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Acne vulgaris
Abstract
Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.
... Given that the matrix is a hydrophilic chitosan and alginate polymer, the analysis began by evaluating the nature of the possible diffusion of the drug using the following Korsmeyer and Peppas equation [44]: (5) where Mt and M∞ are the amounts of drug released at time t and at equilibrium, respectively, k is the constant that depends on the shape and geometry of the drug carrier matrix, n is the diffusion exponent, and t is the release time. Figure 6 shows the average parameters of the data fit to the Korsmeyer-Peppas equation, with their typical standard deviation (SD). ...
Currently, acne therapy relies not only on specific drugs but also on complementary treatments, such as dermocosmetics. Several studies have reported the use of chitosan and alginate in scaffolds for drug delivery systems. These materials can be loaded with a product that exhibits anti-acne properties such as silk sericin, a protein with antioxidant, photoprotective, and moisturizing properties. Therefore, this study proposes the development of a chitosan/alginate scaffold, loaded with sericin, to serve as a dermocosmetic platform complementing the pharmacological treatment of acne. The moisture content of the alginate and chitosan was determined as 14.7 and 21%, respectively; the ash content, which is similar for both polymers, was approximately 5%. The employed chitosan had a deacetylation degree of 82%, as determined by infrared spectrometry and corroborated by potentiometry. This technique was also used to determine the mannuronic/guluronic ratio of the alginate [M/G = 1.3] and confirm the identity of each one of the polymers in the raw materials and the resulting scaffolds. The molecular weights of alginate, chitosan, and sericin were 85, 5.1, and 57.4 kDa, respectively. The pH [6.31] and total protein concentration of the sericin solution [c(SER) = 6.1 mg/mL] were determined using UV-visible spectrophotometry. Swelling and release studies indicated that, although there were varying degrees of cross-linking and certain variables to control, the mechanism that defines the nature of both processes (otherwise complementary) is the relaxation of the polymer chains.
... Acne vulgaris is a shape-altering, long-term inflammatory disease of the pilosebaceous units. Acne is a chronic disease characterized by inflammatory and non-inflammatory lesions as a result of androgen-induced increased sebum production and altered keratinization, inflammation and bacterial colonization of Cutibacterium acnes [39][40][41]. Regarding the most common skin diseases, acne vulgaris ranks second in terms of its rate of incidence [42,43]. The psychological effects of acne include loss of self-confidence, depression, anxiety, and interpersonal and work-related difficulties. ...
Background: Acne is a prevalent dermatological condition characterized by the blockage of hair follicles and sebaceous glands, leading to the formation of acne. The anaerobe pathogen Cutibacterium acnes (formerly known as Propionibacterium acnes) plays an essential role in the pathogenesis of acne, for which generally antimicrobial treatment is required. Acne is a substantial health concern, and continuing research is being conducted to discover novel and efficacious remedies. The antimicrobial activity of plants has been demonstrated in numerous studies, and they are still targeted organisms in drug development. Studies showing that plants are effective against acne pathogens have also been reported. Methods: The antimicrobial activity of the hydroethanolic extracts prepared from 30 plant species was determined against C. acnes standard strains (C. acnes Scholz and Kilian ATCC 11827 and ATCC 11828) and 30 clinical isolates in our preliminary screening. Since acne is an inflammatory skin disease, the anti-inflammatory effect of six active extracts against C. acnes was determined through the in vitro inhibition of collagenase, lipoxygenase (LOX), hyaluronidase and xanthine oxidase (XO) enzymes. Results: Cotinus coggygria Scop. leaf extract displayed the highest hyaluronidase and collagenase inhibition (79.75% and 52.52%, respectively), while the extract from the aerial parts of Helichrysum arenarium (L.) Moench demonstrated a potent XO inhibitory effect (82.51%). Therefore, these two extracts have been chosen for further studies, and LC/MS-MS was used to determine the phenolic profiles of these extracts. Conclusions: Subsequently, nanoemulgels were formulated with the active extracts to develop a prototype herbal anti-acne product, and characterization studies of the formulations were conducted.
... The only human study of contact dermatitis conducted in 1982 reported reduced activity of aryl hydrocarbon hydroxylase (the historical term for CYP1A1) in both irritant and allergic contact dermatitis patients [141]. Indoles have been shown to attenuate inflammation in an AHR-dependent manner in a rat model of acne vulgaris [142], a chronic inflammatory disease of the pilosebaceous unit of the skin [143], not to be confused with chloracne, which is the non-inflammatory skin condition resulting from dioxin exposure [32]. Finally, the identification of a putative causal missense variant in CYP1B1 for FFA [144] provides genetic evidence for an involvement of the AHR pathway, suggesting that AHR modulation may be a useful therapeutic strategy for FFA. ...
In the last decade, the aryl hydrocarbon receptor (AHR) has emerged as a critical peacekeeper for the maintenance of healthy skin. The evolutionary conservation of AHR implied physiological functions for this receptor, beyond the detoxification of man-made compounds, a notion further supported by the existence of physiological AHR ligands, notably derivates of tryptophan by the host and host microbiome. The UV light-derived ligand, 6-formylindolo[3,2-b]carbazole (FICZ), anticipated a role for AHR in skin, a UV light-exposed organ, where physiological AHR activation promotes a healthy skin barrier and constrains inflammation. The clinical development of tapinarof, the first topical AHR modulating drug for inflammatory skin disease, approved by the FDA for mild-to-moderate psoriasis and poised for approval in atopic dermatitis, supports the therapeutic targeting of the AHR pathway to harness its beneficial effect in skin inflammation. Here, we describe how a tightly controlled, physiological activation of the AHR pathway maintains skin homeostasis, and discuss how the pathway is dysregulated in psoriasis and atopic dermatitis, identifying areas offering opportunities for alternative therapeutic approaches, for further investigation.
... Acne vulgaris remains one of the most prevalent skin conditions worldwide, impacting the quality of life of millions of people. Multiple factors contribute to acne, including increased sebum production, follicular hyperkeratinization, dysbiosis of the skin microbiome, and an inflammatory cascade [1]. Cutibacterium acnes (C. ...
Human skin hosts a diverse array of microorganisms that contribute to its health. Key players in the facial skin microbiome include Cutibacterium acnes and staphylococci, whose colonization patterns may influence dermatological conditions like acne vulgaris. This study examined the facial microbiome composition of 29 individuals, including 14 with moderate to severe acne and 15 with healthy skin, using single locus sequence typing (SLST) amplicon sequencing. The results showed a shift in the relative abundances of C. acnes phylotypes: SLST types A, C, and F were increased in acne, while types H, K, and L were reduced compared to healthy skin. Among staphylococci, the relative abundance of S. epidermidis, S. capitis, and S. saphrophyticus increased in acne, while S. saccharolyticus and S. hominis decreased. The amplicon sequencing approach could also identify a population shift of S. epidermidis: a specific S. epidermidis phylogenetic lineage (type 3) was reduced in acne, while two abundant lineages (types 1 and 2) were elevated. These findings suggest that distinct phylogenetic lineages of both C. acnes and S. epidermidis are linked to healthy versus diseased skin, highlighting a potential role for both microorganisms in disease prevention and aggravation, respectively.
... In moderate to severe cases, acne often requires aggressive and sustained interventions to achieve satisfactory outcomes [1]. Traditional pharmacological treatments such as topical retinoids, benzoyl peroxide, antibiotics, and oral isotretinoin are commonly used, but their effectiveness is often limited by side effects, including dryness, irritation, photosensitivity, and the potential for antibiotic resistance [2][3][4]. Furthermore, patient adherence to long-term treatments can be poor due to treatment fatigue and dissatisfaction with a slow or incomplete response, highlighting the need for alternative approaches. ...
Objective: This case series aims to evaluate the efficacy, patient satisfaction, and safety of combined needle radiofrequency (RF) and topical exosome therapy for moderate to severe acne. Methods: This study involved 22 patients (12 females and 10 males, ages 18–35) with moderate to severe acne who underwent combined needle RF and topical exosome (Xomage, Zishel Bio Inc., Seoul, Republic of Korea) treatments. Each patient completed between 6 and 10 sessions, conducted weekly over three-week intervals. Acne severity was assessed using the Investigator’s Global Assessment (IGA) scale, while patient satisfaction was measured on a 5-point Likert scale. Clinical photographs were taken at baseline and after the final treatment session. Results: All patients showed improvement in acne severity with a mean decrease in IGA score of 2.5 points from baseline to the final assessment. Patient satisfaction was high, with the majority expressing satisfaction in skin texture and acne reduction. Conclusion: Needle RF combined with topical exosome therapy appears to be an effective treatment for reducing acne lesions and improving skin quality, demonstrating a strong safety profile and high patient satisfaction.
... Acne is a disorder that affects the pilosebaceous follicles, with acne vulgaris being the most common. A study conducted by the Global Burden of Disease estimated that acne affects approximately 10% of the global population, ranking it as the eighth most prevalent disease worldwide and the third most frequent dermatological condition [1]. Studies have shown that acne can be associated with psychosocial disturbances, including depression, suicide, anxiety, psychosomatic symptoms, embarrassment, and social inhibition [2]. ...
Photodynamic therapy (PDT) using the photosensitizer curcumin and blue light has a relevant effect on bacteriological decontamination caused by C. acne. The aim is to verify PDT’s effectiveness with curcumin in individuals diagnosed with moderate to severe acne. This study was carried out on a total of 35 volunteers of both genders (12–32 years old), with moderate to severe acne vulgaris. The volunteers were randomized into five groups: L (LED), V (Vehicle), C (Curcumin), L + V (LED + Vehicle), and L + C (LED + Curcumin). The curcumin gel and LED with blue wavelength (450 nm ± 10 nm) were used. Qualitative and quantitative evaluations were used to verify the efficacy of the treatment by counting inflamed and non-inflamed lesions. The L + C group until day 30 showed a lower percentage of inflammatory lesions than the Vehicle group for the same period. On day 60, the L + C group showed lower inflammatory lesion values compared to the other groups. Intragroup analysis of hydration in the Vehicle group (V) showed a difference on days 30 and 60 compared to day zero. In an intragroup analysis, the L + C group showed a decrease in the mean scores on day 30, and day 60 compared to day zero, showing an improvement in the psychosocial status of these volunteers. Taken together, our results showed that the combination of blue LED therapy and curcumin proved to be an effective and safe treatment for reducing inflamed acne lesions in individuals with moderate to severe acne, while also enhancing their quality of life from a psychosocial perspective.
... Acne, a chronic inflammatory disease, is caused by androgen-induced sebum increase, changes in keratinization, inflammation, and colonization by Propionibacterium acnes. More than 20% of teenagers have facial scars caused by acne [107]. The pathogenesis of acne involves increased sebum production, follicular hyperkeratosis, bacterial colonization, and an inflammatory response. ...
Skin is a vital barrier for the human body, protecting against external environmental influences and maintaining internal homeostasis. In addition, an imbalance of oxidative stress and antioxidant mechanisms can lead to skin-related diseases. Thus, for treating skin-related diseases, antioxidant therapy may be an important strategy to alleviate these symptoms. However, traditional drug therapies have limitations in treating these conditions, such as lack of lasting effect and insufficient skin permeability. Recently, nano-antioxidants, with their good permeability, sustained-release ability, multifunctionality, and other beneficial characteristics, have showed their advances in the exploration of skin-related diseases from research on safe therapies to clinical practice. Hereby, we review the latest research and advancements in nano-antioxidants for skin-related diseases. We categorize skin-related diseases into four main groups: skin inflammatory diseases, skin damage caused by ultraviolet rays, skin wound healing, and other skin-related conditions. Additionally, we summarize the prospects and potential future directions for nano-antioxidant drugs in treating skin-related diseases.
Acne vulgaris is an immune-mediated inflammatory skin condition. It is the 8th most treated skin condition, affecting over 80% of teenagers globally. The pathophysiology of the disease is intricate and involves the interaction of multiple factors, including hyperactivation of sebaceous glands, abnormal hyperkeratinization of pilosebaceous follicles, dysbiosis of microflora, and, subsequently, immune-mediated inflammation. Due to the multifaceted nature of the disorder, a combination of different anti-acne agents is preferred. However, synthetic topical anti-acne agents such as retinol derivatives and benzoyl peroxide are often associated with common side effects such as redness, dryness, peeling, irritation, and eczema. Also, increasing cases of multidrug resistance against commonly used antibiotics further reduce the therapeutic effectiveness of the treatment and upsurge the overall expense. Many studies validate using plant extracts and secondary metabolites for treating acne. Alongside synergistic formulations, the co-delivery of synthetic and herbal agents is emerging as the latest target for developing novel and efficient acne treatments. This article summarizes the comprehensive pathophysiology of the disease, classification, and grading system evolution, along with detailed information on different FDA-approved synthetic topical and systemic anti-acne agents (retinoids, antibiotics, and diverse medications). In addition, we highlight the new investigation on several phytoconstituents and secondary metabolites for treating acne vulgaris. Finally, we have attached the details of all the ongoing clinical trials on acne therapy.
The skin and gut are closely interconnected organs that engage in bidirectional communication through metabolic, neural, endocrine, and immune pathways, collectively referred to as the skin-gut axis. Both organs host diverse microbiota that influence immune regulation and homeostasis. Disruptions in the gut microbiome, known as dysbiosis, can trigger systemic inflammation and impact skin health, contributing to conditions such as psoriasis, atopic dermatitis, acne vulgaris, rosacea, alopecia areata, and hidradenitis suppurativa. Evidence suggests that gut dysbiosis and increased intestinal permeability can exacerbate inflammatory skin disorders. The skin-gut axis highlights the influence of diet and the potential therapeutic role of probiotics. Probiotic treatments, both topical and oral, have shown promise in restoring microbial balance and alleviating skin conditions by reducing inflammation and enhancing immune responses. While kefir, a traditional probiotic food, is reported to improve skin parameters, further research is needed to confirm its specific role in modulating the skin-gut axis. Understanding this complex interaction offers insights into managing skin disorders through dietary interventions and microbiota-targeted therapies.
Lipid dysregulation within sebaceous glands is a critical factor underlying the pathogenesis of sebaceous gland disorders, particularly acne vulgaris. Sebaceous glands synthesize and secrete a complex mixture of lipids, including triglycerides, wax esters, free fatty acids, and sphingolipids, which contribute to skin barrier function and microbial homeostasis. Dysregulated lipid production, characterized by increased sebum secretion and altered lipid composition, has been implicated in promoting Cutibacterium acnes proliferation, hyperkeratinization, and inflammation, key processes in acne pathogenesis. Recent research highlights the pivotal role of sphingolipid metabolism, particularly ceramides, in modulating sebaceous gland activity and skin inflammation. Ceramide deficiencies in acne-prone skin contribute to compromised barrier integrity, increased microbial colonization, and an exaggerated inflammatory response. Furthermore, sphingolipid intermediates such as sphingosine-1-phosphate (S1P) influence sebocyte differentiation, lipid synthesis, and cytokine release, linking sphingolipid metabolism to sebaceous gland homeostasis. Emerging therapeutic strategies targeting sphingolipid pathways offer new opportunities for managing sebaceous gland disorders. Topical and systemic therapies designed to restore ceramide levels and modulate S1P signaling have shown promise in preclinical studies, with potential to reduce sebum production, enhance barrier function, and attenuate inflammation. Additionally, sphingolipid-targeted formulations combined with established treatments, such as retinoids and antimicrobial agents, may enhance therapeutic outcomes while minimizing side effects. The dysregulation of sebaceous lipid metabolism, particularly sphingolipid pathways, plays a central role in acne pathogenesis, and emerging insights into these mechanisms are shaping innovative strategies for the treatment and prevention of sebaceous gland disorders.
Zusammenfassung
Aknenarben beeinträchtigen in erheblichem Maße das physische Erscheinungsbild und das psychische Wohlbefinden. Dies hat die Erforschung verschiedener Therapien, einschließlich ablativer und nicht‐ablativer Lasertherapien, angestoßen. Die Debatte über ihre Wirksamkeit und Sicherheit hält an, wodurch die Notwendigkeit einer umfassenden Analyse unterstrichen wird. Die vorliegende Metaanalyse vergleicht die therapeutischen Ergebnisse und Sicherheitsprofile ablativer und nicht‐ablativer Laserbehandlungen bei Aknenarben auf der Grundlage einer umfassenden Evaluierung klinischer Studien, die bis März 2023 durchgeführt wurden. Die Auswertung konzentrierte sich auf die klinische Verbesserung, die Patientenzufriedenheit und die Inzidenz behandlungsbedingter Komplikationen. Die Analyse von sieben Studien, die 186 Fälle umfassten, ergab, dass nicht‐ablative Laser bei atrophischen Aknenarben wirksamer sind und ein besseres Sicherheitsprofil mit weniger unerwünschten Wirkungen wie verringerten Schmerzen und kürzerer Erythemdauer bieten. Umgekehrt zeigte die ablative Lasertherapie sowohl bei der beobachter‐ als auch bei der patientenbasierten Auswertung bessere Ergebnisse. Die Erkenntnisse deuten darauf hin, dass zwar beide Lasertypen bei der Milderung von Aknenarben wirksam sind, bei der Wahl zwischen ablativen und nicht‐ablativen Lasern jedoch das Gleichgewicht zwischen Wirksamkeit und Sicherheit zu berücksichtigen ist. Die Studie betont die Notwendigkeit weiterer standardisierter Forschung zur Verfeinerung von Laserbehandlungsprotokollen für Aknenarben mit dem Ziel der Ergebnisoptimierung und Risikominimierung.
Introduction
The use of self-care methods, such as over-the-counter (OTC) products and complementary and alternative medicine (CAM), is common along the acne care pathway. This study aimed to explore self-care methods for acne and assess their associations with acne severity.
Methods
This cross-sectional study was conducted among university students in health programs. Convenience sampling was used to invite participants to complete a survey containing sociodemographic, clinical, and self-care-related questions. Acne diagnosis and severity were evaluated by a physician via the Global Acne Grading System (GAGS). A multivariate regression model was used to analyze the associations between variables.
Results
The final sample comprised 190 participants, with 24.2 % males and 70.8 % females. Most participants had mild acne (77.4 %) and reported positive family histories (82.1 %). Approximately one-third used OTC products (31.1 %), and nearly two-thirds used CAM (62.6 %). The most frequently used OTC products were facial cleansers (48.2 %), followed by creams and moisturizers (30.7 %) and cleansing soap (21.1 %). A lack of acne severity was the primary reason for the use of CAM. Social media (46.7 %) and the internet (46.2 %) were the most frequently reported sources of information. Acne severity was associated with OTC product use (p = 0.009) and the duration of acne (p < 0.001). Furthermore, OTC product use was associated with receiving a professional diagnosis (p < 0.001).
Conclusions
This study identified the most common OTC products and CAM used in acne and demonstrated an association between OTC product use and acne severity. Future studies should explore discussions on self-care methods in clinical consultations and the timing of using these methods throughout the care pathway. Integrating shared decision-making in clinical practice and tailoring educational interventions to patient preferences and communication channels may encourage the safe and effective use of self-care methods.
Purpose
The exact factors leading to the development of acne vulgaris are poorly understood. Besides diet, lifestyle habits like sleep and physical activity have received attention. This study explored the causal associations between genetically predicted sleep traits and exercise and acne vulgaris.
Patients and Methods
The genome-wide association study (GWAS) data for sleep, physical activity, and acne vulgaris were retrieved from the FinnGen Project (1092/211,139 patients/controls) to carry out a two-sample Mendelian randomization (MR) analysis. Validation was performed using a dataset from the Estonian Biobank (34,422/364,991 patients/controls). The inverse variance weighted (IVW) method was the primary analytical method, with robustness tested using the weighted median, weighted mode, and MR-Egger analyses. Heterogeneity was tested using Cochran’s Q-test, horizontal pleiotropy using MR-Egger regression, outliers using MR-PRESSO, and driving SNPs using the leave-one-out method.
Results
The results revealed that genetically predicted chronotype (OR=1.021, 95% CI: 0.786–1.326, P=0.875), insomnia (OR=1.475, 95% CI: 0.676–3.216, P=0.329), daytime sleepiness (OR=0.466, 95% CI: 0.046–4.708, P=0.518), or physical activity (OR=0.990, 95% CI: 0.925–1.059, P=0.767) were not causally associated with acne vulgaris. Cochran’s Q-test detected no heterogeneity (all P>0.05). No horizontal pleiotropy was detected (all P>0.05), indicating that the selected IVs met the third MR assumption. MR-PRESSO revealed no outliers. No single SNP drove the results according to the leave-one-out analysis. These results were validated through the use of additional datasets.
Conclusion
Our study found no causal associations between sleep traits and physical activity and acne vulgaris. However, further research is needed to explore other potential factors and validate these results in more diverse populations.
Acne vulgaris is a common inflammatory dermatosis and the most common disease affecting the hair and sebaceous unit. It usually localizes to the face and, on average, affects 9.4% of the population. Many patients treated for acne vulgaris experience symptoms of anxiety, depression, and social withdrawal, often accompanied by feelings such as anger. This can be particularly exacerbated when dermatological treatment fails to have the expected effect. Given the significant psychosocial effects of the aforementioned dermatosis, early intervention is crucial. The survey was conducted between September 2023 and July 2024. The participants were patients of a cosmetology and aesthetic medicine clinic located in the city of Katowice, Poland. The Teenagers’ Quality of Life Index (T-QoL) and Self-Esteem Scale by M. Rosenberg (RSES) were used to conduct the survey. The study confirmed the significant impact of acne vulgaris on psycho-social aspects in women of different ages. Acne significantly lowers self-esteem and negatively affects the sufferers’ perception of themselves and their appearance. The impact was shown to be more severe in a group of women over 27 years of age, who exhibited lower self-esteem compared to the younger group. Women with acne often feel the need to hide skin lesions and pay a lot of attention to their appearance, which can lead to reduced quality of life and emotional disturbances. A significant number of women have disturbed self-esteem and negative beliefs about themselves, which may be related to current beauty canons and social pressure for an unblemished appearance. The study underscores the need for a holistic approach to female patients with acne vulgaris, considering both medical and psychological aspects, in order to effectively treat and improve psychological well-being.
Commensal microbiota shape skin health and immune response
The skin is our body’s largest organ and acts as a barrier against the outside world. It hosts a variety of tiny organisms, known as microbiota, which include bacteria, fungi and viruses. These microbiota help to keep our skin healthy. However, scientists are still learning how these organisms interact with our skin and immune system. Researchers have found that certain bacteria, such as Staphylococcus epidermidis, help to repair skin and maintain its health. They conducted studies using mice and human skin samples to understand these interactions better. The research showed that these bacteria can influence immune responses and even help in healing wounds. The study highlights that the balance of skin microbiota is crucial for preventing skin diseases such as atopic dermatitis and psoriasis. When this balance is disrupted, it can lead to inflammation and other skin issues.
This summary was initially drafted using artificial intelligence, then revised and fact-checked by the author.
Skin microecology involves a dynamic equilibrium among the host, microbiome, and internal/external environments. This equilibrium, shaped by multifactorial interactions, reflects individual specificity and diversity. Creating a replicable in vitro skin microecological model is highly challenging. Here, we introduce a mimicked stratum corneum microecology model (SCmic). It uses light cured crosslinked hydrogels as a scaffold and moisture source, and nonviable epidermal cells as the main nutrient. This setup establishes a suitable, stable, and reproducible microecology for microbiome colonization. Notably, it replicates the normal/oily skin microbiota with no significant differences from the original native microbiota at the genus level. Simultaneously, we have developed a standardized human skin microbiota model (Hcm), featuring seven dominant strains that form a representative microbial community. The models provide highly convenient approaches for exploring the intricate mutual interactions among skin microecology, influence of microbiota on skin health, and metabolism of chemical substances by microbiota.
Off-label treatment is the use of a drug approved for marketing, outside the registration in terms of indication, age group, dose or route of administration. Despite the constant appearance of new preparations on the market, treatment outside the SmPCs guidelines is a current clinical problem. It is believed that it is based on the needs of patients unmet by classical therapy methods. This work focuses on off-label treatment in inflammatory dermatoses such as atopic dermatitis, psoriasis, acne vulgaris and rosacea. Publications on this subject, available on PubMed, Google Scholar and the Cochrane Library, were analyzed in the form of a review, taking into account the mechanisms of action, efficacy and safety of preparations. Based on the literature analysis, it can be concluded that the use of drugs outside the SmPC indications is a common situation in dermatology. However, it is difficult to determine its exact frequency—there is a lack of data on the prevalence of off-label appliances in inflammatory dermatoses from a European perspective. Publications demonstrate varying effectiveness and safety of this form of therapy, depending on the specific preparation. Off-label treatment in dermatology remains an important and current clinical issue that should be explored in further research.
Objectives
To evaluate the efficacy and safety of Tanshinone capsule as a complementary therapy in managing of Acne Vulgaris.
Methods
A systematic search of six databases was conducted to identify relevant randomized controlled trials (RCTs) from each database for nearly 20 years (from 1 Jan 2004, to 1 June 2024). The Cochrane Handbook was used to evaluate the risk of bias. Meta-analysis was performed using Review Manager 5.4.1, and publication bias was assessed the Stata SE 12.0 software. GRADEpro was used to assess the quality of the evidence.
Results
A total of 2,969 participants from 28 studies were included. We found that Tanshinone capsules can reduce acne recurrence rates [risk ratio (RR) 0.44, 95% confidence interval (CI): 0.34 to 0.57, p < 0.00001]; downregulate levels of necrosis factor-alpha (TNF-α) [ mean difference (MD) 0.44, −10.18, 95% CI: −13.57 to −8.04, p < 0.00001], interleukin (IL) 4 (MD -6.46, 95%CI: −7.14 to −5.77, p < 0.00001), IL-6 (MD -16.14, 95%CI: −30.10 to −2.18, p = 0.02), IL-8 (MD -4.48, 95%CI: −8.30 to −0.65, p = 0.02) and testosterone (MD -14.50, 95%CI: −17.59 to −11.40, p < 0.00001); lower Global Acne Grading System (GAGS) score (MD -4.71, 95%CI: −7.62 to −1.80, p = 0.002); decrease sebum secretion rates (MD -0.29, 95%CI: −0.49 to −0.10, p = 0.003), but the regulation of Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), Estradiol (E2) is not obvious. In terms of safety, the incidence of adverse events in the experimental group was less than that in the control group (RR 0.70, 95%CI: 0.56 to 0.87, p = 0.001). The Begg test and Egger test results indicated no publication bias. Furthermore, the levels of evidence ranged from very low to moderate due to risk of bias and heterogeneity.
Conclusion
Tanshinone capsules can relieve the symptoms of acne vulgaris, regulate inflammatory cytokines and hormone levels in patients, and reduce recurrence. However, due to the limitations of this study, more multi-center and large-sample studies are needed to confirm these conclusions.
Systematic Review Registration
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024562320, identifier CRD42024562320.
Background/Objectives: Acne vulgaris is a skin disorder that affects millions worldwide, with Cutibacterium acnes playing a key role in its inflammation. Antibiotics reduce C. acnes and inflammation, but growing antibiotic resistance has limited their efficacy. Additionally, other common acne treatments with bactericidal activity, like benzoyl peroxide, cause irritation, dryness, and peeling. To fulfill the unmet need for alternative therapies, our strategy focused on identifying potent phage lysins and/or their derived cationic peptides. Methods: The C-terminal cationic antimicrobial peptide of the Prevotella intermedia phage lysin PlyPi01 was synthesized along with several sequence-engineered variants in an attempt to enhance their bactericidal efficacy. In vitro bacterial killing assays evaluated the potency of the lysin-derived peptide derivatives against C. acnes and Staphylococcus aureus, another skin bacterium associated with acne. Antibacterial activity was assessed both in conditions simulating the human skin and in combination with retinoids. Results: The variant peptide P156 was engineered by adding arginine residues at both the N- and C-terminal ends of the parental peptide PiP01. P156 was highly potent and eradicated all tested strains of C. acnes and S. aureus. P156 acted rapidly (>5-log kill in 10 min), further reducing the potential of resistance development. Additionally, P156 maintained its potency under conditions (e.g., temperature, pH, and salt concentration) observed on the skin surface and in hair follicles, as well as in combination with retinoid—all without being toxic to human cells. Conclusions: These collective findings position P156 as a promising topical drug for clinical applications to control acne vulgaris.
Acne scarring significantly affects physical appearance and psychological well‐being, prompting the exploration of various treatment options, including ablative and non‐ablative laser therapies. The debate around their efficacy and safety persists, underscoring the need for a comprehensive analysis. This meta‐analysis compares the therapeutic outcomes and safety profiles of ablative and non‐ablative laser treatments for acne scars, based on a comprehensive review of clinical trials conducted up to March 2023. The evaluation focused on clinical improvement, patient satisfaction, and the incidence of treatment‐related complications. Analysis of seven studies encompassing 186 cases revealed that non‐ablative lasers are more effective for atrophic acne scars, offering a better safety profile with fewer adverse effects, such as reduced pain and shorter erythema durations. Conversely, ablative laser therapy demonstrated superior results in both observer‐based and patient‐driven evaluations. The findings suggest that while both laser types are effective in mitigating acne scarring, the choice between ablative and non‐ablative lasers should consider the balance between efficacy and safety. The study highlights the necessity for more standardized research to refine laser treatment protocols for acne scars, aiming to optimize outcomes and minimize risks.
Purpose of Review
In this narrative review, we provide an overview of how adherence to a Mediterranean dietary pattern can complement traditional treatment strategies for psoriasis, acne, and hidradenitis suppurativa. We emphasize the importance of an integrated approach, with dietary interventions as a key component of holistic patient care.
Recent Findings
Psoriasis, acne, and hidradenitis suppurativa are immune-mediated chronic diseases marked by systemic inflammation, with genetic and environmental factors influencing their onset. The Mediterranean diet, rich in plant-based foods with antioxidant and anti-inflammatory properties—such as whole-grain cereals, extra-virgin olive oil, vegetables, legumes, fruits, and nuts—has been shown to reduce the clinical severity of these conditions. It also supports weight control and positively impacts metabolic and cardiovascular risk factors, which are closely linked to these diseases.
Summary
Dietary education, particularly about the Mediterranean diet, plays a crucial role in the management of these skin diseases and serves as an important non-pharmacological treatment option that can influence patient prognosis. This review offers specific nutrition recommendations for prescribing the Mediterranean diet to patients with chronic inflammatory skin diseases.
Background
Acne is a chronic inflammatory condition affecting the hair follicles and sebaceous glands. Recent research has revealed significant advances in the study of the acne skin microbiome. Systematic analysis of research trends and hotspots in the acne skin microbiome is lacking. This study utilized bibliometric methods to conduct in-depth research on the recognition structure of the acne skin microbiome, identifying hot trends and emerging topics.
Methods
We performed a topic search to retrieve articles about skin microbiome in acne from the Web of Science Core Collection. Bibliometric research was conducted using CiteSpace, VOSviewer, and R language.
Results
This study analyzed 757 articles from 1362 institutions in 68 countries, the United States leading the research efforts. Notably, Brigitte Dréno from the University of Nantes emerged as the most prolific author in this field, with 19 papers and 334 co-citations. The research output on the skin microbiome of acne continues to increase, with Experimental Dermatology being the journal with the highest number of published articles. The primary focus is investigating the skin microbiome’s mechanisms in acne development and exploring treatment strategies. These findings have important implications for developing microbiome-targeted therapies, which could provide new, personalized treatment options for patients with acne. Emerging research hotspots include skincare, gut microbiome, and treatment.
Conclusion
The study’s findings indicate a thriving research interest in the skin microbiome and its relationship to acne, focusing on acne treatment through the regulation of the skin microbiome balance. Currently, the development of skincare products targeting the regulation of the skin microbiome represents a research hotspot, reflecting the transition from basic scientific research to clinical practice.
Background
Medical literature shows there is no ideal treatment for acne, but topical therapies like benzoyl peroxide, retinoids, and antibiotics have proven to improve mild–moderate cases. Replacing benzoyl peroxide (potentially irritating) with hydrogen peroxide has already been suggested in the medical literature.
Aims
We investigated a medical device, a proprietary combination of hyaluronic acid, hydrogen peroxide, and glycine in mild–moderate acne vulgaris.
Methods
Patients of both sexes between ≥ 18 and ≤ 45 years old, with a Global Acne Grading System score ≤ 30, were included. Exclusion criteria were dermal systemic or infectious diseases; allergy to the tested product; pregnant or lactating women; treatment for acne 30 days before baseline; and previous facial aesthetic surgery. Forty patients were treated for 8 weeks several times a day with the tested product and visited at baseline, week 2, week 4, and week 8. Outcomes were decreasing the total number of lesions and the Global Acne Grading System Severity Score, Investigator Global Assessment of Performance with photographs evaluation in blind, Dermatology Life Quality Index, and the Treatment Satisfaction Questionnaire. Adverse events were collected for safety.
Results
A 2‐fold decrease in the number of lesions at the final visit (−56.3%, p < 0.001). The remaining outcomes evidenced a statistically significant reduction at the final visit. Only 8 adverse events (all mild and related to the tested device) were reported.
Conclusions
Results and optimal safety demonstrate that the tested product has a clinical benefit and could be associated with retinoids, as first choice for mild to moderate acne.
Trial Registration
Clinicaltrial.gov as NCT05345093
Background
Zonulin is a signaling protein secreted by enterocytes that can reversibly open tight junctions. Blood zonulin levels are elevated in disorders characterized by increased intestinal permeability.
Aims
The aim of this study is to compare blood zonulin levels and dietary habits between acne vulgaris patients and healthy controls, as well as to investigate the relationship between blood zonulin levels, diet, disease severity, age at onset, and duration in the acne group. Additionally, we aimed to explore the relationship between diet and blood zonulin levels in both groups.
Patients/Methods
Seventy‐five patients with acne vulgaris over the age of 18 years and 75 healthy controls were included in the study. Blood zonulin levels in both groups were analyzed using the sandwich ELISA method. Demographic data, habits, and dietary preferences were recorded.
Results
In the acne group, the mean blood zonulin level was significantly higher than in the control group (195.54 ± 49.05 ng/mL vs. 158.45 ± 85.07 ng/mL, p = 0.001). Additionally, milk and high glycemic index food consumption were significantly higher in the acne group.
Conclusions
Our results support the hypothesis that increased intestinal permeability may be involved in the pathogenesis of acne vulgaris. Moreover, our study confirms the relationship between diet and acne. Future studies are warranted to elucidate the impact of acne‐promoting and acne‐preventive foods on the pathogenesis of acne through intestinal permeability.
Background
Acne vulgaris is a chronic inflammatory skin condition that significantly impacts an individual's quality of life, affecting social interactions, self-esteem and body image. It primarily targets the pilosebaceous unit, where inflammation occurs. Lipid metabolism is crucial in maintaining the skin barrier and modulating inflammatory responses, with specific fatty acids, such as ω-3 and sphingomyelin acid, playing key roles. Previous studies have highlighted associations between specific dietary habits and acne, yet the precise relationship between lipid profiles, particular fatty acids, dietary patterns and acne, remains inadequately understood. This gap in knowledge necessitates a deeper investigation into the mechanisms linking lipid metabolism with acne risk.
Objectives
To investigate the causal association between acne risk and 143 dietary habits alongside 229 blood metabolite markers, focusing on lipid metabolism.
Methods
Using a Mendelian randomization (MR) framework, we leveraged summary statistics data from genome-wide association studies to explore the associations between blood lipid metabolites, dietary factors and acne risk. We used statistical correction methods, including Bonferroni and false discovery rate (FDR) adjustments, to identify robust significant associations.
Results
Our MR analysis identified 10 lipid metabolites significantly associated with acne risk. After applying Bonferroni and FDR corrections, we pinpointed 10 and 27 serum indices or metabolites, respectively, as significantly linked to acne risk. The most prominent protective factors against acne included a higher ratio of polyunsaturated fatty acids to monounsaturated fatty acids (MUFAs) [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65–0.83, P = 5.96×10−7]; a higher ratio of docosahexaenoic acid (DHA) to total fatty acids (OR 0.80, 95% CI 0.72–0.88, P = 6.64×10−6); and a higher ratio of ω-3 fatty acids to total fatty acids (OR 0.86, 95% CI 0.80–0.92, P = 7.54×10−6) and sphingomyelin acid (OR 0.80, 95% CI 0.72–0.88, P = 1.03×10−5). Conversely, the most significant risk factors for acne included elevated ratio of MUFAs to total fatty acids (OR 1.27, 95% CI 1.14–1.40, P = 6.21×10−6), higher ratio of triglycerides to total lipids in large high-density lipoprotein (OR 1.23, 95% CI 1.12–1.36, P = 1.36×10−5) and an increased ratio of ω-6 to ω-3 fatty acids (OR 1.16, 95% CI 1.08–1.24, P = 3.19×10−5).
Conclusion
Our study highlights the causal relationship between lipid markers and acne. Specifically, we identified 10 lipid traits, including monounsaturated and polyunsaturated fatty acids, ω-3/ω-6 and sphingomyelins, that influence acne development. These findings align with existing evidence on the role of lipids in skin health and comedogenesis. Further research is warranted to explore underlying mechanisms and assess the impact of dietary fats on acne, as well as to evaluate targeted interventions for diverse patient subgroups.
Subcision is one of the most frequently used surgical options in improving acne scarring. Concentrated growth factors (CGF), with the potential to assist in the repair and regeneration of tissues, have been extended to the field of cosmetic plastic surgery. Here, we investigate the safety and efficacy of combining CGF (the latest generation of platelet concentrates) with subcision as a novel treatment method. Sixty patients with clinically diagnosed acne scars received either subcision combined with CGF (n = 24) or subcision monotherapy (n = 36). Clinical characteristics and treatment outcomes were documented through photographs, questionnaires, and medical records, with side effects recorded. Both groups showed significant scar improvements, but the combination therapy demonstrated superior outcomes in ECCA score reduction compared to subcision treatment alone. Patients in the combination therapy group reported higher satisfaction levels, and side effects were minimal, except for increased ecchymosis and pain levels which resolved within an acceptable recovery time range for the patients. This combination approach efficiently treats severe acne scars without significant safety risks.
Androgen hormones (androgens) and androgen receptors (ARs) play both a significant role in the pathogenesis of certain skin disorders, such as acne vulgaris (hereafter: acne) and androgenetic alopecia (AGA) in both males and females. Systemic antiandrogen therapies, such as oral contraceptives (DTAs) and spironolactone, are potentially effective strategies for the treatment of acne and AGA. However, they are associated with systemic adverse effects and are unsuitable for use in males. Clascoterone cream, 1%, is a novel topical androgen receptor inhibitor (ARI). The use of a topical antiandrogen drug significantly reduces the risk of these side effects. Clascotereone is currently the only topical ARI approved by the Food and Drug Administration (FDA). It is indicated for patients 12 years of age and older with facial acne vulgaris. Several clinical studies demonstrated the effectiveness of clascoterone in treating acne with a favorable safety profile. The other indications for clascoterone, including the treatment of AGA, are currently under investigation. The promising results from clinical trials suggest that clascoterone may soon play a broader role in dermatology, offering benefits for conditions that currently have limited treatment options.
Acne is a chronic, self-limiting inflammatory disease of pilosebaceous unit. It is multifactorial, affects at least 85% of teenagers and young adults with dermatological and psychological effect too. The current study focuses on clinico-demographic characteristics of patients with acne vulgaris and correlation of Cardiff acne disability index score (CADI) and Global acne grading system score (GAGS)in patients attending the outpatient department of dermatology at a tertiary care hospital, in southern India.
A Cross sectional study conducted in 170 adult patients diagnosed with acne vulgaris attending OPD of Dermatology in a teaching hospital. Institutional ethical clearance and patient’s consent was taken. Pregnant and lactating women, patients who are hypersensitive to retinoids and presented with any other skin condition that would interfere with diagnosis or assessment of acne were excluded from the study. Data on clinico-demographic characteristics, Cardiff acne disability index (CADI) score and Global acne grading system- GAGS of patients was obtained using a semistructured questionnaire. Statistical analysis done using, chi-square, t test and pearsons correlation with P<0.05 considered as statistically significant in SPSS version 22.
Majority of the participants were females (71.8%), and between the age group 26 to 32 years (36.5%) followed by 18 to 25 years (27.6%), with 61.2% found to be unmarried. The cheeks (95.3%) were the most common site of involvement, followed by forehead (51.2%). Chi-square shows significant association with younger age and females (P<0.05). CADI score is positively correlated with GAGS score (pearsons rho = 0.81 with P<0.05).
Gender and age are significant demographic factors associated with acne, CADI score is positively correlated with GAGS score, thus showing effect of acne on quality of life.
Acne vulgaris is a common inflammatory condition that is often treated by dermatologists with isotretinoin. Isotretinoin has a number of effects on inflammatory pathways, with clear efficacy in managing acne vulgaris. There are also well‐documented side effects of isotretinoin, including hyperlipidemia; however, the overall cardiovascular risk is unclear. This systematic review revealed low evidence for major adverse cardiovascular events associated with the use of isotretinoin in acne patients. Despite this low evidence, rare events may be associated and should still be considered when using isotretinoin in acne patients.
Sebum composition may be more important than amount for acne lesions, and current research on skin surface lipids (SSLs) focuses on determining their relative content. The objective of this study was to analyze the changes in the absolute content of SSLs in acne patients and their relationship with skin barrier function. To evaluate skin barrier function, transepidermal water loss (TEWL), skin moisture, sebum content, skin elasticity, and whiteness were measured, while SSL changes were investigated using LC-MS/MS. The results indicated that adult acne patients have reduced skin barrier function, as demonstrated by changes in skin moisture, sebum content, skin flexibility, and whitening. Notably, AGlcSiE, Cer, CL, Co, LPC, PA, PC, PE, PI, SM, So, SQDG, and TG were considerably enhanced in acne patients’ SSLs, whereas CerG1, DG, DGDG, MGDG, PG, and phSM were decreased. Furthermore, side chain analysis showed that the ratio of linoleic acid to linolenic acid in acne patients’ skin surface lipids was higher than in healthy controls, and the caprylic acid/capric acid ratio was likewise greater. The correlation study of SSLs and skin barrier function demonstrated that increasing LPC and decreasing PG are associated with skin barrier function deterioration. In conclusion, acne patients have compromised skin barrier function and altered SSL absolute content, and certain SSL species identified in this study could serve as potential targets for research into acne pathogenesis.
Some studies have confirmed that pathogens can cause infection through bacterial cultures on the surface of infectious keloids. However, further exploration of the comparison between infectious and non-infectious keloids and the bacterial flora of infectious foci is lacking. To investigate the differential flora of purulent secretions on the surface of infectious keloids compared to non-infectious keloids and to determine the microbial composition within the infectious foci. This case–control study involved 17 patients and obtained swab specimens from the surface of keloids in two groups, and from the infectious foci in the infectious group. Bacterial composition was analyzed using 16S ribosomal RNA sequencing. There were no statistical differences in the general condition of patients between the two groups. The presence of the phylum Actinobacteriota, and the orders Propionibacteriales and Corynebacteriales, as well as the genus Taibaiella, was greater on the surface of keloids in the infectious group. The most prevalent genera in infective sites were Staphylococcus, Peptoniphilus, and Cutibacterium. Microbial-associated gene pathways indicated a correlation with inflammation and tumor-like growth in keloids. There is a connection between infectious keloids and microorganisms, providing insights for predicting and treating keloid infections.
Acne vulgaris (AV) is a chronic inflammatory condition of the pilosebaceous units characterized by multiple immunologic, metabolic, hormonal, genetic, psycho-emotional dysfunctions, and skin microbiota dysbiosis. The latter is manifested by a decreased population (phylotypes, i.e., genetically distinct bacterial subgroups that play different roles in skin health and disease) diversity of the predominant skin bacterial commensal - Cutinbacterium acnes. Like in other dysbiotic disorders, an elevated expression of endogenous antimicrobial peptides (AMPs) is a hallmark of AV. AMPs, such as human β-defensins, cathelicidin LL-37, dermcidin, or RNase-7, due to their antibacterial and immunomodulatory properties, function as the first line of defense and coordinate the host-microbiota interactions. Therefore, AMPs are potential candidates for pharmaceutical prophylaxis or treating this condition. This study outlines the current knowledge regarding the importance of AMPs in AV pathomechanism in light of recent transcriptomic studies. In particular, their role in improving the tight junctions (TJs) skin barrier by activating the fundamental cellular proteins, such as PI3K, GSK-3, aPKC, and Rac1, is discussed. We hypothesized that the increased expression of AMPs and their patterns in AV act as a compensatory mechanism to protect the skin with an impaired permeability barrier. Therefore, AMPs could be key determinants in regulating AV development and progression, linking acne-associated immune responses and metabolic factors, like insulin/IGF-1 and PI3K/Akt/mTOR/FoxO1 signaling pathways or glucotoxicity. Research and development of anti-acne AMPs are also addressed.
Background
Acne is a common skin disorder that may be linked to metabolic dysfunction. However, the causal impact of blood metabolites on acne has not been thoroughly investigated.
Methods
We performed a metabolome‐wide Mendelian randomization (MR) analysis on 486 blood metabolites and acne using a genome‐wide association dataset. The study included preliminary inverse‐variance weighted (IVW) analysis, multivariable MR analysis, linkage disequilibrium score (LDSC) analysis, and colocalization analysis, along with reverse MR to address potential reverse causation.
Results
Our analysis identified 12 metabolites significantly associated with acne. LDSC analysis revealed a genetic correlation between nonanoylcarnitine and acne. Colocalization analysis confirmed shared genetic variants, and metabolic pathway analysis implicated the arginine biosynthesis pathway and the selenocompound metabolism pathway in the development of acne.
Conclusion
This study offers a comprehensive understanding of the causal relationships between plasma metabolites and acne. The findings provide insights into potential biomarkers and therapeutic targets for acne treatment, underscoring the need for further research.
Acne vulgaris is a chronic inflammatory skin condition affecting teenagers, with significant impact on self-esteem. Even in mild form, acne has a detrimental psychological effect on patients. Acne vulgaris affects 85% of adolescents, often starts in preadolescence, and persists into adulthood. In conventional method, topical retinoids and other treatment modalities are available; however, these are fraught with potential side effects and expensive, and therefore an alternative method of treatment is required. A case series of three teenagers with acne vulgaris treated with individualized homoeopathy is presented here. The cases are reported according to the Homeopathic Clinical Case Reports (HOM-CASE) guidelines and followed up with photographic documentation. Severity of disease and its impact on quality of life (QoL) was assessed using the global acne grading system (GAGS) and the Teenager's Quality of Life (T-QoL). The Modified Naranjo Criteria for Homeopathy (MONARCH) inventory was used as a tool for assessing the causal relationship between homeopathic intervention and clinical outcome. All cases of acne vulgaris were successfully treated with individualized homeopathy within 2 months' duration without any complication. Eruptions resolved with decrease in both the GAGS and T-QoL scores. Individual curative response of the homeopathic medicine in each case assessed through MONARCH, demonstrated a positive causal attribution of homeopathy. This case series highlights successful outcomes using individualized homeopathic treatment, showing remarkable improvement of acne vulgaris in teenagers. Hence, this case series could serve as a basis for further research into the role of individualized homeopathic medicine in the treatment of acne vulgaris in teenagers.
Background: Acne is caused by blockage of hair follicles and skin pores due to excess sebum production on the skin. Commonly used anti-acne include typical antibiotic creams or gels of clindamycin, tetracycline, and erythromycin. The use of these drugs often causes dry skin, redness, itching, and resistance to bacteria. The cinnamon bark oil which contains cinnamaldehyde, has been studied to have antibacterial activity. Objective: To determine the best formula of Cinnamon bark oil nanoemulgel with good physical quality and the highest antibacterial activity against P. acnes. Method: Cinnamon bark oil was formulated as a nanoemulsion and mixed with Carbopol, a gelling agent. Nanoemulgels were produced and evaluated through organoleptic tests, pH, viscosity, antibacterial activity, and stability testing. Result: The results showed that the particle size, zeta potential, and % transmittance of the cinnamon bark oil emulsion were accurate for an ideal nanoemulsion. All three formulas produced a light yellow, transparent colour, had a thin and mild gel consistency, and cinnamon bark oil scent, and fulfilled the requirements of the best formula of Cinnamon bark oil nanoemulgel that had good physical quality and the highest antibacterial activity against P.acnes. Conclusion: The best formula that had antibacterial activity for P. acnes was Formula 3.
The excessive proliferation of Cutibacterium acnes (C. acnes) is an important reason for the occurrence of acne vulgaris, and genetic detection ratio of C. acnes in acne is as high as 60.5%. Until now, the treatment of C. acnes is mainly limited to antibiotics, but some strains of C. acnes produce antimicrobial resistances, making it difficult for clinical treatment. Additionally, antibiotics can cause severe adverse effects. Therefore, more and more people are paying attention to phytochemicals. It is well known that plants can synthesize a range of secondary metabolites, named phytochemicals, part of which have antibacterial properties. Additionally, the main advantages of phytochemicals are that they have good efficacies and less side effects, so they are suitable choices for medical treatment. This review mainly discusses the effects and mechanisms of phytochemicals against C. acnes.
Isotretinoin has revolutionized the management of acne vulgaris. However, concerns continue regarding the adverse effect profile of isotretinoin. This study aims to review the adverse effects experienced by patients started on isotretinoin by a single dermatologist.
Retrospective chart review of 1743 patients started on isotretinoin for various dermatological conditions over a 6-year period. Details of the dose of isotretinoin used, concomitant medications, adverse effects and outcome were recorded.
One-fifth (18.5%) of patients reported no adverse effects during the study period. Cheilitis was the most commonly reported adverse effect, affecting 78% of users, followed by eczema and tiredness, seen in 12% each. However, these were clearly dose-dependent, as the group treated with doses of isotretinoin under 0.25 mg/kg/day only reported cheilitis in 47%, eczema in 7% and tiredness in 5%, compared with 96%, 16% and 18%, respectively, in those treated with more than 0.75 mg/gm/day. Twenty-four patients (1.4%) stopped isotretinoin because of adverse effects; a further three patients complained of severe adverse effects on at least one occasion, but continued taking the medication. The adverse effect(s) that led to patients stopping isotretinoin were cheilitis (22 patients), mood change (13), tiredness (12), eczema (6) and pregnancy (2). There were no reported instances of suicidal ideation or attempted suicide.
Other than the two oral contraceptive failures, there were no serious adverse events recorded during this review period. Isotretinoin is a very effective medication with a low adverse-effect profile when used at lower doses.
Women with polycystic ovary syndrome (PCOS) are known to have high prevalence of acne and elevated androgen levels. The current study aims to determine if dehydroepiandrosterone sulfate (DHEAS) level is associated with the presence of acne and reduced risk of abdominal obesity in women with PCOS, after considering the concurrent high testosterone level and insulin resistance (IR).
Three hundred and eighteen untreated consecutive Taiwanese women with PCOS were enrolled. Phenotypic hyperandrogenism was recorded, and BMI, waist circumference, waist-to-hip ratio, lipid profiles, fasting glucose and insulin levels and hormone profiles were measured.
Women with acne were younger, had higher serum DHEAS levels (6.01 ± 3.45 versus 4.87 ± 2.49 μmol/l, P = 0.002) and a lower BMI (P = 0.0006), but comparable serum testosterone levels, in comparison with women without acne. The aggravating effect of elevated DHEAS on the risk of acne (odds ratio = 2.15, 95% confidence interval: 1.25-3.68, P = 0.005 for DHEAS cut-off of 6.68 μmol/l) still exited after adjustment for age and BMI. The DHEAS level was positively correlated with the testosterone level, but inversely related to waist circumference, waist-to-hip ratio, BMI, IR index, low-density lipoprotein-cholesterol and triglycerides. Women with PCOS in the highest quartile of DHEAS had the lowest risk of abdominal obesity after adjustment for age, IR, dyslipidemia, testosterone and estradiol levels.
Our results demonstrated the high serum DHEAS in women with PCOS was associated with the presence of acne and a significantly reduced risk of abdominal obesity, independent of serum testosterone concentration and IR.
To assess the risk of attempted suicide before, during, and after treatment with isotretinoin for severe acne.
Retrospective cohort study linking a named patient register of isotretinoin users (1980-9) to hospital discharge and cause of death registers (1980-2001).
Sweden, 1980-2001. Population 5756 patients aged 15 to 49 years prescribed isotretinoin for severe acne observed for 17 197 person years before, 2905 person years during, and 87 120 person years after treatment.
Standardised incidence ratio (observed number divided by expected number of suicide attempts standardised by sex, age, and calendar year), calculated up to three years before, during, and up to 15 years after end of treatment.
128 patients were admitted to hospital for attempted suicide. During the year before treatment, the standardised incidence ratio for attempted suicide was raised: 1.57 (95% confidence interval 0.86 to 2.63) for all (including repeat) attempts and 1.36 (0.65 to 2.50) counting only first attempts. The standardised incidence ratio during and up to six months after treatment was 1.78 (1.04 to 2.85) for all attempts and 1.93 (1.08 to 3.18) for first attempts. Three years after treatment stopped, the observed number of attempts was close to the expected number and remained so during the 15 years of follow-up: standardised incidence ratio 1.04 (0.74 to 1.43) for all attempts and 0.97 (0.64 to 1.40) for first attempts. Twelve (38%) of 32 patients who made their first suicide attempt before treatment made a new attempt or committed suicide thereafter. In contrast, 10 (71%) of the 14 who made their first suicide attempt within six months after treatment stopped made a new attempt or committed suicide during follow-up (two sample test of proportions, P=0.034). The number needed to harm was 2300 new six month treatments per year for one additional first suicide attempt to occur and 5000 per year for one additional repeat attempt.
An increased risk of attempted suicide was apparent up to six months after the end of treatment with isotretinoin, which motivates a close monitoring of patients for suicidal behaviour for up to a year after treatment has ended. However, the risk of attempted suicide was already rising before treatment, so an additional risk due to the isotretinoin treatment cannot be established. As patients with a history of suicide attempts before treatment made new attempts to a lesser extent than did patients who started such behaviour in connection with treatment, patients with severe acne should not automatically have isotretinoin treatment withheld because of a history of attempted suicide.
We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning to acne severity among adolescents aged 18-19 years. A total of 4,744 youth were invited and 3,775 (80%) participated. In all, 14% reported having substantial acne (a lot and very much). Among those with very much acne, as compared those with no/little acne, suicidal ideation was twice as frequently reported among girls (25.5 vs. 11.9%) and three times more frequently reported among boys (22.6 vs. 6.3%). Suicidal ideation remained significantly associated with substantial acne (odds ratio 1.80, 95% confidence interval 1.30-2.50) in a multivariate model including adjustments of symptoms of depression, ethnicity, and family income. Mental health problems, as assessed by the Strengths and Difficulties Questionnaire (2.25, 1.69-3.00), low attachment to friends (1.52, 1.21-1.91), not thriving at school (1.41, 1.12-1.78), never having had a romantic relationship (1.35, 1.05-1.70), and never having had sexual intercourse (1.51, 1.21-1.89) were all associated with substantial acne in a multivariate model. Acne is frequently found in late adolescence and is associated with social and psychological problems. Adverse events including suicidal ideation and depression that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication.
In the course of producing the 2009 NHS Evidence--skin disorders Annual Evidence Update on Acne Vulgaris, 25 randomised controlled trials were examined. From these, at least 12 potentially serious problems of trial reporting were identified. Several trials concluded no effect of a treatment yet they were insufficiently powered to exclude potentially useful benefits. There were examples of duplicate publication and "salami publication", as well as two trials being combined and reported as one. In some cases, an incorrect "within-groups" statistical comparison was made and one trial report omitted original efficacy data and included only P values. Both of the non-inferiority studies examined failed to pre-specify a non-inferiority margin. Trials reported as "double-blind" compared treatments that were dissimilar in appearance or had differing adverse effect profiles. In one case an intention-to-treat analysis was not performed and there was a failure to account for all of the randomized participants. Trial results were made to sound more impressive by selective outcome reporting, emphasizing the statistical significance of treatment effects that were clinically insignificant, and by the use of larger-sounding odds ratios rather than rate ratios for common events. Most of the reporting problems could have been avoided by use of the CONSORT guidelines and prospective trial registration on a public clinical trials database.
Acne vulgaris is a distressing condition that affects the majority of adolescents, but the impact of acne vulgaris on the psychological aspects in this age group is poorly understood.
The purpose of this study was to determine the prevalence of acne, and the level of emotional, social, and functional impairments among Korean adolescents with acne.
Five hundred four middle school students (13~16 years) participated. The severity of acne was graded by visual examination using the Korean Acne Grading System. Self-reported questionnaires, including subjective acne severity rating, the Self Image Questionnaire, the Rosenberg Self-Esteem Questionnaire, the Index of Peer Relations, and the Beck Depression Inventory were used to assess psychologic status.
There was a prevalence of acne in 78.9% of the study samples, with 10.2% of students having moderate-to-severe acne. Acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social impairments. The longer the acne persisted, the more stress the students felt. The degree of stress and extent of self-image impairment were related to subjective severity more than objective grading.
Acne is a common disorder among Korean adolescents and appears to have a considerable impact on mental health. Dermatologists should be aware of the importance of basic psychosomatic treatment in conjunction with early medical, educational intervention in the management of acne.
Isotretinoin is commonly prescribed for the treatment of severe acne. Although cases of inflammatory bowel disease (IBD) have been reported in isotretinoin users, a causal association remains unproven.
We performed a case-control study using a large insurance claims database. Incident cases of IBD were identified and matched to three controls on the basis of age, gender, geographical region, health plan, and length of enrollment. Isotretinoin exposure was assessed in a 12-month period before case ascertainment. Conditional logistic regression was used to adjust for matching variables.
The study population comprised 8,189 cases (3,664 Crohn's disease (CD), 4,428 ulcerative colitis (UC), and 97 IBD unspecified) and 21,832 controls. A total of 60 subjects (24 cases and 36 controls) were exposed to isotretinoin. UC was strongly associated with previous isotretinoin exposure (odds ratio (OR) 4.36, 95% confidence interval (CI): 1.97, 9.66). However, there was no apparent association between isotretinoin and CD (OR 0.68, 95% CI: 0.28, 1.68). Increasing dose of isotretinoin was associated with elevated risk of UC (OR per 20 mg increase in dose: 1.50, 95% CI: 1.08, 2.09). Compared with non-users, the risk of UC was highest in those exposed to isotretinoin for more than 2 months (OR 5.63, 95% CI: 2.10, 15.03).
UC but not CD is associated with previous isotretinoin exposure. Higher dose of isotretinoin seems to augment this risk. Although the absolute risk of developing UC after taking isotretinoin is likely quite small, clinicians prescribing isotretinoin as well as prospective patients should be aware of this possible association.
Acne vulgaris is a multifactorial disease affecting a majority of the adolescent population. The objective of this study was to test for a correlation between fasting serum lipid profiles and levels of testosterone, insulin, leptin, and interleukin 1-beta (IL-1beta) and the incidence of severe acne vulgaris in obese adolescent females. Four groups of adolescent females were studied: obese with acne, obese without acne, non-obese with acne, and non-obese without acne. Obese females with acne, compared to obese females without acne and non-obese subjects, had significantly higher serum triglycerides, low-density lipoprotein cholesterol and apolipoprotein-B (apo-B) (mean +/- SD: 197 +/- 13.7 vs 171 +/- 11.5, 128 +/- 8.3 vs 116 +/- 7.7, 96 +/- 13.7 vs 85 +/- 10.3 mg/dL, respectively) but significantly lower high-density lipoprotein cholesterol and apo-A1 levels (40 +/- 3.3 vs 33 +/- 3.5 and 126 +/- 12 vs 147 +/- 13 mg/dL). Serum testosterone, insulin and leptin levels were significantly higher in obese subjects with or without acne compared to non-obese females with or without acne (3 +/- 0.5 vs 2.1 +/- 0.47, 15.5 +/- 3.3 vs 11.6 +/- 3, 0.9 +/- 0.2 vs 0.6 +/- 0.15 nmol/mL, respectively). Serum IL-1b was significantly elevated in obese and non-obese subjects with acne compared to subjects without acne; in those without acne, these levels were higher in obese than non-obese subjects (2.4 +/- 0.2, 1.4 +/- 0.1 vs 1.8 +/- 0.12 and 1.3 +/- 0.11 pg/mL, respectively). Our results indicate that there is a relationship between obesity (BMI >27) and acne. By early recognition, the etiology and treatment protocol of acne may prevent unwanted conditions.
Sixteen patients with minimal facial acne but with symptoms of dysmorphophobia related to their acne were treated with isotretinoin, 0.5 mg/kg/day, (n = 5); 1 mg/kg/day (n = 11) for 16 weeks. All 16 had previously received long-term antibiotic therapy with no 'perceived' improvement in their acne. Formal psychiatric assessment was not possible through lack of cooperation. Fourteen of 16 patients derived benefit from isotretinoin therapy in that all 14 were subsequently satisfied with the cosmetic results achieved. However, the incidence of relapse was greater than that for a control group, 14 requiring additional therapy in the form of antibiotics or further isotretinoin (seven patients) within 20 months of completing the original course. Patients with acne and dysmorphophobia represent an important group of patients who benefit from treatment with isotretinoin; if possible this should be in conjunction with psychotherapy.
Dapsone, a synthetic sulfone that has been available for over 60 years, has been used to treat a myriad of cutaneous disorders. Prior to the general acceptance of isotretinoin, oral dapsone had been reported to be effective in the treatment of nodulocystic acne. However, the potential for systemic toxicity prevented its widespread adoption in the treatment of acne. For many years scientists explored the possibility of developing a topical formulation of dapsone for the treatment of acne in the hope of minimizing the adverse hematologic effects of oral dapsone. Such a formulation had been unavailable until recently. Dapsone 5% gel (Aczone™) was recently developed to treat acne vulgaris. This topical formulation was approved in the US based on two randomized, vehicle-controlled studies. A 12-month, open-label study was also conducted to assess the safety and efficacy of topical dapsone over the long term. Finally, two open-label phase I pharmacokinetic studies were conducted to evaluate the systemic absorption of topical dapsone compared with oral dapsone.
This article reports the results of these studies, which show a reduction in acne lesion count comparable to those observed in clinical trials of other approved topical acne therapies. With regard to safety, the studies demonstrated that the concentrations of dapsone and N-acetyl dapsone remain low and do not accumulate over time once steady state is reached. Of the total of 50 patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency in all the studies, only two experienced a drop in hemoglobin levels, and those shifts in values were consistent with fluctuations observed for other study participants. A recent study evaluating the risk of hemolysis in patients with G6PD deficiency found topical dapsone 5% gel to be safe to use in this patient population.
Based on the observations noted in the above-mentioned studies, we conclude that topical dapsone 5%gel is safe and effective in the treatment of acne vulgaris.
There is a limited literature reporting on acne in childhood. Childhood acne can be classified in neonatal, infantile, mid-childhood, and prepubertal acne, depending on the age of onset. In this review we will present an update on the clinical approach and therapeutic options when facing prepubertal acne in a child. The use of tetracyclines is contraindicated in children younger than 8 years, and oral isotretinoin is not recommended in children younger than 12 years of age according to the FDA and the European Commission. Nevertheless, there are case reports of 10 patients successfully treated with oral isotretinoin for recalcitrant infantile acne with scarring. Further studies are needed to investigate whether isotretinoin may improve the long-term prognosis of infantile acne, which may be associated with more severe acne in adolescence.
Background Acne lesions spontaneously remit, but the mechanism of this remission has not been elaborated. It is known, however, that the remission is associated with a de-differentiation of sebocytes, causing a cessation of sebum secretion specific to that particular pilosebaceous unit. We have previously described the cytokines that will promote in vitro the lesions of acne.
Objectives To show that those same cytokines may also promote a de-differentiation of sebocytes analogous to that seen during remission of some lesions.
Methods Human chest sebaceous glands were maintained in vitro as whole organs. We then chronicled the effects of the appropriate cytokines and growth factors on the glandular rates of (i) lipogenesis and (ii) DNA synthesis, as well as on (iii) glandular morphology, (iv) the expression patterns of the proliferation marker Ki-67, (v) keratinocyte-specific markers, and (vi) the sebocyte marker epithelial membrane antigen.
Results We have shown that the same cytokines that promote comedogenesis (interleukin-1α), expression of infundibular intercellular adhesion molecule-1 and human leucocyte-associated antigen-DR (tumour necrosis factor-α and interferon-γ), and infundibular disruption (epidermal growth factor/transforming growth factor-α) in human infundibula in vitro, will also inhibit sebaceous lipogenesis in vitro and will also induce, histologically, a de-differentiation of human sebocytes into a keratinocyte-like phenotype.
Conclusions These results confirm our hypothesis that the cytokines that induce the infundibular changes in acne may also inhibit the secretion of lipid from the sebaceous gland and thus, on diffusing down to the gland, contribute to the remission of the individual lesions. These findings help to explain the known natural history of the disease.
Misconceptions exist in the community regarding factors that exacerbate acne vulgaris. In particular stress, diet, lifestyle and personal hygiene are often erroneously claimed to be important factors. In order to investigate whether these common misconceptions persist in medical graduates, we analysed the answers of 215 sixth year medical students, who all subsequently graduated from The University of Melbourne, to a short-answer question on acne management and exacerbating factors in one of their final year examination papers. With respect to exacerbating factors, 67% of students identified stress, 10% identified lifestyle factors (smoking and alcohol consumption), and 25% claimed poor facial hygiene exacerbated acne. Diet was stated to be an important factor by 41% of students, of whom 12% specifically mentioned chocolate. Persistence of these misconceptions among medical graduates is likely to perpetuate misinformation in the community.
Isotretinoin (13-cis retinoic acid) is an effective treatment for severe cystic or recalcitrant acne vulgaris; however, concerns have been raised regarding its potential association with depression and suicidal behavior. We sought to explore the proposed relationship between isotretinoin use and the risk of depression and attempted and completed suicide in patients with acne vulgaris by performing a systematic literature search for studies reporting primary data on depression and suicidal behavior in patients treated with isotretinoin for acne vulgaris. Nine studies met the qualifying criteria for our analysis. Rates of depression among isotretinoin users ranged from 1% to 11% across studies, with similar rates in oral antibiotic control groups. Overall, studies comparing depression before and after treatment did not show a statistically significant increase in depression diagnoses or depressive symptoms. Some, in fact, demonstrated a trend toward fewer or less severe depressive symptoms after isotretinoin therapy. This decrease was particularly evident in patients with pretreatment scores in the moderate or clinical depression range. No correlation between isotretinoin use and suicidal behavior was reported, although only one retrospective study presented data on this topic. Although the current literature does not support a causative association between isotretinoin use and depression, there are important limitations to many of the studies. The available data on suicidal behavior during isotretinoin treatment are insufficient to establish a meaningful causative association.
The demographic profile of facial acne vulgaris has changed during the past several decades; 12 years of age is no longer the low end of the "normal" range for onset of acne. The available epidemiologic evidence raises more questions than it answers regarding the etiology of this downward shift. More study is needed to clarify whether the trend toward an earlier onset of puberty in the United States has influenced the clinical picture of acne. Additional research will help advance understanding of the spectrum of pathophysiologic changes in acne in younger pediatric patients and whether it varies from that found in individuals in whom the onset of acne occurs at approximately 12 years of age or later.
Acne prevalence studies often use subject self-report as data source. Our aim was to evaluate the validity of acne self-report.
Responses of university students to an acne questionnaire were compared to the trained observer's concurrent examination of acne. The validity of self-report was measured by sensitivity, specificity, positive predictive value and negative predictive value. Agreement was measured by Cohen's kappa and correct classification percentage.
The sensitivity of self-report was 0.55 (95% CI 0.47-0.63), the specificity was 0.72 (95% CI 0.63-0.80), the positive predictive value was 0.70 (95% CI 0.61-0.78), and the negative predictive value was 0.57 (95% CI 0.49-0.65). Cohen's kappa was 0.26 (95% CI 0.15-0.38) and correct classification percentage was 63.
Validity of self-report was moderate at best and agreement was fair, indicating that college students could not accurately report that they have acne. This is likely not sufficient for clinical or research activities or to assure that individuals who self-guide their acne therapy actually have acne.
New combination topical formulations for the treatment of acne may improve outcomes by increasing adherence. We assessed adherence to and efficacy of a combination topical medication for acne applied once daily compared with daily applications of 2 separate generic subcomponents. Twenty-six participants with mild to moderate acne vulgaris were randomized to 12 weeks of once daily application of clindamycin phosphate 7.2%-tretinoin 0.025% gel (CTG) combination product or separate daily applications of clindamycin phosphate gel 1% and tretinoin cream 0.025% (C gel + T cream) for a total of 2 applications daily. Disease severity was measured at baseline and weeks 4, 8, and 12. Adherence was monitored using electronic monitoring caps on the medication tubes. Of the 26 participants enrolled, 21 completed the 12-week study. Median adherence in the CTG group was 88% compared with 61% in the C gel + T cream group. There was a 51% mean reduction in total lesions for the CTG group versus a 32% mean reduction for the C gel + T cream group by the end of the study. Both CTG and separate applications of C gel + T cream improved mild to moderate acne. The use of a once daily combination product has the advantage of promoting better adherence and clinical outcomes.
Acne vulgaris is a common condition among adolescents regardless of age, gender, and race. We compare the frequency, severity, help-seeking behavior, treatment, and beliefs about acne among students based on race, ethnicity, gender, and age. Anonymous surveys were administered to 1,214 students aged 10-19 years of varied gender, race, and ethnicity in public middle and high schools in New Jersey. Results showed the frequency and severity of acne were high (76% and 65%, respectively) and more prevalent in white compared to non-white respondents (RR = 1.13, 95% CI = 1.04-1.24 and RR = 1.22, 95% CI = 1.09-1.37, respectively), and also in older compared to younger ages (RR = 1.24, 95% CI = 1.17-1.32 and RR = 1.43, 95% CI = 1.32-1.55, respectively). The majority of respondents (83%) reported never having seen a physician for their acne; however, those reporting acne of some severity were more likely to have seen a physician compared with those who did not report acne (21% vs. 8%, p < 0.001). Blacks who reported mild or moderate severity of acne were more likely to have seen a health professional compared to white respondents with same the acne severity (RR = 3.63, 95% CI = 2.06-6.37 and RR = 3.06, 95% CI = 2.02-4.65, respectively). Conversely, Hispanic respondents with mild or moderate acne were less likely to have seen a health professional compared to whites with the same acne severity (RR = 0.56, 95% CI = 0.35-0.89 and RR = 0.47, 95% CI = 0.26-0.86, respectively). Beliefs about external factors affecting acne also varied by race and ethnicity. In conclusion, the severity, frequency, and beliefs about acne all play a role in help-seeking behaviors, which vary to a significant extent by race and ethnicity.
Acne vulgaris is the most common disorder encountered in ambulatory clinical practice comprising 11.3 percent of office visits to dermatologists in 2005.(1) By comparison, eczematous dermatoses, psoriasis, and skin cancer accounted for 6.2, 3.5, and 10 percent of office visits, respectively.(1) A variety of topical therapeutic options are available for treatment of acne vulgaris, including benzoyl peroxide, antibiotics, retinoids, azelaic acid, and sodium sulfacetamide-sulfur.(2,3) Sodium sulfacetamide 10%-sulfur 5% has been used for the topical treatment of seborrheic dermatitis, acne vulgaris, and rosacea since the mid-1950s and is available in a variety of formulations, including lotions, creams, cleansers, and emollient foams.(4) Recently, an emollient foam sodium sulfacetamide 10%-sulfur 5% formulation indicated for topical therapy of acne vulgaris, rosacea, and seborrheic dermatitis has become available.(5) This article provides an overview of the sodium sulfacetamide 10%-sulfur 5% emollient foam and reports the results of a case report series of patients with acne vulgaris treated with sodium sulfacetamide 10%-sulfur 5% emollient foam as monotherapy or in combination with other topical acne products.
To review recent studies on the use of antibiotics in acne vulgaris which provide insight into the development of antimicrobial resistance.
Sources for this article were identified by searching the English literature by Medline for the period 1960 to March 2009.
The following relevant terms were used: acne, acne vulgaris, acne and antibiotic therapy, acne and antimicrobial resistance, acne and resistance mechanisms, acne and systemic infections, acne and antibiotic resistance and coagulase-negative Staphylococcus aureus (S. aureus), acne and antibiotic resistance and upper respiratory infection.
Both correct and incorrect use of antibiotics for acne vulgaris can promote antimicrobial resistance. The development of this resistance is promoted by several factors, including antibiotic monotherapy, long-term administration of antibiotics, indiscriminate use outside their strict indications, dosing below the recommended levels, and the administration of antibiotics without concurrent benzoyl peroxide and/or topical retinoids.
Long-term use of antibiotics in the treatment of acne vulgaris can lead to antimicrobial resistance with serious and intractable problems not limited to Propionibacterium acnes (P. acnes), the skin and acne vulgaris themselves, but also to other bacterial species, with systemic consequences. These findings suggest that antibiotics should be prescribed in combination with benzoyl peroxide and/or topical retinoids and be limited to a maximum of several months.
Unlabelled:
The first-line treatments for acne vulgaris are conventional topical and/or oral medications. However, many patients have contraindications, only partial response, significant adverse effects, or recurrence. Light-based treatments and photodynamic therapy (PDT) using topical precursors of porphyrins are off-label alternative treatments for acne vulgaris, with their own advantages and disadvantages. To date, there is no consensus on PDT methodology and parameters. An understanding of pathophysiology of acne, light-tissue interactions, and PDT mechanisms of action is helpful whenever PDT is considered as an alternative treatment. In general, blue light alone improves acne because of its antiinflammatory effects. PDT using 5-aminolevulenic acid (ALA) or ALA derivatives induces transient antimicrobial and antiinflammatory effects. At high doses, red light PDT may induce inhibition or destruction of sebaceous glands, resulting in clinical improvement.
Learning objectives:
After completing this learning activity, participants should be able to compare different treatments of acne, recognize when photodynamic therapy may be a useful off-label treatment for acne vulgaris, and identify variables that may affect the efficacy of photodynamic therapy.
In this community-based cross-sectional study, 1443 Japanese adolescents aged 13-19 years participated from two schools in Kagawa Prefecture. Students completed a self-administered questionnaire to assess the prevalence of acne, knowledge about acne, self-management of acne and emotional well-being. A five-item version of the Mental Health Inventory (MHI) subscale of the Short Form 36 was used to assess psychological health and depression status. Among respondents, 859 (59.5%) said they had acne (51.6% of the boys and 64.8% of the girls). A majority (56.8%) of those who said they had acne also reported a family history of acne. Of the 555 female respondents with acne, 39.1% reported experiencing acne flares in temporal proximity to menstruation. Less than half (38.8%) of respondents with acne had sought or were seeking treatment. The three most common factors believed to trigger or exacerbate acne were stress, lack of sleep and sweat. The mean MHI score of 847 students with acne was significantly lower than 475 students without acne. The mean MHI score of female students with acne was significantly lower than male students with acne. Students with acne were also significantly more depressed than those without acne and female students were significantly more depressed than male students. Acne is a common problem for Japanese teenagers and causes personal and social difficulties. Our results suggest the necessity of educational programs in school or public to ensure that adolescents are aware of acne and to encourage young people to improve their mental health through better acne treatment.
Adolescent acne impacts self-esteem and quality of life in adolescents and its aetiology is not fully clarified.
The aim of this study was to describe the epidemiological features of adolescent acne in North East China and determine the impact of genetic and environmental factors on the pathogenesis of acne.
Data were collected from 5696 undergraduates (2920 patients and 2776 controls) using questionnaire. The survey data were analysed using spss version 13.0 and heritability of adolescent acne was calculated using Falconer's method.
Total prevalence of adolescent acne was 51.30% (52.74% in males, 49.65% in females). The difference between genders was statistically significant (P < 0.05). Adolescents with a family history of acne had earlier age of onset (P < 0.001). The prevalence of acne in first- and second-degree relatives of acne patients was 22.5% and 7.19%, respectively, significantly higher than in controls (P < 0.001). Heritability of adolescent acne was 78.47 +/- 2.05% in first-degree relatives and 75.05 +/- 3.18% in second-degree relatives. Risk factors to the acne suffers include (in descending order of occurrence), acne family history, mental stress, menstrual disorder, frequent insomnia, high fat diet, being male, dysmenorrhoea, anxiety, sleeping < 8 h per day, depression, fried food, study pressure, spicy food, oily skin and mixed type skin. Protective factors include (presented in descending order of occurrence) dry skin, neutral skin, frequent fruit consumption and computer access time < 2 h daily.
Adolescent acne includes a familial genetic predisposition. Additional environmental factors of psychological stress, skin oiliness and high caloric diets may also contribute to the onset of acne in Chinese adolescents.
Guidelines support this use of topical retinoids as a fundamental part of acne treatment regimens. However, existing dogma holds that topical retinoids may initially worsen acne.
To review the available data from clinical trials for evidence of initial worsening of acne with topical retinoids.
A PubMed and Google Internet search was performed for sources indicating or refuting worsening of acne with topical retinoids.
No primary data from clinical trials were identified to support the dogma of acne worsening secondary to topical retinoids. Available data point to topical retinoids improving acne, even during the first couple weeks of treatment.
It is unlikely that acne worsens or "flares" due to the initiation of topical retinoids. Some acne patients may have worsening of acne during the first week or two as part of the natural disease process.
Fractional photothermolysis (FP) is one of the most significant milestones in laser technology and resurfacing.
Review of the Medline English literature and recent international conferences regarding FP technology, applications, and indications.
Successful conditions treated with nonablative FP reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis. An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. Most recently, AFP has demonstrated significantly greater improvement than nonablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging.
Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders. Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP is highly needed.
Antibiotic resistance of Propionibacterium acnes (P. acnes) is a growing phenomenon in the wake of widespread use of topical and systemic antibiotics for acne vulgaris. Benzoyl peroxide has a proven track record of safety and efficacy, and can decrease reliance on antibiotics in the treatment of acne.
To review the literature for methods to increase the efficacy and tolerability of benzoyl peroxide (BPO).
A PubMed literature search was done using the terms "benzoyl peroxide," "vehicle," "mechanism," and "delivery system." Relevant papers were reviewed for methods of increasing BPO efficacy and tolerability.
BPO in concentrations of 2.5%, 5% and 10% are equally effective at treating inflammatory acne. However, higher concentrations are associated with more adverse effects. The efficacy of BPO may be enhanced by the presence of Vitamin E and tertiary amines. BPO is also more efficacious if used in combination with topical retinoids than as a monotherapy. Novel vehicles including a microparticle delivery system and those with a hydrophase or urea base increase the tolerability of BPO without sacrificing efficacy.
Benzoyl peroxide has a proven track record of safety and efficacy for the treatment of acne. Recent discoveries have provided new methods of increasing the efficacy and tolerability of topical BPO, making it useful as monotherapy for mild acne or as an adjunct in the treatment of moderate to severe acne vulgaris.
Background:
Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women.
Objectives:
To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies.
Search methods:
In January 2012, we searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP) (Aug 2011). For the initial review, we wrote to researchers to seek any unpublished or published trials that we might have missed.
Selection criteria:
We considered randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placebo or another active therapy for acne in women.
Data collection and analysis:
We extracted data on facial lesion counts, both total and specific (i.e., open or closed comedones, papules, pustules and nodules); acne severity grades; global assessments by the clinician or the participant, and discontinuation due to adverse events. Data were entered and analyzed in RevMan. For continuous data, we calculated the mean difference (MD) and 95% confidence interval (CI). For dichotomous data, we calculated the Peto odds ratio (OR) and 95% CI.
Main results:
The review includes 31 trials with 12,579 participants. Of 24 comparisons made, 6 compared a COC to placebo, 17 different COCs, and 1 compared a COC to an antibiotic. Of nine placebo-controlled trials with data for analysis, all showed COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. A levonorgestrel-COC group had fewer total lesion counts (MD -9.98; 95% CI -16.51 to -3.45), inflammatory and non-inflammatory lesion counts, and were more likely to have a clinician assessment of clear or almost clear lesions and participant self-assessment of improved acne lesions. A norethindrone acetate COC had better results for clinician global assessment of no acne to mild acne (OR 1.86; 95% CI 1.32 to 2.62). In two combined trials, a norgestimate COC showed reduced total lesion counts (MD-9.32; 95% CI -14.19 to -4.45), reduced inflammatory lesion and comedones counts, and more with clinician assessment of improved acne. For two combined trials of a drospirenone COC, the investigators' assessment of clear or almost clear skin favored the drospirenone group (OR 3.02; 95% CI 1.99 to 4.59). In one trial, the drospirenone-COC group showed greater (more positive) percent changes for total lesion count (MD 29.08; 95% CI 3.13 to 55.03), inflammatory and non-inflammatory lesion counts, and papule and closed comedone counts. A dienogest-COC group had greater percentage decreases in total lesion count (MD -15.30; 95% CI -19.98 to -10.62) and inflammatory lesion count, and more women assessed with overall improvement of facial acne. A CMA-COC group had more 'responders,' those with 50% or greater decrease in facial papules and pustules (OR 2.31; 95% CI 1.50 to 3.55)Differences in the comparative effectiveness of COCs containing varying progestin types and dosages were less clear, and data were limited for any particular comparison. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel. A COC with cyproterone acetate showed better acne outcomes than one with desogestrel, but the studies produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes, but results were not consistent. A drospirenone COC appeared to be more effective than norgestimate or nomegestrol acetate plus 17β-estradiol but less effective than cyproterone acetate.
Authors' conclusions:
This update yielded six new trials but no change in conclusions. The six COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few important and consistent differences were found between COC types in their effectiveness for treating acne. How COCs compare to alternative acne treatments is unknown since only one trial addressed this issue. The use of standardized methods for assessing acne severity would help in synthesizing results across trials as well as aid in interpretation.
There is a considerable number of studies linking acne with psychological and psychiatric morbidities, although this literature is not entirely consistent and is largely cross-sectional in methodology.
This study aims to establish the relationship of acne and psychological and psychiatric morbidity in adolescents in a community setting and, via a longitudinal methodology, provide evidence for causality in the relationship.
The study was a 12-month cohort study. Two hundred and forty-four students in Years 8, 9 and 11 (ages 14-17) at four Australian high schools were assessed at baseline 6 months and 12 months. Presence and severity of acne were assessed, along with a number of psychological and psychiatric morbidities and personality traits (depression, anxiety, overall psychiatric morbidity, self-consciousness, neuroticism and introversion/extraversion) and other demographic variables.
Of the 244 participating students, 209 (86%) completed all three rounds of data collection. A further 26 (11%) completed two rounds. The study failed to demonstrate an association of the presence of acne or of acne severity with the examined measures of psychological and psychiatric morbidity, and no evidence for an effect of acne in their causation.
The relationship of acne and psychological morbidities found in previous health care settings was not found in this community sample. This may be due to differences between community and clinical acne populations. Other possible reasons for this finding are attenuation of psychological morbidity in subjects in this study by successful acne treatment, and the role of personality traits in the complex relationship between acne and psychological morbidities. It is suggested that this relationship would be best investigated by means of longer-term cohort studies enlisting subjects at an early age, prior to the onset of acne.
Interest in sebaceous gland physiology and its diseases is rapidly increasing. We provide a summarized update of the current knowledge of the pathobiology of acne vulgaris and new treatment concepts that have emerged in the last 3 years (2005-2008). We have tried to answer questions arising from the exploration of sebaceous gland biology, hormonal factors, hyperkeratinization, role of bacteria, sebum, nutrition, cytokines and toll-like receptors (TLRs). Sebaceous glands play an important role as active participants in the innate immunity of the skin. They produce neuropeptides, excrete antimicrobial peptides and exhibit characteristics of stem cells. Androgens affect sebocytes and infundibular keratinocytes in a complex manner influencing cellular differentiation, proliferation, lipogenesis and comedogenesis. Retention hyperkeratosis in closed comedones and inflammatory papules is attributable to a disorder of terminal keratinocyte differentiation. Propionibacterium acnes, by acting on TLR-2, may stimulate the secretion of cytokines, such as interleukin (IL)-6 and IL-8 by follicular keratinocytes and IL-8 and -12 in macrophages, giving rise to inflammation. Certain P. acnes species may induce an immunological reaction by stimulating the production of sebocyte and keratinocyte antimicrobial peptides, which play an important role in the innate immunity of the follicle. Qualitative changes of sebum lipids induce alteration of keratinocyte differentiation and induce IL-1 secretion, contributing to the development of follicular hyperkeratosis. High glycemic load food and milk may induce increased tissue levels of 5alpha-dihydrotestosterone. These new aspects of acne pathogenesis lead to the considerations of possible customized therapeutic regimens. Current research is expected to lead to innovative treatments in the near future.
Digital imaging of dermatology patients is a novel approach to remote data collection. A number of assessment tools have been developed to grade acne severity and to track clinical progress over time. Although these tools have been validated when used in a face-to-face setting, their efficacy and reliability when used to assess digital images have not been examined. The main purpose of this study was to determine whether specific assessment tools designed to grade acne during face-to-face visits can be applied to the evaluation of digital images. The secondary purpose was to ascertain whether images obtained by subjects are of adequate quality to allow such assessments to be made. Three hundred (300) digital images of patients with mild to moderate facial inflammatory acne from an ongoing randomized-controlled study were included in this analysis. These images were obtained from 20 patients and consisted of sets of 3 images taken over time. Of these images, 120 images were captured by subjects themselves and 180 were taken by study staff. Subjects were asked to retake their photographs if the initial images were deemed of poor quality by study staff. Images were evaluated by two dermatologists-in-training using validated acne assessment measures: Total Inflammatory Lesion Count, Leeds technique, and the Investigator's Global Assessment. Reliability of raters was evaluated using correlation coefficients and kappa statistics. Of the different acne assessment measures tested, the inter-rater reliability was highest for the total inflammatory lesion count (r = 0.871), but low for the Leeds technique (kappa = 0.381) and global assessment (kappa = 0.3119). Raters were able to evaluate over 89% of all images using each type of acne assessment measure despite the fact that images obtained by study staff were of higher quality than those obtained by patients (p < 0.001). Several existing clinical assessment measures can be used to evaluate digital images obtained from subjects with inflammatory acne lesions. The level of inter-rater agreement is highly variable across assessment measures, and we found the Total Inflammatory Lesion Count to be the most reliable. This measure could be used to allow a dermatologist to remotely track a patient's progress over time.
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a clinically heterogeneous entity, encompassing a variety of debilitating conditions that have in common inflammation of the skeletal system and skin. To date, there is a paucity of documented efficacious treatment options. We report a 48-year-old man with skeletal and cutaneous signs and symptoms who improved dramatically after treatment with a combination of isotretinoin and pamidronate. This report provides an alternative treatment regimen for SAPHO that addresses the possible underlying pathophysiology of this likely underdiagnosed syndrome.
The cytochrome P450 (CYP) enzyme CYP26 (retinoic acid [RA] 4-hydroxylase) initiates the catabolism of all-trans RA (tRA) and limits the effects of tRA. The CYP26 enzyme acts specifically on tRA, but not 13-cis RA (isotretinoin), a retinoid used to treat severe acne. However, 13-cis RA can isomerize to tRA, which can then be metabolized by CYP26.
In healthy individuals, we assessed the variability of CYP26 enzymatic activity. We then investigated whether response to oral 13-cis RA among patients with acne correlates with variability in CYP26 expression.
In healthy individuals, we isolated microsomal fractions from the epidermis of keratome biopsy specimens and measured CYP26 enzymatic activity in untreated skin and skin treated with tRA. Enzymatic activity was determined based on rate of formation of 4-hydroxy RA (pg/min/mg microsomal protein). Using real-time polymerase chain reaction we quantified CYP26 messenger RNA induction after tRA application in patients with acne who responded or did not respond to one course of 13-cis RA.
In normal-appearing skin (N = 118), CYP26 enzymatic activity was widely variable (1-180 pg/min/mg microsomal fraction; mean 42.7 +/- 3.5). Furthermore, CYP26 enzymatic activity was inducible in a dose-dependent manner in normal-appearing skin after tRA application, but not correlated with age or sex (N = 29). In patients with acne, CYP26 messenger RNA induction after 0.1% tRA application did not differ (P > .05) between patients who responded (N = 8, 587 +/- 325-fold) or did not respond (N = 8, 657 +/- 227-fold) to one course of 13-cis RA.
The small number of patients with acne treated with 13-cis RA was a major limitation.
Factors other than CYP26 activity may determine response to isotretinoin in acne.
Dapsone, a synthetic sulfone that has been available for over 60 years, has been used to treat a myriad of cutaneous disorders. Prior to the general acceptance of isotretinoin, oral dapsone had been reported to be effective in the treatment of nodulocystic acne. However, the potential for systemic toxicity prevented its widespread adoption in the treatment of acne. For many years scientists explored the possibility of developing a topical formulation of dapsone for the treatment of acne in the hope of minimizing the adverse hematologic effects of oral dapsone. Such a formulation had been unavailable until recently. Dapsone 5% gel (Aczone) was recently developed to treat acne vulgaris. This topical formulation was approved in the US based on two randomized, vehicle-controlled studies. A 12-month, open-label study was also conducted to assess the safety and efficacy of topical dapsone over the long term. Finally, two open-label phase I pharmacokinetic studies were conducted to evaluate the systemic absorption of topical dapsone compared with oral dapsone. This article reports the results of these studies, which show a reduction in acne lesion count comparable to those observed in clinical trials of other approved topical acne therapies. With regard to safety, the studies demonstrated that the concentrations of dapsone and N-acetyl dapsone remain low and do not accumulate over time once steady state is reached. Of the total of 50 patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency in all the studies, only two experienced a drop in hemoglobin levels, and those shifts in values were consistent with fluctuations observed for other study participants. A recent study evaluating the risk of hemolysis in patients with G6PD deficiency found topical dapsone 5% gel to be safe to use in this patient population. Based on the observations noted in the above-mentioned studies, we conclude that topical dapsone 5% gel is safe and effective in the treatment of acne vulgaris.
Data are lacking on the prevalence of acne, its effects on quality of life (QOL) and the treatment usage among Chinese patients in late adolescence.
To derive data about the prevalence and predictive factors of acne, the disability caused by acne and choice of treatment used by Chinese late adolescents in Hong Kong.
This was a cross-sectional study of a random sample of 389 entrants in a university in Hong Kong, using the Global Acne Grading System (GAGS) to measure the clinical severity of acne and the Cardiff Acne Disability Index (CADI) to measure QOL.
The response rate was 99.3%. The prevalence of acne was of 81.5% (95% CI 77.6-85.4%) and coexisted with a high frequency of acne disability at a rate of 81.8% (95% CI 78.1-85.6%). Assessment of the clinical severity of acne did not correlate strongly with the effect on QOL (gamma(s) = 0.445, P < 0.001). Over the previous 6 months, 30.3% of subjects had used topical treatments, 3.9% had taken systemic conventional western drugs and 3.2% of the subjects had used traditional Chinese medicine. Multivariate logistic regression was used to explore the predictive factors for acne disability. Female gender (P = 0.002), higher GAGS score (P < 0.001), higher perceived stress (P = 0.01) and willingness to pay Hong Kong$15,000 (970 pounds) for a hypothetical permanent cure (P = 0.03) were positive predictors.
Acne is prevalent in Hong Kong and has considerable psychological effects. The association between clinical severity and impaired QOL is not strong.
Combination therapy utilizing agents with complementary mechanisms of action is recommended by acne guidelines to help simultaneously target multiple pathogenic factors. A unique, topical, fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has recently been developed for the once-daily treatment of acne.
To evaluate the efficacy and safety of adapalene 0.1%-BPO 2.5% fixed-dose combination gel (adapalene-BPO) relative to adapalene 0.1% monotherapy (adapalene), BPO 2.5% monotherapy (BPO), and the gel vehicle (vehicle) in a large population for the treatment of acne vulgaris.
In total, 1670 subjects were randomized in a double-blind controlled trial to receive adapalene-BPO, adapalene, BPO or vehicle for 12 weeks (1 : 1 : 1 : 1 randomization). Evaluations included success rate (subjects 'clear' or 'almost clear'), percentage change in lesion count from baseline, cutaneous tolerability and adverse events.
Adapalene-BPO was significantly more effective than corresponding monotherapies, with significant differences in percentage lesion count change observed as early as 1 week. Cutaneous tolerability profile was similar to adapalene. Adverse events were more frequent with the combination therapy (mainly due to an increase in mild-to-moderate dry skin), occurred early in the study, and were transient.
Adapalene-BPO provides significantly greater and synergistic efficacy and a faster onset of action with an acceptable safety profile in the treatment of acne vulgaris when compared with the corresponding vehicle and the adapalene and BPO monotherapies.
Community-based studies of acne vulgaris conducted in many parts of the world show that it is very common in adolescents but little is known from Africa.
In a cross-sectional study, 539 randomly selected students aged 11-19 years in a secondary school in Kaduna, Nigeria were administered a questionnaire to assess self-report of acne, its severity and impact; beliefs and perceptions of causes, and treatments used. 418 students were later examined to detect and grade acne severity.
274 (50.8%) were male while 265 (49.2%) were female. Mean age for respondents was 16 years. 320 students (59.4%) self-reported acne. Of 418 students examined, 379 had acne giving a prevalence of 90.7%. There was no significant gender difference in prevalence at all ages of adolescence. Prevalence of acne increased with age (76.7% at age 10-13 years; 88.2% at age 14-16 years; 97.1% at age 17-19 years). 353 of 379 (93.1%) had mild acne while 26 of 379 (6.9%) had moderate acne. The severity of acne was similar in boys and girls. 47.7% of students reported feeling "very sad/unhappy" about their acne although in more than 70% of those who self-reported, this did not interfere with relationship with family, friends or school work. Diet was the commonest factor believed to cause acne. Cleansing agents were the most commonly used treatments.
Acne vulgaris is very common in Nigerian adolescents, although it is mild acne in most.
The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.
Oral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck's depression inventory [BDI]), anxiety (Beck's anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade.
Background:
Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. The most common cause is by increased production of male sex hormones (androgens). It is also affected by increased sensitivity to androgens in the hair follicles, and secretory glands around hair follicles (sebaceous glands). Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism.
Objectives:
The objective was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.
Search strategy:
The Cochrane Menstrual Disorders and Subfertility Group (MDSG) trials register was searched (April 2008). The Cochrane MDSG register is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.
Selection criteria:
All randomised controlled comparisons of spironolactone versus: placebo, steroids (oral contraceptive pill included), spironolactone of varying dosages, or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.
Data collection and analysis:
Nine trials were included in the review, eight trials were excluded. Two other trials are awaiting assessment. Only one trial studied acne as an outcome, the remainder were concerned with hirsutism. Major outcome measures include the following: subjective observations, Ferriman and Gallwey hair scores, hormonal and biochemical parameters, side effects, sebum production measurement.
Main results:
In the two trials that compared 100 mg of spironolactone with placebo significant differences were reported for subjective improvements in hair growth (OR 7.18, 95% CI 1.96 to 26.28), although not the Ferriman-Galwey score (WMD 7.20, 95% CI -10.98 to -3.42)). Data could not be otherwise pooled as only one trial reported an outcome.
Authors' conclusions:
From the studies included in this review, there is some evidence to show that spironolactone is an effective treatment to decrease the degree of hirsutism but there was no evidence for effectiveness for the treatment of acne vulgaris. Studies in this area are scarce and small. Individual study data indicates some superiority of spironolactone over other drugs but results cannot be generalised.
To evaluate the therapeutic effect and safety of acupuncture and moxibustion for treatment of acne, and to analyze the current situation of clinical studies at present.
Retrieve PubMed, Cochrane library, CBM databank, CNKI databank, etc., and collect the randomized and controlled trials of treatment of acne with acupuncture and moxibustion, and select clinical trials conforming with the enrolled criteria, and conduct evaluation of quality with Cochrane systematic manual 5.0, and RevMan 4.2.8 was used for statistical analysis.
Seventeen papers, including 1,613 cases, conformed with the enrolled criteria. Seventeen studies adopted the cured rate as the evaluation index, Meta-analysis showed treatment of acne by acupuncture and moxibustion with routine western medicine as control, significant difference for inter-group comparison [combined RR (random efficacy model) = 2.96, 95% CI (1.63, 4.91), Z=4.08. P<0.0001]; comprehensive acupuncture and moxibustion therapy was controlled with single acupuncture moxibustion therapy, significant difference for inter-group comparison [combined RR (fixed efficacy model) = 2.51, 95% CI (1.76, 3.57), Z=5.11, P<0.00001].
Acupuncture-mox ibustion is safe and effective for treatment of acne, and it is possibly better than routine western medicine, and the comprehensive acupuncture-moxibustion therapy is better than single acupuncture-moxibustion therapy. The conclusion has not been determined yet, because lower quality of a part of literature enrolled.
