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Acne and Rosacea Treatments and Effects

Works Count: 35729

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This cluster of papers explores the management, pathogenesis, and epidemiology of acne vulgaris and rosacea. It delves into topics such as the role of Propionibacterium acnes, inflammation, sebaceous gland function, photodynamic therapy, antibiotic resistance, and the epidemiological aspects of these skin conditions.

Keywords

Acne Vulgaris; Rosacea; Propionibacterium Acnes; Pathogenesis; Treatment; Inflammation; Sebaceous Glands; Epidemiology; Photodynamic Therapy; Antibiotic Resistance

Activation of Toll-Like Receptor 2 in Acne Triggers Inflammatory Cytokine Responses

2002-08-01

Jenny Kim , Marîa Teresa Ochoa , Stephan R. Krutzik +7 more

One of the factors that contributes to the pathogenesis of acne is Propionibacterium acnes; yet, the molecular mechanism by which P. acnes induces inflammation is not known. Recent studies have … One of the factors that contributes to the pathogenesis of acne is Propionibacterium acnes; yet, the molecular mechanism by which P. acnes induces inflammation is not known. Recent studies have demonstrated that microbial agents trigger cytokine responses via Toll-like receptors (TLRs). We investigated whether TLR2 mediates P. acnes-induced cytokine production in acne. Transfection of TLR2 into a nonresponsive cell line was sufficient for NF-kappa B activation in response to P. acnes. In addition, peritoneal macrophages from wild-type, TLR6 knockout, and TLR1 knockout mice, but not TLR2 knockout mice, produced IL-6 in response to P. acnes. P. acnes also induced activation of IL-12 p40 promoter activity via TLR2. Furthermore, P. acnes induced IL-12 and IL-8 protein production by primary human monocytes and this cytokine production was inhibited by anti-TLR2 blocking Ab. Finally, in acne lesions, TLR2 was expressed on the cell surface of macrophages surrounding pilosebaceous follicles. These data suggest that P. acnes triggers inflammatory cytokine responses in acne by activation of TLR2. As such, TLR2 may provide a novel target for treatment of this common skin disease.

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Stratum Corneum Defensive Functions: An Integrated View

2005-08-01

Peter M. Elias

New Cell Formation in Human Sebaceous Glands**From the Division of Dermatology, Department of Medicine, University of California School of Medicine, San Francisco, California.

1966-05-01

Ervin H. Epstein , William L. Epstein , Hedy Krasnobrod

European Evidence‐based (S3) Guidelines for the Treatment of Acne

2012-02-01

Alexander Nast , Brigitte Dréno , Vincenzo Bettoli +7 more

Nasty/Rzany An evidence-based guideline has been defined as ‘a systematically developed statement that assists clinicians and patients in making decisions about appropriate treatment for a specific condition’.1 A guideline will … Nasty/Rzany An evidence-based guideline has been defined as ‘a systematically developed statement that assists clinicians and patients in making decisions about appropriate treatment for a specific condition’.1 A guideline will never encompass therapy specifications for all medical decision-making situations. Deviation from the recommendations may, therefore, be justified in specific situations. This is not a textbook on acne, nor a complete, all-inclusive reference on all aspects important to the treatment of acne. The presentation on safety in particular is limited to the information available in the included clinical trials and does not represent all the available and necessary information for the treatment of patients. Additional consultation of specific sources of information on the particular intervention prescribed (e.g. product information sheet) is necessary. Furthermore, all patients should be informed about the specific risks associated with any given topical and/or systemic therapy. Readers must carefully check the information in this guideline and determine whether the recommendations contained therein (e.g. regarding dose, dosing regimens, contraindications, or drug interactions) are complete, correct, and up-to-date. The authors and publishers can take no responsibility for dosage or treatment decisions. Improvement in the care of acne patients The idea behind this guideline is that recommendations based on a systematic review of the literature and a structured consensus process will improve the quality of acne therapy in general. Personal experiences and traded therapy concepts should be critically evaluated and replaced, if applicable, with the consented therapeutic recommendations. In particular, a correct choice of therapy should be facilitated by presenting the suitable therapy options in a therapy algorithm, taking into account the type of acne and the severity of the disease. Reduction of serious conditions and scarring As a result of the detailed description of systemic therapies for patients with severe acne, reservations about these interventions should be overcome to ensure that patients receive the optimal therapy. With the timely introduction of sufficient therapies, the development of serious post-acne conditions and severe scarring should be reduced. Promotion of adherence Good therapeutic adherence is key to treatment success. Adherence is facilitated by knowledge of the product being used, for example treatment duration, the expected onset of effect, the sequence of the healing process, the maximal achievable average effect, expected adverse events and the benefit to quality of life. Reduction of antibiotic resistance The use of topical and systemic antibiotics should be optimized by using appropriate combinations for a predefined duration, to reduce the development of antibiotic resistance. Health care professionals This guideline has been developed to help health care professionals provide optimal therapy to patients with mild, moderate or severe acne. The primary target groups are dermatologists and other professionals involved in the treatment of acne, such as paediatricians and general practitioners. The target group may vary with respect to national differences in the distribution of services provided by specialists or general practitioners. Patients The recommendations of the guideline refer to patients who suffer from acne. These are mainly adolescents treated in outpatient clinics. The appropriate therapy option is presented according to the type of acne that is present. The primary focus is the induction therapy of facial acne (see Chapter 1.6). Non-primary target groups are patients with special forms of acne, such as, occupational acne, chloracne, acne aestivalis, acne neonatorum, acne inverse (hidradenitis suppurativa). European guidelines are intended for adaptation to national conditions. It is beyond the scope of this guideline to take into consideration the specific costs and reimbursement situations in every European country. Differences in prices, reimbursement systems, willingness and ability to pay for medication among patients and the availability of generics are too large. Therefore, pharmacoeconomic considerations will have to be taken into account when guidelines are developed at national and local levels. The personal financial and health insurance situation of a patient may necessitate amendments to the prioritization of treatment recommendations. However, if financial resources allow, the suggested ranking in the therapeutic algorithm should be pursued. The skin type and stage of disease has to be taken into consideration when choosing the vehicle for topical treatments. The efficacy and safety/tolerability of topical treatments are largely influenced by the choice of vehicle. The face is the primary region of interest for the treatment of acne. Appearance, scarring, quality of life and social stigmatization are important considerations when dealing with facial dermatological diseases. The recommendations of this guideline apply primarily to the treatment of facial acne. More widespread involvement will certainly favour earlier use of a systemic treatment due to the efficacy and practicability of such treatments. Layton/Finlay Acne (synonym ‘acne vulgaris’) is a polymorphic, inflammatory skin disease most commonly affecting the face (99% of cases). Less frequently it also affects the back (60%) and chest (15%).2 Seborrhoea is a frequent feature.3 The clinical picture embraces a spectrum of signs, ranging from mild comedonal acne, with or without sparse inflammatory lesions (IL), to aggressive fulminate disease with deep-seated inflammation, nodules and in some cases associated systemic symptoms. Clinically non-inflamed lesions develop from the subclinical microcomedo which is evident on histological examination early in acne development.2 Non-inflamed lesions encompass both open (blackheads) and closed comedones (whiteheads). Comedones frequently have a mid-facial distribution in childhood and, when evident early in the course of the disease, this pattern is indicative of poor prognosis.4 Closed comedones are often inconspicuous with no visible follicular opening. Most patients have a mixture of non-inflammatory (NIL) and inflammatory lesions.5 Inflammatory lesions arise from the microcomedo or from non-inflammatory clinically apparent lesions and may be either superficial or deep.6 Superficial inflammatory lesions include papules and pustules (5 mm or less in diameter). These may evolve into deep pustules or nodules in more severe disease. Inflammatory macules represent regressing lesions that may persist for many weeks and contribute markedly to the general inflammatory appearance.5 Small nodules are defined as firm, inflamed lesions >5 mm diameter, painful by palpation. Nodules are defined as larger than 5 mm, large nodules are >1 cm in size. They may extend deeply and over large areas, frequently resulting in painful lesions, exudative sinus tracts and tissue destruction. Conglobate acne is a rare but severe form of acne found most commonly in adult males with few or no systemic symptoms. Lesions usually occur on the trunk and upper limbs and frequently extend to the buttocks. In contrast to ordinary acne, facial lesions are less common. The condition often presents in the second to third decade of life and may persist into the sixth decade. Conglobate acne is characterized by multiple grouped comedones amidst inflammatory papules, tender, suppurative nodules which commonly coalesce to form sinus tracts. Extensive and disfiguring scarring is frequently a feature. There are several severe and unusual variants or complications of acne as well as other similar diseases. These include acne fulminans, gram-negative folliculitis, rosacea fulminans, vasculitis, mechanical acne, oil/tar acne, chloracne, acne in neonates and infants and late onset, persistent acne, sometimes associated with genetic or iatrogenic endocrinopathies. The current guidelines do not lend themselves to comprehensive management of all these variants. Finlay/Layton Acne can be largely assessed from two perspectives: objective disease activity (based on measurement of visible signs) and quality of life impact. There are other aspects of measurement, such as sebum excretion rate, scarring development or economic impact. There are inherent difficulties in objectively measuring acne. Over 25 different methods have been described7 but there is no consensus as to which should be used. Most methods are non-validated and consequently the results of separate trials cannot be directly compared. There are detailed reviews on this subject by Barratt et al.,8 Witkowski et al.,9 Thiboutot et al.,10 and Gollnick et al.11 Proper lighting, appropriate patient positioning and prior facial skin preparation (gentle shaving for men, removal of make-up for women) are helpful in facilitating accurate assessment. Palpation in addition to visual inspection may also help define lesions more accurately. Many methods for measuring acne have been described, ranging from global assessments to lesion counting.7, 9 Despite a range of methods being used to measure acne in the 1960’s and 1970’s, it was the Leeds technique12 that dominated acne measurement for the next two decades. The Leeds technique included two methods; the grading technique and the counting technique. The grading technique allocated patients a grade from 0 to 10, with seven subgroups between 0 and 2. Photographic guides illustrating each grade are given, but the importance of palpating lesions is also stressed. The experience on which this system was based stemmed from the pre-isotretinoin era, and acne of the severity described by grades above 2 is now rarely seen. The counting technique involves the direct counting of non-inflamed and inflamed lesions, including superficial papules and pustules, deep inflamed lesions and macules. The revised Leeds acne grading system13 includes numerical grading systems for the back and chest as well as for the face. The Echelle de Cotation des Lesions d’Acne (ECLA) or ‘Acne Lesion Score Scale’ system has demonstrated good reliability.14 However, ECLA scores do not correlate with quality of life scores and the use of both disease and quality of life scores is suggested.15 Global assessment scales incorporate the entirety of the clinical presentation into a single category of severity. Each category is defined by either a photographic repertoire with corresponding numeric scale or descriptive text. Grading is a subjective task, based on observing dominant lesions, evaluating the presence or absence of inflammation, which is particularly difficult to capture, and estimating the extent of involvement. Global methods are much more practically suited to clinical practice. In clinical investigations, they should be combined with lesion counts as a co-primary endpoint of efficacy.16 A simple photographic standard-based grading method using a 0–8 scale has been successfully employed in a number of clinical trials.17 In 2005, the US FDA proposed an IGA (investigator global assessment) that represented a static quantitative evaluation of overall acne severity. To accomplish this, they devised an ordinal scale with five severity grades, each defined by distinct and clinically relevant morphological descriptions that they hoped would minimize inter-observer variability. Indeed, the more detailed descriptive text has resulted in this system being considered to provide even greater reliability than previous global assessments.16 A very simple classification of acne severity was described in the 2003 report from the Global Alliance for better outcome of acne treatment.11 This basic classification was designed to be used in a routine clinic, and its purpose was to map treatment advice onto common clinical presentations. For each acne descriptor a first-choice therapy is advised, with alternatives for female patients and maintenance therapy. There are five simple descriptors: mild comedonal, mild papulopustular, moderate papulopustular, moderate nodular and severe nodular/conglobate. A series of eight photographs span and overlap these five descriptors. Different facial views and different magnifications are used, reducing the comparability of the images. To give treatment recommendations based on disease activity, the EU Guidelines group has considered how best to classify acne patients. It has used the following simple clinical classification: Comedonal acne Mild–moderate papulopustular acne Severe papulopustular acne, moderate nodular acne Severe nodular acne, conglobate acne Other already existing systems are very difficult to compare with one another. The group has tried to map the existing systems to the guidelines’ clinical classification. However, in many cases the systems do not include corresponding categories and often it has to be considered an approximated narrowing rather than a precise mapping (Table 1). Simpson and Cunliffe25‘consider the use of quality of life and psychosocial questionnaires essential to adequately understanding just how the disease is affecting the patient, and to better understand the progress of the disease’. The impact of acne on quality of life can be measured using general health measures, dermatology-specific measures or acne-specific measures. In order for quality of life measures to be used more frequently in the routine clinical work, they need to be easy to use, the scores need to be meaningful and they need to be readily accessible. Clinicians must be convinced that the information gained from using them is of benefit in guiding them to make optimum clinical decisions for their patients, and they need to become aware that the use of these measures may help to justify their clinical decisions. Quality of life measures can influence the choice of therapy. In patients with a severe impact on their quality of life, a more aggressive therapy may be justified. A number of prognostic factors relating to more severe disease should be considered when assessing and managing acne. These are outlined and evidenced in review papers published by Holland and Jeremy 200526 and Dreno et al. 200827 and include family history, course of inflammation, persistent or late-onset disease, hyperseborrhoea, androgenic triggers, truncal acne and/or psychological sequelae. Previous infantile acne may also correlate with resurgence of acne at puberty and early age of onset with mid-facial comedones, early and more severe seborrhoea and earlier presentation relative to menarche are all factors that should alert the clinician to increased likelihood of more severe acne. Scarring usually follows deep-seated inflammatory lesions, but may also occur as a result of more superficial inflamed lesions in scar-prone patients. Acne scarring, albeit mild, has been identified in up to 90% of patients attending a dermatology clinic.28 Scars may show increased collagen (hypertrophic and keloid scars) or be associated with collagen loss. The presence of scarring should support aggressive management and therapy should be commenced early in the disease process. (For further details please see the methods report at http://www.acne-guidelines.com.) Nast/Rzany All experts were officially nominated by the European Dermatology Forum (EDF) or the European Academy of Dermatology and Venereology. They were selected according to their clinical expertise, publication record and/or experience in the field of evidence-based medicine and guideline development. None of the experts received any financial incentive other than reimbursement of travel costs. Participation of patients was difficult to realize, since no patient organization exists. Attempts to invite patients currently treated by the involved experts did not succeed. Patients were invited to participate in the external review. Patient preference was considered as an important outcome and trials looking at patient preferences were included. There is a vast array of treatment options available for acne. The options are further extended by the availability of different vehicles and formulations. When choosing a treatment, different skin types, ethnic groups and subtypes of acne must also be considered. The authors of this guideline selected the most relevant treatments in Europe to be included in the guideline. The fact that a certain treatment was not selected as a topic for this guideline, does not mean that it may not be a good treatment for acne. Additional treatment options may be considered for a later update. Fixed-dose combinations were considered as long as they were licensed in a European country (e.g. adapalene + benzoyl peroxide (BPO), clindamycin + BPO, erythromycin + tretinoin, erythromycin + isotretinoin, erythromycin + zinc). Treatment options consisting of more than two topical components were not included because of the likeliness of reduced patient adherence and/or because of a limitation in the feasibility of discussing all possible combinations and sequences. An extensive search of existing guidelines and systematic reviews was performed at the beginning of the project. The search was performed in Medline, Embase, and Cochrane (for search strategies see the methods report at http://www.acne-guidelines.com). The date of the systematic searches was March 10th 2010 for topical and systemic interventions and April 13th 2010 for laser and light therapies. The results were checked for the inclusion criteria and trial quality using a standardized literature evaluation form. Existing systematic reviews (e.g. Cochrane) and other guidelines served as an additional basis for the body of evidence in this guideline. Pooling of the trials was not attempted due to the lack of common outcome measures and endpoints and the unavailability of some primary data (for details of search strategies, standardized evaluation form and references of included reviews see methods report at http://www.acne-guidelines.com). The aim of this guideline is to give recommendations for specific clinical conditions, e.g. the severity of acne, and not to assess the different medications one by one without respect to clinical stage. However, most trials did not look in detail at subtypes but include patients with ‘acne vulgaris’ in general. Therefore, for some recommendations, ‘indirect evidence’ was generated from looking at suitable outcome parameters: The percentage ‘reduction of non-inflammatory lesions’ was the efficacy parameter considered for comedonal acne. Efficacy in papulopustular acne was assessed by ‘reduction in inflammatory lesions’, ‘reduction in total lesion count’ and other acne grading scales. The generation of evidence for nodular/conglobate acne was particularly difficult, since very few trials included nodular/conglobate acne. Consequently, treatment recommendations also took into account indirect data from trials of severe papulopustular acne. The evidence from clinical trials almost always focuses on facial acne. Trials that examined acne at other locations (e.g. back), were considered as indirect evidence and the level of evidence was downgraded accordingly. Very little attention has been given during clinical trials to the question of a minimal clinically important difference from the perspective of the patient. It would be helpful to know the extent of reduction in the number of acne lesions required for patients to consider that there has been a clinically important improvement. One study has been identified that empirically validated a non-inferiority margin of 10–15% for facial acne lesion counts as appropriate.356 The consensus view of the authors of this guideline is that a treatment should achieve at least a 10% greater reduction in the number of lesions to demonstrate superior efficacy. Hence, for the evaluation of superior or comparable efficacy throughout the evidence generation process, a 10% difference in efficacy (lesion reduction) was considered relevant. Many different grading systems for assessing the quality of evidence are available in the field of guideline development. For this guideline, the authors used the grading system adopted for the European Psoriasis Guidelines with some adaptations taken from the GRADE system.29-31 The available literature was evaluated with respect to the methodological quality of each single trial. A grade of evidence was given to every individual trial included: Randomized, double-blind clinical trial of high quality [e.g. sample-size calculation, flow chart of patient inclusion, intention-to-treat (ITT) analysis, sufficient sample size]. Randomized clinical trial of lesser quality (e.g. only single-blind, limited sample size: at least 15 patients per arm). Comparative trial with severe methodological limitations (e.g. not blinded, very small sample size, no randomization). When looking at a specific question (e.g. efficacy of BPO relative to adapalene) the available evidence was summarized by aligning a level of evidence (LE) using the following criteria: Further research is very unlikely to change our confidence in the estimate of effect. At least two trials are available that were assigned a grade of evidence A and the results are predominantly consistent with the results of additional grade B or C studies. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. At least three trials are available that were assigned a grade of evidence B and the results are predominantly consistent with respect to additional grade C trials. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Conflicting evidence or limited amount of trials, mostly with a grade of evidence of B or C. Any estimate of effect is very uncertain. Little or no systematic empirical evidence; included trials are extremely limited in number and/or quality. All recommendations were agreed in a consensus conference of the authors using formal consensus methodology (nominal group technique). The consensus conference was moderated by Prof. Dr. med. Berthold Rzany MSc, who is a certified moderator for the German Association of Scientific Medical Societies (AWMF). All members of the author committee were entitled to vote in the consensus conference. In general, a high consensus (>90%) was aimed for. In the absence of a consensus, this was noted in the text and reasons for the difference in views were given. All consensus statements are highlighted in a grey box throughout the text. To weigh the different recommendations, the group assigned a ‘strength of recommendation’ grade (see box below). The strength of recommendation considered all aspects of the treatment decision, such as efficacy, safety, patient preference and the reliability of the existing body of evidence (level of evidence). Strength of recommendation To grade the recommendation a ‘standardized guidelines’ language was used: Is strongly recommended. Can be recommended. Can be considered. Is not recommended. May not be used under any circumstances. A recommendation for or against treatment X cannot be made at the present time. An extensive external review was performed. National dermatological societies [European Dermatology Forum (EDF) members], other specialties [paediatrics, gynaecologists, general practitioners as organized in the European Union of Medical Specialists (UEMS)] and patients (patient internet platforms) were invited to participate. Access was open and it was possible for anybody to comment via the internet (using the platform http://www.crocodoc.com). The expert group piloted the guidelines within their own practices and performed a trial implementation within their clinics. (For further details see the methods report at http://www.acne-guidelines.com.). Implementation will be pursued at a national level by local medical societies. Materials such as an online version, a short version and a therapeutic algorithm will be supplied. Strategies for evaluation (e.g. assessment of awareness, treatment adhesion and patient changes) are in preparation and will mostly be pursued at a national level. Guidelines need to be continually updated to reflect the increasing amount of medical information available. This guideline will not be valid after 31.12.2015. In case of important changes in the meantime (e.g., new licensed drugs, withdrawal of drug licensing, new important information) an update will be issued earlier. The guidelines committee under the coordination of the division of evidence-based medicine (dEBM) will access the necessity for an update by means of a Delphi vote. Degitz/Ochsendorf Acne is one of the most frequent skin diseases. Epidemiological studies in Western industrialized countries estimated the prevalence of acne in adolescents to be between 50% and 95%, depending on the method of lesion counting. If mild manifestations were excluded and only moderate or severe manifestations were considered, the frequency was still 20–35%.32-35 Acne is a disease primarily of adolescence. It is triggered in children by the initiation of androgen production by the adrenal glands and gonads, and it usually subsides after the end of growth. However, to some degree, acne may persist beyond adolescence in a significant proportion of individuals, particularly women.36 Even after the disease has ended, acne scars and dyspigmentation are not uncommon permanent negative outcomes.10 Genetic factors have been recognized; there is a high concordance among identical twins,37 and there is also a tendency towards severe acne in patients with a positive family history for acne.38 So far little is known about specific hereditary mechanisms. It is probable that several genes are involved in predisposing an individual to acne. These include the genes for cytochrome P450-1A1 and steroid-21-hydroxylase.39 Racial and ethnic factors may also contribute to differences in the prevalence, severity, clinical presentation and sequelae of acne.40, 41 Environmental factors also appear to be of relevance to the prevalence of acne; populations with a natural lifestyle seem not to develop acne.42 In particular, diet has recently gained attention, with epidemiological43 and investigative studies44 indicating a correlation between acne and Western diet. Dréno/Gollnick Acne is an androgen-dependent disorder of pilosebaceous follicles (or pilosebaceous unit). There are four primary pathogenic factors, which interact to produce acne lesions: (1) sebum production by the sebaceous gland, (2) alteration in the keratinization process, (3) Propionibacterium acnes follicular colonization, and (4) release of inflammatory mediators. Patients with seborrhoea and acne have a significantly greater number of lobules per gland compared with unaffected individuals (the so-called genetically prone ‘Anlage’). Inflammatory responses occur prior to the hyperproliferation of keratinocytes. Interleukin-1α up-regulation contributes to the development of comedones independent of the colonization with P. acnes. A relative linoleic acid deficiency has also been described. Sebaceous lipids are regulated by peroxisome proliferator-activated receptors which act in concert with retinoid X receptors to regulate epidermal growth and differentiation as well as lipid metabolism. Sterol response element-binding proteins mediate the increase in sebaceous lipid formation induced by insulin-like growth factor-1. Substance P receptors, neuropeptidases, α-melanocyte stimulating hormone, insulin-like growth factor (IGF)-1R and corticotrophin-releasing hormone (CRH)-R1 are also involved in regulating sebocyte activity as are the ectopeptidases, such as dipeptidylpeptidase IV and animopeptidase N. The sebaceous gland also acts as an endocrine organ in response to changes in androgens and other hormones. Oxidized squalene can stimulate hyperproliferative behaviour of keratinocytes, and lipoperoxides produce leukotriene B4, a powerful chemoattractant. Acne produces chemotactic factors and promotes the synthesis of tumour necrosis factor-α and interleukin-1β. Cytokine induction by P. acnes occurs through Toll-like receptor 2 activation via activation of nuclear factor-κB and activator protein 1 (AP-1) transcription factor. Activation of AP-1 induces matrix metalloproteinase genes, the products of which degrade and alter the dermal matrix. The improved understanding of acne development on a molecular level suggests that acne is a disease that involves both innate and adaptive immune systems and inflammatory events. Recommendations are based on available evidence and expert consensus. Available evidence and expert voting lead to classification of strength of recommendation (Table 2). General comment: Only one trial looks specifically at patients with comedonal acne. As a source of indirect evidence, trials including patients with papulopustular acne were used and the percentage in the reduction of non-inflammatory lesions was considered as the relevant outcome parameter. Because of the general lack of direct evidence for the treatment of comedonal acne, the strength of recommendation was downgraded for all considered treatment options, starting with medium strength of recommendation as a maximum. Choice of topical vs. systemic treatment Due to the usually mild-to-moderate severity of comedonal acne, a topical therapy is generally recommended. Superior efficacy was defined as a difference of ≥10% in the reduction of non-inflammatory lesions in head-to-head comparisons (see also Chapter 3.3.3.). Superior efficacy against NIL compared with placebo is demonstrated by: azelaic acid45-47 (LE 1), BPO48-60 (LE 1), and the topical retinoids49-51, 60-75 (LE 1) (Table 3). Among the topical antibiotics, clindamycin57, 58,

Epidemiology of acne vulgaris

2012-12-05

Ketaki Bhate , Hywel C Williams

Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of … Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of acne by conducting a systematic review of relevant epidemiological studies. We searched Medline and Embase to the end of November 2011. The role of Propionibacterium acnes in pathogenesis is unclear: antibiotics have a direct antimicrobial as well as an anti-inflammatory effect. Moderate-to-severe acne affects around 20% of young people and severity correlates with pubertal maturity. Acne may be presenting at a younger age because of earlier puberty. It is unclear if ethnicity is truly associated with acne. Black individuals are more prone to postinflammatory hyperpigmentation and specific subtypes such as 'pomade acne'. Acne persists into the 20s and 30s in around 64% and 43% of individuals, respectively. The heritability of acne is almost 80% in first-degree relatives. Acne occurs earlier and is more severe in those with a positive family history. Suicidal ideation is more common in those with severe compared with mild acne. In the U.S.A., the cost of acne is over 3 billion dollars per year in terms of treatment and loss of productivity. A systematic review in 2005 found no clear evidence of dietary components increasing acne risk. One small randomized controlled trial showed that low glycaemic index (GI) diets can lower acne severity. A possible association between dairy food intake and acne requires closer scrutiny. Natural sunlight or poor hygiene are not associated. The association between smoking and acne is probably due to confounding. Validated core outcomes in future studies will help in combining future evidence.

Management of Acne

2003-06-27

Harald Gollnick , W.J. Cunliffe , Diane Berson +5 more

Suicidal Ideation, Mental Health Problems, and Social Impairment Are Increased in Adolescents with Acne: A Population-Based Study

2010-09-16

Jon Anders Halvorsen , Robert S. Stern , Florence Dalgard +3 more

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Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis

1998-11-01

Gupta

We examined the prevalence of depression (measured by the Carroll Rating Scale for Depression, CRSD), wishes to be dead and acute suicidal ideation among 480 patients with dermatological disorders that … We examined the prevalence of depression (measured by the Carroll Rating Scale for Depression, CRSD), wishes to be dead and acute suicidal ideation among 480 patients with dermatological disorders that may be cosmetically disfiguring, i.e. non-cystic facial acne (n = 72; 5.6% suicidal ideation), alopecia areata (n = 45; 0% suicidal ideation), atopic dermatitis (n = 146; 2.1% suicidal ideation) and psoriasis (79 outpatients, 2.5% suicidal ideation and 138 inpatients, 7.2% suicidal ideation). Analysis of variance revealed that the severely affected psoriasis inpatients (mean +/- SD total body surface area affected: 52 +/- 23.4%) had the highest (P < 0.05) CRSD score, followed by the patients with mild to moderate acne; both scores were in the range for clinical depression (CRSD score > 10). The 5.6-7.2% prevalence of active suicidal ideation among the psoriasis and acne patients was higher than the 2.4-3.3% prevalence reported among general medical patients. Our findings highlight the importance of recognizing psychiatric comorbidity, especially depression, among dermatology patients and indicate that in some instances even clinically mild to moderate disease such as non-cystic facial acne can be associated with significant depression and suicidal ideation.

Sebaceous gland lipids

2009-03-01

Mauro Picardo , Monica Ottaviani , Emanuela Camera +1 more

The principal activity of mature sebaceous glands is producing and secreting sebum, which is a complex mixture of lipids. Sebum composition is different among species and this difference is probably … The principal activity of mature sebaceous glands is producing and secreting sebum, which is a complex mixture of lipids. Sebum composition is different among species and this difference is probably due to the function that sebum has to absolve. In human sebum there are unique lipids, such as squalene and wax esters not found anywhere else in the body nor among the epidermal surface lipids. Moreover, they correspond to major components supplying the skin with protection. However, the ultimate role of human sebum, as well the metabolic pathways regulating its composition and secretion rate, are far from a complete understanding. Increased sebum secretion is considered, among all features, the major one involved in the pathophysiology of acne. Along with increased sebum secretion rate, quali- and quantitative modifications of sebum are likely to occur in this pathology. Understanding the factors and mechanisms that regulate sebum production is needed in order to identify new targets that can be addressed to achieve a selective modulation of lipid biosynthesis as a novel therapeutic strategy to correct lipid disregulations in acne and other disorders of the pilosebaceous unit.

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Acne Vulgaris

2002-12-01

Loren Cordain , Staffan Lindeberg , Magdalena Hurtado +3 more

In westernized societies, acne vulgaris is a nearly universal skin disease afflicting 79% to 95% of the adolescent population. In men and women older than 25 years, 40% to 54% … In westernized societies, acne vulgaris is a nearly universal skin disease afflicting 79% to 95% of the adolescent population. In men and women older than 25 years, 40% to 54% have some degree of facial acne, and clinical facial acne persists into middle age in 12% of women and 3% of men. Epidemiological evidence suggests that acne incidence rates are considerably lower in nonwesternized societies. Herein we report the prevalence of acne in 2 nonwesternized populations: the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay. Additionally, we analyze how elements in nonwesternized environments may influence the development of acne.Of 1200 Kitavan subjects examined (including 300 aged 15-25 years), no case of acne (grade 1 with multiple comedones or grades 2-4) was observed. Of 115 Aché subjects examined (including 15 aged 15-25 years) over 843 days, no case of active acne (grades 1-4) was observed.The astonishing difference in acne incidence rates between nonwesternized and fully modernized societies cannot be solely attributed to genetic differences among populations but likely results from differing environmental factors. Identification of these factors may be useful in the treatment of acne in Western populations.

The Complete Genome Sequence of Propionibacterium Acnes , a Commensal of Human Skin

2004-07-30

Holger Brüggemann , Anke Henne , Frank Hoster +6 more

Propionibacterium acnes is a major inhabitant of adult human skin, where it resides within sebaceous follicles, usually as a harmless commensal although it has been implicated in acne vulgaris formation. … Propionibacterium acnes is a major inhabitant of adult human skin, where it resides within sebaceous follicles, usually as a harmless commensal although it has been implicated in acne vulgaris formation. The entire genome sequence of this Gram-positive bacterium encodes 2333 putative genes and revealed numerous gene products involved in degrading host molecules, including sialidases, neuraminidases, endoglycoceramidases, lipases, and pore-forming factors. Surface-associated and other immunogenic factors have been identified, which might be involved in triggering acne inflammation and other P. acnes –associated diseases.

Age-related Changes in Sebaceous Gland Activity

1979-07-01

Peter E. Pochi , John S. Strauss , Donald T. Downing

Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy

1993-06-01

F.M.N. Forton , Bruno Seys

A standardized skin-surface biopsy (1 cm2) of the check was performed in 49 patients with rosacea [13 with erythemato-telangiectatic rosacea (ETR), three with squamous rosacea (SR), 33 with papulopustular rosacea … A standardized skin-surface biopsy (1 cm2) of the check was performed in 49 patients with rosacea [13 with erythemato-telangiectatic rosacea (ETR), three with squamous rosacea (SR), 33 with papulopustular rosacea (PPR)], and 45 controls. A mean density of 0.7 Demodex folliculorum/cm2 was found in controls, 98% of whom had less than five Demodex/cm2. When all clinical types of rosacea were considered collectively, the density of Demodex was significantly higher in patients with rosacea than in controls (mean = 10.8/cm2; P < 0.001). When the various clinical types of rosacea were considered separately, Demodex density was statistically significantly higher than in controls only in the PPR patients (mean = 12.8/cm2; P < 0.001). The same type of comparison was also made for three other groups of subjects--patients with isolated inflammatory papules (n = 4), rhinophyma (n = 3), and HIV infection (n = 21), respectively: in these groups, the Demodex density did not differ significantly from controls. The present study demonstrates a high density of D. folliculorum in PPR, and supports its pathogenic role in the papulopustular phase of rosacea. The study suggests that standardized surface biopsy could be a useful diagnostic tool for PPR, with a 98% specificity when Demodex density is higher than 5/cm2.

Propionibacterium acnes Strain Populations in the Human Skin Microbiome Associated with Acne

2013-01-21

Sorel Fitz‐Gibbon , Shuta Tomida , Bor-Han Chiu +7 more

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A clinical evaluation of acne scarring and its incidence

1994-07-01

Alison Layton , C. A. Henderson , W.J. Cunliffe

Despite scarring being a recognized sequel of acne, the actual extent and incidence of residual scarring remains unknown. One hundred and eighty-five acne patients were included in this study (101 … Despite scarring being a recognized sequel of acne, the actual extent and incidence of residual scarring remains unknown. One hundred and eighty-five acne patients were included in this study (101 females, 84 males). Patients were selected from acne clinics and their acne scarring was examined. The scarring was quantified according to a lesion count and allocated a score. The type and extent of scarring was correlated to the age and sex of the patient, the site of the acne, the previous acne grade according to the Leeds Technique, acne type (noted in clinic at the original referral time) and duration of acne, before adequate therapeutic measures had been instituted. Results indicate that facial scarring affects both sexes equally and occurs to some degree in 95% of cases. Total scarring on the trunk was significantly greater in males, as was hypertrophic and keloid scarring in these sites (P < 0.05). There were significant correlations between the initial acne grade and the overall severity of scarring in all sites and in both sexes (P < 0.01). Superficial inflamed papular acne lesions as well as nodular lesions were capable of producing scars. A time delay up to 3 years between acne onset and adequate treatment related to the ultimate degree of scarring in both sexes and in all three sites. This emphasizes the need for earlier adequate therapy in an attempt to minimize the subsequent scarring caused by acne.

Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea

2007-08-01

Kenshi Yamasaki , Anna Di Nardo , Antonella Bardan +7 more

Acne and sebaceous gland function

2004-09-01

Christos C. Zouboulis

Propionibacterium acnes and lipopolysaccharide induce the expression of antimicrobial peptides and proinflammatory cytokines/chemokines in human sebocytes

2006-05-20

István Nagy , Andor Pivarcsi , Kornélia Kis +7 more

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Prolonged Remissions of Cystic and Conglobate Acne with 13-cis-Retinoic Acid

1979-02-15

Gary L. Peck , Thomas G. Olsen , Frank W. Yoder +5 more

Fourteen patients with treatment-resistant cystic and conglobate acne were treated for four months with oral 13-cis-retinoic acid, a synthetic isomer of naturally occurring all-trans-retinoic acid. The average dose was 2.0 … Fourteen patients with treatment-resistant cystic and conglobate acne were treated for four months with oral 13-cis-retinoic acid, a synthetic isomer of naturally occurring all-trans-retinoic acid. The average dose was 2.0 mg per kilogram per day. Thirteen patients experienced complete clearing of their disease; the other had 75 per cent improvement, as determined by the number of acne nodules and cysts present before and after therapy. Prolonged remissions, currently lasting as long as 20 months after discontinuation of therapy, have been observed in all 14 patients. Clinical toxicity was limited to the skin and mucous membranes in most patients and was dose dependent and rapidly reversible upon discontinuation of therapy. The mechanism of action of 13-cis-retinoic acid in the therapy of acne probably involves a direct inhibitory effect of the drug on the sebaceous gland. (N Engl J Med 300:329–333, 1979)

Establishment and Characterization of an Immortalized Human Sebaceous Gland Cell Line (SZ95)1

1999-12-01

Christos C. Zouboulis , Holger Seltmann , Constantin E. Orfanos +1 more

Rosacea: I. Etiology, pathogenesis, and subtype classification

2004-08-31

Glen H. Crawford , Michelle T. Pelle , William D. James

The assessment of acne vulgaris—the Leeds technique

1984-07-01

Barbara Burke , W.J. Cunliffe

We describe two simple, reproducible scoring systems for assessing acne severity, and we emphasize the technical problems which could invalidate either technique. Constant baseline data is desirable for any clinical … We describe two simple, reproducible scoring systems for assessing acne severity, and we emphasize the technical problems which could invalidate either technique. Constant baseline data is desirable for any clinical trial, and our data clearly show that acne patients should ideally be off all treatment for at least 2 months before the start of a therapeutic trial.

Pathogenesis of acne

2001-03-01

Masahiko Toyoda , Masaaki Morohashi

New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group

2009-04-18

Diane Thiboutot , Harald Gollnick , Vincenzo Bettoli +7 more

Inflammatory Events Are Involved in Acne Lesion Initiation

2003-07-01

Anthony H.T. Jeremy , D.B. Holland , Susan G. Roberts +2 more

TLR2 Expression Is Increased in Rosacea and Stimulates Enhanced Serine Protease Production by Keratinocytes

2010-11-25

Kenshi Yamasaki , Kimberly Natee Kanada , Daniel T. MacLeod +5 more

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A global perspective on the epidemiology of acne

2015-01-17

Jerry Tan , Ketaki Bhate

Acne is estimated to affect 9·4% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, … Acne is estimated to affect 9·4% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, with boys most frequently affected, particularly with more severe forms of the disease. This paper aims to provide an update on the epidemiology of acne worldwide. Recent general and institutional studies from around the world have shown that the prevalence of acne is broadly consistent globally (with the exception of specific populations, which are discussed). However, this review highlights that there is a wide range of disparate outcome measures being applied in epidemiology studies, and we emphasize the need to develop a widely accepted, credible, standard assessment scale to address this in the future. In addition we discuss special populations, such as those devoid of acne, as well as the impact of potential determinants of acne on disease epidemiology.

What is the pathogenesis of acne?

2005-01-27

Christos C. Zouboulis , E. Anne Eady , Matthew Philpott +4 more

Abstract: For a long time, the mantra of acne pathogenesis debates has been that acne vulgaris lesions develop when (supposedly largely androgen‐mediated) increased sebum production, ductal hypercornification, and propionibacteria come … Abstract: For a long time, the mantra of acne pathogenesis debates has been that acne vulgaris lesions develop when (supposedly largely androgen‐mediated) increased sebum production, ductal hypercornification, and propionibacteria come together with local inflammatory process in the unlucky affected individual. And yet, the exact sequence, precise interdependence, and choreography of pathogenic events in acne, especially the ‘match that lights the fire’ have remained surprisingly unclear, despite the venerable tradition of acne research over the past century. However, exciting recent progress in this – conceptually long somewhat stagnant, yet clinically, psychologically, and socioeconomically highly relevant – everyday battlefield of skin pathology encourages one to critically revisit conventional concepts of acne pathogenesis. Also, this provides a good opportunity for defining more sharply key open questions and intriguing acne characteritics whose underlying biological basis has far too long remained uninvestigated, and to emphasize promising new acne research avenues off‐the‐beaten‐track – in the hope of promoting the corresponding development of innovative strategies for acne management.

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New insights into rosacea pathophysiology: A review of recent findings

2013-11-12

Martin Steinhoff , Jürgen Schauber , William D. James

Sexual Hormones in Human Skin

2007-02-01

Christos C. Zouboulis , W.-C. Chen , M. Julie Thornton +2 more

The skin locally synthesizes significant amounts of sexual hormones with intracrine or paracrine actions. The local level of each sexual steroid depends upon the expression of each of the androgen- … The skin locally synthesizes significant amounts of sexual hormones with intracrine or paracrine actions. The local level of each sexual steroid depends upon the expression of each of the androgen- and estrogen-synthesizing enzymes in each cell type, with sebaceous glands and sweat glands being the major contributors. Sebocytes express very little of the key enzyme, cytochrome P450c17, necessary for synthesis of the androgenic prohormones dehydroepiandrosterone and androstenedione, however, these prohormones can be converted by sebocytes and sweat glands, and probably also by dermal papilla cells, into more potent androgens like testosterone and dihydrotestosterone. Five major enzymes are involved in the activation and deactivation of androgens in skin. Androgens affect several functions of human skin, such as sebaceous gland growth and differentiation, hair growth, epidermal barrier homeostasis and wound healing. Their effects are mediated by binding to the nuclear androgen receptor. Changes of isoenzyme and/or androgen receptor levels may have important implications in the development of hyperandrogenism and the associated skin diseases such as acne, seborrhoea, hirsutism and androgenetic alopecia. On the other hand, estrogens have been implicated in skin aging, pigmentation, hair growth, sebum production and skin cancer. Estrogens exert their actions through intracellular receptors or via cell surface receptors, which activate specific second messenger signaling pathways. Recent studies suggest specific site-related distribution of ERalpha and ERbeta in human skin. In contrast, progestins play no role in the pathogenesis of skin disorders. However, they play a major role in the treatment of hirsutism and acne vulgaris, where they are prescribed as components of estrogen-progestin combination pills and as anti-androgens. These combinations enhance gonadotropin suppression of ovarian androgen production. Estrogen-progestin treatment can reduce the need for shaving by half and arrest progression of hirsutism of various etiologies, but do not necessarily reverse it. However, they reliably reduce acne. Cyproterone acetate and spironolactone are similarly effective as anti-androgens in reducing hirsutism, although there is wide variability in individual responses.

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Control and function of sebaceous glands

1989-04-01

A. J. Thody , S. Shuster

This review describes the various types of sebaceous glands, their locations, and where possible their different functions. All sebaceous glands are similar in structure and secrete sebum by a holocrine … This review describes the various types of sebaceous glands, their locations, and where possible their different functions. All sebaceous glands are similar in structure and secrete sebum by a holocrine process. However, the nature of this secretion and the regulation of the secretory process seem to differ among the various types of glands. Methods for measuring sebum secretion and assessing sebaceous gland activity are also described. The area of major interest during the last 20 years has undoubtedly been the mechanisms that control sebaceous gland function. Most studies have focused on the endocrine control and in particular on the role of androgens and pituitary hormones, although evidence suggests that nonendocrine factors may also be important. However, many questions remain and during the next few years attention will certainly be given to the role of retinoids and their mode of action in the treatment of acne.

New developments in our understanding of acne pathogenesis and treatment

2009-06-23

Ichiro Kurokawa , F. William Danby , Qiang Ju +7 more

Interest in sebaceous gland physiology and its diseases is rapidly increasing. We provide a summarized update of the current knowledge of the pathobiology of acne vulgaris and new treatment concepts … Interest in sebaceous gland physiology and its diseases is rapidly increasing. We provide a summarized update of the current knowledge of the pathobiology of acne vulgaris and new treatment concepts that have emerged in the last 3 years (2005-2008). We have tried to answer questions arising from the exploration of sebaceous gland biology, hormonal factors, hyperkeratinization, role of bacteria, sebum, nutrition, cytokines and toll-like receptors (TLRs). Sebaceous glands play an important role as active participants in the innate immunity of the skin. They produce neuropeptides, excrete antimicrobial peptides and exhibit characteristics of stem cells. Androgens affect sebocytes and infundibular keratinocytes in a complex manner influencing cellular differentiation, proliferation, lipogenesis and comedogenesis. Retention hyperkeratosis in closed comedones and inflammatory papules is attributable to a disorder of terminal keratinocyte differentiation. Propionibacterium acnes, by acting on TLR-2, may stimulate the secretion of cytokines, such as interleukin (IL)-6 and IL-8 by follicular keratinocytes and IL-8 and -12 in macrophages, giving rise to inflammation. Certain P. acnes species may induce an immunological reaction by stimulating the production of sebocyte and keratinocyte antimicrobial peptides, which play an important role in the innate immunity of the follicle. Qualitative changes of sebum lipids induce alteration of keratinocyte differentiation and induce IL-1 secretion, contributing to the development of follicular hyperkeratosis. High glycemic load food and milk may induce increased tissue levels of 5alpha-dihydrotestosterone. These new aspects of acne pathogenesis lead to the considerations of possible customized therapeutic regimens. Current research is expected to lead to innovative treatments in the near future.

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The quality of life in acne: a comparison with general medical conditions using generic questionnaires

1999-04-01

MALLON , John Newton , Anne F. Klassen +3 more

Skin diseases such as acne are sometimes thought of as unimportant, even trivial, when compared with diseases of other organ systems. To address this point directly, validated generic questionnaires were … Skin diseases such as acne are sometimes thought of as unimportant, even trivial, when compared with diseases of other organ systems. To address this point directly, validated generic questionnaires were used to assess morbidity in acne patients and compare it with morbidity in patients with other chronic diseases. For 111 acne patients referred to a dermatologist, quality of life was measured using the Dermatology Life Quality Index, Rosenberg's measure of self‐esteem, a version of the General Health Questionnaire (GHQ‐28) and the Short Form 36 (SF‐36). Clinical severity was measured using the Leeds Acne Grade. Population quality of life data for the SF‐36 instrument were available from a random sample of adult local residents (n = 9334) some of whom reported a variety of long‐standing disabling diseases. All quality of life instruments showed substantial deficits for acne patients that correlated with each other but not with clinically assessed acne severity. The acne patients (a relatively severely affected group) reported levels of social, psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain or arthritis. Acne is not a trivial disease in comparison with other chronic conditions. This should be recognized in the allocation of health care resources.

Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea

2004-05-29

Jonathan K. Wilkin , Mark V. Dahl , Michael Detmar +4 more

Antimicrobial Property of Lauric Acid Against Propionibacterium Acnes: Its Therapeutic Potential for Inflammatory Acne Vulgaris

2009-04-23

Teruaki Nakatsuji , Mandy C. Kao , Jia‐You Fang +4 more

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Prevalence of facial acne in adults

1999-10-01

V. Goulden , G.I. Stables , W.J. Cunliffe

The prevalence of acne in adults 20 years and older

2007-12-03

Christin N. Collier , Julie Harper , Wendy C. Cantrell +3 more

Guidelines of care for acne vulgaris management

2007-02-06

John S. Strauss , Daniel P. Krowchuk , William D. James +7 more

Prevalence, Severity, and Severity Risk Factors of Acne in High School Pupils: A Community-Based Study

2009-03-12

Seyed Zahra Ghodsi , Helmut Orawa , Christos C. Zouboulis

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Guidelines of care for the management of acne vulgaris

2016-02-19

Andrea L. Zaenglein , Arun L. Pathy , Bethanee J. Schlosser +7 more

Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can … Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.

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Rosacea

2015-04-16

Aimee Two , Wiggin Wu , Richard L. Gallo +1 more

Methodology series module 3: Cross-sectional studies

2016-01-01

Maninder Singh Setia

Cross-sectional study design is a type of observational study design. In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. … Cross-sectional study design is a type of observational study design. In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. Unlike in case-control studies (participants selected based on the outcome status) or cohort studies (participants selected based on the exposure status), the participants in a cross-sectional study are just selected based on the inclusion and exclusion criteria set for the study. Once the participants have been selected for the study, the investigator follows the study to assess the exposure and the outcomes. Cross-sectional designs are used for population-based surveys and to assess the prevalence of diseases in clinic-based samples. These studies can usually be conducted relatively faster and are inexpensive. They may be conducted either before planning a cohort study or a baseline in a cohort study. These types of designs will give us information about the prevalence of outcomes or exposures; this information will be useful for designing the cohort study. However, since this is a 1-time measurement of exposure and outcome, it is difficult to derive causal relationships from cross-sectional analysis. We can estimate the prevalence of disease in cross-sectional studies. Furthermore, we will also be able to estimate the odds ratios to study the association between exposure and the outcomes in this design.

Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

2017-10-28

Richard L. Gallo , Richard D. Granstein , Sewon Kang +4 more

Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne

2017-11-08

Diane Thiboutot , Brigitte Dréno , Abdullah Abanmi +7 more

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Incidence and prevalence of rosacea: a systematic review and meta-analysis

2018-02-25

Lise Gether , L.K. Overgaard , Alexander Egeberg +1 more

The exact prevalence and incidence of rosacea remain unknown, although it is a common condition associated with severe noncutaneous diseases. To perform a systematic review of the published literature to … The exact prevalence and incidence of rosacea remain unknown, although it is a common condition associated with severe noncutaneous diseases. To perform a systematic review of the published literature to examine the global incidence and prevalence of rosacea. A systematic review of population‐based and dermatological outpatient studies reporting the incidence and/or prevalence of rosacea was performed using three electronic medical databases: PubMed, Embase and Web of Science. Data were extracted and a proportion meta‐analysis was performed to obtain pooled proportions. In total 32 studies were included examining a total of 41 populations with 26 519 836 individuals. Twenty‐two populations were from Europe, three from Africa, four from Asia, nine from North America and three from South America. The pooled proportion of individuals with rosacea was 5·46% [95% confidence interval (CI) 4·91–6·04] in the general population and 2·39% (95% CI 1·56–3·39) among dermatological outpatients. Self‐reported rosacea gave higher prevalence estimates than rosacea diagnosed by clinical examination, suggesting a low specificity of questionnaires based on symptoms. Rosacea affected both women (5·41%, 95% CI 3·85–7·23) and men (3·90%, 95% CI 3·04–4·87), and mostly those aged 45–60 years. We estimated the global prevalence of rosacea based on published data and found that 5·46% of the adult population is affected. However, the prevalence of rosacea depended on the diagnostic method, with higher estimates in questionnaire studies of rosacea symptoms and lower estimates in health registries with International Classification of Diseases codes.

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Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates

2018-06-01

Brigitte Dréno , S. Pécastaings , Stéphane Corvec +3 more

Abstract While the commensal bacterium Propionibacterium acnes ( P. acnes ) is involved in the maintenance of a healthy skin, it can also act as an opportunistic pathogen in acne … Abstract While the commensal bacterium Propionibacterium acnes ( P. acnes ) is involved in the maintenance of a healthy skin, it can also act as an opportunistic pathogen in acne vulgaris. The latest findings on P. acnes shed light on the critical role of a tight equilibrium between members of its phylotypes and within the skin microbiota in the development of this skin disease. Indeed, contrary to what was previously thought, proliferation of P. acnes is not the trigger of acne as patients with acne do not harbour more P. acnes in follicles than normal individuals. Instead, the loss of the skin microbial diversity together with the activation of the innate immunity might lead to this chronic inflammatory condition. This review provides results of the most recent biochemical and genomic investigations that led to the new taxonomic classification of P. acnes renamed Cutibacterium acnes ( C. acnes ), and to the better characterisation of its phylogenetic cluster groups. Moreover, the latest data on the role of C. acnes and its different phylotypes in acne are presented, providing an overview of the factors that could participate in the virulence and in the antimicrobial resistance of acne‐associated strains. Overall, this emerging key information offers new perspectives in the treatment of acne, with future innovative strategies focusing on C. acnes biofilms and/or on its acne‐associated phylotypes.

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Systematic review of the epidemiology of acne vulgaris

2020-04-01

Anna Hwee Sing Heng , Fook Tim Chew

Abstract A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong … Abstract A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong association was observed between several risk factors – family history, age, BMI and skin type – and acne presentation or severity in multiple studies. The pooled odds ratio of 2.36 (95% CI 1.97–2.83) for overweight/obese BMI with reference to normal/underweight BMI and the pooled odds ratio of 2.91 (95% CI 2.58–3.28) for family history in parents with reference to no family history in parents demonstrate this strong association. In addition, a pooled odds ratio of 1.07 (95% CI 0.42–2.71) was obtained for sex (males with reference to females). However, the association between other factors, such as dietary factors and smoking, and acne presentation or severity was less clear, with inconsistent results between studies. Thus, further research is required to understand how these factors may influence the development and severity of acne. This study summarizes the potential factors that may affect the risk of acne presentation or severe acne and can help researchers and clinicians to understand the epidemiology of acne and severe acne. Furthermore, the findings can direct future acne research, with the hope of gaining insight into the pathophysiology of acne so as to develop effective acne treatments.

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Acne vulgaris

2015-09-17

Sara Moradi Tuchayi , Evgenia Makrantonaki , Rūta Gancevičienė +3 more

Acne vulgaris

2011-08-31

Hywel C Williams , Robert P. Dellavalle , Sarah Garner

Methods in yeast genetics, laboratory manual

1987-01-01

Diagnostic Challenges of Demodicosis in a 65-Year-Old Man: A Case of Chronic Pruritus

2025-06-25

Lucero de Maria Moran , Sebastian Lara Carrillo , A. Gonzalez Aguirre +2 more | Cureus

PREVALÊNCIA, CARACTERIZAÇÃO CLÍNICA E SOCIODEMOGRÁFICA DA ACNE EM ADULTOS JOVENS BRASILEIROS: UM ESTUDO TRANSVERSAL

2025-06-24

Marcelo Duarte , Moysés Nascimento , Matheaus Oliveira da Costa +2 more | Revista fisio&terapia.

ACNE VULGARIS AND ITS EFFECT ON QUALITY OF LIFE: A CROSS-SECTIONAL STUDY

2025-06-24

Pallabi Hatikakoty , Krishna Talukdar , Minakshi Narah +3 more | Journal of Population Therapeutics and Clinical Pharmacology

Acne in Population of Medical Students in Novi Sad, Serbia – Prevalence, Risk Factors, and Evaluation of the Quality of Life

2025-06-24

Dunja Vesković , Tatjana Roš , Milana Vuković +7 more | Bratislavské lekárske listy/Bratislava medical journal

Serum exosomal microRNA profiling reveals a down-regulation of hsa-miR-124-3p in patients with severe acne

2025-06-23

Shujuan Zhang , Yimin Liang , Manqi Xia +5 more | Frontiers in Immunology

Background Acne is a chronic inflammatory skin disease affecting pilosebaceous unit. However, its specific mechanism remain incompletely understood. Objectives This study aims to identify and analyze the differential expression of … Background Acne is a chronic inflammatory skin disease affecting pilosebaceous unit. However, its specific mechanism remain incompletely understood. Objectives This study aims to identify and analyze the differential expression of serum exosomal miRNA in severe acne, revealing new insights into the pathogenesis of acne. Methods MiRNAs were extracted from serum exosomes of 15 patients with severe acne and 15 healthy controls. MiRNA libraries were constructed and sequenced using Illumina HiSeq 2500. The DESeq2R was applied to identify differentially expressed miRNAs. The candidate target genes were predicted using multiple miRNA databases. The DAVID database was used to enrich GO function and KEGG pathway analysis of target genes. Cytoscape3.10.0 was employed to construct a PPI interaction network and further screen hub genes. The most significantly differentially expressed miRNAs were validated using RT-qPCR detection. Results Small RNA-Seq analysis identified a total of 96 serum exosome miRNAs, with 33 up-regulated and 63 down-regulated. Target prediction across four miRNA databases identified 10,569 target genes. GO analysis showed that target genes were mainly enriched in transcriptional regulation, signal transduction and protein binding; KEGG analysis revealed enrichment in 160 pathways including PI3K-Akt and MAPK signaling pathway. Cytoscape 3.10.0 identified 7 hub genes: PIK3R1, PIK3CA, SRC, EGFR, JAK2, ERBB2, and IGF1R, along with 35 corresponding differentially expressed miRNAs. RT-qPCR results indicated a significant reduction in exosomal miR-124-3p levels in severe acne. Conclusions Serum exosomal miRNA expression in patients with severe acne significantly differed from that in healthy individuals. The exosomal miR-124-3p expression was markedly reduced in severe acne compared to healthy controls. Consequently, the increase of miR-124-3p expression may have potential therapeutic implications for severe acne.

Minoxidil Overdose: A Case Report and Review of the Literature

2025-06-21

Masakazu Kakurai , Yoshihiro Moriyama | Cureus

Minocycline

2025-06-21

| Reactions Weekly

Clascoterone (Winlevi)

2025-06-20

CDA-AMC | Canadian Journal of Health Technologies

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform nonbinding recommendations that … Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform nonbinding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec. This review assesses clascoterone (Winlevi), 1% cream for topical treatment. Indication: For the topical treatment of acne vulgaris in patients 12 years of age and older.

Severity strata and minimally important differences of <scp>CompAQ</scp> and Skindex‐16 for patients with acne

2025-06-20

Michael R. Nock , Delaney Griffiths , Ali Shields +7 more | Journal of the European Academy of Dermatology and Venereology

A New Tetracycline for Acne: The Role of Sarecycline

2025-06-19

Alicja Witkowska , Barbara Anna Zapalska , Julia Piotrowska +7 more | Quality in Sport

INTRODUCTION AND OBJECTIVEA common dermatological disorder that significantly affects both the physical appearance and mental well-being of patients is acne vulgaris. Its presence is frequently associated with reduced quality of … INTRODUCTION AND OBJECTIVEA common dermatological disorder that significantly affects both the physical appearance and mental well-being of patients is acne vulgaris. Its presence is frequently associated with reduced quality of life due to its chronic nature, visible lesions, and the risk of permanent scarring. The pathogenesis of acne is multifactorial and includes follicular hyperkeratinization, colonization of the skin by Cutibacterium acnes, inflammation, and overproduction of sebum. The purpose of this article is to present sarecycline, a third-generation tetracycline antibiotic approved by the United States Food and Drug Administration in 2018 for the treatment of moderate to severe acne vulgaris. The review summarizes current scientific findings regarding its clinical efficacy and safety profile. MATERIALS AND METHODSThis article is based on a literature review concerning the therapeutic application of sarecycline in acne vulgaris. A comprehensive search was conducted using scientific databases including PubMed and Google Scholar, covering the period from 1999 to 2024. Keywords such as acne, tetracycline, and sarecycline were used to identify relevant studies. CONCLUSIONCompared to traditional tetracyclines, sarecycline demonstrates limited activity against Gram-negative bacteria, which helps reduce the incidence of gastrointestinal side effects. Due to its favorable efficacy and safety profile, it is considered a valuable treatment option, especially for patients requiring long-term antibiotic therapy. Sarecycline has the potential to redefine established treatment paradigms in the management of acne vulgaris.

Comment on the article by Kakpovbia about efficacy of topical treatments for mild‐to‐moderate acne

2025-06-19

Qing Long , Yan Li | Journal of the European Academy of Dermatology and Venereology

Artificial Intelligence and Systemic Isotretinoin: Patient Education on Ophthalmological Side Effects

2025-06-18

Seçil Yigen İritaş , İlter İritaş | Acibadem Universitesi Saglik Bilimleri Dergisi

Background/Purpose: Isotretinoin is frequently utilized in the treatment of skin disorders such as acne vulgaris and rosacea, with its associated side effects occurring relatively often. The most prevalent ophthalmological adverse … Background/Purpose: Isotretinoin is frequently utilized in the treatment of skin disorders such as acne vulgaris and rosacea, with its associated side effects occurring relatively often. The most prevalent ophthalmological adverse effects include conjunctivitis, hordeolum, chalazion, blepharitis, and xerophthalmia. In light of the growing integration of artificial intelligence within healthcare, this study aims to evaluate the capability of ChatGPT to enhance patient education regarding these conditions. Materials and Methods: A questionnaire consisting of fifteen frequently asked questions concerning the ocular side effects of systemic isotretinoin was developed. Eight questions, selected by a dermatologist and a ophthalmologist, were posed to ChatGPT version 4.0. The responses were assessed using a four-point rating scale. Answers were independently categorized as "excellent," "satisfactory with minimal explanation required," "satisfactory with moderate explanation required," or "unsatisfactory." Results: ChatGPT provided accurate and informative responses to all eight questions presented. Six responses were rated as "excellent," while two were categorized as "satisfactory with minimal explanation required." Inter-rater reliability was assessed using Cohen's kappa analysis, resulting in a kappa value of 0.413 (95% confidence interval, 0.007 to 0.825). Conclusion: ChatGPT exhibited a significant capacity to effectively address patient inquiries related to the ophthalmological side effects of systemic isotretinoin. Following a review by dermatologists and ophthalmologists, it may serve as a valuable complementary tool for patient education.

THE CLINICAL SPECTRUM OF PHYMA: A CASE REPORT OF RHINO-METOPHYMA AND REVIEW OF THE LITERATURE

2025-06-18

Ivano Luppino , Francesco Lacarrubba , Anna Elisa Verzì +1 more | Skin Appendage Disorders

Background Phyma of the nose, or rhinophyma, is considered a diagnostic clinical phenotype of rosacea. Rarely, phyma manifestations may be present on the chin (gnathophyma), ear (otophyma), forehead (metophyma) and … Background Phyma of the nose, or rhinophyma, is considered a diagnostic clinical phenotype of rosacea. Rarely, phyma manifestations may be present on the chin (gnathophyma), ear (otophyma), forehead (metophyma) and eyelids (blepharophyma). The purpose of this paper is to present a case of rhino-metophyma and to review the literature on the topic. Summary A 74-year-old Caucasian male with a history of inflammatory rosacea, complained of marked nasal and frontal skin thickening. Based on clinical, ultrasound, and histopathological examination, the diagnosis of rhino-metophyma was formulated. A literature review from 2000 to 2024 revealed 14 cases of rhinophyma associated with other localizations: 7 cases of rhino-otophyma, 4 of rhino-gnathophyma, and 3 of rhino-metophyma. Reported cases of isolated extranasal phyma were 21: 10 of gnathophyma, 9 of otophyma, and 2 of metophyma. Overall, patients with involvement of the nose and extranasal phyma were predominantly males with a male:female ratio 6:1, while among extranasal localizations the male:female ratio was 1.1:1. Key messages The diagnosis of rhinophyma is clinical and in the majority of cases quite easy, less for the isolated phymas in extranasal localizations. Little is also known about the management of these forms, and more studies on the prevalence of extranasal localizations and their therapeutic management would be desirable.

The Singapore/Malaysia Cross-sectional Genetics Epidemiology Study: An Updated and Detailed Analysis of Acne Vulgaris Severity, Scarring, and Phenotypes and Their Associated Risk Factors Among Young Chinese Adults

2025-06-17

Zanche Huang , Jun Jie Lim , Kavita Reginald +2 more | Dermatology

Introduction: Despite the high prevalence of acne vulgaris and its impact on affected individuals, few studies have provided a detailed characterization of acne phenotypes and their associated risk factors. This … Introduction: Despite the high prevalence of acne vulgaris and its impact on affected individuals, few studies have provided a detailed characterization of acne phenotypes and their associated risk factors. This study aims to comprehensively evaluate the prevalence, severity, scarring, and phenotypes of acne, along with their associated risk factors, in a cohort of young Chinese adults, as part of the Singapore and Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES). Methods: Participants were randomly and consecutively recruited from universities in Singapore and Malaysia. Data on sociodemographic, familial medical histories of atopic diseases and acne, and lifestyle habits were collected using a validated investigator-administered questionnaire from 6225 young Chinese adults (mean age = 22.8 ± 5.7 years). A subset of participants underwent clinical assessment for acne severity (n = 2345), scarring grade (n = 2345), and phenotypes (n = 1191) by dermatologically trained personnel. Results: The prevalence of acne was 56.0%. Among acne cases (n = 3504), 38.5% had moderate-severe acne, 52.8% had scarring, 95.7% presented with blackhead and/or whitehead, and 55.8% had inflammatory phenotypes (e.g., papules, pustules, cysts and nodules). A parental history of acne emerged as the strongest risk factor associated with all acne phenotypes. Pet ownership (Adjusted odds ratio [AOR]: 1.403, 95% Confidence level [CI]: 1.131-1.744, p < 0.05) and occasional alcohol consumption (AOR: 1.328, 95% CI: 1.090-1.617, p < 0.05) were associated with a higher odd for blackhead and/or whitehead. Protective factors included higher parental education levels for acne scarring (AOR: 0.650, 95% CI: 0.459-0.904; p < 0.05), male gender (AOR: 0.365, 95% CI: 0.298-0.446; p < 0.05) and birthplace (AOR: 0.674, 95% CI: 0.555-0.819; p < 0.05) for non-inflammatory phenotypes. Conclusions: This study, conducted in a well-defined cohort of young Chinese adults from the SMCGES, reinforces familial history as a key risk factor for acne onset, severity, scarring, and phenotype manifestation. The identification of modifiable and environmental factors associated with acne phenotypes offers valuable insights for targeted interventions to improve acne management and control.

Treatment of Erythematotelangiectatic Rosacea With Collateral Puncture Therapy: Protocol for a Randomized Controlled Trial

2025-06-17

Ahnah Song , Bingnan Cui , X.L. Wang +7 more | JMIR Research Protocols

Background Erythematotelangiectatic rosacea (ETR) is the most common subtype of rosacea, characterized by persistent facial erythema and telangiectasia of varying calibers. It causes significant aesthetic impairment and is often accompanied … Background Erythematotelangiectatic rosacea (ETR) is the most common subtype of rosacea, characterized by persistent facial erythema and telangiectasia of varying calibers. It causes significant aesthetic impairment and is often accompanied by uncomfortable symptoms, such as burning, stinging, dryness, and itching, profoundly affecting patients’ quality of life. Intense pulsed light (IPL) therapy demonstrates notable improvement in persistent erythema and telangiectasia; however, it is associated with issues such as a prolonged treatment course and high costs. Collateral puncture therapy involves rapid puncturing of specific acupuncture points followed by gentle squeezing around the needle holes to induce minor bleeding. Previous studies have shown that collateral puncture therapy for ETR offers advantages such as rapid onset of effect, a simple procedure, and low cost. Nevertheless, more high-quality clinical research data are needed to confirm these findings. Objective This study aims to observe the clinical efficacy and safety of collateral puncture therapy in treating ETR. Methods This study enrolled 60 patients diagnosed with ETR. The patients were randomly divided into 2 groups: one group underwent 4 sessions of collateral puncture therapy with 1-week intervals between treatments, and the other group received a single session of IPL therapy. The primary efficacy end points were the clinician’s erythema assessment and the clinician’s telangiectasia assessment. The secondary efficacy end points included the investigator’s global assessment, patient’s self-assessment, Flushing Assessment Tool results, Dermatology Life Quality Index, and Rosacea-specific Quality-of-Life instrument. The evaluation points were before treatment, immediately after treatment, and during follow-up. The data were statistically analyzed using SPSS (version 25.0; IBM Corp) to compare intragroup and intergroup differences between the 2 sets of data before and after treatment, with a significance level of α=.05 for hypothesis testing. Results Recruitment began on June 1, 2023. All participants have been recruited. Data analysis will be complete by the end of August 2025, with study findings available by December 2025. Conclusions This study has the potential to verify the clinical efficacy and safety of collateral puncture therapy in the treatment of ETR, supplement rosacea treatment methods, standardize treatment protocols, and fill a current clinical gap in treating rosacea. Trial Registration Chinese Clinical Trial Registry ChiCTR2200062639; https://www.chictr.org.cn/showproj.html?proj=177100 International Registered Report Identifier (IRRID) DERR1-10.2196/59682

A split-face clinical trial to compare efficacy of topical tretinoin 0.025% with and without intense pulsed light 530 nm filter in young adult patients of grades 2 and 3 facial acne vulgaris with Fitzpatrick phototype IV-VI

2025-06-17

Vedashri Vinod Ghatbandhe , Uddhao Zambare , ChitraS Nayak | Journal of Cutaneous and Aesthetic Surgery

Objectives: To compare percentage difference in global acne grading scale and absolute lesion count of inflammatory papules and pustules after treatment with topical Tretinoin 0.025% on whole face and one … Objectives: To compare percentage difference in global acne grading scale and absolute lesion count of inflammatory papules and pustules after treatment with topical Tretinoin 0.025% on whole face and one side receiving additional IPL 530 nm once a month for three sessions. Material and Methods: A split-face controlled clinical trial was conducted on young adults over 18 years old with grade 2 or 3 acne vulgaris. The study involved treating the entire face with Tretinoin 0.025% cream while administering IPL therapy on one side of the face. The trial spanned 18 months, with three IPL sessions conducted at four-week intervals. A total of 32 patients were selected through convenience sampling. The primary outcome measures were changes in the Global Acne Grading Scale (GAGS) and absolute lesion count (ALC) for inflammatory papules and pustules. Statistical analysis involved paired t-tests, Wilcoxon signed-rank tests, and Fisher’s exact tests to evaluate the treatment outcomes. Results: The study population had a mean age of 22.66 years, with a female predominance (71.88%). Significant reductions in GAGS and ALC were observed in both treatment groups over the three-month period, with the combination therapy group showing more substantial improvement. The Tretinoin plus IPL group exhibited a higher percentage reduction in both GAGS scores and lesion counts compared to the Tretinoin monotherapy group. Conclusion: The combination of Tretinoin 0.025% cream and IPL therapy is more effective in reducing acne lesions than Tretinoin alone. This combination therapy could serve as a viable alternative to more aggressive systemic treatments, offering a safer and more tolerable option for managing acne vulgaris.

Okuläre Rosazea

2025-06-16

Louise Partzsch , Katrin Nguyen , Sören Korsing +1 more | Deleted Journal

Ocular rosacea is a chronic inflammatory disease that affects the surface of the eye and the eyelids. It often occurs in conjunction with rosacea in the facial area but can … Ocular rosacea is a chronic inflammatory disease that affects the surface of the eye and the eyelids. It often occurs in conjunction with rosacea in the facial area but can also occur independently. It is characterized by bilateral chronic posterior blepharitis and meibomitis, which can involve the entire surface of the eye, including the cornea, during the course of the disease. The diagnosis is largely based on clinical findings. The main symptoms include reddened, burning and itchy eyes, dryness, sensitivity to light and blurred vision. The exact etiology of ocular rosacea is not fully understood. A genetic predisposition, dysregulation of the immune system, environmental factors and microbial factors are involved. Treatment usually includes a combination of eyelid hygiene, topical and, if necessary, systemic agents. The prognosis is generally considered favorable; however, in the case of untreated ocular rosacea, severe progressive courses can also lead to blindness.

Multifaceted Treatment of Severe Rhinophyma With Wide Excision, Esterified Hyaluronic Acid Matrix Placement, Laser Therapy, and Microneedling: A Case Report

2025-06-16

Kimiya Taji , Vaibhav Varma , Shay B Dean | FACE

Rhinophyma is characterized by the irregular dysmorphic growth of the nose emerging from chronic rosacea. The bulbous glandular mass develops from the chronic proliferation of sebaceous glands leading to vascular … Rhinophyma is characterized by the irregular dysmorphic growth of the nose emerging from chronic rosacea. The bulbous glandular mass develops from the chronic proliferation of sebaceous glands leading to vascular compromise. Importantly, the cosmetic consequence of this disease leads to severe psychological distress. Characterized by telangiectasias, erythema, and thickening of the skin, it is vital to use a multi-faceted approach for desirable results. We present the case of a rhinophyma treated with full-thickness tissue removal, esterified hyaluronic acid matrix placement, laser treatment, and microneedling.

Demodex folliculorum

2025-06-15

Ayyad Zartasht Khan , Fredrik Fineide , Jens Wohlmann +4 more | Diagnostics

Herein, we present scanning electron microscopy imagery of Demodex folliculorum on the eyelashes of a patient with a two-year history of dry, burning, and watery eyes. Demodex mites are part … Herein, we present scanning electron microscopy imagery of Demodex folliculorum on the eyelashes of a patient with a two-year history of dry, burning, and watery eyes. Demodex mites are part of the normal human skin flora, inhabiting hair follicles and sebaceous glands. However, in some individuals, they may contribute to ocular surface diseases, including blepharitis and dry eye disease. Symptoms often include itching, photophobia, and a foreign body sensation. The pathogenic role of Demodex is not fully understood but may involve microabrasions, gland obstruction, hypersensitivity reactions, and bacterial dysbiosis. The presence of collarettes at the base of eyelashes is a diagnostic hallmark. Although optimal treatment remains debated, options include topical tea tree oil, ivermectin, and a recently FDA-approved drug lotilaner. Our patient responded favorably to a two-month regimen of tea tree oil-based eyelid wipes. This case underscores the clinical relevance of Demodex infestation in chronic ocular discomfort and highlights the importance of diagnostics.

Effect of Intense Pulsed Light Combined With 3% Tranexamic Acid for Facial Erythema Associated With Acne Vulgaris and Rosacea

2025-06-15

Xueping Liu , Xiaoyi Qi , Yufeng He +2 more | Lasers in Surgery and Medicine

ABSTRACT Background Current treatment options for facial erythema associated with acne and rosacea include oral and topical treatments. Physical modalities are also commonly used recently. Combination therapy usually works better … ABSTRACT Background Current treatment options for facial erythema associated with acne and rosacea include oral and topical treatments. Physical modalities are also commonly used recently. Combination therapy usually works better than a single therapy. There are few studies on the therapeutic effect of IPL combined with TXA on facial erythema. Objective To study the efficacy of intense pulsed light combined with 3% tranexamic acid in the treatment of facial erythema associated with acne and rosacea. Methods A total of 56 patients were included in the study. They were randomly divided into the observation group and the control group, with 28 cases in each group. The observation group was treated with intense pulsed light combined with 3% tranexamic acid for external use, while the control group was treated with intense pulsed light only. The clinical efficacy, erythema degree, and skin disease quality of life index score before and after treatment were observed in the two groups, and the results were compared. Results After treatment, both groups showed improvement; the observation group exhibited a significantly higher overall effective rate than the control group ( p < 0.05). The scores of erythema index and skin quality of life index in the observation group were lower than those in the control group, and the differences were statistically significant ( p < 0.05). There were no obvious adverse reactions in both groups. Conclusion Intense pulsed light combined with 3% tranexamic acid can effectively improve the degree of acne and rosacea erythema without serious adverse effects.

Optimizing Acne Severity Detection: A Deep Learning Approach with Electronic Medical Record System Integration and Diverse Image Data

2025-06-14

Ayesha P. Singhapathiranage , Dulari D.K. Kelaart , Arunali A.M. Thathsarani +2 more | Advances in Technology

Acne vulgaris is the 8th most common skin ailment in the world. Although there are many studies in European countries to predict the severity level of acne, there is a … Acne vulgaris is the 8th most common skin ailment in the world. Although there are many studies in European countries to predict the severity level of acne, there is a significant gap in predicting South Asian skin texture, which is different due to inherent biological differences such as the thickness of the dermis, complexion, and frequency of skin sensitivity. Therefore, the study aims to address this gap with a deep learning (DL) algorithm based on images from different nationalities with different skin colours and features who have low-resolution images and often contain more than one acne lesions. The modal was deployed as a Progressive Web Application (PWA) and embedded in an Electronic Medical Record (EMR). 1,148 training images and 100 testing images were acquired from several resources and labelled into five main categories: from 1 (Clear) to 5 (Severe). A transfer learning approach was implemented by extracting image features using a ResNet-152 pre-trained model, then a fully connected layer was added and trained to learn the target severity level from labelled images. OpenCV (Facial landmark and One-Eye modal) is used to find facial landmarks and extract key skin patches from the images. To address the spatial sensitivity of CNN models, an existing image rolling augmentation approach was used to help the trained CNN model to generalise better on testing data. Theoretically, it causes acne lesions to appear in more locations in the training images and improves the generalisation of the CNN model on test images. Finally, the model’s performance was evaluated on 100 test images using RMSE concerning a consensus among experts. In this research, we obtained a lower RMSE value (0.37) compared to the previous studies, and severity levels are categorised into five alphabetical values.

Optimized Tazarotene Transfersomes Versus Previously Optimized Tazarotene Cubosomes: Exploring Their In Vivo Anti-Acne Activity in a Cutibacterium acnes Inflammatory Murine Model

2025-06-13

Doaa Hegazy , N Fayed , Hanzada T. Nour El‐Din +2 more | BioNanoScience

Decoding the skin microbiota: A Mendelian randomization study reveals new insights into acne causality

2025-06-13

Jie Zhou , Yixin Xu , Haitao Wang | Medicine

The link between skin microbiota and acne, despite being a research focus for years, still lacks full understanding and remains controversial. The genome-wide association studies data utilized in this study … The link between skin microbiota and acne, despite being a research focus for years, still lacks full understanding and remains controversial. The genome-wide association studies data utilized in this study were all sourced from public databases. Microbiota data from sebaceous (acne-prone) skin regions were selected for bidirectional Mendelian randomization analysis with acne. The primary method utilized was the inverse-variance weighted (IVW) method, supported by heterogeneity analysis, horizontal pleiotropy testing, outlier detection, and “leave-one-out” sensitivity analysis. This Mendelian randomization analysis revealed causal connections between the abundance of the genus: staphylococcus (IVW odds ratio [OR]: 1.074; 95% confidence interval [CI]: 1.031–1.119, P = .001) and Propionibacterium acnes (IVW OR = 1.039, 95% CI = 1.007–1.073, P = .017) in sebaceous skin and the risk of acne development. Additionally, ASV004 (Corynebacterium [unclassified]) (IVW OR = 0.967, 95% CI = 0.937–0.999, P = .044) and ASV008 (Staphylococcus [unclassified]) (IVW OR = 0.943, 95% CI = 0.897–0.991, P = .021) were identified as protective factors that could reduce acne incidence. No reverse causality between skin microbiota and acne was found, with all analyses showing no horizontal pleiotropy or heterogeneity. This study is instrumental in exploring the link between skin microbiota and acne, supporting theoretical debates, and shedding light on acne’s pathogenesis.

Chronic Nipple Sinus Secondary to Demodex folliculorum Infestation: A Case Report

2025-06-12

Suhair Al Saad , Hamdi Al Shenawi , Kameela S Majed +1 more | Cureus

ON THE RELATIONSHIP BETWEEN STRESS AND NEUROGENIC INFLAMMATION IN LATE ACNE

2025-06-10

G.L. Belyakova , V.V. Gladko , S.A. Masyukova +1 more | Bulletin of the Medical Institute of Continuing Education

Background. Acne, traditionally considered as a disease, mainly of adolescence, has been increasingly reported in people over the age of 25 in the last decade. The features of the course … Background. Acne, traditionally considered as a disease, mainly of adolescence, has been increasingly reported in people over the age of 25 in the last decade. The features of the course of persistent forms of acne and acne with a late onset are resistance to therapy, persistent post-acne symptoms and a pronounced stress factor. Studying the process of neurogenic inflammation in this group of individuals is necessary for a prognostic understanding of the role and degree of stress as a factor preventing the stable remission of the disease. Purpose. To search for correlations between the degree of neurogenic inflammation and stress levels. Materials and methods. The study of neuropeptide content in blood serum was carried out by competitive inhibition ELISA method. An objective assessment of stress levels was carried out using the Holmes and Rage stress tolerance and social adaptation questionnairesand Spielberger-Hanin test of personality and situational anxiety. Results. Neuropeptides characterizing the severity of neurogenic inflammation showed a statistically significant increase compared to the control. Conclusions. The levels of neuropeptides in the acne group significantly exceeded those of the control group, confirming the association of neurogenic inflammation with the degree of stress.

Dermoscopic Evaluation of Erythema Versus Post‐Inflammatory Hyperpigmentation (PIH) in Skin of Color (SOC) Patients

2025-06-10

Shirley P. Parraga , Tiffany Mayo | JEADV Clinical Practice

AN INNOVATIVE METHOD OF OPHTHALMOROSACEA TREATMENT

2025-06-10

E.G. Perevalova , I.A. Lamotkin | Bulletin of the Medical Institute of Continuing Education

Background. For 6 years (2018-2023), the features of the course of ophthalmorosacea were studied to develop an effective treatment method for this disease. The effectiveness of a new innovative therapy … Background. For 6 years (2018-2023), the features of the course of ophthalmorosacea were studied to develop an effective treatment method for this disease. The effectiveness of a new innovative therapy for ophthalmorosacea was evaluated in 182 people. The treatment consisted of the injection of 1% hyaluronic acid on special active points, followed by the application of 20% lactic acid in the form of peeling. This method of treatment allowed to eliminate the pathogenetic mechanisms of the ophthalmorosacea development. The method has been patented, and the Patent for invention No. 2810361 has been obtained. Purpose. To develop a method for persistent stagnation of the inflammatory process in patients with ocular rosacea. Materials and Methods. 182 patients were selected to analyze the effect of hyaluronic acid on the pathogenesis of ophthalmoacea. The results of the treatment method were observed from 2018 to 2023 inclusive. Results. A method of anti-inflammatory, drainage, and regenerative therapy with 1% injectable hyaluronic acid for ophthalmorosacea was developed. An in-depth analysis and dynamic follow-up of patients were performed at home, 6 and 12 months after therapy, and the optimal amount and time interval between injection therapy were verified. The patient management strategy and tactics have been developed based on the Patent for invention No. 2810361. A highly effective and safe method of treating ocular rosacea with stable and prolonged stagnation of the process has been identified. Conclusion. After carrying out 6 procedures for activating points of 1% hyaluronic acid, relief of ophthalmorosacea was observed in 98.2% of cases, all clinical signs of pathology were eliminated, and patients stopped using moisturizing eye drops.

Exploring the potential link between Helicobacter Pylori and Rosacea: A retrospective matched cohort study

2025-06-09

Nail Omarov , Omer Gezdur | Medical Science and Discovery

Objective: Rosacea is a chronic skin disorder of unknown etiology that primarily affects the central face. This study aimed to determine the prevalence of Helicobacter pylori (H. pylori) infection in … Objective: Rosacea is a chronic skin disorder of unknown etiology that primarily affects the central face. This study aimed to determine the prevalence of Helicobacter pylori (H. pylori) infection in patients with rosacea and to assess whether Helicobacter testing is warranted in this population. Methods: This single-center retrospective study evaluated the prevalence of gastric H. pylori infection, confirmed via the rapid urease Campylobacter-like organism (CLO) test and the 13C-urea breath test, in patients with rosacea. Upper gastrointestinal endoscopy (UGIE) was performed in rosacea patients presenting with dyspepsia, and these individuals were tested for H. pylori. Those without dyspeptic symptoms underwent the 13C-urea breath test. Additionally, patients presenting solely with dyspepsia and undergoing UGIE in the Endoscopy Unit were assessed for H. pylori infection. The prevalence of H. pylori positivity was compared across groups to evaluate the necessity of testing rosacea patients for the infection. Results: A total of 110 patients were diagnosed with rosacea by a dermatologist. Among them, H. pylori positivity was identified in 68 patients (61.8%). In a comparison group of 135 patients who underwent UGIE for dyspepsia alone, 70 (51.8%) tested positive for H. pylori. Subtype analysis revealed that the erythematotelangiectatic rosacea (ETR) subtype was more prevalent than papulopustular rosacea (PPR), and H. pylori positivity was significantly higher in the ETR group (p < 0.001). Conclusion: Our findings indicate a notable association between H. pylori infection and rosacea, particularly within the erythematotelangiectatic subtype. Given the significantly higher prevalence of H. pylori in rosacea patients compared to those with dyspepsia alone, routine testing for H. pylori may be beneficial, especially in rosacea patients presenting with gastrointestinal symptoms. Identifying and treating H. pylori in this subgroup could potentially contribute to more effective management of rosacea. Future prospective studies are warranted to clarify the causal relationship and assess the therapeutic benefits of H. pylori eradication in rosacea treatment.

Acne Treatment Review and Present Perspectives

2025-06-06

Helen Boreham | European Medical Journal

Acne is a chronic inflammatory skin disease whose visible effects can have a significant psychological impact on patients. A multimodal approach to acne management is vital in order to target … Acne is a chronic inflammatory skin disease whose visible effects can have a significant psychological impact on patients. A multimodal approach to acne management is vital in order to target the four interlinked pathological processes that underpin this common skin condition. During interviews conducted by EMJ, Sandeep Cliff, Consultant Dermatologist at Surrey and Sussex University Healthcare Trust, and Alison Layton, Consultant Dermatologist from Harrogate and District NHS Foundation Trust, both in the UK, explored the burden, pathophysiology, and current and future landscape of acne treatment. Experts highlighted existing unmet needs in acne care and explained how therapeutic innovations, such as the novel androgen receptor inhibitor clascoterone, may help to reshape acne management in daily clinical practice moving forward.

Is There a Place for Biologics in Acne?

2025-06-05

Lajos Kemény , Döníz Degovics , Kornélia Szabó | American Journal of Clinical Dermatology

Impact of azithromycin on specific biochemical markers and sebum composition in acne vulgaris patients

2025-06-05

Alaa Sh. Abdulbari , Noor Ali , Ahmed R. Abu‐Raghif +2 more | Archives of Dermatological Research

Antibiotic resistance rates in Cutibacterium acnes isolated from patients with acne vulgaris: a systematic review and meta-analysis

2025-06-04

Chunxiao Zhu , Bo Wei , Yang Li +1 more | Frontiers in Microbiology

Background Cutibacterium acnes ( C. acnes ) is closely related to the pathogenesis of acne, and studies related to the antibiotic resistance rates of C. acnes have been reported worldwide; … Background Cutibacterium acnes ( C. acnes ) is closely related to the pathogenesis of acne, and studies related to the antibiotic resistance rates of C. acnes have been reported worldwide; however, relevant systematic reviews and meta-analyses are still lacking. The aim of this study was to systematically evaluate the resistance in C. acnes to relevant antibiotics, that this information may be used to provide a rational basis for the antibiotic treatment of acne. Methods Relevant studies in PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data were systematically searched from January 1, 2005, to April 1, 2025, and the resistance rates of C. acnes isolates to quinolones, macrolides, tetracyclines, and other relevant antibiotics were collected. The combined resistance rate was calculated via the R language program package 4.3.2, with subgroup analyses based on different years, continents, countries, provinces in China and different drug susceptibility testing methods. Results A total of 8,846 studies were systematically retrieved and 23 studies were included, corresponding to 2,046 isolates of C. acnes , which have shown antibiotic resistance rates ranging from high to low: 48.17% (95% CI: 41.16–55.24%) for roxithromycin, 45.64% (95% CI: 20.49–73.22%) for clarithromycin, 43.33% (95% CI: 27.81–60.29%) for azithromycin, 29.20% (95% CI: 22.14–37.43%) for erythromycin, 22.38% (95% CI: 14.69–32.56%) for clindamycin, 5.93% (95% CI: 2.91–11.69%) for levofloxacin, 2.44% (95% CI: 0.99–5.89%) for doxycycline, 1.47% (95% CI: 0.00–85.72%) for trimethoprim-sulfamethoxazole (TMP–SMX), 1.31% (95% CI: 0.45–3.70%) for tetracycline, 0.28% (95% CI: 0.04–1.94%) for chloramphenicol, 0.22% (95% CI: 0.03–1.89%) for minocycline. Subgroup analysis revealed that, compared with those in other regions, the resistance rates to macrolides and clindamycin were higher in China. In addition, the levofloxacin, erythromycin, and clindamycin resistance rates were progressively increasing over time. Conclusion In certain regions, the relatively high antibiotic resistance rates (e.g., 77% (95% CI: 62–87%) for clarithromycin in China) in C. acnes isolates may be attributed to the overuse of antibiotics in acne treatment. The resistance rates in C. acnes to tetracyclines, such as 2.44% (95% CI: 0.99–5.89%) for doxycycline, remain relatively low, which allows tetracyclines to continue serving as first-line antibiotics for acne treatment. In addition, the resistance rates to levofloxacin, erythromycin, and clindamycin markedly increased over time ( p &lt; 0.05). This emphasizes the significance of rational use of the antibiotics in acne treatment.

The efficacy of combination of oral antioxidants and topical retinoic acid versus topical retinoic acid monotherapy in mild acne vulgaris patients

2025-06-04

Ferra O. Mawu , Marlyn G. Kapantow , Paulus Mario Christopher | Deleted Journal

Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous follicle with multifactorial pathogenesis and pleiomorphic clinical manifestations constituting comedones, papules, pustules, nodules, and cysts. Oxidative stress has been … Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous follicle with multifactorial pathogenesis and pleiomorphic clinical manifestations constituting comedones, papules, pustules, nodules, and cysts. Oxidative stress has been reported to contribute in AV pathogenesis. This phenomenon rationalizes antioxidant supplementation as an adjuvant therapy for AV management. Four cases of 22 to 23 yo women with complaints of worsening facial acne for 1 to 6 mo. Initially, acne lesions appeared as skin-colored papules, which increased in number, became reddish papules and pustules, and extended to the jaw and chin. Lesions were accompanied by temporary itching and pain. Dermatological examination revealed multiple circumscribed discrete erythematous papules, miliar to lenticular in size, comedones (+), and pustules (+), with total lesions <30. According to the Lehmann criteria, patients were diagnosed as mild AV. All patients were treated with 0.025% topical retinoic acid cream, while the other two patients received additional oral antioxidant supplementations (zinc and ɑ-lipoic acid) and were followed up every two weeks. Two cases who received additional oral antioxidant supplementations (Group A) exhibited an earlier and higher clinical improvement, characterized by a reduction in the number of lesions on each follow up, till the current report. Oxidative stress in AV pathogenesis causes microenvironment alteration that favours colonization of Cutibacterium acnes. Together with the increase in sebum production, it stimulates the release of pro-inflammatory cytokines, such as interleukin (IL)-1α, IL-8, and tumor necrosis factor-α (TNF α), contributing to the inflammatory response. Antioxidant supplementation plays a role in suppressing the process of lipid peroxidation and inhibiting the expression of pro-inflammatory cytokines. Comprehensive management of AV is based on pathogenesis and the role of oxidative stress. An earlier and higher clinical improvement reduction was noted in Group A, patients who received a combination of 0.025% topical retinoic acid cream and oral antioxidant supplementation.