Global Acne Grading System Score Research Articles

Immunohistochemical expression of interleukin 1 beta in papule biopsies from patients with acne vulgaris.

Acne vulgaris is the most common inflammatory disease of the skin. IL-1b has been found in acne lesions and is a promising target for therapy, but the evidence is limited. Therefore, this study was conducted to investigate the immunohistochemical expression of IL-1b in papule biopsies of inflammatory acne and its association with disease severity. This study involved 20 patients with acne vulgaris (13 females, median age: 22 years). Samples were taken using punch biopsy. Immunohistochemical IL-1b expression was semi-quantitatively assessed as absent, mild, moderate or strong. Disease severity was evaluated according to the Global Acne Grading System (GAGS). There were 7 patients with mild disease and 11 patients with moderate disease. Median GAGS score was 20. Mild and moderate accounted for 65% and 30% for dermal IL-1b expression, 60% and 40% for epidermal expression, and 70% and 15% for perifollicular expression. Moderate-strong perifollicular expression had significant higher GAGS score than absent-mild expression (median: 22 versus 16). This study shows the elevated immunoreactivity of IL-1b in papule biopsies of inflammatory acne vulgaris. The levels of IL-1b expression also correlates with disease severity. IL-1b could be a good candidate for targeting treatment of acne vulgaris.

Telemedicine management of systemic therapy with isotretinoin of patients with moderate-to-severe acne during the COVID-19 pandemic: A longitudinal prospective feasibility study

Telemedicine management of systemic therapy with isotretinoin of patients with moderate-to-severe acne during the COVID-19 pandemic: A longitudinal prospective feasibility study

The influence of benzoyl peroxide on skin microbiota and the epidermal barrier for acne vulgaris.

The disordered skin microbiome has been reported to contribute to the pathogenesis of acne vulgaris, for which benzoyl peroxide (BPO) has long been recommended as the first-line therapy. However, there are no data regarding the effect of BPO treatment on skin microbiota and the epidermal barrier in young adults with acne vulgaris. Thirty-three patients with acne vulgaris and 19 healthy controls were enrolled in the study. All patients received topical treatment with BPO 5% gel for 12 weeks. The epidermal barrier was analyzed at baseline and after treatment. Microbial diversity was analyzed using a high-throughput sequencing approach targeting the V3-V4 region of 16S rRNA genes. After receiving treatment with BPO, patients had significant improvement in their Global Acne Grading System (GAGS) score, porphyrin, and red areas (p < 0.05), and the presence of sebum, stratum corneum hydration (SCH), and transepidermal water loss (TEWL) increased (p < 0.05). When compared with baseline, microbial diversity was significantly reduced after treatment, as calculated by the goods coverage (p=0.0017), Shannon (p=0.0094), and Simpson (p=0.0017) diversity indices. The prevalence of the genus Cutibacterium (before treatment: 5.64 [3.50, 7.78] vs. after treatment: 2.43 [1.81, 3.05], p=0.011) was significantly reduced after treatment while Staphylococcus (before treatment: 43.80 [36.62, 50.98] vs. after treatment: 53.38 [44.88, 61.87], p=0.075) tended to increase. The abundance of Staphylococcus was negatively associated with SCH (p=0.008, r=-0.286). Despite its contribution to an improved GAGS score, BPO treatment for acne vulgaris may reduce microbial diversity and damage the epidermal barrier.

IMPACT OF ACNE VULGARIS ON A PERSON’S QUALITY OF LIFE AND IT’S CORRELATION WITH THE CLINICAL SEVERITY PRE AND POST-DRUG THERAPY

Objective: The aim of the study is to assess the therapeutic efficacy of drugs used in acne vulgaris by measuring the severity of acne using the Global Acne Grading System score (GAGS) and Cardiff Acne Disability Index (CADI) questionnaire score pre and post-drug therapy. Methods: The present study was conducted in the Department of Dermatology after getting approval from the Institutional Ethics Committee (No MC/190/2007/Pt1/MAR-2019/PG/123) dated 10/04/2019. It was an observational study for a period of 1 y. 172 patients were enrolled in the study. Patients were divided into 4 grades depending on their clinical manifestation. The severity of acne vulgaris and the quality of life were measured using the GAGS scale and the CADI questionnaire, respectively at the first visit and at the follow-up visit in all the grades of acne vulgaris. A correlation was done between the GAGS and the CADI score at the follow-up visit in all grades of acne. Results: It was observed that the GAGS score and the CADI score was significantly improved at the F/U visit (p&lt;0.05) as compared to baseline in all the 4 grades of acne. A correlation between GAGS score and QoL using CADI scale was done using Pearson Parametric Correlation Test. In none of the groups, the correlation was significant (p&gt;0.05). Conclusion: We can conclude from our study that following treatment with drugs, the clinical severity of acne decreased and there was also a significant improvement in the quality of life of patients.

Serum resistin levels and resistin gene polymorphism in patients with acne vulgaris: does it correlate with disease severity?

Acne vulgaris is a disease that inflames the sebaceous gland with multiple etiologies. Many proinflammatory adipokines contribute to this pathogenesis. Resistin is a proinflammatory mediator that activates kappa B, a nuclear factor, and c-Jun N-terminal kinases pathways inducing toll-like receptor-2, interleukin-1, 6, and tumor necrosis factor alpha. Resistin gene affects the promoter and intron regions' polymorphisms' expression levels. We aimed to study the association of resistin gene polymorphisms (RETN -420 C/G) and the development of acne vulgaris and whether it is associated with serum resistin levels and disease severity. Resistin (RETN) gene (rs1862513) genotypes were identified using restriction fragment length polymorphism (RFLP), and serum resistin presence was assessed by enzyme-linked immunosorbent assay in 40 patients with acne vulgaris and 40 age- and sex-matched healthy controls as a cross-reference. Patients were divided into mild, moderate, and severe groups. Global Acne Grading System (GAGS) was used to assess the severity of acne vulgaris. CG and GG genotypes were present in cases (P = 0.006) odds ratio (OR)1 = 4.43; 95% confidence interval (CI) (1.53, 12.7) and OR2 = 5.47; 95% CI (0.99, 30.1); G-allele statistically dominated in the patient group where P = 0.001 and OR = 3.57; 95% CI (1.63, 7.80). A positive significant relationship between RETN genotypes and serum resistin levels and GAGS score was present. RETN genes rs1862513 GG and G allele are correlated to acne vulgaris development and severity in a sample of the Egyptian population. This study comprised a small sample size. The cases may not accurately represent the general population; only one clinic was enrolled in the study.

The Effect of Intense Pulsed Light on the Skin Microbiota and Epidermal Barrier in Patients with Mild to Moderate Acne Vulgaris.

The skin microbiota partly determined by epidermal barrier plays an important role in acne vulgaris and intense pulsed light (IPL) has been verified as a safe and effective therapeutic option for this disease. Nevertheless, the exact role of the IPL treatment on the skin microbiota and epidermal barrier for patients with acne vulgaris remains unclear. This article was designed to solve this problem. Nineteen healthy controls and 20 patients with mild to moderate acne were enrolled in this study, who received IPL treatment for 12 weeks. The epidermal barrier and skin samples were collected at baseline and after treatment. The microbial diversity was analyzed based on a high-throughput sequencing approach, which targets the V3-V4 region of the bacteria 16S ribosomal RNA genes. After treatment of IPL, the Global Acne Grading System (GAGS) scores, sebum, sclererythrin, and red area of patients were significantly improved by IPL treatment (P < 0.05). Although there was no difference in microbiota diversity before and after IPL treatment, the Nonmetric Multidimension Scaling (NMDS) analysis showed that the samples of the acne patients before and after treatment could be divided into two different sets by skin microbiota (P = 0.011), which could be verified by heatmap analysis. Moreover, we found that the relative abundance of Staphylococcus epidermidis (S. epidermidis) significantly increased, but Cutibacterium acnes (C. acnes) decreased after IPL treatment. The sebum concentration was positively correlated with PH value (R = 0.525, P = 0.017), and the GAGS was positively associated with both sclererythrin (R = 0.477, P = 0.002) and red area (R = -0.503, P = 0.001). IPL could successfully improve the GAGS scores of acne vulgaris, as well as regulate the equilibrium between C. acnes and S. epidermidis, and inhibitthe sebum secretion. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Phase angle and Mediterranean diet in patients with acne: Two easy tools for assessing the clinical severity of disease

BackgroundAcne is a chronic, inflammatory and debilitating skin disorder. Dietary factors and nutritional status are among the exacerbating factors of acne. Phase angle (PhA), a direct measure of Bioelectrical Impedance Analysis (BIA), represents an indicator of the chronic inflammatory state. The Mediterranean diet (MD) is a healthy dietary pattern that can exert anti-inflammatory effects in several inflammatory diseases. We aimed to investigate the difference in PhA and adherence to the MD and their associations with the severity of acne in a sample of naïve treatment patients with acne compared to control group.MaterialsIn this cross-sectional, case–control, observational study, we enrolled 51 patients with acne and 51 control individuals. Body composition was evaluated by a BIA phase-sensitive system (50 kHz BIA 101 RJL, Akern Bioresearch, Florence, Italy, Akern). For adherence to the MD, we have used the PREvención con DIeta MEDiterránea (PREDIMED) questionnaire. The clinical severity of acne was assessed by using the global acne grading system (GAGS), a quantitative scoring system to assess acne severity.ResultsPatients with acne had a worse body composition, in particular smaller PhA (p = 0.003), and a lower adherence to the MD (p < 0.001) than the control group, in spite of no differences in gender, age and BMI between the two groups. Stratifying patients with acne according to GAGS categories, both PhA (p = 0.006) and PREDIMED score (p = 0.007) decreased significantly in severe acne than mild/moderate acne. The GAGS score was negative correlations with PhA (r = − 0.478, p < 0.001) and PREDIMED score (r = − 0.504, p < 0.001). The results of the multivariate analysis showed PhA and PREDIMED score were the major determinants of GAGS score (p < 0.001). The receiver operator characteristic (ROC) analysis reporting a value of PhA of ≤ 6.1° and a PREDIMED score of ≤ 9 identified patients with acne with the highest clinical severity of the disease.ConclusionsNovel correlations were reported between PhA and the degree of adherence to the MD with acne severity. Of interest, PhA and PREDIMED scores might represent possible markers of the severity of acne in a clinical setting. This study highlights how a cooperation between dermatologist and nutritionists might provide a combination key in the complex management of acne patients.

Nitric Oxide Generating Formulation as an Innovative Approach to Topical Skin Care: An Open-Label Pilot Study

Nitric oxide (NO) plays multiple roles in both normal and abnormal skin processes. Its deranging disbalance is involved in the pathogenesis of multiple dermatologic diseases such as acne vulgaris, pointing towards beneficial therapeutic directions. A novel NO-producing gel-formulation was tested beneficial in the treatment of acne vulgaris in an open-label pilot study using clinical evaluation scores. It showed a decrease of comedones and inflammatory pustulae and reduced the Global Acne Grading System score by 50% within eight weeks. In addition, we demonstrate a potential use as cosmetic agent where NO therapy leads to an increase of skin integrity and a reduction of skin ageing processes.

Efficacy and tolerability of short contact therapy with tretinoin, clindamycin, and glycolic acid gel in acne: A randomized, controlled, assessor-blinded two-center trial: The MASCOTTE study.

Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to moderate acne. However, irritant contact dermatitis is a common side effect of topical retinoids. A strategy to increase local tolerability is the "short contact therapy" (SCT) approach, consisting in the application of the product with the complete removal after 30 to 60 minutes using a non-aggressive cleanser. A gel containing tretinoin 0.02%, clindamycin 0.8%, and glycolic acid 4% in polyvinyl alcohol (MP-gel) has shown to be effective as monotherapy in mild to moderate acne with a tolerability profile similar to other topical retinoids. So far, no trials have been performed with this gel comparing the tolerability profile of SCT with standard application therapy (SAT). We conducted a 2-center randomized parallel groups, controlled, assessor-blinded study, comparing MP-gel applied as SCT in comparison with MP-gel used as SAT (The "MASCOTTE" trial). Forty-six subjects (nine men and 37 women, mean age 23 ± 4 years, range 18-31 years) with mild-to-moderate acne were enrolled, after their written informed consent in a randomized, parallel groups controlled, assessor-blinded 8-week trial. Twenty-three were assigned to MP-gel once daily (evening application) using the SCT approach (ie, complete removal of product after 1 hour using a gentle cleanser), and 23 were randomized to the SAT approach with the same gel. The primary endpoint was the evolution of the tolerability score (TS) assessed evaluating four items: erythema, dryness, stinging, and burning, using a 4-point score scale (from 0: no symptom to 3: severe symptom). Secondary endpoints were the evolution of global acne grading system (GAGS) score (range: from 0 to >39) and the investigator global assessment (IGA of acne severity) score (range from 0 to 4). TS was evaluated at 2, 4, and 8 weeks. GAGS and IGA scores were evaluated at baseline and at week eight. At week eight, an efficacy global score (EGS) (from 1: no efficacy to 4: very good efficacy) and a tolerability global score (TGS) (from 1: very low tolerability to 3: very good tolerability) evaluation were also done. All the evaluations were performed by an investigator unaware of treatment groups allocation (SCT or SAT). Thirty-eight subjects (83%) completed the 8-week treatment period. Eight subjects (two in the SCT group and six in the SAT group) dropped out prematurely due to low skin tolerability. In the SCT the TS at week two was 1.3 ± 1.7, in the SAT group TS was significantly higher (3.1 ± 1.7) (P = .028). TS was significantly lower in SCT group vs SAT also at weeks four and eight (P = .01; ANOVA test). The GAGS score at baseline was 19 ± 7 in the SCT group and 23 ± 4 in the SAT group (NS). At week 8 the GAGS score in SCT was significantly reduced to 8.5 ± 2.8 (-55%) (P = .001 vs baseline) and was also significantly lower in comparison with SAT group (8.5 vs 15; P = .0054). The IGA scores at baseline were 1.9 ± 0.6 in SCT and 2.4 ± 0.7 in SAT group. At week eight, in comparison with baseline values IGA score was reduced significantly by 48% in SCT and by 30% in SAT. EGS and TGS were significantly higher (better clinical efficacy and better tolerability) in SCT in comparison with SAT (3.6 ± 0.5 and 2.9 ± 0.3 vs 2.7 ± 0.6 and 1.5 ± 0.7; respectively). This tretinoin, clindamycin, glycolic acid gel, applied as SCT, has shown a better skin tolerability and at least a comparable clinical efficacy in comparison with the standard application modality in the treatment of mild-to-moderate acne. The SCT therefore could be an effective treatment strategy which could improve subjects' compliance and adherence.

Serum levels of 25-hydroxyvitamin D and IL17A and their association with acne severity in patients with severe and very severe acne vulgaris

Background Vitamin D deficiency and interleukin-17 (IL17) excess production have been detected in many inflammatory skin diseases. Acne vulgaris is a well-known inflammatory skin disease for which numerous treatment guidelines have been published, with limited success in several situations. Objective To evaluate the association between 25-hydroxyvitamin D [25 (OH) D] and IL17 levels from the patients’ serum and acne vulgaris. To determine the therapeutic effect of vitamin D supplementation on severe acne. Patients and methods This case–control study was conducted on 30 patients with severe and very severe acne vulgaris. The severity of the disease was determined by Global acne grading system (GAGS). Moreover, 15 controls were recruited. Serum levels of 25 (OH) D and IL17A were measured at the baseline in all studied participants. After that, the patients with acne with detected vitamin D hypovitaminosis were given an oral dose of 4000 IU cholecalciferol daily for 3 months, and in this selected group, serum 25 (OH) D and IL17A levels along with GAGS score were measured again at the end of the treatment. Results The mean serum concentration of 25 (OH) D and IL17A in patients with severe acne was statistically different from the controls. Acne severity was negatively correlated with the vitamin D serum level and positively correlated with the IL17A serum level. After supplementation, significant improvement of both the median GAGS score and IL17A serum level was found. Conclusion Vitamin D deficiency might be related to the severity of acne vulgaris, and its supplementation may help ameliorate inflammatory lesions of severe acne through its immunomodulatory effect.

Impact of acne on quality of life in young Pakistani adults and its relationship with severity: A multicenter study.

Objectives:The current study aimed to determine the effect of acne vulgaris on quality of life of young adults and to assess the correlation between acne severity and impairment of quality of life (QOLI).Methods:In this multi-center cross-sectional study, 163 young adults with acne vulgaris were assessed for severity and quality of life impairment between December 2016 and May 2017 at three tertiary care hospitals. Cardiff Acne Disability Index (CADI) was used to assess the quality of life while the severity of acne measured by Global Acne Grading System (GAGS). Data were collected on standardized forms, with CADI, GAGS scores, and sociodemographic data and analyzed using SPSS version 9. The quantitative variables were presented as means, median and qualitative variables expressed as frequency and percentages. P-value ≤0.05 was considered as statistically significant.Results:Out of 163 patients enrolled in this study, the mean age was 21.6 ± 4.9 years and 124 were females and 39 males. In mild QOLI, 56 (87.5%) cases were affected with mild, 11 (13.4%) with moderate and 1 (1.5%) case had severe acne. While, in moderate QOLI, 8(12.5%) cases were of mild, 60 (73.2%) were moderate and 6 (35.3%) cases affected with severe acne. The severe impairment of QOL noted in 11 (13.4%) moderate and 10 (58.8%) severe acne cases. The relationship between sex was statistically significant, (P<0.001). The result showed significant correlation between severity of acne vulgaris and the quality of life impairment of these patients (P<0.001).Conclusion:This study showed significant correlation between acne vulgaris and quality of life impairment. Cardiff acne disability index has proven to be a reliable tool to assess the quality of life. It is recommended to be used routinely in dermatology clinics to provide tailored treatment to individuals because mild disease may be disproportionately distressing for patients.

Homeopathic Treatment of Acne Vulgaris: An Open, Single-Arm, Non-Comparative Study

Abstract Background Acne is often treated at homeopathic clinics in India based on existing literature without using any measurable parameters and the outcomes are seldom reported, hence this study. Objective To evaluate the effects of homeopathy on the treatment of acne using specific outcome measures related to severity and disability. Methods It is an open, single-arm, non-comparative study undertaken at a clinic located in rural India using individualised homeopathy. Global Acne Grading System (GAGS) scores and Cardiff Acne Disability Index (CADI) scores were analysed at baseline and post medication at 3 and 6 months using one-way repeated measure analysis of variance (ANOVA) in Statistical Package for the Social Sciences (SPSS) version 19 to assess the outcomes of intervention. Results Eighty-four patients enrolled in the study were analysed under modified intention to treat approach. Nat-m (n = 14), Calc-s (n = 14), Sulph (n = 13), Kali-br (n = 10) and Hep-s (n = 9) were the most frequently used remedies. Significant differences were found in the severity of the disease and quality of life (QoL) from baseline to 6 months in terms of GAGS (mean difference, 15.47; standard error [SE], 0.69; 95% confidence interval [CI], 13.79–17.16; p &lt; 0.001) and CADI (mean difference, 6.94; SE, 0.33; 95% CI, 6.12–7.75; p &lt; 0.001) scores. A one–way repeated measures ANOVA was calculated and significant effects were found for GAGS scores (Wilks's lambda = 0.142; F [2, 82] = 248.50; p &lt; 0.001; effect size = 0.748) and CADI scores (Wilks's lambda = 0.159; F [2, 82] = 217; p &lt; 0.001; η2 = 0.786) at baseline and 3 and 6 months post medication. There was a positive correlation between the GAGS and CADI: r = 0.585, n = 84, p &lt; 0.001. Conclusions Acne can be effectively treated at homeopathic clinics along with improvement in QoL of patients. Increase in severity of acne was associated with worsening of QoL. Further pragmatic studies with comparative cohort is desirable.

Efficacy and safety of a new topical gel formulation containing retinol encapsulated in glycospheres and hydroxypinacolone retinoate, an antimicrobial peptide, salicylic acid, glycolic acid and niacinamide for the treatment of mild acne: preliminary results of a 2-month prospective study.

Acne vulgaris is a common and chronic skin disease that impacts on physical and psychological perceptions. Combination therapy with topical retinoids and antimicrobial agent is considered the preferred approach for most of the subjects affected by mild-to-moderate acne. A correct therapeutic management should include a prolonged treatment to ensure therapeutic success and to prevent recurrences. The aim of this study was to evaluate the efficacy and tolerability of a new topical gel formulation that combines retinol encapsulated in glycospheres and hydroxypinacolone retinoate, associated with an anti-microbial peptide (BIOPEP-15) salicylic acid, glycolic acid, and niacinamide as monotherapy in mild acne vulgaris. A 2-month prospective study was conducted at the Unit of Dermatology of the Federico II University. Twenty-five patients aged from 14 to 30 years with mild acne of the face (GAGS score ≤ 18) were consecutively enrolled. Each patient was asked to apply the gel formulation once daily in the evening for 8 weeks. The number of acne lesions with VISIA camera system, the global acne grading system (GAGS) score, trans epidermal water loss (TEWL), skin colorimetry (X-rite Spectrocolorimeter), reflectance confocal microscopy exam were evaluated at baseline, after 4 and 8 weeks of treatment for each patient. Tolerability and safety of the product were also evaluated. Twenty-five female patients with a median age of 23.4 were enrolled. Twenty-two (88%) completed the 2-month treatment period visits. At baseline the total acne lesion number, mean (SD), was 5.5 (4) and the GAG score 9 (4). A significant (P=0.001) reduction in number of total acne lesions was observed at week 4 (-57%) and at week 8 (-80%). All patients presented a significant reduction of the GAGS score values: -42% at week 4 and -78% at week 8, confirming the clinical efficacy of the product. At baseline TEWL was 10.2 g/m2/h (1.3) and 10.7 (1.4) at week 8, thus showing that the gel did not impair the skin barrier function. Skin colorimetry was significantly (P=0.0015) reduced by the treatment in comparison with baseline (62 vs. 58). Efficacy of the gel formulation was also confirmed with RCM exams, showing a reduction of dermal inflammation and exocytosis, and an improvement of infundibular hyperkeratinization. We observed that adherence to treatment correlated positively with the improvement of the single parameters. Moreover, side effects such as erythema, dryness, and excessive xerosis were not reported, resulting in a complete adherence to the treatment. Our findings provide favorable evidences of the efficacy and safety of this new product as a first line treatment in patients with mild acne, or, as a maintenance therapy for prolonged periods after the suspension of a systemic treatment. Furthermore, the tolerability of this topical product and the absence of any side effects increased the adherence to the therapy.

Severity of Acne Vulgaris: Comparison of Two Assessment Methods.

PurposeNumerous tools are available to assess acne severity. It is important to have an acceptable and easy to use tool for acne assessment for many reasons, such as initial assessment and follow-ups, clinical trials, and comparisons of clinical studies. The aim was to investigate the agreement between different observers (inter-observer variation) in the evaluation using the Global Acne Grading System (GAGS) and Investigator Global Assessment of Acne (IGA). Besides, to investigate the correlation between the assessment scores and its relation to the quality of life scales Dermatology Life Quality Index (DLQI) and the Cardiff Acne Disability Index (CADI).Patients and MethodsThis was a prospective study. Four investigators involved to evaluate the study subject surveyed 54 patients complaining of acne using IGA and GAGS scores (DLQI and CADI).ResultsA significant relation was seen between GAGS and IGA (Pearson chi-square test p= 0.001), and they demonstrated excellent inter-rater reliability. There was no correlation between IGA and quality of life measures (CADI nor DLQI). However, there was a significant weak correlation between GAGS and CADI.ConclusionThe two methods for acne severity assessment are reliable, and they are correlated. Quality of life concerning acne is not correlated with the severity of the disease.

The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease characterized by chronic abdominal pain and changes in bowel movements without underlying organic pathology. Many skin diseases have been reported to be more common in individuals with functional bowel diseases. In this study, we aimed to investigate a possible relationship between acne vulgaris (AV) and IBS. This prospective controlled study included patients with AV and healthy volunteers. All the subjects were evaluated in terms of the presence of IBS. The diagnosis of IBS was made based on the ROME IV diagnostic criteria. The clinical severity of AV was calculated using the global acne grading system (GAGS). A total of 300 patients with acne vulgaris and 300 age and gender-matched healthy controls were included in the study. The majority of the patients were female (n=175, 58.3%). The mean ages of the patients and controls were 20.22±5.24years and 20.49±5.36years, respectively. A total of 183 patients (61.0%) and 84 (28.0%) controls were diagnosed with IBS based on the Rome IV diagnostic criteria. The frequency of IBS was statistically significantly higher in the patient group than in the control group. (P=.001). There was also statistically significant relationship between the GAGS scores and IBS diagnosis (P=.001), abnormal stool form (P=.001), abdominal distention (P=.001), and feeling of incomplete evacuation (P=.001). Our study showed that IBS is significantly more common in patients with AV than in healthy controls. Additionally, GAGS scores were higher in patients diagnosed with IBS. To the best of our knowledge, this is the first study focusing on the subject.

New onset of axial spondyloarthropathy in patients treated with isotretinoin for acne vulgaris: incidence, follow-up, and MRI findings

Oral isotretinoin is commonly prescribed for acne vulgaris. Several case reports and observational studies have reported serious musculoskeletal side effects; however, the incidence, imaging findings, and longitudinal follow-up data are limited for patients who develop inflammatory back pain (IBP). To assess the incidence of isotretinoin-triggered axial spondyloarthropathy (SpA) in acne vulgaris patients based on clinical features and MRI findings and to examine clinical and radiological outcomes following drug withdrawal. Five hundred thirteen acne patients receiving isotretinoin were screened for IBP; IBP patients were assessed for CRP, plain radiographs, and MRI of the sacroiliac joint. MRI-proven sacroiliitis was scored semi-quantitatively. Patients were followed longitudinally to assess SpA clinical course and longitudinal MRI sacroiliac joints, and CRP levels were reassessed 3weeks after patients were symptom-free, following isotretinoin discontinuation. Of the 513 patients, 23.98% developed IBP. MRI-proven sacroiliitis was detected in 42.3% of the symptomatic patients or 10.1% of the cohort. Among MRI-proven sacroiliitis cases, 51.9% fulfilled the Assessment of Spondyloarthritis International Society criteria for axial SpA. Mean CRP level was 32.05 ± 17.23mg/L at pain onset and 3.4 ± 2.7mg/L after symptom resolution. MRI findings completely resolved within 9months (mean 6.27 ± 1.7) after isotretinoin discontinuation. MRI scores positively correlated with baseline CRP levels and global acne grading system score, pain, and the Ankylosing Spondylitis Disease Activity Score. Isotretinoin-induced axial SpA is a prevalent side effect in acne vulgaris patients. Early detection and follow-up of isotretinoin-induced sacroiliitis can be facilitated by MRI. Cessation of isotretinoin resulted in complete resolution in all affected patients.Key Points• Detection of underdiagnosed isotretinoin side effects which are common but not always correctly diagnosed and managed.• Incidence, diagnosis, and management of these side effects in a real-world setting.• This is the first large prospective longitudinal cohort study to report on axial manifestations in patients treated with isotretinoin as well as the effect of drug cessation upon the clinical, laboratory, and radiological findings.

Efficacy and safety of artemether emulsion for the treatment of mild-to-moderate acne vulgaris: a randomized pilot study

Objective To evaluate the efficacy and safety of artemether emulsion treating patients with mild-to-moderate acne vulgaris. Methods A total of 73 (randomized 1:1) patients were externally administered either artemether emulsion (1%) or fusidic acid emulsion (5g: 0.1g) twice daily for 12 weeks. Efficacy and safety evaluations were performed at weeks 0 and 12 by Global acne Grading System (GAGS), the number of acne and papule, as well as the rate of clinical respond. Results After 12 weeks, patients randomized to the artemether emulsion group received artemether emulsion had significantly lower GAGS scores (5.08 ± 1.99 versus 13.75 ± 4.87, p < .001) compared to patients who received fusidic acid emulsion. Patients in the artemether emulsion group had comparable baseline acne scores (11.11 ± 3.73 versus 10.75 ± 4.66, p = .626) and papule score (16.11 ± 5.58 versus 17.03 ± 6.34, p = .356), but significantly lower acne score (3.00 ± 1.55 versus 9.08 ± 4.90, p < .001) and comparable papule score (2.81 ± 1.61 versus 12.69 ± 5.45, p < .001) compared to the fusidic acid emulsion group at 12 weeks. No major adverse events were noted in either treatment group through 12 weeks. Conclusions Artemether emulsion had better effect in improving mild-to-moderate AV compared to fusidic acid emulsion with barely AEs.

Plasma dermcidin levels in acne patients, and the effect of isotretinoin treatment on dermcidin levels.

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Dermcidin (DCD) is an antimicrobial peptide released from eccrine sweat glands and sebaceous glands. Studies investigating the role of DCD expression in acne development are scarce. The aim of this study was to determine the relationship between DCD expression and acne vulgaris and the effect of oral isotretinoin treatment on DCD levels. Two groups (one patient group and one control group) were included in the study. The patient group consisted of 30 patients with acne vulgaris who were given oral isotretinoin treatment for 6 months until the cumulative dose was attained. Plasma DCD levels were investigated before and 6 months after treatment. The control group comprised 30 volunteer individuals without acne vulgaris or any inflammatory dermatosis. Of the patients, 24 (80%) had Grade 3, 3 (10%) had Grade 1, and 3 (10%) had Grade 4 acne vulgaris, as determined according to the Pillsbury scoring method. The DCD levels in the control group were significantly higher than those in pretreatment patients (39.53 ± 20.2 vs. 28.60 ± 20.12, p = .004). Additionally, pretreatment DCD levels were significantly increased after 6 months of isotretinoin treatment in the patient group (28.60 ± 20.12 vs. 35.07 ± 24.02, p = .012). The mean pretreatment global acne grading system score of 20.86 ± 4.43 was decreased to 5.17 ± 1.91 in patients after treatment (p < .001). This study indicated that DCD plays an important role in the pathogenesis of acne. It demonstrates anti-inflammatory properties in acne vulgaris. Moreover, it was shown that isotretinoin treatment may improve acne vulgaris by increasing DCD levels.

Which quality of life scale should be used to evaluate acne vulgaris patients? CADI or DLQI? A prospective study

Aim: Acne vulgaris is one of the most common diseases that affects quality of life. While the Dermatology Life Quality Index (DLQI) is the most frequently used life quality index for dermatologic disorders, the Cardiff Acne Disability Index (CADI) is an acne-spesific quality of life scale. The aim of this study was to determine which scale should be more appropriate and practical to evaluate the quality of life in acne patients and to compare the differences between two scales.Methods: Acne scores of 273 patients who were admitted to the dermatology outpatient clinic between December 2015 and November 2016 were determined by the Global Acne Grading System (GAGS) (range 0 to 44). The DLQI (range 0 to 30) and CADI scores (range 0 to 20) were calculated to evaluate the effect of patients' quality of life.Results: The mean GAGS score of the patients was 20.3, and the mean of CADI score was 6.1, while the mean of DLQI was 6.0. There was a significant positive correlation between total GAGS score and CADI and DLQI (r=0.639, p&amp;lt;0.001). When the relationship between the distribution of acne lesions and quality of life scales was evaluated; CADI score was significantly higher in the forehead localization group than in the non-forehead localization group (p=0.012), and the CADI and DLQI scores were higher in the upper back group than the group without back localization (p=0.001and p= 0.017 respectively). Conclusion: In our study, it was observed that the DLQI and CADI scales were not superior to each other in evaluating the quality of life in patients with acne. Besides, we think that the effect of quality of life on facial acne cases can be determined more clearly with CADI scale.

Comparison of Quality of Life, Depression, Anxiety, Suicide, Social Anxiety and Obsessive-Compulsive Symptoms Between Adolescents with Acne Receiving Isotretinoin and Antibiotics: A Prospective, Non-randomised, Open-Label Study.

The effects of isotretinoin on suicide, social anxiety and obsessive-compulsive symptoms in adolescents with acne have not been sufficiently investigated. This study aimed to evaluate the quality of life, depression, anxiety, suicide, social anxiety, and obsessive-compulsive symptoms of adolescents receiving systemic isotretinoin and antibiotic treatments at baseline and at 3months. The study included a total of 102 adolescents using isotretinoin (n = 60) and antibiotics (n = 42). The Acne Quality of Life Scale (AQLS), Hospital Anxiety and Depression Scale (HADS), Suicide Probability Scale (SPS), Liebowitz Social Anxiety Scale (LSAS), and Maudsley Obsessive-Compulsive Question List (MOCQL) were administered to both groups at baseline and at 3months. In order to exclude patients with comorbid psychiatric disorders, the patients were evaluated at the beginning of the study with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). There were no significant differences in the mean age, gender distribution, educational level, and family history of mental illness between the two groups. There were significant decreases in the Global Acne Grading System scores, visual analogue scale scores, AQLS scores, total and subscale scores of LSAS, and total and subscale scores of MOCQL at 3months compared with baseline in both groups. However, there were no significant changes in the total and subscale scores of HADS and total and subscale scores of SPS at 3months compared with baseline in both groups. We found that neither isotretinoin nor antibiotic treatment affected the levels of depression, anxiety, and suicide in acne patients. Moreover, both isotretinoin and antibiotic treatment were shown to improve the quality of life, social anxiety, and obsessive-compulsive symptoms in acne patients. However, clinicians should be careful about psychiatric side effects in patients using isotretinoin. Further studies with a larger number of cases and with a longer follow-up period are needed to investigate the complex effects of isotretinoin on the central nervous system.