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PubMed2004

Combined oral contraceptive pills for treatment of acne.

BACKGROUND: Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women. OBJECTIVES: To determine the effectiveness of COCs for the treatment of facial acne compared to placebo or other active therapies. SEARCH STRATEGY: We searched the computerized databases Cochrane Skin Group trial register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, Biological Abstracts and LILACS for randomized controlled trials of COCs and acne. We wrote to authors of identified trials to seek any unpublished or published trials that we might have missed. SELECTION CRITERIA: All randomized controlled trials reported in any language that compare the effectiveness of a COC containing an estrogen and a progestin to placebo or another active therapy for acne in women were eligible. DATA COLLECTION AND ANALYSIS: We extracted data on total and specific (i.e. open or closed comedones, papules, pustules and nodules) facial lesion counts; acne severity grades; global assessments by the clinician or the participant and discontinuation due to adverse events. Data were entered and analyzed in RevMan 4.2. MAIN RESULTS: The search yielded five placebo-controlled trials that made three different comparisons and 14 trials that made nine comparisons between two COC regimens. An additional trial compared a COC to an antibiotic. COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. Differences in the comparative effectiveness of COCs containing varying progestin types and dosages, though, were less clear. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel although this apparent advantage was based on limited data. A COC with cyproterone acetate might result in better acne outcomes than one with desogrestrel; however, the three studies comparing these COCs produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes in one trial, but a second trial found no difference between the COCs. REVIEWERS' CONCLUSIONS: The three COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few differences were found in acne effectiveness between COC types. How COCs compare to alternative acne treatments is unknown since limited data were available regarding this question.

Acne Vulgaris↗
PubMed1988

Studies of transformer repair workers exposed to PCBs: I. Study design, PCB concentrations, questionnaire, and clinical examination results.

A cross-sectional study compared 55 transformer repairmen, 38 currently, and 17 previously exposed to polychlorinated biphenyls (PCBs) with 56 non-exposed subjects. PCBs exposures occurred from air and contaminated surfaces, predominantly from Aroclor 1260 with some exposure to Aroclor 1242. Each worker underwent: a questionnaire; standardized medical examination; delayed hypersensitivity testing; and determination of serum and adipose tissue lipid total PCB concentrations. Adipose and serum [PCBs] were significantly higher in the currently exposed, but previously exposed workers did not differ significantly from comparison subjects. No subjects had a classical syndrome of PCB poisoning. A number of neurobehavioral and irritant symptoms were significantly more prevalent in the exposed group, but were probably not related to PCBs. Comedones were more frequent in the exposed group, but no evidence of classical chloracne was noted. Cutaneous delayed hypersensitivity responses to mumps and to trichophyton antigens did not differ between the groups. The association of PCBs with job functions were explored.

Adipose Tissue↗
PubMed1995

The aerobic and anaerobic microbiology of pustular acne lesions.

Specimens from 32 pustular acne lesions that were inoculated on media supportive for the growth of aerobic and anaerobic bacteria showed bacterial growth. Only aerobic or facultative bacteria were recovered in 15 (47%) specimens, only anaerobic bacteria in 11 (34%) specimens, and mixed aerobic and anaerobic bacteria in 6 (18%) specimens. A total of 57 isolates, 31 anaerobes (1.0 per specimen) and 26 aerobes (0.8 per specimen) were recovered. The predominant isolates were Staphylococcus sp. (19 isolates), Peptostreptococcus sp. (15), and Propionibacterium sp. (10). Twelve (37.5%) of the comedones yielded only one organism. This retrospective study highlighted the polymicrobial nature of over two-thirds of culture positive pustular acne lesions and suggests the potential for pathogenic role of aerobic and anaerobic organisms other than P. acnes and Staphylococcus sp. in acne vulgaris.

Journal Article↗
PubMed1975

Comedo formation in acne.

Comedones contain a considerable quantity of water. In some cases a water content of more than 40% can be detected. The comedo consists of two parts, an inner nucleus built up to unorganized materials and a capsule with concentrically arranged shells. The material of the nucleus contains small scales produced by normal keratinization. The materials of the capsule consists of larger scales, which result from hyperkeratosis. The nucleus of the comedo seems to be identical with the early comedo. A similar structure can be formed in vitro by adding water to sebum. Microorganisms have optimal growth conditions in the early comedo.

Acne Vulgaris↗
PubMed1976

Immunological studies on the proteins of human eccrine sweat.

Proteins present in the eccrine sweat collected from the skin surface of male volunteers were studied. The protein content ranged from 0.154--0.774 g per liter. A total 2282 ml sweat was concentrated until a final protein content of 25 mg/ml was reached. Paper electrophoresis revealed 3 fractions migrating like alpha-, beta-, and gamma-globulins. Eight different proteins were demonstrated by immunoelectrophoretic analyses using rabbit antisera directed against human sweat proteins. Three of these proteins were identified as blood serum proteins. One of the remaining 5 proteins could be of epidermal origin; another one which occurs in comedones as well as in sweat seems to be eluted from the sebum film present on the skin surface.

Animals↗
PubMed2002

The association of serum androsterone glucuronide with inflammatory lesions in women with adult acne.

Serum androsterone glucuronide (AoG) is a metabolite of circulating androgens under the influence of 5alpha-reductase activity and has been shown to be particularly elevated in women with acne. In this study, we wanted to evaluate changes in AoG before and after treatment with an oral contraceptive or placebo, and to assess whether changes correlated with the number and type of acne lesions. In order to accomplish these aims, we obtained sera from a completed prospective randomized trial, which was designed to assess the effectiveness of an oral contraceptive compared to placebo. Assessments were carried out in 56 women with moderate acne who were treated with Ortho Tri-Cyclen (norgestimate and ethinylestradiol) (30 patients) or placebo (26 patients) for 6 months. Before and after treatment, the number and type of skin lesions, serum levels of total T, free-T, DHEAS and AoG were determined. Serum AoG increased significantly in women with moderate acne, although T, free-T and DHEAS were normal. 75% of acne patients had elevated levels of serum AoG. Ratios of serum AoG to androgen precursors were also elevated. Oral contraceptive (OC) treatment significantly reduced levels of free-T and AoG, both of which were unaffected by placebo. While both OC and placebo treatment resulted in improvement of comedones and inflammatory lesions, OC treatment decreased inflammatory lesions to a greater extent (p<0.05). After treatment, serum AoG correlated with the number of inflammatory lesions. Results showed that serum AoG is a sensitive marker of acne in women, even in those with normal circulating precursor androgens; and is lowered by OC treatment, correlating with the reduction of inflammatory lesions. We hypothesize that the increase of serum AoG in normoandrogenic acne may be related to inflammation, and serum AoG may serve as a marker of this process.

Acne Vulgaris↗
PubMed2004

[Treatment of pilonidal sinus and acne inversa].

A pilonidal sinus is a invagination of the skin over the sacrum containing a tuft of hair which enlarges by repeated friction causing the hairs to penetrate the skin. It may become symptomatic if an infection occurs. There are similarities with acne inversa, which is present in about 23% of cases. Acne inversa is an inflammation of the sebaceous glands and terminal hair follicles, chiefly in the intertriginous areas. The first manifestation can occur at any time from puberty to advanced age. 90% of patients are smokers. Initially giant comedones and indolent subcutaneous nodules are found; they progress to form draining sinus tracts. Conservative treatment, incision and/or surgical removal of the abscesses and fistulas is futile. The method of choice is the early complete surgical excision of the involved skin extending into normal tissue both laterally and at the base. In most cases healing of the defects by secondary intention is uneventful.

Adolescent↗
PubMed2005

[Clinical variants of acne].

Acne is a very common dermatosis with characteristic clinical features. It is a polymorphic disease. The clinical expression ranges from non-inflammatory closed and open comedones to inflammatory papules, pustules, and nodules. Most patients have a mixture of non-inflammatory and inflammatory lesions, although some have predominantly one or the other. Acne varies in severity from a very distressing, socially disabling disorder to a state that has been regarded as physiological by some authors. The most severe forms of acne are acne fulminans and acne inversa. Although acne may occur in all age groups, it is most prevalent during adolescence. It is not known why acne subsides in most patients but persists into adulthood in some. Certain medications may be associated with provocation, perpetuation, or exacerbation of pre-existing acne or with acneiform eruptions. Acne-like disorders include rosacea, pseudofolliculitis barbae, and other conditions that share clinical features with acne.

Acne Vulgaris↗
PubMed2000

[Radiation-induced acne].

Radiation-induced acne is a rare, clinically and pathogenetically ill-defined acneiform dermatosis with special features that may occur in irradiated skin areas especially after high doses of deeply penetrating radiation. We report on a patient with an oropharyngeal carcinoma who developed severe radiation-induced acne including comedones and cysts as well as few inflammatory papules and pustules in a skin area irradiated with up to 63 gray of a 6 MeV photon beam. Acnegenic drugs may precipitate the disease; our patient was on longterm therapy with carbamazepine whose acnegenic potency is less well documented than that of testosterone or glucocorticoids. Treatment of radiation-induced acne is comedolytic; topical retinoids are especially valuable.

Acne Vulgaris↗
PubMed2001

[Transverse nasal groove. A rare embryological error in nature].

Two patients presented with a transverse groove located between the lower third and upper two-thirds of the nose since birth. The alar and triangular cartilage attach themselves in a linear transverse fashion, the so called nasal line. It is important to recognize the nasal line as a localizing factor for milia, cysts and comedones. The nasal line is rather easily overlooked but awareness of its existence allows one to quickly confirm that it is not a rarity. We propose an embryological origin.

Aged↗
PubMed1990

A clinical trial comparing the safety and efficacy of a topical erythromycin-zinc formulation with a topical clindamycin formulation.

One hundred three patients with acne vulgaris were randomly designated to receive either a topical formulation of erythromycin plus zinc or a topical solution of 1% clindamycin phosphate (Cleocin-T). The patients treated themselves twice daily and were examined at 3, 6, 9, and 12 weeks after the start of therapy. By week 6 the overall severity grade was consistently lower and the percent reduction of severity, papules, pustules, and total comedones was higher in the erythromycin-zinc-treated group than in the clindamycin-treated group. In the 92 patients who completed this study (48 receiving erythromycin-zinc and 44 receiving clindamycin), no serious topical or systemic side effects were reported. Two patients, one from each treatment group, suffered mild irritation. One patient was withdrawn from the erythromycin-zinc-treated group. Results of patch tests were negative. The superiority of the erythromycin-zinc formulation may be due to the increased (4%) erythromycin concentration and/or the ability of 1.2% zinc acetate to enhance the product's activity.

Acne Vulgaris↗
PubMed1991

Pityrosporum folliculitis in the Philippines: diagnosis, prevalence, and management.

Sixty-eight typical cases were studied to define the course of Pityrosporum folliculitis in a tropical setting. Contrary to reports in the literature, we found Pityrosporum folliculitis to be polymorphic. The "molluscoid" comedopapule was the most characteristic and common lesion, and it yielded consistently high spore counts. The face was commonly involved. To establish the diagnosis, we used direct microscopy of potassium hydroxide/Parker blue-black ink mounts of the lower poles of comedonal plugs. Pityrosporum folliculitis is common in the Philippines, although our adult controls had a low incidence of skin carriage of Pityrosporum orbiculare on the face compared with those reported in the West. Pityrosporum folliculitis coexisted with acne vulgaris in 56% of patients, and the addition of antimycotics to the acne regimen produced dramatic clearing of lesions.

Acne Vulgaris↗
PubMedDate not supplied

The assessment of acne: an evaluation of grading and lesion counting in the measurement of acne.

The basic morphology of acne--comedones, papules, pustules, and nodules--and the extent of involvement do not permit simple evaluation due to the number of variables involved. Because these acne lesions may vary in number during the natural course of the disease, various measurements have been developed, based on clinical examination and photographic documentation. These range from global assessments to lesion counting, with the latter providing more objective data.

Acne Vulgaris↗
PubMedDate not supplied

Acne: physical treatment.

Different physical treatments may be used in acne therapy. The main indications are for treating retentional lesions (open and comedones), inflamed lesions, and scars.

Acne Vulgaris↗
PubMed2006

Treatment of acne conglobata with infliximab.

Acne conglobata is an uncommon nodulocystic condition that is often resistant to therapy. This disorder typically begins in adulthood and presents as numerous comedones, papules, pustules, nodules, abscesses, and draining sinus tracts involving the chest, back, and buttocks. These lesions frequently become secondarily infected with gram-positive bacteria and often heal with scarring. Pathology usually reveals inflammatory infiltrate around follicles, which can often disrupt the normal dermal architecture. Acne conglobata is particularly disfiguring and socially detrimental to patients because of its chronicity, severity, and treatment challenge.

Acne Vulgaris↗
PubMed2006

Acneiform eruptions associated with epidermal growth factor receptor-targeted chemotherapy.

A relatively newer class of chemotherapy agents, known as the epidermal growth factor receptor inhibitors (EGF-RIs), is being used to treat advanced stages of solid tumors. Acneiform eruptions are a frequent adverse effect and one which has been associated with increased survival in some studies. We describe 3 patients who presented shortly after initiation of EGF-RI therapy. Characteristics included an absence of comedones, facial and truncal involvement, and a perifollicular lymphoneutrophilic infiltrate detected on biopsy. Lesion counts were reduced with topical adapalene and oral tetracyclines in two patients. Patient 3 had dramatic clearance with low-dose isotretinoin (20 mg daily) until completion of EGF-RI therapy. Acneiform eruptions are a common adverse reaction to EGF-RI therapy and can be treated with traditional acne therapy. This should not be considered a drug hypersensitivity eruption or allergy, and patients should continue therapy. For patients with severe eruptions, oral isotretinoin is a consideration.

Acne Vulgaris↗
PubMed2005

Demodectic mange in fattening pigs in São Paulo, Brazil.

An investigation was conducted of mange in five Large White adult sows refractory to pyrethroid treatment (cypermethrin 15%). The most important clinical signs consisted of erythema, hyperkeratosis, alopecic macules, micaceous scaling, follicular pluging, and numerous comedones, especially on the facial region. Skin samples were scraped and punched. Elongate mites were found that were classified as Demodex sp., according to the morphological and histopathological characteristics. The protein, vitamin, and mineral levels contained in the rations were considered to be lower than those recommended to attend the requirements of fattening pigs. Adjustment of the rations was adopted, and the treatment of animals with ivermectin premix (450g/tonne of food) daily orally for a further 7 days was prescribed. The success of treatment was observed 15 days after adoption of these measures, when the beginning of remission of signs was observed. No mites were found on scrapings or biopsy punches after the treatment of the sows.

Animals↗
PubMed2005

[Acneiform eruption secondary to cetuximab].

C225 (cetuximab) is a monoclonal antibody that targets the epidermal growth factor receptor (EGF-R). It is used for the treatment of solid malignant tumors in advanced stages. It works against tumors by inhibiting cell proliferation, angiogenesis and the formation of metastases, as well as by promoting cell apoptosis. We present the case of a 64-year-old male patient affected with a colon neoplasm with hepatic metastases, for which treatment with cetuximab was indicated. He came to our department because of a skin eruption with papules and pustules located on the face, neck, presternal area and upper back, but with no cysts or comedones. The biopsy was compatible with an acneiform eruption. The patient was treated with minocycline, 100 mg/day for 2 weeks, with the clinical symptoms responding favorably. When he was given further doses of cetuximab, he once again presented with new eruptions, but of lesser intensity. Because of the high frequency with which this adverse effect appears, it is recommended that cetuximab be included on the list of drugs causing acneiform eruptions.

Acne Vulgaris↗