Role In Pathogenesis Of Acne Research Articles

Challenges in Adult Acne and the Role of Skin Care in Managing the Condition.

Acne vulgaris is a complex, multifactorial, inflammatory skin condition. Although frequently presented at dermatology clinics, the literature on adult acne is scarce, particularly concerning skin barrier function and management. We aimed to provide insights into the role of skin barrier integrity in adult acne patients and the role of cleansers and moisturizers as adjunctive to treating and maintaining adult acne.   Methods: A panel of eight dermatologists who treat adult patients with acne developed a consensus paper on the role of skin barrier function and skin care in adult acne management. The modified Delphi method comprised a face-to-face meeting and online follow-up to discuss the results of a scoping literature review. Drawing from their experience and opinions, they agreed on seven consensus statements.   Results: Epidermal barrier dysfunction plays a vital role in acne pathogenesis and asymmetrically impacts adult female acne. Erythema, pruritus, peeling, and xerosis are common adverse effects of first-line acne treatment options and, if not appropriately counseled and managed, can exacerbate, leading to regimen nonadherence and poor patient experience and outcomes. Improving patient knowledge of comprehensive acne treatments, including quality adjunctive cleansers and moisturizers, may maximize regimen efficacy and provide patients with personalized and successful acne treatment and maintenance tools. J Drugs Dermatol. 2024;23(8):674-679.     doi:10.36849/JDD.8471.

The Microbiome and Acne: Perspectives for Treatment.

The skin microbiome consists of the microorganisms populating the human skin. Cutibacterium acnes (C.acnes, formerly named Propionibacterium acnes) is recognized as a key factor in acne development, regulating inflammatory and immune pathways. Dysbiosis has been described as the imbalance in skin microbiome homeostasis and may play a role in acne pathogenesis. Microbial interference has been shown to be a contributor to healthy skin homeostasis and staphylococcal strains may exclude acne-associated C.acnes phylotypes. In this review we present an update on the skin microbiome in acne and discuss how current acne treatments such as benzoyl peroxide, orally administered isotretinoin, and antibiotics may affect the skin microbiome homeostasis. We highlight the collateral damage of acne antibiotics on the skin microbiome, including the risk of antimicrobial resistance and the dysregulation of the microbiome equilibrium that may occur even with short-term antibiotic courses. Consequently, the interest is shifting towards new non-antibiotic pharmacological acne treatments. Orally administered spironolactone is an emerging off-label treatment for adult female patients and topical peroxisome proliferator-activated receptor gamma (PPARγ) modulation is being studied for patients with acne. The potential application of topical or oral probiotics, bacteriotherapy, and phage therapy for acne are further promising areas of future research.

A review on Yuvanpitika with special reference to Acne Vulgaris

Acne vulgaris is a chronic inflammatory condition of skin in youth. In Ayurveda, acne has been elaborated as one of the Kshudra Rogas (minor ailments). It is manifested in adolescence thus called as Yuvanpidika or Tarunyapitika. Symptoms of Mukhadushika show close resemblance with bacterial infection and inflammatory factors of acne. According to Ayurveda, vitiation of Kapha dosha, Vata dosha and Rakta dhatu lead to acne development. Kapha vitiation may resemble with excess sebum production, Vata vitiation may resemble with hyperkeratinization and Rakta vitiation may resemble with inflammatory mediators in blood, play an important role in pathogenesis of acne. Both modernand Ayurvedic sciences have considered the use of topica Dr. Rahul Ishwalal Desai l as well as oral medications and their combinations for the treatment of acne. Modern medications provide relief from acne vulgaris but causenoticeable side effects. In Ayurveda, acne has been treated mainly by Shodhana (purification of body) and Shamana (conservative treatment) Chikitsa or combination of both. Though, several Ayurveda texts such as Sushruta Samhita, Ashtanga Hrudaya etc., have elaborated the pathophysiology and treatment of acne, the available references are scattered. Thus, there is need of in-depth review and compilation of Ayurvedic texts and literatures. This review may be helpful in better understanding ofcomparative pathophysiology and management of acne vulgaris.

Probiotic supplement combined with topical therapy in the treatment of mild to moderate acne: results from an Italian single centre interventional study.

Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from different cofactors. The alteration of the skin microbiome has recently been revealed to play a role in acne pathogenesis. Concerns with side effects of available systemic treatment for acne resulted in a greater focus on topical therapies, such as topical azelaic acid which showed to be an effective and safe treatment option for acne. The aim of our study was to evaluate the efficacy of a new treatment protocol for acne based on an oral supplement composed of biotin and 3 strains of lactic ferments combined with a topical gel composed of azelaic acid, hydroxypinacolone retinoate, and α-hydroxy acids. An Italian single-center interventional study was performed enrolling patients suffering from mild-to-moderate-acne. Patients were treated with a supplement based on biotin and 3 strains of lactic ferments, combined with a topical gel product (azelaic-acid, hydroxypinacolone retinoate, and α-hydroxy acids). All enrolled patients were scheduled for a total of 2 visits, a baseline visit (V0) and a follow-up visit after 60 days of treatment (V1). A total of 30 patients were enrolled in the study. Between V0 (baseline) and V1 (60 days), there was a reduction of 37.4% in the GAGS Score, 40.7% in the SEBUTAPEtm Score, and 18% in the TEWL Score, and an increment of 44% in the T-Blue Test Score. No cases of serious AEs were reported in our experience. Our results confirmed the promising therapeutic role of a probiotic supplement associated with topical therapy in the treatment of mild to moderate acne.

A review article on Winlevi

<p class="abstract">Acne is a most common multiform skin condition. Androgen plays a major role in acne pathogenesis in both males and females. The appliance of anti-androgen is potentially effective. However, anti-androgens for topical application are not available in market. Clascoterone (cortexolone 17α propionate), an ester derivative of cortexolone is an androgen receptor inhibitor developed as a topical cream and solution for the treatment of androgen dependent skin disorders, including acne vulgaris. Although the mechanism of action of clascoterone (Winlevi) for topical treatment of acne vulgaris is not known. In 2020 clascoterone 1% has been first approved by United States of America (USA) for the topical therapy of acne vulgaris people aged 12 years or above. Assessment of acne is done based on overall severity of acne based on grades- grade 0, grade 1, grade 2, grade 3, and grade 4 (clear- severe). Both inflammatory on non-inflammatory lesions were counted. Treatment success is achieved when the grade or score is clear or almost clear. Clascoterone cream is well tolerated with no significant clinical safety issues. Clascoterone 1% twice daily treatment have the most effective favourable results with low adverse events. Currently first line treatment targeting aspects of acne includes benzyl peroxide topical or oral antibiotics, topical retinoid. Females with acne is treated with combined oral contraceptives (e. g. norgestimate and norethindrone are approved by FDA for treatment of acne in females) or spironolactone which affects androgens. Androgen receptors are present throughout the skin and found in sebaceous glands, dermal cells, and sebocytes. Androgen inhibiton is an effective way for treatment of acne in females.</p>

Evaluation of Total Oxidant and Total Antioxidant Status in Patients with Acne Vulgaris

Acne vulgaris is a common skin disease and has a complex pathogenesis. There is no enough data related with oxidative stress in acne vulgaris. We purposed to assess total oxidant and total antioxidant status in acne vulgaris. We included 32 acne patients and 35 healthy controls in this study. Global Acne Grading System (GAGS) scores were calculated. Serum total oxidant status (TOS) and total antioxidant status (TAS) levels were evaluated and oxidative stress index (OSI) was calculated by proportion of the TOS to the TAS. Mean GAGS scores of acne patients were 14.08 ± 5.72. Mean disease duration of acne patients was 33.97 ± 25.99 months. TAS, TOS and OSI were significantly higher in acne patients (p=0.010, p=0.021, p=0.015, respectively). TAS, TOS and OSI were not correlated with disease duration and GAGS scores (p>0.05). Both oxidant and antioxidant status increased in acne patients. The study showed that oxidative stress may play a role in pathogenesis of acne but it isn’t exactly known that is a cause or a result of acne. Advanced studies especially comparing mild to moderate and severe acne patients are required. In addition we consider that antioxidant agents may be beneficial in the treatment of acne.

Serum Soluble Intercellular Adhesion Molecule-1 (sICAM-1): A Novel Potential Biomarker in Severe Acne Vulgaris.

Acne vulgaris (AV) is a chronic inflammatory disorder. Intercellular adhesion molecule-1 (ICAM-1) is a vital adhesion molecule mediating cellular adhesion during the inflammatory process. To evaluate serum soluble intercellular adhesion molecule-1 (sICAM-1) level in AV patients as an attempt to elucidate its role in acne pathogenesis and to relate with studied clinical parameters. Serum sICAM-1 level was measured using ELISA technique in 60 patients and 60 controls. Serum sICAM-1 level was significantly elevated in studied patients than controls (P < 0.001). Additionally, its level increased significantly with increased acne severity (P < 0.001) but not in patients with post acne scars (P > 0.05). Serum sICAM-1 could be a marker for acne etiopathogenesis. Furthermore, it might be considered as a predictor for disease severity.

Skin Microbiota Content in Children and its Effect on Acne Pathogenesis

Acne is a common chronic inflammatory skin disease in adolescence. The involvement of cosmetically important zones inevitably leads to decrease in our patients' quality of life. This review considers modern methods of skin microbiota analysis, describes the microorganisms' composition in newborns and its changes during growing-up. Cutibacterium acnes (that dominates in the microbiota of skin areas with sebaceous glands) role in acne pathogenesis is described.

Consistency changes of potential lipid markers in acne patients of different ages and their role in acne pathogenesis.

With the development of studies on skin lipid profile changes in acne patients, changes of skin surface lipidome are considered to be another important factor in acne pathogenesis. However, the studies of skin surface lipidome in acne patients of different ages have not been precisely discussed. The mechanism of potential lipid markers in acne patients with different ages was further discussed. On the basis of our previous studies, the changes of skin surface lipidome in acne patients of different ages were analyzed by comprehensive statistics. By counting the skin lipid markers of acne patients of different ages, it is found that seven lipid indexes are dominant in acne patients and play a vital role in the pathogenesis of acne. The analysis found that there was potential consistency in the changes of skin surface lipidome in acne patients of different ages. Moreover, the main lipid markers play an important role in the pathogenesis of acne.

NEW INSIGHTS INTO SKIN MICROBIOTA IN ACNE PATHOPHYSIOLOGY

The role of skin microbiota in acne remains to be fully elucidated. The emotions of stress (e.g., depression and anxiety), for instance, have been hypothesized to aggravate acne by altering the gut microbiota and increasing intestinal permeability, potentially contributing to skin inflammation. It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients. Acne also has close connections with the gastrointestinal tract, and many argue that the gut microbiota could be involved in the pathogenic process of acne. Diet also shapes the gut microbiota. Emerging data suggest that dietary factors (i.e., the Western diet) may influence acne development. Growing evidence indicates that probiotics modify the pathophysiologic factors that contribute to acne, potentially improving patient compliance. Probiotics also have immunomodulatory properties on keratinocytes and epithelial cells. Taken together, the findings suggest that the microbiota plays an important role in acne pathogenesis and can be modulated for clinical improvement, but efforts should be made to identify the exact mechanisms and therapeutic effects of oral/topical probiotics in acne. This presentation concentrates on the skin and gut microbes in acne, the role that the gut–brain– skin axis plays in the immunobiology of acne, and newly emerging microbiomebased therapies that can be applied to treat acne. With the help of Deniplant brand natural remedies, the authors have developed several products for acne that act as immunomodulators of the human microbiome.

Associations between diet and acne lesions.

Acne is one of the most common dermatological conditions affecting millions of people worldwide. It is assumed that the main etiological factors acne are considered to be the excessive production of sebum and hormones, and the colonisation of P. acnes bacteria. The relationship between diet and acne lesions is still the subject of debate and scientific criticism. On the one hand, studies suggest that an elimination diet is of no benefit in the treatment of acne, while other studies indicate that there is a close a close relationship between diet and the occurrence of acne lesions. Already in the 1970s, some scientists claimed that the course of acne could be modified by specific dietary components. Several studies have confirmed, among others, the role of a diet with a high glycemic index diet in acne exacerbation and suggested that a low glycemic index diet for several weeks may lead to a reduction in the number of acne lesions. The effect of milk consumption was also investigated in terms for its potential role in acne pathogenesis, including its ability to increase insulin levels. In the last decade, studies have also emerged to determine the effect of dark chocolate on the exacerbation of acne symptoms. To date, it has not been conclusively established which component of chocolate may have a potentially adverse effects on the course of acne. The article summaries the current knowledge on the relationship between diet and acne lesions, and discusses the results of recent studies on selected dietary components that may exacerbate acne.

Evaluation of perilipin 2 and melanocortin 5 receptor serum levels with sebogenesis in acne vulgaris patients

Acne vulgaris is a multifactorial disease. One of the main factors that plays a role in acne pathogenesis is an increase in sebum secretion. For sebum secretion, sebocyte differentiation followed by sebogenesis is essential. Sebocyte differentiation and proliferation, and sebum synthesis are controlled by complex pathways. Studies have shown that perilipin 2 and melanocortin 5 receptors play a role in sebogenesis. This study sought to determine whether levels of perilipin 2 and melanocortin 5 receptors have an impact on the development of acne vulgaris. A total of 65 patients diagnosed with acne and 43 healthy control subjects were included in the study. Perilipin 2 and melanocortin 5 receptor levels were analyzed using the enzyme-linked immunosorbent assay (ELISA) technique. No significant differences were observed between the acne group and the control group in serum perilipin 2 (p = 0.594) and melanocortin 5 receptor (p = 0.213) levels. In the moderate acne group, perilipin 2 and melanocortin 5 receptor levels were significantly higher than in the mild acne group (p = 0.0014, p = 0.003). The levels in the severe acne group were not higher compared to the moderate and mild acne groups. This study failed to detect any association between acne pathogenesis and perilipin 2 and melanocortin 5 receptor serum levels. However, these proteins may have an influence on acne severity.

A COMPARATIVE STUDY OF SHALMALYADILEPA AND GUDUCHYADIVATI IN THE MANAGEMENT OF YAUVANAPIDIKA W.S.R.TO ACNE VULGARIS – A RESEARCH ARTICLE

Acne vulgaris is a chronic inflammatory condition of skin in youth. In Ayurveda, acne has been elaborated as one of the KshudraRogas (minor ailments). It is manifested in adolescence thus called as Yuvanpidika or Tarunyapitika. Symptoms of Mukhadushika show close resemblance with bacterial infection and inflam-matory factors of acne. According to Ayurveda, vitiation of Kaphadosha, VataDosha and RaktaDhatu lead to acne development. Kapha vitiation may resemble with excess sebum production, Vata vitiation may re-semble with hyperkeratinization and Rakta vitiation may resemble with inflammatory mediators in blood, play an important role in pathogenesis of acne. Both modern and Ayurvedic sciences have considered the use of topical as well as oral medications and their combinations for the treatment of acne. Modern medi-cations provide relief from acne vulgaris but cause noticeable side effects. In this study, 50 patients with symptoms of Yauvanapidika were treated in two groups. In Group A, patients were given local application of Shalmalyadilepa twice a day with milk, while in Group B patients were given 2 gm of Guduchyadivati thrice along with local application of Shalmalyadilepa. At the end of treatment, Group B showed better im-provement in comparison to Group A.

Bacterial identification of acne vulgaris

Background:Â Acne vulgaris (AV) is a chronic inflammation of the pilosebaceous unit with clinical polymorphic lesion consist of non-inflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, and nodules) with varying degree of inflammation and depth. Earlier studies showed that other bacteria might also found and played a role in acne pathogenesis besides Cutibacterium acnes (C. acnes).Patients and Methods:Â This descriptive observational study used cross-sectional method. Samples were collected from 40 subjects with AV. We took the samples from non-inflammatory (closed comedones) and inflammatory lesions (pustule) in each subject, followed by Gram staining, aerobic and anaerobic bacterial culture, and bacterial identification. This research has been approved by the Ethical Committee, Faculty of Medicine, University of Sumatera Utara.Results:Â There were 12 bacterial species that were identified from 80 samples. We identified Cutibacterium acnes (21,2%) in anaerobic culture. While in aerobic culture, we identified Staphylococcus epidermidis (47,5%), Staphylococcus hominis (17,5%), Staphylococcus aureus (8,7%), Staphylococcus haemolyticus (8,7%), Leuconostoc mesentroides (6,2%), Micrococcus luteus (3,7%), Kocuria varians (2,5%), Staphylococcus vitulinus (1,2%), Staphylococcus cohnii (1,2%), Staphylococcus arlettae (1,2%) and Dermacoccus nishinomyaensis (1,2%).Conclusion:Â The two most common bacteria in acne vulgaris are Staphylococcus epidermidis and Cutibacterium acnes

Serum Survivin Level as A Novel Biomarker in Acne Vulgaris Patients

Background: Acne vulgaris is a common skin disease characterized by sebum overproduction, which is hormonally mediated, follicular hyper-keratinization and chronic inflammation of the pilosebaceous unit. Survivin is a member of inhibitors of the apoptosis (IAP) gene family. It is a 16.5 kDa protein that inhibits apoptosis and regulates cell division, proliferation, and survival. Objective: To determine the survivin level in acne vulgaris patients and detect the relation of its levels with acne severity and presence of acne scarring. Patients and Methods: Forty acne vulgaris patients were included in this case control study along with forty age and sex matched healthy controls. The patients were recruited from Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University Hospitals in the period from October 2017 to May 2018. Results: Results showed that there were statistical significant difference in survivin level among the three groups showing highest levels in scar group followed by active acne group then control group (P < 0.001). These findings support that there is a relationship between survivin and developing acne and acne scars. Moreover we found that there was statistical significant increase in survivin level among cases of active acne with progressive course compared to stationary cases (P=0.001). There was also statistical significant positive relation between survivin level and acne severity. Conclusion: The findings of this study showed a significant association between survivin level and both active acne and acne scars, in addition to positive relation between survivin level and severity of acne. All these findings prove that survivin protein has a potential important role in acne pathogenesis and mechanism of acne scarring.

Serum Survivin Level as A Novel Biomarker in Acne Vulgaris Patients

Background: Acne vulgaris is a common skin disease characterized by sebum overproduction, which is hormonally mediated, follicular hyper-keratinization and chronic inflammation of the pilosebaceous unit. Survivin is a member of inhibitors of the apoptosis (IAP) gene family. It is a 16.5 kDa protein that inhibits apoptosis and regulates cell division, proliferation, and survival. Objective: To determine the survivin level in acne vulgaris patients and detect the relation of its levels with acne severity and presence of acne scarring. Patients and Methods: Forty acne vulgaris patients were included in this case control study along with forty age and sex matched healthy controls. The patients were recruited from Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University Hospitals in the period from October 2017 to May 2018. Results: Results showed that there were statistical significant difference in survivin level among the three groups showing highest levels in scar group followed by active acne group then control group (P < 0.001). These findings support that there is a relationship between survivin and developing acne and acne scars. Moreover we found that there was statistical significant increase in survivin level among cases of active acne with progressive course compared to stationary cases (P=0.001). There was also statistical significant positive relation between survivin level and acne severity. Conclusion: The findings of this study showed a significant association between survivin level and both active acne and acne scars, in addition to positive relation between survivin level and severity of acne. All these findings prove that survivin protein has a potential important role in acne pathogenesis and mechanism of acne scarring.

Role of KLF2: New insight in inflammatory acne pathogenesis.

Acne is an inflammatory skin condition of pilosebaceous unit. Its pathogenesis is multifactorial with a central role of inflammatory and pro-inflammatory cytokines mediators. Downregulated Kruppel-like factor 2 (KLF2) leads to rapid secretion of many cytokines that are involved in acne pathogenesis. This study aimed at evaluating the level of KLF2 mRNA, clarifying its role in acne pathogenesis and its relation to acne lesion type, degree of severity, and outcome. The level of KLF2 mRNA was measured in 100 patients with acne and 50 age- and sex-matched healthy controls by using quantitative real-time polymerase chain reaction (qRT-PCR). The value of KLF2 mRNA was lower in acne patients than control group (P<.001), being lowest in inflammatory acne group (grades III, IV, and V) than noninflammatory acne group (grades I and II) and highest in the control group (P<.001). KLF2 mRNA was decreased significantly with increased acne severity grade (P<.001). KLF2 mRNA was lower in cases healed by scars than those healed by postinflammatory hyperpigmentation. Decreased serum level of KLF2 is not only a claimed for AV pathogenesis but also a predictor for degree of acne severity and outcome.

8-hydroxy-2-deoxyguanosine as a new biomarker of oxidative stress in patients with acne vulgaris

Objectives To evaluate the serum level of 8-hydroxy-2-deoxyguanosine (8-OHdG) in patients with acne vulgaris and also to detect relation between serum level of 8-OHdG and acne vulgaris severity. Background Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles, characterized mainly by comedones. The precise mechanisms of acne are not known. Oxidative stress within the pilosebaceous unit are considered an important initiating step in the pathogenesis of acne. 8-OHdG is considered to be one of the main biomarkers of oxidative stress. Patients and methods This cross-sectional study was carried out on 75 patients with mild, moderate, and severe acne vulgaris, along with 15 age-matched and sex-matched healthy individuals. Acne severity was assessed by using the global acne score. Blood samples were taken for measuring serum 8-OHdG levels in patients and controls by using commercial enzyme-linked immunosorbent assay kit. Results The serum levels of 8-OHdG were significantly higher in patients with acne vulgaris when compared with healthy individuals (P = 0.005). A strong positive correlation between serum levels of 8-OHdG and acne severity was found (P Conclusion Oxidative stress has an important role in acne pathogenesis represented by elevated 8-OHdG levels.

Vanin-1 Gene Expression in Acne Vulgaris and its Correlation with Disease Severity

Background: Acne vulgaris is the most prevalent chronic disease worldwide, occurs during adolescence. The pathogenesis is multifactorial with different grades of severity and the human vanin gene family especially vanin-1 might play a role in pathogenesis of acne. Aim: explore the role of Vanin-1 in acne vulgaris and its correlation with disease severity, duration, weight and residency. Patient and method: 42 acne patients and 42 age and sex matched healthy controls were enrolled. Skin biopsies were taken from the patient and normal skin of controls. Vanin-1 gene expression was estimated by real time PCR. Results: Expression of Vanin-1 gene in acne patients was significantly higher than healthy controls (p-value<0.001), also, there are positive correlation between VNN1 gene expression and patients weight and acne duration (P<0.001), also VNN1 gene expression is significantly higher among urban as compared with rural patients. Conclusion: VNN-1 gene expression is significantly higher in acne patients than healthy controls indicating thatVanin-1 gene involved in pathogenesis of acne vulgaris. In dermatological diseases; Vanin-1 might be a new promising target for therapeutic intervention in acne vulgaris.

Eligibility Criteria Related to Hormone Therapy in Acne Clinical Trials: A Systematic Review

Hormones play a complex role in acne pathogenesis and treatment. Androgens typically increase the size and secretion of sebaceous glands, worsening acne, whereas estrogen counters androgen effect by direct local opposition, inhibition of androgen production, and gene regulation (Barros and Thiboutot, 2017; Beinenfeld et al., 2019). Despite multiple guidelines on acne management, there is a paucity of high-quality data on the treatment of acne among patients receiving hormone therapy (Beinenfeld et al., 2019; Del Rosso et al., 2015; Zaenglein et al., 2016).