EADV CONGRESS

BERLIN 11-14 TH
OCTOBER 2023
EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY

DAY - 2
TH
FIRST REPORT THURSDAY 12 ,
OCTOBER 2023

COSMETOLOGY, ACNE & MELASMA

An academic initiative from the makers of
EADV CONGRESS
BERLIN 11-14 TH
OCTOBER 2023
ASIA syndrome pro-
voked by HA filler
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Agnieszka Owczarczyk-
Saczonek et al from The University of Warmia
and Mazury,Poland.
The Autoimmune/Inflammatory Syndrome
Induced by Adjuvants (ASIA) is a proposed
medical condition characterized by autoimmune
and inflammatory responses triggered by expo-
sure to adjuvants. Adjuvants are substances that
can enhance the body's immune response to
antigens.
key points
• A 64-year-old woman received HA injections
into various facial areas using a product called
Perfectha® three years ago.
• After experiencing pharyngitis (sore throat)
and receiving treatment with antibiotics
(amoxicillin and clavulanic acid), inflamma-
tory tumors developed at the sites of the HA
injections.
• The patient complained of general malaise,
sore muscles, and low-grade fever. The
surgeon diagnosed abscesses, incised the
lesions, and applied a surgical drain. Clear,
crystal-like secretion was obtained, and a
culture for bacterial infection was negative.
• The patient was diagnosed with a Delayed
Inflammatory Reaction (DIR), and treatment
was initiated with antibiotics (cloxacillin and
metronidazole) and prednisone (a cortico-
steroid). Intralesional hyaluronidase injec-
tions were administered to break down the
HA filler.
• While the inflammation subsided, solid
nodules at the injection sites still occasionally
swelled. The dose of prednisone was gradu-
ally lowered, but symptoms recurred when
the dose was reduced.
• After a year of treatment with prednisone, the
decision was made to terminate treatment.
Unfortunately, inflammation recurred at the
injection sites, and treatment with prednisone
was resumed. The treatment was eventually
ended after 1.5 years.
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• During the observation period, the patient
developed various symptoms, including
muscle weakness, joint pain, chronic fatigue,
sleep and memory disorders, and elevated
antibodies indicative of autoimmune
thyroiditis.
following bioimplant procedures is not com-
monly recognized, possibly due to a lack of
awareness or diagnostic challenges. The syn-
drome may develop several years after the initial
procedure, making it difficult for patients and
physicians to link it to the treatment. The
involvement of macrophages is noted in both
ASIA and the Delayed Inflammatory Reaction
to hyaluronic acid, suggesting a potential
pathophysiological link.
In summary, a case where a patient experienced
a delayed inflammatory reaction and eventually
developed symptoms consistent with ASIA after
receiving HA injections. This case underscores
the importance of recognizing potential adverse
reactions to medical procedures and the complex
nature of autoimmune responses in some
individuals. It also highlights the need for further
research and awareness in the medical commu-
nity regarding ASIA and its potential triggers.
Skin Anti-Aging Effect
of Oral Vitamin A
Supplementation in
Combination with
Topical Retinoic Acid
Treatment in
Comparison with
Topical Retinoic Acid
Alone: A Randomized,
Prospective, Parallel
Trial
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Massimo Milani, Francesca
Colombo et al from the Cantabria Labs Difa
Cooper.
This study discuss about the results of a prospec-
tive, randomized clinical trial comparing the
effectiveness of an "In & Out" strategy, which
combines oral vitamin A supplementation
(retinol) with a topical retinoic acid gel, for the
treatment of skin aging.
Study's Materials, Methods, and Findings:
• 50 subjects aged over 50 years with moderate
to severe facial skin aging (based on Glogau
scores >2) participated in the trial.
• The participants were randomly assigned to
two groups: Group A and Group B.
• Group A received oral vitamin A supple-
mentation (50,000 U.I.) in the form of one
daily capsule, in addition to applying a 0.02%
retinoic acid topical gel (RG) in the evening.
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• Group B received treatment with the topical
RG alone.
• The primary endpoint of the study was the
assessment of a Skin Aging Global Score
(SAGS), which evaluated six skin parame-
ters: elasticity, wrinkles, roughness, pigmen-
tation, erythema, and skin pores. Each
parameter was rated on a 5-point scale (0 to
4), with a maximum possible score of 20.
• SAGS scores were evaluated at baseline, week
6, and week 12. A subgroup of 20 subjects
underwent a VISIA face analysis. Skin
tolerability was also assessed at weeks 6 and
12 in both groups.
Results:
• All subjects completed the trial.
• At the beginning of the study, the SAGS score
was 15±5 in Group A and 13±5 in Group B.
• After 6 weeks, both groups showed a reduc-
tion in SAGS scores, with Group A experi-
encing a 19% reduction and Group B a 17%
reduction.
• After 12 weeks, both groups demonstrated
further improvements, with a 36% reduction
in SAGS score for Group A and a 30% reduc-
tion for Group B.
• Group A, the "In & Out" strategy group,
showed a significantly greater absolute
reduction in SAGS score compared to Group
B (p=0.02). The absolute difference between
the two groups was -1.2 (95% confidence
interval: -0.19 to -2.2).
• Similar improvements were observed in the
VISIA analysis.
• Both treatment regimens were well tolerated
by the subjects.
The combination of oral retinol supplementa-
tion and topical retinoic acid gel, known as the
"In & Out" strategy, demonstrated superior
efficacy in terms of clinical and instrumental
improvements compared to topical retinoic acid
treatment alone. This strategy was particularly
effective in subjects with moderate to severe skin
aging. The results suggest that the combination
of oral and topical retinoids may be a promising
approach for addressing skin aging.
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OCTOBER 2023
Eyelid Phenol Peeling as
A Potential Alternative
to Surgical
Blepharoplasty: A Case
Series
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Caroline Silva Pereira, Maiara
Onetta Da Silva et al from the 1Human Clinic,
Department of Clinical, Cosmetic and Surgical
Dermatology, São Paulo, Brazil,
This study discusses a technique called deep
phenol peeling, specifically for the eyelid area, as
a method to improve the appearance of wrinkles
and aging features. It outlines the materials and
methods used in this procedure and presents the
results and conclusions from the cases of four
women who underwent the treatment.
• Patient Selection: The procedure was per-
formed on four women with no absolute
contraindications for deep phenol peeling.
They were interested in improving wrinkles
and aging features around the eyelid area.
• Preparation: Patients were instructed to use
the Kligman formula for one month before
the phenol peeling.
• Medication: A non-steroidal antiinflamma-
tory drug (Ketorolac Trometamol 10 mg) was
given to the patients sublingually 30 minutes
before the procedure.
• Procedure: The skin in the desired peeling
area was cleansed with urea foam for one
minute, and then excess foam was removed.
Alcohol 70% was used to clean the skin.
• Phenol Application: Phenol was applied
using a damp cotton swab over multiple layers
until frosting was achieved.
• Post-Procedure: A plastic occlusive mask
was used to seal the area, and a post-phenol
occlusive ointment was applied around the
periocular region. Patients were instructed
not to wash the area for 7-10 days post-
procedure.
• Post-Procedure Care: Patients were pre-
scribed eye drops for dryness and oral analge-
sics as needed.
All four patients found the outcomes to be either
satisfying or very satisfying when they scored the
cosmetic results.
When asked for additional feedback, two
patients mentioned their satisfaction with the
absence of surgical scars, one found the post-
procedure period challenging but worthwhile,
and another patient recommended phenol
peeling as an alternative to surgical blepharo-
plasty.
It concludes that deep phenol peeling, particu-
larly for the eyelid area, is an easy, relatively safe,
and effective technique for achieving desired
aesthetic outcomes in patients who wish to
improve aging features and reduce the appear-
ance of deep wrinkles without resorting to
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surgery. This technique appears to have been
well-received by the patients involved in the cases
described. However, it's important to note that
patient selection and preparation, as well as the
procedure itself, should be conducted with
careful consideration and expertise, as with any
medical or cosmetic procedure.
Prevalence of
Pigmentary Disorders
Diagnosed by
Dermatologists and
Their Impact: Results of
The First Large
International Survey
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Brigitte Dréno, Suzana Puig et
al from the Nantes Université, INSERM, CNRS,
Immunology and New Concepts in Immuno
Therapy, INCIT, UMR Nantes, France.
The study describes the results of a worldwide
survey conducted to assess the self-reported
prevalence of pigmentary disorders (PD) such as
Melasma, Post-inflammatory Hyperpigmenta-
tion (PIH), Solar Lentigo, Vitiligo, Peri-Orbital
Hyperpigmentation (POH), and Axillary
Hyperpigmentation (AH). The survey also
examined the impact of these conditions on the
quality of life (QOL) and stigmatization. The
key findings are as follows:
The survey was conducted in 34 countries across
different continents.
The study sample included 48,000 participants,
ensuring representation across various demo-
graphic factors such as gender, age, employment
status, and country region.
The survey was conducted from December 2022
to February 2023.
An online questionnaire covered demographics,
phototype, self-reported pigmentation condi-
tions, impact on QOL, experiences of stigmati-
zation, and sun protection behaviors.
Results:
• Half of the surveyed population reported
having at least one pigmentary disorder. The
most common disorders were solar lentigo
(27%), AH (18%), PIH (15%), POH (15%),
melasma (11%), and vitiligo (8%).
• The average age of those reporting pig-
mentary disorders was 44, and these condi-
tions affected more women (59%).
• Among those reporting pigmentary disor-
ders, 36% of them had received a diagnosis
confirmed by a dermatologist (PDD). The
percentage of PDD for specific conditions
varied, with vitiligo (49%), melasma (41%),
and PIH (38%) having the highest rates.
• Individuals diagnosed by a dermatologist
(PDD) were more affected by their disorder
compared to those whose condition had not
been diagnosed by a dermatologist (nPDD).
The Dermatology Life Quality Index (DLQI)
score was >10/30 for 40% of PDD, compared
to 20% for nPDD.
• Social stigmatization was more pronounced
among PDD. For example, 54% of PDD
concealed visible affected skin, compared to
40% of nPDD. Additionally, 41% of PDD
avoided some people, while only 27% of
nPDD did.
• The impact of stigmatization extended to
various aspects of people's lives, including
professional (31% experienced discrimina-
tion at work among PDD, compared to 15%
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among nPDD), familial (27% felt they
brought shame to their family among PDD,
compared to 15% among nPDD), and affec-
tive (28% felt pushed away by their partner
among PDD, compared to 14% among
nPDD).
The survey reveals a high prevalence of
pigmentary disorders worldwide and highlights
the substantial impact on the quality of life and
stigmatization experienced by individuals with a
diagnosis confirmed by a dermatologist (PDD).
The findings underscore the importance of
recognizing and addressing the impact of
pigmentary disorders on individuals' lives and
well-being, particularly when diagnosed by
healthcare professionals.
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From the third week onwards, subjects were

Evaluation of The Anti-
Pigmenting Efficacy of
The Association of
Vitamin B3, Vitamin C
and AHA in A Topical
Serum, Compared to
The Reference
Ingredient in The
Management Of
Melasma
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Juliane Rocio, Mukta Sachdev
et al from the Institute of Dermatology and
Aesthetics, Brazil.
This paper discusses a study aimed at evaluating
the effectiveness of a topical serum (referred to as
B3) containing a combination of 5% vitamin B3,
vitamin C, and 8% AHA in treating melasma.
The study compared this serum with a widely
used melasma treatment, hydroquinone 4%
(HQ4). Here's a summary of the study's materi-
als, methods, and findings:
The study was a prospective, double-blind,
randomized trial.
It included 65 women between the ages of 20 and
50 with various skin types (phototypes II to VI)
and melasma that had been present for more
than a year.
For the initial two weeks of the study, all subjects
used a daily face moisturizer and SPF 50+
sunscreen.
divided into two groups. One group applied the
B3 serum twice daily for five months, while the
other group used HQ4 at night for three months.
After three months, the HQ4 group switched to
using the B3 serum twice daily for an additional
two months.
Both groups used SPF 50+ sunscreen daily
throughout the study.
Melasma was evaluated using the MASI
(Melasma Area and Severity Index) scale, which
measures the affected area, pigmentation dark-
ness, and skin homogeneity. A modified MASI
(mMASI), excluding the homogeneity parame-
ter, was also measured. Erythema (skin redness)
was assessed using the IGA (Investigator's
Global Assessment) scale, and clinical
tolerability was assessed using a skin reaction
scale.
Standardized photographs and reflectance
confocal microscopy were used to illustrate and
analyze the efficacy of the treatment.
Results:
• Both the B3 serum and HQ4 resulted in a
reduction in the MASI score after three
months of treatment (3.47 for the B3 serum
and 3.71 for HQ4). The reduction in mMASI
scores was similar for both groups (1.97 for
the B3 serum and 2.05 for HQ4).
• After the HQ4 group switched to the B3
serum in the third month, efficacy was
maintained and improved by the end of the
five-month study (5.68 for MASI and 3.31 for
mMASI when using the B3 serum for the full
five months, and 5.38 for MASI and 2.81 for
mMASI when using HQ4 for three months
followed by the B3 serum for two months).
This corresponds to a more than 40%
decrease in the MASI score in both groups
after five months of treatment compared to
baseline. There was no statistically significant
difference between the treatments.

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• Erythema showed more promising results
with the B3 serum, especially after one month
of treatment. Skin tolerance was better in the
B3 serum group compared to the HQ4 group
during the first three months of treatment
(85% improvement versus 59%).
• Reflectance confocal microscopy indicated a
decrease in keratinocyte pigmentation in over
90% of subjects for both products from the
beginning to the end of the treatment.
Conclusion:
The study suggests that the serum containing a
combination of 5% vitamin B3, vitamin C, and
8% AHA provides superior results in terms of
tolerance and erythema reduction after one
month compared to hydroquinone 4%. Both
treatments demonstrated similar improvements
in melasma after three months, with no signifi-
cant statistical difference. The B3 serum is
considered a safe and effective alternative for
melasma management, either as a standalone
treatment or as an adjuvant to other therapies.
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OCTOBER 2023
The Comparative
Efficacy of Topical
Minocycline Gel 4% Vs
Topical Clindamycin
Phosphate Gel 1% In
Indian Patients with
Acne Vulgaris
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Bela Shah, Dhiraj Dhoot,
Hanmant Barkate from the B J Medical college,
Dermatology, Ahmedabad, India.
The study presented is a randomized, compara-
tive clinical trial conducted to evaluate the
efficacy and safety of topical minocycline 4% gel
and topical clindamycin 1% gel in the treatment
of acne vulgaris (AV). Here's a summary of the
key findings and conclusions from the study:
Background:
• Acne vulgaris is a common skin disorder that
affects pre-adolescents and adolescents with a
global prevalence of 9.4%.
• Cutibacterium acnes and inflammatory
processes are crucial factors in the develop-
ment of acne.
• Clindamycin is a commonly prescribed
topical antibiotic for acne, but there has been
an increase in resistance.
• Topical minocycline 4% was approved in the
US in foam form in 2019 and in India as a gel
formulation in 2022.
Materials & Methods:
• The study involved 100 patients with moder-
ate to severe acne (grade 2-3).
• Patients were divided into two groups, with
one group receiving topical minocycline 4%
ge l a n d t h e o t h e r r e c e iv i n g t o p i c a l
clindamycin 1% gel.
• The study duration was 12 weeks, and no
other treatments were allowed.
• Efficacy was assessed using the Investigator
Global Assessment (IGA), treatment success,
and changes in inflammatory and non-
inflammatory lesion counts.
• Safety was assessed through cutaneous
tolerability assessment and monitoring of
adverse events reported by patients.
Results:
• Out of the 100 patients, 91 completed the 12-
week treatment and were included in the final
analysis.
• Both treatments were effective in reducing
inflammatory and non-inflammatory lesions
at week 12 compared to baseline (p<0.05).
• Topical minocycline was found to be statisti-
cally more effective than clindamycin in
reducing acne lesions.
• Minocycline also outperformed clindamycin
in terms of IGA success.
• No adverse events were reported by patients
in either group.
• Minocycline was better tolerated in terms of
cutaneous tolerability.
• Minocycline was statistically superior to
clindamycin in improving the quality of life
(QoL) of patients.
• Conclusion:
• Clindamycin has been effective in managing
acne in previous clinical studies, but its use
has been limited due to increasing resistance.
• The study suggests that topical minocycline is
a statistically superior option to clindamycin
in reducing acne lesions.
• Topical minocycline is well-tolerated, and it
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may be considered as a first-line topical
antibiotic in the management of acne.
• Unlike systemic minocycline, the topical
form is less likely to produce systemic adverse
events.
• Overall, the study concludes that topical
minocycline may be a more effective and
better-tolerated option than clindamycin for
the treatment of acne, particularly in cases
where resistance to clindamycin is a concern.
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A Tailored Skincare
Routine Provides
Benefits To Patients
With Moderate Acne
Vulgaris And Post
inflammatory
Hyperpigmentation In
Combination With
Topical Trifarotene
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Nathalie Piccardi, Mathieu
Grivet_seyve et al from the 1Galderma, R&D,
Lausanne, Switzerland.
The paper is focused on the evaluation of the
efficacy and safety of trifarotene 50 μg/g cream
(TF) compared to a vehicle (placebo) in the
treatment of moderate acne vulgaris in individu-
als with acne-induced post-inflammatory
hyperpigmentation (PIH). It also investigates the
benefits of a tailored skincare routine as part of
acne management. Here's a summary of the key
findings and conclusions from the study:
Background:
• Post-inflammatory hyperpigmentation (PIH)
is a common occurrence following cutaneous
inflammation, particularly in patients with
acne vulgaris.
• Retinoids, such as trifarotene, are known to be
potent modulators of inflammation, cellular
differentiation, and keratinization in the
context of acne vulgaris.
• Previous in vivo studies have demonstrated
the depigmenting and anti-pigmenting
activity of trifarotene.
Materials & Methods:
• This was a multi-center, randomized, double-
blind, vehicle-controlled parallel-group study
involving approximately 120 subjects aged 13
to 35.
• The study included a diverse population, with
30% having light skin (skin types I-III) and
70% having dark skin (skin types IV-VI).
• Post-inflammatory hyperpigmentation (PIH)
was assessed using the PIH overall disease
severity (ODS) score.
• All subjects were provided with a skincare
routine consisting of a gentle skin cleanser
(used twice daily), a moisturizing lotion, and
an SPF 30 sunscreen formulated for oily skin.
• Subjects were assessed from week 4 to week
24 and provided feedback on their satisfaction
with the products and the full skincare rou-
tine.
Results:
• Trifarotene showed a nominally significant
improvement from baseline in the PIH ODS
score compared to the vehicle at week 12 (-1.6
vs. -1.1; p=0.03).
• However, the absolute change in PIH ODS
scores was comparable between the two
groups at week 24, with both groups showing
improvements from baseline.
• In the TF group, more than 90% of subjects
reported not being bothered by the side effects
of the treatment, and they agreed that the
cleanser and moisturizing lotion helped
reduce skin irritation and dryness, improving
compliance with the acne treatment.
• Additionally, the study observed a decrease in
treatment-emergent adverse events (TEAE)
related to Retinoids associated dermatitis by
up to 50% in the TF group.
• Within the vehicle (Veh) group, there was a
significant 40% reduction in PIH compared
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to baseline, demonstrating the significant
effect of the dermocosmetic regimen on PIH.
Conclusion:
• The study suggests that a tailored skincare
routine should be considered as an integral
part of the management of moderate acne
with PIH.
• The addition of the skincare routine to the
trifarotene treatment demonstrated addi-
tional benefits in managing PIH.
• The skincare routine also improved side
effects such as skin irritation and dryness
associated with trifarotene treatment, leading
to higher satisfaction and compliance among
acne patients.
• In summary, this study highlights the impor-
tance of not only the acne treatment itself but
also the supporting skincare routine in man-
aging moderate acne with post-inflammatory
hyperpigmentation. The regimen not only
had a positive impact on PIH but also
improved patient satisfaction and compliance
with treatment.
International Expert
Consensus
Recommendations for
The Use of Dermo-
cosmetics In Acne
th
Thursday, 12 October 2023
This paper was presented on October 12th 2023
at the 32nd European Academy of Dermatology
and Venerology (EADV) Congress at Berlin,
Germany; by Drs Brigitte Dréno, Diane
Thiboutot et al from the University Nantes,
Nantes, France, Penn State College of Medicine,
Hershey, Hershey PS, United States
The study focuses on the role of dermocosmetics
(cosmeceuticals) in the management of acne
vulgaris. Dermocosmetics are skincare products
that contain active ingredients designed to
address various skin conditions. The study
involved a systematic literature review and a
panel of dermatologists with expertise in acne
management to analyze the existing evidence
and provide recommendations. Here is a sum-
mary of the key findings and conclusions from
this study:
Background:
• Acne vulgaris is a widespread global issue,
and while effective treatments exist, there is a
continuous search for ways to improve acne
management.
• Dermocosmetics are skincare products that
incorporate advanced active ingredients with
the potential for biological activity, which can
support skin health and alleviate skin condi-
tions.
• A systematic literature review was con-
ducted, and a panel of dermatologists special-
izing in acne management analyzed the
available literature.
• The panel of experts held a live meeting and
conducted a three-step Delphi process online
to reach a consensus on the use of dermo-
cosmetics in acne management.
• The panel acknowledged that the evidence
base for dermocosmetics is not as robust as
that for prescription products, but they
utilized the available evidence and their
expert opinions to reach consensus.
Results:
• The panel of experts suggested that der-
mocosmetics may be used as monotherapy to
treat milder forms of acne or to maintain the
benefits post-prescription treatment. This
recommendation is supported by studies
showing improvements in global assessment,
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reduced acne lesion counts, and decreased
skin oiliness, as well as effective maintenance
after acne clearance.
• The experts also recommended the use of
dermocosmetics as adjunctive therapy to
prescription treatments. In this role,
dermocosmetics can help prevent and man-
age irritation and drug-induced adverse
effects. They may also reduce skin oiliness,
improve skin barrier function, enhance
treatment adherence, increase patient satis-
faction, and improve the quality of life for
acne patients.
• Limited evidence suggests that the adjunctive
use of dermocosmetics may enhance the
efficacy of prescription therapy by facilitating
patient adherence to the prescribed treatment.
Conclusion:
• The study's literature review and expert
consensus through the Delphi method
support the use of dermocosmetics in the
management of acne.
• Dermocosmetics can be used as standalone
treatment for milder acne cases and for
maintaining results after prescription treat-
ments. They can also serve as adjunctive
therapy to prescription treatments, helping to
manage side effects and improve treatment
adherence, patient satisfaction, and quality of
life.
• While the evidence for dermocosmetics is not
as strong as that for prescription products,
their role in acne management is recognized
and recommended by experts in the field.
14
 An Educational Initiative by

An academic initiative from the makers of