Acne Severity Research Articles

The role of microcomedones in acne: Moving from a description to treatment target?

A major factor in the pathogenesis of acne is ductal hyperproliferation in the pilosebaceous glands. This takes the form of invisible microcomedones and leads to the subsequent formation of both inflammatory and non-inflammatory clinical lesions. Microcomedones are the initial stage in the cyclical development of acne, so called comedogenesis. Microcomedones can be detected using cyanoacrylate skin surface stripping, electron microscopy, reflection confocal microscopy and other techniques. It has been proposed that the density and the size of microcomedones are positively correlated with acne severity. Thus, the purpose of this review is to summarize the root causes of acne, and suggest that treatment of microcomedones could, at least in part, resolve acne lesions and prevent relapse.

Acromegaly presented with acne vulgaris: a retrospective study with 123 cases.

Acne vulgaris is a prevalent skin condition. We have found that some acromegaly patients have acne. However, no study has examined the relationship between acromegaly and acne. To explore prevalence and correlation of adult acne in patients with acromegaly. For this cross-sectional study, we collected questionnaires, clinical information, and laboratory test results of acromegaly patients from January 2022 to December 2022 at Huashan Hospital. Of the 133 questionnaires returned, 123 had valid responses. Of the 123 patients with acromegaly enrolled in this study, 54.5% had adult acne. No statistically significant difference was found in prevalence between male and female patients. 61.2% of adult acne patients reported late-onset acne. Late-onset acne patients first developed acne years before acromegaly diagnosis (mean of 5.6years for male and 4.5years for female patients). Some acne patients have received traditional anti-acne treatment. Moreover, 31% of the patients reported no improvement, and only 3.5% of patients claimed complete resolution of acne after treatment. Before acromegaly treatment, the prevalence of adult acne was 51.2%, with mild acne accounting for 73.0%, moderate acne accounting for 23.8%, and severe acne accounting for 3.2%. After acromegaly treatment, the prevalence of adult acne was significantly decreased to 37.4% (P = 0.007). An overall decrease in acne severity was noted, with 93.5%, 6.5%, and 0% having mild, moderate, and severe acne, respectively. A total of 83.6% of the patients had self-assessed acne remission, and 33.3% of the patients reported complete acne resolution. However, 9.0% of patients reported that their condition had worsened after acromegaly treatment. After treatment, GH, IGF-1, IGF-1 index, insulin levels, and HOMA-IR decreased significantly in all patients with acromegaly (P < 0.05). Acne remission correlated positively with IGF-1 levels, but not with GH levels. The relationship between acromegaly and acne remains to be elucidated. Our findings provide preliminary evidence of the high prevalence of adult acne in acromegaly patients, and a high rate of late-onset acne as well. Traditional anti-acne treatments are less effective. Acne could be considerably relieved by treating acromegaly. Acne remission positively correlated with IGF-1 decline as well, which revealed the correlation between acne and IGF-1.

Back to the Future: Is GnRHa Treatment in Transgender and Gender Diverse Adolescents Only an Extended Evaluation Phase?

The role of body modifications induced by gonadal suppression in transgender and gender diverse adolescents on psychological functioning has not yet been evaluated. The main aim of the present study was to explore several hormone, physical and psychological functioning changes during gonadotropin-releasing hormone analog (GnRHa) treatment in transgender and gender diverse adolescents (TGDAs). The potential relationship between the physical and hormone effects of GnRHa and psychological well-being, along with its magnitude, was assessed for the first time. This prospective multidisciplinary study included 36 TGDA (22 assigned female at birth, and 14 assigned male at birth) who received psychological assessment followed by triptorelin prescription after referring to the Florence Gender Clinic. This study consisted of 3 time points: first referral (T0), psychological assessment (T1); and treatment with intramuscular injections of triptorelin for 3 up to 12 months (T2). Psychometric questionnaires were administered at each time point, and clinical and biochemical evaluations were performed at T1 and T2. The following results were found: (1) GnRHa showed efficacy in inhibiting puberty progression in TGDAs; (2) an increase in psychopathology was observed before starting GnRHa (T1) compared with baseline levels; (3) during GnRHa treatment (T2), a significant improvement in psychological functioning, as well as decrease in suicidality, body uneasiness, depression, and anxiety levels were observed; (4) hormone and physical changes (in terms of gonadotropin and sex steroid levels, height and body mass index percentiles, waist-hip ratio, and acne severity) observed during triptorelin treatment significantly correlated with a reduction in suicidal ideation, anxiety, and body image concerns. Psychological improvement in TGDA on GnRHa seems to be related to the objective body changes induced by a GnRHa. Therefore, the rationale for treatment with a GnRHa may not only be considered an extension of the evaluation phase, but also the start of a medical (even if reversible) gender-affirming path, especially in TGDAs whose puberty has already progressed.

Efficacy and Tolerability of a Sunscreen Containing Licochalcone a and L-Carnitine as an Adjunct to Retinoids in the Management of Acne and Post-Acne Pigmentation Among Malaysian Patients.

We aim to evaluate the effectiveness and tolerability of a sunscreen formulation containing licochalcone A (LicA) and L-carnitine (LC) as an adjuvant to adapalene in the management of acne and post-acne pigmentation (PAH). A randomized, double-blind, active comparator-controlled trial of 51 patients aged 18 years or older with a clinical diagnosis of mild-to-moderate acne vulgaris was conducted at the Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. The efficacy and tolerability of once-daily adapalene 1.0% were assessed during the 2-week run-in period. Subsequently, patients were randomized to receive either an add-on investigational LicA-containing sunscreen or niacinamide-containing comparator sunscreen every 4 hourly during daytime for 4 weeks. Patients were followed up at Weeks 2 and 4 to assess for improvement in acne severity, PAH, calorimetric parameters and cutaneous tolerability. Two weeks of adapalene usage significantly improved acne severity; however, up to 52% of patients experienced dryness, burning and stinging. Adding LicA-containing or comparator sunscreens was associated with further improvement in acne severity, PAH and calorimetric parameters at the study endpoint. No significant differences in the cutaneous tolerability profiles were observed between treatment groups. Notably, significantly fewer patients receiving LicA-containing sunscreen developed scaliness at Week 4 compared with those in the comparator group. In addition, more patients receiving LicA-containing sunscreen reported less dryness, burning and stinging reactions than the comparator group. Importantly, more patients receiving LicA-containing sunscreen agreed that their treatment led to excellent improvement than the comparator group; of note, one patient reported that their condition worsened with the receipt of the comparator product. The concurrent use of LicA-containing sunscreen with adapalene may improve the cutaneous tolerance to adapalene among Malaysian patients.

Understanding the impact of acne vulgaris and associated psychological distress on self-esteem and quality of life via regression modeling with CADI, DLQI, and WHOQoL

Acne vulgaris (AV) is a psychosomatic disorder and can negatively affect individuals, especially in terms of psychological well-being, self-esteem, and quality of life (QoL). The current study aimed to investigate the association between AV and psychological health, as well as the influence of acne and psychological distress in predicting patients' self-esteem and QoL. This cross-sectional study included 150 patients clinically diagnosed with AV. The severity of acne was measured using GAGS, and following that, patients were instructed to complete the following forms: DASS-21, RSES, CADI, DLQI, and WHOQoL. Female AV patients had significantly higher depression (p = 0.003, t = 3.025) and anxiety (p < 0.001, t = 3.683). Pearson's correlation analysis indicated a strong, positive, and significant correlation between having acne and experiencing depression (r = 0.630), anxiety (r = 0.661), and stress (r = 0.758) (p < 0.001). Multiple regression analysis suggested acne and associated psychological distress had a significant and negative impact on the patient's self-esteem and quality of life. This study highlights the multifaceted consequences of AV and the need to manage its psychological distress. It emphasizes the need for holistic patient care that addresses acne's physical and emotional aspects, with the ultimate goal of enhancing well-being and QoL.

Serum Interleukin-19 Levels in Acne Vulgaris Patients of Varying Clinical Severity in Erbil City.

Background Acne vulgaris (AV) is a common multifactorial disorder affecting the pilosebaceous units. Research has shown that inflammation plays a crucial role in the pathogenesis of AV, including both inflammatory and non-inflammatory acne. Several studies have linked proinflammatory cytokines to AV; however, only a few have explored the correlation between interleukin-19 (IL-19) and AV. Our aim is to estimate the level of IL-19 in patients with AV compared to matched controls and to investigate the role of IL-19 in the pathogenesis of acne. Materials and methods This prospective cross-sectional case and control study includes 80 patients and 40 matched controls. Patients were divided into mild (20), moderate (40), and severe (20) groups based on their global acne score severity index. Detailed history and complete general and dermatological examinations were taken from each patient. Furthermore, 5 ml of blood was taken from all participants to assess the level of IL-19. Results IL-19 levels were significantly higher in patients with AV compared to matched controls. Furthermore, IL-19 concentrations were found to be proportional to the severity of acne, with the highest levels detected in patients with severe AV (p-value <0.005). Conclusion IL-19 levels in AV were significantly higher than in matched control. The difference was proportional to its severity. This might indicate IL-19 as an inflammatory marker and could potentially be related to AV.

The epidemiology of acne vulgaris in a multiethnic adolescent population from Rotterdam, the Netherlands: A cross-sectional study

Although acne is a prevalent multifactorial inflammatory skin condition, few studies were performed in multiethnic populations. To study the prevalence and determinants of acne in a multiethnic study at the start of puberty. This cross-sectional study is embedded in Generation R, a population-based prospective study from Rotterdam, the Netherlands. Three-dimensional facial photos at the center visit in 2016-2019 (of ∼13-year-olds) were used to grade acne severity using the Global Evaluation of the Acne Severity (GEA). Analyses were stratified by biological sex and explored through chi-square tests and multivariable ordinal logistic regression. A total of 4561 children (51% girls) with a median age of 13.5 (IQR 13.3-13.6) were included. The visible acne prevalence (GEA 2-5) for girls vs boys was 62% vs 45% and moderate-to-severe acne (GEA 3-5) 14% vs 9%. Higher puberty stages (adjusted odds ratios: 1.38 [1.20-1.59] and 2.16 [1.86-2.51] for girls and boys, respectively) and darker skin colors V and VI (adjusted odds ratios: 1.90 [1.17-3.08] and 2.43 [1.67-3.56]) were associated with more severe acne in both sexes, and being overweight in boys (adjusted odds ratio: 1.58 [1.15-2.17]). Cross-sectional design. Acne prevalence was high at the age of 13years and was associated with advanced puberty, darker skin color, and weight status.

A Systematic Literature Review and Network Meta-Analysis of Comparative Efficacy of Topical Fixed-Dose Combination Treatments for Moderate to Severe Acne Vulgaris

INTRODUCTION: Several topical and oral monotherapies/combination treatments are available for treating patients with moderate to severe acne vulgaris and a few are currently under review with the United States (US) Food and Drug Administration (FDA). Among these treatments, topical fixed-dose combinations (FDCs) are widely used in the US. No study has assessed the comparative efficacy of topical FDCs based on the treatment success endpoint of the proportion of patients achieving ≥2 grade reduction AND "Clear" or "Almost clear” status by week 12 on an Investigator's Global Assessment (IGA) or equivalent scales. The objective of this study was to conduct a systematic literature review (SLR) and network meta-analysis (NMA) to compare the efficacy of topical FDCs for the treatment of moderate to severe acne.&#x0D; STUDY DESCRIPTION: An SLR was conducted for identifying randomized controlled trials (RCTs), that included at least one topical FDC (currently approved/under review with FDA) arm, in academic (MEDLINE, Embase, Cochrane CENTRAL, PEDE, and NHS EED) and non-academic databases (HTA databases, conference abstracts databases, and trial registries). The search was conducted in May 2022, based on a pre-specified inclusion/exclusion criterion. RCTs included in the analysis evaluated acne severity using IGA or equivalent (Evaluator's Global Severity Score, Investigator’s Static Global Assessment) scales. A Bayesian network meta-regression was conducted, using the proportion of patients with moderate acne, inflammatory and non-inflammatory lesion counts at baseline as covariates to account for acne severity.&#x0D; RESULTS: Twelve Phase II/III/IV RCTs were identified from 5,159 citations comprising 8,349 patients across 8 treatment groups. The odds ratio for treatment success with topical FDC of clindamycin phosphate 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1% (first triple agent FDC) gel was estimated to be 7.61 (95% Credible Interval: 4.44 –13.20) in comparison to Vehicle gel. Comparative effectiveness ranking demonstrated that the topical triple agent FDC gel was the most effective treatment with surface under cumulative ranking of 100%.&#x0D; CONCLUSION: Based on this SLR/NMA, the topical triple agent FDC of clindamycin phosphate 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1% gel, which is currently under FDA review (PDUFA date 10/20/2023), was clinically superior to all other topical FDC treatments for moderate to severe acne vulgaris.

The efficiency and safety of low-dosage isotretinoin therapy for Chinese acne vulgaris patients.

Acne vulgaris is one of the most common skin conditions in dermatology clinics. Accumulating evidence has implicated oral low-dosage isotretinoin was an effective treatment for acne with fewer side effects. Currently, the data on low-dosage isotretinoin use in Chinese is limited. To investigate the efficiency and safety of low-dosage isotretinoin therapy for Chinese acne patients. Three hundred and eighty-eight patients treated with low-dosage isotretinoin (0.2-0.4 mg/kg/d) and who completed the course (120 mg/kg) were enrolled. Medical information on the severity, duration, adverse effects, and outcome of acne was reviewed. The majority (90.2%, n = 350) of patients achieved complete remission, and on average, patients received 13.5 months of treatment. The time between isotretinoin start and the clear date between the mild and moderate groups was not significantly different (74 ± 24 vs. 84 ± 24 days). However, it took longer to resolve for the severe acne group (112 ± 25 days). Follow-up 1 year after completion of the isotretinoin course, 37/350 (10.6%) patients relapsed, but there was no difference in the severity of acne. There were 133 (34.3%), 40 (10.3%), and 14 (2.6%) patients who developed hypercholesterolemia, hypertriglyceridemia, and high LDL, respectively. Thirty-two (8.2%) and 28 patients (7.2%) had elevated serum levels of alanine and aspartate aminotransferases. No values above grade 2 were detected. This study reaffirms the efficacy and safety of low-dosage oral isotretinoin in Chinese patients with acne vulgaris. Lab investigation could be performed after 2 months of therapy in healthy patients with normal baseline liver function and lipid panel tests.

Prévalence et impact psychologique de l’acné en milieu scolaire de Kinshasa, République Démocratique du Congo

Context and objective: Acne affects approximately 80% of adolescents and impacts their quality of life. Our Objective was to: describe the quality of life of acne-prone schoolchildren in Kinshasa. Materials and method: This were a descriptive cross-sectional study conducted in schools in Kinshasa for 2 months. Every student aged from 10 to 19 years, regularly enrolled, who gave their verbal consent and for whom parental consent was obtained, were included. Sampling was random at 4 degrees. The ECLA and CADI grids were used to assess acne severity and quality of life. Data were analyzed using SPSS 21.0 software. Associations between variables were assessed using Pearson’s chi-square test. A value of p &lt; 0.05 was considered as the threshold of statistical significance. Results: The prevalence of acne was of 58%, with a female predominance (54%) and a sex ratio of 1.2. The average age was 15.3±2.2 years, with extremes ranging from 11 to 19 years. 53.4% of the students had a heredofamilial history of acne. The mean age at onset was 13.1±1.9 years. The mean age at menarche was 11.5±3.3 years. Inflammatory lesions were numerous on the face (96.6%). 10.3% of students had severe acne. The total score of the ECLA grid varied from 2 – 19, with an average of 7.3 and a median of 7. The quality of life was slightly impaired in 87.7% of the cases without being linked to sex but associated with acne severity (p = 0.022). The high frequency of severe acne was observed in students with a moderate quality of life (27.8%). Conclusion: The alteration of the quality of life of a student with acne is effective in schools in Kinshasa, without proportionality with the seriousness of the pathology. The dermatologist to resort to the use of the ECLA and CADI grids for a comprehensive management of juvenile acne.

Evaluation of an Acne Severity Grading Self-Assessment System Suitable for the Thai Population - A Pilot Study.

Patient self-assessment is a potential tool in clinical practice to obtain subjective information of acne severity also in clinical trials to assess the general population in research and epidemiologic studies. The patient self-evaluation of acne severity has not yet been developed in Thailand. We aimed to validate an acne severity grading self-assessment suitable for the Thai population. A pilot study was conducted in 77 volunteers with acne lesions. We developed the Thai Global Evaluation Acne Scale (TGEA) and Thai Global Acne Grading System (TGAGS) by translating and adapting the original version. Patient self-assessment of acne severity was performed in two rounds. A training session about acne was provided to all participants lesions before starting the second round. Reliability between the self-assessment and clinician assessment of acne severity was statistically assessed. For TGEA, 48.05% participants rated their acne severity corresponded with the clinicians (Cohen's kappa coefficient, kappa = 0.26). After receiving the training, 79.22% subjects responded their acne severity corresponded with the clinicians (kappa = 0.66). For TGAGS, 77.92% patients who answered their acne severity corresponded with the clinicians (kappa = 0.52). After receiving the training, 94.80% participants responded their acne severity corresponded with the clinicians (kappa = 0.89). For raw score of the TGAGS, the intraclass correlation coefficient (ICC) during the self-assessment of acne severity compared to the clinician assessments was 0.54 and it increased to 0.79 after the training. Due to the almost perfect reliability, we suggested that TGAGS is a reliable subjective self-assessment of acne severity suitable for the Thai population. The training is essential in enhancing the reliability of this instrument. Our study's findings can facilitate clinical practice and research studies.

The Question of Adolescent and Postadolescent Acne: The Nigerian Experience

Introduction: Differences between adolescent and postadolescent acne are increasingly being recognized. This study aimed to document the clinical profile of facial acne vulgaris and, additionally, to compare adolescent to postadolescent acne and any gender-based differences. Methods: Cross-sectional descriptive study of 261 facial acne vulgaris patients was conducted from February 2021 to March 2022 at three dermatology clinics. Patients had their anthropometric measurements, type of acne lesions, and severity and scarring assessed. Results: A total of 261 patients (75.5% females) with a mean age of 24.5 (±7.4) years were diagnosed to have facial acne vulgaris. The severity of acne was mild in 44.8%, moderate in 48.3%, and severe in 6.9%. Acne was noninflammatory in 69.7%, inflammatory in 13.0%, and mixed in 17.2%. Adolescent and postadolescent acne significantly differed in the type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences included BMI, lesions of acne, and severity. Conclusion: There is an increasing prevalence of postadolescent acne with persistent being the most common category. There are significant differences between adolescent and postadolescent acne: type of acne, BMI, type of acne lesions, and acne scarring. Gender-based differences exist in both adolescent and postadolescent acne.

The Relationship Between Adolescents' Perception of Family Emotional Atmosphere and Acne Severity, Self-Esteem, and Quality of Life in Adolescents Diagnosed with Acne Vulgaris.

Acne vulgaris, a prevalent chronic condition among adolescents, significantly impacts patients' quality of life and self-esteem. Our aim was to investigate whether how adolescents perceive their family emotional atmosphere has an impact on their acne severity, quality of life, and self-esteem. This study included 118 patients with acne vulgaris who completed various assessments, including a sociodemographic data form, the Acne Quality of Life Scale, the Hospital Anxiety and Depression Scale, the Shortened Level of Expressed Emotion Scale (SLEES) and, the Rosenberg Self-Esteem Scale. The Global Acne Grading System is performed by an experienced dermatologist to determine the severity of acne. Out of 118 patients, 78 (66.1%) were female and 40 (33.9%) were male. The mean age of patients was 15.2 ± 1.3 years. There was a positive correlation between the severity of acne and the levels of perceived intrusiveness subscores of SLEES (P = .021, r = 0.212). Significant correlations were also observed among quality of life scores, anxiety and depression levels, lack of emotional support (LES) scores, and self-esteem levels. The initial linear regression analysis demonstrated that the level of LES subscores of SLEES and levels of anxiety and depression were predictors of self-esteem. In the second regression analysis, anxiety and depression levels were identified as significant predictors of quality of life. The perceived family emotional atmosphere may be an important factor in evaluating the severity of acne as well as the self-esteem and quality of life of adolescent patients with acne vulgaris.

Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% gel for moderate-to-severe acne: Efficacy and safety results from two randomized phase 3 trials.

A three-pronged acne treatment approach-combining an antibiotic, antibacterial agent, and retinoid-may provide greater efficacy than single/double treatments. Topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1% gel (IDP-126) is the first fixed-dose triple-combination in development for acne. To confirm efficacy, safety, and tolerability of IDP-126 gel in acne treatment. Two phase 3, double-blind, 12-week studies randomized participants aged ≥9years with moderate-to-severe acne (N=183; N=180) 2:1 to once-daily IDP-126 or vehicle gel. Co-primary endpoints comprised participants achieving ≥2-grade reduction from baseline in Evaluator's Global Severity Score (EGSS) and clear/almost clear skin (treatment success) and change from baseline in inflammatory/noninflammatory lesion counts. Treatment-emergent adverse events (TEAEs) were assessed. At week 12, 49.6% and 50.5% of participants achieved treatment success with IDP-126 versus 24.9% and 20.5% with vehicle (P<.01, both). IDP-126 also provided significantly greater reductions in inflammatory/noninflammatory lesions versus vehicle (least-squares mean percent range: 72.7% to 80.1% vs 47.6% to 59.6%; P<.001, all). Most TEAEs were of mild-moderate severity. Inter-observer bias/variation in acne severity ratings, limited treatment duration, and population differences that may not generalize to real-world populations. The innovative fixed-dose, triple-combination IDP-126 gel was efficacious and well tolerated in 2 clinical studies of participants with moderate-to-severe acne.

ANTIHISTAMINE AS AN ADJUNCTIVE TREATMENT IN ACNE VULGARIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Approximately one-tenth of the global population suffer from acne vulgaris, which is a skin disease with considerable psychological impact. Recently, antihistamines have been used in the treatment of acne. However, their overall treatment effects for this indication remain unclear. This systematic review and meta-analysis aim to evaluate the clinical efficacy and safety of the antihistamines in the treatment of acne vulgaris. The following databases were searched: PubMed, Scopus, Embase, Cochrane Central Register of Controlled Clinical Trials, and Google Scholar. We included the randomized controlled trials on acne vulgaris patients which compared any H1- antihistamine drug in combination with other medications to placebo, no treatment, or other medications, with acne lesion (non-inflammatory and inflammatory) counts, acne severity score, patient satisfaction, acne flare, or adverse events as an outcome of interest. Six studies contributing to 388 patients were included, involving two H1 antihistamines (i.e., levocetrizine and desloratadine), isotretinoin, azithromycin, and topical azelaic acid cream. From the network meta–analysis, levocetirizine+isotretinoin was better than the isotretinoin alone in the inflammatory lesion count, but not in the non-inflammatory lesion count. The desloratadine+isotretinoin retained the best balance in terms of non-inflammatory lesion count, inflammatory lesion count, acne flare, and mucocutaneous adverse events. The desloratadine+isotretinoin and levocetirizine+isotretinoin were considered safe.

Relationship between serum amino acid levels and acne severity

AimAcne is a common skin disease in which metabolic factors have been suggested to play a role in its pathogenesis. The aim of this study was to evaluate the relationship between serum amino acid levels and acne and acne scar development. Material and methodsIn this cross-sectional study, 30 patients with scatricial acne, 30 patients with non-scatricial acne and 30 healthy subjects were included. Global acne scores and scar scores were calculated. Venous blood samples of the participants were analyzed by liquid chromatography-tandem mass spectrometry and serum levels of a total of 24 amino acids including nine essential amino acids, 11 nonessential amino acids and four other amino acids were measured. ResultsSerum levels of the branched chain amino acids leucine, isoleucine and valine were significantly higher in the cicatricial acne group (p: <0.001, 0.001, <0.001, respectively) and in the non-cicatricial acne group (p: 0.039, 0.045, 0.001, respectively) compared to healthy subjects. There were also significant positive correlations between the levels of these amino acids and global acne scores (p = 0.048, r = 0.255, p = 0.006, r = 0.354, p = 0.017, r = 0.307, respectively) and scar scores (p = 0.032, r = 0.392, p = 0.021, r = 0.424, p = 0.018, r = 0.427, respectively). Serum tryptophan levels were significantly lower in both scatricial and non-scatricial acne groups compared to healthy subjects (p = 0.033 and < 0.001, respectively). ConclusionImpaired metabolism of branched-chain amino acids and tryptophan may be associated with acne pathogenesis, acne severity and scarring.

Development and validation of an artificial intelligence-powered acne grading system incorporating lesion identification.

The management of acne requires the consideration of its severity; however, a universally adopted evaluation system for clinical practice is lacking. Artificial intelligence (AI) evaluation systems hold the promise of enhancing the efficiency and reproducibility of assessments. Artificial intelligence (AI) evaluation systems offer the potential to enhance the efficiency and reproducibility of assessments in this domain. While the identification of skin lesions represents a crucial component of acne evaluation, existing AI systems often overlook lesion identification or fail to integrate it with severity assessment. This study aimed to develop an AI-powered acne grading system and compare its performance with physician image-based scoring. A total of 1,501 acne patients were included in the study, and standardized pictures were obtained using the VISIA system. The initial evaluation involved 40 stratified sampled frontal photos assessed by seven dermatologists. Subsequently, the three doctors with the highest inter-rater agreement annotated the remaining 1,461 images, which served as the dataset for the development of the AI system. The dataset was randomly divided into two groups: 276 images were allocated for training the acne lesion identification platform, and 1,185 images were used to assess the severity of acne. The average precision of our model for skin lesion identification was 0.507 and the average recall was 0.775. The AI severity grading system achieved good agreement with the true label (linear weighted kappa = 0.652). After integrating the lesion identification results into the severity assessment with fixed weights and learnable weights, the kappa rose to 0.737 and 0.696, respectively, and the entire evaluation on a Linux workstation with a Tesla K40m GPU took less than 0.1s per picture. This study developed a system that detects various types of acne lesions and correlates them well with acne severity grading, and the good accuracy and efficiency make this approach potentially an effective clinical decision support tool.

Burden of treatment in severe acne vulgaris

AbstractBackgroundAcne is associated with a significant burden of disease related to the visual impact of facial lesions, symptoms such as pain, and sequelae such as scarring. However, little research has been performed on the acne‐specific burden of treatment (BOT), defined as the workload of healthcare as well as its impact on functioning and well‐being.ObjectivesThe aim of this study was to examine the BOT of moderate‐severe acne.MethodsA prospective study was performed in our tertiary dermatology department. Patients attending the dermatology department with moderate‐severe acne (defined as an Investigator's Global Assessment of acne severity of 3 or 4) were invited to complete a validated BOT questionnaire, modified for use in acne, with additional qualitative components.ResultsOf 50 patients, 68% were female, with a mean age of 22.6 years (range 16‐45 years). Most (82%, n = 41) patients were on isotretinoin, with 18% (n = 9) on oral antibiotics. The average BOT was 4.2/10 (range 0–8.2) for topical therapies, 4.5/10 (range 2.7–6.8) for oral antibiotics, and 3.8/10 (range 0.69–6.9) for isotretinoin. From qualitative statements, the greatest burdens reported with topical treatment were unpleasant sensations, skin sensitivity, skin dryness, and lack of efficacy; with antibiotic therapy were the requirement for long‐term treatment, limited efficacy, and side‐effects including gastrointestinal upset; and with isotretinoin therapy were cheilitis and xerosis, cost, and need for blood tests. However, 58% (n = 29) of patients believed their overall BOT was decreased with isotretinoin, and 18% (n = 9) felt that it was unchanged with isotretinoin, with statements such as “the side effects can be tough, but the result is definitely worth it.”ConclusionsThe BOT associated with oral isotretinoin is similar or lower to topical therapies and oral antibiotics. This should be taken into consideration when optimizing the care of patients with acne.

Quality of Life in Patient with Acne Vulgaris

INTRODUCTION Acne Vulgaris is one of the common skin disease which can impair the quality of life of the individual. This study is done to assess the quality of life in patient with acne using Dermatology life quality index (DLQI) and Cardiff acne disability index (CADI). MATERIAL AND METHODS This was a cross-sectional, questionnaire-based study in 101 patients of acne vulgaris at dermatology and Venerology OPD of Universal College of Medical Science, Bhairahawa, Nepal. The participants were given DLQI and CADI to assess the quality of life. The severity of acne was assessed by simple grading system. RESULTS There was some effect in quality of life in patient with acne but there was no significant relation with severity of acne and quality of life. CONCLUSION Psychological assessment should be done in patient with acne vulgaris as it can have negative effect in quality of life.

Lipid Metabolism Reprogramming of Immune Cells in Acne: An Update.

Acne vulgaris is one of the most widespread skin conditions and the main reason for visiting a dermatologist. Inflammatory response and abnormal infiltrations of immune cells are the main pathogenesis of acne. The increased lipid is the prerequisite for the acne, and the perturbation of lipid composition and content is consistent with the severity of acne. Furthermore, the increased lipid production not only contributes to the occurrence and development of acne, but also sensitizes the function of immune cells. The lipid metabolic dysfunction aggravates the severity of local tissue and provides pro-inflammatory-cytokine cues, which indicates the crucial roles of lipid metabolism on immune cells. Recent advances have demonstrated the lipid metabolism reprogramming of various immune cells in acne lesion. The abnormal lipid accumulation, lipolysis, and fatty acid oxidation lead to the activation and differentiation of immune cells, which promotes the pro-inflammatory cytokines production. Thus, this review discusses the emerging role of lipid metabolism reprogramming of immune cells in the progress of acne and aims to constitute food for others' projects involved in acne research.