Um dos maiores desafios na área médica dermatológica tem sido o tratamento da acne. Esta dermatose afeta 80 a 90% dos adolescentes. A busca por tratamentos alternativos tornou-se importante devido à resistência bacteriana de Propionibacterium acnes (P. acnes) aos antibióticos comumente utilizados contra este agente etiológico e pelos efeitos colaterais produzidos por estas drogas. Visando minimizar estes efeitos colaterais e proporcionar a eliminação de P. acnes, uma nova modalidade de tratamento vem sendo pesquisada, a terapia fotodinâmica (TFD). TFD já está bem estabelecida no combate a muitos tipos de câncer e tem se mostrado promissora na área estética. Os protocolos de TFD para tratar a acne tem como base a síntese endógena de hematoporfirina e compostos relacionados induzida por ácido 5-aminolevulínico (ALA), um tratamento com tempo de incubação grande, dolorido e usando a luz azul. O objetivo deste estudo foi de um modo geral avaliar a eficácia da inativação fotodinâmica sobre o microrganismo P. acnes utilizando como FS a hipericina e irradiado com um LED amarelo (590 nm). A inativação do microorganismo foi conseguida mesmo com uma concentração baixa de hipericina (menos de 1 \'mü\'g/mL) e foi caracterizada pelo curto tempo de bioacumulação estacionária (cerca de 2 min 30 s). A eficiência fotodinâmica de hipericina foi comprovada nos experimentos, e também pode-se observar que o uso do LED amarelo a partir de doses pequenas (4,55 ± 0,08 J \'CM POT.-2\') sendo capaz de reduzir 63% das células viáveis utilizando 10 \'mü\'g/mL de hipericina. / One of the prominent challenges in medical dermatology has been the treatment of acne. The acne affects 80 to 90% of teenagers. The search for alternative treatment has become important due to bacterial resistance of P. acnes to usually applied antibiotics against this etiologic agent and the side effects produced by these drugs. In order to overcome these limitations to inactivated the P. acnes, the photodynamic based protocols has been studied. Already, well established named photodynamic therapy has been used against many cancers and the use of light has shown promise in the esthetic area, the photodynamic protocols has been used to treat acne based on endogenous synthesis of hematoporphyrin and related compounds induced by -aminolevulinic acid, a long term treatment and using the blue light. The objective of this study was to evaluate the effectiveness of photodynamic inactivation of the P. acnes using hypericin, irradiated by a yellow LED (590 nm). The microorganism inactivation was achieved even at low concentration of hypericin (less than 1 \'mü\'g/mL), and was characterized by the short time bioaccumulation stationary state (around 2.5 minutes). In order to guarantee the reproducibility typically the incubation time was 10 minutes. The photodynamic efficiency was evaluated to be 4.55 ± 0.08 J \'CM POT.-2\' able to reduce 63% of the viable cells using 10 \'mü\'g/mL of hypericin. These results allow concluding that the hypericin is an effective FS to inactivate P. acnes.

M.Tech. (Homoeopathy) / Acne vulgaris is a common skin condition, affecting mostly adolescents. This study attempts to demonstrate the effect of the homoeopathically prepared remedy Testis compositum in the treatment of acne vulgaris. Thirty participants were selected for the study, but only 28 completed the study. The study was conducted over a period of 8 weeks. All the participants formed the control group during the first two weeks of the study, and then formed the experimental group for the next six weeks. During the control period, the participants received placebo medication. At the start of the control period, and at two week intervals through the duration of the study, the participants were assessed by counting the acne lesions – only facial Acne vulgaris was assessed during the trial. At the start of the control period, the start of the experimental period, and after completion of all treatment, frontal and bilateral facial photographs were taken to enable visualisation of the changes that occurred during the study. The results were statistically analysed using the t-test, the Wilcoxon test and descriptive statistics. The results show that treatment with Testis compositum had a significant effect in improving acne vulgaris.

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.

Made available in DSpace on 2019-03-30T00:11:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-10-31 / Introduction: Post-acne scarring, a common condition, causes significant psychosocial impact. The treatment is time-consuming, expensive, has many side effects and variable results. Several treatment modalities are available and scarce evidence supports the choice. Microneedling, a recent therapeutic approach, has been demonstrated to be effective in the treatment of acne scars. In addition, it may be used in combination with countless possibilities of drugs, as it temporarily increases transepidermal absorption. Objective: To evaluate safety and efficacy of microneedling alone as well as associated with a 5% tretinoin peel immediately after needling. Methods: Double-blinded placebo-controlled split-face trial comparing moderate depth microneedling (1.5mm needles) alone versus microneedling plus 5% tretinoin peel. Three procedure sessions were performed after topical anesthesia, with an interval of three weeks between them and final evaluation four weeks after the third session. Clinical analyses were performed through photographs by independent observers, using the Quantitative Global Scarring Grading System for Postacne Scarring, the Qualitative Global Scarring Grading System for Postacne Scarring and a subjective scale. Histological analysis included measurement of epidermal thickness, collagen amount and a qualitative evaluation of collagen appearance before and after treatment by a pathologist. A questionnaire assessed volunteers¿ opinion about the outcomes. Results: Twenty volunteers were included and nineteen of these concluded the protocol. Neither infectious nor allergic granulomatous cutaneous reactions occurred. Pain during sessions was moderated, with a median of 5,6 points in the Visual Analogic Scale. In the observers¿ opinion, there were agreement that 60% of the evaluated sides of the face had their appearance improved, while 40% had their condition worsened. The mean difference in the quantitative score pre and post-treatment in the facial sides that improved was 3 points (maximum 8 points). The median qualitative scores did not change after intervention. Most of the subjective analysis pointed minimum or mild improvement for all kinds of scars. There was no statistically significant difference between the sides of the face that received tretinoin besides microneedling and those who received placebo (p>0,05). In histological analysis, collagen fibers became thicker and less clustered after treatment in both sides. The numeric histological measures did not correlate with clinical parameters. In the volunteers¿ opinion, 42%% had ¿a little¿, 47% had ¿a lot¿ and 11% had ¿complete¿ improvement in their own acne scars, in both sides. Conclusion: Both isolated and combined therapy were safe for acne scar treatment and accomplished volunteer approval, despite significant pain level. Microneedling was effective for acne scars, although clinical response after three sessions of moderate depth microneedling was modest. Drug delivery with 5% tretinoin did not add benefit to microneedling alone. Therefore, it seems that deep, aggressive microneedling should be preferred rather than moderated strategies in acne scars treatment, although there is no comparison between theses strategies, and patients should be warned about the possibility of worsening. More studies are necessary to compare different microneedle lenghts and their respective ideal protocols for acne scars, associated or not with drug delivery, and to compare microneedling and other available therapies. Keywords: acne vulgaris; cicatrix; tretinoin. / Introdução: Cicatrizes atróficas de acne são muito prevalentes e causam impacto psicossocial significativo. Seu tratamento é demorado, caro, passível de efeitos colaterais e de eficácia variável. Há diversas modalidades de tratamento e pouca evidência que dê suporte à escolha adequada. O microagulhamento vem tendo seu benefício demonstrado no tratamento das cicatrizes. Além disso, oferece incontáveis possibilidades de associação com drogas por aumentar temporariamente a absorção transepidérmica. Objetivo: Avaliar a segurança e a eficácia do microagulhamento isolado e associado à tretinoína 5% no pós-operatório imediato no tratamento das cicatrizes atróficas de acne faciais. Metodologia: Ensaio clínico do tipo split-face duplo-cego e controlado por placebo comparando o microagulhamento de injúria moderada (agulhas 1,5mm) isolado ao combinado à tretinoína 5% em peeling, em três sessões com anestesia tópica, intervalos de 3 semanas e reavaliação 4 semanas após a terceira sessão. Análise clínica por fotografias mostradas a observadores independentes, que deram sua pontuação na Quantitative Global Scarring Grading System for Postacne Scarring, na Qualitative Global Scarring Grading System for Postacne Scarring e numa escala de avaliação subjetiva. Análise histológica pela comparação da espessura epidérmica, estimativa da quantidade de colágeno e pelas impressões de um médico patologista antes e depois do tratamento. Análise do grau de satisfação dos voluntários por questionário. Resultados: Foram incluídos 20 voluntários e 19 destes concluíram o protocolo. Não ocorreu nenhum evento adverso infeccioso ou granulomatoso alérgico. A dor nas sessões foi moderada, medida em 5,6 pontos em média pela escala visual analógica. Na avaliação dos observadores, 60% das hemifaces apresentaram melhora no aspecto das cicatrizes e 40% apresentaram piora. A diferença de pontuação quantitativa pré e pós-tratamento nas hemifaces consideradas de melhora foi em média 3 pontos (máximo de 8 pontos). As pontuações medianas no escore qualitativo não se alteraram com a intervenção. As avaliações subjetivas foram predominantemente de melhora mínima a leve para todos os tipos de cicatrizes. Não houve diferença estatisticamente significante entre as hemifaces que receberam a tretinoína além do microagulhamento e as que receberam placebo (p>0,05). Na análise histológica, a impressão do patologista foi de que as fibras colágenas se tornaram mais espessas e menos compactadas, sem diferenças quanto ao acréscimo da tretinoína. Os parâmetros histológicos quantitativos não tiveram correlação com a evolução clínica. Na análise pelos próprios voluntários, 42% relataram ¿um pouco¿, 47% ¿bastante¿ e 11% ¿completa¿ melhora no aspecto das cicatrizes. Conclusão: Tanto o microagulhamento isolado quanto o associado à tretinoína 5% se mostraram seguros no tratamento das cicatrizes de acne e agradaram aos voluntários, apesar do nível considerável de dor. O microagulhamento se mostrou eficaz no tratamento das cicatrizes, embora a resposta obtida com três sessões de microagulhamento de injúria moderada tenha sido leve. O benefício da adição de tretinoína 5% no pós-operatório imediato, aproveitando o período de absorção aumentada, carece de análises adicionais. Sugere-se dar preferência a estratégias de microagulhamento mais agressivas ou em maior número de sessões e alertar os candidatos sobre a possibilidade de piora no tratamento das cicatrizes atróficas de acne. Mais estudos são necessários para comparar protocolos de aplicação do microagulhamento, determinar seu benefício em outras indicações, compreender o aumento de absorção transepidérmica promovido por esse método, compará-lo a outras terapias e determinar o benefício do peeling de tretinoína no contexto de absorção aumentada. Palavras-chave: acne vulgar; cicatriz; tretinoína.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1967. / Vita. Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

M.Tech. (Homoeopathy) / Acne vulgaris is a dermatological condition, pathologically characterized by the inflammation of the sebaceous glands and hair follices and is most prominent among adolescents (Holmes, 2001). Symptoms include the formation of inflammatory and non-inflammatory lesions, which can lead to the formation of scars (Boon et al., 2006). These eruptions occur on the chest, face, back and arms (Martini et al., 2001). The aetiology of acne vulgaris is multifactorial and hence there are a large variety of treatment options which range from topical applications to systemic drug treatment (Docrat, 2008). The homoeopathic complex remedy R53 (Comedonin) ® acne drops is a product which contains a combination of homoeopathic remedies that are used to treat the symptoms of acne vulgaris such as inflammatory and non inflammatory eruptions. The remedy R53 (Comedonin) ® is an over-the-counter remedy that is readily available and is indicated in the treatment of acne vulgaris (Dr.Reckeweg, 2010). No research has been conducted on its efficacy. The aim of this study was to determine the efficacy of R53 (Comedonin) ® acne drops in the treatment of mild to moderate acne vulgaris that presents on the face, chest and / or back in males. The evaluation of symptoms was done by using scales and the Digermizer software to calculate the surface area of the affected areas. This research study was a double blind placebo-control study that was conducted on thirty male participants between the age of fifteen to twenty years old with mild to moderate acne vulgaris on the face, back or chest. Participants who agreed to the procedure of the study were randomly divided into the treatment and placebo groups respectively. These groups consisted of fifteen participants each. The treatment group received the R53 (Comedonin) ® acne drops whereas the placebo group received the placebo drops. This research was conducted over an eight week period at the University of Johannesburg Health Centre. All the participants were instructed to take ten drops of the medication three times a day. Evaluations were conducted at week zero, week four and week eight according to APPENDIX B. As part of the evaluation, photographs of the affected areas were taken at week zero and week eight, in order to attain the surface area affected before and after the treatment period (Appendix B).

Dissertation submitted in partial compliance with the requirements for the Master's degree in Technology: Homoeopathy, Technikon Natal, 1999. / The purpose of this study was to compare the relative effectiveness of miasmatic treatment as opposed to simillimum treatment in terms of the objective clinical findings in patients with acne vulgaris. / M

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.

No description available.

Orientador: Juliano Vilaverde Schmitt / Resumo: Fundamentos: Apesar da isotretinoína oral ser um tratamento eficaz para casos graves e persistentes de acne, existe significativa preocupação e controvérsia sobre seus efeitos adversos psicológicos. Por outro lado, a acne apresenta significativo impacto psicossocial nos portadores. Objetivos: Avaliar adolescentes e adultos jovens sob tratamento com isotretinoína oral para acne moderada a grave quanto a sintomas depressivos e suas relações com variáveis demográficas e clínicas. Métodos: Estudo tipo coorte com portadores de acne tratados com isotretinoína oral. Foram avaliados Cardiff Acne Disability Index (CADI), escala de depressão de Beck (EDB), gravidade da acne e cicatrizes e escore de efeitos adversos mucocutâneos (EEAM). Resultados: Foram incluídos 42 pacientes, 43% do sexo feminino, com idade mediana de 18 [1q-3q:16-21], seguidos por um período de 9 [6-9] meses. EDB passou de 7,5 [2-16] pré-tratamento para 1 [0-5] ao final do seguimento (p<0,01), sendo que 43% apresentavam pontuação para depressão leve ou superior pré-tratamento, contra 14% ao final do seguimento (RP=0,33 (IC 95%: 0,15 a 0,76); p<0,01). EDB pré-tratamento associou-se à presença de antecedentes psiquiátricos, menor renda familiar e maior CADI (p<0,05), enquanto durante o tratamento associou-se à maior duração prévia da acne, a maiores EEAM, à menor dose acumulada e a maiores EDB iniciais (p<0,05). Limitações: Perdas de seguimento, não apresentar grupos controle, monocêntrico. Conclusões: Há melhora nos e... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Despite the effectiveness of oral isotretinoin for severe and persistent acne, there is concern and controversy about its possible psychological adverse effects. On the other hand, acne causes significant psychosocial impact on patients. Objective: Assess treatment with oral isotretinoin for moderate to severe acne in adolescents and young adults regarding depressive symptoms and their relationships with demographic and clinical variables. Methods: Cohort study with patients with acne under treatment with oral isotretinoin. Four aspects were considered: Cardiff Acne Disability Index (CADI), Beck Depression Inventory (BDI), acne and scars severity and Mucocutaneous Adverse Effects Score (MAES). Results: Forty-two participants were included, 43% were female, median age 18 years old [1q-3q:16-21], followed up for 9 [6-9] months. The BDI went from 7.5 [2- 16] before the treatment to 1 [0-5] after the follow up (p<0.01). 43% had score for mild depression or worse before treatment – the number dropped to 14% in the end of the study (RP=0.33 (IC 95%: 0.15 to 0.76); p<0.01). The BDI before treatment correlates to psychiatric history, lower family income and higher CADI (p<0.05), while during the treatment it correlates to the duration of acne, higher MAES, lower cumulative dose and higher initial BDI (p<0.05). Study Limitations: Loss of follow-up, lack of a control group, monocentric. Conclusion: There is improvement on the depression scores when acne vulgaris is treated ... (Complete abstract click electronic access below) / Mestre