Increased in situ expression of melanocortin-1 receptor in sebaceous glands of lesional skin of patients with acne vulgaris

Central or peripheral stress may induce the development of clinical inflammation in the pilosebaceous unit, leading to the development of acne lesions or to exacerbation of pre-existing acne. Melanocortin peptides such as alpha-melanocyte-stimulating hormone and its receptors do not only regulate melanogenesis but can also affect non-pigmentary processes, such as inflammation, apoptosis and sebogenesis. The purpose of the study was to investigate by immunohistochemistry if changes of melanocortin-1 receptor expression exist in acne lesions versus normal skin. In all, 33 patients with acne vulgaris and seven age-matched volunteers without acne participated in the study. Skin biopsies were taken from acne-involved faces, the non-involved thigh skin of the same patients and from normal human skin. Melanocortin-1 receptor immunoreactivity was most prominently detectable in adnexal structures. Sebocytes and keratinocytes of the ductus seboglandularis of acne-involved and non-involved skin showed very intense melanocortin-1 receptor expression in contrast to less intense scattered immunoreactivity in normal skin samples. These data suggest that melanocortin-1 receptor is involved in the pathogenesis of acne.     

Androgen action on human skin – from basic research to clinical significance

Abstract:  Androgens affect several functions of the human skin, such as sebaceous gland growth and differentiation, hair growth, epidermal barrier homeostasis and wound healing. Their effects are mediated by binding to nuclear androgen receptors. Androgen activation and deactivation are mainly intracellular events. They differ from cell type to cell type and between cells at different locations. The major circulating androgens, dehydroepiandrosterone sulfate and androstenedione, are predominantly produced in the adrenal glands, and testosterone and 5α-dihydrotestosterone are mainly synthesized in the gonads. Testosterone in women and 5α-dihydrotestosterone in both genders are also synthesized in the skin. Skin cells express all androgen metabolizing enzymes required for the independent cutaneous synthesis of androgens and the development of hyperandrogenism-associated conditions and diseases, such as seborrhea, acne, hirsutism and androgenetic alopecia. The major thrust of drug design for the treatment of androgen-associated disorders has been directed against several levels of androgen function and metabolism. Partial effectiveness has only been achieved either by androgen depletion, inhibition of androgen metabolism or blockade of the androgen receptor.     

The biological actions of estrogens on skin

There is still extensive disparity in our understanding of how estrogens exert their actions, particularly in non-reproductive tissues such as the skin. Although it has been recognized for some time that estrogens have significant effects on many aspects of skin physiology and pathophysiology, studies on estrogen action in skin have been limited. However, estrogens clearly have an important function in many components of human skin including the epidermis, dermis, vasculature, hair follicle and the sebaceous, eccrine and apocrine glands, having significant roles in skin aging, pigmentation, hair growth, sebum production and skin cancer. The recent discovery of a second intracellular estrogen receptor (ERbeta) with different cell-specific roles to the classic estrogen receptor (ERalpha), and the identification of cell surface estrogen receptors, has provided further challenges to understanding the mechanism of estrogen action. It is now time to readdress many of the outstanding questions regarding the role of estrogens in skin and improve our understanding of the physiology and interaction of steroid hormones and their receptors in human skin. Not only will this lead to a better understanding of estrogen action, but may also provide a basis for further interventions in pathological processes that involve dysregulation of estrogen action.     

饮食与生活习惯对痤疮发病的影响

目的：确定痤疮发病的危险因素,为干预痤疮的发生和发展提供依据。方法：我科对门诊300例痤疮患者进行了饮食及生活习惯问卷调查,用SPSS17.0软件分析与痤疮发病的危险因素。结果：多因素logistic回归分析,病例组的睡眠不规律比例比对照组高,差异具有统计学意义(P <0.05), 其OR值为1.979>1;病例组食用辛辣食品、甜食等饮食因素的比例较对照组高,但差异无统计学意义(P＞0.05)。结论：未发现饮食因素对痤疮的发病有影响,睡眠不规律可能是痤疮发病的独立危险因素。     

几种常见皮肤病和性病患者生活质量的研究

目的：研究湿疹、痤疮和非淋菌性尿道炎（NGU）对患者生活质量的影响。方法：采用皮肤病生活质量指数（DLQI）研究湿疹、痤疮和NGU患者的生活质量及其影响因素。结果：湿疹的DLQI值明显高于痤疮和NGU（P=0．001）。女性湿疹的DLQI值明显高于男性，未婚者的DLQI值高于已婚者，暴露部位受累者的DLQI值高于未受累者；男性痤疮患者的DLQI高于女性（P〈0．05）；男性NGU患者的DLQI值明显高于女性（P=0．003）。DLQI和EASI以及痤疮严重程度显著正相关（r=0．813，r=0．884；P〈0．001）。结论：湿疹对患者生活质量的影响较痤疮和NGU大，NGU对患者生活质量的影响与痤疮相当。     

The impact of psoriasis on quality of life

Psoriasis is a chronic inflammatory skin disease in which the signs vary from one patient to another and over time. Traditionally, physicians have used various parameters to assess the severity of the disease: percentage of body surface area covered, erythema, plaque thickness, degree of scaling and systemic symptoms such as arthritis. However, these clinical assessments alone do not accurately reflect the overall effect of the disease on patients' daily activities. Apart from the clinical severity of affected areas, psoriasis can also have a profound psychosocial impact on the patient's quality of life. This concept is multidimensional, encompassing the physical, social and psychological wellbeing of the person and is based on the patient's view of their condition.     

The impact of acne on quality of life

Optimal acne therapy must take into account not only acne type and severity, but also the impact of this skin disorder on the patients quality of life. Several validated instruments have been used to measure quality of life in acne patients. By using these instruments, acne patients have been shown to experience levels of social, psychological and emotional distress similar to those reported in patients with asthma, epilepsy and diabetes. Several studies have demonstrated that the disability caused by acne can be mitigated by effective therapy.     

The Skindex instruments to measure the effects of skin disease on quality of life

Skindex-29 and Skindex-16 are validated measures of the effects of skin diseases on patients' quality of life. This article reviews the development of both versions of Skindex, discusses their measurement properties and interpretability, and gives examples of how they have been used and adapted for dermatologic research internationally. Studies of quality of life in patients with nonmelanoma skin cancer are described to illustrate the use of Skindex to understand quality of life and to compare effectiveness of different treatments for this highly prevalent condition.     

Effects of skin care and makeup under instructions from dermatologists on the quality of life of female patients with acne vulgaris

Acne vulgaris significantly affects patients' quality of life (QOL) and their lives in various ways, including social behavior and body dissatisfaction. This may be heightened by acne's typical involvement of the face. We investigated whether the use of skin care and makeup could influence the QOL of affected patients without deteriorating conventional acne treatments. Fifty female patients with acne were recruited for our study. Twenty-five patients were instructed how to use skin care and cosmetics, while 25 patients received no specific instructions from dermatologists. Both groups received conventional topical and/or oral medication for acne during the study period for 4 weeks. Both groups did not show any significant difference in clinical improvement of acne severity. Two validated QOL questionnaires, World Health Organization (WHO)QOL26 and the Dermatology Life Quality Index (DLQI) were administered to all patients at first visit and 4 weeks later. The mean scores of psychological and overall domains in WHOQOL26 for patients with instructions were improved significantly, while only the overall score was significantly improved for patients without instructions. The total mean scores and all domains except work/school in DLQI for patients with instructions were improved significantly, while the total scores and all domains except discomfort for treatment in DLQI were significantly improved for patients without instructions. Thus, instructions on the use of skin care and cosmetics for female acne patients did not deteriorate acne treatment and influenced patients' QOL effectively. We therefore suggest that instructions for using skin care and cosmetics complement conventional medical treatments for acne.     

Effects of oral antibiotic roxithromycin on quality of life in acne patients

Macrolides are effective for inflammatory acne, but there are not many studies on roxithromycin. In this study, patients with acne were surveyed for improvement of their quality of life after treatment with roxithromycin. Patients were orally given roxithromycin 300 mg daily for 2–4 weeks. At the time of pre- and post-treatment, the dermatologists graded the severity of acne symptoms, and the patients answered questionnaires. In 123 half faces of 76 patients, 80 half faces were improved, 42 half faces were not changed, and one half face was deteriorated. The score of "symptom and feeling" and "leisure" in DLQI-J and "emotions" and "symptoms" in Skindex-29-J were significantly decreased after roxithromycin treatment. Roxithromycin has a therapeutic effect on inflammatory acne and leads to improvement of quality of life in the patients.     

Effect of standard medication on quality of life of patients with atopic dermatitis

Patients with atopic dermatitis present with debilitating symptoms, including pruritus and subsequent excoriation, which significantly reduces their quality of life (QOL). At present, the standard therapy for atopic dermatitis constitutes a topical steroid and/or a topical immunomodulator, an emollient and an oral antihistamine, although few studies have reported the effect of this treatment regimen on QOL. The current study aimed to verify the efficacy of the standard therapy for both clinical symptom severity and patient QOL, assessed using the validated Skindex-16 questionnaire. Atopic dermatitis patients receiving the standard therapy (n=771) were enrolled in the current phase IV, multicenter, 12-week, open-label study. The Rajka and Langeland scale (used to rate the severity of atopic dermatitis symptoms) and the Skindex-16 QOL questionnaire were completed at weeks 0 (baseline), 4 and 12. Of 415 patients completing the questionnaire at all time points (per-protocol population), 95.2% were prescribed the antihistamine fexofenadine HCl 60 mg. There were significant improvements in symptoms, emotions and functioning scale scores at weeks 4 and 12 compared with baseline (P<0.005). Discomfort associated with itching, as assessed by item 1 on the Skindex-16, improved over the treatment period (score decreased by >or=1 and >or=2 in 75.2% and 50.9% of patients, respectively). Significant (P<0.005) improvements from baseline in global scores were also observed at weeks 4 and 12, and for week 12 compared with week 4. Severity scores improved significantly (P<0.005) from weeks 0-4 and from weeks 4-12. The standard therapy was generally well tolerated with only mild adverse events reported (0.5%). These data suggest that patients with atopic dermatitis and associated pruritus experience significant improvements in both symptom severity and QOL when receiving standard therapy.