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Guertler A, Neu K, Lill D, Clanner-Engelshofen B, French LE, Reinholz M. Exploring the potential of omega-3 fatty acids in acne patients: A prospective intervention study. J Cosmet Dermatol 2024. [PMID: 38982829 DOI: 10.1111/jocd.16434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Omega-3 fatty acids (ω-3 FA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), are essential nutrients known for their anti-inflammatory properties, which involve reducing pro-inflammatory cytokines, eicosanoids, and insulin-like growth factor-1. This suggests their potential to alleviate acne severity, especially when deficits are present. AIMS To elevate EPA/DHA levels in acne patients through dietary intervention and supplementation, observing subsequent clinical effects. METHODS Over 16 weeks, 60 patients without prescription medication (n = 23 acne comedonica [AC], n = 37 acne papulopustulosa [AP]) adhered to a Mediterranean diet, incorporating oral algae-derived ω-3 FA supplementation (600 mg DHA/300 mg EPA week 1-8, 800 mg DHA/400 mg EPA week 8-16). At four visits (V1-V4), blood EPA/DHA levels were tracked using the HS-omega 3 index® (EPA/DHA (%) of total identified fatty acids in erythrocytes; target 8%-11%, deficit <8%, severe deficit <4%), alongside clinical assessments and standardized questionnaires. RESULTS At baseline, 98.3% of patients had an EPA/DHA deficit, with the mean HS-omega 3 index® rising from 4.9% at V1 to 8.3% at V4 (p < 0.001). AC showed significantly higher indices than AP at V4 (p = 0.035). Objective improvements in both inflammatory and non-inflammatory lesions were observed (p < 0.001). While self-reported appearance worsened in four patients, overall quality of life improved (p < 0.001), particularly in AP. Dietary triggers were more clearly defined than beneficial foods. Intake of cow's milk and dairy products reduced (p < 0.001). Compliance was good; no adverse events were reported. CONCLUSION Many acne patients have a ω-3 FA deficit. The HS-omega 3 index® can be increased by a Mediterranean diet and oral supplementation with algae-derived ω-3 FA. Acne severity improved significantly in patients with target ω-3 FA levels.
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Affiliation(s)
- Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Neu
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Diana Lill
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | | | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, USA
| | - Markus Reinholz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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Fang M, Lei J, Zhang Y, Zhang B. Repurposing lipid-lowering drugs as potential treatment for acne vulgaris: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1385948. [PMID: 38903813 PMCID: PMC11187329 DOI: 10.3389/fmed.2024.1385948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Background Acne vulgaris, a chronic inflammatory skin condition predominantly seen in teenagers, impacts more than 640 million people worldwide. The potential use of lipid-lowering medications as a treatment for acne vulgaris remains underexplored. This study seeks to investigate the impact of lipid-lowering therapies on the risk of developing acne vulgaris using two-sample Mendelian randomization (MR) analysis. Method The two-sample MR method was employed for analysis, and information on lipid-lowering drugs was obtained from the DrugBank and ChEMBL databases. The summary data for blood low-density lipoprotein (LDL) and triglycerides were sourced from the Global Lipids Genetics Consortium, while genome-wide association studies (GWAS) summary data for acne vulgaris were obtained from the FinnGen database. Heterogeneity was examined using the Q-test, horizontal pleiotropy was assessed using MR-Presso, and the robustness of analysis results was evaluated using leave-one-out analysis. Results The MR analysis provided robust evidence for an association between lowering LDL cholesterol through two drug targets and acne vulgaris, with PCSK9 showing an odds ratio (OR) of 1.782 (95%CI: 1.129-2.812, p = 0.013) and LDL receptor (LDLR) with an OR of 1.581 (95%CI: 1.071-2.334, p = 0.021). Similarly, targeting the lowering of triglycerides through lipoprotein lipase (LPL) was significantly associated with an increased risk of acne vulgaris, indicated by an OR of 1.607 (95%CI: 1.124-2.299, p = 0.009). Conclusion The current MR study presented suggestive evidence of a positive association between drugs targeting three genes (PCSK9, LDLR, and LPL) to lower lipids and a reduced risk of acne vulgaris.
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Affiliation(s)
- Man Fang
- Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jing Lei
- College of Computer, Chengdu University, Chengdu, Sichuan, China
| | - Yue Zhang
- Xiangya Hospital, Central South University, Changsha, China
| | - Bo Zhang
- Department of Plastic and Cosmetic Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Szefler L, Szybiak-Skora W, Sadowska-Przytocka A, Zaba R, Wieckowska B, Lacka K. Metformin Therapy for Acne Vulgaris: A Meta-Analysis. Pharmaceuticals (Basel) 2024; 17:728. [PMID: 38931395 PMCID: PMC11206792 DOI: 10.3390/ph17060728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Acne vulgaris is a common disease, which occurs in adolescents as well as adults and has a significant influence on the patient's quality of life (QoL) in every aspect. Due to resistance to standard therapies, it has become necessary to prospect for new treatment strategies. It is important to highlight that the diagnosis and treatment of the underlying cause of acne such as metabolic and hormonal disorders may significantly improve the effectiveness of acne treatment. The correlation between Insulin Resistance (IR) and acne has been proven. Both disorders share many common occurrence factors and activation pathways. Metformin, an antihyperglycemic agent, seems to be a possible therapy option, not only because of its insulin sensitizing ability but also via plenty of additional effects of this medicine. While the efficiency of metformin therapy in patients with acne and Polycystic Ovary Syndrome (PCOS) is well explored, it is still necessary to evaluate it in patients without any endocrinopathies. This meta-analysis aimed to estimate the effectiveness of oral metformin as a monotherapy in acne patients without PCOS or other endocrinopathies. Study selection was performed with included criteria such as no PCOS and other endocrinopathies diagnosed, oral administration of metformin, and metformin in monotherapy. Selected studies contained comparisons in the Global Acne Grading System (GAGS) before and after metformin therapy. Statistical analysis detected significant improvement in skin condition after treatment with metformin.
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Affiliation(s)
- Lidia Szefler
- Students’ Scientific Society at Poznań University of Medical Sciences, Student’s Scientific Section of Endocrinology, Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (L.S.); (W.S.-S.)
| | - Weronika Szybiak-Skora
- Students’ Scientific Society at Poznań University of Medical Sciences, Student’s Scientific Section of Endocrinology, Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (L.S.); (W.S.-S.)
| | - Anna Sadowska-Przytocka
- Department of Allergic and Occupational Skin Diseases, Poznań University of Medical Sciences, 61-701 Poznan, Poland
| | - Ryszard Zaba
- Department of Dermatology and Venerology, Poznań University of Medical Sciences, 61-701 Poznan, Poland;
| | - Barbara Wieckowska
- Department of Computer Sciences and Statistics, Poznań University of Medical Sciences, 61-701 Poznan, Poland;
| | - Katarzyna Lacka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Science, 61-701 Poznan, Poland;
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Dessinioti C, Katsambas A. The Microbiome and Acne: Perspectives for Treatment. Dermatol Ther (Heidelb) 2024; 14:31-44. [PMID: 38183614 PMCID: PMC10828138 DOI: 10.1007/s13555-023-01079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024] Open
Abstract
The skin microbiome consists of the microorganisms populating the human skin. Cutibacterium acnes (C. acnes, formerly named Propionibacterium acnes) is recognized as a key factor in acne development, regulating inflammatory and immune pathways. Dysbiosis has been described as the imbalance in skin microbiome homeostasis and may play a role in acne pathogenesis. Microbial interference has been shown to be a contributor to healthy skin homeostasis and staphylococcal strains may exclude acne-associated C. acnes phylotypes. In this review we present an update on the skin microbiome in acne and discuss how current acne treatments such as benzoyl peroxide, orally administered isotretinoin, and antibiotics may affect the skin microbiome homeostasis. We highlight the collateral damage of acne antibiotics on the skin microbiome, including the risk of antimicrobial resistance and the dysregulation of the microbiome equilibrium that may occur even with short-term antibiotic courses. Consequently, the interest is shifting towards new non-antibiotic pharmacological acne treatments. Orally administered spironolactone is an emerging off-label treatment for adult female patients and topical peroxisome proliferator-activated receptor gamma (PPARγ) modulation is being studied for patients with acne. The potential application of topical or oral probiotics, bacteriotherapy, and phage therapy for acne are further promising areas of future research.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, 5, Dragoumi Str, 16 121, Athens, Greece.
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Raza S, Al-Niaimi F, Ali FR. A systematic review of the uses of metformin in dermatology. Clin Exp Dermatol 2023; 48:73-79. [PMID: 36641775 DOI: 10.1093/ced/llac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/16/2023]
Abstract
Metformin is an established staple drug in the management of Type 2 diabetes mellitus. In this systematic review, we sought to establish the clinical utility of metformin in a range of dermatological conditions. The pathophysiology of acne vulgaris and polycystic ovarian syndrome (PCOS) is well suited to the pharmacological profile of metformin, and we found evidence for its efficacy in managing these conditions. We found some evidence for the use of metformin particularly in acne and PCOS; however, the evidence base is of mixed quality. There is scope for clinicians to consider metformin as an adjunct therapy in acne and PCOS. There is generally insufficient evidence to recommend metformin in other dermatological conditions.
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Affiliation(s)
- Sami Raza
- Department of Medicine, Walsall Healthcare NHS Trust, UK.,Faculty of Medicine, Health and Life Science, Swansea University, UK
| | | | - Faisal R Ali
- Department of Dermatology, Mid-Cheshire NHS Foundation Trust, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lawson JS, Glenn WK. Multiple pathogens and prostate cancer. Infect Agent Cancer 2022; 17:23. [PMID: 35637508 PMCID: PMC9150368 DOI: 10.1186/s13027-022-00427-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this review is to consider whether multiple pathogens have roles in prostate cancer. METHODS We have reviewed case control studies in which infectious pathogens in prostate cancer were compared to normal and benign prostate tissues. We also reviewed additional evidence from relevant published articles. RESULTS We confirmed that high risk human papilloma viruses are a probable cause of prostate cancer. We judged Escherichia coli, Cutibacterium acnes, Neisseria gonorrhoea, Herpes simplex, Epstein Barr virus and Mycoplasmas as each having possible but unproven roles in chronic prostatic inflammation and prostate cancer. We judged Cytomegalovirus, Chlamydia trachomatis, Trichomonas vaginalis and the Polyoma viruses as possible but unlikely to have a role in prostate cancer. CONCLUSIONS AND ACTIONS The most influential cause of prostate cancer appears to be infection induced chronic inflammation. Given the high prevalence of prostate cancer it is important for action to can be taken without waiting for additional conclusive evidence. These include: 1. Encouragement of all boys (as well as girls) to have HPV vaccines 2. The vigorous use of antibiotics to treat all bacterial pathogens identified in the urogenital tract 3. The use of antiviral medications to control herpes infections 4. Education about safe sexual practices.
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Affiliation(s)
- James S. Lawson
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, 2052 Australia
| | - Wendy K. Glenn
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, 2052 Australia
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Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context 2021; 10:dic-2021-8-6. [PMID: 34691199 PMCID: PMC8510514 DOI: 10.7573/dic.2021-8-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris. Methods A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English. Results Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies. Conclusion Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Dermatology and Skin Sciences, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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Zdrada J, Stolecka-Warzecha A, Odrzywołek W, Deda A, Błońska-Fajfrowska B, Wilczyński S. The use of light in the treatment of acne vulgaris-a review. J Cosmet Dermatol 2021; 20:3788-3792. [PMID: 34674364 DOI: 10.1111/jocd.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Topical and oral antibiotic therapy is also a popular method of treatment. The effectiveness of this method is limited by the increasing resistance of bacteria to antibiotics. Over the decades since the introduction of antibiotics to treat acne, the resistance levels of bacteria have changed. This defense mechanism is developed evolutionarily. Modifications of antibiotic receptor sites, alteration of drug influx/efflux, or enzymatic degradation are common mechanisms used by bacteria to initiate and strengthen internal antibiotic resistance. The basic chromophores used in light therapy are hemoglobin, melanin, water bound to proteins, and porphyrins. Hemoglobin absorbs light mainly at 580 nm, while melanin absorbs the entire visible spectral range (400-750 nm). Porphyrins are aromatic compounds, classified as photosensitizing substances, intensively absorbing blue light, and to a lesser extent in long visible bands, such as orange and red light. Using IPL makes it possible to cover the maximum light absorption of porphyrins and hemoglobin, therefore it can be an effective tool in the treatment of inflammatory lesions in acne vulgaris. In view of the effectiveness of light therapy and its effect even on antibiotic-resistant bacteria, it is worth considering the possibility of using light therapy instead of antibiotic therapy. Due to the increasing resistance of bacteria to antimicrobials, they should be used with caution and as a last resort. The high-energy light treatment act only locally (unlike with antibiotics taken orally) and on a chromophore, such as melanin, hemoglobin, or porphyrins.
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Affiliation(s)
- Julita Zdrada
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Anna Stolecka-Warzecha
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Wiktoria Odrzywołek
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Anna Deda
- Department of Cosmetology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Barbara Błońska-Fajfrowska
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
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