Recent advances in acne pathogenesis: implications for therapy

The age-old problem of acne

Acne vulgaris is one of the top three most commonly encountered dermatological problems worldwide in both primary and secondary care. Acne diagnosis and treatment date back to ancient Greek and Egyptian times. This article explores acne through the ages and discusses past theories on etiology and treatment with particular focus on the discovery of retinoids and their impact on women's health.

Energy-Based Devices in Treatment of Acne Vulgaris

BACKGROUND

Acne vulgaris is a chronic dermatologic complaint with a multifactorial cause. Traditionally, antibiotics and retinoids have been used to manage the condition; patient compliance has been an ongoing issue. A variety of energy-based devices have been reported to be effective in the treatment of acne vulgaris.

OBJECTIVE

To review and summarize the current literature specific to treatment of acne vulgaris with energy-based devices.

METHODS

A review of the current literature of energy-based devices used for the treatment of acne vulgaris.

RESULTS AND CONCLUSIONS

Although limited randomized controlled trials for the treatment of acne have been performed, significant clinical improvement of acne vulgaris, especially of inflammatory lesions, has been demonstrated with a variety of energy-based devices. Newer approaches may lead to even better results.

Infectious Disease Practice Gaps in Dermatology

The article highlights different educational and practice gaps in infectious diseases as they pertain to dermatology. These gaps include the use of antibiotics in relation to atopic dermatitis and acne vulgaris, treatment of skin and soft tissue infection, and diagnosis and treatment of onychomycosis. In addition, practice gaps related to use of imiquimod for molluscum contagiosum, risk of infections related to immunosuppressive medications and rates of vaccination, and the use of bedside diagnostics for diagnosing common infections were discussed.

Proteolytic activity in the meibomian gland: Implications to health and disease

The function of the meibomian gland in the upper and lower eyelids is critical to maintaining homeostasis at the ocular surface. Highly specialized meibocytes within the gland must differentiate and accumulate intracellular lipid droplets that are released into the tear film following rupture of the cell membrane. Proteases and their inhibitors have been recognized as key players in remodeling extracellular matrices and promoting the normal integrity of glandular tissue. They modulate a wide range of biological processes, such as cell proliferation and differentiation, and can contribute to disease when aberrantly expressed. Deciphering the role of proteolytic activity in the meibomian gland offers an opportunity to gain a more comprehensive and fundamental understanding of the developmental, physiological, and pathological processes associated with this gland.

Evaluation and Management of Refractory Acne Vulgaris in Adolescent and Adult Men

Acne vulgaris alters the normal skin physiology, impairing stratum corneum and transepidermal water loss. A male's normal skin physiologic state is different than a female's and may have implications when choosing treatment when the skin is altered in a disease state. Transepidermal water loss, pH, and sebum production are different between the sexes. Several underlying conditions present in male acne patients at several ages that may require a more in-depth evaluation. As knowledge of the pathogenesis of acne expands, the differences in skin physiology between the sexes may alter the manner in which male patients with acne medications are approached.

Dysbiotic Bacterial and Fungal Communities Not Restricted to Clinically Affected Skin Sites in Dandruff

Dandruff is a prevalent chronic inflammatory skin condition of the scalp that has been associated with Malassezia yeasts. However, the microbial role has not been elucidated yet, and the etiology of the disorder remains poorly understood. Using high-throughput 16S rDNA and ITS1 sequencing, we characterized cutaneous bacterial and fungal microbiotas from healthy and dandruff subjects, comparing scalp and forehead (lesional and non-lesional skin sites). Bacterial and fungal communities from dandruff analyzed at genus level differed in comparison with healthy ones, presenting higher diversity and greater intragroup variation. The microbial shift was observed also in non-lesional sites from dandruff subjects, suggesting that dandruff is related to a systemic process that is not restricted to the site exhibiting clinical symptoms. In contrast, Malassezia microbiota analyzed at species level did not differ according to health status. A 2-step OTU assignment using combined databases substantially increased fungal assigned sequences, and revealed the presence of highly prevalent uncharacterized Malassezia organisms (>37% of the reads). Although clinical symptoms of dandruff manifest locally, microbial dysbiosis beyond clinically affected skin sites suggests that subjects undergo systemic alterations, which could be considered for redefining therapeutic approaches.

Feasibility of combination the outer antibakterialnoy therapy and preparation azelaic acid for treatment of acne

The review presents modern views on the pathogenesis of acne. The data of foreign and domestic clinical trials to study the efficacy and safety of drugs containing 1% clindamycin and 15% azelaic acid used to treat acne. The mechanisms of the effects of these drugs on the main elements of the pathogenesis of acne. Substantiates the appropriateness of the drug combination of clindamycin and azelaic acid in the treatment of acne patients.

Supplementation with Lactobacillus rhamnosus SP1 normalises skin expression of genes implicated in insulin signalling and improves adult acne

Systemic supplementation with probiotics is increasingly being explored as a potential treatment strategy for skin disorders. Because both the gut-skin axis and dysregulation of insulin signalling have been implicated in the pathogenesis of adult acne, we designed the current study to evaluate the effect of supplementation with the probiotic strain Lactobacillus rhamnosus SP1 (LSP1) on skin expression of genes involved in insulin signalling and acne improvement in adult subjects. A pilot, randomised, double-blinded, placebo-controlled study was conducted with 20 adult subjects (14 females and 6 males; mean age: 33.7±3.3 years) with acne. Over a 12-week period, the probiotic group (n=10) consumed a liquid supplement containing LSP1 at a dose of 3×109 cfu/day (75 mg/day), whereas the placebo group (n=10) received a liquid lacking probiotics. Paired skin biopsies - one obtained before treatment initiation and one obtained at the end of the 12-week treatment period - were analysed for insulin-like growth factor 1 (IGF1) and forkhead box protein O1 (FOXO1) gene expression. The clinical criterion for efficacy was the investigator's global improvement rating on a five-point scale. Compared with baseline, the probiotic group showed a 32% (P<0.001) reduction, as well as a 65% increase (P<0.001) in IGF1 and FOXO1 gene expression in the skin, respectively. No such differences were observed in the placebo group. Patients in the probiotic group had an adjusted odds ratio of 28.4 (95% confidence interval = 2.2-411.1, P<0.05) to be rated by physicians as improved/markedly improved (versus worsened or unchanged) compared with the placebo group. We conclude that supplementation with the probiotic strain LSP1 normalises skin expression of genes involved in insulin signalling and improves the appearance of adult acne.

High Frequency of Fibromyalgia in Patients With Acne Vulgaris

Objectives

This study aims to investigate the frequency of fibromyalgia syndrome and to specify fibromyalgia syndrome-associated clinical symptoms in patients with acne vulgaris.

Patients and methods

Eighty-eight patients (28 males, 60 females; mean age 23.2±5.1 years; range 18 to 40 years) with acne vulgaris and age, sex- and body mass index-similar 76 healthy controls (14 males, 62 females; mean age 24.5±2.9 years; range 18 to 35 years) were included. Acne vulgaris was evaluated by using the Global Acne Scale, while Hospital Anxiety and Depression Scale was used to evaluate anxiety.

Results

Fibromyalgia-associated pain, sleep disturbance, anxiety, and menstrual cycle disturbance were significantly more frequent in patients with acne vulgaris than controls. Also, the severity of anxiety and the number of tender points were significantly higher in the acne vulgaris patients than controls.

Conclusion

This study indicates that patients with acne vulgaris have increased frequency of fibromyalgia syndrome than healthy controls (21.6% versus 5.3%, respectively).

Inhibitory effects of Cheongsangbangpoong-tang on both inflammatory acne lesions and facial heat in patients with acne vulgaris: A randomized controlled trial protocol

BACKGROUND

Due to increasing interest from acne patients concerned about the side effects associated with conventional therapies, complementary and alternative medicine (CAM) has been suggested as a new therapeutic modality for acne vulgaris. Herbal medicine is one of these CAM treatments. Cheongsangbangpoong-tang (CBT) is a common herbal formula used in patients with acne vulgaris in the clinical practice of Korean Medicine (KM). However, despite the common use of CBT in clinical practice, the current level of evidence is insufficient to support an inhibitory effect of CBT on inflammatory acne lesions and facial heat. Therefore, this study was designed to assess the inhibitory effect of CBT on both inflammatory acne lesions and facial heat.

METHODS/DESIGN

A randomized, double-blind, parallel-group, and placebo-controlled trial will be conducted. Fifty-six participants with acne vulgaris will be randomized into one of two groups: the CBT or placebo groups. After randomization, participants will be prescribed either CBT or placebo three times a day at a dose of 5 g after meals for 8 weeks. The following outcome measurements will be used in the examination of subjects: the mean percentage change and the count change of the inflammatory and non-inflammatory acne lesions, the temperature of facial points on digital infrared thermal imaging (DITI), serum cortisol, serum dehydroepiandrosterone-sulfate (DHEA-S), visual analogue scale (VAS), investigator global assessment (IGA), and severity score on the Korean Acne Grading System (KAGS) from baseline to the end of the trial.

DISCUSSION

This trial will provide evidence regarding the inhibitory effect of CBT on inflammatory acne lesions and facial heat. The findings of this trial may have important implications for the more widespread use of CBT for the treatment of acne vulgaris.

TRIAL REGISTRATION

The trial is registered with the Clinical Research Information Service (CRiS), Republic of Korea: KCT0001468 .

Investigation of the Association of the Second-to-Fourth Digit Ratio with Skin Sebum Levels in Females with Acne Vulgaris

BACKGROUND

A relationship between acne vulgaris (AV) and the masculinized (lower) second-to-fourth digit (2D:4D) ratio in females was demonstrated in our previous study. Development of the digits and the sebaceous glands both occur during the same gestational period; therefore, the association between the 2D:4D ratios and AV may result from the effects of the prenatal endocrine environment on the sebaceous glands.

OBJECTIVE

The aim of this study was to evaluate the relationship between the 2D:4D ratio and sebum levels in the skin of females with AV.

METHODS

In total, 215 female AV patients and 92 healthy controls, aged 18-35 years, were enrolled in this study. Finger-length measurements were made using a digital Vernier caliper, and the sebum levels of five facial areas were measured using a Sebumeter SM 815. Acne severity was assessed using the International Consensus Conference on Acne Classification System.

RESULTS

The 2D:4D ratios of the AV patients were significantly lower than those of the controls, for both hands. The mean sebum levels in the T-zone, U-zone and whole face were significantly higher for AV patients compared with controls. The 2D:4D ratio in the left hand showed significant negative correlations with the sebum levels in the U-zone; however, no association was found between the 2D:4D ratios and sebum levels in the T-zone and whole face. While acne severity was positively correlated with skin sebum levels, no correlation between acne severity and 2D:4D ratios was observed.

CONCLUSION

This study provides preliminary evidence regarding the association between lower 2D:4D ratios and higher rates of sebum secretion in the U-zone for females with AV. The 2D:4D ratio might be a predictor of sebum levels, as well as acne development, in females.

Acne vulgaris

Acne vulgaris is a chronic inflammatory disease - rather than a natural part of the life cycle as colloquially viewed - of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. Some of the key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. Grading of acne involves lesion counting and photographic methods. However, there is a lack of consensus on the exact grading criteria, which hampers the conduction and comparison of randomized controlled clinical trials evaluating treatments. Prevention of acne relies on the successful management of modifiable risk factors, such as underlying systemic diseases and lifestyle factors. Several treatments are available, but guidelines suffer from a lack of data to make evidence-based recommendations. In addition, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Acne commonly causes scarring and reduces the quality of life of patients. New treatment options with a shift towards targeting the early processes involved in acne development instead of suppressing the effects of end products will enhance our ability to improve the outcomes for patients with acne.