The clinical effectiveness and cost-effectiveness of fractional CO2 laser in acne scars and skin rejuvenation: A meta-analysis and economic evaluation

Introduction: Fractional CO₂ has many indications in medicine including in treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO₂ Laser in comparison with other methods of rejuvenation and acne scar treatment. Materials and Methods: Several databases including Medline, OVID, EMBASE, CINHAL, SCOPUS, Web of science, CRD, and Cochrane were searched. After conducting the search and evaluation of selected publications, critical appraisal was done and eligible studies were accepted for inclusion in the systematic review. Results and Discussion: From 2667 identified publications two of the trials were eligible. The effectiveness and complications of Fractional CO₂ laser were comparable with Er:YAG but Fractional CO₂ laser was 14.7% (p = 0.01) more effective than Q-Switched ND:YAG laser. Cost affectivity of this method was the same as other alternative lasers. In conclusion Fractional CO₂ laser is an effective and safe method for curing of several kinds of skin diseases. Nevertheless there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative CO₂ laser that has the same or lower price and comparable effects.     

Isotretinoin and lymecycline treatments modify the skin microbiota in acne

Oral retinoids and tetracyclines have a major role in acne treatment. Here, we report for the first time the effect of isotretinoin and lymecycline therapy on the skin microbiota in cheek, back and armpit swab samples of acne vulgaris patients using 16S ribosomal RNA (16S rRNA) gene amplicon sequencing. Propionibacterium acnes was the most common in sebaceous areas of healthy and untreated acne skin and more abundant in back than cheek samples. Five taxa, including a Streptococcus taxon, differed significantly between the cheek samples of healthy controls and acne patients, and acne severity was positively correlated with the abundance of Propionibacterium. Both treatments reduced clinical acne grades and the abundance of Propionibacterium, while the abundance of several other taxa was significantly higher in treated cheek samples compared with untreated ones. Less variation was observed in back samples and none in armpit samples. There were no differences in alpha diversity between control and acne patients in any of the sampled skin areas, but the diversity of the microbiota on the cheek and the back was significantly increased after acne treatments. This study provides insight into the skin microbiota in acne and how it is modulated by systemic acne treatment.     

滋肾清肝汤联合挑治法治疗青春期后痤疮合并黄褐斑临床研究

目的:观察滋肾清肝汤联合挑治法对青春期后痤疮合并黄褐斑患者的疗效及激素水平的影响。方法:将45例痤疮合并黄褐斑患者随机分成治疗组和对照组,治疗组24例,内服滋肾清肝汤联合挑治法;对照组21例,仅内服滋肾清肝汤,疗程12周。观察患者外周血的血清激素水平,通过观察皮损数量大小、暗色斑片颜色变化、面积大小等判定疗效,并对比治疗前后激素水平的变化。结果:治疗组痤疮的痊愈率91.67%,总有效率100%;对照组痤疮的痊愈率80.95%,总有效率100%,两组比较差异无统计学意义(P=0.3960.05);治疗组黄褐斑痊愈率37.5%,总有效率95.83%;对照组黄褐斑痊愈率9.52%,总有效率71.43%,总有效率两组比较差异有统计学意义(P=0.0390.05)。治疗组患者经滋肾清肝汤联合挑治法治疗后,外周血清激素水平较治疗前趋于正常。结论:滋肾清肝汤联合挑治法对痤疮合并黄褐斑患者的疗效优于单用滋肾清肝汤组,且复发率低,其作用机制可能与调节机体内分泌水平等有关。     

Evaluating FMX-101 as a promising therapeutic for the treatment of acne

ABSTRACT

Introduction

Oral minocycline is a mainstay of therapy for moderate-to-severe acne; however, systemic side effects which include hepatotoxicity, lupus-like syndrome, drug hypersensitivity syndrome, autoimmune hepatitis, polyarteritis nodosa, gastrointestinal side effects and skin hyperpigmentation are of concern. Topical antibiotics commonly used in acne, such as erythromycin and clindamycin, present high P. acnes resistance rates which has opened the market for new topical antibiotics. FMX-101 is a novel topical minocycline foam that has shown promising results in phase I, II and III trials for the treatment of moderate-to-severe acne with a better safety profile than oral minocycline.     

Non-invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris

Background: During the past few years, various phototherapeutic protocols with full‐spectrum visible light or selected wavebands have been investigated in the treatment of acne vulgaris with variable results. Methods: Fifteen women suffering from moderate acne vulgaris of the face were exposed to 20 J/cm² of broad‐band red (λ: 600–750 nm) light twice weekly for 4 weeks. In addition, with the aim to improve the present knowledge of the mechanisms of action of phototherapy, we measured skin sebum, pH, hydration and trans‐epidermal water loss (TEWL). Lesions of the trunk were not irradiated and served as controls. Results: A significant improvement of acne lesions and a significant decrease of skin sebum excretion and TEWL of the face were registered at the end of the therapy and at the 3‐month follow‐up visit. The results could be related to a reduced follicular colonization of Propionibacterium acnes, in that it was lethally damaged by photoactivated endogenous porphyrins. Conclusion: The present findings seem to indicate that red light phototherapy may represent an effective, well‐tolerated, safe, simple and inexpensive treatment option for moderate acne vulgaris.     

Long-term efficacy of a single course of infliximab in hidradenitis suppurativa

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by abscess formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. Recently, several case reports have been published describing successful treatment of hidradenitis suppurativa with infliximab and other tumour necrosis factor alpha inhibitors. OBJECTIVES: To evaluate the long-term efficacy of a single course of infliximab. METHODS: Ten patients with severe, recalcitrant hidradenitis were treated with infliximab (three infusions of 5 mg kg(-1) at weeks 0, 2 and 6) and followed up for at least 1 year. The disease activity was measured using laboratory parameters and a recently developed acne score. The patients rated the efficacy of infliximab on a 10-point scale at regular intervals. Quality of life was measured before and after treatment using the Dermatology Quality of Life Index (DQLI). RESULTS: All patients improved within 2-6 weeks. The average acne score diminished from 164+/-50 (mean+/-SD) before treatment to 89+/-49 after 1 year (P=0.002). The mean CRP (C-reactive protein) was reduced from 31.7 mg mL(-1) to 5.5 mg mL(-1) after 1 month (P=0.015). Patients judged the efficacy with a score of 7.9. The mean DQLI was reduced from 18.4+/-7.9 before treatment to 9.3+/-9.1 after 1 year (P=0.007). In three patients long-lasting improvement was observed, with no recurrence of lesions in a 2-year follow-up period. The other patients showed recurrence of lesions after 8.5 months (range 4.3-13.4 months). CONCLUSIONS: Infliximab is an effective treatment in severe hidradenitis suppurativa, leading to reduction of symptoms for a prolonged period.