Measuring acne using Coproporphyrin III, Protoporphyrin IX, and lesion-specific inflammation: an exploratory study

Treatment effect of ultra-pulse dynamic CO2 laser and comedone extractor in dense comedones: a prospective, randomized, split-face, evaluator-blind, controlled clinical trial

Clearance of comedone is challenging in the treatment of acne, as it is very likely to develop into inflammatory lesions. However, there is lack of effective treatments for dense comedones. Comedone extractor has been widely employed by dermatologists, but the effect is temporary and may cause irritation. CO2 laser is a potential method for dense comedones, but the efficacy and safety need to be explored. In this single-center, randomized, single-blind, self-controlled study, the faces of patients with dense comedones were randomly assigned into two sides receiving either ultra-pulse dynamic CO2 laser or comedone extraction at an interval of 2 weeks for 4 sessions. After 4 treatments, the average comedone reduction rate of the CO2 laser was 64.49%, which was higher than that by the extractor (46.36%) (P < .001). 79.16% of the patients reached over 50% reduction by CO2 laser, while only 37.5% on extractor treated side reached 50% clearance. Texture index, porphyrin index, red zone, erythema index, and transepidermal water loss decreased after both treatments, and CO2 laser showed more improvement. There was no difference in hydration index and melanin index between the two treatments. No permanent or severe side effects were observed on both sides. The CO2 laser showed higher comedone clearance with lower pain scores than the comedone extractor.

Intradermal injection of Cutibacterium acnes and staphylococcus: A pustular acne-like murine model

BACKGROUND

Skin 16S microbiome diversity analysis indicates that the Staphylococcus genus, especially Staphylococcus aureus (S. aureus), plays a crucial role in the inflammatory lesions of acne. However, current animal models for acne do not fully replicate human diseases, especially pustular acne, which limits the development of anti-acne medications.

AIMS

The aim is to develop a mouse model for acne, establishing an animal model that more closely mimics the clinical presentation of pustular acne. This will provide a new research platform for screening anti-acne drugs and evaluating the efficacy of clinical anti-acne experimental treatments.

METHODS

Building upon the existing combination of acne-associated Cutibacterium acnes (C. acnes) with artificial sebum, we will inject a mixture of S. aureus and C. acnes locally into the dermis in a 3:7 ratio.

RESULTS

We found that the acne animal model with mixed bacterial infection better replicates the dynamic evolution process of human pustular acne. Compared to the infection with C. acnes alone, mixed bacterial infection resulted in pustules with a distinct yellowish appearance, resembling pustular acne morphology. The lesions exhibited redness, vascular dilation, and noticeable congestion, along with evident infiltration of inflammatory cells. This induced higher levels of inflammation, as indicated by a significant increase in the secretion of inflammatory factors such as IL-1β and TNF-α.

CONCLUSION

This model can reflect the clinical symptoms and development of human pustular acne, overcoming the limitations of animal models commonly used in basic research to study this situation. It provides support for foundational research and the development of new acne medications.

A novel professional-use synergistic peel technology to reduce visible hyperpigmentation on face: Clinical evidence and mechanistic understanding by computational biology and optical biopsy

Topicals and chemical peels are the standard of care for management of facial hyperpigmentation. However, traditional therapies have come under recent scrutiny, such as topical hydroquinone (HQ) has some regulatory restrictions, and high concentration trichloroacetic acid (TCA) peel pose a risk in patients with skin of colour. The objective of our research was to identify, investigate and elucidate the mechanism of action of a novel TCA- and HQ-free professional-use chemical peel to manage common types of facial hyperpigmentation. Using computational modelling and in vitro assays on tyrosinase, we identified proprietary multi-acid synergistic technology (MAST). After a single application on human skin explants, MAST peel was found to be more effective than a commercial HQ peel in inhibiting melanin (histochemical imaging and gene expression). All participants completed the case study (N = 9) without any adverse events. After administration of the MAST peel by a dermatologist, the scoring and VISIA photography reported improvements in hyperpigmentation, texture and erythema, which could be linked to underlying pathophysiological changes in skin after peeling, visualized by non-invasive optical biopsy of face. Using reflectance confocal microscopy (VivaScope®) and multiphoton tomography (MPTflex™), we observed reduction in melanin, increase in metabolic activity of keratinocytes, and no signs of inflammatory cells after peeling. Subsequent swabbing of the cheek skin found no microbiota dysbiosis resulting from the chemical peel. The strong efficacy with minimum downtime and no adverse events could be linked to the synergistic action of the ingredients in the novel HQ- and TCA-free professional peel technology.

Combining superpulse dynamic CO2 laser and supramolecular salicylic acid in the treatment of dense comedones with higher clearance in a shorter time: A prospective, randomized, split-face clinical trial

OBJECTIVES

Dense comedones are common in patients with acne vulgaris, and promoting treatment can prevent the progression of acne lesions. However, the efficacy-time conflict makes the treatment challenging and the medication options are limited by the side effects.

MATERIALS AND METHODS

Thirty-five patients with symmetrical dense comedones were enrolled and the two sides of the face were randomly assigned to receive 30% supramolecular salicylic acid (SSA) combined with CO2 laser or CO2 laser monotherapy at an interval of 2 weeks for six treatment sessions. Comedones count, porphyrin index (PI), texture index (TI), melanin index, erythema index, hydration index (HI), transepidermal water loss (TEWL), and side effects were recorded at each visit till the 12th week.

RESULTS

Thirty-one patients completed the study. Comedones on the combined-SSA side were reduced more after six treatments, that the mean reduction rate of the combined-SSA side was 85.76%, and that of the CO2 laser-treated side was 62.32% (Pbetween  < 0.001). Combining SSA also showed a better effect on reducing PI and TI than CO2 laser singly (Pbetween  < 0.001). TEWL and HI between the two sides showed no significant differences after treatments. No permanent or severe side effects were observed on both side.

CONCLUSIONS

The treatment combined CO2 laser with 30% SSA dealt with the efficacy-time conflict while significantly reducing comedones and improving skin texture in 12 weeks and no serious adverse reactions occurred.

LIMITATIONS

It is a single-center study and the number of subjects was small.

Pityriasis Versicolor-A Narrative Review on the Diagnosis and Management

This narrative review presents a comprehensive overview of the diagnosis and management of pityriasis versicolor (PV), a common superficial fungal infection caused by the yeast Malassezia. PV is characterised by scaly hypopigmented or hyperpigmented patches, primarily affecting the upper trunk, neck, and upper arms. Regarding commensal interactions, Malassezia utilises nutrient sources without affecting the human host. In cases of pathogenicity, Malassezia can directly harm the host via virulence factors or toxins, or indirectly by triggering damaging host responses. The diagnosis typically relies on recognising characteristic clinical features. Due to the wide variability in its clinical presentation, recognising the differential diagnosis is critical. In this paper, we discuss the clinical differentials, with their dermatoscopic presentation, but also describe a range of helpful diagnostic techniques (microscopy, conventional and ultraviolet-induced fluorescence dermatoscopy, and confocal microscopy). Topical therapies are the primary treatment for PV, encompassing non-specific antifungal agents like sulphur with salicylic acid, selenium sulphide 2.5%, and zinc pyrithione. Additionally, specific topical antifungal medications with either fungicidal or fungistatic properties may also be incorporated into the topical treatment regimen, such as imidazoles, allylamines, and ciclopirox olamine. Systemic therapies might occasionally be used. Patient education and the promotion of good personal hygiene are pivotal to reduce the risk of recurrence. In recurrent cases, particularly during warmer and more humid periods, prolonged prophylaxis with topical agents should be considered.

Genome-scale metabolic modeling and in silico analysis of opportunistic skin pathogen Cutibacterium acnes

Cutibacterium acnes, one of the most abundant skin microbes found in the sebaceous gland, is known to contribute to the development of acne vulgaris when its strains become imbalanced. The current limitations of acne treatment using antibiotics have caused an urgent need to develop a systematic strategy for selectively targeting C. acnes, which can be achieved by characterizing their cellular behaviors under various skin environments. To this end, we developed a genome-scale metabolic model (GEM) of virulent C. acnes, iCA843, based on the genome information of a relevant strain from ribotype 5 to comprehensively understand the pathogenic traits of C. acnes in the skin environment. We validated the model qualitatively by demonstrating its accuracy prediction of propionate and acetate production patterns, which were consistent with experimental observations. Additionally, we identified unique biosynthetic pathways for short-chain fatty acids in C. acnes compared to other GEMs of acne-inducing skin pathogens. By conducting constraint-based flux analysis under endogenous carbon sources in human skin, we discovered that the Wood-Werkman cycle is highly activated under acnes-associated skin condition for the regeneration of NAD, resulting in enhanced propionate production. Finally, we proposed potential anti-C. acnes targets by using the model-guided systematic framework based on gene essentiality analysis and protein sequence similarity search with abundant skin microbiome taxa.

Significance of Singlet Oxygen Molecule in Pathologies

Reactive oxygen species, including singlet oxygen, play an important role in the onset and progression of disease, as well as in aging. Singlet oxygen can be formed non-enzymatically by chemical, photochemical, and electron transfer reactions, or as a byproduct of endogenous enzymatic reactions in phagocytosis during inflammation. The imbalance of antioxidant enzymes and antioxidant networks with the generation of singlet oxygen increases oxidative stress, resulting in the undesirable oxidation and modification of biomolecules, such as proteins, DNA, and lipids. This review describes the molecular mechanisms of singlet oxygen production in vivo and methods for the evaluation of damage induced by singlet oxygen. The involvement of singlet oxygen in the pathogenesis of skin and eye diseases is also discussed from the biomolecular perspective. We also present our findings on lipid oxidation products derived from singlet oxygen-mediated oxidation in glaucoma, early diabetes patients, and a mouse model of bronchial asthma. Even in these diseases, oxidation products due to singlet oxygen have not been measured clinically. This review discusses their potential as biomarkers for diagnosis. Recent developments in singlet oxygen scavengers such as carotenoids, which can be utilized to prevent the onset and progression of disease, are also described.

Efficacy of the continuous use of a lotion with carbon dioxide on male subjects with mild acne

OBJECTIVE

Acne vulgaris is caused by dyslipidemia, dyskeratosis and/or abnormal bacterial growth. The obstruction of skin pores due to hyperkeratosis of the infundibulum contributes to the formation of comedones. Thus, normalizing keratinization of epidermal cells in skin pores might be useful to improve acne. Recently, it has been found that the transcutaneous application of carbon dioxide (CO₂ ) regulates imbalances of the desquamatory process. In this study, we evaluated the efficacy of a skin lotion containing CO₂ on mild acne.

METHODS

Twenty-four healthy Japanese males (20-29 years old) with mild acne attended this evaluation. The subjects were divided into 2 groups, one group used a skin lotion containing CO₂ and the other group used a skin lotion without CO₂ . Following facial washing, each subject topically applied the skin lotion with or without CO₂ twice a day for 4 weeks. Prior to the start of the evaluation (week 0) and following 2 and 4 weeks of treatment, acne symptoms were assessed by a dermatologist and by instrumental measurements.

RESULTS

Topical application of the skin lotion with CO₂ for 4 weeks significantly improved acne symptoms, which was recognized by the subjects. However, treatment with the skin lotion without CO₂ did not improve acne symptoms. This improvement of acne symptoms by CO₂ was not accompanied by changes in sebum levels, skin surface pH, skin capacitance, or porphyrin levels.

CONCLUSION

The transcutaneous application of a lotion with CO₂ improves acne symptoms by normalizing keratinization without affecting skin surface conditions.

Ultraviolet Fluorescence Photography-Choosing the Correct Filters for Imaging

Ultraviolet (UV) fluorescence is a valuable tool for the imaging of a wide range of subjects. Like all imaging techniques, the key to success depends on the correct choice of equipment and approach used. In fluorescence photography, a filter is placed in front of the camera lens to block unwanted short-wavelength light from entering the camera, which would compromise the image. However, some filters exhibit fluorescence under UV light and can therefore have the potential to produce a color cast on the image. Filters also vary in how well they block unwanted light. A range of commonly used optical filters was assessed for fluorescence under UV light, and their optical transmission between 250 nm and 800 nm was measured. Finally, a simple method to enable the researcher to determine the fluorescence of the filters that they are using or wish to use for their work is described. The results indicate that the filters tested demonstrated a wide range of fluorescence under UV light and varying degrees of UV blocking. Some filters tested had equivalent or reduced fluorescence compared to Schott KV-418, which is a widely used, but, unfortunately, no longer manufactured UV blocking filter commonly used for fluorescence photography.

The Yin and Yang of Skin Microbiota in "Swimmer Acne"

Cutibacterium acnes (C. acnes) is an organism implicated in the pathogenesis of acne. Despite regular immersion in antimicrobial chlorine, adolescent swimmers suffer from acne and tend to be resistant to standard therapies. Given the presence of Pseudomonas within swimming facilities, we hypothesized that "swimmer acne" is potentially driven by a different microbial mechanism. In this study, we aimed to examine the microbial dynamics of C. acnes and Pseudomonadaceae, a family of Gram-negative bacteria (includes Pseudomonas aeruginosa), in swimmers and its potential contribution to pathogenesis of acne in this population. Using fluorescence photography that measures the Coproporphyrin III (CPIII), we quantitated an absolute abundance of C. acnes present on the face of each participant pre- and post-swimming. In addition, 16S rRNA gene sequencing was utilized to assess relative abundance of the skin microbiota on each participant pre- and post-swimming. 16 swimmers (8 girls and 8 boys) completed the study. Seven had acne on the face. The CPIII fluorescence levels decreased for all swimmers after 1 hour of swimming (p-value <0.001). In contrast, relative abundance of C. acnes remained unchanged, while that of Pseudomonadaceae increased after swimming (p-value = 0.027). Comparing the relative abundances of Pseudomonadaceae before swimming, there was a significant increase in variance from the mean in acne group as compared to no acne group (p-value <0.001). Taken together, we conclude that the skin dysbiosis resulting from repeated decolonization and colonization of C. acnes and Pseudomonadaceae, respectively, can potentially be associated with the pathogenesis of acne in swimmers.

Quantitative Assessment of Age-dependent Changes in Porphyrins from Fluorescence Images of Ultraviolet Photography by Image Processing

BACKGROUND

Skin is the first line of defense against harmful external environmental factors. Skin flora living on the skin surface impact skin health and skin disease. Bacteria, form part of the unique and complex skin micro-ecological system. For example, Propionibacterium acnes (P. acnes) is a member of the anaerobic organisms and is involved in the induction of skin acne. It produces porphyrins that absorb ultraviolet light and emit red fluorescence in response. As a result, fluorescence surveillance of the skin can be important in both the diagnosis of skin acne and the evaluation of therapeutic effects. Many different measurement methods for single skin biophysical properties have been reported.. This study focused on the age-dependent changes in porphyrins for normal skin, and developed a novel algorithm to evaluate porphyrins using the fluorescence images by image processing quantitatively.

MATERIALS AND METHODS

An extraction algorithm was proposed for the segmentation of porphyrin fluorescence images in OpenCV. The algorithm consisted primarily of preprocessing, conversion from RGB color space to HSV color space, and classification of fluorescence. There are 3595 healthy Japanese aged 16-85 years enrolled in the study and fluorescence images were acquired from their cheek sites under 375 nm UV-LED excitation. Age-related fluorescence variation was conducted applying the algorithm implemented.

RESULTS

A new extraction algorithm has been proposed with fluorescence image input and three indexes output, including the number of fluorescence, area of fluorescence, and mean intensity of fluorescence. Proposed algorithm was verified by three parameters, the accuracy, sensitivity, and precision, which refer to the ability of algorithm to detect the number of fluorescence correctly and repeatedly. The verification results were 71%, 72%, and 88% respectively, taking a validly fundamental step for skin health record and analysis. Furthermore, large-scale fluorescence image segmentation results revealed that similar trends were coming out for all three indexes in cheek as people get older. All the fluorescence number, area and mean intensity arrived at the highest at 30 years old and fell off since then.

CONCLUSION

The number, area, and fluorescence intensity of porphyrins can be extracted well from fluorescence images with the proposed algorithm in the study, which has the potential to aid in thediagnosis of skin acne and predict skin conditions as an assisted tool. It is implicated that fluorescence status is influenced by age, which rises to the peak around 30 years old for normal cheek's skin.

Visible light. Part I: Properties and cutaneous effects of visible light

Approximately 50% of the sunlight reaching the Earth's surface is visible light (400-700 nm). Other sources of visible light include lasers, light-emitting diodes, and flash lamps. Photons from visible light are absorbed by photoreceptive chromophores (e.g., melanin, heme, and opsins), altering skin function by activating and imparting energy to chromophores. Additionally, visible light can penetrate the full thickness of the skin and induce pigmentation and erythema. Clinically, lasers and light devices are used to treat skin conditions by utilizing specific wavelengths and treatment parameters. Red and blue light from light-emitting diodes and intense pulsed light have been studied as antimicrobial and anti-inflammatory treatments for acne. Pulsed dye lasers are used to treat vascular lesions in adults and infants. Further research is necessary to determine the functional significance of visible light on skin health without confounding the influence of ultraviolet and infrared wavelengths.

A novel UV-fluorescence approach to assess the long wear efficacy of foundations

BACKGROUND

The long wear properties of foundations are regarded as a must-have in terms of claims. Here, we propose an instrumental approach based on UV-fluorescence imaging as an alternative to clinical grading methods.

METHODS

A method was developed, with UV-fluorescence images captured with the Visia CR as a first step, followed by images analysis using Image-Pro plus. Repeated-measures correlation was used to assess the degree of association between the UV-fluorescence method and a grading method when removing the foundation incrementally from the skin using wipes. Thresholds to ascertain whether a foundation pass or fail long-wearing using the newly developed method were established using a mixed linear model and cross-validated using two subsets of a panel of 20 women.

RESULTS

The method could measure incremental removal of foundation using wipes, in a similar fashion to a grading method, as outlined with repeated measures correlation (r = -.86). Pass/fail thresholds established with the mixed linear model were tested versus the grading method when assessing a foundation under real conditions for a duration over 24 hours, with minimal discrepancies between the two methods.

CONCLUSION

By capitalising on foundation physical/chemical properties, the proposed method allows to assess their long wear properties, irrespective of basal skin tone or foundation shade. It offers the advantage of appealing visuals for efficacy and to be less resource intensive than a clinical grading approach.

Handheld swept-source optical coherence tomography guided by smartphone-enabled wide-field autofluorescence photography for imaging facial sebaceous glands

We report a method to image facial sebaceous glands (SGs) using smartphone-enabled wide-field autofluorescence photography (AFP) and handheld swept-source optical coherence tomography (SS-OCT). Smartphone-enabled AFP provides a 2D wide-field fluorescence image that is used both as a functional mapping of the sebum and a positioning guidance for OCT imaging of the SG. Following the guidance, handheld SS-OCT conducts the volume scan to investigate depth-resolved conditions of the SG in the selected regions of interest. We show the results from smartphone-enabled AFP and handheld SS-OCT to demonstrate the ability of our method to image facial SGs, potentially useful for the assessment of skin conditions in dermatology and cosmetology.

High bacterial colonization and lipase activity in microcomedones

BACKGROUND

Although acne vulgaris has a multifactorial aetiology, comedogenesis and bacteria colonization of the pilosebaceous unit are known to play a major role in the onset of inflammatory acne lesions. However, many aspects remain poorly understood such as where and when is the early stage of the Propionibacterium acnes colonization in follicular unit? Our research aimed at providing a precise analysis of microcomedone's structure to better understand the interplay between Propionibacterium acnes and follicular units, and therefore, the role of its interplay in the formation of acne lesions.

METHODS

Microcomedones were sampled using cyanoacrylate skin surface stripping (CSSS). Their morphology was investigated with multiphoton imaging and their ultrastructure with scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Bacterial lipase activity in the microcomedones was quantified using a dedicated enzymatic test as well as a Fourier Transform Infra-Red (FTIR) analysis. The porphyrin produced by bacteria was analysed with HPTLC and fluorescence spectroscopy.

RESULTS

The imaging analysis showed that microcomedones' structure resembles a pouch, whose interior is mostly composed of lipids with clusters of bacteria and whose outer shell is made up of corneocyte layers. The extensive bacteria colonization is clearly visible using TEM. Even after sampling, clear lipase activity was still seen in the microcomedone. A high correlation, r = .85, was observed between porphyrin content measured with HPTLC and with fluorescence spectroscopy. These observations show that microcomedones, which are generally barely visible clinically, already contain a bacterial colonization.

Caveolin-1 as a possible target in the treatment for acne

Expression of caveolin-1 (Cav-1) is an important pathophysiological factor in acne. Cav-1 strongly interacts with such well-recognized etiopathogenic factors such as hyperseborrhea, follicular hyperkeratinization and pathogenicity of Cutibacterium acnes. Cav-1 is a strong negative regulator of transforming growth factor beta (TGF-β) expression. It acts as a critical determinant of autophagy, which is significantly induced in acne lesions through C. acnes and by absorption of fatty acids. Cav-1 also demonstrates different correlations with the development of innate immunity. We propose that normalization of Cav-1 expression can serve as a target in anti-acne therapy.

Multimodal Clinical Imaging Assessment of the Outcome in Mild-to-Moderate Acne: A Prospective Study

Background: The quality of outcome assessment in acne studies has been either subjective/insufficient or time consuming through the ordinary lesion counting. Objective: To evaluate the application of multimodal clinical imaging (MCI), a combination of imaging technology and computation, in the assessment of acne lesions in a clinical study setting. Methods: A prospective, monocentric, single-group open study designed to evaluate the efficacy and tolerance of a cosmetic product (IP/SG) in subjects with mild-to-moderate facial acne by classical clinical counting (CCC) – change in the total/inflammatory/noninflammatory acne lesion number compared with baseline (D0) – Investigator Global Assessment (IGA) and self-reported outcomes. Concomitantly, MCI was administered. The study was performed for 12 weeks (D84) with a 4-week follow-up (D112). Results: Mean age of patients (n = 49) was 18.2 ± 3.7 years (range 13–25). The mean acne duration was 3.8 ± 2.8 years. The total number of lesions did not differ significantly between D0/D84 by both CCC and MCI. However, the Cardiff Acne Disability Index (CADI) and uncomfortable feeling improved at D28/D0, the perception of oily skin improved at D14/D0, and the perception of sticky skin improved from D28/D0 to D56/D0. Deterioration was detected between D84/D0 and D112/D0, namely after product discontinuation. Interestingly, a change in trend was recorded for acne lesions at D14/D0 by MCI but not by CCC. Conclusion: MCI, applied for the first time in a small clinical study setting, is at least as reliable as CCC and may allow for a sensitive longitudinal evaluation of single acne lesions and their response to products, especially in conditions where clinical evaluation reaches its limits.

Update in the management of acne in adolescence

PURPOSE OF REVIEW

This review will update the pediatric provider on recent data on the pathogenesis and treatment of acne in adolescent patients. A special focus was made to summarize recent guidelines and fill in several identified practice gaps.

RECENT FINDINGS

Our understanding of the pathogenesis of acne is greatly expanding and data is emerging to tie diet, particularly the role of IGF-1 with inflammation in acne. Additionally, stronger recommendations to limit antibiotic usage in acne are being made worldwide. Although retinoids are considered the base of most effective acne treatment strategies, data suggests that all providers need to emphasize their importance in maintenance of acne.

SUMMARY

An effective acne management strategy targets multiple pathogenic factors in acne, using a retinoid as the foundation. Systemic antibiotics for moderate-to-severe acne should be used for acute management, then discontinued at 3-4 months, while maintaining on topical treatments. If therapy is ineffective, alternate treatments, such as combined oral contraceptives in females or isotretinoin, should be promptly employed to prevent prolonged psychological impact and cutaneous scarring.