Metabolic syndrome and psoriasis severity in South‐East Asian patients: An investigation of potential association using current and chronological assessments

Although studies regarding prevalence of metabolic syndrome (MS) in Asian psoriatic patients are limited and show varying results, a previous report describes a significant increase in prevalence of MS in Thai psoriatic patients, as compared with rates in the general population. However, no significant association between MS and psoriasis severity using the Psoriasis Area and Severity Index (PASI) was found, which differs from the findings of Korean and Japanese studies. This study aimed at re‐evaluating the association between MS and psoriasis severity in Thai patients using current assessment (PASI) and chronological assessment (historical course and interventions). A total of 273 psoriatic patients were recruited. After controlling for age and sex, 96 patients were assigned to the MS group and 96 patients to the non‐MS group. Similar to the previous study, no significant differences were identified between metabolic and non‐metabolic patients regarding PASI, age of onset, disease duration and family history of psoriasis. However, the numbers of hospitalizations (P = 0.018) and interventions (P = 0.028) were significantly higher in metabolic patients than in non‐metabolic patients. Further, a greater number of metabolic components was significantly associated with a higher number of hospitalizations (P = 0.012), pustular or erythrodermic psoriasis episodes (P = 0.049), and interventions (P = 0.005). Body mass index of 23 kg/m² or more, abdominal obesity and high blood pressure were associated with an increased risk of treatment failure. Using chronological assessment, our study supported that MS negatively affects psoriasis severity and treatment outcomes. Screening for MS is highly recommended for psoriatic patients.     

Epidemiology of acne vulgaris

Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of acne by conducting a systematic review of relevant epidemiological studies. We searched Medline and Embase to the end of November 2011. The role of Propionibacterium acnes in pathogenesis is unclear: antibiotics have a direct antimicrobial as well as an anti‐inflammatory effect. Moderate‐to‐severe acne affects around 20% of young people and severity correlates with pubertal maturity. Acne may be presenting at a younger age because of earlier puberty. It is unclear if ethnicity is truly associated with acne. Black individuals are more prone to postinflammatory hyperpigmentation and specific subtypes such as ‘pomade acne’. Acne persists into the 20s and 30s in around 64% and 43% of individuals, respectively. The heritability of acne is almost 80% in first‐degree relatives. Acne occurs earlier and is more severe in those with a positive family history. Suicidal ideation is more common in those with severe compared with mild acne. In the U.S.A., the cost of acne is over 3 billion dollars per year in terms of treatment and loss of productivity. A systematic review in 2005 found no clear evidence of dietary components increasing acne risk. One small randomized controlled trial showed that low glycaemic index (GI) diets can lower acne severity. A possible association between dairy food intake and acne requires closer scrutiny. Natural sunlight or poor hygiene are not associated. The association between smoking and acne is probably due to confounding. Validated core outcomes in future studies will help in combining future evidence.     

Cultural and linguistic validation of acne‐QoL in French

Background Acne‐Quality of Life (acne‐QoL) is a facial acne‐specific quality‐of‐life instrument developed in English. Objective Our objective was to translate and validate acne‐QoL in French and to establish the reliability and responsivity of this measure. Methods Acne‐QoL was translated into French (acne‐QoLfr) in accordance with international methodological recommendations. The validated French version of the Cardiff Acne Disability Index (CADIfr) was used as a comparator. Acne patients in Quebec (n = 20) and France (n = 14) completed the acne‐QoLfr and CADIfr on three occasions over 3 months (day 0, day 2–3, day 60–90). Results A total of 34 patients were recruited. Pearson’s correlation for total acne‐QoLfr scores at day 0 and day 2–3 was 0.77. Of the four domains comprising the acne‐QoLfr, correlations were highest for symptoms (0.85) and lowest for the role‐emotional domain (0.66). At day 60–90, total acne‐QoLfr scores increased by a mean of 19.7 points, reflecting improved quality‐of‐life with acne therapy and demonstrating responsivity of the instrument. Conclusion Acne‐QoLfr is a linguistically and culturally validated tool for facial acne that is both reliable and responsive.     

An assessment of the efficacy of blue light phototherapy in the treatment of acne vulgaris

Background Acne vulgaris is a common skin condition that affects 8 out of 10 people. It varies from mild to severe, and different treatments target various aspects of the disease. Propionibacterium acnes, one of the culprits involved in the pathogenesis of acne vulgaris, is the main target of all major medical treatments used. Studies conducted in recent years have shown favorable effects within the visible light spectrum for the treatment of acne vulgaris. Objective In this study, we have evaluated the use of intense blue light within the spectral range of 415–425 nm (peak 420 nm) in the treatment of acne vulgaris. Methods Twenty‐one patients with mild to moderate facial acne were treated with blue light phototherapy. All patients were given 14‐min treatment sessions twice a week for 4 weeks. Acne severity was assessed using the Leeds Technique for grading and lesion counts. Disability was assessed using the Dermatology Life Quality Index (DLQI). In addition, standard digital and cross‐polarized light photographs were taken and graded by a blinded evaluator. Visual analog scale (VAS) scores and cultures for P. acnes were carried out before starting the treatment and upon completion of the treatment. Results Significant improvement was achieved in the Leeds Acne Grade (P = 0.001). The inflammatory (P = 0.001) and noninflammatory (P = 0.06) lesion counts also improved significantly. A similar change was noted in the DLQI (P = 0.001); a degree of significance was also achieved in the patients’ and the investigators’ VAS scores (P = 0.01 and P = 0.001, respectively). P. acnes colony counts failed to show a significant decrease at the end of the treatment and remained almost constant (P = 0.660). Conclusions We believe that blue light does appear to have some role in the management of acne and may be beneficial for the treatment of a select group of mild to moderate acne patients.     

Relationship between quinolone use and resistance of Staphylococcus epidermidis in patients with acne vulgaris

Staphylococcus epidermidis is a bacterium known to inhabit the skin. In treatment of acne vulgaris, the cutaneous milieu is exposed to oral or topical antimicrobials. We previously reported that the antimicrobial resistance of Cutibacterium acnes isolated from acne patients is affected by antimicrobial use. The aim of this study was to investigate the relationship between quinolone use and resistance in skin bacteria, particularly S. epidermidis, from acne patients. A total of 92 and 87 S. epidermidis strains isolated from clinic patients and hospital outpatients with acne vulgaris, respectively, were tested. No significant difference was found between the prevalence of methicillin‐resistant S. epidermidis (MRSE) strains from clinic patients (37.0%) and hospital outpatients (39.1%). The MRSE strains (20.6%, 14/68 strains) showed a significantly higher ratio of high‐level levofloxacin resistance (minimum inhibitory concentrations were 64 to ≥256 μg/mL) compared with methicillin‐susceptible S. epidermidis strains (2.7%, 3/111 strains) (P < 0.01). The rate of levofloxacin resistance in C. acnes strains, which were isolated from the same samples of acne patients, showed a strong positive correlation with that in S. epidermidis strains (r = 0.93, P < 0.01). The high‐level levofloxacin‐resistant strains were frequently found in patients with history of quinolone use compared with those without (P < 0.01). Our data showed for the first time that antimicrobial administration for acne treatment affects the antimicrobial resistance in not only C. acnes but also S. epidermidis. Thus, caution should be exercised in antimicrobial use for acne treatment to prevent increasing antimicrobial resistance in these species.     

Evaluation of 25‐hydroxy vitamin D levels and disease severity in patients with acne vulgaris

Acne vulgaris is a multifactorial skin disorder. Many etiological factors are speculated to contribute to the pathogenesis of acne, one of these is vitamin D deficiency. Previous studies reported contradictory results about serum 25 hydroxy vitamin D (25‐OH vitamin D) levels, its association with acne, some claimed that acne lesion might improve with vitamin D supplementation. We aimed to assess serum 25‐OH vitamin D levels in acne patients, identify their relation with disease severity in a larger study group. The study included 134 acne patients, 129 controls. Acne disease severity was identified with Global Acne Grading Scale (GAGS) scores. Serum 25‐OH vitamin D levels were measured in all groups. Serum 25‐OH vitamin D levels were significantly lower in acne patients than in controls (P < .001). The prevalence of vitamin D deficiency was significantly higher in acne group than in control group (77.6% vs 63.9%; P = .041). There was a negative‐strong statistically significant correlation detected between serum 25‐OH vitamin D levels and GAGS scores in patient group (P < .001; r = −.910). According to these results, we claim that evaluating serum 25‐OH vitamin D levels in acne patients, vitamin D supplementation as a treatment option may be a consideration for further studies.     

Treatment of acne vulgaris with fractional radiofrequency microneedling

Fractional radiofrequency microneedling is a novel radiofrequency technique that uses insulated microneedles to deliver energy to the deep dermis at the point of penetration without destruction of the epidermis. It has been used for the treatment of various dermatological conditions including wrinkles, atrophic scars and hypertrophic scars. There have been few studies evaluating the efficacy of fractional radiofrequency microneedling in the treatment of acne, and none measuring objective parameters like the number of inflammatory and non‐inflammatory acne lesions or sebum excretion levels. The safety and efficacy of fractional radiofrequency microneedling in the treatment of acne vulgaris was investigated. In a prospective clinical trial, 25 patients with moderate to severe acne were treated with fractional radiofrequency microneedling. The procedure was carried out three times at 1‐month intervals. Acne lesion count, subjective satisfaction score, sebum excretion level and adverse effects were assessed at baseline and at 4, 8 and 12 weeks after the first treatment as well as 4, 8 and 12 weeks after the last treatment. Number of acne lesions (inflammatory and non‐inflammatory) decreased. Sebum excretion and subjective satisfaction were more favorable at every time point compared with the baseline values (P < 0.05). Inflammatory lesions responded better than non‐inflammatory lesions (P < 0.05). Adverse effects such as pinpoint bleeding, pain and erythema were noted, but were transient and not severe enough to stop treatment. Fractional radiofrequency microneedling is a safe and effective treatment for acne vulgaris.     

Infection in autoimmune bullous diseases: A retrospective comparative study

Certain autoimmune bullous diseases (AIBD), including pemphigoid and pemphigus, confer increased infection risk. Infections have not been systematically studied in these conditions, however. Little is known about infection risk in these conditions, particularly dermatitis herpetiformis (DH). We aimed to characterize and compare infection patterns and risk factors in patients with pemphigoid, pemphigus, and DH. We retrospectively studied the medical records of Olmsted County, Minnesota, residents who had a diagnosis of AIBD between 1 January 1998 and 1 January 2011. Of 81 patients studied, 54 (67%) had pemphigoid, 11 (14%) had pemphigus and 16 (20%) had DH. Most patients studied developed at least one localized infection (72%) or one systemic infection (83%). Almost one‐third of patients (31%) developed infections requiring hospitalization or contributing to death. All patients taking systemic corticosteroids experienced a localized or systemic infection during the follow‐up period. Systemic infections were significantly less frequent in patients with DH than those with pemphigoid or pemphigus (P = 0.03), as were systemic infections requiring hospitalization or contributing to death (P = 0.002). Patients with DH were significantly less likely to require systemic corticosteroids (P < 0.001) and significantly more likely to receive dapsone (P = 0.002). The study design was retrospective and a limited number of patients met the inclusion criteria. Patients with AIBD frequently developed localized and systemic infections, a substantial portion of which contributed to hospitalization or death. Patients with DH experienced infections of lesser severity than patients with pemphigoid or pemphigus.     

Heredity: a prognostic factor for acne

BACKGROUND: The role of heredity in acne severity and therapeutic response remains unclear. OBJECTIVE: A prospective epidemiologic study was performed to compare clinical and evolutive features of acne and response to treatment in 151 patients with acne with (A+) or without (A-) family history of acne. METHODS: A+ and A- patients were compared on clinical and therapeutic criteria. A+ patients were then distributed into subgroups (M+, F+, M+F+) following the origin of family history (father: F, mother: M). RESULTS: The clinical profile was similar in the A+ and A- populations. Acne occurred earlier and more often before puberty in the A+ population, in which oral treatments and relapse after isotretinoin were more frequent. Retentional lesions (number and extent) were more important in the M+ and M+F+ populations. CONCLUSION: This study confirms the importance of heredity as a prognostic factor for acne. Family history of acne is associated with earlier occurrence of acne, increased number of retentional lesions and therapeutic difficulties.     

Clinical and bacteriological evaluation of adapalene 0.1% gel plus nadifloxacin 1% cream versus adapalene 0.1% gel in patients with acne vulgaris

This multicenter, randomized parallel group study investigated the efficacy and tolerability of adapalene 0.1% gel plus nadifloxacin 1% cream (combination therapy) compared with adapalene gel (monotherapy) during 12‐week treatment of acne vulgaris. A total of 184 Japanese patients aged above 12 years with moderate to severe acne as indicated by the Japanese severity grading criteria were randomized to combination therapy (n = 84) and monotherapy (n = 100) groups, both having comparable demographic and baseline characteristics. Adapalene was applied only to inflammatory acne lesions in order to minimize skin irritation and ensure the treatment results. Efficacy and safety evaluations, treatment compliance and satisfaction with drug application were periodically monitored. The combination therapy provided a significantly greater efficacy than adapalene in decrement of inflammatory papulopustular lesions at 4 weeks and thereafter (P = 0.0056). The overall judgment of the therapeutic efficacy by the physician at the end of study revealed a significant difference (P = 0.02496) between the groups in favor of combination therapy. Dryness was reported in a greater proportion of patients undergoing monotherapy than combination therapy at weeks 2 and 4 (P = 0.04652). The patient self‐assessment in satisfaction with the drug application at the end of study revealed a significant difference (P = 0.00268) between the groups in favor of combination therapy. Among 76 strains of Propionibacterium acnes isolated from 87 patients, no strain was resistant to nadifloxacin. Thus, the simultaneous use of adapalene and nadifloxacin may provide an additive and complementary effect, resulting in clinical superiority and greater patient adherence compared to adapalene monotherapy.     

Profile of patients with mild-to-moderate acne in Europe: a survey

Background

Although acne is almost universal in teenagers, few large cohort studies have investigated the profile of acne patients.

Objectives

To identify the profile of European patients with mild-to-moderate acne.

Materials and methods

An epidemiological study was performed using inclusion data from a prospective, international, observational phase IV study conducted in patients prescribed an anti-acne cream containing retinaldehyde, glycolic acid, modified rhamnose and Avene Thermal SpringWater.

Results

Atotal of 2926 patients (73.1% female) with mild to moderate acne (mean Global Evaluation of Acne score of 2.55 ± 0.7), aged 22.5 ± 8.0 years, were included in France, Switzerland, Italy and Portugal. A family history of acne was present in 62.9% of patients and mean age at acne onset was 16.0 ± 4.9 years. In total, 69.6% of patients had moderate to severe hyperseborrhoea, 35.6% acne lesions on both face and trunk, 23.6% facial pigmentation and 46% scars. The extent of acne was significantly associated with sex, age at acne onset, history of acne and presence of scars. In women, acne onset was delayed (p<0.0001) and a family history of acne and extension to the trunk were less common than in men (p = 0.0118, and p<0.0001), as were scars (p = 0.0042). In subjects with a family history of acne, the frequency in men was higher (p = 0.0118), acne onset was earlier (p<0.0001) and extension to the trunk and presence of scars were more common (both p<0.0001).

Conclusion

Further epidemiological studies would help define specific risk factors for acne occurrence or progression, which may be modified.

     

The epidemiology of adolescent acne in North East China

Background Adolescent acne impacts self‐esteem and quality of life in adolescents and its aetiology is not fully clarified. Objective The aim of this study was to describe the epidemiological features of adolescent acne in North East China and determine the impact of genetic and environmental factors on the pathogenesis of acne. Methods Data were collected from 5696 undergraduates (2920 patients and 2776 controls) using questionnaire. The survey data were analysed using spss version 13.0 and heritability of adolescent acne was calculated using Falconer’s method. Results Total prevalence of adolescent acne was 51.30% (52.74% in males, 49.65% in females). The difference between genders was statistically significant (P < 0.05). Adolescents with a family history of acne had earlier age of onset (P < 0.001). The prevalence of acne in first‐ and second‐degree relatives of acne patients was 22.5% and 7.19%, respectively, significantly higher than in controls (P < 0.001). Heritability of adolescent acne was 78.47 ± 2.05% in first‐degree relatives and 75.05 ± 3.18% in second‐degree relatives. Risk factors to the acne suffers include (in descending order of occurrence), acne family history, mental stress, menstrual disorder, frequent insomnia, high fat diet, being male, dysmenorrhoea, anxiety, sleeping < 8 h per day, depression, fried food, study pressure, spicy food, oily skin and mixed type skin. Protective factors include (presented in descending order of occurrence) dry skin, neutral skin, frequent fruit consumption and computer access time < 2 h daily. Conclusion Adolescent acne includes a familial genetic predisposition. Additional environmental factors of psychological stress, skin oiliness and high caloric diets may also contribute to the onset of acne in Chinese adolescents.     

Predictive factors of response to pulse methylprednisolone therapy in patients with alopecia areata: A follow‐up study of 105 Japanese patients

Pulse corticosteroid therapy is effective for alopecia areata (AA) in the early stage. The risk and efficacy of this therapy for patients with several backgrounds, however, remains controversial. To explore the predictive factors of the response and risk factors of this therapy, data from 105 AA patients treated with methylprednisolone (500 mg) i.v. for 3 days consecutively in our facility were retrospectively analyzed. Among good responders, longer time from the onset to therapy was correlated with longer time required for hair regrowth (P = 0.037, n = 27). Multivariate models demonstrated that “severity”, “relapse” and longer “duration from the latest onset” were significantly and independently associated with poorer outcome (P < 0.01). “History of atopic dermatitis (AD)” was also associated with poorer outcome, but this correlation could be explained by the effect that duration from the latest onset of AA was longer among participants with AD. We propose that earlier initiation of pulse corticosteroid therapy is preferable for better outcome of AA, particularly among patients with AD. Clinicians should be mindful of the occurrence of mild adverse effects in the elderly patients.     

Serum and salivary adipsin levels and its association with insulin resistance in acne vulgaris patients

Background

There is scarcity in literature about the reliability of salivary markers in acne vulgaris.

Aims

The aims were to evaluate the insulin resistance (IR) and adipsin levels in serum and saliva in a sample of acne vulgaris patients; and to correlate IR and adipsin levels with the disease severity.

Methods

This prospective case–control study included 60 acne vulgaris patients (patients Group), in addition, 60 apparently healthy individuals (control group). The severity of acne vulgaris was determined according to Global Acne Grading system (GAGS). Serum and salivary adipsin, fasting glucose, and fasting insulin levels were measured using ELISA kits.

Results

Fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in patients group both in serum and saliva were elevated when compared with the control group. Serum and salivary levels of adipsin and Quantitative insulin sensitivity check index (QUIKI) in patients were decreased than the control group. Adipsin serum levels show significant negative correlations with all study variables except QUIKI with which the correlation was positive both in serum and saliva. There was a significant positive correlation between serum and salivary adipsin levels (r = 0.873, p < 0.00001) and serum and salivary fasting glucose (r = 1, p < 0.00001).

Conclusion

Adipsin could be considered as a promising biomarker for acne vulgaris and its associated insulin resistance. Moreover, the salivary measurements may be considered as useful biomarkers in acne vulgaris patients, but more studies are still required.     

Insulin‐like growth factor‐I gene polymorphism in acne vulgaris

Background Acne vulgaris is a multifactorial disease of the skin. Several studies have shown that elevated levels of serum insulin‐like growth factor‐I (IGF‐I) correlate with overproduction of sebum and acne. Recently functional relationship between IGF‐I (CA) polymorphism and circulating IGF‐I levels in adults has been reported. Aims The aim of our study was to investigate for the first time whether IGF‐I (CA) polymorphism might be involved in the pathogenesis of acne or not. Methods We included 115 acne patients and 117 healthy subjects to the study. The clinical grade of acne was assessed based on the Global Acne Grading System. Participants were questioned about diabetes mellitus, PCOS and other systemic disease. We searched for the IGF‐I (CA) 19 polymorphism in this study. The IGF‐I (CA) 19 polymorphism was performed by polymerase chain reaction. Results We categorized the IGF‐I (CA) 19 polymorphism area into three groups as lower than 192 bp, 192–194 bp and higher than 194 bp. We found that the frequency of genotype IGF‐1 (CA) 19 gene was significantly different between control and acne patients (P = 0.0002). A significant association between IGF‐I (CA) genotypes and severity of acne was found (P = 0.015). No significant difference was found between male and female patients (P > 0.05). Conclusions Our results suggest that IGF‐I (CA) 19 polymorphism may contribute to a predisposition to acne in Turkish patients.     

On the relationship between VDR,RORα and RORγ receptors expression and HIF1‐α levels in human melanomas

We analysed the correlation between the expression of HIF‐1α (hypoxia‐inducible factor 1 alpha), the nuclear receptors: VDR (vitamin D receptor), RORα (retinoic acid receptor‐related orphan receptor alpha), and RORγ and CYP24A1 (cytochrome P450 family 24 subfamily A member 1) and CYP27B1 (cytochrome P450 family 27 subfamily B member 1), enzymes involved in vitamin D metabolism. In primary and metastatic melanomas, VDR negatively correlated with nuclear HIF‐1α expression (r = ?.2273, P = .0302; r = ?.5081, P = .0011). Furthermore, the highest HIF‐1α expression was observed in pT3‐pT4 VDR‐negative melanomas. A comparative analysis of immunostained HIF‐1α and CYP27B1 and CYP24A1 showed lack of correlation between these parameters both in primary tumors and melanoma metastases. In contrast, RORα expression correlated positively with nuclear HIF‐1α expression in primary and metastatic lesions (r = .2438, P = .0175; r = .3662, P = .0166). Comparable levels of HIF‐1α expression pattern was observed in localized and advanced melanomas. RORγ in primary melanomas correlated also positively with nuclear HIF‐1α expression (r = .2743, P = .0129). HIF‐1α expression was the lowest in localized RORγ‐negative melanomas. In addition, HIF‐1α expression correlated with RORγ‐positive lymphocytes in melanoma metastases. We further found that in metastatic lymph nodes FoxP3 immunostaining correlated positively with HIF‐1α and RORγ expression in melanoma cells (r = .3667; P = .0327; r = .4208, P = .0129). In summary, our study indicates that the expression of VDR, RORα and RORγ in melanomas is related to hypoxia and/or HIF1‐α activity, which also affects FoxP3 expression in metastatic melanoma. Therefore, the hypoxia can affect tumor biology by changing nuclear receptors expression and molecular pathways regulated by nuclear receptors and immune responses.     

Cortexolone 17α-propionate 1% cream, a new potent antiandrogen for topical treatment of acne vulgaris. A pilot randomized, double-blind comparative study vs. placebo and tretinoin 0·05% cream

Background Acne vulgaris is a disorder of the pilosebaceous unit in which the androgens contribute to its onset and persistence. The use of antiandrogens is therefore potentially effective; however, antiandrogens for topical use are not available on the market. Cortexolone 17α‐propionate (CB‐03‐01; Cosmo S.p.A, Lainate, Italy) is a new potent topical antiandrogen potentially useful in acne vulgaris. Objectives To evaluate the safety and the topical efficacy of CB‐03‐01 1% cream in acne vulgaris as compared with placebo and with tretinoin 0·05% cream (Retin‐A^®; Janssen‐Cilag). Methods Seventy‐seven men with facial acne scored 2–3 according to Investigator’s Global Assessment (IGA) were randomized to receive placebo cream (n = 15), or CB‐03‐01 1% cream (n = 30), or tretinoin 0·05% cream (n = 32) once a day at bedtime for 8 weeks. Clinical efficacy was evaluated every 2 weeks including total lesion count (TLC), inflammatory lesion count (ILC), acne severity index (ASI) and IGA. Safety assessment included local irritancy score, laboratory tests, physical examination, vital signs and recording of adverse events. Results CB‐03‐01 1% cream was very well tolerated, and was significantly better than placebo regarding TLC (P = 0·0017), ILC (P = 0·0134) and ASI (P = 0·0090), and also clinically more effective than comparator. The product also induced a faster attainment of 50% improvement in all the above parameters. Conclusions This pilot study supports the rationale for the use of topical antiandrogens in the treatment of acne vulgaris. CB‐03‐01 1% cream seems to fit with the profile of an ideal antiandrogen for topical use.     

The frequency of polycystic ovary syndrome in females with resistant acne vulgaris

Background Acne vulgaris in females may be resistant to treatment in spite of topical and systemic therapy for a sufficient period. In this condition, acne may be a manifestation of underlying endocrine conditions such as polycystic ovary syndrome (PCOS). Objective To evaluate the frequency of PCOS in females with resistant acne vulgaris. Patients and methods This case‐controlled study was conducted in the Department of Dermatology and Venereology in The Teaching Hospital in Al‐Najaf during the period from October 2007 to November 2008. One hundred and twenty‐three female patients with resistant acne vulgaris were included in this study. One hundred and twenty‐three women, age‐matched, without acne were enrolled as a control group. Detailed history, clinical examination, abdominal ultrasound study, and hormonal assays were obtained for the patients and the control group. Results One hundred and twenty‐three females with resistant acne were included; their ages ranged from 17 to 40 years with a mean of 25.016 ± 6.041 (SD). One hundred and twenty‐three control women without acne were enrolled; their ages ranged from 17–40 years with a mean of 26.014 ± 6.251 (SD). The patients and the control group are age‐matched (P = 0.192). It was found that 63 patients (51.2%) with resistant acne have PCOS in comparison to only eight control women (6.2%). The difference is highly significant. Conclusion Polycystic ovary syndrome is an important contributing factor in females with resistant acne vulgaris.