Propionibacterium (Cutibacterium) granulosum Extracellular DNase BmdE Targeting Propionibacterium (Cutibacterium) acnes Biofilm Matrix, a Novel Inter-Species Competition Mechanism

Acne vulgaris is the most common dermatological disorder worldwide affecting more than 80% of adolescents and young adults with a global prevalence of 231 million cases in 2019. The involvement of the skin microbiome disbalance in the pathophysiology of acne is recognized, especially regarding the relative abundance and diversity of Propionibacterium acnes a well-known dominant human skin commensal. Biofilms, where bacteria are embedded into a protective polymeric extracellular matrix, are the most prevalent life style for microorganisms. P. acnes and its biofilm-forming ability is believed to be a contributing factor in the development of acne vulgaris, the persistence of the opportunistic pathogen and antibiotic therapy failures. Degradation of the extracellular matrix is one of the strategies used by bacteria to disperse the biofilm of competitors. In this study, we report the identification of an endogenous extracellular nuclease, BmdE, secreted by Propionibacterium granulosum able to degrade P. acnes biofilm both in vivo and in vitro. This, to our knowledge, may represent a novel competitive mechanism between two closely related species in the skin. Antibiotics targeting P. acnes have been the mainstay in acne treatment. Extensive and long-term use of antibiotics has led to the selection and spread of resistant bacteria. The extracellular DNase BmdE may represent a new bio-therapeutical strategy to combat P. acnes biofilm in acne vulgaris.

Microneedling Radiofrequency for Acne Vulgaris and Post-Acne Scarring: A Case Report

Background: There are various therapeutic modalities for acne and post acne scarring, but the best option is to have a safe, effective with affordable cost such as monotherapy or combination therapy. One of the recommended combination therapy for acne vulgaris with atrophic acne scars is microneedling radiofrequency which can improve skin structure. Case report: A 25 year old male with moderate comedonal acne vulgaris and severe scarring. The patient came with complaints of uneven skin surface on both cheeks, forehead and chin which had been felt to increase since 3 years ago. The appearance of acne on the face has been felt since 12 years ago. The patient's parents and sister also had acne complaints. On dermatological examination, on the forehead, temples, cheeks, nose and chin found blackheads, whiteheads, papules, hyperpigmented macules, multiple atrophic acne scars. The treatment choice for this patient is microneedling radiofrequency in combination with topical therapy. Discussion: The combination of microneedling with radiofrequency is one of the therapeutic modalities for acne vulgaris and also post-acne scarring with minimal side effects. In the evaluation for 2 weeks after the procedure, this patient did not complaint of any adverse events.

Assessment of serum hormone levels in female patients with acne vulgaris

Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the serum testosterone, estradiol, progesterone levels in women with acne vulgaris. Methods: We conducted a cross-sectional descriptive study, and 175 women with acne vulgaris were examined; their serum estradiol, progesterone, testosterone were analyzed by chemiluminescence technique and compared with the healthy control group. Results: Increased serum hormone levels in women with acne vulgaris were accounted for 29.7%, and hyperandrogenism was accounted for 16.0% of cases. We found significant differences in testosterone levels (mean value, 55.67±25.56 versus 38.37±10.16 ng/dL, p<0.05) respectively in the acne group and the control group. However, the estradiol level of the acne group (323.15±93.31 pmol/L) was lower than the control group (370.94±58.88 pmol/L) with p<0.05). No statistically significant differences were found for progesterone (0.60±0.38 versus 0.50±0.15 ng/mL, p>0.05) levels. Moreover, we did not find the relationship between serum hormone levels and the severity of acne vulgaris. Conclusion: This study showed that the female acne vulgaris patients may have high serum testosterone levels and low serum estradiol levels compared with those of female controls. However, hormone alterations had no correlation with the acne grades.

Clinical Treatment Study of Secondary Multiple Squamous Cell Carcinoma with Psoriasis Vulgaris

Dermatologic diseases are the fourth most frequent nonfatal common illness, yet they have a psychological, economical, and professional burden that is comparable to or larger than other chronic conditions. From a survey in China of 6 provinces, the overall prevalence of psoriasis with squamous cell carcinoma was 0.47%. According to the current investigation, the outburst of skin disease was not associated with gender, but mainly with the climate of the environment; that is, dry cold weather will more likely to induce psoriasis. Approximately 3% of people around the world have psoriasis, which is near the most common autoimmune skin disease in adults. By simple estimation, there are at least two hundred million psoriasis patients in the world. Therefore, it is not just a simple health problem in a country or a region but a serious global challenge. Of note, about half of the adult patients had been reported to be sick in their childhood and they mostly fell ill around 10 years old. Actinic keratosis is perhaps the most common, followed by squamous cell carcinoma and, to a lesser extent, acne vulgaris, psoriasis, and hidradenitis suppurativa, as well as dermatitis herpetiformis. 5-Fluorouracil (5-FU) 0.5 percent is used topically to treat actinic keratosis and squamous cell carcinoma with good outcomes, while it might cause significant toxicity in certain patients. Dapsone, a Valosin-containing protein, is a medication that is often used to treat inflammatory skin disorders like psoriatic arthritis, but it can occasionally cause hemolytic anemia. Furthermore, biologic medications for the treatment of moderate-to-severe psoriasis and multiple squamous cell carcinoma have proven to be successful and safe; nevertheless, a small percentage of patients do not react to biologic treatment in the long term or do not respond at all. Based on the data from the China Food and Drug Administration, the majority of chemical drugs are utilized as the topical formulations, while Chinese medicines are mainly delivered by an oral route, suggesting that the market for topical preparations of Chinese medicine to treat skin diseases like psoriasis is worth exploration. This large interindividual diversity in response could be caused by changes in genes that encode proteins implicated in the disease’s pathologic environment or the medication’s mechanism of action. Pharmacogenetics is the study of the association between genetic differences and medication response, which is valuable for identifying nonresponsive patients and those who are more likely to suffer toxicity as a result of treatment. This study highlights the pharmacogenetic recommendations for dermatology therapies that have the strongest evidence at this time, highlighting those that have been incorporated in clinical practice guides. Pharmacogenetic clinical guidelines for multiple squamous cell carcinoma and psoriasis vulgaris were found in this investigation. Here, for multiple squamous cell carcinoma trichohyalin-like 1 (TCHHL1), 5-fluorouracil (5-FU) 0.5% is recommended. Along with that dapsone, Valosin-containing protein can be recommended for treating the psoriasis vulgaris. We made some clinical trials over the two diseases, and from the result obtained, we hypothesize that the suggested drug may be a novel therapeutic target in treating the multiple squamous cell carcinoma with psoriasis vulgaris.

A Comparative Study of Efficacy of Fractional CO2 Laser vs Microdermabrasion in Treatment of Acne Scars (Total 100 Patients)

Introduction: Acne vulgaris is a common disease affecting pilosebaceous unit that can lead to significant scarring. Fractional CO2 Laser and microdermabrasion are effective non-surgical treatment modalities for acne scars. Aims and objectives: To study and compare the efficacy of fractional CO2 Laser and microdermabrasion therapy in acne scars. Material and methods: Total 100 patients were selected in our study. 50 patients were allotted into each group. Scar grading assessment was done by Goodman and Baron qualitative scar grading system. Result: 50 patients were taken in each group. There was a significant improvement in grading of acne scars at the end of 6months of treatment. On comparison of fractional CO2 Laser with microdermabrasion, p-value was <0.05 that is significant. Conclusion: Fractional CO2 Laser showed better improvement in grading of acne scars then microdermabrasion, though none of these treatments are 100% effective in treating acne scars. Keywords: Acne scars, fractional CO2 laser, microdermabrasion, Goodman and baron grading.

Progress of different treatment modalities to limit the use of antibiotics in the treatment of acne

Acne vulgaris is one of the most common skin diseases, affecting mainly teenagers. Its treatment procedure is complex, with a long duration of medication. Antibiotics are the most preferably prescribed drugs for the treatment of acne. The long-term use of antibiotics leads to various adverse effects such as the disruption of indigenous flora and resistance. Therefore, numerous therapeutic protocols such as antimicrobial stewardship have been proposed to limit the haphazard use of oral antibiotics. This review emphasizes different topical drugs, systemic alternative drugs, laser, and light therapy, as effective therapies for acne. This review also briefly reflects the efficacy of fire needle therapy—a traditional Chinese therapy—for acne.

IMPACT OF ACNE VULGARIS ON A PERSON’S QUALITY OF LIFE AND IT’S CORRELATION WITH THE CLINICAL SEVERITY PRE AND POST-DRUG THERAPY

Objective: The aim of the study is to assess the therapeutic efficacy of drugs used in acne vulgaris by measuring the severity of acne using the Global Acne Grading System score (GAGS) and Cardiff Acne Disability Index (CADI) questionnaire score pre and post-drug therapy. Methods: The present study was conducted in the Department of Dermatology after getting approval from the Institutional Ethics Committee (No MC/190/2007/Pt1/MAR-2019/PG/123) dated 10/04/2019. It was an observational study for a period of 1 y. 172 patients were enrolled in the study. Patients were divided into 4 grades depending on their clinical manifestation. The severity of acne vulgaris and the quality of life were measured using the GAGS scale and the CADI questionnaire, respectively at the first visit and at the follow-up visit in all the grades of acne vulgaris. A correlation was done between the GAGS and the CADI score at the follow-up visit in all grades of acne. Results: It was observed that the GAGS score and the CADI score was significantly improved at the F/U visit (p<0.05) as compared to baseline in all the 4 grades of acne. A correlation between GAGS score and QoL using CADI scale was done using Pearson Parametric Correlation Test. In none of the groups, the correlation was significant (p>0.05). Conclusion: We can conclude from our study that following treatment with drugs, the clinical severity of acne decreased and there was also a significant improvement in the quality of life of patients.