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PubMed1987

Acne management. Primary care physician or dermatologist?

The question of who should treat acne patients--primary care physicians or dermatologists--is debatable. To determine physicians' attitudes toward, and referral patterns in, acne management, the authors conducted two studies. According to results of the first study, primary care physicians were less likely than dermatologists to feel referral was necessary for acne management. Primary care physicians felt that they should treat most patients with less severe (comedonal and papulopustular) acne and were neutral about referral of patients with nodulocystic acne. Dermatologists were neutral about referral of patients with less severe acne and recommended referral for most patients with nodulocystic acne. Results of the second study showed that almost all patients with less severe acne and most patients with nodulocystic acne were managed by primary care physicians. The authors feel that primary care physicians can and should handle most cases of acne without referral.

Acne Vulgaris↗

PubMed1991

Treatment of acne vulgaris. Guidelines for primary care physicians.

The spectrum of acne vulgaris is wide, ranging from minor comedones to devastating nodules and cysts. Appropriate therapy requires an understanding of the various types of lesions, their pathophysiology, and the rationale for treatment. Good patient rapport and communication are important, and close follow-up is necessary until the treatment regimen has stabilized. Timely referral to a dermatologist is essential when therapy is not effective. With effort, the treatment of acne can be quite rewarding for both patient and physician.

Acne Vulgaris↗

PubMed2005

An open study to determine the efficacy of blue light in the treatment of mild to moderate acne.

BACKGROUND: The effective management of acne remains a challenge; achieving an optimal response whilst minimizing adverse events is often difficult. The rise in antibiotic resistance threatens to reduce the future usefulness of the current mainstay of therapy. The need for alternative therapies remains important. Phototherapy has previously been shown to be effective in acne, with renewed interest as both endogenous and exogenous photodynamic therapies are demonstrated for this condition. OBJECTIVES: To determine the effect of narrowband blue light in the reduction of inflammatory and non-inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy. METHODS: We performed an open study utilizing a blue LED light source in 30 subjects with mild to moderate facial acne. Two weeks after screening, lesions were counted and recorded by lesion type. Over 4 weeks, patients received eight 10- or 20-minute light treatments, peak wavelength 409-419 nm at 40 mW/cm2. Assessments were taken at weeks 5, 8 and 12 and lesion counts were recorded. Repeated measures-ANOVA and Dunnett's tests, respectively, allowed assessment of the different scores over time and permitted comparison of mean counts. RESULTS: An overall effect on inflammatory counts was observed at week 5, and a statistically significant decrease in inflamed counts was detected at the week 8 assessments, which continued to week 12. There was little effect on non-inflamed lesions. The treatment was well tolerated with adverse events experienced generally rated as being mild and usually self-limiting. CONCLUSIONS: Eight 10- or 20-minute treatments over 4 weeks with a narrowband blue light was found to be effective in reducing the number of inflamed lesions in subjects with mild to moderate acne. The treatment had little effect on the number of comedones. The onset of the effect was observable at the first assessment, at week 5, and maximal between weeks 8 and 12. Blue light phototherapy using a narrowband LED light source appears to be a safe and effective additional therapy for mild to moderate acne.

Acne Vulgaris↗

PubMed2006

The effect of 2% niacinamide on facial sebum production.

BACKGROUND: The presence of sebum on the face is responsible for both facial shine and the formation of comedonal and inflammatory acne lesions. Sebum control is a goal of many OTC skin care products; however, most currently available products function by absorbing sebum from the face rather than modulating its production. OBJECTIVE: To demonstrate the effect of topical 2% niacinamide on sebum excretion rates and casual sebum production in Oriental and Caucasian populations. METHODS: Separate clinical trials were conducted in both Japan and the USA to evaluate the effect of topical 2% niacinamide in different ethnic groups. A total of 100 Japanese subjects were enrolled in a double-blind, placebo-controlled comparison between two independent balanced groups. Fifty subjects applied the 2% niacinamide moisturizer to the face for 4 weeks and 50 subjects used a placebo moisturizer for 4 weeks, with sebum excretion rate (SER) measurements taken at baseline, week 2, and week 4. In addition, 30 Caucasian subjects were enrolled in a randomized split-face study for 6 weeks with SER and casual sebum levels (CSL) measured at baseline, week 3, and week 6. RESULTS: The results of the Japanese study demonstrated that the SER of the two groups was not significantly different at baseline, but the 2% niacinamide treated group demonstrated significantly lowered SER after 2 and 4 weeks of application. The results were somewhat different in the Caucasian study. After 6 weeks of treatment, the CSL was significantly reduced, but the SER was not significantly reduced. CONCLUSIONS: Topical 2% niacinamide may be effective in lowering the SER in Japanese individuals and CSL in Caucasian individuals.

Administration, Topical↗

PubMed2006

Combination blue (415 nm) and red (633 nm) LED phototherapy in the treatment of mild to severe acne vulgaris.

BACKGROUND AND OBJECTIVE: Acne vulgaris represents both a challenge to the treating dermatologist and a major concern for the patient. Conventional treatments have proved inconsistent with often unacceptable side effects and high rates of recurrence. Non-thermal, non-laser, phototherapy for acne with a combination of blue and red light has recently attracted attention. The present study was designed to assess the efficacy of this combination phototherapy. METHODS: Twenty-four subjects, Fitzpatrick skin types II-V, with mild to severe symmetric facial acne vulgaris were recruited for the study. Subjects were well matched at baseline in terms of both age and duration of acne. Subjects were treated over eight sessions, two per week 3 days apart, alternating between 415 nm blue light (20 minutes/session, 48 J/cm2) and 633 nm red light (20 minutes/session, 96 J/cm2) from a light-emitting diode (LED)-based therapy system. Patients received a mild microdermabrasion before each session. Acne was assessed at baseline and at weeks 2, 4, 8 and 12. RESULTS: Twenty-two patients completed the trial. A mean reduction in lesion count was observed at all follow-up points. At the 4-week follow-up, the mean lesion count reduction was significant at 46% (p=0.001). At the 12-week follow-up, the mean lesion count reduction was also significant at 81% (p=0.001). Patient and dermatologist assessments were similar. Severe acne showed a marginally better response than mild acne. Side effects were minimal and transitory. Comedones did not respond as well as inflammatory lesions. CONCLUSIONS: Combination blue and red LED therapy appears to have excellent potential in the treatment of mild to severe acne. Treatment appears to be both pain- and side effect-free.

Acne Vulgaris↗

PubMed2001

Preparation and comparative clinical evaluation of liposomal gel of benzoyl peroxide for acne.

A novel topical benzovl peroxide (BP) gelformulation containing liposomal BP was shown to significantly reduce local irritation relative to its nonliposomal BP gel (plain BP gel) preparation and also to improve clinical efficacy (almost twofold) in the treatment of acne. BP liposomes were prepared, optimized, and formulated into a carbopol 934gel base. Drug release evaluated using dialysis membrane has repeatedly shown that a new topical gel formulation containing liposomal BP (liposomal BP gel) significantly reduced BP penetration. Clinical evaluation data were also compared with those obtained with liposomal tretinoin (TRE) gel in an earlier investigation of ours. The overall improvement in terms of percentage reduction in total number of skin lesions demonstrated almost similar results for both BP and TRE. However, variation was observed in the treatment of separate types of lesions in which liposomal TRE gel was found to be more effective in treating comedones and liposomal BP gel in treating papules and pustules. Also, the liposomal gel formulation of both the drugs significantly reduced the local adverse effects, thereby improving patient compliance.

Acne Vulgaris↗

PubMed2000

Topical liposomal gel of tretinoin for the treatment of acne: research and clinical implications.

An attempt was made to pharmaceutically develop a topical liposomal tretinoin (TRE) gel and clinically evaluate the developed formulation for the treatment of acne in patients. Liposomes of TRE were prepared using the lipid film hydration technique and the entrapment efficiency of TRE in liposomes was optimized to 79.96%. The drug retention in liposomes and in liposomal TRE gel (Carbopol 934 gel base) studied at three storage conditions indicated maximum drug retention at refrigeration temperature. For liposomal TRE gel, reduced drug leakage was observed as compared to that of liposomes at all three storage conditions. Diffusion studies of plain TRE gel and liposomal TRE gel suggested prolongation (3.4 times reduction in flux value) of drug diffusion and almost two-fold increase in skin drug retention after liposomal encapsulation of drug. A comparative double-blind clinical study of the developed liposomal TRE gel, carried out on 30 acne patients over a period of 3 months, demonstrated significant enhancement (about 1.5-fold) in drug efficacy. More remarkable improvement was observed in the treatment of comedones, where the mean percent reduction in lesions increased from 62.36% for plain TRE gel to 94.17% for liposomal TRE gel. Erythema and irritation associated with the use of plain TRE gel was reduced considerably with the use of liposomal TRE gel. The findings of this investigation therefore underscore potential utility of commercialization of liposomal TRE gel in the treatment of acne.

Acne Vulgaris↗

PubMed1996

Diffuse sebaceous gland hyperplasia. A case report and an immunohistochemical study with cytokeratins.

We report a 43-year-old woman with sebaceous gland hyperplasia that occurred in a diffuse pattern of aggregated papular lesions involving her entire face, neck, and upper chest. Comedones, pustules, and inflammatory papules were absent. The eruption was accompanied by marked seborrhea. Histopathological examination showed enlargement of sebaceous acini, an increased number of immature sebocytes in foci, and a dilated follicular infundibulum. Immunohistochemical investigation showed cytokeratin 14 (CK 14) expression in the keratinocytes of the infundibulum, the isthmus, and sebaceous duct and in the mature and immature sebocytes; CK 17 expression in the keratinocytes of the sebaceous duct; CK 1 expression in the keratinocytes of the infundibulum; and an enhanced expression of the proliferation cell antigen Ki-67 (MiB1) in the immature sebocytes. With CK 18 and CK 19, no staining was observed. Oral therapy with isotretinoin (13-cis-retinoic acid) resulted in remarkable improvement in < or = 3 months. Histopathological and immunohistochemical examination after therapy showed markedly reduced sebaceous glands, a decrease in the staining of MiB1-positive immature sebocytes, and enhanced expression of CK 19 in immature sebocytes and sebaceous duct cells. Diffuse sebaceous gland hyperplasia is a rare variant of seboglandular proliferative disorders that is distinct from the well-known circumscribed type.

Administration, Oral↗

PubMed2005

Bullous solar elastosis.

Solar elastosis is a recognized manifestation of chronic sun exposure affecting mainly Caucasian skin. Recognizable clinical manifestations of solar elastosis include cutis rhomboidalis nuchae, Favre-Racouchot syndrome, actinic comedonal plaque, nodular forms such as elastomas, elastic nodule of the ear and elastotic bands, collagenous plaques of the hand, and colloid milia. We report two patients with an unusual presentation of vesicular lesions clinically and histopathologically situated in zones of severe solar elastosis that has been previously referred to as bullous solar elastosis.

Aged↗

PubMed1992

Tissue expansion in a patient with extensive nevus comedonicus.

Nevus comedonicus is a rare developmental abnormality of the pilosebaceous apparatus that presents as an aggregation of dilated follicular orifices filled with pigmented keratinous material. Occurrence of extensive or giant lesions is even more rare. Indications for treatment include recurrent infections and cosmetic reasons. Therapeutic approaches include topical keratolytic agents, manual extraction of comedones, dermabrasion, and excision of smaller lesions. Increasing clinical experience with tissue expansion has suggested that it might be used effectively in the definitive treatment of an extensive nevus comedonicus previously considered too large to excise without the use of a skin graft, despite the potential risk of infection within the lesion during the course of expansion. We report the first patient with giant nevus comedonicus to be treated using tissue expansion. This patient demonstrates that prompt treatment of cellulitis and abscesses within the lesion will keep this process isolated from the adjacent expanders and will not compromise a planned excision and reconstruction.

Buttocks↗

PubMed2004

Trichofolliculoma with incidental focal acantholytic dyskeratosis.

Incidental focal acantholytic dyskeratosis has been described in a variety of cutaneous lesions, including benign and malignant epithelial lesions, fibrohistiocytic lesions, inflammatory lesions, and melanocytic lesions. It has also been observed in follicular lesions such as comedones and ruptured follicles. We report the case of a 47-year-old man with a firm, flesh-colored 2-mm pruritic papule in the sun-exposed area above the left eyebrow. An excisional biopsy was performed, the tissue was processed, and the hematoxylin and eosin slides were evaluated. Microscopic examination showed a dilated cystic cavity filled with keratinous debris and scattered fragments of hair. Smaller secondary follicular structures branched from the primary cyst's walls into the adjacent dermis. Hyperkeratosis, acantholysis, dyskeratosis, and suprabasilar clefts were also focally present. Correlation of the lesion's clinical morphology and microscopic features established a diagnosis of trichofolliculoma with incidental focal acantholytic dyskeratosis. Hence, trichofolliculoma can be added to the list of follicular lesions in which focal acantholytic dyskeratosis may be observed as an incidental microscopic change.

Acantholysis↗

PubMed2003

Update on pathogenesis and treatment of acne.

Acne vulgaris is a common cutaneous disorder of the pilosebaceous follicle. More than 45 million people are affected with acne vulgaris. In addition, 80% of people in the United States report that they suffered from acne at one point in life. It is estimated that US consumers spend $1.2 billion each year for the treatment of acne. Typically, lesions are pleomorphic and range from open and closed comedones to inflammatory papules, pustules, cysts, and nodules, and scarring may result. The disease is important, with a significant effect on patients' self-esteem. The pathogenesis is only partially understood and is multifactorial. Successful management of acne requires an understanding of the pathophysiology of disease. The first half of this review discusses new discoveries in the pathogenesis of acne, and the second half introduces new and time-honored therapies.

Acne Vulgaris↗

PubMed1985

Acne-like chronic inflammatory activity of Propionibacterium acnes preparations in an animal model: correlation with ability to stimulate the reticuloendothelial system.

The ability of strains and fractions of killed propionibacteria suspensions to produce chronic rat ear inflammation after intradermal injection of 70-micrograms aliquots was highly correlated with production of splenomegaly in the mouse after i.p. injection of 1.4 mg Propionibacterium acnes strains CN 6134, VPI 0009, ATCC 11828, and UCLA SC and N1 produced a 2- to 3-fold increase in rat ear thickness and a 5- to 7-fold increase in mouse spleen weight 15 days post injection. In contrast P. granulosum CN 5888, P. acnes UCLA 6S and periodated, acetylated, or 12-h cultures of VPI 0009 were inactive or weakly active as stimulators of chronic ear inflammation and splenomegaly. Active strains produced in the rat ear a transepidermal elimination response characterized by follicular encapsulation and the formation of secondary comedones. These effects correlated with persistence of phagocytized bacteria within macrophages. Furthermore, when rats were first immunized and then challenged with active strains of P. acnes, an increased sensitivity to low doses of P. acnes and a chronic exacerbation of inflammation was observed.

Acne Vulgaris↗

PubMed1996

Modeling acne in vitro.

To help elucidate the factors responsible for the infundibular changes seen in acne, the human sebaceous pilosebaceous infundibulum was isolated by microdissection and maintained for 7 d in keratinocyte serum-free medium supplemented with 50 micrograms/ml bovine pituitary extract, 100 units/ml penicillin and streptomycin, 2.5 micrograms/ml amphotericin B and CaCl2(10H2O) to give a final Ca2+ concentration of 2 mM. Infundibular structure was maintained over 7 d in this medium; the pattern of cell division mimicked that in vivo. The rate of cell division was significantly higher than previously described for infundibula maintained in supplemented William's E medium, and moreover did not fall over 7 d. The addition of 1 ng/ml interleukin-1 alpha (IL-1 alpha) caused hypercornification of the infundibulum similar to that seen in comedones; this could be blocked by 1000 ng/ml interleukin-1 receptor antagonist (IL-1ra). In about 20% of subjects there was spontaneous hypercornification of the infundibulum that could be blocked by 1000 ng/ml IL-1ra, suggesting that the infundibulum is capable of synthesising IL-1 alpha. The addition of 5 ng/ml epidermal growth factor or 5 ng/ml transforming growth factor-alpha to the medium caused a disorganisation of the keratinocytes of the infundibulum that resulted in rupturing similar to that seen in the more severe, purulent grades of acne. The addition of 1 microM 13-cis retinoic acid caused a significant reduction in the rate of DNA synthesis and apparent parakeratosis. We are now, therefore, able to model histologically the major infundibular changes in acne.

Acne Vulgaris↗

PubMed1977

Skin surface lipid composition, acne, pubertal development, and urinary excretion of testosterone and 17-ketosteroids in children.

Fifty-two children, age 5-10, from acne-prone families, were studied for a period of 1 year to examine the interrelationship between sebum, acne, pubertal development, and urinary steroid excretion. In each of the subjects, 30 boys and 22 girls, the composition of forehead skin lipid was determined 4 times yearly by thin-layer chromatography, with measurement of triglycerides, diglycerides, free fatty acids, wax esters, squalene, cholesterol, and cholesterol esters. Twice yearly, examination was made of the presence or absence of acne, pubertal maturation and the 24-hour urinary excretion of testosterone as determined by radioimmunnoassay, and of total 17-ketosteroids, dehydroepiandrosterone, androsterone, and etiocholanolone, as determined by paper chromatography. The relative amount of sebaceous lipids was positively correlated with age of the subjects (wax esters p less than .001, squalene p less than .05), as was the triglyceride-diglyceride component (p less than .05). No significant correlation was seen with the fatty acids. Acne, primarily comedonal, occurred in 27/52 subjects (15 girls, 12 boys) and was associated with higher sebum values. One-half of the children with acne had no signs of pubertal development. A significantly positive correlation was observed between the relative amount of sebaceous lipid and the urinary excretion of 17-ketosteroids, androsterone, and etiocholanolone in both sexes, and of testosterone and dehydroepiandrosterone in boys. The development of acne in children is an early pubertal event, often evident before other signs of pubertal maturation, and it is associated with an increase in sebum and in the urinary excretion of androgenic steroids.

17-Ketosteroids↗

PubMed1976

A search for mycoplasmas and chlamydiae in acne lesions.

No mycoplasmas and no chlamydiae were found in cultures of 75 uninflamed comedones, 72 papulopustular lesions, and 7 cystic lesions from 14 subjects with acne. Chlamydial serologic tests were negative for 11 subjects and showed antibodies in 3 subjects to 3 different antigenic types of trachoma agent. These results are viewed as substantial evidence against the possibility that either mycoplasmas or chlamydiae play an important part in the pathogenesis of acne.

Acne Vulgaris↗

PubMed1979

The effect on rhino mouse skin of agents which influence keratinization and exfoliation.

The skin of the rhino mouse, an allelic variant of the hariless mouse, contains deep dermal cysts and huge numbers of hornfilled utriculi which resemble comedones. Chemicals which influence either differentiation or desquamation of horny cells were applied topically twice daily for up to 6 weeks. Except for the dermal cysts, the gross epithelial abnormalities were almost completely corrected by retinoic acid in a dose-dependent fashion. Salicylic acid caused partial emptying of the horny masses, but the utriculi did not regress. Lactic acid, propylene glycol and benzoyl peroxide had minor effects on keratinization and exfoliation. The rhino mouse is a suitable model for assessing chemicals which affect epithelial differentiation (retinoids)or which promote loss of cohesion between horny cells (descaling agents).

Animals↗

PubMed1975

The localization and distribution of gram-positive cocci in normal skin and in lesions of acne vulgaris.

The localization of gram-positive cocci in the normal skin and in the lesions of acne vulgaris was investigated using fluorescein-labeled antiserum raised to gram-positive, coagulase-negative cocci. The cocci were found in 10 of 19 specimens from normal facial skin and in 3 of 11 specimens from the normal skin of the rest of the body. The bacteria were found mostly in the openings of follicles, but in 6 of 10 facial skin specimens, they were also present deeply in the lumina of the dilated sebaceous follicles near the sebaceous glands. Cocci were found in 5 of 6 noninflammatory acne comedones. In inflammatory acne they were demonstrated not only in the follicular canals but also sparsely in the infiltrate surrounding the follicles.

Abdomen↗