Currents: Calming the Inflammation of Acne and Rosacea

PDT Continues to Fill a Niche in Acne Care

Photodynamic therapy (PDT) continues to be a viable treatment option for acne. Blue and red light are shown to kill C. acnes directly and indirectly via the the formation of reactive oxygen species (ROS). ROS is also associated with reduction of oil gland cells via apoptosis and a delayed immunologic reaction, says Amy Forman Taub, MD, founder of Advanced Dermatology and skinfo Specialty Skincare Boutique in Lincolnshire, IL.

“I was an early adopter and even pioneer in this method, as procedural treatments for acne seemed to be an exciting new option,” says Dr. Taub, “Many patients were either leery of drugs or had had side effects or not been adequately treated.”

Any patient with moderate to severe acne is a potential candidate for PDT, Dr. Taub says, but cystic and inflammatory acne are particularly amenable to treatment. “PDT can improve apparent pore size and oiliness, as well, and, in fact, may be the best available treatment for these indications. Due to expense and inconvenience, patients do not often pursue PDT just for those indications.” She notes that Levulan had been considered a category B drug, and blue light can be used in dark skin. Patients with mild disease or known sensitivity to the light should should not be treated.

Dr. Taub notes that most patients who choose to undergo PDT do so to avoid medications and their potential side effects. Treatment is not covered by insurance and presents an out-of-pocket cost. Sometimes, weighing the cost of PDT against the option of isotretinoin can tip parents of adolescents toward the systemic drug.

While results of PDT for acne can be impressive, “It also isn’t quite a cure,” Dr. Taub stresses. “Some people experience very long erm results, but most need some maintenance once or twice a year. There are some published reports permanently curing acne with PDT, but these were at very high dosages of light that caused significant downtime and discomfort.”

University of Bradford Propels Skin Microbiome Research

University of Bradford scientists are helping open new areas of research into the skin microbiome. Much like the gut microbiome, the skin has its own community of microorganisms, whose job is to protect us from infection and maintain a healthy state. However, scientists are only now beginning to understand the scope and complexity of the skin microbiome, which makes it an area ripe for new research and potential discoveries that could lead to new healthcare treatments.

The University of Bradford’s Centre for Skin Sciences and UK Research and Innovation (UKRI)-funded Skin Microbiome in Healthy Ageing (SMiHA) project is one of 11 projects funded by the The Biotechnology and Biological Sciences Research Council (BBSRC) and Medical Research Council (MRC).

The University works with an extensive portfolio of companies, including Aveda/Estée Lauder, BASF and Johnson & Johnson.

“Many companies do not have the capacity to do this sort of research in-house, nor the breadth of knowledge, or research environment. Ultimately, companies have a choice of how they commission research, but when they choose to work with a university, such as ours, they not only get what they asked for but also the benefit of the wider research environment,” says Dr. Gillian Westgate is business development manager in the Centre for Skin Sciences, in a news release. “We carry out research for companies that make active ingredients and finished products - things like skin creams and shampoo… It is important for consumers to trust the products they buy, and our work provides the manufacturers with valuable scientific insights.”

Most recently, the University organized and led a “sandpit” event with the SMiHA network, bringing together experts from industry and academia, including other university partners in the SMiHA skin microbiome network: Liverpool, Manchester, East Anglia, and Queen Mary University London.

“As the only network focused on skin, SMiHA aims to discover more about the role of the microbiota that live on our body and how this community of microorganisms contribute to health and wellbeing, especially in older people,” says Professor Julie Thornton, the academic director of the Centre for Skin Sciences. “Feedback from all participants demonstrated an overwhelming desire and excitement to work together with industry in this network, [and] areas of innovation that were raised as priority included women’s health and to understand the impact of the menopause in skin, as well as in intimate health; acne and wound care strategies, working with the microbiome as opposed to conventional anti-microbial approaches, and the need to develop laboratory models to explore innovative approaches to managing skin health via targeting the microbiome.”

To facilitate the development of these priorities, SMiHA will soon be launching a small projects fund which organizers hope will attract ‘matched funding’ from industry. It will have an open brief, a competitive bidding process and is designed to leverage larger funded projects in the future. The fund will also be used to facilitate researcher exchanges. For example, businesses can host an academic with skin microbiome expertise to help with a business-related project.

Global Dermatology Coalition Launches

The Global Dermatology Coalition, a patient-led, multi-stakeholder group of organizations, has launched during the 75th World Health Assembly in Geneva. The Global Dermatology Coalition includes dermatology patient organizations, health care professionals (dermatologists and dermatology nurses), researchers, and industry.

“Collaborative action is needed to change the difficult reality faced by skin patients and for this reason we have established the Global Dermatology Coalition. Together, our organizations are actively working to improve patient outcomes globally,” says Marc Yale, Board President of the International Alliance of Dermatology Patient Organizations (also knowns as GlobalSkin) and Chair of the Global Dermatology Coalition Steering Committee. “This would mean improved access to the diagnosis, care, treatments and support they need, when they need it – no matter where they live in the world. The Coalition speaks as one voice because people living with dermatological diseases, their caregivers and their families deserve to live without stigma, for their diseases not to be minimized and to achieve a higher quality of life.”

WATCH NOW

Treating Acne: Isotretinoin in Practice
Josh Zeichner, MD recently shared updates from his presentation at the American Academy of Dermatology on acne treatment tips for patients on isotretinoin.
“If I could give you one tip it would be to evaluate your patient’s skin when they come into the office. If their skin isn’t dry, then they’re probably not absorbing the drug. So you want to make sure to educate them to take isotretinoin with a fatty meal and to consider going up on the dose if they’re not absorbing it,” Dr. Zeichner says. For more, including his discussion of a recent update that further supports the belief that isotretinoin may not increase risk for suicidal thoughts, visit PracticalDermatology.com/AAD22 to watch the full video.

Diseases of the skin, mucosa, nails and/or hair are a leading cause of global disease burden (GDB), affecting nearly 900 million people in the world at any time and are the fourth most frequent cause of human illness globally. Dermatologists diagnose and treat more than 3,000 different diseases, including atopic eczema, psoriasis, vitiligo, albinism, acne, alopecia and thousands of rare skin diseases. Dermatological diseases cause substantial pain, disfigurement, disability, and stigma while they also lead to serious comorbidities and significant psychological, social and financial burdens for patients and their families. Theses diseases can be inflammatory, infectious and malignant, and are among the most prevalent and disabling disorders, particularly in low resource countries.

The Global Dermatology Coalition will advocate to the World Health Organization and other decision makers globally to elevate the healthcare prioritization of dermatological diseases.