Topical Zinc Therapy for Acne Vulgaris

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

复方多黏菌素B软膏治疗寻常痤疮临床疗效观察

目的观察复方多黏菌素B软膏治疗寻常痤疮的疗效及安全性。方法将156例寻常痤疮患者分为两组,试验组外用复方多黏菌素B软膏每日2次,对照组外用5%过氧苯甲酰凝胶每日2次,疗程均为4周。结果试验组患者经治疗4周后皮损数量明显较治疗前减少,与对照组相比差异有统计学意义(P<0.05);皮损消退显效率两组无明显差异(P>0.05);不良反应发生率试验组低于对照组(P<0.05)。结论复方多黏菌素B软膏治疗Ⅰ、Ⅱ级寻常痤疮有效,且不良反应少。     

Combined topical treatment of acne with erythromycin and tretinoin

Vitamin A acid is the most effective comedolytic agent in the therapy of acne vulgaris. Antibiotics are suitable for the treatment of inflammatory lesions (papulo-pustules). Even topically applied, some antibiotics show a sufficient anti-inflammatory effect. Above all, erythromycin is reliable in the topical treatment of acne. Combined therapy with both topical tretinoin and erythromycin is more effective than either alone. During the first weeks of treatment, tretinoin leads to temporary deterioration of the disease, which can mostly be avoided by the anti-inflammatory effect of erythromycin simultaneously applied.     

A pilot study of the safety and efficacy of picolinic acid gel in the treatment of acne vulgaris

BACKGROUND: Cost limitations, adverse effects or lack of efficacy limit the use of current topical therapies in mild to moderate acne vulgaris. OBJECTIVES: To determine the safety and efficacy of picolinic acid, a novel zinc finger therapy, in the treatment of mild to moderate acne vulgaris. METHODS: Twenty subjects with mild to moderate acne vulgaris were treated at our centre during an open-label study with 10% picolinic acid gel (PCL-016) twice daily to the face over 12 weeks. RESULTS: Fifteen patients completed the 12-week open-label study. A reduction of 58.2% (P < 0.001) in mean total lesion count, 55.5% (P < 0.001) in mean inflammatory lesion count and 59.7% (P < 0.005) in noninflammatory lesion count was seen in this population. No serious adverse events or clinically significant changes in laboratory values were noted. CONCLUSIONS: Results from this study suggest that 10% picolinic acid gel applied twice daily may be safe and effective in the treatment of mild to moderate acne vulgaris.     

420nm强脉冲光联合氯霉素搽剂治疗面部中重度痤疮疗效观察

目的观察420nm强脉冲光联合氯霉素搽剂治疗中重度寻常痤疮的疗效。方法将78例面部中重度寻常痤疮患者随机分为两组,观察组40例采用420nm强脉冲光联合氯霉素搽剂治疗;对照组38例单纯外用氯霉素搽剂治疗。结果观察组和对照组有效率分别为77．5％和47．37％,观察组疗效和有效率明显高于对照组（P〈0．01）。结论420nm强脉冲光联合氯霉素搽剂治疗中重度寻常痤疮的疗效优于单纯外用氯霉素搽剂。     

Clinical efficacy and safety of a topical combination of retinaldehyde 0.1% with erythromycin 4% in acne vulgaris

The objective of this randomized, controlled, multicentre study was to assess the efficacy and safety of a topically applied retinaldehyde 0.1% gel in combination with a topical erythromycin 4% lotion for the treatment of acne vulgaris. Treatment consisted of applying either retinaldehyde or its vehicle every morning and erythromycin every evening for 8 weeks. Efficacy parameters were sequential lesion counts for papules and pustules, and a 6-point semiquantitative scale for comedones and microcysts. Safety parameters were local tolerance and adverse events. Of 74 recruited patients, 73 were appraisable for efficacy and safety. In both treatment groups, papules and pustules were reduced significantly at the end of treatment (P < 0.001), and no statistical difference was observed between the groups. Comedones and microcysts were significantly improved with retinaldehyde combined with erythromycin (P = 0.005), but not with erythromycin alone. However, no statistical difference between the groups could be demonstrated (test power, 50%). Local tolerance of the combined treatment group was very satisfactory, as only a few patients experienced local irritation. In conclusion, retinaldehyde combined with erythromycin appears to be a valuable topical therapy in polymorphic acne.     

Overview of treatments for acne

Acne vulgaris is a chronic inflammatory condition of the pilosebaceous units. Antibiotics are widely used in acne therapy and can be administrated topically or systemically. The main negative effect of antibiotic treatment is bacterial resistance to antibiotics.     

Oral zinc in acne vulgaris: a clinical and methodological study.

In a double-blind investigation of 54 patients suffering from acne vulgaris, the effect of 0.6 g of oral zinc sulphate daily versus placebo was studied. During the active treatment period of 6 weeks, the acne improved by about one-third, as rated with a score system. Clinical comparison with placebo showed the result of zinc sulphate therapy to be slightly, but statistically significantly better. Various methods for the clinical evaluation of acne were studied. Counting of acne lesions was found to be a more precise method than assessment according to the opinion of the patients and the assessment of colour photographs. The correlation between the results obtained by lesion counting and evaluation by photographs was low, as was also the reproducibility of photographic assessment.     

Tazarotene gel is safe and effective in the treatment of acne vulgaris: a multicenter, double-blind, vehicle-controlled study.

Retinoids reverse the abnormal pattern of keratinization seen in acne vulgaris. Tazarotene is the first of a novel family of topical receptor-selective acetylenic retinoids. This study evaluates the safety and efficacy of topical tazarotene 0.1% and 0.05% gels, in comparison to vehicle gel, applied once daily for 12 weeks, in the treatment of mild-to-moderate facial acne vulgaris. A total of 446 patients with facial acne vulgaris were enrolled, and 375 patients, ranging in age from 14 to 44 years, were evaluable in this multicenter, double-blind, randomized study. In comparison to vehicle gel, treatment with tazarotene 0.1% gel resulted in significantly greater reductions in noninflammatory and total lesion counts at all follow-up visits, and inflammatory lesion counts at Week 12. Tazarotene 0.05% gel resulted in significantly greater reductions in noninflammatory and total lesion counts than vehicle gel at Weeks 8 and 12. At Week 12, treatment success rates were 68% and 51% for tazarotene 0.1% and 0.05%, respectively (40% for vehicle gel). Tazarotene gel was an effective, safe, and generally well-tolerated therapy for the treatment of acne vulgaris.     

阿达帕林凝胶治疗寻常痤疮10年回顾

目的 总结阿达帕林凝胶治疗寻常痤疮的临床文献,为临床合理用药提供参考。方法 对阿达帕林凝胶上市10年来国内有关治疗寻常痤疮的疗效及安全性观察的中文文献进行整理和分析。结果 联合用药组疗效高于单用药物组,阿达帕林凝胶组疗效与其他维A酸类药物疗效相当,但高于其他痤疮药物组,不良反应低于其他药物。结论 阿达帕林凝胶治疗轻中度痤疮安全、有效,可单独或联合用药,还可作为维持治疗。     

Studies on the Mechanism of Action of Topical Benzoyl Peroxide and Vitamin A Acid in Acne Vulgaris

Although systemic telracycline remains the most frequent treatment for acne vulgaris, this report indicates that more effective antibacterial therapy can be achieved topically. The effective agent, benzoyl peroxide, produced a mild desquamation: while concommitantly reducing the fatty acids in sebum more dramatically than systemic tetracycline. Bacterial cultures demonstrated the potential of this peroxide to inhibit the growth of C. acnes recovered from sebaceous follicles. Since the mechanism of benzoyl peroxide is different than topical vitamin A acid, combination therapy has been evaluated in over 1,000 acne patients. The clearing of acne lesions is now routine in the majority of these cases within the initial three months of therapy.     

Local treatment of acne vulgaris with erythromycin

2% Erythromycin solution was applied topically in 20 patients with papulopustular acne vulgaris. The treatment proved beneficial and its results were similar to those obtained in the group of patients who additionally received Erythromycin systemically.     

Improved efficacy and tolerability of retinoic acid in acne vulgaris: a new topical formulation with cyclodextrin complex ψ

OBJECTIVES: Retinoic acid (RA) has long been used, both topically and systemically, for disorders of keratinization, acne and related disorders. In the present study, the efficacy and tolerability of topical RA prepared as a cyclodextrin beta complex (beta-CD) is investigated in 66 acne vulgaris patients. METHODS: This randomized, double-blind, placebo-controlled study compares nightly topical application of RA/beta-CD complex hydrogel formulation (0.025%), RA/beta-CD complex in moisturizing base (0.025%), hydrogel base, moisturizer base or a commercial RA gel (0.05%) in acne vulgaris patients. Improvement of acne was assessed using a 5-point improvement scale and by measuring sebum and moisture content of the skin using an SM 810 sebumeter/corneometer. RESULTS: After 3 months of treatment, mean scores of acne improvement on the 5-point scale were 4 with the RA/beta-CD complex hydrogel formulation, 4.1 with the RA/beta-CD complex in moisturizing base, 1.2 with hydrogel placebo base, 1.1 with moisturizer placebo base and 3 with the commercial RA product. All patients treated with the commercial product experienced local side-effects. One patient discontinued due to severe irritation. None of the patients treated with the RA/beta-CD complex in the moisturizing base and hydrogel formulation experienced significant local irritation, although the sebum content of the skin decreased after application of the RA/beta-CD preparations. This change was not significant compared to controls. The moisture content of the skin was better preserved in the group treated with the RA/beta-CD complex in the moisturizing base. CONCLUSION: The topical RA/beta-CD complex, in hydrogel and moisturizing base, was more effective than the twice concentrated commercial RA product. There were few topical side-effects with this new formulation, which increases patient compliance. Topical RA/beta-CD (0.025% RA) did not significantly reduce sebum secretion but may help to preserve optimum epidermal moisture content with the proper base formulation. This is the first study in the literature reporting efficacy and tolerability of the topical RA/beta-CD complex in acne vulgaris. We conclude that the topical RA/beta-CD complex displays an improved efficacy and tolerability profile and is an effective treatment alternative for acne vulgaris.     

(6) Azelaic acid really does work in acne—a double-blind national and international study

Azelaic acid is a natural product of Pityrosporum ovale ; used topically it has been shown to be of benefit in acne by a marked antimicrobial effect against Propionibacterium acnes. No study to date, however, has included a placebo group. We have investigated 40 patients with clinical acne in a double-blind study; half received 20% azelaic acid cream and half the base cream. Assessments were made of total acne grade, lesions counts and side-effects.
Azelaic acid was significantly better than placebo at 1, 2 and 3 months in improving overall acne grade ( P < 0·01) and inflamed lesions ( P < 0·001). Side-effects were minimal—the main drawback of the preparation was greasiness of its base.
We also collaborated in a multicentre study involving 859 patients in which azelaic acid was compared with other treatments. It was found to be as effective as benzoyl peroxide, retinoic acid and oral tetracycline over an 8-month study. It gave a significantly lower incidence of dermatitis ( P < 0·01) than either retinoic acid or benzoyl peroxide and, in contrast to the latter, it did not bleach clothes.
We conclude that azelaic acid is a safe and beneficial topical treatment for acne vulgaris.     

Quality of life in mild to moderate acne: relationship to clinical severity and factors influencing change with treatment

BACKGROUND: Because of its effects on quality of life, acne vulgaris is more than a merely physiological or cosmetic entity. OBJECTIVES: To describe the influence of mild to moderate acne on patients' quality of life, measured using Skindex-29, and to correlate changes in Skindex-29 scores with changes in objective and subjective indices in clinical severity after treatment with topical 4% erythromycin 0.2% zinc. Also, to evaluate efficacy and side-effects of the treatment. METHODS: Observational, prospective study of 1878 patients cared for by 252 clinicians in Spain. Data included epidemiological information and responses to Skindex-29, a subjective change and objective severity index. RESULTS: Baseline Skindex scale scores were worse in women, older patients, and those with more severe clinical disease. Skindex was sensitive to changes in objective severity but changes in Skindex scale scores were also related to other factors. Patients who reported their skin condition to be 'the same' or 'worse' at the end of the study had significantly worse baseline scores on the 'symptoms' and 'emotions' scales but 'functioning' scores were not worse than for those who reported their condition had improved. CONCLUSION: The effects of acne vulgaris on quality of life and changes in quality of life after treatment are not only explainable by objective severity of acne. Patients' and clinicians' judgements about acne severity are different.     

A double-blind trial of a zinc sulphate/citrate complex and tetracycline in the treatment of acne vulgaris

Forty-eight patients participated in a 3-month double-blind study to compare the effect of orally administered zinc sulphate/citrate complex and tetracycline hydrochloride in acne vulgaris. Tetracycline significantly reduced the overall grade, and the number of non-inflamed lesions, papules and pustules by the third month. It also reduced significantly the non-inflamed lesions and papules at the end of the second month. In contrast, zinc therapy only had a significant effect on the pustules at the third month. The results indicate that tetracycline is far superior to the zinc complex in patients with moderately severe acne.     

他扎罗汀乳膏短时接触疗法治疗寻常痤疮的临床研究

目的 评价0.1%他扎罗汀乳膏短时接触疗法治疗寻常痤疮时能否有效减轻局部不良反应,以及对临床疗效和症状反复的影响。方法 多中心、随机对照方法,将纳入观察的187例寻常痤疮病例分为短时接触疗法8周组,短时接触疗法12周组和常规治疗组,按Doshi痤疮综合分级系统（GAGS）计分评价,观察在治疗开始前（基线期）、完成时以及完成后的第2、4、8周内症状变化情况,评估局部不良反应和疗效,以及对病情反复的影响。结果 短时接触疗法8周组、12周组和常规治疗组局部不良反应率分别为11.48%、12.90%和38.33%,三组比较,差异有统计学意义（χ2 = 13.31,P < 0.01）。短时接触疗法12周组总有效率（80.65%）较8周组（63.93%）高（χ2 = 3.84,P < 0.05）。三组总有效率比较,差异无统计学意义（χ2 = 1.98,P > 0.05）。短时接触疗法12周组能明显降低病情反复,三组间2、4、8周各随访段病情反复率比较,差异均有统计学意义（χ2 = 3.29,3.78和5.85,P < 0.05 或P < 0.01）。结论 0.1%他扎罗汀乳膏短时接触疗法治疗寻常痤疮能有效减轻局部不良反应,且不降低疗效;而延长短时接触疗法疗程能减少症状反复,提高疗效。     

Benzoyl peroxide, adapalene, and their combination in the treatment of acne vulgaris

Benzoyl peroxide and adapalene are among the most effective topical agents used in the treatment of acne. We planned an open-labeled, prospective study to compare the effects and side effects of these two drugs alone and in combination in the treatment of acne vulgaris. One hundred and five consecutive patients (30 men and 75 women) with acne vulgaris were included in this study. The patients were randomly divided into three groups with 35 patients in each. The groups were randomly assigned to 0.1% adapalene gel, 5% benzoyl peroxide lotion, or combination of 0.1% adapalene gel +5% benzoyl peroxide treatment. Acne lesions were classified as noninflammatory (open and closed comedones) and inflammatory (papule, pustule, nodule, cyst), and the lesions on the face were counted before the therapy, during the control visits, and after the treatment. Erythema, dryness, burning, and other side effects were recorded during the treatment. The mean age of the patients was 18.44 +/- 3.75 years. Eight patients were excluded because of noncompliance with the treatment regimen or the follow-up schedule, and four patients were excluded due to allergic contact dermatitis. The study revealed that all three therapy protocols were effective in treating noninflammatory and inflammatory lesions in acne vulgaris (p<0.05) and that there was no significant difference between the groups in efficacy or side effects (p>0.05). Adapalene and benzoyl peroxide are effective and well tolerated agents for acne vulgaris; combination therapy has no superiority over adapalene or benzoyl peroxide alone.     

Motretinide versus benzoyl peroxide in the treatment of acne vulgaris

30 patients with acne vulgaris were treated topically with motretinide 0.1% vanishing cream or benzoyl peroxide 5% gel in an open study. Good results were obtained in both groups. Benzoyl peroxide caused local irritation in 73% of the patients, whereas motretinide was well tolerated except in 1 case. Motretinide is considered an alternative in the treatment of papulopustular acne in young adults.     

他扎罗汀乳膏短时接触疗法治疗寻常痤疮的临床研究

目的 评价0.1%他扎罗汀乳膏短时接触疗法治疗寻常痤疮时能否有效减轻局部不良反应,以及对临床疗效和症状反复的影响.方法 多中心、随机对照方法,将纳入观察的187例寻常痤疮病例分为短时接触疗法8周组,短时接触疗法12周组和常规治疗组.按Doshi痤疮综合分级系统(GAGS)计分评价,观察在治疗开始前(基线期)、完成时以及完成后的第2、4、8周内症状变化情况,评估局部不良反应和疗效,以及对病情反复的影响.结果 短时接触疗法8周组、12周组和常规治疗组局部不良反应率分别为11.48%、12.90%和38.33%,三组比较,差异有统计学意义(X2=13.31,P<0.01).短时接触疗法12周组总有效率(80.65%)较8周组(63.93%)高(X2=3.84,P<0.05).三组总有效率比较,差异无统计学意义(X2=1.98,P>0.05).短时接触疗法12周组能明显降低病情反复,三组间2,4、8周各随访段病情反复率比较,差异均有统计学意义(X2=3.29,3.78和5.85,P<0.05或P<0.01).结论 0.1%他扎罗汀乳膏短时接触疗法治疗寻常痤疮能有效减轻局部不良反应,且不降低疗效;而延长短时接触疗法疗程能减少症状反复,提高疗效.