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Studies on inhibitory effect of eucalyptus oil on sebaceous glands for the management of Acne
Abstract
Acne is the most common disorder virtually seen to affect teenagers and young adults between age of 14-30. It is characterized by inflamed specialized sebaceous follicles which are present at face, back and chest. Some serious factors responsible for generation of acne are abnormal follicular keratinization and desquamation, excessive secretion of sebum, and proliferation of Propionibacterium acnes in follicles. Other factors aggravating or worsening the acne conditions are secondary infections caused by some pathogenic strains of bacteria like Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, etc. There are various topical and systemic therapies available in market to treat or control the acne but maximum of them have the side effects like itching, redness, skin peeling, stinging and photosensitivity. Again, the development of resistance of available antibiotics for P. acne and other bacterial strains has necessitated the search for new antimicrobial agents. Thus, the current work was designed to gain attention towards the alternate pathway for controlling the acne condition by decreasing the production of sebum from sebaceous glands. The eucalyptus oil, obtained from Eucalyptus globulus Labill. (Myrtaceae) was chosen and its biocide action on various bacterial strains was established using agar-well diffusion technique to prove its efficacy in controlling the secondary infection condition i.e. worsening of acnes. The in vivo rat sebaceous gland model was chosen to show the effectiveness of eucalyptus oil in decreasing the sebum production by reducing the size of sebaceous glands to control the spread of acne. The results were found to be promising for eucalyptus oil in controlling the sebum protection and thus establishing the other pathway for the management of acne.
... EGO, by inhibiting the production of tyrosinase and melanin, has a depigmenting and even skin tone effect, effectively reducing acne scars [41]. Research conducted by Bhatt et al. [47] determined the range of biocidal activity against various bacterial strains using eucalyptus oil, showing the inhibitory effect of EGO on some pathogenic bacteria associated with the development of acne. It has also been found that the oil is very effective in reducing the size of enlarged sebaceous glands and thus controlling the production of sebum, the excessive amount of which promotes the formation of acne lesions. ...
... It has also been found that the oil is very effective in reducing the size of enlarged sebaceous glands and thus controlling the production of sebum, the excessive amount of which promotes the formation of acne lesions. The EGO has been proven to have a dual effect, reducing sebum production and controlling the secondary infectious stage by other microorganisms, establishing an alternative pathway for acne management [47]. Göger et al. [45] suggest that the EGO and its major constituent, 1,8-cineole works against skin pathogenic bacteria and show an anti-inflammatory effect. ...
... The research of Athikomkulchai et al. [48] shows that EGO has antimicrobial activity against C. acnes. An oilin-water cream containing 2% eucalyptus oil was more effective than a commercial anti-acne gel with 5% benzoyl peroxide [47]. Bey-Ould Si Said et al. [49] confirmed the antibacterial and bactericidal effect of essential oil from E. globulus fruit on reference pathogenic strains: Bacillus subtilis, Listeria innocua, Escherichia coli, and Pseudomonas aeruginosa. ...
Acne is a chronic, common disease that poses a significant therapeutic, psychological and social problem. The etiopathogenesis of this disease is not fully understood. Drugs used in general and external therapy should have anti-seborrhoeic, anticomadogenic, bactericidal, bacteriostatic, and anti-inflammatory properties. Acne treatment is often associated with the long-term use of antibiotics, contributing to the global antibiotic resistance crisis. In order to solve this problem, attention has been paid to essential oils and their terpene components with potent antimicrobial, anti-inflammatory, and antioxidant properties. Research shows that certain essential oils effectively reduce inflammatory acne lesions through mechanisms related to the sebaceous glands, colonization of Cutibacterium acnes, and reactive oxygen species (ROS). An example is tea tree oil (TTO), a more commonly used topical agent for treating acne. TTO has antimicrobial and anti-inflammatory activity. The paper presents the latest scientific information on the activity and potential use of specific essential oils in treating acne. Evidence of antibacterial, anti-inflammatory, and antioxidant activity of several essential oils and their main components was presented, indicating the possibility of using them in the treatment of acne.
... Then each tube was sealed with aluminium foil and placed in incubator at 37 c° for 24 hours. Skin Inflammatory Test: Anti-inflammatory effect of each active fruit extract was determined by following skin irritation and dermal toxicity test reported by Bhatt et al. (2011). The hair of each mouse was shaved from right and left lateral sides of body. ...
... Similarly, third observation was made after 48 hours and final results were recorded after 72 hours. Table 7 At the end no edema and erythema was noticed for all active fruit extracts and the findings of Bhatt et al. (2011) supports the results of present research for anti-inflammatory effect. ...
Present study was designed to explore the anti-acne and anti-inflammatory potential of ethanolic extracts and fresh juices of different dietary and nutritive fruits. The Disc Diffusion (DD) and Minimal Inhibitory Concentration (MIC) methods were used for microbial analysis of all tested 95% ethanolic extracts and fresh juices against four strains (S1, S2, S3, S4) of Staphylococcus aureus. Anti-inflammatory assessment was done through skin irritation and dermal toxicity test for active extracts and fresh juices by using albino mice. Pomegranate peel extract, pomegranate arils extract and fresh lemon juice substantiated as more effective and competent anti-acne agents with growth of inhibition zones up to 24 mm, 17 mm and 18 mm respectively. As well as pomegranate peel extract showed minimum inhibitory concentration at 10% whereas both pomegranate arils extract and fresh lemon juice showed minimum inhibitory concentration at 20 % with anti-inflammatory competency by showing no edema and erythema.
... Many studies have been dedicated to the documentation of traditional uses of medicinal plants for managing dermatological conditions, and these may represent a strong armor in drug discovery in the search for effective acne treatment [25,26]. Many EOs from medicinal plants have also been explored for their wide application in acne management, especially as topical preparations [27][28][29], and hence continue to be the focus of many anti-acne studies. ...
In this study, 10 essential oils (EOs), from nine plants (Cinnamomum camphora, Curcuma longa, Citrus aurantium, Morinda citrifolia, Petroselinum crispum, Plectranthus amboinicus, Pittosporum senacia, Syzygium coriaceum, and Syzygium samarangense) were assessed for their antimicrobial, antiaging and antiproliferative properties. While only S. coriaceum, P. amboinicus (MIC: 0.50 mg/mL) and M. citrifolia (MIC: 2 mg/mL) EOs showed activity against Cutibacterium acnes, all EOs except S. samarangense EO demonstrated activity against Mycobacterium smegmatis (MIC: 0.125–0.50 mg/mL). The EOs were either fungistatic or fungicidal against one or both tested Candida species with minimum inhibitory/fungicidal concentrations of 0.016–32 mg/mL. The EOs also inhibited one or both key enzymes involved in skin aging, elastase and collagenase (IC50: 89.22–459.2 µg/mL; 0.17–0.18 mg/mL, respectively). Turmerone, previously identified in the C. longa EO, showed the highest binding affinity with the enzymes (binding energy: −5.11 and −6.64 kcal/mol). Only C. aurantium leaf, C. longa, P. amboinicus, P. senacia, S. coriaceum, and S. samarangense EOs were cytotoxic to the human malignant melanoma cells, UCT-MEL1 (IC50: 88.91–277.25 µg/mL). All the EOs, except M. citrifolia EO, were also cytotoxic to the human keratinocytes non-tumorigenic cells, HaCat (IC50: 33.73–250.90 µg/mL). Altogether, some interesting therapeutic properties of the EOs of pharmacological/cosmeceutical interests were observed, which warrants further investigations.
... In parallel, all these findings have been confirmed by in vivo studies following various experimental protocols. In 2011, Bhatt and colleagues tested the effectiveness of eucalyptus EO in controlling acne via the inhibition of sebum synthesis from the sebaceous glands [67]. Using a model of rat sebaceous glands, a decrease in the size of these latter was noticed, and consequently, acne spreading was inhibited. ...
Eucalyptus globulus is a plant widely used by the world population, including Morocco,
in the treatment of several pathologies. The aim of this work is to evaluate the antioxidant, antiinflammatory, dermatoprotective, and antimicrobial effects of essential oil and honey from E. globulus,
as well as their combination. Chemical composition was determined by GC-MS analysis. The antioxidant activity was evaluated by three tests, namely, DPPH, reducing power, and the β-carotene/linoleic
acid assay. The anti-inflammatory activity was investigated in vitro (5-lipoxygenase inhibition) and
in vivo (carrageenan-induced paw edema model), while the dermatoprotective activity was tested
in vitro (tyrosinase inhibition). Moreover, the antibacterial activity was assessed using agar well diffusion and microdilution methods. The results showed that eucalyptol presents the main compound
of the essential oil of E. globulus (90.14%). The mixture of essential oil with honey showed the best antioxidant effects for all the tests used (0.07 < IC50 < 0.19 mg/mL), while the essential oil was the most
active against tyrosinase (IC50 = 38.21 ± 0.13 µg/mL) and 5-lipoxygenase (IC50 = 0.88 ± 0.01 µg/mL),
which corroborated the in vivo test. Additionally, the essential oil showed the best bactericidal effects
against all strains tested, with inhibition diameter values ranging from 12.8 to 21.6 mm. The findings
of this work showed that the combination of the essential oil with honey showed important results in
terms of biological activity, but the determination of the underlying mechanisms of action remains a
major prospect to be determined.
... For example, αand γ-mangostins, the active compounds in mangosteen, were able to reduce the proliferation of keratinocytes induced by P. acnes and suppress P. acnes-induced inflammation [1]. In another study, eucalyptus oil was found to decrease sebum production in a rat sebaceous gland model and inhibit secondary infection caused by other strains of bacteria [2]. Resveratrol, a natural compound produced in some fruits such as grapes, has been shown to be effective in reducing the number of acne lesions in a clinical study [3]. ...
Acne vulgaris (acne) is one of the most common dermatological problems affecting adolescents and young adults. Although acne may not lead to serious medical complications, its psychosocial effects are tremendous and scientifically proven. The first-line treatment for acne is topical medications composed of synthetic compounds, which usually cause skin irritation, dryness and itch. Therefore, naturally occurring constituents from plants (phytochemicals), which are generally regarded as safe, have received much attention as an alternative source of treatment. However, the degradation of phytochemicals under high temperature, light and oxygen, and their poor penetration across the skin barrier limit their application in dermatology. Encapsulation in lipid nanoparticles is one of the strategies commonly used to deliver drugs and phytochemicals because it allows appropriate concentrations of these substances to be delivered to the site of action with minimal side effects. Solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs) are promising delivery systems developed from the combination of lipid and emulsifier. They have numerous advantages that include biocompatibility and biodegradability of lipid materials, enhancement of drug solubility and stability, ease of modulation of drug release, ease of scale-up, feasibility of incorporation of both hydrophilic and lipophilic drugs and occlusive moisturization, which make them very attractive carriers for delivery of bioactive compounds for treating skin ailments such as acne. In this review, the concepts of SLNs and NLCs, methods of preparation, characterization, and their application in the encapsulation of anti-acne phytochemicals will be discussed.
... Furthermore, EGEO containing γ-terpinene and p-cymene as the major components with a MIC=9375 µg/mL against P. acnes was reported (Athikomkulchai et al., 2008). In another study, antimicrobial activity of EGEO was evaluated against acne pathogenic microorganisms such as, S. aureus 2079 and S. aureus 5021 (Bhatt, 2011). ...
Eradication of Propionibacterium acnes and associated skin pathogenic species such as Staphylococcus aureus and S. epidermidis involve anti-oxidant as well as anti-inflammatory effects besides antimicrobial action. For this purpose, Pharmacopoeia Grade (PhEur) Eucalyptus globulus essential oil was evaluated against the human pathogenic species such as P. acnes ATCC 6919, P. acnes ATCC 11827, S. aureus ATCC 6538 and S. epidermidis ATCC 12228 using an in vitro microdilution method. The composition and quality of the essential oil was confirmed both by GC/FID and GC/MS techniques, respectively. The in vitro radical-scavenging activity was evaluated using the photometric 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical assay; the anti-inflammatory activity assay performed by using the in vitro lipoxygenase (5-LOX) enzyme inhibition assay. Essential oil analysis confirmed the presence of 1,8-cineole (80.2 %), p-cymene (6.6 %), and limonene (5 %) as main components. The antibacterial performance of the tested oil was more susceptible against Staphylococcus species (MIC=625 µg/mL) compared to P. acnes (MIC=1250 µg/mL). 5-LOX inhibitory activity was determined as IC50 = 58 ±1,4 µg/mL for the essential oil, compared to the inhibition of the standard nordihydroguaiaretic acid = NDGA. The preliminary experimental results suggest that the Eucalyptus essential oil and its major constituent 1,8-cineole acts against skin pathogenic bacteria as a mild natural antimicrobial with anti-inflammatory effects, for further potential topical applications.
... Both A. palaestinum and U. dioica showed modest antimicrobial activities in comparison to other herbs which insignificantly affected the growth of P. acnes.Our results are in agreement with most of the studies conducted on the evaluation of biological activities of Eucalyptus extracts. Oils of Eucalyptus showed potent antimicrobial activity against macrolide resistant P. acnes with a notable decrease of sebum production 24 . In contrast to our results, a stronger effect of Achillea against P. acnes with MIC of 0.83 mg / mLwas reported 25 however, the activity was related to the petroleum ether extract which is known to contain Tannins and alkaloids rather than flavonoids as in our study. ...
Acne vulgaris is one of the most common health problem where medical treatment is sought in adults worldwide. It has been long described the integral role of Propionibacterium acnes in the pathogenesis of this disease. In this study, a group of local herbs known for their antimicrobial effects were selected for the evaluation of potential anti-acnes effects in vitro.Phenolics and flavonoid contents of methanolic extracts of Eucalyptus globulus, Mentharotundifolia, Inulaviscosa, Utricadioica, Malvasylvestris,Quercuscalliprinos, Arum palaestinumandAchilleaodoratacollected from different regions in Jordan during 2016-2017 were screenedfor antimicrobial activity against Propionibacterium acnes by disc diffusion and by broth microdilution method.Measurement of release of interleukin 1 alpha from human skin explants by ELISA was used for the evaluation of anti-inflammatory effects of the herbal preparations and extracts. M.rotundifolia and E.globulus, showed the highest phenolic and flavonoid contents in contrast to M.sylvestris which showed the least phenolic contents. Moreover, polyphenolic fractions exhibited modest anti-acne activity of herbal extracts of E.globulus and A.palaestinum (MIC 0.125 mg/ml), U.dioica (0.25 mg/ml) and I.viscosa (0.5 mg/ ml), compared to not significant antimicrobial activity for others (MIC >1mg/ml). Regarding anti-inflammatory effects of the tested fractions, E. globulus and A.palaestinum extracts showed inhibition of interleukin 1 alpha release by more than 60 % for concentrations of 0.5 mg/ml respectively. The presence of anti-inflammatory and anti-acne activities in the polyphenolic extracts of local medicinal plants would increase the potential of using these herbs in the control of Acne vulgaris. © 2019 Oriental Scientific Publishing Company. All rights reserved.
... Esta activación del sistema de complemento puede ser responsable de la producción de los comedones 38 . Existen otras bacterias que agravan las condiciones de acné como es el caso de Staphylococcus aureus, Pseudomonas aeruginosa y Eschericia coli, 39 sí como Staphylococcus epidermidis, el cual fue encontrado en el cultivo realizado al paciente del presente caso, sin embargo, la acción de esta última bacteria en la patogénesis del acné no ha sido aún del todo esclarecida 40 . ...
Introducción: El acné conglobata (AC) es una forma infre-cuente de acné, caracterizada por desarrollo de un foco in-feccioso crónico, con manifestaciones inflamatorias locales severas, y pérdida de la estructura funcional de la piel, con abscesos confluentes y tejido cicatricial extenso. Descripción del Caso: Paciente masculino de 18 años de edad quien consulta por presentar lesiones cutáneas en cara y tórax de 6 meses de evolución, de carácter nodular, con sig-nos de flogosis y fistulizadas con secreción purulenta fétida, que dejan cicatriz. Previo a la consulta, las lesiones fueron tratadas con trimetropim/sulfametoxazol e ibuprofeno vía oral, y amikacina tópica, sin resultados satisfactorios. El cultivo bacteriológico de la secreción resultó positivo para Staphylococcus epidermidis y Streptococcus pyogenes; mientras que el estudio histopatológico confirmó el diagnóstico de AC con hallazgos de infiltrado inflamatorio crónico de la pared folicu-lar, y neutrófilos perifoliculares, en dermis superficial y pro-funda. Se inició el tratamiento con administración sistémica de moxifloxacina durante 2 semanas; y posteriormente se ini-cia uso tópico de eritromicina, clindamicina, y ácido azelaico, acompañados de isotretinoína vía oral. De manera paralela, se inicia manejo nutricional y psicológico de apoyo. Tras 2 meses de tratamiento se observa mejoría significativa de las lesiones, que se resuelven en su totalidad tras 6 meses. Discusión: El AC es una enfermedad que acarrea conse-cuencias física y psicosociales para el individuo que la pa-dece, especialmente en casos refractarios al tratamiento, el manejo apropiado de esta condición, incluye el correcto diagnóstico, y posteriormente el uso de antibioticoterapia y retinoides, así como terapia psicosocial. Palabras clave: acné conglobata, Staphilococcus ssp, iso-tretinoína, macrólidos, psicoterapia.
... Some studies also used eucalyptus oils at a dose >10% for the ointment. [43,44] However, terpenoids compounds also can cause toxic and poisons activity for mosquito's respiration. [23] Terpenoids content in essential oils can be toxic to mosquitoes, such as limonene, which is a contact poison for insect control. ...
Objective: This research was to evaluate chemical compositions and repellent activity of Eucalyptus tereticornis and Eucalyptus deglupta essential oils against Culex quinquefasciatus mosquito. Methods: Essential oils of E. tereticornis and E. deglupta were extracted by hidrodistillation method. Chemical compositions of essential oils were analyzed by GC-MS, and mosquito repellent assay were evaluated with World Health Organization Pesticide method with modifications. Result: GC-MS analysis indentified that E. tereticornis and E. deglupta had 24 and 35 compounds with β-pinene and nerolidol as the major compounds, respectively. The IC 50 and IC 90 value of E. tereticornis and E. deglupta against C. quinquefasciatus were IC 50 : 0.08%, IC 90 : 6.37% and IC 50 : 0.04%, IC 90 : 7.23%, respectively. E. tereticornis oil showed 91.91% repellency while E. deglupta showed 94.05% repellency average at 8% concentration for 4 h exposure times. These two oils were effective as repellent substances when compare with commercial NN-diethyl-m-toluamide 15% with repellency average was 96.23%. Conclusion: The result shows that E. tereticornis and E. deglupta oils could be considered as potent natural repellent agents against C. quinquefasciatus mosquito.
... Currently grate progress has been made in the biological activity of essential oils of eucalyptus family. These studies well supported the application of some of essential oils of eucalyptuses for antibacterial [1][2][3] , antifungal 4-12 , antioxidant 13,14 , cytotoxic 15 and medical treatment [16][17][18][19][20][21] . Ishikawa and coworkers 22 demonstrated that the Eucalyptus extract promotes decreased ceramide (CER) synthesis in cultured keratinocytes and accelerates the recovery of hydration in a barrier-disrupted model of human skin. ...
This study was designed to examine the chemical composition of essential oils of three Eucalyptus spices (E. spathulata, E. microtheca, and E. torquata) and in vitro antifungal activities of the essential oils of five Eucalyptus spices (E. largiflorens, E. oleosa, E. spathulata, E. microtheca, and E. torquata). The chemical composition of the hydrodistilled essential oils of leaves of these three spices were analyzed by GC-MS and GC-FID. The predominant and common components in the all oils were α-pinene (2.3 - 14.5 %), 1,8- cineole (6.6 - 69.6 %), terpinen-4-ol (0.8 - 9.6 %), α-terpineol (1.1 - 4.3 %), aromadenderene (0.3 - 10.5 %) and viridiflorol (0.0 - 5.7 %). The antifungal activities of essential oils have been investigated by minimum inhibitory concentration (MIC) and disc diffusion methods against A. flavus, A. parasiticus, A. niger, P. chryzogenum and P. citrinum. A high antifungal activity was found in the leaf oil of E. largiflorens. The relationship between the some major constituents and the antifungal activity was also discussed. We concluded that the terpinen-4-ol may be considered as correspond antifungal constituent.
... Furthermore, volatile oils from Eucalyptus globulus (MIC and MBC 9.38 mg/mL) and Psidium guajava leaves (MIC 9.38 mg/mL, MBC 37.50 mg/mL) exhibited antimicrobial activity as determined by agar diffusion and microdilution methods against P. acnes due to -terpinene and -pinene [82]. The in vivo rat sebaceous gland model concluded that eucalyptus oil decreases sebum production by reducing the size of sebaceous glands, thus controlling the spread of acne [83]. ...
Acne is a common but serious skin disease, which affects approximately 80% adolescents and young adults in 11-30 age group. 42.5% of men and 50.9% of women continue to suffer from this disease into their twenties. Bacterial resistance is now at the alarming stage due to the irrational use of antibiotics. Hence, search for new lead molecule/bioactive and rational delivery of the existing drug (for better therapeutic effect) to the site of action is the need of the hour. Plants and plant-derived products have been an integral part of health care system since time immemorial. Therefore, plants that are currently used for the treatment of acne and those with a high potential are summarized in the present review. Most active plant extracts, namely, P. granatum, M. alba, A. anomala, and M. aquifolium exhibit minimum inhibitory concentration (MIC) in the range of 4-50 µg/mL against P. acnes, while aromatic oils of C. obovoides, C. natsudaidai, C. japonica, and C. nardus possess MICs 0.005-0.6 μL/mL and phytomolecules such as rhodomyrtone, pulsaquinone, hydropulsaquinone, honokiol, magnolol, xanthohumol lupulones, chebulagic acid and rhinacanthin-C show MIC in the range of 0.5-12.5 μg/mL. Novel drug delivery strategies of important plant leads in the treatment of acne have also been discussed.
The aims of this study were to determine the main chemical constituents of volatile oils from leaves of Eucalyptus globulus Labill. (eucalyptus) and Psidium guajava L. (guava) and to develop stable anti-acne preparations from these medicinal plants. Volatile oils from eucalyptus and guava leaves were extracted by hydrodistillation and then were analyzed of their main chemical components by means of GC/MS. The antimicrobial activity of the oils was determined by agar diffusion and micro-dilution methods. The GC/MS results showed that the main chemical constituents in the volatile oils from eucalyptus and guava leaves were gamma-terpinene and alpha-pinene. These volatile oils showed good antimicrobial activity against Propionibacterium acnes (MIC, MBC = 9.38 mg/ml for eucalyptus oil and MIC = 9.38 mg/ml, MBC = 37.50 mg/ml for guava oil). Further, oil- in-water creams incorporating 2% w/w eucalyptus oil and 4% w/w guava oils were prepared. Both of them had satisfied texture and exhibited good stability after stored at -4 ° C and 45 ° C alternately (freeze-thawing) for 4 cycles. In addition, they had antimicrobial activity against P. acnes determined by agar well diffusion method (inhibition zone = 8.0 and 9.0 mm for eucalyptus cream and guava cream, respectively) compared to commercial 5% benzoyl peroxide anti-acne gel.
The leaf oils of Eucalyptus globulus Labill., E. camaldulensis Dehn., E. gomphocephala A. DC, E. sideroxylon A. Cunn. ex Wolls, E. robusta Smith, E. tereticomis Smith and E. viminalis Labill. isolated by steam distillation were analyzed by GC/MS. All the species contained α-pinene (2.8–24%), β-pinene (0.2–3.6%), limonene (1.5–4.5%), myrcene (0.1–1.1%), 1,8-cineole (3.5–81%), allo-aromadendrene (0.1–8.8%) and globulol (0.2–5.7%) as principal leaf oil components
Single and mixed infections with 11 clinical isolates of Propionibacterium acnes and three facultative bacteria (Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae) were studied in a subcutaneous abscess model in mice. Abscesses were induced by pure cultures of six of 11 strains of P. acnes and by the three facultative bacteria. The abscesses produced by each of the six "virulent" P. acnes isolates mixed with S. aureus, E. coli or K. pneumoniae were larger than those induced by the single organisms in 16 of the 18 combinations. There was a significant increase in the numbers of the six P. acnes strains in 13 of the 18 bacterial mixtures and in the numbers of the facultative bacteria in 17 of the 18 combinations. These data illustrate the potential virulence of some P. acnes strains and their synergic capacity with facultative bacteria.
Acne vulgaris is a self-limiting skin disorder seen primarily in adolescents, whose aetiology appears to be multifactorial. The four main aetiological factors are hypercornification of the pilosebaceous duct, increased sebum production, colonization withPropionibacterium acnes, and subsequently the production of inflammation. Considerable investigation has addressed the immunologic reaction to extracellular products produced by the acne-causing organism, P acnes. The immunologic response involves both humoral and cell-mediated pathways. Further research should clarify the role of complement, cytotoxins, and neutrophils in this acne-forming response.
Acne is a chronic disease of the pilosebaceous follicle that affects mainly adolescents. It causes polymorph cutaneous lesions that may leave scars after regression. It is characterized by alternation of periods of exacerbation and stability. Spontaneous regression usually occurs after age 20, but some patients may continue suffering during adult life. Diagnosis is clinical and based on the patient's age at the time that the lesions first appear, and on its polymorphism and type of lesions and location. Some patients also need a hormonal and, sometimes, psychological evaluation. The right treatment for the right patient is key to treating acne safely.
The development of new topical anti-acne therapies reflects the need for medications that address the requirements and concerns of an increasingly mature and demanding acne patient population. Some of the topical agents currently under investigation in the United States include several alpha-hydroxy acids (AHAs), the retinoids tazarotene and adapalene, and azelaic acid. All of these agents appear to exert their effect on acne through some effect on the process of keratinization and/or the thickness of the stratum corneum. Azelaic acid also has significant antimicrobial activity relevant to its efficacy in acne vulgaris. While azelaic acid has already been used successfully in many parts of the world for several years, the potential roles of the new retinoids in acne therapy are just beginning to be clarified. The properties of AHAs suggest that they may also be of value in the treatment of acne, but further systematic evaluation is needed.
The inflammatory stage of acne vulgaris is usually of greatest concern to the patient. A number of morphologically different inflammatory lesions may form that can be painful and unsightly. In 30% of patients, such lesions lead to scarring(1). Inflammatory acne and acne scarring can have significant psychological effects on the patient, including depression, anxiety, and poor self-image(2). Although inflammatory acne has been well characterized clinically, the mechanisms by which inflammatory lesions arise are still poorly understood. The human skin commensal bacterium, Propionibacterium acnes, has long been associated with inflammatory acne. This organism has been implicated over and above all of the other cutaneous microflora in contributing to the inflammatory response characteristic of acne. However, its precise role in the disease and its interaction with the human immune system remain to be elucidated.
Acne as a disease is so common as to be considered a normal rite of passage, and costs the community a substantial amount in resources. Yet acne is a devastating disease striking most adolescents at their most vulnerable time when their life long self esteem and sense of identity is being developed. This article reviews the importance of acne to the individual and attempts to make the case for early and aggressive treatment.