***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Skin absorption of  benzoyl peroxide  from a topical lotion containing freely dispersed drug was compared with that from the same lotion in which the drug was entrapped in a controlled-release styrene-divinylbenzene polymer system . In an in vitro diffusion system , statistically significant ( p = 0.01 ) differences were found in the content of benzoyl peroxide in excised human skin and in percutaneous absorption . In vivo , significantly ( p = 0.002 ) less benzoyl peroxide was absorbed through rhesus monkey skin from the polymeric system . This controlled release of benzoyl peroxide to skin can alter the dose relation that exists between efficacy and skin irritation . Corresponding studies showed reduced skin irritation in cumulative irritancy studies in rabbits and human beings , whereas in vivo human antimicrobial efficacy studies showed that application of the formulations containing entrapped benzoyl peroxide significantly reduced counts of Propionibacterium acnes ( p less than 0.001 ) and aerobic bacteria ( p less than 0.001 ) and the free fatty acid/triglyceride ratio in skin lipids . These findings support the hypothesis that , at least for this drug , controlled topical delivery can enhance safety without sacrificing efficacy One hundred sixty-five subjects completed a 10-week , double-blind controlled study comparing the following : ( 1 ) a combination of 3 % erythromycin and 5 % benzoyl peroxide in a gel , ( 2 ) 5 % benzoyl peroxide gel , ( 3 ) 3 % erythromycin gel , and ( 4 ) the gel vehicle . The benzoyl peroxide gel and the erythromycin gel were superior to the control gel ; however , the combination product was more effective than any of the others . This was true for both pustular and papular lesions , but the most dramatic effect was on combined inflammatory lesions , i.e. , papules and pustules BACKGROUND Quantification of acne remains a challenge . It may be difficult to identify lesions by st and ard flash photography . Previous studies have shown that foci of light in fluorescence photographs correspond to high protoporphyrin IX production by Propionibacterium acnes in open comedones , follicles , and inflammatory lesions . OBJECTIVE Our purpose was to study the utility of fluorescence photography for evaluation of acne . METHODS Forty subjects with mild to moderate acne vulgaris were r and omly selected to apply either clindamycin 1 % topical solution or vehicle twice daily . Counts of acne lesions and flash and fluorescence photographs were obtained at baseline , and at 4 , 8 , and 12 weeks . RESULTS At 12 weeks , the treatment group had a larger percentage change in open comedones , less fluorescence in all areas assessed , and a larger percent decrease in fluorescence than the vehicle group . CONCLUSION Fluorescence photography appears to be a useful tool to chart the course of acne treatment A 2.5 % formulation of benzoyl peroxide was compared with its vehicle , and with a 5 % and a 10 % proprietary benzoyl peroxide gel preparation in three double-blind studies involving 153 patients with mild to moderately severe acne vulgaris . The 2.5 % benzoyl peroxide formulation was more effective than its vehicle and equivalent to the 5 % and 10 % concentrations in reducing the number of inflammatory lesions ( papules and pustules ) . Desquamation , erythema , and symptoms of burning with the 2.5 % gel were less frequent than with the 10 % preparation but equivalent to the 5 % gel . The 2.5 % formulation also significantly reduced Propionibacterium acnes and the percentage of free fatty acids in the surface lipids after 2 weeks of topical application Skin diseases such as acne are sometimes thought of as unimportant , even trivial , when compared with diseases of other organ systems . To address this point directly , vali date d generic question naires were used to assess morbidity in acne patients and compare it with morbidity in patients with other chronic diseases . For 111 acne patients referred to a dermatologist , quality of life was measured using the  Dermatology Life Quality Index  ,  Rosenberg 's measure of self‐esteem  , a version of the General Health Question naire ( GHQ‐28 ) and the  Short Form 36 ( SF‐36 ) . Clinical severity was measured using the Leeds Acne Grade . Population quality of life data for the SF‐36 instrument were available from a r and om sample of adult local residents ( n = 9334 ) some of whom reported a variety of long‐st and ing disabling diseases . All quality of life instruments showed substantial deficits for acne patients that correlated with each other but not with clinical ly assessed acne severity . The acne patients ( a relatively severely affected group ) reported levels of social , psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma , epilepsy , diabetes , back pain or arthritis . Acne is not a trivial disease in comparison with other chronic conditions . This should be recognized in the allocation of health care re sources BACKGROUND It has previously been shown that a combination of erythromycin and benzoyl peroxide is superior to either ingredient when used alone in the treatment of acne . A clindamycin/benzoyl peroxide combination gel might have an advantage over erythromycin/benzoyl peroxide gel because the former does not require refrigeration after it is dispensed . OBJECTIVE Our purpose was to determine the efficacy and safety of a combination clindamycin/benzoyl peroxide gel when compared with benzoyl peroxide , clindamycin , or vehicle gels . METHODS In two double-blind , r and omized , parallel , vehicle-controlled trials , patients were treated for 11 weeks with once-nightly application of one of the above preparations . Evaluations were performed at 2 , 5 , 8 , and 11 weeks and included lesion counts and assessment of global responses and irritant effects . RESULTS A total of 334 patients completed the study . All three active preparations were significantly superior to the vehicle in global improvement and in reducing inflammatory lesions and noninflammatory lesions . The combination gel was significantly superior to the two individual agents in global improvement and reduction of inflammatory lesions and also to the clindamycin gel in reducing noninflammatory lesions . There was no significant difference in tolerance to the active gels versus the vehicle gel . CONCLUSION In the treatment of acne , topical clindamycin/benzoyl peroxide combination gel is well tolerated and superior to either individual ingredient Background Topical clindamycin and benzoyl peroxide have each demonstrated clinical efficacy in the treatment of acne vulgaris . When used in combination , they promise greater efficacy than either individual agent used alone and the combined use of benzoyl peroxide with topical antibacterials has been shown to decrease the emergence of antibacterial resistant species . Objective The objective was to determine the efficacy and safety of a combination benzoyl peroxide plus clindamycin in a gel formulation compared with each of its 2 active constituents in gel vehicle , and gel vehicle given alone in the treatment of acne vulgaris . Methods In this 10-week , multicenter , double-blind trial , 480 patients with moderate to moderately severe acne were r and omized to receive twice-daily treatment with 5 % benzoyl peroxide plus 1 % clindamycin , 5 % benzoyl peroxide , 1 % clindamycin , or vehicle . Results Significantly greater reductions in the number of inflammatory and total lesions were demonstrated in patients using combination therapy compared with those using any of its 3 individual components . Likewise , both physicians ’ and patients ’ global evaluations showed significantly greater improvements with the combination therapy than with its individual components . The most frequent adverse effect , dry skin , occurred to a similar extent in the combination and benzoyl peroxide treatment groups . Conclusion The improved efficacy obtained with the combination therapy was accompanied by a tolerability profile similar to that of benzoyl peroxide alone , making this new combination product an alternative antimicrobial therapy for acne vulgaris OBJECTIVE To explore participants ' experience in placebo-controlled r and omized clinical trials ( RCTs ) specifically in relationship to their expectations . BACKGROUND Aspects of being in RCTs , such as informed consent , perception of benefit and underst and ing of r and omization , have been examined . In contrast , little is known concerning the formation of patient expectations before and during trials . METHODS Qualitative methods using in-depth interviews with a semi-structured interview guide of nine patients from four different RCTs . Data analysis was conducted using a codebook format arranging participant responses under broad analytical headings . The interviewer used a semi-structured interview guide to direct the conversation from one broad topic to the next within the context of the ongoing conversation . A checklist of topics encouraged participants to describe their experiences in RCTs . Narratives concerning expectation , blinding and placebo were compared to identify common themes . RESULTS Patient anticipatory processes were influenced and modified both before and during the trial from multiple inputs . Such factors as past experiences in RCTs , past experiences of ineffective treatment , stress of being off regular medications , fear of being a ' placebo responder ' , input of non- study doctors or other health professionals , the experience of other participants , measurements of health parameters made during the trial and the presence or absence of side-effects all affected patient expectation . CONCLUSION Expectations in RCTs are not fixed and instead may be viewed as continuously shaped by multiple inputs that include experience and information received both before and during the trial . Variability in placebo response observed in previous studies may be related to the fluid nature of expectations . Trying to control and equalize expectations in RCTs may be more difficult than previously assumed Background : Literature reports indicate that phospholipid liposomes facilitate the accumulation of active agents in the infundibulum . Objective : The study hypothesis of an improved antibacterial efficacy of benzoyl peroxide ( BPO ) in phospholipid liposomes was tested in comparison with a commercial and a pharmacopoeial BPO preparation . Methods : The infundibular bacterial sample s were obtained with the Permabond technique from 20 acne patients who had been treated with the test substances ( vehicle-controlled ) for 2 weeks twice per day in a single-blinded , comparative study on the upper back . Results : A significant antibacterial effect in the infundibula ( Propionibacteria and Micrococcaceae , both : p < 0.001 ) for a BPO phospholipid liposome formulation could be demonstrated . In comparison to the other significantly efficacious BPO formulations which were also tested ( commercial product and pharmacopoeial formulation ) , the BPO phospholipid liposome formulation showed a significantly greater antibacterial efficacy for Propionibacteria and Micrococcaceae ( both : p < 0.01 ) . Conclusion : A BPO formulation in phospholipid liposomes may represent an improvement of the conventional external BPO treatment of acne BACKGROUND A fixed-dose combination gel with adapalene 0.1 % and benzoyl peroxide ( BPO ) 2.5 % has been developed for the once-daily treatment of acne . OBJECTIVE To evaluate the efficacy and safety of adapalene 0.1 % -BPO 2.5 % fixed combination gel ( adapalene-BPO ) for the treatment of acne . METHODS A total of 517 subjects were r and omized in a double-blind controlled trial to receive either adapalene-BPO , adapalene , BPO , or vehicle for 12 weeks ( 2:2:2:1 r and omization ) . Evaluation included success rate ( subjects " clear " or " almost clear " ) , lesion count , cutaneous tolerability , and adverse events . RESULTS The fixed-dose combination gel of adapalene and BPO was significantly more effective than corresponding monotherapies , with significant differences in total lesion counts observed as early as 1 week . Adverse event frequency and cutaneous tolerability profile for adapalene-BPO were similar to adapalene monotherapy . LIMITATIONS These data were generated in a controlled trial . Results obtained in clinical practice could differ . CONCLUSIONS The fixed-dose combination of adapalene and BPO provides significantly greater efficacy for the treatment of acne vulgaris as early as week 1 relative to monotherapies , with a comparable safety profile to adapalene A double‐blind , r and omized study comparing isotretinoin gel ( Isotrex‐ ® ) , its vehicle base , and benzoyl peroxide was performed on 77 patients with mild to moderate acne vulgaris Abstract In a pooled analysis of four r and omized controlled trials of acupuncture in patients with migraine , tension‐type headache , chronic low back pain , and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome . The 864 patients included in the analysis received either 12 sessions of  acupuncture or minimal ( i.e. sham ) acupuncture ( superficial needling of non‐acupuncture points ) over an 8 week period . Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment . After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving . Patients were classified as responders if the respective main outcome measure improved by at least fifty percent . Both univariate and multivariate analyses adjusted for potential confounders ( such as condition , intervention group , age , sex , duration of complaints , etc . ) consistently showed a significant influence of attitudes and expectations on outcome . After completion of treatment , the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 ( 95 % confidence interval 1.20–2.32 ) . For personal expectations and confidence after the third session , odds ratios were 2.03 ( 1.26 
    Output:
    
No treatment ” groups may facilitate determination of accurate treatment efficacies