Dissatisfaction and acne vulgaris in male adolescents and associated factors

BACKGROUND

Acne vulgaris has high prevalence, disturbing quality of life during adolescence.

OBJECTIVES

To measure dissastifaction and acne in 18-year-old male individuals and its associated factors.

METHODS

A questionnaire was applied by trained interviewers to all boys during selection for the military service. Dissatisfaction and acne was evaluated using a self-administered face scale. Facial, prestrernal and dorsal acne were evaluated separately.

RESULTS

A total of 2,200 adolescents, aged 18 years, were interviewed. Among these, 1,678 had acne on the face and 974 (54.05%) showed some degree of dissatisfaction. Regarding the impact of acne located on the chest, 326 out of 686 adolescents (47.52%) reported dissatisfaction. For acne located on the back, 568 out of 1,103 affected individuals (51.50%) showed dissatisfaction. Facial / dorsal acne and dissatisfaction were statistically associated with lower income, lower education levels and with non-whites. Presternal acne and dissatisfaction were statistically asssociated with lower income and lower education levels.

CONCLUSION

This population-based study found a high prevalence of acne on the face, back and chest, with high rates of dissatisfaction.     

Perception of brittle nails in dermatologic patients: a cross-sectional study

Brittle Nails Syndrome is characterized by fragility of the nail plate, affecting 27% of women. We evaluated dermatology patients in a cross-sectional study about perception of nail fragility. One hundred and thirtyeight women were included, with median age of 36.5 years. Nail examination showed changes in 57% and 49% reported nail fragility. The first three fingernails were the most affected. Onychoschizia was related to onychophagia (OR = 3.29), housework (OR = 2.95) and water contact (OR = 2.44). Onychorrhexis had the strongest association with nail fragility perception (OR = 17.89). The fragility was more perceived by those who were black, of mixed race and atopic, and was associated with depressed mood.     

Epidemiology of acne vulgaris

Acne vulgaris is a common disease with prevalence up to 80 % during adolescence. Twin studies provide solid evidence of a genetic background for this disease. Similarly there is no doubt about the influences of hormones, especially androgens, on the disorder. Less clear, however, is the data on other risk factors as smoking and certain diets.     

寻常痤疮及痤疮瘢痕的物理疗法

痤疮是一种有着极其复杂发病机制且十分常见的皮肤疾病。人群发病率非常高,特别是青少年。痤疮主要发生于面部,可形成粉刺、丘疹、脓疱、囊肿、结节、瘢痕等损害。活动性痤疮及其后遗症,特别是持久性瘢痕,对患者的生理和心理都会造成很大的影响。因此,痤疮和痤疮瘢痕的治疗显得非常重要。目前越来越多的物理疗法应用于临床,并取得很好的疗效。本文主要对寻常痤疮及痤疮瘢痕的物理治疗方面的有关进展做一综述。     

光动力疗法治疗寻常痤疮的研究进展

寻常痤疮是临床上最常见的皮肤病之一,是一种由多因素综合作用引起的,累及毛囊皮脂腺的慢性炎症性皮肤病,其发病率呈逐年上升的趋势,并且影响患者的生活质量.传统的治疗方法为局部或系统治疗,具有潜在的毒副作用,加之细菌对抗生素耐药性的不断增加.近年来,光动力疗法已广泛应用于痤疮的治疗中,并成为治疗痤疮的有效方法,尤其是针对炎症性痤疮,其疗效优于单独光照治疗.光动力疗法的光源主要有二极管激光、强脉冲光、蓝光、红光.研究结果显示,该疗法安全、有效,不良反应较小.     

抗雄激素疗法治疗痤疮的进展

雄激素在痤疮发生过程中起着重要的作用,对于抗生素和维A酸类药物反应不佳的女性患者而言,无论其血雄激素水平是否正常,联合使用抗雄激素疗法可能是一种理想的选择,但具体机制尚不明确.抗雄激素疗法的药物可分为以下4类:雄激素受体拮抗剂、肾上腺源性雄激素阻断剂、卵巢源性雄激素阻断剂、酶抑制剂.外用抗雄激素制剂可能成为新的研究方向.概述抗雄激素治疗痤疮的机制、治疗方法以及新的研究进展.     

Quality of life,self-esteem and psychosocial factors in adolescents with acne vulgaris

Background

Dermatological diseases, among which acne vulgaris, have psychological impact on the affected generating feelings of guilt, shame and social isolation.

Objectives

To compare quality of life, self-esteem and other psychosocial variables amongst adolescents with and without acne vulgaris, and between levels of severity.

Methods

Cross-sectional observational study in a sample of 355 high school students from the city of João Pessoa. Data collection was performed with questionnaires and clinical-dermatological evaluation. The primary variables were the incidence of AV; quality of life, set by the Children''s Dermatology Quality of Life Index and Dermatology Quality of Life Index; and self-esteem, measured by the Rosenberg Self-Esteem Scale. For calculation of statistical tests, we used the SPSS 20.0 software, considering p=0.05.

Results

The sample, with an average age of 16, showed 89.3% prevalence of acne vulgaris. The most prevalent psychosocial issue was "afraid that acne will never cease", present in 58% of affected youth. The median score of Quality of Life in Children''s Dermatology Index was different amongst students with and without acne vulgaris (p=0.003), as well as the Quality of Life in Dermatology (p=0.038) scores, so that students with acne vulgaris have worse QoL. There was a correlation between the severity of acne vulgaris and worse quality of life. Self-esteem was not significantly associated with the occurrence or severity of acne vulgaris.

Conclusions

acne vulgaris assumes significance in view of its high prevalence and the effect on quality of life of adolescents, more severe at the more pronounced stages of disease (p<0.001). The psychosocial impact of acne vulgaris should be valued in the management of patients with this condition.     

两种羟基乙酸治疗面部寻常痤疮的疗效观察

目的 评价两种羟基乙酸活肤液治疗面部痤疮的临床疗效和安全性。 方法 随机、单盲、自身半脸对照试验。60例轻中度痤疮患者,随机分配左右面部为试验侧或对照侧,依次应用浓度为20%、35%、50%、70%两种羟基乙酸活肤液治疗4次,第1次与第2次治疗间隔2周,以后每4周治疗1次。每次治疗前及最后1次治疗后4周计算两侧面部炎性和非炎性皮损数,并按照6级评分法分别观察痘印、毛孔粗大和痤疮瘢痕恢复情况。 结果 治疗2、6、10、14周后,试验侧炎性皮损改善率分别为20.4%、43.3%、66.9%、80.2%,对照侧分别为21.6%、44.2%、68.1%、79.8%;试验侧非炎性皮损改善率分别为18.5%、34.0%、41.3%、59.6%,对照侧分别为17.8%、31.2%、44.9%、57.1%。试验结束时,试验侧有效率为80.0%,对照侧有效率为78.3%。羟基乙酸治疗后均有不同程度的疼痛、红斑、白霜等不良反应,经冷敷等对症处理后症状缓解。两侧疗效和不良反应差异无统计学意义（P > 0.05）。 结论 两种羟基乙酸活肤液治疗面部痤疮均有效。     

寻常痤疮细菌感染病因学探讨

对１３２例寻常痤疮患者的皮损内容取材，同时进行需氧菌和厌氧菌培养。其中有１１２例分离到细菌，细菌培养阳性率８４．８％。１１２例共分离出１３７株细菌，其中需氧菌７５株，厌氧菌６２株，痤疮丙酸杆菌的分离率为４２．３％。１１２例中５８例分离到痤疮丙酸杆菌，阳性率为５１．８％；２４例为混合感染。１６例用特丽仙溶液治疗６周后，细菌培养阴转率为７５．０％；脓疱、丘疹、粉刺数的平均值分别由２．０６、１７．６９和２３．６３个减至０．７５、３．６３和１５．５６个。结果证明细菌感染在寻常痤疮病因学中的作用。     

Optimizing use of oral antibiotics in acne vulgaris

Oral antibiotics are commonly used to treat acne vulgaris, primarily in patients presenting with moderate to severe facial or truncal disease severity. These agents are most appropriately used in combination with a topical regimen containing benzoyl peroxide and a topical retinoid. The most common oral antibiotics for treating acne vulgaris are the tetracycline derivatives, although macrolide agents such as erythromycin have also been used extensively. Over the past 4 decades, as the sensitivity of Propionibacterium acnes to several oral and topical antibiotics has decreased, the efficacy of oral tetracycline and erythromycin has markedly diminished, leading to increased use of doxycycline, minocycline, and other agents, such as trimethoprim/sulfamethoxazole.     

348例痤疮遗传因素分析

目的 探讨痤疮的遗传模式及遗传因素在痤疮发病中的作用。方法 采用遗传流行病学病例对照研究方法.对348例痤疮先证者家系和443例对照组家系的痤疮患病情况进行调查,分别使用Li-Mantel-Gart法、Falconer法及Penrose法估算痤疮的分离比、遗传度和遗传模式。结果 病例组一、二级亲属痤疮患病率明显高于对照组亲属(P<0.001),分离比为0.183(0.144～0.232),低于0.25,不符合单基因遗传性疾病特征;患者一、二级亲属加权平均遗传度为88%±0.092%;遗传模式估计,一级亲属和一般人群患病率之比3.89.最接近于多基因模型理论值3.32。结论 痤疮属多基因遗传方式.遗传因素对其发病有一定的作用。     

Systemic antibiotic therapy of acne vulgaris

Background: Inflammatory, medium to severe acne vulgaris is treated with systemic antibiotics worldwide. The rationale is an effect on Propionibacterium acnes as well as the intrinsic anti‐inflammatory properties of these antibiotics. Although there are no correlations between the number of P. acnes and the severity of the disease, associations between the degree of humoral and cellular immune responses towards P. acnes and the severity of acne have been reported. Exact data on practical use of these compounds, such as differential efficacy or side effects are unavailable.A summary of currently available studies is presented. Methods: The data of studies of systemic antibiotic therapy of acne vulgaris up to 1975, the summary of literature in English up to 1999, a systematic review of minocycline from 2002 as well as the data of randomized controlled studies published and listed in Medline thereafter were reviewed. Results: Tetracyclines [tetracycline 1 000 mg daily, doxycycline 100 (?200) mg daily, minocycline 100 (?200) mg daily, lymecycline 300 (?600) mg] and erythromycin 1 000 mg daily are significantly more effective than placebo in the systemic treatment of inflammatory acne.The data for tetracycline are best founded. Clindamycin is similarly effective. Co‐trimoxazole and trimethoprim are likely to be effective. Clear differences between the tetracyclines or between tetracycline and erythromycin cannot be ascertained. The data for the combination with topical treatments [topical benzoyl peroxide (BPO) or retinoids] suggest synergistic effects.Therefore systemic antibiotics should not be used as monotherapy. In case of similar efficacy, other criteria, such as pharmacokinetics (doxycycline, minocycline, lymecycline have longer half‐lives than tetracyclines), the rate of side‐effects (tetracycline: side effect‐rate ～4 % mild side effects; erythromycin: frequent gastrointestinal complaints; minocycline: rare, but potentially severe hypersensitivity reactions; doxycycline: dose‐dependent phototoxic reactions), the resistance rate [percentage of resistant bacteria higher with erythromycin (～ 50 %) than with tetracycline‐therapy (～ 20 %)], and the costs of therapy have to be taken into account. Conclusions: The systemic antibiotic therapy of widespread papulo‐pustular acne not amenable to a topical therapy is effective and well‐tolerated. In general therapy can be carried out for 3 months and should be combined with BPO to prevent resistance.     

女性痤疮患者性激素水平及伴发多囊卵巢的研究

对２７例女性寻常痤疮患者及２５名正常女性血清性激素水平的测定与卵巢Ｂ超检查发现，痤疮组血清平均睾酮浓度与黄体生成素浓度显著高于对照组。痤疮组约５２％伴有多囊卵巢，与对照组之间有极显著差异。此项研究提示伴多囊卵巢的女性寻常痤疮属于一个特殊的痤疮亚型。     

炎症小体NLRP3与寻常痤疮发病机制的研究进展

寻常痤疮是青春期常见的炎症性皮肤病,主要累及毛囊皮脂腺,其特点是在粉刺的基础上产生丘疹、脓疱、结节等损害.尽管痤疮治疗已取得较大的进展,但作为一种多炎性介质及细胞因子参与的疾病,对于痤疮在机体免疫系统方面的发病机制仍然知之甚少.在固有免疫中起重要作用的炎症小体是多种蛋白质组成的复合体,其激活后可导致促炎性细胞因子白细胞介素1β和白细胞介素18等的活化,影响痤疮病情变化.探讨炎症小体NLRP3与痤疮发病机制的研究,为痤疮治疗开辟新的思路.     

Chemotactic efficiency of various chemoattractants for polymorphonuclear leukocytes in inflammatory acne vulgaris

Summary The chemoattractant efficiencies of a Propionibacterium acnes (P. acnes) cell wall preparation, a P. acnes culture supernatant, and a soluble comedonal extract in the presence and absence of autologous serum for polymorphonuclear leukocytes (PMNs) have been compared in the present study. It has been found that all three preparations have no or very little chemotactic activity for PMNs in the absence of serum. In the presence of autologous serum chemotactic factors is generated by all preparations via the alternative complement pathway. The relative efficiencies of the various preparations to induce chemotactic factor by the alternate complement pathway has been evaluated. Based on the bacterial numbers of the original preparations from which the test preparations had been derived the comedonal extract appears to be more efficient in generating chemotactic factor than the other preparations. It is concluded that in vivo generation of chemotactic factors occurs mainly via the alternate complement pathway activated by soluble comedonal factors diffusing through the follicular wall.Supported by a grant from Dr. Rentschler Arzneimittel GmbH, Laupheim, FRG     

Efficacy and safety of intense pulsed light in the treatment of inflammatory acne vulgaris with a novel filter

Acne vulgaris is one of the most common skin diseases affecting young people. Intense pulsed light (IPL) has become a well-recognized method in the treatment of acne vulgaris. We aim evaluate the clinical efficacy and safety of a novel IPL filter at wavelength of 400–600 nm and 800–1,200 nm in the treatment of inflammatory acne lesions. Twenty-one patients with Pillsbury I–III facial acne vulgaris between July 2017 and January 2018 were enrolled in this prospective clinical study. Five sessions of IPL treatment were administered to the subjects at 4-week interval. Final assessment was performed 1 month after the final treatment. One month posttreatment, over 75% subjects exhibited excellent or good response. Of the Pillsbury I–II patients, the effective rate reached 88.24%. The inflammatory lesions were dramatically decreased (25.23 ± 2.76 versus 14.01 ± 1.98) and statistically evident (P = .031). According to Hayashi assessment of acne severity, there was a significant improvement at follow-up visit (P = .022). Moreover, patients reported significant improvements in self-evaluation. The novel IPL filter at wavelength of 400–600 nm and 800–1,200 nm provides an effective option to treatment of inflammatory acne lesions, especially for Pillsbury I–II acne patients, with minimal reversible side effects, such as transient post-inflammatory pigmentation.     

Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: a status report

This article reviews the anti-inflammatory and nonantimicrobial effects of antibiotics in acne and other diseases and examines issues relating to the emergence of decreased bacterial sensitivity to antibiotics and how these issues relate to clinical practice. It includes an overview of the inflammatory activities of some antibiotic agents and their potential for use in various dermatologic and nondermatologic diseases. It demonstrates that P. acnes-resistant organisms may be associated with therapeutic failure in some patients with acne, and that the prudent use of antibiotics is necessary to ensure that we can continue to use these drugs to combat disease effectively. It concludes that there are treatment strategies that can effectively minimize the potential for development of resistant P. acnes organisms.     

异维A酸红霉素凝胶治疗寻常痤疮的多中心随机对照临床研究

目的 比较异维A酸红霉素凝胶与阿达帕林凝胶治疗轻中度寻常痤疮的疗效和安全性。方法 多中心、开放、随机、平行对照研究。按照中国痤疮治疗指南痤疮严重程度标准入选轻、中度（Ⅰ ~ Ⅲ级）寻常痤疮患者192例,纳入疗效分析169例,安全性分析190例。试验组86例,外用异维A酸红霉素凝胶;对照组83例,外用阿达帕林凝胶,均为每晚1次,共用药6周。在基线、治疗2、4和6周时分别记录患者白头粉刺、黑头粉刺、炎性丘疹、脓疱数,评价各时间点患者痤疮严重程度,同时记录皮肤局部耐受性以及其他不良反应。结果 随着治疗时间延长,两组的有效率逐渐提高,总体病情严重程度改善。在治疗6周时,试验组总有效率为51.16%,对照组为40.96%,两组差异无统计学意义（P > 0.05）;但在治疗4周及6周时,试验组患者脓疱及炎性皮损的疗效优于对照组（P < 0.05）,同时试验组痤疮分级较对照组低（P < 0.01）。两组不良反应类似,均表现为局部刺激,可耐受。结论 异维A酸红霉素凝胶治疗轻、中度寻常痤疮总有效率与阿达帕林凝胶类似,对于炎性损害疗效优于阿达帕林凝胶,并且对患者总体严重程度降低更快。