Higher body mass index is a significant risk factor for acne formation in schoolchildren

Obesity is frequently accompanied by peripheral hyperandrogenism, which may be associated with increased sebum production and the development of severe acne. Body mass index (BMI) is one of the most accurate ways to measure and determine obesity. The aim of the present study was to study the correlation between obesity and the point prevalence and patterns of acne in schoolchildren. A total of 3,274 children (aged 6-11 years) from Magong Township were examined by two board-certified dermatologists. The acne prevalence was 7.3%, with more girls affected than boys (ratio = 1.5). Comedones were more commonly observed than inflammatory acne (10.4% vs. 6.9%). The mean of BMI in non-acne students (18.2 +/- 3.4) was significantly lower than that in acne subjects (19.5 +/- 3.7), without gender difference. Overall schoolchildren with a BMI < 18.5 had less prevalence rate of acne, especially the inflammatory lesions, while those with a BMI-for-age > or = 95% had a significantly higher rate of acne development.     

Pruritus, an uncommon but important symptom of systemic carcinoma.

A distinctive pruritic syndrome associated with systemic cancer is described. Prolonged, variably severe pruritus with a tendency to localization on the legs, upper trunk, and extensor surfaces of the upper extremities is the presenting symptom. Patients with unexplained persistent itching as herein described should be investigated for a hidden malignancy. The persistence or recurrence of itching, months or even years after apparent cure of a systemic carcinoma, suggests that destruction or removal of the primary tumor was incomplete, or that metastasis has supervened. A small carcinomatous focus may exist for many months and at times for years before clinical recognition is possible with diagnostic methods currently available.     

Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients

BACKGROUND: Pruritus is the most frequent and distressing symptom associated with dermatoses and various internal and neurological diseases. OBJECTIVES: To investigate two different populations of patients with pruritus, one in Germany and one in Uganda, with a particular focus on clinical characteristics, aetiology and quality of life. METHODS: We investigated by questionnaire 132 patients (59 men, 73 women, mean age 54.5 years) who were referred to the Department of Dermatology at the University Hospital of Magdeburg, Germany, with the diagnosis of pruritus as a leading symptom. The questionnaire was also applied in 84 patients who consulted the Dermatology Clinic at Mbarara, Uganda for pruritus. The questions referred to personal data and disease history of the individual, history and present occurrence of concomitant diseases, present and past therapy, quality, frequency and triggers of itching and scratching, other disorders and complaints, quality of life and impact on work and disability. RESULTS: Seventy-five (57%) of the German patients had pruritus due to dermatoses, 47 patients (36%) had pruritus due to a systemic disease and in 10 patients (8%) pruritus was of unknown origin. Most had a history of pruritus of several months up to years. Pruritus associated with dermatoses mostly affected the whole body and was permanent with an undulatory character. Affective reactions such as aggression and depression occurred more frequently in dermatological patients compared with those with systemic pruritus. The former group felt that pruritus had a greater impact on their lives. Almost all Ugandan patients had pruritus due to dermatoses except for three patients with pruritus of unknown origin. Eczema and prurigo were the most frequently observed dermatoses in both German and Ugandan patients. Patients with pruritus in both populations showed an impaired quality of life. There was no pronounced difference between the populations with regard to feelings of depression and suicidal thoughts. CONCLUSIONS: A great deal of helpful information in this complex group of patients can be obtained using this questionnaire. Pruritus has a major impact on quality of life and especially impairs those patients with pruritus associated with dermatoses and pruritus of unknown origin.     

Less common methods to treat acne

Effective medications to treat acne sometimes become unavailable in certain countries, either for economic reasons or for shortage of them in the pharmaceutical market. The purpose of this report is to review a series of drugs of topical and systemic use; some old and some new. The topical group includes agents such as sulfur, salicylic acid and the alpha-hydroxy acids, while the systemic group includes diaminodiphenylsulfone, clofazimine, ibuprofen and others. Some presumably useful physical methodologies and the recent findings in phototherapy, particularly the properties of blue light and blue-red light, are also reviewed. Finally, we report on the results obtained from the combined use of isotretinoin and methylprednisone in severe inflammatory acne, to prevent a possible triggering of the 'pseudo' acne fulminans.     

Papular acne scars. A common cutaneous finding

One hundred thirty-three patients were examined for the presence of a cutaneous eruption consisting of small, asymptomatic, hypopigmented, follicular papules on the upper part of the trunk. The papules were present in 57% of patients who had a history of acne vulgaris and in 9% of patients who denied ever having had acne. Biopsy specimens from five patients revealed circumscribed, perifollicular or parafollicular lesions in which both elastic and collagen fibers were attenuated in comparison with those in normal adjacent dermis. These changes are consistent with scar. We conclude that the papules are a scarring process secondary to acne vulgaris and propose calling the lesions papular acne scars. They appear closely related to or identical with changes previously termed perifollicular elastolysis, postacne anetoderma-like scars, and papular elastorrhexis.     

Pruritus: a review

The history, neurophysiology, clinical aspects and treatment of pruritus are reviewed in this article. The different forms of pruritus in dermatological and systemic diseases are described, and the various aetiologies and pathophysiology of pruritus in systemic diseases are discussed. Lack of understanding of the neurophysiology and pathophysiology of pruritus has hampered the development of adequate therapies. Nevertheless, the discovery of primary afferent neurons and, presumably, second-order neurons with typical histamine responses mediating pruritic sensations can be regarded as a breakthrough in our understanding of the mechanisms behind pruritus. The number of experimental and therapeutic studies has greatly increased during the past few years, reflecting an increased interest in this topic. However, further effort is needed to develop new therapeutic concepts and clarify some confusion arising from promising case reports and uncontrolled clinical studies. A precise work-up for evaluating patients with pruritus is proposed, which may help the physician to identify the underlying causes and thus to treat the patient appropriately.     

Most common patterns of acne in male adolescents: a population‐based study

Background Acne vulgaris is a common skin disease affecting more than 85% of adolescents and often continuing into adulthood. Population‐based studies to assess the patterns and severity of acne have not been achieved. Objectives The aim of this study was to assess the most common patterns of facial and trunk acne in young (18‐year‐old) men in a representative sample of male adolescents in a city in southern Brazil and to investigate the severity of inflammatory and non‐inflammatory lesions in these individuals. Methods In Brazil, military service is compulsory for all males. Every adolescent male must report to his military service headquarters to submit to a medical screening examination. The study included 2201 adolescents, each of whom underwent a skin examination conducted by a dermatologist to identify and quantify all non‐inflammatory (comedones) and inflammatory (papules, pustules, and nodules) lesions. Results Non‐inflammatory lesions (comedones) were observed on 1487 individuals, and inflammatory lesions (papules and pustules) were noted on 1497 individuals. The most common patterns of facial acne were the full‐face, bilateral malar and frontal mentonian distributions. Conclusions This is the first population‐based study to evaluate patterns of acne. Facial involvement was very prevalent, and the frontal region was found to dominate patterns of distribution of acne vulgaris. Comedonian acne of the face was much more intense and affected the entire face. In inflammatory facial acne, the majority of the study subjects exhibited up to five lesions in the region under study.     

Isotretinoin produces significant inhibition of monocyte and neutrophil chemotaxis in vivo in patients with cystic acne

The effect of oral isotretinoin (13-cis-retinoic acid) on in vivo chemotactic responses was studied longitudinally in 7 patients with cystic acne. As measured in a microchamber chemotaxis assay, both monocyte and neutrophil chemotaxis were inhibited 98% (p less than 0.001) during isotretinoin treatment. In vivo chemotactic responses returned to normal within 2 months of cessation of treatment. Biopsies of skin chamber sites from patients on isotretinoin showed no significant dermal or epidermal leukocytic accumulation in response to autologous zymosan-activated serum, whereas chambers from controls showed extensive neutrophilic infiltrates even in the epidermis. In contrast, in vitro chemotactic responses of neutrophils and monocytes from patients on isotretinoin were not diminished. Sera and plasma from patients on isotretinoin contained no inhibitors of chemotaxis, and activated sera from these patients were excellent attractants for normal monocytes. We postulate that isotretinoin produces significant anti-inflammatory effects by inhibition of monocyte and neutrophil chemotaxis across intact biologic barriers in vivo.     

Formaldehyde is a significant allergen in women with hand eczema

Among patients consecutively patch tested at St John's from 1984-1989, the prevalence rate of formaldehyde sensitivity was 2.2% for men and 3.7% for women. During these 6 years, 117 women were primarily sensitized by formaldehyde, of whom 61 (52%) had hand eczema. Exposure was occupational in 12% and domestic in 88%. Cleaning products were the main source of exposure in the domestic group. 20 women with hand eczema avoided formaldehyde and their hands healed in 2, greatly improved in 11 and were better in 7.