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PubMed2004

Diagnosis and treatment of acne.

Acne can cause significant embarrassment and anxiety in affected patients. It is important for family physicians to educate patients about available treatment options and their expected outcomes. Topical retinoids, benzoyl peroxide, sulfacetamide, and azelaic acid are effective in patients with mild or moderate comedones. Topical erythromycin or clindamycin can be added in patients with mild to moderate inflammatory acne or mixed acne. A six-month course of oral erythromycin, doxycycline, tetracycline, or minocycline can be used in patients with moderate to severe inflammatory acne. A low-androgen oral contraceptive pill is effective in women with moderate to severe acne. Isotretinoin is reserved for use in the treatment of the most severe or refractory cases of inflammatory acne. Because of its poor side effect profile and teratogenicity, isotretinoin (Accutane) must by prescribed by a physician who is a registered member of the manufacturer's System to Manage Accutane-Related Teratogenicity program.

Acne Vulgaris↗
PubMed2004

The pathophysiology of acne vulgaris in children and adolescents, Part 1.

Microcomedones, the earliest lesions of acne, appear at adrenarche, which typically occurs at about 8 years of age when androgens of adrenal origin begin to stimulate follicular hyperkeratosis and sebaceous hyperplasia in pilosebaceous units on the face. Comedones appear about 2 years later, when androgens of gonadal origin are produced and colonization of follicles by Propionibacterium acnes increases. Inflammatory lesions, such as pustules, papules, and nodules, are the result of the host's immune responses to P acnes; the proinflammatory cytokines are released by immunocompetent leukocytes that are recruited in response to this bacterium and its metabolic by-products. Androgens also affect the barrier function of the skin, and disturbances of barrier function may stimulate epidermal DNA synthesis. This leads to epidermal hyperplasia, which may also contribute to follicular hyperkeratosis in acne. Optimal treatment for this disorder will address these various pathophysiologic factors.

Acne Vulgaris↗
PubMed2004

The pathophysiology of acne vulgaris in children and adolescents, part 2: Tailoring treatment.

Various pathophysiologic factors are involved in the development of acne lesions, microcomedones, comedones, and inflammatory lesions. These factors include follicular hyperkeratosis, increased colonization of follicles by Propionibacterium acnes, increased sebum production, and inflammatory mediators. Optimal treatment of acne involves the use of agents that address these various underlying pathogenetic factors.

Acne Vulgaris↗
PubMed2004

Topical tazarotene: The BEST (balancing efficacy, speed, and tolerability) in acne trial.

Results of clinical trials have shown that tazarotene cream used as monotherapy effectively reduces the number of both inflammatory and noninflammatory lesions in patients with acne vulgaris. The efficacy of tazarotene cream in clinical practice, however, has not been reported. To evaluate the benefits of tazarotene cream in everyday clinical practice, an uncontrolled observational study was conducted in a large population of patients with facial acne vulgaris; 243 investigators enrolled 1118 patients for treatment with once-daily tazarotene 0. 1% cream as monotherapy, or in combination with other agents, for up to 12 weeks. Tazarotene efficacy was well rated by both investigators and patients and had a rapid onset of action. Reduction in comedone counts was greatest when tazarotene 0.1% was used as first-line therapy. The incidence of adverse events (almost exclusively peeling, erythema, dryness, or burning) was low and typically declined with continued use of the medication. The combination of tazarotene 0.1% cream and clindamycin-benzoyl peroxide was the best tolerated of all the treatment regimens. Patients and investigators reported high levels of treatment satisfaction with topical tazarotene 0.1% cream.

Acne Vulgaris↗
PubMed2005

[Perolen cream for therapy of rosacea].

Acne rosacea belongs to the most common inflammatory dermatoses of the face. Current treatments for this disease remain unsatisfactory, that's why searching for new methods and remedy are very important. For the topical therapy we have used a new cream perolen ("New Pharma", Georgia). The main component of the creme is the water extract of gastric mucous membrane of cow, which is the source of proteolytic ferments. Another main component is a Perilla oil which contains unsaturated fatty acids--linolenic and linol, presented in the highest amounts. The cream is characterized by bactericidal, bacteriostatical, anti-inflammatory and anti-oxidant effects, it also assists to tissue regeneration, make blood vessels more elastic and decreases penetration. We have observed 40 patients with papulo-pustular subtype of rosacea (25 females and 15 males). Patients were divided into two groups. For oral therapy in both groups we used Tetracycline and Trichopol. For topical treatment in the first group of patients was used rosamet cream and in the second group--perolen cream. Both of these creams were applied once daily during 2 months. Reduction of comedones, inflammations, papules, pustules and small nodules occurred after one month. Erythema, oedema, desquamation improved significantly during the treatment, but the positive effects were more prominent in the second group of patients. In conclusion, the study shows that topically used cream perelon represents a new approach in the management of acne rosacea.

Adult↗
PubMed1979

[Acne-like eruption induced by pseudo-xanthoma elasticum (author's transl)].

Pseudoxanthoma elasticum can induce acne-like eruption. The lesions are located on the latero-cervical parts and consist of comedones, cysts and inflammatory nodules. Histologically, there are no transepithelial eliminations or follicultitis, but a very important granulomatosus tissue with epithelioid cells and a giganto-cellular reaction with elastotic fibres phagocytosis. These findings are different from the cases with association of P.X.E. and elastosis perforans, but they are closely related to it. We think that these features are of a very great interest for the dermatological practice.

Acne Vulgaris↗
PubMed2005

[Evaluation of dermatological symptoms of Yusho patients in the annual examination in 2003-2004].

We evaluated the severity grades and the skin severity scores of the skin symptoms who visited the annual examinations of Fukuoka prefecture in 2003 and 2004. The severity of skin symptoms improved significantly in the first 20 years; nowadays, however, further improvement can hardly be observed. More than 36 years have passed since the Yusho incident, and about 60% of the patients currently present no skin symptoms. In contrast, in about 40% of the patients, characteristic skin symptoms of Yusho, such as pigmentation of skin, black comedones and acneform eruptions, could still be observed. Using Peason's correlation coefficient test and Spearman's correlation coefficient test, we analyzed correlation between "PCB pattern" and the blood PCB concentration, the skin severity grade and the skin severity scores. However, we could not find out any obvious correlation.

Biomarkers↗
PubMed2005

Superoxide dismutase and myeloperoxidase activities in polymorphonuclear leukocytes in acne vulgaris.

BACKGROUND AND DESIGN: Acne vulgaris frequently occurs in the second decade of life. The pathogenesis of the disease is multifactorial and in the present study, we aimed to investigate the role of reactive oxygen species in the inflammation of acne by determining the activities of myeloperoxidase (MPO) and superoxide dismutase (SOD) in polymorphonuclear leukocytes (PMN). MATERIALS AND METHODS: Forty-three patients with acne vulgaris and 24 healthy controls were enrolled. The severity of the acne was categorized from mild (subjects with only comedonic lesions) to severe (subjects with nodulocystic lesions). SOD and MPO activities in PMN were measured spectrophotometrically. RESULTS: There was no significant difference in the activity of MPO between the patients and controls.However, SOD activity in PMN was significantly lower in the patients than in the controls (p<0.001). Nocorrelation was detected between the activities of enzymes and the severity of the disease. CONCLUSION: Propionibacterium acnes may not play a primary role in the pathogenesis of acne as a bacterium. However, the low activity of SOD in PMN may be responsible for the increased levels of superoxide anion radicals in the epidermis. New anti-acne drugs should include substances with lymphocyte stimulating and anti-oxidative properties.

Acne Vulgaris↗
PubMed2005

Color-dilution alopecia in dogs.

Color-dilution alopecia is a relatively uncommon hereditary skin disease seen in "Blue" and other color-diluted dogs. This syndrome is associated with a color-dilution gene. The initial clinical signs are the gradual onset of a dry, dull and poor hair coat quality. Hair shafts and hair regrowth are poor, and follicular papules may develop and progress to frank comedones. Hair loss and comedo formation are usually most severe on the trunk, especially color-diluted area on the skin. Six cases of color-dilution alopecia are reported in 3 months to 10 years old dogs. The breeds of dogs are blue Doberman Pinscher, Miniature Pinscher, Dachshund, and Schnauzer. Grossly, extensive partial hair loss was seen on the skin. Histopathologically, the epidermis is relatively normal but may be hyperplastic. Hair follicles are characterized by atrophy and distortion. Heavily clumped melanin is present in the epidermis, dermis and hair follicles.

Alopecia↗
PubMedDate not supplied

Clinical and bacteriological evaluation of nadifloxacin 1% cream in patients with acne vulgaris: a double-blind, phase III comparison study versus erythromycin 2% cream.

The aim of this double-blind, multinational, phase III study was to investigate the clinical and bacteriological efficacy of nadifloxacin 1% cream compared with erythromycin 2% cream in 474 European patients with predominantly inflamed slight-to-moderate acne vulgaris. During 12 weeks of treatment both nadifloxacin and erythromycin caused significant reduction in the number of inflamed papulo-pustular lesions (66.7% and 64.7%, respectively) and open and closed comedones. The microbiological evaluation showed a significant reduction of coagulase negative staphylococci (CNS) only in the nadifloxacin group, while Propionibacterium acnes was significantly reduced by both formulations. A significantly higher resistance and the extent of resistant of P. acnes and CNS against erythromycin compared to nadifloxacin were also evidenced. All adverse events reported were minor in both groups. This pivotal erythromycin-controlled study has demonstrated that nadifloxacin 1% cream was as efficacious and safe as erythromycin 2% and extremely low numbers of nadifloxacin-resistant microorganisms were detected in the treatment period.

Acne Vulgaris↗
PubMedDate not supplied

Higher body mass index is a significant risk factor for acne formation in schoolchildren.

Obesity is frequently accompanied by peripheral hyperandrogenism, which may be associated with increased sebum production and the development of severe acne. Body mass index (BMI) is one of the most accurate ways to measure and determine obesity. The aim of the present study was to study the correlation between obesity and the point prevalence and patterns of acne in schoolchildren. A total of 3,274 children (aged 6-11 years) from Magong Township were examined by two board-certified dermatologists. The acne prevalence was 7.3%, with more girls affected than boys (ratio = 1.5). Comedones were more commonly observed than inflammatory acne (10.4% vs. 6.9%). The mean of BMI in non-acne students (18.2 +/- 3.4) was significantly lower than that in acne subjects (19.5 +/- 3.7), without gender difference. Overall schoolchildren with a BMI < 18.5 had less prevalence rate of acne, especially the inflammatory lesions, while those with a BMI-for-age > or = 95% had a significantly higher rate of acne development.

Acne Vulgaris↗
PubMed1991

A syndrome of acne vulgaris and subclinical dermographic urticaria.

Patients with acne vulgaris and subclinical dermographism constitute a distinct, common, and hitherto unrecognized group. One hundred and thirty such clinical patients were observed in a private dermatology practice. These patients relate that their acne produces the symptoms of itching, burning, soreness, and/or tenderness. The lesions are characterized clinically by one or a combination of the following signs: erythema, violaceous discoloration, ecchymoses, and a scarlet to livid halo about the pustule or inflamed closed comedone. I tested for the dermographic phenomena in patients with acne both entering and already being treated in a private dermatology practice over a two-year period. Patient's age, sex, whether or not dermographism predated or postdated onset of acne, symptoms of lesions, premenstrual flare, and history of atopy were recorded. Most patients were between the ages of twenty and forty years, and the majority were women. All had symptomatic lesions, and a significant minority noted no prior dermographic capability. The vast majority of women had premenstrual flares. A greater number of these patients were atopic than had been anticipated. The nonsedating antihistamine terfenadine mitigated both the signs and symptoms of the process. The syndrome of acne vulgaris with dermographism presenting as a unique visual and symptomatic variant of common acne is frequently seen, easily recognized, and highly treatable.

Acne Vulgaris↗
PubMedDate not supplied

Anti-inflammatory properties of narrow-band blue light.

BACKGROUND: Narrow-band blue light (420 nm) has demonstrated safety and efficacy in the treatment of acne vulgaris. It works by exhibiting a phototoxic effect on the heme metabolism of Propionibacterium acnes. Previous studies using blue light showed more improvement in inflammatory lesions than in comedones, as well as some improvement on the untreated side. Cytokines have demonstrated a critical role in the development of inflammation. The expression of pro-inflammatory cytokines such as IL-1alpha have been shown to result in the expression of vascular and dermal adhesion molecules, the chemoattraction of inflammatory cells, and the stimulation of other inflammatory mediators. In addition, UVB radiation serves as a potent modulator of cell-mediated immune responses. PURPOSE: This study investigated the effect of narrow-band blue light on the inflammatory process in the presence and absence of cytokines and UVB using IL-1alpha and ICAM-1 as markers for inflammation. METHODS: Two immortalized keratinocyte cell lines were compared: HaCaT, produced by spontaneous immortalization of a genetically altered cell line, and hTERT, obtained by stable transfection of primary cell culture with human telomerase reverse transcriptase. Cells were treated with INF-y and TNF-alpha and exposed to UVB (312 nm at 50 mJ/cm2) and/or blue light (420 nm at 54 mJ/cm2 and 134 mJ/cm2). The expression of IL-1alpha and ICAM-1 was measured by quantitative ELISA. RESULTS: The results showed that blue light and low-dose UVB treatment of HaCaT and hTERT cells resulted in inhibition of cytokine-induced production of IL-1alpha. The level of IL-1alpha decreased by 82% in HaCaT and by 75% in hTERT cells when exposed to blue light. It decreased by 95% in HaCaT and by 91% in hTERT cells when blue light was used in combination with UVB. ICAM-1 expression was similarly reduced in HaCaT, but not in hTERT cells. CONCLUSIONS: This study showed that narrow-band blue light has anti-inflammatory effects on keratinocytes by decreasing the cytokine-induced production of IL-1alpha and ICAM-1. In addition, blue light demonstrated synergistic effects with low-dose UVB light. These results expand the properties of narrow-band blue light in modulating the inflammatory process and will facilitate testing of its phototherapeutic applications in different inflammatory skin conditions.

Acne Vulgaris↗
PubMed1991

Postmenopausal acne.

Postmenopausal acne originates at or after menopause in darker-skinned, formerly oily-skinned, large-pored women who usually did not experience adolescent acne. It is a low-grade, long-smoldering acne in which small closed comedones are dominant, among which there is a scattering of dimunitive papulopustules. There is a seeming association with chin and upper lip hirsutism. Topical tretinoin is an effective therapy. Unopposed adrenal androgens present after ovarian failure may be the chief causes of this condition.

Acne Vulgaris↗
PubMed1991

[Dermatological findings in the annual examination of the patients with Yusho in 1989-1990].

We reported the skin symptoms of the patients with Yusho in the 1989 and 1990 annual examinations. We also studied the alteration of the skin symptoms in 33 patients followed up for 14 years (1977-1990). Most of these patients showed obvious improvement in their skin symptoms during 12 years (1977-1988). However, a remarkable improvement was not observed in recent 3 years and approximately 40% of the patients still had comedones and/or acneiform eruptions.

Female↗
PubMed1991

[Nevus comedonicus. A rare skin disease of the hair follicles].

Naevus comedonicus is a rare disorder of the skin which is due to defect development of the hair follicles. The undifferentiated epithelium of the hair follicles produces keratin, which is packed in laminated layers and forms a plug. The keratin plug expands the follicle and gives the clinical appearance of a naevus comedonicus with dark and vaulted crypts of the skin. Comedones appear mainly on the face, neck and trunk. The condition is usually asymptomatic, but may be complicated by infection and scarring. No malignancy has been reported. Local treatment may be application of retinoic acid. This accelerates the exfoliation of the epithelium, and the expulsion of the keratin layers prevents the formation of keratin plugs in the skin. The treatment with retinoic acid will not eliminate the crypts and pits in the skin. Surgical treatment seems to be the best alternative.

Adult↗
PubMed1990

Linear basal cell nevus.

We report a case of linear basal cell nervus occurring on the thigh of a forty-five-year-old woman. In this lesion, the characteristic comedones were absent. Linear basal cell nevus is a rare, benign condition that must be differentiated from both basal cell nevus syndrome and linear basal cell carcinoma, either of which can be locally aggressive.

Basal Cell Nevus Syndrome↗
PubMed1985

Enzyme production of propionibacteria from patients with acne vulgaris and healthy persons.

375 strains of propionibacteria isolated from pustules, comedones, and from normal skin of patients with acne vulgaris and from healthy persons have been examined for their enzymatic activity. In contrast to healthy individuals, protease and caseinase production of strains from acne patients was significantly lower. On the other hand, DNA'ase production of strains from acne lesions was increased, and lecithinase could be demonstrated in strains from acne patients only.

Acne Vulgaris↗