异维A酸治疗中度寻常痤疮临床疗效观察

目的:评价异维A酸治疗中度痤疮的疗效和安全性。方法:采用随机、阳性药物平行对照的临床试验。试验组患者每日服用异维A酸(泰尔丝);对照组患者每日服用维胺酯,两组患者均治疗6周。治疗2、4、6周,对两组痤疮患者的粉刺、丘疹、脓疱、结节囊肿、皮脂溢出等评分比较。结果:试验组皮损的总评分差值从(0.2166±0.1291)分增至(6.2469±1.1826)分,对照组则从(0.1290±0.3191)分增至(5.6297±1.4489)分,两组间痤疮评分差值比较,差异有显著性。治疗结束时,试验组痊愈率和有效率分别为58.18%和100.00%,对照组分别为22.41%和82.75%,二组间疗效比较差异有显著性。试验组有23例患者出现局部不良反应,对照组有31例患者出现局部不良反应。结论:异维A酸治疗中度寻常痤疮疗效好于维胺酯。     

A review of the European Directive for prescribing systemic isotretinoin for acne vulgaris

Since the introduction of generic oral isotretinoin there have been discussions around harmonizing the summary of product characteristics of each formulation. As a result of these discussions, a European Directive concerned with the prescribing of oral isotretinoin has been introduced and the FDA (Food and Drugs Administration) has recently implemented new regulations. The aims of this article are to summarize the history of the processes involved, outline the new recommendations and discuss the impact of these changes in clinical practice.     

Downregulation of S100a7a antimicrobial peptide in acne vulgaris patients after isotretinoin therapy

The S100a7a protein is expressed in keratinocytes, its level is increased in acne condition. As isotretinoin therapy is known to alter some of S100 peptides, these could be important specific targets for acne therapy and may have an important role in clinical remission. A randomized controlled trial was held in a dermatology clinic in Baghdad, where 30 patients with moderate to severe acne vulgaris condition aged 16–31 years were enrolled. Five milliliters of venous blood samples were taken before and after 6 weeks of isotretinoin therapeutic trial. A placebo‐control group of 26 acne patients was also enrolled. The S100a7a peptide was measured in both groups using the ELISA technique before and after the trial. High levels of serum S100a7a were found in acne patients of both groups before therapeutic trial. Following the trial, a significant statistical difference (p = .0003) was noticed between mean S100a7a protein level of study and control groups. By comparing the mean S100a7a protein level before and after isotretinoin therapy in the study group, a highly significant statistical difference was also found (p = .001). The current study showed a downregulatory effect of isotretinoin therapy on the S100a7a peptide mean level.     

Spironolactone in adolescent acne vulgaris

Acne vulgaris (AV) is the most common skin condition affecting adolescents, most likely due to elevated androgen levels during puberty. Androgens stimulate and enlarge the sebaceous glands and keratinocytes, resulting in increased production of sebum and abnormal hyperproliferation of keratinocytes which lead to the formation of acne lesions. Current standard of care for AV includes topical therapies for mild cases and antibiotics or oral retinoids for severe cases. In recent years, spironolactone, an aldosterone antagonist and diuretic, has been applied to the treatment of AV due to its anti‐androgen effects. Spironolactone is currently recommended in women who use oral contraceptives, are refractory to or contraindicated for standard treatment, show clinical signs of hyperandrogenism, or present with late‐onset or persistent‐recurrent AV past the teenage years. It is not prescribed to adolescents due to potential side effects; however, current data studying adults indicate that most side effects are mild, and that potential associations with hyperkalemia and increased risk of cancer are not sufficiently supported. Hence, we believe that spironolactone may be a safe and effective therapy for adolescent AV.     

Mood changes and clinical decision making in adolescent patients on isotretinoin therapy for acne vulgaris

Although numerous studies have demonstrated no causal relationship between isotretinoin and depression or suicide, subtle mood changes and idiosyncratic mood symptoms have been reported in patients on isotretinoin treatment for acne vulgaris, and few studies have described the full range of mood symptoms and clinical course after a mood change arises. We reviewed 247 patients, ages 10–25 years, with acne vulgaris on isotretinoin and found that 26/247 (10.5%) patients experienced mood changes, the most common being depressive symptoms, anxiety, aggression, and emotional lability. Regardless of treatment management, 22/25 (88%) patients experienced improvement of mood symptoms to baseline, and 22/25 (88%) were able to complete their isotretinoin course without symptom recurrence. Our findings highlight the importance of monitoring for a broad range of mood changes in patients on isotretinoin, especially those related to a pre-existing mood disorder and including those which do not meet formal criteria for a psychiatric disorder.     

The practicalities of photodynamic therapy in acne vulgaris

A staple clinical skill in a dermatologist’s repertoire is the ability to treat acne vulgaris effectively. Light‐based therapies such as photodynamic therapy (PDT) widen the therapeutic options available for acne. Numerous review articles have agreed on the answer to core questions such as: ‘Does PDT work?’ and ‘Which acne lesions respond best to PDT?’ They conclude that PDT is especially useful in inflammatory acne and may be superior to light therapy alone. This literature review seeks to offer guidance regarding treatment‐specific queries about the photosensitizer, route of administration, treatment intervals, light sources and patient selection. Ovid Medline, PubMed and EMBASE database searches were executed between January 2007 and March 2008. Due to the scarcity of data, all five randomized trials, four of which were at least investigator blinded and controlled, 12 open clinical studies, two case reports and two abstracts published in English were considered. Four hundred and nineteen patients were recruited. As the quality of the data was suboptimal in a significant number of articles, the conclusions are drawn in very broad strokes: topical short‐contact (90 min or less) 5‐aminolaevulinic acid or methyl aminolaevulinate using a noncoherent light source at 2–4‐week intervals for a total of two to four treatments produces the greatest clinical effect. Papulopustular acne is more responsive and all Fitzpatrick skin types are eligible. However, patients with skin types I–III have a reduced risk of postinflammatory hyperpigmentation seen in darker skin types. These treatment parameters demonstrate a good side‐effect profile resulting in acne remission for at least 3 months to a year in a relatively cost‐effective manner. Well‐designed nonsplit‐face randomized controlled trials would offer further guidance, especially for queries surrounding the light source and illumination schemes.     

Evaluation of hematological parameters in patients using systemic isotretinoin with diagnosis of acne vulgaris

Objectives

Oral isotretinoin is the most effective treatment option in patients with acne. However, it can cause various hematologic and biochemical abnormalities. This study aimed to evaluate hematologic abnormalities during oral isotretinoin treatment in patients with acne.

Material and Methods

In this cross-sectional study, the hematologic and inflammatory parameters of 138 patients with acne using 0.3-1 mg/kg/day oral isotretinoin for at least 6 months were retrospectively analyzed.

Results

In the study, the female-to-male ratio was 2.83, and the mean age of the patients was 23.1 ± 5.8 years. At the third and sixth months of isotretinoin treatment, there was a statistically significant decrease in the neutrophil count compared to the pre-treatment values (p = 0.003 and p = 0.032, respectively). The platelet count showed the most statistically significant increase (p < 0.001) at the first month of treatment. The most statistically significant decrease in the neutrophil-to-lymphocyte ratio (NLR) was observed at the third month of treatment (p < 0.001). No significant changes were observed in hemoglobin, hematocrit, white blood cell count, mean corpuscular volume, and mean platelet volume.

Conclusions

There was a decrease in neutrophils and NLR and an increase in platelets during isotretinoin treatment, and these changes were usually mild. However, it would be appropriate to monitor blood counts during treatment in patients with neutropenia or thrombocytosis.     

Decrease in glutathione may be involved in pathogenesis of acne vulgaris

Background Some past studies reported that oxidative stress components such as reactive oxygen species (ROS) or lipid peroxide (LPO) are involved in the pathogenesis and progression of acne vulgaris. In this study, we hypothesized that the pathogenesis of acne vulgaris may depend on the differences in antioxidative activity among antioxidants in our body. We collected samples of stratum corneum from acne patients and healthy subjects and compared the quantity of gluthathione (GSH), one of many antioxidative components in our body, for comparison. Methods Samples of stratum corneum were collected from facial acne‐involved lesion, facial uninvolved area, and the medial side of the upper arm in acne vulgaris patients. Similarly, samples were collected from a facial uninvolved area and the medial side of the upper arm in healthy subjects. The quantity of GSH was measured in each area. In vitro effects of alpha‐melanocyte stimulating hormone (α‐MSH) on GSH synthesis‐related gene were also examined. Results The quantity of GSH in stratum corneum from each area was significantly lower in acne vulgaris patients than that of healthy subjects. There was no significant difference in quantity of GSH between the acne‐involved lesion and uninvolved area in acne patients. In vitro studies showed that the expression level of Glutamate‐cysteine ligase catalytic subunit (GCLC), one of the GSH synthesis‐related genes, was significantly decreased by the additional use of α‐MSH. Conclusions We conclude that a decline in antioxidative activity led by a decrease in GSH quantity may play an important role in pathogenesis of acne vulgaris. The use of α‐MSH may further decrease the GSH level.     

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.     

Oxidative stress in acne vulgaris

Background Acne vulgaris is one of the common dermatological diseases and its pathogenesis is multifactorial. In this study, we aimed to determine the effects of oxidative stress in acne vulgaris. Materials and methods The study involved 32 patients with acne vulgaris in the patient group and 34 healthy adults in the control group. The parameters of oxidative stress such as catalase (CAT), superoxide dismutase (SOD), xanthine oxidase (XO), nitric oxide (NO) and malondialdehyde (MDA) in the venous blood of patients were measured spectrophotometrically. The values were compared with those of the control group. Results The serum levels of MDA and XO activity in the patients with acne vulgaris were significantly higher than those of the controls. A significantly lower SOD and CAT activity was found in the patient group than in the control group. Although the patient group had higher serum levels of NO than the control group, the difference was not statistically significant. Conclusion These results suggest that oxidative damage may play a role in the pathogenesis of acne; therefore, significant alterations may occur in the antioxidant defence system.     

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.     

Evaluation of subclinical atherosclerosis in Turkish patients with acne vulgaris receiving systemic isotretinoin

Studies conducted on isotretinoin have shown that it may indirectly lead to atherosclerosis. The objective of this study was to determine the effect of systemic isotretinoin on subclinical atherosclerosis. The present study included 63 patients with acne vulgaris who had used isotretinoin for 6 months. Glucose, insulin, and homeostatic model assessment of insulin resistance levels; body mass index; waist circumference; blood pressure; lipid profile; and lectin‐like oxidized low‐density lipoprotein receptor‐1 (LOX‐1), high‐sensitivity C‐reactive protein, and oxidized low‐density lipoprotein (Ox‐LDL) levels were compared in the patients at the initiation and discontinuation of the treatment. At the discontinuation of the treatment, LOX‐1 and Ox‐LDL levels showed a significant increase (P < .001 and P = .040, respectively). Differences in waist circumference were positively correlated with an increase in LOX‐1 levels (r = .274; P = .030). Isotretinoin causes an increase in the levels of subclinical atherosclerosis markers. Although the present study sample size was small, we believe that caution should be exercised considering the risk of atherosclerosis during isotretinoin use in men with high waist circumference and cardiovascular risk factors; further studies are warranted in this regard.     

Significant reduction of inflammation and sebaceous glands size in acne vulgaris lesions after intense pulsed light treatment

Intense pulsed light (IPL) has been used for years in treatment of acne vulgaris. However, quantitative evaluation of histopathological changes after its use as a sole therapy was poorly investigated. Accordingly, this study aims to objectively evaluate inflammatory infiltrate and sebaceous glands in acne vulgaris after IPL. Twenty‐four patients of acne were treated with six IPL sessions. Clinical evaluation was done at 2 weeks after last session by counting acne lesions. Patient satisfaction using Cardiff Acne Disability Index (CADI) was recorded at baseline, 2 weeks and 3 months after IPL. Using histopathological and computerized morphometric analysis, quantitative evaluation of inflammatory infiltrate and measurement of surface area of sebaceous glands were performed for skin biopsies at baseline and 2 weeks after last session. After IPL, there was significant reduction of all acne lesions especially inflammatory variety with significant decrease of CADI score at 2 weeks and 3 months after IPL (p < .05). Microscopically, there was significant decrease in density of inflammatory infiltrate and surface area of sebaceous glands (p < .05). So, IPL is fairly effective therapy in acne vulgaris especially inflammatory variety. The results suggest that IPL could improve acne lesions through targeting both inflammation and sebaceous glands.     

The effectiveness of intermittent isotretinoin treatment in mild or moderate acne

BACKGROUND: Isotretinoin is the only drug that affects almost all factors in acne pathogenesis. Recently, its use for the treatment of chronic mild or moderate acne unresponsive to long-term antibiotic therapy, and with a tendency to cause scarring and leading to negative psychological effects, has became popular. The aim of the study was to investigate the effectiveness of intermittent isotretinoin treatment in mild or moderate acne. METHODS: Sixty patients with mild or moderate acne localized to the face were enrolled in the study. The treatment regimen consisted of isotretinoin, 0.5-0.75 mg/kg per day, applied for 1 week every 4 weeks for a total period of 6 months, according to the degree of acne and number of inflammatory lesions. RESULTS: Forty-one (68.3%) of the 60 patients completed the 6-month therapy. At the end of the treatment complete improvement was observed in 34 patients (82.9%) out of 41. All adverse effects were mild and discontinuation of the treatment was not necessary. CONCLUSION: Intermittent isotretinoin treatment was found to be a safe and effective choice for patients with mild or moderate acne.