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1.
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.2.
Background
Although acne is almost universal in teenagers, few large cohort studies have investigated the profile of acne patients.Objectives
To identify the profile of European patients with mild-to-moderate acne.Materials and methods
An epidemiological study was performed using inclusion data from a prospective, international, observational phase IV study conducted in patients prescribed an anti-acne cream containing retinaldehyde, glycolic acid, modified rhamnose and Avene Thermal SpringWater.Results
Atotal of 2926 patients (73.1% female) with mild to moderate acne (mean Global Evaluation of Acne score of 2.55 ± 0.7), aged 22.5 ± 8.0 years, were included in France, Switzerland, Italy and Portugal. A family history of acne was present in 62.9% of patients and mean age at acne onset was 16.0 ± 4.9 years. In total, 69.6% of patients had moderate to severe hyperseborrhoea, 35.6% acne lesions on both face and trunk, 23.6% facial pigmentation and 46% scars. The extent of acne was significantly associated with sex, age at acne onset, history of acne and presence of scars. In women, acne onset was delayed (p<0.0001) and a family history of acne and extension to the trunk were less common than in men (p = 0.0118, and p<0.0001), as were scars (p = 0.0042). In subjects with a family history of acne, the frequency in men was higher (p = 0.0118), acne onset was earlier (p<0.0001) and extension to the trunk and presence of scars were more common (both p<0.0001).Conclusion
Further epidemiological studies would help define specific risk factors for acne occurrence or progression, which may be modified.3.
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.4.
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.5.
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.6.
Background
Atopic dermatitis is a chronic disabling inflammatory skin disorder, typically characterized by intensely itching, oozing, crusted, eroded vesicles or papules developing on erythematous plaques. Conventional treatments, both topical and systemic, may produce unsuccessful and unsatisfactory results.Objectives
we aimed to assess the efficacy of apheretic treatments in patients with severe, recalcitrant AD, in particular, the pruritic component.Patients and methods
four patients affected by recalcitrant and debilitating atopic dermatitis, who had previously received conventional topical and systemic therapies with poor clinical improvement, were treated with extracorporeal photopheresis or therapeutic plasma exchange.Results
a satisfactory response to apheresis was observed with a reduction of pruritus and skin lesions.Conclusion
In our experience, apheretic therapies might be used as monotherapy but, more effectively, in combination with topical and/or systemic treatments. Indeed, they proved to be a safe “enhancer” for increasing the efficacy of conventional therapeutics.7.
8.
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.9.
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 studies10.
Bayaki Saka Abla Séfako Akakpo Julienne Noude Téclessou Abas Mouhari-Toure Garba Mahamadou Piham Gnossike Waguéna Gnassingbé Aurel Abilogoun-Chokki Adjalamotom Tawelessi Koussake Kombaté Palokinam Pitché 《BMC dermatology》2018,18(1):7
Background
Acne is a chronic inflammatory condition affecting the pilosebaceous follicle that mainly affects adolescents and young adults. The aim of this study was to assess the quality of life (QOL) of patients with acne, and to determine the correlation between the QOL and the severity of acne, in Lomé (Togo).Method
From July 2017 to February 2018, we conducted a study in three dermatology departments of Lomé. The clinical evaluation of acne and assessment of the QOL were done using the ECLA (Echelle de Cotation des Lésions d’acné) and CADI (Cardiff Acne Disability Index) scores respectively.Results
We enrolled 300 patients aged 12 to 52 years; 71.3% of whom were female. The face was affected by acne in 100% of cases and papulopustular acne was the most common clinical form (66.7%). Acne was mild to moderate in 162 patients (54%) and severe in 138 (46%). Impairment was observed in all patients’ QOL (scores ranged from 1 to 14 points). There was a positive correlation between severity of acne and QOL impairment in the patients (r?=?0.21; p?=?0.0002). We also found a positive correlation between overall CADI score and factors F1 and F3 of the ECLA scale: the severity of facial acne (r?=?0.15; p?=?0.0073) and the presence of scars (r?=?0.21; p?=?0.0002). In contrast, the global ECLA score was significantly correlated with items 2, 3, and 5 of the CADI questionnaire: the patient’s relationship (r?=?0.13; p?=?0.0241), avoidance behaviors (r?=?0.21; p?=?0.0002) and perception of acne (r?=?0.16; p?=?0.0067).Conclusion
Acne negatively impacts the QOL of patients. The severity of acne has an impact on the patient’s relationships, avoidance behaviors and perception of the acne.11.
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.12.
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.13.
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.14.
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).15.
Anne?Isvy-Joubert Jean-Michel?Nguyen Aurélie?Gaultier Mélanie?Saint-Jean Marie?Le Moigne Elodie?Boisrobert Amir?Khammari Brigitte?Dreno
Background
The prevalence of acne in the adult population is increasing, particularly in women. Spironolactone regulates sebaceous gland activity by blocking androgen receptor.Objectives
To evaluate retrospectively the efficacy of spironolactone in women with acne.Materials & methods
Data from 70 women of at least 20 years, treated for their acne between 2010 and 2015 with low-dose spironolactone (≤150 mg/day), were analysed. Remission was defined by the number of retentional lesions inferior or equal to five and inflammatory lesions inferior or equal to two on the face. Variables influencing the response were studied using the Cox model.Results
The mean age was 31.3 years; 39 (56%) women had prior courses of isotretinoin and 53 (76%) had an oral contraception prior to treatment. Remission data from a median treatment period of six months (95% CI: 4-9) were obtained from 47 (71%) women. Markers for a positive response to spironolactone were a high number of inflammatory lesions at inclusion (OR: 1.08; 95% CI: 1.03-1.13; p = 0.001) and relapse with previous isotretinoin (OR: 2.46; 95% CI: 1.09-5.54; p = 0.03). The marker for a negative response was an association with oral contraceptives containing first or second-generation progestin (OR: 2.77; 95% CI: 1.35-5.71; p = 0.005).Conclusion
This retrospective data analysis confirms that the use of low doses of spironolactone is a valuable alternative in women with acne in whom oral isotretinoin has failed. Moreover, the analysis shows that first and second-generation oral contraceptives decrease the efficacy of spironolactone, confirming the interest of using two third or fourth-generation oral contraceptives.16.
Background
Low grade inflammation is associated with both chronic spontaneous urticaria (CSU) and atherosclerosis. Data regarding an association between urticarial inflammation and atherosclerosis and subsequent cardiovascular events are scarce. It has been demonstrated that matrix GLA protein (MGP), a biomarker of arterial calcification, is increased in patients with atherosclerosis.Objectives
To evaluate circulating levels of markers of arterial calcification and acute phase response (APR) in patients with CSU.Methods
Concentrations of MGP and IL-6 were measured in venous blood samples of patients with long-lasting moderate-severe CSU.Results
There were no significant differences in serum MGP concentration between healthy subjects and CU patients. Serum IL-6 concentration was significantly higher in CSU patients as compared with healthy subjects.Conclusions
The results confirm that CSU is accompanied by a low grade systemic inflammatory state. However, the long lasting urticarial inflammation was not paralleled by an increased circulating level of the calcification marker matrix Gla protein.17.
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.18.
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.19.
Lorena?Capriotti Biagio?Didona Stefania?Madonna Claudia?Scarponi Maria?Antonietta?Pilla Francesco?Facchiano Martina?Cordella Andrea?Cavani Cristina?Maria?Failla
Background
Eosin has been traditionally employed as a topical treatment for psoriasis, but the biological mechanism of its therapeutic action has not been fully elucidated.Objectives
To analyse eosin effects on psoriatic skin in vivo and keratinocytes and endothelial cells in vitro.Materials & Methods
Skin biopsies were taken from psoriatic plaques before and after a three-day eosin treatment and processed for histological analysis. Cultured human psoriatic keratinocytes and dermal endothelial cells were treated with eosin, and release of inflammatory chemokines was analysed by multiplexed bead-based immunoassay and ELISA.Results
In patients, the three-day eosin treatment significantly reduced the number of infiltrating T lymphocytes, neutrophilic granulocytes, and dermal dendritic cells.Areduction in VEGF-A expressionwas also observed. In vitro, eosin treatment significantly decreased the release of CCL2, CCL5, and VEGF-A by keratinocytes and angiopoietin-2 by endothelial cells.Conclusions
Eosin treatment impacts on psoriatic inflammatory infiltrates and dampens the release of proinflammatory chemokines and angiogenic factors.20.