Type Of Acne Research Articles

Difficult and rare forms of acne

Acne is the most common of skin diseases, being characterized as a chronic inflammatory disease of the pilosebaceous unit. Although acne is usually straightforward to diagnose and treat, some patients have difficult or rare forms of acne. What seems to be “nonresponding acne” in a patient may be caused by another acneiform disease that clinically mimics acne, thus misleading the clinician, if not ruled out, with scrutiny. Difficulties in the management of acne may be attributable to patient-related issues (low adherence to treatment or fear for side effects), treatment-related issues (inappropriate treatment, dose, or duration of treatment), or difficult-to-treat acne types (acne conglobata or acne fulminans). Rare forms of acne may be present in the context of complex syndromes, such as the synovitis, acne, pustulosis, hyperostosis, osteitis syndrome; pyogenic arthritis, pyoderma gangrenosum, acne syndrome; pyoderma gangrenosum, acne, and suppurative hidradenitis syndrome; or congenital adrenal hyperplasia, in association with other systemic findings, often with a positive family history.

Strains of the Propionibacterium acnes type III lineage are associated with the skin condition progressive macular hypomelanosis.

Progressive macular hypomelanosis (PMH) is a common skin disorder that causes hypopigmentation in a variety of skin types. Although the underlying aetiology of this condition is unclear, there is circumstantial evidence that links the skin bacterium Propionibacterium acnes to the condition. We now describe the first detailed population genetic analysis of P. acnes isolates recovered from paired lesional and non-lesional skin of PMH patients. Our results demonstrate a strong statistical association between strains from the type III phylogenetic lineage and PMH lesions (P = 0.0019), but not those representing other phylogroups, including those associated with acne (type IA1). We also demonstrate, based on in silico 16S rDNA analysis, that PMH isolates previously recovered from patients in Europe are also consistent with the type III lineage. Using comparative genome analysis, we identified multiple genomic regions that are specific for, or absent from, type III strains compared to other phylogroups. In the former case, these include open reading frames with putative functions in metabolism, transport and transcriptional regulation, as well as predicted proteins of unknown function. Further study of these genomic elements, along with transcriptional and functional analyses, may help to explain why type III strains are associated with PMH.

Cutaneous Findings and Systemic Associations in Women With Polycystic Ovary Syndrome

Understanding of the associations among cutaneous findings, systemic abnormalities, and fulfillment of the diagnostic criteria in women suspected of having polycystic ovary syndrome (PCOS) is incomplete. To identify cutaneous and systemic features of PCOS that help distinguish women who do and do not meet the diagnostic criteria. Retrospective cross-sectional study of a racially diverse referred sample of women seen at the University of California, San Francisco, Polycystic Ovary Syndrome Multidisciplinary Clinic over a 6-year period between May 18, 2006, and October 25, 2012. Participants were 401 women referred for suspected PCOS. In total, 68.8% (276 of 401) met the Rotterdam PCOS diagnostic criteria, while 12.0% (48 of 401) did not. Overall, 11.5% (46 of 401) had insufficient data to render a diagnosis, 1.7% (7 of 401) were excluded from the study, and 6.0% (24 of 401) refused to participate in the study. Comprehensive skin examination and transvaginal ultrasonography. All patients were tested for levels of total testosterone, free testosterone, dehydroepiandrosterone (DHEAS), androstenedione, luteinizing hormone, and follicle-stimulating hormone. Levels of serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were obtained, in addition to 0-hour and 2-hour oral glucose tolerance test (OGTT) results, with measurement of glucose and insulin levels. Findings from comprehensive skin examination, laboratory testing, and transvaginal ultrasonography. In total, 401 women with suspected PCOS were included in the study. The median patient age was 28 years. Compared with women who did not meet the diagnostic criteria for PCOS, women who met the criteria had higher rates of hirsutism (53.3% [144 of 270] vs 31.2% [15 of 48], P = .005) (with higher mean modified Ferriman-Gallwey scores of 8.6 vs 5.6, P = .001), acne (61.2% [164 of 268] vs 40.4% [19 of 47], P = .004), and acanthosis nigricans (AN) (36.9% [89 of 241] vs 20.0% [9 of 45], P = .03). Cutaneous distributions also varied. Women who met the PCOS criteria demonstrated more severe truncal hirsutism and higher rates of axillary AN. Women who met the PCOS criteria had elevated total testosterone levels (40.7% [105 of 258] vs 4.3% [2 of 47], P < .001). Among women with PCOS, the presence of hirsutism (43.9% [54 of 123] vs 30.9% [34 of 110], P = .04) or AN (53.3% [40 of 75] vs 27.0% [40 of 148], P < .001) was associated with higher rates of elevated free testosterone levels as well as several metabolic abnormalities, including insulin resistance, dyslipidemia, and increased body mass index. Although the prevalence of acne was increased among women with PCOS, there were minimal differences in acne types and distribution between the women meeting vs not meeting the PCOS criteria. Hirsutism and AN are the most reliable cutaneous markers of PCOS and require a comprehensive skin examination to diagnose. When present, hirsutism and AN should raise clinical concern that warrants further diagnostic evaluation for metabolic comorbidities that may lead to long-term complications. Acne and androgenic alopecia are prevalent but unreliable markers of biochemical hyperandrogenism among this population.

Resistin gene polymorphisms are associated with acne and serum lipid levels, providing a potential nexus between lipid metabolism and inflammation.

Acne vu lgaris is a multifactorial inflammatory skin disease causing social stigma and psychological effect on patients. We hypothesized that the genes that can affect both lipid metabolism and inflammation may be central for acne formation and present targets for treatment. Pro-inflammatory adipokine resistin, one such likely target, activates NFkB and JNK pathways inducing TLR-2, IL-1, IL-6, and TNFα genes. The polymorphisms in promoter and intron region of the resistin gene affect its expression levels. Therefore, we explored the association of resistin polymorphisms (RETN +299G>A and -420C>G) with pathogenesis of acne vulgaris. We used PCR-RFLP method to genotype at the two single nucleotide polymorphisms at RETN promoter in 530 acne patients vs. 550 age- and sex-matched control subjects. We also measured serum lipid levels in acne patients and associated these with RETN genotypes. We found that the RETN gene polymorphisms are strongly associated with acne vulgaris and the severity of acne symptoms. In females the variant allele frequencies of both SNPs are statistically higher in patients than in controls; in males frequency distribution does not reach significance. The haplotype containing both variant alleles is significantly more common in patients than in controls. We find no association of RETN SNPs with the acne types. Importantly, we found that the levels of HDL-C were significantly decreased in variant genotype of RETN. Our results show that the RETN polymorphisms expected to boost resistin expression increase the risk of developing acne. We suggest that resistin may provide an attractive target for treatment.

Zespół SAPHO jako potencjalna przyczyna przewlekłego zapalenia kości żuchwy oraz zaburzeń funkcji stawów skroniowo-żuchwowych – opis przypadku

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) is a rare disease, with an unknown, probably multifactor etiology, comprising osteoarticular disorders of aseptic inflammatory character, and cutaneous changes of massive acne or palmoplantar pustulosis type. Usually the changes involve the anterior thoracic wall, and sternoclavicular and sacroiliac joints. According to literature reports, the mandible is affected in 10% of cases. The paper presents a case of SAPHO syndrome in an 18-year-old patient, with the involvement of the right body, angle, and branch of the mandible and the right temporomandibular joint. Considering the results of imaging examinations (computed tomography, magnetic resonance, and scintigraphy), as well as laboratory, histopathological and microbiological investigations, the authors discuss the possible diagnostic problems and the differentiation of SAPHO syndrome with other diseases. The article also presents different treatment methods, including temporomandibular joint reconstruction with the use of an alloplastic prosthesis. The aim of the paper is to present SAPHO syndrome as a potential cause of primarily chronic mandibular bone inflammation and stomatognathic system dysfunction.

Comparison of TLR-2, TLR-4, and antimicrobial peptide levels in different lesions of acne vulgaris

Context: Recent studies have shown that tolls like receptors (TLRs) and antimicrobial peptides (hBD-1, cathelicidin) play an important role in the pathogenesis of acne vulgaris (AV).Objective: To evaluate and report the expression of TLR-2, TLR-4, hBD-1 and cathelicidin in different regions of skin in AV.Participants: This study was performed in 80 patients with AV and a control group of 20 healthy individuals.Material and methods: Skin biopsies were performed from 20 papular, 20 pustular, 20 comedonal and 20 nodular lesions of patients and 20 healthy volunteers. Expression levels of TLR-2, TLR-4, hBD-1 and cathelicidin in four separate areas (epidermis, dermis, inflammation region and skin appendages) were evaluated by immunohistochemical method. Further, these parameters were compared between different skin lesions.Results: A significant difference was found between the levels of staining of TLR-2, TLR-4 and hBD-1 from the epidermis, inflammation region, dermis and skin appendages (p < 0.05). Levels of cathelicidin were different in only the inflammation region (p < 0.05). The level of TLR-2 in the epidermis with nodules was lower than the papules and comedones (p < 0.05). Levels of TLR-2 in the inflammation and dermis of the cases with papules were significantly higher when compared to pustules (p < 0.05). The levels of staining of TLR-4 in the dermis with comedones were significantly lower compared to the cases with papules (p < 005). The level of hBD-1 in the epidermis region of comedones was significantly higher compared to nodules (p < 0.05). The expression of cathelicidin in the inflammation region of comedones was significantly low (p < 0.05).Conclusion: It is thought that TLR-2, TLR-4, hBD-1 and cathelicidin play an important role in the pathogenesis of AV and in the development of different acne types. We think that, better results could be obtained in treatment of AV with different treatment options targeted in regulation of TLR-2, TLR-4, hBD-1 and cathelicidin release.

Chemical peel treatments in dermatology

Chemical peel treatments, which utilize a number of chemical peeling solutions subject to patient indication, are an easy to learn therapeutic technique suited for, in particular, various types of acne, acne scars, actinic keratosis and "sun-damaged skin". Especially the positive and long-lasting results of deep peels in the area of skin rejuvenation are deemed the gold standard against which other techniques, including lasers, must compare themselves. Other benefits of chemical peels include the flexibility to mix and match chemical solutions to custom design the treatment best suited for the desired degree of skin penetration, as well as the relatively low cost.

Acne Causes and Practical Management Danby F. William Acne Causes and Practical Management First edition 256pp £79.99 Wiley Blackwell 9781118232774 1118232771

THIS BOOK is a detailed exploration of acne, which seems to be aimed at dermatology specialists. It includes a description of the three types of acne, as well as its pathophysiology and treatment.

Acne in women.

This review focuses on the subject of acne in women, a disease that is increasingly common and that can also affect men. Adult acne differs from the type of acne that occurs in teenagers, and it may persist beyond adolescence or have its onset at an older age (adult-onset acne or late acne). Acne can have a negative impact on the quality of life of patients at any age, leading to a negative body image and decrease in self-esteem, and in older patients it can result in discrimination in the workplace and in other social environments. Acne in women must be understood as a specific problem, and here we discuss the pathogenesis, clinical presentation, psychology and treatment of this very prevalent problem.

Isopropyl Myristate and Cocoa Butter are not Appropriate Positive Controls for Comedogenicity Assay in Asian Subjects

Background: Comedogenicity is an important consideration in development of topical products, such as cosmetics. An animal test using rabbit ear has long been served as a model for prediction of comedogenicity of topical products, but correlation to the human skin remained controversial. Isopropyl myristate and cocoa butter which are used as positive controls in animal test, also used in human clinical assay but report for the comedogenicity of those two positive controls in human, especially in Asian skin is limited. Objective: To assess the comedogenicity of isopropyl myristate and cocoa butter in Asian skin using a modified human model established by Mill and Kligman. Methods: We selected eight Asian subjects with prominent follicular orifices and the prone to acne type skin on the upper back. Two substances, isopropyl myristate and cocoa butter, were applied on the upper back skin three times a week for four weeks. Petrolatum and non-treated skin served as negative controls. Microcomedones were estimated by cyanoacrylate follicular biopsy at baseline and after four weeks of application. The number of follicles and microcomedones were determined by quantitative image analysis. Results: Microcomedone activities of isopropyl myristate and cocoa butter have no significant difference to negative controls in Asian skin. Conclusion: Comedogenic activity of isopropyl myristate and cocoa butter is too weak that those are not appropriate positive controls for clinical human assay in Asian skin. Further studies are necessary to determine appropriate positive controls in the human model for all ethnic populations.

Acne vulgaris

Acne vulgaris is worldwide the most common skin disease. Acne is an inflammatory disorder in whose emergence androgens, PPAR ligands, the IGF-1 signaling pathway, regulating neuropeptides and environmental factors are probably involved. These factors interrupt the natural cycling process in the sebaceous gland follicle and support the transition of microcomedones to comedones and inflammatory lesions. Proinflammatory lipids and cytokines are mediators for the development of acne lesions. Bacterial antigens can potentate the inflammatory phenomena. Acne is predominantly treated with combination therapy. Selecting a treatment regimen depends on the exact classification of acne type and severity. The development of scars is the main criterion for the choice of systemic therapy. Retinoids for mild comedonal acne and the combination of retinoids with antibiotics and/or benzoyl peroxide for mild to moderate papulopustular acne are the drugs of first choice for topical treatment. The use of topical antibiotics is not recommended any more because of the development of resistant bacterial strains. Systemic antibiotics, in combination with topical retinoids and/or benzoyl peroxide, for moderate papular/nodular acne and isotretinoin for severe nodular/conglobate acne are the columns of systemic acne treatment. Systemic anti-androgens are used in women against moderate papulopustular acne. Due to advances in the understanding of the underlying inflammatory mechanisms in recent years the development of new therapeutic agents with good efficacy and better side effect profile should be expected in the future.

Treating adult acne vulgaris: a summary of the topical and oral preparations

Previously, the most effective therapeutic modality for treatment of this type of acne has been the administration of topical preparations and oral antibiotics; however, more recently, experts claim that oral isotretinoin, which is still a controversial treatment, is more effective than any other treatment. The problem of antibiotic resistance still exists and non-concordance is a major contributory factor in the failure of acne treatment. This article demonstrates how dermatology and aesthetic medicine combined can benefit patients with this skin condition. Hormonal therapies are not discussed in this article.

Acne vulgar: diagnóstico e manejo pelo médico de família e comunidade

A acne vulgar é a doença cutânea mais frequente, afetando 85 a 100% da população em algum momento da vida; constituindo, por isso, um motivo frequente de consulta na atenção primária à saúde. Geralmente, tem início na puberdade, situando-se o pico de incidência entre os 14 e 17 anos nas adolescentes, e entre os 16 e 19 anos nos rapazes, sendo mais grave e prevalente no sexo masculino. Apesar de extensamente debatida, a acne vulgar requer uma atualização constante. Foi feita uma revisão das diretrizes clínicas, meta-análises e revisões sistemáticas publicadas nos últimos 15 anos, relacionadas à acne vulgar e seu tratamento. Esta patologia é normalmente dividida em três tipos clínicos: comedônica, pápulo-pustulosa e nódulo-cística. O diagnóstico é clínico, contudo outros diagnósticos diferenciais devem ser considerados. Das várias opções terapêuticas farmacológicas disponíveis, destacam-se os retinoides, os antimicrobianos e a terapêutica hormonal, cuja utilização deve ser ponderada, tendo-se em conta as suas indicações – tipo de acne e sua gravidade – e os seus efeitos colaterais. Assim, o médico de família e comunidade desempenha um papel de primeira linha na abordagem da acne vulgar, desde o diagnóstico à gestão das opções terapêuticas.

The influence of united psychosomatic factors on clinical features of acne vulgaris

Acne is a chronic inflammatory disorder of the pilosebaceal unit. Dermatological disorders are often associated with a variety of psychological problems which the patient have. Psichodermatologic disorders (acne) are associated with skin problems that are not directly connected to the mind, but that react to emotional states, such as stress. The aim of this article is to show if there is any psychological characteristic which are common for the whole group of ill-patients from acne, as well as whether there is correlation between any type of acne and psychological parameters. Own exploration consist at thirty patients with three clinical type of acne. Personality test-Kornel index were used for identification and diagnostic psychosomatic disorders. The results are: neurastenic parameters, parameters of conversion and parameters of psychopathy in different percent at both sex, and different clinical features. We show correlation united 2-6 psichosomatic disorders in male sex with softly type of acne. In female sex with any type of acne are responsible 7-12 united findings. The association of several psychosomatic factors could possibly be responsible for the onset of acne at any type.

Skin diseases and conditions among students of a medical college in southern India.

Introduction:Skin diseases are a common problem among young adults. There is paucity of data about it among medical students. This study aimed to find out the pattern of skin disorders and to describe their association with various socio-demographic factors among medical students.Materials and Methods:This cross-sectional study was conducted in June 2011 in a medical college in Mangalore, Karnataka. Two-hundred and seventy eight medical students were chosen from the 4th, 6th and 8th semester through convenient sampling method. Data on hair and skin morbidities suffered over past 1 year and its associated factors were collected using a self-administered questionnaire.Results:Most of the participants 171 (61.5%) were of the age group 20-21 years and majority were females 148 (53.2%). The most common hair/skin morbidities suffered in the past one year were acne 185 (66.6%), hair loss 165 (59.3%), and sun tan 147 (52.9%). Fungal infection (P = 0.051) and severe type of acne (P = 0.041) were seen significantly more among males while hair morbidities like hair loss (P = 0.003), split ends of hairs (P < 0.0001) and dandruff (P =0.006) were seen significantly more among female students. Patterned baldness (P = 0.018) and sun tan (P < 0.0001) were significantly more among non-Mangalorean students than native Mangaloreans. Presence of dandruff was significantly associated with hair loss (P = 0.039) and usage of sunscreen was found to protect from developing sun tans (P = 0.049).Conclusion:Skin disorders, particularly the cosmetic problems are very common among medical students. Gender and place of origin were found to significantly influence the development of certain morbidities.

Assessment of temperament and character profile with anxiety and depression in patients with acne.

Acne is the most common skin disease, affecting nearly 85% of the population as well as their lives. Acne can severely affect social and psychological functioning. Patients with acne may have anxiety, depression, decreased self-esteem, interpersonal difficulties, unemployment, social withdrawal, and even suicidal intent. The aim of this study was to evaluate the temperament and character inventory (TCI) of patients with acne and to compare the results with those of healthy controls. Case-control study. The study population consisted of 47 patients with acne, and 40 healthy control subjects. All participants were instructed to complete a self-administered 240-item TCI and the Hospital Anxiety and Depression Scale. In this study, the scores for the temperament properties Worry and pessimism (HA1) and Dependence (RD4) and the character properties Social acceptance (C1) and Integrated conscience (C5) were found to be higher in acne patients than in healthy controls (p<0.05). Compared to the controls, depression and anxiety scores were found to be markedly higher in the patients with acne. Acne type correlated positively with the Disorderliness (NS4) subscale of Novelty seeking (NS) and anxiety. Additionally, acne type correlated negatively with the Attachment (RD3) subscale of Reward Dependence (RD), with the Transpersonal identification (ST2) and Spiritual acceptance (ST3) subscales of Self-Trancendence (ST), and with the Compassion (C4) sub-scale of Cooperativeness (C). Studies in this area may lead to the development of specific and focused interventions for TCI in patients with acne vulgaris. We suggest that the evaluation and treatment of acne should also include psychosomatic approaches in clinical practice.

Overview of the treatment of acne vulgaris

Acne vulgaris is one of the most common conditions presented to the family physician. The vast array of topical and systemic medications available can make choosing an appropriate treatment seem overwhelming. Because every case of acne is different, the choice of medication should be selected on a case-by-case basis based on the type of acne, its location and patient factors. In this article, we attempt to provide a concise review of how to quickly diagnose acne based on the type(s) of lesion(s), and how to choose a treatment regimen appropriate for each type. We review the pathophysiology and key clinical features of acne, in addition to treatment options.

Efficacy of Vitamin E to Prevent Dermal Complications of Isotretinoin

Acne treatment depends on whether patents have a mild, moderate, or severe type of acne. The aim of this study was to compare the using of Isotretinoin (Rokutan) with and without oral vitamin E in treating acne. This study was performed on 60 patients on 0.5 mg/kg/day isotretinoin treatment for 6 months. The first group received 800 IU day(-1) Vit E during treatment and the second group recieved 800 Iu day(-1) cod liver oil capsules. All patients were observed for the complications at 1th, 4th and 6th weeks during treatment. Cheilitis was the most common side effect among these patients (69%). Epistaxis was the second side effect in both groups (22%). Other side effects were xerosis, pruritus, epigastric pain and nail fragility. The frequency and the severity of complications were less common at 4th and 6th weeks of treatment. Isotretinoin is a useful and effective drug in treating severe and treatment-resistance acne lesions.

Systematically optimized biocompatible isotretinoin-loaded solid lipid nanoparticles (SLNs) for topical treatment of acne

Isotretinoin (ITR) is a drug of choice in the treatment of all types of acne, including recalcitrant, severe and nodulocystic. The most widely employed route of its administration, i.e., oral intake, is reported to be associated with severe side-effects including teratogenecity, skin dryness and psychological disorders. Topical delivery, though advised for ITR, is marked with several hiccups like irritation, erythema and peeling of skin. The current studies, therefore, were embarked upon to develop “optimized” SLNs of ITR employing formulation by design (FbD) approach. The developed system was characterized and evaluated for skin compliance, skin transport characteristics and anti-acne potential against testosterone-induced acne in male Laca mice. The SLNs were able to transport the drug to various skin layers effectively while formed drug micro-reservoirs. The nano-colloidal systems showed marked anti-acne potential and tolerability on the mouse skin vis-à-vis the marketed product. The optimized SLNs exhibited drug entrapment of 89.49±4.1%, while the size was found to be in the nano-range (i.e., 75.3±2.4nm). The ITR formulation was found to be stable too as per ICH guidelines. The results vouch immense promise of the optimized SLNs of ITR in reducing dermal irritation and increasing the therapeutic performance, thus resulting in an efficacious and patient-compliant formulation.

The In vitro anti-acne activity of two unani drugs.

Background:Acne is the most common disorder treated by dermatologists. As many as 80-90% of all adolescents have some type of acne and 30% of them require medical treatment. It is an inflammatory disease of the pilosebaceous unit characterized by the formation of open and closed comedones, papules, pustules, nodules, and cysts.Aims:The present study was conducted to investigate the in vitro anti-acne activity of two Unani single drugs Darchini (Cinnamomum zeylanicum Bl.) and Tukhm Khashkhash (Papaver somniferum L. seeds).Materials and Methods:The antibacterial activity of aqueous, ethanolic and hydroalcoholic extracts of both drugs were investigated against two acne causing bacteria, i.e., Propionibacterium acne and Staphylococcus epidermidis using well diffusion method.Results:The result showed that both drugs were active against the two bacteria. Against P. acne aqueous and ethanolic extract of Darchini and Tukhm Khashkhash showed the zone of inhibition of 18 ± 1.02 mm and 18 ± 1.6 mm and 13 ± 1.04 mm and 14 ± 1.8 mm, respectively. Against S. epidermidis aqueous, hydroalcoholic and ethanolic extracts of Darchini showed 22 ± 1.7 mm, 22 ± 1.2 mm and 15 ± 1.8 mm zone of inhibition respectively. Hydroalcoholic and ethanolic extracts of Tukhm Khashkhash showed 15 ± 1.09 mm and 13 ± 1.6 mm zone of inhibition respectively.Conclusion:This suggests that C. zeylanicum and P. somniferum have potential against acne causing bacteria and hence they can be used in topical anti-acne preparations and may address the antibiotic resistance of the bacteria.