Managing acne inflammation to reduce inflammation-driven pigment change

Dr. Jerry Tan on how to pro-actively minimize acne-related inflammation with topical approaches (650 words, 3 mins.)

In highly reactive darker skin, inflammation caused by untreated or under-treated acne can lead to long-lasting pigment changes that patients may find more troubling than the acne itself.

Successful treatment of acne begins with providing patients with anticipated timelines so that their mindset can be “based on practical reality,” Windsor, Ont.-based dermatologist Dr. Jerry Tan said in a presentation at Skin Spectrum Summit in Vancouver.

Then it is necessary to select a type of treatment available to each patient and follow through with the proper application, he said.

“At the end of the road, all you want is to maximize outcomes, so it starts with appropriate selection of treatment.”

Dr. Tan noted that acne starts with hormonal triggers. Some of these hormonal triggers may include a Western diet, dairy intake and changes in pubertal sensitivities.

These triggers can influence sebocytes in terms of the amount and quality of sebum made. Dr. Tan reported that “sebum by itself can trigger acne.” Sebum can activate inflammatory mechanisms, leading to increased inflammation. However, in other cases, hormones can increase sebum, which increases the proliferation of P. acnes, which generates lipases.

After identifying acne and its triggers, Dr. Tan suggested using various treatments already proven to be successful.

Retinoids are one of the only products that stop the development of microcomedones. Dr. Tan emphasized that “comedones are technically inflammatory, and when biopsied, inflammatory infiltrates can be found.” To treat these, he advised using a combination of topical retinoids and benzoyl peroxide, both of which have been known to work against the proliferation of comedones.

  • Dr. Tan described the importance of confirming that the treatment is both available and affordable to the patient.

  • He related the application of a topical treatment to playing a sport: “When you are thinking about topical treatments, I want you to think about defence. You have to cover the field. You don’t know where the next spots might come from.” He emphasized the need to engage with patients through positive reinforcement because patients will need reminders to adhere to the treatment.

  • He discussed a study that discovered that only 60% of patients opened the tube; however, the percentage increases to 100% when their doctor reminds them.

The takeaway: Dr. Tan recommends that patients continue with their ongoing acne treatment as trials have shown that maximum improvement plateaus only at 20 weeks. After that point, patients may try managing their acne with healthy lifestyle choices.

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FROM THE LITERATURE ON ACNE AND SKIN INFLAMMATION

Tips for addressing common conditions affecting pediatric and adolescent patients with skin of colour

  • This article provides advice on how to combine an understanding of cultural practices and the social implications of skin conditions with empathetic patient communication. The paper aims to support the counselling and treatment of pediatric and adolescent patients with skin of colour.

From “Pediatric Dermatology”

The effectiveness of galactomyces ferment filtrate, dexpanthenol, and Centella Asiatica combination serum in the treatment of post-acne hyperpigmentation in subjects with skin of colour

  • A combination serum-containing galactomyces ferment filtrate (GFF), dexpanthenol, and Centella Asiatica (also known as Gotu Kola, Brahmi, Indian pennywort or Asiatic pennywort) appear to make acne-related post-inflammatory hyperpigmentation fade more quickly. In an eight-week study of 51 people with Fitzpatrick skin types IV and V, those treated with the serum had more significant improvements in Lightness score and melanin index than people in the placebo group.

From “Skinmed”

Androgens and acne: Perspectives on clascoterone, the first topical androgen receptor antagonist

  • This review article discusses the potential role of clascoterone in the management of acne. The topical androgen receptor antagonist influences sebum production and inflammation through the same pathways as dihydrotestosterone (DHT) and spironolactone, but with no reported systemic effects.

From “Expert opinion on pharmacotherapy”

The use of tranexamic acid to prevent and treat post-inflammatory hyperpigmentation

  • The authors describe how they have successfully used tranexamic acid off-label to treat or prevent post-inflammatory hyperpigmentation in 82 patients at high risk of pigmentary change. These patients included those scheduled for epidermis-disrupting medical procedures and ones who had injuries to their skin.

From “Journal of Drugs in Dermatology”

VIDEO: Patients on oral isotretinoin are not at increased risk of Covid-19 infection

AT THE INTERSECTION OF SKIN AND SOCIETY

  • Researchers studying the impact of hair and skin discrimination on children.

    Through an online survey, open until May 31, a group of researchers are trying to understand better how adults' prior experiences of acceptance or rejection based on colourism can shape their recognition of the impact of colourism on children.

    In a press release from Tulane University in New Orleans, where the research is being conducted, the study’s principal investigator, Marva Lewis, said that while colourism and hair-type discrimination are pervasive and widely depicted in the media, little research has been carried out on the socioemotional impact of such experiences on children.

    “On one end of the spectrum, we’ve seen insensitive and demeaning talk about what the skin colour of the children of Prince Harry and Meghan Markle would look like,” Lewis said. “On the other end of the spectrum, we've seen a celebration of hair in the 2019 Academy Award-winning animated short film ‘Hair Love.’”

    Lewis is an associate professor of social work at the Tulane School of Social Work.

    The survey focuses on “colourism,” racial resentment, childhood hair type, tender headedness, adverse childhood experiences and parent acceptance. Titled “A Pilot Study of Childhood Experiences of Race-based Trauma from Colorism: Messages of Skin Tone and Hair Type,” the survey is open to all people over 18 years of age, regardless of race or ethnicity.

This Week

Something to think about during the week ahead…

Next Week

Dr. Joël Claveau discusses how inflammatory skin conditions present differently in darker skin types.

Skin Spectrum Weekly is launching the Skin Spectrum Podcast series, launching this summer. Please watch this space for more details. As always, we welcome your questions and comments on topics in Ethnodermatology.

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