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1.  Acne: a review of immunologic and microbiologic factors 
Postgraduate Medical Journal  1999;75(884):328-331.
Acne vulgaris is a self-limiting skin disorder seen primarily in adolescents, whose aetiology appears to be multifactorial. The four main aetiological factors are hypercornification of the pilosebaceous duct, increased sebum production, colonization with Propionibacterium acnes, and subsequently the production of inflammation. Considerable investigation has addressed the immunologic reaction to extracellular products produced by the acne-causing organism, P acnes. The immunologic response involves both humoral and cell-mediated pathways. Further research should clarify the role of complement, cytotoxins, and neutrophils in this acne-forming response.


Keywords: acne vulgaris; Propionibacterium acnes
PMCID: PMC1741272  PMID: 10435165
2.  Cutaneous induction of corticotropin releasing hormone by Propionibacterium acnes extracts 
Dermato-endocrinology  2009;1(2):96-99.
The skin commensal bacillus Propionibacterium acnes is known to play a major role in the development of acne vulgaris and it is established that this bacteria is involved both in the induction and maintenance of the inflammatory phase of acne. The corticotropin releasing hormone (CRH), a neuropeptide originally isolated from the hypothalamus, is also produced by the skin. CRH has been reported to play a role in the inflammation, the production of sebum and finally the differentiation of keratinocytes. At the therapeutic level, zinc is known to act specifically on inflammatory lesions with still partially known mechanisms and thus could play an important role in the development of inflammatory acne lesions. Our objective was to study the modulation of CRH expression by keratinocytes induced by P. acnes extracts. CRH expression was examined using immunohistochemistry technique on deep-frozen sections of normal human skin explants incubated with two different extracts of P. acnes and with or without zinc salts. We observed that the membrane fraction (FM) of P. acnes increased the CRH expression in the epidermis. This result indicates that P. acnes, by stimulating the production of CRH, can both modulate the differentiation of keratinocytes and increase the local inflammation, arguing that this bacterium plays a role not only in the development of inflammatory acne lesions but also in the formation of the microcomedo in the early stages of acne.
PMCID: PMC2835898  PMID: 20224691
acne; Propionibacterium acnes; stress; corticotropin releasing hormone; zinc
3.  Refractory Postinflammatory Hyperpigmentation Treated Fractional CO2 Laser 
Objective: Postinflammatory hyperpigmentation is a reactive hypermelanosis of the skin that occurs as a consequence of an inflammatory process, such as acne, eczema, drug reactions, burns, chemical peelings, and laser applications. Although topical agents remain to be the first-line treatment of postinflammatory hyperpigmentation, treatment of recalcitrant cases is challenging. The Q-switched ruby laser, the low-dose Q-switched neodymium-doped yttrium aluminum garnet laser, and the fractional 1550nm erbium-doped fiber laser have been reported to improve postinflammatory hyperpigmentation. Design/setting/participants: The authors present a case of refractory postinflammatory hyperpigmentation successfully treated with two sessions of fractional CO2 laser in a 24-year-old woman with Fitzpatrick skin type III. Results: After two treatment sessions with a one-month interval, the lesion totally cleared without any complications. Conclusion: Although many laser systems, including fractional CO2 lasers, can cause postinflammatory hyperpigmentation, they also can be very efficacious tools by using conservative laser settings and by providing appropriate post-treatment care in recalcitrant postinflammatory hyperpigmentation treatment.
PMCID: PMC3970832  PMID: 24688626
4.  Clindamycin 1.2% Tretinoin 0.025% Gel versus Clindamycin Gel Treatment in Acne Patients 
Background: Acne vulgaris affects individuals of all races and ethnicities. Understanding the safety and efficacy of topical agents benefits the practicing clinician when treating patients with skin of color. Purpose: To report observations in acne patients representing all six Fitzpatrick skin types based on a Phase 3 study that evaluated the efficacy and safety of a clindamycin phosphate 1.2% tretinoin 0.025% gel versus a clindamycin phosphate 1.2% gel alone. Methods: The two treatments were compared in a randomized, double-blind, multicenter, parallel, 12-week study employing a total of 2,010 patients with moderate-to-severe acne. Primary efficacy endpoints were 1) treatment success defined as percentage of patients who were clear or almost clear or achieved at least a 2-grade improvement in Evaluators Global Severity Scores at Week 12 and 2) percent change from baseline versus 12-week scores for noninflamed, inflamed, and total lesions. Results: The 12-week, 37.8-percent Evaluators Global Severity Scores treatment success for clindamycin phosphate 1.2% tretinoin 0.025% gel was greater than the 31.7 percent observed for clindamycin phosphate 1.2% gel alone (P = 0.002). Percent changes from baseline versus 12-week scores for noninflamed, inflamed, and total lesions obtained with clindamycin phosphate 1.2% tretinoin 0.025% gel (49.8, 60.9, and 54.5%, respectively) were significantly greater than those observed for clindamycin phosphate 1.2% gel alone (41.3, 54.8, and 46.9%, respectively); all comparisons P<0.001. Conclusion: Use of clindamycin phosphate 1.2% tretinoin 0.025% gel resulted in greater percent reductions of Evaluators Global Severity Scores treatment success scores and acne lesions in patients with all six Fitzpatrick skin types combined than clindamycin phosphate 1.2% gel alone. Both products were well tolerated, with no hypo- or hyperpigmentation noted. Side effects observed were similar to those previously reported for the individual ingredients.
PMCID: PMC3140902  PMID: 21779414
5.  Easy as PIE (Postinflammatory Erythema) 
Background: No term exists to date describing the phenomenon of pink-to-red discoloration after an inflammatory acne lesion. Objectives: To introduce new terminology into the dermatology literature to describe erythema often seen after inflammatory acne vulgaris and to present a treatment option for this type of erythema. Methods: New terminology describing erythema after inflammatory acne is addressed, and a treatment option for postinflammatory erythema is presented. Results: Postinflammatory erythema is a new, accurate descriptor of erythema that occurs after inflammatory acne. Additionally, pulsed dye laser treatment improved postinflammatory erythema in the authors’ patients. Limitations: This paper only presents anecdotal cases. Conclusion: The addition of postinflammatory erythema to the dermatology literature may facilitate accurate communication among providers and direct laser treatment for postinflammatory erythema.
PMCID: PMC3780804  PMID: 24062874
6.  Efficacy and Safety of Clindamycin Phosphate 1.2% and Tretinoin 0.025% Gel for the Treatment of Acne and Acne-induced Post-inflammatory Hyperpigmentation in Patients with Skin of Color 
Objective: To assess the efficacy and safety of a topical gel containing clindamycin 1.2% and tretinoin 0.025% for the treatment of acne and acne-induced postinflammatory hyperpigmentation (PIH) in darker skinned patients. Design: Randomized, double-blind, placebo-controlled study. Setting: Two United States clinical sites. Participants: Thirty-three patients 12 years of age or older with skin types IV to VI, mild-to-moderate facial acne, and PIH were enrolled. Measurements: Patients applied clindamycin phosphate/tretinoin gel or a nonmedicated vehicle each evening and a sun protection factor 30 sunscreen daily. Changes in skin erythema and hyperpigmentation were measured using a chromameter and photographic images. Efficacy was assessed using the Evaluators Global Acne Severity Scale, lesion counts, Post-inflammatory Hyperpigmentation Severity Scales and Patient’s Global Assessment Scale. Safety and tolerability were assessed by adverse event reports and a Safety Assessment Scale. Results: The mean (SD) baseline inflammatory lesion count was 11.9 (11.1) in clindamycin/tretinoin-treated patients, decreasing by 5.5 (6.56) after 12 weeks while the mean baseline inflammatory lesion count was 13.6 (11.15) in placebo-treated patients, decreasing by 4.1 (11.36) (p=0.05 for change from baseline, clindamycin/tretinoin vs. placebo). Clindamycin/tretinoin-treated patients generally demonstrated superior efficacy versus placebo treatment. The clindamycin/tretinoin topical gel was well tolerated, causing little or no irritation, although one patient withdrew due to periorbital edema of moderate severity possibly related to clindamycin/tretinoin gel. Conclusion: Although limited by small sample size, the results of this pilot study suggest clindamycin phosphate 1.2% and tretinoin 0.025% topical gel is a safe and effective option for treating mild-to-moderate acne in patients with skin of color.
PMCID: PMC3396458  PMID: 22798973
7.  Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles 
Acne vulgaris is a common dermatological disorder, one that is frequently associated with depression, anxiety and other psychological sequelae. In recent years there has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. Emerging studies have shown that patients with acne are under increased cutaneous and systemic oxidative stress. Indeed, there are indications that lipid peroxidation itself is a match that lights an inflammatory cascade in acne. The notion that lipid peroxidation is a 'starter gun' in acne is not a new one; here we review the nearly 50-year-old lipid peroxidation theory and provide a historical perspective to the contemporary investigations and clinical implications.
In addition, we present a novel hypothesis in which lipid peroxidation may be priming an increased susceptibility to co-morbid depression and anxiety in those with acne. The emerging research on the systemic burden of oxidative stress in acne sheds further light on the brain-skin axis. The recent findings also suggest potential avenues of approach for the treatment of acne via specific nutrients, dietary modifications, oral and topical interventions.
doi:10.1186/1476-511X-9-141
PMCID: PMC3012032  PMID: 21143923
8.  The Role of Skin Care as an Integral Component in the Management of Acne Vulgaris: Part 1: The Importance of Cleanser and Moisturizer Ingredients, Design, and Product Selection 
Acne vulgaris is a very common facial skin disorder accounting for approximately 10 percent of all visits to ambulatory dermatology practices across the United States annually. Over time, greater attention has been directed to the roles of multiple epidermal barrier functions in various dermatological disorders, especially the stratum corneum permeability barrier and antimicrobial barrier. As a result, it has become readily apparent that professional direction of skin care is very important in the overall management of acne vulgaris. This article discusses several reasons that support the importance of incorporating specified skin care recommendations and instructions into the overall management plan for acne vulgaris. In addition, the article reviews formulation characteristics and some of the scientific data on two commercially available products that are recommended for use as a skin care regimen in patients with acne-prone and acne-affected skin, a foam wash and a moisturizer with a sun protection factor 30 broad spectrum photoprotection rating. The rationale for inclusion of specific ingredients are discussed along with an overview of research results including use in patients with acne vulgaris.
PMCID: PMC3997205  PMID: 24765221
9.  Antibodies Elicited by Inactivated Propionibacterium acnes-Based Vaccines Exert Protective Immunity and Attenuate the IL-8 Production in Human Sebocytes: Relevance to Therapy for Acne Vulgaris 
Propionibacterium acnes is a key pathogen involved in the progression of inflammation in acne vulgaris. We examined whether vaccination against P. acnes suppressed P. acnes-induced skin inflammation. Inactivation of P. acnes with heat was employed to create a P. acnes-based vaccine. Intranasal immunization in mice with this inactivated vaccine provoked specific antibodies against P. acnes. Most notably, immunization with inactivated vaccines generated in vivo protective immunity against P. acnes challenge and facilitated the resolution of ear inflammation in mice. In addition, antibodies elicited by inactivated vaccines effectively neutralized the cytotoxicity of P. acnes and attenuated the production of proinflammatory cytokine IL-8 in human sebocyte SZ95 cells. Intranasal immunization using heat-inactivated P. acnes-based vaccines provided a simple modality to develop acne vaccines. These observations highlight the concept that development of vaccines targeting microbial products may represent an alternative strategy to conventional antibiotic therapy.
doi:10.1038/jid.2008.117
PMCID: PMC3070419  PMID: 18463682
10.  Acne Vulgaris and the Epidermal Barrier 
Acne vulgaris is a common dermatological disorder that predominantly affects teenagers, but can also affect preadolescents and post-teen individuals. Despite the fact that acne vulgaris is the most common skin disorder encountered in ambulatory dermatology practice in the United States, there has been limited research on the epidermal permeability barrier in untreated skin of people with acne vulgaris and also after use of acne therapies. This article reviews the research results and discusses the available literature on this subject area. The importance of proper skin care as a component of the management of acne vulgaris is supported by the information that is currently available.
PMCID: PMC3579484  PMID: 23441236
11.  Evaluation of biophysical skin parameters and assessment of hair growth in patients with acne treated with isotretinoin 
Introduction
Treatment of the severe forms of acne vulgaris remains a challenge. Isotretinoin is a drug often used in these cases. Retinoids affect the mechanisms that play a role in the pathogenesis of acne, reduce the production of sebum and sizes of the sebaceous glands. However, isotretinoin appears to have undesirable side effects in the skin, mucous membranes and hair.
Aim
The aim of this study was to assess the effect of acne vulgaris treatment with isotretinoin on biophysical skin parameters: skin sebum and stratum corneum hydration levels, transepidermal water loss values, pH, erythema and hair growth parameters: total number, density and proportion of anagen hair.
Material and methods
The study included thirty patients with acne types: papulopustular, conglobata and phlegmonosa. Patients were treated with isotretinoin at a dose of 0.5–1.0 mg/kg/day for a period of 4–7 months. The measurements of skin biophysical parameters were performed before and after the treatment using Sebumeter SM815, Corneometer CM825, Tewameter TM300, MX Mexameter MX18 and Skin-pH-Meter PH908. Hair growth parameters were evaluated with FotoFinder Dermoscope using the TrichoScan Professional V3.0.8.76 software.
Results
The results of biophysical skin parameter measurements after the treatment showed a reduction in the severity of seborrhea. However, the skin was dry, which confirmed a lowered degree of stratum corneum hydration and an increase in transepidermal water loss values. Moreover, severity of erythema, an increase in pH value, and variations in selected hair growth parameters: decrease in total count, density and proportion of anagen hair were demonstrated.
Conclusions
The reduction in the skin sebum levels was observed after the treatment. There was dryness of the skin, which was confirmed by biophysical skin parameter measurements. Changes in the hair growth parameters showed telogen effluvium hair loss.
doi:10.5114/pdia.2013.39432
PMCID: PMC3907898  PMID: 24493996
acne vulgaris; isotretinoin; biophysical skin parameters; trichoscan
12.  Acne vulgaris 
Clinical Evidence  2008;2008:1714.
Introduction
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 67 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin (alone or plus zinc), isotretinoin, tetracycline, tretinoin), and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline).
Key Points
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne, and can cause scarring and psychological distress.
Topical benzoyl peroxide should be considered as first-line treatment in mild acne. Topical benzoyl peroxide and topical azelaic acid reduce inflammatory and non-inflammatory lesions compared with placebo, but can cause itching, burning, stinging, and redness of the skin.
Topical antibiotics such as clindamycin and erythromycin (alone or with zinc) reduce inflammatory lesions compared with placebo, but have not been shown to reduce non-inflammatory lesions. Tetracycline may reduce overall acne severity. Antimicrobial resistance can develop with use of topical or oral antibiotics, and their efficacy may decrease over time.Tetracyclines may cause skin discoloration, and should be avoided in pregnant or breastfeeding women.Topical preparations of tretinoin, adapalene, and isotretinoin may reduce inflammatory and non-inflammatory lesions, but can also cause redness, burning, dryness, and soreness of the skin.
Oral antibiotics (doxycycline, erythromycin, lymecycline, minocycline, oxytetracycline, and tetracycline) are considered useful for people with more severe acne, although we don't know for sure whether they are effective. Oral antibiotics can cause adverse effects such as contraceptive failure.Minocycline has been associated with an increased risk of systemic lupus erythematosus, and of liver disorders.Oral isotretinoin has been associated with skin problems, change in liver function, teratogenesis, and psychiatric disorders.
PMCID: PMC2907987  PMID: 19450306
13.  Acne vulgaris 
Clinical Evidence  2011;2011:1714.
Introduction
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne and can cause scarring and psychological distress.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical and oral treatments in people with acne vulgaris? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 69 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: topical treatments (adapalene, azelaic acid, benzoyl peroxide, clindamycin, erythromycin [alone or plus zinc]; isotretinoin, tetracycline, tretinoin); and oral treatments (doxycycline, isotretinoin, lymecycline, minocycline, oxytetracycline, tetracycline).
Key Points
Acne vulgaris affects over 80% of teenagers, and persists beyond the age of 25 years in 3% of men and 12% of women. Typical lesions of acne include comedones, inflammatory papules, and pustules. Nodules and cysts occur in more severe acne, and can cause scarring and psychological distress.
Topical benzoyl peroxide should be considered as first-line treatment in mild acne. Topical benzoyl peroxide and topical azelaic acid reduce inflammatory and non-inflammatory lesions compared with placebo, but can cause itching, burning, stinging, and redness of the skin.
Topical antibiotics such as clindamycin and erythromycin (alone or with zinc) reduce inflammatory lesions compared with placebo, but have not been shown to reduce non-inflammatory lesions. Tetracycline may reduce overall acne severity. Antimicrobial resistance can develop with use of topical or oral antibiotics, and their efficacy may decrease over time.Tetracyclines may cause skin discoloration, and should be avoided in pregnant or breastfeeding women.Topical preparations of tretinoin, adapalene, and isotretinoin may reduce inflammatory and non-inflammatory lesions, but can also cause redness, burning, dryness, and soreness of the skin.
Oral antibiotics (doxycycline, erythromycin, lymecycline, minocycline, oxytetracycline, and tetracycline) are considered useful for people with more severe acne, although we don't know for sure whether they are effective. Oral antibiotics can cause adverse effects such as contraceptive failure.Minocycline has been associated with an increased risk of systemic lupus erythematosus and liver disorders.Oral isotretinoin has been associated with skin problems, change in liver function, teratogenesis, and psychiatric disorders.
PMCID: PMC3275168  PMID: 21477388
14.  Antimicrobial Property of Lauric Acid Against Propionibacterium acnes: Its Therapeutic Potential for Inflammatory Acne Vulgaris 
The strong bactericidal properties of lauric acid (C12:0), a middle chain-free fatty acid commonly found in natural products, have been shown in a number of studies. However, it has not been demonstrated whether lauric acid can be used for acne treatment as a natural antibiotic against Propionibacterium acnes (P. acnes), which promotes follicular inflammation (inflammatory acne). This study evaluated the antimicrobial property of lauric acid against P. acnes both in vitro and in vivo. Incubation of the skin bacteria P. acnes, Staphylococcus aureus (S. aureus), and Staphylococcus epidermidis (S. epidermidis) with lauric acid yielded minimal inhibitory concentration (MIC) values against the bacterial growth over 15 times lower than those of benzoyl peroxide (BPO). The lower MIC values of lauric acid indicate stronger antimicrobial properties than that of BPO. The detected values of half maximal effective concentration (EC50) of lauric acid on P. acnes, S. aureus, and S. epidermidis growth indicate that P. acnes is the most sensitive to lauric acid among these bacteria. In addition, lauric acid did not induce cytotoxicity to human sebocytes. Notably, both intradermal injection and epicutaneous application of lauric acid effectively decreased the number of P. acnes colonized with mouse ears, thereby relieving P. acnes-induced ear swelling and granulomatous inflammation. The obtained data highlight the potential of using lauric acid as an alternative treatment for antibiotic therapy of acne vulgaris.
doi:10.1038/jid.2009.93
PMCID: PMC2772209  PMID: 19387482
15.  Effect of a Polyherbal Unani formulation in acne vulgaris: A preliminary study 
Acne vulgaris is the most common disorder treated by dermatologists. Acne is a disease of pilosebaceous units characterized by the formation of the open and closed comedones, papules, pustules, nodules and cysts. A preliminary trial was conducted in the department of Medicine, National Institute of Unani Medicine, Bangalore, India, to assess the safety and efficacy of a Polyherbal Unani Formulation (PHUF) in the management of Acne Vulgaris on scientific parameters. Twenty five patients, diagnosed with acne, were included in the study after obtaining their informed consents. All the patients were clinically assessed and diagnosed on the basis of thorough history and dermatological examination. Then, PHUF was administered locally once at night for a period of 45 days. The severity of acne and efficacy of treatment was assessed by Cook′s acne grading scale. The results showed significant reduction in the Cook′s acne grading scores of post-treatment group (P<0.01) as compared to pre-treatment scores. Further, PHUF was found safe and fairly well accepted by the patients. It was therefore, concluded that PHUF can be used safely and effectively for the treatment of acne vulgaris.
doi:10.4103/0975-9476.104430
PMCID: PMC3545236  PMID: 23326087
Acne vulgaris; Basoore Labaniya; Polyherbal Unani formulation; Cook's acne grading scale
16.  The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey* 
Anais brasileiros de dermatologia  2012;87(6):862-869.
BACKGROUND
Acne vulgaris can severely affect social and psychological functioning.
OBJECTIVE
The aim of this study was to investigate the impact of acne vulgaris and its severity on Quality of Life of young adolescents in Greece.
METHODS
We conducted a questionnaire based survey among 1560 adolescent between the ages of 11 and 19 years old and 1531 of these were completed. Adolescents with acne filled all the questions including the Children Dermatology Life Quality Index. Adolescents without acne filled the questions about age, family history of acne, stress and smoking. Data were analyzed with Pearson Chi Square test.
RESULTS
Acne prevalence was 51.2% affecting both sexes equally. Self reported mild acne was present in 71.2% and moderate-severe acne in 28.8% of the study population. The mean age of the study population was 15.77y. The median score of Children Dermatology Life Quality Index was 4.02. The impact of acne on quality of life is associated with the severity of the acne (p<0.0001). Patients with moderate/severe acne experience greater psychosocial and emotional impairment (p<0.0001). Body image is modified proportionally to the severity of acne (p<0.0001). Symptoms and treatment of acne are factors that also influence their quality of life. Girls and boys are equally affected. Stress and heredity are correlated with acne and its severity (p<0.0001). We didn't find any correlation between smoking and acne.
CONCLUSION
Acne affects Quality of Life of young adolescents in Greece. The impact is proportional to the severity of acne. More severe acne is associated with greater effect on quality of life with implications for self esteem, body image and relationships with others.
doi:10.1590/S0365-05962012000600007
PMCID: PMC3699905  PMID: 23197205
Acne vulgaris; Adolescent; Health of institutionalized adolescents; Quality of life
17.  Polymorphisms in the promoters of MMP-2 and TIMP-2 genes in patients with acne vulgaris 
Acne, a chronic inflammatory skin disease, can be seen at any age but it most often occurs in adolescents and young people. Several factors, including increased sebum production, abnormal cornification of the pilosebaceous units, proliferation of Propionibacterium acne, and extracellular matrix (ECM) remodeling, are thought to be associated with the pathogenesis of the acne. The remodeling of the ECM is regulated by a balance between matrix metalloproteinases (MMPs) and their inhibitors called tissue inhibitors of metalloproteinases (TIMPs). The current study investigated the potential association between MMP-2 (-1306 C/T) and TIMP-2 (-418 G/C) polymorphisms and the risk for acne in a Turkish population. The study was conducted with 85 subjects who presented to the Dermatology Department of Duzce University Hospital. DNA was isolated from 2 ml of peripheral blood taken from each subject, and their genotypes were analyzed with the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The CC, CT, and TT genotypes for MMP-2 (-1306 C/T) polymorphism were similar between the patient and control group (24 [55.8%], 17 [39.5%], and 2 [4.7%], respectively, vs. 21 [50%], 18 [42.9%], and 3 [7.1%], respectively). However, the distribution of the GG, GC, and CC genotypes for TIMP-2 (-418 G/C) polymorphism were different between the patient and control group (30 [69.8%], 9 [14.8%] and 4 [9.3%], respectively, vs. 26 [61.9%], 14 [33.3%], and 2 [4.8%], respectively). The results demonstrated that the TIMP-2 (-418 CC) genotype was nearly two times more common in the patient group compared to the control group (p=0.686, OR=1.45). It may be possible that the TIMP-2 (-418 CC) genotype increases the tendency to develop acne vulgaris by disrupting the balance between MMPs and TIMPs. Further investigations are needed to clarify more precisely the relationship between acne and MMP-TIMP genes.
PMCID: PMC3832336  PMID: 24260605
Acne vulgaris; MMPs; TIMPs; polymorphism
18.  Psychological Impairments in the Patients with Acne 
Indian Journal of Dermatology  2013;58(1):26-29.
Background:
The psychological impacts of acne appearance and its-related negative emotional reactions have been proved; however, these reactions are varied in different populations.
Aim:
We investigated whether acne and its severity affected psychological functioning in those who suffered from this disorder among Iranians.
Materials and Methods:
One hundred and six patients with acne vulgaris who consecutively attended the dermatology outpatient clinics in Semnan city in 2008 were included. Among them, 103 patients met the study's inclusion criterion and agreed to participate. One hundred and six age and gender cross-matched healthy volunteers were included as controls that attended the clinic with their diseased relatives. All acne patients were evaluated using the Symptom Check List-90 (SCL-90).
Results:
According to the American Academy of Dermatology classification, 25.2% of the patients had mild acne, 50.5% moderate acne, and 24.3% severe acne. A higher percentage of participants than controls required further evaluation and psychological consultant when studying each psychological problem. The most common psychological symptoms requiring treatment due to disturbed daily activities in acne group were psychoticism (34.0%) and depression (31.1%), respectively. Significant positive correlations were observed between the duration of illness and SCL-90 total score. When evaluating the SCL-90 scores, patients with multiple sites of involvement were affected more severely than those with a single site of involvement.
Conclusion:
Acne vulgaris has significant effects on psychological status. Effective concomitant anti-acne therapy and psychological assessment make significant contributions for the mental health and should be strongly recommended.
doi:10.4103/0019-5154.105281
PMCID: PMC3555368  PMID: 23372208
Acne; prevalence; psychodermatology
19.  Cigarette Smoke-Induced Interleukin-1 Alpha May Be Involved in the Pathogenesis of Adult Acne 
Annals of Dermatology  2014;26(1):11-16.
Background
Lipid peroxide (LPO) in comedones, which are produced as a result of sebum oxidation, might potentially induce interleukin-1α (IL-1α) and exacerbate comedogenesis and inflammatory changes in comedones.
Objective
To investigate the relationship of proinflammatory cytokines and LPO levels in the extracts of comedones with the acne of clinical difference between smokers and non-smokers, and with the severity and distribution of the acne lesions.
Methods
Twenty-two non-smoking and 21 smoking adult acne patients were evaluated by comedone extraction and measurement of proinflammatory cytokines and LPO levels. Acne severity and distribution of the lesions were also analyzed.
Results
Relative to the non-smoking group, smokers had significantly higher levels of IL-1α and LPO in comedones. Their levels showed a positive correlation. However, there were no statistically significant difference between the severity or distribution of the disease and the levels of LPO and IL-1α in comedones.
Conclusion
Smoking may be involved in the pathogenesis of adult acne by increasing the oxidative stress that results in subsequent accumulation of LPO in comedones.
doi:10.5021/ad.2014.26.1.11
PMCID: PMC3956775  PMID: 24648681
Adult acne; Comedone; Lipid peroxide; Oxidative stress; Smoking
20.  Safety and Effectiveness of a New Blue Light Device for the Self-treatment of Mild-to-moderate Acne 
Objective: To assess the safety and effectiveness of treating acne for eight weeks using a new blue light device at a dose of ˜2J/cm2/day (representing typical full-face treatment) or ˜29J/cm2/day (representing the typical dose after localized spot treatment of acne). Design: Prospective, single-center, open-label study evaluating two levels of blue light in each subject. Setting: Subjects were recruited from the local community for self-treatment at home. Participants: Thirty-two subjects with mild or moderate facial acne vulgaris. Measurements: Inflammatory lesion count; number, severity, and redness of flares; improvement in skin characteristics (overall appearance, clarity, radiance, tone, texture, and smoothness); tolerability; subject satisfaction. Results: The blue light treatment was associated with significant reductions from baseline in inflammatory lesion count as early as Week 1 with ˜29J/cm2/day and Week 3 with ˜2J/cm2/day (P≤ 0.01). It was also associated with significant reductions in the number, severity, and redness of flares and with improvements in the skin’s appearance, clarity, radiance, tone, texture, and smoothness. Overall, 53 percent of subjects considered the treatment much gentler than traditional acne treatments and 61 percent were satisfied. Three adverse events were probably related to treatment—minimal transient skin dryness (2) and minimal transient hyperpigmentation (1). Conclusion: The blue light treatment is effective and well tolerated, offering rapid, gentle, and convenient treatment of inflammatory acne. The blue light device offers a valuable alternative to antibiotics and potentially irritating topical treatments and can also be used adjunctively to complement other therapies.
PMCID: PMC3366451  PMID: 22808306
21.  Evaluating of Life Quality in Patients with Acne Vulgaris Using Generic and Specific Questionnaires 
Background. Acne vulgaris is a common skin disease that can adversely affect the quality of life of patients. Objective. The aim of this study was to determine the quality of life in patients with acne vulgaris. Methods. This study was carried out on 70 patients with acne vulgaris (28 males, 42 females). All the patients filled out two Persian versions of questionnaires: short form 36 (SF-36) and Dermatology Life Quality Index (DLQI). The obtained data were analyzed by using SPSS software (version 17). Results. The scores for physical functioning, social functioning, and bodily pain domains in patients were over 70%, but the scores for role physical, general health, vitality, role emotional, and mental health in patients were under 70%. Scores on the DLQI in patients with acne vulgaris ranged from 0 to 22 (mean ± SD, 8.18 ± 4.83). After comparing mean score of DLQI with respect to gender and age, it was found that the difference between the two groups was not statistically significant. Conclusion. Acne vulgaris has a significant effect on the quality of life. There was not any significant gender or age related difference in QOL.
doi:10.1155/2013/108624
PMCID: PMC3859265  PMID: 24371434
22.  The Role of Inflammation in the Pathology of Acne 
The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes the duct of the sebaceous follicle, causing an innate immune response and the progression from a so-called noninflammatory comedo to an inflammatory papule, pustule, or nodule. However, this viewpoint has come under increasing scrutiny over the last decade, as evidence has emerged supporting a role for inflammation at all stages of acne lesion development, perhaps subclinically even before comedo formation. The immunochemical pathways underlying the initiation and propagation of the inflammation in acne are complex and still being elucidated, but may involve Propionibacterium acnes as well as several inflammatory mediators and their target receptors, including cytokines, defensins, peptidases, sebum lipids, and neuropeptides. This review presents evidence to support the notion that acne is primarily an inflammatory disease, challenging the current nomenclature of noninflammatory versus inflammatory acne lesions and suggesting that the nomenclature is outdated and incorrect. The evidence in support of acne as an inflammatory disease also has clinical implications, in that anti-inflammatory drugs used to treat the disease can be expected to exert effects against all lesion stages, albeit via distinct mechanisms of anti-inflammation.
PMCID: PMC3780801  PMID: 24062871
23.  Oxidative Stress in Patients With Acne Vulgaris 
Mediators of Inflammation  2005;2005(6):380-384.
Acne vulgaris is one of the common dermatological diseases and its pathogenesis is multifactorial. In this study, we aim to determine the effects of oxidative stress in acne vulgaris. Forty-three consecutive acne patients and 46 controls were enrolled. The parameters of oxidative stress such as catalase (CAT), glucose-6-phosphate dehydrogenase (G6PD), superoxide dismutase (SOD), and malondialdehyde (MDA) in the venous blood of cases were measured spectrophotometrically. The values compared with control group, the relation between the severity and distribution of acne, and the correlation of each enzyme level were researched. CAT and G6PD levels in patients were found to be statistically decreased, and SOD and MDA levels were found to be statistically increased (P < .001). However, any statistical difference and correlation could not be found between the severity and distribution of lesions and the mean levels of enzymes. In addition, we found that each enzyme is correlated with one another. Our findings show that oxidative stress exists in the acne patients. It will be useful to apply at least one antioxidant featured drug along with the combined acne treatment.
doi:10.1155/MI.2005.380
PMCID: PMC1533901  PMID: 16489259
24.  Evaluation of the Quantitative and Qualitative Alterations in the Fatty Acid Contents of the Sebum of Patients with Inflammatory Acne during Treatment with Systemic Lymecycline and/or Oral Fatty Acid Supplementation 
Background. Acne is a dermatosis that involves an altered sebum pattern. Objectives. (1) To evaluate if a treatment based on antibiotics (lymecycline) can alter fatty acids contents of the sebum of patients with acne; (2) to evaluate if oral supplementation of fatty acids can interfere with fatty acids contents of the sebum of patients with acne; (3) to evaluate if there is any interaction in fatty acids contents of the sebum of patients with acne when they use both antibiotics and oral supplementation of fatty acids. Methods. Forty-five male volunteers with inflammatory acne vulgaris were treated with 300 mg of lymecycline per day, with 540 mg of γ-linolenic acid, 1,200 mg of linoleic acid, and 510 mg of oleic acid per day, or with both regimens for 90 days. Every 30 days, a sample of sebum from the forehead was collected for fatty acids' chromatographic analysis. Results. Twelve fatty acids studied exhibited some kind of pattern changes during the study: C12:0, C14:0, C15:0, C16:1, C18:0, C18:1n9c+C18:1n9t, C18:2n6t, C18:3n6, C18:3n3, C20:1, C22:0, and C24:0. Conclusions. The daily administration of lymecycline and/or specific fatty acids may slightly influence some fatty acids levels present in the sebum of patients with inflammatory acne vulgaris.
doi:10.1155/2013/120475
PMCID: PMC3803126  PMID: 24191156
25.  OXIDANT/ANTIOXIDANT STATUS IN OBESE ADOLESCENT FEMALES WITH ACNE VULGARIS 
Indian Journal of Dermatology  2009;54(1):36-40.
Background and Objectives:
Acne vulgaris is a distressing skin condition, which can carry with it significant psychological disability. Oxidant/antioxidant imbalance leads to increased production of free radicals, that cause many diseases. Some nutrients, along with systemic oxidative stress, have been implicated in acne vulgaris. The goal of the present study was to assess oxidant and antioxidant status in correlation with the incidence of acne vulgaris in adolescent obese females.
Materials and Methods:
A total of 60 adolescent females (age 16-22 years) were divided into four groups (15 each) as follows: The first included obese females with acne; the second included obese females without acne; the third included non obese with acne and the fourth included non obese without acne. Fasting serum Malondialdehyde (MDA), β-carotene, and Vitamins A, E, and C were measured. In addition, platelet monoamineoxidase (MAO), and erythrocyte catechol-o-methyltransferase (COMT) activities were determined.
Results:
It was found that serum MDA was statistically significantly decreased in obese and non obese subjects with acne, as compared to those without acne (P<0.05, P<0.001) respectively. In contrast, the levels of β-carotene, vitamins A, E and C and the activity of MAO were significantly decreased in the obese and non obese with acne, as against the obese and non obese without acne.
Interpretation:
In obese subjects, increased fat content facilitates free radical production and lipid peroxidation, as indicated by increased MDA level, which is scavenged by the antioxidant vitamins. The decreased activity of MAO may be inhibited by free radicals and this causes psychological depression in adolescents. However there were non significant changes in the activity of COMT among the studied groups.
Conclusion:
The nutritional factors and a weakened antioxidant defense system may interplay, to increase the risk of psychological sequelae in acne vulgaris.
doi:10.4103/0019-5154.48984
PMCID: PMC2800868  PMID: 20049267
Acne vulgaris; adolescent; obese females; oxidative stress

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