Dietary Patterns in Acne and Rosacea Patients-A Controlled Study and Comprehensive Analysis

The cutaneous effects of androgens and androgen-mediated sebum production and their pathophysiologic and therapeutic importance in acne vulgaris

Background: The recognition of an association between the development of acne vulgaris (AV) and pubertal hormonal changes during adolescence dates back almost 100 years. Since these formative observations, a significant role of circulating hormones in the pathophysiology of AV and other cutaneous disorders has been established.Aims: This review article aims to provide an overview of clinical and preclinical evidence supporting the influences of androgens on the skin and their therapeutic importance in AV pathophysiology.Results: The cutaneous effects of hormones are attributable, to a large extent, to the influence of steroid hormones, particularly androgens, on sebocyte development and sebum production in both sexes. Androgen-mediated excess sebum production is implicated as a necessary early step in AV pathophysiology and is therefore considered an important therapeutic target in AV treatment. Although the local production and/or activity of androgens within the skin is believed to be important in AV pathophysiology, it has received limited therapeutic attention.Conclusions: We have summarized the current evidence in support of the therapeutic benefits of targeted hormonal treatment to decrease androgen-stimulated sebum production for the effective and safe treatment of AV in both male and female patients.

The Relationship between Chocolate Consumption and the Severity of Acne Lesions-A Crossover Study

The aim of this study was to assess the relationship between the daily consumption of 50 g of chocolate with 85% cocoa content and the severity of acne lesions.

METHODS

The study involved 92 participants with acne who were divided into two groups, A (n = 51) and B (n = 41). In the first week, both groups had to follow an anti-inflammatory diet (AID), then for the next 4 weeks, group A continued on with the AID, and group B followed an AID with chocolate. After this time, group B started a 4-week AID without chocolate, and group A started a 4-week AID with chocolate. The severity of acne lesions was assessed using the Investigator's Static Global Assessment scale, where zero points indicated no lesions and five points indicated severe acne.

RESULTS

As a result of the consumption of 50 g of chocolate, a statistically significant intensification of acne lesions was observed in both groups. After 4 weeks of following the chocolate diet, the severity of acne lesions increased from 2.5 ± 0.7 to 3.4 ± 0.8 points (p < 0.0001) in group A, and from 2.4 ± 0.7 to 3.5 ± 0.6 points (p < 0.0001) in group B. Overall, chocolate intake contributed to the exacerbation of acne lesions by one point in 65 participants, by two points in 13 participants and by three points in one participant.

CONCLUSIONS

The obtained results suggest that daily consumption of 50 g of chocolate with 85% cocoa content, even with an anti-inflammatory diet, may intensify acne lesions in this study group. However, it remains unclear which chocolate components may lead to the exacerbation of acne.

Ocular surface changes in moderate-to-severe acne vulgaris

AIM

To investigate ocular surface disorders and tear function changes in patients with acne vulgaris and explore the potential relationship between acne vulgaris and dry eye.

METHODS

This cross-sectional study included right eyes of 53 patients with acne vulgaris and 54 healthy controls. The participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The following ocular surface-related parameters were measured: tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), Schirmer I test (SIT), lipid layer thickness (LLT) score of the tear film, meibum score, meibomian gland orifice obstruction score, the ratio of meibomian gland loss, conjunctival hyperemia score, and corneal fluorescein staining (CFS) score.

RESULTS

The stability of the tear film decreased in acne vulgaris patients. In the acne group, the TMH and NIBUT were lower, whereas the OSDI, meibum score, meibomian gland orifice obstruction score, ratio of meibomian gland loss, and conjunctival hyperemia score were higher compared with controls (P<0.05). There were no significant differences in the CFS score, SIT, or LLT score between the groups (P>0.05). In two dry eye groups, the TMH, NIBUT, and LLT score were lower in the acne with dry eye (acne-DE) group, and the meibum score, meibomian gland orifice obstruction score, ratio of meibomian gland loss and conjunctival hyperemia score in the acne-DE group were higher (P<0.05). There were no significant differences between OSDI, SIT, and CFS score (P>0.05).

CONCLUSION

Patients with moderate-to-severe acne vulgaris are more likely to experience dry eye than those without acne vulgaris. Reduced tear film stability and meibomian gland structure dysfunction are more pronounced in patients with moderate-to-severe acne and dry eye.

Impact of Diet and Nutrition in Patients with Acne Vulgaris

Acne vulgaris is a widespread a chronic inflammatory dermatosis that affects millions of people around the world, which has a significant influence on patients' standard of living. The progression of this dermatosis results in the appearance of inflammatory and non-inflammatory changes, and, in severe cases, disfiguring scars and hyperpigmentation. The aetiopathogenesis of acne is complex. It involves a complex interaction of many different factors, both endo- and exogenous in their effect on the hair and sebaceous unit. Genetic predisposition, hormones, the skin and gut microbiome, psychological stress, air pollutants, aggressive facial products, and certain medications are cited as factors influencing acne formation. The link between nutrition and acne is extensively debated for many years and is still relatively controversial. Diet is commonly recognised to have a direct relationship with certain biochemical markers and the transcription of genes related to sebaceous gland function, and the proliferation of bacteria and inflammation that encourage the progression of the disease. In this review, the authors take a closer look at the existing scientific reports on the involvement of nutrition in the development of acne vulgaris.

Characteristics of Gut Microbiota in Rosacea Patients-A Cross-Sectional, Controlled Pilot Study

BACKGROUND

Recent studies have suggested a possible connection between rosacea and patients' gut microbiota.

OBJECTIVE

To investigate the differences in fecal microbial profiles between patients with rosacea and healthy controls.

METHODS

Gut microbiota of 54 rosacea patients (RP) were analyzed using MiSeq 16S rRNA sequencing. Enterotypes, the Firmicutes/Bacteroides (F/B) ratio, the significance of alpha and beta diversity, and differential abundance analysis (DAA) were calculated and compared with age- and gender-matched controls (CP, n = 50).

RESULTS

Significant changes in the enterotypes and F/B ratio were observed between the RP and CP (p = 0.017 and p = 0.002, respectively). The RP showed a decreased microbial richness and diversity compared to the CP (Shannon p = 0.012, inverse Simpson p = 0.034). Beta diversity also differed between both groups (PERMANOVA, p = 0.006). Fourteen significantly different taxa were detected according to DAA. Faecalibacterium prausnitzii (coef. -0.0800, p = 0.008), Lachnoospiraceae ND 3007 group sp. (coef. -0.073, p < 0.001), and Ruminococcaceae (coef. -0.072, p = 0.015) were significantly decreased; Oscillobacter sp. (coef. 0.023, p = 0.031), Flavonifractor plautii (coef. 0.011, p = 0.037), and Ruminococccaceae UBA 1819 (coef. 0.010, p = 0.031) were significantly increased in the RP compared to the CP.

CONCLUSION

Significant alterations in gut microbiota were present in the RP. Taxonomic shifts and reduced richness and diversity were observed when compared to the CP. Larger prospective studies are needed to investigate correlations with clinical features and to translate these findings into future therapeutic approaches.

Deficit of Omega-3 Fatty Acids in Acne Patients-A Cross-Sectional Pilot Study in a German Cohort

Omega-3 fatty acids (ω-3 FAs) exert anti-inflammatory effects, including the downregulation of pro-inflammatory cytokines, eicosanoids, and insulin-like growth factor-1. Therefore, they may improve acne severity as an adjunct treatment. However, there is a paucity of data regarding patients' existing deficits. The aim of this study was to determine ω-3 FA levels in acne patients in correlation with self-reported dietary preferences and clinical severity. A single-center, cross-sectional study of 100 acne patients was conducted. Patients' blood parameters, including ω-3 FAs levels, were assessed using the HS-omega-3 Index® in erythrocytes (Omegametrix® GmbH, Martinsried, Germany). Dietary preferences were assessed using a standardized food frequency questionnaire. Clinical dermatologic evaluation was performed using the Investigator Global Assessment (IGA) of acne. The values of the HS-omega-3 Index® were outside the recommended range of 8-11% in 96 patients (mean 5.15%), independent of the clinical severity or affected anatomic sites. A severe deficit (HS-omega-3 Index® < 4%) was seen more commonly in men than in women (p = 0.021). The regular consumption of legumes was significantly associated with higher ω-3 FA levels (p = 0.003), as was oral ω-3 FA supplementation (p = 0.006) and the lack of sunflower oil intake (p = 0.008). This pilot study demonstrated a deficit of ω-3 FAs in a German acne cohort. Higher ω-3 FAs levels were observed in patients with regular legume intake and oral ω-3 FAs supplementation. Further prospective studies are needed to investigate whether the clinical severity of acne improves in patients with normal HS-omega-3 Index®.