V. Goulden

Prevalence of facial acne in adults

BACKGROUND Acne is usually considered a disorder of adolescence, and a number of studies have examined the prevalence of this condition in the adolescent population. There are, however, relatively few data on the prevalence of acne in the adult population. OBJECTIVE A community-based study was carried out to investigate the current prevalence of facial acne in adults. METHODS Seven hundred forty-nine persons older than 25 years were examined for facial acne by means of the Leeds acne-grading technique. RESULTS A degree of facial acne was recorded in 231 women and 130 men, giving an overall prevalence of 54% (95% confidence interval [CI], 49-58) in women and 40% (95% CI, 35-45) in men (P <.001). The acne observed in volunteers consisted principally of physiological acne, but clinical facial acne (grade > 0.75) was recorded in 3% (95% CI, 1.2-4.8) of men and in 12% (95% CI, 9-15) of women (P <.001). The prevalence of acne did not substantially decrease until after the age of 44 years (P <.001). CONCLUSION This study shows a prevalence of clinical facial acne in women of 12%, which is likely to persist into middle age.

Topical aminolaevulinic acid‐photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action

Background   Acne affects 83–95% of 16‐year‐olds of both sexes, and many seek help from a clinician. Emerging problems with conventional acne treatments, specifically antibiotic resistance of Propionibacterium acnes and fears over the safety and tolerance of oral isotretinoin, create a demand for novel treatment modalities in acne.

Post-adolescent acne: a review of clinical features

Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years. The clinical features of 200 patients over the age of 25 years, referred to our department for treatment of acne. were evaluated with a view to establishing possible aetiological factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25‐55 years). The acne was mild or moderate in severity, consisting principlly of inflammatory lesion, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late‐onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty‐seven per cent of women had features of hyperandrogenicity. One hundred and sixty‐four patients (82%) had failed to respond to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with one or more courses of isotretinoin. External factors, such as cosmetics. drugs and occupation, were not found to be significant aetiological factor. A family history revealed that 100 (50%) of patients had a first‐degree relative with post‐adolescent acne.

Photodynamic therapy using aminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa

SIR, Hidradenitis suppurativa (HS) is a chronic, inflammatory, scarring disease of the apocrine sweat gland-bearing skin. The primary event in the development of abscesses and sinus tracts is follicular occlusion caused by keratinized, stratified squamous epithelium, with the apocrine glands becoming involved only at a later stage. Treatment approaches are similar to those in acne vulgaris, including topical and systemic antibiotics, hormonal therapy and oral retinoids. Phototherapy with a combination of blue (415 nm) and red (660 nm) light was found significantly to reduce the number of comedones in patients with acne. In addition, photodynamic therapy (PDT) using aminolaevulinic acid (ALA) has been shown to be an effective treatment in acne vulgaris. A study by Hongcharu et al. has provided some evidence to support a reduction of follicular obstruction through changes in keratinocyte shedding and hyperkeratosis as a possible mechanism of action of ALA-PDT in acne, although much higher fluences of light were used in this compared with previous studies. Under the hypothesis that treatment with ALA-PDT could reduce the number of comedonal lesions and subsequently of inflammatory lesions in patients with HS, we performed an open pilot study investigating the effect of ALA-PDT in HS. Local Ethics Committee approval was obtained. Endpoints were defined as significant improvement not requiring any further treatment (agreed by both patient and observer) or three completed treatments, whichever came first. Patients with axillary or groin disease were eligible for enrolment. The severity of the condition was assessed by a scoring system as described by Sartorius et al. as well as with visual analogue scales recording the degree of disease activity and pain as perceived by the patient. The site with the highest HS regional score (groin or axilla) was chosen for treatment. ALA was applied locally (20% in Unguentum; Merck, Darmstadt, Germany) and occluded for 4 h. The treatment area was then anaesthetized by infiltration of local anaesthetic (1% lignocaine), followed by treatment with the therapeutic light source, the Ceramoptec diode laser (633 nm) in three patients and a broadband red light source, CureLight lamp (570–670 nm) in one patient. A total dose of 15 J cm was applied per treatment. A maximum of three treatments at weekly intervals was given, depending on the response. Assessments were performed pretreatment, 1 week following each treatment and 8 weeks after the last treatment. Results are shown in Table 1. Four patients were enrolled, three with axillary disease and one with groin disease. Two patients reached an endpoint: one patient completed three treatments (patient 1), and the other noticed a significant improvement after two treatments, and no more treatments were therefore given (patient 2). At 8-week follow-up, however, the regional HS score had improved only marginally in one patient but had worsened in the other patient compared with baseline values. Of the two patients who did not complete the study, one received only one treatment and then decided against further treatments because of severe burning and stinging (patient 3). The fourth patient had two treatments and then decided against continuing therapy as the condition appeared to worsen (patient 4). Again, regional HS scores at follow-up in both patients did not show any improvement, but marked deterioration in one patient (patient 4).

The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy

Background.  There is a lack of data regarding the use of narrowband ultraviolet B (NB‐UVB) phototherapy in children with atopic dermatitis (AD). Many centres use this mode of treatment for children with AD; however, there have only been two previous studies observing the effect of NB‐UVB in children with AD. 

Guidelines for the Management of Acne Vulgaris in Adolescents

This article reviews the treatment of acne in adolescents. The choice of therapy should be principally based on the type of lesion and the severity of the acne, but psychosocial disability relating to the disease and the presence of scarring may also influence the approach to treatment.Mild acne generally requires topical treatment only. Benzoyl peroxide, azelaic acid, and antibacterials are generally used for inflammatory lesions. Topical retinoids are particularly effective for noninflamed lesions, and combination therapies are useful for mixed lesions.Moderately severe acne generally requires oral antibacterials. Tetracyclines/oxytetracycline and erythromycin are usually the first-line antibacterials. Second-generation tetracyclines, such as lymecycline, doxycycline, and minocycline, show improved absorption. Minocycline has the advantage of being rarely associated with Propionibacterium acnes antibacterial resistance, but can occasionally lead to potentially serious adverse effects. Trimethoprim is a useful third-line antibacterial therapy for patients resistant to other antibacterial therapies. Benzoyl peroxide should generally be used in combination with oral antibacterials as this has been shown to reduce the development of antibacterial resistance.For severe nodular acne, isotretinoin is the treatment of choice. In addition, over recent years dermatologists have increasingly used this drug to treat patients with moderate acne which has not responded to other systemic therapies, particularly when associated with scarring or significant psychological disability. However, this use is outside the current license of the drug. Isotretinoin is associated with a number of serious adverse effects and careful monitoring of patients during therapy is required.Physical therapies for the treatment of acne nodules and macrocomedones are also important adjuncts to drug therapies.

Investigation of the use of the pulsed dye laser in the treatment of Bowen's disease using 5-aminolaevulinic acid phototherapy.

Background  The use of 5‐aminolaevulinic acid photodynamic therapy (ALA‐PDT) for the treatment of Bowens disease is well established. However, treatment with a continuous light source has the disadvantage of prolonged treatment time during which patients often experience significant discomfort requiring the use of local anaesthetic.

A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide and adapalene in the treatment of mild to moderate facial acne vulgaris

Background  Antibiotics are often combined with other agents to provide topical acne treatments that are effective against both inflammatory and noninflammatory lesions and minimize the development of antibiotic resistance. Retinoids and associated treatments also have anti‐inflammatory activity and decrease microcomedo formation. To date, few direct comparisons of these different acne treatments have been conducted.

Sweet’s syndrome presenting as palmoplantar pustulosis

Sweets syndrome was initially described as a reactive dermatosis characterized by sudden onset of fever, leucocytosis, and raised erythematous plaques infiltrated with neutrophils, and therefore called acute febrile neutrophilic dermatosis. However, later it became obvious that fever and neutrophilia are variable features, and a number of other characteristics have been described. Although the dorsa of the hands are frequently affected, the palmoplantar involvement mimicking pustulosis observed in our case appears to be unusual.

Photochemotherapy for localized morphoea: effect on clinical and molecular markers

Background.  Effective treatment options for morphoea remain limited. As a result, there has been increasing interest in the role of phototherapy in the management of this condition.