Treatment of acne vulgaris

The role of current synthetic and possible plant and marine phytochemical compounds in the treatment of acne

Acne is a long-standing skin condition characterized by plugged hair follicles due to the accumulation of dead skin cells, sebum, and Propionibacterium acnes (P. acnes) bacteria, causing inflammation, and the formation of pimples or lesions. Acne was recognized in the ancient times by the ancient Egyptians, Greeks, and Romans. Since ancient times, folk medicine from different cultures have comprised herbal and natural products for the treatment of acne. Current acne medications include antibiotics, keratolytics, corticosteroids, in addition to hormonal therapy for women. However, these conventional drugs can cause some serious side effects. And therefore, seeking new safe treatment options from natural sources is essential. Plants can be a potential source of medicinal phytochemicals which can be pharmacologically active as antibacterial, antioxidant, anti-inflammatory, keratolytic and sebum-reducing. Organic acids, obtained from natural sources, are commonly used as keratolytics in dermatology and cosmetology. Most of the promising phytochemicals in acne treatment belong to terpenes, terpenoids, flavonoids, alkaloids, phenolic compounds, saponins, tannins, and essential oils. These can be extracted from leaves, bark, roots, rhizomes, seeds, and fruits of plants and may be incorporated in different dosage forms to facilitate their penetration through the skin. Additionally, medicinal compounds from marine sources can also contribute to acne treatment. This review will discuss the pathogenesis, types and consequences of acne, side effects of conventional treatment, current possible treatment options from natural sources obtained from research and folk medicine and possible applied dosage forms.

Increase adapalene delivery using chemical and herbal enhancers

BACKGROUND

Acne is one of the skin diseases that include abnormalities in the production of sebum, changes in the microbial flora, abnormal keratinization, and inflammation. Adapalene is a good choice in the treatment of acne with fewer side effects and high effectiveness. However, the absorption of adapalene through human skin is low. We investigated the effect of several enhancers on the skin absorption of adapalene.

METHODS

For the preparation of a topical formulation, this drug needs proper skin absorption. Therefore, to increase the effect of chemical absorption of the Adapalene skin permeability, it should first be put on the skin in a touch of some absorption like Eucalyptus, Urea, Clove oil, propylene glycol, and oleic acid for 1 and 2 hours and was then examined for the passing of the drug on the treated skin and for the effect of absorptions by calculating of the permeability parameters using DSC and FT-IR techniques.

RESULT AND CONCLUSION

The results show that the enhancers used increased the permeability of the drug adapalene to water. Several mechanisms including lipid liquefaction, degradation of the fat structure, as well as irreversible denaturation of intracellular creatine caused by Eucalyptus, urea clove oil, PG, and oleic acid are the main mechanisms of drug penetration. Based on the results, it was found that among the enhancers studied, eucalyptus and urea had the highest and the lowest absorption effect in 2- and 1-hour pre-contact, respectively.

Examining Quality of Life After Treatment with Azelaic and Pyruvic Acid Peels in Women with Acne Vulgaris

Purpose

This randomized parallel study aims to investigate the azelaic acid (AA), and pyruvic acid (PA) peels treatment effect on health-related quality of life (QOL) in young adult women with acne vulgaris.

Patients and Methods

The participants were 120 female undergraduate students, with mild to moderate facial acne and an average age of 22 years old (M = 22.2, SD = 16.1). Eligibility criteria were as follows: female gender, 18–25 years of age, no dermatological treatment within the last 12 months and mild to moderate papulopustular acne. Patients were randomly divided into two groups, the first group was treated with AA, and the second group was treated with PA. Both groups received treatment every 2 weeks, for a total of 12 weeks. The Hellgren–Vincent scale was used to assess acne severity, and the Dermatology Life Quality Index (DLQI) and Skindex-29 were used to evaluate the quality of life of each patient. These scores were calculated before treatment, and after finishing the final treatment.

Results

All scoring systems used (Hellgren–Vincent scale, DLQI, and Skindex-29) demonstrated improvement in both groups. QOL scores were slightly better in the group using pyruvic acid compared with azelaic acid.

Conclusion

Both AA and PA have a significant impact on the objective assessment of acne symptoms, as well as the subjectively measured quality of life of young adult women with acne. There is a slightly greater improvement in QOL scores with PA compared with AA peeling treatment.

Bio-inspired apatite particles limit skin penetration of drugs for dermatology applications

Most treatments of skin pathologies involve local administration of active agents. One issue can however be the partial transcutaneous diffusion of the drug to blood circulation, leading to undesirable effects. In this work, the original use of submicron mineral particles based on bio-inspired calcium phosphate apatite was explored for the first time as drug carriers for favoring topical delivery. The permeation of a model drug across synthetic and biological membranes was investigated in both static and dynamic conditions. Our data show that adsorption of the drug on the apatite particles surface drastically limits its permeation, with lower effective diffusion coefficients (P_eff) and smaller total released amounts. The retention of the apatite colloidal particles on porcine ear skin explants surface was demonstrated by combining histological observations and Raman confocal microscopy. All results converge to show that association of the drug to apatite particles favors skin surface effects. These findings point to the relevance of mineral-based particles as drug carriers for local delivery to the skin, and open the way to novel applications of bio-inspired apatites in dermatology. STATEMENT OF SIGNIFICANCE: Calcium phosphates (CaP) are major biomaterials in orthopedics and dentistry. Their resemblance to bone mineral allows new applications beyond bone repair, e.g. in nanomedicine. In 2018, a 14-page detailed review (M. Epple, Acta Biomaterialia 77 (2018) 1-14) provided clear facts in favor of the non-toxicity of nanosized CaP as an answer to discussions from EU and US study groups, thus clarifying the path to novel applications of nano CaP. In the present paper, bio-inspired apatite nanoparticles are used for the first time as drug carriers for dermatology for drastically limiting drug transcutaneous permeation and retaining a topical effect. We demonstrate this proof of concept via permeation cell tests, histology, Raman microscopy and photoluminescence after application on porcine ear skin.

An approach on the potential use of probiotics in the treatment of skin conditions: acne and atopic dermatitis

Acne and Atopic Dermatitis (AD) are chronic inflammatory skin conditions with severe impact on a patient's life. Current treatments are related to adverse effects and do not represent a definitive cure. The present paper reviews the alterations in skin microbiome, specifically in acne and AD, and aims in searching for potential treatments based on benefic microorganisms, called probiotics. The review was made through bibliographic search of the main databases (Science Direct, PubMed, Scielo, Medline) between September 2015 and June 2016. Acne lesions create an environment that facilitates the excess growth of Propionibacterium acnes (P. acnes). AD is related to an increase in the proportion of Staphylococcus aureus (S. aureus) during flare-ups. Some microorganisms have been shown to act not only in the prevention but also in the competition for pathogenic microorganisms and beneficially affect the inflammatory process present in these conditions. Despite the high variety of tested bacteria, Staphylococcus, Streptococcus, Lactococcus, Lactobacillus, and Enterococcus are the ones which showed the highest potential to control acne, and Vitreoscilla filiformis (V. filiformis), Staphylococcus epidermidis (S. epidermidis), and species of Lactobacillus and Bifidobacterium in the treatment of AD. Many of these studies were in vitro, and more detailed research should be performed in order to prove the real efficacy and safety of probiotics in these situations. An interesting alternative seems to be the use of Bacteriocin-like inhibitory substances produced by probiotics, responsible for their antimicrobial activity.

Design and characterization of clindamycin-loaded nanofiber patches composed of polyvinyl alcohol and tamarind seed gum and fabricated by electrohydrodynamic atomization

In this study, we developed a polymeric nanofiber patch (PNP) for topical disease treatment using electrohydrodynamic atomization (EHDA). The nanofibers were prepared using various concentrations of polyvinyl alcohol (PVA) and tamarind seed gum and loaded with clindamycin HCl as a model drug. The precursor polymer solutions were sprayed using the EHDA technique; the EHDA processing parameters were optimized to obtain blank and drug-loaded PNPs. The skin adherence, translucence, and ventilation properties of the prepared PNPs indicated that they are appropriate for topical application. The conductivity of the polymer solution increased with increasing PVA and clindamycin concentrations, and increasing the PVA concentration enhanced the solution viscosity. Based on scanning electron microscopy analysis, the PVA concentration had a pronounced effect on the morphology of the sprayed product. Nanofibers were fabricated successfully when the solution PVA concentration was 10%, 13%, or 15% (w/v). The applied voltage significantly affected the diameters of the prepared nanofibers, and the minimum nanofiber diameter was 163.86 nm. Differential scanning calorimetry and X-ray diffraction analyses indicated that the model drug was dispersed in PVA in an amorphous form. The PNP prepared with a PVA:gum ratio of 9:1 absorbed water better than the PVA-only PNP and the PNP with a PVA:gum ratio of 9.5:0.5. Moreover, the PNPs loaded with clindamycin at concentrations of 1%–3% prohibited the growth of Staphylococcus aureus more effectively than clindamycin gel, a commercially available product.

New perspectives on antiacne plant drugs: contribution to modern therapeutics

Acne is a common but serious skin disease, which affects approximately 80% adolescents and young adults in 11-30 age group. 42.5% of men and 50.9% of women continue to suffer from this disease into their twenties. Bacterial resistance is now at the alarming stage due to the irrational use of antibiotics. Hence, search for new lead molecule/bioactive and rational delivery of the existing drug (for better therapeutic effect) to the site of action is the need of the hour. Plants and plant-derived products have been an integral part of health care system since time immemorial. Therefore, plants that are currently used for the treatment of acne and those with a high potential are summarized in the present review. Most active plant extracts, namely, P. granatum, M. alba, A. anomala, and M. aquifolium exhibit minimum inhibitory concentration (MIC) in the range of 4-50 µg/mL against P. acnes, while aromatic oils of C. obovoides, C. natsudaidai, C. japonica, and C. nardus possess MICs 0.005-0.6 μL/mL and phytomolecules such as rhodomyrtone, pulsaquinone, hydropulsaquinone, honokiol, magnolol, xanthohumol lupulones, chebulagic acid and rhinacanthin-C show MIC in the range of 0.5-12.5 μg/mL. Novel drug delivery strategies of important plant leads in the treatment of acne have also been discussed.

Physicochemical properties and anti-Propionibacterium acnes activity of film-forming solutions containing alpha-mangostin-rich extract

The objective of this study was to study the effect of formulation compositions on physicochemical properties and anti-Propionibacterium acnes activity of film-forming solutions containing alpha-mangostin-rich extract (AM). Film-forming solution bases and film-forming solutions containing AM were prepared by using Eudragit RL PO or Klucel LF or combinations of them as film-forming polymers. Rheological properties, pH values of the solutions, and mechanical properties of the dry films were investigated. An optimized formulation was selected and evaluated for the film surface, in vitro AM release, an anti-P. acnes activity, and potential for being a skin irritant. It was found that mechanical properties of the dry films were affected by total polymer contents, ratios of Klucel LF/Eudragit RL PO, AM, and contents of triethyl citrate. The film-forming solutions containing AM had pH values around 7.0. Their flow curves exhibited Newtonian flow behaviors. The optimized formulation provided films possessing smooth and nonporous surfaces. These films showed greater anti-P. acnes activity than their base films without toxicity to skin fibroblasts. Furthermore, AM released from the film matrix obeyed Higuchi's equation. In conclusion, the film-forming solutions containing AM had potential for treatment of acne vulgaris caused by P. acnes. However, further in vivo study is necessary to determine their efficacy and safety for using in patients suffering from acne vulgaris.

Acne vulgarism treatment using ultra-short laser pulse generated by micro- and nano-ring resonator system

Acne vulgaris is adebilitating dermatologic disease, and is conventionally treated by laser therapy using a microring resonator system. An evolving understanding of laser-tissue interactions involving Propioni bacterium acneproducing porphyrins, and the development of lasers to target the sebaceous glands, has led to the development of an escalating number of laser light for acne treatment. The results show that the full width at half maximum of the proposed laser pulse of 0.15 nm can be generated using a microring resonator system. The power of the laser is 200 W and the wavelength laser is 1,032 nm, which is proposed as a treatment of acne vulgaris diseases.