Severe osteoarticular involvement in isotretinoin-triggered acne fulminans: two cases successfully treated with anakinra.

Acne fulminans (AF) is a severe form of inflammatory and ulcerated acne associated with fever, malaise, joint swellings and polyarthralgia.1 Osteoarticular lesions are often described and can be radiologically indistinguishable from those observed in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome.2,3 SAPHO is an autoinflammatory disease characterized by osteoarticular and cutaneous manifestations, the latter including nodular and fulminans acne, hidradenitis suppurativa and palmoplantar pustulosis.3 Thus, AF is considered part of the SAPHO spectrum.

Nutritional factors associated with acne vulgaris

Acne Vulgaris is a common dermatological condition defined as a chronic inflammatory dermatosis of the pilosebaceous unit that affects more than 17 million Americans.^1 Although it is not considered a dangerous condition, it may drastically impair quality of life and leave a substantial psychological impact.^2 Acne’s multifactorial pathogenesis is typically categorized into four aspects: increased sebum production, altered keratinization, inflammation, and bacterial colonization.^3 Dietary factors contribution to the pathogenesis of acne has remained controversial throughout the literature. However, currently there exists a greater understanding between how diet may influence endocrine factors contributing to acne pathogenesis.^4 Additionally, recent published evidence and public paradigm shifts highlighting the relationship between diet and health have caused a resurgence of this topic, particularly among patients seeking a more gentle, alternate solution to current treatments. Some of the most promising recent correlating evidence supports an association between acne prevalence and dairy consumption, particularly skim milk consumption.^5 It is hypothesized that milk consumption affects the presence of both reproductive, non-reproductive hormones, and growth factors in our body, which may contribute to increased acne prevalence.^6 However, there has been a lack of randomized controlled trials to determine the cause and effects nature of this relationship, as all previous studies are observational.^1 Therefore, this study will conduct a randomized controlled trial to determine the significance between dietary non-fermented dairy consumption and acne prevalence in adolescents. We hypothesize the adaptation of a diet of decreased dairy consumption will decrease the prevalence or severity of acne vulgaris in adolescents between the ages of 13-18. It is our hope that the conclusion of this study will advance our understanding of the dietary correlation between dairy and acne vulgaris in order to provide further insight to guide medical practitioners’ ability to help treat this distressing condition

Determination of releationship Between the Zinc serumic level &severity of Acne vulgaris among patients refer Dermatology clinic of Emam-Khomani-Hospital-Ardebil

Bachground & aim: Acne vulgaris is a common human skin disease, characterized by areas of skin with seborrhea , comedones (blackheads and whiteheads), papules , pustules , nodules and possibly scarring. Acne affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.Acne occurs most commonly during adolescence, and often continues into adulthood. Acne affects in males and females but the most sever forms of acne occur more frequently in males. Materials & Methods: This study has been done as a case study. case study sample consisted of 100 people with Acne vulgaris disease who had referd to skin clinics of Emam. KHomeyni hospital. 100 healthy people who had the same sex & same age were selected & then zinc serum levels were measured on this 2 groups. Through biochemical experiments. Then the fnding were analyzed by student t –test by spss software & compared & average different of zinc serum levels in 2 groups by p<0.05 was considered miningful. Result:Among 100 case study sample, 17 people were male & 83 were female.the mean of age is 21.39 years old..The common type of disease is Mild (64%). The average zinc serum levels in patients is 81.31 & 82.63 in healthly people that p<0.598 was'n meaningful difference between zinc serum level on 2 groups & was'nt meaningful difference between zinc serum level & sex & duration. But was meaningful difference between zinc serum level & severity of acne (p<0.028 ) & forms & zone of acne . Conclusion: Meaningful relation between reduction of zinc serum level & severity of acne & forms & zone of acne

Profile of clindamycin phosphate 1.2%/benzoyl peroxide 3.75% aqueous gel for the treatment of acne vulgaris.

Acne vulgaris is a common and chronic skin disease, and is a frequent source of morbidity for affected patients. Treatment of acne vulgaris is often difficult due to the multifactorial nature of this disease. Combination therapy, such as that containing clindamycin and benzoyl peroxide, has become the standard of care. Several fixed formulations of clindamycin 1% and benzoyl peroxide of varying concentrations are available and have been used with considerable success. The major limitation is irritation and dryness from higher concentrations of benzoyl peroxide, and a combination providing optimal efficacy and tolerability has yet to be determined. Recently, a clindamycin and benzoyl peroxide 3.75% fixed combination formulation was developed. Studies have suggested that this formulation may be a safe and effective treatment regimen for patients with acne vulgaris. Here, we provide a brief review of acne pathogenesis, benzoyl peroxide and clindamycin, and profile a new Clindamycin-BP 3.75% fixed combination gel for the treatment of moderate-to-severe acne vulgaris

Acneiform dermatoses

Acneiform dermatoses are follicular eruptions. The initial lesion is inflammatory, usually a papule or pustule. Comedones are later secondary lesions, a sequel to encapsulation and healing of the primary abscess. The earliest histological event is spongiosis, followed by a break in the follicular epithelium. The spilled follicular contents provokes a nonspecific lymphocytic and neutrophilic infiltrate. Acneiform eruptions are almost always drug induced. Important clues are sudden onset within days, widespread involvement, unusual locations (forearm, buttocks), occurrence beyond acne age, monomorphous lesions, sometimes signs of systemic drug toxicity with fever and malaise, clearing of inflammatory lesions after the drug is stopped, sometimes leaving secondary comedones. Other cutaneous eruptions that may superficially resemble acne vulgaris but that are not thought to be related to it etiologically are due to infection (e.g. gramnegative folliculitis) or unknown causes (e.g. acne necrotica or acne aestivalis)

Demographic Features, Beliefs And Socio–Psychological Impact Of Acne Vulgaris Among Its Sufferers In Two Towns In Nigeria

There is paucity of reports in the demographic knowledge, belief and socio-psychological impact of acne vulgaris sufferers towards the disorder in a black population. This is the first study from Nigeria designed to address this issue. A total of 174 facial acne sufferers completed a self-administered questionnaire, which contained several items mentioning different areas in their belief, knowledge, perception, severity, socio-psychological impact and medication attention. The findings were discussed and compared to those of the Caucasians. The occurrence of the disorder was higher in females (65.0%) compared to the males (35.0%). About 54.0% of the female subjects indicated increase in severity of the disorder during their pre-menstrual period. Also 64.9% of acne sufferers indicated increase in severity during the rainy season, while 93.1% of the population implicated stress to perpetuate the severity of the disorder. Most (75.7%) of the acne sufferers believed that it is caused by oily diet, 40.8% thought that it is hereditary, while barely 5.2% had at sometime sought doctor's attention. Non- prescription products used by acne sufferers were cleansers and cream/lotions. Psychological abnormalities experienced by the sufferers included social inhibition, depression and anxiety. Pain and discomfort are the psychosomatic symptoms. No major differences were found in the beliefs, misconception and socio-psychological impact of acne sufferers in a black population (Nigeria) compared to the Caucasians. There is need to improve the understanding of the disorder in Nigeria through health education programmes

Metagenomic study of the human skin microbiome associated with acne

The human microbiota contributes to our normal postnatal development and plays a significant role in defining our physiology. To understand the role of microbiota in human health and disease, we study the skin microbiome in pilosebaceous units (hair follicles) and its association with acne.&#xd;&#xa;&#xd;&#xa;Acne is one of the most common skin diseases. Although its etiology still needs to be defined, a bacterial factor has been suggested in the development of the disease. In fact, antibiotic therapy targeting _Propionibacterium acnes_ has been a mainstay treatment for more than 30 years.&#xd;&#xa;&#xd;&#xa;Our preliminary study shows that the microcomedone, a specialized skin compartment where acne arises, has a tractable microbiome, with a single dominant species, _P. acnes_. This system offers a unique advantage allowing in-depth analysis of a human microbiome at the subspecies level by sequencing. Our preliminary study suggests that the microbiome associated with acne offers promise for understanding the correlation between the composition of the microbiome and human health and disease.&#xd;&#xa;&#xd;&#xa;The goal of the project is to determine whether the microbiota in the pilosebaceous units contributes to acne. We plan to investigate the microbiome associated with acne in three directions. First, we plan to investigate the strain diversity of _P. acnes_ in a disease cohort and a normal cohort and examine whether certain strains of _P. acnes_ are correlated with the disease. Second, we plan to investigate the non- _P. acnes_ microbes in microcomedones and disease lesions and examine whether they correlate with acne pathogenesis. Third, we will examine the interactions between the microbes and the host by transcriptional profiling of both the microbiota and the host.&#xd;&#xa;&#xd;&#xa;During the first year of this project, two main questions were asked. 1. Are certain strains of _P. acnes_ associated with acne, but rarely found in normal individuals? 2. If specific strains are associated with acne, what are the differences in their genetic composition compared to other _P. acnes_ strains that are not associated with acne? We collected microcomedone samples from more than 100 subjects, including acne patients and normal individuals. Genomic DNA was extracted from each sample, and 16S rDNA was amplified using universal primers (8F and 1510R), cloned and sequenced using Sanger method. Approximately 384 near full length 16S rDNA sequences were obtained for each sample. Some of the microcomedone samples were also cultured under anaerobic condition to isolate different P. acnes strains. Sixty-eight isolates were selected for whole genome shotgun sequencing using Solexa/Illumina platform. By the end of the first year of the project, we completed the sequencing of more than 40,000 16S rDNA clones and 68 genomes of _P. acnes_ isolates.&#xd;&#xa

Diagnostic challenges and treatment difficulties in a patient with excoriated acne conglobata

Acne conglobata is a rare and severe form of acne vulgaris, characterized by the presence of comedones, papules, pustules, nodules and sometimes hematic or meliceric crusts. Acne excoriée is a form of self-inflicted skin condition in which the patient picks on imaginary or real acne lesions. We report the case of a 16 year old Caucasian female patient from the urban area who addressed our dermatology department for erythematous, edematous plaques covered by pustules and crusts, located on the face. The anamnesis revealed that during the last weeks she had had a depressive mood after ending a relationship with her boyfriend and started scratching and picking on the lesions. The patient\u27s depressive mood prior to the worsening of the disease was probably aggravated by the condition. This might have determined the picking of the skin which could have impeded the response to standard treatment. The self-excoriative behavior could also be regarded as an appeal for help

Comprasion of Acnea prevalence in melasmatic and non-melasmatic (with and without Hirsutism) more than 27 years old woman

Objective: Melasma is the adventitious increase of skin pigments that is created slowly and with a symmetric form.Acne is a chronic inflammatory disease of the pilosebaceous units.Because of high prevalence of melasma in Ardabils women & because of existing the acne and hirsutism at the same time in number of studies, this study conducted to evaluation about prevalence of acne in melasmatic and non-melasmatic (with and without hirsutism) women. Methods: This study is a case-control study that 141individuals from womans with melasma with ages higher than 27 years old and 141individuals from women without melasma and also without Hirsutism with ages higher than 27 years old and 141individuals from women without malasma but with hirsutism who are consulting the specialized skin clinic, are selected randomly, moreover, they are going to answer the questionnaires,after collecting these questionnaires, according to the patients' responses and by using statistical soft wares the considered purposes are analyzed.to diagnosis of acne GAGS classifying is used. Results:The average ages of patients in case group wase 34.8-+5.2 & in first control group wase 31.6-+5.1 & in second control group wase 32.4-+5.5. in case group 75.88% & in first control group 70.2% & in second control group 64.53% of patients sufferd from acne. Conclusion: Acne usually resolve until 25 years & only in 7-17% of individuals it persists beyond of 25 years. The high prevalence of acne in case group confirmed the findings of previous studies so maybe common cause between acne and melasma exists & this cause can be androgenic hormone or skins more sensitivity to special receptor

Acne resolution rates: Results of a single-blind, randomized, controlled, parallel phase III trial with EE/CMA (Belara (R)) and EE/LNG (Microgynon (R))

Background and Objective: Acne in women can often be successfully treated by the intake of oral contraceptives containing gestagens with anti-androgenic properties. This study aimed to evaluate the efficacy of the monophasic oral contraceptive ethinylestradiol/chlormadinone acetate (EE/CMA; Belara (R)) for the treatment of mild to moderate papulopustular acne of the face and acne-related disorders in comparison to EE/levonorgestrel (LNG; Microgynon (R)). Methods: 199 female acne patients were enrolled in a single-blind, randomized, multicentre phase III study and divided into two groups who received either EE/CMA or EE/LNG. The primary end point was fulfilled if the number of papules/pustules per half of the face present on admission had decreased by at least 50% in the 12th medication cycle. Results: 59.4% of the women under EE/CMA and 45.9% under EE/LNG were responders. The relative frequency of women with complete resolution was 16.5% under EE/CMA and 4.3% under EE/LNG at cycle 12. Conclusion: EE/CMA is an efficient treatment for women with mild and moderate papulopustular acne of the face and related disorders, reflecting the well-known anti-androgenic properties of the progestogen CMA. Copyright (C) 2001 S, Karger AG, Basel