Acné en la adolescencia: como reconocerlo y abordarlo / Acne in adolescents: how to recognize it and treat it / Acne na adolescencia: como reconhecer-lo e tratá-lo

El acné una de las enfermedades dermatológicas crónicas más frecuentes, siendo la adolescencia donde se observa su mayor incidencia y prevalencia. Constituye un motivo de consulta frecuente y a pesar de que su abordaje inicial es de resorte del pediatra, dependiendo de la evolución y los tipos de acné requieren la derivación y tratamiento con dermatólogo. Es una enfermedad cutánea, de carácter inflamatorio y que involucra la unidad pilosebácea. Su etiología es multifactorial y el diagnóstico es clínico al constatar las lesiones típicas. Teniendo en cuenta la importancia de la imagen corporal en esta etapa de la vida y el impacto de esta en la calidad de vida de los adolescentes, es imprescindible el reconocimiento precoz y tratamiento inicial por parte del pediatra. Existen posibilidades terapéuticas cada vez más novedosas, exigiendo a los profesionales de salud estar actualizados. Esta revisión pretende mostrar una puesta al día de la temática y ofrecer información actualizada sobre los tratamientos disponibles a nivel local.

Acne is one of the most common chronic dermatological diseases and it is primarily observed in adolescents. It is one of the causes of frequent consultation, and despite the fact that Its initial detection and approach is that of the pediatrician, depending on the evolution and the types of acne, referral and treatment by a dermatologist will be required. It is a skin disease, inflammatory in nature and involving the pilosebaceous unit. It has a multifactorial etiology and it requires clinical diagnosis when typical lesions are found. Considering importance of adolescents' image at this stage and the impact on their quality of life, early detection and treatment by the pediatrician are essential. There are increasing new therapeutic possibilities, which require health professionals to be updated. This review aims at showing an update of the subject and at providing updated information regarding the available treatments locally.

A acne é uma das doenças dermatológicas crônicas mais comuns, sendo a adolescência onde observase sua maior incidência e prevalência. Constitui motivo de consulta frequente e apesar de sua abordagem inicial é a do pediatra, dependendo da evolução e dos tipos de acne que necessitam de tratamento e encaminhamento feito por um dermatologista. É uma doença cutânea, de natureza inflamatória e que envolve a unidade pilossebácea. Sua etiologia é multifatorial e o diagnóstico é clínico quando são encontradas lesões típicas. Tendo em conta a importância da imagem corporal nesta fase da vida e o impacto dela na qualidade de vida dos adolescentes, o reconhecimento inicial pelo pediatra e o tratamento precoces são essenciais. Existem cada vez mais novas possibilidades terapêuticas, exigindo que os profissionais de saúde estejam atualizados. Este papertem como objetivo mostrar uma atualização do assunto e fornecer informação atualizada sobre os tratamentos disponíveis a nível local.

Preparation of tanshinone Ⅱ_A-glycyrrhetinic acid solid lipid nanoparticles and its inhibitory effect on acne / 中国中药杂志

The optimal prescription of tanshinone Ⅱ_A(TSN)-glycyrrhetinic acid(GA) solid lipid nanoparticles(GT-SLNs) was explored and evaluated in vivo and in vitro, and its effect on acne after oral administration was investigated. The preparation processing and prescription were optimized and verified by single factor and response surface methodology. The in vitro release of GA and TSN in GT-SLNs was determined by ultra-performance liquid chromatography(UPLC). The effect of GT-SLNs on acne was investigated by the levels of sex hormones in mice, ear swelling model, and tissue changes in sebaceous glands, and the pharmacokinetics was evaluated. The 24-hour cumulative release rates of GA and TSN in SLNs were 65.87%±5.63% and 36.13%±2.31% respectively. After oral administration of GT-SLNs and the mixture of GA and TSN(GT-Mix), the AUC_(0-t) and AUC_(0-∞) of TSN in GT-SLNs were 1.98 times and 4.77 times those in the GT-Mix group, respectively, and the peak concentration of TSN in the GT-SLNs group was 17.2 times that in the GT-Mix group. After intragastric administration of GT-SLNs, the serum levels of testosterone(T) and the ratio of testosterone to estradiol(T/E2) in the GT-SLNs group significantly declined, and the sebaceous glands of mice were atrophied to a certain extent. The results demonstrated that obtained GT-SLNs with good encapsulation efficiency and uniform particle size could promote the release of GA and TSN. GT-SLNs displayed therapeutic efficacy on acne manifested by androgen increase, abnormal sebaceous gland secretion, and inflammatory damage.

Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor as an Adjuvant Therapy for Patients with Atrophic Acne Scar / 中国医学科学院学报

Objective To study the influence of recombinant bovine basic fibroblast growth factor as an adjuvant therapy on scar alleviation and inflammatory cytokines in patients with atrophic acne scar. Methods The random number table was employed to randomly assign 120 patients with atrophic acne scar into a test group and a control group.Both groups of patients were treated with CO2 lattice laser.After the operation,the control group was routinely smeared with erythromycin ointment and the test group was coated with recombinant bovine basic fibroblast growth factor gel.The clinical efficacy,clinical indicators,scar alleviation,and inflammatory cytokine levels before and after treatment were compared,and adverse reactions were counted. Results The test group had higher total effective rate(P=0.040) and lower total incidence of adverse reactions(P=0.028) than the control group.Compared with the control group,the test group showcased short erythema duration after treatment(P=0.025),early scab forming(P=0.002),and early edema regression(P<0.001).After treatment,the proportion of grade 1 scars graded by Goodman and Baron's acne scar grading system in the test group and control group increased(P=0.001,P=0.027),and the proportion of grade 4 scars decreased(P<0.001,P=0.034).Moreover,the proportion of grade 1 scars in the test group was higher than that in the control group(P=0.031) after treatment,and the proportion of grade 4 scars presented an opposite trend(P=0.031).After treatment,the levels of tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) in both groups declined(all P<0.001),and the test group had lower TNF-α and IL-1β levels than the control group(all P<0.001). Conclusion The recombinant bovine basic fibroblast growth factor gel as an adjuvant therapy of CO2 lattice laser can effectively alleviate the atrophic acne scar,relieve local inflammatory reaction,and has good curative effect and less adverse reactions.

Analysis on formulation regularity and characteristics of acne-relieving Chinese medicinal health products and Chinese patent medicines / 中国中药杂志

This study summarized and analyzed the current acne-relieving Chinese medicinal health products and Chinese patent medicines,aiming at providing references for the formulation and development of acne-relieving health products. The information on acne-relieving health products published by the Department of Special Food Safety Supervision and Management,the State Administration for Market Regulation( SAMR) was retrieved,and the Chinese patent medicines on DRUGDATAEXPY were searched. Microsoft Excel and the Traditional Chinese Medicine Inheritance Support System V2. 5( TCMISS) were employed to statistically analyze the characteristics of formulations. Forty-three acne-relieving health products were obtained,including 40 ones containing Chinese herbal medicines. Six Chinese herbal medicines showed a usage frequency ≥8,with 61 times in use totally,including Salviae Miltiorrhizae Radix et Rhizoma( 13),Lonicerae Japonicae Flos( 12),Taraxaci Herba( 11),ALOE( 9),Carthami Flos( 8),and Rhei Radix et Rhizoma( 8). A total of 29 Chinese patent medicines with similar efficacy were collected in DRUGDATAEXPY. Nine Chinese herbal medicines showed a usage frequency ≥6,with 63 times in use,including Rhei Radix et Rhizoma( 10),Glycyrrhizae Radix et Rhizoma( 8),Scutellariae Radix( 8),Lonicerae Japonicae Flos( 7),Angelicae Sinensis Radix( 6),Paeoniae Radix Rubra( 6),Astragali Radix( 6),Paeoniae Radix Alba( 6),and Gardeniae Fructus( 6). Through unsupervised hierarchical entropy-based clustering of the above-mentioned Chinese medicinal health products and Chinese patent medicines,five and three new formulas were obtained,respectively. The selection of Chinese herbal medicines was consistent with the principles of traditional Chinese medicine( TCM) theories in relieving acne,i. e.,dispelling exterior wind,ventilating lungs,clearing heat,dissipating mass,promoting diuresis,relaxing bowels,removing toxin,activating blood,resolving stasis,eliminating phlegm,and regulating Qi. According to the " lung governing skin and body hair" and " interior-exterior relationship between lung and large intestine" in TCM theories,the idea that acne could be treated by relieving constipation was proposed,which provided new methods and references for the research and development of Chinese medicinal health products.

Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology

Abstract Background: Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. Objective: To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. Methods: Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. Results: With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. Conclusions: Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.

Effects of oral isotretinoin therapy on the nasal cavities / Efeitos nasais da terapia com isotretinoína oral

Abstract Introduction Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure. Objective The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy. Methods Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints. Results The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47 ± 1.48 (0-5); 0.35 ± 1.30 (0-5) at admission, 3.57 ± 4.45 (0-10); 2.26 ± 4.71 (0-20) at the first month, and 4.28 ± 6 (0-20); 2.26 ± 4.71 (0-20) at the third month of the treatment respectively. Total nasal resistance of 0.195 ± 0.079 (0.12-0.56) Pa/cm3/s at admission, 0.21 ± 0.084 (0.12-0.54) Pa/cm3/s at the first month, and 0.216 ± 0.081 (0.14-0.54) Pa/cm3/s at the third month. Conclusion Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.

Resumo Introdução A isotretinoína (ácido-13 cis-retinóico) é o tratamento por via oral mais eficaz para acne vulgar e é a única opção de tratamento que pode produzir remissão ou cura permanente. Objetivo Usar métodos subjetivos e objetivos para avaliar as queixas nasais de pacientes com acne grave que receberam terapia com isotretinoína oral. Método Foram incluídos no estudo 54 indivíduos. Todos os indivíduos foram avaliados por meio de testes subjetivos (questionários NOSE e escala EVA) e objetivos (rinomanometria e teste de sacarina) para determinar a gravidade de suas queixas nasais. Resultados Os escores médios de gravidade (min: 0; max: 100) para ressecamento/crostas e epistaxe nasal foram de 0,47 ± 1,48 (0-5); 0,35 ± 1,30 (0-5) no início, 3,57 ± 4,45 (0-10); 2,26 ± 4,71 (0-20) no primeiro mês e 4,28 ± 6 (0-20); 2,26 ± 4,71 (0-20) no terceiro mês do tratamento, respectivamente. A resistência nasal total foi de 0,195 ± 0,079 (0,12 a 0,56) Pa/cm3/s no início, 0,21 ± 0,084 (0,12 a 0,54) Pa/cm3/s no primeiro mês e 0,216 ± 0,081 (0,14 a 0,54) Pa/cm3/s no terceiro mês. Conclusão A terapia com isotretinoína por via oral pode resultar em queixa de obstrução nasal. Além disso, queixas nasais, tais como ressecamento/formação de crostas e epistaxe, aumentam significativamente nos pacientes durante o esquema terapêutico.

Efeitos adversos associados a uso de contraceptivos orais em discentes / Adverse effects associated with students' use of oral contraceptives

Objetivos: Investigar o número de mulheres, as causas que levam a fazer o uso e descrever os efeitos adversos mais comuns associados ao uso de contraceptivos orais de forma contínua. Métodos: Trata-se de estudo observacional, transversal ou de prevalência e quantitativo. A pesquisa teve população de 832 alunas do curso de Direito dos turnos matutino, vespertino e noturno, no período de agosto a setembro, tendo como amostra 248 participantes para esse estudo. O questionário versou sobre o uso de anticoncepcionais, o perfil das usuárias e os possíveis efeitos adversos observados ao longo do uso. Resultados: A prevalência de uso dos contraceptivos orais foi de 42,3%, justificada principalmente pelo desejo de evitar a concepção (42,9%), regular os níveis hormonais (25,7%) e tratar acne (15,2%). Cerca de 63,8% relataram que já sentiram algum desconforto associado ao uso destes medicamentos, sendo os mais frequentes aumento de peso corporal (32,4%), alterações de humor (24,3%), dor nas mamas (13,5%), cefaleia (4,1%), dor abdominal (2,7%). Conclusão: A prevalência de efeitos adversos decorrentes do uso contínuo de contraceptivos orais é alta, evidenciando-se a necessidade de conscientizar as usuárias a buscarem profissionais habilitados, para que elas façam uso do anticoncepcional mais adequado, minimizando o desconforto advindo dos efeitos adversos.

Objectives: To investigate the number of women, the causes that lead to making use, and to describe the most common adverse effects associated with oral contraceptive continuous use. Methods: This is an observational, cross-sectional, or prevalence and quantitative study. The research had a population of 832 students of the law course of the morning, afternoon and evening shifts, from August to September, with a sample of 248 participants for this study. The questionnaire was about contraceptive use, users' profile, and possible adverse effects observed during use. Results: The prevalence of oral contraceptive use was 42.3%, mainly explained by the desire to avoid conception (42.9%), regulate hormone levels (25.7%), and to treat acne (15.2%). About 63.8% reported already having some discomfort associated with the use of these medications, with the most frequent being body weight gain (32.4%), mood swings (24.3%), breast pain (13.5%), headache (4.1%), abdominal pain (2.7%). Conclusion: The prevalence of adverse effects resulting from the continued use of oral contraceptives is high, so there is a need to guide users to seek qualified professionals so that they make use of the most appropriate contraceptive, minimizing the discomfort arising from adverse effects.

Use of oral isotretinoin to treat acne in the public system: a hospital-based retrospective cohort

ABSTRACT BACKGROUND: Acne needs to be treated early to prevent negative psychosocial impacts. In severe or moderate forms, which tend to leave scars, oral isotretinoin is the first-line therapy. However, concern about its adverse events, especially in developed countries, delays effective treatment. In contrast, isotretinoin is widely prescribed in Brazilian private clinics. OBJECTIVES: To describe the use of isotretinoin for treating acne in a Brazilian public hospital, and to analyze whether its prescription is effective or belated. DESIGN AND SETTING: Retrospective cohort study in a public hospital. METHODS: Clinical and therapeutic data were obtained from the medical records of patients who were undergoing or had undergone acne treatment with isotretinoin in this hospital's general dermatology outpatient clinic over the last seven years, up to April 2018. RESULTS: 1526 medical records from patients with acne were analyzed. Isotretinoin was prescribed for 279 patients (18.28%) with mild (1.19%), moderate (57.37%), severe (35.85%) or conglobata (5.57%) forms of acne vulgaris. Sequelae of acne were present at the start of most of these patients' treatment. An initial daily dose of 20 mg was usually prescribed. The average initial dose/weight ratio was 0.33 mg/kg/day. The average total dose/weight ratio was 127.61 mg/kg. There were only a few cases of laboratory abnormalities. CONCLUSION: Sequelae of acne at the onset of treatment reveal delayed indication of isotretinoin, which can have negative psychosocial impacts on quality of life. Isotretinoin should be indicated early to prevent this. Its use is supported by its lack of laboratory alterations and controllable adverse events.

Adult female acne: a guide to clinical practice

Abstract: Background: Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. Objective: To develop a guide for the clinical practice of adult female acne. Methods: A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. Results: The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. Conclusion: Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.

Abordaje del acné desde atención primaria / Approaching acne from primary care

El Acné es un motivo de consulta dermatológica frecuente en la población joven de atención primaria (APS), que sin ser una patología de urgencia, se asocia a complicaciones estéticas y/o psicológicas que tienen un gran impacto en la calidad de vida del paciente. En su fisiopatología interactúan una serie de factores tales como: la queratinización anormal de la piel, y consiguiente obstrucción de la unidad pilosebácea, con posterior formación de microcomedones. El aumento del sebo, permite la colonización del P. Acnes y la consecuente cascada inflamatoria. Aunque no existe un consenso en cuanto a la clasificación, estas se pueden dividir en lesiones inflamatorias (pápulas, pústulas, nódulos o quística) o no-inflamatoria, (comedoniano). El tratamiento está orientado al tipo de lesión y su severidad. El arsenal farmacológico en APS considera el tratamiento tópico (retinoides y/o antibióticos) indicado a través de recetas magistrales y antibióticos orales para casos más avanzados. Sin embargo, a pesar de ser una patología manejable en APS, se debe tener en consideración la necesidad de derivación en casos determinados.

Acne is a frequent reason for dermatological consultation in the young population of primary care (PHC), which without being an emergency pathology, is associated with aesthetic and/or psychological complications that have a great impact on the quality of life of the patient. A series of factors interact in its physiopathology, such as: abnormal keratinization of the skin, and consequent obstruction of the pilosebaceous unit, with subsequent formation of microcomedons. The increase of sebum allows the colonization of P. Acnes and the consequent inflammatory cascade. Although there is no consensus as to the classification, these can be divided into inflammatory (papules, pustules, nodules or cystic) or non-inflammatory (comedonian) lesions. Treatment is oriented to the type of lesion and its severity. The pharmacological arsenal in APS considers topical treatment (retinoids and/or antibiotics) indicated through master prescriptions and oral antibiotics for more advanced cases. However, despite being a manageable pathology in PHC, the need for referral in certain cases must be taken into consideration.

Tratamiento del acné en la adolescencia / Treatment of acne in adolescents

El acné es la enfermedad dermatológica más común de la adolescencia. Aunque casi todos los casos remiten alrededor de la tercera década de la vida, cuando este problema conlleva una carga emocional para el paciente se requiere indicar tratamiento. En esta actualización, los autores revisan los distintos grados de compromiso de esta patología, el tratami-ento y los niveles de evidencia que tiene cada uno de ellos, con el objetivo de facilitar a los médicos de atención primaria el manejo de los pacientes que presentan esta enfermedad. (AU)

Acne is the most common dermatological condition in adolescents. Even though almost all cases will resolve around the third decade of life, treatment is indicated when this health problem carries an emotional burden for the patient. In this update, the authors review the grades of involvement of the disease and the available treatments according to levels of evidence, with the aim of helping primary care physicians to manage the patients presenting this illness. (AU)

Effects of isotretinoin on the olfactory function in patients with acne

Abstract: Background: Isotretinoin is a synthetic analog of vitamin A. Recent studies support a role for retinoic acid in the recovery of olfactory function following injury in mice. Objective: This study aimed at determining the effect of isotretinoin on olfactory function in patients who have acne and are otherwise healthy. Methods: Forty-five patients (aged 25-40 years) with acne were included in the study. All patients underwent a rhinological examination. Olfactory function was assessed by the Sniffin' Sticks Test. The test was assessed at baseline and in the third month of isotretinoin treatment. Results: Isotretinoin improved the performance of patients in the olfactory test. The SST score increased from 8.7±1.09 to 9.5±1.19 (p<0.001), prevalence of hyposmia decreased from 40% to 24% and normosmia increased from 60% to 75% (p=0.059). The percentage of patients whose olfactory function was categorized as "good" increased from 6% to 21.3%. This increase was statistically significant (p<0.05). Study limitations: Absence of a control group is one of the limitations of this study. Also, we did not evaluate patients with smell test after stopping isotretinoin treatment. Conclusion: We examined the effect of systemic isotretinoin on olfactory function. It can be concluded from the present investigation that isotretinoin therapy improves the sense of smell.

Acne fulminans

Abstract: Acne fulminans is a rare and severe variant of acne. In Brazilian medical journals, cases are infrequently reported, confirming its rarity. We followed five young male patients with this severe variant of cutaneous lesions, accompanied by also severe systemic symptoms: fever, anorexia, weight loss, and arthralgia. All had a good response to corticosteroids (prednisone), but had significant scarring.