New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group

Topical clindamycin for acne vulgaris: analysis of gastrointestinal events

Purpose: Topical clindamycin, a lincosamide antibiotic, is commonly combined with benzoyl peroxide or a retinoid for acne vulgaris (AV) treatment. While oral and topical clindamycin carry warnings/contraindications regarding gastrointestinal (GI) adverse events (AEs), real-world incidence of GI AEs with topical clindamycin is unknown. This review provides background information and an overview of safety data of topical clindamycin for treating AV.Materials and Methods: Available safety data from published literature, previously unpublished worldwide pharmacovigilance data, and two retrospective cohort studies were reviewed.Results and Conclusions: According to pharmacovigilance data, the rate of GI adverse drug reactions with topical clindamycin-containing products was 0.000045% (64/141,084,533). Results from two retrospective medical record studies of patients with AV indicated that physicians prescribe topical clindamycin equally to patients with or without inflammatory bowel disease history, and that rates of pseudomembranous colitis in these patients were low. In 8 published pivotal clinical trials of topical clindamycin for AV, GI AEs were reported in 1.4% of participants. Limitations include under/inaccurate reporting of AEs or prescription data and limited generalizability. This review of published case reports, worldwide pharmacovigilance data, retrospective US prescription data, and clinical trials safety data demonstrates that the incidence of colitis in patients exposed to topical clindamycin is extremely low.

Unveiling the mechanism of essential oil action against skin pathogens: from ancient wisdom to modern science

Essential oils are among the most well-known phyto-compounds, and since ancient times, they have been utilized in medicine. Over 100 essential oils have been identified and utilized as therapies for various skin infections and related ailments. While numerous commercial medicines are available in different dosage forms to treat skin diseases, the persisting issues include their side effects, toxicity, and low efficacy. As a result, researchers are seeking novel classes of compounds as substitutes for synthetic drugs, aiming for minimal side effects, no toxicity, and high efficacy. Essential oils have shown promising antimicrobial activity against skin-associated pathogens. This review presents essential knowledge and scientific information regarding essential oil's antimicrobial capabilities against microorganisms that cause skin infections. Essential oils mechanisms against different pathogens have also been explored. Many essential oils exhibit promising activity against various microbes, which has been qualitatively assessed using the agar disc diffusion experiment, followed by determining the minimum inhibitory concentration for quantitative evaluation. It has been observed that Staphylococcus aureus and Candida albicans have been extensively researched in the context of skin-related infections and their antimicrobial activity, including established modes of action. In contrast, other skin pathogens such as Staphylococcus epidermidis, Streptococcus pyogens, Propionibacterium acnes, and Malassezia furfur have received less attention or neglected. This review report provides an updated understanding of the mechanisms of action of various essential oils with antimicrobial properties. This review explores the anti-infectious activity and mode of action of essential against distinct skin pathogens. Such knowledge can be valuable in treating skin infections and related ailments.

Investigating Propionibacterium acnes antibiotic susceptibility and response to bacteriophage in vitro and in vivo

Introduction

A total of 94 Propionibacterium acnes (P. acnes) isolates were obtained from a hospital in Beijing to evaluate their susceptibility to erythromycin, clarithromycin, doxycycline, and minocycline. As well as the determination of the effectiveness of P. acnes phages in vitro and in P. acnes-induced lesions mouse model.

Methods

Patients with acne vulgaris (AV) were enrolled from August 2021 to October 2022. Standard methods were employed for specimen collection, culture, and identification of P. acnes. Susceptibility testing was conducted using E-strips for erythromycin, clarithromycin, minocycline, and doxycycline. Phage culture and identification followed standard procedures. A mouse model with P. acnes-induced skin lesions was established, and data was analyzed using χ 2 test.

Results

The results showed that all isolates were susceptible to minocycline and doxycycline, while 53 (56.4%) and 52 (55.3%) isolates were susceptible to erythromycin and clarithromycin, respectively. Interestingly, younger patients and those with lower acne severity exhibited reduced resistance. Phage cleavage rates ranged from 88.30 to 93.60%. Multilocus sequence typing (MLST) analysis was conducted on eight randomly selected P. acnes isolates, and the IA-2 subtype was used in experiments to address P. acnes-induced lesions in mice. Phage therapy proved effective in this model.

Discussion

This study highlights the high susceptibility of P. acnes to doxycycline and tetracycline, while erythromycin and clarithromycin exhibited elevated resistance. Additionally, P. acnes phages demonstrated high cleavage rates and potential effectiveness in treating P. acnes-induced lesions. These findings suggest promising avenues for further exploration of phage therapy in acne treatment.

A review of the topical management of acne and its associated sequelae in the Asia-Pacific region with a spotlight on trifarotene

Acne, a highly prevalent skin disease, can be particularly bothersome for patients of Asian background because of its impact on self-confidence and social interactions. In addition to active acne lesions, some patients may develop sequelae such as scarring, macular/postinflammatory hyperpigmentation, or erythema. The tendency of Asian skin to develop sequelae because of its increased susceptibility to irritation, cultural preferences for lighter skin phototypes, and differences in skincare regimens may all contribute to the increased burden of acne. Moreover, many Asia-Pacific countries do not have their own guidelines for acne management, and those that do often have no schedule in place for regular updates. In this article, we provide a critical review of the published guidance for the management of acne and its sequelae in the Asia-Pacific region, identifying gaps in current recommendations that could be addressed to enhance standards of acne care in Asia-Pacific countries. Along with highlighting the importance of a comprehensive skincare regimen to increase treatment efficacy and adherence, we discuss topical retinoids and retinoid combination options in the acne armamentarium that may be beneficial for sequelae prevention and management, such as adapalene 0.3% ± benzoyl peroxide 2.5%, tretinoin 0.05%, tazarotene 0.1%, and trifarotene 0.005%. In particular, trifarotene 0.005% has been observed to significantly reduce acne scar counts in a Phase 4 study. The recent data highlight the need to establish up-to-date guidance for acne and acne sequelae management in Asia-Pacific countries to provide optimal care to Asian patients.

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.

Iberia Consensus on Strategies to Prevent and Manage Irritation by Topical Retinoids in Facial and Trunk Acne

OBJECTIVE

To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible.

METHOD

After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology).

RESULTS

In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥85% agreement in 22 recommendations and≥70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence.

CONCLUSIONS

Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.

Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease

Clindamycin is a highly effective antibiotic of the lincosamide class. It has been widely used for decades to treat a range of skin and soft tissue infections in dermatology and medicine. Clindamycin is commonly prescribed for acne vulgaris, with current practice standards utilizing fixed-combination topicals containing clindamycin that prevent Cutibacterium acnes growth and reduce inflammation associated with acne lesion formation. Certain clinical presentations of folliculitis, rosacea, staphylococcal infections, and hidradenitis suppurativa are also responsive to clindamycin, demonstrating its suitability and versatility as a treatment option. This review describes the use of clindamycin in dermatological practice, the mechanism of protein synthesis inhibition by clindamycin at the level of the bacterial ribosome, and clindamycin's anti-inflammatory properties with a focus on its ability to ameliorate inflammation in acne. A comparison of the dermatologic indications for similarly utilized antibiotics, like the tetracycline class antibiotics, is also presented. Finally, this review addresses both the trends and mechanisms for clindamycin and antibiotic resistance, as well as the current clinical evidence in support of the continued, targeted use of clindamycin in dermatology.

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.

Trifarotene Reduces Risk for Atrophic Acne Scars: Results from A Phase 4 Controlled Study

BACKGROUND

Atrophic acne scarring often accompanies acne vulgaris. The efficacy of topical retinoids for treatment of acne is well documented; however, evidence for use in atrophic acne scars is limited.

METHODS

In this randomized, split-face, double-blind study, subjects (age: 17-34 years, N = 121) with moderate-to-severe facial acne, with acne scars present, were treated with either trifarotene 50 μg/g or vehicle once daily for 24 weeks. Efficacy was assessed by absolute and percent change from baseline in atrophic acne scar counts, Scar Global assessment (SGA), and IGA success rates as well as acne lesion counts.

RESULTS

At week 24, a statistically significantly greater reduction in the mean absolute change from baseline in the total atrophic scar count was noted in the trifarotene- vs vehicle-treated area (- 5.9 vs - 2.7; p < 0.0001) with differences between sides noted as early as week 2 (- 1.5 vs - 0.7; p = 0.0072). The SGA success rate was higher in the trifarotene side at week 12 (14.9% vs 5.0%, P < 0.05) and improved through week 24 (31.3% vs 8.1%, P < 0.001). Similarly, at week 24, the IGA success rate was higher with trifarotene (63.6% vs 31.3%, P < 0.0001) along with reductions in total (70% vs 45%) and inflammatory (76% vs 48%) lesion counts. The incidence of treatment-emergent adverse events was 5.8% (trifarotene) and 2.5% (vehicle); most common (> 1%) was skin tightness (1.7% vs 0.8%), and all events were mild to moderate in severity.

CONCLUSIONS

Trifarotene was effective and well tolerated in treating moderate-to-severe facial acne and reducing atrophic acne scars, with reduction of total atrophic scar count as early as week 2.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04856904.

Synergistic approach for acne vulgaris treatment using glycerosomes loaded with lincomycin and lauric acid: Formulation, in silico, in vitro, LC-MS/MS skin deposition assay and in vivo evaluation

This study aims to develop a pharmaceutical formulation that combines the potent antibacterial effect of lincomycin and lauric acid against Cutibacterium acnes (C. acnes), a bacterium implicated in acne. The selection of lauric acid was based on an in silico study, which suggested that its interaction with specific protein targets of C. acnes may contribute to its synergistic antibacterial and anti-inflammatory effects. To achieve our aim, glycerosomes were fabricated with the incorporation of lauric acid as a main constituent of glycerosomes vesicular membrane along with cholesterol and phospholipon 90H, while lincomycin was entrapped within the aqueous cavities. Glycerol is expected to enhance the cutaneous absorption of the active moieties via hydrating the skin. Optimization of lincomycin-loaded glycerosomes (LM-GSs) was conducted using a mixed factorial experimental design. The optimized formulation; LM-GS4 composed of equal ratios of cholesterol:phospholipon90H:Lauric acid, demonstrated a size of 490 ± 17.5 nm, entrapment efficiency-values of 90 ± 1.4 % for lincomycin, and97 ± 0.2 % for lauric acid, and a surface charge of -30.2 ± 0.5mV. To facilitate its application on the skin, the optimized formulation was incorporated into a carbopol hydrogel. The formed hydrogel exhibited a pH value of 5.95 ± 0.03 characteristic of pH-balanced skincare and a shear-thinning non-Newtonian pseudoplastic flow. Skin deposition of lincomycin was assessed using an in-house developed and validated LC-MS/MS method employing gradient elution and electrospray ionization detection. Results revealed that LM-GS4 hydrogel exhibited a two-fold increase in skin deposition of lincomycin compared to lincomycin hydrogel, indicating improved skin penetration and sustained release. The synergistic healing effect of LM-GS4 was evidenced by a reduction in inflammation, bacterial load, and improved histopathological changes in an acne mouse model. In conclusion, the proposed formulation demonstrated promising potential as a topical treatment for acne. It effectively enhanced the cutaneous absorption of lincomycin, exhibited favorable physical properties, and synergistic antibacterial and healing effects. This study provides valuable insights for the development of an effective therapeutic approach for acne management.

Cross-Sectional Assessment of Dermatologists' Knowledge and Attitude Towards Isotretinoin-Related Ocular Side Effects in Aseer, Saudi Arabia

BACKGROUND

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, which includes the hair follicle, hair shaft and sebaceous gland. The only treatment that has an effect on all the main aetiological causes of acne is isotretinoin. However, it may have a variety of negative side effects. The aim of this study was to evaluate the knowledge and attitudes of dermatologists regarding ocular effects following isotretinoin prescribing in the Aseer region, Saudi Arabia.

METHODOLOGY

An anonymous online cross-sectional survey was conducted in August 2022 to investigate dermatologists' knowledge and attitude regarding isotretinoin-related ocular side effects in Aseer, Saudi Arabia. Participants were recruited using convenience and snowball sampling methods.

RESULTS

A total of 48 dermatologists were included in this survey. The age distribution ranged from 25 to over 60 years. Sixteen (37.5%) were aged 31-40 years, 29 (60.4%) were male and 20 (41.7%) were specialists. All dermatologists reported that it can cause dry eye, 32 (66.7%) reported that it can cause contact lens intolerance, 10 (20.8%) reported that it can cause a decrease in dark adaptation and two (4.2%) thought that it can cause ectopia lentis and retinoblastoma. Regarding attitude, 43 (87.5%) thought that a course of isotretinoin is not recommended if the patient has recently undergone refractive surgery, 30 (62.5%) always inform patients about ocular side effects, 31 (72.9%) do not consider referring patients for ophthalmic examinations before initiating isotretinoin, 12 (25.0%) always prescribe lubricant eye drops, 15 (31.3%) always ask patients about recent refractive surgery, 17 (35.4%) always warn patients about avoiding refractive surgery during isotretinoin use and 19 (39.6%) always inform patients concerning discomfort with contact lenses.

CONCLUSIONS

The survey reveals that dermatologists in Aseer, Saudi Arabia, generally have good knowledge of isotretinoin related to some ocular side effects, especially dry eye and contact lens intolerance. However, there is some variation in their practices with regard to patient education, referrals for ophthalmic examinations, the use of lubricant eye drops and refractive surgery during isotretinoin treatment. Thus, dermatologists should receive educational training on the safety profile of isotretinoin while managing acne vulgaris.

Evaluating the effect of tranexamic acid as mesotherapy on persistent post-acne erythema: A before and after study

BACKGROUND

Acne vulgaris is a common skin disease that is more common in young population and it can be associated with some sequels after resolving the lesions. Post-inflammatory erythema is one of these complications that can be disturbing for patients and does not have any definite treatment. This study was aimed to evaluate the efficacy and safety of tranexamic acid (TA) as mesotherapy in treatment of post-acne erythema (PAE) treatment.

METHOD

This clinical trial study was performed in the dermatology clinic on 17 patients with persistent PAE (3 months after acne recovery). Two sessions of treatment were performed by a physician with 2-week intervals; TA was injected as mesotherapy into the right side of each patient's face as the case group, while the opposite side was used as the control group. A Visioface device was used to compare before and after treatment photographs of each side of the face in color mode with quantitative measures such as lesions count, area, and area percent.

RESULTS

Finally, 15 patients completed treatment sessions. There were statistically significant differences in right side lesions before and after treatment with p-values of 0.047, 0.002, and 0.035 for count, area, and area percent, respectively. There was no significant difference before and after treatment in terms of count, area. and area-percent on the left side.

CONCLUSION

According to the results of this study, TA injection as mesotherapy for resolving PAE can be effective. However, due to small sample size, further studies are needed.

The 1450-nm Diode Laser Reduces Redness and Porphyrin Density: An Image-Based, Patient-Oriented Appraisal

BACKGROUND

Acne vulgaris remains the leading dermatological condition. The efficacy of laser treatment has been supported by many clinical studies, but studies investigating its multidimensional action are lacking.

AIM

To comprehensively investigate the efficacy of 1450-nm diode laser treatment in patients with inflammatory acne and provide objective and subjective data for doctors in clinical practice.

METHODS

This retrospective study included patients with inflammatory acne lesions who underwent three courses of 1450-nm diode laser treatment between October 2019 and August 2020. Facial surface analysis was performed via objective computer assessments using the Canfield VISIA imaging system. Post-treatment subjective assessments were retrieved and analyzed using the clinical global impression-improvement index (CGI-I) and patient global impression of improvement scales (PGI-I).

RESULTS

The final analysis included 20 patients. The changes in the porphyrin VISIA system scores demonstrated significant improvement, with median scores being 35.83, 48.83, and 54.83, respectively. The changes in the red area VISIA scores also showed improvement, with the median scores being 48, 50.33, and 58.83, respectively. The average CGI-I scale scores were 2.2 ± 1.01, 1.70 ± 0.80, and 1.50 ± 0.76, respectively (p = 0.001), and the average PGI-I scale scores were 3.10 ± 0.85, 3.10 ± 0.97, and 3.05 ± 0.95, respectively (p = 0.727), with no significant changes observed in sebum production.

CONCLUSIONS

The present study is the first to provide objective and subjective evidence proving that the 1450-nm diode laser can reduce inflammatory acne lesions.

Comparison of 2 Hyaluronic Acid-based Fillers for the Treatment of Acne Scars: Structural Lifting Versus Biostimulatory Effect

BACKGROUND

Hyaluronic acid (HA)-based fillers are effective at mitigating acne scars due to their filling effect. Complexes of high and low molecular weight HA demonstrated a delayed biostimulatory effect.

OBJECTIVE

The authors sought to compare the results of acne scar treatment using a filler composed of complexes of high and low molecular weight HA versus a traditional cross-linking HA filler.

METHODS

Thirty patients with moderate-to-severe atrophic acne scarring were included in this prospective, split-face, double-blinded, randomized controlled study. Each underwent 3 monthly injections of a novel formula of combined high and low molecular weight HA (P) to the base of acne scars on 1 side of the face and traditional cross-linking HA (JV) filler on the other. Patients were evaluated 6 months after their last treatment for objective and subjective improvements.

RESULTS

For JV, statistically significant reductions were observed in the acne scar volume but nearly no change in elasticity and stretch during early treatments. For P, no significant differences were observed in early treatments; however, statistically significant improvements were observed in later visits.

CONCLUSION

Although the traditional JV filler demonstrated an earlier impact than P, the latter produced delayed positive changes that were more pronounced than the traditional filler.

A cross-sectional study examining the prevalence of antibiotic-resistant Cutibacterium acnes isolated from patients with acne in Bangkok, Thailand

Cutibacterium acnes is associated with the pathogenesis of acne vulgaris (AV). The relationship between antibiotic-resistant C. acnes and AV remains unclear. The authors aimed to determine the prevalence of antibiotic-resistant C. acnes and investigate the association of acne severity with topical and systemic treatments in patients with acne. Samples were collected of inflammatory and noninflammatory acne, including closed and open comedones and erythematous papules/pustules from the face of patients with mild to severe acne. The samples were cultured under anaerobic conditions for the isolation of C. acnes. Antibiotic susceptibility tests for erythromycin, tetracycline, doxycycline, clindamycin, and trimethoprim/sulfamethoxazole were performed using the agar dilution method. From 153 patients, 143 viable C. acnes samples were isolated (93.5%). They were found resistant to trimethoprim/sulfamethoxazole (143/143, 100%), clindamycin (108/143, 75.5%), erythromycin (105/143, 73.4%), tetracycline (74/143, 51.7%), and doxycycline (73/143, 51.1%). There was no significant correlation between the prevalence of antibiotic resistance and acne severity. High-level resistant C. acnes correlated with higher clinical severity of acne in patients taking doxycycline (τ_b  = 0.3). The present prevalence of antibiotic-resistant C. acnes was high in Thailand. Antibiotic stewardship in AV treatment should be encouraged to prevent further antibiotic resistance crises.

Role of Oral Retinoids in Treatment of Acne Vulgaris With a Bioinformatics-Based Perspective of Personalized Medicine

Acne vulgaris is a skin condition characterized by the inflammation or hyperactivity of sebaceous glands on the skin, which results in the creation of comedones, lesions, nodules, and perifollicular hyperkeratinization. Increased sebum production, follicular blockage, and bacterial colonization may contribute to the disease etiology. Environmental factors, hormonal imbalance, and genetic predisposition can alter the severity of the disease. Its mental and monetary effects can be problematic for the society. In this study, we examined the role of isotretinoin in the treatment of acne vulgaris based on evidence from prior research. This review literature study compiled publications on the treatment of acne vulgaris from 1985 to 2022 based on PubMed and Google Scholar publications. Additional bioinformatics analyses were accompanied by GeneCards, STRING model, and DrugBank databases. These complementary analyses were designed to obtain a better perspective of personalized medicine which is highly required for dose-precise administrations of acne vulgaris treatment. Isotretinoin has been recognized as an effective treatment for acne vulgaris, particularly in cases that have been resistant to previous medications or have resulted in scarring, according to gathered data. Oral isotretinoin inhibits the proliferation of Propionibacterium acne, a critical factor in the development of acne lesions; also, it has been shown to be effective in reducing the number of Propionibacterium-resistant patients and regulating sebum production and reducing sebaceous gland size more effectively than other treatment options resulting in general improvements in skin clarity and acne severity and reduce inflammatory in 90% of patients. In addition to its efficacy, the majority of patients have shown that oral isotretinoin is well tolerated. This review highlights the use of oral retinoids, particularly isotretinoin, as an effective and well-tolerated treatment option for acne vulgaris. It has been proven that oral isotretinoin is useful for achieving long-lasting remission in patients with severe or resistant instances. Despite the fact that oral isotretinoin is related to a number of potential harmful effects, skin dryness was the most common side effect reported by patients that can be managed with the aid of suitable monitoring and drug administration against specific genes identified by genotyping of the susceptible variants of genes involved in TGFβ signaling pathway.

Efficacy and Safety of Transplantation of Autologous Fat, Platelet-Rich Plasma (PRP) and Stromal Vascular Fraction (SVF) in the Treatment of Acne Scar: Systematic Review and Meta-analysis

BACKGROUND

The efficacy and safety evaluation of the transplantation of autologous fat, platelet-rich plasma (PRP) and stromal vascular fraction (SVF) in acne scars has not been completely unified. This article will analyze and process the data of the included studies through evidence-based medicine to evaluate the efficacy and safety of autologous fat grafting, PRP and SVF for acne scar treatment, so as to provide treatment basis and strategy for the clinical treatment of acne scars.

METHODS

We searched the PubMed, Embase, Cochrane Library databases, CNKI, Wanfang and CQVIP databases for studies published during the time between the establishment of the databases through October 2022. We included studies that report autologous fat grafting, SVF and PRP for patients with acne scars. We excluded repeated publication, researches without full text, incomplete information or inability to conduct data extraction and animal experiments, case report, reviews and systematic reviews. STATA 15.1 software was used to analyze the data.

RESULTS

The findings showed that fat grafting had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 36%, 27%, 18% and 18%, respectively, PRP had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 0%, 26%, 47% and 25%, respectively, and the SVF had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 73%, 25%, 3% and 0%, respectively. Additionally, the pooled results showed that there was no significant difference between PRP treatment and pre-treatment in Goodman and Baron scale score. However, Shetty et al. reported that Goodman and Baron scale score after fat grafting was significantly lower than pre-treatment. The results also showed that after fat grafting treatment, incidence of pain after fat grafting was 70%. After PRP treatment, in addition to pain (17%), there is a higher probability of postinflammatory hyperpigmentation (17%) and hematoma (6%). After SVF treatment, the incidence of postinflammatory hyperpigmentation and hematoma was all 0%.

CONCLUSION

Autologous fat grafting, PRP and SVF are effective for the treatment of acne scars, and the safety of autologous fat grafting, PRP and SVF is acceptable. Autologous fat grafting and SVF may be a better treatment for acne scars than PRP. However, this hypothesis still needs to be tested in the future large randomized controlled trials.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Antimicrobial Activity of Gelatin Nanofibers Enriched by Essential Oils against Cutibacterium acnes and Staphylococcus epidermidis

Acne vulgaris is a prevalent skin condition that is caused by an imbalance in skin microbiomes mainly by the overgrowth of strains such as Cutibacterium acnes and Staphylococcus epidermidis which affect both teenagers and adults. Drug resistance, dosing, mood alteration, and other issues hinder traditional therapy. This study aimed to create a novel dissolvable nanofiber patch containing essential oils (EOs) from Lavandula angustifolia and Mentha piperita for acne vulgaris treatment. The EOs were characterized based on antioxidant activity and chemical composition using HPLC and GC/MS analysis. The antimicrobial activity against C. acnes and S. epidermidis was observed by the determination of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The MICs were in the range of 5.7-9.4 μL/mL, and MBCs 9.4-25.0 μL/mL. The EOs were integrated into gelatin nanofibers by electrospinning and SEM images of the fibers were taken. Only the addition of 20% of pure essential oil led to minor diameter and morphology alteration. The agar diffusion tests were performed. Pure and diluted Eos in almond oil exhibited a strong antibacterial effect on C. acnes and S. epidermidis. After incorporation into nanofibers, we were able to focus the antimicrobial effect only on the spot of application with no effect on the surrounding microorganisms. Lastly, for cytotoxicity evaluation, and MTT assay was performed with promising results that samples in the tested range had a low impact on HaCaT cell line viability. In conclusion, our gelatin nanofibers containing EOs are suitable for further investigation as prospective antimicrobial patches for acne vulgaris local treatment.

Hyaluronic acid-FGF2-derived peptide bioconjugates for suppression of FGFR2 and AR simultaneously as an acne antagonist

Acne is a chronic skin condition that has serious consequences for mental and social well-being because it frequently occurs on the face. Several acne treatment approaches have commonly been used but have been hampered by side effects or weak activity. Thus, the investigation of the safety and efficacy of anti-acne compounds is of considerable medical importance. Herein, an endogenous peptide (P5) derived from fibroblast growth factors 2 (FGF2) was conjugated to the polysaccharide hyaluronic acid (HA) to generate the bioconjugate nanoparticle HA-P5, which suppresses fibroblast growth factor receptors (FGFRs) to significantly rehabilitate acne lesions and reduce sebum accumulation in vivo and in vitro. Moreover, our results show that HA-P5 inhibits both fibroblast growth factor receptor 2 (FGFR2) and androgen receptor (AR) signalling in SZ95 cells, reverses the acne-prone transcriptome, and decreases sebum secretion. Furthermore, the cosuppression mechanism revealed that HA-P5 blocks FGFR2 activation, as well as the YTH N6-methyladenosine RNA binding protein F3 (YTHDF3) downstream molecules, including an N6-methyladenosine (m6A) reader that facilitates AR translation. More importantly, a significant difference between HA-P5 and the commercial FGFR inhibitor AZD4547 is that HA-P5 does not trigger the overexpression of aldo-keto reductase family 1 member C3 (AKR1C3), which blocks acne treatment by catalyzing the synthesis of testosterone. Overall, we demonstrate that a polysaccharide-conjugated and naturally derived oligopeptide HA-P5 can alleviate acne and act as an optimal FGFR2 inhibitor and reveal that YTHDF3 plays a crucial role in signalling between FGFR2 and AR.

Polymeric Nanoparticles as Tunable Nanocarriers for Targeted Delivery of Drugs to Skin Tissues for Treatment of Topical Skin Diseases

The topical route is the most appropriate route for the targeted delivery of drugs to skin tissues for the treatment of local skin diseases; however, the stratum corneum (SC), the foremost layer of the skin, acts as a major barrier. Numerous passive and active drug delivery techniques have been exploited to overcome this barrier; however, these modalities are associated with several detrimental effects which restrict their clinical applicability. Alternatively, nanotechnology-aided interventions have been extensively investigated for the topical administration of a wide range of therapeutics. In this review, we have mainly focused on the biopharmaceutical significance of polymeric nanoparticles (PNPs) (made from natural polymers) for the treatment of various topical skin diseases such as psoriasis, atopic dermatitis (AD), skin infection, skin cancer, acute-to-chronic wounds, and acne. The encapsulation of drug(s) into the inner core or adsorption onto the shell of PNPs has shown a marked improvement in their physicochemical properties, avoiding premature degradation and controlling the release kinetics, permeation through the SC, and retention in the skin layers. Furthermore, functionalization techniques such as PEGylation, conjugation with targeting ligand, and pH/thermo-responsiveness have shown further success in optimizing the therapeutic efficacy of PNPs for the treatment of skin diseases. Despite enormous progress in the development of PNPs, their clinical translation is still lacking, which could be a potential future perspective for researchers working in this field.

Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis

Objectives

This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG).

Methods

A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists’ evaluation(DE), the patients’ overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH).

Results

Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2.

Conclusion

FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present.

Registration

PROSPERO CRD42021242160

(available from https://www.crd.york.ac.uk/prospero).

Prescribing Trends for Acne Vulgaris Visits in the United States

Acne vulgaris is the most common reason for pediatric patients and third most common reason for adult patients to seek care from a dermatologist in the US. However, referring providers may be reluctant to initiate patients on acne treatment or certain prescriptions. We assessed over-the-counter (OTC) and prescription acne (antibiotic and non-antibiotic) treatment rates to characterize differences by patient demographics and provider specialty. The National Ambulatory Medical Care Survey (NAMCS) was analyzed for all acne therapies prescribed for at least 10 unweighted visits between 1993 and 2016 (most recent years available). Prescription rates varied by age, with younger patients more likely to receive a prescription; insurance status, with privately insured patients more likely to receive a prescription; and across and within specialties, with dermatologists more likely to recommend a prescription medication than family medicine and pediatric providers. Among all forms of antibiotics for acne vulgaris, oral minocycline was the most commonly prescribed antibiotic by dermatologists, followed by oral doxycycline. Oral minocycline was also the most common antibiotic prescribed by family physicians, followed by oral doxycycline and oral clindamycin, respectively. Pediatricians appeared to be less likely to prescribe oral antibiotics for acne. The OTC topical antimicrobial benzoyl peroxide was the most utilized drug for acne among pediatricians, and it was also the most commonly recommended OTC drug for acne among dermatologists, family physicians, and pediatricians.

Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment

Acne vulgaris is one of the most common chronic inflammatory diseases and is characterized by papules, pustules, comedones, and nodules. Although adolescence is the preferential age group, acne may affect various age groups. Acne shares different properties in adults and adolescents. These differences extend from epidemiology to treatments. Increased awareness of these two subtypes will allow for better management of the disease. In this review, the authors examined all aspects of acne in adults and adolescents under the light of current literature.

A pilot study on the efficacy of topical lotion containing anti-acne postbiotic in subjects with mild -to -moderate acne

Introduction

Acne can compromise facial esthetics and become a mental burden, especially when it occurs in puberty. Skincare cosmetics with anti-acne efficiency is more convenient than other treatment modalities, such as dietary supplements, in certain circumstances. The purpose of this study was to investigate the efficacy of an anti-acne lotion in alleviating acne.

Methods

In our study, an anti-acne lotion containing ferment lysate produced by Lactiplantibacillus plantarum VHProbi^® E15 were applied to subjects with mild -to -moderate acne over 4 weeks. The efficacy was evaluated based on instrumental measurements using Visia^®-CR and CK-MPA^® system.

Results and discussion

The anti-acne lotion exhibited favorable safety, meeting the stringent criteria for the detection of microbes, heavy metals, toxicity, and irritation. After 2 weeks of treatment, a statistically significant improvement in acne lesions was observed compared to baseline (P < 0.01), and this continued to the end of the study. After 4 weeks of treatment, the transepidermal water loss (P < 0.05) and sebum production (P < 0.05) were significantly decreased in subjects compared to baseline. In addition, the pore/area of interest (AOI) and stratum corneum hydration displayed slightly positive changes throughout treatment. Thus, we conclude that applying topical anti-acne lotion may be safe and confer effective benefits in people with mild -to -moderate acne and represents a promising therapeutic option for acne.

A comprehensive review on invasomal carriers incorporating natural terpenes for augmented transdermal delivery

Background

Transdermal drug delivery is one of the most widely used drug administration routes, which offer several advantages over other routes of drug delivery. The apical layer of the skin called the stratum corneum is the most dominant obstacle in the transdermal drug delivery, which restricts the passage of drugs across the skin. Considerable strategies have been applied to enhance the rate of permeation across the epithelial cells; however, the most widely used strategy is the use of sorption boosters, also known as permeation enhancers.

Main body

Terpenes were considered as efficient skin permeation enhancers and are generally recognized as safe as per Food and Drug Administration. Terpenes improve the permeability of drugs either by destructing the stratum corneum’s tightly packed lipid framework, excessive diffusivity of drug in cell membrane or by rampant drug partitioning into epithelial cells. Various vesicular systems have been developed and utilized for the transdermal delivery of many drugs. Invasomes are one such novel vesicular system developed which are composed of phospholipids, ethanol and terpenes. The combined presence of ethanol and terpenes provides exceptional flexibility to the vesicles and improves the permeation across the barrier offered due to the stratum corneum as both ethanol and terpenes act as permeation enhancers. Therefore, utilization of invasomes as carriers to facilitate higher rate of drug permeation through the skin can be a very useful approach to improve transdermal drug delivery of a drug.

Conclusion

The paper focuses on a broad updated view of terpenes as effective permeation enhancers and invasomes along with their applications in the pharmaceutical formulations.

Adipose-derived stem cells attenuate acne-related inflammation via suppression of NLRP3 inflammasome

Background

Acne is a chronic facial disease caused by Propionibacterium acnes, which proliferates within sebum-blocked skin follicles and increases inflammatory cytokine production. Several therapeutic drugs and products have been proposed to treat acne, yet no single treatment that ensures long-term treatment efficacy for all patients is available. Here, we explored the use of facial autologous fat transplant of adipose-derived stem cells (ADSCs) to dramatically reduce acne lesions.

Methods

THP-1 cells were treated with active P. acnes for 24 h at different multiplicities of infection, and alterations in inflammatory factors were detected. To study the effect of THP-1 on inflammasome-related proteins, we first co-cultured ADSCs with THP-1 cells treated with P. acnes and evaluated the levels of these proteins in the supernatant. Further, an acne mouse model injected with ADSCs was used to assess inflammatory changes.

Results

Propionibacterium acnes-mediated stimulation of THP-1 cells had a direct correlation with the expression of active caspase-1 and interleukin (IL)-1β in an infection-dependent manner. ADSCs significantly reduced the production of IL-1β induced by P. acnes stimulation through the reactive oxygen species (ROS)/Nod-like receptor family pyrin domain-containing 3 (NLRP3)/caspase-1 pathway. The results showed that ADSCs inhibit the skin inflammation induced by P. acnes by blocking the NLRP3 inflammasome via reducing the secretion of IL-1β in vivo.

Conclusions

Our findings suggest that ADSCs can alter IL-1β secretion by restricting the production of mitochondria ROS, thereby inhibiting the NLRP3/caspase-1 pathway in P. acnes-induced inflammatory responses. This study indicates that anti‐acne therapy can potentially be developed by targeting the NLRP3 inflammasome.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-022-03007-7.

Topical methylene blue nanoformulation for the photodynamic therapy of acne vulgaris

Acne vulgaris is a common skin disease caused by multifactorial reasons involving excessive sebum secretion and inflammation by Cutibacterium acnes (C. acnes). Various conventional therapies are available for the treatment of acne vulgaris; however, topical photodynamic therapy (PDT) has attracted much attention because of its great potential for sebum-reducing, anti-inflammatory, and antimicrobial activities. Although 5-aminolevulinic acid (ALA) has been broadly used as a photosensitizer for topical PDT, it has several limitations such as long incubation time, pain, and post-inflammatory hyperpigmentation. Here, we report a biocompatible nanoformulation consisting of methylene blue and salicylic acid (MBSD), as a potent PDT and acne therapeutics, enclosed within oleic acid. Photoactivated MBSD showed antimicrobial activity against C. acnes along with long-term stability. When 24 patients with acne were treated with MBSD and light irradiation 5 times at 1-week intervals, MBSD-based PDT exhibited a remarkable reduction in acne lesions and sebum production. In addition, the therapeutic procedure was painless and safe, without any adverse events. Therefore, MBSD is a promising topical PDT agent for biocompatible, safe, and effective acne treatment.

Simultaneous HPLC Determination of Clindamycin Phosphate, Tretinoin, and Preservatives in Gel Dosage Form Using a Novel Stability-Indicating Method

The most well-known, effective medicines for acne therapy are clindamycin phosphate and tretinoin. For the first time, we have developed and validated a reversed-phase HPLC stability-indicating technique for the detection of clindamycin phosphate (CLP), tretinoin (TRN), and two preservatives, methylparaben (MP) and imidazolidinyl urea (IU), simultaneously in this work. Most of the chromatographic conditions in the present study were optimized to achieve better separation. The best separation results were obtained using gradient elution on a C-18 (250 × 4.6 mm), 5 µm column, with a mobile phase consisting of solution A (1 mL/L ortho-phosphoric acid in water) and solution B (methanol), at a flow rate of 1.0 mL/min, with UV detection at wavelengths of 200 nm and 353 nm. Standard parameters such as system suitability, precision, accuracy, specificity, robustness, linearity, range, detection limit, quantification limit, and reagent stability were used to validate the developed technique. According to the standards of the International Council for Harmonization, all of the experimental parameters were found to be within allowable bounds (ICH). The simultaneous concentrations of clindamycin phosphate, tretinoin, methylparaben, and imidazolidinyl urea in pharmaceutical formulations were successfully determined using the suggested approach. The proposed RP-HPLC method detected no interfering peaks in the chromatogram. We may conclude from the data that the new RP-HPLC method can be utilized in pharmaceutical laboratories to simultaneously assess clindamycin phosphate, tretinoin, and two preservatives, methylparaben and imidazolidinyl urea, for both qualitative and quantitative analyses.

Acne Vulgaris, Atopic Dermatitis and Rosacea: The Role of the Skin Microbiota-A Review

The skin harbors a huge number of different microorganisms such as bacteria, fungi and viruses, and it acts as a protective shield to prevent the invasion of pathogens and to maintain the health of the commensal microbiota. Several studies, in fact, have shown the importance of the skin microbiota for healthy skin. However, this balance can be altered by intrinsic and extrinsic factors, leading to the development of skin disease, such as acne vulgaris (AV), atopic dermatitis (AD) and rosacea(RS). Although these diseases are widespread and affect both adolescents and adults, the scientific correlation between these disorders and the skin microbiota and physiological parameters (TEWL, hydration and lipid composition) is still unclear. This review aims to investigate the current literature regarding the correlation between the skin microbiota and its imbalance underlying microbiological aspects, how the skin microbiota changes over the course of the disease and the current possible treatments. The following reported studies show a general imbalance of the bacterial flora. For this reason, more in-depth studies are necessary to explore the different subspecies and strains involved in all three diseases.

Analysis of the epidemiological burden of acne vulgaris in China based on the data of global burden of disease 2019

Acne vulgaris is a chronic, inflammatory skin disease, which has brought an increasing disease burden to patients and society. But there is no systematic study on the disease burden and social development of acne vulgaris in China. This study aimed to analyze the epidemiological burden and trend of acne vulgaris in China from 1990 to 2019 based on the data in the global burden of disease 2019 (GBD 2019). The number of incidences/illnesses, age-standardized incidence/prevalence rates, disability-adjusted life years (DALYs), and DALY rate of acne vulgaris in China from 1990 to 2019 were obtained from the GBD 2019 to evaluate the epidemiological trends and age-period-cohort trends. The associations between disease burden and social development degrees were analyzed using a sociodemographic index. In 2019, the age-standardized prevalence and incidence of acne vulgaris in China were both at low levels in the world. From 1990 to 2019, the prevalent cases and incident cases of acne vulgaris in China rose firstly and then fell (peaked in 2005 and 2003, respectively), and the age-standardized prevalence/incidence/DALY rates showed growth trends continuously. The prevalence of acne vulgaris peaked in the 15–19 age group while the incidence peak age was 10–14 years old and there was an obvious gender difference, females were higher than males. With the increase of sociodemographic index (SDI) value, the morbidity of acne vulgaris showed a linear growth trend (P < 0.05). From 1990 to 2019, the disease burden of acne vulgaris is increasing in China, which is correlated with social and medical development. Active research on the epidemiological data of acne vulgaris and its relationship with the level of social development is important for both the diagnosis and treatment of acne vulgaris and for the development of health policies.

Antibacterial and Anti-Inflammatory Activities of Thymus vulgaris Essential Oil Nanoemulsion on Acne Vulgaris

Antibiotics are frequently used in acne treatment and their prolonged use has led to an emergence of resistance. This study aimed to investigate the use of natural antimicrobials as an alternative therapy. The antimicrobial and anti-inflammatory activities of five commonly used essential oils (EOs) (tea tree, clove, thyme, mentha and basil EOs), and their possible mechanisms of action against Cutibacterium acnes and Staphylococcus epidermidis, were explored. The effect of the most potent EO on membrane permeability was elucidated and its anti-inflammatory action, when formulated as nanoemulsion, was tested in an in vivo acne model. The in vitro studies showed that thyme EO had the most potent antimicrobial and antibiofilm activity, with phenolics and terpenoids as main antimicrobial constituents of EO. Thyme EO affected cell membrane permeability of both bacterial species, evident by the detection of the leakage of intracellular ions and membrane integrity by the leakage of nucleic acids. Morphological alteration in bacterial cells was confirmed by transmission electron microscopy. Thyme EO nanoemulsion led to the suppression of an inflammatory response in acne animal models along with a bacterial load decrease and positive histopathological changes. Collectively, thyme EO nanoemulsion showed potent antimicrobial and anti-inflammatory effects compared to the reference antibiotics, suggesting its effectiveness as a natural alternative in acne treatment.

The Synergy between Pharmacological Regimens and Dermocosmetics and Its Impact on Adherence in Acne Treatment

Background

Acne is the most common inflammatory skin disease in adolescence. It is also prevalent in adults, especially females. The disease has a considerable impact on health-related quality of life. Many studies have reported the negative impact of acne on patients due to skin disfigurement, ineffective treatment, and adverse effects of the treatment. Numerous factors contribute towards nonadherence to therapy. Summary. This review discusses the various factors that are related to treatment nonadherence such as ineffective therapy, adverse effects with topical pharmacotherapy such as skin irritation and erythema as well as patient-related factors such as lack of knowledge of disease and a poor patient-physician relationship. Various methods are being adopted to increase adherence to treatments. Increased adherence to acne therapy has been associated with the use of dermocosmetics, such as moisturizers and cleansers. Encouraging the use of dermocosmetics in synergy with pharmacological regimens could support improved treatment adherence resulting in better clinical outcomes for acne patients.

Conclusion

Dermocosmetics as an adjunct to pharmacological regimens has the potential to improve clinical outcomes by increasing treatment adherence in patients with acne.

Evaluation of Psychological Wellbeing and Social Impact of Combined Facial and Truncal Acne: a Multi-national, Mixed-Methods Study

INTRODUCTION

Half of the individuals with facial acne develop truncal acne, but the impact of combined facial and truncal acne (CA) on patients' quality of life is poorly researched.

METHODS

A 60-min interview of 30 participants with CA was conducted that formed the basis for a cross-sectional survey of 694 adolescents and adults with CA.

RESULTS

The main themes identified from the qualitative interviews among CA subjects included acceptability to self and others, social functioning and emotional wellbeing. Feelings of embarrassment, self-consciousness and low confidence were experienced often or all the time by over 50% of participants, and were more frequent in those who perceived their acne to be out of control (P = 0.003). Half of patients reported feeling stigmatised because of their CA, and 65.4% believed that others associated their truncal acne with unhealthy or unhygienic habits. Perceived stigma was associated with more feelings of embarrassment (P = 0.005), self-consciousness (P = 0.034) and low self-confidence (P = 0.017). Overall, 64% participants reported that CA interfered with daily life, 46.4% often or always avoided social interaction, 48.6% were often concerned about talking to unfamiliar people and 47.4% were uncomfortable showing affection. Further, 32% and 24.4% participants ≥ 16 years old avoided dating or having romantic/intimate relationships because of their facial and truncal acne, respectively. Social and leisure activities were more frequently negatively impacted among those with perceived uncontrolled CA than among those with controlled CA. Avoiding undressing in front of spouse/partner/friends/relatives was more commonly reported by participants with perceived uncontrolled truncal acne than by those with controlled truncal acne (90.5% versus 80.6%, P = 0.031).

CONCLUSION

CA is associated with considerable psychological morbidity, with several exacerbating (e.g. perceived stigma) and attenuating factors (e.g. acne being perceived as being under control) that should be accounted for in CA management.

Calcipotriol: A Novel Tool In Treatment of Acne Vulgaris

BACKGROUND

Retinoids and active vitamin D₃ analogues regulate the proliferation and differentiation of keratinocytes. Retinoids are the main stay in the treatment of acne vulgaris through their comedolytic and anti-inflammatory effects. However, the effect of calcipotriol on the different forms of acne lesions has not been reported.

OBJECTIVE

This split face prospective study aimed to detect the efficacy of topical calcipotriol in the treatment of acne lesions in comparison with that of adapalene.

METHODS

Forty patients with acne vulgaris were treated with topical calcipotriol (0.005%) cream and 0.1% adapalene gel on the right and left sides of the face respectively. Clinical and histological assessment of the used treatments was done 2 months after the start of treatment.

RESULTS

Two months after treatment, there was significant reduction of all acne lesions with significant decrease of physician global assesment and patient global assesment scores (p = 0.0001) on both sides of the face with no significant difference between both sides. Histologically, there was significant decrease in the density of inflammatory infiltrate, which was more significant on the right side (p < 0.0001).

CONCLUSION

Topical calcipotriol can serve a significant role in the treatment of acne vulgaris, through its anti-inflammtory effect which was comparable to that of adapalene. This article is protected by copyright. All rights reserved.

Host Microbiota Balance in Teenagers with Gum Hypertrophy Concomitant with Acne Vulgaris: Role of Oral Hygiene Associated with Topical Probiotics

Gum hypertrophy is a very frequent condition linked to orthodontic treatment, especially in teenagers, and the same time, about 80% of young adults are affected by acne vulgaris, a chronic inflammatory skin disease, typically treated with antibacterial therapy. The use of probiotics has gained popularity in the medical field, and many studies have demonstrated its effectiveness, such as the positive effects of some bacterial strains belonging to Lactobacillus species. The aim of this study is to document the effect of Lactobacillus reuteri (L. reuteri) on facial skin that was randomly observed in two orthodontic patients. We present two case reports of a 14-year-old female patient and a 15-year-old male patient suffering from acne vulgaris who, during fixed orthodontic treatment, showed clinical signs of gingivitis with high values of Full Mouth Plaque Score (FMPS) and Bleeding on Probing (BOP). The patients were treated first with professional oral hygiene sessions and Scaling and Root Planing (SRP) procedures, and then with the administration of a formulate containing L. reuteri as a probiotic. The follow-up was made at four weeks. During the follow-up analysis, both patients showed a significant clinical remission for gum hypertrophy and skin acne vulgaris.

Tetracyclines-An Important Therapeutic Tool for Dermatologists

Tetracyclines are a group of antibiotics whose first representative was discovered over 70 years ago. Since then, they have been of great interest in dermatology. In addition to their antibacterial activity, they are able to inhibit metalloproteinases and exhibit anti-inflammatory, anti-apoptotic and antioxidant effects. The side effects have been thoroughly studied over the years, the most characteristic and important ones in daily dermatological practice being: phototoxicity, hyperpigmentation, onycholysis, photoonycholysis, induced lupus erythematosus, and idiopathic intracranial hypertension. In this article, we summarize the use of tetracyclines in infectious diseases and inflammatory dermatoses, and further discuss the instances where the efficacy and safety of tetracyclines have been highlighted over the past few years.

C. acnes qPCR-Based Antibiotics Resistance Assay (ACQUIRE) Reveals Widespread Macrolide Resistance in Acne Patients and Can Eliminate Macrolide Misuse in Acne Treatment

Background

Macrolides have been widely used to treat moderate-to-severe acne for more than 50 years. However, the prevalent antibiotic resistance of Propionibacterium acnes, along with the absence of clinically available resistance tests, has made macrolide misuse a frequent occurrence around the globe, with serious consequences.

Objective

We developed Cutibacterium acnes quantitative PCR (qPCR)-based antibiotics resistance assay (ACQUIRE) to enable fast and accurate detection of C. acnes macrolide resistance in clinical settings, representing an opportunity to administer antibiotics more wisely and improve the quality of care.

Methods

A cross-sectional observational study (n = 915) was conducted to probe into the macrolide resistance of C. acnes in patients with acne.

Results

The high sensitivity of ACQUIRE enabled us to reveal a much higher C. acnes 23S recombinant DNA (rDNA) point mutation rate (52%) and thus a higher macrolide resistance (75.5%) compared to previous reports. Carriage of ermX gene was discovered on 472 (53%) subjects, which concurs with previous studies.

Conclusion

The macrolide resistance of C. acnes is much higher than previously reported. Integrating ACQUIRE into acne treatment modalities may eliminate macrolide misuse and achieve better clinical improvements.

Bee Venom and Its Major Component Melittin Attenuated Cutibacterium acnes- and IGF-1-Induced Acne Vulgaris via Inactivation of Akt/mTOR/SREBP Signaling Pathway

Acne vulgaris is the most common disease of the pilosebaceous unit. The pathogenesis of this disease is complex, involving increased sebum production and perifollicular inflammation. Understanding the factors that regulate sebum production is important in identifying novel therapeutic targets for the treatment of acne. Bee Venom (BV) and melittin have multiple effects including antibacterial, antiviral, and anti-inflammatory activities in various cell types. However, the anti-lipogenic mechanisms of BV and melittin have not been elucidated. We investigated the effects of BV and melittin in models of Insulin-like growth factor-1 (IGF-1) or Cutibacterium acnes (C. acnes)-induced lipogenic skin disease. C. acnes or IGF-1 increased the expression of sterol regulatory element-binding protein-1 (SREBP-1) and proliferator-activated receptor gamma (PPAR-γ), transcription factors that regulate numerous genes involved in lipid biosynthesis through the protein kinase B (Akt)/mammalian target of rapamycin (mTOR)/SREBP signaling pathway. In this study using a C. acnes or IGF-1 stimulated lipogenic disease model, BV and melittin inhibited the increased expression of lipogenic and pro-inflammatory factor through the blockade of the Akt/mTOR/SREBP signaling pathway. This study suggests for the first time that BV and melittin could be developed as potential natural anti-acne agents with anti-lipogenesis, anti-inflammatory, and anti-C. acnes activity.

Comparing the frequency of isotretinoin-induced hair loss at <0.5-mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review

Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin.

An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities.

Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible.

Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.

Impact of Facial Atrophic Acne Scars on Quality of Life: A Multi-country Population-Based Survey

Background

Acne affects more than 80% of adolescents and young adults, who most often develop acne scars. Supporting data on the effect of acne scars on patient’s health-related quality of life (HRQOL) are limited.

Objective

The aim was to determine how the severity of acne scars impacts the HRQOL of afflicted individuals.

Methods

In this population-based cross-sectional study, 723 adults with facial acne scars but without active acne lesions self-completed the Self-assessment of Clinical Acne-Related Scars (SCARS) questionnaire formulated to investigate degree of acne scarring. The Facial Acne Scar Quality of Life (FASQoL), Dermatology Life Quality Index (DLQI), and Dysmorphic Concern Questionnaire (DCQ) were completed to assess the attitude of these patients toward their scars and the impact of scarring on their HRQOL.

Results

The mean (standard error) DLQI score for facial acne scars was 6.26 (0.22). Acne scars were considered a ‘very large’ or ‘extremely large’ concern by 19.3% of participants with mild scars as compared to 20.1% and 34.0% of participants with moderate and severe/very severe scars, respectively (P = 0.003). Higher FASQoL scores were associated with increased severity of scarring (P = 0.001). In total, 16.9% of participants had clinical features of dysmorphia (i.e., DCQ > 13). DCQ scores were significantly higher among participants with more severe scarring (mean DCQ score of 8.04 [0.28], 8.40 [0.18], and 10.13 [0.08] among participants with mild, moderate, and severe/very severe acne scars, respectively; P = 0.001). Most commonly reported signs of emotional distress were self-consciousness (68.0%) and worry about scars not going away (74.8%).

Conclusions

This study highlights the significant psychosocial impact of atrophic acne scars in the form of embarrassment and self-consciousness. Individuals with mild scars also expressed significant impact on quality of life that increased with aggravation of scar severity. Patient-reported outcomes provide an insight into the physical, functional, and psychological impact of acne scarring from the patient’s perspective.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40257-021-00628-1.

Combined subcision, autologous platelet-rich plasma, and CROSS technique in the treatment of atrophic acne scars: Prospective split face study

Acne scars represent a therapeutic dilemma. This study aimed to evaluate the efficacy of combined subcision, autologous platelet-rich plasma (PRP), and chemical reconstruction of skin scars (CROSS) technique in the treatment of acne scars. In 20 patients with atrophic acne scars, one facial side was treated with subcision plus PRP, and the other was treated with the same combination plus CROSS technique (trichloroacetic acid 50%) for 3 sessions at 3-week intervals. Clinical evaluation, digital photography, quantitative global scarring grading system, and Lipper and Perez score were done at baseline, every session, and 1 month after the last session. Participants assessed their improvement at the end of the follow-up period using a scale (0 to 10). There was a significant reduction in quantitative global scarring grading system (P < .001) and Lipper and Perez score (P < .001) after treatment compared with baseline in both sides. No significant difference was found when the two treated sides were compared after treatment by both scores. Patients' satisfaction was excellent (12 patients [60%]) and good (eight patients [40%]) with no significant difference between both sides. In conclusion, combined subcision and PRP is recommended for acne scars. Adding CROSS technique (trichloroacetic acid 50%) did not further ameliorate the condition.

Isotretinoin-Delonix polymeric nanoparticles: Potentials for skin follicular targeting in acne treatment

In acne management, oral isotretinoin (IST) is associated with various untoward systemic effects, while its topical formulation has irritation side effects. Delonix (DLX) is a natural galactomannan derived from Delonix regia seed that can fabricate nanoparticles for topical skin delivery. This study aims to develop IST-DLX nanoparticles and assess their prospects for acne treatment. Fluorescent-DLX nanoparticles (made with a lipophilic BODIPY dye) or IST-DLX nanoparticles were prepared and characterized. BODIPY-DLX nanoparticles' skin distribution and IST-DLX nanoparticles' in-vitro targeting were assessed in pig ear skin, inflammatory modulation was assessed in AMJ-2 macrophage cells, while skin penetration and irritation were assessed in Wistar rats. IST-DLX nanoparticles had ≈230 nm, negative zeta potential, and ≈30% encapsulation efficiency. Confocal showed BODIPY in DLX nanoparticles accumulated in hair follicles as compared to BODIPY solution. IST-DLX nanoparticles released ≈37% IST over 48 h and increased IST 3-fold in hair follicles compared to IST solution. IST-DLX nanoparticles suppressed IL-6 expression in cells and reduced photo-irritation in Wistar rats compared to IST solution. In conclusion, IST-DLX nanoparticles may target and deliver adequate IST to skin layers associated with acne, avoid systemic penetration, modulate inflammatory pathogenic acne stage and prevent IST topical photo-irritation.

Acne Syndromes and Mosaicism

Abnormal mosaicism is the coexistence of cells with at least two genotypes, by the time of birth, in an individual derived from a single zygote, which leads to a disease phenotype. Somatic mosaicism can be further categorized into segmental mosaicism and nonsegmental somatic mosaicism. Acne is a chronic illness characterized by inflammatory changes around and in the pilosebaceous units, commonly due to hormone- and inflammatory signaling-mediated factors. Several systemic disorders, such as congenital adrenal hyperplasia, polycystic ovarian syndrome, and seborrhoea-acne-hirsutism-androgenetic alopecia syndrome have classically been associated with acne. Autoinflammatory syndromes, including PAPA, PASH, PAPASH, PsAPASH, PsaPSASH, PASS, and SAPHO syndromes include acneiform lesions as a key manifestation. Mosaic germline mutations in the FGFR2 gene have been associated with Apert syndrome and nevus comedonicus, two illnesses that are accompanied by acneiform lesions. In this review, we summarize the concept of cutaneous mosaicism and elaborate on acne syndromes, as well as acneiform mosaicism.

Guidance for the pharmacological management of acne vulgaris

INTRODUCTION

Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne.

AREAS COVERED

Herein, the author discusses the treatment of comedonal, papulopustular, and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases.

EXPERT OPINION

The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.

Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations

BACKGROUND AND OBJECTIVES

Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs.

STUDY DESIGN/MATERIALS AND METHODS

An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence.

RESULTS

The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome.

CONCLUSION

Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.

Effect of Blue Light on Acne Vulgaris: A Systematic Review

Acne is a dermatosis that affects almost 90% of the adolescent population worldwide and its treatment is performed with retinoids, antimicrobials, acids, and topical or systemic antibiotics. Side effects such as skin irritation in addition to microbial resistance to antibiotics are the main side effects found. Phototherapy with blue light is being used as an alternative treatment. Our objective was to analyze the use of blue light to treat inflammatory acne. We conducted a systematic literature review, following the recommendation PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses), including in the sample randomized clinical trial studies that compared blue light with another intervention as control. The research was carried out in the PUBMED and WEB of SCIENCE databases and the methodological quality of the studies evaluated were made by the Cochrane Collaboration Bias Risk Scale. After the exclusion of duplicates, the titles and abstracts of 81 articles were evaluated, and 50 articles were selected for full reading, including in the review at the end 8 articles. Studies have shown significant improvements in the overall picture of acne. It is concluded that despite the great potential in its use in the treatment of acne, there is a need for more detailed trials on the effect of blue light on the treatment of inflammatory acne.

Acupuncture: A therapeutic approach against acne

Acne is a common but chronic skin disease that influence large population especially juvenile. Acne can continue, begin, or grow into severe form in adult age, affecting face, back, and chest. It may be a serious issue if not cared or treated timely. Even if acne got treated it leaves a persistent scar, which is difficult to alleviate. These acne lesions are long-lasting and result in significant impact on mental and physical health of an individual. There are four mechanisms that are involved in acne lesion formation. However, the accurate series of events of the interaction among the factors in acne pathogenesis is still unsettled. Pubescent acne is due to increase hormone levels, when in fact adult acne is due to fluctuation in hormone levels. There are various approaches for the treatment of acne, including oral medications, creams or gels, acupuncture. Traditional Chinese Medicine stated acne as a infection that is associated with the pathogenic influence of damp heat and heat on specific meridians. As an ancient and integral part of Chinese medicine acupuncture therapy is employed in the treatment of many diseases including acne. It functions by ameliorating the deep-rooted mechanisms playing crucial role in acne development. In this review, we have explained the acne causes, pathogenesis, and its available treatment options. Additionally, we also discussed the acupuncture therapy methods, devices, different techniques. and its mechanism of action in treating acne. Furthermore, clinical trials studies motivated us to highlight the scope of acupuncture in the growing system of medicine.

Estrogen regulates the expression of retinoic acid synthesis enzymes and binding proteins in mouse skin

Topical 17-beta-estradiol (E2) regulates the hair cycle, hair shaft differentiation, and sebum production. Vitamin A also regulates sebum production. Vitamin A metabolism proteins localized to the pilosebaceous unit (PSU; hair follicle and sebaceous gland); and were regulated by E2 in other tissues. This study tests the hypothesis that E2 also regulates vitamin A metabolism in the PSU. First, aromatase and estrogen receptors localized to similar sites as retinoid metabolism proteins during mid-anagen. Next, female and male wax stripped C57BL/6J mice were topically treated with E2, the estrogen receptor antagonist ICI 182,780 (ICI), letrozole, E2 plus letrozole, or vehicle control (acetone) during mid-anagen. E2 or one of its inhibitors regulated most of the vitamin A metabolism genes and proteins examined in a sex-dependent manner. Most components were higher in females and reduced with ICI in females. ICI reductions occurred in the premedulla, sebaceous gland, and epidermis. Reduced E2 also reduced RA receptors in the sebaceous gland and bulge in females. However, reduced E2 increased the number of retinal dehydrogenase 2 positive hair follicle associated dermal dendritic cells in males. These results suggest that estrogen regulates vitamin A metabolism in the skin. Interactions between E2 and vitamin A have implications in acne treatment, hair loss, and skin immunity.