Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair.
Explore the source record for details and available documents.
Administration, Topical↗
Biomedical subjects
John E Wolf
Publications and source records attributed to John E Wolf.
Efficacy and safety of once-daily metronidazole 1% gel compared with twice-daily azelaic acid 15% gel in the treatment of rosacea.
Rosacea is an inflammatory dermatologic disorder characterized by the presence of facial erythema, visible blood vessels, papules, and pustules. The National Rosacea Society has established a classification system that identifies 4 distinct rosacea subtypes based on clinical presentation: erythematotelangiectatic, papulopustular, phymatous, and ocular. The goal of topical therapy for rosacea is to reduce inflammatory lesion counts; decrease intensity of erythema; and reduce symptoms such as stinging, burning, and pruritus. Metronidazole and azelaic acid are thought to reduce the inflammation associated with rosacea by inhibiting the production of reactive oxygen species produced by neutrophils. Both metronidazole 1% gel and azelaic acid 15% gel recently have been approved for the treatment of rosacea. The current study was conducted to compare the once-daily application of metronidazole 1% gel with twice-daily applications of azelaic acid 15% gel for the treatment of patients with moderate rosacea (N=160). Both treatments showed similar reductions in inflammatory lesion counts (77% for metronidazole 1% gel and 80% for azelaic acid 15% gel) and high success rates in both global severity (53.7% vs 56.4% for metronidazole 1% gel and azelaic acid 15% gel, respectively) and erythema (42.7% vs 42.3% for metronidazole 1% gel and azelaic acid 15% gel, respectively). On average, the efficacy (including reduction in erythema) of the once-daily application of metronidazole 1% gel and twice-daily applications of azelaic acid 15% gel were similar.
Administration, Cutaneous↗
Safety and tolerability in the MORE trial.
Adverse events and a high potential for cutaneous irritation may have a negative effect on patient adherence to acne treatments, the primary factor contributing to optimal outcomes. In addition to effectiveness and subject satisfaction, the Measuring Acne Outcomes in a Real-World Experience (MORE) trial evaluated adverse events and cutaneous tolerability of adapalene gel 0.1% in 1396 subjects who received initial combination therapy with adapalene gel 0.1% and 468 subjects who added adapalene gel 0.1% to their existing regimen (safety population). Adverse events were uncommon (reported by 5.8% of subjects) and generally mild, the most frequent being skin and subcutaneous tissue disorders (2.7%). Overall, investigators rated cutaneous tolerability as high. Adherence to therapy also was high with both the initial combination and add-on therapies. The MORE trial confirms that adapalene gel 0.1% is safe and well tolerated and therefore likely to enhance adherence to treatment and the likelihood of optimal treatment outcomes for patients with moderate to moderately severe acne.
Acne Vulgaris↗
Present and future rosacea therapy.
Despite its prevalence, rosacea has not received the same attention of researchers as other dermatologic disorders. Nevertheless, new pharmacologic and nonpharmacologic therapies for the condition continue to be developed. The future of rosacea treatment will probably involve a combination of drugs and devices. Certain core therapies (i.e., topical metronidazole, topical azelaic acid, oral tetracyclines, and topical sulfur/sodium sulfacetamide) are validated by the greatest amount of high-order clinical evidence and will undoubtedly remain first-line therapeutic choices. However, more research is necessary to validate the efficacy and safety of newer pharmacologic agents and light-based therapy. Because rosacea is a chronic condition, pharmacologic maintenance therapy is necessary to maintain remission.
Anti-Infective Agents↗
The role of topical metronidazole in the treatment of rosacea.
Many topical and oral pharmacologic agents have shown well-tolerated efficacy for the treatment of rosacea. Metronidazole was the first topical therapy approved for rosacea and is still considered the foundation therapy by many researchers and dermatologists. The efficacy and tolerability of topical metronidazole in combination with an oral antibiotic or as monotherapy to maintain remissions have been shown in multiple well-controlled trials.
Administration, Topical↗
The treatment of rosacea.
The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physicians better diagnose and manage these subtypes. A lively discussion centered on treatment options for the various subtypes of rosacea ensued.
Anti-Infective Agents↗
Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: a multicenter, randomized, investigator-blinded study.
This multicenter, randomized, investigator-blinded study investigated the efficacy and tolerability of adapalene gel 0.1% plus clindamycin phosphate lotion 1%, compared with clindamycin plus vehicle for the treatment of mild to moderate acne vulgaris. A total of 249 patients applied clindamycin lotion twice daily and adapalene (125 patients) or vehicle gel (124 patients) once daily for 12 weeks. A significantly greater reduction of total (P <.001), inflammatory (P =.004) and noninflammatory lesions (P <.001) was seen in the clindamycin plus adapalene group than in the clindamycin plus vehicle group. These significant treatment effects were observed as early as week 4 for both noninflammatory and total lesion counts. Both treatment regimens were well tolerated. Although the worst scores for scaling (P <.05), dryness (P <.01), and stinging/burning (P <.05) were higher in the clindamycin plus adapalene group than in the clindamycin plus vehicle group in patients with moderate or severe irritation; in most cases these symptoms were of mild intensity.
Acne Vulgaris↗
Potential anti-inflammatory effects of topical retinoids and retinoid analogues.
The topical retinoid tretinoin and topical retinoid analogues such as adapalene and tazarotene help normalize hyperkeratinization in acne vulgaris and have demonstrated significant anti-inflammatory effects in experimental trials. Inhibition of various immune factors, including the activity of leukocytes, the release of proinflammatory cytokines and other mediators, and the expression of transcription factors and toll receptors involved in immunomodulation, has emerged in both in vitro studies and in vivo animal experiments. These multiple mechanisms of action should encourage clinicians to consider these agents in the first-line management of inflammatory acne lesions.
Adapalene↗
Maintenance therapy for acne vulgaris: the fine balance between efficacy, cutaneous tolerability, and adherence.
Maintenance therapy is defined as the regular use of appropriate therapeutic agents to ensure that acne remains in remission. Topical agents are the mainstay of maintenance therapy. A number of topical therapeutic options are available, including topical retinoids, benzoyl peroxide, and azelaic acid. The choice of topical agents should be based on a number of criteria: efficacy in addressing the subclinical microcomedo, which is the precursor lesion for both comedones and inflammatory lesions; tolerability, due to the need for application to a broader epidermal surface; and other properties that may enhance adherence. Patients may be more motivated to use agents that are easily integrated into their lifestyles and that have potential "skin-repairing" properties.
Acne Vulgaris↗