Acne Grading Research Articles

Association of Vitamin D with Moderate to Severe Acne Vulgaris.

To determine the association of vitamin D deficiency in moderate to severe acne. A comparative study. Place and Duration of the Study: Dermatology OPD at Dow University of Health Sciences, Karachi, Pakistan, from December 2021 to May 2022. Fifty patients with moderate acne, 50 patients with severe acne, and 50 healthy controls were inducted. Information regarding age, gender, and medical and medication history were taken. The severity of acne was rated according to the GAGS (global acne grading system) score. Levels of 25(OH) D were classified as sufficient (>20 ng/mL), insufficient (12-20 ng/mL), or deficient (<12 ng/mL). Significance was taken at p-value <0.05. The median concentration of vitamin D levels was 7.09 ng/ml in severe acne vulgaris, 13.7 ng/ml in moderate acne vulgaris and 21.6ng/ml in the control group. Serum vitamin D levels were significantly lower (p<0.001) in individuals with acne vulgaris as compared to the healthy controls. However, the decrease in level of vitamin D did not correspond with the severity of acne vulgaris. Vitamin D deficiency is additionally pronounced in acne vulgaris individuals, but vitamin D levels are not proportional to the severity of acne vulgaris. Acne vulgaris, Vitamin D deficiency, Pilosebaceous unit, GAGS score.

Impact of Insulin Resistance in Acne Vulgaris and Hirsutism Patients: An Analytical Cross-Sectional Study

Objective: The study's goals are to identify a causal connection between insulin resistance (IR) and hirsutism and acne vulgaris, as well as to evaluate the severity of the two conditions in relation to rising IR. Study design: An analytical cross-sectional study Place and Duration: This study was conducted at Primary Health Care Corporation, Qatar from August 2021 to August 2022. Methodology: In a predetermined proforma, a patient's entire clinical history as well as required variables, such as height, weight, body mass index (BMI), etc., were recorded in order to establish a link between IR and acne with/without hirsutism and only hirsutism.A HOMA-IR value of more than 2.5 was regarded as important and indicative of IR. Global Acne Grading System (GAGS) was used to determine the degree of acne, and the Modified Ferriman Gallwey Score was used to determine the severity of hirsutism (mFG). Results: The 354 participants in our study were divided into three groups: There was a statistically significant connection between IR and the severity and recurrence of acne in the Acne-only (N = 310) group. The homeostatic model assessment for insulin resistance (HOMA-IR), the modified Ferriman-Gallwey score, and recurrence were substantially correlated in the hirsutism-only (N = 26) group, demonstrating that insulin resistance increased with hirsutism severity and recurrence. In the sample of 18 people with acne and hirsutism (N = 18), higher BMI was positively linked with IR but not with the severity of both disorders. Conclusion: Causing serious, resistant acne and hirsutism, IR has come to be recognized as a significant contributory, if not causal, event. The mental stress affected by these conditions is greatly impacted, requiring a different approach to case management. Keywords: Acne, Hirsutism, Dermatology practice, Psoriasis, PCOS, Insulin resistance

New insights into the characteristic skin microorganisms in different grades of acne and different acne sites.

The increasing maturity of sequencing technology provides a convenient approach to studying the role of skin microorganisms in acne pathogenesis. However, there are still too few studies about the skin microbiota of Asian acne patients, especially a lack of detailed analysis of the characteristics of the skin microbiota in the different acne sites. In this study, a total of 34 college students were recruited and divided into the health, mild acne, and severe acne groups. The bacterial and fungal flora of samples were separately detected by 16S and 18S rRNA gene sequencing. The biomarkers of different acne grades and different acne sites [forehead, cheek, chin, torso (including chest and back)] were excavated. Our results indicated that there was no significant difference in species diversity between groups. The genera like Propionibacterium, Staphylococcus, Corynebacterium, and Malassezia, which have a relatively high abundance in the skin microbiota and were reported as the most acne-associated microbes, were no obvious differences between groups. On the contrary, the abundance of less reported Gram-negative bacteria (Pseudomonas, Ralstonia, and Pseudidiomarina) and Candida has a significant alteration. Compared with the health group and the mild group, in the severe group, the abundance of Pseudomonas and Ralstonia sharply reduced while that of Pseudidiomarina and Candida remarkably raised. Moreover, different acne sites have different numbers and types of biomarkers. Among the four acne sites, the cheek has the greatest number of biomarkers including Pseudomonas, Ralstonia, Pseudidiomarina, Malassezia, Saccharomyces, and Candida, while no biomarker was observed for the forehead. The network analysis indicated that there might be a competitive relationship between Pseudomonas and Propionibacterium. This study would provide a new insight and theoretical basis for precise and personalized acne microbial therapy.

Tolerability and effectiveness of a dermocosmetic product containing Silybum marianum fruit extract in adolescents and young adults with acne-prone skin: An international, phase IV, longitudinal study.

Dermocosmetic products are often used to maintain or enhance the tolerance and effectiveness of medical anti-acne therapies. Recent discoveries about the pathophysiology of acne-prone skin indicate that skincare products may help maintain homeostasis around the sebaceous gland progenitor cells, thereby preventing microcomedone formation. To evaluate the tolerance and effectiveness of a dermocosmetic product containing Silybum marianum fruit extract (SMFE) in adolescents and young adults with acne-prone skin. This real-life, international, observational, multicenter study was conducted in patients aged 12-25 years with mild-to-moderate acne. Patients (N=4230) used the product twice daily for 8-12 weeks, either alone before ("initial group") or after an anti-acne therapy ("maintenance group"), or in association with their usual prescribed anti-acne therapies ("association group"). The tolerance, effectiveness, and cosmetic properties of the product were assessed. Patient quality of life (QoL) was also evaluated. Dermatologists rated the tolerance of the product as "good" or "very good" in about 95% of the patients and the effectiveness of the product as "effective" or "highly effective" in about 80% of the patients, with a significant reduction in the mean global evaluation of acne (GEA) grade (-36% ± 39%, p < 0.0001) at study end. The QoL of most patients (80%) improved by the end of the study, and the majority (79% to 94%) appreciated the cosmetic properties of the product. Overall, the product was a clinical success in >84% of patients. This dermocosmetic product can be used by adolescents and young adults with acne-prone skin to limit the initial or chronic use of medical anti-acne therapies.

Evaluation of 30% supramolecular salicylic acid followed by 1565-nm non-ablative fractional laser on facial acne and subsequent enlarged pores.

The treatment of acne vulgaris and enlarged pore remains challenging. The 30% supramolecular salicylic acid (SSA) is a newly developed form of SA which affects pathogenic factors of acne. Non-ablative fractional laser (NAFL) promotes remodeling and decreases sebum excretion with minimal side effect. The current study was aimed to evaluate the sequential modality with 30% SSA followed by 1565-nm NAFL on facial acne and subsequent enlarged pores. A 20-week-duration prospective study was performed. Consecutive 4 sessions of 30% SSA treatment were conducted, at 2-week intervals. Two weeks after the last session of 30% SSA, 3 sessions of 1565-nm NAFL treatment were applied, at 4-week intervals. The noninvasive devices measured scores of red areas and pores, cuticle moisture, and sebum secretion. The main subjective evaluation was global acne grading system (GAGS). The side effects were recorded. Compared to baseline, the scores of red areas and pores, sebum secretion, and GAGS significantly decreased after series sessions of 30% SSA treatments (P < 0.05). The sequential application of 1565-nm NAFL maintained the good results (P < 0.05, comparing to baseline) and even further decreased the sebum secretion (P < 0.05, comparing to SSA). The cuticle moisture remained unchanged during whole period, and side effects including tingling sensation, pain, erythema, and edema were quickly reversible and acceptable. The significant improvements of acne and pores were produced by 30% SSA, and 1565-nm NAFL inhibited the sebum secretion and maintained the efficacies of 30% SSA. The sequential modality of 30% SSA followed by 1565-nm NAFL was an alternative choice for acne vulgaris companied with enlarged pores.

A novel automatic acne detection and severity quantification scheme using deep learning

Accurate detection and severity quantification of acne are of great significance in the precise treatment of patients. Due to the similar appearance of acne with close severity, it is challenging for dermatologists to grade acne accurately and efficiently. This study aims to propose an accurate and efficient scheme based on deep learning (DL) to assist dermatologists in acne detection and severity quantification. The proposed frame consists of two steps: the Localization deep learning (Localization-DL) model and the Class segmentation (ClassSeg) model. The first model uses the distilled lightweight convolution network as the backbone and extracts multi-scale features through a pyramid pooling module for facial region localization and distinction. The second model is a unified framework that combines a Class module to distinguish background and facial skin sub-images and a segmentation (Seg) module to perform segmentation for different classes to obtain lesion masks. The facial skin segmentation branch of the ClassSeg model is built based on a high-resolution network (HRNet) and modified by mask-aware attention, shuffle attention, and conditional channel weight block. The experiments show that the two models achieve promising results and demonstrate effectiveness in lesion detection compared to other methods. The proposed scheme shows excellent results in acne severity quantification and yields a comparable performance with dermatologists (accuracy: 0.9091 for ours, 0.9301 for SDerms, 0.8741 for IDerms, and 0.7483 for JDerms). The assessment performance also outperforms the existing approaches. This work opens new avenues for acne severity quantification and provides valuable diagnosis evidence for dermatologists in clinical practice.

EFFECTS OF ISOTRETINOIN ON PLATELET COUNT AND MEAN PLATELET VOLUME DURING TREATMENT OF ACNE VULGARIS

The most effective systemic therapy for acne is Isotretinoin. However, Isotretinoin has many side effects, including known side effects like dryness, palmoplantar exfoliation, rash, teratogenicity, raised intraocular pressure, and deranged liver functions and lipid profile. Its lesser-known side effects include its effects on platelet count and mean platelet volume (M.P.V.). This Quasi-experimental case series was conducted to observe the change in platelet count and mean platelet volume in patients taking Isotretinoin for acne vulgaris, attending the dermatology outpatient department at Jinnah Hospital Lahore from May 10th 2016 to November 9th 2016. After ethical committee approval and informed consent, subjects of acne vulgaris with an indication for Isotretinoin were included in the study from O.P.D. Relevant demographic and clinical details were recorded in a standardized predesigned proforma. Citrated blood samples were taken under aseptic conditions. Baseline platelet counts and mean platelet volume were determined using an auto-analyzer in the pathology laboratory of Jinnah hospital Lahore. All the patients were advised to take daily Isotretinoin at a dose of 0.5 mg/kg for 12 weeks. Platelet counts and mean platelet volume were again measured after twelve weeks after the start of treatment. A total of 100 patients completed the study. The age of the patients ranged from 18 to 60 years with a mean + sd age of 27.26+5.88 years. Out of these 41%(n=41) were male and 59%(n=59) were females. The severity of acne was measured using Global Acne Grading System (G.A.G.S.). It was recorded that 62%(n=62) had moderate, 22%(n=22) had severe while 16%(n=16) had very severe acne vulgaris. The mean pre-treatment platelet count was 271273+9139 c/µL, while 259192+11717 c/µL was post-treatment. The mean difference was 12080+8140 c/µL, and the p-value was 0.001. The mean platelet volume was 10.63+1.01 fl as pre-treatment and 9.77+1.01 fl as post-treatment. The mean difference was 0.85+0.04 fl, and the p value was 0.001. We concluded that Isotretinoin decreases platelet count and means platelet volume in patients receiving isotretinoin treatment for acne vulgaris.

COPPER AND ZINC MICROMINERALS LEVELS IN PATIENTS OF ACNE VULGARIS: A CASE CONTROL STUDY

Acne vulgaris is one of the most commonly occurring inammatory disorders among various skin diseases. It is said to be the gift of pubertal age, however it stays for higher age also. Trace minerals like Copper (Cu) and Zinc (Zn) may play an important role in either cause or severity of Acne vulgaris.Present study aimed to estimate serum copper and zinc in patients of acne vulgaris. 140 acne vulgaris patients of different age group and either sex was enrolled for the study. Result showed that levels of serum Cu and Zn was decreased in patients of Acne vulgaris (94.39±28.861 and 65.39±22.104 respectively). These levels also showed signicant association with different age groups as well as grade of acne. Hence can be concluded these differences may be associated with severity of acne lesions, age and gender

The relationship of quality of life and acne severity with chronotype and insomnia in patients with acne vulgaris.

This study aimed to examine the relationship between acne severity and quality of life, insomnia, and chronotype. This study included 151 patients diagnosed with acne vulgaris, aged 18-30years. A sociodemographic data form was completed by the clinician, and acne severity was evaluated using the Global Acne Grading System (GAGS). The Visual Analogue Scale (VAS), Acne Quality of Life Scale (AQLS), Hospital Anxiety Depression Scale (HADS), Insomnia Severity Index (ISI), and Morningness-Eveningness Questionnaire (MEQ) were completed by the participants. There was a significant difference between the MEQ scores of the participants who were divided into three groups according to the severity of global acne, as mild, moderate, and severe. In the post hoc analysis, the MEQ scores of the patients with mild acne were determined to be significantly higher than the scores of the patients with moderate and severe acne. A statistically significant negative correlation was observed between the GAGS scores and the MEQ scores. In addition, a statistically significant positive correlation was found between the participants' ISI scores and AQLS scores. Considering the variables related to chronotype and sleep in the treatment planning for patients with acne vulgaris may be appropriate within the scope of integrative treatment.

Hematological parameters in patients with acnes.

To compare complete blood count (CBC) parameters and inflammatory factors in the patients with different grade of acne vulgaris and healthy controls. A total of 20 patients were enrolled in this study. Patients were divided into mild group and moderate-to-severe group based on the acne severity, and compared to controls. Inflammatory factors (TNF-α, IL-6, IL-8, and IL1-α) detected by ELISA and complete blood count parameters (MPV, NLR, dNLR, PLR, LMR, and SII) obtained by routine blood tests were compared among the three group. All CBC parameters were not significantly elevated in patients with acne compared to healthy controls. However, the present studies have found that the inflammatory factors in acne patients were significantly elevated relative to healthy controls, and increase with the acne grade. Inflammatory factors are convenient parameters to show inflammatory response to acne vulgaris, and may be a new clinical method for judging the acne grades of objectively. Considering the use of antibiotic, we believe that this metric worth further study.

ORAL RESVERATROL AS AN ADJUVANT THERAPY IN THE TREATMENT OF MILD TO MODERATE ACNE VULGARIS: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Acne vulgaris is an inammatory skin disease usually affecting individuals between 12 and 24 years of age. Many topical and systemic agents are used in the treatment of acne, based on the grade. Complementary and alternative medicine therapies like vitamin C, nicotinamide, zinc, resveratrol, curcumin, etc. are increasing in popularity in the treatment of acne and rosacea. Resveratrol is a natural ingredient that is most abundant in the skin of red grapes, blueberries, boiled peanuts, etc. Resveratrol has considerable anti-inammatory, antioxidant, antiaging, and anti-microbial properties. However, there is a paucity of data regarding the use of oral Resveratrol in the management of acne; hence, this study is undertaken. To study the effectiveness of oral resveratrol as a Aim: n adjuvant therapy in patients with mild to moderate acne vulgaris. Materials And Methods: Forty-six patients diagnosed with mild or moderate acne vulgaris were sampled via consecutive sampling and assigned to two groups, those receiving a combination of topical 1% clindamycin plus 0.1% adapalene and oral resveratrol 50 mg (24) and those receiving topical 1% clindamycin plus 0.1% adapalene (22). Both groups were assessed at weeks 4, 8, and 12 by applying the global acne grading system, and side effects were noted. Both groups showed remarkable responses at weeks 4, 8, a Results And Conclusions: nd 12. However, the Resveratrol group showed an earlier response at weeks 4 and 8, with an early decrease in lesion counts. On intergroup comparison, no signicant difference was found in terms of response rates at week 12. As a result of our ndings, resveratrol appears to be effective as adjuvant therapy in the treatment of acne vulgaris It has the advantage of better tolerability as compared to topical 1% Clindamycin plus 0.1% adapalene

A Brief Review on Acne Vulgaris: Chronic Inflammatory Disease

Acne vulgaris (AV) is a chronic inflammatory disease rather than a natural part of the life cycle as colloquially viewed of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. Some of the key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. Grading of acne involves lesion counting and photographic methods. However, there is a lack of consensus on the exact grading criteria, which hampers the conduction and comparison of randomized controlled clinical trials evaluating treatments. Prevention of acne relies on the successful management of modifiable risk factors, such as underlying systemic diseases and lifestyle factors. Several treatments are available, but guidelines suffer from a lack of data to make evidence-based recommendations. In addition, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Acne commonly causes scarring and reduces the quality of life of patients. New treatment options with a shift towards targeting the early processes involved in acne development instead of suppressing the effects of end products will enhance our ability to improve the outcomes for patients with acne.

Revisiting the question of assessment by severity and classification of acne

The paper presents an analysis of different variants of acne classifications and the assessment of acne severity, carried out by the working group of the RODVK Committee for Classifications in Dermatovenereology. There is a division of acne vulgaris according to age and severity. Assessing the severity of acne is important for choosing the correct prescriptions in daily practice and for the evaluation of treatment outcomes. Most of existing acne grading systems are based either on a global grading of severity or on calculating the number of lesions in a variety of anatomic locations. For clinical practice of dermatovenereologists, as well as for educational and scientific purposes, the working group proposed to supplement the acne classification based on severity grading with counting the number of the lesions, and to take into account localization, rash prevalence and scarring when determining the acne severity.

Stabilization of Acne Vulgaris-Associated Microbial Dysbiosis with 2% Supramolecular Salicylic Acid.

Facial microbiota dysbiosis is an important factor in causing acne vulgaris. The present study aimed to analyze the effect of 2% Supramolecular Salicylic Acid (SSA) on acne-associated facial bacteria. In the current study, 30 acne vulgaris patients (treated with 2% SSA for eight weeks) and ten volunteers with no facial acne were selected. Samples from acne patients (before and after treatment) and volunteers (not treated) were analyzed via high throughput sequencing, Deblur algorithm, and R microbiome package. After treatment with 2% SSA, the total lesion count and global acne grading system (GAGS) score reduced significantly (p < 0.001). Metagenomic sequencing analysis revealed that the pre-treated acne group had low α and deviated β diversity compared to the control and post-treated acne groups. Due to the treatment with 2% SSA, α diversity index was increased and β diversity was stabilized significantly (p < 0.001). The relative abundance of bacterial genera in the pre-treated acne group was uneven and had a high proportion of Staphylococcus, Ralstonia, and Streptococcus. The proportion of these three genera was significantly decreased in the post-treated group, and overall bacteria genera distribution tends toward the healthy individual. It is concluded that 2% SSA normalizes the microbial communities associated with the skin.

A study to evaluate the effectiveness of aloe neemtherapy regarding acne and quality of life among early adolescents in selected schools at Mysuru

Aim: The study is to assess the effectiveness of Aloeneem therapy regarding acne and quality of life among early adolescence in selected school at Mysuru.Methods: The research design adopted was quasi-experimental design. Sixty adolescence from two schools had been selected, among which 30 adolescence from BGS Public School in experimental group and 30 adolescence from Sree Nataraja Public School in control group, by using Modified Global Acne Grading Scale and Modified Cardiff Quality Index scale containing 5 questionnaires used, 1 month of Aloeneem intervention given after the pre -test done. A post test was conducted after the Aloeneem therapy using the same scale. Data was analyzed by using paired and unpaired test to find the effectiveness and chi square test was used to find the association with demographic variables. Results: The findings of the study revealed that the Aloeneem therapy regarding acne and quality of life among early adolescence was effective, mean pre-test and post- test scoring by Modified Global Acne Grading System and Modified Cardiff Quality Index. Hence research hypothesis accepted. The association between pre-test acne grading and selected demographic variables are significant with age, class studying and acne affects negatively in experimental group. And the acne affect negatively in control group. The association between pre-test Quality of life and selected demographic variables are significant with age, class studying, previous exposure to acne, acne affects negatively in experimental group. And the class studying in control group.Interpretation and Conclusion: It was evident from the study in early adolescence with acne had acne grading score more and low quality of life and the aloeneem therapy was highly effectiveness in reducing acne grading score and improving quality of life among early adolescence.

Serum survivin in acne versus post-acne scarring and the possible effect of isotretinoin therapy on its level

Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit. Survivin is an apoptosis inhibitor protein, and it contributes crucially to cell cycle regulation. This study measures the serum level of survivin in acne and post-acne scarring patients, and assesses the possible effect of isotretinoin therapy on its level. Sixty participants, including 40 acne patients (Group IA, IB), and 20 age- and sex-matched controls (Group II) were included. Group IA included 20 patients with active moderate-to-severe acne without scarring, and this group was further prescribed oral isotretinoin therapy for 3 months. Group IB included 20 patients with post-acne scarring of a duration not more than 6 months, without evident active acne lesions. Serum survivin levels were measured in the three groups using an enzyme-linked immunosorbent assay. There was a statistically significant higher serum survivin level in the acne scar group, followed by the active acne group, than in controls. In addition, there was a statistically significant reduction in survivin levels after treatment, and it was positively correlated with a reduction in the global acne grading system (GAGS) in the active acne group. Survivin may play a role in the evolution of acne and acne scarring, and it could be a possible target for isotretinoin therapy.

Comparisons of Four Acne Grading Systems Recommended in China, Korea, and Japan.

Acne vulgaris is one of the most prevalent skin disorders. The treatment regimen depends on how severe the AV is. The acne grading system is crucial for clinical and research work. The aim of this work was to evaluate intra-grader differences between 5 investigators using Acne Grading System (AGS), the International Improved Grading System (IIGS), the Korean Acne Grading System (KAGS), and the Japanese Acne Grading System (JAGS) to assess acne vulgaris (AV) severity. AV sufferers from dermatological clinics of five hospitals in China were the subject of a prospective cross-sectional study. AGS, IIGS, KAGS and JAGS were utilized by 5 investigators to verify the severity of AV. The correlation between AGS, IIGS, KAGS and JAGS was examined. A complete of 1107 AV sufferers were enrolled in the study. There were indications that the AGS, IIGS, KAGS and JAGS had sufficient internal consistency. As for the reliability amongst raters, AGS, IIGS, KAGS and JAGS confirmed gorgeous reliability. There were strong correlations amongst AGS, IIGS, KAGS and JAGS (P≤0.01). The interior reliability of investigator 1 one year ago and later after usage of AGS and IIGS was excellent (P≤0.01). IIGS and AGS exhibited great correlation with KAGS and JAGS and were highly reliable.

Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia.

Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students. A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables. The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS. The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.

Metformin Contributes to the Therapeutic Effects of Acne Vulgaris by Modifying the Gut Microbiome

Background. Considering the increasing side effects of the first‐line treatment for acne vulgaris, metformin was developed to be an effective adjunct therapy, but its mechanism of action is poorly defined. Recent evidence shows that the gut microbiota is a site of metformin action. The aim of this study was to evaluate the effects and mechanism of action for metformin in the adjuvant treatment of acne vulgaris by regulating gut microbiota. Methods. First, untreated acne patients were randomly allocated into two treatment groups. Both groups were treated with isotretinoin, but only one was additionally treated with metformin, for three months. Sprague Dawley (SD) rats were used as acne models, and they were also separated into groups that received isotretinoin, metformin, a combination of isotretinoin and metformin, and the vehicle, respectively. Then, the fecal samples from drug‐intervention rats were transferred to germ‐free rats with acne. The severity of the disease was evaluated using the Global Acne Grading System (GAGS) scoring for patients, and the number of comedones and mononuclear cells in pathological sections was used for rats. The composition of the gut microbiota was detected using gene sequencing for 16S rDNA. Results. Metformin had strong effects on the composition and function of the gut microbiota, and this correlated with the reduction in the severity of acne in both humans and rats. The fecal transfer to pseudo‐germ‐free rats improved both the inflammatory phenotype and comedones of acne in recipients of metformin‐altered microbiota. Conclusion. The results suggest that metformin improves the symptoms of acne vulgaris by modulating the gut microbiota.

Role of Insulin Resistance in Patients of Acne Vulgaris and Hirsutism in the Western Part of India- A Cross-Sectional Study.

Despite being common and easy to treat conditions, acne and hirsutism may have a striking consequence on one's perception of self. Though understanding the pathogenesis of acne and hirsutism has undergone a major paradigm shift, one of them being insulin resistance (IR), extensive research is still underway. The purpose of the study is to establish causal relationship linking IR with acne vulgaris and hirsutism, as well as to assess severity of the two with increasing IR. A cross-sectional observational study was conducted in the dermatology department. Patient's detailed clinical history and necessary parameters like height, weight, body mass index (BMI), etc., were recorded in predefined proforma, noting signs and symptoms of underlying IR, along with acne severity calculated by global acne grading system (GAGS) and hirsutism severity by modified Ferriman Gallwey score (mFG), then analyzing using Pearson's correlation test to establish correlation between IR and acne with/without hirsutism and hirsutism alone. A total of 349 patients included in our study were divided into three groups, (i) Acne-only (N = 308) group showed statistically significant correlation of IR with acne severity (P < 0.0001) and recurrence (P < 0.0001). (ii) In hirsutism-only (N = 24) group, homeostatic model assessment for insulin resistance (HOMA-IR) was strongly associated with modified Ferriman-Gallwey score and recurrence suggesting raised insulin resistance with increased severity of hirsutism (P < 0.0001) and recurrence (P < 0.007). (iii) In acne + hirsutism (N = 17) group, raised BMI was found to be positively associated with IR but not with severity of both conditions. IR has emerged as an important contributory, if not, causative event in pathogenesis of severe, resistant acne, and hirsutism. These conditions have great deal of impact on the psychological health of those affected necessitating different approach to manage such cases.