I. Renova Fact File

Renova was launched by Johnson & Johnson Pharmaceuticals.

Johnson & Johnson, through its operating companies, is the world's most comprehensive and broadly based manufacturer of health care products, as well as provider of related services, for the consumer, pharmaceutical, and medical devices and diagnostic markets.

Johnson & Johnson was named # 9 on Fortune's 2005 Most admired companies list and ranked as the number one company in the annual survey's Pharmaceutical category.

II. Renova Medication

Renova medication (Tretinoin) is used to treat acne and also to treat sun-damaged skin or wrinkles and is usually applied once per day.

Renova medication works partly by keeping skin pores clear. Generic Renova medication is thought to help unplug follicles and keep pores clear. It also increases the speed at which surface skin cells are replaced.

Generic Renova medication (Tretinoin) works best when used within a skin care program that includes protecting the treated skin from the sun. However, it does not completely or permanently erase these skin problems or greatly improve more obvious changes in the skin, such as deep wrinkles caused by sun or the natural aging process.

Anti-Acne Drugs

There are several treatment options for acne. An important goal of acne treatment is to prevent or minimize scarring. Specific treatment regimens will vary from person to person, depending on acne severity and tolerance to the medication. It may require several weeks to months of treatment before improvement is seen. Generally, mild to moderate acne is treated with over-the-counter benzoyl peroxide products, sulfur-resorcinol-salicylic acid combination products, or azelaic acid. Moderately severe acne may require topical or oral antibiotics or tretinoin. Severe acne that is not responsive to conventional treatments may require treatment with isotretinoin (Accutane).

Below is a list of commonly used medications. They are divided into topical medications and oral medications.

1. Topical Acne Products
   i. Benzoyl Peroxide
   Benzoyl peroxide if often used to treat mild to moderate acne. It is available in several strengths, some of which are only available by prescription, and comes as soaps, lotions, gels, and creams. Gel formulations are typically the most potent.
   
   ii. Sulfur, Resorcinol, and Salicylic Acid
   Sulfur, resorcinol, and salicylic acid products are not considered as effective as benzoyl peroxide but may be tried for treating mild acne. The combination of sulfur, resorcinol, and salicylic acid is available in creams, lotions, gels, and soaps. Although these products are less irritating than benzoyl peroxide, they have a strong smell and may cause the skin to turn brown.
   
2. Topical Antibiotics
   Topical antibiotics are used to treat moderate to severe acne when acne is resultant from bacteria. Topical antibiotics include clindamycin, tetracycline, and erythromycin. These antibiotics are available in lotions, solutions, gels, powders, and creams. They can be combined with other acne medications (such as benzoyl peroxide and salicylic acid) for optimal control of acne. Topical antibiotics, while effective, can cause occasional skin irritation and stinging upon applications along with sensitivity to the sun.
   
   i. Azelaic Acid
   Azelaic Acid is a cream used in the treatment of mild to moderate acne. It has antibacterial effects and may help with skin inflammation.
   
   ii. Tretinoin
   Tretinoin is available in various strengths and comes in creams, gels, solutions, a microsphere gel, and liquid polymer. For mild acne, weaker strengths are typically used first and increased as needed for moderately severe forms of acne. A "flare" of acne may occur after starting tretinoin, but clears after about 8 to 12 weeks of therapy. Tretinoin works well when combined with benzoyl peroxide or a topical antibiotic.
   
   iii. Adapalene
   Adapalene is available as a gel or lotion and is used to treat mild to moderate acne. Adapalene is thought to be less irritating than tretinoin. Adapalene is typically used as an alternative to tretinoin in patients with mild to moderate acne that cannot tolerate tretinoin. Improvement is generally seen by 12 weeks of therapy.
   
   iv. Tazarotene
   Tazarotene gel is used to treat mild to moderate facial acne.
   
3. Oral Acne Products
   
   i. Oral Antibiotics
   As discussed earlier, bacteria may reside in acne lesions. Oral antibiotics (tetracycline, minocycline, doxycycline, erythromycin, clindamycin, and cotrimoxazole) are often used in combination with topical acne products for moderately severe acne. Tetracycline is the most commonly prescribed antibiotic for treating acne, but it may cause sun sensitivity and predispose a woman to vaginal yeast infections. Minocycline and doxycycline are commonly used in people whose acne does not respond to tetracycline. Minocycline may cause skin discoloration. Clindamycin is not as widely used as the other oral antibiotics due to a side effect of diarrhea. Erythromycin is similarly effective to tetracycline and may have fewer side effects. Cotrimoxazole may be as effective as tetracycline but it is generally reserved for acne that does not respond to tetracycline or other antibiotics. The reason for this is to minimize the potential for resistance to develop (meaning that the bacteria that causes acne can become resistant to cotrimoxazole's effects). Improvement in acne can generally be seen in 4 to 12 weeks using these medications.
   
   ii. Oral Contraceptives
   Excess sebum (oil) production in the skin is typically triggered by an increase in androgen hormones ("masculine hormones"). In recent years, some oral contraceptives like Ortho TriCyclen have gained FDA-approval for the treatment of acne. They work to treat acne by decreasing androgen hormone levels and thus decreasing sebum production. Oral contraceptives may be an effective treatment option for women with moderate acne.
   
   iii. Isotretinoin
   Isotretinoin (Accutane) is used to treat severe, cystic acne that has not improved with other therapies. Some dermatologists use isotretinoin in mild to moderate acne that has not responded well to 6 months of standard therapies. Treatment with this drug usually continues until there is a 70% reduction in the number of cysts, but usually this can be seen in 15 to 20 weeks. Some studies have shown that a 16-week course of treatment with isotretinoin has a 70% success rate followed by a 20-month or longer remission (meaning acne has not re-flared).

Acne: Information

Acne, also called acne vulgaris , is a common inflammatory skin condition that is characterized by pimples, blackheads, and red, swollen bumps on the skin (usually the face, neck, shoulders, or back). The term acne is used to describe the condition when a person has between 5 to 10 pimples, blackheads, or red and swollen bumps on his or her body at the same time. Acne is typically thought to occur in adolescence, but it can also occur in adulthood. While not a life-threatening condition, acne can have significant psychological and physical impact on a person's life, causing poor self-image, anxiety, depression, and permanent scarring of the skin.

Causes of Acne

Acne is thought to be the result of several different factors occurring either separately or at the same time. Most commonly, acne develops because of excess sebum (oil) production by the sebaceous glands (oil glands) in the skin. Excess oil production is typically triggered by an increase in androgen hormones ("masculine hormones") such as testosterone or androsterone. Both males and females produce androgen hormones--the production normally increases during adolescence to help the body mature. Increases in androgen hormone levels lead to increased sebum production, which in turn increases the likelihood for developing acne.

Along with excess sebum production, bacteria can also cause acne. A bacterium called Propionibacterium acnes or P. acnes is normally found on the skin, but if it gets trapped inside hair follicles, it can trigger acne.

Certain medications can also cause acne. Specifically, hormone medications like contraceptive agents [medroxyprogesterone injections (Depo-Provera) and older oral contraceptives--newer birth control pills such as Ortho Tri-Cyclen and Estrostep can actually improve acne], testosterone, corticosteroids [prednisone, methylprednisone, dexamethasone, prednisolone, betamethasone, cortisone, hydrocortisone, and triamcinolone], and anabolic steroids [danocrine (Danazol) and stanozolol (Stomba)] can all aggravate acne. Other medications known to exacerbate acne include certain antidepressants, drugs used to treat tuberculosis, anti-seizure medications, and cyclosporin (Neoral, Sandimmune).

Oftentimes, it is difficult for doctors to determine the sole cause of acne. Because of this, it may take time and multiple trials of medication to find the medication most effective for the treatment of your acne.

Risk Factors of Acne

Risk factors are characteristics that predispose people to develop a condition. Common risk factors for acne include the following:

• Family history of acne: Some dermatologists believe that the type, pattern, duration, and severity of acne that you may experience is related to the experiences of your parents. However, it is impossible to predict which type you will develop. While studies have been highly suggestive of a heriditary link for acne, no "acne gene" has been discovered yet.
• Hormone levels: Higher levels of sex hormones (like testosterone and androsterone) stimulate oil production by the glands surrounding hair follicles. This excess oil clogs these follicles or pores, thus causing a pimple.

Along with risk factors for developing acne, certain factors can aggravate acne. These aggravating factors include the following:

• Environment: Individuals living in humid areas may develop more severe acne breakouts.
• Cosmetics: Certain ingredients within cosmetics may worsen acne. These ingredients include lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol, and oleic acid. These ingredients may be contained in moisturizers, foundations, and pomades.
• Petroleum oils: Individuals who work in fast food restaurants and those exposed to motor oil regularly maybe more prone to acne break-outs. This occurs because the grease or oil in the air causes the skin to become irritated.
• Pressure from wearing headbands or chinstraps: People who wear helmets or sporting equipment should continue to do so for safety reasons. However, oils can collect on headbands, chinstraps, and helmets and lead to acne breakouts. Thus, it is important to clean and thoroughly rinse these items after wearing them.

Symptoms of Acne

Most dermatologists consider an outbreak of more than 5 to 10 lesions in one area at one time to be acne. Different types of lesions can occur. A person may even experience more than one type of lesion at the same time. Below is a list and a description of the different types of lesions.

A. Non-Inflammatory Lesions

1. Blackheads or open comedones. Blackheads result when sebum and skin cells become clogged in the sebaceous hair follicle. They appear to be black in color.
   
2. Whiteheads or closed comedones. Whiteheads result when the sebaceous follicle is completely clogged with sebum and skin cells. They appear to be either white or skin colored, hence the name "whiteheads." Whiteheads can form as small bumps on top of the skin or under the skin.

B. Inflammatory Lesions

1. Papules are small, firm, red-colored lesions. Although they may contain pus, is not easily seen because of the redness. Papules often continue to grow in size and become pustules.
2. Pustules are small papules but they are round, red, swollen, and contain pus. Although they contain pus, they generally don't have a lot of bacteria inside.
3. Nodules also referred to as cysts. Oftentimes, nodules are very red, swollen, and contain a large amount of pus. They develop deep in the skin and may be painful. Unlike the other types of lesions, upon healing, nodules generally leave scars.

How Acne occurs

Diagram 1: How Acne occurs

Diagram 2: Stages of acne. (A) Normal follicle; (B) open comedo (blackhead); (C) closed comedo (whitehead); (D) papule; (E) pustule.

To understand how acne occurs, you need to have some understanding of skin. Skin consists of two thin layers - an outer layer called the epidermis and a deeper layer called the dermis. The dermis contains blood vessels and fibres, which give the skin its elasticity.

The epidermis contains a hard protein called keratin, which helps protect the skin. Hairs are present everywhere on the skin's surface apart from the soles of the feet, the palms of the hands and parts of the genitalia. Each hair has a root and a shaft. Small glands called sebaceous glands near the root secrete a fatty substance called sebum, which also gives the skin a protective covering. It is this area of hair and sebaceous glands that is affected when acne develops. And the substances keratin and sebum are major players in the development of acne. Bacteria at the site of a blocked gland aggravates the condition.

Acne affects areas of the skin that have a lot of sebaceous glands, such as the face, centre of the chest, the back above the waistline, shoulders and the neck.

A black and white issue

The primary defect in acne is thought to be that there is too much keratin produced at the exit of the hair shaft. This blocks the surface and doesn't allow the sebum out. Too much sebum is also being produced. Consequently the sebum builds up underneath and a plug of keratin and sebum then forms. If the upper portion of this plug is at the surface it becomes dark in color from pigment (melanin) produced by surrounding cells in the epidermis. The result is a blackhead. If the plug remains under the surface it is referred to as a whitehead.

Sometimes sebum will continue to be produced under the blackhead or whitehead and because it has no means of escape the sebaceous gland itself begins to swell and eventually bursts into the dermis underneath. Because sebum is not normally present in the dermis it causes irritation. Redness and inflammation occur and pus is formed. Occasionally, in severe cases the dermis reacts by trying to 'wall off' the sebum and acne cysts are formed during this process. Scarring is also a rare feature of severe cases.

Side effects of Anti-acne Drugs

A common side effect of benzoyl peroxide is skin dryness and irritation. To help avoid this side effect, start with a lower potency formulation (2.5%) and increase the strength (5% to 10%) as needed for acne control. You can also adjust the application frequency by starting low (applying every other day) then working up to daily applications and then to twice daily applications.

Azelaic acid is generally well tolerated with a low incidence of transient side effects such as skin redness, itching, and burning.

Tazarotene can cause skin irritation, peeling, and redness.

While extremely effective for treating acne, isotretinoin is associated with some potentially bothersome side effects including extreme drying of the mouth, nose, and eyes (approximately 90% of patients taking isotretinoin experience these side effects); joint aches, muscle stiffness, and sun sensitivity. Isotretinoin can also cause birth defects if used during pregnancy.

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III. Useful links

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

About.com Health section

http://www.jnj.com/our_company/fast_facts/general.htm

http://www.acne.org/prescription.php?view=Tretinoin

http://www.drugs.com/cons/Renova.html

http://www.drugdigest.org/DD/PrintablePages/HealthConditions/1,20041,550226,00.html

Pharmacy sites

http://www.roche.com/home/company/com_hist.htm

http://www.healthdigest.org/Bactrim-DS(Oral)_2006_PRO.php

http://www.hsforum.com/stories/storyReader$1509

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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