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Skin lipids in acne e seasonal changes and effect on the epidermal barrier Apostolos Pappas, PhD, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States; Karen Meyer, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States; Ruth Tannahill, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States; Nikoleta Batchvarova, PhD, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States
The use of intravenous ertapenem in the management of severe hidradenitis suppurativa Cynthia Nicholson, MD, Henry Ford Department of Dermatology, Detroit, MI, United States; Melissa Williams, MD, Marshfield Clinic Dermatology, Marshfield, WI, United States; Virginia Reeder, MD, Tulane University Department of Dermatology, New Orleans, LA, United States; Mayur Ramesh, MD, Henry Ford Division of Infectious Disease, Detroit, MI, United States; Iltefat Hamzavi, MD, Henry Ford Department of Dermatology, Detroit, MI, United States Background: Hidradenitis suppurativa (HS) is a chronic follicular disorder characterized by painful abscesses, fistula formation, and scarring. Effective treatment options for advanced HS are currently limited, and despite multiple treatment regimens, many Hurley stage II and III patients have severely resistant disease to traditional therapies. Currently, there is little known about the role of ertapenem, a parenterally administered carbapenem antibiotic, in treatment.
The main objective of this research was to gain new fundamental understanding of the mechanism of acne lesion formation by using the advances in lipid analysis. Three clinical studies were conducted. Assessment of epidermal and sebaceous lipids was performed and correlated to acne and skin barrier parameters in different age populations with varying levels of acne severity. The first study was a 12-month long clinical involving 17 teenage boys with or without acne. Each month epidermal and sebaceous skin lipids were acquired using noninvasive tapes, skin barrier function was measured, and acne severity assessed. Monthly lipid analyses of sebum revealed differences in the amount and type of sebaceous lipids between acne and nonacne subjects. Greater secretion of sebaceous lipids (triglycerides, wax esters, free fatty acids [FFA], and squalene) was observed in the acne group than the nonacne group at all time points, and concentrations varied seasonally within groups. Detailed HPTLC/GC-FID analysis revealed differences in the sebaceous FFA class between the two groups. Subjects with acne had a [7.2-fold higher (P \.05) unsaturated FFA fraction and a 14.8-fold higher (P \.05) level of sapienic acid than the age-matched nonacne group. More unexpectedly changes were observed in the composition and levels of epidermal lipids isolated from acne individuals. The proportion of ceramides to total lipids was 28% in the acne group and 56% in the nonacne group. Seasonal increases in ceramides appeared to be associated with improved acne although the changes were observed in both groups. Barrier function was impaired in the acne group compared with the non-acne group (increased TEWL). A second clinical study was conducted following monthly changes in the skin of women suffering from cycling acne lesions associated with the menstrual cycle. That study also revealed similar observations on changes in skin lipids and barrier correlated with acne. In a third study, assessing facial skin changes in children approaching puberty (ages 6 to 13), an increase in sebum with age also correlated with increase in TEWL, an indicator of a compromised skin barrier. In conclusion, the results from these three clinical studies on subjects with acne demonstrate that there are substantial differences in epidermal and sebaceous skin lipids and in skin barrier compared to normal skin and suggest that acne can be considered a type of impaired skin barrier condition. Supported by Johnson & Johnson Consumer Inc.
Objective: To determine the efficacy, changes in satisfaction, purulent drainage, quality of life, level of pain, and safety in patients who have been treated with ertapenem. Methods: A retrospective chart review and telephone interview was completed for 12 refractory Hurley stage II or III patients who were currently being treated or had been treated with 1 gram of ertapenem daily. Results: Twelve patients were interviewed about their experience with ertapenem treatments. The mean age of the patients who received ertapenem was 46.3 and they had an average BMI of 37.2. All patients were resistant to typical treatments and had either Hurley stage II (n ¼ 2) or Hurley stage III (n ¼ 10) disease. Average duration of treatment was 62 days. In this study, 100% reported improvements in quality of life, 80% were satisfied with their treatment, 100% had decreased drainage, and 60% reported decreased pain associated with HS. Adverse events included gastrointestinal complaints (n ¼ 4), PICC line thrombosis (n ¼ 2), and significant elevation of liver function tests (n ¼ 1). Limitations: This was a small retrospective study that was completed at a single center. There was also inconsistent follow-up. Conclusion: Ertapenem appears to be a well-tolerated antibiotic that can be used as an effective method to rapidly improve control of the disease. It can be used to bridge patients who have advanced HS to a more definitive treatment. Further prospective studies are needed to determine the mechanism of action in HS. We hypothesize that there is a possible immunomodulatory role, impact on antimicrobial peptides, or on biofilms. Commercial support: None identified.
3641 Stigmatization of acne Kathryn T. Shahwan, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Jessica M. Donigan, MD, Department of Dermatology, University of Utah, Salt Lake City, UT, United States; Vanessa L. Pascoe, MD, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, United States; Alexa B. Kimball, MD, MPH, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Introduction: Acne vulgaris often develops during adolescence, a critical time in psychosocial development, and has been associated with reduced self-esteem, altered body image, feelings of shame and embarrassment, social dysfunction, and perceived stigmatization. This study aimed to explore perceptions of acne in the general public in order to better characterize the factors leading to its stigmatization. Methods: Healthy subjects (n ¼ 56) were shown images of common skin conditions including acne, psoriasis, eczema, vitiligo, rosacea, herpes (labialis and whitlow), warts, and tinea versicolor, and completed a questionnaire exploring their reactions to the images and perceptions of each condition. Results: The majority (62.5%) of subjects were upset by the acne images. This level was greater than any other condition aside from herpes, and this difference was statistically significant compared to eczema, vitiligo, rosacea, and tinea versicolor (P \.05). Location, color, and open sores were the most commonly reported upsetting features. Over half (55.4%) of subjects believed that acne was caused by poor hygiene, 37.5% thought it was related to diet, and 50% believed it was infectious. The majority of subjects said they would feel ashamed if they had acne and would find someone with acne unattractive (67.9%). In addition, 41.1% would feel uncomfortable being seen in public with a person with acne, and 44.6% would feel uncomfortable touching them. Only a minority of subjects, however, would exclude them from social events (19.6%), avoid hiring them for a job (14.3%), or separate from a significant other due to the disease (3.6%). Over 80% of subjects felt pity towards acne sufferers, which was significantly higher than for all the other skin conditions except psoriasis (P \.05).
3715 TNF-alfa inhibitors and hidradenitis suppurativa: Our clinical experience Valentina Dini, MD, PhD, University of Pisa, Pisa, Italy; Teresa Oranges, MD, University of Pisa, Pisa, Italy; Luca Rotella, MD, University of Pisa, Pisa, Italy; Marco Romanelli, MD, PhD, University of Pisa, Pisa, Italy Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory disease affecting approximately 1% of the general population, and it is characterized by recurrent, painful abscesses and inflammatory nodules in the axilla and groin areas, which can lead to chronically draining wounds and sinus tract. TNF-alfa inhibitors such as infliximab and adalimumab have demonstrated a significant efficacy in patients with moderate to severe HS. Objective: The purpose of this pilot study was to assess the efficacy and safety of TNF inhibitors in the treatment of HS patients resistant to conventional therapies.
Conclusion: Acne can have a profound psychosocial impact on its sufferers and is highly stigmatized. This may be due to its visibility on the face, although images of rosacea were significantly less upsetting to the subjects in this study. It may also be related to common misconceptions about its etiology, such as poor diet or hygiene, and interestingly, the belief that it may be contagious.
Materials and methods: We have included 10 patients affected by HS with Hurley II and III. 6 males and 4 females (17-64 yrs) with a diagnosis of HS since more than 6 months and prior to baseline visit that involved at least 2 distinct anatomical areas. All patients were not responding to conventional therapies including systemic antibiotics and retinoids. Three patients were treated in monotherapy with infliximab (5 mg/kg at week 0, 2, 6, and every 8 weeks) and 7 patients with adalimumab (80 mg at week 0 and 40 mg after 1 week and 40 mg weekly). Sartorius score and DLQI were used to assess the disease stage every two months for 1 year. Results: One of the patients treated with infliximab did not improve and had to be switched to adalimumab with a significant clinical improvement. Two patients treated with infliximab for 12 months have shown an important improvement of Sartorius score and DLQI but they have been lost to follow up. In the 7 patients treated with adalimumab, Sartorius score and DLQI were significantly improved compared to baseline, without a complete remission of HS. A relevant pain relief has been noted in all patients during treatment with TNF alpha inhibitors. Conclusions: In our experience, TNFalfa inhibitors therapy could be a valid option in the treatment of HS in order to improve the quality of life and to increase work productivity particularly in young patients.
Commercial support: None identified.
Commercial support: None identified.
MAY 2016
J AM ACAD DERMATOL Downloaded for Armyn Dwi Putra ([email protected]) at Universitas Muslim Indonesia from ClinicalKey.com by Elsevier on April 02, 2019. For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
AB9
3267
Skin lipids in acne e seasonal changes and effect on the epidermal barrier Apostolos Pappas, PhD, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States; Karen Meyer, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States; Ruth Tannahill, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States; Nikoleta Batchvarova, PhD, Johnson & Johnson Consumer, Inc, New Brunswick, NJ, United States
The use of intravenous ertapenem in the management of severe hidradenitis suppurativa Cynthia Nicholson, MD, Henry Ford Department of Dermatology, Detroit, MI, United States; Melissa Williams, MD, Marshfield Clinic Dermatology, Marshfield, WI, United States; Virginia Reeder, MD, Tulane University Department of Dermatology, New Orleans, LA, United States; Mayur Ramesh, MD, Henry Ford Division of Infectious Disease, Detroit, MI, United States; Iltefat Hamzavi, MD, Henry Ford Department of Dermatology, Detroit, MI, United States Background: Hidradenitis suppurativa (HS) is a chronic follicular disorder characterized by painful abscesses, fistula formation, and scarring. Effective treatment options for advanced HS are currently limited, and despite multiple treatment regimens, many Hurley stage II and III patients have severely resistant disease to traditional therapies. Currently, there is little known about the role of ertapenem, a parenterally administered carbapenem antibiotic, in treatment.
The main objective of this research was to gain new fundamental understanding of the mechanism of acne lesion formation by using the advances in lipid analysis. Three clinical studies were conducted. Assessment of epidermal and sebaceous lipids was performed and correlated to acne and skin barrier parameters in different age populations with varying levels of acne severity. The first study was a 12-month long clinical involving 17 teenage boys with or without acne. Each month epidermal and sebaceous skin lipids were acquired using noninvasive tapes, skin barrier function was measured, and acne severity assessed. Monthly lipid analyses of sebum revealed differences in the amount and type of sebaceous lipids between acne and nonacne subjects. Greater secretion of sebaceous lipids (triglycerides, wax esters, free fatty acids [FFA], and squalene) was observed in the acne group than the nonacne group at all time points, and concentrations varied seasonally within groups. Detailed HPTLC/GC-FID analysis revealed differences in the sebaceous FFA class between the two groups. Subjects with acne had a [7.2-fold higher (P \.05) unsaturated FFA fraction and a 14.8-fold higher (P \.05) level of sapienic acid than the age-matched nonacne group. More unexpectedly changes were observed in the composition and levels of epidermal lipids isolated from acne individuals. The proportion of ceramides to total lipids was 28% in the acne group and 56% in the nonacne group. Seasonal increases in ceramides appeared to be associated with improved acne although the changes were observed in both groups. Barrier function was impaired in the acne group compared with the non-acne group (increased TEWL). A second clinical study was conducted following monthly changes in the skin of women suffering from cycling acne lesions associated with the menstrual cycle. That study also revealed similar observations on changes in skin lipids and barrier correlated with acne. In a third study, assessing facial skin changes in children approaching puberty (ages 6 to 13), an increase in sebum with age also correlated with increase in TEWL, an indicator of a compromised skin barrier. In conclusion, the results from these three clinical studies on subjects with acne demonstrate that there are substantial differences in epidermal and sebaceous skin lipids and in skin barrier compared to normal skin and suggest that acne can be considered a type of impaired skin barrier condition. Supported by Johnson & Johnson Consumer Inc.
Objective: To determine the efficacy, changes in satisfaction, purulent drainage, quality of life, level of pain, and safety in patients who have been treated with ertapenem. Methods: A retrospective chart review and telephone interview was completed for 12 refractory Hurley stage II or III patients who were currently being treated or had been treated with 1 gram of ertapenem daily. Results: Twelve patients were interviewed about their experience with ertapenem treatments. The mean age of the patients who received ertapenem was 46.3 and they had an average BMI of 37.2. All patients were resistant to typical treatments and had either Hurley stage II (n ¼ 2) or Hurley stage III (n ¼ 10) disease. Average duration of treatment was 62 days. In this study, 100% reported improvements in quality of life, 80% were satisfied with their treatment, 100% had decreased drainage, and 60% reported decreased pain associated with HS. Adverse events included gastrointestinal complaints (n ¼ 4), PICC line thrombosis (n ¼ 2), and significant elevation of liver function tests (n ¼ 1). Limitations: This was a small retrospective study that was completed at a single center. There was also inconsistent follow-up. Conclusion: Ertapenem appears to be a well-tolerated antibiotic that can be used as an effective method to rapidly improve control of the disease. It can be used to bridge patients who have advanced HS to a more definitive treatment. Further prospective studies are needed to determine the mechanism of action in HS. We hypothesize that there is a possible immunomodulatory role, impact on antimicrobial peptides, or on biofilms. Commercial support: None identified.
3641 Stigmatization of acne Kathryn T. Shahwan, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Jessica M. Donigan, MD, Department of Dermatology, University of Utah, Salt Lake City, UT, United States; Vanessa L. Pascoe, MD, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, United States; Alexa B. Kimball, MD, MPH, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Introduction: Acne vulgaris often develops during adolescence, a critical time in psychosocial development, and has been associated with reduced self-esteem, altered body image, feelings of shame and embarrassment, social dysfunction, and perceived stigmatization. This study aimed to explore perceptions of acne in the general public in order to better characterize the factors leading to its stigmatization. Methods: Healthy subjects (n ¼ 56) were shown images of common skin conditions including acne, psoriasis, eczema, vitiligo, rosacea, herpes (labialis and whitlow), warts, and tinea versicolor, and completed a questionnaire exploring their reactions to the images and perceptions of each condition. Results: The majority (62.5%) of subjects were upset by the acne images. This level was greater than any other condition aside from herpes, and this difference was statistically significant compared to eczema, vitiligo, rosacea, and tinea versicolor (P \.05). Location, color, and open sores were the most commonly reported upsetting features. Over half (55.4%) of subjects believed that acne was caused by poor hygiene, 37.5% thought it was related to diet, and 50% believed it was infectious. The majority of subjects said they would feel ashamed if they had acne and would find someone with acne unattractive (67.9%). In addition, 41.1% would feel uncomfortable being seen in public with a person with acne, and 44.6% would feel uncomfortable touching them. Only a minority of subjects, however, would exclude them from social events (19.6%), avoid hiring them for a job (14.3%), or separate from a significant other due to the disease (3.6%). Over 80% of subjects felt pity towards acne sufferers, which was significantly higher than for all the other skin conditions except psoriasis (P \.05).
3715 TNF-alfa inhibitors and hidradenitis suppurativa: Our clinical experience Valentina Dini, MD, PhD, University of Pisa, Pisa, Italy; Teresa Oranges, MD, University of Pisa, Pisa, Italy; Luca Rotella, MD, University of Pisa, Pisa, Italy; Marco Romanelli, MD, PhD, University of Pisa, Pisa, Italy Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory disease affecting approximately 1% of the general population, and it is characterized by recurrent, painful abscesses and inflammatory nodules in the axilla and groin areas, which can lead to chronically draining wounds and sinus tract. TNF-alfa inhibitors such as infliximab and adalimumab have demonstrated a significant efficacy in patients with moderate to severe HS. Objective: The purpose of this pilot study was to assess the efficacy and safety of TNF inhibitors in the treatment of HS patients resistant to conventional therapies.
Conclusion: Acne can have a profound psychosocial impact on its sufferers and is highly stigmatized. This may be due to its visibility on the face, although images of rosacea were significantly less upsetting to the subjects in this study. It may also be related to common misconceptions about its etiology, such as poor diet or hygiene, and interestingly, the belief that it may be contagious.
Materials and methods: We have included 10 patients affected by HS with Hurley II and III. 6 males and 4 females (17-64 yrs) with a diagnosis of HS since more than 6 months and prior to baseline visit that involved at least 2 distinct anatomical areas. All patients were not responding to conventional therapies including systemic antibiotics and retinoids. Three patients were treated in monotherapy with infliximab (5 mg/kg at week 0, 2, 6, and every 8 weeks) and 7 patients with adalimumab (80 mg at week 0 and 40 mg after 1 week and 40 mg weekly). Sartorius score and DLQI were used to assess the disease stage every two months for 1 year. Results: One of the patients treated with infliximab did not improve and had to be switched to adalimumab with a significant clinical improvement. Two patients treated with infliximab for 12 months have shown an important improvement of Sartorius score and DLQI but they have been lost to follow up. In the 7 patients treated with adalimumab, Sartorius score and DLQI were significantly improved compared to baseline, without a complete remission of HS. A relevant pain relief has been noted in all patients during treatment with TNF alpha inhibitors. Conclusions: In our experience, TNFalfa inhibitors therapy could be a valid option in the treatment of HS in order to improve the quality of life and to increase work productivity particularly in young patients.
Commercial support: None identified.
Commercial support: None identified.
MAY 2016
J AM ACAD DERMATOL Downloaded for Armyn Dwi Putra ([email protected]) at Universitas Muslim Indonesia from ClinicalKey.com by Elsevier on April 02, 2019. For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
AB9
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