Factors aggravating acne vulgaris during the COVID-19 pandemic in China: a web-based cross-sectional survey

OBJECTIVE

Acne vulgaris is a common skin disease worldwide. Throughout the COVID-19 pandemic, many patients with acne complained of worsening symptoms. This investigation was designed to survey the impact of COVID-19 regulations on acne and guide patients with acne on symptom management during the pandemic.

MATERIALS AND METHODS

From April 7th to April 21st, 2020, an anonymous, self-completed, web-based questionnaire was distributed to patients previously diagnosed with acne (via the Chinese internet medical software). Information collected included patients' mask-wearing routines and behavioral factors including dietary habits, sleep habits, facial hygiene, and make-up use habits.

RESULTS

508 qualified questionnaire responses were collected. During the COVID-19 outbreak in China, there was an overall worsening of patients' acne symptoms (152, 29.9%). Behaviors including intake of sweets (34.9% vs. 16.0%, p<0.01), dairy consumption (32.9% vs. 23.3%, p<0.05), greasy (19.1% vs. 11.2%, p<0.05) and spicy food intake (30.3% vs. 14.3%, p<0.01) and mask-wearing frequency (>28 hours per week) (25.0% vs. 15.3%, p<0.05) presented a statistically significant difference between the acne aggravated and non-aggravated groups. Longtime mask-wearing (>28 hours per week), rather than the mask type, was significantly associated with acne symptom deterioration during the COVID-19 outbreak (odds ratio [OR]: 2.164; 95% confidence interval [CI]: 1.232-3.801).

CONCLUSIONS

Besides the well-known risk factors, such as sweets intake, dairy consumption, and greasy and spicy food intake, wearing masks appears to trigger or aggravate acne during the COVID-19 pandemic. Limiting overall mask-wearing time may help to manage acne.

Novel role of estrogen receptor-α on regulating chondrocyte phenotype and response to mechanical loading

OBJECTIVE

In knee cartilage from patients with osteoarthritis (OA), both preserved cartilage and damaged cartilage are observed. In this study, we aim to compare preserved with damaged cartilage to identify the molecule(s) that may be responsible for the mechanical loading-induced differences within cartilage degradation.

METHODS

Preserved and damaged cartilage were harvested from the same OA knee joint. RNA Sequencing was performed to examine the transcriptomic differences between preserved and damaged cartilage cells. Estrogen receptor-α (ERα) was identified, and its function of was tested through gene knockin and knockout. The role of ERα in mediating chondrocyte response to mechanical loading was examined via compression of chondrocyte-laded hydrogel in a strain-controlled manner. Findings from the studies on human samples were verified in animal models.

RESULTS

Level of estrogen receptor α (ERα) was significantly reduced in damaged cartilage compared to preserved cartilage, which were observed in both human and mice samples. Knockdown of ESR1, the gene encoding ERα, resulted in an upregulation of senescence- and OA-relevant markers in chondrocytes. Conversely, knockin of ESR1 partially reversed the osteoarthritic and senescent phenotype of OA chondrocytes. Using a three-dimensional (3D) culture model, we demonstrated that mechanical overload significantly suppressed ERα level in chondrocytes with concomitant upregulation of osteoarthritic phenotype. When ESR1 expression was suppressed, mechanical loading enhanced hypertrophic and osteogenic transition.

CONCLUSION

Our study demonstrates a new estrogen-independent role of ERα in mediating chondrocyte phenotype and its response to mechanical loading, and suggests that enhancing ERα level may represent a new method to treat osteoarthritis.