Mast Cells in Acne Inflammation
Increasing attention has been directed towards interactions between components of the nervous system and multiple target cells of the immune system. Communication between nerves and MCs is a prototypic demonstration of such neuroimmune interactions. Several studies have demonstrated that MCs are often found in close contact with nerves and that there may be a functional interaction between mast cells and the nervous system 28 . In addition, recent evidence suggests that SP is an important...
Abstract Ftz
Systemic treatment is required in patients with moderate-to-severe acne, especially when acne scars start to occur. Antibiotics with anti-inflammatory properties, such as tetracyclines oxytetracycline, tetracycline chloride, doxycycline, minocycline and limecycline and macrolide antibiotics erythromycin and azithromycin are the agents of choice for papulopustular acne, even though the emerging resistant bacterial strains are minimizing their effect, especially regarding erythromycin. Systemic...
Prepubertal Acne
Increasing number of early onset acne before obvious signs of puberty is a recognized phenomenon associated more with pubertal development than with age. There is apparently a genetic predisposition. Pubertal development has two components, normal adrenarche related to maturation of adrenal glands and true puberty because of maturation of testis and ovary mediated by the hypothalamic-pituitary axis. Adrenarche presents with high levels of DHEA and DHEAS that start rising at 6-7 years in girls...
MidChildhood Acne
This type of acne occurs between 1 and 7 years of age. Acne is very rare in this group and when it occurs should be evaluated for hyperandrogenemia. Differential diagnosis includes Cushing's syndrome, congenital adrenal hyperplasia, gonadal or adrenal tumors and a true precocious puberty. Evaluation should be done with a bone age measurement, growth chart and laboratory tests that include serum total and free testosterone, DHEA, DHEAS, LH, FSH, prolactin and 17a-hydroxyprogesterone. Occasional...
Acne Genetics
The genetic influence on pathogenesis of acne is well documented in twins 30 and genealogic studies. In some types of acne, such as acne conglobata, hereditary factors are more apparent, and a correlation has been suggested between neonatal acne and familial hyperandrogenism 4 . Nodulocystic IA is often observed in relatives of patients with extensive steatocystoma, adolescent and postadolescent acne 31 . Fifty percent of postadolescent acne patients have at least one first-degree relative with...
References Rcu
1 Cunliffe WJ, Gollnick H Acne Diagnosis and Management. London, Martin Dunitz, 2001. 2 Gollnick H, Schramm M Topical therapy in acne. J Eur Acad Dermatol Venerol 1998 11 suppl 1 8-12, discussion S28-S29. 3 Plewig G, Kligman AM Acne and Rosacea, ed 3. New York, Springer-Verlag, 2000. 4 Leid M, Kastner P, Chambon P Multiplicity generates diversity in the retinoic acid signalling pathways. Trends Biochem Sci 1992 17 427-433. 5 Zouboulis CC Retinoids - which dermatologi-cal indications will...
Conclusions
Hormonal therapy is an option for treatment when acne is not responding to conventional therapy. If there are signs of hyperandrogenism, an endocrine evaluation is indicated, consisting of an assessment of DHEAS, total and free-testosterone levels and an LH FSH ratio. Although an indication for hormonal therapy is hyperandro-genism, women with normal serum androgen levels also respond well to treatment. Hormonal therapy choices consist of androgen-receptor blockers, androgen-produc-tion...
Systemic Treatment
Oral antibiotics are indicated for several groups of patients with inflammatory acne table 3 33, 38 . They include tetracyclines tetracyclines, doxycycline, minocy-cline , erythromycin, clindamycin, and cotrimoxazole table 4 . These agents improve inflammatory acne by inhibiting the growth of P. acnes tetracyclines and erythromy-cin have additional anti-inflammatory properties. Tetracyclines of the first generation tetracycline, oxy-tetracycline and tetracycline chloride are the most commonly...
Comedonal Types
The clinical type of comedo could, and perhaps should, influence the treatment prescribed. Biopsy sections of normal-looking skin in an acne-prone individual with comedonal acne will frequently 28 show histological features of microcomedones. Biopsies of papules taken at up to 72 h of development will reveal a microcomedone in 52 of subjects, a whitehead in 22 and a blackhead in 10 22 , confirming even further the practical need to apply topical therapies to apparently non-involved skin....
New Developments and Future Trends
After decades of stagnation, research on systemic acne treatment has expanded markedly in the last several years. The results of numerous studies have greatly increased our understanding of both the pathophysiology of the disease and the mechanisms of action for current therapies. New developments occurred including the low-dose long-term isotretinoin regimen, new isotretinoin formulations, understanding of isotretinoin's anti-sebotropic action, new antibiotics, and combination treatments to...
Options for Hormonal Therapy
Once the decision has been made to initiate hormonal therapy, there are various options to choose from 1 androgen receptor blockers, or antiandrogens this class of drugs block the effect of androgens on the sebaceous gland and on the infundibulum of the follicle 2 inhibition of androgen production by the ovary or adrenal gland, or 3 in the future, inhibition of androgen metabolizing enzymes in the skin may be possible see 'Enzyme inhibitors' section below . It is important to note that hormonal...
Topical Treatment
Sulfur used to be the most common ingredient in antiacne formulations. In spite of its comedogenic and presumably comedolytic properties, it has now come into disuse, particularly because of its odor. Sulfur-containing formulations have been reported to be comedogenic in the rabbit ear model and also in humans, when applied under occlusions for 6 weeks 1 . However, other studies have failed to reproduce this experience on the potential come-dogenicity of sulfur-containing preparations 2 ....
Conclusion
Despite the interest on the development of topical treatments for acne in the last decades 30 , systemic treatment is still a milestone, especially in the treatment of moderate-to-severe scarring types of the disease. The establishment of new systemic drugs for acne is based on the consideration of successes and pitfalls of the past and the emerging knowledge of the future 125 . Among all pathogenetic factors of acne, inflammation seems to be rediscovered 13 and anti-inflammatory concepts seem...
Estrogens and Sebum Production
Very little is known about the role of estrogens in modulating sebum production. Any estrogen given sys-temically in sufficient amounts will decrease sebum production. The dose of estrogen required to suppress sebum production however is greater than the dose required to suppress ovulation. Although some patients acne will respond well to lower-dose agents containing 0.035-0.050 mg of ethinyl estradiol or its esters, higher doses of estrogen are often required to demonstrate a reduction in...
Contents
4 Editorial Current and Future Aspects on Acne Zouboulis, Ch.C. Berlin Herane, M.I. Santiago Thiboutot, D. Hershey, Pa. 5 Foreword and Critical Remarks Dreno, B. Nantes Poli, F. Creteil 11 Comedogenesis Some Aetiological, Clinical and Therapeutic Strategies Cunliffe, W.J. Holland, D.B. Clark, S.M. Stables, G.I. Leeds 24 Acne in Infancy and Acne Genetics Herane, M.I. Santiago Ando, I. Kawasaki 29 Topical Treatment in Acne. Current Status and Future Aspects Gollnick, H.P.M. Krautheim, A....
John S Strauss
Department of Dermatology, University of Iowa, Iowa City, Iowa, USA The acne symposium held at the 20th World Congress in Paris in July 2002 was an opportunity for some of those working in the field to present their findings on a wide selection of topics related to the pathogenesis and treatment of acne. The presentations were indeed world-wide, including investigators from Argentina, Chile, France, Germany, Japan, Taiwan, United Kingdom, United States, and Venezuela. As is appropriate for the...