Treatment of adult female acne: a new challenge

Elimination Diet Guided by Food-Specific IgG Antibodies Measurements in Chronic Adult Acne in Thailand: A Prospective RCT Study

Background: Adult female acne is increasingly prevalent and significantly affects quality of life. Current treatments, including antibiotics and hormonal therapies, often yield varied efficacy and risks. While adult acne shares similarities with adolescent acne, its pathogenesis involves genetic, hormonal, immune, and dietary factors. Emerging research implicates high glycemic load diets, milk proteins, and insulin/IGF1 signaling in exacerbating acne. Despite growing understanding, dietary influences remain poorly understood, overshadowed by persistent myths. Inflammation, preceding follicular plugging and hyperkeratinization, suggests a potential shift towards addressing gut inflammation and digestive issues. IgG-mediated food reactions, linked to conditions like IBS and migraines, are controversial in diagnosing acne but warrant investigation, especially in Thai patients. Objective: Evaluate the efficacy of elimination diets guided by food-specific IgG antibodies measurement in chronic adult acne. Patients and Methods: This randomized controlled trial and prospective cohort study enrolled 75 participants with chronic acne aged 19 to 45 years, meeting stringent inclusion criteria. Participants were randomized into three groups: one receiving elimination diets based on reversed IgG antibody measurements, another on common food-specific IgG antibodies, and a third on individual IgG antibody measurements. Elimination diets were informed by Genarrayt™ 200+ Food IgG kit results, with compliance monitored through dietary checklists. Primary outcomes were assessed using the Global Acne Grading System (GAGS) Score, with secondary outcomes including the Thai version of the Dermatology Life Quality Index Questionnaire and a Multiorgan-Symptoms Checklist. Follow-ups were conducted at 2, 4, 8, and 12 weeks. Results: The study cohort, predominantly female (74.7%), exhibited a mean age of 29.3 ± 5.3 years and an average GAGS Score indicating moderate acne severity. Significant differences in GAGS Scores were found among groups (P<0.001), indicating reduced acne severity in the elimination diet groups. Statistically significant reductions in weight and BMI were observed in one group (p-values = 0.048), but not in the other groups. Compliance with follow-up criteria was high. Conclusion: Elimination diets guided by food-specific IgG antibodies measurement show promise in reducing chronic adult acne severity, as indicated by GAGS Scores. This study sheds light on the relationship between diet and adult acne pathophysiology, emphasizing the potential of personalized treatment approaches. Further research is warranted to validate these findings and elucidate underlying mechanisms.

Paeoniflorin mitigates insulin-like growth factor 1-induced lipogenesis and inflammation in human sebocytes by inhibiting the PI3K/Akt/FoxO1 and JAK2/STAT3 signaling pathways

Insulin-like growth factor-1 (IGF-1) is considered as a pathogenic factor contributing to sebaceous gland dysfunction, which leads to acne vulgaris. Paeoniflorin (Pae), a bioactive monomer derived from total glycosides of paeony, has shown potential in treating various diseases. However, its anti-acne effects on human sebocytes are not well understood. In this study, we investigated the effects of Pae on acne development induced by IGF-1 in SZ95 sebocytes. Following IGF-1 stimulation, SZ95 sebocytes were exposed to Pae and then determined for proliferation, cell cycle, apoptosis, lipogenesis and pro-inflammatory cytokine secretion. We also analyzed the expression of proteins involved in the PI3K/Akt/FoxO1 and JAK2/STAT3 pathways. In vitro experiments demonstrated that Pae significantly inhibited colony formation, induced G1/S cell cycle arrest, promoted apoptosis, inhibited lipogenesis and cytokine synthesis in IGF-1-treated SZ95 sebocytes. Furthermore, Pae suppressed the phosphorylation of Akt, FoxO1, JAK2, and STAT3. Importantly, the sebo-suppressive and anti-inflammatory effects of Pae were enhanced by blocking PI3K and JAK2. In summary, our findings suggest that Pae has potent anti-proliferative and pro-apoptotic effects in SZ95 sebocytes. Additionally, Pae effectively protects against IGF-1-induced lipogenesis and inflammation by targeting the PI3K/Akt/FoxO1 and JAK2/STAT3 signaling pathways.

Triple Combination Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% for Acne: Efficacy and Safety from a Pooled Phase 3 Analysis

INTRODUCTION

A three-pronged approach to acne treatment combining an antibiotic, antimicrobial, and retinoid may be more efficacious than single/double treatments while potentially reducing antibiotic resistance. This study evaluated the efficacy and safety of the first fixed-dose, triple-combination topical acne product, clindamycin 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1% gel (CAB) using pooled phase 3 data.

METHODS

In two identical phase 3 (N = 183; N = 180), double-blind, 12-week studies, participants aged ≥ 9 years with moderate-to-severe acne were randomized 2:1 to receive once-daily CAB or vehicle gel. Endpoints included ≥ 2-grade reduction from baseline in Evaluator's Global Severity Score and clear/almost clear skin (treatment success) and least-squares mean percent change from baseline in acne lesion counts. Treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were evaluated.

RESULTS

At week 12, 50.0% of participants achieved treatment success with CAB versus 22.6% with vehicle gel (P < 0.001). CAB resulted in > 70% reductions in inflammatory and noninflammatory lesions at week 12 (77.9% and 73.0%, respectively), which were significantly greater than vehicle (57.9% and 48.2%; P < 0.001, both). Most TEAEs were of mild-moderate severity, and < 3% of CAB-treated participants discontinued study/treatment because of AEs. Transient increases from baseline in scaling, erythema, itching, burning, and stinging were observed with CAB, but resolved back to or near baseline values by week 12.

CONCLUSIONS

The innovative fixed-dose, triple-combination clindamycin phosphate 1.2%/adapalene 0.15%/BPO 3.1% gel was efficacious and well tolerated in children, adolescents, and adults with moderate-to-severe acne. Half of participants achieved clear/almost clear skin by 12 weeks, rates not previously seen in clinical studies of other topical acne products.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04214639 and NCT04214652.

The Question of Adolescent and Postadolescent Acne: The Nigerian Experience

Introduction

Differences between adolescent and postadolescent acne are increasingly being recognized. This study aimed to document the clinical profile of facial acne vulgaris and, additionally, to compare adolescent to postadolescent acne and any gender-based differences.

Methods

Cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted from February 2021 to March 2022 at three dermatology clinics. Patients had their anthropometric measurements, type of acne lesions, and severity and scarring assessed.

Results

A total of 261 patients (75.5% females) with a mean age of 24.5 (±7.4) years were diagnosed to have facial acne vulgaris. The severity of acne was mild in 44.8%, moderate in 48.3%, and severe in 6.9%. Acne was noninflammatory in 69.7%, inflammatory in 13.0%, and mixed in 17.2%. Adolescent and postadolescent acne significantly differed in the type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences included BMI, lesions of acne, and severity.

Conclusion

There is an increasing prevalence of postadolescent acne with persistent being the most common category. There are significant differences between adolescent and postadolescent acne: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and postadolescent acne.

Comparative Efficacy Between Intense Pulsed Light Narrow Spectrum and Broad Spectrum in the Treatment of Post-Acne Erythema (PAE)

Purpose

Post-acne erythema (PAE) is one of the most common physical sequelae of acne regression, PAE can resolve spontaneously, but in some patients it may last for years. This study aimed to evaluate the efficacy and safety of narrow and broad spectrum filters of intense pulsed light (IPL) for the treatment of PAE.

Patients and Methods

This prospective study evaluated 60 patients with PAE for at least 6 months, assigned equally to three groups: 1st group received narrow-spectrum with vascular filter (530-650 nm and 900-1200 nm), 2nd group received broad-spectrum with (560/590-1200 nm) filters, the appropriate adjustments were made according to patient's skin colour. Every patient received four sessions one month apart. 3rd group is blank control group did not receive any treatment. CAT (CEA (Clinical Erythema Assessment), Area, and Telangiectasia) used to grade clearance of PAE before and after treatment, Investigators Global Assessment (IGA) used to assess the improvement score after the treatment, and Cardiff Acne Disability Index (CADI) used to evaluate the impact of PAE on patients' Quality of Life (QoL). Self-satisfaction scale completed at the follow-up. Adverse events and acne relapse were recorded.

Results

A significant decrease of CAT score in vascular group (P<0.05). IGA scale showed significant improvement after vascular treatment. A significant decrease in CADI (P<0.05) after vascular treatment. Patient satisfaction was higher in vascular group than control and blank control groups. Acne relapse observed in control and blank control groups (40% and 15%, respectively).10% of patients showed pigmentation, 15% had blisters after 590 nm treatment.

Conclusion

IPL vascular filter (530-650 nm and 900-1200 nm) have efficacy in the treatment of PAE. CADI score, patient satisfaction, and acne relapse were significantly better after vascular narrow spectrum treatment than broad-spectrum treatment.

Real-World Case Studies Showing the Effective Use of Azelaic Acid in the Treatment, and During the Maintenance Phase, of Adult Female Acne Patients

Acne Vulgaris is a chronic inflammatory skin disease, and one of the most prevalent inflammatory dermatoses among teenagers, affecting more than >95% of boys and 85% of girls. Adult female acne (AFA) is a subtype of acne, pragmatically defined as affecting women over the age of 25. The clinical presentation of AFA may be distinguished from adolescent acne according to some key clinical and psychosocial characteristics. The etiopathogenic factors and the chronic clinical course that are implicated in AFA make management complex and challenging. A frequent tendency to relapse makes the requirement for maintenance therapy highly likely. Therefore, AFA typically requires a specific, tailored therapeutic approach. This paper presents six challenging case studies that demonstrate the efficacy of azelaic acid gel (AZA) in adult female acne. The six cases use AZA as monotherapy, as part of a combination regimen at treatment initiation, or as maintenance treatment (which is frequently required in this adult population). The positive outcomes achieved in this case series demonstrate that AZA can be efficacious, result in excellent patient satisfaction in mild to moderate adult female acne, and can be effective as a maintenance therapy.

Evaluation of Hormonal Factors in Acne Vulgaris and the Course of Acne Vulgaris Treatment with Contraceptive-Based Therapies in Young Adult Women

Acne vulgaris is a common chronic inflammatory skin disease, which is considered one of the diseases of civilization due to the significant influence of environmental factors on the severity and frequency of these lesions. The aim of this study was to evaluate the hormonal profile of patients before treatment and to assess selected hormonal parameters after treatment. Our first objective was to examine the correlation between the selected hormonal parameters and the severity of acne before treatment. Our second objective was to evaluate the impact of treatment with three therapies, as measured by the selected hormonal parameters and acne severity. Statistical calculations were performed using the R v.4.1.1 statistical calculation environment (IDE RStudio v. 1.4.1717) with a significance level for the statistical tests set at α = 0.05. The results showed that the women in the pre-treatment (T1) and control (C) groups had significant differences in testosterone, androstendione, FAI, SHBG, prolactin, ACTH, and cortisol concentrations. After treatment, there were still significant differences in testosterone, androstendione, FAI, and SHBG concentrations between the post-treatment (T2) and control groups. We concluded that testosterone, androstendione, and cortisol concentrations correlate with acne severity. Acne in adult women may be an important clinical marker of androgen excess syndrome and cannot be considered a transient symptom of puberty. The mainstay of acne treatment is contraceptive therapy (ethonylestradiol and drospirenone). In this study, we confirmed the effectiveness of three contraceptive-based treatments using hormonal parameters and acne severity.

Efficacy of a retinoid complex plus anti-inflammatory component cream alone or in combination with prebiotic food supplement in adult acne: A randomized, assessor-blinded, parallel-group, multicenter trial on 184 women

BACKGROUND

Adult female acne (AFA) nowadays is a very common skin condition affecting mainly women aged between 25 and 40. The treatment of AFA could be challenging.

STUDY AIM

We evaluate and compare the efficacy and tolerability of a cream formulation containing two retinoid molecules (hydroxypinacolone/retinyl palmitate) combined with Iris Florentina root extract and a complex of three oligopeptides (C) applied twice a day (morning and evening) alone or in combination (C + O) with a food supplement containing a mixture of prebiotic molecules (FOS&GOS) zinc, lactoferrin, and niacinamide.

SUBJECTS AND METHODS

In a multicenter, randomized, assessor-blinded, 12-week trial, we assessed the efficacy of these two regimens in the evolution of AFA lesions (non-inflammatory: NI-L; inflammatory: IL; and total number of lesions: TL). Additional efficacy endpoints were the evolution of the 6-point (from 0 to 5) GEA and Adult Female Acne Scoring Tool (AFAST) scores.

RESULTS

One hundred and eighty-four women (mean age 32 ± 6 years) with AFA agreed to participate after obtaining informed consent. They were randomized (2:1) to the topical product (n = 123) (Group C) or to the combination (n = 61) (Group C + O) treatment. All enrolled patients concluded the trial with no drop-out. At baseline, NI-L, IL, and TL acne lesion count were 15 ± 9, 9 ± 5, and 24 ± 14 in the Group C and 19 ± 8, 9 ± 4, and 29 ± 10 in Group C + O. In comparison with the number of the acne lesions at the baseline, both treatment regimens induced a significant reduction (p = 0.0001, ANOVA test) at Week 12 in NI-L, IL, and TL by -54%, -63%, and - 59% in Group C and by -55%, -73%, and - 61% in the Group C + O, respectively. At Week 12, the absolute IL count reduction vs. baseline was significantly (p = 0.0158) greater in Group C + O (-7.0) in comparison with Group C (-5.5). The GEA absolute score reduction in Group C + O group was significantly greater in comparison with Group C (-1.5 vs. -1.1; p = 0.0097). In the Group C + O, a greater percentage of success treatment (defined as a GEA score of 0/1 at Week 12) was observed in comparison with Group C (39% vs. 27%; p = 0.06). AFAST score at baseline was 2.4 ± 0.5 in group C and 2.8 ± 0.6 in group C + O. AFAST score was reduced by 21% and by 51% after 6 and 12 weeks of treatment in group C and by 22% and 55% in group C + O, respectively. Both treatment regimens were well tolerated. Not relevant adverse events were recorded.

CONCLUSION

A cream containing retinoid molecules and Iris Florentina root extract is effective and well tolerated in the management of AFA. The treatment combination with a prebiotic and anti-inflammatory food supplement offers an additional clinical benefit mainly in reducing inflammatory lesions and improving the severity acne score.

Analysis of the epidemiological burden of acne vulgaris in China based on the data of global burden of disease 2019

Acne vulgaris is a chronic, inflammatory skin disease, which has brought an increasing disease burden to patients and society. But there is no systematic study on the disease burden and social development of acne vulgaris in China. This study aimed to analyze the epidemiological burden and trend of acne vulgaris in China from 1990 to 2019 based on the data in the global burden of disease 2019 (GBD 2019). The number of incidences/illnesses, age-standardized incidence/prevalence rates, disability-adjusted life years (DALYs), and DALY rate of acne vulgaris in China from 1990 to 2019 were obtained from the GBD 2019 to evaluate the epidemiological trends and age-period-cohort trends. The associations between disease burden and social development degrees were analyzed using a sociodemographic index. In 2019, the age-standardized prevalence and incidence of acne vulgaris in China were both at low levels in the world. From 1990 to 2019, the prevalent cases and incident cases of acne vulgaris in China rose firstly and then fell (peaked in 2005 and 2003, respectively), and the age-standardized prevalence/incidence/DALY rates showed growth trends continuously. The prevalence of acne vulgaris peaked in the 15–19 age group while the incidence peak age was 10–14 years old and there was an obvious gender difference, females were higher than males. With the increase of sociodemographic index (SDI) value, the morbidity of acne vulgaris showed a linear growth trend (P < 0.05). From 1990 to 2019, the disease burden of acne vulgaris is increasing in China, which is correlated with social and medical development. Active research on the epidemiological data of acne vulgaris and its relationship with the level of social development is important for both the diagnosis and treatment of acne vulgaris and for the development of health policies.

The Social and Psychological Impact of Acne Treatment: A Cross-Sectional Study of Blood Donors

BACKGROUND

Acne in adolescence and adulthood is believed to have a long-term impact on socioeconomic status (SES) and health-related quality-of-life (HRQoL) in adults.

OBJECTIVE

To estimate the cross-sectional prevalence of medically treated (MedTreAc) and untreated acne (UnTreAc) and to characterize its long-term impact in adults.

METHODS

A nationwide cross-sectional study on 17 428 blood donors aged 18-35 was performed. Associations among acne and HRQoL, depressive symptoms, total income, and SES were investigated via linear/logistic/multinomial logistic regression analyses adjusted for relevant covariables. HRQoL was measured by the Short Form-12, and depressive symptoms by the Major Depression Inventory. The data were self-reported.

RESULTS

Of the participants, 3591 (20.6%) and 1354 (7.8%) identified as the MedTreAc and UnTreAc phenotype, respectively. Neither phenotype was associated with a long-term impact on total income, but the MedTreAc group was associated with being an apprentice/student (OR = 1.26; 95% CI: 1.12, 1.42; P = 1.3×10^-4) or high skill-level employee (OR = 1.22, 95% CI: 1.07; 1.39, P = .0023), while self-employment was more common for those with UnTreAc (OR = 1.53; 95% CI: 1.12, 2.06, P = .0061). Additionally, the UnTreAc group was associated with a lower mental HRQoL (SF-12 mental component summary score -1.05, 95% CI: -1.56, -0.54; P = 1.4×10^-9) and increased odds ratio of depressive symptoms (OR = 1.44; 95% CI: 1.00, 2.02, P = .046).

CONCLUSION

In this population of blood donors, the cumulative prevalence of MedTreAc and UnTreAc were 20.6% and 7.8%, respectively. Untreated acne had a long-term impact on psychosocial well-being in adulthood. It was associated with lower mental HRQoL and higher occurrence of depressive symptoms. Acne was not associated with a lower salary or SES.

Adult female acne: Clinical and therapeutic particularities (Review)

Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne.

Predictors of quality of life in adults and adolescents with acne: A cross-sectional study

Background:

Acne is becoming more prevalent in adults, particularly women across the globe. Although previous studies have compared clinical and epidemiologic characteristics of adolescent and adult acne, an adequate understanding of the quality of life (QoL) of adult acne patients and associated comorbidities are still lacking.

Objectives:

We sought to compare the differences between adolescent and adult patient groups, regarding gender, socio-clinico-demographic factors, and comorbid associations, as well as their relatedness with life quality.

Methods:

This is a cross-sectional study with 1013 acne patients. Data on the severity, onset and location of acne, sex, family history of acne, smoking and alcohol habits, medication history, presence of seborrhea, and other comorbidities were collected. We employed the classification used by the American Academy of Dermatology for assessing acne severity. To assess the QoL in the patients, the Dermatology Life Quality Index (DLQI) score was used.

Results:

Of the 1013 patients included in this study; 380 (female: 333, male: 47) were adult, and 633 (female: 535 and male: 98) were adolescent cases. The median total DLQI scores of adult and adolescent groups were not significantly different. Our results showed that factors such as age, gender, duration, body mass index, family history, and psychiatric disorders exhibited no impact on QoL in both adolescents and adults. Age of onset was correlated with DLQI scores in the adult group. The main influencers of DLQI in the adult group were allergic disorders, hormonal imbalances, and previous treatment history. Besides, major influencers in adolescent patients were acne severity, acne location, hirsutism, hyperseborrhea, premenstrual exacerbation, menstrual irregularities, previous treatment history, and smoking.

Conclusions:

The findings of our current study have shown that DLQI has been influenced by different factors in adolescents and adults that should be kept in mind.

Dermatology: how to manage acne vulgaris

Background

Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris.

Methods

A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English.

Results

Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies.

Conclusion

Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.

Late acne in women: patients of gynecologists, endocrinologists or dermatologists?

The article raises the problem of late acne in women. As a result of observation of 326 patients aged 20 to 40 years, evaluation of the data of a significant number of laboratory and instrumental tests, it was found that 257 (79%) women had hyperandrogenism of various etiologies. On the basis of which, 6 groups of patients were identified, which allows applying etiological treatment. It is concluded that only the cooperation of dermatovenerologists, gynecologists, endocrinologists can help an increasing number of such patients.

Adult female acne: A cross-sectional study of diet, family history, body mass index, and premenstrual flare as risk factors and contributors to severity

Background

The risk factors for adult female acne (AFA) and their influence on severity are unclear. The aim of this study was to document the role of diet, body mass index (BMI), premenstrual flare, and family history of acne as risk factors and cause of severity of AFA.

Methods

This was a prospective, cross-sectional, case-control study of 112 women age ≥25 years. The women were clinically evaluated. Sociodemographic data (age, family history of acne, premenstrual flare, weight, and height) and dietary habits were documented. Age, weight, height, and dietary habits of controls were also documented. Data were analyzed using SPSS, version 22.

Results

The mean age of the 56 patients with AFA was 33.4 ± 8.2 years (controls: 24.5 ± 4.4 years). Premenstrual flare of acne was noted in 58.9% of patients, a family history of acne was present in 51.8% of patients, and the mean BMI was 25.2 ± 4.9 (32.1%). A risk factor for AFA was a family history of acne (p ≤ 0.001). Dietary habits (chicken, p = 0.457; beef, p = 0.845; cakes and sweets, p = 0.956; starchy food, p = 0.361; and type of milk, p = 0.919) and BMI (p = 0.486) were not risk factors for AFA. Premenstrual flare (p = 0.178), BMI (p = 0.206), family history of acne (p = 0.592), and diet did not contribute to the severity of AFA.

Conclusion

Diet and BMI are not risk factors for AFA, but a family history of acne is. Severity of AFA is independent of premenstrual flares, diet, BMI, and a family history of acne.

Topical antimicrobial peptides in combined treatment of acne patients

BACKGROUND

Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous unit that affects over 80% of adolescents and young adults. This study aimed to compare the therapeutic efficacy and tolerability of an isotretinoin treatment course with GDP-20 (granulysin-derived peptides) versus the conventional isotretinoin monotherapy prescribed to patients with mild-to-moderate acne.

METHODS

Our study included 60 Russian subjects affected with AV of mild-to-moderate severity divided into two therapeutic groups. Half of the patients were female; mean age was 19.5 ± 5.6 years. Group 1 was treated with topical GDP-20 twice daily to the affected skin of the face combined with systemic isotretinoin in a fixed low dose of 0.3 mg/kg/day. Group 2 was treated with systemic isotretinoin as a monotherapy.

RESULTS

The assessment of the changes of AV lesion count on the 12th week of the treatment showed that in Group 1, the mean value of open comedo number reduced from 21.4 ± 6.1 at day 0 to 4.4 ± 2.5 (p < 0.05), the mean number of closed comedo reduced from 7.6 ± 3.5 to 2.4 ± 1.05 (p < 0.05), and those of papules-pustules reduced from 6.1 ± 1.03 to 1.4 ± 0.2 (p < 0.05).

CONCLUSIONS

Topical antimicrobial peptides (GDP-20) combined with low doses of systemic isotretinoin mild-to-moderate resulted in considerable improvement of clinical manifestations of mild-to-moderate AV and threefold reduction in the disease severity with IGA score 0-1 after 12 weeks. Topical application of GDP-20 antimicrobial peptides can improve the efficacy of low-dose systemic isotretinoin in combined treatment of mild-to-moderate AV.

Salicylic Acid Peel and Fusion Peel with Salicylic & Mandelic Acid Peel for Treatment of Acne Scars - A Comparative Study

Introduction. Acne vulgaris is one of the most common skin diseases affecting more than 85% of individuals worldwide. The study aimed to compare the therapeutic efficacy of Salicylic acid peel and Salicylic acid - mandelic acid peel for treatment of acne scars.

Material and Methods. A comparative study was conducted on 41 patients, divided into two groups based on treatment choice by the subjects. Group A (23) were treated with 30% salycilic acid peels, and group B (18) were treated with 20% salycilic acid and 10% mandelic acid peels at an interval of 2 weeks for three sessions. The physician’s global assessment scale and clinical photographs were used at the end of three sessions. All the data were analysed using SPSS considering P<0.05 as significant.

Results. Of the total 41 patients analyzed, the mean age in both the groups were comparable. (Group A: 20.4 years; Group B: 20.5 years). Duration of acne was >12 months in both the groups 13 (56.52%) & 10 (55.56%)). Thirteen patients (56.52%) in group A and 1 (5.56%) in group B had no side effects which was statistically significant (p=0.01). Using the physician’s global assessment scale 51-75% (Good) an improvement was seen in grade I 4 (17%) and 18 (78%) in grade II in group A and 2 (11%) in grade I and 12 (67%) in grade II in group B, respectively which was statistically significant (p=0.001).

Conclusion. Both agents showed almost equal efficacy in improving mild-to-moderate acne scars. Adverse effects were less with Salicylic acid peel compared with mandelic acid peel..

Efficacy and safety of intense pulsed light using a dual-band filter for the treatment of facial acne vulgaris

Intense pulsed light (IPL) devices have been used in acne treatment in combination with conventional topical and oral medications. This study aimed to evaluate the efficacy and safety of IPL treatment using a dual-band filter (400-600 nm and 800-1200 nm) in facial acne vulgaris treatment. Twenty-three acne vulgaris patients were enrolled in this study. The patients were treated on both sides of the face. The treatments were performed in 2-week intervals for a total of five sessions. The final visit for the clinical evaluation was 2 weeks after the fifth treatment session. The mean number of papules, pustules, and comedones, and the melanin index, was significantly decreased at the final visit. However, sebum production and the erythema index showed no statistically significant differences after treatment. IPL treatment using a dual-band filter can be an alternative for patients who are unfit for systemic acne medication. It can also be used with conventional acne treatment for better treatment results.

Effects of Topical Hydrogen Purification on Skin Parameters and Acne Vulgaris in Adult Women

BACKGROUND

Acne vulgaris is a prevalent dermatological disease characterized by skin eruptions, which may decrease the sufferer's quality of life. Hydrogen purification treatment is a new procedure used in cosmetology to improve the skin parameters of the face. This study examined the effectiveness of hydrogen purification treatment to improve women's skin conditions with regard to acne vulgaris.

METHODS

In this study, 30 women participated who suffered from a high level of sebum and acne. The control group was comprised of 30 healthy women with a low level of sebum. The Hellgren-Vincent Scale and Derma Unit SSC 3 device were used to assess acne vulgaris severity and skin properties, respectively. Four hydrogen purification sessions were carried out at 7-day intervals, using the Hebe Hydrogenium+ generating alkaline water.

RESULTS

At baseline and 7 and 14 days after finishing the series of treatments, the levels of oiliness, moisture, and skin pH were tested. The main effects of treatment were significant in the following parameters: pH around the bottom lip, moisture between the eyebrows and around the nose, and oily skin in all three face sites.

CONCLUSIONS

The level of sebum decreased and moisture levels increased during hydrogen purification. Topical hydrogen purification is an effective and safe treatment for acne vulgaris.

Two Percentage of Ketoconazole Cream for the Treatment of Adult Female Acne: A Placebo-Controlled Trial

Introduction

Our objective was to determine the efficacy of ketoconazole (KTZ) 2% cream for the treatment of mild adult female acne (AFA).

Materials and methods

This placebo-controlled trial was conducted in District Headquarters (DHQ) Teaching Hospital, Sahiwal, Pakistan. The study was completed in a period of January 2019-June 2020. A total of 60 females of age > 25 years having mild AFA were included. In Group I, the patients were advised to apply 2.0% KTZ cream covering the whole skin area twice daily for a period of eight weeks. In Group II (placebo group) patients, a topical cream containing propylene glycol was applied for similar period. After eight weeks, the cream was discontinued and participants were advised to use routine skincare products, and follow-up was done after two weeks. The main study outcome was reduction in the total count of acne lesions including both inflammatory and non-inflammatory lesions and overall success rate of treatment.

Results

Mean age was 36.2 ± 6.3 years in KTZ group versus 35.4 ± 6.5 years in control group. Mean duration of acne was 14.3 ± 7.3 years in KTZ group versus 15.1 ± 6.9 years in control group. Improvement in facial adult female acne scoring tool (AFAST) scale (AFAST-F) was observed in 13 (43.3%) patients in KTZ group and in only 4 (13.3%) patients in control group (p value = 0.009). Improvement in submandibular AFAST (AFAST-S) was observed in 12 (40.0%) patients in KTZ group and in eight (26.7%) patients in control group. The overall success rate of treatment was 14 (46.7%) in KTZ group versus 4 (13.3%) in control group (p value = 0.012).

Conclusions

In our study, we found significant improvement in reduction of acne lesions as well as complete recovery using 2.0% ketoconazole for the treatment of mild AFA. So KTZ can be used as a preferred treatment option for these patients.

Correlation Between Lipid Profile and Acne Vulgaris

Background and Aim

Acne is a common skin disease resulting from a complex interaction of various pathogenetic factors. The aim of this study was to find out lipid profile abnormalities in acne vulgaris patients.

Material and Methods

This descriptive analytic cross-sectional study was conducted on 45 acne patients and 45 age- and sex-matched healthy controls to assess plasma total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride (TG) levels.

Results

We showed a higher cholesterol level in acne patients (P=0.025), particularly in men (P=0.04). Other plasma lipids including TG, LDL, and HDL in male and female patients were higher compared to controls, but this is not statistically significant.

Discussion and Conclusion

In conclusion, lipid profile was altered in our patients, with high cholesterol level as the commonest derangement, particularly in men. Therefore, screening for lipid profile abnormalities could be considered in the treatment of acne patients.

Integrated targeted serum metabolomic profile and its association with gender, age, disease severity, and pattern identification in acne

Background

Westernized diet and nutritional metabolism are important in acne pathogenesis, especially in adult patients. However, clinical and basic data are lacking. Pattern identification (PI) is a tool that results in a diagnostic conclusion based on a cluster of concurrent symptoms and signs in traditional medicine. Acne can be classified by PI. However, whether the metabolomic profile differs according to the PI of acne is unknown. Metabolomic data would help clarify the pathogenesis of acne.

Methods

We conducted a cross-sectional study involving 40 healthy controls and 60 subjects with acne. We evaluated androgens, serum lipids, essential amino acids, nonessential amino acids, other amino acids, and pro-inflammatory cytokines of all subjects and compared the metabolomic profiles between acne subjects and healthy controls, and in subgroups according to gender, age, severity, and PI.

Results

Dehydroepiandrosterone sulfate and serum fatty acids were significantly higher in female subjects, adolescents, and those with disharmony of the thoroughfare and conception vessels. The total essential and nonessential amino acids were significantly lower in the overall, female, adult, severe, and phlegm-stasis group. The latter group exhibited elevated serum levels of interleukin-1β and -6.

Conclusions

This is the first study to investigate serum lipids, amino acids, and cytokines in subjects with acne. We analyzed the differences between metabolomic profiles to determine the diagnostic value of PI. Prospective studies with more patients are needed to confirm the characteristics of each PI and lipidomic data will enrich knowledge concerning lipid mechanism.

Daylight photodynamic therapy with 5-aminolevulinic acid 5% gel for the treatment of mild-to-moderate inflammatory acne

BACKGROUND

Acne vulgaris is a chronic inflammatory disease that frequently occurs in adolescence. This common condition is often treated with topical or systemic therapies according to severity. Photodynamic therapy (PDT) with topical delta-aminolaevulinic acid is a novel drug-sparing, but time-consuming approach. Recently, sunlight exposure has been considered a quicker, safer, cheaper and more agreeable alternative light source for PDT, but efficacy has only been proven in the oncological field. This study aimed to evaluate the efficacy and tolerability of daylight PDT (DL-PDT) for the treatment of inflammatory acne vulgaris of face, chest and trunk lesions.

METHODS

Twenty patients with mild-to-moderate acne vulgaris were enrolled and treated with a topical gel based on 5% delta-aminolaevulinic acid, administered 4 times at 14-day intervals. Efficacy was assessed with mean lesion count, Physician Global Assessment (PGA), Investigator's Global Assessment (IGA) and patients' self-assessment (10-point scale).

RESULTS

Compared to T0, mean inflammatory lesions count decreased in all patients at FU1, from 16.7±4.4 to 5.2±3.3 (P). No adverse events were reported, and no patients were lost to follow-up. PGA results of "excellent" or "good" improvement were reported in 95% at T3 and 90% at FU1. Patients' self-assessments was 7.6±1.0 (T3). Discomfort was 0.5±0.2 (T3 and FU1).

CONCLUSIONS

DL-PDT seems to be an effective and tolerable therapy for the treatment of mild-to-severe inflammatory acne. This novel regimen seems to be a viable option in the panorama of acne therapies.

Abnormal plasma lipids profile in women with post-adolescent acne

Introduction

Acne vulgaris is a multifactorial chronic inflammatory disease that is increasingly recognized in adult women.

Aim

To investigate a relationship between plasma lipids profile and acne in women and a correlation between selected clinical features of acne (severity, age of onset, location of lesions and the presence of comedones) and lipids profile.

Material and methods

Sixty-four adult women with post-adolescent acne and 20 healthy controls were included in the study. Plasma total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were determined in all the subjects.

Results

Adult women with acne had statistically significantly increased levels of TC, TG and LDL-C compared to healthy controls (p < 0.05). The level of HDL-C did not differ between the two groups. There was no relationship between higher levels of TC, TG and LDL-C and a clinical picture of acne.

Conclusions

Acne in adult women is likely to be associated with increased levels of TC, TG and LDL-C. This abnormality seems to be important in the pathogenesis of adult acne and could be a result of high fatty acid diet. Performing a lipid profile examination in women with acne should be taken into account when screening patients and followed by appropriate dietary recommendations.

Adult female acne: a guide to clinical practice

BACKGROUND

Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution.

OBJECTIVE

To develop a guide for the clinical practice of adult female acne.

METHODS

A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne.

RESULTS

The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne.

CONCLUSION

Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.

Female type of adult acne: Physiological and psychological considerations and management

Today we see more cases of acne after adolescence, with a greater prevalence in females than males. Adult female acne has a distinct clinical presentation and is associated with a number of specific pathophysiological features and gender-specific triggers. The psychological impact of acne is generally significant and largely underestimated; stress during professional and private life, anxiety and sleep quality, in particular, have a reciprocal relationship with disease susceptibility and severity. It is essential to compare with males. Acne in females often causes greater distress in adults than in adolescents. The impact of disease may therefore be greater for female patients, triggering higher levels of psychosocial anguish and increasing the likelihood of sequelae such as skin picking and the risks of cutaneous superinfection, scarring and PIH and acne recurrence. The management of adult female acne should encompass not just medical treatment of the symptoms, but also a comprehensive, holistic approach to the patient as a whole, her individual lifestyle factors and the impact of acne on her quality of life. Future management of this disease should aim to improve patient adherence to therapy and to develop validated outcomes of treatment regarding overall skin appearance and quality of life.

The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis

BACKGROUND

Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence-based support in the efficacy and safety of non-pharmacological therapies is lacking.

OBJECTIVE

To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris.

METHODS

A systematic literature review, including a best-evidence synthesis, was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017.

RESULTS

Thirty-three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified laser- and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction in acne lesions. However, only seven studies had a high methodologic quality. Based on these seven trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), intense pulsed light (400-700 and 870-1200 nm) and the diode laser (1450 nm). Initially, conflicting evidence was found for pulsed dye laser (585-595 nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient.

CONCLUSION

Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.

Clinical behavior of a cohort of adult women with facial acne treated with combined oral contraceptive: ethinylestradiol 20 µg/dienogest 2 mg

Acne vulgaris is the most common skin disease. It affects the young adult female population and generates great impact on physical and mental health. One of the treatments with good results for affected women is combined oral contraceptive pills (COCPs). The aim of this study was to determine the clinical effect of facial acne management with ethinylestradiol 20 µg/dienogest 2 mg in a cohort of Colombian adult women. A cohort of 120 female university students was followed for 12 months. These participants were enrolled in the Sexual and Reproductive Health Program of the Santiago de Cali University. This cohort admitted women between 18 and 30 years old who had chosen to start birth control with ethinylestradiol 20 µg/dienogest 2 mg COCPs, did not have contraindi cations to the use of COCPs, and had been diagnosed with acne. Monthly monitoring of facial acne lesion count was performed. Relative changes in facial lesion count were identified. At the end of follow-up, the percentage of reduction of lesions was 94% and 23% of women had a 100% reduction in acne lesions. In conclusion, the continued use of the ethinylestradiol 20 µg/dienogest 2 mg COCPs reduced inflammatory and non-inflammatory acne lesions in reproductive-age women between 18 and 30 years of age with no severe acne.

The prevalence of acne in Mainland China: a systematic review and meta-analysis

INTRODUCTION

Acne, a very common skin disease, can result in psychological distress and sustain impairment in quality of life. Data on the prevalence of acne and the differences in gender, region and age are limited. The aim of this review is to estimate the prevalence of acne in Mainland China comprehensively and to quantify its association with gender, region and age.

METHODS

We searched electronic databases with predetermined search terms to identify relevant studies published between 1 January 1996 and 30 September 2016. We pointed out repeated results using Note Express software and evaluated the studies for inclusion. Two independent reviewers extracted the data, followed with statistical analyses using Comprehensive Meta-Analysis software version 2.0. A random effects model was adopted to calculate the overall pooled prevalence and to merge categories, including gender (males and females), region (Northern China and Southern China) and age (primary and secondary students: 7-17 years old; undergraduates: 18-23 years old; overall: no limits of age) for subgroup analyses. Logistic meta-regression analysis was used to clarify the associations between acne and the predictors age, gender and region using OR and their associated 95% CI.

RESULTS

25 relevant studies were included in this meta-analysis. The overall pooled prevalence rates of acne were 39.2% (95% CI 0.310 to 0.479). The prevalence rates in different age groups were 10.2% overall (95% CI 0.059 to 0.171), 50.2% for primary and secondary students (95% CI 0.451 to 0.554), and 44.5% for undergraduates (95% CI 0.358 to 0.534); by gender, the prevalence rates were 35.7% for females (95% CI 0.275 to 0.448) and 39.7% for males (95% CI 0.317 to 0.482); and by region, the prevalence rates were 34.2% for Northern China (95% CI 0.242 to 0.458) and 46.3% for Southern China (95% CI 0.374 to 0.555). The associations between acne and the predictors age, gender and region were statistically significant.

CONCLUSIONS

In Mainland China, primary and secondary students exhibited higher prevalence rates than undergraduate students; males had higher prevalence rates of acne than females; and the prevalence rates of acne in Southern China was higher than Northern China.

Acne RA-1,2, a novel UV-selective face cream for patients with acne: Efficacy and tolerability results of a randomized, placebo-controlled clinical study

BACKGROUND

General skincare measures such as the use of moisturisers and products containing adequate photoprotection are important components of acne patients' management to complement the pharmacological regimen. Acne RA-1,2 is a novel dermato-cosmetic product which contains selective photofilters and active ingredients against the multifactorial pathophysiology of acne.

OBJECTIVES

To evaluate the tolerability of Acne RA-1,2 and its effect on the clinical signs of acne.

METHODS

This double-blind, placebo-controlled study randomized 40 adult patients with 10-25 comedones per half face to once-daily application of Acne RA-1,2 or placebo for 8 weeks. Evaluations after 4 and 8 weeks included the number of comedones, transepidermal water loss (TEWL), sebum production, and tolerability.

RESULTS

In the Acne RA-1,2 group, there was a significant 35% decrease in the mean number of comedones from 26 at baseline to 17 at Week 8 (P<.001), a 7% significant reduction in TEWL (9.32 to 8.66 g/h/m² ; P<.001), and a 24% significant reduction in sebum production (154.8 to 117.6 μg/cm² ; P<.001). The reductions in TEWL and sebum production were significantly greater than those in the placebo group at Weeks 4 and 8 (P<0.05). There were no adverse events.

CONCLUSIONS

Acne RA-1,2 was well tolerated and effective at reducing comedones and sebum production and improving epidermal barrier function. These results suggest that Acne RA-1,2 is useful against acne-prone facial skin, particularly as it targets sebum production, which topical pharmacological acne therapies do not address.

Skincare Bootcamp: The Evolving Role of Skincare

Background:

Although cosmetic procedures have a significant impact on certain aspects of aging, such as deep, wrinkling, sagging, and volume loss, they fail to address the overall quality of the skin.

Methods:

Daily skincare routines potentially can have a significant long-term impact on the overall quality of a person’s complexion.

Results:

By expanding our product knowledge, we can help our patients individualize their at-home skincare routine using effective products and ingredients designed to address their specific skin concern and support the professional care we deliver.

Conclusions:

Here, we discuss the types of products and ingredients suitable for the most common dermatologic concerns, from wrinkling to skin sensitivity, acne to sun damage.

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.

Consensus-Based Acne Classification System and Treatment Algorithm for Spain

Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered.

Epidemiology of post-adolescence acne and adolescence acne in Singapore: a 10-year retrospective and comparative study

INTRODUCTION

Acne vulgaris commonly affects adolescents. But recent reports suggest a rising prevalence of post-adolescence acne. While there are few reports on post-adolescence acne, there are even fewer reports comparing adolescence acne and post-adolescence.

METHODS

Epidemiological data of adolescence (<25 years) and post-adolescence (≥25 years) acne patients diagnosed between 2004 and 2013 in a tertiary dermatology referral centre was analysed. From the pool of patients seen in 2010, 80 adolescence and 84 post-adolescence acne patients' epidemiological characteristics and treatment responses were analysed.

RESULTS

During the 10-year study period, there was an increase in the number and proportion of acne cases. In 2004, 4447 (5.77%) of all new diagnoses made were of acne vulgaris. The proportion rose to 5723 (8.13%) in 2013. There were consistently more female than male acne patients. The proportion of post-adolescent cases remained constant at about 30% of all acne patients seen. Mean age of acne vulgaris patients decreased from 23.1 years in 2004 to 22.6 years in 2013. In the subgroup analysis, there were more males than females with adolescence acne (61.3% vs. 38.8%, P < 0.01) and more females with post-adolescence acne (69.0% vs. 31.0%, P < 0.01). Thirty-four (40.5%) post-adolescence acne patients had acne from adolescence persisting into adulthood. Comedonal acne was more prevalent in the adolescence acne patients (58.8% vs. 40.5%, P = 0.019), whereas cystic acne was more prevalent in post-adolescence patients (18.1% vs. 7.5%, P = 0.044). Systemic retinoids were more often used for treatment in the adolescence acne patients than post-adolescence acne patients (23.8% vs. 10.7%, P = 0.027).

CONCLUSION

Acne predominantly affects adolescents but post-adolescence acne is not uncommon. For post-adolescence acne, females predominate over males. Inflammatory and cystic acne tends to be more predominant in post-adolescence acne patients, whereas comedonal acne is more often seen in adolescence acne patients.