Acne Handouts on Dermatologist's Website

For instance, Dermatologists of SW Ohio in Dayton, Ohio has added over 100 patient handouts regarding skin care topics to the practice’s own Website, including in-depth references to help their  patients manage their acne.

Dermatologists have published patient handouts online that cover a wide range of acne topics, including:

• adult acne, teenage acne, truncal acne, acne scars
• mild acne, moderate acne, and severe acne
• acne medications, such as topical retinoids (Differin, Epiduo, Retin A Micro), isotretinoin and oral antibiotics (minocycline, Solodyn).

Nearly 80% of people will experience some form of acne during their lifetimes. Acne is the most common skin disorder in the United States, affecting 60 million Americans at any one time, according to the American Academy of Dermatology (AAD). The American Acne and Rosacea Society (AARS) has established June as National Acne Awareness Month to increase awareness of the impact of acne on people’s lives and the various acne treatment options that are available.

The management of acne has evolved over the years with recent Acne Management Guidelines emphasizing the importance of early treatment prior to the formation of acne scars and the use of a topical retinoid as a mainstay of acne treatment and for long-term use to keep acne under control.

Newer acne treatment options include photodynamic therapy (PDT) and the development of combination acne medications that combine two active ingredients into one convenient formulation. More recent combination medications include Acanya, Epiduo, and Ziana.

There has long been rumor that a poor diet and consumption of junk food was associated with the development of acne, but this was long rebutted by “medical science”. However, more recent clinical studies have shown that high carbohydrate food (those with a high glycemic index) may, in fact, be associated with the development of acne. Interest in investigating the link between acne and diet was first renewed when epidemiological studies showed that cultures with a low carbohydrate diet (i.e. no candy, sodas) had a very low incidence of acne.

Lawrence Eichenfeld, M.D., Dermatologist

New acne medications that combine active ingredients provide a powerful and effective treatment option against acne, according to a leading dermatologist speaking at a medical conference of pediatricians.

“I can wipe out virtually anyone’s acne,” said Dr. Lawrence Eichenfeld, Assistant Chief of Pediatric and Adolescent Dermatology at the University of California, San Diego (UCSD).

Topical retinoids are now considered the standard therapy for most cases of acne because they treat “microcomedos”, the early precursors of a zit. In some cases, a topical or oral antibiotic, such as minocycline or doxycline, may be added to the treatment regimen.

The Propionibacterium acnes (P. Acnes) bacterias that causes the acne lesions to become inflamed can develop resistance to topical antibiotics. However, combining them with benzoyl peroxide reduces the risk of developing resistance.

Some pharmaceutical firms are now developing combination treatments that combine acne medications. Some medications combine benzoyl peroxide with clindamycin, such as Benzaclin. Others combine a topical retinoid with other agents, such as Ziana (tretinoin + clindamycin) and Epiduo (adapalene + benzoyl peroxide)

Dr. Eichenfeld considers these medications to be “excellent products“, but added that the drawback is the added cost. He pointed out that some of these combination acne medications can run as much as $160 a tube.

Dr. Eichenfled suggested that acne patients look for rebate coupons on the Internet.

Dr. Eichenfeld pointed out that topical treatments alone may not bring moderate to severe acne under control. In many cases, oral antibiotics may need to be prescribed in combination with topical retinoids. Older teenage female patients may be prescribed birth control pills as a way of reducing sebum production. In cases of severe acne, when the risk of developing acne scars is high, oral isotretinoin (Accutane) remains a standard of care.

The full story of Dr. Eichenfeld’s comments were published in Internal Medicine News.

Jeffrey Poole, M.D., Dermatologist

Acne treatment with isotretinoin is reviewed by leading dermatologist Jeffrey C. Poole, M.D.

Isotretinoin is the active ingredient of several oral acne medication brands, including Accutane (now withdrawn from the market), Amnesteem, and Sotret. Although there have been concerns raised about a range of possible side effects, isotretinoin continues to be prescribed for acne because of its unique benefits.

“Isotretinoin is by far our most effective therapy for acne, and has the potential to cure someone’s acne” said Dr. Poole.  “It is a very safe medicine when properly prescribed, and virtually every patient I have treated with isotretinoin is thrilled with the results and lack of significant side effects.”

Generally, isotretinoin has been thought of as a “last resort” treatment or for severe-nodular cystic acne.  According to Dr. Poole he prescribes isotretinoin in a wider variety of cases:

• for the persistant or resistant acne that is not responding well to standard treatments
• for the patient that is beginning to develop or at risk of developing acne scars
• for the patient with moderate but extensive acne at a young age with a family history of severe or scarring acne
• and often for the adult patient who has persistent moderate acne and is tired of all the creams and pills and wants a “cure”.

“These are some of the most common reasons I use for starting isotretinoin, but I address each person individually regarding their acne and situation, and often present isotretinoin as one, excellent option”, added Dr. Poole.

Dr. Jeffrey Poole is a board-certified dermatologist and pediatrician in private practice in Metairie, Louisana and serves as Assistant Clinical Professor of Dermatology at both the LSU and Tulane Schools of Medicine. He is a Fellow of the American Academy of Dermatology, the American Society of Dermatologic Surgery, the American Society of Laser Medicine and Surgery and the Society for Pediatric Dermatology. He is a member of the Louisiana Dermatologic Society and the Greater New Orleans Pediatric Society, and was recently elected President of the Louisiana Dermatological Society for 2008.

In order to minimize possible side effects from the use of isotretinoin, the FDA and pharmaceutical manufacturers established the iPledge program that requires that patients complete questionnaires or certain tests (such as a pregnancy test) prior to filling or refilling their prescription.

Adolescent acne associated with mental health risks

Teenagers with acne are at greater risk of having mental health problems and thoughts of suicide, according to a study published in the September 16, 2010 issue of the Journal of Investigative Dermatology.

According to the study’s authors, “acne is frequently found in late adolescence and is associated with social and psychological problems.

3,775 teenagers participate in the study, in which 14% reported having “a lot” and “very much” acne. Among girls with “very much” acne,  suicidal ideation was reported twice as often compared those girls with “no or “a little” acne. The risk for boys with “very much” acne was three times greater compared to pby with “no” or “a little” acne. (The survey was a way of gauging the person’s own perception of having mild, moderate or severe acne)

Accutane (now withdrawn from the market) and other forms of isotretinon have been scrutinized as a possible cause of depression and suicidal risk in those teeangers who were taking the medication.

The authors point out that “suicidal ideation and depression that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication.”

Alan Shalita, M.D., Acne expert

The article, “Acne and Diet” authored by acne experts Alan Shalita, M.D., Whitney Bowe, M.D., and Smita Joshi, M.D. and published in the July 2010 issue of the Journal of the American Academy of Dermatology (JAAD), critically reviewed the existing medical literature.

According to the authors, certain foods were thought to worsen acne before the 1960′s, but later studies showed no association and most physicians referred to the connection of acne and diet as a “myth”. Newer studies in the last decade have led dermatologists to revisit the link between diet and acne.

The authors stated that “dermatologists can no longer dismiss the association between diet and acne. Compelling evidence exists that high glycemic load diets may exacerbate acne.”  (High glycemic load diets result from eating carbohydrates, such as breads, pastas, deserts, sodas, and other foods manufactured with high fructose corn syrup.)

The authors added that “dairy ingestion appears to be weakly associated with acne, and the roles of omega-3 fatty acids, antioxidants, zinc, vitamin A, and dietary fiber remain to be elucidated.”

The review concluded that “we hope that this review will encourage others to explore the effects of diet on acne.”

In honor of this public health effort, more than 3,000 dermatologists have published in-depth acne education content to their practice Websites to help their patients manage their acne and understand their acne treatment options.

Dermatologists have published patient handouts that cover a wide range of skin care topics, including:

• Teenage acne and adult acne
• Mild acne, moderate acne, and severe acne.
• Acne medications, including topical retinoids (Differin, Epiduo, Retin A Micro), isotretinoin and oral antibiotics (minocycline, Solodyn)
• Acne scars and treatments for acne scars, including fractionated lasers

“Acne is a common skin disorder, and over reliance on over-the-counter medications may be ineffective and lead to the development of acne scars”, said Mark Becker, M.D. “We are pleased to expand our acne education content in support of Acne Awareness Month, because even mild acne can benefit from professional treatment.”

Nearly 80% of people will experience some form of acne during their lifetimes. Acne is the most common skin disorder in the United States, affecting 60 million Americans at any one time, according to the American Academy of Dermatology (AAD) and American Acne and Rosacea Society. Acne Awareness Month is promoted as a means to increase awareness of the impact of acne on people’s lives and the various acne treatment options that are available.

Hilary Baldwin, M.D, Dermatologist

She provides her patients and the New York City community with online access to variety of patient handouts that review the different types of acne (adult acne, teenager acne, truncal acne) and various acne treatments, including antibiotics, topical retinoids, and oral isotretinoin.

This provides additional evidence that the Internet offers a variety of ways to deliver medical care efficiently and improve access, while maintaining quality.

These recent study results were published in the April 2010 issue of the Archives of Dermatology, “A randomized trial to evaluate the efficacy of online follow-up visits in the management of acne“.

Acne patients who participated in “e-visits” with dermatologists experienced similar reductions in inflammatory lesions as those who had office visits. Dermatologists were satisfied with acne treatment they provided via eVisits. Although the dermatologists spent about the same amount of time per patient, the patients were spared the travel time to and from the doctor’s office.

The study explored some of the challenges of adopting a new technology into the practice workflow, and the limitations of applying eVisits across all patient populations. However, these limitations did not lessen the opportunity to derive efficiency and time savings from new technology. Because visual changes of the skin can be transmitted via the Internet and offer measurement of treatment responses, dermatology may be a medical specialty well suited for a variety of Web-based clinical applications.

How about follow up care via eVisits for rosacea (primarily a condition that affects the face and easily photographed by the patient at home)? Or how about eVisits to follow up on wound healing? There are a variety of applications.

Organizations like the Institute for Healthcare Improvement and telemedical companies are helping to move the ball forward. Of course all of this is a long way from being accepted, by both dermatologists and patients. Heck, using email to communicate with one’s doctor is still a long ways from being the norm.

But it’s interesting to think about what might lead to faster adoption. Higher gas prices that make the 15 mile drive to the doctor’s office a bit more expensive? Higher co-pays for an in-office visits? What about being told you can be seen online today, but have to wait 2 weeks to be seen in the office?

Just as the medical treatment options are evolving rapidly with the discovery of new medications and surgical procedures,  so are the ways in which medical care is delivered.

Topical retinoids are a standard component of acne treatment. They are useful for the management of both comedonal acne (blackheads and whiteheads) and inflammatory acne. In addition to generic tretinoin, there are several commonly prescribed brands of topical retinoids, including Differin™, Retin A Micro™, Tazorac™ and generic tretinoin. There are also newer brands that combine a topical retinoid with another acne medication, such as Epiduo™ (adapalene combined with benzoyl peroxide) and Ziana™ (tretinoin combined with clindamycin).

Dr. Benest wrote that “Topical retinoids (vitamin A related creams) play an integral role in the treatment and also prevention of acne. Almost all patients will benefit from a topical retinoid. The process of unblocking pores takes time and patience, often months. However, some results are seen almost immediately, they just continue to improve over time.”

Topical retinoids may be prescribed alone, particularly for cases of mild acne, or in combination with other topical or oral acne medications. They may also be prescribed for long-term use after the acne lesions have cleared to provide long-term acne control.

Dr. Benest provided her expert opinion regarding acne treatment with topical retinoids along with other leading dermatologists enrolled for the Vivacare patient education service.

Adapalene, the active ingredient of Differin, is a topical retinoid. Topical retinoids are a category of dermatology medication derived from vitamin A. They are a fundamental component of acne therapy and have also been shown to be safe and effective for the treatment of psoriasis and aging skin.

Differin has been available as a 0.1% gel, a 0.1% cream and a 0.3% gel. The new lotion is formulated for efficacy, tolerability and spreads easily. It will be available in a convenient, easy-to-use pump dispenser.

Like other topical retinoids, Differin may be prescribed for use alone or in combination with other acne medications, particularly for cases of moderate acne or severe acne.