Personality disorders and its association with anxiety and depression among patients of severe acne: A cross-sectional study from Eastern India

Antimicrobial Activity of Gelatin Nanofibers Enriched by Essential Oils against Cutibacterium acnes and Staphylococcus epidermidis

Acne vulgaris is a prevalent skin condition that is caused by an imbalance in skin microbiomes mainly by the overgrowth of strains such as Cutibacterium acnes and Staphylococcus epidermidis which affect both teenagers and adults. Drug resistance, dosing, mood alteration, and other issues hinder traditional therapy. This study aimed to create a novel dissolvable nanofiber patch containing essential oils (EOs) from Lavandula angustifolia and Mentha piperita for acne vulgaris treatment. The EOs were characterized based on antioxidant activity and chemical composition using HPLC and GC/MS analysis. The antimicrobial activity against C. acnes and S. epidermidis was observed by the determination of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The MICs were in the range of 5.7-9.4 μL/mL, and MBCs 9.4-25.0 μL/mL. The EOs were integrated into gelatin nanofibers by electrospinning and SEM images of the fibers were taken. Only the addition of 20% of pure essential oil led to minor diameter and morphology alteration. The agar diffusion tests were performed. Pure and diluted Eos in almond oil exhibited a strong antibacterial effect on C. acnes and S. epidermidis. After incorporation into nanofibers, we were able to focus the antimicrobial effect only on the spot of application with no effect on the surrounding microorganisms. Lastly, for cytotoxicity evaluation, and MTT assay was performed with promising results that samples in the tested range had a low impact on HaCaT cell line viability. In conclusion, our gelatin nanofibers containing EOs are suitable for further investigation as prospective antimicrobial patches for acne vulgaris local treatment.

Assessment of body image disturbance, self-esteem and quality of life among adolescents and young adults with acne in a tertiary care facility of India

Background:

Impact of acne on the psychological aspect among adolescents and young adults is poorly understood and many times goes unnoticeable.

Aim:

To assess body image disturbance, self-esteem, quality of life among adolescents and young adults with acne.

Materials and Methods:

A cross sectional survey on 250 adolescents and young adults aged 13-25 years in Dermatology OPD of a tertiary care hospital, was performed. Severity of acne, body image disturbance, self-esteem, and quality of life were assessed using standardized tools like IGA scale, BIDQ, RSES, and TAQOL respectively.

Results:

A majority of the participants, 163 (65%), were aged 20–25 years, in which 141 (56.4%) were male, 237 (94.8%) were unmarried, 192 (76.8%) were residing in urban area, 142 (56.8%) were graduate/post-graduate, 173 (69.2%) were students and 113 (45.2%) belonged to upper middle class of socio-economic status. More than half, 137 (54.8%), had a family history of acne, 228 (91.2%) had oily skin, 166 (67.4%) had normal nutritional status, 154 (61.6%) had moderate form of acne whereas 80 (32%) had severe acne. The mean BIDQ score was 3.05 (SD = 0.89); 169 (67.60%) had normal self-esteem and 174 (69.64%) had mild impairment in quality of life. Severity of acne had significant association with body image disturbance (P = 0.007) and quality of life (P = 0.001) but not related with self-esteem.

Conclusion:

The results revealed body image disturbance and impaired quality of life among adolescents and young adults with acne which draws the attention of dermatologists towards unidentified psychological aspects of acne during treatment. However, the majority of them revealed normal self-esteem in the study.

Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India

BACKGROUND

Personality disorders (PD) lead to frequent emergency department (ED) visits. Existing studies have evaluated high-risk ED populations in Western settings. PD screening tools, such as the Standardized Assessment of Personality - Abbreviated Scale (SAPAS), have thus far only been validated in Western populations.

AIMS

This study aimed to establish the screened prevalence of PD, and to evaluate the performance of the SAPAS as a screening tool within an ED setting in India.

METHODS

The study took place in the ED of a private multi-speciality hospital in Kolkata, India. All attendees were approached during two days per week over three months, except those who were medically unfit to participate. The SAPAS and the International Personality Disorder Examination (IPDE) were translated into Bengali and then used as screening tools for PD and as the reference standard for PD diagnosis.

RESULTS

Out of 120 ED attendees approached, 97 participated (48 men and 49 women), of whom 24% met the criteria for a diagnosis of PD. A cut-off score of 4 on the SAPAS provided the best trade-off between sensitivity and specificity for detecting PD.

CONCLUSION

The prevalence of PD was similar to Western samples, and the SAPAS showed promise for use in a non-Western setting.

Evaluation of life quality, anxiety, and depression in patients with skin diseases

To investigate the incidence of skin diseases, the factors affecting the life quality, anxiety, and depression of patients with skin diseases and the correlation among the 3.A total of 1127 patients with skin diseases were selected online from March 2018 to June 2018. Logistic regression was used to analyze the factors influencing life quality, anxiety, and depression. Spearman rank correlation was used to analyze the correction among the life quality, anxiety, and depression.There was no significant difference in ethnicity, education, and time of question among patients (P > .05). Sex ratio, age, marital status, and occupation were statistically significant difference among patients with different skin diseases (P < .05). The life quality index of patients with psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia were 11.96 ± 6.74, 9.84 ± 6.99, 11.57 ± 6.85, 13.86 ± 6.31, 7.86 ± 6.82, respectively. The differences were statistically significant (P < .05). The main factors affecting quality of life included age, family history, and types of skin diseases. The age, ethnicity, education, and family history of skin diseases were the main factors affecting anxiety of patients with different skin diseases. Additionally, sex, marital status, education, and family history of skin diseases were the main factors influencing depression. Spearman rank correlation analysis showed that the life quality, anxiety, and depression were positively correlated.Psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia have a certain impact on the life quality of most patients, and may cause different degrees of anxiety and depression.

Psychodermatologic pathology in adolescents: findings from the Colombian National Mental Health Survey

Background Associations between mental health and dermatology have generated a new branch of study called psychodermatology, which includes relevant conditions to the adolescent population. However, there is limited research focusing on this field and this specific population. Objective To estimate the prevalence of dermatological pathologies in the Colombian adolescent population and their possible associations with mental health conditions. Methods We performed a secondary analysis of the Colombian National Mental Health Survey results. A representative sample of the adolescent Colombian population answered questions regarding dermatological conditions and mental health disorders. We estimated the prevalence and evaluated associations using the chi squared independence test. Results Of 1753 adolescents, 8.3% (CI95%=[6.8-10.1]) had dermatitis or skin allergies and 4.5% (CI95%=[3.3-6.1]) acne. For dermatitis, we found associations with age, education, and family dysfunction (p-Values=0.024; <0.001; 0.046 respectively). Acne was associated with age, sex, educational level, the number of social groups involved in, alcohol consumption, psychoactive substances use and previous violent experiences (respective p-Values=0.007; 0.004; 0.005; 0.036; 0.002; 0.003; 0.044). Regarding mental health, dermatological conditions were associated with depression, affective disorders, suicide attempt and suicide ideation. Conclusion Our results are the first to describe the prevalence of these disorders in Colombia. This is an exploratory study; nonetheless, it is of great value since it is the first to describe these associations in adolescents in a middle-income country, which should be considered during clinical examinations. Further longitudinal studies evaluating possible causal relationship between psychiatric and dermatological conditions are fundamental to establish causal links.

Management strategies for borderline and narcissistic personality disorders in dermatology practice: a review

Dermatologists are often ill-equipped to promptly identify and manage patients with personality disorders. Patients with borderline personality disorder (BPD) and narcissistic personality disorder (NPD) frequently present to dermatology clinics, particularly those that provide esthetic services. Although dermatologists should ideally utilize specific management strategies when working with these patients, there is a lack of awareness and availability of resources on how to do so. Here, we review the psychiatry, plastic and reconstructive surgery, and dermatology literature to provide recommendations on tangible management strategies for dermatologists to avoid common mistakes that are made while managing patients with BPD and NPD. Additionally, we also discuss common dermatologic manifestations of BPD and NPD to improve providers' ability to identify patients with these conditions in their practices.

Culture and Borderline Personality Disorder in India

The present paper discusses how cultural context can be used as an essential tool in the diagnosis of mental disorders as well as in segregating individuals with normal or abnormal personality functioning. Further, such information about the culture can be used to diagnose individuals specifically with borderline personality disorder (BPD). BPD is a mental illness marked by impulsivity and instability in interpersonal relationships, moods, and self-image. We discuss how culture shapes patterns of behavior in the individual with BPD. An extensive review of manifestation of BPD in eastern countries suggests that culture and social norms are the two crucial factors, which can differentiate normal and abnormal behavioral patterns in BPD. For example, the social norms shape and give directions to our interpersonal functioning, emotions are experienced within the cultural context and expressed accordingly, and self is a reflection and representation of one’s culture. Hence, these constructs of BPD (such as interpersonal functioning, emotions, and self) indicate that they are experienced differently in different cultures and vary on the continuum of normal to abnormal personality functioning. The cultural manifestation of BPD helps to understand the specific profile of the three constructs of BPD in an eastern culture like India. A synthesis of studies on prevalence, development, and symptom presentation of BPD in the Indian context is emphasized to support the personality functioning within the constructs of BPD. The literature review indicates that BPD research in India is based only on a few cases and a tiny sample of such patients. However, studies on BPD in the cultural context are minimal and incomprehensive. Hence, it suggests the importance of more empirical studies concerning the appropriate diagnosis of BPD within the cultural context of India.

Photodynamic therapy for severe facial acne vulgaris with 5% 5-aminolevulinic acid vs 10% 5-aminolevulinic acid: A split-face randomized controlled study

BACKGROUND

Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) has been described as an effective treatment for severe acne. However, very little evidence exists on the optimal concentration of ALA used in PDT for severe acne.

OBJECTIVES

To compare the efficacy and safety of PDT with 5% ALA vs 10% ALA in severe acne.

METHODS

Twenty-three patients with severe facial acne were randomly assigned to receive PDT with 5% ALA or 10% ALA on the left or right side of the face. Four PDT sessions were conducted with a light dose of 96 J/cm2 . The reduction rates of lesion counts between the two groups were compared at the week-4 and week-12 follow-up visits. Effective rate at the week-12 visit was the primary clinical outcome. Pain and other side effects were evaluated at each visit.

RESULTS

The decrease in inflammatory lesions in the 10% ALA group was greater than that in the 5% ALA group at both week-4 (79.2% vs 62.5%, P = 0.009) and week-12 follow-up visits (88.5% vs 78.3%, P = 0.018), while the decrease in noninflammatory lesion counts between the two groups was not statistically significant at each follow-up visit. The effective rate in the 10% ALA group was significantly higher than that in the 5% ALA group (95.7% vs 69.6%, P = 0.02). No significant difference was observed in pain scores between the two groups except in the first treatment session.

CONCLUSIONS

Photodynamic therapy using 10% ALA was more effective for severe acne than PDT using 5% ALA.

Antimicrobial activity of certain natural-based plant oils against the antibiotic-resistant acne bacteria

The unceasing emerging of multidrug-resistant bacteria imposes a global foremost human health threat and discovery of new alternative remedies are necessity. The use of plant essential oil in the treatment of many pathogenic bacteria is promising. Acne vulgaris is the most common skin complaint that fears many people about their aesthetic appearance. In this work we investigated the antibacterial activity of some plant oils against acne-inducing bacteria. Three bacterial isolates were identified from Egypt, biochemically and by means of 16s rRNA gene typing, and were designated as Staphylococcus aureus EG-AE1, Staphylococcus epidermidis EG-AE2 and Cutibacterium acnes EG-AE1. Antibiotic susceptibility test showed resistance of the isolates to at least six antibiotics, yet they are still susceptible to the last resort Vancomycin. In vitro investigations of eleven Egyptian plant oils, identified tea tree and rosemary oils to exhibit antibacterial activity against the antibiotic-resistant acne isolates. Inhibition zones of 15 ± 0.5, 21.02 ± 0.73 and 20.85 ± 0.76 mm was detected when tea tree oil applied against the above-mentioned bacteria respectively, while inhibition zones of 12.5 ± 1.5, 15.18 ± 0.38 and 14.77 ± 0.35 mm were detected by rosemary oils. Tea tree and rosemary oils exhibited bacteriostatic and bactericidal activity against all the strains with MICs/MBCs ranging between 39-78 mg/L for tea tree oil and 39-156 mg/L for rosemary oil. All the isolates were killed after 4 and 6 h upon growing with 200 mg/L of tea tree and rosemary oils, respectively. Additionally, gas chromatography mass spectrometry (GC/MS) profiling identified and detected a variable number of antimicrobial compounds in both oils.

The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample

BACKGROUND

Little is known about the mental health (MH) hospitalization among patients with acne and rosacea.

AIMS

To determine the MH disorders and cost burden associated with acne and rosacea.

METHODS

Data were examined from the 2002-2012 US National Inpatient Sample, comprising a sample of ~20% of all US paediatric and adult hospitalizations (n = 87 053 155 admissions).

RESULTS

A diagnosis of ≥ 1 MH disorder was much more common among all inpatients with vs. those without a diagnosis of acne (43.7% vs. 20.0%, respectively) and rosacea (35.1% vs. 20.0%, respectively). In multivariable logistic regression models controlling for sex, age, race/ethnicity and insurance status, acne (adjusted OR = 13.02; 95% CI 11.75-14.42) and rosacea (adjusted OR = 1.70; 95% CI 1.56-1.95) were associated with significantly higher odds of a primary admission for an MH disorder (13 and 8, respectively, of 15 MH disorders examined). Both acne and rosacea were associated with higher risk of mood, anxiety, impulse control and personality disorders, and with > $2 million of excess mean annual costs of hospitalization for MH disorders in the USA.

CONCLUSION

In this study, inpatients with acne or rosacea had increased odds of comorbid MH disorders. In particular, there was an increased number of hospital admissions secondary to a primary MH disorder with coexistent acne/rosacea. MH comorbidities were associated with considerable excess costs among inpatients with acne or rosacea.