Effects of oral zinc and vitamin A in acne.

The effects of oral zinc sulfate (corresponding to 135 mg of zinc daily) alone and in combination with vitamin A (300,000 international units) daily on acne lesions have been compared with those of vitamin A alone and of a placebo. The number of comedones, papules, pustules, and infiltrates were counted at each visit. After four weeks, there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. The effect of zinc plus vitamin A was not better than zinc alone. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The mechanism for the effect of zinc therapy in acne, to our knowledge, is not presently known.?     

Meclosorb, a new topical antibiotic agent in the treatment of acne vulgaris: a double-blind clinical study

The clinical effect on acne vulgaris of topical treatment with meclocycline sulfosalicylate and systemic treatment with peroral tetracycline (500 mg daily) was compared in a double-blind study of 60 patients treated for 8 weeks. The reducing effect of Meclosorb cream and tetracycline tablets on the number of closed comedones, pustules, papules and cysts was marked and not significantly different. The effect of Meclosorb on open comedones was weak and of slow onset. No side effects were registered. Topical treatment with Meclosorb is an effective and safe alternative to systemic tetracycline treatment of acne vulgaris.     

5-氨基酮戊酸光动力疗法治疗寻常痤疮临床应用研究

目的 探索5-氨基酮戊酸光动力疗法(ALA-PDT)治疗寻常痤疮的ALA最适浓度和最佳敷药时间.方法 将30例中、重度寻常痤疮患者随机分为两组,第一组15例,给以10%ALA乳膏外敷,分别在不同时间点(1、2、3、4、5 h)和不同皮损进行原卟啉Ⅸ(PpⅨ)荧光光动力诊断和皮损组织PpⅨ荧光采集与定量分析;第二组15例,在每例患者的右侧面颊、左侧面颊、前额的痤疮皮损上分别给以3%、5%、10%ALA乳膏外敷3 h后进行PpⅨ荧光光动力诊断和荧光定量研究;同时对该组患者不同部位采用不同浓度ALA-PDT的疗效和不良反应进行临床研究.结果 第一组痤疮患者经10%ALA乳膏外敷,暗室环境下采用激发光源照射皮损后发现,炎性丘疹、脓疱和囊肿均显示PpⅨ强砖红色荧光;粉刺、炎性丘疹、脓疱和囊肿的PpⅨ荧光强度分别为1.3、4.3,5.1和5.8校准单位,PpⅨ荧光强度随着皮损严重程度的增加而增强;同时,随着外敷时间的延长,PpⅨ荧光强度逐渐增强,敷药3 h,4 h、5 h时PpⅨ荧光强度明显高于1 h和2 h(P<0.05).第二组患者不同部位采用3%、5%、10%ALA封包3 h,其相同皮损内PpⅨ荧光强度差异无统计学意义(P>0.05);分别以3%、5%、10%ALA乳膏外涂于15例患者右侧面颊、左侧面颊、前额部位,经过两次ALA-PDT治疗后,痊愈5例、显效6例,总有效率为73%;每例患者的不同部位皮损之间,疗效改善情况无明显差异.副作用表现为轻至中度的红斑、肿胀,严重时少许渗出,仅2例出现暂时性色素沉着,所有病例均未出现溃疡和瘢痕等严重不良反应.结论 ALA-PDT适用于以炎性丘疹、脓疱和囊肿为主要表现的寻常痤疮治疗,宜采用3%ALA浓度和3 h敷药时间.     

Oral zinc therapy of acne. Absorption and clinical effect.

In a double-blind controlled comparison that lasted eight weeks, tablets of zinc sulfate monohydrate, 411 mg total daily dosage, and a lactose placebo were administered orally to 22 male subjects with moderate acne. At the same time, levels of zinc were determined in serum and urine. There were no statistically significant differences in the lesion counts (papules, pustules, open comedones, and closed comedones) in the zinc-treated and lactose-treated cases, despite evidence in serum and urine of absorption of zinc. The data from this study indicate that oral zinc therapy has no early clinical effect on male patients with moderate acne.     

A clinical trial comparing the safety and efficacy of a topical erythromycin-zinc formulation with a topical clindamycin formulation

One hundred three patients with acne vulgaris were randomly designated to receive either a topical formulation of erythromycin plus zinc or a topical solution of 1% clindamycin phosphate (Cleocin-T). The patients treated themselves twice daily and were examined at 3, 6, 9, and 12 weeks after the start of therapy. By week 6 the overall severity grade was consistently lower and the percent reduction of severity, papules, pustules, and total comedones was higher in the erythromycin-zinc-treated group than in the clindamycin-treated group. In the 92 patients who completed this study (48 receiving erythromycin-zinc and 44 receiving clindamycin), no serious topical or systemic side effects were reported. Two patients, one from each treatment group, suffered mild irritation. One patient was withdrawn from the erythromycin-zinc-treated group. Results of patch tests were negative. The superiority of the erythromycin-zinc formulation may be due to the increased (4%) erythromycin concentration and/or the ability of 1.2% zinc acetate to enhance the product's activity.     

A 4% erythromycin and zinc combination (Zineryt®) versus 2% erythromycin (Eryderm®) in acne vulgaris: a randomized, double-blind comparative study

A double-blind, randomized multi-centre study was performed to evaluate the efficacy of a 4% erythromycin and zinc combination (Zineryt) versus 2% erythromycin (Eryderm). One-hundred and twenty-two patients suffering from acne vulgaris were treated with either Zineryt lotion or 2% erythromycin lotion. Acne grading and lesion counts for comedones, papules, pustules, nodules and macules were performed at each visit at 0, 1, 2, 4, 8 and 12 weeks. Treatment with Zineryt lotion was found to be more effective than with 2% erythromycin as regards the reduction in number of the acne lesions and the severity grade of the acne.     

Clinical efficacy and safety of a topical combination of retinaldehyde 0.1% with erythromycin 4% in acne vulgaris

The objective of this randomized, controlled, multicentre study was to assess the efficacy and safety of a topically applied retinaldehyde 0.1% gel in combination with a topical erythromycin 4% lotion for the treatment of acne vulgaris. Treatment consisted of applying either retinaldehyde or its vehicle every morning and erythromycin every evening for 8 weeks. Efficacy parameters were sequential lesion counts for papules and pustules, and a 6-point semiquantitative scale for comedones and microcysts. Safety parameters were local tolerance and adverse events. Of 74 recruited patients, 73 were appraisable for efficacy and safety. In both treatment groups, papules and pustules were reduced significantly at the end of treatment (P < 0.001), and no statistical difference was observed between the groups. Comedones and microcysts were significantly improved with retinaldehyde combined with erythromycin (P = 0.005), but not with erythromycin alone. However, no statistical difference between the groups could be demonstrated (test power, 50%). Local tolerance of the combined treatment group was very satisfactory, as only a few patients experienced local irritation. In conclusion, retinaldehyde combined with erythromycin appears to be a valuable topical therapy in polymorphic acne.     

Oral zinc sulphate therapy in acne vulgaris: a double-blind trial

The effect of zinc sulphate and placebo was compared in a double-blind trial in 56 patients suffering from acne vulgaris. Serum vitamin A levels were studied in all, before and at the end of therapy, 29 patients received zinc sulphate 600 mg daily and 27 patients received placebo. Patients on placebo showed no improvement. After 12 weeks of treatment with zinc sulphate, 17 patients (58%) showed significant improvement. There was a statistically significant decrease in the number of papules, infiltrates and cysts. In zinc-treated cases there was statistically significant increase in serum vitamin A levels, while no change was found in the placebo group.     

Efficacy of low-dose cyproterone acetate compared with minocycline in the treatment of acne vulgaris

A multi-centre controlled trial of low-dose cyproterone acetate (Diane®, Schering Health t are Ltd) compared with minocycline hydrochloride (Minocin®, Lederle Laboratories Ltd) in female patients with acne vulgaris has been undertaken. Seventy-eight patients completed the study. Over a 24-week treatment period, Diane and Minocin were found to be equally effective in reducing the lesion count for comedones, papules and pustules, and in the patients' subjective assessment of their skin. No significant changes in weight or blood pressure were found in either treatment group, and the number of patients reporting; side-effects was similar.     

Pulsed dye laser treatment of acne. Study of clinical efficacy and mechanism of action

IntroductionAcne vulgaris is a multifactorial disease of the pilosebaceous unit characterized by the development of inflammatory (papules, pustules, cysts) and/or non inflammatory lesions (open and closed comedones) that may progress to scars. The increase of bacterial resistances, adverse effects and teratogenicity of retinoids and lack of response to usual therapies have led to investigate new therapeutic alternatives for acne.Material and methodWe studied 36 patients with mild to moderate acne vulgaris. We performed treatment every 4 weeks using pulsed dye laser therapy with a wavelength of 585 nm and pulse duration of 350 microseconds.ResultsAt twelve weeks of treatment a decrease of 27 % of non inflammatory lesions and of 57 % of active lesions was observed. Treatment was well tolerated and considered positive, in terms of healing, in 25 patients.ConclusionsPulse dye laser therapy mainly improves inflammatory lesions of acne with few adverse effects.     

Demonstration of polarizable crystals in fresh comedonal extracts: sebum crystallizes

Previous studies using paraffin-embedded sections showed the presence of varying degrees of lipidic calculus (sebolith) formation in the pilosebaceous duct in acne comedonal lesions. The objective of this study was to examine the content of fresh acne comedonal extracts and pustules in polarizable crystalline material. Furthermore, to investigate if the amount of crystalline material correlates with the morphology, evolutionary stage, age and location of the comedone we performed polariscopic examination of 20 fresh acne comedonal extracts and 6 acne pustules. As controls, we used extracts from solar comedones, milia and epidermal inclusion cysts, follicular extracts from acne rosacea lesions, pustules of bacterial folliculitis and extracts from normal follicles from acne-prone individuals. The vast majority of acne comedones contained considerable amounts of polarizable crystalline material. Crystallization was more prominent in closed comedones, long-standing macrocomedones and conglobate comedones. Crystal formation was seen less commonly (p < 0.01) in solar comedones, milia and epidermal inclusion cysts. As shown in this study, crystallization of sebum is a common element of comedogenesis and may possibly contribute to comedo preservation.     

Water-based versus alcohol-based benzoyl peroxide preparations in the treatment of acne vulgaris

Forty-eight patients with acne vulgaris in the face were treated with a water-based (Basiron) and an alcohol-based (Panoxyl) 5% benzoyl peroxide preparation. A randomized double-blind, contralateral study was used. No difference in clinical effect was found. Treatment for 8 weeks resulted in at least 50% reduction in the number of closed comedones, papules and pustules in over 80% of the patients. In more than 70% of the patients, the reduction exceeded 75%. The water-based Basiron caused significantly less skin irritation than the alcohol-based preparation of Panoxyl.     

异维A酸红霉素凝胶治疗寻常痤疮的多中心随机对照临床研究

目的 比较异维A酸红霉素凝胶与阿达帕林凝胶治疗轻中度寻常痤疮的疗效和安全性。方法 多中心、开放、随机、平行对照研究。按照中国痤疮治疗指南痤疮严重程度标准入选轻、中度（Ⅰ ~ Ⅲ级）寻常痤疮患者192例,纳入疗效分析169例,安全性分析190例。试验组86例,外用异维A酸红霉素凝胶;对照组83例,外用阿达帕林凝胶,均为每晚1次,共用药6周。在基线、治疗2、4和6周时分别记录患者白头粉刺、黑头粉刺、炎性丘疹、脓疱数,评价各时间点患者痤疮严重程度,同时记录皮肤局部耐受性以及其他不良反应。结果 随着治疗时间延长,两组的有效率逐渐提高,总体病情严重程度改善。在治疗6周时,试验组总有效率为51.16%,对照组为40.96%,两组差异无统计学意义（P > 0.05）;但在治疗4周及6周时,试验组患者脓疱及炎性皮损的疗效优于对照组（P < 0.05）,同时试验组痤疮分级较对照组低（P < 0.01）。两组不良反应类似,均表现为局部刺激,可耐受。结论 异维A酸红霉素凝胶治疗轻、中度寻常痤疮总有效率与阿达帕林凝胶类似,对于炎性损害疗效优于阿达帕林凝胶,并且对患者总体严重程度降低更快。     

Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne.

BACKGROUND/AIMS: The primary aim of the study was to establish the clinical efficacy and safety of a combined treatment consisting of topical 20% azelaic acid (AA) cream and the oral antibiotic minocycline in the therapy of severe inflammatory acne (nodular papulopustular acne and acne conglobata) in a comparison with oral isotretinoin therapy. The secondary aim was to establish the value of AA cream as maintenance therapy in the prevention of recurrent acne. METHODS: This open-label but randomised study involved 85 patients with nodular papulopustular acne or acne conglobata (Leeds grading scale > 4) who were treated for 6 months. In an immediately subsequent 3-month second phase, eligible patients from the initial combination group used the AA cream as maintenance therapy, while the eligible patients from the isotretinoin group served as untreated control. RESULTS: A 6-month course of treatment with topical 20% AA cream plus oral minocycline in 50 patients proved to be effective in nodular forms of acne (median reduction of facial comedones: 70%; of papules and pustules: 88%; of deep inflammatory acne lesions: 100%). Overall, the combined treatment was not quite as effective as treatment with oral isotretinoin (35 patients; reduction of comedones: 83%; of papules and pustules: 97%; of deep inflammatory acne lesions: 100%). In the 3-month maintenance therapy phase, about half of the patients who received AA monotherapy maintained the very good facial result achieved by the end of phase I. A similar rate was found in the patients of the isotretinoin group, who received no further active acne treatment. In the other 50% of patients, differences existed between the groups as regards the degree of deterioration: Marked deterioration occurred more frequently under AA treatment, while only slight deterioration was more frequent in the isotretinoin group. The combination was tolerated much better than isotretinoin. The incidence of local side effects observed under the combination of AA and minocycline (36.5%, mainly transient burning and itching of mild or moderate intensity) was considerably lower than that seen with isotretinoin (65.7%). The rate of local side effects of marked intensity observed under the combination, i.e. 6%, was well within the range of 5-10% previously reported for AA. The incidence of systemic side effects was lower (8%, mainly gastrointestinal symptoms) under the combined therapy than under isotretinoin (14.3%). CONCLUSION: The combination of topical 20% AA cream and oral minocycline is an highly effective treatment in severe forms of acne. It is better tolerated and associated with fewer risks than oral isotretinoin - in particular, there is no risk of teratogenicity. The combination can be regarded as a valuable alternative in patients for whom isotretinoin is not indicated, who do not wish to use or can not tolerate isotretinoin therapy and particularly in female acne patients of child-bearing potential. Topical 20% AA cream can be used successfully as maintenance therapy to prolong the recurrence-free interval.     

The retinoic acid derivative Ro 11-1430 in Acne vulgaris. A controlled multicenter trial against retinoic acid.

In a double-blind controlled multicenter trial consisting of 257 patients with acne vulgaris an 8-week topical treatment with the retinoic acid derivative Ro 11-1430 (0.1% lotion) was compared with vitamin A acid (0.05% lotion) and the lotion alone (placebo). In reducing the number of comedones vitamin A acid was superior to Ro 11-1430, which was significantly better than placebo. The reduction in number of papules and pustules was not statistically significant on either treatment. Local side effects, i.e. erythema, desquamation, burning and pruritus occurred more frequently and were more severe on vitamin A acid than on Ro 11-1430 and placebo which did not differ. No correlation was found between incidence and severity of local reactions and therapeutic effect.     

Radiogene Akne

Radiation-induced acne is a rare, clinically and pathogenetically ill-defined acneiform dermatosis with special features that may occur in irradiated skin areas especially after high doses of deeply penetrating radiation. We report on a patient with an oropharyngeal carcinoma who developed severe radiation-induced acne including comedones and cysts as well as few inflammatory papules and pustules in a skin area irradiated with up to 63 gray of a 6 MeV photon beam. Acnegenic drugs may precipitate the disease; our patient was on longterm therapy with carbamazepine whose acnegenic potency is less well documented than that of testosterone or glucocorticoids. Treatment of radiation-induced acne is comedolytic; topical retinoids are especially valuable.     

Most common patterns of acne in male adolescents: a population‐based study

Background Acne vulgaris is a common skin disease affecting more than 85% of adolescents and often continuing into adulthood. Population‐based studies to assess the patterns and severity of acne have not been achieved. Objectives The aim of this study was to assess the most common patterns of facial and trunk acne in young (18‐year‐old) men in a representative sample of male adolescents in a city in southern Brazil and to investigate the severity of inflammatory and non‐inflammatory lesions in these individuals. Methods In Brazil, military service is compulsory for all males. Every adolescent male must report to his military service headquarters to submit to a medical screening examination. The study included 2201 adolescents, each of whom underwent a skin examination conducted by a dermatologist to identify and quantify all non‐inflammatory (comedones) and inflammatory (papules, pustules, and nodules) lesions. Results Non‐inflammatory lesions (comedones) were observed on 1487 individuals, and inflammatory lesions (papules and pustules) were noted on 1497 individuals. The most common patterns of facial acne were the full‐face, bilateral malar and frontal mentonian distributions. Conclusions This is the first population‐based study to evaluate patterns of acne. Facial involvement was very prevalent, and the frontal region was found to dominate patterns of distribution of acne vulgaris. Comedonian acne of the face was much more intense and affected the entire face. In inflammatory facial acne, the majority of the study subjects exhibited up to five lesions in the region under study.     

Guidelines for treating acne

Acne, a chronic inflammatory disease of the pilosebaceous units of the face, neck, chest, and back, is the most common skin disorder occurring universally, with an estimated prevalence of 70-87%.(1) It is a pleomorphic disorder characterized by both inflammatory (papules, pustules, nodules) and noninflammatory (comedones, open and closed) lesions. Grading of acne is mandatory to determine the appropriate therapeutic strategy. Mild acne can be purely comedonal or mild papulopustular, with a few papulopustules present as well.(2) Moderate acne is characterized by numerous comedones, few to many pustules, and few small nodules, with no residual scarring.(2) In severe acne papulopustules are numerous, many nodules can be detected, inflammation is marked, and scarring is present.(2) Very severe acne can be recognized by sinus tracts, grouped comedones, many deeply located nodules, and severe inflammation and scarring.(2) Although acne does not affect health overall, its impact on emotional well-being and function can be critical and is often associated with depression, anxiety, and higher-than-average unemployment rates.(3) Effective treatment can dramatically improve a person's quality of life.     

Folliculotropic mycosis fungoides. Study of four cases

Folliculotropic mycosis fungoides is a variant of mycosis fungoides characterized by the presence of folliculotropic infiltrates, often with sparing of the epidermis, and preferential involvement of the head and neck. We report our experience with four cases of folliculotropic mycosis fungoides followed in our department in the last years. There are four patients (three men and one woman) aged 45 to 68 years. Clinically the lesions presented as cysts, comedones, follicular papules and plaques with follicular plugging. The histopathological study showed a peri and intrafollicular infiltrate with partial or total sparing of the epidermis. This infiltrate was mainly composed of atypical lymphocytes. Some cystic formations were also observed. Three cases showed mucin deposits and one showed syringotropism. The immunohistochemical analysis was positive for CD3, CD5 and CD4. All patients received different treatments based on the stage of their disease. One of them died of septic shock and the rest showed partial responses and frequent relapses.     

Randomized controlled study of a cosmetic treatment for mild acne

Background. Cosmetic products are not tested with the same rigour as medical treatments, but recent high‐quality studies have shown significant reductions in changes of skin ageing with use of cosmetic antiageing products. Aim. To test whether a cosmetic ‘anti‐spot’ two‐step treatment containing a complex of seaweed‐derived oligosaccharide and zinc would produce a significant improvement in mild acne. Methods. A double‐blind, vehicle‐controlled trial of this treatment was performed for 8 weeks on 60 age‐matched participants with mild acne. They were divided into two groups: 30 participants were treated with vehicle control and 30 with the active treatment containing a seaweed‐derived oligosaccharide complexed with 0.1% zinc pyrrolidone. Results. After 8 weeks, both groups had a reduction in comedones, papules and pustules, and this was significantly greater in the active than control group at 2, 4 and 8 weeks. Conclusions. Cosmetic products may offer some benefit for mild acne and still meet the requirements of the European Cosmetic Directive. In particular, the seaweed‐derived oligosaccharide complexed with 0.1% zinc pyrrolidone used in this study produced a significant reduction in acne vs. a control treatment. Cosmetic companies should conduct blinded controlled trials of their product’s efficacy and publish the results.