30% supramolecular salicylic acid peels effectively treats acne vulgaris and reduces facial sebum

Acne and the cutaneous microbiome: A systematic review of mechanisms and implications for treatments

BACKGROUND

Acne vulgaris is a pervasive skin disease characterized by inflammation of sebaceous units surrounding hair follicles. It results from the complex interplay between skin physiology and the intricate cutaneous microbiome. Current acne treatments, while effective, have major limitations, prompting a shift towards microbiome-based therapeutic approaches.

OBJECTIVES

This study aims to determine the relationship between acne and the cutaneous microbiome, assess the effects of current treatments on the cutaneous microbiome, and explore the implications for developing new therapies.

METHODS

A systematic review was performed using PubMed and SCOPUS databases within the last 10 years. Methodological quality was assessed independently by two authors. The search retrieved 1830 records, of which 26 articles met the inclusion criteria. Meta-analysis of alpha diversity change was assessed using fixed and randomized effect models per therapeutic group.

RESULTS

Eight studies pertain to the role of the cutaneous microbiome in acne, identifying C. acnes, S. aureus and S. epidermidis as key contributors through overproliferation, commensalism, or dysbiosis. Eleven studies discuss current acne treatments, including doxycycline (1), topical benzoyl peroxide (BPO) (4), isotretinoin (2), sulfacetamide-sulfur (SSA) (2) and aminolevulinic acid-photodynamic therapy (ALA-PDT) (2), identified as modulating the cutaneous microbiome as a mechanism of efficacy in acne treatment. Seven studies discuss new treatments with topical probiotics, plant derivatives, and protein derivatives, which contribute to acne clearance via modulation of dysbiosis, inflammatory markers and diversity indexes. A meta-analysis of the effects of existing therapeutics on the cutaneous microbiome identified benzoyl peroxide as the only treatment to facilitate significant change in diversity.

CONCLUSIONS

Despite the heterogeneity of study types and microbiome classifications limiting the analysis, this review underscores the complexity of microbial involvement in acne pathogenesis. It delineates the effects of acne therapeutics on microbial diversity, abundance, and composition, emphasizing the necessity for personalized approaches in acne management based on microbiome modulation.

Acne vulgaris: advances in pathogenesis and prevention strategies

PURPOSE

The aim is to encourage the creation of innovative prevention and treatment measures and to help readers in selecting the most effective ones.

BACKGROUND

Acne vulgaris is the most prevalent skin condition of adolescents, affecting approximately 9% of the global population. Patients become more prone to mental and psychological problems because of it. Several strategies have been established to effectively improve acne vulgaris. However, the complexity of its pathogenesis and the limitations of the existing strategies to control it in terms of bacterial resistance, patient compliance, and safety have made the development of new control strategies a hot topic in skin health research.

RESULTS

This review systematically summarizes the pathogenesis and prevention strategies of acne vulgaris according to the most recent studies. The limitations of the current research on acne vulgaris and future research directions are presented based on the analysis of the strengths and weaknesses of the existing prevention and treatment strategies.

Betaine-salicylic acid cocrystal for enhanced skincare and acne treatment

Salicylic acid (SA) is a natural lipophilic active ingredient commonly used in cosmetics and skin disease treatments, offering benefits such as exfoliation, anti-inflammation effects, antibacterial properties, oil control, and acne alleviation. However, its poor water solubility, low bioavailability, and potential side effects, such as allergies, irritation, and dryness, hinder its widespread application. In this study, we prepared a betaine-salicylic acid (BeSA) cocrystal and systematically characterized its crystal structure, biological activity, and clinical efficacy. The results showed that BeSA has significantly lower irritancy and cytotoxicity than SA, but exhibits excellent anti-inflammatory and antioxidant properties as well as high moisturizing and anti-acne efficacy, making it a potential alternative to SA. Further, quantum chemical calculations and molecular docking simulations were conducted to investigate the intrinsic mechanisms underlying the excellent bioactivity of BeSA cocrystals. This study introduces an innovative solution for safer and more effective skincare formulations based on SA and offers theoretical guidance regarding material engineering and further material optimization, which has crucial implications for both industry and academia.

30% Supramolecular Salicylic Acid Improved Symptoms and Skin Barrier in Papulopustular Rosacea

BACKGROUND

Rosacea is a chronic skin condition that affects millions of people worldwide, and its management continues to pose a significant challenge in dermatology.

AIM

In this study, we investigated the efficacy and safety of 30% supramolecular salicylic acid (SSA) as a treatment for papulopustular rosacea, with a particular focus on improving skin lesions, reducing persistent erythema, and enhancing skin barrier function.

METHODS

Thirty-four patients diagnosed with papulopustular rosacea were randomly divided into an experimental group treated with 30% SSA and a control group receiving a placebo. Clinical outcomes were evaluated based on lesion reduction rates, investigator severity assessment (ISA) scores, VISIA red area scores, and skin barrier, including trans-epidermal water loss (TEWL), sebum levels, stratum corneum hydration, and pH values.

RESULTS

A total of 34 patients were collected for both the experimental and control groups, with no statistical differences in age or disease severity between the groups (p > 0.05). The effective rate was 68.75% in the experimental group (p < 0.01). After treatment, the ISA score was 1.75 ± 0.68 in the experimental group and 2.40 ± 0.83 in the control group, indicating significant improvement (p < 0.05). The improvement rate of the VISIA redness score was 25.1% in the experimental group (p < 0.01). Among the 17 patients who underwent skin barrier function testing. Skin hydration significantly improved on left cheek (p < 0.05), right cheek (p < 0.01), and nose (p < 0.05) after 30% SSA treatment in experimental group. Sebum levels were significantly reduced on both cheeks and forehead (p < 0.05). No statistical differences were observed in other locations. Skin TEWL and pH value showed no changes.

CONCLUSION

30% SSA reduced papules and pustules in rosacea, improved persistent erythema, and enhanced stratum corneum hydration in the 30% SSA-treated group compared to the placebo group. No significant differences were observed in TEWL and skin pH values between the two groups. Our findings suggest that 30% SSA is an effective and safe option for managing papulopustular rosacea, offering a well-tolerated alternative to traditional treatments.

Supramolecular Salicylic Acid Alleviates Skin Photoaging by Increasing Collagen Density and Elasticity

BACKGROUND

Skin rejuvenation has always been of great concern. Although salicylic acid (SA) has multiple properties, it is mainly used in dermatology as a superficial peeling agent that can improve photodamaged epidermis. However, the effect of SA on the photoaging dermis is unclear.

PURPOSE

To evaluate the efficacy and safety of supramolecular SA alone for treating photoaged skin, and the effect of SSA on photoaged dermis.

METHODS

This is a double-blind, randomized, placebo-controlled trial. 36 patients with photodamaged hands were enrolled. One hand was randomly selected as SSA treated side. 30% SSA biweekly and 2% SSA daily was applied for 4 months; an additional follow-up was performed 2 weeks after the last treatment. Skin photoaging score (SPS), global aesthetic improvement scale (GAIS), viscoelasticity, ultrasound parameters, color and transepidermal water loss (TEWL) were assessed.

RESULTS

SSA treatment induced a significant increase in collagen density and skin elasticity, accompanied by an increase in dermal thickness and a decrease in melanin index and TEWL. As result, the GAIS and the SPS were improved significantly after SSA treatment. No adverse events were observed after SSA treatments, and 98% of the subjects were satisfied or very satisfied with the treatment.

CONCLUSION

SSA can increase collagen density and skin elasticity to alleviate skin photoaging effectively and safely.

LEVEL OF EVIDENCE I

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 .

SSA-ZP on Scalp Seborrheic Dermatitis: Regulating Sebum Levels and Scalp Barrier

BACKGROUND

The occurrence of scalp seborrheic dermatitis (SD) is closely related to the production of sebum and scalp barrier function. Supramolecular salicylic acid has the keratolytic and anti-inflammatory properties, and zinc pyrithione is an antifungal drug delivered as a microparticle to skin epithelia.

OBJECTIVE

This study aimed to assess the efficacy and safety of 2% supramolecular salicylic acid (SSA) combined with 0.8% zinc pyrithione conditioner (SSA-ZP) in treating scalp SD focusing on key outcome measures including sebum levels and scalp barrier function.

METHODS

Five patients with mild to moderate scalp SD were included in the 2-week self-controlled prospective study, receiving daily SSA-ZP treatment. Evaluation on days 0, 7, and 14 included dermoscopy, the adherent scalp flaking scale (ASFS), sebum level, transepidermal water loss (TEWL), pH, and stratum corneum hydration. We also performed the fungal count across specific scalp regions, such as the left and right sides of the forehead, the top of the head, and the occiput.

RESULTS

Five patients with mild to moderate scalp SD participated in this study. After 2 weeks of SSA-ZP treatment, significant reductions in ASFS scores, sebum levels, and fungal count were observed, alongside improvements in TEWL and pH values across multiple scalp regions. Moreover, there was no difference in the hydration of stratum corneum.

CONCLUSION

SSA-ZP demonstrated efficacy in treating scalp SD without adverse effects, suggesting its potential as a first-line treatment option. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings.

Supramolecular salicylic acid combined with niacinamide in chloasma: a randomized controlled trial

BACKGROUND

Chloasma is a common skin hyperpigmentation condition, with treatment options ranging from topical agents to advanced interventions such as chemical peels and laser therapy. Salicylic acid, including its supramolecular form (SSA), has shown promise in managing chloasma. However, to date, no multicentre randomized controlled trial of SSA for chloasma is available.

OBJECTIVES

The purpose of this study was to assess the efficacy and safety of 30% SSA combined with 10% niacinamide in treating -chloasma.

METHODS

This multicentre (n = 15), randomized, double-blind, parallel placebo-controlled trial (Clinical trial registration number: ChiCTR2200065346) enrolled and randomized 300 participants (1 : 1) to either 30% SSA treatment or placebo, with 150 allocated to treatment and 150 to placebo in the full analysis set, and 144 to treatment and 147 to placebo in the per-protocol set. A Visia® Skin Analysis System was used at each visit to assess the degree of improvement in chloasma lesions. The primary endpoint was the effective rate after 16 weeks, assessed using the modified Melasma Area and Severity Index (mMASI) score [(pretreatment score - post-treatment score)/pretreatment score × 100%].

RESULTS

The total mMASI score, overall score on the Griffiths 10-point scale, and Griffiths 10 score for the left and the right sides of the face were significantly lower in the 30% SSA group than in the placebo group (all P < 0.001). One study of drug-related adverse events (AEs) and one study of drug-unrelated AEs were reported in the 30% SSA group. No AE was reported in the placebo group.

CONCLUSIONS

Among our patients, 30% SSA combined with 10% niacinamide was shown to be effective and safe for treating chloasma.

Clinical efficacy of 595 nm pulsed dye laser in combination with supramolecular salicylic acid in the treatment of rosacea

OBJECTIVE

This research was aimed at ascertaining the clinical effects of 595 nm pulsed dye laser (PDL) in combination with supramolecular salicylic acid (SSA) in the treatment of rosacea.

METHODS

Eighty-four patients with rosacea were selected, of which 42 patients treated with PDL alone were considered as the control group, and 42 patients treated with 595 nm PDL in combination with 30% SSA were regarded as the observation group. The treatment continued for 4 months in the two groups. Clinical symptom scores, skin barrier function indicators, serum inflammatory factors, Acne⁃QOL scores and adverse reactions between the two groups were compared.

RESULTS

After treatment, levels of inflammatory factors, clinical symptom scores, transdermal water loss, and oil volume were decreased, and epidermal water content and Acne-QOL scores were increased in both groups (all P < 0.05), and the changes in the observation group were more pronounced versus the control group (all P < 0.05). The difference in the incidence of adverse reactions was not statistically significant between the two groups (P > 0.05).

CONCLUSION

595 nm PDL in combination with SSA is safe in the treatment of rosacea.

Preparation and efficacy verification of three-dimensional printed partitioned multi-effect precision-care gel facial mask

OBJECTIVE

A partition multi-effect precision-care gel facial mask conforming to facial skin characteristics was prepared using three-dimensional (3D) printing technology.

METHODS

First, the hydrogel matrix and humectant of a 3D-printed gel for facial masks were screened, and three 3D-printed gels of arbutin, hexapeptide, and salicylic acid were prepared with whitening, wrinkle removal, and oil control functions, respectively. Skin irritation tests were performed on the gels. Physicochemical properties such as pH, heat and cold tolerance were evaluated. The efficacy of three 3D-printed gels was assessed by measuring melanin value, wrinkle depression score, and oil secretion. Finally, the facial mask model design and printing parameters were studied, and a partition multi-effect precision-care gel facial mask was printed in line with facial skin characteristics.

RESULTS

For the 3D-printed facial mask, the gel prescription with 2% hydroxyethyl cellulose gel as matrix and 7% glycerol as humectant was the best. The prepared 3D-printed gel did not irritate the human skin, and its physicochemical properties met the Chinese facial mask industry standard (QB/T2872-2017). We showed that three types of 3D-printed gels containing arbutin, hexapeptide, and salicylic acid could be applied to the corresponding parts of the face to solve different problems, such as facial skin dullness, wrinkles, and oil secretion. Therefore, according to facial physiological characteristics, the facial mask model was designed for the forehead and nasolabial fold, which needs to be anti-wrinkled; the cheek, which needs to be whitened; and the nose and chin, which need oil control. The optimal printing parameters were 0.26 mm nozzle diameter, 90 mm/s printing speed, 30% filling density, 140% wire extrusion ratio, and 0.25 mm layer height. Different skin care effects can be achieved using a three-nozzle printer to print arbutin, hexapeptide, or salicylic acid gel on the mask's forehead and nasolabial fold, cheek, and nose and chin, respectively.

CONCLUSION

The 3D-printed partition multi-effect care gel facial mask prepared according to the skin features of different parts of the face can overcome the problem of the single skincare effect of the mass-produced facial masks.

The updates and implications of cutaneous microbiota in acne

Acne is a chronic inflammatory skin disorder that profoundly impacts the quality of life of patients worldwide. While it is predominantly observed in adolescents, it can affect individuals across all age groups. Acne pathogenesis is believed to be a result of various endogenous and exogenous factors, but the precise mechanisms remain elusive. Recent studies suggest that dysbiosis of the skin microbiota significantly contributes to acne development. Specifically, Cutibacterium acnes, the dominant resident bacterial species implicated in acne, plays a critical role in disease progression. Various treatments, including topical benzoyl peroxide, systemic antibiotics, and photodynamic therapy, have demonstrated beneficial effects on the skin microbiota composition in acne patients. Of particular interest is the therapeutic potential of probiotics in acne, given its direct influence on the skin microbiota. This review summarizes the alterations in skin microbiota associated with acne, provides insight into its pathogenic role in acne, and emphasizes the potential of therapeutic interventions aimed at restoring microbial homeostasis for acne management.

0.5-5% Supramolecular Salicylic Acid Hydrogel is Safe for Long-Term Topical Application and Improves the Expression of Genes Related to Skin Barrier Homeostasis in Mice Models

Background

As a keratolytic, salicylic acid (SA) can be topically applied in various formulations and doses in dermatology. Supramolecular SA hydrogel, a new SA formulation with higher bioavailability, is developed and commercially available nowadays. However, there still remain concerns that the long-term and continual application of SA at low concentrations may jeopardize the cutaneous barrier properties.

Aim of the Study

To reveal the long-term effects of 0.5-5% supramolecular SA hydrogel on the skin barrier in normal mice models.

Materials and Methods

The 0.5%, 1%, 2%, and 5% supramolecular SA hydrogel or hydrogel vehicle without SA was applied to mice's shaved dorsal skin once per day respectively. Tissue samples of the dorsal skin were harvested on day 14 and 28 of the serial application of SA for histopathological observation and transcriptomic analysis.

Results

Following topical supramolecular SA hydrogel therapy with various concentrations of SA (0.5%, 1%, 2%, and 5%) for 14 days and 28 days, there were no obvious macroscopic signs of impaired cutaneous health and no inflammatory or degenerative abnormalities were observed in histological results. Additionally, the transcriptomic analysis revealed that on day 14, SA dramatically altered the expression of genes related to the extracellular matrix structural constituent. And on day 28, SA regulated gene expression profiles of keratinization, cornified envelope, and lipid metabolism remarkably. Furthermore, the expression of skin barrier related genes was significantly elevated after the application of SA based on RNA-seq results, and this is likely to be associated with the PPAR signaling pathway according to the enrichment analysis.

Conclusion

Our findings demonstrated that the sustained topical administration of the 0.5-5% supramolecular SA hydrogel for up to 28 days did no harm to normal murine skin and upregulated the expression of genes related to the epidermal barrier.

Effect of 30% Supramolecular Salicylic Acid Peel on Skin Microbiota and Inflammation in Patients with Moderate-to-Severe Acne Vulgaris

INTRODUCTION

Thirty-percent supramolecular salicylic acid (SSA), a modified salicylic acid preparation, is a safe and effective treatment for moderate-to-severe acne vulgaris (AV). However, its mechanism of action remains unclear. We aimed to analyze the role of 30% SSA peels on skin microbiota and inflammation in patients with moderate-to-severe AV.

METHODS

A total of 28 patients were enrolled and received 30% SSA peels biweekly for 2 months. The Global Acne Grading System (GAGS) score, skin water content, transepidermal water loss (TEWL), pH, and sebum levels were assessed. Skin microbial samples and perilesional skin biopsies were obtained at the onset and 2 weeks after treatment completion. Samples were characterized using a high-throughput sequencing approach targeting a portion of the bacterial 16S ribosomal RNA gene.

RESULTS

After treatment, patients showed a significant improvement in their GAGS score and skin barrier indicators (P < 0.05). The GAGS score was positively associated with both the sebum concentration (R = 0.3, P = 0.027) and pH (R = 0.39, P = 0.003). Increased expression of caveolin-1 and decreased expression of interleukin (IL)-1a, IL-6, IL-17, transforming growth factor beta, and toll-like receptor 2 were observed in the skin tissue after treatment. The richness and evenness of the cutaneous microbiome decreased after treatment and the Staphylococcus proportion decreased significantly (P < 0.05), whereas the Propionibacterium proportion tended to decrease (P = 0.066).

CONCLUSIONS

On the basis of analyses of the skin barrier and microbiota, we speculate that the 30% SSA peel may have a therapeutic effect in patients with moderate-to-severe AV by improving the skin microenvironment and modulating the skin microbiome, thus reducing local inflammation.