Pilosebaceous Duct Research Articles

STEATOCYSTOMA MULTIPLEX IN AN ADOLESCENT BOY: A CASE REPORT

Steatocystoma multiplex (SM) is a rare genodermatosis transmitted as an autosomal dominant trait caused most often by a mutation in the gene coding for keratin 17. There are some sporadic cases described in the literature. The disease commonly manifests as numerous intradermal cysts caused by hamartomatous malformations of the pilosebaceous duct junction. The cysts can be located in any skin region, mainly on the chest. The disease is usually benign and asymptomatic, but it can be exceptionally disfiguring, which is the main reason for a medical visit. Pachyonychia congenita type-2 and the eruptive vellus hair cyst are closely related to SM; therefore, histopathological confirmation is necessary before starting any treatment. Here, we present a case of a widespread SM in an adolescent boy, focusing on its clinical and histopathological characteristics.

Association Between Acne Vulgaris and Body Mass Index - A Cross Sectional Study in Tertiary Hospital of Western Nepal

INTRODUCTION Acne vulgaris is a chronic inflammatory disease of pilosebaceous duct mainly affecting adolescents. There is conflicting data regarding association between acne and body mass index (BMI). The main objective was to find the association between different grades of acne and BMI. MATERIAL AND METHODS We conducted a cross-sectional observational study involving 251 patients with acne vulgaris. Severity of acne vulgaris was assessed using simple grading system and WHO reference was used for classification of body mass index (BMI). Data was analyzed using SPSS, version 20. p value of less than 0.05 was considered statically significant. RESULTS The study included 149 females (59.4%) and 102 males (40.6%). Acne vulgaris is recorded in 47.8% in age group12-20 years, followed by 44.6% in age group 21-30 years and 7.6% in age group 31-40 years. Grade 2 acne vulgaris was the most common (47%), followed by grade 3 (24.7%), grade1 (16.7%), and grade 4 (11.6%). About 49.4% of acne vulgaris patient had normal BMI, 19.5% had obesity. There was no significant association between different grades of acne vulgaris and BMI (p=0.07). CONCLUSION There was no signficant association beween severetiy of acne and BMI.

Herbal Products for Acne Vulgaris: A Review

Acne is a prevalent skin condition that affects a considerable portion of the population, primarily teenagers and young adults. In most cases, it causes pimples on the face, neck, and upper back. A variety of red and flaky skin patches, as well as blackheads, whiteheads, nodules, and pustules, characterize this condition. Acne has a significant cutaneous and psychological illness burden, and its pathophysiology and current therapies are challenging. The severity of acne varies, and some people are more likely to get it because of their genes. Acne inflammation has been linked to the pus-forming bacteria Propionibacterium acnes (P. acne). In the past century, many treatment options have been available in the market that could be taken in oral or topical treatment options. Plant extracts that are useful in treating acne have recently gained popularity as a natural acne treatment alternative. This article aims to discover how antibacterial herbal medicines work against the things that cause acne vulgaris. Pathogenic reasons are high sebum production, pilosebaceous duct calcification, dysbiosis, and inflammation. As part of the treatment, synthetic drugs with significant side effects must be taken continuously throughout the year. Because of this, the safest, most effective medications are needed for therapy. Medications made from plant extracts, such as herbal ones, are a safe alternative to synthetic drugs. The herbal plants in this article are research-based, using active components of the plants that have anti-inflammatory, antibacterial properties and reduce sebum production to help treat or alleviate acne. Hence, herbal therapy aims to give people access to safe, effective, and cost- effective medicines. The current review summarizes different herbal products' roles in treating acne, where many databases were gathered and searched to find every medicinal plant with anti-acne action and provide effective treatment options for individuals who opt to consider herbal medication for acne

Serum Level of Follistatin in Patients with Scarring and non Scarring Acne Vulgaris

Acne vulgaris is a chronic cutaneous inflammatory disorder. Four factors play vital roles in acne pathophysiology: hyperseborrhea , altered keratinization of the pilosebaceous duct, propionobacterium acnes (p. acnes) and inflammation. to assess serum level of follistatin in patients with scarring and non scarring AV aiming at understanding the pathogenesis of post acne scars. serum FST level was assessed in 60 acne patients (30 non scarring patients - 30 scarring patients) and 20 apparently healthy subjects as control with matched age and sex. Every patient included in the study was subjected to detailed history taking, complete general and dermatological examination and assessment of serum level of FST by using commercial ELISA kits.AV, non scarring and scarring patients had significantly higher frequency with positive family history, sun exposure and excess stress when compared to control group (p value 0.010, 0.005 and <0.001 respectively. However , No significant differences were found in risk factors between acne groups. serum FST level was significantly lower in patients with acne than control group although its level was significantly lower in scarring acne patients than non scarring patients.

The Obsidian Impediment - Comedones

Comedones appear as blackheads and whiteheads and implicate cutaneous zones with dense sebaceous follicles, particularly the face, upper chest or dorsal torso. Acne vulgaris is frequently enunciated with comedones. Hyper-proliferation and aberrant desquamation of ductal keratinocytes is enunciated which impedes sebum exudation within a pilo-sebaceous duct, thus engendering comedones. Also, a prototypicpilo-sebaceous duct unit metamorphoses into a comedone when progenitor component of the sebaceous glands differentiate into epithelial-like cells.“Micro-comedone theory” cogitates acne configuration as “comedogenesis” which is contingent to androgen secretion, hyper-proliferating keratinocytes with accumulation of keratin and sebum within the pilo-sebaceous unit. Hyperkeratinisation is also due to secretion of pro-inflammatory cytokines interleukin -1 alpha (IL-1α) produced as a result of cutaneous colonization of Propionibacterium acnes.

The evolution of healthy skin to acne lesions: a longitudinal, in vivo evaluation with reflectance confocal microscopy and optical coherence tomography.

Comedogenesis is defined as the process of the development of a new comedo, which is of great importance for the understanding of acne. To evaluate the formation and evolution of acne lesions from clinically unaffected skin of patients with mild-moderate acne to characterize the morphological changes and natural resolution by means of in vivo reflectance confocal microscopy (RCM) and dynamic optical coherence tomography (D-OCT). Ten patients with mild-moderate acne, not assuming any topical or systemic therapy, comprised between 12 and 30 years of age, were recruited. A target area of 4 × 4 mm of the face, without acne lesions at baseline, was selected. A set of standardized clinical pictures, RCM and D-OCT images were acquired weekly for 6 weeks and evaluated. Seventy full sets of clinical, RCM and D-OCT images were analysed. The appearance of acne lesion is preceded by an increase of large bright follicles in the area corresponding to infundibular keratinization, followed by increment of inflammation parameter, such as increased of small bright cells upon RCM and vascular network upon D-OCT, which return to normal after the resolution of acute inflammation. Acne skin dynamics is complex and seems characterized by the early increase in the number of dysmorphic pilosebaceous units and the hyperkeratinization of the acroinfundibulum of the pilosebaceous duct prior to the occurrence of inflammatory events around the follicle. The processes of hyperkeratinization and inflammatory phenomena may generate a pathologic vicious cycle, which characterizes acne through progressive worsening and a self-sustainment mechanism.

From pathogenesis of acne vulgaris to anti-acne agents.

Acne vulgaris is a cutaneous chronic inflammatory disorder with complex pathogenesis. Four factors play vital roles in acne pathophysiology: hyperseborrhea and dysseborrhea, altered keratinization of the pilosebaceous duct, Cutibacterium acnes (C. acnes) and inflammation. The main hormones responsible for the development of acne vulgaris include androgens, insulin and insulin-like growth factor-1. Other factors involved in this process are corticotropin-releasing hormone, α-melanocyte-stimulating hormone and substance P. Wnt/β-catenin signaling pathway, phosphoinositide 3-kinase (PI3K)/Akt pathway, mitogen-activated protein kinase pathway, adenosine 5'-monophosphate-activated protein kinase pathway and nuclear factor kappa B pathway participate in the modulation of sebocyte, keratinocyte and inflammatory cell (e.g. lymphocytes, monocytes, macrophages, neutrophils) activity. Among all the triggers and pathways mentioned above, IGF-1-induced PI3K/Akt/Forkhead box protein O1/mammalian target of rapamycin (mTOR) C1 pathway is the most important signaling responsible for acne pathogenesis. Commonly used anti-acne agents include retinoids, benzoyl peroxide, antibiotics and hormonal agents (e.g. spironolactone, combination oral contraceptive and flutamide). New approaches including peroxisome proliferator-activated receptor γ modifier, melanocortin receptor antagonists, epigallocatechin-3-gallate, metformin, olumacostat glasaretil, stearoyl-CoA desaturase inhibitor omiganan pentahydrochloride, KDPT, afamelanotide, apremilast and biologics have been developed as promising treatments for acne vulgaris. Although these anti-acne agents have various pharmacological effects against the diverse pathogenesis of acne, all of them have a synergistic mode of action, the attenuation of Akt/mTORC1 signaling and enhancement of p53 signal transduction. In addition to drug therapy, diet with no hyperglycemic carbohydrates, no milk and dairy products is also beneficial for treatment of acne.

Assessment of Serum Level of lipocalin2 in Patients with Acne Vulgaris

Acne vulgaris(AV) is a chronic disease of the pilosebaceous unit which is most common during adolescence. Four factors are believed to play a key role in the development of acne lesions: excess sebum production, disturbed keratinization within the follicle, colonization of the pilosebaceous duct by Propionibacterium acnes,and the release of inflammatory mediators into the skin. Evaluation of serum levels of lipocalin2(LCN2) in acne vulgaris patients.Serum LCN2 concentrations were measured in 30 patients with AV and 30 healthy controls using enzyme-linked immunosorbent assay (ELISA).Serum levels of LCN2 in patients with AV were found to be higher than in healthy controls (p < 0.001). Increased serum LCN2 probably reflect the role of LCN2 in the pathogenesis of AV.

Elevated homeostatic model assessment of insulin resistance level increases the risk of acne

Insulin resistance and carbohydrate diets are currently considered to be influential in acne aetiology. Insulin is a hormone that does not only regulate the concentration of blood glucose but also affects the production of sebum and through the Insulin Growth Factor-1 (IGF-1) receptor stimulates androgen synthesis which will increase the proliferation of keratinocytes of the pilosebaceous duct and the production of sebum in acne. This is a cross sectional observational analytic study involving 38 acne patient and 38 non acne patients. This study aims to determine whether the increase in Homeostatic Model Assessment o f Insulin Resistance (HOMA-IR) value is a risk factor for acne. HOMA-IR formula was used to determine insulin activity in basal state. High HOMA-IR values ​​are expressed from cut-off point ≥2. Sampling by consecutive sampling that meets inclusion and exclusion criteria. Fasting insulin and glucose levels is derived from venous blood examination. The average age of acne subjects was 23.71 years (10 men and 28 women). The mean value of HOMA-IR in the acne group was higher (2.63 ± 0.29) than those in the non acne group (1.71 ± 0.26) and statistically significant (p value <0.001). The prevalence ratio was 31.58, meaning that patients with high HOMA-IR were 31.6 times more likely to have acne than patients with normal HOMA-IR values. These results were statistically significant with p value <0.001. The conclusion was elevated HOMA-IR is one of the factors that increase the risk of someone developing acne.

Bacteriological study of Acne Vulgaris in Cairo Egypt

Background: acne vulgaris is chronic inflammatory dermatosis of the pilosebaceous units which is characterized by open and/or closed comedones (blackheads and whiteheads) and inflammatory lesions including papules, pustules, or nodules, in some cases, is accompanied by scarring. Acne is multifactorial disease including increased sebum production, hypercornification of pilosebaceous duct, an abnormality of microbial flora especially colonization of the duct with propionibacterium acne and the production of inflammation. P.acne has been implicated in the pathogenesis of acne for more than 100 years. Objective: the present work was done to determine bacteria involved in acne vulgaris among Egyptian acne patients. Patients and Methods: this study was conducted on one hundred patients with inflammatory acne vulgaris recruited from the Dermatology outpatient clinic of Al-Hussien hospital. Results: in this study, S.epidermidis was higher in normal skin than in acne lesion. But P.acne was higher in acne lesion than in normal skin with significant statistical difference. There was a significant relation between type of organisms isolated and severity of acne lesions in both aerobic and anaerobic state. There was a significant relation between positive acne family history and liability for post acne scar. Even though there was no significant relation between hermonal therapy and severity of acne lesions. We noticed that the majority of female patients with POP history had moderate acne lesions. In this study, the high percentage of S.epidermidis was observed in moderate acne lesion and in normal skin in aeorobic state but high percentage of P.acne was found in moderate acne lesions in anaerobic state. However, P.acne can not be solely held responsible for the initiation of inflammation in inflamed acne lesions or for the variation in its severity. Conclusion: the high percentage of no growth result in this study directs us that the antibiotic treatments are not the most useful treatment for acne and there are other effective methods for treatment whether topical as retenoids or ablative as Lasers. Patient with family history of acne lesion especially first relative (mother) we must keep in mind that they are more susceptible for post acne scar so we should start with the perfect treatment as early as possible to prevent the post acne sequels.

Bacteriological study of Acne Vulgaris in Cairo Egypt

Background: acne vulgaris is chronic inflammatory dermatosis of the pilosebaceous units which is characterized by open and/or closed comedones (blackheads and whiteheads) and inflammatory lesions including papules, pustules, or nodules, in some cases, is accompanied by scarring. Acne is multifactorial disease including increased sebum production, hypercornification of pilosebaceous duct, an abnormality of microbial flora especially colonization of the duct with propionibacterium acne and the production of inflammation. P.acne has been implicated in the pathogenesis of acne for more than 100 years. Objective: the present work was done to determine bacteria involved in acne vulgaris among Egyptian acne patients. Patients and Methods: this study was conducted on one hundred patients with inflammatory acne vulgaris recruited from the Dermatology outpatient clinic of Al-Hussien hospital. Results: in this study, S.epidermidis was higher in normal skin than in acne lesion. But P.acne was higher in acne lesion than in normal skin with significant statistical difference. There was a significant relation between type of organisms isolated and severity of acne lesions in both aerobic and anaerobic state. There was a significant relation between positive acne family history and liability for post acne scar. Even though there was no significant relation between hermonal therapy and severity of acne lesions. We noticed that the majority of female patients with POP history had moderate acne lesions. In this study, the high percentage of S.epidermidis was observed in moderate acne lesion and in normal skin in aeorobic state but high percentage of P.acne was found in moderate acne lesions in anaerobic state. However, P.acne can not be solely held responsible for the initiation of inflammation in inflamed acne lesions or for the variation in its severity. Conclusion: the high percentage of no growth result in this study directs us that the antibiotic treatments are not the most useful treatment for acne and there are other effective methods for treatment whether topical as retenoids or ablative as Lasers. Patient with family history of acne lesion especially first relative (mother) we must keep in mind that they are more susceptible for post acne scar so we should start with the perfect treatment as early as possible to prevent the post acne sequels.

Steatocystoma Multiplex: Case Report and Review of Treatment

Steatocystoma multiplex, an uncommon autosomal dominant disorder, is characterized by numerous asymptomatic skin-colored cystic nodules. The leading hypothesis regarding the pathophysiology of this disease involves a defect at the pilosebaceous duct junction, which leads to cyst formation. Herein, we describe a case of a male patient that presented with steatocystoma multiplex. We examine the cosmetic outcomes of different techniques used in his treatment as well as review the varied therapeutic options available to such patients, including surgical removal, needle aspiration, cryotherapy, isotretinoin, and CO2 laser treatment.

Propionibacterium acnes and antimicrobial resistance in acne

The human commensal bacterium Propionibacterium acnes (P. acnes) resides in the pilosebaceous duct of the skin. It has been long implicated in the pathogenesis of acne, although its exact role in the development of inflammatory acne lesions and in the formation of the microcomedo in the early stages of acne remains controversial. The worldwide prevalence of antibiotic-resistant P. acnes is increasing, with rates varying in different parts of the world. The reason for the difference in the antibiotic resistance patterns of P. acnes among different countries is not clear, although it may be attributed to different antibiotic prescribing habits, concomitant use of topical agents (retinoids, benzoyl peroxide, or other antibiotics), varying methods of bacterial sampling, or even different P. acnes populations. Although the relative abundances of P. acnes may be similar among patients with acne and individuals without acne, P. acnes populations and the presence of P. acnes biofilms differ, with different potential virulence properties and antimicrobial resistance patterns. Implications of the use of antibiotics and of antimicrobial resistance in patients with acne include the decreased efficacy of antibiotic treatments for acne, and the possible emergence of other resistant bacterial species via selective pressure by antibiotic use.

Éruption de kystes épidermiques après application d’imiquimod topique

Imiquimod is a local immune-response modifier that works by stimulating innate and acquired immunity. It is frequently used to treat superficial basal cell carcinoma, the most common form of skin cancer. Marked local inflammatory reaction is common during treatment. We report a case of the rare condition, multiple eruptive milia, during topical imiquimod therapy. A 67-year-old male patient presented infiltrating basal cell carcinoma above the left eyebrow. The patient underwent surgery and skin grafting. He presented superficial relapse at the periphery of the graft and was initially treated with Aldara®. Fifteen days after initiation, Aldara® was withdrawn due to a critical inflammatory reaction. A few weeks after complete healing, an erythematous annular plaque of milia, excluding the graft zone, appeared. This element was confirmed by histopathology. The most common local side effects reported with Aldara® are erythema, irritation and crusting. Reports of eruptive milia following Aldara® therapy are rare and they are never mentioned in the summary of product characteristics. Application of imiquimod in fact induces local inflammatory reaction due to stimulation of local cytokines, which can result in marked reaction in the infundibular epithelium of hair follicles and thus in the production of abnormal keratin that can cause pilosebaceous duct obstruction and thus the formation of epidermoid cysts. This pathological mechanism explains the absence of lesions on the skin graft of the inner arm. The occurrence of eruptive milia during treatment with Aldara® is rarely described. The timing of occurrence of these eruptive milia as well as the mechanism of action of the drug made such a reaction highly probable in our patient.

Isolated extragenital lichen sclerosus et atrophicans in a middle-aged male: a case report

Lichen sclerosus et atrophicans (LSA) is an idiopathic inflammatory dermatosis. It mainly affects the anogenital area. Extragenital sites are affected rarely in isolation. It presents as ivory or porcelain-white, shiny, round macules or papules, coalescing to form sclerotic plaques with prominent dilated pilosebaceous or sweat duct orifices. Histopathology is indicated to differentiate it from previtiligo, morphea, and atrophic lichen planus. There is no known cure for LSA. Standard treatment modality includes topical corticosteroid and calcineurin inhibitors, such as tacrolimus. We report a case of a middle-aged man with isolated extragenital LSA.

What's new in the physiopathology of acne?

There are four central factors that contribute to acne physiopathology: the inflammatory response, colonization with Propionibacterium acnes, increased sebum production and hypercornification of the pilosebaceous duct. In addition, research in the areas of diet and nutrition, genetics and oxidative stress is also yielding some interesting insights into the development of acne. In this paper we review some of the most recent research and novel concepts revealed in this work, which has been published by researchers from diverse academic disciplines including dermatology, immunology, microbiology and endocrinology. We discuss the implications of their findings (particularly in terms of opportunities to develop new therapies), highlight interrelationships between these novel factors that could contribute to the pathology of acne, and indicate where gaps in our understanding still exist.

Understanding innate immunity and inflammation in acne: implications for management.

Acne has long been understood to have a complex physiological basis involving several main factors: hormonally-stimulated sebum production, abnormal keratinization of the pilosebaceous duct, and an inflammatory immune response to Propionibacterium acnes. Recent studies at the molecular and cellular level have begun clarifying how all of these factors interact, and the role of the innate immune system is better appreciated. Inflammation has been demonstrated in all acne lesions - the preclinical microcomedo, comedones, inflammatory lesions, 'post-inflammatory' erythema or hyperpigmentation, and scarring. Inflammation localized to the pilosebaceous unit can be considered the defining feature of acne and should be addressed via multiple therapeutic pathways. Clinicians tend to think oral antibiotics should be used to 'calm' inflammatory acne, but there is good evidence showing that topical retinoids also have anti-inflammatory properties as a class effect. For best therapeutic outcomes, most patients with acne should be treated first line with a topical retinoid plus an antimicrobial agent, as has been demonstrated in thousands of patients involved in clinical trials and recommended by the Global Alliance to Improve Outcomes in Acne for more than a decade. Moving away from reliance on antibiotic therapy for acne is particularly important in an era of worsening antimicrobial resistance and worldwide calls to reduce antibiotic use. Improved understanding about the role of P.acnes and the innate immune system in acne should help clinicians in designing efficacious treatment strategies.

From new findings in acne pathogenesis to new approaches in treatment.

Acne is a chronic disease of the pilosebaceous unit which is most common during adolescence. Four factors are believed to play a key role in the development of acne lesions: excess sebum production, disturbed keratinization within the follicle, colonization of the pilosebaceous duct by Propionibacterium acnes, and the release of inflammatory mediators into the skin. Consequently, in order to effectively and rapidly reduce acne lesions, treatments need to address as many of these underlying factors as possible. Currently, about half of patients have poor adherence to acne treatments. To overcome this limitation, treatments need to be developed which are well tolerated by patients, and easy for them to use, handle and apply. Topical monotherapies for acne such as retinoids and antimicrobials by themselves have a restricted range of actions against the pathogenic factors of acne. Instead, the Global Alliance to Improve Outcomes in Acne Group recommends combination therapy with a topical retinoid and an antimicrobial agent as the preferred approach for almost all acne patients. The principal advantage of such combinations is that they target more of the underlying pathogenic factors of acne than individual monotherapies and this results in faster and more complete clearing of acne lesions. Fixed-dose combinations are also more convenient than applying two medications separately, which leads to improved adherence with the regimen. By normalizing desquamation, the retinoid component of these combinations allows entry of the antimicrobial agent into the pilosebaceous unit resulting in faster clearance of P.acnes. In conclusion, topical retinoid/antimicrobial fixed-dose combinations represent a rational approach for the treatment of acne. They should be considered as the cornerstone of acne management and should be used much more in the future.

Vulval Swelling: A Diagnostic Dilemma.

Vulval swellings have always caused dilemmas in diagnosis and more so when they are huge in size. Sebaceous cysts are known to occur as a result of blocked pilo-sebaceous gland and duct or as a result of any injury to the skin. Face, neck, chest, back, scalp, and ears are known sites, however, they also occur over private parts. They are mostly asymptomatic but cause intense pain and discomfort if infected. Symptomatic cysts warrant removal.

Steatocystoma multiplex of face: A case report

Introduction: steatocystoma, an uncommon cutaneous disorder, initially thought to be a sebaceous or retention cyst is recognized as a hamartomatous malformation of the pilosebaceous duct junction characterized by the development of numerous sebum containing dermal cysts with sebaceous glands in the cyst walls. case report: A 70-year-old male patient presented with asymptomatic dark patches, bilaterally on malar region. surgical excision was done under local anesthesia. Histopathology conmfirmed steatocystoma. conclusion: steatocystoma is a cosmetic problem and a lifelong condition. steatocystoma multiplex should be considered as a spectrum with different variations in anatomical distribution which can be treated successfully.