Psychosocial impact of acne vulgaris. evaluation of the relation between a change in clinical acne severity and psychosocial state

Negative perceptions and emotional impact of striae gravidarum among pregnant women

Background

The impact of striae gravidarum (SG), or stretch marks of pregnancy, on quality of life (QoL) is unclear.

Objective

The purpose of this study was to investigate how SG affect QoL in pregnant women.

Methods

In this cross-sectional survey study of healthy pregnant women who developed SG during their current pregnancy, we asked about the impact of lesions on emotional, psychological, and life-quality facets. Spearman product-moment correlation coefficients were generated to determine the strength of relationships between variables.

Results

We analyzed 116 valid surveys. Participants reported permanency of SG as the top physical concern (n = 87; 75%). With regard to severity, nearly three-quarters of participants rated their lesions as very prominent (n = 24; 21%) or moderate (n = 57; 49%). Among the life-quality facets queried, embarrassment/self-consciousness was the most frequently associated with SG, with over one-third of participants reporting “a lot” (n = 19; 16%) or a “moderate” (n = 26; 22%) amount of embarrassment/self-consciousness related to having SG. Lesion severity significantly correlated with the degree of embarrassment/self-consciousness (r = .543), as well as the impact of SG on other life-quality facets, including overall QoL (r = .428), clothing choice (r = .423), self-image/self-esteem (r = .417), feelings of anxiety/depression (r = .415), and social activities (r = .313; all p ≤ .001). Nearly one-quarter of participants believed that emotional distress related to SG was similar or greater than that caused by other skin problems, such as acne, psoriasis, or eczema.

Conclusion

SG can be associated with a host of negative reactions reflecting increased psychological and emotional distress, including embarrassment and decreased QoL. These consequences may compound the emotional stress of pregnancy, potentially warranting psychological support and adjustment strategies.

Burden of skin disease and associated socioeconomic status in Asia: A cross-sectional analysis from the Global Burden of Disease Study 1990-2017

Introduction

Skin diseases have a significant global impact on quality of life, mental health, and loss of income. The burden of dermatologic conditions and its relationship with socioeconomic status in Asia is currently not well understood.

Methods

We selected Global Burden of Disease Study datasets to analyze disability-adjusted life years (DALYs) in 50 Asian countries, including Central Asia, northern Asia, eastern Asia, western Asia, southeastern Asia, and southern Asia, between 1990 and 2017. We compared DALYs to the socioeconomic status using the sociodemographic index and gross domestic product per capita of a country. Statistical analysis was performed using Pearson's correlation.

Results

Some countries had higher or lower than expected age-standardized DALY rates of skin diseases. Asian countries, especially high-income countries, had a high burden of inflammatory dermatoses, including acne, alopecia areata, atopic dermatitis, contact dermatitis, decubitus ulcers, psoriasis, pruritus, and seborrheic dermatitis. The burden of infectious dermatoses was greater in low-income Asian countries. The burden of skin cancer in Asia was relatively low.

Conclusion

There is a high burden of skin disease, especially inflammatory conditions, in Asian countries, but the burden of individual dermatoses in Asia varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Asia.

Comparing clinical acne vulgaris severity to adolescent and parent perceptions of acne severity and impact on quality of life

BACKGROUND/OBJECTIVES

Little research has compared clinician acne severity assessment with either adolescent- or parent-rated scales of acne severity or impact on quality of life (QOL). We sought to assess how adolescents and their parents perceive the severity and impact of acne on the adolescent's QOL and correlate this with clinical severity.

METHODS

Each adolescent and a parent completed a validated QOL survey regarding the adolescent's acne and rated the adolescent's acne severity and QOL impact using a Likert scale. Clinicians assessed the adolescent's acne using a standardized acne severity scale. Statistical analysis compared adolescent scores with respective parent scores or with clinician assessment using a paired t test or Spearman rank-order correlation test.

RESULTS

The Likert impact score more accurately reflected acne impact on QOL for adolescents than for parents when considering the validated QOL survey as the gold standard (r²  = .56 vs r²  = .36). Likert scores for adolescents and parents were weakly correlated for acne severity but not for acne QOL impact (r²  = .36 vs r²  = .18). Correlations of acne severity scores between clinician and either adolescent or parent were weak.

CONCLUSIONS

Parents and adolescents are in relative agreement regarding acne severity and QOL impact. However, parent and adolescent perceptions are disparate from clinician acne assessment. It is important that physicians identify and consider adolescent and parent perceptions in addition to clinical assessment to better inform the approach to acne management.

Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health-related QoL assessment in acne and because of the high impact of acne on patients' lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations.

The prevalence of acne in Mainland China: a systematic review and meta-analysis

INTRODUCTION

Acne, a very common skin disease, can result in psychological distress and sustain impairment in quality of life. Data on the prevalence of acne and the differences in gender, region and age are limited. The aim of this review is to estimate the prevalence of acne in Mainland China comprehensively and to quantify its association with gender, region and age.

METHODS

We searched electronic databases with predetermined search terms to identify relevant studies published between 1 January 1996 and 30 September 2016. We pointed out repeated results using Note Express software and evaluated the studies for inclusion. Two independent reviewers extracted the data, followed with statistical analyses using Comprehensive Meta-Analysis software version 2.0. A random effects model was adopted to calculate the overall pooled prevalence and to merge categories, including gender (males and females), region (Northern China and Southern China) and age (primary and secondary students: 7-17 years old; undergraduates: 18-23 years old; overall: no limits of age) for subgroup analyses. Logistic meta-regression analysis was used to clarify the associations between acne and the predictors age, gender and region using OR and their associated 95% CI.

RESULTS

25 relevant studies were included in this meta-analysis. The overall pooled prevalence rates of acne were 39.2% (95% CI 0.310 to 0.479). The prevalence rates in different age groups were 10.2% overall (95% CI 0.059 to 0.171), 50.2% for primary and secondary students (95% CI 0.451 to 0.554), and 44.5% for undergraduates (95% CI 0.358 to 0.534); by gender, the prevalence rates were 35.7% for females (95% CI 0.275 to 0.448) and 39.7% for males (95% CI 0.317 to 0.482); and by region, the prevalence rates were 34.2% for Northern China (95% CI 0.242 to 0.458) and 46.3% for Southern China (95% CI 0.374 to 0.555). The associations between acne and the predictors age, gender and region were statistically significant.

CONCLUSIONS

In Mainland China, primary and secondary students exhibited higher prevalence rates than undergraduate students; males had higher prevalence rates of acne than females; and the prevalence rates of acne in Southern China was higher than Northern China.

Translation, cultural adaptation and validation for Brazilian Portuguese of the Cardiff Acne Disability Index instrument

BACKGROUND

The Cardiff Acne Disability Index was originally developed in English for measuring quality of life of acne patients. Considering the psychosocial impact of this disease, it is important to have instruments culturally and linguistically validated for use in Brazilian adolescents.

OBJECTIVE

To translate the Cardiff Acne Disability Index into Brazilian Portuguese, culturally adapt it, and verify its reliability and validity in adolescent patients with acne.

METHODS

In the first step, the Cardiff Acne Disability Index was translated and validated linguistically to Brazilian Portuguese in accordance with international guidelines published. In the second step, the validation of the Cardiff Acne Disability Index into Brazilian Portuguese instrument was performed, when patients aged from 12 to 20 years with acne were selected. The participants were interviewed to collect demographic data, submitted to the classification of acne by the Global Acne Grading System and invited to respond the Cardiff Acne Disability Index into Brazilian Portuguese version and DLQI (>16 years) or CDLQI (≤16 years). The internal consistency of Cardiff Acne Disability Index into Brazilian Portuguese was assessed by Cronbach's alpha coefficient and concurrent validity was measured by the Spearman correlation coefficient and Student 's t-test for paired samples.

RESULTS

The study included 100 adolescents. The Cardiff Acne Disability Index into Brazilian Portuguese version showed good reliability and internal consistency (Cronbach's alpha = 0.73). The concurrent validity of the scale was supported by a strong and significant correlation with CDLQI / DLQI instruments (rs=0.802;p<0.001).

CONCLUSIONS

Cardiff Acne Disability Index into Brazilian Portuguese version is a reliable, valid and valuable tool to measure the impact of acne on quality of life in adolescent patients.

Psychological impact of acne on 21st-century adolescents: decoding for better care

The psychological consequences of acne have been the subject of many studies. As a particularly visible skin disorder, acne complicates the daily lives of adolescents who are undergoing multiple transformations: physical, intellectual and emotional. While it is well established that acne can be responsible for depression and low self-esteem, it is likely that this impact is aggravated by the sociological evolution of adolescents in the 21st century. Understanding the codes of adolescents today (who can be characterized as being more concerned by their appearance than previous generations at the same age) allows us to optimize our medical approach to acne and facilitates treatment compliance and adherence.

The Relationship Between Dermatologist- and Patient-Reported Acne Severity Measures and Treatment Recommendations

Background:

Acne treatment recommendations for individual patients may be derived from multiple factors including dermatologist- and patient-reported constructs.

Objectives:

To evaluate the effects of dermatologist- and patient-reported measures on acne treatment recommendations by dermatologists.

Methods:

An observational cross-sectional survey of acne patients was conducted with patient-reported quality of life and dermatologist-reported measures of primary and secondary (scar) acne severity using 3 assessment approaches: maximal regional grade, total grade, and facial grade.

Results:

The most highly associated factors with acne treatment recommendations were patient emotions, maximal regional acne severity, and total acne scar grade. Better acne-specific quality of life was negatively related to acne treatment recommendation intensity, while all 3 grading approaches were positively related to acne treatment recommendations.

Conclusions:

For dermatologists, overall acne severity is most highly associated with maximal regional acne grade, total scar grade, and patient’s emotional response to acne.

Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine

Acne vulgaris has long been postulated to feature a gastrointestinal mechanism, dating back 80 years to dermatologists John H. Stokes and Donald M. Pillsbury. They hypothesised that emotional states (e.g. depression and anxiety) could alter normal intestinal microbiota, increase intestinal permeability, and contribute to systemic inflammation. They were also among the first to propose the use of probiotic Lactobacillus acidophilus cultures. In recent years, aspects of this gut-brain-skin theory have been further validated via modern scientific investigations. It is evident that gut microbes and oral probiotics could be linked to the skin, and particularly acne severity, by their ability to influence systemic inflammation, oxidative stress, glycaemic control, tissue lipid content, and even mood. This intricate relationship between gut microbiota and the skin may also be influenced by diet, a current area of intense scrutiny by those who study acne. Here we provide a historical background to the gut-brain-skin theory in acne, followed by a summary of contemporary investigations and clinical implications.

Acne-specific quality of life questionnaire (Acne-QoL): translation, cultural adaptation and validation into Brazilian-Portuguese language

BACKGROUND

many studies about the psychosocial impact of acne have been reported in international medical literature describing quality of life as a relevant clinical outcome. It is well known that the patient's perception about the disease may be different from the physician's evaluation. Therefore, it is important to use validated instruments that turn the patient's subjective opinion into objective information.

OBJECTIVES

to translate into Brazilian-Portuguese language and to culturally adapt a quality of life questionnaire, the Acne-Specific Quality of Life Questionnaire (Acne-QoL), as well as to evaluate its reliability and validity.

METHODS

measurement properties were assessed: 1) validity: comparison between severity and Acne-QoL domain scores, correlations between acne duration and Acne-QoL domain scores, and correlation between Acne-QoL domain scores and SF-36 components; 2) internal consistency: Cronbach's α coefficient; 3) test-retest reproducibility: intraclass correlation coefficient and Wilcoxon test.

RESULTS

Eighty subjects with a mean age of 20.5 ± 4.8 years presenting mild (33.8%), moderate (36.2%) and severe (30%) facial acne were enrolled. Acne-QoL domain scores were similar among the different acne severity groups except for role-social domain. Subjects with shorter acne duration presented significant higher scores. Acne-QoL domains showed significant correlations, both between themselves and with SF-36 role-social and mental health components. Internal consistency (0.925-0.952) and test-retest reproducibility were considered acceptable (0.768-0.836).

CONCLUSIONS

the Brazilian-Portuguese version of the Acne-QoL is a reliable and valid satisfactory outcome measure to be used in facial acne studies.

Inflammatory Acne in the Asian Skin Type III Treated with a Square Pulse, Time Resolved Spectral Distribution IPL System: A Preliminary Study

BACKGROUND AND AIMS

Acne remains a severe problem for both patients and clinicians. Various approaches using photosurgery and phototherapy have been reported with varying degrees of success and robustness of results. An improved intense pulsed light (IPL) system has become available with interesting beam characteristic which might improve IPL treatment of inflammatory acne in the Asian skin, Fitzpatrick type III/IV.

SUBJECTS AND METHODS

The 18 study subjects comprised 15 females and 3 males with active mild to moderately severe inflammatory acne (mean age 25.3 ± 7.70 yr, range 17-47 yr, Burton scale 1-4, all Fitzpatrick type III Asian skin). They were treated once (8 subjects) or twice (10 subjects) with an IPL system offering both square pulse and time resolved spectral distribution technologies (420 nm cut-off filter, 30 ms pulse, 8 - 12 J/cm(2), 2-3 passes). Clinical photography was taken at baseline and at 4 weeks after the final treatment. Percentage of acne clearance was assessed by an independent dermatological panel and graded from zero to 5, 5 being total clearance.

RESULTS

All subjects completed the study. Post-treatment side effects were mild and transient, with virtually no downtime or postinflammatory hyperpigmentation (PIH) experienced by any subject. All subjects had some improvement and no exacerbation was seen in any subject. Clearance was evaluated by the panel as grade 4 in 5 subjects, grade 3 in 8, grade 2 in 4 and grade 1 in 1, so that 14 of 18 subjects (78%) had clearance of at least 60%. Patient evaluation was in general slightly better than that of the panel.

CONCLUSIONS

The special beam characteristics of the IPL system used in the present preliminary study achieved good to very good results in the treatment of acne in the Fitzpatrick type III Asian skin without PIH induction. The results suggested that acne treatment in the Asian skin using this system is both safe and effective, and merits larger population studies to further optimize parameters and standardize top-up treatments.

Female gender and acne disease are jointly and independently associated with the risk of major depression and suicide: a national population-based study

Acne is a common disease in adolescence with female preponderance. It could cause poor self-esteem and social phobia. Previous studies based on questionnaires from several thousands of adolescents showed that acne is associated with major depression and suicide. However, the gender- and age-specific risk of depression and suicide in patients with acne remain largely unknown. Using a database from the National Health Insurance, which included 98% of the population of Taiwan in 2006, we identified patients of acne, major depression, and suicide based on ICD-9-CM codes. Totally 47111 patients with acne were identified (16568 males and 30543 females) from 1 million subjects. The youths of 7–12 years had the highest prevalence of acne (14.39%). Major depression was more common in those with acne (0.77%) than controls (0.56% , P < 0.0001) regardless of gender. Multiple logistic regression showed an increased risk of major depression in women without acne (OR = 1.85, 95% CI 1.75–1.96). The risk is additive in women with acne (OR = 2.78, 95% CI 2.43–3.17). Similar additive risk of suicide was noticed in women with acne. In conclusion, acne and gender, independently and jointly, are associated with major depression and suicide. Special medical support should be warranted in females with acne for the risk of major depression and suicide.

The clinical impact and cost-effectiveness of essential oils and aromatherapy for the treatment of acne vulgaris: a protocol for a randomized controlled trial

BACKGROUND

Acne is a prevalent, chronic, and sometimes severe skin disorder affecting an estimated 85% of adolescents and 50% of adults older than age 20 years. The psychosocial implications of acne can be considerable, often continuing long after physical symptoms resolve. Although effective acne medications are available, most exhibit adverse-effect profiles that can leave the patient with few effective treatment options. Emerging evidence indicates that plant-derived essential oils may be a biologically plausible treatment for acne, although high-quality evidence of effectiveness and safety is lacking.

OBJECTIVE

To examine the clinical effectiveness and cost-effectiveness of essential oils and aromatherapy for the treatment of acne.

DESIGN

This randomized, wait-list controlled trial will have three parallel groups; 192 participants with acne vulgaris, aged 16-45 years, will be recruited primarily through eight Technical and Further Education campuses across Adelaide, South Australia. Participants will be randomly assigned to standard essential oil blend, customized aromatherapy treatment, or wait-list control. Changes in the physical and psychosocial symptoms of acne will be assessed at baseline and 6 and 12 weeks by using the Leeds Acne Grading System, Assessment of Quality of Life-8 Dimension instrument, and Acne-Specific Quality of Life instrument. Costs of treatment will be measured on the basis of resource inputs and unit costs and will be limited to acne treatment. The clinical effectiveness and cost-effectiveness will be compared between each intervention and against usual care, using standard health economic techniques.

CONCLUSIONS

The provision of high-quality evidence of the effectiveness of essential oils and aromatherapy in the treatment of acne may help consumers make better-informed choices about acne management. Insights gained from this research will also contribute to the academic field of complementary medicine, specifically aromatherapy, for which the evidence base is extremely limited.

Social anxiety and functional impairment in patients seeking surgical evaluation for hyperhidrosis

Primary hyperhidrosis is characterized by excessive sweating and often accompanied by social avoidance. Social anxiety disorder (SAD) is characterized by fear and avoidance of social situations, often partly related to fears of showing signs of excessive autonomic nervous system activation, such as sweating. To clarify the relationship of hyperhidrosis and SAD, this study assessed severity of sweating, overall social anxiety and social anxiety due to sweating, and disability in 2 groups: patients seeking surgical treatment for hyperhidrosis (n = 40) and patients seeking treatment for SAD (n = 64). Hyperhidrosis and SAD patients overlapped in severity of overall social anxiety and social anxiety related to sweating. Hyperhidrosis patients reported elevated levels of social anxiety, with mean severity near the threshold for the generalized subtype of SAD, but significantly lower social anxiety than in the SAD patients. Significantly more hyperhidrosis patients than SAD patients attributed most of their social anxiety to sweating (76% vs 20%). Among hyperhidrosis patients, the pattern of correlations of sweating, social anxiety, and disability was consistent with a model of social anxiety as a mediator of sweating-related disability. The overlap of symptoms in patients presenting for treatment of SAD or hyperhidrosis suggests that both social anxiety and sweating should be assessed in these patients and considered as potential targets of treatment.

Acne vulgarism treatment using ultra-short laser pulse generated by micro- and nano-ring resonator system

Acne vulgaris is adebilitating dermatologic disease, and is conventionally treated by laser therapy using a microring resonator system. An evolving understanding of laser-tissue interactions involving Propioni bacterium acneproducing porphyrins, and the development of lasers to target the sebaceous glands, has led to the development of an escalating number of laser light for acne treatment. The results show that the full width at half maximum of the proposed laser pulse of 0.15 nm can be generated using a microring resonator system. The power of the laser is 200 W and the wavelength laser is 1,032 nm, which is proposed as a treatment of acne vulgaris diseases.

Quality of life in patients with skin diseases in central Saudi Arabia

Background

Previous national and international studies of quality of life (QoL) in patients with skin diseases have revealed different levels of QoL impairment. The aims of this study were to assess QoL in patients with skin diseases in central Saudi Arabia using the newly validated Skindex-16 instrument and to determine the association between QoL in patients with skin disease, sociodemographic data, and disease characteristics.

Methods

A cross-sectional study was conducted in 283 adult patients who visited the outpatient dermatology clinics of King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 months. The patients were interviewed using a pretested Arabic version of the Skindex-16 to measure the effect of skin disorders on their QoL during the previous 7 days. Patient characteristics, medical history, and clinical findings were collected. Multiple linear regression analyses were used to relate the demographic and clinical characteristics to the percentage mean QoL score, and P ≤ 0.05 was considered to be statistically significant.

Results

QoL was good in 69% of the respondents, with a total percent mean score of 31.80 ± 20.16. The emotional domain was the most affected (mean percentage score 44.27 ± 27.06), followed by symptoms (31.45 ± 28.40) and functioning (14.61 ± 22.75). After adjustment for potential confounders, poorer QoL was significantly associated with female gender (P = 0.03), older age (P = 0.003), rural origin (P = 0.03), positive family history of the same lesion(s) (P = 0.01), shorter duration of ≤6 months (P = 0.02), generalized spread (P ≤ 0.02), and lack of isotretinoin treatment (P = 0.02).

Conclusion

. The QoL results in this study were generally more optimistic than those of many previous studies. This discrepancy may be due to biases in questionnaire responses or to cultural differences in experience of skin disease and perception of disability. Significant predictors of QoL were not the same for the three domains of the Skindex scale. Further studies of specific diseases and educational programs targeting patients at higher risk for QoL impairments are recommended.

Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?

Over 70 years have passed since dermatologists John H. Stokes and Donald M. Pillsbury first proposed a gastrointestinal mechanism for the overlap between depression, anxiety and skin conditions such as acne. Stokes and Pillsbury hypothesized that emotional states might alter the normal intestinal microflora, increase intestinal permeability and contribute to systemic inflammation. Among the remedies advocated by Stokes and Pillsbury were Lactobacillus acidophilus cultures. Many aspects of this gut-brain-skin unifying theory have recently been validated. The ability of the gut microbiota and oral probiotics to influence systemic inflammation, oxidative stress, glycemic control, tissue lipid content and even mood itself, may have important implications in acne. The intestinal microflora may also provide a twist to the developing diet and acne research. Here we provide a historical perspective to the contemporary investigations and clinical implications of the gut-brain-skin connection in acne.

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

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

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

Possible gender differences in the quality of life and choice of therapy in acne

BACKGROUND

Acne is a very common skin disease that has major impact on the patients' quality of life. Although the disease has been extensively studied we still need more knowledge of factors influencing the decisions for choice of therapy.

OBJECTIVE

To evaluate the relationships between clinical severity, patients' self-reported quality of life, treatment choice and the outcome of therapy in a structured out-patient acne clinic.

METHODS

In total 211 consecutive patients (143 females, 68 males) at a structured acne clinic were included. At the first visit a clinical assessment was conducted, therapy was initiated and the patients answered a quality-of-life questionnaire (Dermatology Life Quality Index, DLQI). A follow up was performed after six months, when patients once again answered the DLQI questionnaire and the clinical outcome was assessed by the physician.

RESULTS

The quality of life was improved after treatment at a group level. At the first visit, the quality of life showed a gender difference (females scoring worse) but did not correlate to the clinical grading nor to the choice of therapy. At six months the DLQI correlated with clinical outcome. Patients with isotretinoin therapy showed a significantly greater improvement in quality of life. There was a tendency to gender difference in the choice of therapy, as in females 32% of the patients were treated with isotretinoin although they were clinically graded as moderate. The corresponding figure for males was 23%. A correlation was found between the initial clinical grading and gender, age and the choice of therapy.

CONCLUSION

DLQI can be used to evaluate treatment effects in acne. However, the self-reported quality of life will depend on several factors including age, gender, psychosocial factors and clinical severity.

Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV

BACKGROUND AND OBJECTIVES

Blue light is effective for acne treatment, inducing photodynamic destruction of Propionibacterium acnes (P. acnes). This study was designed to investigate the efficacy of combined blue and red light-emitting diode (LED) phototherapy for acne vulgaris.

MATERIALS AND METHODS

Twenty-four patients with mild to moderately severe facial acne were treated with quasimonochromatic LED devices, alternating blue (415 nm) and red (633 nm) light. The treatment was performed twice a week for 4 weeks. Objective assays of the skin condition were carried out before and after treatment at each treatment session. Clinical assessments were conducted before treatment, after the 2nd, 4th, and 6th treatment sessions and at 2, 4, and 8 weeks after the final treatment by grading and lesion counting.

RESULTS

The final mean percentage improvements in non-inflammatory and inflammatory lesions were 34.28% and 77.93%, respectively. Instrumental measurements indicated that the melanin levels significantly decreased after treatment. Brightened skin tone and improved skin texture were spontaneously reported by 14 patients.

CONCLUSION

Blue and red light combination LED phototherapy is an effective, safe and non-painful treatment for mild to moderately severe acne vulgaris, particularly for papulopustular acne lesions.

A pilot investigation comparing low-energy, double pass 1,450 nm laser treatment of acne to conventional single-pass, high-energy treatment

BACKGROUND AND OBJECTIVES

Laser treatment using a 1,450 nm diode laser has been shown to improve acne and acne scarring. Its widespread adoption in younger populations has been significantly limited by discomfort.

STUDY DESIGN/MATERIALS AND METHODS

Six subjects with active papular acne were treated in a pilot study to determine parameters for a split-face, double-pass, low-energy protocol of 1,450 nm laser treatment. Sides of the face were randomized to receive single-pass, high-energy treatment (13-14 J/cm(2)), or double-pass, low energy treatment (8-11 J/cm(2)), for a total of four treatments delivered at monthly intervals. Acne counts and standardized, digital photograph were performed 2 months following the final treatment, and compared to pre-treatment counts and photographs.

RESULTS

Improvement was evaluated comparing pre- and post-treatment photos and averaged 2.5 for the high-energy, single-pass side and 2.3 for the low-energy, double-pass side, using a 0 (worse) to 4 (max improvement) scale. Acne counts were reduced 78% on the high-energy, single-pass side and 67% on the low-energy, double-pass side. Pain ratings on a 1 (min) to 10 (max) scale averaged 5.6 (range 1-9) for the high-energy, single-pass side and 1.3 (range 1-2) for the low-energy, double-pass side.

CONCLUSIONS

Low-energy, double-pass 1,450 nm laser treatment effectively reduces acne counts 2 months post-treatment, and dramatically reduces the pain associated with treatment. The treatment parameters used in this study have eliminated the need for anesthetic cream in daily practice.

ECCA Grading Scale: An Original Validated Acne Scar Grading Scale for Clinical Practice in Dermatology

INTRODUCTION

The ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné) is a tool designed to help dermatologists to assess the severity of acne scars and to standardize the discussions about the treatments of scars.

METHODS

We developed an acne scar clinical grading scale called ECCA, which consists of 6 items designed to assess easily and quickly the severity of acne scars by a global score. The interobserver reliability of the ECCA grading was statistically validated.

RESULTS

The statistical analysis showed the interinvestigator reliability of the ECCA grading scale among 7 dermatologists who used it on the same group of 10 acne patients.

CONCLUSION

ECCA is a new tool which will now be available for dermatologists to use in their everyday practice and for clinical trials evaluating the efficacy of treatments on acne scars.

Quality of life and acne in Scottish adolescent schoolchildren: use of the Children's Dermatology Life Quality Indexc (CDLQI) and the Cardiff Acne Disability Indexc (CADI)

BACKGROUND

Acne vulgaris is known to adversely affect all aspects of quality of life. However, although acne is thought to occur in the majority of adolescents, there are few data currently available on the impact of acne in this age group.

OBJECTIVES

Measurement of the impairment of health-related quality of life (HRQoL) in teenage Scottish schoolchildren in a comparative study using two HRQoL questionnaires. A secondary objective was to collect data on the use and perceived efficacy of medical and over-the-counter (OTC) preparations.

STUDY DESIGN

An anonymous cross-sectional survey of 200 adolescent (15-18 years) Dundee schoolchildren was conducted by means of two self-reported questionnaires: the Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI). Data on demographics and therapeutic modalities and their perceived efficacy were also collected.

ANALYSIS

Statistical analysis was performed using the package Stata 7.0.

RESULTS

Self-reported acne was present in 83% of teenagers (147/178), with similar sex distribution (54% male, 46% female). The overall mean CDLQI score (max. 30) was low 1.7 {6% impairment} (CI -1 to 0), range 0-19. Nine pupils scored between 5 and 9 {17-30% impairment} suggesting moderate HRQoL impairment and three scored > 10 {> 33% impairment} indicating severe impairment. The overall mean CADI score (max. 15) of 1.9 {13% impairment}, CI 0 to 1 (range 0-15) was also low, but 12 pupils scored between 5 and 9 {33-60% impairment}, one scoring 10 + {> 67% impairment} and one scoring the maximum, 15 {100% impairment}. There was no significant difference in mean scores between the sexes in either questionnaire (P = 0.5). There was good correlation between the results from the two questionnaires (Spearman's rho = 0.62). Three-quarters (75%) had used OTC products, of which only a third (33%) felt they helped 'a lot'. Fifteen per cent were receiving prescribed treatment from their doctors of which 66% found it helpful.

CONCLUSIONS

Self-reported acne occurred in 83% (147/178) of the Scottish teenagers involved in this study, which confirms previous reports of a high prevalence of acne in teenagers. Cross-validation of the CLDQI and CADI demonstrated good correlation and both scales were easy to administer and identified 11% (16/147) of teenagers who perceive their lives to be significantly affected by their acne (8% moderately to severely, 3% severely). It is important to identify and treat such teenagers early to reduce the future socio-economic burden of their acne.

Life quality assessment among patients with atopic eczema

BACKGROUND

Quantification of quality of life (QoL) related to disease severity is important in patients with atopic eczema (AE), because the assessment provides additional information to the traditional objective clinical scoring systems.

OBJECTIVES

To measure health-related QoL (HRQoL) in patients with AE; to analyse discriminant, divergent and convergent validity by examining the association between various QoL methods; and to examine the association between disease severity assessed by an objective Severity Scoring of Atopic Dermatitis (SCORAD) and QoL.

METHODS

HRQoL was assessed at two visits at a 6-monthly interval in 101 patients with AE and 30 controls with one dermatology-specific questionnaire [Dermatology Life Quality Index (DLQI) or Children's DLQI (CDLQI)], one generic instrument (SF-36) and three visual analogue scales (VASs) of severity and pruritus. Objective SCORAD was used to measure disease severity.

RESULTS

Patients with AE had significantly lower QoL than healthy controls and the general population. DLQI /CDLQI, pruritus, and patient and investigator overall assessment of eczema severity were significantly (P < 0.0001) and positively correlated with SCORAD, while the generic questionnaire showed only poor correlation. A gender difference was found for the mental component score of SF-36 (P = 0.019).

CONCLUSIONS

AE has an impact on HRQoL. Patients' mental health, social functioning and role emotional functioning seem to be more affected than physical functioning. A simple VAS score of patients' assessment of disease severity showed the highest and most significant correlations with most of the HRQoL methods used. There is evidence to support the ability of patients with AE to make an accurate determination of their disease severity and QoL.

The new age of acne therapy: light, lasers, and radiofrequency

BACKGROUND

Current treatments for acne vulgaris include topical and oral medications that counteract microcomedone formation, sebum production, Propionibacterium acnes, and inflammation. Concerns about the short- and long-term consequences of these medications, along with technological advancements, have to significant progress in the management of acne. These developments include light, laser, and radio frequency, which may offer faster onset of action, equal or greater efficacy, and greater convenience than traditional approaches.

CONCLUSION

Research emphasizing long-term follow-up and comparative, randomized trials is necessary to determine whether these emerging technologies will become a viable alternative to standard therapies such as antibiotics.

'Nobody likes damaged goods': the experience of adult visible acne

OBJECTIVES

While mild to severe acne is a common problem in the teenage years, many adults also suffer from the condition. Although there is an appreciable body of dermatological literature on this issue, the psychosocial concomitants of severe, visible adult acne are little elaborated. The aim of this research is to detail the salient experiences of adults with severe visible acne, and to set out the implications of these experiences.

DESIGN

A phenomenological qualitative approach was adopted to elicit detailed accounts of the impact of visible acne upon the lives of a small sample of sufferers.

METHOD

11 adults suffering from severe visible acne took part in semi-structured interviews via e-mail, over an extended period of time. Transcripts of these interviews served as the data for an interpretative phenomenological analysis.

RESULTS

Five themes emerged, detailing different aspects of respondents' personal and social lives in the context of their acne. These were: powerlessness and the variable nature of acne; comparisons, self-image and identity; the experience of general social interaction; relationships with family and friends; and gender, sexuality, and romantic relationships.

CONCLUSIONS

These themes allowed a deeper understanding of issues reported in previous quantitative research in the area, as well as revealing findings that had not been previously reported in relation to the experience of adult acne and its impact upon personal and social relationships. With an acknowledgement of these experiences, personal and professional acquaintances have the potential to improve their interpersonal relationship with the person concerned, and encourage positive changes in their psychological health and social interaction.

Lasers and Light Therapy for Acne Vulgaris

Acne vulgaris remains an emotionally and debilitating dermatologic disease, and is conventionally treated with a variety of oral and topical therapies with a number of significant side effects. An evolving understanding of laser-tissue interactions involving Propionibacterium acnes-produced porphyrins, and the development of infrared nonablative lasers to target sebaceous glands, has lead to the development of an escalating number of laser, light and radiofrequency devices for acne. Used as monotherapy or in combination, these devices are showing promise as a method to clear acne in a convenient, non-invasive manner, though there remains a clear need for long-term data and randomized, blinded studies.

Use of lasers and light-based therapies for treatment of acne vulgaris

Over the last two decades, lasers and light-based therapies have been developed to treat a wide variety of cutaneous maladies. Given the prevalence and number of patients who suffer from refractory acne, alternatives to existing care are constantly sought after. In this review, we discuss the evidence currently available to justify the use of laser and light-based modalities and conclude that in combination therapy, such approaches provide a safe and effective treatment for acne vulgaris.

Coping with mild inflammatory catamenial acne. A clinical and bioinstrumental split-face assessment

BACKGROUND

Acne is a multifactorial disease exhibiting distinct clinical presentations. Among them, the catamenial type is a matter of concern for young women. Some oral contraceptives may help without, however, clearing the skin condition.

AIM

The present open study aimed at evaluating the effect of overnight applications of a paste made of petrolatum,15% zinc oxide and 0.25% miconazole nitrate.

METHOD

The split-face trial was conducted in 35 women. A non-medicated cream was used as control. Clinical evaluations and biometrological assessments on cyanoacrylate follicular biopsies were performed monthly for 3 months. Comedometry and the density in autofluorescent follicular casts were used as analytical parameters. In addition, the five most severe cases at inclusion were tested at the completion of the study for follicular bacterial viability using dual flow cytometry.

RESULTS

Compared with baseline and to the control hemi-face, the medicated paste brought significant improvement of acne. The number of papules and their redness were reduced beginning with the first treatment phase. A reduction in the follicular fluorescence was yielded beginning with the second treatment phase. The ratios between injured and dead bacteria, on the one hand, and live bacteria, on the other hand were significantly increased at completion of the study.

CONCLUSION

A miconazole paste applied for 1 week at the end of the ovarian cycle has a beneficial effect on catamenial acne.

Anger and acne: implications for quality of life, patient satisfaction and clinical care

BACKGROUND

Acne is a common skin disorder with a significant psychological and social impact for some people. Little is known about how personality and emotional traits affect acne and its impact on quality of life and treatment. Trait anger (TA), which is related to heart disease and other morbidities, may also affect acne and patients' adjustment to it.

OBJECTIVES

To evaluate the relationship between TA and acne severity, skin-related quality of life, satisfaction with treatment, and adherence to treatment.

PARTICIPANTS AND METHODS

A sample of 479 individuals with acne completed a survey instrument to assess acne severity, skin care practices, skin-related quality of life, satisfaction with treatment, adherence, TA and demographic variables. Respondents who reported high TA were compared with individuals with low TA on outcome variables. Regression analyses adjusted for covariates and identified the significant predictors of quality of life, satisfaction and adherence.

RESULTS

High TA was unrelated to acne severity (P = 0.2) or frequency of face washing (P = 0.9). Anger was significantly related to both global quality of life (P < 0.001) and skin-related quality of life (P = 0.002) as well as to satisfaction with treatment (P = 0.001) and adherence to treatment advice (P = 0.05) in bivariate analyses. Regression analyses revealed that high TA remained a significant predictor of global (P < 0.001) and skin-related quality of life (P = 0.003) and satisfaction with treatment (P = 0.04), but not adherence to treatment advice (P = 0.8) after controlling for covariates.

CONCLUSIONS

Anger is associated with the quality of patients' lives and with their satisfaction with treatment. Care of acne patients should include attention to anger and other chronic emotional states, quality of life, as well as to clinical severity. Simple guidelines are suggested for how clinicians might approach this important aspect of care.

Selecting an oral contraceptive agent for the treatment of acne in women

In women, acne can be successfully treated with oral contraceptives. This article focuses on the results of clinical studies on the treatment of acne with oral contraceptives. From the literature, 12 such studies could be traced over the last 10 years. Most of the studies were multicenter, randomized, and double blind. Five studies were placebo controlled. All of these studies were analyzed and compared with each other. Statistically, all placebo-controlled studies showed a better result with the active treatment, than with the placebo. However, the placebo groups also showed an improvement in the acne lesions. In seven studies, two oral contraceptives were compared for their effect on acne vulgaris. All oral contraceptives studied showed a beneficial effect on the severity of acne. It can be concluded, based on these studies, that all oral contraceptives have a more or less beneficial effect on mild to moderate acne in women. Comparing the various clinical trials, ethinylestradiol/drospirenone is as good as ethinylestradiol/cyproterone, which is slightly better than ethinylestradiol/desogestrel and ethinylestradiol/gestodene. Ethinylestradiol/chlormadinone is slightly better than ethinylestradiol/levonorgestrel, which is as effective as ethinylestradiol/norethindrone, which is far better than the placebo. Ethinylestradiol/norgestimate is better than placebo.

Clinical evidence of the endocrinological influence of a triphasic oral contraceptive containing norgestimate and ethinyl estradiol in treating women with acne vulgaris. A pilot study

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate the efficacy of a triphasic combination oral contraceptive (OC) containing norgestimate and ethinyl estradiol in the treatment of women with acne vulgaris.

METHODS

12 female patients were included and 10 completed the trial. Over a period of 6 months, efficacy was assessed by means of facial acne lesion counts, by an investigator's global assessment, by patients' self-assessments and by measuring epidermal moisture and skin surface lipids. In addition, a photo documentation was compiled and hormone levels were measured.

RESULTS

After 6 months of therapy, the number of acne counts improved. The success of treatment was rated positively both by the investigator and by all patients but one who did not report any changes. Skin surface lipids were significantly reduced while skin hydration showed no significant change. Testosterone and progesterone decreased, and sex-hormone-binding globulin increased, significantly.

CONCLUSION

Our data show that an OC containing norgestimate and ethinyl estradiol is a good therapeutic option for women of fertile age suffering from mild to moderate acne vulgaris.

Preliminary results of a nonrandomized, multicenter, open-label study of patient satisfaction after treatment with combination benzoyl peroxide/clindamycin topical gel for mild to moderate acne

BACKGROUND

Assessments of patient satisfaction are needed to determine treatment-related improvement in acne from the patient's perspective.

OBJECTIVES

The aims of this study were to assess patient satisfaction, drug efficacy, and the social aspects of quality of life after treatment with benzoyl peroxide/clindamycin topical gel in patients who were dissatisfied with their previous acne treatment regimens.

METHODS

This nonrandomized, open-label, multicenter study was open to patients aged > or = 12 years who were dissatisfied with their previous acne treatments. Patients applied topical benzoyl peroxide/clindamycin gel twice daily for 8 weeks. Patient satisfaction was assessed on an 11-point analog scale (0 = not satisfied; 10 = very satisfied). The social effects of acne were assessed using a 9-question acne quality of life (AQOL) scale, and treatment efficacy was assessed using the global acne grading system (GAGS). Safety and tolerability were monitored continuously through self-reporting and patient questioning.

RESULTS

Preliminary results were gathered for 257 patients. Relative to baseline, patients were significantly more satisfied after 8 weeks of treatment with benzoyl peroxide/ clindamycin gel (P < 0.001). The mean overall cumulative AQOL score improved significantly among 249 patients aged > or = 12 years (P < 0.001), but the clinical relevance of this finding is unknown. The mean GAGS score decreased from 15.9 (SD = 6.0) at baseline to 8.2 (SD = 5.7) at week 8 (P < 0.001). The most common adverse events were dry skin and skin irritation.

CONCLUSIONS

These preliminary results suggest that patients who are dissatisfied with their current acne regimen may be more satisfied after treatment with benzoyl peroxide/clindamycin gel. However, more definitive conclusions can be drawn only following the completion of the study.