The Microbiome and Acne: Perspectives for Treatment.

The skin microbiome consists of the microorganisms populating the human skin. Cutibacterium acnes (C. acnes, formerly named Propionibacterium acnes) is recognized as a key factor in acne development, regulating inflammatory and immune pathways. Dysbiosis has been described as the imbalance in skin microbiome homeostasis and may play a role in acne pathogenesis. Microbial interference has been shown to be a contributor to healthy skin homeostasis and staphylococcal strains may exclude acne-associated C. acnes phylotypes. In this review we present an update on the skin microbiome in acne and discuss how current acne treatments such as benzoyl peroxide, orally administered isotretinoin, and antibiotics may affect the skin microbiome homeostasis. We highlight the collateral damage of acne antibiotics on the skin microbiome, including the risk of antimicrobial resistance and the dysregulation of the microbiome equilibrium that may occur even with short-term antibiotic courses. Consequently, the interest is shifting towards new non-antibiotic pharmacological acne treatments. Orally administered spironolactone is an emerging off-label treatment for adult female patients and topical peroxisome proliferator-activated receptor gamma (PPARγ) modulation is being studied for patients with acne. The potential application of topical or oral probiotics, bacteriotherapy, and phage therapy for acne are further promising areas of future research.

Expression of lymphatic markers and lymphatic growth factors in psoriasis before and after anti-TNF treatment

BACKGROUND: Angiogenesis is an early stage of psoriatic lesion development, but less is known about lymphagiogenesis and its role in the development of psoriasis. OBJECTIVE: To examine the expression of specific lymphatic markers and lymphatic growth factors in untreated psoriatic skin, in the unaffected skin of patients and skin of healthy volunteers, as well as their alteration after treatment with an anti-TNF agent. METHODS: Immunohistochemistry for the lymphatic markers D2-40 and LYVE-1, in addition to the VEGF-C and VEGF-D growth factors, was performed in the skin biopsies of psoriatic lesions and adjacent non-psoriatic skin of 19 patients before and after treatment with etanercept, as well as in the skin biopsies of 10 healthy volunteers. RESULTS: The expressions of D2-40, VEGF-C and VEGF-D on lymphatic vessels underwent statistically significant increases in untreated psoriatic skin compared with non-lesional skin, in contrast to LYVE-1, which did not involve significant increase in expression in psoriatic skin. VEGF-C expression on lymphatic vessels diminished after treatment with etanercept. Moreover VEGF-C and VEGF-D staining on fibroblasts presented with higher expression in lesional skin than in non-lesional adjacent skin. CONCLUSION: Remodeling of lymphatic vessels possibly occurs during psoriatic lesion development, parallel to blood vessel formation. The exact role of this alteration is not yet clear and more studies are necessary to confirm these results. .

The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece: results of a population survey / O impacto da acne vulgar na qualidade de vida e saúde psíquica em jovens adolescentes na Grécia: resultados de uma pesquisa populacional

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.

FUNDAMENTOS: Acne vulgar pode afetar seriamente o funcionamento social e psicológico. OBJETIVO: O objetivo deste estudo foi investigar o impacto da acne vulgar e sua gravidade na Qualidade de Vida de jovens adolescentes na Grécia. MÉTODOS: Nós conduzimos uma pesquisa baseada em questionário entre 1560 adolescentes com idades entre 11 e 19 anos e 1531 destes foram completados. Adolescentes com acne completaram todas as questões incluindo o Children Dermatology Life Quality Index (CDLQI). Adolescentes sem acne completaram as questões sobre idade, história familiar de acne, estresse e tabagismo. Os dados foram analisados pelo teste de chi-quadrado de Pearson. RESULTADOS: A prevalência de acne foi de 51.2%, afetando igualmente ambos os sexos. O auto relato de acne leve estava presente em 71.2% e de acne moderada a grave em 28.8% da população. A idade média da população em estudo foi de 15.77 anos. O escore médio do Children Dermatology Life Quality Index foi de 4.02. O impacto da acne na Qualidade de Vida está associado à gravidade da acne (p<0.0001). Pacientes com acne moderada/grave experimentam maior piora psico-social e emocional (p<0.0001). A imagem corporal é modificada proporcionalmente à gravidade da acne (p<0.0001). Sintomas e tratamento da acne são fatores que também influenciam sua qualidade de vida. Meninas e meninos são afetados igualmente. Estresse e hereditariedade estão correlacionados à acne e sua gravidade (p<0.0001). Nós não encontramos nenhuma correlação entre tabagismo e acne. CONCLUSÃO: Acne afeta a qualidade de vida de jovens adolescentes na Grécia. O impacto é proporcional à gravidade da acne. A acne mais grave está associada a um maior efeito na qualidade de vida com implicações na auto-estima, imagem corporal e relacionamento com outros.

Láseres para el rejuvenecimiento facial: revisión / Lasers for facial rejuvenation: a review

Antecedentes: Revisamos los diferentes tipos de láser para estirar la piel y remodelar el colágeno mediante cirugía cutánea con láser. Métodos: Se realizó una revisión sistemática de los diferentes tipos de láser que se emplean actualmente para el rejuvenecimiento de la piel. Estos sistemas son de ablación [láser de dióxido de carbono (COZ) de alta energía pulsado o controlado que emite a una longitud de onda de 10.600 nm, láser erbio: itrio aluminio granate (Er: YAG)) de pulso sencillo o variable o doble con ablación/coagulación, que emite a una longitud de onda de 2.940 nm o combinación de las longitudes de onda de 10.600 nm y 2.940 nm] o no ablativo [láser granate neodimio:itrio aluminio (NdYAG) con cambio de Q, que emite a una longitud de onda de 1.064 nm, láser Nd: YAG que emite a una longitud de onda de 1.320 nm o láser de diodo, que emite a una longitud de onda de 1.450 nm. Se comentan los diferentes protocolos, selección de pacientes, técnicas de tratamiento y complicaciones de cada uno de los sistemas. Resultados: Los láseres de COZ de nueva generación para rejuvenecer la piel han sido muy eficaces en la piel dañada por la luz y con cicatrices, con una morbilidad postquirúrgica dependiente de la profundidad de la lesión térmica. Debido a su penetración mínima, el láser pulsado Er: YAG, generalmente, usado en el tratamiento de arrugas más superficiales, produce menos morbilidad postquirúrgica. Se han desarrollado nuevos sistemas de ablación y -el mayor conocimiento de la interacción entre el tejido y el láser nos ha permitido diseñar sistemas no ablativos para el tratamiento de las arrugas, cicatrices y piel dañada por la luz, cuya eficacia no se ha evaluado a largo plazo. Conclusiones: Hay muchos tipos de técnicas eficaces para la revisión y tratamiento de las cicatrices de la piel envejecida, pero todas tienen problemas debido a una falta de control precisa de la profundidad y de las lesiones indeseables de las capas inferiores de la dermis. El láser ErYAG es el tratamiento de elección para las cicatrices y las líneas finas superficiales, mientras que el láser de COZ es mejor en arrugas más profundas y cicatrices. En el futuro se usará una combinación de láseres para el rejuvenecimiento facial (AU)