Moderate Acne Vulgaris Research Articles

A Comparative Study of Topical Azailic Acid Cream 20% and Active Lotion Containing Triethyl Citrate and Ethyl Linoleate in the Treatment of Mild to Moderate Acne Vulgaris

Background: Acne vulgaris is a common disorder affecting 79% - 95% of the adolescent population. The choice of treatment depends on the severity, patients with mild to moderate acne should receive topical therapy such as azelaic acid. Rising antibiotic drug resistance consequent to the widespread use of topical antibiotics is causing concern and effective non-antibiotic treatments are needed. Objective: To compare the efficacy and side effects of topical azelaic acid cream 20% versus active lotion containing triethyl citrate and ethyl linoleate (TCEL) in treatment of mild to moderate acne vulgaris. Patients and Methods: This single, blinded, comparative, therapeutic study was done in the Department of Dermatology-Baghdad Teaching Hospital, Baghdad, Iraq; from May 2013-July 2014. Scoring of acne was carried out and the patients were examined every 2 weeks for 10 weeks of treatment. One month after stopping drugs, patients were evaluated for drug complications and disease recurrence. Sixty patients fulfilling enrollment criteria were included in this study. Patients were divided into 2 groups: Group A (30 patients) treated twice daily with TCEL lotion and Group B (30 patients) treated twice daily with topical azelaic acid cream 20%. Results: Both topical TCEL lotion and azelaic acid cream were statistically an effective therapy for treatment of mild to moderate acne vulgaris. TCEL lotion was more effective and act earlier than azelaic acid cream starting from 4 weeks of therapy till the end of treatment (after 10 weeks) and even after 4 weeks after stopping the treatment (P-value non-inflammatory acne lesions. Its use would reduce the risk of antibiotic resistance developing within the skin flora.

Treatment of Acne Vulgaris Using the Combination of Topical Erythromycin and Miconazole

Background: Acne vulgaris is a multifactorial disease of the pilosebaceous unit. Malassezia furfur is one of the causative agents of the disease.It provides a proper environment for Propionibacterium to grow. Miconazole inhibits the Propionibacterium growth by its fungicidal activity. Objectives: The aim of this study was to evaluate the treatment of Acne vulgaris using the combination of topical erythromycin and miconazole. Patients and Methods: In a single-blinded randomized clinical trial, 60 patients who were referred to the dermatology clinics of Isfahan University of Medical Sciences with mild to moderate acne vulgaris were selected by simple random sampling method. The patients were randomly allocated to two groups. One group was treated with 2% erythromycin alcoholic solution and the other group was treated with 2% erythromycin and 2% miconazole alcoholic solution. Patients were followed up each month for three months. The efficacy of treatment was evaluated by the Acne Severity Index (ASI) and the data were analyzed by the SPSS. Results: In the second and the third months of treatment, ASI and inflammatory acne lesions significantly reduced in the erythromycin plus miconazole group in comparison to the erythromycin group (P < 0.05). Efficacy of erythromycin plus miconazole in reduction of acne lesions was moderate and excellent in the second and third months of treatment, respectively. Both treatment methods were highly effective in reducing the inflammatory lesions (papules and pustules) and were least effective in noninflammatory lesions (comedones). Conclusions: This study showed that erythromycin plus miconazole alcoholic solution is effective in treating the mild to moderate acne lesions as an adjuvant therapy.

Topical erythromycin-zinc acetate complex lotion versus topical erythromycin gel in treatment of mild to moderate acne vulgaris

Introduction: Topical antibiotics are the main step in the treatment of mild to moderate acne vulgaris. Erythromycin is one of the effective topical therapies for this disease. Zinc sulfate 5% solution was reported to be effective in treatment of acne vulgaris and rosacea. Aim: To compare the effectiveness and side effects of topical erythromycin in combination with zinc and erythromycin alone in treatment of mild to moderate acne vulgaris. Material and Methods: This single, blind, therapeutic, comparative study was done in the Department of Dermatology – Baghdad Teaching Hospital, Baghdad, Iraq; from May 2012 August 2013.Scoring of acne was carried out and the patients were examined every two weeks for 10 weeks of treatment. One month after stopping drugs, patients were evaluated for drug complications and disease recurrence. Eighty patients fulfilling enrollment criteria were included in this study. Patients were divided into two groups: Group A (40 patients) treated twice daily with topical erythromycin-zinc complex lotion and Group B (40 patients) treated twice daily with topical 2% erythromycin gel. Results: Both topical erythromycin-zinc lotion and erythromycin gel were statistically an effective therapy starting after 6 weeks treatment and up to 4 weeks after stopping treatment. Erythromycin-zinc lotion was more effective and act earlier than erythromycin gel starting from 4 weeks of therapy till the end of treatment (after 10 week) and even after 4 weeks after stopping the treatment (p value <0.0001). Conclusions: Erythromycin-zinc complex lotion was an effective and well tolerated topical therapy for mild to moderate inflammatory acne vulgaris and was more effective than erythromycin gel alone.

Body mass index is negatively associated with acne lesion counts in Taiwanese women with post-adolescent acne.

Acne in adult women tends to be chronic, refractory to treatment and associated with psychosocial problems. Body mass index (BMI) has been reported to be a risk factor for acne in school children and adolescents, but not in adult women. The aim of this study was to demonstrate the relationship between BMI and acne lesion counts in women with post-adolescent acne. Hundred and four women between 25 and 45years of age, with moderate or severe acne vulgaris were enrolled in this study. The main outcome evaluated was the number of acne lesions, which were then assessed using multiple linear regression analysis. The coefficients of multiple regression analysis with stepwise model showed that BMI (β=-0.36; p=0.001) and family history (β=0.21; p=0.04) were the main predictors of the number of acne lesions. Initial findings indicate that BMI is negatively associated with the number of acne lesions in Taiwanese women with moderate to severe post-adolescent acne.

Topical epidermal growth factor for the improvement of acne lesions: a randomized, double-blinded, placebo-controlled, split-face trial.

Acne is one of the most common adverse events associated with the use of anticancer agents, such as epidermal growth factor receptor (EGFR) inhibitors. Based on data from several previous reports, we predicted that topical application of EGF could improve acne vulgaris. To evaluate the clinical efficacy and safety of topical recombinant human EGF (rhEGF) cream for the treatment of facial acne vulgaris. Twenty Korean adults with mild to moderate acne vulgaris applied topical rhEGF cream on one half of the face and a vehicle cream on the other half twice daily for sixweeks. Clinical assessments were conducted at baseline, two, four, and sixweeks. Two assessment methods were applied: inflammatory and non-inflammatory acne lesion counts and acne severity score by investigator's global assessment. Skin sebum output level and hydration level were also measured at each visit. All volunteers completed the study. At the final visit, inflammatory acne lesions were reduced by 33.5% on the rhEGF-applied side. Non-inflammatory acne lesions also decreased by 25.4%, whereas the lesions on the control side increased. The majority of patients demonstrated improvement on the side of the face where rhEGF cream was applied. Sebum output decreased on the rhEGF side, and skin hydration level increased on both sides. No severe side effects were observed during the study. Topical rhEGF seems to be an effective and safe adjuvant treatment option for mild to moderate acne vulgaris.

Treatment of acne vulgaris with two glycolic acid-containing preparations: a clinical observation

Objective To evaluate the clinical efficacy and safety of two glycolic acid-containing liquid preparations for the treatment of facial acne vulgaris.Methods Sixty patients with mild to moderate acne vulgaris were included in a randomized,single-blinded,split-face,controlled study.The left and right sides of each patient's face were randomly assigned to the test group (treated with one hydroxy acid-containing liquid preparation) and control group (treated with the other hydroxy acid-containing liquid preparation).In total,all the patients were given four times of treatment at week 0,2,6 and 10 with the concentration of hydroxy acid in both preparations being 20％,35％,50％ and 70％,respectively.The number of inflammatory and noninflammatory acne lesions was counted,and the improvement in acne mark,scar and pores was evaluated by a 6-point grading scale before every treatment and 4 weeks after the last treatment.Results At 2,6,10,and 14 weeks after initiation of treatment,the clearance rate for inflammatory lesions was 20.4％,43.3％,66.9％ and 80.2％ respectively in the test group,21.6％,44.2％,68.1％ and 79.8％ respectively in the control group,while that for noninflammatory lesions was 18.5％,34.0％,41.3％ and 59.6％ respectively in the test group,17.8％,31.2％,44.9％ and 57.1％ respectively in the control group.The response rate was 80.0％ in the test group and 78.3％ in the control group at the end of the study.Adverse effects were observed in both groups,including temporary pain,erythema and formation of hoar frost,all of which well responded to symptomatic treatment.There were no significant differences in clinical efficacy or adverse effects between the two groups (both P ＞ 0.05).Conclusion Both of the hydroxy acid-containing preparations are effective and safe for mild to moderate acne vulgaris. Key words: Acne vulgaris; Glycolic acid; Treatment outcome

A randomized, double-blind, placebo-controlled study of a novel pantothenic Acid-based dietary supplement in subjects with mild to moderate facial acne.

IntroductionThe purpose of this study was to determine the safety, tolerability and effectiveness of daily administration of an orally administered pantothenic acid-based dietary supplement in men and women with facial acne lesions.MethodsA randomized, double-blind, placebo-controlled study of adults previously diagnosed with mild to moderate acne vulgaris was performed. Subjects were randomized to the study agent, a pantothenic acid-based dietary supplement, or a placebo for 12 weeks (endpoint). The primary outcome of the study was the difference in total lesion count between the study agent group versus the placebo group from baseline to endpoint. Secondary measurements included differences in mean non-inflammatory and inflammatory lesions, Investigators Global Assessment and Dermatology Life Quality Index (DLQI) scores between the two groups. Investigator assessment of overall improvement and skin photographs were also taken. Safety and tolerability endpoints were the assessment of adverse events and measurement of serum complete blood count and hepatic function.ResultsForty-eight subjects were enrolled and 41 were evaluable. There was a significant mean reduction in total lesion count in the pantothenic acid group versus placebo at week 12 (P = 0.0197). Mean reduction in inflammatory lesions was also significantly reduced and DLQI scores were significantly lower at week 12 in the pantothenic acid group versus placebo. The study agent was safe and well tolerated.ConclusionsThe results from this study indicate that the administration of a pantothenic acid-based dietary supplement in healthy adults with facial acne lesions is safe, well tolerated and reduced total facial lesion count versus placebo after 12 weeks of administration. Secondary analysis shows that the study agent significantly reduced area-specific and inflammatory blemishes. Further randomized, placebo-controlled trials are warranted.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0052-3) contains supplementary material, which is available to authorized users.

An acne-clearing device for the treatment of acne vulgaris: a clinical study

Objective To evaluate the efficacy and safety of an acne-clearing device in treating acne vulgaris.Methods A bicenter,randomized,single-blinded,placebo-controlled,parallel-group study was conducted.Seventy-three patients with mild to moderate acne vulgaris were enrolled for the trial.Two similar,clinically matched inflammatory papules were selected from each patient,and divided into a test group and a control group to be treated with an acne-clearing device with an output temperature of 46-50 ℃ and a control device without heat source respectively,for three sessions with the interval varying from 1 to 12 hours between the first two sessions and from 18 to 48 hours between the last two sessions.Every treatment lasted three minutes.Lesional color and size were recorded before and on day 1,5 and 14 after the first treatment.Side effects were also recorded for the evaluation of safety.Results Clinical improvement was observed in 66 (90.4％),73 (100.0％) and 72 (98.6％) patients,and marked improvement in 27 (37.0％),64 (87.7％) and 72 (98.6％) patients on day 1,5 and 14 after the first treatment,respectively.Significant differences existed between the control and test group in improvement rate on day 1 and 5,and in marked improvement rate on all the three time points (all P ＜ 0.01).The average time taken for erythematous swelling to begin to subside and time for lesions to completely heal were 19.51 hours and 7.15 days respectively in the test group,significantly shorter than those in the control group by 82.41 hours and 5.07 days respectively.Conclusions The acne-clearing device proves to be effective and safe for the treatment of mild to moderate acne vulgaris,which can rapidly relieve the inflammation in acne,shorten the time required for erythematous swelling to subside and for lesions to completely heal. Key words: Acne vulgaris; Physical therapy modalities; Hyperthermia, induced; Randomized controlled trials

Novel over-the-counter hydrogen peroxide based acne kit in treating acne: Randomized, controlled, multicenter study of a hydrogen peroxide-based acne system versus the benzoyl peroxide-based acne system in the treatment of mild to moderate acne vulgaris

Novel over-the-counter hydrogen peroxide based acne kit in treating acne: Randomized, controlled, multicenter study of a hydrogen peroxide-based acne system versus the benzoyl peroxide-based acne system in the treatment of mild to moderate acne vulgaris

Efficacy of 10% Azelaic Acid Gel with Hydro-alcoholic or Alcohol-free Bases in Mild to Moderate Acne Vulgaris; the First Clinical Trial

Efficacy of 10% Azelaic Acid Gel with Hydro-alcoholic or Alcohol-free Bases in Mild to Moderate Acne Vulgaris; the First Clinical Trial

Treatment of a 25-year-old female patient with moderate acne vulgaris

Acne vulgaris is a chronic skin condition that affects up to 80% of people aged 11-30 years ( National Institute for Health and Care Excellence, 2013 ). In this article, the author presents a case study of a 25-year-old female patient with acne vulgaris who attended a consultation with a nurse independent prescriber at a private aesthetic skin clinic. The case study discusses best practice for acne vulgaris diagnosis, such as using clinical grading severity scoring and comedone identification. Comedonal identification is found to be a key diagnostic indicator of acne, as it is the root in which all acne lesions form. While many acne treatments are available, four treatment options are analysed using the literature. The patient was prescribed a once-daily administration of lymecycline 408 mg antibiotic in conjunction with Epiduo (adapalene 0.1%, benzoyl peroxide 2.5%), which was found to be most efficacious for this patient's presenting condition, targeting three out of the four pathogenic factors of acne. It is also a cost-effective treatment, when medicines adherence is taken into account.

Clinical Evaluation of Glycolic Acid Chemical Peeling in Patients with Acne Vulgaris: A Randomized, Double-Blind, Placebo-Controlled, Split-Face Comparative Study

Glycolic acid (GA) peels are frequently performed as adjuvants to the treatment of facial acne. There have been few clinical trials reported of GA peels for acne in people with darker skin. To determine the safety and efficacy of GA peels in the treatment of moderate acne vulgaris in Asian skin. In this prospective, randomized, double-blind, placebo-controlled, split-face clinical trial, 26 patients with moderate acne were treated with 40% GA (pH 2.0) on half of the face and placebo on the other half. The procedure was performed five times at 2-week intervals. The GA sides had statistically significant reductions in acne lesions at each time point from baseline values. There were statistically significant differences between the GA and placebo sides. The GA sides had better responses for noninflammatory lesions than for inflammatory lesions. In bioengineering measurements, sebum levels were statistically significantly reduced after the initiation of therapy on both sides at weeks 8 and 10, but there were no statistically significant differences between the two sides. Forty percent GA peels significantly improved moderate acne in this study. It is effective and safe in Asians.

Decreased vitamin B12 and folic Acid concentrations in acne patients after isotretinoin therapy: a controlled study.

Background:Oral isotretinoin treatment might influence the levels of vitamin B12 and folic acid.Aims and Objectives:The aim of this study is to compare vitamin B12 and folic acid levels in patients with moderate and severe acne vulgaris with those of the healthy control group and to investigate the effect of isotretinoin treatment on these vitamins.Materials and Methods:Patients who completed 6 months of isotretinoin therapy for moderate and severe forms of acne vulgaris and a control group consisting of healthy individuals between February 2011 and March 2012 were included in the study. Before isotretinoin therapy and at 6.- months of the therapy, serum vitamin B12 and folic acid levels were measured. In the healthy control group, vitamin B12 and folic acid levels were assessed only once.Results:In total, 120 patients with moderate and severe acne vulgaris who completed 6 months isotretinoin therapy and 100 healthy individuals who constituted the control group were included in the study. Pre-treatment vitamin B12 values of the patient group were found to be statistically significantly higher (P = 0.002), but any statistically significant difference was not detected in folic acid measurements (P = 0.566). A statistically significant decrease was detected in post-treatment vitamin B12 and folic acid levels (P < 0.05).Conclusion:Vitamin B12/folic acid treatment should be given under medical surveillance before and during isotretinoin therapy. Supplementation of these vitamins should be recommended in cases of their deficiency, so as to decrease the risks of neuropsychiatric and occlusive vascular diseases.

Efficacy and tolerability of topical fixed combination of nadifloxacin 1% and adapalene 0.1% in the treatment of mild to moderate acne vulgaris in indian patients: A multicenter, open-labelled, prospective study

Background:A combination of topical retinoid and antibacterial therapy is often advocated for acne to enhance therapeutic efficacy.Aims:A preliminary study to evaluate the efficacy and tolerability of a topical fixed combination of nadifloxacin (1%) and adapalene (0.1%) in the treatment of mild to moderate acne in Indian patients.Materials and Methods:This was an open-labeled, phase 3 non-randomized, non-comparative study conducted at five centers (Ahmedabad, Nagpur, Thane, Bangalore, and Mumbai) across India. Of 119 enrolled patients with mild to moderate acne, 117 patients were evaluated at the end of the study for efficacy parameters. A fixed combination of nadifloxacin (1%) and adapalene (0.1%) topical gel was applied at the affected area once at night for a period of 8 weeks. Reduction in the total, inflammatory and non-inflammatory lesion counts from the baseline, investigator global assessment (IGA) and reduction in the severity of acne as per combined acne severity classification were the primary efficacy variables measured at 2 weeks, 4 weeks, and 8 weeks.Results:Overall, 98.3% patients showed a statistically significant progressive reduction in non-inflammatory lesion counts, inflammatory lesion counts, and total lesion counts over the study duration. By the end of 8 weeks, 75% of the patients had their global assessment scores approaching to normal healthy skin score. The adverse events were mild to moderate in severity.Conclusion:This preliminary study shows that a fixed combination of 1% nadifloxacin and 0.1% adapalene topical gel could be an effective and well-tolerated option for the treatment of mild to moderate acne vulgaris. However, further well-controlled, randomized and comparative evaluation of this combination is necessary.

Effects of Adapalene-Benzoyl Peroxide Combination Gel in Treatment or Maintenance Therapy of Moderate or Severe Acne Vulgaris: A Meta-Analysis

BackgroundAn antibiotic-free, fixed-dose combination gel with adapalene (A) 0.1% and benzoyl peroxide (BPO) 2.5% has been developed for treatment of acne vulgaris.ObjectiveTo compare the clinical outcomes of A-BPO combination gel with vehicle gel for treatment or maintenance therapy of patients with acne vulgaris.MethodsAn electronic search of the database PubMed (1966 to September 2012), Embase (1984 to September 2012), and Cochrane Controlled Trials Register (CENTRAL; 3rd Quarter, 2012) was undertaken to identify relevant studies. Main clinical outcomes were success rate, treatment-related adverse events (AEs), AEs leading to discontinuation, satisfaction with the effectiveness, and overall satisfaction.ResultsSix studies were finally included in this meta-analysis. The A-BPO group yielded better clinical outcomes regarding the success rate (p<0.00001), satisfaction with the effectiveness of treatment (p=0.005), and overall satisfaction (p=0.005) compared to the vehicle group. The incidence of treatment-related AEs in the A-BPO group was comparable with that of vehicle group (p=0.09), while the A-BPO group was associated with a slightly increase in the incidence of AEs leading to discontinuation when compared with the vehicle group (p=0.02).ConclusionA-BPO combination gel yields better clinical outcomes including success rate, satisfaction with the effectiveness, and overall satisfaction compared to vehicle gel, despite an increased incidence of AEs leading to discontinuation. The A-BPO combination agent most likely contributes to the treatment of moderate acne vulgaris rather than severe acne vulgaris, but it may be useful in maintenance therapy of patients with severe acne vulgaris.

Effect of acupuncture anesthesia on acne vulgaris of pricking-bloodletting cupping: a single-blind randomized clinical trail

ObjectiveTo evaluate the effect on acne vulgaris of pricking-bloodletting cupping at Dazhui (GV 14) under acupuncture anesthesia, and establish whether providing anesthesia to the treatment area by manipulating Hegu (LI 4) and Quchi (LI 11) might have an additional therapeutic benefit. MethodsThirty-eight patients were recruited and randomized into a control group and an intervention group with a single-blind (observer-blind) method. The control group was treated by pricking-bloodletting cupping at Dazhui (GV 14) and the studied group by pricking-bloodletting cupping at Dazhui (GV 14) under acupuncture anesthesia at Hegu (LI 4) and Quchi (LI 11). Both groups were treated twice weekly for 6 weeks. The analgesic and therapeutic effects of acupuncture were evaluated on a visual analog scale (VAS) and global acne grading system (GAGS), respectively. ResultsThere were differences in the VAS scores of pain on pricking and in the pricked area, and the duration of pain between the groups. After 12 treatments, there was a significant reduction in GAGS scores from baseline in both groups, but there was no significant difference between the groups. ConclusionAcupuncture anesthesia at Hegu (LI 4) and Quchi (LI 11) is an effective means of alleviating the pain of pricking-bloodletting cupping and reducing the duration of pain in the treatment area. Pricking-bloodletting cupping at Dazhui (GV 14) improves the skin lesions of patients with moderate acne vulgaris, but acupuncture anesthesia does not appear to have an additional therapeutic effect.

Clinical and usability study to determine the safety and efficacy of the Silk'n Blue Device for the treatment of mild to moderate inflammatory acne vulgaris

Introduction: Home devices for acne vulgaris have emerged as a way to utilize our current light based technology for the care of our patients suffering from acne vulgaris. Materials and methods: Patient received eight treatments with the Silk'n Blue device over a 4-week period. Follow-up visits were at 1 month and 3 months. Results: Seventeen subjects were entered into this institutional review board (IRB) approved clinical research project. There was a statistically significant decrease in mean acne counts from baseline through the follow-up visits, p = 0.002. Percent reduction was also statistically significant, p = 0.041. The study also showed that 36.4% of the patients had complete clearance with the study device. 100% of the patients showed full comprehension with the label for the device. There were no adverse events. Photos were captured. Discussion: The Silk'n Blue device has an array of 24 LEDs emitting a spectrum of light in the blue-violet range of light (405–460 nm). Subjects enrolled in this clinical trial clearly were able to understand the labeling for the device. Conclusions: The Silk'n Blue device is a safe efficacious at home device for the treatment of mild to moderate inflammatory acne vulgaris.

Efficacy of daily low dose versus intermittent isotretinoin regimens in patients with moderate acne vulgaris: A randomized-controlled trial

Background: Oral isotretinoin, a vitamin A acid derivative, is the most effective treatment of severe acne. As its use is associated with many side effects, low-dose and intermittent application protocols for patients with mild or moderate acne have been reported. Aim: Our purpose was to compare the outcome of two different regimens of low dose isotretinoin; daily versus monthly doses in patients with moderate acne vulgaris. Patients and methods: A randomized controlled trial was conducted on 75 patients with moderate acne vulgaris attending outpatient clinic in the dermatology department at El-Jumhuriya hospital in Benghazi city during the period of June 2009 to June 2011. The patients were randomly assigned to two groups. Group 1 consisted of 45 patients, treated with a daily fixed dose of 20 mg of isotretinoin and group 2 consisted of 30 patients, treated with 20 mg of isotretinoin twice daily for seven days every month. Both groups were treated for a total period of four months. No topical treatments were permitted for both groups. Clinical assessment was done at 0, 4, 8, 12, and 16 weeks, which included acne lesion counts, total acne load, the assessment of severity score of acne and the side effects of the treatment. Patients were followed for six months after stopping treatment. Results: Fifty five patients with moderate acne vulgaris completed the study. Group 1 consisted of 32 patients with equal proportion of females and males; their mean age and standard deviation (SD) was 20.2±4.1 years. Group 2 consisted of 23 patients; 52.2% were females and 47.8% were males, their mean age and SD was 20±3.4 years. No statistically significant difference was observed according to the age and gender among both groups. Acne scores in each group were significantly lower at the end of treatment period. The mean decrease in the inflammatory and non-inflammatory lesion counts was more and earlier in group 1 compared to group 2, this difference was statistically insignificant. Both treatment regimens were well tolerated; cheilitis was the most frequent side-effect seen in 81.3% and 69.6% of patients in group 1 and group 2 respectively. However, there was no statistically significant differences among both groups regarding the frequency and severity of the side effects. The total cumulative dose was significantly higher in group 1 as compared to group 2 (P=0.000). During the follow- up period there was no statistically significant difference between both groups in relapse rate which has been seen in 7 (21.9%) patients in group 1 and 9 (39.1%) patients in group 2. Conclusion: Both isotretinoin regimens were safe and effective treatment for moderate acne vulgaris, however, intermittent sotretinoin regimen may be a cost- effective alternative.

Efficacy of &lt;em&gt;Garcinia mangostana&lt;/em&gt; L. (mangosteen rind extract) to reduce acne severity

Background: In vitro studies showed that extract of mangosteen rind (EMR) (Garcinia mangostana L.) containing xanthones has antibacterial effect against Propionibacterium acnes and also anti-inflammatory effect. The aim of this study is to determine the efficacy of EMR in reducing acne vulgaris (AV). Methods: A randomized, double-blind, placebo controlled clinical trial was done on 94 subjects (18-30 years) with mild and moderate AV. The treatment group was given 400 mg EMR 3 times daily orally, for 3 weeks and control group was given placebo capsules. As a standard therapy, all subjects were given a topical cream of 0.025% retinoic acid applied on acne lesions during night time. Efficacy was assessed by counting the acne lesion number as well as proportion of subjects with more than 20% decrease in lesion. The decrease of plasma malondialdehyde (MDA) levels were also measured. Results: After 3 weeks of treatment, acne lesion counts was significantly reduced in both groups [from 934 to 584 lesion (37%) in treatment group, p 0.55). The proportion of subjects whose acne lesion reduced ≥ 20% was 73% (33 of 45 subjects) in treatment group vs 66% (27 of 41 subjects) in control (p > 0.2). The level MDA was reduced from 1.16 to 1.02 nmol/mL in treatment group and from 1.32 become 1.02 nmol/mL in control (p > 0.48). Conclusion: Extract of mangosteen rind given orally for 3 weeks clinically reduced acne severity better than placebo, although statistically was not significant. Antioxidant effect of EMR seem to be unspecific in reducing acne severity. (Med J Indones. 2013;22:167-72. doi: 10.13181/mji.v22i3.586)

Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris

Nicotinamide and clindamycin gels are two popular topical medications for acne vulgaris. This study aimed to compare efficacy of the topical 4% nicotinamide and 1% clindamycin gels in these patients. In this randomized, double-blind clinical trial, patients with moderate inflammatory facial acne vulgaris were randomly allocated to receive either topical 4% nicotinamide (n=40) or 1% clindamycin gels (n=40) twice daily. In each group, they were further categorized in two subgroups with oily and non-oily types of facial skin. The Cook's acne grade was determined at baseline and at weeks 4 and 8 post treatment. Acne grade decreased from an average of 5.93±0.83 at baseline to 4.03±1.33 at week 4 and 2.08±1.59 at week 8 in nicotinamide receivers, and from an average of 5.70±0.94 at baseline to 3.85±1.66 at week 4 and 2.03±1.53 at week 8 in the clindamycin group (within-group P<0.001, between-group P>0.05). Comparing with each other, nicotinamide and clindamycin gels were significantly more efficacious in oily and non-oily skin types, respectively. No major side effect was encountered by any patient. Skin type is a significant factor in choosing between topical nicotinamide and clindamycin in patients with acne vulgaris.