JEADV
DOI: 10.1111/jdv.13182
PREFACE
Pathophysiology and management of acne H.P.M.Gollnick1, B. Dreno*2 1
Department Dermatology & Venereology, Otto-von-Guericke University, Magdeburg, Germany Nantes ‘Department of Dermatology, University Hospital, France *Correspondence: B. Dreno. E-mail: [email protected]
2
Received: 3 April 2015; Accepted: 7 April 2015
During the last decade, we have learned a tremendous amount from research in the pathophysiology of acne and the management of therapies. Acne is an important disease characterized by a chronic inflammatory and relapsing course. Quality of life can be severely affected and psychosomatic disturbances – depression or even suicidal ideation – are associated with moderate to severe courses of the disease. In addition, post-acne sequelae occur, and can include different degrees and types of scarring. In 2006, an American multivariate analysis in approximately 5 million patients showed that about 70% used some acne medication. Further, prescriptions accounted for about 36% of the total acne-related annual health care costs. About 85% of individuals between 12 and 25 years are affected by acne vulgaris. However, we know that acne today can start before the age of 12, along with an earlier onset of puberty; there has also been an significant increase of late-type acne (acne tarda) with persistence/ relapse or late onset in the third and fourth life decade. Research into the different factors in the pathophysiology of acne, the function of the sebaceous gland as an endocrine skin organ and the immune reactions initiating and maintaining the inflammation has helped us to better understand certain steps in the cascade from the initial lesion to the fully developed lesion and its chronic evolution. We have more insight into the scarring process as well. In addition, we now have deeper insight into the molecular biology of the inflammatory process in and around the pilosebaceous unit. Looking back, four decades ago the role of Propionibacterium acnes was overestimated and treatment with topical and systemic antibiotics was the rule. Not long after that, we learned more about the androgen driven proliferation and differentiation of the sebocyte. In the 1990s, we learned also that follicular keratinocytes are under androgen control. Most recently, we have begun to elucidate the influence of other hormones, growth factors, prostaglandins, leukotrienes and neuropeptides. Each of these has a role in the pathophysiology of acne. Parallel work conducted in the second half of the 1990s shed light on the role of the cytokine network and the differentiation of cell types involved in the inflammatory process of acne. Interest increased in the anti-inflammatory properties of systemic tetracyclines; the para-antibiotic actions had been known since
JEADV 2015, 29 (Suppl. 4), 1–2
experiments in 1966 to suppress development of pustules. Tetracyclines have several anti-inflammatory actions, including suppression of reactive oxygen species, reduction of leukotaxis and down regulation of matrix-metalloproteinases. The role of tolllike receptor 2, activation of AP-1, and downstream cascade or interaction with macrophages and neutrophils was discovered. Very recently, research has investigated how PPARs and inflammasome are involved in acne, and the role of non-steroidal drugs or of biologics as therapeutic targets has been discussed. The article of B. Dreno and co-authors from the Global Alliance to Improve Outcomes in Acne (GA) in this supplement discusses current knowledge about the interplay of inflammation and innate immunity in acne, helping us to better understand the role of P acnes and management with topical and systemic drugs. Recent worldwide warnings about antimicrobial resistance in human and veterinary medicine are also an important topic in dermatology and therefore in the treatment of acne. One of the strong recommendations stated in the consensus papers of the GA and the S3 European Dermatology Forumguideline on acne is to avoid use of topical and systemic antibiotics as monotherapy. We must exert every effort to avoid resistance not only of P acnes but also of Staphylococcus aureus and other skin organisms. Two further articles by H. Gollnick et al. discuss management of moderate to moderate-severe acne with the topical combination of a retinoid (adapalene) and benzoyl peroxide (BPO) in a fixed combination under daily practice conditions. These articles present clinical efficacy and safety data as well as adherence and quality of life results from an open-label study involving more than 5000 acne patients. Today, we know that retinoids such as adapalene have multiple actions; they correct disturbances of keratinization and also have a direct anti-inflammatory effect. BPO is currently the strongest antimicrobial agent that has no known association with development of resistance. A fixed-dose combination product with adapalene and BPO attacks at least three factors triggering the acne process. It is shown here that the degree of improvement on the Leed‘s Scale significantly correlated with the severity at baseline: more severe cases improved more dramatically. Furthermore, life quality after 9 months of treatment improved significantly and long-term adherence was about 84%.
© 2015 European Academy of Dermatology and Venereology
2
The fourth article by U. Gieler et al. focuses on the topic quality of life in acne and its impact and management. The review deals in particular with the changes and improvement of life quality with appropriate selection of topical agents and the role of adherence. These authors also highlight the importance of
JEADV 2015, 29 (Suppl. 4), 1–2
Acne and management
psychosocial stress in the group of adolescents, an age where the personality is particularly vulnerable. We hope that this supplement will contribute to good continuous medical education in understanding of acne, its treatment and management.
© 2015 European Academy of Dermatology and Venereology
DOI: 10.1111/jdv.13182
PREFACE
Pathophysiology and management of acne H.P.M.Gollnick1, B. Dreno*2 1
Department Dermatology & Venereology, Otto-von-Guericke University, Magdeburg, Germany Nantes ‘Department of Dermatology, University Hospital, France *Correspondence: B. Dreno. E-mail: [email protected]
2
Received: 3 April 2015; Accepted: 7 April 2015
During the last decade, we have learned a tremendous amount from research in the pathophysiology of acne and the management of therapies. Acne is an important disease characterized by a chronic inflammatory and relapsing course. Quality of life can be severely affected and psychosomatic disturbances – depression or even suicidal ideation – are associated with moderate to severe courses of the disease. In addition, post-acne sequelae occur, and can include different degrees and types of scarring. In 2006, an American multivariate analysis in approximately 5 million patients showed that about 70% used some acne medication. Further, prescriptions accounted for about 36% of the total acne-related annual health care costs. About 85% of individuals between 12 and 25 years are affected by acne vulgaris. However, we know that acne today can start before the age of 12, along with an earlier onset of puberty; there has also been an significant increase of late-type acne (acne tarda) with persistence/ relapse or late onset in the third and fourth life decade. Research into the different factors in the pathophysiology of acne, the function of the sebaceous gland as an endocrine skin organ and the immune reactions initiating and maintaining the inflammation has helped us to better understand certain steps in the cascade from the initial lesion to the fully developed lesion and its chronic evolution. We have more insight into the scarring process as well. In addition, we now have deeper insight into the molecular biology of the inflammatory process in and around the pilosebaceous unit. Looking back, four decades ago the role of Propionibacterium acnes was overestimated and treatment with topical and systemic antibiotics was the rule. Not long after that, we learned more about the androgen driven proliferation and differentiation of the sebocyte. In the 1990s, we learned also that follicular keratinocytes are under androgen control. Most recently, we have begun to elucidate the influence of other hormones, growth factors, prostaglandins, leukotrienes and neuropeptides. Each of these has a role in the pathophysiology of acne. Parallel work conducted in the second half of the 1990s shed light on the role of the cytokine network and the differentiation of cell types involved in the inflammatory process of acne. Interest increased in the anti-inflammatory properties of systemic tetracyclines; the para-antibiotic actions had been known since
JEADV 2015, 29 (Suppl. 4), 1–2
experiments in 1966 to suppress development of pustules. Tetracyclines have several anti-inflammatory actions, including suppression of reactive oxygen species, reduction of leukotaxis and down regulation of matrix-metalloproteinases. The role of tolllike receptor 2, activation of AP-1, and downstream cascade or interaction with macrophages and neutrophils was discovered. Very recently, research has investigated how PPARs and inflammasome are involved in acne, and the role of non-steroidal drugs or of biologics as therapeutic targets has been discussed. The article of B. Dreno and co-authors from the Global Alliance to Improve Outcomes in Acne (GA) in this supplement discusses current knowledge about the interplay of inflammation and innate immunity in acne, helping us to better understand the role of P acnes and management with topical and systemic drugs. Recent worldwide warnings about antimicrobial resistance in human and veterinary medicine are also an important topic in dermatology and therefore in the treatment of acne. One of the strong recommendations stated in the consensus papers of the GA and the S3 European Dermatology Forumguideline on acne is to avoid use of topical and systemic antibiotics as monotherapy. We must exert every effort to avoid resistance not only of P acnes but also of Staphylococcus aureus and other skin organisms. Two further articles by H. Gollnick et al. discuss management of moderate to moderate-severe acne with the topical combination of a retinoid (adapalene) and benzoyl peroxide (BPO) in a fixed combination under daily practice conditions. These articles present clinical efficacy and safety data as well as adherence and quality of life results from an open-label study involving more than 5000 acne patients. Today, we know that retinoids such as adapalene have multiple actions; they correct disturbances of keratinization and also have a direct anti-inflammatory effect. BPO is currently the strongest antimicrobial agent that has no known association with development of resistance. A fixed-dose combination product with adapalene and BPO attacks at least three factors triggering the acne process. It is shown here that the degree of improvement on the Leed‘s Scale significantly correlated with the severity at baseline: more severe cases improved more dramatically. Furthermore, life quality after 9 months of treatment improved significantly and long-term adherence was about 84%.
© 2015 European Academy of Dermatology and Venereology
2
The fourth article by U. Gieler et al. focuses on the topic quality of life in acne and its impact and management. The review deals in particular with the changes and improvement of life quality with appropriate selection of topical agents and the role of adherence. These authors also highlight the importance of
JEADV 2015, 29 (Suppl. 4), 1–2
Acne and management
psychosocial stress in the group of adolescents, an age where the personality is particularly vulnerable. We hope that this supplement will contribute to good continuous medical education in understanding of acne, its treatment and management.
© 2015 European Academy of Dermatology and Venereology
