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PubMed1981

The relationship between bacteria and the abnormal follicular keratinization in acne vulgaris.

The structural organization and bacteriological profile of follicular casts and early comedones in prepuberal children were investigated. Follicular casts were present in all samples but were not as abundant as usually seen in older individuals with acne. When examined with the light microscope, all casts and comedones were composed of numerous layers of horny cells and sebum, but were devoid of bacteria. Neither follicular casts nor comedones yielded bacteria when cultured. Electron microscopy of the follicular casts revealed the presence of small round, discrete lipid droplets, and alternating dense and less dense lamellar configurations within the horny cells. Some horny cells closest to the sebum-filled lumen contained large lipid masses, resulting in "balloon-shaped" regions. Prepuberal follicular horny cells contained all of the abnormalities usually seen in follicular casts and biopsy material from acne patients, which suggests that these casts are potential comedones. These aberrations occurred in the complete absence of bacteria indicating that bacteria are not essential to the formation of casts or comedones. Furthermore, our findings indicate that bacteria play little if any role in the initial events of pathological keratinization.

Acne Vulgaris↗
PubMed1993

Isotretinoin for acne vulgaris--10 years later: a safe and successful treatment.

The purpose of this study was to assess the long-term benefit of isotretinoin in otherwise therapy-resistant acne. We also assessed risk factors which might influence the long-term outcome. We studied 88 patients (mean age 20.8 years), most of whom had suffered from acne for many years (mean 7.4 years). They received isotretinoin in an initial dose of 0.5 or 1.0 mg/kg/day. The dose was subsequently adjusted according to response and side-effects. Most patients only required 4 months' therapy to produce at least 85% clinical improvement. The patients were seen up to 10 years post-therapy (mean 9 years). Sixty-one patients were still virtually clear of disease. Of the others, 16% required further treatment with conventional antibiotics and 23% required a second course of isotretinoin. Of those who relapsed, 96% did so within 3 years of stopping therapy. The patients' age, sex, and duration of acne did not influence outcome. However, in patients with predominantly truncal acne, especially when severe, there was an increased incidence of relapse. Sebum excretion is known to correlate with acne severity, but the long-term degree of sebum suppression was found not to be related to relapse. The dose schedule, in particular cumulative dose, was an important factor in determining relapse rate. Those patients who received 0.5 mg/kg daily, or a cumulative dose of < 120 mg/kg, had a significantly higher relapse rate than patients receiving a larger dose. We did not elicit any long-term systemic or biochemical side-effects. We conclude that isotretinoin is a safe and effective therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acne Vulgaris↗
PubMed1995

In situ hybridization analysis of CRABP II expression in sebaceous follicles from 13-cis retinoic acid-treated acne patients.

The aim of this study was to investigate the effects of 13-cis retinoic acid treatment on cellular retinoic acid binding protein II (CRABP II) mRNA expression in sebaceous follicles from acne patients, using in situ hybridization. Biopsies were taken from uninvolved skin areas in close juxtaposition to inflamed comedos before therapy, and at 2-4 or 14-16 weeks of treatment. Paraffin sections were used for in situ hybridization study with riboprobes transcribed from human CRABP II cDNA. After oral treatment with 13-cis retinoic acid, sebaceous glands were reduced in size and atrophic, and the ratio of sebum-free to fully differentiated (sebum-producing) sebocytes was dramatically increased. The CRABP II expression in the sebaceous gland, and to some extent in infundibular structures, was strongly increased compared with the level of expression in the epidermis. The maximum signal was always found in layers of suprabasal sebocytes lacking lipid droplets, but never in the basal layers. These findings indicate a selective activity of 13-cis retinoic acid on CRABP II mRNA expression in the sebaceous glands of acne patients.

Acne Vulgaris↗
PubMedDate not supplied

The development of BRL 7660 as an anti-acne agent.

BRL 7660, a 16,16 di-substituted androstene steroid, was initially developed by Beecham Pharmaceuticals as a potential anti-fertility agent for males. It proved inactive in this area, but subsequent studies showed it to be a potent testosterone 5-alpha-reductase inhibitor. It showed little classical steroidal activity but reduced sebum secretion in the rat. In the hamster flank organ, it reduced the stimulant effect of testosterone but not 5-alpha-dihydrotestosterone after topical administration, but had little oral activity. Human studies showed that topical administration significantly reduced sebum secretion. Acne symptoms were reduced in many patients who showed enthusiasm for the treatment. Placebo effects were variable and reduced significance, which suggested that further formulation studies were required. Commercial pressures from other drugs in development prevented our researchers from pursuing this approach, and the project was terminated.

5-alpha Reductase Inhibitors↗
PubMed1998

Baseline biophysical parameters in subjects with sensitive skin.

Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to external factors. The stinging test, performed by applying lactic acid to the nasolabial fold and evaluating the intensity of subjective symptoms, is widely accepted as a marker of sensitivity and employed for the selection of subjects experiencing invisible cutaneous irritation. However, this test is based on self-perceived assessment and lacks objectivity. In order to contribute to the finding of objective descriptors, we assessed baseline biophysical parameters in subjects with sensitive skin by means of transepidermal water loss (TEWL), capacitance, pH, sebum and skin colour measurements, and compared the data with those obtained in normal subjects, also correlating the results with those of clinical assessments and functional tests. Subjects with sensitive skin showed a trend towards higher scores at all assessment times both for the stinging and the washing test. The skin of sensitive subjects was described as less supple, less hydrated and more erythematous and telangiectatic with respect to the skin of normal subjects. A trend towards an increase in TEWL, pH and colorimetric a* values, and a decrease in capacitance, sebum and colorimetric L* values on the face of subjects with sensitive skin was observable. However, significances were only present for capacitance and a* values. Thus, alterations of baseline capacitance values indicate the tendency to barrier impairment and support the view that skin hyperreactivity to water-soluble irritants is induced by a greater amount of irritants absorbed, whereas the increase in the erythema parameter shows that cutaneous vascular hyperreactivity in subjects with sensitive skin also corresponds to baseline vasodilation.

Adult↗
PubMed2005

Effect of hormonal replacement therapy on skin biophysical properties of menopausal women.

BACKGROUND/PURPOSE: Hormonal replacement therapy (HRT) has been shown in the past to influence well being as well as several somatic features in menopausal women. The aim of this analysis was to study the effect of HRT on various biophysical properties of the skin of menopausal women. Two sub-samples were built to test the effect (1) of 'short-term' HRT in recently menopausal women (n=15), and (2) the effect of 'medium- and long-term' HRT in menopausal women (n=78). METHODS: The analysis was performed on data from a study of 106 menopausal Caucasian women with apparent healthy skin. Self-report data on the menopausal status, the duration of the menopause, whether or not HRT has been taken and the duration of the HRT were collected. A series of biophysical measurements on the cheek, the forehead and the inner forearm were performed under controlled environmental conditions. Twenty women were menopausal for less than 5 years (eight with HRT for at least 1 year and seven who had never taken HRT) and 86 women for at least 5 years (35 with HRT for at least 5 years and 43 who had never taken HRT). Analyses of covariance with adjustment for age were performed. RESULTS: With regard to skin colour, the measurements in women treated for at least 1 year were significantly higher for red intensity (a*) and lower for brightness (L*) on the forearm as compared with the non-treated women. Furthermore, yellow intensity (b*) mean values were higher on the forehead and the forearm in women treated for at least 5 years compared with the non-treated women. Concerning sebum casual level, the mean values were significantly higher on the forehead and the cheek in women treated for at least 5 years. Regarding skin surface parameters reflecting hydration, the mean values for capacitance on the forehead and the cheek were significantly higher in women treated for at least 5 years. Finally, as regards with skin relief, parameters mean values for amplitude and roughness on the forehead were significantly higher in women treated for at least 5 years. CONCLUSION: The skin colour parameters showed a higher red intensity value in menopausal women who had been treated for at least 1 year. In menopausal women who had been treated for at least 5 years, the biophysical measurements were significantly higher for the parameters reflecting hydration and sebum secretion, which generally decrease after the menopause. These features were associated with higher values for the yellow intensity parameter and the skin relief parameters on the forehead. Our results support the subjective impression and the clinical evaluation concerning the impact of HRT on the development and the evolution of some skin properties after menopause.

Aged↗
PubMed2005

A toll-like receptor 2-responsive lipid effector pathway protects mammals against skin infections with gram-positive bacteria.

flake (flk), an N-ethyl-N-nitrosourea-induced recessive germ line mutation of C57BL/6 mice, impairs the clearance of skin infections by Streptococcus pyogenes and Staphylococcus aureus, gram-positive pathogens that elicit innate immune responses by activating Toll-like receptor 2 (TLR2). Positional cloning and sequencing revealed that flk is a novel allele of the stearoyl coenzyme A desaturase 1 gene (Scd1). flake homozygotes show reduced sebum production and are unable to synthesize the monounsaturated fatty acids (MUFA) palmitoleate (C(16:1)) and oleate (C(18:1)), both of which are bactericidal against gram-positive (but not gram-negative) organisms in vitro. However, intradermal MUFA administration to S. aureus-infected mice partially rescues the flake phenotype, which indicates that an additional component of the sebum may be required to improve bacterial clearance. In normal mice, transcription of Scd1-a gene with numerous NF-kappaB elements in its promoter--is strongly and specifically induced by TLR2 signaling. Similarly, the SCD1 gene is induced by TLR2 signaling in a human sebocyte cell line. These observations reveal the existence of a regulated, lipid-based antimicrobial effector pathway in mammals and suggest new approaches to the treatment or prevention of infections with gram-positive bacteria.

Animals↗
PubMed1985

Acne: double blind clinical and laboratory trial of tetracycline, oestrogen-cyproterone acetate, and combined treatment.

Since the recent introduction of a drug regimen containing 2 mg of the antiandrogen cyproterone acetate and 50 micrograms ethinyl-oestradiol (Diane; oestrogen-cyproterone acetate) several uncontrolled reports have extolled the benefits of this drug. Double blind studies, however, are lacking. Sixty two patients with moderate or moderately severe acne were therefore included in a double blind trial of treatment for six months comparing tetracycline alone, oestrogen-cyproterone acetate alone, and a combination of these agents. Sebum excretion rates and bacterial counts were measured before, during, and after treatment, at the same time as a clinical assessment was made. At six months the acne (as assessed by overall grade) had improved by 68% in the antibiotic treated group and by 74% in the oestrogen-cyproterone treated group. The group given a combination of both agents improved by 82%, which was significantly better (p less than 0.025) than the improvement in the tetracycline treated patients. No significant difference was found between the groups given oestrogen-cyproterone alone and the combined treatment. The sebum excretion rate was suppressed by 25% in the patients in both groups receiving oestrogen-cyproterone but not in the group given antibiotics alone. Oestrogen-cyproterone acetate is as effective as antibiotics in treating acne in women, and adding antibiotics offers no advantage over using oestrogen-cyproterone on its own, although in this study the combination was more effective than tetracycline alone at six months.

Acne Vulgaris↗
PubMed1997

Oral isotretinoin. Where now, where next?

The introduction of oral 13-cis-retinoic acid (isotretinoin, Roaccutane/Accutane) has been a key step in he history of dermatological treatments; it was and still is more than 15 years later the only compound which cures acne while oral antibiotics and other therapies, at best, have less dramatic effects. That oral isotretinoin works so well is probably entirely linked to its effect of the sebaceous glands that dedifferentiate and stop producing sebum. Amongst oral retinoids, both natural (such an all-trans-retinoic acid and 9-cis-retinoic acid) and synthetic (such as etretinate, acitretin, arotinoids), only 13-cis-retinoic acid exerts such an effect on sebum production and therefore on acne. The cause of this specificity is still intriguing. It is likely that some pharmacokinetic properties of isotretinoin result in the specific targeting of sebaceous glands. Due to its specificity and efficacy, isotretinoin has been used for 15 years worldwide in millions of patients. Considering the broad experience gained with this drug until now, guidelines for adequate use are evolving. Accordingly, it appears appropriate to: (1) redefine the indications for treatment with oral isotretinoin; (2) reconsider cost-benefit; (3) update labeling recommendations regarding daily doses since a cumulative treatment dose appears to be accepted as a means of preventing relapse, and (4) continue to control the teratogenic risk. These questions were the 'raison d'être' of this symposium.

Acne Vulgaris↗
PubMed1996

Does hormonal skin aging exist? A study of the influence of different hormone therapy regimens on the skin of postmenopausal women using non-invasive measurement techniques.

BACKGROUND AND DESIGN: The skin properties of 98 postmenopausal women with hormone replacement therapy (oestradiol gel or patches) or without hormone replacement therapy were studied using non-invasive techniques: skin thickness with skin echography, skin hydration with a dryness score and measurement of capacitance, skin surface lipids with a Sebumeter and microtopography with image analysis of cutaneous replicas. RESULTS: In this open study we demonstrated an increase in skin thickness and sebum in the treated group in comparison to the untreated group (7-15% according to area for skin thickness, 35% for sebum). Hydration and microtopography were not different in the two groups. CONCLUSIONS: Postmenopausal women who were receiving hormonal substitution have a greater thickness and casual level than untreated women. We therefore suggest that hormonal aging exists and that cutaneous atrophy can be prevented with hormone replacement therapy.

Biopsy↗
PubMed1987

Isotretinoin--an explanation for its long-term benefit.

Isotretinoin is of undisputed benefit in the treatment of acne. In doses of 1 mg/kg/day for 4 months the drug produces a highly significant reduction in sebum excretion rate (90 +/- 3%) in comedone formation as measured by assessing follicular casts (70 +/- 5%), and in surface Propionibacterium acnes. However, the mechanisms of long-term clinical remission are not well understood. There are however, risk factors which predetermine the outcome to treatment with isotretinoin. Younger subjects (14-19 years) and those who have had acne for less than 6 years, respond less well than older subjects. Subjects with more truncal acne also fare less well than those with predominantly facial acne. A return of the reduced sebum excretion rate to within 10% of the pre-treatment level also is a poor prognostic factor. This and future studies could lead to development of more logical dose regimes depending, for example, on the age of the patient; duration of acne and its site. However, until proven otherwise, this study confirms our earlier data, and that of the German multi-centres and Strauss et al (1), that the optimum dose schedule for treating acne patients is 1 mg/kg/day regime.

Acne Vulgaris↗
PubMed1998

Hyperlipidemia and cutaneous abnormalities in transgenic mice overexpressing human apolipoprotein C1.

Transgenic mice were generated with different levels of human apolipoprotein C1 (APOC1) expression in liver and skin. At 2 mo of age, serum levels of cholesterol, triglycerides (TG), and FFA were strongly elevated in APOC1 transgenic mice compared with wild-type mice. These elevated levels of serum cholesterol and TG were due mainly to an accumulation of VLDL particles in the circulation. In addition to hyperlipidemia, APOC1 transgenic mice developed dry and scaly skin with loss of hair, dependent on the amount of APOC1 expression in the skin. Since these skin abnormalities appeared in two independent founder lines, a mutation related to the specific insertion site of the human APOC1 gene as the cause for the phenotype can be excluded. Histopathological analysis of high expressor APOC1 transgenic mice revealed a disorder of the skin consisting of epidermal hyperplasia and hyperkeratosis, and atrophic sebaceous glands lacking sebum. In line with these results, epidermal lipid analysis showed that the relative amounts of the sebum components TG and wax diesters in the epidermis of high expressor APOC1 transgenic mice were reduced by 60 and 45%, respectively. In addition to atrophic sebaceous glands, the meibomian glands were also found to be severely atrophic in APOC1 transgenic mice. High expressor APOC1 transgenic mice also exhibited diminished abdominal adipose tissue stores (a 60% decrease compared with wild-type mice) and a complete deficiency of subcutaneous fat. These results indicate that, in addition to the previously reported inhibitory role of apoC1 on hepatic remnant uptake, overexpression of apoC1 affects lipid synthesis in the sebaceous gland and/or epidermis as well as adipose tissue formation. These APOC1 transgenic mice may serve as an interesting in vivo model for the investigation of lipid homeostasis in the skin.

Animals↗
PubMed2000

Separation of visibly-excited fluorescent components in fingerprint residue by thin-layer chromatography.

The use of lasers for the detection of fingermarks is widespread in the forensic field. Despite this, and the fact that many studies have been conducted into the composition of fingermark residue, the components responsible for the inherent visible fluorescence remain unidentified. Traditionally compositional studies have been performed on sweat, sebum, or skin surface washes, none of which are truly representative of the situation when a fingerprint is deposited on a surface. In this paper thin-layer chromatography (TLC) has been performed on sebum-rich fingermarks laid directly onto TLC plates and an argon ion laser used to visualize the separated components. It has been found to be a robust and reproducible method for studying the fluorescent components in fingermark residue and is considered to be more realistic than other methods of sample preparation as it eliminates the chances of extraneous matter being extracted from the skin surface. Investigations into the nature of the separated compounds have also been made and the results are reported.

Chromatography, Thin Layer↗
PubMed2002

The effect of 2 combined oral Contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea.

A new oral contraceptive has been developed that contains a unique progestogen, drospirenone (DRSP), and that has both antiandrogenic and antimineralocorticoid activity. Our objective was to compare the effect of 30 microg ethinyl estradiol (EE)/3 mg DRSP (EE/DRSP; Yasmin, Schering AG, Berlin, Germany) with that of 35 microg EE/2 mg cyproterone acetate (EE/CPA; Diane-35, Schering AG, Berlin, Germany) on mild-to-moderate cases of acne. Diane-35 is used worldwide (it is not on the market in the United States and Japan) as a hormone treatment for acne, with additional contraceptive benefits. This multicenter, double-blind, randomized study was completed over 9 treatment cycles. A total of 128 women with mild-to-moderate facial acne, with or without seborrhea and/or hirsutism, were randomized. Treatment with either EE/DRSP or EE/CPA was assigned in a 2:1 ratio. Acne lesions, sebum production, and hair growth on the upper lip, chin, and chest were assessed, as well as levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH). At study completion, dermatologists, gynecologists, and subjects gave their overall assessment of the effect of treatment on acne. After 9 treatment cycles, the median total acne lesion count was reduced markedly by 62.5% in the EE/DRSP group and 58.8% in the EE/CPA group. A comparison of the 2 groups revealed that EE/DRSP was at least as effective as EE/CPA. Both preparations also reduced sebum production and hair growth on the upper lip and chin. A 3-fold increase in the levels of SHBG was observed in both treatment groups, and levels of androgens and LH decreased. Treatment differences were not seen. Subjective evaluation of the effect of treatment on facial acne by dermatologists, gynecologists, and the subjects themselves indicated an excellent or good improvement for most subjects in both groups. EE/DRSP has been shown to be as effective for treating mild-to-moderate acne as a preparation containing EE/CPA. This new preparation may provide useful hormone therapy for women with androgen-dependent disorders who also require contraception.

Acne Vulgaris↗
PubMed2003

Pathogenesis of acne: recent research advances.

The pathogenesis of acne is complex and dependent on the interplay of multiple factors. Ductal epidermal hyperproliferation, excess sebum, inflammation, and the presence of P acnes all contribute to the development of acne vulgaris. Isotretinoin, arguably the most effective acne treatment, normalizes ductal hyperproliferation, greatly diminishes sebum production and sebocyte terminal differentiation, and manifests decreased numbers of P acnes organisms. Isotretinoin also exhibits anti-inflammatory properties. A positive response to isotretinoin is durable in 85% of patients after one course of therapy, despite the reversal of many of these observed changes. The exact mechanism of isotretinoin is unknown. Much remains unknown in our understanding of the pathogenesis of acne. What is the initial stimulus for follicular hyperproliferation? Why do some persons develop acne and others do not despite similar serum hormone levels and similar P acnes counts? What determines the severity of acne in a given patient? Is acne primarily an inflammatory dermatosis? Much progress has been made in the study of acne, but many questions remain. Perhaps the most important question is, how do we treat our patients with acne more effectively and safely than we are now? The answer to this question lies in the development of a deeper understanding of the pathogenesis of acne vulgaris.

Acne Vulgaris↗
PubMedDate not supplied

Characterization of the lipid composition at the proximal root regions of human hair.

The hair lipid composition collected from 44 Japanese females between 1 and 81 years of age was examined for eight lipids including hydrocarbons (HCs), squalene (SQ), wax esters (WEs), triglycerides (TGs), fatty acids (FAs), cholesterol (CH), ceramides (CERs), and 18-methyl eicosanoic acid (MEA). In this study, the 5-cm length from the proximal root end of hair fibers, which had never been exposed to any chemical treatment, was used after 5-min incubation with hexane following shampooing. Hair lipids were extracted with solvent and subsequent alkali-solvent and were then analyzed by a combination of chromatography. Although the average contents of the lipids showed great fluctuations among individuals, there were significant correlations between the levels of each lipid, which allowed for the classification of the hair lipids into four groups: group A: SQ, WEs, TGs, and FAs (designated as endogenous lipids based upon their sebum origin); group B: CH and CERs (designated as endogenous lipids); group C: HC (unknown origin); and group D: MEA (the other endogenous lipid). A principal component analysis for eight lipids revealed that the hair lipid composition was characterized by a predominant negative correlation between each lipid for groups A and B. This negative correlation suggests that the endogenous lipids in group B serve as a barrier against the penetration of predominantly sebum-derived exogenous lipids (group A). Endogenous lipids consisting of CH and CERs (group B) and MEA (group D) should be designated as intrinsic internal lipids of human hair.

Adolescent↗
PubMed2005

Objective biophysical findings in patients with sensitive skin.

The term sensitive skin has been used to describe a clinical phenomenon of hyperreactivity of the human skin, which develops exaggerated reactions when exposed to external factors. The aim of this study was to determine objective biophysical findings in patients with sensitive skin compared to those individuals with nonsensitive skin. Thirty-two patients with sensitive skin and 30 healthy volunteers with nonsensitive skin were studied. The testing methods included in vivo and in vitro tests: epicutaneous testing (Patch tests); measurement of sebum and hydration of the skin; alkali resistance test; stinging test with lactic acid; reaction to aqueous solution of methyl nicotinate 0.5%, 1.4% and acetyl-b-methylcholine chloride 1:1000; pH measurement; dermographism; and measurement of total and specific IgE. Significant results were observed in the measurement of sebum (p < 0.01) and hydration (p < 0.05) of the skin, in the alkali resistance test (p < 0.05), in the vascular reaction to methyl nicotinate (p < 0.01) and to acetyl-b-methylcholine chloride (p < 0.01) and in the skin response to allergens of the European standard (p < 0.01) and cosmetic series (p < 0.05). In addition, the subjective findings of stinging test produced significant results (p < 0.001) as was anticipated. Patients with sensitive skin possess very dry skin with low fatness, which leads to a disturbance of the protective skin barrier function. They also present a hyperreaction of the skin blood vessels, increased transcutaneous penetration of water-soluble chemicals, enhanced immune responsiveness, significant decrease of alkali resistance and a heightened neurosensory stimulation.

Adult↗
PubMed2006

The efficacy of topical cyproterone acetate alcohol lotion versus placebo in the treatment of the mild to moderate acne vulgaris: a double blind study.

Acne is an inflammatory condition of the pilosebaceous unit. One of the essential factors for development of acne lesions is increased sebum excretion that is promoted by androgen. It is shown that oral cyproterone acetate significantly reduces the sebum excretion. In this study we evaluated the efficacy of cyproterone acetate alcohol lotion (CAAL) in the treatment of the mild to moderate acne vulgaris. This was a randomized double-blind clinical trial performed on 86 female patients with mild to moderate acne. They were randomly divided into 3 groups and were treated with 0.5 percent CAAL (n = 30), 1 percent CAAL (n = 13) and placebo (n = 43). They were followed every 15 days for a period of 45 days. Response to treatment was evaluated by the total acne lesions counting (TLC) and acne severity index (ASI) and was analyzed statistically by SPSS program. The efficacy of treatment on TLC was maximum for 1 percent CAAL (90 % reduction in TLC)(P value = 0.000). CAAL at 0.5 percent was able to reduce TLC as high as 80.8 percent during 6 weeks followup. The efficacy of placebo was determined to be 38.5 percent. Regarding TLC, 1 percent CAAL was 2.33 times more effective than placebo. CAAL at 0.5 percent was 2.09 times more effective than placebo in this respect. The efficacy of treatment on ASI was maximum for 1 percent CAAL (88 % reduction in ASI)(P value = 0.000). CAAL at 0.5 percent reduced ASI as much as 79.5 percent during 6 weeks of followup. The efficacy of placebo was calculated to be 9.8 percent in reduction of ASI . Regarding ASI, 1 percent CAAL was 8.97 times more effective than placebo. CAAL at 0.5 percent was 8.06 times more effective than placebo. Regarding the results of this study, we suggest the use of cyproterone acetate alcohol lotion as one of the main treatments for mild-moderate acne in female patients and as an adjuvant treatment for moderate to severe acne vulgaris.

Acne Vulgaris↗