Novel pharmacological approaches for the treatment of acne vulgaris

The role of botulinum neurotoxin BoNT-A in the management of oily skin and acne vulgaris: A comprehensive review

Oily skin and acne vulgaris are prevalent dermatological conditions with a significant impact on both physical and emotional well-being. Despite numerous available treatments, there is a pressing need for effective, long-term solutions. Botulinum Neurotoxin (BoNT-A) has emerged as a potential therapeutic option. However, existing reviews in this area are often limited. This review aims to comprehensively assess the use of BoNT-A in managing oily skin and acne vulgaris while addressing gaps in previous publications. It integrates the latest research, clinical trials, and case studies to provide an up-to-date analysis of BoNT-A mechanisms of action, efficacy, safety, and long-term outcomes. The review systematically analyzes existing evidence, critically evaluates study strengths and limitations, and explores potential synergies with other treatments. It also examines the safety profile of BoNT-A and its potential long-term effects. This review uncovers promising insights into how BoNT-A affects oily skin and acne vulgaris, including its ability to regulate sebum production, reduce inflammation, and potentially shrink pore size. It provides a comprehensive overview of relevant studies and clinical trials, detailing their methodologies, protocols, measures, and results. Collectively, these studies show significant reductions in sebum production, increased patient satisfaction, and smaller pores following BoNT-A treatment. In conclusion, this review addresses knowledge gaps and provides a comprehensive analysis of BoNT-A as a therapeutic option for oily skin and acne vulgaris. By consolidating evidence and highlighting areas for further investigation, it guides clinicians and researchers toward more effective, personalized treatments for individuals with these dermatological challenges.

The Effect of Synthetic Acetylhexapeptide-8 (AH8) on Sebaceous Function

OBJECTIVE

This study aims to evaluate the in vitro and clinical effects of topical acetylhexapeptide-8 (AH8) on the appearance of oily skin.

METHODS

In vitro SEB-1 human sebocyte cell lines were exposed to different concentrations of AH8 , then the lipid content of the sebocytes was measured. For the randomized, controlled, split-face clinical study, participants received AH8 10% lotion formulated in Cetaphil Moisturizing Facial Lotion on one side of their face and the control vehicle lotion on the other side of their face. Facial oiliness was assessed by a trained physician using a 3-point grading system, high-resolution digital photographs, and a sebumeter (SM815). Participants also filled out self-assessments of their skin oiliness.

RESULTS

The in vitro experiments showed that sebocyte lipid content significantly decreased after AH8 treatment (p < 0.05 at 0.00005% AH8 , p=0.09 at 0.0005% AH8 , p < 0.05 at 0.005% AH8,and p < 0.001 at 0.025% AH8). In the clinical study, participants trended towards a 10% reduction (p=0.16) in sebum production after AH8 treatment in comparison to the vehicle treatment.

CONCLUSION

AH8 inhibits the accumulation of lipids in sebocytes in vitro without altering cell proliferation or SREBP-1 expression. Topical AH8 trended toward decreased sebum production in human participants. The use of AH8 may serve as a promising agent to reduce sebocyte lipid production and the appearance of oily skin.

Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.

Orobol, A Derivative of Genistein, Inhibits Heat-Killed Propionibacterium acnes-Induced Inflammation in HaCaT Keratinocytes

Acne is a chronic skin disease that typically occurs in the teens and twenties, and its symptoms vary according to age, sex, diet, and lifestyle. The condition is characterized by hyperproliferation of keratinocytes in the epidermis, sebum overproduction, excessive growth of Propionibacterium acnes, and P. acnes-induced skin inflammation. Interleukin (IL)-1α and IL-6 are predominant in the inflammatory lesions of acne vulgaris. These cytokines induce an inflammatory reaction in the skin in the presence of pathogens or stresses. Moreover, IL-1α accelerates the production of keratin 16, which is typically expressed in wounded or aberrant skin, leading to abnormalities in architecture and hyperkeratinization. Orobol (3',4',5,7-tetrahydroxyisoflavone) is a metabolite of genistein that inhibited the P. acnes-induced increases in IL-6 and IL-1α levels in human keratinocytes (HaCaTs) more effectively compared with salicylic acid. In addition, orobol decreased the IL-1α and IL-6 mRNA levels and inhibited the phosphorylation of inhibitor of kappa-B kinase, nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha, and mitogen-activated protein kinase induced by P. acnes. Finally, the expression of Ki67 was decreased by orobol. Thus, orobol ameliorated the inflammation and hyperkeratinization induced by heat-killed P. acnes and thus has potential for use in functional foods and cosmetics.

Formulation and Characterization of a 3D-Printed Cryptotanshinone-Loaded Niosomal Hydrogel for Topical Therapy of Acne

Cryptotanshinone (CPT) is an efficacious acne treatment, while niosomal hydrogel is a known effective topical drug delivery system that produces a minimal amount of irritation. Three-dimensional (3D) printing technologies have the potential to improve the field of personalized acne treatment. Therefore, this study endeavored to develop a 3D-printed niosomal hydrogel (3DP-NH) containing CPT as a topical delivery system for acne therapy. Specifically, CPT-loaded niosomes were prepared using a reverse phase evaporation method, and the formulation was optimized using a response surface methodology. In vitro characterization showed that optimized CPT-loaded niosomes were below 150 nm in size with an entrapment efficiency of between 67 and 71%. The CPT-loaded niosomes were added in a dropwise manner into the hydrogel to formulate CPT-loaded niosomal hydrogel (CPT-NH), which was then printed as 3DP-CPT-NH with specific drug dose, shape, and size using an extrusion-based 3D printer. The in vitro release behavior of 3DP-CPT-NH was found to follow the Korsmeyer-Peppas model. Permeation and deposition experiments showed significantly higher rates of transdermal flux, Q₂₄, and CPT deposition (p < 0.05) compared with 3D-printed CPT-loaded conventional hydrogel (3DP-CPT-CH), which did not contain niosomes. In vivo anti-acne activity evaluated through an acne rat model revealed that 3DP-CPT-NH exhibited a greater anti-acne effect with no skin irritation. Enhanced skin hydration, wide inter-corneocyte gaps in the stratum corneum and a disturbed lipid arrangement may contribute towards the enhanced penetration properties of CPT. Collectively, this study demonstrated that 3DP-CPT-NH is a promising topical drug delivery system for personalized acne treatments.

Analgesic and anti-inflammatory effects and mechanism of action of borneol on photodynamic therapy of acne

This study aims to explore the analgesic and anti-inflammatory effects of borneol, a traditional Chinese medicine, on photodynamic treatment of acne. Here, we found that borneol significantly decreased the auricular swelling rate and pain threshold of rats. We also showed that borneol noticeably reduced macrophage and lymphocyte infiltration. The number of Th cells was significantly higher in the control PDT group than in the PDT plus borneol treatment group (P < 0.05). The expression of IL-6, TNF-α, and IL-8 mRNA and proteins were noticeably lower in the treatment group in comparison to those of the PDT control group, while PDT plus borneol activated the p38-COX-2-PGE2 signaling pathway, increasing expression in the treatment group. Borneol has significant analgesic and anti-inflammatory effects on PDT of acne, and enhances the healing of acne by activating p38-COX-2-PGE2 signaling pathway.

Gene expression profile analysis of ileum transcriptomes in pigs fed Gelsemium elegans plants

Gelsemium elegans is a flowering plant in the Loganiaceae. Because it can promote the growth of pigs and sheep, it is widely used, including in veterinary clinics, but little information is available about its biological effects. Here, we used high-throughput sequencing to characterize the differentially expressed genes (DEGs) in the ileums of pigs between a control group and a group fed Gelsemium elegans for 45 days. We found that Gelsemium elegans affected many inflammatory and immune pathways, including biological processes such as defense responses, inflammation and immune responses. Moreover, this study identified several important genes related to the anti-inflammatory activity of Gelsemium elegans (e.g., CXCL-8, IL1A, and CSF2), which will be beneficial for further study of the pharmacological mechanisms and clinical applications of Gelsemium elegans.

Prospects of Phage Application in the Treatment of Acne Caused by Propionibacterium acnes

Propionibacterium acnes is associated with purulent skin infections, and it poses a global problem for both patients and doctors. Acne vulgaris (acne) remains a problem due to its chronic character and difficulty of treatment, as well as its large impact on patients' quality of life. Due to the chronic course of the disease, treatment is long lasting, and often ineffective. Currently there are data regarding isolation of P. acnes phages, and there have been numerous studies on phage killing of P. acnes, but no data are available on phage application specifically in acne treatment. In this review, we have summarized the current knowledge on the phages active against P. acnes described so far and their potential application in the treatment of acne associated with P. acnes. The treatment of acne with phages may be important in order to reduce the overuse of antibiotics, which are currently the main acne treatment. However, more detailed studies are first needed to understand phage functioning in the skin microbiome and the possibility to use phages to combat P. acnes.

Ethosomes Loaded with Cryptotanshinone for Acne Treatment through Topical Gel Formulation

The aim of this study was to develop ethosomes loaded with cryptotanshinone (CPT) and formulate them as a topical gel for the treatment of acne. Ethosomes were prepared and evaluated for vesicle size, CPT loading and encapsulation efficiency. Optimized ethosomes were formulated as Carbomer 974 gels and compared with conventional hydroethanolic gels for transdermal permeation and skin deposition in vitro. The anti-acne activity and skin irritation of the gel was investigated in rabbits. Optimized ethosomes had an average vesicle size of 69.1 ± 1.9 nm with CPT loading and encapsulation efficiency of 0.445 ± 0.007 mg/mL and 40.31 ± 0.67%, respectively. The transdermal flux and skin deposition of the optimized ethosomal gel were 2.5- and 2.1-times those of conventional gels. The ethosomal gel revealed better anti-acne effect with only slight skin irritation. This study demonstrates that ethosomal formulation is an effective dermal delivery system for CPT, and that CPT ethosomal gels are promising future acne treatments.

Suppression of Propionibacterium acnes Infection and the Associated Inflammatory Response by the Antimicrobial Peptide P5 in Mice

The cutaneous inflammation associated with acne vulgaris is caused by the anaerobic bacterium Propionibacterium acnes through activation of the innate immune system in the skin. Current standard treatments for acne have limitations that include adverse effects and poor efficacy in many patients, making development of a more effective therapy highly desirable. In the present study, we demonstrate the protective effects of a novel customized α-helical cationic peptide, P5, against P. acnes-induced inflammatory responses in vitro and in vivo. Application of P5 significantly reduced expression of two inflammatory cytokines IL-8 and TNF-α in P. acnes-treated primary human keratinocytes, where P5 appeared to act in part by binding to bacterial lipoteichoic acid, thereby suppressing TLR2-to-NF-κB signaling. In addition, in a mouse model of acne vulgaris, P5 exerted both anti-inflammatory and antimicrobial effects against P. acnes, but exerted no cytotoxic effects against skin cells. These results demonstrate that P5, and perhaps other cationic antimicrobial peptides, offer the unique ability to reduce numbers P. acnes cells in the skin and to inhibit the inflammation they trigger. This suggests these peptides could potentially be used to effectively treat acne without adversely affecting the skin.

Emerging drugs for the treatment of acne

INTRODUCTION

Acne is the most common skin condition in the US. The mainstay of acne therapy includes: topical retinoids, topical antibiotics, benzoyl peroxide (BP), and oral isotretinoin for severe cases. Although these treatment options are highly effective they do have certain drawbacks. Current acne treatment regimens often require patients to use multiple medications, some of which may have irritating side effects. Furthermore, Propionibacterium acnes resistance to antibiotics has become an increasing problem due to the rise in antibiotic use.

AREAS COVERED

New therapies that have either been released onto the market or that are being developed include: adapalene-BP combination agent, dapsone 5% gel, minocycline foam, topical nitric oxide-releasing agent, cortexolone 17 α-propionate, and CIP isotretinoin. Some of these new therapies address the challenges faced with existing treatment options. For instance, the relatively new combination therapy, adapalene-BP, limits antibiotic resistance and also helps simplify treatment regimens. The newly developed topical nitric oxide-releasing agent also holds potential in limiting antibiotic resistance.

EXPERT OPINION

Many of the new therapies discussed in this paper are still in early stages of testing so it is difficult to predict their outlook; however, based on preliminary findings, these therapies seem to be promising.