Hormonal Profiles and Prevalence of Polycystic Ovary Syndrome in Women with Acne

One of the important etiologic factors in acne is an increase in sebaceous gland activity, which is androgen dependent. Acne is a common manifestation of hyperandrogenemia. Therefore, acne may not only cause cosmetic concern but may also be a sign of underlying disease. In females, the most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS). The purpose of this study was to determine the hormonal profiles of women with acne and the prevalence of PCOS in women attending the dermatological clinic with acne problems. The diagnostic criteria of PCOS were clinical findings of menstrual disturbances and hyperandrogenism (acne, seborrhea, hirsutism), pelvic ultrasound imaging of PCO (multiple subcapsular ovarian cysts 2–8 mm. in diameter, with dense echogenic stroma), and an elevated luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. There were 51 women with acne; 20 regularly menstruating volunteers without acne served as a control group. PCOS was found in 19 out of 51 patients with acne (37.3%) and none of the control group. Twenty acne patients had abnormal menstruation (39.2%). Acne cases had higher mean levels of serum total testosterone (T), free T, dehydroepiandrosterone sulfate (DHEAS) and prolactin (PRL). No statistically significant difference was observed for LH, FSH or sex hormone binding globulin (SHBG). Because of this high prevalence of PCOS in women with acne, all women presenting with acne should be asked about their menstrual pattern and examined for other signs of hyperandrogenemia. Hormonal profile determination as well as pelvic ultrasonography for ovarian visualization should be performed to confirm the diagnosis of PCOS in female acne patients who have menstrual disturbances.     

Ovarian morphology and prevalence of polycystic ovary syndrome in reproductive aged women with or without mild acne

Background Acne and hirsutism are common manifestations of hyperandrogenemia. They may also be a sign of underlying severe diseases. Aim To compare ovarian morphology and prevalence of polycystic ovary syndrome (PCOS) in reproductive aged women with or without mild acne and hirsutism. Methods 52 women with mild acne and 59 age‐matched controls were included in this study. Main outcome measures were the prevalence of PCOS, ovarian morphology, and ovarian stromal thickness in both groups, and acne and hirsutism subgroups. Patients in both groups were taking no hormonal therapy at that time. Androgen profiles were compared between the two groups. Results The prevalence of PCOS was 17.1% (19/111) in all women included in this study. In the acne group, the prevalence of PCOS was 26.9% (14/52), and significantly more prevalent than in control group [8.4% (5/59), P = 0.001]. Total ovarian volume was significantly larger and stromal thickness of the ovary was thicker in women with acne than women without acne. There were no statistically significant difference between the two groups in terms of dehydroepiandrosterone sulfate, and 17‐hydroxyprogesterone, respectively, while serum total testosterone levels were significantly higher (P < 0.05) in women with acne than those women in the control group. Conclusions Acne and hirsutism may not only cause cosmetic concern but may also be a sign of underlying PCOS. Therefore, women presenting with acne and/or hirsutism should be evaluated in terms of PCOS.     

Antibiotic resistance of microbial strains isolated from Korean acne patients

Over several decades, topical and systemic antibiotics have been the mainstay of treatment for acne vulgaris. The widespread and long‐term use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. We aimed to examine the bacteriology of acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne in Korea. We examined the species of bacteria aerobically and anaerobically isolated from 100 Korean acne patients. Among the bacteria isolated, Staphylococcus epidermidis (36 patients) was the most common, followed by Propionibacterium acnes (30 patients). Eleven strains of P. acnes (36.7%) and 25 strains of S. epidermidis (69.4%) were resistant to one or other of the antibiotics tested. A higher proportion of P. acnes isolates were resistant to clindamycin (30%) and erythromycin (26.7%), than to any other antibiotics tested (P = 0.0003). Some S. epidermidis isolates were resistant to tetracycline and doxycycline in addition to clindamycin and erythromycin. In the previous studies, few strains of P. acnes were found to be resistant to any of the antibiotics, but this study shows that antibiotic‐resistant strains have been increasing in Korea acne patients.     

The correlation between ABO blood types and acne vulgaris severity

Background

Acne vulgaris is a chronic inflammatory disease with multifactorial etiology. Studies on the pathogenesis of acne are still important. Recently, various studies have been conducted on the significance of genetics in the pathogenesis of acne. Blood group is transferred genetically and could affect the development, progress, and severity of certain diseases.

Aim

In the current study, the correlation between the severity of acne vulgaris and ABO blood groups was investigated.

Materials and Methods

A total of 380 patients (263 mild and 117 severe acne vulgaris patients) and 1000 healthy individuals were included in the study. Severity of acne vulgaris patients and healthy controls was determined based on the blood group and Rh factor data obtained retrospectively from the patient files in the hospital automation system.

Results

In the study, the rate of females was significantly higher in the acne vulgaris group (X²:154.908; p:0.000). The mean age of the patient was significantly lower when compared to the controls (t:37.127; p:0.0001). The mean age of the patients with severe acne was significantly lower when compared to those with mild acne. When compared to the control group, the incidence of severe acne was higher in those A blood type when compared to the patients with mild acne, while the incidence of mild acne was higher in other blood groups when compared to the control (X²:17.756; p:0.007). No significant difference was determined between the Rh blood groups of the patients with mild, severe acne and the control group (X²:0.812; p:0.666).

Conclusion

The results revealed a significant correlation between acne severity and ABO blood groups. Future studies that would be conducted with larger samples in different centers could confirm the current study findings.     

伴多囊卵巢综合征的痤疮性激素水平变化及相关分析

为探讨成年女性痤疮患者血清性激素水平的变化及与多囊卵巢综合征（PCOS）的相关性，对60例成年女性痤疮患者进行血清性激素水平测定和妇科B超检查，其中24例伴PCOS痤疮患者行腹腔镜下微波治疗。结果发现患者组血清睾酮（T），黄体生成素（LH）高于对照组（P＜0．05），微波术后其T，LH值明显下降（P＜0．05），该手术对痤疮治愈率和总有效率分别为58．3％和91．7％，提示成年女性痊痤疮与PCOS有相关性，高雄激素血症可能是引起女性痤疮的主要因素之一。     

Skin improvement with two different oestroprogestins in patients affected by acne and polycystic ovary syndrome: clinical and instrumental evaluation

Background Despite it is accepted that acne is mostly caused by an hyper‐responsiveness of the pilo‐sebaceous unit to normal circulating androgen hormones, in a few patients, especially women, acneic lesions can be associated with increased serum androgen levels (hyperandrogenism), of which polycystic ovary syndrome (PCOS) is the most common cause. In women with acne and proven PCOS therapy with estroprogestins (EPs) can be an excellent option. Objective The aim of the study was to assess the effects of two estroprogestins (EPs), ethinyl‐estradiol (EE) 30 mcg/drospirenone (DRSP) 3 mg, and ethinyl‐estradiol (EE) 30 mcg/chlormadinone acetate (CMA) 2 mg, both on increased serum androgen levels and on several skin parameters in women affected by mild to severe acne and polycystic ovary syndrome (PCOS). Methods Fifty‐nine women were randomized to receive EE/DRSP (n = 32) or EE/CMA (n = 27) for six months. Evaluation of serum androgen levels, grading of acne and hirsutism (respectively with Pillsbury and Ferriman‐Gallwey score) and non‐invasive assessment of skin hydration, transepidermal water loss (TEWL) and skin homogeneity were performed at baseline, at 3 and 6 months (end of treatment). Results Both treatments were well tolerated and showed a significant improvement of skin and hormonal parameters, although EE/DRSP showed a more potent effect on acne and seborrhea. Conclusions Estroprogestins represent an effective and safe treatment in women with acne and polycystic ovary syndrome (PCOS). Nevertheless, the combination EE 30 mcg/DRSP 3 mg appears to be a more potent therapeutic option.     

Plasma dermcidin levels in acne patients,and the effect of isotretinoin treatment on dermcidin levels

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Dermcidin (DCD) is an antimicrobial peptide released from eccrine sweat glands and sebaceous glands. Studies investigating the role of DCD expression in acne development are scarce. The aim of this study was to determine the relationship between DCD expression and acne vulgaris and the effect of oral isotretinoin treatment on DCD levels. Two groups (one patient group and one control group) were included in the study. The patient group consisted of 30 patients with acne vulgaris who were given oral isotretinoin treatment for 6 months until the cumulative dose was attained. Plasma DCD levels were investigated before and 6 months after treatment. The control group comprised 30 volunteer individuals without acne vulgaris or any inflammatory dermatosis. Of the patients, 24 (80%) had Grade 3, 3 (10%) had Grade 1, and 3 (10%) had Grade 4 acne vulgaris, as determined according to the Pillsbury scoring method. The DCD levels in the control group were significantly higher than those in pretreatment patients (39.53 ± 20.2 vs. 28.60 ± 20.12, p = .004). Additionally, pretreatment DCD levels were significantly increased after 6 months of isotretinoin treatment in the patient group (28.60 ± 20.12 vs. 35.07 ± 24.02, p = .012). The mean pretreatment global acne grading system score of 20.86 ± 4.43 was decreased to 5.17 ± 1.91 in patients after treatment (p < .001). This study indicated that DCD plays an important role in the pathogenesis of acne. It demonstrates anti‐inflammatory properties in acne vulgaris. Moreover, it was shown that isotretinoin treatment may improve acne vulgaris by increasing DCD levels.     

Benzoyl peroxide, adapalene, and their combination in the treatment of acne vulgaris

Benzoyl peroxide and adapalene are among the most effective topical agents used in the treatment of acne. We planned an open-labeled, prospective study to compare the effects and side effects of these two drugs alone and in combination in the treatment of acne vulgaris. One hundred and five consecutive patients (30 men and 75 women) with acne vulgaris were included in this study. The patients were randomly divided into three groups with 35 patients in each. The groups were randomly assigned to 0.1% adapalene gel, 5% benzoyl peroxide lotion, or combination of 0.1% adapalene gel +5% benzoyl peroxide treatment. Acne lesions were classified as noninflammatory (open and closed comedones) and inflammatory (papule, pustule, nodule, cyst), and the lesions on the face were counted before the therapy, during the control visits, and after the treatment. Erythema, dryness, burning, and other side effects were recorded during the treatment. The mean age of the patients was 18.44 +/- 3.75 years. Eight patients were excluded because of noncompliance with the treatment regimen or the follow-up schedule, and four patients were excluded due to allergic contact dermatitis. The study revealed that all three therapy protocols were effective in treating noninflammatory and inflammatory lesions in acne vulgaris (p<0.05) and that there was no significant difference between the groups in efficacy or side effects (p>0.05). Adapalene and benzoyl peroxide are effective and well tolerated agents for acne vulgaris; combination therapy has no superiority over adapalene or benzoyl peroxide alone.     

Decrease in glutathione may be involved in pathogenesis of acne vulgaris

Background Some past studies reported that oxidative stress components such as reactive oxygen species (ROS) or lipid peroxide (LPO) are involved in the pathogenesis and progression of acne vulgaris. In this study, we hypothesized that the pathogenesis of acne vulgaris may depend on the differences in antioxidative activity among antioxidants in our body. We collected samples of stratum corneum from acne patients and healthy subjects and compared the quantity of gluthathione (GSH), one of many antioxidative components in our body, for comparison. Methods Samples of stratum corneum were collected from facial acne‐involved lesion, facial uninvolved area, and the medial side of the upper arm in acne vulgaris patients. Similarly, samples were collected from a facial uninvolved area and the medial side of the upper arm in healthy subjects. The quantity of GSH was measured in each area. In vitro effects of alpha‐melanocyte stimulating hormone (α‐MSH) on GSH synthesis‐related gene were also examined. Results The quantity of GSH in stratum corneum from each area was significantly lower in acne vulgaris patients than that of healthy subjects. There was no significant difference in quantity of GSH between the acne‐involved lesion and uninvolved area in acne patients. In vitro studies showed that the expression level of Glutamate‐cysteine ligase catalytic subunit (GCLC), one of the GSH synthesis‐related genes, was significantly decreased by the additional use of α‐MSH. Conclusions We conclude that a decline in antioxidative activity led by a decrease in GSH quantity may play an important role in pathogenesis of acne vulgaris. The use of α‐MSH may further decrease the GSH level.     

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.     

Prevalence of non classical congenital adrenal hyperplasia due to 21‐hydroxylase deficiency in Greek women with acne: a hospital‐based cross‐sectional study

Aim To determine the prevalence and frequency of non classical congenital adrenal hyperplasia (NC‐CAH) due to 21‐OHD at the time of clinical presentation and at the peripubertal period in a substantial sample of Greek women with acne and to investigate the correlation of serum T, 17‐OHP and DHEA‐S with acne appearance at the time of clinical presentation. Methods One hundred and twenty‐three unselected women with hyperandrogenemic symptoms were examined. After the ACTH stimulation test, 6 (4.9%) women were diagnosed with NC‐CAH due to 21‐OHD. Results There was not any statistical significant difference in the frequency of peripubertal acne between NC‐CAH group of patients (6.4%) and patients with hyperandrogenemia of other aetiology (93%), mainly ovarian (P = 0.41). However, there was a statistical significant difference in the prevalence of acne at the time of clinical examination between the two groups (P = 0.04). Acne was present in 83.3% of women with NC‐CAH vs. 41.02% of women in the hyperandrogenic group without NC‐CAH. A statistically significant decrease of acne from the peripubertal time to the time of clinical examination in the group of women with hyperandrogenemia of other aetiology (?21.37%) was observed compared to women with NC‐CAH (P < 0.001). Conclusion We have shown that acne persists from peripubertal period to adult life in NC‐CAH women whereas it tends to diminish in women with hyperandrogenemia of other aetiology. Acne is a prominent finding in women with NC‐CAH. Serum concentrations of 17‐OHP after ACTH stimulation (17‐OHP_6O) should be investigated in women with persistent acne in adult life.     

The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals

Acne is principally a disorder of adolescence but persists into middle age in a small minority of individuals. There is some evidence, primarily from twin studies, to suggest that acne may be an inherited disease. We have carried out an investigation of the familial risk of persistent adult acne by studying the occurrence of this condition in first-degree relatives of patients with adult persistent acne compared with the relatives of unaffected matched controls. Two hundred and four patients over the age of 25, referred to our department with facial acne which had persisted from adolescence, were included in the study. For each patient, a detailed pedigree which included all first-degree relatives was drawn up. For all relatives over the age of 25, demographic details and the presence or absence of facial acne was recorded. One hundred and forty-four unaffected controls were recruited. These were matched with the patient group in terms of age, social class and ethnic origin. The same questions were asked of controls as of the cases, and they provided the same information on their first-degree relatives. In total, 204 acne cases and 144 non-acne control volunteers were studied, contributing 1203 and 856 first-degree relatives, respectively. Two hundred and three first-degree relatives of cases were affected with facial acne, compared with 42 first-degree relatives of volunteers. The risk of adult acne occurring in a relative of a patient with adult acne was significantly greater than for the relative of an unaffected individual (odds ratio 3.93, 95% confidence interval 2.79-5.51; P < 0.001). Our study suggests that familial factors are important in determining individual susceptibility to adult persistent facial acne. Genetic factors may determine the failure of acne-prone follicles to evolve into acne-resistant follicles in early adult life.     

Acne analysis,grading and computational assessment methods: an overview

Introduction: This paper presents a comprehensive review of acne grading and measurement. Acne is a chronic disorder of the pilosebaceous units, with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity. Most patients are affected with acne vulgaris, which is the prevalent type of acne. Acne vulgaris consists of comedones (whitehead and blackhead), papules, pustules, nodules and cysts. Objectives: To review and identify the issues for acne vulgaris grading and computational assessment methods. To determine the future direction for addressing the identified issues. Methods: There are two main methods of assessment for acne severity grading, namely, lesion counting and comparison of patient with a photographic standard. For the computational assessment method, the emphasis is on computational imaging techniques. Results: Current acne grading methods are very time consuming and tedious. Generally, they rely on approximation for counting lesions and hence the assessment is quite subjective, with both inter and intra‐observer variability. It is important to accurately assess acne grade to evaluate its severity as this influences treatment selection and assessment of response to therapy. This will further help in better disease management and more efficacious treatment. Conclusion: Semi‐automated or automated methods based on computational imaging techniques should be devised for acne grade assessment.     

Tissue and blood superoxide dismutase activities and malondialdehyde levels in different clinical severities of acne vulgaris

Background Acne vulgaris is one of the commonest dermatological diseases and its pathogenesis is multifactorial. Objectives To determine the role of oxidative stress in acne vulgaris and to determine a possible link with the clinical severity. Methods Twenty‐three patients with different grades of acne vulgaris and 23 age‐ and sex‐matched controls were enrolled. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at tissue and blood levels. Results There were no significant differences in SOD activities and MDA levels between patients and controls. However, significant differences were found in patients with severe acne in comparison with those with mild and moderate acne. Moreover, comparison between different patient subgroups and controls revealed statistically significantly higher SOD activities in patients with mild acne in comparison with patients with moderate and severe acne, and with controls. Furthermore, severe acne showed statistically significantly lower SOD activities and higher MDA levels when compared with other patient subgroups and controls. Conclusions Oxidative stress exists in patients with acne vulgaris and may play a role in aetiopathogenesis and/or progression of the disease. The addition of drugs with antioxidative effects seems to be valuable in the treatment of acne vulgaris.     

复方木尼孜其颗粒治疗女性寻常痤疮临床疗效观察

[摘要]目的观察复方木尼孜其颗粒治疗女性寻常痤疮的临床疗效。方法78例女性寻常痤疮患者随机分为两组,试验组40例口服复方木尼孜其颗粒6g,每日3次;对照组38例口服维胺脂胶囊25mg,每日3次,两组均连续治疗12周。结果试验组有效率为87．50％,对照组为60．53％,两组有效率相比差异有统计学意义（P〈0．05）。结论复方木尼孜其颗粒治疗女性寻常痤疮有效。     

Polycystic ovary syndrome and acne

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive aged women. It is typically characterized by hyperandrogenism, chronic anovulation, and polycystic ovaries. Women with PCOS often experience dermatologic manifestations of hyperandrogenism, including hirsutism, acne vulgaris, and androgenic alopecia. This article will review the treatments for acne due to androgen excess in PCOS women.     

Acne vulgaris and depression: a retrospective examination

Background  Acne vulgaris is a common skin disease that affects patients both physically and mentally.
Purpose  To examine the prevalence of reported depression in acne patients.
Methods  Patient information was obtained from a medical claims database and analyzed using the Total Resource Utilization Benchmarks™ process. Benchmarks in this study include: age, gender, co-morbid depression, antidepressant utilization, and acne treatment modality. Depression prevalence in acne patients was compared with general population.
Results  Depression was two to three times more prevalent in acne patients than in the general population, with a reported 8.8% of acne patients having clinical depression. The majority of cases of depression and antidepressant therapy utilization were observed in acne patients aged 18 and over with the highest percentage in the 36–64 age group. Approximately 65.2% of the acne patient population was female, with twice as many reported to have depression as males (10.6% females vs. 5.3% males).
Limitations  This analysis included only patients that sought treatment for their acne and had also reported having clinical depression. This may underestimate the total prevalence of acne and associated depression.
Conclusions  Acne is a disease that affects people of all ages both physically and psychologically. A correlation exists between clinical depression and acne patients, particularly those older than 36. "There is no single disease which causes more psychic trauma and more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic assessment than does acne vulgaris" (Sulzberger, 1948 ¹ ).     

An observational study of methionine‐bound zinc with antioxidants for mild to moderate acne vulgaris

APC is a novel methionine‐based zinc complex with antioxidants that has been used in acne as a nutritional supplement. This is based on the proven role of zinc and antioxidants in improving acne, specially the inflammatory lesions. The objectives of this study are to explore the efficacy, safety, and tolerability of APC in acne patients with mild to moderate facial acne vulgaris. In this exploratory trial, 48 patients were treated with oral APC thrice a day for 3 months followed by a 4‐week treatment‐free period. At the end of treatment (Week 12), there was a statistically significant improvement in the global acne count (p < 0.05), which began after 8 weeks (p < 0.05). Almost 79% (38/48) of the patients had 80–100% improvement. There was a significant reduction in pustules (8 weeks (p < 0.05) and 12 weeks (p < 0.001)), and papules and closed comedones (8 weeks (p < 0.05) and 12 weeks (p < 0.001)). Only two patients had side effects. The current data indicate that treatment with oral APC thrice daily for 12 weeks in patients with mild to moderate facial acne vulgaris is efficacious and well tolerated. As the onset of action is late, concomitant topical therapy can enhance the results.     

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。