A comparative study of topical retinoids tretinoin-0.04% and adapalene - 0.1% in acne grade 1 and grade 2

Acne is a chronic, self-limiting inflammatory disease of pilosebaceous unit. It is multifactorial, of which Propioniobacterium acne and Sebum play an important role in etiopathogenesis.The aim of the study is to compare efficacy of Tretinoin and Adapalene in Acne Vulgaris and to compare the side effects of topical tretinoin and adapalene.Randomized prospective comparative clinical trial with sample size of 50 patients who are recruited from department of dermatology of MMCH&RI.Adapalene 0. 1% produced numerically greater lesion reduction than tretinoin 0. 04% for all lesion types. Thus, Adapalene was found superior to Tretinoin in reducing average number of lesions. Highest reduction in number of lesions with both topical retinoids was for comedones (p< 0. 001) followed by papules (p<0. 00) and pustule (p= 0.001).In Patients who applied adapalene, most of them were reduced to grade 0 and grade I and only few were in grade II. Whereas in patients who applied tretinoin only few were reduced to grade 0 and many were in grade I and grade II. Side effects were more commonly seen in patient treated with topical Tretinoin than with topical Adapalene. Adapalene was better tolerated than tretinoin. Hence adapalene is a safe and effective in treatment of acne.

Confluent and Reticulated Papillomatosis of Carteaud and Gougerot in a Young Nepali Male

Confluent and reticulated papillomatosis of Carteaud and Gougerot is a keratinization disorder with an infective aetiology. Patients present with hyperpigmented papules on the upper trunk and axillae that coalesce centrally and demonstrate reticulation peripherally. Diagnosis is based on clinical findings, characteristic histopathologic changes and response to therapy. We report a case of a young Nepali male who presented with gradual onset of asymptomatic raised dark brown lesions on his neck, trunk and axillae over the course of eight years. The condition was previously misdiagnosed as pityriasis versicolor and had received oral and topical antifungals. The diagnosis was revised to confluent and reticulated papillomatosis based on clinical and histopathological examination. He was subsequently started on oral minocycline 50 mg twice daily and nightly application of topical tretinoin 0.05% gel. There was complete resolution of all his lesions except for residual hyperpigmentation at the end of two months of therapy. There has been no relapse six months from the end of therapy. This is to our knowledge, the first case of confluent and reticulated papillomatosis reported from Nepal. Oral minocycline and topical tretinoin should be considered first line in the treatment of confluent and reticulated papillomatosis.

RETROSPECTIVE STUDY: INITIAL PHARMACOTHERAPY PROFILE OF NEW ACNE VULGARIS PATIENTS

Background: Acne Vulgaris (AV) is one of the most common diseases in the field of dermatology and ranks as the eighth most prevalent disease worldwide. Early management of this potentially deforming skin disease may reduce the pathophysiological burden and improve the quality of life of patients. Purpose: This study aimed to determine the pharmacotherapy for new patients with AV. Methods: This cross-sectional study used new patients with AV of the Cosmetic Division of the Outpatient Skin and Venereal Health Unit, Regional Public Hospital (RSUD) Dr. Soetomo, from January to December 2013 that were descriptively presented. The variable was the pharmacotherapy given. This study used secondary data collection by looking at the patients’ medical records. The variables studied were acne lesions and pharmacotherapy regimens, including the administration route and the medicine used. Results: The number of samples that met the inclusion criteria was 951 patients. Comedonal acne was most commonly given topical tretinoin. Papulopustular acne was most commonly given a topical combination of clindamycin and tretinoin, while acne conglobata was most commonly given a combination of topical clindamycin and tretinoin with oral doxycycline. Conclusion: The new patients with comedonal acne were mostly prescribed topical tretinoin pharmacotherapy. A pharmacotherapy combination of topical clindamycin and tretinoin was given to most new patients with papulopustular acne, whereas new patients with conglobata acne were given a pharmacotherapy combination of topical tretinoin and clindamycin with oral doxycycline.

Treatment of post-menopausal acne with tretinoin lotion 0.05% delivers rapid results and concomitant benefits

We describe a case of comedonal acne in a post-menopausal female treated with a novel tretinoin lotion 0.05%. The patient also had some actinic keratoses, which are hyperkeratotic, scaly lesions caused by prolonged exposure to ultraviolet radiation. These lesions have the ability to progress into squamous cell carcinoma. Actinic keratoses can occur in patients as young as 20 years, but are more common in patients aged 50 years and older. Topical retinoids are recommended as monotherapy in comedonal acne but despite their documented clinical efficacy are underutilized due to concerns about cutaneous tolerability. Topical tretinoin is currently not recommended as first-line therapy in the treatment of actinic keratosis as its efficacy is not comparable to that of other modalities. In this patient, a novel tretinoin lotion 0.05% resulted in rapid in and sustained improvement of acne. The investigator also observed improvement in actinic keratoses and photodamage. If these results can be confirmed in a larger patient population this may be an attractive area of investigation for the treatment of patients with adult acne and photodamaged skin.