Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome: a single-institution case series with a focus on management.

BACKGROUND: Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome is a rare condition characterized by clinical features of all three dermatologic conditions. The management of PASH syndrome is difficult, with no consensus on treatment guidelines. Since PASH syndrome can increase morbidity and adversely impact quality of life, better characterization of effective therapies is needed. METHODS: A retrospective cohort study was conducted to identify all patients with pyoderma gangrenosum (PG) treated at The Ohio State University Wexner Medical Center between 2015 and 2021. PG diagnosis was confirmed via PARACELSUS score. Subsequent chart review identified eight patients with concomitant hidradenitis suppurativa (HS) and acne who were clinically diagnosed with PASH syndrome. RESULTS: Eight patients were clinically diagnosed with PASH syndrome based on their clinical presentation at our institution. Seven patients had failed some type of medical therapy prior to presentation, including topical corticosteroids, oral corticosteroids, oral antibiotics, and biologics. One patient had also tried surgical drainage at an outside institution. Six patients were effectively treated with biologics, usually in combination with other therapies. One patient experienced improvement of her skin lesions after diagnosis and treatment of her underlying hematologic malignancy. CONCLUSIONS: Medical management with biologics in combination with corticosteroids and/or antibiotics was effective in the management of most patients. Diagnosis and treatment of an underlying condition should be prioritized in refractory cases. If workup is negative, surgical management may be considered. Further investigation with a greater number of patients is required to develop management guidelines for PASH syndrome.

Relationship between elevated serum decorin levels and acne vulgaris in women with PCOS.

OBJECTIVE: The primary aim of this study was to investigate the serum levels of decorin, a small leucine-rich proteoglycan, in women diagnosed with polycystic ovary syndrome (PCOS) and concurrently presenting with moderate to severe acne vulgaris. PATIENTS AND METHODS: Sixty patients with acne vulgaris symptoms, subsequently diagnosed with PCOS according to the revised Rotterdam criteria, were enrolled in the study. Acne severity was assessed using the acne global severity scale (AGSS), with patients fitting AGSS category 4 (moderate) and 5 (severe) grouped into two separate cohorts of 30 individuals each. The moderate acne group comprised patients with few inflammatory lesions and a minor nodule alongside predominantly non-inflammatory lesions, whereas the severe group contained patients with multiple nodules and a mix of non-inflammatory and inflammatory lesions. A control group of twenty healthy women without acne vulgaris or PCOS was also established. The study measured serum testosterone, follicle-stimulating hormone (FSH), Luteinizing Hormone (LH), and insulin levels, and calculated insulin resistance via the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) formula. Quantitative sandwich enzyme immunoassay was employed to determine decorin levels from venous blood samples. RESULTS: While age, body mass index (BMI), serum FSH, LH, testosterone, and HOMA-IR values demonstrated similarity between the moderate and severe acne cohorts, comparisons between the control and both acne groups (AGSS-4 and AGSS-5) revealed significantly elevated values in the latter, excluding age, BMI, and FSH. Importantly, the serum decorin levels in both acne groups were substantially higher than in controls. A significant positive correlation was observed between serum decorin levels and both HOMA-IR (r=7.88, p<0.01) and testosterone (r=0.813, p<0.01). CONCLUSIONS: This study suggests that elevated circulating decorin levels play a pivotal role in the manifestation of acne vulgaris in women with PCOS.

Integrated Short-Term and Long-Term Efficacy of Topical Clascoterone Cream 1% in Patients Aged 12 Years or Older With Acne Vulgaris.

BACKGROUND: Clascoterone cream 1% is approved for the treatment of acne vulgaris in patients aged 12 years or older based on results from two identical pivotal Phase 3 trials. Integrated efficacy of clascoterone in patients aged 12 years or older with acne vulgaris from the pivotal trials (NCT02608450 and NCT02608476) and long-term extension (LTE) study (NCT02682264) is reported. METHODS: In the pivotal trials, patients with moderate-to-severe acne vulgaris were randomized 1:1 to twice-daily application of clascoterone cream 1% or vehicle for 12 weeks; they could then enter the LTE study, where all patients applied clascoterone to the face and, if desired, trunk for up to 9 additional months. Efficacy was assessed from treatment success based on Investigator's Global Assessment scores (IGA 0/1) in patients aged 12 years or older in the intention-to-treat population; lesion counts were assessed through week 12. Missing data were handled using multiple imputation in the pivotal studies and were not imputed in the LTE study. RESULTS: Of 1421 patients enrolled, 1143 (clascoterone, 576; vehicle, 567) completed week 12; 600 entered and 343 completed the LTE study. The treatment success rate and most lesion count reductions following clascoterone vs placebo treatment reached statistical significance at week 12; the overall treatment success rate increased to 30.2% for facial acne after 12 months and 31.7% for truncal acne after 9 months of treatment. CONCLUSIONS: The efficacy of clascoterone cream 1% for the treatment of acne vulgaris continued to increase over time for up to 12 months in patients aged 12 years or older with acne vulgaris.   J Drugs Dermatol. 2024;23(1):1278-1283.     doi:10.36849/JDD.7719.

Unusual cause of inflammatory backache: SAPHO syndrome.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is a rare chronic inflammatory disease that develops in adults. We present a case of SAPHO syndrome in a 37-year-old male presenting with gradually worsening back and neck pain for a 7-year period. The episodes were preceded by a history of pustular skin eruptions, which first appeared on the upper trunk and then involved his face and were pustular and scarring. The purpose of presenting this case report from Iraq is to raise awareness about this rare condition, which is frequently misdiagnosed and under-recognized.

Metformin: A Potential Treatment for Acne, Hidradenitis Suppurativa and Rosacea.

Metformin is a widely used drug for treatment of diabetes mellitus, due to its safety and efficacy. In addition to its role as an antidiabetic drug, numerous beneficial effects of metformin have enabled its use in various diseases. Considering the anti-androgenic, anti-angiogenic, anti-fibrotic and antioxidant properties of metformin, it may have the potential to improve chronic inflammatory skin diseases. However, further evidence is needed to confirm the efficacy of metformin in dermatological conditions, This review focuses on exploring the therapeutic targets of metformin in acne vulgaris, hidradenitis suppurativa and rosacea, by studying their pathogeneses.

The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study.

BACKGROUND: The journey of patients with skin diseases through healthcare has been scarcely investigated. OBJECTIVE: To analyse the journey of people with skin diseases in the different healthcare environment in Europe. METHODS: This multinational, cross-sectional, European study was conducted on a representative sample of the adult general population of 27 European countries. The prevalence of the most frequent skin diseases was determined. Information was collected on the patient journey from the first medical consultation to the diagnosis, and the reasons for not consulting a healthcare professional. RESULTS: On a total of 44,689 individuals, 30.3% reported to have consulted a dermatologist during the previous 2 years. Participants consulted mainly for mole control or skin cancer screening (22.3%), followed by chronic skin diseases (16.2%). The diagnoses of acne, atopic dermatitis, psoriasis and rosacea were made most frequently by a dermatologist, while fungal skin infections were diagnosed more often by a general practitioner (GP), and sexually transmitted diseases (STD) by other specialists. The diagnosis was not always definitive at the first consultation, in particular for STD. The percentage of people who did not consult a healthcare professional for their skin disease was particularly high for acne (36.4%), alopecia (44.7%) and fungal infection (30.0%). Moreover, 17.7% of respondents with psoriasis did not consult. A high percentage of participants with alopecia thought that the disease was not worrying, while patients with psoriasis often answered that they were able to manage the disease since they had already consulted a doctor. Many patients with acne (41.1%) and fungal infection (48.2%) thought that they were able to handle the disease by themselves. CONCLUSION: The analysis of the self-reported medical journey of patients with common skin diseases may allow to understand the unmet needs of patients, thus improving outcomes and reducing expenses.

A preliminary study on the evaluation of photodynamic diagnosis for acne inflammatory skin lesions.

OBJECTIVE: This study aimed to observe the fluorescence characteristics of acne inflammatory skin lesions in 5-aminolevulinic acid-based photodynamic diagnosis (ALA-PDD), and discuss the viability of using ALA-PDD to evaluate acne inflammatory skin lesions and explore the advantages of predicting subclinical skin lesions. METHODS: The OBSERV facial skin detector collected photographs of 20 patients before and after optical intra-tissue fiber irradiation photodynamic therapy (OFI-ALA-PDT) in both ALA-PDD and white light patterns. The patients were treated once a week for four consecutive weeks in order to analyze the correlation between the two patterns in recognizing inflammatory skin lesions. RESULTS: Before and after treatment, there was no significant difference between the two patterns for recognizing acne inflammatory skin lesions (p > 0.05). Both patterns demonstrated a strong correlation (r > 0.90) for the recognition of various types of inflammatory skin lesions at different treatment stages. CONCLUSION: ALA-PDD is a feasible method for evaluating acne inflammatory lesions, guiding treatment and judging efficacy. It has advantages in predicting subclinical skin lesions and deserves further study.

Polycystic Ovary Syndrome: Common Questions and Answers.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of childbearing age. Its complex pathophysiology includes genetic and environmental factors that contribute to insulin resistance in patients with this disease. The diagnosis of PCOS is primarily clinical, based on the presence of at least two of the three Rotterdam criteria: oligoanovulation, hyperandrogenism, and polycystic ovaries on ultrasonography. PCOS is often associated with hirsutism, acne, anovulatory menstruation, dysglycemia, dyslipidemia, obesity, and increased risk of cardiovascular disease and hormone-sensitive malignancies (e.g., at least a twofold increased risk of endometrial cancer). Lifestyle modification, including caloric restriction and increased physical activity, is the foundation of therapy. Subsequent management decisions depend on the patient's desire for pregnancy. In patients who do not want to become pregnant, oral contraceptives are first-line therapy for menstrual irregularities and dermatologic complications such as hirsutism and acne. Antiandrogens such as spironolactone are often added to oral contraceptives as second-line agents. In patients who want to become pregnant, first-line therapy is letrozole for ovulation induction. Metformin added to lifestyle management is first-line therapy for patients with metabolic complications such as insulin resistance. Patients with PCOS are at increased risk of depression and obstructive sleep apnea, and screening is recommended.

Supplement Individual Article: Pediatric Acne Patients' Treatment Real-World Case Series Using Skincare as Monotherapy, Adjunctive, and Maintenance Treatment.

BACKGROUND: Pediatric acne is a common, complex, multifactorial inflammatory skin disease with various expressions in childhood that can be categorized by age, severity, and pubertal status. A pediatric acne case series is presented to educate health care providers treating children with acne to tailor acne prescription, nonprescription acne therapy, skin care, and maintenance treatment to improve patient outcomes. METHODS: A panel of 8 advisors in pediatric dermatology, dermatology, and pediatrics who treat pediatric patients with acne reported on clinical cases from their practice. During the meeting, the advisors discussed 17 pediatric acne cases and agreed to select 8 cases covering various presentations of pediatric acne, patient ages, and skin types. The case series gives a logical flow from youngest to oldest pediatric patients with acne. RESULTS: The 8 cases covered neonatal acne: birth to ≤8 weeks; preadolescent acne: ≥7 to 12 years; and adolescent acne: ≥12 to 19 years or after menarche for girls. It is to be noted that acne eruptions in children ages 1 to 6 years old are unusual and often associated with underlying endocrine and tumor issues. They are not included in this work. The advisors discussed why they selected the case, previous treatment, type of prevention and education provided, skin care as mono or adjunctive treatment, prescription and nonprescription therapy and maintenance treatment, key takeaways, and clinical pearls from the case. Skincare products containing lipids such as ceramides promote a healthy skin barrier in acne monotherapy, adjunctive, and maintenance treatment. However, their role in pediatric acne is not well defined and requires more studies. CONCLUSION: Sharing best practices in acne therapy and maintenance treatment for pediatric patients with acne may support health care providers treating children to improve clinical outcomes. J Drugs Dermatol. 2023;22:2(Suppl):s3-14.

Pathologic acne in pre-pubertal children: A case series and review on when to refer to pediatric endocrinology.

Acne vulgaris is an extremely common chronic disease of the pilosebaceous unit. Despite its ubiquity, acne in the childhood years of approximately ages 1-6 years is exceedingly rare. Physicians should be suspicious of underlying systemic disease processes in patients of this age who present with onset of acne lesions, as pre-pubertal acne in childhood has a distinctly different pathology than that of other age groups. Through a case series, we highlight the importance of a thorough work-up and provide a review on when to refer to pediatric endocrinology to rule out precocious puberty and tumors as the cause of pre-pubertal acne.

A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with isolated lesions of the thoracic spine.

We report a case of isolated lesions of the thoracic spine attributed to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. A 55-year-old woman who suffered from 6 months of back pain had vertebral osteomyelitis on magnetic resonance imaging (MRI). There were no laboratory findings suggestive of infection, malignancy, or autoimmune disease. Radiography, computed tomography (CT), and MRI of the thoracic spine showed mixed lesions of sclerosis and erosion, whereas bone scintigraphy did not show accumulation at any site except the thoracic spine. No lesions in the anterior chest wall or sacroiliac joints were apparent from CT and MRI. No lesions other than at the thoracic spine were observed. As the isolated lesions of the thoracic spine were considered not to have resulted from infection, malignancy, or autoimmune disease, the patient was referred to our department for differential diagnosis. Given that isolated sterile hyperostosis/osteitis among adults is included in the modified diagnostic criteria for SAPHO syndrome, we suspected that the mixed lesions of sclerosis and erosion of the thoracic spine in this case may reflect SAPHO syndrome with chronic non-bacterial osteitis (CNO) of the thoracic spine. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) was initiated and led to alleviation of her back pain, although the thoracic spine lesions remained on the 6-month MRI. Based on the CNO of the thoracic spine and the rapid response to NSAIDs, the final diagnosis was SAPHO syndrome with isolated lesions of the thoracic spine.

Acné en la adolescencia: como reconocerlo y abordarlo / Acne in adolescents: how to recognize it and treat it / Acne na adolescencia: como reconhecer-lo e tratá-lo

El acné una de las enfermedades dermatológicas crónicas más frecuentes, siendo la adolescencia donde se observa su mayor incidencia y prevalencia. Constituye un motivo de consulta frecuente y a pesar de que su abordaje inicial es de resorte del pediatra, dependiendo de la evolución y los tipos de acné requieren la derivación y tratamiento con dermatólogo. Es una enfermedad cutánea, de carácter inflamatorio y que involucra la unidad pilosebácea. Su etiología es multifactorial y el diagnóstico es clínico al constatar las lesiones típicas. Teniendo en cuenta la importancia de la imagen corporal en esta etapa de la vida y el impacto de esta en la calidad de vida de los adolescentes, es imprescindible el reconocimiento precoz y tratamiento inicial por parte del pediatra. Existen posibilidades terapéuticas cada vez más novedosas, exigiendo a los profesionales de salud estar actualizados. Esta revisión pretende mostrar una puesta al día de la temática y ofrecer información actualizada sobre los tratamientos disponibles a nivel local.

Acne is one of the most common chronic dermatological diseases and it is primarily observed in adolescents. It is one of the causes of frequent consultation, and despite the fact that Its initial detection and approach is that of the pediatrician, depending on the evolution and the types of acne, referral and treatment by a dermatologist will be required. It is a skin disease, inflammatory in nature and involving the pilosebaceous unit. It has a multifactorial etiology and it requires clinical diagnosis when typical lesions are found. Considering importance of adolescents' image at this stage and the impact on their quality of life, early detection and treatment by the pediatrician are essential. There are increasing new therapeutic possibilities, which require health professionals to be updated. This review aims at showing an update of the subject and at providing updated information regarding the available treatments locally.

A acne é uma das doenças dermatológicas crônicas mais comuns, sendo a adolescência onde observase sua maior incidência e prevalência. Constitui motivo de consulta frequente e apesar de sua abordagem inicial é a do pediatra, dependendo da evolução e dos tipos de acne que necessitam de tratamento e encaminhamento feito por um dermatologista. É uma doença cutânea, de natureza inflamatória e que envolve a unidade pilossebácea. Sua etiologia é multifatorial e o diagnóstico é clínico quando são encontradas lesões típicas. Tendo em conta a importância da imagem corporal nesta fase da vida e o impacto dela na qualidade de vida dos adolescentes, o reconhecimento inicial pelo pediatra e o tratamento precoces são essenciais. Existem cada vez mais novas possibilidades terapêuticas, exigindo que os profissionais de saúde estejam atualizados. Este papertem como objetivo mostrar uma atualização do assunto e fornecer informação atualizada sobre os tratamentos disponíveis a nível local.

Supplement Article: Dysbiosis, (Barrier) Dysfunction, and Dermatoses: A Chicken-and-Egg Dilemma.

Acne vulgaris (AV) and rosacea are two of the most common dermatoses diagnosed and managed by dermatologists.1,2 Despite this and our improved understanding of the unique pathogenesis of each, there has been little focus on general skin care and how it may affect physiologic functioning of the epidermis until recently.

Isotretinoin-induced inflammatory back pain and sacroiliitis in patients with moderate-to-severe acne vulgaris.

INTRODUCTION: Isotretinoin has been reported to induce inflammatory back pain (IBP) and sacroiliitis in the patients with acne vulgaris. The aim of this study is to investigate the incidence of IBP and sacroiliitis in patients receiving isotretinoin treatment compared with oral antibiotics for acne vulgaris. MATERIALS AND METHODS: A total of 201 patients with moderate-to-severe acne vulgaris who received isotretinoin (n = 100) or oral antibiotics (n = 101) were included in the study. All patients were monthly questioned for IBP symptoms during their treatment. Patients described IBP were also evaluated for sacroiliitis by c-reactive protein, sedimentation rate, HLAB27, and sacroiliac magnetic resonance imaging (MRI). Isotretinoin was discontinued in all patients diagnosed as sacroiliitis, and these patients were reevaluated after 3 months. RESULTS: IBP was observed in 21 (10.4%), and sacroiliitis was detected in 11 (11%) patients on isotretinoin treatment; in oral antibiotic group, we did not observe IBP or sacroiliitis. The incidence of IBP and sacroiliitis differed significantly between the isotretinoin and oral antibiotic groups (p < 0.0001, p = 0.02). Complete regression was observed in the great majority of patients following cessation of isotretinoin. CONCLUSIONS: Our study is the largest prospective controlled study that investigated the incidence of sacroiliitis in patients receiving isotretinoin and compared with patients using oral antibiotics.

Inflammatory markers in acne vulgaris: Saliva as a novel diagnostic fluid.

BACKGROUND: Despite the wide use of saliva-based measurements in inflammatory, autoimmune and neoplastic conditions, its use in dermatology is still limited. AIMS: The aims of this study were to assess the serum and salivary levels of interleukin-1 beta (IL-1ß) and C-reactive protein (CRP) in patients with acne vulgaris. PATIENTS/METHODS: The study included 84 moderate-to-severe acne vulgaris patients, in addition to 105 healthy control subjects. Serum and salivary levels of CRP and IL-1ß were estimated using enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: Using T-test, the serum and salivary levels of both CRP and IL-1ß in the patients were significantly higher than the measured levels in the control subjects (p < 0.001). Using Pearson correlation coefficient, serum and salivary CRP and serum IL-1ß levels showed significantly positive correlation with GAGS scores (p < 0.001). The levels of IL-1ß in saliva did not show significant correlation with GAGS scores or with serum and salivary CRP. CONCLUSIONS: The current study supports the emerging role of saliva as a valid noninvasive tool for monitoring inflammation and as a reliable and stress-free tool to evaluate cytokines and other inflammatory marker levels in acne vulgaris.

[Acne in the newborn.] / Acné en el recién nacido

Neonatal acne (NA) is a transitory dermatosis that occurs between the second and fourth weeks of life in 20% of children. This condition is more frequent in males, with a male-female ratio of 4.5:1. Present primary skin lesions are open and closed comedones which can evolve into papules, erythematous pustules and, in rare cases, nodules and cysts. NA topography includes the forehead, cheeks, chin, and eyelids, but occasionally it spreads to the scalp, neck, and trunk. NA occurs due to an elevated production of placental and neonatal androgens (of adrenal origin in both sexes and of testicular origin in males) which cause enlargement of the sebaceous glands and increases the production of sebum. Most cases are mild and transient, but if NA is severe and long-lasting, clinical and paraclinical examination will be necessary to find congenital adrenal hyperplasia or a virilizing tumor of adrenal or gonadal origin. The diagnosis of NA is clinical; its main differential -diagnoses are neonatal cephalic pustulosis, other neonatal vesiculopustular dermatoses, infectious diseases, and acneiform reactions. The resolution of NA is spontaneous. In most cases, the use of a mild dermal cleanser and water will be sufficient. For comedogenic lesions (open and closed comedones), topical retinoids or 20% azelaic acid may be used, as well as some topical antibiotics for inflammatory lesions.

El acné neonatal es una dermatosis transitoria que ocurre entre la segunda y la cuarta semanas de vida en uno de cada cinco niños. Es más frecuente en los varones, con una relación de sexo masculino-femenino de 4.5:1. Las manifestaciones clínicas incluyen comedones abiertos y cerrados que pueden progresar a lesiones inflamatorias como pápulas, pústulas eritematosas y, en casos raros, nódulos y quistes. Las zonas afectadas incluyen la frente, las mejillas, el mentón y los párpados, y en algunas ocasiones puede extenderse a la piel cabelluda, el cuello y el tronco. Ocurre por la mayor producción de andrógenos placentarios y neonatales (de origen suprarrenal en ambos sexos y de origen testicular en los varones), que provoca hipertrofia de las glándulas sebáceas y mayor producción de sebo. La mayoría de los casos son leves y autolimitados. Cuando el acné neonatal es grave y prolongado, se debe considerar la posibilidad de hiperandrogenismo, cuyas causas más frecuentes en esta edad son la hiperplasia suprarrenal congénita y los tumores, adrenales o gonadales, productores de andrógenos. El diagnóstico del acné neonatal es clínico: se debe distinguir de la pustulosis cefálica neonatal, otras dermatosis neonatales vesiculopustulares, enfermedades infecciosas y reacciones acneiformes. Habitualmente, un dermolimpiador suave y agua resultan suficientes para su manejo. Las lesiones obstructivas (comedones abiertos y cerrados) pueden requerir retinoides tópicos o ácido azelaico al 20%, y las lesiones inflamatorias, algunos antibióticos tópicos.

Comparison of 1565-nm Nonablative Fractional Laser and 10600-nm Ablative Fractional Laser in the Treatment of Mild to Moderate Atrophic Acne Scars.

BACKGROUND: The 10,600-nm ablative fractional laser (AFL) is widely used for treating facial atrophic acne scars but with evident side effects. By contrast, the common Er:Glass non-AFL (NAFL) is safer but lacks of comparable outcomes. A novel 1,565 nm Er:Glass NAFL improves thermal energy delivery and could yield better outcomes. OBJECTIVE: We aimed to compare the effectiveness and safety between the 1,565-nm NAFL and 10,600-nm AFL in treating mild-to-moderate facial atrophic acne scars. METHODS: Nineteen patients with mild-to-moderate bilateral facial atrophic acne scars were enrolled in a randomized split-face trial, which involved 3-session procedures for each laser. The effectiveness and safety were evaluated by doctors and patients who were blinded to the treatment assignment. RESULTS: Both lasers improved the acne scar profiles comparably. A marked reduction in erythema, crusting durations, and degree of pain were noted on the sides treated with the 1,565-nm NAFL, relative to those treated with the 10,600-nm AFL. CONCLUSION: Both 1,565 nm-NAFL and 10,600-nm AFL can improve mild-to-moderate acne scars. Patients should never expect complete resolution. The 1,565-nm NAFL has less side effects.