Comparison of Topical Herbal Cream and 1% Clindamycin Gel for Treatment of Mild-to-moderate Acne: A Randomized Clinical Trial

Background: Acne is the most common chronic skin disease affecting young adults and adolescents worldwide. A characteristic of this disease is the chronic inflammation of sebaceous glands leading to comedones, papules, pustules, nodules, and cysts. Topical and systemic uses of medicines are common approaches to treat acne. However, these medicines are associated with some adverse effects and increased microbial resistance. Objectives: We aimed to prepare and apply an herbal formulation containing several herbs with different effects on mechanisms associated with acne formation. Methods: In this study, 66 patients with mild-to-moderate acne randomly received a packet containing herbal medicine or clindamycin gel. The treatment period was two months, and the total acne lesions and acne severity index were measured every four weeks. After eight weeks of treatment and follow-up, the physician examined clinical outcomes and possible complications. Results: Decreases in total acne lesions and acne severity index were significantly different in both treatment groups (P < 0.05 in both groups). Although the herbal cream provided better improvement than clindamycin, there was no significant difference between the two groups (P > 0.05). Conclusions: The use of the herbal cream could be recommended for treating acne lesions due to few complications, greater patient satisfaction, and avoiding microbial resistance to chemical antimicrobials.

Automatic Image Characterization of Psoriasis Lesions

Psoriasis is a chronic skin disease that affects 125 million people worldwide and, particularly, 2% of the Spanish population, characterized by the appearance of skin lesions due to a growth of the epidermis that is seven times larger than usual. Its diagnosis and monitoring are based on the use of methodologies for measuring the severity and extent of these spots, and this includes a large subjective component. For this reason, this paper presents an automatic method for characterizing psoriasis images that is divided into four parts: image preparation or pre-processing, feature extraction, classification of the lesions, and the obtaining of parameters. The methodology proposed in this work covers different digital-image processing techniques, namely, marker-based image delimitation, hair removal, nipple detection, lesion contour detection, areal-measurement-based lesion classification, as well as lesion characterization by means of red and white intensity. The results obtained were also endorsed by a professional dermatologist. This methodology provides professionals with a common software tool for monitoring the different existing typologies, which proved satisfactory in the cases analyzed for a set of 20 images corresponding to different types of lesions.

Intense Impact of Health Alert Due to COVID-19 on Adherence of Moderate to Severe Psoriasis Patients to Hospital Therapy

Background: Psoriasis is a chronic skin disease in which lifelong treatment is required. Recently, we faced COVID-19 pandemic where adherence to a prescribed drug could have been affected. Objectives: We conduct a study to assess this statement. Methods: The study was performed in Dermatology Department with Pharmacy database in the Hospital Universitario de La Princesa. A retrospective observational database study was performed, including all psoriatic patients with a biological therapy prescription between March 13 and May 31, 2020, with a paired control group between March 13 and May 31, 2019. Medication possession ratio (MPR) was used to determine the adherence. Results: A total of 244 patients were included in the cohort and 228 in the control group. We observed a decrease in the percentage of adherent patients of 40.0% in COVID-19 period. Overall, MPR was lower in the 2020 period than in 2019. MPRs by treatment and drug family, with the exception of etanercept, certolizumab pegol, and guselkumab, were significantly lower between the 2019 and the 2020 period. Conclusions: Adherence to a prescribed drug can be affected by different factors such as age, sex, income quintile, or stress. We have demonstrated a deep impact on adherence because of the situation created by COVID-19 pandemic. These data are in contrast with previously reported results where adherence was slightly affected, probably due to the different epidemiological situation in different countries. Further efforts are needed to be done to mitigate COVID-19 pandemic influence on the therapeutic adherence.

Comparison of Epidermal Barrier Integrity in Adults with Classic Atopic Dermatitis, Atopic Prurigo and Non-Atopic Prurigo Nodularis

A deficient epidermal barrier is a key feature of atopic dermatitis (AD) and comprises altered lipid and protein content and composition of the stratum corneum resulting in disturbed water balance. Clinically, eczematous lesions on dry skin and pruritus develop. Pruritic nodules occur in prurigo nodularis (PN), another chronic skin disease, which can be associated with atopy. We aimed at comparing the three clinical pictures, classic AD, atopic prurigo (AP), and non-atopic PN, to healthy controls regarding the epidermal barrier. We determined clinical parameters and performed biophysical measurements, histology/immunohistochemistry, electron microscopy, and molecular biological analysis. We found distinctively elevated clinical scores, reduced hydration and increased transepidermal water loss, epidermal hyperplasia and inflammation reduced filaggrin and increased loricrin and involucrin expression, as well as reduced intercellular lipid lamellae in all three disease groups. These findings show a severe disruption in epidermal barrier structure and function in all three disorders so that epidermal barrier impairment is now proven not only for AD but also for PN.

Establishment of an Intradermal Ear Injection Model of IL-17A and IL-36γ as a Tool to Investigate the Psoriatic Cytokine Network

Psoriasis is a chronic skin disease affecting 2–3% of the global population. The proinflammatory IL-17A is a key cytokine in psoriasis. Accumulating evidence has revealed that IL-36γ plays also a pathogenic role. To understand more precisely the role of the IL-17A–IL-36γ cytokine network in skin pathology, we used an ear injection model. We injected IL-17A or IL-36γ alone and in combination into the ear pinnae of mice. This resulted in a significant increase in ear thickness measured over time. Histological evaluation of IL-17A + IL-36γ-treated skin showed a strong acanthosis, hyperparakeratosis and infiltration of neutrophils. The same histological features were found in mice after injection of IL-36γ alone, but to a lesser extent. IL-17A alone was not able to induce psoriasis-like changes. Genes encoding proteins of the S100 family, antimicrobial peptides and chemo-attractants for neutrophils were upregulated in the IL-17A + IL-36γ group. A much weaker expression was seen after the injection of each cytokine alone. These results strengthen the hypothesis that IL-17A and IL-36γ drive psoriatic inflammation via a synergistic interaction. Our established intradermal ear injection model can be utilized in the future to monitor effects of various inhibitors of this cytokine network.

Role of matrix metalloproteinases in acne inflammation: pathogenesis, diagnosis, treatment, prognosis

Modern therapeutic views on the pathogenesis of acne indicate the role of permanent inflammation and expand the arsenal of medicines and combined techniques necessary for the successful treatment of this chronic skin disease. The complex process of immune inflammation in acne with the participation of pro-inflammatory cytokines is due to the interaction of trigger factors and factors of innate immunity. It was found that C. acne is able to interact with markers of increased immunity, such as Toll-like and protease-activated receptors. Based on a detailed analysis of the literature in search systems like PubMed, eLibrary.ru, CyberLeninka, it was found that one of the key roles in inflammation in acne belongs to matrix metalloproteinases. Thus, C. acnes are involved in many processes in the pathogenesis of acne, including inflammation, hyperkeratosis and hyperproduction of sebum, which necessitates its eradication and is an important component of complex therapy. Minocycline (Minolexin) is a highly effective drug for the treatment of moderate to severe forms of acne, including a low-dose regimen, and is included in the European Treatment Guidelines. Minocycline is considered the most powerful inhibitor of MMP, has a pronounced anti-inflammatory effect and a high level of lipophilicity, quickly penetrates the lipid layer of the bacterium and intensively accumulates in the sebaceous glands.

Polymeric Gels and Their Application in the Treatment of Psoriasis vulgaris: A Review

Psoriasis is a chronic skin disease, and it is especially characterized by the occurrence of red, itchy, and scaly eruptions on the skin. The quality of life of patients with psoriasis is decreased because this disease remains incurable, despite the rapid progress of therapeutic methods and the introduction of many innovative antipsoriatic drugs. Moreover, many patients with psoriasis are dissatisfied with their current treatment methods and the form with which the drug is applied. The patients complain about skin irritation, clothing stains, unpleasant smell, or excessive viscosity of the preparation. The causes of these issues should be linked with little effectiveness of the therapy caused by low permeation of the drug into the skin, as well as patients’ disobeying doctors’ recommendations, e.g., concerning regular application of the preparation. Both of these factors are closely related to the physicochemical form of the preparation and its rheological and mechanical properties. To improve the quality of patients’ lives, it is important to gain knowledge about the specific form of the drug and its effect on the safety and efficacy of a therapy as well as the patients’ comfort during application. Therefore, we present a literature review and a detailed analysis of the composition, rheological properties, and mechanical properties of polymeric gels as an alternative to viscous and greasy ointments. We discuss the following polymeric gels: hydrogels, oleogels, emulgels, and bigels. In our opinion, they have many characteristics (i.e., safety, effectiveness, desired durability, acceptance by patients), which can contribute to the development of an effective and, at the same time comfortable, method of local treatment of psoriasis for patients.

Development and Evaluation of the Psychosocial Adaptation Questionnaire among Patients with Chronic Skin Disease

Background/Objective: Chronic skin disease (CSD) often has physiological, psychological, and social impacts, which requires the patient to adjust to achieve psychosocial adaptation (PSA). As a standardized assessment instrument was lacking, we developed a PSA questionnaire for patients with CSD (PSAQ-CSD). Methods: According to the steps of questionnaire development, a systematic process of scoping review, qualitative research, content validity expert review, testing in a sample of 321 adults, item analysis, and classical test theory methods were applied. Results: Following item analysis and exploratory factor analyses, 18 items were eventually entered into the model of confirmatory factor analyses, with a cumulative contribution of 65.435%. Three subscales were developed: emotional, self-cognitive, and social dimensions. Item analysis, exploratory factor analyses, and content validity expert review narrowed the subscales to 8, 6, and 4 items, respectively. Conclusions: The 18-item PSAQ-CSD has been confirmed to have good internal consistency reliability and convergent and discriminant validity. It may be a useful tool to evaluate the PSA among patients with CSD and provide a basis for further research.