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Kim HJ, Kim YH. Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies. Int J Mol Sci 2024; 25:5302. [PMID: 38791344 PMCID: PMC11121268 DOI: 10.3390/ijms25105302] [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: 03/22/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.
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Affiliation(s)
- Hyun Jee Kim
- Department of Dermatology, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Republic of Korea;
| | - Yeong Ho Kim
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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2
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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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Moosa AS, Lim SF, Koh YLE, Aau WK, Tan NC. The management of acne vulgaris in young people in primary care: A retrospective cohort study. Front Med (Lausanne) 2023; 10:1152391. [PMID: 37020676 PMCID: PMC10067560 DOI: 10.3389/fmed.2023.1152391] [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: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Background Acne vulgaris (acne) is common among young persons (YPs). Clinical practice guidelines are available for acne management to minimize their physical and psychological impact. However, evidence of adherence to these guidelines is sparse in primary care practices. The study aimed to determine the demographic profile of YPs who sought primary care consultations for acne, their related prescriptions and referrals to specialists for further management. Method A retrospective study was conducted using data from a cluster of eight public primary care clinics in Singapore. Demographic, clinical, prescription, and referral data were extracted from the electronic health records of YPs aged 10-29 years with a documented diagnosis of acne (ICD-10 classification) from 1st July 2018 to 30th June 2020. The data were reviewed, audited for eligibility criteria, and de-identified before analysis. Results Complete data from 2,700 YPs with acne were analyzed. Male (56.1%) YPs and those of Chinese ethnicity (73.8%) had the most frequent attendances for acne. The mean and median age at presentation was 19.2 (standard deviation = 4.3) and 19 (interquartile range = 16-22) years, respectively. Only 69.7% of YPs received an acne-related medication; 33.5% received antibiotic monotherapy; 53.0% were prescribed oral doxycycline, 35.0% acne cream (combination of sulfur, salicylic acid, and resorcinol), and 28.4% benzoyl peroxide 5% gel; 54.3% of those treated with antibiotics were prescribed with a shorter duration than recommended; 51.3% were referred to a dermatologist on their first visit, and 15.8% had more than one visit. Conclusion Acne management for YPs can be enhanced with refresher training among primary care physicians for better adherence to its clinical practice guidelines.
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Affiliation(s)
- Aminath Shiwaza Moosa
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- *Correspondence: Aminath S. Moosa,
| | - Shu Fen Lim
- SingHealth Polyclinics, Singapore, Singapore
| | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Lytvyn Y, McDonald K, Mufti A, Beecker J. Comparing the frequency of isotretinoin-induced hair loss at <0.5-mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review. JAAD Int 2022; 6:125-142. [PMID: 35199047 PMCID: PMC8841364 DOI: 10.1016/j.jdin.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin. An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities. Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible. Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.
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Yang TH, Li CN, Huang YC. The Efficacy of Pulsed Dye Laser Treatment for Acne Vulgaris: A Systemic Review and Meta-Analysis. Dermatol Surg 2022; 48:209-213. [PMID: 34923532 DOI: 10.1097/dss.0000000000003345] [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: 11/25/2022]
Abstract
BACKGROUND Previous reports have shown that pulsed dye laser (PDL) is promising for the treatment of acne; however, results provide conflicting evidence. OBJECTIVE To determine the efficacy of PDL in treating acne vulgaris. METHODS A systematic review and meta-analysis of studies published before March 31, 2020 was conducted. Randomized controlled trials and case series were analyzed. The meta-analysis estimated the standardized mean difference (SMD) in acne severity score changes in patients treated by PDL versus control and also the SMD of the acne severity scores and comedone counts changes before and after PDL treatment. RESULTS Eleven studies were included in this systematic review. Six studies were included in the meta-analysis. Pulsed dye laser treatment was not found to be superior to the control group in treating acne vulgaris (SMD: -0.285; 95% confidence interval [CI], -0.886 to 0.317). However, single-arm studies revealed a significantly improved acne severity score after PDL therapy (SMD, -1.321; 95% CI, -2.057 to -0.586), especially when a multiple-session treatment and a longer pulse duration were employed. The comedone counts were significantly decreased after PDL therapy (SMD, -0.596; 95% CI, -1.137 to -0.054). CONCLUSION When treatment consisted of 4 or more sessions or longer pulse duration, PDL could significantly decrease the acne severity score.
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Affiliation(s)
- Ting-Hua Yang
- Dr. Shine Clinic, New Taipei City, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | | | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
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Affiliation(s)
| | - Joanne Hui Min Quah
- SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Choon How How
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore.,Changi General Hospital, Singapore
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Eubanks SW, Solomon JA. Safety and efficacy of fractional radiofrequency for the treatment and reduction of acne scarring: A prospective study. Lasers Surg Med 2022; 54:74-81. [PMID: 34412150 PMCID: PMC9291574 DOI: 10.1002/lsm.23453] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Skin rejuvenation with radiofrequency has been a widely used treatment modality for the safe and efficient remodeling of the dermis and revision of textural irregularities, achieved with minimal downtime. The efficacy of fractional radiofrequency (FRF) specifically for acne scarring has not been widely established. The objective of this clinical trial was to establish the efficacy and safety of FRF for moderate to severe acne scarring in a wide range of Fitzpatrick skin types using two different applicator tips to deliver energy to the skin (80-pin of up to 124 mJ/pin and 160-pin of up to 62 mJ/pin). METHODS Enrolled subjects received a series of three FRF treatments to the full face, each 4 weeks apart. A visual analog scale was utilized to assess pain of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Photographs were graded for change by three blinded evaluators using the Global Aesthetic Improvement Scale (GAIS). RESULTS Image sets of 23 enrolled subjects were assessed by blinded evaluation, showing a statistically significant improvement (p = 0.009) from the baseline visit to the 12-week follow-up on the GAIS for acne scarring. Subject satisfaction was high with subjects giving an average satisfaction score of 3.27 ("satisfied") out of 4. Pain was "mild" as treatments were rated an average of 2.15 on a 10-point visual analog scale. The GAIS score of the 80-pin tip improved patients' acne scars treated with that applicator by 1.06 points and 0.85 for the 160-pin tip. Ninety-five percent (95.5%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Ninety-one percent of subjects reported that they would recommend the treatment to a friend. CONCLUSION FRF produced a statistically significant improvement in acne scarring when assessed by independent blinded evaluators. No serious adverse events resulted from treatment by either applicator tip. Treatment pain was low and tolerable among subjects of all Fitzpatrick skin types. Subjects had high levels of satisfaction with the results.
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Affiliation(s)
- Stephen W. Eubanks
- Ameriderm ResearchLeavitt Medical Associates of FloridaPort OrangeFloridaUSA
| | - James A. Solomon
- Ameriderm ResearchLeavitt Medical Associates of FloridaPort OrangeFloridaUSA
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
- College of MedicineFlorida State UniversityOrlandoFloridaUSA
- Department of DermatologyCarle‐Illinois College of MedicineUrbanaIllinoisUSA
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Shang W, Quan Tan AY, van Steensel MAM, Lim X. ABERRANT WNT SIGNALING INDUCES COMEDO-LIKE CHANGES IN THE MURINE UPPER HAIR FOLLICLE. J Invest Dermatol 2021; 142:2603-2612.e6. [PMID: 34929175 DOI: 10.1016/j.jid.2021.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
Stem cell proliferation and differentiation must be carefully balanced to support tissue maintenance and growth. Defective stem cell regulation may underpin diseases in many organs, including the skin. Lrig1-expressing stem cells residing in the HF junction zone (JZ) support sebaceous gland (SG) homeostasis. An emerging hypothesis from observations in both mouse and human holds that imbalances in key stem cell regulatory pathways such as Wnt signaling may lead to abnormal fate determination of these Lrig1+ve cells. They accumulate and form cystic structures in the JZ that are similar to the comedones found in human acne. To test the possible involvement of Wnt signals in this scenario, we used the Lrig1-CreERT2 mouse line to modulate Wnt signaling in JZ stem cells. We observed that persistent activation of Wnt signaling leads to JZ cyst formation with associated SG atrophy. The cysts strongly express stem cell markers and can be partially reduced by all-trans retinoic acid treatment as well as by Hedgehog signaling inhibition. Conversely, loss of Wnt signaling leads to enlargement of JZ, infundibulum and SGs. These data implicate abnormal Wnt signaling in the generation of mouse pathologies that resemble human acne and respond to acne treatments.
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Affiliation(s)
- Wei Shang
- Skin Research Institute of Singapore, Agency for Science, Technology, and Research
| | - Alvin Yong Quan Tan
- Skin Research Institute of Singapore, Agency for Science, Technology, and Research
| | - Maurice A M van Steensel
- Skin Research Institute of Singapore, Agency for Science, Technology, and Research;; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore
| | - Xinhong Lim
- Skin Research Institute of Singapore, Agency for Science, Technology, and Research;.
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Valente Duarte de Sousa IC. Guidance for the pharmacological management of acne vulgaris. Expert Opin Pharmacother 2021; 23:49-62. [PMID: 34686076 DOI: 10.1080/14656566.2021.1990263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne. AREAS COVERED Herein, the author discusses the treatment of comedonal, papulopustular, and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases. EXPERT OPINION The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.
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Cutibacterium acnes tetracycline resistance profile in patients with acne vulgaris, in a Colombian dermatologic center. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Adolescents' beliefs and perceptions of acne vulgaris: A cross-sectional study in Montenegrin schoolchildren. PLoS One 2021; 16:e0253421. [PMID: 34133464 PMCID: PMC8208562 DOI: 10.1371/journal.pone.0253421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background Acne is a common chronic inflammatory skin disease with a high prevalence in adolescent and early adult years. The aim of this study was to assess the self-perceived beliefs of Montenegrin secondary school pupils regarding the acne aggravating and ameliorating factors. Methods This cross-sectional survey of the pupils was conducted during October and November 2020 in four randomly selected public secondary schools in Podgorica, Montenegro. All 500 pupils were asked to fill in a questionnaire that included questions on age, sex, presence of acne, perceived acne aggravating and ameliorating factors, and sources of their information about acne. Results A total of 500 pupils, 234 (46.8%) boys, and 266 (53.2%) girls, aged 14−17 years, participated in the study. Acne was self-reported in 249 (49.8%) pupils, whereas 251 (50.2%) did not report acne. Factors most often believed to aggravate acne were inadequate face washing (85.0%), hormones (84.0%), sweets (82.0%), greasy food (72.6%), makeup (71.2%), and stress (67.8%). Overall the most prevalent acne ameliorating factors were cosmetic treatment (80.4%), increased water consumption (77.6%), a diet change to a healthier food choice (77.4%), and being on school holidays (62.2%). Girls reported more frequently that genetics, stress, sweets consumption, inadequate face wash, and makeup are acne exacerbating factors, whilst cosmetic treatment, increased water consumption, smoking, and being on school holidays are acne ameliorating factors. Boys more frequently considered the benefit of losing weight. There was no statistically significant difference between pupils with and without acne in perceived factors, except for cosmetic treatment. Those with acne more frequently believed in the benefits of cosmetic treatment. Conclusions Many adolescents’ self-perceived beliefs about factors that aggravate and ameliorate acne are myths and misconceptions without evidence-based justification. More efforts are needed to educate pupils about the acne aggravating and ameliorating factors, its health-related consequences, and the treatment possibilities.
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Heng AHS, Say YH, Sio YY, Ng YT, Chew FT. Epidemiological Risk Factors Associated with Acne Vulgaris Presentation, Severity, and Scarring in a Singapore Chinese Population: A Cross-Sectional Study. Dermatology 2021; 238:226-235. [PMID: 34062533 DOI: 10.1159/000516232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acne vulgaris is classified based on the severity of skin lesions and post-healing scar types of these lesions. Numerous epidemiology studies have investigated the risk factors associated with acne presentation and severity, but studies for acne scarring are lacking. OBJECTIVE To investigate the prevalence of acne, severity, and scarring grades and their associated risk factors among Singapore Chinese. METHODS A total of 3,888 subjects (2,090 cases/1,798 controls; median age = 21 ± 4.589; range 17-71) completed an investigator-administered questionnaire as part of a cross-sectional study, which included sociodemographics, familial medical history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 991) and scarring (n = 988) grades by a trained personnel. RESULTS The majority of the acne cases had mild acne/grade 1 scarring, while less than 1% had severe acne/grade 4 scarring. Parental acne was significantly associated with acne presentation and moderate/severe acne, while sibling acne was significantly associated with grade 3/4 scarring. Gender and age affected acne severity and scarring but not acne presentation, while tertiary maternal education level and the possession of ≥3 siblings were particularly associated with acne scarring. Underweight BMI was protective against acne presentation, while atopic diseases (asthma, allergic rhinitis, eczema) were its predisposing factors. Of the evaluated lifestyle factors, computer/TV usage had significant association with acne presentation, while alcohol consumption was significantly associated with acne severity. Frequent milk consumption was associated with a protective effect for moderate-severe acne, while frequent butter consumption had a detrimental effect on acne scarring extent. CONCLUSION Positive familial history is a strong predisposing factor in determining acne presentation, severity, and scarring. Demographic factors (gender, age) and sedentary lifestyle (increased computer/TV usage) influence acne presentation, while dietary habits (milk and butter consumption) influence acne severity and scarring. The predisposing factors revealed in this study could help us to gain insights into acne pathophysiology and hence develop interventions especially targeting modifiable risk factors.
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Affiliation(s)
- Anna Hwee Sing Heng
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Yee-How Say
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore,
| | - Yang Yie Sio
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Yu Ting Ng
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
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Castellanos Lorduy HJ, Pérez Cely HC, Casadiego Rincón EJ, Henao Riveros SC, Colorado CL. Cutibacterium Acnes Tetracycline Resistance Profile in Patients with Acne Vulgaris, in a Colombian Dermatologic Center. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00191-5. [PMID: 34022206 DOI: 10.1016/j.ad.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. MATERIALS AND METHODS An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. RESULTS Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. CONCLUSIONS The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance.
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Affiliation(s)
- H J Castellanos Lorduy
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia; Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - E J Casadiego Rincón
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | | | - C L Colorado
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia
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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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Bagatin E, Costa CS, Rocha MADD, Picosse FR, Kamamoto CSL, Pirmez R, Ianhez M, Miot HA. Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:19-38. [PMID: 33036809 PMCID: PMC7772596 DOI: 10.1016/j.abd.2020.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. OBJECTIVE To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. METHODS Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. RESULTS With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. CONCLUSIONS Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.
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Affiliation(s)
- Ediléia Bagatin
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Fabíola Rosa Picosse
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Rodrigo Pirmez
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mayra Ianhez
- Department of Tropical Medicine and Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Faculdade de Ciências Médicas e Biológicas de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.
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Bagatin E, Costa CS. The use of isotretinoin for acne - an update on optimal dosing, surveillance, and adverse effects. Expert Rev Clin Pharmacol 2020; 13:885-897. [PMID: 32744074 DOI: 10.1080/17512433.2020.1796637] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Acne is a chronic, inflammatory, and immune mediated disease of pilosebaceous unit, highly prevalent in adolescents. It involves face, trunk, and back; may leave scars and affect quality of life. Early, effective, and safe treatment is the key for disease resolution. Oral isotretinoin is the unique treatment for cure or prolonged remission for moderate and severe acne, preventing psychosocial impact and scars. It inhibits sebaceous glands activity and has anti-inflammatory and immunoregulatory properties. AREAS COVERED We performed a comprehensive literature search on PubMed database, up to March 2020, regarding oral isotretinoin for acne treatment. We synthetized data about acne pathogenesis and mechanism of action, efficacy, and safety of isotretinoin. EXPERT OPINION This drug is effective, despite common, controllable, and reversible mucocutaneous side effects. Serious adverse events are rare and represent individual reactions. Teratogenicity is the most severe, requiring rigorous control. We believe that no other therapeutic option, even topicals combined to oral antibiotics accomplish same results. Recurrence after treatments other than isotretinoin is the rule, prolonging risk of scars, compromising skin appearance, and causing emotional distress in teenagers. If there is no absolute contraindication, isotretinoin should be the first line treatment for moderate to severe inflammatory acne.
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Affiliation(s)
- Edileia Bagatin
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, EPM/UNIFESP , Sao Paulo, SP, Brazil
| | - Caroline Sousa Costa
- Department of Specialized Medicine, Discipline of Dermatology, Universidade Federal do Piauí, UFPI , Teresina, PI, Brazil
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Savo I, Jorgaqi E, Vasili E, Mishtaku S, Demaj D, Jafferany M. Treatment‐seeking behavior, knowledge and beliefs about acne vulgaris among adolescents: A cross‐sectional study in high school students in Tirana, Albania. Dermatol Ther 2020; 33:e13500. [DOI: 10.1111/dth.13500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Irena Savo
- Dermatology Unit American Hospital Tirana Albania
| | - Ekleva Jorgaqi
- Dermatology Service University Hospital Center “Mother Theresa” Tirana Albania
| | - Ermira Vasili
- Dermatology Service University Hospital Center “Mother Theresa” Tirana Albania
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18
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Zhou M, Yang M, Zheng Y, Dong K, Song L, He C, Liu W, Wang Y, Jia Y. Skin surface lipidomics revealed the correlation between lipidomic profile and grade in adolescent acne. J Cosmet Dermatol 2020; 19:3349-3356. [DOI: 10.1111/jocd.13374] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Mingyue Zhou
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
| | - Manli Yang
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
| | - Yumei Zheng
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
| | - Kun Dong
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
| | - Liya Song
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
| | - Congfen He
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
| | - Wei Liu
- Department of Dermatology The General Hospital of Air Force Beijing China
| | - Yiyu Wang
- Department of Dermatology The General Hospital of Air Force Beijing China
| | - Yan Jia
- Beijing Key Laboratory of Plant Resources Research and Development School of Science Beijing Technology and Business University Beijing China
- Key Laboratory of Cosmetic of China National Light Industry School of Science Beijing Technology and Business University Beijing China
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Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep 2020; 10:5754. [PMID: 32238884 PMCID: PMC7113252 DOI: 10.1038/s41598-020-62715-3] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong association was observed between several risk factors – family history, age, BMI and skin type – and acne presentation or severity in multiple studies. The pooled odds ratio of 2.36 (95% CI 1.97–2.83) for overweight/obese BMI with reference to normal/underweight BMI and the pooled odds ratio of 2.91 (95% CI 2.58–3.28) for family history in parents with reference to no family history in parents demonstrate this strong association. In addition, a pooled odds ratio of 1.07 (95% CI 0.42–2.71) was obtained for sex (males with reference to females). However, the association between other factors, such as dietary factors and smoking, and acne presentation or severity was less clear, with inconsistent results between studies. Thus, further research is required to understand how these factors may influence the development and severity of acne. This study summarizes the potential factors that may affect the risk of acne presentation or severe acne and can help researchers and clinicians to understand the epidemiology of acne and severe acne. Furthermore, the findings can direct future acne research, with the hope of gaining insight into the pathophysiology of acne so as to develop effective acne treatments.
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Affiliation(s)
- Anna Hwee Sing Heng
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore.
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20
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Ghanem RE, Mostafa SH, Abu Hamamda NK, Khdour MR. Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Palestine: a cross-sectional study. Int J Dermatol 2020; 59:506-512. [PMID: 31930495 DOI: 10.1111/ijd.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/07/2019] [Accepted: 12/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acne vulgaris (AV) is a common dermatological disease affecting almost 85% of teenagers. Patients with AV usually present at community pharmacies during the early stages of their disease. AIM The aim of this study was to assess community pharmacists' knowledge, attitudes, and practice toward AV management in West Bank in Palestine. METHODS This study was a cross-sectional questionnaire-based study. The questionnaire included four sections: 1) demographic, 2) knowledge, 3) attitude and practice items related causes, and 4) treatment options and counseling during management of patients with AV. A convenience sampling method was implemented in this study. Parametric and non-parametric tests were used to compare different issues as appropriate. P < 0.05 were considered significant. RESULT A total of 270 community pharmacists were interviewed, and more than half (54.1%) were males. The study revealed that community pharmacists had an inadequate level of knowledge on management of AV; only 7.7% had high levels of knowledge. Pharmacists have positive attitude regarding AV management, but inadequate knowledge was reflected on their treatment practices; only 10% of participants independently dealt with AV without referral. Pharmacists with a low level of knowledge showed five times more referrals than those with a high level of knowledge (OR: 5.3; P < 0.001), and those with a bachelor degree showed three times more referrals than postgraduates (OR: 3.3; P < 0.001). CONCLUSION There is a demand to update dermatological knowledge of community pharmacists and encourage them to attend structured training programs about the management of AV.
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Affiliation(s)
- Rania E Ghanem
- Faculty of Pharmacy, Al-Quds University, Abu Deis, West Bank, Palestine
| | - Saja H Mostafa
- Faculty of Pharmacy, Al-Quds University, Abu Deis, West Bank, Palestine
| | | | - Maher R Khdour
- Faculty of Pharmacy, Al-Quds University, Abu Deis, West Bank, Palestine
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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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22
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Dogra S, Sumathy TK, Nayak C, Ravichandran G, Vaidya PP, Mehta S, Mittal R, Mane A, Charugulla SN. Efficacy and safety comparison of combination of 0.04% tretinoin microspheres plus 1% clindamycin versus their monotherapy in patients with acne vulgaris: a phase 3, randomized, double-blind study. J DERMATOL TREAT 2020; 32:925-933. [PMID: 32020824 DOI: 10.1080/09546634.2020.1720579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objectives: There is an unmet need for topical treatments with good tolerability in management of acne vulgaris. The present study aimed to evaluate efficacy and safety of a novel tretinoin (microsphere, 0.04%) formulation in combination with clindamycin (1%) gel for treatment of acne vulgaris.Materials and methods: This phase 3 randomized, double-blind study included patients with moderate-to-severe acne. Patients were treated with tretinoin (microsphere, 0.04%) + clindamycin (1%) or one of the monotherapies (tretinoin, 0.025%; clindamycin, 1%). Key endpoints included percent change in lesion counts, and improvement in Investigator's Static Global Assessment (ISGA) score.Results: 750 patients were randomized (combination, n = 300; tretinoin and clindamycin, each n = 150). At week 12, reductions in inflammatory (77%), non-inflammatory (71%) and total lesions (73%) were significantly greater with combination treatment versus either monotherapy (p < .03). Proportion of patients rated 'clear' or 'almost clear' with ≥2-grade ISGA improvement was higher with combination (46%) versus monotherapies (p < .02). Adverse events occurred in 20 patients, most were mild-moderate; no deaths or serious adverse events were reported. The discontinuation rates due to adverse events with combination therapy were low (≤1%).Conclusion: The once-daily, microsphere-based formulation was generally tolerable with a positive impact on therapeutic outcomes and patients' compliance. ClinicalTrial Registration No.: CTRI/2014/08/004830.
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Affiliation(s)
- S Dogra
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - T K Sumathy
- Department of Dermatology, M.S. Ramaiah Medical College and Hospital, Bengaluru, India
| | - C Nayak
- Department of Dermatology, BYL Nair CH Hospital & TNMC, Mumbai, India
| | - G Ravichandran
- Department of Dermatology, Apollo Hospitals, Chennai, India
| | - P P Vaidya
- Department of Dermatology, Apollo Jehangir Hospital, Pune, India
| | - S Mehta
- Medical Affairs Division, Dr Reddy's Laboratories Ltd, Hyderabad, India
| | - R Mittal
- Medical Affairs Division, Dr Reddy's Laboratories Ltd, Hyderabad, India
| | - A Mane
- Medical Affairs Division, Dr Reddy's Laboratories Ltd, Hyderabad, India
| | - S N Charugulla
- Medical Affairs Division, Dr Reddy's Laboratories Ltd, Hyderabad, India
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Clayton R, Göbel K, Niessen C, Paus R, Steensel M, Lim X. Homeostasis of the sebaceous gland and mechanisms of acne pathogenesis. Br J Dermatol 2019; 181:677-690. [DOI: 10.1111/bjd.17981] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- R.W. Clayton
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Centre for Dermatology Research University of Manchester, and NIHR Manchester Biomedical Research Centre Manchester U.K
| | - K. Göbel
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Department of Dermatology Cologne Excellence Cluster on Stress Responses in Aging Associated Diseases (CECAD), and Centre for Molecular Medicine Cologne The University of Cologne Germany
| | - C.M. Niessen
- Department of Dermatology Cologne Excellence Cluster on Stress Responses in Aging Associated Diseases (CECAD), and Centre for Molecular Medicine Cologne The University of Cologne Germany
| | - R. Paus
- Centre for Dermatology Research University of Manchester, and NIHR Manchester Biomedical Research Centre Manchester U.K
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL U.S.A
| | - M.A.M. Steensel
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
| | - X. Lim
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
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24
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Common J, Barker J, Steensel M. What does acne genetics teach us about disease pathogenesis? Br J Dermatol 2019; 181:665-676. [DOI: 10.1111/bjd.17721] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 12/18/2022]
Affiliation(s)
- J.E.A. Common
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR) Singapore
| | - J.N. Barker
- St John's Institute of Dermatology Faculty of Life Sciences and Medicine King's College London London U.K
| | - M.A.M. Steensel
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR) Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building Novena Singapore
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Castillo DE, Nanda S, Keri JE. Propionibacterium (Cutibacterium) acnes Bacteriophage Therapy in Acne: Current Evidence and Future Perspectives. Dermatol Ther (Heidelb) 2018; 9:19-31. [PMID: 30539425 PMCID: PMC6380980 DOI: 10.1007/s13555-018-0275-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 12/30/2022] Open
Abstract
Acne vulgaris is the most common dermatological disorder worldwide. It is a multifactorial disease that involves increased sebum production, hyperkeratinization of the pilosebaceous unit, Propionibacterium acnes (Cutibacterium acnes) colonization, and inflammation. The human skin microbiome hosts a wide variety of microorganisms, including bacteria, viruses, and fungi. A delicate balance of these microorganisms is essential for the barrier function of the skin. Propionibacterium acnes represents nearly 90% of the human skin microbiome of healthy adults. Acne is a chronic recurrent disease that requires long-lasting treatment, which has led to the emergence of antibiotic resistance. New alternatives to traditional therapy are emerging, including antimicrobial peptides, natural engineered antibodies, and bacteriophages. Bacteriophages have been shown to play a role in human skin health and disease. There is evidence supporting phage therapy in many types of skin infections. P. acnes bacteriophages have been isolated and characterized. However, only a few in vitro studies have tested the ability of bacteriophages to kill P. acnes. Furthermore, there is no evidence on bacteriophage therapy in the treatment of acne in humans. In this review, we summarize the most recent evidence regarding P. acnes bacteriophages and the potential role of these bacteriophages in the treatment of acne. Further research on this field will provide the evidence to use phage therapy to decrease rates of antibiotic resistance and restore antibiotic susceptibility of P. acnes.
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Affiliation(s)
- David E Castillo
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonali Nanda
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonette E Keri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Veterans Affairs Miami Health Care System, Miami, FL, USA.
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Costa CS, Bagatin E, Martimbianco ALC, da Silva EMK, Lúcio MM, Magin P, Riera R. Oral isotretinoin for acne. Cochrane Database Syst Rev 2018; 11:CD009435. [PMID: 30484286 PMCID: PMC6383843 DOI: 10.1002/14651858.cd009435.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit associated with socialisation and mental health problems, may affect more than 80% of teenagers. Isotretinoin is the only drug that targets all primary causal factors of acne; however, it may cause adverse effects. OBJECTIVES To assess efficacy and safety of oral isotretinoin for acne vulgaris. SEARCH METHODS We searched the following databases up to July 2017: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and LILACS. We updated this search in March 2018, but these results have not yet been incorporated in the review. We also searched five trial registries, checked the reference lists of retrieved studies for further references to relevant trials, and handsearched dermatology conference proceedings. A separate search for adverse effects of oral isotretinoin was undertaken in MEDLINE and Embase up to September 2013. SELECTION CRITERIA Randomised clinical trials (RCTs) of oral isotretinoin in participants with clinically diagnosed acne compared against placebo, any other systemic or topical active therapy, and itself in different formulation, doses, regimens, or course duration. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 31 RCTs, involving 3836 participants (12 to 55 years) with mild to severe acne. There were twice as many male participants as females.Most studies were undertaken in Asia, Europe, and North America. Outcomes were generally measured between eight to 32 weeks (mean 19.7 weeks) of therapy.Assessed comparisons included oral isotretinoin versus placebo or other treatments such as antibiotics. In addition, different doses, regimens, or formulations of oral isotretinoin were assessed, as well as oral isotretinoin with the addition of topical agents.Pharmaceutical companies funded 12 included trials. All, except three studies, had high risk of bias in at least one domain.Oral isotretinoin compared with oral antibiotics plus topical agentsThese studies included participants with moderate or severe acne and assessed outcomes immediately after 20 to 24 weeks of treatment (short-term). Three studies (400 participants) showed isotretinoin makes no difference in terms of decreasing trial investigator-assessed inflammatory lesion count (RR 1.01 95% CI 0.96 to 1.06), with only one serious adverse effect found, which was Stevens-Johnson syndrome in the isotretinoin group (RR 3.00, 95% CI 0.12 to 72.98). However, we are uncertain about these results as they were based on very low-quality evidence.Isotretinoin may slightly improve (by 15%) acne severity, assessed by physician's global evaluation (RR 1.15, 95% CI 1.00 to 1.32; 351 participants; 2 studies), but resulted in more less serious adverse effects (67% higher risk) (RR 1.67, 95% CI 1.42 to 1.98; 351 participants; 2 studies), such as dry lips/skin, cheilitis, vomiting, nausea (both outcomes, low-quality evidence).Different doses/therapeutic regimens of oral isotretinoinFor our primary efficacy outcome, we found three RCTs, but heterogeneity precluded meta-analysis. One study (154 participants) reported 79%, 80% and 84% decrease in total inflammatory lesion count after 20 weeks of 0.05, 0.1, or 0.2 mg/kg/d of oral isotretinoin for severe acne (low-quality evidence). Another trial (150 participants, severe acne) compared 0.1, 0.5, and 1 mg/kg/d oral isotretinoin for 20 weeks and, respectively, 58%, 80% and 90% of participants achieved 95% decrease in total inflammatory lesion count. One RCT, of participants with moderate acne, compared isotretinoin for 24 weeks at (a) continuous low dose (0.25 to 0.4 mg/kg/day), (b) continuous conventional dose (0.5 to 0.7 mg/kg/day), and (c) intermittent regimen (0.5 to 0.7 mg/kg/day, for one week in a month). Continuous low dose (MD 3.72 lesions; 95% CI 2.13 to 5.31; 40 participants; one study) and conventional dose (MD 3.87 lesions; 95% CI 2.31 to 5.43; 40 participants; one study) had a greater decrease in inflammatory lesion counts compared to intermittent treatment (all outcomes, low-quality evidence).Fourteen RCTs (906 participants, severe and moderate acne) reported that no serious adverse events were observed when comparing different doses/therapeutic regimens of oral isotretinoin during treatment (from 12 to 32 weeks) or follow-up after end of treatment (up to 48 weeks). Thirteen RCTs (858 participants) analysed frequency of less serious adverse effects, which included skin dryness, hair loss, and itching, but heterogeneity regarding the assessment of the outcome precluded data pooling; hence, there is uncertainty about the results (low- to very-low quality evidence, where assessed).Improvement in acne severity, assessed by physician's global evaluation, was not measured for this comparison.None of the included RCTs reported birth defects. AUTHORS' CONCLUSIONS Evidence was low-quality for most assessed outcomes.We are unsure if isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician-assessed acne severity. Only one serious adverse event was reported in the isotretinoin group, which means we are uncertain of the risk of serious adverse effects; however, isotretinoin may result in more minor adverse effects.Heterogeneity in the studies comparing different regimens, doses, or formulations of oral isotretinoin meant we were unable to undertake meta-analysis. Daily treatment may be more effective than treatment for one week each month. None of the studies in this comparison reported serious adverse effects, or measured improvement in acne severity assessed by physician's global evaluation. We are uncertain if there is a difference in number of minor adverse effects, such as skin dryness, between doses/regimens.Evidence quality was lessened due to imprecision and attrition bias. Further studies should ensure clearly reported long- and short-term standardised assessment of improvement in total inflammatory lesion counts, participant-reported outcomes, and full safety accounts. Oral isotretinoin for acne that has not responded to oral antibiotics plus topical agents needs further assessment, as well as different dose/regimens of oral isotretinoin in acne of all severities.
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Affiliation(s)
- Caroline S Costa
- Universidade Federal de São PauloEmergency Medicine and Evidence Based MedicineRua Napoleão de Barros, 865São PauloSao PauloBrazil04024‐002
| | - Ediléia Bagatin
- Universidade Federal de São PauloDepartment of DermatologyRua Borges Lagoa, 508São PauloSão PauloBrazil04038‐000
| | - Ana Luiza C Martimbianco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Edina MK da Silva
- Universidade Federal de São PauloEmergency Medicine and Evidence Based MedicineRua Napoleão de Barros, 865São PauloSao PauloBrazil04024‐002
| | - Marília M Lúcio
- Universidade Federal de São PauloBrazilian Cochrane CentreRua Pedro de Toledo, 598São PauloSão PauloBrazil04039‐001
| | - Parker Magin
- The University of NewcastleDiscipline of General Practice, School of Medicine and Public HealthNewbolds Buiding, University of Newcastle,University DriveNewcastleAustralia2308
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
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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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Yang S, Long V, Liau M, Lee S, Toh M, Teo J, Tan C, Aw D. A profile ofPropionibacterium acnesresistance and sensitivity at a tertiary dermatological centre in Singapore. Br J Dermatol 2018; 179:200-201. [DOI: 10.1111/bjd.16380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S.S. Yang
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | | | - M.M. Liau
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - S.H. Lee
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - M. Toh
- National University of Singapore; Singapore Singapore
| | - J. Teo
- Laboratory Medicine; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - C. Tan
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - D. Aw
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
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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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30
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Wolkenstein P, Machovcová A, Szepietowski J, Tennstedt D, Veraldi S, Delarue A. Acne prevalence and associations with lifestyle: a cross-sectional online survey of adolescents/young adults in 7 European countries. J Eur Acad Dermatol Venereol 2017; 32:298-306. [DOI: 10.1111/jdv.14475] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022]
Affiliation(s)
- P. Wolkenstein
- Department of Dermatology; Hôpital Henri Mondor; APHP; UPEC; Créteil France
| | - A. Machovcová
- Department of Dermatology and Venerology; Motol Hospital; Prague Czech Republic
| | - J.C. Szepietowski
- Department of Dermatology, Venerology and Allergology; Medical University; Wroclaw Poland
| | - D. Tennstedt
- Department of Dermatology; UCL; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - S. Veraldi
- Department of Pathophysiology and Transplantation; University of Milan; Milan Italy
| | - A. Delarue
- Pierre Fabre Dermatologie; Les Cauquillous; Lavaur France
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Abstract
INTRODUCTION: Although acne vulgaris is common in adolescents, information on their understanding of acne is minimal. OBJECTIVES: To evaluate the perceptions and beliefs of Saudi youth on acne. MATERIALS AND METHODS: Three hundred twenty-nine male students (aged 13–22 years) from 6 secondary schools in the Eastern Saudi Arabia completed a self-reported questionnaire on knowledge, causation, exacerbating and relieving factors of acne. Data were analyzed by SPSS version 15.0. Results of subjects with acne, a family history of acne, and parents' educational levels were compared. Differences between the analyzed groups were assessed by a Chi-square test; p ≤ 0.05 was considered statistically significant. RESULTS: Over half (58.9%) of the participants considered acne a transient condition not requiring therapy. Only 13.1% knew that the proper treatment of acne could take a long time, even several years. Over half (52%) thought acne can be treated from the first or after few visits to the doctor. Popular sources of information were television/radio (47.7%), friends (45.6%), and the internet (38%). Only 23.4% indicated school as a source of knowledge. Reported causal factors included scratching (88.5%) and squeezing (82.1%) of pimples, poor hygiene (83.9%), poor dietary habits (71.5%), and stress (54.1%). Ameliorating factors included frequent washing of the face (52.9%), exercise (41.1%), sunbathing (24.1%), and drinking of mineral water (21%). The correlations of these facts are discussed. CONCLUSION: Results of this study point out that misconceptions of acne are widespread among Saudi youth. A health education program is needed to improve the understanding of the condition.
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Affiliation(s)
- Sahar H Al-Natour
- Department of Dermatology, College of Medicine, University of Dammam, Dammam, Kingdom of Saudi Arabia
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Campbell CE, Strassmann BI. The blemishes of modern society? Acne prevalence in the Dogon of Mali. Evol Med Public Health 2016; 2016:325-337. [PMID: 27651516 PMCID: PMC5046992 DOI: 10.1093/emph/eow027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Non-communicable diseases may reflect an evolutionary mismatch between our human ancestry and modern environments. To explore the mismatch hypothesis for Acne vulgaris, we studied the prevalence and severity of acne in Dogon adolescents in Mali, West Africa. METHODOLOGY We graded the prevalence and severity of acne in 1182 Dogon adolescents aged 11-18 years from nine villages using facial photos taken as part of a prospective cohort study. Eighty-nine (89%) of the individuals in the cohort migrated to the city during adolescence, enabling us to assess the effect of urban migration. Using multivariable logistic regression, we estimated the effect of predictor variables on the presence of acne. RESULTS The prevalence of acne in the cohort was 28%, with 90% of cases being mild or very mild. Thus, the prevalence and severity of acne was much lower than for adolescents in high-income countries. Controlling for age, puberty, and body mass index (BMI), the odds of boys developing acne was 85% lower in the city than in the villages (P = 0.002). CONCLUSION AND IMPLICATIONS Acne is similar to the 'diseases of civilization' in being promoted by the pro-inflammatory properties of modern diets. The low prevalence and severity of acne in the Dogon supports the mismatch hypothesis and suggests that acne should join the list of diseases of modern lifestyles. However, we also observed an unexpected decrease in acne in urban boys. Future research is needed for a deeper mechanistic understanding of the interplay between diet, inflammation, immune function and other environmental exposures that differ between urban and rural environments.
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Affiliation(s)
- Christine E Campbell
- Department of Anthropology & Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Beverly I Strassmann
- Department of Anthropology & Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Tan JKL, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol 2016; 172 Suppl 1:3-12. [PMID: 25597339 DOI: 10.1111/bjd.13462] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 12/15/2022]
Abstract
Acne is estimated to affect 9.4% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, with boys most frequently affected, particularly with more severe forms of the disease. This paper aims to provide an update on the epidemiology of acne worldwide. Recent general and institutional studies from around the world have shown that the prevalence of acne is broadly consistent globally (with the exception of specific populations, which are discussed). However, this review highlights that there is a wide range of disparate outcome measures being applied in epidemiology studies, and we emphasize the need to develop a widely accepted, credible, standard assessment scale to address this in the future. In addition we discuss special populations, such as those devoid of acne, as well as the impact of potential determinants of acne on disease epidemiology.
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Affiliation(s)
- J K L Tan
- Windsor Clinical Research Inc. and Western University, London, ON, Canada
| | - K Bhate
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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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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[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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Chuah SY, Goh CL. The Impact of Post-Acne Scars on the Quality of Life Among Young Adults in Singapore. J Cutan Aesthet Surg 2015; 8:153-8. [PMID: 26644739 PMCID: PMC4645145 DOI: 10.4103/0974-2077.167272] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: Post-acne scarring is a common and well-known sequelae of acne vulgaris. We aim to study the impact of post-acne scarring on the quality of life (QOL) among young adults in Singapore. Settings and Design: This was a non-interventional prospective study. Materials and Methods: Patients aged 21-40 years with atrophic and hypertrophic acne scars who attended the National Skin Centre, Singapore were recruited in the study. They answered a simple questionnaire and the clinical severity of their acne scars were assessed by the doctor. Statistical Analysis Used: Descriptive analyses using absolute and percentage frequencies were performed on all data. The test of significance was two-sided and was set at 5% (P ≤ 0.05). Differential analyses were conducted using the parametric, independent two-sample t-test and non-parametric Mann–Whitney U-test. The statistical assessments were performed using SPSS version 18.0. Results: A total of 100 patients were studied. The mean patients’ subjective self-scoring on the severity of their post-acne scars was 5.78/10 and the mean Dermatology Life Quality Index (DLQI) for post-acne scars was 5.61. Many (36%, n = 36) were self-conscious of their acne scars and 24%, (n = 24) felt that their acne scars was affecting their social activities. Conclusions: Our study showed that post-acne scars have a significant negative effect on the QOL of young adults. It highlights the need to increase public awareness of acne vulgaris and its sequelae through education programs and advocating early treatment to reduce the risk of scarring.
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Affiliation(s)
- Sai Yee Chuah
- Department of Dermatology, National Skin Centre, Singapore
| | - Chee Leok Goh
- Department of Dermatology, National Skin Centre, Singapore
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Su P, Chen Wee Aw D, Lee SH, Han Sim Toh MP. Beliefs, perceptions and psychosocial impact of acne amongst Singaporean students in tertiary institutions. J Dtsch Dermatol Ges 2015; 13:227-33. [PMID: 25721632 DOI: 10.1111/ddg.12578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acne vulgaris is a common skin condition which can have a negative impact on a patient's quality of life. PATIENTS AND METHODS A survey was distributed among students at tertiary institutions. Data was collected on participants' own rating of acne grade and how acne affected their social life. A clinician on-site graded the participants' acne. RESULTS Of the 429 students who participated in the survey, 59.8 % felt embarrassed or self-conscious because of their acne. There was a low but statistically significant correlation (Spearman's Correlation Coefficient = 0.471, p < 0.001) between participants' and clinicians' grading of acne. CONCLUSIONS Acne vulgaris causes a considerable amount of psychosocial stress. There are unfounded beliefs surrounding acne and unawareness of treatment options available.
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Affiliation(s)
- Peiqi Su
- Department of Dermatology, National University Hospital, Singapore
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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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Park SY, Kwon HH, Min S, Yoon JY, Suh DH. Epidemiology and risk factors of childhood acne in Korea: a cross-sectional community based study. Clin Exp Dermatol 2015; 40:844-50. [PMID: 26011595 DOI: 10.1111/ced.12686] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The epidemiology of acne vulgaris appears to be evolving, with an increasingly earlier onset seen in childhood. Relevant studies have been rarely performed in Asia. AIM We sought to estimate the prevalence and clinical characteristics of acne among schoolchildren, and its association with treatment-seeking behaviour, body mass index (BMI), nutritional habits and other lifestyle elements. METHODS A cross-sectional study was conducted with elementary schoolchildren aged 7-12 years. Children were interviewed by self-administered questionnaires, and were subsequently evaluated by dermatologists. RESULTS Of 693 children enrolled, 36.2% were diagnosed with acne, and the prevalence increased with age. Additionally, clinical characteristics including severity, duration of disease and lesion distribution were significantly different between the lower (aged 7-9 years) and the higher (aged 10-12 years) grades. Subjective features including recognition about acne and treatment-seeking behaviours were also different between the two groups. Overweight or obesity (BMI ≥ 25 kg/m(2) at 18 years of age; OR = 2.7) and consumption of chocolates/sweets (OR = 1.6) were significant risk factors for acne. CONCLUSIONS In the current study, the prevalence of acne among elementary schoolchildren was high, but only a few children had received treatment. Physicians should be attentive to childhood acne, and educate patients and their parents about the need to treat it.
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Affiliation(s)
- S Y Park
- Department of Dermatology, Seoul National University Hospital, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - H H Kwon
- Department of Dermatology, Seoul National University Hospital, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - S Min
- Department of Dermatology, Seoul National University Hospital, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - J Y Yoon
- Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - D H Suh
- Department of Dermatology, Seoul National University Hospital, Seoul, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
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Su P, Wee Aw DC, Hui Lee S, Han Sim Toh MP. Vorstellungen, Wahrnehmung und psychosoziale Auswirkungen von Akne bei singapurischen Hochschulstudenten. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12578_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Peiqi Su
- Department of Dermatology, National University Hospital; Singapore
| | | | - Siew Hui Lee
- Department of Dermatology, National University Hospital; Singapore
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Karciauskiene J, Valiukeviciene S, Stang A, Gollnick H. Beliefs, perceptions, and treatment modalities of acne among schoolchildren in Lithuania: A cross-sectional study. Int J Dermatol 2015; 54:e70-8. [DOI: 10.1111/ijd.12753] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Jurgita Karciauskiene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Andreas Stang
- Institute of Clinical Epidemiology; Martin-Luther-University; Halle Germany
| | - Harald Gollnick
- Department of Dermatology and Venereology; Otto-von-Guericke-University; Magdeburg Germany
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44
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Wang H, Guo M, Shen S, He L, Zhang X, Zuo X, Yang S. Variants inSELL,MRPS36P2,TP63,DDB2,CACNA1H,ADAM19,GNAI1,CDH13andGABRG2interact to confer risk of acne in Chinese population. J Dermatol 2015; 42:378-81. [PMID: 25573302 DOI: 10.1111/1346-8138.12754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/18/2014] [Indexed: 12/18/2022]
Affiliation(s)
- HongYan Wang
- Institute of Dermatology and Department of Dermatology at No. 1 Hospital; Anhui Medical University; Hefei Anhui China
| | - MeiHua Guo
- Kunming Medical University; Kunming Yunnan China
| | - SongKe Shen
- Institute of Dermatology and Department of Dermatology at No. 1 Hospital; Anhui Medical University; Hefei Anhui China
| | - Li He
- Kunming Medical University; Kunming Yunnan China
| | - XueJun Zhang
- Institute of Dermatology and Department of Dermatology at No. 1 Hospital; Anhui Medical University; Hefei Anhui China
| | - XianBo Zuo
- Institute of Dermatology and Department of Dermatology at No. 1 Hospital; Anhui Medical University; Hefei Anhui China
| | - Sen Yang
- Institute of Dermatology and Department of Dermatology at No. 1 Hospital; Anhui Medical University; Hefei Anhui China
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45
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Ogedegbe EE, Henshaw EB. Severity and impact of acne vulgaris on the quality of life of adolescents in Nigeria. Clin Cosmet Investig Dermatol 2014; 7:329-34. [PMID: 25525376 PMCID: PMC4266243 DOI: 10.2147/ccid.s73302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acne vulgaris is a common skin condition, which affects most adolescents at some point in their lives. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicide ideation. Many studies have assessed the impact of acne vulgaris on the quality of life (QoL) in different population subgroups around the world, but there is a dearth of reports from the African subcontinent. This study thus seeks to assess the severity of acne vulgaris and determine its effect on the QoL of adolescents in Lagos, Nigeria. METHODS In a cross-sectional survey employing a two-stage sampling method, the severity of acne vulgaris and its impact on the QoL of adolescents attending a senior secondary school in Lagos, Nigeria was assessed using the Global Acne Grading Scale (GAGS) and the Cardiff Acne Disability Index (CADI), respectively. The correlation between the results of the GAGS and CADI was also determined. RESULTS One hundred and sixty adolescent students with acne were recruited, with males accounting for 51.9% and females 48.1%. The mean and standard deviation of the GAGS severity scores were 11.3±5.4 for males and 11.9±5.4 for females. Only one student had severe acne vulgaris (GAGS, 31-38), 10% moderate (GAGS, 19-30), and 89.4% mild (GAGS, 1-18). The overall CADI score was 3.4±3.0, which suggests mild impairment in QoL; however, the solitary student with severe acne had severe QoL impairment. There was a weak positive correlation between the GAGS and the CADI score. CONCLUSION Most adolescents in our study had mild acne vulgaris, and the overall impact on their QoL was mild. However, the correlation between the psychosocial impact and acne severity was weak. There is a need for similar studies in other parts of the country and for further studies to determine the adequacy of the existing instruments in assessing the impact of acne vulgaris in Nigerian adolescents.
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Affiliation(s)
| | - Eshan B Henshaw
- Department of Medicine, Faculty of Medicine and Dentistry, University of Calabar, Cross River State, Nigeria
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Kumar A, Baboota S, Agarwal SP, Ali J, Ahuja A. Treatment of acne with special emphasis on herbal remedies. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.3.1.111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Sociodemographic Characteristics of Acne among University Students in Damascus, Syria. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/974019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To estimate the prevalence and identify risk factors that may be associated with acne among university students in Syria, a cross-sectional study was conducted in the Syrian International University for Science and Technology in December 2009. A sample of 500 students was chosen. Each participant was subjected to an interview and clinical examination of acne in addition to height and weight measurements. Acne prevalence was 34.7% (172/496). Male students had higher rate of acne compared to females (42.9% versus 23.6%, P<0.0001) and their acne started significantly at a younger age (18.13 versus 19.04 years old, P<0.0001). Face was the commonest site for acne in both males and females. Washing face frequently per day in both sexes has a significant relation with a decreased prevalence of acne. Moreover, psychological stress particularly when the students were away from family was associated with a significant higher rate of acne. We found that the prevalence of acne steadily increased with increasing body mass index. Acne is a health and psychological problem among university students particularly when affecting the face. Several factors such as gender, body mass index, and stress were found to be associated with acne formation.
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Igbeneghu OA. The antimicrobial assessment of some Nigerian herbal soap. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2013; 10:513-8. [PMID: 24311879 DOI: 10.4314/ajtcam.v10i6.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Twenty samples of herbal soaps were evaluated for their antimicrobial activity against bacteria and yeast of significance in skin infections with the aim to provide some justification for the continued use of the soaps in the management of superficial skin infections. All the soaps were found to possess antimicrobial activity in a concentration and organism dependent manner. The soaps were more active against the gram positive organisms than the Gram negative organisms while none of the soaps had activity against the tested yeasts. Only 35% of the soaps were appropriately packaged with adequate directions for use and storage. The study showed that the tested soaps possessed antimicrobial properties and they can contribute to the treatment and management of skin infections caused by bacteria if well prepared with the appropriate plant materials to target specific causative organisms and packaged with appropriate directions for use and storage.
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Affiliation(s)
- O A Igbeneghu
- Department of Pharmaceutics, Obafemi Awolowo University, Ile-Ife
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50
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Karciauskiene J, Valiukeviciene S, Gollnick H, Stang A. The prevalence and risk factors of adolescent acne among schoolchildren in Lithuania: a cross-sectional study. J Eur Acad Dermatol Venereol 2013; 28:733-40. [DOI: 10.1111/jdv.12160] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J. Karciauskiene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - S. Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - H. Gollnick
- Department of Dermatology and Venereology; Otto-von-Guericke-University; Magdeburg Germany
| | - A. Stang
- Institute of Clinical Epidemiology; Martin-Luther-University; Halle Germany
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