Effects of Diet on Acne and Its Response to Treatment

Exploring the potential of omega-3 fatty acids in acne patients: A prospective intervention study

BACKGROUND

Omega-3 fatty acids (ω-3 FA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), are essential nutrients known for their anti-inflammatory properties, which involve reducing pro-inflammatory cytokines, eicosanoids, and insulin-like growth factor-1. This suggests their potential to alleviate acne severity, especially when deficits are present.

AIMS

To elevate EPA/DHA levels in acne patients through dietary intervention and supplementation, observing subsequent clinical effects.

METHODS

Over 16 weeks, 60 patients without prescription medication (n = 23 acne comedonica [AC], n = 37 acne papulopustulosa [AP]) adhered to a Mediterranean diet, incorporating oral algae-derived ω-3 FA supplementation (600 mg DHA/300 mg EPA week 1-8, 800 mg DHA/400 mg EPA week 8-16). At four visits (V1-V4), blood EPA/DHA levels were tracked using the HS-omega 3 index® (EPA/DHA (%) of total identified fatty acids in erythrocytes; target 8%-11%, deficit <8%, severe deficit <4%), alongside clinical assessments and standardized questionnaires.

RESULTS

At baseline, 98.3% of patients had an EPA/DHA deficit, with the mean HS-omega 3 index® rising from 4.9% at V1 to 8.3% at V4 (p < 0.001). AC showed significantly higher indices than AP at V4 (p = 0.035). Objective improvements in both inflammatory and non-inflammatory lesions were observed (p < 0.001). While self-reported appearance worsened in four patients, overall quality of life improved (p < 0.001), particularly in AP. Dietary triggers were more clearly defined than beneficial foods. Intake of cow's milk and dairy products reduced (p < 0.001). Compliance was good; no adverse events were reported.

CONCLUSION

Many acne patients have a ω-3 FA deficit. The HS-omega 3 index® can be increased by a Mediterranean diet and oral supplementation with algae-derived ω-3 FA. Acne severity improved significantly in patients with target ω-3 FA levels.

NeoGenesis MB-1 with CRISPR Technology Reduces the Effects of the Viruses (Phages) Associated with Acne - Case Report

We present a case of acne successfully treated with a topical spray containing live bacteria. The live bacteria used in the spray contain CRISPR, and adaptive immune system in the bacteria that are used to disable viral replication. Because acne skin contains bacteria in the microbiome where a shift toward non-CRISPR bacteria occurs, these bacteria are susceptible to bacteriophage infection and lysogeny. Normalizing the bacterial microbiome to one containing more CRISPR-containing bacteria renormalizes the microbiome by killing inflammation-causing bacteriophage infecting the non-CRISPR bacteria associated with acne.

Milking the Alternatives: Understanding Coffee Consumers' Preferences for Non-Dairy Milk

Consumer interest in plant-based milk alternatives is growing, despite extra charges in coffeehouses. While much research exists on non-dairy alternatives, plant-based milks in coffee drinks remain understudied. This study examines consumer preferences and behaviors regarding milk alternatives in coffee, using the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW). A survey of 200 participants from 19 countries explored demographics, coffee habits, attitudes towards non-dairy milk charges, and marketing awareness. Market insights showed taste as the main reason for coffee choice, with a preference for cow's milk and local cafes for quality. Many opposed the extra charges for non-dairy options, citing lactose intolerance or allergies, especially among Gen Z and Millennials. Regional variations included stronger opposition in the UK and Germany compared to the UAE and USA. The marketing for non-dairy milk was less memorable than general coffee advertisements. Regression analysis confirmed that viewing non-dairy milk as a dietary staple increased consumption, aligning with the TDF's "Beliefs about Consequences" domain. Finally, within the BCW framework, the intervention strategies centered on training and coercion were discussed. Implementing these approaches could encourage the wider adoption of non-dairy milk options in coffee shops, fostering inclusivity, health awareness, and supporting environmental sustainability efforts.

The Role of Probiotics in Skin Care: Advances, Challenges, and Future Needs

The skin, being the largest organ in the human body, plays a pivotal role in safeguarding the body against invasive pathogens. Therefore, it is essential to reinforce and protect this vital organ. Current research supports the impact of probiotics on skin health and their ability to alleviate various skin disorders. However, the effectiveness and probable side effects of probiotics in skin care remain a subject of debate, necessitating further investigation and analysis. Hence, this study aims to highlight existing gaps and future needs in the current research on probiotics in skin care and pave the way for future investigations. Therefore, we scrutinized the effects of oral (fermented foods and dietary supplements) and non-oral/topical probiotics on skin care, and the mechanism of probiotics that affect skin health. The results of most studies showed that fermented foods containing probiotics, particularly dairy products, positively impact skin health. The research results regarding the efficacy of probiotic supplements and live strains in treating skin disorders show promising potential. However, safety evaluations are crucial, to identify any potential adverse effects. While research has identified numerous potential mechanisms by which probiotics may influence skin health, a complete understanding of their precise mode of action remains elusive. However, it seems that probiotics can exert their positive effects through the gut-skin and gut-skin-brain axis on the human body. Therefore, following the identification of safe probiotics, additional studies should be carried out to establish optimal dosages, potential side effects, suitable regulatory guidelines, and validation methods.

Whey protein and male acne: A double-blind, randomized controlled trial

BACKGROUND

Acne vulgaris (AV) exacerbation after whey protein (WP) consumption remains inconclusive among experts.

OBJECTIVES

To investigate the association between WP consumption and acne severity in men with acne.

METHODS

A noninferiority trial was conducted in men with mild to moderate facial and/or truncal acne. After randomization, participants in an intervention group took daily WP 30 g with a non-WP nutritional supplement 18 g (WP group, n = 25), while the control group took a non-WP nutritional supplement 46 g (non-WP group, n = 24). At each follow-up appointment, investigators evaluated acne count (total acne lesions, comedonal lesions, and inflammatory lesions) and severity.

RESULTS

Forty-nine participants had a mean age of 19.7 years (standard deviation [SD], 0.9) and 20.3 years (SD, 1.4) in the WP and non-WP groups, respectively. The mean differences in the facial and truncal total acne lesions for the WP and non-WP group were -5.99 (95% confidence interval [CI], -13.18 to 1.19, p = 0.09) and -2.18 (95% CI, -11.83 to 7.48, p = 0.65), respectively. For severity changes, only one (4.3%) participant in the non-WP group reported an increase in the Investigator Global Assessment scale of at least two levels.

CONCLUSIONS

In this 6-month trial, men with acne who undertook WP supplementation showed a noninferior difference in the changes in total acne lesions and severity of facial and truncal acne compared with the non-WP group.

The Relationship between Chocolate Consumption and the Severity of Acne Lesions-A Crossover Study

The aim of this study was to assess the relationship between the daily consumption of 50 g of chocolate with 85% cocoa content and the severity of acne lesions.

METHODS

The study involved 92 participants with acne who were divided into two groups, A (n = 51) and B (n = 41). In the first week, both groups had to follow an anti-inflammatory diet (AID), then for the next 4 weeks, group A continued on with the AID, and group B followed an AID with chocolate. After this time, group B started a 4-week AID without chocolate, and group A started a 4-week AID with chocolate. The severity of acne lesions was assessed using the Investigator's Static Global Assessment scale, where zero points indicated no lesions and five points indicated severe acne.

RESULTS

As a result of the consumption of 50 g of chocolate, a statistically significant intensification of acne lesions was observed in both groups. After 4 weeks of following the chocolate diet, the severity of acne lesions increased from 2.5 ± 0.7 to 3.4 ± 0.8 points (p < 0.0001) in group A, and from 2.4 ± 0.7 to 3.5 ± 0.6 points (p < 0.0001) in group B. Overall, chocolate intake contributed to the exacerbation of acne lesions by one point in 65 participants, by two points in 13 participants and by three points in one participant.

CONCLUSIONS

The obtained results suggest that daily consumption of 50 g of chocolate with 85% cocoa content, even with an anti-inflammatory diet, may intensify acne lesions in this study group. However, it remains unclear which chocolate components may lead to the exacerbation of acne.

Metformin Therapy for Acne Vulgaris: A Meta-Analysis

Acne vulgaris is a common disease, which occurs in adolescents as well as adults and has a significant influence on the patient's quality of life (QoL) in every aspect. Due to resistance to standard therapies, it has become necessary to prospect for new treatment strategies. It is important to highlight that the diagnosis and treatment of the underlying cause of acne such as metabolic and hormonal disorders may significantly improve the effectiveness of acne treatment. The correlation between Insulin Resistance (IR) and acne has been proven. Both disorders share many common occurrence factors and activation pathways. Metformin, an antihyperglycemic agent, seems to be a possible therapy option, not only because of its insulin sensitizing ability but also via plenty of additional effects of this medicine. While the efficiency of metformin therapy in patients with acne and Polycystic Ovary Syndrome (PCOS) is well explored, it is still necessary to evaluate it in patients without any endocrinopathies. This meta-analysis aimed to estimate the effectiveness of oral metformin as a monotherapy in acne patients without PCOS or other endocrinopathies. Study selection was performed with included criteria such as no PCOS and other endocrinopathies diagnosed, oral administration of metformin, and metformin in monotherapy. Selected studies contained comparisons in the Global Acne Grading System (GAGS) before and after metformin therapy. Statistical analysis detected significant improvement in skin condition after treatment with metformin.

A meta-analysis of the incidence of acne vulgaris in patients treated with GLP-1 agonists

Background

With the emerging popularity of GLP-1 receptor agonists, patients are noticing acne vulgaris side effects that are seemingly related to the concurrent treatment with the drug. Due to the correspondence between these drugs' relatively recent emergence in the U.S. market and their high demand, it is important to investigate what is currently known in the literature so that patients can be properly informed.

Objective

The aim of this study is to investigate the relationship, or lack thereof, between glucagon like peptide 1 (GLP-1) receptor agonist usage and acne-related side effects in patients.

Methods

A web-based analysis of 6 GLP-1 receptor agonists (3 with a once-weekly dosing schedule, and 3 with a once-daily dosing schedule) was conducted on PubMed online database. Boolean criteria were used to narrow the search. Included in the meta-analysis were 45 research articles that fulfilled the search criteria.

Results

The results of the search showed that from the following long-acting GLP-1 receptor agonists, dulaglutide, exenatide extended release, and semaglutide (Wegovy), no conclusive acne side effects were reported. In addition, the results also showed that from the following short-acting GLP-1 receptor agonists, liraglutide, lixisenatide, and semaglutide (Rybelsus), no conclusive acne side effects were reported.

Limitations

Limitations of this study include a limited amount of literature regarding the relationship between GLP-1 agonists and acne vulgaris.

Conclusion

It is unlikely that GLP-1 agonists themselves are directly responsible for the acne that some patients may develop during treatment. Rather, it is more probable that the weight loss yielded by treatment with these drugs may induce intrinsic physiologic and hormonal changes that induce or exacerbate acne vulgaris in such patients.

Impact of Diet and Nutrition in Patients with Acne Vulgaris

Acne vulgaris is a widespread a chronic inflammatory dermatosis that affects millions of people around the world, which has a significant influence on patients' standard of living. The progression of this dermatosis results in the appearance of inflammatory and non-inflammatory changes, and, in severe cases, disfiguring scars and hyperpigmentation. The aetiopathogenesis of acne is complex. It involves a complex interaction of many different factors, both endo- and exogenous in their effect on the hair and sebaceous unit. Genetic predisposition, hormones, the skin and gut microbiome, psychological stress, air pollutants, aggressive facial products, and certain medications are cited as factors influencing acne formation. The link between nutrition and acne is extensively debated for many years and is still relatively controversial. Diet is commonly recognised to have a direct relationship with certain biochemical markers and the transcription of genes related to sebaceous gland function, and the proliferation of bacteria and inflammation that encourage the progression of the disease. In this review, the authors take a closer look at the existing scientific reports on the involvement of nutrition in the development of acne vulgaris.

Acne treatment challenges - Recommendations of Latin American expert consensus

BACKGROUND

Acne is a chronic inflammatory disorder of the pilosebaceous unit that is associated with a negative impact on quality of life, causing anxiety, depression, and poor self-esteem. The treatment of acne is not simple and presents some new challenges. This article addresses important issues faced by dermatologists on their daily, some of them specific for Latin America.

OBJECTIVE

To discuss daily practice recommendations when managing acne patients.

METHODS

A literature review was conducted by a group of eight experts with extensive experience in the field of acne. The results of the data review were presented at an initial kick-off meeting to align the consensus topics. Two e-surveys using the Delphi methodology and an interim group webinar meeting were held.

RESULTS

The expert panel reached a consensus on all proposed key statements, providing scientific support to help dermatologists and healthcare providers make acne management decisions on topics that can be challenging in the everyday practice of dermatology, such as the characteristics of Generation Z or the importance of the maintenance phase of adult acne treatment.

CONCLUSION

This article provides current recommendations for managing acne patients. The high level of agreement achieved based on the latest evidence supports the best acne therapeutic choices in both established topics and new important issues that have emerged in recent years, such as the impact of social media, Generation Z characteristics, and transgender male patient specifics.

The Antioxidant Power of a Diet May Improve the Quality of Life of Young Women with Acne Vulgaris

Acne vulgaris (AV) significantly reduces the quality of life (QoL) of young people, so it is important to look for factors that can improve their QoL. The aim of this study was to assess the relationship between dietary antioxidants measured using the new DAQI index and QoL measured using standardized tests. The DAQI included the following elements: antioxidant vitamins, minerals, carotenoids, polyphenols, phytosterols, lignans, and the total antioxidant capacity of the diet. The study involved 165 young women with AV, mainly students. A self-report survey was used to collect basic data on their sociodemographic status, anthropometric information, and lifestyle. The energy value of the diet and the content of vitamins, minerals, and carotenoids with antioxidant activity in the diet were estimated using 3-day food diaries and the Diet 6.0 program. The antioxidant potential of the diet and the content of polyphenols, phytosterols, lignans, and selenium were calculated based on the consumption of individual food products and available databases. The results of this study showed that the QoL of the young women with AV was impaired. However, greater adherence to an antioxidant diet reduces the risk of AV impact on the QoL by approximately 30-32% and the risk of depression by 33%. The DAQI may be used as a new indicator of diet quality in acne vulgaris.

Deficit of Omega-3 Fatty Acids in Acne Patients-A Cross-Sectional Pilot Study in a German Cohort

Omega-3 fatty acids (ω-3 FAs) exert anti-inflammatory effects, including the downregulation of pro-inflammatory cytokines, eicosanoids, and insulin-like growth factor-1. Therefore, they may improve acne severity as an adjunct treatment. However, there is a paucity of data regarding patients' existing deficits. The aim of this study was to determine ω-3 FA levels in acne patients in correlation with self-reported dietary preferences and clinical severity. A single-center, cross-sectional study of 100 acne patients was conducted. Patients' blood parameters, including ω-3 FAs levels, were assessed using the HS-omega-3 Index® in erythrocytes (Omegametrix® GmbH, Martinsried, Germany). Dietary preferences were assessed using a standardized food frequency questionnaire. Clinical dermatologic evaluation was performed using the Investigator Global Assessment (IGA) of acne. The values of the HS-omega-3 Index® were outside the recommended range of 8-11% in 96 patients (mean 5.15%), independent of the clinical severity or affected anatomic sites. A severe deficit (HS-omega-3 Index® < 4%) was seen more commonly in men than in women (p = 0.021). The regular consumption of legumes was significantly associated with higher ω-3 FA levels (p = 0.003), as was oral ω-3 FA supplementation (p = 0.006) and the lack of sunflower oil intake (p = 0.008). This pilot study demonstrated a deficit of ω-3 FAs in a German acne cohort. Higher ω-3 FAs levels were observed in patients with regular legume intake and oral ω-3 FAs supplementation. Further prospective studies are needed to investigate whether the clinical severity of acne improves in patients with normal HS-omega-3 Index®.

Autologous Nanofat Injection Combined with Fractional CO2 Laser in the Treatment of Atrophic Acne Scars

Background

Atrophic acne scarring is a widely prevalent condition and one of the most distressing complications of acne vulgaris. Numerous options with variable outcomes are available for the treatment of acne scarring. Laser is considered a first-line therapy for acne scars, and recently there has been a growing interest in using stem cells and their derivatives for treating acne scars. In addition, combined therapeutic modalities often achieve more satisfactory results than a single treatment.

Objective

We tried to evaluate the role of nanofat and fractional CO2 laser as a combined treatment approach for atrophic acne scarring.

Methods

Twenty-five patients with atrophic acne scarring were enrolled. They received a single session of intradermal nanofat injection, at different points 1 cm apart, for acne scars. Two weeks later, they were treated with three sessions of fractional CO2 laser at monthly intervals. Patients were evaluated three months after the last session using the quantitative Goodman and Baron scoring system. Pain, side effects, and patients' satisfaction were also evaluated.

Results

There were two males and 23 females with a mean age of 25.96 years. Their skin type ranged between Fitzpatrick skin type III, IV, and V. Boxcar scars were the most common scar type in 13 patients (52%). After treatment, there was a significant reduction (p <0.05) in the quantitative Goodman and Baron scores. The improvement was more evident in rolling scars. Seven patients reported significant improvement, and 12 reported marked improvement.

Conclusion

This study showed that combining nanofat and fractional CO2 laser is a safe and effective treatment modality for atrophic acne scars.

A Study of FoxO1, mTOR, miR-21, miR-29b, and miR-98 Expression Levels Regarding Metabolic Syndrome in Acne Vulgaris Patients

BACKGROUND

Acne vulgaris (AV) is an inflammatory skin disease caused by the mechanistic target of rapamycin complex 1 (mTORC1). forkhead box protein (Fox) O1 is known to regulate the relationship between the mTORC1 signaling pathway and insulin resistance (IR). Increased mTORC1 signaling is known to predispose one to diseases such as insulin resistance (IR), obesity, and diabetes mellitus. One of the major components of mTORC1 is mTOR. FoxO1 and mTOR play key roles in the onset and progression of metabolic syndrome (MetS). In this study, we aimed to elucidate the relationship between AV and MetS through FoxO1 and mTOR signaling pathways and microRNAs (miRs) associated with these signaling pathways.

METHODS

We examined 20 AV patients without MetS, 16 AV patients with MetS, and 20 healthy controls. The demographic characteristics of the patients, MetS parameters, clinical severity of AV (Global Acne Grading System, GAGS), and the homeostasis model assessment (HOMA) values were compared between the groups. In addition, the expression levels of FoxO1 and mTOR genes, along with the expression levels of miR-21, miR-29b, and miR-98, were assessed in skin biopsy samples from all groups using real-time polymerase chain reaction methods. FoxO1, mTOR, and miRNA expression levels were recorded as fold change.

RESULTS

The mean age of patients with AV without MetS was statistically lower. In AV patients with MetS, those with moderate GAGS scores had statistically significantly higher HOMA values than those with mild GAGS scores. FoxO1 expression was significantly lower in AV patients compared to controls. The mTOR expression levels of AV patients with MetS were significantly higher than the other two groups. The expression levels of miR-21 and miR-29b were significantly increased in the group of AV patients with MetS compared to the group of AV patients without MetS.

CONCLUSIONS

These results suggested that the mTOR pathway may play an important role in explaining the relationship between AV and MetS in acne pathogenesis. They also suggested that miR-21 and miR-29b play a role in the inflammatory process of AV.

Impact of Lifestyle and Dietary Habits on the Prevalence of Acne Vulgaris: A Cross-Sectional Study From Saudi Arabia

Background Acne vulgaris is a prevalent dermatological condition worldwide, with its impact significantly influenced by various genetic, environmental, and lifestyle factors. Despite its global prevalence, data on acne's prevalence and risk factors in Saudi Arabia remain sparse. This study aims to fill this gap by examining the prevalence of acne vulgaris and identifying associated lifestyle and environmental risk factors within the Saudi population. Methodology Employing a cross-sectional survey-based design, this study collected data from a representative sample of the Saudi population aged 18 years and older. Participants were selected through stratified random sampling and completed a self-administered online questionnaire covering demographic information, lifestyle factors, and acne history. Statistical analyses, including descriptive statistics, chi-square tests, and multivariable logistic regression, were utilized to identify significant risk factors associated with acne vulgaris. Results The survey, completed by 1,983 participants, revealed a diverse age distribution with a slight predominance of the 21-25-year age group (32.5%). Gender distribution was nearly balanced (52% female, 48% male), and the majority were single (67.3%). Lifestyle assessments indicated varied water intake, with a significant portion consuming less than 1-2 L per day. Sleep duration for most fell within the 5-7 hours range. Fast food consumption was frequent among 24% of respondents, and physical activity levels showed 40% of participants exercised minimally. Notably, 72% reported a history of acne, predominantly beginning between ages 16 and 20. Acne was mainly mild to moderate in severity and primarily affected the face. Treatment was sought by 60%, with a preference for topical solutions. Awareness around acne causes was moderate, with a high consensus on the impact of stress and diet on acne development. Conclusions Acne vulgaris in Saudi Arabia is significantly associated with various modifiable lifestyle factors, suggesting that interventions focusing on lifestyle modifications may be effective in managing and preventing acne. This study advocates for the integration of lifestyle counseling into acne treatment protocols, offering a holistic approach to managing this pervasive condition.

Revealing the Impact of Gut Microbiota on Acne Through Mendelian Randomization Analysis

Background

The association between acne and gut microbiota has garnered considerable attention; nevertheless, given the substantial diversity within gut microbiota, the precise cause-and-effect relationship linking specific microbial species to acne remains elusive. To address this gap in knowledge, our study utilized Mendelian randomization analysis to elucidate a potential causal link between gut microbiota composition and acne development while also investigating underlying mechanisms involving microbial factors associated with metabolic disorders.

Materials and Methods

The independent single nucleotide polymorphisms (SNPs) closely associated with 196 gut microbiota samples (N=18340) were selected as variable tools. The relationship between gut microbiota and acne (N=212438) was analyzed using the Twosample package in R4.3.1, employing various methods including inverse variance weighting (IVW), weighted median, MR-Egger, Simple-mode, and Weighted-mode. To ensure the stability of the estimates, a series of sensitivity analyses were conducted, such as Cochran's Q-test, MR-Egger intercept analysis, leave-one-out analysis, and funnel plots. Additionally, the impact of each instrumental variable was calculated.

Results

In the Mendelian randomization analysis, we identified twelve microbial taxa potentially associated with acne: family.Bacteroidaceae, family.Clostridiaceae1, genus.Allisonella, genus.Bacteroides, genus.Butyricimonas, genus.Clostridiumsensustricto1, and genus.Coprococcus3. These seven bacterial groups were found to be potential risk factors for acne. Conversely, family.Lactobacillaceae and genus.Ruminococcustorquesgroup along with genus.CandidatusSoleaferrea, genus.Fusicatenibacter, family.Lactobacillaceae, and genus.Lactobacillus exhibited a protective effect against acne. Furthermore, our investigation revealed that some of these microbial taxa have been implicated in metabolic diseases through previous studies. Importantly though, no causal relationship was observed in the reverse Mendelian randomization analysis.

Use of Oral Supplements and Topical Adjuvants for Isotretinoin-Associated Side Effects: A Narrative Review

Acne is a chronic inflammatory disease of the pilosebaceous unit with a multifactorial etiology and is one of the most common conditions treated by dermatologists and primary care physicians. Within an extensive and evolving treatment landscape, oral isotretinoin has demonstrated efficacy for treatment of severe, recalcitrant acne. Several side effects of isotretinoin have been reported, including laboratory abnormalities, mucocutaneous, and musculoskeletal effects, which may reduce compliance and patient satisfaction with treatment. In this narrative review, we aim to review the efficacy and safety profile of oral supplements or topical adjuvant therapies in mitigating isotretinoin-associated mucocutaneous and musculoskeletal side effects. Oral supplements reviewed include omega-3 fatty acids, vitamin E, folic acid and vitamin B12, antihistamines, l-carnitine, biotin, and combined oral supplements. Topical adjuvants include a hyaluronic acid, biosaccharide gum-2, and glycerine gel-cream; a nongreasy, noncomedogenic, fragrance-free moisturizing cream; dexpanthenol; trichloroacetic acid; and a combination cream. Most of the supplements and topical adjuvants demonstrated efficacy with an adequate level of supporting evidence and no reported adverse events, indicating an adequate safety profile. Patients on isotretinoin may benefit from using oral supplements and topical adjuvants to minimize primarily mucocutaneous side effects, increase adherence to treatment, and thereby improve overall outcomes.

The impact of current investigational drugs for acne on future treatment strategies

INTRODUCTION

Acne vulgaris is one of the most prevalent diseases worldwide with a considerably high cost and a burden on quality of life. There are currently many topical and systemic therapies for acne; however, many are limited by their local adverse event profile. This review provides an update on current, novel Phase I and II trials for acne vulgaris.

AREAS COVERED

This review searched the National Institutes of Health US National Library of Medicine online database of clinical trials (ClinicalTrials.gov) for ongoing Phase I and II trials. Only papers discussing novel therapies were discussed, and combinations of previously FDA-approved drugs were excluded.

EXPERT OPINION

The current investigational approaches to acne treatment reflect an attempt to mitigate the underlying cause of acne pathogenesis. By targeting key mechanisms involved, studies aim to show long-term improvement with less frequent treatment use. This provides potential for more tolerable treatments with better patient adherence, in turn leading to increased efficacy.

The Impact of Consuming Probiotics and Following a Vegetarian Diet on the Outcomes of Acne

Acne vulgaris is a common skin condition that affects millions of people worldwide. While the exact cause of acne is not fully understood, it is believed to be influenced by various factors such as the skin microbiome, host immunity, hormones, genetics, and possibly diet. There are several treatment options for acne, including antibiotics and vitamin A derivatives (retinoids). However, these treatments can have side effects, such as dryness, redness, and peeling of the skin. The relationship between diet and acne remains somewhat controversial. Studies have found that Western societies have a higher incidence of acne than non-Western societies, which is believed to be due to dietary differences. Several experiments were conducted to target the skin microbiome and treat acne with the hope of using probiotics orally or topically to regulate the immune response and reduce inflammation in acne. In addition, studies have shown that a plant-based diet can benefit individuals with acne. Avoiding dairy consumption is one of the most effective dietary changes for reducing acne. As part of our investigation, we conducted a review to determine the effect of probiotics and vegetarian diets on acne.

Exploring the Multifaceted Impact of Acne on Quality of Life and Well-Being

A suitable portion of the total population still suffers through acne vulgaris, a widespread dermatological illness that mostly affects teens and young adults. Although acne is typically considered to be a cosmetic problem, recent research has concluded that certainly it has a significant role on impacting many physiological aspects of human health. This thorough investigation attempts to examine the intricate effects of acne on human physiology, taking into consideration both systemic and local effects. The study synthesizes research from a number of scientific disciplines, including dermatology, endocrinology, immunology, and psychoneuroimmunology. It investigates the complex interrelationships between several factors, such as sebum production, follicular hyperkeratinization, hormone imbalance, and Propionibacterium acnes colonisation, that lead to the development of acne. The study also sheds information on the intricate physiological mechanisms, oxidative stress, and immune response that contribute to the aetiology of acne. Along with it, the review investigates the relationship between endocrine problems and acne, emphasizing hormonal anomalies and their possible role in acne severity. The psychological effects of acne are also discussed, including the psychological problems, concerns with self-esteem, and decreased quality of life that acne sufferers encounter. On comprehensively examining the diverse physiological aspects affected by acne, this review provides a foundation for future research endeavours and informs the development of targeted therapeutic interventions. Ultimately, the integration of multidisciplinary approaches will enable healthcare professionals to address the physiological complexities of acne and improve the overall well-being of individuals affected by this common skin condition.

Dietary Patterns in Acne and Rosacea Patients-A Controlled Study and Comprehensive Analysis

As the relationship between exposome factors and inflammatory skin diseases is gaining increasing attention, the objective of this study was to investigate dietary patterns among acne and rosacea patients and to establish the disease risk attributable to nutrition. In this cross-sectional, controlled study, patients' dietary habits were assessed via subjective ratings of beneficial and trigger foods, followed by standardized food frequency surveys (FFS). Scores for disease-specific risk stratification based on dietary habits were proposed. Clinical assessments, dermatologic examinations, and laboratory analyses were performed. A total of 296 patients (acne group (AG) n = 120, control group (ACG) n = 32; rosacea group (RG) n = 105, control group (RCG) n = 39) were included. The significant impact of diet on disease severity was self-reported by 80.8% of the AG and 70.5% of the RG. Leading dietary triggers were found in both groups, while beneficial food items were identified more clearly by the AG. FFS revealed significant dietary differences between the AG, RG, and control groups. Disease-specific scores showed greater precision for acne (odds ratio 14.5 AG, 5.5 RG). The AG had higher insulin-like growth factor (IGF)-1 levels correlating with dairy intake (p = 0.006). Overall, this study underlines the influence of diet on acne and rosacea, providing valuable disease-specific scores for dietary risk stratification. Consuming vegetables, legumes, oily fish, olive oil, and nuts, and limiting meat, cheese, and alcohol appear to be beneficial for both acne and rosacea. Future studies can build on these data to further improve preventive and therapeutic strategies.

Therapeutic Efficacy of Bovine Basic Fibroblast Growth Factor Combined with Ultrapulsed Fractional CO2 Laser in Acne Scars: Randomized Controlled Trial

Objective

To observe the therapeutic efficacy of ultrapulsed fractional CO2 laser combined with bovine basic fibroblast growth factor (bFGF) on acne scars, so as to provide clinical evidence for future treatment of acne scars.

Methods

One hundred and twenty patients with acne scars admitted between October 2021 and August 2022 were selected as the research participants, of which 60 cases treated with bFGF plus ultrapulsed fractional CO2 laser were regarded as the research group (RG) and 60 cases with ultrapulsed fractional CO2 laser therapy alone were set as the control group (CG). The clinical efficacy, Échelle d'évaluation clinique des cicatrices d'acné (ECCA) score, and scar base depth before and after treatment were comparatively analyzed, and changes in skin pore value, texture value and skin barrier function were detected. Finally, the duration of redness, scabbing and erythema after treatment and the incidence of adverse reactions after treatment were counted.

Results

A higher overall response rate was determined in RG versus CG (P<0.05). Besides, RG was lower than CG in post-treatment ECCA score, scar base depth, skin pore value, texture value and transepidermal water loss (TEWL), and higher in skin water and epidermal oil content (P<0.05). Moreover, the duration of redness, scabbing and erythema was shorter and the incidence of adverse reactions was lower in RG than in CG after treatment (P<0.05).

Conclusion

The combination of bFGF and ultrapulsed fractional CO2 laser is highly effective and safe in the treatment of acne scars, which reserves widespread use in clinical practice.

Nanomedicine-fortified cosmeceutical serums for the mitigation of psoriasis and acne

Cosmetics have a long history of use for regenerative and therapeutic purposes that are appealing to both genders. The untapped potential of nanotechnology in cosmeceuticals promises enhanced efficacy and addresses the issues associated with conventional cosmetics. In the field of cosmetics, the incorporation of nanomedicine using various nanocarriers such as vesicle and solid lipid nanoparticles significantly enhances product effectiveness and promotes satisfaction, especially in tackling prevalent skin diseases. Moreover, vesicle-fortified serum is known for high skin absorption with the capacity to incorporate and deliver various therapeutics. Additionally, nano-embedded serum-based cosmeceuticals hold promise for treating various skin disorders, including acne and psoriasis, heralding potential therapeutic advancements. This review explores diverse nanotechnology-based approaches for delivering cosmetics with maximum benefits.

Dairy and Plant-Based Milks: Implications for Nutrition and Planetary Health

PURPOSE OF REVIEW

Dairy milk products are dominant in the market; however, plant-based milks are gaining prominence among USA consumers. Many questions remain about how plant-based milk products compare to dairy milk from a nutrition, public health, and planetary health perspective. Here, we compare the retail sales, nutrient profiles, and known health and environmental impacts of the production and consumption of dairy and plant-based milks and identify knowledge gaps for future studies. For our plant-based milk comparisons, we reviewed almond, soy, oat, coconut, rice, pea, cashew, and other plant-based milks as data were available.

RECENT FINDINGS

The retail unit price of plant-based milks was generally higher than that of cow's milk, making it less accessible to lower-income groups. Many plant-based milks are fortified to match the micronutrient profile of dairy milk more closely. Notable differences remained, especially in protein, zinc, and potassium, depending on the base ingredient and individual product. Some plant-based milks contain added sugar to improve flavor. Plant-based milks were generally associated with lower environmental impacts (e.g., greenhouse gas emissions, water use) than cow's milk, with the notable exception of the higher water footprint of almond milk. This review of recent studies and consumer purchases confirmed that retail sales of plant-based milks are increasing and shifting among products. Further research is needed to better characterize the environmental impacts of newer plant-based milks, such as cashew, hemp, and pea milks; consumer attitudes and behavior towards plant-based milks; and the safety and potential health effects related to their long-term and more frequent consumption.

Targeting Inflammation in Acne: Current Treatments and Future Prospects

Acne is a common, chronic inflammatory condition affecting millions of people worldwide, with significant negative impact on quality of life and mental health. Acne is characterized by comedones, inflammatory papules, pustules, and nodulocystic lesions, with long-lasting sequelae including scarring and dyspigmentation, the latter of which is more common in skin of color. The four main pillars of acne pathophysiology include alteration of sebum production and concentration, hyperkeratinization of the follicular unit, Cutibacterium acnes strains, and an inflammatory immune response. Newer research has provided greater insight into these pathophysiologic categories. This greater understanding of acne pathogenesis has led to numerous new and emerging treatment modalities. These modalities include combinations of existing treatments, repurposing of existing agents historically used for other conditions, new topical treatments, novel antibiotics, topical and oral probiotics, and various procedural devices. This article will provide an overview of emerging treatments of acne and their link to our current and improved understanding of acne pathogenesis.

In vitro and in vivo study of the efficacy of a new sebum control essence

BACKGROUND

People with oily skin often suffer from skin problems such as oily face, blackheads, acne, and enlarged pores. It is necessary to regulate oily skin with skin care products.

AIMS

To develop an effective sebum control essence to reduce oiliness of skin.

METHODS

The composition of the essence was designed in consideration of different oil control mechanism targets. The skin irritation was assessed in 30 volunteers by a single application close patch test. The efficacy of the essence was evaluated by in vitro experiment, short- and long-term clinical trials with over 60 volunteers.

RESULTS

The results of both in vitro and clinical trials showed that the essence had significant oil control and moisturizing effect, the skin oil content decreased by 21.8% within 8 h and 30.05% after 28 days, which indicated that the essence could achieve rapid and persistent sebum control efficacy. In addition, the essence could relieve the problems of enlarged pores, blackheads and whiteheads in long-term use.

CONCLUSIONS

The essence developed in this study can alleviate the problems of oily skin from many aspects, and achieve an excellent effect in oily skin regulation. It is suitable for a daily application in oily skin regulation.

Epidemiology and Perception of Acne Among Adolescents in Jos, Nigeria: Cross-Sectional School-Based Study

BACKGROUND

Adolescents who make up a vast majority of the secondary school population are at a stage at which they are largely affected by acne. This condition, which is widely visible and easily recognized by peers, has numerous misperceptions surrounding it, which may influence attitudes toward people affected by it. There is a paucity of information on the prevalence of acne and how adolescents in Jos, Nigeria, view the condition.

OBJECTIVE

This study aimed to determine the prevalence of acne, perceived risk factors, and the accuracy of self-report among adolescents in Jos, Nigeria. The study also sought to understand perceptions surrounding acne in this age group.

METHODS

This descriptive cross-sectional study was conducted among adolescents attending private and public secondary schools in Jos, Nigeria. In total, 482 students were recruited through a multistaged stratified random sampling method. A self-administered semistructured questionnaire was used to collect information on history of acne, perceptions of causes, and the attitude toward those who have the condition. All participants were examined for the presence of acne. Univariate, bivariate, and multivariate analysis were conducted using SPSS (version 26; IBM Corp).

RESULTS

The self-reported prevalence of acne was 44% and that upon clinical examination was 55%. Self-report showed a moderate degree of agreement with clinical diagnosis (Cohen κ=57.3%; P<.001). Predictive factors for the presence of acne in general were age of ≥15 years (odds ratio [OR] 1.79, 95% CI 1.12-2.87; P=.02), being in a private school (OR 2.17, 95% CI 1.38-3.42; P=.001), and being in a senior secondary class (OR 2.14, 95% CI 1.32-3.47; P=.002). The female gender (OR 3.03, 95% CI 1.64-5.61; P=.001) and religion (OR 3.24, 95% CI 1.27-8.24; P=.02) were predictive for acne only among adolescents aged <15 years, while a positive family history was predictive in those aged ≥15 years (OR 2.04, 95% CI 1.15-3.61; P=.02). A distinct perception and attitude pattern surrounding acne was observed, as a significant proportion (84/131, 64.1% vs 47/131, 35.9%; P=.02) of those who related acne to a biological phenomenon had acne themselves; however, the belief that acne is caused by skin lightening practices was significantly more common in those without acne (19/28, 67.9%) than in those with acne (9/28, 32.1%; P=.01). One-fourth of the adolescents (n=122, 25.3%) had no idea of the possible causes of acne.

CONCLUSIONS

Though acne is a prevalent skin condition among Nigerian adolescents, many misperceptions and unfavorable attitudes surround acne and persons affected by the condition. Our findings have revealed the need to work with the school health program to educate the general adolescent population about acne, to refer and manage teenagers with acne.

Efficacy of FRO on Acne Vulgaris Pathogenesis

Acne vulgaris is a common skin disease characterized by increased sebum production, inflammation, and Cutibacterium acnes (CA: formerly Propionibacterium acnes) hyperproliferation in pilosebaceous follicles. This study evaluated the efficacy of FRO, a formula composed of fermented Rhus verniciflua Stokes and Orostachys japonicus, against acne pathogenesis via antimicrobial assessment and an in vitro analysis. Stimulated model cells treated with hormones, CA, or lipopolysaccharide (LPS) were designed based on the characteristics of acne pathogenesis, including inflammation and sebum hypersecretion. High-performance liquid chromatography, disc diffusion, MTS, and western blotting assays were used to examine potential anti-acne effects. FRO was determined to contain phenolics such as gallic acid, fisetin, quercetin, and kaempferol. FRO exerted antimicrobial activity against CA and inhibited reactive oxygen species production that was otherwise increased by LPS or CA in HaCaT cells. Additionally, FRO exerted anti-inflammatory effects by inhibiting iNOS, TNF-α, IL-6, p-STAT-3, and p-NF-κB, which were previously upregulated by LPS or CA in THP-1 and HaCaT cells. FRO inhibited lipogenesis induced by steroid hormones and CA by decreasing FAS and SREBP-1 levels in sebocytes. Additionally, FRO down-regulated the androgen receptor, 5α-reductase, SREBP-1, and FAS levels, which were upregulated by steroid hormone in LNCaP cells. Taken together, our findings suggest that FRO alleviates acne by inhibiting the growth of CA, inflammation, and excess sebum and could be used for functional cosmetics or acne treatments.

Management of Acne Vulgaris With Trifarotene

Topical retinoids have an essential role in treatment of acne. Trifarotene, a topical retinoid selective for retinoic acid receptor (RAR) γ, is the most recent retinoid approved for treatment of acne. RAR-γ is the most common isoform of RARs in skin, and the strong selectivity of trifarotene for RAR-γ translates to efficacy in low concentration. Trifarotene, like other topical retinoids, acts by increasing keratinocyte differentiation and decreasing proliferation, which reduces hyperkeratinization. Retinoids have also been shown to inhibit inflammatory pathways via effects on leukocyte migration, toll-like receptors, and Activator Protein (AP)-1. Large-scale randomized, controlled clinical trials have demonstrated trifarotene to be safe, well tolerated, and efficacious in reducing both comedones and papules/pustules of acne. However, unlike all other retinoids, trifarotene is the first topical retinoid with rigorous clinical data on safety and efficacy in truncal acne. Data supporting use of trifarotene to manage acne are reviewed in this publication.

Beneficial Effects of Plant-Based Diets on Skin Health and Inflammatory Skin Diseases

The human skin is a crucial organ that protects the organism from the outer environment. Skin integrity and health depend on both extrinsic and intrinsic factors. Intrinsic factors such as aging and genetic background contribute to weakened skin and disease susceptibility. Meanwhile, extrinsic factors including UV radiation, pollution, smoking, humidity, and poor diet also affect skin health and disease. On the other hand, healthy dietary patterns such as plant-based diets have gained popularity as a complementary therapy for skin health. A plant-based diet is defined as all diets based on plant foods, including an abundance of vegetables, fruits, beans, lentils, legumes, nuts, seeds, fungi, and whole grains, with limited or no animal products or processed foods. However, some authors also exclude or limit processed foods in the definition. Recent research has shown that these diets have beneficial effects on inflammatory skin diseases. This review explored the beneficial effects of plant-based diets on inflammatory skin diseases and plant-based functional foods on healthy skin. In conclusion, plant-based diets and plant-based functional foods may have beneficial effects on skin health through the gut microbiome.

Efficacy of Oxybrasion and Cosmetic Acids on Selected Skin Parameters in the Treatment with Acne Vulgaris

Purpose

The present study aimed to evaluate the efficacy of an oxybrasion treatment applied alone and an oxybrasion treatment combined with cosmetic acids in improving acne-prone skin and selected skin parameters.

Patients and Methods

A single-blind placebo study in a sample of 44 women diagnosed with acne vulgaris was conducted. Group A (n = 22) had a series of five oxybrasion treatments, while group B (n = 22) received a synergy of five oxybrasion treatments and a mixture of phytic, pyruvic, and lactic and lactic ferulic acids at 40% pH 1.4. Cosmetic treatments were performed every 14 days, and The Derma Unit SCC3 apparatus (Courage & Khazaka, Cologne, Germany) Sebumeter SM 815 and Corneometer CM825 and GAGS scale were used to check their effectiveness.

Results

A Bonferroni post hoc test showed that group A and B did not differ from each other in acne severity before treatment (p = 1.00). However, these samples differed significantly after treatment (p < 0.001), suggesting that combined treatment of oxybrasion and cosmetic acids has a better effect than oxybrasion alone. Also, two treatment conditions (before and after) were statistically different for groups A and B separately (p < 0.001), indicating a similar efficacy of both treatments on acne severity.

Conclusion

Cosmetic treatments improved acne-prone skin and selected skin parameters. Better results were obtained by combining an oxybrasion treatment with cosmetic acids.

Clinical Trial Approval

The clinical trial with ID ISRCTN 28257448 approved this study.

Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia

BACKGROUND

Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students.

MATERIALS AND METHODS

A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables.

RESULTS

The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS.

CONCLUSION

The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.

Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes

BACKGROUND

Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes.

AIMS

To describe the impact of the exposome on acne and how photoprotection can improve outcomes.

METHODS

A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light."

RESULTS

Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties.

CONCLUSIONS

The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.

Metabolic and Dietary Factors in Acne Vulgaris and Evaluation of the Acne Vulgaris Treatment with Oral Contraceptive-Based Therapies in Young Adult Women

The etiopathogenesis of acne is complex, as several endo- and exogenous factors that affect the sebaceous-hair unit are involved in the development of acne lesions. The main aim of the study was to evaluate selected metabolic parameters before treatment. Another goal of the study was to determine the correlation between selected metabolic and dietary parameters and the severity of acne before treatment. The third objective was to assess the severity of acne before and after treatment, considering the type of treatment used. The final objective was to assess the relationship between the difference in acne severity before and after treatment, considering the type of treatment used and factors of dairy or sweets intake. 168 women participated in the study. The patients belonged to two groups: the study group (99 patients with acne vulgaris) and the control group (69 patients without skin lesions). The study group was divided into subgroups according to the treatment used: contraceptive preparation, contraceptive preparation and cyproterone acetate, and contraceptive preparation and isotretinoin preparation. We found that LDL levels and consumption of sweets correlated with acne severity. The mainstay of acne treatment is contraceptive treatment (ethinylestradiol and drospirenone). The effectiveness of the three contraceptive-based treatments was confirmed by observing the severity of acne. There were no significant correlations between the difference in acne severity before and after treatment with the three treatments and factors of dairy or sweet consumption.

Long-term exposure to low levels of ambient UVB are associated with a decreased risk of moderate-to-severe acne: A retrospective cohort study in college students

BACKGROUND

As a crucial component of solar radiation, the association between exposure to ambient ultraviolet (UV) radiation and acne remains unclear.

METHODS

This was a multicenter retrospective cohort study of incoming college students in five universities of China. Previous exposure (6 years prior to enrollment) to different wavelengths of ambient UVs were obtained from public repositories by linking to individual hometown addresses. Logistic models were applied to assess the relationship between ambient UV exposure and acne. Subgroup analysis was conducted by sun protection behaviors and time of daily sun exposure. Overall effect and single effect of exposure to four different wavelengths of UVs (305, 310, 324, and 380 nm) were estimated by Bayesian kernel machine regression (BKMR).

RESULTS

A total of 19,939 participants was included for analysis. Analysis in all participants showed a significant association between log-transformation levels of exposure to UV at 305 nm (log (UV 305 nm)) and acne (OR = 0.77, p = .021). The effect size was stronger in participants reporting no sun protection habit. Both UVs at 305 nm (OR = 0.51, p = .001) and 310 nm (OR = 0.50, p = .012) were associated a decreased risk of acne in participants reporting no sun protection habit. This inverse association was also observed in those exposed to low levels of UV (<1 h/day). The BKMR indicated consistent results that low levels of exposure to UVs combination and UVs at 305 and 310 nm were associated with a lower risk of acne.

CONCLUSION

Long-term exposure to relatively low levels of ambient UVB are associated with a decreased risk of moderate-to-severe acne in college students.

The effect of the ketogenic diet on Acne: Could it be a therapeutic tool?

Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of the hair follicles of the face, neck, chest and back by Propionibacterium acnes. Overall, inflammation and immune responses are strongly implicated in the pathogenesis of acne. Although early colonization with Propionibacterium acnes and family history may play an important role in the disease, it remains unclear exactly what triggers acne and how treatment affects disease progression. The influence of diet on acne disease is a growing research topic, yet few studies have examined the effects of diet on the development and clinical severity of acne disease, and the results have often been contradictory. Interestingly, very low-calorie ketogenic diet (VLCKD) has been associated with both significant reductions in body weight and inflammatory status through the production of ketone bodies and thus it has been expected to reduce the exacerbation of clinical manifestations or even block the trigger of acne disease. Given the paucity of studies regarding the implementation of VLCKD in the management of acne, this review aims to provide evidence from the available scientific literature to support the speculative use of VLCKD in the treatment of acne.

Dietary Intake and Systemic Inflammation: Can We Use Food as Medicine?

PURPOSE OF REVIEW

This review summarizes the current literature regarding the association between diet and systemic inflammation.

RECENT FINDINGS

Data in humans suggests that consumption of plant-based nutrients is associated with a reduction in systemic inflammation, while consumption of red meat and excessive dairy has the opposite effect and may increase risk of acute flares in those that suffer from certain chronic diseases like inflammatory bowel disease or psoriasis and certain cancers. There is a known association between diet and systemic inflammation; thus, we recommend that clinicians discuss plant-based, whole food diets with patients, particularly those that suffer from chronic inflammatory diseases as an adjunct treatment for these conditions. Future research should evaluate whether adherence to these types of diets is sustainable in the long term and how these changes affect important quality of life concerns.

Real-World Case Studies Showing the Effective Use of Azelaic Acid in the Treatment, and During the Maintenance Phase, of Adult Female Acne Patients

Acne Vulgaris is a chronic inflammatory skin disease, and one of the most prevalent inflammatory dermatoses among teenagers, affecting more than >95% of boys and 85% of girls. Adult female acne (AFA) is a subtype of acne, pragmatically defined as affecting women over the age of 25. The clinical presentation of AFA may be distinguished from adolescent acne according to some key clinical and psychosocial characteristics. The etiopathogenic factors and the chronic clinical course that are implicated in AFA make management complex and challenging. A frequent tendency to relapse makes the requirement for maintenance therapy highly likely. Therefore, AFA typically requires a specific, tailored therapeutic approach. This paper presents six challenging case studies that demonstrate the efficacy of azelaic acid gel (AZA) in adult female acne. The six cases use AZA as monotherapy, as part of a combination regimen at treatment initiation, or as maintenance treatment (which is frequently required in this adult population). The positive outcomes achieved in this case series demonstrate that AZA can be efficacious, result in excellent patient satisfaction in mild to moderate adult female acne, and can be effective as a maintenance therapy.

Insulin Resistance and Acne: The Role of Metformin as Alternative Therapy in Men

The association between acne and insulin resistance has not been investigated as thoroughly in males as it has been in women, despite the fact that in adult men, acne prevalence has grown. On the face, sebaceous glands produce and secrete sebum, which lubricates the skin and protects it from friction. Metformin, an insulin-sensitizing medication, may modify the association between acne vulgaris and insulin resistance (IR). Individuals with IR, metabolic syndrome or with impaired glucose tolerance are sometimes treated 'off label' with Metformin. In these conditions, IR may be a leading factor in the pathogenesis of acne, and in men, Metformin treatment may reduce the Global Acne Grading System (GAGS) score by enhancing insulin sensitivity. However, additional clinical studies are required to corroborate these assumptions.

The Impact of Common Acne on the Well-Being of Young People Aged 15-35 Years and the Influence of Nutrition Knowledge and Diet on Acne Development

Acne is a disorder of sebaceous glands, and it most commonly develops on the face. The role of the diet in triggering and treating acne is controversial and has been widely debated in the literature. A knowledge of the environmental factors that contribute to acne could improve the patient’s physical and emotional well-being, increase the efficacy of treatment, and minimize the risk of anxiety and depressive disorders. The aim of this study was to assess the impact of acne on the daily lives and well-being of people aged 15−30 years, to analyze young people’s knowledge about the influence of various foods and other dietary factors on the prevalence, severity, and treatment of acne, as well as their adherence to an anti-acne diet. The study was conducted between April 2021 and May 2022. A total of 1329 respondents, including 963 women and 366 men, participated in the study. In 99% of men and women respondents, acne breakouts were typically located on the face. An analysis of HADS scores revealed moderate anxiety in 57% of women (F) and 22.5% of men (M) respondents. Acne breakouts located on the face were problematic for 81% of the study population (regardless of sex). More than ¾ of women and 2/3 of men claimed that acne made them feel less attractive. The impact of acne on the participants’ emotional well-being and social life differed between genders. Women experienced psychological discomfort more frequently than men (p = 0.0023). More than 50% of the participants eliminated acne-triggering foods from their diets, and 2/3 of these respondents observed a marked improvement or disappearance of skin breakouts as a result. A significantly higher number of respondents with severe/moderate anxiety were convinced that acne breakouts were affected by diet (OR 1.56; 95% CI 1.23−1.87, p < 0.001) and foods with a high glycemic index (OR 1.56; 95% CI 1.23−1.94, p < 0.001). Acne affects the patients’ emotional well-being. It can act as a barrier to social interactions and lead to mood disorders of varied severity. Persons with moderate/severe mood disorders associated with anxiety significantly more often recognized the role of dietary factors in acne aggravation, and the severity of mood disorders was directly correlated with more frequent consumption of sweets, sweetened beverages, and foods with a high glycemic index.

Management of acne in transgender and gender diverse youth part 1: Gender affirming care and risk factors for the development of acne

Acne vulgaris is among the most common skin disorders afflicting adolescents worldwide, and though well-established guidelines of care exist for acne management, these guidelines do not uniformly consider or address the unique psychosocial and medical needs of transgender and gender diverse (TGD) youth. TGD youth may possess distinct goals of therapy when treating their acne; the use of medicines routinely employed to treat acne may also expose TGD adolescents receiving gender affirming medical therapy to greater risk of adverse events. Part 1 of this two-part review provides dermatologists an understanding of gender affirming care and its timing, as well as its potential impacts on the development of acne in TGD youth.

A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris

BACKGROUND

Various treatments for acne vulgaris exist, but little is known about their comparative effectiveness in relation to acne severity.

OBJECTIVES

To identify best treatments for mild-to-moderate and moderate-to-severe acne, as determined by clinician-assessed morphological features.

METHODS

We undertook a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, published up to May 2020. Outcomes included percentage change in total lesion count from baseline, treatment discontinuation for any reason, and discontinuation owing to side-effects. Risk of bias was assessed using the Cochrane risk-of-bias tool and bias adjustment models. Effects for treatments with ≥ 50 observations each compared with placebo are reported below.

RESULTS

We included 179 RCTs with approximately 35 000 observations across 49 treatment classes. For mild-to-moderate acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with benzoyl peroxide (BPO) [mean difference 26·16%, 95% credible interval (CrI) 16·75-35·36%]; physical - chemical peels, e.g. salicylic or mandelic acid (39·70%, 95% CrI 12·54-66·78%) and photochemical therapy (combined blue/red light) (35·36%, 95% CrI 17·75-53·08%). Oral pharmacological treatments (e.g. antibiotics, hormonal contraceptives) did not appear to be effective after bias adjustment. BPO and topical retinoids were less well tolerated than placebo. For moderate-to-severe acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with lincosamide (clindamycin) (44·43%, 95% CrI 29·20-60·02%); oral pharmacological - isotretinoin of total cumulative dose ≥ 120 mg kg-1 per single course (58·09%, 95% CrI 36·99-79·29%); physical - photodynamic therapy (light therapy enhanced by a photosensitizing chemical) (40·45%, 95% CrI 26·17-54·11%); combined - BPO with topical retinoid and oral tetracycline (43·53%, 95% CrI 29·49-57·70%). Topical retinoids and oral tetracyclines were less well tolerated than placebo. The quality of included RCTs was moderate to very low, with evidence of inconsistency between direct and indirect evidence. Uncertainty in findings was high, in particular for chemical peels, photochemical therapy and photodynamic therapy. However, conclusions were robust to potential bias in the evidence.

CONCLUSIONS

Topical pharmacological treatment combinations, chemical peels and photochemical therapy were most effective for mild-to-moderate acne. Topical pharmacological treatment combinations, oral antibiotics combined with topical pharmacological treatments, oral isotretinoin and photodynamic therapy were most effective for moderate-to-severe acne. Further research is warranted for chemical peels, photochemical therapy and photodynamic therapy for which evidence was more limited. What is already known about this topic? Acne vulgaris is the eighth most common disease globally. Several topical, oral, physical and combined treatments for acne vulgaris exist. Network meta-analysis (NMA) synthesizes direct and indirect evidence and allows simultaneous inference for all treatments forming an evidence network. Previous NMAs have assessed a limited range of treatments for acne vulgaris and have not evaluated effectiveness of treatments for moderate-to-severe acne. What does this study add? For mild-to-moderate acne, topical treatment combinations, chemical peels, and photochemical therapy (combined blue/red light; blue light) are most effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy (light therapy enhanced by a photosensitizing chemical) are most effective. Based on these findings, along with further clinical and cost-effectiveness considerations, National Institute for Health and Care Excellence (NICE) guidance recommends, as first-line treatments, fixed topical treatment combinations for mild-to-moderate acne and fixed topical treatment combinations, or oral tetracyclines combined with topical treatments, for moderate-to-severe acne.

Potential roles of gut microbial tryptophan metabolites in the complex pathogenesis of acne vulgaris

Acne vulgaris is a chronic inflammatory skin disease in which the influence of gut microbiota has been implicated but without clarification of mechanisms. Gut microbiota may exert such an influence via metabolites, particularly those of tryptophan. End metabolites of tryptophan activate receptors, including aryl hydrocarbon, G protein-coupled, and pregnane X receptors to stabilize the immune microenvironment and intestinal mucosal homeostasis. Any impact on the pathogenesis of acne vulgaris remains unclear. The current review collates recent advances concerning potential roles of tryptophan metabolism in mediating skin inflammation, follicular sebaceous gland function and intestinal permeability, all of which influence the pathogenesis of acne vulgaris. The aim was to improve understanding of the pathogenesis of acne vulgaris and to expose therapeutic opportunities.

Association between Nutritional Behaviours and Acne-Related Quality of Life in a Population of Polish Male Adolescents

Acne vulgaris is diagnosed in the majority of adolescents, decreasing their quality of life, while the diet may influence its aetiology in a gender-dependent manner. The aim of the study was to analyse associations between nutritional behaviours and acne-related quality of life in a population of Polish male adolescents. The study was conducted on a population of Polish secondary school adolescents (a studied sample of 925 adolescents), while the random quota sampling procedure of secondary schools was applied. To assess acne-related quality of life, the Acne Quality of Life (AQoL) Scale and Acne Disability Questionnaire (ADQ) were applied, while the Social Quality of Life (SOCQOL) Score and Cardiff Acne Disability Index (CADI) were calculated. To assess the diet, an Acne-specific Food Frequency Questionnaire (Acne-FFQ) was applied. Neither for the ADQ results, nor for the CADI calculated on the basis of ADQ, was there an association with dietary intake (p > 0.05). The results of the SOCQOL Score (calculated on the basis of AQoL) were positively correlated with the intake of fish (p = 0.0085; R = 0.1144), salty snacks (p = 0.0495; R = 0.0854), and non-chocolate confectionary (p = 0.0078; R = 0.1156). In a group of respondents declaring any acne-related quality of life problems in AQoL, while compared with those declaring no such problems, higher intakes of dairy beverages other than milk (p = 0.0063), white bread (p < 0.0001), other white cereal products (p < 0.0001), fast foods (p = 0.0006), salty snacks (p < 0.0001), chocolate confectionary (p < 0.0001), and other confectionary (p < 0.0001), but lower intake of wholegrain bread (p = 0.0084) were observed. It may be concluded that acne-related quality of life is associated with dietary intake in a population of Polish male adolescents. In the studied population, the most prominent influencing factors were salty snacks and non-chocolate confectionary, with both of them having a proacnegenic effect.

The increasing importance of the gut microbiome in acne vulgaris

Acne is a frequently presented dermatological condition brought about by an interplay among inflammation, increased sebum production, hyperkeratinisation, and predominantly Propionibacterium acnes (renamed as Cutibacterium acnes) proliferation, leading to debilitating psychological scars. However, it has been shown that it is the loss of microbial diversity in the skin and the imbalance among C. acnes phylotypes that brings about acne rather than the C. acnes species as a whole. Interestingly, recent evidence suggests that other microorganisms may be implicated, such as the fungi Malassezia and the bacteria Cutibacterium granulosum. A plethora of scientific evidence suggests that the gut microbiome is implicated in the overall health and physiology of the host; studies show that the gut microbiome of acne patients is distinct and depicts less microbial diversity compared to individuals without acne. Herein, using the key terms: acne, C. acnes, IGF-1, sebum, and gut microbiome, we carried out a review of the literature, using Google Scholar and PubMed, and discussed the role of the gut and skin microbiome in relation to acne, as a narrative review. The role of hormones, diet, sebum, and stress in relation to the gut microbiome was also investigated. Therapeutic implications and the use of pre-/postbiotics are also deliberated upon. In this light, future research should investigate the relationship between the gut microbiome and the agreed upon factors of acne pathology, potentially leading to the discovery of novel acne treatments with milder side effects.

Analysis on the difference of skin surface lipids during blue light therapy for acne by lipidomics

Acne is a chronic inflammatory skin disease of the sebaceous glands of the hair follicles, caused by a variety of factors and tends to recur, causing skin damage and psychological stress to patients. Blue light (415nm) is a popular physical therapy for acne, however, studies on the effects of blue light on skin surface lipids (SSL) have not been exhaustively reported. So, we want to investigate the difference in SSL before and after acne treatment with blue light and to reveal the potential mechanism of acne treatment with blue light from the lipid level. SSL samples were collected and physiological indicators (moisture content, transepidermal water loss (TEWL), sebum content and pH) were measured. By using ultra performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) with multivariate data analysis methods to obtain specific information on the lipid composition. Analysis of the physiological index data showed a significant increase in moisture content (p = 0.042), pH (p = 0.000) and a significant decrease in sebum content(p = 0.008) in the after treatment area (AT group), while there was no significant change in TEWL values. A total of 2398 lipids were detected by lipidomics analysis and 25 differential lipids were screened. Triradylglycerols (TGs), isoprenoids and hopanoids being the potential differential lipids. Among the lipids associated with the skin barrier, only monounsaturated fatty acids (MUFA) (p = 0.045) were significantly increased. This study revealed significant changes in SSL after blue light treatment for acne, suggesting that blue light exposure may cause changes in the relative lipid content and redistribution of lipid components, and that whether it damages the skin barrier requires further study.

Spotting fake news: a qualitative review of misinformation and conspiracy theories in acne vulgaris

Acne vulgaris is an extremely common disorder of the pilosebaceous unit, typically manifest as a highly visible facial and upper trunk dermatosis, with teenagers most frequently affected. This cohort is markedly susceptible to misinformation, given their impressionable age, distress about their appearance and high internet usage. This study aimed to assess the content of acne‐related misinformation available online. A formal review of PubMed was performed in March 2022, using the terms ‘acne’ AND ‘misinformation’ OR ‘disinformation’ OR ‘conspiracy theory’, along with an informal Google search using combinations of these terms, and further targeted searches on TikTok, Twitter, Facebook and Instagram. Key themes of acne‐related misinformation included diet and other ‘causes’ of acne, unconventional acne ‘cures’ and a distrust of conventional acne treatments. Websites promoting misinformation were frequently affiliated with companies selling products that promised to cure acne, often in a remarkably short time. Dermatologists should be aware of the nature of acne‐related misinformation available online and be prepared to counter it with scientific principles and facts.

Adult female acne: Clinical and therapeutic particularities (Review)

Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne.