New acne guidelines released by AAD
Today's report also covers topical Tx of acne in Asian patients, acne-metabolic syndrome, whey protein contributing to acne, and more (1,200 words, 6 minutes, 30 seconds)
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Good morning, and welcome to the seventh issue of Focus on Acne, presented by Skin Spectrum Weekly. This series provides up-to-date information on developing therapies and trends in acne treatment. We appreciate your feedback and suggestions and invite you to be in touch. Please write to us at health@chronicle.org
AAD releases new acne guidelines
The American Academy of Dermatology has released new evidence-based recommendations for managing acne.
Published in the Journal of the American Academy of Dermatology (May 2024; 90(5):1006.e1-1006.e30), the recommendations were developed by a working group that conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.
The new guideline presents 18 evidence-based recommendations and five good practice statements.
Strong recommendations are made for:
Benzoyl peroxide
Topical retinoids
Topical antibiotics
Oral doxycycline
The authors strongly recommend oral isotretinoin for acne that is severe, causing psychosocial burden or scarring, or when patients fail standard oral or topical therapy.
Conditional recommendations are made for:
Topical clascoterone
Salicylic acid
Azelaic acid
Oral minocycline
Sarecycline
Combined oral contraceptive pills
Spironolactone
The good practice recommendations include combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions.
New guidance needed for topical Tx of acne in Asian patients
Findings from a recent literature review (International Journal of Dermatology, Apr. 21, 2024, online ahead of print) suggest there is a need for up-to-date guidance on the topical management of acne in Asia-Pacific countries, as well as on the management of acne sequelae in Asian patients.
The authors provide a critical review of the published guidance for managing acne and its sequelae in the Asia-Pacific region, identifying gaps in current recommendations that could be addressed to enhance standards of acne care in Asia-Pacific countries.
Along with highlighting the importance of a comprehensive skincare regimen to increase treatment efficacy and adherence, they discuss topical retinoids and retinoid combination options in the acne armamentarium that may benefit sequelae prevention and management. The discussion covers adapalene 0.3% with or without adding benzoyl peroxide 2.5%, tretinoin 0.05%, tazarotene 0.1%, and trifarotene 0.005%. The authors note that trifarotene 0.005% has significantly reduced acne scar counts in a Phase 4 study.
Role of mTOR pathway in acne-metabolic syndrome relationship clarified
New findings suggest that the mechanistic target of the rapamycin (mTOR) pathway may play an important role in explaining the relationship between acne vulgaris (AV) and metabolic syndrome in acne pathogenesis. The authors of the study, published in Cureus (Mar. 20, 2024; 16(3):e56562), say their findings suggest that miR-21 and miR-29b play a role in the inflammatory process of AV.
In the paper, the investigators note that mTOR complex 1 (mTORC1) drives AV and that increased mTORC1 signalling predisposes individuals to diseases such as insulin resistance (IR), obesity, and diabetes mellitus. Also, the forkhead box protein (Fox) O1 is known to regulate the relationship between the mTORC1 signalling pathway and IR.
The investigators studied to clarify the relationship between AV and metabolic syndrome through FoxO1 and mTOR signalling pathways and microRNAs (miRs) associated with these signalling pathways.
They examined 20 AV patients without metabolic syndrome, 16 AV patients with the syndrome, and 20 healthy controls. Researchers compared demographic characteristics, metabolic syndrome parameters, and clinical severity of AV using the Global Acne Grading System (GAGS) and homeostasis model assessment (HOMA) values between the groups. They also assessed expression levels of FoxO1, mTOR genes, miR-21, miR-29b, and miR-98 from skin biopsies.
Investigators found the mean age of patients with AV without metabolic syndrome was statistically lower than that of patients with metabolic syndrome. AV patients with metabolic syndrome and moderate GAGS scores had statistically significantly higher HOMA values than those with mild GAGS scores. FoxO1 expression was substantially lower in AV patients compared to controls. The mTOR expression levels of AV patients with MetS were significantly higher than the other two groups. The expression levels of miR-21 and miR-29b increased dramatically in the AV patients with MetS compared to the group of AV patients without MetS.
Whey protein supplements may contribute to acne
A Jordanian study found a positive association between the consumption of whey protein supplements and the risk of acne vulgaris in male adolescents.
In the observational, case-control study published in Dermatology Research and Practice (Apr. 9, 2024; 2024:2158229, researchers assessed data on 201 male teenagers and young adults attending fitness centres in Irbid, Jordan. Individuals with acne were considered cases, and those without acne were categorized as controls.
To examine the association of whey protein supplements on acne risk among male adolescents and young adults.
Investigators compared 100 cases to 101 healthy controls with similar demographics, including age, body mass index, educational level, smoking habits, and vitamin B12, corticosteroids, and anabolic steroids intake.
They found considerably more participants in the acne group (47%) were taking whey protein supplements than in the control group (27.7%) (p=0.0047). The significance of this difference was maintained after multivariate analysis.
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