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PubMedDate not supplied

Overview of the evaluation and management of acne vulgaris.

Acne vulgaris is a disease of the pilosebaceous unit where abnormally adherent keratinocytes cause plugging of the follicular duct followed by accumulation of sebum, keratinous debris, and bacteria within this structure. It remains one of the most common inflammatory dermatoses among adolescents and is frequently seen in newborns in both pediatric and dermatology practices. This article summarizes the key factors involved in the pathogenesis of acne, reviews the clinical evaluation process, and clarifies the rationale for the selection of specific therapies. The psychosocial impact of acne is also addressed, including its impact on quality of life. The overarching goal is to prescribe effective therapy early to avoid both clinical and psychologic scarring along with ensuring adequate patient education for optimizing treatment outcomes.

Acne Vulgaris↗
PubMedDate not supplied

Optical properties of hair: effect of treatments on luster as quantified by image analysis.

Image analysis has been employed to measure the luster of hair simulated by light reflected from a curved hair tress. Hair samples (up to four) were mounted side-by-side in a special sample holder in the form of a cylinder and illuminated by a uniform beam of white light. Digital images of hair tresses were captured with a high-resolution camera and were analyzed by scanning across highlighted and dark areas of the resultant image using image analysis software with developed macros. Plots, similar to goniophotometric scattering curves, were used to calculate luster values according to previously published work by Nickerson, Stamm, and Reich-Robbins. Both the Stamm and Reich-Robbins approaches were found to give similar results, while the Nickerson gloss parameter exhibited less sensitivity to hair modification with cosmetic ingredients. The procedure was employed to assess the luster of natural white, light blonde, light brown, medium brown, and dark brown hair, and revealed an increase in luster indices in proportion to an increase in fiber pigmentation. Cosmetic oils such as phenyl trimethicone, amodimethicone, and castor oil were also found to increase the luster of hair as a result of the change in contrast between specular and diffuse reflection. Styling resins such as butyl ester of PVM/MA copolymer, vinyl caprolactam/PVP/dimethylaminoethyl methacrylate copolymer, and isobutylene/ethylmaleimide/hydroxyethylmaleimide copolymer were shown to increase hair gloss by a similar mechanism, as evidenced by calculated higher values of the Stamm and Reich-Robbins luster parameters. An effect of hair dulling by deposition of micronized ZnO at various concentrations, as well as by synthetic sebum, is also discussed.

Cosmetics↗
PubMedDate not supplied

Optical properties of hair--detailed examination of specular reflection patterns in various hair types.

Details of the specular reflection of curved hair tresses, resulting from illumination with a collimated incident light source, were examined both qualitatively and quantitatively using high-resolution photography and image analysis. The reflections were found to consist of a multitude of light dots aligned with the fibers and typically separated by a distance of 81-145 microm. The contrast between the dots (specular reflection) and the darker regions (diffuse reflection) of the entire reflection band was found to increase with increasing pigmentation of hair. Highly pigmented Oriental hair provided more contrast within the specular reflection band than unpigmented natural white hair. A quantitative description of the light reflection patterns within the specular reflection band included two-dimensional distribution of luminosity, histograms of the frequency of appearance for peak maxima and minima in luminosity distribution plots, and histograms of absolute maxima and minima of luminosity along the length of the fibers. Specular reflection from African hair, which consists of many curls that provide multiple and randomly distributed reflection centers, have also been investigated. Using microscopy software, Image Tool 2.0, and a method termed image threshold, the number of reflection sites and their shapes could be quantified. For example, treatment of African hair with synthetic sebum was shown to significantly affect the reflection patterns, resulting in a decrease in the overall hair luster. Comparison of reflection patterns from Caucasian frizzy, very curly, and curly hair is also discussed.

Hair↗
PubMed2004

[Relationship between the Demodex and bacteria infection in human rosacea].

OBJECTIVE: To understand the relationship between Demodex and bacteria infection in rosacea (brandy nose), and to find effective means for the treatment. METHODS: Cellophane tape was used to detect Demodex on the nasolabial grooves and the face; sebum and tissue on face was scraped and cultured to examine bacteria under microscope. The hospital-made anti-rosacea lotion was used on the affected part two times a day for 7 days. RESULTS: It was found that 193 (74.2%) of 260 cases with rosacea were infected by Demodex and 209 (80.4%) of the patients were infected by bacteria. The overall effective rate of the treatment for rosacea was 73.5%. CONCLUSION: Bacteria infection in rosacea is an important factor inducing rosacea. The curative effect of the anti-rosacea lotion is good.

Adolescent↗
PubMed2004

[Mud and baththerapy in the acne cure].

The skin, it is well know, is an organ of frontier and it is natural seat to natch, or collition, between exogenous stimoli and endogenous responses. Termal water and spud mud revelead their better potency on the skin and for that their tird close attention in dermatology. Our primary pourpose was to evalue eventuals modifications induced by thermal water and mud on healty skin and to know how their alter in significative mode functionals parameters, an alteration of which characterising pathogenetics events in development of acne. They are: follicular keratinisation, sebum synthesis by sebaceum glands, skin inflammation, loss of gate function of epidermidis. Results are showed.

Acne Vulgaris↗
PubMed2004

Superiority of a combined contraceptive containing drospirenone to a triphasic preparation containing norgestimate in acne treatment.

This double-blind study compared the efficacy and tolerability of a combined oral contraceptive containing 30 microg ethinyl estradiol and 3 mg drospirenone (EE/DRSP; Yasmin) with a triphasic preparation containing 35 microg EE and 0.180, 0.215, 0.250 mg norgestimate (EE/NGM; Pramino, also known as Ortho Tri-Cyclen) in the treatment of acne vulgaris. The combined presence of antiandrogenic and antimineralocorticoid activities of drospirenone is unique to this novel progestin in that these characteristics most closely resemble those of progesterone. The study was designed to show that EE/DRSP was noninferior or superior to EE/NGM as to the relative decrease from baseline to cycle 6 in percentage of inflammatory and total lesion counts and the investigators' assessment of acne improvement. Other outcomes included subjects' assessment of therapeutic effect, sebum production, and hormone levels. Female subjects were randomized to EE/DRSP (n = 568) or EE/NGM (n = 586) for 6 treatment cycles, consisting of 21 consecutive days of hormone intake, followed by 7 hormone-free days. The preparation containing EE/DRSP was superior to EE/NGM for reduction in total lesion count (-3.3% in favor of EE/DRSP [95% CI, -6.5 to -0.1; P = .020]) and for investigators' assessment of therapeutic effect on facial acne (+3.6% in favor of EE/DRSP [95% CI, 0.8 to 6.3; P = .006]). The 2 preparations were comparable as to their decreases in inflammatory lesion count. Evaluation of the effect of treatment by subjects was consistent with that of the investigators. Furthermore, both preparations increased the level of sex hormone-binding globulin (SHBG) and decreased the levels of androgens, changes typically associated with acne improvement. Both preparations were well tolerated. In conclusion, owing to the unique pharmacologic activities of drospirenone, the combined oral contraceptive EE/DRSP provides an effective treatment option in female patients with mild to moderate acne.

Acne Vulgaris↗
PubMed1978

[Clinical evaluation of a topical ethyl lactate treatment of acne vulgaris (author's transl)].

The efficacy of a lotion containing 10 p. 100 ethyl lactate was evaluated in a double-blind clinical trail during 8 weeks. Test subjects were 45 male and female patients with polymorphous juvenile acne. They were divided into three groups and received the following treatments: Group A: oral antibiotic + topical placebo lotion. Group B: oral antibiotic + topical ethyl lactate lotion. Group C: topical ethyl lactate lotion only. The lotions were applied twice daily with a swab of cotton-wool. The antibiotic doses (tetracycline hydrochloride) were decreased as the trial progressed. Patients were examined before the trial, then after 1, 2, 4, 6 and 8 weeks. At each visit, comedones, microcysts, pustules and nodules were counted on a skin surface of 9 cm2. Colour photographs were taken before and at the end of the trial and served for counting inflammatory lesions. Also, at each visit, skin lipids were sampled and analysed by I. R. spectrophotometry in order to asses the effect of the treatments on the free fatty acid/triglyceride ratio. The treatments showed similar effectiveness as regards comedones and microcysts, but only treatments A and B succeeded in reducing the number of inflamed lesions. With respect to the latter, the combined treatment B (oral antibiotic + topical ethyl lactate lotion) was more effective than treatment A (oral antibiotic + topical placebo); both treatments were more effective than treatment C (topical ethyl lactate lotion only). At the end of the trial, all three groups of patients showed significant overall improvement, but acne scores (total number of lesions) did not differ significantly between treatments. When comparing these results with literature data concerning the effects of vitamin A acid and benzoyl peroxide, it appears that ethyl lactate is slightly less effective for topical treatment of acne than vitamin A acid, but slightly more effective than benzoyl peroxide. It should be underlined that ethyl lactate is well tolerated by the skin. Analysis of sebum samples failed to yield evidence of a decrease in the free fatty acid/triglyceride ratio in skin lipids of the patients irrespective of the treatment applied.

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

[Hormonal factors in etiology of common acne].

Common acne is steatorrhoeic chronic disease, to which specific is, among others, the presence of blackheads, papulopustular eruptions, purulent cysts and cicatrices. Such hormonal factors belong to elements inherent in etiology of the affection. Sebaceous glands have cell receptors on their surface for androgens. In etiopathogenesis of common/simple acne, a decisive role is played by a derivative of testosterone, i.e. 5-alpha-dihydrotestosterone (DHT). However, some experts are of opinion that there is no correlation between the increased intensity of common acne and other symptoms of hyperandrogenism. Numerous authors assume, however, that common acne-affected patients may be sometimes subjected to intense reactions caused by sebaceous glands against physiological androgens concentrations. Naturally, estrogens can inhibit release of such androgens. Under physiological conditions, natural progesterone does not conduct to intensification of the seborrhea, but the activity of sebum secretion may be triggered off by its synthetic counterparts. Hormonal etiology can be very distinctly visible in the steroid, androgenic, premenstrual, menopausal acne, as well as in juvenile acne and acne neonatorum. In case of females affected by acne, hormonal therapy should be persistently supported and consulted with dermatologists, endocrinologists and gynecologists. Antiandrogenic preparations are applied, such as: cyproterone acetate concurrently administered with estrogens and, as well as not so frequently with chlormadinone acetate (independently or during estrogenic therapy).

Acne Vulgaris↗
PubMed1979

[Therapeutic aspects of seborrhea oleosa and pityriasis simplex capillitii].

The treatment of seborrhoea oleosa capillitii should aim at inhibiting depletion of the sebaceous glands, lipid synthesis in the sebaceous gland and microbial lipolysis of the triglycerides in the scalp and hair lipids. The use of isopropyl alcohol as a vehicle in a hair tonic reduces sebum depletion. Coal tar and estrogens reduce the lipid synthesis in the sebaceous gland. The lipolysis can be inhibited by various surfactants, isopropyl alcohol, colloidal sulphur, selenium disulphide, Omadine MDS and benzoyl peroxide. In the treatment of pityriasis simplex capillitii (dandruff) one aims at achieving inhibition of mitosis in the epidermis and, if possible, an additional "keratolytic" effect. Inhibition of mitosis could be demonstrated for coal tar, corticosteroids, selenium disulphide, cadmium sulphide, Omadine MDS, Zn Omadine and ichthyol sodium. Colloidal sulphur, salicylic acid, Omadine MDS and various surfactants act "keratolytically".

Adrenal Cortex Hormones↗
PubMed2004

[How I treat... Belgian consensus document on the treatment of acne].

This article describes the consensus on the treatment of acne, reached by a Belgian working group. An effective treatment has to rely as much as possible on the pathophysiologic factors: the increased production of sebum, the abnormal desquamation (retention hyperkeratosis) of the epithelium of he sebaceous gland, the proliferation of Propionibacterium acnes and inflammation. The therapeutic arsenal contains topical as well as systemic drugs. This consensus gives an overview of both modalities and an algorithm is presented describing the practical approach to acne treatment.

Acne Vulgaris↗
PubMed2002

Managing cutaneous manifestations of hyperandrogenic disorders: the role of oral contraceptives.

Cutaneous manifestations of hyperandrogenic disorders (acne, seborrhea, hirsutism and androgenetic alopecia) can be caused by elevated levels of free testosterone or androgen precursors. In women with normal serum levels of testosterone or androgen precursors, enhanced local conversion to testosterone, or to the more potent androgen dihydrotestosterone, may lead to increased androgen activity in the pilosebaceous unit. Large individual variations in the response to normal or elevated androgens suggests considerable differences in local androgen metabolism and androgen receptor-mediated activities, which may partly be related to genetic disposition. Androgens cause opposite effects on hair follicles in the scalp compared with the face and body, and there are large differences in the length of anagen phase. Androgens enhance sebum production and keratinization, prolong the growth phase of face and body hair, stimulate the transformation of vellus to terminal hair, and shorten the anagen phase of scalp hair. Estrogens may antagonize the androgen-induced actions on sebaceous glands and hair follicles. Treatment with oral contraceptives (OCs) reduces the production of androgens and androgen precursors and increases sex hormone-binding globulin, resulting in a decrease of free testosterone levels. According to type and dose, the estrogen and progestogen components of OCs may directly reduce the effect of androgens within sebaceous glands and hair follicles. Therefore, OCs with a predominant estrogen effect may improve mild to moderate forms of acne and seborrhea, hirsutism and androgenetic alopecia, in a time-dependent manner. In women who do not respond satisfactorily, treatment with OCs containing a progestogen with antiandrogenic activity is recommended. In many women with severe acne or hirsutism, a considerable increase in the local concentration of the antiandrogenic progestogen is required to reduce the androgenic interaction with the androgen receptor. For this therapy, an OC containing cyproterone acetate can be used. If necessary, the dose of cyproterone acetate can be increased in a stepwise manner. While androgenetic alopecia is best treated with a low-dose OC containing cyproterone acetate (optimal effect occurs after at least 12 months of therapy), severe acne and hirsutism are significantly improved after 6-12 months of regimens containing high doses of cyproterone acetate (25-100 mg/day). After termination of treatment the disorders may reappear, therefore treatment with suitable low-dose formulations is recommended to maintain the therapeutic effect.

Contraceptives, Oral↗
PubMed2005

[Evaluation the antimycotic activity of itraconazole in human stratum corneum with vitro fungi cultivation].

OBJECTIVE: To establish a new model to evaluate the antifungal activity of antimycotics. METHODS: Twenty-one healthy adult volunteers without clinically significant differences in demographic characteristics, hydration status of the skin, and sebum excretion were randomly divided into two groups: group 1 receiving 200 mg itraconazole bid for 1 week, and group 2 receiving itraconazole 200 mg qd for 1 weeks. Stratum corneum stripping was taken from the forearm skin at days 0, 1, 4, 7, 10, 14, 21, 28, and 35. Spores of selected fungi (Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum canis) were deposited and cultured on the center of the stratum corneum stripping. After 1-week culture the stratum corneum stripping was staining by PAS, and the area covered by dermatophyte was measured by corneofungimetry and computerized-assisted image analysis so as to calculate the inhibitory effect of the oral antifungal agents administered. RESULTS: All three dermatophytes grew on the stratum corneum stripping, the area covered by the dermatophyte was dense before administration of antifungal agent, and decreased gradually after the administration of drug, and to the least on the seventh day (P < 0.01), however, the area covered by the dermatophyte began to increase since the tenth day, and reach the biggest on the thirty-fifth day. Itraconazole at two different dosages showed significant activity against these 3 dermatophytes without significant difference between the two groups (all P > 0.05). CONCLUSION: The ex vivo growth environment of dermatophyte on human stratum corneum is very similar to that of human milieu interne. Itraconazole displays a high antidermatophyte activity in human stratum corneum. Corneofungimetric bioassay is a new method between in vitro trial and in vivo effect.

Adult↗
PubMed1979

Acne.

The cause of acne is still obscure, but genetic predisposition, sebaceous overactivity, overgrowth of bacterial flora and exposure to comedogenic substances are all significant factors. Acne lesions occur mainly in sebaceous follicles, which are characterized by deep follicular canals and large sebaceous glands. The associated seborrhea is not due to a circulatory excess of androgens but may be caused by a local amplification of androgenic activity. This, in turn, may be due to large numbers of androgen receptors and a high concentration of enzymes such as 17beta-hydroxysteroid dehydrogenase, within the sebaceous gland itself. Hyperkeratosis of the retention type in the pilary infrainfundibulum obstructs the outflow of sebum and keratin flakes. This favors the proliferation of Propionibacterium acnes which may initiate inflammation in microcomedos and lead to formation of pustules, papules or nodules. Topical therapy with tretinoin, benzoyl peroxide and antibiotics such as clindamycin is widely used today. Oral tetracyclines and other chemotherapeutic agents remain necessary in severe cases.

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↗
PubMed2006

The mechanisms of action of nicotinamide and zinc in inflammatory skin disease.

Nicotinamide (niacinamide), a physiologically active form of niacin (nicotinic acid), in combination with zinc is being assessed in clinical studies for the treatment of inflammatory skin diseases such as acne vulgaris and bullous pemphigoid. The basis for these investigations is the variety of potential mechanisms of action of nicotinamide and zinc, including an anti-inflammatory effect via inhibition of leukocyte chemotaxis, lysosomal enzyme release, lymphocytic transformation, mast cell degranulation, bacteriostatic effect against Propionibacterium acnes, inhibition of vasoactive amines, preservation of intracellular coenzyme homeostasis, and decreased sebum production. Other possible mechanisms involve suppression of vascular permeability and inflammatory cell accumulation, as well as protection against DNA damage. The goal of this paper is to review the pathophysiology of inflammatory skin diseases and discuss the role, mechanisms of action, and safety of nicotinamide and zinc as therapeutic options for these disorders.

Acne Vulgaris↗
PubMed2005

[Demodicidosis in humans as a current problem in dermatology].

Demodex mites are common parasites in the hair follicles and in the pilosebaceous glands. Demodex folliculorum and D. brevis have been identified in humans and play a role in three facial conditions: Pityriasis folliculorum, rosacea-like demodicidosis and Demodicidosis gravis. The highly infected sites by this mites are: forehead, area around the orbit, area around the nose, chin and area around the mouth. Infection of the skin by D. folliculorum is more frequent among females and in the elderly people. The presence of mites can be determined by microscopic inspection of secretion from sebum glands and skin surface biopsy. The aim of our study was to report a 25-year-old woman suffering from skin diseases with high D. folliculorum density.

Administration, Cutaneous↗
PubMed2006

Treatment considerations for inflammatory acne: clinical evidence for adapalene 0.1% in combination therapies.

Acne vulgaris is an exceptionally common, chronic, and recurring disease. It involves multiple etiological factors including follicular hyperkeratinization, increased sebum production, Propionibacterium acnes proliferation, and inflammation. Presently, oral isotretinoin is the only single agent that is effective against all 4 major pathophysiologic features. However, this drug is also responsible for several serious side effects, including teratogenicity. Therefore, it should be used in only the most severe cases and alternative treatment approaches for inflammatory acne, such as initial combination therapy, should be considered first. Combination therapy in inflammatory acne simultaneously targets multiple pathogenic factors. Current guidelines recommend early initiation of combination therapy with a topical retinoid and antimicrobials for mild to moderate inflammatory acne and topical retinoids with oral antibiotics (with or without the use of benzoyl peroxide) for moderate to severe cases of acne, followed by maintenance therapy with topical retinoids. This review evaluates the rationale and clinical evidence for the use of adapalene in combination therapy for inflammatory acne.

Acne Vulgaris↗