Zinc sulfate in acne vulgaris.

The effects of orally administered zinc sulfate in 52 patients with mild to moderate acne vulgaris were compared to those of a placebo capsule. The numbers of comedones, papules, pustules, infiltrates, and cysts were counted at each visit over a 12-week period. Forty patients completed the study. Zinc appeared to have a somewhat beneficial effect on pustules but not on comedones, papules, infiltrates, or cysts. Fourteen patients (50%) in the zinc group had side effects of nausea, vomiting, or diarrhea. Six patients (21%) in the zinc group could not tolerate the nausea and withdrew from the study.     

Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris.

The factors that initiate the inflammatory response in acne are not known. The presence of pro-inflammatory cytokines in acne comedones was therefore investigated. One hundred eight open comedones were collected from 18 untreated acne patients (10 male, 8 female). Each comedone was homogenized and centrifuged, and the supernatant was analyzed for bioactive and immunochemically detectable IL-1 alpha, IL-1 beta, and TNF alpha. Viable counts of propionibacteria, staphylococci, and Malassezia spp. were determined in the comedone pellet. Bioactive IL-1 alpha-like material was demonstrated in 76% of open comedones (range of 23-4765 pg IL-1 alpha-like bioactivity/mg of comedone material). In 58% of comedones, levels exceeded 100 pg/mg. There was no correlation between IL-1 alpha-like bioactivity and IL-1 alpha determined immunochemically. Bioactive IL-1 beta was not detected in any comedones. Twenty-four percent contained low levels of immunochemical IL-1 beta (range 12-103 pg IL-1 beta/mg comedone material). Bioactive TNF alpha was detected in three comedones with a further five comedones containing immunochemical TNF alpha (range of 61-820 pg TNF alpha/mg comedone material). The majority of open comedones (97%) contained microorganisms. There was, however, no significant correlation (Spearman's rank) between levels of any cytokine, in particular IL-1 alpha-like bioactivity, and numbers of microorganisms. Thus, bioactive IL-1 alpha-like material in the majority of open comedones may be concerned in the initiation of inflammation in acne following spongiosis or rupture of the pilosebaceous follicle wall.     

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.?     

Predictive factors for acne flare during isotretinoin treatment

Flare of acne is common at the beginning of isotretinoin treatment. However, severe flare is rare. Multiple comedones, male gender and young age are reported as promoting factors. However, detailed information is still limited. Our aim was to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence. 244 patients were enrolled. Acne grade was defined according to global acne grading system (GAGS) score. Flare was classified according to the increase in number of inflammatory nodules and treatment requirements of the patients. Risk factors (age, sex, duration of acne, basal acne grade, baseline numbers of comedones, papule-pustules, nodules, hyperandrogenism, and presence of sinuses) were investigated. 161 patients completed the study. 79 patients (32%) had facial and/or truncal flare. Flare was mild in 18% (n = 44), moderate in 10% (n = 24), and severe in 4.5% (n = 11) of the patients. For severe flare, male sex, severe acne, GAGS cut-off score greater than 28, presence of more than 44 facial comedones and 2 facial nodules and presence of truncal nodules were found to be predictive. Recognizing predictive factors for severe flare may help to take early precautions and to prevent severe flares which may result with permanent scars.     

Analysis of soluble proteins in comedones.

The detergent-soluble fraction of purified, concentrated comedo samples was analysed for protein by disc-gel electrophoresis and fluorescamine assay. Spectrophotometer scanning revealed a characteristic pattern of 14 peaks which was essentially uniform in comedones from individuals having acne, Favre-Racouchot syndrome, or prepubertal comedones. The pattern was different in material derived from keratinous cysts and the contents of follicles from the nose. The presence of small amounts of serum proteins, notably globulins, was detected by immunodiffusion.     

Anti-P. acnes antibody in comedonal extracts

Extracts of comedonal material obtained from patients with acne vulgaris were analyzed for albumin, IgG, IgM, IgA, and anti-Propionibacterium acnes antibodies using immunodiffusion and anti-immunoglobulin hemagglutination tests. Extracts were obtained from comedones of patients with (1) comedonal, (2) papulopustular, (3) nodular-cystic, (4) "burned out" acne, (5) patients under oral tetracycline treatment, and (6) with pustules. In all comedonal extracts analyzed, albumin and IgG (ratio approximately 1:2.5) could be detected. IgM, IgA, and C3 could not be found in noninflamed comedones by the techniques used; pustules, however, contained all immunoglobulin classes and albumin in ratios found in serum as well as C3. The anti-P. acnes antibody activity in the comedonal extracts was associated with the IgG class. Immunofluorescence microscopical examination of material from single comedones obtained by the cyano-acrylate technique showed IgG antibody on rod-shaped bacteria. The amount of IgG and albumin in comedonal extracts from the various patient groups was not different. It is concluded that IgG (and antibody of the IgG class) in comedones is derived from the serum and selectively accumulated in the follicle by an unknown mechanism.     

Topical Zinc Therapy for Acne Vulgaris

Abstract: A double-blind study of 30 patients with mild to moderate acne vulgaris was conducted to evaluate the efficacy of a topically applied 2% zinc sulfate solution for acne therapy. Over a 12-week period, no difference was noted between placebo- and zinc-treated participants in regard to either the number or type of acne lesions. The irritancy due to topically applied zinc was significantly greater (p 0.05) than that due to the placebo. Zinc serum levels were not significantly elevated between the two regimens before, during, or after treatment. This study suggests that topical zinc therapy alone is not of significant benefit in the treatment of acne vulgaris.     

Dark chocolate exacerbates acne

The effects of chocolate on acne exacerbations have recently been reevaluated. For so many years, it was thought that it had no role in worsening acne. To investigate whether 99% dark chocolate, when consumed in regular daily amounts, would cause acne to worsen in acne‐prone male subjects, twenty‐five acne prone male subjects were asked to consume 25 g of 99% dark chocolate daily for 4 weeks. Assessments which included Leeds revised acne scores as well as lesion counts took place weekly. Food frequency questionnaire was used, and daily activities were recorded. Statistically significant changes of acne scores and numbers of comedones and inflammatory papules were detected as early as 2 weeks into the study. At 4 weeks, the changes remained statistically significant compared to baseline. Dark chocolate when consumed in normal amounts for 4 weeks can exacerbate acne in male subjects with acne‐prone skin.     

Topical Zinc Therapy for Acne Vulgaris

A double-blind study of 30 patients with mild to moderate acne vulgaris was conducted to evaluate the efficacy of a topically applied 2% zinc sulfate solution for acne therapy. Over a 12-week period, no difference was noted between placebo- and zinc-treated participants in regard to either the number or type of acne lesions. The irritancy due to topically applied zinc was significantly greater (p less than or equal to 0.05) than that due to the placebo. Zinc serum levels were not significantly elevated between the two regimens before, during, or after treatment. This study suggests that topical zinc therapy alone is not of significant benefit in the treatment of acne vulgaris.     

The clinical features of late onset acne compared with early onset acne in women

Background Little is known about the clinical characteristics of acne based on the age of onset. Objectives The aim of this study was to investigate the clinical characteristics of patients according to the age of onset of acne and evaluate whether the findings were related to regional differences in the density of Propionibacterium acnes or the levels of sebum secretion. Methods A total of 89 women were recruited. The acne lesions were assessed by counting the lesions using standard digital photographs. Digital fluorescent photography for the evaluation of the density of P. acnes were taken and quantitative measurements of facial sebum secretion were performed. Results In women with acne, the age of onset was negatively correlated with the number of comedones and the proportion of comedones. By comparing the number of comedones and the proportion of comedones, onset of acne after 21 years of age was defined as late onset acne. In the patients with late onset acne, the number of comedones, the total number of acne lesions and the proportions of comedones were significantly less than in the patients with early onset acne. However, there were no significant differences in the fluorescence density of P. acnes or the level of sebum secretion between the two groups. Conclusions The results of this study, using objective evaluation tools, suggest that late onset acne has different clinical characteristics. Other possible factors might explain the clinical differences in late onset acne.     

女性更年期痤疮患者的临床特征及睾酮和雌二醇水平的检测

目的 探讨女性更年期痤疮患者血清性激素水平的变化,临床特征及治疗方法。方法 对66例患者的临床特征及治疗进行了观察;测定其中35例患者的血清睾酮和雌二醇水平。结果 患者睾酮、雌二醇与正常人对照组相比较差异无显著性,但睾酮/雌二醇显著高于正常人对照组(P<0.05)。63.6%的患者在更年期发病。皮损以上唇及颏部最多,其次为颊部、额部,多呈散在分布,以粉刺及炎性丘疹或丘脓疱疹为主,少数有炎性结节。多为轻至中度痤疮。78.8%的患者一般治疗即可治愈,其余患者用性激素治愈。结论 更年期因卵巢功能衰退,雌激素分泌减少,雌雄激素比例失衡,肾上腺源性雄激素相对过甚而导致痤疮。更年期痤疮多为轻至中度,皮损以粉刺、炎性丘疹或丘脓疱疹为主,以上唇及颏部最多。绝大多数患者一般治疗即可治愈。     

The chemoattractant properties of comedonal components.

Acculation of clusters of polymorphonuclear leukocytes (PMN) along the periphery of the walls of comedones (predominantly of the closed variety), has been described as the first change marking the transition of quiescent, noninflamed lesions in acne, into inflammatory ones. The present study analyzed the chemoattractant properties of different comedonal components for human PMN in an effort to evaluate the potential significance of these substances in stimulating the chemotactic response of PMN in the initial phases of inflammatory acne. It was found that the lipids extracted from pooled comedones had chemotactic activity for PMN in vitro. Beyond that, all chemotactic activity in comedones was related to bacteria. Propionibacterium acnes produced low molecular weight, dialyzable, heat stable chemotactic factors which were released into culture medium during bacterial growth. In addition to the extracellular cytotaxins, P. acnes whole cells and other extracellular products were strong cytotaxigens and activated heat labile chemotactic factors in human and guinea pig serum.     

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.     

Postadolescent acne in women.

A low-grade, persistent acne is quite common in hard-working professional women in their twenties, thirties, and forties. Closed comedones are the dominant lesions, with a scattering of papulopustules. Premenstrual flares are typical. Most such patients passed through adolescence without acne. Acne cosmetica has to be ruled out. The latter is more inflammatory and the lesions are denser. It is postulated that chronic stress leads to enhanced secretion of adrenal androgens, resulting in sebaceous hyperplasia and subsequent induction of comedones. Postadolescent acne is an authentic variety of acne vulgaris; it responds well to treatment with conventional topical medicaments.     

A possible role for squalene in the pathogenesis of acne. II. In vivo study of squalene oxides in skin surface and intra-comedonal lipids of acne patients

Skin surface lipids and lipids from open and closed comedones in acne patients were analysed by thin layer chromatography. The results showed that these lipids were enriched in polar lipids, as compared with the skin surface lipids obtained from controls without acne. In both open and closed comedones, these polar lipids appeared to be derived mainly from the oxidation of squalene, which is in agreement with our previous in vitro results. We suggest that squalene oxidation is the link between comedogenesis and bacterial colonization, and based on this, we propose a hypothesis of the pathogenesis of acne.     

蛇丹合剂对兔耳痤疮模型的治疗作用

目的观察蛇丹合剂对兔耳痤疮模型病理改变的改善作用,探讨其治疗作用机理。方法取健康雄兔18只,按体重分层随机分为A,B,C三组,在其左耳涂用煤焦油进行造模2周,右耳不涂煤焦油作为正常对照。A组给予小剂量蛇丹合剂,B组给予大剂量蛇丹合剂,C组为模型对照组,治疗前后对兔耳进行肉眼及病理切片观察。结果外涂煤焦油2周后,兔左耳表面粗糙,可见粉刺、丘疹,且光镜下组织学改变与人类痤疮相似。灌药2周后,实验各剂量组肉眼可见粉刺、丘疹消退;光镜亦有相应改变;但模型对照组改善不明显。结论蛇丹合剂能有效改善兔耳痤疮模型的皮损及病理改变。     

A randomized,double‐blind,placebo‐controlled trial to determine the efficacy and safety of lactoferrin with vitamin E and zinc as an oral therapy for mild to moderate acne vulgaris

Lactoferrin is an iron‐binding milk‐derived protein that has shown antibacterial and anti‐inflammatory effects in vitro and in vivo. The objective of this study was to determine the efficacy and safety of lactoferrin, combined with vitamin E and zinc, for mild to moderate acne vulgaris. In this randomized, double‐blind, placebo‐controlled trial, 168 subjects aged 13–40 years old were randomly assigned to take either a capsule formulation containing lactoferrin with vitamin E and zinc or placebo twice a day for 3 months. The primary outcome measure was a reduction in the number of acne lesions compared to placebo. A total of 164 subjects completed the study per protocol. The lactoferrin group (n = 82) showed a significant median percent reduction in total lesions as early as 2 weeks (14.5%, P = 0.0120), with the maximum reduction occurring at week 10 (28.5%, P < 0.0001) compared to placebo group (n = 82). Maximum reduction in comedones (32.5%, P < 0.0001) and inflammatory lesions (44%, P < 0.0001) was also seen at week 10 compared to placebo. Sebum scores were improved by week 12. No adverse events were observed during the trial. A twice daily regimen of lactoferrin with vitamin E and zinc significantly reduced acne lesions in people with mild to moderate acne vulgaris.     

A search for mycoplasmas and chlamydiae in acne lesions.

No mycoplasmas and no chlamydiae were found in cultures of 75 uninflamed comedones, 72 papulopustular lesions, and 7 cystic lesions from 14 subjects with acne. Chlamydial serologic tests were negative for 11 subjects and showed antibodies in 3 subjects to 3 different antigenic types of trachoma agent. These results are viewed as substantial evidence against the possibility that either mycoplasmas or chlamydiae play an important part in the pathogenesis of acne.     

Acne treatment: a comparative efficacy trial of clindamycin and tetracycline.

Tetracycline was compared to clindamycin as adjunctive therapy in the treatment of moderate to moderately severe acne under double-blind controlled conditions. Both antibiotics were efficacious and differences were not appreciable. Lesion counts of both comedones and pustules were reduced and clinical improvement was noted in the majority of subjects. Side effects were not a problem. The place of clindamycin in the therapeutic armamentarium of the dermatologist is discussed.     

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.