Hossein Alinia

Assessment of rosacea severity: A review of evaluation methods used in clinical trials

BACKGROUND Novel rosacea treatments are needed. Assessment methodologies for clinical trials of rosacea treatments are not standardized and are relatively inadequate. To determine the efficacy of new treatments, a valid and reliable assessment methodology is needed. OBJECTIVE We sought to determine the assessment methodologies used in clinical trials for rosacea treatments, to demonstrate the need for a valid and reliable assessment tool, and to describe the relevant properties of such a tool. METHODS PubMed and MEDLINE were searched for clinical trials of rosacea treatments since January 1, 1985. RESULTS In all, 32 clinical trials met inclusion criteria. Assessment methodologies were highly variable, and standardized assessment methodologies were used in only 3 studies. The various manifestations of rosacea were assessed inconsistently. LIMITATIONS Eighteen articles could not be included as a result of lack of access to the full text. CONCLUSIONS The diverse methodologies make the assessment of novel treatments and comparison of treatments difficult. A valid and reliable assessment tool is needed to properly assess novel treatments to improve the management of rosacea.

Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring

Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short‐term adherence. Psoriasis is a chronic disease, and long‐term adherence is an even bigger problem.

Tolerability of Topical Retinoids: Are There Clinically Meaningful Differences Among Topical Retinoids?

Background: Topical retinoids are first-line treatment options for acne vulgaris. These drugs, however, produce varying degree of cutaneous irritation within the first few weeks of treatment. Objective: Our purpose was to examine differences in tolerability of topical retinoids and assess whether these differences would be clinically meaningful. Methods: A PubMed search was performed for sources on topical retinoids in acne vulgaris treatment. Thirty-four clinical studies were analyzed. Results: Thirteen studies had statistically significant results on tolerability of retinoid based on retinoid, vehicle, concentration, or skin type. All studies classified most of skin reactions as mild-moderate. Large differences in the number of dropouts due to irritation were not identified. Conclusion: Irritation studies did not show a high frequency of clinically significant irritation with topical retinoids. We anticipate that the large variation in patient use of topical retinoids would likely account for more variation in response than differences between drug formulations.

Rosacea patients seeking advice: Qualitative analysis of patients’ posts on a rosacea support forum

Abstract Background: Social media have become outlets for patients to voice opinions and ask questions. Since suffering from rosacea is an isolating experience and the disease is poorly understood, patients use social media to expand their knowledge about the condition. Objective: To understand rosacea patients’ online health information seeking habits to obtain a better insight of their educational needs. Methods: Ten percent of posts in online rosacea forum composed of 3350 members and 27 051 posts, discussing patient viewpoints and concern, selected by stratified random sampling. Three hundred and nine queries were directly categorized to patients “seeking advice” by two investigators and qualitatively analyzed. Results: Patients primarily sought advice about treatments (n = 155, 50.1%), triggers (n = 53, 17.1%), diet (n = 48, 15.5%), skin care (n = 37, 11.9%) and special presentations of the disease (n = 22, 7.1%). Questions frequently pertained to adverse effects, efficacy and target of therapy (78, 49, 30 posts, respectively). Conclusion: Proactively providing reliable resources and comprehensive explanations on treatments, triggers, diet and skin care could be helpful in reducing patients’ confusion about rosacea and enhancing rosacea patient–physician relationships.

New developments in the treatment of rosacea – role of once-daily ivermectin cream

Rosacea is a chronic dermatological disorder with a variety of clinical manifestations localized largely to the central face. The unclear etiology of rosacea fosters therapeutic difficulty; however, subtle clinical improvement with pharmacologic treatments of various drug categories suggests a multifactorial etiology of the disease. Factors that may contribute to disease pathogenesis include immune abnormality, vascular abnormality, neurogenic dysregulation, presence of cutaneous microorganisms, UV damage, and skin barrier dysfunction. The role of ivermectin in the treatment of rosacea may be as an anti-inflammatory and anti-parasitic agent targeting Demodex mites. In comparing topical ivermectin and metronidazole, ivermectin was more effective; this treatment modality boasted more improved quality of life, reduced lesion counts, and more favorable participant and physician assessment of disease severity. Patients who received ivermectin 1% cream had an acceptable safety profile. Ivermectin is efficacious in decreasing inflammatory lesion counts and erythema.

Emerging treatment options for psoriasis

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Psoriasis: Targets and Therapy 2014:4 27–35 Psoriasis: Targets and Therapy Dovepress

Assessing medication adherence using indirect self-report.

Poor adherence to medication is common, particularly in patients with chronic diseases who are prescribed multiple medications. A major public health problem, nonadherence is associated with poor clinical outcomes, increased health care costs, prolonged hospitalization, and higher mortality and morbidity. Assessing patients’ medication adherence may be helpful for assessing responses to treatment and for modifying treatment regimens.1,2 Many measurement tools have been suggested, and these methods can be divided into biochemical and pharmacologic markers of drug levels vs methods that quantify how many pills were taken. These latter methods include objective methods (eg, medical records and administration databases, pill count, and electronic monitoring systems) and subjective methods (eg, selfreport questionnaires). Each of these methods has its own strengths and limitations, and none of them covers all aspects of the complex and multidimensional nonadherence problem.1,3 While objective measures provide more reliable assessments of adherence, they are costly and not practical for use in routine clinical settings. Self-report of adherence is the most practical instrument for clinical use but is of limited accuracy.1,3,4 The correlation between medication adherence reported by selfreport questionnaires and electronic monitoring systems varies from 0.24 to 0.87 in different studies and reflects the fact that patients tend to overestimate their adherence in self-reports.2 Self-reported adherence is confounded by many biases, leading to overestimation of adherence.2,3,5 Patients are particularly prone to recall error when the time interval between drug consumption and assessment increases; they tend to recall the routine or intention to take medication instead of actual behavior.1,3 Self-report questionnaires generally focus on undesirable aspects of nonadherence that might make patients feel defensive. If patients think their report of poor adherence will cause an unpleasant effect, it may cause them to inaccurately self-report.3 In theory, using lessjudgmental direct questions about adherence may be useful,3 but one study found that less-judgmental direct questioning did not significantly improve the accuracy of patients’ self-report.4,5 When the subject of a question might make the respondents uncomfortable, using indirect questioning, with less threatening words and options, may lead to more accurate responses. Moreover, developing indirect questions that focus on patients’ current situation instead of relying on their long-term memory may further enhance accurate reporting. We developed a series of questions based on the process of medication use that does not rely on the memory of an individual dose to elicit information from patients about adherence without sounding judgmental (Box). Poor adherence to treatment has been underrecognized and should be considered when evaluating poor response to treatment. Using indirect questioning about

Spotlight on brimonidine topical gel 0.33% for facial erythema of rosacea: safety, efficacy, and patient acceptability

Background Brimonidine tartrate is a highly selective alpha 2 agonist that induces direct vasoconstriction of small arteries and veins, thereby reducing vasodilation and edema. Objective To review the current literature regarding the safety, efficacy, and patient acceptability of brimonidine 0.33% gel. Methods A PubMed search was performed using the terms brimonidine 0.33% gel, rosacea, safety, efficacy, and acceptability. Peer-reviewed clinical trials and case reports from 2012 to 2016 were screened for inclusion of safety, efficacy, and/or patient acceptability data. Results Brimonidine topical gel 0.33% is associated with mild, transient skin-related adverse reactions. Efficacy may be achieved within 30 minutes of administration with maximal reductions in erythema 3–6 hours after administration. Patient satisfaction with use of brimonidine topical gel is superior to vehicle gel for facial appearance, treatment effect, facial redness, and daily control of facial redness. Limitations Studies were typically limited to 1-year follow-up. Only one study has examined the use of brimonidine topical gel in combination with other rosacea and acne medications. Discussion Brimonidine topical gel 0.33% is a safe, effective, and patient-accepted treatment for facial erythema of rosacea.

How Frequency of Electrosurgical Current and Electrode Size Affect the Depth of Electrocoagulation.

BACKGROUND Many factors affect the depth of electrocoagulation. OBJECTIVE To evaluate the effect of current frequency and electrode size on the depth of electrocoagulation. METHODS AND MATERIALS In this in vitro study, 4 cylindrical electrodes (2, 2.3, 3, and 4 mm) were used to apply 3 electrosurgical currents (0.4, 1.5, and 3 MHz) to bovine liver. Each electrode was placed at different points on the surface of the liver, and energy at various levels and frequencies was delivered to the tissue. Subsequently, cross-sections of the liver were analyzed. RESULTS Coagulation started at the periphery of the electrode-tissue contact area. With higher energy levels, coagulation spreads to involve the remainder of the contact area. Neither the frequency nor the electrode size had any effect on this coagulation pattern. The frequency of the current also did not show any relation with depth of coagulation; however, there was a direct correlation between the size of the electrode and the depth of coagulation. CONCLUSION Larger-tip electrodes provided deeper coagulation compared with finer-tip electrodes.

Topical clobetasol in conjunction with topical tretinoin is effective in preventing scar formation after superficial partial-thickness burn ulcers of the skin: A retrospective study

Abstract Background: Deep erythema and inflammation after re-epithelialization of superficial wounds is a sign of scar formation. Corticosteroids may prevent scarring by suppression of inflammation and fibroblast activity. Tretinoin may increase the efficacy of corticosteroids in this setting. Objective: To evaluate the efficacy of corticosteroids plus tretinoin for prevention of scars after superficial wounds. Methods: In a retrospective study of patients with superficial partial thickness thermal skin burn, we compared the patients who received clobetasol plus tretinoin after re-epithelialization with patients who did not receive any medication. Clobetasol propionate 0.05% ointment was used twice daily with overnight occlusive dressing in conjunction with twice weekly topical tretinoin 0.05% cream. Results: Among 43 patients who had light pink or no erythema after re-epithelialization and consequently did not receive clobetasol + tretinoin, no scar was developed. Among patients who had deep erythema after re-epithelialization, rate of scar formation was significantly higher in 14 patients who did not receive clobetasol + tretinoin than in 21 patients who received clobetasol + tretinoin (64% and 19%, respectively; p = 0.01). Conclusion: Clobetasol + tretinoin can significantly decrease the incidence of scar formation in patients with inflammation after re-epithelialization of superficial wounds.