“ADULT FEMALE ACNE IS NOT TEENAGE ACNE” · 2016-01-27 · third of the face and the neck. In a...

Satellite Symposium EADV 2011

“ADULT FEMALE ACNE IS NOT TEENAGE ACNE”

Chair: Professor Dr. Brigitte Dréno October 22nd

Room: Auditorium III

ABSTRACT BOO

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F_Abstract Book Skinoren.indd 1 07/09/11 18:24

Acne in adult females: A growing concern PROFESSOR Dr. B. DRÉNO

Psychology of the adult female acne patientPROFESSOR Dr. A. ZALEWSKA

Azelaic acid for adult female acne: A good match Dr. JL. LÓPEZ ESTEBARANZ

Adherence drives success Dr. A. LAYTON

Chair: Professor Dr. Brigitte Dréno

Program


Intendis, a part of Bayer HealthCare, is proud to welcome you to our EADV 2011 satellite symposium focussing on adult female acne.

We are conducting this satellite symposium for the dermatology community as we perceive a growing interest in this topic, in conjunction with a growing number of adult females consulting dermatologists for the treatment of this particular type of acne.

The program is designed to explore and share the current understanding of adult female acne from different angles.Well-known experts will discuss:

• Epidemiology and clinical appearance of adult female acne.• Psychological impact for the patient and how to cope with this.• Clinical data for Azelaic acid and its application in adult female acne.• Best practices to ensure adherence with the proposed treatment scheme.

Special focus will be placed on the differences between adult female acne and the already well-described teenage acne as

Adult Female Acne is Not Teenage Acne

We wish you a very thought-provoking symposium!

Eugene O’Keefe, MDHead of Global Development INTENDIS

Welcome

Eugene O’Keefe


Brigitte Dréno is an “exceptional class” Professor (leading full professor) at Nantes University Hospital and vice dean for research at the Faculty of Medicine. She is Head of the Department of Dermatology and Skin Cancer and of the GMP Unit of Cell and Gene Therapy in Nantes‘ Hospital. She qualified in medicine in 1980 and obtained her PhD in 1988. Professor Dréno’s main interests lie in the treatment of melanoma; specifically she is interested in cell therapy and vaccination and in the physiopathology and treatment of acne both in teenagers and adults. She received a “Victoire de la Médecine” award for her work in 2005. She is vice president of the COSSEC committee of the INSERM that supports clinical trials in the field of cell and gene therapy. She is also vice president of the Cell Therapy committee of the AFSSAPS and external expert on quality of life and biotechnology for the European Commission. She is member of a number of national and international professional dermatological societies. She was the president of the French Society of Dermatology for 2 years and is the actual president of the College of French Professors in Dermatology (CEDEF). In January 2011 she received the distinction of the Knight of the Legion of Honor

Although acne is widely perceived as a disease of adolescence, nowadays a significant and increasing number of adult females present to dermatologists with acne. Whilst the prevalence of acne is highest in adolescents, the absolute number of adult females suffering from acne is comparable with that of adolescents: although lower in prevalence per age group, the length of the disease of up to 20 or more years raises the overall numbers to similar levels.

Around 13% to 17% of adult females suffer from clinical acne, with an additional 24% presenting with physiological acne, leading to a total acne prevalence of over 40%1. Some publications have identified an even higher prevalence2, 3. Adult female acne presents itself in two subtypes: persistent acne (80%) and / or late-onset acne (20%).Both subtypes have similar clinical features. Lesions are mostly inflammatory and are usually located in the lower third of the face and the neck. In a majority of the cases, the disease is graded as mild or moderate acne; severe adult female acne is rare4, although some patients will present with macro-comedones and more extensive involvement on the trunk.

Brigitte Dréno

Acne in adult females:a growing concern

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Psychodermatology DepartmentChair of Clinical Immunology and MicrobiologyMedical University of Lodz

Professor Anna Zalewska is Head of Psychodermatology Department at the Medical University of Lodz. Prior to taking up the chair position at Psychodermatology Dpt., she was consultant dermatologist at the Department of Dermatology and Venereology, Medical University of Lodz.

She is an author of several articles in peer reviewed research journals concentrated on psychological factors involvement in chronic skin diseases. Her professional interests include stress components of chronic dermatological conditions both from clinical and neurobiological point of view.

Literature demonstrates a substantial decrease in health related quality of life in acne patients, as well as higher levels of embarrassment and self-consciousness. Many patients suffer from self-image and self-esteem problems. Moreover, depression and anxiety are more commonly encountered in acne patients5,6. Patients’ perception of acne severity differs very often from that of the medical health provider. Therefore, an empathic approach based on adequate patient communication is necessary to address this quality of life diminishing disease.

• In addition to the physician’s objective assessment of acne severity assessment, the patient’s subjective assessment of its condition should be considered regarding the treatment decision. A topical medical treatment may therefore be adequate even in cases that appear as rather mild in severity from a morphological point of view.

• A holistic approach consisting of a medical treatment with cosmetic and adjunct therapy as well as a psychological support and coaching on the condition should be taken into consideration.

Anna Zalewska

Psychology of the adult female acne patient

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M.D. , PhD. , Dermatologist, Madrid, Spain

José Luis López Estebaranz is a dermatologist and Head of the Dermatology Department at the University Hospital Fundación Alcorcón. He is also Associate Professor of the Rey Juan Carlos University. His clinical research interests include acne, psoriasis and skin cancer focus on melanoma. He has participated in several research studies financed by national public funds (FIS, MEC) as principal investigator or coinvestigator (melanoma, lymphoma, scleroderma, poxvirus). Dr. López Estebaranz received his M.D. degree from the Autonoma University School of Medicine of Madrid in 1987. He obtained his Ph.D degree in 1994 after the residency training at University Hospital 12 de Octubre in Madrid. He was visiting dermatologist at St. Thomas’ Hospital in London in 1991. He occupied the position of Consultant Dermatologist at Hospital 12 de Octubre from1994 to 1998 before obtaining the position of Director of the Department of Dermatology at University Hospital Fundación Alcorcon in Madrid. He is a member of the Spanish Academy of Dermatology, the Iberoamerican Dermatology College and the American Academy of Dermatology. He is a member of the Spanish Psoriasis Group and has participated in the elaboration of Spanish psoriasis guidelines and monographs and guidelines on acne.Dr. López Estebaranz has authored and /or coauthored more than 100 dermatology papers and book chapters. He has received several prizes from the European and Spanish Academy of Dermatology. He is an editorial board member of several Spanish and international scientific journals.

Azelaic acid (available as 20% cream and 15% gel) is an efficacious mono-therapy7, 8.

Azelaic acid offers three mechanisms of action against the pathology of acne:

• Anti-inflammatory action• Anti-keratinizing action• Anti-microbial action

As acne lesions in adult females are generally inflammatory, it is important to offer a treatment with an anti-inflammatory action. Furthermore, Azelaic acid possesses an excellent side effect profile allowing for long-term treatment9. Thus, its specific characteristics are very well compatible with the requirements of adult female acne therapy.

José Luis López Estebaranz

Azelaic acid for adult female acne: a good match

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Time (months)

50

Tota

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edia

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Azelaic acid

Tretinoin

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40

20

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Effect of therapy

on the median number of the sum of

lesions

Time (months)

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(%)

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-20

-40

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Azelaic acid

Benzoylperoxide

Median reduction in

facial papules and pustules

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0 1 2 3 4

Azelaic acid

Clindamycin

Median reduction in

facial papules and pustules


M.B. , Ch.B. , FRCPConsultant Dermatologist Harrogate & District NHS Foundation Trust.Associate Medical Director for Research Harrogate & District NHS Foundation Trust.Clinical Director North East Yorkshire North Lincolnshire Comprehensive Local Research Network UK.

Dr. Alison Layton was appointed as Consultant Dermatologist at Harrogate and District NHS Foundation Trust in 1994. She has a particular interest in androgen mediated disorders including acne and polycystic ovary syndrome (PCOS). She sits on the Executive Council of PCOS UK. She has conducted many clinic trials embracing acne and rosacea as well as other inflammatory dermatoses. Dr. Layton is involved in basic science research examining the immunology and microbiological aspects of acne. She is one of the reviewers for the prodigy guidelines for rosacea and acne as well as for a number of NICE guidelines related to dermatological conditions. She has recently been involved in helping to develop the European Dermatology Forum Evidence based acne guideline. She has written the acne chapter for the eighth edition of Rook’s Textbook of Dermatology and a recent chapter on Sebaceous Gland disorders for the Oxford Textbook of Medicine. She has lectured and presented at many international symposiums on subjects related to acne and rosacea and has written many chapters and review articles specifically relating to these conditions. Dr. Layton was appointed to the position of Clinical Director for the North East Yorkshire Comprehensive Research Network in 2010 and is Associate Medical Director for research for her trust.

Treatment of adult female acne requires - like all medical interventions for chronic diseases – the patient’s willingness to stick to an agreed healthcare plan for a long period of time in order to achieve treatment success (adherence). Gender and age, social and psychological factors as well as quality of life impairments do impact a patient’s adherence.

In general, adult females are perceived as the subgroup with the best adherence to topical treatment. Yet, they still need proper education on their disease management to ensure treatment over a sufficiently long time period to effectively reduce frequency and severity of relapses. Dermatologists, through their interaction with the patient, are a key driver of adherence in this disease10. Overall it is important that:

• Dermatologist and patient agree on the treatment schedule.

• The Patient is educated to understand the acne disease with regards to:

o Usage recommendations.o Necessary length of treatment.o Undesired effects that may occur.

Alison Layton

Adherence drives success

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ABSTRACT BOO

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References: 1. Poli, F., Dreno, B. & Verschoore, M. An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol 15, 541-545 (2001). 2. Goulden, V., G. I. Stables, et al..”Prevalence of facial acne in adults.” J Am Acad Dermatol 41(4): 577-580 (1999). 3. Plunkett, A., K. Merlin, et al.. The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia.” Int J Dermatol 38 (12): 901-908 (1999). 4. Goulden, V., Clark, S.M. & Cunliffe, W.J. Post-adolescent acne: a review of clinical features. Br J Dermatol 136, 66-70 (1997). 5. Tan, J.K., et al. Divergence of demographic factors associated with clinical severity compared with quality of life impact in acne. J Cutan Med Surg 12, 235-242 (2008). 6. Lasek, R.J. & Chren, M.M. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol 134, 454-458 (1998). 7. Katsambas, A., Graupe, K. & Stratigos, J. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin. Acta Derm Venerol, Suppl, 143:35-39 (1989) 8. Gollnick, H.P., Graupe, K. & Zaumseil, R.P. [Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies]. J Dtsch Dermatol Ges 2, 841-847 (2004). 9. Graupe, K., Cunliffe, W.J., Gollnick, H.P. & Zaumseil, R.P. Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Cutis 57, 20-35 (1996). 10. Dreno, B., et al. Large-scale worldwide observational study of adherence with acne therapy. Int J Dermatol 49, 448-456 (2010).

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