Effect of oral 13-cis-retinoic acid at three dose levels on sustainable rates of sebum secretion and on acne

Effects of isotretinoin on body mass index, serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients

Introduction

Isotretinoin has been successfully used for the treatment of acne vulgaris.

Aim

To investigate the effects of isotretinoin on body mass index (BMI), to determine whether isotretinoin causes any changes in serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients, and to correlate variables.

Material and methods

Thirty-two patients were included in this study. Oral isotretinoin was begun at a dose of 0.5–0.6 mg/kg and raised to 0.6–0.75 mg/kg. Pretreatment and posttreatment third-month BMI and adiponectin, leptin, and ghrelin serum levels were measured.

Results

The pre- and posttreatment BMI values were not significantly different. In addition, serum adiponectin and leptin levels were significantly increased following isotretinoin therapy while serum ghrelin levels were not different.

Conclusions

Isotretinoin may exert its anti-inflammatory activity by increasing leptin and adiponectin levels.

Reduced central corneal thickness in patients with isotretinoin treatment

CONTEXT

It is well known that oral isotretinoin treatment causes numerous ocular side-effects.

OBJECTIVE

To investigate the effect of systemic isotretinoin treatment on central corneal thickness (CCT) values due to meibomian gland disease (MGD).

PARTICIPANTS

In this prospective study, 47 patients (27 men, 20 women) with nodulocystic acne vulgaris treated with oral isotretinoin (0.8 mg/kg daily) were included.

METHODS

All patients were analyzed with the Pentacam Scheimpflug topography at baseline, on the 3rd and 6th month of treatment. Main outcome measures were MGD scores and CCT.

RESULTS

The mean age of patients was 25.1 ± 4.4 years. The mean MGD scores were significantly higher at 3rd month (1.3 ± 0.9) and 6th month (1.5 ± 1.0) of treatment compared with baseline (1.1 ± 0.9) (p < 0.001). The mean CCT value at baseline was 540.5 ± 22.1 µm; 536.9 ± 20.5 µm at 3rd month and 531.4 ± 22.2 µm at 6th month. The differences between baseline and 6th month CCT measurements were statistically significant (p < 0.001). There was negative correlation between mean MGD scores and CCT values at the 6th month of treatment which was statistically significant (p = 0.038, r = -0.221).

CONCLUSION

Isotretinoin treatment causes higher MGD scores. A statistically significant decrease in CCT due to MGD was detected at 6th month of treatment.

Systemic treatment of severe forms of acne: experience of using Isotretinoin in the Russian Federation

The article presents the results of a large-scale Russian program of the follow-up and treatment of acne patients with Isotretinoin (Roaccutane). The analysis of the results included information about 1,349 acne patients. In 71% of patients, the therapy was initiated at the dose of 0.5-1.0 mg/kg of the body weight. The average duration of treatment was 21.5±0.16 weeks while the average course dose was 119.9±0.8 mg/kg of the body weight. As many as 96% of patients achieved a positive result; women demonstrated a higher improvement rate than men. On the whole, Roaccutane was well-tolerated while adverse effects included dry lips (43.4%), dry skin in different areas (12.45%), retinoid dermatitis (6.45%), epistaxis (2.45%), conjunctivitis (1.41%) and hoarseness (0.22%). The Russian experience of using Roaccutane confirmed high efficacy of the systemic therapy for severe forms of acne.

Temporal changes in gene expression in the skin of patients treated with isotretinoin provide insight into its mechanism of action

Isotretinoin (13-cis RA) is the most potent agent in the treatment of acne. Insights into its mechanism of action can lead to drug discovery of alternative compounds with comparable efficacy but improved safety. The goal of this study is to compare the temporal changes in gene expression in the skin of acne patients after 1 week and 8 weeks of treatment with isotretinoin. Microarray analysis was performed on skin biopsies taken from eight acne patients prior to and at 8 weeks of treatment with isotretinoin. Results were compared with data obtained from seven acne patients biopsied at one week of treatment in a prior study. Distinctly different patterns of gene expression were noted. At 8 weeks, genes encoding extracellular matrix proteins were upregulated and numerous genes encoding lipid metabolizing enzymes were downregulated. At 1 week, genes encoding differentiation markers, tumor suppressors and serine proteases were upregulated. Only three genes were commonly downregulated. The temporal changes in gene expression in patient skin noted with isotretinoin substantiate many previously reported effects of isotretinoin and other retinoids, suggesting a model wherein isotretinoin induces apoptosis leading to reduced sebaceous gland size, decreased expression of lipid metabolizing enzymes and increased matrix remodeling during acne resolution.

The 1,450-nm diode laser reduces sebum production in facial skin: a possible mode of action of its effectiveness for the treatment of acne vulgaris

BACKGROUND AND OBJECTIVES

Over the last several years, several light-based systems have been employed for the treatment of acne vulgaris. The 1,450-nm diode laser has been shown to improve acne, and this has been suggested to be due to effects on sebaceous glands. However, an effect on sebum production has not been demonstrated. The objective of this study was to evaluate if the 1,450-nm diode laser indeed reduces sebum production.

STUDY DESIGN/MATERIALS AND METHODS

Eight patients with a history of acne were recruited and treated with the 1,450-nm diode laser on the right side of the nose over a 6-week period, for a total of three treatments. Sebum production was quantified using the Sebutape method.

RESULTS

The number of sebum-producing follicles was reduced by 8.5 and 16.7% at weeks 4 and 6, respectively (P<0.05). A significant reduction in total collected sebum (-18%) was observed at week 6.

CONCLUSION

This data suggests that the clinical effectiveness of the 1,450-nm diode laser may be based, at least in part, on its effects on sebaceous glands, with subsequent reduction in sebum production.

Low dose isotretinoin combined with tretinoin is effective to correct abnormalities of acne. Niedrig dosierte Isotretinoin-Therapie ist wirksam zur Behandlung der Acne conglobata und Acne papulopustulosa

BACKGROUND

Isotretinoin is well known in the therapy of acne papulopustulosa and acne conglobata. No study has investigated the pathophysiological changes of the skin of acne patients, especially when low dose oral isotretinoin is given in combination with topical tretinoin.

PATIENTS AND METHODS

28 patients were treated for 6 months with oral isotretinoin. In the acne conglobata group (A-C) patients were treated with 10 mg (Group A) or 20 mg isotretinoin (Groups B, C) in combination with topical 0.05% tretinoin cream. Group C was treated the first 2 weeks with 0.05% betamethasone valerate cream instead of tretinoin cream. In the acne papulopustulosa group, the patients received 0.5 mg isotretinoin/kg bodyweight and 0.05% tretinoin cream, either alone (Group E), or with oral methylprednisolone during induction (Group D).

RESULTS

Acne conglobata--A reduction of inflammatory lesion by 87-94% and of non-inflammatory lesions by 81-88% was achieved (Groups A-C). A reduction of sebaceous gland size by 35-58%, sebum production by 90-95%, follicular keratinization by 55-70% and Propionibacteria by 33-73% was seen (Groups B and C better than Group A). In Group A the amount of lipids was only reduced by 6%, in Group B by 35% and in Group C by 40%. Acne papulopustulosa--Sebum excretion rate and follicular keratinization were reduced in Group D by 89% and 50% respectively, with isotretinoin alone by 94% and 53%. The amount of lipids was reduced in Group D by 40% and in Group E by 21%.

CONCLUSIONS

Because of the efficacy and cost-benefit relationship of isotretinoin in the treatment of acne compared to other therapeutic approaches, further use low dose isotretinoin in the described settings seems to justified.

Topical spironolactone reduces sebum secretion rates in young adults

The effects of topically applied spironolactone on the sebum secretion rates (SSR) of young adults were investigated. SSR was expressed as the ratio of wax esters/[cholesterol+cholesterol esters] (WE/[C+CE]) and the amount of sebaceous lipids (squalene, triacylglycerol and wax esters). Topical spironolactone 5% gel applied to the right cheeks of the subjects produced a significant reduction in the SSR at 12 weeks (4 weeks after termination of application), but not at 8 weeks (the end of treatment). Untreated "control" areas (the left cheeks of the subjects) showed no significant change during the study. None of the subjects experienced skin rash or signs of local irritation. This results suggests that topical spironolactone may be effective in the treatment of acne patients with high SSR.

Evaluation of a method for measuring the sustainable rate of sebaceous wax ester secretion

Sebaceous wax ester secretion rates were measured in six subjects on six occasions each, using absorption into bentonite clay and analysis of the collected lipid by quantitative thin-layer chromatography. On each occasion eight samples were collected, four from the left and four from the right side of the forehead in four successive intervals. The first two intervals, which totaled 14 h, were intended to deplete the follicular reservoir of sebum so that a constant rate of absorption could be obtained during the third and fourth intervals, which were 3 h each. Thin-layer analysis of each sample was done in triplicate. The data were examined using analysis of variance techniques to determine the reproducibility of the measurement method and to identify possible sources of variability. The intraclass correlation coefficient (rI) for all 432 post-depletion determinations was 0.80. The reproducibility was considerably better for three of the subjects (rI = 0.93) than for the other three (rI = 0.75). Variability within the latter three subjects did not seem to be attributable to lack of reproducibility in the thin-layer analysis. Real biological variability also seems unlikely considering the holocrine mechanism of sebum secretion. Therefore, the variability probably arises from non-representative collection of sebum into the bentonite absorbent.

Electrophoretic mobility of corneocytes measured by laser Doppler spectroscopy

A new approach studying the characteristics of the stratum corneum is presented: the electrophoretic mobility of corneocytes by laser Doppler spectroscopy. The detergent scrub technique was used for harvesting corneocytes from three body regions (forehead, palm, and sole) of normal persons (n = 20) under casual conditions and after thorough defattening of the skin with 70% isopropyl alcohol or petrol. Similarly, cells from the forehead, shoulder, and palm were obtained from 22 acne patients treated with isotretinoin (13-cis retinoic acid) 0.5-0.7 mg/kg body weight (b.wt.)/day for 12-16 weeks, and in patients receiving arotinoid (Ro 15-0778) 192 mg (n = 5) or 500 mg (n = 5) per kg/b.wt./day for 6 weeks (forehead and shoulder). In another experiment, cell suspensions with a pH ranging from 5.0-7.3 were evaluated. Measurements were performed by dynamic laser light scattering. This laser application allows exact electrophoretic mobility measurements in a short time (3 min). When cells pass the laser beam, the scattered light is frequency-shifted due to the optical Doppler effect. These frequency shifts are analyzed by the heterodyne light beating technique. The analog signal of the photodetector is converted into a power spectrum by Fourier analysis. This power spectrum represents the spectrum of electrophoretic cell mobility distribution. Results showed different electrophoretic mobility values for corneocytes dependent on the topographic region: forehead 1.18 +/- 0.16, palm 1.10 +/- 0.14, and sole 0.83 +/- 0.10 (means +/- SEM) micron cm/Vs. Defattening with isopropyl alcohol decreased the mobility values to 0.90 +/- 0.09 (p less than or equal to 0.01), 0.95 +/- 0.10, and 0.77 +/- 0.10 micron cm/Vs respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related changes in sebaceous wax ester secretion rates in men and women

Sustainable rates of sebaceous wax ester secretion were measured on the foreheads of 109 men and 167 women, aged 15-97. Each measurement was made after first depleting the cutaneous sebum reservoir by overnight absorption of lipid into a layer of bentonite clay. Lipid was then absorbed for 3 h into fresh clay in which two 2-cm cloth disks were embedded. The absorbed lipid was extracted from the disks with ether and analyzed for wax esters by thin-layer chromatography. For both men and women there was a wide range of wax ester secretion rates at all ages. Rates were highest in the 15- to 35-year-olds and appeared to decline continuously throughout the adult age range. Values of log(wax esters) were better correlated with age than the untransformed values of wax ester secretion. The equations of best fit of log(wax esters) vs age suggested that sebum secretion declines about 23% per decade in men and 32% per decade in women.

Measurement of sebum secretion rates in young children

Sustainable rates of lipid secretion were measured on the foreheads of 24 children, ages 6-8. The method of measurement involved absorption of skin surface lipid into bentonite clay and subsequent separation and measurement of the various lipid classes by quantitative thin-layer chromatography. In 9 of the children, sebum secretion appeared to be virtually nonexistent, judging by the low amounts of lipid recovered and the low percentages of wax esters and squalene, which are purely sebaceous lipid classes. An effect of age on sebum secretion rates was observed with median rates of wax ester secretion, being 7, 28, and 48 micrograms/10 cm2/3 h for 6-, 7-, and 8-year-olds, respectively. These values are well below those of most young adults. The relation between wax ester secretion rate and skin surface lipid composition on the forehead was investigated and found to conform to the formula: microgram wax esters/10 cm2/3 h = 28 X wax esters/(cholesterol + cholesterol esters), with a correlation coefficient (r) of 0.94.

Suppression of sebum secretion with 13-cis-retinoic acid: effect on individual skin surface lipids and implications for their anatomic origin

The contribution of the keratinizing epidermis to the human skin surface lipid film has been difficult to ascertain because, after its release from the epidermal cells, epidermally derived lipid inevitably becomes mixed with sebum. In the present study, the sustainable rates of production of the 5 neutral lipid classes found on the skin surface (triglycerides + free fatty acids, wax esters, cholesterol, cholesterol esters, and squalene) were measured on the foreheads of acne patients before, during, and following treatment with 13-cis-retinoic acid, a drug which suppresses sebum production profoundly. Since sebum production was high in the patients before treatment and was suppressed to a few percent of the pretreatment level in some of the patients during treatment, data covering a wide range of sebum production rates were obtained. By using squalene as a measure of sebum production and plotting the rates of production of the other lipid classes vs the rate of production of squalene, it was possible through extrapolation to estimate the residual (i.e., epidermal) rate of production of each lipid class at zero sebum production. The results indicated that epidermis releases triglycerides + free fatty acids and cholesterol to the skin surface. The cholesterol esters in freshly secreted skin surface lipids appeared to be almost entirely sebaceous in origin. Measurements were also made of the percentages of cholesterol esters in lipid collected from the scalp after several days' accumulation and were compared to corresponding values for the forehead lipid. The percentages of cholesterol esters in scalp lipid tended to rise when sebum production was suppressed by the drug, rather than remaining relatively constant as occurred in the freshly secreted forehead lipid. This result indicated that epidermis may contribute to skin surface cholesterol esters, probably through skin surface esterification of epidermal cholesterol.