benefits of smoother, softer, and clearer skin.
In this article, I will discuss the benefits of adding the Clarisonic skincare brush to photodynamic therapy procedures, an off-label use of which is to improve the appearance of acne vulgaris, rosacea, sebaceous gland hyperplasia, oiliness of the skin, and improved texture and smoothness by minimizing pore size.
Photodynamic Therapy Treatment
Photodynamic therapy (PDT) is a treatment that utilizes 5-aminolevulinic acid (ALA) as a photosensitizing agent that is activated with a variety of lasers and light sources (e.g., blue lights, intense pulsed lights [IPL] and pulsed dye lasers [PDL]) for the treatment of various skin conditions.
In the United States, PDT is primarily used to treat photodamage with or without associated actinic keratoses. In Europe, PDT is primarily used for non-melanoma skin cancers. Although many U.S. doctors are very familiar with PDT, many do not regularly incorporate it into their practices for a variety of reasons — reimbursement being the most obvious at this time. There is, however, more PDT being performed today than at any other time in the United States, and the trend is for this to continue to increase.
This increase in PDT treatments is primarily due to its efficacy and an increase in public knowledge of PDT. In the United States, this public knowledge is growing but is still not great, whereas in Europe and other places around the world, PDT knowledge is much higher.
Indications for Clarisonic Brushes
In my practice, when we recommend any type of laser or light source treatments, chemical peels, or PDT procedures, we now begin those treatments by incorporating Clarisonic into the pre-treatment protocol as a high-tech cleansing step that we believe also improves the absorption of topical medications.
The Clarisonic and the Clarisonic MD skin care brushes were initially designed for gentle and effective daily facial cleansing. The oscillatory action of the brush works with the natural elasticity of the skin and pores to loosen dirt and oil, leaving the skin looking and feeling softer, smoother, and healthier.
Clinical studies conducted by Pacific Bioscience Laboratories, support Clarisonic’s effectiveness, gentleness, and benefits to the treatment of various skin disorders; these have been published in the scientific literature and presented at the American Academy of Dermatology.
How We Use Clarisonic Skincare Brushes
We’ve had great success incorporating the Clarisonic into our protocols, and in this instance, taking the standard ALA-PDT protocol to the next level by incorporating the brushes into several steps of the PDT treatment, including cleansing before and after microdermabrasion or an acetone scrub.
I’ve outlined our PDT procedure and suggest where incorporating the Clarisonic can be advantageous:
1. Patients arrive at the center. We discuss the process of the ALA-PDT procedure and provide the patient with home care instructions.
2. We instruct patients on use of the Clarisonic. We then usually have the patient cleanse their face with the Clarisonic and any type of soapless cleanser — we have a whole back-bar system of products — which cleansers we use really depends on the products that are being currently promoted from our medical spa. Prior to the applying ALA, the Clarisonic quickly and efficiently removes makeup from the skin while deep cleansing the pores. Absorption of ALA appears to improve and be distributed more uniformly.
3. An acetone scrub or microdermabrasion is then used to further prepare and exfoliate the skin.
4. The treatment medicine (ALA) is painted on to the treatment area — usually the full face.
5. The medicine is allowed to incubate for about an hour. During incubation, ALA targets photodamaged cells and is cleared from healthy, normal cells prior to ALA activation through laser/light exposure.
6. The medicine is usually wiped off.
7. The face/treatment area is again cleansed with the Clarisonic. By additionally cleansing with the brush immediately prior to PDT exposure, excess medicine can be removed to help ensure more precise targeting of only the photodamaged cells.
8. The laser or light source treatment is performed.
9. After treatment, the face is once again cleansed with the Clarisonic. I feel it adds benefit in making sure that any excess medicine is removed from the skin — crucial at the end of the procedure as medicine left on the skin can lead to photosensitivity.
10. The patient applies sunscreen and is instructed to stay out of the sun for the next 24 to 48 hours.
In summary, the Clarisonic skin care brush has proven effective as an adjunct to our PDT-ALA procedures. In our opinion, the advantages of Clarisonic over manual cleansing include superior cleansing prior to the treatment; increased absorption of the sensitizing drug Levulan; and more thorough removal of remaining medicine from the skin, which helps avoid photosensitivity.
Post-Hoc Subgroup Data Analysis of MORE Trial Finds Adult Females Respond Better to Acne Treatment than Adolescent Females
Post-hoc subgroup analysis of adult and adolescent females participating in a Measuring Acne Outcomes in a Real-World Experience (MORE) concluded that the adult females who had undergone treatment with adapalene gel 0.1% had better treatment outcomes than the adolescent female patients.
Study
Noting an increase in post-adolescent acne — either late onset or persistent — among females, a group of investigators evaluated data from an open-label, community-based, multi-center trial sponsored by Galderma Laboratories to compare treatment response in this population to that of the adolescent females participating in the trial.
The study from which their findings were extrapolated was a Phase IV study of the efficacy and safety of its adapalene gel, 0.1%, when used with other acne treatments, either as part of an initial combination regimen or as an add-on to the patient’s existing acne regimen.
Patients and Methods
In this post-hoc subgroup analysis, data obtained from the female patients were analyzed to observe trends in treatment responses between the adolescent population and the adult population.
The MORE trial had enrolled 1,277 female patients, with 550 patients in the adolescent population and 727 patients in the adult population. In this subgroup analysis, 1,092 patients comprised the female intent-to-treat population. Patients 12 to 19 years of age were in the adolescent population (481) and patients 20 years of age and older were in the adult population (611).
Results
While there was no difference in baseline acne severity or patient-reported treatment compliance between adolescents and adults at weeks 6 or 12, and both groups had satisfactory results, adult females had a statistically significant greater median percent change in total lesion counts (69.23%, P<.0001), including noninflammatory (67.86%, P <.0001) and inflammatory (76.67%, P<.0001) lesions.
Conclusions
Authors noted that although there was no difference in patient-reported treatment compliance between adolescents and adults, actual differences that were not reported may have occurred. In addition, in this trial, a patient who reported taking only 50% of doses was defined as compliant, so it was possible that meaningful differences related to compliance could be missed with this definition.
Poster authors: Stein Gold L, Colón LE, Johnson LA, Gottschalk RW.
Clindamycin-Benzoyl Peroxide Combo, Not Retinoid Choice, Key to Optimizing Acne Treatment
A community-based trial weighing combination therapy factors to maximize clinical efficacy while minimizing side effects suggested that the 5% benzoyl peroxide/1% clindamycin (BP/C) topical gel in combination with a retinoid was effective whether the retinoid was micronized tretinoin 0.04% or 0.1%. Citing concern about Propionibacterium acnes resistance, the researchers noted strategies to help prevent P.acnes resistance in acne therapy,which included minimizing long-term use of oral antibiotics, avoiding antibiotic monotherapy and using BP if long-term antibiotic therapy was required,making the point that products with benzoyl peroxide (BPO) + topical antibiotics have been shown to prevent antibiotic-resistant P.acnes.
Study
With that in mind,the purpose of the 12-week study, which was supported by an educational grant from Stiefel Laboratories, was to compare the use of BP/C with either micronized tretinoin gel 0.04% (RAM 0.04%),adapalene gel 0.1% (AP 0.1%) or micronized tretinoin gel 0.1% (RAM 0.1%) in a community setting.
In the largest well-controlled,community-based trial examining the use of topical BP/C in combination with retinoids, the prospective, randomized, investigator-blinded study enrolled 353 patients at 41 sites.
Findings
Topical benzoyl peroxide/clindamycin gel, in combination with micronized tretinoin gel,was found to be significantly superior to combination adapalene 0.1% gel in percent reduction of total inflammatory lesions with either micronized tretinoin 0.04% or 0.1% gel,and overall,adverse events were minimal and lower than those reported in retinoid monotherapy clinical trials.
Conclusion
To minimize the risk of bacterial resistance,the researchers recommended combining topical antibiotics with benzoyl peroxide.For optimal results they concluded,benzoyl peroxide/clindamycin gel should be initiated early in the acne treatment regimen and combined with either micronized tretinoin 0.04% or 0.1%.
Poster author: Kircik L.
Study Examines Insurance Claims to Discern Physician Prescribing Patterns for Newly Diagnosed Rosacea Patients
A poster presentation supported by CollaGenex Corporation indicated that treatment of rosacea has changed since the introduction of anti-inflammatory dose (40-mg delayed-release) doxycycline, noting that fewer pre- scriptions have been written for antibiotic-dose tetracyclines for rosacea,particularly by dermatologists.
These findings were based on a retrospective rosacea cohort analysis that evaluated privately-insured paid medical and prescription drug claims gathered from approximately 100 payers,including Blue Cross/Blue Shield plans and third-party administrators.
The author pointed out that prescription data used differentiated the usage of individual therapies specifically for patients diagnosed with rosacea,unlike commonly used databases that do not correlate individual prescriptions with diagnosis. The data consisted of insured patients who obtained care from more than 200,000 unique practitioners since 1999,representing 360 million annual claims in the United States.
Findings
Newly diagnosed patients with rosacea were most often treated initially with branded topical metronidazole formulations,although dermatologists were more likely than primary care providers to prescribe sulfacetamide sodium/sulfur or azelaic acid as initial therapy. Independent of specialty,the majority of these patients (approximately 50%) were prescribed a topical metronidazole formulation — although dermatologists were more likely to utilize another medical treatment alternative than were primary care physicians.
Dermatologists as a group were less likely to prescribe antibiotic-dose doxycycline than primary care providers (14.5% vs 27.6%). Patients treated by dermatologists were more likely to receive anti-inflammatory dose doxycycline than those treated by primary care providers.
Primary care providers wrote fewer prescriptions for anti-inflammatory dose doxycycline (40-mg delayed release),doing so less than 1% of the time for newly diagnosed patients.This prescribing behavior among this provider group is most likely due to less overall familiarity with this more-recent therapeutic option.
Poster author:Del Rosso JQ.
Photodynamic Therapy Enhancement Using Clarisonic Brushes
By Michael H. Gold, M.D.
Prior to its release in early 2005, my practice was involved in evaluating the Clarisonic for its ability to cleanse the skin, particularly as an adjunct to prescription therapies for various skin conditions, such as acne and oily skin, but additionally for the cosmetic benefits of smoother, softer, and clearer skin.
In this article, I will discuss the benefits of adding the Clarisonic skincare brush to photodynamic therapy procedures, an off-label use of which is to improve the appearance of acne vulgaris, rosacea, sebaceous gland hyperplasia, oiliness of the skin, and improved texture and smoothness by minimizing pore size.
Photodynamic Therapy Treatment
Photodynamic therapy (PDT) is a treatment that utilizes 5-aminolevulinic acid (ALA) as a photosensitizing agent that is activated with a variety of lasers and light sources (e.g., blue lights, intense pulsed lights [IPL] and pulsed dye lasers [PDL]) for the treatment of various skin conditions.
In the United States, PDT is primarily used to treat photodamage with or without associated actinic keratoses. In Europe, PDT is primarily used for non-melanoma skin cancers. Although many U.S. doctors are very familiar with PDT, many do not regularly incorporate it into their practices for a variety of reasons — reimbursement being the most obvious at this time. There is, however, more PDT being performed today than at any other time in the United States, and the trend is for this to continue to increase.
This increase in PDT treatments is primarily due to its efficacy and an increase in public knowledge of PDT. In the United States, this public knowledge is growing but is still not great, whereas in Europe and other places around the world, PDT knowledge is much higher.
Indications for Clarisonic Brushes
In my practice, when we recommend any type of laser or light source treatments, chemical peels, or PDT procedures, we now begin those treatments by incorporating Clarisonic into the pre-treatment protocol as a high-tech cleansing step that we believe also improves the absorption of topical medications.
The Clarisonic and the Clarisonic MD skin care brushes were initially designed for gentle and effective daily facial cleansing. The oscillatory action of the brush works with the natural elasticity of the skin and pores to loosen dirt and oil, leaving the skin looking and feeling softer, smoother, and healthier.
Clinical studies conducted by Pacific Bioscience Laboratories, support Clarisonic’s effectiveness, gentleness, and benefits to the treatment of various skin disorders; these have been published in the scientific literature and presented at the American Academy of Dermatology.
How We Use Clarisonic Skincare Brushes
We’ve had great success incorporating the Clarisonic into our protocols, and in this instance, taking the standard ALA-PDT protocol to the next level by incorporating the brushes into several steps of the PDT treatment, including cleansing before and after microdermabrasion or an acetone scrub.
I’ve outlined our PDT procedure and suggest where incorporating the Clarisonic can be advantageous:
1. Patients arrive at the center. We discuss the process of the ALA-PDT procedure and provide the patient with home care instructions.
2. We instruct patients on use of the Clarisonic. We then usually have the patient cleanse their face with the Clarisonic and any type of soapless cleanser — we have a whole back-bar system of products — which cleansers we use really depends on the products that are being currently promoted from our medical spa. Prior to the applying ALA, the Clarisonic quickly and efficiently removes makeup from the skin while deep cleansing the pores. Absorption of ALA appears to improve and be distributed more uniformly.
3. An acetone scrub or microdermabrasion is then used to further prepare and exfoliate the skin.
4. The treatment medicine (ALA) is painted on to the treatment area — usually the full face.
5. The medicine is allowed to incubate for about an hour. During incubation, ALA targets photodamaged cells and is cleared from healthy, normal cells prior to ALA activation through laser/light exposure.
6. The medicine is usually wiped off.
7. The face/treatment area is again cleansed with the Clarisonic. By additionally cleansing with the brush immediately prior to PDT exposure, excess medicine can be removed to help ensure more precise targeting of only the photodamaged cells.
8. The laser or light source treatment is performed.
9. After treatment, the face is once again cleansed with the Clarisonic. I feel it adds benefit in making sure that any excess medicine is removed from the skin — crucial at the end of the procedure as medicine left on the skin can lead to photosensitivity.
10. The patient applies sunscreen and is instructed to stay out of the sun for the next 24 to 48 hours.
In summary, the Clarisonic skin care brush has proven effective as an adjunct to our PDT-ALA procedures. In our opinion, the advantages of Clarisonic over manual cleansing include superior cleansing prior to the treatment; increased absorption of the sensitizing drug Levulan; and more thorough removal of remaining medicine from the skin, which helps avoid photosensitivity.
Post-Hoc Subgroup Data Analysis of MORE Trial Finds Adult Females Respond Better to Acne Treatment than Adolescent Females
Post-hoc subgroup analysis of adult and adolescent females participating in a Measuring Acne Outcomes in a Real-World Experience (MORE) concluded that the adult females who had undergone treatment with adapalene gel 0.1% had better treatment outcomes than the adolescent female patients.
Study
Noting an increase in post-adolescent acne — either late onset or persistent — among females, a group of investigators evaluated data from an open-label, community-based, multi-center trial sponsored by Galderma Laboratories to compare treatment response in this population to that of the adolescent females participating in the trial.
The study from which their findings were extrapolated was a Phase IV study of the efficacy and safety of its adapalene gel, 0.1%, when used with other acne treatments, either as part of an initial combination regimen or as an add-on to the patient’s existing acne regimen.
Patients and Methods
In this post-hoc subgroup analysis, data obtained from the female patients were analyzed to observe trends in treatment responses between the adolescent population and the adult population.
The MORE trial had enrolled 1,277 female patients, with 550 patients in the adolescent population and 727 patients in the adult population. In this subgroup analysis, 1,092 patients comprised the female intent-to-treat population. Patients 12 to 19 years of age were in the adolescent population (481) and patients 20 years of age and older were in the adult population (611).
Results
While there was no difference in baseline acne severity or patient-reported treatment compliance between adolescents and adults at weeks 6 or 12, and both groups had satisfactory results, adult females had a statistically significant greater median percent change in total lesion counts (69.23%, P<.0001), including noninflammatory (67.86%, P <.0001) and inflammatory (76.67%, P<.0001) lesions.
Conclusions
Authors noted that although there was no difference in patient-reported treatment compliance between adolescents and adults, actual differences that were not reported may have occurred. In addition, in this trial, a patient who reported taking only 50% of doses was defined as compliant, so it was possible that meaningful differences related to compliance could be missed with this definition.
Poster authors: Stein Gold L, Colón LE, Johnson LA, Gottschalk RW.
Clindamycin-Benzoyl Peroxide Combo, Not Retinoid Choice, Key to Optimizing Acne Treatment
A community-based trial weighing combination therapy factors to maximize clinical efficacy while minimizing side effects suggested that the 5% benzoyl peroxide/1% clindamycin (BP/C) topical gel in combination with a retinoid was effective whether the retinoid was micronized tretinoin 0.04% or 0.1%. Citing concern about Propionibacterium acnes resistance, the researchers noted strategies to help prevent P.acnes resistance in acne therapy,which included minimizing long-term use of oral antibiotics, avoiding antibiotic monotherapy and using BP if long-term antibiotic therapy was required,making the point that products with benzoyl peroxide (BPO) + topical antibiotics have been shown to prevent antibiotic-resistant P.acnes.
Study
With that in mind,the purpose of the 12-week study, which was supported by an educational grant from Stiefel Laboratories, was to compare the use of BP/C with either micronized tretinoin gel 0.04% (RAM 0.04%),adapalene gel 0.1% (AP 0.1%) or micronized tretinoin gel 0.1% (RAM 0.1%) in a community setting.
In the largest well-controlled,community-based trial examining the use of topical BP/C in combination with retinoids, the prospective, randomized, investigator-blinded study enrolled 353 patients at 41 sites.
Findings
Topical benzoyl peroxide/clindamycin gel, in combination with micronized tretinoin gel,was found to be significantly superior to combination adapalene 0.1% gel in percent reduction of total inflammatory lesions with either micronized tretinoin 0.04% or 0.1% gel,and overall,adverse events were minimal and lower than those reported in retinoid monotherapy clinical trials.
Conclusion
To minimize the risk of bacterial resistance,the researchers recommended combining topical antibiotics with benzoyl peroxide.For optimal results they concluded,benzoyl peroxide/clindamycin gel should be initiated early in the acne treatment regimen and combined with either micronized tretinoin 0.04% or 0.1%.
Poster author: Kircik L.
Study Examines Insurance Claims to Discern Physician Prescribing Patterns for Newly Diagnosed Rosacea Patients
A poster presentation supported by CollaGenex Corporation indicated that treatment of rosacea has changed since the introduction of anti-inflammatory dose (40-mg delayed-release) doxycycline, noting that fewer pre- scriptions have been written for antibiotic-dose tetracyclines for rosacea,particularly by dermatologists.
These findings were based on a retrospective rosacea cohort analysis that evaluated privately-insured paid medical and prescription drug claims gathered from approximately 100 payers,including Blue Cross/Blue Shield plans and third-party administrators.
The author pointed out that prescription data used differentiated the usage of individual therapies specifically for patients diagnosed with rosacea,unlike commonly used databases that do not correlate individual prescriptions with diagnosis. The data consisted of insured patients who obtained care from more than 200,000 unique practitioners since 1999,representing 360 million annual claims in the United States.
Findings
Newly diagnosed patients with rosacea were most often treated initially with branded topical metronidazole formulations,although dermatologists were more likely than primary care providers to prescribe sulfacetamide sodium/sulfur or azelaic acid as initial therapy. Independent of specialty,the majority of these patients (approximately 50%) were prescribed a topical metronidazole formulation — although dermatologists were more likely to utilize another medical treatment alternative than were primary care physicians.
Dermatologists as a group were less likely to prescribe antibiotic-dose doxycycline than primary care providers (14.5% vs 27.6%). Patients treated by dermatologists were more likely to receive anti-inflammatory dose doxycycline than those treated by primary care providers.
Primary care providers wrote fewer prescriptions for anti-inflammatory dose doxycycline (40-mg delayed release),doing so less than 1% of the time for newly diagnosed patients.This prescribing behavior among this provider group is most likely due to less overall familiarity with this more-recent therapeutic option.
Poster author:Del Rosso JQ.
Photodynamic Therapy Enhancement Using Clarisonic Brushes
By Michael H. Gold, M.D.
Prior to its release in early 2005, my practice was involved in evaluating the Clarisonic for its ability to cleanse the skin, particularly as an adjunct to prescription therapies for various skin conditions, such as acne and oily skin, but additionally for the cosmetic benefits of smoother, softer, and clearer skin.
In this article, I will discuss the benefits of adding the Clarisonic skincare brush to photodynamic therapy procedures, an off-label use of which is to improve the appearance of acne vulgaris, rosacea, sebaceous gland hyperplasia, oiliness of the skin, and improved texture and smoothness by minimizing pore size.
Photodynamic Therapy Treatment
Photodynamic therapy (PDT) is a treatment that utilizes 5-aminolevulinic acid (ALA) as a photosensitizing agent that is activated with a variety of lasers and light sources (e.g., blue lights, intense pulsed lights [IPL] and pulsed dye lasers [PDL]) for the treatment of various skin conditions.
In the United States, PDT is primarily used to treat photodamage with or without associated actinic keratoses. In Europe, PDT is primarily used for non-melanoma skin cancers. Although many U.S. doctors are very familiar with PDT, many do not regularly incorporate it into their practices for a variety of reasons — reimbursement being the most obvious at this time. There is, however, more PDT being performed today than at any other time in the United States, and the trend is for this to continue to increase.
This increase in PDT treatments is primarily due to its efficacy and an increase in public knowledge of PDT. In the United States, this public knowledge is growing but is still not great, whereas in Europe and other places around the world, PDT knowledge is much higher.
Indications for Clarisonic Brushes
In my practice, when we recommend any type of laser or light source treatments, chemical peels, or PDT procedures, we now begin those treatments by incorporating Clarisonic into the pre-treatment protocol as a high-tech cleansing step that we believe also improves the absorption of topical medications.
The Clarisonic and the Clarisonic MD skin care brushes were initially designed for gentle and effective daily facial cleansing. The oscillatory action of the brush works with the natural elasticity of the skin and pores to loosen dirt and oil, leaving the skin looking and feeling softer, smoother, and healthier.
Clinical studies conducted by Pacific Bioscience Laboratories, support Clarisonic’s effectiveness, gentleness, and benefits to the treatment of various skin disorders; these have been published in the scientific literature and presented at the American Academy of Dermatology.
How We Use Clarisonic Skincare Brushes
We’ve had great success incorporating the Clarisonic into our protocols, and in this instance, taking the standard ALA-PDT protocol to the next level by incorporating the brushes into several steps of the PDT treatment, including cleansing before and after microdermabrasion or an acetone scrub.
I’ve outlined our PDT procedure and suggest where incorporating the Clarisonic can be advantageous:
1. Patients arrive at the center. We discuss the process of the ALA-PDT procedure and provide the patient with home care instructions.
2. We instruct patients on use of the Clarisonic. We then usually have the patient cleanse their face with the Clarisonic and any type of soapless cleanser — we have a whole back-bar system of products — which cleansers we use really depends on the products that are being currently promoted from our medical spa. Prior to the applying ALA, the Clarisonic quickly and efficiently removes makeup from the skin while deep cleansing the pores. Absorption of ALA appears to improve and be distributed more uniformly.
3. An acetone scrub or microdermabrasion is then used to further prepare and exfoliate the skin.
4. The treatment medicine (ALA) is painted on to the treatment area — usually the full face.
5. The medicine is allowed to incubate for about an hour. During incubation, ALA targets photodamaged cells and is cleared from healthy, normal cells prior to ALA activation through laser/light exposure.
6. The medicine is usually wiped off.
7. The face/treatment area is again cleansed with the Clarisonic. By additionally cleansing with the brush immediately prior to PDT exposure, excess medicine can be removed to help ensure more precise targeting of only the photodamaged cells.
8. The laser or light source treatment is performed.
9. After treatment, the face is once again cleansed with the Clarisonic. I feel it adds benefit in making sure that any excess medicine is removed from the skin — crucial at the end of the procedure as medicine left on the skin can lead to photosensitivity.
10. The patient applies sunscreen and is instructed to stay out of the sun for the next 24 to 48 hours.
In summary, the Clarisonic skin care brush has proven effective as an adjunct to our PDT-ALA procedures. In our opinion, the advantages of Clarisonic over manual cleansing include superior cleansing prior to the treatment; increased absorption of the sensitizing drug Levulan; and more thorough removal of remaining medicine from the skin, which helps avoid photosensitivity.
Post-Hoc Subgroup Data Analysis of MORE Trial Finds Adult Females Respond Better to Acne Treatment than Adolescent Females
Post-hoc subgroup analysis of adult and adolescent females participating in a Measuring Acne Outcomes in a Real-World Experience (MORE) concluded that the adult females who had undergone treatment with adapalene gel 0.1% had better treatment outcomes than the adolescent female patients.
Study
Noting an increase in post-adolescent acne — either late onset or persistent — among females, a group of investigators evaluated data from an open-label, community-based, multi-center trial sponsored by Galderma Laboratories to compare treatment response in this population to that of the adolescent females participating in the trial.
The study from which their findings were extrapolated was a Phase IV study of the efficacy and safety of its adapalene gel, 0.1%, when used with other acne treatments, either as part of an initial combination regimen or as an add-on to the patient’s existing acne regimen.
Patients and Methods
In this post-hoc subgroup analysis, data obtained from the female patients were analyzed to observe trends in treatment responses between the adolescent population and the adult population.
The MORE trial had enrolled 1,277 female patients, with 550 patients in the adolescent population and 727 patients in the adult population. In this subgroup analysis, 1,092 patients comprised the female intent-to-treat population. Patients 12 to 19 years of age were in the adolescent population (481) and patients 20 years of age and older were in the adult population (611).
Results
While there was no difference in baseline acne severity or patient-reported treatment compliance between adolescents and adults at weeks 6 or 12, and both groups had satisfactory results, adult females had a statistically significant greater median percent change in total lesion counts (69.23%, P<.0001), including noninflammatory (67.86%, P <.0001) and inflammatory (76.67%, P<.0001) lesions.
Conclusions
Authors noted that although there was no difference in patient-reported treatment compliance between adolescents and adults, actual differences that were not reported may have occurred. In addition, in this trial, a patient who reported taking only 50% of doses was defined as compliant, so it was possible that meaningful differences related to compliance could be missed with this definition.
Poster authors: Stein Gold L, Colón LE, Johnson LA, Gottschalk RW.
Clindamycin-Benzoyl Peroxide Combo, Not Retinoid Choice, Key to Optimizing Acne Treatment
A community-based trial weighing combination therapy factors to maximize clinical efficacy while minimizing side effects suggested that the 5% benzoyl peroxide/1% clindamycin (BP/C) topical gel in combination with a retinoid was effective whether the retinoid was micronized tretinoin 0.04% or 0.1%. Citing concern about Propionibacterium acnes resistance, the researchers noted strategies to help prevent P.acnes resistance in acne therapy,which included minimizing long-term use of oral antibiotics, avoiding antibiotic monotherapy and using BP if long-term antibiotic therapy was required,making the point that products with benzoyl peroxide (BPO) + topical antibiotics have been shown to prevent antibiotic-resistant P.acnes.
Study
With that in mind,the purpose of the 12-week study, which was supported by an educational grant from Stiefel Laboratories, was to compare the use of BP/C with either micronized tretinoin gel 0.04% (RAM 0.04%),adapalene gel 0.1% (AP 0.1%) or micronized tretinoin gel 0.1% (RAM 0.1%) in a community setting.
In the largest well-controlled,community-based trial examining the use of topical BP/C in combination with retinoids, the prospective, randomized, investigator-blinded study enrolled 353 patients at 41 sites.
Findings
Topical benzoyl peroxide/clindamycin gel, in combination with micronized tretinoin gel,was found to be significantly superior to combination adapalene 0.1% gel in percent reduction of total inflammatory lesions with either micronized tretinoin 0.04% or 0.1% gel,and overall,adverse events were minimal and lower than those reported in retinoid monotherapy clinical trials.
Conclusion
To minimize the risk of bacterial resistance,the researchers recommended combining topical antibiotics with benzoyl peroxide.For optimal results they concluded,benzoyl peroxide/clindamycin gel should be initiated early in the acne treatment regimen and combined with either micronized tretinoin 0.04% or 0.1%.
Poster author: Kircik L.
Study Examines Insurance Claims to Discern Physician Prescribing Patterns for Newly Diagnosed Rosacea Patients
A poster presentation supported by CollaGenex Corporation indicated that treatment of rosacea has changed since the introduction of anti-inflammatory dose (40-mg delayed-release) doxycycline, noting that fewer pre- scriptions have been written for antibiotic-dose tetracyclines for rosacea,particularly by dermatologists.
These findings were based on a retrospective rosacea cohort analysis that evaluated privately-insured paid medical and prescription drug claims gathered from approximately 100 payers,including Blue Cross/Blue Shield plans and third-party administrators.
The author pointed out that prescription data used differentiated the usage of individual therapies specifically for patients diagnosed with rosacea,unlike commonly used databases that do not correlate individual prescriptions with diagnosis. The data consisted of insured patients who obtained care from more than 200,000 unique practitioners since 1999,representing 360 million annual claims in the United States.
Findings
Newly diagnosed patients with rosacea were most often treated initially with branded topical metronidazole formulations,although dermatologists were more likely than primary care providers to prescribe sulfacetamide sodium/sulfur or azelaic acid as initial therapy. Independent of specialty,the majority of these patients (approximately 50%) were prescribed a topical metronidazole formulation — although dermatologists were more likely to utilize another medical treatment alternative than were primary care physicians.
Dermatologists as a group were less likely to prescribe antibiotic-dose doxycycline than primary care providers (14.5% vs 27.6%). Patients treated by dermatologists were more likely to receive anti-inflammatory dose doxycycline than those treated by primary care providers.
Primary care providers wrote fewer prescriptions for anti-inflammatory dose doxycycline (40-mg delayed release),doing so less than 1% of the time for newly diagnosed patients.This prescribing behavior among this provider group is most likely due to less overall familiarity with this more-recent therapeutic option.
Poster author:Del Rosso JQ.
