Acne Research Articles

Impact of Acne on the Quality of Life of Adolescents in the Territory of the Northern and Southern Regions of Montenegro.

Acne vulgaris is a chronic inflammatory disease predominantly known as a disease of adolescents. We aimed to assess the quality of life of adolescents with acne in the territory of northern and southern regions of Montenegro. This cross-sectional study was conducted in 2024, in four secondary schools in the north and south of Montenegro with total number of 561 subjects. To assess the quality of life of adolescents with acne we used the Children's Dermatology Life Quality Index and to measure acne-related disability we used The Cardiff Acne Disability Index. The average value of the total CDLQI score among adolescents from the northern region of Montenegro was 4.45±3.31, and 4.03±3.50 among southern region. The average value of the total CADI score among adolescents from the northern region of Montenegro was 3.56±1.77, and 3.50±1.98 among adolescents from the southern region. A statistically significantly higher mean value of sub scores in adolescents from the northern region compared to adolescents from the southern region existed in the domain of symptoms and feelings, vacation and treatment (P< 0.05). The regression analysis was also performed. This study confirms the negative impact of acne on the quality of life of Montenegrin adolescents, especially those in the northern region. It is necessary to give more attention to the acne problems from doctors, and to increase awareness among adolescents and provide them early and the most effective therapy.

Epidemiology and Healthcare of Juvenile and Late-Onset Acne: Claims Data Analysis.

Acne is the most frequent chronic inflammatory skin condition in adolescence but occurs also in later age. Our study aimed to characterise the epidemiology, geographical distribution, comorbidity and healthcare of acne juvenilis (AJ) and acne tarda (AT). Statutory health insurance (SHI) data from 2016 to 2020 were analysed. Prevalence rates, including geographical distribution, comorbidities and drug use by specialists group, were measured. In 2020, the prevalence of acne among adults was 1.50% (AT > 25years) and among adolescents was 3.88% (AT ≤ 25years). The highest prevalence (13.02%) was observed at the age of 17 years. Sex differences were higher in AT (73.80% in women) than in AJ (64.55% in women). Compared with non-affected persons, individuals with acne - in particular with AT - showed significantly higher rates of skin-related comorbidities, including folliculitis (rate ratio (RR) 8.89), pyoderma (RR 7.27) and rosacea (RR 5.53), and non-skin-related comorbidities, such as ovarian dysfunction (RR 2.36), rhinitis allergica (RR 1.84) and Crohn's disease (RR 1.79). Preferred systemic therapeutics prescribed were anti-infectives in AT (46.86%) and retinoids in AJ (52.35%). In the majority of cases, dermatologists were involved in the treatment of acne (AT 65.77%; AJ 76.27%). The most commonly prescribed topical agents were adapalene with benzoyl peroxide (AT 87.72%; AJ 85.75%), while systemic isotretinoin (AT 81.20%; AJ 90.06%) was also a frequently used drug. General practitioners were more likely to prescribe anti-infectives, especially topical antibiotics such as chlortetracycline (AT 52.38%; AJ 44.44%) and systemic antibiotics, especially tetracycline (AT 58.33%; AJ 67.50%). Acne affects a relevant proportion of the German population not only in adolescence, and management of this inflammatory skin disease does not naturally follow medical guidelines or specialist recommendations. These findings emphasise the importance of specialised care and comprehensive therapeutic management that should also consider the exploration of comorbidities.

Tetracyclines revisited: tetracyclines in the field of dermatology.

Tetracyclines are a class of broad-spectrum antibiotics favored by dermatologists. Over the last decade, the clinical efficacy of tetracyclines has expanded into various dermatoses. This review tries to encompass the possible indications of tetracycline in the field of dermatology and possible mechanisms of action. This comprehensive review encompasses all possible indications of tetracyclines besides acne vulgaris and rosacea: hidradenitis suppurativa, autoimmune bullous dermatoses, vitiligo, alopecia, prurigo pigmentosa, granulomatous dermatoses, Kaposi sarcoma, cold urticaria, atopic dermatitis, scrub typhus, scarring, and miscellaneous dermatoses. We also focus on the recently approved sarecycline, a third generation narrow-spectrum tetracycline, and its clinical efficacy and potential impact on the microbiome. Our review provides a better understanding of this extremely familiar drug class and encourages its use in a wider spectrum of dermatologic diseases and symptoms.

Unveiling new protein biomarkers and therapeutic targets for acne through integrated analysis of human plasma proteomics and genomics.

The current landscape of acne therapeutics is notably lacking in targeted treatments, highlighting a critical need for the discovery of new drug targets to improve treatment outcomes. This study aims to investigate the connections between proteomics and genetics in relation to acne across extensive population cohorts, aspiring to identify innovative preventive and therapeutic approaches. Employing a longitudinal cohort of 54,306 participants from the UK Biobank Pharmacological Proteomics Project (UKB-PPP), we performed an exhaustive evaluation of the associations between 2,923 serum proteins and acne risk. Initial multivariate Cox regression analyses assessed the relationship between protein expression levels and acne onset, followed by two-sample Mendelian Randomization (TSMR), Summary-data-based Mendelian Randomization (SMR), and colocalization to identify genetic correlations with potential protein targets. Within the UKB cohort, we identified 19 proteins significantly associated with the risk of acne. Subsequent analysis using Two-Sample Mendelian Randomization (TSMR) refined this to two specific proteins: FSTL1 and ANXA5. Each one-standard deviation increase in the expression levels of FSTL1 and ANXA5 was associated with a 24% and 32% increase in acne incidence, respectively. These results were further validated by additional Summary-data-based Mendelian Randomization (SMR) and differential expression analyses. Our comprehensive analysis of proteomic and genetic data from a European adult cohort provides compelling causal evidence that several proteins are promising targets for novel acne treatments.

New insights from the integration of dapsone, flutamide, tea tree oil, and rose oil as a topical combined microemulsion for the management of Acne Vulgaris: Design, development, and in vitro/in vivo characterization

Acne vulgaris (AV) is a multifactorial sebaceous glands disorder resulting from androgen receptor activation associated with follicular colonization by bacteria. Oral administration of the androgenic antagonist flutamide (FLU) and the antibacterial dapsone (DAP) may cause several side effects. Hence, this study aimed to design a topical microemulsion (ME) combining these drugs to manage AV. Drugs solubility was examined in different oils, surfactants and cosurfactants. Pre-formulation and compatibility studies were performed. The selected MEs were characterized to determine one ME to be investigated regarding stability, and skin irritation as well as antibacterial, anti-inflammatory, and anti-acne activities. Based on the in vitro characterization of the selected MEs, o/w ME (F1) based on 15 % w/w oils (tea tree oil (TTO)/rose oil (RO)) and 40%w/w of tween 20 as surfactant together with transcutol p as co-surfactant was chosen as the optimized ME. The results revealed that F1 showed acceptable pH, viscosity, conductivity, and droplet size (172.6 ± 9.7 nm). The in vitro release and ex vivo permeation of DAP and FLU were efficiently enhanced by their combination in F1. Moreover, F1 exhibited considerable antimicrobial activity against Staphylococcus aureus (S. aureus). Topical application of F1 resulted in low expression levels of interleukin 1β associated with a reduction in the number of androgenic receptors (AR). In conclusion, F1 could be suggested as a combination topical therapy to control AV via its anti-inflammatory, anti-acne, and antimicrobial activities.

Impact of Comorbidities and Skin Diseases on Post-Vaccination Reactions: A Study on COVID-19 Vaccinations in Poland.

Background: The COVID-19 pandemic necessitated rapid and widespread vaccination efforts, which proved critical in reducing the severity and mortality of the virus. However, the interplay between vaccinations, pre-existing skin conditions, and other comorbidities still needs to be explored. This study investigated the occurrence and severity of adverse events following immunization (AEFIs) with COVID-19 vaccines in individuals with chronic skin diseases and comorbidities within a Central European cohort. Methods: An anonymous online survey was conducted between May 2022 and February 2023, targeting students and employees of universities in Wrocław, Poland. A total of 513 respondents were analyzed, focusing on AEFIs following the first, second, and third doses of COVID-19 vaccines and the effects of COVID-19 on conditions such as atopic dermatitis, psoriasis, vitiligo, acne vulgaris, rosacea, and various comorbidities. Results: COVID-19 vaccination effectively protected against severe disease across all doses. The analysis revealed no significant impact of either COVID-19 infection or vaccination on the course of selected skin diseases and comorbidities. The reporting of AEFIs to the Sanitary Inspection was notably low. The Moderna and Pfizer mRNA-based vaccines were associated with a higher reported number of AEFIs, particularly after the second and third doses, compared to AstraZeneca, which exhibited fewer adverse events after subsequent doses. Conclusions: COVID-19 vaccination is both safe and effective, even in patients with pre-existing skin conditions and comorbidities. Vaccine selection may benefit from considering individual health profiles, and better reporting of AEFIs is needed to enhance vaccine safety monitoring.

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

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

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

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

A study of granulysin and pentraxin 3 genetic polymorphisms and their contribution to acne susceptibility.

This study aims to examine the genetic polymorphisms of the granulysin (GNLY) and pentraxin 3 (PTX3) genes and their association with acne in Egypt. Acne vulgaris is classified as a disorder of the pilosebaceous unit. Clinical, histological, and immunological findings indicate that inflammation is involved in every stage of acne development. GNLY and PTX3 are both involved in the body's immune system and may play a role in the pathophysiology of acne. This case-control study included 180 participants who have acne and 180 healthy controls. Real-time PCR was used to genotype GNLY rs7908 and PTX3 rs2305619 polymorphisms. Genotype occurrence and allelic spreading for both single nucleotide polymorphisms (SNP) are in Hardy-Weinberg equilibrium. Regarding rs7908, no statistical difference was observed in the genotype and allele distributions between acne patients and controls. On the other hand, rs2305619 showed a statistical difference in the genotype and allele distributions between acne patients and controls, with a marked prevalence of the GG group and G allele in acne patients. Our study revealed a significant link between the PTX3 rs2305619 and acne susceptibility in Egypt, with the AG + GG genotype strongly predicting acne. In contrast, the GNYL rs7908 polymorphism was not associated with acne. These results highlight a genetic component to acne and suggest that PTX3 rs2305619 could be a key marker for understanding acne susceptibility.

VP-net: an end-to-end deep learning network for elastic wave velocity prediction in human skin in vivo using optical coherence elastography.

Acne vulgaris, one of the most common skin conditions, affects up to 85% of late adolescents, currently no universally accepted assessment system. The biomechanical properties of skin provide valuable information for the assessment and management of skin conditions. Wave-based optical coherence elastography (OCE) quantitatively assesses these properties of tissues by analyzing induced elastic wave velocities. However, velocity estimation methods require significant expertise and lengthy image processing times, limiting the clinical translation of OCE technology. Recent advances in machine learning offer promising solutions to simplify velocity estimation process. In this study, we proposed a novel end-to-end deep-learning model, named velocity prediction network (VP-Net), aiming to accurately predict elastic wave velocity from raw OCE data of in vivo healthy and abnormal human skin. A total of 16,424 raw phase slices from 1% to 5% agar-based tissue-mimicking phantoms, 28,270 slices from in vivo human skin sites including the palm, forearm, back of the hand from 16 participants, and 580 slices of facial closed comedones were acquired to train, validate, and test VP-Net. VP-Net demonstrated highly accurate velocity prediction performance compared to other deep-learning-based methods, as evidenced by small evaluation metrics. Furthermore, VP-Net exhibited low model complexity and parameter requirements, enabling end-to-end velocity prediction from a single raw phase slice in 1.32ms, enhancing processing speed by a factor of ∼100 compared to a conventional wave velocity estimation method. Additionally, we employed gradient-weighted class activation maps to showcase VP-Net's proficiency in discerning wave propagation patterns from raw phase slices. VP-Net predicted wave velocities that were consistent with the ground truth velocities in agar phantom, two age groups (20s and 30s) of multiple human skin sites and closed comedones datasets. This study indicates that VP-Net could rapidly and accurately predict elastic wave velocities related to biomechanical properties of in vivo healthy and abnormal skin, offering potential clinical applications in characterizing skin aging, as well as assessing and managing the treatment of acne vulgaris.

A Mendelian randomization analysis of inflammatory skin disease risk due to mineral deficiencies.

Mineral deficiencies, such as iron (Fe), zinc (Zn), and selenium (Se), play crucial roles in inflammation and immune responses and are linked to chronic inflammatory skin diseases. This study used genome-wide association study (GWAS) data and Mendelian randomization (MR) to investigate the genetic causality among serum levels of five minerals (Fe, Cu, Zn, Se, Ca), three iron metabolism indicators (TSAT, TIBC, ferritin), and three chronic inflammatory skin diseases [psoriasis (PS), atopic dermatitis (AD), acne vulgaris (AV)]. Two-sample MR analyses using the "TwoSample MR" package in R were conducted with aggregate outcome data from the FinnGen database. The inverse-variance-weighted (IVW) method was applied to assess causal relationships between mineral levels and disease outcomes. Robustness was examined via heterogeneity and pleiotropy tests. IVW analysis showed significant association between blood transferrin saturation (TSAT) and PS (p = 0.004, OR = 1.18). Serum Zn and Se levels showed inverse correlation with AD (p = 0.039, OR = 0.92). However, due to limited SNPs, robustness was reduced. TSAT is genetically linked to PS, highlighting iron homeostasis in disease development. Zn and Se intake may reduce AD risk.

Pulsed Wave Mode of Fractional Radiofrequency Microneedling as a New Advance in the Treatment of Inflammatory Acne Vulgaris

Inflammatory acne vulgaris (IAV) is a common skin condition characterized by the presence of reddish, inflamed, and painful lesions on the skin. IAV can drastically affect individuals, specifically their self-esteem, psychological health, and quality of their life in general. Despite new advances in the field, traditional treatment modalities withstand many challenges. Hence, in the current study, we sought to assess the efficacy and safety of a new pulsed wave mode of the fractional microneedling radiofrequency device in the treatment of IAV. This advanced technique employs insulated microneedles to administer energy to the deep dermis without causing damage to the epidermis. Eighty patients (40 males, 40 females, age 21 ± 3, Fitzpatrick skin type III and IV), with acne severity ranging from moderate to severe, were employed in this trial. They were randomly assigned into two groups, 40 patients each. The treated group (A) underwent four sessions of fractionated microneedle RF, 1.5-month apart, whereas group B was designated as the control group that received placebo treatment. Six months following the last session, the degree of improvement assessed by the quantity of IAV lesions and the overall skin appearance in terms of facial pores, sebum excretion, scar, skin tone, and texture. The RF-treated group showed significant improvement compared to the control group after the follow-up period (p-value = 0.0071). Regarding safety, very mild adverse effects were reported, such as discomfort during the session, pinpoint hemorrhage, and erythema, with no major side effects such as burns, scarring, hyperpigmentation, or hypopigmentation were reported. Thus, our data suggest a potential role of the fractional microneedling radiofrequency device in IAV treatment that is both effective and safe.

Prevalence of Acne Vulgaris in Adolescents and Young Adults in Al-Baha Region, Saudi Arabia.

Introduction Acne vulgaris affects 9.4% of the global population, primarily targeting teenagers, and persists into adulthood. It is considered a major health challenge in Saudi Arabia due to its high prevalence, but there is a lack of studies in Al-Baha City, Saudi Arabia. Therefore, our goal is to estimate the prevalence of acne vulgaris in Al-Baha, which, in turn, may guide the education of those who are affected and help develop preventive measures. Methodology This is an observational cross-sectional study targeting adolescents and young adults in Al-Baha. The data was collected using an online version of a questionnaire designed to achieve the study's objectives. Data was collected in Excel(Microsoft Corporation, Redmond, Washington, United States) and imported into R software version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/). Result Approximately 70.2% (n=641) of the participants either currently have or have experienced acne, with the majority experiencing it on their faces (92%, n=451). The likelihood of experiencing acne was higher among individuals aged 23-25 years and females. The majority of participants assessed their acne as moderate (65%, n=292). Severe acne was associated with a higher risk of low mood and low self-esteem (p < 0.001). Conclusion Almost two-thirds of the participants (70.2%, n=641) reported either currently having or having experienced acne. Therefore, awareness should be raised about acne vulgaris and its management.

Psychological Impact of Acne and Post Inflammatory Hyperpigmentation Among Sudanese Women

&amp;lt;i&amp;gt;Introduction: &amp;lt;/i&amp;gt;Acne vulgaris is a chronic inflammatory disorder of the skin which often causes a negative impact on a woman&amp;apos;s psychological state and quality of life. This study seeks to provide basic data and information about the psychological impact of acne on Sudanese women. &amp;lt;i&amp;gt;Methodology: &amp;lt;/i&amp;gt;A cross-sectional questionnaire-based study was conducted during the period from June 2022 to January 2023. A total of 400 females aged 15 years and above were included in this study. These are Sudanese women who had suffered from acne in their lives, and who responded to the online study questionnaire. Cardiff Acne Disability Index (CADI) was used to assess the psychological effect of acne.&amp;lt;i&amp;gt; Results: &amp;lt;/i&amp;gt;Seventy one percent of respondents had active acne. Acne scars were observed in (74.8%) of participants, while post-acne hyperpigmentation was observed in (71.3%). Facial acne was the most common, as it was observed in (75.8%) of the respondents. The mean age at acne onset was 15.66 years and ranged between 10 and 36 years. Mild and moderate acne were the most common types, accounting for (37.0%) and (41.5%) of cases, respectively. Acne was found to affect the psychological state of the vast majority of the respondents (89%). Cosmetics or makeup were used by (42.3%) of the respondents to conceal acne and scars. Late onset of acne treatment was reported in (42%) of the cases. Most respondents (72.5%) visited doctors to treat acne. The mean Cardiff Acne Disability Index (CADI) score was 4.55, which reflects mild effects of acne on the quality of life of most of the respondents. The adverse psychological impact was found to be significantly associated with increased acne severity, scarring, and hyperpigmentation as well as with university educated respondents. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;It was found that acne has mild effects on the quality of life of Sudanese women. Late onset of acne treatment resulted in widespread scarring and post-inflammatory hyperpigmentation in most participants, which was associated with the psychological impact of acne. There is an urgent need to encourage early treatment of acne to reduce the physical sequalae of acne to reduce the psychosocial consequences associated with the disease and the risk of scarring and hyperpigmentation on Sudanese women. Sudanese health authorities and Sudanese doctors can address this issue through education and awareness programs.

A survey on healthcare professionals’ perspective on the use of benzoyl peroxide cleanser for acne management

Background: Acne vulgaris is a prevalent chronic dermatological condition affecting adolescents and young adults, with significant consequences on quality of life if left untreated. Effective management strategies are crucial to prevent scarring and psychological distress associated with acne. This study investigated the role of cleansers in acne management and explored healthcare professionals' perspectives and practices regarding acne treatment. Methods: An online questionnaire-based study, involving 126 healthcare professionals [HCPs (dermatologists and cosmetologists)] and 459 acne patients was conducted to assess patients’ acne severity, adherence to cleansing regimens, preferred cleansing agents, treatment duration, adjunctive therapies, and the impact of benzoyl peroxide 5% cleanser on acne control and patient satisfaction. Results: The majority of the patients presented with an IGA grade 3 (moderate) acne (48.59%) in the present survey. HCPs rated benzoyl peroxide as the most preferred cleansing agent for acne management in most of their patients (87.33%). Majority of the patients (41.53%) exhibited improvement within 15 days of using the benzoyl peroxide cleanser, highlighting its relatively rapid onset of action. The benzoyl peroxide treatment duration varied for patients, emphasizing the individualized nature of acne treatment. In most of the severe cases (39.87%), HCPs commonly supplemented benzoyl peroxide with topical retinoids, oral antibiotics, oral isotretinoin, or combination therapy. Conclusions: This study emphasizes the effectiveness and preference for benzoyl peroxide-based cleansers among HCPs and patients.

Dermocosmetics in the management of Acne Vulgaris

Dermocosmetics in the management of Acne Vulgaris

Computational Studies in Dermo-cosmetics: In silico Discovery of Therapeutic Agents Targeting a Variety of Proteins for Skin Diseases.

Healthy skin is essential for balanced health. Currently, skin diseases are considered a major global health issue, impacting individuals of all ages. Skin conditions can vary broadly, ranging from common issues like acne and eczema to more serious diseases such as psoriasis, melanoma, and other types of skin cancer. In recent years, computational methods have appeared as powerful tools for explaining the lurking mechanisms of skin diseases and the advancement of the discovery regarding updated therapeutics. This review spotlights the notable researches that have been performed in using computational approaches such as virtual screening, molecular modelling, and molecular dynamics simulations to discover potential treatments for dermatological conditions such as eczema, psoriasis, acne vulgaris, skin cancer, and tyrosinase-related disorders. Moreover, using in silico methods, researchers have explored the molecular interactions between cosmetic actives and skin targets, providing insights into the binding affinities, stability, and efficacy of these compounds. This computational exploration allows the identification of potential off-target effects and toxicity profiles, ensuring that only the most promising candidates proceed to clinical testing. In addition, the use of molecular dynamics simulations helps to understand conformational changes and interaction dynamics over time, further refining the selection of effective cosmetic actives. Overall, the integration of computational chemistry into dermo-cosmetic research has immense potential to accelerate the discovery and development of innovative treatments to improve skin health and address dermatological concerns.

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

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

Re-evaluating the necessity of routine laboratory monitoring during isotretinoin therapy for acne.

In this letter, we discuss the topic of necessity of routine laboratory monitoring during isotretinoin treatment for acne. According to Park and colleagues, it is advisable to monitor the levels of triglycerides, alanine aminotransferase, and aspartate aminotransferase every 5 to 6 months. Additionally, the levels of total cholesterol and low-density lipoprotein should be checked within the first two months of treatment. Isotretinoin is a commonly prescribed agent mainly used to treat acne. Despite its high effectiveness, it necessitates regular monitoring of laboratory parameters due to its side effect profile. Currently, there remains a lack of consensus on the appropriate frequency for monitoring these parameters during treatment with isotretinoin. This letter will provide insight into this complex and controversial topic. Based on existing literature, we concluded that the incidence of changes in lipid and liver aminotransferase levels during isotretinoin treatment for acne was low and likely clinically insignificant. For generally healthy people, we recommend testing lipid and liver profiles once at baseline and a second time at the peak dosage. However, frequent testing might still be beneficial in certain populations of patients.

Acne and rosacea: similarities and differences. A review

Acne and rosacea are frequently encountered in the clinical practice of a dermatologist. These diseases can develop simultaneously in the same patient. Most often, the erythematous form of rosacea is combined with acne. Because of the similarity of clinical manifestations with acne, the diagnosis of rosacea can be easily missed. Common pathogenetic factors in the 2 diseases are thought to be genetics, alterations in the microbiome, immune disorders, and skin barrier dysfunction. There are few works addressing the relationship between acne and rosacea. A recent study identified a number of common differentially expressed genes, including interleukin-1B and matrix metalloproteinase 9, and showed that gamma delta T cells may play an important role in the development of both diseases. Despite the common pathogenesis and the similarity of some clinical manifestations (papules and pustules), acne and rosacea must be distinguished. In rosacea, there is persistent facial erythema induced by vasoregulatory neutropeptides, whereas in acne, the inflammatory process is due to excess sebum and changes in the skin microbiome. Isotretinoin is used for systemic therapy of both diseases. The drug affects the level of some cytokines, including inhibiting the expression of matrix metalloproteinase 9. In addition, it reduces sebum production in acne, and due to its ability to alter the skin microenvironment, it can reduce Propionibacterium acnes in acne and Demodex folliculorum in rosacea. Daily and cumulative doses for rosacea and acne will differ, as will topical therapy for these conditions. For acne, the combination of clindamycin and benzoyl peroxide is well established for the treatment of acne, allowing rapid meaningful clinical effect. In rosacea, metronidazole in cream form, which has better tolerability, is recommended as a topical agent. In patients suffering from both diseases simultaneously, a combination of clindamycin and benzoyl peroxide should be used to relieve acute inflammation, after which it is possible to switch to metronidazole.