Non-inflammatory Lesions Research Articles

A Study of the Efficacy of Doxycycline plus Trifarotene in the Treatment of Moderate to Severe Acne Vulgaris

Introduction: Acne is a common cutaneous disease affecting the pilosebaceous apparatus, in which there is hyperkeratinization, excessive sebum production, follicular colonization with Propionibacteriun acnes & inflammation. It manifests as comedones, papules, pustules, nodules & cysts on the face, neck, and trunk. Epidemiologic studies indicate acne affects approximately 9.4% of the global population, ranking it as the eighth most prevalent disease worldwide. It is a common skin condition of the face and trunk that negatively impacts the quality of life. Objectives: We evaluated the efficacy of oral doxycycline in combination with topical trifarotene in the treatment of moderate to severe acne vulgaris. Methods: This was an interventional study for 12-week duration to see the treatment outcome in moderate & severe acne patients. This study was carried out at the Dept. of Dermatology & Venereology, Enam medical college Hospital, Savar, Dhaka, Bangladesh from January 2022 to September 2022. We evaluated a new therapeutic regimen: Doxycycline 100 mg (Oral) once daily during dinner with food and enough water,21 days / month, for three consecutive months along with topical Trifarotene 0.005%w/w once daily at night after proper cleansing for the same duration. Acne severity was graded using Investigator Global Acne Assessment Scale (IGAS). Results: A total of 96 patients with moderate to severe acne were treated & among them 85 completed this study. Out of these 85, 15 are males & 70 are females. There was a marked improvement in IGAS with marked reduction in the number of inflammatory and non-inflammatory lesions between the beginning of the study and through follow up visits. Clinical response to Doxycycline Plus Trifarotene was excellent in 15%, good in 68%, moderate in 14% and mild in 3% and satisfaction to treatment was 22% very satisfied, 60% satisfied and 17% somewhat satisfied. Side effects were low and only 2.1% of cases had mild irritation. ........

Effect of various types of photodynamic therapy on inflammatory and non-inflammatory lesions in patients with acne: A network meta-analysis of randomized controlled trials

BackgroundRecent studies have demonstrated that photodynamic therapy (PDT) is safe and effective in treating acne vulgaris. The present study aimed to evaluate various PDTs on inflammatory and non-inflammatory lesions in patients with acne by a network meta-analysis (NMA) of randomized controlled trials (RCTs). MethodsThe researchers of this paper searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to March 2022 to identify suitable RCTs. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool. Twenty-one RCTs were included, with a total sample size of 898 participants. ResultsNetwork meta-analysis (NMA) revealed that indocyanine green (ICG) + near-infrared (NIR) diode laser, ICG+830 nm light-emitting diode (LED), indole-3-acetic acid (IAA) + 520 nm LED, and 5-aminolevulinic acid (ALA) + sunlight demonstrated obvious curative effects in patients with acne vulgaris. Importantly, ICG+NIR diode laser provided the greatest improvement in both inflammatory and non-inflammatory acne lesions (surface under the cumulative ranking curve [SUCRA]: 84.4% and 93.5%, respectively). ConclusionsBased on the NWM and SUCRA ranking, ICG + NIR diode laser can be considered more effective in treating acne than the other PDTs of the RCTs. However, this conclusion should be interpreted with caution due to the limitations of the present study.

Central and Peripheral Nervous System Complications of Vasculitis Syndromes from Pathology to Bedside: Part 2-Peripheral Nervous System.

Peripheral nervous system vasculitides (PNSV) are a heterogeneous group of disorders with a clinical subset that may differ in prognosis and therapy. We provide a comprehensive update on the clinical assessment, diagnosis, complications, treatment, and follow-up of PNSV. Progress in neuroimaging, molecular testing, and peripheral nerve biopsy has improved clinical assessment and decision-making of PNSV, also providing novel insights on how to prevent misdiagnosis and increase diagnostic certainty. Advances in imaging techniques, allowing to clearly display the vessel walls, have also enhanced the possibility to differentiate inflammatory from non-inflammatory vascular lesions, while recent histopathology data have identified the main morphological criteria for more accurate diagnosis and differential diagnoses. Overall, the identification of peculiar morphological findings tends to improve diagnostic accuracy by defining a clearer boundary between systemic and non-systemic neuropathies. Therefore, the definition of epineurium vessel wall damage, type of vascular lesion, characterization of lymphocyte populations, antibodies, and inflammatory factors, as well as the identification of direct nerve damage or degeneration, are the common goals for pathologists and clinicians, who will both benefit for data integration and findings translation. Nevertheless, to date, treatment is still largely empiric and, in some cases, unsatisfactory, thus often precluding precise prognostic prediction. In this context, new diagnostic techniques and multidisciplinary management will be essential in the proper diagnosis and prompt management of PNSV, as highlighted in the present review. Thirty to fifty percent of all patients with vasculitis have signs of polyneuropathy. Neuropathies associated with systemic vasculitis are best managed according to the guidelines of the underlying disease because appropriate workup and initiation of treatment can reduce morbidity. Steroids, or in severe or progressive cases, cyclophosphamide pulse therapy is the standard therapy in non-systemic vasculitic neuropathies. Some patients need long-term immunosuppression. The use of novel technologies for high-throughput genotyping will permit to determine the genetic influence of related phenotypes in patients with PNSV.

Prospective Evaluation of a Topical Botanical Skin Care Regimen on Mild to Moderate Facial and Truncal Acne and Mood

Acne vulgaris is a common inflammatory condition that can be associated with profound psychosocial impacts. Conventional treatment includes topical retinoids, benzoyl peroxide, and antimicrobials, and some may cause irritation and skin dryness. In this 8-week open-label study, we examined the effects of a botanical skin care regimen (Codex Labs Shaant Balancing regimen) on mild to moderate facial and truncal acne. Twenty-four male and female subjects between the ages of 12 and 45 years were assessed for eligibility, 20 were enrolled, and 15 completed all study visits. Facial and truncal acne lesion counts, skin hydration, sebum excretion rate, and mood were assessed at baseline, week 4, and week 8. Total facial lesion counts (inflammatory and non-inflammatory lesions) decreased by 20.5% at week 4 (p = 0.06) and by 25.2% at week 8 (p < 0.05). Inflammatory lesion counts on the trunk were found to decrease at week 8 relative to baseline by 48% (p < 0.05). Forehead sebum excretion rate decreased by 40% at week 4 (p = 0.07) and 22% at week 8 (p = 0.08), and cheek skin hydration increased by 27.6% at week 4 (p = 0.14) and 65% at week 8 (p = 0.10). Participants also experienced significant improvement in components of a positive effect, such as feeling "strong" and "inspired", and a decrease in negative effects, such as feeling "irritable." Overall, the botanical skin care regimen was found to be well-tolerated. Our study suggests that a botanical skin care regimen may reduce facial and truncal acne lesion counts, increase skin hydration, reduce sebum production, and augment positive effects and moods in those with mild to moderate facial and truncal acne.

P105 Epithelial microRNA signatures as potential biomarkers in Crohn’s disease related to clinical and endoscopic activity

Abstract Background Emerging evidence suggests that epithelial cell-derived microRNAs (miRNA) are involved in the pathogenesis of inflammatory bowel disease; however, as of now specific implications in the real clinical practice, especially in relation to biologics use are yet far-fetched. Therefore, we tried to investigate specific epithelial cell derived miRNA signatures related to clinical and endoscopic activity in Crohn’s disease (CD) patients. Methods We prospectively collected terminal ileum tissue samples via ileocolonoscopy from healthy control (n=12), CD patients in remission (n=32) and active CD patients (n=36). CD remission was defined as clinical remission of Crohn's disease activity index (CDAI) &amp;lt;150 and achievement of endoscopic mucosal healing. Both inflamed and non-inflamed lesions were sampled in the active CD patients. Clinical information, medication use, chemistry data were measured within a week from the tissue sample date. miRNA levels were measured by small-RNA sequencing and qRT-PCR. Diagnostic ability of specific miRNA found were evaluated by receiver operating characteristic (ROC) curve analysis. Results The study cohort was followed up until January 2022. Mean follow-up period of the prospective CD cohort was 13.06 months. In comparing to the healthy control, CD patients in remission and active state revealed specific miRNA profiles in small-RNA sequencing. Through RT-PCR validation, we found that the expression levels of miR-141-3p, miR-338-3p, miR-378a-3p, and miR-200b-3p were significantly decreased, while miR-125b-5p, miR-29b-3p and miR-155-5p were significantly increased in the inflamed tissue of active CD patients. Moreover, in case of active CD patients, expressions of miR-150-5p, miR-200b-3p and miR-155-5p were significantly down-regulated in those using biologics, compared with biologics naïve patients. This may suggest that these miRNAs were not only as biomarkers of CD patients, but also as biomarkers related to inflammation and biologics response. ROC curve analysis suggested miRNAs with different diagnostic activity related to both clinical disease activity and endoscopic inflammation status. MiR-338-3p, miR-141-3p and miR-378a-3p demonstrated area under curve of greater than 0.9 in predicting active CD patients. Conclusion We report specific miRNA biomarkers identifying CD and its disease inflammation activity with relation to biologics use, suggesting potential treatment target in CD pathogenesis. These miRNA signatures could also be of potential clinical use in positioning biologics, which we intend to explore in the near future.

Prospective Placebo-Controlled Assessment of Spore-Based Probiotic Supplementation on Sebum Production, Skin Barrier Function, and Acne.

Probiotic supplementation has been shown to modulate the gut-skin axis. The goal of this study was to investigate whether oral spore-based probiotic ingestion modulates the gut microbiome, plasma short-chain fatty acids (SCFAs), and skin biophysical properties. This was a single-blinded, 8-week study (NCT03605108) in which 25 participants, 7 with noncystic acne, were assigned to take placebo capsules for the first 4 weeks, followed by 4 weeks of probiotic supplementation. Blood and stool collection, facial photography, sebum production, transepidermal water loss (TEWL), skin hydration measurements, and acne assessments were performed at baseline, 4, and 8 weeks. Probiotic supplementation resulted in a decreasing trend for the facial sebum excretion rate and increased TEWL overall. Subanalysis of the participants with acne showed improvement in total, noninflammatory, and inflammatory lesion counts, along with improvements in markers of gut permeability. The gut microbiome of the nonacne population had an increase in the relative abundance of Akkermansia, while the subpopulation of those with acne had an increase in the relative abundance of Lachnospiraceae and Ruminococcus gnavus. Probiotic supplementation augmented the circulating acetate/propionate ratio. There is preliminary evidence for the use of spore-based probiotic supplementation to shift the gut microbiome and augment short-chain fatty acids in those with and without acne. Further spore-based supplementation studies in those with noncystic acne are warranted.

Tretinoin 0.1% and Benzoyl Peroxide 3% Cream for the Treatment of Facial Acne Vulgaris.

To assess the efficacy, safety, and clinical application of tretinoin 0.1%-benzoyl peroxide 3% cream for the topical treatment of acne vulgaris. A systematic review of the literature was performed using the terms Twyneo OR tretinoin and benzoyl peroxide OR S6G5T-3 in MEDLINE (PubMed) and EMBASE. ClinicalTrials.gov was searched to obtain completed clinical trial results not published elsewhere. All human studies published in English prior to November 2022 related to pharmacology, clinical trials, safety, and efficacy were evaluated for inclusion. In two 12-week, phase 3, randomized, vehicle-controlled clinical trials, tretinoin 0.1%-benzoyl peroxide 3% cream significantly reduced inflammatory and noninflammatory facial acne lesions and significantly improved Investigator Global Assessment (IGA) rating to clear or almost clear. The cream has a suitable safety profile, with application site pain and dryness as the most common adverse events. Tretinoin-BPO had similar IGA success compared to other topical retinoid and retinoid-BPO treatments for acne vulgaris. Compared to individual tretinoin and benzoyl peroxide therapy, the combination product streamlines application, which will improve medication adherence; however, the cost of tretinoin-BPO cream may be prohibitive. Tretinoin 0.1%-benzoyl peroxide 3% cream is safe and effective for the treatment of moderate-to-severe acne. Long-term trial data on efficacy and tolerability are not yet available.

Efficacy and Tolerability of 0.1% Adapalene With 1% Clindamycin Versus 0.1% Adapalene With 2.5% Benzoyl Peroxide on Acne Vulgaris: A Case Control Study

Objective: Combination therapy is currently the preferred acne treatment. We conducted this study to compare the efficacy and tolerability of 0.1% adapalene with 1% clindamycin versus 0.1% adapalene with 2.5% benzoyl peroxide (BPO) in the treatment of acne vulgaris. Methods: This study was conducted over a period of 1 year from September 2014 to September 2015. One-hundred patients aged 14 to 30 years with mild to moderate acne vulgaris were included. The patients were randomly allocated to 2 equal groups (n = 50 in each group), and received a topical combination of 0.1% adapalene with 1% clindamycin andtopical combination of 0.1% adapalene with 2.5% BPO, respectively). The efficacy and tolerability of two treatments were compared. The unpaired student t test was used to compare the difference in continuous variables between 2 groups, while the chi-square test or Fisher exact test was used for categorical variables. Results: One-hundred patients with mild to moderate acne vulgaris were randomly allocated to 2 equal groups (n = 50 in each group). After 12 weeks of treatment, there were no significant differences between the adapalene-clindamycin and adapalene-BPO in the mean reductions in the numbers of non-inflammatory lesions (11.16 ± 8.01 and 11.12 ± 8.62, respectively), inflammatory papules (49.78 ± 37.57 and 50.48 ± 36.57, respectively), and total lesions (67.50 ± 44.59 and 70.12 ± 46.83, respectively). The incidence of a burning sensation was significantly greater in the adapalene-BPO group than the adapalene-clindamycin group (32% vs. 6%; P = 0.002). Conclusion: Topical adapalene plus clindamycin and adapalene plus BPO had similar efficacies in the treatment of acne. Adapalene with clindamycin was better tolerated than adapalene with BPO.

The effectiveness of galactomyces ferment filtrate, dexpanthenol, and Centella asiatica combination serum in the treatment of post-acne hyperpigmentation

Background: Acne vulgaris is a chronic inflammation of the pilosebaceous gland that may result in non-inflammatory and inflammatory lesions. A hypermelanotic reaction to skin inflammation causes post-acne hyperpigmentation (PAH). It can occur secondary to the inflammation process and, depending on the severity, may persist for a prolonged period.&#x0D; Objective To determine the effectiveness of galactomyces ferment filtrate (GFF), dexpanthenol, and Centella asiatica combination serum in the treatment of PAH&#x0D; Methods: This was a placebo-controlled randomized clinical trial. Sixty-eight subjects were divided into two groups: the experimental group received combination serum while the control group received a placebo for eight weeks. Three drops of serum were applied to the area with PAH twice daily in the morning and night. The melanin, erythema, roughness, and L*, a*, and b* scores were assessed objectively using mexameter, chromameter and skin analyzer every two weeks. Pearson’s correlation test and independent T-test were used to assess the trend of the parameters and compare the results of both groups.&#x0D; Results: The results of statistical calculations using the Pearson correlation test showed the treatment group showed a significant decreasing trend of the melanin and spots score. Both groups showed a significant decreasing trend in erythema, L* score and roughness. However, no significant difference was found between both groups in all parameters.&#x0D; Conclusion: The combination serum may decrease the melanin and spot scores suggesting that it affects the melanocyte activity. It has shown good efficacy in treating PAH.

Assessment of the Benefit of a Deep Cleansing Gel Containing Salicylic Acid 2%, Zinc Gluconate 0.2% and Lipohydroxy Acids 0.05% in Patients with Mild to Moderate Truncal Acne: Results from an Exploratory Study

Acne is a skin condition of the pilosebaceous unit that affects mainly the face, chest and trunk. Approximately 50% of subjects with facial acne also have acne of the trunk. This study investigated the clinical benefit of a cleansing gel containing salicylic acid 2%, zinc gluconate 0.2% and lipohydroxy acid 0.05% in truncal acne after 84 days of daily use. A single center, open label, non-randomized study with 51 subjects with mild to moderate truncal acne was conducted. Thirty-five (35) subjects completed the study; mean age was 23 years. Inflammatory and non-inflammatory lesions, Transepidermal water loss (TEWL) and local tolerance were assessed at baseline, Day 42 and Day 84 and total lesion count was calculated. The total lesion count was significantly reduced (p<0.05) after 42 days (-21.5%) and 84 days (-56.3%). Non-inflammatory lesions were significantly decreased after 84 days (-64.0%) only, while inflammatory lesions were decreased at Day 42 (-29.2%), and Day 84 (-48.2%). A statistically significant skin barrier improvement was observed at Day 84 (-21.26%). No adverse events or relevant local intolerance were reported. The use of the cleansing gel studied was effective in improving mild to moderate truncal acne and contributed to the skin barrier improvement. The product was well tolerated. NCT05584150.

Development of an Effective Acne Treatment Based on CBD and Herbal Extracts: Preliminary In Vitro, Ex Vivo, and Clinical Evaluation.

Acne vulgaris, the most common form of acne, is characterized by a mixed eruption of inflammatory and noninflammatory skin lesions primarily affecting the face, upper arms, and trunk. The pathogenesis of acne is multifactorial and includes abnormal keratinization and plugging of the hair follicles, increased sebum production, proliferation and activation of Cutibacterium acnes (C. acnes; formerly Propionibacterium acnes, P. acnes), and finally inflammation. Recent studies have found that cannabidiol (CBD) may be beneficial in the treatment of acne. The aim of this study was to explore natural plant extracts that, when combined with CBD, act synergistically to treat acne by targeting different pathogenic factors while minimizing side effects. The first stage of the study investigated the capacity of different plant extracts and plant extract combinations to reduce C. acnes growth and decrease IL-1β and TNFα secretion from U937 cells. The results found that Centella asiatica triterpene (CAT) extract as well as silymarin (from Silybum marianum fruit extract) had significantly superior anti-inflammatory activity when combined with CBD compared to either ingredient alone. In addition, the CAT extract helped potentiate CBD-induced C. acnes growth inhibition. The three ingredients were integrated into a topical formulation and evaluated in ex vivo human skin organ cultures. The formulation was found to be safe and effective, reducing both IL-6 and IL-8 hypersecretion without hampering epidermal viability. Finally, a preliminary clinical study of this formulation conducted on 30 human subjects showed a statistically significant reduction in acne lesions (mainly inflammatory lesions) and porphyrin levels, thereby establishing a tight correlation between in vitro, ex vivo, and clinical results. Further studies must be conducted to verify the results, including placebo-controlled clinical assessment, to exclude any action of the formulation itself.

A Novel, Hand‐Held, and Low‐Level Light Therapy Device for the Treatment of Acne Vulgaris: A Single‐Arm, Prospective Clinical Study

There is an increasing demand for low‐level light therapy devices for the treatment of dermatologic conditions, such as acne, hair loss, undesirable body hair, and skin aging. This study evaluated the safety and effectiveness of a novel hand‐held low‐level light therapy device with a 680 nm red laser diode and a 450 nm blue light‐emitting diode for the treatment of mild‐to‐moderate acne. A prospective clinical study was conducted on 57 patients with mild‐to‐moderate acne and Fitzpatrick skin types II–IV. Treatments were self‐administered by the patients at home daily for 4 weeks. Conventional treatment was restricted during the study period. The number of inflammatory and noninflammatory lesion counts, Investigator’s Global Assessment grade, patients’ self‐assessment, and adverse events were measured every two weeks, and follow‐ups were performed until four weeks after the final treatment. Moreover, we evaluated the bactericidal effect of low‐level light therapy on Cutibacterium acnes, a causative agent of acne vulgaris, in vitro. The mean number of inflammatory acne lesions decreased statistically at weeks 4 ( ∗∗∗p &lt; 0.001) and 8 ( ∗∗∗p &lt; 0.001). The proportion of Investigator’s Global Assessment grade 3, indicating moderate acne severity, decreased significantly at the final visit. No severe adverse reactions were reported. Furthermore, there was a significant reduction in the viability of Cutibacterium acnes following low‐level light therapy exposure in vitro. The results of this study demonstrate that this novel, hand‐held, and low‐level light therapy device are safe and effective for the treatment of inflammatory acne, with good adherence.

Effect of Application, Duration and Dosing Frequency on the Efficacy and Adverse Effect of Adapalene in Acne Vulgaris: an Open-Label Randomized Controlled Study

Introduction: Topical retinoids are the mainstay of treatment for mild and moderate acne but longer duration of application causes adverse effects. The study aimed to evaluate the effect of application, duration, and dosing frequency on the efficacy and adverse effect of Adapalene in Acne Vulgaris.Materials and Methods: The study design was an open-label randomized controlled split-face trial. Patients with acne grades 1 and 2 were randomized into three groups using the split-face technique on the right and left sides. On the right side, patients applied adapalene daily in all the groups and alternately on the left face. The three groups of the study were overnight, 1 hour, and ½ hour application of adapalene. Follow up period was 4,8 and 12 weeks. Lesion count and side effects were evaluated at each follow-up.Results: Out of 292 who completed the study, the decrease in total lesion count was highest in the overnight group. Regarding specific lesion count, the decrease in non-inflammatory lesions was highest in the overnight group. However, short contact therapy with 1-hour application showed comparable efficacy with the overnight group in regards to inflammatory lesion count. There was a significant reduction of lesions in all groups from baseline to 12 weeks, with ½ hour group having minimal side effects followed by 1 hour and overnight.Conclusion: Short contact therapy for acne shows promising results in regard to efficacy and better tolerance.

An Overview About Acne Vulgaris

Background: Acne vulgaris (acne) is a long-term inflammatory skin disease. Typical features of acne that often appears in adolescents on the forehead include visible, clinically recognized blackheads or whiteheads (comedones) that develop into inflammatory red papules or pustules and possible scarring. Acne primarily affects skin with a relatively high number of sebaceous glands including face, neck, chest, and upper back. Acne and postinflammatory hyperpigmentation have a strong negative impact on mental health, including mood disorde,r, depression, and suicidal thoughts. Also acne may cause low self-esteem, decrease social interactions and quality-of-life scores in adolescents. Typical features of acne include increased secretion of sebum by the skin, microcomedones (a structure invisible to the naked eye), comedones, papules, nodules, pustules, and often results in scarring. It may result in psychological and social problems. Acne lesions are classified into non inflammatory and inflammatory. Non inflammatory acne lesions consist of open and closed comedones. Open comedones are clearly obvious in the skin and can be found in the face centrally. Closed comedones, by inspection in a good light room, are slightly hypopigmented ,tiny, usually less than 1mm in size, with no visible opening . Comedones are superficial and can remain with no progress or get inflammed and become deep. Inflammatory acne lesions include papules ( red, inflammed, raised lesions of size less than 5 mm), pustules ( scattered pus-filled papules) and nodules ( lesions, 5 mm or larger in size). these lesions affect deep structures in the skin so their inflammation can lead to formation of scars. Acne vulgaris is a chronic skin disease of the pilosebaceous unit that occurs as a result of the following four factors: increased sebum production (due to increased activity of androgens and IGF-1), excessive deposition of keratin in pilosebaceous follicles leading to comedo formation, colonization of the follicle by P. acnes bacteria, and the local release of pro-inflammatory chemicals in the skin through certain inflammatory mechanisms. Limited evidence supports comedo extraction, but it is an option for comedones that do not improve with standard treatment. Another procedure for immediate relief is the injection of a corticosteroid into an inflamed acne comedo. Electrocautery and electrofulguration are effective alternative treatments for comedones. Inflammatory and non-inflammatory lesions are common in acne vulgaris, which is a complex illness linked to the pilosebaceous follicle. Since inflammation can occur in both the early stages of acne vulgaris and the late stages of the disease, inflammation plays a critical role in the development of acne vulgaris lesions, both inflammatory and non-inflammatory. There are different updated modalities for acne vulgaris treatment.

Efficacy of Azithromycin and Doxycycline in the Treatment of Acne Vulgaris- A Single Center Study in Bangladesh

Background: Acne vulgaris is a very common skin disease which is seen primarily in adolescents and young adults. For cost-effectiveness and tradition, doxycycline has been used in treating acne vulgaris for a long period of time. On the other hand, it is assumed that as azithromycin poses a long half-life so it is more effective than any other antibiotic in treating acne vulgaris. But we have very little comparative data regarding this issue. Aim of the Study: The aim of this study was to compare the efficacy of azithromycin with doxycycline in treating acne vulgaris. Methods: This prospective, comparative study was conducted in Department of Skin &amp; Venereology, Joypurhat District Hospital, Bangladesh, during the period from July 2020 to June 2021. A total of 110 patients with moderate-to-moderately severe (Grade II and III), acne vulgaris were finalized as the study population and divided into two groups. Patients of Group A were given azithromycin 500 mg three times a week as pulse therapy along with 0.05% topical tretinoin for one month and the patients of Group B were given doxycycline 100mg once daily along with 0.05% topical tretinoin for one month. Results: In this study, after 1 month of treatment, in Group A among 33(60.0%) and 22(40.0%) participants we found mild and moderate non-inflammatory lesions respectively which were found in 35(63.6%) and 20(36.4%) cases respectively in Group B and we found a significant correlation (P=0.004). Besides these, after 1 month of treatment, in Group A among 35(63.6%) and 19(34.6%) participants, we found mild and moderate inflammatory lesions respectively which were found in 33(60.0%) and 21(38.2%) cases respectively in Group B and we found a significant correlation (P=0.004) also. But at the same time, in analyzing the frequencies of ‘total lesions’ between the groups we found an extremely significant correlation where the P value was found as &lt;0.001. Conclusion: Although, for eradicating non- inflammatory lesions, ....

Skin dysbiosis and Cutibacterium acnes biofilm in inflammatory acne lesions of adolescents

Acne vulgaris is a common inflammatory disorder affecting more than 80% of young adolescents. Cutibacterium acnes plays a role in the pathogenesis of acne lesions, although the mechanisms are poorly understood. The study aimed to explore the microbiome at different skin sites in adolescent acne and the role of biofilm production in promoting the growth and persistence of C. acnes isolates. Microbiota analysis showed a significantly lower alpha diversity in inflammatory lesions (LA) than in non-inflammatory (NI) lesions of acne patients and healthy subjects (HS). Differences at the species level were driven by the overabundance of C. acnes on LA than NI and HS. The phylotype IA1 was more represented in the skin of acne patients than in HS. Genes involved in lipids transport and metabolism, as well as potential virulence factors associated with host-tissue colonization, were detected in all IA1 strains independently from the site of isolation. Additionally, the IA1 isolates were more efficient in early adhesion and biomass production than other phylotypes showing a significant increase in antibiotic tolerance. Overall, our data indicate that the site-specific dysbiosis in LA and colonization by virulent and highly tolerant C. acnes phylotypes may contribute to acne development in a part of the population, despite the universal carriage of the microorganism. Moreover, new antimicrobial agents, specifically targeting biofilm-forming C. acnes, may represent potential treatments to modulate the skin microbiota in acne.

357 Cutibacterium acnes CAMP factor 1-related peptides as Toll-Like Receptor-2 modulators

Acne vulgaris is a disorder affecting the pilosebaceous unit resulting in both inflammatory and non-inflammatory clinical lesions. Cutibacterium acnes (C. acnes) of a specific lineage, plays a key role in inflammatory acne by producing several virulence factors thereby increasing their inflammatory capacity. The C. acnes mutated CAMP1 factor display strong TLR-2 binding property in highly inflammatory C. acnes strains. CAMP1 peptide array analysis of 116 15-mer peptides sequences with an overlap of 11 amino acids, were immobilized onto glass plate and showed that seven peptides (A14, A15, B1, B2, B3, C1 and C3) were specifically recognized by TLR-2 and located on the same side of the in silico 3D-CAMP1 structure.

A Topical Combination Regimen of Benzoyl Peroxide and Retinol Moisturizer for Mild to Moderate Acne

Topical therapies, in many cases over-the-counter (OTC) formulations, are available for the treatment of acne, including benzoyl peroxide (BPO), salicylic acid, and retinoids. While these agents provide therapeutic efficacy, combination regimens can offer improved outcomes due to their ability to address multiple pathways involved in acne formation, making them better suited to address the multiple factors involved in acne pathogenesis and the breadth of complexion issues associated with the condition. The present study assessed the efficacy and tolerability of a daily regimen comprised of topical low-dose (2.5%) BPO applied in the morning and topical retinol applied in the evening in 33 subjects with mild to moderate acne who completed the study. A significant reduction in global total acne count from baseline to week 12 (primary endpoint) was achieved, in addition to significant improvements in Investigator Global Assessment (IGA) of acne severity and reductions in inflammatory and non-inflammatory lesions. Treatment also significantly improved acne-complexion graded efficacy parameters (tactile surface roughness, uneven skin tone, skin blotchiness, and lack of skin clarity), and was well-tolerated, with no statistically significant (P&lt;0.05) increases in objective or subjective facial irritation. Significant improvements from baseline to week 12 were observed for both self-assessment of facial skin conditions and quality of life (QoL) scores. No product-related adverse events (AEs) were observed in the study subjects. J Drugs Dermatol. 2022;21(12):1340-1346. doi:10.36849/JDD.6845.

The Effectiveness of Manual Acupuncture Therapy for Acne Vulgaris: A Case Report

Acne vulgaris (AV) is a chronic inflammation of pilosebaceous glands. The clinical presentation of AV can be described as an inflammatory lesion and non-inflammatory lesions. The diagnosis of AV is through clinical evaluations. AV was graded according to clinical severity using Lehmann’s criteria. AV predilection most commonly appears on the face, chest, and back. AV causes the greatest burden between 10 to 30 years old and can cause anxiety and decrease self-confidence, instigating decreased quality of life. Acupuncture is a non-pharmacological treatment modality that is performed using filiform needles at acupuncture points. An 18-year-old woman was diagnosed with a moderate degree of AV based on Lehmann's criteria. She received manual acupuncture acupoints with the needles retained for 30 minutes. The treatment was conducted 2 times a week for a total of 12 treatments. After 12 treatments of acupuncture therapy, the degree of AV was reduced from moderate to mild, with an 81.25% reduction in total lesions. Follow-up was carried out 1 month after the treatment, showing that the effect of acupuncture remained. The acupuncture mechanism works directly on acne lesions by improving microcirculation, reducing proinflammatory reactions, and increasing anti-inflammatory, as well as regulating the HPA axis which can reduce stress and improve hormones. Manual acupuncture can be considered a non-pharmacological therapeutic modality to treat AV with minimal side effects.

The SII reflects inflammation in acne vulgaris, but fails to determine categorical severity.

Systemic Immune Inflammation Index (SII; calculated by multiplying neutrophil-lymphocyte ratio and platelet count) has been investigated as a marker of inflammation. we aimed to investigate the relationship of SII with acne severity and whether it can be used as a practical method in determining categorical acne severity. All participants (aged 15-30 years, n=212) were prospectively evaluated with acne severity scales, including the Global Acne-Grading System (GAGS), the Comprehensive Acne Severity Scale (CASS), and the Patient-centered Acne Severity Scale. Patients were grouped according to GAGS: healthy individuals (n=53), patients with mild (n=44), moderate (n=86), and severe acne (n=29). Patients' hemogram data obtained simultaneously with the physical examination were used in the analysis. The groups were statistically similar in terms of age and gender, both according to acne severity and current lesion types. The neutrophil count was significantly higher in patients with nodulocystic acne than in acne patients with non-inflammatory lesions or healthy individuals (p: 0.022). SII was significantly higher in acne patients with nodulocystic lesions than in individuals with milder lesions, both non-inflammatory and inflammatory (p= 0.004). SII was weakly significantly correlated with GAGS, CASS, and the number of nodulocystic lesions (r= 0.164, p= 0.018; r= 0.147, p= 0.034; r= 0.222, p= 0.001). However, none of the hemogram parameters, including SII, differed in classifying acne severity according to GAGS (p> 0.05). Systemic immune inflammation index may be a new and reliable inflammatory marker to reflect the severity of inflammation, especially in patients with nodulocystic acne, although it is not useful in categorizing acne severity.