The psychosocial impact of acne: patients' perceptions

Comparison of 70% and 100% concentration of trichloroacetic acid peeling efficacy with chemical reconstruction of skin scars technique in atrophic acne scar treatment

INTRODUCTION

The CROSS (Chemical Reconstruction of Skin Scars) technique employs high concentrations of trichloroacetic acid (TCA). This study aimed to compare the efficacy, safety, and tolerability of the CROSS technique using 70% and 100% TCA.

METHODS

A total of 40 patients were randomly assigned to two equal groups of 20: the first group received 70% TCA, while the second group was treated with 100% TCA. Both patient-reported outcomes and researcher assessments were utilized to evaluate treatment success. The intensity of the burning sensation experienced during the procedure was quantified, and the duration of the frosted appearance was recorded.

RESULTS

The mean age of participants was 27.07 ± 5.48 years in the 70% TCA group and 23.5 ± 2.9 years in the 100% TCA group. No significant differences were observed between post-treatment scores provided by patients and researchers. However, within the 100% TCA group, treatment efficacy was significantly greater for icepick scars than for boxcar scars. Additionally, crusting durations were significantly prolonged in the 100% TCA group.

CONCLUSION

No significant differences in overall efficacy were observed between the two treatment groups. Notably, the crusting time following the procedure was longer in the group treated with 100% TCA.

Microneedling With Topical Insulin Versus Microneedling With Placebo in the Treatment of Postacne Atrophic Scars: A Randomized Control Trial

BACKGROUND

Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method.

OBJECTIVE

To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars.

METHODS AND MATERIALS

Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools.

RESULTS

Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects.

CONCLUSION

Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.

Acne, self-esteem, and mental health: a scoping review

Acne vulgaris is one of the most common skin diseases worldwide, with a prevalence ranging from 20-95%. Given the effect of acne on one's psychological well-being, investigating this relationship is important. This review aims to synthesize the main findings on the relationship between acne, self-esteem, and mental health. The SciELO, PubMed, PsycINFO, Scopus, and Web of Science databases were searched. We used the Joanna Briggs Institute methodology for scoping reviews and the PRISMA protocol and Rayyan tool for the selection and inclusion of studies. The terms used in the electronic search were 'acne' and 'self-esteem'. After reading the abstracts and applying the inclusion and exclusion criteria, 10 studies were selected for quantitative synthesis. The findings of this study indicate that patients with acne experience more mental health disorders, with their subjective perceptions linked to depression, anxiety, and incapacity. Females tend to have lower self-esteem, and their assessments vary depending on the evaluation method used. These results clarify the relationship between acne, self-esteem, and mental health. Furthermore, they provide evidence of factors that increase vulnerability to psychological impacts associated with acne. In conclusion, the literature emphasizes the importance of ongoing research on acne, its impact on self-esteem, and its relationship with other psychological dimensions. While acne is not lethal, it can be disabling, lead to suffering, and negatively affect daily functioning. Effective treatment of this condition requires an integrated approach that combines medical and psychological care.

The impact of social media information exposure on appearance anxiety in young acne patients: a moderated chain mediation model

Introduction

The boom of social media has provided a wider space for ordinary people to display themselves, but visual presentation has also intensified the focus on appearance, which in turn triggers anxiety about appearance. The study aims to investigate the impact of social media information exposure on appearance anxiety in young acne patients and the pathways and mechanisms that cause this effect.

Methods

A moderated chain mediation model was constructed, and a questionnaire was used to collect information on social media information exposure, internalization of beauty ideals, fear of negative evaluation, self-esteem, and appearance anxiety in young acne patients (N = 382), and the relationships between the variables were explored through regression analysis.

Results

The results show that there was a significant path of effect (t > 2.5, p < 0.05) between social media information exposure, internalization of beauty ideals, fear of negative evaluation, and appearance anxiety. Self-esteem significantly moderated the relationship between social media information exposure and internalization of beauty ideals (t < -2, p < 0.05).

Discussion

In conclusion, in young acne patients, internalization of beauty ideals and fear of negative evaluation chain mediated the association between social media information exposure and appearance anxiety, and young acne patients' internalization of beauty ideals was inversely correlated with their level of self-esteem.

Acne influences life-changing decisions among young adults

BACKGROUND

Acne is a chronic inflammatory disease predominantly affecting young people. This study was undertaken to assess the impact of acne in young adults on their major life-changing decisions (MLCD), paying attention to the relationships between major life-changing decisions profile (MLCDP) and Quality of Life (QoL), feeling of stigmatization and acceptance of the disease.

METHODS

The study was performed on 213 young people diagnosed with acne. A variety of questionnaires were employed to measure the clinical and psychological aspects of acne.

RESULTS

The majority of patients (N.=148, 73.3%) reported at least one MLCD that acne affected in any way (mean number 2.9±3.2, range: 0-18). The most common MLCD influenced by acne appeared to be a decision of changing eating habits (N.=132, 65.3%), followed by changing habits associated with smoking and alcohol (N.=85, 42.1%) and deciding to be more active physically (N.=61, 30.2%). The total score of MLCDP ranged from 0 to 33 points (mean 5.41±6.23 points). MLCDP total score significantly correlated with clinical acne severity (P=0.006), QoL (P<0.001), stigmatization (P<0.001) and illness acceptance (P<0.001).

CONCLUSIONS

Acne has an important impact on life-changing decisions in young adults. MLCDP correlates with impaired QoL, level of stigmatization and degree of illness acceptance. This should be taken into consideration in the holistic approach to acne patients.

Understanding the impact of acne vulgaris and associated psychological distress on self-esteem and quality of life via regression modeling with CADI, DLQI, and WHOQoL

Acne vulgaris (AV) is a psychosomatic disorder and can negatively affect individuals, especially in terms of psychological well-being, self-esteem, and quality of life (QoL). The current study aimed to investigate the association between AV and psychological health, as well as the influence of acne and psychological distress in predicting patients' self-esteem and QoL. This cross-sectional study included 150 patients clinically diagnosed with AV. The severity of acne was measured using GAGS, and following that, patients were instructed to complete the following forms: DASS-21, RSES, CADI, DLQI, and WHOQoL. Female AV patients had significantly higher depression (p = 0.003, t = 3.025) and anxiety (p < 0.001, t = 3.683). Pearson's correlation analysis indicated a strong, positive, and significant correlation between having acne and experiencing depression (r = 0.630), anxiety (r = 0.661), and stress (r = 0.758) (p < 0.001). Multiple regression analysis suggested acne and associated psychological distress had a significant and negative impact on the patient's self-esteem and quality of life. This study highlights the multifaceted consequences of AV and the need to manage its psychological distress. It emphasizes the need for holistic patient care that addresses acne's physical and emotional aspects, with the ultimate goal of enhancing well-being and QoL.

DMT310, a novel once-weekly topical treatment for patients with moderate-to-severe acne vulgaris: Results of a phase 2b randomized, double-blind, placebo-controlled trial

BACKGROUND

Poor patient adherence with antiacne medications is a common clinical challenge. DMT310, a natural, topical product with a once-weekly application schedule, may alleviate this obstacle.

OBJECTIVE

Evaluate the safety, tolerability, and efficacy of DMT310 in treating moderate-to-severe acne.

METHODS

This 12-week, randomized, double-blind, placebo-controlled, multicenter clinical trial enrolled participants 12 years and older with moderate-to-severe acne.

RESULTS

The intent-to-treat population included a total of 181 participants (DMT310, N = 91; placebo, N = 90). Participants who received DMT310 vs participants treated with placebo demonstrated a statistically significant greater reduction in the number of inflammatory and noninflammatory lesions at all time points: inflammatory lesion counts at week 12 (-15.64 vs -10.84, P < .001); noninflammatory lesion counts at week 12 (-18.26 vs -12.41, P < .001). DMT310-treated participants also had higher rates of Investigator's Global Assessment treatment success than participants in the placebo group at all time points: Investigator's Global Assessment at week 12 (44.40% vs 17.78%; P < .001). No serious treatment related adverse events occurred.

CONCLUSIONS

DMT310 once-weekly topical treatment significantly reduced both inflammatory and noninflammatory lesions and yielded a greater proportion of Investigator's Global Assessment treatment success at all time points in participants with moderate-to-severe acne.

Novel 1726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types

BACKGROUND

Traditional acne management with topical therapy, systemic antibiotics, hormonal agents, or oral isotretinoin requires compliance and may produce significant side effects. However, alternative treatments with lasers had failed to demonstrate durable clearance.

OBJECTIVE

To assess the tolerability and therapeutic outcomes of a novel 1726 nm laser treatment of moderate-to-severe acne across skin types.

METHODS

A prospective, open-label, single-arm, Investigational Device Exemption-approved, institutional review board-approved study of 104 subjects with moderate-to-severe facial acne and Fitzpatrick Skin Types ranging from II-to-VI was conducted. Subjects received 3 laser treatments at 3 (-1/+2)-week intervals.

RESULTS

Following final treatment, ≥50% reduction in active acne inflammatory lesions was 32.6% at 4-weeks follow-up, increasing further to 79.8% and 87.3% at 12 and 26-weeks, respectively. The percentage of subjects clear or almost clear increased from 0% at baseline to 9%, 36.0%, and 41.8% at 4-, 12-, and 26-weeks follow-up. No serious adverse events were observed related to device or protocol; treatments were well tolerated, requiring no anesthetic. Therapeutic outcomes and discomfort were similar across all skin types.

LIMITATIONS

Lack of control group.

CONCLUSIONS

The study findings demonstrate the novel 1726 nm laser is well tolerated with durable progressive posttreatment improvement to at least 26 weeks for moderate-to-severe acne across skin types.

Efficacy of fractional CO2 laser therapy combined with hyaluronic acid dressing for treating facial atrophic acne scars: a systematic review and meta-analysis of randomized controlled trials

The present work aimed to systematically identify the efficacy and safety of fractional carbon dioxide (CO2) laser plus hyaluronic acid (HA) dressing in dealing with facial atrophic acne scars. Randomized controlled trials (RCTs) concerning fractional CO2 laser in combination with HA dressing for treating atrophic acne scars were screened in 8 electronic databases (containing PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet, Wanfang, Sinomed as well as VIP). Besides, for the purpose of evaluating the risk of bias of the enrolled RCTs, the Cochrane Collaboration tool was adopted. Statistical analysis was completed using Revman5.3 software and Stata 14.0 software. Meanwhile, the quality of evidence was assessed by the GRADE system. Finally, 6 studies involving 623 patients were enrolled. According to the findings in this study, compared with fractional CO2 laser alone, fractional CO2 laser therapy combined with HA dressing reduced the scores of ECCA (échelle d'évaluation clinique des cicatrices d'acné) grading scale (MD=-3.37,95% CI [-5.03, -1.70], P<0.0001), shortened the time of crust formation (MD=-0.42,95% CI [-0.80, -0.04], P=0.03) and the time of crust removal(MD=-1.31,95% CI [-1.67, -0.95], P<0.00001), enhanced patient satisfaction (RR=1.85, 95% CI [1.44, 2.38], P<0.00001). All the reported adverse events including hyperpigmentation, erythema, edema, mild itching, and slight burning pain were controllable. In addition, fractional CO2 laser combined with HA dressing therapy had a lower incidence of hyperpigmentation than fractional CO2 laser alone (RR=0.37, 95% CI [0.23, 0.61], P<0.0001). The level of evidence for outcomes was classified to be low to moderate. According to our findings, fractional CO2 laser combined with HA dressing is efficacious and safe option for facial atrophic acne scars. Nevertheless, more high-quality trials are required for further verification in the future.

A Single Center, Prospective, Randomized, Blinded Study to Evaluate the Efficacy and Safety of a Topical Tripeptide/Hexapeptide Anhydrous Gel When Used Pre- and Post- Hybrid Fractional Laser for the Treatment of Acne Scars

Background

Acne scarring remains a significant problem. Laser therapy has produced varying results with deeper ablative therapies occasionally associated with side effects including delayed healing, infection, scarring, erythema, acne, milia, edema and dyspigmentation.

Objective

Can adjuvant topical therapy impact the healing process and outcome of patients treated with fractional laser for acne scarring?

Methods and Materials

Ten patients were randomized to receive either Regenerating Skin Nectar with TriHex Technology^®- RSN or a bland moisturizer. Patients underwent two laser procedures one month apart with Hybrid Fractional Laser. The topical was applied twice daily for 2 weeks prior to the first laser procedure, and through completion of the study. Seven study visits occurred over a 90-day period. Measurements were conducted in lesional and non-lesional areas - transepidermal water loss (TEWL), erythema, photography, Goodman and Baron qualitative scale, Global Aesthetic Improvement Scale and patient questionnaires - to assess functional recovery and aesthetic outcomes in the scarred areas. One patient from each cohort consented to biopsy before the procedures and 90 days after the first procedure.

Results

Reduced TEWL scores in the RSN group were evident at all time points with statistically significant reductions occurring 4 days after first and second procedures indicating more efficient fluid conservation at a critical point in the healing trajectory. Erythema index demonstrated a consistent decrease in the RSN cohort over the control from day 4 through day 90 on lesional and non-lesional skin. Acne scar assessment scores improved in the RSN cohort compared with the control at all time points. Biopsy results showed early elastin regeneration in the RSN biopsy with controlled non-hypertrophic collagen formation evident.

Conclusion

The use of RSN pre- and post- laser resurfacing significantly decreased postprocedural TEWL and erythema, and increased aesthetic improvement in acne scars and patient satisfaction, when compared with bland moisturizer.

A novel 1726-nm laser system for safe and effective treatment of acne vulgaris

Selective photothermolysis of the sebaceous glands has the potential to be an effective alternative for treating acne vulgaris. However, the translation of this technique to clinical settings has been hindered by a lack of appropriate energy sources to target sebaceous glands, concerns surrounding safety, and treatment-related discomfort and downtime. In this work, we introduce the first FDA-approved system that combines a 1726-nm laser and efficient contact cooling to treat mild, moderate, and severe acne effectively while ensuring safety and minimal patient discomfort without adjunct pain mitigation techniques. Light transport and bioheat transfer simulations were performed to demonstrate the system's efficacy and selectivity. The resulting thermal damage to the skin and sebaceous glands was modeled using the Arrhenius kinetic model. Numerical simulations demonstrated that combining laser energy and optimal contact cooling could induce a significant temperature increase spatially limited to the sebaceous gland; this results in highly selective targeting and maximum damage to the sebaceous gland while preserving other skin structures. In vivo human facial skin histology results corroborated the simulation results. The studies reported here demonstrate that the presented 1726-nm laser system induces selective photothermolysis of the sebaceous gland, providing a safe and effective method for the treatment of acne vulgaris.

Safety and efficacy of fractional radiofrequency for the treatment and reduction of acne scarring: A prospective study

OBJECTIVES

Skin rejuvenation with radiofrequency has been a widely used treatment modality for the safe and efficient remodeling of the dermis and revision of textural irregularities, achieved with minimal downtime. The efficacy of fractional radiofrequency (FRF) specifically for acne scarring has not been widely established. The objective of this clinical trial was to establish the efficacy and safety of FRF for moderate to severe acne scarring in a wide range of Fitzpatrick skin types using two different applicator tips to deliver energy to the skin (80-pin of up to 124 mJ/pin and 160-pin of up to 62 mJ/pin).

METHODS

Enrolled subjects received a series of three FRF treatments to the full face, each 4 weeks apart. A visual analog scale was utilized to assess pain of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Photographs were graded for change by three blinded evaluators using the Global Aesthetic Improvement Scale (GAIS).

RESULTS

Image sets of 23 enrolled subjects were assessed by blinded evaluation, showing a statistically significant improvement (p = 0.009) from the baseline visit to the 12-week follow-up on the GAIS for acne scarring. Subject satisfaction was high with subjects giving an average satisfaction score of 3.27 ("satisfied") out of 4. Pain was "mild" as treatments were rated an average of 2.15 on a 10-point visual analog scale. The GAIS score of the 80-pin tip improved patients' acne scars treated with that applicator by 1.06 points and 0.85 for the 160-pin tip. Ninety-five percent (95.5%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Ninety-one percent of subjects reported that they would recommend the treatment to a friend.

CONCLUSION

FRF produced a statistically significant improvement in acne scarring when assessed by independent blinded evaluators. No serious adverse events resulted from treatment by either applicator tip. Treatment pain was low and tolerable among subjects of all Fitzpatrick skin types. Subjects had high levels of satisfaction with the results.

Negative perceptions and emotional impact of striae gravidarum among pregnant women

Background

The impact of striae gravidarum (SG), or stretch marks of pregnancy, on quality of life (QoL) is unclear.

Objective

The purpose of this study was to investigate how SG affect QoL in pregnant women.

Methods

In this cross-sectional survey study of healthy pregnant women who developed SG during their current pregnancy, we asked about the impact of lesions on emotional, psychological, and life-quality facets. Spearman product-moment correlation coefficients were generated to determine the strength of relationships between variables.

Results

We analyzed 116 valid surveys. Participants reported permanency of SG as the top physical concern (n = 87; 75%). With regard to severity, nearly three-quarters of participants rated their lesions as very prominent (n = 24; 21%) or moderate (n = 57; 49%). Among the life-quality facets queried, embarrassment/self-consciousness was the most frequently associated with SG, with over one-third of participants reporting “a lot” (n = 19; 16%) or a “moderate” (n = 26; 22%) amount of embarrassment/self-consciousness related to having SG. Lesion severity significantly correlated with the degree of embarrassment/self-consciousness (r = .543), as well as the impact of SG on other life-quality facets, including overall QoL (r = .428), clothing choice (r = .423), self-image/self-esteem (r = .417), feelings of anxiety/depression (r = .415), and social activities (r = .313; all p ≤ .001). Nearly one-quarter of participants believed that emotional distress related to SG was similar or greater than that caused by other skin problems, such as acne, psoriasis, or eczema.

Conclusion

SG can be associated with a host of negative reactions reflecting increased psychological and emotional distress, including embarrassment and decreased QoL. These consequences may compound the emotional stress of pregnancy, potentially warranting psychological support and adjustment strategies.

Emulgel for improved topical delivery of Tretinoin: Formulation design and characterization

OBJECTIVES

The chief objective of the present research was to reduce local side effects by reducing the dose, controlling the release, and improving the stability by developing and optimizing tretinoin (TRT)-loaded topical emulgel formulation.

METHODS

TRT emulgel (TE) was prepared and optimized at varying ratios of excipients and using 3² optimal response surface design (ORSD). The TRT emulgel was optimized based on TRT content and in vitro release profile of TRT from formulated emulgel batches. The optimized TRT was characterized for physical properties, pH, viscosity, spreadability, extrudability, photomicroscopy, in vitro anti-acne, in vivo skin irritation, in vivo anti-inflammatory activity, and stability study.

RESULTS

The FTIR and DSC analysis revealed the compatibility between TRT and formulation excipients of emulgel. The batch F5 of emulgel formulation displayed maximum drug content (98.69±1.26%), and controlled TRT release (78.27±0.69%). Thus, batch F5 was selected as an optimized batch for further characterization. The photomicroscopic analysis of optimized TE exhibited the presence of spherical globules. The pH and viscosity of optimized TE were found to be 6.20±0.12 and 3240cP respectively. Besides, the optimized TE showed good spreadability and extrudability. The in vitro anti-acne activity against Propionibacterium acne (P. acne) of optimized TE (diameter of zone of inhibition 34.54±0.26mm) was found to be the comparatively same as that of marketed Sotret® gel (diameter of zone of inhibition 36.13±0.43mm). Moreover, no sign of irritation was observed in rats treated with optimized TE indicating the safety of TE. Furthermore, the optimized TE displayed significant (p<0.01) in vivo anti-inflammatory activity when compared to marketed gel. Besides, optimized TE was found to be stable when stored in cool conditions for three months.

CONCLUSION

Thus, the emulgel could be a promising approach for the topical delivery of TRT with improved performance and reduced side effects.

Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research

OBJECTIVES

The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs).

DESIGN

Systematic review and synthesis of qualitative papers.

METHODS

Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings.

RESULTS

A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people's experience of acne and HCPs' attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was 'trivialised' by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others.

CONCLUSIONS

People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use.

PROSPERO REGISTRATION NUMBER

CRD42016050525.

Effectiveness of CO2 laser therapy in treating acne depressed scar: A protocol of systematic review

BACKGROUND

This study is to assess the effectiveness of CO2 laser therapy (COLT) in treating patients with acne depressed scar (ADS).

METHODS

Relevant randomized controlled trials will be checked by search the electronic databases of Cochrane Library, PUBEMD, EMBASE, Web of Science, Allied and Complementary Medicine Database, VIP Database, CBM database, and China National Knowledge Infrastructure. All potential randomized controlled trials of COLT for patients with ADS will be identified by 2 independent authors by searching all sources from inception to present. Two authors will independently undertake literature selection, data collection and study quality assessment. Any divergences between 2 authors will be settled down by a third author through discussion. RevMan 5.3 software will be used for statistical analysis.

RESULTS

This study will assess the effectiveness of COLT for patients with ADS.

CONCLUSIONS

This study may provide helpful evidence to determine whether COLT is an effective intervention for patients with ADS.

STUDY REGISTRATION

OSF (osf.io/m9ghv).

Topical Nano-emulgel for Skin Disorders: Formulation Approach and Characterization

BACKGROUNDS

Acne vulgaris is a common chronic skin disease that affects around 9.4% (approx. 650 million people) of the global population. Growing research in the field of nanomedicine over the years has now been exploited in management of various human disorders. The nanomedicine concept has an immense opportunity for the effective management and control of acne disease by designing a novel, low-dose topical delivery system. Topical nanoemulsion-based gel preparations are said to have various benefits over the conventional formulations. The recent patents on topical anti-acne formulation (US 7241456B2; US 6897238B2; US 6284234B1) provided the concept to design thymol loaded nano-emulgel for topical application in acne.

METHODS

The objective of the current investigation was to design a thymol loaded nanoemulgel preparation by exploiting low-energy emulsification method for topical application in acne. Furthermore, developed formulation was characterized for thermodynamic stability, mean droplet size, zeta potential, drug content and in-vitro drug diffusion study.

RESULTS

The optimized thymol loaded nanoemulsion was found to be 13.60±0.117 nm with PdI 0.197±0.008. Nanoemulsions will provide an enormous surface area for better penetration of therapeutic agent into the pilosebaceous region, resulting better efficacy.

CONCLUSIONS

From the above studies, it concluded that aqueous-based gel vehicle of the developed formulation system exploited for topical delivery has moisturising properties which can improve local tolerability also.

Identifying the Impacts of Acne: A Delphi Survey of Patients and Clinicians

BACKGROUND

Acne can adversely impact those affected in multiple dimensions. The purpose of this study was to determine the most prominent impacts identified by acne patients and by clinicians.

METHODS

Independent Delphi surveys for acne patients and clinicians were conducted to achieve consensus regarding acne impacts within each group. Acne patients were recruited from outpatient clinics of authors (AL, JT, and DT). The first phase involved qualitative responses, where emergent themes were identified and used to generate items for 2 subsequent phases.

RESULTS

The qualitative phase generated 64 items in 3 themes: psychological, sociological, and treatment related. These items were independently ranked in importance by patients and by clinicians. Consensus for importance was achieved for 34 items by patients and 43 by clinicians. Patient-identified highest ranked items were being self-conscious, feeling unattractive, feeling uncomfortable in own skin, unattractive to others, would not want pictures taken, envious of people with clear skin, and time/effort spent concealing scarring; while clinicians identified feeling unattractive.

CONCLUSIONS

We identify acne impacts within psychological, sociological, and treatment-related domains by acne patients and clinicians. Further, we establish discrepancies between patients and clinicians regarding the impact of acne. This provides evidence for the importance of establishing patient-reported outcomes.

Platelet-rich plasma in noninvasive procedures for atrophic acne scars: A systematic review and meta-analysis

BACKGROUND

The use of platelet-rich plasma (PRP) combined with noninvasive, nonenergy procedures for atrophic acne scars has shown promise. To date, there has not been a systematic review or meta-analysis of the effectiveness of this therapy.

AIMS

To use meta-analysis to compare Goodman and Baron qualitative scores, patient satisfaction outcomes, and adverse effects in patients undergoing combination procedures with PRP, combination procedures without PRP, and noninvasive monotherapy without PRP in the treatment of patients with atrophic acne scars.

PATIENTS/METHODS

The Pubmed and Cochrane library databases were searched for relevant studies published before May 1, 2019. PRISMA guidelines were utilized. Studies that compared the use of PRP in combination with a noninvasive procedure and therapies without PRP for the treatment of atrophic acne scars were included. Cochrane's handbook was utilized to assess the individual biases of the included studies. Publication bias was assessed.

RESULTS

A total of 311 participants (153 whole-face participants and 158 split-face participants) were reviewed across eight included studies. Quantitative analysis of 241 participants across six included studies showed a statistically significant reduction in scar severity scores in favor of microneedling or subcision with PRP (P < .001). Combination therapy with intradermal or topical PRP was significantly more effective than monotherapy alone and combination therapy with an adjunct other than PRP (P < .001 and .001, respectively).

CONCLUSION

This systematic review and meta-analysis demonstrated that microneedling or subcision with PRP produced statistically significant improvement in validated outcomes over microneedling or subcision alone.

A Prospective Study of Fractionated Dual-Wavelength Picosecond Laser in Treating Acne Scar

BACKGROUND AND OBJECTIVES

The picosecond (PICO) laser has been a new and promising device. But, so far, there have not been many prospective studies investigating the efficacy in acne scar treatment. This study evaluated the efficacy and safety of the dual-wavelength picosecond laser in the treatment of acne scar.

STUDY DESIGN/MATERIALS AND METHODS

A total of 20 patients with skin type III-IV were enrolled in this study. Eighteen patients completed the study. All patients completed six treatment sessions within a 1-month interval. All patients were treated using both 532 and 1,064 nm fractionated dual-wavelength picosecond handpieces. In evaluation, Goodman and Baron's quantitative global acne scarring grading system (GSS) was scored by two physicians. Patients also judged the results themselves by Visual Analog Scale (VAS) and pain score.

RESULTS

The average baseline score of GSS quantity and quality were 15.22 and 3.00, respectively. The final scores were 10.61 and 2.33. The average baseline of patient VAS score was 4.28. The final score was 2.00. All scores achieved statistical significance (P < 0.05). No serious long-term side effects were recorded.

CONCLUSION

Acne scar treatment with the fractionated dual-wavelength picosecond laser has shown both efficacy and safety in this study. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

The Validity of Cutaneous Body Image as a Construct and as a Mediator of the Relationship Between Cutaneous Disease and Mental Health

Introduction

Cutaneous body image (CBI) is a construct encompassing how individuals perceive their hair, skin, and nails. Negative CBI has been related to negative psychological outcomes and body image concerns. The first aim of our study was to further validate CBI as a construct. Second, as individuals with dermatologic conditions are at an increased risk for anxiety and depression, the study examined CBI as a mediator of the relationships between having a skin condition and anxiety and depression.

Methods

A convenience sample of clinical participants with dermatologist-validated diagnoses of psoriasis, atopic dermatitis, or acne who were currently taking systemic medication (n = 128) were matched to a sample of comparison participants without skin conditions (n = 128) on self-reported gender, ethnicity, developmental stage, and weight status (body mass index). All participants reported on their CBI, self-esteem (global, appearance-related, and weight-related), body dissatisfaction, drive for thinness, dietary restraint, anxiety, depression, and demographic characteristics.

Results

Cutaneous body image was more negative in those respondents with skin conditions (regression analysis B = − 0.61, standard error 0.23, p = 0.008), demonstrating the criterion-related validity of the measure. CBI was significantly correlated with global (r  = 0.39, p  < 0.001) and appearance-related self-esteem (r  = 0.50, p  < 0.001), which establishes convergent validity. CBI was not significantly related to a drive for thinness (r  = − 0.12, p  = 0.06) or to dietary restraint (r  = − 0.05, p  = 0.39), supporting discriminant validity. CBI mediated the relationships between having a dermatologic condition and anxiety [point estimate of indirect effect 0.07, 95% confidence interval (CI) 0.02, 0.15] and depression (point estimate of indirect effect 0.04, 95% CI 0.01, 0.08).

Conclusions

The measure of CBI has been further validated. Dermatologists must be aware that various dermatoses may impact patient mental health via the mechanism of negative CBI.

Electronic supplementary material

The online version of this article (10.1007/s13555-020-00351-5) contains supplementary material, which is available to authorized users.

Young people's perceptions of acne and acne treatments: secondary analysis of qualitative interview data

Background

Acne vulgaris is a common skin condition affecting approximately 95% of adolescents to some extent. First‐line treatments are topical preparations but nonadherence is common. A substantial proportion of patients take long courses of oral antibiotics, associated with antibiotic resistance.

Objectives

This study aimed to explore young people's views and experiences of acne and its treatments.

Methods

We report a secondary thematic analysis of interview data collected by researchers in the Health Experiences Research Group (HERG), University of Oxford. A total of 25 transcripts from young people aged 13–24 years with acne were included.

Results

Acne is often perceived as a short‐term self‐limiting condition of adolescence and this appears to have implications for seeking treatment or advice. Participants widely perceived topical treatments as being ineffective, which seemed related to unrealistic expectations around speed of onset of action. Many participants felt they had tried all available topical treatments, although were unsure what was in them or unaware of differences between cosmetic and pharmaceutical treatments. They had concerns around how to use topicals ‘properly’ and how to avoid side‐effects. They were also concerned about the side‐effects or necessity of oral treatments, although few seemed aware of antibiotic resistance.

Conclusions

People with acne need support to manage their condition effectively, particularly a better understanding of different topicals, how to use them and how to avoid side‐effects. Unrealistic expectations about the onset of action of treatments appears to be a common cause of frustration and nonadherence. Directing people towards accessible evidence‐based information is crucial.

What's already known about this topic?

There is a common perception that acne is a short‐term condition that will resolve without treatment.

Previous research has shown that nonadherence to topical treatments is common and that oral antibiotics are the most commonly prescribed treatment for acne in the U.K.

Further research is needed to understand how young people perceive acne treatments and the implications of this for treatment adherence and self‐management.

What does this study add?

People often said they had tried all available topical preparations for acne, but seemed confused between cosmetic and pharmaceutical treatments.

People seemed unsure how to use topical treatments ‘properly’ or how to avoid side‐effects. This was rarely discussed with health professionals.

People's perception of acne as a short‐term condition appeared to influence their expectations around onset of action of treatment and their views about its effectiveness and necessity.

What are the clinical implications of the work?

The perception of acne as a short‐term condition has implications for self‐management and motivation to seek and adhere to treatments.

Providing advice about onset of action of treatments and how to prevent side‐effects is crucial, including directing people towards accessible, written, evidence‐based information.

People's confusion about the different topical treatments available may be alleviated by such information, or by encouraging photos or other recordings of treatments tried and for how long.

Linked Comment: Prior. Br J Dermatol 2020; 183:208–209.

Linked Comment: Prior. Br J Dermatol 2020; 183:208–209.

Plain language summary available online

The combined effect of tranilast 8% liposomal gel on the final cosmesis of acne scarring in patients concomitantly treated by isotretinoin: prospective, double-blind, split-face study

BACKGROUND

Tranilast [N-(3,4-dimethoxycinnamoyl) anthranilic acid] has never been investigated for the prevention and treatment of acne scars.

AIM

To evaluate the efficacy and safety of tranilast 8% gel in improving the final appearance of patients with acne scarring concomitantly treated by isotretinoin.

METHODS

This was a prospective, double-blind, split-face study, which enrolled 40 otherwise healthy participants (aged 18-49 years) with facial acne scars. For each patient, one half of the face were treated with tranilast 8% liposomal gel and the other half with a water-based placebo. Using the Global Aesthetic Improvement Scale (GAIS), acne scars were evaluated by two dermatologists and by the patients, and the patients also rated their satisfaction with the treatment and reported adverse effects.

RESULTS

In total, 32 participants completed the trial. The mean GAIS scores at 5 months post-treatment were significantly lower (better outcome) for the tranilast-treated side than the placebo-treated areas in patients concomitantly treated with isotretinoin (P < 0.001). All the isotretinoin-treated patients reported greater satisfaction and better general improvement in the skin's appearance and texture, and also greater improvement of pigment and redness on the tranilast 8% gel-treated side compared with the control side.

CONCLUSION

Combined topical application of tranilast 8% gel twice daily with oral isotretinoin treatment in the active phase of acne vulgaris may result in fewer scars, finer skin texture and enhanced appearance.

Cutaneous leishmaniasis in Sri Lanka: effect on quality of life

BACKGROUND

The quality of life in many patients is affected by skin lesions. Cutaneous leishmaniasis (CL), the commonest form of leishmaniasis, is no exception. In Sri Lanka, CL is an emerging parasitological condition with over 3,000 cases within the last decade. Lesions are often seen on exposed parts of the body which may cause social stigma, and hence a study was done to assess the changes in quality of life of CL patients.

METHOD

A total of 294 patients (200 civilians and 94 army personnel) answered a previously validated Sinhala self-administered Dermatology Life Quality Index (DLQI) questionnaire and an interviewer-administered questionnaire.

RESULTS

From the majority of the civilian population, 47% had no effect on their quality of life due to CL lesions, 33.5% were affected in a small way, 12.5% were affected moderately, 6.5% suffered in a large way, and 0.5% (one patient) were extremely affected due a large ulcerative lesion being on the face. The effect on quality of life was negligible in the majority of army patients as well (35.1% no effect, 31.9% small effect), with a few patients affected moderately and very largely (22.3 and 10.6%, respectively). The most affected domain in patients was symptoms and feeling 1.27 ± 1.400 (mean ± SD), and the least was the relationships domain 0.27 ± 0.625.

CONCLUSION

CL does not seem to affect the quality of life in the majority of Sri Lankan patients when compared to CL in other parts of the world or other skin diseases.

Acne Scarring Management: Systematic Review and Evaluation of the Evidence

BACKGROUND

Modalities for atrophic acne scarring can be classified depending upon the needs they satisfy; that is, resurfacing, lifting/volumization, tightening, or surgical removal/movement of tissue that is required for correction. A plethora of treatment options have resulted from the need to treat various acne scar types, variability of responses noted in various skin types, and increasing popularity of minimally invasive modalities. Still, there is a lack of consensus guidelines on treatment or combination therapies for various clinical scenarios.

OBJECTIVE

This systematic review includes a critical evaluation of the evidence relevant to these modalities and various multimodality therapies.

METHODS

We performed a systematic literature search in Medline and EMBASE databases for studies on acne scar management. Also, we checked the reference lists of included studies and review articles for further studies. A total of 89 studies were included in our quality of evidence evaluation.

RESULTS

The efficacy of lasers and radiofrequency in atrophic acne scarring is confirmed by many comparative and observational studies. Other modalities can be used as an adjunct, the choice of which depends on the type, severity, and number of atrophic scars. Minimally invasive procedures, such as fractional radiofrequency and needling, provide good outcomes with negligible risks in patients with dark or sensitive skin types.

CONCLUSIONS

There is a lack of high-quality data. Fractional lasers and radiofrequency offer significant improvement in most types of atrophic acne scars with minimal risks and can be combined with all other treatment options. Combination therapies typically provide superior outcomes than solo treatments.

A Comparative Study of Combined Dermaroller and Platelet-Rich Plasma Versus Dermaroller Alone in Acne Scars and Assessment of Quality of Life Before and After Treatment

Background:

Scarring due to acne is a frequently encountered problem in dermatological outpatient department. Microneedling has been a well-accepted modality for the treatment of atrophic acne scars. Platelet-rich plasma (PRP) is a newer option to investigate.

Aims:

The aims of this study were (1) to compare the efficacy of combined dermaroller and PRP therapy with dermaroller alone in facial acne scars and (2) to assess the psychosocial impact due to acne scars and its treatment.

Methods:

A total of 55 patients were included in the study and randomly divided into two groups, Group A: 28 and Group B: 27. Proper counseling was done, and detailed clinical findings were recorded. Patients in Group A were treated with dermaroller alone while Group B patients underwent treatment with a combination of dermaroller and intradermal PRP injections. A total of three sitting were done at monthly interval. Final response was assessed at 1 month after the last sitting. Criteria of evaluation included Goodman and Baron's quantitative scale, visual analog score, and dermatology life quality index scores. Side effects were noted. Results were analyzed using Chi-square test and t-test.

Results:

Significant percentage improvement was noted in both the groups. However, Group B treated with both modalities had better results when compared with that in the Group A.

Conclusion:

A combination approach using dermaroller and PRP was a safe and better option than using dermaroller alone in atrophic acne scars for clinical improvement as well as for improvement in dermatology life quality index score.

Differences in Dietary Glycemic Load and Hormones in New York City Adults with No and Moderate/Severe Acne

BACKGROUND

Glycemic index (GI) and glycemic load (GL) may be implicated in acne pathogenesis.

OBJECTIVE

This cross-sectional study examined differences between GI/GL and biological factors associated with acne among adults with and without moderate/severe acne. Secondary objectives included examining differences between food-aggravated acne beliefs and acne-specific quality of life among adults with and without moderate/severe acne.

DESIGN

As part of a cross-sectional study, participants completed a 5-day food record; blood draw to measure biological factors associated with acne (ie, glucose, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein-3, and sex hormone-binding globulin concentrations); body composition assessment; and questionnaire to evaluate food-aggravated acne beliefs and acne-specific quality of life. Food records were analyzed using Nutrition Data Services for Research.

PARTICIPANTS

Sixty-four participants (no acne, n=32; moderate/severe acne, n=32) from New York City, NY, were included in this study.

STATISTICAL ANALYSIS

Independent sample t tests and Mann-Whitney tests examined differences in anthropometric measurements, dietary intakes, biological factors associated with acne, insulin resistance, and acne-specific quality of life between acne groups. A χ² test for independence assessed differences in food-aggravated acne beliefs between acne groups.

RESULTS

Participants with moderate/severe acne consumed greater total carbohydrate (P=0.003), available carbohydrate (P<0.001), percent energy from carbohydrate (P<0.001), and GL (P<0.001) compared to participants without acne. Participants with moderate/severe acne had greater insulin (P=0.002) and insulin-like growth factor-1 (P=0.009) concentrations, greater insulin resistance (P=0.001), and lower sex hormone-binding globulin (P=0.015) concentrations compared to participants without acne. Although there were no differences between groups, 61% of participants reported food-influenced acne. Participants with moderate/severe acne reported a lower quality of life compared to participants without acne (P<0.001).

CONCLUSIONS

The results from this cross-sectional study suggest a relationship between dietary carbohydrate, including GL, and acne. Future research is necessary to determine the effect of medical nutrition therapy on biological factors associated with acne and acne severity.

A Report of Two Cases of Solid Facial Edema in Acne

Introduction

Solid facial edema (SFE) is a rare complication of acne vulgaris. To examine the clinical features of acne patients with solid facial edema, and to give an overview on the outcome of previous topical and systemic treatments in the cases so far published.

Methods

We report two cases from Switzerland, both young men with initially papulopustular acne resistant to topical retinoids.

Results

Both cases responded to oral isotretinoin, in one case combined with oral steroids. Our cases show a strikingly similar clinical appearance to the cases described by Connelly and Winkelmann in 1985 (Connelly MG, Winkelmann RK. Solid facial edema as a complication of acne vulgaris. Arch Dermatol. 1985;121(1):87), as well as to cases of Morbihan’s disease that occurs as a rare complication of rosacea.

Conclusion

Even 30 years after, the cause of the edema remains unknown. In two of the original four cases, a potential triggering factor was identified such as facial trauma or insect bites; however, our two patients did not report such occurrencies. The rare cases of solid facial edema in both acne and rosacea might hold the key to understanding the specific inflammatory pattern that creates both persisting inflammation and disturbed fluid homeostasis which can occur as a slightly different presentation in dermatomyositis, angioedema, Heerfordt’s syndrome and other conditions.

Azelainsäure 20 % Creme: Auswirkung auf Lebensqualität und Krankheitsaktivität bei erwachsenen Patientinnen mit Acne vulgaris

HINTERGRUND

Zur Wirksamkeit von Aknetherapien und deren Auswirkungen auf die Lebensqualität erwachsener Patienten liegen kaum Daten vor. ZIEL: Erhebung der Wirkung von Azelainsäure 20 % Creme (Skinoren^® ) auf Akne-Schweregrad und krankheitsbedingte Lebensqualität.

PATIENTEN UND METHODIK

Nichtinterventionelle Studie bei erwachsenen Patientinnen mit leichter bis mittelschwerer Akne. Wirksamkeitsparameter waren DLQI sowie Akne-Schweregrad im Gesicht, am Dekolleté sowie am Rücken im Gesamturteil des Prüfarztes (IGA-Skala: Grad 1 = annähernd reine Haut; 2 = leichte Akne; 3 = mittelschwere Akne). Visiten waren zu Studienbeginn sowie nach 4-8 und zwölf Wochen geplant.

ERGEBNISSE

Von den 251 eingeschlossenen Patientinnen lag zu Studienbeginn bei 59 %, 31 % bzw. 10 % ein IGA-Grad von 1, 2 bzw. 3 vor; die am häufigsten betroffene Hautpartie war das Gesicht (IGA-Grad 2 oder 3: 79 %). Nach zwölf Behandlungswochen war eine signifikante Besserung der Acne vulgaris im Gesicht (IGA-Grad 0 oder 1: 82 %) sowie auf Dekolleté und Rücken feststellbar. Der mediane DLQI-Wert sank von neun zu Studienbeginn auf fünf nach zwölf Behandlungswochen. Neunzig Prozent der behandelnden Ärzte und Patientinnen beurteilten die Verträglichkeit der Behandlung als sehr gut oder gut.

SCHLUSSFOLGERUNGEN

Die Anwendung von 20%iger Azelainsäure-Creme führt bei erwachsenen Frauen zu einer signifikanten Besserung der Acne vulgaris und der krankheitsbedingten Lebensqualität.

Azelaic acid 20 % cream: effects on quality of life and disease severity in adult female acne patients

BACKGROUND

Data on the efficacy of acne treatments and their impact on quality of life (QoL) in adult patients is sketchy.

OBJECTIVE

Assessment of the efficacy of azelaic acid 20 % cream (Skinoren^® ) on acne severity and disease-related QoL.

PATIENTS AND METHODS

Noninterventional study in adult female patients with mild to moderate acne. Efficacy variables included DLQI and acne severity on the face, chest, and back using the Investigator's Global Assessment (IGA) scale (grade 1 = nearly clear skin; 2 = mild acne; 3 = moderate acne). Visits were scheduled at baseline, at 4-8 weeks, and at twelve weeks.

RESULTS

Of the 251 women enrolled, 59 % had grade 1 acne at baseline; 31 %, grade 2; and 10 %, grade 3; the most commonly affected area of the body was the face (IGA grades 2 or 3: 79 %). After twelve weeks, there was significant improvement of acne on the face (IGA grades 0 or 1: 82 %), chest, and back. Median DLQI decreased from nine at baseline to five after twelve weeks. Ninety percent of physicians and patients rated the tolerability of the treatment as very good or good.

CONCLUSIONS

Treatment with azelaic acid 20 % cream significantly improves acne severity and disease-related QoL in adult women.

Trichloroacetic Acid Versus Salicylic Acid in the Treatment of Acne Vulgaris in Dark-Skinned Patients

BACKGROUND

Treatment options for acne include chemical peeling. Trichloroacetic acid (TCA) has been used for treating acne. The ability of TCA to diminish corneocyte cohesion and keratinocyte plugging addresses this mode of treatment. Salicylic acid is an excellent keratolytic agent. It is believed to function through solubilization of intercellular cement, thereby reducing corneocyte adhesion.

OBJECTIVE

Comparing the therapeutic efficacy of TCA 25% peels with those of salicylic acid 30% in patients with acne vulgaris.

MATERIALS AND METHODS

Twenty patients, Fitzpatrick skin Types III to V with facial acne, were enrolled. Twenty-five percent of TCA was applied to the right half of the face and 30% salicylic acid to the left half at 2-week interval for 2 months.

RESULTS

Total improvement was more frequent with salicylic acid peeling (95%) versus (85%) with TCA. Total comedones improvement was more frequent with TCA peeling (80%) versus (70%) with salicylic acid. Improvement of inflammatory lesions was more frequent among the side treated with salicylic acid (85%) versus (80%) with TCA peeling. However, the results did not reach the statistical significance level.

CONCLUSIONS

Trichloroacetic acid is more superior in treating comedonal lesions, whereas salicylic is more superior in treating inflammatory lesions, without significant different between their results.

Assessment of psychiatric morbidity and quality of life in children and adolescents with cutaneous leishmaniasis and their parents

Introduction

Cutaneous leishmaniasis (CL) is a common parasitic infectious disease caused by different species of the leishmania genus. The skin lesions are usually found on exposed areas, especially the face, arms and legs. Although the disease does not cause significant morbidity, the lesions can be troublesome and unsightly. The disease have negative impacts in areas such as patients’ psychological well-being, social life and daily activities in adults.

Aim

To determine the frequency of psychiatric morbidity in children and adolescents who have cutaneous leishmaniasis (CL) and to determine the effect of CL on their levels of depression and anxiety and on their quality of life (QoL).

Material and methods

Fifty-four patients with CL (29 males and 25 females), who were 7 to 18 years of age, were assessed with the Child Depression Inventory (CDI) and the State-Trait Anxiety Inventories for Children (STAIC). The patients and their mothers were assessed with the Pediatric Quality of Life Inventory Parent and Child Versions (PedQL-P and C, respectively). This questionnaires were filled in by the control group consisting of 40 healthy children and adolescents (20 males and 20 females) and their parents from the local community matched for age, gender, and education level of the parents.

Results

Both the patient group and the control group had high scores on the depression measurement scale (t = 5.36, p < 0.05). These measurements also show significant differences between children and adolescents, who were defined as 12 years of age and under as well as older than 12 years, respectively (12 years of age and under (t = 3.14, p = 0.04); over 12 years (t = 5.37, p < 0.001)). However, there was no significant difference between the anxiety scores of the general patient group and the control group when classified according to age. The anxiety sensitivity index scores did not differ in either group from those of the control group. The patients’ and the mothers’ QoL scores for all of the scales, including all subscale scores, were significantly different from those of the control group (both 12 years of age and under as well as older than 12 years).

Conclusions

The results have shown that the frequency of depressive symptoms is much higher in patients who have CL than in healthy controls. In addition, the QoL of children and adolescents with CL and of their mothers was found to be much lower than that of the control group. Therefore, the follow-up for patients with CL who are referred to dermatology clinics should include a psychiatric evaluation. If necessary, they should be referred for psychiatric support.

Study of lipid profile in adult women with acne

Objective

The aim of this study was to establish the lipid profile of female patients with acne in the Acne-in-Adult-Women Ambulatory Care Clinic in order to observe the prevalence of dyslipidemia in those patients.

Methods

This is a retrospective transversal study that evaluated the medical records of 416 patients who attended at the Acne-in-Adult-Women Ambulatory Care Clinic, at the Dermatology Department, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil, in the year 2012. Relevant data included age and clinical classification of acne. The lipid profile was analyzed according to the results of laboratory tests ordered during outpatient visits, which included total and fractionated cholesterol levels and triglycerides.

Results

The epidemiological study sample was of 219 patients, with ages ranging from 21 to 61 years (mean of 32.23 years). The predominant clinical grade was papule-pustule acne (grade II) with 156 patients (71%). Regarding the lipid profile of the patients, there was a high increase in total cholesterol levels in 17.35% of the cases. High-density lipoprotein levels were low in 11.42% of the patients, with normal prevalence in 194 subjects. Low-density lipoprotein levels were normal in most patients (60.27%). Very-low-density lipoprotein values were normal in almost all patients (94.06%) and increased in only 13 patients (5.94%). Only 18 patients presented high levels of triglycerides (8.22%).

Conclusion

The conclusion was that patients with grades II and III acne are more likely to have total cholesterol and low-density lipoprotein altered. A correct and early diagnosis can be an important measure for the prevention of the metabolic syndrome in these patients.

Epidemiology and risk factors of childhood acne in Korea: a cross-sectional community based study

BACKGROUND

The epidemiology of acne vulgaris appears to be evolving, with an increasingly earlier onset seen in childhood. Relevant studies have been rarely performed in Asia.

AIM

We sought to estimate the prevalence and clinical characteristics of acne among schoolchildren, and its association with treatment-seeking behaviour, body mass index (BMI), nutritional habits and other lifestyle elements.

METHODS

A cross-sectional study was conducted with elementary schoolchildren aged 7-12 years. Children were interviewed by self-administered questionnaires, and were subsequently evaluated by dermatologists.

RESULTS

Of 693 children enrolled, 36.2% were diagnosed with acne, and the prevalence increased with age. Additionally, clinical characteristics including severity, duration of disease and lesion distribution were significantly different between the lower (aged 7-9 years) and the higher (aged 10-12 years) grades. Subjective features including recognition about acne and treatment-seeking behaviours were also different between the two groups. Overweight or obesity (BMI ≥ 25 kg/m(2) at 18 years of age; OR = 2.7) and consumption of chocolates/sweets (OR = 1.6) were significant risk factors for acne.

CONCLUSIONS

In the current study, the prevalence of acne among elementary schoolchildren was high, but only a few children had received treatment. Physicians should be attentive to childhood acne, and educate patients and their parents about the need to treat it.

Tretinoin Nanogel 0.025% Versus Conventional Gel 0.025% in Patients with Acne Vulgaris: A Randomized, Active Controlled, Multicentre, Parallel Group, Phase IV Clinical Trial

BACKGROUND

Conventional topical tretinoin formulation is often associated with local adverse events. Nanogel formulation of tretinoin has good physical stability and enables good penetration of tretinoin into the pilo-sebaceous glands.

AIM

The present study was conducted to assess the efficacy and safety of a nanogel formulation of tretinoin as compared to its conventional gel formulation in the treatment of acne vulgaris of the face.

MATERIALS AND METHODS

This randomized, active controlled, multicentric, phase IV clinical trial evaluated the treatment of patients with acne vulgaris of the face by the two gel formulations locally applied once daily at night for 12 wk. Acne lesion counts (inflammatory, non-inflammatory & total) and severity grading were carried out on the monthly scheduled visits along with the tolerability assessments.

RESULTS

A total of 207 patients were randomized in the study. Reductions in the total (72.9% vs. 65.0%; p = 0.03) and inflammatory (78.1% vs. 66.9%; p = 0.02) acne lesions were reported to be significantly greater with the nanogel formulation as compared to the conventional gel formulation. Local adverse events were significantly less (p = 0.04) in the nanogel group (13.3%) as compared to the conventional gel group (24.7%). Dryness was the most common adverse event reported in both the treatment groups while peeling of skin, burning sensation and photosensitivity were reported in patients using the conventional gel only.

CONCLUSION

In the treatment of acne vulgaris of the face, tretinoin nanogel formulation appears to be more effective and better tolerated than the conventional gel formulation.

There Is No Correlation between Acne Severity and AQOLS/DLQI Scores

The prevalence of psychiatric disorders is quite high in dermatological diseases. Psychiatric problems are also seen in acne, which involves young people in particular. In this study, carried out to evaluate the effect of acne on the quality of the social, school and private lives of university students, a total of 19 questions contained in AQOLS (Acne Quality of Life Scale) and DLQI (Dermatology Life Quality Index) were asked of the acne patients and healthy controls. The statistically significant relationships between the acne severity and AQOLS/DLQI as well as any possible differences between the AQOLS and DLQI scores in acne patients and healthy controls were investigated. Mann-Whitney U, Kruskal-Wallis and Spearman correlation tests were used in statistical analyses. For reliability, Cronbach-a analysis was used. The ages of 108 patients, 67 females (62%) and 41 males (38%), ranged between 16 and 29 (20.43+/-1.92). The ages of 100 controls, 61 females (61%) and 39 males (39%), ranged between 18 and 24 (19.45 +/- 1.35). There were no significant relationships between acne severity and AQOLS/DLQI (p=0.767). No statistically significant correlation was found between the acne patients with scars and those without scars with respect to AQOLS (p=0.253) and DLQI (p=0.255) scores. Statistically, AQOLS (p=0.000) and DLQI (p=0.000) scores of the patients with acne were found to be significantly higher as compared to the control groups. Consequently, it has been found in our study that the life quality of acne patients can be affected by reasons other than acne severity and presence of scars. The reasons can be social, personal, emotional and school-related problems of the patients. For that reason, life quality of patients should be evaluated with psychiatric measurements other than AQOLS and DLQI. In conclusion, these scores are not good enough to evaluate acne patients's quality of life.

'I sort of balance it out'. Living with facial acne in emerging adulthood

Many emerging adults live with mild-to-moderate visible facial acne, but little is known about their experiences. A qualitative interview study was conducted with 11 adults aged 18-22 years, which aimed to explore the meaning of living with visible acne. A thematic analysis revealed three superordinate themes: coping strategies, self-perceptions and interpersonal relationships. Results revealed the utility of researching visible acne in emerging adulthood, including the use of multiple coping strategies. Health psychologists need to consider individual differences for young adults who are living with a visible difference. The importance of the peer group and family is also explicated.

Mood changes, depression and suicide risk during isotretinoin treatment: a prospective study

BACKGROUND

Depression and mood changes appear as potentional side effects of isotretinoin in the Summary of Product Characteristics. There have been many studies treating this topic but in most cases not identifying any significant depression or suicide risk. To further investigate this issue, we conducted a prospective, uncontrolled study to evaluate mood changes and suicidal ideations in patients receiving isotretinoin therapy.

METHODS

One-hundred patients were included in our single center, no-blind, and no controlled prospective study. All patients completed the Beck's Depression Inventory, Version II (BDI-II) before the treatment, following the first month of the treatment and then every third month until finishing the isotretinoin therapy. All questionnaires were checked by a psychiatrist. Suicidal ideations were monitored. Statistical analysis of BDI-II scores was performed.

RESULTS

All patients completed the study. Before the treatment, six percent of the patients had suffered from depressive symptoms. During the isotretinoin treatment, we did not find any deterioration of depression problems in any of these patients. On the contrary, in most patients the depressive symptoms disappeared. Symptoms of depression occurred in two patients, in which case coexisting situational factors were found to be the cause. No occurrence of suicidal ideations was found.

CONCLUSIONS

We did not find any depressive symptoms or suicide risk caused by isotretinoin. On the contrary, a statistically significant improvement of BDI-II scores was found. In our opinion, patients have to be informed about the risk of depression but emphasizing the fact that it is very rare.

Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial

Background A previous clinical trial evaluating autologous fibroblasts (human dermal) injections for the treatment of facial contour deformities found significantly greater improvements in wrinkle and acne scar appearance than with placebo treatment.

Objective To compare the efficacy and safety of autologous fibroblast treatment of moderate to severe, depressed, distensible facial acne scars with that of vehicle control.

Methods This was a randomized multicenter, double-blind, placebo-controlled trial in subjects with bilateral moderate to severe acne scarring; subjects served as their own controls. Skin biopsies were obtained from randomized subjects for fibroblast production. Subjects (n = 99) underwent three intradermal injection sessions with 2 mL of autologous fibroblast suspension (10–20 million cells/mL) on one cheek and vehicle control (cell culture medium) on the other at 14-day intervals. Efficacy was based on the blinded subject’s, evaluator’s, and independent photographic viewer’s (IPR) assessment of acne scarring 1 to 4 months after the last treatment.

Results Autologous fibroblast treatment was associated with significantly greater treatment success than vehicle control for the subject (43% vs 18%), evaluator (59% vs 42%), and IPR assessments. Autologous fibroblast injections were well tolerated, without permanent adverse effects.

Conclusions Autologous fibroblast injections safely and effectively improved the appearance of depressed distensible acne scars.

Cardiff acne disability index in Sarawak, Malaysia

Background

Acne is considered a cosmetic nuisance in Malaysia since no insurance coverage is provided for its treatment. Its psychological impact is unknown.

Objective

The aim of this study is to determine the impact of acne on quality of life and its relationship with severity.

Methods

A cross-sectional study using the Cardiff acne disability index (CADI) and Global Acne Grading System for acne severity grading was done in three government-run dermatology clinics in Sarawak, Malaysia.

Results

The study cohort of 200 patients had a mean CADI score of 5.1. Most of the patients (59.5%) had mild CADI impairment, with the domain of feelings most affected. Patients with a family income <1,000 United States Dollor/month had a higher mean CADI (mean 5.5 vs. 4.4; p=0.04). Females, indigenous groups, and patients with tertiary education tended to have more severe CADI impairment (p>0.05). The correlation between CADI and mild acne severity was low (Pearson correlation coefficient=0.35; p<0.001) but became insignificant for moderate and severe acne.

Conclusion

Acne impairment in Sarawak was moderate and must be addressed. It should be viewed as a psychologically disabling disease requiring optimal management and resource allocation.

Physical and psychosocial impact of acne in adult females

Background:

Acne, the most common problem that presents to dermatologists, can persist beyond teen years. Although its physical and psychosocial impact is studied in teen years, it is poorly understood in the Indian adult population.

Aim:

To study the physical and psychosocial impact of acne in adult females.

Settings and Design:

This exploratory study was done in the university setting.

Materials and Methods:

Eleven adult, unmarried females, between the age group of 18 and 25 years, having (mild-to-moderate), acne, for two consecutive years, were interviewed using a semi-structured clinical interview of the Skindex, a quality-of-life measure for patients with skin disease, developed by Chren et al., along with some open-ended questions. Both qualitative and quantitative analysis was done to analyze the data.

Results:

The results indicated a higher level of emotional and social impairment, in terms of the feelings of physical discomfort, anger, and the intermingling impact of these, among the participants.

Conclusions:

Acne is a common problem among adults and appears to have a considerable impact on the mental health, therefore, for the treatment to be successful, a sympathetic approach by doctors and significant others, with the basic psychosomatic treatment, are necessary.