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PubMed1978

[Clinical evaluation of a topical ethyl lactate treatment of acne vulgaris (author's transl)].

The efficacy of a lotion containing 10 p. 100 ethyl lactate was evaluated in a double-blind clinical trail during 8 weeks. Test subjects were 45 male and female patients with polymorphous juvenile acne. They were divided into three groups and received the following treatments: Group A: oral antibiotic + topical placebo lotion. Group B: oral antibiotic + topical ethyl lactate lotion. Group C: topical ethyl lactate lotion only. The lotions were applied twice daily with a swab of cotton-wool. The antibiotic doses (tetracycline hydrochloride) were decreased as the trial progressed. Patients were examined before the trial, then after 1, 2, 4, 6 and 8 weeks. At each visit, comedones, microcysts, pustules and nodules were counted on a skin surface of 9 cm2. Colour photographs were taken before and at the end of the trial and served for counting inflammatory lesions. Also, at each visit, skin lipids were sampled and analysed by I. R. spectrophotometry in order to asses the effect of the treatments on the free fatty acid/triglyceride ratio. The treatments showed similar effectiveness as regards comedones and microcysts, but only treatments A and B succeeded in reducing the number of inflamed lesions. With respect to the latter, the combined treatment B (oral antibiotic + topical ethyl lactate lotion) was more effective than treatment A (oral antibiotic + topical placebo); both treatments were more effective than treatment C (topical ethyl lactate lotion only). At the end of the trial, all three groups of patients showed significant overall improvement, but acne scores (total number of lesions) did not differ significantly between treatments. When comparing these results with literature data concerning the effects of vitamin A acid and benzoyl peroxide, it appears that ethyl lactate is slightly less effective for topical treatment of acne than vitamin A acid, but slightly more effective than benzoyl peroxide. It should be underlined that ethyl lactate is well tolerated by the skin. Analysis of sebum samples failed to yield evidence of a decrease in the free fatty acid/triglyceride ratio in skin lipids of the patients irrespective of the treatment applied.

Acne Vulgaris↗
PubMed1979

Evaluation of abrasives in acne therapy.

Various abrasive materials, such as pumice, polyethylene, and aluminum oxide are widely used as adjuncts in the therapy of acne. The apparent rationale is that abrasion should unseat comedones and deter their formation. We assessed the efficacy of various abrasives and abradant pads. Varying degrees of peeling and erythema were produced, but there was no appreciable reduction of comedones. Aggravation was noted in some cases. Generally, the resorption of papules and pustules was enhanced.

Acne Vulgaris↗
PubMed2006

Facial edema induced by isotretinoin use: a case and a review of the side effects of isotretinoin.

Isotretinoin (13-cis-retinoic acid) is a retinoid that is used to treat cystic acne, comedonal acne, and other diseases. For the treatment of acne, isotretinoin is dosed at 0.5 to 2 mg/kg daily for 5 months with a target total dose of approximately 120 mg/kg. Its most common side effects are mucocutaneous and ocular in nature (ie, cheilitis, ocular sicca, and decreased dark adaptation). It can also cause xerosis. Patients should be made aware of these side effects before taking isotretinoin and also that utilization of moisturizers and eye drops can help to mitigate such side effects. Sometimes, however, the dose of isotretinoin needs to be decreased to reduce the induction of side effects. Isotretinoin's most significant side effect is the induction of birth defects if a fetus is exposed to isotretinoin, which is pregnancy category X. Isotretinoin should be used with 2 forms of birth control by fecund women. It can rarely increase serum levels of triglycerides, which can, if very elevated, be related to the development of pancreatitis and xanthomas. Isotretinoin's well-documented but rarer side effects include intracranial hypertension. It can induce bony changes. A review of the literature demonstrates that isotretinoin is not linked to depression and suicide. Facial swelling has been linked to isotretinoin use in 3 previous case reports. We note herein the first case of facial swelling that occurred in an acne patient being treated with isotretinoin who at the time the swelling developed had no cysts, comedones, pustules, or evidence of bacterial infection. Possible reasons for the patient's facial swelling include some type of retinoid induced angioedema, exacerbation of inflammation by isotretinoin, and isotretinoin induced capillary leak syndrome.

Acne Vulgaris↗
PubMed2006

Clinical inquiries. What is the best treatment for mild to moderate acne?

For mild comedonal acne, monotherapy with topical retinoids is the treatment of choice (strength of recommendation [SOR]: A). For moderate comedonal and mild to moderate papulopustular acne, combination therapy with either benzoyl peroxide or topical retinoids (adapalene [Differin], tazarotene [Tazorac], tretinoin [Retin-A]) plus topical antibiotics (erythromycin or clindamycin) is proven most effective (SOR: A). Six to 8 weeks should be allowed for most treatments to work before altering the regimen (SOR: A).

Acne Vulgaris↗
PubMed1991

Postadolescent acne in women.

A low-grade, persistent acne is quite common in hard-working professional women in their twenties, thirties, and forties. Closed comedones are the dominant lesions, with a scattering of papulopustules. Premenstrual flares are typical. Most such patients passed through adolescence without acne. Acne cosmetica has to be ruled out. The latter is more inflammatory and the lesions are denser. It is postulated that chronic stress leads to enhanced secretion of adrenal androgens, resulting in sebaceous hyperplasia and subsequent induction of comedones. Postadolescent acne is an authentic variety of acne vulgaris; it responds well to treatment with conventional topical medicaments.

Acne Vulgaris↗
PubMed1989

Efficacy and tolerability of combined topical treatment of acne vulgaris with tretinoin and erythromycin in general practice.

Efficacy and tolerability of a gel preparation with 0.025% tretinoin and 4% erythromycin in acne vulgaris was evaluated in an open multicentre study. A total of 1337 patients of either sex, aged 8 to 68 years, were enrolled in the study; 13 had to be excluded from analysis. Some 499 patients had received former acne treatment; this was described as non-efficient or poorly efficient in 90% of the patients. The treatment period lasted up to 14 weeks. Efficacy was determined by counting the acne lesions (comedones, papules and pustules) before drug administration and every second week during the treatment period. Lesions had diminished after 2 weeks in about 35% of the patients. At the end of the treatment period, comedones were eliminated in 47.0% and improved in another 41.4%. Papules were eliminated and improved in 58.2% and 32.6%, pustules in 74.3% and 18.3% respectively. Side-effects (erythema, burning, pruritus, scaling and dryness of the skin) occurred in 203 patients (15.3%). Treatment was stopped in 25 subjects (1.9%) due to intolerance reactions. The results of the present study thus confirm the high efficacy and tolerability of the fixed combination observed previously in more selected patients. The fixed combination of tretinoin and erythromycin makes retinoic acid treatment possible even by a general practitioner.

Acne Vulgaris↗
PubMed1986

Chap Stick acne.

We describe two patients with an unusual, limited form of acne manifest as a single row of large, open comedones along the entire cutaneous margin of the upper lip. The acne began after repetitive application to the lips of Chap Stick in one patient and petroleum jelly (Vaseline) in the other. It was treated successfully by eliminating the Chap Stick and petroleum jelly, respectively, as well as by microincision and expression of the comedones. Petrolatum, the major ingredient of Chap Stick, appears to be responsible for this type of acne.

Acne Vulgaris↗
PubMed1988

Tretinoin-sunscreen mixture in the treatment of acne vulgaris.

In an open design study of fifty-four patients with grade I or grade II acne vulgaris, the combination of 0.1 percent tretinoin cream (Retin-A) and a sunscreen with sun protection factor 15 (Sundown) was evaluated. Overall study results of the forty-six patients who could be evaluated demonstrated a decrease in papule count of 25.9 percent, a decrease in closed comedones of 49.1 percent, and a decrease in open comedones of 36.3 percent by the end of the eight-week study period. These results indicate that the addition of a noncomedogenic sunscreen to tretinoin did not compromise its effectiveness and successfully prevented photoaccentuation reactions.

Acne Vulgaris↗
PubMed1984

Meclosorb, a new topical antibiotic agent in the treatment of acne vulgaris: a double-blind clinical study.

The clinical effect on acne vulgaris of topical treatment with meclocycline sulfosalicylate and systemic treatment with peroral tetracycline (500 mg daily) was compared in a double-blind study of 60 patients treated for 8 weeks. The reducing effect of Meclosorb cream and tetracycline tablets on the number of closed comedones, pustules, papules and cysts was marked and not significantly different. The effect of Meclosorb on open comedones was weak and of slow onset. No side effects were registered. Topical treatment with Meclosorb is an effective and safe alternative to systemic tetracycline treatment of acne vulgaris.

Acne Vulgaris↗
PubMed1982

Comparison of topical erythromycin 1.5 percent solution versus topical clindamycin phosphate 1.0 percent solution in the treatment of acne vulgaris.

Commercial topical solutions of erythromycin 1.5 percent and clindamycin phosphate 1.0 percent were evaluated in a randomized, double-blind, twelve-week comparison in sixty-six patients with moderate acne. Both treatment groups showed significant reductions of total lesions, inflammatory lesions, and papules. Additionally, the group using erythromycin 1.5 percent showed significant decreases in total noninflammatory lesions and closed comedones, and the group using clindamycin phosphate 1.0 percent showed significant reductions in pustules. The only statistically significant differences between the treatments were the greater reductions in closed comedones for those patients using erythromycin 1.5 percent and greater reductions in pustules for those patients using clindamycin 1.0 percent. Nearly two thirds of the patients in each group had a good or excellent overall response after twelve weeks. One erythromycin-treated patient discontinued treatment because his wife became sensitized to it. This reportedly also occurred with the use of topical clindamycin. Other side effects were minor or transient. In this study, topical erythromycin 1.5 percent and clindamycin 1.0 percent appeared to be clinically equivalent for treating moderate facial acne.

Acne Vulgaris↗
PubMed1982

[Cytotoxicity in acne vulgaris].

Three cellular cytotoxic lymphocytary populations were studied in patients with different forms of inflammatory acne vulgaris: direct or spontaneous, antibodies dependent and phytohemagglutinine stimulated. To these was added "Propionibacterium acnes" from cultures of material extracted separately from comedones and pustules. The direct or spontaneous and antibodies dependent cytotoxicity were normal. The subpopulation responsible of the phytohemagglutinine stimulated cytotoxicity has shown a clear hyperactivity which was augmented by the addition of these bacteria. But this hyperactivity stimulation was selective for the "Propionibacterium acnes" from pustules and not for those from comedones. These findings could contribute to the knowledge of the immune cellular mechanisms in acne vulgaris inflammation provoked by these bacteria.

Acne Vulgaris↗
PubMed1996

Pilotropic cutaneous T-cell lymphoma without mucinosis. A variant of mycosis fungoides? French Study Group of Cutaneous Lymphomas.

BACKGROUND: In the course of mycosis fungoides, pilofollicular manifestations without mucinosis (papules, keratoses, comedones, or epidermal cysts) are rare (15 cases reported). Therefore, histological and clinical diagnoses may be difficult. The clinical course and histopathological and immunohistochemical findings in 9 patients are described. OBSERVATIONS: Pilofollicular lesions were present at the onset (n = 3), before (n = 3), or during a relapse of mycosis fungoides (n = 3). Comedones and epidermal cysts were most frequent (n = 5). They disappeared with lymphoma therapy (n = 4), therapy with isotretinoin (n = 3), or spontaneously (n = 1), or they persisted (n = 1). Clues to the histopathological diagnosis consisted of pilotropism of the infiltrate with minor alteration of the hair follicle walls. The infiltrate was monomorphous and composed of sezariform CD4+ lymphocytes. Pilotropic or peripilofollicular infiltrates, or the absence of infiltrate, were detected in consecutive biopsy specimens obtained from the same patient. The keratinocyte expression of intercellular adhesion molecule type 1 was observed in the hair follicle bulb in front of the pilotropic infiltrate but not in the epidermis. No staining was observed in biopsy specimens of 6 of 7 patients with follicular mucinosis, of folliculitis lesions, or of normal hair follicles. CONCLUSIONS: Our findings indicate the role of adhesion molecules in pilotropism leading to mechanical obstruction of the follicle by tumoral cells followed by hyperkeratosis and cyst formation. It remains to be determined if the expression of intercellular adhesion molecule type 1 is the cause or the consequence of pilotropism. By becoming more aware of it, this variant of mycosis fungoides is probably not so rare.

Adult↗
PubMed1996

The Mexican hairless dog as a model for assessing the comedolytic and morphogenic activity of retinoids.

The skin of the Mexican hairless dog is covered with comedones, and this animal therefore provides a potentially useful model to assess the comedolytic activity of topical anti-acne drugs. We treated an animal with three different formulations of tretinoin for a 14-week period, and all produced a similar clinical response. There was a striking reduction in the number of comedones, and the skin became lighter and more uniform in colour. Histological changes were similar to those reported in humans treated with tretinoin, but a novel finding was incomplete neogenesis of hair follicles. We suggest that the Mexican hairless dog may be a useful model for screening novel molecules for retinoid activity.

Acne Vulgaris↗
PubMed2002

Acne vulgaris: a disease of Western civilization.

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

Acne Vulgaris↗
PubMed2003

Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne.

OBJECTIVE: To determine if treatment with subantimicrobial-dose (SD) doxycycline hyclate (20-mg tablets taken twice daily) improved clinical outcome, had any detectable effect on skin flora, led to overgrowth or colonization of skin by opportunistic pathogens, or resulted in an increase in antibiotic resistance by the surface skin microflora in patients with moderate acne compared with placebo. DESIGN: Multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. SETTING: Two university-based clinics. SUBJECTS: Adults (N = 51) with moderate facial acne. INTERVENTIONS: Patients were randomized to receive SD doxycycline (Periostat; CollaGenex Pharmaceuticals Inc, Newtown, Pa) or placebo twice daily for 6 months. MAIN EFFICACY OUTCOMES: Primary: changes from baseline in numbers of inflammatory, noninflammatory, and total lesions. Secondary: changes from baseline of individual counts of papules, pustules, and nodules and global assessments of clinical improvement by patient and physician. RESULTS: Forty patients completed 6 months of treatment. At 6 months, the SD doxycycline group had a significantly greater percent reduction in the number of comedones (P<.01), inflammatory and noninflammatory lesions combined (P<.01), and total inflammatory lesions (P<.05) than did the placebo group. They also had significantly greater improvement according to the clinician's global assessment (P =.03). There were no significant differences in microbial counts between groups and no evidence of change in antibiotic susceptibility or colonization by potential pathogens. The treatment was well tolerated. CONCLUSIONS: Twice-daily SD doxycycline treatment significantly reduced the number of inflammatory and noninflammatory lesions in patients with moderate facial acne, was well tolerated, had no detectable antimicrobial effect on the skin flora, and did not result in any increase in the number or severity of resistant organisms.

Acne Vulgaris↗
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↗
PubMed1977

Effects of oral zinc and vitamin A in acne.

The effects of oral zinc sulfate (corresponding to 135 mg of zinc daily) alone and in combination with vitamin A (300,000 international units) daily on acne lesions have been compared with those of vitamin A alone and of a placebo. The number of comedones, papules, pustules, and infiltrates were counted at each visit. After four weeks, there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. The effect of zinc plus vitamin A was not better than zinc alone. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The mechanism for the effect of zinc therapy in acne, to our knowledge, is not presently known.¿

Acne Vulgaris↗
PubMed2004

Treatment of acne vulgaris with a pulsed dye laser: a randomized controlled trial.

CONTEXT: The high prevalence of acne vulgaris and its significant morbidity underscore the need for convenient, low-risk, and efficacious therapy. Treatment with various lasers has been reported to improve acne. OBJECTIVE: To evaluate the clinical efficacy of pulsed dye laser therapy in the treatment of acne. DESIGN, SETTING, AND PATIENTS: Randomized, single-blind, controlled, split-face clinical trial of a volunteer sample of 40 patients aged 13 years or older with facial acne conducted at an academic referral center from August 2002 to September 2003. INTERVENTION: One or 2 nonpurpuric pulsed dye laser treatments to half of the face (fluence of 3 J/cm2), serial blinded clinical assessments (lesion counts), and grading of acne severity using standardized bilateral serial photographs. MAIN OUTCOME MEASURES: Comparison of the changes in lesion counts from baseline to 12 weeks between treated and untreated sides of the face and changes in photographic evidence of acne severity as graded by a panel of dermatologists blinded to treatment assignment. RESULTS: After 12 weeks, using intent-to-treat analysis with last observation carried forward, there were no significant differences between laser-treated and untreated skin for changes in mean papule counts (-4.2 vs -2.2; P =.08), mean pustule counts (0 vs -1.0; P =.12), or mean comedone counts (2.9 vs 1.6; P =.63). Grading of serial photographs confirmed the clinical assessments, showing no significant mean (SE) differences in Leeds scores (range, 1-12) for treated skin (3.98 [0.32] at baseline and 3.94 [0.27] at week 12) compared with untreated skin (3.83 [0.32] at baseline and 3.79 [0.28] at week 12) (P>.99). CONCLUSIONS: In this study, the nonpurpuric pulsed dye laser therapy did not result in significant improvement of facial acne. More research is needed before this laser therapy may be recommended as an acne treatment.

Acne Vulgaris↗