The use of oral antibiotics in treating acne vulgaris: a new approach

Although acne is not an infectious disease, oral antibiotics have remained a mainstay of treatment over the last 40 years. The anti‐inflammatory properties of oral antibiotics, particularly the tetracyclines, are efficacious in treating inflammatory acne lesions. Common prescribing practices in Dermatology exert significant selection pressure on bacteria, contributing to the development of antibiotic resistance. Antibiotic use for acne not only promotes resistance in Propionibacterium acnes, but also affects other host bacteria with pathogenic potential. This review will summarize the commonly used treatments for acne vulgaris, and how they should be combined as rational treatment. The indications for using oral antibiotics in acne will be highlighted. Strategies described in the literature to conserve the utility of oral antibiotics will be summarized. These include limiting the duration of antibiotic therapy, concomitant use of a topical non‐antibiotic agent, use of subantimicrobial dose doxycycline, and the introduction of topical dapsone.     

Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that causes a significant decline in quality of life. There are numerous treatment options; however, real‐life data on the efficacy of these treatments is limited. This study was performed in two centers to describe clinical characteristics and assess treatment outcome in a cohort of 139 patients with HS. Data on demographic and clinical characteristics, Hurley stage and comorbidities were collected from patient charts and evaluated retrospectively. Treatment response was measured with HS clinical response index (HISCR). Mean body mass index was 27.8±4.88 . Inflammatory comorbidities were present in 23%. Among first‐line drugs systemic doxycycline resulted in 60% HISCR followed by rifampicin–clindamycin combination (46.4%). Isotretinoin had the lowest HISCR (30.7%) in this group. For second‐line therapies, all acitretin treated patients achieved response and patients treated with tumor necrosis factor alpha (TNF‐α) inhibitors had the highest HISCR. Currently recommended first‐line therapies have moderate efficacy in HS. Acitretin appears to be a reasonable alternative for the highly effective TNF‐α inhibitors in patients with severe and resistant HS. Overall, these results support that excessive inflammatory response play an important role in pathogenesis of HS.     

miR-376b-3p可促进Runx2诱导C2C12细胞进行成骨细胞早期分化

背景：转录因子Runx2是调节成骨分化及骨发育的关键因子,过表达Runx2可诱导间质细胞C2C12分化为成骨细胞,但相关诱导分化分子机制并不清楚。    目的：分析miR-376家族成员在Runx2诱导C2C12细胞进行成骨分化过程中的作用。方法：利用可诱导表达Runx2的细胞系C2C12/Runx2^Dox,在不同的时间点通过荧光定量PCR方法检测miR-376家族成员表达情况。C2C12/Runx2 ^Dox细胞转染miR-376b-3p mimic后利用荧光定量PCR检测成骨细胞标记基因碱性磷酸酶及骨钙素表达情况,并利用碱性磷酸酶染色法分析碱性磷酸酶活性。利用在线工具miRanda, miRWalk与TargetScan共同预测miR-376b-3p潜在靶基因。利用DAVID Bioinformatics Resources数据库对得到的靶基因进行功能聚类分析。结果与结论：在Runx2诱导C2C12进行成骨分化过程中miR-376b-3p表达显著增加,其他成员表达无明显变化。转染miR-376b-3p mimic可上调碱性磷酸酶表达,但对骨钙素表达无影响;转染miR-376b-3p mimic也可增加碱性磷酸酶活性。靶基因功能聚类分析结果表明miR-376b-3p可参与机体骨骼发育过程,表明其在成骨分化过程中的作用。研究结果表明,Runx2通过上调miR-376b-3p的方式对与成骨分化相关基因的表达进行调节,以促进C2C12进行成骨细胞的早期分化。     

Current topical and systemic approaches to treatment of rosacea

Rosacea is a common, often overlooked, chronic facial dermatosis characterized by intermittent periods of exacerbation and remission. Clinical subtypes and grading of the disease have been defined in the literature. On the basis of a genetic predisposition, there are several intrinsic and extrinsic factors possibly correlating with the phenotypic expression of the disease. Although rosacea cannot be cured, there are several recommended treatment strategies appropriate to control the corresponding symptoms/signs. In addition to adequate skin care, these include topical and systemic medications particularly suitable for the papulopustular subtype of rosacea with moderate to severe intensity. The most commonly used and most established therapeutic regimens are topical metronidazole and topical azelaic acid as well as oral doxycycline. Conventionally, 100–200 mg per day have been used. Today also a controlled release formulation is available, delivering 40 mg per day using non-antibiotic, anti-inflammatory activities of the drug. Anti-inflammatory dose doxycycline in particular allows for a safe and effective short- and long-term therapy of rosacea. Topical metronidazole and topical azelaic acid also appear to be safe and effective for short-term use. There are indications that a combined therapy of anti-inflammatory dose doxycycline and topical metronidazole could possibly have synergy effects. Further interesting therapy options for the short- and long-term therapy of rosacea could be low-dose minocycline and isotretinoin; however, too little data are available with regard to the effectiveness, safety, optimal dosage and appropriate length of treatment for these medications to draw final conclusions.

Conflicts of interest

None declared.     

Quality of life in patients with facial steroid dermatitis before and after treatment

Background Improper long‐term, even low‐dose, topical corticosteroids, especially application to the face, could induce steroid dermatitis, which was refractory and detrimental to the quality of life. Objective To evaluate the quality of life in patients with facial steroid dermatitis before and after the treatment of doxycycline and indomethacin plus support therapy. Study design A prospective study. Setting Outpatients of the Department of dermatology, the Third Hospital of Hangzhou, from August 2, 2004, to April 20, 2005. Subjects Fifty consecutive outpatients completed the treatment. Intervention The intervention is doxycycline 10 mg twice a day and indomethacin 25 mg twice a day for 4 weeks, cetirizine or loratadine 10 mg daily if pruritic, topical white petroleum if feeling dry and wet dressing if burning and oedema, plus psychological support and health education. Main outcome measure The efficacy of the treatment was quantified using a 24‐point steroid clinical score. The detriment of the quality of life was quantified using a 30‐point Dermatology Life Quality Index. Results The steroid dermatitis clinical score decreased significantly from 15.06 ± 4.61 at baseline to 4.52 ± 3.39 at 2 weeks after the end of treatment (week 6; P < 0.001). Twenty‐one patients underwent a rebound phenomenon and the steroid dermatitis clinical score increased significantly from 13.71 ± 4.33 at baseline (week 0) to 19.24 ± 3.40 at 1 week after treatment (week 1; P < 0.001). Quality of life score decreased significantly from 13.76 ± 7.68 at baseline to 3.44 ± 2.57 at 2 weeks after the end of treatment (week 6; P < 0.001). Conclusions The quality of life was profoundly affected by facial steroid dermatitis. Doxycycline and indomethacin plus support therapy might be effective in patients with facial steroid dermatitis.     

Development of an indirect competitive ELISA for the detection of doxycycline residue in animal edible tissues

A synthetic hapten doxycycline (DOX) with a spacer-arm (para-aminobenzoic acid (PABA)) was attached to bovine serum albumin (BSA) or ovalbumin (OVA) by the diazonium coupling reaction and mixed anhydride methods. Then, DOX–PABA–OVA conjugate was used as a coating antigen in enzyme-linked immunosorbent assay (ELISA), while DOX–PABA–BSA was used as an immunogen to produce polyclonal antibodies. A reliable and sensitive indirect competitive enzyme-linked immunosorbent assay was developed and applied to the quantitative determination of DOX residue in muscle and liver samples. After the optimisation of the main parameters, 50% inhibition was 8.74 µg/l and the limit of detection was 1.96 µg/l. A weak cross-reactivity (CR) was also observed with other structurally related compounds, such as oxytetracycline (10.71%), tetracycline (4.10%) and chlortetracycline (1.89%). The CRs with other antibiotics were all below 0.1%. With the ELISA method, the recoveries were demonstrated to be from 80.19 to 89.41% in liver samples and 83.98–94.75% in muscle samples. The mean of the coefficients of variation with the intra-assay test were 5.75 and 7.53% in liver and muscle samples, respectively. For the inter-assay test, the average of the coefficients of variation was 5.92% in liver and 7.21% in muscle samples. The ELISA method is accurate and reliable for the detection of DOX residue in edible foods of animal origins.     

强力霉素抑制MMP-9对大鼠局灶性缺血再灌注脑损伤的保护作用

目的观察强力霉素对脑缺血再灌注MMP-9活性的影响,探讨其对神经元的保护作用。方法利用大脑中动脉线栓法(middle cerebral artery occlusion,MCAO)制备局灶性脑缺血再灌注模型,SD大鼠分为假手术组、生理盐水组、强力霉素组,每组18只。激光多普勒血流仪分别检测大鼠手术前、MCAO时、再灌注24 h大脑中动脉脑血流;再灌注24 h时应用TTC染色法观察大鼠脑梗死体积;明胶酶谱法检测缺血区脑组织MMP-9活性变化;透射电镜观察缺血区脑组织神经元超微结构。结果生理盐水组与强力霉素组大鼠在再灌注24 h时脑血流[分别为基础值的(57.98±4.20)%、(59.23±3.30)%]与MCAO时[分别为基础值的(22.94±3.16)%、(21.63±3.46)%]差异显著(P<0.01),但在同一时间点两组间无显著差异(P>0.05);强力霉素组大鼠脑梗死体积[(9.77±2.68)%]与生理盐水组[(33.44±4.50)%]相比显著减少(P<0.01);生理盐水组大鼠MMP-9活性(5.95±0.73)与假手术组(1.21±0.15)相比显著升高(P<0.01),应用强力霉素后MMP...     

复方多西环素缓释凝胶的体内释放度测定

目的：观察复方多西环素缓释凝胶的体内缓释性能。方法将11名患者的26颗患牙随机分为实验组和对照组,于基础治疗1周后,分别在牙周袋内置入复方多西环素缓释凝胶和复方多西环素凝胶,并于置药后每天定时用滤纸条法采集龈沟液样本,高效液相色谱法测定龈沟液内多西环素的浓度。结果复方多西环素凝胶在用药后第3天,龈沟液内多西环素浓度已降至6．82μg/ml;复方多西环素缓释凝胶在用药7 d后龈沟液内多西环素浓度仍可达到60．46μg/ml。结论复方多西环素缓释凝胶在牙周袋内可缓慢释放,较长时间维持有效浓度。     

复方多西环素缓释凝胶对实验性牙周炎龈沟液IL-4和 TNF-α的影响

目的：研究复方多西环素缓释凝胶对实验性牙周炎大鼠牙龈指数（ GI）、牙周袋深度（ PD）、附着丧失程度（AL）及龈沟液中白介素-4（IL-4）和肿瘤坏死因子-α（TNF-α）水平的影响。方法选用Wister大鼠42只,随机分为3组：正常对照组（N组）,阳性对照组（C组）和实验组（T组）,每组14只。 C组和T组建立牙周炎模型后,C组给米诺环素软膏治疗,T组给复方多西环素缓释凝胶治疗,均为每周上药1次共4次,并分别在治疗前和治疗后记录GI、PD、AL及龈沟液中IL-4和TNF-α水平。结果治疗后,C组和T组GI、PD、AL均较治疗前显著下降（ P ＜08．05）。牙周炎大鼠龈沟液中IL-4水平显著低于正常组（ P ＜0．05）,治疗后显著增高（ P ＜0．05）,且T组明显高于C组（ P ＜0．05）;牙周炎大鼠龈沟液中TNF-α水平显著高于正常组（ P ＜0．05）,治疗后显著降低（ P ＜0．05）,T组和C组治疗后差异无统计学意义（ P ＞0．05）。结论复方多西环素缓释凝胶能明显改善牙周炎临床症状,显著降低龈沟液中TNF-α水平,提高龈沟液中IL-4水平。     

Indian tick typhus presenting as Purpura fulminans

Seriously ill patients presenting with purpura fulminans, sepsis and multi-organ failure often require extensive diagnostic workup for proper diagnosis and management. Host of common infections prevalent in the tropics, e.g. malaria, dengue; other septicemic infections e.g. meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever, viral exanthems like measles, infectious mononucleosis, collagen vascular diseases (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions are often kept in mind, and the index of suspicion for rickettsial illness is quite low. We present a case of Indian tick typhus presenting with purpura fulminans (retiform purpura all over the body), sepsis and multiorgan failure without lymphadenopathy and eschar, successfully treated with doxycycline and discharged home. Hence, a high index clinical suspicion and prompt administration of a simple therapy has led to successful recovery of the patient.