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Cutting-edge therapies
for skin challenges

Therapeutic focus

Innovating medical therapies for unmet needs in skin diseases is at the heart of Almirall. We continuously invest in research and development, applying medical science in search of ground-breaking therapies.

Today, we help patients suffering with acne, actinic keratosis, dermatitis, and impetigo improve their skin.

 

Acne

Acne

Acne

Acne (acne vulgaris) is a common chronic skin condition affecting approximately 9.4% of the world’s population,1 with nearly 50 million cases in the United States alone.2 Acne is a disease of the pilosebaceous unit (PSU) and affects regions of the skin where PSUs are most dense, namely the face, torso, back, and upper arms.3 Presentation varies from mild to severe and may involve both inflammatory and non-inflammatory lesions. Depending on severity, acne is characterized by open and closed comedones (blackheads and whiteheads), raised lesions (papules), inflamed pus-filled lesions (pustules), and large inflamed nodules and cysts.4

Multiple factors may cause acne or impact its severity. A familial history may predispose individuals to develop acne, indicating a genetic component.6,8 Acne is also associated with age and sex, as incidence and severity are highest during puberty and teenage years, with males often experiencing greater disease severity. Lifestyle and dietary factors may also impact incidence of acne and its severity.5

Acne treatment is variable and largely based on severity, and numerous prescription and over-the-counter oral medications and topical therapies are currently available.

 

Actinic keratosis

Actinic keratosis

Actinic keratosis (“solar” keratosis) is a cutaneous disorder characterized by patches of rough, reddened, sun-damaged skin resulting from chronic or excessive solar radiation exposure6,7 and is one of the most common conditions seen by dermatologists.8 Actinic keratoses (AKs) are clinically described as scaly plaques or lesions of variable thickness, some of which may be non-visible but present to touch.7,8 AKs are considered benign or premalignant but have the potential to become cancerous.6,8

AKs affect areas most exposed to the sun, namely the face, arms, neck, and back of the hands.

Several factors increase susceptibility to developing AKs, including male sex, having fair skin, and older age.6 Worldwide prevalence is 11 to 25% and varies by geographic region, with higher rates in countries close to the Equator.6,8

Choice of therapy for AKs is dependent upon several factors, including the location and degree of lesion progression. Treatments for individual AKs (lesion-directed therapy) include cryosurgery and curettage; topical agents may also be used. Field-directed approaches have the advantage of treating skin areas with multiple AKs and typically involve topical medications, photodynamic therapy, and laser resurfacing.8,9 AKs can transform into squamous cell carcinoma.6,8 Average risk for malignant transformation is approximately 8%, ranging from 0.025% to 16%.8,10,11 Appropriate treatment and follow-up, along with preventive strategies, may reduce the risk of progression.8

Dermatitis

Dermatitis

Dermatitis

Dermatitis is a general term describing common irritation and inflammation of the skin characterized by redness, itchiness, and rash. Several types of dermatitis are known that vary in cause and presentation.12

Atopic dermatitis (AD), also known as atopic eczema, is a chronic, relapsing, inflammatory condition that affects both children and adults with 80% to 90% of cases beginning by five years of age.13,14 AD has a worldwide prevalence of 15% to 20% of children and 1% to 3% of adults.14 The clinical presentation of AD varies with age and typically affects the neck, eyelids, forehead, face, wrists, and back of feet and hands.14 Acute AD is characterized by dry skin and fluid-filled blisters that may ooze and crust over. Subacute AD presents as abnormally red skin with dry, scaly plaques and papules. Chronic AD skin patches become cracked and dry, with areas of lichenification (becoming thick and leathery) from continued scratching.13-15 Anti-inflammatory medications and topical corticosteroids, combined with agents to keep skin moisturized, are central to AD treatment.

Seborrheic dermatitis (SD) is another chronic inflammatory skin disorder affecting 1% to 3% of the general population, more commonly in males. SD can occur at any age, with many cases appearing at 2 to 12 months of age and in adolescence or early adulthood.16 SD typically impacts areas of the body with high sebaceous (oil-producing) gland density, such as the scalp, face, upper chest, and back.17 Presentation differs with age; SD in infancy is characterized by yellowish, greasy-looking scales, often on the scalp. “Cradle cap” is a common manifestation at this age.18 In later years, chronic or relapsing SD presents with patches of reddened skin and oily, flaky scales.16,18 Treatment for SD includes anti-fungal and anti-inflammatory agents and maintaining good skin and scalp health.18

 

Impetigo

Impetigo

Impetigo is a common, superficial bacterial skin infection affecting more than 140 million people worldwide.19 An estimated 111 million are children, with a possible point prevalence of more than 162 million children affected at any given time.20 Impetigo disproportionately impacts people living in developing countries and impoverished areas with limited resources.21 It is associated with multiple factors, including a hot, humid climate, low socioeconomic status, malnutrition, and poor hygiene.22 Impetigo is highly contagious and easily spreads through schools, daycare settings, and crowded living conditions. People of any age can contract impetigo, with highest incidence in children aged two to five years.22

There are two variants of impetigo, bullous and nonbullous. Nonbullous accounts for 70% of cases and is caused by Staphylococcus aureus and Streptococcus pyogenes. Nonbullous “crusted” impetigo presents as superficial ulcerations covered by an adhering crust of dried discharge23 and is commonly found on the face and extremities.22 Bullous impetigo, caused by S. aureus,19 is characterized by large, flaccid, fluid-filled blisters,23 typically found on the trunk, armpits, extremities, and diaper area.20 Impetigo is treated with topical, injectable, and oral medications.24 Complications are rare, but if left untreated, impetigo can lead to deeper infections and scarring.

References
  1. Tan JKL, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(Suppl 1):3-12.
  2. Oge' LK, Broussard A, Marshall MD. Acne vulgaris: diagnosis and treatment. Am Fam Physician. 2019;100(8):475-484.
  3. Raza K, Talwar V, Setia A, Katare OP. Acne: an understanding of the disease and its impact on life. Int J Drug Dev & Res. 2012;4(2):14-20.
  4. Heng, A. H. S., & Chew, F. T. Systematic review of the epidemiology of acne vulgaris. Scientific reports, 2020; 10(1):1-29.
  5. niams.nih.gov/health-topics/acne
  6. De Oliveira ECV, da Motta VRV, Pantoja PC, et al. Actinic keratosis - review for clinical practice. Int J Dermatol. 2017;177(2):350-358.
  7. Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol. 2017;177(2):350-358.
  8. Marques E, Chen TM. Actinic keratosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. http://www.ncbi.nlm.nih.gov/books/NBK557401/. Updated July 18, 2021. Accessed May 12, 2022.
  9. Eisen DB, Asgari MM, Bennett DD, et al. Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol. 2021;85(4):e209-e233.
  10. Hashim PW, Chen T, Rigel D, Bhatia N, Kircik LH. Actinic keratosis: current therapies and insights into new treatments. J Drugs Dermatol. 2019;18(5):s161-166.
  11. Cramer P, Stockfleth E. Actinic keratosis: where do we stand and where is the future going to take us? Expert Opin Emerg Drugs. 2020;25(1):49-58.
  12. Dermatitis: symptoms and causes. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/dermatitis-eczema/symptoms-causes/syc-20352380. Accessed May 12, 2022.
  13. Torres T, Ferreira EO, Gonçalo M, Mendes-Bastos P, Selores M, Filipe P. Update on atopic dermatitis. Acta Med Port. 2019;32(9):606-613.
  14. Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care. 2017;23(Suppl 8):S115-S123.
  15. Berke R, Singh A, Guralnick M. Atopic dermatitis: an overview. Am Fam Physician. 2012;86(1):35-42.
  16. Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91(3):185-190.
  17. Adalsteinsson JA, Kaushik S, Muzumdar S, Guttman-Yassky E, Ungar J. An update on the microbiology, immunology and genetics of seborrheic dermatitis. Exp Dermatol. 2020;29(5):481-489.
  18. Borda LJ, Wikramanayake TC. Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol. 2015;3(2):10.13188/2373-1044.1000019.
  19. Johnson MK. Impetigo. Adv Emerg Nurs J. 2020;42(4):262-269.
  20. Bowen AC, Mahé A, Hay RJ, et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS ONE. 2015;10(8):e0136789.
  21. May PJ, Tong SYC, Steer AC, et al. Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review. Trop Med Int Health. 2019;24(3):280-293.
  22. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician. 2014;90(4):229-235.
  23. Pereira LB. Impetigo – review. An Bras Dermatol. 2014;89(2):293-299.
  24. Abrha S, Tesfaye W, Thomas J. Intolerable burden of impetigo in endemic settings: a review of the current state of play and future directions for alternative treatments. Antibiotics (Basel). 2020;9(12):909.
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