Psychodermatology of acne: Dermatologist's guide to inner side of acne and management approach

Anti-microbial impact of non-antibiotic agents; salicylic acid, N-acetylcysteine, and isotretinoin against Cutibacterium acnes in patients with acne vulgaris

There are two main strategies to eliminate Cutibacterium acnes and to reduce antibiotic resistance in acne treatment. The first is to target the pathogenic bacteria and the second is to change the environment for their growth. The present study aimed to evaluate the anti-microbial role of non-antibiotic agents against Cutibacterium acnes (C. acnes) in acne vulgaris patients. The three agents of interest in the study were isotretinoin, salicylic acid, and N-acetylcysteine (NAC). The study included forty-eight patients with acne vulgaris with ages ranging from 16 to 30 years, and they had different grades of the disease. Azithromycin and Doxycycline sensitivity and the ability of biofilm formation of C. acnes isolated from all patients were assessed before and after adding the 3 agents. Azithromycin and Doxycycline sensitivity was improved after adding the 3 agents and the ability of biofilm formation of C. acnes was also reduced. Isotretinoin, salicylic acid, and NAC can be promising adjuvants in treating acne vulgaris by their anti-microbial effect in reducing biofilm formation and improving antibiotic sensitivity. Clinical Trial NCT06179056.

Development of the acne-specific quality of life questionnaire Quality of Life Relevance-Acne

Background

Participating members of the European Academy of Dermatology and Venereology Task Forces on quality of life (QoL) and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa initiated data collection in 9 European countries and formed the list of the most relevant topics for acne patients.

Objective

The aim of this study was to develop a new acne-specific health-related QoL instrument based on the list of the most relevant topics for acne patients.

Methods

After assessment by acne patients (n = 715) on how clear and relevant the items in the prototype questionnaire were, a group of experts on acne and QoL performed discussions on items inclusion, which resulted in a series of 21 items. Then another group of acne patients (n = 1502) filled in the new version of the instrument. A factor analysis was conducted on the 21-item version.

Results

Three-factor model with 19 items indicated a satisfactory fit. The three dimensions were called: Socioemotional; Symptoms; Stigma and Suicidal thoughts.

Limitations

Included patients and experts may not fully represent acne patients and health care professionals worldwide.

Conclusion

A final 19-item version of the Quality of Life Relevance-Acne was developed.

Hair Follicle-Targeted Delivery of Azelaic Acid Micro/Nanocrystals Promote the Treatment of Acne Vulgaris

Purpose

Acne vulgaris is a chronic inflammatory skin disorder centered on hair follicles, making hair follicle-targeted delivery of anti-acne drugs a promising option for acne treatment. However, current researches have only focused on the delivering to healthy hair follicles, which are intrinsically different from pathologically clogged hair follicles in acne vulgaris.

Patients and Methods

Azelaic acid (AZA) micro/nanocrystals with different particle sizes were prepared by wet media milling or high-pressure homogenization. An experiment on AZA micro/nanocrystals delivering to healthy hair follicles was carried out, with and without the use of physical enhancement techniques. More importantly, it innovatively designed an experiment, which could reveal the ability of AZA micro/nanocrystals to penetrate the constructed clogged hair follicles. The anti-inflammatory and antibacterial effects of AZA micro/nanocrystals were evaluated in vitro using a RAW264.7 cell model stimulated by lipopolysaccharide and a Cutibacterium acnes model. Finally, both the anti-acne effects and skin safety of AZA micro/nanocrystals and commercial products were compared in vivo.

Results

In comparison to commercial products, 200 nm and 500 nm AZA micro/nanocrystals exhibited an increased capacity to target hair follicles. In the combination group of AZA micro/nanocrystals and ultrasound, the ability to penetrate hair follicles was further remarkably enhanced (ER value up to 9.6). However, toward the clogged hair follicles, AZA micro/nanocrystals cannot easily penetrate into by themselves. Only with the help of 1% salicylic acid, AZA micro/nanocrystals had a great potential to penetrate clogged hair follicle. It was also shown that AZA micro/nanocrystals had anti-inflammatory and antibacterial effects by inhibiting pro-inflammatory factors and Cutibacterium acnes. Compared with commercial products, the combination of AZA micro/nanocrystals and ultrasound exhibited an obvious advantage in both skin safety and in vivo anti-acne therapeutic efficacy.

Conclusion

Hair follicle-targeted delivery of AZA micro/nanocrystals provided a satisfactory alternative in promoting the treatment of acne vulgaris.

Anhedonia in Acne Vulgaris: A Cross-Sectional Study of 104 Consecutive Acne Patients

Background

Anhedonia is defined as a reduced ability to experience or even a total loss of pleasure.

Purpose

This study was undertaken to evaluate anhedonia in 104 consecutive acne patients.

Material and Methods

Acne severity was assessed with Investigator Global Assessment (IGA), anhedonia was studied with the Snaith-Hamilton Pleasure Scale (SHAPS), Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS) and Temporal Experience of Pleasure Scale (TEPS). Moreover, the quality of life (QoL) and stigmatization, as well as depression and anxiety (Hospital Anxiety and Depression Scale - HADS), were additionally evaluated.

Results

Anhedonia was found in 20.19% of acne patients and was more common (p=0.007) in males (34.29%) than in females (13.04%). Based on SHAPS, males with acne showed significantly (p=0.049) higher levels of anhedonia (2.39 ± 3.18 points) than acne females (1.26 ± 2.36 points). Anhedonia significantly correlated with the clinical acne severity (SHAPS: r=0.205, p=0.038 and ACIPS: r=-0.222, p=0.026). Although the intensity of anhedonia did not show any relationship with QoL and stigmatization assessments, there was a significant correlation between anhedonia and depressive symptoms (SHAPS: r=0.310, p<0.001; ACIPS: r=-0.364, p<0.001). Such dependency was not documented for anxiety.

Conclusion

Anhedonia seems to be a common phenomenon in acne and should be considered in the holistic approach to acne patients.

Clinical Characteristics, Metabolic Parameters, and Risk Factors for Suicide Attempts Vary with Untreated Major Depressive Disorder Duration

Suicidal attempts (SAs) are common in major depressive disorder (MDD). However, only few studies have so far assessed how risk factors for SAs in patients with MDD might be related to the duration of untreated illness (DUI). We interviewed 1,718 drug-naive outpatients with MDD with first-episode SAs and divided them into groups that had and had not attempted suicide. DUI was used as an additional grouping criterion. The patients (20.14%; 346/1718) who had a history of SAs were older and had a longer DUI; lower educational level (middle school-educated only); more psychotic symptoms; higher scores on depression and anxiety scales; and higher BP, plasma BG, TC, and LDL-C levels, but lower HDL-C concentrations. Anxiety symptoms, high education level, and being unmarried were risk factors for SA in patients with MDD with DUIs of <3 months; anxiety symptoms, low BMI, high plasma TC, and low plasma HDL-C were risk factors for SA in the group with DUIs between 3 and 8 months; age, anxiety symptoms, and higher systolic blood pressure were risk factors for those with DUIs > 8 months. This study was a single-center cross-sectional survey, and its limitations include a lack of outside validation. Patients with MDD with and without a SA history have different clinical characteristics and metabolic parameters, and risk factors for suicide vary across DUI stages. Anxiety was a general risk factor, suggesting that clinicians should strengthen their assessment of SA risk in patients with MDD during diagnosis and treatment.

The Mind Body Connection in Dermatologic Conditions: A Literature Review

Psychodermatology pertains to the relationship between the skin and brain. This review aims to summarize the evidence of the mind body connection in four psychophysiological conditions: rosacea, atopic dermatitis (AD), acne vulgaris (AV), and psoriasis. A literature search was conducted using several English language databases. All four conditions share similar psychiatric co-morbidities, including but not limited to anxiety, depression, and suicidality. In rosacea, the upregulation of transient receptor potential vanilloid type 1, Toll like receptor 2, and Th17 cells releases downstream products that are simultaneously implicated in mood disorders. Stress exacerbates AV through the hypothalamic-pituitary-adrenal (HPA) system, which alters functioning of sebocytes and Cutibacterium acnes. In AD and psoriasis, the HPA axis influences Th1, Th2, Th22, and Th1, Th17 immune mediated responses, respectively. This leads to the secretion of pro-inflammatory cytokines which are also involved in the pathogenesis of anxiety and depression. Neurotransmitters implicated in mental illness, such as gamma-aminobutyric acid and serotonin, may also play a role in the development of AD and psoriasis. The management of cutaneous disease may mitigate psychological distress, and future research may show the corollary to also be true.

The Relationship of Acne With Somatosensory Amplification, Health Anxiety, and Depression Levels

Objective The objective of this study is to evaluate the somatosensory amplification, as well as anxiety and depression levels in acne vulgaris (AV) patients, and to examine their relationship with disease severity. Methods Sociodemographic form, Global Acne Grading System (GAGS), Somatosensory Amplification Scale (SSAS), Health Anxiety Inventory (HAI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were applied to the patient group. All scales, except GAGS, were also applied to the healthy controls. Results All psychiatric scale scores of acne patients were higher than those of the control group. Moreover, the patient group had significantly higher SSAS, BDI scores, HAI total scores, and subscales of hypersensitivity to somatic symptoms and anxiety compared to the healthy controls. A positive but weak correlation was found between all scale scores. In patients with AV, no correlation was found between acne severity, age, disease duration, and all scale scores. Conclusion A significant relationship was found between somatosensory amplification, depression, and health anxiety in acne patients, independent of global acne severity, age, and disease duration. More successful acne treatment and patient management will be possible with an interdisciplinary approach that includes both psychiatry and dermatology.

Microneedling Monotherapy for Acne Scar: Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Acne scarring, formed by the deposition of collagen following inflammatory acne, not only represents a cosmetic problem but also poses a psychological health risk to patients. As microneedling has become a common treatment for acne scarring, an increasing number of studies have compared the efficacy and safety of microneedling. In this study, we conducted a meta-analysis of randomized controlled trials (RCTs) comparing microneedling with other treatments.

METHOD

Three databases, namely Embase, PubMED, and Cochrane library, were searched until June 20, 2021, for RCTs only. Studies using microneedling in both treatments were excluded.

RESULTS

Twelve studies, totaling 414 participants, were included in our meta-analysis. For objective scar improvement, the pooled estimate analysis of the first group, treated with microneedling without radiofrequency, yielded a mean difference of 0.42 (95% CI-0.12-0.73%) with a significant difference at the 5% significance level. The second group, treated with fractional radiofrequency microneedling, exhibited no significance at the 5% significance level. Regarding subjective satisfaction, most results exhibited no significant difference between microneedling and other treatments. Although no case of secondary scarring or infection was reported in our study, the pooled result of postinflammatory hyperpigmentation was significant at the 5% significance level and preferred microneedling treatment.

CONCLUSION

Microneedling without radiofrequency achieved superior results in terms of scar improvement. No form of microneedling caused postinflammatory hyperpigmentation-an advantage in acne scar treatment. Thus, microneedling is a favorable choice for the treatment of acne scarring.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of a combined chemical peel and topical salicylic acid-based gel combination in the treatment of active acne

BACKGROUND

Acne vulgaris is a common skin condition affecting the pilosebaceous unit of the skin characterized by the presence of comedones, papules, pustules, nodules, and cysts, which might result in permanent scars. It commonly affects adolescents, but it can occur in any age-group with the second group of incidence in young women in their 30s. Acne vulgaris can highly affect a person's quality of life. Therefore, it is necessary to act against it to prevent emotional impact and long-term complications.

AIM

This study aimed to demonstrate the efficacy of a chemical peel in combination with a home care-exfoliating and purifying product in improving mild and moderate acne.

METHODS

The study included 45 patients with mild-to-moderate acne. Patients were treated with a chemical peel containing a mix of salicylic acid, pyruvic acid, and retinoic acid once every 3 weeks for 4 times, plus a home care treatment after the healing process. Michaelson's acne severity score, Subject Global Aesthetic Improvement Scale, and Face Skin Q questionnaire were used to evaluate patients' skin improvement and patients' satisfaction.

RESULTS

All patients have shown improvement in skin lesions after 4 sessions of chemical peel according to Michaelson's acne severity score and Subject Global Aesthetic Improvement Score. Face Skin Q questionnaire demonstrated an improved quality of life in all treated patients.

CONCLUSION

The combination of salicylic acid-based chemical peel plus exfoliating home care treatment appears to be a very good strategy against acne. Therefore, the physician may use this combination as an effective treatment for patients dealing with acne vulgaris.

Skincare in Social Media: Analyzing Prominent Themes in Online Dermatologic Discussions

Introduction: As the size and influence of online dermatologic communities have developed significantly in recent years, literature concerning the relationship between social media and dermatology grows more important. One community of interest is r/SkincareAddiction, a forum of over 1.2 million members on Reddit that serves as both a support group and discussion aggregator sourcing information from multiple social media platforms.

Methods: This study reports on the qualitative analysis of 300 highly engaged posts to identify prominent themes in online dermatologic discussions and determine the extent of multiplatform interaction between Reddit and other dermatology-relevant social networks.

Results: Results of an inductive analysis indicate discussions place an emphasis on communicating advice and improving general wellbeing, comprising 71% of measured posts. However, a large portion of this counsel lacks evidence and pseudoscientific recommendations are often accepted as factual. Additionally, 31% of entries were drawn from alternative social media sites.

Conclusion: Assessing the prevalent points of discussion in dermatology-relevant communities can inform clinical practice and reveal alternative methods to advance the delivery of care. As patients increasingly seek health advice and support online, developing digital literacy in common dermatologic trends offers a unique opportunity to improve communication, disseminate evidence-based counsel, and combat misinformation in both clinical and online settings.