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Common reasons why acne patients call the office
P7979
P8369
Are tetracycline-resistant Propionibacterium acnes increasing in our acne community? Mohammed Sayeedullah Shareef, Harrogate and District Hospital NHS Foundation Trust, Harrogate, United Kingdom; Alison Layton, Harrogate and District Hospital NHS Foundation Trust, Harrogate, United Kingdom; E. A. Eady, Harrogate and District Hospital NHS Foundation Trust, Harrogate, United Kingdom; Raed El-Naes, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom Resistance in Propionibacterium acnes (P acnes) is a worldwide problem, especially to macrolide-lincosamide-streptogramin B antibiotics (65% of patients colonised) and less so to tetracycline (20-30%). Antibiotics remain the mainstay of treatment for acne and there are studies to demonstrate that harbouring resistant strains of P acnes is associated with reduced efficacy to antibiotic therapy. The use of’antibiotics also drives the resistance in the resident bacterial flora of the skin and mucosa. In response to these concerns, there have been concerted efforts over the last few years to rationalize antibiotic prescribing in acne by avoiding the use of macrolides and instead’using tetracyclines, adopting regimes to include benzoyl peroxide alongside antibiotics as an antiresistant agent and topical retinoids to expedite efficacy and minimise antibiotic exposure. The aim of this study is to assess whether the incidence of resistance in P acnes has changed particularly in the context of recommended guidance on antibiotic usage in acne which now advocates tetracyclines over macrolides as well as methods to reduce the likelihood of resistance developing. 436 patients referred to a secondary care dermatology department had P acnes cultured from acne affected areas. The swabs are inoculated on Columbia blood agar and then WilkinseChalgren anaerobe agar. The plates are incubated at 378C for 1 day and 7 days, respectively. Sensitivities to erythromycin, clindamycin and tetracycline were assessed. The results from these cultures were correlated with prescribing habits. This study will demonstrate the current numbers of patients affected by resistant P acnes in this population, indicate whether tetracycline-resistant P acnes are more common following recommended guidance and provide some further indication on need for improved antibiotic prescribing and / or need for alternative therapies at a time when awareness on antibiotic usage is paramount.
Characterization of patients’ quality of life and experience in the course of acne treatment Robert Skaggs, II, Wake Forest School of Medicine, Winston-Salem, NC, United States; Emily Hix, Wake Forest School of Medicine, Winston-Salem, NC, United States; Karen Huang, MS, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest School of Medicine, Winston-Salem, NC, United States Background: While quantitative studies demonstrate that acne impacts quality of life, there is a relative lack of qualitative studies that provide complementary and more detailed data. Objective: The purpose of this study was to learn patients’ impressions of quality of life and personal experiences in the course of an acne treatment. Methods: Video interviews of 27 teenagers and young adults with acne enrolled in a 12-week clinical trial of adapalene/benzoyl peroxide gel were transcribed. Transcripts were then coded using Weft QDA software and qualitatively analyzed. Results: Four thematic domains were found in all participants that affected quality of life and experience: physical symptoms of disease, self-perception, social placement and perception of control. Successful treatment resulted in increased self-esteem and better performance at work and school. Increased perception of control was associated with increased quality of life and overall treatment satisfaction. Conclusions: Successful acne treatment increases patients’ quality of life by improving physical appearance and self-perception, satisfaction with social placement and perception of control. Psychosocial support in acne treatment, which can include an emphasis on patients acquiring an internal locus of control, may improve patient satisfaction. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
Commercial support: None identified.
P8403 Biomarker expression reflects the cyclical nature of rosacea in subjects treated with oral doxycycline modified release Anna Di Nardo, MD, PhD, Department of Medicine-Dermatology Research, University of California, San Diego, La Jolla, CA, United States; Adrienne M. Badeaux, PhD, Galderma Laboratories, L.P., Fort Worth, TX, United States; Eugene Y. Huang, MD, PhD, Therapeutics Clinical Research, San Diego, CA, United States; Norman Preston, PhD, Galderma Laboratories, L.P., Fort Worth, TX, United States; Richard L. Gallo, MD, PhD, University of California, San Diego, La Jolla, CA, United States; Ronald W. Gottschalk, MD, Galderma Laboratories, L.P., Fort Worth, TX, United States While an estimated 16 million people suffer from rosacea in the US, the numerous pathogenic factors believed to augment the inflammation of papulopustular rosacea (PPR) remain unknown. One such factor is the innate immune response which includes increased cutaneous levels of antimicrobial peptides and their proinflammatory peptide byproducts. These proinflammatory peptides are thought to be the product of increased activity of cutaneous members of the kalikrein (KLK) family of serine proteases, which can in turn be activated by proteolytic cleavage by certain matrix metalloproteinases (MMP). While these biomarkers were identified in advanced disease states, it was unclear whether effective therapy known to improve PPR would result in modification of these biomarkers. Previously, it was determined that MMP levels greater than or equal to 0.01RFU/s imply a ‘‘state of inflammation’’ based on mouse models. This study evaluated doxycycline 40 mg modified release (MR) capsules efficacy, safety, and impact on inflammatory biomarkers in subjects 18 to 70 years old with PPR. Investigator’s global assessment, lesion count, and biomarker levels by tape strips were evaluated. Subjects with MMP levels above 0.01 RFU/s at baseline had reduced MMP levels with doxycycline MR treatment. Doxycycline MR treatment also maintained or reduced MMP levels in subjects that improved clinically according to IGA score and lesion count. Subjects with MMP levels below 001 RFU/s at baseline, but with clinical inflammatory markers, saw an IGA score of clear or near clear as early as week 4 with doxycycline MR treatment compared to placebo. Subjects with MMP levels above 0.01 RFU/s at baseline and clinical inflammatory markers also saw a greater improvement in IGA scores with doxycycline MR treatment compared to placebo. Additionally, the percent reduction in inflammatory lesion counts were similar. Doxycycline MR was well tolerated in both groups, above and below 0.01 RFU/s with most adverse events reported as mild or moderate. The most common AEs were nausea, sinusitis, and upper respiratory infection. MMP levels do not always reflect the clinical status of the disease, but the baseline MMP levels may predict clinical treatment success depending on where in the rosacea inflammatory cycle the MMP levels are when treatment with doxycycline MR is administered. Supported by Galderma Laboratories, L.P.
AB6
J AM ACAD DERMATOL
P8114 Common reasons why acne patients call the office Lauren Barnes, Wake Forest School of Medicine, Winston-Salem, NC, United States; Amir Al-Dabagh, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest School of Medicine, Winston-Salem, NC, United States; William Huang, MD, MPH, Wake Forest School of Medicine, Winston-Salem, NC, United States Background: Communication between physicians and patients is essential to provide proper medical care, and patients at times leave with questions that were not sufficiently addressed during the visit. Patients call the clinic for additional information, which can be disruptive to the flow of clinical care, delay proper treatment, and reduce patient satisfaction. Purpose: We examine the post-visit questions of acne patients to develop interventions to improve patient education and reduce clinic call-backs. Methods: A retrospective electronic medical record (EMR) chart review was performed in the Wake Forest Baptist Health (WFBH) Dermatology clinic for visits between October 1, 2012 and October 31, 2012. Acne patients were identified using clinic visit notes, and their charts were reviewed for telephone calls to the clinic occurring between October 1, 2012 and March 29, 2013. Notes were grouped into seven categories. Results: Of 315 acne patients, 31 (9.8%) called the clinic. Isotretinoin was the subject of 66.7% of the calls, and half the calls regarding isotretinoin involved questions about potential side effects while taking the medication. Calls that did not refer to isotretinoin addressed topical acne medications, acne symptoms, and pharmacy requests. Limitations: The study involved one center, and email and fax correspondence was not captured. Conclusions: We found gaps in communication sufficient to require patients to call in for support, specifically for oral isotretinoin treatment. Interventions to address these questions can be expected to improve quality of care. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
MAY 2014
P8369
Are tetracycline-resistant Propionibacterium acnes increasing in our acne community? Mohammed Sayeedullah Shareef, Harrogate and District Hospital NHS Foundation Trust, Harrogate, United Kingdom; Alison Layton, Harrogate and District Hospital NHS Foundation Trust, Harrogate, United Kingdom; E. A. Eady, Harrogate and District Hospital NHS Foundation Trust, Harrogate, United Kingdom; Raed El-Naes, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom Resistance in Propionibacterium acnes (P acnes) is a worldwide problem, especially to macrolide-lincosamide-streptogramin B antibiotics (65% of patients colonised) and less so to tetracycline (20-30%). Antibiotics remain the mainstay of treatment for acne and there are studies to demonstrate that harbouring resistant strains of P acnes is associated with reduced efficacy to antibiotic therapy. The use of’antibiotics also drives the resistance in the resident bacterial flora of the skin and mucosa. In response to these concerns, there have been concerted efforts over the last few years to rationalize antibiotic prescribing in acne by avoiding the use of macrolides and instead’using tetracyclines, adopting regimes to include benzoyl peroxide alongside antibiotics as an antiresistant agent and topical retinoids to expedite efficacy and minimise antibiotic exposure. The aim of this study is to assess whether the incidence of resistance in P acnes has changed particularly in the context of recommended guidance on antibiotic usage in acne which now advocates tetracyclines over macrolides as well as methods to reduce the likelihood of resistance developing. 436 patients referred to a secondary care dermatology department had P acnes cultured from acne affected areas. The swabs are inoculated on Columbia blood agar and then WilkinseChalgren anaerobe agar. The plates are incubated at 378C for 1 day and 7 days, respectively. Sensitivities to erythromycin, clindamycin and tetracycline were assessed. The results from these cultures were correlated with prescribing habits. This study will demonstrate the current numbers of patients affected by resistant P acnes in this population, indicate whether tetracycline-resistant P acnes are more common following recommended guidance and provide some further indication on need for improved antibiotic prescribing and / or need for alternative therapies at a time when awareness on antibiotic usage is paramount.
Characterization of patients’ quality of life and experience in the course of acne treatment Robert Skaggs, II, Wake Forest School of Medicine, Winston-Salem, NC, United States; Emily Hix, Wake Forest School of Medicine, Winston-Salem, NC, United States; Karen Huang, MS, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest School of Medicine, Winston-Salem, NC, United States Background: While quantitative studies demonstrate that acne impacts quality of life, there is a relative lack of qualitative studies that provide complementary and more detailed data. Objective: The purpose of this study was to learn patients’ impressions of quality of life and personal experiences in the course of an acne treatment. Methods: Video interviews of 27 teenagers and young adults with acne enrolled in a 12-week clinical trial of adapalene/benzoyl peroxide gel were transcribed. Transcripts were then coded using Weft QDA software and qualitatively analyzed. Results: Four thematic domains were found in all participants that affected quality of life and experience: physical symptoms of disease, self-perception, social placement and perception of control. Successful treatment resulted in increased self-esteem and better performance at work and school. Increased perception of control was associated with increased quality of life and overall treatment satisfaction. Conclusions: Successful acne treatment increases patients’ quality of life by improving physical appearance and self-perception, satisfaction with social placement and perception of control. Psychosocial support in acne treatment, which can include an emphasis on patients acquiring an internal locus of control, may improve patient satisfaction. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
Commercial support: None identified.
P8403 Biomarker expression reflects the cyclical nature of rosacea in subjects treated with oral doxycycline modified release Anna Di Nardo, MD, PhD, Department of Medicine-Dermatology Research, University of California, San Diego, La Jolla, CA, United States; Adrienne M. Badeaux, PhD, Galderma Laboratories, L.P., Fort Worth, TX, United States; Eugene Y. Huang, MD, PhD, Therapeutics Clinical Research, San Diego, CA, United States; Norman Preston, PhD, Galderma Laboratories, L.P., Fort Worth, TX, United States; Richard L. Gallo, MD, PhD, University of California, San Diego, La Jolla, CA, United States; Ronald W. Gottschalk, MD, Galderma Laboratories, L.P., Fort Worth, TX, United States While an estimated 16 million people suffer from rosacea in the US, the numerous pathogenic factors believed to augment the inflammation of papulopustular rosacea (PPR) remain unknown. One such factor is the innate immune response which includes increased cutaneous levels of antimicrobial peptides and their proinflammatory peptide byproducts. These proinflammatory peptides are thought to be the product of increased activity of cutaneous members of the kalikrein (KLK) family of serine proteases, which can in turn be activated by proteolytic cleavage by certain matrix metalloproteinases (MMP). While these biomarkers were identified in advanced disease states, it was unclear whether effective therapy known to improve PPR would result in modification of these biomarkers. Previously, it was determined that MMP levels greater than or equal to 0.01RFU/s imply a ‘‘state of inflammation’’ based on mouse models. This study evaluated doxycycline 40 mg modified release (MR) capsules efficacy, safety, and impact on inflammatory biomarkers in subjects 18 to 70 years old with PPR. Investigator’s global assessment, lesion count, and biomarker levels by tape strips were evaluated. Subjects with MMP levels above 0.01 RFU/s at baseline had reduced MMP levels with doxycycline MR treatment. Doxycycline MR treatment also maintained or reduced MMP levels in subjects that improved clinically according to IGA score and lesion count. Subjects with MMP levels below 001 RFU/s at baseline, but with clinical inflammatory markers, saw an IGA score of clear or near clear as early as week 4 with doxycycline MR treatment compared to placebo. Subjects with MMP levels above 0.01 RFU/s at baseline and clinical inflammatory markers also saw a greater improvement in IGA scores with doxycycline MR treatment compared to placebo. Additionally, the percent reduction in inflammatory lesion counts were similar. Doxycycline MR was well tolerated in both groups, above and below 0.01 RFU/s with most adverse events reported as mild or moderate. The most common AEs were nausea, sinusitis, and upper respiratory infection. MMP levels do not always reflect the clinical status of the disease, but the baseline MMP levels may predict clinical treatment success depending on where in the rosacea inflammatory cycle the MMP levels are when treatment with doxycycline MR is administered. Supported by Galderma Laboratories, L.P.
AB6
J AM ACAD DERMATOL
P8114 Common reasons why acne patients call the office Lauren Barnes, Wake Forest School of Medicine, Winston-Salem, NC, United States; Amir Al-Dabagh, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, PhD, Wake Forest School of Medicine, Winston-Salem, NC, United States; William Huang, MD, MPH, Wake Forest School of Medicine, Winston-Salem, NC, United States Background: Communication between physicians and patients is essential to provide proper medical care, and patients at times leave with questions that were not sufficiently addressed during the visit. Patients call the clinic for additional information, which can be disruptive to the flow of clinical care, delay proper treatment, and reduce patient satisfaction. Purpose: We examine the post-visit questions of acne patients to develop interventions to improve patient education and reduce clinic call-backs. Methods: A retrospective electronic medical record (EMR) chart review was performed in the Wake Forest Baptist Health (WFBH) Dermatology clinic for visits between October 1, 2012 and October 31, 2012. Acne patients were identified using clinic visit notes, and their charts were reviewed for telephone calls to the clinic occurring between October 1, 2012 and March 29, 2013. Notes were grouped into seven categories. Results: Of 315 acne patients, 31 (9.8%) called the clinic. Isotretinoin was the subject of 66.7% of the calls, and half the calls regarding isotretinoin involved questions about potential side effects while taking the medication. Calls that did not refer to isotretinoin addressed topical acne medications, acne symptoms, and pharmacy requests. Limitations: The study involved one center, and email and fax correspondence was not captured. Conclusions: We found gaps in communication sufficient to require patients to call in for support, specifically for oral isotretinoin treatment. Interventions to address these questions can be expected to improve quality of care. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P.
MAY 2014