Evidence-based topical treatments (azelaic acid, salicylic acid, nicotinamide, sulfur, zinc, and fruit acid) for acne: an abridged version of a Cochrane systematic review.

OBJECTIVE: The effects of topical azelaic acid, salicylic acid, nicotinamide, sulfur, zinc, and fruit acid (alpha-hydroxy acid) for acne are unclear. We aimed to assess the effects of these topical treatments by collecting randomized controlled trials. METHODS: We searched The Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS up to May 2019. We also searched five trials registers. Two review authors independently extracted data and assessed risk of bias. Meta analyses were performed by using Review Manager 5 software. RESULTS: We included a total of 49 trials involving 3880 participants. In terms of treatment response (measured using participants' global self-assessment of acne improvement, PGA), azelaic acid was probably less effective than benzoyl peroxide (RR = 0.82, 95% CI 0.72-0.95). However, there was probably little or no difference in PGA when comparing azelaic acid to tretinoin (RR = 0.94, 95% CI 0.78-1.14). There may be little or no difference when comparing salicylic acid to tretinoin (RR = 1.00, 95% CI 0.92-1.09). There were no studies measured PGA when evaluating nicotinamide. With respect to alpha-hydroxy acid, there may be no difference in PGA when comparing glycolic acid to salicylic-mandelic acid (RR = 1.06, 95% CI 0.88-1.26). We were uncertain about the effects of sulfur and zinc. Adverse events associated with these topical treatments were always mild and transient. CONCLUSIONS: Moderate-quality evidence was available for azelaic acid and low- to very-low-quality evidence for other topical treatments. Risk of bias and imprecision limit our confidence in the evidence.

The Use of Cosmeceuticals in Acne: Help or Hoax?

The use of cosmeceuticals by patients with acne is common; however, their role is unclear and confusing, with many asking, "Do they really help acne?" Cosmeceuticals are intermediate products between prescription medications and cosmetics, available to consumers over the counter. These products are popular and may be used without the direct supervision of a dermatologist, creating a practice gap in educating patients. Herein, a variety of cosmeceuticals are discussed, including retinoids, niacinamide, and glycolic acid. The evidence for and against cosmeceutical use in patients with acne is reviewed.

Adjuvant alternative treatment with chemical peeling and subsequent iontophoresis for postinflammatory hyperpigmentation, erosion with inflamed red papules and non-inflamed atrophic scars in acne vulgaris.

The standard management of acne vulgaris in Japan includes a combination of topical treatment with benzoyl peroxide (BPO) and BPO/clindamycin (CLDM), topical adapalene and systemic antimicrobials. However, the treatment of therapy-resistant complications such as postinflammatory hyperpigmentation (PIH), erosions with inflamed red papules and atrophic scars has not been established. We performed chemical peeling with glycolic acid and iontophoresis with ascorbyl 2-phosphate 6-palmitate and DL-α-tocopherol phosphate for the treatment of PIH, erosions with inflamed red papules and non-inflamed atrophic scars in 31 patients with acne vulgaris (mild to severe severity), and evaluated the efficacy and safety of these interventions. In most of cases, there was remarkable improvement in PIH and erosions with inflamed red papules after treatment. There was also some improvement in non-inflamed atrophic scars without erythema. Mild redness and irritation was observed in four cases as adverse reactions. Early initial treatment of PIH and erosions with red papules by chemical peeling and iontophoresis is an effective and safe method to prevent the formation of atrophic scars in patients with acne vulgaris.

A randomized controlled study for the treatment of acne vulgaris using high-intensity 414 nm solid state diode arrays.

The treatment of acne vulgaris poses a challenge to the dermatologist, and the disease causes emotional anxiety for the patient. The treatment of acne vulgaris may be well-suited to home-use applications, where sufferers may be too embarrassed to seek medical treatment. This randomized controlled study is designed to quantify the effectiveness of using a blue light device in a therapy combined with proprietary creams, in the investigation of a self-treatment regimen. A total of 41 adults with mild-to-moderate facial inflammatory acne were recruited. The subjects were randomly assigned to combination blue light therapy (n = 26) or control (n = 15). Photography was used for qualitative assessment of lesion counts, at weeks 1, 2, 4, 8, and 12. All subjects in the treatment cohort achieved a reduction in their inflammatory lesion counts after 12 weeks. The mean inflammatory lesion counts reduced by 50.02% in the treatment cohort, and increased by 2.45% in the control cohort. The reduction in inflammatory lesions was typically observable at week-3, and maximal between weeks 8 and 12. The treatment is free of pain and side-effects. The blue light device offers a valuable alternative to antibiotics and potentially irritating topical treatments. Blue light phototherapy, using a narrow-band LED light source, appears to be a safe and effective additional therapy for mild to moderate acne.

Multiple minute digitate hyperkeratosis affecting the face and folds: clinical, dermoscopic, and histological report of a familial case.

A case of a generalized non-follicular digitate keratosis classified as multiple minute digitate hyperkeratosis is described with suggestive clinical, dermoscopic, and histopathogical data. The patient was a 52-year-old Caucasian woman presenting a 6-year history of multiple asymptomatic skin-colored digitate lesions, 3 to 5 mm long and 1 to 2 mm wide, distributed on the forehead, neck, and extensor surface of the arms as well as in the inframammary folds, axillae, and lower limbs, especially on the popliteal fold. She reported having a 67-year-old sister and a 39-year-old niece with an identical eruption. Treatment with 15% glycolic acid (AHA) lotion and heliotherapy improved this disturbing eruption.

Rapid treatment of mild acne with a novel skin care system containing 1% salicylic acid, 10% buffered glycolic acid, and botanical ingredients.

The biggest hurdle in the treatment of acne vulgaris is patient non-compliance that is due in large part to poor tolerability to common acne medications. As such, new acne treatments must be developed that balance good anti-acne efficacy with excellent tolerability in order to ensure patient adherence and by extension ensure good clinical outcomes. The goal of the present study was to determine the tolerability and efficacy of a novel skin care system, composed of a cleanser, containing 1% salicylic acid and botanical ingredients, and a treatment gel, containing 1% salicylic acid, 10% buffered glycolic acid and botanical ingredients for the treatment of mild acne. In this single-center, open-label clinical study, 25 male and female volunteers used the test cleanser and test gel twice daily over six weeks. Tolerability assessments showed that the skin care regimen was very well tolerated by all study volunteers. Acne severity was significantly reduced by two acne grades at six weeks. Inflammatory lesion counts were significantly reduced, on average, by 59.06% (P ≤ 0.0001), 91.62% (P ≤ 0.0001), 90.85% (P ≤ 0.0001) and by 98.55% (P ≤ 0.0001) at weeks 1, 2, 4, and 6, respectively. Non-inflammatory lesion counts were reduced, on average, by 13.54% (ns), 38.95% (P ≤ 0.0001), 44.48% (P ≤ 0.0001), and by 56.10% (P ≤ 0.0001) at weeks 1, 2, 4, and 6, respectively. Standardized photography also demonstrated a progressive reduction in acne lesions over time. In conclusion, results of the present study suggest that the tested skin care regimen offers rapid acne clearance and excellent tolerability that together may help to improve patient adherence as well as treatment outcome.

A comparative study on efficacy of high and low fluence Q-switched Nd:YAG laser and glycolic acid peel in melasma.

BACKGROUND: Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. With the advent of newer therapies, there is interest in the use of glycolic acid peels and Q-switched Nd:YAG laser (QSNYL) in high and low fluence for this disorder. AIMS: To compare the therapeutic efficacy of low fluence QSNYL, high fluence QSNYL, and glycolic acid peel in melasma in three study groups of 25 patients each. METHODS: Seventy-five Indian patients diagnosed as melasma were included. These patients were randomly divided in three groups (Group A = 25 patients of melasma treated with low-fluence QSNYL at weekly intervals, Group B = 25 patients of melasma treated with glycolic acid peel at 2 weeks intervals, Group C = 25 patients of melasma treated with high-fluence QSNYL at 2 weeks intervals). Study period and follow-up period was of 12 weeks each. Out of the 75 patients included, 21 patients in Group A, 19 patients in Group B, and 20 patients in Group C completed the study. Response to treatment was assessed using melasma area and severity index score. RESULTS: Significant improvement was recorded in all the three groups. The improvement was statistically highly significant in Group A as compared to Group C (P<0.005), significant in Group A as compared to Group B (P<0.05), and also in Group B when compared to Group C (P<0.05). Low-fluence QSNYL was associated with least side effects. CONCLUSIONS: This study shows the efficacy of low-fluence QSNYL and glycolic acid peel in melasma. These could be an effective treatment options compared to conventional methods for the treatment of melasma.

Melasma: a comprehensive update: part II.

Several methods of treatment are available to patients with melasma. First-line therapy usually consists of topical compounds that affect the pigment production pathway, broad-spectrum photoprotection, and camouflage. Second-line therapy often consists of the addition of chemical peels, although these must be used cautiously in patients with darker skin. Laser and light therapies represent potentially promising options for patients who are refractory to other modalities, but also carry a significant risk of worsening the disease. A thorough understanding of the risks and benefits of various therapeutic options is crucial in selecting the best treatment.

A 10% glycolic acid containing oil-in-water emulsion improves mild acne: a randomized double-blind placebo-controlled trial.

BACKGROUND: Acne is characterized by hyperseborrhea, follicular hyperkeratosis, and growth of propionibacteria. Alpha hydroxy acids depending on the pH of the finished product exhibit comedolytic as well as antimicrobial properties. OBJECTIVES: The aim of this study was to investigate an oil-in-water emulsion-containing 10% glycolic acid (pH 4; Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany) as monotherapy in mild acne regarding clinical efficacy and tolerability for 90 days. PATIENTS AND METHODS: Patients (n = 120; 73 f, 47 m) suffering from mild acne (Leeds score 0.25-1) aged ≥12 (mean 21 ± 5.8) were included in this double-blind, placebo-controlled, randomized, monocentric trial. The cream was applied once daily in the evening. No additional products were used. Cleansing was standardized by supplying the same product to all patients. RESULTS: The number of patients (n = 115) in the per-protocol and intention-to-treat analysis was the same. Acne improved significantly in the verum group up to day 90. Already at day 45, there was a statistical significant (5% level) difference against placebo. The subjective evaluation of the verum by physicians and patients regarding clinical efficacy and tolerability was favorable. Regarding reported adverse effects, there was no statistically significant difference (5% level) between verum and placebo. CONCLUSIONS: The 10% glycolic acid containing oil-in-water emulsion improved mild acne applied as monotherapy in this study significantly, already after 45 days of treatment. Regarding tolerability, there was no objective or subjective difference between the 10% glycolic acid containing oil-in-water emulsion and the corresponding placebo.

Treatment of melasma with a depigmentation cream determined with colorimetry.

BACKGROUND: Melasma is a pigmentary disorder often recalcitrant to treatment. Few studies have objectively evaluated the efficacy of treatment colorimetrically. AIM: To evaluate the safety and efficacy of a depigmentation cream, including mainly glycolic acid and Rumex occidentalis. METHOD: Twenty-seven patients applied the cream twice daily for the first 3 months and twice weekly for the following 3 months. L*, C* and h* values of the target lesions and the perilesional area were analyzed at baseline, 12 and 24 weeks colorimetrically. The physician and patient evaluated the clinical response rate. These results were compared statistically between the lesional and perilesional area. RESULTS: There was a significant difference between 0-12, 0-24 (L*, C* and h* values) and 12-24 weeks (L* value) (p <0.001). For C* and h* values, the difference was not significant between 12 and 24 weeks (p = 0.464 and 0.151, respectively). Statistical significance was detected only between 3 and 6 months for C* value (p < 0.05) for the lesional and the perilesional areas. Clinical response rate was significant (p < 0.05). CONCLUSION: Our depigmentation cream is a moderate effective agent, well tolerated and can be considered as an alternative treatment of melasma. Twice-daily application may enhance the efficacy of treatment instead of twice-weekly application in the maintenance period.

Evaluation of a kojic acid, emblica extract, and glycolic acid formulation compared with hydroquinone 4% for skin lightening.

Hydroquinone has been the standard prescription agent for skin lightening; however, its use recently has become controversial. Hydroquinone is banned in Europe and parts of Asia because of potential long-term consequences, including carcinogenesis when orally consumed. These concerns have stimulated research to develop alternative skin lightening agents with efficacy comparable to hydroquinone but with a better safety profile. This double-blind study examined the skin lightening ability of a topical formulation containing kojic acid, emblica extract, and glycolic acid compared with prescription generic hydroquinone cream 4%. Eighty multiethnic participants with mild to moderate facial dyschromia were randomly assigned to use the study product or hydroquinone 4% twice daily for 12 weeks to evaluate product efficacy, tolerability, and safety using investigator assessment, participant assessment, and dermospectrophotometry. Study results demonstrated efficacy parity between the study product and hydroquinone 4%. Thus this novel skin lightening preparation is an alternative to hydroquinone 4% for participants with mild to moderate facial dyschromia.

Glycolic acid peels versus amino fruit acid peels for acne.

INTRODUCTION: Chemical exfoliation resulting in the reduction of keratotic plugs serves as a second-line treatment used as an adjunct to anti-acne agents. This study was designed to compare the therapeutic effects of glycolic acid (GA) peels and amino fruit acid (AFA) peels in patients with acne vulgaris. METHODS: In this single-blind, randomized, right-left comparison study, 24 patients received 12 serial peels (GA and AFA, at concentrations from the lowest to the highest) on the two halves of the face at 2-week intervals for 6 months. In addition, cutaneous tolerability assessments during the applications and the patient preference test between both peeling methods at the end of the study were performed. RESULTS: There was a statistically significant decrease in the number of non-inflamed lesions with GA following the first month and with AFA following the second month (p < 0.05). The decrease in the number of inflamed lesions was statistically significant with GA at the end of the fifth and sixth months and with AFA only at the end of the fifth month (p < 0.05). When the two applications were compared with each other, there was not a statistically significant difference in terms of non-inflamed and inflamed lesions (p > 0.05). During the application, it was observed that AFA peels caused fewer problems than GA peels did. AFA concentrations were increased more rapidly and more sessions were performed at the highest concentration of AFA. CONCLUSION: Based on the results of this study, we can state that both GA and AFA peels are efficacious for comedonal acne. And, compared to a GA peel, an AFA peel is less irritating and better tolerated.

Interest of the association retinaldehyde/glycolic acid in adult acne.

BACKGROUND: Topical retinoids have been successfully used in the treatment of acne vulgaris but may induce irritation when used twice daily. The association of retinaldehyde (RAL) with glycolic acid (GA) have complementary activities, which could be of interest for adult women with acne because of a better tolerance/efficacy ratio. The aim of this study was to evaluate the tolerance and the efficiency of RAL (0.1%)/GA (6%) in adult women with acne when used alone or in combination with their usual acne products except retinoids. METHODS: Three hundred ninety-seven women with acne (aged between 30 and 40 years old) were included in this open multicentric study. They had to apply cream containing RAL/GA for 90 days without stopping their previous acne treatment (except topical retinoids). The tolerance was the main criteria and the second one is the efficacy, which was assessed by counting inflammatory and retentional lesions after 30 and 90 days of treatment. RESULTS: Used alone or in association with other anti-acne treatments, RAL/GA was considered to be highly tolerated. A significant decrease in both inflammatory and retentional lesions between day 0 and day 90 indicates that RAL/GA can be used as monotherapy for mild acne or could potentate the efficiency of other anti-acne products used at the same time by patients suffering from moderate acne. Complaints about side-effects were rare. The subjective evaluation of the preparation's efficacy by investigators and patients was strongly favourable. CONCLUSION: These data show that a combination of RAL 0.1% and GA 6% may be used in association with other topical anti-acne treatments with an excellent tolerance.

Enhancing cosmetic outcomes by combining superficial glycolic acid (alpha-hydroxy acid) peels with nonablative lasers, intense pulsed light, and trichloroacetic acid peels.

Nonablative lasers, intense pulsed light (IPL), and trichloroacetic acid (TCA) peels are cosmetic rejuvenation techniques used to remodel skin and provide improved skin texture, firmness, and even pigmentation. Glycolic acid is an alpha-hydroxy acid that can be used as a topical skin peel to provide important complementary benefits to nonablative lasers, IPL, and TCA peels. Superficial glycolic acid peels provide both epidermal and dermal antiaging benefits, can be used to smooth the stratum corneum to reduce light scattering, and can enable the use of lower concentrations of TCA during a peel procedure. When used with these procedures, glycolic acid peels can enhance skin benefits and perceived patient outcomes. Methods of combining nonablative lasers, IPL, and TCA peels with glycolic acid peels were discussed at a dermatologist roundtable event and are summarized in this article.

Use of nonthermal blue (405- to 420-nm) and near-infrared light (850- to 900-nm) dual-wavelength system in combination with glycolic acid peels and topical vitamin C for skin photorejuvenation.

BACKGROUND AND OBJECTIVES: A major cause of skin aging is a chronic microinflammation created by environmental conditions and ultraviolet exposures. The hand-free application on the skin of a new intense light combining a narrowband blue-light (405- to 420-nm) antiinflammatory emission and a near-infrared (850- to 890-nm) emission inducing self-defense mechanisms provides a new component to photorejuvenation and antiaging treatment protocols. STUDY DESIGN: An innovative skin rejuvenation schedule is presented in this study. It includes skin exposure to the light, with concomitant glycolic peels and daily vitamin C cream regimen for group A and only topical vitamin C cream and glycolic peels for control group B. RESULTS: Results show a significant improvement on pore size, rhytids, and radiance in group A. Conversely no improvement is noticed in group B except for a brief increase of skin radiance. Mechanisms of action of that specific light source are discussed. CONCLUSION: The exposure to this device can clinically enhance conventional antiaging protocols in skin rejuvenation.

Topical retinaldehyde with glycolic acid: study of tolerance and acceptability in association with anti-acne treatments in 1,709 patients.

BACKGROUND: Retinaldehyde (RAL), a key metabolite between vitamin A and retinoic acid, acts by modulating differentiation and proliferation of keratinocytes, which is of interest in acne lesions, mainly retentional lesions. Glycolic acid increases the exfoliation of corneocytes explaining its mild activity on retentional lesions. Thus, RAL and glycolic acid combined in the same product (Diacneal) have complementary activities which can be of interest for acne patients. The aim of this study was to evaluate the tolerance of Diacneal used by 1,709 acne patients in combination with their usual acne products except retinoids. RESULTS: This study demonstrated a very good tolerance of Diacneal when used with other acne treatments for 90 days. Complaints about side-effects were rare. Moreover, the significant decrease in both inflammatory and retentional lesions between day 0 and day 90 indicates that Diacneal could amplify the efficiency of other anti-acne products used at the same time by the patients. The subjective evaluation of the preparation's efficacy by investigators and patients was strongly favourable. CONCLUSION: These data show that a combination of RAL 0.1% and glycolic acid 6% may be used in association with other topical anti-acne treatments (benzoyl peroxide and topical antibiotics) with an excellent tolerance.

Antihypertensive and renal effects of tienilic acid.

Tienilic acid, a diuretic agent effective at the cortical diluting segment of the distal tubule, has been found to have equivalent antihypertensive action in a dose of 250 mg twice daily to hydrochlorothiazide in a dose of 50 mg twice daily. Tienilic acid reduced arterial pressure without diminishing renal plasma flow or endogenous creatinine clearance; moreover, it did so whilst achieving hypouricaemia through a uricosuric effect. Hypokalaemia was observed but corrected by supplemental potassium. A transient but reversible, slight elevation in serum creatinine concentration and significant hypertriglyceridaemia were also observed. In conclusion, tienilic acid seems to be a novel diuretic, well-suited for the patient with hypertension, particularly if there is coincidental gout or coexisting hyperuricaemia.