A randomized, double-blind, placebo-controlled trial to determine the efficacy and safety of lactoferrin with vitamin E and zinc as an oral therapy for mild to moderate acne vulgaris

Transdermal characteristic study of bovine sialoglycoproteins with anti-skin aging and accelerating skin wound healing

BACKGROUND

Sialoglycoproteins play important roles in various biological processes, including cell adhesion, immune response, and cell signaling. Our previous studies indicated that the bovine sialoglycoproteins could be developed as a reagent against skin aging and as a new candidate for accelerating skin wound healing as well as inhibiting scar formation. However, transdermal characteristic of the bovine sialoglycoproteins is still unknown.

AIMS

This study investigated the transdermal permeation of the bovine sialoglycoproteins through porcine skin using the Franz diffusion cell method.

RESULTS

Our study showed that the bovine sialoglycoproteins could penetrate through the porcine skin with a linear permeation pattern described by the regression equation N% = 11.49 t-3.858, with a high coefficient of determination (R2 = 0.9903). The histochemical results demonstrated the widespread distribution of the bovine sialoglycoproteins between the epidermal and dermal layers, which suggesting parts of the bovine sialoglycoproteins had ability to traverse the epidermal barrier. The results of the lectin microarrays indicated highly enriched glycopatterns on the bovine sialoglycoproteins, which also appeared in permeated porcine skin. The LC-MS/MS analysis further showed that the bovine sialoglycoproteins were composed of approximately 100 proteins with molecular weight ranging from 748.4 kDa to 10 kDa, and there were 23 specific bovine sialoglycoproteins with molecular weight ranging from 69.2 kDa to 10 kDa to be characterized in permeated porcine skin.

CONCLUSIONS

Parts of the bovine sialoglycoproteins with molecular weight less than 69.2 kDa had ability to traverse the epidermal barrier. Understanding the permeation characteristics of the bovine sialoglycoproteins for developing innovative formulations with therapeutic benefits, contributing to advancements in cosmetic and dermatological fields.

Longitudinal Correlations between Molecular Compositions of Stratum Corneum and Breast Milk Factors during Infancy: A Prospective Birth Cohort Study

Breast milk contains numerous factors that are involved in the maturation of the immune system and development of the gut microbiota in infants. These factors include transforming growth factor-β1 and 2, immunoglobin A, and lactoferrin. Breast milk factors may also affect epidermal differentiation and the stratum corneum (SC) barrier in infants, but no studies examining these associations over time during infancy have been reported. In this single-center exploratory study, we measured the molecular components of the SC using confocal Raman spectroscopy at 0, 1, 2, 6, and 12 months of age in 39 infants born at our hospital. Breast milk factor concentrations from their mothers' breast milk were determined. Correlation coefficients for the two datasets were estimated for each molecular component of the SC and breast milk factor at each age and SC depth. The results showed that breast milk factors and molecular components of the SC during infancy were partly correlated with infant age in months and SC depth, suggesting that breast milk factors influence the maturation of the SC components. These findings may improve understanding of the pathogenesis of skin diseases associated with skin barrier abnormalities.

International expert consensus recommendations for the use of dermocosmetics in acne

BACKGROUND

A wide variety of dermocosmetics (products with both active skincare and cosmetic activity) are available for the management of acne vulgaris. These products are important because they may be the first line of approach for patients desiring to self-treat and they can also have beneficial effects-reducing lesion counts and improving global acne severity. When used in conjunction with medical therapy, dermocosmetics can improve tolerability and enhance results. We reviewed available evidence and combined it with our clinical experience to help guide clinicians in selecting skincare products with acne-targeting ingredients.

METHODS

An international panel of dermatologists with an interest and expertise in managing acne performed a literature review, formulated clinical questions related to the role of dermocosmetics in the acne setting, used a modified GRADE approach to evaluate available evidence and then utilized an online iterative Delphi process to create consensus recommendations. It should be noted that due to the limited number of available studies, the category of dermocosmetics was evaluated rather than specific ingredients.

RESULTS

The quality of evidence was found to be low to moderate. Key recommendations were made based on available evidence for the use of dermocosmetics in acne to improve acne global assessment, reduce acne lesion counts, reduce superficial skin oiliness and serve as maintenance therapy after medical treatment, while providing a good tolerability. Recommendations were also made for using dermocosmetics as adjuncts to medical treatment.

CONCLUSIONS

While there is a need for better quality evidence, dermocosmetics have demonstrated some benefit for acne both when used alone in its milder clinical presentations or in maintenance post acne medication and as adjunct to acne treatments.

Statistical simplex centroid experimental design for evaluation of pectin, modified chitosan and modified starch as encapsulating agents on the development of vitamin E-loaded microparticles by spray-drying

Vitamin E encapsulation into biopolymer-based microparticles, obtained by spray-drying technology, was proposed to improve the encapsulation efficiency and the controlled release of fat-soluble vitamin. Binary and ternary blends of pectin, modified chitosan and modified starch, modified starch + modified chitosan, modified starch + pectin, modified chitosan + pectin and modified starch + modified chitosan + pectin ((0.33, 0.33, 0.33), (0.70, 0.15, 0.15), (0.15, 0.70, 0.15) and (0.15, 0.15, 0.70)) were proposed to produce and evaluate different carrier-based delivery systems. Vitamin E-loaded microparticles and empty microparticles were created with a product yield between 9 and 49 %. The mean diameter among all microparticles varied between 3.74 ± 0.02 and 421 ± 21 μm (differential volume distribution). Oval, spherical or irregular microparticles, with a variable morphology from a smooth to a high rough surface structure, with concavities, were produced. All vitamin E-loaded microparticles exhibited an encapsulation efficiency higher than 70 %. The slower vitamin E controlled release was observed from microparticles composed by modified chitosan (>36 h), while the faster release was achieved from microparticles individually composed by pectin (39 min). In general, the Fickian diffusion is the main release mechanism involved in the microparticles produced with modified chitosan, other formulations combine also other mechanisms such as swelling.

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

INTRODUCTION

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

AREAS COVERED

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

EXPERT OPINION

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

Modulatory role of vitamins A, B3, C, D, and E on skin health, immunity, microbiome, and diseases

Disruption of the skin barrier and immunity has been associated with several skin diseases, namely atopic dermatitis (AD), psoriasis, and acne. Resident and non-resident immune cells and the barrier system of the skin are integral to innate immunity. Recent advances in understanding skin microbiota have opened the scope of further understanding the various communications between these microbiota and skin immune cells. Vitamins, being one of the important micronutrients, have been reported to exert antioxidant, anti-inflammatory, and anti-microbial effects. The immunomodulatory action of vitamins can halt the progression of skin diseases, and thus, understanding the immuno-pharmacology of these vitamins, especially for skin diseases can pave the way for their therapeutic potential. At the same time, molecular and cellular markers modulated with these vitamins and their derivatives need to be explored. The present review is focused on significant vitamins (vitamins A, B3, C, D, and E) consumed as nutritional supplements to discuss the outcomes and scope of studies related to skin immunity, health, and diseases.

Featured Prebiotic Agent: The Roles and Mechanisms of Direct and Indirect Prebiotic Activities of Lactoferrin and Its Application in Disease Control

Lactoferrin (LF) is a glycoprotein found in mammalian milk, and lactoferricin is a peptide derived from LF hydrolysate. Both LF and lactoferricin (LFcin) have diverse functions that could benefit mammals. Bovine LF (BLF) and BLFcin exhibit a wide range of antimicrobial activities, but most probiotic strains are relatively resistant to their antibacterial effects. BLF and BLF hydrolysate can promote the growth of specific probiotics depending on the culture conditions, the dose of BLF or BLF-related peptides, and the probiotic strains used. BLF supplementation has been shown to modulate several central molecular pathways or genes in Lacticaseibacillus rhamnosus GG under cold conditions, which may explain the prebiotic roles of BLF. LF alone or in combination with selected probiotics can help control bacterial infections or metabolic disorders, both in animal studies and in human clinical trials. Various LF-expressing probiotics, including those expressing BLF, human LF, or porcine LF, have been developed to facilitate the combination of LFs with specific probiotics. Supplementation with LF-expressing probiotics has positive effects in animal studies. Interestingly, inactivated LF-expressing probiotics significantly improved diet-induced nonalcoholic fatty liver disease (NAFLD) in a mouse model. This review highlights the accumulated evidence supporting the use of LF in combination with selected LF-resistant probiotics or LF-expressing probiotics in the field.

The Effect of Cosmetic Treatment and Gel Laser Therapy on the Improvement of Comedogenic Skin Type

Comedogenic skin care receives little attention compared to the care or treatment of more serious acne manifestations. Traditional therapies may have limited success with potential side effects. Cosmetic care supported by the effect of a biostimulating laser may offer a desirable alternative. The aim of the study was to evaluate the biological effectiveness of combined cosmetic treatment with lasotherapy on comedogenic skin type using noninvasive bioengineering methods. Twelve volunteers with comedogenic skin type underwent a 28-week application of Lasocare Basic 645^® cosmetic gel containing Lactoperoxidase and Lactoferrin in combination with laser therapy (Lasocare^® method). The effect of treatment on skin condition was monitored using noninvasive diagnostic methods. The parameters were the amount of sebum, the pore count, the ultraviolet-induced red fluorescence assessment of comedonic lesions (percentage of the area and quantification of orange-red spots), hydration, transepidermal water loss, and pH. A statistically significant decrease in sebum production was observed on the skin of the treated volunteers, as well as a decrease in porphyrins, indicating the presence of Cutibacterium acnes populating comedones and causing enlarged pores. The balance of epidermal water in the skin was regulated adjusting the acidity of the skin coat in individual zones, which decreased the presence of Cutibacterium acnes. Cosmetic treatment in combination with the Lasocare^® method successfully improved the condition of comedogenic skin. In addition to transient erythema, there were no other adverse effects. The chosen procedure appears to be a suitable and safe alternative to traditional treatment procedures known from dermatological practice.

Lactoferrin: An Effective Weapon in the Battle Against Bacterial Infections

The emergence of multidrug-resistant bacterial strains with respect to commercially available antimicrobial drugs has marked a watershed in treatment therapies to fight pathogens and has stimulated research on alternative remedies. Proteins of the innate immune system of mammals have been highlighted as potentially yielding possible treatment options for infections. Lactoferrin (Lf) is one of these proteins; interestingly, no resistance to it has been found. Lf is a conserved cationic nonheme glycoprotein that is abundant in milk and is also present in low quantities in mucosal secretions. Moreover, Lf is produced and secreted by the secondary granules of neutrophils at infection sites. Lf is a molecule of approximately 80 kDa that displays multiple functions, such as antimicrobial, anti-viral, anti-inflammatory, and anticancer actions. Lf can synergize with antibiotics, increasing its potency against bacteria. Lactoferricins (Lfcins) are peptides resulting from the N-terminal end of Lf by proteolytic cleavage with pepsin. They exhibit several anti-bacterial effects similar to those of the parental glycoprotein. Synthetic analog peptides exhibiting potent antimicrobial properties have been designed. The aim of this review is to update understanding of the structure and effects of Lf and Lfcins as anti-bacterial compounds, focusing on the mechanisms of action in bacteria and the use of Lf in treatment of infections in patients, including those studies where no significant differences were found. Lf could be an excellent option for prevention and treatment of bacterial diseases, mainly in combined therapies with antibiotics or other antimicrobials.

Zinc in dermatology

Zinc has numerous pharmacological uses in dermatology. Its antioxidant and immunomodulatory properties are thought to correlate with its efficacy in acne vulgaris and leishmaniasis, amongst other cutaneous conditions. We conducted a review of the literature on the use of zinc in dermatology; in particular, we investigated its role in acne vulgaris, hair loss, hidradenitis suppurativa, leishmaniasis, and warts. We searched MEDLINE selecting only articles in English and evaluating the evidence using the Oxford Center of Evidence-Based Medicine 2011 guidance. This review has found evidence to support the use of zinc in patients in infectious conditions (leishmaniasis and warts), inflammatory conditions (acne rosacea, hidradenitis suppurativa) and in hair loss disorders.Ppatients with zinc deficiency should also receive oral supplementation. Further research and large randomized controlled trials are required to investigate the role of zinc as a monotherapy.

Lactoferrin: Cytokine Modulation and Application in Clinical Practice

Multiple properties of lactoferrin have been reported in the literature so far. Decades of in vitro and in vivo studies have demonstrated the important antimicrobial, anti-inflammatory, anti-oxidant, and immunomodulating properties. It suggests the use of lactoferrin as an effective and safe option for the treatment of several common disorders. Herein, we show the applications of lactoferrin in clinical practice, highlighting its evidence-based capacities for the treatment of heterogeneous disorders, such as allergic, gastrointestinal, and respiratory diseases, and hematologic, oncologic, gynecologic, dermatologic, and dental disorders. Moreover, the widespread use of lactoferrin in neonatology is summarized here. As a result of its antiviral properties, lactoferrin has also been proposed as a valid option for the treatment for COVID-19 patients. Here, the uses of lactoferrin in clinical practice as a new, safe, and evidence-based treatment for many types of disorders are summarized.

The Association Between Short-Term Air Pollution Exposure and Post-Adolescent Acne: The Evidence from a Time Series Analysis in Xi'an, China

BACKGROUND

Post-adolescent acne is a common skin disease faced by adults. However, whether air pollution (AP) serves as a risk factor for post-adolescent acne remains elusive.

AIM

To determine the relationship between short-term AP exposure (within 7 days) and outpatient visits for post-adolescent acne.

METHODS

Daily outpatient visit data for post-adolescent acne and routinely AP data between 2010 and 2013 were collected from Xi'an, China. A generalized additive regression model was used to analyze the relationship between outpatient visits for post-adolescent acne and short-term ambient AP exposure. The gender-specific analyses were conducted as well.

RESULTS

Totally, 27,190 outpatient visits for post-adolescent acne were included. The results revealed that a 10 μg/m3 increase in PM10, SO2, and NO2 at lag 0-7 day was associated with the increase of outpatient visits for post-adolescent acne at 0.84% (95% CI: 0.53%, 1.16%), 1.61% (95% CI: 0.12%, 3.10%), and 3.50% (95% CI: 1.60%, 5.40%), respectively. The significant positive associations of PM10, SO2, and NO2 were found at both single-lag models and moving average models. The gender-specific analyses showed that the effect estimates of PM10 was stronger for females than for males, while there was no observed gender difference in the effects of SO2 and NO2.

CONCLUSION

Short-term exposure to AP was associated with increased outpatient visits for post-adolescent acne, especially for females in the effects of PM10.

Tailoring of Retinyl Palmitate-Based Ethosomal Hydrogel as a Novel Nanoplatform for Acne Vulgaris Management: Fabrication, Optimization, and Clinical Evaluation Employing a Split-Face Comparative Study

AIM

Retinyl palmitate (RP), the most stable vitamin A derivative, is used to treat photoaging and other skin disorders. The need to minimize the adverse effects of topical drug administration has led to an enhanced interest in loading RP on ethosomes for topical drug delivery. The aim of the current study was to prepare and compare the performance of RP decorated ethosomal hydrogel with tretinoin cream in the treatment of acne vulgaris as an approach to improve drug efficacy and decrease its side effects.

METHODS

RP-loaded ethosomes were prepared using the injection sonication technique. A Box-Behnken design using Design Expert® software was used for the optimization of formulation variables. Particle size, zeta potential (ZP), entrapment efficiency percent (EE%), % drug release, and permeation over 24 h of different formulations were determined. The optimal formulation was incorporated into a hydrogel. Finally, the efficacy and tolerability of the optimized RP ethosomal hydrogel were clinically evaluated for acne treatment using a split-face comparative clinical study.

RESULTS

The optimized ethosomal RP showed particle size of 195.8±5.45 nm, ZP of -62.1±2.85 mV, EE% of 92.63±4.33%, drug release % of 96.63±6.81%, and drug permeation % of 85.98 ±4.79%. Both the optimized RP ethosomal hydrogel and tretinoin effectively reduced all types of acne lesions (inflammatory, non-inflammatory, and total lesions). However, RP resulted in significantly lower non-inflammatory and total acne lesion count than the marketed tretinoin formulation. Besides, RP-loaded ethosomes showed significantly improved tolerability compared to marketed tretinoin with no or minimal skin irritation symptoms.

CONCLUSION

RP ethosomal hydrogel is considerably effective in controlling acne vulgaris with excellent skin tolerability. Therefore, it represents an interesting alternative to conventional marketed tretinoin formulation for topical acne treatment.

Acne Vulgaris and Intake of Selected Dietary Nutrients-A Summary of Information

Acne vulgaris (AV) is a chronic disease that affects a significant percentage of the world’s population. Its development is influenced by both external and internal factors. The purpose of this review is to demonstrate the effect of basic nutrient intake on the exacerbation or alleviation of AV lesions. A retrospective review of publications in PubMed regarding diet therapy and the impact of individual nutrient intake on the skin condition of patients was conducted. Ingestion of products with a high glycaemic index may indirectly lead to sebum overproduction, which promotes infection with Cutibacterium acnes and causes inflammation. Consumption of certain dairy products may result in skin deterioration caused by the presence of hormones in these products, i.e., progesterone and testosterone precursors. The beneficial effect of fatty acids on the skin is manifested by the reduction in inflammation. Of significance in AV treatment are vitamins A, C, D, E and B, as well as mineral elements zinc and selenium. Proper nutrition may not only prevent or alleviate AV but also increase treatment efficacy.

Milk Proteins-Their Biological Activities and Use in Cosmetics and Dermatology

Milk and colostrum have high biological potential, and due to their natural origin and non-toxicity, they have many uses in cosmetics and dermatology. Research is ongoing on their potential application in other fields of medicine, but there are still few results; most of the published ones are included in this review. These natural products are especially rich in proteins, such as casein, β-lactoglobulin, α-lactalbumin, lactoferrin, immunoglobulins, lactoperoxidase, lysozyme, and growth factors, and possess various antibacterial, antifungal, antiviral, anticancer, antioxidant, immunomodulatory properties, etc. This review describes the physico-chemical properties of milk and colostrum proteins and the natural functions they perform in the body and compares their composition between animal species (cows, goats, and sheep). The milk- and colostrum-based products can be used in dietary supplementation and for performing immunomodulatory functions; they can enhance the effects of certain drugs and can have a lethal effect on pathogenic microorganisms. Milk products are widely used in the treatment of dermatological diseases for promoting the healing of chronic wounds, hastening tissue regeneration, and the treatment of acne vulgaris or plaque psoriasis. They are also increasingly regarded as active ingredients that can improve the condition of the skin by reducing the number of acne lesions and blackheads, regulating sebum secretion, ameliorating inflammatory changes as well as bestowing a range of moisturizing, protective, toning, smoothing, anti-irritation, whitening, soothing, and antiaging effects.

A Comprehensive View of Frozen Shoulder: A Mystery Syndrome

Frozen shoulder is a common epidemiological affliction. Data acquired from people who suffer from this type of damage in other joints such as the hip, wrist and ankle also exist; although these syndromes are less common. Treatment for frozen shoulder is primarily physical (physiotherapy, manual therapy), secondary medical (corticosteroid injections) and finally surgical but with limited success. The difficulty in treating this type of condition successfully lies in the lack of knowledge about the risk factors involved and the pathophysiology underlying this mysterious syndrome. This review gives an overview of the current scientific position of frozen shoulder in terms of evolutionary factors, etiology, the different mechanisms of action involved, current treatment options and other possible interventions based on recent discoveries of pathophysiological mechanisms. The overall objective is to clarify several unknown aspects of a syndrome that affects up to 5% of the world's population.

Effects of Zinc Supplementation on Inflammatory Skin Diseases: A Systematic Review of the Clinical Evidence

BACKGROUND

Zinc has been used in patients with acne vulgaris for its anti-inflammatory effects; however, it is unclear if zinc supplementation is also beneficial in other inflammatory skin conditions.

OBJECTIVE

The objective of this article was to determine the effect of zinc supplementation on inflammatory dermatologic conditions.

DATA SOURCES

We searched the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Ovid with no time limit up to 29 May, 2019. Trials examining supplementation with zinc in the treatment of inflammatory dermatological conditions (acne vulgaris, atopic dermatitis, diaper dermatitis, hidradenitis suppurativa, psoriasis, and rosacea) in children and adults were selected.

RESULTS

Of 229 articles, 22 met inclusion criteria. Supplementation with zinc was found to be beneficial in ten of 14 studies evaluating its effects on acne vulgaris, one of two studies on atopic dermatitis, one of one study on diaper dermatitis, and three of three studies evaluating its effects on hidradenitis suppurativa. However, the one article found on psoriasis and the one article found on rosacea showed no significant benefit of zinc treatment on disease outcome.

CONCLUSIONS AND IMPLICATIONS

Some preliminary evidence supports the use of zinc in the treatment of acne vulgaris and hidradenitis suppurativa; however, more research is needed with similar methodologies and larger sample sizes in these diseases. Further, zinc may be of some benefit in the treatment plan for atopic dermatitis and diaper dermatitis; however, additional studies should be conducted to further evaluate these potentially positive associations. To date, no evidence is available to suggest that zinc may be of benefit in rosacea and psoriasis; however, limited data are available evaluating the use of zinc in these conditions.

Effects of Lactoferrin on Subjective Skin Conditions in Winter: A Preliminary, Randomized, Double-Blinded, Placebo-Controlled Trial

Objective

To investigate the effects of lactoferrin (LF) on subjective skin conditions in winter.

Design

A preliminary, randomized, double-blinded, placebo-controlled trial.

Setting and subjects

Healthy adults in Japan.

Interventions

Intake of placebo, 200 mg, or 600 mg of LF for 12 weeks in winter.

Endpoints

Changes in the scores of subjective skin conditions.

Results

Three hundred and forty-six subjects were randomized. Nine subjects (placebo, n=0; 200 mg, n=5; 600 mg, n=4) withdrew consent, and 7 subjects (placebo, n=4; 200 mg, n=2; 600 mg, n=1) were lost to follow-up, resulting in 330 for a full analysis set.

Outcomes

Changes in the scores of moisture were greater in the 600 mg group than in the placebo group. Changes in the scores of moisture were greater in the 200 mg and 600 mg groups, and of texture were greater in the 600 mg group than in the placebo group in female subjects.

Conclusion

Intake of LF may improve moisture or texture of skin in winter.

Zinc-containing compounds for personal care applications

It is well-known that zinc ions are widely used in cosmetic products. Their popularity is associated with the multifunctional profile of Zn²⁺ , which is classified as an essential chemical element in the human body. This review examines numerous beneficial biological properties of zinc-containing compounds and classifies the compounds used in cosmetic products according to their functionality profile: antioxidant, sunscreen, anti-inflammatory, anti-pigmentation, anti-ageing, anti-acne, antimicrobial, anti-odour, cleansing or stabilizing activity. It also underlines the significance of zinc in enzymatic processes, which depends on the enzyme type acts as inhibitor or enzymatic stimulator. Moreover, the article describes the chemical nature of the most interesting groups of Zn compounds.