Acne Pathogenesis: History of Concepts

Tilles, Gérard

doi:10.1159/000364860

Cited by 27 publications

(18 citation statements)

References 246 publications

(345 reference statements)

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“…Given the crucial role of hormones in the pathogenesis of acne, therapies with antiandrogenic or antisebogenic properties are mechanistically enticing options. [31][32][33][34][35] Spironolactone is a synthetic 17-lactone steroid that has antagonistic effects on the androgen and progesterone receptors. Although its original clinical application was as a potassiumsparing diuretic, due to its impact on sebum production through inhibition of the androgen receptor on sebocytes, spironolactone has been used off-label in the treatment of acne for over 30 years.…”

Section: Spironolactonementioning

confidence: 99%

Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Barbieri

Spaccarelli

Margolis

et al. 2019

Journal of the American Academy of Dermatology

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Acne is one of the most common diseases worldwide and affects approximately 50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use may be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications such as spironolactone, combined oral contraceptives, and oral isotretinoin. Antibiotic resistance is a growing problem across medicine and rates of antibiotic resistance among isolates of Cutibacterium (formerly Propionibacterium) acnes have been rising, including to tetracycline-class antibiotics. 1-4 In addition to resistance among C. acnes, the use of oral antibiotics is associated with disruption of the normal flora, bacterial resistance among other organisms, and increased rates of upper respiratory infection and pharyngitis. 5-8 Antibiotic use may also be associated with inflammatory bowel disease and collagen vascular disease. 7-16 Finally, there may be an association between the use of oral tetracycline-class antibiotics and risk of breast and colon cancer. 17,18 As a result, there have

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Section: Spironolactonementioning

confidence: 99%

Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Barbieri

Spaccarelli

Margolis

et al. 2019

Journal of the American Academy of Dermatology

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“…Nagler et al ( 2016 ) reported that the average duration of antibiotic therapy in acne in some cases may even exceed 1 year (Nagler et al, 2016 ). Such prolonged therapy can be shortened by the addition of isotretinoin (a 13-cis-retinoic acid which is a non-aromatic retinoid; Tilles, 2014 ), whose action is associated with reduction of sebum production, anti-inflammatory properties, reduction in P. acnes and an effect on comedogenesis (decreasing hyperkeratinization; Layton, 2009 ). Isotretinoin is used to treat severe and recalcitrant cases of inflammatory acne.…”

Section: Conventional Treatment Of Acnementioning

confidence: 99%

Prospects of Phage Application in the Treatment of Acne Caused by Propionibacterium acnes

et al. 2017

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Propionibacterium acnes is associated with purulent skin infections, and it poses a global problem for both patients and doctors. Acne vulgaris (acne) remains a problem due to its chronic character and difficulty of treatment, as well as its large impact on patients' quality of life. Due to the chronic course of the disease, treatment is long lasting, and often ineffective. Currently there are data regarding isolation of P. acnes phages, and there have been numerous studies on phage killing of P. acnes, but no data are available on phage application specifically in acne treatment. In this review, we have summarized the current knowledge on the phages active against P. acnes described so far and their potential application in the treatment of acne associated with P. acnes. The treatment of acne with phages may be important in order to reduce the overuse of antibiotics, which are currently the main acne treatment. However, more detailed studies are first needed to understand phage functioning in the skin microbiome and the possibility to use phages to combat P. acnes.

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“…Acne vulgaris is a disease of the pilosebaceous unit with four pathogenic factors, including abnormal keratinization, increased sebum production, Propionibacterium acnes (P acnes) colonization, and inflammation. 1,2 Treatment of acne is based on its severity, which is broadly classified into mild, moderate, and severe forms. In mild disease, topical regimens such as retinoids, antibiotics, and benzoyl peroxide are the cornerstones of treatment, while systemic therapies are considered in patients with moderate to severe disease.…”

Section: Introductionmentioning

confidence: 99%

Acne treatment efficacy of intense pulsed light photodynamic therapy with topical licochalcone A, l‐carnitine, and decanediol: A spilt‐face, double‐blind, randomized controlled trial

Wanitphakdeedecha

Tavechodperathum

Tantrapornpong

et al. 2019

J of Cosmetic Dermatology

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Background: Depending on disease severity, standard acne treatments can vary from topical to systemic therapy. However, poor compliance caused by adverse events and antibiotic resistance is a major cause of treatment failure. Aims: To determine the effectiveness of photodynamic therapy (PDT) with intense pulsed light (IPL) in the treatment of acne when combined with a cream containing licochalcone A, L-carnitine and decanediol (so-called, 'active formulation') versus PDT alone. Patients/Methods: Twenty-nine volunteers, aged 21-39 years (26 women and 3 men, mean age 29.41 ± 5.24 years), with mild to severe facial acne, were enrolled. Each subject's face sides were randomized in a split-face manner to either receive PDT (IPL with a 400-720 nm cutoff filter, at 4 sessions with two-week intervals) combined with the active formulation cream twice daily for 10 weeks on one face side; or PDT and the vehicle cream on the other side, with the same treatment protocol. Reduction in acne quantity, melanin index and erythema index were assessed 2 weeks after the second treatment (day 28), 1 week after the fourth treatment (day 49), and 1 month after the fourth treatment (day 70). Results: Compared to baseline, patients in the active formulation group demonstrated a faster onset of reduction in the number of lesions at 2 weeks after the second treatment (p=0.010 for inflammatory acne and p=0.001 for non-inflammatory acne). A significantly greater reduction in lesion count was observed in the active formulation group compared with the vehicle group at all timepoints of evaluation for noninflammatory acne (day 28, day 49, and day 70; p=0.003, 0.005 and 0.002 respectively), and at 1 month after the fourth treatment for inflammatory acne (p=0.036). Compared to the vehicle group, the melanin index of the active formulation group decreased significantly at 1 month after the fourth treatment (p=0.015).

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Acne Pathogenesis: History of Concepts

Cited by 27 publications

References 246 publications

Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Prospects of Phage Application in the Treatment of Acne Caused by Propionibacterium acnes

Acne treatment efficacy of intense pulsed light photodynamic therapy with topical licochalcone A, l‐carnitine, and decanediol: A spilt‐face, double‐blind, randomized controlled trial

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