Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances

Development of Clindamycin-Loaded Microneedles for the Treatment of Nodular Acne: A Novel Therapeutic Approach

Background: Acne is a common and often chronic skin condition that requires prolonged treatment. Conventional topical therapies are limited by their inability to effectively penetrate the deeper layers of the skin, reducing their effectiveness in treating comedones and inflammatory acne lesions. This study aimed to fabricate dissolvable microneedles (MNs) as a novel approach for delivering clindamycin directly to the obstructed sebaceous glands beneath the skin's surface. Methods: MNs were fabricated using 3D-printed molds of various shapes and lengths, employing materials such as chitosan, polyvinylpyrrolidone (PVP), and polyvinyl alcohol (PVA). Pyramid-shaped MNs, 2500 μm in length, were created using PVA soaked in sodium sulfate. Their physical properties, insertion capabilities, and dissolution profiles were evaluated through texture analysis, in vitro penetration testing, and drug release studies. Results: Pyramid-shaped MNs made from PVA demonstrated the highest mechanical strength and structural integrity, confirmed through scanning electron microscopy and texture analysis. In vitro penetration testing showed that these MNs penetrated beyond four layers of Parafilm, simulating their ability to breach the stratum corneum. Dissolution studies indicated complete MN dissolution within 7-8 min, with rapid drug release occurring within 3 min. Conclusion: The study demonstrates the feasibility of creating dissolvable MNs for delivering clindamycin, offering a promising alternative to conventional therapies by improving drug penetration and providing rapid drug release for the treatment of acne.

Foam-Based Drug Delivery Systems for Skin Disorders: A Comprehensive Review

Foam-based drug delivery systems signify a significant innovation in dermatology, facilitating improved drug penetration and administration via a gas-liquid dispersion matrix. These formulations have shown considerable promise in the medical, cosmetic, and pharmaceutical fields. Recent improvements in topical foams have resulted in their extensive utilization in dermatological therapies, with a growing emphasis on categorization techniques grounded in formulation composition and the creation of novel methodologies for assessing essential physicochemical factors. Foam formulations comprising calcipotriol and betamethasone demonstrate 30% enhanced therapeutic effectiveness in the treatment of psoriasis compared to traditional topical therapies. The low-density, aerated structure of foams promotes improved skin covering and hydration, which is especially advantageous for disorders like eczema. Moreover, novel advances such as propellant-free foams and the incorporation of nanotechnology have broadened the use of foam-based delivery methods in targeted drug administration and customized medicine. Ongoing research into new biomaterials and refined formulation procedures seeks to overcome these constraints, ensuring that foam-based systems emerge as a breakthrough method in dermatological care. These systems promise to enhance clinical results and overall patient quality of life by increasing medication bioavailability, patient adherence, and therapeutic effectiveness.

Efficacy and safety of the 589/1319 nm solid-state dual-wavelength laser combined with topical benzoyl peroxide for inflammatory acne vulgaris: a split-face randomized controlled trial

The 589/1319 nm solid-state dual-wavelength (SSDW) laser, which does not require consumable dye, has the potential to target inflammation and sebum production in acne vulgaris pathogenesis. To assess the efficacy and safety of 598/1319 nm SSDW laser as an adjunctive treatment to conventional treatment, 18 patients with bilateral facial acne, with inflammatory papules or pustules, were recruited. Patients were instructed to apply 2.5% benozoyl peroxide (BPO), the drug for inflammatory acne, to their entire face throughout the study. One side of the face was randomly assigned to receive 4 sessions of 589/1319 nm SSDW laser treatments, administered every 2 weeks. After the last laser treatment, 3 monthly follow-ups were scheduled. Inflammatory lesion count (ILC) and acne-related skin parameters, including hemoglobin level, melanin level, skin depression, and skin roughness were measured. Adverse events (AEs) and patients' satisfaction were assessed. At the 3-month follow-up, the ILC reduced by 46% on the adjunctive laser (BPO + laser) side (p = 0.0080), compared with a 29% reduction on the BPO monotherapy side (p = 0.1875). On the adjunctive laser side, the change in ILC positively correlated with the change in melanin level (r = 0.51, p = 0.0301) and showed a trend towards a positive correlation with the change in depression volume (r = 0.45, p = 0.0606) and roughness level (r = 0.42, p = 0.0806). The patients reported a pain score of 3.4 ± 2.3 on scale of 10. No serious AEs occurred. Patients' satisfaction scores were higher with the adjunctive laser therapy, although this was not statistically significant (p = 0.2758). In conclusion, the 589/1319 nm SSDW laser provided a synergistic effect as an adjunctive treatment to BPO in inflammatory acne in terms of reducing ILC and improving post inflammatory hyperpigmentation without causing discomfort or downtime.

Plant-Based Foods for Chronic Skin Diseases: A Focus on the Mediterranean Diet

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. 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.

Linoleic Fatty Acid from Rwandan Propolis: A Potential Antimicrobial Agent Against Cutibacterium acnes

Acne is a very common skin condition that causes pimples in 80% of adolescents despite the many effective treatments developed. Various compounds have been employed in the treatment of acne, including erythromycin ointments and antiseptics, yielding mixed results. The rise in erythromycin-resistant C. acnes strains has driven the pursuit of new antimicrobial agents, especially those obtained from natural sources. Propolis that was collected in Rwanda was extracted, fractioned, and analyzed for its activity against C. acnes growth in accordance with NCLSI guidelines. Our work revealed that linoleic acid has a significant effect on C. acnes growth at a low concentration (16 µg/mL). A comparison of the antimicrobial activities of a broad panel of well-known fatty acids revealed a specific mode of action for linoleic acid, characterized by a significant membranotropic effect on Bacillus cereus established by measuring extracellular ATP levels as an indicator of membrane permeability. Our data suggest that linoleic acid is effective against C. acnes and could be a promising candidate for developing a propolis-based ointment for acne treatment.

Efficacy of alginate-coated gold nanoparticles against antibiotics-resistant Staphylococcus and Streptococcus pathogens of acne origins

Acne is a serious multifactorial inflammatory disease that leads to significant and long-lasting changes. The widespread occurrence of bacterial acne and the excessive use of antibiotics to treat it have increased resistance to antibiotic treatment and led researchers to seek and develop newer antimicrobial agents suitable for various medical purposes. In this study, alginate-coated gold nanoparticles (GANPs), synthesized by the previously reported known method, using sodium alginate and gold salt, investigated the efficacy of the GANPs against various clinical isolates of Staphylococcus, i.e., Staphylococcus aureus, Staphylococcus lentus, Staphylococcus haemolyticus, and Streptococcus thoraltensis, which were all obtained from patients suffering from acne conditions. The results showed that the GANPs had antibacterial efficacy against all the acne-isolated bacteria. The GANP activity against bacterial resistance suggested that metal-based nanoparticulate materials are a promising alternative for treating multidrug-resistant microorganisms.

Probiotics and gut microbiota modulation: implications for skin health and disease management

The gut microbiota, consisting of a varied population of microorganisms in the digestive tract, is essential for sustaining overall human health, encompassing skin health. This review explored the intricate relationship between gut microbiota and various skin disorders, investigating the pathways through which gut dysbiosis may have impacted the development and progression of these conditions. We focused on the impact of gut microbiota on atopic dermatitis, psoriasis, acne vulgaris, acne rosacea, and melanoma. The review highlighted the potential of probiotics as a therapeutic strategy for modulating gut microbiota composition and, consequently, improving skin health. We discussed the evidence supporting the use of probiotics in managing these skin disorders and explored the mechanisms by which probiotics delivered their positive effects. Finally, we discussed the potential role of gut microbiota in other skin diseases, emphasizing the need for further research to unravel the complex interplay between the gut and the skin. Significant gaps remain in understanding the gut-skin axis, how microbial interactions contribute to skin disorders, and how to effectively manipulate the microbiome for therapeutic purposes. This review provided extensive research on the gut-skin axis, highlighting the promising prospects of modulating gut microbiota as a therapeutic strategy for various dermatological conditions.

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.

Role of Polyphenols in Dermatological Diseases: Exploring Pharmacotherapeutic Mechanisms and Clinical Implications

Although not frequently lethal, dermatological diseases represent a common cause of consultation worldwide. Due to the natural and non-invasive approach of phytotherapy, research for novel alternatives, such as polyphenols, to treat skin disorders is a subject of interest in modern medicine. Polyphenols, in particular, have been considered because of their anti-inflammatory, antitumoral, antimicrobial, and antioxidant properties, low molecular weight, and lipophilic nature that enables the passage of these compounds through the skin barrier. This review discusses the treatment of common dermatological diseases such as acne vulgaris, fungal infections, dermatitis, alopecia, and skin cancer, using polyphenols as therapeutic and prophylactic options. The specific molecules considered for each disorder, mechanisms of action, current clinical trials, and proposed applications are also reviewed.

Nanoparticle-Encapsulated Plant Polyphenols and Flavonoids as an Enhanced Delivery System for Anti-Acne Therapy

This study conducted a literature review by searching for articles related to the treatment of skin infections/wrinkles using nano-delivery systems containing natural compounds. The search was conducted in various databases for articles published in the last 10 years, with strict inclusion and exclusion criteria. Of the 490 articles found, 40 were considered relevant. Acne vulgaris is a common dermatological disorder characterised by inflammation of the sebaceous glands, often resulting in the development of pimples, cysts, and scarring. Conventional treatments, including antibiotics and topical retinoids, frequently demonstrate limitations such as side effects, resistance, and insufficient skin absorption. Recent advancements in nanotechnology have enabled the creation of innovative drug-delivery systems that enhance the effectiveness and reduce the adverse effects of anti-acne medications. Polyphenols and flavonoids, natural bioactive compounds with notable anti-inflammatory, antioxidant, and antibacterial properties, are recognised for their therapeutic effectiveness in acne treatment. However, their practical application is hindered by insufficient solubility, stability, and bioavailability. The incorporation of these compounds into nanoparticle-based delivery systems has shown promise in resolving these challenges. Various nanoparticle platforms, including lipid-based nanoparticles, polymeric nanoparticles, and solid lipid nanoparticles, are evaluated for their ability to improve the stability, controlled release, and targeted delivery of polyphenols and flavonoids to the skin. The advent of polyphenol and flavonoid-loaded nanoparticles marks a new acne therapy era.

A Cross-Sectional Study Analyzing Recent Trends in the Treatment of Acne Vulgaris: Prescription Patterns and Demographic Data From the 2018-2019 National Ambulatory Medical Care Survey (NAMCS) Database

INTRODUCTION

 Acne vulgaris is one of the most common inflammatory skin conditions worldwide, with notable psychosocial ramifications. Despite the availability of multiple treatment options, evolving clinical guidelines and healthcare policies may influence prescription practices over time. This study examines the latest trends in acne management using recent data from the National Ambulatory Medical Care Survey (NAMCS).

METHODS

We analyzed 2018-2019 NAMCS data to characterize acne treatment patterns across all age groups in outpatient settings in the United States. Treatments encompassed oral isotretinoin; hormonal therapies, such as oral contraceptive pills (OCPs) and spironolactone; systemic antibiotics, including minocycline, doxycycline, sarecycline, and tetracycline; and topical therapies, such as benzoyl peroxide, topical antibiotics, topical retinoids, azelaic acid, and salicylic acid.

RESULTS

 A total of 8,756,594 acne-related visits were recorded, with 41.5% occurring among patients aged 13-19 years. Female patients constituted 65.4% of visits. Isotretinoin emerged as the most frequently prescribed treatment among women (31.1%), followed by oral antibiotics (17.4%) and spironolactone (11.2%). Spironolactone usage nearly doubled compared to prior data (5.1%-11.2%), while oral antibiotic prescriptions decreased from 22.9% to 17.4%. The use of OCPs slightly declined (5.7%-4.5%).

CONCLUSION

 Our findings indicate a shift in acne management patterns, characterized by a rise in antiandrogenic therapies and a reduction in oral antibiotic use, suggesting heightened antibiotic stewardship efforts. The elevated frequency of isotretinoin prescriptions likely reflects the iPledge program requirements for periodic follow-up visits rather than an actual increase in disease severity. While these trends underscore ongoing changes in clinical practice, further longitudinal research is warranted to assess how these prescription shifts influence long-term patient outcomes.

Efficacy and safety of Spironolactone in treating patients with acne vulgaris: a systematic review and meta-analysis of 1,086 patients

Acne vulgaris affects 9% of the global population, particularly women, affecting their quality of life. Topical treatments are preferred for mild acne, while systemic management is necessary for moderate and severe cases. Spironolactone, an androgen receptor inhibitor, may be effective for severe acne, although no concrete evidence exists. A comprehensive literature search was conducted on five databases up until July 25th, 2024, to evaluate the effectiveness or safety of Spironolactone for acne vulgaris. A meta-analysis using R software was conducted to assess the total number of lesions, acne severity score, adverse events, mean count of comedones, papules, and pustules, and acne severity. Search process identified 14 studies (n = 1,086). Meta-analysis found that Spironolactone 5% was more effective than placebo in reducing total lesion count and acne severity index (ASI) (MD - 6.85, 95% CI [-10.94; -2.76], P < 0.01) and (MD - 6.33, 95% CI [- 8.89; -3.76], P < 0.01) respectively. The 100 mg group showed a significant improvement in ASI compared to the topical group. A meta-analysis of randomized controlled trials found no significant difference in comedones and pustules count over 6-8 weeks, while single-arm studies showed significant improvement after 8 weeks. Meta-analysis found that spironolactone 5% significantly reduced total lesion count and acne severity index after eight weeks, while also reducing comedones and papules. The safety profile is excellent. The limited number of eligible studies and evidence from single-arm studies indicates the need for more randomized controlled trials.

Attention Deficit Hyperactivity Disorder and Treatment Adherence in Adolescent Acne Patients: Investigating the Relationship for Better Care Strategies

INTRODUCTION

Accompanying comorbidities in acne vulgaris (AV) patients affect treatment adherence.

OBJECTIVES

The purpose of this study was to investigate the relationship between treatment compliance and attention deficit hyperactivity disorder (ADHD) in adolescents with AV.

METHODS

This study included 140 patients with AV. At the beginning of the treatment, each patient acne severity was assessed, and the Conners-Wells Adolescent Self-Report Scale-Long Form (CASS-L) was administered. The Morisky Medication Adherence Scale (MMAS-8) was used to assess treatment adherence. The treatment response was assessed using a six-point scale.

RESULTS

Significant differences were found in the scores on the 10 subscales of the CASS-L among the 3 groups. The Global Acne Grading System (GAGS) scores showed a positive correlation with the scores of the subscales of the CASS-L, with 3 of them at a moderate level and 7 at a weak level. Five MMAS subscales had a weak correlation and 5 had a moderate correlation with the CASS-L subscale scores. The 9 subscales and the treatment response showed a slight negative correlation.

CONCLUSIONS

ADHD is one of the many psychiatric comorbidities that frequently coexist with acne vulgaris. Its treatment is long-term and achieving a good treatment response relies heavily on patient adherence. Our study, which showed a decrease in acne treatment adherence and response as ADHD symptoms increased, will raise awareness among dermatologists to be more vigilant in their approach to this patient group.

Efficacy of Probiotic Supplements and Topical Applications in the Treatment of Acne: A Scoping Review of Current Results

Acne vulgaris is a prevalent dermatological condition characterized by comedones, papules, and pustules, with significant physical and psychological implications. Conventional treatments for this condition, including antibiotics and retinoids, face challenges, such as side effects and antibiotic resistance, necessitating alternative treatments. Recent studies show the potential of probiotics to modulate skin microbiome and alleviate acne symptoms. Therefore, this study aimed to consolidate evidence from randomized controlled trials (RCTs) and clinical investigations, evaluating the efficacy of probiotics in acne management. A comprehensive literature search was conducted across PubMed, Scopus, and Cochrane databases using several keywords, such as "probiotic", "microbiome", and "acne vulgaris". Inclusion criteria are RCTs and clinical studies from 2009 to 2024 examining probiotics for acne treatment. Studies were selected, screened, and analyzed based on population, intervention, design, and results. Descriptive statistics were used to summarize study characteristics. Fifteen studies including 811 participants met the inclusion criteria. The studies tested various oral and topical probiotics, including Lactobacillus, Bifidobacterium, Bacillus, and Enterococcus strains, over treatment periods ranging from 4 to 12 weeks. The results showed that probiotics, reduced acne lesions, improved skin barrier function, and decreased inflammatory markers. Both oral and topical probiotics showed potential in balancing skin microbiome and reducing acne severity. Some studies reported outcomes comparable to conventional acne treatments, such as antibiotics and benzoyl peroxide. However, there is variability in individual responses to different probiotic strains, and potential side effects, though rare, have been reported in some cases. Probiotics presented a natural, effective alternative to conventional acne treatment. However, future studies are needed to determine optimal treatment protocols.

Decoding Acne Vulgaris: Insights into Pathogenesis, Treatment Modalities, Diagnosis and Recent Advancements

BACKGROUND

Acne vulgaris, an alternative term for acne, is a persistent inflammatory skin condition affecting the pilosebaceous unit. Its development involves a combination of factors, including increased sebum production, changes in keratinization leading to comedone formation, colonization of hair follicles by Propionibacterium acnes (P. acnes), and the release of inflammatory mediators in the vicinity of the pilosebaceous unit.

OBJECTIVE

This review provides a concise overview of acne, covering its pathogenesis, epidemiology, diagnosis, treatment options, and recent advancements involved in acne.

DISCUSSION

Various therapeutic approaches, encompassing topical, systemic, combination, and hormonal treatments, are employed to address acne. Prolonged use of synthetic medications is common in acne therapy, but their potential for severe side effects prompts a preference for herbal- based treatments. Herbal remedies utilizing extracts of natural origin are considered safer due to their lower toxicity and reduced likelihood of adverse drug reactions. Recent advancements, particularly in personalized medicine and microbiome research have enhanced our understanding and opened new avenues for more effective management.

CONCLUSION

Decoding acne vulgaris has provided insights into its pathogenesis, treatment modalities, diagnostics, and recent advancements. Integrating synthetic and herbal treatments, personalized medicine, microbiome research, and advanced modeling techniques offer promising acne management strategies.

The Therapeutic Mechanisms of Huayu Quban Capsule in Treating Acne Vulgaris Are Uncovered Through Network Pharmacology and Molecular Docking

PURPOSE

To uncover how the Huayu Quban (HYQB) capsule treats acne vulgaris (AV) through the use of network pharmacology and molecular docking technology.

METHODS

The traditional Chinese medicine system pharmacology database (TCMSP) was used to identify the components and potential targets of HYQB capsule. Targets related to AV were identified by screening the GeneCards, Disease Gene Network (DisGeNET) and Online Mendelian Inheritance in Man (OMIM) databases. The protein-protein interaction (PPI) network between targets of active ingredients and AV targets was built using the STRING database. Cytoscape3.7.2 software was used to create the visualization network for the 'herb-component-target' and identify the key targets. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were utilized for functional enrichment analysis of the primary targets. Subsequently, molecular docking technology was employed to confirm the interaction between key components and core targets.

RESULTS

The technique discovered 50 different active substances and 270 associated therapeutic targets in the HYQB capsule as well as predicting 70 targets for treating acne vulgaris. Cytoscape hubba plug-in identified 19 key target genes, with the top 5 being TNF, IL1B, CCL2, SIRT1, IFNG, and IL10. Analysis of KEGG pathways revealed significant enrichment of immune-related pathways, including TNF and IL-17 signaling pathways, among the target genes. The HYQB capsule also involves lipid and atherosclerosis, Th17 cell differentiation, and the AGE-RAGE signaling pathway in diabetic complication signaling pathways. Molecular docking results showed that quercetin, luteolin, kaempferol, and wogonin, the core components of HYQB, had good binding ability with the first 4 core targets.

CONCLUSIONS

The HYQB capsule may have a synergistic effect on inhibiting sebaceous adipogenesis and sebum cell differentiation and play an effect on AV through anti-inflammatory and antioxidant effects of different signaling pathways.

The effects of Ramadan fasting on acne vulgaris: clinical, immunological, and oxidative status considerations

BACKGROUND

Acne vulgaris, a prevalent inflammatory skin condition, is closely linked to the immune system's regulation and oxidative stress. During Ramadan, the practice of intermittent fasting-abstaining from food and drink from dawn to sunset-can impact both body and skin health, potentially influencing the pathophysiology of acne including the immune response and the oxidative status. The objective of this study was to investigate the impact of Ramadan fasting on disease severity, Th1/Th17 cytokine levels, and oxidative status in patients with acne vulgaris.

METHOD

The study involved 40 patients with acne vulgaris. The severity of the condition was evaluated using the Global Acne grading System (GAGS) score, body mass index (BMI) was calculated, and levels of interleukin (IL-17), interferon gamma (IFN-γ), and Malondialdehyde (MDA) were measured both before and after the fasting period.

RESULTS

A significant reduction in GAGS score, IL-17, IFN-γ, and MDA levels was observed after Ramadan fasting compared to before Ramadan. Additionally, the percentage decrease in GAGS score showed a positive correlation with the percentage decrease in IFN-γ.

CONCLUSION

Intermittent fasting during Ramadan could potentially benefit acne vulgaris by reducing the Th1/Th17 immune response and lowering oxidative stress.

Cutibacterium acnes bacteriophage therapy: exploring a new frontier in acne vulgaris treatment

The skin microbiome, encompassing a variety of microorganisms, plays a critical role in skin health and function. Acne vulgaris, affecting approximately 9.4% of the global population, is a prevalent skin condition primarily targeting pilosebaceous units rich in sebaceous glands. The condition is influenced by factors such as hormonal changes, sebaceous gland dysfunction, and the activity of Cutibacterium acnes, a gram-positive bacterium linked to acne development. The skin's immune system, particularly keratinocytes with pattern recognition receptors like Toll-like receptors (TLRs), plays a crucial role in recognizing and responding to bacterial presence. The onset of acne is often linked to adolescence, marked by significant hormonal fluctuations. Genetics also plays a role, with family history being a notable risk factor. Acne is characterized by distinct alterations in the C. acnes composition, with specific phylotypes associated with either commensal or pathogenic behavior. Traditional treatments include antibiotics, but the rise of antibiotic resistance has led to exploring alternative therapies, such as bacteriophage therapy. Bacteriophages offer a targeted approach to treating acne by targeting C. acnes strains, potentially reducing antibiotic resistance and enhancing treatment efficacy. Phage therapy shows promise, but further research is needed to fully understand its effectiveness and potential in clinical applications. Additionally, combining phages with antibiotics may offer a synergistic approach to overcoming antibiotic resistance and managing acne.

Phyto-pharmaceuticals as a safe and potential alternative in management of psoriasis: a review

Psoriasis is a chronic autoimmune skin disease with a worldwide prevalence of 1-3 % results from uncontrolled proliferation of keratinocytes and affects millions of people. While there are various treatment options available, some of them may come with potential side effects and limitations. Recent research has shown that using bioactive compounds that originate from natural sources with a lower risk of side effects are relatively useful in safe management psoriasis. Bioactive compounds are molecules that are naturally available with potential therapeutic efficacy. Some of bioactive compounds that have shown promising results in the management of psoriasis include curcumin, resveratrol, quercetin, epigallocatechin-3-gallate, etc., possess anti-inflammatory, antioxidant, immunomodulatory, and anti-proliferative properties, with capabilities to suppress overall pathogenesis of psoriasis. Moreover, these bioactive compounds are generally considered as safe and are well-tolerated, making them potential options for long-term use in the management of various conditions linked with psoriasis. In addition, these natural products may also offer a more holistic approach to treat the disease, which is appealing to many patients. This review explores the bioactive compounds in mitigation of psoriasis either in native or incorporated within novel drug delivery. Moreover, recent clinical findings in relation to natural product usage have been also explored.

Nutritional and Microbial Strategies for Treating Acne, Alopecia, and Atopic Dermatitis

BACKGROUND/OBJECTIVES

Diet is one of the major determinants of the composition and function of the gut microbiome, and diverse studies have established directional connections between gut microbiome dysbiosis and skin dyshomeostasis. Furthermore, a significant link between the gut and certain skin-related disorders has been reported. This work reviews the mechanisms underlying the relationship between nutritional factors, gut microbiome, and certain skin diseases such as acne vulgaris, alopecia, and atopic dermatitis. In addition, it explores how the modulation of the gut microbiome and human skin through diet and various microbial strategies, including probiotics, synbiotics, postbiotics, and fecal microbiota transplantation, may serve as future treatments for skin diseases, possibly replacing traditional methods such as antibiotic, topical corticosteroid, and laser therapies.

RESULTS

The adequate intake of certain foods can promote a balanced gut microbiome, potentially reducing skin inflammation and improving overall skin health, while poor dietary choices may lead to worse outcomes by disrupting gut homeostasis. In this regard, diets high in antioxidants, fiber, and phytonutrients appear to be beneficial for enhancing skin health and preventing associated comorbidities. In addition, the administration of probiotics, synbiotics, and postbiotics in the treatment of cutaneous diseases has been shown to restore skin dyshomeostasis and to improve the symptoms of the reviewed skin conditions.

CONCLUSIONS

Consuming a healthy, plant-based diet can reduce skin inflammation and enhance overall skin health. Although the application of probiotics, synbiotics, and postbiotics has demonstrated promise in modulating inflammation, enhancing tissue regeneration, and inhibiting pathogenic colonization, further research is required.

A Mendelian randomization analysis of inflammatory skin disease risk due to mineral deficiencies

Background

Mineral deficiencies, such as iron (Fe), zinc (Zn), and selenium (Se), play crucial roles in inflammation and immune responses and are linked to chronic inflammatory skin diseases. This study used genome-wide association study (GWAS) data and Mendelian randomization (MR) to investigate the genetic causality among serum levels of five minerals (Fe, Cu, Zn, Se, Ca), three iron metabolism indicators (TSAT, TIBC, ferritin), and three chronic inflammatory skin diseases [psoriasis (PS), atopic dermatitis (AD), acne vulgaris (AV)].

Methods

Two-sample MR analyses using the "TwoSample MR" package in R were conducted with aggregate outcome data from the FinnGen database. The inverse-variance-weighted (IVW) method was applied to assess causal relationships between mineral levels and disease outcomes. Robustness was examined via heterogeneity and pleiotropy tests.

Results

IVW analysis showed significant association between blood transferrin saturation (TSAT) and PS (p = 0.004, OR = 1.18). Serum Zn and Se levels showed inverse correlation with AD (p = 0.039, OR = 0.92). However, due to limited SNPs, robustness was reduced.

Conclusion

TSAT is genetically linked to PS, highlighting iron homeostasis in disease development. Zn and Se intake may reduce AD risk.

In Vitro Cytotoxicity and Antimicrobial Activity against Acne-Causing Bacteria and Phytochemical Analysis of Galangal (Alpinia galanga) and Bitter Ginger (Zingiber zerumbet) Extracts

Galangal (Alpinia galanga (L.) Willd) and bitter ginger (Zingiber zerumbet (L.) Roscoe) are aromatic rhizomatous plants that are typically used for culinary purposes. These rhizomatous plants have many biological properties and the potential to be beneficial for pharmaceutics. In this study, we evaluated the antioxidant and antimicrobial activities, with a specific focus on acne-causing bacteria, as well as the phytochemical constituents, of different parts of galangal and bitter ginger. The rhizomes, stems, and leaves of galangal and bitter ginger were separately dried for absolute ethanol and methanol extractions. The extracts were used to evaluate the antioxidant activity using a DPPH radical scavenging assay (0.005-5000 μg/mL), antimicrobial activity against acne-causing bacteria (0.50-31.68 mg/mL), and in vitro cytotoxicity toward human keratinocytes and fibroblasts (62.5-1000 μg/mL), as well as analyses of bioactive phytochemicals via GC-MS and LC-MS/MS (500 ppm). The ethanol and methanol extracts of bitter ginger and galangal's rhizomes (BRhE, BRhM, GRhE, and GRhM), stems (BStE, BStM, GRhE, and GRhM), and leaves (BLeE, BLeM, GLeE, and GLeM), respectively, showed antioxidant and antimicrobial activities. The extracts of all parts of bitter ginger and galangal were greatly antioxidative with 0.06-1.42 mg/mL for the IC50 values, while most of the extracts were strongly antimicrobial against C. acnes DMST 14916, particularly BRhM, BRhE, GRhM, and GRhE (MICs: 3.96-7.92 mg/mL). These rhizome extracts had also antimicrobial activities against S. aureus TISTR 746 (MICs: 7.92-31.68 mg/mL) and S. epidermidis TISTR 518 (MICs: 7.92-15.84 mg/mL). The extracts of bitter ginger and galangal rhizomes were not toxic to HaCaT and MRC-5 even at the highest concentrations. Through GC-MS and LC-MS/MS analysis, phytochemicals in bitter ginger rhizome extracts, including zerumbone, tectorigenin, piperic acid, demethoxycurcumin, and cirsimaritin, and galangal rhizome extracts, including sweroside and neobavaisoflavone, were expected to provide the antioxidant and anti-microbial activities. Therefore, the results suggest that the bitter ginger and galangal extracts could be natural anti-acne compounds with potential for pharmaceutic, cosmetic, and aesthetic applications.

Impact of Acne on the Quality of Life of Adolescents in the Territory of the Northern and Southern Regions of Montenegro

Background

Acne vulgaris is a chronic inflammatory disease predominantly known as a disease of adolescents. We aimed to assess the quality of life of adolescents with acne in the territory of northern and southern regions of Montenegro.

Methods

This cross-sectional study was conducted in 2024, in four secondary schools in the north and south of Montenegro with total number of 561 subjects. To assess the quality of life of adolescents with acne we used the Children's Dermatology Life Quality Index and to measure acne-related disability we used The Cardiff Acne Disability Index.

Results

The average value of the total CDLQI score among adolescents from the northern region of Montenegro was 4.45±3.31, and 4.03±3.50 among southern region. The average value of the total CADI score among adolescents from the northern region of Montenegro was 3.56±1.77, and 3.50±1.98 among adolescents from the southern region. A statistically significantly higher mean value of sub scores in adolescents from the northern region compared to adolescents from the southern region existed in the domain of symptoms and feelings, vacation and treatment (P< 0.05). The regression analysis was also performed.

Conclusion

This study confirms the negative impact of acne on the quality of life of Montenegrin adolescents, especially those in the northern region. It is necessary to give more attention to the acne problems from doctors, and to increase awareness among adolescents and provide them early and the most effective therapy.

Recent Advances in the Use of Cubosomes as Drug Carriers with Special Emphasis on Topical Applications

Topical drug delivery employing drug nanocarriers has shown prominent results in treating topical ailments, especially those confined to the skin and eyes. Conventional topical formulations persist with drug and disease-related challenges during treatment. Various nanotechnology-driven approaches have been adopted to mitigate the issues associated with conventional formulations. Among these, cubosomes have shown potential applications owing to their liquid crystalline structure, which aids in bioadhesion, retention, sustained release, and loading hydrophilic and hydrophobic moieties. The phase transition behavior of glyceryl monooleate, the concentration of stabilizers, and critical packing parameters are crucial parameters that affect the formation of cubosomes. Microfluidics-based approaches constitute a recent advance in technologies for generating stable cubosomes. This review covers the recent topical applications of cubosomes for treating skin (psoriasis, skin cancer, cutaneous candidiasis, acne, and alopecia) and eye (fungal keratitis, glaucoma, conjunctivitis, and uveitis) diseases. The article summarizes the manufacturing and biological challenges (skin and ocular barriers) that must be considered and encountered for successful clinical outcomes. The patented products are successful examples of technological advancements within cosmeceuticals that support various topical applications with cubosomes in the pharmaceutical field.

Investigating the Use of 0.3% Adapalene/2.5% Benzoyl Peroxide Gel for the Management of Moderate-to-Severe Acne in Indian Patients: A Phase 4 Study Assessing Safety and Efficacy

Background Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit associated with an increase in sebum secretion. Topical treatment with adapalene and benzoyl peroxide (BPO) is considered effective when used either as monotherapy or in fixed-dose combinations. However, the combination gel of 0.3% adapalene with 2.5% benzoyl peroxide (A0.3%+BPO2.5%) has not been evaluated in Indian patients with acne. This study aimed to evaluate the safety and efficacy of A0.3%+BPO2.5% gel in Indian patients with moderate-to-severe acne vulgaris. Methodology This was a 12-week prospective, multicenter, open-label, phase IV study conducted at six centers in India. Safety was assessed based on local tolerability (stinging or burning, erythema, dryness, and scaling) and any reported adverse events. Efficacy was evaluated based on reductions in the number of inflammatory and noninflammatory lesions, the Investigator's Global Assessment (IGA) scale, and the Global Assessment of Improvement (GAI) score. The patient-reported outcome was measured using the Subject Satisfaction Questionnaire. Results Of the 135 patients, 132 completed the study between December 24, 2021, and July 18, 2022 (93.9% had moderate acne; 6.1% had severe acne at baseline). The A0.3%+BPO2.5% gel was well tolerated. The reductions in the severity scores of erythema, scaling, and dryness from baseline to week 12 were 38.9%, 47.4%, and 76.5%, respectively. A targeted reduction of ≥50% in the number of inflammatory and noninflammatory lesions was achieved in 115 (87.1%) and 109 (82.6%) patients, respectively. Based on the investigator's responses to the IGA questionnaire at week 12, 28% and 40.9% of patients had clear and almost clear skin, respectively. Using the GAI scale, investigators reported that at 12 weeks from baseline, most patients presented with improvements in symptoms, such as erythema, scaling, and dryness, and none reported any worsening. Treatment satisfaction was rated as 91% by the patients. Conclusions The A0.3%+BPO2.5% gel effectively reduced the inflammatory and noninflammatory lesions and was found to be safe and well tolerated in Indians with moderate‑to‑severe acne vulgaris.

Evaluation of the effectiveness of Berberis integerrima Bunge root extract combined with spearmint essential oil in the treatment of acne vulgaris: A randomized controlled clinical trial

BACKGROUND

Acne vulgaris is one of the most common dermatological disorders. Berberis integerrima Bunge belongs to the Berberidaceae family. Several studies on different Berberis species in addition to B. integerrima have shown antimicrobial, antioxidant, and anti-inflammatory effects. Spearmint essential oil also has antioxidant, antibacterial, and anti-inflammatory activities. This study aimed to evaluate the clinical effectiveness of the topical combination of B. integerrima root extract and spearmint essential oil in the treatment of acne vulgaris.

METHODS

Patients with mild to moderate facial acne who met the inclusion criteria were randomly assigned to either drug (B. integerrima extract/spearmint essential oil topical solution) or control (clindamycin 1% topical solution) groups. Each group applied the solution twice a day for 4 weeks. Before and at the end of the intervention, the number of lesions and mGAGS (Modified Global Acne Grading Scale) score were recorded.

RESULTS

Thirty patients in each group of drug and control completed the study. Topical B.integerrima root extract/spearmint essential oil significantly reduced the number of lesions (27.33 ± 26.17 vs. 21.58 ± 21.10; p < 0.001) and mGAGS (18.76 ± 8.61 vs. 13.87 ± 8.14; p < 0.001) at the end of the intervention. However, there was no significant difference between the two groups regarding the number of lesions (p = 0.906) and mGAGS (p = 0.882).

CONCLUSIONS

B. integerrima root extract combined with spearmint essential oil has significant anti-acne effects, comparable to topical antibiotic clindamycin. It could be considered as a potential treatment for acne vulgaris. However, more studies with larger sample sizes and longer durations are required to confirm this effect.

Does "all disease begin in the gut"? The gut-organ cross talk in the microbiome

The human microbiome, a diverse ecosystem of microorganisms within the body, plays pivotal roles in health and disease. This review explores site-specific microbiomes, their role in maintaining health, and strategies for their upkeep, focusing on oral, lung, vaginal, skin, and gut microbiota, and their systemic connections. Understanding the intricate relationships between these microbial communities is crucial for unraveling mechanisms underlying human health. Recent research highlights bidirectional communication between the gut and distant microbiome sites, influencing immune function, metabolism, and disease susceptibility. Alterations in one microbiome can impact others, emphasizing their interconnectedness and collective influence on human physiology. The therapeutic potential of gut microbiota in modulating distant microbiomes offers promising avenues for interventions targeting various disorders. Through interdisciplinary collaboration and technological advancements, we can harness the power of the microbiome to revolutionize healthcare, emphasizing microbiome-centric approaches to promote holistic well-being while identifying areas for future research.

Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies

Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.

Adult Female Acne: Recent Advances in Pathophysiology and Therapeutic Approaches

Adult acne is a chronic inflammatory disease of the pilosebaceous unit characterized by the excessive production of abnormal sebum favoring an imbalance of the skin microbiota and the hyperproliferation of Cutibacterium acnes and other virulent microbial strains, leading to an inflammatory environment, innate immunity overactivation, and keratinocyte hyperproliferation in hair follicles pores. Degraded keratinocytes plug the pores, consequently forming microcomedons, which can later evolve to papules, nodules, pustules and scars. Distinct from juvenile acne, in adult female acne (AFA) the symptomatology occurs or persists in postadolescence (after age 25). Although hyperandrogenism or the excessive sensitivity of androgen receptors are the main causes, AFA can be triggered by multiple factors, either including or not including androgen disturbances. The prevalence in adult women is 15–20%. Hyperandrogenism is present in 50% of cases; 70% of hyperandrogenism cases feature polycystic ovary syndrome (PCOS), a complex endocrine and metabolic condition. Genetic susceptibility occurs in 80% of acne cases, often with familial inheritance. Beyond classical stepwise therapeutic protocols (topical agents, isotretinoin, antibiotics, hormonal therapy with estrogens, progestins, spironolactone), novel approaches include the highly effective topical antiandrogen clascoterone, the management of insulin resistance by diet, exercise, stress avoidance, and adjuvant therapies such as berberine. Vaccines against the pathogenic proinflammatory C. acnes hyaluronidase A are in development.

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.

Nitrocellulose for Prolonged Permeation of Levofloxacin HCl-Salicylic Acid In Situ Gel

Currently, the application of solvent exchange-induced in situ gel is underway for drug delivery to the body target site. Nitrocellulose was attempted in this research as the matrix-forming agent in solvent exchange-induced in situ gel for acne and periodontitis treatments. The gel incorporated a combination of 1% w/w levofloxacin HCl and 2% w/w salicylic acid as the active compounds. In order to facilitate formulation development, the study explored the matrix-forming behavior of different concentrations of nitrocellulose in N-methyl pyrrolidone (NMP). Consequently, their physicochemical properties and matrix-forming behavior, as well as antimicrobial and anti-inflammatory activities, were evaluated using the agar cup diffusion method and thermal inhibition of protein denaturation in the egg albumin technique, respectively. All prepared formulations presented as clear solutions with Newtonian flow. Their contact angles on agarose gel were higher than on a glass slide due to matrix formation upon exposure to the aqueous phase of agarose, with an angle of less than 60° indicating good spreadability. Nitrocellulose concentrations exceeding 20% initiated stable opaque matrix formation upon contact with phosphate buffer pH 6.8. The high hardness and remaining force of the transformed gel indicated their robustness after solvent exchange. Fluorescence tracking using sodium fluorescein and Nile red confirmed the retardation of NMP and water diffusion by the nitrocellulose matrix. From the Franz cell permeation study, these drugs could permeate through neonate porcine skin and tissue of porcine buccal from the nitrocellulose in situ forming gel. Their accumulation in these tissues might enable the inhibition of the invading bacterial pathogens. The developed in situ gels effectively inhibited Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acnes, and Porphyromonas gingivalis. Furthermore, the formulations demonstrated an anti-inflammatory effect. The low viscosity of LvSa25Nc makes it appropriate for injectable treatments targeting periodontitis, while the higher viscosity of LvSa40Nc renders it appropriate for topical applications in acne treatment. Therefore, the nitrocellulose in situ gel loaded with combined levofloxacin HCl and salicylic acid emerges as a promising dosage form for treating acne and periodontitis.

Zinc, Copper, and Iron in Selected Skin Diseases

Trace elements are essential for maintaining the body's homeostasis, and their special role has been demonstrated in skin physiology. Among the most important trace elements are zinc, copper, and iron. A deficiency or excess of trace elements can be associated with an increased risk of skin diseases, so increasing their supplementation or limiting intake can be helpful in dermatological treatment. In addition, determinations of their levels in various types of biological material can be useful as additional tests in dermatological treatment. This paper describes the role of these elements in skin physiology and summarizes data on zinc, copper, and iron in the course of selected, following skin diseases: psoriasis, pemphigus vulgaris, atopic dermatitis, acne vulgaris and seborrheic dermatitis. In addition, this work identifies the potential of trace elements as auxiliary tests in dermatology. According to preliminary studies, abnormal levels of zinc, copper, and iron are observed in many skin diseases and their determinations in serum or hair can be used as auxiliary and prognostic tests in the course of various dermatoses. However, since data for some conditions are conflicting, clearly defining the potential of trace elements as auxiliary tests or elements requiring restriction/supplement requires further research.

Recent Trends in the Management of Acne Vulgaris: A Review Focusing on Clinical Studies in the Last Decade

Acne vulgaris is a prevalent chronic inflammatory skin condition with significant implications for quality of life, particularly among adolescents and young adults. Recent advancements in understanding its pathophysiology and developing novel therapeutic modalities have reshaped the landscape of acne management. This review provides an overview of recent trends in acne management, focusing on clinical studies conducted in the past decade. Key findings include insights into acne pathogenesis, emerging treatment modalities, comparative effectiveness of traditional and emerging therapies, and considerations for patient-centered care. The review underscores the importance of staying updated with recent clinical studies to provide evidence-based care and optimize patient treatment outcomes. Moreover, it highlights the need for continued research efforts to develop personalized treatment approaches, explore combination therapies, and address the psychosocial impact of acne. Collaborative endeavors between clinicians and researchers are essential to advance the field of acne management and improve patient outcomes.

Impact of Lifestyle and Dietary Habits on the Prevalence of Acne Vulgaris: A Cross-Sectional Study From Saudi Arabia

Background Acne vulgaris is a prevalent dermatological condition worldwide, with its impact significantly influenced by various genetic, environmental, and lifestyle factors. Despite its global prevalence, data on acne's prevalence and risk factors in Saudi Arabia remain sparse. This study aims to fill this gap by examining the prevalence of acne vulgaris and identifying associated lifestyle and environmental risk factors within the Saudi population. Methodology Employing a cross-sectional survey-based design, this study collected data from a representative sample of the Saudi population aged 18 years and older. Participants were selected through stratified random sampling and completed a self-administered online questionnaire covering demographic information, lifestyle factors, and acne history. Statistical analyses, including descriptive statistics, chi-square tests, and multivariable logistic regression, were utilized to identify significant risk factors associated with acne vulgaris. Results The survey, completed by 1,983 participants, revealed a diverse age distribution with a slight predominance of the 21-25-year age group (32.5%). Gender distribution was nearly balanced (52% female, 48% male), and the majority were single (67.3%). Lifestyle assessments indicated varied water intake, with a significant portion consuming less than 1-2 L per day. Sleep duration for most fell within the 5-7 hours range. Fast food consumption was frequent among 24% of respondents, and physical activity levels showed 40% of participants exercised minimally. Notably, 72% reported a history of acne, predominantly beginning between ages 16 and 20. Acne was mainly mild to moderate in severity and primarily affected the face. Treatment was sought by 60%, with a preference for topical solutions. Awareness around acne causes was moderate, with a high consensus on the impact of stress and diet on acne development. Conclusions Acne vulgaris in Saudi Arabia is significantly associated with various modifiable lifestyle factors, suggesting that interventions focusing on lifestyle modifications may be effective in managing and preventing acne. This study advocates for the integration of lifestyle counseling into acne treatment protocols, offering a holistic approach to managing this pervasive condition.