Modulation of Toll Like Receptor-2 on sebaceous gland by the treatment of adult female acne

Adult female acne is a chronic inflammatory, immune-mediated disease that affects the pilosebaceous unit in women in their 20s to 40s, and is considered different from acne vulgaris. Propionibacterium acnes is recognized by TLR-2, resulting in activation of this receptor and an inflammatory response through the NF kappa B pathway. This therapeutic, interventional, open, randomized, evaluator-blinded and comparative trial included 38 adult women with moderate facial acne and 10 age-matched controls, all aged between 26 and 44 years. Two treatments were performed over six months: 15% azelaic acid gel (AA) bid (n = 18) and oral contraceptive (COC) drospirenone 3 mg/ethinylestradiol .02 mg (n = 20). Biopsies were taken at baseline (control, lesion, perilesional) and at the conclusion (lesion and perilesional) of the study to evaluate TLR-2 expression by immunohistochemistry. Lesion count and blind photographic evaluation were used for efficacy. The groups were homogeneous: 70% of lesions were located in the submandibular area, 95% of participants had inflammatory lesionsof these, 50% had persistent and 50% had late-onset acne. The mean ages were 33.7 +/- 5.5 and 33.1 +/- 5.3 years (COC and AA group, respectively). A moderate clinical improvement was observed in both groups. No difference in TLR-2 expression in the lesion or perilesional areas was observedhowever, reduced TLR-2 expression was seen in the control group. A significant reduction in expression was observed after both treatments, with no difference between the groups. This finding suggests an anti-inflammatory effect of COCs and AA in adult female acne, via modulation of the TLR-2 receptor.Dermatology - Sao Paulo Regional of BrazilianSociety of Dermatology - FUNADERSPUniv Fed Sao Paulo, Dept Prevent Med, Dept Dermatol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Prevent Med, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Prevent Med, Dept Dermatol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Prevent Med, Sao Paulo, BrazilWeb of Scienc

Low-dose oral isotretinoin versus topical retinoic acid for photoaging: a randomized, comparative study

BackgroundOral isotretinoin (ISO) is the only drug which promotes prolonged remission or cure of severe acne. It also has other properties, supporting its use for non-acne indications. Retinoic acid (RA) is gold standard treatment for photoaging. ISO for photoaging treatment was reported in non-controlled trials as alternative to RA, which causes skin irritation.ObjectiveTo compare clinical, histological, and immunohistochemical effects of low-dose ISO and 0.05% topical RA to treat photoaging.MethodsRandomized, comparative, evaluator-blinded, single-center study. Twenty-four healthy, Caucasian, 50 to 75-year-old men and women (menopausal or sterilized) with advanced photoaging were included. Twelve subjects received ISO, 20 mg/day, and 12 subjects were treated with RA cream, for six months; both treatments were administered every other day, and moisturizer and sunscreen were also used. Outcome measures included patient assessments, blinded photographic evaluations, Life Quality Index, histological (HE, Verhoeff) and immunohistochemical (p53, collagen type I) evaluations, adverse events, liver function, lipid profile, and blood count. Statistical analysis with generalized estimating equations and repeated measures ANOVA tests was used.ResultsEleven subjects in each group completed the study. Patient and photographic assessments showed overall improvement in skin appearance. Quality-of-life scores were reduced for all subjects. Histological analysis revealed corneal layer diminution, epidermal thickness increase, and elastosis reduction. Immunohistochemical findings revealed significant epidermal p53 reduction and dermal collagen 1 increase. No differences were found between groups; laboratory tests showed no significant alterations.ConclusionDespite being safe and effective, low-dose ISO was not superior to 0.05% RA for advanced photoaging treatment.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Dermatol, BR-18618000 Sn Botucatu, SP, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Dermatol, BR-18618000 Sn Botucatu, SP, BrazilFAPESP: 2009/51271-9Web of Scienc