Pretreatment improves efficacy of ALA-PDT for acne
Today's report also covers routine labs in isotretinoin patients, acne incidence rates in women, meibography scales, and more (1,400 words, 6 minutes, 50 seconds)
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Good morning, and welcome to the ninth issue of Focus on Acne, presented by Skin Spectrum Weekly. This series provides up-to-date information on developing therapies and trends in acne treatment. We appreciate your feedback and suggestions and invite you to be in touch. Please write to us at health@chronicle.org
Pretreatment improves efficacy of ALA-PDT for acne
Both CO2 fractional laser and microneedling pretreatment improve the efficacy of aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of moderate to severe acne.
These findings come from a paper published online ahead of print in Photodiagnosis and Photodynamic Therapy (July 30, 2024:104298)
In the study, researchers randomly divided 150 patients with moderate to severe acne evenly into three groups. Group A was pre-treated with CO2 fractional laser before ALA-PDT, Group B received microneedling before the phototherapy, and Group C received ALA-PDT with no pretreatment.
Each group underwent photodynamic therapy once a week for three weeks. Investigators assessed efficacy at the end of the fourth week and recurrence at the end of the twelfth week.
Four weeks after the end of treatment, the effective rates were 88% for Group A, 62% for Group B, and 36% for Group C. Researchers observed statistically significant (p<0.05) differences between the groups, with Group A showing superior efficacy compared to Group B (p<0.05).
The authors observed no serious systemic or local adverse reactions in any group. They also saw no recurrence in any group 12 weeks after the end of treatment, and some patients continued to show improvement in skin lesions over time.
Routine labs may be unnecessary in isotretinoin patients with early normal results
The authors of a new paper suggest healthy acne patients with normal laboratory results at baseline when starting isotretinoin therapy and during the first two months may not need routine monitoring after the second month on the medication. They also suggest that routine monitoring of complete blood count (CBC) is not necessary.
For a study published in SKINmed (Aug. 2, 2024; 22(2):100-107), researchers conducted a retrospective cohort study comprising 444 acne patients prescribed isotretinoin at Boston Medical Center from 2004 to 2017. Each patient had at least one available baseline laboratory result.
Investigators categorized the patients into Group A (normal values at baseline and during the first two months of isotretinoin therapy) and Group B (abnormal values at baseline or during the first two months of isotretinoin therapy). They assessed the laboratory values after two months.
The frequencies of abnormal results for triglycerides, cholesterol, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) after two months for patients in group A were 21.1%, 13.6%, 8.8%, and 6.0%, respectively, with very rare grade 2 (moderate) or higher abnormalities.
In contrast, the frequencies of abnormal results for patients in group B for triglycerides, cholesterol, AST, and ALT were higher at 67.9%, 88.0%, 40.0%, and 25.0%, respectively (p<0.05, except for ALT).
No patient developed higher than grade 1 (mild) CBC abnormality.
LNG-IUDs may impact acne incidence rate in young women
Findings from a review article suggest that the use of the levonorgestrel-releasing intrauterine device (LNG-IUD) contraceptive may impact the incidence of acne in adolescents and young women.
A narrative review, published online ahead of print in The European Journal of Contraception & Reproductive Health Care (Aug. 7, 2024:1-6), used the PubMed, Embase, Cochrane, and SciELO databases to assess the incidence of acne in adolescents and young women using LNG-IUD (13.5, or 19.5 mg, or 52 mg). Researchers included cohort, cross-sectional studies, clinical trials, and meta-analyses without a date limit. They excluded studies that did not evaluate women in the age of interest or were not in English.
The investigators included nine articles in the final review, only evaluating clinical trials, cohort studies, and cross-sectional studies. Two cross-sectional studies evaluated the incidence of acne in women using any contraceptive methods, with the incidence of acne being 36% in women aged 17 to 47 years using LNG-IUD in one study. In another study, acne incidence ranged from 2 to 8% in women using any contraceptive methods, with higher rates in younger women and LNG-IUD users.
Researchers found that the incidence of acne varies, and participants between 16 and 35 years of age were more likely to report new acne or worsening of pre-existing acne. In one prospective cohort study of women between 16 and 24 years, acne was a common adverse effect, with 44% in the first year.
In their conclusion, the authors say further research should focus on the effects of LNG-IUD on acne in young populations, with rigorous study designs and consideration of previous contraceptive use.
New meibography scale for patients on isotretinoin
Researchers have developed a rating scale for isotretinoin-induced changes in meibography, which they say is a simple and reliable way to evaluate the impact of treatment on the eyelid sebaceous glands.
The findings were published in Arquivos Brasileiros de Oftalmologia (Aug. 2, 2024; 88(1):e20230150).
After analyzing meibography images obtained from systemic isotretinoin users, researchers proposed a grading scale named the “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins.
A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale. The medical professionals were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. Researchers determined the kappa statistic to test interrater reliability.
The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 had the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores, and Group B had the lowest.
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