Acne Grading Research Articles

Association of Serum Vitamin D3 Levels with the Severity of Acne Vulgaris in Adolescents: A Cross-sectional Study from Western Odisha, India

Introduction: Vitamin D3 plays an important role in the immune system, and its deficiency has been implicated in various skin diseases, including atopic dermatitis and psoriasis. Acne is a common inflammatory skin disease of adolescence and young adulthood that affects the face and upper trunk. The scarring caused by acne can have a significant psychological impact on patients and greatly affect their quality of life. However, the association between the severity of acne and vitamin D3 levels remains unclear. Aim: To assess the role of vitamin D3 in the severity of acne vulgaris in adolescents. Materials and Methods: This prospective cross-sectional study was conducted at the Department of Dermatology and Biochemistry, VIMSAR, Burla, Sambalpur, Odisha, India, from August 2022 to November 2022. Adolescents between the ages of 10 and 19 years, of either sex, with acne were clinically examined, and the severity of acne was evaluated using the Global Acne Grading System (GAGS) score. Serum vitamin D3 levels were measured using a Chemiluminescence Immunoassay (CLIA) analyser (Electra FA). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 21.0 (SPSS IBM Corporation, Armonk, New York), and a p-value <0.05 was considered statistically significant. Results: A total of 150 clinically diagnosed cases of acne vulgaris patients were evaluated. The study included 73 males and 77 females. The mean age of males was 19.1±2.3 years, and for females, it was 18.2±2.4 years. Serum vitamin D3 levels were lower in patients with severe acne (18.03 ng/mL) compared to those with moderate acne (23.57 ng/mL) and mild acne (28.02 ng/mL). The association between serum vitamin D3 concentration and the different degrees of acne vulgaris was statistically significant (p<0.05). There was a strong negative correlation between severe acne and serum vitamin D3 levels (r=-0.042, p-value=0.002). Conclusion: Vitamin D3 deficiency was more prevalent in patients with severe acne, and serum vitamin D3 levels were inversely correlated with the severity of acne vulgaris.

Association Between Acne Vulgaris and Body Mass Index - A Cross Sectional Study in Tertiary Hospital of Western Nepal

INTRODUCTION Acne vulgaris is a chronic inflammatory disease of pilosebaceous duct mainly affecting adolescents. There is conflicting data regarding association between acne and body mass index (BMI). The main objective was to find the association between different grades of acne and BMI. MATERIAL AND METHODS We conducted a cross-sectional observational study involving 251 patients with acne vulgaris. Severity of acne vulgaris was assessed using simple grading system and WHO reference was used for classification of body mass index (BMI). Data was analyzed using SPSS, version 20. p value of less than 0.05 was considered statically significant. RESULTS The study included 149 females (59.4%) and 102 males (40.6%). Acne vulgaris is recorded in 47.8% in age group12-20 years, followed by 44.6% in age group 21-30 years and 7.6% in age group 31-40 years. Grade 2 acne vulgaris was the most common (47%), followed by grade 3 (24.7%), grade1 (16.7%), and grade 4 (11.6%). About 49.4% of acne vulgaris patient had normal BMI, 19.5% had obesity. There was no significant association between different grades of acne vulgaris and BMI (p=0.07). CONCLUSION There was no signficant association beween severetiy of acne and BMI.

Over-the-counter (OTC) product use patterns in medical students with acne vulgaris

Introduction: Acne vulgaris (AV) is a skin disorder caused by inflammation in the pilosebaceous unit and may cause a psychosocial burden for patients. Self-medication is common in medical students, including in treating AV. This study aimed to determine the behavioral characteristics of using over-the-counter (OTC) products for acne-prone skin in medical students in Jakarta. Methods: This was a cross-sectional observational study of 100 medical students with AV. The study was conducted using questionnaires consisting of clinical survey, medications, and OTC products. The clinical assessment of the severity of AV was determined using the Global Acne Grading System (GAGS) criteria. Results: Sixty-nine study subjects only used OTC products for their acne management. The most common OTC product was a facial cleanser, which facial cleanser (89 subjects) and cleansing oil (29 subjects). Fifty percent of the study subjects did not know the active ingredients in the products; 15% used benzoyl peroxide, 13% used topical retinoid, and 12% used nicotinamide. Conclusion: Self-medication with OTC products for acne-prone skin is frequent among medical students in Jakarta, and the most commonly used product is a facial cleanser. Most study subjects did not know the active ingredients in their OTC products.

Effect of Application, Duration and Dosing Frequency on the Efficacy and Adverse Effect of Adapalene in Acne Vulgaris: an Open-Label Randomized Controlled Study

Introduction: Topical retinoids are the mainstay of treatment for mild and moderate acne but longer duration of application causes adverse effects. The study aimed to evaluate the effect of application, duration, and dosing frequency on the efficacy and adverse effect of Adapalene in Acne Vulgaris.Materials and Methods: The study design was an open-label randomized controlled split-face trial. Patients with acne grades 1 and 2 were randomized into three groups using the split-face technique on the right and left sides. On the right side, patients applied adapalene daily in all the groups and alternately on the left face. The three groups of the study were overnight, 1 hour, and ½ hour application of adapalene. Follow up period was 4,8 and 12 weeks. Lesion count and side effects were evaluated at each follow-up.Results: Out of 292 who completed the study, the decrease in total lesion count was highest in the overnight group. Regarding specific lesion count, the decrease in non-inflammatory lesions was highest in the overnight group. However, short contact therapy with 1-hour application showed comparable efficacy with the overnight group in regards to inflammatory lesion count. There was a significant reduction of lesions in all groups from baseline to 12 weeks, with ½ hour group having minimal side effects followed by 1 hour and overnight.Conclusion: Short contact therapy for acne shows promising results in regard to efficacy and better tolerance.

Efficacy and Safety of Intense Pulsed Light in Patients of Inflammatory Acne Vulgaris

Objective: To assess the efficacy and safety of IPL in patients with inflammatory Acne Vulgaris.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Dermatology, Pakistan Air Force Hospital, Fazaia Medical College, Islamabad Pakistan, from Aug 2019 to Jan 2020.
 Methodology: Ninety patients with inflammatory facial acne were enrolled and received four Intense Pulsed Light (IPL) sessions at two weeks intervals with fluence 25J/cm2 and 420nm cut-off filter. The duration of treatment for each patient was two months. Clinical improvement was assessed using the Global Acne Grading System score (GAGs score).
 Results: Mean age of the patients was 18.5±3.3years, of which nine were males (10%), and 81 were females (90%). IPL was effective in 42(46.7%) patients with inflammatory acne vulgaris. The median GAGS score before treatment was 20(22–19), and after treatment was 10(12-9), with a significant p-value(<0.001). Only 8(9%) developed erythema, and 1(1%) patient developed post-inflammatory hyperpigmentation.
 Conclusions: Intense Pulsed Light was a significantly effective and safe treatment for inflammatory acne of all grades, ages,and genders.Keywords: Efficacy, Inflammatory acne vulgaris, Intense pulsed light, Safety, Treatment.

Akne vulgarisli kadın hastalarda tendon ve bağ kalınlıkları ölçümünün ve alt ekstremitelerde entezit varlığının değerlendirilmesi: randomize kontrollü bir çalışma

Aim: Acne Vulgaris (AV) is a multifactorial disease which affects young population and is most common in adolescents. There are no studies in the literature invastigating the presence of enthesitis and lower extremity tendons and ligaments thicknesses in patients with AV. To investigate the presence of enthesitis and to evaluate the tendon and ligament thicknesses in lower extremities in patients with AV. 
 Material and Method: Thirty patients with a diagnosis of AV and 18 healthy participants, were included. Acne severity was determined with the Global Acne Grading System (GAGS). A single radiologist performed ultrasonographic evaluation with respect to Glasgow Ultrasonographic Enthesitis Scoring System (GUESS). Measurement were done on quadriceps tendons, patellar tendons, Achilles tendons and plantar fascias of the bilaterally lower extremity.
 Results: Age, body mass index, alcohol usage and smoking were similar between groups. GUESS score was similar in both group. Proximal patellar ligaments, distal patellar ligaments, Achilles tendons and plantar fascias thicknesses were significantly increased in dominant and non-dominant legs in patients with AV (p

Insulin Resistance and Acne: The Role of Metformin as Alternative Therapy in Men

The association between acne and insulin resistance has not been investigated as thoroughly in males as it has been in women, despite the fact that in adult men, acne prevalence has grown. On the face, sebaceous glands produce and secrete sebum, which lubricates the skin and protects it from friction. Metformin, an insulin-sensitizing medication, may modify the association between acne vulgaris and insulin resistance (IR). Individuals with IR, metabolic syndrome or with impaired glucose tolerance are sometimes treated 'off label' with Metformin. In these conditions, IR may be a leading factor in the pathogenesis of acne, and in men, Metformin treatment may reduce the Global Acne Grading System (GAGS) score by enhancing insulin sensitivity. However, additional clinical studies are required to corroborate these assumptions.

The Relationship of Acne With Somatosensory Amplification, Health Anxiety, and Depression Levels.

Objective The objective of this study is to evaluate the somatosensory amplification, as well as anxiety and depression levels in acne vulgaris (AV) patients, and to examine their relationship with disease severity. Methods Sociodemographic form, Global Acne Grading System (GAGS), Somatosensory Amplification Scale (SSAS), Health Anxiety Inventory (HAI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were applied to the patient group. All scales, except GAGS, were also applied to the healthy controls. Results All psychiatric scale scores of acne patients were higher than those of the control group. Moreover, the patient group had significantly higher SSAS,BDI scores, HAI total scores, and subscales of hypersensitivity to somatic symptoms and anxiety compared to the healthy controls. A positivebut weak correlation was found between all scale scores. In patients with AV, no correlation was found between acne severity, age, disease duration, and all scale scores. Conclusion A significant relationship was found between somatosensory amplification, depression, and health anxiety in acne patients, independent of global acne severity, age, and disease duration. More successful acne treatment and patient management will be possible with an interdisciplinary approach that includes both psychiatry and dermatology.

Prevalence of Metabolic Syndrome and Insulin Resistance in Adult Patients with Acne: Association with Traditional Cardiovascular Risk Factors and Acne Severity.

Introduction: Acne is a chronic inflammatory disease that affects the pilosebaceous unit, and there are conflicting evidences regarding its association with metabolic syndrome (MS) and insulin resistance (IR). Methods: A cross-sectional study was performed with 162 acne patients, over 20 years of age, matched for age and sex with 78 healthy controls without acne. The measured parameters included waist circumference (WC), body mass index (BMI), systolic blood pressure, diastolic blood pressure, fasting blood glucose, fasting insulin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and total cholesterol. Acne severity was determined according to the Global Acne Grading System. The criteria used for the diagnosis of MS were those of the Harmonizing the Metabolic Syndrome Statement, adjusted for South Americans, and the IR was calculated using the HOMA-IR. Results: The prevalence of MS was significantly higher in cases, compared to controls (12.3% vs. 2.6%, P = 0.014), as was the prevalence of IR (11.7% vs. 3.8%, P = 0.047). In addition, MS and IR showed a positive correlation with the degree of acne severity (P = 0.011 and P = 0.021, respectively). HDL levels were significantly lower in cases (P = 0.012) and showed an association with acne severity (P = 0.038). In the logistic regression model, the risk factor that independently influenced both MS and IR in patients with acne was the WC (P = 0.001). Conclusions: Adults with acne, especially the most severe cases, are significantly more likely to have MS, IR, and lower HDL levels, compared to controls without acne.

Serum and salivary adipsin levels and its association with insulin resistance in acne vulgaris patients.

There is scarcity in literature about the reliability of salivary markers in acne vulgaris. The aims were to evaluate the insulin resistance (IR) and adipsin levels in serum and saliva in a sample of acne vulgaris patients; and to correlate IR and adipsin levels with the disease severity. This prospective case-control study included 60 acne vulgaris patients (patients Group), in addition, 60 apparently healthy individuals (control group). The severity of acne vulgaris was determined according to Global Acne Grading system (GAGS). Serum and salivary adipsin, fasting glucose, and fasting insulin levels were measured using ELISA kits. Fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in patients group both in serum and saliva were elevated when compared with the control group. Serum and salivary levels of adipsin and Quantitative insulin sensitivity check index (QUIKI) in patients were decreased than the control group. Adipsin serum levels show significant negative correlations with all study variables except QUIKI with which the correlation was positive both in serum and saliva. There was a significant positive correlation between serum and salivary adipsin levels (r=0.873, p < 0.00001) and serum and salivary fasting glucose (r=1, p < 0.00001). Adipsin could be considered as a promising biomarker for acne vulgaris and its associated insulin resistance. Moreover, the salivary measurements may be considered as useful biomarkers in acne vulgaris patients, but more studies are still required.

Clinical Profile and Treatment of Acne Vulgaris Patients

Background: Acne vulgaris (AV) is not a deadly condition may affect one’s quality of life. Treatment of AV includes topical and oral, depending on the severity. Antibiotics as oral treatment should not be given alone because it can precipitate resistance. Purpose: To describe the clinical characteristics of AV in a tertiary hospital in Indonesia and evaluate the treatment given. Methods: This is a descriptive, retrospective study with a cross-sectional design. The study subject was classified based on severity according to Plewig and Kligman’s acne grading. Further evaluation was made according to the type of lesion, the risk factortopical and oral treatment in subjects with grades 2, 3, and 4. This research was conducted at the Cosmetic Medic Division, Dermatology and Venereology Outpatient Clinic at Dr. Soetomo General Academic Hospital Surabaya based on medical records from the period of 2017 to 2019. Result: From 2017 to 2019, there were 525 (1.1%) new AV patients out of a total of 45,754 new patients. AV was the major diagnosis in the Cosmetic Medic division. AV grades 2, 3, and 4 were found in 167 patients (32.0%). The most common lesion was papulopustular (75.4%) and the most common risk factor was hormonal (58.7%). All the patients received tretinoin, clindamycin gel 1.2%, and sunscreen for topical treatment. Doxycycline was the most common oral antibiotic used (98.2%) Conclusion: The most common AV grade in this study was mild AV. Oral antibiotics were given to moderate-to-severe AV patients in combination with topical treatment to prevent resistance.

Effect of 30% Supramolecular Salicylic Acid Peel on Skin Microbiota and Inflammation in Patients with Moderate-to-Severe Acne Vulgaris.

Thirty-percent supramolecular salicylic acid (SSA), a modified salicylic acid preparation, is a safe and effective treatment for moderate-to-severe acne vulgaris (AV). However, its mechanism of action remains unclear. We aimed to analyze the role of 30% SSA peels on skin microbiota and inflammation in patients with moderate-to-severe AV. A total of 28 patients were enrolled and received 30% SSA peels biweekly for 2months. The Global Acne Grading System (GAGS) score, skin water content, transepidermal water loss (TEWL), pH, and sebum levels were assessed. Skin microbial samples and perilesional skin biopsies were obtained at the onset and 2weeks after treatment completion. Samples were characterized using a high-throughput sequencing approach targeting a portion of the bacterial 16S ribosomal RNA gene. After treatment, patients showed a significant improvement in their GAGS score and skin barrier indicators (P < 0.05). The GAGS score was positively associated with both the sebum concentration (R = 0.3, P = 0.027) and pH (R = 0.39, P = 0.003). Increased expression of caveolin-1 and decreased expression of interleukin (IL)-1a, IL-6, IL-17, transforming growth factor beta, and toll-like receptor 2 were observed in the skin tissue after treatment. The richness and evenness of the cutaneous microbiome decreased after treatment and the Staphylococcus proportion decreased significantly (P < 0.05), whereas the Propionibacterium proportion tended to decrease (P = 0.066). On the basis of analyses of the skin barrier and microbiota, we speculate that the 30% SSA peel may have a therapeutic effect in patients with moderate-to-severe AV by improving the skin microenvironment and modulating the skin microbiome, thus reducing local inflammation.

Effects of hormonal treatment on dermatological outcome in transgender people: a multicentric prospective study (ENIGI)

PurposeThe aim of our study was to assess dermatological changes in transgender people after the start of gender-affirming hormonal treatment (GAHT) and to investigate whether various hormonal preparations differently affect dermatological changes in trans AFAB (assigned female at birth) people.MethodsIn a multicenter prospective study, 484 participants (193 assigned male at birth/AMAB and 291 AFAB) were evaluated at baseline (T0), 6 (T1) and 12 months (T2) after the start of GAHT. Hair growth was assessed by the Ferriman–Gallwey (FG) score, acne by the Global Acne Grading Scale (GAGS), and alopecia by the Norwood Hamilton (NH) score.ResultsIn AFAB people, a significant increase in FG score and NH grade was observed across time, as well as in GAGS score in a subsample of 71 individuals (p < 0.001). Testosterone (T) undecanoate and esters showed a higher increase in hair distribution at T2 vs. T1 as compared to T gel (p < 0.01). T esters showed a significantly higher impact in GAGS score modifications at T1 and at T2 vs. T0 compared to T gel (p = 0.021 and p = 0.003, respectively). In trans AMAB people, a significant decrease of FG score was observed across time (p < 0.001), although 51.3% of individuals still reported an FG score higher than eight after 12 months.ConclusionT treatment increased hair growth, acne and alopecia prevalence in AFAB people, with T undecanoate and esters influencing hair growth more than T gel. Opposite dermatological changes were observed in AMAB people.

Comparison of the Efficacy of Tazarotene 0.1% Cream Versus Clindamycin 1% Gel in the Treatment of Acne Vulgaris

Objective: To compare the efficacy of Tazarotene 0.1% cream versus Clindamycin 1% gel in treating acne vulgaris.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of the Study: Dermatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2018.&#x0D; Methodology: One hundred and fifty-four patients of both genders who had moderate acne vulgaris for more than four weeks were divided into two Groups. In both Groups, patients applied one-fourth fingertip unit of Tazarotene 0.1% cream in the evening once daily and Clindamycin 1% gel over the affected area in the morning once daily for 12 weeks. The Global Acne Grading System Score (GAGS score) was used for severity and efficacy assessment.&#x0D; Results: The majority of the patients belonged to 13-25 years of age, i.e., 61(79.2%) and 54(70.1%) in Group-A (Tazarotene 0.1% cream) and Group-B (Clindamycin 1% gel), respectively. The efficacy of topical Tazarotene cream (0.1%) was better than topical Clindamycin 1% gel, and the difference was statistically significant with a p-value less than 0.01. GAGS score &lt;10 was observed in 54.5% and 33.8% of patients in Group-A and Group-B, respectively.&#x0D; Conclusion: Topical Tazarotene cream (0.1%) was more effective than topical Clindamycin 1% gel in treating acne vulgaris.

A STUDY OF CLINICAL PATTERN OF ACNE VULGARIS PATIENTS PRESENTING IN A TERTIARY CARE HOSPITAL

Objective: To evaluate the clinical pattern of acne vulgaris in patients attending a tertiary care hospital. Methods: This hospital-based observational study was conducted from September 2021 to March 2022. A total of 203 consecutive patients with acne vulgaris attending dermatology OPD were included. Pregnant and lactating women, drug-induced acne, and other acneiform eruptions were excluded. Data were collected in a pre-designed proforma. The parameters included were age, gender, age of onset, duration, sites of involvement, acne grade, types of lesions, menstrual history, and post-acne complications. Results were expressed in percentages. MS Excel software was used for data entry and analysis. Results: Two hundred and three cases were included, among which 61.6% were female and 38.4% were male. The commonest age group affected was 21-25 y (37.9%) followed by 16-20 y (31.5%). The commonest site of involvement in acne was the face (86.2%) followed by the trunk (9.4%). Arms (2.5%) and the neck (1.9%) were less affected areas. The majority of patients had Grade 2 (53.7%) acne, followed by Grade 3 (21.8%) and Grade 1 (20.7%) and Grade 4 (3.9%). Persistence of acne in females till late age was observed. Post-acne hyperpigmentation 98 (48.3%) and scarring 46 (22.7%) were most common complications. Premenstrual flare was seen in 36 (17.7%) patients. The commonly associated disease with acne is seborrheic dermatitis, observed in 28 (13.8%) patients. Conclusion: This study revealed the clinical pattern of acne vulgaris in a tertiary care hospital in Assam.

Efficacy and safety of silymarin containing antioxidant serum as an adjuvant treatment of mild-to-moderate acne vulgaris: Aprospective, open-label pilot study.

Silymarin is the active component of milk thistle, which has antioxidant properties by scavenging free radicals and potential comedolytic properties. This study aimed to assess the efficacy and safety of 0.5% silymarin-loaded antioxidant serum (SAS) used to treat mild-to-moderate acne. A prospective, open-label pilot study was conducted. We enrolled 22 Korean acne patients who applied the 0.5% SAS on the whole face twice daily while continuing the current anti-acne medications. Grade of acne severity, individual lesion counts, sebum output levels, skin erythema, and melanin pigmentation were assessed. After a 4-week application, the modified Global Acne Grading Score (mGAGS), Global Evaluation Acne (GEA) scale, and the acne lesion counts were significantly decreased. Sebum secretion, skin pigmentation, and erythema were also reduced during the study period, yet only the melanin pigmentation index reached statistical significance. Subgroup analysis revealed that the patients who took the low-dose oral isotretinoin during the study period showed more noticeable improvements in skin sebum output and melanin pigmentation. Additionally, no adverse event was associated with using the 0.5% SAS. The 0.5% silymarin-containing antioxidant formulation improved acne's clinical severity and related skin biophysical parameters.

Efficacy of Hydrogen Purification and Cosmetic Acids in the Treatment of Acne Vulgaris: A Preliminary Report.

Acne and skin lesions that appear in its course deteriorate the quality of life of patients, cause depression and the emergence of suicidal thoughts. Cosmetic treatments can have a positive effect on improving skin condition by cleaning up skin eruptions, thus improving the well-being of affected people. Hydrogen purification is a treatment that uses alkaline water generated by a device, which reduces sebum from the surface of the epidermis. This is a novel treatment that has recently been introduced to beauty salons. On the other hand, cosmetic acids have been used for many years for treating people with acne vulgaris and give spectacular results in terms of improving the skin condition. In this study, skin condition was evaluated with a Derma Unit SSC 3 device. The Global Acne Grading System (GAGS) was used to check acne severity. Twenty-four women aged 19-21 years (M = 20.13, SD = 0.80) diagnosed with mild acne vulgaris and a high sebum level participated in the study. Group A underwent a hydrogen purification treatment using an H2jet manipulator, which ejected alkaline water from the manipulator under pressure. Group B underwent a hydrogen purification treatment with the use of a phytic, pyruvic, lactic and ferulic acids at 40% mixture (pH 1.4). A series of four treatments was performed at 14-day intervals in both groups. Skin parameters were measured before and 30 days after the series of treatment. Very good results were obtained in both groups. The skin eruptions in patients were reduced and we also observed lower amounts of sebum on the surface of the epidermis, and an improvement in skin hydration. However, in group B, the results were better than in group A. The study showed that the synergy of the treatments produced much better effects than those obtained by completing the hydrogen purification treatment alone.

The Relevant of Sex Hormone Levels and Acne Grades in Patients with Acne Vulgaris: A Cross-Sectional Study in Beijing.

BackgroundThe tests of sex hormones play pivotal roles in the clinical diagnosis and treatment of acne vulgaris, but the majority of patients with acne vulgaris present regular sex hormone levels within the normal reference range.ObjectiveTo determine the correlation among levels of sex hormones, ratio of androgen to estrogen and acne grades in patients with acne vulgaris.MethodsA cross-sectional study was applied to collect 693 patients with acne vulgaris. All samples were screened by cluster sampling among those who underwent tests of sex hormones at Beijing Jingcheng Skin Hospital from July 2021 to June 2022. A gender stratified analysis was performed to classify acne grades I–IV. Spearman correlation analysis was used to analyze the relationship between age, sex hormones, ratio of androgen to estrogen and acne grades, with multinomial logistic regression to analyze the association of sex hormones with acne grades in patients with acne.Results(1) The testosterone levels were mostly within normal reference values for both males and females with varying degrees of acne. For females, the serum follicle-stimulating hormone, estradiol, progesterone, testosterone, and ratio of androgen to estrogen were significantly different between acne grades. For males, there were significant differences in serum estradiol, testosterone, and ratio of androgen to estrogen across acne grades. (2) The acne grade was negatively correlated with estradiol and positively correlated with the ratio of androgen to estrogen; the female acne grade was also negatively correlated with age and progesterone, but positively correlated with follicle-stimulating hormone. (3) Multivariate logistic regression analysis indicated that the ratio of androgen to estrogen was independently correlated with the grade of acne and that acne grade worsened as the ratio increased.ConclusionThe increase in the ratio of androgen to estrogen may aggravate the acne grade in patients with acne vulgaris.

Efficacy of Unani Combination Therapy in the Management of Acne Vulgaris: A Randomised Standard Controlled Study

Acne vulgaris is one of the common chronic inflammatory diseases of the pilosebaceous unit with multiple pathophysiologies affecting adolescents mainly. Aims: To evaluate the efficacy of Shahtra (Fumaria indica) orally along with the topical use of Zimad Muhasain and the management of moderate to severe category of acne vulgaris on the Global Acne Grading System (GAGS) scale. Material &amp; Methods: This was a randomized standard control clinical study. The test group patients were given Shahtra ( 500 mg), 2 capsules twice daily with a local application of Zimad Muhasa paste once daily; the control group patients were given tablet Azithromycin 500 mg thrice weekly with a local application of Benzoyl peroxide 5% gel once daily for 8 weeks. Result: In the test group, there was a 77.3% reduction in the GAGS score at the final follow-up with p&lt;0.0001; in the control group, there was a 69.8% reduction in GAGS score with p&lt;0.0001, showing extremely significant improvement in both groups. The results indicate the superiority of the test group regimen over the control group by at least 7%. Furthermore, adverse effects like burning sensation, dryness, and itching due to Benzoyl peroxide and diarrhoea due to Azithromycin were only reported in the control group whereas the Unani formulations were found to be free of such adverse effects. Conclusion: The test formulations comprising a dried aqueous extract of Shahtra and Zimad Muhasa were found to be more effective and safe in the management of acne vulgaris in moderate to severe acne, compared to the control combination of Azithromycin and Benzoyl peroxide gel.

A study of efficacy and safety of newer chemical peels for acne vulgaris grade 1 to grade 3

Acne is a common and complex and multifactorial skin disease that affects individuals of all ages. It commonly presents as Seborrhoea and formation of comedones, papules and pustules. Aim of our study is to evaluate various new chemical peeling agent for search of treatment which stand out with maximum efficacy and least side effect.A total 120 patients were included in our study. Grading of acne was done according to Pillsbury classification and divided into five Treatment groups: Group A: Azelaic peel (20% Azelaic acid peel) Group B: Black peel (8% Acetic acid peel) Group C: Kojic acid peel (12% kojic acid peel) Group D: Lactic acid peel (90% lactic acid peel) Group E: Mandelic acid peel (35% mandelic acid peel). Patients in each arm were subjected to respective chemical peels at an interval of 15 days for a total of 6 sessions. Last visit was done at 12th week. Evaluation done by dermatological examination for acne including counting the number of comedones, papules and pustules.Patients with improvement at the end of 12 weeks the overall reduction rate was 60.4%, 72.4%, 24.1%, 35.2% and 50.1% with Azelaic peel, Black peel, Kojic acid peel, Lactic acid peel and Mandelic acid peel respectively.Our study thus concluded that the efficacy of Black peel is highest in the treatment of acne vulgaris grade I to III in Indian patients. The resolution was also observed good with Azelaic acid and Mandelic acid while response was not up to the mark by Lactic acid and Kojic acid peel. However, immediate erythema and burning sensations were more common side effects with black peel. Though the side effects observed with these peels reduced by itself, application of emollients, mild steroids and sun screeners hastened the recovery.