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PubMed2005

Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women.

OBJECTIVES: To determine if insulin-like growth factor 1 (IGF-1) and androgen levels (1) correlate with the presence and severity of acne in adult men and women, and (2) correlate directly with each other and interact in affecting acne. DESIGN: Case-control study and single-center examination of hormone levels in a cohort of volunteers. SETTING: Academic referral center. PATIENTS: Thirty-four subjects (8 women and 8 men with clinical acne, 10 women and 8 men without clinical acne). Clinical acne is defined by a history of persistent acne (acne present on most days for several years), recent acne treatment, and the presence of 10 or more inflammatory acne lesions and 15 or more comedones. INTERVENTIONS: Single visit for serum sampling. MAIN OUTCOME MEASURES: Serum levels of IGF-1 and androgens were determined, adjusted for age, and compared based on the presence or absence of clinical acne using an analysis of covariance. Correlations between hormone levels and acne lesion counts were calculated within each subgroup. Correlations were also calculated between serum levels of IGF-1 and androgens. Further statistical testing was conducted to determine whether IGF-1 or androgens had a greater effect on acne lesion counts. RESULTS: Dehydroepiandrosterone (DHEAS), dihydrotestosterone (DHT), and IGF-1 correlated positively with acne lesion counts in women. Androstenedione and DHEAS correlated with acne lesion counts in men. Although the age-adjusted mean serum levels of IGF-1 were higher in women with clinical acne than in women without clinical acne, this difference did not achieve statistical significance. No difference in IGF-1 level was noted in men based on the presence of clinical acne. In women with clinical acne, IGF-1 correlated with DHT. In men with clinical acne, IGF-1 correlated with DHEAS and androstenedione. In men and women with clinical acne, the effects of androgens on increased acne lesion counts were dependent on the influence of IGF-1. CONCLUSIONS: Increased IGF-1 levels in addition to androgens may influence acne in adult men and women. While IGF-1 appears to have a stronger effect on acne in women, androgens may play a greater role in acne for men. However, in both men and women these hormones are interrelated, possibly owing to reciprocal effects on hormone production.

Acne Vulgaris↗
PubMed2000

Anxiety, depression, and nature of acne vulgaris in adolescents.

BACKGROUND: The reported prevalence of acne in adolescence is variable; improved treatment may have modified its prevalence and severity; acne has been related to psychiatric morbidity for many years. METHODS: Two thousand six hundred and fifty-seven high school students were examined, and adolescents with acne were interviewed about the subject of acne vulgaris. The severity of acne was graded using the Global Acne Grading System (GAGS). The Hospital Anxiety and Depression (HAD) scale was evaluated for one of every two subjects with acne (n = 308) and for the same number of sex-matched control subjects (n = 308) to determine the prevalence of depression and anxiety. RESULTS: Six hundred and fifteen of the subjects (23. 1%) were determined to have acne. Acne prevalence in girls and boys was 16.1% and 29.2%, respectively (P < 0.001). Two hundred and twenty-five (15.8%) of 1424 boys and only 109 (8.8%) of 1233 girls had moderate or severe/very severe acne (P < 0.001), but the GAGS scores in the groups of boys and girls with acne were not significantly different. The acne and control groups showed no significant differences in the HAD anxiety and depression subscale scores. The HAD anxiety subscale scores of girls were significantly higher than those of boys in the acne group. The severity of acne was not correlated with the HAD anxiety or depression subscale scores. CONCLUSIONS: Acne results in higher anxiety in adolescent girls. Although acne and moderate/severe acne are more common in adolescent boys, the severity of acne was found to be similar in boys and girls with acne. Adolescent girls are more vulnerable than boys to the negative psychological effects of acne.

Acne Vulgaris↗
PubMed1997

Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study.

OBJECTIVES: The objectives of this study were to determine which factors in early pubertal girls might be predictive of later, severe facial acne. STUDY DESIGN: The study was a 5-year longitudinal cohort study, with yearly visits from 1987 through 1991, in a volunteer sample of 439 black and 432 white fourth- and fifth-grade girls with consent from their legal guardians. The subjects were recruited from public and parochial schools in Cincinnati, Ohio. The degree of facial acne was classified annually as mild, moderate, or severe. Blood samples were obtained at the first, third, and fifth years of the study. Using the acne status during the fifth year of the study as the outcome variable, we determined the contributions from the prior acne status and the serum levels of dehydroepiandrosterone sulfate (DHEAS), testosterone, free testosterone (FT), estradiol (E2), progesterone, and testosterone-estrogen binding globulin (TEBG) and compared the results at various ages and at times before and after menarche. RESULTS: No racial differences in acne or hormone levels were found. There was a progressive increase in the number of acne lesions with age and maturation. The girls exhibited many more comedonal than inflammatory acne lesions, regardless of age. The girls in whom severe acne developed by the fifth year of the study had significantly more comedones and inflammatory lesions than girls with mild or moderate acne, as early as age 10 years, approximately 2 h years before menarche, a time when their degree of acne was mild. Girls with mild comedonal acne had significantly later onset of menarche (12.5 compared with 12.2 years) than girls with severe comedonal acne. Girls in whom severe comedonal acne developed had significantly higher levels of serum DHEAS and, in a longitudinal analysis, somewhat higher levels of testosterone and FT in comparison with girls who had mild or moderate comedonal acne. Serum E2, testosterone/E2, progesterone, and TEBG values were no different in girls with severe compared with mild or moderate comedonal acne. CONCLUSIONS: The early development of comedonal acne may be one of the best predictors of later, more severe disease. The adrenal hormone DHEAS appears to play an important role in the initiation of acne. DHEAS, testosterone, and FT are associated with the perpetuation of severe comedonal acne. Early recognition of young girls at risk of having severe comedonal acne may enable the clinician to intervene and thus prevent unwanted sequelae.

Acne Vulgaris↗
PubMed2006

Condensation and validation of a 4-item index of the Acne-QoL.

BACKGROUND: The 19-item Acne-QoL is a validated psychometric instrument designed for use in clinical trials. OBJECTIVE: The purpose of this study was to develop a condensed version of the Acne-QoL as an alternative measure of psychosocial impact for use in routine clinical practice. METHODS: Four condensed versions of the Acne-QoL were evaluated by regression analysis in a subset of 434 patients. The version with four items most broadly representative of acne-specific quality of life combined with a high level of correlation to Acne-QoL total score was selected for further validation in two different patient samples. RESULTS: The patient ranked condensation, representing items from each domain of greatest patient-perceived importance and relevance was selected for further analysis (Acne-Q(4)). The Acne-Q(4) explained 98.5% of the variation in total score of Acne-QoL. Validation of the Acne-Q(4) in a follow-up group and an independent subset of patients resulted in Pearson correlation coefficients of 0.967 (p<0.001). Construct validity of the Acne-Q(4) was confirmed by demonstrating a similar relationship as the Acne-QoL to acne severity. LIMITATIONS: There is less breadth and detail of QoL information in the Acne-Q(4) than in the Acne-QoL. The analysis relied on a total score for Acne-QoL, which the original developers did not validate. CONCLUSIONS: The Acne-Q(4) is accurately reflective of the parent instrument and may facilitate the psychometric evaluation of the impact of facial acne on patients in routine clinical practice by its practicality.

Acne Vulgaris↗
PubMed2001

An epidemiological study of acne in female adults: results of a survey conducted in France.

BACKGROUND: Acne is usually perceived as a disease of teenagers, and most epidemiological studies have focused on adolescents. OBJECTIVE: The primary objective was to investigate the prevalence of acne in a representative sample of French females. Information about skin type, life-style factors influencing acne and quality of life were also recorded. METHODS: A self-administered questionnaire was sent to 4,000 adult women aged 25-40 years, after a validation test by three dermatologists. A definition of acne severity, according to questionnaire answers, was established before the questionnaire was sent out. RESULTS: A total of 3394 women completed the questionnaire of which 3,305 were useable. The data showed a prevalence of acne in 17% of the population, and physiological acne in 24%. Thus, the total acne prevalence was 41%. Forty-nine per cent of the acne patients had acne sequelae (scars and/or pigmented macules). Forty-one per cent of adult acne patients had not experienced acne during their adolescence. A premenstrual flare and stress was recorded as causing acne in 78% and 50%, respectively. Twenty-two per cent of acne subjects were currently receiving therapy. For most patients, acne did not severely impair their quality of life. CONCLUSION: This study shows a prevalence of acne in 41% of women in the general population. A high proportion of these acne cases are late onset acne.

Acne Vulgaris↗
PubMed2004

Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action.

BACKGROUND: Acne affects 83-95% of 16-year-olds of both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and fears over the safety and tolerance of oral isotretinoin, create a demand for novel treatment modalities in acne. OBJECTIVES: To study the efficacy of aminolaevulinic acid-photodynamic therapy (ALA-PDT) in the treatment of acne and to identify the mode of action, looking specifically at the effects on surface numbers of P. acnes and on sebum excretion. METHODS: Ten patients (nine men and one woman, age range 16-40 years) with mild to moderate acne on their backs were recruited. Each patient's back was marked with four 30-cm2 areas of equal acne severity. Each site was then randomly allocated to either ALA-PDT treatment, light alone, ALA alone or an untreated control site. At baseline, numbers of inflammatory and noninflammatory acne lesions were counted, sebum excretion measured by Sebutapes (CuDerm, Dallas, TX, U.S.A.) and surface P. acnes swabs performed. ALA cream (20% in Unguentum Merck) was applied under occlusion to the ALA-PDT and ALA alone sites for 3 h. Red light from a diode laser was then delivered to the ALA-PDT and light alone sites (635 nm, 25 mW cm(-2), 15 J cm(-2)). Each patient was treated weekly for 3 weeks. At each visit acne lesion counts were performed and 3 weeks following the last treatment sebum excretion rates and P. acnes swabs were repeated. RESULTS: There was a statistically significant reduction in inflammatory acne lesion counts from baseline after the second treatment at the ALA-PDT site but not at any of the other sites. No statistically significant reduction in P. acnes numbers or sebum excretion was demonstrated at any sites including the ALA-PDT site. CONCLUSIONS: ALA-PDT is capable of clinically improving acne. An alternative mode of action for ALA-PDT other than direct damage to sebaceous glands or photodynamic killing of P. acnes is suggested from the results of this study.

Acne Vulgaris↗
PubMed1997

Treatment of acne with intermittent isotretinoin.

Adults with acne represent an increasingly important population of acne sufferers referred for treatment. Acne, in these patients, is generally mild or moderate in severity but tends to be resistant to conventional antibiotic therapy. A study was carried out to assess the efficacy of intermittent moderate dose isotretinoin as a treatment for acne. Eighty consecutive patients, over the age of 25 years, referred with acne unresponsive to, or relapsing rapidly after three or more courses of conventional antibiotic therapy were recruited. Acne severity was assessed on the face, chest and back using the Leeds grading scale and the number of inflamed lesions was counted at the site showing the highest acne grade. The patients were 22 men and 58 women. The treatment regimen consisted of isotretinoin, 0.5 mg/kg per day for 1 week in every 4 week for a total period of 6 months. Seventy-five patients completed the study. The therapy was very well tolerated with mild cheilitis as the only side-effect. At the end of treatment, both total acne grade and lesion counts were significantly reduced (P < 0.0001). The acne had resolved in 68 (88%) patients. Twelve months after treatment, acne grades and inflamed lesion counts remained significantly improved (P < 0.0001) in the 68 patients who responded; however, 26 (39%) patients had relapsed. There was a significantly higher incidence of relapse in patients with predominantly truncal acne (P = 0.01). Patients who relapsed also had a significantly higher total acne grade, lesion count (P < 0.0001) and sebum excretion rate (P < 0.001) compared with those whose acne resolved. This study suggests that intermittent moderate dose isotretinoin may be a cost-effective alternative to full dose isotretinoin in a carefully selected group of adult patients with-acne. Selection criteria should include predominantly facial acne, total acne grade less than 1, inflamed lesion count less than 20 and sebum excretion rate less than 1.25 micrograms/cm2 per min.

Acne Vulgaris↗
PubMed1994

Acne vulgaris in premenarchal girls. An early sign of puberty associated with rising levels of dehydroepiandrosterone.

BACKGROUND: This study examined the relationships of pubertal maturation and sex steroid hormones to the development of acne in young girls. Black (n = 317) and white (n = 306) premenarchal girls with a mean age of 9.97 +/- 0.62 years were evaluated for acne prevalence and severity, pubic hair and areolar maturation, and sex steroid hormone levels. RESULTS: Overall, 77.8% of the girls had some acne; of the whole group, 48.3% had only comedonal acne, 2.2% had only inflammatory acne, and 27.3% had both types. Although black girls matured at an earlier age than white girls, racial differences in acne were minimal when adjusted for pubertal maturation. Acne increased with advancing maturation; at Tanner pubic hair stages 1, 2, and 3, the prevalence of acne rose from 73.1% to 84.0% and to 90.6%, respectively. Acne lesion counts at seven facial locations revealed a predominance of midfacial acne on the middle aspect of the forehead, nose, and chin. Sex steroid hormone levels measured in 365 of the girls were found to increase significantly during maturation from prepuberty to early puberty. Testosterone-estrogen-binding globulin and the ratio of testosterone to estradiol decreased. In 118 prepubertal girls, estradiol, total and free testosterone, progesterone, testosterone to estradiol ratio, and testosterone-estrogen-binding globulin levels were no different whether in subjects with acne or without acne. However, the level of dehydroepiandrosterone sulfate, an androgen of adrenal origin, was significantly higher in prepubertal girls with acne. CONCLUSION: Acne, especially the comedonal type, can be the first sign of pubertal maturation in girls, even preceding pubic hair and areolar development. Concentration of dehydroepiandrosterone sulfate is significantly and specifically associated with the initiation of acne in young girls.

Acne Vulgaris↗
PubMed2006

Persistent acne in women : implications for the patient and for therapy.

Acne is traditionally regarded as a skin disorder of the teenage years. However, recent epidemiologic studies have shown that a significant number of female patients aged >25 years experience acne. One recent community-based UK study estimated the prevalence of facial acne in adult women aged between 26 and 44 years to be 14%. It is not clear whether there is a true increase in acne in this age group or whether these patients are less tolerant of their acne and/or better informed of available therapies and so seek advice. The reasons for persistent acne are not fully understood. External factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered when managing these patients. Post-adolescent acne in females can be divided into 'persistent acne', which represents a continuation of acne from adolescence into adult life, and 'late-onset' acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The clinical picture of each of these forms of acne in adult females can differ slightly from conventional adolescent disease. The course of each form is more indolent. Because of these variations, the approach to investigation and management of these cases may have subtle differences when compared with that for teenage disease. Acne treatment should aim to reduce sebum, comedogenesis, propionibacteria population, and inflammation. Treatment selection will depend on the acne grade and site as well as the patient's preference and ability to comply with therapy. Maintenance therapy plays an important role in managing this group of patients. As the response to treatment is inevitably slow, patients must be encouraged to adhere to the chosen treatment regimen. This article reviews the literature on persistent acne in women in terms of clinical presentation and possible etiologic factors, and outlines principles of therapy related to managing these cases.

Acne Vulgaris↗
PubMed2005

[Methods for treating various forms of acne in the years 1991-2000, Department of Dermatology, Silesian Medical School].

Common acne, the most frequently occurring dermatosis of adolescence may lead to mentally unstable states, even depression, due to localization, its very prolonged duration, and in some patients leaving deforming cicatrices. The objective of the present paper is to answer the following questions: which treatment procedures were used for curing patients with different types of acne who were admitted to Department of Dermatology, Silesian Medical School, Katowice, Poland, in the years between 1991 and 2000. During 1991 to 2000, 206 patients were hospitalized with the diagnosis of acne. Mean age of patients was 25.51 years. The following types of acne were recognized: 108 patients--acne punctata, 82--acne conglobata, 4--acne fulminant, 4--papulous-pustular acne, 8--inverse acne, respectively. Analyses have been performed on the basis of case records related to patients admitted to Department of Dermatology, and registered at Outpatient Clinic in the years 1991-2000. It has been proven that there existed a substantial statistical difference between the age of patients affected by acne conglobata and inverse one and those suffering from acne conglobata and acne punctata. A significant difference in the age between the group of patients locally treated and the group of those cured by Roaccutane was observed. The results obtained point out that most frequently diagnosed cases: acne conglobata and acne punctata were treated by Roaccutane and locally, respectively. Results obtained revealed that the percentage of patients treated orally by retinoids showed a rising tendency, while a relatively constant percentage of local treatment methods (strongly marked in the late 1990s) and variable rate of administered antibiotics for curing acne was observed.

Acne Vulgaris↗
PubMed2003

The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress.

BACKGROUND: Although emotional stress has long been suspected to exacerbate acne vulgaris, previous reports addressing its influence on acne severity have been mainly anecdotal. OBJECTIVES: To elucidate the possible relationship between stress and acne exacerbation by evaluating changes in acne severity during nonexamination and examination periods and to assess the possible relationship of these changes in severity with perceived examination stress by using previously validated scales measuring acne severity and perceived stress. DESIGN: Prospective cohort study. SETTING: General university community. PARTICIPANTS: A volunteer sample of 22 university students (15 women and 7 men) with a minimum acne vulgaris severity of 0.5 on the photonumeric Leeds acne scale (baseline scores, 0.50-1.75). MAIN OUTCOME MEASURES: Participants were graded on their acne severity using the Leeds acne scale, and had their subjective stress levels assessed with the Perceived Stress Scale questionnaire during both nonexamination and examination periods. RESULTS: Subjects had a higher mean grade of acne severity and mean perceived stress score (P<.01 for both) during examinations. Using regression analysis and adjusting for the effects of confounding variables, such as changes in sleep hours, sleep quality, diet quality, and number of meals per day, increased acne severity was significantly associated with increased stress levels (r = 0.61, P<.01), while self-assessed change in diet quality was the only other significant association (P =.02). CONCLUSIONS: Patients with acne may experience worsening of the disease during examinations. Furthermore, changes in acne severity correlate highly with increasing stress, suggesting that emotional stress from external sources may have a significant influence on acne.

Acne Vulgaris↗