Acne Medications

Chlorhexidine prevents hypochlorous acid-induced inactivation

2009-08-17T04:55:00.000-07:00

Chlorhexidine digluconate has been used as a topical antiseptic in the treatment of acne vulgaris and periodontitis. The acute phase of these diseases involves neutrophilic infiltration. Neutrophil activation and recruitment to inflammatory sites are crucial in both protection against bacterial infections and induction of hystotoxic damage.

Activated neutrophils release several enzymes (elastase and myeloperoxidase [MPO]), which contribute to tissue injury through the direct toxic activity, the generation of oxidants and the inactivation of protective factors, such as alpha-1-antitrypsin (alpha-1-AT). In the present study, we investigated if chlorhexidine might modulate neutrophil-mediated histotoxicity.

2. Human primary neutrophils were isolated from healthy donors. Inactivation of alpha-1-AT by neutrophils or reagent hypochlorous acid (HOCl) was evaluated by spectrophotometer and SDS-PAGE analysis of its capacity to complex with porcin pancreatic elastase (PPE). Neutrophil generation of HOCl, superoxide anion and MPO release were assessed spectrophometrically.

3. Chlorhexidine dose-dependently prevented HOCl-induced alpha-1-AT inactivation and reduced HOCl recovery by PMA-treated human neutrophils. Chlorhexidine did not inhibit superoxide anion and MPO release by phorbol-12-myristate-13-acetate (PMA)-treated neutrophils. Chlorhexidine directly inhibited HOCl recovery from neutrophils and HOCl-induced inactivation of alpha-1-AT in a cell-free assay.

Accordingly, chlorhexidine reversed HOCl-mediated inhibition of alpha-1-AT capacity to complex with PPE. 4. These data suggest that chlorhexidine prevents neutrophil-induced alpha-1-AT inactivation through the direct inhibitory activity on HOCl. Although highly speculative, the present article indicates that chlorhexidine might protect inflamed tissues not only through its antimicrobial properties, but also through a direct anti-inflammatory activity on neutrophil toxic products.

"Chlorhexidine prevents hypochlorous acid-induced inactivation of alpha-1-antitrypsin (alpha-1-AT)."
Clin Exp Pharmacol Physiol. 2009 Aug 4; Montecucco F, Bertolotto M, Ottonello L, Pende A, Dapino P, Quercioli A, Mach F, Dallegri F1.(hubmed.org)

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Acne inversa: early inflammatory

2009-08-10T16:25:00.000-07:00

Hidradenitis suppurativa (acne inversa) is a chronic suppurative and scarring inflammatory disease with predilection in the apocrine gland-bearing areas. Histological investigations in the 1990s showed keratotic occlusion of the terminal follicle structure to be the initial cause.

Our investigations describe and reproduce the morphology and try to figure out very early lesions of HS. A total of 262 operative specimens from 60 patients were investigated by routine histology and 11 operative specimens by immunohistochemistry: HS is dominated by a heterogeneous histological image. 82% of the surgical specimens showed mild or pronounced follicular hyperkeratosis, whereas an isotopic hyperplasia of follicular epithelium was evident in 77%.

Pronounced perifolliculitis was seen in 68% and rupture of the follicle structure in 28%. Features which had not so far been described in detail were: epidermal psoriasiform hyperplasia (43%) and subepidermal interfollicular inflammatory infiltrate (78%).

In all 11 specimens, immunohistochemical investigations showed a perifollicular and subepidermal inflammation of CD-3-, CD-4-, CD-68-, CD-79- and CD-8-cells, the latter with a striking selective epitheliotropism. To conclude, we could show follicular hyperkeratosis and lymphocytic perifollicular inflammation as early patterns in pathogenesis, whereas rupture of the follicle structure takes place later.

Finally, it seems that there are two hot spots of inflammatory events (perifollicular and subepidermal) composed of a comparable inflammatory cell mixture. The CD-8 cell epitheliotropism (follicular and epidermal) described here and its influence in follicular hyperkeratosis, in hyperplasia of follicular epithelium and in epidermal psoriasiform hyperplasia will be of further interest, for instance, concerning early pharmacological intervention.

Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis
Exp Dermatol. 2009 Jul 29; Laffert MV, Helmbold P, Wohlrab J, Fiedler E, Stadie V, Marsch WC (Hubmed.org)

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Photodynamic therapy in dermatology

2009-08-09T15:42:00.000-07:00

Photodynamic therapy (PDT) is used for the prevention and treatment of non-melanoma skin cancer. Until recently, clinically approved indications have been restricted to actinic keratoses, nodular and superficial basal cell carcinoma, and, since 2006, Bowen disease.

However, the range of indications has been expanding continuously. PDT is also used for the treatment of non-malignant conditions such as acne vulgaris and leishmaniasis, as well as for treating premature skin aging due to sun exposure.

The production of reactive oxygen intermediates like singlet oxygen depends on the light dose applied as well as the concentration and localization of the photosensitizer in the diseased tissue.

Either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory skin conditions are induced. Treating superficial non-melanoma skin cancer, PDT has been shown to be highly efficient, despite the low level of invasiveness. The excellent cosmetic results after treatment are beneficial, too.

Photodynamic therapy in dermatology: a review.
Lasers Med Sci. 2009 Aug 5; Choudhary S, Nouri K, Elsaie ML (Hubmed.org)

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Acne inversa: early inflammatory

2009-08-09T06:56:00.001-07:00

Hidradenitis suppurativa (acne inversa) is a chronic suppurative and scarring inflammatory disease with predilection in the apocrine gland-bearing areas. Histological investigations in the 1990s showed keratotic occlusion of the terminal follicle structure to be the initial cause.

Our investigations describe and reproduce the morphology and try to figure out very early lesions of HS. A total of 262 operative specimens from 60 patients were investigated by routine histology and 11 operative specimens by immunohistochemistry: HS is dominated by a heterogeneous histological image. 82% of the surgical specimens showed mild or pronounced follicular hyperkeratosis, whereas an isotopic hyperplasia of follicular epithelium was evident in 77%.

Pronounced perifolliculitis was seen in 68% and rupture of the follicle structure in 28%. Features which had not so far been described in detail were: epidermal psoriasiform hyperplasia (43%) and subepidermal interfollicular inflammatory infiltrate (78%).

In all 11 specimens, immunohistochemical investigations showed a perifollicular and subepidermal inflammation of CD-3-, CD-4-, CD-68-, CD-79- and CD-8-cells, the latter with a striking selective epitheliotropism. To conclude, we could show follicular hyperkeratosis and lymphocytic perifollicular inflammation as early patterns in pathogenesis, whereas rupture of the follicle structure takes place later.

Finally, it seems that there are two hot spots of inflammatory events (perifollicular and subepidermal) composed of a comparable inflammatory cell mixture. The CD-8 cell epitheliotropism (follicular and epidermal) described here and its influence in follicular hyperkeratosis, in hyperplasia of follicular epithelium and in epidermal psoriasiform hyperplasia will be of further interest, for instance, concerning early pharmacological intervention.

Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis
Exp Dermatol. 2009 Jul 29; Laffert MV, Helmbold P, Wohlrab J, Fiedler E, Stadie V, Marsch WC (Hubmed.org)

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Oral hormonal contraception

2009-07-31T20:48:00.001-07:00

Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation.

The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly.

In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years.

There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception.

However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD.

The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection.

There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections.

In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use.

The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy.

The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception.

Intrauterine devices: an effective alternative to oral hormonal contraception
Prescrire Int. 2009 Jun; 18(101): 125-30(1) (Hubmed.org)

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Dehydroepiandrosterone supplementation in assisted reproduction

2009-07-29T01:47:00.000-07:00

To present the possible positive effect of dehydroepiandrosterone administration in assisted reproduction and especially in poor responders, women with diminished ovarian reserve, premature ovarian failure and premature ovarian aging in the course of ovarian stimulation protocols followed either by intrauterine insemination or IVF.

RECENT FINDINGS:
Overall, 50-75 mg of dehydroepiandrosterone supplementation for at least 4 months may either result in natural conception or considerably improves intrauterine insemination and IVF outcome and pregnancy rates to women with confirmed diminished ovarian reserve, premature ovarian failure or premature ovarian aging. Positive effect has been reported to oocyte and embryo quality, even to women aged 40-47 years. The number of euploid embryos is increased, and miscarriage rate is decreased.

SUMMARY:
Although more data on the dehydroepiandrosterone effect on assisted reproduction are needed, results obtained over the last few years confirm the improvement of oocyte production and pregnancy rates. No significant side effects are reported, and those include mainly hirstusism and acne.

Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results.
Curr Opin Obstet Gynecol. 2009 Aug; 21(4): 306-8Mamas L, Mamas E

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The endocannabinoid system of the skin in health and disease

2009-07-28T16:15:00.000-07:00

The newly discovered endocannabinoid system (ECS; comprising the endogenous lipid mediators endocannabinoids present in virtually all tissues, their G-protein-coupled cannabinoid receptors, biosynthetic pathways and metabolizing enzymes) has been implicated in multiple regulatory functions both in health and disease.

Recent studies have intriguingly suggested the existence of a functional ECS in the skin and implicated it in various biological processes (e.g. proliferation, growth, differentiation, apoptosis and cytokine, mediator or hormone production of various cell types of the skin and appendages, such as the hair follicle and sebaceous gland).

It seems that the main physiological function of the cutaneous ECS is to constitutively control the proper and well-balanced proliferation, differentiation and survival, as well as immune competence and/or tolerance, of skin cells. The disruption of this delicate balance might facilitate the development of multiple pathological conditions and diseases of the skin (e.g. acne, seborrhea, allergic dermatitis, itch and pain, psoriasis, hair growth disorders, systemic sclerosis and cancer).

"The endocannabinoid system of the skin in health and disease: novel perspectives and therapeutic opportunities.'
Trends Pharmacol Sci. 2009 Jul 14; BÃrÃ³ T, TÃ³th BI, HaskÃ³ G, Paus R, Pacher P

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Heat-killed Propionibacterium acnes

2009-07-26T23:31:00.001-07:00
The etiology of acne is a complex process, and acne is one of the most common skin disorders affecting millions of people. The pathogenesis of acne is closely associated with the bacterium, Propionibacterium acnes which was previously known as Corynebacterium parvum.

Both viable and non-viable P. acnes/C. parvum have been shown to induce an immunostimulatory effect in vivo, suggesting that even dead bacteria continue to activate an inflammatory response. Acne treatments with lasers or devices, induce a bactericidal effect through heat generation which may not address the immunogenic activity of P. acnes and the resulting acne inflammation.

Therefore, we sought to determine whether killed P. acnes is capable of inducing an inflammatory response and therefore could be a contributing factor in acne. Direct heat treatment of P. acnes cultures with temperatures ranging from 50 degrees C to 80 degrees C reduced P. acnes viability. Both viable and heat-killed P. acnes activated the p38 MAP kinase and its downstream substrate Hsp27. Stimulating keratinocytes with normal and heat-inactivated P. acnes resulted in an induction of proinflammatory nitric oxide and IL-8 production.

Thus killed P. acnes is capable of inducing inflammation in skin suggesting that therapies that have both bactericidal and anti-inflammatory effects may result in a more effective treatment of patients with acne than treatments that are bactericidal alone.

"Heat-killed Propionibacterium acnes is capable of inducing inflammatory responses in skin"
Exp Dermatol. 2009 Jul 14; Lyte P, Sur R, Nigam A, Southall MD

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Risk of High-Grade Skin Rash

2009-07-23T15:13:00.001-07:00

Cetuximab, a chimeric antibody against epidermal growth factor receptor has emerged as an effective therapy for advanced colorectal cancer (CRC) and head-neck cancer. However, severe skin toxicity may limit its use.

Its efficacy in the treatment of other cancers is also undergoing extensive investigation. We performed a systemic review and meta-analysis of published clinical trials to quantify the overall incidence and risk of severe skin rash.

Methods:
Databases Medline (OVID 1998 to July 2008), Web of Science, and abstracts presented at the American Society of Clinical Oncology conferences from 2004 through July 2008 were searched to identify relevant studies.

Eligible studies include phase II and III clinical trials in which patients were treated with a single agent, i.e. cetuximab at 400 mg/m(2) as initial dose followed by 250 mg/m(2) weekly. Incidence, relative risk (RR), and 95% confidence intervals (CI) were calculated using a fixed-effects or random-effects model based on the heterogeneity of included studies.

Results:
A total of 2,037 patients with a variety of solid tumors from 16 trials were included for analysis. The overall incidence of all-grade skin rash was 88.2% (95% CI: 84.8-91.0%), with11.3% (95% CI: 8.8-14.3%) being high-grade (grade 3 or above). The overall incidence of all-grade acne-like skin rash was 81.6% (95% CI: 75.4-86.6%) with 6.5% (95% CI: 4.1-10.0%) being high-grade.

Notably, patients with CRC exhibited a significantly higher incidence of high-grade skin rash (12.6%, 95% CI: 9.7-16.4%) than those with non-CRC (6.6%, 95% CI: 3.6-11.8%) with a risk ratio of 1.9 (95% CI: 1.0-3.6, p = 0.049).

From randomized controlled studies, patients who received cetuximab had a significantly increased risk of developing high-grade skin rash in comparison with controls (RR 21.8, 95% CI: 6.9-68.8, p < 0.001).

Conclusion:
Cancer patients who received cetuximab have a substantial risk of developing high-grade skin rash. The risk may be particularly increased in patients with CRC. Further studies are strongly recommended for the prevention and treatment of high-grade skin rash.

Risk of High-Grade Skin Rash in Cancer Patients Treated with Cetuximab - an Antibody against Epidermal Growth Factor Receptor: Systemic Review and Meta-Analysis.
Oncology. 2009 Jul 22; 77(2): 124-133Su X, Lacouture ME, Jia Y, Wu S(Hubmed.org)

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Aesthetic dermatology: fillers and lasers treatments

2009-07-23T07:00:00.001-07:00

In esthetic dermatology, filling and laser treatments are two essential techniques. Several recent studies on calcium hydroxyapatite in filling treatments and facial volumetry, in esthetics, but also in HIV patients, have been published. It was also tested in accentuated melomental folds where it is superior to hyaluronic acid.

In aging of the skin of the dorsal aspect of the hands, hyaluronic acid provides slightly better results than collagen. Filler rhinoplasty can correct minor deformations of the nose. Lipofilling is advantageous for linear scleroderma of the face, at least in the forehead region, and adipocyte stem cells may be a future solution for facial aging or lipoatrophy. The risk of local and/or general sarcoid reactions related to interferon in patients having undergone filling injections has been reported.

In the field of laser treatment, fractionated photothermolysis has motivated much more research and seem particularly valuable in treating acne scars, aging of the dorsal aspect of the hands, and, more anecdotally, in colloid milium and pearly penile papules. Laser is also useful in preventing surgical scars where a mini-diode can also be used. For axillary hyperhidrosis, subdermic Nd-YAG laser competes with botulinum toxin, with longer-lasting results. Solutions are appearing for treatment of red or white striae cutis distensae.

Intense pulsed light is the reference technique for poikiloderma of Civatte, and seems effective, with new devices, for melasma. However, inappropriately used by nonphysicians, IPL can cause serious ocular accidents; one case of uveitis has been reported.

"What's new in aesthetic dermatology: fillers and lasers treatments"
Ann Dermatol Venereol. 2009 May; 136 Suppl 4: S152-9Beylot C (Hubmed)

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A Randomized Trial of Oral DHEA Treatment for Sexual Function, Well-Being, and Menopausal Symptoms in Postmenopausal Women with Low Libido.

2009-07-23T03:45:00.001-07:00
Dehydroepiandrosterone (DHEA) and its sulfate DHEAS, which are the most abundant steroids in women, decline with age. We have shown association between low sexual function and low circulating DHEAS levels in women.

The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young individuals improves sexual function. Methods.

Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week randomized, double-blind, placebo controlled trial and received either DHEA 50 mg or placebo (PL) daily.

Main Outcome Measures. Efficacy was assessed through 26 weeks. The main outcome measures were the change in total satisfying sexual events (SSE) and the change in the Sabbatsberg Sexual Self-Rating Scale (SSS) total score. Secondary measures were the Psychological General Well-Being Questionnaire (PGWB), and the Menopause-Specific Quality of Life Questionnaire (MENQOL).

Hormonal levels, adverse events (AEs), serious adverse events (SAEs) and clinical labs were evaluated over 52 weeks. Results. Eighty-five participants (91%) were included in the 26-week efficacy analysis. There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS, PGWB, and MENQOL change scores.

Overall AE reports and number of withdrawals as a result of AEs were similar in both groups; however more women in the DHEA group experienced androgenic effects of acne and increased hair growth. Conclusions. In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA resulted in no significant improvements in sexual function over PL therapy over 26 weeks.

A Randomized Trial of Oral DHEA Treatment for Sexual Function, Well-Being, and Menopausal Symptoms in Postmenopausal Women with Low Libido.
J Sex Med. 2009 Jul 10; Panjari M, Bell RJ, Jane F, Wolfe R, Adams J, Morrow C, Davis S (Hubmed)

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Repair of acne scars with Dermicol-P35

2009-07-15T15:56:00.001-07:00
Acne vulgaris is a prevalent skin condition that can cause disfiguring residual scarring. While the complete removal of acne scars is unlikely, several treatments exist that can improve the appearance of acne scars.

Dermal fillers offer a simple, nonsurgical corrective procedure that can provide improved skin texture. Dermicol-P35 (Evolence [Ortho Dermatologics, Skillman, NJ]) is a new, highly purified, ribose cross-linked, porcine collagen-based dermal filler that has demonstrated low immunogenicity and results that persist for at least 12 months.

This article presents the aesthetic results of a male patient treated with Dermicol-P35 for severe facial acne scars.

Repair of acne scars with Dermicol-P35.
Aesthet Surg J. 2009 May-Jun; 29(3 Suppl): S16-8Smith KC (Hubmed)

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Minocycline-induced skin pigmentation

2009-07-15T15:35:00.001-07:00
Minocycline is a commonly used antibiotic for long-term treatment of acne vulgaris. A well-documented and cosmetically displeasing side effect is skin pigmentation.

Three distinct types occur: Type I, blue-black/grey pigment on the face in areas of scarring or inflammation associated with acne; type II, blue-grey pigment on normal skin on the shins and forearms; type III, diffuse muddy-brown discoloration in areas of sun exposure.

Types I and II stain for iron and melanin extracellularly and within macrophages in the dermis. Type III shows nonspecific increased melanin in basal keratinocytes and dermal melanophages staining for melanin only.

The etiology of this pigmentation is unknown, but may be related to polymerized reactive metabolites, insoluble chelation products, and lengthy treatment durations of minocycline compared to other tetracyclines.

Types I and II tend to resolve slowly over time, whereas type III persists indefinitely. Treatment involves early recognition, discontinuation of the drug, sun protection, and laser for persistent pigmentation.

Minocycline-induced skin pigmentation
Acta Dermatovenerol Croat. 2009; 17(2): 123-6Geria AN, Tajirian AL, Kihiczak G, Schwartz RA(Hubmed)

The development and optimization of a fixed combination of clindamycin and benzoyl peroxide aqueous gel

2009-07-14T02:39:00.001-07:00
Fixed combination products of clindamycin 1% (as 1.2% clindamycin phosphate) and benzoyl peroxide (BPO) 5% are commonly used in the treatment of acne vulgaris. Although any given topical acne product may be therapeutically effective, signs and symptoms of cutaneous tolerability may lead to missed applications by the patient, thus limiting adherence to therapy.

BPO and other formulation components such as surfactants, preservatives and high levels of organic solvents can cause cutaneous irritation and dryness.

BPO irritation is dose-dependent. An approach to optimizing the BPO concentration was undertaken to develop a surfactant- and preservative-free, clindamycin and low concentration

The development and optimization of a fixed combination of clindamycin and benzoyl peroxide aqueous gel.
J Drugs Dermatol. 2009 Jul; 8(7): 634-8Bucks D, Sarpotdar P, Yu K, Angel A, Del Rosso J (Hubmed)

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Pathogenesis of acne vulgaris: recent advances.

2009-07-13T20:45:00.001-07:00
J Drugs Dermatol. 2009 Jul; 8(7): 615-8Bhambri S, Del Rosso JQ, Bhambri AAcne vulgaris is the most common disorder seen in ambulatory dermatology practice. Acne causes significant morbidity and the direct costs associated with it exceed $2.2 billion per year in the United States (U.S.). The pathogenesis is multifactorial, and our understanding of the mechanisms involved in the development of acne lesions has improved with time. Follicular hyperkeratinization, sebum production, presence of Propionibacterium acnes (P. acnes), inflammatory mediators, and androgens have been identified as key components of acne pathophysiology. Recent advances have been made in this area with the discovery of P. acnes interaction with Toll-like receptors (TLRs), vaccines targeting P. acnes or its components, antimicrobial peptides and the role of hormones.

Comparative efficacy and safety results of two topical combination acne regimens.

2009-07-13T18:09:00.001-07:00
J Drugs Dermatol. 2009 Jul; 8(7): 624-30Kircik LHCombination therapy has become the standard for the management of acne, particularly for moderate-to-severe cases. Among these combinations, those regimens containing benzoyl peroxide (BPO), clindamycin and a retinoid have been used frequently as they address most aspects of acne pathogenesis. This study compares the efficacy and safety of two common topical treatment regimens in the treatment of a moderate to severe facial acne vulgaris: fixed-combination gel containing BPO 5% and clindamycin 1% (BPO/C) plus tretinoin microsphere gel 0.04% (RAM) versus a regimen of a fixed-combination gel containing clindamycin phosphate 1.2% and tretinoin 0.025% (CPT) plus a once-daily BPO 5% wash. While both regimens were safe and effective, regimen BPO/C+RAM yielded a more rapid onset of effect versus regimen CPT+BPO against both non-inflammatory and inflammatory lesions. Both treatment regimens were well-tolerated.

Tretinoin microsphere gel pump 0.04% versus tazarotene cream 0.05% in the treatment of mild-to-moderate facial acne vulgaris.

2009-07-13T14:10:00.001-07:00
J Drugs Dermatol. 2009 Jul; 8(7): 650-4Kircik LHThis 12-week, single-center, investigator-blinded, randomized, parallel-design study assessed the safety and efficacy of tretinoin microsphere gel 0.04% delivered by pump (TMG PUMP) to tazarotene cream 0.05% (TAZ) in mild-to-moderate facial acne vulgaris. Efficacy measurements included investigator global assessment (IGA), lesion counts, and subject self-assessment of acne signs and symptoms. Efficacy was generally comparable between treatment groups, although TMG PUMP provided more rapid results in several parameters. IGA showed a more rapid mean change from baseline at week 4 in the TMG PUMP group (-0.18 versus -0.05 in the TAZ subjects). TMG PUMP yielded more rapid improvement in papules. At week 4, the mean percentage change from baseline in open comedones was statistically significant at -64% in the TMG PUMP group (P=0.0039, within group) versus -19% in the TAZ group (not statistically significant within the group; P=0.1875). Skin dryness, peeling and pruritus were significantly less in the TMG PUMP group as early as week 4. Adverse events related to study treatment were rare in both groups and all resolved upon discontinuation of study medication.

Advancement in benzoyl peroxide-based acne treatment: methods to increase both efficacy and tolerability.

2009-07-12T18:22:00.001-07:00
J Drugs Dermatol. 2009 Jul; 8(7): 657-61Fakhouri T, Yentzer BA, Feldman SRBACKGROUND: Antibiotic resistance of Propionibacterium acnes (P. acnes) is a growing phenomenon in the wake of widespread use of topical and systemic antibiotics for acne vulgaris. Benzoyl peroxide has a proven track record of safety and efficacy, and can decrease reliance on antibiotics in the treatment of acne. PURPOSE: To review the literature for methods to increase the efficacy and tolerability of benzoyl peroxide (BPO). METHODS: A PubMed literature search was done using the terms "benzoyl peroxide," "vehicle," "mechanism," and "delivery system." Relevant papers were reviewed for methods of increasing BPO efficacy and tolerability. RESULTS: BPO in concentrations of 2.5%, 5% and 10% are equally effective at treating inflammatory acne. However, higher concentrations are associated with more adverse effects. The efficacy of BPO may be enhanced by the presence of Vitamin E and tertiary amines. BPO is also more efficacious if used in combination with topical retinoids than as a monotherapy. Novel vehicles including a microparticle delivery system and those with a hydrophase or urea base increase the tolerability of BPO without sacrificing efficacy. CONCLUSION: Benzoyl peroxide has a proven track record of safety and efficacy for the treatment of acne. Recent discoveries have provided new methods of increasing the efficacy and tolerability of topical BPO, making it useful as monotherapy for mild acne or as an adjunct in the treatment of moderate to severe acne vulgaris.

Treatment of acne vulgaris using blue light photodynamic therapy in an African-American patient.

2009-07-11T23:29:00.001-07:00
J Drugs Dermatol. 2009 Jul; 8(7): 669-71Terrell S, Aires D, Schweiger ESBACKGROUND: Studies indicate photodynamic therapy is an effective treatment of inflammatory acne lesions on patients with Fitzpatrick skin types 1-3. There is a lack of evidence in the literature regarding the use of photodynamic therapy to treat acne vulgaris in African American patients. This article reports the first case of blue light photodynamic therapy to treat moderate inflammatory facial acne on an African American patient with type 5 skin. OBSERVATIONS: This article describes a 26-year-old African American woman with moderate inflammatory facial acne vulgaris. On examination, she had over 15 inflammatory papules on her face and post-inflammatory hyperpigmentation. The patient had a history of treatment failure with the following therapies: topical benzoyl peroxide, topical antibiotics, topical retinoids and oral antibiotics. At presentation, the patient was using a combination topical benzoyl peroxide/clindamycin product in the morning and tazoratene gel in the evening without success. The patient was treated with 20% aminolevulinic acid/blue-light photodynamic therapy spaced monthly for a total of four treatments, a once-daily application of hydroquinone 4% cream and her existing topical regimen. The patient reported significant improvement of inflammatory acne lesions and post-inflammatory hyperpigmentation following two treatments with photodynamic therapy and was virtually clear of all acne lesions after the third treatment. CONCLUSION: Photodynamic therapy is an emerging remedy for patients with acne vulgaris resistant to standard treatment, particularly in patients with skin of color who are more sensitive to post-inflammatory hyperpigmentation. In this African-American patient, 20% aminolevulinic acid/blue-light photodynamic therapy was effective in treating facial acne vulgaris.

Effects of oral antibiotic roxithromycin on quality of life in acne patients.

2009-07-10T18:03:00.001-07:00
J Dermatol. 2009 Jul; 36(7): 383-91Kobayashi M, Kabashima K, Nakamura M, Tokura YMacrolides are effective for inflammatory acne, but there are not many studies on roxithromycin. In this study, patients with acne were surveyed for improvement of their quality of life after treatment with roxithromycin. Patients were orally given roxithromycin 300 mg daily for 2-4 weeks. At the time of pre- and post-treatment, the dermatologists graded the severity of acne symptoms, and the patients answered questionnaires. In 123 half faces of 76 patients, 80 half faces were improved, 42 half faces were not changed, and one half face was deteriorated. The score of "symptom and feeling" and "leisure" in DLQI-J and "emotions" and "symptoms" in Skindex-29-J were significantly decreased after roxithromycin treatment. Roxithromycin has a therapeutic effect on inflammatory acne and leads to improvement of quality of life in the patients.

Combined oral contraceptive pills for treatment of acne.

2009-07-10T16:14:00.000-07:00
Cochrane Database Syst Rev. 2009; CD004425Arowojolu AO, Gallo MF, Lopez LM, Grimes DA, Garner SEBACKGROUND: Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women. OBJECTIVES: To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies. SEARCH STRATEGY: We searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We wrote to authors of identified trials to seek any unpublished or published trials that we might have missed. SELECTION CRITERIA: All randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placebo or another active therapy for acne in women were eligible. DATA COLLECTION AND ANALYSIS: We extracted data on total and specific (i.e., open or closed comedones, papules, pustules and nodules) facial lesion counts; acne severity grades; global assessments by the clinician or the participant and discontinuation due to adverse events. Data were entered and analyzed in RevMan. MAIN RESULTS: The search yielded 25 trials: 7 placebo-controlled trials made 4 different comparisons, 17 trials made 13 comparisons between 2 different COC regimens, and 1 additional trial compared a COC to an antibiotic. COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. Differences in the comparative effectiveness of COCs containing varying progestin types and dosages, though, were less clear. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel, although this apparent advantage was based on limited data. A COC with cyproterone acetate might result in better acne outcomes than one with desogestrel; however, the three studies comparing these COCs produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes in one trial, but a second trial found the COC groups were similar. AUTHORS' CONCLUSIONS: The four COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few important differences were found between COC types in their effectiveness for treating acne. How COCs compare to alternative acne treatments is unknown since limited data were available regarding this question.

Pyrin Modulates the Intracellular Distribution of PSTPIP1.

2009-07-09T20:44:00.001-07:00
PLoS One. 2009; 4(7): e6147Waite AL, Schaner P, Richards N, Balci-Peynircioglu B, Masters SL, Brydges SD, Fox M, Hong A, Yilmaz E, Kastner DL, Reinherz EL, Gumucio DLPSTPIP1 is a cytoskeleton-associated adaptor protein that links PEST-type phosphatases to their substrates. Mutations in PSTPIP1 cause PAPA syndrome (Pyogenic sterile Arthritis, Pyoderma gangrenosum, and Acne), an autoinflammatory disease. PSTPIP1 binds to pyrin and mutations in pyrin result in familial Mediterranean fever (FMF), a related autoinflammatory disorder. Since disease-associated mutations in PSTPIP1 enhance pyrin binding, PAPA syndrome and FMF are thought to share a common pathoetiology. The studies outlined here describe several new aspects of PSTPIP1 and pyrin biology. We document that PSTPIP1, which has homology to membrane-deforming BAR proteins, forms homodimers and generates membrane-associated filaments in native and transfected cells. An extended FCH (Fes-Cip4 homology) domain in PSTPIP1 is necessary and sufficient for its self-aggregation. We further show that the PSTPIP1 filament network is dependent upon an intact tubulin cytoskeleton and that the distribution of this network can be modulated by pyrin, indicating that this is a dynamic structure. Finally, we demonstrate that pyrin can recruit PSTPIP1 into aggregations (specks) of ASC, another pyrin binding protein. ASC specks are associated with inflammasome activity. PSTPIP1 molecules with PAPA-associated mutations are recruited by pyrin to ASC specks with particularly high efficiency, suggesting a unique mechanism underlying the robust inflammatory phenotype of PAPA syndrome.

Effect of body mass index on clinical manifestations in patients with polycystic ovary syndrome.

2009-07-07T16:51:00.001-07:00
Int J Gynaecol Obstet. 2009 Jul 2; Tamimi W, Siddiqui IA, Tamim H, Aleisa N, Adham MOBJECTIVE: To determine whether there is a correlation between body mass index (BMI) and blood pressure or clinical features such as hirsutism in women with polycystic ovary syndrome (PCOS). METHOD: In this cross-sectional study, 62 women with PCOS were allocated to one of 3 groups according to a BMI range defining normal weight, overweight, or obesity. Blood pressure, waist-to-hip ratio, Ferriman and Gallwey hirsutism score, and presence of acne were recorded for each participant and the means were compared among groups. RESULTS: The overall mean age was 35.85+/-5.03 years; BMI, 31.91+/-6.40; systolic and diastolic blood pressure, 113.02+/-16.10 mm Hg and 71.79+/-10.04 mm Hg; waist-to-hip ratio, 0.82+/-0.07; and hirsutism score, 3.63+/-4.35. Acne was present in 24 participants. Of these, 8 (33.3%) were overweight and 13 (54.2%) obese. When groups were compared, a progressive and significant increase in systolic and diastolic blood pressure was observed from the normal weight to the obese group. CONCLUSION: We observed a significant and progressive correlation between BMI and both blood pressure and clinical features in women with PCOS.

Quality of medical care of patients with acne vulgaris in Germany - nationwide survey of pharmacy clients.

2009-07-05T19:01:00.001-07:00
J Dtsch Dermatol Ges. 2009 Jul 1; Franzke N, Zimmer L, SchÃ¤fer I, Radermacher C, Kresken J, Augustin MBackground: No empirical "real world" data on the health care of patients with acne vulgaris in Germany currently exist. The objective of this study was to get an informative basis of health care of patients with acne vulgaris in Germany, taking into account both doctor-prescribed medication and self-medication. Patients and Methods: Surveying both medically and self-treated patients, n = 504 patients with acne vulgaris were interviewed in 48 pharmacies nationwide. In addition to socio-demographic data, the duration of illness, localization and therapy as well as patient-relevant outcomes such as patient benefit, psychological strain and markers of compliance were evaluated. The participation and significance of individual treatment providers were also evaluated. Results: A large percentage of the patients found acne vulgaris to be burdensome. Despite the longstanding necessity of treatment and the chronic course of the illness, the treatment of acne vulgaris was deemed a rather satisfactory experience by most of those affected. Dermatologists were most frequently consulted for treatment. A great number of medicinal products were further acquired through self-medication or after consulting with a pharmacist. The medically regulated therapies predominantly complied with the latest guidelines. Conclusions: Acne vulgaris is a burdensome, socio-economically relevant illness, and dermatologists treat most cases in Germany. Surveying across a network of pharmacies offers a unique access to relevant treatment data. Selection effects, particularly by choice of doctors and self-medication, were minimized.

Treatment of Punched-Out Atrophic and Rolling Acne Scars in Skin Phototypes III, IV, and V with Variable Square Pulse Erbium:Yttrium-Aluminum-Garnet Laser Resurfacing.

2009-07-01T15:11:00.001-07:00
Dermatol Surg. 2009 Jun 22; Wanitphakdeedecha R, Manuskiatti W, Siriphukpong S, Chen TMBACKGROUND Treatment of acne scars remains a challenge, especially in dark-skinned individuals. Treatment parameters may be optimized by selecting appropriate pulse width and laser energy that enhance tissue thermal response with limited morbidity. OBJECTIVE To determine the efficacy and side effects of variable square pulse (VSP) erbium:yttrium-aluminum-garnet (Er:YAG) laser resurfacing for treatment of punched-out atrophic and rolling acne scars. METHODS Twenty-four subjects with acne scars were treated monthly for 2 months with four passes of VSP Er:YAG laser resurfacing using a 7-mm spot size and a fluence of 0.4 J/cm(2). Subjects were divided into two groups and treated with two different pulse widths: 300 mus (short pulse, SP) and 1,500 mus (extra-long pulse, XLP). Objective and subjective assessments were obtained at baseline and 1, 2, and 4 months after treatment. RESULTS In the SP group, skin smoothness improved significantly (p

SAPHO syndrome in an adult with ulcerative colitis responsive to intravenous pamidronate: a case report and review of the literature.

2009-07-01T02:38:00.001-07:00
Rheumatol Int. 2009 Jun 24; Siau K, Laversuch CJSynovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare group of sterile, inflammatory osteoarticular disorders classically associated with skin lesions. It is occasionally associated with enteropathic disease such as ulcerative colitis. We present a 39-year-old patient with chronic ulcerative colitis who developed enteropathic SAPHO and responded well to pamidronate. We discuss the clinicopathological features with particular attention to bone pathology, and perform a literature review of this fascinating syndrome.

Acne's relationship with psychiatric and psychological morbidity: results of a school-based cohort study of adolescents.

2009-06-30T16:37:00.001-07:00
J Eur Acad Dermatol Venereol. 2009 Jun 23; Magin P, Pond C, Smith W, Goode SAbstract Background There is a considerable number of studies linking acne with psychological and psychiatric morbidities, although this literature is not entirely consistent and is largely cross-sectional in methodology. Objective This study aims to establish the relationship of acne and psychological and psychiatric morbidity in adolescents in a community setting and, via a longitudinal methodology, provide evidence for causality in the relationship. Methods The study was a 12-month cohort study. Two hundred and forty-four students in Years 8, 9 and 11 (ages 14-17) at four Australian high schools were assessed at baseline 6 months and 12 months. Presence and severity of acne were assessed, along with a number of psychological and psychiatric morbidities and personality traits (depression, anxiety, overall psychiatric morbidity, self-consciousness, neuroticism and introversion/extraversion) and other demographic variables. Results Of the 244 participating students, 209 (86%) completed all three rounds of data collection. A further 26 (11%) completed two rounds. The study failed to demonstrate an association of the presence of acne or of acne severity with the examined measures of psychological and psychiatric morbidity, and no evidence for an effect of acne in their causation. Conclusion The relationship of acne and psychological morbidities found in previous health care settings was not found in this community sample. This may be due to differences between community and clinical acne populations. Other possible reasons for this finding are attenuation of psychological morbidity in subjects in this study by successful acne treatment, and the role of personality traits in the complex relationship between acne and psychological morbidities. It is suggested that this relationship would be best investigated by means of longer-term cohort studies enlisting subjects at an early age, prior to the onset of acne. Conflicts of interest None declared.

New developments in our understanding of acne pathogenesis and treatment.

2009-06-27T17:27:00.001-07:00
Exp Dermatol. 2009 Jun 23; Kurokawa I, Danby FW, Ju Q, Wang X, Xiang LF, Xia L, Chen W, Nagy I, Picardo M, Suh DH, Ganceviciene R, Schagen S, Tsatsou F, Zouboulis CCPlease cite this paper as: New developments in our understanding of acne pathogenesis and treatment. Experimental Dermatology 2009.Abstract: 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.

[Evaluation and treatment of adolescent girls with hirsutism]

2009-06-26T18:23:00.001-07:00
Ginekol Pol. 2009 May; 80(5): 374-8Bumbuliene Z, Alisauskas JClinical manifestations of androgen excess which are skin and hair related (hirsutism, acne, alopecia) are common and distressing symptoms for an adolescent girls. During puberty and at the time of the first menstruation cycles, physiological hyperandrogenism can be observed. The causes of hirsutism can be various, including familial, idiopathic, and those, caused by excess androgen secretion by the ovary (PCOS, tumors), or by adrenal glands (congenital adrenal hyperplasia, tumor), or exogenous pharmacologic sources of androgens. The diagnosis and treatment of hirsutism remains quite problematic due to innumerous endocrinologic aspects and unsatisfactory treatment results. Androgen excess during puberty must be appropriately recognized, clinically evaluated and treated. Pharmacologic and cosmetic treatments may have beneficial effect. Oral contraceptives and antiadrogens combinations may be recommended as the treatment of choice in adolescents.

Expression of human neutrophil proteins in acne vulgaris.

2009-06-26T15:37:00.001-07:00
J Eur Acad Dermatol Venereol. 2009 Jun 22; AdÄ±Åen E, YÃ¼ksek J, Erdem O, Aksakal F, Aksakal ABackground In acne vulgaris patients, the presence of a dysregulation of the production of innate and specific antimicrobial peptides has been postulated. Objective This study aims to determine whether human neutrophil proteins (HNP) 1-3 are expressed in acne patients. Materials and methods HNP 1-3 expression was investigated in 35 acne patients treated with isotretinoin and in 25 healthy subjects. At the beginning of the study, two skin biopsies were taken from acne patients; one biopsy was taken from an established pustule and one from uninvolved skin, and the biopsies were repeated after treatment. Only one biopsy was obtained from controls. Results The statistical analysis showed that pustular lesions of acne patients had significantly higher levels of perivascular and interstitial HNP 1-3 expression when compared with the biopsy of uninvolved skin of these patients (P = 0.003, P = 0.001, respectively) and with that of healthy controls (P = 0.007, P = 0.014, respectively). Isotretinoin treatment achieved a decrease in the perivascular and interstitial HNP 1-3 expression of pustular lesions (P = 0.01, P = 0.001, respectively). Conclusion Our current study demonstrates the novel observation that a recently identified antimicrobial peptide, HNP 1-3, is expressed in neutrophils of acne inflammation but not in uninvolved skin of these patients. These results suggest that HNP 1-3 may contribute to the development of inflammatory lesions of acne. Conflicts of interest None declared.

Efficacy of topical tacrolimus 0.3% in clobetasol propionate 0.05% ointment in therapy-resistant cutaneous lupus erythematosus: a cohort study.

2009-06-26T06:27:00.001-07:00
Clin Exp Dermatol. 2009 Jun 22; Madan V, August PJ, Chalmers RJSummary Background. Despite a range of available topical and systemic therapies, treatment of cutaneous lupus erythematosus (CLE) can be challenging. Objectives. To evaluate the efficacy of a specially formulated preparation of tacrolimus 0.3% in clobetasol propionate 0.05% ointment (TCPO) in the treatment of CLE. Methods. Case notes of 13 patients with treatment-resistant CLE (11 discoid LE, 1 systemic LE and 1 subacute cutaneous LE) who had used twice-daily TCPO (TCPO group) were reviewed. These were compared with five similar patients with resistant CLE who had been given 0.1% tacrolimus ointment alone (TO group). Results. In the TCPO group (mean treatment duration 20 months, range 1-72), a good or excellent response was seen in five and six patients, respectively; one patient showed slight improvement. Telangiectasia and acne were observed in two patients. No systemic side-effects were noted. In the TO group (mean treatment duration 6 months, range 1-24), one patient showed good improvement and two showed slight improvement. Conclusion. The results of our small retrospective study suggest that TCPO may be more effective than either 0.1% tacrolimus or clobetasol propionate 0.05% ointment monotherapy in the treatment of recalcitrant CLE. Randomized controlled trials are needed to confirm these preliminary findings.

Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome.

2009-06-26T02:14:00.001-07:00
Gynecol Endocrinol. 2009 Jun 23; 1-6Zacche MM, Caputo L, Filippis S, Zacche G, Dindelli M, Ferrari ABackground. Polycystic ovary syndrome (PCOS) is the most common endocrine cause of hirsutism, acne and pattern alopecia, often characterised by ovulation disorders (usually manifested as oligo- or amenorrhea). In addition, 30-40% of women with PCOS have impaired glucose tolerance, and a defect in the insulin signalling pathway seems to be implicated in the pathogenesis of insulin resistance. For this reason, insulin-lowering medications represent novel approach in women with PCOS. The aim of this study was to evaluate the effects of myo-inositol (MYO), an isoform of inositol, belonging to the vitamin B complex, in the treatment of cutaneous disorders like hirsutism and acne. Methods. Fifty patients with PCOS were enrolled in the study. BMI, LH, FSH, insulin, HOMA index, androstenedione, testosterone, free testosterone, hirsutism and acne were evaluated at the baseline and after receiving MYO therapy for 6 months. Results. After 3 months of MYO administration, plasma LH, testosterone, free testosterone, insulin and HOMA index resulted significantly reduced; no significant changes were observed in plasma FSH and androstenedione levels. Both hirsutism and acne decreased after 6 months of therapy. Discussion. MYO administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne.

An investigation of the association between diet and occurrence of acne: a rational approach from a traditional Chinese medicine perspective.

2009-06-26T01:17:00.001-07:00
Clin Exp Dermatol. 2009 Jun 22; Law MP, Chuh AA, Molinari N, Lee ASummary Background. The association between diet and acne vulgaris has long been suggested but remains unproven in western medicine. In contrast, the diet-acne relationship is considered important in traditional Chinese medicine (TCM). Aim. To investigate the association between diet and acne, using a TCM approach. Methods. Using a cross-sectional study of 322 entrants to a university in Hong Kong, China, we examined the participants' clinical severity of acne using the Global Acne Grading System and the participants' yin and yang scores using a quantitative method. We then divided them into two groups, a yin-predominant group (yin-PG) and a yang-predominant group (yang-PG) before the diet-acne relationship was investigated. Results. In total, 82 (25.2%) participants were in the clinical acne group and 240 (74.5%) were in the reference group. There were 155 (48.1%) participants in the yin-PG and 167 (51.9%) in the yang-PG group. No association of diet and acne was found when the participants were considered as a homogenous group. In yin-PG, intake of foods from street stalls (P = 0.04) was significantly associated with a lower incidence of acne. In yang-PG, the intake of desserts (P = 0.04) and fresh fruit juices (P = 0.02) was significantly associated with a higher incidence of acne, whereas the intake of dairy and soy products (P = 0.04) was significantly associated with a lower incidence of acne. Conclusions. The application of a TCM approach led to the detection of significant associations between diet and the incidence of acne.

Remote assessment of acne: the use of acne grading tools to evaluate digital skin images.

2009-06-25T18:00:00.001-07:00
Telemed J E Health. 2009 Jun; 15(5): 426-30Bergman H, Tsai KY, Seo SJ, Kvedar JC, Watson AJDigital imaging of dermatology patients is a novel approach to remote data collection. A number of assessment tools have been developed to grade acne severity and to track clinical progress over time. Although these tools have been validated when used in a face-to-face setting, their efficacy and reliability when used to assess digital images have not been examined. The main purpose of this study was to determine whether specific assessment tools designed to grade acne during face-to-face visits can be applied to the evaluation of digital images. The secondary purpose was to ascertain whether images obtained by subjects are of adequate quality to allow such assessments to be made. Three hundred (300) digital images of patients with mild to moderate facial inflammatory acne from an ongoing randomized-controlled study were included in this analysis. These images were obtained from 20 patients and consisted of sets of 3 images taken over time. Of these images, 120 images were captured by subjects themselves and 180 were taken by study staff. Subjects were asked to retake their photographs if the initial images were deemed of poor quality by study staff. Images were evaluated by two dermatologists-in-training using validated acne assessment measures: Total Inflammatory Lesion Count, Leeds technique, and the Investigator's Global Assessment. Reliability of raters was evaluated using correlation coefficients and kappa statistics. Of the different acne assessment measures tested, the inter-rater reliability was highest for the total inflammatory lesion count (r = 0.871), but low for the Leeds technique (kappa = 0.381) and global assessment (kappa = 0.3119). Raters were able to evaluate over 89% of all images using each type of acne assessment measure despite the fact that images obtained by study staff were of higher quality than those obtained by patients (p < 0.001). Several existing clinical assessment measures can be used to evaluate digital images obtained from subjects with inflammatory acne lesions. The level of inter-rater agreement is highly variable across assessment measures, and we found the Total Inflammatory Lesion Count to be the most reliable. This measure could be used to allow a dermatologist to remotely track a patient's progress over time.

Prevalence and risk factors of inflammatory acne vulgaris in rural and urban Ghanaian schoolchildren.

2009-06-24T15:53:00.001-07:00
Br J Dermatol. 2009 May 26; Hogewoning AA, Koelemij I, Amoah AS, Bouwes Bavinck JN, Aryeetey Y, Hartgers F, Yazdanbakhsh M, Willemze R, Boakye DA, Lavrijsen AP

Photodynamic therapy with low-strength ALA, repeated applications and short contact periods (40-60 minutes) in acne, photoaging and vitiligo.

2009-06-24T04:34:00.001-07:00
J Drugs Dermatol. 2009 Jun; 8(6): 562-8Serrano G, Lorente M, Reyes M, MillÃ¡n F, Lloret A, Melendez J, Navarro M, Navarro MTopical aminolevulinic acid (ALA) photodynamic therapy (PDT) is currently being used for the treatment of actinic keratosis of the face and scalp. This study reports the results obtained after three to four treatments with ALA-PDT in patients with acne (n=12), photoaging (n=8) and vitiligo (n=6). ALA was applied on large areas (e.g., full face) and at very low strengths (1-2%). Side effects were minimal and self-limited.

Painful parotid hypertrophy with bulimia: a report of medical management.

2009-06-23T21:35:00.001-07:00
J Drugs Dermatol. 2009 Jun; 8(6): 577-9Park KK, Tung RC, de Luzuriaga ARIn eating disorders, such as bulimia nervosa, body image disturbance often extends beyond the realm of weight and shape into the dermatologic spectrum. While commonly associated conditions due to binging and self-induced vomiting include cutaneous entities (e.g., Russell's sign, acne, alopecia and hypertrichosis) and oral pathologies (e.g., enamel erosion, caries and mild parotid hypertrophy), a rare but troubling manifestation is disfiguring parotid enlargement (sialoadenomegaly). This article presents a case of painful sialoadenomegaly associated with hyperamylasemia in a bulimic patient successfully managed with pilocarpine.

Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome treated with a combination of isotretinoin and pamidronate.

2009-06-23T18:46:00.001-07:00
J Am Acad Dermatol. 2009 Jul; 61(1): 123-5Galadari H, Bishop AG, Venna SS, Sultan E, Do D, Zeltser RSynovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a clinically heterogeneous entity, encompassing a variety of debilitating conditions that have in common inflammation of the skeletal system and skin. To date, there is a paucity of documented efficacious treatment options. We report a 48-year-old man with skeletal and cutaneous signs and symptoms who improved dramatically after treatment with a combination of isotretinoin and pamidronate. This report provides an alternative treatment regimen for SAPHO that addresses the possible underlying pathophysiology of this likely underdiagnosed syndrome.

Comparison of 2 clindamycin 1%-benzoyl peroxide 5% topical gels used once daily in the management of acne vulgaris.

2009-06-20T17:22:00.001-07:00
Cutis. 2009 May; 83(5): 265-72Dhawan SSCombination therapy for the topical treatment of acne vulgaris using benzoyl peroxide (BPO) and an antibiotic is more efficacious and better tolerated than treatment with either component alone. Moreover, the addition of BPO to antibiotic therapy is recommended as a means of preventing the development of Propionibacterium acnes antibiotic resistance. However, BPO is an irritant, and the dryness and irritation experienced by some patients using topical therapy containing BPO can negatively impact compliance. Historically, once-daily treatment application has enhanced compliance versus twice daily. The current 12-week study aimed to compare the efficacy of a clindamycin 1%-BPO 5% topical gel with the hydrating excipients dimethicone and glycerin (C/BPO HE) and a clindamycin 1%-BPO 5% topical gel that does not contain hydrating excipients (C/BPO) applied once daily for the treatment of 20 participants with facial acne vulgaris and to determine if there were differences in product preference and participant acceptability between the treatments. Both C/BPO HE and C/BPO were effective in the treatment of acne, with substantive reductions (-60.8% and -61.3%, respectively) in total inflammatory lesions at week 4 in both treatment groups. Participants receiving C/BPO HE demonstrated a more consistent treatment response than with C/BPO, with incremental reductions in total inflammatory lesions at each time point, whereas the response to C/BPO waned at week 8. As a result, greater percentage reductions in inflammatory and noninflammatory lesions were observed with C/BPO HE treatment than C/BPO treatment at week 8 (papules: -71.9% vs -49.4%, P=.053; pustules: -64.8% vs -28.0%, P=.134; open comedones: -44.5% vs 2.6%, P=.480; closed comedones: -35.5% vs -26.3%, P=.501). With the exception of papules, greater reductions in all lesion subtypes also were observed at week 12. None of the between-group differences reached statistical significance. Both treatment groups displayed similar disease signs and symptoms throughout the study period. However, scaling, erythema, dryness, and pruritus occurred more frequently in participants using C/BPO. Treatment satisfaction was greatest with C/BPO HE; participants reported that this formulation was easy to apply and 100% (9/9) of participants reported that they would continue using C/BPO HE compared with 80% (8/10) of participants using C/BPO. Both treatments were well-tolerated. In this pilot study, both formulations were effective in the treatment of inflammatory and noninflammatory acne lesions, but C/BPO HE produced a more consistent reduction in total inflammatory lesions over 12 weeks. The addition of hydrating excipients in the C/BPO HE formulation appears to improve patient tolerance and acceptance, which will likely help patients to comply with therapy.

Smoking and obesity are associated factors in acne inversa: results of a retrospective investigation in 100 patients.

2009-06-17T07:02:00.001-07:00
Eur J Dermatol. 2009 Jun 15; Cesko E, KÃ¶rber A, Dissemond JAcne inversa is a chronic, recurring acneiform skin disease with inflammation of the follicular epithelium of the sebaceous glands and the terminal hair follicle. It primarily manifests in the intertriginous areas. So far, the aetiology of acne inversa is unknown. Smoking, amongst others, is being discussed and should be evaluated as a possible aetiological factor. In this study a retrospective investigation was carried out in 100 patients with acne inversa. The parameters; age, BMI, sex, weight, height, location of acne inversa, quantity of smoking, smoking behaviour and the date of initial diagnosis of acne inversa were considered. In most cases, the acne inversa is located in the axillary and inguinal areas. Overall, 96% of the 100 patients had a positive, long standing, on average almost 20-year, smoking history. On average, over 20 cigarettes are smoked daily. Over 50% of the patients are overweight. Merely 26.1% fall into the normal weight category. Our results suggest that especially smoking, but also obesity, may present an aetiologically relevant factor in the origin of acne inversa.

Accumulation of lipid peroxide in the content of comedones may be involved in the progression of comedogenesis and inflammatory changes in comedones.

2009-06-17T05:08:00.001-07:00
J Cosmet Dermatol. 2009 Jun; 8(2): 152-8Tochio T, Tanaka H, Nakata S, Ikeno HBackground Previous studies reported that lipid peroxide (LPO) caused by oxidation of sebum is associated with the progression of acne vulgaris, and that therapy with antioxidative ingredients is efficacious for treatment. In this study, we hypothesized that lipid accumulation in comedones induces progression of comedogenesis and inflammatory changes in comedones, and investigated the possible role of accumulated LPO in comedogenesis and its inflammatory changes. Methods We first sampled comedones and the stratum corneum from patients with acne vulgaris. The quantities of LPO, interleukin-1-alpha (IL-1alpha), and NF-kappa-B (NF-kappaB) in comedones and in the stratum corneum from each patient were measured for comparison. Next, comedones were sampled again from the same patients and classified into five groups: microcomedo (MC), noninflammatory open comedo (NIOC), noninflammatory closed comedo (NICC), inflammatory open comedo (IOC), and inflammatory closed comedo (ICC). We measured quantities of LPO in each group. Results The quantities of LPO, IL-1alpha, and NF-kappaB were significantly higher in the content of comedones than those in the stratum corneum. The quantities of LPO in the content of IOC and ICC were significantly higher than those of MC, NIOC, and NICC; however, there were no significant differences in quantities of LPO between the content of MC, NIOC, and NICC. Conclusions We conclude that the accumulation of a certain amount of LPO in the content of comedones may play an important role in the progression of comedogenesis and the excessive accumulation of LPO may be involved in inflammatory changes in comedones.

Comparison of bioactive compounds content, free radical scavenging and anti-acne inducing bacteria activities of extracts from the mangosteen fruit rind at two stages of maturity.

2009-06-16T15:27:00.001-07:00
Fitoterapia. 2009 Jun 11; Pothitirat W, Chomnawang MT, Supabphol R, Gritsanapan WContents of bioactive components, free radical scavenging and anti-acne producing bacteria activities of young and mature fruit rind extracts of mangosteen were compared. The young fruit rind extract contained significantly higher contents of phenolics and tannins and promoted higher free radical scavenging activity than the mature fruit rind extract, while the later extract contained higher contents of flavonoids and alpha-mangostin xanthone and gave higher anti-acne producing bacteria activity than the young fruit rind extract. Thus, the young and mature stages of mangosteen fruit rind should be beneficial for further development of antioxidant and anti-acne pharmaceutical preparations, respectively.

Depressive symptoms and suicidal ideation during isotretinoin treatment: a 12-week follow-up study of male Finnish military conscripts.

2009-06-16T13:55:00.001-07:00
J Eur Acad Dermatol Venereol. 2009 Jun 11; Rehn L, Meririnne E, HÃ¶Ã¶k-Nikanne J, IsometsÃ¤ E, Henriksson MObjective To investigate the putative association between isotretinoin treatment and depressive symptoms or suicidal ideation among Finnish male military conscripts. Methods Consecutive acne patients were enrolled into an uncontrolled, prospective 12-week follow-up study conducted at the Central Military Hospital, Helsinki, Finland. Of the 135 patients prescribed isotretinoin, 126 (93.3%) completed the follow-up. Depression and suicidal ideation were investigated with the Beck Depression Inventory (BDI) at baseline, weeks 4-6, and weeks 10-12. Results BDI mean score was low at baseline and declined further significantly (p < 0.001) during the follow-up from 3.0 (SD 3.948) to 1.8 (SD 3.783) among patients on isotretinoin. Moreover, the proportion of patients with clinically significant depressive symptoms (BDI >/= 10) declined non-significantly from 7.1 % to 3.2 %. Suicidal ideation was reported by 17 (13.5 %) patients at baseline and 9 (7.1%) patients at the end of the follow-up (NS). During the follow-up, one non-depressed patient attempted suicide while intoxicated by alcohol. Conclusion On group level, isotretinoin seems not to be typically associated with treatment-emergent depression or suicidal ideation among young men. However, the possibility that individual patients may be susceptible for mood effects of isotretinoin as a rare idiosyncratic reaction can not be excluded. Conflicts of interest None declared.

Retinoic acid 4-hydroxylase inducibility and clinical response to isotretinoin in patients with acne.

2009-06-16T01:42:00.001-07:00
J Am Acad Dermatol. 2009 Jun 12; Wang F, Kwak HS, Elbuluk N, Kaczmarek AL, Hamilton T, Voorhees JJ, Fisher GJ, Kang SBACKGROUND: The cytochrome P450 (CYP) enzyme CYP26 (retinoic acid [RA] 4-hydroxylase) initiates the catabolism of all-trans RA (tRA) and limits the effects of tRA. The CYP26 enzyme acts specifically on tRA, but not 13-cis RA (isotretinoin), a retinoid used to treat severe acne. However, 13-cis RA can isomerize to tRA, which can then be metabolized by CYP26. OBJECTIVE: In healthy individuals, we assessed the variability of CYP26 enzymatic activity. We then investigated whether response to oral 13-cis RA among patients with acne correlates with variability in CYP26 expression. METHODS: In healthy individuals, we isolated microsomal fractions from the epidermis of keratome biopsy specimens and measured CYP26 enzymatic activity in untreated skin and skin treated with tRA. Enzymatic activity was determined based on rate of formation of 4-hydroxy RA (pg/min/mg microsomal protein). Using real-time polymerase chain reaction we quantified CYP26 messenger RNA induction after tRA application in patients with acne who responded or did not respond to one course of 13-cis RA. RESULTS: In normal-appearing skin (N = 118), CYP26 enzymatic activity was widely variable (1-180 pg/min/mg microsomal fraction; mean 42.7 +/- 3.5). Furthermore, CYP26 enzymatic activity was inducible in a dose-dependent manner in normal-appearing skin after tRA application, but not correlated with age or sex (N = 29). In patients with acne, CYP26 messenger RNA induction after 0.1% tRA application did not differ (P > .05) between patients who responded (N = 8, 587 +/- 325-fold) or did not respond (N = 8, 657 +/- 227-fold) to one course of 13-cis RA. LIMITATIONS: The small number of patients with acne treated with 13-cis RA was a major limitation. CONCLUSION: Factors other than CYP26 activity may determine response to isotretinoin in acne.

Sorafenib-induced erythema multiforme in metastatic renal cell carcinoma.

2009-06-13T01:44:00.001-07:00
Cutan Ocul Toxicol. 2009; 28(2): 90-2BilaÃ§ C, MÃ¼ezzinoÄlu T, Ermertcan AT, Kayhan TC, TemeltaÅ G, OztÃ¼rkcan S, Temiz PSorafenib is a new therapeutic agent being used in metastatic renal cell carcinoma, hepatocellular carcinoma, and malignant melanoma. The most frequently seen cutaneous side effects due to sorafenib are erythema, exfoliative dermatitis, acne vulgaris, and flushing. Folliculitis, eczema, and erythema multiforme are other, rare side effects of sorafenib. A 59-year-old man underwent left radical nephrectomy due to renal cell carcinoma 8 months ago, and after the operation he received immunochemotherapy and then sorafenib. On the third day of sorafenib therapy his lesions occurred. His dermatologic examination revealed multiple erythematous papules on his neck, arms, and legs and bullae and iris lesions on his palms and soles. He was diagnosed as having erythema multiforme. In the literature we found only 1 other erythema multiforme case due to sorafenib. We present this interesting case to show and discuss cutaneous side effects of sorafenib, especially erythema multiforme as a very rare cutaneous side effect.

Severe cutaneous reaction to cetuximab with possible association with the use of over-the-counter skin care products in a patient with oropharyngeal cancer.

2009-06-12T18:33:00.001-07:00
Cutan Ocul Toxicol. 2009; 28(1): 41-4Waris W, Naik S, Idrees I, Taha H, Camosino L, Mehrishi A, Saif MWBACKGROUND: The management of locally advanced head and neck cancer remains a challenge to most oncologists and their patients. Treatment with epithelial growth factor receptor inhibitors (EGFRIs) is associated with a good response. Cetuximab, a chimeric monoclonal antibody directed against epithelial growth factor receptor (EGFR), in combination with radiation therapy is indicated for the treatment of locally advanced squamous cell carcinoma of the head and neck. Although a mild acneiform skin rash (Grade 1, 2) is very common in these patients, severe rash (Grade 3) is uncommon. CASE REPORT: A 61-year-old African American man with locally advanced oropharyngeal cancer was treated with cetuximab and radiation. He developed a sudden flare-up of a skin rash after the 5th cycle of cetuximab following use of over-the-counter (OTC) skin care remedies. The rash manifested with severe maculopapular eruption and erythematous rash, along with desquamation and exfoliation of the skin, mainly on the face and neck area. The patient denied any extraordinary sun exposure. Cetuximab and radiation therapy were held for 1 week and the rash was treated with doxycycline, diphenhydramine, and continued use of natural emollient (Vaseline petroleum jelly). After 1 week, a dramatic improvement of the facial rash was noticed. DISCUSSION: Our report describes a sudden flare-up of a skin rash (Grade 3) after the 5th cycle of cetuximab following use of OTC skin care remedies, which was unusual for this patient, suggesting a possible relation to the therapy. Skin crucially depends on EGFR for its normal function and becomes extremely sensitive during cetuximab therapy. Topical OTC acne and dry skin remedies can suddenly change the mild acneiform rash into severe skin toxicity associated with marked desquamation and exfoliation. Avoidance of further skin damage caused by topical applications and the use of doxycycline and diphenhydramine show a significant success in the management of skin toxicity.

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and acne fulminans: are they part of the same disease spectrum?

2009-06-12T03:09:00.001-07:00
Clin Exp Dermatol. 2009 Mar 14; Chua SL, Angus JE, Ravenscroft J, Perkins W

Acne vulgaris: review and guidelines.

2009-06-12T02:14:00.001-07:00
Dermatol Nurs. 2009 Mar-Apr; 21(2): 63-8; quiz 69Ramos-e-Silva M, Carneiro SCAcne is a chronic disease of the pilosebaceous follicle that affects mainly adolescents. It causes polymorph cutaneous lesions that may leave scars after regression. It is characterized by alternation of periods of exacerbation and stability. Spontaneous regression usually occurs after age 20, but some patients may continue suffering during adult life. Diagnosis is clinical and based on the patient's age at the time that the lesions first appear, and on its polymorphism and type of lesions and location. Some patients also need a hormonal and, sometimes, psychological evaluation. The right treatment for the right patient is key to treating acne safely.

Item Reduction and Psychometric Validation of the Oily Skin Self Assessment Scale (OSSAS) and the Oily Skin Impact Scale (OSIS).

2009-06-11T18:12:00.001-07:00
Value Health. 2009 Mar 10; Arbuckle R, Clark M, Harness J, Bonner N, Scott J, Draelos Z, Rizer R, Yeh Y, Copley-Merriman KABSTRACT Introduction: Developed using focus groups, the Oily Skin Self Assessment Scale (OSSAS) and Oily Skin Impact Scale (OSIS) are patient-reported outcome measures of oily facial skin. Objective: The aim of this study was to finalize the item-scale structure of the instruments and perform psychometric validation in adults with self-reported oily facial skin. Methods: The OSSAS and OSIS were administered to 202 adult subjects with oily facial skin in the United States. A subgroup of 152 subjects returned, 4 to 10 days later, for test-retest reliability evaluation. Results: Of the 202 participants, 72.8% were female; 64.4% had self-reported nonsevere acne. Item reduction resulted in a 14-item OSSAS with Sensation (five items), Tactile (four items) and Visual (four items) domains, a single blotting item, and an overall oiliness item. The OSIS was reduced to two three-item domains assessing Annoyance and Self-Image. Confirmatory factor analysis supported the construct validity of the final item-scale structures. The OSSAS and OSIS scales had acceptable item convergent validity (item-scale correlations >0.40) and floor and ceiling effects (

An evaluation of dapsone gel 5% in the treatment of acne vulgaris.

2009-06-11T00:46:00.001-07:00
Expert Opin Pharmacother. 2009 Jun; 10(9): 1515-21Pickert A, Raimer SBACKGROUND: Oral dapsone has been available for over 60 years. Its first clinical use was discovered in 1945, when it was found to be efficacious in inhibiting the progression of leprosy. The combined antibacterial and anti-inflammatory pharmacologic activities of dapsone have made it a widely investigated drug, particularly for use in refractory and unusual dermatologic conditions. However, the possibility of significant hematological side effects, even at low doses, has limited its use. Currently, oral dapsone has FDA approval for the treatment of leprosy and dermatitis herpetiformis. The potential of oral dapsone to treat acne vulgaris is well established, but the risks of serious side effects have made it an undesirable drug for use in the relatively healthy acne population. Recently, a topical formulation of dapsone (Aczone, Allergan, Inc., Irvine, CA, USA) has been approved by the FDA for the treatment of acne vulgaris. OBJECTIVE/METHODS: The aims of this study were to review the published literature on dapsone pharmacology and pharmacokinetics, and to evaluate the gel's efficacy and safety in treating acne vulgaris, and finally to provide personal insight into its future as a topical agent for acne vulgaris. RESULTS/CONCLUSIONS: Clinical studies indicate dapsone gel 5% is effective in treating mild to moderately severe acne. It is well tolerated, with pharmacokinetic evidence indicating topical dosing in comparison to oral administration significantly reduces systemic concentrations of the drug, and therefore risk of serious side effects. Data suggests that dapsone gel 5% has the potential to become an established topical drug for the treatment of acne vulgaris. However, studies comparing the clinical effectiveness of the dapsone gel 5% to other available topical antiacne drugs are needed as are studies accessing its usefulness and safety when combined with other acne pharmaceuticals.

Acne vulgaris.

2009-06-10T01:55:00.001-07:00
BMJ. 2009; 338: a2738Hamilton F, Car J, Layton A

Efficacy of an oral contraceptive containing EE 0.03 mg and CMA 2 mg (Belara) in moderate acne resolution: a randomized, double-blind, placebo-controlled Phase III trial.

2009-06-10T01:48:00.001-07:00
Contraception. 2009 Jul; 80(1): 25-33Plewig G, Cunliffe WJ, Binder N, HÃ¶schen KBACKGROUND: The study was conducted to assess the effects of the monophasic combined oral contraceptive containing ethinyl estradiol (EE) 0.03 mg and chlormadinone acetate (CMA) 2 mg (EE/CMA) on papulopustular acne of the face, dÃ©colletÃ© (low neck) and back; on moderate comedonal acne of the face; and on seborrhea, alopecia and hirsutism. STUDY DESIGN: Three hundred seventy-seven women were randomized (2:1) to receive EE/CMA (n=251) or placebo (n=126) for six medication cycles. Due to the placebo-controlled, double-blind design of the trial, condoms were supplied for contraception. The primary efficacy end point was defined as a reduction of at least 50% in the number of papules and/or pustules of the face from admission to Medication Cycle 6. RESULTS: In total, 64.1% (161/251) of subjects treated with EE/CMA responded compared with 43.7% (55/126) of those taking placebo (p=.0001). The median reduction in papules/pustules on the face at Cycle 6 compared with admission was 63.6% (EE/CMA) compared with 45.3% (placebo group). For comedonal lesions of the face, the reduction in lesion numbers was 54.8% (EE/CMA) compared with 32.4% (placebo). Moderate papulopustular acne of the dÃ©colletÃ© decreased by 92.9% (EE/CMA) vs. 50% (placebo group) and of the back by 86.0% and 58.3%, respectively. For these skin conditions, the p values for the relative difference between groups vs. baseline were

Isotretinoin and intestinal damage.

2009-06-07T01:23:00.001-07:00
Prescrire Int. 2008 Aug; 17(96): 154-6(1) Isotretinoin, a vitamin A derivative, is marketed as an oral treatment for refractory severe acne. It is known to carry a risk of severe birth defects. The skin tends to become dry and fragile during isotretinoin treatment; (2) Some adverse effects of isotretinoin are caused by damage to the intestinal mucosae. These effects include bloody and mucousy diarrhoea, colitis, ileitis (sometimes severe and necessitating surgery), and aggravation of inflammatory bowel disease such as Crohn's disease; (3) Isotretinoin can affect all mucous membranes, causing multiple disorders of varying severity, affecting: the eyes (conjunctivitis); ear, nose and throat (epistaxis); respiratory tract; gastrointestinal tract (colitis); and urinary tract; (4) Patients must be informed of the risk of mucosal damage and especially of intestinal disorders associated with isotretinoin therapy. Isotretinoin should be borne in mind as a possible cause when a young patient presents with gastrointestinal disorders, and its withdrawal should be envisaged. Isotretinoin is an additional risk factor in patients with a personal or familial history of inflammatory bowel disease.

[Discussion on the suitable diseases and symptoms of bleeding therapy]

2009-06-06T23:05:00.001-07:00
Zhongguo Zhen Jiu. 2009 May; 29(5): 397-9Chen B, Gao C, Li C, Chen ZL, Guo YIn order to explore the suitable diseases and symptoms treated by bleeding therapy so as to guide the clinical practice. The retrospective study of periodical literature series is used and all clinical literatures about bleeding therapy were searched in the China Journal Full Text Database in CNKI, the VIP Chinese Scientific Journals Full Text Database (CSJD), Wanfang Database, and the Chinese Bio-medical Literature Database, and the frequen cy of the literature and the total cases treated with bleeding therapy were statistically analyzed, and the principles and methods of clinical epidemiology and evidence-based medicine were used to classify and grade the literatures, and the diseases were classified according to the international statistical classification about diseases and related healthy problems (ICD10) issued by World Health Organization. As a result, 1149 effective literatures including 98,526 cases were searched out, which were involved in 18 major systems and 261 kinds of diseases. It is indicated that the bleeding therapy has lots of suitable diseases and symptoms and it is worth to be popularized. Particularly, this therapy has obvious advantages for treatment of herpes zoster, acne, hordeolum, cervical spondylosis, and oral ulcer.

Dapsone 5% gel: a review of its efficacy and safety in the treatment of acne vulgaris.

2009-06-06T17:19:00.001-07:00
Am J Clin Dermatol. 2009; 10(4): 221-7Stotland M, Shalita AR, Kissling RFDapsone, a synthetic sulfone that has been available for over 60 years, has been used to treat a myriad of cutaneous disorders. Prior to the general acceptance of isotretinoin, oral dapsone had been reported to be effective in the treatment of nodulocystic acne. However, the potential for systemic toxicity prevented its widespread adoption in the treatment of acne. For many years scientists explored the possibility of developing a topical formulation of dapsone for the treatment of acne in the hope of minimizing the adverse hematologic effects of oral dapsone. Such a formulation had been unavailable until recently. Dapsone 5% gel (Aczone) was recently developed to treat acne vulgaris. This topical formulation was approved in the US based on two randomized, vehicle-controlled studies. A 12-month, open-label study was also conducted to assess the safety and efficacy of topical dapsone over the long term. Finally, two open-label phase I pharmacokinetic studies were conducted to evaluate the systemic absorption of topical dapsone compared with oral dapsone. This article reports the results of these studies, which show a reduction in acne lesion count comparable to those observed in clinical trials of other approved topical acne therapies. With regard to safety, the studies demonstrated that the concentrations of dapsone and N-acetyl dapsone remain low and do not accumulate over time once steady state is reached. Of the total of 50 patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency in all the studies, only two experienced a drop in hemoglobin levels, and those shifts in values were consistent with fluctuations observed for other study participants. A recent study evaluating the risk of hemolysis in patients with G6PD deficiency found topical dapsone 5% gel to be safe to use in this patient population. Based on the observations noted in the above-mentioned studies, we conclude that topical dapsone 5% gel is safe and effective in the treatment of acne vulgaris.

Clindamycin and benzoyl peroxide combined was more effective than either agent alone or placebo for acne vulgaris.

2009-06-05T21:56:00.001-07:00
Evid Based Med. 2009 Jun; 14(3): 85Williams H

Dispelling the myths and misconceptions of acne.

2009-06-05T18:20:00.001-07:00
J Pak Med Assoc. 2009 May; 59(5): 264-5Zaidi Z

Acne keloidalis of the scalp in a renal transplant patient treated with cyclosporine.

2009-06-05T02:23:00.001-07:00
Acta Derm Venereol. 2009; 89(3): 312-3Piaserico S, Fortina AB, Cavallini F, Alaibac M

Scoring systems in acne vulgaris.

2009-06-04T16:21:00.001-07:00
Indian J Dermatol Venereol Leprol. 2009 May-Jun; 75(3): 323-6Adityan B, Kumari R, Thappa DM

Isotretinoin: psychiatric disorders.

2009-06-04T06:53:00.001-07:00
Prescrire Int. 2008 Dec; 17(98): 242Disturbing reports of suicides have been collected in several countries. The role of isotretinoin should be considered when mental disorders occur in patients taking the drug.

Acne vulgaris: clinical features, assessment and treatment.

2009-06-04T02:59:00.001-07:00
Nurs Stand. 2009 Apr 29-May 5; 23(34): 49-56; quiz 58McWilliam JAcne vulgaris is the most common form of acne. This article outlines the psychological effects of the condition and describes the treatments available. There is also a brief description of other forms of acne.

Inter-observer agreement on acne severity based on facial photographs.

2009-06-04T01:55:00.001-07:00
J Eur Acad Dermatol Venereol. 2009 May 27; Beylot C, Chivot M, Faure M, Pawin H, Poli F, Revuz J, Auffret N, Moyse D, DrÃ©no B, Abstract Background The three-grade acne classification (mild, moderate, severe) is widely used to define the licensed indications of acne treatments, and for therapeutic decision-making in clinical practice, but its reproducibility has never been assessed. Methods Ten photographs of facial acne were scored independently by eight experts using the three-grade acne classification. We conducted a descriptive analysis of the results, based on graphical representation of the scores for each photograph. Results Inter-observer agreement on acne severity based on the three-grade acne classification was very poor. Conclusion The classical three-grade acne classification is poorly reproducible. A new rating tool accompanied by a clinical description of each severity level would be extremely useful. Conflicts of interest GEA and Dominique Moyse received an unrestricted grant from Galderma International, La DÃ©fense, France, for this study.

Acne prevalence and beyond: acne disability and its predictive factors among Chinese late adolescents in Hong Kong.

2009-06-03T23:35:00.001-07:00
Clin Exp Dermatol. 2009 May 26; Law MP, Chuh AA, Lee A, Molinari NSummary Background. Data are lacking on the prevalence of acne, its effects on quality of life (QOL) and the treatment usage among Chinese patients in late adolescence. Aim. To derive data about the prevalence and predictive factors of acne, the disability caused by acne and choice of treatment used by Chinese late adolescents in Hong Kong. Methods. This was a cross-sectional study of a random sample of 389 entrants in a university in Hong Kong, using the Global Acne Grading System (GAGS) to measure the clinical severity of acne and the Cardiff Acne Disability Index (CADI) to measure QOL. Results. The response rate was 99.3%. The prevalence of acne was of 81.5% (95% CI 77.6-85.4%) and coexisted with a high frequency of acne disability at a rate of 81.8% (95% CI 78.1-85.6%). Assessment of the clinical severity of acne did not correlate strongly with the effect on QOL (gamma(s) = 0.445, P < 0.001). Over the previous 6 months, 30.3% of subjects had used topical treatments, 3.9% had taken systemic conventional western drugs and 3.2% of the subjects had used traditional Chinese medicine. Multivariate logistic regression was used to explore the predictive factors for acne disability. Female gender (P = 0.002), higher GAGS score (P < 0.001), higher perceived stress (P = 0.01) and willingness to pay Hong Kong$15 000 ( pound970) for a hypothetical permanent cure (P = 0.03) were positive predictors. Conclusions. Acne is prevalent in Hong Kong and has considerable psychological effects. The association between clinical severity and impaired QOL is not strong.

[Autoinflammatory syndromes]

2009-06-03T17:45:00.001-07:00
Internist (Berl). 2009 Jun; 50(6): 676-84Lamprecht P, Gross WLIn its strict sense, the term "autoinflammatory syndromes" comprises the hereditary periodic fever syndromes (HPF), which are caused by mutations of pattern-recognition receptors (PRR) and perturbations of the cytokine balance. These include the crypyrinopathies, familial Mediterranean fever, TNF-receptor associated periodic fever syndrome (TRAPS), hyper-IgD and periodic syndrome (HIDS), pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, NALP12-HPF, and the Blau syndrome. The diseases are characterized by spontaneous activation of cells of the innate immunity in the absence of ligands. Autoantibodies are usually not found. HPF clinically present with recurrent fever episodes and inflammation, especially of serosal and synovial interfaces and the skin. Intriguingly, PRR-mediated autoinflammtory mechanisms also play a role in a number of chronic inflammatory and autoimmune diseases.

[Hidradenitis suppurativa]

2009-06-03T16:01:00.001-07:00
Tidsskr Nor Laegeforen. 2009 May 14; 129(10): 992-6Tolaas E, Knudsen CW, Sviland L, TÃ¸nseth KABACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by recurrent tender nodules and boils, usually in the armpits and groins. Draining fistulas and hypertrophic scarring are hallmarks of more severe disease. The objective of this article is to review the clinical presentation, diagnostic considerations and treatment of the disease. MATERIAL AND METHODS: The article is based on a non-systematic literature search in PubMed, review of dermatology textbooks and the author's personal clinical experience. RESULTS: Hidradenitis suppurativa, also known as acne inversa, is a follicular occlusion disease that can severely reduce quality of life. Staphylococci and other pathogenic bacteria frequently colonize the lesions, but the disease is not primarily a bacterial infection. Smoking and obesity can worsen disease activity. Moderate and severe disease is usually treated with excisional surgery. Antibiotics, often tetracyclines, are indicated for mild disease and as an adjunct to surgery in more severe disease. Antibiotics, however, are not curative. New treatment options, such as TNF-alpha inhibitors and zinc gluconate should still be considered experimental. INTERPRETATION: Hidradenitis suppurativa is probably underdiagnosed. The disease is often recalcitrant to treatment. The effect of medical treatment is not supported by high quality evidence.

Treatment of Acne with Oral Isotretinoin in Patients with Cystic Fibrosis.

2009-05-31T07:03:00.001-07:00
Arch Dis Child. 2009 May 21; Perera E, Massie J, Phillips RJBACKGROUND: Theoretical concerns about liver disease and vitamin A deficiency have limited the use of oral isotretinoin for troublesome acne in adolescents with cystic fibrosis. METHODS: We administered oral isotretinoin to 9 patients with cystic fibrosis who had troublesome acne unresponsive to antibiotics. All patients were followed for 1-4 years after cessation of treatment. RESULTS: Isotretinoin treatment cleared active acne lesions in all patients. It was well tolerated and no patient had significant side effects. All nine patients were pleased or delighted with the improvement in their skin. CONCLUSIONS: Adolescents with cystic fibrosis and acne can be treated with oral isotretinoin. Oral isotretinoin should be considered for adolescents with cystic fibrosis who have acne associated with scarring, acne not clearing with topical and antibiotic treatment, acne associated with depression, or severe cystic acne.

Phototherapy, photodynamic therapy and lasers in the treatment of acne.

2009-05-29T04:11:00.001-07:00
J Dtsch Dermatol Ges. 2009 Apr 21; Degitz KModern acne therapy uses anticomedogenic, antimicrobial, antiinflammatory, and antiandrogenic substances. As an additional approach in recent years, treatments have been developed based on the application of electromagnetic radiation. Visible light or infrared wave lengths are utilized by most techniques, including blue light lamps, intense pulsed light, photodynamic therapy and lasers. This review evaluates the various methods with regard to efficacy and their current role in the management of acne. Although UV radiation has been frequently used to treat acne, it is now regarded as obsolete due to the unfavorable risk-benefit ratio. Visible light, especially of blue wavelengths, appears to be suitable for the treatment of mild to moderate inflammatory acne. Photodynamic therapy is effective, but, due to considerable immediate side effects, it is best reserved for selected situations. Despite promising observations, intense pulsed light and lasers have to be evaluated in further studies, before they can be recommended.

Cryptomeria japonica essential oil inhibits the growth of drug-resistant skin pathogens and LPS-induced nitric oxide and pro-inflammatory cytokine production.

2009-05-28T22:15:00.001-07:00
Pol J Microbiol. 2009; 58(1): 61-8Yoon WJ, Kim SS, Oh TH, Lee NH, Hyun CGIn this study, the chemical composition of Cryptomeria japonica essential oil (CJE) was analyzed and its biological activities were tested. CJE was obtained by steam distillation from leaves collected from Jeju Island and analyzed by gas chromatography (GC)-flame ionization detection (FID) and GC-MS. Kaurene (17.20%), elemol (10.88%), gamma-eudesmol (9.41%), and sabinene (8.86%) were the major components in CJE. The antibacterial and anti-inflammatory activities of CJE against drug-susceptible and -resistant skin pathogens have been not reported previously. Thus, we determined the anti-bacterial activities of CJE using the disk diffusion method and minimum inhibitory concentration (MIC) values. CJE showed excellent antibacterial activities against Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. The MIC of CJE against drug-susceptible and -resistant P. acens and S. epidermidis ranged from 0.16 to 10.0 microl/ml. In addition, the effects of CJE on nitric oxide (NO), prostaglandin E2 (PGE2), tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. Pro-inflammatory cytokine and mediator tests indicated that CJE has excellent dose-dependent inhibitory activities. Therefore, based on these results, we propose that CJE is an attractive acne-mitigating candidate for skin health.

Pcos.

2009-05-27T23:14:00.001-07:00
Clin Evid (Online). 2009; 2009: Cahill DJINTRODUCTION: Polycystic ovary syndrome (PCOS) is diagnosed in up to 10% of women attending gynaecology clinics, but the prevalence in the population as a whole is unclear. PCOS has been associated with hirsutism, infertility, acne, weight gain, type 2 diabetes, cardiovascular disease (CVD), and endometrial hyperplasia. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: finasteride, flutamide, metformin, spironolactone, cyproterone acetate-ethinylestradiol (co-cyprindiol), interventions to achieve weight loss, ketoconazole, and mechanical hair removal.

Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients.

2009-05-27T20:47:00.001-07:00
Br J Dermatol. 2009 May 21; Gollnick HP, Draelos Z, Glenn MJ, Rosoph LA, Kaszuba A, Cornelison R, Gore B, Liu Y, Graeber M, Summary Background Combination therapy utilizing agents with complementary mechanisms of action is recommended by acne guidelines to help simultaneously target multiple pathogenic factors. A unique, topical, fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has recently been developed for the once-daily treatment of acne. Objectives To evaluate the efficacy and safety of adapalene 0.1%-BPO 2.5% fixed-dose combination gel (adapalene-BPO) relative to adapalene 0.1% monotherapy (adapalene), BPO 2.5% monotherapy (BPO), and the gel vehicle (vehicle) in a large population for the treatment of acne vulgaris. Methods In total, 1670 subjects were randomized in a double-blind controlled trial to receive adapalene-BPO, adapalene, BPO or vehicle for 12 weeks (1 : 1 : 1 : 1 randomization). Evaluations included success rate (subjects 'clear' or 'almost clear'), percentage change in lesion count from baseline, cutaneous tolerability and adverse events. Results Adapalene-BPO was significantly more effective than corresponding monotherapies, with significant differences in percentage lesion count change observed as early as 1 week. Cutaneous tolerability profile was similar to adapalene. Adverse events were more frequent with the combination therapy (mainly due to an increase in mild-to-moderate dry skin), occurred early in the study, and were transient. Conclusions Adapalene-BPO provides significantly greater and synergistic efficacy and a faster onset of action with an acceptable safety profile in the treatment of acne vulgaris when compared with the corresponding vehicle and the adapalene and BPO monotherapies.

Efficacy and tolerance of superoxidized solution in the treatment of mild to moderate inflammatory acne. A double-blinded, placebo- controlled, parallel-group, randomized, clinical trial.

2009-05-27T00:33:00.001-07:00
J Dermatolog Treat. 2009 Jan 1; 1-4Tirado-Sanchez A, Maria Ponce-Olivera RIntroduction: Superoxidized solution (SOS) is an electrochemically processed aqueous solution manufactured from pure water and sodium chloride. Inflammatory skin disorders have all improved their outcomes with the use of SOS. These indications suggest that SOS could be useful in acne. Methods: A total of 89 patients were enrolled in this double blinded, clinical trial. Patients presented with 10--50 inflammatory lesions (papules and pustules) and an absence of nodulocystic lesions. Results: Improvement was excellent in nine patients (23%) using SOS, compared with five patients (21%) using benzoyl peroxide (BP) (p = 0.378); good in 21 patients (54%) using SOS and 12 patients (50%) using BP (p = 0.794), compared with four patients (18%) taking placebo (p = 0.001); and fair in six patients (15%) using SOS and five patients (21%) using BP (p = 0.415), compared with 12 patients taking placebo (55%) (p = 0.014). In three patients using SOS (8%) the response was poor, compared with two patients (8%) using BP (p = 0.725) and six patients (27%) taking placebo (p = 0.075). We did not need to change a dose during the study period and no systemic effect was observed. Conclusions: We found that SOS is an important choice to treat inflammatory acne, comparable with benzoyl peroxide; however, a larger sample is needed.

In vitro activities of three synthetic peptides derived from epinecidin-1 and an anti-lipopolysaccharide factor against Propionibacterium acnes, Candida albicans, and Trichomonas vaginalis.

2009-05-26T14:52:00.001-07:00
Peptides. 2009 Jun; 30(6): 1058-1068Pan CY, Chen JY, Lin TL, Lin CHThe synthetic epinecidin-1(22-42) peptide was derived from positions 22-42 of Epinephelus coioides epinecidin-1. The synthetic SALF(55-76) cyclic peptide (csSALF(55-76)) and SALF(55-76) linear peptide (lsSALF(55-76)) contained sequences from positions 55 to 76 of the Penaeus monodon anti-lipopolysaccharide factor (ALF), respectively. We studied the in vitro activities of epinecidin-1(22-42), csSALF(55-76), and lsSALF(55-76) against Propionibacterium acnes, Candida albicans, and Trichomonas vaginalis. The minimum inhibitory concentrations (MICs) of epinecidin-1(22-42) for the test pathogen strains ranged 12.5-200mug/ml, those of csSALF(55-76) ranged 100-200mug/ml, and those of lsSALF(55-76) ranged 25-200mug/ml. epinecidin-1(22-42) exhibited cytotoxicity towards P. acnes, C. albicans, and T. vaginalis (one strain of which was a metronidazole-resistant strain, while the other strain was not), suggesting that epinecidin-1 functions like a lytic peptide. Similar cytotoxicity was identified against T. vaginalis treated with the csSALF(55-76) and lsSALF(55-76) peptides. The antimicrobial activities of these peptides were confirmed by scanning electron microscopy (SEM), transmission electron microscopy (TEM), a viable cell count assay, and flow cytometric analysis. TEM and SEM examinations of T. vaginalis treated with these three peptides showed that severe swelling preceded cell death and breakage of the outer membrane, and the intracellular inclusion was found to have effluxed extracellularly. This phenomenon was also found with epinecidin-1(22-42) treatment of P. acnes and C. albicans. Our results suggest that the epinecidin-1(22-42), csSALF(55-76), and lsSALF(55-76) peptides may be good candidates for treating trichomoniasis, and epinecidin-1(22-42) may have potential as a drug supporting therapy for acne and candidiasis.

[Hidradenitis suppurativa.]

2009-05-25T18:06:00.001-07:00
Tidsskr Nor Laegeforen. 2009 May 14; 129(10): 992-996Tolaas E, Knudsen CW, Sviland L, TÃ¸nseth KABACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by recurrent tender nodules and boils, usually in the armpits and groins. Draining fistulas and hypertrophic scarring are hallmarks of more severe disease. The objective of this article is to review the clinical presentation, diagnostic considerations and treatment of the disease. MATERIAL AND METHODS:. The article is based on a non-systematic literature search in PubMed, review of dermatology textbooks and the author's personal clinical experience. RESULTS: Hidradenitis suppurativa, also known as acne inversa, is a follicular occlusion disease that can severely reduce quality of life. Staphylococci and other pathogenic bacteria frequently colonize the lesions, but the disease is not primarily a bacterial infection. Smoking and obesity can worsen disease activity. Moderate and severe disease is usually treated with excisional surgery. Antibiotics, often tetracyclines, are indicated for mild disease and as an adjunct to surgery in more severe disease. Antibiotics, however, are not curative. New treatment options, such as TNF-α inhibitors and zinc gluconate should still be considered experimental. INTERPRETATION: Hidradenitis suppurativa is probably underdiagnosed. The disease is often recalcitrant to treatment. The effect of medical treatment is not supported by high quality evidence.

Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian Patients.

2009-05-24T23:05:00.001-07:00
Dermatol Surg. 2009 Apr 27; Kim S, Cho KHBACKGROUND Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that has been proposed. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced. OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers. METHODS A series of 20 patients (skin phototypes IV-V) with atrophic facial acne scars were randomly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high (group A) and low (group B) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half. Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively. Clinical assessment scores were determined at each treatment session and follow-up visit. RESULTS Although the use of the ablative fractional laser with high energy resulted in an improvement in patients' acne scars, the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results, as assessed in photographs as well as by the overall appearance of the acne scars. With the combination method, fewer complications were observed. The authors have indicated no significant interest with commercial supporters.

A histopathological approach: when papulopustular lesions should be in the diagnostic criteria of BehÃ§et's disease?

2009-05-24T21:38:00.001-07:00
J Eur Acad Dermatol Venereol. 2009 Apr 24; Kalkan G, Karadag AS, AstarcÄ± HM, Akbay G, Ustun H, Eksioglu MAbstract Background Papulopustular lesions (PPL) are commonly seen cutaneous lesions in BehÃ§et's disease (BD). Some authorities do not recommend using cutaneous lesions for diagnostic criteria because these lesions are confused with acne vulgaris. Objective To understand if PPL have diagnostic value in BD. Methods Biopsy was performed on papulopustular lesions of BehÃ§et's patients for histopathological examination to compare with the control group composed of patients with acne vulgaris. Forty two patients with BD and 21 control patients with acne vulgaris were enrolled in the study. Histopathological findings were classified as leukocytoclastic vasculitis, lymphocytic vasculitis, superficial and/or deep perivascular infiltration, and folliculitis and/or perifolliculitis. Results Of the specimens from 42 BehÃ§et's disease patients, 7 (16.7%) revealed leukocytoclastic vasculitis and 3 (7.1%) had lymphocytic vasculitis, 15 (35.7%) had superficial perivascular and/or interstitial infiltration, 12 (28.6%) had superficial and deep perivascular and/or interstitial infiltration, 5 (11.9%) had folliculitis or perifolliculitis. Of the control group patients, 9 (42.9%) had folliculitis or perifolliculitis, 8 (38.1%) revealed superficial perivascular inflammation and 4 (19.0%) revealed mixed superficial and deep perivascular inflammation. Vasculitis was not encountered in any control group specimens. Vasculitis ratio was statistically higher in Behcet's disease patients (P = 0.016). Conclusions We evaluated more patients than previous related studies reported in the literature. Histopathological findings of vasculitis were encountered only in BD group. Non-vasculitis histopathological findings were also encountered in the control group patients. In conclusion, PPL can be used as a diagnostic criterion of BD subsequent to finding vasculitis in histopathological examination of the biopsy specimen of the PPL. Conflicts of interest None declared.

A study on clinical and sonographic features in obese and nonobese patients with polycystic ovary syndrome.

2009-05-23T16:58:00.001-07:00
Arch Gynecol Obstet. 2009 May 22; Siddiqui IA, Tamimi W, Tamim H, Aleisa N, Adham MBACKGROUND: Polycystic ovary syndrome (PCOS) is an endocrine metabolic dysfunction closely associated with obesity, which predisposes to pregnancy complications. PCOS is a common endocrine disorder affecting 5-10% of the population. It is characterized by chronic anovulation and hyperandrogenism with clinical manifestations of oligomenorrhea, hirsutism and acne. Obese females are at higher risk for metabolic syndrome due to severe hyperandrogenemia, which also leads to high blood pressure. OBJECTIVES: To determine, among patients with PCOS, the correlation of body mass index (BMI) with (1) the clinical manifestations of PCOS and (2) blood pressure. METHOD: We performed a cross-sectional study of 62 women of reproductive age (29-43 years), who attended the Obstetrics and Gynecology Clinic at King Fahd National Guard Hospital in Riyadh, Kingdom of Saudi Arabia, with the confirmed diagnosis of PCOS. These patients were divided into two BMI groups: nonobese (BMI less than 25 kg/m(2)) and obese (BMI more than 25 kg/m(2)). Patients' waist to hip ratio, acne, hirsutism, and systolic and diastolic blood pressures were also recorded as clinical manifestations in PCOS and compared between the two BMI groups. RESULTS: The mean age of the patients was 35.85 +/- 5.03 years, BMI was 31.91 +/- 6.40 kg/m(2), waist-hip ratio was 0.82 +/- 0.067, Ferriman and Gallway's score for hirsutism was 3.63 +/- 4.35, systolic blood pressure was 113.02 +/- 16.10 mmHg, diastolic blood pressure was 71.79 +/- 10.04 mmHg, and acne was present in 24 cases (38.7%). When the groups were compared according to BMI, a significant increase in systolic and diastolic blood pressures (p = 0.001 and 0.003, respectively) was seen in obese patients, but there was no significant rise in the waist-hip ratio and hirsutism score. CONCLUSION: We observed a significant and progressive effect of BMI on clinical manifestations and blood pressure levels in patients with PCOS.

Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris.

2009-05-21T00:23:00.001-07:00
Braz J Med Biol Res. 2009 Jun; 42(6): 501-5Abulnaja KOAcne vulgaris is a multifactorial disease affecting a majority of the adolescent population. The objective of this study was to test for a correlation between fasting serum lipid profiles and levels of testosterone, insulin, leptin, and interleukin 1-beta (IL-1beta) and the incidence of severe acne vulgaris in obese adolescent females. Four groups of adolescent females were studied: obese with acne, obese without acne, non-obese with acne, and non-obese without acne. Obese females with acne, compared to obese females without acne and non-obese subjects, had significantly higher serum triglycerides, low-density lipoprotein cholesterol and apolipoprotein-B (apo-B) (mean +/- SD: 197 +/- 13.7 vs 171 +/- 11.5, 128 +/- 8.3 vs 116 +/- 7.7, 96 +/- 13.7 vs 85 +/- 10.3 mg/dL, respectively) but significantly lower high-density lipoprotein cholesterol and apo-A1 levels (40 +/- 3.3 vs 33 +/- 3.5 and 126 +/- 12 vs 147 +/- 13 mg/dL). Serum testosterone, insulin and leptin levels were significantly higher in obese subjects with or without acne compared to non-obese females with or without acne (3 +/- 0.5 vs 2.1 +/- 0.47, 15.5 +/- 3.3 vs 11.6 +/- 3, 0.9 +/- 0.2 vs 0.6 +/- 0.15 nmol/mL, respectively). Serum IL-1b was significantly elevated in obese and non-obese subjects with acne compared to subjects without acne; in those without acne, these levels were higher in obese than non-obese subjects (2.4 +/- 0.2, 1.4 +/- 0.1 vs 1.8 +/- 0.12 and 1.3 +/- 0.11 pg/mL, respectively). Our results indicate that there is a relationship between obesity (BMI >27) and acne. By early recognition, the etiology and treatment protocol of acne may prevent unwanted conditions.

Prospective, open-label, comparative study of clindamycin 1%/benzoyl peroxide 5% gel with adapalene 0.1% gel in Asian acne patients: efficacy and tolerability.

2009-05-18T06:18:00.001-07:00
J Eur Acad Dermatol Venereol. 2009 Mar; 23(3): 245-50Ko HC, Song M, Seo SH, Oh CK, Kwon KS, Kim MBBACKGROUND: Used as individual agents, topical antibiotics and benzoyl peroxide are known to be effective in treatment of acne. Clindamycin phosphate 1% with benzoyl peroxide 5% (CDP/BPO) is a new combination gel, made by rationale, in that combination drug is more effective than either ingredients used alone. Adapalene 0.1% (ADA) is the third-generation retinoid, shown to be as effective as other topical retinoid with well tolerability. OBJECTIVES: To compare the efficacy and tolerability in combination of CDP/BPO in comparison with ADA in Asian patients with mild to moderate acne vulgaris. METHODS: Total of 69 patients, including 31 patients for CDP/BPO group and 38 for ADA group, with mild to moderate acne vulgaris were enrolled for a 12-week prospective, randomized, open-label comparative study of topical agents. Efficacy was assessed by lesion counts, acne grading system, and global improvement. Adverse events were also evaluated in scale of 0 (none) to 3 (severe). RESULTS: Both CDP/BPO and ADA were effective in reducing lesion counts and acne severity scale and showed significant global improvement. However, CDP/BPO offered greater efficacy against inflammatory lesions than ADA. Both drugs were well tolerated with minimal adverse drug reactions. CONCLUSION: Combination formulation of CDP/BPO and ADA were shown to be both effective in decreasing total, inflammatory, and non-inflammatory lesion counts along with well tolerability in Asian patients with mild to moderate acne vulgaris.

Clindamycin lotion alone versus combination lotion of clindamycin phosphate plus tretinoin versus combination lotion of clindamycin phosphate plus salicylic acid in the topical treatment of mild to mo

2009-05-17T17:38:00.001-07:00
Indian J Dermatol Venereol Leprol. 2009 May-Jun; 75(3): 279-82NilFroushzadeh MA, Siadat AH, Baradaran EH, Moradi SBACKGROUND: Acne vulgaris is a common skin disease that affects 85% to 100% of people at some time during their lives. It is characterized by noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. AIMS: To compare the efficacy of combination treatment of clindamycin+salicylic acid, versus clindamycin+tretinoin versus clindamycin alone in the treatment of the mild-to-moderate acne vulgaris. METHODS: This was a single-blinded, randomized clinical trial.Forty-two female patients (age range: 15-25 years) with mild-to-moderate acne vulgaris were selected randomly and subsequently randomized to 3 groups. Group A patients were treated with 1% clindamycin lotion (C lotion) twice daily. Group B patients were treated with 1% clindamycin+0.025% tretinoin lotion once nightly (CT lotion). Group C patients were treated with 1% clindamycin+2% salicylic acid lotion twice daily (CS lotion) for 12 weeks. For comparison of efficacy of these treatments, and regarding the skewed distribution of the data, Kruskal-Wallis Test and Mann-Whitney U test were used. SPSS software was used for statistical analysis. RESULTS: There was a significant difference between 3 types of treatment in the respect of the total lesion count (TLC) improvement (P = 0.039). The efficacy of treatment on Acne Severity Index (ASI) was maximum for CS lotion (81.80% reduction in ASI). CT lotion reduced ASI by as much as 73.73% during 12 weeks of treatment. The efficacy of C lotion was calculated to be 37.87% in the reduction of ASI. CONCLUSIONS: Our data suggested that the efficacy of CS lotion was significantly more than C lotion with respect to the TLC and ASI, although there was no significant difference between CS and CT lotion.

Profile of acne vulgaris--a hospital-based study from South India.

2009-05-17T04:23:00.001-07:00
Indian J Dermatol Venereol Leprol. 2009 May-Jun; 75(3): 272-8Adityan B, Thappa DMBACKGROUND: Acne vulgaris is believed to be the most common disease of the skin. There is no Indian study on the profile of acne vulgaris, markers of severe forms of acne vulgaris and a possible correlation between acne vulgaris and markers of androgenicity in females. AIM: To study the profile of acne vulgaris, its seasonal variation, relationship with smoking and possible correlation between acne vulgaris and markers of androgenicity in females. METHODS: The study was conducted between August 2006 and June 2008. All patients with acne vulgaris who consented to participate in the study were included. The parameters evaluated included age, gender, age of onset, duration of lesions, site of lesions, grade, relation with menstrual cycle, markers of androgenicity, number of acne lesions such as comedones, papules pustules and nodules, number and site of post-acne scarring, post-acne hyperpigmentation, seasonal variation and history of smoking. RESULTS: A total of 309 patients with acne vulgaris were included in the study. The frequency of acne vulgaris in our study was 1.068%. Mean age of the study group was 19.78 years. Male to female ratio was 1.25:1. The most common age group involved was 16 to 20 years (59.8%). Mean age of onset was 15.97 years. Face was involved in all the patients, followed by back (28.2%), chest (20.1%), neck (9.4%) and arms (10%). In the older age groups, women were more likely to report having acne vulgaris than men (P = 0.01). The closed comedones outnumbered open comedones by a factor of 4.9:1. A total of 186 patients (60.2%) had grade 1 acne vulgaris, 85 (27.5%) had grade 2 acne, 8 (2.6%) had grade 3 acne and 30 (9.7%) had grade 4 acne vulgaris. There was a higher incidence of scarring (39.5%) and post-acne hyperpigmentation (24.6%) in our study. In female patients, 57.7% had premenstrual flare and 12.4% had cutaneous markers of androgenicity. There was no association between severity of acne vulgaris and other markers of androgenicity (P = 0.108). Seborrheic dermatitis (21.35%) was the most common disease associated. Seasonal variation was observed only in 80 patients (25.9%); 71 patients (23%) exacerbated in summer and 9 patients (2.9%) in winter. Smokers had more severe grade of acne vulgaris compared to nonsmokers (P = 0.001). CONCLUSION: This study brings out the clinical profile of acne vulgaris in a tertiary care hospital in South India.

Case 1: Severe acne - not just skin deep.

2009-05-15T01:52:00.001-07:00
Paediatr Child Health. 2008 Jul; 13(6): 507-9Savlov D, O'Gorman C, Urbach S, Pope E

[Autoinflammatory syndromes.]

2009-05-14T05:49:00.001-07:00
Internist (Berl). 2009 May 13; Lamprecht P, Gross WLIn its strict sense, the term "autoinflammatory syndromes" comprises the hereditary periodic fever syndromes (HPF), which are caused by mutations of pattern-recognition receptors (PRR) and perturbations of the cytokine balance. These include the crypyrinopathies, familial Mediterranean fever, TNF-receptor associated periodic fever syndrome (TRAPS), hyper-IgD and periodic syndrome (HIDS), pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, NALP12-HPF, and the Blau syndrome. The diseases are characterized by spontaneous activation of cells of the innate immunity in the absence of ligands. Autoantibodies are usually not found. HPF clinically present with recurrent fever episodes and inflammation, especially of serosal and synovial interfaces and the skin. Intriguingly, PRR-mediated autoinflammtory mechanisms also play a role in a number of chronic inflammatory and autoimmune diseases.

[Acne juvenilis]

2009-05-14T02:49:00.001-07:00
Hautarzt. 2009 May; 60(5): 402-8Lehmann PAcne is the most common disease in teens, with a prevalence of about 80-90%. The severity of acne varies greatly among individuals, and genetic background plays an important role. Pathogenetic factors include androgen-induced seborrhea, follicular hyperkeratosis, microbial population, and immunological and inflammatory processes. These factors influence each other, leading to the acne phenotype. Classical acne forms must be differentiated from special acne entities. Among those, acne induced by self-administered anabolic steroids ("bodybuilding acne") has especially become a widespread problem. Psychological effects induced by the disfiguring appearance of severe acne manifestations in pubertal adolescents should not be underestimated. Acne juvenilis may be well controlled by a variety of pathogenesis-oriented antiacne treatment strategies. Because the treatment is always longstanding, and success is achieved only after a prolonged period of time, a very good patient-doctor relationship is required.

Ethnicity and incidence of Hodgkin lymphoma in Canadian population.

2009-05-14T01:39:00.001-07:00
BMC Cancer. 2009 May 11; 9(1): 141Pahwa P, Karunanayake CP, Spinelli JJ, Dosman JA, McDuffie HHABSTRACT: BACKGROUND: Research has shown that ethnicity is a significant predictor of Hodgkin lymphoma (HL). Variations in cancer incidence among ethnic groups in the same country can lead to important information in the search for etiological factors. Other risk factors important in the etiology of HL are medical history and exposure to pesticides. In this report we investigated the association between ethnicity and HL in the presence of medical history, and exposure to pesticides. METHODS: The data resulting from a matched population-based case-control study conducted in six provinces of Canada (Ontario, Quebec, Manitoba, Saskatchewan, Alberta, and British Columbia) was analyzed to determine whether or not there was any association between ethnicity and incidence of HL when adjusted for personal medical history and pesticide exposure. Information on ethnicity, personal medical history, and pesticide exposure was collected by questionnaires via mail on 316 men diagnosed with HL; and on 1506 controls. A conditional logistic regression was utilized and results were presented as odds ratios and 95% confidence intervals. RESULTS: In our study population, the distribution of ethnic groups was: 38.5% North American, 15% British, 8.4% Western European, 8.2% Eastern European, 1.7% Asian, 1.4% Scandinavian and 27% of other ethnic origin. Compared to North Americans (i) the risk of HL was greater among the Eastern European descendents (Odds Ratio (ORadj): 1.82; 95% confidence interval (CI): 1.02, 3.25) and Western European (ORadj: 1.62; 95% CI: 0.95-2.76) descent population (borderline significance at 5% level); and (ii) the risk of HL was lower in Asian descents. Diagnosis with measles (ORadj: 0.72, 95% C.I.: 0.53-0.98) and/or positive history of allergy desensitization shots (ORadj: 0.55, 95% C.I.: 0.30-0.99) were negatively associated with the incidence of HL, while diagnosis with acne (ORadj: 2.12, 95% C.I.: 1.19-3.78), shingles (ORadj: 2.41, 95% C.I.: 1.38-4.22) and positive family history of cancer (ORadj: 1.93, 95% C.I.: 1.40-2.65) increased the risk of HL. Exposure to individual herbicide dichlorprop showed an increased risk of HL (ORadj: 6.35, 95% C.I.: 1.56-25.92). CONCLUSIONS: In Canada, compared to North Americans descendents, the risk of HL was significantly greater among the Eastern European and Western European descent population. Our results related to association between ethnicity and HL support the findings reported by other researchers. Our data showed that subjects who were diagnosed with measles or had allergy desensitization shots negatively associated with the incidence of HL; and other medical conditions, ever diagnosed with acne, and positive family history of cancer were positively associated with the incidence of HL.

Solving acne inversa (hidradenitis suppurativa) in crohn disease with buried chip skin grafts.

2009-05-13T06:42:00.001-07:00
J Cutan Med Surg. 2009 May-Jun; 13(3): 164-8Bleiziffer O, Dragu A, Kneser U, Horch REBACKGROUND:Acne inversa is a progressive chronic inflammatory disease associated with abscess and fistula formation and subsequent scarring. In recent years, an increasing number of reports have been published about acne inversa and concomitantly occurring Crohn disease. Extensive anogenitoperineal soft tissue defects represent an enormous challenge to therapy. Common treatment strategies of reconstructive surgery such as local flaps, free flaps, or split-thickness skin grafts are frequently problematic and associated with poor outcomes.OBJECTIVE:The aim of this case report is to demonstrate the clinical problem of extensive anogenitoperineal soft tissue defects and to present a surgical technique that can be successfully used in such difficult cases.METHODS:In both cases, extensive excision of the affected areas was carried out down to the gluteal muscles followed by intramuscular grafting of buried skin chip grafts.RESULTS:In both cases, the final postoperative results after numerous surgeries were very good, with complete wound closure resulting in complete recovery and social reintegration.CONCLUSION:The technique of buried skin chip grafting has long been ignored since split-thickness skin grafting and different techniques of flap coverage evolved, but it may constitute a highly efficient treatment strategy in challenging reconstructive situations.

Aczone, a topical gel formulation of the antibacterial, anti-inflammatory dapsone for the treatment of acne.

2009-05-13T01:22:00.001-07:00
Curr Opin Investig Drugs. 2009 May; 10(5): 474-81Scheinfeld NAllergen Inc has launched Aczone, a topical gel formulation of the antibacterial, anti-inflammatory agent dapsone, for the potential treatment of acne vulgaris. Oral dapsone has demonstrated efficacy in acne, but was associated with severe side effects such as anemia, which was particularly serious in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Aczone was developed to overcome this limitation, and is formulated using solvent-microparticle technology for improved absorption and action and for fewer side effects. In a phase I clinical trial, systemic exposure to dapsone was 126-fold lower following treatment with Aczone compared with oral dapsone. Aczone significantly reduced lesion counts in patients with acne in phase III trials, and was particularly effective in reducing inflammatory lesions. In a phase IV trial, Aczone was safely applied to patients with G6PD deficiency without inducing anemia. Phase IV trials in patients with acne were ongoing at the time of publication to assess safety and to compare Aczone monotherapy with combinations of Aczone and other anti-acne therapeutics. At the time of publication, Allergen was also developing Aczone for the treatment of rosacea; the drug was undergoing phase II trials for this indication. Aczone appears to be a novel promising anti-acne therapeutic option, particularly for patients with inflammatory acne.

Efficacy On Renal Function Of Early Conversion

2009-05-10T00:44:00.001-07:00
Sirolimus (SRL) allows to minimize the use of cyclosporine (CsA), but de novo administration after transplantation is associated with various complications. We report a prospective, open-label, multicenter randomized study to evaluate conversion from a CsA-based regimen to a SRL-based regimen 3 months after transplantation.

One hundred ninety-two of a total of 237 patients were eligible at 3 months to be converted to SRL (n = 95) or to continue CsA (n = 97). All patients were also given mycophenolate mofetil (MMF) and oral steroids, planned to be discontinued at month 8.

The primary endpoint, the clearance estimated according to Cockcroft and Gault at week 52, was significantly better in the SRL group (68.9 vs. 64.4 mL/min, p = 0.017). Patient and graft survival were not statistically different.

The incidence of acute rejection episodes, mainly occurring after withdrawal of steroids, was numerically but not statistically higher in the SRL group (17% vs. 8%, p = 0.071).

Sixteen patients discontinued SRL, mainly for adverse events (n = 11), and seven patients discontinued CsA for renal failure or acute rejection. Significantly, more patients in the SRL group reported aphthous, diarrhea, acne scar medications and high triglyceride levels.

Conversion CsA to SRL 3 months after transplantation combined with MMF is associated with improvement in renal function.

"Efficacy on renal function of early conversion from cyclosporine to sirolimus 3 months after renal transplantation: concept study."
Am J Transplant. 2009 May; 9(5): 1115-23Lebranchu Y, Thierry A, Toupance O, Westeel PF, Etienne I, Thervet E, Moulin B, Frouget T, Le Meur Y, Glotz D, Heng AE, Onno C, Buchler M, Girardot-Seguin S, Hurault de Ligny B

Commercialization of animal-derived remedies as complementary medicine in the semi-arid region of northeastern Brazil.

2009-05-09T17:36:00.001-07:00
In this study we aim to document the use of animal species in traditional medicine and healing practices in the semi-arid region of Northeastern Brazil. While widespread and of great importance to large population that has limited access to contemporary medicine, such practices are poorly understood and the potential value of medicinal animal species largely unknown.

MATERIALS AND METHODS:
Based on interviews with merchants of medicinal animals, we calculated the Informant Consensus Factor (ICF) to determine the consensus over which species are effective for particular ailments, as well as the species relative importance to determine the extent of potential utilization of each species.

RESULTS:
We describe the therapeutic effects of 36 animal species used medicinally. The zootherapeutical products sold commercially are used to treat 40 health problems that were classified into 10 broad categories. We also highlight those species valued for their effectiveness against a range of ailments. The highest ICF value (0.91) was cited for diseases of the skin and subcutaneous tissue, which include relief of symptoms such as topical acne scar medications and furuncles.

DISCUSSION AND CONCLUSION:
This study demonstrates that many animal species play an important role in healing practices. Animals provide the raw materials for remedies prescribed clinically and are also used in the form of amulets and charms in magic-religious rituals and ceremonies. The medicinal value of animal species depends on the local knowledge that exists within user communities and therefore the conservation of animal species is imperative to the preservation of local medicinal knowledge and culture.

Commercialization of animal-derived remedies as complementary medicine in the semi-arid region of northeastern Brazil.
J Ethnopharmacol. 2009 May 4; Alves RR, Neto NA, Brooks SE, Albuquerque UPAIM OF THE STUDY

Retinoids: new use by innovative drug-delivery systems.

2009-05-08T04:07:00.001-07:00
Expert Opin Drug Deliv. 2009 May; 6(5): 465-83Trapasso E, Cosco D, Celia C, Fresta M, Paolino DBACKGROUND: Retinoids represent an old class of bioactives used in the treatment of different skin pathologies (such as acne and psoriasis) and in the treatment of many tumors. Unfortunately, they present several side effects, i.e., burning of skin and general malaise after systemic administration and they are very unstable after exposition to light. METHODS: One of the most promising new approaches for reducing the side effects of retinoids while improving their pharmacological effect is the use of drug-delivery devices. This review explains the current status of retinoid drug transport, which has been developing over the last few years, explaining the modification of their biopharmaceutical properties in detail after encapsulation/inclusion in vesicular and polymeric systems. RESULTS/CONCLUSION: Different colloidal and micellar systems containing retinoid drugs have been realized furnishing important potential advancements in traditional therapy.

Acne vulgaris in Nigerian adolescents--prevalence, severity, beliefs, perceptions, and practices.

2009-05-07T02:26:00.001-07:00
Int J Dermatol. 2009 May; 48(5): 498-505Yahya HBACKGROUND: Community-based studies of acne vulgaris conducted in many parts of the world show that it is very common in adolescents but little is known from Africa. METHODS: In a cross-sectional study, 539 randomly selected students aged 11-19 years in a secondary school in Kaduna, Nigeria were administered a questionnaire to assess self-report of acne, its severity and impact; beliefs and perceptions of causes, and treatments used. 418 students were later examined to detect and grade acne severity. RESULTS: 274 (50.8%) were male while 265 (49.2%) were female. Mean age for respondents was 16 years. 320 students (59.4%) self-reported acne. Of 418 students examined, 379 had acne giving a prevalence of 90.7%. There was no significant gender difference in prevalence at all ages of adolescence. Prevalence of acne increased with age (76.7% at age 10-13 years; 88.2% at age 14-16 years; 97.1% at age 17-19 years). 353 of 379 (93.1%) had mild acne while 26 of 379 (6.9%) had moderate acne. The severity of acne was similar in boys and girls. 47.7% of students reported feeling "very sad/unhappy" about their acne although in more than 70% of those who self-reported, this did not interfere with relationship with family, friends or school work. Diet was the commonest factor believed to cause acne. Cleansing agents were the most commonly used treatments. CONCLUSIONS: Acne vulgaris is very common in Nigerian adolescents, although it is mild acne in most.

Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial.

2009-05-06T02:24:00.001-07:00
Lancet. 2009 May 2; 373(9674): 1525-31Pirker R, Pereira JR, Szczesna A, von Pawel J, Krzakowski M, Ramlau R, Vynnychenko I, Park K, Yu CT, Ganul V, Roh JK, Bajetta E, O'Byrne K, de Marinis F, Eberhardt W, Goddemeier T, Emig M, Gatzemeier U, BACKGROUND: Use of cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), has the potential to increase survival in patients with advanced non-small-cell lung cancer. We therefore compared chemotherapy plus cetuximab with chemotherapy alone in patients with advanced EGFR-positive non-small-cell lung cancer. METHODS: In a multinational, multicentre, open-label, phase III trial, chemotherapy-naive patients (>or=18 years) with advanced EGFR-expressing histologically or cytologically proven stage wet IIIB or stage IV non-small-cell lung cancer were randomly assigned in a 1:1 ratio to chemotherapy plus cetuximab or just chemotherapy. Chemotherapy was cisplatin 80 mg/m(2) intravenous infusion on day 1, and vinorelbine 25 mg/m(2) intravenous infusion on days 1 and 8 of every 3-week cycle) for up to six cycles. Cetuximab-at a starting dose of 400 mg/m(2) intravenous infusion over 2 h on day 1, and from day 8 onwards at 250 mg/m(2) over 1 h per week-was continued after the end of chemotherapy until disease progression or unacceptable toxicity had occurred. The primary endpoint was overall survival. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00148798. FINDINGS: Between October, 2004, and January, 2006, 1125 patients were randomly assigned to chemotherapy plus cetuximab (n=557) or chemotherapy alone (n=568). Patients given chemotherapy plus cetuximab survived longer than those in the chemotherapy-alone group (median 11.3 months vs 10.1 months; hazard ratio for death 0.871 [95% CI 0.762-0.996]; p=0.044). The main cetuximab-related adverse event was acne-like rash (57 [10%] of 548, grade 3). INTERPRETATION: Addition of cetuximab to platinum-based chemotherapy represents a new treatment option for patients with advanced non-small-cell lung cancer. FUNDING: Merck KGaA.

Acne Induced By Amineptine

2009-05-04T23:13:00.001-07:00
We report one case of very severe acne-like lesions associated with amineptine (Survector). They were most prominent on the face and back, but were also observed on sites not affected by acne vulgaris, such as perineum, arms and legs.

The lesions appeared after long-term self-medication of high doses. Keratoacanthoma-like lesions were also present, and the small ones were successfully treated with topical imiquimod. The case is significant since the disease is quite rare.

"Acne Induced By Amineptine"
An Bras Dermatol. 2009 Jan-Feb; 84(1): 71-4Guedes AC, Bentes AA, Machado-Pinto J, Carvalho Mde L

Changing the face of acne therapy.

2009-05-04T21:55:00.000-07:00
Many innovations in acne therapy have evolved since the discovery in 1949 that vitamin A derivatives affected epidermal proliferation.

Approval of topical tretinoin solution in 1971 was followed by modifications in the formulation to improve tolerability and provide flexibility in dosing. Identification of retinoid receptors led to research that resulted in 2 receptor-selective synthetic retinoids: adapalene and tazarotene.

Today, topical retinoids are one of the cornerstones of acne therapy and are recommended as first-line therapy for all but the most severe forms of acne.

They are used as monotherapy in mild comedonal acne; for inflammatory acne, topical retinoids are used in combination with benzoyl peroxide (BPO) and antibiotics (topical or oral) and/or hormonal therapy for females.

Because of the high prevalence of antibiotic-resistant strains of Propionibacterium acnes, topical antibiotics should no longer be used as monotherapy. Topical retinoid monotherapy is recommended for maintenance because it prevents formation of microcomedones, the precursor lesions in acne.

Combination topical retinoid/antimicrobial therapy has become the current recommended standard of care for the management of patients with acne. Combination therapy can target multiple pathogenic factors: abnormal follicular keratinization, P acnes proliferation, inflammation, and increased sebum production. A number of fixed-combination products are available.

These products are effective, generally well-tolerated, and more convenient for patients than multiple individual agents. By reducing the number of medications and applications, fixed-combination products have the potential to improve patient adherence, thereby improving treatment outcomes.

"Changing the face of acne therapy"
Cutis. 2009 Feb; 83(2 Suppl): 4-15Ghali F, Kang S, Leyden J, Shalita AR, Thiboutot DM

Anti-acne activities of pulsaquinone, hydropulsaquinone, and structurally related 1, 4-quinone derivatives.

2009-05-04T18:15:00.001-07:00
Arch Pharm Res. 2009 Apr; 32(4): 489-94Cho SC, Sultan MZ, Moon SSQuinone type compound, pulsaquinone 1, isolated from the aqueous ethanol extract of the roots of Pulsatilla koreana exhibited antimicrobial activities against an anaerobic non-spore-forming gram-positive bacillus, Propionibacterium acnes, which is related with the pathogenesis of the inflamed lesions in a common skin disease, acne vulgaris. Compound 1 was unstable on standing and thus converted to more stable compound 2, namely hydropulsaquinone by hydrogenation, whose activity was comparable to mother compound 1 (MIC for 1 and 2 against P. acnes: 2.0 and 4.0 mug/mL, respectively). Other structurally-related quinone derivatives (3-13) were also tested for structure-activity relationship against anaerobic and aerobic bacteria, and fungi. The antimicrobial activity was fairly good when the quinone moiety was fused with a nonpolar 6- or 7-membered ring on the right side whether or not conjugated (1,4-naphtoquinone derivatives 3-5), while simple quinone compounds 6-9 showed poor activity. It seems that the methoxy groups at the left side of the quinone function deliver no considerable antimicrobial effect.

Retinoid-Responsive Transcriptional Changes In Epidermal Keratinocytes

2009-05-04T04:48:00.000-07:00
Retinoids (RA) have been used as therapeutic agents for numerous skin diseases, from psoriasis to acne and wrinkles.

While RA is known to inhibit keratinocyte differentiation, the molecular effects of RA in epidermis have not been comprehensively defined. To identify the transcriptional targets of RA in primary human epidermal keratinocytes, we compared the transcriptional profiles of cells grown in the presence or absence of all-trans retinoic acid for 1, 4, 24, 48, and 72 h, using large DNA microarrays.

As expected, RA suppresses the protein markers of cornification; however the genes responsible for biosynthesis of epidermal lipids, long-chain fatty acids, cholesterol, and sphingolipids, are also suppressed.

Importantly, the pathways of RA synthesis, esterification and metabolism are activated by RA; therefore, RA regulates its own bioavailability. Unexpectedly, RA regulates many genes associated with the cell cycle and programmed cell death. This led us to reveal novel effects of RA on keratinocyte proliferation and apoptosis.

The response to RA is very fast: 315 genes were regulated already after 1 h. More than one-third of RA-regulated genes function in signal transduction and regulation of transcription. Using in silico analysis, we identified a set of over-represented transcription factor binding sites in the RA-regulated genes.

Many psoriasis-related genes are regulated by RA, some induced, others suppressed. These results comprehensively document the transcriptional changes caused by RA in keratinocytes, add new insights into the molecular mechanism influenced by RA in the epidermis and demonstrate the hypothesis-generating power of DNA microarray analysis. J. Cell. Physiol. (c) 2009 Wiley-Liss, Inc.

"Retinoid-responsive transcriptional changes in epidermal keratinocytes"
J Cell Physiol. 2009 Apr 22; Lee DD, Stojadinovic O, Krzyzanowska A, Vouthounis C, Blumenberg M, Tomic-Canic M

Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity.

2009-05-04T03:06:00.001-07:00
J Am Acad Dermatol. 2009 Apr 28; Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, Poli F, Faye O, Bastuji-Garin SBACKGROUND: Factors associated with the severity of hidradenitis suppurativa (HS) are not known. OBJECTIVE: We sought to identify factors associated with the severity of HS. METHODOLOGY: The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. RESULTS: Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). LIMITATIONS: The referral center base of the study may have biased recruitment. CONCLUSION: Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.

Pulsed dye laser-mediated photodynamic therapy for acne inversa is not successful: A pilot study on four cases.

2009-05-03T19:06:00.001-07:00
J Dermatolog Treat. 2009 Jan 1; 1-2Passeron T, Khemis A, Ortonne JPThe relapses and the chronicity of acne inversa cause a significant impact on the quality of life of the affected patients and urge for a search of more effective treatments. We report the treatment of four consecutive acne inversa patients with pulse dye laser-mediated photodynamic therapy (PDL-PDT). Three months after the end of the treatment there was no improvement in comparison with opposite control sites. Intense pain during treatment was reported by all the patients. These cases do not support the use of PDL-PDT for treating acne inversa.

Abies koreana Essential Oil Inhibits Drug-Resistant Skin Pathogen Growth and LPS-Induced Inflammatory Effects of Murine Macrophage.

2009-05-03T02:49:00.001-07:00
Lipids. 2009 Apr 7; Yoon WJ, Kim SS, Oh TH, Lee NH, Hyun CGSince acne vulgaris is the combined result of a bacterial infection and the inflammatory response to that infection, we examined whether Abies koreana essential oil (AKE) possessed anti-inflammatory and antibacterial activities against skin pathogens. In this study, AKE showed excellent antibacterial activities against drug-susceptible and -resistant Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. In addition, AKE reduced the LPS-induced secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, NO and PGE(2) in RAW 264.7 cells, indicating that it has anti-inflammatory effects. Therefore, we suggest that AKE may be an attractive candidate for promoting skin health.

A combined analysis of 2 randomized clinical studies of tretinoin gel 0.05% for the treatment of acne.

2009-05-03T02:05:00.001-07:00
Cutis. 2009 Mar; 83(3): 146-54Webster G, Cargill DI, Quiring J, Vogelson CT, Slade HBAcne vulgaris is a widely prevalent skin disorder primarily treated with retinoids, which have been shown to cause skin irritation. This report describes the combined analysis of 2 similar phase 3 studies designed to evaluate the efficacy and safety of an aqueous gel formulation of tretinoin relative to its vehicle (both studies) and a marketed microsphere formulation of tretinoin (one study) for once-daily topical treatment of acne. Randomized participants 10 years and older with mild to moderate acne (N=1537) received tretinoin gel 0.05% (n=674), tretinoin gel microsphere 0.1% (n=376), or vehicle (n=487) once daily for 12 weeks. Tretinoin gel was more effective than vehicle in reducing inflammatory (P

Vitex agnus-castus - Monograph.

2009-05-01T19:01:00.001-07:00
Altern Med Rev. 2009 Mar; 14(1): 67-71Vitex agnus-castus (chaste tree) is a deciduous shrub that is native to Europe and Asia. Medicinally, the berries have been used for centuries for conditions such as acne, constipation, infertility, lactation support, and libido control. Current clinical uses for chaste tree are menstrual irregularities, premenstrual syndrome, and mastalgia. These indications are supported by the German Commission E reports and a recent survey of practitioners. Recent clinical research identified a dopaminergic effect of chaste tree on the pituitary, with central prolactin inhibition. Hormone modulation by Vitex is seen through dopamine antagonism, not by stimulation of FSH and LH, as was originally reported by early clinical studies. Due to its high degree of safety and efficacy, Vitex is widely used by German physicians, herbalists, and naturopathic physicians for many gynecological conditions.