A Taiwanese expert review on the role of dermocosmetics in acne management

There have been very few studies on the prevalence and severity of acne scars in Japanese patients. The aim of the present study was to investigate the prevalence of acne scars and their impact on the quality of life (QOL) in Japanese acne patients. Acne scars were classified as mini-scars (atrophic scars of ≥0.5 and <2mm in diameter) atrophic scars (≥2 mm in diameter), and hypertrophic scars. The severity of acne and acne scars were evaluated. The background of patients and their QOL in relation to acne were assessed. Of 240 subjects, 218 (90.8%) had scars. All patients with scars had mini-scars; 61.2% and 14.2% of 240 had atrophic scars and hypertrophic scars, respectively. Severe scarring was found in patients who had experienced severe acne symptoms, although 15.0% of patients with scars had experienced only mild acne symptoms. The total Dermatology Life Quality Index score was significantly higher in patients with scars than in patients without scars (5.9±4.4 vs 4.2±4.1). Almost all the patients had small atrophic scars with a diameter of 0.5 or more and less than 2mm, which we have termed "mini-scars". Acne scars had a negative impact on patient QOL. Early initiation of treatment is recommended to avoid acne scars.

Methods report on the development of the European S3 guidelines for the treatment of acne

Background:Scarring is one of the most dreadful complications of acne for which patients seek surgical treatment.Objective:The aim of this research was to study the morphological features of acne scarring and the relationship between severity of acne and its treatment with type and severity of acne scars.Materials and Methods:This was a hospital-based, noninterventional, cross-sectional study carried out over a period of 1 month on 100 patients with post-acne scarring. A morphological evaluation of the types, sites, and severity of acne scars was done, and details of the severity and treatment of acne were recorded.Results:Of 100 patients included in the study, 61 were male and 39 were females. Females had an earlier onset of acne (15.8 years) as compared to males (16.5 years). The mean duration of active acne was longer in males (99.3 months) than that in females (74.4 months). Male patients had more severe acne vulgaris as compared to females (P = 0.0001). Of 100 patients, 52 started treatment 1 year after the onset of acne, and 18 patients had never taken any anti-acne medication. Morphologically, majority of post-acne scars were ice pick scars in 94% patients, followed by rolling scars in 86%, boxcar scars in 54%, and keloidal scars in 10% patients. Male patients had more severe acne scarring than females (P < 0.05). Of 54 patients with severe acne, 22 progressed to moderate grade and 32 patients progressed to severe grade of acne scarring. Significant reduction in the severity of acne scarring was observed in patients who received isotretinoin as compared to that in patients who received oral antibiotics.Conclusion:Majority of patients with active acne delay treatment, which leads to increased acne scarring. Ice pick scars are the most common type of acne scars, and keloidal scars are more common in males. Males have a longer duration of acne, they delay treatment, and have more severe acne scarring. Early introduction of oral isotretinoin may help to reduce the severity of acne scarring. Public education is essential to urge patients to seek early and appropriate treatment of acne that can reduce the incidence and severity of acne scarring and its psychosocial consequences.

Acne vulgaris (acne) is one of the most common skin diseases with complex pathogenesis. Numerous studies have shown that the microecosystem of sebaceous glands and Cutibacterium acnes play key roles in its pathogenesis. Antibiotics targeting C. acnes have been widely used in acne treatment, but the growing prevalence of antibiotic resistance has become alarming. Further research into the microecosystem of sebaceous glands and the role of specific C. acnes phylotypes in acne pathogenesis has led to a paradigm shift in acne treatment. Currently, non-antibiotic therapies such as light therapy and laser therapy are becoming increasingly popular, opening up new opportunities in acne management. Studies on the microecosystem of sebaceous glands associated with acne and the effects of light and laser therapies on the microecosystem in acne treatment were retrieved from the PubMed database. Dysbiosis of the microecosystem of the pilosebaceous unit is closely related to the pathogenesis of acne. Light and laser therapies have an impact on the microecosystem of the pilosebaceous unit in acne treatment. Light and laser therapies are the popular alternative options in acne treatment. The mechanisms of their effect on the microecosystem of sebaceous glands are not completely clear and require further research, especially for laser therapy.

Background Acne vulgaris (AV) is a common multifactorial disorder affecting the pilosebaceous units. Research has shown that inflammation plays a crucial role in the pathogenesis of AV, including both inflammatory and non-inflammatory acne. Several studies have linked proinflammatory cytokines to AV; however, only a few have explored the correlation between interleukin-19 (IL-19) and AV. Our aim is to estimate the level of IL-19 in patients with AV compared to matched controls and to investigate the role of IL-19 in the pathogenesis of acne. Materials and methods This prospective cross-sectional case and control study includes 80 patients and 40 matched controls. Patients were divided into mild (20), moderate (40), and severe (20) groups based on their global acne score severity index. Detailed history and complete general and dermatological examinations were taken from each patient. Furthermore, 5 ml of blood was taken from all participants to assess the level of IL-19. Results IL-19 levels were significantly higher in patients with AV compared to matched controls. Furthermore, IL-19 concentrations were found to be proportional to the severity of acne, with the highest levels detected in patients with severe AV (p-value <0.005). Conclusion IL-19 levels in AV were significantly higher than in matched control. The difference was proportional to its severity. This might indicate IL-19 as an inflammatory marker and could potentially be related to AV.

Background : Fractional CO2 laser resurfacing in the treatment of acne scars, attempts to reduce the adverse effect of laser resurfacing by creating microscopic injury zones to the dermis with skipped interval areas. Aim of the study : The purpose of this study is to compare the safety and efficacy of high pulse energy (70 mJ) and low pulse energy (45 mJ) of fractional CO2 laser resurfacing in the treatment of facial acne scars. Patients and Methods : Twenty patients with moderate to severe atrophic acne scars were treated with three sessions of fractional CO2 laser resurfacing at four-week intervals with high and low energy levels applied to each side of the face separately. The severity of acne scars at baseline and after treatment was assessed using Goodman and Baron’s qualitative scar grading system. Patient satisfaction score was obtained using a quartile grading scale. Results : The severity of acne scars on both sides was comparable to each other before the treatment (p = 0.643). At the final assessment, both sides with high and low energy levels demonstrated an excellent response (p = 0.000). However, the difference between the mean final scores of both sides was not significant (p = 0.731). The most frequently reported side effects were crustation and erythema. Crustation lasted longer on the right side (mean = 6.75 days) whereas for the left side (mean = 5.45 days). Erythema was transient and only in four cases persisted beyond a week (right side mean = 10.5 days while left side mean = 8.75 days) Conclusions : Both high energy (70 mJ/pulse) and low energy (45 mJ/pulse) CO2 fractional laser resurfacing of acne scar results in satisfactory outcomes with no statistically significant differences. While the duration of side effects (crustation and erythema) was increased slightly with higher fluence.

Backgrounds/objectives:Acne is an inflammatory disease of the pilosebaceous unit (PSU). The over-expression of survivin and insulin-like growth factor (IGF)-I in some fibrotic disorders suggests a possible implication in the pathogenesis of acne and or post-acne scar. We aimed to evaluate their potential role in pathogenesis in acne and post-acne scar.Methods:Serum survivin and IGF-I levels were estimated in 30 patients with acne and post-acne scar compared to 30 controls.Results:There was a statistically significant difference in survivin and IGF-I levels between controls and patients (P < 0.05). However, there was no linear correlation between survivin and IGF-I.Conclusions:Survivin and IGF-I could have a possible role in the pathogenesis of active acne and in post-inflammatory acne scar.

Acne vulgaris is a chronic inflammatory skin condition that primarily affects the face, affecting a person's physical appearance. Anxiety, depression, and body dysmorphic disorder (BDD) are the three primary psychological conditions seen in dermatological patients. This study aimed to assess how prevalent anxiety, depression, and BDD in acne patients and the negative effect of acne on quality of life and self-esteem in dermatology patients. This cross-sectional study was done at the dermatology clinic in East Jeddah Hospital, Jeddah, Saudi Arabia. Data was collected using two pre-designed questionnaires. Part 1 contained demographic information and part 2 included four sets of questionnaires including the dermatology life quality index (DLQI), Rosenberg Self-Esteem Scale (RSES), Hospital Anxiety and Depression Scale (HADS), and Body Dysmorphic Disorder Questionnaire (BDDQ). Post-acne hyperpigmentation index (PAHPI), globalscale for acne scar severity (SCAR-S), and LEEDS were used by the dermatologist to assess the patients' acne severity, post-acne scars, and pigmentation conditions. Data were analyzed using the IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). The majority of the participants were females (76%), Saudi Arabians (95%), students (58%), single (82%), and attended university (66%). The mean acne duration was 5.75 ± 4.58 years and 44% of the participants used social media for more than five hours per day. The participants scored high on the RSES (27.54 ± 3.05), indicating normal self-esteem. The HADS-A score was 11.14 ± 2.74, whereas the HADS-D score was 11.46 ± 1.78, indicating anxiety and depression symptoms. Their mean SCAR-S score is 4.38 ± 2.89. DLQI scores (6.04 ± 6.05) indicate that acne had a moderate effect on patients' quality of life. The percentage of positive BDD patients is significantly higher than those with negative BDD (p = 0.022). Furthermore, a significant association between PAHPI total score and SCAR-S (r = 0.48, p ≤ 0.001) and HADS-D (r = 0.39, p = 0.005) total scores. The study focuses on how acne vulgaris affects patients' quality of life. The findings suggest that acne-related quality of life is positively associated with anxiety and depressive symptoms. This study provides clinicians with practical advice for implementing a more thorough management strategy for acne vulgaris.

Acne vulgaris is a common cutaneous disorder of the pilosebaceous follicle. More than 45 million people are affected with acne vulgaris. In addition, 80% of people in the United States report that they suffered from acne at one point in life. It is estimated that US consumers spend $1.2 billion each year for the treatment of acne. Typically, lesions are pleomorphic and range from open and closed comedones to inflammatory papules, pustules, cysts, and nodules, and scarring may result. The disease is important, with a significant effect on patients' self-esteem. The pathogenesis is only partially understood and is multifactorial. Successful management of acne requires an understanding of the pathophysiology of disease. The first half of this review discusses new discoveries in the pathogenesis of acne, and the second half introduces new and time-honored therapies.

scarring is an important component of overall acne severity, but there are no global scales for its evaluation inclusive of the face and trunk. our objective was to develop a global scale for acne scar severity inclusive of the trunk and the face. a six-category global severity scale (SCAR-S) was developed for assessment of acne scarring at each of the face, chest, and back. We evaluated SCAR-S against acne severity and patient-reported scar severity. of 973 subjects, 73% reported acne scarring. Self-assessment of scarring was associated with facial SCAR-S and overall SCAR-S scores (p < .001, r = .31 and .30, respectively). Acne scarring was observed at the face in 87%, the back in 51%, and the chest in 38%. Clinically relevant scarring (mild or greater) at each of these regions was 55%, 24%, and 14%, respectively. Acne severity correlated with SCAR-S (p < .001) for the back (r = .612), the chest (r = .548), and the face (r = .514). Acne duration correlated with patient-reported severity of scarring (r = .244) and overall SCAR-S scores (r = .152). Clinically relevant scarring increased with acne duration. SCAR-S is a practical, validated, global system for acne scar evaluation and is clinically relevant in overall severity grading of acne.

Background: Acne vulgaris is a common chronic inflammatory skin condition affecting the pilosebaceous unit. Although hormonal factors are well-recognized in its pathophysiology, emerging evidence suggests that dietary factors may influence the onset, severity, and progression of acne. Objective: This review aims to evaluate the current literature on the role of diet in acne vulgaris, focusing on specific dietary components that may exacerbate or alleviate the condition. Methods: A literature review was conducted to examine the relationship between dietary patterns—including glycemic index, dairy intake, dietary fats, and micronutrients—and acne pathogenesis. The biological mechanisms through which these factors may influence sebaceous activity, inflammation, and hormonal regulation were also explored. Databases such as PubMed and Google Scholar were searched using the following terms: “acne vulgaris,” “IGF-1 and acne,” “mTORC1 acne pathway,” and “inflammatory skin diseases.” Studies were selected based on their relevance to dietary modulation of acne pathophysiology, mechanistic insights, and clinical outcomes. Results: High-glycemic index diets, dairy consumption, and saturated and trans fats have been associated with increased acne severity, potentially through the stimulation of insulin and IGF-1 (nsulin-like growth factor-1) pathways, activation of mTORC1, and upregulation of sebum production. Conversely, diets low in glycemic load and rich in omega-3 fatty acids may have protective effects by reducing inflammation and normalizing sebaceous gland activity. Conclusion: Diet appears to play a significant role in acne pathophysiology through various hormonal and inflammatory mechanisms. While further large-scale and controlled studies are needed, dietary modification may serve as a useful adjunct in acne management.

Acne vulgaris is a multifactorial disease that mostly heals by scarring. Interleukin-1 beta (IL-1β) is a proinflammatory cytokine, suggested to play a key role in acne pathogenesis. To study the immunohistochemical (IHC) expression of IL1β in acne vulgaris and acne scars to evaluate its possible role in their pathogenesis and to study the relation between the expression of IL1β and the clinicopathological parameters. This study was conducted on sixty subjects (twenty patients with acne vulgaris and twenty patients with acne scars), and twenty healthy volunteers as controls. Skin biopsies were taken from patients and controls for routine histopathological examination with hematoxylin and eosin stain and IHC staining of IL-1β. There was a statistically significant increase in expression of IL-1β in acne vulgaris compared with post-acne scars and controls, (p<0.001) for both. IL-1β expression was significantly positively correlated with both clinical severity of acne vulgaris (p=0.022) and severity of histopathological inflammation (p=0.011). Interleukin-1β expression was associated with acne vulgaris and post-acne scars with significant positive correlation to clinical and histopathological severity of acne vulgaris. Thus, IL-1β could be a key player cytokine in acne pathogenesis, its severity and development of post-acne scars.

Introduction: Acne vulgaris is one of the most common skin disorders, which various factors are involved in its pathogenesis. Recent investigations on intracellular signaling pathway show that the over expression of mTORC1 complex (mammalian target of rapamycin), leads to increased sebum production and altered keratinization, therefore it has an important role in acne pathogenesis. Another studies also showed that the expression of mTORC1 is significantly increased in the skin cells of the patients, which confirm the linkage between acne pathogenesis and mTORC1 over expression. The aim of this study is to represent a way to confront the impaired endocrine signaling, in order to relieve the acne symptoms. Methods and Results: The linkage between acne pathogenesis and endocrine signaling pathway was demonstrated through the collected signaling data from popular scientific databases such as www.Kegg.Jp . Insulin resistance is one of the major factors that leads to mTORC1 over expression. Metformin, a biguaniide that increases the cell's sensitivity to insulin, is the drug of choice for this condition, as it is able to suppress mTORC1 over expression through AMPK (5' adenosine monophosphate-activated protein kinase) activation. So, applying a topical form of the drug on acne spots, may lead to relieve the symptoms. Topical semi solid formulation of metformin was prepared with the use of suitable thickening polymers and formulation was optimized through the point of viscosity and rheological behaviors of the aqueous gel, so the optimum ratio of the thickening polymers was determined. Conclusions: Signaling pathways show that acne pathogenesis is mediated through mTORC1 over activation, so we were aimed to design a formulation which is able to suppress this over expression in order to relieve acne symptoms. Metformin, formulated in a topical form, is the drug of choice, as it is a safe drug which can suppress the mTORC1 over expression through AMPK activation in the skin of acne patients. Key words: Metformin, mTORC1, Acne Vulgaris, AMPK Grants: This study was part of a Pharm.D thesis supported by Shiraz University of Medical Sciences (SUMS; Grant no. 13955)

Acne scars may negatively impact quality of life. The purpose of this study was to collect preliminary data on the efficacy and safety of injectable poly-L-lactic acid (PLLA, Sculptra, Dermik Laboratories) for the treatment of acne scars. Twenty subjects aged 42.4+/-10.7 years (10 men, 10 women) with facial scars resulting from moderate to severe acne or varicella participated in this single-center, open-label prospective study. The primary end point was the resolution of the acne or varicella scars. Secondary end points were the physician and subject assessments of scar improvement. PLLA reconstituted with 5 mL of sterile water was injected serially at or near the sites of the acne scars without topical anesthesia. Investigator-assessed reductions in acne scar size and severity were significant (p<.0001) during the course of seven treatments. Subject-rated reduction in scar severity was also significant (p=.0078). Subject satisfaction with treatment trended toward an increase with each treatment session and approached significance (p=.0899). Adverse events were limited to depression (n=1) not related to the treatment. Injectable PLLA as used in this investigation appears to correct the types of acne scars treated in this study without serious adverse effects.

Acne vulgaris is a common disease involving adolescents predominantly, which can lead to scar formation. This study aimed to compare the efficacy of fractional CO2 laser therapy, alone or combined with topical Timolol or insulin, for acne scar treatment, which has not been yet rigorously investigated. In this Randomized Controlled Trial (RCT) conducted in 2024, we enrolled 30 subjects and randomly assigned them to groups A and B. Both groups received bilateral fractional CO2 laser therapy; one group received unilateral topical 0.5% Timolol Maleate, while the other received unilateral topical regular insulin. Scar severity was assessed using the Scale for Acne Scar Severity (SCAR-S), Acne Scar Assessment Scale (ASAS), and Goodman and Baron Quantitative Global Scarring Grading System (GBAQGS) before and after the therapy. Additionally, patients' quality of life was evaluated using the Dermatologic Life Quality Index (DLQI) questionnaire at the designated time points. Statistical analyses were conducted using the IBM ™ SPSS Statistics application (version 26.0). The subjects consisted of 20 females and 10 males of Persian ethnicity, with a mean age of 32.20 years. Despite significant improvements in acne scar severity, and quality of life observed following fractional CO2 laser therapy alone and in combination with topical Timolol or insulin application, no significant differences existed between these treatment approaches. No adverse effect was seen during the study. Fractional CO2 laser alone or its combination with topical Timolol or insulin mitigated acne scar severity and enhanced patients' quality of life, despite the absence of significant differences.