Sun exposure, a relevant exposome factor in acne patients and how photoprotection can improve outcomes.

BACKGROUND: Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes. AIMS: To describe the impact of the exposome on acne and how photoprotection can improve outcomes. METHODS: A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light." RESULTS: Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties. CONCLUSIONS: The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.

Factores etiológicos del prurigo estrófulo en niños de una población rural de Venezuela / Etiological factors of the prurigo stropholus in children from a Venezuelan rural population

El estudio dermatológico de 177 niños procedentes de un área rural de Venezuela demostró la presencia de prurigo estrófulo (PE) como la dermatosis más frecuente (25,4 per cent). Se evaluó también la presencia de otros factores asociados a PE, como la presencia de parásitos intestinales y la sensibilización frente a antígenos comunes. Se demostró la presencia de valores significativamente más altos de IgE específica a Culex pipiens en los niños con PE (p < 0,01), así como una alta prevalencia de ascariasis y giardiasis (p < 0,01). La presencia de estas parasitosis podría predisponer al aumento de la síntesis de IgE y a la sensibilización a las picaduras de insectos (AU)

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Clinical trial with clofazimine for treating erythema dyschromicum perstans. Evaluation of cell-mediated immunity.

Eight patients were studied to determine the possible use of clofazimine for treating erythema dyschromicum perstans (EDP). The T-helper/T-suppressor cytotoxic ratio (CD-4/CD-8) and the in vitro lymphoproliferative response on stimulation with phytohemaglutin (PHA) and concanavalin A (Con A) were determined in peripheral blood before and after treatment. Of the eight patients studied, seven had excellent to good responses, whereas only one had a marginal response. The immunologic evaluation before and after treatment showed a significant change in the CD-4/CD-8 ratio, a decrease of the response to PHA, and no change in the response to Con A. The results obtained show that clofazimine is useful for treating this nosologic entity because of its cosmetic effect, and also because it induces changes in cell-mediated response, which could be very important therapeutically.

[Double-blind clinical study of the treatment of melasma with azelaic acid versus hydroquinone]. / Estudio clínico doble ciego en el tratamiento del melasma entre ácido azelaico versus hidroquinona.

A comparative double-blind study was carried out on sixty patients received oral contraceptives. Patients were treated with 20% azelaic acid or 4% hydroquinone. They were observed for 24 weeks and the results compared and checked for side effects. The results showed that the azelaic acid was not better than the hydroquinone in the treatment of melasma but it could be used as alternative drug.

[Generalized lichen planus with erosive lesions of the penis, treated with thalidomide. Report of a case and review of the literature]. / Liquen plano generalizado con lesión erosiva del pene, tratado con talidomida. Reporte de un caso y revisión de la literatura.

A patient with generalized lichen planus with lesions in the infrequent localization like face, palms, soles and an extensive erosion of glans penis, is described in a 46 year old patient. He had received various treatment which include systemic steroids, without improvement. After treatment with thalidomide (initial doses 300 mg/day for 2 weeks and 200 mg/day for further 10 weeks) he presents resolution of his lesions and symptomatology. A review of lichen planus etiopathogenesis, making emphasis in the immunological hypothesis is made. As well as the different uses and action mechanism of thalidomide in various inflammatory dermatoses.

[Use of cyproterone acetate in the treatment of acne]. / Uso del acetato de ciproterona en el tratamiento del acné.

Forty two female patients with strong acne and oiliness were studied all of them were treated with a tablet daily of 2 mg. of cyprosterone Acetate and 0.05 mg of ethinyl oestradiol for 3 weeks and a week without it. We found intolerance to the treatment in 9 out of 42 patients and a high percentage of cure or marked improvement in 96.9% of patients. In conclusion this drug is a good help to the treatment of female acne with seborrheic skin.