Relationship of whole blood zinc levels to acne severity among Filipinos 18-25 years old: A cross-sectional comparative study in a tertiary government hospital

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Acne Vulgaris is one of the most common dermatologic diagnoses in the world. It can persist for years, result in permanent scarring, and have serious adverse effects on psychosocial development.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine the relationship between whole blood zinc levels and severity of acne.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a cross-sectional comparative study. Whole blood zinc levels of 30 patients with acne vulgaris divided into mild (n=10), moderate (n=10), and severe (n=10), and 10 healthy patients were measured. Acne severity was evaluated using the Global Acne Grading System (GAGS).</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 40 patients participated in this study. The mean whole blood zinc level in acne patients and non-acne patients were 5.03 ± 1.92 mcg/mL and 7.39 ± 0.79 mcg/mL, respectively. The mean zinc level of the controls was significantly higher compared to that of the acne patients (p=0.0006). Furthermore, mean whole blood zinc level of the patients with severe acne was significantly lower compared to that of the controls, mild acne and moderate acne (p<0.001). Adjusting for age and sex, there is a significant association between severity of acne vulgaris and blood zinc levels (p<0.0001). Specifically, the mean blood zinc level of the patients with moderate and severe acne were significantly lower compared to that of the control group (p=0.019 and p<0.001, respectively).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Whole blood zinc levels were inversely correlated with acne vulgaris severity in the Filipino population. Further studies are recommended to determine the role of zinc in the pathogenesis of acne and the effects of oral zinc supplementation on acne patients.</p>

Efficacy and Safety of Azithromycin in Moderate Acne Vulgaris

@#Introduction: Acne vulgaris is a chronic inflammatory dermatosis caused by Propionibacterium acnes. Clinicians are constantly attempting to discover the best antibiotic regimes in treating acne vulgaris. This study compares two regimens in terms of efficacy, tolerability, compliance and recurrence rate to make recommendation on which is the best regime. Methods: An open-labelled prospective randomized investigator-blinded interventional study was carried on moderate acne vulgaris patients. Patients were assigned to treatment arm at enrolment followed by follow-up and maintenance visits. Demographic data were collected at enrolment and questionnaire enquiring acne condition, general health and quality of life impairment were filled at every visit followed by blinded dermatologist assessment. Antibiotic tablets were provided based on assigned arm until follow-up 3. Results: 26 mild acne vulgaris patients aged 17 to 29 years were recruited. Physician assessment based on GAGS and photo assessment analysis showed an overall significant change (p<0.05) with decreasing trend indicating that the treatment is statistically effective. However, no significant differences (p>0.05) were found between regimens. Similarly, patient self-perceived assessment and CADI assessment also showed overall significant changes (p<0.05) with increasing trend indicating improvement in acne condition but no significant differences (p<0.05) between regimens. Conclusion: Neither regimen were significantly more efficacious than another. In view of cost, oral azithromycin 500mg daily for consecutive 4 days monthly is suggested as a better option.

Acne Severity Scoring Using Deep Learning / 대한피부과학회지

BACKGROUND: Acne is a chronic inflammatory disease of the pilosebaceous unit, mainly on the face. It can have various clinical manifestations and should be appropriately treated based on the severity. In Korea, the ‘Korea Acne Severity Rating System (KAGS)’ is a standardized index to determine the severity of acne according to specific Korean characteristics. However, the actual use of the KAGS in clinical settings has been limited. OBJECTIVE: We sought to analyze whether we could effectively measure acne severity using a deep learning algorithm, which is an image learning method. METHODS: Acne severity was classified into three levels of mild, moderate, and severe based on the KAGS, and learning and verification were performed using the CNN (Convolutional Neural Network), a deep learning technique. RESULTS: GoogLeNet's Inception-v3 algorithm showed the highest accuracy at 86.7%. CONCLUSION: This study confirmed that the use of a deep learning algorithm may facilitate the scoring of acne severity.

The Efficacy of Oral Isotretinoin (Roaccutane(R)) in the Treatment of Acne by Using the Korean Acne Grading System / 대한피부과학회지

BACKGROUND: Although oral isotretinoin is an effective established therapy for acne, Korean data related with this therapy is very limited. Moreover, there is no published data available on the efficacy of this drug that uses a grading system suitable for Korean acne patients. OBJECTIVE: The purpose of this study is to evaluate the efficacy of oral isotretinoin (Roaccutane?) by using the Korean Acne Grading System (KAGS) and the general satisfaction of patients in treating acne. METHODS: In this multicenter and prospective clinical study, 499 patients with acne, who visited at 5 dermatologic clinics during 11 months, were enrolled. The drug dosage was 0.2~1.0 mg/kg/day over 4 months. The efficacy assessment was performed at baseline and monthly after, with an acne grading based on the KAGS and the patient satisfaction questionnaire. RESULTS: Out of the 499 patients, 435 and 371 have completed the 3-month and 4-month treatments, respectively. After the 4-month treatment, the mean acne grades significantly decreased from 2.71 to 0.68, thus showing a 75.9% reduction in pretreatment scores. The mean patient satisfaction scores improved at the end of 4-month treatment, showing a 4.42 out of 5. CONCLUSION: In this paper, we describe the efficacy of oral isotretinoin by using the KAGS, which has not been previously reported in the Korean literature. Our results show that oral isotretinoin is an effective and satisfactory treatment modality for acnes of all grades in Korean patients, regardless of the dosage.

Topical Aminolaevulinic Acid-Photodynamic Therapy for the Treatment of Mild to Moderate Inflammatory Acne

BACKGROUND: Photodynamic therapy (PDT) using aminolevulinic acid (ALA) is a new technique. PDT is being studied extensively and is used in a variety of dermatology settings. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of topical ALA-PDT in patients with mild to moderate inflammatory acne. METHOD: Ten patients were enrolled in a clinical trial to evaluate ALA-PDT with activation by intense pulsed light. They were given a 20% topical ALA photosensitizing agent that remained in contact with the skin for 60 minutes before irradiation. No additional treatment was provided after PDT. RESULTS: The Korean acne grading system was used for clinical assessment. Our results showed a statistically significant clinical improvement of the inflammatory acne at eight weeks after two sessions of treatment. Side effects such as slight discomfort, burning and stinging were reported during the irradiation. CONCLUSION: ALA-PDT is a safe and effective treatment modality for inflammatory acne.

Korean Acne Grading System / 대한피부과학회지

BACKGROUND: A good acne grading system should reflect epidemiological and clinical features of a particular patient group. Current Korean acne grading systems are mostly based on the skin colors, epidemiology, and clinical features of Western countries, which make them less than being ideal for Korean acne patients. OBJECTIVE: We tried to devise an acne grading system based on clinical and epidemiological characteristics of Korean acne patients. This system is intended for use in primary care setting as well as in research purposes. METHODS: In the formulation of a new acne grading system, a panel of 5 dermatologists from 5 referral centers took into account the degree of complexity of the system, criteria for severity as well as skin colors through the review of clinical photographs of 250 acne patients. The new grading system then underwent inter-rater and intra-rater discrepancy assessment and simulation with 149 patient photos to find out an optimal epidemiological representation. RESULTS: We developed 6-scale grading system with both standard pictures and ranges of number of lesions as criteria. Intra-rater and inter-rater reproducibility turned out to be moderate to strong, suggesting clear instruction and easy performance. Simulation with 4 different models yielded best parameter ranges for the optimal criteria. CONCLUSIONS: With the feedback from the large-scale field applications, this new acne grading system will serve as a multipurpose acne grading system for Korean patients.