Acne is a disorder of the pilosebaceous unit often complicated by scarring. Five studies were performed to test the hypothesis that acne is common among Chinese and that the use of laser and light source is safe and effective for the treatment of acne and acne scars in Asians. The self-reported prevalence of acne in Hong Kong was assessed using a questionnaire among a randomised sample of 522 persons aged 15-25 years. The prevalence was 91.3% with a point prevalence of 52.2%, and acne scars and pigmentation were reported by 52.6%. The existing topical and oral anti-acne medications are limited by their efficacy, adverse effects and patient compliance. Light can target the pilosebaceous unit and reduce the growth of Propionibacterium acnes, for which lasers or light sources have been explored as therapeutic options. The aim of this study was to determine whether lower fluence and shorter cooling of the 1450-nm diode laser would improve acne while minimising post-laser hyperpigmentation in Asians. A total of 26 Chinese subjects received four treatments of three passes with this laser at a fluence of 8 J/cm2 with dynamic cooling of 25 ms. A 40% reduction (p<0.03) in mean lesion count was observed 6 months after treatment with a significant improvement in sebum production and a hyperpigmentation rate of 3.8%. A split-face, controlled study was performed to evaluate the effectiveness of intense pulsed light (IPL) alone or in combination with short-contact 16% methyl aminolevulinate photodynamic therapy (PDT) in 30 Chinese subjects with acne. Among the PDT-treated group, 25% withdrew due to treatment discomfort. No significant differences in the reduction of inflammatory lesions were observed between the intervention groups and the control group. A delayed effect with reductions in non-inflammatory lesions was observed in the PDT-treated (38%; p=0.05) and IPL-treated (43%; p=0.01) groups 12 weeks after treatment. Liposome was used to deliver 5-aminolevulinic acid (5-ALA) into the pilosebaceous unit to lower the concentration of 5-ALA by 40-fold during PDT. The study aimed to investigate the tolerability and efficacy of PDT with IPL using 0.5% liposomal 5-ALA for inflammatory acne. A mean reduction of 65% in the inflammatory lesion count was observed after 6 months (p=0.043) in 12 Chinese subjects. No dropout or significant side effects were observed. The treatment of acne scars has often been complicated by Asian skin phototypes regarding the risk of post-inflammatory hyperpigmentation. Fractionated radiofrequency induces deep dermal heating with less epidermal disruption. The aim of this study was to examine the efficacy and safety of combined bipolar radiofrequency and fractional diode 915 nm laser followed by fractional radiofrequency in 24 Chinese subjects with acne scars. The mean grade improved by 29% (p<0.001), and 52% subjects were rated as having at least a moderate global improvement at 3 months. Subjective improvement was moderate to significant in 36.8%. Hyperpigmentation occurred after 6.5% of the treatments. In conclusion, the studies indicated that laser and light source can be used effectively and safely for the treatment of acne and acne scars commonly found in Asians. / published_or_final_version / Medicine / Master / Doctor of Medicine

Acne is a common, chronic disorder that affects many adolescents. The most effective acne medication is systemic isotretinoin. It provides a permanent cure for many patients, but has various side effects. A South African Acne Treatment Guideline was introduced in 2005. Adherence to this guideline could lead to safer, more effective acne management. The primary aim of this study was to investigate the appropriateness of medications prescribed in the treatment of acne in South Africa, and to evaluate the safety and efficacy of systemic isotretinoin utilised by patients in the Nelson Mandela Metropole (NMM). A drug utilisation study (including 18 803 South African acne patients’ chronic prescription data between 2000 and 2005) and a patient questionnaire survey (including information from 57 patients in the NMM who used systemic isotretinoin) were conducted. Basic descriptive and interferential statistics were calculated. The drug utilisation study revealed that systemic antibiotics were the acne treatment prescribed to most (43.3 percent) patients, followed by 42.1 percent of patients on systemic isotretinoin, 33.2 percent on hormonal therapy and 18.9 percent on topical therapy. Topical retinoids were underused. The questionnaire survey indicated a lack of compliance by prescribers with guideline recommendations regarding the prescription (and accompanying counselling and monitoring) of isotretinoin. Incorrect cumulative doses were frequently prescribed, and a lack of proper implementation of pregnancy prevention measures was evident. The majority of isotretinoin patients reported a high efficacy of isotretinoin in clearing their acne.

Acne is one of the most common skin conditions worldwide, affecting 80% of people between the ages of 11 and 30 with over $3 billion dollars spent annually on treatment in the United States alone. While the visible symptoms of acne (comedones and inflammatory lesions) are well-known, acne is more than skin-deep. Up to 85% of adolescents with acne will experience a negative psychosocial outcome related to their skin condition. The most common negative outcomes are anxiety, depression, body dysmorphic disorder, decreased self-esteem, and decreased quality of life. These comorbidities can be extremely detrimental if unrecognized and untreated; acne is the second-most common skin condition to end in suicide. One of the major difficulties in providing well-rounded care for the acne patient beyond their dermatologic needs has been the identification of these psychosocial comorbidities. There is no current standard for evaluating for the presence of these symptoms and they can be difficult to elicit in a pediatric population. While surveys can screen for symptoms (the Children’s Dermatology Life Quality Index; the Cardiff Acne Disability Index), they are infrequently used. Subsequently, necessary treatment for these symptoms is foregone when the problem goes unrecognized. In order to better identify and treat the negative psychosocial impacts of acne, a multidisciplinary approach involving a concurrent medical and psychological approach is recommended. Examples include support groups, educational interventions, and multidisciplinary clinics. The aim of this proposed study is to evaluate the utility of a multidisciplinary behavioral health clinic in which patients are seen by a dermatologist and a psychologist at the same session. With this model, the dermatologist can evaluate the patients’ skin and encourage them to discuss how their acne may be impacting their life. Then, the psychologist can offer advice on what may help each patient’s individual symptoms. This advice may include coping strategies or referrals to specialists for further support. Patients will attend the clinic monthly and their progress will be recorded via Children’s Dermatology Life Quality Index scores, acne severity, and psychological diagnoses made at the clinic. It is predicted that the multidisciplinary behavioral health clinic will reveal previously undiagnosed psychological conditions in acne patients, improve patients’ quality of life, and improve the severity of their acne. This is clinically significant in providing a comprehensive treatment approach to the pediatric acne patient, recognizing that the symptoms and outcomes of acne are more than skin deep.

Acne vulgaris is an extremely common disease, affecting large numbers of adolescents and adults, with substantial physical and psychosocial impacts. Antibiotics have been used for many years in the anti-microbial and anti-inflammatory treatment of acne, and have generated reasonable success rates. In recent years, along with a growing popularity of oral contraceptives to reduce unwanted pregnancies, they have also been applied in acne treatment because of their overall anti-androgenic effects. Very little direct comparisons between these two methods have been published, and this study serves as a preliminary measure for the effectiveness of both treatments against each other. Using an extensive literature search of PUBMED and MEDLINE for randomized clinical trials involving antibiotics or oral contraceptives, data were taken and used in an analysis to assess efficiency of both drug groups in the reduction of lesion counts and percentage reduction in inflammatory acne lesions, non-inflammatory lesions, and total lesions based off original baseline counts in each study. A total of 15 studies were used in the analysis. Antibiotics, oral contraceptives, and placebo treatment groups were evaluated at three months’ time, while oral contraceptives and placebo treatments were also continued out to six months to reflect longer trial durations. In all cases, antibiotics were superior to placebo at three months. Oral contraceptives were also superior to all placebo arms at both three and six months, except for in the average percent reduction of total lesions where the placebo at six months is not significantly different than the contraceptives at three months. Antibiotics and contraceptives showed no significant difference between each other at three or six months times, except for the lesion number reduction at three months for inflammatory lesions compared to antibiotics. All comparisons used the average percentage or number reduction, and 95% confidence intervals to determine significance. After three months, antibiotics showed a 45.40% weighted mean reduction in total lesion counts, compared to 36.41% for oral contraceptives at three months and 43.76% at six months. With the confidence intervals, the ranges for significance are 38.40%-52.40%, 31.92%-40.90%, and 33.87%-53.64% respectively, corresponding to an insignificant difference between all three treatments. Percentage changes for both inflammatory and non-inflammatory lesion reductions were also similar in their confidence intervals overlapping. The study showed a surprising similarity between antibiotics and contraceptives in their ability to treat acne, in both inflammatory and non-inflammatory lesions. With the exception of the three month antibiotics out-performing the oral contraceptives at three months’ time for reduction of inflammatory lesions, the percentage reduction was not significantly different, indicating discrepancies with starting numbers. Overall, both treatments were effective in the treatment of acne lesions, but the limitations of oral contraceptives including their utility is confined to women, and the relatively short recommended treatment time for oral antibiotics each have their drawbacks. Oral contraceptives seem to represent a better long term treatment plan for women who are comfortable taking birth control.

The use of minocycline for the treatment of a broad range of systemic infections and for severe acne has been associated with vestibular side effects. The severity of side effects may lead to poor adherence to therapy by patients. The use of sustained release formulations of minocycline that display slow dissolution of minocycline following administration may be beneficial in reducing the incidence and severity of side effects. Therefore, sustained release capsule dosage forms containing 100 mg minocycline (base) were manufactured and assessed for use as sustained release oral dosage forms of minocycline. Minocycline sustained release capsules were manufactured based on matrix technologies using hydroxypropylmethyl cellulose (HPMC) and Compritol® as release retarding polymers. The rate and extent of minocycline release from the capsules was evaluated using USP Apparatus 1 and samples were analysed using a validated High Performance Liquid Chromatographic (HPLC) method with ultraviolet (UV) detection. Differences in the rate and extent of minocycline release from formulations manufactured using HPMC or Compritol® were influenced by the concentration of polymer used in the formulations. The rate and extent of minocycline release was faster and greater when low concentrations of polymer were used in formulations. The effect of different excipients on the release pattern(s) of minocycline and particularly their potential to optimise minocycline release from experimental formulations was investigated. The use of diluents such as lactose and microcrystalline cellulose (MCC) revealed that lactose facilitated minocycline release when HPMC was used as the polymer matrix. In contrast, the use of lactose as diluent resulted in slower release of minocycline from Compritol® based formulations. The addition of sodium starch glycolate to HPMC based formulations resulted in slower release of minocycline than when no sodium starch glycolate was used. Compritol® based formulations were observed to release minocycline faster following addition of sodium starch glycolate and Poloxamer 188 to experimental formulations. In vitro dissolution profiles were compared to a target or reference profile using the difference and similarity factors, ƒ1 and ƒ2 , and a one way analysis of variance (ANOVA). In addition, the mechanism of minocycline release was elucidated following fitting of dissolution data to the Korsmeyer-Peppas, Higuchi and Zero order models. Minocycline release kinetics were best described by the Korsmeyer-Peppas model and the values of the release exponent, n (italics), revealed that drug release was a result of the combined effects of minocycline diffusion through matrices and erosion of the matrices. These in vitro dissolution profiles were better fit to the Higuchi model than to the Zero order model. Two formulations that displayed a fit to the Zero order model were identified for further studies as potential dosage forms for sustained release minocycline.

Acne vulgaris is a complicated disease. It is primarily caused by dead skin, excessive sebum, and bacteria proliferation, all of which clogs hair follicles. The nature of this disease can start as comedone acne that affects young children, which progress into inflammatory acne in adolescent. The disease can persist into adulthood and is even reported to affect those 40 years of age. In adulthood, acne is more prevalent in women than in men. In addition to scarring and other physical damage, acne can also be psychologically damaging, especially in adolescents and adults. This paper will attempt to elucidate the causes of acne which includes: hormone, diet, smoking, environment, and human biology. Then this paper will explain common treatments that include: oral antibiotics, isotretinoin, topical treatment, hormone therapy, and light and laser therapy. After establishing researched causes and treatments, this paper will look into misconceptions regarding acne. Since there are many myths surrounding acne, this paper will only visit a few well documented misconceptions. Finally, this paper will formulate some new areas of research that acne literature is lacking. Acne is a serious disease and new information and research must be done in order to clear up misconceptions and allow physicians to provide better treatment.

Erythromycin (ERY) is a macrolide antibiotic which is used in the treatment of acne vulgaris.Acne is a common skin condition that occurs when the sebaceous glands and hair shafts become infected by the bacteria Propionibacterium acnes. Acne is a chronic condition that may last for years and the severity of the effects of the disease on patients is often undermined especially in third world countries where more emphasis is placed on other more life-threatening diseases. It may cause considerable physical and emotional distress to sufferers along with the possibility of permanent scarring. Although use of topical ERY formulations is not the first line of treatment it has proven to be effective in treating inflammation of skin and skin structures cause by the responsible bacteria. To-date there are a variety of vehicles which are used in preparing topical ERY formulations namely ointment and gel bases, alcoholic solutions and pledgets. All the gel formulations on the market contain hydroxypropyl cellulose, alcohol and water along with the active ingredient(s). However, some gel formulations contain propylene glycol in addition to these excipients an example being Emgel®. Propylene glycol has been shown to affect the penetration of topically applied drugs through the skin suggesting that it would be highly likely that those formulations which contain propylene glycol may release more ERY into the skin following application. With this in mind, two ERY gel formulations were produced which contained different percentages of propylene glycol. According to the FDA guidelines, pharmacokinetic measurements in blood, plasma and/or urine of topical dermatological drug products are not feasible to document bioequivalence since the active ingredient(s) in topical formulations is/are not intended to be absorbed into the systemic circulation and in addition, concentrations in extracutaneous biological tissues would generally not be measurable. This limits determination of bioavailability and assessment of bioequivalence of such products to pharmacodynamic measurements, clinical trials and dermatopharmacokinetic (DPK) measurements such as tape stripping (TS) and microdialysis (MD).TS is a sampling technique which involves sequential removal of layers of the stratum corneum using strips of adhesive tape. This technique has found increasing use in DPK studies for investigation of drug kinetics in the skin following the application of a topical formulation. The technique has also been used as a diagnostic tool in assessing the quality of the stratum corneum in diseased skin. In the current research study, the tape stripping technique was used to investigate the pharmaceutical/biological availability of topical gel formulations containing ERY. MD is another DPK sampling technique which has been used to determine the amount of a topically applied drug that penetrates through the stratum corneum to reach deeper tissues of the skin. The in vivo sampling technique involves the insertion of microdialysis probes beneath the skin surface in the dermal tissue and allows for real-time sampling of the analyte at its target site. Recently in vitro MD has also been successfully used to assess the pharmaceutical availability of a topical corticosteroid, mometesone furoate, from topical formulations. Based on this work, microdialysis was used to determine the pharmaceutical availability of ERY from gel formulations which were developed for use in this research. The results of the pharmaceutical availability of ERY from in vivo tape stripping studies and the in vitro microdialysis studies were compared to establish correlation between the data. Pharmaceutical equivalence and bioequivalence data obtained from the respective studies on the gel formulations were investigated by statistical analysis of the data generated from both the in vitro and in vivo experiments. In summary the objectives of this research were: 1. To develop and validate a high performance liquid chromatography method suitable to analyse ERY concentrations obtained from in vitro microdialysis studies and in vivo tape stripping studies. 2. To prepare two different ERY gel formulations with different percentage content of propylene glycol. 3. To determine the pharmaceutical availability of ERY from two different gel formulations using in vitro microdialysis. 4. To develop and validate a tape stripping technique which could be used to determine percutaneous penetration and bioequivalence of the gel formulations. 5. To compare in vitro microdialysis and in vivo tape stripping data and attempt to establish a correlation between the two different approaches.