The efficacy of glycolic acid, salicylic acid, gluconolactone, and licochalcone A combined with 0.1% adapalene vs adapalene monotherapy in mild-to-moderate acne vulgaris: a double-blinded within-person comparative study

International expert consensus recommendations for the use of dermocosmetics in acne

BACKGROUND

A wide variety of dermocosmetics (products with both active skincare and cosmetic activity) are available for the management of acne vulgaris. These products are important because they may be the first line of approach for patients desiring to self-treat and they can also have beneficial effects-reducing lesion counts and improving global acne severity. When used in conjunction with medical therapy, dermocosmetics can improve tolerability and enhance results. We reviewed available evidence and combined it with our clinical experience to help guide clinicians in selecting skincare products with acne-targeting ingredients.

METHODS

An international panel of dermatologists with an interest and expertise in managing acne performed a literature review, formulated clinical questions related to the role of dermocosmetics in the acne setting, used a modified GRADE approach to evaluate available evidence and then utilized an online iterative Delphi process to create consensus recommendations. It should be noted that due to the limited number of available studies, the category of dermocosmetics was evaluated rather than specific ingredients.

RESULTS

The quality of evidence was found to be low to moderate. Key recommendations were made based on available evidence for the use of dermocosmetics in acne to improve acne global assessment, reduce acne lesion counts, reduce superficial skin oiliness and serve as maintenance therapy after medical treatment, while providing a good tolerability. Recommendations were also made for using dermocosmetics as adjuncts to medical treatment.

CONCLUSIONS

While there is a need for better quality evidence, dermocosmetics have demonstrated some benefit for acne both when used alone in its milder clinical presentations or in maintenance post acne medication and as adjunct to acne treatments.

Resolving acne with optimized adapalene microspongeal gel, in vivo and clinical evaluations

In our pursuit of enhancing acne treatment while minimizing side effects, we developed tailored Adapalene microsponges (MS) optimized using a Box-Behnken design 33. The independent variables, Eudragit RS100 percentage in the polymer mixture, organic phase volume, and drug to polymer percentage, were explored. The optimized formulation exhibited remarkable characteristics, with a 98.3% ± 1.6 production yield, 97.3% ± 1.64 entrapment efficiency, and a particle size of 31.8 ± 1.1 µm. Notably, it achieved a 24 h cumulative drug release of 75.1% ± 1.4. To delve deeper into its efficacy, we evaluated the optimized microspongeal-gel in vitro, in vivo, and clinically. It demonstrated impressive retention in the pilosebaceous unit, a target for acne treatment. Comparative studies between our optimized Adapalene microspongeal gel and marketed Adapalene revealed superior performance. In vivo studies on Propionibacterium acnes-infected mice ears showed a remarkable 97% reduction in ear thickness, accompanied by a significant decrease in inflammatory signs and NF-κB levels, as confirmed by histopathological and histochemical examination. Moreover, in preliminary clinical evaluation, it demonstrated outstanding effectiveness in reducing comedonal lesions while causing fewer irritations. This not only indicates its potential for clinical application but also underscores its ability to enhance patient satisfaction, paving the way for future commercialization.

Evaluation of the effects of 10% and 30% gluconolactone chemical peel on sebum, pH, and TEWL

BACKGROUND

Gluconolactone (GLA) exhibits antioxidant and moisturizing effects. It also presents soothing effects, protects elastin fibers from UV-induced degradation, and improves the function of the skin barrier.

AIMS

Evaluation of skin parameters such as pH, transepidermal water loss (TEWL), sebum levels before, during, and after a series of applications of 10% and 30% GLA chemical peel in a split-face model.

MATERIALS AND METHODS

The study involved 16 female subjects. Three split-face procedures were performed using two concentrations of GLA solution applied on two sides of the face. The skin parameters were measured before treatments and 7 days after the last procedure at four measurement sites on either side of the face, that is, on the forehead, around the eye, on the cheek, and on the nose wing.

RESULTS

Measurement of sebum demonstrated some statistically significant changes between sebum levels in the cheeks after a series of treatments. The pH measurement showed that the pH value was reduced after each treatment at all measurement points. The level of TEWL after treatments was significantly lower around the eyes, on the left forehead, and on the right cheek. There were no significant differences between the use of different concentrations of the GLA solution.

CONCLUSIONS

The results of the study show that GLA has a significant influence on lowering skin pH and TEWL. GLA also has seboregulatory properties.

Split-face evaluation: Gluconolactone plus oxybrasion versus gluconolactone plus microneedling. The effects on skin parameters

BACKGROUND

The application of polyhydroxy acids and alpha-hydroxy acids to the skin is often used in cosmetology. To enhance the effect of gluconolactone chemical peeling, a combined method including water-oxygen oxybrasion or microneedle mesotherapy can be used.

OBJECTIVES

To evaluate skin parameters such as hydration, sebum, pH and TEWL after application of a 10% gluconolactone chemical peel in combination with oxybrasion and microneedling.

MATERIALS AND METHODS

Twenty-one Caucasian women participated in the study. A series of three split face treatments was carried out at 1-week intervals. Oxybrasion was performed on the right side of the face and micro-needle mesotherapy on the left side. A 10% gluconolactone solution was applied to the entire face. Before the first and third treatments and 2 weeks after the last treatment, skin parameters were evaluated. Photographic documentation was also made before and after the treatment series.

RESULTS AND CONCLUSION

Evaluation of skin parameters using Courage & Khazaka 580 Multi Probe Adapter probes (Courage + Khazaka electronic GmbH, Cologne, Germany) showed an increase in hydration and a decrease in sebum, pH and TEWL for both treatments. There were no statistically significant differences between the treatments. Combining chemical peeling of gluconolactone with oxybrasion and microneedle mesotherapy is a good method to seal the hydrolipid barrier and increase skin hydration.

Investigation on the Biological Safety and Activity of a Gluconolactone-Based Lotion for Dermocosmetic Application

(1) Background: Cosmeceuticals are formulas enriched with active ingredients that exert efficacy on different skin molecular targets. (2) Methods: Cell viability and the absence of potential irritant risk were evaluated on keratinocytes (HaCaT), fibroblasts (NHDF), adipocytes (3T3-L1), sebocytes (PCi-SEB_CAU) and reconstructed human epidermis (RHE), respectively. Several treatments were performed to evaluate the ability of the lotion to stimulate the production of collagen and elastin, stimulate the differentiation of keratinocytes and reduce the number of senescent cells following UVB stimulation. In addition, the modulation of genes involved in the production, storage and accumulation of sebum were investigated. (3) Results: The results obtained demonstrated the biosafety of the formula in all cell lines tested. The 24-h treatment with non-cytotoxic concentrations determined an increase in the expression of the collagen (COL1A1), elastin (ELN) and involucrin (IVL) genes, while a reduction of peroxisome proliferator-activated receptor-gamma (PPARγ) gene expression and a reduction of SA-βgal-positive cells were found. Moreover, the treatment did not interfere with normal steroid 5-alpha reductase (5RDA3) gene expression levels. (4) Conclusions: Data collected demonstrated the biosafety of the lotion, the non-comedogenic property and a multi targets anti-aging effect. In particular, data collected on the booster lotion make it a valid way to counteract the pore dilatation aging related.

Efficacy and safety of a new peeling formulated with a pool of PHAs for the treatment of all skin types, even sensitive

BACKGROUND

Actually, the use of chemical peels in cosmetics and dermatology continues to grow due to their versatility, clinical endpoint-directed predictability, and favorable risk profile in comparison to lasers. The chemical peel is a generally safe method for treatment of some skin disorders and to refresh and rejuvenate the skin. The major challenge of chemical peels is the tolerability, that is because of sensitive skin which is one of the most common skin disorders.

AIM

The aim of this study was to evaluate the effectiveness of the new Miamo Renewal Peel Serum formulated with a pool of new generation acids (ELPA25™) on sensitive skin with respect to mandelic acid serum only and with respect to placebo comparison.

MATERIALS AND METHODS

The "in vivo" study following the half-face experimental protocol active versus placebo involved 30 healthy Caucasian female volunteers between 25 and 64 years, with sensitive skin, who were divided into two different groups. ELPA25™ serum was applied in one group three times a week for 8 weeks. The other group, with the same protocol, applied an active serum containing mandelic acid, as control, versus placebo. In particular, skin moisturizing, skin viscoelastic properties, skin surface smoothness, wrinkle reduction, and stratum corneum renewal were evaluated.

RESULTS

Renewal Peel Serum was very well tolerated from sensitive skin. A significant decrease in skin roughness and wrinkle breadth, and an improvement in firmness and in skin elasticity, was observed after 2 months of treatment with respect both to mandelic acid serum and to placebo comparison.

CONCLUSIONS

Scientific protocol using self-controlled study methodology and noninvasive skin bioengineering techniques with adequate statistical methods were able to evaluate both the safety and the efficacy of the new Miamo Renewal Peel Serum. This study highlighted that the Miamo Renewal Peel Serum formulated with a patent-pending mixture of new generation acids (ELPA25™) exerts many beneficial effects and it can be successfully employed for sensitive skin.

Measurement of the effects of the IMAGE MD® skin care regimen on skin surface features via modern imaging technology with the Visia® complexion analysis camera system

Objective

Objective analysis of the effects of a series of skin care products by application of modern imaging technology.

Method

A study was conducted in 25 volunteers who attended a plastic surgical clinic. The cosmeceuticals chosen for investigation were from the IMAGE MD^® series provided by the company IMAGE Skincare. Facial images were taken with the Visia^® camera system by the company Canfield Scientific. The volunteers stopped their own skin care regimen after the initial facial captures and applied a series of the products for three months. 19 volunteers returned and underwent again facial capture. Eight different skin aspects - spots, wrinkles, skin texture, pores, UV spots, brown spots, red marks and porphyrins - as well as the skin age were determined and analysed.

Results

Overall, the volunteers turned out to appear younger by 1.4 years, however not at a significant level. There was a spread in the results and a tendency for a stronger reduction of the measured skin age in women under 55 years old by 3.2 years. Best effects of the studied product line were obtained for the skin aspects red areas and brown spots. For the criteria spots, texture, pores and UV spots at least two thirds of the comparisons between the two time points, before and after treatment, were positive. In wrinkles and porphyrins, results did not improve. Altogether the majority of the examined skin criteria improved.

Conclusion

The IMAGE MD^® product series caused the volunteer testers overall to appear slightly younger. An objective measurement of skin changes over time by application of the Visia^® imaging technology was found to be possible.

Investigation of the precision of the Visia® complexion analysis camera system in the assessment of skin surface features

Background

The aim of this study was to independently investigate the precision of the high resolution Visia^® camera, from Canfield Scientific, to capture several skin surface features.

Method

Facial images of eight volunteers were taken with closed eyes and a relaxed face. The capture was conducted in a resting position within a positioning rig. Frontal view images were taken. In the first capture session, the images were captured three times in a row with the head steadily resting in the capture rig. Each volunteer then left the capture rig and returned to it one week later repositioning the face, and the capture was repeated three times. On the basis of this study, it was additionally investigated which number of study participants would be required in order to make a claim as to the reproducibility of the captures. As a possible approach to making this determination, a power analysis was considered. In order to conduct this analysis, it was necessary to determine which differences between individual image captures would be clinically acceptable. To answer this question, a subjective assessment of the repeated image captures for all study participants and for all skin surface features was conducted in order to identify any differences that were visible with the human eye.

Results

Differences in skin criteria of the eight volunteers in terms of means and standard deviations were collected for weeks one and two. For the criteria skin texture, UV spots, brown spots and porphyrins, these differences were less than 2% and for pores and red areas they were between 2% and 4%. The results for spots and wrinkles were around 6%. Looking at the differences between the data from week one and two as well as the standard deviations, these differences turned out to be relatively small. This finding also pointed to a quite good precision of the measurement technique. The subjective assessment of the images of the eight participants on each of the eight skin criteria revealed that no differences were detectable in the recaptured versions of the images of the participants' faces in their native digital forms solely with the human eye. There was an exception for only one participant, in whom a distinction between two image captures appeared to be subjectively visible with the human eye, but only for the criterion of red areas. As the subjective assessment revealed that no clinically relevant differences could be identified, a power analysis involving a test for significant differences between the recaptured images was discarded. As a consequence, the number of participants recruited for the study on the reproducibility of the system presented herein was deemed to be sufficient.

Conclusion

The precision of the Visia^® camera system was found to be satisfactory in this study. The Visia^® camera helped to visualise skin features beyond what is visible to the human eye. Thus, the Visia^® camera system provides new objective information on skin surface characteristics beyond what can be acquired through purely subjective assessments.

Calcipotriol: A Novel Tool In Treatment of Acne Vulgaris

BACKGROUND

Retinoids and active vitamin D₃ analogues regulate the proliferation and differentiation of keratinocytes. Retinoids are the main stay in the treatment of acne vulgaris through their comedolytic and anti-inflammatory effects. However, the effect of calcipotriol on the different forms of acne lesions has not been reported.

OBJECTIVE

This split face prospective study aimed to detect the efficacy of topical calcipotriol in the treatment of acne lesions in comparison with that of adapalene.

METHODS

Forty patients with acne vulgaris were treated with topical calcipotriol (0.005%) cream and 0.1% adapalene gel on the right and left sides of the face respectively. Clinical and histological assessment of the used treatments was done 2 months after the start of treatment.

RESULTS

Two months after treatment, there was significant reduction of all acne lesions with significant decrease of physician global assesment and patient global assesment scores (p = 0.0001) on both sides of the face with no significant difference between both sides. Histologically, there was significant decrease in the density of inflammatory infiltrate, which was more significant on the right side (p < 0.0001).

CONCLUSION

Topical calcipotriol can serve a significant role in the treatment of acne vulgaris, through its anti-inflammtory effect which was comparable to that of adapalene. This article is protected by copyright. All rights reserved.

Validation of the Visia® Camera System for skin analysis through assessment of the correlations among the three offered measurements - the percentile, feature count and absolute score - as well as the three capture perspectives, from the left, front and right

Objective

Validation of the Visia^® Camera System in terms of providing data on various skin aspects via the establishment of the correlations among the obtained measurements - the percentile, feature count and absolute score.

Method

A large data cloud was analysed statistically following a clinical study. In the study, facial images of nineteen women were obtained at two different time points, before and three months after following a skin care routine. Objective analysis was provided by the Visia^® Camera System, which provided measurements firstly as percentiles, secondly as feature counts and thirdly as absolute scores on eight different skin aspects. The eight skin criteria were spots, wrinkles, skin texture, pores, UV spots, brown spots, red marks and porphyrins. Data on the facial skin were gathered from three different perspectives, namely the left, front and right views. The correlations between pairs of the three obtained measurements, i.e., the percentile, the feature count and the absolute score, were calculated. Further, the correlation coefficients for the three capture perspectives, from the left, front and right, were calculated. Data from the two time points, i.e., before and after application of the skin care cosmetic line were analysed. The statistical analyses were conducted using R (R Core Team 2016).

Results

There was a high level of correlation among the three offered measurement methods. From 144 calculations of the correlations 128 (88.9%) were statistically significant (p<0.05). The correlation coefficients in the vast majority of cases pointed to very clear correlations between the two examined variables. In particular, 50% of the absolute values of these correlations were above 0.945. The few insignificant results were in UV spots and wrinkles. All three methods used to measure the data on skin aspects, i.e., the percentiles, the feature count and the absolute score, served equally well when making comparisons between the two time points. When examining the correlation coefficients for the three capture perspectives, i.e., left, front and right views, their percentages of significant results were found to be only marginally different. Of the 144 examined correlations, 121 were found to be statistically significant (84%). The average correlation coefficient was r=0.74, which pointed to a very clear correlation between the data. The few insignificant results were in wrinkles, UV spots and spots. The Visia^® Camera System was found to be an objective tool with which to examine the effects of a cosmeceutical skin care regime. However, there was a learning curve associated with the application of this system.

Conclusion

The Visia^® Camera System was successfully validated by investigation of the correlations between measurement methods and capture perspectives. The camera system can not only serve as a tool with which to visualise, provide communications concerning or sell a skin care product, but it can also provide objective data for clinical follow-up studies. Thus, investigations into which skin aspect can be improved the most by a cosmetic product line are possible.

A Narrative Review on the Role of Acids, Steroids, and Kinase Inhibitors in the Treatment of Keratosis Pilaris

Keratosis pilaris is a common and benign genetic skin disorder that results in patches of rough bumps on the skin, with varying degrees of reddening and inflammation. These bumps in the skin are caused by the dead skin cells that plug the hair follicles. Keratosis pilaris often manifests in small, hard bumps on the legs and arms. A common treatment method for many acne conditions, including keratosis pilaris, is acid, which has shown promise in recent years. This review examines the use and success of multiple types of acids, steroids, and kinase inhibitors in clinical and non-clinical settings to treat and understand keratosis pilaris. In the treatment of keratosis pilaris, acid primarily works by breaking down the dead skin cells that clog the hair follicles. Some types of steroids have anti-inflammatory properties that have proven useful in minimizing the appearance of acne. Kinase inhibitors control important skin cell functions, such as cell signaling, metabolism, division, and survival, which undoubtedly affect the appearance of skin as a whole. The known impact of acid, steroids, and kinase inhibitors on keratosis pilaris is underestimated and should be given more attention by healthcare industry leaders.

Corneometric evaluation of skin moisture after application of 10% and 30% gluconolactone

BACKGROUND

Dry skin, caused by improper care or genetic conditions, can affect people of all ages. Skin hydration is determined its lipid content, which inhibits water loss from the epidermis, as well as other substances such as polyhydroxy acids and gluconolactone that can bind water. The aim of this study was to evaluate skin hydration after the application of 10% and 30% gluconolactone solution in a split face model.

MATERIALS AND METHODS

Sixteen healthy women were qualified for the study. Three split face treatments were performed, with 10% and 30% gluconolactone solution applied to two sides of the face. Skin moisture was measured before each treatment and a week after the last treatment at three measurement sites on either side of the face, that is, on the forehead, around the eye and on the cheek.

RESULTS

Corneometric measurements showed a significant increase in facial skin hydration after gluconolactone treatment. No significant differences were observed between the application of 10% and 30% solution.

CONCLUSION

Gluconolactone is a moisturizing substance which works well in dry skin care.

A Double-Blinded, Randomized, Vehicle-Controlled Study of the Efficacy of Moisturizer Containing Licochalcone A, Decanediol, L-Carnitine, and Salicylic Acid for Prevention of Acne Relapse in Asian Population

Many topical agents are available for treating the acute phase of acne; however, few agents have been proven beneficial during the maintenance phase. Objective. To evaluate the efficacy and safety of moisturizer containing licochalcone A, 1,2-decanediol, L-carnitine, and salicylic acid during the maintenance phase of mild to moderate acne in Thai patients. Methods. One hundred and ten patients with mild to moderate acne vulgaris were initially treated with a fixed combination of adapalene 0.1%/benzoyl peroxide 2.5% gel once daily for 8 weeks. Fifty patients who achieved at least 50% reduction in lesion counts or at least a 2-grade improvement in the Investigator's Global Assessment (IGA) grade from baseline were enrolled in the maintenance phase, which was an investigator-masked, left-right comparison, randomized, controlled, intraindividual study. Moisturizers with and without the active study ingredients were applied twice a day to each side of the face, respectively, for 12 weeks. Assessments included acne lesion counts, acne severity by IGA scoring, skin bioengineering measurements, and skin tolerability as assessed by both patient and physician. Results. The treatment group had a significant reduction in the mean counts of noninflammatory, inflammatory, and total lesions compared to the vehicle group at week 12 and also between baseline and week 12. There was no significant difference in the mean scores for skin dryness, stinging/burning, or pruritus at any time point between groups. Conclusions. Moisturizer containing licochalcone A, 1,2-decanediol, L-carnitine, and salicylic acid reduced acne lesions and prevented the development of new lesions during the maintenance phase. This trial is registered with ClinicalTrials.gov registration no. NCT04002024.