16 January 2019
WEDNESDAY, Jan. 16, 2019 (HealthDay News) — U.S. dermatologists are prescribing fewer antibiotics overall but are writing more short-term orders for the drugs, a new study finds. Dermatologists prescribe more antibiotics per doctor than any other medical specialty — more than 7.1 million prescriptions per year, the University of Pennsylvania researchers said. According to their analysis of 2008-2016 data from privately insured patients, antibiotic prescriptions by dermatologists fell from 3.36 to 2.13 per 100 visits. That works out to about 500,000 fewer antibiotic prescriptions a year. The drop was significant among patients taking extended courses of antibiotics — down 53 percent over the study period. That includes a 28 percent reduction in antibiotic prescriptions for acne, the study authors said. But the investigators found a nearly 70 percent surge in short-term use of antibiotics, especially for skin-surgery patients. Those prescriptions rose from 3.92 to 6.65 per 100 visits. In addition, antibiotic prescriptions associated with cysts increased 35 percent, according to the study published Jan. 16 in JAMA Dermatology. Many dermatological patients, including those taking antibiotics for inflammatory skin conditions such as acne and rosacea, may stay on antibiotics for long periods. That’s an issue, because overuse of antibiotics can lead to reduced effectiveness, the researchers explained. “Overall, our findings are hopefully a sign that we’re making progress, but we need to evaluate how we can optimize the use of antibiotics in dermatologic surgery,” lead study author Dr. John Barbieri said in a university news release. That includes more studies to determine which skin surgery patients benefit most from antibiotics, he said. Barbieri is a dermatology research fellow at Penn. While prescription rates were down overall, the types of antibiotics used and length of treatment remained the same, the findings showed. “This may be a sign that treatment guidelines have raised awareness about overuse, though it’s also noteworthy that there are biologic and other alternate treatments that give patients more options than they’ve ever had before,” Barbieri added. More information The American Academy of Family Physicians has more on antibiotics.
03 January 2019
THURSDAY, Jan. 3, 2019 (HealthDay News) — An old acne drug may hold the key to developing a new, safer treatment, a study suggests. Isotretinoin (Myorisan, formerly branded as Accutane), is a form of vitamin A, and has been prescribed for acne for decades. It works by reducing oil in the skin, thus helping prevent acne. An additional benefit of the drug has recently come to light. It alters the bacteria on the skin of acne patients to more closely resemble the skin of people without acne, researchers report. This discovery might lead the way to create bacteria-based treatments, said lead researchers Makedonka Mitreva, an associate professor of medicine, and Dr. William McCoy, a dermatologist and instructor of medicine, both at Washington University in St. Louis. Although isotretinoin is effective, it can cause severe birth defects, so it’s dangerous when used in women of childbearing age, which is why an alternative is needed, the researchers explained. Antibiotics are often prescribed to target the bacteria called Cutibacterium acnes, also called Propionibacterium acnes. These drugs, however, aid the development of resistant strains of bacteria and can kill off potentially beneficial microbes. Isotretinoin isn’t an antibiotic. It’s believed to treat acne by drying out the skin, which makes it a less inviting place for acne germs to flourish. It’s the only treatment that reliably clears acne over the long term, the researchers noted. For the study, the investigators sampled bacteria from the skin of 17 patients treated with isotretinoin. They compared this bacteria with samples from eight people who hadn’t been treated — four had normal skin and four had acne. In isotretinoin patients, an increase in the diversity of microbes was seen on the skin. DNA sequencing identified four types of bacteria that bloomed with isotretinoin. None of these had been associated with improved acne before. With isotretinoin, a reduced amount of Propionibacterium acnes bacteria was also seen, even though diversity of bacteria increased. By understanding how isotretinoin works, it might be possible to develop a similar drug that is more effective and doesn’t have negative side effects, the scientists said. “Women often will go without treatment for acne during their pregnancies because there just aren’t good therapies that are totally safe to use during that time,” McCoy said in a university news release. “They need other options. Our study suggests there could be a way to provide some type of microbial ‘fertilizer’ or ‘weed killer’ on the skin to help promote the growth of healthy microbes,” said McCoy. “We’re conducting a larger study to look more closely at these questions.” The report was published recently in the Journal of Investigative Dermatology. More information The American Academy of Dermatology has more on acne.
31 December 2018
MONDAY, Dec. 31, 2018 (HealthDay News) — One of your New Year’s resolutions should be to be good to your skin, and dermatologists have 10 ways to help. “All the stresses and excesses of the holidays can leave your skin in bad shape, which makes you feel low, too,” said Dr. Megan Rogge, an assistant professor of dermatology the University of Texas Health Science Center at Houston. “At the start of a new year, we all want to look great,” she added in a university news release. “The good news is that with a little extra time and effort, or sometimes just breaking bad habits, you can change your skin condition for the better.” Here’s how: Chill out: Stress can cause many skin problems and make some worse. So try to relax. “Acne, psoriasis, eczema, and certain types of hair loss all get worse when you’re feeling stressed. Unfortunately, these are the four most common complaints of my patients,” Rogge said. Yoga or meditation can help you decompress, but even simple breathing exercises can make a difference, she said.” Give your diet a makeover: A healthy diet not only helps control weight, it also will make your skin look better. Dr. Rajani Katta, a clinical professor of dermatology at UT, urges her patients “to eat more foods rich in antioxidants, especially fruits, vegetables, herbs and spices, since they’ve been shown to help combat the effects of free radicals.” These take a toll on skin. Use sunscreen: “Even in winter, the sun’s rays still emit damaging ultraviolet radiation. I advise using a product with an SPF of 30, and placing it by your toothbrush so you don’t forget each morning,” Rogge said. Drink lots of water: It’s easy to become dehydrated in winter. Beyond fatigue and other health effects, “dehydration also accentuates fine lines and wrinkles,” Katta said. Remove makeup at day’s end: Use a gentle cleanser morning and evening. “Any buildup of dirt or oil in your skin can leave it looking flat. It can also block your pores, resulting in acne breakouts and irritations,” Rogge said. Get your zzzzzs: Scientific research supports the importance of beauty sleep. “Being sleep-deprived can increase those dreaded dark circles. Concealer can help hide the issue, but there’s no substitute for shut-eye,” Katta said. Use moisturizer: For best results, use thick creams, not lotions. “Applying twice daily is normally sufficient, and you can help lock in moisture further by applying while your skin is still damp,” Rogge said. Get plenty of fresh air: The effects of poor air quality can show on your face. “Secondhand smoke and pollution can also accelerate aging of the skin,” Katta said. Antioxidant-rich foods will help protect your skin from pollution and smoke-induced free radicals. Keep up with your skin routine: Great skin takes effort, particularly as you age. “Setting a routine morning and night is crucial because most skin care regimens give the best results when they are consistently followed,” Rogge said. Be patient: “Although it’s natural to want a product to have an immediate impact, it usually takes six weeks to be able to assess its effectiveness and start noticing any significant difference,” Rogge said. More information The U.S. National Institutes of Health has more about healthy skin.
03 October 2018
WEDNESDAY, Oct. 3, 2018 (HealthDay News) — The impact of acne is more than skin-deep, and often disrupts sleep and well-being, scientists have found. Researchers in Ireland report that perceived social stigma diminishes quality of life for many who have acne — especially girls and women. “We know from previous research that many acne sufferers experience negative feelings about their condition, but we have never before been able to draw such a direct link between quality of life and perception of social stigma around acne,” said study author Aisling O’Donnell. She’s a lecturer in the University of Limerick’s psychology department. The study findings echo previous research “showing that individuals with visible physical distinctions, which are viewed negatively by society, can experience impaired psychological and physical well-being as a result,” O’Donnell said in a university news release. Acne isn’t only a teen problem. The skin condition affects almost 13 percent of adults aged 59 and older and more than 1 in 10 kids between ages 5 and 13, the study authors said. For the new report, the authors surveyed almost 300 people with the blackheads and pimples that characterize acne. They found that those who perceived the most acne-related stigma had more psychological distress and physical symptoms such as trouble sleeping, headaches and digestive issues. Women reported more severe symptoms than men. And acne severity correlated with the quality-of-life issues and mental distress, though only an association rather than a cause-and-effect link was seen. Facebook and other social media may indirectly reinforce perceptions of acne stigma, the researchers said. “Like many physical attributes that are stigmatized, acne is not well represented in popular culture, advertising or social media. This can lead people with acne to feel that they are ‘not normal’ and therefore negatively viewed by others,” said study co-author Jamie Davern, a Ph.D. student also at the University of Limerick. Davern said the findings are important for health care providers and anyone who has a loved one dealing with acne. “The wider negative impacts some acne sufferers experience are very challenging and require sensitivity and support,” he added. The study was published online Sept. 28 in PLOS ONE. More information The American Academy of Dermatology provides more on acne.
23 September 2018
SUNDAY, Sept. 23, 2018 (HealthDay News) — It may be tempting to squeeze a large pimple, but doing so could make the zit worse, skin doctors say. Up to 50 million Americans struggle with various forms of acne, particularly red, swollen, painful bumps that develop deep in the skin, according to the American Academy of Dermatology. There are better, more effective ways to manage acne, said board-certified dermatologist Dr. Meghan Feely. “Although there are no overnight or immediate cures for acne, you don’t have to stand by and suffer, either,” Feely said in an academy news release. She’s an attending physician at Mount Sinai Health System in New York City. “Make sure you use noncomedogenic and oil-free cosmetics, cleansers and sunscreens, and never try to scrub away a pimple, as this can further irritate it and make it worse,” she said. Noncomedogenic products are less likely to clog pores. There are other strategies that can help keep acne under control. Feely recommended the following: Use a mild cleanser. It’s important to apply acne treatment to clean skin. Opt for a fragrance-free cleanser and wash the skin gently. Apply ice, then heat. A cold compress can help ease the pain and swelling of a pimple. Wrap an ice cube in a paper towel and apply it to the affected area for five to 10 minutes. Repeat this process twice, taking 10-minute breaks between applications. Once a whitehead begins to form, a warm compress can help release the pus that accumulates under the skin. Soak a clean washcloth in hot water. Apply the warm cloth to the affected area for 10 to 15 minutes. Repeat this step three to four times daily until the pimple begins to heal. Target bacteria. Once the skin is clean, apply a small amount of acne treatment to the pimple. Choose a product that contains 2 percent benzoyl peroxide. This will help kill the bacteria that causes acne. Apply only a thin layer to avoid irritating the skin. Keep in mind that benzoyl peroxide can bleach fabrics, so avoid contact with clothing, colored sheets and towels. Resist the urge to pop or pick at pimples. You’ll only make your pimples more noticeable and increase the risk for infection and scarring. Be wary of “natural” acne remedies. Products advertised as natural could do more harm than good. Even natural ingredients may be combined with potentially harmful products. Talk to a doctor. Board-certified dermatologists are trained to help treat acne and prevent future breakouts. They can treat painful, swollen pimples with a cortisone injection. A dermatologist can also prescribe treatments to help maintain a clear complexion. “Today, virtually every case of acne can be successfully treated, even severe acne,” Feely said. “However, not everyone’s acne can be treated the same way. If you have a lot of acne, or if your acne isn’t responding to over-the-counter acne medications after four to six weeks, make an appointment to see a board-certified dermatologist.” More information The American Academy of Family Physicians has more about acne.
11 September 2018
TUESDAY, Sept. 11, 2018 (HealthDay News) — As if the start of a new school year isn’t stressful enough, many teens may find their acne worsens when classes start, a skin doctor says. During summer vacation, teens’ acne often eases because they have less stress and more sun exposure, but it could flare up now that they’re back in school, explained Dr. David Shupp. He’s a dermatologist at Penn State Health Medical Group. “A teen often feels alone in suffering from embarrassing pimples,” Shupp said in a Penn State news release. “Because acne is caused primarily by hormone levels, the condition often begins at puberty and clears up by the late 20s,” he added. “Girls are more susceptible than boys to hormone-related acne.” For teens with mild acne, the first step is to try over-the-counter creams, gels or lotions applied directly to affected areas. Teens with other skin conditions — such as eczema or psoriasis — should consult their doctor before using over-the-counter acne medications, Shupp advised. The most common over-the-counter acne medications contain: Benzoyl peroxide, which kills bacteria, helps remove excess oil from the skin and reduces inflammation. Salicylic acid, which dries excess oils and works best for blackheads and whiteheads. Adapalene, which prevents plugging of hair follicles and is available over-the-counter in 0.1 percent strength. “If over-the-counter medications don’t provide enough relief from acne, it’s time to discuss prescription medications with a dermatologist or family physician,” Shupp suggested. Prescription acne treatments include: Stronger retinoids, such as Retin-A. These are among the most effective topical medications but can be more drying than over-the-counter options. Antibiotics, which can be administered orally or via a topical gel or cream to kill excess bacteria. Topical antibiotics are often combined with benzoyl peroxide to maximize effectiveness while lowering the risk of antibiotic resistance. Hormonal treatments, which impact the balance of hormones that cause acne and are usually prescribed to supplement topical medications or antibiotics in young women. Isotretinoin (Accutane) is a powerful vitamin A derivative used to treat severe acne that does not respond to other medications. Potential side effects include birth defects, so teenage and adult women taking this oral medication must undergo monthly pregnancy tests. Don’t use acne medications prescribed for someone else, Shupp said. Along with treatment, there are a number of things teens can do to reduce acne, he added. Gently clean affected skin twice a day. Avoid scrubbing, which can damage the skin and aggravate an acne problem. Do not use abrasive products. Use oil-free cosmetics, sunscreen, moisturizer and hair products. They’re labeled “noncomedogenic.” Keep hands and hair away from the face to reduce the transfer of oil. Don’t squeeze pimples. This can cause permanent scarring. The most common skin condition in the United States, acne strikes close to 85 percent of people between the ages of 12 and 24, according to the American Academy of Dermatology. More information The American Academy of Family Physicians has more on acne.
04 September 2018
TUESDAY, Sept. 4, 2018 (HealthDay News) — Acne and adolescence go hand in hand. But researchers say the skin lesions might become a torment of the past if preliminary tests of an experimental vaccine pan out. So far, the vaccine has only been tried on animals and human skin samples. It uses antibodies to target a toxin secreted by the bacteria responsible for acne, explained study author Chun-Ming Huang. He’s a professor of dermatology at the University of California, San Diego. Potentially, such a vaccine could help the 85 percent of U.S. teens and more than 40 million American adults suffering with the lesions, scars and emotional stigma of acne, he added. Huang said his team is “actively seeking a company to work with us to conduct a clinical trial.” According to Huang, “The efficacy of this vaccine has been validated in human acne biopsies. It works to reduce inflammation in acne lesions.” If the results of clinical trials are positive, it’s possible the vaccine could be available “within three to five years,” he said. Acne “afflicts 650 million people — almost one in 10 — and is the eighth most common disease worldwide,” Huang noted. Current treatments — such as skin creams, antibiotics or systemic retinoids — often provoke unpleasant side effects, such as extreme skin dryness and irritation, according to background notes with the study. For many skin-pocked teenagers and adults, the frustration and shame of uncontrolled acne has been linked to a higher risk for clinical depression and suicide or suicidal thoughts. The proposed acne vaccine focuses on acne-causing bacteria that is common on human skin, the study authors explained. This bacteria — known as P. acnes — releases a toxin known as CAMP. In theory, the vaccine works by generating antibodies that eliminate this toxin. “Once the toxin is neutralized, inflammation in the acne lesion will be suppressed,” Huang said. Testing with mice and human skin samples showed that the vaccine “significantly diminishes” both P. acnes “colonization” and inflammation. Whether such success can be replicated by direct administration to people remains to be seen, however. Nevertheless, Huang suggested that acne vaccines that are “bacteria-specific” should mean side effects would be minimal. Emmanuel Contassot is a dermatology faculty member at the University of Zurich, in Switzerland, and author of an editorial accompanying the study. “Vaccination is a very promising approach” to acne intervention, he said. “Current treatments consist of antibiotics or retinoids, both being not specific and associated with side effects,” Contassot said. “Targeting P. acnes with a vaccine would be more specific and less toxic than chemical therapies.” Still, Contassot pointed out that it’s important to understand that P. acnes comes in various strains, some good, some bad. “The good ones participate actively in skin barrier integrity, notably by preventing [harmful] bacteria to proliferate. The bad ones are involved in acne,” he explained. Any effective and safe vaccine must target the bad bacteria while preserving the good ones, he stressed. In fact, “targeting the wrong antigen might worsen patients’ condition by disturbing skin integrity,” Contassot added. On that front, Contassot said Huang and his colleagues appear to be on the right track. But he thinks further research is needed prior to clinical studies. The new findings were published online Aug. 29 in the Journal of Investigative Dermatology. More information There’s more on acne at the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
09 February 2018
FRIDAY, Feb. 9, 2018 (HealthDay News) — Acne can be emotionally devastating at any age, and new research suggests it could even throw you into a deep depression. “Our research has shown that patients with acne have a 63 percent increased risk of developing major depressive disorder in their first year following an acne diagnosis, compared to patients without acne,” said study author Isabelle Vallerand. “We also found that this risk remained significantly elevated up to five years following the first acne diagnosis,” said Vallerand. She is an epidemiologist with the department of community health sciences at the University of Calgary, in Canada. “Living with acne may have an impact on an individual’s sense of self-worth,” Vallerand said. And people of all ages, not just the classic pimple-plagued teen who shies away from socializing, were vulnerable to the agony of acne, she noted. “Our results suggest that the risk of depression among patients with acne does not depend on age,” Vallerand said. Her team analyzed data collected between 1986 and 2012 by The Health Improvement Network, a British primary care database. The data covered more than 134,000 patients with acne, as well as another 1.7 million patients without acne. Prior research has already suggested that upwards of one-quarter of all acne sufferers struggle with some mental health issues, the researchers pointed out. The new study looked at various patient characteristics. After tracking the patients for an average of 15 years, the study found that those with acne faced an 18.5 percent risk for developing clinical depression, compared with just 12 percent among those without acne. However, the elevated risk was only evident throughout the first five years following an acne diagnosis, and the study did not prove that acne itself causes depression risk to rise. Still, “we were surprised to find that this risk was substantially high. So this highlights that mental health concerns among patients with acne should be taken seriously, and that treatment for depression among these patients should be started early when needed,” Vallerand said. One dermatologist said that she has witnessed the connection firsthand. Dr. Whitney Bowe, medical director of integrative dermatology, aesthetics and wellness at Advanced Dermatology in New York City, said she sees “the emotional and physical scars of acne . . . every single day” in her practice. “The devastating effect this disease can have on an individual’s confidence and self-esteem, and the positive transformation that can result following effective therapy, was actually the reason I went into the field of dermatology,” she said. “Skin issues are not just skin deep,” Bowe added. “In fact, the skin and the brain are intimately connected, and as dermatologists we need to evaluate the patient in an integrative, comprehensive way if we truly want to determine the best course of treatment,” she explained. “I have been taking a comprehensive approach to my patients for years, inquiring about their stress levels, sleep patterns and coping mechanisms in addition to examining their skin,” Bowe said. “And this study only provides more evidence supporting this approach.” Vallerand and her colleagues reported their findings in a research letter published online Feb. 7 in the British Journal of Dermatology. More information There’s more on depression risk at the U.S. National Institute of Mental Health.
26 January 2018
FRIDAY, Jan. 26, 2018 (HealthDay News) — Waiting for acne to clear up on its own can be frustrating, especially for teens who are already self-conscious about their appearance. Untreated acne can cause low self-esteem and anxiety as well as permanent facial scars. Ignoring it or assuming kids will outgrow it can harm them physically and emotionally. Acne can also continue into the adult years, and be especially problematic for women. Mild cases with just a few blemishes or blackheads may respond in a month or two to over-the-counter drugstore products with ingredients such as benzoyl peroxide or salicylic acid. These are designed to unblock pores and encourage cell turnover. But deep pimples and inflamed pustules need the strength of prescription products and the know-how of a dermatologist. Most prescriptions are topical. That means they’re applied to the skin, typically to kill bacteria and/or reduce oil. Often in gel form, they may contain a retinoid (a vitamin A-based ingredient), prescription-strength benzoyl peroxide, or antibiotics. There are many effective combinations that your dermatologist can recommend. If one doesn’t work, another might. Severe acne, with cysts and nodules, often needs medication in pill form, from antibiotics to the most powerful vitamin A drug called isotretinoin. According to the American Academy of Dermatology, one 4- or 5-month course of isotretinoin brings about clear skin in 85 percent of patients. However, it can have serious side effects, primarily birth defects, so it’s essential that people taking it don’t become pregnant (or even breast-feed) while on it. There are also many office procedures that may help, such as lasers and other light therapies; chemical peels; and extractions, which remove stubborn cysts and help prevent scarring. With so many options, there’s no reason to suffer through this skin condition. More information The American Academy of Dermatology has a section on acne on its website, including the latest treatments.