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1.
Background
Acne is a chronic inflammatory disease associated with scar development in many patients.Objectives
To check whether early inflammatory events in the epidermis via keratinocytes influence the development of scars in acne patients.Methods
We investigated several immunological markers involved in epidermal innate immunity in both clinically normal skin and inflammatory early papules in acne patients prone to scars or not.Results
In normal skin of acne patients prone to scars vs not prone to scars, TLR-4, IL-2, IL-10, TIMP-2 and JUN were significantly overexpressed and the MMP-9 protein level was decreased. Similar results were obtained in early inflammatory papules (no more than three days), except for TLR-4.Conclusion
These results suggest for the first time a link between the early events of inflammation with levels of activation of innate immunity in normal epidermis of acne patients and the development of scars. These markers could be a target for drugs in the field of scar prevention.2.
3.
Background
The efficacy and safety of clindamycin phosphate 1.2%/tretinoin 0.025% (Clin-RA) were evaluated in three 12-week randomised studies.Objectives
To perform a pooled analysis of data from these studies to evaluate Clin-RA’s efficacy and safety in a larger overall population, in subgroups of adolescents and according to acne severity.Materials & Methods
4550 patients were randomised to Clin-RA, clindamycin, tretinoin and vehicle. Evaluations included percentage change in lesions, treatment success rate, proportions of patients with ≥50% or ≥80% continuous reduction in lesions, adverse events and cutaneous tolerability.Results
In the overall population, the percentage reduction in inflammatory, non-inflammatory and total lesions and the treatment success rate were significantly greater with Clin-RA compared with clindamycin, tretinoin and vehicle alone (all p<0.01). The percentage reduction in all types of lesions was also significantly greater with Clin-RA in the adolescent subgroup (2915 patients, p<0.002) and in patients with mild/moderate acne (3662 patients, p<0.02) versus comparators. In patients with severe acne (n = 880), the percentage reduction in all lesion types was significantly greater with Clin-RA versus vehicle (p<0.0001). A greater proportion of Clin-RA treated patients had a ≥50% or ≥80% continuous reduction in all types of lesions at week 12 compared with clindamycin, tretinoin and vehicle. Adverse event frequencies in the active and vehicle groups were similar. Baseline-adjusted mean tolerability scores over time were <1 (mild) and similar in all groups.Conclusion
Clin-RA is safe, has superior efficacy to its component monotherapies and should be considered as one of the first-line therapies for mild-to-moderate facial acne.4.
5.
Background
Androgens and insulin may contribute to increased sebum production in the pathogenesis of acne vulgaris.Objective
We investigated the association between serum desnutrin levels and acne vulgaris in the pathogenesis of insulin resistance.Material and methods
25 patients presenting with acne vulgaris and 25 control subjects participated in this study. Fasting blood glucose, triglycerides, LDL, VLDL, HDL, total cholesterol, insulin, C-peptide and thyroid function tests were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to calculate insulin resistance. Desnutrin levels were determined by enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s protocol.Results
Patients with acne vulgaris had a mean serum desnutrin level of (8.83 ± 1.13 μIU/mL), which was statistically significantly lower in the control group (10:58 ± 3.43 μIU/mL). In patients with acne vulgaris the serum glucose levels, insulin levels and HOMA-IR values (87.92 ± 7:46 mg/dL, 11.33 ± 5.93 μIU/mL, 2.49 ± 1.40, respectively) were significantly higher than the control group (77.36 ± 9.83 mg/dL, 5.82 ± 2.68 μIU/mL, 1.11 ± 0.51, respectively) (p = 0.01, p<0.001, p<0.001, p<0.001, respectively).Conclusion
Full cohort (patients and controls) evaluation revealed a negative correlation between the serum glucose and desnutrin levels (r = ?0.31, p<0.05).Apositive correlationwas found between insulin and desnutrin levels (r = 0.42, p<0.001). In patients with acne vulgaris, as a result of increased levels of serum glucose and insulin, the function of desnutrin was suppressed, perhaps contributing to insulin resistance.6.
Background
Ghrelin in the pilosebaceous tissues of human skin and ghrelin levels in patients with acne vulgaris have not yet been investigated.Objective
The purpose of this study was to screen ghrelin immunoreactivity by immunohistochemistry in human pilosebaceous tissues of human skin and also to determine the quantities of ghrelin in the serum of the patients with acne vulgaris.Methods
30 patients presenting with acne vulgaris and 30 control subjects participated in this study. Ghrelin levels were determined by enzyme linked immunosorbent assay (ELISA). Human hair follicles and sebaceous glands were immunohistochemically examined.Results
Immunohistochemistry results showed that there is a strong ghrelin immunoreactivity in the hair follicles and sebaceous glands in sections of human skin. The mean serum ghrelin levels (27.58 ± 15.44 pg/mL) in patients with acne vulgaris was significantly lower than those of controls (35.62±20.46 pg/mL).Conclusions
Ghrelin produced in hair follicles and sebaceous glands of the skin might participate in the pathogenesis of acne vulgaris and also acne vulgaris in humans might be associated with decreased serum ghrelin.7.
Background
To date, the term ‘acne mechanica’ defines different cutaneous lesions caused by mechanical injury.Objective
To re-define the spectrum of cutaneous lesions caused by mechanical injury by determining their clinical and histological characteristics, to discuss and identify triggering and pathophysiologic elements.Methods
Clinical, histological and pathophysiological differences of 135 published cases of acne mechanica were analysed and compared to cases provided from our clinics.Results and Conclusions
Mechanical factors cause 2 types of mainly inflammatory cutaneous lesions: one presents with inflammatory papules, open comedones or has no comedonal lesions. We propose using the term ‘folliculitis mechanica’. The second type corresponds to a flare-up of acne in areas prone to the condition. These lesions present the typical clinical and histological features of acne vulgaris, comprising inflammatory and retentional lesions. Treatment may include topical products, including adjunctive care for reconstruction of the cutaneous barrier and the microbiome. Conventional acne medication should be used in cases of acne flare-up.8.
Background
Administrative databases provide valuable patient data and are used to conduct population-based studies. However, no studies have been conducted to validate the codes for dermatological conditions.Objective
To evaluate the validity of ICD 9 code 706 for acne.Methods
This was a retrospective chart review of patients seen in dermatology clinics at Sunnybrook Health Sciences Centre between March 1 and May 31, 2013. The billing code for a clinic visit was compared to the diagnosis documented in the medical chart.Results
There were 4,248 participants; 201 with an ICD-9 code of acne. This code had a PPV and sensitivity with 95% confidence intervals (CI) of 84.58% (78.67–89.13%) and 86.29% (80.51–90.62%), respectively. The specificity was 99.20% (98.86–99.45%).Conclusions
We showed that ICD-9 code 706 can be used to accurately identify patients with acne in a dermatology setting. This information can be applied to future epidemiologic studies9.
Background
Systematic investigations of clinical manifestation and factors associated with the severity of seborrheic dermatitis (SD) have rarely been reported in Asia.Objectives
We investigated the clinical manifestation and associated factors of SD.Materials & Methods
Patients were asked to fill a self-questionnaire including symptom severity and aggravating factors.We evaluated objective severity and involved sites of SD. Patients were categorized into three groups; young age group (age<30), middle age group (30≤ age <60), and old age group (age ≥60) and we compared clinical features among them.Results
Among 253 patients included, scalp was the most frequently involved site and the most frequently reported aggravating factor was psychological stress. Different age groups have distinct clinical features and severity. Severity of SD decreased with age and patients in the old age group had less frequent involvement of the lower face. Risk factors of scalp involvement were male gender, disease duration ≥7 years and a history of acne.Conclusion
We investigated associated factors of SD and observed different clinical features between the age groups.We suggest that the adult form of SD can be categorized into three groups; young age SD, middle age SD and old age SD.10.
Andac Salman Emel Kurt Volkan Topcuoglu Zeynep Demircay 《American journal of clinical dermatology》2016,17(3):305-311
Background
Vitiligo and acne vulgaris, commonly affecting the face, have significant psychological effects and impair the quality of life of the affected individuals. Because of their negative effect on physical appearance, these conditions may act as a potential barrier to social relationships and cause social anxiety.Objective
The objective of the study was to investigate the social anxiety, quality of life, anxiety, and depression levels of acne and vitiligo patients with facial involvement and compare these levels with healthy controls.Methods
Thirty-seven vitiligo and 37 acne patients, aged older than 18 years, with facial involvement and 74 age- and sex-matched healthy control subjects were included in the study. The patients and healthy controls were asked to complete the Liebowitz Social Anxiety Scale, the Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. Disease severity was evaluated both objectively by the physician and subjectively by the patients using a visual analog scale.Results
Social anxiety, depression, and anxiety levels of vitiligo and acne patients were significantly higher than healthy controls (p < 0.05). Quality of life was impaired in both patient groups (Dermatology Life Quality Index scores for vitiligo: 5.6 ± 5.1; acne: 6.4 ± 6.2). There was no correlation between psychiatric scale scores and disease severity. Quality of life was negatively correlated with social anxiety and depression levels in both patient groups in our study.Conclusion
Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.11.
Jerry Tan 《Journal of cutaneous medicine and surgery》2004,8(4):11-15
Background
Recent controlled clinical trials have demonstrated the efficacy of various hormonal preparations, including oral contraceptives, in treatment of acne.Objective
The goal of this article is to evaluate the best current evidence on the efficacy of hormonal treatment of acne.Methods
English-language controlled clinical trials of systemic hormonal treatment of acne were sought by search of references of general dermatology texts, reviews on acne, drug product monographs, and computer-assisted search of MEDLINE, CINAHL, and COCHRANE databases between 1970 and 2003 using the key words hormonal, oral contraceptive, acne, spironolactone, cyproterone, flutamide, and therapy. For each agent, studies fulfilling the highest level of evidence were selected for further evaluation.Results
The literature search recovered two placebo-controlled random controlled trials (RCTs) each of ethinyl estradiol 0.035 mg and norgestimate and ethinyl estradiol 20 μg and leonorgestrel 100 μg, three active-comparator RCTs of ethinyl estradiol 0.035 mg and cyproterone acetate 2 mg, one active comparator RCT of ethinyl estradiol 30 μg and drosperinone 3 mg, three small placebo-controlled RCTs of spironolactone, and one active-comparator RCT of flutamide.Conclusions
The efficacy of Tri-Cyclen® and Alesse® in acne is supported by high-quality RCTs (level A evidence). Evidence for the efficacy of Diane-35®, spironolactone, and flutamide is derived from lower-quality RCTs (level B evidence). Results from a population-based epidemiological study suggests that Diane-35 is the most effective of these oral contraceptives in the treatment of acne (level B evidence; epidemiological study).12.
Jacinto?Orgaz-Molina Cesar?Magro-Checa José?Luis?Rosales-Alexander Miguel?A.?Arrabal-Polo Luisa?Castellote-Caballero Agustin?Buendía-Eisman Enriqué?Raya-álvarez Salvador?Arias-Santiago
Background
Psoriasis has been associated with vitamin D insufficiency and cardiovascular risk factors. Reports show that serum 25-hydroxyvitamin D (25-OHD) levels are inversely associated with chronic inflammatory systemic diseases, cardiovascular risk factors and cardiovascular outcomes.Objective
To analyze the association between 25-hydroxyvitamin D serum levels and subclinical carotid atherosclerosis (maximal intima-media thickness (MIMT)) in psoriasis patients and controls. MIMT was compared and associated factors were analyzed.Patients and Method
This was a case-control study with 44 psoriatic patients without arthritis from a Dermatology outpatient clinic in Granada (Spain) and 44 controls. Confounding factors related to 25-OHD serum levels and cardiovascular risk factors were also analyzed.Results
25-OHD levels were significantly lower in the psoriatic than in the control group (29.20 vs. 38.00 ng/mL p<0.0001) and a significant negative correlation was found between serum 25-OHD levels and the MIMT (rs = ?0.678, p<0.0001) in psoriatic patients. No correlation was found in healthy controls. This association remained after adjusting for confounders. Serum 25-OHD levels were significantly lower (p = 0.003) in psoriatic patients with carotid atheromatous plaque (22.38 ± 10.23 ng/mL) than in those without (31.74 ± 8.62 ng/mL). Patients with a longer history of psoriasis presented significantly higher MIMT than controls (638.70 ± 76.21 vs 594.67 ± 80.20 μm; p = 0.026 for ≥6 yrs with psoriasis).Conclusions
In psoriasis patients, lower serum 25-OHD levels were associated with higher MIMT after adjusting for selected confounding factors. The MIMT risk increases with a longer history of psoriasis, regardless of the patient’s age.13.
Background
About 20% of children have cutaneous scars following chickenpox. In contrast, skin scars are not often reported after herpes zoster (HZ). Risk factors for post-HZ scarring remain undetermined.Objective
Our objective was to prospectively study the incidence of and risk factors for post-HZ scarring.Methods
This was a 3-year prospective study of patients with HZ attending a tertiary university hospital. Baseline data, including age, sex, immunosuppression, prior history of scarring, severity and extension of HZ, afflicted HZ dermatome, and antiviral treatment received, were recorded. At 1 month after the HZ skin lesions had healed, patients were screened for skin scars at the prior HZ site. These patients were followed every 2 months for 6 months.Results
At 6 months, 11 (9.7%) of 113 HZ patients still had post-HZ scarring (fair-skinned patients: hypopigmented [n?=?3], hyperpigmented [n?=?2], atrophic cicatricial [n?=?3], and hypertrophic cicatricial [n?=?1]; dark-skinned patients: severe hyperpigmented hypertrophic scarring [n?=?2]). HZ was extensive and severe in all cases. Nine of the 11 patients were immunocompromised. Three cases had a history of hypertrophic/keloid scarring but no post-varicella scars. The most frequent location was the trunk (n?=?5), followed by the cervical region (n?=?3) and the face (n?=?3). Given the study setting, it is possible that immunocompromized patients with severe HZ were overrepresented in this study.Conclusions
Scarring after HZ is probably overlooked. The principal risk factors seem to be severe HZ and immunosuppression. Hence, prompt instigation of antiviral treatment for HZ and HZ vaccination could help reduce the incidence of post-HZ scarring.14.
Background/Objectives
Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for long durations; thus, acne therapy results in extensive antibiotic exposure. This article discusses the role of antibiotic therapy in acne from the perspective of how clinicians can best preserve the utility of these important drugs while providing efficacious and safe therapy for acne patients.Methods
Review of literature augmented by expert opinion when literature was sparse.Results
Antibiotic monotherapy (topical or oral) is not recommended due to the availability of clinically superior regimens. Systemic antibiotics are important for managing moderate to severe acne and should be used for a limited duration of time (3–4 months). Topical antibiotics should be paired with benzoyl peroxide to limit potential for resistance. Information gained in recent years about the pathophysiology of acne has shed light on the role of Propionibacterium acnes as well as other key pathogenic pathways such as inflammation.Conclusions
The improved understanding of acne pathogenic mechanisms can and should be applied to develop modern therapeutic approaches that are efficacious and mesh with current public health concerns.15.
Background
Photodynamic therapy (PDT) has been used for acne, however, the efficacy and safety need to be determined.Objective
To assess the effects and safety of PDT for acne using an evidence-based approach.Methods
Randomized controlled trials (RCTs) on the treatment of acne with PDT were identified by searching PubMed, CNKI and the Cochrane Library.Results
A total of 14 RCTs involving 492 patients were included. Photosensitizers included aminolevulinic acid (ALA), methylaminolevulinate (MAL), and indole-3-acetic acid (IAA). Light sources included red light, pulsed dye laser (PDL), intense pulsed light (IPL), long-pulsed dye laser (LPDL) and green light. The PDT protocols, including ALA + red light, ALA + PDL, ALA + IPL, MAL + red light, and MAL + LPDL, all showed great efficacy on inflammatory lesions. ALA + red light also had effects on non-inflammatory lesions and sebum secretion. ALA + IPL and IAA + green light significantly decreased sebum secretion. Triple treatment protocols showed great improvement on inflammatory and non-inflammatory lesions. Increasing ALA concentration, ALA incubation time, PDT sessions, dose of light source or using occlusion for photosensitizers, or a combination of other treatments with PDT may achieve greater efficacy. The common side effects of PDT were tolerable and transient.Conclusion
Limited evidence indicates that PDT shows good efficacy in the treatment of acne with acceptable side effects. ALA + red light was shown to be the optimal choice. However, more RCTs are needed to determine the types and concentrations of photosensitizers and light sources, and the duration of light activation and incubation.16.
Caroline?Schell Ramona?Schleich Florian?Walker Amir?S.?Yazdi Holger?Lerche Martin?R?cken Detlef?Axmann Kamran?Ghoreschi
Background
Restless legs syndrome (RLS) is characterized by unpleasant sensations in the legs and an uncontrollable urge to move them in order to gain relief. Higher frequencies of RLS have been reported in systemic lupus, multiple sclerosis, rheumatoid arthritis and atopic dermatitis.Objectives
Since the disease-related stress present in psoriasis is similar to the stress of those diseases, we aimed to study the frequency of RLS in a German cohort of patients with psoriasis.Methods
300 patients with psoriasis and 300 healthy controls were evaluated for RLS symptoms in this study.Results
While 17% (n = 51) of patients with psoriasis reported symptoms of RLS, only 4% (n = 12) of individuals without psoriasis suffered from RLS symptoms (95% confidence interval: 0.08–0.18, p<0.01). In patients with psoriasis and RLS the average RLS score was 16.0 ± 9.2 whereas individuals with RLS in the control group had an average RLS score of 13.5 ± 7.1.Conclusions
Our findings indicate an increased frequency of RLS in patients with psoriasis, suggesting screening patients with psoriasis for the presence of RLS as a well-treatable co-morbidity.17.
Background
Currently, different types of treatments for pathological scars are available, however, to date, there is no established method of measurement to objectively assess therapeutic outcome. Treatment success is usually evaluated clinically by the physician and patient. Non-invasive imaging techniques, such as HD-OCT (high-definition optical coherence tomography), may represent a valuable diagnostic tool to objectively measure therapeutic outcome.Objectives
To compare HD-OCT with ultrasound and subjective evaluation tools, such as questionnaires.Materials & methods
In total, eight patients with pathological scars were treated in this pilot study with cryotherapy and intralesional steroid injections, and evaluated pre- and post-treatment using clinical examination, photography, sonography, and HD-OCT. The analysis of objective and subjective measuring methodswas used to draw direct comparisons.Results
HD-OCT revealed reduced epidermal and dermal thickness of the scar after four treatments with triamcinolone acetonide and cryotherapy. Based on sonography, a total reduction in scar height and reduction in scar depth was demonstrated. Both methods correlated well with the injected amount of triamcinolone acetonide. In addition, a positive correlation between well-established subjective and objective evaluation methods was found.Conclusion
We demonstrate that HD-OCT may be used as an objective diagnostic instrument to evaluate skin thickness under therapy for pathological scars, and serves as a valuable adjunctive device in combination with ultrasound and subjective evaluation tools. This provides additional information for the therapist concerning the quality and success of the applied treatment.18.
Background
Melanoma is a common type of skin cancer with poor survival in advanced stages. Screening efforts aim to detect and tackle tumors at an early stage. However, regional population-based data at the time of initial diagnosis are sparse.Objectives
To analyse clinical and pathologic tumor characteristics in a Swiss population.Materials and Methods
Melanoma samples diagnosed at a large Swiss academic department were evaluated for demographic, clinical and histopathologic data.Results
We analysed a total of 254 melanoma samples. In situ tumors were more common in females than in males (70.6% vs. 29.4%; p = 0.0032). The acro-lentiginous subtype was more common in in situ compared to invasive tumors (14.7% vs. 5.5%; p = 0.0011). Invasive tumors showed a preference for male gender in patients beyond 60 years of age (p = 0.0080). The most frequent anatomic sites were the trunk in males and the legs in females. Regression was more common in males than in females (35.2% vs. 11.7%; p = 0.0001). Breslow’s thickness correlated significantly with age but not with gender. Ulceration was commonin tumors thicker than 2.01mm(48.4%; p = 0.0001). Regression was frequently detected in melanomas thinner than 1.00 mm (29.3%; p = 0.0263).Conclusion
Screening efforts should target elderly patients. Skin examinations should include acral localisations and focus on the trunk in males and the lower extremities in females. Population-based analyses can help to fine-tune melanoma screening in defined regional populations.19.
Background
To date, facial acne flare-ups in adult women during the luteal phase of the menstrual cycle have been poorly investigated.Objectives
To clinically characterize premenstrual acne flare-up in adult women and investigate the effect of a dermocosmetic treatment.Material and methods
This single-centre study included 32 young adult women with declared premenstrual acne flares and was composed of two phases: (1) an observational phase (two menstrual cycles) and (2) an interventional phase (one menstrual cycle) in a controlled, randomised, double-blind, intra-individual (half-face) setting in which a dermocosmetic (containing lipohydroxyacid, nicotinamide, and piroctone-olamine) and placebo were compared.Results
Initially, during the first part of the study, we observed that premenstrual acne flare-ups in adult women were characterized by a significant increase in the number of papules (20.2 vs. 13.7; p = 0.0008) and to a lesser extent, closed comedones (25.6 vs. 22.7; p = 0.04). Secondly, during the interventional phase, the half-face treated with the dermocosmetic formulation showed a significantly lower number of inflammatory lesions (7.6 vs 9.4; p = 0.01) during the luteal phase compared to the half-face treated with the placebo. Tolerance of the dermocosmetic formulation was rated as good or excellent.Conclusion
Our data indicate a significant increase in the number of papules during premenstrual acne flare-ups in adult women and the use of a dermocosmetic may be of benefit in partially reducing this premenstrual inflammatory flare-up.20.