痤疮易感基因的研究进展

痤疮是发生于毛囊皮脂腺的一种慢性炎症性疾病,发病机制尚不完全清楚.目前认为,主要与雄激素、皮脂分泌增多、毛囊导管的异常角化、痤疮丙酸杆菌感染、外界因素、机体的免疫反应和遗传有关.近年来研究表明,痤疮是一种多基因遗传病,尤其是重型痤疮与遗传密切相关.CYP11α、CYP17、CYP1A1、雄激素受体基因、CYP21等基因被认为是痤疮易感基因.因此,探讨痤疮的易感基因,对痤疮尤其是重型痤疮的早期诊断、治疗和预防具有重要意义.

Abstract：

Acne is a common chronic inflammatory disease affecting hair follicles and sebaceous glands with unclear pathogenesis. It is a multifactorial disease and several pathogenetic factors have been identified, including the increase of androgen and sebum excretion, follicular hyperkeratinization, infection with Propionibacterium acnes, external factors, innate immunity, genetics, etc. Latest studies have indicated that acne is a polygenic disease and there is a particularly close correlation between severe acne and heredity. Many predisposing genes have been discovered for acne, including human CYP11α gene, CYP17 gene, CYP1A1gene, androgen receptor gene, CYP21 gene, etc. Therefore, the investigation into susceptible genes for acne may be beneficial to the early diagnosis, treatment and prevention of severe acne.     

寻常痤疮患者外周血单核细胞TLR2的表达及其与IL-8和TNF-α的相关性研究

目的 探讨Toll样受体2(TLR2)在寻常痤疮发病中的作用及意义.方法 选择轻、中、重度痤疮患者各30例,采用流式细胞仪检测其外周血CD14+单核细胞TLR2的表达,并采用双抗体夹心酶联免疫吸附法(ELISA)检测血清IL-8和TNF-α的水平.另取30例正常人作为对照组.结果 轻、中、重度组痤疮患者外周血单核细胞表面TLR2的表达均显著高于正常人对照组(P＜0.01).各组患者血清中IL-8和TNF-α的水平也显著高于正常人对照组(P＜0.01).直线相关分析显示,各组患者TLR2的表达与IL-8、TNF-α水平均呈正相关性(r分别为0.382、0.517、0.436、0.641、0.725、0.593,P＜0.05).痤疮严重程度与TLR2的表达呈正相关性(r=0.406,P＜0.01).结论 TLR2表达水平及相关细胞因子浓度与痤疮严重程度密切相关.

Abstract：

Objective To explore the role of Toll like receptor 2 (TLR2) in the pathogenesis of acne vulgaris. Methods Venous blood was collected from 30 normal human controls and 90 patients with acne vulgaris. The patients were equally divided into three groups, i.e., mild, moderate and severe groups, according to disease severity. Flow cytometry was performed to detect the expression of TLR2 in PBMCs, and double antibody sandwich ELISA to measure the levels of serum interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α). Results A significant increase was observed in the expression of TLR2 in PBMCs, serum level of IL-8and TNF-α in the three groups of patients with acne vulgaris compared with the normal human controls (all P ＜0.01). The expression of TLR2 was positively correlated with the expression of IL-8 (r=0.382, 0.517,0.436,respectively, all P＜0.05) and TNF-α(r=0.641, 0.725, 0.593, respectively, all P＜0.05) in the patients with mild, moderate and severe acne vulgaris, respectively, and with the severity of acne vulgaris (r = 0.406,P＜0.01 ). Conclusion The expression level of TLR2 and related cytokines seems closely correlated with the severity of acne vulgaris.     

反常性痤疮发病机制和治疗的研究进展

反常性痤疮是一种慢性复发性炎症性疾病,女性多发,主要累及腋窝、腹股沟、肛周等顶泌汗腺部位,其病因和发病机制尚不清楚,与遗传因素、毛囊改变、细菌感染、免疫因素、性激素、吸烟和肥胖等多种因素相关.治疗的主要方法包括抗生素、维A酸、性激素、肿瘤坏死因子拮抗剂、激光和手术治疗.为了更好地防治反常性痤疮,概述近年来该病发病机制和治疗方面的研究进展.

Abstract：

Acne inversa (AI) is a kind of chronic recúrrent inflammatory disease.Females are more likely to be affected by AI than males.Apocrine gland-bearing areas including axillary,inguinal,perianal,and perineal regions are commonly involved.The etiology of AI is unknown,and may be associated with genetic factors,hair follicular changes,bacterial infection,immunological factors,sexual hormones,smoking and obesity.Treatment includes antibiotics,retinoids,sexual hormones,tumor necrosis factor-alpha inhibitors,laser and surgery.This article presents the advances in the pathogenesis and treatment of AI,which may benefit its prevention and control.     

痤疮丙酸杆菌相关性皮肤病

痤疮丙酸杆菌是一种低致病力的革兰阳性菌,主要定植在人类皮肤毛囊皮脂腺的滤泡中.既往发现痤疮丙酸杆菌通过诱导分泌的细胞因子、酶类等参与痤疮的发病,近年来发现它可能通过影响黑素合成、黑素小体分布、免疫反应等参与进行性斑状色素减退症和外伤后致死性肉芽肿的发病,概述与其相关的几种疾病.

Abstract：

Propionibacterium acnes is a low-pathogenic and gram-positive bacteria. It is predominately colonized in sebaceous follicles of human skin. Past studies demonstrated that P.acnes took part in the occurrence of acne by inducing the secretion of cytokines and enzymes. Recently, it has been observed that P.acnes is involved in the development of progressive macular hypomelanosis and fatal granuloma after trauma via influencing melanogenesis, melanosome distribution, immune reactions, etc. This paper overviews some skin diseases associated with P.acnes.     

银屑病瘙痒机制及治疗研究进展

瘙痒是银屑病患者的一种常见症状,严重影响患者的生活质量.但其瘙痒的机制尚不清楚,许多常规治疗瘙痒的药物并不能有效缓解银屑病的瘙痒.目前认为,银屑病皮损中神经分布异常增多和敏感性增加,炎症细胞在病灶中聚集、活化并释放炎症介质是银屑病瘙痒的主要原因.抗组胺药不能有效控制银屑病瘙痒,而神经肽受体拮抗剂、免疫抑制剂及光疗等为治疗银屑病瘙痒的有效方法.

Abstract：

Pruritus is an important symptom of psoriasis.It seriously affects the quality of life of psoriatic patients,but its pathogenesis remains unanswered.Many routine treatments cannot relieve the pruritus in psoriasis effectively.It has been demonstrated that the pruritus in psoriasis is mainly attributed to the abnormally increased innervation and sensitivity of sensory nerves,as well as the aggregation,activation of and release of inflammatory mediators by inflammatory cells.Antihistamine drugs are usually ineffective for the treatment of pruritus in psoriasis,while antagonists of neuropeptide receptors,immunosuppressants and phototherapy have shown favorable efficacy.     

Human β-defensin-2 and skin diseases

Human β-defensin-2 (hBD-2) is an endogenous antimicrobial peptide recently found in the skin with broad-spectrum antimicrobial activity and unique mechanism of function. Recent studies have confirmed that the expression of hBD-2 is upregulated in the lesions of some dermatoses, such as psoriasis,acne vulgaris, verruca, dermatophytosis and basal cell carcinoma, etc. The susceptibility to bacterial and viral infections may be associated with the decreased or absent expression of hBD-2. Further researches into HBD-2will provide a new direction for the prevention and treatment of skin diseases.     

IL-22在银屑病发病机制中的作用

研究显示,白介素22能促进上皮细胞产生异常炎症介质.白介素22是一种重要的细胞因子,主要由Th17细胞产生,参与炎性细胞浸润,细胞增殖,细胞迁移及防御作用等.在银屑病皮损中,白介素22水平升高,其通过与角质形成细胞表面白介素22受体结合,导致细胞因子和炎症介质改变,起到趋化炎性细胞,促角质形成细胞增殖,抑制角质形成细胞分化的作用,是银屑病发病中重要的细胞因子.介绍银屑病皮疹中白介素22促进炎症细胞浸润和角质化细胞增殖的作用,以及银屑病中角质形成细胞活化产物的变化并通过白介素22治疗银屑病的疗效应证实其作用.

Abstract：

Studies have shown that IL-22 could promote epithelial cells to produce abnormal inflammatory mediators.IL-22 is an important cytokine mainly produced by Th17 cells and participates in inflammatory cell infiltration, cell proliferation, migration, defense, and so on.In psoriatic lesions, the expression level of IL-22 is elevated.By binding to its receptor on the surface of keratinocytes, IL-22 can alter the expressions of cytokines and inflammatory mediators, induce the chemotaxis of inflammatory cells, promote the proliferation and inhibit the differentiation of keratinocytes.Therefore, IL-22 is an important cytokine in the pathogenesis of pasoriasis.This paper describes the upregulatory effect of IL-22 on inflammatory cell infiltration and keratinocyte proliferation, alterations in products of activated keratinocytes in psoriasis, as well as the role of IL-22 in the pathogenesis of psoriasis which has been evidenced by the therapeutic effect of IL-22 on psoriasis.     

Study of substance P and its receptor neurokinin-1 in psoriasis and their relation to chronic stress and pruritus

Substance P and its receptor(R) neurokinin (NK)-1 may have a role in the pathogenesis of psoriasis. Stress has been reported to play a role in the onset and exacerbation of psoriasis, which might include the substance P-NK-1 receptor(R) pathway. A feature of psoriasis, that has been correlated to the severity of stress and secretion of substance P, is pruritus. The objective of this study was to investigate the expression of substance P and the NK-1R in involved and noninvolved psoriatic skin, using a biotinylated streptavidin technique. Moreover, a possible correlation between the patient′s level of chronic stress, measured by salivary cortisol samples, degree of lesional pruritus, measured by means of a visual analogue scale, and the expression of substance P- and the NK-1R, was investigated. There was a low number of substance P positive nerve fibres in noninvolved and involved skin, the major immunoreactivity for substance P being found in inflammatory cells. The number of substance P- and NK-1R positive inflammatory cells was increased in involved compared to noninvolved psoriatic skin. The substance P positive cells were mostly lymphocytes, while most of the NK-1R positive cells were mast cells. NK-1R immunoreactivity was also seen as a reticular pattern in the upper part of the epidermis of involved skin in the majority of the patients. Low cortisol ratios in the patients, being an indicator of chronic stress, were correlated to an increased number of substance P- and NK-1R positive inflammatory cells in noninvolved psoriatic skin, and higher cortisol ratios to the presence of keratinocyte NK-1R immunoreactivity in involved skin. The degree of pruritus could not be correlated to the number of substance P positive fibers nor cells. Nonneuronal substance P and its receptor NK-1 might have a role in psoriasis, also during chronic stress.     

长脉冲1064nm Nd:YAG激光治疗兔耳增生性瘢痕的实验研究

目的 通过建立兔耳增生性瘢痕模型,评价长脉冲1064 nm激光治疗增生性瘢痕的疗效.方法 选用新西兰长耳白兔10只,雌雄各半,体质量2.0～2.5 kg.在所有兔耳腹侧面建立增生性瘢痕模型,每只兔耳4处1.5 cm x 1.5 cm正方形造模.10只兔子共80个创面形成增生性瘢痕74处,将左侧和右侧兔耳增生性瘢痕块分为对照组和治疗组,治疗组应用长脉冲1064 nm激光照射,对照组未予治疗.30 d后观察实验组及对照组瘢痕的颜色、质地;彩色超声测量瘢痕厚度;瘢痕取材,HE染色和CD31免疫组化染色,记数瘢痕成纤维细胞密度和微血管密度;Masson染色观察胶原纤维.结果 激光治疗组较对照组瘢痕颜色变浅,质地变柔软,瘢痕厚度变薄,对照组搬痕的平均厚度为3.089 mill,治疗组为2.137 mm,两组比较,t=5.72,P<0.01.对照组血管密度均值为68.056个/mm2,治疗组为38.333个/mm2,两组比较,t=4.93,P<0.01,治疗组血管密度较对照组明显降低.成纤维细胞数量均值对照组为355.000个/mm2,治疗组为166.940个/mm2,两组比较,t=13.36,P<0.01,治疗组成纤维细胞数量明显减少.Masson染色观察对照组胶原纤维排列紊乱,治疗组胶原纤维排列疏松,规则.结论 长脉冲1064 nm激光可以促进早期增生性瘢痕消退,对瘢痕增生具有抑制作用.

Abstract：

Objective To evaluate the therapeutic effect of long-pulsed Nd:YAG 1064 laser on hyperplastic scars by using a rabbit ear model.Methods Five female and five male New Zealand long-ear white rabbits weighting 2.0-2.5 kg were used in this experiment.Four square full-thickness skin wounds sized 1.5 cm x1.5 cm were created on the ventral surface of each ear to develop a model of hyperplastic scar.Finally,a total of 74 hyperplastic scars developed on the 80 wounds,and the scars on the left and right ears served as the control (unirradiated) and treatment (irradiated with long-pulsed 1064 nm Nd:YAG laser) group,respectively.After 30 days of irradiation,the color and texture of scars were observed and the scar thickness was measured by color Doppler ultrasonogTaphy.Then,the scars were harvested followed by the analysis of density of fibroblasts and microvessels as well as the changes in collagen fibers in scars by HE staining,CD31 staining and Masson staining,respectively.Results A decrease was observed in the color,hardness and thickness of scars in the irradiated ears compared with the unirradiated ears.The average thickness of scars,microvessel density and fibroblast density in scars were significantly lower in the treatment group than in the control group(2.137vs.3.089 am,t=5.72,P<0.01;38.333/mm2vs.68.056/mm2,t=4.93,P<0.01;166.940/mm2vs.355.000/mm2,t=13.36.P<0.01).Masson staining revealed a disorganized arrangement of collagen fibers in the control group but a sparse and regular alignment in the treatment group.Conclusion Long-pulsed 1064 nm Nd:YAG laser may promote the shrinkage and suppress the hyperplasia of scars.     

磷酸化NF-κB亚基P65介导化学性缺氧诱导的HaCaT细胞炎症损伤

目的 探讨核因子-κB(NF-κB)亚基P65磷酸化是否参与化学性缺氧模拟剂氯化钴(CoCl2)诱导的永生化人皮肤角质形成细胞(HaCaT)毒性作用及炎症反应.方法 用2 mmol/L CoCl2处理HaCaT细胞,建立化学性缺氧诱导HaCaT细胞损伤的体外模型.RNA干扰法下调NF-κB亚基P65的表达.细胞计数试剂盒-8比色法检测细胞存活率;ELISA法检测培养基中IL-6和IL-8的含量;Western印迹法检测总量P65及磷酸化P65的蛋白表达.结果 CoCl2处理HaCaT细胞0～4 h,可促进NF-κB亚基P65的磷酸化,在0.5 h时P65亚基开始磷酸化,1.5 h时P65亚基的磷酸化水平达到高峰,约为对照组的6.6倍,而4 h基本恢复到正常水平.CoCl2处理HaCaT细胞0～6 h,可时间依赖性地降低细胞活力,2、4和6 h的细胞存活率与对照组比较,P值分别＜0.05、＜0.01及＜0.01.CoCl2处理6 h,还引起IL-6和IL-8的释放显著增加.RNA干扰法下调P65的表达后,CoCl2处理引起的HaCaT细胞毒性作用被明显减弱,即使细胞存活率升高了11%左右,下调P65表达还明显抑制了CoCl2处理引起的IL-6和Il-8释放增多.结论 磷酸化NF-κB亚基P65介导CoCl2诱导的HaCaT细胞毒性及炎症反应.

Abstract：

Objective To explore whether the phosphorylation of NF-κB P65 subunit is involved in the cytotoxicity to and inflammation in an immortal human keratinocyte cell line HaCaT during cobalt chloride (CoCl2-induced chemical hypoxia. Methods HaCaT cells were treated with CoCl2 of 2 mmol/L to set up a chemical hypoxia-induced cell model of injury. Then, RNA interference was used to down-regulate the expression of P65 in CoCl2-induced HaCaT cells. After additional culture, cell viability was tested by cell counting kit8 (CCK-8), the levels of interleukin 6 (IL-6) and interleukin 8 (IL-8) were detected by ELISA kits, phosphorylated and total P65 protein was measured by Western blot. Results The exposure of HaCaT cells to 2 mmol/L CoCl2 for 0 to 4 hours enhanced the phosphorylation of P65, which began at 0.5 hour, peaked at 1.5 hours, and restored to the normal level at 4 hours, and the level of P65 phosphorylation was about 6.6 times that in the untreated control group. The CoCl2 of 2 mmol/L decreased the cell viability of HaCaT cells in a time dependent manner, and a significant difference was observed in the viability of HaCaT cells between CoCl2-treated and untreated HaCaT cells at 2, 4, and 6 hours (P ＜ 0.05, 0.01, 0.01 ). The release of IL-6 and IL-8 from HaCaT cells was also promoted by CoCl2 treatment. The knockdown of P65 expression with siRNA markedly suppressed the CoCl2-induced cytotoxicity to and increase in the release of IL-6 and IL-8 from HaCaT cells,despite of an increment in cell viability by about 11%. Conclusion The phosphorylated P65 subunit mediates CoCl2-induced cytotoxicity and inflammatory injury to HaCaT cells.     

Analysis of common side effects of isotretinoin

Patients with severe recalcitrant nodular acne that is unresponsive to conventional therapy (including topical and systemic antibiotics) have few alternative effective treatment modalities other than the use of oral isotretinoin (Accutane). The cause of acne vulgaris is multifactorial, but the pathogenesis of this disorder of the pilosebaceous follicles arises mainly from endogenous factors. It is usually, but not always, associated with the onset of puberty. Severe acne, defined by the prevalence of facial and truncal inflammatory lesions, is a disfiguring disease that can often result in significant permanent scarring after the healing of deep inflammatory lesions and other disorders, such as systemic bacterial infections. Topical treatments are considered as the first line of therapy for less severe forms of acne, although systemic treatments such as antibiotics or antiandrogen agents are effective for either mild or moderate forms and sometimes effective for severe acne. However, in many patients with large numbers of nodules, longer treatment periods with these agents are required to reduce the count of inflammatory lesions. It has become increasingly evident that (because topical agents and antibiotic or antiandrogenic therapy have a slow onset of action) even mild or moderate acne that is treated in this way can result in scarring. In addition, the excessive use of systemic antibiotics has led to the detection of increasing numbers of antibiotic-resistant bacteria on the skin of patients with acne.(1) Therefore, because of its relatively rapid onset of action and its high efficacy with reducing more than 90% of the most severe inflammatory lesions, Accutane has a role as an effective treatment in patients with severe acne that is recalcitrant to other therapies.     

Parameters of cellular and humoral immunity in patients with severe acne

Severe forms of acne, characterized by predominance of inflammatory reactions and persistence of the disease for years, still present therapeutic problems. The purpose of our study was to investigate the role of the immune system in severe persisting forms of acne by means of determination of cellular and humoral immunobiological parameters. The study was performed on 52 patients (47 males and 5 females) having suffered from severe acne for six years on an average, including papulopustular acne grade IV resistant to therapy, nodulocystic acne, conglobate acne, and acne tetrade. The results were compared with those of 52 healthy controls of the same age showing no inflammatory diseases, who were tested on the same day. In 56% of the acne patients, one or more parameters showed pathological values, while in nodulocystic and conglobate acne there were similar results with regard to cellular defects and acute phase reactants. The lymphocytic proliferation induced by mitogens was significantly decreased in 35% of the acne patients. We assume that the immunodeficiency observed in these patients may be mainly secondary; however, it may contribute to the perpetuance of the disease and its resistance to therapy.     

Therapeutic Considerations for Severe Nodular Acne

Severe nodular acne, defined as grade 4 or 5 acne on the Investigator's Static Global Assessment scale, is a skin condition characterized by intense erythema, inflammation, nodules, cysts, and scarring. Both the well known risk of physical scarring and the more recent recognition that acne can be a chronic, psychologically distressing disease with significant adverse effects on a patient's quality of life, have prompted earlier, more aggressive treatment with more effective medications, in the hope of preventing progression to more severe, nodular forms of the disease. Oral antibacterials, primarily tetracyclines, have long been the first-line therapy for severe nodular acne, which frequently remained refractory to therapy. However, concerns of antibacterial adverse effects, patient adherence, and antimicrobial resistance prompted the search for alternate therapies and combinations thereof in order to target the multifactorial pathogenesis of the disease. Isotretinoin, an oral retinoid introduced in 1982, has since become the gold standard therapy in severe acne and has revolutionized its treatment. Several adjunctive agents exist. Oral antibacterials are indicated as an alternative for patients with severe acne who cannot tolerate oral retinoids, or for whom a contraindication exists. In order to prevent bacterial resistance, antibacterials should always be used in combination with benzoyl peroxide, a nonantibiotic antimicrobial agent with anti-inflammatory activity. Topical retinoids are often added to this regimen. In women, hormonal agents, which include oral contraceptives, spironolactone, and oral corticosteroids, and, in Europe, cyproterone acetate, may be used as monotherapy or concomitantly with isotretinoin. For rapid treatment of inflammatory nodules, intralesional corticosteroids are effective. These treatment modalities have been studied, refined, and combined in novel ways in order to target the multifactorial pathogenesis of the disease, and in this article we review each of their roles.     

Akne im Kindesalter

Childhood acne has different clinical expressions which may be present from birth or manifest within the first weeks of life or after the third to sixth month of life. The condition may occur as a physiological phenomenon or may be pathological and require endocrinologic evaluation and treatment. It may be induced by drugs or ointments or due to intoxication. Severe courses with a tendency to scarring in childhood may be observed. Childhood acne may persist and develop into juvenile acne. It is likely that childhood acne may represent a risk factor for the development of severe acne in puberty.     

Childhood acne. Clinical expression, etiology, and relationship to juvenile acne

Childhood acne has different clinical expressions which may be present from birth or manifest within the first weeks of life or after the third to sixth month of life. The condition may occur as a physiological phenomenon or may be pathological and require endocrinologic evaluation and treatment. It may be induced by drugs or ointments or due to intoxication. Severe courses with a tendency to scarring in childhood may be observed. Childhood acne may persist and develop into juvenile acne. It is likely that childhood acne may represent a risk factor for the development of severe acne in puberty.     

Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial

Background  Inflammatory acne vulgaris is a very common condition, particularly in adolescents and young adults, and new effective and well-tolerated treatments are needed.
Objectives  To evaluate the efficacy and tolerability of methyl aminolaevulinate-based photodynamic therapy (MAL-PDT) in patients with moderate to severe facial acne vulgaris in a randomized, controlled and investigator-blinded trial.
Methods  Twenty-one patients were assigned to the treatment group and 15 patients to the control group. The treatment group received two MAL-PDT treatments, 2 weeks apart. Both groups were evaluated 4, 8 and 12 weeks after treatment. Efficacy evaluation included changes from baseline in numbers of noninflammatory and inflammatory lesions, changes from baseline in global acne severity grade and clinical assessments of clinical improvement by patient and evaluating dermatologist. Pain scores during treatment and local adverse effects were also evaluated.
Results  Twelve weeks after treatment the treatment group showed a 68% reduction from baseline in inflammatory lesions vs. no change in the control group ( P =  0·0023). We found no reduction in number of noninflammatory lesions after treatment. All patients experienced moderate to severe pain during treatment and developed severe erythema, pustular eruptions and epithelial exfoliation. Seven patients did not receive the second treatment due to adverse effects.
Conclusions  MAL-PDT proved to be an efficient treatment for inflammatory acne. The treatment was associated with severe pain during treatment and severe adverse effects after treatments. Efforts must be made to optimize the treatment regimen and to avoid adverse effects.     

Systemische Aknetherapie

The development of scarring in inflammatory acne may induce permanent disfigurement and considerable psychosocial impact on the lives of affected individuals. The early use of systemic acne therapy can help to prevent these unfortunate consequences. Antiinflammatory antibiotics such as tetracyclines are required in moderate to severe papulopustular acne. The recommended treatment duration is 3 months; combination with topical retinoids and benzoyl peroxide increases the speed and efficacy of lesion reduction and helps to prevent bacterial resistance. Oral isotretinoin is the treatment of choice in severe acne resistant to adequate conventional therapy. Hormonal treatment represents an alternative regimen for women with acne and is the first choice in late-onset acne and in those with clinical signs of hyperandrogenism.     

Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study

BACKGROUND: There is a need for alternative treatments for moderate to severe acne vulgaris. Preliminary experience suggests that topical methyl aminolaevulinate photodynamic therapy (MAL-PDT) may have potential. OBJECTIVES: To investigate the efficacy and tolerability of MAL-PDT for treatment of moderate inflammatory facial acne. PATIENTS/METHODS: Thirty patients aged 15-28 years with moderate to severe acne were included in a blinded, prospective, randomized, placebo-controlled multicentre study. Each side of each patient's face was randomly assigned to treatment with MAL (160 mg g1) or placebo cream, applied for 3 h prior to illumination. A second treatment was given 2 weeks later. On each occasion, patients assessed the intensity of pain using a 10-cm visual analogue scale. Inflammatory and noninflammatory acne lesions were counted at baseline and 4 and 10 weeks after the last PDT treatment. The investigator assessed the global severity of acne at baseline (seven patients had severe acne on at least one side of the face) and each study visit using a six-point rating scale. Data were analysed on an intention-to-treat basis, including all 30 patients. RESULTS: There was a statistically significant greater reduction in the total inflammatory lesion count with MAL-PDT compared with placebo PDT at week 12; median reduction 54% [95% confidence interval (CI) 35-64%] vs. 20% (95% CI 8-50%), P = 0.0006. MAL-PDT was associated with more pain than placebo PDT, although intensity varied across centres and was reduced with repeated treatment. Local adverse events were consistent with this treatment modality. CONCLUSIONS: MAL-PDT is effective in the treatment of moderate to severe inflammatory facial acne. Further studies are warranted to optimize this promising procedure.     

Unilateral sacroiliitis associated with systemic isotretinoin treatment

Background Acne fulminans is the most severe form of inflammatory acne characterized by the acute onset of inflammatory nodules and plaques, most commonly on the chest and the back. The lesions undergo rapid suppuration, leaving ragged hemorrhagic ulcers. Typically, it affects adolescent males with a history of mild to moderate acne. The affected patients often have constitutional symptoms such as fever, malaise, arthralgias, and myalgias. Leukocytosis is commonly associated. Sacroiliitis is reported in 21% of acne fulminans patients in association with arthritis and in a few cases it is reported during isotretinoin treatment, suggesting the drug triggering. Conclusion We report a case of a young male patient in whom the induction of acne fulminans by systemic isotretinoin was associated with unilateral sacroiliitis.     

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.