Induction of toll-like receptors by Propionibacterium acnes

BACKGROUND: The bacterium Propionibacterium acnes is involved in the induction and maintenance of the inflammatory phase of acne. Recent studies have found that keratinocytes express toll-like receptors (TLRs) implicated in immediate immunity. No studies have, to date, been carried out on the action of P. acnes upon TLR activation in keratinocytes. OBJECTIVES: Focusing on the inflammatory phase of acne, to clarify the role of P. acnes in immediate immunity by inducing expression of TLR-2 and TLR-4 by keratinocytes. We also studied how the secretion and expression of matrix metalloproteinase (MMP)-9 is induced by P. acnes. METHODS: The work was carried out on two levels: in vivo with the study of the expression of TLR-2 and TLR-4 proteins in biopsies of acne lesions and in vitro on cultured keratinocyte monolayers to study the modulating effects of P. acnes on the expression of TLR-2 and TLR-4 and also on the expression and secretion of MMP-9. RESULTS: Our findings reveal that in vivo TLR-2 and TLR-4 expression is increased in the epidermis of acne lesions. In vitro, an increase in TLR-2 and TLR-4 expression by human keratinocytes occurred in the first hours of incubation with bacterial fractions as well as an increase of the expression and secretion by the keratinocytes of MMP-9, which plays a role in inflammation. CONCLUSIONS: This work demonstrates that P. acnes induces TLR expression and that this mechanism could play an essential role in acne-linked inflammation. These receptors could be involved notably in acute acne.     

Ocular surface disorders and tear function changes in nodulo-cystic acne

The aim of this study was to investigate the ocular surface disorders and tear function changes in patients with nodulo-cystic acne. Eighty-seven patients with nodulo-cystic acne vulgaris and 50 healthy subjects were included in the study. All subjects underwent full ocular examinations. Subjective ocular complaints were recorded. Corneal staining with fluorescein, tear film break-up time (BUT), and Schirmer test were applied. Abnormal tear film BUT and abnormal Schirmer scores were significantly more common in the acne group than in the control group. The tear film BUT was abnormal in 18 (20.7%) cases in the patient group and in 2 (4%) subjects in the control group (p=0.007). The mean Schirmer score was abnormal in 7 (8%) and decreased in 18 (20.7%) acne patients, and it was decreased in only 3 (6%) control subjects (p=0.005). Corneal punctuate epithelial erosions were detected in 3 (3.4%) acne patients, but not any of the control subjects. However, the difference between the groups was not statistically significant (p=0.184). Subjective ocular complaints were present in 28 cases (32.2%) in the patient group. Five (10%) subjects in the control group had such complaints (p=0.003). Tear function tests are also significantly altered in patients with nodulo-cystic acne. Our data suggest that severe acne patients should be referred to an ophthalmologist.     

Abnormal production of tumor necrosis factor (TNF) -- alpha and clinical efficacy of the TNF inhibitor etanercept in a patient with PAPA syndrome [corrected

We report a family with pyogenic sterile arthritis, pyoderna and acne syndrome (PAPA). The proband presented several episodes of sterile pyogenic arthritis and became unresponsive to glucocorticoids. After treatment with the tumor necrosis factor inhibitor etanercept, the disease underwent rapid and sustained clinical remission. Production of tumor necrosis factor-alpha by mononuclear cells of the proband and of the affected relatives was abnormally elevated.     

Treatment of rhinophyma with Er:YAG laser

BACKGROUND AND OBJECTIVE: Rhinophyma is a benign, disfiguring disorder of the nose which presents the end stage of acne rosacea, and can also occasionally result in nasal airway obstruction. We describe the first series of patients treated with Erbium laser. STUDY DESIGN/MATERIALS AND METHODS: Severe-to-moderate rhinophyma in six patients were treated at our institution between 1995 and 1996, using the Erbium:YAG (Erb:YAG) laser. RESULTS: All patients achieved marked cosmetic improvement, with no complications. Post-operative healing time was seven to fourteen days-significantly shorter than similar other modalities. CONCLUSIONS: The Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period as shown in our study.     

中药内服配合皮肤外治法治疗痤疮350例免疫学改变及疗效分析

目的：探讨用中药内服配合皮肤外治法治疗痤疮的临床疗效及对免疫学指标的影响。方法：对350例痤疮患者采用中药辨证分型内服配合皮肤外治法治疗，检测其治疗前后免疫学指标。结果：中药内服配合皮肤外治法治疗痤疮疗效甚佳，痤疮患者的免疫学改变和治疗疗效有直接联系。     

Severe acne as a side effect of propranolol and nadolol in a migraineur

Beta-blockers have proven effective in the treatment of migraine. Dermatologic side effects are extremely rare. We report a patient with migraine who developed an acnelike dermatitis with two different beta-blockers with complete resolution of the acne upon discontinuation of each drug.     

Contemporary surgical treatment of hidradenitis suppurativa (HS) with a focus on the use of the diode hair laser in a case

Abstract

Hidradenitis suppurativa, a chronic recurrent disorder, characterized by painful, deep-seated nodules and abscesses commonly affecting the pilosebaceous-apocrine unit of the axillary, inguinal and mammary region in females, while the perianal area and buttocks are the prevalent sites in males. Its onset is after puberty, and may persist thereafter. Its exact aetiology is speculative. Follicular occlusion is the primary event leading to secondary inflammation, infection and destruction of the unit, ultimately affecting the adjoining subcutaneous tissue. Smoking and obesity may trigger or aggravate the condition. Stage of disease determines the mode of treatment. Medical treatment is valid in the early stage, but the results are transient. The early stage may warrant incision, and drainage of abscesses coupled with limited excision for locally recurring draining sinuses. While radical excision and healing with secondary intention, skin grafting, and flaps is recommended in advanced stages, laser therapy including the diode laser may prove a promising and innovative alternative.     

Therapeutic utility of antibacterial peptides in wound healing

Cationic antimicrobial peptides were first thought to fight infection in animal models by disintegrating bacterial peptides and later by inhibiting bacteria-specific intracellular processes. However, ever increasing evidences indicate that cationic peptides accumulate around and modulate the immune system both systemically and in cutaneous and mucosal surfaces where injuries and infections occur. Native and designer antibacterial peptides as well as cationic peptides, never considered as antibiotics, promote wound healing at every step of cutaneous tissue regeneration. This article provides an introductory list of examples of how cationic peptides are involved in immunostimulation and epithelial tissue repair, eliminating wound infections and promoting wound healing in potential therapeutic utility in sight. Although a few antimicrobial peptides reached the Phase II clinical trial stage, toxicity concerns limit the potential administration routes. Resistance induction to both microbiology actions and the integrity of the innate immune system has to be carefully monitored.     

New photographic techniques for clinical evaluation of acne

Clinical evaluation of acne is usually based on direct visual assessment and ordinary flash photography, both of which are compromised by viewer subjectivity. It is difficult to accurately assess individual acne lesions and to observe early response to therapy. Standard flash photography has inherent limitations owing to the physics of light; it does not permit consistent visualization of subtle cutaneous characteristics like erythema or microcomedones, and it tends to blur distinctions between active inflammatory lesions and older hyperpigmented macules. Over the last decade there has been increasing interest in newer techniques aimed at increasing the accuracy and objectivity of acne evaluation. These include parallel‐polarized light photography, cross (or perpendicular)‐polarized light photography, videomicroscopy, and fluorescence photography. This article will review the advances of the past decade and summarize new techniques to evaluate acne lesions. Moreover, findings of a study that evaluated the course of individual acne lesions and the effects of adapalene gel 0.1% on inflammatory and non‐inflammatory acne lesions will be viewed. In this study, the use of parallel‐polarized and cross‐polarized photography, in combination with videomicroscopy and sebum production measurement, provided objective, detailed information on the evolution of different variable acne lesions and their response to adapalene gel 0.1%. Adapalene treatment produced rapid resolution of inflammatory and non‐inflammatory lesions, and inhibited formation of new lesions. Sebum secretion rates also declined during treatment. Use of the new assessment techniques proved to be a valuable, non‐invasive and reliable method of assessing acne vulgaris and its response to treatment.     

Technologies for cutaneous exfoliation using salicylic acid

The use of superficial chemical peels to achieve cutaneous exfoliation is valuable in maintaining a smooth skin texture. One of the preferred chemical modalities to perform superficial peels is salicylic acid. Salicylic acid can used to safely peel many different skin types because of its ability to self-neutralize. In addition, it is beneficial in the treatment of acne because of its comedolytic effect. The methodology for salicylic acid peeling is presented.