Acne Research Articles

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.

6450 Leydig Cell Tumor: A Rare Cause of Post-menopausal Hyperandrogenism

Abstract Disclosure: R. Nakdali: None. S. Athimulam: None. Introduction: Ovarian steroid cell tumors are a rare subtype of sex-cord stromal tumors. Leydig cell tumors is a subtype of sex-stromal tumors that is found in < 1% of all ovarian tumors. They are typically benign, unilateral, and secrete androgens which causes virilization. Below we present the case of a postmenopausal woman who presented with signs of virilization and was diagnosed with an ovarian Leydig cell tumor. Case: A 62-year-old postmenopausal woman, with a history of partial hysterectomy with right oophorectomy presented to Endocrinology clinic for evaluation of thyroid nodules. However, clinically she had signs of virilization noted by the provider on examination. She reported progressive androgenic alopecia, cystic acne, oily skin, hoarseness of voice and hirsutism, with increase hair growth over upper lip, chin and jaw line requiring daily shaving. She denied taking any supplements. She reported embarrassment of these physical changes and prior providers had attributed this to aging, therefore not prompting further testing. This caused significant emotional distress to the patient, leading to isolation. Biochemical testing confirmed elevated bioavailable testosterone (193.1 ng/dL) and total testosterone levels (579 ng/dL), with no evidence of hypercortisolemia. Magnetic resonance imaging (MRI) revealed a heterogenous soft tissue mass (2.9 x 2.1 x 2.1 cm) in the left ovary. She underwent a left salpingo-oophorectomy and pathology confirmed a well-differentiated 2.4 cm Leydig cell tumor. Post-operatively, she reported improvement in facial and body hirsutism, reduced shaving frequency decrease in androgenic hair loss, with noticeable hair growth in her frontal scalp, and her skin became less oily with reduced acne. Post-operative labs confirmed cure of hyperandrogenism (Bioavailable testosterone < 2.6 ng/dL; Total testosterone: < 10ng/dL; and Free androgen index < 0.5%). She has been referred to genetics for evaluation. Discussion: Post-menopausal hyperandrogenism poses a diagnostic challenge as it can be mistaken for hormonal imbalances seen with aging. Often times, patients do not report symptoms due to embarrassment unless specifically addressed by provider. Initial testing consists of total and free testosterone and dehydroepiandrosterone sulfate (DHEAS) levels to assess the source of hyperandrogenism. Ruling out hypercortisolemia and assessment for ingestion of testosterone or DHEA supplements is vital. Pelvic ultrasound or cross-sectional imaging (CT or MRI) of abdomen and pelvis can identify structural abnormalities in the ovaries or adrenal glands. Prompt evaluation and management can alleviate significant distress to the patient. Leydig cell tumors represent a rare but important consideration in the differential diagnosis of postmenopausal hyperandrogenism, such as in our patient. Presentation: 6/2/2024

6450 Leydig Cell Tumor: A Rare Cause of Post-menopausal Hyperandrogenism

Abstract Disclosure: R. Nakdali: None. S. Athimulam: None. Introduction: Ovarian steroid cell tumors are a rare subtype of sex-cord stromal tumors. Leydig cell tumors is a subtype of sex-stromal tumors that is found in < 1% of all ovarian tumors. They are typically benign, unilateral, and secrete androgens which causes virilization. Below we present the case of a postmenopausal woman who presented with signs of virilization and was diagnosed with an ovarian Leydig cell tumor. Case: A 62-year-old postmenopausal woman, with a history of partial hysterectomy with right oophorectomy presented to Endocrinology clinic for evaluation of thyroid nodules. However, clinically she had signs of virilization noted by the provider on examination. She reported progressive androgenic alopecia, cystic acne, oily skin, hoarseness of voice and hirsutism, with increase hair growth over upper lip, chin and jaw line requiring daily shaving. She denied taking any supplements. She reported embarrassment of these physical changes and prior providers had attributed this to aging, therefore not prompting further testing. This caused significant emotional distress to the patient, leading to isolation. Biochemical testing confirmed elevated bioavailable testosterone (193.1 ng/dL) and total testosterone levels (579 ng/dL), with no evidence of hypercortisolemia. Magnetic resonance imaging (MRI) revealed a heterogenous soft tissue mass (2.9 x 2.1 x 2.1 cm) in the left ovary. She underwent a left salpingo-oophorectomy and pathology confirmed a well-differentiated 2.4 cm Leydig cell tumor. Post-operatively, she reported improvement in facial and body hirsutism, reduced shaving frequency decrease in androgenic hair loss, with noticeable hair growth in her frontal scalp, and her skin became less oily with reduced acne. Post-operative labs confirmed cure of hyperandrogenism (Bioavailable testosterone < 2.6 ng/dL; Total testosterone: < 10ng/dL; and Free androgen index < 0.5%). She has been referred to genetics for evaluation. Discussion: Post-menopausal hyperandrogenism poses a diagnostic challenge as it can be mistaken for hormonal imbalances seen with aging. Often times, patients do not report symptoms due to embarrassment unless specifically addressed by provider. Initial testing consists of total and free testosterone and dehydroepiandrosterone sulfate (DHEAS) levels to assess the source of hyperandrogenism. Ruling out hypercortisolemia and assessment for ingestion of testosterone or DHEA supplements is vital. Pelvic ultrasound or cross-sectional imaging (CT or MRI) of abdomen and pelvis can identify structural abnormalities in the ovaries or adrenal glands. Prompt evaluation and management can alleviate significant distress to the patient. Leydig cell tumors represent a rare but important consideration in the differential diagnosis of postmenopausal hyperandrogenism, such as in our patient. Presentation: 6/2/2024

8319 Pituitary Apoplexy Leads to the Spontaneous Resolution of Hypercortisolism Secondary to Cushing Disease: A Clinical Case

Abstract Disclosure: N. Sweis: None. J. Sanchez Perez: None. M. Fariduddin: None. R.M. Sargis: None. D.J. Toft: None. S. Reutrakul: None. Background: Pituitary apoplexy is a potentially fatal condition involving the infarction or hemorrhage of the pituitary gland. Rarely, it can occur in the setting of an ACTH-secreting pituitary adenoma. Clinical Case: A 27-year-old female with a past medical history of obesity, spontaneous miscarriages, and amenorrhea presented to the ER with an acute onset frontal headache of throbbing quality, associated with nausea and vomiting. The headache began two days prior, rapidly intensified, and did not improve with oral acetaminophen. CT of the head revealed an enlarged pituitary gland, while neurovascular imaging showed no abnormalities. Her neurologic examination was normal. She denied visual changes, photophobia, neck rigidity, fevers, chills, or recent infections. Furthermore, she endorsed a weight gain of about 40 pounds over the past year despite no change in dietary habits. This was accompanied by amenorrhea, hair thinning, itchy comedonal acne, hirsutism, and a loss of libido. Her physical examination was remarkable for the presence of cushingoid features including violaceous abdominal striae, facial acne, moon facies, a dorsal fat pad, and acanthosis nigricans around the neck and axillae. Pituitary MRI with and without contrast showed an enlarged sellar and suprasellar macroadenoma measuring approximately 2.1x1.4x1.2 cm abutting the optic chiasm. The visualized lesion contained hemorrhagic products, suggesting pituitary apoplexy. Biochemical testing on admission included a low morning plasma cortisol of 6.5 ug/dL (ref. range: 6.7-22.6 ug/dL), a 24-hour urine free cortisol of 12.0 (<=45.0 ug/24 hour), and an elevated ACTH of 145.0 pg/mL (7.2 - 63.3 pg/mL). A1c was 5.8% (<5.7%). Serum levels of prolactin, IGF1, GH, LH, FSH, TSH, Free T4, estradiol, total and bioavailable testosterone were within normal limits. She was evaluated with an ACTH stimulation test, which showed a morning cortisol level of 1.2 ug/dL at baseline, lower from prior. Cortisol levels were adequately increased at 19.6 ug/dL and 22.6 ug/dL, 30 and 60 minutes after the administration of Cosyntropin 250 mcg, respectively (>=18 ug/dL after 30-60 mins). The level of ACTH at the time was also decreased to 76.6 pg/mL. The patient was therefore started on steroid replacement therapy with hydrocortisone and later underwent transsphenoidal resection of the pituitary mass without complications. Histopathological examination of the resected mass showed pituitary adenoma cells with diffuse weak to moderate ACTH staining, most consistent with a sparsely granulated corticotroph pituitary adenoma. Conclusion: We report an interesting case of Cushing disease that spontaneously resolved after pituitary apoplexy. Our case underlines the importance of close monitoring of such patients who may rapidly undergo a period of adrenal insufficiency after hypercortisolism. Presentation: 6/3/2024

Preparation and evaluation the effects of retinoic acid loaded proliposomal nanofibers on microbial biofilm inhibition

The electrospinning method involves the production of different drug delivery systems using various polymers. The production of proliposomes with electrospinning provides the hybridization of two novel drug delivery systems. Retinoic acid, also known as all-trans retinoic acid (ATRA), is a common and effective drug for acne therapy. This study aimed to prepare ATRA-loaded proliposomal nanofibers and evaluate their effectiveness on microbial biofilm inhibition. Blank and ATRA-loaded proliposomal nanofiber formulations were fabricated in various polyvinylpyrrolidone, phosphatidylcholine and cholesterol ratios. TEM images verified the rapid formation of the liposomes after the hydration of nanofibers. The vesicle size, polydispersity index and zeta potential values of self-assembled liposomes were measured. The vesicle size values were found to be 321.9–363.8 nm with PDI values varying between 0.332 and 0.511 and zeta potential values of (−16.8) to (−20.5)mV. ATRA-loaded proliposomal nanofibers provided higher bioadhesion (0.25 mJ/cm2) than the commercial cream (0.07 mJ/cm2). The short-term stability results showed that the initial characteristics remained for three months at 4 °C. The proposed ATRA-loaded self-assembled proliposomal system provided antibacterial, fungistatic or fungicidal effects superior to retinoic acid itself and inhibited biofilm formation in lower concentrations. This approach can combine the stability advantage of nanofibers in the dry state with the high effectiveness of liposomes in acne treatment presenting antibacterial and anti-biofilm-forming activity against Candida albicans and Cutibacterium acnes.

Dual-Plane Treatment With Highly Concentrated Hybrid Cooperative Complexes of Hyaluronans for Facial Atrophic Acne Scars.

Managing patients with acne scars remains an important challenge, as scarring negatively affects psychosocial wellbeing. Hyaluronic acid (HA) cross-linked fillers have demonstrated good efficacy and tolerability for the correction of acne scars but are limited by their reduced biological activity and low concentrations. This study investigated the efficacy and safety on scars of a high-concentration (4.5%) HA-based filler with hybrid cooperative complexes (HCC) of high-molecular-weight and low-molecular-weight HA. Participants received treatment twice; the first was provided at baseline (T0) and the second after 4 weeks (T1). Data were collected at T1 and after 4 months (T2) by photographs and instrumental evaluation of the skin. The study population included 28 patients. Improvements in the mean Goodman and Baron grade were significant across time points T0 and T1 (12% improvement; p = .0002) and T0 and T2 (31% improvement; p < .0001). Instrumental evaluation of the skin surface demonstrated a 20% reduction in the average deepness of acne scars after 4 months (p < .0001). No serious adverse events were reported during the study procedure. Highly concentrated (4.5%) HCC appears to be an effective option for the correction of facial acne scars.

Effectiveness of Azadirachta indica and Ocimum gratissimum for Acne Vulgaris: A Literature Review

Acne vulgaris is a common dermatological condition characterized by inflammation of the pilosebaceous units, predominantly affecting adolescents and young adults. Its multifactorial etiology involves hormonal imbalances, microbial overgrowth, and environmental factors, leading to increased sebum production and inflammation. Conventional treatments often vary in efficacy and tolerability, driving interest in alternative therapies to reduce the severity and recurrence of lesions and enhance appearance, the acne severity. This literature review explores the therapeutic potential of two herbal remedies, Azadirachta indica (Neem) and Ocimum gratissimum (African basil), known for their antimicrobial, anti-inflammatory, and antioxidant properties. Azadirachta indica is recognized for its rich phytochemical profile, including compounds like nimbin and azadirachtin, which effectively combat acne pathogens such as Cutibacterium acnes. Meanwhile, Ocimum gratissimum exhibits significant antimicrobial and antioxidant activities, contributing to skin healing and sebum regulation. The combined use of these herbs offers a holistic approach to acne management, targeting multiple aspects of its pathogenesis, including inflammation and microbial imbalance. The therapeutic benefits of Azadirachta indica and Ocimum gratissimum highlight their valuable role in advancing dermatological care and offer promising prospects for individuals seeking holistic and plant-based solutions for acne management. This review emphasizes the potential and effectiveness of Azadirachta indica and Ocimum gratissimum in advancing dermatological care and providing effective, plant-based solutions for acne management. Keywords: Acne vulgaris, azadirachta indica, clove basil, neem, ocimum gratissimum, treatment

The Essential Role of Herbal-based Therapies in Combatting Acne Vulgaris

Inflammation, follicular epidermal hyperproliferation, and Propionibacterium acnes (P. acnes) are the primary causes of acne vulgaris, a prevalent skin condition that affects millions of young adults and adolescents. This intricate pathophysiology leads to various acne symptoms, such as whiteheads and blackheads, inflammatory nodules, and scarring. Among the many traditional allopathic acne therapies that often have serious side effects include hormone therapy, hydroxy acids, oral and topical antibiotics, retinoic acid derivatives, and acne medications. Herbal extracts are becoming more and more well-liked as more holistic, kinder substitutes with fewer side effects. Herbal extracts with antibacterial, anti-inflammatory, and antioxidant qualities include Eucalyptus Globulus, Thymus vulgaris (thyme), Melaleuca alternifolia (tea tree), Lavandula angustifolia (lavender), Origanum vulgare (oregano), and Curcuma longa (turmeric). Because of these qualities, they are considered to be viable candidates for treating different elements of acne etiology, including wound healing, inflammation reduction, and P. acnes growth inhibition. Developing herbal remedies is a viable approach to developing efficient and minimally invasive acne treatments. Medicinal plants and essential oils have a long history of traditional use and the potential to attenuate harmful exposures and lessen drug-induced side effects. Their use in dermatological treatments demonstrates their ability to offer comprehensive and natural solutions for the treatment of acne vulgaris, a common and frequently upsetting skin condition.

Use of Plasma-Rich in Growth Factors (PRGF) in the Treatment of Acne

Use of Plasma-Rich in Growth Factors (PRGF) in the Treatment of Acne

In-vitro anti-acne activity of Teucrium oliverianum methanolic extract against Cutibacterium acnes.

Acne vulgaris is a skin infection widely seen in adolescents between 10-19years with males affected more than females. It mainly affects the face but may also affect the back and chest. The symptoms vary with mild acne manifesting as comedones and moderate acne as inflammatory lesions (papulopustular), nodules, and mild scarring while severe acne has the same symptoms that have not subsided within 6months of treatment. Various treatments including topical medications containing different antibiotics are used to treat acne. Recently, herbal treatments have been shown as better alternatives to conventional treatment. Teucrium oliverianum Ging. ex Benth (Lamiaceae) is traditionally used for skin infections such as wound healing and biofilm formation. Methanolic extract of T. oliverianum was subjected to liquid chromatography-mass spectrometry (LC-MS) analysis, and its antibacterial effect against Cutibacterium acnes. The anti-acne, anti-inflammatory, and antioxidant effects were also assessed using HaCaT cells infected with C. acnes. The cytotoxicity of the extract was evaluated using a neutral red uptake assay, and anti-inflammatory effects were determined by measuring TNF-α, IL-1β, INF-γ, and COX2 inhibition. The antioxidant action was assessed by ROS generation in HaCaT cells infected with C. acnes. LC-MS analysis of the extract showed the presence of 16 different metabolites with L-carnitine, esculin sesquihydrate, and gamma-linoleic acid as major metabolites. The methanolic extract of T. oliverianum showed an antibacterial effect against C. acnes with an IC50 value of 263.2μg/mL. The extract attenuated the cytotoxicity of C. acnes on the HaCaT cell and the IC50 was found to be 676.2μg/mL. It also decreased dose-dependently the expression of TNF-α, IL-1β, INF-γ, and inhibited COX2 in the HaCaT cells infected with C. acnes. It also decreased the generation of reactive oxygen species. The results support the use of T. oliverianum as an anti-acne agent but it possesses mild antibacterial action. It showed anti-inflammatory effects in HaCaT cells infected with C. acnes. It is also an effective antioxidant and decreased the generation of reactive oxygen species. Comparison of the anti-acne effects and adverse reactions of extract with other treatments will provide more insight into its clinical efficacy and toxicity.

Low-tech Treatments for Acne Scarring: CROSS, Subcision, and Injectables

Dermatologists routinely treat acne with the objective of preventing acne scarring. Once control of acne has been achieved, our patients are often keen to improve textural skin changes such as atrophic acne scars. We often equate the management of atrophic acne scars with the need to reach for high-tech devices such as resurfacing lasers or radiofrequency-microneedling. While these modalities can play a pivotal role in resurfacing the skin, low-tech treatments can also be used in monotherapy or combination treatment to improve specific types of acne scars. In this article, we discuss the CROSS technique, subcision, and the use of injectables for acne scars.

Acne-related UVA-induced facial fluorescence: An exploratory study from physiological properties to tissue structure information

UVA-induced facial fluorescence (UVAF) is recognized as an objective measurement technique to quantify the severity of acne. However, notable inconsistencies in quantitative outcomes have been observed in various studies, possibly due to the fact that different colors of fluorescence represent different pathophysiological implications. This study investigated the pathophysiological importance of UVAF color differences and improved its reliability in assessing acne severity. MIDOO Smart Skin Imager was used to capture UVAF and analyze the correlation between fluorescence colors and acne lesions. Techniques such as two-photon excited fluorescence microscopy, scanning electron microscopy, western blot, and high performance liquid chromatography-mass spectrometry (HPLC-MS/MS) were used to examine the biochemical composition and structure of comedonal plugs and follicular casts associated with different fluorescence colors. We found that green fluorescence correlates with non-inflammatory acne lesions (comedones), while orange-red fluorescence shows no correlation with either type of lesion. Green fluorescence is associated with higher levels of keratin, indicating keratinization, while orange-red fluorescence is associated with porphyrin from S. epidermidis. UVAF color differences - orange-red are from porphyrins and green from keratin. This distinction helps to understand the structural and physiological bases of facial fluorescence, with potential implications for clinical evaluations of acne.

Correlation Between Reduced IL-1β Levels in Acne Lesions and the Decrease in Acne Inflammatory Lesions Following Topical Vitamin D Administration: A Double-Blind Randomized Controlled Trial.

The inflammatory process in acne vulgaris (AV) is characterized by the upregulation of specific pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, and IL-8, within sebocytes and keratinocytes. Sebocytes have been identified as target cells for bioactive vitamin D. Experimental studies on animal models have demonstrated the potent comedolytic effects of topical vitamin D. However, further research is required to specifically evaluate the impact of vitamin D on inflammatory lesions in acne vulgaris (AV). To evaluate the effectiveness of topical vitamin D in treating acne vulgaris (AV) lesions by investigating its anti-inflammatory effects on pro-inflammatory cytokine modulation, specifically assessing the correlation between IL-1β levels in acne lesions and the reduction in AV severity. This study is a double-blind, randomized, placebo-controlled clinical trial with a 2-arm design over an 8-week intervention period. Participants were randomly assigned to either the topical vitamin D group (cholecalciferol 50 mcg) or the topical placebo group, with each group comprising 32 subjects. All participants received concomitant treatment with topical adapalene 0.1%. Cytokine levels within acne lesions were assessed using Luminex Polystyrene Screening Assays to detect and quantify IL-1β levels. The effectiveness of the treatment was evaluated by monitoring the reduction in the number of inflammatory lesions, while the safety of topical vitamin D was assessed by documenting and analyzing any reported side effects. The study found a significant correlation between the reduction in IL-1β levels within acne lesions and the decrease in moderate and severe inflammatory lesions in acne vulgaris (p = 0.028). The topical application of vitamin D led to a significant reduction in inflammatory AV lesions (p = 0.045). No significant topical side effects were observed in either the vitamin D or placebo groups. This study demonstrates that the topical administration of vitamin D in acne vulgaris (AV) lesions is effective in reducing pro-inflammatory cytokine levels within acne lesions and in decreasing the severity of AV. NCT05758259. September 5, 2022.

Low Serum Vitamin E Levels Positively Correlate with the Severity of Acne Vulgaris

ABSTRACT Acne vulgaris (AV) is a common disorder of the pilosebaceous, especially prevalent in adolescents. Acne vulgaris ranks among the top ten most prevalent diseases globally. Although AV may resolve spontaneously, sequelae such as scar formation can persist, causing aesthetic and psychological disturbances. There is an antioxidant to counteract acne-causing oxidative stress, vitamin E, which is an important antioxidant in the human body. Therefore, vitamin E in the skin can reduce the formation of squalene peroxide and prevent the occurrence of AV. This is an analytical observational study using a cross-sectional design. The investigation was conducted at the Dermatology and Venereology Clinic of Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital and the laboratory of the Faculty of Medicine, Udayana University, from February 2024 until the sample size was fulfilled. The sample consisted of patients aged 12-45 years with acne vulgaris who visited the clinic and were then selected through consecutive sampling according to the inclusion and exclusion criteria. In the non-AV group, the mean serum vitamin E level was 19.3 ± 0.99 µg/ml, whereas in the AV group, it was 4.49 ± 19.1 µg/ml, indicating a significant variance. There was a positive correlation between low vitamin E levels and the severity of AV. The linearity graph shows the direction of the relationship between serum vitamin E levels and the severity of AV, which leads to the lower right, indicating that the higher the severity of AV, the lower the serum vitamin E levels. The mean levels differed significantly between the non-AV and AV groups. A favorable association was found between low vitamin E levels and the severity of AV. Keywords: Acne Vulgaris, Severity, Serum Vitamin E, Reactive Oxygen Species (ROS)

Combinations of Energy-based Devices plus isotretinoin for management of acne and acne scars: A systematic review.

A 6-month interval between systemic isotretinoin (ISO) and the initiation of energy-based interventions has been recommended, due to concerns about keloid formation and delayed wound healing. While this postponement goes against the current trend of early intervention for acne scarring. This systematic review evaluates the efficacy, safety, and patient satisfaction of combinations of ISO with energy-based devices (EBD). PubMed, Embase, Web of Science, Cochrane Library, and Cochrane Central Register of Controlled Trials were comprehensively searched up to April 2023 according to PRISMA guidelines. Two independent reviewers screened the titles and abstracts to select articles. The quality of the literature was assessed for each study design. A total of 16 studies addressing the efficacy and safety of energy-based modalities combined with ISO were identified, including six randomized controlled trials (RCTs), two case series, seven cohort studies, and one case report. ISO combinations with intense pulsed light (IPL), fractional ablative CO2 laser, pulsed dye laser (PDL), non-ablative fractional laser (NAFL) and fractional microneedle radiofrequency (FMRF) have been tested for improving acne severity, acne scarring and erythema. The current evidence does not justify delaying the use of EBDs for patients who have recently undergone or are currently receiving ISO treatment. Evidence-based treatments such as PDL, NAFL, and FMRF etc. are suggested relatively safe and effective in treating acne and acne scarring.

Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel for Male and Female Acne: Phase 3 Analysis.

Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% gel (CAB) is the only fixed-dose triple-combination treatment approved for acne. This post hoc analysis assessed the impact of sex on efficacy and safety/tolerability of CAB. In two multicenter, double-blind, phase 3 studies (NCT04214639 and NCT04214652), participants aged &ge;9 years with moderate-to-severe acne were randomized (2:1) to 12 weeks of once-daily treatment with CAB or vehicle gel. Pooled data were analyzed by sex. Assessments included treatment success (&ge;2-grade reduction from baseline in Evaluator&rsquo;s Global Severity Score and a score of 0 [clear] or 1 [almost clear]), inflammatory/noninflammatory lesion counts, Acne-Specific Quality of Life (Acne-QoL) questionnaire, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability. At week 12, treatment success rates were significantly greater with CAB versus vehicle irrespective of sex (females: 53.7% vs 23.0%; males: 43.1% vs 24.6%; P&lt;0.05, both). CAB-treated female and male participants both experienced greater reductions from baseline versus vehicle in inflammatory (females: 77.7% vs 57.9%; males: 77.5% vs 57.1%; P&lt;0.001, both) and noninflammatory lesions (females: 72.5% vs 45.6%; males: 72.3% vs 49.6%; P&lt;0.001, both). Acne-QoL improvements from baseline to week 12 were significantly greater with CAB than vehicle. No significant differences in any efficacy measures between CAB-treated males and females were observed. Most TEAEs were of mild-to-moderate severity; no sex-based trends for safety/tolerability were observed. CAB demonstrated comparable efficacy, quality-of-life improvements, and safety in female and male participants with moderate-to-severe acne. As the first fixed-dose, triple-combination topical formulation, CAB represents an important new treatment for acne. J Drugs Dermatol. 2024;23(10):873-881. doi:10.36849/JDD.8484.

Effectiveness and Safety of a Dermocosmetic Cream as an Adjunct to Adapalene for Mild and Moderate Acne in Indonesia: Results of a Multicenter Randomized Controlled Study.

Acne is a chronic inflammatory skin condition affecting mainly teenagers and adults as well. Guidelines recommend retinoids as a first-line treatment for mild-to-moderate acne. However, dermocosmetics in adjunct could potentially improve efficacy and tolerability. This study was conducted to determine the effectiveness and safety of a dermocosmetic cream containing salicylic acid, lipohydroxy acid, niacinamide, Aqua posae filiformis, procerad and zinc salt in the treatment of mild-to-moderate acne vulgaris in adjunct to different regimens of adapalene compared to adapalene only. This randomized, controlled, parallel-group, evaluator-blind study was conducted over 8weeks on male and female acne subjects at five teaching hospitals in Indonesia. A total of 291 participants were enrolled and divided into three treatment groups: Group A adapalene 0.1% cream nightly - Group B dermocosmetic cream daily + adapalene 0.1% cream every two nights - Group C dermocosmetic cream daily + adapalene 0.1% cream nightly. Clinical evaluations of treatment included scoring on Global Evaluation of Acne (GEA) scale, lesion count (Indonesian Acne Expert Meeting scale), treatment tolerability and treatment satisfaction. Evaluations were performed on Day28 and Day56 of treatment. After 28 and 56days of treatment, all groups exhibited improvements across the various measures. Data analysis, utilizing Anova for repeated measurements, revealed a statistically significant difference between GroupsC and A for reduction of GEA scores (p = 0.038) in favor of GroupC. On Day56, percentages of subjects with GEA Scale improvements of at least 1grade in comparison with baseline were in GroupC (61.7%) followed by GroupA (47.9%) and GroupB (45.3%). Better treatment tolerance and satisfaction scores were noted in GroupsB and C. Combination of the dermocosmetic cream with adapalene showed higher efficacy, tolerability and satisfaction in comparison to adapalene alone.