The Role of Inflammation in the Pathogenesis of Acne and Acne Scarring

An Exploratory Study of PN HPT for Treating Postsurgical Atrophic and Depressed Scars

BACKGROUND

Postsurgical atrophic scars tend to respond poorly to treatments, especially non-energy-based ones. Hydrophilic PN HPT (Polynucleotides High Purification Technology) injected intradermally is a non-energy-based option with an immediate volume-enhancing effect that indirectly improves the fibroblast synthesis of collagen and extracellular matrix. The PN HPT ingredient has the further benefit of a dermal "priming" effect that enhances the efficacy of other scar treatments.

OBJECTIVES

Verify retrospectively, with advanced techniques, the efficacy of PN HPT monotherapy as postsurgical scar treatment.

METHODS

Retrospective data collection in 18- to 65-year-old women with moderate-to-severe atrophic scars after mammary surgery undergoing a five-session intradermal treatment course with 0.75% PN HPT gel formulation in single-use syringes starting 6 months after surgery. Primary retrospective efficacy parameter: changes in scar morphology and symptom severity after three and 6 months (modified Vancouver Scar Scale, mVSS). Secondary efficacy parameters: roughness score 6 months after baseline (Antera 3D CS tridimensional skin analysis system) and Global Aesthetic Improvement Scale (GAIS, Investigator and Patient subscales) after three and 6 months.

RESULTS

Total mean mVSS highly significantly improved from 11.2 ± 1.92 at baseline to 7.0 ± 1.68 and 6.9 ± 1.55 after three and 6 months, respectively; the mean Antera 3D CS roughness score improved from 13.5 ± 4.14 to 10.0 ± 3.49 after 6 months. After three and 6 months, the GAIS subscores for investigators and cohort subjects were identical (3.0 ± 0.81 and 3.0 ± 0.72, respectively). The photographic documentation supported the previous results.

CONCLUSIONS

In monotherapy, the intradermal PN HPT ingredient seems to quickly and safely relieve the burden of postsurgical atrophic scars. However, the lack of a formal parallel control group is a severe limitation. The objective quantitative measurements confirmed the long-lasting benefits.

Intradermal injection of Cutibacterium acnes and staphylococcus: A pustular acne-like murine model

BACKGROUND

Skin 16S microbiome diversity analysis indicates that the Staphylococcus genus, especially Staphylococcus aureus (S. aureus), plays a crucial role in the inflammatory lesions of acne. However, current animal models for acne do not fully replicate human diseases, especially pustular acne, which limits the development of anti-acne medications.

AIMS

The aim is to develop a mouse model for acne, establishing an animal model that more closely mimics the clinical presentation of pustular acne. This will provide a new research platform for screening anti-acne drugs and evaluating the efficacy of clinical anti-acne experimental treatments.

METHODS

Building upon the existing combination of acne-associated Cutibacterium acnes (C. acnes) with artificial sebum, we will inject a mixture of S. aureus and C. acnes locally into the dermis in a 3:7 ratio.

RESULTS

We found that the acne animal model with mixed bacterial infection better replicates the dynamic evolution process of human pustular acne. Compared to the infection with C. acnes alone, mixed bacterial infection resulted in pustules with a distinct yellowish appearance, resembling pustular acne morphology. The lesions exhibited redness, vascular dilation, and noticeable congestion, along with evident infiltration of inflammatory cells. This induced higher levels of inflammation, as indicated by a significant increase in the secretion of inflammatory factors such as IL-1β and TNF-α.

CONCLUSION

This model can reflect the clinical symptoms and development of human pustular acne, overcoming the limitations of animal models commonly used in basic research to study this situation. It provides support for foundational research and the development of new acne medications.

The assessment of moderate acne vulgaris face skin using blood perfusion and hyperspectral imaging-A pilot study

BACKGROUND

Microcirculation is the flow of blood through the smallest vessels in the circulatory system. Capillaries respond to various pathologies much earlier than arteries and veins, the changes which indicate that the disease is already developing. Careful monitoring of the functioning of the capillary system often allows the detection of in vivo disorders at an early stage.

AIMS

The aim of the study was to evaluate the microcirculation within acne lesions. A noninvasive method of semi-quantitative blood perfusion measurement based on laser speckle contrast analysis (LASCA) and a quantitative assessment of the acne severity using the hyperspectral imaging method supported by image analysis and processing methods were used.

PATIENTS/METHOD

The acne lesion perfusion was compared to the healthy skin perfusion of the control group. The reflectance in the range from 400 to 1000 nm was also compared for acne lesions and healthy skin. A dedicated version of the algorithm based on the gray-level co-occurrence matrix was used to compare differences between acne lesions and healthy skin.

RESULTS

Blood perfusion in acne lesions is on average 117% higher than in healthy skin. The reflectance of acne lesions was lower in the range of 400-600 nm compared to the healthy skin. A statistically significant decrease in the reflectance of acne lesions was demonstrated for wavelengths: 434, 549, and 588 nm.

CONCLUSIONS

Increased blood perfusion in acne lesions compared to healthy skin suggests increased chemotaxis of inflammatory cells and wound healing. Decrease points in skin reflectance resemble the absorption peaks for hemoglobin and coproporphyrin III produced by Cutibacterium acnes. Thus, the proposed methods may serve not only for the early detection of acne lesions, before they manifest themselves clinically for the naked eye, but may also be a tool for quantifying the effectiveness of acne treatment.

Formulation of lemongrass oil (Cymbopogon citratus)-loaded solid lipid nanoparticles: an in vitro assessment study

Cymbopogon citratus (DC) stapf. (Gramineae) is a herb known worldwide as lemongrass. The oil obtained, i.e., lemongrass oil has emerged as one among the most relevant natural oils in the pharmaceutical industry owing to its extensive pharmacological and therapeutic benefits including antioxidant, antimicrobial, antiviral and anticancer properties. However, its usage in novel formulations is constrained because of its instability and volatility. To address these concerns, the present study aims to formulate lemongrass-loaded SLN (LGSLN) using hot water titration technique. In the Smix, Tween 80 was selected as a surfactant component, while ethanol was taken as a co-surfactant. Different ratios of Smix (1:1, 1:2, 1:3, 2:1 and 3:1) were utilized to formulate LG-loaded SLN. The results indicated the fact that the LGSLN formulation (abbreviated as LGSLN1), containing lipid phase 10% w/w (i.e., LG 3.33% and SA 6.67%), Tween 80 (20% w/w), ethanol (20% w/w) and distilled water (50% w/w), revealed suitable nanometric size (142.3 ± 5.96 nm) with a high zeta potential value (- 29.12 ± 1.7 mV) and a high entrapment efficiency (77.02 ± 8.12%). A rapid drug release (71.65 ± 5.33%) was observed for LGSLN1 in a time span of 24 h. Additionally, the highest values for steady-state flux (Jss; 0.6133 ± 0.0361 mg/cm2/h), permeability coefficient (Kp; 0.4573 ± 0.0141 (cm/h) × 102) and enhancement ratio (Er; 13.50) was also conferred by LGSLN1. Based on in vitro study results, the developed SLN appeared as a potential carrier for enhanced topical administration of lemongrass oil. The observed results also indicated the fact that the phyto-cosmeceutical prospective of the nanolipidic carrier for topical administration of lemongrass oil utilizing pharmaceutically acceptable components can be explored further for widespread clinical applicability.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-023-03726-5.

Oxidative stress and metabolic syndrome in acne vulgaris: Pathogenetic connections and potential role of dietary supplements and phytochemicals

Acne vulgaris is a highly prevalent skin condition caused by androgen-induced elevated sebum secretion, abnormal keratinization, bacterial colonization, and inflammation. Current research indicates a link between acne vulgaris and the metabolic syndrome, a group of disorders that includes obesity, insulin resistance, hypertension, and dyslipidemia. This link is thought to be modulated by excessive concentrations of oxidative stress markers and chronic inflammation, which are included in the pathophysiological mechanisms shared by both conditions. Excessive generation of reactive oxygen species damages cellular components and initiates an inflammatory response, hence promoting the development of both disorders. The current narrative review focuses on the molecular implications of inflammatory, hormonal, and environmental factors in the acne-metabolic syndrome correlation. Furthermore, it outlines the current state of knowledge related to the phyto-therapeutic approach to these conditions as an adjuvant strategy to allopathic treatment, but future multicenter and larger-scale research studies are needed establish new algorithms to be included in the future management of patients with these conditions.

Investigation of fungus at stratum corneum of patients with acne vulgaris

BACKGROUND

The pathophysiology of acne is complex and multifactorial. In recent years, fungal infections have increased significantly.

OBJECTIVES

The purpose of this study was to evaluate the role of fungi in the etiopathogenesis of acne vulgaris.

METHODS

This was a prospective case-control study. A total of 200 individuals (100 with acne vulgaris and 100 without acne vulgaris) were enrolled in the study. Direct microscopic investigation and culturing of the samples were done according to Clinical and Laboratory Standards Institute criteria. Descriptive analyses, independent sample t-tests, and chi-squared tests were used for statistical analysis. The subjects in the control group were paired by age and gender with the patients.

RESULTS

Direct microscopic examination revealed hyphae in the samples of all subjects with acne and in the samples of four of the healthy controls. The cultures of 18 of the patients with acne vulgaris were positive for the following: 6 with Aspergillus spp., 7 with Penicillium spp., 3 with Cladosporium spp., 1 with Candida spp., and 1 with Acremonium spp. In addition, Candida spp. was observed in the cultures of two of the healthy controls.

CONCLUSION

We conclude that fungi may be involved in the etiopathogenesis of acne vulgaris.

Microneedle fractional radiofrequency for atrophic acne scars: in vivo evaluation of results by 3D analysis and reflectance confocal microscopy

BACKGROUND

The efficacy of microneedle fractional radiofrequency (MFR) for the treatment of atrophic acne scars has been recently described, but accurate in vivo microscopic documentation of the processes occurring has never been reported.

AIMS

The aim of this study is to describe in vivo morphological atrophic acne scars' variations after treatment with MFR by means reflectance confocal microscopy (RCM) and three-dimensional (3D) imaging.

PATIENTS/METHODS

A total of 11 patients requiring treatment for atrophic facial acne scars were treated with four monthly sessions of MFR. 3D imaging and RCM were assessed at baseline and 1 months after last session. Clinical improvement, according to Global Assessment Improvement Scale (GAIS), and patients' satisfaction were evaluated.

RESULTS

Clinical improvement was observed in all the treated patients, although better results were obtained for boxcar scars (p= 0.043). 3D imaging revealed a significant improvement in terms of mean scars' depth (p<0.001). Otherwise, RCM highlighted collagen remodeling with restoration of a reticular structure.

CONCLUSIONS

Our study confirms the efficacy and safety of MFR in acne scars' treatment and provides the microscopic description of the results using RCM. This article is protected by copyright. All rights reserved.

Double-blind, randomized controlled trial comparing the use of microneedling alone versus chemical peeling alone versus a combination of microneedling and chemical peeling in the treatment of atrophic post-acne scars. An assessment of clinical effectiveness and patients' quality-of-life

Introduction

Acne vulgaris is a common, chronic disease. One of the most commonly encountered complications of acne is permanent atrophic scarring. Treatment of atrophic scars includes fillers, dermabrasion, laser resurfacing, microneedling and peelings and it is often difficult to treat. In our double-blind randomized controlled trial (RCT), we investigated the synergistic effect of microneedling with the application of trichloroacetic acid, kojic acid and hydrogen peroxide in the treatment of atrophic acne scars.

Aim

To assess the clinical effectiveness and patients' quality-of-life (HRQoL) after three types of atrophic post-acne scar treatment, namely microneedling alone (MN) vs chemical peeling alone (CP) vs. a combination of microneedling and chemical peeling (MN + CP).

Material and methods

A total of 120 patients were enrolled into the study following strict inclusion/exclusion criteria and randomized into the three treatment groups - MN, CP (a combination of trichloroacetic acid, kojic acid and hydrogen peroxide), and MN + CP. According to a preapproved protocol, each patient underwent four treatment sessions, each spread 20 days apart. Both pre- and post-treatment clinical status (using the Goodman-Baron scale; two expert raters blinded to the treatment used) and patients' HRQoL (using the Dermatology Life Quality Index) were assessed.

Results

During the 5-month recruitment period, a total of 120 patients were approached and agreed to take part in the study (94 females - 78.3% and 26 males) (mean age of 30.14 ±3.64 years; range: 18-45 years). Only in the MN + CP group there was a statistically significant improvement according to the G-B scale post-treatment (2.87 ±0.83 vs. 2.03 ±1.16 respectively; p = 0.0005). Patients in all three treatment groups experienced a statistically significant improvement in their HRQoL post-treatment (all p's < 0.05).

Conclusions

A combination of microneedling and chemical peeling produces the best, objectively measured effects in the treatment of atrophic post-acne scars. All examined treatments, even if not producing a clinically significant treatment outcome, improve patients' HRQoL.

Nanoemulsification Improves the Pharmaceutical Properties and Bioactivities of Niaouli Essential Oil (Melaleuca quinquenervia L.)

We develop a suitable delivery system for niaouli essential oil (NEO) using a nanoemulsification method for acne vulgaris. Prepared nanoemulsions (NEs) were characterized for droplet dimension, rheology, surface charge, and stability. The ability of NEO formulations against Propionibacterium acnes and Staphylococcus epidermidis was investigated and all formulations showed antiacne potential in vitro. Ex vivo permeation studies indicated significant improvement in drug permeations and steady state flux of all NEO-NEs compared to the neat NEO (p < 0.05). On the basis of the studied pharmaceutical parameters, enhanced ex vivo skin permeation, and marked effect on acne pathogens, formulation NEO-NE4 was found to be the best (oil (NEO; 10% v/v); Kolliphor EL (9.25% v/v), Carbitol (27.75% v/v), and water (53% v/v)). Concisely, the in vitro and ex vivo results revealed that nanoemulsification improved the delivery as well as bioactivities of NEO significantly.

Short-pulsed and Q-switched ND-YAG laser with topical carbon versus fractional CO2 laser in the treatment of enlarged facial pores: A split-face comparative study

OBJECTIVES

To assess and compare the efficacy and safety of topical carbon plus short-pulsed and Q-switched Nd-YAG laser to fractional carbon dioxide (CO₂ ) laser in improving the appearance of wide facial pores.

MATERIALS AND METHODS

Thirty Egyptian patients with wide facial pores were treated in a split-face manner with two sessions of fractional CO₂ laser on one side of the face and topical carbon followed by short-pulsed and Q-switched Nd-YAG laser on the other side at 4-week intervals. Clinical evaluation by Investigator Global Assessment (IGA), patient satisfaction level, and photography before treatment and 1 month after the second laser session was performed and adverse effects were monitored. Dermoscopic evaluation by dermoscopy pore score and optical coherence tomography (OCT) evaluation by surface irregularities score were performed at baseline and 1-month posttreatment.

RESULTS

One month after treatment, both modalities produced significant reduction in IGA score, dermoscopy pore score, and surface irregularities by OCT (p < 0.001, p < 0.001). Both procedures were well-tolerated. There was no significant difference in IGA, dermoscopy pore score, surface irregularities score by OCT, adverse effects or patient satisfaction level between both treated sides.

CONCLUSION

Fractional CO₂ laser and topical carbon application followed by short-pulsed and Q-switched Nd-YAG laser can be safely and effectively used to improve the appearance of wide facial pores.

A systematic review of N-acetylcysteine for treatment of acne vulgaris and acne-related associations and consequences: Focus on clinical studies

Acne vulgaris is one of the most common dermatologic disorders affects people of all races and ethnicities and has many adverse effects on the quality of life. The increased bacterial resistance to antibiotics has reduced the effectiveness of treatment with these agents. There is an increasing focus on the involvement of oxidative stress in the pathophysiology of acne. This study investigates the effect of N-acetylcysteine (NAC) as an antioxidant in the treatment of acne vulgaris. This systematic review was conducted through a search in databases such as Science Direct, PubMed, Scielo, and Medline using keywords including acne vulgaris, anti and NAC, and all the keywords associated with each of the subtitles. The factors affecting the occurrence and expansion of acne include increased sebum synthesis, hyperkeratinization of pilosebaceous units, colonization with Propionibacterium acnes, and increased release of inflammatory mediators and ROS. Studies have shown that glutathione stimulation following the administration of NAC increases glutathione levels for the detoxification of oxygen-free radicals. Moreover, NAC prevents the synthesis and release of inflammatory cytokines such as TNF-α, IL-8, IL-6, MP9, and IL-1β and has shown antibacterial activities against important bacteria including E. coli, S. epidermidis, Pseudomonas, and Klebsiella. This medication has anti-proliferative effects and is also used for excoriation and PCOD. The results of the present study showed the beneficial effects of using NAC in patients with acne vulgaris in terms of the disease complications and comorbidities. Given its diverse functional mechanisms, this medication can be used to treat acne and its consequences.

Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials

To date, treatment of atrophic acne scars remains a therapeutic challenge for dermatologists, yet there is no standard option on the most effective treatment. Microneedling (MN) is a minimally invasive technology that involves repetitive skin puncture using sterile microneedles to disrupt dermal collagen that connects the scar tissue. Recent studies have demonstrated the potency of MN, such as dermaroller and fractionated microneedle radiofrequency, in the treatment of atrophic scars. The objective of this review is to evaluate systematically the current literature on MN for atrophic acne scars. A systematic search of literature was performed from PubMed, Medline, Cochrane Central, and Google Scholar databases for articles published during the last 20 years. Only randomised controlled trials (RCTs) with full‐text version of the manuscript available were included in our study. Nine RCTs were included in this review. All treatment modalities demonstrated consistent results that MN was efficacious in treating atrophic acne scars as a monotherapy or in combination with other treatments. Moreover, no serious adverse effects were reported in all studies after MN treatment. MN is a well‐tolerated and effective therapeutic modality in treating atrophic acne scars. Further research is required to validate the efficacy of MN with a larger sample size and lengthy follow‐up.

Microbotox for the treatment of wide facial pores: A promising therapeutic approach

BACKGROUND

Microbotox is the injection of multiple microdroplets of diluted onabotulinum toxin A into the upper dermis. It has been previously used in one study only to decrease pore size and to improve skin texture.

AIMS

To evaluate the efficacy and safety of microbotox in the treatment of wide facial pores.

METHODS

Thirty-five patients with wide facial pores received a single session of microbotox. Objective measurements regarding improvement of pore size (0-4 scale) were recorded by two-blinded dermatologists. The improvements were confirmed by dermoscopic examination. Patient satisfaction was measured by Likert satisfaction scale (1-5 scale). Follow-up of the patients was done for 1 year.

RESULTS

After a single treatment session, the total average of improvement was 87.2%. The average improvement of pore size was 3.7 (0-4 scale). The average patient satisfaction after the end of therapy was 4.7. Dermoscopic evaluation confirmed the reduction in the size and number of pores. There were no serious or long-term side effects.

CONCLUSIONS

A single treatment session of microbotox appears to be safe and effective for the reduction of facial pore size. Improvement of skin texture and oiliness was also observed.

Evaluation of the efficacy of microneedle fractional radiofrequency in Turkish patients with atrophic facial acne scars

BACKGROUND

Scarring is an undesirable and severe complication of acne resulting in loss of self-esteem in young people. Although microneedle fractional radiofrequency (MFR) system has emerged as a good option to treat acne scars in recent years, it was examined in a few studies which were commonly from Asian countries.

AIMS

We sought to evaluate the efficacy of MFR in Turkish patients with facial acne scars.

METHODS

Nine patients with atrophic facial acne scars treated with MFR device were included in the study. The number of treatment sessions was varied from one to five (median three) with 4-week intervals. Demographic and basal clinical features were recorded. Efficacy of the device was evaluated by the physicians' global assessment and patients' self-assessment scales 4 weeks after the last treatment session.

RESULTS

Of nine patients, two were male and seven were female (mean age, 31.33 years). Two patients had mild, four had moderate, and three had severe facial acne scars. Mean acne scar age was 13.22 ± 8.79 years. According to the predominant scar subtype, three patients had V-shaped, three had U-shaped, and three had M-shaped atrophic acne scars. A clinical improvement of >25% has been reported in seven patients (77.7%) and eight patients (88.9%) by the physicians and patients, respectively. U-shaped atrophic acne scars responded better to the treatment than the other types, as statistically nonsignificant. There were no severe side effects.

CONCLUSIONS

Microneedle fractional radiofrequency system showed a quite good efficacy and safety in the treatment of atrophic facial acne scars (Department of Dermato-Cosmetology, Uludag University Medical School).

A systematic review and critical evaluation of immunohistochemical associations in hidradenitis suppurativa

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease with significant morbidity and impact on quality of life. Our understanding of the pathophysiology is incomplete, impairing efforts to develop novel therapeutic targets. Immunohistochemistry studies have produced conflicting results and no systematic evaluation of study methods and results has been undertaken to date. Methods: This systematic review aimed to collate and describe all reports of immunohistochemical staining in HS. This systematic review was registered with PROSPERO and conducted in line with the PRISMA reporting guidelines. Potential bias was assessed using the NIH Criteria and antibodies used across various studies were tabulated and compared. Results: A total of 22 articles were identified describing results from 494 HS patients and 168 controls. 87 unique immunohistochemical targets were identified. The overall quality of studies was sub-optimal with staining intensity confounded by active treatment. Conflicting data was identified and able to be reconciled through critical evaluation of the study methodology. Conclusions: Keratinocyte hyperplasia with loss of cytokeratin markers co-localizes with inflammation comprising of dendritic Cells, T-lymphocytes and macrophages, which are known to play central roles in inflammation in HS. Primary follicular occlusion as a pathogenic paradigm and the principal driver of HS is unclear based upon the findings of this review. Inflammation as a primary driver of disease with secondary hyperkeratosis and follicular occlusion is more consistent with the current published data.

A systematic review and critical evaluation of immunohistochemical associations in hidradenitis suppurativa

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease with significant morbidity and impact on quality of life. Our understanding of the pathophysiology is incomplete, impairing efforts to develop novel therapeutic targets. Immunohistochemistry studies have produced conflicting results and no systematic evaluation of study methods and results has been undertaken to date. Methods: This systematic review aimed to collate and describe all reports of immunohistochemical staining in HS. This systematic review was registered with PROSPERO and conducted in line with the PRISMA reporting guidelines. Potential bias was assessed using the NIH Criteria and antibodies used across various studies were tabulated and compared. Results: A total of 22 articles were identified describing results from 494 HS patients and 168 controls. 87 unique immunohistochemical targets were identified. The overall quality of studies was sub-optimal with staining intensity confounded by active treatment. Conflicting data was identified and able to be reconciled through critical evaluation of the study methodology. Conclusions: Keratinocyte hyperplasia with loss of cytokeratin markers co-localizes with inflammation comprising of dendritic Cells, T-lymphocytes and macrophages, which are known to play central roles in inflammation in HS. Primary follicular occlusion as a pathogenic paradigm and the principal driver of HS is not consistent with the findings of this review. Inflammation as a primary driver of disease with secondary hyperkeratosis and follicular occlusion is more consistent with the current published data.

Atrophic scar formation in patients with acne involves long-acting immune responses with plasma cells and alteration of sebaceous glands

BACKGROUND

Possible outcomes of acne lesions are atrophic scars, which may cause serious psychological distress. Current treatments for postacne scarring often require invasive procedures. Pathophysiological studies on acne scarring have only investigated the first week of papule life.

OBJECTIVES

To study the pathophysiology of atrophic scar formation to identify molecular and cellular pathways that can lead to new therapies for the prevention of acne scarring.

METHODS

Large-scale gene expression profiling and immunohistochemistry analysis were performed on uninvolved skin and papules in both scar-prone (SP) and non-scar-prone (NSP) patients with acne, at different time points.

RESULTS

Gene expression and immunohistochemistry analyses showed a very similar immune response in 48-h-old papules in SP and NSP populations, characterized by elevated numbers of T cells, neutrophils and macrophages. However, the immune response only persisted in SP patients in 3-week-old papules, and was characterized by an important B-cell infiltrate. Transient downmodulation of sebaceous gland markers related to lipid metabolism was observed in 48-h-old papules in NSP patients, followed by normalization after 3 weeks. In contrast, in SP patients a drastic reduction of these markers persisted in 3-week-old papules, suggesting an irreversible destruction of sebaceous gland structures after inflammatory remodelling in SP patients with acne.

CONCLUSIONS

Long-lived acne papules are characterized by a B-cell infiltrate. A relationship exists between the duration and severity of inflammation and the alteration of sebaceous gland structures, leading to atrophic scar formation in acne.

Adult-onset acne: prevalence, impact, and management challenges

Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestation; hirsutism and acanthosis nigricans are often present. The majority of the normoandrogenic acne patients present a history since adolescence, but in many cases the lesion distribution and intensity change with time. There is often a typical localization of the lesions in the lower third of the face and lateral region of the neck. Another interesting feature is related to the impact on quality of life (QoL), which is always intense. Often there are signs of depression, even when the lesions are mild. As most adult patients are women, in addition to the conventional options, there is also hormone treatment. Combined oral contraceptives and spironolactone are good options. Knowing more about the particularities in etiopathogenesis, impact on QoL, and specific treatment options is important to all dermatologists who face the challenge of treating acne in adults.

Dramatic improvement of severe acne pustolosa after adalimumab in a patient with ulcerative colitis

A 22‐year‐old male with extensive steroid‐dependent/azathioprine‐refractory ulcerative colitis and preexistent severe refractory acne pustolosa (AP) was successfully treated with adalimumab for both conditions. Severe AP could be considered a further indication, instead of a relative restriction, to anti‐TNFα in steroid‐dependent IBD patients needing therapy with this class of drugs.

Serum 25-hydroxy vitamin D levels in patients with acne vulgaris and its association with disease severity

BACKGROUND

Since vitamin D is a recent known immunoregulatory factor in some diseases which are addressed in immune system disorders such as SLE, [psoriasis] and others.

OBJECTIVE

To determine the serum levels of 25-hydroxy vitamin D3 [25(OH)D] in patients with acne vulgaris and its association with clinical features.

METHODS

This cross-sectional study was conducted over months. This study included 39 patients with acne vulgaris and 40 healthy controls. Subjects who did not use alcohol, vitamin D supplements, oral steroids or PUVA and/or NBUVB for more than three months were included. Serum 25(OH)D levels were measured. Baseline demographics, family history and comorbidities like PCO were recorded. Statistical analyses were performed using SPSS 16.0.0.

RESULTS

The median concentration of 25(OH)D was 8.4 ng/mL (range: 1.4-99) in patients and 10.4 ng/mL (range: 3.1-56.7) in controls, with no statistical significant difference. PCOS was a significant predictor of the occurrence of acne vulgaris (OR=6.25; 95% CI: 1.52-25.66; p=0.01). There were no significant associations between severity of disease and serum 25(OH)D levels (rs=-0.12, p=0.45), age (rs=-0.28, p=0.09), BMI (rs=-0.12, p=0.46), age at onset of disease (rs=-0.08, p=0.63) and duration of disease (rs=-0.10, p=0.54).

CONCLUSION

Based on the previous studies this is highly suspected that vitamin D would be a prominent factor in acne patients and more performances with bigger sample size could be useful to get positive results.

Profile of clindamycin phosphate 1.2%/benzoyl peroxide 3.75% aqueous gel for the treatment of acne vulgaris

Acne vulgaris is a common and chronic skin disease, and is a frequent source of morbidity for affected patients. Treatment of acne vulgaris is often difficult due to the multifactorial nature of this disease. Combination therapy, such as that containing clindamycin and benzoyl peroxide, has become the standard of care. Several fixed formulations of clindamycin 1% and benzoyl peroxide of varying concentrations are available and have been used with considerable success. The major limitation is irritation and dryness from higher concentrations of benzoyl peroxide, and a combination providing optimal efficacy and tolerability has yet to be determined. Recently, a clindamycin and benzoyl peroxide 3.75% fixed combination formulation was developed. Studies have suggested that this formulation may be a safe and effective treatment regimen for patients with acne vulgaris. Here, we provide a brief review of acne pathogenesis, benzoyl peroxide and clindamycin, and profile a new Clindamycin-BP 3.75% fixed combination gel for the treatment of moderate-to-severe acne vulgaris.

Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action

Over-the-counter acne treatments containing tea tree oil from the plant Melaleuca alternifolia are widely available, and evidence indicates that they are a common choice amongst those self-treating their acne. The aims of this review were to collate and evaluate the clinical evidence on the use of tea tree oil products for treating acne, to review safety and tolerability and to discuss the underlying modes of therapeutic action.

Acne from the point of view of dermatologists and cosmetologists

Goal. To compare approaches taken by dermatologists and cosmetologists to management of patients suffering from acne taking into consideration the clinical picture of the disease and patient’s age and sex, and to assess the efficacy and safety of an external therapy with azelaic acid in acne patients. Materials and methods. A study conducted by the MIR-O-MED Clinic involved 300 patients aged 14-48 with different forms of acne of different severity. To analyze particular features of the clinical picture of acne as well as age and sex differences in acne patients consulting dermatologists and cosmetologists, researchers collected statistics on the basis of primary medical documents, and then grouped the data by principal and additional indices. Both dermatologists and cosmetologists recommended azelaic acid in the form of a monotherapy and in a combination with cosmetic products as first-line treatment of primary acne patients. The efficacy and safety of an external therapy of acne patients with azelaic acid was assessed. Results. Clinical recovery and considerable clinical improvement was achieved in 94% of the patients who received an external therapy with azelaic acid. Conclusion. A lack of contradictions in coordinated measures taken by cosmetologists and dermatologists predetermines the correct order and combination of basic treatment measures involving tolerable and timely cosmetic correction, which is a prerequisite for solving the acne problem. Azelaic acid used by these categories of physicians for treatment of acne patients substantially improves the quality and efficacy of therapeutic measures.

A Consensus on Acne Management Focused on Specific Patient Features

Background:

Most treatment guidelines for acne are based on clinical severity. Our objective was to expand that approach to one that also comprised individualized patient features: a case-based approach.

Methods:

An expert panel of Canadian dermatologists was established to develop demographic and clinical features considered to be particularly important in acne treatment selection. A nominal group consensus process was used for inclusion of features and corresponding appropriate treatments.

Results:

Consensus was achieved on the following statements: follicular epithelial dysfunction contributes to acne pathogenesis; inflammation from underlying disease(s) or prior treatment may impact further patient management; management focusing on specific patient features and on addressing psychosocial factors, including impact on quality of life, may improve treatment adherence and outcomes; and case-based scenarios are a practical approach to illustrate the effect of these factors. To address the latter, eight case profiles were developed.

Conclusions:

Management of acne should be based on multifactorial considerations beyond clinically determined acne severity and should include patient-reported impact, gender, skin sensitivity (including preexisting dermatoses), and phototype.

Fractional CO2 lasers for the treatment of atrophic acne scars: a review of the literature

This review examines the efficacy and safety of fractional CO2 lasers for the treatment of atrophic scarring secondary to acne vulgaris. We reviewed 20 papers published between 2008 and 2013 that conducted clinical studies using fractional CO2 lasers to treat atrophic scarring. We discuss the prevalence and pathogenesis of acne scarring, as well as the laser mechanism. The histologic findings are included to highlight the ability of these lasers to induce the collagen reorganization and formation that improves scar appearance. We considered the number of treatments and different laser settings to determine which methods achieve optimal outcomes. We noted unique treatment regimens that yielded superior results. An overview of adverse effects is included to identify the most common ones. We concluded that more studies need to be done using uniform treatment parameters and reporting in order to establish which fractional CO2 laser treatment approaches allow for the greatest scar improvement.

Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches

Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.

Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles

Acne vulgaris is a common dermatological disorder, one that is frequently associated with depression, anxiety and other psychological sequelae. In recent years there has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. Emerging studies have shown that patients with acne are under increased cutaneous and systemic oxidative stress. Indeed, there are indications that lipid peroxidation itself is a match that lights an inflammatory cascade in acne. The notion that lipid peroxidation is a 'starter gun' in acne is not a new one; here we review the nearly 50-year-old lipid peroxidation theory and provide a historical perspective to the contemporary investigations and clinical implications.

In addition, we present a novel hypothesis in which lipid peroxidation may be priming an increased susceptibility to co-morbid depression and anxiety in those with acne. The emerging research on the systemic burden of oxidative stress in acne sheds further light on the brain-skin axis. The recent findings also suggest potential avenues of approach for the treatment of acne via specific nutrients, dietary modifications, oral and topical interventions.

Optimizing use of oral antibiotics in acne vulgaris

Oral antibiotics are commonly used to treat acne vulgaris, primarily in patients presenting with moderate to severe facial or truncal disease severity. These agents are most appropriately used in combination with a topical regimen containing benzoyl peroxide and a topical retinoid. The most common oral antibiotics for treating acne vulgaris are the tetracycline derivatives, although macrolide agents such as erythromycin have also been used extensively. Over the past 4 decades, as the sensitivity of Propionibacterium acnes to several oral and topical antibiotics has decreased, the efficacy of oral tetracycline and erythromycin has markedly diminished, leading to increased use of doxycycline, minocycline, and other agents, such as trimethoprim/sulfamethoxazole.

Acne vulgaris, mental health and omega-3 fatty acids: a report of cases

Acne vulgaris is a common skin condition, one that is associated with significant psychological disability. The psychological impairments in acne include higher rates of depression, anxiety, anger and suicidal thoughts. Despite a paucity of clinical research, patients with skin conditions and/or mental health disorders are frequent consumers of dietary supplements. An overlap may exist between nutrients that potentially have both anti-acne and mood regulating properties; examples include omega-3 fatty acids from fish oil, chromium, zinc and selenium. Here we report on five cases of acne treated with eicosapentaenoic acid and antioxidant nutrients. Self-administration of these nutrients may have improved inflammatory acne lesions and global aspects of well-being; the observations suggest a need for controlled trials.

Tissue and blood superoxide dismutase activities and malondialdehyde levels in different clinical severities of acne vulgaris

BACKGROUND

Acne vulgaris is one of the commonest dermatological diseases and its pathogenesis is multifactorial.

OBJECTIVES

To determine the role of oxidative stress in acne vulgaris and to determine a possible link with the clinical severity.

METHODS

Twenty-three patients with different grades of acne vulgaris and 23 age- and sex-matched controls were enrolled. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at tissue and blood levels.

RESULTS

There were no significant differences in SOD activities and MDA levels between patients and controls. However, significant differences were found in patients with severe acne in comparison with those with mild and moderate acne. Moreover, comparison between different patient subgroups and controls revealed statistically significantly higher SOD activities in patients with mild acne in comparison with patients with moderate and severe acne, and with controls. Furthermore, severe acne showed statistically significantly lower SOD activities and higher MDA levels when compared with other patient subgroups and controls.

CONCLUSIONS

Oxidative stress exists in patients with acne vulgaris and may play a role in aetiopathogenesis and/or progression of the disease. The addition of drugs with antioxidative effects seems to be valuable in the treatment of acne vulgaris.