Emil Tanghetti - Academia.edu (original) (raw)

Papers by Emil Tanghetti

Research paper thumbnail of Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 5: a guide on the management of rosacea

Cutis, Mar 1, 2014

The last article in this 5-part series provides a final overview of consensus recommendations fro... more The last article in this 5-part series provides a final overview of consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. Optimal management of rosacea requires careful assessment of the patient's clinical features with integration of therapies that adequately treat the presenting signs and symptoms. The treatment consensus recommendations from the AARS are based on 2 major common clinical presentations of rosacea: (1) centrofacial erythema with papulopustular lesions, and (2) centrofacial erythema without papulopustular lesions. The recommendations provided here serve to guide clinicians in their clinical practice.

Research paper thumbnail of The Evolution of Benzoyl Peroxide Therapy

Research paper thumbnail of Cynergy with MultiPlex Provides Double Effect for Vascular Lesions Aesthetic Buyers Guide

Research paper thumbnail of Therapeutic dermabrasion

Research paper thumbnail of An Observation Study Evaluating the Treatment of Plaque Psoriasis With Tazarotene Gels, Alone and With an Emollient and/or Corticosteroid

Cutis; cutaneous medicine for the practitioner

A large-scale observation study has been performed to evaluate how tazarotene is used to treat pl... more A large-scale observation study has been performed to evaluate how tazarotene is used to treat plaque psoriasis in everyday clinical practice and to elucidate whether the efficacy and tolerability of tazarotene treatment can be optimized through the adjunctive use of an emollient and/or a topical corticosteroid. A total of 1393 patients with mild-to-moderate stable plaque psoriasis applied tazarotene 0.05% or 0.1% gel once daily for up to 12 weeks, either as monotherapy or in combination with other topical psoriasis therapies as deemed necessary by the investigator. The adjunctive use of an emollient and/or a corticosteroid enhanced the efficacy of tazarotene treatment and increased the percentage of patients who were satisfied with their treatment. Adjunctive steroid use also enhanced tolerability. The optimal treatment regimen was combination therapy of tazarotene and a corticosteroid.

Research paper thumbnail of Optimizing the use of tazarotene for the treatment of facial acne vulgaris through combination therapy

Cutis; cutaneous medicine for the practitioner

A multicenter, investigator-masked, randomized, parallel-group study was performed in 440 patient... more A multicenter, investigator-masked, randomized, parallel-group study was performed in 440 patients with mild-to-moderate facial acne vulgaris to compare the efficacy and tolerability of tazarotene monotherapy with 3 combination regimens--tazarotene plus benzoyl peroxide gel, tazarotene plus erythromycin/benzoyl peroxide gel, and tazarotene plus clindamycin phosphate lotion. An additional treatment group-monotherapy with clindamycin phosphate lotion-also was included as a reference arm. The only combination therapy to achieve a significantly greater global improvement than tazarotene monotherapy was tazarotene plus clindamycin. For reducing noninflammatory lesions specifically, none of the combination regimens offered significant benefit over tazarotene monotherapy (though tazarotene plus clindamycin and tazarotene plus erythromycin/benzoyl peroxide were significantly more efficacious than clindamycin monotherapy). For reducing inflammatory lesions, tazarotene plus erythromycin/benzoyl peroxide was significantly more efficacious than all the other regimens. Although tazarotene plus clindamycin and tazarotene plus benzoyl peroxide reduced the incidence of adverse effects compared with tazarotene monotherapy, the difference did not achieve statistical significance.

Research paper thumbnail of The clinical impact of vehicle technology using a patented formulation of benzoyl peroxide 5%/clindamycin 1% gel: comparative assessments of skin tolerability and evaluation of combination use with a topical retinoid

Journal of drugs in dermatology: JDD

A major challenge encountered in clinical practice in patients with acne vulgaris is irritation r... more A major challenge encountered in clinical practice in patients with acne vulgaris is irritation related to topical medications used for treatment. Advances in vehicle technology have improved formulations containing active ingredients known to produce irritation in some patients, such as benzoyl peroxide (BP) and topical retinoids. Clinical studies, including combination therapy studies have demonstrated that certain additives, such as silicates and specific humectants, reduce irritation by maintaining barrier integrity. A patented gel formulation of BP 5%/clindamycin phosphate 1% (clindamycin) containing dimethicone and glycerin has been studied both as a monotherapy and in combination with topical retinoid use. This article evaluates specific vehicle additives included in this gel formulation and explains their role in reducing irritation. Data from clinical trials utilizing this technology in acne management are also reviewed.

Research paper thumbnail of Solubilized benzoyl peroxide versus benzoyl peroxide/clindamycin in the treatment of moderate acne

Journal of drugs in dermatology: JDD

Benzoyl peroxide (BPO) is poorly soluble. A solubilized formulation of BPO has been developed to ... more Benzoyl peroxide (BPO) is poorly soluble. A solubilized formulation of BPO has been developed to maximize its bioavailability and enhance follicular penetration. Patients with acne vulgaris were randomly assigned to receive solubilized BPO 5% gel on one side of the face and a BPO 5%/clindamycin 1% combination product on the contralateral side, twice daily for 4 weeks. Of 23 patients enrolled, 100% completed the study. Reductions in lesion count with the solubilized BPO gel were at least as great as with BPO/clindamycin--and significantly greater (P< or =.05) for noninflammatory lesions at week 1 and inflammatory lesions at week 4. Both regimens were generally well tolerated and patient satisfaction was comparable. Solubilized BPO 5% gel monotherapy offers significantly greater efficacy, and comparable patient satisfaction, compared with BPO/clindamycin. The early reduction in lesion counts observed with the solubilized BPO gel in the absence of an antibiotic is clinically relevant.

Research paper thumbnail of The role of topical vitamin D modulators in psoriasis therapy

Journal of drugs in dermatology: JDD

Psoriasis affects more than 5 million adults in the United States (U.S.), causing significant imp... more Psoriasis affects more than 5 million adults in the United States (U.S.), causing significant impairments in quality of life and incurring substantial costs in treatment. The disease is characterized by hyperproliferation and abnormal differentiation of epidermal keratinocytes resulting from a disordered immune response. Topical therapies, such as corticosteroids, are the most common treatment for psoriasis. However, long-term use of more potent topical corticosteroids is associated with potential risk for side effects. Topical vitamin D agents have been developed as a newer therapeutic option for use in place of, or in addition to, topical corticosteroids. These agents act to inhibit keratinocyte proliferation, normalize differentiation and modulate the activity of immune cells with minimal effect on serum calcium hemostasis. Calcipotriene is the most widely used member of this class, and is one of the most frequently prescribed topical agents for psoriasis. Although evidence suggests that it is approximately as effective as low-to-medium potency corticosteroids, it is associated with cutaneous irritation, especially when used in sensitive areas. Calcitriol ointment is a new option for topical therapy and is the only vitamin D3 ointment available for use in the U.S. and contains the naturally occurring active form of vitamin D3 that is associated with a relatively low rate of side effects.

Research paper thumbnail of Tazarotene versus tazarotene plus clindamycin/ben-zoyl peroxide in the treatment of acne vulgaris: a multicenter, double-blind, randomized parallel-group trial

Journal of drugs in dermatology: JDD

Topical retinoids offer highly effective treatment for both inflammatory and non-inflammatory acn... more Topical retinoids offer highly effective treatment for both inflammatory and non-inflammatory acne, with tazarotene demonstrating greater efficacy than other topical retinoids. A multicenter, double-blind, randomized, parallel-group trial has been performed to evaluate whether the adjunctive use of clindamycin/benzoyl peroxide could enhance the efficacy of tazarotene still further. Patients with moderate to severe inflammatory acne applied tazarotene 0.1% cream each evening and were randomly assigned to morning applications of vehicle gel or a ready-to-dispense formulation of clindamycin 1%/benzoyl peroxide 5 % gel containing 2 emollients. Tazarotene/clindamycin/benzoyl peroxide achieved a significantly greater reduction in comedo count than tazarotene monotherapy and, among patients with a baseline papule plus pustule count of > or =25 (the median value), a significantly greater reduction in inflammatory lesion count. The combination therapy was also at least as well-tolerated as tazarotene monotherapy. The adjunctive use of clindamycin/benzoyl peroxide gel with tazarotene cream promotes greater efficacy and may also enhance tolerability. Any improvements in tolerability could be due to the emollients in the clindamycin/benzoyl peroxide gel formulation.

Research paper thumbnail of Tazarotene 0.1 percent cream plus clindamycin 1 percent gel versus tretinoin 0.025 percent gel plus clindamycin 1 percent gel in the treatment of facial acne vulgaris

Dermatology online journal

Topical retinoids are the cornerstone of therapy for acne vulgaris. Nevertheless, the adjunctive ... more Topical retinoids are the cornerstone of therapy for acne vulgaris. Nevertheless, the adjunctive use of other anti-acne agents can help enhance the efficacy of topical retinoids still further. Given that tazarotene 0.1 percent gel has previously shown significantly greater efficacy than tretinoin 0.025 percent gel, it is likely that tazarotene plus clindamycin offers superior efficacy to tretinoin plus clindamycin, which has recently become available as a combination product. A total of 150 patients with facial acne vulgaris were randomly assigned to receive either tazarotene 0.1 percent cream plus clindamycin 1 percent gel, or tretinoin 0.025 percent gel plus clindamycin 1 percent gel. Each medication was applied once daily in the evening (clindamycin followed by the retinoid 5-10 minutes later) for up to 12 weeks. At week 12, the reduction from baseline in lesion counts was greater with tazarotene/clindamycin than tretinoin/clindamycin for both the non-inflammatory lesion count (71% vs. 52%, p< or =.01) and the inflammatory lesion count (77% vs. 67%, P=.053). Tazarotene/clindamycin also resulted in a significantly higher incidence of patients achieving > or = 50 percent global improvement (incidence of 88% vs. 75% at week 12; p< or =.05). Both regimens were similarly well tolerated. In the treatment of facial acne vulgaris, tazarotene plus clindamycin offers significantly greater efficacy than tretinoin plus clindamycin and has comparable tolerability.

Research paper thumbnail of Comparison of 5% 5-fluorouracil cream and 5% imiquimod cream in the management of actinic keratoses on the face

Journal of drugs in dermatology: JDD

It is timely to compare the efficacy and tolerability of 2 actinic keratosis (AK) therapies--5% 5... more It is timely to compare the efficacy and tolerability of 2 actinic keratosis (AK) therapies--5% 5-fluorouracil (5-FU) cream and imiquimod cream. Thirty-six patients with 4 or more AKs were randomly assigned to receive 5% 5-FU cream twice daily for 2 to 4 weeks or 5% imiquimod cream twice weekly for 16 weeks. Five percent 5-FU was more effective than imiquimod in exposing what were presumed to be subclinical AKs, reducing the final AK count (total AK count declined during the 24-week study by 94% vs. 66%, P < .05), achieving complete clearance (incidence of 84% vs. 24% by week 24, P < .01), and achieving clearance rapidly. Tolerability was similar except for erythema, which was initially significantly higher with 5-FU than imiquimod but resolved rapidly and was significantly lower than imiquimod by week 16. Five percent 5-FU remains the gold standard field therapy for AKs.

Research paper thumbnail of Combining clindamycin 1%-benzoyl peroxide 5% gel with multiple therapeutic options

Cutis; cutaneous medicine for the practitioner

This article reports on recent studies and case reports that evaluated the stability, tolerabilit... more This article reports on recent studies and case reports that evaluated the stability, tolerability, and efficacy of clindamycin 1%-benzoyl peroxide 5% tube gel in combination with topical retinoids and oral antibiotics. Overall, these combinations appeared to be well-tolerated, effective, and, as reported in the case studies, adaptable to common clinical practice.

Research paper thumbnail of An evaluation of potential correlations between pathophysiologic mechanisms, clinical manifestations, and management of rosacea

Cutis; cutaneous medicine for the practitioner

This article discusses rosacea, a common facial dermatosis of uncertain etiology and recent inves... more This article discusses rosacea, a common facial dermatosis of uncertain etiology and recent investigations that have begun to shed considerable light on the sequence of events leading to clinical manifestations of rosacea. The article content is based on a dedicated meeting about rosacea sanctioned by the American Acne & Rosacea Society (AARS) and represents the consensus of the authors and AARS Board of Directors.

Research paper thumbnail of The noncompliant patient with acne

Skin therapy letter

Clinical studies with topical and systemic agents for acne show remarkable improvement over a 3 m... more Clinical studies with topical and systemic agents for acne show remarkable improvement over a 3 month period of time, with continued progress in long-term use. However, in clinical practice it is uncommon to see these favorable results. Clinical experience and recent published data suggest that compliance, perhaps better referred to as adherence, is a major obstacle in achieving these outcomes. This article will review this problem and offer a number of suggestions, including dosing considerations and the use of laser/light devices, to better treat the nonadherent patient.

Research paper thumbnail of Understanding the burden of adult female acne

The Journal of clinical and aesthetic dermatology, 2014

Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limite... more Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women. Cross-sectional, web-based survey. Data were collected from a diverse sample of United States females. Women ages 25 to 45 years with facial acne (≥25 visible lesions). Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity. A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin,...

Research paper thumbnail of Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 3: a status report on systemic therapies

Cutis, 2014

The third article in this 5-part series reviews systemic therapies used to treat cutaneous rosace... more The third article in this 5-part series reviews systemic therapies used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The consensus recommendations are based on current understanding of research that describes pathophysiologic mechanisms that appear to be operative in rosacea, correlation of these underlying pathophysiologic mechanisms with specific clinical manifestations of rosacea, and outcomes from clinical trials that evaluate therapies for rosacea both as monotherapy and in combination with other agents. Systemic agents used for treatment of rosacea have been administered as oral formulations (ie, tablets, capsules). The only oral agent for rosacea approved by the US Food and Drug Administration (FDA) is a modified-release doxycycline 40-mg capsule. Other non-FDA-approved oral agents also are discussed including other tetracyclines, macrolides, me...

Research paper thumbnail of The role of inflammation in the pathology of acne

The Journal of clinical and aesthetic dermatology, 2013

The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes th... more The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes the duct of the sebaceous follicle, causing an innate immune response and the progression from a so-called noninflammatory comedo to an inflammatory papule, pustule, or nodule. However, this viewpoint has come under increasing scrutiny over the last decade, as evidence has emerged supporting a role for inflammation at all stages of acne lesion development, perhaps subclinically even before comedo formation. The immunochemical pathways underlying the initiation and propagation of the inflammation in acne are complex and still being elucidated, but may involve Propionibacterium acnes as well as several inflammatory mediators and their target receptors, including cytokines, defensins, peptidases, sebum lipids, and neuropeptides. This review presents evidence to support the notion that acne is primarily an inflammatory disease, challenging the current nomenclature of noninflammatory versus inf...

Research paper thumbnail of A status report on topical tazarotene in the management of acne vulgaris

Journal of drugs in dermatology : JDD, 2013

Tazarotene is a synthetic retinoid that, depending on the concentration and vehicle, is approved ... more Tazarotene is a synthetic retinoid that, depending on the concentration and vehicle, is approved by the US Food and Drug Administration for the topical treatment of acne vulgaris (AV) and plaque psoriasis. Tazarotene is also used as adjunctive treatment for specified clinical manifestations of chronically photodamaged skin (facial fine wrinkling, mottled facial hypopigmentation and hyperpigmentation, and benign facial lentigines), along with comprehensive skin care and photoprotection from sunlight. The gel formulation was released in the United States in 1997, with the cream formulation made available in 2000. Multiple studies are available supporting the effective and safe use of topical tazarotene for each of its indications. This article provides an overview of the pharmacology of topically applied tazarotene, discussing in particular up-to-date information on the efficacy, tolerability, and safety of topical tazarotene for AV, including monotherapy and combination therapy studi...

Research paper thumbnail of A Three-Step Acne System Containing Solubilized Benzoyl Peroxide versus Benzoyl Peroxide/Clindamycin in Pediatric Patients with Acne

The Journal of clinical and aesthetic dermatology, 2009

Objective. To evaluate the clinical benefit in adolescents of a three-step acne system containing... more Objective. To evaluate the clinical benefit in adolescents of a three-step acne system containing solubilized benzoyl peroxide. Design. Patients in this multicenter, investigator-blind trial were randomly assigned to receive 10 weeks of treatment with either the three-step acne system for normal-to-oily skin (proprietary 2% salicylic acid cleanser twice daily + proprietary 2% salicylic acid toner once daily + solubilized 5% benzoyl peroxide gel twice daily) or with control cleanser + 5% benzoyl peroxide/1% clindamycin gel twice daily. Setting. Patients seeking acne treatment from a dermatologist. Pediatric subgroup analysis from a larger trial. Participants. Eighty-two adolescents with mild-to-moderate facial acne vulgaris. Measurements. Noninflammatory and inflammatory lesion counts, erythema, dryness, peeling, burning/stinging, and itching. Results. The three-step acne system was significantly more effective than benzoyl peroxide/clindamycin in reducing the noninflammatory lesion ...

Research paper thumbnail of Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 5: a guide on the management of rosacea

Cutis, Mar 1, 2014

The last article in this 5-part series provides a final overview of consensus recommendations fro... more The last article in this 5-part series provides a final overview of consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. Optimal management of rosacea requires careful assessment of the patient's clinical features with integration of therapies that adequately treat the presenting signs and symptoms. The treatment consensus recommendations from the AARS are based on 2 major common clinical presentations of rosacea: (1) centrofacial erythema with papulopustular lesions, and (2) centrofacial erythema without papulopustular lesions. The recommendations provided here serve to guide clinicians in their clinical practice.

Research paper thumbnail of The Evolution of Benzoyl Peroxide Therapy

Research paper thumbnail of Cynergy with MultiPlex Provides Double Effect for Vascular Lesions Aesthetic Buyers Guide

Research paper thumbnail of Therapeutic dermabrasion

Research paper thumbnail of An Observation Study Evaluating the Treatment of Plaque Psoriasis With Tazarotene Gels, Alone and With an Emollient and/or Corticosteroid

Cutis; cutaneous medicine for the practitioner

A large-scale observation study has been performed to evaluate how tazarotene is used to treat pl... more A large-scale observation study has been performed to evaluate how tazarotene is used to treat plaque psoriasis in everyday clinical practice and to elucidate whether the efficacy and tolerability of tazarotene treatment can be optimized through the adjunctive use of an emollient and/or a topical corticosteroid. A total of 1393 patients with mild-to-moderate stable plaque psoriasis applied tazarotene 0.05% or 0.1% gel once daily for up to 12 weeks, either as monotherapy or in combination with other topical psoriasis therapies as deemed necessary by the investigator. The adjunctive use of an emollient and/or a corticosteroid enhanced the efficacy of tazarotene treatment and increased the percentage of patients who were satisfied with their treatment. Adjunctive steroid use also enhanced tolerability. The optimal treatment regimen was combination therapy of tazarotene and a corticosteroid.

Research paper thumbnail of Optimizing the use of tazarotene for the treatment of facial acne vulgaris through combination therapy

Cutis; cutaneous medicine for the practitioner

A multicenter, investigator-masked, randomized, parallel-group study was performed in 440 patient... more A multicenter, investigator-masked, randomized, parallel-group study was performed in 440 patients with mild-to-moderate facial acne vulgaris to compare the efficacy and tolerability of tazarotene monotherapy with 3 combination regimens--tazarotene plus benzoyl peroxide gel, tazarotene plus erythromycin/benzoyl peroxide gel, and tazarotene plus clindamycin phosphate lotion. An additional treatment group-monotherapy with clindamycin phosphate lotion-also was included as a reference arm. The only combination therapy to achieve a significantly greater global improvement than tazarotene monotherapy was tazarotene plus clindamycin. For reducing noninflammatory lesions specifically, none of the combination regimens offered significant benefit over tazarotene monotherapy (though tazarotene plus clindamycin and tazarotene plus erythromycin/benzoyl peroxide were significantly more efficacious than clindamycin monotherapy). For reducing inflammatory lesions, tazarotene plus erythromycin/benzoyl peroxide was significantly more efficacious than all the other regimens. Although tazarotene plus clindamycin and tazarotene plus benzoyl peroxide reduced the incidence of adverse effects compared with tazarotene monotherapy, the difference did not achieve statistical significance.

Research paper thumbnail of The clinical impact of vehicle technology using a patented formulation of benzoyl peroxide 5%/clindamycin 1% gel: comparative assessments of skin tolerability and evaluation of combination use with a topical retinoid

Journal of drugs in dermatology: JDD

A major challenge encountered in clinical practice in patients with acne vulgaris is irritation r... more A major challenge encountered in clinical practice in patients with acne vulgaris is irritation related to topical medications used for treatment. Advances in vehicle technology have improved formulations containing active ingredients known to produce irritation in some patients, such as benzoyl peroxide (BP) and topical retinoids. Clinical studies, including combination therapy studies have demonstrated that certain additives, such as silicates and specific humectants, reduce irritation by maintaining barrier integrity. A patented gel formulation of BP 5%/clindamycin phosphate 1% (clindamycin) containing dimethicone and glycerin has been studied both as a monotherapy and in combination with topical retinoid use. This article evaluates specific vehicle additives included in this gel formulation and explains their role in reducing irritation. Data from clinical trials utilizing this technology in acne management are also reviewed.

Research paper thumbnail of Solubilized benzoyl peroxide versus benzoyl peroxide/clindamycin in the treatment of moderate acne

Journal of drugs in dermatology: JDD

Benzoyl peroxide (BPO) is poorly soluble. A solubilized formulation of BPO has been developed to ... more Benzoyl peroxide (BPO) is poorly soluble. A solubilized formulation of BPO has been developed to maximize its bioavailability and enhance follicular penetration. Patients with acne vulgaris were randomly assigned to receive solubilized BPO 5% gel on one side of the face and a BPO 5%/clindamycin 1% combination product on the contralateral side, twice daily for 4 weeks. Of 23 patients enrolled, 100% completed the study. Reductions in lesion count with the solubilized BPO gel were at least as great as with BPO/clindamycin--and significantly greater (P< or =.05) for noninflammatory lesions at week 1 and inflammatory lesions at week 4. Both regimens were generally well tolerated and patient satisfaction was comparable. Solubilized BPO 5% gel monotherapy offers significantly greater efficacy, and comparable patient satisfaction, compared with BPO/clindamycin. The early reduction in lesion counts observed with the solubilized BPO gel in the absence of an antibiotic is clinically relevant.

Research paper thumbnail of The role of topical vitamin D modulators in psoriasis therapy

Journal of drugs in dermatology: JDD

Psoriasis affects more than 5 million adults in the United States (U.S.), causing significant imp... more Psoriasis affects more than 5 million adults in the United States (U.S.), causing significant impairments in quality of life and incurring substantial costs in treatment. The disease is characterized by hyperproliferation and abnormal differentiation of epidermal keratinocytes resulting from a disordered immune response. Topical therapies, such as corticosteroids, are the most common treatment for psoriasis. However, long-term use of more potent topical corticosteroids is associated with potential risk for side effects. Topical vitamin D agents have been developed as a newer therapeutic option for use in place of, or in addition to, topical corticosteroids. These agents act to inhibit keratinocyte proliferation, normalize differentiation and modulate the activity of immune cells with minimal effect on serum calcium hemostasis. Calcipotriene is the most widely used member of this class, and is one of the most frequently prescribed topical agents for psoriasis. Although evidence suggests that it is approximately as effective as low-to-medium potency corticosteroids, it is associated with cutaneous irritation, especially when used in sensitive areas. Calcitriol ointment is a new option for topical therapy and is the only vitamin D3 ointment available for use in the U.S. and contains the naturally occurring active form of vitamin D3 that is associated with a relatively low rate of side effects.

Research paper thumbnail of Tazarotene versus tazarotene plus clindamycin/ben-zoyl peroxide in the treatment of acne vulgaris: a multicenter, double-blind, randomized parallel-group trial

Journal of drugs in dermatology: JDD

Topical retinoids offer highly effective treatment for both inflammatory and non-inflammatory acn... more Topical retinoids offer highly effective treatment for both inflammatory and non-inflammatory acne, with tazarotene demonstrating greater efficacy than other topical retinoids. A multicenter, double-blind, randomized, parallel-group trial has been performed to evaluate whether the adjunctive use of clindamycin/benzoyl peroxide could enhance the efficacy of tazarotene still further. Patients with moderate to severe inflammatory acne applied tazarotene 0.1% cream each evening and were randomly assigned to morning applications of vehicle gel or a ready-to-dispense formulation of clindamycin 1%/benzoyl peroxide 5 % gel containing 2 emollients. Tazarotene/clindamycin/benzoyl peroxide achieved a significantly greater reduction in comedo count than tazarotene monotherapy and, among patients with a baseline papule plus pustule count of > or =25 (the median value), a significantly greater reduction in inflammatory lesion count. The combination therapy was also at least as well-tolerated as tazarotene monotherapy. The adjunctive use of clindamycin/benzoyl peroxide gel with tazarotene cream promotes greater efficacy and may also enhance tolerability. Any improvements in tolerability could be due to the emollients in the clindamycin/benzoyl peroxide gel formulation.

Research paper thumbnail of Tazarotene 0.1 percent cream plus clindamycin 1 percent gel versus tretinoin 0.025 percent gel plus clindamycin 1 percent gel in the treatment of facial acne vulgaris

Dermatology online journal

Topical retinoids are the cornerstone of therapy for acne vulgaris. Nevertheless, the adjunctive ... more Topical retinoids are the cornerstone of therapy for acne vulgaris. Nevertheless, the adjunctive use of other anti-acne agents can help enhance the efficacy of topical retinoids still further. Given that tazarotene 0.1 percent gel has previously shown significantly greater efficacy than tretinoin 0.025 percent gel, it is likely that tazarotene plus clindamycin offers superior efficacy to tretinoin plus clindamycin, which has recently become available as a combination product. A total of 150 patients with facial acne vulgaris were randomly assigned to receive either tazarotene 0.1 percent cream plus clindamycin 1 percent gel, or tretinoin 0.025 percent gel plus clindamycin 1 percent gel. Each medication was applied once daily in the evening (clindamycin followed by the retinoid 5-10 minutes later) for up to 12 weeks. At week 12, the reduction from baseline in lesion counts was greater with tazarotene/clindamycin than tretinoin/clindamycin for both the non-inflammatory lesion count (71% vs. 52%, p< or =.01) and the inflammatory lesion count (77% vs. 67%, P=.053). Tazarotene/clindamycin also resulted in a significantly higher incidence of patients achieving > or = 50 percent global improvement (incidence of 88% vs. 75% at week 12; p< or =.05). Both regimens were similarly well tolerated. In the treatment of facial acne vulgaris, tazarotene plus clindamycin offers significantly greater efficacy than tretinoin plus clindamycin and has comparable tolerability.

Research paper thumbnail of Comparison of 5% 5-fluorouracil cream and 5% imiquimod cream in the management of actinic keratoses on the face

Journal of drugs in dermatology: JDD

It is timely to compare the efficacy and tolerability of 2 actinic keratosis (AK) therapies--5% 5... more It is timely to compare the efficacy and tolerability of 2 actinic keratosis (AK) therapies--5% 5-fluorouracil (5-FU) cream and imiquimod cream. Thirty-six patients with 4 or more AKs were randomly assigned to receive 5% 5-FU cream twice daily for 2 to 4 weeks or 5% imiquimod cream twice weekly for 16 weeks. Five percent 5-FU was more effective than imiquimod in exposing what were presumed to be subclinical AKs, reducing the final AK count (total AK count declined during the 24-week study by 94% vs. 66%, P < .05), achieving complete clearance (incidence of 84% vs. 24% by week 24, P < .01), and achieving clearance rapidly. Tolerability was similar except for erythema, which was initially significantly higher with 5-FU than imiquimod but resolved rapidly and was significantly lower than imiquimod by week 16. Five percent 5-FU remains the gold standard field therapy for AKs.

Research paper thumbnail of Combining clindamycin 1%-benzoyl peroxide 5% gel with multiple therapeutic options

Cutis; cutaneous medicine for the practitioner

This article reports on recent studies and case reports that evaluated the stability, tolerabilit... more This article reports on recent studies and case reports that evaluated the stability, tolerability, and efficacy of clindamycin 1%-benzoyl peroxide 5% tube gel in combination with topical retinoids and oral antibiotics. Overall, these combinations appeared to be well-tolerated, effective, and, as reported in the case studies, adaptable to common clinical practice.

Research paper thumbnail of An evaluation of potential correlations between pathophysiologic mechanisms, clinical manifestations, and management of rosacea

Cutis; cutaneous medicine for the practitioner

This article discusses rosacea, a common facial dermatosis of uncertain etiology and recent inves... more This article discusses rosacea, a common facial dermatosis of uncertain etiology and recent investigations that have begun to shed considerable light on the sequence of events leading to clinical manifestations of rosacea. The article content is based on a dedicated meeting about rosacea sanctioned by the American Acne & Rosacea Society (AARS) and represents the consensus of the authors and AARS Board of Directors.

Research paper thumbnail of The noncompliant patient with acne

Skin therapy letter

Clinical studies with topical and systemic agents for acne show remarkable improvement over a 3 m... more Clinical studies with topical and systemic agents for acne show remarkable improvement over a 3 month period of time, with continued progress in long-term use. However, in clinical practice it is uncommon to see these favorable results. Clinical experience and recent published data suggest that compliance, perhaps better referred to as adherence, is a major obstacle in achieving these outcomes. This article will review this problem and offer a number of suggestions, including dosing considerations and the use of laser/light devices, to better treat the nonadherent patient.

Research paper thumbnail of Understanding the burden of adult female acne

The Journal of clinical and aesthetic dermatology, 2014

Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limite... more Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women. Cross-sectional, web-based survey. Data were collected from a diverse sample of United States females. Women ages 25 to 45 years with facial acne (≥25 visible lesions). Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity. A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin,...

Research paper thumbnail of Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 3: a status report on systemic therapies

Cutis, 2014

The third article in this 5-part series reviews systemic therapies used to treat cutaneous rosace... more The third article in this 5-part series reviews systemic therapies used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The consensus recommendations are based on current understanding of research that describes pathophysiologic mechanisms that appear to be operative in rosacea, correlation of these underlying pathophysiologic mechanisms with specific clinical manifestations of rosacea, and outcomes from clinical trials that evaluate therapies for rosacea both as monotherapy and in combination with other agents. Systemic agents used for treatment of rosacea have been administered as oral formulations (ie, tablets, capsules). The only oral agent for rosacea approved by the US Food and Drug Administration (FDA) is a modified-release doxycycline 40-mg capsule. Other non-FDA-approved oral agents also are discussed including other tetracyclines, macrolides, me...

Research paper thumbnail of The role of inflammation in the pathology of acne

The Journal of clinical and aesthetic dermatology, 2013

The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes th... more The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes the duct of the sebaceous follicle, causing an innate immune response and the progression from a so-called noninflammatory comedo to an inflammatory papule, pustule, or nodule. However, this viewpoint has come under increasing scrutiny over the last decade, as evidence has emerged supporting a role for inflammation at all stages of acne lesion development, perhaps subclinically even before comedo formation. The immunochemical pathways underlying the initiation and propagation of the inflammation in acne are complex and still being elucidated, but may involve Propionibacterium acnes as well as several inflammatory mediators and their target receptors, including cytokines, defensins, peptidases, sebum lipids, and neuropeptides. This review presents evidence to support the notion that acne is primarily an inflammatory disease, challenging the current nomenclature of noninflammatory versus inf...

Research paper thumbnail of A status report on topical tazarotene in the management of acne vulgaris

Journal of drugs in dermatology : JDD, 2013

Tazarotene is a synthetic retinoid that, depending on the concentration and vehicle, is approved ... more Tazarotene is a synthetic retinoid that, depending on the concentration and vehicle, is approved by the US Food and Drug Administration for the topical treatment of acne vulgaris (AV) and plaque psoriasis. Tazarotene is also used as adjunctive treatment for specified clinical manifestations of chronically photodamaged skin (facial fine wrinkling, mottled facial hypopigmentation and hyperpigmentation, and benign facial lentigines), along with comprehensive skin care and photoprotection from sunlight. The gel formulation was released in the United States in 1997, with the cream formulation made available in 2000. Multiple studies are available supporting the effective and safe use of topical tazarotene for each of its indications. This article provides an overview of the pharmacology of topically applied tazarotene, discussing in particular up-to-date information on the efficacy, tolerability, and safety of topical tazarotene for AV, including monotherapy and combination therapy studi...

Research paper thumbnail of A Three-Step Acne System Containing Solubilized Benzoyl Peroxide versus Benzoyl Peroxide/Clindamycin in Pediatric Patients with Acne

The Journal of clinical and aesthetic dermatology, 2009

Objective. To evaluate the clinical benefit in adolescents of a three-step acne system containing... more Objective. To evaluate the clinical benefit in adolescents of a three-step acne system containing solubilized benzoyl peroxide. Design. Patients in this multicenter, investigator-blind trial were randomly assigned to receive 10 weeks of treatment with either the three-step acne system for normal-to-oily skin (proprietary 2% salicylic acid cleanser twice daily + proprietary 2% salicylic acid toner once daily + solubilized 5% benzoyl peroxide gel twice daily) or with control cleanser + 5% benzoyl peroxide/1% clindamycin gel twice daily. Setting. Patients seeking acne treatment from a dermatologist. Pediatric subgroup analysis from a larger trial. Participants. Eighty-two adolescents with mild-to-moderate facial acne vulgaris. Measurements. Noninflammatory and inflammatory lesion counts, erythema, dryness, peeling, burning/stinging, and itching. Results. The three-step acne system was significantly more effective than benzoyl peroxide/clindamycin in reducing the noninflammatory lesion ...