Inflammatory Acne Vulgaris Research Articles

Human skin microbiota in health and disease: The cutaneous communities' interplay in equilibrium and dysbiosis: The cutaneous communities' interplay in equilibrium and dysbiosis.

Cutaneous microbial composition is driven by the microenvironment of the skin, as well as by internal and external factors. Local changes in the microenvironment can affect the configuration of the community, which may lead toward an imbalance of microbiota. Alterations in the microbial profile are common in both inflammatory skin diseases and chronic infections. A shift in balance within the microbiota, toward limited variation and a greater abundance of specific pathogens, may further worsen the pathogenicity of the diseases. These alterations may be prevented by topical treatment of probiotic solutions stimulating a balanced multispecies community. Compositional variations may further constitute potential biomarkers to predict flares or monitor efficacy during therapy. New approaches such as machine learning may contribute to this prediction of microbial alterations prior to the development of chronic infections and flares. This review provides insight into the composition and distribution of a healthy community of microorganisms in the skin and draws parallels with the community in chronic infections and chronic inflammatory skin diseases such acne vulgaris and Hidradenitis Suppurativa. We discuss the potential role of specific species in the pathogenesis and the possible prevention of disease exacerbation.

Relationship between Acne and Diet: A Trial Review

This paper reviews evidence presented by A Randomized, Controlled trial called a Low glycaemic load diet is shown to be effective in treating acne vulgaris in Korean patients, both clinically and histologically, suggesting that dietary variables, such as dietary variables, such as glycaemic load, is involved in the pathophysiology of acne. According to this article, investigation has proposed that dietary, especially Glycaemic load, have a role in the evolution of Acne Vulgaris. The study's goal was to see how a low glycaemic load diet influenced acne vulgaris lesions clinically and histologically. In a ten-week dietary intervention research, Participants with varying degrees of acne were randomly assigned to either a low GI load diet or a control group diet cohort. The outcomes indicate that the glycaemic load was successfully reduced. In the low-GI cohort, the percentage of non-inflammatory and inflammatory acne vulgaris lesions reduced substantially. Histopathological findings indicate that the low glycaemic load group had small pilosebaceous glands, less redness, and lower levels of Sterol Binding Protein -1and Interleukin -1 in skin samples. Acne had improved after reducing the glycaemic amount of the diet for ten weeks.

Surfactin-oleogel with therapeutic potential for inflammatory acne vulgaris induced by Propionibacterium acnes.

Accumulating evidence suggested that suppression of Propionibacterium acnes-induced inflammation was a promising strategy to alleviate acne vulgaris. This study evaluated the alleviating effect of surfactin-oleogel on P. acnes-induced inflammatory acne vulgaris in mice. Epidermis morphology and histopathological examination showed that surfactin-oleogel effectively ameliorated the P. acnes-induced epidermis swelling and erythema. Surfactin-oleogel reduced the epidermis thickness to 48.52% compared to the model control group. The colony of P. acnes in the epidermis was decreased by 1 log CFU/mL after receiving surfactin-oleogel treatment. Furthermore, surfactin-oleogel attenuated oxidative stress in the epidermis by increasing the activities of superoxide dismutase, catalase, and glutathione peroxidase. In addition, the expression of inducible nitric oxide synthase, nitric oxide, cyclooxygenase-2, pro-inflammatory cytokines (e.g. tumour necrosis factor-α and interleukin-1β), and nuclear factor kappa-B in the epidermis were reduced after treating with surfactin-oleogel. Moreover, total cholesterol and free fatty acids were decreased, whereas the treatment of surfactin-oleogel increased triglycerides and linoleic acid content. Besides, immunohistochemical assay and real-time PCR analysis indicated that surfactin-oleogel blocked the TLR2-mediated NF-κB signalling pathways in the epidermis. Consequently, our results demonstrated that surfactin-oleogel had antibacterial and anti-inflammation activities to treat P. acnes-induced inflammatory acne vulgaris.Key points• Surfactin-oleogel effectively relieves inflammation and oxidative stress caused by P. acnes.• Surfactin-oleogel effectively reduced the P. acnes colony.• Surfactin-oleogel relieves P. acnes-induced inflammation by inactivated the TLR-mediated NF-κB.

Comparison of brain-derived neurotrophic factor (BDNF) serum level in inflammatory and non-inflammatory acne vulgaris

Background: Acne vulgaris is a chronic and self-limiting inflammation disorder of the pilosebaceous unit, generally manifested in adolescents with polymorphic lesions, such as comedones, papules, nodules, and cyst. Brain-derived neurotrophic factor (BDNF) is a member of neurotrophins that can be downregulated because of stress. It is suspected that a lower BDNF level is induced inflammatory process, although its relationship with acne vulgaris has not been widely studied. This study compared BDNF serum levels in the inflammatory and non-inflammatory type of acne vulgaris.Methods: This is analytical observational research with a cross-sectional design that involved 31 acne vulgaris patients with inflammatory lesions and 31 acne vulgaris patients with non-inflammatory lesions. Each subject was interviewed and going through dermatology examinations, followed by blood sampling to assessed their BDNF serum levels through the ELISA test. The collected data were analyzed statistically using an independent T-test. P<0.05 was significant.Result: The mean BDNF serum levels in acne vulgaris patients were 32,53±6,32 ng/ml. In subjects with inflammatory-type lesions, the mean BDNF level is 27,55±3,31 ng/ml. While, in the non-inflammatory type lesions group, the mean BDNF is 37,51±4,37 ng/ml. The BDNF serum level is significantly lower in inflammatory-type subjects than in non-inflammatory type (p < 0,001).Conclusion: There was a significant difference in serum BDNF levels between the inflammatory and non-inflammatory type acne groups.

Comparison of efficacy & safety of Blue Light vs topical application of 1% Clindamycin solution in the treatment of mild to moderate inflammatory Acne Vulgaris

Aim: To compare the efficacy & safety of blue light vs topical application of 1% clindamycin solution in the treatment of mild to moderate inflammatory acne vulgaris. Study Design: Comparative interventional study done in Dermatology Outpatient Department Unit-II, KEMU/ Mayo Hospital, Lahore six months i.e. 1-06-2014 – 30-11-2014 Methodology: After an informed and written consent, 130 patients fulfilling the selection criteria were enrolled in the study and divided in two study groups A & B by balloting method. At first visit, a detailed history and clinical examination was recorded on a specially designed proforma. The acne was graded according to the acne grading scale of American Academy of Dermatology.4,13 Group A was exposed to blue light for twenty minutes twice weekly for eight weeks. Group B was given 1% clindamycin to apply twice daily for a period of eight weeks. Post- treatment follow up was done for next four weeks. Patients were assessed at 2nd, 4th, 6th, 8th, 10th, and 12th week. All findings and side effects were recorded on a predesigned proforma. To determine the efficacy of treatment, Acne Severity Index (ASI) was used.5 Result: Efficacy of treatment [≥ 50% improvement in ASI score] was seen in 39(60%) patients in blue light group while in clindamycin group it was achieved in 8 (12.3%) patients only. Blue light group had significantly less number of side effects observed in 35 (37.23%) patients while clindamycin group had a higher number of side effects observed in 59 (62.77%) patients, p-value= 0.013. Conclusion: Blue light is more efficacious and safer than topical 1% clindamycin in the treatment of mild to moderate inflammatory acne vulgaris. Keywords: Blue light, 1% Clindamycin, Acne vulgaris

HMGB1-RAGE-moesin axis may be indicted for acne vulgaris.

High-mobility group box 1 (HMGB1)-receptor for advanced glycation end (RAGE)-moesin axis could be implicated in induction of inflammation. However, there is a scarcity in literature discussing the role of this axis in inflammatory skin disorders. The aim of the present study was to evaluate the serum levels of HMGB1 and moesin in patients with inflammatory acne vulgaris. This comparative cross-sectional study included 66 inflammatory acne vulgaris patients classified according to Global Acne Grading System (GAGS) into three groups (22 patients each): mild, moderate, and severe acne vulgaris. In addition, 82 acne-free individuals were included as a control group. Serum HMGB 1 and moesin levels were measured using enzyme-linked immunosorbent assay kits. High-mobility group box 1 and moe sin serum levels in acne patients were significantly higher than the levels in control subjects (p=0.04, 0.0005 respectively). Serum levels of both markers in severe acne patients and in those with post-acne scarring were elevated when compared to the levels in the other groups, and however, this elevation was significant only for moesin levels. There was a significant positive correlation between the serum levels of HMGB1 and moesin in the studied patient's sample (r=0.3079, p=0.011). High-mobility group box 1-receptor for advanced glycation end-moesin axis may be implicated in acne vulgaris pathogenesis, and it may be a promising therapeutic target.

Activation of Janus kinase signaling pathway in acne lesions.

The Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway has been linked to the pathogenesis of many inflammatory skin diseases; however, the role of JAKs in the pathogenesis of acne vulgaris has not been previously elucidated. We aimed to analyze the cutaneous expression of JAK1/2/3 proteins in acne vulgaris and investigate the possible role of JAK signaling in acne pathogenesis. This case-control study was carried out on 28 patients with inflammatory acne vulgaris vs 20 age- and sex-matched healthy volunteers. Acne severity was assessed using Global acne severity grading system (GAGS). Skin biopsies were collected from lesional and non-lesional skin of patients and from control group. The expression of JAK1/2/3 proteins was examined by real-time quantitative polymerase chain reaction. JAK1 and JAK3 were overexpressed in acne lesions, compared to non-lesional skin and the control group. No significant difference was found in JAK2 expression between patients and controls. JAK1 and JAK3 showed no significant relation with the patients' age, sex, family history, duration of acne, or GAGS score. Our results suggest the activation of JAK pathway in acne lesions, indicating that it may play a pivotal role in the inflammatory disease process. JAK1 and JAK3 may be possible new targets for acne therapy.

COMPARISON OF MALASSEZIA SPP. PROPORTIONS IN INFLAMMATORY AND NON-INFLAMMATORY FACIAL ACNE VULGARIS LESIONS

Objective: The skin microbiome plays a role in the pathogenesis of acne vulgaris (AV). Among other species, Malassezia spp. can be found in the pilosebaceous follicle. However, its role on the pathogenesis of AV has not yet been described. The objective of this study was to identify the presence and the distribution of Malassezia spp. in facial AV lesions and also to compare the distribution of Malassezia spp. between inflammatory and non-inflammatory lesions.
 Methods: One hundred and twenty subjects were allocated into two groups: inflammatory lesions and non-inflammatory lesions. Samples were taken from hair follicles and examined by microscopy using 20% potassium hydroxide and Parker ink and cultured for species identification.
 Results: There was no difference in the spore load between the two groups (p=0.142). Malassezia spp. were isolated from 64.2% of subjects and consisted of M. dermatis (43%), M. sympodialis (18%), M. slooffiae (16%), M. japonica (5%), M. furfur (5%), M. pachydermatis (3%), and M. restricta (1%). There was a higher Malassezia spp. proportion in non-inflammatory lesions (p=0.019). The predominant species in inflammatory AV lesions was M. dermatis (45,8%), followed by M. sympodialis (17.1%), and M. slooffiae (11.4%).
 Conclusion: Malassezia spp. were found in facial acne lesions. M. dermatis was the predominant species found in facial AV, followed by M. sympodialis, and M. slooffiae. A higher proportion of Malassezia spp. was found in non-inflammatory lesions.

The efficacy and safety of a 577-nm high-power optically pumped semiconductor laser in the treatment of postacne erythema.

Postacne erythema (PAE) is a common sequela of inflammatory acne vulgaris, treatment of which has been challenging due to limited options available and the variability of results for each modality. Recently, a 577-nm high-power optically pumped semiconductor laser (HOPSL) initially developed for vascular lesions has shown promising results for the treatment of PAE. To evaluate the efficacy and safety of 577-nm HOPSL in the treatment of postacne erythema. This was a split-face, randomized controlled trial pilot study. Twenty-one patients with PAE on both sides of their face were enrolled. Each subject's face sides were randomly assigned to either receive 577-nm HOPSL treatment (QuadroStar PRO™, Asclepion Laser Technologies) using the scanner handpiece, 1mm spot size, 80% coverage, 12-15J/cm2 , 30ms, 2 passes for 3 sessions at 1-month intervals, or no treatment at all. Outcome measures such as overall improvement, the Erythema Index (EI), and Melanin Index (MI) from 3 different areas on both treatment and control sides were assessed at baseline, and 1-month follow-up after each treatment session. Side effects including pain, erythema, swelling, and crusting were also recorded. Upon completion of the treatment period, the mean EI was significantly decreased in both treated and nontreated sides of the face (P<.001 and P=.001, respectively). The laser-treated sides already demonstrated significant reduction in the mean EI compared with nontreated sides at 1month after the 2nd treatment (P=.007). The mean MI of both sides, however, did not show any statistically significant differences from baseline, and likewise when comparing between sides. Patients reported more improvement on laser-treated sides compared with nontreated sides. Reported side effects were limited to mild discomfort during treatment and transient facial erythema lasting approximately 30minutes. Patients who received treatment with the 577-nm HOPSL had better outcomes with minimal side effects at 1month after 2 treatments as compared to those who did not receive any treatment. Therefore, the 577-nm HOPSL may be considered as an effective adjuvant treatment for PAE and early erythematous atrophic scars.

Topical Treatment of Truncal Acne with Tretinoin Lotion 0.05% and Azelaic Acid Foam

Truncal acne is present in approximately half of all patients with facial acne but is also occasionally seen in isolation. Important considerations when selecting treatment options for adult female acne, whether on the face, back, chest, or shoulders, include patient compliance, treatment response time, tolerability of the treatment, and psychosocial impact of the disease. Oral antibiotics are widely prescribed for truncal acne due to the challenges of applying topical therapy to such an extensive body surface area. In cases of severe inflammatory and nodular acne vulgaris, this may be a reasonable consideration; however, oral antibiotics should only be used for short durations. Overprescription contributes to microbial resistance and may cause disruption of the gastrointestinal microbiome. In many cases of mild, moderate, or even severe truncal acne, combinations of topical therapies may be valid alternatives. The introduction of foam formulations with enhanced percutaneous absorption and tretinoin lotion formulations that incorporate moisturizing/hydrating agents challenges the previously held idea that effective and tolerable treatment of truncal acne requires oral treatment. This case series describes four female African-American patients with truncal acne successfully treated with a combination of tretinoin lotion 0.05% and azelaic acid 15% foam.

Evaluation of the role of interleukin-31 in inflammatory acne vulgaris: a case–control study

Background Acne vulgaris (AV) is a chronic inflammatory disease with multifactorial etiology and a significant psychological disability. Inflammation is a fundamental process in the early and late stage of acne. Physical symptoms of AV include soreness, itching, and pain. Interleukin-31 (IL-31) is a novel T-helper-lymphocyte-derived cytokine with an established role in inducing inflammation and pruritus.Objective Evaluation of the role of IL-31in inflammatory AV and its correlation to itching.Patients and methods Forty patients with AV as well as 40 healthy controls were included. History taking and clinical examination of patients to assess the severity of AV were done and the grade of itching of the lesions was recorded. Biopsy from an acne lesion and a serum sample were taken. For controls, a biopsy from normal skin as well as a serum sample was taken for comparison. Tissue and serum levels of IL-31 were measured by the sandwich ELISA technique.Results The mean tissue and serum levels of IL-31 were significantly higher in patients than in controls (P<0.001). The tissue level of IL-31 was significantly higher in patients with severe AV in comparison with its levels in moderate AV (P=0.001). A statistically significant correlation was found between the Cardiff Acne Disability Index and levels of IL-31 in both tissue (P=0.001) and serum (P=0.049).Conclusion IL-31 potentially plays a role in the pathogenesis of inflammatory AV. Larger scale studies are required to verify this finding.

Daylight photodynamic therapy with 5-aminolevulinic acid 5% gel for the treatment of mild-to-moderate inflammatory acne.

Acne vulgaris is a chronic inflammatory disease that frequently occurs in adolescence. This common condition is often treated with topical or systemic therapies according to severity. Photodynamic therapy (PDT) with topical delta-aminolaevulinic acid is a novel drug-sparing, but time-consuming approach. Recently, sunlight exposure has been considered a quicker, safer, cheaper and more agreeable alternative light source for PDT, but efficacy has only been proven in the oncological field. This study aimed to evaluate the efficacy and tolerability of daylight PDT (DL-PDT) for the treatment of inflammatory acne vulgaris of face, chest and trunk lesions. Twenty patients with mild-to-moderate acne vulgaris were enrolled and treated with a topical gel based on 5% delta-aminolaevulinic acid, administered 4 times at 14-day intervals. Efficacy was assessed with mean lesion count, Physician Global Assessment (PGA), Investigator's Global Assessment (IGA) and patients' self-assessment (10-point scale). Compared to T0, mean inflammatory lesions count decreased in all patients at FU1, from 16.7±4.4 to 5.2±3.3 (P). No adverse events were reported, and no patients were lost to follow-up. PGA results of "excellent" or "good" improvement were reported in 95% at T3 and 90% at FU1. Patients' self-assessments was 7.6±1.0 (T3). Discomfort was 0.5±0.2 (T3 and FU1). DL-PDT seems to be an effective and tolerable therapy for the treatment of mild-to-severe inflammatory acne. This novel regimen seems to be a viable option in the panorama of acne therapies.

Non-medical treatments for inflammatory acne vulgaris: a comprehensive review on laser, radiofrequency and microneedling

There are many patients with inflammatory acne vulgaris who are not compliant or eligible to consume acne medications, such as oral antibiotics or isotretinoin. PubMed and Medline databases were searched for all related articles. All finding were summarized and chronologically presented in the tables. Nonmedical device-based therapies largely improve the treatment of active inflammatory acne vulgaris, especially in patients who are not compliant or eligible to consume acne medications, do not respond to these drugs over a specified period of time, or do not sustain in the remission phase.

Clinical assessment of topical erythromycin gel with and without zinc acetate for treating mild-to-moderate acne vulgaris

Purpose: Erythromycin is an effective topical antibiotic for treating mild-to-moderate inflammatory acne vulgaris, especially papules acne during puberty as well as papules - pustular acne in adult women. Erythromycin is a macrolide antibiotic that has long been used as a topical dosage form to treat acne. It has favorable effects in resolving inflammatory acne lesions not only by reducing Propioni bacterium acnes density, but also by directly inhibiting neutrophil chemotactic factors and reactive oxygen species (ROS) production. Zinc, a metallic element has bacteriostatic activity against Propioni bacterium acnes. Combining zinc with antibiotic (erythromycin) can reduce antibiotic resistance and increase antibiotic absorption in-to the skin.Material and methods: In the present study, erythromycin (2% w/v) with zinc acetate (1.2% w/v) as ‘topical gel’ and erythromycin (2% w/v) gel alone were evaluated for treating mild to moderate inflammatory acne vulgaris. This double-blind study was carried out on 102 patients 13–25 years of age, divided into two groups. The group A received erythromycin and group B received erythromycin with zinc acetate topical gels during 3 weeks. Acne grading and lesion counts for comedones, papules and pustules were performed during each visit zero, first, second and third weeks.Results: Erythromycin treatment (with zinc acetate) gel showed to be more effective than erythromycin (alone) gel with respect to reducing the number of acne lesions and severity grade of acne.Number of lesions and severity of acne were significantly reduced at the end of 3rd week in both groups (p < .001). Conclusions: In conclusion, it can be stated that erythromycin with and without zinc acetate was clinically effective, and both formulations produced a significant reductions in acne grading as well as inflamed and noninflamed lesion counts (p < .000). Statistically, there was no significant difference between formulation A and B.

Efficacy and Safety Study of VB-1953 Topical Gel for Inflammatory Facial Acne Vulgaris

Efficacy and Safety Study of VB-1953 Topical Gel for Inflammatory Facial Acne Vulgaris

A comparative study between topical adapalene (0.1%) versus a combination of topical adapalene (0.1%) and intense pulsed light therapy in the treatment of inflammatory and noninflammatory facial acne vulgaris: A split-face randomized controlled trial

Introduction: Acne vulgaris is a common dermatological disorder encountered in dermatology practice. Various treatment modalities are available for acne. Lasers and light-based therapies are also gaining popularity with good clinical results. The choice of treatment depends on the type and severity of acne. Aims:(1) To evaluate the efficacy and safety of topical adapalene (0.1%) gel in facial acne vulgaris. (2) To evaluate the efficacy and safety of topical adapalene (0.1%) gel in combination with intense pulsed light (IPL) in facial acne vulgaris. (3) To compare the above results. Materials and Methods: A total of 50 patients with facial acne were included. IPL device equipped with an acne treatment filter emitting light between 430 and 1200 nm was used. Adapalene 0.1% in gel form was used. One side of the face was treated with plain adapalene gel and another side with a combination of daily application of adapalene, with fortnightly exposure of IPL. A total of four sittings of IPL at the interval of 15 days were given. Final evaluation was done 2 weeks after the last session of IPL. Results: On adapalene + IPL-treated side, statistically significant reduction in comedones started from the 2nd visit,P

Argon Plasma: A New Approach for the Effective Treatment of Inflammatory Acne Vulgaris and Enlarged Pores in Asian Patients

Argon Plasma: A New Approach for the Effective Treatment of Inflammatory Acne Vulgaris and Enlarged Pores in Asian Patients

A Microtube Array Membrane (MTAM) Encapsulated Live Fermenting Staphylococcus epidermidis as a Skin Probiotic Patch against Cutibacterium acnes.

Antibiotics without selectivity for acne treatment may destroy the beneficial microbes in the human microbiome that helps to fight Cutibacterium acnes (C. acnes), a bacterium associated with inflammatory acne vulgaris. Probiotic treatment by direct application of live Staphylococcus epidermidis (S. epidermidis) onto the open acne lesions may run the risk of bloodstream infections. Here, we fabricated the polysulfone microtube array membranes (PSF MTAM) to encapsulate probiotic S. epidermidis. We demonstrate that the application of the encapsulation of S. epidermidis in PSF MTAM enhanced the glycerol fermentation activities of S. epidermidis. To mimic the granulomatous type of acne inflammatory acne vulgaris, the ears of mice were injected intradermally with C. acnes to induce the secretion of macrophage inflammatory protein-2 (MIP-2), a murine counterpart of human interleukin (IL)-8. The C. acnes-injected mouse ears were covered with a PST MTAM encapsulated with or without S. epidermidis in the presence of glycerol. The application of S. epidermidis-encapsulated PST MTAM plus glycerol onto the C. acnes-injected mouse ears considerably reduced the growth of C. acnes and the production of MIP-2. Furthermore, no S. epidermidis leaked from PSF MTAM into mouse skin. The S. epidermidis-encapsulated PST MTAM functions as a probiotic acne patch.

Transconjugation of erm(X) conferring high-level resistance of clindamycin for Cutibacterium acnes.

Cutibacterium acnes (C. acnes) can become an exacerbating factor in acne vulgaris. Clindamycin has been most frequently used for the treatment of inflammatory acne vulgaris. We studied clindamycin susceptibility and resistance determinants of C. acnes isolated from acne patients in Japan. The isolation rate of clindamycin-resistant C. acnes had significantly increased from 20.3 % in 2009-2010 to 44.1 % in 2016-2017. Strains carrying erm(X), which confers high-level resistance to clindamycin, had significantly increased from 1.4 to 11.8 %. Sequence analysis of the resistance determinant showed that erm(X) was coded on transposon Tn5432. A transconjugation experiment showed that erm(X) can be transferred between C. acnes strains with high frequency and the transconjugants harboured transposon Tn5432 encoding erm(X). Our data show the transconjugation of erm(X) in C. acnes and strongly suggest that the transmission of erm(X) between C. acnes contributes to the increase and spread of clindamycin-resistant C. acnes strains in acne patients.

Is IL-1β Further Evidence for the Role of Propionibacterium acnes in Degenerative Disc Disease? Lessons From the Study of the Inflammatory Skin Condition Acne Vulgaris.

The pathogenesis of degenerative disc disease is a complex and multifactorial process in which genetics, mechanical trauma, altered loading and nutrition present significant etiological factors. Infection of the intervertebral disc with the anaerobic bacterium Propionibacterium acnes is now also emerging as a potentially new etiological factor. This human commensal bacterium is well known for its long association with the inflammatory skin condition acne vulgaris. A key component of inflammatory responses to P. acnes in acne appears to be interleukin (IL)-1β. Similarly, in degenerative disc disease (DDD) there is compelling evidence for the fundamental roles of IL-1β in its pathology. We therefore propose that P. acnes involvement in DDD is biologically very plausible, and that IL-1β is the key inflammatory mechanism driving the host response to P. acnes infection. Since there is a solid theoretical basis for this phenomenon, we further propose that the relationship between P. acnes infection and DDD is causal.