Acne and quality of life - impact and management

The adjuvant treatment role of ω-3 fatty acids by regulating gut microbiota positively in the acne vulgaris

Objectives:We aimed to explore the potential role of omega-3 (ω-3) fatty acids on acne vulgaris by modulating gut microbiota.Materials and Methods:We randomly divided the untreated acne patients into two groups with or without ω-3 fatty acids intervention for 12 weeks. The Sprague Dawley (SD) rats with acne model were given isotretinoin, ω-3 fatty acids or their combination respectively. Then the colonic contents samples of the drug intervention SD rats were transferred to the pseudo sterile rats with acne model. The severity of the disease was assessed by the Global Acne Grading System (GAGS) score of the patients, and the swelling rate of auricle and the pathological section of the rat with acne model. The 16S rDNA gene sequencing was performed to detect the alteration of the gut microbiota.Results:ω-3 fatty acids could increase the diversity of the gut microbiota and regulate the flora structure positively both in the patients and rats, increase the abundance of butyric acid producing bacteria and GAGS score in the patients, and alleviate the inflammation and comedones of rats.Conclusion:Supplementation of ω-3 fatty acids could alleviate the inflammation of acne vulgaris by increasing the abundance of butyric acid producing bacteria.

International expert consensus recommendations for the use of dermocosmetics in acne

BACKGROUND

A wide variety of dermocosmetics (products with both active skincare and cosmetic activity) are available for the management of acne vulgaris. These products are important because they may be the first line of approach for patients desiring to self-treat and they can also have beneficial effects-reducing lesion counts and improving global acne severity. When used in conjunction with medical therapy, dermocosmetics can improve tolerability and enhance results. We reviewed available evidence and combined it with our clinical experience to help guide clinicians in selecting skincare products with acne-targeting ingredients.

METHODS

An international panel of dermatologists with an interest and expertise in managing acne performed a literature review, formulated clinical questions related to the role of dermocosmetics in the acne setting, used a modified GRADE approach to evaluate available evidence and then utilized an online iterative Delphi process to create consensus recommendations. It should be noted that due to the limited number of available studies, the category of dermocosmetics was evaluated rather than specific ingredients.

RESULTS

The quality of evidence was found to be low to moderate. Key recommendations were made based on available evidence for the use of dermocosmetics in acne to improve acne global assessment, reduce acne lesion counts, reduce superficial skin oiliness and serve as maintenance therapy after medical treatment, while providing a good tolerability. Recommendations were also made for using dermocosmetics as adjuncts to medical treatment.

CONCLUSIONS

While there is a need for better quality evidence, dermocosmetics have demonstrated some benefit for acne both when used alone in its milder clinical presentations or in maintenance post acne medication and as adjunct to acne treatments.

Research progress on the role of macrophages in acne and regulation by natural plant products

Acne vulgaris is one of the most common skin diseases. The current understanding of acne primarily revolves around inflammatory responses, sebum metabolism disorders, aberrant hormone and receptor expression, colonization by Cutibacterium acnes, and abnormal keratinization of follicular sebaceous glands. Although the precise mechanism of action remains incompletely understood, it is plausible that macrophages exert an influence on these pathological features. Macrophages, as a constituent of the human innate immune system, typically manifest distinct phenotypes across various diseases. It has been observed that the polarization of macrophages toward the M1 phenotype plays a pivotal role in the pathogenesis of acne. In recent years, extensive research on acne has revealed an increasing number of natural remedies exhibiting therapeutic efficacy through the modulation of macrophage polarization. This review investigates the role of cutaneous macrophages, elucidates their potential significance in the pathogenesis of acne, a prevalent chronic inflammatory skin disorder, and explores the therapeutic mechanisms of natural plant products targeting macrophages. Despite these insights, the precise role of macrophages in the pathogenesis of acne remains poorly elucidated. Subsequent investigations in this domain will further illuminate the pathogenesis of acne and potentially offer guidance for identifying novel therapeutic targets for this condition.

Acne microbiome: From phyla to phylotypes

Acne vulgaris is a chronic inflammatory skin disease with a complex pathogenesis. Traditionally, the primary pathophysiologic factors in acne have been thought to be: (1) altered sebum production, (2) inflammation, (3) excess keratinization and (4) colonization with the commensal Cutibacterium acnes. However, the role of C. acnes has been unclear, since virtually all adults have C. acnes on their skin yet not all develop acne. In recent years, understanding of the role of C. acnes has expanded. It is still acknowledged to have an important place in acne pathogenesis, but evidence suggests that an imbalance of individual C. acnes phylotypes and an alteration of the skin microbiome trigger acne. In addition, it is now believed that Staphylococcus epidermidis is also an actor in acne development. Together, C. acnes and S. epidermidis maintain and regulate homeostasis of the skin microbiota. Antibiotics, which have long been a staple of acne therapy, induce cutaneous dysbiosis. This finding, together with the long-standing public health edict to spare antibiotic use when possible, highlights the need for a change in acne management strategies. One fertile direction of study for new approaches involves dermocosmetic products that can support epidermal barrier function and have a positive effect on the skin microbiome.

Anatomical variants of acne differ in their impact on social perception

BACKGROUND

Acne negatively affects quality of life, however quality-of-life scores poorly correlate with disease severity scores. Previous research demonstrated existence of facial areas in which skin lesions have greater impact on gaze patterns. Therefore, we hypothesized that anatomical variants of acne may be perceived differently.

OBJECTIVES

The aim was to investigate effect of anatomical variants of acne on natural gaze patterns and resulting impact on social perception of acne patients.

METHODS

We tracked eye movements of participants viewing neutral and emotional faces with acne. Images were rated for acne-related visual disturbance, and emotional faces were rated for valence intensity. Respondents of an online survey were asked to rate their perception of pictured individuals' personality traits.

RESULTS

All faces with acne were perceived as less attractive and received poorer personality judgements with mid-facial acne presenting smallest deviation from healthy faces. T-zone and mixed acne exhibited the least significant difference in respondents gaze behaviour pattern from each other. In addition, there was no significant difference in respondents' grading of acne visual disturbance or ratings for attractiveness, success and trustworthiness. U-zone adult female acne was rated as the most visually disturbing and received the lowest scores for attractiveness. Happy faces with adult female acne were rated as less happy compared to other acne variants and clear-skin faces.

CONCLUSIONS

Anatomic variants of acne have a distinct impact on gaze patterns and social perception. Adult female acne has the strongest negative effect on recognition of positive emotions in affected individuals, attractiveness ratings and forming social impressions. If perioral acne lesions are absent, frontal lesions determine impact of acne on social perception irrespective of the presence of mid-facial lesions. This perceptive hierarchy should be taken into consideration while deciding treatment goals in acne patients, prioritizing achieving remission in perioral and frontal area.

Long-term efficacy and safety of nonablative monopolar radiofrequency in the treatment of moderate to severe acne vulgaris

BACKGROUND

Acne vulgaris (AV) is a prevalent skin condition known for its potential to cause scarring and psychological distress, often leading to diminished self-esteem. While topical and oral treatments are commonly prescribed, some patients experience treatment failure, adverse effects, or contraindications to conventional therapies. In response to these challenges, laser and energy-based device therapies have emerged as promising alternatives for individuals who fall into these categories, showing considerable potential in the treatment of AV.

OBJECTIVE

This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) in treatment of moderate to severe AV.

METHODS

Twenty-four patients with moderate to severe AV underwent a series of two NMRF treatment sessions, spaced 4 weeks apart. To evaluate treatment outcomes, live in-person lesion counts and measurements of pore size and volume, and sebum production were quantified using Antera® 3D imaging system, and Sebumeter®, respectively. Patients' self-assessment data regarding degree of improvement and facial oiliness were gathered. Dermatology life quality index (DLQI) questionnaire was utilized to assess the impact of AV on their quality of life. All objective and subjective evaluations were conducted at the baseline, 1 month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment sessions. Adverse effects were also recorded during each visit.

RESULTS

Twenty out of the 24 subjects completed the study protocol. The mean inflammatory lesion counts significantly reduced by 42.86% and 45.71% from the baseline at 3 (p = 0.027) and 6 months (p = 0.032) after the second treatment. Sebum excretion likewise significantly decreased from baseline by 11.62% (p = 0.012), 13.37% (p < 0.001), and 21.51% (p = 0.004), 1 month after the first treatment, 1 and 6 months after the second treatment, respectively. The pore volume continued to decrease by 35% (p = 0.003) and 41.5% (p < 0.001) at 1 and 6 months following the final treatment, respectively. The DLQI significantly decreased from 10.00 (interquartile range [IQR]: 6.50-15.00) to 2.00 (IQR: 1.00-4.75), corresponding to 80% improvement of the index, 1 month after the last treatment and was sustained up to the last follow-up visit. Patients' self-assessments on degree of improvement and facial oiliness also significantly improved following NMRF treatments. The treatments were well-tolerated without significant adverse effects.

CONCLUSION

NMRF appears to be an effective and safe treatment for inflammatory AV, with therapeutic outcomes persisting up to 6 months after two treatment sessions.

Integration of Single-Cell Transcriptomics Data Reveal Differences in Cell Composition and Communication in Acne

Purpose

Acne is a kind of hair follicle sebaceous inflammatory disease, which has a high incidence rate among adolescents. Comparative data on cells which beneficial for precise treatment of acne patients.

Patients and Methods

After integrating and removing the batch effect of single-cell transcriptomics data of acne patients and health skin, the dimensionality reduction clustering was performed and the change in characteristics of each cell group were analyzed. Further, cell communication differences between gender were analyzed by use Cellchat software.

Results

70,189 cells were analyzed, and 11 cell groups were identified. The proportion of basal cells and macrophages in skin of acne patients are relatively high than that of skin in healthy people. The results of cell communication showed that the communication intensity of acne patients was significantly higher than that of healthy skin, and the endothelial cells showed a strong ability to receive signals. From the perspective of gender differences, the proportion of macrophages in male patients were higher than that in female patients, and there were a large number of basal cells in the lesion area of female patients. There are also have some specific immune response ligand-receptor regulatory signals in male patients.

Conclusion

There are significant differences in skin cell composition and cell communication patterns between acne patients and healthy people, especially reflected in gender differences. Basal cells, macrophages and endothelial cells can serve as key targets for acne treatment. The treatment methods for men and women should be more personalized.

Scars

Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.

Ultrapulse carbon dioxide dot matrix laser for facial scar treatment: A meta-analysis

A meta-analysis was performed to investigate the efficacy of ultrapulse carbon dioxide dot matrix laser treatment for patients with facial scars. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Biomedical Literature Database, and Wanfang Database were systematically searched for randomised controlled trials (RCTs) investigating ultrapulse carbon dioxide dot matrix laser treatment for facial scars, and the search was conducted from the time of database inception to July 2023. The retrieved literature was screened independently by two researchers, and data extraction and quality assessments were performed. The meta-analysis was conducted using RevMan 5.4 software. Outcome metrics included overall treatment effectiveness, complication rate, and Echelle d'évaluation clinique des cicatrices d'acné (ECCA) scores. Seventeen RCTs comprising 3703 patients were included, with 1853 patients in the experimental group and 1850 in the control group. The results showed that the experimental group had significantly increased overall treatment efficacy rates (odds ratio [OR]: 3.84, 95% confidence interval [CI]: 3.02-4.90, p < 0.001), reduced complication rates (OR: 0.35, 95% CI: 0.27-0.44, p < 0.001), and improved ECCA scores (standardised mean difference: -1.79, 95% CI: -2.53 to -1.05, p < 0.001) compared with the control group. In conclusion, as the primary treatment modality for facial acne depression scars, ultrapulse carbon dioxide dot matrix laser can significantly increase the overall treatment efficacy rate and ECCA scores and reduce the incidence of complications; however, higher-quality studies are needed for further validation.

Impact of Pediatric Dermatologic Conditions on Child and Parent Quality of Life

Dermatologic conditions can confer a negative effect on pediatric patients and their caretakers. We aim to study the relationship between child and parent quality of life among various dermatoses to further understand the psychosocial impacts of dermatologic disease. We conducted a cross-sectional study of 100 pediatric patients (aged 7-18) and 98 parents who presented to the Pacific Skin Institute, Sacramento, CA, from November 2020 to January 2022. Patients and their parents were evaluated using the Children's Dermatology Life Quality Index (CDLQI) and Family Dermatology Life Quality Index (FDLQI). The maximum score for both indices was 30, with a higher score indicating greater impairment on quality of life. From all the patients and parents identified for various dermatoses, FDLQI scores (mean, 7.8; n = 98) exceeded CDLQI scores (mean, 5.8; n = 100) in nearly every condition. Acne was the only diagnosis with greater CDLQI scores (mean, 9.2; n = 43) than FDLQI scores (mean, 8.8; n = 42). Psoriasis had the greatest difference between FDLQI scores (mean, 10.4; n = 9) and CDLQI scores (mean, 5.9; n = 9). Our study found that parents of children with dermatologic conditions often experience a greater impairment on quality of life compared to the patient. This is likely because parents are highly involved in the management of their child's condition and are burdened with the costs associated with dermatoses. These findings call for a more holistic evaluation by clinicians and the expansion of resources for patients and their parents.

The Effect of Cosmetic Treatment and Gel Laser Therapy on the Improvement of Comedogenic Skin Type

Comedogenic skin care receives little attention compared to the care or treatment of more serious acne manifestations. Traditional therapies may have limited success with potential side effects. Cosmetic care supported by the effect of a biostimulating laser may offer a desirable alternative. The aim of the study was to evaluate the biological effectiveness of combined cosmetic treatment with lasotherapy on comedogenic skin type using noninvasive bioengineering methods. Twelve volunteers with comedogenic skin type underwent a 28-week application of Lasocare Basic 645^® cosmetic gel containing Lactoperoxidase and Lactoferrin in combination with laser therapy (Lasocare^® method). The effect of treatment on skin condition was monitored using noninvasive diagnostic methods. The parameters were the amount of sebum, the pore count, the ultraviolet-induced red fluorescence assessment of comedonic lesions (percentage of the area and quantification of orange-red spots), hydration, transepidermal water loss, and pH. A statistically significant decrease in sebum production was observed on the skin of the treated volunteers, as well as a decrease in porphyrins, indicating the presence of Cutibacterium acnes populating comedones and causing enlarged pores. The balance of epidermal water in the skin was regulated adjusting the acidity of the skin coat in individual zones, which decreased the presence of Cutibacterium acnes. Cosmetic treatment in combination with the Lasocare^® method successfully improved the condition of comedogenic skin. In addition to transient erythema, there were no other adverse effects. The chosen procedure appears to be a suitable and safe alternative to traditional treatment procedures known from dermatological practice.

Acne and risk of mental disorders: A two-sample Mendelian randomization study based on large genome-wide association data

Background

Despite a growing body of evidence that acne impacts mental disorders, the actual causality has not been established for the possible presence of recall bias and confounders in observational studies.

Methods

We performed a two-sample Mendelian randomization (MR) analysis to evaluate the effect of acne on the risk of six common mental disorders, i.e., depression, anxiety, schizophrenia, obsessive–compulsive disorder (OCD), bipolar disorder, and post-traumatic stress disorder (PTSD). We acquired genetic instruments for assessing acne from the largest genome-wide association study (GWAS) of acne (N = 615,396) and collected summary statistics from the largest available GWAS for depression (N = 500,199), anxiety (N = 17,310), schizophrenia (N = 130,644), OCD (N = 9,725), bipolar disorder (N = 413,466), and PTSD (N = 174,659). Next, we performed the two-sample MR analysis using four methods: inverse-variance weighted method, MR-Egger, weighted median, and MR pleiotropy residual sum and outliers. Sensitivity analysis was also performed for heterogeneity and pleiotropy tests.

Results

There was no evidence of a causal impact of acne on the risk of depression [odds ratio (OR): 1.002, p = 0.874], anxiety (OR: 0.961, p = 0.49), OCD (OR: 0.979, p = 0.741), bipolar disorder (OR: 0.972, p = 0.261), and PTSD (OR: 1.054, p = 0.069). Moreover, a mild protective effect of acne against schizophrenia was observed (OR: 0.944; p = 0.033).

Conclusion

The increased prevalence of mental disorders observed in patients with acne in clinical practice was caused by modifiable factors, and was not a direct outcome of acne. Therefore, strategies targeting the elimination of potential factors and minimization of the occurrence of adverse mental events in acne should be implemented.

Effect of various types of photodynamic therapy on inflammatory and non-inflammatory lesions in patients with acne: A network meta-analysis of randomized controlled trials

BACKGROUND

Recent studies have demonstrated that photodynamic therapy (PDT) is safe and effective in treating acne vulgaris. The present study aimed to evaluate various PDTs on inflammatory and non-inflammatory lesions in patients with acne by a network meta-analysis (NMA) of randomized controlled trials (RCTs).

METHODS

The researchers of this paper searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to March 2022 to identify suitable RCTs. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool. Twenty-one RCTs were included, with a total sample size of 898 participants.

RESULTS

Network meta-analysis (NMA) revealed that indocyanine green (ICG) + near-infrared (NIR) diode laser, ICG+830 nm light-emitting diode (LED), indole-3-acetic acid (IAA) + 520 nm LED, and 5-aminolevulinic acid (ALA) + sunlight demonstrated obvious curative effects in patients with acne vulgaris. Importantly, ICG+NIR diode laser provided the greatest improvement in both inflammatory and non-inflammatory acne lesions (surface under the cumulative ranking curve [SUCRA]: 84.4% and 93.5%, respectively).

CONCLUSIONS

Based on the NWM and SUCRA ranking, ICG + NIR diode laser can be considered more effective in treating acne than the other PDTs of the RCTs. However, this conclusion should be interpreted with caution due to the limitations of the present study.

Prescribing Trends for Acne Vulgaris Visits in the United States

Acne vulgaris is the most common reason for pediatric patients and third most common reason for adult patients to seek care from a dermatologist in the US. However, referring providers may be reluctant to initiate patients on acne treatment or certain prescriptions. We assessed over-the-counter (OTC) and prescription acne (antibiotic and non-antibiotic) treatment rates to characterize differences by patient demographics and provider specialty. The National Ambulatory Medical Care Survey (NAMCS) was analyzed for all acne therapies prescribed for at least 10 unweighted visits between 1993 and 2016 (most recent years available). Prescription rates varied by age, with younger patients more likely to receive a prescription; insurance status, with privately insured patients more likely to receive a prescription; and across and within specialties, with dermatologists more likely to recommend a prescription medication than family medicine and pediatric providers. Among all forms of antibiotics for acne vulgaris, oral minocycline was the most commonly prescribed antibiotic by dermatologists, followed by oral doxycycline. Oral minocycline was also the most common antibiotic prescribed by family physicians, followed by oral doxycycline and oral clindamycin, respectively. Pediatricians appeared to be less likely to prescribe oral antibiotics for acne. The OTC topical antimicrobial benzoyl peroxide was the most utilized drug for acne among pediatricians, and it was also the most commonly recommended OTC drug for acne among dermatologists, family physicians, and pediatricians.

Revisiting the question of assessment by severity and classification of acne

The paper presents an analysis of different variants of acne classifications and the assessment of acne severity, carried out by the working group of the RODVK Committee for Classifications in Dermatovenereology. There is a division of acne vulgaris according to age and severity. Assessing the severity of acne is important for choosing the correct prescriptions in daily practice and for the evaluation of treatment outcomes. Most of existing acne grading systems are based either on a global grading of severity or on calculating the number of lesions in a variety of anatomic locations. For clinical practice of dermatovenereologists, as well as for educational and scientific purposes, the working group proposed to supplement the acne classification based on severity grading with counting the number of the lesions, and to take into account localization, rash prevalence and scarring when determining the acne severity.

The management of acne vulgaris in young people in primary care: A retrospective cohort study

Background

Acne vulgaris (acne) is common among young persons (YPs). Clinical practice guidelines are available for acne management to minimize their physical and psychological impact. However, evidence of adherence to these guidelines is sparse in primary care practices. The study aimed to determine the demographic profile of YPs who sought primary care consultations for acne, their related prescriptions and referrals to specialists for further management.

Method

A retrospective study was conducted using data from a cluster of eight public primary care clinics in Singapore. Demographic, clinical, prescription, and referral data were extracted from the electronic health records of YPs aged 10-29 years with a documented diagnosis of acne (ICD-10 classification) from 1st July 2018 to 30th June 2020. The data were reviewed, audited for eligibility criteria, and de-identified before analysis.

Results

Complete data from 2,700 YPs with acne were analyzed. Male (56.1%) YPs and those of Chinese ethnicity (73.8%) had the most frequent attendances for acne. The mean and median age at presentation was 19.2 (standard deviation = 4.3) and 19 (interquartile range = 16-22) years, respectively. Only 69.7% of YPs received an acne-related medication; 33.5% received antibiotic monotherapy; 53.0% were prescribed oral doxycycline, 35.0% acne cream (combination of sulfur, salicylic acid, and resorcinol), and 28.4% benzoyl peroxide 5% gel; 54.3% of those treated with antibiotics were prescribed with a shorter duration than recommended; 51.3% were referred to a dermatologist on their first visit, and 15.8% had more than one visit.

Conclusion

Acne management for YPs can be enhanced with refresher training among primary care physicians for better adherence to its clinical practice guidelines.

The influence of cosmetics dedicated to oily and acne-prone skin on skin parameters

INTRODUCTION

Patient compliance with care recommendations is closely related to the role of cosmetics in delaying or preventing the side effects of medications used to treat acne.

METHODS

A total of 33 volunteers with symptoms of acne vulgaris were qualified for the study. The skin parameters were measured before the experiment, after the 4 and at the 8 weeks of use. The measurements were subject to moisturizing the skin and secretion of sebum and skin color. A skin acoustic parameters using high-frequency ultrasound (33 MHz) was also performed. The recorded images were used to determine the epidermal entrance echo thickness and echo density of dermis.

RESULTS

The results show a change in the value of skin parameters during the 8-week application of a specific skin care procedure. The secretion of sebum did not change significantly, there was a decrease in hydration, and the level of melanin and hemoglobin remained at the same level. The thickness of the epidermis entrance echo in the ultrasound image was thinned.

CONCLUSION

For many mild/moderate acne patients, cosmetics proven to be effective and well tested in clinical trials can offer a real benefit in reducing both inflammation, sebum production, melanin, and irritation, but should also be moisturizing.

The Social and Psychological Impact of Acne Treatment: A Cross-Sectional Study of Blood Donors

BACKGROUND

Acne in adolescence and adulthood is believed to have a long-term impact on socioeconomic status (SES) and health-related quality-of-life (HRQoL) in adults.

OBJECTIVE

To estimate the cross-sectional prevalence of medically treated (MedTreAc) and untreated acne (UnTreAc) and to characterize its long-term impact in adults.

METHODS

A nationwide cross-sectional study on 17 428 blood donors aged 18-35 was performed. Associations among acne and HRQoL, depressive symptoms, total income, and SES were investigated via linear/logistic/multinomial logistic regression analyses adjusted for relevant covariables. HRQoL was measured by the Short Form-12, and depressive symptoms by the Major Depression Inventory. The data were self-reported.

RESULTS

Of the participants, 3591 (20.6%) and 1354 (7.8%) identified as the MedTreAc and UnTreAc phenotype, respectively. Neither phenotype was associated with a long-term impact on total income, but the MedTreAc group was associated with being an apprentice/student (OR = 1.26; 95% CI: 1.12, 1.42; P = 1.3×10^-4) or high skill-level employee (OR = 1.22, 95% CI: 1.07; 1.39, P = .0023), while self-employment was more common for those with UnTreAc (OR = 1.53; 95% CI: 1.12, 2.06, P = .0061). Additionally, the UnTreAc group was associated with a lower mental HRQoL (SF-12 mental component summary score -1.05, 95% CI: -1.56, -0.54; P = 1.4×10^-9) and increased odds ratio of depressive symptoms (OR = 1.44; 95% CI: 1.00, 2.02, P = .046).

CONCLUSION

In this population of blood donors, the cumulative prevalence of MedTreAc and UnTreAc were 20.6% and 7.8%, respectively. Untreated acne had a long-term impact on psychosocial well-being in adulthood. It was associated with lower mental HRQoL and higher occurrence of depressive symptoms. Acne was not associated with a lower salary or SES.

Efficacy and tolerability of three topical acne treatments by body mass index: post hoc analysis including overweight and obese patients

BACKGROUND

Acne prevalence may be higher in overweight/obese individuals, potentially due to hormonal, inflammatory, and/or dietary factors. However, the effects of body mass index (BMI) on topical acne treatments are largely unknown.

METHODS

Post hoc analyses of changes in inflammatory/noninflammatory lesions and treatment success were conducted using phase 3 data: clindamycin phosphate/benzoyl peroxide (CP/BPO) 1.2%/3.75% gel (NCT01701024); tretinoin 0.05% lotion (NCT02965456 and NCT02932306; pooled); and tazarotene 0.045% lotion (NCT03168321 and NCT03168334; pooled). Data were analyzed by BMI subgroups: <25kg/m² (underweight-to-normal), 25-<30kg/m² (overweight), and ≥30kg/m² (obese).

RESULTS

Among participants analyzed (CP/BPO = 495; tretinoin = 1,636; tazarotene = 1,612), ∼20-25% were overweight and 15-20% were obese. At week 12, mean percent changes from baseline in inflammatory lesions were: CP/BPO (overweight: -63.2%, obese: -56.0%); tretinoin (-57.6%, -53.1%); tazarotene (-59.9%, -56.8%). Mean changes in noninflammatory lesions were: CP/BPO (-54.2%, -50.8%); tretinoin (-51.6%, -44.9%); tazarotene (-56.7%, -54.6%). Treatment success rates with active treatment ranged from 16.2% to 33.5% across BMI groups.

CONCLUSIONS

CP/BPO 1.2%/3.75% gel, tretinoin 0.05% lotion, and tazarotene 0.045% lotion were all effective in reducing acne lesions by ≥45% in overweight/obese patients with moderate-to-severe acne, comparable to the underweight-to-normal group. Efficacy of these topical acne treatments is not greatly impacted by BMI and may be affected more by the formulation.

Microbiome and Probiotics in Acne Vulgaris—A Narrative Review

Acne vulgaris is a chronic disease characterised by the appearance of eruptions such as whiteheads, blackheads, pustules, papules, and cysts. Among factors that cause acne vulgaris are the abnormal keratinisation of the sebaceous canal, bacterial colonisation (Cutibacterium acnes), increased sebum production, genotypic factors, and hormonal disorders. Treatment is often long and tedious, and can lead to a reduction in quality of life and social isolation. The intestinal microbiota is greatly important in the formation of acne lesions. It is also responsible for the proper immunity of the organism. Acne is a disease that can be related to the condition of the digestive tract and its microbiome. Research shows that the use of probiotics may reduce skin eruptions. The probiotic supplementation and cosmetics markets are very dynamically developing. The use of internal supplementation and probiotic-containing cosmetics gives hope for the improvement of the skin condition of people with acne.

Combined Effect of Microneedling and Platelet-Rich Plasma for the Treatment of Acne Scars: A Meta-Analysis

Background

Microneedling is a promising method for the treatment of acne scars, while the effect of microneedling combined with platelet-rich plasma (PRP) remains unknown. We performed a meta-analysis of controlled studies to compare the efficacy and safety of microneedling treatment with and without additional PRP in patients with acne scars.

Methods

Randomized and non-randomized controlled studies were identified by search of Medline, Embase, and Cochrane's Library databases. Results were pooled with a random-effects model, incorporating the possible heterogeneity.

Results

Four randomized and 10 split-face non-randomized controlled studies with 472 patients were included. Compared to microneedling therapy without PRP, combined treatment with microneedling and PRP was associated with increased odds of clinical improvement of >50% in Goodman's qualitative scale [GQS: odds ratio (OR): 2.97, 95% confidence interval (CI): 1.96–4.51, p < 0.001; I² = 0%], and a significantly improved mean GQS score (mean difference: −0.32, 95% CI: −0.44 to −0.20, p < 0.001; I² = 0%). Combined treatment was associated with a higher patient satisfying rate (OR: 4.15, 95% CI: 2.13 to 8.09, p < 0.001; I² = 53%), while the incidence of severe adverse events such as severe erythema (OR: 1.59, 95% CI:.73 to 3.46, P = 0.24; I² = 0%) and severe edema (OR: 1.14, 95% CI: 0.47 to 2.76, P = 0.77; I² = 0%) were not significantly different.

Conclusions

Combined treatment with microneedling with PRP is more effective than microneedling without PRP for patients with acne scars.

Clinical Features of Acne in Primary Care Patients Assessed Through Teledermatology

Introduction/Objectives:

Acne is present in about 90% of teenagers and 12% to 14% of adults. Face and trunk are the most affected areas. Lesions can result in postinflammatory hyperpigmentation and scarring, leading to reduced quality of life. Asynchronous teledermatology has been increasingly used around the world, facilitating patient access to dermatologists. Our objectives were to assess: (1) clinical features of acne patients according to gender, age, severity, site of lesions, excoriation, postinflammatory hyperpigmentation (PIH), and atrophic scar (AS) and (2) how many referrals to in-person consultations with dermatologists could be avoided using asynchronous teledermatology in primary care attention?

Methods:

We analyzed images, demographic and clinical data of 2459 acne patients assisted by teledermatology, with the aim to confirm the diagnoses, to classify acne severity according to grades I to IV, and to search for the presence of postinflammatory hyperpigmentation, atrophic scars, and/or excoriated acne (EA). We compared the clinical and biological data, looking for associations among them.

Results:

Acne severity and age were associated with the most common sequels: postinflammatory hyperpigmentation (mainly on the trunk and in females, P < .0001) and atrophic scars (mainly on the face and in males, P < .0001). We also observed different frequencies according to age and sex: 13 to 24 years in males (P = .0023); and <12 (P = .0023) and 25 to 64 years old (P <.0001) for females; 68% of the patients had no need for in-person dermatologists’ referral, being kept at primary care attention with proper diagnosis and treatment.

Conclusion:

Clinical features of acne and its sequels differ according to gender, age, site, and severity. The new findings of PIH associated with women and AS, with men, may help offer a more personalized management to patients. Teledermatology was suitable for the majority of the acne cases in primary care.

There is no association between combined oral hormonal contraceptives and depression: a Swedish register-based cohort study

OBJECTIVE

To investigate whether users of hormonal contraceptives (HCs) are at increased risk of depression compared with non-users.

DESIGN

Register-based cohort study.

SETTING

Sweden.

SAMPLE

Women aged 15-25 years between 2010 and 2017 with no prior antidepressant treatment, psychiatric diagnose or contraindication for HCs (n = 739 585).

METHODS

Women with a prescription of HC were identified via the Swedish Prescribed Drug Register (SPDR). Relative risks (RRs) for first depression diagnosis in current HC-users compared with non-users were modelled by Poisson regression. Adjustments included age, medical indication for HC-use and parental history of mental disorders, among others.

MAIN OUTCOME MEASURES

Depression, captured by a redeemed prescription of antidepressant treatment, or a first depression diagnosis in the SPDR and the National Patient Register.

RESULTS

Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression, relative risk (RR) 0.89 (95% CI 0.87-0.91) and 1.03 (95% CI 0.99-1.06) after adjustments, respectively. Age-stratified analyses demonstrated that COC use in adolescents conferred no increase in risk (RR 0.96, 95% CI 0.93-0.98), whereas use of progestogen-only pills (RR 1.13, 95% CI 1.07-1.19), contraceptive patch/vaginal ring (RR 1.43, 95% CI 1.30-1.58), implant (RR 1.38, 95% CI 1.30-1.45) or a levonorgestrel intrauterine device (RR 1.59, 95% CI 1.46-1.73) were associated with increased risks.

CONCLUSIONS

This study did not find any association between use of COCs, which is the dominating HC in first time users, and depression. Non-oral products were associated with increased risks. Residual confounding must be addressed in the interpretation of the results.

TWEETABLE ABSTRACT

There is no association between combined hormonal contraceptives and depression.

Guidance for the pharmacological management of acne vulgaris

INTRODUCTION

Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne.

AREAS COVERED

Herein, the author discusses the treatment of comedonal, papulopustular, and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases.

EXPERT OPINION

The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.

Dermatology: how to manage acne vulgaris

Background

Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris.

Methods

A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English.

Results

Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies.

Conclusion

Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.

Quality of life in young adults with acne: Results of a cross-sectional study

BACKGROUND

The impact of acne on quality of life (QoL) may vary between patients from different age groups. There are limited data in the literature on QoL of young adults with acne and acne scars.

OBJECTIVES

To assess the QoL of young adults (age 18 to 25) with acne by using dermatology life quality index (DLQI) and Cardiff acne disability index (CADI), to assess the scores of individual items on DLQI and CADI, and to compare the two scales.

METHODS

In this cross-sectional questionnaire study of 1392 subjects with acne, each subject completed two questionnaires: DLQI and CADI. Mean values of DLQI and CADI, and those of individual items on DLQI and CADI were calculated; t-test was used for testing mean values and Spearman's rho coefficient for correlation between two questionnaires.

RESULTS

Mean DLQI (4.50) and CADI (3.60) scores were low. However, scores were significantly higher in females and in those with acne scars. "Feelings of embarrassment" and "interference with social activities" scored significantly higher for females across both questionnaires. There was no correlation between severity (as well as duration) of acne and HRQoL scores. Spearman's rho coefficient of correlation between DLQI and CADI was 0.71.

CONCLUSIONS

Acne impaired the QoL of young adults, acne scars more so. Females felt worse about their appearance with greater embarrassment and impaired social activities. QoL scores seem to depend on patients' perceptions, which may depend on factors other than objective severity of acne. We found good correlation between the two scales.

The impact of acne treatment on quality of life and self-esteem: A prospective cohort study from Lebanon

Background

Acne is highly prevalent among teenagers and young adults, with proven negative psychological and emotional impact. To our knowledge, no study has been conducted to quantify the repercussions of acne on quality of life (QoL) and self-esteem in Lebanon.

Objective

This study aimed to highlight the effect of acne treatment on QoL and self-esteem of Lebanese adolescents and young adults.

Methods

In this observational prospective study, patients between 15 and 40 years old with moderate-to-severe acne were allocated to one of two treatment groups (isotretinoin vs. systemic antibiotics combined with topical treatments) and followed for a period of 6 months. The effect of acne on QoL was measured using the Dermatology Life Quality Index, Cardiff Acne Disability Index, and Rosenberg Self-esteem Scale before treatment initiation (T1), after 3 months (T2), and after 6 months (T3). A multivariate analysis of covariance model was used.

Results

Sixty-two patients were included, of whom 79% were female and 61.3% had moderate acne. Fifty-five percent of patients were treated with systemic antibiotics combined with topical treatments, and 45% received isotretinoin. Mean scores of Cardiff Acne Disability Index, Dermatology Life Quality Index, and Rosenberg Self-esteem Scale at T1 were comparable between the two groups. A significant improvement was noticed in both groups at T2 and T3. The multivariate analysis of covariance model showed an interaction of time and age that concerned 25- to 40-year-old patients in both groups, who were the most negatively affected by acne at T1 and improved the most at T3.

Conclusion

This study demonstrated the equivalence between acne treatments in improving QoL and revealed the social obstacle that acne creates and its recrudescence in the subgroup of women of childbearing age.

Towards individualised contraceptive counselling: clinical and reproductive factors associated with self-reported hormonal contraceptive-induced adverse mood symptoms

OBJECTIVE

The study aim was to establish which demographic, clinical, reproductive and psychiatric factors are associated with self-reported hormonal contraceptive (HC)-induced adverse mood symptoms.

STUDY DESIGN

We compiled baseline data from two Swedish studies: one cross-sectional study on combined oral contraceptive (COC)-induced adverse mood symptoms (n=118) and one randomised controlled trial on adverse mood symptoms on COC (n=184). Both included women eligible for COC use, aged over 18 years. All women answered a questionnaire on HC use and associated mood problems. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to capture mood and anxiety disorders. Women who acknowledged HC-induced adverse mood symptoms, ongoing or previously (n=145), were compared with women without any such experience (n=157).

RESULTS

Compared with women without self-reported HC-induced adverse mood symptoms, women with these symptoms were younger at HC start (adjusted odds ratio (aOR) 0.83, 95% CI 0.72 to 0.95), had more often undergone induced abortion (OR 3.36, 95% CI 1.57 to 7.23), more often suffered from an ongoing minor depressive disorder (n=12 vs n=0) and had more often experienced any previous mental health problem (aOR 1.90, 95% CI 1.01 to 3.59).

CONCLUSIONS

In line with previous research, this study suggests that women with previous or ongoing mental health problems and women who are younger at HC start are more likely to experience HC-induced adverse mood symptoms. Former and current mental health should be addressed at contraceptive counselling, and ongoing mental health disorders should be adequately treated.

IMPLICATIONS

This study adds valuable knowledge for identification of women susceptible to HC-induced adverse mood symptoms. It should facilitate the assessment of whether or not a woman has an increased risk of such symptoms, and thus enable clinicians to adopt a more personalised approach to contraceptive counselling.

The Impact of Acne, Atopic Dermatitis, Skin Toxicities and Scars on Quality of Life and the Importance of a Holistic Treatment Approach

Skin conditions such as acne, atopic dermatitis, skin toxicity from oncology treatment, and scars are among the most common health conditions and negatively impact quality of life (QoL). Yet the physician perception of this impact often varies greatly from the patient perception. This is important because patient illness perception is closely linked with seeking help and treatment adherence behaviors. The objective of this review is to better understand the impact of these four highly prevalent skin conditions on QoL including their health-related economic factors to improve treatment outcomes. The literature search included literature published on QoL with acne, atopic dermatitis, scars (from any cause) and skin toxicities on PubMed between 2015 and 2020. We found that patients with skin conditions have a much higher frequency of altered QoL and psychological distress than those without. Also, skin conditions negatively impact self-image and can cause feelings of isolation, loneliness, lower self-esteem, and lower body satisfaction. Additionally, physical discomfort adds to the psychological distress. These physical and psychological impacts are an enormous financial burden on patients, their families and society. We found evidence that holistic treatment including treating the skin condition itself, providing wider peer and psychological support as well as shared decision-making, therapeutic patient education and dermatologist involvement improves outcomes. Holistic history-taking, checklists, or the use of more formal QoL scoring tools can be incorporated into routine consultations to better assess patient well-being and provide clinicians with important information for adapting treatment to individual patient requirements. In conclusion, this review highlights the overall impact of skin conditions (including psychological and QoL impacts) and the importance of providing holistic care to optimize treatment outcomes. A comprehensive QoL screening tool would be useful to help provide patient-centered treatment.

Construction and Evaluation of a Deep Learning Model for Assessing Acne Vulgaris Using Clinical Images

Introduction

Accurate assessment is the basis for the effective treatment of acne vulgaris. The goal of this study was to achieve standardised diagnosis and treatment based on a deep learning model that was developed according to the current Chinese Guidelines for the Management of Acne Vulgaris.

Methods

The first step was to divide each image of acne vulgaris into four regions. Each of these four regions of the same patient was then combined to form a complete facial region. The second step was to classify the images based lesion type, in accordance with the current Chinese guidelines, and by treatment strategy adopted by experienced dermatologists. The final step was to evaluate the performance of the deep learning model in patients with acne vulgaris.

Results

The results showed that the average F1 value of the assessment model is 0.8 (optimum value = 1). The weighted kappa coefficient between the evaluation according to the artificial intelligence model and the evaluation by the attending dermatologists was 0.791 (95% confidence interval 0.671–0.910, P < 0.001), indicating a high degree of consistency.

Conclusions

The assessment model based on deep learning and according to the Chinese guidelines had a slightly higher overall performance is comparable to that of the attending dermatologist.

Combination of 5-Aminolevulinic acid photodynamic therapy and isotretinoin to treat moderate-to-severe acne

BACKGROUND

In China, photodynamic therapy(PDT) has been widely accepted in the treatment of acne. However, there are few studies on PDT combined with isotretinoin of moderate to severe acne.

AIMS

To evaluate the efficacy and safety of PDT combined with isotretinoin in the treatment of moderate to severe acne.

METHODS

70 cases of moderate and severe acne patients were randomly divided into PDT group and combination group. In combination group, patients were treated with PDT, once/2weeks, for 3 times; and oral isotretinoin, 10 mg twice a day for 3 months. The PDT group was treated with PDT alone. The skin lesions were counted before treatment and in the 4th, 6th, 8th, and 12th weeks to evaluate the clinical efficacy. Adverse reactions during the treatment were recorded. We monitored the liver function of the combination group once a month. The recurrence rate was recorded 6 months after treatment.

RESULTS

A total of 67 patients completed the study. The effective rates of combination group in the 4th, 6th, 8th, and 12th weeks of treatment were 28.6 %, 71.4 %, 91.4 %, and 94.1 %, respectively; the effective rates of PDT group in the 4th, 6th, 8th, and 12th weeks of treatment were 22.9 %, 54.3 %, 74.3 %, and 78.8 %, respectively; the effective rates of two groups were statistically significant in the 6th, 8th, and 12th weeks of treatment (P < 0.05). There was no significant difference in pain score between two groups during the photodynamic therapy(P＞0.05). Adverse reactions, such as erythema and pustule during photodynamic therapy in both groups were tolerable. The pigmentation subsided in about 3 months. The recurrence rate of combination group was significantly lower than that of PDT group(7% VS 24 %,P＜0.05).

CONCLUSION

PDT combined with isotretinoin has higher effective rate and lower recurrence rate than single PDT, and is a choice for the treatment of moderate to severe acne.

Acne: modern approaches to solving an old problem

Background. Acne is one of the most common chronic dermatoses, which occurs in almost 8590% of the population. The disease manifests itself as polymorphic eruptions and is characterized by a recurrent and torpid course. Acne treatment is constantly improving, requires an integrated approach and long courses of therapy. Aims. To increase the effectiveness of acne therapy using new opportunities and promising methodological approaches using a combination of the therapeutic effects of platelet-rich plasma (PRP) and topical bacteriophage therapy. Materials and methods. The study included 30 patients with papulopustular acne of mild and moderate severity. Patients with mild acne were treated with PRP procedures as monotherapy. For moderate acne, PRP therapy was combined with regular applications of a staphylococcal bacteriophage (NPO Microgen, Nizhny Novgorod, Russia). The treatment was carried out on an outpatient basis: at least 3 procedures with an interval of 12 weeks (up to a maximum of 6 procedures within one year). The results were analyzed using descriptive statistics and the parametric Student's t-test. Data processing was carried out using the Biostat software. The value of the level of statistical significance of differences was taken as p 0.05. Results. Evaluation of the effectiveness of treatment was carried out on the basis of an analysis of the immediate outcomes of the disease, the dynamics of clinical symptoms and the severity of acne: regression of inflammatory elements of acne, a decrease in the phenomenon of seborrhea, improvement of the skin relief. As a result of the therapy, a transition to remission was noted in 16.6% of patients, an improvement in their condition 36.7%, a significant improvement 46.7%. Conclusions. An integrated approach combining PRP procedures and bacteriophage therapy can serve as a pathogenetically substantiated strategy for treating acne. A promising direction for further research is the development of new regimens and combinations of alternative therapeutic strategies using bacteriophages.

Acne: modern approaches to solving an old problem

Background. Acne is one of the most common chronic dermatoses, which occurs in almost 8590% of the population. The disease manifests itself as polymorphic eruptions and is characterized by a recurrent and torpid course. Acne treatment is constantly improving, requires an integrated approach and long courses of therapy. Aims. To increase the effectiveness of acne therapy using new opportunities and promising methodological approaches using a combination of the therapeutic effects of platelet-rich plasma (PRP) and topical bacteriophage therapy. Materials and methods. The study included 30 patients with papulopustular acne of mild and moderate severity. Patients with mild acne were treated with PRP procedures as monotherapy. For moderate acne, PRP therapy was combined with regular applications of a staphylococcal bacteriophage (NPO Microgen, Nizhny Novgorod, Russia). The treatment was carried out on an outpatient basis: at least 3 procedures with an interval of 12 weeks (up to a maximum of 6 procedures within one year). The results were analyzed using descriptive statistics and the parametric Student's t-test. Data processing was carried out using the Biostat software. The value of the level of statistical significance of differences was taken as p 0.05. Results. Evaluation of the effectiveness of treatment was carried out on the basis of an analysis of the immediate outcomes of the disease, the dynamics of clinical symptoms and the severity of acne: regression of inflammatory elements of acne, a decrease in the phenomenon of seborrhea, improvement of the skin relief. As a result of the therapy, a transition to remission was noted in 16.6% of patients, an improvement in their condition 36.7%, a significant improvement 46.7%. Conclusions. An integrated approach combining PRP procedures and bacteriophage therapy can serve as a pathogenetically substantiated strategy for treating acne. A promising direction for further research is the development of new regimens and combinations of alternative therapeutic strategies using bacteriophages.

Objective and Long-Term Evaluation of the Efficacy and Safety of a 1064-nm Picosecond Laser With Fractionated Microlens Array for the Treatment of Atrophic Acne Scar in Asians

BACKGROUND AND OBJECTIVE

Fractional 1064-nm picosecond-domain laser has recently been utilized for the treatment of atrophic acne scars and showed promising results. However, data on the safety and efficacy of this procedure in dark-skinned patients are limited. This prospective, self-controlled study was conducted to objectively evaluate the safety and efficacy of a 1064-nm picosecond laser coupled with a microlens array (MLA) for the treatment of atrophic acne scars on Asian skin.

STUDY DESIGN/MATERIALS AND METHODS

Twenty-six subjects of Fitzpatrick skin types (FSTs) III and IV with atrophic acne scars were enrolled. All subjects were treated with a 1064-nm picosecond laser (spot size of 8 mm, fluence of 1.0 J/cm² , a repetition rate of 10 Hz) in combination with the MLA handpiece for an average of three passes, for 6 monthly sessions. Objective (measurement of scar volume using three-dimensional (3D) photography and skin roughness analysis using ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment.

RESULTS

Statistically significant reduction of the scar volume from baseline at 1, 3, and 6 months after the final treatment were observed by 3D photography and ultraviolet A-light video camera. At the 6-month follow-up, 50% (13 of 26) of the subjects were rated as having at least 50% improvement of the scars. The rate of improvement significantly increased from the 1-month follow-up to the 6-month follow-up (P = 0.013). Similarly, at the 6-month follow-up, the scar volume (P = 0.024) and skin roughness (P = 0.001) also significantly improved, in comparison with the baseline. Mild postinflammatory hyperpigmentation (PIH) was observed to develop in approximately 18% of all the treatment sessions. All cases of PIH were temporary and resolved within 4 weeks on average.

CONCLUSIONS

The 1064-nm picosecond laser with MLA is a safe therapeutic alternative for the treatment of atrophic acne scars in dark-skinned individuals. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

The Effects of Once-Daily Tretinoin 0.05% Lotion on Quality of Life in Patients with Moderate-to-Severe Acne Vulgaris

BACKGROUND

In two phase III clinical trials of patients with moderate-to-severe acne (NCT02932306, NCT02965456), tretinoin 0.05% lotion reduced inflammatory and noninflammatory lesions relative to vehicle lotion, with low potential for cutaneous irritation.

OBJECTIVE

Data from these studies were analyzed post hoc to investigate the effects of tretinoin 0.05% lotion on patient-reported quality of life, as assessed using the Acne-Specific Quality of Life Questionnaire (Acne-QoL).

METHODS

Mean changes from baseline to week 12 in Acne-QoL scores were analyzed in the pooled intent-to-treat population and a subgroup with treatment success (≥ 2-grade improvement on the Evaluator's Global Severity Scale and rating of "clear" or "almost clear"). Pearson correlations were conducted in the pooled intent-to-treat population to assess the relationship between the Acne-QoL acne symptoms domain and each of the other three domains.

RESULTS

In the pooled intent-to-treat population (n = 1640), greater mean improvements were found with tretinoin 0.05% lotion vs vehicle in all four domains: self-perception (mean change: 7.4 vs 6.7); role-emotional (6.8 vs 6.0); role-social (4.8 vs 4.6); acne symptoms (6.5 vs 5.6); all p < 0.05. Relative to the intent-to-treat population, participants who experienced treatment success with tretinoin 0.05% lotion had higher (better) mean Acne-QoL scores at week 12. Correlations between acne symptoms and the other three domains were found at baseline and week 12 (p < 0.05).

CONCLUSIONS

Participants with moderate-to-severe acne reported better quality of life after 12 weeks of treatment with tretinoin 0.05% lotion. Clinical improvements in acne symptoms may have contributed to these outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02932306, NCT02965456.

Comparative Efficacy of Pharmacological and Nonpharmacological Interventions for Acne Vulgaris: A Network Meta-Analysis

Acne has several effects on physical symptoms, but the main impacts are on the quality of life, which can be improved by treatment. There are several acne treatments but less evidence comparing their relative efficacy. Thus, we assessed the comparative efficacy of pharmacological and nonpharmacological interventions for acne. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2019, to include randomized controlled trials for acne that compared topical antibiotics (TA), benzoyl peroxide (BPO), topical retinoids (TR), oral antibiotics (OA), lasers, light devices including LED device (LED), photodynamic therapy (PDT), and intense pulsed light, chemical peels (CP), miscellaneous therapies or complementary and alternative medicine (MTCAM), or their combinations. We performed Bayesian network meta-analysis with random effects for all treatments compared with placebo and each other. Mean differences (MDs) of lesions count and risk ratios of adverse events with their 95% credible intervals (CrIs) were calculated, and all interventions were ranked by the Surface Under the Cumulative Ranking (SUCRA) values. Additional frequentist additive network meta-analysis was performed to detect the robustness of results and potential interaction effects. Sensitivity analyses were carried out with different priors, and metaregression was to adjust for nine potential effect modifiers. In the result, seventy-three randomized controlled trials (27,745 patients with mild to moderate acne), comparing 30 grouped intervention categories, were included with low to moderate risk of bias. For adverse effects, OA had more risk in combination treatment with others. For noninflammatory lesions reduction, seventeen interventions had significant differences comparing with placebo and three interventions (TR+BPO: MD = −21.89, 95%CrI [−28.97, −14.76]; TR+BPO+MTCAM: −22.48 [−34.13, −10.70]; TA+BPO+CP: −20.63 [−33.97, −7.13]) were superior to others with 94, 94, and 91% SUCRA values, respectively. For inflammatory lesions reduction, nineteen interventions were significantly better than placebo, and three interventions (TR+BPO: MD = −12.13, 95%CrI [−18.41, −5.80]; TR+BPO+MTCAM: −13.21 [−.39, −3.04]; LED: −11.30 [−18.34, −4.42]) were superior to others (SUCRA: 81, 81, and 77%, respectively). In summary of noninflammatory and inflammatory lesions results, TR+BPO and TA+BPO were the best options compared to others. The frequentist model showed similar results as above. In summary, current evidence supports the suggestion that TR+BPO and TA+BPO are the best options for mild to moderate acne. LED is another option for inflammatory lesions when drug resistance occurs. All the combinations involved with OA showed more risk of adverse events than others. However, the evidence of this study should be cautiously used due to the limitations.

Inhibitory Effects of a Sargassum miyabei Yendo on Cutibacterium acnes-Induced Skin Inflammation

Acne vulgaris is a chronic inflammatory condition of skin sebaceous follicles. To explore its effects on acne vulgaris, we investigated the antibacterial and anti-inflammatory activities of Sargassum miyabei Yendo (a brown alga) ethanolic extract (SMYEE) on Cutibacterium acnes (C. acnes)-stimulated inflammatory responses, both in vivo and in vitro. To induce inflammation in vivo, C. acnes was intradermally injected into the dorsal skin of mice, to which SMYEE was applied. The antimicrobial activity of SMYEE was evaluated by the determination of minimum inhibitory concentrations (MICs). To explore in vitro anti-inflammatory effects, HaCaT cells were stimulated with C. acnes after treatment with SMYEE. The levels of IL-8 and the underlying molecular effects in C. acnes-stimulated HaCaT cells were assessed by enzyme-linked immunosorbent assay, Western blotting, and an electrophoretic mobility shift assay. Mouse skin lesions improved after treatment with SMYEE (50 μg/mouse). Neutrophil infiltration was significantly reduced in SMYEE-treated compared to SMYEE-untreated skin lesions. SMYEE reversed the C. acnes-induced increase in IL-8 levels in HaCaT cells and suppressed dHL-60 cell migration. SMYEE also inhibited C. acnes-induced phosphorylation of the extracellular signal-regulated kinase and inhibited activator protein-1 signaling. SMYEE may be a useful treatment for C. acnes-induced acne vulgaris.

GPs' practice and attitudes to initiating isotretinoin for acne vulgaris in Ireland: a cross-sectional questionnaire survey in primary care

BACKGROUND

Isotretinoin is prescribed in secondary care for severe acne vulgaris. Anecdotal reports suggest that GPs in Ireland currently initiate isotretinoin.

AIM

To ascertain the prevalence and management of isotretinoin in Irish general practice and to describe GPs' attitudes about the use of isotretinoin in Ireland.

DESIGN AND SETTING

A cross-sectional questionnaire survey of GPs in Ireland between October 2018 and February 2019.

METHOD

Two short questionnaires were developed: one for GPs who prescribe isotretinoin and one for GPs who do not prescribe isotretinoin. Questionnaires were distributed via email and online via GP Forum to GPs in Ireland.

RESULTS

Of a total 298 GPs who completed the questionnaire, 52 (17%) initiated isotretinoin. Older GPs (aged 35 years) and male GPs were more likely to prescribe isotretinoin. GPs cited prolonged dermatology waiting lists (n = 34, 65%) and a special interest in dermatology (n = 31, 60%) as two key drivers to initiating isotretinoin. However, this study found evidence of suboptimal blood monitoring, pregnancy testing, and contraceptive advice. Most GPs (n = 246, 83%) did not initiate isotretinoin and identified multiple barriers: medicolegal concerns (n = 150, 61%), being unaware that GPs may initiate isotretinoin (n = 135, 55%), and being unfamiliar with managing isotretinoin (n = 102, 41%). Important enablers to initiating isotretinoin cited by GPs include Irish College of General Practitioners guidelines (n = 118, 48%) and dermatologist support (n = 119, 48%). Two-thirds of the GPs questioned (n = 164, 67%) expressed an interest in initiating isotretinoin and most (n = 223, 91%) agreed that GPs can safely manage isotretinoin.

CONCLUSION

Few GPs in Ireland currently initiate treatment of acne with isotretinoin, and there is suboptimal adherence to recommended monitoring. Barriers to and enablers for GPs initiating isotretinoin were identified. Most GPs expressed an interest in initiating isotretinoin.

The use of isotretinoin for acne - an update on optimal dosing, surveillance, and adverse effects

INTRODUCTION

Acne is a chronic, inflammatory, and immune mediated disease of pilosebaceous unit, highly prevalent in adolescents. It involves face, trunk, and back; may leave scars and affect quality of life. Early, effective, and safe treatment is the key for disease resolution. Oral isotretinoin is the unique treatment for cure or prolonged remission for moderate and severe acne, preventing psychosocial impact and scars. It inhibits sebaceous glands activity and has anti-inflammatory and immunoregulatory properties.

AREAS COVERED

We performed a comprehensive literature search on PubMed database, up to March 2020, regarding oral isotretinoin for acne treatment. We synthetized data about acne pathogenesis and mechanism of action, efficacy, and safety of isotretinoin.

EXPERT OPINION

This drug is effective, despite common, controllable, and reversible mucocutaneous side effects. Serious adverse events are rare and represent individual reactions. Teratogenicity is the most severe, requiring rigorous control. We believe that no other therapeutic option, even topicals combined to oral antibiotics accomplish same results. Recurrence after treatments other than isotretinoin is the rule, prolonging risk of scars, compromising skin appearance, and causing emotional distress in teenagers. If there is no absolute contraindication, isotretinoin should be the first line treatment for moderate to severe inflammatory acne.

Evaluation of reliability and validity of the Patient Health Questionnaire-9 in patients with acne

To evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) in patients with acne. Three hundred acne patients were enrolled from January 2019 to December 2019. PHQ-9 and Hamilton Depression Scale(HAMD) survey was conducted to evaluate their depression status. Cronbach's α coefficient and test-retest reliability after 1 week were used to analyze the reliability of PHQ-9. Factor analysis, Spearman correlation analysis, receiver operating characteristic curve (ROC curve) were used for validity analysis of the PHQ-9.The screening validity was analyzed in different subgroups. Two hundred fifty-eight patients with acne completed the questionnaire. Forty-seven were diagnosed with depressive disorder. The best cut-off point for the PHQ-9 score is 9 points, with a sensitivity of 95.7%,a specificity of 88.6% and the area under the ROC curve(AUC) of 0.973.In validity analysis, the correlation coefficient between the total score of PHQ-9 and HAMD was 0.766,the kappa value was 0.530.Factor analysis revealed two common factors (cognitive-affective factor and somatic symptom factor),which explained 65.52% of the total variances. In reliability analysis, the Cronbach's α coefficient of the PHQ-9 was 0.851,the test-retest reliability value was 0.824.The time to complete the PHQ-9 was significantly less than the time to complete HAMD (P < .001).The PHQ-9 shows good reliability and validity for the diagnosis of depression in patients with acne, and can be used for preliminary screening of depression.

Treatment of post-menopausal acne with tretinoin lotion 0.05% delivers rapid results and concomitant benefits

We describe a case of comedonal acne in a post-menopausal female treated with a novel tretinoin lotion 0.05%. The patient also had some actinic keratoses, which are hyperkeratotic, scaly lesions caused by prolonged exposure to ultraviolet radiation. These lesions have the ability to progress into squamous cell carcinoma. Actinic keratoses can occur in patients as young as 20 years, but are more common in patients aged 50 years and older. Topical retinoids are recommended as monotherapy in comedonal acne but despite their documented clinical efficacy are underutilized due to concerns about cutaneous tolerability. Topical tretinoin is currently not recommended as first-line therapy in the treatment of actinic keratosis as its efficacy is not comparable to that of other modalities. In this patient, a novel tretinoin lotion 0.05% resulted in rapid in and sustained improvement of acne. The investigator also observed improvement in actinic keratoses and photodamage. If these results can be confirmed in a larger patient population this may be an attractive area of investigation for the treatment of patients with adult acne and photodamaged skin.

Treatment of acne vulgaris using 1,565 nm non-ablative fractional laser in combination with isotretinoin and pricking blood therapy

Objective: We aimed to evaluate the efficacy and safety of the 1,565 nm non-ablative fractional laser (NAFL) in combination with isotretinoin and pricking blood therapy (PBT) for treatment of AV.Methods: A retrospective analysis of 60 patients with moderate-to-severe AV was performed. Four groups (n = 15) were evaluated: 1,565nm NAFL alone, oral isotretinoin alone, double therapy (NAFL + isotretinoin) and triple therapy (NAFL + isotretinoin + PBT).Results: The triple therapy showed the highest improvement rate of inflammatory papules and boxcar atrophic scars. The patients receiving oral isotretinoin alone, double or triple therapy showed a significant decrease in volume of boxcar atrophic scars. The NAFL alone, double or triple therapy significantly decreased index of hemoglobin. Furthermore, the triple therapy significantly decreased indexes of hemoglobin and red areas as compared to the other three treatments. All four treatments significantly decreased indexes of pore sizes and wrinkles.Conclusion: This study showed that the triple therapy is effective for treatment of AV, which is worthy of further evaluation and investigation.

The efficacy and safety of fractional radiofrequency nanoneedle system in the treatment of atrophic acne scars in Asians

Background

Multiple treatment modalities have been developed to treat atrophic acne scars with varying degrees of success. Post‐inflammatory hyperpigmentation (PIH) after acne scar treatments remain a major concern in Asian patients. Fractional radiofrequency (FRF) has been used in many dermatological skin conditions including acne scars.

Aims

To determine the efficacy and safety of FRF nanoneedle system in the treatment of acne scars in Asians.

Methods

This is a prospective, evaluator‐blinded study with 25 subjects diagnosed with moderate to severe acne scarring. All subjects received 3 monthly treatments of the FRF nanoneedle system on both cheeks. Primary outcome was the clinical improvement of acne scars graded by 2 blinded dermatologists at baseline, 1‐, 3‐, and 6‐month follow‐ups. Objective scar volume analysis was done using ultraviolet A (UVA) light video camera. Subjects’ self‐assessment, pain score, and adverse events were also recorded.

Results

Twenty‐three out of 25 subjects completed the study and attended all follow‐up. Clinical improvement of acne scars was observed as early as 1‐month follow‐up. Objective evaluation of acne scar volume decreased significantly on all follow‐up compared to baseline (P < .005). Majority of the subjects (48%) reported marked improvement in their acne scars. Adverse events such as pain, erythema, burning sensation, edema, scab formation, and PIH were mild and temporary.

Conclusions

FRF nanoneedle system is a safe and effective treatment for acne scars in Asians. However, despite the significant changes in the scar volume, caution should be used to avoid excessive coagulation resulting in PIH.

Cannabinoids in the Pathophysiology of Skin Inflammation

Cannabinoids are increasingly-used substances in the treatment of chronic pain, some neuropsychiatric disorders and more recently, skin disorders with an inflammatory component. However, various studies cite conflicting results concerning the cellular mechanisms involved, while others suggest that cannabinoids may even exert pro-inflammatory behaviors. This paper aims to detail and clarify the complex workings of cannabinoids in the molecular setting of the main dermatological inflammatory diseases, and their interactions with other substances with emerging applications in the treatment of these conditions. Also, the potential role of cannabinoids as antitumoral drugs is explored in relation to the inflammatory component of skin cancer. In vivo and in vitro studies that employed either phyto-, endo-, or synthetic cannabinoids were considered in this paper. Cannabinoids are regarded with growing interest as eligible drugs in the treatment of skin inflammatory conditions, with potential anticancer effects, and the readiness in monitoring of effects and the facility of topical application may contribute to the growing support of the use of these substances. Despite the promising early results, further controlled human studies are required to establish the definitive role of these products in the pathophysiology of skin inflammation and their usefulness in the clinical setting.

Antimicrobial activity of certain natural-based plant oils against the antibiotic-resistant acne bacteria

The unceasing emerging of multidrug-resistant bacteria imposes a global foremost human health threat and discovery of new alternative remedies are necessity. The use of plant essential oil in the treatment of many pathogenic bacteria is promising. Acne vulgaris is the most common skin complaint that fears many people about their aesthetic appearance. In this work we investigated the antibacterial activity of some plant oils against acne-inducing bacteria. Three bacterial isolates were identified from Egypt, biochemically and by means of 16s rRNA gene typing, and were designated as Staphylococcus aureus EG-AE1, Staphylococcus epidermidis EG-AE2 and Cutibacterium acnes EG-AE1. Antibiotic susceptibility test showed resistance of the isolates to at least six antibiotics, yet they are still susceptible to the last resort Vancomycin. In vitro investigations of eleven Egyptian plant oils, identified tea tree and rosemary oils to exhibit antibacterial activity against the antibiotic-resistant acne isolates. Inhibition zones of 15 ± 0.5, 21.02 ± 0.73 and 20.85 ± 0.76 mm was detected when tea tree oil applied against the above-mentioned bacteria respectively, while inhibition zones of 12.5 ± 1.5, 15.18 ± 0.38 and 14.77 ± 0.35 mm were detected by rosemary oils. Tea tree and rosemary oils exhibited bacteriostatic and bactericidal activity against all the strains with MICs/MBCs ranging between 39-78 mg/L for tea tree oil and 39-156 mg/L for rosemary oil. All the isolates were killed after 4 and 6 h upon growing with 200 mg/L of tea tree and rosemary oils, respectively. Additionally, gas chromatography mass spectrometry (GC/MS) profiling identified and detected a variable number of antimicrobial compounds in both oils.