103 patients with acne vulgaris either received erythromycin plus zinc or atopical solution of 1% clindamycin phosphate (Cleocin-T). The medication was applied 2 times daily and patients were examined at 3, 6, 9 and 12 weeks after starting therapy. At 6 weeks there was considerable improvement in the zinc-treated group versus the Clindamycin-treated group. There were no serious side effects in the 92 patients who completed the study.
It is postulated that the superiority of the Erythromycin-zinc formulation may be due to the increased (4%) erythromycin concentration and/or the ability of 1.2% zinc acetate solution to enhance the product's activity. Both of the products were safe and effective.
The zinc-erythromycin provides a better therapeutic benefit in a shorter amount of time.
"A Clinical Trial Comparing the Safety and Efficacy of Topical Erythromycin-Zinc Formulation With A Topical Clindamycin Formulation", Schachner, Lawrence, et al, Journal of The American Academy of Dermatology, March 1990;22(3):489-495.
Acne occurs more frequently in newborns and infants than one would gather from written accounts. Acne neonatorum tends to be overlooked because it is usually minor and transient. In contrast, acne infantum, which generally does not make its appearance until after 3 months of life, is more serious. Even acne conglobata may develop in infants.
There are many other types of acne in childhood reflecting different pathogenetic mechanisms; included in this group are acne venenata infantum, steroid acne, hormonal disturbances, and toxic reactions.
Jansen T et al., Pathogenesis and treatment of acne in childhood. Pediatr Dermatol, 1997 Jan-Feb, 14:1, 17-21.
To determine which factors in early pubertal girls might be predictive of later, severe facial acne.
The degree of facial acne was classified annually as mild, moderate, or severe. Blood samples were obtained at the first, third, and fifth years of the study. Using the acne status during the fifth year of the study as the outcome variable, we determined the contributions from the prior acne status and the serum levels of dehydroepiandrosterone sulfate (DHEAS), testosterone, free testosterone (FT), estradiol (E2), progesterone, and testosterone-estrogen binding globulin (TEBG) and compared the results at various ages and at times before and after menarche.
No racial differences in acne or hormone levels were found. There was a progressive increase in the number of acne lesions with age and maturation. The girls exhibited many more comedonal than inflammatory acne lesions, regardless of age. The girls in whom severe acne developed by the fifth year of the study had significantly more comedones and inflammatory lesions than girls with mild or moderate acne, as early as age 10 years, approximately 2 years before menarche, a time when their degree of acne was mild.
Girls with mild comedonal acne had significantly later onset of menarche (12.5 compared with 12.2 years) than girls with severe comedonal acne.
Girls in whom severe comedonal acne developed had significantly higher levels of serum DHEAS and, in a longitudinal analysis, somewhat higher levels of testosterone and FT in comparison with girls who had mild or moderate comedonal acne. Serum E2, testosterone/E2, progesterone, and TEBG values were no different in girls with severe compared with mild or moderate comedonal acne.
The early development of comedonal acne may be one of the best predictors of later, more severe disease. The adrenal hormone DHEAS appears to play an important role in the initiation of acne. DHEAS, testosterone, and FT are associated with the perpetuation of severe comedonal acne. Early recognition of young girls at risk of having severe comedonal acne may enable the clinician to intervene and thus prevent unwanted sequelae.
Lucky AW et al., Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study [see comments]. J Pediatr, 1997 Jan, 130:1, 30-9.
Oils & Solvents
Ship's engineers are exposed to mineral oil and solvents in their work. This study was intended to investigate if the ship's engineers had an increased prevalence of skin disorders and whether any such increased risk could be linked to exposure to mineral oils and solvents.
The increased prevalence of skin disorders found among ship's engineers in this investigation may be explained by direct contact with mineral oils and solvents.
Svendsen K & Hilt B: Skin disorders in ship's engineers exposed to oils and solvents. Contact Dermatitis, 1997 Apr, 36:4, 216-20.
Sun exposure has a beneficial effect on acne vulgaris, but it is not clear which wavelengths contribute to the favorable effect.
All the light sources using 'full spectrum', green and violet improved the acne, leading to 14%, 22% and 30% improvement, respectively. No statistically significant differences between the three different light sources were found, although there was a tendency that violet light was better than the other light qualities. No side-effects were observed.
Visible light is a moderately effective alternative for treatment of acne vulgaris.
Sigurdsson V et al., Phototherapy of acne vulgaris with visible light. Dermatology, 1997, 194:3, 256-60.
Sunbed use was studied in relation to phenotype, erythema, sunscreen use and skin disease.
Of all sunbed users, 44% reported erythema. Adolescents with acne/seborrhoca, eczema or psoriasis used sunbeds more than others without skin diseases. The proportion with sunbed erythema (44%) indicates an unrecognized susceptibility to artificial ultraviolet radiation (UVR) among adolescents. The association between high exposure to UVR and sunscreen use stresses the importance of sunscreens being used as supplementary protection, not as a tool for tanning.
Boldeman C et al., Sunbed use in relation to phenotype, erythema, sunscreen use and skin diseases. A questionnaire survey among Swedish adolescents. Br J Dermatol, 1996 Nov, 135:5, 712-6.
Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years.
There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity, consisting principally of inflammatory lesions, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had features of hyperandrogenicity.
A family history revealed that 100 (50%) of patients had a first-degree relative with post-adolescent acne. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers.
Two main clinical groups were identified: those with persistent acne and those with late-onset acne. A minority of women also had features of hyperandrogenicity. These patients, and those with late-onset acne, may represent a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.
Goulden V et al., Post-adolescent acne: a review of clinical features. Br J Dermatol, 1997 Jan, 136:1, 66-70.
It has been suggested that cystic acne is rare in women 15 to 44 years of age and infrequent in men.
Analyzed the primary data from the National Health and Nutrition Examination Survey (NHANES) that included a cutaneous examination of a stratified random sample of 20,749 noninstitutionalized U.S. residents.
The prevalence of acne conglobata and acne of at least a moderate degree with cysts and scars was 832,000 for women and 1,319,000 for men 15 to 44 years of age. The male/female ratio for acne with cysts and scars is approximately 1.6:1.
The NHANES examination data demonstrate that acne with cysts and scars is common in both men and women.
Stern RS: The prevalence of acne on the basis of physical examination. J Am Acad Dermatol, 1992 Jun, 26:6, 931-5.
Quality of Life
Quality of life (1)
Although psychosocial aspects of skin diseases are well known, disease-specific questionnaires validated for use in clinical trials are not available to assess the impact of facial acne on health-related quality of life or to evaluate therapeutic change. Development of such an instrument was undertaken and included item generation, reduction and pilot-testing phases.
The resulting instrument takes 10 minutes to complete, and consists of 24 questions assessing how acne affected certain aspects of patients' lives during the past week on a 7-point scale.
Girman CJ et al., Evaluating health-related quality of life in patients with facial acne: development of a self-administered questionnaire for clinical trials. Qual Life Res, 1996 Oct, 5:5, 481-90.
Quality of life (2)
The Dermatology-Specific Quality of Life (DSQL) instrument is a new tool to quantify the effects of skin disease on physical discomfort and symptoms, psychologic well-being, social functioning, self-care activities, performance at work or school, and self-perceptions.
Examined the reliability and validity of the DSQL in two disease cohorts comprising patients with contact dermatitis and acne vulgaris.
The DSQL scales had high internal consistency and test-retest reliability, and were moderately to highly correlated with patient global ratings of symptom and overall disease severity.
Patients rated with severe contact dermatitis or acne scarring had higher DSQL scores than those with less severe skin disease. Factor analyses found separate dimensions of physical, emotional, and social functioning involvement from skin disease.
The DSQL provides valid and reliable assessments of quality of life impacts associated with acne and contact dermatitis.
Anderson RT & Rajagopalan R: Development and validation of a quality of life instrument for cutaneous diseases. J Am Acad Dermatol, 1997 Jul, 37:1, 41-50.
The improvement of acne in summertime or the aggravation of acne in winter is a traditional dermatologic opinion. Ultraviolet rays are thought to be beneficial in the treatment of acne. In the existing literature there is no proof of this.
The purpose of this study was to find out whether or not acne generally worsens in winter.
About one-third of the patients reported an aggravation of their acne in winter, but also approximately one-third of the patients complained about an aggravation of their acne in summer. Another third did not notice any change.
Sun-bathing may be beneficial for psychologic reasons and may produce euphoric effects, but we do not see any reason to treat acne with ultraviolet radiation because of all its negative effects on the skin.
Gfesser M & Worret WI: Seasonal variations in the severity of acne vulgaris. Int J Dermatol, 1996 Feb, 35:2, 116-7.
To identify unsupervised anabolic steroid regimens used by athletes.
Anabolic steroid doses ranged from 250 to 3200 mg per week and users combined different drugs to achieve these doses. Injectable and oral preparations were used in cycles lasting four to 12 weeks. Eighty six per cent of users admitted to the regular use of drugs other than steroids for various reasons, including additional anabolic effects, the minimization of steroid related side effects, and withdrawal symptoms. Acne, striae, and gynecomastia were the most commonly reported subjective side effects.
Evans NA: Gym and tonic: a profile of 100 male steroid users. Br J Sports Med, 1997 Mar, 31:1, 54-8.
Tea Tree Oil
Australian dermatologists have been utilizing tea-tree oil (Melaleuca alternifolia) in the treatment of a wide variety of skin pathologies including acne. One hundred and twenty-four patients with mild to moderate acne in a single-blind randomized trial were given either a 5% gel of tea-tree oil or 5% benzoyl peroxide lotion. Both treatments resulted in significant improvement of noninflamed and inflamed lesions after three months, with tea-tree oil causing more severe facial erythema and benzoyl peroxide being more effective in noninflamed lesions. There were less unwanted side effects in the tea-tree oil group, 44% versus 79%.
It is concluded that tea-tree oil may be a valuable alternative to traditional treatment of acne.
"Tea-Tree Oil and Acne", The Lancet, December 8, 1990;1438/Bassett, I.B. et al, "A Comparative Study of Tea-Tree Oil Versus Benzoyl Peroxide in The Treatment of Acne", Medical Journal of Australia, 1990;153:455-458.
Zinc and Acne
Sixty-six patients with inflammatory acne in a double-blind trial using 30 mgs/d of elemental zinc (zinc gluconate) showed a significant improvement over controls. Zinc's effectiveness may be attributed to its actions on inflammatory cells. Zinc has a regulatory role in controlling bactericidal activity, phagocytosis and chemotaxis of granulocytes.
"Low Doses of Zinc Gluconate For Inflammatory Acne", Dreno, B., et al, ACTA Derm. Venerol Stockh, 1989;69:541-543.
Zinc tape applied to acne lesions for two weeks and removed is stated to work excellently. The tape may be used during showering and possibly has benefits against warts.
Weiss, TH: "Zinc Tape For Clear Skin", Cortlandt Forum, December 1990;72:34-40.
Acne flare-ups may be a result of hormonal shifts associated with women's menstrual periods, according to this study. By interviewing 400 females between the ages of 12 and 52, the authors ascertained that 44% of the women experienced acne flare-ups just before their period began. The severity of the acne, ethnicity of the subject, and oral contraceptive use did not affect the premenstrual flare rate of the women interviewed. The age of the women, however, did seem to affect the rate. Women older than 33 had a higher rate of premenstrual flares compared to women aged 20 to 33.
Stoll S, Shalita AR, Webster GF, Kaplan R, Danesh S, Penstein A: The effect of the menstrual cycle on acne, J Am Acad Dermatol 2001 Dec;45(6):957-60