Acne Pustules Research Articles

Psychosocial impact of acne scarring: correlational study at Euderma Clinic Bali

Purpose: Acne scars are abnormalities in the contour and color of the skin that occur due to acne vulgaris, caused by increased tissue formation or local tissue damage and loss, which often causes disability, especially on the face. Acne scars often cause aesthetic, psychological, social, and emotional problems. This is a challenge for doctors to carry out comprehensive treatment strategies including primary, secondary, and tertiary prevention efforts. This research aims to determine the correlation between psychosocial impact and acne scars at the Euderma Clinic.
 Methods: The research method used was descriptive cross-sectional. The sampling technique used consecutive sampling, namely collecting participants who underwent acne scar management at the Euderma Clinic in the period May-July 2023. In this study, data collection was carried out using a questionnaire that included patient characteristics, acne history, and description of acne scars. The data was analyzed descriptively and correlatively for further data interpretation. 
 Results: Descriptive test results on 121 samples, mostly female (77.7%), mature (72.7%), had a history of untreated acne for > 12 months, (46.3%), and had a habit of squeezing. acne (53.7%), and the severity of acne pustules > 20 (51.9%). The appearance of acne scars is mostly mild (40.5%) and moderate (39.7%). The correlation test results show a close relationship between acne scars and psychosocial impacts. 
 Conclusion: The severity of acne scars in adults is mostly at the mild to moderate stage. Prevention efforts that can be taken are to carry out appropriate acne treatment so that inflammation does not prolong. Management of mild moderate acne scars can be done with laser procedures and subcision to increase patient confidence.

Development of skin sebum medium and inhibition of lipase activity in Cutibacterium acnes by oleic acid.

Cutibacterium acnes is associated with the exacerbated inflammation of acne vulgaris, which occurs through the immune induction and pathogenicity factor production. Sebum, which is not present in the growth medium currently used to study acne, is present in acne pustules in differing concentrations among the pathological stages, such as the initial formation and inflammatory phase. To evaluate the effect of C. acnes on inflammation exacerbation in acne pustules in vitro, we developed an skin sebum medium containing artificial sebum and studied the growth and pathogenicity factor production of C. acnes in the skin sebum medium. The growth and lipase activity of C. acnes ATCC11828 were tested using skin sebum medium containing different sebum concentrations. Only lipase activity decreased in the skin sebum medium culture containing 0.5 % sebum when compared with that without sebum, while both growth and lipase activity decreased in cultures with 1.0 % sebum. Therefore, the growth and lipase activity of C. acnes changed in the presence of sebum. Furthermore, when the growth and lipase activity of C. acnes were tested in skin sebum medium containing sebum components, unsaturated fatty acids, such as oleic acid and triolein, led to a decrease in lipase activity without inducing a change in growth. In the presence of oleic acid, C. acnes lipase activity decreased noncompetitively in a concentration-dependent manner. Our data showed that C. acnes growth and lipase activity changed upon sebum addition to the skin sebum medium, and acne inflammation caused by C. acnes needs to be studied under conditions similar to those in acne pustules.

633 Comparison of soluble proteins from skin sections of acne and TCA induced postinflammatory hyperpigmentation and erythema

Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis occurring after cutaneous inflammation or injury that can arise in all skin types, but more frequently affects skin-of-color. The differences in the ethology of PIH and Postinflammatory erythema (PIE) in skin of color were evaluated from soluble protein extracts collected from skin section samples, using Somascan protein kit1.3 k (n=5). The skin samples were collected from selected gluteal TCA-induced lesions and truncal acne pustules, of either PIH or PIE, at day 28 post initial evaluation.

An invivo model of postinflammatory hyperpigmentation and erythema: clinical, colorimetric and molecular characteristics.

Postinflammatory hyperpigmentation (PIH) is a common, acquired pigmentary disorder of the skin associated with significant quality-of-life impairment, especially in individuals with skin of colour. Current treatment for PIH is limited, largely due to a poor understanding of disease pathogenesis and the lack of a representative disease model. This study is intended to further develop, update and validate our previously designed invivo model of acne-induced PIH/postinflammatory erythema (PIE) using different concentrations of trichloroacetic acid (TCA), a medium-depth chemical peel. Twenty-nine patients with skin types II-VI and clinician-confirmed presence of two or more truncal acne pustules and PIH/PIE were included. On the basis of Investigator's Global Assessment (IGA), clinical polarized photography (CPP), colorimetry and Skindex, we experimentally determined an optimum TCA concentration and assessed our model's ability to exhibit a dose-response relationship between degree of inciting insult and severity of resulting pigmentation. We also performed differential microRNA profiling and pathway analysis to explore the potential of microRNAs as molecular adjuncts to our model. Application of TCA 30% produced lesions indistinguishable from acne-induced PIH and PIE lesions on the basis of colorimetry data without causing epidermal necrosis. Application of progressively increasing TCA doses from 20% to 30% resulted in concentration-dependent increases in CPP, IGA and colorimetry scores at all timepoints during the study. miRNA-31 and miRNA-23b may play a role in PIH pathogenesis, although further validation is required. Our TCA-based invivo model, using TCA concentrations between 20% and 30% with an optimum of 30%, enables the quantitative assessment of the pigmentary response to varying degrees of cutaneous inflammation in a fashion that mirrors natural acne-induced PIH and PIE.

Bacterial Aetiology and Susceptibility of Pathogens Associated with Acne Vulgaris

Introduction: Acne vulgaris is a pilosebaceous disorder among youth during puberty and also in young adults. Hormonal imbalance, bacterial activity and inflammation can cause acne formation. Due to some anti-inflammatory effects and temporary self treatment of acne using some antibiotics, there is overuse/ improper use of antimicrobial agents which leads to resistance in bacterial strains. Aim: To provide an overview of bacteria that may cause acne and determine their susceptibility to antibiotics and reduce the overuse of antibiotics which leads to antibiotic resistance. Materials and Methods: This was a cross-sectional study done on samples from from 100 patients with chief complaints of acne, attending Dermatology Department at Konaseema Institute of Medical Sciences and Research Foundation (KIMS RF). This study was done between November 2019 to February 2021. Acne pustules were cultured on all the basic media like blood agar and Mac Conkey agar, under aerobic and anaerobic conditions. Bacterial identification was performed by gram staining and relevant biochemical tests. Antibiotic susceptibility was done based on the Clinical and Laboratory Standards Institute (CLSI) 2019. Data was calculated and analysed statistically by Statistical Package for Social Science (SPSS) version 21.0. Results: Total 100 participants were taken for the study. Females (63%) were more commonly affected as compared to males (37%) and the most commonly affected age group was teenage i.e., 10 to 20 years in both male and females. Among 100 subjects, 77 cases showed bacterial growth by aerobic and anaerobic culture and 23 cases showed negative for bacterial culture. All isolates were susceptible to rifampin (100%) (p<0.001). Propionibacterium acnes (P. acnes) was susceptible to doxycycline (88.8%) and minocycline (88.8%), while 22.3% was resistant to erythromycin, clindamycin, and tetracycline while 33.3% showed resistance to ofloxacin. Gram positive cocci like Staphylococcus epidermidis (S.epidermidis) was susceptible to the antibiotic minocycline and rifampin (100%); but resistant to quinolines like ofloxacin (52.5%) macrolides like erythromycin (62.5%), clindamycin (47.5%) and tetracycline (17.5%). The susceptibility of gram positive cocci like S. epidermidis to doxycycline was (87.5%), which was lower than that of P. acnes (88.8%). Staphylococcus aureus (S. aureus) was found to be sensitive to minocycline (90.9%), doxycycline (72.7%), clindamycin (63.6%), and tetracycline (63.6%); but it was resistant to macrolide like erythromycin (45.5%) and quinolines like ofloxacin (36.5%). Conclusion: This study suggested that bacterial culture and antibiotic sensitivity can be better suggested if the culture and sensitivity is available so that, sensitivity and resistant pattern is known. The use of clindamycin and macrolide (erythromycin) needs to be reduced as most gram positive cocci like S. epidermidis were resistant to both.

Dermal application of a Cimicifuga racemosa (CR)-containing cream has beneficial effects on acne

We have recently shown that the BNO 1055 extract of Cimicifuga racemosa rhizome contained 5- a -reductase inhibitory effects by which it inhibited growth prostate cancer cells in vitro and in vivo [Seidlova-Wuttke et al., Planta Medica 2550;72:521–6]. Hence, conversion of testosterone to the more active androgen 5- a -dihydro-testosterone (5- a -DHT) can be inhibited by this extract. Production of sebum and growth of facial and body hair is also stimulated by 5- a -DHT and its formation occurs locally through 5- a -reductase located in sebum-producing apocrine cells and in hair follicles. The development of acne is a result of overproduction of sebum which is often due to excessive 5- a -DHT action in the skin. This can possibly be inhibited by the 5- a -reductase inhibitor(s) present in CR. Therefore, we tested the efficacy of a dermal application of a CR extract. In this open study, the beneficial effects on androgenic acne in female and male patients were tested. The severity of facial or body rump acne ranged from moderate to severe and was documented photographically. Each patient was seen 4–8 weeks after initiation of local application of the CR-containing cream and the severity of acne was documented photographically again. In all cases, in both females and males, the severity of acne was significantly reduced. In 8 of the 12 patients, the acne pustules had totally disappeared. It is concluded that the Cimicifuga racemosa extracts present in the dermally used preparation have significant beneficial effects on acne which are most likely attributable to the 5- a -reductase inhibitory ingredients in Cimicifuga racemosa .

Demonstration of Polarizable Crystals in Fresh Comedonal Extracts: Sebum Crystallizes

Previous studies using paraffin-embedded sections showed the presence of varying degrees of lipidic calculus (sebolith) formation in the pilosebaceous duct in acne comedonal lesions. The objective of this study was to examine the content of fresh acne comedonal extracts and pustules in polarizable crystalline material. Furthermore, to investigate if the amount of crystalline material correlates with the morphology, evolutionary stage, age and location of the comedone we performed polariscopic examination of 20 fresh acne comedonal extracts and 6 acne pustules. As controls, we used extracts from solar comedones, milia and epidermal inclusion cysts, follicular extracts from acne rosacea lesions, pustules of bacterial folliculitis and extracts from normal follicles from acne-prone individuals. The vast majority of acne comedones contained considerable amounts of polarizable crystalline material. Crystallization was more prominent in closed comedones, long-standing macrocomedones and conglobate comedones. Crystal formation was seen less commonly (p < 0.01) in solar comedones, milia and epidermal inclusion cysts. As shown in this study, crystallization of sebum is a common element of comedogenesis and may possibly contribute to comedo preservation.

420 nm intense continuous light therapy for acne

BACKGROUND: Topical antibiotics, isotretinoin or systemic antibiotics are usually used for acne therapy. However, isotretinoin cannot be used during pregnancy because it can cause significant birth defects while systemic antibiotics can have adverse side effects such as gastrointestinal irritation, photosensitivity and tetracycline sensitivity. Describe here is a high-intensity, narrow-band, blue light (ClearLight) system, and its therapeutic clinical effect is investigated on acne using cutaneous measurements, bacterial observations and ultrastructural changes. MATERIALS AND METHODS: A total of 28 adult healthy volunteers with facial acne (mean age 28.1 years, range 16-56 years) were recruited for this study. They were treated with a total of eight serial biweekly 15-minute treatment sessions. Clinical counts of acne, as well as moisture, sebum and pH measurements were taken between each session. Nine of the 28 patients were followed for 2-3 months after the last treatment. Detection of bacteria in acne pustules was analyzed by culture and by polymerase chain reaction (PCR). Ultrastructural changes were examined in eight patients after four sessions of the light therapy. RESULTS: All patients completed the study. Overall, there was a 64.7% improvement in acne lesions. There were no bacterial changes before or after the therapy, although damaged Propionibacterium acnes were observed at the ultrastructural level. CONCLUSIONS: ClearLight performed eight times over 4 weeks can be useful in the treatment of acne. Further investigation will be needed to elucidate the mechanism of action of ClearLight.

Extraspinal enthesopathy caused by isotretinoin therapy

Objective: To discuss a case of diffuse pe-ripheral enthesopathy in a patient previously treated with long-term isotretinoin (Accutane) for severe acne. Clinical Features: A 47-year old man with 1 month history of moderate neck and right upper extremity pain, with hypoesthesia of the right second and third fingers. Palpable bony prominences around multiple superficial joints were noted on physical examination, raising the initial question of osteochondromatosis. Multiple active acne pustules were noted. A limited skeletal survey demonstrated diffuse peripheral enthesophyte formation and hyperostoses, resembling those of diffuse idiopathic skeletal hyperostosis, but without accompanying spinal changes. A history of long-term Accutane therapy was then elicited. Intervention and Outcome: The enthesopathy was believed to represent an asymptomatic, long-standing, iatrogenically induced abnormality. No specific therapy or follow-up was indicated. The patient had discontinued use of Accutane years ago. Cervical symptoms improved with four sessions of cervical traction and nonsteroidal anti-inflammatory medications, but upper extremity symptoms were refractory. Conclusion: Accutane-induced enthesopathy should be considered in individuals with correlating radiologic and clinical features and history of retinoic acid therapy for acne. This should be a diagnosis by exclusion, after eliminating other potential causes of peripheral enthesopathy, particularly diffuse idiopathic skeletal hyperostosis, seronegative spondylarthropathy, and fluorosis. (J Manipulative Physiol Ther 1999;22:417-20)

In Vitro Study of Antibacterial action of Various Chemicals on Corynebacterium acnes

Six strains of Corynebacterium acnes , isolated directly from acne pustules, were tested for their susceptibility to various levels of hexachlorophene, bithionol, cetyl pyridinium chloride, propylparaben, p -chloro- m -xylenol, salicylic acid, and resorcinol. The zones of inhibition produced in agar cups by these agents in a seeded anaerobic medium with and without 0.25 per cent synthetic sebum were measured. In the absence of sebum, hexachlorophene and bithionol produced the largest zones over a wide range of concentrations. Although the zones produced by all the compounds were decreased significantly in the presence of the synthetic sebum, p -chloro- m -xylenol was least affected.

Antibiotic Sensitivity of Corynebacterium Acnes (Propionibacterium Acnes)

The role of microorganisms in the pathogenesis of acne has been open to considerable debate ever since Unna detected a short, pleomorphic bacillus in histologic sections of comedones (1). This organism, known as Corynebacterium acnes (Propionibacterium acnes), was first isolated by Sabouraud from acne pustules, and it was felt to play an important role in acne (2). However, when subsequently it was cultured from normal skin (3), its significance in acne was seriously questioned.

Role of antibiotics in therapy of acne.

THE ROLE of pyogenic bacteria in the production of acne pustules has evoked considerable discussion among dermatologists, and there is a wide divergence of opinion concerning its importance. Comparative studies reveal that most authors agree that the management of the recurrent cystic and large indurated acne lesions presents a therapeutic challenge. In Becker's series of 65 patients he performed bacteriologic studies and recovered hemolytic Staphylococcus albus in 7, nonhemolytic Staphylococcus albus in 25, hemolytic Staphylococcus aureus in 3, nonhemolytic Staphylococcus aureus in 12, a mixed growth of bacteria in 8, and no growth in the remaining 10. Sensitivity tests indicated that the organisms were more highly sensitive to penicillin than to the other antibiotics; however, clinical tests did not support these findings. Sulzberger and Baer reported excellent results with local injections of aqueous solutions of penicillin and of bacitracin directly into the cystic lesions after aspiration of the