Global Acne Grading System Score Research Articles

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

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

Unmasking Acne: Azithromycin Edges Out Doxycycline in Randomized Trial at Tertiary Care Centre

Background: Acne vulgaris, a prevalent global condition, often necessitates antibiotic therapy. Doxycycline has been a mainstay treatment; however, recent research suggests azithromycin might be superior. Conflicting data and a lack of local studies regarding their comparative efficacy warrant further investigation. Objectives: This study aimed to compare the efficacy of oral azithromycin with oral doxycycline in treating acne vulgaris at a tertiary care hospital in Islamabad. Methods: A randomized controlled trial was conducted. Patients aged 14-30 years (n=190) were enrolled and randomly assigned to either azithromycin or doxycycline treatment groups. Baseline and post-treatment (12 weeks) Global Acne Grading System (GAGS) scores were assessed. Percent reductions in GAGS score were categorized into four groups (&lt;25%, 25-50%, 51-75%, and &gt;75%) for intergroup comparison. Written informed consent was obtained from all participants. Results: The mean patient age was 21.30±4.93 years, with a female predominance (male:female ratio 1:1.2). Most patients had Fitz-Patrick Skin Type-V (64.7%) compared to Type-IV (35.3%). Baseline GAGS scores were comparable between groups (p=0.612). Notably, post-treatment GAGS scores were significantly lower in the azithromycin group (p&lt;0.001), demonstrated by a greater mean change (19.33±3.03 vs. 17.70±2.99; p&lt;0.001) and percent reduction (81.87±8.74 vs. 75.97±11.12%; p&lt;0.001) compared to doxycycline. Additionally, 75.3% of patients achieved an excellent reduction in GAGS score, with a significantly higher proportion observed in the azithromycin group (87.4% vs. 63.2%; p&lt;0.001). Similar significant differences were observed across subgroups based on age, gender, and skin type. Conclusion: This study suggests that azithromycin demonstrates superior efficacy to doxycycline for acne vulgaris management, regardless of patient demographics or skin type. Its established better safety profile further supports its potential as a preferred therapeutic option in future dermatological practice. Keywords: Acne Vulgaris, Azithromycin, Doxycycline, Percent Reduction in GAGS Score

Correlation between depression scores and serum NF-ĸB/NLRP3 axis, biotinidase, and HMGB1 after treatment with isotretinoin in patients with acne vulgaris.

Acne vulgaris (AV) is an inflammatory skin disorder leading to scars and discomfort, its intensity has major psychological consequences such as depression. To investigate the effect of isotretinoin (ISO) on NF-κB/NLRP3, biotinidase, and HMGB and correlation with depression. This was a case-control study that involved two groups. Group 1 is 20 healthy control, and group 2 is 20 patients diagnosed with AV according to Global Acne Grading System (GAGS) and received 20 mg ISO for 2 months. Before and after therapy, the Hamilton Depression Rating Scale (HDRS) was applied to assess each participant's level of depression. Nuclear factor kappa B (NF-ĸB), biotinidase, high mobility group box protein (HMGB1), nucleotide-binding domain, leucine-rich-containing family, and pyrin domain-containing-3 (NLRP-3) were measured in serum samples. There was no significant difference in all measured markers of healthy group before and after 2 months. Regarding group 2, there was a statistically significant decrease in all measured markers after 2 months of treatment and significant correlations between GAGS, NF-ĸB, HMGB1, NLRP3, biotinidase, and depression score. Increased GAGS, HMGB1, NLRP3, and biotinidase were associated with depression severity in AV patients and ISO treatment significantly reduced these parameters and reduced depressive symptoms.

Oral isotretinoin with desloratadine compared with oral isotretinoin alone in the treatment of moderate to severe acne: a randomized, assessor-blinded study.

Our aim was to measure the effectiveness of oral isotretinoin with desloratadine compared with oral isotretinoin alone in treating moderate to severe acne at a tertiary care teaching hospital in North India. In this study, 90 patients with moderate to severe acne were enrolled to participate based on their fulfilling the inclusion criteria. A randomized, assessor-blinded, parallel-arm study was conducted. Randomization was done using computer-generated tables to allocate treatments in a 1:1 ratio. A low-dose oral isotretinoin at a dose of 0.3 mg/kg/day with tab desloratadine at 5 mg/day was applied to the study group and compared against the same patients going without the dosage when controls were conducted. Follow-up was at 4, 8, and 12 weeks. The primary outcome was an improved global acne grading system (GAGS) score and decreased acne lesion count. patient satisfaction with treatment. The 90 participants were randomized and 15 participants dropped out of the study, leaving 75 participants for intention to treat analysis (n = 41, n = 30). At week 12, the GAGS score and acne lesion count between the study and control groups were comparable (P > 0.05). Pruritus reported was 9.76% in the study versus 33.33% in the control group (P = 0.018). Also, 53.66% of participants reported "excellent" treatment satisfaction in the study group versus 36.67% in the control group. The addition of desloratadine to an isotretinoin regimen has a role in reducing disease and therapy-related pruritus in acne and leads to improved patient satisfaction.

Comparing the Efficacy of Topical 4% Benzoyl Peroxide Versus Topical 0.1% Adapalene for Treatment of Acne Vulgaris in Skin of Color Population: A South Asian Perspective.

Introduction Acne vulgaris is one of the most common skin problems encountered in the dermatology department. It is a chronic, inflammatory disease of the pilosebaceous unit, clinically presenting with comedones, papules, pustules, nodules, and cysts. With its particularly high prevalence in the younger population, it has significant adverse sequelae on patient's quality of life. At present, due to an enhanced understanding of the pathogenesis of acne, various therapeutic modalities are available. The current management strategies generally follow a systematic treatment escalation based on disease severity and treatment response. However meticulous choice of appropriate anti-acne medicine for the acne type is the key to the management plan. Starting with mild to moderate types of acne as per the Leeds photometric grading scale, the most useful topical agents include topical retinoids, benzoyl peroxide, and topical antibiotics while systemic therapies such as oral antibiotics or isotretinoin are generally reserved for moderate to severe acne treatment. The skin of color (SOC) population is a relatively neglected group concerning the optimum and safe management strategies in different dermatological conditions and acne is no different, where there remains a need for comparing the available topical modalities for appropriate drug selection in the treatment of mild to moderate acne in SOC population. Objective The objective of this study was tocompare the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalenein the treatment of acne vulgaris in the SOC population. Methods The participants were divided into two groups, groups A and B. A total of 64 patients of both genders, with acne vulgaris (duration > three months) were included in the study. In group A, 32 patients were administered topical 0.1% adapalene whereas, in group B, 32 patients were given topical 4% benzoyl peroxide. Both medicines were applied at night daily. Patients were called for follow-up after 12 weeks. In both groups, the final efficacy evaluation was done using the Global Acne Grading System (GAGS) scoreafter 12 weeks of treatment period. Results In group A, the age ranged from 15 to 40 years with a mean age of 25.781±3.93 years while the duration of complaint was 5.843±1.27 months. GAGS score was 25.281±2.65 and mean BMI was 23.092±3.51 kg/m2. In group B, the mean age was 25.187± 4.06 years, the duration of complaint was 7.375±2.25 months, the GAGS score was 23.906± 2.60 while the mean BMI was 21.485±3.88 kg/m2. Efficacy in group A was noted in 25 (78.1%) patients as compared to 24 (75%) patients in group B (p =0.768). Conclusion The present study showed that the safety and efficacy of 0.1% adapalenethe traditional drug 4% benzoyl peroxide in the SOC population was comparable.

Intense Pulsed Light (IPL) therapy in acne vulgaris management: Assessing efficacy and safety.

Objective: To evaluate efficacy and safety of IPL in the treatment of Acne vulgaris. Study Design: Quasi-experimental study. Setting: CMH, Peshawar. Period: 15th January 23 to 15th May 23. Material &amp; Methods: 35 participants having acne vulgaris with age range from 18-35 years were selected. Participants who had used any form of topical, oral, or alternative treatments for acne, including retinoids, within the six months preceding the commencement of the study, history of systemic steroid intake, photosensitivity and herpes simplex, were excluded. Global Acne Grading System (GAGS) score was used to ascertain the severity of acne vulgaris. Four sessions of weekly Intense Pulsed Light (IPL) sessions, utilizing filters of 420nm, 510nm and 560nm for participants having skin type III, IV and V respectively were employed. GAGS score was calculated one week after the last session. Side effects were recorded, degree of improvement and patient reported outcome was noted using a four-point scale limited =&lt;25%, marked =25%-50%, promising 50-75% and profound =&gt;75%. Results: Mean age of participants was 21.63 ± 4.63 years, with a mean duration of acne was 4.26 ± 2.20 years. The mean baseline GAGS score I decreased from 22.00±5.26 to 11.58±4.80, as observed one week following the last IPL session. The calculated p-value was statistically significant (&lt;0.000). 54% of patients encountered no adverse reactions. Conclusion: Intense Pulsed Light (IPL) emerges as a secure and efficacious treatment choice, particularly in the initial stages, to enhance the response to therapy.

Lack of Association of Acne Severity with Depression, Anxiety, Stress, and Eating Attitudes: A Cross-Sectional Study.

this study aimed to investigate the relationship between acne severity and depression, anxiety, stress, and negative eating attitudes in patients with acne vulgaris. This study was conducted with 81 patients with acne vulgaris who applied to the dermatology outpatient clinic of Karaman Training and Research Hospital. The patients were asked to complete a sociodemographic data form, the three-factor nutrition questionnaire (TFEQ-21), and the depression anxiety stress scale (DASS-21). Acne severity was assessed using the global acne grading system (GAGS) by an expert dermatologist. Of the 81 patients, 74.1% were female and the average age of the cohort was 22.86 years. The average body mass index of the patients was 21.78 and the GAGS average score was 24.25. Correlation tests revealed the lack of any relationship between the GAGS score and the DASS-21 and TFEQ-21 scale scores (and their subscales). The DASS-21 depression subscale was correlated with the TFEQ-21 total score, and TFEQ-21 emotional eating and TFEQ-21 uncontrolled eating scores. Additionally, a relationship was identified between the DASS21-stress subscale score and TFEQ-21 uncontrolled Eating and TFEQ-21 total score, as well as between the DASS21-anxiety scale and the TFEQ-21 total score and TFEQ-21 uncontrolled eating subscale score. Although no relationship was found between acne severity and depression, anxiety, or eating disorders, these conditions can increase the risk of eating disorders among acne patients. Therefore, it is critical to take the necessary precautions for the treatment of depression and anxiety disorders in this patient population.

The adjuvant treatment role of ω-3 fatty acids by regulating gut microbiota positively in the acne vulgaris

Objectives: We aimed to explore the potential role of omega-3 (ω-3) fatty acids on acne vulgaris by modulating gut microbiota. Materials and Methods: We randomly divided the untreated acne patients into two groups with or without ω-3 fatty acids intervention for 12 weeks. The Sprague Dawley (SD) rats with acne model were given isotretinoin, ω-3 fatty acids or their combination respectively. Then the colonic contents samples of the drug intervention SD rats were transferred to the pseudo sterile rats with acne model. The severity of the disease was assessed by the Global Acne Grading System (GAGS) score of the patients, and the swelling rate of auricle and the pathological section of the rat with acne model. The 16S rDNA gene sequencing was performed to detect the alteration of the gut microbiota. Results: ω-3 fatty acids could increase the diversity of the gut microbiota and regulate the flora structure positively both in the patients and rats, increase the abundance of butyric acid producing bacteria and GAGS score in the patients, and alleviate the inflammation and comedones of rats. Conclusion: Supplementation of ω-3 fatty acids could alleviate the inflammation of acne vulgaris by increasing the abundance of butyric acid producing bacteria.

Comparative evaluation of therapeutic efficacy and safety of black peel versus 25% trichloroacetic acid peel in mild to moderate acne vulgaris: a split face study.

Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. Thirty patients (or 60 sites) with age ranging from 15 to 45 years with mild-to-moderate acne vulgaris were included in the study. Assessment at baseline was done by the global acne grading system score for including mild and moderate acne patients. On grading the improvement according to the 5-point Global Assessment Scale (GAS), it was found that in area A (black peel), 6.7% of patients showed excellent improvement, 86.7% of patients showed good improvement, and 6.7% of patients showed fair improvement. In area B (25%TCA peel), 6.7% of patients showed excellent improvement, 80% of patients showed good improvement, and 13.3% of patients showed fair improvement. None of the patients showed poor or worse outcomes in any of the areas. The difference between the groups was not significant (P = 0.688). There is a paucity of data in the literature regarding the comparison of black peel with other conventional peels in the treatment of acne vulgaris. To the best of our knowledge, this is the first study comparing black peel with TCA peel in the treatment of acne vulgaris.

Assessment of the Effect of Rehmannia glutinosa Leaf Extract in Maintaining Skin Health: A Proof-of-Concept, Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

A double-blind, placebo-controlled, randomized, proof-of-concept trial aimed to evaluate the efficacy and safety of VerbasnolTM [Rehmannia glutinosa Libosch leaf-based extract (RGLE)] in females, with moderate to severe acne vulgaris. Twenty-two females aged 18 to 35 years having moderate to severe acne with Global Acne Grading System (GAGS) scores of 19 to 38 were included in the study and were randomized in a 1:1 ratio to receive either one capsule (100 mg/day) of RGLE or placebo orally after breakfast for 56 days. The primary outcome was a change in acne severity measured by the GAGS compared to the placebo on day 56. The secondary outcomes were changes in the number of inflammatory acne lesions, facial sebum secretion, quality of life, local pain and itching, skin wrinkle severity, and other skin characteristics, including radiance, luminosity, smoothness, texture, firmness, and hydration. Additionally, the percentage of responders and global tolerability and efficacy were evaluated. The mean GAGS score was reduced by 21.72% and 14.20% on day 28 in RGLE (n=10) and placebo groups (n=12), respectively, which further reduced in both groups on day 56. The RGLE group reported better improvement in other skin characteristics on day 56. No safety or tolerability concerns were reported for the extract. RGLE reduced acne and improved the skin quality in females compared to placebo as early as 28 days of supplementation. RGLE supplementation at a dose of 100 mg/day has provided a clinically relevant decrease in acne severity and improved the skin hydration and quality of life of the participants with acne after 56 days of dose administration.

Evaluation of the Effect of Oral Isotretinoin on the Level of Serum YKL40 in Acne Vulgaris Patients: A Cross-Sectional Case-Control.

In the entire world, acne vulgaris (AV) is the most prevalent skin condition. Approximately 9.4% of people worldwide have acne vulgaris. This study compared the blood levels of chitinase 3-like protein 1 (YKL-40) in acne vulgaris patients before and after oral isotretinoin therapy. The design of the study was cross-sectional case-control. Forty patients with moderate to severe acne vulgaris and twenty healthy participants participated in this study. Using the Global Acne Grading System (GAGS) score, patients with acne vulgaris were evaluated both before and after concluding their treatment. Using the enzyme-linked immunosorbent assay (ELISA), the serum levels of YKL-40 were measured before and after oral isotretinoin therapy in healthy controls and acne patients. Patients with acne vulgaris had considerably greater serum levels of YKL-40 than healthy control subjects (p 0.001) did. After three months of oral isotretinoin medication, the GAGS score and blood levels of YKL-40 in acne vulgaris patients both significantly decreased. The conclusion of this study was that reducing the blood levels of YKL-40 and the GAGS score in patients with acne vulgaris who took oral isotretinoin for three months was a crucial strategy.

Clinicoepidemiological Pattern and Quality of Life Indices among Adult Males with Acne Vulgaris: A Hospital-based Cross-sectional Study

Background and Aim: Adults with acne have been found to have a higher incidence of anxiety, depression, and suicidal ideation as compared to the general population. To the best of our knowledge, there is a dearth of studies assessing the quality of life among males with acne. This study explores the clinical patterns of acne with special emphasis on quality of life among adult males with acne vulgaris. Materials and Methods: All male patients visiting the dermatology outpatient department with acne were included after obtaining informed consent. Demographic data were recorded. Clinical assessment was done based on Global Acne Grading System (GAGS) and qualitative global acne scar grading. Assessment of quality of life was done using Dermatological Life Quality Index (DLQI) and Cardiff Acne Disability Index (CADI) in each patient. Results: Among 322 patients recruited in this study, 293 patients (91.3%) had mild acne, followed by 29 patients (8.7%) who had moderate acne as per GAGS score. The mean DLQI and CADI scores were 5.07 ± 5.0 and 4.0 ± 2.8, respectively. GAGS was found to have a significant correlation with CADI but not with DLQI. Conclusion: CADI score is an important tool which can enable dermatologists to assess the psychosocial burden of the disease in men with acne. This can enable the development of a comprehensive management plan which will enable better treatment and better quality of life in men with acne.

Association of Vitamin D with Moderate to Severe Acne Vulgaris.

To determine the association of vitamin D deficiency in moderate to severe acne. A comparative study. Place and Duration of the Study: Dermatology OPD at Dow University of Health Sciences, Karachi, Pakistan, from December 2021 to May 2022. Fifty patients with moderate acne, 50 patients with severe acne, and 50 healthy controls were inducted. Information regarding age, gender, and medical and medication history were taken. The severity of acne was rated according to the GAGS (global acne grading system) score. Levels of 25(OH) D were classified as sufficient (>20 ng/mL), insufficient (12-20 ng/mL), or deficient (<12 ng/mL). Significance was taken at p-value <0.05. The median concentration of vitamin D levels was 7.09 ng/ml in severe acne vulgaris, 13.7 ng/ml in moderate acne vulgaris and 21.6ng/ml in the control group. Serum vitamin D levels were significantly lower (p<0.001) in individuals with acne vulgaris as compared to the healthy controls. However, the decrease in level of vitamin D did not correspond with the severity of acne vulgaris. Vitamin D deficiency is additionally pronounced in acne vulgaris individuals, but vitamin D levels are not proportional to the severity of acne vulgaris. Acne vulgaris, Vitamin D deficiency, Pilosebaceous unit, GAGS score.

The relationship of quality of life and acne severity with chronotype and insomnia in patients with acne vulgaris.

This study aimed to examine the relationship between acne severity and quality of life, insomnia, and chronotype. This study included 151 patients diagnosed with acne vulgaris, aged 18-30years. A sociodemographic data form was completed by the clinician, and acne severity was evaluated using the Global Acne Grading System (GAGS). The Visual Analogue Scale (VAS), Acne Quality of Life Scale (AQLS), Hospital Anxiety Depression Scale (HADS), Insomnia Severity Index (ISI), and Morningness-Eveningness Questionnaire (MEQ) were completed by the participants. There was a significant difference between the MEQ scores of the participants who were divided into three groups according to the severity of global acne, as mild, moderate, and severe. In the post hoc analysis, the MEQ scores of the patients with mild acne were determined to be significantly higher than the scores of the patients with moderate and severe acne. A statistically significant negative correlation was observed between the GAGS scores and the MEQ scores. In addition, a statistically significant positive correlation was found between the participants' ISI scores and AQLS scores. Considering the variables related to chronotype and sleep in the treatment planning for patients with acne vulgaris may be appropriate within the scope of integrative treatment.

Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia.

Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students. A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables. The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS. The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.

Efficacy and Safety of Intense Pulsed Light in Patients of Inflammatory Acne Vulgaris

Objective: To assess the efficacy and safety of IPL in patients with inflammatory Acne Vulgaris.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Dermatology, Pakistan Air Force Hospital, Fazaia Medical College, Islamabad Pakistan, from Aug 2019 to Jan 2020.&#x0D; Methodology: Ninety patients with inflammatory facial acne were enrolled and received four Intense Pulsed Light (IPL) sessions at two weeks intervals with fluence 25J/cm2 and 420nm cut-off filter. The duration of treatment for each patient was two months. Clinical improvement was assessed using the Global Acne Grading System score (GAGs score).&#x0D; Results: Mean age of the patients was 18.5±3.3years, of which nine were males (10%), and 81 were females (90%). IPL was effective in 42(46.7%) patients with inflammatory acne vulgaris. The median GAGS score before treatment was 20(22–19), and after treatment was 10(12-9), with a significant p-value(&lt;0.001). Only 8(9%) developed erythema, and 1(1%) patient developed post-inflammatory hyperpigmentation.&#x0D; Conclusions: Intense Pulsed Light was a significantly effective and safe treatment for inflammatory acne of all grades, ages,and genders.Keywords: Efficacy, Inflammatory acne vulgaris, Intense pulsed light, Safety, Treatment.

Effect of 30% Supramolecular Salicylic Acid Peel on Skin Microbiota and Inflammation in Patients with Moderate-to-Severe Acne Vulgaris.

Thirty-percent supramolecular salicylic acid (SSA), a modified salicylic acid preparation, is a safe and effective treatment for moderate-to-severe acne vulgaris (AV). However, its mechanism of action remains unclear. We aimed to analyze the role of 30% SSA peels on skin microbiota and inflammation in patients with moderate-to-severe AV. A total of 28 patients were enrolled and received 30% SSA peels biweekly for 2months. The Global Acne Grading System (GAGS) score, skin water content, transepidermal water loss (TEWL), pH, and sebum levels were assessed. Skin microbial samples and perilesional skin biopsies were obtained at the onset and 2weeks after treatment completion. Samples were characterized using a high-throughput sequencing approach targeting a portion of the bacterial 16S ribosomal RNA gene. After treatment, patients showed a significant improvement in their GAGS score and skin barrier indicators (P < 0.05). The GAGS score was positively associated with both the sebum concentration (R = 0.3, P = 0.027) and pH (R = 0.39, P = 0.003). Increased expression of caveolin-1 and decreased expression of interleukin (IL)-1a, IL-6, IL-17, transforming growth factor beta, and toll-like receptor 2 were observed in the skin tissue after treatment. The richness and evenness of the cutaneous microbiome decreased after treatment and the Staphylococcus proportion decreased significantly (P < 0.05), whereas the Propionibacterium proportion tended to decrease (P = 0.066). On the basis of analyses of the skin barrier and microbiota, we speculate that the 30% SSA peel may have a therapeutic effect in patients with moderate-to-severe AV by improving the skin microenvironment and modulating the skin microbiome, thus reducing local inflammation.

Comparison of the Efficacy of Tazarotene 0.1% Cream Versus Clindamycin 1% Gel in the Treatment of Acne Vulgaris

Objective: To compare the efficacy of Tazarotene 0.1% cream versus Clindamycin 1% gel in treating acne vulgaris.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of the Study: Dermatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2018.&#x0D; Methodology: One hundred and fifty-four patients of both genders who had moderate acne vulgaris for more than four weeks were divided into two Groups. In both Groups, patients applied one-fourth fingertip unit of Tazarotene 0.1% cream in the evening once daily and Clindamycin 1% gel over the affected area in the morning once daily for 12 weeks. The Global Acne Grading System Score (GAGS score) was used for severity and efficacy assessment.&#x0D; Results: The majority of the patients belonged to 13-25 years of age, i.e., 61(79.2%) and 54(70.1%) in Group-A (Tazarotene 0.1% cream) and Group-B (Clindamycin 1% gel), respectively. The efficacy of topical Tazarotene cream (0.1%) was better than topical Clindamycin 1% gel, and the difference was statistically significant with a p-value less than 0.01. GAGS score &lt;10 was observed in 54.5% and 33.8% of patients in Group-A and Group-B, respectively.&#x0D; Conclusion: Topical Tazarotene cream (0.1%) was more effective than topical Clindamycin 1% gel in treating acne vulgaris.

Efficacy of Unani Combination Therapy in the Management of Acne Vulgaris: A Randomised Standard Controlled Study

Acne vulgaris is one of the common chronic inflammatory diseases of the pilosebaceous unit with multiple pathophysiologies affecting adolescents mainly. Aims: To evaluate the efficacy of Shahtra (Fumaria indica) orally along with the topical use of Zimad Muhasain and the management of moderate to severe category of acne vulgaris on the Global Acne Grading System (GAGS) scale. Material &amp; Methods: This was a randomized standard control clinical study. The test group patients were given Shahtra ( 500 mg), 2 capsules twice daily with a local application of Zimad Muhasa paste once daily; the control group patients were given tablet Azithromycin 500 mg thrice weekly with a local application of Benzoyl peroxide 5% gel once daily for 8 weeks. Result: In the test group, there was a 77.3% reduction in the GAGS score at the final follow-up with p&lt;0.0001; in the control group, there was a 69.8% reduction in GAGS score with p&lt;0.0001, showing extremely significant improvement in both groups. The results indicate the superiority of the test group regimen over the control group by at least 7%. Furthermore, adverse effects like burning sensation, dryness, and itching due to Benzoyl peroxide and diarrhoea due to Azithromycin were only reported in the control group whereas the Unani formulations were found to be free of such adverse effects. Conclusion: The test formulations comprising a dried aqueous extract of Shahtra and Zimad Muhasa were found to be more effective and safe in the management of acne vulgaris in moderate to severe acne, compared to the control combination of Azithromycin and Benzoyl peroxide gel.

Evaluation of Total Oxidant and Total Antioxidant Status in Patients with Acne Vulgaris

Acne vulgaris is a common skin disease and has a complex pathogenesis. There is no enough data related with oxidative stress in acne vulgaris. We purposed to assess total oxidant and total antioxidant status in acne vulgaris. We included 32 acne patients and 35 healthy controls in this study. Global Acne Grading System (GAGS) scores were calculated. Serum total oxidant status (TOS) and total antioxidant status (TAS) levels were evaluated and oxidative stress index (OSI) was calculated by proportion of the TOS to the TAS. Mean GAGS scores of acne patients were 14.08 ± 5.72. Mean disease duration of acne patients was 33.97 ± 25.99 months. TAS, TOS and OSI were significantly higher in acne patients (p=0.010, p=0.021, p=0.015, respectively). TAS, TOS and OSI were not correlated with disease duration and GAGS scores (p>0.05). Both oxidant and antioxidant status increased in acne patients. The study showed that oxidative stress may play a role in pathogenesis of acne but it isn’t exactly known that is a cause or a result of acne. Advanced studies especially comparing mild to moderate and severe acne patients are required. In addition we consider that antioxidant agents may be beneficial in the treatment of acne.