Coping with mild inflammatory catamenial acne. A clinical and bioinstrumental split-face assessment

Acne cream reduces the deep Cutibacterium acnes tissue load before elective open shoulder surgery: a randomized controlled pilot trial

BACKGROUND

Cutibacterium acnes is the main pathogen in periprosthetic shoulder infections. In acne vulgaris therapy, benzoyl peroxide-miconazole nitrate cream effectively reduces the superficial C acnes burden of the skin. Its additional potential in the subcutaneous and capsular layers (eg, for prevention of future periprosthetic shoulder infections) is unknown. The aim of this study was to investigate the efficacy of a topical acne vulgaris cream (benzoyl peroxide-miconazole nitrate) to reduce subcutaneous and capsular C acnes in individuals with C acnes skin colonization undergoing open shoulder surgery.

METHODS

A prospective randomized pilot trial was performed, allocating 60 adult patients (1:1) to either a 7-day preoperative application of a commercial acne cream (benzoyl peroxide-miconazole nitrate) on the preoperative skin (intervention group) or no cream (control group) from November 1, 2018, to May 31, 2020. The superficial skin of the shoulder was sampled at enrollment and before incision, and deep subcutaneous and capsular shoulder samples were taken during surgery.

RESULTS

Sixty patients (mean age, 59 years; 55% female patients) undergoing primary open shoulder surgery (17 Latarjet procedures and 43 arthroplasties) were included in the study. At baseline, both randomized groups showed the presence of C acnes on the skin at a rate of 60% (18 of 30 patients in intervention group and 19 of 30 patients in control group, P = .79). In patients with C acnes skin colonization, the intervention resulted in a significant reduction in the overall number of intraoperative samples with positive findings compared with the control group (8 of 18 patients vs. 16 of 19 patients, P = .01), especially in capsular samples (0 of 18 patients vs. 4 of 19 patients, P = .04).

CONCLUSION

The topical 7-day preoperative skin application of acne cream (benzoyl peroxide-miconazole nitrate) significantly reduced the intraoperative C acnes load in 56% of the patients in the intervention group compared with 16% of the control patients.

Cyclic catamenial dermatoses

Circulating sex hormones follow major fluctuations during the ovarian cycle. The so-called premenstrual syndrome represents a global condition grouping the diversity of catamenial disorders. At the skin level, the sebaceous gland activity is obviously modulated by these endocrine fluctuations. In addition, a series of pathological manifestations take place simultaneously in some women. Among them, the most frequent skin condition is represented by catamenial acne. Concurrently, the autoimmune progesterone dermatitis refers to a diversity of skin alterations resulting from an immune reaction to progesterone. It is present under variable clinical aspects. A series of other recurrent skin conditions are not specifically induced but are merely exacerbated at the end of the ovarian cycle.

Dynamics of Skin Barrier Repair following Topical Applications of Miconazole Nitrate

The skin barrier function (SBF) is an important aspect of skin biology, particularly in the elicitation of inflammation. The SBF recovery rate after tape stripping and surfactant challenge can be assessed by measuring the transepidermal water loss (TEWL). Previous clinical studies have shown some inflammatory effect after topical applications of miconazole. The aim of this study was to compare the effect of pastes (petrolatum and 15% zinc oxide) containing or not miconazole nitrate on controlled impaired SBF. Fifteen volunteers were enrolled. In each subject, successive cyanoacrylate skin surface strippings were harvested from 5 sites of the volar forearm until TEWL raised above 15 g/cm(2)/h on all test sites. In addition, one daily soak session with a 0.2% dishwashing liquid further damaged the SBF. Each of the test formulations was applied twice daily for 5 days at two dosages, namely 1 and 2 mg/cm(2), on randomized test sites. Another site remained untreated. TEWL was measured daily for 5 days. A fastened SBF repair was observed on all treated sites, particularly where the largest amount of the products had been applied. A faster SBF recovery rate was obtained at the site receiving the miconazole nitrate paste. We conclude that the occlusive effect of a paste helped mitigate SBF defect. The adjunction of miconazole nitrate improved the efficacy.

High-resolution epiluminescence colorimetry of striae distensae

BACKGROUND

Colours of striae distensae are often different from that of the surrounding skin. A close look using dermoscopy discloses distinct patterns of melanized networks at these sites. The aim of the study was to design a method of high-\resolution analytical analysis of the skin colours using the combination of photographic dermoscopy and small field reflectance colorimetry.

METHODS

Clinical photographs were taken from striae distensae and their surrounding skin using a Dermaphot (Heine Optotechnik, Hersching, Germany). A final magnification of 125x was obtained on paper photographs. The reflectance colorimeter Visi-Chroma VC-100 (Biophotonics, Lessines, Belgium) was used to measure colours of the pigmentary networks in the L*a*b* system. Differential colour parameters (deltaE*ab, deltaL*, deltaa*, deltab*) were calculated for each case between the lesional and the surrounding normal skin, and between the melanized reticulated pattern and the enclosed lighter areas.

RESULTS

Objective colorimetric assessments distinguished four distinct types, namely striae albae, striae rubrae, striae caeruleae and striae nigrae. The latter peculiar hyperpigmented type of striae distensae was specifically identified by epiluminescence examination in dark-skinned subjects. The fine-melanized honeycomb network present on the adjacent intact skin was reshaped inside striae in a streaky pattern perpendicular to the striae axis. Strong linear correlations were found between all combinations of deltaL* and deltab* evaluating colours of the reticulated and the honeycomb alveolar patterns both inside and outside the striae distensae. By contrast, no correlations were found between deltaa* and the other colorimetric parameters.

CONCLUSION

The direct and/or indirect influences of melanocyte mechanobiology appear to have a prominent effect on the various colours of striae distensae.

Effect of a single overnight topical application of miconazole nitrate paste on acne papules

BACKGROUND

The classical management of acne calls for prolonged oral and/or topical treatments; however, some patients request a rapid effect to make the papules disappear within a few hours or days.

OBJECTIVE

To test the effect of a single overnight application of a paste containing 0.25% miconazole nitrate on acne papules, and comparison with the effect of the same but unmedicated paste.

METHOD

Narrow-band reflectance spectroscopy was used to assess the changes in E index (erythema) after overnight application of the pastes. In the first study, a total of 117 acne papules were assessed in 15 adolescents. Measurements of the E index were performed at 24-h intervals for 4 days on acne papules and the surrounding normal-looking skin. The last two assessments were performed the mornings preceding and following, respectively, a single application of the medicated paste. The second part of the study consisted of a double-blind, split-face study on 25 adolescents with acne. They applied each of the two formulations on a randomized part of the forehead. A total of 161 acne papules received the medicated paste and 160 received the same but unmedicated paste. Measurements were performed the mornings before and after the overnight treatment.

RESULTS

In the first part of the study, no significant daily difference was observed between the three series of pretreatment E indices, on both acne papules and normal skin. The treatment did not affect the E index of normal skin. By contrast, it decreased significantly the E index of the acne papules. The second part of the study also showed that the medicated paste significantly decreased the E index of acne papules. This effect was significantly (P < 0.05) superior to that of the unmedicated paste.

CONCLUSION

A single overnight application of miconazole nitrate paste appears to reduce the erythematous aspect of acne papules.