Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.

Botulinum Neurotoxin Type A in the Treatment of Oily Skin and Acne: Evidence and a Proposed Mechanism

Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to the overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of oily skin and acne with botulinum neurotoxin type A.

Evaluation of Serum Interleukin 36 in Egyptian Acne Vulgaris Patients versus Controls

Background Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, and it is one of the most common dermatological conditions worldwide. Some of the key mechanisms of pathogenesis are the disturbed sebaceous gland activity associated with excess sebum production and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, and induction of inflammation and dysfunction of the innate and adaptive immunity. Objectives We aimed to evaluate the serum IL36 levels in acne vulgaris patients in comparison with healthy controls and to correlate its level to different severities of acne vulgaris. Patients and Methods This is a case control study which included 30 acne vulgaris patients who were recruited from the Outpatient Dermatology Clinic at Ain Shams University Hospitals during the period between September 2018 and December 2018. Results The study revealed a highly significant increase in IL-36 serum levels which can differentiate cases form controls with a high degree of specificity of the test according to the ROC curve However, there was no association between IL-36 and the disease severity. Expression of high levels of IL-36 in all acne cases including mild cases suggests a probable role in early inflammatory stage of the disease. Furthermore, duration of the disease, body mass index, family history and sex were all insignificant factors on affecting IL-36 levels. Conclusion We found that IL-36 is involved in acne pathogenesis and its serum levels are elevated even in mild cases with comedonal lesions suggesting the possible involvement in the early events of acne vulgaris. Further studies are required to demonstrate more detailed explanation of IL-36 pathogenic role in acne.

Assessment of the dynamics of indicators of morphological and functional characteristics of the skin in patients with the combined subtype of rosacea under the influence of complex phototherapy

Rosacea is a common chronic inflammatory dermatosis of vascular origin, characterized by a lesion of the face skin in the form of erythema and papulopustular elements. Taking into account the new research devoted to the treatment of rosacea, it is of scientific and practical interest to develop new methods for the treatment of this dermatosis using complex physiotherapy approaches and their synergy, for example, IPL radiation (without the use of photo filters) and submilisecond neodymium 1,064nm laser radiation. Material and methods. The study included 130patients with the combined subtype of rosacea (CSR) with varying degrees of severity of ETR and PPR. In order to study the effectiveness of complex photo- and laser therapy of CSR, all patients were divided into 4groups by simple randomization (envelope method). The treatment of the patients in each separate group included: group I — laser therapy and 1% metronidazole cream; group II — phototherapy and 1% metronidazole cream; group III — complex photo-laser therapy and 1% metronidazole cream; group IV — comparison group, patients received only 1% metronidazole cream. This work takes into account the synergism of both physiotherapeutic effects provided by non-truncated (without the use of photo filters) IPL radiation and submilisecond neodymium 1,064 nm laser radiation, as well as the increased destruction of pathologically altered vessels observed during the sequential use of both procedures, and the developed original method of treating patients with CSR. Conclusion. Based on the obtained results, it was concluded that the maximum improvement in the morphofunctional parameters of the skin was in the third group of patients with CSR. The increase in the hydration index of the skin exceeded the indicators of the other groups of patients with CSR. Also, the intensity of sebum production decreased most significantly. There was a maximum narrowing of the excretory ducts of the sebaceous glands, while in the other groups, the narrowing of the excretory ducts of the sebaceous glands occurred to a lesser and equal extent. Such changes reflect the pronounced effect of complex phototherapy on the tone of the sphincter of the excretory duct, the intensity of sebum production, as well as on the synthesis of collagen and elastin, which is reflected in the maximum approximation to the indicators of the group of healthy volunteers of such characteristics as «hydration» and «smoothness».

A CONCEPTUAL STUDY ON ETIOLOGY AND AYURVEDIC MANAGEMENT OF MUKHADUSHIKA W.S. R TO ACNE VULGARIS: A REVIEW

Ayurveda is considered an ancient healthcare system of India which is based on the eternal principle of healthy life. The whole clinical approach of Ayurveda is based on the preventive, promotive & curative aspects that aim of Ayurveda. Now a days, the whole world is gradually turning towards Ayurveda for a safe and complete cure of diseases, especially in the field of skin problems, Ayurveda can contribute remarkably. Skin is known as the larg- est organ of the human body, which performs many functions like thermoregulation, vitamin D synthesis, sensory perception, immunological function etc. But besides this, it also seems an important symbol of beauty. Acne vul- garis is the most common problem affecting the normal texture of skin bothering teenagers today. This skin con- dition lights the mankind and caricature of youth. Acne vulgaris is known as a disease of the pilosebaceous folli- cle characterized by non-inflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, and nodules). Four major factors involved in the disease production are inflammation, rise in sebum production, cornification of pilosebaceous ducts and microbial involvement. In Ayurveda, Shalmali thorn-like eruptions on the face of a youth caused by Kapha, Vata and Rakta are known as Yuvanpidika. They are also known as Mukha- dushika.1The painful eruptions packed with Meda, similar to the thorns of Shalmali having their site on the face of adults are known as Yuvanpidika2. This article describes the Ayurvedic review of Mukhadushika with Nidan, Pur-varoop, Roop, Samprapti and Chikitsa along with its modern counterpart of Acne with its definition, causative factors, and types of acne, complications and treatment modalities. Keywords: Mukhadushika, Ksudrarogas, Yuvanpidika, Acne vulgaris, Shalmali

Assessment of the dynamics of indicators of morphological and functional characteristics of the skin in patients with the combined subtype of rosacea under the influence of complex phototherapy

Rosacea is a common chronic inflammatory dermatosis of vascular origin, characterized by a lesion of the face skin in the form of erythema and papulopustular elements. Taking into account the new research devoted to the treatment of rosacea, it is of scientific and practical interest to develop new methods for the treatment of this dermatosis using complex physiotherapy approaches and their synergy, for example, IPL radiation (without the use of photo filters) and submilisecond neodymium 1,064 nm laser radiation. Material and methods: The study included 130 patients with the combined subtype of rosacea (CSR) with varying degrees of severity of ETR and PPR. In order to study the effectiveness of complex photo- and laser therapy of CSR, all patients were divided into 4 groups by simple randomization (envelope method). The treatment of the patients in each separate group included: group I — laser therapy and 1% metronidazole cream; group II — phototherapy and 1% metronidazole cream; group III — complex photo-laser therapy and 1% metronidazole cream; group IV — comparison group, patients received only 1% metronidazole cream. This work takes into account the synergism of both physiotherapeutic effects provided by non-truncated (without the use of photo filters) IPL radiation and submilisecond neodymium 1,064 nm laser radiation, as well as the increased destruction of pathologically altered vessels observed during the sequential use of both procedures, and the developed original method of treating patients with CSR. Conclusion: Based on the obtained results, it was concluded that the maximum improvement in the morphofunctional parameters of the skin was in the third group of patients with CSR. The increase in the hydration index of the skin exceeded the indicators of the other groups of patients with CSR. Also, the intensity of sebum production decreased most significantly. There was a maximum narrowing of the excretory ducts of the sebaceous glands, while in the other groups, the narrowing of the excretory ducts of the sebaceous glands occurred to a lesser and equal extent. Such changes reflect the pronounced effect of complex phototherapy on the tone of the sphincter of the excretory duct, the intensity of sebum production, as well as on the synthesis of collagen and elastin, which is reflected in the maximum approximation to the indicators of the group of healthy volunteers of such characteristics as «hydration» and «smoothness».

Botulinum Toxins in Medical and Cosmetic Dermatology

Background: Botulinum toxin (BoNT), a bacterially produced neurotoxin, is a mainstay in the dermatologic armamentarium. Although BoNT is commonly used to treated rhytides associated with ageing, it can be employed for a variety of other cosmetic purposes and medical disorders. Objective: In this review, the authors aim to describe the multitude of uses for BoNT in the dermatologic field. Materials and Methods: This manuscript was designed as a retrospective review of the on- and off-label applications of BoNT in dermatology.Results: In addition to treatment of rhytides, BoNT has been shown to decrease rosacea, menopause-associated flushing, and facial sebum production, while improving patient confidence in their appearance. Furthermore, BoNT has been successfully used to treat primary hyperhidrosis, hair loss, aberrant scarring, Raynaud’s phenomenon-associated vasospasm, as well as a variety of skin diseases. Side effects of BoNT include pain or discomfort associated with injections during treatment, bruising, asymmetry, and swelling. Patients are generally satisfied with clinical results after BoNT treatment. Conclusion: Dermatologists should be aware of all on- and off-label applications of BoNT to provide patients with timely and appropriate medical care. Further research must be completed to fully characterise the safety and use of BoNT for off-label purposes.

Histone Deacetylase 1 Reduces Lipogenesis by Suppressing SREBP1 Transcription in Human Sebocyte Cell Line SZ95

Proper regulation of sebum production is important for maintaining skin homeostasis in humans. However, little is known about the role of epigenetic regulation in sebocyte lipogenesis. We investigated histone acetylation changes and their role in key lipogenic gene regulation during sebocyte lipogenesis using the human sebaceous gland cell line SZ95. Sebocyte lipogenesis is associated with a significant increase in histone acetylation. Treatment with anacardic acid (AA), a p300 histone acetyltransferase inhibitor, significantly decreased the lipid droplet number and the expression of key lipogenic genes, including sterol regulatory-binding protein 1 (SREBP1), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC). In contrast, treatment with trichostatin A (TSA), a histone deacetylase (HDAC) inhibitor, increased the expression of these genes. Global HDAC enzyme activity was decreased, and HDAC1 and HDAC2 expression was downregulated during sebaceous lipogenesis. Interestingly, HDAC1 knockdown increased lipogenesis through SREBP1 induction, whereas HDAC1 overexpression decreased lipogenesis and significantly suppressed SREBP1 promoter activity. HDAC1 and SREBP1 levels were inversely correlated in human skin sebaceous glands as demonstrated in immunofluorescence images. In conclusion, HDAC1 plays a critical role in reducing SREBP1 transcription, leading to decreased sebaceous lipogenesis. Therefore, HDAC1 activation could be an effective therapeutic strategy for skin diseases related to excessive sebum production.