Severe Acne Vulgaris Research Articles

Isotretinoin-Induced Thrombocytosis

We report a case of thrombocytosis possibly associated with isotretinoin . The patient was a 19-year-old female who had severe acne vulgaris for 5 years. Systemic oral isotretinoin treatment was used daily at a dose of 0.5 mg/kg. All of the laboratory parameters were within normal limits, and the platelet count was 282,000 /μ L at the beginning of the treatment (reference range: 150,000 - 400,000 /μ L). In the following months, thrombocytosis (630,000 /μ L) was found, and the treatment was ended. The platelet count was in the normal range (343,000 /μ L) in the next monthly visit. The patient had no other illnesses or medications. The exact mechanism by which isotretinoin caused thrombocytosis in this patient is not clearly understood. To our knowledge, this case is the second case of isotretinoin -associated thrombocytosis. Clinicians who are prescribing isotretinoin should be aware of thrombocytosis, and a complete blood cell count with platelets should be part of the monthly monitoring routine in all patients receiving isotretinoin therapy. doi: http://dx.doi.org/ 10.14740 / jh140e J Hematol. 2014;3(2):61-62

Safety and efficacy of tazarotene foam for the treatment of acne vulgaris

BackgroundTazarotene foam is the first topical retinoid foam approved for the treatment of acne vulgaris.ObjectiveTo review the safety and efficacy studies of tazarotene foam in the treatment of moderate to severe acne.MethodsFive Phase I safety studies in normal controls are reviewed and two Phase III safety and efficacy studies in patients with moderate to severe acne are reviewed.ConclusionTazarotene foam, 0.1% was effective in the treatment of moderate to severe acne vulgaris with an acceptable tolerability profile. This treatment provides a cosmetically favorable alternative for topical retinoid therapy.

Azithromycin Versus Co-trimoxazole in The Treatment of Doxycycline Resistant Acne Vulgaris In Iraqi Patients

Background: Acne is a multifactorial disease with multiple pathogenic factors. Many types of therapies are available including systemic antibiotics , choosing the appropriate one depend on the experience of the doctor , side effects , antimicrobial resistance , availability and cost. Although doxycycline is effective and commonly prescribed as first line systemic treatment for moderate to severe inflammatory acne vulgaris , some cases do not respond because of antimicrobial resistance.
 Objective: To evaluate and compare the effectiveness and safety of azithromycin and co-trimoxazole in the treatment of acne vulgaris cases that are resistant to doxycycline in Iraqi patients.
 Patients and methods: A randomized clinical trial was carried out at the Department of Dermatology and Venereology of Baghdad Teaching hospital between April 2009 and October 2010. A total of 50 patients with doxycycline resistant moderate to severe papulopustular acne vulgaris were divided to two equal groups to receive either azithromycin or co-trimoxazole. Both groups received treatment for 2 months . in the first group azithromycin 250 mg was prescribed daily for 1 months and everyother day for the second month. The second group received co-trimoxazole 960 mg twice daily for 2 months. The clinical assessment was done by counting the number of inflammatory lesions at 3 occasions : baseline ,after 1 month and after 2 months . Patients also seen after 2 months of cessation of therapy to asses the relapse rate.
 Results: After 2 months both groups show statistically significant difference from the base line in reducing the number of inflammatory lesions and improving acne but azithromycin was superior to co-tomoxazole.
 Conclusion: This study showed that both azithromycin and co-trimoxazole are effective and safe alternative drugs in the treatment of doxycycline resistant acne vulgaris . But Azithromycin is more effective with less relapse rate and better compliance, but it is more costy than co-trimoxazole . Co-trimoxazole is safe and good alternative option in treating doxycycline resistant acne vulgaris.

Treatment with adapalene-benzoyl peroxide improve quality of life in patients with severe acne vulgaris

Treatment with adapalene-benzoyl peroxide improve quality of life in patients with severe acne vulgaris

İSOTRETİNOİN TEDAVİSİNİN NÖTROFİL/LENFOSİT ORANI VE DİĞER HEMOGRAM PARAMETRELERİNE ETKİSİNİN DEĞERLENDİRİLMESİ

Aim: There are reports of various side effects of isotretinoin. Recent studies have controversial results about the necessity of laboratory investigation including hemogram and blood chemistry of patients during the follow up periodon isotretinoin.We aimed to investigate the effects of isotretinoin on Neutrophil/lymhocyte ratio (NLR) a systemic inflammation marker and the other hemogram parameters. Material and methods: Sixty seven patients with moderate to severe acne vulgaris aged between 18 to 25, who were prescribed 0.5mg/kg isotretinoin, were included to the study. Patients’ hemogram parameters before treatment and at the third month of treatment were recorded on SPSS 20.0 programme retrospectively. The difference between two values <0.05 was considered as statistically significant. Results: There were 37 female and 30 male patients, with a mean age of 21.12±3.54 years. There were no differences between the two groups by means of white blood count, neutrophil, lymphocyte counts and NLR. Among the other parameters, there was a statistically significant increase in monocyte count whereas basophil, eosinophil, platelet counts and hematocrit values revealed no differences. Red blood cells, hemoglobin, mean corpuscular volume and plateletocrit values revealed a statistically significant decrease (p<0.01). Conclusion: Isotretinoin, which is used as a miracle drug and favorable treatment of acne, may cause changes in hemogram parameters. It may lead to decreased hemoglobin values and increase of monocyte count during treatment. Patients with prominent iron deficiency may require close monitorization. Besides the unchanged NLR values may support no inflammatory reactions occur during muticentered studies, evaluating these parameters with larger sample sizes are required. isotretinoin treatment. Obviously

Effectiveness of photodynamic therapy with topical 5‐aminolevulinic acid and intense pulsed light in Chinese acne vulgaris patients

The success rates of conventional treatments to acne vulgaris are limited because of intolerance and resistance. Photodynamic therapy with topical 5-aminolevulinic acid (ALA) and red light has been introduced. However, the side effects especially pigmentation are common. To study the efficacy and safety of ALA-photodynamic therapy (PDT) with 420-950 nm intense pulsed light (IPL) in Chinese patients with acne vulgaris. Forty-one patients with moderate to severe facial acne were randomly assigned to ALA-IPL-PDT group and IPL group. Ten percent topical ALA was applied to patients in the ALA-IPL-PDT group, while placebos were applied to patients in the IPL group. After 1 h occlusion, all patients were illuminated with 420-950 nm IPL. The patients in both groups had four treatment sessions with 1-week intervals. One week after each treatment and 4, 8, and 12 weeks after four sessions, acne lesion counts and adverse events were observed. Twelve weeks after treatments, mean reductions of global lesion counts of ALA-IPL-PDT group and IPL group were 75.2% and 51.0%, respectively. Mean reductions of inflammatory and non-inflammatory lesion counts in ALA-IPL-PDT group were (83.6 ± 4.1)% and (57.5 ± 6.8)%, respectively. No severe adverse events were observed. ALA-IPL-PDT is an effective treatment for moderate to severe acne vulgaris, and side effects are mild and reversible.

The Immunogenetic Analysis of Acne Vulgaris

Polymorphisms that occur in the CYP1A1, CYP17 and TNF-α genes affects hyperkeratinzation process, se-bum production and inflammation in acne vulgaris. Polymorphisms of CYP1A1, CYP17 and TNF-α genes can be identified by using PCR and sequencing techniques. The aim of this study is to demonstrate the role of polymorphisms of CYP1A1, CYP17, and TNF-α genes and the interaction polimorphisms of CYP1A1, CYP17 and TNF-α genes to severe acne vulgaris. This study was conducted as an observational study with case-control method, in 64 patients with severe acne, and as controls 73 patients with mild acne and healthy people. Criteria based on Combined Acne Severity Classification. Biospesimen blood 1 ml taken from vena mediana cubiti then performed PCR and sequencing to determine the sequence of nucleotides in DNA fragments. The conclution from the study shows that polymorphisms of CYP1A1, CYP17, TNF-α genes and the interaction polimorphisms of CYP1A1, CYP 17 and TNF-α genes is not a risk factor for severe acne vulgaris, but polymorphism of CYP1A1 gene is a risk factor for acne vulgaris.

An 8-Year-Old Boy with a Linear Lesion on the Nose

CME EDUCATIONAL OBJECTIVES1.Recognize the transverse nasal crease and its association.2.Identify treatment options for milia in the nasal crease.3.Identify cutaneous findings associated with atopy in children. An 8-year-old male presented for evaluation of a lesion across his nasal bridge. This had been worsening and getting more prominent over the last 6 months. He frequently rubbed his nose with the palm of his hand due to rhinitis. His medical history was significant for asthma, allergic rhinitis, conjunctivitis, and resolved peanut allergy. He lived with his parents and was the youngest of five children. The boy's family history was significant for atopy in parents, and a sister with anaphylaxis to tree nuts. There was no family history of severe or scarring acne vulgaris. Review of systems was normal.

The activity of adenosine deaminase and oxidative stress biomarkers in scraping samples of acne lesions

Acne vulgaris is one of the most common dermatological diseases, and its pathogenesis is multifactorial. Although there are some reports about role of oxidative stress biomarkers in blood, serum, plasma in the pathogenesis of acne, there has been no report about oxidative stress biomarkers in scraping samples. For this reason, the aim of our study is to determine the role of oxidative stress biomarkers and adenosine deaminase (ADA) in scraping samples of acne lesion and to determine a possible link with the clinical severity. Fifty patients with different severity of acne vulgaris and forty healthy controls were enrolled. In both groups, ADA and oxidative stress biomarkers such as the levels of malondialdehyde (MDA), and reduced glutathione (GSH), the activities of superoxide dismutase (SOD) and catalase (CAT) in scraping samples were measured spectrophotometrically. The levels of SOD, CAT, GSH, MDA, and ADA of patients with acne were higher than the control patients (P < 0.05). ADA and MDA levels in patients with severe acne were significantly higher about two- to four-fold compared with other acne groups (P < 0.05). However, CAT, SOD, and GSH levels were lower in patients with severe acne vulgaris than the others (P < 0.05). Increased antioxidant enzyme levels of scraping samples in patients might be a local response of the organism to increased oxidative stress. Also, we believe that oxidative stress increases in parallel with the disease severity, hence antioxidant therapy may be beneficial if given in addition to the routine treatment of severe acne.

Aqueous Extract of Dried Fruit of Berberis vulgaris L. in Acne vulgaris, a Clinical Trial

ABSTRACTBerberis vulgaris L. (barberry) is a very well-known herb in traditional medicine. Apart from its anti-inflammatory and antibacterial properties, the antilipogenic effect of barberry on the sebaceous glands in animals may further suggest it could be employed as an anti-acne agent. This study examined the effect of oral aqueous extract of barberry on acne vulgaris. Adolescents aged 12–17 years with moderate to severe acne vulgaris were randomly given oral gelatin capsules containing either aqueous extract of dried barberry (600 mg daily for 4 weeks, n = 25) or placebo (n = 24). Counts of facial noninflamed, inflamed, and total acne lesions, as well as the Michaelson's acne severity score were documented at baseline and at weeks 2 and 4. Both groups were comparable in terms of the patients’ characteristics and baseline variables. After 4 weeks, the mean number of noninflamed, inflamed, and total lesions as well as mean Michaelson's acne severity score declined significantly by 43.25 ± 10.88% (median: 42.11%), 44.53 ± 11.78% (median: 45.45%), 44.64 ± 8.46% (median: 46.15%), and 44.38 ± 8.25% (median: 44.07%), respectively, among the extract receivers (p <.001 for all the changes). Similar changes were not significant in the placebo group. No notable complication or side effect was reported in relation to barberry. In conclusion, oral aqueous extract of dried barberry is a safe, well-tolerated, and effective choice in teenagers with moderate to severe acne vulgaris.

Prospective Study of Topical 5-Aminolevulinic Acid Photodynamic Therapy for the Treatment of Moderate to Severe Acne Vulgaris in Chinese Patients

Topical photodynamic therapy (PDT) mediated with 5-aminolevulinic acid (ALA) offers an alternative option for the treatment of acne vulgaris. To study the effects of ALA dose, incubation time, and lesion type on protoporphyrin IX (PpIX) production and treatment outcomes. To examine the time course of PpIX production, 10% ALA was applied to inflammatory papules for 1 to 5 hours and followed by in situ fluorescence examination. To determine the effects of ALA dose and lesion type, 3, 5, and 10% ALA was applied to acne lesions in split-face fashion for 3 hours followed by whole-face light irradiation at 633 nm and 30 to 70 J/cm2. Treatment was repeated twice at 2-week intervals. PpIX reached a stable level after 3 hours of incubation. Similar PpIX levels were seen in areas receiving 3, 5, and 10% ALA. Poisson regression analyses indicated that lesion counts decreased by 0.791 times for a one-unit increase in treatment times (95% CI 0.782-0.799 < .0001) but only by 0.999 times for a one-unit increase in ALA dose (95% CI 0.998-1.000 = .22). The combination of low-dose ALA and a red light is a safe and effective option for the treatment of moderate to severe acne.

Inflammatory bowel disease and isotretinoin: An overlooked potential side effect?

Here, we describe two cases of inflammatory bowel disease in two young female patients, after treatment with oral isotretinoin for severe acne vulgaris and hidradenitis suppurativa, respectively. IBD may potentially be a serious side effect to oral isotretinoin in dermatology practice.

Homocysteine, folic acid and vitamin B12 levels in females with severe acne vulgaris

Article Homocysteine, folic acid and vitamin B12 levels in females with severe acne vulgaris was published on November 1, 2012 in the journal Clinical Chemistry and Laboratory Medicine (CCLM) (volume 50, issue 11).

Use of intense pulse light for acne vulgaris in Indian skin – a case series

Intense pulse light (IPL) has become extremely popular in Indian cosmetology circles. Yet, literature is silent on its effect in heavily melanized skin. A descriptive study to gauge the effect of IPL on acne vulgaris in Indian patients done in a tertiary care center in south India. Patients with moderate to severe acne vulgaris were given a maximum of five sittings of IPL treatment. Lesion counts were performed and photographs compared before and after treatment. IPL was offered to 10 patients with acne vulgaris. Two patients dropped out, seven patients had a good response after a mean of 3.4 sittings; 87.5% patients expressed satisfaction with the procedure. No adverse effects were noted. IPL serves a useful role in the treatment of acne vulgaris and could reduce treatment costs and pill burden. There is no increased risk of side effects with IPL on Indian skin with standard care.

Combination of adapalene-benzoyl peroxide and oral doxycycline is efficacious in short-term therapy: Maintenance with adapalene-benzoyl peroxide prevents relapse in treatment of severe acne vulgaris

Combination of adapalene-benzoyl peroxide and oral doxycycline is efficacious in short-term therapy: Maintenance with adapalene-benzoyl peroxide prevents relapse in treatment of severe acne vulgaris

A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuously improves efficacy among patients with severe acne vulgaris: results of a randomized controlled trial

A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuously improves efficacy among patients with severe acne vulgaris: results of a randomized controlled trial

Combination therapy with adapalene–benzoyl peroxide and oral lymecycline in the treatment of moderate to severe acne vulgaris: a multicentre, randomized, double-blind controlled study

Combination therapy with adapalene–benzoyl peroxide and oral lymecycline in the treatment of moderate to severe acne vulgaris: a multicentre, randomized, double-blind controlled study

Use of Fractionated Microneedle Radiofrequency for the Treatment of Inflammatory Acne Vulgaris in 18 Korean Patients

Nonablative radiofrequency (RF) devices have been shown to be clinically effective for the treatment of moderate to severe acne lesions. To evaluate the efficacy and safety of a fractionated microneedle RF device in the treatment of inflammatory acne vulgaris. Eighteen patients (15 male, 3 female; mean age 27, range: 19-33; Fitzpatrick skin type IV) with moderate to severe acne vulgaris who were treated with two sessions of fractionated microneedle RF at 1-month intervals were enrolled in this study. Evaluation of improvement, which took into account number of inflammatory acne lesions, showed that two of the 18 patients had grade 4 clinical improvement, eight had grade 3 improvement, and six had grade 2 improvement. Improvement scores in terms of lesion severity were also evaluated. One of the 18 patients had grade 4 clinical improvement, eight grade 3, and seven grade 2. No patient had worsening of inflammatory acne lesions. Fractionated microneedle RF can have a positive therapeutic effect on inflammatory acne vulgaris and related scars. In addition, this technique does not worsen active acne lesions.

Evaluation of the clinical efficacy of the 1450 nm laser in acne vulgaris: a randomized split-face, investigator-blinded clinical trial

The 1450 nm laser shrinks sebaceous glands histologically, reduces seborrhoea and has been shown in numerous small uncontrolled studies to improve inflammatory acne. To assess objectively the clinical efficacy and long-term outcome of the 1450 nm laser for inflammatory acne vulgaris. Participants over 16 years of age with moderate to severe acne vulgaris were recruited from a secondary care dermatology department. A split-face format was used: the side of the face to be treated was randomized with the other side serving as a within-patient control. Treatment was delivered with the Candela 1450 nm Smoothbeam laser (Candela, Cwmbran, U.K.) using a double-pass technique, 6 mm spot size, 210 ms pulse duration and fluence of 8 or 9 J cm(-2) . Three treatments were performed monthly. The primary outcome was the change in inflammatory lesion count and grading (using the Leeds Revised Acne Grading Scale) between baseline and 4 weeks after the third treatment on the treated side as compared with the change in the control side. Participants were followed up every 3 months for 12 months after the last treatment. The single assessor was blinded as to the side treated. Thirty-eight participants entered the study and 32 completed the study at the primary outcome measure. Within participants, on average, the lesion count reduced by the same amount on both sides of the face [median 0, 95% confidence interval (CI) -4 to 2]. On average, acne grade reduced by the same amount on both sides (median 0, 95% CI -1 to 0). Twelve months after the last treatment (n = 23) the change in lesion count and grade between the treated and control sides of the face remained similar. Treatment was well tolerated. Treatment with the 1450 nm laser does not reduce inflammatory lesion count or acne grade when compared with a control side, using a split-face format in participants recruited from secondary care. Both sides of the face improved and a systemic effect of the laser is possible.

Isotretinoin systemic therapy and the shadow cast upon dermatology's downtrodden hero

Isotretinoin has revolutionized the field of dermatology, offering a cure for severe acne vulgaris and a therapeutic option for a variety of other chronic diseases and cancers. This drug has done more for many diseases in medicine than many drug classes have done for a single disorder, and yet, its use and availability have been threatened in the United States. Federal restrictions in the form of the IPLEDGE teratogenicity prevention plan have made the use of this drug more complex. Millions of dollars in litigation and claims of injury have fueled hysteria among laymen about the use of this drug. Overwhelmed with worries of its potential adverse effects, the public forgets that withholding isotretinoin therapy is not without its own risks. Isoteretinoin therapy can prevent lifelong and permanent physical and psychological scarring that comes as a matter of course with severe acne. Over 20 million people worldwide have taken the drug, with several studies demonstrating its safety and few long term adverse effects. This wonder drug's continued availability depends upon its responsible and informed use. This paper will review and put in perspective the issues important to consider in the proper use of isotretinoin.