A systematic review published in The Journal of Dermatology investigated the efficacy and safety of topical spironolactone in the treatment of acne. The use of topical spironolactone 5% showed a reduction in the number of closed comedones and papules at four and eight weeks. Topical spironolactone 2% was also effective in reducing the number of papules, pustules, and comedones, with efficacy similar to that of clindamycin 1.5% solution. The authors observed that the 2% formulation given for 12 weeks yielded more favorable outcomes compared to 5% spironolactone for six to eight weeks, which, according to the authors, may be due to a longer treatment duration. Despite having a greater drug concentration in the gel formulation (5%), 2% topical spironolactone in solution form displayed more promising results.
[Read about potassium monitoring in women on spironolactone inDermWorld Weekly.]
There were no significant side effects with topical spironolactone. The authors concluded that topical spironolactone is an effective treatment for acne, although more trials are needed with a standardized dose and larger sample size to determine its role in treatment.
Is spironolactone use associated with risk of cancer? Read more in DermWorld Weekly.
DermWorld Insights and Inquiries: The ironclad promise of ferroptosis
Ferroptosis is an iron-dependent cell death accompanied by a large amount of iron accumulation and lipid peroxidation during the cell death process. Ferroptosis will become increasingly relevant to dermatologists. Deng et al have identified differentially expressed ferroptosis-related genes (FRGs) and pathways in UVB-induced skin photodamage. FRGs have significant potential for targeted therapies for squamous cell carcinoma chemotherapy resistance. Ferroptosis-related long non-coding RNAs have been demonstrated to accurately predict the prognosis and immune checkpoint inhibitor outcome of melanoma patients. Ferroptosis is involved in autoimmunity; further research may lead to insights in the pathogenesis and treatment of disorders such as lupus and psoriasis. Keep reading!
Topical lidocaine-prilocaine vs. ice packs for laser hair removal
A study published in JAAD compared the effectiveness of ice packs to topical lidocaine-prilocaine for pain reduction during axillary laser hair removal. Participants in this randomized controlled trial received a topical lidocaine-prilocaine mixture to one axilla and ice packs to the other before undergoing hair removal treatment with an 810-nm diode laser monthly for three months. The ice pack was applied to the axilla for 10 minutes before treatment, and the topical anesthetic was applied under occlusion for 60 minutes before the treatment.
Participants reported higher pain scores immediately after treatment with the topical anesthetic compared with ice. After five minutes, pain scores were higher with ice. While topical anesthetics provide longer-lasting anesthesia, the authors indicate that ice packs require less time and help avoid potential side effects associated with topical anesthetics.
Efficacy of tretinoin creams in treating acanthosis nigricans
Authors of a study published in the Archives of Dermatological Research compared the efficacy and safety of 0.025% and 0.05% tretinoin creams for the treatment of acanthosis nigricans. The outcome of reduced skin pigmentation was determined by changes in melanin and erythema obtained using narrowband reflectance spectrophotometry. Both concentrations of tretinoin significantly improved the melanin index and severity score at week eight. A majority of patients in both groups rated more than 75% improvement in their skin findings. There was no significant difference in efficacy or side effects between the two groups.
Dermatologists’ knowledge of compounding pharmacy regulations
According to survey results published in the International Journal of Dermatology, 94.7% of dermatologists use compounding pharmacies. The most common reasons for using compounding pharmacies include warts, rosacea, and melasma. Less than half surveyed know about these pharmacies’ regulations, such as compliance with USP standards, licensure for shipping, pharmacy accreditation status, or testing of drug products. Since accreditation and FDA inspection are not required, the authors state that it is important to use pharmacies that are accredited — and licensed to ship out-of-state — and have a lead pharmacist serving as a constant point of contact.
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