Management of acne

Integrative bioinformatics and experimental validation of hub genetic markers in acne vulgaris: Toward personalized diagnostic and therapeutic strategies

BACKGROUND

Acne vulgaris is a widespread chronic inflammatory dermatological condition. The precise molecular and genetic mechanisms of its pathogenesis remain incompletely understood. This research synthesizes existing databases, targeting a comprehensive exploration of core genetic markers.

METHODS

Gene expression datasets (GSE6475, GSE108110, and GSE53795) were retrieved from the GEO. Differentially expressed genes (DEGs) were identified using the limma package. Enrichment analyses were conducted using GSVA for pathway assessment and clusterProfiler for GO and KEGG analyses. PPI networks and immune cell infiltration were analyzed using the STRING database and ssGSEA, respectively. We investigated the correlation between hub gene biomarkers and immune cell infiltration using Spearman's rank analysis. ROC curve analysis validated the hub genes' diagnostic accuracy. miRNet, TarBase v8.0, and ChEA3 identified miRNA/transcription factor-gene interactions, while DrugBank delineated drug-gene interactions. Experiments utilized HaCaT cells stimulated with Propionibacterium acnes, treated with retinoic acid and methotrexate, and evaluated using RT-qPCR, ELISA, western blot, lentiviral transduction, CCK-8, wound-healing, and transwell assays.

RESULTS

There were 104 genes with consistent differences across the three datasets of paired acne and normal skin. Functional analyses emphasized the significant enrichment of these DEGs in immune-related pathways. PPI network analysis pinpointed hub genes PTPRC, CXCL8, ITGB2, and MMP9 as central players in acne pathogenesis. Elevated levels of specific immune cell infiltration in acne lesions corroborated the inflammatory nature of the disease. ROC curve analysis identified the acne diagnostic potential of four hub genes. Key miRNAs, particularly hsa-mir-124-3p, and central transcription factors like TFEC were noted as significant regulators. In vitro validation using HaCaT cells confirmed the upregulation of hub genes following Propionibacterium acnes exposure, while CXCL8 knockdown reduced pro-inflammatory cytokines, cell proliferation, and migration. DrugBank insights led to the exploration of retinoic acid and methotrexate, both of which mitigated gene expression upsurge and inflammatory mediator secretion.

CONCLUSION

This comprehensive study elucidated pivotal genes associated with acne pathogenesis, notably PTPRC, CXCL8, ITGB2, and MMP9. The findings underscore potential biomarkers, therapeutic targets, and the therapeutic potential of agents like retinoic acid and methotrexate. The congruence between bioinformatics and experimental validations suggests promising avenues for personalized acne treatments.

Efficacy of Topical Treatments in the Management of Mild-to-Moderate Acne Vulgaris: A Systematic Review

Acne vulgaris, commonly called acne, is a skin condition affecting many individuals globally. It is a chronic condition characterized by developing pimples, blackheads (open comedones), whiteheads (closed comedones), and other skin lesions. Acne usually appears on the face, neck, chest, and back. It is commonly associated with puberty and adolescence but can also affect adults of all ages. Acne can be very frustrating and embarrassing, leading to low self-esteem and social isolation. The condition arises from various factors, including clogged pores, excessive sebum production, bacteria, and inflammation. This systematic review assesses the effectiveness of topical antibiotics, retinoids, niacinamide, azelaic acid, and clascoterone in treating mild-to-moderate acne vulgaris. A comprehensive search across PubMed, PubMed Central, and Google Scholar yielded 10 articles focused on topical antibiotics, with findings from 198 subjects indicating the efficacy of doxycycline against inflammatory lesions. Retinoids, such as tretinoin and adapalene, significantly improved both lesion types (open and closed comedones). Niacinamide, examined in a randomized controlled trial involving 41 participants, reduced sebum production. Another study with 60 patients revealed that azelaic acid effectively reduced both inflammatory and non-inflammatory lesions. Clascoterone emerged as a promising antiandrogenic treatment, supported by a randomized controlled trial involving 4,440 patients. It is essential that individualized therapy, incorporating patient preferences and considering adverse effects, is emphasized for optimizing acne management.

Effect of isotretinoin treatment on inflammatory and hematological parameters in patients with acne vulgaris

PURPOSE

Although the inflammatory and anti-inflammatory effects of isotretinoin (ISO) treatment in patients with acne vulgaris have been discussed in the literature in recent years, no sensitive and specific marker has been found in studies so far. Neutrophil/HDL (high-density lipoprotein) (NHR), lymphocyte/HD L(LHR), platelet/HDL (PHR), and lymphocyte/monocyte (LMR) are new biomarkers related to inflammation. Triglyceride/HDL (TG/HDL), LDL/HDL, and total cholesterol/HDL have been shown to be cardiometabolic risk factors predicting both cardiovascular disease risk and metabolic risk, rather than just a simple dyslipidemia scale. To our knowledge, the relationship between these parameters and ISO treatment has never been studied before. We aimed to evaluate the immuno-inflammatory response of ISO treatment in patients with acne vulgaris with NHR, LHR, PHR, LMR, TG/HDL, LDL/HDL, and total cholesterol/HDL parameters.

MATERIALS AND METHODS

In this study, 153 patients who received oral ISO treatment for at least 3 months with a diagnosis of moderate-severe acne vulgaris were evaluated retrospectively. Patients were given oral isotretinoin at a dose of 0.5-1 mg/kg. Pre and post-treatment leukocyte (WBC), neutrophil (NE), lymphocyte (LY), platelet (PLT), red cell distribution width (RDW), plateletcrit (PCT), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), mean platelet volume (MPV), monocyte/lymphocyte (MLR), LMR, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, MHR, NHR, LHR, PHR, TG/HDL, total cholesterol/HDL, LDL/HDL parameters were evaluated.

RESULTS

It was found that post-treatment WBC and MPV values increased statistically significantly; NLR, neutrophil, and PCT values, on the other hand, decreased significantly (p < 0.05). No statistically significant change was detected in PLR, MLR, LMR, MHR, NHR, LHR, PHR, lymphocyte, monocyte, platelet, and RDW parameters (p > 0.05). It was determined that post-treatment total cholesterol, triglyceride, VLDL, and LDL levels increased statistically significantly; however, the HDL level decreased significantly (p < 0.05). Levels of total cholesterol/HDL, TG/HDL, and LDL/HDL were also found to increase statistically significantly (p < 0.05).

CONCLUSION

Our study suggests that the MPV and NLR ratio as biomarkers can be used as indicators of atherosclerosis-related inflammation due to ISO treatment, but the MHR, NHR, LHR, PHR, MLR, LMR ratios cannot be used. Moreover, we believe that the ratios of TG/HDL, LDL/HDL, and total cholesterol/HDL offer a new contribution as indicators of cardiovascular risk and systemic inflammation related to ISO treatment.

Practice and attitude of general practitioners towards initiating isotretinoin for acne vulgaris in Fars province, Iran: cross-sectional study

BACKGROUND

Since general practitioners manage acne-related referrals, there needs to be more information in Iran about how drugs such as Isotretinoin are prescribed and the treatment plan. Thus, this study aimed to evaluate general practitioners s' practices and attitudes in prescribing Isotretinoin for acne vulgaris in primary care.

METHODS

This web-based cross-sectional descriptive study was conducted using two questionnaires designed with the target population of GPs working in Fars province in 2021 regarding the prescription of Isotretinoin. Moreover, demographic information, questions about interest in dermatology, and participation in dermatology workshops were gathered.

RESULTS

A total of 308 complete questionnaires were obtained. According to our results, 85 (27.6%) GPs prescribed Isotretinoin in primary care. Based on our results, higher age (OR: 1.042; CI95%: 1.013-1.072; P-value:0.004) and attending dermatological courses (OR: 3.280; CI95%: 1.592-6.755; P-value:0.001) were significantly correlated with more frequent Isotretinoin administration. Among GPs who do not prescribe Isotretinoin, the most common causes are concerns about liver dysfunction (54.7%), teratogenic concerns (37.2%), and lack of familiarity with the drug (31.4%) respectively.

CONCLUSION

The results of this study depicted the reluctance of most physicians to prescribe Isotretinoin and factors such as taking part in supplementary courses under the supervision of dermatologists and following national guidelines that could encourage them to prescribe Isotretinoin.

New Molecules of Importance in the Prevention and Treatment of Acne: A Systematic Patent Review (2016-2020)

BACKGROUND

Acne is a highly prevalent disease that mainly affects the pilosebaceous units associated with sebaceous glands, causing inflammatory skin lesions and affecting the self-esteem, mental health, and quality of life of those who suffer from this disease. Different treatments exist today to prevent, reduce, and improve symptoms; however, over the years, there have been problems with bacterial resistance and slight effectiveness with prolonged use.

OBJECTIVE

The purpose of this article is based on the review of patents of new products of principal topical administration for the treatment of acne in recent years 2016-2020, to evaluate and analyze novel synthetic molecules and semi-synthetics with potential therapeutic and preventive in the acne treatment.

METHODS

A systematic review of patents was conducted through the official database of the European Patent Office - Espacenet, where the search focused on the keywords: "acne and bacteria" in the title or abstract. Only patents granted between the years 2016-2020 were included, with products having molecules with a synthetic and semi-synthetic origin, without considering natural, biological products or those used as diagnostic means.

RESULTS

A total of 19 patents were selected, most with principally antimicrobial and antiinflammatory action, where the reduction in the appearance of resistance by C. acnes is verified, and its action is complemented by inhibiting the different pathophysiological mechanisms that lead to the worsening of the disease.

CONCLUSION

Novel approaches in the treatment and prevention of acne, mainly topically, are focused on the reduction of bacterial resistance and irritation compared to current treatments. The use of combined formulations provides better results with additional benefits, improving treatment times and patient adherence.

Knowledge, Attitude, and Practice Regarding the Use of Isotretinoin in Saudi Arabia

Background Acne vulgaris is a widespread chronic inflammatory dermatological disease with a worldwide prevalence of 9.4%, affecting a large percentage of the young population in the Kingdom of Saudi Arabia. This study aimed to measure the knowledge, attitude, and practice toward the use of isotretinoin among the Saudi population. Methodology This cross-sectional study was conducted among the general population in Saudi Arabia between April 2023 and July 2023. A self-administered questionnaire was distributed across five regions of Saudi Arabia (central, eastern, western, southern, and northern) using Google Survey. The questionnaire included sociodemographic data, the pattern of isotretinoin used, and a 24-item questionnaire to assess the knowledge about isotretinoin. Results Of the 3,001 participants, 77.1% were females, and 55.4% were aged between 16 and 25 years. The prevalence of participants who previously used isotretinoin was 30.6%. The total mean knowledge score was 10.4 (SD = 5.99) out of 24 points, with more than half (52.9%) considered to have poor knowledge, 39.1% moderate knowledge, and only 7.9% good knowledge. Younger participants, female gender, Saudi nationality, never been married, and previous use of isotretinoin were associated with increased knowledge. Conclusions The knowledge of the general population regarding isotretinoin use was lacking. However, younger Saudi females who had previous isotretinoin usage tended to be more knowledgeable about isotretinoin compared to the rest of the participants. Increasing the general public's knowledge regarding isotretinoin and its safe use is necessary.

Scientometric analysis of trends in global research on acne treatment

Acne or acne vulgaris is the most common chronic inflammatory disease of the sebaceous follicles.

Objectives

The present study aims to identify the main lines of research in the field of acne treatment using reproducible scientometric methods. In this article, we reviewed the following research trends: facial acne, different antibiotics, retinoids, anti-inflammatory drugs, epidermal growth factor receptor inhibitors therapy, and associated diseases.

Methods

The analysis of publications from the PubMed collection was carried out from 1871 to 2022. All data were analyzed using Microsoft Excel. The evolution of the terminological portrait of the disease is shown.

Results

Trends in the use of various groups of antibiotics, retinoids, anti-inflammatory drugs, and photodynamic therapy for acne treatment have been found. There is a growing interest in clindamycin and doxycycline (polynomial and exponential growth, respectively). The effects of isotretinoin are also being studied more frequently (active linear growth). The publication of studies on spironolactone is increasing (linear growth). There is also a steady interest in the use of epidermal growth factor receptor inhibitors in the recent years. There is active research on acne and polycystic ovary syndrome (exponential growth).

Limitations

Only articles in English were selected. The most frequent terms were considered.

Conclusions

The dynamics of publication activity in the field of acne was considered. The aim of the current scientometric study was to analyze the global trends in acne treatments. The trend analysis made it possible to identify the most explored areas of research, as well as indicate those areas in dermatology in which interest is declining.

Expression of a recombinant endolysin from bacteriophage CAP 10-3 with lytic activity against Cutibacterium acnes

The bacteriophage CAP 10-3 forming plaques against Cutibacterium acnes which causes skin acne was previously isolated from human skin acne lesion. Incomplete whole genome sequence (WGS) of the bacteriophage CAP 10-3 was obtained and it had 29,643 bp long nucleotide with 53.86% GC content. The sequence was similar to C. acnes phage PAP 1-1 with a nucleotide sequence identity of 89.63% and the bacteriophage belonged to Pahexavirus. Bioinformatic analysis of the WGS predicted 147 ORFs and functions of 40 CDSs were identified. The predicted endolysin gene of bacteriophage CAP 10-3 was 858 bp long which was deduced as 285 amino acids (~ 31 kDa). The protein had the highest similarity with amino acid sequence of the endolysin from Propionibacterium phage PHL071N05 with 97.20% identity. The CAP 10-3 endolysin gene was amplified by PCR with primer pairs based on the gene sequence, cloned into an expression vector pET-15b and transformed into Escherichia coli BL21(DE3) strain. The predicted protein band (~ 33 kDa) for the recombinant endolysin was detected in an SDS-PAGE gel and western blot assay. The concentrated supernatant of cell lysate from E. coli BL21(DE3) (pET-15b_CAP10-3 end) and a partially purified recombinant CAP 10-3 endolysin showed antibacterial activity against C. acnes KCTC 3314 in a dose-dependent manner. In conclusion, the recombinant CAP 10-3 endolysin was successfully produced in E. coli strain and it can be considered as a therapeutic agent candidate for treatment of human skin acne.

Clinical pharmacist role in improving the knowledge and outcomes in patients using isotretinoin: A randomized, controlled study

Objective

To evaluate the role of a clinical pharmacist in improving knowledge and outcomes among isotretinoin users.

Methods

Patients were randomly assigned to an intervention group (received education about isotretinoin by a clinical pharmacist in addition to the physician) and a control group (received routine education by the physician), then followed for three months. Patients' knowledge about isotretinoin optimal use, and side effects and their management and other outcomes were measured in both groups at baseline and at follow up after three months using a validated questionnaire.

Results

Two-hundred and three patients completed the study; 103 were in the intervention group and 100 in the control group. The knowledge improvement between baseline score and follow-up score was greater in the intervention group (mean = 2.835 ± 1.329) compared to the control group (mean = 0.530 ± 0.784) with mean differences = -2.30495, P < 0.001.

Conclusion

Implementing clinical pharmacy services in dermatology clinics can positively increase patients' level of knowledge about isotretinoin, which could reduce the severity of its side effects. Therefore, improving patients' quality of life, and improvement in acne.

Practice implications

Implementing clinical pharmacist services to patients using isotretinoin is feasible in an outpatient setting. Clinical pharmacist counseling and education improve the medication knowledge among patients who use isotretinoin.

Emerging Insights into the Applicability of Essential Oils in the Management of Acne Vulgaris

The occurrence of pustules, comedones, nodules, and cysts defines acne vulgaris, a prevalent chronic inflammatory dermatological condition. In the past few decades, essential oils extracted from varied natural sources have acquired recognition due to their potential medicinal applications in acne therapy. However, there is not yet sufficient medical data to fully characterize this interaction. Multiple factors contribute to the development of acne vulgaris, including excessive sebaceous production, inflammatory processes, hyperkeratinization, and infection with Cutibacterium acnes. Essential oils, including oregano, lavender, lemon grass, myrtle, lemon, thyme, eucalyptus, rosemary, and tea tree, have been found to possess anti-inflammatory, antioxidant, and antimicrobial properties, which may target the multifactorial causes of acne. Analytical methods for determining antioxidant potential (i.e., total phenolic content, diphenyl-1-picrylhydrazyl free radical scavenging assay, reducing power assay, ferrous ion chelating activity, thiobarbituric acid reactive species assay, β-carotene bleaching assay, etc.) are essential for the evaluation of these essential oils, and their method optimization is crucial. Further studies could include the development of novel acne treatments incorporating essential oils and an assessment of their efficacy in large clinical trials. In addition, further research is necessary to ascertain the mechanisms of action of essential oils and their optimal doses and safety profiles for optimal implementation in the management of acne vulgaris.

Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Saudi Arabia

Background and objectives

In Saudi Arabia, Acne vulgaris is a very predominant ailment and Pharmacists currently have standardized protocols at their disposal for the treatment of acne. Pharmacists often prescribe medications for minor cases of acne. Therefore, this study aimed to explore community pharmacists (CPs)' knowledge, attitudes, and practice toward acne management in Riyadh, Saudi Arabia.

Methods

An online cross-sectional study was conducted among CPs working in Riyadh, Saudi Arabia from January and April 2021, using a self-administered, questionnaire, was divided into four sections that collected information from the CP's Knowledge, attitudes, and practices and the management of acne vulgaris. The data were analyzed using the Statistical Package for the Social Sciences version 26 (SPSS).

Result

A total of 313 CPs were enrolled in the study who successfully returned the questionnaire. The mean score of knowledge on etiology, pathophysiology, and therapy for AV was 5.3 ± (SD = 1.5). However, the majority of CPs had a moderate level of knowledge (80.8%), followed by mild to moderate (12.8%). This study showed that CPs had an insufficient level of knowledge about ace management, about 6% of CPs have a high level of knowledge. Inadequate knowledge was revealed in their management practice, only 0.3% of CPs treated patients with acne on their own without a referral. In addition, CPs showed a positive attitude toward acne management.

Conclusion

There is a need to improve CPs' understanding of acne care and to contribute to participating in organized training sessions on the management of AV.

The updates and implications of cutaneous microbiota in acne

Acne is a chronic inflammatory skin disorder that profoundly impacts the quality of life of patients worldwide. While it is predominantly observed in adolescents, it can affect individuals across all age groups. Acne pathogenesis is believed to be a result of various endogenous and exogenous factors, but the precise mechanisms remain elusive. Recent studies suggest that dysbiosis of the skin microbiota significantly contributes to acne development. Specifically, Cutibacterium acnes, the dominant resident bacterial species implicated in acne, plays a critical role in disease progression. Various treatments, including topical benzoyl peroxide, systemic antibiotics, and photodynamic therapy, have demonstrated beneficial effects on the skin microbiota composition in acne patients. Of particular interest is the therapeutic potential of probiotics in acne, given its direct influence on the skin microbiota. This review summarizes the alterations in skin microbiota associated with acne, provides insight into its pathogenic role in acne, and emphasizes the potential of therapeutic interventions aimed at restoring microbial homeostasis for acne management.

Skin drug delivery using lipid vesicles: A starting guideline for their development

Lipid vesicles can provide a cost-effective enhancement of skin drug absorption when vesicle production process is optimised. It is an important challenge to design the ideal vesicle, since their properties and features are related, as changes in one affect the others. Here, we review the main components, preparation and characterization methods commonly used, and the key properties that lead to highly efficient vesicles for transdermal drug delivery purposes. We stand by size, deformability degree and drug loading, as the most important vesicle features that determine the further transdermal drug absorption. The interest in this technology is increasing, as demonstrated by the exponential growth of publications on the topic. Although long-term preservation and scalability issues have limited the commercialization of lipid vesicle products, freeze-drying and modern escalation methods overcome these difficulties, thus predicting a higher use of these technologies in the market and clinical practice.

Acne Vulgaris Relapse in Sudanese Patients Treated with Oral Isotretinoin: Rate and Predictive Factors

Purpose

Acne vulgaris is a skin disorder primarily affecting teenagers and young adults. Acne relapse is the main drawback of oral isotretinoin (OI), which is the golden therapy for severe acne. This study aimed to assess the rate and predictive factors of acne relapse among Sudanese patients using OI.

Patients and Methods

A cross-sectional study was conducted in a dermatology and venereology clinic-Sudan, using a self-administered questionnaire and data collection sheet. Patients using OI for acne treatment were enrolled in the study. Chi-square test and logistic regression analysis were used to evaluate the association between variables. P-value <0.05 was considered statistically significant.

Results

225 acne patients (mean age: 26.0±4.2 years, females: 88.9%) were included in this study. OI daily dose ranged from 0.25 to 1 mg/kg/day, with frequent daily doses of 40-49 mg (57.3%) over 3-6 months (81.8%). Around one-third of patients (36%) received maintenance therapy after completion of OI course. At a 2-year follow-up, approximately 36% of patients experienced acne relapse that commonly occurred within 6-18 months after the last OI therapy. Early discontinuation of OI was a positive predictor of acne relapse which was 3.99 times greater in patients who had early discontinued OI than those completing the planned OI course (OR=3.99; p=0.002). OI cumulative doses of 120-139 mg/kg and 140-159 mg/kg were negative predictors of acne relapse (OR=0.23; p=0.001 and OR=0.15; p=0.02, respectively). Most patients (94.2%) received prescription OI, and 76.4% of women were advised to use contraceptives. About 69% of patients practiced skin care.

Conclusion

About one-third of patients experienced acne relapse. Early discontinuation and low cumulative doses of OI are the main risk factors for acne relapse. Long-term therapy of OI, with cumulative doses of 120-159 mg/kg, would be beneficial to reduce acne relapse.

Polymeric Nanoparticles as Tunable Nanocarriers for Targeted Delivery of Drugs to Skin Tissues for Treatment of Topical Skin Diseases

The topical route is the most appropriate route for the targeted delivery of drugs to skin tissues for the treatment of local skin diseases; however, the stratum corneum (SC), the foremost layer of the skin, acts as a major barrier. Numerous passive and active drug delivery techniques have been exploited to overcome this barrier; however, these modalities are associated with several detrimental effects which restrict their clinical applicability. Alternatively, nanotechnology-aided interventions have been extensively investigated for the topical administration of a wide range of therapeutics. In this review, we have mainly focused on the biopharmaceutical significance of polymeric nanoparticles (PNPs) (made from natural polymers) for the treatment of various topical skin diseases such as psoriasis, atopic dermatitis (AD), skin infection, skin cancer, acute-to-chronic wounds, and acne. The encapsulation of drug(s) into the inner core or adsorption onto the shell of PNPs has shown a marked improvement in their physicochemical properties, avoiding premature degradation and controlling the release kinetics, permeation through the SC, and retention in the skin layers. Furthermore, functionalization techniques such as PEGylation, conjugation with targeting ligand, and pH/thermo-responsiveness have shown further success in optimizing the therapeutic efficacy of PNPs for the treatment of skin diseases. Despite enormous progress in the development of PNPs, their clinical translation is still lacking, which could be a potential future perspective for researchers working in this field.

Prospective Evaluation of a Topical Botanical Skin Care Regimen on Mild to Moderate Facial and Truncal Acne and Mood

Acne vulgaris is a common inflammatory condition that can be associated with profound psychosocial impacts. Conventional treatment includes topical retinoids, benzoyl peroxide, and antimicrobials, and some may cause irritation and skin dryness. In this 8-week open-label study, we examined the effects of a botanical skin care regimen (Codex Labs Shaant Balancing regimen) on mild to moderate facial and truncal acne. Twenty-four male and female subjects between the ages of 12 and 45 years were assessed for eligibility, 20 were enrolled, and 15 completed all study visits. Facial and truncal acne lesion counts, skin hydration, sebum excretion rate, and mood were assessed at baseline, week 4, and week 8. Total facial lesion counts (inflammatory and non-inflammatory lesions) decreased by 20.5% at week 4 (p = 0.06) and by 25.2% at week 8 (p < 0.05). Inflammatory lesion counts on the trunk were found to decrease at week 8 relative to baseline by 48% (p < 0.05). Forehead sebum excretion rate decreased by 40% at week 4 (p = 0.07) and 22% at week 8 (p = 0.08), and cheek skin hydration increased by 27.6% at week 4 (p = 0.14) and 65% at week 8 (p = 0.10). Participants also experienced significant improvement in components of a positive effect, such as feeling "strong" and "inspired", and a decrease in negative effects, such as feeling "irritable." Overall, the botanical skin care regimen was found to be well-tolerated. Our study suggests that a botanical skin care regimen may reduce facial and truncal acne lesion counts, increase skin hydration, reduce sebum production, and augment positive effects and moods in those with mild to moderate facial and truncal acne.

Topical Administration of Lactiplantibacillus plantarum (SkinDuoTM) Serum Improves Anti-Acne Properties

The tailoring of the skin microbiome is challenging and is a research hotspot in the pathogenesis of immune-mediated inflammatory skin diseases such as acne. Commonly encountered preservatives used as functional ingredients have an impact on the skin microbiota and are known to inhibit the survival of skin commensal bacteria. The selected species is Lactiplantibacillus plantarum, formulated with natural enhancers for topical use (SkinDuo^TM). Ex vivo human skin models were used as a test system to assess the strain viability which was then validated on healthy volunteers. SkinDuo^TM showed increased viability over time for in vitro skin models and a stable viability of over 50% on healthy skin. The strain was tested on human primary sebocytes obtained from sebaceous gland rich areas of facial skin and inoculated with the most abundant bacteria from the skin microbiota. Results on human ex vivo sebaceous gland models with the virulent phylotype of Cutibacterium acnes and Staphylococcus epidermidis present a significant reduction in viability, lipid production, and anti-inflammatory markers. We have developed an innovative anti-acne serum with L. plantarum that mimics the over-production of lipids, anti-inflammatory properties, and improves acne-disease skin models. Based on these results, we suggest that SkinDuo^TM may be introduced as an acne-mitigating agent.

Role of topical spironolactone in the treatment of acne: A systematic review of clinical trials-Does this therapy open a path towards favorable outcomes?

Acne vulgaris is the eighth most common disease worldwide and presents with inflammatory and noninflammatory skin lesions along with other dermal abnormalities. Oral spironolactone is used for treating acne vulgaris due to its antiandrogenic properties and inhibition of sebogenesis. Recent evidence shows that spironolactone in topical form has similar efficacy to its oral form with comparatively fewer adverse events associated with its use. However, to establish an evidence-based understanding, this systematic review aims to investigate the efficacy and safety of topical spironolactone in the treatment of acne vulgaris. PubMed, ClinicalTrials.gov, Cochrane library, and Google Scholar were comprehensively searched from the date of inception till March 18, 2022 All the clinical trials experimenting with the role of topical spironolactone in the treatment of acne were included. Articles examining the effects of oral spironolactone or other topical agents were excluded. The Cochrane risk of bias assessment tool (RoB 2.0, version 2019) was used to assess the risk of bias in each study. The study findings have been reported in line with PRISMA 2020 guidelines. The literature search yielded 600 articles. Five clinical trials with 195 patients were included in this review. Out of the five trials, two showed a high risk of bias while three had overall some concerns. Patients treated with topical spironolactone showed a significant decrease in the number of papules (p = 0.004), closed comedones (p < 0.05), and lesions (p < 0.05). Compared to placebo, treatment with 5% spironolactone showed a significant decrease in total lesion count (p = 0.007). In addition, 2% spironolactone showed efficacy over clindamycin and reduced the number of comedones (p < 0.0001), papules (p < 0.0001), and pustules (p < 0.0001) while the acne severity index was also considerably lowered (p < 0.0001). Spironolactone was not found to affect significant skin hydration, sebum, elasticity, melanin, and redness (p > 0.05). Topical spironolactone yields better results than other first-line treatments for acne and displays fewer side effects. However, further large-scale clinical trials are required before spironolactone can be used as the preferred treatment in the clinical management of acne.

Selective photothermolysis with a novel 1726 nm laser beam: A safe and effective solution for acne vulgaris

BACKGROUND

Selective photothermolysis on sebaceous glands is an effective method for treating acne vulgaris (AV); however, safety, efficacy, and discomfort hinder its utilization in clinical settings.

AIMS

The primary objective is to evaluate the safety and efficacy of a novel 1726 nm laser with contact cooling to treat AV.

METHODS

Seventeen patients aged 18 to 36 were enrolled and treated in this IRB-approved, single-center, open-label study. Patients received up to three facial laser sessions up to seven weeks apart. Follow-up visits happened ten days post-session and at the 4 and 12 weeks following the final session. The investigator assessed the severity of device-related adverse events (AEs). Investigator Global Assessment (IGA) and inflammatory lesion counts (ILC) were used as metrics to evaluate acne resolution and skin condition enhancement. Patients' perspectives on satisfaction and comfort using this technology were assessed using Subject Experience Questionnaires (SEQ).

RESULTS

Safety assessment showed mild and transient AEs. All subjects tolerated anesthetics-free treatments well, with a mean treatment discomfort score of 4.9 ± 1.5. Compared to baseline, a statistically significant reduction in ILC (p = 0.003) of 52% to 56% is achieved four to twelve weeks following treatment. Long-term follow-ups showed progressive improvement 24 months post-treatment with a 97% reduction in ILC. SEQs revealed high subject satisfaction (71%) with psychosocial improvement three months post-treatment.

CONCLUSION

The novel 1726 nm laser appears safe and effective for treating mild-to-severe acne. Acne resolution is apparent within the first month and progresses beyond the study duration.

Evaluating the effectiveness of stromal-vascular fraction (SVF) cells along with subcision method in the treatment of acne scars: A double-blind randomized controlled clinical trial study

BACKGROUND

Subcision method is one of the main techniques for treatment of acne scars or stromal-vascular fraction (SVF) and combined therapy can improve treatment strategy.

OBJECTIVE

To use subcision method along with SVF for treatment of acne scar and comprised with alone subcision method.

MATERIALS AND METHODS

In this double-blind clinical trial study, 10 patients with acne scars were entered into the study. Subcision technique was randomly performed on one side of the face and subcision technique plus SVF on opposite side of the face. All patients were examined before treatment and after 3 months by Visioface for volume, area, and depth of scars, as well as thickness and density of the epidermis and dermis of the scars in question. In addition, doctor's and patients' satisfaction, tolerability, and safety were determined after 3 months of treatment. Finally, statistical analysis was done by SPPS, version 25.

RESULTS

In terms of volume and area of scars, the mean percent change was 46.55 ± 13.92 and 44.60 ± 5.76, for the case group, and 13.31 ± 9.27 and 11.28 ± 9.64 for the control group, respectively. So, combined therapy led to significant recovery compared with alone subcision method (p value < 0.001). In both interventions, the increase of density and thickness was proven after treatment, also a significant difference in complete, epidermal, and dermal thickness and epidermal density variables was observed between combined therapy and alone subcision (p value < 0.05). Mean score of doctor's and patients' satisfaction in combined therapy (7.10 ± 0.74 and 7.10 ± 0.99, respectively), was also significantly higher than subcision alone (5.50 ± 0.53 and 5.30 ± 1.25, respectively). Finally, no complications were observed in the patients.

CONCLUSION

According to the acquired results, combined therapy can be considered as effective and safe treatment for acne scars with significant higher efficacy compared with subcision alone.

Effect of systemic isotretinoin use on neutrophil/lymphocyte ratio in acne patients: A retrospective study

Objective: Acne vulgaris (AV) describes a chronic inflammatory condition that occurs in the pilosebaceous unit, which is common in the community. Increase in sebum production, abnormal follicular keratinization, Propionibacterium acnes (P.acnes) colonization and inflammation play a role in acne development. ISO, comedolytic, is the only agent that has an effect on all four conditions that determine the pathogenesis of acne, such as a large reduction in sebaceous gland size, suppression of sebum production and reduction in inflammation. In this study, it was aimed to compare the N/L ratio values at the beginning of the treatment and at the 4th month of the treatment in acne vulgaris patients receiving systemic ISO treatment. Material and Method 50 patients with acne vulgaris who applied to the dermatology outpatient clinics of Karaman Training and Research Hospital between October 2020 and February 2021, had moderate and severe acne vulgaris and were started on oral isotretinoin were included in the study. The medical records of the patients were reviewed retrospectively. The neutrophil/lymphocyte (N/L) ratio values of the patients at the beginning of Isotretinoin treatment and after four months were recorded. Results The mean age of the patients was 23.1±6.23, 52.0% (26 persons) were male. There was a significant decrease in the N/L ratio in total and in both genders with isotretinoin use (p

In Vitro Antibacterial and Anti-Inflammatory Activity of Arctostaphylos uva-ursi Leaf Extract against Cutibacterium acnes

Cutibacterium acnes (C. acnes) is the main causative agent of acne vulgaris. The study aims to evaluate the antimicrobial activity of a natural product, Arctostaphylos uva-ursi leaf extract, against C. acnes. Preliminary chemical–physical characterization of the extract was carried out by means of FT-IR, TGA and XPS analyses. Skin permeation kinetics of the extract conveyed by a toning lotion was studied in vitro by Franz diffusion cell, monitoring the permeated arbutin (as the target component of the extract) and the total phenols by HPLC and UV-visible spectrophotometry, respectively. Antimicrobial activity and time-killing assays were performed to evaluate the effects of Arctostaphylos uva-ursi leaf extract against planktonic C. acnes. The influence of different Arctostaphylos uva-ursi leaf extract concentrations on the biofilm biomass inhibition and degradation was evaluated by the crystal violet (CV) method. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test was used to determine the viability of immortalized human keratinocytes (HaCaT) after exposure to Arctostaphylos uva-ursi leaf extract for 24 and 48 h. Levels of interleukin (IL)-1β, IL-6, IL-8 and tumour necrosis factor (TNF)-α were quantified after HaCaT cells cotreatment with Arctostaphylos uva-ursi leaf extract and heat-killed C. acnes. The minimum inhibitory concentration (MIC) which exerted a bacteriostatic action on 90% of planktonic C. acnes (MIC₉₀) was 0.6 mg/mL. Furthermore, MIC and sub-MIC concentrations influenced the biofilm formation phases, recording a percentage of inhibition that exceeded 50 and 40% at 0.6 and 0.3 mg/mL. Arctostaphylos uva-ursi leaf extract disrupted biofilm biomass of 57 and 45% at the same concentrations mentioned above. Active Arctostaphylos uva-ursi leaf extract doses did not affect the viability of HaCaT cells. On the other hand, at 1.25 and 0.6 mg/mL, complete inhibition of the secretion of pro-inflammatory cytokines was recorded. Taken together, these results indicate that Arctostaphylos uva-ursi leaf extract could represent a natural product to counter the virulence of C. acnes, representing a new alternative therapeutic option for the treatment of acne vulgaris.

High-frequency devices effect in vitro: promissing approach in the treatment of acne vulgaris?

BACKGROUND

Acne vulgaris is an inflammatory skin disorder leading to an impairment of quality of life and is therefore not only a cosmetic issue. Its pathogenesis is multifactorial - of particular importance is the colonization with the bacterium Propionibacterium acnes. A wide range of different treatment options exists including topical and systemic treatments depending on severity. High Frequency (HF) therapy, historically developed in the 19^th century, claims antimicrobial effects on acne skin, but solid data on its efficacy and mechanism of action is lacking.

OBJECTIVES

The main objective of this study was to determine the efficacy of HF therapy on skin flora and P. acnes in vitro using a commercial device as well as to review studies on the mechanism of action.

METHODS

The plasma source was investigated regarding electrical settings, heat, and ozone development. Bacterial skin flora, fungal isolates, and P. acnes were exposed to HF in vitro and compared to unexposed controls by evaluating the number of colonies on agar plates. To further analyze bacterial species from normal skin flora, 16S-sequencing was performed. Statistical analyses were carried out using row analysis and unpaired t-test.

RESULTS

HF treatment led to a significant reduction of almost every bacterial and fungal species investigated in this study. Moreover, the number of colonies forming units was significantly decreased in P. acnes after HF treatment compared to controls in vitro.

STUDY LIMITATIONS

The experiments were performed in vitro only. To assess clinical effects further in vivo experiments are necessary.

CONCLUSIONS

The results collected in this study, although in vitro, provide a mechanistic basis for HF as a complementary treatment option for patients with acne. It might also have a beneficial effect on patients with superficial infectious skin of the skin.

Concomitant Therapy of Oral Isotretinoin with Multiplex Pulsed Dye Laser and Nd: YAG Laser for Acne

OBJECTIVE

To evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser and Nd:YAG laser.

METHODS

A retrospective chart review of patients who received treatment of oral isotretinoin and non-ablative laser therapy to treat acne vulgaris at a single outpatient dermatology clinic site in Ontario, Canada between 2009 and 2017.

RESULTS

187 patients were included, consisting of 45.5 percent males (n=85) and 54.5 percent females (n=102) with a mean age of 21.4 years. 31.6 percent (n=59) of patients reported experiencing side effects from concomitant isotretinoin and NAL therapy, the most common being eczema (n=14), erythema (n=11), significant dry skin/lips/eyes (n=8), flushing (n=6), and bruising (n=6). 99.2 percent of patients achieved clear or almost clear at treatment completion. Of those who expressed satisfaction, 65.2 percent (n=122) reported being satisfied with the treatment and the remaining patients did not report satisfaction nor dissatisfaction.

LIMITATIONS

Limitations exist mainly due to the absence of standardized lesion counts and a comparator cohort. Thus, it is not possible to comment on whether the combination of isotretinoin and NAL is more efficacious that either treatment alone.

CONCLUSION

Concomitant use of isotretinoin and non-ablative laser therapy is a safe and effective treatment option for acne vulgaris that provides patient satisfaction.

Identification of natural inhibitors to inhibit C. acnes lipase through docking and simulation studies

Acne vulgaris is a common skin disease affecting 80-90% of teenagers worldwide. C. acnes producing lipases are the main virulence factor that catalyzes sebum lipid into free fatty acid that is used for C. acnes growth. Recently, computational biology and bioinformatics play a significant role in drug discovery programs and the identification of novel lead(s). In this study, potential inhibitors against the C. acnes lipase have been identified via cost-effective computational investigations. Molecular docking, MD simulations, and binding affinity analysis have been performed between the active site of C. acnes lipase protein and selected natural plant constituents. First, C. acnes lipase protein was downloaded from PDB and defined the catalytically active site. Next, 16 active natural plant constituents were shortlisted from the PubChem library (based on their pharmacokinetics, pharmacodynamics, and antibacterial activity). Docking studies identified the best five active compounds that showed significantly strong binding affinity interacted through hydrogen bonding, hydrophobic interactions, and π-stacking with the active site residues of the target protein. Furthermore, a 100 ns MD simulation run showed a stable RMSD and less fluctuating RMSF graph for luteolin and neryl acetate. In silico investigation suggested that luteolin, neryl acetate, and isotretinoin were involved in stable interactions which were maintained throughout the MD run with the C. acnes lipase enzyme, virtually. The results advocated that these could potentially inhibit lipase activity and be used in the clinical management of acne.

Treatment of Resistant Acne Vulgaris in Adolescents Using Dietary Supplementation with Magnesium, Phosphate and Fatty Acids (Omega 6 and 7): Comparison with 13-Cis-Retinoic Acid

The burden of disease associated with acne vulgaris has continued to increase over time in the world population. This continued growth suggests that there is an unmet dermatologic need for this condition worldwide. Potential sequelae of acne, such as scarring, depigmentation, and marked emotional and psychological problems (e.g., low self-esteem), can lead to significant morbidity. The purpose of this study was to investigate whether dietary supplementation with magnesium, phosphate, omega 6 (linoleic acid calcium salt - C18:2 fatty acid Ca salt), and omega 7 (palmitoleic acid calcium salt - C16:1 fatty acid Ca salt) would help patients with acne vulgaris, and to compare with isotretinoin (13-cis retinoic acid). Magnesium has anti-inflammatory properties. Linoleic and palmitoleic acids have bactericidal activity against Staphylococcus aureus and Cutibacterium acnes (formerly known as Propionibacterium acnes). A single-blind randomized study was conducted in which 257 patients were treated with the above dietary supplementation (group A) and 275 patients with isotretinoin (group B) for 6 months. All patients in group A (100%) reported complete regression of symptoms after 6 months of treatment. On the other hand, 187 subjects (68%) in group B reported complete resolution of symptoms during the same period. The difference between the groups (p < 0.05) was statistically significant. The study was approved by the CEP/CONEP. This natural formulation promotes regression and/or cure of acne vulgaris symptoms and has better results than drugs (such as isotretinoin), without significant side effects.

Effect of Evening Primrose Oil Supplementation on Selected Parameters of Skin Condition in a Group of Patients Treated with Isotretinoin-A Randomized Double-Blind Trial

Background: Retinoids, which include isotretinoin, reduce sebum levels, the degree of epidermal wetness (CORN) and cause an increase in transepidermal water loss (TEWL). Weight gain has also been observed in isotretinoin-treated patients. An agent that can reduce the severity of isotretinoin side effects is evening primrose oil (Oenothera paradoxa). The purpose of this study was to evaluate the effect of evening primrose oil supplementation in patients with acne vulgaris treated with isotretinoin on skin hydration status (CORN), transepidermal water loss (TEWL), skin oiliness (sebum) and changes in body weight and BMI. Methods: Patients diagnosed with acne were assigned to the isotretinoin-treated group (n = 25) or the isotretinoin and evening primrose oil-treated group (n = 25). The intervention lasted 9 months. CORN (with a corneometer), TEWL (with a tewameter) and sebum (with a sebumeter) were assessed twice, as well as body weight and BMI (Tanita MC-780). Results: The isotretinoin-treated group showed statistically significant reductions in CORN (p = 0.015), TEWL (p = 0.004) and sebum (p < 0.001) after the intervention. In the group treated with isotretinoin and evening primrose oil, TEWL and sebum levels also decreased significantly (p < 0.05), while CORN levels increased from 42.0 ± 9.70 to 50.9 ± 10.4 (p = 0.017). A significant decrease in body weight (p < 0.001) and BMI (p < 0.001) was observed in both groups after 9 months of intervention. Conclusions: During isotretinoin treatment, supplementation with evening primrose oil increased skin hydration. However, there were no differences between groups in transepidermal water loss, skin oiliness, weight loss and BMI.

Evaluation of Hormonal Profile and Ovarian Morphology among Adolescent Girls with Menstrual Irregularities in a Tertiary Care Centre at Central India

Menstrual disturbances are common among adolescents with a prevalence rate of 11.3–26.7%. The most frequent menstrual irregularities are oligomenorrhea, menorrhagia, polymenorrhoea, and hypomenorrhea. PCOS (polycystic ovarian syndrome) is now recognized as the most prevalent endocrine disorder among the women of reproductive age. The current study was planned to evaluate socio-demographic factors, endocrine profiles, and ovarian morphology among adolescent girls with menstrual irregularities and compare these parameters in different phenotypes of adolescent PCOS cases. It is a hospital-based cross-sectional study among 248 adolescent girls (10–19 years) with menstrual irregularities. After obtaining informed consent, history and clinical examination findings were recorded on preform proforma. All girls were assessed on day 2/3 of the menstrual cycle for hormonal profile (serum TSH, FSH, LH, prolactin, and serum testosterone) and ovarian morphology (by transabdominal ultrasonography). All participating girls were divided into three groups (groups 1, 2, and 3) corresponding to phenotypes A, B, & D as per the Rotterdam criteria. In the study, oligomenorrhea was the most common menstrual disorder (70.97%). Biochemical hyperandrogenism and thyroid dysfunction were reported in 14.91% and 8.46% of girls, respectively. Our study noted that phenotype D ,i.e., group 3 (MI + PCOM-HA; 49.43%) was the most common phenotype in the study. In a comparative analysis of different groups, significant differences (p < 0.05) in hormonal and metabolic parameters showed highest in group 2, which represents phenotype B of PCOS (hyperandrogenic anovulation). This analysis revealed that adolescent hyperandrogenism (phenotypes A and B) is associated with a more deranged hormonal and metabolic profile than nonandrogenic PCOS (phenotype D). To prevent long-term sequelae, lifestyle changes, early treatment, and close follow-up are recommended in this subset of girls.

The increasing importance of the gut microbiome in acne vulgaris

Acne is a frequently presented dermatological condition brought about by an interplay among inflammation, increased sebum production, hyperkeratinisation, and predominantly Propionibacterium acnes (renamed as Cutibacterium acnes) proliferation, leading to debilitating psychological scars. However, it has been shown that it is the loss of microbial diversity in the skin and the imbalance among C. acnes phylotypes that brings about acne rather than the C. acnes species as a whole. Interestingly, recent evidence suggests that other microorganisms may be implicated, such as the fungi Malassezia and the bacteria Cutibacterium granulosum. A plethora of scientific evidence suggests that the gut microbiome is implicated in the overall health and physiology of the host; studies show that the gut microbiome of acne patients is distinct and depicts less microbial diversity compared to individuals without acne. Herein, using the key terms: acne, C. acnes, IGF-1, sebum, and gut microbiome, we carried out a review of the literature, using Google Scholar and PubMed, and discussed the role of the gut and skin microbiome in relation to acne, as a narrative review. The role of hormones, diet, sebum, and stress in relation to the gut microbiome was also investigated. Therapeutic implications and the use of pre-/postbiotics are also deliberated upon. In this light, future research should investigate the relationship between the gut microbiome and the agreed upon factors of acne pathology, potentially leading to the discovery of novel acne treatments with milder side effects.

Effect of Evening Primrose Oil Supplementation on Biochemical Parameters and Nutrition of Patients Treated with Isotretinoin for Acne Vulgaris: A Randomized Double-Blind Trial

Background: Acne vulgaris is one of the most common skin diseases. One of the therapeutic options recommended for severe acne or acne that has not responded to previous therapies is isotretinoin. However, its use may lead to adverse changes in the serum lipid profile and increased levels of transaminases. In this study, we evaluated the effect of supplementation with evening primrose oil in acne vulgaris patients treated with isotretinoin on blood lipid parameters and transaminase activity. Methods: Study participants were randomly assigned to two treatments: conventional with isotretinoin (25 patients) and novel with isotretinoin combined with evening primrose oil (4 × 510 mg/day; 25 patients) for 9 months. Results: Compared to isotretinoin treatment, isotretinoin treatment combined with evening primrose oil had a positive effect on TCH concentrations (mean: 198 vs. 161, p < 0.001), LDL (95.9 vs. 60.2, p < 0.001), HDL (51.0 vs. 48.0, p < 0.001), TG (114 vs. 95.0, p < 0.001), ALT (24.0 vs. 22.0, p < 0.001), and AST (28.0 vs. 22.0, p < 0.001), but had no effect on the energy and ingredient content of the diets (p > 0.05) after treatment. Conclusion: Evening primrose oil was found to have beneficial effects on lipid profiles and transaminase activity during isotretinoin treatment. However, longer studies are needed to make more reliable decisions regarding the use of evening primrose oil and its safety in clinical practice. The evening primrose oil treatment group also showed a reduction in dietary energy due to a reduction in dietary protein and carbohydrates.

BMAL1 regulates Propionibacterium acnes-induced skin inflammation via REV-ERBα in mice

Acne vulgaris is a common skin disease, affecting over 80% of adolescents. Inflammation is known to play a central role in acne development. Here, we aimed to investigate the role of the central clock gene Bmal1 in acne-associated inflammation in mice. To this end, mice were injected intradermally with Propionibacterium acnes (P. acnes) to induce acne-associated skin inflammation. We found that Bmal1 and its target genes Rev-erbα, Dbp, Per1 and Cry2 were down-regulated in the skin of P. acnes-treated mice, suggesting a role of Bmal1 in the condition of acne. Supporting this, Bmal1-deleted or jet-lagged mice showed exacerbated P. acnes-induced inflammation in the skin. Regulation of P. acnes-induced inflammation by Bmal1 was further confirmed in RAW264.7 cells and primary mouse keratinocytes. Transcriptomic and protein expression analyses suggested that Bmal1 regulated P. acnes-induced inflammation via the NF-κB/NLRP3 axis, which is known to be repressed by REV-ERBα (a direct target of BMAL1). Moreover, loss of Rev-erbα in mice exacerbated P. acnes-induced inflammation. In addition, Rev-erbα silencing attenuated the inhibitory effects of Bmal1 on P. acnes-induced inflammation. Bmal1 knockdown failed to modulate P. acnes-induced inflammation in Rev-erbα-silenced cells. It was thus proposed that Bmal1 restrained P. acnes-induced skin inflammation via its target REV-ERBα, which acts on the NF-κB/NLRP3 axis to repress inflammation. In conclusion, Bmal1 disruption is identified as a potential pathological factor of acne-associated inflammation. The findings increase our understanding of the crosstalk between skin clock and acne and suggest targeting circadian rhythms as a promising approach for management of acne.

Hydrogel Containing Borassus flabellifer L. Male Flower Extract for Antioxidant, Antimicrobial, and Anti-Inflammatory Activity

Borassus flabellifer L. is a plant in Arecaceae family, widely distributed and cultivated in tropical Asian countries. The purpose of this study was to identify the bioactive compounds of B.flabellifer L. male flower ethanolic extract and investigate the antioxidant, anti-inflammatory, and antibacterial activities against Cutibacterium acnes. Total phenolic compounds and total flavonoids in B.flabellifer L. male flower ethanolic extract were determined by the Folin–Ciocalteu method and aluminum chloride colorimetric assay, respectively. Active substances in the extract and their quantities were analyzed by liquid chromatography and mass spectrometry (LC–MS/MS). The antioxidant evaluation was carried out using DPPH, ABTS free radical scavenging assays, and FRAP assay. C. acnes inhibitory activity was performed by the broth microdilution method. Anti-inflammatory activity was determined by the protein denaturation assay. In addition, gel containing different amounts of B.flabellifer L. male flower extract was formulated. The physical stability of the gel was observed by measuring viscosity and pH after six heating and cooling cycles, as well as 1-month storage at 4, 30, and 45 °C. The total phenolic content in the extract was 268.30 ± 12.84 mg gallic acid equivalent/g crude dry extract. The total flavonoid contents in the extract were 1886.38 ± 55.86 mg quercetin equivalent/g extract and 2884.88 ± 128.98 mg EGCG equivalent/g extract, respectively. The LC–MS/MS analysis revealed the presence of gallic acid, coumarin, and quercetin and the concentrations of quercetin, coumarin, and gallic acid in B. flabellifer male flower ethanolic extract were 0.912, 0.021, and 1.610 µg/mL, respectively. DPPH and ABTS antioxidant assays indicated that the B.flabellifer L. male flower extract had IC₅₀ values of 31.54 ± 0.43 and 164.5 ± 14.3 µg/mL, respectively. FRAP assay revealed that the B.flabellifer male flower extract had high ferric ion reducing power. The extract was able to inhibit C.acnes bacteria with a minimum inhibitory concentration (MIC) of 250 mg/mL. At 250 and 500 µg/mL, the extract demonstrated the highest anti-inflammatory activity. The gel containing 31.25% w/w and 62.5% w/w showed good physical stability after six heating and cooling cycles, as well as 1-month storage.

Isotretinoin Induced Hyperlipidemia and Impact of Leptin Gene rs 7799039 Polymorphism in Safety of Acne Patients

Background

Acne vulgaris (AV) is a chronic inflammatory disease that affects the pilosebaceous unit. Leptin (LEP) gene polymorphisms is associated with higher risk of multiple disorders. Insulin-like growth factor-1 (IGF-1) exerts comedogenic effect by stimulating the sebaceous glands. Isotretinoin is an effective oral therapy for AV with many side effects including hyperlipidemia and increased serum levels of liver enzymes.

Purpose

To evaluate the impact of LEP gene rs7799039 polymorphism in acne patients' clinical response lipid profile and liver enzymes following 6 months oral isotretinoin therapy in Egyptian AV patients.

Methods

One hundred eligible AV patients received 0.5 mg/kg oral isotretinoin for 6 months. Patients' demographics and clinical data were obtained. Body mass index (BMI), lipid profile, liver enzymes and IGF-1 were measured at baseline and after 6 months of therapy. Genotyping was done for LEP gene rs 7799039.

Results

Six month administration of oral isotretinoin in Egyptian AV patients is associated with significantly elevated aspartate transaminase (AST) in CC and AC genotypes (P<0.001). Significant alanine aminotransferase (ALT) elevation was observed in CC, AC and AA genotypes (P <0.001, 0.004, 0.002, respectively). Total cholesterol (TC), triglycerides (TG) and low density lipoprotein (LDL) were elevated significantly P<0.001) in the three genotypes. IGF-1 was decreased significantly in CC and AC genotypes (P<0.001). CC genotype is associated with highest response (P<0.001).

Conclusion

LEP rs7799039 gene had an impact on the clinical response, lipid profile and liver enzymes in AV patients treated with oral isotretinoin. LEP rs7799039 CC genotype is predicted to be the treatment candidate for 6 month oral isotretinoin.

Clinical Features of Acne in Primary Care Patients Assessed Through Teledermatology

Introduction/Objectives:

Acne is present in about 90% of teenagers and 12% to 14% of adults. Face and trunk are the most affected areas. Lesions can result in postinflammatory hyperpigmentation and scarring, leading to reduced quality of life. Asynchronous teledermatology has been increasingly used around the world, facilitating patient access to dermatologists. Our objectives were to assess: (1) clinical features of acne patients according to gender, age, severity, site of lesions, excoriation, postinflammatory hyperpigmentation (PIH), and atrophic scar (AS) and (2) how many referrals to in-person consultations with dermatologists could be avoided using asynchronous teledermatology in primary care attention?

Methods:

We analyzed images, demographic and clinical data of 2459 acne patients assisted by teledermatology, with the aim to confirm the diagnoses, to classify acne severity according to grades I to IV, and to search for the presence of postinflammatory hyperpigmentation, atrophic scars, and/or excoriated acne (EA). We compared the clinical and biological data, looking for associations among them.

Results:

Acne severity and age were associated with the most common sequels: postinflammatory hyperpigmentation (mainly on the trunk and in females, P < .0001) and atrophic scars (mainly on the face and in males, P < .0001). We also observed different frequencies according to age and sex: 13 to 24 years in males (P = .0023); and <12 (P = .0023) and 25 to 64 years old (P <.0001) for females; 68% of the patients had no need for in-person dermatologists’ referral, being kept at primary care attention with proper diagnosis and treatment.

Conclusion:

Clinical features of acne and its sequels differ according to gender, age, site, and severity. The new findings of PIH associated with women and AS, with men, may help offer a more personalized management to patients. Teledermatology was suitable for the majority of the acne cases in primary care.

Management of cutaneous side effects of inflammatory bowel disease therapy: A dermatologic viewpoint

Medications used in the treatment of inflammatory bowel disease cause a wide range of dermatologic side effects, and minimal guidance exists on how to manage them. The intention of this review article is to summarize common dermatologic adverse reactions related to inflammatory bowel disease therapy and to provide evidence-based guidance on management. We conducted a scoping review using PubMed and Google Scholar to identify studies reporting clinical information on dermatologic side effects of medications used in the treatment of inflammatory bowel disease. The most commonly reported dermatological adverse effects from inflammatory bowel disease therapy were cutaneous malignancy and cutaneous infections. Thiopurines, methotrexate, tumor necrosis factor (TNF) inhibitors, interleukin (IL)-12/23 inhibitors, and integrin inhibitors can be continued if nonmelanoma skin cancer arises during therapy and the malignancy should be surgically excised. TNF inhibitors and IL-12/23 inhibitors can be continued in the setting of stage I surgically resectable melanoma but should be discontinued in advanced melanoma. For complicated cutaneous bacterial infections, methotrexate and TNF inhibitors should be halted, and IV antibiotics should be administered. Complicated herpes zoster infection warrants discontinuation of TNF inhibitors, whereas IL-12/23 and JAK inhibitors can be continued. Inflammatory bowel disease therapies are associated with several dermatological adverse effects, and management options vary by agent. Certain agents may require discontinuation in the setting of nonmelanoma skin cancer, melanoma, and cutaneous infections. Many other dermatological adverse effects from inflammatory bowel disease therapy require specialized management or referral to dermatology.

Unexpected Effects of Oral Isotretinoin in Adolescents With Acne Vulgaris

Background This study aimed to assess the effects of isotretinoin treatment on hirsutism, menstrual cycle and hormonal response in adolescents with acne vulgaris (AV). Methods In the study, 76 participants with nodulocystic acne were included. Free testosterone (fT), total testosterone (tT), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17-OH progesterone (17-OH PG), and sex hormone-binding globulin (SHBG) levels of the participants were measured before and at the third and sixth months of treatment. Furthermore, the patients were evaluated for hirsutism and menstrual irregularity. Results The rates of menstrual irregularity and hirsutism at the beginning and at the third and sixth months of treatment were found to be different (p < 0.05). fT, tT and DHEAS levels at the third and sixth months of treatment were higher than those at the beginning of treatment, and the SHBG level at the sixth month was found to be lower than that at the beginning and third month of treatment (p < 0.05). The tT levels were found to be lower and DHEAS levels were higher than those at the beginning of treatment in patients who presented with menstrual irregularity at the third month of treatment (p < 0.05). The LH and 17-OH PG levels were noted to be lower and DHEAS levels were higher than those at the beginning of treatment in patients who developed hirsutism at the third month of treatment (p < 0.05). The SHBG levels were observed to be lower and DHEAS levels were higher than those before treatment in patients who developed menstrual irregularity at the sixth month of treatment (p < 0.05). SHBG levels were discerned to be lower and DHEAS levels were higher compared to those at the beginning of treatment in patients who developed hirsutism at the sixth month of the treatment (p < 0.05). Conclusions Isotretinoin can cause alterations in the adrenal hormone levels. Hirsutism and menstrual irregularity can be observed during treatment follow-ups.

Therapeutic Effect of a Newly Isolated Lytic Bacteriophage against Multi-Drug-Resistant Cutibacterium acnes Infection in Mice

Acne vulgaris, which is mostly associated with the colonization of Cutibacterium acnes (C. acnes), is a common skin inflammatory disease in teenagers. However, over the past few years, the disease has extended beyond childhood to chronically infect approximately 40% of adults. While antibiotics have been used for several decades to treat acne lesions, antibiotic resistance is a growing crisis; thus, finding a new therapeutic target is urgently needed. Studies have shown that phage therapy may be one alternative for treating multi-drug-resistant bacterial infections. In the present study, we successfully isolated a C. acnes phage named TCUCAP1 from the skin of healthy volunteers. Morphological analysis revealed that TCUCAP1 belongs to the family Siphoviridae with an icosahedral head and a non-contractile tail. Genome analysis found that TCUCAP1 is composed of 29,547 bp with a G+C content of 53.83% and 56 predicted open reading frames (ORFs). The ORFs were associated with phage structure, packing, host lysis, DNA metabolism, and additional functions. Phage treatments applied to mice with multi-drug-resistant (MDR) C.-acnes-induced skin inflammation resulted in a significant decrease in inflammatory lesions. In addition, our attempt to formulate the phage into hydroxyethyl cellulose (HEC) cream may provide new antibacterial preparations for human infections. Our results demonstrate that TCUCAP1 displays several features that make it an ideal candidate for the control of C. acnes infections.

A review of Nigella sativa plant-based therapy in dermatology

Nigella sativa (N. sativa) is a widely used medicinal herb with a rich cultural and religious history in Unani, Ayurveda, Chinese, and Arabic medicine. N. sativa contains many natural bioactive agents including alkaloids, saponins, alpha-hederin, and thymoquinone that contribute to its broad range of benefits as a diuretic, bronchodilator, antihypertensive, antidiabetic, and analgesic. In addition, N. sativa possesses antimicrobial, anti-inflammatory, and antineoplastic effects, making it an interesting potential therapy for the treatment of dermatological conditions. This article reviews the current literature surrounding the pharmacological effects of N. sativa for the treatment of acne vulgaris, melanoma, vitiligo, atopic dermatitis, plaque psoriasis, and wound healing.

Systematic review of low-dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies

Oral isotretinoin is the most effective treatment for moderate to severe acne and its side effects are mostly dose-dependent. Low dose isotretinoin (0.5 mg/kg/day for 1 week every 4 weeks for 6-months) could be effective and even in its end result, comparable with high or optimal doses. In this systematic review, we aimed to sum up the results of clinical trials regarding indications, dosage, prescription protocol, effectiveness, side effects, patient satisfaction, recurrence rate, and follow-up period of low dose isotretinoin in treatment of acne. Cochrane, Google Scholar, Science Direct, PubMed, and Medline were searched. A total of 460 articles were searched electronically and 382 articles were excluded. About 4 were non-English and 2, before 1980. The full text of 72 articles was reviewed. Finally 15 documents met the inclusion criteria for entering this systematic review. The standard dose of isotretinoin is 0.5-1 mg/kg/day for 4 months with a total dose of 120-140 mg/kg/day. Daily doses between 0.1 and 0.3 mg/kg can be recommended for more than 6 months due to the occurrence of fewer side effects and more economical concerns. For greater effectiveness, it could be combined with other medications.

Hydrogel-Based Active Substance Release Systems for Cosmetology and Dermatology Application: A Review

Hydrogels are playing an increasingly important role in medicine and pharmacy. Due to their favorable physicochemical properties, biocompatibility, and designed interaction with living surroundings, they seem to be one of the most promising groups of biomaterials. Hydrogel formulations from natural, semi, or synthetic polymeric materials have gained great attention in recent years for treating various dermatology maladies and for cosmetology procedures. The purpose of this review is to present a brief review on the basic concept of hydrogels, synthesis methods, relevant mechanisms, and applications in dermatology or cosmetology. This review discusses transdermal therapies and the recent advances that have occurred in the field.

Formulation and Profile of FMX101 4% Minocycline Topical Foam for the Treatment of Acne Vulgaris

FMX101 4% minocycline is a hydrophobic, topical foam formulation of minocycline recently approved by the United States Food and Drug Administration (FDA) for the treatment of non-nodular inflammatory lesions in moderate-to-severe acne vulgaris. It was developed to harness the anti-inflammatory and antibiotic activity of minocycline while minimizing potentially serious systemic adverse events associated with oral delivery. The composition and profile of this novel treatment have yet to be described. This article discusses the components of the foam-based product and the rationale for their selection. It reviews microbiologic data for FMX101 4% and presents previously unpublished data regarding sebum penetration, minocycline permeation, and disposition into skin structures. The effects of FMX101 4% were compared with those of several commercially available acne preparations to determine how the FMX101 4% formulation affects the physical properties of model human sebum in vitro. The hydrophobic formulation of FMX101 4% was found to lower the melting temperature of model human sebum below that of normal skin temperature, decreasing its viscosity. FMX101 4% achieved high concentrations of minocycline in the sebaceous appendage, while minimizing permeation beyond the dermal layer. Finally, this article summarizes efficacy and safety data for FMX101 4% from three Phase III studies (FX2014-04, FX2014-05, and FX2017-22). FMX101 4% appeared to be safe, effective, and well tolerated for the treatment of non-nodular inflammatory lesions in moderate-to-severe acne vulgaris. In conclusion, the topical formulation of minocycline in FMX101 4% represents a unique treatment for acne vulgaris and a viable alternative to oral administration.

Topical benzoyl peroxide for acne

BACKGROUND

Acne is a common, economically burdensome condition that can cause psychological harm and, potentially, scarring. Topical benzoyl peroxide (BPO) is a widely used acne treatment; however, its efficacy and safety have not been clearly evaluated.

OBJECTIVES

To assess the effects of BPO for acne.

SEARCH METHODS

We searched the following databases up to February 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of relevant randomised controlled trials (RCTs) and systematic reviews.

SELECTION CRITERIA

We included RCTs that compared topical BPO used alone (including different formulations and concentrations of BPO) or as part of combination treatment against placebo, no treatment, or other active topical medications for clinically diagnosed acne (used alone or in combination with other topical drugs not containing BPO) on the face or trunk.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures as expected by Cochrane. Primary outcome measures were 'participant global self-assessment of acne improvement' and 'withdrawal due to adverse events in the whole course of a trial'. 'Percentage of participants experiencing any adverse event in the whole course of a trial' was a key secondary outcome.

MAIN RESULTS

We included 120 trials (29,592 participants randomised in 116 trials; in four trials the number of randomised participants was unclear). Ninety-one studies included males and females. When reported, 72 trials included participants with mild to moderate acne, 26 included participants with severe acne, and the mean age of participants ranged from 18 to 30 years. Our included trials assessed BPO as monotherapy, as add-on treatment, or combined with other active treatments, as well as BPO of different concentrations and BPO delivered through different vehicles. Comparators included different concentrations or formulations of BPO, placebo, no treatment, or other active treatments given alone or combined. Treatment duration in 80 trials was longer than eight weeks and was only up to 12 weeks in 108 trials. Industry funded 50 trials; 63 trials did not report funding. We commonly found high or unclear risk of performance, detection, or attrition bias. Trial setting was under-reported but included hospitals, medical centres/departments, clinics, general practices, and student health centres. We reported on outcomes assessed at the end of treatment, and we classified treatment periods as short-term (two to four weeks), medium-term (five to eight weeks), or long-term (longer than eight weeks). For 'participant-reported acne improvement', BPO may be more effective than placebo or no treatment (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.12 to 1.45; 3 RCTs; 2234 participants; treatment for 10 to 12 weeks; low-certainty evidence). Based on low-certainty evidence, there may be little to no difference between BPO and adapalene (RR 0.99, 95% CI 0.90 to 1.10; 5 RCTs; 1472 participants; treatment for 11 to 12 weeks) or between BPO and clindamycin (RR 0.95, 95% CI 0.68 to 1.34; 1 RCT; 240 participants; treatment for 10 weeks) (outcome not reported for BPO versus erythromycin or salicylic acid). For 'withdrawal due to adverse effects', risk of treatment discontinuation may be higher with BPO compared with placebo or no treatment (RR 2.13, 95% CI 1.55 to 2.93; 24 RCTs; 13,744 participants; treatment for 10 to 12 weeks; low-certainty evidence); the most common causes of withdrawal were erythema, pruritus, and skin burning. Only very low-certainty evidence was available for the following comparisons: BPO versus adapalene (RR 1.85, 95% CI 0.94 to 3.64; 11 RCTs; 3295 participants; treatment for 11 to 24 weeks; causes of withdrawal not clear), BPO versus clindamycin (RR 1.93, 95% CI 0.90 to 4.11; 8 RCTs; 3330 participants; treatment for 10 to 12 weeks; causes of withdrawal included local hypersensitivity, pruritus, erythema, face oedema, rash, and skin burning), erythromycin (RR 1.00, 95% CI 0.07 to 15.26; 1 RCT; 60 participants; treatment for 8 weeks; withdrawal due to dermatitis), and salicylic acid (no participants had adverse event-related withdrawal; 1 RCT; 59 participants; treatment for 12 weeks). There may be little to no difference between these groups in terms of withdrawal; however, we are unsure of the results because the evidence is of very low certainty. For 'proportion of participants experiencing any adverse event', very low-certainty evidence leaves us uncertain about whether BPO increased adverse events when compared with placebo or no treatment (RR 1.40, 95% CI 1.15 to 1.70; 21 RCTs; 11,028 participants; treatment for 10 to 12 weeks), with adapalene (RR 0.71, 95% CI 0.50 to 1.00; 7 RCTs; 2120 participants; treatment for 11 to 24 weeks), with erythromycin (no participants reported any adverse events; 1 RCT; 89 participants; treatment for 10 weeks), or with salicylic acid (RR 4.77, 95% CI 0.24 to 93.67; 1 RCT; 41 participants; treatment for 6 weeks). Moderate-certainty evidence shows that the risk of adverse events may be increased for BPO versus clindamycin (RR 1.24, 95% CI 0.97 to 1.58; 6 RCTs; 3018 participants; treatment for 10 to 12 weeks); however, the 95% CI indicates that BPO might make little to no difference. Most reported adverse events were mild to moderate, and local dryness, irritation, dermatitis, erythema, application site pain, and pruritus were the most common.

AUTHORS' CONCLUSIONS

Current evidence suggests that BPO as monotherapy or add-on treatment may be more effective than placebo or no treatment for improving acne, and there may be little to no difference between BPO and either adapalene or clindamycin. Our key efficacy evidence is based on participant self-assessment; trials of BPO versus erythromycin or salicylic acid did not report this outcome. For adverse effects, the evidence is very uncertain regarding BPO compared with adapalene, erythromycin, or salicylic acid. However, risk of treatment discontinuation may be higher with BPO compared with placebo or no treatment. Withdrawal may be linked to tolerability rather than to safety. Risk of mild to moderate adverse events may be higher with BPO compared with clindamycin. Further trials should assess the comparative effects of different preparations or concentrations of BPO and combination BPO versus monotherapy. These trials should fully assess and report adverse effects and patient-reported outcomes measured on a standardised scale.

Targeted Topical Delivery of Retinoids in the Management of Acne Vulgaris: Current Formulations and Novel Delivery Systems

Acne vulgaris is a common inflammatory pilosebaceous condition that affects 80-90% of adolescents. Since the introduction of tretinoin over 40 years ago, topical retinoid products have been a mainstay of acne treatment. The retinoids are very effective in addressing multiple aspects of the acne pathology as they are comedolytic and anti-inflammatory, and do not contribute to antibiotic resistance or microbiome disturbance that can be associated with long-term antibiotic therapies that are a common alternative treatment. However, topical retinoids are associated with skin dryness, erythema and pain, and may exacerbate dermatitis or eczema. Thus, there is a clear need to target delivery of the retinoids to the pilosebaceous units to increase efficacy and minimise side effects in surrounding skin tissue. This paper reviews the current marketed topical retinoid products and the research that has been applied to the development of targeted topical delivery systems of retinoids for acne.

Assessment of autonomic nervous system functions and cardiac rhythms in patients using isotretinoin

AIM

The aim of the study was to analyze the potential effects of isotretinoin, frequently used in the treatment of acne vulgaris these days.

MATERIAL AND METHODS

For this purpose, we used the methods of sympathetic skin response (SSR) electrophysiological analysis and electrocardiographic (ECG) analysis in patients using isotretinoin. Thirty patients who were diagnosed with acne vulgaris and treated with oral isotretinoin with a dose of 0.5 mg/kg for at least 1 month were included in the study. In all patients ECG scanning and SSR analysis were performed both before treatment and 1 month after the start of treatment.

CONCLUSIONS

This study is very important because SSR results show that increasing the existing sympathetic activity in acne vulgaris after isotretinoin usage could explain the exacerbation in acne lesions for the first month, and according to the ECG results the medication did not cause cardiac side effects.

Exploring the Use of Amine Modified Mesoporous Magnesium Carbonate for the Delivery of Salicylic Acid in Topical Formulations: In Vitro Cytotoxicity and Drug Release Studies

Salicylic acid (SA) has for a long time been used to treat various skin disorders due to its anti-inflammatory, bacteriostatic, and antifungal properties. In the present work, mesoporous magnesium carbonate (MMC), a promising drug carrier, was modified with 3-aminopropyl-triethoxysilane to enable loading of SA. The amine modified MMC (aMMC) was successfully loaded with 8 wt.% of SA via a solvent evaporation method. SA was later completely released from the carrier in less than 15 min. Furthermore, the cytotoxicity of the functionalized material was evaluated. aMMC was found to be non-toxic for human dermal fibroblast cells with particle concentration of up to 1000 µg/mL when exposed for 48 h. The presented results form the basis of future development of aMMC as a potential carrier for SA in dermatological applications.