Acne more severe in PCOS patients
Today's report also covers clascoterone, Nd:YAG lasers in all Fitzpatrick skin types, inflammatory markers linked to isotretinoin, and more (1,750 words, 8 minutes, 20 seconds)
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Good morning, and welcome to the eleventh 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
Acne more severe in PCOS patients
Findings from a recent study suggest that in patients with polycystic ovary syndrome (PCOS), acne is both more severe and associated with hypertestosteronemia and hyperprolactinemia. In particular, PCOS phenotype A was the most likely to cause severe acne.
The findings were published in the Archives of Dermatological Research (Oct. 26, 2024; 316:711).
Researchers aimed to determine the prevalence of PCOS in patients presenting with acne as their main dermatological complaint and to compare the metabolic and hormonal clinical characteristics of acne patients with PCOS to those with isolated acne.
The study included patients seeking treatment for acne at Farhat Hached University Hospital in Sousse, Tunisia, from Jan. 2023 to Jan. 2024. Researchers divided the 212 patients into two groups: those with confirmed PCOS and those with isolated acne. All patients underwent hormonal assessment and ovarian ultrasound.
Investigators found that 65.6% of the acne patients had been diagnosed with PCOS. Nodular lesions were significantly more frequent in patients with PCOS (p=0.02). They found a link between acne and hirsutism, which was more prevalent in PCOS (94.2% PCOS vs. 67.1% isolated acne), as well as androgenic alopecia (51% PCOS vs. 21.9% isolated acne) (p<0.001). Patients in the PCOS group showed evidence of biological hyperandrogenism, with a mean testosterone level of 0.72±0.27 ng/mL, significantly higher than in the isolated acne group. The luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio was greater than one in 72.7% of cases in the PCOS group, demonstrating a significant difference compared to isolated acne, where it was greater than one in 24.7% of cases (p<0.001).
In their conclusions, the authors note that identifying this aspect of the dermatologic impact of PCOS should prompt physicians to screen for this endocrine disorder in all adult women seeking acne treatment.
Mild, reversible HPA-axis suppression seen with clascoterone acne Tx
In patients treated with the topical anti-androgen clascoterone 1% cream for acne vulgaris, researchers found evidence of medication-induced mild, reversible hypothalamic-pituitary-adrenal (HPA) axis suppression under maximum-use exposure.
The findings were published in the Journal of Drugs in Dermatology (June 1, 2024; 23(6):433-437).
Two open-label, multicenter, Phase 2 trials evaluated HPA axis suppression in patients with moderate-to-severe acne vulgaris. Study 1 (NCT01831960) enrolled cohorts of adults older than 18 and adolescents between 12 and 18 years of age. Study 2 (NCT02720627) enrolled adolescents 9 to 12 years of age. The patients applied clascoterone twice daily at maximum-exposure dosages for 14 days. Researchers evaluated adrenal suppression via cosyntropin stimulation test (CST) at baseline and day 14. Patients with an abnormal CST result had a follow-up CST approximately four weeks later. The investigators also collected blood for pharmacokinetic analysis.
Five of 69 clascoterone-treated patients had an abnormal CST result on day 14, including one of 20 adults, two of 22 patients aged 12 to 18 years, and two of 27 patients aged 9 to 12 years. All patients had normal cortisol levels at follow-up testing approximately four weeks later. Researchers observed no relationship between abnormal CST results and clascoterone plasma concentrations or the amount of study drug applied. They saw no clinically relevant AEs or clinically significant changes in safety measures in patients with adrenal suppression.
Long-lasting acne clearance in all Fitzpatrick skin types with pulsed 1,064 nm Nd:YAG laser
Treatment with a 650-microsecond, pulsed 1,064-nm Nd:YAG laser appears to provide long-lasting clearance of mild to severe facial acne vulgaris with high subject satisfaction and without adverse effects on skin types I to VI.
These findings come from a paper published in the Journal of Drugs in Dermatology (Nov. 1, 2024; 23(11):957-964).
Researchers enrolled participants with Fitzpatrick skin types I to VI and mild, moderate, or severe acne. The subjects received five treatments at two-week intervals with a 650-microsecond, 1,064-nm, pulsed Nd:YAG laser. No anesthesia or skin cooling was used. Follow-up visits were 30 days and 90 days after the final treatment. At each visit, investigators performed global assessments, lesion counts, investigator's global assessments (IGAs), and tolerability appraisals.
The median percent reduction in lesion count was 48.15% after one treatment and 83.72% at treatment three, remaining at 86.67% at 90 days. Sixty per cent of subjects noted improvement after treatment one, and most subjects noticed improvement on or before treatment three.
Median IGA values decreased rapidly to reach a plateau of 1.0 (almost clear) at week six and remained there at the 30- and 90-day follow-up. Ninety per cent of subjects were slightly to highly satisfied after three treatments, and 90% slightly to strongly agreed that their acne treatments improved their self-esteem after four treatments. Researchers observed no adverse events.
Specific inflammatory markers linked to systemic or pilosebaceous inflammation in isotretinoin Tx
A study investigating the impact of oral isotretinoin on various inflammatory markers in acne patients has found a link between some markers and the medication's action on the pilosebaceous unit. In contrast, others show systemic inflammatory activity of isotretinoin.
The authors of the paper (Cutaneous and ocular toxicology Nov. 5, 2024:1-7) note that there have been conflicting reports on the effect of isotretinoin on inflammatory markers. They write that no studies have been reported on the relationship between isotretinoin and lymphocyte/high-density lipoprotein cholesterol (HDL-C) ratio, neutrophil/HDL-C ratio, or platelet/HDL-C ratio in acne patients.
To investigate this relationship, the researchers examined data on 361 patients with moderate-to-severe acne vulgaris who received systemic isotretinoin for at least six months.
Investigators examined complete blood count and a range of biochemical analyses of inflammatory markers obtained at the treatment onset and the end of the first, third, and sixth months of treatment.
They found no significant difference in monocyte/HDL-C ratio and neutrophil/HDL-C ratio levels between repeated measures. A significant increasing trend was seen in lymphocyte/HDL-C ratio and platelet/HDL-C ratio (p=0.001 and p=0.011, respectively). HDL-C levels gradually and significantly declined during the six months (p<0.001). Serum neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, monocyte/lymphocyte ratio, and aggregate index of systemic inflammation showed a significant decrease in line with clinical improvement in acne during the six months of therapy (p<0.05).
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