New developments in hormonal therapy for acne.

Skin Therapy Lett. 2007 Sep;12(7):1-3

Authors: Tan JK

Oral contraceptives (OCs) are a valuable option for the treatment of women with acne. The use of OCs can be considered across the spectrum of acne disease severity in women. In Canada, three preparations are approved for mild-to-moderate acne, and a fourth is indicated for severe acne. These formulations contain estrogen in the form of ethinyl estradiol and a progestin. In Canada, the most recently approved OC is ethinyl estradiol 0.03 mg and drospirenone 3mg (Yasmin, Bayer). With the accumulating evidence on the efficacy and safety of drospirenone-containing hormonal preparations, this formulation provides dermatologists with a new treatment option for acne and other hyperandrogenic disorders.

PMID: 17940710 [PubMed - indexed for MEDLINE]

Isotretinoin: an Indian experience.

Indian J Dermatol Venereol Leprol. 2001 Jul-Aug;67(4):180-2

Authors: Sheth R, Poonevala V

In this study we retrospectively analysed the unique efficacy and incidence of potentially significant side-effects of a new drug which has claimed to be a major milestone in dermatotherapeutics-isotretinoin. We concluded that oral retinoids 'do things' that nothing else can in several skin disorders-especially recalcitrant acne vulgaris which can emotionally, physically and psychologically cripple an individual for life.

PMID: 17664733 [PubMed]

Long term topical application of lactic acid/lactate lotion as a preventive treatment for acne vulgaris.

Indian J Dermatol Venereol Leprol. 2002 May-Jun;68(3):137-9

Authors: Garg T, Ramam M, Pasricha JS, Verma KK

In an open clinical study, efficacy of 5% aqueous solution of lactate for preventing acne was evaluated in 22 patients. Lactate lotion was used topically all over the face twice a day and continued like a cosmetic for 1 year. Systematic antibiotics were given for periods of 4 weeks whenever the disease was severe. The effect of the treatment was evaluated by counting the number of comedones, inflammatory lesions and cysts separately once a month and recording them graphically. The greatest reduction in the lesion counts was achieved in 8-24 weeks for the inflammatory lesions and 8-30 weeks for the comedones. At the end of 1 year 90-100% reduction of the inflammatory lesions was achieved in 40.9% patients and non-inflammatory lesions in 22.7% patients. The remaining patients showed 50-90% reduction, while 2 patients showed less than 50% reduction in the non-inflammatory lesions. Thus, most of the patients showed significant reduction in the lesion counts. Aggravations were associated with the hot and the rainy season and required concomitant treatment with oral antibiotics.

PMID: 17656910 [PubMed]

Topical lincomycin gel in acne vulgaris.

Indian J Dermatol Venereol Leprol. 2003 Nov-Dec;69(6):429-30; author reply 430

Authors: Modi N

PMID: 17642962 [PubMed]

Safety and efficacy of adapalene gel 0.1% in acne vulgaris: results of a post-marketing surveillance study.

Indian J Dermatol Venereol Leprol. 2003 Jul-Aug;69(4):277-80

Authors: Percy SH

INTRODUCTION: Adapalene is a novel retinoid indicated for the topical treatment of acne vulgaris. The drug was introduced in India in 2001. Aims: A post-marketing surveillance study was conducted to assess the safety and efficacy of adapalene gel 0.1% when used as monotherapy or in combination with other anti-acne agents in Indian patients of acne vulgaris. MATERIAL AND METHODS: A 12-week, multicentre, open-label, non-comparative study involving 571 patients from 21 centers across India was conducted between January and September of 2002. Concomitant prescription of other anti-acne drugs was permitted, if needed. RESULTS: Of the 571 patients, 441 completed the treatment as per protocol. At the end of therapy, 96.3% of patients showed an improvement in their acne from baseline, with greater than 75% improvement seen in two-thirds of patients. Adverse events were reported in 24% of the patients, none of which were serious. The tolerability of therapy was rated as excellent/good in 81% of patients by physicians and in 78% by the patients. CONCLUSION: Adapalene gel 0.1% is a safe and effective topical agent in the treatment of mild to moderate acne vulgaris in Indian patients. It may be safely combined with other topical and oral anti-acne agents.

PMID: 17642911 [PubMed]

Comparison of oral azithromycin pulse with daily doxycycline in the treatment of acne vulgaris.

Indian J Dermatol Venereol Leprol. 2003 Jul-Aug;69(4):274-6

Authors: Singhi MK, Ghiya BC, Dhabhai RK

INTRODUCTION: Oral azithromycin has been advocated by some in the treatment of acne. However, its efficacy has not been established. MATERIAL AND METHODS: This non-randomized controlled trial was conducted on 70 outpatients with acne vulgaris to compare the efficacy and safety of azithromycin and doxycycline in the treatment of inflammatory acne. In the first group, azithromycin was administered 500 mg daily before meals for 3 consecutive days in a 10-day cycle, with the remaining seven days in each cycle being drug-free days. The second group was given doxycycline 100 mg daily after meals. Topical erythromycin was prescribed to all patients. Clinical assessment was done at 10-day intervals for both the groups up to three months. We followed the severity index described by Michaelsson for assessment of outcome measures. RESULTS: There was 77.26% improvement in azithromycin treated group in comparison to 63.74% in the doxycycline treated group. There was a statistically significant reduction in severity in the azithromycin treated group. CONCLUSION: The study showed that a combination of azithromycin with topical erythromycin was significantly better than doxycycline with topical erythromycin in the treatment of acne vulgaris. The incidence and severity of side effects were also lower with azithromycin.

PMID: 17642910 [PubMed]

Topical lincomycin gel in acne vulgaris: a multicentric placebo controlled study.

Indian J Dermatol Venereol Leprol. 2003 Jul-Aug;69(4):271-3

Authors: Sharma AD, Gupte PD, Sundaram M, Janaki VR, Rege VL, Bilimoria FE, Arora J

INTRODUCTION: Acne vulgaris is commonly treated with topical antibacterials. We evaluated lincomycin gel, a new topical formulation for mild to moderate acne. MATERIAL AND METHODS: A multicentric, randomized, double blind, placebo controlled, clinical trial was conducted with lincomycin hydrochloride in 2% gel form in 200 patients with grade II and grade III acne. The severity of acne lesions was noted at baseline and after 4 weeks. RESULTS: About 70% cases in the study group showed a good to excellent response, which was significantly more as compared to 23% in the placebo group. The frequency and severity of adverse reactions in the two groups were similar. CONCLUSION: Lincomycin hydrochloride gel is an effective and safe treatment option for mild to moderate acne vulgaris.

PMID: 17642909 [PubMed]

Comparison of efficacy of topical clindamycin and nicotinamide combination with plain clindamycin for the treatment of acne vulgaris and acne resistant to topical antibiotics.

Indian J Dermatol Venereol Leprol. 2003 Mar-Apr;69(2):138-9

Authors: Sardesai VR, Kambli VM

A total of 75 patients with inflammatory acne vulgaris were divided into three groups. Group A was treated with combination of 4% nicotinamide and 1% clindamycin combination, Group B was treated with plain 1% clindamycin and Group C which was considered to have resistance to local antibiotics due to no response to treatment was treated with the combination. At the end of 8 weeks the results were compared. It was concluded that addition of nicotinamide was of not much value in treating inflammatory acne and results were some as for plain clindamycin and also the combination did not offer much relief in treatment of resistant acne.

PMID: 17642859 [PubMed]

Multicenter study to evaluate efficacy and irritation potential of benzoyl peroxide 4% cream in hydrophase base (Brevoxyl) in acne vulgaris.

Indian J Dermatol Venereol Leprol. 2003 Jan-Feb;69(1):19-22

Authors: Sawleshwarkar SN, Salgaonkar V, Oberai CM

In this multicenter, open, non-comparative study, the efficacy and irritation potential of 4% benzoyl peroxide cream in hydrophase base (Brevoxyl) was evaluated for the treatment of acne vulgaris. All evaluable patients (n=567) received treatment with 4% benzoyl peroxide cream in hydrophase base for six weeks. The investigators evaluated the patients at baseline and at 1,2,4 &6 weeks. Patients also rated their improvement and adverse effects. Doctor's assessment showed that at the end of 6'h week 85.6% had good to very good effect of the treatment. The profile of side effects observed by doctors revealed that 53.8% of total patients did not have any irritation whereas only 11.6% had moderate to severe irritation. 53.8% of patients did not report any irritation: 41.4% had some irritation whereas only 4.8% patients reported troublesome irritation. A satisfactory response was reported as ear;y as two weeks and most of the patients had a very satisfactory response after six weeks and were willing to continue the treatment. This supports the theory that the hydrophase formulation in 'Brevoxyl helped to enhance efficacy and decrease the irritation associated with use of benzoyl peroxide.

PMID: 17642816 [PubMed - in process]

Comparative evaluation of clindamycin phosphate 1% and clindamycin phosphate 1% with nicotinamide gel 4% in the treatment of acne vulgaris.

Indian J Dermatol Venereol Leprol. 2003 Jan-Feb;69(1):8-9

Authors: Dos SK, Barbhuiya JN, Jana S, Dey SK

Eighty patients with moderate acne vulgaris were enrolled from out-patient department for the comparative evaluation of clindamycin phosphate 1% and clindamycin phosphate 1% with nicotinamide gel 4%. In group I forty patients were given clindamycin phosphate 1% alone.ln group II forty patients were given clindamycin phosphate 1% and nicotinamide gel 4% in combination. The study did not show any added advantage of clindamycin phosphate 1% in combination with nicotinamide gel 4% over clindamycin phosphate 1% alone.

PMID: 17642812 [PubMed - in process]

An open study to evaluate the efficacy and safety of tazarotene gel (0.1%) in acne vulgaris.

Indian J Dermatol Venereol Leprol. 2004 Mar-Apr;70(2):92-5

Authors: Saple DG, Torsekar RG, Pawanarkar V, Dhanalakshmi UR, Ravichandran G, Kaur D, Dongre N, Desai A

BACKGROUND: Tazarotene is a new third generation topical acetylenic retinoid. The present study was conducted to evaluate the efficacy and safety of tazarotene gel (0.1%) in Indian patients of acne vulgaris. METHODS: The present study was a prospective, open, multicentric, phase III trial. The duration of study was 14 weeks, including a 12-week active treatment period, preceded by a 2-week washout phase. Patients applied 0.1% tazarotene gel as a thin film over the affected area once daily in the evening. The efficacy was evaluated by analyzing changes in the number of facial acne lesions and patient's and physicians' global assessment. The efficacy parameters were assessed at baseline, visits 2, 4, 8, and 12 weeks. Tolerability and safety was assessed by physical examination, laboratory parameters and evaluation of adverse events. RESULTS: A total of 126 patients in 6 centers completed the study. At the end of the 8th and 12th weeks, the mean number of inflammatory lesions reduced by 70.6% and 86.1%, non-inflammatory lesions by 81.5% and 92%, and total lesion count 75.6% and 88.8% respectively from baseline. Also, 90.7% and 93.6% of total study cases showed complete to moderate clearance of acne lesions according to physicians at the end of the 8th and 12th weeks. CONCLUSIONS: This study confirms the efficacy and safety of tazarotene gel (0.1%) in Indian patients of acne vulgaris.

PMID: 17642573 [PubMed]

Scleral and conjunctival pigmentation following minocycline therapy.

Can J Ophthalmol. 2007 Aug;42(4):626-7

Authors: McAllum P, Slomovic A

PMID: 17641711 [PubMed - indexed for MEDLINE]

No association found between patients receiving isotretinoin for acne and the development of depression in a Canadian prospective cohort.

Can J Clin Pharmacol. 2007;14(2):e227-33

Authors: Cohen J, Adams S, Patten S

BACKGROUND: There has been concern that the use of isotretinoin to treat acne may lead to depression. To date, research has not conclusively determined if this concern is warranted when contemplating the use of isotretinoin. OBJECTIVE: This study investigated the impact of isotretinoin use for patients with acne on mood status. The hypothesis was that an association exists between the use of isotretinoin and the development of depression, aside from acne severity. METHODS: We studied the relationship between isotretinoin and depression using a prospective, controlled, cohort design. The study was conducted in a community dermatology clinic. The exposed cohort consisted of consenting patients who were initiating isotretinoin treatment for acne. Patients were either treated with isotretinoin (Acutaneï) therapy (study group) (N=100) or by oral (N=41) or topical acne therapy (control group) (N=59). The Center for Epidemiologic Studies Depression scale and the Zung Depression Status Inventory were used to assess depression both at baseline and after 2 months of prescribed use of isotretinoin or a control medication (topical or oral antibiotics). RESULTS: There was no correlation between isotretinoin use and the development of depression, based on either the Centre for Epidemiologic Studies Depression scale (Fisherâs exact test, P=0.497) or Zung Depression Status Inventory (ANOVA; F=1.4, P=0.2). CONCLUSION: Isotretinoin does not appear to be associated with the development of depression. Thus, denying patients with significant acne an effective medication for fear of developing depression may not be indicated at this point in time.

PMID: 17556790 [PubMed - indexed for MEDLINE]

Minocycline-induced hypersensitivity syndrome presenting with meningitis and brain edema: a case report.

J Med Case Reports. 2007;1:22

Authors: Lefebvre N, Forestier E, Farhi D, Mahsa MZ, Remy V, Lesens O, Christmann D, Hansmann Y

: BACKGROUND: Hypersentivity Syndrome (HS) may be a life-threatening condition. It frequently presents with fever, rash, eosinophilia and systemic manifestations. Mortality can be as high as 10% and is primarily due to hepatic failure. We describe what we believe to be the first case of minocycline-induced HS with accompanying lymphocytic meningitis and cerebral edema reported in the literature. CASE PRESENTATION: A 31-year-old HIV-positive female of African origin presented with acute fever, lymphocytic meningitis, brain edema, rash, eosinophilia, and cytolytic hepatitis. She had been started on minocycline for inflammatory acne 21 days prior to the onset of symptoms. HS was diagnosed clinically and after exclusion of infectious causes. Minocycline was withdrawn and steroids were administered from the second day after presentation because of the severity of the symptoms. All signs resolved by the seventh day and steroids were tailed off over a period of 8 months. CONCLUSION: Clinicians should maintain a high index of suspicion for serious adverse reactions to minocycline including lymphocytic meningitis and cerebral edema among HIV-positive patients, especially if they are of African origin. Safer alternatives should be considered for treatment of acne vulgaris. Early recognition of the symptoms and prompt withdrawal of the drug are important to improve the outcome.

PMID: 17511865 [PubMed - in process]

Clindamycin phosphate plus tretinoin 1.2%/0.025% gel (Ziana) for acne.

Skinmed. 2007 May-Jun;6(3):135-6

Authors:

PMID: 17478992 [PubMed - indexed for MEDLINE]

Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris.

Indian J Dermatol Venereol Leprol. 2007 Mar-Apr;73(2):94-6

Authors: Iraji F, Sadeghinia A, Shahmoradi Z, Siadat AH, Jooya A

BACKGROUND: Twenty percent azelaic acid gel is recommended as a topical treatment for acne due to its favorable profile. AIM: Our objective in this study was to evaluate the efficacy of 20% azelaic acid gel in the treatment of mild to moderate acne vulgaris. METHODS: This was a double blind, randomized clinical trial. Sixty patients with mild to moderate acne vulgaris were selected randomly to receive either azelaic acid gel or the vehicle gel alone. Patients were followed up every 15 days for a period of 45 days. The number of lesions and the acne severity index (ASI) were recorded and compared using Student's t-test. RESULTS: Total lesion count was reduced by 60.6% and 19.9% by azelaic acid gel and the placebo respectively (P = 0.002). ASI was reduced by 65.2% and 21.3% by azelaic acid gel and the placebo respectively (P = 0.001), i.e, azelaic acid gel was 3.06 times more effective than the placebo in reducing ASI. CONCLUSION: Azelaic acid gel can be used as an effective treatment in mild to moderate acne vulgaris.

PMID: 17456913 [PubMed - indexed for MEDLINE]

Genome sequence and analysis of a Propionibacterium acnes bacteriophage.

J Bacteriol. 2007 Jun;189(11):4161-7

Authors: Farrar MD, Howson KM, Bojar RA, West D, Towler JC, Parry J, Pelton K, Holland KT

Cutaneous propionibacteria are important commensals of human skin and are implicated in a wide range of opportunistic infections. Propionibacterium acnes is also associated with inflammatory acne vulgaris. Bacteriophage PA6 is the first phage of P. acnes to be sequenced and demonstrates a high degree of similarity to many mycobacteriophages both morphologically and genetically. PA6 possesses an icosahedreal head and long noncontractile tail characteristic of the Siphoviridae. The overall genome organization of PA6 resembled that of the temperate mycobacteriophages, although the genome was much smaller, 29,739 bp (48 predicted genes), compared to, for example, 50,550 bp (86 predicted genes) for the Bxb1 genome. PA6 infected only P. acnes and produced clear plaques with turbid centers, but it lacked any obvious genes for lysogeny. The host range of PA6 was restricted to P. acnes, but the phage was able to infect and lyse all P. acnes isolates tested. Sequencing of the PA6 genome makes an important contribution to the study of phage evolution and propionibacterial genetics.

PMID: 17400737 [PubMed - indexed for MEDLINE]

Antipropionibacterial activity of BAL19403, a novel macrolide antibiotic.

Antimicrob Agents Chemother. 2007 Jun;51(6):1956-61

Authors: Heller S, Kellenberger L, Shapiro S

BAL19403 exemplifies a new family of macrolide antibiotics with excellent in vitro activity against propionibacteria. MICs indicated that BAL19403 was very active against erythromycin-resistant and clindamycin-resistant propionibacteria with mutations in the region from positions 2057 to 2059 (Escherichia coli numbering) of the 23S rRNA, although it is less active against those rare clinical isolates in which a methyltransferase, ErmX, confers macrolide and lincosamide resistance by dimethylation of the adenine moiety at position 2058. BAL19403 was predominantly bacteriostatic toward the propionibacteria, and population analyses indicated resistance selection frequencies for BAL19403 and the comparator drugs (erythromycin, clindamycin) in the range 10(-8) to 10(-9) for cutaneous propionibacteria with diverse antibiotic resistance profiles. On the basis of its antipropionibacterial activity and its high anti-inflammatory activity, BAL19403 represents a promising topical treatment for mild to moderate inflammatory acne vulgaris.

PMID: 17387155 [PubMed - indexed for MEDLINE]

Ziana (clindamycin phosphate 1.2% and tretinoin 0.025%)gel.

Skinmed. 2007 Mar-Apr;6(2):85-7

Authors: Gupta AK, Gover MD, Abramovits W

PMID: 17342021 [PubMed - indexed for MEDLINE]

The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study.

Indian J Dermatol Venereol Leprol. 2007 Jan-Feb;73(1):22-5

Authors: Enshaieh S, Jooya A, Siadat AH, Iraji F

BACKGROUND: Finding an effective treatment for acne that is well tolerated by the patients is a challenge. One study has suggested the efficacy of tea tree oil in treatment of the acne vulgaris. AIM: To determine the efficacy of tea tree oil in mild to moderate acne vulgaris. METHODS: This was a randomized double-blind clinical trial performed in 60 patients with mild to moderate acne vulgaris. They were randomly divided into two groups and were treated with tea tree oil gel (n=30) or placebo (n=30). They were followed every 15 days for a period of 45 days. Response to treatment was evaluated by the total acne lesions counting (TLC) and acne severity index (ASI). The data was analyzed statistically using t-test and by SPSS program. RESULTS: There were no significant differences regarding demographic characteristics between the two groups. There was a significant difference between tea tree oil gel and placebo in the improvement of the TLC and also regarding improvement of the ASI. In terms of TLC and ASI, tea tree oil gel was 3.55 times and 5.75 times more effective than placebo respectively. Side-effects with both groups were relatively similar and tolerable. CONCLUSION: Topical 5% tea tree oil is an effective treatment for mild to moderate acne vulgaris.

PMID: 17314442 [PubMed - indexed for MEDLINE]

[A perianal condition treated for acne conglobata as initial Crohn's disease]

Rev Esp Enferm Dig. 2007 Jan;99(1):46-7

Authors: Barreales M, Laluela A, Manzano M, González C, Solís Herruzo JA

PMID: 17295598 [PubMed - indexed for MEDLINE]

Psychological sequelae of acne vulgaris: results of a qualitative study.

Can Fam Physician. 2006 Aug;52:978-9

Authors: Magin P, Adams J, Heading G, Pond D, Smith W

OBJECTIVE: To investigate the psychological sequelae of acne vulgaris. DESIGN: Qualitative study using a grounded-theory approach. SETTING: General practices and specialty dermatology practices in Newcastle, Australia. PARTICIPANTS: Patients with current acne recruited from the practices. METHOD: We used semistructured interviews and recorded participants' comments verbatim. Data analysis was cumulative and concurrent throughout the data-collection period. Coding and analysis was done in the inductive tradition. MAIN FINDINGS: Interviews were conducted with 26 subjects who represented a range of ages and acne severity. Psychological morbidity was considerable. Though participants had mood and anxiety symptoms, these symptoms tended to be subsyndromal and evanescent. More prominent symptoms were embarrassment, impaired self-image, low self-esteem, self-consciousness, frustration, and anger. Some subjects thought that acne had affected their personalities permanently and adversely. Psychological sequelae were attributed to the effects of facial acne on appearance. CONCLUSION: The psychological effects of acne can be considerable. The psychological morbidity is complex and often does not conform to standard psychiatric disease criteria. Recognition and management of the psychological sequelae of acne by general practitioners is of considerable importance.

PMID: 17273501 [PubMed - indexed for MEDLINE]

Immunohistochemical expression of interleukin 8 in skin biopsies from patients with inflammatory acne vulgaris.

Diagn Pathol. 2007;2:4

Authors: Abd El All HS, Shoukry NS, El Maged RA, Ayada MM

BACKGROUND: This study was conducted to evaluate the immunohistochemical (IHC) expression of interleukin 8 (IL-8) in skin biopsies of inflammatory acne vulgaris (IAV) in an attempt to understand the disease pathogenesis. MATERIALS AND METHODS: A total of 58 biopsies, 29 from lesional IAV and 29 normal non lesional sites were immunostained for IL-8. The intensity of staining was evaluated in the epidermis and dermis and was scored as mild, moderate and severe. The expression was correlated with the clinical grade, disease course and histological changes. RESULTS: IL-8 immunoreactivity was expressed in lesional IAV compared to non lesional skin biopsies (p < 0.001). Increased expression was significantly associated with epidermal hyperplasia and follicular hyperkeratosis (p < 0.001). In addition, the more pronounced IL-8 expression of the dermal endothelial cells and neutophilic inflammatory infiltrate correlated with dermal angiogenesis and the extent of dermal inflammatory response (p < 0.001). Moreover, increased dermal immunoreactivity paralleled progressive course (p = 0.02) but not the duration of the disease. CONCLUSION: We were able to demonstrate altered immunoreactivity of IL-8 in IAV compared to normal skin. Targeted therapy to block IL-8 production may hold promise in limiting the deleterious effects of IL-8-mediated inflammatory response and angiogenesis.

PMID: 17263887 [PubMed]

Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective.

Br J Clin Pharmacol. 2007 Feb;63(2):196-205

Authors: B&#xE9;rard A, Azoulay L, Koren G, Blais L, Perreault S, Oraichi D

AIMS: To estimate the population-based incidence rates of pregnancy, spontaneous and elective abortions, and birth defects associated with isotretinoin use, and to determine predictors of pregnancy while on isotretinoin. METHODS: Using the RAMQ (medical and pharmaceutical data), MED-ECHO (hospitalizations) and ISQ (births and deaths) databases for the period 1984-2002, a cohort of 8609 women between 13 and 45 years of age and with a first prescription for isotretinoin (date of entry in the cohort) was identified. Women were eligible if they were insured by RAMQ for their medications at least 12 months before entry in the cohort and until 1 month after the end of their isotretinoin treatment. Pregnancies, spontaneous and elective abortions, and birth defects were identified using procedure codes and medical diagnoses. RESULTS: Of the 8609 women included, 90 became pregnant, an annual incident pregnancy rate during isotretinoin treatment of 32.7 per 1000 person-years of treatment (95% confidence interval 26.6, 40.1). Of the 90 women who became pregnant while on the drug, 76 terminated the pregnancy (84%), three had a spontaneous abortion (3%), two had trauma during delivery resulting in neonatal deaths (2%) and nine had a live birth (10%). Among the live births, only one had a congenital anomaly of the face and neck (11%). Adjusting for potential confounders, predictors of becoming pregnant while on isotretinoin were lower socio-economic level, one or more visits to the doctor or to the emergency department, or one or more hospitalization while on isotretinoin; concomitant isotretinoin and oral contraceptive use had a preventive effect. CONCLUSIONS: This first non-interventional population-based study generated incidence rates of pregnancy while on isotretinoin four times greater than what has been reported in the literature thus far; elective abortion rates were also much higher in our study. This shows the importance of using population-based data for public health purposes.

PMID: 17214828 [PubMed - indexed for MEDLINE]

Treatment of acne scarring.

Skin Therapy Lett. 2006 Dec-2007 Jan;11(10):7-9

Authors: Alam M, Dover JS

Acne scarring is common but surprisingly difficult to treat. Scars can involve textural change in the superficial and deep dermis, and can also be associated with erythema, and less often, pigmentary change. In general, treatment of acne scarring is a multistep procedure. First, examination of the patient is necessary to classify the subtypes of scarring that are present. Then, the patient's primary concerns are elicited, and the patient is offered a menu of procedures that may address the various components of the scarring process. It is important to emphasize to the patient that acne scarring can be improved but never entirely reversed.

PMID: 17180246 [PubMed - indexed for MEDLINE]

Variable expression of immunoreactive surface proteins of Propionibacterium acnes.

Microbiology. 2006 Dec;152(Pt 12):3667-81

Authors: Lodes MJ, Secrist H, Benson DR, Jen S, Shanebeck KD, Guderian J, Maisonneuve JF, Bhatia A, Persing D, Patrick S, Skeiky YA

Despite accumulating data implicating Propionibacterium acnes in a variety of diseases, its precise role in infection remains to be determined. P. acnes antigen-specific CD4(+) T cells are present in early inflamed acne lesions and may be involved in the inflammatory response; however, little is known about the specific antigens involved. In this study, B cell and T cell antigens from P. acnes expression libraries were cloned and evaluated and the four predominant proteins identified were investigated. Two of these antigens share some homology with an M-like protein of Streptococcus equi and have dermatan-sulphate-binding activity (PA-25957 and 5541). The remaining two antigens, PA-21693 and 4687, are similar to the product of the Corynebacterium diphtheriae htaA gene from the hmu ABC transport locus, although only one of these (PA-21693) is encoded within an hmu-like operon and conserved amongst a range of clinical isolates. All four proteins contain an LPXTG motif, although only PA-21693 contains a characteristic sortase-sorting signal. Variation in the expression of PA-4687, 25957 and 5541 is evident amongst clinical isolates and is generated both by frameshifts associated with the putative signal peptide and by variable numbers of repeat regions toward the carboxy-terminus, potentially generating heterogeneity of molecular mass and antigenic variation. In addition, in the case of PA-25957, a frameshift in a C-rich region at the extreme carboxy-terminus eliminates the LPXTG motif in some isolates. For the dermatan-sulphate-binding PA-25957, IgG1 antibody in serum from acne-positive donors was shown to be specific for the amino-terminal region of the protein, which also contains a CD4(+) T cell epitope. In contrast, serum from acne-negative donors shows an IgG2 and IgG3 antibody subclass response to the carboxy-terminal region. These data have implications for the potential role of P. acnes in inflammatory acne and other diseases.

PMID: 17159220 [PubMed - indexed for MEDLINE]

What is the best approach to reducing birth defects associated with isotretinoin?

PLoS Med. 2006 Nov;3(11):e483

Authors: Abroms L, Maibach E, Lyon-Daniel K, Feldman SR

BACKGROUND TO THE DEBATE: Isotretinoin is an effective treatment for severe acne, a condition which can be physically, emotionally, and socially disabling. Because the drug is teratogenic, causing severe birth defects, women taking the drug are directed to avoid pregnancy. In the United States, a series of risk reduction programs have been implemented that aim to prevent pregnant women from taking the drug and to prevent women taking it from getting pregnant. The most recent, and most stringent, is an Internet-based, performance-linked system called iPLEDGE, which tries to ensure that the drug is dispensed only when there is documentary proof that the patient is not pregnant and is using two forms of birth control. Is iPLEDGE the best way to reduce isotretinoin birth defects, or is it an unproven and overly burdensome system?

PMID: 17121451 [PubMed - indexed for MEDLINE]

Antibiotics and risk of breast cancer: up to 9 years of follow-up of 2.1 million women.

Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2102-6

Authors: Friedman GD, Oestreicher N, Chan J, Quesenberry CP, Udaltsova N, Habel LA

Antibiotic use has been associated with risk of breast cancer in previous reports. Using Cox proportional hazards analysis, we evaluated this association in 2,130,829 adult female subscribers of a health care program according to their receipt of prescriptions of antibiotics from outpatient pharmacies. Hormone use was taken into account. Altogether, 18,521 women developed breast cancer in up to 9.4 years of follow-up. Use of any antibiotic was associated with slightly increased risk [hazard ratio (HR), 1.14; 95% confidence interval (95% CI), 1.10-1.18] but there was little, if any, evidence of dose response, with HR of 1.17 (95% CI, 0.97-1.42) for >1,000 days of use compared with no use. The only two weakly associated antibiotic groups (HR >1.10 for >100 days of use) were tetracyclines and macrolides with HRs (95% CI) of 1.23 (1.11-1.36) and 1.16 (0.98-1.36), respectively. An association of lincosamides with breast cancer in an earlier, smaller database was not confirmed, but follow-up was too short in the present data for adequate evaluation. Medical record review suggested that acne and/or rosacea could be the underlying factor, associated with long-term antibiotic therapy and found by others to be associated with risk of breast cancer. Although causality cannot be ruled out, the observed associations of antibiotics overall, tetracyclines, and macrolides with breast cancer were weak and could be explained by uncontrolled confounding by the diseases being treated or by other factors.

PMID: 17119034 [PubMed - indexed for MEDLINE]

Solodyn (Minocycline HCl, USP) extended-release tablets.

Skinmed. 2006 Nov-Dec;5(6):291-2

Authors: Gupta AK, Gover MD, Abramovits W, Perlmutter A

PMID: 17085996 [PubMed - indexed for MEDLINE]

Acne.

BMJ. 2006 Nov 4;333(7575):949-53

Authors: Purdy S, de Berker D

PMID: 17082546 [PubMed - indexed for MEDLINE]

Additional case of minocycline-induced cutaneous polyarteritis nodosa: comment on the article by Culver et al.

Arthritis Rheum. 2006 Oct 15;55(5):831; author reply 832

Authors: Abad S, Kambouchner M, Nejjari M, Dhote R

PMID: 17013846 [PubMed - indexed for MEDLINE]

The skin and the mind.

Aust Fam Physician. 2006 Sep;35(9):723-5

Authors: Chuh A, Wong W, Zawar V

BACKGROUND: The intimate relationship of the skin and the mind illustrates the importance of a holistic approach in caring for patients with skin problems. Habits related to psychological problems may lead to skin problems such as lichen simplex chronicus and acne excori&#xE9;e. Emotional stress may affect skin diseases such as atopic dermatitis, perioral dermatitis, pompholyx, and plaque psoriasis. OBJECTIVE: This article describes the relationship between the mind and skin disease. DISCUSSION: Skin disease can exert a profound effect on the psychosocial dimension of a patient's life. Its effect on quality of life can be objectively assessed and documented by validated tools specific for the skin. Patient rated measures should be taken into account when evaluating the efficacy and adverse effects of treatments for skin disease.

PMID: 16969446 [PubMed - indexed for MEDLINE]

Managing acne vulgaris effectively.

Aust Fam Physician. 2006 Sep;35(9):705-9

Authors: Goodman G

The management of acne is a gratifying experience. Available treatments are effective, relatively nontoxic and generally safe. However, there is no quick fix. Antibiotics, hormone therapies and topical therapies are maintenance treatments. Isotretinoin can induce remission, as can some of the newer physical modalities of lights, lasers and radiofrequency devices. Effective management of acne often requires using a combination of treatments that act on different parts of the pathogenic process of acne development.

PMID: 16969442 [PubMed - indexed for MEDLINE]

SAPHO syndrome with a tumour-like bony proliferative lesion in distal femur. A case report.

Ups J Med Sci. 2006;111(2):243-8

Authors: Watanuki M, Hatori M, Kokubun S

SAPHO syndrome is a group of bone and joint abnormalities associated with skin lesions. A 29-year-old male presented with severe acne on his trunk and anterior chest wall, right knee and foot pain. Radiographs and magnetic resonance images showed hyperostosis in the sternocostoclavicular region, sclerosis of one-third of the right distal 5th metatarsal bone and bony outgrowth from the medial condyle of the right femur. The histological findings of the biopsy specimen were consistent with-those of old osteomyelitis. All fungal and microbacterial cultures were negative. Pain and swelling of the right knee and foot repeated remission and aggravation. There were no radiological changes of the above-mentioned lesions noted within 4-years follow-up.

PMID: 16961180 [PubMed - indexed for MEDLINE]

Improvement of cystic fibrosis during treatment with isotretinoin.

Skinmed. 2006 Sep-Oct;5(5):252-5

Authors: Buckley JL, Chastain MA, Rietschel RL

A 15-year-old boy with a history significant for multiple respiratory infections since birth presented for evaluation of acne vulgaris. He was initially prescribed doxycycline, topical tretinoin, and topical clindamycin solution, with the later addition of a benzoyl peroxide preparation to his regimen. The patient returned 6 months later after having been diagnosed with CF (cystic fibrosis) by sweat testing and genetic testing. His skin condition had not responded adequately to prior therapy, so all acne medications were discontinued. The 84-kg patient was started on 80 mg (0.95 mg/kg/d) of isotretinoin (13-cis-retinoic acid) daily. The patient's dose was decreased to 40 mg/d 2 weeks later following an episode of blood in his stool and epistaxis. At the 1- and 2-month follow-up visits, the patient reported improvement in his acne and mentioned that his lung secretions seemed reduced. His acne cleared after 4 months of therapy, so the isotretinoin was discontinued. The patient and his mother noted that no respiratory infections had occurred during the course of therapy. The patient's acne relapsed nearly 2 years later, so isotretinoin was restarted at 60 mg/d. During the next 7 months while on the drug, he experienced no further episodes of epistaxis or bloody stools and his acne had resolved by the end of therapy. The patient and his mother again reported fewer bronchopulmonary secretions and no infections requiring antibiotics during treatment with isotretinoin. This was unusual because he had experienced numerous respiratory infections requiring antibiotics during the prior 2 years. Since discontinuing the drug, the patient has had intermittent pulmonary infections and exacerbations in the symptomatology of his CF.

PMID: 16957442 [PubMed - indexed for MEDLINE]

Expert committee recommendations for acne management.

Pediatrics. 2006 Sep;118(3):1188-99

Authors: Zaenglein AL, Thiboutot DM

In 2003, an international committee of physicians and researchers in the field of acne, working together as the Global Alliance to Improve Outcomes in Acne, developed consensus guidelines for the treatment of acne. These guidelines were evidence based when possible but also included the extensive clinical experience of this group of international dermatologists. As a result of the evaluation of available data and the experience, significant changes occurred in the management routines for acne. The greatest change arose on the basis of improved understanding of acne pathophysiology. The recommendation now is that acne treatments should be combined to target as many pathogenic factors as possible. A topical retinoid should be the foundation of treatment for most patients with acne, because retinoids target the microcomedo, the precursor to all acne lesions. Retinoids also are comedolytic and have intrinsic antiinflammatory effects, thus targeting 2 pathogenic factors in acne. Combining a topical retinoid with an antimicrobial agent targets 3 pathogenic factors, and clinical trials have shown that combination therapy results in significantly faster and greater clearing as opposed to antimicrobial therapy alone. Oral antibiotics should be used only in moderate-to-severe acne, should not be used as monotherapy, and should be discontinued as soon as possible (usually within 8-12 weeks). Because of their effect on the microcomedo, topical retinoids also are recommended as an important facet of maintenance therapy.

PMID: 16951015 [PubMed - indexed for MEDLINE]

A population-based analysis of laboratory abnormalities during isotretinoin therapy for acne vulgaris.

Arch Dermatol. 2006 Aug;142(8):1016-22

Authors: Zane LT, Leyden WA, Marqueling AL, Manos MM

OBJECTIVE: To determine the incidence of abnormal laboratory test results among isotretinoin users. DESIGN: Retrospective cohort. SETTING: Comprehensive managed care health plan in Northern California. PARTICIPANTS: The study population comprised 13 772 patients aged 13 to 50 years with acne, undergoing oral isotretinoin therapy between March 1995 and September 2002. MAIN OUTCOME MEASURES: Laboratory values for serum triglyceride, total cholesterol, and liver transaminase levels; white blood cell count, hemoglobin level, and platelet count; and frequency of abnormal laboratory results by severity grade as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. RESULTS: Substantial increases in the cumulative incidence of abnormalities were seen in serum lipid and transaminase levels, but not in hematologic parameters, during isotretinoin treatment compared with the baseline period. The cumulative incidence of new abnormalities in patients with normal values at baseline was 44% for triglyceride level, 31% for total cholesterol level, and 11% for transaminase level. Moderate to severe abnormalities in lipid and transaminase levels were generally transient and reversible. New abnormalities in hematological test results were uncommon. CONCLUSIONS: The incidence of abnormally high serum lipid levels during isotretinoin treatment may be greater than previously estimated. Elevations in transaminase level are generally mild. Normal baseline values of serum lipid and transaminase levels do not preclude the development of new abnormalities during isotretinoin treatment. Routine monitoring of white blood cell count, hemoglobin level, and platelet count during isotretinoin therapy may be of little utility without clinical suspicion of an abnormality. The clinical significance of laboratory abnormalities during isotretinoin therapy remains to be determined.

PMID: 16924051 [PubMed - indexed for MEDLINE]

Acne--natural history, facts and myths.

Aust Fam Physician. 2006 Aug;35(8):613-6

Authors: Goodman G

This article describes the epidemiology and natural history of acne and discusses the common aetiological myths and beliefs surrounding acne. Acne is a polymorphic disease with noninflammatory and inflammatory aspects and a wide spectrum of severity. The severe inflammatory patterns tend to be those that most frequently scar and therefore require early intervention. The pattern of disease, relative severity, distribution, and patient's social circumstances will influence appropriate management. However, effective management also includes patient education about acne, its natural history, and dispelling acne myths.

PMID: 16894437 [PubMed - indexed for MEDLINE]

Acne: more than skin deep.

Postgrad Med J. 2006 Aug;82(970):500-6

Authors: Ayer J, Burrows N

Acne is one of the most prevalent skin conditions affecting teenagers. It is a disease of the pilosebaceous unit. Blockage of sebaceous glands and colonisation with Proionobacterium acnes leads to acne. Grading the severity of acne helps to determine the appropriate treatment. Treatment of acne should be started as early as possible to minimise the risk of scarring and adverse psychological effects. It should be tailored to the individual patient, the type of acne, its severity, the patient's ability to use the treatment, and the psychological state. Topical agents are the mainstay for treatment of mild acne. Moderate acne is treated with oral antibiotics. Resistance to antibiotics may be reduced by subsequent use of non-antibiotic topical medications. Severe acne is treated with isotretinoin, and this can lead to permanent remission. With better education and care given by medical profession, acne treatment could be significantly improved.

PMID: 16891439 [PubMed - indexed for MEDLINE]

Japanese version of the Dermatology Life Quality Index: validity and reliability in patients with acne.

Health Qual Life Outcomes. 2006;4:46

Authors: Takahashi N, Suzukamo Y, Nakamura M, Miyachi Y, Green J, Ohya Y, Finlay AY, Fukuhara S,

BACKGROUND: Patient-reported quality of life is strongly affected by some dermatologic conditions. We developed a Japanese version of the Dermatology Life Quality Index (DLQI-J) and used psychometric methods to examine its validity and reliability. METHODS: The Japanese version of the DLQI was created from the original (English) version, using a standard method. The DLQI-J was then completed by 197 people, to examine its validity and reliability. Some participants completed the DLQI-J a second time, 3 days later, to examine the reproducibility of their responses. In addition to the DLQI-J, the participants completed parts of the SF-36 and gave data on their demographic and clinical characteristics. Their physicians provided information on the location and clinical severity of the skin disease. RESULTS: The participants reported no difficulties in answering the DLQI-J items. Their mean age was 24.8 years, 77.2% were female, and 78.7% had acne vulgaris. The mean score of DLQI was 3.99(SD: 3.99). The responses were found to be reproducible and stable. Results of principal-component and factor analysis suggested that this scale measured one construct. The correlations of DLQI-J scores with sex or age were very poor, but those with SF-36 scores and with clinical severity were high. CONCLUSION: The DLQI-J provides valid and reliable data despite having only a small number of items.

PMID: 16884543 [PubMed - indexed for MEDLINE]

Ulcerative colitis probably associated with isotretinoin.

Indian J Gastroenterol. 2006 May-Jun;25(3):171-2

Authors: Bankar RN, Dafe CO, K&#xF6;hnke A, Babu PS

PMID: 16877847 [PubMed - indexed for MEDLINE]

Conundrums in nosology: synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome and spondylarthritis.

Arthritis Rheum. 2006 Aug 15;55(4):665-9

Authors: Rohekar G, Inman RD

PMID: 16874770 [PubMed - indexed for MEDLINE]

Acne and acne scarring - the case for active and early intervention.

Aust Fam Physician. 2006 Jul;35(7):503-4

Authors: Goodman G

Acne as a disease is so common as to be considered a normal rite of passage, and costs the community a substantial amount in resources. Yet acne is a devastating disease striking most adolescents at their most vulnerable time when their life long self esteem and sense of identity is being developed. This article reviews the importance of acne to the individual and attempts to make the case for early and aggressive treatment.

PMID: 16820822 [PubMed - indexed for MEDLINE]

Acne vulgaris: false-positive finding on integrated 18F-FDG PET/CT in a patient with melanoma.

AJR Am J Roentgenol. 2006 Jul;187(1):W117-9

Authors: Pawlik TM, Erasmus JJ, Truong MT, Macapinlac H, Ross MI, Gershenwald JE

PMID: 16794124 [PubMed - indexed for MEDLINE]

Peroxidated squalene induces the production of inflammatory mediators in HaCaT keratinocytes: a possible role in acne vulgaris.

J Invest Dermatol. 2006 Nov;126(11):2430-7

Authors: Ottaviani M, Alestas T, Flori E, Mastrofrancesco A, Zouboulis CC, Picardo M

In order to investigate whether products derived from the oxidation of sebum can be responsible for the induction of inflammatory processes, HaCaT keratinocytes were treated with peroxidated squalene. NF-kappaB activation, secretion, and expression of IL-6, as well as peroxisome proliferator-activated receptor alpha (PPARalpha) mRNA and protein levels, were measured at the end of the treatment and after 24 and 48 hours of recovery. Squalene peroxidation products were administered in amounts able to elicit significant hyperproliferation and to induce lipoxygenase (LOX) activity. The results showed an early activation of NF-kappaB followed by an increase in PPARalpha mRNA and protein levels. Moreover, squalene peroxides induced an initial upregulation of IL-6 production and secretion that was counteracted by PPARalpha activation, as suggested by the subsequent decrease of NF-kappaB nuclear translocation and IL-6 levels. Inflammatory processes play an important role in the development of acne vulgaris. In combination with our own previous findings, which indicated an association between LOX stimulation and increased percentage of proinflammatory lipids in acne as well as a correlation between increased cytokine levels in the infundibulum, pilosebaceous duct hyperkeratinization, and augmented sebogenesis, the present data further support the involvement of lipid peroxides, in particular squalene peroxides, in establishing an inflammatory process in acne.

PMID: 16778793 [PubMed - indexed for MEDLINE]

Comparison of tazarotene and minocycline maintenance therapies in acne vulgaris: a multicenter, double-blind, randomized, parallel-group study.

Arch Dermatol. 2006 May;142(5):605-12

Authors: Leyden J, Thiboutot DM, Shalita AR, Webster G, Washenik K, Strober BE, Shupack J

OBJECTIVE: To evaluate the efficacy of 3 maintenance regimens (topical tazarotene, oral minocycline hydrochloride, or both) in sustaining improvement in acne. DESIGN: Multicenter, open-label treatment phase followed by double-blind, randomized, parallel-group maintenance phase. SETTING: Ambulatory patients in research or referral centers. PATIENTS: Volunteer sample of 189 patients with moderately severe to severe acne vulgaris (110 entered maintenance phase, 90 completed, and 2 discontinued because of adverse events). INTERVENTIONS: All patients were treated with 0.1% tazarotene gel (each evening) and a 100-mg capsule (twice daily) of minocycline hydrochloride for up to 12 weeks. Patients with 75% or greater global improvement at week 12 were randomly assigned to 12 weeks of maintenance therapy with tazarotene gel plus placebo capsules, vehicle gel plus minocycline capsules, or tazarotene gel plus minocycline capsules. MAIN OUTCOME MEASURES: Overall disease severity, global improvement, and lesion counts. RESULTS: All regimens were effective in sustaining improvements in acne. After 12 weeks of maintenance therapy, the mean reductions from baseline in noninflammatory and inflammatory lesion count, respectively, were 60% and 54% with tazarotene, 52% and 66% with minocycline, and 64% and 66% with tazarotene plus minocycline. At week 24, more than 80% of patients in each group had maintained a 50% or greater global improvement from baseline, and more than 50% had maintained a 75% or greater global improvement. CONCLUSIONS: A high percentage of patients with moderately severe to severe acne can maintain improvement in their condition with topical retinoid monotherapy. Maintenance with combination tazarotene and minocycline therapy showed a trend for greater efficacy but no statistical significance vs tazarotene alone. Topical retinoid monotherapy should be considered for maintenance to help minimize antibiotic exposure.

PMID: 16702498 [PubMed - indexed for MEDLINE]

Adapalene gel, 0.1%, as maintenance therapy for acne vulgaris: a randomized, controlled, investigator-blind follow-up of a recent combination study.

Arch Dermatol. 2006 May;142(5):597-602

Authors: Thiboutot DM, Shalita AR, Yamauchi PS, Dawson C, Kerrouche N, Arsonnaud S, Kang S

OBJECTIVE: To assess the maintenance effect of adapalene gel, 0.1%, relative to gel vehicle in subjects successfully treated in a previous 12-week study of adapalene-doxycycline, 100 mg, combination therapy. DESIGN: Multicenter, investigator-blind, randomized, controlled study. SETTING: Thirty-four US centers. SUBJECTS: A total of 253 subjects with severe acne vulgaris who showed at least moderate improvement from baseline (50% improvement from baseline) when treated with either adapalene plus doxycycline or doxycycline plus gel vehicle in a previous 12-week study. INTERVENTIONS: Subjects were randomized to receive adapalene gel, 0.1%, or gel vehicle once daily for 16 weeks. MAIN OUTCOME MEASURES: Efficacy and safety criteria included maintenance rate (subjects maintaining at least 50% improvement in lesion counts from previous therapy), lesion counts (total, inflammatory, and noninflammatory), global severity assessment, cutaneous tolerability, and adverse events. RESULTS: Adapalene maintenance therapy resulted in significantly larger maintenance rates (75% vs 54%; P<.001) and significantly lower lesion counts (total [P = .005], inflammatory [P = .01], and noninflammatory [P = .02]) compared with gel vehicle. Adapalene was safe and well tolerated in this study.Conclusion This study demonstrates a clinical benefit of continued treatment with adapalene gel, 0.1%, as a maintenance therapy for acne.

PMID: 16702497 [PubMed - indexed for MEDLINE]

Analyzing the functional and structural consequences of two point mutations (P94L and A368D) in the CYP11B1 gene causing congenital adrenal hyperplasia resulting from 11-hydroxylase deficiency.

J Clin Endocrinol Metab. 2006 Jul;91(7):2682-8

Authors: Krone N, Grischuk Y, M&#xFC;ller M, Volk RE, Grötzinger J, Holterhus PM, Sippell WG, Riepe FG

CONTEXT: Congenital adrenal hyperplasia is a group of autosomal recessive inherited disorders of steroidogenesis. The deficiency of steroid 11-hydroxylase (CYP11B1) resulting from mutations in the CYP11B1 gene is the second most frequent cause. OBJECTIVE: We studied the functional and structural consequences of two CYP11B1 missense mutations, which were detected in a 1.8-yr-old boy with acne and precocious pseudopuberty, to prove their clinical relevance and study their impact on CYP11B1 function. RESULTS: The in vitro expression studies in COS-7 cells revealed an almost complete absence of CYP11B1 activity for the P94L mutant to 0.05% for the conversion of 11-deoxycortisol to cortisol. The A368D mutant severely reduced the CYP11B1 enzymatic activity to 1.17%. Intracellular localization studies by immunofluorescence revealed that the mutants were correctly localized. Introducing these mutations in a three-dimensional model structure of the CYP11B1 protein provides a possible explanation for the effects measured in vitro. We hypothesize that the A368D mutation interferes with structures important for substrate specificity and heme iron binding, thus explaining its major functional impact. However, according to structural analysis, we would expect only a minor effect of the P94L mutant on 11-hydroxylase activity, which contrasts with the observed major effect of this mutation both in vitro and in vivo. CONCLUSION: Analyzing the in vitro enzyme function is a complementary procedure to genotyping and a valuable tool for understanding the clinical phenotype of 11-hydroxylase deficiency. This is the basis for accurate genetic counseling, prenatal diagnosis, and treatment. Moreover, the combination of in vitro enzyme function and molecular modeling provides valuable insights in cytochrome P450 structural-functional relationships, although one must be aware of the limitations of in silico-based methods.

PMID: 16670167 [PubMed - indexed for MEDLINE]

Safe use of acne drug.

FDA Consum. 2005 Nov-Dec;39(6):4

Authors:

PMID: 16669109 [PubMed - indexed for MEDLINE]

Severe acne vulgaris and tobacco smoking in young men.

J Invest Dermatol. 2006 Aug;126(8):1749-52

Authors: Klaz I, Kochba I, Shohat T, Zarka S, Brenner S

As the relationship between tobacco smoking and acne remains unclear, we examined the relationship between cigarette smoking and severe acne in a large cohort of young men. Trained nurses interviewed subjects upon discharge from compulsory military service, regarding family history, habits, and tobacco smoking habits. Data was correlated with severe acne status, as diagnosed and coded by board-certified dermatologists. In total, 27,083 male subjects participated in the study from 1983 to 2003, of which 237 (0.88%) had severe acne, 11,718 (43.27%) were active smokers, and 15,365 (56.73%) were nonsmokers at the time of interviews. Active smokers showed a significantly lower prevalence of severe acne (0.71%) than nonsmokers (1.01%) (P = 0.0078). An inverse dose-dependent relationship between severe acne prevalence and daily cigarette consumption became significant from 21 cigarettes a day (chi2 and trend test: P < 0.0001), odds ratio: 0.2 (95% CI: 0.06-0.63). The study did not aim to establish a temporal correlation, and passive smoking and acne treatments were not measured. Previous in vitro and clinical studies strongly support an association with nicotine. We suggest a trial with topical nicotine treatment for acne to further investigate this association.

PMID: 16645586 [PubMed - indexed for MEDLINE]