Safety and Effectiveness of Oral Nutraceuticals for Treating Acne: A Systematic Review.

Importance: Patients with acne are interested in nutraceuticals as a potential treatment option. However, there is uncertainty regarding the efficacy and safety of these products. Objective: To evaluate the evidence for oral nutraceuticals in the treatment of acne. Evidence Review: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched from inception through January 30, 2023, to identify randomized clinical trials evaluating oral nutraceutical interventions (ie, vitamins and minerals, botanical extracts, prebiotics, and probiotics) in individuals with acne. Clinician-reported outcomes (eg, investigator global assessment, lesion counts), patient-reported outcomes (eg, quality of life), and adverse events were extracted from the included studies. The quality of evidence was assessed using the Cochrane Risk of Bias checklist tool for randomized clinical trials. Based on the Risk of Bias tool, articles were converted to Agency for Healthcare Research and Quality standards of good, fair, or poor quality. Findings: A total of 2582 abstracts were identified in the database search, 42 of which met inclusion criteria (a total of 3346 participants). Studies of fair or good quality showed the potential benefit of vitamins B5 and D, botanical extracts (green tea), probiotics, and ω-3 fatty acids in the treatment of acne. These interventions were most frequently associated with decreased lesion counts or improved investigator global assessment scores. Adverse effects were rare for most of the therapies evaluated, but gastrointestinal tract adverse effects were reported for zinc therapy. Conclusions and Relevance: This systematic review suggests a possible role for nutraceutical supplements in the treatment of acne. Physicians should be prepared to discuss the evidence regarding the potential role of nutraceuticals with patients. Many studies were of small size, and future research should focus on larger randomized clinical trials to assess the utility of nutraceuticals in the treatment of acne.

Laser-Assisted and Device-Assisted Filler Delivery: A Histologic Evaluation.

BACKGROUND: Lasers and devices are used to enhance transcutaneous delivery of fillers. However, little has been published on the histologic findings of this form of laser/device-assisted delivery to determine the optimal devices and fillers. OBJECTIVE: To objectively evaluate the histological effects of laser-assisted and device-assisted filler delivery. METHODS: Ex vivo human abdominoplasty skin samples were treated with fractional CO 2 laser (ECO 2 , 120 µm tip, 120 mJ), fractional radiofrequency microneedling (FRMN, Genius, 1.5 mm, 20 mJ/pin), and microneedling (2.0 mm). Immediately after poly- l -lactic acid (PLLA), hyaluronic acid gel, calcium hydroxylapatite, and black tissue marking dye were topically applied. After treatment, biopsies were collected for histologic evaluation. RESULTS: Histology revealed that PLLA and black dye were found in greatest abundance, hyaluronic acid was found to a lesser extent, and calcium hydroxylapatite was least found within channels created by fractional CO 2 laser. Microneedling was effective only at delivering black dye, whereas FRMN failed to show significant channel formation or delivery of the studied products. CONCLUSION: Among the devices and fillers studied, fractional CO 2 laser and PLLA proved to be the most effective combination for laser/device-assisted filler delivery. Neither microneedling nor FRMN was effective as devices to enhance filler delivery.

Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta-analysis.

BACKGROUND: Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking. OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of topical agents for melasma. METHODS: The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations. RESULTS: A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [-1.6 to -1.0]), HQ-containing combination therapy (-1.4, [-1.7 to -1.1]), cysteamine (-1.6, [-2.0 to -1.2]), tranexamic acid (-1.5, [-2.0 to -1.1]), azelaic acid (-1.3, [-1.7 to -1.0]), and kojic acid (-0.9, [-1.3 to -0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (-1.2, [-2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk. CONCLUSIONS: In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.

Sequence types 8, 59, and 45 methicillin resistant Staphylococcus aureus as the predominant strains causing skin and soft tissue infections in Taiwan's prisons and jails.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the predominant cause of skin and soft tissue infections (SSTIs), which is a problem in prisons and jails. We conducted this study to understand MRSA molecular characteristics among inmates with SSTIs, and we chose MRSA isolates from a community hospital as a comparison. METHODS: A total of 219 MRSA isolates from three custodial facilities and 134 isolates from a community hospital in Taiwan were collected in the 2017 calendar year. MRSA isolates were investigated molecularly by staphylococcal chromosome cassette mec (SCCmec) type, mupirocin, and chlorhexidine genotypical resistance, and multi-locus sequence typing (ST). RESULTS: Of the 219 MRSA isolates from custodial facilities, SCCmec IV was the most prevalent type (65.3%), followed by type VT (32.4%) and type V (1.8%). Regarding sequence types, ST59 (36.4%), 8 (35.3%), and 45 (17.9%) were the leading three predominant types out of 184 selected MRSA isolates, and ST45 MRSA was more prevalent in custodial facilities (p = 0.019). The antimicrobial resistance rates varied for different MRSA strains, with ST45 MRSA having the lowest rates of resistance to most antimicrobials. Overall, 91.5% of isolates carried mupA gene and 25.8% were positive for qacA/B gene, this was independent of the MRSA sequence types. CONCLUSIONS: ST59, ST8, and ST45 MRSA are the leading three MRSA strains causing SSTIs in Taiwan, 2017, but the molecular distribution varied distinctly between the custodial facilities and hospital settings. The genotypical mupirocin resistance rate is quite high in this study. The frequency of chlorhexidine resistance gene is relatively low, especially in MRSA isolates from custodial facilities.

Tai Chi Chuan training improves the pulmonary function of asthmatic children.

BACKGROUND AND PURPOSE: Tai Chi Chuan, a traditional Chinese exercise, is thought to improve cardiopulmonary function in patients with chronic disease. This study investigated the effect of Tai Chi Chuan on the pulmonary function and daily symptoms of asthmatic children. METHODS: Thirty asthmatic children were enrolled into the study. Fifteen of the 30 children participated in a 12-week Tai Chi Chuan program and the remaining 15 constituted the control group. Prior to study participation, the pulmonary function of all enrolled children was assessed at rest, after exercise, and after exercise plus iced water. A 3-day symptoms questionnaire was also completed and a score obtained after each pulmonary function test. RESULTS: There were no significant differences between the two groups in baseline pulmonary function and severity of asthmatic symptoms before study commencement, at rest, after exercise, or after exercise plus iced water. However, after the 12-week program, children in the Tai Chi Chuan group had a significant improvement in pulmonary function compared to the control group. Although there were no significant differences in post-training symptom scores at rest and after exercise between the two groups, under the stronger challenge of exercise plus iced water, children in the Tai Chi Chuan group had milder symptoms than those in the control group. CONCLUSION: Our data show that Tai Chi Chuan can improve the pulmonary function of asthmatic children. However, long-term follow-up is required to determine the impact of Tai Chi Chuan on the severity of asthmatic symptoms.

Treatment of propylene glycol monomethyl ether acetate in air streams by a biofilter packed with fern chips.

This study aimed to develop a biofilter packed only with fern chips for the removal of airborne propylene glycol monomethyl ether acetate (PGMEA). Fern chips could avoid the shortcomings of traditional media, such as compaction, drying, and breakdown, which lead to the performance failure of the biofilters. In addition, the fern chip medium has the following merits: (1) simplicity in composition; (2) low pressure drop for gas flow (<20 mmH2O x m(-1)); (3) simple in humidification, nutrient addition, pH control, and metabolite removal; (4) economical (US$174-385 x m(-3)), and (5) low weight (wet basis around 290 kg x m(-3)). A two-stage downflow biofilter (2.18 m in height and 0.4 x 0.4 m in cross-sectional area) was constructed for the performance test. Both stages were packed with fern chips of 0.30 m in height and 0.40 x 0.40 m in cross-section. Results indicate that with operation conditions of media moisture content controlled in the range of 50-74%, media pH of 6.5-8.3, empty bed retention time (EBRT) of 0.27-0.4 min, influent PGMEA concentrations of 100-750 mg x m(-3), volumetric organic loading of <170 g x m(-3) x hr(-1), and nutrition rates of Urea-nitrogen 66 g x m(-3) x day(-3), potassium dihydrogen phosphate (KH2PO4)-phosphorus 13.3 g x m(-3) x day(-3), and milk powder 1.00 g x m(-3) x day(-1), the fern-chip-packed biofilter could achieve an overall PGMEA removal efficacy of around 94%. Instant milk powder or liquid milk was essential to the good and stable performance of the biofilter for PGMEA removal.