ANTIBIOTIC STEWARDSHIP AND ADVANCES IN ANTIBIOTICS FOR ACNE
Antibiotic stewardship (i.e., the right dose of the right antibiotic at the right time for the right duration) was a particularly hot topic at many dermatology meetings in 2022. Research on trends in antibiotic stewardship and data on new narrow-spectrum antibiotics that will decrease the risk of antibiotic resistance were presented across several meetings.
An Expert Panel Questionnaire for Assessing Patient-reported and Caregiver-reported Outcomes in Acne Vulgaris
Although acne has been shown to negatively affect patient quality of life, functioning, and psychosocial factors, current patient-reported outcome (PRO) tools do not sufficiently evaluate the impact of acne on patients. As such, Baldwin et al1 created an expert panel questionnaire (EPQ) containing acne-specific PRO and caregiver-reported measures to assess disease impact and patient experience in acne and improve outcomes. A 10-person consensus panel identified 11 PROs to complement the Acne Symptom and Impact Scale (ASIS) and were determined as optimal for use in community-based, real-world research. The 11 items in the EPQ encompass emotional functioning, social functioning, activities of daily living (ADL), and perspectives of parents/caregivers.
Impact of Acne on Social Functioning, Emotional Functioning, and Activities of Daily Living Among Patients with Moderate to Severe Non-nodular Acne Vulgaris Administered Sarecycline in Real-world Community Practices Across the United States
Here, Fried et al2 utilized a novel EPQ to assess the impact of acne on emotional functioning, social functioning, and ADL among patients with moderate-to-severe non-nodular acne receiving sarecycline. At Week 12, there was a significant improvement in patients reporting “never/rarely” or “not at all/slightly/a little” for 10 of 11 EPQ items, indicating a significant reduction of acne burden among patients. The proportion of patients reporting a high acne burden significantly decreased at Week 12 as well. Thus, treatment with sarecycline was associated with improved emotional functioning, social functioning, and ADL in patients with acne.
Patient Reported Outcomes and Investigator Global Assessment of Acne Vulgaris Among Patients with Moderate to Severe Non-nodular Acne Vulgaris Administered Sarecycline in Real-world Community Practices Across the United States
In this study, Graber et al3 assessed PROs using ASIS and Investigator Global Assessment (IGA) scores among patients with moderate-to-severe non-nodular acne receiving sarecycline. At Week 12, 58.9 percent of patients achieved clear or almost clear skin (IGA score: 0/1). Additionally, only 11.1 percent of patients had moderate-to-severe acne at Week 12. Mean ASIS scores decreased significantly from baseline to Week 12, indicating improvements in acne symptoms and emotional/social impact. Additionally, 88.1 percent of patients reported satisfaction with sarecycline treatment outcomes at Week 12.
Determinants of Antibiotic Stewardship for Acne: A Pilot Survey of Key Stakeholders
Case et al4 conducted research evaluating determinants of antibiotic stewardship. In this study, researchers surveyed 30 key stakeholders including 22 dermatologists, four infectious diseases specialists, two dermatology advanced practice providers, and two dermatology residents. Influences on antibiotic prescribing practices were quantified using the validated 23-item “Influences on Patient Safety Behaviors Questionnaire” (IPSBQ). IPSBQ scores were summarized descriptively. Participants were 53-percent female. 73.3 percent identified as non-Hispanic White, 20 percent non-Hispanic Asian, 3.3 percent non-Hispanic Black, and 3.3 percent Hispanic. Participants had practiced for an average of 15.1 (SD,13.4) years. Factors reflecting highest barriers to antibiotic stewardship included “social influence”, “beliefs about capabilities”, “memory, attention, and decision processes”, and “environmental context and resources” with mean IPSBQ domain scores (SD) of 3.28 (0.79), 3.21 (1.09), 2.9 (0.93) and 2.67 (1.01), respectively.
Management of Truncal Acne with Oral Sarecycline: Pooled Results from Two Phase III Clinical Trials
Truncal acne is present in at least 50 percent of patients with acne, but clinical studies have predominately focused on facial acne. Del Rosso et al5 evaluated oral sarecycline for the treatment of truncal acne in two Phase III clinical trials using Investigator Global Assessment (IGA) success evaluated at Weeks 3, 6, 9, and 12. After conducting this study, chest IGA success rates showed significant improvement with sarecycline versus placebo comparing results at Week 3 (11.84% vs. 7.71%, respectively; p=0.0192) versus Week 12. (33.42% vs. 20.77%, respectively; p<0.0001 IGA success rates on the back also showed significant improvement with sarecycline versus placebo group at Week 3 (12.13% vs. 7.04%, respectively; p=0.0023), compared to Week 12 (33.07% vs. 21.91%, respectively; p<0.0001).
Trends in Oral Antibiotic Use for Acne Treatment: A Population-based Study in the United States, 2014–2016
Grada et al6 evaluated trends in oral antibiotic use for the treatment of acne vulgaris in a population-based study. Patients included in this study were at least nine years of age or older, prescribed an oral antibiotic, and had two or more diagnoses of acne seven or more days apart. Across all patients, the most commonly prescribed antibiotics were doxycycline and minocycline; 73.4%, 11.4%, 4.1%, and 10.9% of patients were prescribed tetracycline-class antibiotics, penicillin, macrolides, and another antibiotic class. Overall, 36.3 percent, 17.6 percent, 10.3 percent, and 5.4 percent of patients continuously used any oral antibiotic at 3, 6, 9, and 12 months. In this retrospective study, researchers discovered approximately 20 percent of patients used oral antibiotics for six months or greater. Based on these results, authors concluded that there is opportunity to reduce the rate of antibiotic resistance and antibiotic-associated complications by considering alternative treatments such as narrow-spectrum oral antibiotics, hormonal therapy, earlier initiation of isotretinoin, and laser and light-based modalities.
Efficacy of Oral Sarecycline in Hispanic Patients with Facial Inflammatory Acne
Moore et al7 conducted a subgroup analysis from two Phase III trials that evaluated over 500 Hispanic patients in hopes of better understanding the efficacy of oral sarecycline for facial inflammatory acne. Sarecycline, an FDA-approved treatment for moderate-to-severe acne for patients nine years or older, was evaluated in this study. Over 2,000 subjects were randomized to receive oral sarecycline at 1.5 mg/kg/day or placebo. Researchers found that in Hispanic patients, facial inflammatory lesions decreased at Week 6 by 41 percent versus 30 percent, at Week 9 by 51 percent versus 38 percent, and at Week 12 by 55 percent versus 37 percent in patients on sarecycline versus placebo, respectively. Additionally, results showed low rates of gastrointestinal treatment emergent adverse events.
Rapid Response of Truncal Acne with Oral Sarecycline
In this study, Moore et al8 assessed the efficacy of oral sarecycline for the treatment of truncal acne. Researchers assessed 10 patients with acne vulgaris on the trunk treated with sarecycline monotherapy once daily for three months. The subjects were evaluated for inflammatory lesion counts, reduction in disease and IGA scores of truncal acne at baseline and Week 12 of treatment. Results showed a significant improvement in truncal acne by Week 12, showing reduction in lesions counts and improved IGA scores.
Interplay Between the Facial Cutaneous Microbiome and Acne Vulgaris: A Pilot Study from the Largest National Gathering of Twins
According to research by Marson et al,9 studies have shown there is a tendency for epidermal dysfunction in acne vulgaris severity due to the negative reaction that occurs in the facial cutaneous microbiome. The researchers sought to determine a correlation between the facial cutaneous microbiome and the presence and severity in acne vulgaris in this study. They evaluated the medical and social history of a number of identical and fraternal twins with and without acne vulgaris to examine the correlation. The results showed of the 222 individuals that were assessed, twins with acne were significantly younger, had a lower BMI, and were more likely to be currently using benzoyl peroxide, prescription topical and systemic acne medications, and sunscreen. Also, facial cutaneous microbiome showed a decreased richness and evenness along with a difference between microbiome of individuals with acne and control. The authors were confident in concluding that environmental factors including acne therapy can alter relative abundances of specific microbial genera and lead to decreased evenness and richness.
Interplay Between the Facial Impact of Telehealth on Duration of Tetracycline Prescription During COVID-19
With the increasing use of telehealth during and following the COVID-19 pandemic, Munjal et al10 aimed to evaluate whether virtual visits have impacted duration of doxycycline prescription. They also sought to determine whether provider type (physician assistant, resident, fellow, or staff attending) affected duration of doxycycline prescription. They designed a retrospective cohort using all documented pharmaceutical prescriptions of doxycycline in 2019 and 2020 prescribed by dermatology providers at the University of Iowa Hospitals. According to the researchers, preliminary results showed an overall increase in telemedicine visits—from 13.73 percent in 2019 to 38.13 percent in 2020. Their analysis also demonstrated that only 25 percent of total in-person dermatology visits resulted in a doxycycline prescription of less than 31 days versus 47.49 percent of total virtual visits. However, the researchers note that despite the demonstrated increase in virtual visits in 2020, year did not seem to play a factor in the duration of antibiotic prescription, with roughly equal instances between 2019 and 2020.
Diet and quality of life in acne: A gut-brain-skin axis approach
Molina et al11 conducted a cross-sectional at a dermatology center in Bogotá, Colombia, study with the aim of evaluating the severity of acne in relation to daily diet and quality of life in patients. Demographic characteristics were gathered, acne severity was assessed using the Global Acne Grading System (GAGS), QoL, anxiety and/or depression symptoms were evaluated using the Dermatologic Life Quality Index (DLQI), Generalized Anxiety Disorder (GAD-7) scale and Patient Health questionnaire (PHQ-2), respectively. Participants were also surveyed on their weekly weekly frequency of consumption of certain food groups. Of 158 patients, 68 percent were women and the mean age was 21.63 years. The majority had mild-to-moderate acne (93.03%) and 6.96 percent had severe to very severe acne. DLQI/CDLQI results showed that 81.01 percent had little or no effect on their QoL. Regarding psychiatric symptoms, 18 people had mild to moderate depression symptoms, and 12 had severe anxiety symptoms. Of the patients, 49.36 percent reported daily consumption of dairy products and wheat foods, and 67.72 percent reported daily sugar intake.
How Lifestyle-Based Environmental Exposures Impact Skin Health through Microbiome
Here, Li et al12 aimed to create a knowledge network through systematically analyzing the correlations of environmental exposure (ultraviolet [UV], pollution, temperature, humidity), skin conditions and microbiome. In an eight-week clinical trial, healthy women with dry skin used a portable device to track personal real-life environment metrics (temperature, humidity, air pollutants), and daily recorded lifestyle-based environment exposures. Skin microbiome was collected and quantified based on 16S sequencing, and skin signs were measured using non-invasive instruments and dermatologist grading. Subjects were split into four clusters (C1–C4) based their skin tone, texture, and presence of acne. Environmental exposure variables and microbiome characteristics of each cluster were identified and correlated with skin conditions. Bayesian network was then applied to construct regulatory networks, which were validated by literature scraping using data collected from publications. 3,682 relationships across five domains were identified, and 499 relationships were validated, revealing skin microbiome mediated lifestyle-based environmental aggressors’ impact on skin health. Subjects with dull, rough, and acne-free skin (C3) had higher rates of UV and automobile exhaust exposure, whereas subjects with dull, rough, and acneic skin (C4) had the highest rate of kitchen fumes exposure. The microbiome in C3 consisted of Polycyclic Aromatic Hydrocarbon degraders, which may contribute to less acne.
- Baldwin H, Graber E, Fried RG. An Expert Panel Questionnaire for Assessing Patient-reported and Caregiver-reported Outcomes in Acne Vulgaris. Presented at: Fall Clinical Dermatology Conference, October 20-23, 2022, Las Vegas, Nevada.
- Fried RG, Rieder EA, Alexis AF, et al. Impact of Acne on Social Functioning, Emotional Functioning, and Activities of Daily Living Among Patients with Moderate to Severe Non-nodular Acne Vulgaris Administered Sarecycline in Real-world Community Practices Across the US (PROSES Study). Presented at: Fall Clinical Dermatology Conference, October 20-23, 2022, Las Vegas, Nevada.
- Graber E, Baldwin H, Harper JC, et al. Patient Reported Outcomes and Investigator Global Assessment of Acne Vulgaris Among Patients with Moderate to Severe Non-nodular Acne Vulgaris Administered Sarecycline in Real-world Community Practices Across the US (PROSES Study). Presented at: Fall Clinical Dermatology Conference, October 20-23, 2022, Las Vegas, Nevada.
- Case KB, Thompson EC, Barron J, Radi R, Chu L, Yeung H. Determinants of antibiotic stewardship for acne: A pilot survey of key stakeholders. Presented at: Society for Investigative Dermatology, May 18–21, 2022, Portland, Oregon.
- Del Rosso JQ, Stein Gold L, Baldwin H, et al. Management of Truncal Acne with Oral Sarecycline: Pooled Results from Two Phase-3 Clinical Trials. Presented at: Maui Derm NP+PA Fall 2022; September 18-21, 2022, Nashville, Tennessee.
- Grada A, Barbieri JS, Armstrong AW, Salem R, Feldman SR. Trends in oral antibiotic use for acne treatment: A population-based study in the United States, 2014-2016. Presented at: Society for Investigative Dermatology, May 18-21, 2022, Portland, Oregon.
- Moore A, Moore SA, Grada A. Efficacy of Oral Sarecycline in Hispanics with Facial Inflammatory Acne. Presented at: American Academy of Dermatology 2022; March 25-29, 2022, Boston, Massachusetts.
- Moore YA, Moore SA, Trying SK. Rapid Response of Truncal Acne with Oral Sarecycline. Presented at American Academy of Dermatology 2022; March 25-29, 2022, Boston, Massachusetts.
- Marson J, Berto S, Mouser P, Baldwin HE. Interplay Between the Facial Cutaneous Microbiome and Acne Vulgaris: A Pilot Study from the Largest National Gathering of Twins. Presented at: American Academy of Dermatology 2022; March 25-29, 2022, Boston, Massachusetts.
- Munjal A, Tripathi R, Kinn P, et al. Impact of Telehealth on Duration of Tetracycline Prescription During COVID-19. Presented at: American Academy of Dermatology 2022; March 25-29, 2022, Boston, Massachusetts.
- Molina DAC, Sanchez-Zapata MJ, Fierro-Lozada JD. Diet and quality of life in acne: A gut-brain-skin axis approach.Presented at: American Academy of Dermatology 2022; March 25-29, 2022, Boston, Massachusetts.
- Li X, Yan B, Fu Y. How Lifestyle-Based Environmental Exposures Impact Skin Health through Microbiome. Presented at: American Academy of Dermatology 2022; March 25-29, 2022, Boston, Massachusetts.