Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women

The impact of using the levonorgestrel-releasing intrauterine device on the incidence of acne in adolescents and young women

PURPOSE

To evaluate the impact of levonorgestrel-releasing intrauterine device (LNG-IUD) use on the incidence of acne in adolescents and young women.

METHODS

A narrative review was conducted in PubMed, Embase, Cochrane, and SciELO assessing the incidence of acne in adolescents and young women using LNG-IUD (13.5, or 19.5 mg, or 52 mg). Cohort, cross-sectional studies, clinical trials, and meta-analyses were included, without a date limit. Studies that didn't evaluate women in the age of interest were excluded. Only articles in English were selected.

RESULTS

Nine articles were included in this narrative review. Only clinical trials, cohort studies, and cross-sectional studies were evaluated. Two cross-sectional studies evaluated the incidence of acne in women using any contraceptive methods, with the incidence of acne being 36% in women aged 17 to 47 using LNG-IUD in one study. In another study, acne incidence ranged from 2 to 8% in women using any contraceptive methods, with higher rates in younger women and LNG-IUD users. The incidence of acne varies and participants between 16 to 35 years were more likely to report new acne or worsening of pre-existing acne. In a prospective cohort study of women between 16 and 24 years, acne was a common adverse effect, with 44% in the first year.

CONCLUSION

The data indicate variability in the incidence of acne among LNG-IUD users, with a higher prevalence observed in younger women. Further research should focus on the effects of LNG-IUD on acne in young populations, with rigorous study designs and consideration of previous contraceptive use.

The epidemiology of acne vulgaris in a multiethnic adolescent population from Rotterdam, the Netherlands: A cross-sectional study

BACKGROUND

Although acne is a prevalent multifactorial inflammatory skin condition, few studies were performed in multiethnic populations.

OBJECTIVES

To study the prevalence and determinants of acne in a multiethnic study at the start of puberty.

METHODS

This cross-sectional study is embedded in Generation R, a population-based prospective study from Rotterdam, the Netherlands. Three-dimensional facial photos at the center visit in 2016-2019 (of ∼13-year-olds) were used to grade acne severity using the Global Evaluation of the Acne Severity (GEA). Analyses were stratified by biological sex and explored through chi-square tests and multivariable ordinal logistic regression.

RESULTS

A total of 4561 children (51% girls) with a median age of 13.5 (IQR 13.3-13.6) were included. The visible acne prevalence (GEA 2-5) for girls vs boys was 62% vs 45% and moderate-to-severe acne (GEA 3-5) 14% vs 9%. Higher puberty stages (adjusted odds ratios: 1.38 [1.20-1.59] and 2.16 [1.86-2.51] for girls and boys, respectively) and darker skin colors V and VI (adjusted odds ratios: 1.90 [1.17-3.08] and 2.43 [1.67-3.56]) were associated with more severe acne in both sexes, and being overweight in boys (adjusted odds ratio: 1.58 [1.15-2.17]).

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

Acne prevalence was high at the age of 13 years and was associated with advanced puberty, darker skin color, and weight status.

Risk Factors for Chalazion Diagnosis and Subsequent Surgical Excision

PURPOSE

To identify factors associated with chalazion diagnosis and surgical excision.

METHODS

Patients with an incident chalazion diagnosis from 2002 to 2019 were compared 1:5 with matched controls. Multivariable logistic regression was performed to identify variables associated with diagnosis and surgical excision.

RESULTS

Chalazion patients (n = 134,959) and controls (678,160) were analyzed. Risk factors for diagnosis included female sex, non-white race, northeast location, conditions affecting periocular skin and tear film (blepharitis, meibomian gland dysfunction, rosacea, pterygium), non-ocular inflammatory conditions (gastritis, inflammatory bowel disease, sarcoidosis, seborrheic dermatitis, Graves' disease), and smoking (p < .001 for all comparisons). Thirteen percent of patients with chalazion underwent subsequent surgical excision. Diabetes and systemic sclerosis diagnoses decreased odds of diagnosis (p < .001). Male sex, rosacea diagnosis, Black and Hispanic race, antibiotic use, and doxycycline use increased odds of surgery (p < .001).

CONCLUSION

Female sex, non-white race, conditions affecting periocular skin and the tear film, several non-ocular inflammatory conditions, and smoking were risk factors for chalazion diagnosis. Male sex, rosacea diagnosis, Black and Hispanic race, antibiotic use, and doxycycline use were risk factors for surgical intervention for chalazion. Our results prompt further study of these variables and their relationship to chalazion diagnosis to understand physiology and improve clinical outcomes. Furthermore, the results of this study suggest early recognition and treatment of concomitant rosacea may serve an important role in the management of chalazion and in the prevention of surgical intervention.

Evaluation of an Acne Severity Grading Self-Assessment System Suitable for the Thai Population - A Pilot Study

Background

Patient self-assessment is a potential tool in clinical practice to obtain subjective information of acne severity also in clinical trials to assess the general population in research and epidemiologic studies. The patient self-evaluation of acne severity has not yet been developed in Thailand.

Objective

We aimed to validate an acne severity grading self-assessment suitable for the Thai population.

Methods

A pilot study was conducted in 77 volunteers with acne lesions. We developed the Thai Global Evaluation Acne Scale (TGEA) and Thai Global Acne Grading System (TGAGS) by translating and adapting the original version. Patient self-assessment of acne severity was performed in two rounds. A training session about acne was provided to all participants lesions before starting the second round. Reliability between the self-assessment and clinician assessment of acne severity was statistically assessed.

Results

For TGEA, 48.05% participants rated their acne severity corresponded with the clinicians (Cohen's kappa coefficient, kappa = 0.26). After receiving the training, 79.22% subjects responded their acne severity corresponded with the clinicians (kappa = 0.66). For TGAGS, 77.92% patients who answered their acne severity corresponded with the clinicians (kappa = 0.52). After receiving the training, 94.80% participants responded their acne severity corresponded with the clinicians (kappa = 0.89). For raw score of the TGAGS, the intraclass correlation coefficient (ICC) during the self-assessment of acne severity compared to the clinician assessments was 0.54 and it increased to 0.79 after the training.

Conclusion

Due to the almost perfect reliability, we suggested that TGAGS is a reliable subjective self-assessment of acne severity suitable for the Thai population. The training is essential in enhancing the reliability of this instrument. Our study's findings can facilitate clinical practice and research studies.

12-Week, Single-Center Study of a Targeted Pigment-Correcting Dark Spot Treatment for Post-Inflammatory Hyperpigmentation and Solar Lentigines

Purpose

Post-inflammatory hyperpigmentation (PIH) and solar lentigines are dark spots of skin from excessive melanin production due to injury or UV exposure. This 12-week single-center study assessed the efficacy and tolerability of a novel targeted pigment-correcting spot treatment gel suspension cream (Dark Spot Treatment) for improving mild-to-moderate PIH or solar lentigines.

Patients and Methods

Female participants (N = 41) aged 25-65 with mild-to-moderate facial dark spots applied Dark Spot Treatment daily for 12 weeks. Investigators assessed overall hyperpigmentation, skin tone evenness, and dark spot intensity, contrast, and size at Weeks 2, 4, 8, and 12. Participant self-assessments occurred at Weeks 1, 2, 4, 8, and 12. Tolerability was assessed by clinical grading and participant reporting.

Results

Dark Spot Treatment improved overall hyperpigmentation, skin tone evenness, and dark spot intensity and contrast at Weeks 2 through 12, and dark spot size at Weeks 4 through 12 (all p < 0.001 compared to baseline). Participant self-assessments showed high overall satisfaction. Dark Spot Treatment was well tolerated.

Conclusion

The novel pigment-correcting Dark Spot Treatment significantly improved the appearance of PIH and solar lentigines, had high participant satisfaction, and was well tolerated.

Acne characteristics in Latin American patients and the potential role of trifarotene

BACKGROUND

Individualization of treatment based on acne type and severity, location, disease burden, and patient preference is required to maximize efficacy, safety, and adherence to therapy. Latin American populations have unique attributes that must be considered as part of this process to improve clinical success and achieve patient goals. Acne is more common among patients with darker skin phototypes, in whom it is often associated with postinflammatory hyperpigmentation and scarring-the most important acne sequelae-potentially due to more frequent and more severe underlying inflammatory processes in this population.

DISCUSSION

These data argue for an early and proactive approach to managing acne in these patients with agents that target the inflammatory processes that underlie acne and its sequelae. As a class, retinoids offer a spectrum of activity that may be useful in addressing the unique needs of Latin American populations.

CONCLUSION

Trifarotene, a novel, selective retinoid, has been evaluated in relevant patient populations.

Dermatologic conditions in skin of color compared to white patients: similarities, differences, and special considerations

The US population is becoming increasingly diverse, yet patients of color remain underrepresented in dermatology. The lack of diverse images in dermatologic learning materials can lead to discomfort in treating patients of color, delayed, and missed diagnoses. In this review, we compare and contrast the clinical presentation, management, and special considerations of common skin conditions between patients of color and white patients as well as provide a visual representation of these differences.

Highly Purified Microdroplet Liquid Injectable Silicone for the Treatment of Acne Scars in Lighter and Darker Skin Types: A Retrospective Review

BACKGROUND

Treatment of acne scarring in darker skin types is fraught with challenges. Highly purified liquid injectable silicone (LIS) is effective in the treatment of acne scars, although its use in darker skin types has yet to be evaluated.

OBJECTIVE

Retrospective evaluation of the safety and efficacy of highly purified LIS for the treatment of acne scars in lighter and darker skin types.

MATERIALS AND METHODS

A retrospective chart review of patients who received highly purified LIS for acne scars between July 2010 and March 2021.

RESULTS

Two hundred six total treatments in 96 patients, 32.29% ( n = 31) of whom were Fitzpatrick skin type IV ( n = 20, 20.83%) and V ( n = 11, 11.46%), with depressed and both broad-based and shallow acne scarring were reviewed. Mean age was 50.77 years (SD 16.77), and 83% were female. Complications such as granuloma formation, migration, extrusion of silicone, hyperpigmentation, hematoma, or infection were not observed. The average follow-up time was 6.31 years (SD 3.02).

CONCLUSION

Highly purified LIS is a safe and effective permanent treatment for acne scars in all skin types. Injection of highly purified LIS using small volume microdroplet technique at 6- to 8-week intervals did not yield any complications, including in patients with darker skin types.

Racial and Ethnic Health Disparities in Dermatology

Health disparities are differences in health or disease incidence, prevalence, severity, or disease burden that are experienced by disadvantaged populations. Their root causes are attributed in large part to socially determined factors, including educational level of attainment, socioeconomic status, and physical and social environments. There is an expanding body of evidence documenting differences in dermatologic health status among underserved populations. In this review, the authors highlight inequities in outcomes across 5 dermatologic conditions, including psoriasis, acne, cutaneous melanoma, hidradenitis suppurativa, and atopic dermatitis.

[Inflammatory dermatoses in skin of color]

Acne, rosacea, atopic dermatitis, and psoriasis vulgaris are common inflammatory dermatoses. Of note, the epidemiology and clinical presentation of these common dermatologic diseases varies considerably between people with different colors of skin. Yet, most dermatology textbooks present and describe the clinical pictures of White people. To provide excellent dermatological care for all patients, it is of central importance to know the epidemiology and recognize key clinical characteristics of these diseases in patients with skin of color (SOC). In acne, cultural habits of Blacks (use of steroid-based lighteners, comedogenic hair care products) may lead to manifestation of specific forms of acne. In addition, postinflammatory hyperpigmentation and keloids pose particular therapeutic challenges in this patient group. Atopic dermatitis in Asians shows a clinical and histological picture that is similar to psoriasis in Whites. By contrast, atopic dermatitis manifests on the extensor side in Black people. Due to the difficulty of recognizing erythema in SOC, the severity of the respective inflammatory diseases in these individuals is often underestimated. The treatment of acne, rosacea, atopic dermatitis, and psoriasis does not differ between people of different skin colors. The exception is the necessary therapy for postinflammatory hyperpigmentation in all the inflammatory dermatoses mentioned, and for keloids in acne.

Adolescent acne vulgaris: current and emerging treatments

Acne vulgaris is one of the commonest inflammatory skin diseases seen worldwide, affecting all ethnicities and races, with a peak prevalence between age 15 years and 20 years. The burden of this condition, and the resulting clinical and psychological sequelae, is substantial. The visual appearance of acne and its sequelae, including scarring and pigment changes, frequently results in psychological and social morbidity because of concerns about appearance. As understanding of the pathophysiology has evolved, approaches to achieving the optimal outcomes with effective treatment regimens continue to emerge. In the past few years, several novel therapeutics have been developed, including new agents aimed at reducing antimicrobial resistance and products with specific actions targeting retinoid receptors and androgen receptors. This Review considers the management approaches of an adolescent with acne vulgaris and reviews treatment options from the evidence base and international expert opinion. Approaches to selecting current treatments and novel and emerging treatment regimens are discussed.

A Post Hoc Analysis of Efficacy Data on Sarecycline in Hispanics with Acne from Two Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trials

Sarecycline is a novel, narrow-spectrum, third generation tetracycline class antibiotic approved by the Food and Drug Administration (FDA) for the treatment of moderate-to-severe acne in patients ages nine and older. Recently, focus has increased on whether treatment responses differ in acne in skin of color. Here, we aimed to analyze the efficacy of using sarecycline in Hispanics. We report pooled post hoc analysis of efficacy data on sarecycline in Hispanics with acne from two phase 3, multicenter, randomized, double-blind, placebo-controlled clinical trials, SC1401 and SC1402. Of 2002 patients in the pooled trials with moderate-to-severe acne, 26.9% were Hispanic. Facial inflammatory lesion counts decreased as early as week 3 by 26% (p = 0.0279), with continued reduction by 41% by week 6 (p = 0.0003), by 51% by week 9 (p < 0.0001), and by 55% by week 12 (p < 0.0001). Acne is the most common skin condition diagnosed in Hispanics, and this study illustrates a statistically significant reduction in acne in Hispanic patients with moderate-to-severe acne treated with oral sarecycline. Therefore, oral sarecycline shows promising results as a safe and effective treatment for acne in Hispanics.

Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment

Acne vulgaris is one of the most common chronic inflammatory diseases and is characterized by papules, pustules, comedones, and nodules. Although adolescence is the preferential age group, acne may affect various age groups. Acne shares different properties in adults and adolescents. These differences extend from epidemiology to treatments. Increased awareness of these two subtypes will allow for better management of the disease. In this review, the authors examined all aspects of acne in adults and adolescents under the light of current literature.

The management of acne vulgaris in young people in primary care: A retrospective cohort study

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.

Skin dysbiosis and Cutibacterium acnes biofilm in inflammatory acne lesions of adolescents

Acne vulgaris is a common inflammatory disorder affecting more than 80% of young adolescents. Cutibacterium acnes plays a role in the pathogenesis of acne lesions, although the mechanisms are poorly understood. The study aimed to explore the microbiome at different skin sites in adolescent acne and the role of biofilm production in promoting the growth and persistence of C. acnes isolates. Microbiota analysis showed a significantly lower alpha diversity in inflammatory lesions (LA) than in non-inflammatory (NI) lesions of acne patients and healthy subjects (HS). Differences at the species level were driven by the overabundance of C. acnes on LA than NI and HS. The phylotype IA1 was more represented in the skin of acne patients than in HS. Genes involved in lipids transport and metabolism, as well as potential virulence factors associated with host-tissue colonization, were detected in all IA1 strains independently from the site of isolation. Additionally, the IA1 isolates were more efficient in early adhesion and biomass production than other phylotypes showing a significant increase in antibiotic tolerance. Overall, our data indicate that the site-specific dysbiosis in LA and colonization by virulent and highly tolerant C. acnes phylotypes may contribute to acne development in a part of the population, despite the universal carriage of the microorganism. Moreover, new antimicrobial agents, specifically targeting biofilm-forming C. acnes, may represent potential treatments to modulate the skin microbiota in acne.

Efficacy of alpha hydroxy acid combined with intense pulsed light in the treatment of acne vulgaris: A meta-analysis

BACKGROUND

Acne patients frequently receive combination therapy. However, there has been no rigorous review of the efficacy of combining alpha hydroxy acid with IPL for acne vulgaris treatment.

OBJECTIVE

Assessing the effectiveness and safeness of alpha hydroxy acids in combination with IPL in the treatment of people with acne vulgaris.

METHODS

A computer search of common biomedical databases, including PubMed, Web of Science, Cochrane Library, Embase, Wanfang, CNKI, SinoMed, and VIP, was extensively conducted to identify previous studies on randomized controlled trials of alpha hydroxy acid combined with IPL in the management of acne vulgaris.

RESULTS

A total of 18 publications were included (1435 patients with common acne met the inclusion criteria). The meta-analysis showed that alpha hydroxy acid (AHA) combined with IPL had higher overall efficacy than the control group (OR = 4.24; 95% CI 2.66 ~ 6.74; p < 0.01). In the case of acne vulgaris, AHA combined with IPL and the AHA alone showed a remarkable difference in total efficiency (OR = 4.10; 95% CI 2.12 ~ 7.91; p < 0.01), and AHA combined with IPL were more effective than IPL alone (OR = 4.02; 95% CI 2.25 ~ 7.16; p < 0.01). In addition, the occurrence of adverse reactions that occurred in AHA combined with IPL and control groups did not differ (OR = 0.86; 95% CI 0.46 ~ 1.60; p = 0.64).

CONCLUSION

AHA combined with IPL therapy was superior to other therapies. Although it was slightly more expensive, it was effective and had a wide range of applications.

Dermatologic manifestations in patients with the Hermansky-Pudlak syndrome types 1 and 3

Background

The Hermansky–Pudlak syndrome (HPS) is a genetically heterogeneous group of diseases characterized by oculocutaneous albinism, bleeding diathesis, and systemic complications. It is the most common genetic disorder in Puerto Rico. These patients are at a significant risk of developing a variety of skin complications and little is known about the prevalence of dermatologic diagnoses in this population.

Objectives

To report dermatologic manifestations in patients with Hermansky–Pudlak syndrome (HPS). Secondary aims include skin concerns, sun protection habits, barriers to dermatologic care, and skin cancer knowledge.

Methods

Cross-sectional study with twenty-nine Puerto Rican patients who carried a clinical diagnosis of HPS type 1 or type 3 through a telephonic questionnaire.

Results

Twenty-nine patients participated with a mean (SD) age of 37.3 (16.8) years and the majority were female (69%). The most common diagnoses were skin cancer (34.5%), acne (34.5%), bacterial skin infections (34.5%), warts (24%), urticaria (17.2%), and psoriasis (17.2%). The most common skin concerns were dry skin (62.1%), hair loss (58.9%), redness (34.5%), moles (31%), and rash (31%). The most common sun protection behavior was wearing a shirt that covers the shoulders (93.1%, often or always) and the least common was wearing a hat (24.1%, often or always). Higher income was significantly associated with being more likely to use sunscreen often or always (OR = 3.38, 95% CI 1.02–11.18, p = 0.04). Those in northern urban areas were significantly less likely to report barriers to dermatologic care (OR = 0.13, 95% CI 0.02–0.76, p = 0.02).

Conclusions

This study provides an important overview of the most common self-reported skin manifestations in patients with HPS. Unfortunately, a high prevalence of cutaneous malignancy was reported. The results stress the need for adequate care and potential interventions to promote sun protection behaviors and skin cancer prevention.

Efficacy and tolerability of three topical acne treatments by body mass index: post hoc analysis including overweight and obese patients

BACKGROUND

Acne prevalence may be higher in overweight/obese individuals, potentially due to hormonal, inflammatory, and/or dietary factors. However, the effects of body mass index (BMI) on topical acne treatments are largely unknown.

METHODS

Post hoc analyses of changes in inflammatory/noninflammatory lesions and treatment success were conducted using phase 3 data: clindamycin phosphate/benzoyl peroxide (CP/BPO) 1.2%/3.75% gel (NCT01701024); tretinoin 0.05% lotion (NCT02965456 and NCT02932306; pooled); and tazarotene 0.045% lotion (NCT03168321 and NCT03168334; pooled). Data were analyzed by BMI subgroups: <25kg/m² (underweight-to-normal), 25-<30kg/m² (overweight), and ≥30kg/m² (obese).

RESULTS

Among participants analyzed (CP/BPO = 495; tretinoin = 1,636; tazarotene = 1,612), ∼20-25% were overweight and 15-20% were obese. At week 12, mean percent changes from baseline in inflammatory lesions were: CP/BPO (overweight: -63.2%, obese: -56.0%); tretinoin (-57.6%, -53.1%); tazarotene (-59.9%, -56.8%). Mean changes in noninflammatory lesions were: CP/BPO (-54.2%, -50.8%); tretinoin (-51.6%, -44.9%); tazarotene (-56.7%, -54.6%). Treatment success rates with active treatment ranged from 16.2% to 33.5% across BMI groups.

CONCLUSIONS

CP/BPO 1.2%/3.75% gel, tretinoin 0.05% lotion, and tazarotene 0.045% lotion were all effective in reducing acne lesions by ≥45% in overweight/obese patients with moderate-to-severe acne, comparable to the underweight-to-normal group. Efficacy of these topical acne treatments is not greatly impacted by BMI and may be affected more by the formulation.

Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: a post hoc integrated analysis of three phase 3 randomized, double-blind, placebo-controlled trials

BACKGROUND

Acne is the most frequent adverse event (AE) associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis (AD).

OBJECTIVE

To characterize the AE of acne associated with upadacitinib.

METHODS

This was a post hoc integrated analysis of three phase 3 randomized, double-blind, placebo-controlled trials of upadacitinib, alone (NCT03569293 and NCT03607422) or in combination with topical corticosteroids (NCT03568318). Data included were from the 16-week placebo-controlled period.

RESULTS

Over 16 weeks, 84/857 (9.8%), 131/864 (15.2%), and 19/862 (2.2%) patients randomized to receive upadacitinib 15 mg, upadacitinib 30 mg, and placebo, respectively, experienced acne. All cases of acne, except 1, were mild/moderate in severity; 2 patients discontinued treatment due to moderate acne. Acne occurred at higher rates among younger, female, and non-White patients. Acne required no intervention in 40.5% and 46.6% of patients receiving upadacitinib 15 or 30 mg, respectively; most remaining cases were managed with topical antibiotics, benzoyl peroxide, and/or retinoids. Acne also had no impact on patient-reported outcomes.

LIMITATIONS

This study was relatively short in duration and had a small patient population.

CONCLUSIONS

Acne associated with upadacitinib for AD treatment is usually mild/moderate in severity and managed with topical therapies or no intervention.

Management of post-inflammatory hyperpigmentation in skin of color: A short review

Post-inflammatory hyperpigmentation (PIH) is a common cosmetic complaint affecting patient quality of life. PIH has been proven to disproportionately affect skin of color. While several treatment options exist, special consideration must be given when managing PIH in patients of color, as topical treatments and aesthetic procedures, such as chemical peels and lasers, may either exacerbate or prove ineffective against PIH.

Phenotypical Conversions of Dermal Adipocytes as Pathophysiological Steps in Inflammatory Cutaneous Disorders

Adipocytes from the superficial layer of subcutaneous adipose tissue undergo cyclic de- and re-differentiation, which can significantly influence the development of skin inflammation under different cutaneous conditions. This inflammation can be connected with local loading of the reticular dermis with lipids released due to de-differentiation of adipocytes during the catagen phase of the hair follicle cycle. Alternatively, the inflammation parallels a widespread release of cathelicidin, which typically takes place in the anagen phase (especially in the presence of pathogens). Additionally, trans-differentiation of dermal adipocytes into myofibroblasts, which can occur under some pathological conditions, can be responsible for the development of collateral scarring in acne. Here, we provide an overview of such cellular conversions in the skin and discuss their possible involvement in the pathophysiology of inflammatory skin conditions, such as acne and psoriasis.

Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee

In endocrine and reproductive endocrine literature, adult female acne is considered as a possible clinical expression of hyperandrogenism, with most polycystic ovary syndrome (PCOS) guidelines considering acne as a condition of androgen excess. Adult female acne, however, in the dermatological literature is considered as an inflammatory skin disease and new guidelines on adult female acne have been produced by dermatological societies, with little perspective from any endocrine or reproductive endocrine points of view. An expert task force was appointed by the AE-PCOS society to determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female adult acne. The following are the recommendations (level of evidence A or B): (1) diagnosis of female adult acne is mainly clinical, but a grading tool is needed for optimizing the treatment; (2) measurement of serum androgen values (total testosterone, free testosterone, and dehydroepiandrosterone sulfate) by high-quality assays is recommended in all women with adult acne; (3) in women with adult acne and proven hyperandrogenism, oral combined estroprogestins should be added to the topical or systemic treatment of acne, independently of severity of acne; (4) all second- and third-generation estroprogestins may be used, independently of the estrogen dose and progestin component; (5) spironolactone may be added to estroprogestins in women with moderate or severe hyperandrogenic adult acne, not responding to usual treatments; (6) estroprogestins may be used in nonhyperandrogenic patients with adult acne as second-line therapy.

Racial/Ethnic Health Disparities in Dermatology in the United States Part 2: Disease-specific Epidemiology, Characteristics, Management, and Outcomes

Racial and ethnic disparities in dermatology negatively affect outcomes such as mortality and quality of life. Dermatologists and dermatologic surgeons should be familiar with disease-specific inequities that may influence their practice. The second article in this two-part continuing medical education series highlights gaps in frequency, clinical presentation, management, and outcomes by race and ethnicity. We review cutaneous malignancies including basal cell carcinoma, squamous cell carcinoma, melanoma, Merkel cell carcinoma, dermatofibrosarcoma protuberans, and cutaneous T cell lymphoma, and inflammatory disorders including atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, and rosacea.

Elevated survivin levels in patients with acne vulgaris

OBJECTIVE

Acne vulgaris is a multifactorial disease of the pilosebaceous unit. As the most common skin disease, it may affect approximately 85% of the young population. Survivin, a member of the inhibitors of the apoptosis (IAP) gene family, can inhibit apoptosis and regulate cell division and proliferation. In the study, we aimed to investigate the potential role of serum survivin in acne vulgaris.

METHODS

Forty individuals who were diagnosed with acne vulgaris and forty healthy subjects as the control group were enrolled in the study. Venous blood samples were collected from each participant, and the serum levels of survivin were measured by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using SPSS software version 25.

RESULTS

The serum survivin levels were statistically significant between the groups, and the levels of survivin were measured as acne vulgaris patients group 153.44 and control group 104.17 pg/ml, respectively (p < 0.018). When the serum survivin levels were compared according to gender, females had higher levels of survivin than the males (168.16 versus 50.45 pg/mL, p = 0.001). A significant correlation was found between acne severity (p = 0.017) and Scale for Acne Scar severity (SCAR-S) score (p = 0.001) according to the survivin levels. In terms of age, no significant relationship was found between age and survivin (p = 0.4048).

CONCLUSION

Elevated serum levels of survivin were determined in acne vulgaris. Moreover, there was a significant correlation between acne stage and SCAR-S score according to survivin levels.

Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice

Acne is a common cause for post-inflammatory hyperpigmentation (PIH), particularly in patients with skin of color (SOC), and PIH is often more distressing to patients than the acne itself. Topical retinoids are approved for the treatment of acne and for pigmentation disorders such as melasma or mottled hyperpigmentation associated with photodamage; moreover, they have been shown to reduce hyperpigmentation in patients with SOC. Therefore, treatment with topical retinoids should be started as early as possible unless contraindicated. Use of novel formulations or application of commonly recommended moisturizers may help reduce irritation. Combining retinoids with other topical agents and procedures such as superficial chemical peels can help to improve hyperpigmentation. Primary acne lesions are likely to improve weeks before PIH resolves and helping patients manage their expectations may reduce frustration. Providing clinicians and researchers with more education about the presentation and management of dermatologic conditions in patients with SOC is also recommended.

Features of Common Skin Disorders in Pediatric Patients with Skin of Color

Many dermatologic conditions common in the pediatric population may have unique presentations in skin of color or occur with greater incidence. This may be due to ethnic origin, socioeconomic factors, or other influences. Awareness of the potential variations in skin of color may enhance prompt diagnosis, appropriate treatment, and/or reassurance as indicated.

Magnitude and temporal trend of acne vulgaris burden in 204 countries and territories from 1990 to 2019: A analysis from the Global Burden of Disease Study 2019

BACKGROUND

Acne vulgaris is widespread across the world. Mapping the latest magnitudes and temporal trends of acne vulgaris provides the essential foundation for targeted public policies at the national, regional, and global levels.

METHODS

Complying with the framework of the Global Burden of Disease 2019 Study, the incidence, prevalence and disability-adjusted life years (DALYs) on acne vulgaris were retrieved in 204 countries and regions from 1990 to 2019. The average annual percentage change was calculated to depict the temporal trends in age-standardized rates (ASRs) of acne vulgaris burden by region, sex, and age.

RESULTS

Globally, 117.4 [95% uncertainty interval (UI): 103.0, 133.7] million incident cases of acne vulgaris, 231.2 million (95% UI: 208.2, 255.5) prevalent cases and 5.0 (95% UI: 3.0, 7.9) million DALYs were estimated in 2019, with about 47% increase compared with 1990. Moreover, the overall ASRs of acne vulgaris increased by around 0.55% annually over the past three decades. We observed huge disparities in ASRs of acne vulgaris with its changing trends in sex, location, and age. The ASR of acne vulgaris among women was around 1.3 times that of men, but the gender difference was narrowed for the pronounced increase among men. The ASRs of acne vulgaris were higher in high-income regions, but the increasing trend was more pronounced in other regions.

CONCLUSION

The burden rate of acne vulgaris continues to increase in almost all countries. Understanding the specific characteristics of acne vulgaris burden is essential to formulate more effective and targeted interventions for controlling acne burden.

Acne and rosacea in skin of colour

Acne and rosacea are common inflammatory skin conditions present in numerous racial and ethnic groups. There are distinct differences in clinical presentation, exacerbating factors, potential triggers and consequences of both conditions in individuals with skin of colour (SOC), classified as Fitzpatrick skin types III-VI. For example, acne can be complicated by the development of postinflammatory hyperpigmentation and keloid scarring in SOC, and this can influence treatment choice. Although rosacea is reported less frequently in SOC, this may be the result of delayed diagnosis or late presentation due to the difficulty in discerning the classic features of erythema in darker skin tones. In such cases, additional clues in the medical history and clinical examination may assist in making the diagnosis. This review aims to summarize nuances in both the diagnosis and management of these two common skin conditions in patients with SOC to support clinicians in providing an individualized treatment approach.

Addressing Human Skin Ethnicity: Contribution of Tissue Engineering to the Development of Cosmetic Ingredients

Recent publications describe various skin disorders in relation to phototypes and aging. The highest phototypes (III to VI) are more sensitive to acne, with the appearance of dark spots due to the inflammation induced by Cutibacterium acnes (previously Propionibacterium acnes). Dryness with aging is due to a lower activity of specific enzymes involved in the maturation of lipids in the stratum corneum. To observe and understand these cutaneous issues, tissue engineering is a perfect tool. Since several years, pigmented epidermis with melanocytes derived from specific phototypes allow to develop in vitro models for biological investigations. In the present study, several models were developed to study various skin disorders associated with phototypes and aging. These models were also used to evaluate selected ingredients’ ability to decrease the negative effects of acne, inflammation, and cutaneous dryness. Hyperpigmentation was observed on our reconstructed pigmented epidermis after the application of C. acnes, and pollutant (PM10) application induced increased inflammatory cytokine release. Tissue engineering and molecular biology offer the capability to modify genetically cells to decrease the expression of targeted proteins. In our case, GCase was silenced to decrease the maturation of lipids and in turn modify the epidermal barrier function. These in vitro models assisted in the development of ethnic skin-focused cosmetic ingredients.

Incidence and Factors Associated With Acne Among Transgender Patients Receiving Masculinizing Hormone Therapy

Importance

Acne is a common condition among transgender patients receiving masculinizing hormone therapy (MHT), but the incident risk and predictors of developing acne in this population have not yet been studied on a large scale.

Objective

To assess risk of acne among a large population of transgender patients receiving MHT and clinical risk factors for acne diagnosis.

Design, Setting, and Participants

A retrospective cohort study that included 988 patients who started MHT between January 1, 2014, and December 31, 2017, with at least 1 year of follow-up was performed. Data analysis was conducted from September 1 to 15, 2019. Data were obtained using electronic health records from a community health center serving the sexual and gender minority community. The population included every patient who began receiving MHT during the study period who was aged 18 years or older at the time of MHT initiation and whose assigned sex at birth was female.

Main Outcomes and Measures

The main outcome was acne defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for acne. Overall prevalence and incidence proportions over 2 years after initiation of MHT were calculated. Baseline demographic and clinical characteristics were collected at the time of MHT initiation. A series of univariate analyses for all factors was calculated to test for an association with acne diagnosis, followed by multivariate analyses to test for independent predictors.

Results

For 988 patients (median age, 25.8 years; interquartile range, 20.8-28.2 years), there was an overall acne prevalence of 31.1% (n = 307). The 1-year post-MHT acne incidence proportion was 19.0% and the 2-year incidence proportion was 25.1%. A younger age at MHT initiation was associated with a higher likelihood of developing acne, with a median of 22.4 years (interquartile range, 19.7-25.6 years) among patients who developed acne vs 24.7 years (interquartile range, 21.3-29.4 years) among patients who did not (P = .002).

Conclusions and Relevance

Acne is a common condition among transgender patients on MHT, with a prevalence increasing from 6.3% to 31.1% following MHT initiation. Patients aged 18 to 21 years appear to be the most likely to develop acne after MHT initiation.

[Acne]

Acne vulgaris is one of the most frequent dermatological diseases with a lifetime prevalence of about 85%. The clinical spectrum shows a great variety. Key factors of pathogenesis are increased sebum production, hyperkeratinization of the follicular infundibulum, inflammatory processes, and a dysbiosis of the skin microbiome. In addition to endogenous factors (e.g., disturbances of the androgen metabolism) or other hormonal changes, exogenous factors (e.g., diet, mechanical irritation or the use of inappropriate cosmetics) can also play an important role. The clinical spectrum is broad, extending from neonatal Acne (A.) to adult A., from comedonal A. to fulminant A., from cosmetic A. to A. excoriée (skin picking disorder). The psychological effects of acne can be profound and can cause a severe reduction in quality of life. Therefore, in addition to an effective therapy with regular medical check-ups and good adherence, it is always necessary to consider psychological aspects.

Incidence and Clinical Implications of Autoimmune Thyroiditis in the Development of Acne in Young Patients

Autoimmune thyroiditis (AIT) is on the rise among the population, and is frequently associated with patients with acne vulgaris, especially females aged between 18–55 years old. The connection between the two is not fully elucidated. In this study, 236 patients diagnosed with acne in the dermatological office of the private Pelican Hospital and in few private dermatological offices from Oradea, Romania, during January 2018–December 2020, aged between 12 and 55 years old, were endocrinologically investigated to determine AIT and its influence on the severity of the acne. The values for the thyroid antibodies and thyroid-stimulating hormone (TSH) were determined for all of the subjects. The frequency of AIT in the study group was 72% and was associated with severe acne (p < 0.001). Patients with AIT with normal or hypofunction had more frequent severe acne than those with hyperfunction (p < 0.001, p = 0.002). The TSH and anti thyroidperoxidase (TPO) values did not influence the severity of the acne (p = 0.494; p = 0.111), while the anti-TG values were associated with severe acne (p = 0.007). The risk analysis indicated that raised values of anti-TPO (2.91 times greater) correlated with high anti-thyroglobulin (TG) values (4.36 times greater) doubled the risk of developing severe acne in patients. In acne evolution, the existence of AIT involves significant modifications.

Incidence and Clinical Implications of Autoimmune Thyroiditis in the Development of Acne in Young Patients

Autoimmune thyroiditis (AIT) is on the rise among the population, and is frequently associated with patients with acne vulgaris, especially females aged between 18–55 years old. The connection between the two is not fully elucidated. In this study, 236 patients diagnosed with acne in the dermatological office of the private Pelican Hospital and in few private dermatological offices from Oradea, Romania, during January 2018–December 2020, aged between 12 and 55 years old, were endocrinologically investigated to determine AIT and its influence on the severity of the acne. The values for the thyroid antibodies and thyroid-stimulating hormone (TSH) were determined for all of the subjects. The frequency of AIT in the study group was 72% and was associated with severe acne (p < 0.001). Patients with AIT with normal or hypofunction had more frequent severe acne than those with hyperfunction (p < 0.001, p = 0.002). The TSH and anti thyroidperoxidase (TPO) values did not influence the severity of the acne (p = 0.494; p = 0.111), while the anti-TG values were associated with severe acne (p = 0.007). The risk analysis indicated that raised values of anti-TPO (2.91 times greater) correlated with high anti-thyroglobulin (TG) values (4.36 times greater) doubled the risk of developing severe acne in patients. In acne evolution, the existence of AIT involves significant modifications.

Ocular surface characteristics in acne vulgaris

Clinical relevance: Since acne vulgaris is a disease of the sebaceous glands, it may have potential effects on the ocular surface and tear homoeostasis, which are essential for good vision. Optometrists should be aware of ocular surface pathologies when prescribing glasses or contact lenses for the visual rehabilitation of these young patients.Background: To evaluate the ocular surface features, meibomian glands, and tear parameters of patients with acne vulgaris.Methods: The right eyes of 70 individuals (34 patients with acne vulgaris, 36 healthy volunteers) were evaluated. The tear break-up time of participants was measured, and the Schirmer test was performed. Then, to determine ocular surface characteristics, samples were taken from the conjunctiva for impression cytology. Finally, the loss rates of the upper and lower eyelid meibomian glands were determined by taking meibography (Sirius, CSO, Florence, Italy).Results: Tear break-up time was significantly lower in the study group compared to the control group (p < 0.001). No statistically significant difference was determined between the groups in respect of Nelson grade in the conjunctival impression cytology (p = 0.141). Grade 3 cytological changes were not observed in either group. The median value of the loss rate in the meibomian glands in the upper eyelid of patients with acne vulgaris was 19.10% (IQR: 18%), while it was 8.75% (IQR: 9.53%) in the control group (p = 0.001). The median value of the loss rate in the meibomian glands in the lower eyelid was 15.70% (IQR: 15.13%) and 7.70% (IQR: 6.53%) in the acne vulgaris and control groups, respectively (p < 0.001).Conclusion: Our study shows that patients with acne vulgaris may have a predisposition to meibomian gland damage and tear instability. Therefore, we consider that a more detailed ophthalmologic examination should be performed in patients with acne vulgaris.

Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study

Importance

Acne is a chronic, multifactorial inflammatory disease. The association between consumption of dairy products and fatty and sugary foods and occurrence and progression of acne remains unclear.

Objective

To assess the association between dietary behavior and current acne in adults.

Design, Setting, and Participants

A cross-sectional study was performed as part of the NutriNet-Santé study, which is an ongoing observational, web-based cohort study that was launched in France in May 2009. The present study was conducted from November 14, 2018, to July 8, 2019. A total of 24 452 participants completed an online self-questionnaire to categorize their acne status: never acne, past acne, or current acne. Associations between dietary behavior (food intake, nutrient intake, and the dietary pattern derived from a principal component analysis) and current or past acne were studied in multinomial logistic regression models adjusted for potential confounding variables (age, sex, physical activity, smoking status, educational level, daily energy intake, number of dietary records completed, and depressive symptoms).

Results

The 24 452 participants (mean [SD] age, 57 [14] years; 18 327 women [75%]) completed at least 3 dietary records. Of these, 11 324 individuals (46%) reported past or current acne. After adjustment, there was a significant association between current acne and the consumption of fatty and sugary products (adjusted odds ratio [aOR], 1.54; 95% CI, 1.09-2.16), sugary beverages (aOR, 1.18; 95% CI, 1.01-1.38), and milk (aOR, 1.12; 95% CI, 1.00-1.25). An energy-dense dietary pattern (high consumption of fatty and sugary products) was associated with current acne (aOR, 1.13; 95% CI, 1.05-1.18).

Conclusions and Relevance

In this study, consumption of milk, sugary beverages, and fatty and sugary products appeared to be associated with current acne in adults. Further large-scale studies are warranted to investigate more closely the associations between diet and adult acne.

Air pollution and skin disorders

Air pollution is being shown to play an increasing causation role in our most common skin diseases. Acne, hyperpigmentation, atopic dermatitis, and psoriasis have been shown to be influenced by air pollution. It is important for pollution to be added as a risk factor for these skin disorders, and thus we must discuss mitigating its negative affects with patients. Air pollution is the contamination of outdoor (ambient) and indoor (household) environments by any chemical, physical, or biological agent that modifies the natural characteristics of the atmosphere. Nearly all (90%) of the world's population experience daily pollution. In 2019, air pollution was considered by the World Health Organization to be the biggest environmental health risk to humans, responsible for killing more than 7 million people prematurely every year. Preliminary studies link air pollution to COVID-19 deaths, as there were high death tolls in some of the most globally polluted areas. Air pollution affects many organ systems such as cardiovascular, pulmonary, central nervous, reproductive, and integumentary systems. In this study, we detail the current evidence linking specific skin and health disorders to air pollution.

Research Techniques Made Simple: Cutaneous Colorimetry: A Reliable Technique for Objective Skin Color Measurement

Skin color evaluation contributes to assessment of an individual's cutaneous phenotype. Skin color changes provide important clues to disease progression or treatment response. Skin color is also a predictor of skin cancer risk. Melanin pigment, blood flow, skin thickness, and photoaging contribute to skin color. Melanin, hemoglobin, bilirubin, and carotene are the primary chromophores of skin color. Their concentrations vary depending on the individual's phenotype, anatomic location, external insults of chemical irritants and UVR, and physiological changes. The evaluation and perception of skin color are often subjective. Objective quantification of skin color can be achieved with colorimetric devices such as tristimulus colorimeters. These devices compute the intensity of light reflected from skin and correlate with pigmentation and erythema. Cutaneous color and color changes can be quantified under color organization systems, such as the CIELAB color space, which is standardized by the Commission Internationale de l'Eclairage (CIE). The CIELAB expresses color's lightness, red/green intensity, and yellow/blue intensity, as L*, a*, and b* values, respectively. Additionally, skin color's full spectral characteristics and cutaneous physiology can be measured with spectrophotometers. This article outlines basic principles of the CIELAB color system and how to optimally use colorimetric devices as a skin research tool.

Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Palestine: a cross-sectional study

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.

Common Skin Disorders in Pediatric Skin of Color

Children with skin of color represent a large proportion of the pediatric population. There are numerous skin conditions that commonly occur in this population, including but not limited to acne, atopic dermatitis, pityriasis alba, tinea versicolor, progressive macular hypomelanosis, traction alopecia, and confluent and reticulated papillomatosis. This article highlights the clinical presentations of these conditions in skin of color and briefly addresses pathophysiology and treatment modalities.

The Spectrum and Sequelae of Acne in Black South Africans Seen in Tertiary Institutions

INTRODUCTION

Acne is a chronic disorder of the pilosebaceous unit affecting all ethnic groups. It remains in the top 5 skin conditions seen worldwide. The paucity of data characterizing acne in South African Blacks led us to the documentation of types and sequelae of acne.

METHODS

This is a cross- sectional study describing the spectrum and variants of acne in 5 tertiary hospitals in the second most populous province in South Africa over 3 months (January 1 - March 31, 2015).

RESULTS

Out of 3,814 patients seen in tertiary dermatology clinics, 382 (10%) had a primary diagnosis of acne or rosacea, forming the fourth most common condition seen. Acne accounted for 361 (94.5%); acne vulgaris was the commonest subtype at 273 (75.6%), followed by steroid-induced acne 46 (12.7%), middle-age acne 6 (1.7%), acne excoriée 2 (0.6%), and "undefined" 34 (9.4%).

CONCLUSION

The observation of steroid-induced acne as the second most common variant in Black patients underlines the need to enquire about steroid use and education about the complications of using steroid-containing skin-lightening creams. Treatment of postinflammatory hyperpigmentation should be part of the armamentarium for holistic acne treatment in Blacks, as it remains a major concern even after active acne has resolved.

The worldwide diversity of scalp seborrhoea, as daily experienced by seven human ethnic groups

OBJECTIVE

The re-greasing process and kinetics of the human scalp, post-shampooing, have been previously documented, in vivo, on a few Caucasian subjects. The objective of the presented research was to extend such knowledge over seven different ethnic groups.

METHODS

The post-shampooing re-greasing kinetics of the scalp was studied on 1325 subjects (women and men of two distinct age classes) from seven different ethnic groups in their residential and native country. Sebum amounts were determined onto small shaved scalp areas at various times post-shampooing, using the Sebumeter^® technique.

RESULTS

As previously published on Caucasian subjects, scalp re-greasing process follows a hyperbolic-like kinetics over days. However, amounts of collected sebum highly vary with ethnicity. As recorded through the casual level (CL) at the equilibrium phase, 2-3 days post-shampooing, the highest amount of sebum was found in African American subjects, followed in descending order by Caucasian American, Japanese, Chinese, Thai, Caucasian European and Indian subjects, the latter showing very low values. Lower amounts of sebum were recorded in the older age class in all ethnics, as compared to the younger one, and male subjects were found higher sebum producers than women, irrespective of ethnicity.

CONCLUSION

The kinetics and slopes of the re-greasing process of the human scalp appear similar in all ethnic groups studied. However, striking quantitative differences are found between the seven ethnic groups, resulting from different sebaceous production levels and scalp hygiene routines.

Pollution and acne: is there a link?

In recent years, the critical role that inflammation may play in the development and progression of acne has become increasingly recognized. The prevalence of acne is similar between Asian and Caucasian women, but Asian women have a higher prevalence of inflammatory acne. They also report their symptoms exacerbate during periods of high air pollution. The objective of this study was to review the current evidence that links air pollution to worsening of acne symptoms. Firstly, a group of five Asian and three European scientists with expertise in Dermatology reviewed the current literature and described current acne treatment practices in their countries. During this activity, they identified the need for further epidemiological and clinical research. Secondly, additional studies ensued which provided evidence that acne symptoms might exacerbate in regions of high ambient air pollution. Based on these findings, the authors suggest that people with acne should protect the natural barrier function of their skin with emollients and ultraviolet (UV)A/UVB protection.

Updates in the understanding and treatments of skin & hair disorders in women of color

Skin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA).

The possible role of diet in the pathogenesis of adult female acne

Acne in adults is a chronic, increasingly common disease, especially among women. It differs in pathogenesis and clinical presentation from adolescent acne. Acne in adults is associated with Western diet, defined as high consumption of milk, high glycemic load and high calorie intake. Metabolic signals of this diet result in a significant increase in insulin/insulin growth factor 1 serum level and consequently in the molecular interplay of mammalian target of rapamycin complex 1 kinase (mTORC1)/forkhead box protein 1 (FoxO1) mediated nutrient signaling, leading to increased proliferation of keratinocytes, increased lipogenesis and sebum production and finally to aggravation of acne.