Management of Acne Vulgaris: A Review

Analysis of global trends and hotspots of skin microbiome in acne: a bibliometric perspective

BACKGROUND

Acne is a chronic inflammatory condition affecting the hair follicles and sebaceous glands. Recent research has revealed significant advances in the study of the acne skin microbiome. Systematic analysis of research trends and hotspots in the acne skin microbiome is lacking. This study utilized bibliometric methods to conduct in-depth research on the recognition structure of the acne skin microbiome, identifying hot trends and emerging topics.

METHODS

We performed a topic search to retrieve articles about skin microbiome in acne from the Web of Science Core Collection. Bibliometric research was conducted using CiteSpace, VOSviewer, and R language.

RESULTS

This study analyzed 757 articles from 1362 institutions in 68 countries, the United States leading the research efforts. Notably, Brigitte Dréno from the University of Nantes emerged as the most prolific author in this field, with 19 papers and 334 co-citations. The research output on the skin microbiome of acne continues to increase, with Experimental Dermatology being the journal with the highest number of published articles. The primary focus is investigating the skin microbiome's mechanisms in acne development and exploring treatment strategies. These findings have important implications for developing microbiome-targeted therapies, which could provide new, personalized treatment options for patients with acne. Emerging research hotspots include skincare, gut microbiome, and treatment.

CONCLUSION

The study's findings indicate a thriving research interest in the skin microbiome and its relationship to acne, focusing on acne treatment through the regulation of the skin microbiome balance. Currently, the development of skincare products targeting the regulation of the skin microbiome represents a research hotspot, reflecting the transition from basic scientific research to clinical practice.

Exploring the multifaceted side effects of isotretinoin: a deep dive into case reports and observational studies

This review addresses gaps in understanding isotretinoin's side effects for acne vulgaris. While effective, the risks are often underestimated. It emphasizes careful patient selection and monitoring to optimize outcomes and minimize harm. By providing a comprehensive evaluation, the review aims to enhance patient safety and inform clinical decision-making. This review examined isotretinoin's side effects through case reports and observational studies. A literature search on Google Scholar, PubMed, Scopus, and Web of Science covered publications from 2000 to 2024 using terms like "isotretinoin" and "side effects," focusing on English-language studies. Inclusion criteria targeted studies detailing adverse effects across dermatological, musculoskeletal, psychiatric, ocular, gastrointestinal, endocrine, and renal areas. Data included population size, dosage, treatment duration, and side effects. No statistical analysis was performed. This review underscores a wide array of side effects associated with isotretinoin, ranging from common issues such as dry skin and cheilitis to more serious conditions including psychiatric disorders, musculoskeletal complications, and autoimmune diseases. Notably, rare side effects like psychosis and rhabdomyolysis have also been observed. The review emphasizes the necessity for meticulous patient selection, thorough risk assessment, and vigilant monitoring, especially for at-risk populations such as women of reproductive age. This review emphasizes the need for personalized evaluations and monitoring during isotretinoin treatment, particularly for high-risk groups like women of reproductive age. Healthcare providers must consider the risk-benefit ratio due to potential side effects. Regular check-ups and proactive management are crucial to optimize outcomes and minimize risks.

Development of a Self-Assembled Micelles Based on Cryptotanshinone and Glycyrrhizic acid: An efficient strategy for Acne Treatment

Acne vulgaris is a prevalent inflammatory skin disease affecting the folliculosebaceous unit. Current treatments, such as antibiotics and anti-inflammatory drugs, face challenges like drug resistance and side effects. Cryptotanshinone (CTS), a diterpenoid from Salvia miltiorrhiza, exhibits potential acne-treating effects by inhibiting sebaceous gland secretion, regulating follicular keratosis and exhibiting anti-inflammatory properties. However, its poor water solubility and skin permeability hinder clinical application. CTS was researched in the previous work and CTS cerasomes was prepared. However, the issues of low encapsulation rate and large particle size still existed. Here, we propose a strategy for encapsulating CTS using a glycyrrhizin-based carrier to address the issues above. Under microscopic observation, the glycyrrhizic acid-encapsulated CTS micelles (GA-CTS), with an average size of 24.81 ± 1.40 nm, exhibited a uniform spherical shape. In vitro permeation assay demonstrated that the water solubility and skin permeability of CTS were significantly improved, indicating a higher bioavailability. GA-CTS also inhibited Cutibacterium acnes (C. acnes) and reduced Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β) expression in HaCaT cells. In vivo, a BALB/c mouse acne model was established via intradermal C. acnes injection. HE staining, IL-1β immunohistochemistry, and qRT-PCR were used to assess the treatment effect of GA-CTS. Compared to CTS or GA alone, GA-CTS significantly inhibited C. acnes growth, reduced skin swelling, and improved skin histology. Notably, GA-CTS inhibited keratin 16 (K16) gene expression, improving abnormal skin keratinization, and regulated 5-α reductase mRNA expression, potentially impacting androgen metabolism and offering another mechanism for acne treatment. In conclusion, GA-CTS micelles show promising potential in acne treatment, offering new insights and methods for anti-acne drug development and clinical application.

Smart bacteria cellulose facial mask for sensing and recovering skin pH

The utilization of skin care products and cleansers is a prevalent method for maintaining facial skin health. However, excessive use of these products is an unnoticed factor that can result in serious skin problems. Currently, there are no products on the market to provide users with skin acclimatization and restoration services. Herein, we introduce a facial mask with a smart pH sensor to monitor and repair facial skin. Specifically, bacterial cellulose fragments were mechanically dispersed, co-mingled with carboxymethyl cellulose and hydroxypropyltrimethylammonium chloride chitosan, with anthocyanin added as a pH-indicating reagent. The composite mask was then prepared by hot air drying. This mask exhibited notable anti-hornification effect, robust water absorption, water retention, wet strength, and antibacterial and antioxidant properties, making it suitable for a high-end facial mass base material with an excellent pH sensitivity within the range of 2.0-12.0, which could be observed directly through colorimetry with the naked eye.

The combination of RL-QN15 and OH-CATH30 promotes the repair of acne via the TLR2/NF-κB pathway

Acne is a prevalent and chronic inflammatory skin disease, and its treatment remains a huge clinical challenge. In the present study, we evaluated the therapeutic potential of combining the peptides RL-QN15 and OH-CATH30 for the treatment of acne in mice. Results indicated that the topical application of RL-QN15 and OH-CATH30 significantly inhibited the proliferation of Propionibacterium acnes (P. acnes) and alleviated acne-induced edema. Furthermore, the combined treatment suppressed the overexpression of proinflammatory cytokines induced by P. acnes, including interleukin -1 beta (IL-1β), interleukin -6 (IL-6), interleukin -8 (IL-8), tumor necrosis factor-alpha (TNF-α) induced by P. acnes and facilitated collagen deposition, thereby effectively mitigating skin damage associated with acne. Mechanistically, the combination of RL-QN15 and OH-CATH30 inhibited the expression of toll-like receptor 2 (TLR2) and activation nuclear factor kappa-B (NF-κB) signaling pathway (phosphorylation of P65 and IκB) in both mice and RAW 264.7 cells. These results suggested that this combination may inhibit the excretion of inflammatory factors and facilitate the collagen deposition by TLR2/NF-κB signaling. Overall, our study demonstrates the potent therapeutic effects of the combined application of RL-QN15 and OH-CATH30, highlights the TLR2/NF-κB pathway as a key target in acne treatment, and provides a novel strategy for developing innovative acne therapeutics.

Cutibacterium acnes as an overseen autoimmunity trigger: Unearthing heat-shock driven molecular mimicry

Cutibacterium acnes, common resident of the human skin, can establish both commensal and pathogenic relations with the human host; however, long-term consequences of C. acnes-induced inflammation remained un(der)explored. To infer the capacity of triggering autoimmunity in humans via molecular mimicry, a comprehensive immunoinformatics analysis of the experimentally characterized C. acnes proteome was performed. The protocol included homology screening between the C. acnes and the human proteome, and validation of shared specificity regions against the collection of experimentally characterized T-cell epitopes, related to autoimmunity. To obtain highly reliable predictions, the results were subjected to additional cross-validation by a dedicated MHC-restriction analysis, including a docking study of C. acnes mimotopes and human counterparts with the highest degree of sequence similarity to MHCII molecules representing the highest risk for detected autoimmune pathologies. Due to mimicking of highly immunogenic, but also evolutionary conserved autoantigens from the Heat Shock protein family, association between C. acnes and the pathogenesis of highly incident autoimmune diseases: Type 1 Diabetes, Rheumatoid Arthritis, and Juvenile Idiopathic Arthritis, was found. To the best of our knowledge, this study is the first one to provide preliminary information and a mechanistic link on the putative involvement of C. acnes in the pathogenesis of autoimmunity in humans.

Efficacy and safety of combined fractional carbon dioxide laser and topical timolol maleate 0.5% solution versus topical timolol maleate 0.5% solution alone in inflammatory facial acne; a randomized split face controlled study

In this study, we aimed to investigate the efficacy and safety of combined fractional carbon dioxide laser and topical timolol maleate 0.5% solution versus topical timolol maleate 0.5% solution alone in inflammatory acne. Thirty adult patients with inflammatory facial acne were randomized in this study. The patients received 3 biweekly sessions of fractional CO2 laser on one side of the face followed by topical timolol maleate ophthalmic solution 0.5% once daily for 7 days on both sides. Outcome was evaluated 2 weeks after the first session, 2 weeks after the last session, and 1 month after the last session by lesion count, erythema, hyperpigmentation, qualitative global scarring grading, and patients' satisfaction. Side effects were also evaluated. Trial registration (IRB No. 417, 30/10/2023). At 2 weeks after the first session, there were insignificant differences between both sides regarding lesion count, erythema, hyperpigmentation, and qualitative global scarring grading (p value = 0.8, 0.05, 0.7, 0.1 respectively). At 2 weeks after the last session, the erythema on the combined side was reduced by a mean of 0.2 ± 0.4 SD compared to timolol only side with significant difference between both sides (p value = 0.03), while there were insignificant differences between both sides regarding lesion count, hyperpigmentation, qualitative global scarring grading, and patients' satisfaction (p value = 0.1, 0.5, 0.8, 0.3 respectively). Recurrence was detected at one month after the last session. No side effects were reported. Combined fractional CO2 laser and topical timolol maleate 0.5% solution were significantly more effective than topical timolol maleate 0.5% solution alone in reduction of erythema of inflammatory facial acne in adolescent men with Fitzpatrick's skin type III-IV at 2 weeks after 3 biweekly sessions with insignificant differences between both sides regarding lesion count, hyperpigmentation, qualitative global scarring grading, and patients' satisfaction. Further and larger studies are still needed.

Efficacy of a Postbiotic Formulation Combined With Microneedling for Mild-to-Moderate Acne: A Self-Control Study

BACKGROUND

Acne vulgaris significantly affects young individuals globally, with its onset associated with an increased prevalence of C acnes, a naturally occurring skin bacterium. In light of the rising concerns regarding antibiotic resistance and the potential for adverse effects, pharmacological interventions may not consistently represent the most suitable option. Nonpharmacological approaches, such as microneedling, offer promising alternative treatment modalities. Furthermore, the integration of postbiotics in skincare formulations for acne management has gained traction recently. Nonetheless, there remains a lack of sufficient evidence to establish the efficacy and safety of postbiotics when combined with microneedling.

OBJECTIVE

To assess the clinical effectiveness of a postbiotic formulation combined with microneedling in mild-to-moderate facial acne vulgaris.

METHODS

Twenty Chinese patients were enrolled, all received one treatment and were monitored 4 weeks posttreatment. The evaluation assessed symptom improvement, treatment safety, and patient satisfaction.

RESULTS

The global acne grading system (GAGS) score decreased more than half based on the baseline. Clinical photographs following treatment revealed improved the skin lesions and brightened skin tone. Statistics from VISIA showed excellent improvement in speckle, pore, red region, and porphyrin. No significant adverse reactions have been reported during the treatment period. Additionally, more than 85% were very satisfied or satisfied with the outcome.

CONCLUSION

Our results showed that the postbiotic formulation combined with microneedling may benefit the restoration of the skin barrier and the equilibrium of skin microbiota. This approach may help mitigate inflammation and address skin lesions, presenting a promising therapeutic avenue for the prevention and management of acne vulgaris.

Efficacy and safety of Spironolactone in treating patients with acne vulgaris: a systematic review and meta-analysis of 1,086 patients

Acne vulgaris affects 9% of the global population, particularly women, affecting their quality of life. Topical treatments are preferred for mild acne, while systemic management is necessary for moderate and severe cases. Spironolactone, an androgen receptor inhibitor, may be effective for severe acne, although no concrete evidence exists. A comprehensive literature search was conducted on five databases up until July 25th, 2024, to evaluate the effectiveness or safety of Spironolactone for acne vulgaris. A meta-analysis using R software was conducted to assess the total number of lesions, acne severity score, adverse events, mean count of comedones, papules, and pustules, and acne severity. Search process identified 14 studies (n = 1,086). Meta-analysis found that Spironolactone 5% was more effective than placebo in reducing total lesion count and acne severity index (ASI) (MD - 6.85, 95% CI [-10.94; -2.76], P < 0.01) and (MD - 6.33, 95% CI [- 8.89; -3.76], P < 0.01) respectively. The 100 mg group showed a significant improvement in ASI compared to the topical group. A meta-analysis of randomized controlled trials found no significant difference in comedones and pustules count over 6-8 weeks, while single-arm studies showed significant improvement after 8 weeks. Meta-analysis found that spironolactone 5% significantly reduced total lesion count and acne severity index after eight weeks, while also reducing comedones and papules. The safety profile is excellent. The limited number of eligible studies and evidence from single-arm studies indicates the need for more randomized controlled trials.

Global, regional and national burdens of acne vulgaris in adolescents and young adults aged 10-24 years from 1990 to 2021: a trend analysis

BACKGROUND

Acne vulgaris is a common skin condition affecting adolescents and young adults worldwide, yet data on the burden and trends of this disease remain limited. We aimed to investigate trends in the burden of acne vulgaris among adolescents and young adults aged 10-24 years at global, regional and national levels.

METHODS

We retrieved data from the Global Burden of Disease Study 2021 for individuals aged 10-24 years in 204 countries and territories from 1990 to 2021. We analysed the numbers, age-standardized rates and average annual percentage changes (AAPCs) of the prevalence, incidence and disability-adjusted life years (DALYs) for acne vulgaris at the global, regional and national levels. Additionally, we examined these global trends by age, sex and Sociodemographic Index (SDI).

RESULTS

Globally, the age-standardized prevalence rate of acne vulgaris among adolescents and young adults increased from 8563.4 per 100 000 population [95% uncertainty interval (UI) 7343.5-9920.1] in 1990 to 9790.5 (95% UI 8420.9-11 287.2) per 100 000 population in 2021, with an AAPC of 0.43 [95% confidence interval (CI) 0.41-0.46]. The age-standardized incidence rate and age-standardized DALY rate also showed a similar upward trend. Regionally, Western Europe had the highest age-standardized prevalence, incidence and DALY rates, while North Africa and the Middle East had the largest increase in these rates. By SDI quintile, the high SDI region had the highest age-standardized prevalence, incidence and DALY rates from 1990 to 2021, whereas the low-middle SDI region had the lowest burden of acne vulgaris but experienced the most significant increase in these rates. Globally, the age-standardized prevalence rate of acne vulgaris in 2021 was approximately 25% higher in young women than in young men (10 911.8 per 100 000 population vs. 8727.8 per 100 000 population). Among all age groups, adolescents aged 15-19 years had the highest age-specific prevalence rate, while adolescents aged 10-14 years experienced the largest increase from 1990 to 2021 (AAPC 0.50, 95% CI 0.48-0.52).

CONCLUSIONS

The burden of acne vulgaris among adolescents and young adults has continued to increase in nearly all countries since the 1990s. Managing this condition remains a significant challenge, necessitating more effective and targeted interventions to control the acne burden.

Current perspectives for metabolomics and lipidomics in dyslipidemia of acne vulgaris: a mini review

Acne vulgaris (AV) is a common inflammatory disorder involving the pilosebaceous unit. Many studies have reported that people with AV have higher levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-c) compared to healthy controls. Hence, they concluded that an unhealthy lipid profile is an independent risk factor for AV. Recent research in metabolomics and lipidomics has been propelled by rapid advancements in technologies including computational methods and mass spectrometry. Using metabolomics and lipidomics approach, a broad range of structurally diverse lipid species were detected and important lipid biomarkers were identified that are vital to the pathogenesis of AV. In this review, we will describe the recent progress in dyslipidemia of AV using metabolomics and lipidomics advances. We will begin with a literature overview of dyslipidemia of AV, followed by a short introduction of metabolomics and lipidomics. Finally, we will focus on applying metabolomics and lipidomics in dyslipidemia of AV.

Pharmaceutical care for patients with acne

Pharmaceutical care for patients with acne Acne is a multifactorial inflammatory skin disease affecting mostly adolescents, but it can persist into adulthood. The aim of treatment is to improve the patient's dermatological condition and improve the overall quality of life. Pharmacists play a very important role in the care of acne patients and this article reviews opportunities for pharmaceutical care of such patients. Pharmacists can identify patients with different forms of acne, engage in acne prevention including lifestyle modifications, and contribute to optimizing the choice and use of appropriate pharmacotherapy accompanied by non-pharmacological approaches according to the specific patient characteristics. The mainstay of acne treatment is topical pharmacotherapy, where over-the-counter products containing benzoyl peroxide or azelaic acid may be recommended for mild to moderate forms of acne. Retinoids or their combination with antibiotics are prescribed for moderate and severe forms of acne. When topical treatment is ineffective or resistant, systemic treatment including for example oral antibiotics or isotretinoin is considered. Pharmacists thus engage themselves in maximizing the effect and minimizing the risks of these drugs and, last but not least, educating patients on how to properly care for their skin using so called dermocosmetics, which is defined in this article.

Teledermatology and Virtual Visits for Acne Management: A Review

Acne vulgaris is a common dermatological condition requiring individualized management. Teledermatology provides convenience and accessibility that is highly suitable for this dermatological condition. Herein, our review aimed to describe the current state of teledermatology in the context of acne management and to assess patient satisfaction, adherence to virtual care, and the experiences of health care providers in delivering remote dermatological services. A systematic search for articles was conducted in Medline, Embase, and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Title, abstract, full-text screening, and data abstraction were carried out in duplicate. One thousand one hundred three nonduplicate articles were screened based on title and abstract review. A total of 21 studies were included in the review. It was found that teledermatology is well-suited to the effective management of acne vulgaris. When compared to in-person care, teledermatology resulted in similar outcomes on several acne-grading scales. Additionally, patient satisfaction was comparable, with a large proportion of patients preferring virtual care to traditional in-person visits. However, compliance was found to be lower for virtual care. There are several secondary benefits to telemedicine, including time savings and greater accessibility to care for rural patients. Teledermatology is an evolving, promising medium for acne management for both clinicians and patients. Future research comparing the effectiveness of different teledermatology platforms, its limitations and pitfalls, and integration of patient and physician preferences to improve treatment outcomes is warranted.

Role of TREM2 in immune and neurological diseases: Structure, function, and implications

Triggering Receptor Expressed on Myeloid Cells 2 (TREM2), a transmembrane receptor initially linked to neurodegenerative diseases, has recently emerged as a key player in conditions such as obesity and cancer. This review explores the structure, function, and mechanisms of TREM2 across these diverse pathological contexts, with a particular focus on its critical roles in immune regulation and neuroprotection. TREM2 primarily modulates cellular activity by binding extracellular ligands, thereby activating downstream signaling pathways and exerting immunomodulatory effects. Additionally, the therapeutic potential of targeting TREM2 is discussed, emphasizing its promise as a future treatment strategy for various diseases.

Zuojin Pill Alleviates Precancerous Lesions of Gastric Cancer by Modulating the MEK/ERK/c-Myc Pathway: An Integrated Approach of Network Pharmacology, Molecular Dynamics Simulation, and Experimental Validation

Background

Precancerous lesions of gastric cancer (PLGC) represent critical stages in gastric cancer progression, with a high risk of malignancy. Current treatments, such as Helicobacter pylori eradication, show limited efficacy in reversing precancerous molecular changes. Zuojin Pill (ZJP), a traditional Chinese medicine, has demonstrated potential for treating digestive disorders and may offer a promising approach for PLGC intervention.

Objective

This study aims to investigate the therapeutic effects and mechanisms of ZJP in treating PLGC, focusing on its active components, target pathways, and molecular interactions. By using advanced analytical techniques, we provide a scientific foundation for ZJP's potential application in early gastric cancer intervention.

Methods

Using ultra-high performance liquid chromatography-quadrupole orbitrap high-resolution mass spectrometry (UPLC-Q-Orbitrap HRMS), we identified active components in ZJP. A network pharmacology approach was then applied to construct a "ZJP-compound-target-disease" network. Molecular docking and molecular dynamics simulations were conducted to analyze the stability and interactions of the main active components of ZJP with core protein targets in PLGC. Animal experiments were used to validate significant targets and pathways in vivo.

Results

Tangeritin, Isorhamnetin, Caffeic Acid, Azelaic Acid, and Adenosine were identified as the main active components of ZJP in the treatment of PLGC, with key targets including PIK3R1, MAPK3, SRC, JAK2, STAT3, and PIK3CA. Molecular docking and molecular dynamics simulations further confirmed the relationship between compounds and target proteins. The potential molecular mechanism of ZJP predicted by network pharmacology analysis was confirmed in PLGC rats. ZJP downregulated IL-6, TNF-α, c-myc, p-MEK1 and p-ERK1/2, effectively reversing the progression of PLGC.

Conclusion

ZJP can reverse MNNG-induced PLGC, potentially through inhibition of the MEK/ERK/c-myc pathway and regulation of cellular proliferation and apoptosis.

Approved natural products-derived nanomedicines for disease treatment

In recent years, there has been an increasing emphasis on exploring innovative drug delivery approaches due to the limitations of conventional therapeutic strategies, such as inadequate drug targeting, insufficient therapeutic efficacy, and significant adverse effects. Nanomedicines have emerged as a promising solution with notable advantages, including extended drug circulation, targeted delivery, and improved bioavailability, potentially enhancing the clinical treatment of various diseases. Natural products/materials-derived nanomedicines, characterized by their natural therapeutic efficacy, superior biocompatibility, and safety profile, play a crucial role in nanomedicine-based treatments. This review provides a comprehensive overview of currently approved natural products-derived nanomedicines, emphasizing the essential properties of natural products-derived drug carriers, their applications in clinical diagnosis and treatment, and the current therapeutic potential and challenges. The aim is to offer guidance for the application and further development of these innovative therapeutic approaches.

Honey Phytochemicals: Bioactive Agents With Therapeutic Potential for Dermatological Disorders

Honey has been reported to have a range of biological activities including antimicrobial, immunomodulatory, and wound healing effects. Indeed, medical-grade honey is currently used in hospitals for the clinical management of wound infections. Honey is also of scientific interest for its therapeutic effects on other dermatological disorders such as atopic dermatitis, rosacea, and skin cancer. Recent studies have uncovered that honey contains a range of phytochemicals including flavonoids, dicarboxylic acids, coumarins, and phenolic acids. In this review, PubMed was used to search the scientific literature on the biological properties of honey phytochemicals in relation to dermatological disorders and to evaluate their potential as bioactive agents, drugs, or cosmeceuticals for the treatment of skin disease. The review revealed that phytochemicals found in honey have antimicrobial, anti-inflammatory, antiaging, antioxidant, anticancer, depigmenting, photoprotective, wound healing, and skin barrier enhancing properties. Although further high-quality studies are required to establish clinical efficacy, these findings suggest that honey phytochemicals may have the potential to be used as bioactive agents for the management of a range of dermatological disorders including wounds, psoriasis, atopic dermatitis, vitiligo, rosacea, and skin cancer.

Advances in Microbiome-Based Therapeutics for Dermatological Disorders: Current Insights and Future Directions

The human skin hosts an estimated 1000 bacterial species that are essential for maintaining skin health. Extensive clinical and preclinical studies have established the significant role of the skin microbiome in dermatological disorders such as atopic dermatitis, psoriasis, diabetic foot ulcers, hidradenitis suppurativa and skin cancers. In these conditions, the skin microbiome is not only altered but, in some cases, implicated in disease pathophysiology. Microbiome-based therapies (MBTs) represent an emerging category of live biotherapeutic products with tremendous potential as a novel intervention platform for skin diseases. Beyond using established wild-type strains native to the skin, these therapies can be enhanced to express targeted therapeutic molecules, offering more tailored treatment approaches. This review explores the role of the skin microbiome in various common skin disorders, with a particular focus on the development and therapeutic potential of MBTs for treating these conditions.

Contraception Choice for Female Endurance Athletes: What's Sport Got to Do With It? A Cross-Sectional Survey

BACKGROUND

While there are several prescribed contraceptive methods available, limited evidence exists to guide contraceptive decision-making in the context of endurance sport.

OBJECTIVES

Study objectives were to characterize current and previous use, perceived impacts, and the decision process around contraceptives in endurance athletes.

METHODS

This was an online survey study with female endurance athletes recruited through social media and emails to university/club coaches and sport organizations. Quantitative and qualitative data were analyzed with descriptive statistics and conventional content analysis, respectively.

RESULTS

A total of 323 female endurance athletes participated. Among current contraception users (n = 182), 51% used hormonal intrauterine devices (hIUDs), 29% oral contraceptive pills (OCPs), and 13% nonhormonal IUDs (nhIUDs). hIUD users had the highest perceived positive training (39%) and competition (29%) impacts, citing reduced menstrual bleeding and symptoms as positive side effects. OCP and nhIUD users had higher rates of perceived negative training impacts (OCPs 10%, nhIUDs 30%). For OCP users, 31% reported perceived adverse body composition outcomes and 37% reported negative mood changes. Among nhIUD users, 74% experienced heavier, more irregular menstrual bleeding. Over half of participants were unsure about the impact of their current method on performance. For contraceptive selection, 95% felt that information from physicians was important, yet 32% felt performance was inadequately considered during counseling discussion. Athletes reported less frustration with their contraception choice when counseled in the context of sport.

CONCLUSIONS

This exploratory study quantifies and qualifies the lived experiences of female endurance athletes with contraception. hIUDs were the most currently used and well-tolerated contraceptives among participants. This research offers valuable insights for athletes seeking contraception and looking to optimize both performance and health, along with the healthcare professionals guiding them.

Advances in polymeric nano-delivery systems targeting hair follicles for the treatment of acne

Acne is a common chronic inflammatory disorder of the sebaceous gland in the hair follicle. Commonly used external medications cause skin irritation, and the transdermal capacity is weak, making it difficult to penetrate the cuticle skin barrier. Hair follicles can aid in the breakdown of this barrier. As nanomaterials progress, polymer-based nanocarriers are routinely used for hair follicle drug delivery to treat acne and other skin issues. Based on the physiological and anatomical characteristics of hair follicles, this paper discusses factors affecting hair follicle delivery by polymer nanocarriers, summarizes the common combination technology to improve the targeting of hair follicles by carriers, and finally reviews the most recent research progress of different polymer nanodrug-delivery systems for the treatment of acne by targeting hair follicles.

An update on the pharmacological management of acne vulgaris: the state of the art

INTRODUCTION

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that affects approximately 9.4% of the global population. Current treatment strategies aim to target as many pathogenic factors involved in the appearance of acne lesions and are centered on a systematic treatment escalation based on disease severity, extension, and treatment response, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases. A literature search, which included clinical guidelines, clinical studies, and review articles on acne treatment and maintenance, was conducted to review the pharmacological approaches currently available to treat this disease.

AREAS COVERED

Topical therapies such as topical retinoids, benzoyl peroxide, azelaic acid, salicylic acid, topical antibiotics, and clascoterone, as well as systemic treatments such as oral antibiotics and isotretinoin are discussed in detail. Combined oral contraceptives and spironolactone will not be discussed in this article.

EXPERT OPINION

There is a need for a blockbuster acne drug that simultaneously targets the four main pathogenic factors involved in the appearance of acne lesions while presenting with minimal side effects. Until such a drug exists, combination therapy will remain the standard of treatment for most acne patients.

Tetracyclines Revisited: Tetracyclines in the Field of Dermatology

BACKGROUND

Tetracyclines are a class of broad-spectrum antibiotics favored by dermatologists. Over the last decade, the clinical efficacy of tetracyclines has expanded into various dermatoses.

SUMMARY

This review tries to encompass the possible indications of tetracycline in the field of dermatology and possible mechanisms of action. This comprehensive review encompasses all possible indications of tetracyclines besides acne vulgaris and rosacea: hidradenitis suppurativa, autoimmune bullous dermatoses, vitiligo, alopecia, prurigo pigmentosa, granulomatous dermatoses, Kaposi's sarcoma, cold urticaria, atopic dermatitis, scrub typhus, scarring, and miscellaneous dermatoses. We also focus on the recently approved sarecycline, a third-generation narrow-spectrum tetracycline, and its clinical efficacy and potential impact on the microbiome. Our review provides a better understanding of this extremely familiar drug class and encourages its use in a wider spectrum of dermatologic diseases and symptoms.

KEY MESSAGES

This study comprehensively reviewed the current literature on potential indications of tetracyclines in the field of dermatology.

What's New After NICE Acne Guidelines

INTRODUCTION

Acne remains one of the most common inflammatory dermatoses seen worldwide. There are significant challenges when managing acne relating to a variety of factors, including (1) lack of consensus on the use of the numerous available grading systems and outcome measures, (2) appreciation of the numerous areas that relate to severity, (3) the chronic nature of acne which requires a longitudinal approach to management (including both facial and truncal disease), and (4) the need to target acne early to avoid physical and psychosocial scarring. Consideration of these aspects when managing acne should result in improved outcomes. Acne guidelines review the available evidence based on robust clinical trials and are usually supplemented with some expert opinion when evidence is not available.

METHODS

In this paper, the UK Acne Working Group reflects on the latest National Institute for Health and Care Excellence (NICE) acne guidelines with a goal of providing additional practical insights.

CONCLUSION

The group have identified areas where new evidence has now become available since the formulation of the NICE acne guidelines. This publication considers newly approved acne medications in the UK, guidance on assessing acne severity, approaches to managing truncal acne, acne sequelae, and adult female acne with hormonal therapies.

Stimuli-responsive drug delivery systems for inflammatory skin conditions

Inflammatory skin conditions highly influence the quality of life of the patients suffering from these disorders. Symptoms include red, itchy and painful skin lesions, which are visible to the rest of the world, causing stigmatization and a significantly lower mental health of the patients. Treatment options are often unsatisfactory, as they suffer from either low patient adherence or the risk of severe side effects. Considering this, there is a need for new treatments, and notably of new ways of delivering the drugs. Stimuli-responsive drug delivery systems are able to deliver their drug cargo in response to a given stimulus and are, thus, promising for the treatment of inflammatory skin conditions. For example, the use of external stimuli such as ultraviolet light, near infrared radiation, or alteration of magnetic field enables drug release to be precisely controlled in space and time. On the other hand, internal stimuli induced by the pathological condition, including pH alteration in the skin or upregulation of reactive oxygen species or enzymes, can be utilized to create drug delivery systems that specifically target the diseased skin to achieve a better efficacy and safety. In the latter context, however, it is of key importance to match the trigger mechanism of the drug delivery system to the actual pathological features of the specific skin condition. Hence, the focus of this article is placed not only on reviewing stimuli-responsive drug delivery systems developed to treat specific inflammatory skin conditions, but also on critically evaluating their efficacy in the context of specific skin diseases. STATEMENT OF SIGNIFICANCE: Skin diseases affect one-third of the world's population, significantly lowering the quality of life of the patients, who deal with symptoms such as painful and itchy skin lesions, as well as stigmatization due to the visibility of their symptoms. Current treatments for inflammatory skin conditions are often hampered by low patient adherence or serious drug side effects. Therefore, more emphasis should be placed on developing innovative formulations that provide better efficacy and safety for patients. Stimuli-responsive drug delivery systems hold considerable promise in this regard, as they can deliver their cargo precisely where and when it is needed, reducing adverse effects and potentially offering better treatment outcomes.

Comparing EQ-5D-5L, PROPr, SF-6D and TTO utilities in patients with chronic skin diseases

OBJECTIVES

We aim to compare the measurement properties of three indirect (EQ-5D-5L, PROPr, SF-6D) and one direct (time trade-off, TTO) utility assessment methods in patients with chronic skin diseases.

METHODS

120 patients with physician-diagnosed chronic skin diseases (psoriasis 39%, atopic dermatitis 27%, acne 19%) completed a cross-sectional survey. Respondents completed the EQ-5D-5L, PROMIS-29+2 and SF-36v1 questionnaires and a 10-year TTO task for own current health. Utilities were computed using the US value sets. Ceiling, convergent and known-group validity were compared across the utilities derived with these four methods. Known-groups were defined based on general, physical and mental health. The agreement between utilities was assessed using intraclass correlation coefficients (ICC).

RESULTS

Mean utilities for the EQ-5D-5L, PROPr, SF-6D and TTO were 0.79, 0.47, 0.76 and 0.89. In corresponding order, the ceiling was 28%, 0%, 2% and 65%. The SF-6D showed excellent agreement with the EQ-5D-5L (ICC = 0.770). PROPr demonstrated poor agreement with the EQ-5D-5L (ICC = 0.381) and fair with SF-6D utilities (ICC = 0.445). TTO utilities showed poor agreement with indirectly assessed utilities (ICC = 0.058-0.242). The EQ-5D-5L better discriminated between known groups of general and physical health, while the SF-6D and PROPr outperformed the EQ-5D-5L for mental health problems.

CONCLUSION

There is a great variability in utilities across the four methods in patients with chronic skin conditions. The EQ-5D-5L, despite its higher ceiling, appears to be the most efficient in discriminating between patient groups for physical health aspects. Our findings inform the choice of instrument for quality-adjusted life year calculations in cost-utility analyses.

Plant Phenolics in the Prevention and Therapy of Acne: A Comprehensive Review

Plants are a rich source of secondary metabolites, among which phenolics are the most abundant. To date, over 8000 various polyphenolic compounds have been identified in plant species, among which phenolic acids, flavonoids, coumarins, stilbenes and lignans are the most important ones. Acne is one of the most commonly treated dermatological diseases, among which acne vulgaris and rosacea are the most frequently diagnosed. In the scientific literature, there is a lack of a detailed scientific presentation and discussion on the importance of plant phenolics in the treatment of the most common specific skin diseases, e.g., acne. Therefore, the aim of this review is to gather, present and discuss the current state of knowledge on the activity of various plant phenolics towards the prevention and treatment of acne, including in vitro, in vivo and human studies. It was revealed that because of their significant antibacterial, anti-inflammatory and antioxidant activities, phenolic compounds may be used in the treatment of various types of acne, individually as well as in combination with commonly used drugs like clindamycin and benzoyl peroxide. Among the various phenolics that have been tested, EGCG, quercetin and nobiletin seem to be the most promising ones; however, more studies, especially clinical trials, are needed to fully evaluate their efficacy in treating acne.

Unraveling the Potential of Vitamin B3-Derived Salts with a Salicylate Anion as Dermal Active Agents for Acne Treatment

This study is focused on the utilization of naturally occurring salicylic acid and nicotinamide (vitamin B3) in the development of novel sustainable Active Pharmaceutical Ingredients (APIs) with significant potential for treating acne vulgaris. The study highlights how the chemical structure of the cation significantly influences surface activity, lipophilicity, and solubility in aqueous media. Furthermore, the new ionic forms of APIs, the synthesis of which was assessed with Green Chemistry metrics, exhibited very good antibacterial properties against common pathogens that contribute to the development of acne, resulting in remarkable enhancement of biological activity ranging from 200 to as much as 2000 times when compared to salicylic acid alone. The molecular docking studies also revealed the excellent anti-inflammatory activity of N-alkylnicotinamide salicylates comparable to commonly used drugs (indomethacin, ibuprofen, and acetylsalicylic acid) and were even characterized by better IC50 values than common anti-inflammatory drugs in some cases. The derivative, featuring a decyl substituent in the pyridinium ring of nicotinamide, exhibited efficacy against Cutibacterium acnes while displaying favorable water solubility and improved wettability on hydrophobic surfaces, marking it as particularly promising. To investigate the impact of the APIs on the biosphere, the EC50 parameter was determined against a model representative of crustaceans─Artemia franciscana. The majority of compounds (with the exception of the salt containing the dodecyl substituent) could be classified as "Relatively Harmless" or "Practically Nontoxic", indicating their potential low environmental impact, which is essential in the context of modern drug development.

Potential functionality of Cutibacterium acnes extracellular vesicles in atopic dermatitis and acne vulgaris: A comparative proteomic analysis

BACKGROUND

Cutibacterium acnes is a commensal bacterium residing in healthy skin and plays a critical role in maintaining skin homeostasis. C. acnes has been considered closely related to acne vulgaris, while recent studies suggest that C. acnes and its metabolites may have a protective role in atopic dermatitis (AD) by modulating the immune system and maintaining skin homeostasis. Extracellular vesicles (EVs) are small membranous vesicles secreted by bacteria that participate in bacteria-host interactions.

METHODS

This study first compared C. acnes EVs from AD lesions (AD-EVs), acne lesions (Acne-EVs), and healthy skin (NC-EVs), using Label-free quantitative LC-MS/MS and validated differently expressed proteins by parallel reaction monitoring (PRM). Then Normal Human Epidermal Keratinocytes (NHEK) and human primary keratinocytes (KC) were treated with C. acnes EVs isolated from different groups, and the expressions of inflammatory factors were measured by quantitative real-time PCR and Western blotting.

RESULTS

Compared with the acne group, the AD group showed greater downregulation of proteins related to energy metabolism and carbon source utilization pathway. Differences in protein profile in AD and acne lesion-separated C. acnes EVs correspond to the abnormal sebum secretion pattern in both diseases. C. acnes EVs from different groups affected different expressions of Th1 and Th2 inflammatory factors and epidermal barrier markers in NHEK and KC, indicating different immunomodulatory potentials.

CONCLUSIONS

This study observed distinct proteomic differences between AD-EVs and Acne-EVs, and provided insights into the functional differences of C. acnes EVs in AD and acne.

Efficacy and safety of CO2 fractional laser versus Er:YAG fractional laser in the treatment of atrophic acne scar: A meta-analysis and systematic review

BACKGROUND

To date, a consensus on the relative efficacy and safety of CO2 fractional laser versus erbium-doped yttrium aluminum garnet (Er:YAG) fractional laser treatments for atrophic acne scars has not been reached. This meta-analysis aims to systematically assess and compare their effectiveness and safety in clinical practice.

METHODS

For this meta-analysis, we conducted comprehensive searches in Pubmed, Embase, and Cochrane databases, covering publications from their inception up to August 2023. Our focus was on studies comparing fractional CO2 laser with Er:YAG fractional laser treatments for atrophic acne scars. We excluded duplicate publications, research lacking full-text access, incomplete data, or cases where data extraction was not feasible. Additionally, animal experiments, reviews, and systematic reviews were not considered. Data analysis was performed using STATA 15.1.

RESULTS

Eight studies (seven randomized controlled trials (RCTs) and a retrospective study) were included in this meta-analysis. The sample size ranged from 28 to 106 with a total of 418 patients, including 210 in the CO2 fractional group and 208 in Er:YAG fractional group. The pooled results showed that the effective rate of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (OR = 1.81, 95% CI: 1.08-3.01) and the downtime of CO2 fractional laser in treating atrophic acne scar was significantly shorter than that of Er:YAG fractional laser (Weighted Mean Difference (WMD) = -2.11, 95% CI: -3.11 to -1.10). In addition, VAS of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (WMD = 1.77, 95% CI: 1.32-2.21) and the duration of erythema of CO2 fractional laser in treating atrophic acne scar was significantly longer than that of Er:YAG fractional laser (WMD = 1.85, 95% CI: 1.63-2.07). However, there was no significant difference in the duration of pain and incidence of PIHbetween CO2 fractional laser and of Er:YAG fractional laser.

CONCLUSION

When it comes to treating atrophic acne scars, CO2 fractional laser demonstrates superior efficacy and leads to shorter downtime. However, it is important to note that CO2 fractional laser treatments tend to result in higher pain intensity and may carry a higher risk of post-treatment pigmentation compared to Er:YAG fractional laser procedures.

A Novel Treatment of Acne Vulgaris Using a 1927 nm Fractional Thulium Laser: A Case Series

Background and Aims

Acne vulgaris remains one of the most common and problematic dermatological conditions. Recently, a fractional 1927 nm thulium laser has been developed with specific water absorption characteristics which may be of interest in the treatment of acne.

Subjects and Methods

Nine consecutive Korean subjects, 6 females and 3 males, ages ranging from 13 to 33 yr, presented with a mixture of inflammatory and noninflammatory acne. Baseline clinical photography, image analysis and lesion counts were performed. A fractional 1927 nm thulium laser (FTL) delivered 6 treatment sessions in 5 subjects and 5 sessions in 4 subjects, 4 weeks between sessions. Pain during treatment was assessed. At 32 weeks after the last treatment session, an independent Investigator Global Assessment (IGA) performed lesion counts and graded the severity of the acne at baseline and the final assessment on a quintile scale. Data were analyzed statistically.

Results

All 9 subjects completed the study with significant reductions in the inflammatory and noninflammatory lesions (P values 0.0012 and 0.0081, respectively) with overall lesion counts at the final assessment ranging from 60% to 97.1%, and acne grades in the IGA dropping by an average of 1.67 (range 1 to 3 grades). There was no significant difference in lesion counts or acne grades between the subjects who had 6 treatments and those who had 5 (P = 0.7695). Mild pain was reported during treatment, and no adverse events were reported by either the subjects or investigator.

Conclusions

The FTL at the parameters used in the present study caused disruption to the upper portion of the affected follicles and sebaceous glands under an intact stratum corneum, thereby destroying or damaging the causative Cutibacterium acnes. The superficial controlled coagulation additionally induced follicular remodeling and tissue regeneration, potentially contributing to the noticeable results in inflammatory and noninflammatory acne lesions.

Topically Applied Therapies for the Treatment of Skin Disease: Past, Present, and Future

The purpose of this review is to summarize essential biological, pharmaceutical, and clinical aspects in the field of topically applied medicines that may help scientists when trying to develop new topical medicines. After a brief history of topical drug delivery, a review of the structure and function of the skin and routes of drug absorption and their limitations is provided. The most prevalent diseases and current topical treatment approaches are then detailed, the organization of which reflects the key disease categories of autoimmune and inflammatory diseases, microbial infections, skin cancers, and genetic skin diseases. The complexity of topical product development through to large-scale manufacturing along with recommended risk mitigation approaches are then highlighted. As such topical treatments are applied externally, patient preferences along with the challenges they invoke are then described, and finally the future of this field of drug delivery is discussed, with an emphasis on areas that are more likely to yield significant improvements over the topical medicines in current use or would expand the range of medicines and diseases treatable by this route of administration. SIGNIFICANCE STATEMENT: This review of the key aspects of the skin and its associated diseases and current treatments along with the intricacies of topical formulation development should be helpful in making judicious decisions about the development of new or improved topical medicines. These aspects include the choices of the active ingredients, formulations, the target patient population's preferences, limitations, and the future with regard to new skin diseases and topical medicine approaches.

Therapeutic-driven framework for bioequivalence assessment of complex topical generic drug products

Despite the continuous research on understanding how topical drugs and the skin interact, the development of a topical generic product remains a challenge. Due to their local action effect rather than systemic, establishing suitable frameworks for documenting bioequivalence between reference and test formulations is anything but straightforward. In previous years, clinical endpoint trials were considered the gold standard method to demonstrate bioequivalence between topical products. Nevertheless, significant financial and time resources were required to be allocated owing to the inherent complexity of these studies. To address this problem, regulatory authorities have begun to accept alternative approaches that could lead to a biowaiver, avoiding the need for clinical endpoint trials. These alternatives encompass various in vitro and/or in vivo techniques that have been analysed and the benefits and drawbacks of each method have been considered. Furthermore, other factors like the integration of a quality by design framework to ensure a comprehensive understanding of the product and process quality attributes have also been taken into account. This review delves into international regulatory recommendations for semisolid topical products, with a focus on those established by the European Medicines Agency, as well as the Food and Drug Administration. Both approaches were carefully examined, discussing aspects such as acceptance criteria, sample size, and microstructure evaluation. Additionally, novel and innovative therapeutic-driven approaches based on in vitro disease models for the rapid and effective development of topical generic products are presented.

Evaluation of in vitro Skin Permeation of Clascoterone From Clascoterone Topical Cream, 1% (w/w)

Winlevi® (clascoterone) topical cream (1%, w/w) was approved by the U.S. FDA for the treatment of acne vulgaris in patients 12 years of age and older. The active ingredient, clascoterone, is not stable in physiological solutions and can hydrolyze to cortexolone at body temperature. Instability of clascoterone poses a significant challenge in accurately assessing the rate and extent of clascoterone permeation in vitro. Therefore, the purpose of this study was to develop an in vitro skin permeation test (IVPT) method, and a robust analytical method, that can minimize hydrolyzation of clascoterone during the study for quantification of clascoterone. Two IVPT methods, using either vertical diffusion cells or flow-through cells, were developed and compared to evaluate in vitro permeation of clascoterone from Winlevi. A liquid chromatography with tandem mass spectrometry (LC-MS/MS) method was developed to monitor the level of clascoterone and cortexolone in the IVPT samples. The analytical method features a 2-min high-throughput analysis with good linearity, selectivity, and showed a lower limit of quantitation (LLOQ) of 0.5 ng/mL for both clascoterone and cortexolone. The in vitro skin permeation of clascoterone and cortexolone was observed as early as 2 h in both IVPT methods. A substantive amount of clascoterone was found to hydrolyze to cortexolone when using the vertical static diffusion cells with aliquot sampling. Conversely, degradation of clascoterone was significantly minimized when using the flow-through diffusion cells with fractional sampling. The data enhanced our understanding of in vitro permeation of clascoterone following topical application of the Winlevi topical cream, 1% and underscores the importance of IVPT method development and optimization during product development.

Successful treatment of a lactating women with severe acne through the combination of fire needle and photodynamic therapy: A case report

Severe acne, characterized by cysts and nodules, can significantly impact a patient's self-image and quality of life [1]. In China, first-line treatments for severe acne typically include oral isotretinoin, topical benzoyl peroxide, and oral or topical antibiotics [2]. However, due to concerns about safety, oral isotretinoin and antibiotics are not recommended for lactating women, posing challenges in treating acne in this population and often leading to emotional distress. While photodynamic therapy has shown effectiveness in patients unwilling to take oral medications [3], treating severe acne during lactation remains a complex issue with limited research available. In this unique case, fire needle combined with photodynamic therapy was successfully utilized to address severe acne in a lactating patient. Following treatment, the patient experienced clearance of cysts, nodules, and pustules, as well as an improvement in depressive symptoms, yielding significant outcomes. Nevertheless, the efficacy and safety of this combined approach warrant further investigation through clinical trials.

Investigation of the effect of adapalene 0.3%/benzoyl peroxide 2.5% gel in Korean patients with acne: a randomized, double-blind clinical trial, with a histopathological and immunohistochemical study

BACKGROUND

Acne vulgaris poses significant physical and psychological challenges worldwide. Data of adapalene 0.3%/benzoyl peroxide 2.5% gel (A0.3/BPO2.5) for acne treatment in Asian patients is limited.

METHODS

In this randomized double-blind clinical trial, 49 Korean patients with moderate-to-severe acne and scars were assigned to the A0.3/BPO2.5 (N.=37) or vehicle (N.=12) group. Acne and acne scar severity scores were assessed at baseline and 4, 8, 12, and 24 weeks. The primary outcomes were treatment success rate (reduction of ≥2 Investigator's Global Assessment grade and reaching a grade of 0 or 1) and proportional acne lesion and scar count reduction against the baseline. To assess histological changes, 2-mm punch biopsies were performed at baseline and week 24 on the respective inflammatory lesions or scars.

RESULTS

At week 24, the A0.3/BPO2.5 group had a significantly higher treatment success rate than the vehicle group. The total acne count, inflammatory lesion count, and non-inflammatory lesion count percentages (against baselines) with A0.3/BPO2.5 and the vehicle were 12.1% vs. 96.7%, 8.0% vs. 101.2%, and 13.3% vs. 98.9%, respectively (all P<0.001). Scar count percentages (against baselines) with A0.3/BPO2.5 and the vehicle were 27.3% and 96.5%, respectively (P<0.001). Significant elevations in collagen 1 and 3, elastin, CK15, and p63 levels, with increases of 172.7%, 230.6%, 176.5%, 286.2%, and 105.9%, respectively, in comparison to baseline (all P<0.05). No major adverse events leading to discontinuation were observed.

CONCLUSIONS

A0.3/BPO2.5 was an effective and safe treatment for acne and acne scars in Asian patients supported by robust histopathological and immunohistochemical evidence.

Safety profiles of doxycycline, minocycline, and tigecycline in pediatric patients: a real-world pharmacovigilance analysis based on the FAERS database

Introduction

Recently, the rise of antibiotic resistance has prompted a reconsideration of tetracyclines. However, existing studies are inadequate in assessing the pediatric safety of this class of antibiotics. To address the gap, our study aims to comprehensively assess the safety of tetracyclines in children.

Methods

Adverse event (AE) reports from January 2005 to September 2023 were obtained from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database, and reporting odds ratio (ROR) was performed to identify potential risk signals in children under 18 years old who were administered any of the three tetracyclines: doxycycline, minocycline, and tigecycline.

Results

A total of 1903 AE cases were included in our study: 782 for doxycycline, 981 for minocycline, and 140 for tigecycline. Doxycycline and tigecycline were predominantly associated with "general disorders and administration site conditions" and "gastrointestinal disorders," while minocycline was more frequently linked to "skin and subcutaneous tissue disorders" and "gastrointestinal disorders." Psychiatric risks predominantly included depression, suicidal ideation, and suicide attempt. In the category of skin and subcutaneous tissues, 30.88% of the minocycline-induced drug reaction with eosinophilia and systemic symptoms (DRESS) cases resulted in death, alongside a high occurrence of co-occurring AEs such as multiple organ dysfunction syndrome, Type 1 Diabetes Mellitus (T1DM), and autoimmune thyroiditis. As for the endocrine system, both doxycycline and minocycline were found to potentially increase the risk of thyroid dysfunction. For children under the age of 8, doxycycline was associated with tooth discoloration (N = 7, ROR = 20.11%, 95% CI: 9.48-42.67), although it remained unclear whether the discoloration was permanent.

Conclusion

Our findings indicated that for pediatric patients, the majority of results were in line with the prescribing information and previous studies, and minocycline tended to cause more frequent and severe AEs than doxycycline. However, it is noteworthy that exceptions were found for psychiatric disorders and thyroid dysfunction associated with doxycycline, which are not mentioned in its FDA prescribing information. Additionally, further safety studies on tigecycline are still needed for children. When prescribing tetracyclines to pediatric patients, a careful risk-benefit assessment is crucial.

Investigating the mechanism of PAD in the treatment of acne based on network pharmacology and molecular docking: A review

Acne is a common and chronic skin condition characterized by high incidence, recurrent symptoms and difficult cure. Summarizing the clinical treatment experience, it was found that the powder for ascending and descending was effective in the treatment of acne. Our aim was to use network pharmacology and molecular docking to reveal the hub genes, biological functions, and signaling pathways of powder for ascending and descending against acne. First, the chemical components and target genes of PAD were sifted using the TCMSP and HERB database. The targets of acne were obtained simultaneously from the CTD, OMIM and GeneCards database. The obtained drug targets and disease targets were imported into the R language software to draw Venn diagrams. Then, the potential targets were imported into the String website to construct a protein interaction network diagram. And Cytoscape software was used for topological analysis to screen the core targets, and the core targets were analyzed by GO functional enrichment and KEGG pathway enrichment. Finally, molecular docking was used to verify the predictions of key genes' reliability. The core targets of the treatment of acne were TNF, GADPH, IL-6 and so on. The results of enrichment analysis showed that the treatment of acne with PAD may be related to TNF signaling pathway and AGE-RAGE signaling pathway. The molecular docking verification showed that the components were well bound to the core targets of acne, and the docking ability of stigmasterol and TNF (-12.73 kcal/mol) was particularly outstanding.

Recommendations for managing adult acne and adolescent acne based on an epidemiological study conducted in China

There are numerous differences between adult acne and adolescent acne in terms of causes, distribution, and characteristics of skin lesions, as well as treatment. This paper aims to summarize the differences between adult and adolescent acne in China, in order to propose more suitable ways to improve their quality of life. We collected basic information, acne-related information, acne-affecting factors, quality of life scores and treatment-related information of acne patients. A total of 552 questionnaires were collected. Adult acne is typically predominant on the cheeks, similar to adolescent acne, with a relatively lower incidence in other areas, apart from the jawline. Pigmentation and depressed scars are present in nearly half of acne patients, while hypertrophic scars are less frequently observed. Teenagers often have a higher consumption of dairy products, sugary drinks, and high-sugar and high-fat foods. Eczema is more common in adult acne. Additionally, more adults than teenagers experience stress and poor quality of life related to acne. Adolescents are more likely to seek treatment online and on social media. Clinicians must thoroughly evaluate diverse risk factors and formulate personalized acne management strategies for patients with different types of acne.

Acne treatment: research progress and new perspectives

Acne is a chronic inflammatory skin disease that primarily affects adolescents and is attributed to various factors, including hormonal changes, genetic predisposition, and environmental influences. It typically manifests in areas rich in sebaceous glands such as the face, chest, and back. Symptoms of acne can range from mild to severe and may present as pimples, pustules, nodules, cysts, and scarring. The appearance of acne can significantly impact both the physical and mental well-being of patients, potentially leading to feelings of anxiety, depression, and social withdrawal. The pathogenesis of acne is multifaceted involving genetic predisposition as well as environmental factors such as hormonal imbalances, inflammation, abnormal follicular sebaceous unit keratinization, proliferation of follicular microorganisms like Propionibacterium acnes, increased sebum production, and dietary influences. Traditional treatment methods for acne include topical drug therapy, oral drug therapy, photoelectric therapy, and chemical peeling. With ongoing research into the pathogenesis of acne, treatment methods are rapidly evolving with novel antibiotics, probiotics, biological agents, topical anti-androgen drugs, topical vitamin A acid metabolism blockers, antimicrobial peptides, immunotherapy, micro-needling, and micro-needling patches. This article aims to provide a comprehensive review of recent advancements in acne treatment.

The occurrence of mental health symptoms in isotretinoin-treated adolescents

BACKGROUND

Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents.

METHODS

This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12-18 prescribed isotretinoin over a 10-year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms.

RESULTS

One hundred seventy-seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009).

CONCLUSIONS

A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new-onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.

Evaluation of the effectiveness of Berberis integerrima Bunge root extract combined with spearmint essential oil in the treatment of acne vulgaris: A randomized controlled clinical trial

BACKGROUND

Acne vulgaris is one of the most common dermatological disorders. Berberis integerrima Bunge belongs to the Berberidaceae family. Several studies on different Berberis species in addition to B. integerrima have shown antimicrobial, antioxidant, and anti-inflammatory effects. Spearmint essential oil also has antioxidant, antibacterial, and anti-inflammatory activities. This study aimed to evaluate the clinical effectiveness of the topical combination of B. integerrima root extract and spearmint essential oil in the treatment of acne vulgaris.

METHODS

Patients with mild to moderate facial acne who met the inclusion criteria were randomly assigned to either drug (B. integerrima extract/spearmint essential oil topical solution) or control (clindamycin 1% topical solution) groups. Each group applied the solution twice a day for 4 weeks. Before and at the end of the intervention, the number of lesions and mGAGS (Modified Global Acne Grading Scale) score were recorded.

RESULTS

Thirty patients in each group of drug and control completed the study. Topical B.integerrima root extract/spearmint essential oil significantly reduced the number of lesions (27.33 ± 26.17 vs. 21.58 ± 21.10; p < 0.001) and mGAGS (18.76 ± 8.61 vs. 13.87 ± 8.14; p < 0.001) at the end of the intervention. However, there was no significant difference between the two groups regarding the number of lesions (p = 0.906) and mGAGS (p = 0.882).

CONCLUSIONS

B. integerrima root extract combined with spearmint essential oil has significant anti-acne effects, comparable to topical antibiotic clindamycin. It could be considered as a potential treatment for acne vulgaris. However, more studies with larger sample sizes and longer durations are required to confirm this effect.

Efficacy and safety of topical minocycline foam (FMX101 4%) in treatment of Chinese subjects with moderate-to-severe facial acne vulgaris: A phase 3, multi-centre, randomized, double-blind, vehicle-controlled study

BACKGROUND

FMX101 4%, as a topical foam formulation of minocycline, has been approved by US Food and Drug Administration for the treatment of moderate-to-severe acne vulgaris (AV).

OBJECTIVE

To evaluate the efficacy and safety of FMX101 4% in treating Chinese subjects with moderate-to-severe facial AV.

METHODS

This was a multi-centre, randomized, double-blind, vehicle-controlled phase 3 study in Chinese subjects with moderate-to-severe AV. Eligible subjects were randomized 2:1 to receive either FMX101 4% or vehicle foam treatment for 12 weeks. The primary efficacy endpoint was the change in inflammation lesion count (ILC) from baseline at week 12. The key secondary endpoint was the treatment success rate according to Investigator's Global Assessment (IGA) at week 12.

RESULTS

In total, 372 subjects were randomized into two groups (FMX101 4% group, n = 248; vehicle group, n = 124). After 12 weeks treatment, the reduction in ILC from baseline was statistically significant in favour of FMX101 4%, compared with vehicle foam (-21.0 [0.08] vs. -12.3 [1.14]; LSM [SE] difference, -8.7 [1.34]; 95% CI [-11.3, -6.0]; p < 0.001). FMX101 4% treatment yielded significantly higher IGA treatment success rate at week 12 as compared to the control treatment (8.06% vs. 0%). Applying FMX101 4% also resulted in significant reduction in noninflammatory lesion count (nILC) versus vehicle foam at week 12 (-19.4 [1.03] vs. -14.9 [1.47]; LSM [SE] difference, -4.5 [1.74]; 95% CI [-8.0, -1.1]; p = 0.009). Most treatment-emergent adverse events (TEAEs) were mild-to-moderate in severity, and no treatment-related treatment-emergent serious adverse event (TESAE) occurred. Thus, FMX101 4% was considered to be a safe and well-tolerated product during the 12-week treatment period.

CONCLUSION

FMX101 4% treatment for 12 weeks could lead to significantly reduced ILC and nILC, and improved IGA treatment success rate in Chinese subjects with moderate-to-severe facial AV. It also showed a well acceptable safe and tolerability profile.

Expert Consensus on Big Data Collection of Skin and Appendage Disease Phenotypes in Chinese

The collection of big data on skin and appendage phenotypes has revolutionized the field of personalized diagnosis and treatment by enabling the evaluation of individual characteristics and early detection of abnormalities. To establish a standardized system for collecting and measuring big data on phenotypes, a systematic categorization of measurement entries has been undertaken, accompanied by recommendations on measurement entries, environmental equipment requirements, and collection processes, tailored to the needs of different usage scenarios. Specific collection sites have also been recommended based on different index characteristics. A multi-center, multi-regional collaboration has been initiated to collect big date on phenotypes of healthy and diseased skin in the Chinese population. This data will be correlated with patient disease information, exploring the factors influencing skin phenotype, analyzing the phenotypic data features that can predict prognosis, and ultimately promoting the exploration of the pathophysiology and pathogenesis of skin diseases and therapeutic approaches. Non-invasive skin measurement robots are also in development. This consensus aims to provide a reference for the study of phenomics and the standardization of phenotypic measurements of skin and appendages in China.

Fire needle pretreatment with 5-aminolevulinic acid photodynamic therapy combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne

BACKGROUND

Nodulocystic acne is a severe form of acne, which is commonly treated with oral isotretinoin, hormones, or antibiotics. However, drug therapy often has some side effects and poor compliance. Fire needle combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a simple, effective, short-term treatment with few adverse reactions, which is expected to be an effective physiotherapy for nodulocystic acne. Moreover, the combination with isotretinoin can reduce the dosage of the drug, thereby reducing the side effects of isotretinoin.

OBJECTIVES

To evaluate the safety and efficacy of fire-needle pretreated ALA-PDT combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne.

METHODS

This study reported 10 patients with refractory nodulocystic acne who received combined treatment. During the treatment period, all patients received a low dose of oral isotretinoin capsules daily. The acne lesions were pretreated with fire needle before ALA-PDT treatment. The number of acne lesions, including papules, pustules, and nodular cysts, was documented at weeks 0, 2, 4, 8, and 12 to assess the therapeutic efficacy. Concurrently, adverse reactions such as pain, pruritus, and pigmentation changes were recorded and evaluated throughout the treatment course.

RESULTS

After combined treatment, all patients achieved good therapeutic effects, with an overall effective rate of 90 % at week 12. After treatment, skin lesions such as nodules, and cysts subsided significantly. The combination therapy has no serious adverse effects and has a favorable safety profile.

CONCLUSION

Fire needle pretreatment ALA-PDT combined with low-dose isotretinoin is effective and safe in the treatment of severe refractory nodular cystic acne, which is worthy of clinical promotion and research.

Mapping the evolution of acne research based on 100 top-cited articles: A bibliometric analysis of trends and hotspots from 2014 to 2023

BACKGROUND

Acne is a prevalent inflammatory condition of the pilosebaceous unit, which seriously affects the appearance and mental health of patients. Bibliometrics is the statistical analysis of academic literature in a certain field. We aimed to characterize the 100 most cited articles on acne from a bibliometric perspective, as well as explore the frontier hotspots and trends of acne.

METHODS

A search was conducted on the Web of Science database on August 8, 2023. we employed the terms "acne," "acne Vulgaris," and "common acne" in our search. The top 100 articles with the most citations throughout the time frame of 2014 to 2023 were discovered and assessed. The visualization study was carried out using bibliometric tools such as CiteSpace 6.2.R4, VOSviewer 1.6.18, and MapChart.

RESULTS

The top 100 most cited articles were published between 2014 and 2021, originated from a diverse range of 48 countries, with a predominant focus on the United States of America (USA) and Germany. The top 100 papers were cited between 50 and 712 times. Dreno B, from Nantes University, was the most frequently nominated author. With 12 papers, the Journal of the European Academy of Dermatology and Venereology contributed the most to the top 100 list. Alongside the term "acne", the following terms or phrases were observed frequency in the top 100 articles, Cutibacterium acnes, sebaceous, western diet, antibiotic resistance, staphylococcus-epidermidis, insulinlike growth factor 1, benzoyl peroxide, and polyunsaturated fatty acids. Alongside the term "acne", terms or phrases such as Cutibacterium acnes, sebaceous, western diet, antibiotic resistance, staphylococcus-epidermidis, insulinlike growth factor 1, benzoyl peroxide, and polyunsaturated fatty acids, etc also have a high frequency in the top 100 articles.

CONCLUSION

This analysis summarizes the shifting trends of acne research over the last decades. Research on acne is currently flourishing. The related pathogenesis and therapeutic strategies have been the focus of current research and developmental trends in future research.

The causal relationship between serum metabolites and acne vulgaris: a Mendelian randomization study

In individuals with acne vulgaris, alterations occur in serum metabolite composition, yet the exact causal link between these metabolites and acne development remains elusive. Using genome-wide association datasets, we performed bidirectional Mendelian randomization (MR) to investigate the potential causal relationship between 309 serum metabolites and acne vulgaris. We performed sensitivity analysis to evaluate the presence of heterogeneity and pleiotropy. Forward MR analysis found 14 serum metabolites significantly associated with acne vulgaris, and reverse MR analysis found no significant association between acne vulgaris and these serum metabolites. Through validation using data from the FinnGen database of acne vulgaris studies, we found a conclusive and significant correlation between stearoylcarnitine and acne vulgaris. This provides new evidence in the search for new targets for the treatment of acne vulgaris.

Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies

Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.

Guidelines of care for the management of acne vulgaris

BACKGROUND

Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.

OBJECTIVE

The objective of this study was to provide evidence-based recommendations for the management of acne.

METHODS

A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.

RESULTS

This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.

LIMITATIONS

Analysis is based on the best available evidence at the time of the systematic review.

CONCLUSIONS

These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Triple Combination Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% for Acne: Efficacy and Safety from a Pooled Phase 3 Analysis

INTRODUCTION

A three-pronged approach to acne treatment combining an antibiotic, antimicrobial, and retinoid may be more efficacious than single/double treatments while potentially reducing antibiotic resistance. This study evaluated the efficacy and safety of the first fixed-dose, triple-combination topical acne product, clindamycin 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1% gel (CAB) using pooled phase 3 data.

METHODS

In two identical phase 3 (N = 183; N = 180), double-blind, 12-week studies, participants aged ≥ 9 years with moderate-to-severe acne were randomized 2:1 to receive once-daily CAB or vehicle gel. Endpoints included ≥ 2-grade reduction from baseline in Evaluator's Global Severity Score and clear/almost clear skin (treatment success) and least-squares mean percent change from baseline in acne lesion counts. Treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were evaluated.

RESULTS

At week 12, 50.0% of participants achieved treatment success with CAB versus 22.6% with vehicle gel (P < 0.001). CAB resulted in > 70% reductions in inflammatory and noninflammatory lesions at week 12 (77.9% and 73.0%, respectively), which were significantly greater than vehicle (57.9% and 48.2%; P < 0.001, both). Most TEAEs were of mild-moderate severity, and < 3% of CAB-treated participants discontinued study/treatment because of AEs. Transient increases from baseline in scaling, erythema, itching, burning, and stinging were observed with CAB, but resolved back to or near baseline values by week 12.

CONCLUSIONS

The innovative fixed-dose, triple-combination clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1% gel was efficacious and well tolerated in children, adolescents, and adults with moderate-to-severe acne. Half of participants achieved clear/almost clear skin by 12 weeks, rates not previously seen in clinical studies of other topical acne products.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04214639 and NCT04214652.