Article

A double-blind study of the effect of zinc and oxytetracyline in acne vulgaris

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Abstract

With a double-blind technique, the effects of oral zinc and tetracyclines were compared in 37 patients with moderate and severe acne. No difference in effect between the treatments was seen and no side-effects were noted in any group. After 12 weeks of treatment, the average decrease in the acne score was about 70% in both groups.

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... 15 Michaelsson also noticed in acne Gr III and IV patients low initial S zinc level of 0.89 µg/ml while in controls 0.962 µg/ml. 14 In this study only 4/77 had serum zinc level below 0.70 µg/ml which is reported as lower limit of normal range. ...
... Michaelsson observed that mean score was 63.9 who had normal serum zinc level. 14 Fall in severity score was 30% after3 weeks, 40% after 6 weeks, 46% after 9 weeks and 55.45% after 12 weeks in the present study. ...
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p class="abstract"> Background: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit occurring in adolescent age group. Though not life threatening it can cause physical and psychological scars which can produce social problems in house, school and office. It is a multifactorial disease. Many treatment options are available, but not optimal. Zinc was found to be effective in pustular acne in a patient with acrodermatitis enteropathica. Hence a study on the level serum zinc in acne patients and the effect of zinc on acne is worthwhile. The aim was estimation of serum zinc level in acne patients and correlation of serum zinc level and improvement of acne. Methods: Pre-treatment serum zinc level was estimated in acne and non-acne patients. Acne patients were given oral zinc 220 mg two times a day and control group was given placebo. Post treatment serum zinc levels were estimated and the serum zinc level and improvement of acne was correlated. Results: Study subjects attained average serum zinc level of 5.829 µg/ml from 1.33 µg/ml. 59.5% patients on zinc therapy showed more than 50% improvement in acne severity. 10.6% showed >75%, 48.9% showed 50-75%, 36.1% showed 25-50% and 4.25% patients showed less than 25% improvement. Conclusions: Statistically significant low levels of zinc were not observed in acne. Oral zinc sulphate 220 mg two times a day raised serum level to 5.82 µg/ml Exponential response in acne was noticed as serum zinc level was raised. Inflammatory lesions showed better response than comedo. Oral zinc has definite role in treatment of acne.</p
... Yapılan randomize kontrollü bir çalışmada, oral çinko alımı şiddetli ve inflamatuar aknenin tedavisinde etkili bulunmuştur. 35 Fakat çinko etkin olduğu dozlarda genellikle bulantı ve ishal gibi gastrointestinal intoleransa neden olabilmektedir. ...
Article
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Acne vulgaris is a multifactorial chronic inflammatory disease of the pilosebaceous unit, which affects approximately 85% of individuals in the adolescent period. The four main factors in the pathogenesis of acne are hypersecretion of sebum, abnormal proliferation in the follicle, bacterial colonization and host inflammatory response. Secondary factors thought to have an effect on the pathogenesis of acne vulgaris are dietary, genetic and immunological factors, neuropeptides, cytokines, toll-like receptors, skin microbiology, mechanical obstruction, hormones, stress, cosmetics, emollients, and some drugs. The relationship between diet and acne has always aroused interest. It is known that acne was not occured in the limited societies that received the paleolithic diet. These epidemiological data have encouraged researchers to investigate what are the main acne triggers in the relationship between acne and diet. In this study, we aimed to review the relationship between acne vulgaris and diet in accordance with the information in the literature. Keywords: Acne vulgaris; diet; the role of diet in acne; etiopathogenesis; glycemic index
... Fourteen studies compared a zinc-containing product to other available treatments for acne vulgaris (Bojar, Eady, Jones, Cunliffe, & Holland, 1994;Chu, Huber, & Plott, 1997;Cunliffe, Burke, Dodman, & Gould, 1979;Cunliffe et al., 2005;Dreno et al., 2001;Feucht, Allen, Chalker, & Smith, 1980;Habbema, Koopmans, Menke, Doornweerd, & De Boulle, 1989;Langner, Sheehan-Dare, & Layton, 2007;Micha€ elsson, 1980;Micha€ elsson, Juhlin, & Ljunghall, 1977;Papageorgiou & Chu, 2000;Schachner, Pestana, & Kittles, 1990;Sharquie, Noaimi, & Al-Salih, 2008) (Table 3), out of which only four were controlled (Feucht et al., 1980;Micha€ elsson, 1980;Papageorgiou & Chu, 2000). Ten studies compared a zinc-containing compound to an antibiotic. ...
Article
Acne vulgaris is a chronic disease of the pilosebaceous units presenting as inflammatory or noninflammatory lesions in individuals of all ages. The current standard of treatment includes topical formulations in the forms of washes, gels, lotions, and creams such as antibiotics, antibacterial agents, retinoids, and comedolytics. Additionally, systemic treatments are available for more severe or resistant forms of acne. Nevertheless, these treatments have shown to induce a wide array of adverse effects, including dryness, peeling, erythema, and even fetal defects and embolic events. Zinc is a promising alternative to other acne treatments owing to its low cost, efficacy, and lack of systemic side effects. In this literature review, we evaluate the effectiveness and side-effect profiles of various formulations of zinc used to treat acne.
... A revie actors and acne Acne vulgaris ha work was also d nd psychiatric mo e shown that the s blockage migh n. [8] showed in [12] between the rity of acne or was deduced o observed in thic hirsutism. effective role d testosterone by [15]. in A has also tive measures ISSN: 0975-0185 against acne. [16] used retinol to control severely inflammatory Acne vulgaris within 3 to 4 months. ...
... In early studies on the influence of zinc on human skin conducted by Michaelsson and Fitzherbert in 1970's, it has been shown that acne improved with oral zinc supplementation in zinc-deficient patients [45,46]. Later studies have confirmed that patients with acne often are deficient in zinc [47,48] and its oral supplementation has a positive effect on treatment of acne vulgaris [49][50][51][52][53][54][55]. ...
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The relationship between diet and acne is highly controversial. Several studies during the last decade have led dermatologists to reflect on a potential link between diet and acne. This article presents the latest findings on a potential impact that diet can have on pathogenesis of acne vulgaris. The association between diet and acne can no longer be dismissed. Compelling evidence shows that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne and the roles of omega-3 fatty acids, dietary fiber, antioxidants, vitamin A, zinc and iodine remain to be elucidated. The question of what the impact of diet is on the course of acne vulgaris still remains unclear.
... In a randomized, doubleblind controlled comparative study between zinc gluconate (equivalent to 30 mg elementary zinc /d) and minocycline (100 mg /d), after a treatment period of three months zinc proved to be effective but less effective than minocycline (n=332) [358]. In further studies zinc proved to be comparably effective as oxytetracycline (n=37) [359] and less effective than tetracyclines (n=40) [360]. ...
... In einer randomisierten, doppelblind kontrollierten Vergleichsstudie zwischen Zinkglukonat (entsprechend 30 mg elementarem Zink täglich) und Minocyclin (100 mg täglich) erwies sich Zink nach einem Behandlungszeitraum von 3 Monaten als wirksam, jedoch weniger wirksam als Minocyclin (n = 332) [349]. In weiteren Studien erwies sich Zink als vergleichbar effektiv wie Oxytetracyclin (n = 37) [350] sowie weniger effektiv als Tetracycline (n = 40) [351]. Über Kombinationstherapien mit anderen Aknetherapeutika liegen keine Daten vor. ...
Article
Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. A mean disease incidence of 6.0 per 100 000 person-years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The central pathogenic event in HS is believed to be the occlusion of the upper part of the hair follicle leading to a perifollicular lympho-histiocytic inflammation. A highly significant association between the prevalence of HS and current smoking (Odds ratio 12.55) and overweight (Odds ratio 1.1 for each body mass index unit) has been documented. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by classical surgery or LASER techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus rifampicine, tetracyclines), acitretin and biologics (adalimumab, infliximab). A Hurley severity grade-relevant treatment of HS is recommended by the expert group following a treatment algorithm. Adjuvant measurements, such as pain management, treatment of superinfections, weight loss and tobacco abstinence have to be considered. © 2015 European Academy of Dermatology and Venereology.
... Similarly, oral zinc gluconate has been found useful in managing inflammatory acne but the initial loading dose is not beneficial [41][42][43]. However, acne treatment with zinc salts appears to be equal or less effective compared with systemic tetracyclines (minocycline, oxytetracycline) [40,42,44]. Recently a methionine bound zinc complex with antioxidants has been tried and found useful in managing mild to moderate acne vulgaris [45]. ...
Article
Full-text available
Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc.
... 3,6 Zinc salts inhibit toll-like receptor 2 surface expression by keratinocytes, thus adding another facet in its anti-inflammatory action. 6 Though cyclines are probably the most common antibiotic, resistance to them is rising. 1 Zinc salts have been found to be either as good or better than cyclines, 6,7,10 but this is probably dependent on the base used as results to the contrary have also been noted 8,9 (Fig. 1). In vitro data suggest that sensitivity to zinc salts is the same in erythromycin-resistant and erythromycin-sensitive strains of P. acnes, and addition of zinc in the culture medium could restore P. acnes sensitivity to erythromycin (EM). ...
Article
where the use of oral zinc sul-fate was not associated with significant improvement inrosacea severity over a 90-day trial is contrary to existingliterature, though this can be explained by the differencein population race/ethnicity and dietary conditions. Wefeel that the issue of the effects of zinc in acne vulgarisand rosacea should focus on the preparation of zinc used.The available preparations include zinc acetate, zinc octo-ate, zinc citrate, zinc picolinate, zinc ascorbate, zinc glu-conate, and methionine-bound zinc.
... In einer randomisierten, doppelblind kontrollierten Vergleichsstudie zwischen Zinkglukonat (entsprechend 30 mg elementarem Zink täglich) und Minocyclin (100 mg täglich) erwies sich Zink nach einem Behandlungszeitraum von 3 Monaten als wirksam, jedoch weniger wirksam als Minocyclin (n = 332) [349]. In weiteren Studien erwies sich Zink als vergleichbar effektiv wie Oxytetracyclin (n = 37) [350] sowie weniger effektiv als Tetracycline (n = 40) [351]. Über Kombinationstherapien mit anderen Aknetherapeutika liegen keine Daten vor. ...
... In a randomized, doubleblind controlled comparative study between zinc gluconate (equivalent to 30 mg elementary zinc /d) and minocycline (100 mg /d), after a treatment period of three months zinc proved to be effective but less effective than minocycline (n=332) [358]. In further studies zinc proved to be comparably effective as oxytetracycline (n=37) [359] and less effective than tetracyclines (n=40) [360]. ...
... In a randomized, doubleblind controlled comparative study between zinc gluconate (equivalent to 30 mg elementary zinc /d) and minocycline (100 mg /d), after a treatment period of three months zinc proved to be effective but less effective than minocycline (n=332) [358]. In further studies zinc proved to be comparably effective as oxytetracycline (n=37) [359] and less effective than tetracyclines (n=40) [360]. ...
Article
To optimize the treatment of acne in Germany, the German Society of Dermatology (DDG) and the Association of German Dermatologists (BVDD) initiated a project to develop consensus-based guidelines for the management of acne. The Acne Guidelines focus on induction therapy, maintenance therapy and treatment of post-acne scarring. They include an evaluation of the most commonly used therapeutic options in Germany. In addition, they offer detailed information on how to administer the various treatments and on contraindications, adverse drug reactions, and drug interactions, taking into account gender and special conditions such as pregnancy and lactation. The Acne Guidelines were developed following the recommendations of the Association of Scientific Medical Societies in Germany (AWMF). The treatment recommendations were developed by an expert group and finalized by an interdisciplinary consensus conference. The first choice treatments for acute acne according to acne type are as follows: 1) comedonal acne: topical retinoids; 2) mild papular/pustular acne: fixed or sequential combinations of BPO and topical retinoids or of BPO and topical antibiotics; 3) moderate papular/pustular acne: oral antibiotic plus BPO or plus topical retinoid, or in a fixed combination 4) acne papulo-pustulosa nodosa and acne conglobata: oral antibiotic plus topical retinoid plus BPO or oral isotretinoin. For maintenance treatment: topical retinoid or its combination with BPO. Particular attention should be paid to compliance and quality of life. Additional treatment options are discussed in the main body of the text.
... [7] The beneficial effect of zinc is independent of zinc deficiency. [7] In earlier studies, Michaelsson et al. [8] found zinc to be beneficial in acne vulgaris while Weimer et al. [9] did not find zinc to be better than placebo except that zinc appeared to have some-what beneficial effect on acne pustules. A recent case report suggests that oral zinc sulfate may be useful in dissecting cellulitis and acne conglobata. ...
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Article
Zinc has numerous pharmacological uses in dermatology. Its antioxidant and immunomodulatory properties are thought to correlate with its efficacy in acne vulgaris and leishmaniasis, amongst other cutaneous conditions. We conducted a review of the literature on the use of zinc in dermatology; in particular, we investigated its role in acne vulgaris, hair loss, hidradenitis suppurativa, leishmaniasis, and warts. We searched MEDLINE selecting only articles in English and evaluating the evidence using the Oxford Center of Evidence-Based Medicine 2011 guidance. This review has found evidence to support the use of zinc in patients in infectious conditions (leishmaniasis and warts), inflammatory conditions (acne rosacea, hidradenitis suppurativa) and in hair loss disorders.Ppatients with zinc deficiency should also receive oral supplementation. Further research and large randomized controlled trials are required to investigate the role of zinc as a monotherapy.
Article
The ever-increasing frequency of metabolic syndrome (MetS) is still a major challenge of the public health care system, worldwide. In recent years, researchers have been drawn to the uncommon (at first look) link between skin illnesses and MetS. Because of the pro-inflammatory mechanisms and insulin resistance (IR) that are upregulated in metabolic syndrome, many skin disorders are correlated to metabolic dysfunctions, including acne vulgaris. A comprehensive understanding of the link between MetS and acne vulgaris may contribute to the development of new treatment strategies. The current review focuses on dietary and therapeutic interventions and assesses the effect of various approaches such as improving diet by avoiding certain food products (i.e., milk and chocolate) or increasing the intake of others (i.e., food products rich in omega-3 fatty acids), metformin administration, therapy with plant extracts, plant essential oils, and probiotic supplementation on the improvement of certain acne vulgaris severity parameters. These therapeutic approaches, when combined with allopathic treatment, can improve the patients' quality of life.
Article
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This literature review detines the biological role ot zinc in the human body, immune homeostasis and skin physiology as well as pathophysiology ot skin diseases. It describes the current range ot systemic and topical zinc preparations and their pharmacological characteristics. The review also describes skin diseases that may be treated with the use ot zinc preparations on a grounded basis, and discloses the clinical experience ot the use ot these drugs described in the world literature. It sets out certain recommendations tor using zinc preparations in clinical practice.
Chapter
The complicated and multifactorial nature of acne pathophysiology provides a multitude of opportunities for vitamins and minerals to disrupt the inflammatory cascade. In their traditional roles as dietary necessities, vitamins and minerals participate in keratinocyte proliferation and maturation, modulation of lipid production in human sebocytes, and inhibition of pro-inflammatory cytokines, matrix metalloproteinases, and antimicrobial peptides, as well as act as antioxidants. Not surprisingly, then, there is considerable in vitro and preclinical data predicting their efficacy in acne. Although conclusive clinical evidence is currently lacking for many of them, more vigorous trials are being conducted with increasingly convincing in vivo data. At this time, data for vitamin A analogs, zinc, and niacinamide is most compelling. It may well be that combination therapy will be more efficacious than monotherapy. Fortunately, due to their large safety margin, we can afford to be generous with our recommendations while awaiting more definitive results.
Article
Background Zinc has been used in patients with acne vulgaris for its anti-inflammatory effects; however, it is unclear if zinc supplementation is also beneficial in other inflammatory skin conditions. Objective The objective of this article was to determine the effect of zinc supplementation on inflammatory dermatologic conditions. Data sources We searched the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Ovid with no time limit up to 29 May, 2019. Trials examining supplementation with zinc in the treatment of inflammatory dermatological conditions (acne vulgaris, atopic dermatitis, diaper dermatitis, hidradenitis suppurativa, psoriasis, and rosacea) in children and adults were selected. Results Of 229 articles, 22 met inclusion criteria. Supplementation with zinc was found to be beneficial in ten of 14 studies evaluating its effects on acne vulgaris, one of two studies on atopic dermatitis, one of one study on diaper dermatitis, and three of three studies evaluating its effects on hidradenitis suppurativa. However, the one article found on psoriasis and the one article found on rosacea showed no significant benefit of zinc treatment on disease outcome. Conclusions and implications Some preliminary evidence supports the use of zinc in the treatment of acne vulgaris and hidradenitis suppurativa; however, more research is needed with similar methodologies and larger sample sizes in these diseases. Further, zinc may be of some benefit in the treatment plan for atopic dermatitis and diaper dermatitis; however, additional studies should be conducted to further evaluate these potentially positive associations. To date, no evidence is available to suggest that zinc may be of benefit in rosacea and psoriasis; however, limited data are available evaluating the use of zinc in these conditions.
Article
Many supplements and products containing botanical extracts are marketed to patients for the treatment of acne vulgaris. Additionally, increasing attention has been paid to the role of diet in acne vulgaris. Studies on this topic including pediatric patients are limited, with variable efficacy data. Despite these limitations, knowledge of alternative therapies in pediatric acne vulgaris is often expected from pediatric dermatologists. Here we review available data on the efficacy of complementary and alternative medicines for treatment of acne in pediatric patients, focusing on topical, oral, and dietary modifications.
Chapter
Wenn man sich seit Jahren aus Anlaß unserer Fortbildungsveranstaltungen vor die Aufgabe gestellt sieht, eine Tour d’horizon dermatologique zu absolvieren, so kommt man zu der Feststellung, daß diese Aufgabe von Mal zu Mal schwieriger zu bewältigen ist. Das Fachgebiet Dermatologie und Venerologie nimmt eine so rasche Entwicklung, daß es kaum möglich ist, anders als eklektisch vorzugehen und einiges vorzutragen, was dem Referenten von praktisch-dermatologischer Bedeutung erscheint.
Chapter
The trace element zinc is an essential element for many physiologic reactions in man. It is part of the molecular structure of various enzymes, e.g., alcohol dehydrogenase, lactate dehydrogenase, several other dehydrogenases, and DNA polymerase. It is also involved in the synthesis and release of the retinol-binding protein (RBP), which is a specific transport protein. Its plasma levels reflect the amount of vitamin A available in the tissues. With a regular diet and no metabolic disturbances there is no need for supplement of zinc in our food.
Chapter
Die Akne ist eine lästige Erkrankung der Pubertät; ihre Auswirkungen können gerade in dieser Lebensphase verheerend sein, in der Ereignisse vielfach überbewertet werden, so daß ein winziges emotionales Trauma lebenslänglich Folgen hinterlassen kann. Die Akne ist eine ernst zu nehmende Erkrankung in einer Gesellschaft, deren kosmetisches Bewußtsein über Gebühr ausgeprägt ist.
Chapter
Starting with sulfonamides and penicillin, each new antibiotic and chemotherapeutic drug has been enthusiastically touted as an effective acne treatment. Most have not lived up to the promise. This examplifies the difficulties of therapeutic evaluations; penicillin is ineffective, and sulfonamides are more harmful than helpful. It is almost impossible to compare results from different investigators, despite efforts to obtain objective data by controlled studies.
Chapter
1977 berichtete Michaëlsson [1] zum ersten Mal über das therapeutische Ergebnis einer oralen Zinkanwendung bei der Acne vulgaris. Seither sind eine Reihe von klinischen Studien durchgeführt worden [2–9] (Haavelsrud, persönliche Mitteilung; Multicenterstudie Deutschland, unveröffentlicht), zu deren Ergebnissen gehört, daß die Indikation für eine orale Zinktherapie die entzündlichen Formen der Acne vulgaris sind, also die pustulöse und papulöse Akne. Insbesondere die Pusteln und dann die Papeln reagieren auf die Zufuhr von Zink in 60–70% der Fälle gut.
Chapter
1973 zeigten Barnes und Moynahan, daß das Spurenelement Zink in der Pathogenese der Akrodermatitis enteropathica eine zentrale Rolle spielt [1]. 1977 berichteten Michaelsson et al. über klinische Behandlungserfolge mit oraler Zinktherapie bei Acne vulgaris [7, 8]. Sie hatten beobachtet, daß bei einem Patienten mit Akrodermatitis enteropathica unter Zinkgaben eine gleichzeitig bestehende Akne abheilte. Aufgrund dieser Fallbeobachtung und der Kenntnis, daß bei Tieren für die Aufrechterhaltung des normalen Vitamin-A-Plasmaspiegels und retinolbindender Proteine Zink essentiell ist, sowie der Überlegung, daß Vitamin A als Aknemittel verwendet wird, inaugurierten die Autoren eine orale Zinkbehandlung der Acne vulgaris.
Chapter
Zahlreiche Vitaminmangelzustände gehen mit Hauterscheinungen einher. Die Substitution der fehlenden Vitamine ist die Therapie der Wahl. Diesbezüglich sei auf die umfangreiche Literatur verwiesen [1].
Chapter
The most common dermatological diseases are the diseases of the sebaceous glands, such as acne, dermatophyte infections, malignant and benign tumors, seborrheic dermatitis, atopic dermatitis, and psoriasis. Dermatology has had to be content to use drugs initially developed for other diseases, although the new discipline of dermatopharmacology has emerged to optimize the delivery of existing drugs and, more importantly, to develop the animal models of skin diseases and use them to identify new dermatologic agents. The field of immunodermatology has also been discussed in the chapter stressing the importance of immunologic derangement in many skin disorders. This chapter includes specific developments made concerning psoriasis, atopic dermatitis, acne, and more general sections on inflammatory mediators likely to play a role in skin inflammation, topical anti-inflammatories, and vehicles of current use in topical therapy. Psoriasis is a common, multifactorial, genetically determined disease of unknown etiology that is characterized by a benign, unrestricted epithelial growth of skin. It produces recurrent lesions that are often emotionally and physically debilitating to the patient. Atopic dermatitis is a chronic inflammatory skin disease that occurs most frequently in people with a personal or family history of allergies (for example, asthma or allergic rhinitis). Acne vulgaris is the most common disease of the skin. It is characterized by a variety of lesions that may be noninflammatory (open and closed comedones) or inflammatory (papules, pustules, nodules).
Chapter
The trace element, zinc, is both a nutrient and a drug. As a nutrient, its role in correcting zinc deficiency states is incontrovertible. That topic has been reviewed in Chaps. 17 and 18 of this volume. However, a variety of therapeutic roles for zinc, apart from those associated with the reversal of nutritional depletion or recovery from zinc-deficiency-related symptoms, have been suggested. This domain of zinc as a drug will be the focus of the present chapter.
Article
Die moderne Aknetherapie beruht auf der Anwendung von antikomedogenen, antimikrobiellen und entzündungshemmenden Substanzen sowie Antiandrogenen. Ergänzend stehen traditionelle oder neu entwickelte Verfahren zur Verfügung. Hierzu zählen pharmakologische (Dapson, Zink) und physikalische (Phototherapie, photodynamische Therapie, Aknetoilette, Abrasiva) Prinzipien. Diese ergänzenden Verfahren werden hinsichtlich ihrer Wirksamkeit und ihres Stellenwertes innerhalb der Aknetherapie beurteilt. The mainstays of modern acne therapy include comedolytic, antimicrobial, and anti-inflammatory substances, as well as antiandrogens. Additionally, traditional or newly developed therapeutic approaches may be considered, including pharmacologic (dapsone, zinc) and physical measures (phototherapy, photodynamic therapy, comedone extraction, abrasives). This article reviews such adjunctive therapies with regard to efficacy and their roles in acne therapy.
Article
Article
Über den Wirkungsmechanismus des Zinks bei der Acne vulgaris nach oraler Gabe gibt es noch keine abschließenden und schlüssigen Untersuchungen. Über die Bestimmung des Zinkspiegels in der Haut vor und während einer oralen Zinktherapie und über die Wirkung einer oralen Zinktherapie auf die Talgexkretionsrate kann der mögliche Wirkungsmechanismus eingegrenzt werden. Über die Ergebnisse dieser Untersuchungen wird berichtet. Im weiteren wird die Indikation für eine orale Zinktherapie diskutiert, und Probleme der Dosierung, klinische Wirkungen und Nebenwirkungen, die Vor- und Nachteile gegenüber anderen Therapien werden dargestellt.Is the Oral Zinc Therapy in Acne an Advancement?Conclusive studies have not yet been made on the action of orally applied zinc on acne vulgaris. The mechanism of such action can be followed by the zinc level in skin before and during oral zinc therapy and by the rate of excretion of skin lipids. The results of these studies are reported. Indication of an oral zinc therapy is discussed and the problems of dose, clinical actions and side reactions as well as advantages and disadvantages compared to other therapies are presented.
Article
Zinc is an essential trace element for the human organism. It acts like cofactor for the metalloenzymes involved in many cellular processes. Its anti-inflammatory activity, which is the basis of therapeutic use, other than acrodermatitis enteropathica, is not well known: production of cytokines, antioxidant activity… Its toxicity is very low, but marked at high doses during chronic administration by the risk of hypocupremia. It is not teratogenic and can be given during pregnancy. Its absorption, through the duodenum, is inhibited by excessive phytate intake. Maximum concentration is reached after 2 to 3 hours. It is widely distributed in the organism, mainly in muscles and bone. Excretion is predominantly digestive. Its spectacular effect in acrodermatitis enteropathica, through compensation of genetically determined malabsorption was discovered in 1973. Its usefulness in acne is based on the anti-inflammatory action and was first described with zinc sulfate, then with better tolerated gluconate. Many controlled studies have shown an efficacy on inflammatory lesions. Doses varied from 30 to 150 mg of elemental zinc and studies against cyclines have shown that minocycline has a superior effect; but zinc might be an alternative treatment when cyclines are contraindicated. To date we don’t have convincing data for its use in other indications (leishmaniosis, warts, cutaneous ulcers). Tolerance at usual doses (200 mg of zinc gluconate or 30 mg of elemental zinc) is good. Major side effects are abdominal with nausea, vomiting, but are fleeting and dose dependent.
Chapter
Structure and distribution Acne vulgaris Aetiology of acne Clinical features Treatment Uncommon associations with acne Severe acne variants Ectopic sebaceous glands Sebaceous gland hyperplasia, adenoma and carcinoma ‘Sebaceous’ (epidermoid) cysts and steatocystoma multiplex References
Chapter
Structure and distributionAcne vulgarisAetiology of acneClinical featuresTreatmentUncommon associations with acneSevere acne variantsEctopic sebaceous glandsSebaceous gland hyperplasia, adenoma and carcinoma‘Sebaceous’ (epidermoid) cysts and steatocystoma multiplex
Chapter
Core Messages • Several minerals such as zinc, iron, and copper have an impact on skin. • Adequate intake of minerals positively influences the overall appearance of skin. • Deficiency of certain minerals results in certain manifestations in skin, hair, and nails and it is associated with skin diseases. • Dermatological effects are observed when the minerals are either orally supplemented or topically applied. • Mineral supplements should be taken with care because excessive intake of minerals can lead to intoxication
Article
Zinc is a cofactor of many metalloenzymes explaining that it plays a crucial role in cell proliferation and also in the regulation of immune system. It has been shown by different data that it could play a crucial role not only in the regulation of adaptative immunity but also in innate immunity which plays a crucial role in skin. In this article, we proposed an overview of published information in the literature, on zinc and cutaneous innate immunity. At the basic level, we gave a synthesis of data related to zinc's cutaneous targets in innate immunity, and then at clinical level selected studies on cutaneous disorders where zinc could be a therapeutic approach and discussed the targets of zinc in these pathologies. The specific activity of zinc salts on the innate immunity of the skin with different targets can explain why zinc is more specifically involved in cutaneous affection in which inflammation plays a particular important role, such as inflammatory acne, acrodermatitis enteropathica, hidradenitis suppurativa, folliculitis decalvans.
Article
This chapter discusses the importance of zinc in human nutrition. Zinc is an essential trace element for humans, animals, and plants. It is vital for many biological functions and plays a crucial role in more than 300 enzymes in the human body. The adult body contains about 2–3 grams of zinc. Zinc is found in all parts of the body: it is in organs, tissues, bones, fluids, and cells. Muscles and bones contain most of the body's zinc. Particularly, high concentrations of zinc are in the prostate gland and semen. Zinc is generally less available from foods of plant origin than from foods of animal origin. The calculated zinc requirements for infants indicate that zinc in human milk should be highly available for absorption if requirements are to be satisfied. Observations on infants and animals have shown that zinc is substantially less available from cow milk than from human milk.
Article
APC is a novel methionine-based zinc complex with antioxidants that has been used in acne as a nutritional supplement. This is based on the proven role of zinc and antioxidants in improving acne, specially the inflammatory lesions. The objectives of this study are to explore the efficacy, safety, and tolerability of APC in acne patients with mild to moderate facial acne vulgaris. In this exploratory trial, 48 patients were treated with oral APC thrice a day for 3 months followed by a 4-week treatment-free period. At the end of treatment (Week 12), there was a statistically significant improvement in the global acne count (p < 0.05), which began after 8 weeks (p < 0.05). Almost 79% (38/48) of the patients had 80-100% improvement. There was a significant reduction in pustules (8 weeks (p < 0.05) and 12 weeks (p < 0.001)), and papules and closed comedones (8 weeks (p < 0.05) and 12 weeks (p < 0.001)). Only two patients had side effects. The current data indicate that treatment with oral APC thrice daily for 12 weeks in patients with mild to moderate facial acne vulgaris is efficacious and well tolerated. As the onset of action is late, concomitant topical therapy can enhance the results.
Article
Severe zinc deficiency states, such as acrodermatitis enteropathica, are associated with a variety of skin manifestations, such as perioral, acral, and perineal dermatitis. These syndromes can be reversed with systemic zinc repletion. In addition to skin pathologies that are clearly zinc-dependent, many dermatologic conditions (eg, dandruff, acne, and diaper rash) have been associated and treated with zinc. Success rates for treatment with zinc vary greatly depending on the disease, mode of administration, and precise zinc preparation used. With the exception of systemic zinc deficiency states, there is little evidence that convincingly demonstrates the efficacy of zinc as a reliable first-line treatment for most dermatologic conditions. However, zinc may be considered as an adjunctive treatment modality. Further research is needed to establish the indications for zinc treatment in dermatology, optimal mode of zinc delivery, and best type of zinc compound to be used.
Article
The exact pathophysiology and curative treatment of many common dermatologic conditions remains unclear. Often, conventional treatments are only partially effective, leading patients to look for alternative therapy. No new promising alternative treatments for aphthous stomatitis could be found in the literature. Acne may be helped by nicotinamide gel and azelaic acid. Atopic dermatitis may be helped by a trial of elimination diet, n-3 fatty acid supplementation, or Chinese 10-herb tea. Psoriasis may be helped by aloe vera or thermal baths combined with sun exposure.
Article
Modern acne therapy is based on the application of anticomedogenic, antimicrobial, or antiinflammatory substances, and antiandrogens. Additionally, traditional or newly developed therapeutic approaches may be considered, including pharmacologic (dapsone, zinc) and physical measures (phototherapy, photodynamic therapy, laser, comedone extraction, abrasives). This article reviews such adjunctive therapies with regard to efficacy and their roles in the therapy of acne.
Article
There is a plethora of complementary and alternative medicines (CAM) used by sufferers of skin diseases. For the most part, the use of these therapies is based on anecdotal evidence or on traditional patterns of use. Relatively little empirical evidence exists for the use of CAM therapies in skin diseases. Those studies that have examined CAM skin disease therapies have often been flawed methodologically. A small number of CAM therapies have been accepted or are on the cusp of acceptance in dermatological practice. Even here, the evidence for CAM use is often limited or equivocal. Equally, issues of poorly documented adverse effect profiles, quality control of preparations and product adulteration and contamination hamper the integration of CAM therapies into orthodox dermatology practice. Thus, it may be more appropriate to consider `pluralism' rather than `integration' in the relationship of CAM and conventional medicine.
Article
Historically, the relationship between diet and acne has been highly controversial. Before the 1960s, certain foods were thought to exacerbate acne. However, subsequent studies dispelled these alleged associations as myth for almost half a century. Several studies during the last decade have prompted dermatologists to revisit the potential link between diet and acne. This article critically reviews the literature and discusses how dermatologists might address diet when counseling patients with acne. Dermatologists can no longer dismiss the association between diet and acne. Compelling evidence exists that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne, and the roles of omega-3 fatty acids, antioxidants, zinc, vitamin A, and dietary fiber remain to be elucidated. This study was limited by the lack of randomized controlled trials in the literature. We hope that this review will encourage others to explore the effects of diet on acne.
Article
The inhibitory effect of zinc on the gastrointestinal absorption of tetracycline has been investigated in 7 healthy volunteers. Zinc (45 mg Zn++) was given as a solution of zinc sulphate and as a zinc citrate complex; tetracycline (500 mg) was administered as a commercially available preparation. Serum tetracycline concentrations and the area under the serum tetracycline concentration-time curve (up to 6 h) were significantly reduced when tetracycline was taken with either zinc sulphate or the zinc citrate complex. Although the reduction of absorption seemed more pronounced after zinc sulphate, the difference between the inhibitory effects of the two forms of zinc was not significant. It is concluded that simultaneous administration of zinc and tetracycline may reduce absorption of tetracycline.
Article
A preliminary trial of oral zinc supplementation was conducted in twenty-four patients with chronic, refractory rheumatoid arthritis. Zinc sulphate (220 mg three times daily) or placebo capsules of identical appearance were added to pre-existing therapy for 12 wk. This double-blind trial was followed by an open 12-wk period when all subjects took zinc. During the double-blind phase, zinc-treated patients fared better than controls with regard to joint swelling, morning stiffness, walking time, and the patient's own impression of overall disease activity. The indices and joint tenderness also improved with zinc treatment in both groups of subjects during the second 12-wk period. These encouraging results indicate that oral zinc sulphate deserves futher study in patients with active rheumatoid arthritis.
Article
The effects of oral zinc sulfate (corresponding to 135 mg of zinc daily) alone and in combination with vitamin A (300,000 international units) daily on acne lesions have been compared with those of vitamin A alone and of a placebo. The number of comedones, papules, pustules, and infiltrates were counted at each visit. After four weeks, there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. The effect of zinc plus vitamin A was not better than zinc alone. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The mechanism for the effect of zinc therapy in acne, to our knowledge, is not presently known.¿
Article
The serum levels of zinc and retinol-binding protein (RBP) have been determined in 173 patients with acne and compared with those of a control group. The RBP is a specific transport protein and its level in plasma reflects the amount of vitamin A available to the tissues. Patients with severe acne were found to have lower levels of RBP than either patients with mild acne or healthy subjects of the same age. In the case of males with severe acne, the mean serum zinc level was significantly lower than that of the control group. No such difference was observed for girls. The observed condition of low levels of zinc and vitamin A in the serum of patients with severe acne may provide a rationale for the clinically good effect of oral zinc treatment.
Article
The interaction between tetracyclines and di- and trivalent ions such as are contained in aluminium, magnesium, calcium, iron and zinc-containing salts or complexes or antacids is well documented. The potential for interaction between tetracyclines and zinc and bismuth salts is often not realised, but is emphasised by the findings reported here. The absorption of 250 mg phosphate-potentiated tetracycline hydrochloride was reduced by 75% when administered concurrently with 220 mg zinc sulphate. The absorption of 250 mg phosphate-potentiated tetracycline hydrochloride was reduced by 50% when administered concurrently with 10 ml bicitropeptide, a bismuth-protein complex. Tetracyclines should thus not be administered concurrently with zinc salts or bicitropeptide.
The effect of zinc sulphate and of bicitropeptide on tetracycUne absorptioni977) Effects of oral zinc and vitamin A in acne (i977) Serum zinc and retinol-binding protein in acne Oral zinc sulphate in rheumatoid arthritis
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