Topical tretinoin may alter skin microbiome
Today's report also covers broadband light photodynamic therapy, acne vulgaris, low-dose isotretinoin in Chinese patients, and more (1,400 words, 6 minutes, 30 seconds)
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Good morning and welcome to the fifth 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
Topical tretinoin may alter skin microbiome
Findings from a recent study indicate topical application of tretinoin may alter the skin microbiome in patients with acne, suggesting a potential additional therapeutic mechanism of tretinoin.
The study was published in a research letter in JAAD International (March 2024; 14:1-3).
Hypothesizing that topical tretinoin without known antibacterial properties can induce alteration of the skin microbiome in patients with acne, researchers assessed the changes in the skin microbiota associated with therapeutic response in patients with acne, treated with tretinoin 0.05% lotion.
For this study, the investigators recruited 12 control subjects and 12 acne patients. Four of the control subjects and four acne patients were lost to follow-up after the first visit. Samples were taken before treatment (visit one), after 90 days of topical tretinoin treatment (visit two), and 60 days after discontinuation of treatment (visit three).
The researchers observed the relative abundance, at baseline, of Kingella bacteria at the genus level was 5.8-fold higher in acne patients compared to healthy controls. After treatment with tretinoin, there was no statistically significant difference in the relative abundance of Kingella between acne patients and healthy controls. After discontinuation of tretinoin, there was no statistically significant difference in the relative abundance of Kingella in patients with acne between visit two and visit three. The investigators found three additional taxa at the family level to be significant.
Sequential broadband light photodynamic therapy for moderate-to-severe acne
A combination of 560-1,200 nm and 420-1,200 nm broadband light (BBL) photodynamic therapy can effectively treat moderate-to-severe acne vulgaris with tolerable adverse reactions, according to new findings. The study authors say this could represent a new option for patients with higher aesthetic requirements.
The findings were published in Photodiagnosis and Photodynamic Therapy (Nov. 19, 2023; 44:103902, online ahead of print).
Researchers included 24 patients with moderate-to-severe acne vulgaris in the study. All patients expressed a strong desire for beauty.
After aminolevulinic acid (ALA) gel was applied, the patients' faces were sequentially irradiated with BBL with a 560 nm cut-off filter (560-1200 nm), followed by BBL with a 420 nm cut-off filter (420-1200 nm). The authors evaluated clinical efficacy by the proportion of patients achieving cured response and excellent response (effective rate), based on the percentage reduction in lesion count (treatment rate).
In patients with moderate acne, the mean treatment rates were 57.74%±16.40% and 87.40%±8.521% at the sixth week and 12th week of treatment, respectively. In patients with severe acne, the mean treatment rates were 60.95%±12.06% and 85.04%±9.115% at the sixth week and 12th week of treatment, respectively. At the sixth and 12th weeks of treatment, the effective rates of patients were 20.00% and 93.33% in patients with moderate acne, and 0.000% and 88.89% in patients with severe acne, respectively.
Researchers recorded significantly higher pain scores in patients with severe acne compared to patients with moderate acne when receiving 560-1,200 nm BBL-PDT. Patients exhibited significantly higher pain scores when receiving 420-1,200 nm BBL-PDT than when receiving 5,60-1200 nm BBL-PDT. The degree of erythema was more severe in patients with severe acne than in those with moderate acne. The authors observed pigmentation changes in one patient with moderate acne and one patient with severe acne.
Significant psychological distress from acne vulgaris
There is a need to manage the psychological distress associated with acne vulgaris, and for a holistic approach to patient care that addresses the physical and emotional aspects of the skin condition to enhance patient well-being and QoL.
These were the conclusions of a cross-sectional study published in Scientific Reports (Nov. 30, 2023; 13(1):21084).
Researchers included 150 patients clinically diagnosed with acne vulgaris. The investigators measured acne severity using the Global Acne Grading System (GAGS), and instructed patients to complete a selection of forms: the Depression, Anxiety and Stress Scale-21 Items (DASS-21), Rosenberg Self Esteem Scale (RSES), Cardiff Acne Disability Index (CADI), Dermatology Life Quality Index (DLQI), and World Health Organization Quality of Life (WHOQoL) scale.
They found that female patients with acne vulgaris had significantly higher depression (p=0.003, t=3.025) and anxiety (p<0.001, t=3.683). Statistical analysis indicated a strong, positive, and significant correlation between having acne and experiencing depression (r=0.630), anxiety (r=0.661), and stress (r=0.758) (p<0.001).
Multiple regression analysis suggested acne and associated psychological distress had a significant and negative impact on the patient's self-esteem and quality of life.
Low-dose isotretinoin safe, effective in Chinese patients
A recent study has reaffirmed the efficacy and safety of low-dosage oral isotretinoin in Chinese patients with acne vulgaris.
The findings were published online ahead of print in the Journal of Cosmetic Dermatology (Nov. 7, 2023).
Researchers enrolled 388 patients treated with low-dosage isotretinoin (0.2-0.4 mg/kg/d) and who completed the treatment course (120 mg/kg) in the study.
They found the majority (90.2%, n=350) of patients achieved complete remission, and on average, patients received 13.5 months of treatment. The difference in the time between starting isotretinoin and the clear date was not significantly different between the mild and moderate groups (74±24 vs. 84±24 days). However, the authors found acne took longer to resolve for the severe acne group (112±25 days).
By a one-year follow-up after completion of the isotretinoin course, 37/350 (10.6%) patients relapsed, but there was no difference in the severity of acne. There were 133 (34.3%), 40 (10.3%), and 14 (2.6%) patients who developed hypercholesterolemia, hypertriglyceridemia, and high LDL, respectively. Thirty-two (8.2%) and 28 patients (7.2%) had elevated serum levels of alanine and aspartate aminotransferases. No values above grade 2 were detected.
The authors write their data supports the idea that frequent laboratory monitoring is unwarranted during isotretinoin treatment. They suggest lab work could be performed after two months of treatment in healthy patients with normal baseline liver function and lipid panel tests. No further testing may be required if the findings are normal.
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