Cobalt folliculitis

Clinical observations in 60 cases of folliculitis or pronounced activation of acne in patients taking cobalt led to conclusion that the development or aggravation of the dermal lesions were owing to ingestion of the metal. The dermal manifestations abated when use of cobalt was discontinued. Active acne is considered a contraindication to the use of vitamin-iron-mineral supplements containing cobalt. Short courses of antibiotics in addition to regular acne regimen helped shorten the course of the eruption.     

Prevalence of facial acne vulgaris in late adolescence and in adults.

A survey of 1066 healthy women and 1089 healthy men aged 18-70 years, performed to determine the prevalence of facial acne, showed that clinical acne was not confined to adolescents. Though it was more prevalent among men than women at 18, beyond the age of 23 clinical acne was more prevalent among women as the prevalence in men gradually declined. At 40-49 years 3% of men and 5% of women still had definite, albeit mild, clinical acne, and at 50-59 years 6% of men and 8% of women had physiological acne. The surprisingly high prevalence of acne in adults may be related to antibiotic treatment or, in women, to the use of oral contraceptives or cosmetics, though this survey did not study their influence. Further studies in different populations are needed to establish the prevalence of acne in the community, and its distribution.     

Congenital dislocation of the hip

In surgical skin planing steel wire brushes have been largely replaced by the less hazardous diamond chip burs or "fraises" and serrated steel wheels. In addition to acne pits and wrinkling, multiple actinic (senile) keratoses are an important indication for planing. Planing provides a nonscarring method for the treatment of existing keratoses, as well as a prophylaxis against skin cancer by replacing the sun-damaged, precancerous epidermis with new epidermal cells derived from the cutaneous adnexa (pilosebaceous and sweat gland units). There are clinical landmarks indicating the depth of planing which can serve as a guide to the operator and can be correlated with microscopic findings. The results of experiments on the comparative effects of refrigerants on animal and human skin indicate that human facial skin can tolerate considerable freezing with ethyl chloride or dichlorotetrafluoroethane (Freon 114) but that mixtures containing large proportions of the much colder dichlorodifluoromethane (Freon 12) may be undesirable. Refreezing an area of the skin in order to perform a more adequate planing is not considered hazardous.THE REGENERATION OF THE SKIN FOLLOWING PLANING HAS THREE COMPONENTS: Epidermal, adnexal and dermal. The cells of the epidermis and the adnexa are equipotential. A knowledge of the anatomy of the acne pit enables the operator to decide which pits can be benefited by planing and which should be excised before planing. The successful treatment of acne pits of the face by planing in patients having keloids elsewhere on the body is reported.     

6-[2-(adamantylidene)-hydroxybenzoxazole]-O-sulfamate, a steroid sulfatase inhibitor for the treatment of androgen- and estrogen-dependent diseases

Steroid sulfatase (STS) offers a new target for the treatment of steroid hormone-dependent diseases, such as breast and prostate cancer and androgen-dependent skin diseases. We here characterize a novel non-estrogenic inhibitor of the enzyme, namely 6-[2-(adamantylidene)-hydroxybenzoxazole]-O-sulfamate (AHBS), with special attention to its potential use in the treatment of acne. The compound blocks STS activity in homogenates of human skin with IC(50)=16 nM. Following a single oral dose (5 mg/kg) in rats, the compound blocks STS in the skin by 95% at 8 h, followed by recovery of activity over 5 days. Following topical application to the skin, both in vitro and in vivo, AHBS passes through the stratum corneum leading to inhibition of STS activity in the dermal compartment with rapid onset and long duration. Topical application of AHBS to G?ttingen minipigs for a period of 2 weeks does not induce symptoms of ichthyosis as seen in STS-deficient human subjects, but leads to a reduction of sebum secretion to the skin surface. Based on these data, clinical studies with AHBS in acne patients are warranted, in order to verify the hypothesis on the importance of the sulfatase pathway in androgen-dependent skin diseases.     

Acne in schoolchildren: no longer a concern for dermatologists.

OBJECTIVE--To determine the prevalence and severity of acne among schoolchildren in Glasgow. DESIGN--Secondary schools in Glasgow were divided by postcode into five socioeconomic cluster groups. Different numbers of schools were selected at random from the five groups to ensure proportional representation. One class from each registration year of the chosen schools was selected at random and the whole class recruited into the study. SETTING--15 Secondary schools in Glasgow. SUBJECTS--2014 Randomly selected schoolchildren aged 12-17 (5% of total secondary school roll). INTERVENTIONS--None. END POINT--Assessment of facial acne by two independent examiners by a recognised acne scoring system. MEASUREMENTS AND MAIN RESULTS--The prevalence of acne in boys increased from 40% (75/189) at age 12 to 95% (108/114) at age 16, and in girls it increased from 61% (114/187) at age 12 to 83% (136/164) at age 16. On a scale of 0 to 10 only 18 boys (1.8%) and three girls (0.3%) had grades of acne of 1.0 or greater; most of the pupils had grade 0.05-0.375 (minimal) acne. Nine per cent of boys (88/973) and 14% of girls (145/1041) had visited their general practitioner specifically for advice on and treatment for acne; only five pupils (0.3%) had been referred to a dermatologist. CONCLUSIONS--Both the prevalence and severity of acne have decreased over the past 20 years. This has probably been due to improvement of treatment for acne by primary care doctors and the greater availability and use of over the counter preparations for acne.     

钙离子和氯化钴促进成纤维细胞色素上皮衍生因子的表达

目的探讨色素上皮衍生因子(PEDF)在成纤维细胞中的表达以及钙离子和氯化钴对其表达的影响。方法 19例包皮标本根据年龄分为2组:13例40岁以下者为I组,6例40岁以上者为II组。以I型胶原酶分离真皮成纤维细胞,37oC5%CO2培养。以1.0mmol/L氯化钙和100μmol/L的氯化钴作用于培养的成纤维细胞。以免疫荧光法检测PEDF蛋白质的表达,以逆转录-聚合酶链反应(RT-PCR)检测PEDF mRNA的表达情况。结果 PEDF表达于正常成纤维细胞,而且在组I和组II间mRNA相对表达量无差异性(分别为,P>0.05)。1.0mmol/L氯化钙和100μmol/L氯化钴显著增加PEDF mRNA相对表达量,分别为2.3倍和1.4倍,二者差异具有显著性(P<0.05)。结论真皮成纤维细胞表达PEDF,而且受钙离子和氯化钴的调节。     

Sexual hormones in human skin.

The skin locally synthesizes significant amounts of sexual hormones with intracrine or paracrine actions. The local level of each sexual steroid depends upon the expression of each of the androgen- and estrogen-synthesizing enzymes in each cell type, with sebaceous glands and sweat glands being the major contributors. Sebocytes express very little of the key enzyme, cytochrome P450c17, necessary for synthesis of the androgenic prohormones dehydroepiandrosterone and androstenedione, however, these prohormones can be converted by sebocytes and sweat glands, and probably also by dermal papilla cells, into more potent androgens like testosterone and dihydrotestosterone. Five major enzymes are involved in the activation and deactivation of androgens in skin. Androgens affect several functions of human skin, such as sebaceous gland growth and differentiation, hair growth, epidermal barrier homeostasis and wound healing. Their effects are mediated by binding to the nuclear androgen receptor. Changes of isoenzyme and/or androgen receptor levels may have important implications in the development of hyperandrogenism and the associated skin diseases such as acne, seborrhoea, hirsutism and androgenetic alopecia. On the other hand, estrogens have been implicated in skin aging, pigmentation, hair growth, sebum production and skin cancer. Estrogens exert their actions through intracellular receptors or via cell surface receptors, which activate specific second messenger signaling pathways. Recent studies suggest specific site-related distribution of ERalpha and ERbeta in human skin. In contrast, progestins play no role in the pathogenesis of skin disorders. However, they play a major role in the treatment of hirsutism and acne vulgaris, where they are prescribed as components of estrogen-progestin combination pills and as anti-androgens. These combinations enhance gonadotropin suppression of ovarian androgen production. Estrogen-progestin treatment can reduce the need for shaving by half and arrest progression of hirsutism of various etiologies, but do not necessarily reverse it. However, they reliably reduce acne. Cyproterone acetate and spironolactone are similarly effective as anti-androgens in reducing hirsutism, although there is wide variability in individual responses.     

宏基因组学技术在痤疮研究中的应用进展

高通量测序技术的发展提高了人们对微生物组的认识。宏基因组学技术因其全面和深入的分析功能被广泛应用于各种环境微生物组的研究中,尤其在阐明各种疾病与人体微生物组的关系中,宏基因组学技术具有重要作用。痤疮作为一种常见的皮肤疾病,严重影响人们皮肤美观度和心理健康。利用宏基因组学技术挖掘皮肤微生物与痤疮的关系,将有助于痤疮发病机理的研究和临床治疗方法的改进。通过介绍宏基因组学技术的发展背景、概述及其应用研究进展,探讨皮肤微生物与痤疮的关系,综述宏基因组学技术在痤疮研究中的应用现状,并总结目前宏基因组学技术在皮肤疾病研究中存在的问题,旨在为痤疮的宏基因组研究提供参考。     

The temperature dependence of porphyrin production in Propionibacterium acnes after incubation with 5-aminolevulinic acid (ALA) and its methyl ester (m-ALA).

Topical PDT treatment of the common skin disease acne vulgaris is now in clinical use. Propionibacterium acnes (P. acnes) is known to play an important role in acne. 5-Aminolevulinic acid (ALA) supplementation leads to an enhanced porphyrin production in the bacteria. Subsequent illumination with light of the proper wavelengths can reduce the number of bacteria and this might at least partly explain the PDT effect on acne. We have assessed the effects of temperature on P. acnes washed cell suspensions incubated for 4 h with ALA or ALA methyl ester (m-ALA). The effect on porphyrin production of both the cell suspension incubation temperature as well as the initial growth temperature of the cultivated cells prior to harvesting and use in suspension experiments was investigated. The bacterial porphyrin content was estimated from fluorescence emission spectra. It was found that incubation with ALA or m-ALA at a temperature 42 degrees C resulted in an approx. 100% and 33% increase in the total amount of PDT-relevant porphyrins produced as compared to incubation at 37 degrees C. These results support increasing the skin temperature during incubation with ALA or m-ALA in the clinic. The initial growth temperature, prior to the incubation, had no apparent effect on the ALA or m-ALA induced porphyrins. Activation energy studies indicate slightly higher temperature dependence in the case of ALA produced porphyrins as compared to m-ALA produced porphyrins (77 and 65 kJ mol(-1), respectively).     

Antibacterial and anti-inflammatory effects of Jeju medicinal plants against acne-inducing bacteria

Propionibacterium acnes and Staphylococcus epidermidis are pus-forming bacteria that trigger inflammation in acne. The present study was conducted to evaluate the antimicrobial activities of Jeju medicinal plants against these etiologic agents of acne vulgaris. Ethanol extracts of Jeju plants were tested for antimicrobial activities by disc diffusion and broth dilution methods. The results from the disc diffusion assays revealed that four medicinal plants, Mollugo pentaphylla, Angelica anomala, Matteuccia orientalis, and Orixa japonica inhibited the growth of both pathogens. Among these, A. anomala had strong inhibitory effects. Its MIC values were 15.6 microg/ml and 125 microg/ml against P. acnes and S. epidermidis, respectively. The cytotoxic effects of the four extracts were determined by colorimetric MTT assays using two animal cell lines: human dermal fibroblasts and HaCaT cells. Although the M. orientalis root extract had moderate cytotoxicity in HaCaT cells at 200 microg/ml, most extracts exhibited low cytotoxicity at 200 microg/ml in both cell lines. In addition, the extracts reduced the P. acnes-induced secretion of interleukin-8 and tumor necrosis factor-alpha (TNF-alpha) in THP-1 cells, an indication of their anti-inflammatory effects. Based on these results, we suggest that M. pentaphylla, A. anomala, M. orientalis, and O. japonica are attractive acne-mitigating candidates for topical application.     

Dermal bone in early tetrapods: a palaeophysiological hypothesis of adaptation for terrestrial acidosis

The dermal bone sculpture of early, basal tetrapods of the Permo-Carboniferous is unlike the bone surface of any living vertebrate, and its function has long been obscure. Drawing from physiological studies of extant tetrapods, where dermal bone or other calcified tissues aid in regulating acid-base balance relating to hypercapnia (excess blood carbon dioxide) and/or lactate acidosis, we propose a similar function for these sculptured dermal bones in early tetrapods. Unlike the condition in modern reptiles, which experience hypercapnia when submerged in water, these animals would have experienced hypercapnia on land, owing to likely inefficient means of eliminating carbon dioxide. The different patterns of dermal bone sculpture in these tetrapods largely correlates with levels of terrestriality: sculpture is reduced or lost in stem amniotes that likely had the more efficient lung ventilation mode of costal aspiration, and in small-sized stem amphibians that would have been able to use the skin for gas exchange.     

Treatment of Acne Vulgaris with Tetracyline Hydrochloride: a Double-blind Trial with 51 Patients

Fifty-one patients with acne vulgaris were included in a double-blind trial to assess the therapeutic effect of 250 mg. tetracycline hydrochloride twice daily for three months. The results, assessed clinically and photographically, showed that tetracycline hydrochloride had a statistically significant beneficial effect. Hence, since it is cheap and rarely has side-effects in healthy young adults, its use is suggested, as well as local therapy, in the more severe forms of acne.     

Propionibacterium acnes GehA lipase, an enzyme involved in acne development, can be successfully inhibited by defined natural substances

Propionibacterium acnes, a usual inhabitant of human skin, plays an important role in acne development, related to the production of numerous enzymatic activities involved in the degradation of host molecules. Among these enzymes, P. acnes lipase (GehA, glycerol-ester hydrolase A) has been recognized as one of the major factors in the pathogenesis of acne, being responsible for the hydrolysis of sebum and the release of inflammatory compounds. Anti-acne treatments are based on the use of retinoids or benzoyl peroxide, frequently in combination with antibiotics. However, the low effectiveness of such treatments and the increasing antibiotic resistance has led to the development of alternative therapies such as Kampo formulations, containing traditional herbal drugs. Search for new anti-acne treatments led us to perform the cloning, characterization and inhibition of P. acnes GehA, considered an interesting pharmaceutical target for anti-acne therapies. The genetic, molecular and biochemical properties of the cloned lipase were analysed, and several inhibitor agents were tested, including natural substances like saponins, alkaloids or flavonoids. Among these, the flavonoids (±)-catechin and kaempferol were the most promising candidates for acne treatment, whereas saponins like glycyrrhicic acid and digitonin produced a lower inhibition of the enzyme. No inhibition by alkaloids was found. Therefore, the inhibition caused by (±)-catechin and kaempferol on GehA, together with their wide anti-acne properties and low toxicity, make them very suitable candidates for the treatment of acne and other P. acnes-related diseases.     

Taurine bromamine (TauBr) - its role in immunity and new perspectives for clinical use

This review is an attempt to summarize our knowledge about taurine bromamine (TauBr) properties, its role in innate immunity and its therapeutic potential.TauBr and taurine chloramine (TauCl) are major haloamines generated by eosinophils and neutrophils at a site of inflammation. Both haloamines share anti-inflammatory and anti-oxidant properties. TauBr, similarly to TauCl, decreases the production of proinflammatory mediators. Their anti-inflammatory and anti-oxidant activities are enhanced by their ability to induce the expression of heme oxygenase-1 (HO-1). TauCl is more stable than TauBr. On the other hand, only TauBr was found to be highly membrane-permeable showing stronger microbicidal activity than TauCl.In the light of the anti-inflammatory and antimicrobial properties of TauBr we discuss its therapeutic potential in local treatment of inflammation, especially acne vulgaris, the most common inflammatory skin disorder. TauBr, at non-cytotoxic concentrations, is able to kill Propionibacterium acnes, the skin bacteria involved in pathogenesis of acne vulgaris.As topical antibiotics used in the therapy of acne are associated with the emergence of resistant bacteria, topical TauBr seems to be a good candidate for an alternative therapy.Recently, in a double blind trial, the efficacy of TauBr was compared with the efficacy of clindamycin, one of the most common topical antibiotics used in acne therapy. Comparable reduction of acne lesions was observed in the TauBr and clindamycin groups of patients with mild and moderate inflammatory facial acne vulgaris. We conclude that this pilot study supports our concept that TauBr can be used as a topical agent in the treatment of acne vulgaris, especially in patients who have already developed antibiotic resistance. Further studies are necessary to substantiate the more extended use of TauBr as an anti-inflammatory and anti-oxidant agent in human medicine.     

黄瓜香等中草药对寻常型痤疮治疗效果的观察

目的应用黄瓜香等中草药作为微生态调节剂治疗青少年寻常型痤疮。方法通过比较治疗前后痤疮患者面部皮肤痤疮丙酸杆菌和表皮葡萄球菌数量以及面部皮疹的数量来判断黄瓜香等中草药治疗痤疮的疗效。结果黄瓜香抑制了痤疮丙酸杆菌和表皮葡萄球菌生长（P〈0．05）;减少了皮疹数量（P〈0．05）,使皮疹不再出现。结论黄瓜香等能够治疗青少年寻常型痤疮。     

Augmentation rhinoplasty with dermal graft and review of the literature

Nasal augmentation required following a trauma or a rhinoplasty operation poses a challenging problem to many plastic surgeons. Currently, allografts and autologous tissues are used for nasal augmentation; however, an ideal technique has not yet been described. Although preferred for augmentation of different parts of the body, pure dermal graft use has not been described for nasal augmentation. The authors performed nasal augmentation using a dermal graft in 90 patients in their hospital between 1994 and 2000, and they followed up the patients for 6 months to 8 years. In this article, the early and late results of dermal grafts for nasal augmentation are presented, and their advantages and disadvantages are discussed with a review of the literature. It was concluded that the easily obtained dermal graft could be an appropriate alternative in nasal augmentation, though it has not been used widely for this purpose.     

Further Observations on the Pathogenesis of Acne

The composition of the lipid of the forehead skin surface and the sebum excretion rate were determined in 217 subjects and controls. Acne was associated with an increase in serum excretion rate and in the squalene and wax and sterol esters in surface lipid. The changes in sebum excretion rate and squalene were statistically significant only in women, but acne in men was associated with a significant decrease in the free fatty acid content or surface lipid.The increased amounts of squalene and wax esters may lead to pilosebaceous obstruction in acne subjects. The increased sebum excretion rate in acne may ensure increased production of sebaceous triglyceride substrate available for lipolysis to irritant free fatty acids, which may then mediate the inflammatory changes of acne.     

Acne and anticonvulsants.

The severity of acne and rate of excretion of sebum were assessed in 243 patients with epilepsy taking various anticonvulsants who were in hospital long term and in matched controls derived from a normal population of 2176 people. Neither the prevalence of acne nor the sebum excretion rate significantly increased in the patients compared with the controls or in patients taking phenytoin compared with those not. It is concluded that anticonvulsant treatment does not cause acne.     

Striae and Their Relation to Topical Steroid Therapy

Atrophic striae have been reported to occur normally in 35% of adolescents and abnormally in a variety of medical conditions. Recently, the occurrence of striae has been observed in adults after the use of potent topical steroids with occlusion. Pre-existing striae have been found to enlarge after topical steroid therapy, even without occlusion. The mechanism of striae formation appears to be due to the action of the steroids on the dermal connective tissue and/or dermal matrix rather than to mechanical tension.