DOI: 10.1111/ajd.
14034
ABSTRACT
Acne
Prescription retinoid and concomitant
contraception use in reproductive aged women in
Australia
Laura Gerhardy1; Natasha Nassar2; Melisa Litchfield3;
Debra Kennedy4; Annika Smith5; Malcolm Gillies3;
Sallie Pearson3; Helga Zoega6; Antonia Shand7
1
Royal Hospital for Women, Sydney, New South Wales,
Australia; 2Child Population and Translational Health
Research, Children's Hospital at Westmead Clinical School
and Menzies Centre for Health Policy and Economics,
University of Sydney, Camperdown, New South Wales,
Australia; 3School of Population Health, University of New
South Wales, Kensington, New South Wales, Australia;
4
Royal Hospital for Women, Randwick, New South Wales,
Australia; 5Westmead Hospital Dermatology Department,
Westmead, New South Wales, Australia; 6School of
Population Health, University of New South Wales and
Centre of Public Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavik, Iceland; 7Royal Hospital
for Women and Child Population and Translational Health
Research, Children's Hospital at Westmead Clinical School
and Menzies Centre for Health Policy and Economics,
University of Sydney, Sydney, New South Wales, Australia
Aims: Oral retinoids are teratogenic in pregnancy, and
contraception is recommended to prevent pregnancy. This
study assessed the demographic characteristics and trends
in use of prescription retinoids and contraception among
reproductive-­aged women (15–­44 years) in Australia.
Methods: Pharmaceutical Benefits Scheme (PBS) dis-
pensing claims were used from a 10% random sample of
Australian reproductive-­aged women between 2013 and
2021. Annual numbers and trends in dispensing claims
were described. Each retinoid dispensing was analysed
for whether there was a concomitant contraceptive dis-
pensing within an appropriate time frame to reasonably
assume contraception co-­use. We have multiplied results
by 10 to extrapolate to population numbers.
Results: During the study period there were over 1.5 mil-
lion PBS retinoid dispensings and over 20 million PBS
contraceptive dispensings. Retinoid dispensing increased
annually, from 61,080 women in 2013 to 92,590 women in
Editorial material and organization © 2023 Australasian College of Dermatologists Copyright of individual abstracts remains with the authors.
Australas J Dermatol. 2023;64(Suppl. 1):3–6.  wileyonlinelibrary.com/journal/ajd
2021 (an increase from 1.3% of the age-­sex specific pop-
ulation to 1.8%). The rate of oral retinoid users doubled
over the study period, while topical retinoid use remained
static. Oral retinoid use was highest among younger
women, and decreased with increasing age. Contraceptive
methods changed across the study period, with a decrease
in combined oral contraceptive dispensings, and an in-
crease in levonorgestrel intrauterine device dispensings.
When adjusted for the contraceptive time supplied with
a dispensing, the contraceptive coverage did not change
over time. Among women receiving an oral retinoid dis-
pensing, only 25% had a contraception concomitant dis-
pensing in 2021, rising slightly from 19% in 2013.
Conclusions: Oral retinoid use in Australian reproductive
aged women has increased over time, while PBS contracep-
tion coverage has remained static. Most women dispensed
oral retinoids were not concomitantly dispensed PBS
contraception, posing a risk of unplanned pregnancy and
congenital anomaly. Initiatives are required to improve
contraception use in women dispensed oral retinoids.
Clearing the way –­Adalimumab for recalcitrant
acne fulminans
Frank Po-­Chao Chiu; Aaron Boyce
Townsville University Hospital, Townsville, Queensland,
Australia
Acne fulminans (AF) is a rare, severe form of acne char-
acterized by the development of painful, inflammatory
nodules, pustules and haemorrhagic ulcers, often but not
necessarily in association with systemic manifestations
including fever, arthralgia, myalgia and blood abnormali-
ties. It typically affects adolescent males and primarily
involves the face, neck, arms, back and chest. The patho-
genesis of AF is likely multifactorial and is suspected to
include genetic susceptibility, altered immune responses,
hormonal changes, infections and other iatrogenic causes.
Treatment is difficult and first-­ line therapy has tradi-
tionally involved the use of isotretinoin with oral corti-
costeroids. When contraindicated or ineffective, other
systemic agents have been trialled including dapsone,
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4    ABSTR​ACT​
methotrexate or cyclosporine. For AF refractory to con-
ventional therapies, use of certain biologic agents have re-
cently emerged as potentially effective treatment options.
Herein, we report the case of a 14-­year-­old male who
developed isotretinoin-­induced AF that was successfully
managed with off-­label use of Adalimumab. He presented
with a 1-­year history of severe cystic acne involving his
face, chest and back, which was non-­responsive to topical
therapy and antibiotics. Within 2 weeks of commencing
isotretinoin and despite concurrent oral prednisone, our
patient developed painful pustules, haemorrhagic nodules
and leukocytosis with associated malaise and lethargy. He
was diagnosed with AF, which flared repeatedly despite
minimal doses of isotretinoin, ongoing oral prednisone
and antibiotics. Upon review of the current literature and
considering the side effect profile of other systemic agents,
he was commenced on Adalimumab. Within 6 weeks, our
patient demonstrated clinical improvement and tolerated
increased doses of daily isotretinoin without complica-
tion. He has continued improving after 6 months of treat-
ment, without requiring oral prednisone or antibiotics.
This case demonstrates the effectiveness of Humira as a
newer, well-­tolerated therapy for the treatment of AF in
adolescent patients, where traditional treatments have
been unsuccessful. Acne fulminans (AF) is a rare, severe
form of acne characterized by the development of painful,
inflammatory nodules, pustules and.
Long-­term safety and efficacy of 1% clascoterone
cream in patients ≥12 years old with acne vulgaris
Lawrence Eichenfield1; Adelaide Hebert2;
Linda Stein Gold3; Martina Cartwright4; Luigi Moro5;
Jenny Han6; Nicholas Squittieri7; Alessandro Mazzetti8
1
University of California San Diego School of Medicine
and Rady Children's Hospital San Diego, San Diego,
California, USA; 2UTHealth McGovern Medical School,
Camperdown, California, USA; 3Henry Ford Health
System, West Bloomfield, Michigan, USA; 4Cassiopea Inc.,
Beverly Hills, California, USA; 5Cassiopea S.p.A., Lainate,
Italy; 6Pharmapace Inc.; 7Sun Pharmaceutical Industries,
Inc., Princeton, New Jersey, USA; 8Cassiopea S.p.A., San
Diego, California, USA
Aims: Clascoterone cream 1% is approved for the treat-
ment of acne vulgaris in patients aged ≥12 years based on
results in two 12-­week, randomized, double-­blind, vehicle-­
controlled, Phase 3 studies in patients with moderate-­to-­
severe acne. Patients who completed one of these pivotal
studies could enter an open-­ label long-­term extension
study and receive treatment for up to 9 additional months.
Long-­term safety and efficacy of clascoterone for up to
14400960, 2023, S1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/ajd.14034 by Cochrane Romania, Wiley Online Library on [10/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
12 months in patients aged ≥12 years from the extension
study are presented.
Methods: All patients who continued into the open-­
label, long-­term extension study (NCT02682264) applied
clascoterone twice daily to the entire face and, if desired,
any truncal acne, for up to 9 months. Patients achieving
Investigator's Global Assessment score of 0 or 1 (IGA 0/1)
could stop treatment and resume if/when acne worsened.
Safety was assessed from treatment-­ emergent adverse
events (TEAEs) and local skin reactions (LSRs [telangi-
ectasia, skin atrophy, striae rubrae, erythema, edema,
scaling/dryness, stinging/burning, and pruritus]) in all
treated patients. Efficacy was assessed from percentage of
patients with IGA 0/1 among those who completed the ex-
tension study without significant protocol deviations (per-­
protocol [PP] population).
Results: Of 598 patients treated in the extension study, 108
(18.1%) experienced 187 TEAEs, with similar frequency
between patients previously treated with vehicle (52/287
[18.1%]) vs. clascoterone (56/311 [18.0%]). Frequency of
LSRs was low throughout the study. Percentage of PP pa-
tients with facial and truncal IGA 0/1 increased over time
to 48.9% (156/319) and 52.4% (65/124), respectively, at
end of study and was greatest in patients applying clasco-
terone for 12 months (face, 67/119 [56.3%]).
Conclusions: Clascoterone cream 1% maintained a fa-
vourable safety and efficacy profile for up to 12 months in
patients aged ≥12 years.
Efficacy and safety of clascoterone cream 1% in
patients with acne vulgaris across subgroups
defined by demographic characteristics
Lawrence Eichenfield1; Adelaide Hebert2;
Diane Thiboutot3; Linda Stein Gold4;
Martina Cartwright5; Luigi Moro6; Jenny Han7;
Nicholas Squittieri8; Alessandro Mazzetti9
1
University of California San Diego School of Medicine
and Rady Children's Hospital San Diego, San Diego,
California, USA; 2UTHealth McGovern Medical School,
California, USA; 3Penn State Hershey Dermatology,
California, USA; 4Henry Ford Health System, West
Bloomfield, Michigan, USA; 5Cassiopea Inc., Beverly
Hills, California, USA; 6Cassiopea S.p.A., Lainate, Italy;
7
Pharmapace Inc.; 8Sun Pharmaceutical Industries, Inc.,
Princeton, New Jersey, USA; 9Cassiopea S.p.A., San Diego,
California, USA
Aims: Clascoterone cream 1% is approved for the treat-
ment of acne vulgaris in patients aged ≥12 years. Pooled
efficacy and safety data analyses stratified by age and sex
from two Phase 3 studies and a long-­term extension study

A​BST​RACT
of clascoterone cream 1% in patients ≥12 years of age with
moderate-­to-­severe acne vulgaris are presented.
Methods: Patients with moderate-­ to-­
severe acne
were randomized 1:1 to twice-­daily treatment of the
face with clascoterone or vehicle for 12 weeks; all pa-
tients continuing into the extension study applied
clascoterone for up to 9 additional months. Efficacy
was assessed from proportion of randomized patients
achieving Investigator's Global Assessment score of 0
or 1 (IGA 0/1) among those completing the extension
study per protocol (PP population). Safety was assessed
from treatment-­emergent adverse events (TEAEs) in
all treated patients.
Results: Of 709/712 patients aged ≥12 years origi-
nally randomized to clascoterone/vehicle, 63.9%/60.4%
were female, with mean ± standard deviation age
19.8 ± 6.1/19.5 ± 6.1 years; 11/13 were male patients
aged ≥25 years. Among patients in the PP population
randomized to clascoterone/vehicle, 17.3%/3.8% (12–­
17 years; p < 0.0001), 25.3%/8.6% (≥18 years; p < 0.0001),
and 32.6%/10.1% (female patients ≥25 years; p = 0.0009)
achieved IGA 0/1 by Week 12; 45.3%, 55.4%, and 44.4%
of extension study patients aged 12–­17, ≥18, and female
patients ≥25 years, respectively, achieved IGA 0/1 after
12 months applying clascoterone. Frequency of TEAEs
through Week 12 in clascoterone/vehicle-­treated patients
was 10.8%/14.2%, 11.5%/11.6%, and 9.6%/12.9% for ages
12–­17, ≥18, and female patients ≥25 years, respectively.
Conclusions: Clascoterone efficacy and safety were
maintained in adolescent and adult patients, including fe-
male patients aged ≥25 years.
Rhabdomyolysis induced by low dose isotretinoin
Lois Zhang1; Margot Whitfeld2; Nancy Todes-­Taylor3
1
St. Vincent's Hospital, Darlinghurst, New South Wales,
Australia; 2Department of Dermatology St Vincent's
Hospital, Sydney, New South Wales, Australia;
3
St Leonards Dermatology & Laser, St Leonards,
New South Wales, Australia
The use of isotretinoin in the treatment of acne vulgaris is
common practice within dermatology clinics as it is highly
effective in moderate to severe cases. Side effects with treat-
ment are generally well tolerated as low-­dosing is becoming
more favourable. Rhabdomyolysis is a rare complication of
treatment with isotretinoin with only a few reported cases
in the literature. We present a case where low-­dose treat-
ment in combination with vigorous exercise had induced
rhabdomyolysis in an otherwise healthy 16-­year-­old male
who had been on treatment for 5 months. His symptoms
had primarily consisted of fatigue and myalgia which
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14400960, 2023, S1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/ajd.14034 by Cochrane Romania, Wiley Online Library on [10/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   5
quickly resolved after cessation of medication and support-
ive treatment with fluids. This case highlights the impor-
tance of routine follow up and laboratory monitoring in a
commonly treated skin disorder.
Trichloroacetic acid paint for boxcar and
polymorphic acne scars
Cong Sun1; Davin Lim2
1
Mater Hospital Brisbane, Brisbane, Queensland,
Australia; 2Cutis Clinic, Brisbane, Queensland, Australia
Background: Scarring is a common complication of acne
vulgaris with a significant impact on the psychological
well-­being of patients. Focal application of high concen-
tration trichloroacetic acid (TCA) has been proven effica-
cious in treating ice-­pick scars, but the utility in other scar
types is understudied.
Objective: The aim of this study is to evaluate the efficacy
and safety of 90% TCA in boxcar and polymorphic acne
scars using a novel brush applicator.
Materials and Methods: Forty-­one patients with acne
scars were recruited for treatment of boxcar and polymor-
phic scar with 90% TCA applied with a cosmetic brush.
Each patient received 3 treatment sessions spaced be-
tween 7 and 9 weeks apart.
Results: All participants had good to excellent outcomes
as per Jacob and colleagues grading. Patients with skin
Type 3–­6 had more excellent outcomes (13 patient, 59%)
than patients of skin type 1–­2 (9 patients, 41%). Two par-
ticipants (5%) had postprocedural complications. Five
participants (14%) were on concomitant isotretinoin with
no appreciable increase in reepithelialization time or rate
of complications.
Conclusion: Focal 90% TCA with a cosmetic brush appli-
cator is safe and effective in treating boxcar and polymor-
phic scars. The clinical outcome is good to excellent with
low rates of complication. Fine paint brush is a new novel
applicator for TCA CROSS technique which allows accu-
rate application and minimize spillover over healthy skin.
Stem cell therapy for facial rejuvenation
Redwan Al-­Karim Bhuiyan
Dermatology Department, Tamavua P.J.Twomey Hospital,
Suva, Fiji
Adipose-­ derived stem cells (ADSC) are a potent skin
regeneration agent. They release growth hormones and
anti-­inflammatory cytokines, promote tissue regenera-
tion by boosting extracellular protein production, and
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6    ABSTR​ACT​
secrete antioxidants that neutralize free radicals. The
result obtained in an office technique, without cell incu-
bation and counting, is stromal vascular fraction, which
contains not only stem cells but also a variety of other ac-
tive cells such as pericytes, preadipocytes, immune cells,
and extracellular matrix. When adipose-­ derived stem
cells were injected into the dermis, they enhanced skin
density and attractiveness while also increasing skin hy-
dration and the number of capillary capillaries. In this
study our main goal is to describe the possibility of using
autologous-­derived medicines in face rejuvenation. A sys-
tematic review of English and non-­English articles using
MEDLINE and the Cochrane Controlled Trials Register
(1960–­2005), and EMBASE (1991–­2005). Search terms
included randomized controlled trial, controlled clinical
trial, random allocation, double-­blind method, experi-
mental study, stem cell therapy, adipose tissue stem cell,
skin aging, wound healing, fat cell. According to multiple
14400960, 2023, S1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/ajd.14034 by Cochrane Romania, Wiley Online Library on [10/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
studies it was found that most of the cases platelet rich
plasma(PRP), ADSC are found safer and can be used for
the therapy of skin defects and wounds. In addition, SVF
is a source of stem cells, but its ability to regenerate is
also dependent on other active cells. Regenerative medi-
cine is still in its early stages. Physicians are fascinated by
the mechanism of action of ADSCs and their multidirec-
tional influence on dermal regeneration. ADSCs release
antioxidative chemicals, stimulate wound healing, and
secrete ECM proteins. Several studies have shown that
ADSC injections enhance skin density and have anti-­
wrinkle benefits. Skin moisture increases, and the overall
look improves. The majority of fat and stem cell transfers
performed for cosmetic reasons are one-­stage in-­office
procedures that do not include cytometry or cell count-
ing. The survival and viability of stem cells appear to be
substantially related to the harvesting procedure, and
there are no unambiguous standards.