Acne Grading Research Articles

Effect of oral doxycycline, azithromycin and isotretinoin on haematological inflammatory markers and interleukin-17A levels in acne vulgaris: a single blinded randomised interventional study.

Amidst the existing literature on the effect of isotretinoin on serum interleukin-17 levels in acne patients, the effects of oral antibiotics azithromycin and doxycycline on serum interleukin-17 is scarce. We conducted an investigator blinded randomized interventional study to compare the effect of doxycycline, azithromycin and isotretinoin on inflammatory markers and Interleukin-17A (IL-17A) levels in acne. Patients were randomized and received the treatment according to treatment arm till 12 weeks. At baseline and 12 weeks/treatment completion, clinical improvement and Red-cell-distribution width (RDW),Neutrophil-lymphocyte ratio(NLR),Platelet-lymphocyte ratio(PLR), Mean-Platelet volume(MPV), Platelet-distribution width(PDW) and Interleukin-17A levels were analysed. P-value < 0.05 was considered statistically significant. Out of 120 patients, 110 patients completed the study. Baseline Global acne grading scale (GAGS) in doxycycline, azithromycin or isotretinoin group was 24.32 ± 3.119, 24.12 ± 2.804 and 25.10 ± 3.985 respectively and post-treatment was 5.216 ± 1.88, 7.265 ± 2.17 and 2.769 ± 1.08. All the drugs caused a statistically significant decrease in RDW and IL-17A levels. Baseline levels of IL-17A were significantly higher in patients with higher GAGS and post-acne scarring. One of the limitations of our study was that we excluded severe nodulocystic acne patients thereby these results have to be carefully extrapolated.

Evaluating the Effectiveness of Probiotic Supplementation in Combination With Doxycycline for the Treatment of Moderate Acne: A Randomized Double-Blind Controlled Clinical Trial.

Acne is a chronic inflammatory skin disease that negatively affects patients' quality of life. Increasing antibiotic resistance is making acne less responsive to treatment. Probiotics are live microorganisms that can provide health benefits by fighting pathogens and maintaining intestinal homeostasis and skin microbiome balance. This study investigates the effects of probiotics in the treatment of acne vulgaris. In this randomized controlled clinical trial, 80 patients with moderate acne were divided into two groups of 40. All patients received the same topical treatment, which consisted of a daily antibacterial face wash and Adapalene gel every other night. The control group received one capsule of doxycycline (100 mg) daily, whereas the intervention group received one probiotic capsule daily in addition to doxycycline. Patients underwent photography of facial acne lesions, and treatment response was assessed using the global acne grading system (GAGS) and acne grading method at baseline, as well as during follow-up visits at 1, 2, and 3 months. The global acne grading system indicated that both groups showed improvement. However, analyses revealed that outcomes were significantly better in the doxycycline plus probiotics group for the forehead (p = 0.018), chin (p = 0.021), and nose (p = 0.021). No significant differences were observed for the left and right cheeks, back, and chest areas, with the mean GAGS score reduction between the two groups differing by only 2%. Treatment with probiotics significantly reduced the severity of lesions compared to the control group (p < 0.001). The acne grading method also indicated that the intervention group had a significantly better treatment response than the control group (p < 0.001). Furthermore, treatment with probiotics did not result in any side effects. Probiotics can serve as an effective and safe treatment option, enhancing the outcomes of routine acne treatments, particularly for patients with acne on the forehead, chin, and nose.

Automatic Acne Severity Grading with a Small and Imbalanced Data Set of Low-Resolution Images.

Developing automatic acne vulgaris grading systems based on machine learning is an expensive endeavor in terms of data acquisition. A machine learning practitioner will need to gather high-resolution pictures from a considerable number of different patients, with a well-balanced distribution between acne severity grades and potentially very tedious labeling. We developed a deep learning model to grade acne severity with respect to the Investigator's Global Assessment (IGA) scale that can be trained on low-resolution images, with pictures from a small number of different patients, a strongly imbalanced severity grade distribution and minimal labeling. A total of 1374 triplets of images (frontal and lateral views) from 391 different patients suffering from acne labeled with the IGA severity grade by an expert dermatologist were used to train and validate a deep learning model that predicts the IGA severity grade. On the test set we obtained 66.67% accuracy with an equivalent performance for all grades despite the highly imbalanced severity grade distribution of our database. Importantly, we obtained performance on par with more tedious methods in terms of data acquisition which have the same simple labeling as ours but require either a more balanced severity grade distribution or large numbers of high-resolution images. Our deep learning model demonstrated promising accuracy despite the limited data set on which it was trained, indicating its potential for further development both as an assistance tool for medical practitioners and as a way to provide patients with an immediately available and standardized acne grading tool. chinadrugtrials.org.cn identifier CTR20211314.

The influence of blue light sources on somnological disorders among patients with mild to moderate acne

Background. The acne is a chronic inflammatory skin disease that affects all age groups of the population and has a serious impact on the quality of life of patients. Various endogenous and exogenous factors are involved in the pathogenesis of dermatosis. The increasing of usage of digital media and the Internet has an impact on people's sleep habits and, with changes in sleep quality, symptoms of depression, anxiety and stress may increase, which leads to a more severe course of chronic dermatoses, including acne. Aim. To evaluate the relationship between somnological disorders (SLD) and the frequency of smartphone use before bedtime in patients with mild to moderate acne (MMA). Materials and methods. A single-center observational prospective study was conducted from 2023 to 2024: 130 patients aged 18 to 30 years (average age 23.32±2.75 years) diagnosed with MMA were observed. The data on the severity of acne were assessed using the Global Acne Grading System (GAGS), the degree of sleep disturbance was determined using the Pittsburgh Sleep Quality Index (PSQI), and the quality of life of patients was determined according to the Dermatology Life Quality Index (DLQI). Taking into account indicators on the use of a smartphone with the iOS or Android operating system included calculating average screen time, assessing addiction and the fact of using a smartphone 1 hour before bedtime. The statistical processing was carried out using the Jamovi version 2.3.21 program. Results. The SLD were identified in 85 (65.38%) patients with MMA. The dermatosis had a strong impact on quality of life (DLQI20) in 82.31% (n=107). In group I of patients "poor sleeping" there was a direct correlation between SLD (PSQI) and the severity of dermatosis (ρ=0.533; p0.001) and the duration of screen time (ρ=0.628; p0.001) spent on a smartphone per day. The patients of group I had a greater dependence on a smartphone compared to group II of patients "well sleeping": 15.94±1.89 points versus 7.71±1.96 points (p0.001). Conclusion. It has been established that the level of SLD has a high incidence in the group of patients with MMA. There is a pronounced correlation between dyssomnia and the severity of dermatosis; in patients with disturbed sleep, a high dependence on the phone and a correlation with the duration of screen time spent on a smartphone per day were revealed. This study demonstrates the need to pay attention to the presence of disturbances in the quality of sleep in people suffering from skin diseases, in particular acne.

Translation, cultural adaptation and validation of the Tamil version of the Cardiff Acne Disability Index (CADI) in Sri Lanka

BackgroundAssessment of QoL has become an essential component in the holistic care of patients with acne. The Cardiff Acne Disability Index (CADI) is used globally to assess quality of life (QoL) in patients with acne. This study was done to validate CADI in Tamil, as 90 million of the global population are native speakers and Tamil is an official language of several countries.MethodsCADI was translated and validated into Tamil according to published guidelines. The Tamil versions of both CADI and Dermatology Life Quality Index (DLQI), was administered to 150 Sri Lankan young adults with acne. The clinical severity was assessed using the Global Acne Grading System (GAGS). Discriminant validity was tested by comparing the results of CADI with those of GAGS and DLQI, using reliability, validity, Cronbach’s alpha, and Spearman’s correlation coefficient measurements. Construct validity was assessed by factor analysis.Results70% were female, and the mean age was 25.1 (SD, 5.2). The majority (91.3%) had acne of mild to moderate severity when measured by GAGS. CADI-Tamil showed high internal consistency and reliability (Cronbach’s alpha coefficient = 0.83). The CADI total score showed a strong correlation (0.86) with that of DLQI. The correlation between CADI and GAGS was low, whereas CADI had a high and significant correlations with the DLQI. The construct validity explained 61% of the variability.ConclusionsThe CADI-Tamil is a reliable and valid tool for assessing the QoL of Tamil speaking patients with acne. This tool will help clinicians understand the patient’s perspective on acne.

SS-ALDL: Consistency-based semi-supervised label distribution learning for acne severity classification

Acne vulgaris is a common skin disease among adolescents. Accurate classification of acne severity is critical to patient treatment. Most existing acne severity classification models ignore the number of acne lesions and the similarity between samples. Moreover, training a supervised model requires collecting a large amount of labeled data, which is labor-intensive and time-consuming. To solve the above problems, this study presents a consistency-based semi-supervised label distribution learning (SS-ALDL) framework, which is the first acne-specific semi-supervised framework for acne severity classification. It generates three distributions based on acne grading criteria, including acne severity, lesion counts, and grading transformed by counts. These three distributions are integrated by multi-task learning loss and optimized in supervised training for joint acne image grading and counting. Furthermore, a feature similarity consistency learning method is proposed for semi-supervised training. By maintaining the batch-level feature similarity matrix between different samples under different perturbations, the proposed method can effectively explore extra semantic information from the unlabeled data. The performance of the proposed model is evaluated on the ACNE04 dataset, the RetinaMNIST dataset, and a private dataset. It achieves the best classification accuracy and the lowest mean absolute error. These experimental results show that the proposed method outperforms other state-of-the-art semi-supervised methods and can significantly reduce the manual assessment workload.

Relationship between acne vulgaris and attention deficit hyperactivity disorder in adolescent: A cross-sectional study.

High androgen hormone exposure in intrauterine life is held to be responsible for the etiopathogenesis of both acne vulgaris (AV) and attention-deficit hyperactivity disorder (ADHD). In this study, we aimed to investigate the prevalence of ADHD in AV patients. Patients between the ages of 12 and 17, diagnosed with AV and a control group were included in the study. The Conners-Wells Adolescent Self-Report Scale-Long Form (CASS-L) was applied to both groups to determine the severity of the ADHD. Ninety-eight patients diagnosed with AV and 96 healthy controls participated in the study. All parameters of the CASS-L were found to be significantly higher in AV patients compared to the control group. In addition, with the severity of the Global Acne Grading System, a positive low level among conduct problems (r = 0.223), cognitive problems (r = 0.271), ADHD index (r = 0.238), inattention (r = 0.238), and a positive moderate level among hyperactivity (r = 0.349), hyperactivity-impulsivity (r = 0.414), and total score (r = 0.429). According to our results, patients diagnosed with AV were more prone to ADHD than the control group. Our study showed that adolescent patients diagnosed with AV were more prone to ADHD than people of similar age and gender without a diagnosis of AV. It should be noted that AV is not only a dermatological disease but may also be accompanied by psychiatric morbidities.

Evaluating the efficacy of Kali bromatum in treating Adolescent Acne: A Clinical study

Acne is a skin condition where the hair follicles get blocked due to sebum and dead skin cells.1 This study aimed to assess the effectiveness of Kali bromatum in treating acne among adolescents aged 13-20 years.  Methodology: A total of 30 patients participated in the study. Different potencies were administered based on the severity and duration of the disease. 30 potency in 11 patients, 200 in 17 patients, and 1M in 2 patients. Assessment of acne was done using the Global Acne Grading System.  Results: 19 patients showed good improvement and 11 patients showed moderate improvement. The study was significant with p value 5.354×10-21 which is less than 0.05.  Conclusion: Kali bromatum has proven potential in treating adolescent acne.

A Novel Treatment of Acne Vulgaris Using a 1927 nm Fractional Thulium Laser: A Case Series.

Acne vulgaris remains one of the most common and problematic dermatological conditions. Recently, a fractional 1927 nm thulium laser has been developed with specific water absorption characteristics which may be of interest in the treatment of acne. Nine consecutive Korean subjects, 6 females and 3 males, ages ranging from 13 to 33 yr, presented with a mixture of inflammatory and noninflammatory acne. Baseline clinical photography, image analysis and lesion counts were performed. A fractional 1927 nm thulium laser (FTL) delivered 6 treatment sessions in 5 subjects and 5 sessions in 4 subjects, 4 weeks between sessions. Pain during treatment was assessed. At 32 weeks after the last treatment session, an independent Investigator Global Assessment (IGA) performed lesion counts and graded the severity of the acne at baseline and the final assessment on a quintile scale. Data were analyzed statistically. All 9 subjects completed the study with significant reductions in the inflammatory and noninflammatory lesions (P values 0.0012 and 0.0081, respectively) with overall lesion counts at the final assessment ranging from 60% to 97.1%, and acne grades in the IGA dropping by an average of 1.67 (range 1 to 3 grades). There was no significant difference in lesion counts or acne grades between the subjects who had 6 treatments and those who had 5 (P = 0.7695). Mild pain was reported during treatment, and no adverse events were reported by either the subjects or investigator. The FTL at the parameters used in the present study caused disruption to the upper portion of the affected follicles and sebaceous glands under an intact stratum corneum, thereby destroying or damaging the causative Cutibacterium acnes. The superficial controlled coagulation additionally induced follicular remodeling and tissue regeneration, potentially contributing to the noticeable results in inflammatory and noninflammatory acne lesions.

Comparative study on efficacy of benzoyl peroxide with adapalene versus plain adapalene in the treatment of acne vulgaris

BACKGROUND Acne vulgaris is a dermatological disorder of pilosebaceous unit, characterized by formation of comedones and inflammatory lesions. It is one of the most common skin manifestations among adolescents, also affecting the adult population. The treatment of acne basically involves reduction of lesions and prevention of permanent scarring. The current line of treatment for mild to moderate acne is topical medications with antimicrobials and retinoids. The present study assessed the efficacy of combination of adapalene and benzoyl peroxide in comparison to adapalene for topical treatment of mild to moderate acne vulgaris. OBJECTIVE The purpose of the study was to compare the clinical efficacy of topical adapalene and topical adapalene with benzoyl peroxide in treatment of mild to moderate cases of acne vulgaris. METHODOLOGY A prospective, comparative study was carried out among 84 patients with mild and moderate acne vulgaris visiting the Department of Dermatology, Kathmandu Medical College and Teaching Hospital, Bhaktapur, Nepal from December 2019 till March 2021. The patients fulfilling the inclusion criteria were divided into two groups. Group A received topical adapalene whereas Group B received topical adapalene with benzoyl peroxide. The efficacy of treatment in both groups were determined based on the reduction of total lesion count. Both inflammatory and non-inflammatory lesions were counted at 4th week, 8th week and 12th week. RESULTS All patients were assessed according to Global Acne Grading System (GAGS) and grouped as mild and moderate. The most frequent age group affected by acne vulgaris was 18-22 years. The mean age was 22.15 ± 5.315. Females (64.30%) were affected more commonly than males (35.7%). Majority of patients presented with moderate or inflammatory acne lesions. The face (90.5%) was most commonly affected site by acne vulgaris. The number of patients enrolled in the study were 84 out of which 63 (75%) completed the study. It was found that the reduction of non-inflammatory, inflammatory and total lesion count from the baseline were highly significant in between and both the group (P&lt;0.001). A total of 52.4% had very good result of the treatment, 44.4% of them had good result and remaining 3.2% of the patients’ result was fair. However, the efficacy of benzoyl peroxide with adapalene was found to be better than adapalene alone. CONCLUSIONThis study concluded that topical benzoyl peroxide with adapalene is more efficacious to treat mild to moderate acne vulgaris.

Non-linear association between air pollutants and secondary sensitive skin in acne patients.

There is a growing number of patients suffering from sensitive skin secondary to acne, but its prevalence and influencing factors are not yet well-understood. The aim of this study is to investigate the nonlinear relationship between air pollutants and secondary sensitive skin in acne patients. A cross-sectional study comprising 4325 acne outpatients in China was carried out between September 2021 and December 2022, employing a simple random sampling approach. Air pollutants data was derived from the nearest air quality monitoring station corresponding to the subjects' residential locations. Furthermore, socio-economic characteristics, biological attributes, and lifestyle data of patients were acquired via questionnaire surveys. The data were subsequently analyzed utilizing the XGBoost machine learning model. A nonlinear relationship has been observed between secondary sensitive skin in acne patients and various factors, including particulate matter (PM2.5), inhalable particulate matter (PM10), ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), the severity of depression, different levels of exercise intensity, acne grading, frequency of sunscreen application, gender, and age. The occurrence of secondary sensitive skin in acne patients be mitigated through the implementation of measures such as the control of air pollutant emissions, regulation of negative emotions, and improvement of personal lifestyle.

Unmasking Acne: Azithromycin Edges Out Doxycycline in Randomized Trial at Tertiary Care Centre

Background: Acne vulgaris, a prevalent global condition, often necessitates antibiotic therapy. Doxycycline has been a mainstay treatment; however, recent research suggests azithromycin might be superior. Conflicting data and a lack of local studies regarding their comparative efficacy warrant further investigation. Objectives: This study aimed to compare the efficacy of oral azithromycin with oral doxycycline in treating acne vulgaris at a tertiary care hospital in Islamabad. Methods: A randomized controlled trial was conducted. Patients aged 14-30 years (n=190) were enrolled and randomly assigned to either azithromycin or doxycycline treatment groups. Baseline and post-treatment (12 weeks) Global Acne Grading System (GAGS) scores were assessed. Percent reductions in GAGS score were categorized into four groups (&lt;25%, 25-50%, 51-75%, and &gt;75%) for intergroup comparison. Written informed consent was obtained from all participants. Results: The mean patient age was 21.30±4.93 years, with a female predominance (male:female ratio 1:1.2). Most patients had Fitz-Patrick Skin Type-V (64.7%) compared to Type-IV (35.3%). Baseline GAGS scores were comparable between groups (p=0.612). Notably, post-treatment GAGS scores were significantly lower in the azithromycin group (p&lt;0.001), demonstrated by a greater mean change (19.33±3.03 vs. 17.70±2.99; p&lt;0.001) and percent reduction (81.87±8.74 vs. 75.97±11.12%; p&lt;0.001) compared to doxycycline. Additionally, 75.3% of patients achieved an excellent reduction in GAGS score, with a significantly higher proportion observed in the azithromycin group (87.4% vs. 63.2%; p&lt;0.001). Similar significant differences were observed across subgroups based on age, gender, and skin type. Conclusion: This study suggests that azithromycin demonstrates superior efficacy to doxycycline for acne vulgaris management, regardless of patient demographics or skin type. Its established better safety profile further supports its potential as a preferred therapeutic option in future dermatological practice. Keywords: Acne Vulgaris, Azithromycin, Doxycycline, Percent Reduction in GAGS Score

Social media use as a source of information by acne vulgaris patients.

Social media and internet usage is undeniably high. Misinformation obtained from the internet and wrong treatment methods can cause serious problems in patients with acne vulgaris (AV). In this study, the sociodemographic data of AV patients, their frequency of using the internet as an information source, the relationship between them, and their attitudes and behaviors regarding their disease due to these programs were examined. 481 patients aged 14 and over diagnosed with AV were included in the study. It was conducted in a descriptive cross-sectional type. Acne severity of all patients included in the study was determined using the Global Acne Grading System. 78.3 percent of participants use social media to get information about AV. It was determined that men and single people used social media about their illnesses at a statistically significantly higher rate than women and married people (p = 0.004). In addition, patients aged 13-18 and high school graduates use social media as a source of information about their diseases, and this rate is statistically significantly higher (p < 0.001). Especially in the last decade, the use of social media tools to spread health messages has increased significantly. Because it has a chronic course and can cause cosmetic problems, AV patients may frequently resort to communication sources such as social media. Considering the possibility of social media misinforming patients, physicians should be aware that their patients with AV frequently use social media and should improve themselves in creating correct awareness on this issue.

The Effectiveness of Combined Prebiotic and Postbiotic Moisturiser as an Adjuvant Therapy in Improving Maskne

Personal protective equipment (PPE) has become the new social norm as part of COVID-19 protection since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, but it has had an impact on the skin barrier, particularly the face. Maskne refers to acne eruptions around the facemask area. The combination of friction, repeated pressure, sweat, or stress on the skin from wearing the mask results in acne or exacerbates pre-existing acne. This study aimed to analyse the effectiveness of a combined prebiotic and postbiotic moisturiser (CPPM) as an adjuvant therapy for improving maskne. This was a double-blind randomised control trial with systematic random sampling of 1:1 to receive either CPPM or placebo moisturisers. From December 2022 to May 2023, patients diagnosed with maskne at the Dermatology Clinic, Hospital Al-Sultan Abdullah, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Selangor, Malaysia were studied. Subjects were assessed at baseline, week 2 and 4 after the application of moisturisers, using modified global acne grading system (mGAGS) and Cardiff Acne Disability Index (CADI) score. A total of 150 patients completed the study. Using the mGAGS score, compared to baseline, the mean score reduction was statistically significant at week 4 [5.33 (±4.06) vs 1.13 (±4.33); p&lt; 0.001] in the CPPM arm compared to the placebo arm. In terms of CADI score, compared to baseline, there was also a significant reduction in mean score at week 4 [2.23 (±2.53) vs 0.55 (±2.59); p&lt; 0.001] in the CPPM arm compared to the placebo arm. This study found that using CPPM as an adjuvant moisturiser improved maskne significantly.

Correlation between depression scores and serum NF-ĸB/NLRP3 axis, biotinidase, and HMGB1 after treatment with isotretinoin in patients with acne vulgaris.

Acne vulgaris (AV) is an inflammatory skin disorder leading to scars and discomfort, its intensity has major psychological consequences such as depression. To investigate the effect of isotretinoin (ISO) on NF-κB/NLRP3, biotinidase, and HMGB and correlation with depression. This was a case-control study that involved two groups. Group 1 is 20 healthy control, and group 2 is 20 patients diagnosed with AV according to Global Acne Grading System (GAGS) and received 20 mg ISO for 2 months. Before and after therapy, the Hamilton Depression Rating Scale (HDRS) was applied to assess each participant's level of depression. Nuclear factor kappa B (NF-ĸB), biotinidase, high mobility group box protein (HMGB1), nucleotide-binding domain, leucine-rich-containing family, and pyrin domain-containing-3 (NLRP-3) were measured in serum samples. There was no significant difference in all measured markers of healthy group before and after 2 months. Regarding group 2, there was a statistically significant decrease in all measured markers after 2 months of treatment and significant correlations between GAGS, NF-ĸB, HMGB1, NLRP3, biotinidase, and depression score. Increased GAGS, HMGB1, NLRP3, and biotinidase were associated with depression severity in AV patients and ISO treatment significantly reduced these parameters and reduced depressive symptoms.

Metformin Therapy for Acne Vulgaris: A Meta-Analysis.

Acne vulgaris is a common disease, which occurs in adolescents as well as adults and has a significant influence on the patient's quality of life (QoL) in every aspect. Due to resistance to standard therapies, it has become necessary to prospect for new treatment strategies. It is important to highlight that the diagnosis and treatment of the underlying cause of acne such as metabolic and hormonal disorders may significantly improve the effectiveness of acne treatment. The correlation between Insulin Resistance (IR) and acne has been proven. Both disorders share many common occurrence factors and activation pathways. Metformin, an antihyperglycemic agent, seems to be a possible therapy option, not only because of its insulin sensitizing ability but also via plenty of additional effects of this medicine. While the efficiency of metformin therapy in patients with acne and Polycystic Ovary Syndrome (PCOS) is well explored, it is still necessary to evaluate it in patients without any endocrinopathies. This meta-analysis aimed to estimate the effectiveness of oral metformin as a monotherapy in acne patients without PCOS or other endocrinopathies. Study selection was performed with included criteria such as no PCOS and other endocrinopathies diagnosed, oral administration of metformin, and metformin in monotherapy. Selected studies contained comparisons in the Global Acne Grading System (GAGS) before and after metformin therapy. Statistical analysis detected significant improvement in skin condition after treatment with metformin.

A multifaceted and standardised approach is needed to improve acne severity assessment in clinical practice: an online survey of UK health professionals.

We summarise the findings from a survey based on how health professionals assess acne severity in UK clinical practice. Findings suggest there is interest in a multifaceted and standardised approach to grading acne severity.

A Randomized Clinical Trial to Evaluate the Efficacy of an Oral Probiotic in Acne Vulgaris.

The relevance of the gut microbiota in some skin inflammatory diseases, including acne vulgaris, has been emphasized. Probiotics could play a role in the modulation of the microbiota, improving the clinical course of this disease. A 12-week randomized, double-blind, placebo-controlled, clinical trial with patients aged 12 to 30 years with acne vulgaris was conducted. The study product was a capsule composed of the probiotic Lacticaseibacillus rhamnosus (CECT 30031) and the cyanobacterium Arthrospira platensis (BEA_IDA_0074B). Patients with improvement in the Acne Global Severity Scale were 10/34 (29.41%) in the placebo group compared with 20/40 (50%) in the probiotic group (p = 0.03). A significant reduction (p = 0.03) in the number of non-inflammatory acne lesions was observed in the probiotic group (-18.60 [-24.38 to -12.82]) vs the placebo group (-10.54 [-17.43 to -3.66]). Regarding the number of total lesions, a reduction almost reaching statistical significance (p = 0.06) was observed in the probiotic group (-27.94 [-36.35 to -19.53]) compared with the placebo group (-18.31 [-28.21 to -8.41]). In addition, patients with improvement attending the Global Acne Grading System were 7/34 (20.58%) in the placebo group vs 17/40 (42.50%) in the probiotic group (p = 0.02). The number of adverse events was similar in both groups. The probiotic used in this study was effective and well tolerated, and it should be considered for acne vulgaris patients.

Comparing the Use of 80% Trichloroacetic Acid and 50% Trichloroacetic Acid for the Treatment of Ice Pick Acne Scars.

Chemical reconstruction of skin scars (CROSS) using high concentration trichloroacetic acid (TCA) is a safe, effective, and low-cost treatment for ice pick acne scars. To compare the efficacy and effectiveness of the CROSS technique using 50% TCA and 80% TCA for treating ice pick scars. A nonrandomized, single-blinded, and self-controlled clinical trial was undertaken. Four CROSS sessions were conducted using 50% TCA on the left hemiface and 80% TCA on the right hemiface. The E' chelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) acne grading scale was used to assess the scars pretreatment and posttreatment. Complications were evaluated after each session. Thirty-one patients participated in our study. Significant differences were found between pretreatment and posttreatment ECCA scores ( p < .0001) on both hemifaces. Scores were significantly lower on the side treated with 80% TCA; however, there was no statistical significance in mean ECCA score differences (pretreatment minus posttreatment) between the 2 treatment sides. The adverse events were more serious on the sides treated with 80% TCA. The CROSS method using TCA was well-tolerated and effective for treating ice pick acne scars. Less severe complications were associated with 50% TCA, whereas efficacy was the same as 80% TCA.

Validation and Cultural Adaptation of the Sinhala Translation of the Cardiff Acne Disability Index (CADI).

Quality of life (QoL) is impaired in patients with acne vulgaris. The Cardiff Acne Disability Index (CADI) that assesses QoL of acne patients was initially developed in English and is being currently used widely after being validated in different languages. This study was conducted to validate the CADI in Sinhala, a language used by the majority of Sri Lanka. The CADI was translated into Sinhala, and lingually validated as per published guidelines. This CADI-Sinhala version and the Sinhala version of the Dermatology Life Quality Index (DLQI) were simultaneously administered to 150 Sinhala-speaking young adults with acne. The clinical severity of acne was assessed using the Global Acne Grading System (GAGS). The Cronbach's alpha and Spearman correlation coefficients were used to determine the internal consistency, reliability, and validity of the CADI-Sinhala. Construct validity was examined using a factor analysis. The study included 90% females and their mean age was 23 (SD, 2.5) years. The majority (97.3%) had acne of mild to moderate severity when measured by the GAGS. The CADI-Sinhala Scale showed a Cronbach's alpha coefficient of 0.819 indicating high internal consistency and reliability. The mean item-total correlation coefficient was 0.74 (range, 0.42-0.87) with CADI Q3 having the lowest correlation. CADI Sinhala showed a strong and highly significant correlation with the Sinhala DLQI (Spearman's rho = 0.66; P< 0.001) indicating concurrent validity. The correlation with GAGS was of low intensity, although it was statistically significant (p < 0.01). The CADI-Sinhala is a reliable and valid tool for assessing the QoL of Sinhala-speaking acne patients. This five-item tool will help clinicians to provide holistic treatment through improved understanding of patient's perspectives.