Acne Infections Research Articles

Acne, folliculitis and post-operative infection rates of penile prosthetic implants

ABSTRACT Introduction and Objective Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI). Methods The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant. Results Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b). Conclusions There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome).

Acne, Folliculitis and Post-Operative Infection Rates of Penile Prosthetic Implants

ABSTRACT Introduction Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. Objective In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI). Methods The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant. Results Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b). Conclusions There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome

Antibacterial activity test of mixture seed extracts of Moringa oleifera Lamk and Schleichera oleosa L. against Staphylococcus epidermidis and Shigella dysenteriae

Moringa (M. oleifera Lamk.) is known to have antibacterial ability, because the seeds contain tannin, flavonoids, alkaloids, and saponins. Kesambi or Malay lac tree (S. oleosa L.) has been used to fight skin inflammation, ulcers, itching, acne and skin infections. Its seeds contain oil, which is very good for the skin. The ability of a mixture of the seed of moringa and kesambi has not been widely reported. This study aims to determine the inhibitory power resulting from a mixture seed extracts of Moringa and kesambi against S. epidermidis and S. dysenteriae. The method used is experimental using CDR (Completely Randomized Design) with 5 treatments and 3 replicates which are P1 = 10 g Moringa + 0 g Kesambi, P2 = 2.5 g Moringa + 7.5 g Kesambi, P3 = 5 g Moringa + 5 g Kesambi, P4 = 7.5 g Moringa + 2.5 g Kesambi, P5 = 0 g Moringa + 10 g Kesambi. One way Anova and Tukey test were performed for statistical justification. The inhibitory test of the mixture seeds extract of moringa and kesambi showed that there was antibacterial activity against S. epidermidis and S. dysenteriae. The mixed extract showed the maximum effect on Gram (+) S. epidermidis, namely P3 with inhibitory power of 25.33±0.76 mm. While on the Gram (-) bacteria, S. Dysenteriae, the P4 had the highest inhibition (9.17±1.15 mm). The mixture of Moringa seed extract and kesambi seed has a higher effect on gram positive bacteria.

Patterns and barriers of teledermatology in resource-limited settings in COVID-19 pandemic: A descriptive cross-sectional survey of Nepalese dermatologists

BackgroundThe COVID-19 pandemic has limited in-person consultations and disturbed easy health care access. Teledermatology (Td) is used to provide services in such situations.ObjectiveTo find the pattern and barriers of Td during the COVID-19 pandemic in resource-limited settings.MethodsAn online survey focused on dermatologists and residents in dermatology in Nepal was conducted. The online form with the prepared questionnaire was sent to the potential participants.ResultsA total of 86 responses were received, with 60% response rate. Approximately 62.8% (n = 54) of the participants were involved in COVID-19 care. The most common method used was a store-and-forward technique. Approximately 90% of the participants used smartphones for Td, and Viber was the most commonly used application. The straightforward diagnoses in Td were fungal infections, acne, alopecia, pyoderma, and viral infections. The common barriers were poor image quality, inability for further test, and unsuitability for all patients. The majority of the participants believed that there is a need for guidelines for Td.LimitationsA small sample size and associated technical difficulties.ConclusionTd has proven to be an excellent tool; however, it may never replace the in-person consultation. A newer guideline must be prepared to regulate Td in the future.

Antibacterial Activity of the Essential Oil From Litsea cubeba Against Cutibacterium acnes and the Investigations of Its Potential Mechanism by Gas Chromatography-Mass Spectrometry Metabolomics.

Cutibacterium acnes (C. acnes) is an anaerobic Gram-positive bacterium generally considered as a human skin commensal, but is also involved in different infections, such as acne and surgical infections. Although there are a variety of treatments, the side effects and the problem of bacterial drug resistance still limit their clinical usage. In this study, we found that essential oil (EO) distilled from fresh mature Litsea cubeba possessed promising antibacterial activity against C. acnes. In order to elucidate its potential mechanism, bacteriostatic activity test, Live/Dead kit assay, scanning electron microscope (SEM), transmission electron microscope (TEM), and metabolomics were employed. In addition, the content of adenosine triphosphate (ATP) in bacterium and the activities of key enzymes involved in critical metabolic pathways were detected using a variety of biochemical assays. The results showed that EO exhibited significant antibacterial activity against C. acnes at a minimum inhibitory concentration (MIC) of 400 μg/mL and a minimum bactericidal concentration (MBC) of 800 μg/mL, and EO could destroy C. acnes morphology and inhibit its growth. Moreover, results from our study showed that EO had a significant effect on the C. acnes normal metabolism. In total, 86 metabolites were altered, and 34 metabolic pathways related to the carbohydrate metabolism, energy metabolism, amino acid metabolism, as well as cell wall and cell membrane synthesis were perturbed after EO administration. The synthesis of ATP in bacterial cells was also severely inhibited, and the activities of key enzymes of the glycolysis and Wood-Werkman cycle were significantly affected (Pyruvate Carboxylase, Malate Dehydrogenase and Pyruvate kinase activities were decreased, and Hexokinase was increased). Taken together, these results illustrated that the bacteriostatic effect of EO against C. acnes by breaking the bacterial cell morphology and perturbing cell metabolism, including inhibition of key enzyme activity and ATP synthesis. The results from our study may shed new light on the discovery of novel drugs with more robust efficacy.

Teledermatology in São Paolo, Brazil

Background There are places in the world where access to dermatologists can be very challenging and general practitioners may not be well trained in the diagnosis and treatment of skin conditions. Store-and-forward teledermatology may improve access to specialty care, provide accurate diagnoses, and reduce time to treatment, resulting in high patient satisfaction. The early detection and timely treatment of severe skin diseases could prevent adverse health outcomes and death. On the other hand, some skin conditions such as mild atopic dermatitis, acne, and fungal infections could be managed within primary care using teledermatology. Objective We aimed to (1) evaluate the proportion of individuals who could be assessed in primary care using teledermatology and how this affects the waiting time for an in-person dermatologist appointment and (2) assess the most frequent dermatoses according to demographic data and referrals made by the teledermatologist. Methods A cross-sectional retrospective study, involving 30,976 individuals and 55,624 skin lesions, was conducted from July 2017-July 2018 in the city of São Paulo. We assessed the frequency of diagnoses and referrals to biopsy, in-person dermatologists, or primary care, and compared the waiting time for an in-person dermatologist appointment before and after the teledermatology implementation. Results We found that 53% of the patients were managed by the primary care physician, 43% were referred to in-person dermatologists, and 4% were referred directly to biopsy, leading to a reduction in waiting time for in-person appointments of 78% when compared to the previous period (from 6.7 months to 1.5 months). The most frequent diseases were melanocytic nevus, seborrheic keratosis, acne, benign neoplasms, onychomycosis, atopic dermatitis, solar lentigo, melasma, xerosis, and epidermoid cyst, with significant differences according to sex, age, and referrals (Multimedia Appendix 1A,B). Conclusions The use of teledermatology as a triage tool significantly reduced the waiting time for in-person visits, improving health care access and using public resources wisely. Knowledge of sex, age, diagnoses, and treatment of common skin conditions can enable the creation of public policies for prevention and orientation of the population, as it can be used to train general physicians to address such cases. Conflicts of Interest None declared.

Hough Transform Sensitivity Factor Calculation Model Applied to the Analysis of Acne Vulgaris Skin Lesions

The number of infectious spots or pathological structures recorded on dermatological images is a tool to aid in the diagnosis and monitoring of disease progression. Dermatological images for the detection and monitoring of the evolution of acne infections are evaluated globally, comparing whether the increase or decrease in infectious lesions appearing on an image is significant. This evaluation method is only indicative since its accuracy is low. The accuracy problem could be improved by an exact count of the number of structures and spots appearing on the image. The mathematical function circular Hough transform (CHT) function implemented in MATLAB is here applied to develop a procedure for counting these structures. CHT has been used in the recognition of benign and distorted red blood cells, in the detection of pellet sizes in industrial processes and in the automated detection and morphological characterization of breast tumor masses from infrared images, as well as for the detection of brain aneurysms and use in magnetic resonance imaging. The sensitivity factor is one of the many parameters required to feed the CHT algorithm. Its choice is unclear as there is no proper methodology to select an optimum value suitable for each image. In this work, a procedure for determining the optimal value of the sensitivity factor is proposed The approach is validated by comparison with the results of the manual counting of the points (ground truth).

Promising Natural Products in New Drug Design, Development, and Therapy for Skin Disorders: An Overview of Scientific Evidence and Understanding Their Mechanism of Action.

The skin is the largest organ in the human body, composed of the epidermis and the dermis. It provides protection and acts as a barrier against external menaces like allergens, chemicals, systemic toxicity, and infectious organisms. Skin disorders like cancer, dermatitis, psoriasis, wounds, skin aging, acne, and skin infection occur frequently and can impact human life. According to a growing body of evidence, several studies have reported that natural products have the potential for treating skin disorders. Building on this information, this review provides brief information about the action of the most important in vitro and in vivo research on the use of ten selected natural products in inflammatory, neoplastic, and infectious skin disorders and their mechanisms that have been reported to date. The related studies and articles were searched from several databases, including PubMed, Google, Google Scholar, and ScienceDirect. Ten natural products that have been reported widely on skin disorders were reviewed in this study, with most showing anti-inflammatory, antioxidant, anti-microbial, and anti-cancer effects as the main therapeutic actions. Overall, most of the natural products reported in this review can reduce and suppress inflammatory markers, like tumor necrosis factor-alpha (TNF-α), scavenge reactive oxygen species (ROS), induce cancer cell death through apoptosis, and prevent bacteria, fungal, and virus infections indicating their potentials. This review also highlighted the challenges and opportunities of natural products in transdermal/topical delivery systems and their safety considerations for skin disorders. Our findings indicated that natural products might be a low-cost, well-tolerated, and safe treatment for skin diseases. However, a larger number of clinical trials are required to validate these findings. Natural products in combination with modern drugs, as well as the development of novel delivery mechanisms, represent a very promising area for future drug discovery of these natural leads against skin disorders.

Self-Assembly Polymeric Nano Micelles for the Futuristic Treatment of Skin Cancer and Phototoxicity: Therapeutic and Clinical Advancement.

In the last few years, the polymeric micelles played a major role as a drug carrier in nano-sized drug delivery system. The polymeric micelles are designed from synthetic block co-polymers and graft copolymers. In the mixed micelles, the bilayer lipid membrane and surfactants are used. Both micelles are in nano-sized and used to enhance the drug delivery to treat different diseases. In this review, we will discuss some examples from the literature included demonstrating the polymeric micelles used as drug-carriers in skin cancer treatment by using different drugs. We also summarized mixed micelles, polymeric micelles in skin drug delivery, various polymers, and techniques of polymeric micelles. These micelles may improve delivery of drug in the skin's targeted sites in specific and dermatological diseases like skin cancer, acne, and fungal infection. In the comparison of surfactant micelles, the polymeric micelles are more stable. Polymeric micelles act as a colloidal carrier for incorporating poorly water-soluble and amphiphilic drugs.

Thymol-loaded PLGA nanoparticles: an efficient approach for acne treatment

BackgroundAcne is a common skin disorder that involves an infection inside the hair follicle, which is usually treated with antibiotics, resulting in unbalanced skin microbiota and microbial resistance. For this reason, we developed polymeric nanoparticles encapsulating thymol, a natural active compound with antimicrobial and antioxidant properties. In this work, optimization physicochemical characterization, biopharmaceutical behavior and therapeutic efficacy of this novel nanostructured system were assessed.ResultsThymol NPs (TH-NP) resulted on suitable average particle size below 200 nm with a surface charge around − 28 mV and high encapsulation efficiency (80%). TH-NP released TH in a sustained manner and provide a slow-rate penetration into the hair follicle, being highly retained inside the skin. TH-NP possess a potent antimicrobial activity against Cutibacterium acnes and minor effect towards Staphylococcus epidermis, the major resident of the healthy skin microbiota. Additionally, the stability and sterility of developed NPs were maintained along storage.ConclusionTH-NP showed a promising and efficient alternative for the treatment of skin acne infection, avoiding antibiotic administration, reducing side effects, and preventing microbial drug resistance, without altering the healthy skin microbiota. Additionally, TH-NP enhanced TH antioxidant activity, constituting a natural, preservative-free, approach for acne treatment.Graphical

Surface-Modified Multifunctional Thymol-Loaded Biodegradable Nanoparticles for Topical Acne Treatment.

The present work is focused on the development of novel surface-functionalized poly(lactic-co-glycolic acid) nanoparticles loaded with thymol (TH-NPs) for topical administration enhancing thymol anti-inflammatory, antioxidant and wound healing activities against acne. TH-NPs were prepared by solvent evaporation method using different surface functionalization strategies and obtaining suitable physicochemical parameters and a good short-term stability at 4 °C. Moreover, TH-NPs skin penetration and antioxidant activity were assessed in ex vivo pig skin models. Skin penetration of TH-NPs followed the follicular route, independently of the surface charge and they were able to enhance antioxidant capacity. Furthermore, antimicrobial activity against Cutibacterium acnes was evaluated in vitro by the suspension test showing improved antibacterial performance. Using human keratinocyte cells (HaCat), cytotoxicity, cellular uptake, antioxidant, anti-inflammatory and wound healing activities were studied. TH-NPs were non-toxic and efficiently internalized inside the cells. In addition, TH-NPs displayed significant anti-inflammatory, antioxidant and wound healing activities, which were highly influenced by TH-NPs surface modifications. Moreover, a synergic activity between TH-NPs and their surface functionalization was demonstrated. To conclude, surface-modified TH-NPs had proven to be suitable to be used as anti-inflammatory, antioxidant and wound healing agents, constituting a promising therapy for treating acne infection and associated inflammation.

Ethosomes as Nanocarriers for the Development of Skin Delivery Formulations.

The use of nanotechnology has been extensively explored for developingefficient drug delivery systems towards topical and transdermal applications. Ethosomes constitute a vesicular nanocarrier containing a relatively high concentration of ethanol (20-45%). Ethanol is a well-known permeation enhancer, which confers ethosomes unique features, including high elasticity and deformability, allowing them to penetrate deeply across the skin and enhance drug permeation and deposition. The improved composition of ethosomes offer, thereby, significant advantages in the delivery of therapeutic agents over particularly the conventional liposomes regarding different pathologies, including acne, psoriasis, alopecia, skin infections, hormonal deficiencies, among others. This review provides a comprehensive overview of the ethosomal system and an assessment of its potential as an efficient nanocarrier towards the skin delivery of active ingredients. Special attention is given to the composition of ethosomes and the mechanism of skin permeation, as well as their potential applications in different pathologies, particularly skin pathologies (acne, psoriasis, atopic dermatitis, skin cancer and skin infections). Some examples of ethosome-based formulations for the management of skin disorders are also highlighted. Besides the need for further studies, particularly in humans, ethosomal-based formulations hold great promise in the skin delivery of active ingredients, which increasingly asserts oneself as a viable alternative to the oral route.

Is there an association between long-term antibiotics for acne and subsequent infection sequelae and antimicrobial resistance? A systematic review.

BackgroundAntimicrobial resistance (AMR) is a global health priority. Acne vulgaris is a common skin condition for which antibiotic use ranges from a few months to years of daily exposure.AimTo systemically search for and synthesise evidence on the risk of treatment-resistant infections, and other evidence of AMR, following long-term oral antibiotic use for acne.Design & settingIn this systematic review, a literature search was carried out using the databases Embase, MEDLINE, Cochrane, and Web of Science. They were searched using MeSH, Emtree, or other relevant terms, and followed a pre-registered protocol.MethodSearch strategies were developed with a librarian and undertaken in July 2019. All searches date from database inception. The primary outcome was antibiotic treatment failure or infection caused by a resistant organism. Secondary outcomes included detection of resistant organisms without an infection, rate of infection, or changes to flora.ResultsA total of 6996 records were identified. Seventy-three full-text articles were shortlisted for full review, of which five were included. Two investigated rates of infection, and three resistance or changes to microbial flora. Three studies had 35 or fewer participants (range 20–118 496). Three studies had a serious or high risk of bias, one moderate, and one a low risk of bias. Weak evidence was found for an association between antibiotic use for acne and subsequent increased rates of upper respiratory tract infections and pharyngitis.ConclusionThere is a lack of high quality evidence on the relationship between oral antibiotics for acne treatment and subsequent AMR sequelae. This needs to be urgently addressed with rigorously conducted studies.

Polyphenol Rich Sugar Cane Extract Inhibits Bacterial Growth.

Plants that are primarily used as a food source commonly have undervalued biological properties beyond the basic supply of nutrients. One important example of this are the antimicrobial properties of plants. Inclusion of natural and food grade antimicrobial ingredients in recipes to prevent food spoilage and disease transmission, or in cosmetic products to prevent transient and pathogenic bacteria would have world-wide public health implications. A patented natural polyphenol rich sugar cane extract (PRSE), is marketed as a high anti-oxidant and polyphenol ingredient, but its anti-microbial activity has not been reported previously. We determined the anti-bacterial properties of PRSE on common human pathogens relating to a range of diseases including food poisoning, tooth decay, acne and severe skin infections using disc/well diffusion experiments. Our findings indicate that PRSE is an efficient antimicrobial, which could be included at differing dosages to target a range of food borne and environmental pathogens.

Recent Patents on Phytoconstituents-based Formulations for the Treatment of Acne Infection: A Review.

Acne is an infection of the skin that occurs in both men and women during their lifespan. There are various natural or synthetic products available in the market to prevent and cure this disease. The majority of the world population depends on the herbs or natural resources for the relief of acne disease. These are used to lessen the cost of treatment and the side effects of synthetic analogs. We have explored the various authentic web resources to compile information regarding different patented and marketed herbal formulations for acne treatment. It has been found that most of the herbal formulation for acne include the plant actives/extracts having the potential activity against the Propionibacterium acne. The occurrence of this skin disease is also associated with the presence of free radicals in the body, which also causes the inflammation and redness of the skin. Further, the study of various patents also revealed that herbs with anti-oxidant properties have been used in most of the herbal anti-acne formulations. Moreover, the various patents also give the idea that herbal formulations also prevent the appearance of pimples on the skin. It has been concluded that the herbal anti-acne formulation is not only used to treat acne but also prevents this disease safely and economically.

Active pharmaceutical ingredient poly(ionic liquid)-based microneedles for the treatment of skin acne infection

As an inflammatory skin disease of pilosebaceous follicles, Propionibacterium acnes (P. acnes) can aggravate local inflammatory responses and forms acne lesions. However, due to the skin barrier, various transdermal measures other than antibiotic creams are necessary. Microneedle (MN) patches are emerging platforms for the transdermal delivery of various therapeutics since it can effectively create transport pathways in the epidermis. Herein, we develop an active pharmaceutical ingredient poly(ionic liquid) (API PIL)-based MN patches containing salicylic acid (SA). The PIL-based MNs are simply prepared through photo-crosslinking of an imidazolium-type ionic liquid (IL) monomer in MN micro-molds, and following by anion exchange with salicylic acid anions (SA−). The fabricated SA-loaded PIL-MNs exhibited therapeutic efficiency in the topical treatment of P. acnes infection in vitro and in vivo. These active pharmaceutical ingredient PIL-based MNs can improve acne treatment, demonstrating potential applications for skin diseases. Statement of SignificanceMicroneedle (MN) patches can be used as platforms for transdermal delivery of various therapeutics to treat bacterial infection. Here, a facile strategy was developed to synthesize active pharmaceutical ingredient poly(ionic liquid)-based microneedle patches by anion-exchange with salicylic acid anion (SA−). The fabricated SA-loaded PIL-MNs are active on not only anti-bacteria but also anti-inflammation in P. acnes treated mice, and may have potential applications for skin acne infection.

Antioxidant, Anti-inflammatory, Cytotoxic and Analgesic Activities of Sensevieria trifasciata

Sansevieria trifasciata is a common perennial ornamental plant which freely grows and widely found in homes, parks, and woodlands. Traditionally, this plant has been used against acne, allergy, helminths and fungal infections. In the present study, the ethanolic extract of leaves of Sansevieria trifasciata (STET) has been used to study the phytoconstituents and several bioactivities. In vitro antioxidant activity of STET has been determined by DPPH scavenging assay and measuring the total tannins and phenolic contents. Anti-inflammatory activity has been evaluated by hypotonic solution and heat induced hemolysis. Moreover, cytotoxic and analgesic activities have also been evaluated by brine shrimp lethality assay and acetic acid induced writhing inhibition method, respectively. STET confirmed the presence of reducing sugar, combined reducing sugar, tannins, flavonoids, glycosides, proteins and steroids. In DPPH scavenging assay, STET revealed the IC50 value 2.19 μg/ml whereas the standard showed 1.39 μg/ml. In addition, the total tannins and total phenolic contents were found to be 10.78 mg and 31.99 mg GAE/g of dried plant extract, respectively. In hypotonic solution induced hemolysis test, the plant extract exhibited 39.27, 37.04 and 33.19 % inhibition at 0.5, 1.0 and 2.0 mg/ml concentration where the reference standard displayed 30.57 % inhibition. In heat-induced hemolysis, the STET also displayed 34.25 % inhibition of hemolysis at 1 mg/ml. Furthermore, in analgesic and cytotoxic activity tests, STET showed potential activities in a dose dependent manner. The results of the present studies suggest that STET has antioxidant, anti-inflammatory, cytotoxic and analgesic activities. Bangladesh Pharmaceutical Journal 23(2): 195-200, 2020

Is there an association between long-term antibiotics for acne and subsequent infection sequelae and antimicrobial resistance? A systematic review protocol

IntroductionAntimicrobial resistance (AMR) is a global health emergency. Acne vulgaris is a highly prevalent condition and the dominant role antibiotics play in its treatment is a major concern. Antibiotics are...

Miracles of Herbal Phytomedicines in Treatment of Skin Disorders: Natural Healthcare Perspective.

Human skin is considered as the first line of defense and barrier against the majority of infections caused through the skin that affect humans. Healthy skin promotes a healthy body that can be achieved with the usage of modern, allopathic and natural remedies. Major skin ailments affecting humans are skin cancers, eczema, herpes infection, fungal infection, anti-aging, itching, insect bites, pemphigus vulgaris, trauma, psoriasis, athlete's foot infections, rashes, skin pigmentation, acne, major and minor wound infections that are slowly becoming a burden on health care. Skin infections can be treated from sources that originate from animals and plants. In spite of advancements in science and technology, the emergence of natural herbal remedies for managing skin disorders has become a pivotal and essential contributor in treating skin infections due to increased demand for herbals and their lower price, and continuous adverse effects of modern medicines. In the recent era, herbal extracts and their phytomedicines have made a vital contribution to human health care. Herbal products nowadays are considered as a single line of treatment for many diseases like Cancers, Diabetes, Cardiovascular and Brain disorders, thereby creating awareness regarding purity, efficacy and safety of herbal medicines for health care management. Many therapeutically active natural herbal resources like Aloe, Neem, Liquorice, Tulsi, Amla, Papaya, Ginger and Eucalyptus are potent and safe in the treatment of dermatological infections. This review article summarizes the significance of herbal plants for protecting, treating and minimizing skin infections through the utility of herbal pharmaceuticals like creams, decocted extracts, poultice, paste and lotions that aid in the treatment of skin infections and diseases at a relatively lower cost with lesser side effects as compared to modern and allopathic medicines.

375 The association between antibiotics for acne and subsequent infection sequelae and antimicrobial resistance: A systematic review

Background: Antimicrobial resistance (AMR) is a major global health priority and antibiotics are the leading contributor to increasing AMR. Acne is highly prevalent and antibiotics are widely used in its treatment. Average antibiotic use for acne ranges from a few months to many years. The dominant role antibiotics play in the treatment of healthy people with acne leads to questions about associations with AMR. Aim: To systemically search for and synthesize evidence around whether long-term oral antibiotic use in the treatment of acne in those over 8 years of age contributes to increased risk of infection or other outcomes suggestive of AMR. Method: We searched the following databases: Embase, MEDLINE, Cochrane and Web of Science using strategies developed with a librarian. Searches ran in July 2019 and date back to database inception. Inclusion criteria: RCT, cohort or case-control studies investigating oral antibiotics for minimum of 28 days compared to those with acne not treated with oral antibiotics or the general population. Primary outcome: antibiotic treatment failure or infection caused by a resistant organism. Data extraction and bias assessment using ROBINS-I were undertaken by three reviewers with medical and epidemiological training. Results: 6996 abstracts and titles were screened for eligibility, 73 full text papers were reviewed and seven studies were included comprising one RCT, five cohort studies and one case-control study. Due to heterogeneity it was not possible to perform meta-analysis. Four studies investigated changes to flora (total across studies n=141,20-60) and three susceptibility of infection (total across studies n=35,019,102-34,623) including pharyngitis and respiratory infections. Studies had mixed findings and most had a serious or critical bias risk. Conclusion: The relationship between long-term antibiotics for acne and infectious or resistance sequelae needs to be urgently addressed with more rigorous studies.