Acne Medications

Dermatol Surg. 2009 Apr 6; Hu S, Chen MC, Lee MC, Yang LC, Keoprasom NBACKGROUND Atrophic facial acne scars is one of the most common problems in patients with inflammatory acne. Ablative laser resurfacing has unpleasant complications and a long recovery peroid. Nonablative therapies yield less improvement and satisfaction. The introduction of fractional photothermolysis (FP) is an alternative treatment for atrophic acne scars. OBJECTIVE To evaluate the effectiveness and safety of a nonablative 1,550-nm erbium-doped fiber laser in the FP of atrophic facial acne scars in one treatment session. METHODS Forty-five patients (skin type III-IV, mean age 29) with atrophic facial acne scars were enrolled in the study. Each patient received one treatment of FP. Comparative photographs were taken using specific complexion analysis to identify and quantify depressed scars and texture. Physician evaluations and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit. RESULTS The improvement in atrophic scars and texture after a FP treatment were significant. Twenty-seven (60%) of the patients had good to excellent results after 1 month. CONCLUSION The FP of atrophic facial acne scars resulted in significant improvement even in a single treatment, with good satisfaction and unremarkable side effects. The authors have indicated no significant interest with commercial supporters.

J Invest Dermatol. 2009 Apr 23; Katoh MFibroblast growth factor receptor (FGFR)2 is regulated on the basis of the balance of FGFs, heparan-sulfate proteoglycans, FGFR2 isoforms, endogenous inhibitors, and microRNAs. FGFR2 signals cross-talk with hedgehog, bone morphogenetic protein, and other regulatory networks. Some cases of congenital skeletal disorders with an FGFR2 mutation show skin phenotypes, including acne, cutis gyrata, and acanthosis nigricans. Gain-of-function mutations or variations of human FGFR2 occur in estrogen receptor-positive breast cancer, diffuse-type gastric cancer, and endometrial uterine cancer. Oral administration of AZD2171 or Ki23057 inhibits in vivo proliferation of cancer cells with aberrant FGFR2 activation in rodent therapeutic models. However, loss-of-function mutations of FGFR2 are reported in human melanoma. Conditional Fgfr2b knockout in the rodent epidermis leads to increased macrophage infiltration to the dermis and adipose tissue, epidermal thickening accompanied by basal-layer dysplasia and parakeratosis, and the promotion of chemically induced squamous-cell carcinoma. Dysregulation of FGFR2 results in a spectrum of bone and skin pathologies and several types of cancer.Journal of Investigative Dermatology advance online publication, 23 April 2009; doi:10.1038/jid.2009.97.

Photodiagnosis Photodyn Ther. 2008 Jun; 5(2): 134-8Buggiani G, Troiano M, Rossi R, Lotti TPhotodynamic therapy (PDT) is a treatment technique that permits the clearance of different skin lesions with high success rates in many dermatological diseases. Worldwide recognized uses for PDT in dermatology include non-melanoma skin cancer, actinic keratoses, acne vulgaris, photorejuvenation, and hidradenitis suppurativa. In the European Union, and in the USA, its indication is for the treatment of nonhyperkeratotic actinic keratoses (AKs) of the face and scalp, for basal cell carcinoma and for Bowen's disease. However, due to its intriguing mechanism of action, many dermatologists have begun to look at the use of PDT in photorejuvenation, acne vulgaris and hidradenitis suppurativa. Moreover, clinicians have to learn how to maximize this kind of therapy to treat other dermatologic entities, and many anecdotic reports can already be found in the literature. This paper aims to briefly but critically review these reports to give the dermatologist a useful guide to what could be the future experiences in PDT and how to target their efforts in clinics and research.

Fertil Steril. 2009 Apr 24; Cupisti S, Häberle L, Dittrich R, Oppelt PG, Reissmann C, Kronawitter D, Beckmann MW, Mueller AOBJECTIVE: To evaluate the impact of smoking on endocrine, metabolic, and clinical parameters in women with polycystic ovary syndrome (PCOS). DESIGN: Cohort analysis. SETTING: University hospital. PATIENT(S): 346 women with PCOS, including 98 smokers and 248 nonsmokers. INTERVENTION(S): Screening panel, including physical examination, weight and height measurement, and ultrasound examination of the ovaries, and hormone and insulin measurements. MAIN OUTCOME MEASURE(S): Clinical, metabolic, and endocrine parameters, oral glucose tolerance test, calculation of insulin resistance indexes. RESULT(S): In women with PCOS, smoking was associated with statistically significantly increased levels of fasting insulin and calculated free testosterone (cFT) and with a raised free androgen index (FAI) score, which resulted in aggravated scores on the homeostatic model for assessment of insulin resistance (HOMA-IR). However, no differences were observed between the smoking and nonsmoking groups with regard to the clinical parameters for hirsutism, acne, ovulatory function (classified as eumenorrhea, oligomenorrhea, and amenorrhea), or polycystic ovaries using the ultrasound criteria recommended according to the Rotterdam definition. CONCLUSION(S): In women with PCOS, smoking is associated with increased free testosterone and fasting insulin levels, resulting in aggravated insulin resistance. However, there were no differences between smokers and nonsmokers when clinical parameters were compared.

Dermatol Surg. 2009 Mar 20; Niwa AB, Mello AP, Torezan LA, Osório NBACKGROUND Hypertrophic scars are common problems and represent a challenging condition to treat. Fractional photothermolysis has been effective at resurfacing photodamaged skin, acne scars, and atrophic scars, but there are few reports on its use for hypertrophic scars. OBJECTIVE To evaluate the safety and efficacy of 1,550-nm erbium-doped fiber laser treatment of hypertrophic scars in eight patients. METHODS Eight patients (skin phototypes II-IV) with hypertrophic scars received monthly treatments with a 1,550-nm erbium-doped fiber laser. Energy settings ranged from 35 to 50 mJ, and eight to 10 passes were applied with treatment levels 6 to 8. An independent physician evaluator assessed the treatment response by comparing pre- and posttreatment clinical photographs using a quartile grading scale (grade 1, 75%=near total improvement. RESULTS At four weeks after the last treatment session, a mean grade of 2.4 was achieved based on an independent physician's clinical assessment. Improvement in pigmentation occurred in all hyperpigmented scars. CONCLUSION Hypertrophic scars can be effectively and safely improved with 1,550-nm erbium-doped fiber laser treatment. The authors have indicated no significant interest with commercial supporters.

J Cosmet Laser Ther. 2009 Apr 24; 1-7Leheta TMBackground: Acne vulgaris is a disease of the pilosebaceous unit characterized by the development of inflammatory and/or non-inflammatory lesions that may progress to scars. The increase of bacterial resistance and adverse effects, the teratogenicity of retinoids and lack of response to usual therapies has led to the investigation of new therapeutic alternatives. Objective: To evaluate the role of the pulsed dye laser in the treatment of acne in comparison with other topical therapeutic modalities. Methods: We studied 45 patients with mild to moderate acne. Patients were randomly divided into three groups: group A received treatment with pulsed dye laser therapy every 2 weeks, group B received topical preparations and group C was subjected to chemical peeling using trichloroacetic acid 25%. Results: At 12 weeks of treatment, there was a significant improvement of the lesions within each group with the best results seen in group A; however, no significant difference was detected between the three treatment protocols after the treatment period. Remission in the follow-up period was significantly higher in the first group. Conclusions: Pulse dye laser therapy mainly improves the inflammatory lesions of acne with few adverse effects.

Acta Dermatovenerol Croat. 2009; 17(1): 70-6Gorgievska Sukarovska B, Turcić P, Marasović D, Lipozencić JTopical antibiotics are frequently introduced in therapy by various specialists, e.g., dermatologists-venereologists, ENT specialists, proctologists, ophthalmologists, and others. In dermatology, topical antibiotics are used in the treatment of superficial inflammatory skin lesions, acne and rosacea. These agents are also used in the prevention of inflammatory lesions after surgical and corrective procedures. Long-term and uncontrolled application of topical antibiotics, on the skin with impaired protective barrier in particular, implies a risk for the development of hypersensitivity to these agents. Considering the very wide utilization of these agents, hypersensitivity to topical antibiotics poses a major problem worldwide. The groups at a high risk of contact sensitivity to topical antibiotics include patients with chronic venous insufficiency, chronic ulcers and chronic otitis externa, as well as individuals at occupational exposure to antibiotics, e.g., human medicine and veterinary medicine professionals, pharmaceutical industry workers, cattle breeders, etc. When long-term therapy fails to result in improvement in the above mentioned chronic states, the possibility of allergic reactions to topical agents should be taken in consideration. Cross-sensitivity, which is frequently associated with the use of topical aminoglycoside antibiotics, poses a significant problem.

J Cosmet Laser Ther. 2009 Apr 24; 1-4Sadick NBackground and objective: Acne vulgaris remains a major problem in dermatological practice. Phototherapy for acne with blue (415nm) and red (633nm) light-emitting diode (LED) arrays has recently attracted attention. This pilot study assessed the efficacy of the combination of 415nm and near-infrared (IR) LED therapy for moderate acne. Methods: Seventeen individuals were recruited: 13 females and four males. Skin types ranged from type II to type VI, and the acne grades at baseline ranged from Burton grade 1 to 5. Patients underwent twice-weekly 20-minute sessions of LED therapy for 4 weeks, alternating between the blue (415nm) and near-IR (830nm) heads. No other treatment was allowed. Results were assessed and compared with the baseline values at 1, 4 and 8 weeks post-treatment. Results: Six individuals failed to complete the study. Eleven individuals showed improvement ranging from 0% to 83.3%. A downward shift in the Burton grade was seen overall. Non-inflammatory lesion counts increased in four patients, but improved in the other seven by an average of 48.8%. No adverse effects were reported. Conclusions: The combination therapy for acne produced results which were less effective in the reduction of inflammatory lesions than those achieved with the previously reported blue/red combination. Further study with a much larger patient population is warranted.

J Am Acad Dermatol. 2009 May; 60(5 Suppl): S1-50Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, Shalita AR, Lozada VT, Berson D, Finlay A, Goh CL, Herane MI, Kaminsky A, Kubba R, Layton A, Miyachi Y, Perez M, Martin JP, Ramos-E-Silva M, See JA, Shear N, Wolf J, The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment-such as lasers and light therapy-and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.

J Dermatol. 2009 Apr; 36(4): 213-23Akaza N, Akamatsu H, Kishi M, Mizutani H, Ishii I, Nakata S, Matsunaga KPropionibacterium acnes is one of the most significant pathogenic factors of acne vulgaris. This bacteria relates to acne by various pathways. It has also been reported that P. acnes influences pro-inflammatory cytokine production in keratinocytes in vitro. However, the influence on the differentiation of keratinocytes by P. acnes has not been studied extensively. We analyzed the expression of keratinocyte differentiation-specific markers, keratins, and pro-inflammatory cytokines in normal human epidermal keratinocytes (NHEK) exposed to P. acnes in vitro. All P. acnes strains used in this study increased transglutaminase (TGase), keratin 17 (K17) and interleukin (IL) mRNA expression levels in NHEK, and decreased K1 and K10 expression levels. Some P. acnes strains increased involucrin and K6 mRNA expression levels in NHEK and decreased filaggrin, K6 and K16 expression levels in vitro. This experiment clarified that P. acnes influences the differentiation of NHEK in vitro. As a result, P. acnes influenced the expression of not only pro-inflammatory cytokines but also some keratinocyte differentiation-specific markers and keratins in NHEK. Our results suggest that P. acnes relates to acne pathogenesis by not only the induction of inflammation but also in the differentiation of keratinocytes. Moreover, it was considered that the reaction of NHEK to P. acnes may be different depending on the type of bacteria.

J Nurs Res. 2009 Mar; 17(1): 20-29Chang YT, Chen YCABSTRACT:: The purposes of this study were to assess menstrual attitudes and menstrual distress and investigate factors associated with menstrual distress among postmenarcheal female elementary students. A total of 129 female students from 12 elementary schools in Taiwan's Hualien County participated in this study. A stratified cluster random sampling method was adopted. The questionnaire used consisted of three sections asking questions regarding the individual's menstrual characteristics, menstrual attitudes, and menstrual distress. Study results showed that most respondents experienced menstrual blood seepage during the daytime and awakened at night during their periods due to worries about menstrual blood seepage. This study found that indigenous students had significantly more frequent episodes of menstrual blood seepage during the daytime and awakened at night during period than did nonindigenous students. The mean score on the Menstrual Attitude Questionnaire was 1.88 (SD = 0.36, possible score = 1-4). The three most prevalent symptoms of menstrual distress were dysmenorrhea, acne, and fatigue. The mean score on the Menstrual Distress Questionnaire was 1.00 (SD = 0.76; possible score = 0-4). Moreover, there was a significantly negative correlation between menstrual attitudes and menstrual distress and significantly positive correlations between menstrual distress and (a) time since menarche, (b) menstrual blood seepage during the daytime, and (c) menstrual blood seepage while sleeping. Study results recommend that families and elementary schools help postmenarcheal female elementary students to accept menstruation as a natural process.

J Clin Endocrinol Metab. 2009 Apr 7; Kuijper EA, Vink JM, Lambalk CB, Boomsma DIIntroduction: Intra-uterine androgens of a male fetus may influence the female fetus in opposite sex-twin pairs. As female intra-uterine overexposure to androgens could lead to polycystic ovary syndrome, the prevalence of PCOS should be higher, in women from dizygotic opposite-sex twin pairs. Therefore, the aim of the current study was to evaluate the prevalence of polycystic ovary syndrome in women from opposite-sex twin pairs compared to women from same-sex twin pairs, sisters and female spouses of twins. Subjects and Methods: Data from 1325 monozygotic twins, 1191 dizygotic twins (711 women from same-sex twin pairs and 480 women from opposite-sex twin pairs), 745 sisters of twins and 218 spouses of male twins were evaluated. PCOS was defined as less than nine natural menstrual cycles a year combined with either hirsutism or acne. The prevalence of PCOS was compared using a chi-squared test. Binary logistic regression analyses were conducted to test for confounding effects of smoking, age and BMI. Results: No significant differences in PCOS prevalence were found between women from same sex twin pairs (either monozygotic or dizygotic), opposite-sex twin pairs, sisters and spouses. Conclusion: The prevalence of polycystic ovary syndrome is not different in women from opposite-sex and same-sex twin pairs, singleton sisters or spouses. This indicates that possible androgen exposure of the female fetus, caused by a shared intra-uterine environment with a male fetus, does not result in PCOS-like traits.

J Invest Dermatol. 2009 Apr 23; Nakatsuji T, Kao MC, Fang JY, Zouboulis CC, Zhang L, Gallo RL, Huang CMThe strong bactericidal properties of lauric acid (C12:0), a middle chain-free fatty acid commonly found in natural products, have been shown in a number of studies. However, it has not been demonstrated whether lauric acid can be used for acne treatment as a natural antibiotic against Propionibacterium acnes (P. acnes), which promotes follicular inflammation (inflammatory acne). This study evaluated the antimicrobial property of lauric acid against P. acnes both in vitro and in vivo. Incubation of the skin bacteria P. acnes, Staphylococcus aureus (S. aureus), and Staphylococcus epidermidis (S. epidermidis) with lauric acid yielded minimal inhibitory concentration (MIC) values against the bacterial growth over 15 times lower than those of benzoyl peroxide (BPO). The lower MIC values of lauric acid indicate stronger antimicrobial properties than that of BPO. The detected values of half maximal effective concentration (EC(50)) of lauric acid on P. acnes, S. aureus, and S. epidermidis growth indicate that P. acnes is the most sensitive to lauric acid among these bacteria. In addition, lauric acid did not induce cytotoxicity to human sebocytes. Notably, both intradermal injection and epicutaneous application of lauric acid effectively decreased the number of P. acnes colonized with mouse ears, thereby relieving P. acnes-induced ear swelling and granulomatous inflammation. The obtained data highlight the potential of using lauric acid as an alternative treatment for antibiotic therapy of acne vulgaris.Journal of Investigative Dermatology advance online publication, 23 April 2009; doi:10.1038/jid.2009.93.

Gesundheitswesen. 2009 Apr 22; Hensen G, Schiller M, Luger TA, Hensen POBJECTIVE: This survey aims to identify psychosocial issues in the outpatient care of acne vulgaris in dermatological and paediatric practices. The main object of the study lies on the impact of psychosocial stresses and strains, and offers of support in medical care. METHOD: Questionnaires were sent out to all dermatologists and paediatricians in private practice in Westphalia-Lippe (n=678) using a combined quantitative and qualitative approach. The average response rate was 41.0% (n=278), for paediatrics 43.7% (n=190) and dermatology 36.3% (n=88), respectively. Methods of descriptive statistics were applied. Qualitative data were analysed using a qualitative content analysis. RESULTS: From the physicians' point of view several needs of psychosocial care are seen, however, predominantly focussing on psychotherapeutic and inpatient medical care. Correspondingly, patients' demands for psychosocial care were also indicated. The responding physicians were not aware of low threshold offers of support such as self-help, support and advocacy organisations, social services or help-desks. These offers do not play an important role in outpatient care. Altogether only a minor group of respondents cooperates with these named institutions providing psychosocial care services. CONCLUSIONS: The integration of psychosocial care is not common practice in the outpatient care of acne vulgaris. On the one hand physicians are willing to cooperate with caring institutions inside and outside the health care system; on the other hand cooperation is limited by lots of structural and fiscal barriers. The mental and psychological stresses related to acne vulgaris are evident and important for social and emotional development of children and adolescents. Although this fact is actually being perceived, the implementation of psychosocial issues is medical practice remains inadequate.

Acta Dermatovenerol Croat. 2009; 17(1): 84Bukvić Mokos Z, Lipozencić JFor decades now, dermatologic offices are not only visited by patients with various dermatologic diseases but also by individuals wishing to improve their own appearance. At first, these were mostly persons with acne scars and pigmentation changes, later also those with changes associated with skin aging. The acquisition of new scientific concepts has been paralleled by novel scientific developments resulting in new therapeutic methods in corrective dermatology. Mechanical dermabrasion was one of the first therapeutic procedures in corrective dermatology. The skin is abraded to dermoepidermal junction by use of a metal, diamond or ruby grinder. The procedure is usually performed to remove scars or reduce wrinkles, the depth of abrasion depending on the indication. In Croatia, among the pioneers having introduced the method in corrective dermatology mention should be made of Professor Ante Vukas, MD, PhD, with more than 700 procedures and Professor Zdravko Peris, MD, PhD from University Department of Dermatology and Venereology, Rijeka University Hospital Center, who carried out more than 2000 procedures and published first professional papers in the field. Head Doctor Zdenka Jurin-Zmegac, MD, introduced the method at Outpatient Clinic of Medical Cosmetology, University Department of Dermatology and Venereology, Zagreb University Hospital Center in 1972. Chemical peeling is a method by which concentrated chemicals are applied to the skin to peel off the epidermis and dermis. This results in regeneration of the dermis and epidermis with synthesis of new collagenous and elastic fibers in the dermis. Chemical peeling is performed to remove acne and/or acne scars, hyperpigmentation and signs of skin aging. According to the depth of action, chemical peel can be superficial, medium depth and deep, depending on the chemical used and length of skin exposure. Superficial peel implies epidermal peel to the dermoepidermal junction, mostly by use of alpha-hydroxy acids in various concentrations. The objective of treatment is to achieve keratolytic effect with fibroblast stimulation, thus improving the skin texture, and reducing the number of comedones and hyperpigmentation. Medium depth peel results in necrosis of the epidermis and part of or entire papillary layer of the dermis. The procedure is usually performed by use of trichloroacetic acid at a concentration of up to 30%. The indications for medium depth peel include wrinkles, hyperpigmentation, shallow scars and signs of solar skin degeneration. Deep peel is used to remove deep scars. This procedure results in necrosis of the epidermis and the entire papillary dermis, also involving the upper part of reticular dermis. Deep peel is a demanding procedure that can only be carried out by experienced therapists using high concentrations of trichloroacetic acid (45%-50%) or phenol solution (Baker-Gordon formula). At Outpatient Clinic of Medical Cosmetology, University Department of Dermatology and Venereology, Zagreb University Hospital Center, chemical peeling has been performed since 1995, when Professor Aleksandra Basta-Juzbasić, MD, PhD introduced chemical peel with glycolic acid. Nowadays, corrective dermatology is almost inconceivable without the use of laser, one of the recent methods of treatment that has been rapidly and continuously developing over the past few decades. Target removal of various skin lesions is based on the theory of selective photothermolysis, set up by Anderson and Parrish in 1983. This revolutionary theory is based on the understanding that cutaneous chromophores (hemoglobin, melanin, water) absorb particular light wavelength applying a laser beam wavelength corresponding to maximal absorption of the chromophore contained in a particular lesion will lead to selective destruction of the target tissue. The greatest advantage of laser over other therapeutic methods is selectivity in removing target skin lesion with minimal thermal damage to the surrounding tissue. It should be noted that following laser treatment strict sun protection is required to avoid the unpleasant side effect of hyperpigmentation. Along with avoiding sun exposure for several weeks, irrespective of the season of the year, use of creams and emulsions with a >30 protection factor is recommended. The Center for Laser Use in Dermatology (Cosmetology) has been working at University Department of Dermatology and Venereology, Zagreb University Hospital Center for six years now, as the only university center in the region. During these six years, precious experience has been collected in the use of laser for removal of many congenital and acquired skin changes, including vascular and pigmented lesions, benign skin growths, laser epilation, and removal of wrinkles and scars (laser resurfacing). A variety of laser systems have been and are used, e.g., diode Nd:YVO4 532 laser, diode 810 nm laser, Q-switched ruby 694 nm laser, Er:YAG 2940 nm laser and CO2 10600 nm laser. Implants or fillers are various substances injected into the skin to fill in the wrinkles, atrophic scars and skin defects, skin rejuvenation (mesotherapy) and face remodeling (lip, zygomatic region, chin and nose enlargement). Implants are classified according to the process of degradation (biodegradable or non-biodegradable), origin (natural or synthetic), organic or inorganic character, and duration of effect (short-term, long-term or permanent). An ideal implant should be safe and of optimal duration, simple to apply with minimal discomfort, hypoallergenic and isovolemically degradable; upon the treatment, the face should have natural appearance, and the price of the treatment should be acceptable. After all, the ideal effect means stimulation of own fibroblasts for the synthesis of own collagen. Unfortunately, none of the agents available meets all the conditions mentioned above. Hyaluronic acid, a biodegradable implant, is currently most widely used because of its excellent therapeutic results associated with a very low risk of side effects. Therapeutic effect lasts for three months to two years in case of biodegradable implants, whereas non-biodegradable implants may last for years or even indefinitely. However, the application of non-biodegradable agents may be associated with the development of foreign-body granulomas, pseudocysts and abscesses. In addition to popular fillers, the clients show increasing interest in the use of botulinum toxin to correct mimicry wrinkles (around the eyes, between the eyebrows and forehead). Botulinum toxin is a potent neurotoxin produced by the bacterium Clostridium botulinum, which causes temporary paralysis of striated muscles. The main precondition for therapeutic success is proper training and experience of the physician, who should have profound knowledge of the treated area anatomy, be sure in choosing correct indication and agent dosage, and using appropriate injection technique. Therapeutic result in terms of wrinkle reduction can be observed within a week of the injection and lasts for several (4-12) months; the interval between two procedures should be at least three months. Recently, combinations of the methods listed above have been ever more employed, depending on indication. Proper choice of high quality treatments is the responsibility of dermatologist-venereologist specialized in the field of corrective dermatology, especially in the light of the great number of new therapeutic options offered by fast technological advancement. Unfortunately, these demanding corrective treatments are ever more frequently performed at non-medical institutions and by incompetent persons. Properly trained and experienced physician is fully aware of the crucial role of appropriate assessment of the patient and his/her expectations. He will explain to him/her the corrective procedure, the potential risks and the expected outcome. A predictable lack of patient compliance with proper skin care after the treatment and unrealistic expectations are considered absolute contraindications for any corrective treatment.

Maturitas. 2009 Apr 7; Schwenkhagen A, Studd JHypoactive sexual desire disorder (HSDD) is a common clinical problem that may have a very negative impact on a woman's quality of life. Diagnosis and treatment is challenging, as one must keep in mind the complex web of factors influencing sexual functioning alone or in concert. Data suggest that androgens are significant independent factors affecting sexual desire, sexual activity and satisfaction, as well as other components of women's health such as mood and energy. For decades, physicians used various androgen preparations to improve sexual function in women, based on the results of smaller clinical trials and personal clinical observations when taking care of patients. Today, there is substantial body of evidence from randomized placebo-controlled trials that low-dose testosterone treatment is efficacious in women with HSDD who have an established cause of androgen deficiency such as surgical menopause. Recent data support the hypotheses that androgens may also be beneficial in naturally menopausal women or in premenopausal women with low circulating testosterone levels and a decrease in satisfying sexual activity. No single testosterone level has been found to be predictive for low female sexual function, even though women suffering from HSDD commonly have low testosterone levels. The most frequently reported side effects of testosterone treatment are mild hirsutism or acne. Long-term safety is not yet established. Several clinical trials are in progress to further investigate potential benefits and risks of androgen treatment in women with sexual dysfunction.

J Dermatol. 2009 May; 36(5): 255-61Hahm BJ, Min SU, Yoon MY, Shin YW, Kim JS, Jung JY, Suh DHOral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck's depression inventory [BDI]), anxiety (Beck's anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade.

J Drugs Dermatol. 2009 Apr; 8(4): 358-64Elsaie ML, Abdelhamid MF, Elsaaiee LT, Emam HMBACKGROUND: Botanical extracts and preparations have been used in different pathological conditions with success. An important group of phytochemical phenolic compounds are the catechins found in green tea. Acne is a widely occurring inflammatory condition that is estimated to affect 40 to 50 million Americans. Finding an effective, safe, cost-effective and well-tolerated treatment is the challenge. OBJECTIVE: To determine the efficacy of 2% green tea lotion in mild-to-moderate acne vulgaris. METHODS: Twenty patients fulfilling enrolment criteria were included. Green tea was given and applied twice daily for a period of 6 weeks. The patients were seen every 2 weeks to evaluate the lesions and any side effects. To determine efficacy on acne severity, the authors used both total lesion count (TLC) and their devised severity index (SI). Total lesions count (TLC) was calculated as papules + pustules while SI was scaled with numbers (1, 2 or 3) correlating to TLC in order of increasing intensity. TLC < 10 was given an SI of 1, TLC 10-20 was given an SI of 2 and TLC > 20 was given an SI of 3. RESULTS: The mean total lesion count (TLC) decreased from 24 before the treatment to 10 after 6 weeks after treatment, a reduction of 58.33%. The difference was statistically significant (P < 0.0001, 95% confidence interval [CI] of the difference = 8.58 - 19.42). The mean severity index (SI) decreased from 2.05 before treatment to 1.25 after 6 weeks treatment, a decrease of 39.02%. The difference was statistically significant (P < 0.0001, confidence interval [CI] of the difference = 0.54-1.26). Conclusion: Topical 2% green tea lotion is an effective, cost-effective treatment for mild-to-moderate acne vulgaris.

J Dermatol Sci. 2009 Apr 16; Sugisaki H, Yamanaka K, Kakeda M, Kitagawa H, Tanaka K, Watanabe K, Gabazza EC, Kurokawa I, Mizutani HBACKGROUND: Acne vulgaris is a multifactorial inflammatory disease of the sebaceous follicles of the face and torso that frequently occurs in adolescence. Initially, acne starts as a non-inflammatory comedo. Subsequently, inflammatory reactions evolve to pustules, granulomas and cystic lesions. Many pathogenic mechanisms have been proposed including sebum excretion, obstruction of hair follicles, impaired keratinization of hair epithelium, bacterial overgrowth and immunological mechanisms; the role of Propionibacterium acnes (P. acnes) is particularly important. Facultative anaerobic gram-positive rods have been implicated in acne pathogenesis. However, the host immune response to P. acnes has not been as yet elucidated. OBJECTIVES: The aim of the present study is to evaluate the importance of the immune response to P. acnes and the bacteriological factor in the pathogenesis of acne. METHODS: P. acnes isolated from acne lesions and healthy volunteers skin were cultured. The peripheral blood mononuclear cells (PBMC) from acne patients or healthy volunteers were stimulated with viable P. acnes, and cytokine production was evaluated using RT-PCR and ELISA. RESULTS: IFN-gamma, IL-12p40, and IL-8 mRNA and protein production were significantly increased in PBMC from acne patients compared to that from normal donors. However, different P. acnes species isolated from acne lesions or normal subjects showed no difference in cytokines production from acne patients and normal subjects PBMC. CONCLUSIONS: The inflammatory response of acne appears to be attributable to P. acnes-induced host immune response rather than P. acnes strains from normal skin or acne lesions.

Curr Opin HIV AIDS. 2008 Jul; 3(4): 453-60Huiras E, Preda V, Maurer T, Whitfeld MPURPOSE OF REVIEW: The introduction of highly active antiretroviral therapy (HAART) has altered the pattern of dermatologic disease among HIV-infected patients. While the majority benefit substantially from highly active antiretroviral therapy-induced immune recovery, a subset of patients experience unmasking of new skin disease or paradoxical worsening of existing dermatologic conditions, attributable to immune reconstitution inflammatory syndrome. We review the current literature regarding the dermatologic manifestations of immune reconstitution inflammatory syndrome. RECENT FINDINGS: Cutaneous immune reconstitution inflammatory syndrome is described in association with a range of infectious, inflammatory, neoplastic, and autoimmune disorders. The list of skin manifestations of immune reconstitution inflammatory syndrome continues to grow, with current literature highlighting the emergence of tropical skin diseases, such as leishmaniasis and leprosy, presenting in the context of immune recovery. Increasingly, we are recognizing common skin eruptions such as acne may be associated with immune reconstitution inflammatory syndrome. There are also recent descriptions of previously unreported presentations of well established immune reconstitution inflammatory syndrome-related conditions. These include Mycobacterium avium presenting as cutaneous ulceration and an epidermodysplasia verruciformis-like eruption of warts. Additionally, authors are attempting to define the unique immunopathology associated with immune reconstitution inflammatory syndrome in the context of specific cutaneous diseases. SUMMARY: Optimal management depends on recognition of immune reconstitution inflammatory syndrome as a unique syndrome by healthcare providers, rather than a failure of highly active antiretroviral therapy or an adverse drug reaction. Our understanding of dermatologic immune reconstitution inflammatory syndrome continues to evolve as the diversity of reported cutaneous immune reconstitution inflammatory syndrome-associated disorders expands.

Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. The most common cause is by increased production of male sex hormones (androgens). It is also affected by increased sensitivity to androgens in the hair follicles, and secretory glands around hair follicles (sebaceous glands). Spironolactone is an antiandrogen and aldosterone antagonist used to treat hirsutism.

OBJECTIVES:
The objective was to investigate the effectiveness of spironolactone and/or in combination with steroids (oral contraceptive pill included) in reducing excess hair growth and/or acne in women.

SEARCH STRATEGY:
The Cochrane Menstrual Disorders and Subfertility Group (MDSG) trials register was searched (April 2008). The Cochrane MDSG register is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, all reference lists of relevant trials were searched and drug companies contacted for details of unpublished trials.

SELECTION CRITERIA:
All randomised controlled comparisons of spironolactone versus: placebo, steroids (oral contraceptive pill included), spironolactone of varying dosages, or spironolactone and steroids versus steroids alone when used to reduce hair growth and acne in women.

DATA COLLECTION AND ANALYSIS:
Nine trials were included in the review, eight trials were excluded. Two other trials are awaiting assessment. Only one trial studied acne as an outcome, the remainder were concerned with hirsutism. Major outcome measures include the following: subjective observations, Ferriman and Gallwey hair scores, hormonal and biochemical parameters, side effects, sebum production measurement.

MAIN RESULTS:
In the two trials that compared 100 mg of spironolactone with placebo significant differences were reported for subjective improvements in hair growth (OR 7.18, 95% CI 1.96 to 26.28), although not the Ferriman-Galwey score (WMD 7.20, 95% CI -10.98 to -3.42)). Data could not be otherwise pooled as only one trial reported an outcome.

AUTHORS' CONCLUSIONS:
From the studies included in this review, there is some evidence to show that spironolactone is an effective treatment to decrease the degree of hirsutism but there was no evidence for effectiveness for the treatment of acne vulgaris. Studies in this area are scarce and small. Individual study data indicates some superiority of spironolactone over other drugs but results cannot be generalised.

"Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne."

Hirsutism, acne, alopecia, and oligo-amenorrhea are clinical expressions of hyperandrogenism, one of the most frequent endocrine disorders in women of reproductive age. Women referred to our endocrine clinics for skin symptoms of hyperandrogenism underwent a laboratory workup to evaluate hormone measurements and received antiandrogen therapy.

We retrospectively analyzed the outcome of 228 consecutive patients investigated over 6 years.Patients with hirsutism had higher levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), and salivary testosterone; lower levels of sex hormone-binding globulin (SHBG); and a higher prevalence of oligo-amenorrhea than patients with alopecia, while patients with acne showed intermediate values.

Hirsutism score correlated positively with androstenedione, DHEAS, and salivary testosterone, and correlated negatively with SHBG; salivary testosterone showed the highest correlation coefficient.

Total testosterone was not significantly different among patients with hirsutism, alopecia, or acne, and did not significantly correlate with hirsutism score. Hirsutism and oligo-amenorrhea were the most sensitive symptoms of hyperandrogenism, and no androgenic parameter alone allowed us to identify all cases of hyperandrogenism.

Patients of central European origin sought consultation with milder hirsutism scores than patients of southern European origin. There was, however, no difference in the clinical-biological correlation between these groups, arguing against differences in skin sensitivity to androgens.

Polycystic ovary syndrome, defined as hyperandrogenism (hirsutism or elevated androgens) and oligo-amenorrhea, was diagnosed in 63 patients (27.6%), an underestimate compared with other reports that include systematic ovarian ultrasound studies.

Neither pelvic ultrasound, used in a limited number of cases, nor the luteinizing hormone/follicle-stimulating hormone ratio helped to distinguish patients with polycystic ovary syndrome from the other diagnostic groups.

These included hyperandrogenism (hirsutism or elevated androgens) and eumenorrhea (101 patients; 44.3%); normal androgens (acne or alopecia and eumenorrhea) (51 patients; 22.4%); isolated low SHBG (7 patients; 3.1%); nonclassical congenital adrenal hyperplasia (4 patients; 1.8% of total, 4.9% of patients undergoing cosyntropin stimulation tests); and ovarian tumor (2 patients; 0.9%).

Ethinylestradiol and high-dose cyproterone acetate treatment lowered the hirsutism score to 53.5% of baseline at 1 year, and was also effective in treating acne and alopecia. The clinical benefit is ascribed to the peripheral antiandrogenic effect of cyproterone acetate as well as the hormone-suppressive effect of this combination.

Salivary testosterone showed the most marked proportional decrease of all the androgens under treatment. Cost-effectiveness and tolerance of ethinylestradiol and high-dose cyproterone acetate compared well with other antiandrogenic drug therapies for hirsutism.

The less potent therapy with spironolactone only, a peripheral antiandrogen without hormone-suppressive effect, was effective in treating isolated alopecia in patients with normal androgens.

Androgen Dependence Of Hirsutism, Acne, And Alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism.

Medicine (Baltimore). 2009 Jan; 88(1): 32-45Karrer-Voegeli S, Rey F, Reymond MJ, Meuwly JY, Gaillard RC, Gomez F

The asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases.

The Asian patient with Fitzpatrick skin types III-V is rarely highlighted in publications on cutaneous disorders or cutaneous laser surgery.

However, with changing demographics, Asians will become an increasingly important group in this context. Although high melanin content confers better photoprotection, photodamage in the form of pigmentary disorders is common.

Melasma, freckles, and lentigines are the epidermal disorders commonly seen, whilst nevus of Ota and acquired bilateral nevus of Ota-like macules are common dermal pigmentary disorders.

Post-inflammatory hyperpigmentation (PIH) occurring after cutaneous injury remains a hallmark of skin of color. With increasing use of lasers and light sources in Asians, prevention and management of PIH is of great research interest.

Bleaching agents, chemical peels, intense pulsed light (IPL) treatments, and fractional skin resurfacing have all been used with some success for the management of melasma. Q-switched (QS) lasers are effective for the management of epidermal pigmentation but are associated with a high risk of PIH.

Long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers and IPL sources pose less of a PIH risk but require a greater number of treatment sessions. Dermal pigmentary disorders are better targeted by QS ruby, QS alexandrite, and QS 1064-nm Nd:YAG lasers, but hyper- and hypopigmentation may occur.

Non-ablative skin rejuvenation using a combination approach with different lasers and light sources in conjunction with cooling devices allows different skin chromophores to be targeted and optimal results to be achieved, even in skin of color.

Deep-tissue heating using radiofrequency and infra-red light sources affects the deep dermis and achieves enhanced skin tightening, resulting in eyebrow elevation, rhytide reduction, and contouring of the lower face and jawline.

For management of severe degrees of photoaging, fractional resurfacing is useful for wrinkle and pigment reduction, as well as acne scarring. Acne, which is common in Asians, can be treated with topical and oral antibacterials, hormonal treatments, and isotretinoin. Infra-red diode lasers used with a low-fluence, multiple-pass approach have also been shown to be effective with few complications.

Fractional skin resurfacing is very useful for improving the appearance of acne scarring. Hypertrophic and keloid scarring, another common condition seen in Asians, can be treated with the combined used of intralesional triamcinolone and fluorouracil, followed by pulsed-dye laser.

Esthetic enhancement procedures such as botulinum toxin type A and fillers are becoming increasingly popular. These are effective for rhytide improvement and facial or body contouring. We highlight the differences between Asian skin and other skin types and review conditions common in skin of color together with treatment strategies.

Am J Clin Dermatol. 2009; 10(3): 153-68Ho SG, Chan HH

Here The Commandment For Acne :

• Clean the skin with a cleanser specifically for acne (type exfoliating)
• WASH both morning and night with warm water. If sport wash your face very well, to remove impurities and fat.
• Use a clean towel or tissue and not "refregar" skin. Very smooth.
• Do not touch, rub or scratch injury, can harm the area.
• Not to support the hands on the face, avoid the risk of irritation and infection.
• Identify and avoid anything that aggravates acne, food, cosmetics, medicines, etc..
• Use fat-free cosmetics (oil-free)
• Avoid alcohol, snuff and stress.
• Put any cream or treatment, but knowing that having acne is something "normal" in adolescence.
• Avoid exposing the skin to many hours of sun, and patches that can appear on the skin.

Zeno is an electronic medical device designed to eliminate the pimples caused by acne and specially designed for use in total comfort anywhere, since it is portable, rechargeable and small. It has been clinically proven to make pimples disappear fast and efficiently.

In fact, the medical device is the most advanced available and effective for treating acne pimples generated without requiring a prescription.

Effective anti-acne treatment

Zeno technology creates a heat stroke in the microorganisms that cause skin lesions, making the self-destruction of these bacteria and thus allowing the skin back to normal and healthy. In the case of acne, the acne bacteria is the cause of 90% of the shins.

Zeno ™ is a simple, electronic, designed to safely heat for acne to a predetermined temperature range to cause a crash. The treatment of heat shock response is a bacteria that convert a set of genes that activate heat shock proteins. These proteins are involved in eliminating the bacteria causing it to self.

Zeno Treatment

The grains appear when the pores become blocked because the fat and skin cells accumulate faster than it can go, and it is this which causes an obstruction of the follicle bulge. The blockage causes a break in the wall of the follicle, which we know from shin.

Controlled by applying heat for a certain time we get the bacteria to self. When the bacteria die, the pimple disappears. So Zeno applies a precisely controlled dose of heat to the pimple through a metal.