The influence of dietary patterns on acne vulgaris in Koreans.

The association between acne and food has been evaluated with inconsistent results. We enrolled 783 patients with acne and 502 control subjects. For the patients with acne, blood tests for insulin, insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), post prandial 2 hours blood glucose (PP2), and dehydroepiandrosterone sulphate (DHEAS) were performed. The acne patients were divided into an "aggravated by food" group (AF) and a "not aggravated by food" group (NAF). All participants were asked to fill out a questionnaire. The frequency of vegetables (yellow, green leafy, cruciferous) (P = .001) and fish (white flesh and green fish, blue tuna) ((P = .03) intake was significantly higher in the control group than in the acne group. Intake of instant noodles (P = .01), junk food (P = .002), carbonated drinks (P = .005), snacks (P = .001), processed cheeses (P = .04), pork (braised) (P = .02), pork (roast) (P < .001), chicken (fried) (P = .001), chicken (stewed) (P = .001), nuts (P = .002) and seaweed (P = .003) were significantly higher in the acne patients than in the controls. Intake of roast pork (P = .02), fried chicken (P < .02), and nuts (P = .03) was significantly higher in the AF than NAF. In addition, the regularity of inter-meal intervals (P < .001) and breakfast intake (P < .001) were significantly lower in the acne patients. IGF-1 and IGFBP-3 showed sexual differences. This study also showed that a high glycemic load diet, dairy food intake, high fat diet, and iodine in Korean foods appear to play a role in acne exacerbation. In addition, irregular dietary patterns were found to aggravate acne.

Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study.

BACKGROUND: No studies have reported a comparison of the pulsed dye laser (PDL) and the 1064-nm long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment of acne scars in the same patient. OBJECTIVE: To compare the efficacies of these two lasers in the treatment of acne scars. METHODS: Eighteen patients received 4 sessions of PDL or Nd:YAG laser at 2-week intervals in a randomized split-face manner. RESULTS: Both lasers induced notable and comparable improvement in the appearance of acne scars, particularly superficial scars, with significant reductions in the scores associated with the clinical evaluation scale for acne scarring (ECCA). Histologic evaluations revealed significant increases in collagen production and deposition following both lasers. Patient satisfaction scores concurred with these improvements. Ice-pick scars and boxcar scars tended to respond better to PDL and Nd:YAG lasers, respectively. LIMITATIONS: The number of subjects was small. CONCLUSIONS: Both lasers are effective modalities for the treatment of acne scars. Optimal outcomes might be achieved considering scar types and responses to a specific laser.

Comparison of a pulsed dye laser and a combined 585/1,064-nm laser in the treatment of acne vulgaris.

BACKGROUND: The effect of combined 585/1,064-nm (sequential dual-wavelength pulsed dye laser (PDL) and neodymium-doped yttrium aluminium garnet) laser therapy for acne vulgaris has not been evaluated. OBJECTIVES: To compare the efficacy and safety of PDL and of combined 585/1,064-nm laser treatment for mild to moderate facial acne. METHODS: A 12-week, randomized, prospective, split-face, double-blind study was performed. Sixteen participants with mild to moderate acne were treated with a single pass of a combined 585/1,064-nm laser on half of the face and PDL on the other half during each treatment session. Patients underwent three treatment sessions at 2-week intervals and were followed up at 8 and 12 weeks after treatment commencement. RESULTS: At the final visit, inflammatory acne lesions were reduced by 86% on the PDL sides and by 89% on the 585/1,064-nm laser sides. Noninflammatory acne lesions showed corresponding reductions of 69% and 64%, respectively. A significant difference between the two treatments was observed for noninflammatory acne lesions at the eighth week. Histopathologic examinations showed that both treatments decreased inflammation and interleukin-8 expression and increased transforming growth factor beta expression. CONCLUSIONS: PDL and combined 585/1,064 nm laser were safe and effective for the treatment of inflammatory and noninflammatory acne lesions.

Epigallocatechin-3-gallate improves acne in humans by modulating intracellular molecular targets and inhibiting P. acnes.

Acne vulgaris is a highly prevalent skin disorder characterized by hyperseborrhea, inflammation, and Propionibacterium acnes overgrowth. Only isotretinoin and hormonal therapy reduce sebum production. To identify a new drug candidate that modulates sebum, we examined the effects of EGCG, the major polyphenol in green tea, on human SEB-1 sebocytes and in patients with acne. In SEB-1 sebocytes, we found that EGCG reduced sebum by modulating the AMPK-SREBP-1 signaling pathway. EGCG also reduces inflammation by suppressing the NF-κB and AP-1 pathways. EGCG also induces cytotoxicity of SEB-1 sebocytes via apoptosis and decreases the viability of P. acnes, thus targeting almost all the pathogenic features of acne. Finally, and most importantly, EGCG significantly improved acne in an 8-week randomized, split-face, clinical trial, and was well tolerated. Our data provide a therapeutic rationale for the use of EGCG in acne.

A multicenter epidemiological study of acne vulgaris in Korea.

BACKGROUND: Acne is a common skin disorder that affects both adolescents and adults. However, few epidemiological studies on this condition have been conducted in Asia. OBJECTIVES: The purpose of this study was to analyze the incidence of acne and to identify its demographic and clinical features and aggravating factors. In addition, we examined the relationships between these factors. METHODS: Epidemiological and clinical data were obtained, using a self-administered questionnaire, from patients who visited 17 general hospitals and from the consulting dermatologists. RESULTS: A total of 1236 patients were involved in this study. Acne first developed and presented most commonly on the forehead and cheeks, although the cheeks were more severely affected. Significant associations were found between the clinical, epidemiological, and behavioral characteristics of acne patients according to several factors, such as sex, age at onset, previous treatment history, and family history. The present study indicates that stress, lack of sleep, smoking, alcohol consumption, and menstruation aggravate acne. CONCLUSIONS: This study presents the demographic features and clinical characteristics of acne sufferers in Korea. This large-scale analysis provides a useful overview of acne in Korea.

A study of the efficacy of cleansers for acne vulgaris.

BACKGROUND: Acne treatments are sometimes expensive, and mild acne patients need some simpler form of treatment and, thus, the need for easier and cheaper ways of managing acne is increasing. METHODS: An 8-week, double-blind, randomized clinical trial was conducted to determine whether cleansers are effective at producing clinical improvements in patients with acne vulgaris. A total of 13 acne patients applied cleanser A to one half of the face and cleanser B (cleanser A plus triclosan, salicylic acid, and azelaic acid) to the other half, twice daily. RESULTS: The numbers of inflammatory and non-inflammatory lesions decreased on both sides. A rebound tendency was noted for cleanser A with respect to inflammatory lesions at 4 weeks post-discontinuation, whereas inflammatory lesions continued to decrease on sides treated with cleanser B during this period. However, non-inflammatory lesion counts were not significantly different in the two groups. Though patients were generally satisfied with both treatments, they were more satisfied with cleanser B. Moreover, histopathologic examinations showed a profound decrease in inflammatory reactions in the cleanser B group. CONCLUSION: These results show that acne cleansers reduced both inflammatory and non-inflammatory acne lesion counts, and might be helpful for acne treatment.

Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients.

Oral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck's depression inventory [BDI]), anxiety (Beck's anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade.

Disseminated Superficial Porokeratosisin a Patient with Gastric Cancer.

Disseminated superficial porokeratosis (DSP) is a rare variant of porokeratosis, which is characterized histologically by cornoid lamella and clinically by central atrophy with elevated borders. DSP is usually associated with immunosuppressive states and hematopoietic malignancies, but rarely with malignancies of visceral organs. A 65-year-old male presented with numerous brownish macules with elevated borders on the trunk and limbs that had been present for 1 year. Before the visit to our clinic, gastric cancer was diagnosed at about the same time the skin lesions suddenly increased in size and number. Clinical and histopathological examination revealed that the lesions were consistent with DSP. We herein report a rare case of disseminated superficial porokeratosis that occurred in association with gastric cancer.

Combination therapy of cyclosporine and methylprednisolone on severe alopecia areata.

BACKGROUND: Although systemic cyclosporine appears to be one of the treatment options for chronic severe alopecia areata (AA), the high recurrence rates after discontinuation and side effects make cyclosporine a nominal agent for the treatment of AA. OBJECTIVE: This study was designed to determine whether the combination therapy of cyclosporine and methylprednisolone could be an effective treatment for severe AA. METHODS: A total of 46 patients with severe AA were treated with a combination of cyclosporine (200 mg twice daily, two 100 mg tablets) and methylprednisolone (24 mg twice daily for men, 20 mg twice daily for women, and 12 mg twice daily for children). The doses of methylprednisolone were diminished by 4 mg/day weekly, and the dose of cyclosporine was decreased gradually after cessation of administration of methylprednisolone. RESULTS: Three (6.5%) of 46 patients discontinued the treatment due to side effects. Of the remaining 43 patients, 38 (88.4%) had significant hair regrowth and five (11.6%) were considered to be treatment failures. Nine (23.7%) relapsed during the observation period of 12 months. CONCLUSIONS: Although limited by its uncontrolled character, this study shows that combination therapy with cyclosporine and methylprednisolone may be a useful treatment for severe AA.

Treatment-seeking behaviors and related epidemiological features in Korean acne patients.

Little is known about the treatment-seeking behaviors of acne patients, especially Asian acne patients. This study was performed to obtain detailed information about the treatment-seeking behaviors in Korean acne patients. Patients who visited the dermatology departments at 17 university hospitals completed a self-administered questionnaire. Most patients obtained information about acne from doctors or the Internet. The most important criteria for selecting a treatment method or choosing a particular clinic were effectiveness and accessibility. Patients used traditional medicine, visited beauty clinics, drank more water, and used over-the-counter topical agents more frequently than they sought doctors during the worsening period. The degree of satisfaction in treatment was found to depend on the total cost of treatment, number of places visited, site affected by acne, and emotional stress. Those who had experienced a side effect tended to have been treated for longer, to have paid more for treatment, and to have an associated skin disease. Treatments prescribed by dermatology clinics had the lowest aggravating rate, although improvement rates for family medicine clinics were also fairly high. This is the first study to investigate in detail the demographic features and characteristics of the treatment-seeking behaviors of acne patients in Asia.