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At least 217 records · Page 12Linked to original sources
PubMed1999

Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients.

BACKGROUND: The efficacy of oral isotretinoin in acne has been established, though the role of the mean daily dose (MDD) is still unclear. OBJECTIVE: To determine the predictive factors of resistance to oral isotretinoin and the role of the MDD of isotretinoin on relapse of acne while taking into account patient characteristics and the total cumulative dose (TCD). METHODS: Two hundred and thirty-seven patients treated with oral isotretinoin for the first time were enrolled by a single dermatologist. Patients with closed comedonal acne and with hyperandrogenism received adequate therapy prior to isotretinoin. RESULTS: Closed comedonal acne was the only predictive factor of resistance to isotretinoin with an adjusted OR = 2.7 (95% CI: 1.0-7.3). The estimated rates of relapse at 1, 3 and 5 years were 14, 40 and 48%, respectively. Age and grade of facial acne were the only predictive factors for relapse with adjusted relative risks of 0.6 (95% CI: 0.4-0.8) for age >/= 20 and 1.5 (95% CI: 1.0-2.2) for grade > 3. CONCLUSION: MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.

Acne Vulgaris↗
PubMed2000

Topical therapy for acne.

Acne is a common problem in adolescents and young adults. The disorder is caused by abnormal desquamation of follicular epithelium that results in obstruction of the pilosebaceous canal. This obstruction leads to the formation of comedones, which can become inflamed because of overgrowth of Propionibacterium acnes. Topical retinoids such as tretinoin or adapalene are effective in many patients with comedonal acne. Patients with inflammatory lesions benefit from treatment with benzoyl peroxide, azelaic acid or topical antibiotics. Frequently, the use of comedonal and antibacterial agents is required.

Acne Vulgaris↗
PubMed1989

Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin.

20% azelaic acid cream was compared clinically with it vehicle in a 3-month double-blind study of 92 patients with moderate inflammatory acne. In a single-blind study of 289 patients with comedonal acne, the topical azelaic acid preparation was compared with 0.05% tretinoin cream over a period of 6 months. In both controlled studies, 20% azelaic acid cream significantly reduced the number of acne lesions and yielded clinically relevant improvement rates. Azelaic acid cream was significantly and substantially more effective than its vehicle, indicating that the dicarboxylic acid itself is an active drug in acne treatment. In the study of comedonal acne, 20% azelaic acid cream was equally effective as 0.05% tretinoin cream in reducing the number of comedones and with respect to overall response. However, azelaic acid cream was better tolerated, causing fewer local side effects than the topical retinoid.

Acne Vulgaris↗
PubMed1986

[Topical cimetidine treatment of acne].

We present first results of topically applied cimetidine in acne. Ten patients suffering from papulopustular and comedone acne administered 2% cimetidine in indifferent lotion on their face twice a day. Clinical controls were performed every two weeks; sebum was monthly determined. After treatment of 13 weeks on the average, the clinical success was generally good. Comedones responded best, followed by papules. Pustules were hardly reduced. There was no significant reduction of SER and the lipid fractions at the end of treatment. Low concentration or insufficient penetration might be possible explanations. The efficient reduction of comedones might be an antiandrogenic effect due to modulation of the keratinization in the follicle excretory duct. Immune-modulatory effects of cimetidine and effects on the skin vessels are other possible explanations for the clinical efficacy of topical application of cimetidine in acne.

Acne Vulgaris↗
PubMed1986

Nevoid basal cell carcinoma syndrome. A review and case report of a patient with unilateral basal cell nevus syndrome.

An exceptionally rare example of nevoid basal cell carcinoma syndrome occurring unilaterally is presented, along with a review of the syndrome. We ruled out the possible association of this case with the linear unilateral basal cell nevus with comedones because of several incongruities, including the absence of epidermal cysts and strialike atrophy and the presence of pigmented basal cell carcinomas. Linear unilateral basal cell nevus with comedones is not a variant of the nevoid basal cell carcinoma syndrome and the tumors follow a benign course. The aggressive, destructive behavior of numerous pigmented basal cell carcinomas that involve the eyelid and medial canthus of the eye and the head and neck area represents important evidence that our patient's condition was not an example of linear unilateral basal cell nevus with comedones.

Basal Cell Nevus Syndrome↗
PubMed1982

[A new salt of erythromycin (A-137 or erythromycin lauryl sulfate) in the topical treatment of acne].

Thirty six patients affected of acne vulgaris, preferently inflammatory, graded from I to IV according to Plewig & Kligman scale, were included in a double blind trial of erythromycin laurilsulfate (A-137) alcoholic solution versus only the vehicle, both for topical. The solutions were assigned after randomisation and both groups were found to be statistically comparable in what concerned to age, sex and length of the disease and initial number of the different lesions. The treatment has been carried over 8 weeks, the solution was applied 3 times daily and controls were made fortnightly. It was assessed: a) Individual count of lesions existing in one side of the face; b) Grade of severity (I to IV); c) Frontal and lateral colour pictures; d) Overall opinion of patient. The statistical analysis of results shows significant differences between both groups in behalf of A-137 in the following parameters: number of closed comedones in the 2nd week (P less than 0,05), in closed comedones (P less than 0,05) and pustules (P less than 0,005) during the 4th week, in the number of pustules (P less than 0,025) during the 6th week and in closed comedones (P less than 0,05), papules (P less than 0,05) and pustules (P less than 0,0,25) at the end of the 8 weeks treatment. The severity grade was equally lower (P less than 0,025) in the A-137 group on the 8th week. There were no intolerance phenomena reported nor any kind of unwanted side effects during the study.

Acne Vulgaris↗
PubMedDate not supplied

Acne-like eruption induced by pseudoxanthoma elasticum: effectiveness of liquid nitrogen cryotherapy.

We report a case of pseudoxanthoma elasticum associated with an acneiform eruption involving the cervical area. When she was 16 years-old our patient was diagnosed with pseudoxanthoma elasticum, affecting the skin (flexural, cervical and neck areas) and the eyes (bilateral ocular angioid streaks). Ten years later, acneiform lesions (inflammatory and comedones) developed on these lesions: - the inflammatory lesions were characterized by phagocytosis of pathological elastic fibers inducing granuloma - the histological aspects of pseudoxanthoma elasticum were observed around large comedones. This association is rarely reported and we think that atypical, cervical acneiform lesions may be an indication of pseudoxanthoma elasticum. The mechanism for this association is not clearly understood. In our case, Von-Kossa staining was negative for the granulomatous lesions and positive for the comedones: calcification could protect elastopathic fibers from phagocytosis. Treatment is difficult: anti-acneic treatments are not effective except for tetracylines, the anti-inflammatory effects of which can improve granulomatous lesions. As its efficacy has been reported in elastosis perforans serpiginosa, we used liquid nitrogen cryotherapy on the inflammatory lesions with good results (separation of epidermis from dermis perhaps promoting transepithelial elimination of the abnormal dermal elastic tissue).

Acne Vulgaris↗
PubMed1998

Efficacy of the fixed 1.2% clindamycin phosphate, 0.025% tretinoin gel formulation (Velac) and a proprietary 0.025% tretinoin gel formulation (Aberela) in the topical control of facial acne.

BACKGROUND: A formulation containing agents affecting the non-inflammatory as well as the inflammatory lesions of acne vulgaris at the same time would be efficient, probably showing a high efficacy and possibly a considerable shortening of the duration of treatment. One single formulation would simplify drug administration thereby enhancing patient compliance and possibly leading to improved therapeutic results. In two studies this seems to have been corroborated for the fixed clindamycin phosphate-tretinoin gel formulation. OBJECTIVE: This study was designed to assess whether the recently developed fixed formulation of 1.2% clindamycin phosphate and 0.025% tretinoin in a gel base (Velac), further referred to as Clindamycin phosphate Tretinoin Gel is at least as effective as a proprietary 0.025% tretinoin gel formulation (Aberela, Janssen Cilag Ab, Sollentuna, Sweden; further defined as tretinoin) showing an additional anti-inflammatory effect in the treatment of moderate to severe acne vulgaris. METHODS: In a double-blind, randomised study 72 patients were treated with CTG and 73 with tretinoin gel in a once daily regimen for 12 weeks. Responses, irritation as well as possible systemic and other adverse effects were recorded after 4, 8 and 12 weeks of treatment and the improvement, compared to baseline, assessed in all included patients. An additional assessment of the safety parameters was carried out at week 2. Parameters of efficacy were the various acne lesion counts, the overall acne severity grade and the calculated totals of acne lesion counts. RESULTS: CTG was statistically significantly more effective than tretinoin at the P = 0.05 level in the papular and the total mean inflammatory lesion counts as well as in the estimated or calculated mean overall acne severity scores. CTG and tretinoin gel were equally effective in the remaining parameters: open and closed comedones, the calculated total mean comedone, the pustule as well as the nodule lesion counts. The onset of action was faster for CTG than for tretinoin gel and evident in all assessed parameters except in open comedone lesion counts. In the calculated total mean acne lesion counts, half of all acne lesions had disappeared by week 6 of treatment with CTG, whereas this was recorded at week 9 for tretinoin gel. No clinically relevant changes in the parameters of safety as a consequence of treatment were observed, although the burning component of irritation was shown to be significantly less for CTG than for tretinoin gel. The observed adverse effects were considered minor. Treatment had to be discontinued in five patients on CTG and three on tretinoin. CONCLUSION: The addition of clindamycin to tretinoin, as in CTG, enhances the comedolytic efficacy of tretinoin in moderate to severe acne of the face, maintaining at the same time its anti-inflammatory efficacy thus accelerating resolution of all types of acne lesions without affecting the safety of response to both components.

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↗
PubMed2004

Treatment of acne vulgaris.

CONTEXT: Management of acne vulgaris by nondermatologists is increasing. Current understanding of the different presentations of acne allows for individualized treatments and improved outcomes. OBJECTIVE: To review the best evidence available for individualized treatment of acne. DATA SOURCES: Search of MEDLINE, EMBASE, and the Cochrane database to search for all English-language articles on acne treatment from 1966 to 2004. STUDY SELECTION: Well-designed randomized controlled trials, meta-analyses, and other systematic reviews are the focus of this article. DATA EXTRACTION: Acne literature is characterized by a lack of standardization with respect to outcome measures and methods used to grade disease severity. DATA SYNTHESIS: Main outcome measures of 29 randomized double-blind trials that were evaluated included reductions in inflammatory, noninflammatory, and total acne lesion counts. Topical retinoids reduce the number of comedones and inflammatory lesions in the range of 40% to 70%. These agents are the mainstay of therapy in patients with comedones only. Other agents, including topical antimicrobials, oral antibiotics, hormonal therapy (in women), and isotretinoin all yield high response rates. Patients with mild to moderate severity inflammatory acne with papules and pustules should be treated with topical antibiotics combined with retinoids. Oral antibiotics are first-line therapy in patients with moderate to severe inflammatory acne while oral isotretinoin is indicated for severe nodular acne, treatment failures, scarring, frequent relapses, or in cases of severe psychological distress. Long-term topical or oral antibiotic therapy should be avoided when feasible to minimize occurrence of bacterial resistance. Isotretinoin is a powerful teratogen mandating strict precautions for use among women of childbearing age. CONCLUSIONS: Acne responses to treatment vary considerably. Frequently more than 1 treatment modality is used concomitantly. Best results are seen when treatments are individualized on the basis of clinical presentation.

Acne Vulgaris↗
PubMed1994

Liposomal tretinoin for uncomplicated acne vulgaris.

Frequently occurring skin irritancy and flare-up reactions impede the use of topical tretinoin for acne vulgaris due to poor patient compliance. Liposome encapsulation improves penetration into the skin and local tolerability in animals. We investigated efficacy and local tolerability of liposomal tretinoin in man. In a double-blind study 20 patients with uncomplicated acne vulgaris received liposomal tretinoin (0.01%) on one side of the body and a commercial gel preparation with either 0.025% or 0.05% on the other once daily for 10 weeks. Comedones and papules/pustules were counted every 2 (-4) weeks. Then also redness, scaling, and burning were rated according to a four-point scale. Moreover, the patients noted skin irritancy in a diary on a daily base. With conventional tretinoin the gels were equally efficacious and equally well tolerated. Liposomal tretinoin also appeared equipotent to the reference gels. There may even have been a slightly more rapid clearing of comedones following the liposome preparation. With respect to skin irritancy, however, liposomal tretinoin was superior. As rated by the patients, liposome encapsulated tretinoin induced less burning (mean cumulative score 2.7 +/- 1.2) than the 0.025% gel (16.1 +/- 7.1) and the 0.05% gel (9.7 +/- 4.1) gel and less erythema (1.8 +/- 0.7) than the 0.025% gel (11.4 +/- 3.8; (P < 0.05). Liposomal tretinoin was also better tolerated according to the rating by the investigator. Liposomal encapsulation of tretinoin allows reduction of the concentration of the active agent without a decline in efficacy for acne vulgaris. Since local tolerability is thus increased, liposomal tretinoin should favor the acceptance of this treatment by the patient.

Acne Vulgaris↗
PubMed2001

Pathogenesis of acne.

Acne vulgaris is a skin disorder of the sebaceous follicles that commonly occurs in adolescence and in young adulthood. The major pathogenic factors involved are hyperkeratinization, obstruction of sebaceous follicles resulting from abnormal keratinization of the infundibular epithelium, stimulation of sebaceous gland secretion by androgens, and microbial colonization of pilosebaceous units by Propionibacterium acnes, which promotes perifollicular inflammation. The clinical presentation of acne can range from a mild comedonal form to severe inflammatory cystic acne of the face, chest, and back. At the ultrastructural level, follicular keratinocytes in comedones can be seen to possess increased numbers of desmosomes and tonofilaments, which result in ductal hypercornification. The increased activity of sebaceous glands elicited by androgen causes proliferation of P. acnes, an anaerobe present within the retained sebum in the pilosebaceous ducts. The organism possesses a ribosome-rich cytoplasm and a relatively thick cell wall, and produces several biologically active mediators that may contribute to inflammation, for instance, by promoting leukocyte migration and follicular rupture. In inflamed lesions, numerous neutrophils and macrophages infiltrate around hair follicles and sometimes phagocytose P. acnes. To examine the participation of neurogenic factors in the pathogenesis of acne, we quantitatively assessed the effects of neuropeptides on the morphology of sebaceous glands in vitro using electron microscopy. Substance P, which can be elicited by stress, promoted the development of cytoplasmic organelles in sebaceous cells, stimulated sebaceous germinative cells, and induced significant increases in the area of sebaceous glands. It also increased the size of individual sebaceous cells and the number of sebum vacuoles for each differentiated sebaceous cell, all of which suggests that substance P promotes both the proliferation and the differentiation of sebaceous glands. In this review, we introduce the general concept of pathogenic factors involved in acne, including typical electron microscopic findings and recent evidence of stress-induced exacerbation of acne from a neurological point of view. An improved understanding of the pathogenesis of acne should lead to a rational therapy to successfully treat this skin disease.

Acne Vulgaris↗
PubMed1992

Dowling-Degos' disease mimicking chloracne.

We describe a patient with clinical features that resembled severe chloracne; however, histopathologic findings revealed a reticulated pigmented anomaly. Innumerable comedones, many cysts, acneiform scarring, and flexural and facial pigmentation were noted in this patient, who is a machinist. A serum test for polychlorinated biphenyl was negative, which eliminated a diagnosis of chloracne. The spectrum of clinical features of the histologically well-defined Dowling-Degos' disease is discussed; in this disease lesions can be flexural or acral and can appear as macules, comedones, or cysts.

Acne Vulgaris↗
PubMed1994

Carcinogens show comedogenic activity: a potential animal screen for tumorigenic substances.

Formation of a comedo, an impaction of horny cells in sebaceous follicles, entails a metaplastic change in the differentiation patterns of the follicular epithelium. Since metaplasia is a requisite early stage in carcinogenesis, we postulated that carcinogens might be comedogenic. The rabbit ear was used to assay the comedogenic potentialities of an array of known tumorigens. Complete carcinogens and some tumor promotors were invariably strongly comedogenic at concentrations of 1.0% and below. Comedogenic chemicals commonly found in skin care products usually required concentrations of 40% and greater to induce comedones which were small in comparison to carcinogen induced comedones. We suggest that the rabbit ear model might be an easy and reliable way to screen for carcinogenicity.

9,10-Dimethyl-1,2-benzanthracene↗
PubMedDate not supplied

Acne: clinical presentations.

Acne vulgaris, the most common disease of the skin, can be manifested in a wide variety of clinical presentations. As a result of this clinical variation, there are almost as many classifications of acne as there are clinicians with particular interest in the disease. Thus acne has been classified as types I-IV, inflammatory versus noninflammatory, comedonal, comedopapular, papular, papulopustular, pustular, and "cystic" or nodular (even nodular-cystic). For those who are enamored of classification, there are subdivisions of the various categories, including "sandpaper comedones" and microcysts. There is even disagreement as to what constitutes a papule versus a nodule. The classic textbook definition of a nodule refers to lesions 1 cm or larger, but the early investigators of oral isotretinoin defined nodules as 4 mm or larger, and this definition has creeped into many texts, recently clarified by Bologna.(1)

Acne Vulgaris↗
PubMed2006

A re-evaluation of the comedogenicity concept.

BACKGROUND: Comedogenicity is an important consideration in the development of topical medications, cosmetics, and skin care products. The concept of "acne cosmetica" was developed to link the use of certain ingredients to comedo formation. Animal models were originally used to determine the comedogenic potential of raw materials with the assumption that finished formulations containing these ingredients would also be comedogenic. Based on this assumption, dermatologists were presented with lists of substances to avoid in patients with the ability to develop comedones. OBJECTIVE: We sought to use a modification of the Mills and Kligman human assay for assessing comedogenic potential of finished cosmetic products. METHODS: Six individuals with prominent follicular orifices and the ability to form comedones on the upper aspect of the back were enrolled. Each person received patches to the upper aspect of the back saturated with 0.2 to 0.5 mL of the finished cosmetic study products 3 times weekly for 4 weeks. Cyanoacrylate biopsies were performed to determine the number of follicles and microcomedones per square inch. LIMITATIONS: Only a finite number of finished cosmetic products could be analyzed. CONCLUSION: Finished products using comedogenic ingredients are not necessarily comedogenic.

Acne Vulgaris↗
PubMed2006

[Skin signs associated with epidermal growth factor inhibitors].

BACKGROUND: Inhibitors of epidermal growth factor receptors (EGFR) constitute a new alternative treatment for patients presenting certain advanced stage solid cancers (bowel, breast, ovary). Adverse cutaneous effects of these drugs are now starting to be described. OBSERVATIONS: Our study involved 2 men and 2 women with no previous history of acne included in a treatment protocol comprising EGFR inhibitors. Mean age was 52 years. The primary cancers were breast, ovary, bowel and unidentified. The EGFR inhibitors used were gefitinib (ZD1839) (2 cases), carnetinib (Cl1033) and cetuximab (IMC-C225). Skin lesions appeared after 7 days and included erythematous papules and follicular pustules of the face, back and upper chest. No comedons were seen, and there were no nodules or cysts. The severity of the rash resulted in discontinuation of treatment in 2 patients with complete disappearance of skin lesions in both cases. In one patient, reduction of the dosage of gefitinib (IMC-C225) led to gradual resolution of the rash. Histological examination of papules and pustules concluded on an acute suppurative folliculitis. Smears and cultures ofa nasal lesion and pustules revealed coagulase-positive Staphylococcus aureus in 2 patients. Combined doxycycline 100 mg daily and benzoyl peroxide was prescribed for 3 months and a favourable outcome was achieved after a mean 2 weeks. DISCUSSION: EGFR inhibitors act by inhibiting mechanisms oftumour proliferation in certain cancers at advanced stages or refractory to other treatments. Our findings in these four patients are similar to the published cases in terms of rapid onset of monomorphous, papulopustular, follicular eruption without comedons. Rapid response to cyclines and benzoyl peroxide is also reported in literature. This treatment must be instituted rapidly and patients must be informed about the cutaneous side-effects of EGFR inhibitors before the start of therapy. The pathophysiology of these eruptions is still unknown. Skin signs are probably due to interaction with EGFR functions, including overexpression of EGFR in keratinocytes and hair follicles.

Adult↗
PubMed1985

Cutaneous histologic findings in chemical workers with and without chloracne with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

Histopathologic examination of the skin in seventy-seven chemical workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was performed in 1981 to determine whether changes specific for chloracne were present. Prior to biopsy, subjects had been classified as having clinical evidence of residual chloracne (48%), having a past history of chloracne but no current dermatologic evidence of it (24%), or never having had chloracne (27%). Follicular infundibular dilatation and/or comedones and cysts were found in 76%, 39%, and 32% of the current, past, and never chloracne groups, respectively; the differences were significant between current and never groups (p less than 0.001) and between current and past groups (p less than 0.01). A combined mean score of follicular infundibular dilatation, comedones, and cysts was significantly different only between the current and never groups (p less than 0.005). Solar elastosis, histologically present in all subjects, was related to age but not chloracne. No relationship was found between smoking habit and any of the histologic findings. Changes specific for chloracne were not found. Four-millimeter skin biopsy is unlikely to be either diagnostic or useful in persons with past exposure to TCDD that is ill defined or insufficient to produce chloracne.

Acne Vulgaris↗