Guidelines of care for the management of acne vulgaris.

Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.

Anti-Aging Effects of Probiotics.

The body of evidence demonstrating the beneficial effects of probiotics on the skin continues to grow in the published literature. Insights into their effects at the molecular level, in animal models, and in human clinical trials build the case for their role in slowing the skin manifestations of both intrinsic and extrinsic aging. The reports reviewed in this manuscript demonstrate that probiotics can restore acidic skin pH, alleviate oxidative stress, attenuate photoaging, improve skin barrier function, and enhance hair quality.

Effect of Midfacial Volume Augmentation With Non Animal Stabilized Hyaluronic Acid on the Nasolabial Fold and Global Aethestic Appearance.

INTRODUCTION: Non animal stabilized hyaluronic acid (Perlane, Galderma, SA) was FDA approved in 2007 for the treatment of facial wrinkles and folds. Off-label use led to the observation that injection of Perlane in the midface improved both global aesthetic appearance and reduced the depth of nasolabial folds. A proof-of-concept trial was undertaken to explore this clinical observation further. METHODS: Twenty subjects with moderate midfacial volume loss and prominence of nasolabial folds underwent injection of the midface with Perlane between May and July, 2009. The average volume administered was 3.68 +/- 0.55 ml. Assessments were performed by the injecting physician and subject self-assessment for 6 months following treatment. RESULTS: 17 of 20 subjects completed all study visits. At the 6-month follow up visit 16 of 17 subjects were found to have clinically significant improvement of the midface and 14 of 17 subjects were found to have clinically significant improvement of the nasolabial folds. No serious adverse events occurred. CONCLUSION: In this early stage, proof-of-concept trial, the majority of patients treated demonstrated clinically significant, aesthetically pleasing improvement 6 months after injection of Perlane in the midface.

Antibiotic resistance and acne: where we stand and what the future holds.

Antibiotic resistance is described as "a global public health challenge" and a "major health security challenge of the 21st century" by global health authorities,1 and there is a growing need for dermatologists to counteract it in their treatments of acne.3,4 Antibiotic limiting regimens, such as a combination of topical retinoids and benzoyl peroxide, have shown effectiveness in the treatment of acne; and topical probiotics could also play a needed role.

Diet and acne update: carbohydrates emerge as the main culprit.

The prevalence of adult acne in the US appears to be increasing over the last few decades. But what's behind the rise: is it nature or nurture? We are well aware that genetics can strongly influence a patient's risk of developing acne. However, significant changes in germline genetic variants are unlikely to have occurred over the last 20 years. Consequently, we are forced to examine environmental variables, including diet. This review article presents the most updated evidence supporting a link between refined carbohydrates and acne. Based on the data summarized here, dermatologists should encourage their acne patients to minimize their intake of high glycemic index foods.

Cosmetic benefits of natural ingredients.

Photoaging is a leading concern for patients and many of these patients will express a desire to utilize natural ingredients as treatment. Mushrooms, feverfew, green tea, licorice, olive oil, soy, and coffee berry have been shown to have antioxidant properties and may play a role in the treatment and prevention of photoaging. In this manuscript, the most recent select basic science and clinical studies examining the mechanisms and efficacy of these ingredients will be discussed.

The importance of photoprotection and moisturization in treating acne vulgaris.

Skin care products are recognized by dermatologists as critical adjunctive therapeutic modalities for patients suffering from acne vulgaris (AV). Prescribing an acne medication without reviewing a patient's skin care regimen can lead to poor compliance, intolerable side effects, and resulting patient and physician frustration. Striking that delicate balance between maintaining the skin barrier while controlling oil and shine has always been a challenge when treating this chronic inflammatory condition, and it necessitates a unique set of ingredients and formulation. Cetaphil® DermaControl™ Moisturizer SPF 30 (Galderma Laboratories, L.P., Fort Worth, Texas) is a new generation of skin care specifically designed for acne-prone skin and acne-affected skin. Both Cetaphil® DermaControl™ Foam Wash and Cetaphil DermaControl Moisturizer SPF 30 incorporate pharmacologically tested, state-of-the-art ingredients and technologies that studies have shown impart substantial benefits to AV patients.

The clinical efficacy and tolerability of a novel triple acid exfoliating blend for reducing signs of photoaging in sensitive skin.

BACKGROUND: Chemical exfoliation of the skin is a frequently utilized treatment in dermatology to improve the appearance and health of photoaged skin. Photodamaged skin is especially prone to dryness and irritation. Over-exfoliation with at-home products are partially to blame for the "epidemic" of sensitive skin affecting over half the population. Combining AHA, BHA, and PHA together creates a complementary blend that has the potential to target numerous age-related changes in the skin including the appearance of pores and smoothing skin texture, while firming skin and increasing its collagen and moisture content. OBJECTIVES: The following study tested the clinical efficacy of a triple acid blend designed specifically for sensitive skin and measured improvements in signs of photodamage and hydration levels in the skin over time. METHODS: Thirty females aged 35-60 with mild to moderate facial lines, wrinkles, sun damage, uneven skin tone/texture, dark spots, or pores were enrolled. Subjects were instructed to use the test article, DWB-EN, on a clean face at night 3 times weekly with 48 h between applications for 4 weeks. RESULTS: Statistically significant improvements were noted in all parameters of photoaging clinical assessments (wrinkles, pores, overall appearance, luminosity, visible texture, skin tone evenness, hyperpigmentation) at the end of the 4-week study period. There were no instances of skin irritation throughout the duration of this study despite half of the women having sensitive skin. CONCLUSIONS: Overall, this study demonstrated the clinical efficacy and tolerability of DWB-EN for treating photoaging in subjects with all skin types.

Cosmetic benefits of natural ingredients: mushrooms, feverfew, tea, and wheat complex.

Natural ingredients are frequently used in an effort to address cosmetic concerns such as fine lines, wrinkles, uneven tone, and texture. Many of these ingredients found in nature possess potent antioxidant as well as anti-inflammatory properties. Some, such as mushroom extracts, are even capable of accelerating the skin turnover rate and repairing dermal molecular components that provide structure and elasticity to the skin. Others, such as green tea, provide photoprotection against ultraviolet-induced DNA damage. In this manuscript, the cosmetic benefits of mushrooms, feverfew, and tea are discussed in the context of their ability to improve the appearance of the skin. The healing effects that wheat complex can have on damaged hair are also addressed.

A clinical evaluation of the efficacy and tolerability of a novel topical antioxidant formulation featuring vitamin C, astaxanthin, and fermented turmeric.

BACKGROUND: Ultraviolet light, visible light, infrared light, and pollution are a few examples of environmental factors that exacerbate the formation of reactive oxygen species (ROS) that cause damage to skin cells' DNA, proteins, and lipids. By supplementing the skin with antioxidants, we can help neutralize ROS formed by these extrinsic factors before they can damage the skin. AIMS: This prospective open-label study explores the safety and efficacy of this novel topical formulation of antioxidants (vitamin C, astaxanthin, fermented turmeric, and vitamin E) designed to fight free radical damage and improve overall skin quality, as well as the appearance of fine lines, wrinkles, radiance, and hyperpigmentation of the skin. PATIENTS/METHODS: This single-center clinical study evaluated the efficacy of twice-daily application of the test article (Asta C™ Vitamin C Age Defense Serum, Dr. Whitney Bowe Beauty) in 32 subjects for 12 weeks. Healthy female subjects aged 35-60 with mild to moderate fine lines, wrinkles, and hyperpigmentation/uneven skin tone were enrolled in this study. Fitzpatrick skin types I-VI, all skin types (dry, normal, combination, oily), and subjects with sensitive skin were included. RESULTS: All subjects demonstrated improvement in overall skin quality (face, neck, and chest) by the end of the 12-week study period. One hundred percent of subjects demonstrated improvement in the appearance of fine lines at Week 12. CONCLUSIONS: Overall, the current clinical study demonstrates that Asta C™ is safe, well-tolerated, and effective in improving overall skin quality, as well as the appearance of fine lines, wrinkles, radiance, and hyperpigmentation of the skin.

Acne vulgaris: the role of oxidative stress and the potential therapeutic value of local and systemic antioxidants.

Acne vulgaris is a common dermatological condition characterized by hormonally-mediated sebum overproduction, follicular hyperkeratinization, and chronic inflammation of the pilosebaceous unit. Microbes, genetic susceptibilities, and various environmental factors have been linked to the pathogenesis of the condition. Over the last several years it has become apparent that patients with acne are under increased cutaneous and systemic oxidative stress. Moreover, the burden of oxidative stress may not be a mere consequence of acne; rather, the oxidative stress, lipid peroxidation in particular, may be an early event that helps to drive the acne process. Here, we explore the role of oxidative stress and review the preliminary research involving the administration of local and systemic antioxidants.

Diet and acne.

Historically, the relationship between diet and acne has been highly controversial. Before the 1960s, certain foods were thought to exacerbate acne. However, subsequent studies dispelled these alleged associations as myth for almost half a century. Several studies during the last decade have prompted dermatologists to revisit the potential link between diet and acne. This article critically reviews the literature and discusses how dermatologists might address diet when counseling patients with acne. Dermatologists can no longer dismiss the association between diet and acne. Compelling evidence exists that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne, and the roles of omega-3 fatty acids, antioxidants, zinc, vitamin A, and dietary fiber remain to be elucidated. This study was limited by the lack of randomized controlled trials in the literature. We hope that this review will encourage others to explore the effects of diet on acne.

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.

The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review.

OBJECTIVE: To review recent studies on the use of antibiotics in acne vulgaris which provide insight into the development of antimicrobial resistance. DATA SOURCES: Sources for this article were identified by searching the English literature by Medline for the period 1960 to March 2009. STUDY SELECTION: The following relevant terms were used: acne, acne vulgaris, acne and antibiotic therapy, acne and antimicrobial resistance, acne and resistance mechanisms, acne and systemic infections, acne and antibiotic resistance and coagulase-negative Staphylococcus aureus (S. aureus), acne and antibiotic resistance and upper respiratory infection. DATA SYNTHESIS: Both correct and incorrect use of antibiotics for acne vulgaris can promote antimicrobial resistance. The development of this resistance is promoted by several factors, including antibiotic monotherapy, long-term administration of antibiotics, indiscriminate use outside their strict indications, dosing below the recommended levels, and the administration of antibiotics without concurrent benzoyl peroxide and/or topical retinoids. CONCLUSION: Long-term use of antibiotics in the treatment of acne vulgaris can lead to antimicrobial resistance with serious and intractable problems not limited to Propionibacterium acnes (P. acnes), the skin and acne vulgaris themselves, but also to other bacterial species, with systemic consequences. These findings suggest that antibiotics should be prescribed in combination with benzoyl peroxide and/or topical retinoids and be limited to a maximum of several months.

Validity of subject self-report for acne.

BACKGROUND/OBJECTIVE: Acne prevalence studies often use subject self-report as data source. Our aim was to evaluate the validity of acne self-report. METHODS: Responses of university students to an acne questionnaire were compared to the trained observer's concurrent examination of acne. The validity of self-report was measured by sensitivity, specificity, positive predictive value and negative predictive value. Agreement was measured by Cohen's kappa and correct classification percentage. RESULTS: The sensitivity of self-report was 0.55 (95% CI 0.47-0.63), the specificity was 0.72 (95% CI 0.63-0.80), the positive predictive value was 0.70 (95% CI 0.61-0.78), and the negative predictive value was 0.57 (95% CI 0.49-0.65). Cohen's kappa was 0.26 (95% CI 0.15-0.38) and correct classification percentage was 63. CONCLUSIONS: Validity of self-report was moderate at best and agreement was fair, indicating that college students could not accurately report that they have acne. This is likely not sufficient for clinical or research activities or to assure that individuals who self-guide their acne therapy actually have acne.

Body dysmorphic disorder symptoms among patients with acne vulgaris.

BACKGROUND: Acne is one of the most common concerns of patients with body dysmorphic disorder (BDD), a psychiatric condition defined as a preoccupation with a slight or imagined defect in appearance that causes significant disruption in daily functioning. OBJECTIVE: We sought to screen for BDD symptoms among patients with acne across a spectrum of acne severity. METHODS: We used a validated self-report questionnaire and an objective assessment of acne severity by a single observer. RESULTS: Rates of BDD ranged from 14.1% using more stringent criteria to assess acne severity to 21.1% using less stringent criteria. Two-fold increased odds of having BDD was seen in patients requiring systemic isotretinoin therapy. LIMITATIONS: Cross-sectional study design is a limitation. CONCLUSION: A significant proportion of patients, regardless of their acne severity at the time of examination, have substantial distress and preoccupation related to their facial appearance.

Upper respiratory tract infection in household contacts of acne patients.

BACKGROUND: Antibiotic use in acne patients has been associated with an increased risk of upper respiratory tract infection (URTI). METHODS: This was a retrospective cohort study using the General Practice Research Database of the United Kingdom. All study subjects were identified as sharing a residence with a patient with a diagnosis of acne. Outcome of interest was a URTI. RESULTS: We identified 98,094 contacts of acne patients. A contact of an acne patient who had a URTI was about 43% more likely to develop a URTI than a contact of an acne patient who did not have a URTI (OR = 1.43 CI = 1.33-1.52, p < 0.001). Exposure to an acne patient using antibiotics did not independently increase a contact's risk of URTI (OR = 0.94, CI = 0.89-1.00, p = 0.063). CONCLUSIONS: Although acne patients on antibiotics are about 2 times more likely to develop URTIs, their household contacts do not appear to be at an increased risk of URTI.