The familial risk of acne vulgaris in Chinese Hans – a case-control study

BACKGROUND: Acne is a chronic inflammatory disease of the pilosebaceous follicles. Recent studies bring us increasing evidences that hereditary factors play an important but indirect role in acne. OBJECTIVE: To investigate the possible role of genetic factors in the pathogenesis of acne vulgaris in Chinese Han ethnic group. PATIENTS AND METHODS: Volunteers of 975 acne cases and 580 controls were included, contributing 3009 and 1825 first-degree relatives, respectively. One thousand and eighty-five first-degree relatives of acne cases were affected with facial acne. This compared with 223 first-degree relatives of non-acne controls. The odds ratio was used to estimate the relative risk for acne vulgaris associated with having an affected first-degree relative. RESULTS: The risk of acne vulgaris occurring in a relative of a patient with acne vulgaris was significantly greater than for the relative of an unaffected individual (odds ratio 4.05, 95% confidence interval (CI): 3.45-4.76, P<0.001). CONCLUSION: Our study suggests that familial factors are important in determining individual susceptibility to acne vulgaris.     

The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ

The cutaneous microbiology and antibody status to Propionibacterium acnes of patients with persistent (males, n = 32; females, n = 33) and late-onset (females, n = 25) acne were compared with individuals with adolescent acne (males, n = 22; females, n = 18) and normal control volunteers (persistent acne: males, n = 26; females, n = 30; late-onset: females, n = 20). Males had significantly higher grades of acne compared with females (P < 0.05). The microflora consisted in the main of propionibacteria, staphylococci and Malassezia; other bacteria represented less than 0.01% of the total microflora. At all sites for all samples there were significantly more propionibacteria than staphylococci or Malassezia (P < 0.05). There were significantly higher (P < 0.05) numbers of microorganisms in follicular casts from patients compared with their control volunteers for female facial skin and male back skin. Twenty-six papules and 48 normal follicles were analysed. A bimodal distribution of microbial colonization was noted, with about 90% of normal follicles and about 10% of acne follicles having no detectable viable microorganisms. Anti-P. acnes IgG antibody titres were measured using a secondary fluorescein isothiocyanate antibody technique, and no significant differences in titre were found between any groups of patients (P > 0.05). Correlation analysis showed no association between the population densities of P. acnes and anti-P. acnes IgG titres. There were no differences in the microbiology of skin of adolescent acne patients, persistent acne patients or late-onset acne patients which could account for these various forms of acne.     

Prevalence of facial acne in adults.

BACKGROUND: Acne is usually considered a disorder of adolescence, and a number of studies have examined the prevalence of this condition in the adolescent population. There are, however, relatively few data on the prevalence of acne in the adult population. OBJECTIVE: A community-based study was carried out to investigate the current prevalence of facial acne in adults. METHODS: Seven hundred forty-nine persons older than 25 years were examined for facial acne by means of the Leeds acne-grading technique. RESULTS: A degree of facial acne was recorded in 231 women and 130 men, giving an overall prevalence of 54% (95% confidence interval [CI], 49-58) in women and 40% (95% CI, 35-45) in men (P <.001). The acne observed in volunteers consisted principally of physiological acne, but clinical facial acne (grade > 0.75) was recorded in 3% (95% CI, 1.2-4.8) of men and in 12% (95% CI, 9-15) of women (P <.001). The prevalence of acne did not substantially decrease until after the age of 44 years (P <.001). CONCLUSION: This study shows a prevalence of clinical facial acne in women of 12%, which is likely to persist into middle age.     

The frequency of polycystic ovary syndrome in females with resistant acne vulgaris

Background Acne vulgaris in females may be resistant to treatment in spite of topical and systemic therapy for a sufficient period. In this condition, acne may be a manifestation of underlying endocrine conditions such as polycystic ovary syndrome (PCOS). Objective To evaluate the frequency of PCOS in females with resistant acne vulgaris. Patients and methods This case‐controlled study was conducted in the Department of Dermatology and Venereology in The Teaching Hospital in Al‐Najaf during the period from October 2007 to November 2008. One hundred and twenty‐three female patients with resistant acne vulgaris were included in this study. One hundred and twenty‐three women, age‐matched, without acne were enrolled as a control group. Detailed history, clinical examination, abdominal ultrasound study, and hormonal assays were obtained for the patients and the control group. Results One hundred and twenty‐three females with resistant acne were included; their ages ranged from 17 to 40 years with a mean of 25.016 ± 6.041 (SD). One hundred and twenty‐three control women without acne were enrolled; their ages ranged from 17–40 years with a mean of 26.014 ± 6.251 (SD). The patients and the control group are age‐matched (P = 0.192). It was found that 63 patients (51.2%) with resistant acne have PCOS in comparison to only eight control women (6.2%). The difference is highly significant. Conclusion Polycystic ovary syndrome is an important contributing factor in females with resistant acne vulgaris.     

The epidemiology of adolescent acne in North East China

Background Adolescent acne impacts self‐esteem and quality of life in adolescents and its aetiology is not fully clarified. Objective The aim of this study was to describe the epidemiological features of adolescent acne in North East China and determine the impact of genetic and environmental factors on the pathogenesis of acne. Methods Data were collected from 5696 undergraduates (2920 patients and 2776 controls) using questionnaire. The survey data were analysed using spss version 13.0 and heritability of adolescent acne was calculated using Falconer’s method. Results Total prevalence of adolescent acne was 51.30% (52.74% in males, 49.65% in females). The difference between genders was statistically significant (P < 0.05). Adolescents with a family history of acne had earlier age of onset (P < 0.001). The prevalence of acne in first‐ and second‐degree relatives of acne patients was 22.5% and 7.19%, respectively, significantly higher than in controls (P < 0.001). Heritability of adolescent acne was 78.47 ± 2.05% in first‐degree relatives and 75.05 ± 3.18% in second‐degree relatives. Risk factors to the acne suffers include (in descending order of occurrence), acne family history, mental stress, menstrual disorder, frequent insomnia, high fat diet, being male, dysmenorrhoea, anxiety, sleeping < 8 h per day, depression, fried food, study pressure, spicy food, oily skin and mixed type skin. Protective factors include (presented in descending order of occurrence) dry skin, neutral skin, frequent fruit consumption and computer access time < 2 h daily. Conclusion Adolescent acne includes a familial genetic predisposition. Additional environmental factors of psychological stress, skin oiliness and high caloric diets may also contribute to the onset of acne in Chinese adolescents.     

Persistent Acne in Women

Acne is traditionally regarded as a skin disorder of the teenage years. However, recent epidemiologic studies have shown that a significant number of female patients aged >25 years experience acne. One recent community-based UK study estimated the prevalence of facial acne in adult women aged between 26 and 44 years to be 14%. It is not clear whether there is a true increase in acne in this age group or whether these patients are less tolerant of their acne and/or better informed of available therapies and so seek advice. The reasons for persistent acne are not fully understood. External factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered when managing these patients. Post-adolescent acne in females can be divided into 'persistent acne', which represents a continuation of acne from adolescence into adult life, and 'late-onset' acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The clinical picture of each of these forms of acne in adult females can differ slightly from conventional adolescent disease. The course of each form is more indolent. Because of these variations, the approach to investigation and management of these cases may have subtle differences when compared with that for teenage disease. Acne treatment should aim to reduce sebum, comedogenesis, propionibacteria population, and inflammation. Treatment selection will depend on the acne grade and site as well as the patient's preference and ability to comply with therapy. Maintenance therapy plays an important role in managing this group of patients. As the response to treatment is inevitably slow, patients must be encouraged to adhere to the chosen treatment regimen. This article reviews the literature on persistent acne in women in terms of clinical presentation and possible etiologic factors, and outlines principles of therapy related to managing these cases.     

Acne tarda

Acne is one of the most common skin diseases in the general population, especially among adolescents. Acne tarda (adult acne) is defined as acne that develops (late-onset acne) or continues (persistent acne) after 25 years of age. The disease is more common in women. The clinical features are quite specific: inflammatory acne in the lower facial region or macrocomedones (microcysts) spread over the face. Involvement of the trunk is much more common in men. The etiology of acne tarda is still controversial, as cosmetics, drugs, smoking, stress, diet, and endocrine abnormalities have been implicated. Women with acne tarda and other symptoms of hyperandrogenism have a high probability of endocrine abnormalities such as polycystic ovary syndrome. Treatment is similar to that of acne in adolescence. Long-term treatment over years or decades may be required.     

Post-adolescent acne: a review of clinical features

Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years. The clinical features of 200 patients over the age of 25 years, referred to our department for treatment of acne. were evaluated with a view to establishing possible aetiological factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity, consisting principlly of inflammatory lesion, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had features of hyperandrogenicity. One hundred and sixty-four patients (82%) had failed to respond to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with one or more courses of isotretinoin. External factors, such as cosmetics. drugs and occupation, were not found to be significant aetiological factor. A family history revealed that 100 (50%) of patients had a first-degree relative with post-adolescent acne. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers. External factors do not seem to have a significant aetiological role. Two main clinical groups were identified: those with persistent acne and those with late-onset acne. A minority of women also had features of hyperandrogenicity. These patients, and those with late-onset acne, may represent a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.     

四川地区汉族寻常痤疮相关因素调查分析

目的 了解寻常痤疮发病的相关影响因素.方法 选择2017年6月—2018年2月到四川省人民医院皮肤科门诊就诊的痤疮患者及体检中心体检者,填写问卷调查表.结果 本次调查共收集问卷394份;痤疮家族史在痤疮发病中有重要作用;公众对痤疮的认识亟待提高;经多因素回归分析,影响寻常痤疮发病的独立危险因素有:情绪差、一级亲属患寻常...     

皮肤科门诊女性痤疮患者的心理状态及生活质量调查

 目的: 调查皮肤科门诊青春期及成人期女性痤疮患者心理状态与生活质量情况。方法：收集2020年1月至2021年1月就诊于香港大学深圳医院皮肤科门诊的689例女性痤疮患者,调查广泛性焦虑障碍量表（GAD-7）、健康问卷抑郁症状群量表（PHQ-9）及痤疮特异性生活质量（AQOL）的得分情况;并按照年龄分组,评估青春期组及成人组心理状态和生活质量的差异。结果：女性痤疮患者中46.30%的患者有抑郁情绪,47.60%的患者有焦虑情绪,AQOL平均得分为68.90±27.40。两组间焦虑、抑郁比例及AQOL评分比较,差异均无统计学意义（均P>0.05）。结论：痤疮对女性患者心理状态和生活质量产生明显的负面影响,青春期与成人期患者无明显区别。     

An epidemiological study of acne in female adults: results of a survey conducted in France

BACKGROUND: Acne is usually perceived as a disease of teenagers, and most epidemiological studies have focused on adolescents. OBJECTIVE: The primary objective was to investigate the prevalence of acne in a representative sample of French females. Information about skin type, life-style factors influencing acne and quality of life were also recorded. METHODS: A self-administered questionnaire was sent to 4,000 adult women aged 25-40 years, after a validation test by three dermatologists. A definition of acne severity, according to questionnaire answers, was established before the questionnaire was sent out. RESULTS: A total of 3394 women completed the questionnaire of which 3,305 were useable. The data showed a prevalence of acne in 17% of the population, and physiological acne in 24%. Thus, the total acne prevalence was 41%. Forty-nine per cent of the acne patients had acne sequelae (scars and/or pigmented macules). Forty-one per cent of adult acne patients had not experienced acne during their adolescence. A premenstrual flare and stress was recorded as causing acne in 78% and 50%, respectively. Twenty-two per cent of acne subjects were currently receiving therapy. For most patients, acne did not severely impair their quality of life. CONCLUSION: This study shows a prevalence of acne in 41% of women in the general population. A high proportion of these acne cases are late onset acne.     

56例新生儿痤疮临床分析

目的：了解新生儿痤疮的临床特点,提高医生对该病的认识。方法：对近一年来我院皮肤科确诊的新生儿痤疮进行问卷调查,并对资料进行回顾性分析。结果：共收集患儿56例,其中男41例(73.21%),女15例(26.79%),平均发病年龄为(16.15±3.28)天,平均病程（10.0±1.32）天。炎性丘疹和脓疱47例(83.93%),是最常见的皮损;部位均累及面颊,其中合并额头眉弓部16例。17例患儿伴发湿疹10例,血管瘤2例,无色素痣2例,太田痣1例。纯母乳喂养41例(73.2％)。47例患儿父母一方或双方有痤疮病史,14例父母或姊妹患有特应性皮炎史。21例患者曾在外院诊断为湿疹,其中16例给予糖皮质激素治疗。结论：新生儿痤疮皮损好发于面部,出生后2周至3周发病,大多数为轻度炎性丘疹和脓疱,大部分患儿父母亲在青春期有痤疮发病史。临床上易误诊为湿疹。     

No evidence for follicular keratinocyte hyperproliferation in acne lesions as compared to autologous healthy hair follicles

Abnormal hyperkeratinization in sebaceous hair follicles has long been believed to play an important role in acne pathogenesis. Several early reports purported to provide histological evidence for hyperproliferation of keratinocytes in acne lesions by showing a higher expression of the Ki67 as well as certain keratins. The evidence is, however, not robust, and a number of methodological and technical limitations can be identified in these studies. In this study, we looked at the expression of proliferation, mitosis and apoptosis markers directly at acne skin lesions in 66 patients with acne vulgaris. Ki67 was assessed using immunohistochemistry and α‐tubulin, phospho‐histone H3 and cleaved‐PARP with immunofluorescence microscopy. Allogenic unaffected hair follicles from the same acne patients were used as an internal control. In both acne and control hair follicles, the α‐tubulin staining was universal, approaching 100% cells and showed no signs of changed assembly. Expression of cleaved‐PARP—the apoptosis marker—was a rare event. Cell proliferation rate measured by the expression of Ki67 and phospho‐histone H3 was virtually identical between acne and the two control groups. Our findings show the absence of increased keratinocyte proliferation in acne vulgaris. Alternative mechanisms are likely responsible for infundibular hyperkeratinization in acne pathogenesis.     

Do acne treatments affect insulin‐like growth factor‐1 serum levels? A clinical and laboratory study on patients with acne vulgaris

Acne is a chronic inflammatory disease affecting sebaceous gland follicles. Lately, acne has considered an insulin‐like growth factor‐1 (IGF‐1) mediated disease. Recent research demonstrated that IGF‐1 levels decrease after 3 months of isotretinoin. The purpose of our study is evaluating the influence of acne treatments on IGF‐1 serum levels. Forty‐six subjects with acne vulgaris aged 14 to 30 years were subdivided into three groups according to their severity of acne and treated following the European Dermatology Forum guidelines. IGF‐1 was measured in patients before and after the treatment and then compared to the IGF‐1 of a healthy population of the same age. IGF‐1 resulted higher in patients than in controls but there was not a statistically significant variation after treatment. To the best of our knowledge, this is the first study evaluating the influence of topical and systemic acne treatment on IGF‐1 serum levels. In contrast with the literature, our results suggest that common therapies for acne are not able to significantly modify IGF‐1 serum levels.     

系统性红斑狼疮患者及其家庭成员外周血基因表达谱的研究

目的 研究家族性SLE患者、一级亲属和正常人外周血基因表达谱的改变,探讨家族性SLE发病机制。方法 首先从外周血提取总RNA,逆转录合成单链、双链cDNA后,体外转录合成生物素标记的cRNA与基因芯片进行杂交,再通过抗原抗体反应机制标记上荧光染料Cy3后,使用基因芯片扫描仪进行图像扫描。使用分析软件进行表达差异和聚类分析。结果 在3000多个基因中,鉴定出59个基因存在表达差异,其中有34个基因表达上调,25个基因表达下调,这与散发性SLE患者的表达差异基因基本相同。在34个表达上调基因中,有22个基因在SLE患者和其未患病的姐妹中都表达上调;在25个表达下调的基因中,有17个基因在SLE患者和其未患病的姐妹中都表达下调。聚类分析显示根据外周血基因表达谱可明确地将SLE患者、未患病亲属及正常人对照区分开。结论 该基因芯片技术有较高的重复性和稳定性,能有效地进行家族性SLE疾病相关基因的初步筛选。     

Adult female acne: a new paradigm

In the adult female, acne is a chronic condition with a substantial negative psychological, social and emotional impact. Based on time of onset, two subtypes of adult female acne are recognized: ‘persistent acne’ is a continuation of the disease from adolescence, while ‘late‐onset acne’ first presents in adulthood. The morphological characteristics of adult female acne are often distinct from adolescent acne. In adults, inflammatory lesions (particularly papules, pustules and nodules) are generally more prominent on the lower chin, jawline and neck, and comedones are more often closed comedones (micro cysts). Adult acne is mainly mild‐to‐moderate in severity and may be refractory to treatment. A holistic approach to acne therapy should be taken in adult females, which combines standard treatments with adjunctive therapy and cosmetic use. A number of factors specific to the adult female influence choice of treatment, including the predisposition of older skin to irritation, a possible slow response to treatment, a high likelihood of good adherence, whether of child‐bearing age, and the psychosocial impact of the disease. Adherence to therapy should be encouraged through further patient education and a simplified regimen that is tailored to suit the individual patient’s needs and lifestyle. This article reviews the specific characteristics of adult female acne, and provides recommendations for acne therapy in this patient group.     

Does facial sebum excretion really affect the development of acne?

BACKGROUND: It is generally accepted that the severity of acne is correlated with facial sebum secretion. However, previous studies on the relation between seborrhoea and the development of acne did not consider topographical differences in facial sebum secretion and used relatively vague acne severity grading systems. OBJECTIVES: To elucidate the relation between topographical variations in facial sebum secretion and the severity of acne in women. METHODS: Forty-six female controls and 46 women with acne were included in this study. The Sebumeter was used to measure facial sebum secretion in the following facial areas: forehead, nose, chin, and right and left cheek. We counted noninflammatory comedones and inflammatory acne lesions in the same areas. We compared sebum secretion between patients with acne and controls, and analysed the relation between the quantity of sebum secreted and the number of acne lesions. RESULTS: Sebum secretions in the whole face and in the T- and U-zones (areas of high and low sebum secretion, respectively) were higher in patients with acne than in controls. There was no correlation between sebum quantity and acne lesion count in most facial regions. CONCLUSIONS: Increased levels of facial sebum secretion were observed in patients with acne. Our findings indicate that increased sebum levels do not directly cause development of acne lesions.     

Temporal changes in sebum excretion and propionibacterial colonization in preadolescent children with and without acne

BACKGROUND: It is generally accepted that the onset of sebum secretion occurs before puberty in boys and girls as a result of increasing androgen output during the adrenarche. Propionibacteria are part of the commensal skin flora and, in adults, are found in highest numbers in sebum-rich areas of skin such as the face and upper trunk. Previous studies investigating the association between sebum output and propionibacterial population densities have been cross-sectional and have been carried out mainly in adults. OBJECTIVES: The purpose of this study was to examine the association between the onset of sebum secretion and expansion of the propionibacterial flora in a population of early adolescent children aged between 5.5 and 12 years, and to evaluate the temporal relation between the two factors longitudinally. In addition, the study aimed to evaluate the change with age in sebaceous gland activity and propionibacterial colonization on the skin and in the nares between children who developed acne and those who did not. METHODS: Biannual examinations of volunteers included age, pubertal (Tanner) stage, weight and height, lesion counting on the face, propionibacterial colonization on the skin surface and in the nares and sebum secretion. A longitudinal analysis based on all observations of each subject throughout the study was applied to examine the change of sebaceous gland activity and propionibacterial colonization with age and pubertal stage. A generalized estimating equation was used with a 0.05 level of significance. RESULTS: The commencement of sebum production was asynchronous, with only a small number of follicles initially starting to secrete sebum onto the skin surface. The number of secreting follicles and the area of sebum increased with age and pubertal stage (P < 0.0001, P < 0.05, respectively). Numbers of propionibacteria on the skin tended to increase after the age of 9 years, but not significantly so. In contrast, numbers of propionibacteria in the nares increased significantly with age (P < 0.0001) but not with pubertal maturation. Children who developed acne had higher sebum output and propionibacterial densities with increasing age than children who did not develop acne. This effect was significant for the increase of total sebum area with age in pubertal children (P = 0.0023), the increase in number of secreting follicles with age (P = 0.020) in prepubertal children, and the increase in propionibacteria densities in the nares with age (P = 0.0005) in pubertal children. Sebaceous gland activity and propionibacterial numbers on the skin surface remained unchanged with increasing age in children who did not develop acne. Propionibacterial population densities in the nares increased with age regardless of the development of acne. CONCLUSIONS: Onset of sebum secretion and consequently expansion of the propionibacterial skin flora occur earlier in children who develop acne than in children of the same age and pubertal status who do not develop acne. These observations suggest that postponing the onset of sebum production or the expansion of the propionibacterial skin flora until after puberty may represent ways of preventing the disease or minimizing its severity. Determinants of propionibacterial colonization on the skin and in the nares may be different.     

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.