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PubMed1997

Propionibacterium acnes treatment diminishes CD4+ NK1.1+ T cells but induces type I T cells in the liver by induction of IL-12 and IL-18 production from Kupffer cells.

LPS injection into normal mice does not induce liver injury, while the same treatment of Propionibacterium acnes-primed mice induces severe liver injury, indicating that P. acnes treatment renders the mice susceptible to LPS. Since IFN-gamma sensitizes macrophages to LPS, we investigated the mechanism of induction and activation of IFN-gamma-producing (type 1) T cells by P. acnes. Twenty percent of liver lymphocytes of C57BL/6 mice are CD4+ NK1.1+ T cells that promptly produce IL-4 in response to anti-CD3 in vitro. However, P. acnes treatment diminished these lymphocytes. Therefore, liver lymphocytes from P. acnes-primed mice showed reduced IL-4 production. Furthermore, P. acnes treatment induced CD4- type 1 T cells in the liver. Isolated P. acnes-elicited Kupffer cells produced IL-12 and to a lesser degree IL-18 in vitro. Injection of anti-IL-12 Ab totally abrogated these actions of P. acnes, while injection of anti-IL-18 Ab caused only partial abrogation. Thus, administration of P. acnes diminished CD4+ NK1.1+ T cells, but induced type 1 T cells in the liver by induction of IL-12 and IL-18 production. Injection of IL-12 (approximately 1,000 ng) dose dependently diminished CD4+ NK1.1+ T cells, but induced type 1 T cells. In contrast, injection of IL-18 (approximately 1,000 ng) failed, although injection of a much larger dose of IL-18 (10,000 ng) or IL-18 (approximately 1,000 ng) with suboptimal doses of IL-12 (1-100 ng) diminished CD4+ NK1.1+ T cells in a dose-dependent manner. Thus, P. acnes treatment renders the mice highly susceptible to LPS by induction and activation of type 1 T cells.

Animals↗
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↗
PubMed2005

Toll-like receptor 2 mediates inflammatory cytokine induction but not sensitization for liver injury by Propioni- bacterium acnes.

Recognition of Gram-positive bacteria by Toll-like receptor 2 (TLR2) induces activation of proinflammatory pathways. In mice, sensitization with the Gram-positive Propionibacterium acnes followed by a challenge with the TLR4 ligand, lipopolysaccharide (LPS), results in fulminant hepatic failure. Here, we investigated the role of TLR2 in liver sensitization to LPS-induced injury. Stimulation of Chinese hamster ovary cells and peritoneal macrophages with heat-killed P. acnes required expression of TLR2 but not of TLR4, suggesting that P. acnes was a TLR2 ligand. Cell activation by P. acnes was myeloid differentiation primary-response protein 88 (MyD88)-dependent, and it was augmented by coexpression of CD14 in mouse peritoneal macrophages. In vitro, P. acnes behaved as a TLR2 ligand and induced TLR4 hetero- and TLR2 homotolerance in peritoneal macrophages. In vivo priming of wild-type mice with P. acnes, but not with the selective TLR2 ligands peptidoglycan and lipotheicoic acid, resulted in hepatocyte necrosis, hyperelevated serum levels of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, interferon-gamma (IFN-gamma), and IL-12 (p40/p70), and increased RNA expression of proinflammatory cytokines (IL-12p40, IL-1alpha, IL-6, IL-1beta, IL-18, IFN-gamma) in the liver after a LPS challenge. Furthermore, P. acnes priming sensitized TLR2-deficient (TLR2-/-) but not MyD88-/- mice to LPS-induced injury, evidenced by hepatocyte necrosis, increased levels of serum TNF-alpha, IFN-gamma, IL-6, and liver proinflammatory cytokine mRNA expression. IFN-gamma, a cytokine sensitizing to endotoxin, was induced by P. acnes in splenocytes of TLR2-/- and TLR9-/- but not MyD88-/- mice. These results suggest that although P. acnes triggers TLR2-mediated cell activation, TLR2-independent but MyD88-dependent mechanisms mediate in vivo sensitization by P. acnes for LPS-induced liver injury.

Adaptor Proteins, Signal Transducing↗
PubMed2002

Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open study and in vitro investigation.

The purpose of this study was to investigate the efficacy of phototherapy with a newly-developed high-intensity, enhanced, narrow-band, blue light source in patients with mild to moderate acne. An open study was performed in acne patients who were treated twice a week up to 5 weeks. Acne lesions were reduced by 64%. Two patients experienced dryness. No patient discontinued treatment due to adverse effects. In vitro investigation revealed that irradiation from this light source reduced the number of Propionibacterium acnes (P. acnes), but not Staphylococcus epidermidis that were isolated from the acne patients. Phototherapy using this blue light source was effective and well tolerated in acne patients and had an ability to decrease numbers of P. acnes in vitro, suggesting that this phototherapy may be a new modality for the treatment of acne.

Acne Vulgaris↗
PubMed2005

Granulysin-derived peptides demonstrate antimicrobial and anti-inflammatory effects against Propionibacterium acnes.

Propionibacterium acnes is a key therapeutic target in acne, yet this bacterium has become resistant to standard antibiotic agents. We investigated whether the human antimicrobial protein granulysin is a potential candidate for the treatment of acne. Granulysin and synthetic granulysin-derived peptides possessing a helix-loop-helix motif killed P. acnes in vitro. Modification of a helix-loop-helix peptide, 31-50, by substitution of a tryptophan for the valine at amino acid 44 (peptide 31-50v44w) to increase its interaction with bacterial surfaces also increased its antimicrobial activity. Moreover, when synthesized with D- rather than L-type amino acids, this peptide (D-31-50v44w) became less susceptible to degradation by proteases and more effective in killing P. acnes. Granulysin peptides were bactericidal, demonstrating an advantage over standard bacteriostatic antibiotics in their control of P. acnes. Moreover, peptide D-31-50v44w killed P. acnes in isolated human microcomedone preparations. Importantly, peptides 31-50, 31-50v44w, and D-31-50v44w also have potential anti-inflammatory effects, as demonstrated by suppression of P. acnes-stimulated cytokine release. Taken together, these data suggest that granulysin peptides may be useful as topical therapeutic agents, providing alternatives to current acne therapies.

Acne Vulgaris↗
PubMed2003

Is antibiotic resistance in cutaneous propionibacteria clinically relevant? : implications of resistance for acne patients and prescribers.

It is well recognized that some patients with acne do not respond adequately to antibiotic therapy. It is important to distinguish antibiotic recalcitrant acne which we would suggest represents acne that shows a diminished response to treatment irrespective of the cause as opposed to 'antibiotic-resistant acne' which is acne that is less responsive to treatment as a direct consequence of skin colonization with resistant propionibacteria. Here we show that antibiotic-resistant acne is not just a theoretical possibility but a real phenomenon that could have important consequences for patients and prescribers. The relationship between skin colonization by antibiotic-resistant propionibacteria and treatment outcomes is a complex one that is explained at the follicular level by physiological differences affecting local drug concentrations. A systematic review of the literature on antibiotic-resistant propionibacteria revealed methodological shortcomings in studies of their prevalence and a paucity of evidence on their clinical significance. Despite the elucidation of resistance mechanisms in cutaneous propionibacteria, our continuing inability to distinguish between strains of Propionibacterium acnes means that we still do not fully understand how resistance spreads, although person-to-person transfer is most likely. Finally, we present a decision tree for acne management in an era of prudent antimicrobial prescribing that provides an alternative to existing treatment algorithms by placing topical retinoids and not antibiotics at the cornerstone of acne management.

Acne Vulgaris↗
PubMed2005

Antibiotic treatment of acne may be associated with upper respiratory tract infections.

OBJECTIVE: To determine if the long-term use of antibiotics for the treatment of acne results in an increase in either of 2 common infectious illnesses: upper respiratory tract infections (URTIs) or urinary tract infections. DESIGN: Retrospective cohort study. SETTING: General Practice Research Database of the United Kingdom, London, England, from 1987 to 2002. PATIENTS: Patients with a diagnosis of acne. MAIN OUTCOME MEASURE: The onset of either a URTI or a urinary tract infection. RESULTS: Of 118 496 individuals with acne (age range, 15-35 years) who were identified in the General Practice Research Database, 84 977 (71.7%) received a topical or oral antibiotic (tetracyclines, erythromycin, or clindamycin) for treatment of their acne and 33 519 (28.3%) did not. Within the first year of observation, 18 281 (15.4%) of the patients with acne had at least 1 URTI, and within that year, the odds of a URTI developing among those receiving antibiotic treatment were 2.15 (95% confidence interval, 2.05-2.23; P<.001) times greater than among those who were not receiving antibiotic treatment. Multiple additional analyses, which were conducted to show that this effect was not an artifact of increased health care-seeking behavior among our cohorts, included comparing the cohorts of patients with acne with a cohort of patients with hypertension and the likelihood of developing a urinary tract infection. CONCLUSIONS: Patients with acne who were receiving antibiotic treatment for acne were more likely to develop a URTI than those with acne who were not receiving such treatment. The true clinical importance of our findings will require further investigation.

Acne Vulgaris↗
PubMed2003

Effect of vaccination therapy for acne, using a staphylococci antigenic complex in combination with clindamycin.

A group of 46 patients with acne vulgaris were prescribed clindamycin in combination with a vaccination therapy using a staphylococci antigenic complex (Polystafana; Sevapharma, Czechia). Acne papulopustulosa was diagnosed in 36 patients and acne indurata in 10 patients. The clinical effect of clindamycin and Polystafana was determined on the basis of the regression of the inflammatory manifestation of acne: regression by 0-30% was considered unsuccessful, by 30-80% satisfactory, and above 80% excellent; the immunomodulation effect of the treatment was evaluated in parallel. The clinical effect was excellent in 21 patients with acne papulopustulosa and in 6 with acne indurata; it was accompanied by pronounced immunomodulation effect as both cellular and humoral immunity was also tended to return to normal values. A satisfactory clinical effect was observed in 15 patients with acne papulopustulosa, whose cellular immunity component was also stimulated. Only 4 patients with acne indurata failed to respond successfully. These were the patients who showed a pronounced deficit of the cellular immunity component persisting even after the treatment. The administration of clindamycin in combination with Polystafana vaccination can be recommended as an effective means for the treatment of acne vulgaris.

Acne Vulgaris↗
PubMed1992

The prevalence of acne on the basis of physical examination.

BACKGROUND: It has been suggested that cystic acne is rare in women 15 to 44 years of age and infrequent in men. OBJECTIVE: To determine the prevalence of acne, we analyzed the primary data from the National Health and Nutrition Examination Survey (NHANES) that included a cutaneous examination of a stratified random sample of 20,749 noninstitutionalized U.S. residents. METHODS: We calculated the prevalence of various disease states based on NHANES primary data and the NHANES population weights. Prevalence estimates and male/female ratios of these estimates were calculated. RESULTS: From 1971 to 1974, the projected prevalence of acne conglobata (grade IV acne) for women and men 15 to 44 years of age in the United States was 250,000 and 570,000, respectively. At the time of examination, an additional 582,000 women and 749,000 men were projected to have moderate acne with cysts and scars. Therefore the prevalence of acne conglobata and acne of at least a moderate degree with cysts and scars was 832,000 for women and 1,319,000 for men 15 to 44 years of age. The male/female ratio for acne with cysts and scars is approximately 1.6:1. CONCLUSION: The NHANES examination data demonstrate that acne with cysts and scars is common in both men and women.

Acne Vulgaris↗
PubMed1993

Acne fulminans: report of clinical findings and treatment of twenty-four patients.

BACKGROUND: Acne fulminans is an ulcerative form of acne with an acute onset and systemic symptoms. It most commonly affects adolescent boys. OBJECTIVE: Clinical and laboratory findings and treatment results of patients with acne fulminans were reviewed to obtain a better understanding of the clinical course and outcome of the disease. METHODS: Data of patients with severe acne were collected from the Dermatology Departments of Finnish hospitals during the years 1970 to 1991. RESULTS: Twenty-four patients with acne fulminans are described. All patients had ulcerative acne with acute onset. In 22 patients acne was associated with high fever for at least 1 week. All patients had musculoskeletal pain. Increased uptake in bone scan or radiographic findings compatible with an infectious origin were detected in 17 patients. Eight patients were treated with antibiotics alone, but the response was poor; three patients had a relapse of musculoskeletal symptoms. Ten patients were given systemic steroids in addition to antibiotics. In this group the response was rapid, but acne and musculoskeletal symptoms tended to relapse when the steroid dosage was reduced. Four patients were treated with a combination of antibiotics, systemic steroids, and isotretinoin; all responded well, but one of these patients also had a relapse. CONCLUSION: Musculoskeletal symptoms are common in patients with acne fulminans. Systemic steroid treatment rapidly controls the skin lesions and systemic symptoms. The duration of steroid treatment should be 2 to 4 months to avoid relapses. Therapy with isotretinoin, antibiotics, or both was often combined with steroids, but the role of these agents is still uncertain.

Acne Vulgaris↗
PubMedDate not supplied

Acne and sebaceous gland function.

The embryologic development of the human sebaceous gland is closely related to the differentiation of the hair follicle and the epidermis. The number of sebaceous glands remains approximately the same throughout life, whereas their size tends to increase with age. The development and function of the sebaceous gland in the fetal and neonatal periods appear to be regulated by maternal androgens and by endogenous steroid synthesis, as well as by other morphogens. The most apparent function of the glands is to excrete sebum. A strong increase in sebum excretion occurs a few hours after birth; this peaks during the first week and slowly subsides thereafter. A new rise takes place at about age 9 years with adrenarche and continues up to age 17 years, when the adult level is reached. The sebaceous gland is an important formation site of active androgens. Androgens are well known for their effects on sebum excretion, whereas terminal sebocyte differentiation is assisted by peroxisome proliferator-activated receptor ligands. Estrogens, glucocorticoids, and prolactin also influence sebaceous gland function. In addition, stress-sensing cutaneous signals lead to the production and release of corticotrophin-releasing hormone from dermal nerves and sebocytes with subsequent dose-dependent regulation of sebaceous nonpolar lipids. Among other lipid fractions, sebaceous glands have been shown to synthesize considerable amounts of free fatty acids without exogenous influence. Sebaceous lipids are responsible for the three-dimensional skin surface lipid organization. Contributing to the integrity of the skin barrier. They also exhibit strong innate antimicrobial activity, transport antioxidants to the skin surface, and express proinflammatory and anti-inflammatory properties. Acne in childhood has been suggested to be strongly associated with the development of severe acne during adolescence. Increased sebum excretion is a major factor in the pathophysiology of acne vulgaris. Other sebaceous gland functions are also associated with the development of acne, including sebaceous proinflammatory lipids; different cytokines produced locally; periglandular peptides and neuropeptides, such as corticotrophin-releasing hormone, which is produced by sebocytes; and substance P, which is expressed in the nerve endings at the vicinity of healthy-looking glands of acne patients. Current data indicate that acne vulgaris may be a primary inflammatory disease. Future drugs developed to treat acne not only should reduce sebum production and Propionibacterium acnes populations, but also should be targeted to reduce proinflammatory lipids in sebum, down-regulate proinflammatory signals in the pilosebaceous unit, and inhibit leukotriene B(4)-induced accumulation of inflammatory cells. They should also influence peroxisome proliferator-activated receptor regulation. Isotretinoin is still the most active available drug for the treatment of severe acne.

Acne Vulgaris↗
PubMed2005

Elevated 17-hydroxyprogesterone serum values in male patients with acne.

BACKGROUND: Androgen excess may provoke or aggravate acne by inducing seborrhea. In women, androgen disorders are frequently suspected when acne is accompanied by hirsutism or irregularities of the menstrual cycle. In men, however, acne may be the only sign of androgen excess. OBJECTIVE: Our aim was to investigate whether male patients with acne display pathologic androgen blood values. METHODS: This case-control study at a university dermatology department with referred and unreferred patients investigated male acne patients (n = 82, consecutive sample) in whom the diagnosis of mild to severe acne was made, as well as a control group of men without acne (n = 38). The main outcome measures were androgen parameters including morning values of testosterone, luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulfate, androstenedione, and 17-hydroxyprogesterone; as well as a corticotropin stimulation test. RESULTS: 17-Hydroxyprogesterone levels were significantly higher (P = .01) in acne patients than in the control group, whereas the other parameters did not differ significantly. In addition, the corticotropin stimulation test revealed abnormal 17-hydroxyprogesterone induction values in 10 of 82 patients. LIMITATIONS: The analysis is limited to a selection of androgen parameters. CONCLUSION: The results suggest that in men irregularities of adrenal steroid metabolism may be a factor contributing to acne.

17-alpha-Hydroxyprogesterone↗
PubMed2006

Propionibacterium acnes and lipopolysaccharide induce the expression of antimicrobial peptides and proinflammatory cytokines/chemokines in human sebocytes.

Acne is a common skin disorder of the pilosebaceous unit. In addition to genetic, hormonal and environmental factors, abnormal colonization by Propionibacterium acnes has been implicated in the occurrence of acne via the induction of inflammatory mediators. To gain more insight into the role that sebocytes play in the innate immune response of the skin, particularly in acne, we compared the antimicrobial peptide and proinflammatory cytokine/chemokine expression at mRNA and protein levels, as well as the viability and differentiation of SZ95 sebocytes in response to co-culture with representative isolates of P. acnes type IA and type IB as well as Escherichia coli-derived lipopolysaccharide (LPS). We found that, in vitro, P. acnes type IA and IB isolates and LPS induced human beta-defensin-2 and proinflammatory cytokine/chemokine expression, and influenced sebocyte viability and differentiation. Our results provide evidence that sebocytes are capable of producing proinflammatory cytokines/chemokines and antimicrobial peptides, which may have a role in acne pathogenesis. Furthermore, since P. acnes types IA and IB differentially affect both the differentiation and viability of sebocytes, our data demonstrate that different strains of P. acnes vary in their capacity to stimulate an inflammatory response within the pilosebaceous follicle.

Antimicrobial Cationic Peptides↗
PubMed1984

Acne and hyperandrogenism.

Elevated serum androgen levels have been reported in patients with acne resistant to conventional dermatologic therapy. This study was designed to investigate the relationship between serum androgen levels and the presence of acne in an unselected population of women seen consecutively by a dermatologist for various dermatologic complaints. Elevated serum testosterone levels were associated with acne regardless of whether this was the presenting complaint or an incidental finding. Women with both acne and hirsutism had higher serum testosterone levels than those with acne alone. Higher incidence of irregular menstrual cycles was noted in women complaining of acne. Normal serum testosterone levels were found only in those patients with regular menstrual cycles and the absence of acne or hirsutism. In conclusion, this study suggests that elevated serum testosterone levels are related to the presence of acne. Attention is called to the possibility that acne may be a clinical manifestation of a disorder with systemic and reproductive consequences.

Acne Vulgaris↗
PubMed2000

The role of androgens in determining acne severity in adult women.

BACKGROUND: Although many arguments have been put forth supporting the role of androgens in the aetiology of acne, their part in determining the severity of the disease is not well established. OBJECTIVES: The aim of our study was to evaluate the relationship between acne severity and the clinical and laboratory markers of androgenicity in a large group of patients. METHODS: Ninety women over 17 years of age with acne were enrolled into the study. The levels of testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulphate and sex hormone binding globulin (SHBG) were measured. Menstrual cycle regularity, hirsutism score, acne severity and ultrasound evaluation of polycystic ovaries were recorded. One-way analysis of variance, chi(2)-test and correlation analysis were used for data processing. RESULTS: Hirsutism was documented in 19 (21%) subjects, elevated levels of at least one androgen in 73 (81%) subjects, an irregular cycle was reported by 43 (48%) women, and polycystic ovaries were found in 45 (50%) women. The patients were divided into three groups according to acne severity. Acne was graded using the Leeds technique as minor in 43 (48%) cases, mild in 27 (30%) and moderate in 20 (22%). We did not demonstrate a positive correlation between the grade of acne severity and any of the clinical or laboratory markers of androgenicity assessed. On the contrary, women with a higher grade of acne severity showed lower values of the index of free testosterone, a lower hirsutism score and higher SHBG levels. CONCLUSIONS: Our study suggests that the severity of acne manifestation in adult women is not determined by androgen production.

Acne Vulgaris↗
PubMed2003

Antibiotic-resistant acne: lessons from Europe.

BACKGROUND: Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K. OBJECTIVES: To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres. METHODS: Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA. RESULTS: Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51%) and highest in Spain (94%). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91% in Spain) than resistance to the tetracyclines (highest prevalence 26.4% in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41% in Hungary to 86% in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria. CONCLUSIONS: The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.

Acne Vulgaris↗
PubMed2002

A community-based epidemiological study of acne vulgaris in Hong Kong adolescents.

Using a questionnaire survey, the prevalence and severity of acne were assessed in a randomized sample of 522 persons (aged 15-25 years) out of 5,522 telephone interviews in Hong Kong. The prevalence of self-reported acne was 91.3%. At the time of interview, 52.2% had acne. More acne scars and pigmentation were present (52.6%) than in a Western population; 26.6% were disturbed psychologically by acne and 82.9% by its physical appearance. Only 2.4% had sought the advice of a doctor for managing acne, while 41.5% had tried some form of medical treatment. Topical treatment comprised 94.7% of medications used for acne. The results show that acne and its complications are common problems. The treatment of acne scars and pigmentation is difficult and complicated by Asian skin phototypes. The findings suggest the need for refined educational programmes to ensure that adolescents know what effective treatments are available so that complications can be reduced.

Acne Vulgaris↗
PubMed2004

Acne update: 2004.

PURPOSE OF REVIEW: Acne vulgaris is a common skin disorder among children and young adults that carries enormous financial and psychosocial impact. Contemporary therapies attempt to address factors underlying acne as a disorder of the pilosebaceous unit. These longstanding paradigms regarding pathogenesis and treatment continue to evolve in light of recent work on this ubiquitous disease. RECENT FINDINGS: This review focuses on new literature that has emerged regarding the biology of the folliculosebaceous unit, the identification of particular mediators responsible for inflammatory acne, the use of topical and systemic retinoids in acne therapy, and approaches to address the emergence of antibiotic-resistant Propionibacterium acnes strains. In addition, the use of several novel therapeutic avenues is discussed, including combination therapies, lipoxygenase inhibitors, and lasers. SUMMARY: As the understanding of the factors that initiate and exacerbate acne vulgaris continues to increase, so does the diversity of therapeutic options. Rational use of available treatment options based on the type and severity of acne lesions is a key component of successful acne therapy and allows the physician who treats adolescents with acne to provide optimum care.

Acne Vulgaris↗