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Summary Eleven hundred and twenty-eight strains of anaerobic diphtheroids from human skin could be divided into two groups according to their colonial morphology on casein-yeast-lactate-glucose agar and their susceptibility to lysis by bacteriophages. Members of group I were sensitive and those of group I1 resistant to the action of phage. Biochemical tests confirmed this division among 200 strains, and permitted a subdivision of group I1 into a proteolytic and a non-proteolytic subgroup-IIA and IIB respectively. A simple scheme, based on colonial morphology, phage susceptibility, the production of indole, nitrate reduction, DNAase, gelatinase and caseinase formation, haemolysis, and the acidification of sucrose, sorbitol, and trehalose, could be used for the classification of these organisms. Members of group I were most numerous on the skin of the scalp, forehead, and back, and in follicular material from the alae nasi. Group-IIA strains were found most often in the axilla, and group-IIB strains were occasionally present in small numbers at all sites.

25 acne-prone women aged 18-34 years were evaluated before and for at least 4 months after oral contraceptives (OCs) were begun. 13 of the 19 patients taking androgen-dominant OCs either began to have acne or preexisting acne worsened. None was improved and 6 remained unchanged. 1 of the 6 patients taking estrogen-dominant OCs was worse 2 were improved and 3 were unchanged. 13 patients whose acne worsened while taking adrogen-dominant OCs were switched to an estrogen-dominant medication. All showed definite improvements after the first 2 months and showed marked improvement by 4 months except 1 patient who showed no change. The use of estrogen-dominant OCs for acne-prone women when no contraindications exist was encouraged.

Although systemic telracycline remains the most frequent treatment for acne vulgaris, this report indicates that more effective antibacterial therapy can be achieved topically. The effective agent, benzoyl peroxide, produced a mild desquamation: while concommitantly reducing the fatty acids in sebum more dramatically than systemic tetracycline. Bacterial cultures demonstrated the potential of this peroxide to inhibit the growth of C. acnes recovered from sebaceous follicles. Since the mechanism of benzoyl peroxide is different than topical vitamin A acid, combination therapy has been evaluated in over 1,000 acne patients. The clearing of acne lesions is now routine in the majority of these cases within the initial three months of therapy.

SUMMARY The proliferative activity of sebaceous glands of uninvolved skin from acne patients was analysed by means of 3H-thymidine autoradiography and by planimetry. Twelve specimens of normal skin from the back (with thirty-five glands) and two specimens from the face (with six glands) were analysed. Labelling indices and planimetric values were determined separately for the two portions within each gland: the differentiating cell pool with germinative cells and large lipid cells; and the undiffer-entiated cell pool with multilayered cells. The germinative cells of the differentiating cell pool on the back and face of patients with acne showed a significantly greater labelling index than in control subjects. The undifferentiated cell pool, although having a higher labelling index than the differentiating cell pool, was similar both in acne patients and in controls. Planimetry confirmed that the sebaceous glands of patients are much larger than those of normal subjects. Therefore, the known increase in sebum excretion in acne patients is a result of two factors—an increase in lipid cell production and an increase in sebaceous gland size.

SUMMARY Using a surface microscope technique to measure the pilo-sebaceous duct orifices in vivo, it has been shown that keratin hydration, as produced either by a hot bath or by polythene occlusion, decreases the pilo-sebaceous orifice size. These changes arc reversed within 90 min. This reduction in pilo-sebaceous duct orifice size would increase sebum outflow resistance and aggravate duct obstruction. The observations therefore help to explain the exacerbation of acne seen in humid environments, such as in the tropics, and in certain occupations.

SUMMARY Shoulder skin from young men with and without acne was incubated in vitro in Krebs Improved Ringer I medium with 7α-3Hdehydroepiandrosterone,7α-3Handrostenedione and 7α-3Htestosterone. There were no marked differences in steroid metabolism between the acne and control groups but skin from acne patients did form rather more 5α-dihydrotestosterone from testosterone than did skin from control subjects. Skin from the shoulder (acne area) of acne and control subjects metabolized dehydroepiandrosterone more rapidly than did skin from the thigh (non-acne area); this appeared to be due to higher activity of 3β-hydroxysteroid dehydrogenase Δ4-5 isomerase in shoulder than thigh skin. A comparison of steroid metabolism in skin incubated in Krebs Ringer medium with that in cryostat sections of skin incubated in a tris-buffered medium showed that the method of incubation could affect the quantitative pattern of steroid metabolism in vitro.

Topically applied compounds are the most common means of treating the milder forms of acne vulgaris. We performed a two-phase study on 147 patients to determine the effect of topical application of vitamin A acid in the treatment of mild and moderate acne of the face. The first phase of the study was performed single-blind, using a 0.05% solution of vitamin A acid. The second phase, using swabs impregnated with the same solution, was carried out under controlled double-blind conditions. Patients showed greater improvement with the active medication than with the vehicle alone (placebo). Most patients experienced erythema and peeling in association with use of vitamin A acid.

Juvenile New Zealand White rabbits were castrated and treated systemically for a period of 4 weeks with a total dose of 2000 mg of Triolandren®, a depot androgen preparation. Thereafter, for a further four weeks, well defined areas on the inner side of the animals' ears were treated topically, five days a week, with 0.05 ml of solutions containing 20% w/w 17β-oestradiol or 17α-methyl-B-nortestosterone in dimethylsulphoxide (30%)-acetone (70%) (total surface dose: 32 and 31 mg steroid per sq.cm skin). One control group was treated with the vehicle only and another received no topical treatment. Biopsies were performed before and after topical treatment, and the size of the sebaceous glands was determined histoplanimetrically.

Fifty-eight patients with acne were studied in regard to the microbial flora of the scalp, forehead, cheek, anterior nares, and open and closed comedones. Males carried higher numbers of aerobic bacteria and Pityrosporum at all sites. Patients with inflammatory acne also supported larger populations of these organisms in comparison to those with dominantly comedonal disease. Corynebacterium acnes density was not clearly affected by sex or type of disease. Group II C. acnes occurred most frequently in the nose and in comedones. Greater densities were found in patients with inflammatory disease. Bacteriophage against group I C. acnes was recovered from all but three patients.

According In our current state of knowledge, free fatty acids are formed in sebaceous follicles primarily through hydrolysis of sebum triglycerides by microbial lipases. Because of their comedogenic and irritant qualities, these free fatty acids are probably responsible for many of the alterations in the follicle that result in acne lesions.

SUMMARY The prevalence of Corynebacterium acnes on the foreheads of male and female children of caucasoid and negroid origin has been investigated using a semi-quantitative technique. Few organisms were recovered from children of less than 12 years of age. The increase in count occurred earliest in Negroid girls and latest in caucasoid boys. This may be related to the age of puberty.

Summary An unusual facial eruption occurring in twenty-two negro children is described. The cause is obscure but certain aetiological factors are discussed.

Skin surface lipids were estimated on the uninvolved skin of the back of hands in patients with atopic dermatitis by a gravimetric method and a significant decrease was found. According to results of thin layer chromatographic studies recorded by densitometry, this lipid reduction is due to a decrease in skin lipids of sebaceous origin. The low sebum excretion on the hands in atopic dermatitis is in agreement with clinical observations of frequent dryness of the skin in this region.

Summary.— Skin surface lipid composition and sebum excretion rate were determined before and after one and 2 months of therapy in patients taking clindamycin for severe acne vulgaris. All patients showed marked clinical improvement. Clindamycin produced a significant reduction in skin surface free fatty acids and a significant reciprocal increase in skin surface triglycerides after one and 2 months of therapy. There was no significant change in the sebum excretion rate. These results support the hypothesis that free fatty acids are important in the pathogenesis of acne vulgaris.

This is a survey of known side effects of commercial oral contraceptives. It is now generally accepted that 10-40% of women who begin oral anticonception develop moderate inconveniences and symptons in the 1st months including nausea general malaise tiredness breast tension and mental depression. These symptons normally disappear within the 1st couple of months with only 5-10% of the cases so severe that the question arises of ceasing administration or changing the treatment. In addition to these more common and transient side effects there are other side effects which require more detailed explanation. A classification of these symptons and side effects is made according to their probable geneses: estrogenic gestagenic androgenic and anabolic effects. This survey includes both minor problems such as irritability and such serious possibilities as endocrine system changes. Following each brief description changes which can be made to relieve the problem are suggested.

Summary.— A procedure is described for determining unchanged and conjugated 2-naphthol in plasma and urine. The method, based on gas chromatography is rapid and has a limit of detection of approximately 2 g/m/1−1. Twenty-four hours urine excretion data of 2-naphthol, after therapeutic application of a 2-naphthol-containing ointment on the skin of patients, are reported. Plasma levels of 2-naphthol and conjugated 2-naphthol during and after topical treatment with a 2-naphthol peeling paste were measured in 4 patients. Plasma levels of 2-naphthol were significantly lower than the plasma levels of conjugated 2-naphthol. The cutaneous barriers were found to be easily traversed by 2-naphthol. The relevance of the data for clinical practice is discussed.

The present investigation was designed as a double-blind crossover study of 4 different oral contraceptives: Anovlar mite norethisteron acetate 3 mg plus ethinyl estradiol .05 mg; Lyndiol mite lynestrenol 2.5 mg plus mestranol .075 mg; Ovulen ethynodiol diacetate 1 mg plus mestranol .1 mg; Volidan megestrol acetate 4 mg plus ethinyl estradiol .05 mg. Each subject received the 4 preparations randomly distributed during 4 cycles and then in the same order of distribution during 8 more cycles. In all 159 women entered the trials and of these 126 continued for 12 consecutive treatment periods (1.512 periods). Volidan showed a very high incidence of spotting and breakthrough bleeding. Ovulen gave less spotting and breakthrough bleeding than Volidan but significantly more than Anovlar mite and Lyndiol mite. Ovulen caused more nausea than the other preparations. No significant change in weight occurred during Volidan treatment all the other pills gave a significant weight increase. This weight increase was significantly higher for Anovlar mite. The menstrual blood loss was measured in 19 subjects before and during treatment for 187 periods. The blood loss decreased from 30.8 ml before treatment to 14.2 ml during treatment in this series. No significant difference between preparations were found in this respect.

51 acne patients on low dosage of tetracyclines for more than 6 months (mean, 16 months) were compared (by means of a questionnaire) with 51 matched healthy controls as to their opinion of the occurrence of symptoms of some types of infection. There was no indication of an increased susceptibility to develop infections. In another series of 44 women, 6 had symptoms of monilial infection of the genitals.

Tetracycline is widely used in the treatment of acne vulgaris, and several studies have demonstrated significant clinical improvement in patients on such therapy (1, 2). Yet, why this drug is helpful in acne is not completely understood. Small doses do result in a reduction in the number of bacteria on the skin surface, (3) as well as in the free fatty acid content of surface lipids (4). The beneficial effect of tetracycline may be due to its antibiotic action against Coryneb act erium acnes. However, the fact that other antibacterial agents, notably penicillin, which are equally effective against C. acnes in vitro (5) do not produce equal clinical improvement in acne or reduce the free fatty acid content of skin surface lipids, leads to consideration of other possible mechanisms of action of tetracycline in this condition.

Summary A case of haemolytic anaemia in a tuberculous patient with liver disease is described in which stilboestrol may have acted indirectly as the causal agent.

In the treatment of acne with estrogens, a method commonly used in women is the administration of the estrogen for cyclic periods of 10-14 days up to the onset of menses. With such a treatment schedule there are interval periods of 2 or more weeks wherein no drug is administered. Since the secretion of the sebaceous glands, which are primarily responsible for the inflammatory lesions in acne (1), can be suppressed by the exogenous administration of adequate amounts of estrogen (2, 3), it seemed reasonable to question whether such intermittent therapy could effect significant sebaceous gland suppression. Therefore, the present report will detail the results of sebum production studies comparing 2-week and 3-week cycles of oral administration of conjugated equine estrogens to women.MATERIALS AND METHODSTwenty-two female subjects, age 16 to 29, comprised the study group ;f eight had acne of varying severity. Conjugated equine estrogens (Pre-marin®)t were administered orally in 30 separate drug trials, ranging in duration from 19 to 24 weeks. Six subjects received 2 or 3 separate trials involving different dose schedules. The estrogen was administered either in 2-week cycles or in 3-week cycles. With the 2-week cycles, medication was begun at mid-cycle and continued for 14 days to the onset of menses. This procedure wast Volunteer subjects at the Walter E. Fernald State School, Commonwealth of Massachusetts, Malcolm J. Farrell, M.D., Superintendent; and volunteer subjects at the Massachusetts Correctional Institution, Framingham, Massachusetts, Betty C. Smith, Superintendent.I Supplied by John B. Jewell, M.D., Ayerst Laboratories, New York, N. Y.repeated in subsequent cycles for the duration of the treatment period. With this treatment schedule, doses of conjugated equine estrogens, ranging from 2.5 mg to 7.5 mg daily, were administered in 12 individual drug trials to 10 subjects. With 8-week cyclic administration, the estrogen was started on the 5th day of menses and continued for 21 days. On drug withdrawal, menses usually ensued in 2 or 3 days, and medication was re-instituted either on day 5 of menses or no later than the 7th interval day. In the 3-week treatment group, an oral progestin, medroxyprogesterone acetate (Provera®), was concomitantly administered in a dose of 10 mg a day in the last 5 days of each drug cycle in order to allow for regular cyclic bleeding on withdrawal of medication. With this treatment schedule, doses of conjugated equine estrogens, from 125 mg to 7.5 mg daily, were administered in 18 separate drug trials to 15 subjects.In each subject, sebum production measurements were carried out with the use of a quantitative gravimetric procedure reported by us previously (4). An average of 6 weekly sebum measurements were made prior to drug administration. The subjects were then tested weekly during the entire period of estrogen treatment although in a few cases testing was done less often.RESULTSTable I lists the data for sebum production in the group of 10 subjects administered various dosages of conjugated equine estrogens in 2-week cycles. Since sebaceous gland suppression from estrogen, when it occurs, is often not evident until the 3rd month or more, the mean sebum value from estrogen treatment for all the subjects in the study was that calculated as the average of all values obtained after the 8th week of drug administration. A significant decrease in sebaceous gland activity was observed in only 2 instances, namely subject 1 receiving 7.5 mg daily and subject 6 with 5.0 mg daily. Subjects 3, 4, 9 and 10 had acne. There was no improvement in their disease, as mig

Over an eight-week period, three treatments for moderately severe acne were compared in groups of adolescents: (1) 0.05% daily vitamin A acid (retinoic acid) alone; (2) demeclocycline hydrochloride alone, 600 mg a day for the first three weeks, 300 mg thereafter; (3) a combination of the two. In addition to clinical assessment, subjects in each group were studied with regard to the relationship of free fatty acids (FFA) to the density of Corynebacterium acnes . The combination therapy produced the swiftest and greatest effect on all three factors: therapeutic benefit, decreased FFA, and reduction in the anaerobic microflora. It was postulated that vitamin A potentiated the effect of demeclocycline by bringing about an increased tissue concentration of the antibiotic.

Acne conglobata, chronic hidradenitis suppurativa, and dissecting cellulitis of the scalp make up the follicular occlusion triad. A brief review of the literature is followed by a discussion of treatment.

SUMMARY. The sebum excretion rate, sebaceous count and the chemical composition of the sebum have been determined in 10 young men without or with minimal acne vulgaris and 20 young men with gross acne vulgaris. No significant relation between the sebum excretion rate and the presence of acne was found. Significant differences were found in the triglyceride and the aliphatic alcohol wax ester contents of sebum from the 2 groups. The results are discussed in relation to current ideas on the pathogenesis of acne.

TLC† analysis of comedo lipids from the face, neck, chest and back of acne patients of both sexes, ages 12 to 26 years, (some 65 specimens) gave the same gross composition except for hydrocarbons more saturated than squalene and lipids more polar than free cholesterol. Quantitative data (chromatography plus GLC of isolated fractions) on both comedo and surface lipids from each of 3 acne patients revealed the following. Free fatty acids plus triglycerides comprised ∼63% of both comedo and skin surface lipids. However, for the comedo, 90% of this sum was free fatty acids compared with only 25% for surface lipid. This implies that triglycerides in comedo lipids are nearly completely hydrolyzed but only 25% hydrolyzed in surface lipids. GLC patterns of the free fatty acids were almost identical for both surface and comedo lipids in all 3 subjects except for slightly more unsaturated acids in surface lipids. For comedo and surface lipids respectively, wax esters were 14% and 24%, sterol esters 4% and 2%, free cholesterol 12% and 2%, and squalene 8% and 9%. Absence of free alcohols and constancy of GLC composition of the entire wax ester fraction indicated it was not hydrolyzed in either surface or comedo lipids. GLC composition of the entire sterol ester fraction from comedones indicated that the fatty acids were derived from epidermis and sebum.

This is a report of the first documented neuropsychiatric presentation of hypervitaminosis A. The patient was an 18-year-old female without antecedent nervous system disease. Previous case reports have documented a small number of adults in which vitamin A toxicity has led to pseudotumor cerebri. All have had prominent and early involvement of related organ systems, i.e., dermatologic and hematologic. None have presented with primarily neurologic or psychiatric involvement. In the present communication, the development of a severe toxic psychotic reaction followed almost immediately by pseudotumor with resolution of both entities upon cessation of vitamin A establishes, we believe, vitamin A as an exogenous agent capable of closely imitating primary psychiatric disease.

The pattern of skin diseases in 3,168 patients seen in several dermatological clinics in the Kenyan highlands is presented. Results are compared with other surveys from subsahara Africa. A resemblance with the pattern of dermatoses in early 20th century Europe is found, whereas typical tropical conditions are notably rare. Disparities in frequency with other African surveys and western countries are discussed and some particular African conditions are described more extensively.

An investigation of steroid metabolism in a 28-year-old male with metastatic adrenocortical carcinoma, who exhibited feminization, hypertension, edema and acne, has yielded information on the role of steroids in the production of these signs and symptoms. Initially, when feminization was the only finding, the patient excreted abnormally large amounts of estrogens and normal amounts of 17-ketosteroids and 17-hydroxycorticosteroids. Later, hypertension, edema and acne appeared in association with abnormally high and rapidly rising levels of estrogens and tetrahydro-11-deoxycortisol, but normal levels of tetrahydrocortisol, tetrahydrocortisone, androsterone and etiocholanolone. ACTH administration caused a disproportionately marked increase in the excretion of estrogens and tetrahydro-11-deoxycortisol. Estrogen excretion also increased upon the administration of methopyrapone (2-methyl-l,2-bis[3-pyridyl]-l-propanone), an 11β-hydroxylase inhibitor. These studies of steroid excretion suggested: 1) that the tum...

SUMMARY.— We examined 1555 school children aged 8 to 18 and graded them according to the presence and severity of acne lesions on the face and neck. Comedones were present in a large proportion of even the youngest children and were virtually universal by the mid-teens. Clinical acne appeared 2 years earlier in girls than boys and the maximum prevalence was reached at age 14 in girls and 16 in boys. Thereafter the prevalence of the more severe grades of acne continued to increase steadily in boys, but declined in girls. The age of the menarche in girls did not affect the severity of acne which ultimately developed. More girls than boys sought medical advice despite the generally milder form of the disease in girls.