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Acta Dermato-venereologica Feb 2024Acne in adult females is triggered mainly by hormones. Doxycycline is a reference treatment in acne. Spironolactone targets the androgen receptor of sebaceous glands and... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Spironolactone Compared with Doxycycline in Moderate Acne in Adult Females: Results of the Multicentre, Controlled, Randomized, Double-blind Prospective and Parallel Female Acne Spironolactone vs doxyCycline Efficacy (FASCE) Study.
Acne in adult females is triggered mainly by hormones. Doxycycline is a reference treatment in acne. Spironolactone targets the androgen receptor of sebaceous glands and is prescribed off-label for female adult acne. This multicentre, controlled, randomized, double-blind prospective and parallel study assessed the efficacy of spironolactone compared with doxycycline in adult female acne. A total of 133 women with moderate acne were randomized to receive treatment with: (i) doxycycline and benzoyl peroxide for 3 months followed by a 3-month treatment with its placebo and benzoyl peroxide, or (ii) spironolactone and benzoyl peroxide for 6 months. Successfully treated patients continued with benzoyl peroxide or spironolactone alone for a further 6 months. Primary endpoints were treatment success at month 4 and month 6 with the AFAST score. At all visits, the ECLA score, lesion counts, local and systemic safety and quality of life were assessed. Spironolactone performed better at month 4 and showed a statistically significant better treatment success after 6 months than doxycycline (p = 0.007). Spironolactone was 1.37-times and 2.87-times more successful compared with doxycycline at respective time-points. AFAST and ECLA scores, as well as lesion counts always improved more with spironolactone. Patients' quality of life was better with spironolactone at month 4 and month 6. Spironolactone was very well tolerated. This is the first study to show that, in female adults with moderate acne, treatment with spironolactone is significantly more successful than doxycycline and very well tolerated.
Topics: Adult; Humans; Female; Doxycycline; Spironolactone; Quality of Life; Prospective Studies; Acne Vulgaris; Benzoyl Peroxide; Treatment Outcome; Double-Blind Method
PubMed: 38380975
DOI: 10.2340/actadv.v104.26002 -
BMJ (Clinical Research Ed.) Nov 2006
Review
Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Dermatologic Agents; Diet; Female; Humans; Male; Retinoids
PubMed: 17082546
DOI: 10.1136/bmj.38987.606701.80 -
The Journal of Dermatological Treatment Dec 2024Sebum physiology and its contributions to acne vulgaris (AV) pathophysiology have been long debated. Within the pilosebaceous unit, androgens drive sebocyte production... (Review)
Review
BACKGROUND
Sebum physiology and its contributions to acne vulgaris (AV) pathophysiology have been long debated. Within the pilosebaceous unit, androgens drive sebocyte production of sebum, comprising mono-, di-, and triglycerides (the latter converted to fatty acids); squalene; cholesterol; cholesterol esters; and wax esters. Upon release to the skin surface, human sebum has important roles in epidermal water retention, antimicrobial defenses, and innate immune responses.
AIMS
Alterations in sebum alone and with other pathogenic factors (inflammation, follicular hyperkeratinization, and [] proliferation) contribute to AV pathophysiology. Androgen-driven sebum production, mandatory for AV development, propagates proliferation and upregulates inflammatory and comedogenic cascades.
RESULTS
Some sebum lipids have comedogenic effects in isolation, and sebum content alterations (including elevations in specific fatty acids) contribute to AV pathogenesis. Regional differences in facial sebum production, coupled with patient characteristics (including sex and age), help exemplify this link between sebum alterations and AV lesion formation.
CONCLUSIONS
To date, only combined oral contraceptives and oral spironolactone (both limited to female patients), oral isotretinoin and topical clascoterone (cortexolone 17α-propionate) modulate sebum production in patients with AV. A better understanding of mechanisms underlying sebaceous gland changes driving AV development is needed to expand the AV treatment armamentarium.
Topics: Humans; Female; Sebum; Acne Vulgaris; Sebaceous Glands; Skin; Fatty Acids
PubMed: 38146664
DOI: 10.1080/09546634.2023.2296855 -
Anais Brasileiros de Dermatologia 2014Acne vulgaris has high prevalence, disturbing quality of life during adolescence.
BACKGROUND
Acne vulgaris has high prevalence, disturbing quality of life during adolescence.
OBJECTIVES
To measure dissastifaction and acne in 18-year-old male individuals and its associated factors.
METHODS
A questionnaire was applied by trained interviewers to all boys during selection for the military service. Dissatisfaction and acne was evaluated using a self-administered face scale. Facial, prestrernal and dorsal acne were evaluated separately.
RESULTS
A total of 2,200 adolescents, aged 18 years, were interviewed. Among these, 1,678 had acne on the face and 974 (54.05%) showed some degree of dissatisfaction. Regarding the impact of acne located on the chest, 326 out of 686 adolescents (47.52%) reported dissatisfaction. For acne located on the back, 568 out of 1,103 affected individuals (51.50%) showed dissatisfaction. Facial / dorsal acne and dissatisfaction were statistically associated with lower income, lower education levels and with non-whites. Presternal acne and dissatisfaction were statistically asssociated with lower income and lower education levels.
CONCLUSION
This population-based study found a high prevalence of acne on the face, back and chest, with high rates of dissatisfaction.
Topics: Acne Vulgaris; Adolescent; Back; Brazil; Emotions; Facial Dermatoses; Humans; Male; Prevalence; Quality of Life; Risk Factors; Severity of Illness Index; Socioeconomic Factors; Surveys and Questionnaires; Thoracic Wall
PubMed: 25054743
DOI: 10.1590/abd1806-4841.20142634 -
Breast Cancer Research and Treatment Sep 2019Hormonal imbalance early in life is thought to be associated with breast cancer risk. Severe acne may arise from hormonal imbalance and could serve as an indicator of...
PURPOSE
Hormonal imbalance early in life is thought to be associated with breast cancer risk. Severe acne may arise from hormonal imbalance and could serve as an indicator of increased breast cancer risk. We explored whether severe acne was associated with incident breast cancer.
METHODS
We used data from the Sister Study, a large (n = 50,884) prospective cohort of women who had a sister diagnosed with breast cancer, but who were free of breast cancer themselves at baseline. Participants completed a structured questionnaire that included demographics, lifestyle factors, and medical history, including any diagnosis of severe acne. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association of severe acne and breast cancer (invasive disease or ductal carcinoma in situ).
RESULTS
During an average of 8.4 years of follow-up, 3049 breast cancer cases were diagnosed. Ever being diagnosed with severe acne was associated with a higher risk of breast cancer (HR 1.23; 95% CI 0.98, 1.54), particularly in women who were diagnosed prior to age 18 years (HR 1.40; 95% CI 1.04, 1.90). Results were similar when limited to invasive cancers.
CONCLUSIONS
Our study supports a non-significant positive association between severe acne-a potential marker of hormonal imbalance-and breast cancer risk. These findings suggest that severe acne, when considered along with other risk factors, could help to identify women who may be at a higher risk of breast cancer.
Topics: Acne Vulgaris; Adult; Aged; Breast Neoplasms; Disease Susceptibility; Female; Humans; Middle Aged; Proportional Hazards Models; Risk Assessment; Risk Factors; Severity of Illness Index
PubMed: 31165375
DOI: 10.1007/s10549-019-05302-z -
Medical Hypotheses Jan 2020Acne is a disease unique to humans and is associated with sebaceous glands that are found at high density on the scalp, forehead and face. Despite being a near universal...
Acne is a disease unique to humans and is associated with sebaceous glands that are found at high density on the scalp, forehead and face. Despite being a near universal problem in adolescence, the reason why such troublesome sebaceous glands exist at all is not well understood. Some interesting theories have been postulated including roles for skin maintenance, immunological function and perhaps even pheromones, but pre-pubertal skin which has sebaceous glands that are largely inactive, is healthy. Dystocia, obstructed labour, is unique to humans and no other animal has as much trouble giving birth. This is thought to reflect the relatively large human foetal head and proportionally small maternal pelvis. Noting the high density of sebaceous glands on the face, chest and back; these are exactly the same structures that pose the greatest obstruction during childbirth. Sebaceous glands develop after the fourth month of gestation and are large and well-developed at birth. Sebum production is also relatively high at birth. Having extra lubrication at these sites would help make the baby more slippery for birth conferring a selective advantage to successful delivery, as does the presence of the vernix caseosa, a white creamy substance, unique to humans that coats new-born infants. It is proposed that the sebaceous glands that cause acne are present on the face and forehead as they confer a selective advantage by 'lubricating' the widest parts of the new born baby to ease the passage of childbirth. Later in life, sebaceous glands may be inappropriately and pathologically primed, driven by a combination of hormones, diet and lifestyle to create acne.
Topics: Acne Vulgaris; Adolescent; Androgens; Biofilms; Diet; Dystocia; Female; Hair Follicle; Head; Humans; Infant, Newborn; Inflammation; Models, Biological; Organ Size; Parturition; Pregnancy; Propionibacterium acnes; Scalp; Sebaceous Glands; Sebum; Selection, Genetic; Species Specificity; Vernix Caseosa
PubMed: 31622924
DOI: 10.1016/j.mehy.2019.109412 -
Anais Brasileiros de Dermatologia 2017Acne is one of the most common skin diseases. It has significant effect on self-image and negative impact on quality of life. Postinflammatory hyperpigmentation is an...
BACKGROUND:
Acne is one of the most common skin diseases. It has significant effect on self-image and negative impact on quality of life. Postinflammatory hyperpigmentation is an acquired hypermelanosis that occurs after a skin injury or cutaneous inflammation. It is common sequelae in acne patients.
OBJECTIVES:
This study aimed to investigate the psychosocial impact of acne and postinflammatory hyperpigmentation among patients treated in a dermatology outpatient clinic at the University of Miami Hospital.
METHODS:
The study had the participation of 50 patients with acne and postinflammatory hyperpigmentation. All participants volunteered to complete an anonymous questionnaire containing socio-demographical information, questions about patient's attitudes toward postinflammatory hyperpigmentation caused by acne, the Cardiff Acne Disability Index and the Dermatology Life Quality Index.
RESULTS:
Postinflammatory hyperpigmentation was more predominant in the face. Makeup was frequently used to conceal the imperfections and the majority of patients felt embarrassed due to their condition. Interestingly, the majority of our patients did not have their quality of life impacted for acne and postinflammatory hyperpigmentation.
STUDY LIMITATIONS:
A limitation of the study was the relatively small sample size. For this reason, the findings of the study should not be generalized to the broader community.
CONCLUSION:
The current medical literature has many studies analyzing the psychological impact of acne. This study is the first study in the literature that analyzed the psychosocial impact of acne and postinflammatory hyperpigmentation caused by acne.
Topics: Acne Vulgaris; Adolescent; Adult; Female; Humans; Hyperpigmentation; Male; Quality of Life; Severity of Illness Index; Sex Factors; Sickness Impact Profile; Surveys and Questionnaires; Young Adult
PubMed: 28954099
DOI: 10.1590/abd1806-4841.20175645 -
Indian Journal of Dermatology,... 2023Objectives This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum... (Meta-Analysis)
Meta-Analysis Review
Objectives This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG). Methods A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists' evaluation(DE), the patients' overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH). Results Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2. Conclusion FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present. Registration PROSPERO CRD42021242160 (available from https://www.crd.york.ac.uk/prospero).
Topics: Humans; Cicatrix; Aluminum; Treatment Outcome; Erbium; Network Meta-Analysis; Acne Vulgaris; Connective Tissue Diseases; Hyperpigmentation; Atrophy; Lasers, Solid-State
PubMed: 37067138
DOI: 10.25259/IJDVL_572_2021 -
British Medical Journal (Clinical... Oct 1982
Topics: Acne Vulgaris; Adolescent; Adult; Androgens; Female; Hormones; Humans
PubMed: 6214295
DOI: 10.1136/bmj.285.6346.912 -
The Journal of Dermatological Treatment Dec 2024The recognition of an association between the development of acne vulgaris (AV) and pubertal hormonal changes during adolescence dates back almost 100 years. Since... (Review)
Review
The recognition of an association between the development of acne vulgaris (AV) and pubertal hormonal changes during adolescence dates back almost 100 years. Since these formative observations, a significant role of circulating hormones in the pathophysiology of AV and other cutaneous disorders has been established. This review article aims to provide an overview of clinical and preclinical evidence supporting the influences of androgens on the skin and their therapeutic importance in AV pathophysiology. The cutaneous effects of hormones are attributable, to a large extent, to the influence of steroid hormones, particularly androgens, on sebocyte development and sebum production in both sexes. Androgen-mediated excess sebum production is implicated as a necessary early step in AV pathophysiology and is therefore considered an important therapeutic target in AV treatment. Although the local production and/or activity of androgens within the skin is believed to be important in AV pathophysiology, it has received limited therapeutic attention. We have summarized the current evidence in support of the therapeutic benefits of targeted hormonal treatment to decrease androgen-stimulated sebum production for the effective and safe treatment of AV in both male and female patients.
Topics: Adolescent; Humans; Female; Male; Androgens; Sebum; Skin; Acne Vulgaris; Dermatitis
PubMed: 38192024
DOI: 10.1080/09546634.2023.2298878