Table Of Content

ACNE AND ITS THERAPY BASIC AND CLINICAL DERMATOLOGY Series Editors ALAN R. SHALITA,M.D. DistinguishedTeachingProfessorandChairman DepartmentofDermatology SUNYDownstateMedicalCenter Brooklyn,NewYork DAVID A. NORRIS,M.D. DirectorofResearch ProfessorofDermatology TheUniversityofColorado HealthSciencesCenter Denver,Colorado 1. CutaneousInvestigationinHealthandDisease:NoninvasiveMethodsand Instrumentation,editedbyJean-LucLe´veˆque 2. IrritantContactDermatitis,editedbyEdwardM.JacksonandRonaldGoldner 3. FundamentalsofDermatology:AStudyGuide,FranklinS.Glickmanand AlanR.Shalita 4. AgingSkin:PropertiesandFunctionalChanges,editedbyJean-LucLe´veˆque andPierreG.Agache 5. Retinoids:ProgressinResearchandClinicalApplications,editedby MariaA.LivreaandLesterPacker 6. ClinicalPhotomedicine,editedbyHenryW.LimandNicholasA.Soter 7. CutaneousAntifungalAgents:SelectedCompoundsinClinicalPractice andDevelopment,editedbyJohnW.RipponandRobertA.Fromtling 8. OxidativeStressinDermatology,editedbyJu¨rgenFuchsandLesterPacker 9. ConnectiveTissueDiseasesoftheSkin,editedbyCharlesM.Lapie`reand ThomasKrieg 10. EpidermalGrowthFactorsandCytokines,editedbyThomasA.Lugerand ThomasSchwarz 11. SkinChangesandDiseasesinPregnancy,editedbyMarwaliHarahapand RobertC.Wallach 12. FungalDisease:Biology,Immunology,andDiagnosis,editedby PaulH.JacobsandLexieNall 13. ImmunomodulatoryandCytotoxicAgentsinDermatology,editedby CharlesJ.McDonald 14. CutaneousInfectionandTherapy,editedbyRazaAly,KarlR.Beutner,and HowardI.Maibach 15. TissueAugmentationinClinicalPractice:ProceduresandTechniques, editedbyArnoldWilliamKlein 16. Psoriasis:ThirdEdition,RevisedandExpanded,editedbyHenryH.Roenigk, Jr.,andHowardI.Maibach 17. SurgicalTechniquesforCutaneousScarRevision,editedbyMarwaliHarahap 18. DrugTherapyinDermatology,editedbyLarryE.Millikan 19. ScarlessWoundHealing,editedbyHariG.GargandMichaelT.Longaker 20. CosmeticSurgery:AnInterdisciplinaryApproach,editedbyRhodaS.Narins 21. TopicalAbsorptionofDermatologicalProducts,editedbyRobertL.Bronaugh andHowardI.Maibach 22. GlycolicAcidPeels,editedbyRonaldMoy,DebraLuftman,andLenoreS.Kakita 23. InnovativeTechniquesinSkinSurgery,editedbyMarwaliHarahap 24. SafeLiposuctionandFatTransfer,editedbyRhodaS.Narins 25. PyschocutaneousMedicine,editedbyJohnY.M.KooandChaiSueLee 26. Skin,Hair,andNails:StructureandFunction,editedbyBoForslindand MagnusLindberg 27. Itch:BasicMechanismsandTherapy,editedbyGilYosipovitch,Malcolm W.Greaves,AlanB.Fleischer,andFrancisMcGlone 28. Photoaging,editedbyDarrellS.Rigel,RobertA.Weiss,HenryW.Lim,and JeffreyS.Dover 29. Vitiligo:ProblemsandSolutions,editedbyTorelloLottiandJanaHercogova 30. PhotodamagedSkin,editedbyDavidJ.Goldberg 31. AmbulatoryPhlebectomy,SecondEdition,editedbyMitchelP.Goldman, MihaelGeorgiev,andStefanoRicci 32. CutaneousLymphomas,editedbyGunterBurgandWernerKempf 33. WoundHealing,editedbyAnnaFalabellaandRobertKirsner 34. PhototherapyandPhotochemotherapyforSkinDisease,ThirdEdition, WarwickL.Morison 35. AdvancedTechniquesinDermatologicSurgery,editedbyMitchelP.Goldman andRobertA.Weiss 36. TissueAugmentationinClinicalPractice,SecondEdition,editedbyArnold W.Klein 37. Cellulite:PathophysiologyandTreatment,editedbyMitchelP.Goldman, PierAntonioBacci,GustavoLeibaschoff,DorisHexsel,andFabrizioAngelini 38. Photodermatology,editedbyHenryW.Lim,HerbertHo¨nigsmann,and JohnL.M.Hawk 39. RetinoidsandCarotenoidsinDermatology,editedbyAndersVahlquistand MadeleineDuvic 40. AcneandItsTherapy,editedbyGuyF.WebsterandAnthonyV.Rawlings ACNE AND ITS THERAPY Edited by Guy F. Webster Jefferson Medical College of Thomas Jefferson University Philadelphia, Pennsylvania, USA Anthony V. Rawlings AVR Consulting LTD Northwich, Cheshire, UK DK4962-Webster-FM_R2_020407 InformaHealthcareUSA,Inc. 52VanderbiltAvenue NewYork,NY10017 #2007byInformaHealthcareUSA,Inc. InformaHealthcareisanInformabusiness NoclaimtooriginalU.S.Governmentworks PrintedintheUnitedStatesofAmericaonacid-freepaper 10 9 8 7 6 5 4 3 2 1 InternationalStandardBookNumber-10:0-8247-2971-4(Hardcover) InternationalStandardBookNumber-13:978-0-8247-2971-4(Hardcover) Thisbookcontainsinformationobtainedfromauthenticandhighlyregardedsources.Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the authorandthepublishercannotassumeresponsibilityforthevalidityofallmaterialsorforthe consequenceoftheiruse. Nopartofthisbookmaybereprinted,reproduced,transmitted,orutilizedinanyformbyanyelec- tronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permissionfromthepublishers. For permission to photocopyor use material electronically from this work, please access www. copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC)222RosewoodDrive,Danvers,MA01923,978-750-8400.CCCisanot-for-profitorganization that provides licenses and registration for a variety of users. For organizations that have been grantedaphotocopylicensebytheCCC,aseparatesystemofpaymenthasbeenarranged. TrademarkNotice:Productorcorporatenamesmaybetrademarksorregisteredtrademarks,and areusedonlyforidentificationandexplanationwithoutintenttoinfringe. LibraryofCongressCataloging-in-PublicationData Acneanditstherapy/[editedby]GuyF.Webster,AnthonyV.Rawlings. p.;cm.--(Basicandclinicaldermatology;40) Includesbibliographicalreferencesandindex. ISBN-13:978-0-8247-2971-4(hardcover:alk.paper) ISBN-10:0-8247-2971-4(hardcover:alk.paper) 1.Acne.2.Acne--Treatment.I.Webster,GuyF.II.Rawlings,AnthonyV.,1958-III. Series. [DNLM:1.AcneVulgaris.2.AcneVulgaris--therapy.W1CL69Lv.402007/WR430 A1872007] RL131.A25682007 616.503--dc22 2007005325 VisittheInformaWebsiteat www.informa.com andtheInformaHealthcareWebsiteat www.informahealthcare.com DK4962-Webster-FM_R2_020407 B Introduction During the past 25 years, there has been a vast explosion in new information relating to the art and science of dermatology as well as fundamental cutaneous biology. Furthermore, this information is no longer of interest only to the small but growing specialty of dermatology. Clinicians and scientists from a wide variety of disciplines have come to recognize both the importance of skin in fundamental biological processes and the broad implications of understanding thepathogenesisofskindisease.Asaresult,thereisnowamultidisciplinaryand worldwideinterestintheprogressofdermatology. With these factors in mind, we have undertaken this series of books specifi- cally oriented to dermatology. The scope of the series is purposely broad, with books ranging from pure basic science to practical, applied clinical dermatology. Thus, while there is something for everyone, all volumes in the series will ultimatelyprovetobevaluableadditionstothedermatologist’slibrary. Thelatestadditiontotheseries,volume40,editedbyDrs.GuyF.Websterand AnthonyV.Rawlings,isbothtimelyandpertinent.Theeditorsareinternationally respected for their basic science and clinical expertise in the pathogenesis and treatment of acne, and have assembled an outstanding group of contributors for this latest addition to our series. We trust that this volume will be of broad interesttoscientistsandcliniciansalike. AlanR.Shalita,MD DistinguishedTeachingProfessorandChairman DepartmentofDermatology SUNYDownstateMedicalCenter Brooklyn,NewYork,U.S.A. iii DK4962-Webster-FM_R2_020407 DK4962-Webster-FM_R2_020407 B Preface Theintentionofthisbookistoreviewthelatestdevelopmentsintheunderstanding of acne and its treatment. The contents cover the molecular and cell biological aspects ofsebocytes,sebaceousglands, and the pilosebaceous unit through tothe pathogenesis of acne, its treatment with hormones, antimicrobials, retinoids, and laser.Novelactivesarereviewed,suchastheeffectofoctadecenedioicacid,sphin- golipids,andenzymeinhibitors.Formulationprinciplesandtheimportanceoffol- licular delivery through sebum are overviewed and, finally, in vitro testing methods.Thisbookisaninvaluableresourcefordermatologistsaswellasscientists workinginthepharmaceuticalandskincareindustries.Eachchapterreviewsthe most relevant literature and gives personal insight into tackling the problems associated with the treatment of acne, its underlying pathophysiology, and its therapy. Thebookisaresultofthecontributionsofexpertsintheirownareasandisthe work of an international team representing scientists from many disciplines. Der- matologists, cosmetic scientists, and researchers will find Acne and Its Therapy an invaluableandin-depthanalysisofthepathogenesisofacneanditstreatment. GuyF.Webster AnthonyV.Rawlings v