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Bachmann LH, Barbee LA, Chan P, Reno H, Workowski KA, Hoover K, Mermin J, Mena L. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recomm Rep 2024; 73:1-8. [PMID: 38833414 PMCID: PMC11166373 DOI: 10.15585/mmwr.rr7302a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
No vaccines and few chemoprophylaxis options exist for the prevention of bacterial sexually transmitted infections (STIs) (specifically syphilis, chlamydia, and gonorrhea). These infections have increased in the United States and disproportionately affect gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW). In three large randomized controlled trials, 200 mg of doxycycline taken within 72 hours after sex has been shown to reduce syphilis and chlamydia infections by >70% and gonococcal infections by approximately 50%. This report outlines CDC's recommendation for the use of doxycycline postexposure prophylaxis (doxy PEP), a novel, ongoing, patient-managed biomedical STI prevention strategy for a selected population. CDC recommends that MSM and TGW who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months should receive counseling that doxy PEP can be used as postexposure prophylaxis to prevent these infections. Following shared decision-making with their provider, CDC recommends that providers offer persons in this group a prescription for doxy PEP to be self-administered within 72 hours after having oral, vaginal, or anal sex. The recommended dose of doxy PEP is 200 mg and should not exceed a maximum dose of 200 mg every 24 hours.Doxy PEP, when offered, should be implemented in the context of a comprehensive sexual health approach, including risk reduction counseling, STI screening and treatment, recommended vaccination and linkage to HIV PrEP, HIV care, or other services as appropriate. Persons who are prescribed doxy PEP should undergo bacterial STI testing at anatomic sites of exposure at baseline and every 3-6 months thereafter. Ongoing need for doxy PEP should be assessed every 3-6 months as well. HIV screening should be performed for HIV-negative MSM and TGW according to current recommendations.
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Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Stein Gold LF, Tan JKL, Tollefson MM, Weiss JS, Wu PA, Zaenglein AL, Han JM, Barbieri JS. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024; 90:1006.e1-1006.e30. [PMID: 38300170 DOI: 10.1016/j.jaad.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS These guidelines provide evidence-based recommendations for the management of acne vulgaris.
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Affiliation(s)
- Rachel V Reynolds
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fran Cook-Bolden
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Seemal R Desai
- Innovative Dermatology, Plano, Texas; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kelly M Druby
- Penn State Health Hampden Medical Center, Enola, Pennsylvania
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonette E Keri
- University of Miami, Miller School of Medicine, Miami, Florida; Miami VA Medical Center, Miami, Florida
| | | | - Jerry K L Tan
- Western University, London, Ontario, Canada; Windsor Clinical Research Inc., Windsor, Ontario, Canada
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Jonathan S Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Georgia Dermatology Partners, Snellville, Georgia
| | - Peggy A Wu
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State/Hershey Medical Center, Hershey, Pennsylvania
| | - Jung Min Han
- American Academy of Dermatology, Rosemont, Illinois.
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Rana MS, Kim J, Kim S. First Report of Plasmid-Mediated Macrolide-Clindamycin-Tetracycline Resistance in a High Virulent Isolate of Cutibacterium acnes ST115. Pathogens 2023; 12:1286. [PMID: 38003751 PMCID: PMC10674219 DOI: 10.3390/pathogens12111286] [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: 09/05/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Cutibacterium acnes, a prevalent skin commensal, has emerged as a significant global challenge due to its widespread antibiotic resistance. To investigate the antibiotic resistance mechanisms and clinical characterization of C. acnes in Korea, we collected 22 clinical isolates from diverse patient specimens obtained from the National Culture Collection for Pathogens across Korea. Among the isolates, KB112 isolate was subjected to whole genome sequencing due to high resistance against clindamycin, erythromycin, tetracycline, doxycycline, and minocycline. The whole genome analysis of KB112 isolate revealed a circular chromosome of 2,534,481 base pair with an average G + C content of 60.2% with sequence type (ST) 115, harboring the potential virulent CAMP factor pore-forming toxin 2 (CAMP2), the multidrug resistance ABC transporter ATP-binding protein YknY, and the multidrug efflux protein YfmO. The genomic sequence also showed the existence of a plasmid (30,947 bp) containing the erm(50) and tet(W) gene, which confer resistance to macrolide-clindamycin and tetracycline, respectively. This study reports plasmid-mediated multi-drug resistance of C. acnes for the first time in Korea.
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Affiliation(s)
- Md Shohel Rana
- Department of Biomedical Sciences, The Graduate School, Kyungpook National University, Daegu 41944, Republic of Korea; (M.S.R.); (J.K.)
| | - Jungmin Kim
- Department of Biomedical Sciences, The Graduate School, Kyungpook National University, Daegu 41944, Republic of Korea; (M.S.R.); (J.K.)
- Department of Microbiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Shukho Kim
- Department of Biomedical Sciences, The Graduate School, Kyungpook National University, Daegu 41944, Republic of Korea; (M.S.R.); (J.K.)
- Department of Microbiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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4
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Ruchiatan K, Rizqandaru T, Satjamanggala PR, Tache N, Cahyadi AI, Rezano A, Gunawan H, Sutedja EK, Dwiyana RF, Hidayah RMN, Achdiat PA, Sutedja E, Suwarsa O, Hindritiani R. Characteristics of Biofilm-Forming Ability and Antibiotic Resistance of Cutibacterium acnes and Staphylococcus epidermidis from Acne Vulgaris Patients. Clin Cosmet Investig Dermatol 2023; 16:2457-2465. [PMID: 37719934 PMCID: PMC10503511 DOI: 10.2147/ccid.s422486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
Introduction Acne vulgaris (AV) is a common and chronic disorder of the pilosebaceous unit and has a multifactorial pathology, including activities of Cutibacterium acnes (C. acnes) and Staphylococcus epidermidis (S. epidermidis). Antibiotic resistance has become a major concern in dermatology daily practice, and the ability of biofilm formation by both bacteria is suggested to increase antibiotic resistance in acne. Purpose Our aim was to analyze the comparison of antibiotic resistance between biofilm-forming (BF) and non-biofilm-forming (NBF) strains of C. acnes and S. epidermidis towards seven antibiotics commonly used for acne. Methods This is a cross-sectional analytical study involving 60 patients with AV. Samples were obtained from closed comedones on the forehead using the standardized skin surface biopsy (SSSB) method at the Cosmetic Dermatology Clinic Dr. Hasan Sadikin in Bandung, Indonesia. Isolates were cultured and identified before undergoing the biofilm-forming test using the tissue culture plate method. Antibiotic susceptibility testing for each antibiotic was then performed using the disc diffusion method. Results The incidence of antibiotic resistance to clindamycin in BF and NBF C. acnes isolates was 54.5% (p=1.00), while in BF and NBF S. epidermidis isolates, it was 54.5% and 45.5% respectively (p=0.67). The incidence of antibiotic resistance to erythromycin and azithromycin in BF and NBF C. acnes isolates was 54.5% and 63.6% respectively (p=1.00), whereas for S. epidermidis BF and NBF isolates, it was 54.5% (p=1.00). There was no resistance observed to tetracycline, doxycycline, levofloxacin, and cotrimoxazole in all groups. Conclusion There were no significant differences in resistance against seven antibiotics between the C. acnes and S. epidermidis in BF and NBF groups. Furthermore, although statistically not significant, some resistances were observed against clindamycin, erythromycin, and azithromycin. Consequently, the use of these three antibiotics should be judiciously regulated.
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Affiliation(s)
- Kartika Ruchiatan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
- Doctorate Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Trustia Rizqandaru
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Panji Respati Satjamanggala
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Nisrina Tache
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Adi Imam Cahyadi
- Division of Microbiology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Andri Rezano
- Division of Cell Biology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
- Graduate School of Biomedical Sciences Master Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Eva Krishna Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Risa Miliawati Nurul Hidayah
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Reti Hindritiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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Sermswan P, Sriharat R, Saithong S, Laowansiri M, Amornruk N, Chiewchengchol D, Noppakun N, Asawanonda P, Chatsuwan T, Kumtornrut C. A cross-sectional study examining the prevalence of antibiotic-resistant Cutibacterium acnes isolated from patients with acne in Bangkok, Thailand. J Dermatol 2023. [PMID: 37183535 DOI: 10.1111/1346-8138.16823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/08/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
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 (τb = 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.
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Affiliation(s)
- Peerada Sermswan
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Rakwaree Sriharat
- Department of Microbiology, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supichcha Saithong
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Matchima Laowansiri
- Department of Microbiology, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nutchaya Amornruk
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Direkrit Chiewchengchol
- Department of Microbiology, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nopadon Noppakun
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanat Kumtornrut
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Ashby NS, Johnson TJ, Castillo-Ronquillo Y, Payne CJ, Davenport C, Hoopes PC, Moshirfar M. Cutibacterium (Formerly Propionibacterium ) acnes Keratitis: A Review. Eye Contact Lens 2023; 49:212-218. [PMID: 36888541 DOI: 10.1097/icl.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ABSTRACT Infectious keratitis is a devastating cause of vision loss worldwide. Cutibacterium acnes ( C. acnes ), a commensal bacterium of the skin and ocular surface, is an underrecognized but important cause of bacterial keratitis. This review presents the most comprehensive and up-to-date information for clinicians regarding the risk factors, incidence, diagnosis, management, and prognosis of C. acnes keratitis (CAK). Risk factors are similar to those of general bacterial keratitis and include contact lens use, past ocular surgery, and trauma. The incidence of CAK may be approximately 10%, ranging from 5% to 25% in growth-positive cultures. Accurate diagnosis requires anaerobic blood agar and a long incubation period (≥7 days). Typical clinical presentation includes small (<2 mm) ulcerations with deep stromal infiltrate causing an anterior chamber cell reaction. Small, peripheral lesions are usually resolved, and patients recover a high visual acuity. Severe infections causing VA of 20/200 or worse are common and often do not significantly improve even after treatment. Vancomycin is considered the most potent antibiotic against CAK, although other antibiotics such as moxifloxacin and ceftazidime are more commonly used as first-line treatment.
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Affiliation(s)
- Nathaniel S Ashby
- Creighton University School of Medicine (N.S.A.), Omaha, NE; Spencer Fox Eccles School of Medicine at the University of Utah (T.J.J.), Salt Lake City, UT; Hoopes Vision Research Center (Y.C.-R., C.J.P., C.D., P.C.H., M.M.), Hoopes Vision, Draper, UT; Case Western Reserve University School of Medicine (C.J.P.), Cleveland, OH; John A. Moran Eye Center (M.M.), Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT; and Utah Lions Eye Bank (M.M.), Murray, UT
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Legiawati L, Halim PA, Fitriani M, Hikmahrachim HG, Lim HW. Microbiomes in Acne Vulgaris and Their Susceptibility to Antibiotics in Indonesia: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:antibiotics12010145. [PMID: 36671346 PMCID: PMC9854683 DOI: 10.3390/antibiotics12010145] [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: 12/17/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Hot and humid countries such as Indonesia have a higher prevalence of acne vulgaris (AV). The activity of skin microbes, not only Cutibacterium acnes, contribute to the formation of AV. Topical and oral antibiotics are routinely prescribed to treat AV. As antimicrobial resistance rates increase globally, there are concerns about decreased efficacy. This study intends to systematically evaluate the microbiomes isolated from AV lesions and their antibiotics susceptibility in Indonesia. The data were retrieved through PubMed, EMBASE, Google Scholar, and ScienceDirect searches for articles published until July 2022 using three multiword searches. Sixteen studies published between 2001 and 2022 were identified from which the data were pooled using a random effects model. The pooled prevalence estimates demonstrated that C. acnes, Staphylococcus epidermidis, and Staphylococcus aureus were the three common microbes associated with AV in Indonesia. Tetracyclines had lower resistance rates compared to those of macrolides and clindamycin, with C. acnes showing a resistance rate that is as high as 60.1% against macrolides. C. acnes resistance against minocycline showed an increasing trend, whereas the resistances to doxycycline, clindamycin, and macrolides stagnated. The high resistance prevalence and trends signify a public health concern. The results of this study call for the development of antibiotic stewardship programs in Indonesia, which may lead to improved acne outcomes.
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Affiliation(s)
- Lili Legiawati
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Central General Hospital, Jakarta 10430, Indonesia
- Correspondence:
| | - Paulus Anthony Halim
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Central General Hospital, Jakarta 10430, Indonesia
| | - Magna Fitriani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Central General Hospital, Jakarta 10430, Indonesia
| | | | - Henry W. Lim
- Department of Dermatology, Henry Ford Health, Detroit, MI 48202, USA
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Kurrimboccus F, Orchard A, Danckwerts MP, van Vuuren S. Antimicrobial Formulation of Chrysopogon zizanioides Essential Oil in an Emulsified Lotion for Acne. PLANTA MEDICA 2022; 88:1256-1262. [PMID: 34963181 DOI: 10.1055/a-1699-3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Acne is a skin condition arising from excess sebum production and microbial overgrowth within the pilosebaceous unit. Several commercial essential oils have shown promising activity against acne-related pathogens. Due to their volatility and thermal instability, the formulation of essential oils into commercial products remains a pharmaceutical challenge. Thus, this study aimed to develop a viable anti-acne topical treatment as an oil-in-water emulsified lotion to overcome these challenges. Chrysopogon zizanioides (vetiver) displayed noteworthy antimicrobial activity with a mean minimum inhibitory concentration of 0.14 mg/mL against Cutibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. Emulsified lotions containing C. zizanioides were developed through the hydrophilic-lipophilic balance approach. At tested hydrophilic-lipophilic balance values of 8, 9, and 10, C. zizanioides emulsified lotions displayed maximum stability at hydrophilic-lipophilic balance 9 with a minimum change in mean droplet size and polydispersity index of 20.61 and 33.33%, respectively, over 84 days. The C. zizanioides emulsified lotion at optimum hydrophilic-lipophilic balance 9 completely inhibited the growth of C. acnes and killed S. aureus, S. epidermidis, and S. pyogenes within 24 h. Additionally, the lotion retained antimicrobial activity against these test micro-organisms over the 84-day stability test period. Thus, the C. zizanioides emulsified lotion demonstrated physical stability and antimicrobial efficiency, making it an ideal natural product anti-acne treatment.
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Affiliation(s)
- Fadilah Kurrimboccus
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ané Orchard
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Paul Danckwerts
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandy van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Targeting Acne Bacteria and Wound Healing In Vitro Using Plectranthus aliciae, Rosmarinic Acid, and Tetracycline Gold Nanoparticles. Pharmaceuticals (Basel) 2022; 15:ph15080933. [PMID: 36015081 PMCID: PMC9412649 DOI: 10.3390/ph15080933] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022] Open
Abstract
Gold nanoparticles from plant extracts and their bioactive compounds to treat various maladies have become an area of interest to many researchers. Acne vulgaris is an inflammatory disease of the pilosebaceous unit caused by the opportunistic bacteria Cutibacterium acnes and Staphylococcus epidermis. These bacteria are not only associated with inflammatory acne but also with prosthetic-implant-associated infections and wounds. Studies have hypothesised that these bacteria have a mutualistic relationship and act as a multispecies system. It is believed that these bacteria form a multispecies biofilm under various conditions and that these biofilms contribute to increased antibiotic resistance compared to single-species biofilms. This study aimed to investigate the antibacterial and wound healing potential of synthesised gold nanoparticles (AuNPs) from an endemic South African plant, Plectranthus aliciae (AuNPPAE), its major compound rosmarinic acid (AuNPRA) and a widely used antibiotic, tetracycline (AuNPTET). Synthesised gold nanoparticles were successfully formed and characterised using ultraviolet–visible spectroscopy (UV–vis), dynamic light scattering (DLS), Fourier transform infrared spectroscopy (FTIR), zeta potential (ζ-potential), high-resolution transmission electron microscopy (HRTEM), and selected area electron diffraction (SAED), and they were investigated for stability under various biological conditions. Stable nanoparticles were formed with ζ-potentials of −18.07 ± 0.95 mV (AuNPPAE), −21.5 ± 2.66 mV (AuNPRA), and −39.83 ± 1.6 mV (AuNPTET). The average diameter of the AuNPs was 71.26 ± 0.44 nm, 29.88 ± 3.30 nm, and 132.6 ± 99.5 nm for AuNPPAE, AuNPRA, and AuNPTET, respectively. In vitro, biological studies confirmed that although no antibacterial activity or biofilm inhibition was observed for the nanoparticles tested on the multispecies C. acnes and S. epidermis systems, these samples had potential wound closure activity. Gold nanoparticles formed with rosmarinic acid significantly increased wound closure by 21.4% at 25% v/v (≈29.2 µg/mL) compared to the negative cell control and the rosmarinic acid compound at the highest concentration tested of 500 µg/mL. This study concluded that green synthesised gold nanoparticles of rosmarinic acid could potentially be used for treating wounds.
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Abstract
Acne vulgaris is a common chronic inflammatory skin disease. In the present study, we reported the anti-acne vulgaris effect of the Mesua ferrea (M. ferrea) flower extract. The extract was evaluated for three anti-acne-causing bacteria properties including Cutibacterium acnes (C. acnes), Staphylococcus epidermidis (S. epidermidis) and Staphylococcus aureus (S. aureus). The results indicated that the M. ferrea flower extract could be considered as the bactericidal agent against S. epidermidis and S. aureus with MIC values of 0.78 and 6.25 mg mL−1 and MBC values of 1.56 and 12.50 mg mL−1 and the bacteriostatic agent against C. acnes with MIC and MBC values of 3.12 and 25.00 mg mL−1, respectively. The extract at a concentration of 25 µg mL−1 also presented potent anti-inflammatory activity with a significant decrease of nitric oxide (NO) and tumor necrosis factor (TNF)-α productions in RAW 264.7 macrophage cells stimulated by LPS. In addition, the extract showed moderate to weak anti-oxidative capacities against DPPH, ABTS, FRAP and NO assays and also showed weak anti-tyrosinase activity. M. ferrea flower extract may serve as the alternative natural anti-acne formulations.
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Yadav AK, Bhooshan S, Johnson A, Asati DP, Nema S, Biswas D. Association of Antimicrobial Susceptibility and Treatment Outcome in Acne Vulgaris Patients: A Pilot Study. J Lab Physicians 2021; 12:233-238. [PMID: 33469248 PMCID: PMC7808859 DOI: 10.1055/s-0040-1720943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose
Cutibacterium acnes
(
C. acnes
) is an emerging pathogen that is highly resistant to antibiotics and is capable of causing persistent infections that are difficult to treat.
Methods & Materials
Acne vulgaris patients visiting dermatology OPD of our tertiary care hospital during the study period of 2 months were recruited. Skin swabs were collected, and the sample was processed on 5% sheep-blood agar for anaerobic culture by the GasPak method. Isolates were identified by the standard biochemical test. Antimicrobial susceptibility testing was performed for clinically relevant antibiotics by the E-strip method. The clinical response was evaluated after 1-month follow-up to the prescribed antibiotics.
Results
Minocycline, doxycycline, ceftriaxone, and tetracycline were the most effective antibiotics. Nonsusceptibility to clindamycin and erythromycin were observed in 11.9% and 31% isolates, respectively, with 9.5% isolates being nonsusceptible to both. For none of the antibiotics we found significant difference in the proportion of susceptible and nonsusceptible isolates between mild, moderate, and severe grades of acne vulgaris. For none of the antibiotic regimens, significant difference was observed between nonresponders and responders. Twenty-seven patients received clindamycin and among them 16 of 19 responders and 6 of 8 nonresponders yielded growth of clindamycin-susceptible isolates (
p
= 0.57).
Conclusion
We observed significant prevalence of resistant strains of
C. acnes
among patients with acne vulgaris. No association was observed between in vitro susceptibility results and treatment outcome.
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Affiliation(s)
- Ashvini K Yadav
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Suneel Bhooshan
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Allen Johnson
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Dinesh P Asati
- Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Shashwati Nema
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Debasis Biswas
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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12
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Hashem NM, Hosny AEDM, Abdelrahman AA, Zakeer S. Antimicrobial activities encountered by sulfur nanoparticles combating Staphylococcal species harboring scc mecA recovered from acne vulgaris. AIMS Microbiol 2021; 7:481-498. [PMID: 35071944 PMCID: PMC8712535 DOI: 10.3934/microbiol.2021029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Over decades, sulfur has been employed for treatment of many dermatological diseases, several skin and soft tissue, and Staphylococcus infections. Because of its abuse, resistant bacterial strains have emerged. Nanotechnology has presented a new horizon to overcome abundant problems including drug resistance. Nano-sized sulfur has proven to retain bactericidal activity. Consequently, the specific aims of this study are exclusively directed to produce various sulfur nanoparticles formulations with control of particle size and morphology and investigate the antibacterial activity response specifically classified by the category of responses of different formulations, for the treatment of acne vulgaris resistant to conventional antibiotics. In this study, we produced uncoated sulfur nanoparticles (SNPs), sulfur nano-composite with chitosan (CS-SNPs), and sulfur nanoparticles coated with polyethylene glycol (PEG-SNPs) and evaluate their bactericidal impact against Staphylococcus aureus and Staphylococcus epidermidis isolated from 173 patients clinically diagnosed acne vulgaris. Accompanied with molecular investigations of ermB and mecA resistance genes distribution among the isolates. Sulfur nanoparticles were synthesized using acid precipitation method and were characterized by scanning electron microscope (SEM), transmission electron microscopy (TEM), energy dispersed x-ray spectroscopy (EDX), and Fourier transform infrared spectroscopy (FTIR). Moreover, agar diffusion and broth micro-dilution methods were applied to determine their antibacterial activity and their minimum inhibitory concentration. PCR analysis for virulence factors detection. Results: TEM analysis showed particle size of SNPs (11.7 nm), PEG-SNPs (27 nm) and CS-SNPs (33 nm). Significant antibacterial activity from nanoparticles formulations in 100% dimethyl sulfoxide (DMSO) with inhibition zone 30 mm and MIC at 5.5 µg/mL. Furthermore, the prevalence of mecA gene was the most abundant among the isolates while ermB gene was infrequent. Conclusions: sulfur nanoparticles preparations are an effective treatment for most Staphylococcus bacteria causing acne vulgaris harboring multi-drug resistance virulence factors.
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Affiliation(s)
- Noha M. Hashem
- Ministry of Health, Cairo, Egypt
- * Correspondence: ; Tel: +201003019064
| | - Alaa El-Din M.S. Hosny
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University
- Department of Microbiology and Immunology, Faculty of Pharmacy, MTI University, Egypt
| | - Ali A. Abdelrahman
- Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Egypt
| | - Samira Zakeer
- Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Egypt
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13
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Kim IH. Do we need topical antibiotics for simple excision or the dressing after a skin wound? JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.12.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We often use topical antibiotics for simple excisions or the skin after minor wounds. This is a long-standing practice to minimize scarring by preventing wound or surgical site infection to promote wound healing. Is this old practice the right way for today? Is there a scientific basis for it and can it persist? These questions are related to the increase in antibiotic-resistant bacteria in Korea. Currently, the guidelines for the use of oral antibiotics have been established and are being applied relatively well-controlled to prevent overuse and misuse, while discussions for evaluating the adequacy of the prophylactic use of topical antibiotics or establishing correct guidelines are lacking. Based on related research data, American Academy of Dermatology has been continuously campaigning against the abuse of prophylactic antibiotics by the public and doctors, following the increase in the abuse of topical antibiotics since 2013. Therefore, we discuss the necessity of using topical antibiotics for the prophylaxis based on literature evidence. Now is the time to make efforts to prevent the increase of antibiotic-resistant bacteria through the correct use and by reducing the prescription of topical antibiotics in Korea.
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14
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Alkhawaja E, Hammadi S, Abdelmalek M, Mahasneh N, Alkhawaja B, Abdelmalek SM. Antibiotic resistant Cutibacterium acnes among acne patients in Jordan: a cross sectional study. BMC DERMATOLOGY 2020; 20:17. [PMID: 33203374 PMCID: PMC7673087 DOI: 10.1186/s12895-020-00108-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Antibiotics have been used for decades against Cutibacterium acnes (previously known as Propionibacterium acnes; C. acnes). Alarmingly, antibiotic resistance to this bacterium has become a worldwide problem in recent years. No studies are available on the antibiotic susceptibility patterns of C. acnes among Jordanian acne patients and how that is influenced by antibiotic use. This study aims to assess antibiotic resistance patterns of C. acnes clinical isolates and neighboring Gram-positive normal flora of the skin obtained from acne patients attending dermatology clinics in Amman -Jordan appraising the role of antibiotic consumption. METHODS This is a cross-sectional study of acne patients presenting to selected dermatology outpatient clinics over a 6-month study period. Swabs obtained from inflamed lesions were cultured aerobically and anaerobically. Isolates were identified and screened for antibiotic susceptibility. In addition, all patients were asked to fill in a questionnaire that included questions about the history of antibiotic treatment. RESULTS C. acnes was isolated from lesions of 100 patients out of 115 participants included in this study. 73% of the isolates were resistant to erythromycin and 59% to clindamycin 37% to doxycycline, 36% to tetracycline, 31% to trimethoprim / sulfamethoxazole, 15% to levofloxacin, and 3% to minocycline. Multi drug resistance (MDR) in C. acnes isolates as well as Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) with a similar pattern of resistance were detected from the same patient in most cases. A pattern of higher resistance towards variable antibiotic was observed in patients previously treated with antibiotics for acne management. CONCLUSIONS The findings of this study demonstrate the distribution of antibiotic resistance of C. acnes towards used antibiotics and emphasizes the influence of antibiotic consumption on development of antibiotic resistance. The similar pattern of resistance between skin bacteria tested in this study highlights the genetic transfer of resistance between skin commensals including S. aureus and S. epidermidis hence promoting its circulation in the community.
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Affiliation(s)
- Eman Alkhawaja
- Department of Pharmacology and Biomedical Sciences, Faculty of Pharmacy, Petra University, Amman, Jordan
| | - Saleem Hammadi
- Department of Pharmacology and Biomedical Sciences, Faculty of Pharmacy, Petra University, Amman, Jordan
| | | | - Naser Mahasneh
- Department of Dermatology, Faculty of Medicine, Jordan University, Amman, Jordan
| | - Bayan Alkhawaja
- Department of Pharmaceutical Medicinal Chemistry & Pharmacognosy, Faculty of Pharmacy, Petra University, Amman, Jordan
| | - Suzanne M Abdelmalek
- Department of Pharmacology and Biomedical Sciences, Faculty of Pharmacy, Petra University, Amman, Jordan.
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15
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Jusuf NK, Putra IB, Sari L. Differences of Microbiomes Found in Non-Inflammatory and Inflammatory Lesions of Acne Vulgaris. Clin Cosmet Investig Dermatol 2020; 13:773-780. [PMID: 33122933 PMCID: PMC7591237 DOI: 10.2147/ccid.s272334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
Purpose Bacterial activity and inflammation both influence acne vulgaris (AV) formation. Cutibacterium acnes is considered as an actor involved in inflammation of AV. Besides Cutibacterium acnes, other microbiomes found in AV may also play a role in the pathogenesis. This research was conducted to overview microbiomes found in non-inflammatory and inflammatory lesions of AV. Patients and Methods An observational descriptive study with cross-sectional approach was designed. Sample collection was performed with 40 subjects with AV. In every patient, both non-inflammatory (closed comedone) and inflammatory (pustule) lesion samples were collected by swab. Afterward, bacterial culture was performed, continued by bacterial identification. Results In non-inflammatory lesions, the growth of nine bacterial species was observed from 40 samples. In an anaerobic culture, Cutibacterium acnes (17,5%) was identified. In aerobic cultures, different bacterial species were found including Staphylococcus epidermis (52.5%), Staphylococcus hominis (12.5%), Staphylococcus haemolyticus (7.5%), Micrococcus luteus (7.5%), Leuconostoc mesentroides (7.5%), Staphylococcus aureus (5%), Kocuria varians (5%), and Staphylococcus vitulinus (2.5%). In inflammatory lesions, nine bacterial species were found, in which was the anaerobic culture we identified Cutibacterium acnes (25.0%). Aerobic cultures have revealed the growth colonies of Staphylococcus epidermidis (42.5%), Staphylococcus hominis (22.5%), Staphylococcus aureus (12.5%), Staphylococcus haemolyticus (10.0%), Leuconostoc mesentroides (5.0%), Staphylococcus cohnii (2.5%), Staphylococcus arlettae (2.5%), and Dermacoccus nishinomyaensis (2.5%). Two mixed bacterial growths were observed in non-inflammatory lesions, while four mixed bacterial growths were found in inflammatory lesions. Conclusion Differences in bacterial isolates were observed both in non-inflammatory and inflammatory lesions of AV.
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Affiliation(s)
- Nelva Karmila Jusuf
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Imam Budi Putra
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Lovena Sari
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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16
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Formulation of Creams Containing Spirulina Platensis Powder with Different Nonionic Surfactants for the Treatment of Acne Vulgaris. Molecules 2020; 25:molecules25204856. [PMID: 33096785 PMCID: PMC7587940 DOI: 10.3390/molecules25204856] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
Natural products used in the treatment of acne vulgaris may be promising alternative therapies with fewer side effects and without antibiotic resistance. The objective of this study was to formulate creams containing Spirulina (Arthrospira) platensis to be used in acne therapy. Spirulina platensis belongs to the group of micro algae and contains valuable active ingredients. The aim was to select the appropriate nonionic surfactants for the formulations in order to enhance the diffusion of the active substance and to certify the antioxidant and antibacterial activity of Spirulina platensis-containing creams. Lyophilized Spirulina platensis powder (SPP) was dissolved in Transcutol HP (TC) and different types of nonionic surfactants (Polysorbate 60 (P60), Cremophor A6:A25 (CR) (1:1), Tefose 63 (TFS), or sucrose ester SP 70 (SP70)) were incorporated in creams as emulsifying agents. The drug release was evaluated by the Franz diffusion method and biocompatibility was tested on HaCaT cells. In vitro antioxidant assays were also performed, and superoxide dismutase (SOD) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays were executed. Antimicrobial activities of the selected compositions were checked against Staphylococcus aureus (S. aureus) and Cutibacteriumacnes (C. acnes) (formerly Propionibacterium acnes) with the broth microdilution method. Formulations containing SP 70 surfactant with TC showed the most favorable dissolution profiles and were found to be nontoxic. This composition also showed significant increase in free radical scavenger activity compared to the blank sample and the highest SOD enzyme activity was also detected after treatment with the cream samples. In antibacterial studies, significant differences were observed between the treated and control groups after an incubation time of 6 h.
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17
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Layton AM, Thiboutot D, Tan J. Reviewing the global burden of acne: how could we improve care to reduce the burden? Br J Dermatol 2020; 184:219-225. [PMID: 32770673 DOI: 10.1111/bjd.19477] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 01/09/2023]
Abstract
Acne (also known as acne vulgaris) remains the most common inflammatory dermatosis treated worldwide, as estimated by global skin disease prevalence studies. Latest reports suggest that the prevalence may be increasing in adolescents and adults, particularly female adults. The concept of 'burden of skin disease' is multidimensional and can be difficult to quantify in light of different healthcare systems across the globe. In acne, the resulting burden may vary according to patient demographics, access to treatments and duration of the disease. The visible nature of acne, symptoms and sequelae all contribute physically and psychosocially to the overall burden of disease, as do the costs required for management. Acne typically presents in adolescence at a time of significant transition. Profound effects on functional status have been demonstrated, along with a strong impact on interpersonal relationships, social functioning and mental health. The high prevalence of acne also presents an economic burden for society. The widespread and prolonged use of antibiotics introduces a potential added burden through resulting antimicrobial resistance. A James Lind Alliance Acne Priority Setting Partnership has identified numerous areas to inform future research, which would help to improve acne management and reduce the burden. The lack of standardized assessments is a major issue in acne trials and challenges the ability to compare treatments and perform meta-analyses. This paper reviews the current literature on burden of acne, identifies areas of treatment uncertainties and summarizes the work of the Acne Core Outcome Research Network as a means of supporting a reduction in the burden of disease.
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Affiliation(s)
- A M Layton
- Hull York Medical School, York University, Heslington, York, UK.,Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UK
| | - D Thiboutot
- Department of Dermatology, The Pennsylvania State University, 500 University Drive, Hershey, 17033, PA, USA
| | - J Tan
- Department of Medicine, Western University, Windsor Campus, ON, Canada
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18
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Karadag AS, Aslan Kayıran M, Wu CY, Chen W, Parish LC. Antibiotic resistance in acne: changes, consequences and concerns. J Eur Acad Dermatol Venereol 2020; 35:73-78. [PMID: 32474948 DOI: 10.1111/jdv.16686] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
Antibiotic resistance in acne was first observed in the 1970s and has been a major concern in dermatology since the 1980s. The resistance rates and types of antimicrobials have subsequently shown great variations in regions and countries. Illustrative of this is the resistance to topical erythromycin and clindamycin which continues to be a problem worldwide, while resistance to systemic treatment with tetracyclines has remained low during the past decade. The resistance for the newer macrolides like azithromycin and clarithromycin has been increasing. The results of antibiotic resistance may include treatment failure of acne, disturbance of skin microbiota, induction of opportunistic pathogens locally and systemically, and dissemination of resistant strains to both healthcare personnel and the general population. The ensuing complications, such as aggravated opportunistic infections caused by Propionibacterium acnes and the emergence of multiresistant superbugs, have not yet been confirmed.
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Affiliation(s)
- A S Karadag
- Department of Dermatology and Venereology, School of Medicine, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - M Aslan Kayıran
- Department of Dermatology and Venereology, School of Medicine, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - C-Y Wu
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - W Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - L C Parish
- Department of Dermatology and Cutaneous Biology and Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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19
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Dunaway S, Fleischer AB. Assessing adherence to evidence-based guidelines of care for acne vulgaris. J DERMATOL TREAT 2020; 33:138-142. [DOI: 10.1080/09546634.2020.1729950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Spencer Dunaway
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alan B. Fleischer
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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20
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Asadi A, Abdi M, Kouhsari E, Panahi P, Sholeh M, Sadeghifard N, Amiriani T, Ahmadi A, Maleki A, Gholami M. Minocycline, focus on mechanisms of resistance, antibacterial activity, and clinical effectiveness: Back to the future. J Glob Antimicrob Resist 2020; 22:161-174. [PMID: 32061815 DOI: 10.1016/j.jgar.2020.01.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/17/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The increasing crisis regarding multidrug-resistant (MDR) and extensively drug-resistant microorganisms leads to appealing therapeutic options. METHODS During the last 30 years, minocycline, a wide-spectrum antimicrobial agent, has been effective against MDR Gram-positive and Gram-negative bacterial infections. As with other tetracyclines, the mechanism of action of minocycline involves attaching to the bacterial 30S ribosomal subunit and preventing protein synthesis. RESULTS This antimicrobial agent has been approved for the treatment of acne vulgaris, some sexually transmitted diseases and rheumatoid arthritis. Although many reports have been published, there remains limited information regarding the prevalence, mechanism of resistance and clinical effectiveness of minocycline. CONCLUSION Thus, we summarize here the currently available data concerning pharmacokinetics and pharmacodynamics, mechanism of action and resistance, antibacterial activity and clinical effectiveness of minocycline.
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Affiliation(s)
- Arezoo Asadi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Abdi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Pegah Panahi
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Ahmadi
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abbas Maleki
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehrdad Gholami
- Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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21
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Esmael A, Hassan MG, Amer MM, Abdelrahman S, Hamed AM, Abd-raboh HA, Foda MF. Antimicrobial activity of certain natural-based plant oils against the antibiotic-resistant acne bacteria. Saudi J Biol Sci 2020; 27:448-455. [PMID: 31889869 PMCID: PMC6933203 DOI: 10.1016/j.sjbs.2019.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/09/2019] [Accepted: 11/10/2019] [Indexed: 01/12/2023] Open
Abstract
The unceasing emerging of multidrug-resistant bacteria imposes a global foremost human health threat and discovery of new alternative remedies are necessity. The use of plant essential oil in the treatment of many pathogenic bacteria is promising. Acne vulgaris is the most common skin complaint that fears many people about their aesthetic appearance. In this work we investigated the antibacterial activity of some plant oils against acne-inducing bacteria. Three bacterial isolates were identified from Egypt, biochemically and by means of 16s rRNA gene typing, and were designated as Staphylococcus aureus EG-AE1, Staphylococcus epidermidis EG-AE2 and Cutibacterium acnes EG-AE1. Antibiotic susceptibility test showed resistance of the isolates to at least six antibiotics, yet they are still susceptible to the last resort Vancomycin. In vitro investigations of eleven Egyptian plant oils, identified tea tree and rosemary oils to exhibit antibacterial activity against the antibiotic-resistant acne isolates. Inhibition zones of 15 ± 0.5, 21.02 ± 0.73 and 20.85 ± 0.76 mm was detected when tea tree oil applied against the above-mentioned bacteria respectively, while inhibition zones of 12.5 ± 1.5, 15.18 ± 0.38 and 14.77 ± 0.35 mm were detected by rosemary oils. Tea tree and rosemary oils exhibited bacteriostatic and bactericidal activity against all the strains with MICs/MBCs ranging between 39-78 mg/L for tea tree oil and 39-156 mg/L for rosemary oil. All the isolates were killed after 4 and 6 h upon growing with 200 mg/L of tea tree and rosemary oils, respectively. Additionally, gas chromatography mass spectrometry (GC/MS) profiling identified and detected a variable number of antimicrobial compounds in both oils.
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Affiliation(s)
- Ahmed Esmael
- State Key Laboratory of Agricultural Microbiology, College of Plant Science and Technology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, China
- Botany and Microbiology Department, Faculty of Science, Benha University, Qalubiya Governorate 13511, Egypt
| | - Mervat G. Hassan
- Botany and Microbiology Department, Faculty of Science, Benha University, Qalubiya Governorate 13511, Egypt
| | - Mahmoud M. Amer
- Botany and Microbiology Department, Faculty of Science, Benha University, Qalubiya Governorate 13511, Egypt
| | - Soheir Abdelrahman
- Clinical Pathology Department, Faculty of Medicine, Benha University, Qalubiya Governorate 13511, Egypt
| | - Ahmed M. Hamed
- Dermatology Department, Faculty of Medicine, Benha University, Qalubiya Governorate 13511, Egypt
| | - Hagar A. Abd-raboh
- Botany and Microbiology Department, Faculty of Science, Benha University, Qalubiya Governorate 13511, Egypt
| | - Mohamed F. Foda
- State Key Laboratory of Agricultural Microbiology, College of Plant Science and Technology, College of Life Science and Technology, College of Science, Huazhong Agricultural University, Wuhan 430070, China
- Department of Biochemistry, Faculty of Agriculture, Benha University, Moshtohor, Toukh 13736, Egypt
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22
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Depypere M, Kuehl R, Metsemakers WJ, Senneville E, McNally MA, Obremskey WT, Zimmerli W, Atkins BL, Trampuz A. Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International Expert Group. J Orthop Trauma 2020; 34:30-41. [PMID: 31567902 PMCID: PMC6903362 DOI: 10.1097/bot.0000000000001626] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
Fracture-related infection (FRI) is a major complication in musculoskeletal trauma and one of the leading causes of morbidity. Standardization of general treatment strategies for FRI has been poor. One of the reasons is the heterogeneity in this patient population, including various anatomical locations, multiple fracture patterns, different degrees of soft-tissue injury, and different patient conditions. This variability makes treatment complex and hard to standardize. As these infections are biofilm-related, surgery remains the cornerstone of treatment, and this entails multiple key aspects (eg, fracture fixation, tissue sampling, debridement, and soft-tissue management). Another important aspect, which is sometimes less familiar to the orthopaedic trauma surgeon, is systemic antimicrobial therapy. The aim of this article is to summarize the available evidence and provide recommendations for systemic antimicrobial therapy with respect to FRI, based on the most recent literature combined with expert opinion. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | | | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Martin A. McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - William T. Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Werner Zimmerli
- Kantonsspital Baselland, Interdisciplinary Unit for Orthopedic Infections, Liestal, Switzerland; and
| | - Bridget L. Atkins
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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23
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Nath R, Grennan T, Parry R, Baharuddin F, Connell JP, Wong J, Grace D. Knowledge and attitudes of syphilis and syphilis pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: a qualitative study. BMJ Open 2019; 9:e031239. [PMID: 31753877 PMCID: PMC6886914 DOI: 10.1136/bmjopen-2019-031239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In British Columbia, Canada, syphilis is at record-high rates, with over 80% of cases in 2017 seen in gay, bisexual and other men who have sex with men (GBM). The syphilis epidemic is of particular concern for those living with HIV, since syphilis may lead to more serious complications in this population. We sought to explore syphilis-related knowledge and attitudes around biomedical prevention options for syphilis, with the goal of informing effective strategies to prevent syphilis. DESIGN We conducted a qualitative study consisting of in-depth, individual interviews from December 2016 to June 2017. Our interviews focused on participants' knowledge about syphilis and perceptions regarding syphilis pre-exposure prophylaxis (PrEP). Interviews were analysed using Grounded Theory. PARTICIPANTS Twenty-five GBM were interviewed (64% white; median age: 43 years), including men living with HIV and/or with a history of syphilis. SETTING Vancouver, British Columbia. RESULTS Five interrelated themes emerged. First, GBM were aware of the local syphilis epidemic. Second, syphilis-related knowledge differed according to syphilis and HIV serostatus. Third, competing ideas emerged regarding men's concerns about syphilis. While our participants expressed concern about getting syphilis, they also described the importance of sexual pleasure. Fourth, many participants said that syphilis was not perceived to be alarming; preventing HIV infection remained a primary concern for many. Finally, while syphilis PrEP was appealing to those living with HIV or a prior syphilis diagnosis, others were concerned about antibiotic resistance, cost and side effects. CONCLUSIONS Our participants organised their safer sex strategies around HIV, not syphilis. Although syphilis-related knowledge was relatively high among GBM living with HIV and those with a prior syphilis diagnosis, this knowledge did not appear to be related with safer sexual practices, such as increased condom use. This work highlights the importance of examining other potential prevention solutions, such as syphilis PrEP.
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Affiliation(s)
- Ronita Nath
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Department of Infectious diseases, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Infectious diseases, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Robin Parry
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Fahmy Baharuddin
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James P Connell
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Claudel JP, Auffret N, Leccia MT, Poli F, Corvec S, Dréno B. Staphylococcus epidermidis: A Potential New Player in the Physiopathology of Acne? Dermatology 2019; 235:287-294. [DOI: 10.1159/000499858] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/25/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Cutibacterium acnes has been identified as one of the main triggers of acne. However, increasing knowledge of the human skin microbiome raises questions about the role of other skin commensals, such as Staphylococcus epidermidis, in the physiopathology of this skin disease. Summary: This review provides an overview of current knowledge of the potential role of S. epidermidis in the physiopathology of acne. Recent research indicates that acne might be the result of an unbalanced equilibrium between C. acnes and S. epidermidis,according to dedicated interactions. Current treatments act on C. acnesonly. Other treatment options may be considered, such as probiotics derived from S. epidermidis to restore the naturally balanced microbiota or through targeting the regulation of the host’s AMP mediators. Key Messages: Research seems to confirm the beneficial role of S. epidermidis in acne by limiting C. acnes over-colonisation and inflammation.
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Sitohang IBS, Fathan H, Effendi E, Wahid M. The susceptibility of pathogens associated with acne vulgaris to antibiotics. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i1.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Acne vulgaris is a pilosebaceous disorder. Bacterial activity and inflammation both influence acne formation. Antibiotics suppress the bacterial activities and elicit anti-inflammatory effects. The overuse of antibiotics may lead to resistance in bacteria. This study was aimed to provide an overview of bacteria that may cause acne and determine their susceptibility to antibiotics.METHODS This was a cross-sectional study sampling from 93 patients with acne in Ciptomangunkusumo Hospital. Comedones were extracted and cultured on Brucella blood agar, under aerobic and anaerobic conditions at 35oC for 24–48 hours. Bacterial identification was performed using Vitek®, and susceptibility test using E-test. Data interpretation was based on the Clinical and Laboratory Standards Institute 2015.RESULTS Staphylococcus epidermidis (50.5%), Propionibacterium acnes (11.0%), and Staphylococcus aureus (7.7%) were identified. Bacteria were not found in 69.2% and 1.1% of samples in anaerobic and aerobic cultures, respectively. P. acnes was susceptible to doxycycline (100%) and minocycline (100%), while 10% was resistant to erythromycin, clindamycin, and tetracycline. S. epidermidis was susceptible to minocycline (100%); but resistant to erythromycin (65.2%), clindamycin (52.2%) and tetracycline (32.6%). The susceptibility of S. epidermidis to doxycycline was 89.1%, which was lower than that of P. acnes (100%). S. aureus was found to be sensitive to minocycline (100%), doxycycline (71.4%), clindamycin (71.4%), and tetracycline (71.4%); but it was resistant to erythromycin (42.9%).CONCLUSIONS Doxycycline and minocycline showed 100% effectiveness for P. acnes. The isolated bacteria were more susceptible to doxycycline compared to tetracycline. The use of clindamycin and erythromycin needs to be limited as most S. epidermidis isolates were resistant to both.
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Zhu T, Zhu W, Wang Q, He L, Wu W, Liu J, Li Y, Sun D. Antibiotic susceptibility of Propionibacterium acnes isolated from patients with acne in a public hospital in Southwest China: prospective cross-sectional study. BMJ Open 2019; 9:e022938. [PMID: 30782869 PMCID: PMC6368155 DOI: 10.1136/bmjopen-2018-022938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/02/2018] [Accepted: 11/30/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Antibiotics have been routinely used for several decades against Propionibacterium acnes (P. acnes), but antibiotic resistance of P. acnes is becoming a global problem. Only one related Chinese study is available. The aim of this study was to assess the antibiotic susceptibility of P. acnes obtained from patients with acne in Southwest China. DESIGN This was a prospective cross-sectional study. Cutaneous samples were obtained from acne lesions on the face of 375 patients. Samples were cultured in anaerobic medium to identify the presence of P. acnes. Susceptibility tests of isolated P. acnes were performed for tetracycline, doxycycline, clindamycin, erythromycin, azithromycin and clarithromycin using the Epsilometer test. RESULTS P. acnes was isolated from 227 patients; 224 isolates (98.7%) were susceptible to doxycycline and 220 (96.9%) were susceptible to tetracycline, followed by clindamycin and clarithromycin in 101 (44.5%) and 102 (44.93%) isolates, respectively. Susceptibility of P. acnes was detected for erythromycin in 96 (42.3%) patients, followed by azithromycin in 94 (41.4%). Subjects who received antibiotics (topical and oral) had higher frequencies of antibiotic-resistant P. acnes as well as increased antibiotic minimum inhibitory concentrations compared with patients without antibiotic treatment. CONCLUSIONS P. acnes was highly sensitive to cyclines (doxycycline and tetracycline). P. acnes showed higher resistance rates to macrolides-lincosamides-streptogramins antibiotics (such as erythromycin, azithromycin, clarithromycin and clindamycin). The irrational use of antibiotics for acne treatment is probably a problem in China and elsewhere. These results suggest that dermatologists should be more prudent in prescribing antibiotics for acne.
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Affiliation(s)
- Tingting Zhu
- Department of Dermatology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenyi Zhu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qisa Wang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenjuan Wu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinju Liu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Li
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dongjie Sun
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Platsidaki E, Dessinioti C. Recent advances in understanding Propionibacterium acnes ( Cutibacterium acnes) in acne. F1000Res 2018; 7. [PMID: 30613388 PMCID: PMC6305227 DOI: 10.12688/f1000research.15659.1] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/08/2023] Open
Abstract
The skin commensal
Propionibacterium acnes, recently renamed
Cutibacterium acnes, along with the other major pathophysiological factors of increased seborrhea, hyperkeratinization of the pilosebaceous unit, and inflammation, has long been implicated in the pathogenesis of acne. Recent advances have contributed to our understanding of the role of
P. acnes in acne. Although there are no quantitative differences in
P. acnes of the skin of patients with acne compared with controls, the
P. acnes phylogenic groups display distinct genetic and phenotypic characteristics,
P. acnes biofilms are more frequent in acne, and different phylotypes may induce distinct immune responses in acne.
P. acnes plays a further important role in the homeostasis of the skin’s microbiome, interacting with other cutaneous commensal or pathogenic microorganisms such as
Staphylococcus epidermidis,
Streptococcus pyogenes, and
Pseudomonas species. In the era of increasing antimicrobial resistance, the selection of acne treatment targeting
P. acnes and the prevention of antibiotic resistance play a key role in improving outcomes in acne patients and public health.
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Affiliation(s)
- Eftychia Platsidaki
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
| | - Clio Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, Athens, Greece
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Kim JE, Park AY, Lee SY, Park YL, Whang KU, Kim HJ. Comparison of the Efficacy of Azithromycin Versus Doxycycline in Acne Vulgaris: A Meta-Analysis of Randomized Controlled Trials. Ann Dermatol 2018; 30:417-426. [PMID: 30065581 PMCID: PMC6029975 DOI: 10.5021/ad.2018.30.4.417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/13/2023] Open
Abstract
Background Acne vulgaris is one of the most common disorders of the pilosebaceous unit. Although doxycycline is considered to be a first-line anti-acne antibiotic, various other antibiotics have been tried due to its adverse effects and contraindications. We performed a meta-analysis of randomized controlled trials (RCTs) that compared the efficacy of oral azithromycin pulse therapy with that of oral daily doxycycline in the management of moderate to severe acne vulgaris. Methods Five scientific databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched to identify relevant studies. A review of 1,341 publications produced six RCTs that met our predefined inclusion criteria. The clinical outcome measures were remaining acne lesion counts, patients' self-assessment of treatment, and the investigators' assessment of treatment after 12 weeks. Results We included six studies assessing 906 patients with moderate to severe acne vulgaris. Meta-analyses of clinical outcome measures revealed no significant difference between the two groups regarding remaining acne lesion counts (p=0.27), patients' self-assessment of treatment (p=0.67), and the investigators' assessment of treatment (p=0.32). The incidence of severe adverse events leading to the discontinuation of therapy was higher in the doxycycline daily therapy group when compared with the azithromycin pulse therapy group. Conclusion This study indicates that azithromycin pulse therapy is equivalent to doxycycline at 12 weeks in the efficacy of the treatment for moderate to severe acne vulgaris Therefore, oral azithromycin pulse therapy may be a good alternative to doxycycline in the management of acne for those unable to tolerate doxycycline.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - A Young Park
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung Yul Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Kyu Uang Whang
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Ng V, Kuehne SA, Chan WC. Rational Design and Synthesis of Modified Teixobactin Analogues: In Vitro Antibacterial Activity against Staphylococcus aureus
, Propionibacterium acnes
and Pseudomonas aeruginosa. Chemistry 2018; 24:9136-9147. [DOI: 10.1002/chem.201801423] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Vivian Ng
- School of Pharmacy; Centre for Biomolecular Sciences; University of Nottingham; University Park Nottingham NG7 2RD United Kingdom
| | - Sarah A. Kuehne
- School of Dentistry; Institute for Microbiology and Infection; University of Birmingham; Birmingham B5 7EG United Kingdom
| | - Weng C. Chan
- School of Pharmacy; Centre for Biomolecular Sciences; University of Nottingham; University Park Nottingham NG7 2RD United Kingdom
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Gupta T, Sardana K, Kumar B, Gautam HK. Letter to the editor submitted in response to “the extinction of topical erythromycin therapy for acne vulgaris and concern for the future of topical clindamycin”. J DERMATOL TREAT 2018; 29:105-106. [DOI: 10.1080/09546634.2017.1335852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tanvi Gupta
- Department of Dermatology & VD, Maulana Azad Medical College, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology & VD, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Bipul Kumar
- Department of Microbial Biotechnology, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Hemant K. Gautam
- Department of Microbial Biotechnology, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
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Tan AU, Schlosser BJ, Paller AS. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol 2017; 4:56-71. [PMID: 29872679 PMCID: PMC5986265 DOI: 10.1016/j.ijwd.2017.10.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 01/19/2023] Open
Abstract
This review focuses on the treatment options for adult female patients with acne. Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. Acne has various psychosocial effects that impact patients’ quality of life. Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. Treatments vary widely and treatment should be tailored specifically for each individual woman. We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.
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Affiliation(s)
- A U Tan
- Northwestern University, Department of Dermatology, Chicago, IL
| | - B J Schlosser
- Northwestern University, Department of Dermatology, Chicago, IL
| | - A S Paller
- Northwestern University, Department of Dermatology, Chicago, IL
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Nakase K, Okamoto Y, Aoki S, Noguchi N. Long-term administration of oral macrolides for acne treatment increases macrolide-resistantPropionibacterium acnes. J Dermatol 2017; 45:340-343. [DOI: 10.1111/1346-8138.14178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Keisuke Nakase
- Department of Microbiology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
| | - Yuhei Okamoto
- Department of Microbiology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
| | - Sae Aoki
- Department of Microbiology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
| | - Norihisa Noguchi
- Department of Microbiology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
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Gollnick H, Abanmi A, Al-Enezi M, Al Hammadi A, Galadari I, Kibbi AG, Zimmo S. Managing acne in the Middle East: consensus recommendations. J Eur Acad Dermatol Venereol 2017; 31 Suppl 7:4-35. [DOI: 10.1111/jdv.14491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- H. Gollnick
- Universitätsklinik für Dermatologie und Venerologie; Otto-von-Guericke Universität; Magdeburg Germany
| | - A.A. Abanmi
- Dr Sulaiman Al Habib Hospital; Riyadh Saudi Arabia
| | | | | | - I. Galadari
- Faculty of Medicine; United Arab Emirates University; Dubai UAE
| | - A.-G. Kibbi
- American University of Beirut Medical Center; Beirut Lebanon
| | - S. Zimmo
- King Abdulaziz University; Jeddah Saudi Arabia
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Wunnoo S, Saising J, Voravuthikunchai SP. Rhodomyrtone inhibits lipase production, biofilm formation, and disorganizes established biofilm in Propionibacterium acnes. Anaerobe 2016; 43:61-68. [PMID: 27923605 DOI: 10.1016/j.anaerobe.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/30/2022]
Abstract
Virulence enzymes and biofilm a play crucial role in the pathogenesis of Propionibacterium acnes, a major causative agent of acne vulgaris. In the present study, the effects of rhodomyrtone, a pure compound identified from Rhodomyrtus tomentosa (Aiton) Hassk. leaves extract against enzyme production and biofilm formation production by 5 clinical isolates and a reference strain were evaluated. The degree of hydrolysis by both lipase and protease enzymes significantly decreased upon treatment with the compound at 0.125-0.25 μg/mL (p < 0.05). Lipolytic zones significantly reduced in all isolates while decrease in proteolytic activities was found only in 50% of the isolates. Rhodomyrtone at 1/16MIC and 1/8MIC caused significant reduction in biofilm formation of the clinical isolates (p < 0.05). Percentage viability of P. acnes within mature biofilm upon treated with the compound at 4MIC and 8MIC ranged between 40% and 85%. Pronounced properties of rhodomyrtone suggest a path towards developing a novel anti-acne agent.
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Affiliation(s)
- Suttiwan Wunnoo
- Department of Microbiology, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand; Excellence Research Laboratory on Natural Products, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Jongkon Saising
- School of Health Science, Mae Fah Luang University, Muang, Chiang Rai, 57100, Thailand; Excellence Research Laboratory on Natural Products, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Supayang Piyawan Voravuthikunchai
- Department of Microbiology, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand; Excellence Research Laboratory on Natural Products, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand.
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Goh CL, Noppakun N, Micali G, Azizan NZ, Boonchai W, Chan Y, Cheong WK, Chiu PC, Etnawati K, Gulmatico-Flores Z, Foong H, Kubba R, Paz-Lao P, Lee YY, Loo S, Modi F, Nguyen TH, Pham TL, Shih YH, Sitohang IB, Wong SN. Meeting the Challenges of Acne Treatment in Asian Patients: A Review of the Role of Dermocosmetics as Adjunctive Therapy. J Cutan Aesthet Surg 2016; 9:85-92. [PMID: 27398008 PMCID: PMC4924420 DOI: 10.4103/0974-2077.184043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Conventional acne treatment presents several challenges such as intolerable side effects and antibiotic resistance. Dermocosmetic products may be used to reduce these unwanted effects. Dermocosmetics include skin cleansers, topical sebum-controllers, skin antimicrobial/anti-inflammatory agents, moisturizers, sunscreens, and camouflage products. Appropriate use of these products may help augment the benefit of acne treatment, minimize side effects, and reduce the need for topical antibiotics. In Asia, there is currently limited scientific data on the application and recommendations for dermocosmetic use in acne vulgaris (AV). This article reviews the evidence on dermocosmetics for AV and provides practice recommendations as discussed during the 4th Asia-Pacific Acne Leaders' Summit held in Bangkok, Thailand, on 7 and 8 February 2015. Through a premeeting survey, a series of plenary lectures, a stepwise program of discussion sessions, and Medline article review, the Expert Panel set forth relevant recommendations on the role of dermocosmetics as adjunct for treating AV in Asian patients.
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Affiliation(s)
- Chee Leok Goh
- Department of Dermatology, National Skin Centre, Singapore
| | - Nopadon Noppakun
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Noor Zalmy Azizan
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Waranya Boonchai
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yung Chan
- Cutis Medical Group, Hong Kong, China
| | | | - Pin Chi Chiu
- International Aesthetic Medical Center, Chinese Medical University Hospital, Taichung City, Taiwan
| | - Kristiana Etnawati
- Department of Dermatology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Henry Foong
- Foong Skin Specialist Clinic, Ipoh, Perak, Malaysia
| | | | - Purita Paz-Lao
- Derma Clinic, Makati Medical Center, Makati City, Manila, Philippines
| | | | - Steven Loo
- Dermatology and Venereology, Hong Kong Adventist Hospital, Hong Kong, China
| | - Farida Modi
- Dermacare Skin Clinic and Cosmetic Centre, Mumbai, India
| | | | - Thi Lan Pham
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | - Yi Hsien Shih
- Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Irma Bernadette Sitohang
- Cosmetic Dermatology Division, Department of Dermatovenereology, Faculty of Medicine Universitas/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Su Ni Wong
- Dr SN Wong Skin, Hair, Nails and Laser Specialist Clinic, Mt Elizabeth Medical Centre, Singapore
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Totté JEE, van der Feltz WT, Bode LGM, van Belkum A, van Zuuren EJ, Pasmans SGMA. A systematic review and meta-analysis on Staphylococcus aureus carriage in psoriasis, acne and rosacea. Eur J Clin Microbiol Infect Dis 2016; 35:1069-77. [PMID: 27151386 PMCID: PMC4902839 DOI: 10.1007/s10096-016-2647-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/09/2016] [Indexed: 10/28/2022]
Abstract
Staphylococcus aureus might amplify symptoms in chronic inflammatory skin diseases. This study evaluates skin and mucosal colonization with S. aureus in patients with psoriasis, acne and rosacea. A systematic literature search was conducted. Both odds ratios (OR) for colonization in patients versus controls and the prevalence of colonization in patients are reported. Fifteen articles about psoriasis and 13 about acne (12 having a control group) were included. No study in rosacea met our inclusion criteria. For psoriasis, one study out of three controlled studies showed increased skin colonization (OR 18.86; 95 % confidence interval [CI] 2.20-161.99). Three out of the five studies that reported on nasal colonization showed significant ORs varying from 1.73 (95 % CI 1.16-2.58) to 14.64 (95 % CI 2.82-75.95). For acne one of the three studies that evaluated skin colonization reported a significant OR of 4.16 (95 % CI 1.74-9.94). A relation between nasal colonization and acne was not found. Limitations in study design and low sample sizes should be taken into consideration when interpreting the results. Colonisation with S. aureus seems to be increased in patients with psoriasis. This bacterial species, known for its potential to induce long-lasting inflammation, might be involved in psoriasis pathogenesis. Information on acne is limited. Prospective controlled studies should further investigate the role of S. aureus in chronic inflammatory skin diseases.
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Affiliation(s)
- J E E Totté
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - W T van der Feltz
- Molecular and Cellular Life Sciences, Utrecht University, Utrecht, The Netherlands
| | - L G M Bode
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A van Belkum
- bioMérieux, Scientific Office, La Balme Les Grottes, France
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Sardana K, Gupta T, Kumar B, Gautam HK, Garg VK. Cross-sectional Pilot Study of Antibiotic Resistance in Propionibacterium Acnes Strains in Indian Acne Patients Using 16S-RNA Polymerase Chain Reaction: A Comparison Among Treatment Modalities Including Antibiotics, Benzoyl Peroxide, and Isotretinoin. Indian J Dermatol 2016; 61:45-52. [PMID: 26955094 PMCID: PMC4763694 DOI: 10.4103/0019-5154.174025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a worldwide problem in acne patients due to regional prescription practices, patient compliance, and genomic variability in Propionibacterium acnes, though the effect of treatment on the resistance has not been comprehensively analyzed. AIMS Our primary objective was to assess the level of antibiotic resistance in the Indian patients and to assess whether there was a difference in the resistance across common treatment groups. SUBJECTS AND METHODS A cross-sectional, institutional based study was undertaken and three groups of patients were analyzed, treatment naïve, those on antibiotics and patients on benzoyl peroxide (BPO) and/isotretinoin. The follicular content was sampled and the culture was verified with 16S rRNA polymerase chain reaction, genomic sequencing, and pulsed-field gel electrophoresis. Minimum inhibitory concentration (MIC) assessment was done for erythromycin (ERY), azithromycin (AZI), clindamycin (CL), tetracycline (TET), doxycycline (DOX), minocycline (MINO), and levofloxacin (LEVO). The four groups of patients were compared for any difference in the resistant strains. RESULTS Of the 52 P. acnes strains isolated (80 patients), high resistance was observed to AZI (100%), ERY (98%), CL (90.4%), DOX (44.2%), and TETs (30.8%). Low resistance was observed to MINO (1.9%) and LEVO (9.6%). Statistical difference was seen in the resistance between CL and TETs; DOX/LEVO and DOX/MINO (P < 0.001). High MIC90 (≥256 μg/ml) was seen with CL, macrolides, and TETs; moreover, low MIC90 was observed to DOX (16 μg/ml), MINO (8 μg/ml), and LEVO (4 μg/ml). Though the treatment group with isotretinoin/BPO had the least number of resistant strains there was no statistical difference in the antibiotic resistance among the various groups of patients. CONCLUSIONS High resistance was seen among the P. acnes strains to macrolides-lincosamides (AZI and CL) while MINO and LEVO resistance was low.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi - 110 025, India
| | - Tanvi Gupta
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi - 110 025, India
| | - Bipul Kumar
- CSIR-Institute of Genomics and Integrative Biology, Department of Microbial Biotechnology, Sukhdev Vihar, Mathura Road, New Delhi - 110 025, India
| | - Hemant K Gautam
- CSIR-Institute of Genomics and Integrative Biology, Department of Microbial Biotechnology, Sukhdev Vihar, Mathura Road, New Delhi - 110 025, India
| | - Vijay K Garg
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi - 110 025, India
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Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, Bowe WP, Graber EM, Harper JC, Kang S, Keri JE, Leyden JJ, Reynolds RV, Silverberg NB, Stein Gold LF, Tollefson MM, Weiss JS, Dolan NC, Sagan AA, Stern M, Boyer KM, Bhushan R. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016; 74:945-73.e33. [PMID: 26897386 DOI: 10.1016/j.jaad.2015.12.037] [Citation(s) in RCA: 704] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.
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Affiliation(s)
| | | | | | | | | | - Diane S Berson
- Weill Cornell Medical College, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Whitney P Bowe
- SUNY Down State Medical Center-Brooklyn, New York, New York
| | - Emmy M Graber
- Boston University School of Medicine, Boston, Massachusetts; Boston Medical Center, Boston, Massachusetts
| | | | - Sewon Kang
- Johns Hopkins Medicine, Baltimore, Maryland
| | - Jonette E Keri
- University of Miami Health System, Miami, Florida; Miami VA Hospital, Miami, Florida
| | | | - Rachel V Reynolds
- Harvard Medical Faculty Physicians, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nanette B Silverberg
- Mount Sinai Health System-Beth Israel, New York, New York; St. Lukes-Roosevelt, New York, New York
| | | | | | | | | | | | | | - Kevin M Boyer
- American Academy of Dermatology, Schaumburg, Illinois
| | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois.
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Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. THE LANCET. INFECTIOUS DISEASES 2016; 16:e23-33. [PMID: 26852728 DOI: 10.1016/s1473-3099(15)00527-7] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
Abstract
Topical and oral antibiotics are routinely used to treat acne. However, antibiotic resistance is increasing, with many countries reporting that more than 50% of Propionibacterium acnes strains are resistant to topical macrolides, making them less effective. We reviewed the current scientific literature to enable proposal of recommendations for antibiotic use in acne treatment. References were identified through PubMed searches for articles published from January, 1954, to March 7, 2015, using four multiword searches. Ideally, benzoyl peroxide in combination with a topical retinoid should be used instead of a topical antibiotic to minimise the impact of resistance. Oral antibiotics still have a role in the treatment of moderate-to-severe acne, but only with a topical retinoid, benzoyl peroxide, or their combination, and ideally for no longer than 3 months. To limit resistance, it is recommended that benzoyl peroxide should always be added when long-term oral antibiotic use is deemed necessary. The benefit-to-risk ratio of long-term antibiotic use should be carefully considered and, in particular, use alone avoided where possible. There is a need to treat acne with effective alternatives to antibiotics to reduce the likelihood of resistance.
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Affiliation(s)
- Timothy R Walsh
- Department of Medical Microbiology and Infectious Diseases, Heath Hospital, Cardiff, UK.
| | | | - Brigitte Dréno
- Department of Dermatology, Nantes University Hospital, Nantes, France
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[Bacterial resistance in acne? A meta-analysis of the controversy]. CIR CIR 2016; 84:190-5. [PMID: 26738649 DOI: 10.1016/j.circir.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/20/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Acne is one of the dermatological pathologies with the highest incidence around the world. It is a multifactorial disease and its treatment can be complex. Propionibacterium acnes play a key role in the inflammation of this dermatosis. Topical antibiotics, including mainly erythromycin and clindamycin, have been used, but there is controversy over their use due to the widely documented bacterial resistance. For this reason a meta-analysis of the publications over the past 10 years is presented in order to confirm this hypothesis. MATERIAL AND METHODS A search was made of the publications over the past 10 years that included the results of antibiogams of patients with acne. MeSH type searches were performed with the terms "acne vulgaris", "Propionibacterium acnes", "topical administration", "treatment", "erythromycin", "clindamycin", "nadifloxacin", "antibacterial agent", "bacterial drug resistance" in PubMed, Ovid, EBSCO, Cochrane, ScienceDirect and ClinicalKey meta-searches. RESULTS A total of 13 articles were found that met the inclusion criteria. The mean odds ratio (OR 1.24, 95% CI) of the articles showed a slight tendency toward resistance of Propionibacterium acnes. CONCLUSIONS An increase in bacterial resistance to topical erythromycin and clindamycin can be confirmed, thus the use of these antibiotics is recommended in selective cases for short periods, and in combination with benzoyl peroxide for the best clinical outcome in patients with acne vulgaris.
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Richter C, Trojahn C, Hillmann K, Dobos G, Stroux A, Kottner J, Blume-Peytavi U. Reduction of Inflammatory and Noninflammatory Lesions with Topical Tyrothricin 0.1% in the Treatment of Mild to Severe Acne Papulopustulosa: A Randomized Controlled Clinical Trial. Skin Pharmacol Physiol 2015; 29:1-8. [DOI: 10.1159/000439439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022]
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Goh CL, Abad-Casintahan F, Aw DCW, Baba R, Chan LC, Hung NT, Kulthanan K, Leong HN, Medina-Oblepias MS, Noppakun N, Sitohang IB, Sugito TL, Wong SN. South-East Asia study alliance guidelines on the management of acne vulgaris in South-East Asian patients. J Dermatol 2015. [PMID: 26211507 DOI: 10.1111/1346-8138.12993] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of acne in South-East Asia is unique, as Asian skin and local variables require a clinical approach unlike that utilized in other parts of the world. There are different treatment guidelines per country in the region, and a group of leading dermatologists from these countries convened to review these guidelines, discuss current practices and recent advances, and formulate consensus guidelines to harmonize the management of acne vulgaris in the region. Emphasis has been placed on formulating recommendations to impede the development of antibiotic resistance in Propionibacterium acnes. The group adopted the Acne Consensus Conference system for grading acne severity. The group recommends that patients may be treated with topical medications including retinoids, benzoyl peroxide (BPO), salicylic acid, a combination of retinoid and BPO, or a combination of retinoids and BPO with or without antibiotics for mild acne; topical retinoid with topical BPO and a oral antibiotic for moderate acne; and oral isotretinoin if the patient fails first-line treatment (a 6- or 8-week trial of combined oral antibiotics and topical retinoids with BPO) for severe acne. Maintenance acne treatment using topical retinoids with or without BPO is recommended. To prevent the development of antibiotic resistance, topical antibiotics should not be used as monotherapy or used simultaneously with oral antibiotics. Skin care, comprised of cleansing, moisturizing and sun protection, is likewise recommended. Patient education and good communication is recommended to improve adherence, and advice should be given about the characteristics of the skin care products patients should use.
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Affiliation(s)
| | | | | | - Roshidah Baba
- Department of Dermatology, Hospital Melaka, Melaka, Malaysia
| | - Lee Chin Chan
- Department of Dermatology, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | - Nguyen Thanh Hung
- Ho Chi Minh Dermatology and Venereology Hospital, Ho Chi Minh City, Vietnam
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hoe Nam Leong
- Rophi Clinic, Mount Elizabeth Novena Specialist Centre, Singapore
| | | | - Nopadon Noppakun
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Irma Bernadette Sitohang
- Cosmetic Dermatology Division, Department of Dermatovenereology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Titi Lestari Sugito
- Department of Dermato-Venereology, Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Su-Ni Wong
- Dr SN Wong Skin, Hair, Nails & Laser Specialist Clinic, Mt Elizabeth Medical Centre, Singapore
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Sardana K, Gupta T, Garg VK, Ghunawat S. Antibiotic resistance toPropionobacterium acnes: worldwide scenario, diagnosis and management. Expert Rev Anti Infect Ther 2015; 13:883-96. [DOI: 10.1586/14787210.2015.1040765] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sibi G. Inhibition of lipase and inflammatory mediators by Chlorella lipid extracts for antiacne treatment. J Adv Pharm Technol Res 2015; 6:7-12. [PMID: 25709963 PMCID: PMC4330611 DOI: 10.4103/2231-4040.150364] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Acne vulgaris is a chronic inflammatory disease, and its treatment is challenging due to the multifactorial etiology and emergence of antibiotic-resistant Propionibacterium acnes strains. This study was focused to reduce antibiotics usage and find an alternate therapeutic source for treating acne. Lipid extracts of six Chlorella species were tested for inhibition of lipase, reactive oxygen species (ROS) production, cytokine production using P. acnes (Microbial Type Culture Collection 1951). Lipase inhibitory assay was determined by dimercaprol Tributyrate - 5, 5'- dithiobis 2-nitrobenzoic acid method and ROS production assay was performed using nitro-blue tetrazolium test. The anti-inflammatory activity of algal lipid extracts was determined by in vitro screening method based on inhibition of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α) produced by human peripheral blood mononuclear cells. Minimum inhibitory concentration (MIC) values of lipid extracts were determined by microdilution method, and the fatty acid methyl esters (FAME) were analyzed by gas chromatography-mass spectroscopy. Chlorella ellipsoidea has the highest lipase inhibitory activity with 61.73% inhibition, followed by Chlorella vulgaris (60.31%) and Chlorella protothecoides (58.9%). Lipid extracts from C. protothecoides and C. ellipsoidea has significantly reduced the ROS production by 61.27% and 58.34% respectively. Inhibition of pro-inflammatory cytokines TNF-α showed the inhibition ranging from 58.39% to 78.67%. C. vulgaris has exhibited the MICvalue of 10 μg/ml followed by C. ellipsoidea, C. protothecoides and Chlorella pyrenoidosa (20 μg/ml). FAME analysis detected 19 fatty acids of which 5 were saturated fatty acids, and 14 were unsaturated fatty acids ranging from C14 to C24. The results suggest that lipid extracts of Chlorella species has significant inhibitory activity on P. acnes by inhibiting lipase activity. Further, anti-inflammatory reaction caused by the pathogen could be reduced by the inhibiting the production of ROS and inflammatory mediators TNF-α and exposes new frontiers on the antiacne activities of Chlorella lipid extracts.
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Affiliation(s)
- G Sibi
- Department of Biotechnology, Indian Academy Degree College, Centre for Research and Post Graduate Studies, Bengaluru, Karnataka, India
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Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev 2015; 27:419-40. [PMID: 24982315 DOI: 10.1128/cmr.00092-13] [Citation(s) in RCA: 397] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Propionibacterium acnes is known primarily as a skin commensal. However, it can present as an opportunistic pathogen via bacterial seeding to cause invasive infections such as implant-associated infections. These infections have gained more attention due to improved diagnostic procedures, such as sonication of explanted foreign materials and prolonged cultivation time of up to 14 days for periprosthetic biopsy specimens, and improved molecular methods, such as broad-range 16S rRNA gene PCR. Implant-associated infections caused by P. acnes are most often described for shoulder prosthetic joint infections as well as cerebrovascular shunt infections, fibrosis of breast implants, and infections of cardiovascular devices. P. acnes causes disease through a number of virulence factors, such as biofilm formation. P. acnes is highly susceptible to a wide range of antibiotics, including beta-lactams, quinolones, clindamycin, and rifampin, although resistance to clindamycin is increasing. Treatment requires a combination of surgery and a prolonged antibiotic treatment regimen to successfully eliminate the remaining bacteria. Most authors suggest a course of 3 to 6 months of antibiotic treatment, including 2 to 6 weeks of intravenous treatment with a beta-lactam. While recently reported data showed a good efficacy of rifampin against P. acnes biofilms, prospective, randomized, controlled studies are needed to confirm evidence for combination treatment with rifampin, as has been performed for staphylococcal implant-associated infections.
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Staphylococcus epidermidis in the human skin microbiome mediates fermentation to inhibit the growth of Propionibacterium acnes: implications of probiotics in acne vulgaris. Appl Microbiol Biotechnol 2013; 98:411-24. [PMID: 24265031 DOI: 10.1007/s00253-013-5394-8] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/07/2013] [Accepted: 11/09/2013] [Indexed: 12/21/2022]
Abstract
Increasing evidence demonstrates that commensal microorganisms in the human skin microbiome help fight pathogens and maintain homeostasis of the microbiome. However, it is unclear how these microorganisms maintain biological balance when one of them overgrows. The overgrowth of Propionibacterium acnes (P. acnes), a commensal skin bacterium, has been associated with the progression of acne vulgaris. Our results demonstrate that skin microorganisms can mediate fermentation of glycerol, which is naturally produced in skin, to enhance their inhibitory effects on P. acnes growth. The skin microorganisms, most of which have been identified as Staphylococcus epidermidis (S. epidermidis), in the microbiome of human fingerprints can ferment glycerol and create inhibition zones to repel a colony of overgrown P. acnes. Succinic acid, one of four short-chain fatty acids (SCFAs) detected in fermented media by nuclear magnetic resonance (NMR) analysis, effectively inhibits the growth of P. acnes in vitro and in vivo. Both intralesional injection and topical application of succinic acid to P. acnes-induced lesions markedly suppress the P. acnes-induced inflammation in mice. We demonstrate for the first time that bacterial members in the skin microbiome can undergo fermentation to rein in the overgrowth of P. acnes. The concept of bacterial interference between P. acnes and S. epidermidis via fermentation can be applied to develop probiotics against acne vulgaris and other skin diseases. In addition, it will open up an entirely new area of study for the biological function of the skin microbiome in promoting human health.
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Desbois AP, Lawlor KC. Antibacterial activity of long-chain polyunsaturated fatty acids against Propionibacterium acnes and Staphylococcus aureus. Mar Drugs 2013; 11:4544-57. [PMID: 24232668 PMCID: PMC3853744 DOI: 10.3390/md11114544] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/31/2013] [Accepted: 11/04/2013] [Indexed: 01/10/2023] Open
Abstract
New compounds are needed to treat acne and superficial infections caused by Propionibacterium acnes and Staphylococcus aureus due to the reduced effectiveness of agents used at present. Long-chain polyunsaturated fatty acids (LC-PUFAs) are attracting attention as potential new topical treatments for Gram-positive infections due to their antimicrobial potency and anti-inflammatory properties. This present study aimed to investigate the antimicrobial effects of six LC-PUFAs against P. acnes and S. aureus to evaluate their potential to treat infections caused by these pathogens. Minimum inhibitory concentrations were determined against P. acnes and S. aureus, and the LC-PUFAs were found to inhibit bacterial growth at 32–1024 mg/L. Generally, P. acnes was more susceptible to the growth inhibitory actions of LC-PUFAs, but these compounds were bactericidal only for S. aureus. This is the first report of antibacterial activity attributed to 15-hydroxyeicosapentaenoic acid (15-OHEPA) and 15-hydroxyeicosatrienoic acid (HETrE), while the anti-P. acnes effects of the six LC-PUFAs used herein are novel observations. During exposure to the LC-PUFAs, S. aureus cells were killed within 15–30 min. Checkerboard assays demonstrated that the LC-PUFAs did not antagonise the antimicrobial potency of clinical agents used presently against P. acnes and S. aureus. However, importantly, synergistic interactions against S. aureus were detected for combinations of benzoyl peroxide with 15-OHEPA, dihomo-γ-linolenic acid (DGLA) and HETrE; and neomycin with 15-OHEPA, DGLA, eicosapentaenoic acid, γ-linolenic acid and HETrE. In conclusion, LC-PUFAs warrant further evaluation as possible new agents to treat skin infections caused by P. acnes and S. aureus, especially in synergistic combinations with antimicrobial agents already used clinically.
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Affiliation(s)
- Andrew P Desbois
- Marine Biotechnology Research Group, Institute of Aquaculture, School of Natural Sciences, University of Stirling, Stirlingshire, Scotland FK9 4LA, UK.
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