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Excess amounts of skin surface oil can lead to adverse psychological consequences. Grease-spot photometry-based techniques measure sebum production rate. However, besides being tedious, these measurements are influenced by contact area, applied pressure, and time of application. Image analysis of polarized images has the potential to provide objective, quantitative information of skin oiliness. This study was designed to set up an imaging device for capturing and enhancing the changes in skin surface oiliness and to clinically and quantitatively, (via image analysis), evaluate varying levels of skin surface oiliness. Mineral oil was used to simulate skin surface oil. 40.5 µL of the mineral oil was applied within a two inch square area of interest on facial skin in twelve steps, from 1 to 40.5 µL, at 40% increments. The results indicate a strong correlation between the quantitative skin surface oiliness measurements and the clinical assessments. This sensitive technique has the potential to be utilized in future studies to evaluate product efficacies in reducing skin oiliness.

Demodex parasites may cause skin and eyelash lesions by settling on the pilosebaceous unit. This parasite plays a role in the pathophysiology of acne in polycystic ovarian syndrome (PCOS). We aimed to examine the relationship between Demodex folliculorum and blood glucose control in patients with PCOS with skin and eyelash lesions. Forty-four patients with PCOS with skin lesions were enrolled in the study. At least two specimens were taken from the skin lesions using the standard method and at least six epilated eyelashes were taken from both eyes under a biomicroscope and evaluated using a light microscope. The demographic characteristics, body mass index (BMI) and clinical parameters of the patients were recorded. Demodex folliculorum was present at a rate of 59.1% in the skin lesions of the patients with PCOS, 40.9% in eyelash samples and 43.18% in both skin and lashes. Homeostasis model assessment of insulin resistance (HOMA-IR), glycosylated haemoglobin (HB A1c) concentrations, and BMIs were significantly higher in the patients who had D. folliculorum in skin samples than in those without ( p  = .010, p  = .007 and p  = .02). Impaired glucose regulation may explain the pathophysiology of the increased D. folliculorum presence in the skin lesions of patients with PCOS.Impact statement What is already known on this subject? Although several studies on Demodex folliculorum and PCOS have been conducted, we have not yet found a study that examines D. parasites in the eyelashes and skin correlating with glucose regulation in PCOS. This study presents new information about the relationship between the presence of folliculorum parasites in the eyelashes and skin correlating with glucose regulation in PCOS. This study presents new information about the relationship between the presence of D. is seen more commonly in skin lesions in patients with PCOS with impaired blood glucose regulation. folliculorum is present in both skin and eyelash lesions in patients with PCOS. These lesions may be prevented by avoiding unregulated glucose levels and obesity. In future studies, the investigation of the resorption of What do the results of this study add? parasites in skin lesions with the continuation of normal glucose levels in patients with PCOS will reveal a more interesting linkage.D. folliculorum is seen more commonly in skin lesions in patients with PCOS with impaired blood glucose regulation. What are the implications of these findings for clinical practice and/or further research? D. folliculorum is present in both skin and eyelash lesions in patients with PCOS. These lesions may be prevented by avoiding unregulated glucose levels and obesity. In future studies, the investigation of the resorption of D. folliculorum parasites in skin lesions with the continuation of normal glucose levels in patients with PCOS will reveal a more interesting linkage.

Background: The role of skin microbiota in acne remains to be fully elucidated. Initial culture-based investigations were hampered by growth rate and selective media bias. Even with less biased genomic methods, sampling, lysis and methodology, the task of describing acne pathophysiology remains challenging. Acne occurs in sites dominated by Cutibacterium acnes (formerly Propionibacterium acnes) and Malassezia species, both of which can function either as commensal or pathogen., Objectives: This article aims to review the current state of the art of the microbiome and acne., Methods: The literature regarding the microbiome and acne was reviewed., Results: It remains unclear whether there is a quantitative difference in microbial community distribution, making it challenging to understand any community shift from commensal to pathogenic nature. It is plausible that acne involves (i) change in the distribution of species/strains, (ii) stable distribution with pathogenic alteration in response to internal (intermicrobe) or external stimuli (host physiology or environmental) or (iii) a combination of these factors., Conclusions: Understanding physiological changes in bacterial species and strains will be required to define their specific roles, and identify any potential intervention points, in acne pathogenesis and treatment. It will also be necessary to determine whether any fungal species are involved, and establish whether they play a significant role. Further investigation using robust, modern analytic tools in longitudinal studies with a large number of participants, may make it possible to determine whether the microbiota plays a causal role, is primarily involved in exacerbation, or is merely a bystander. It is likely that the final outcome will show that acne is the result of complex microbe-microbe and community-host interplay., (© 2019 British Association of Dermatologists.)

Background: Cutibacterium acnes has been identified as one of the main triggers of acne. However, increasing knowledge of the human skin microbiome raises questions about the role of other skin commensals, such as Staphylococcus epidermidis, in the physiopathology of this skin disease., Summary: This review provides an overview of current knowledge of the potential role of S. epidermidis in the physiopathology of acne. Recent research indicates that acne might be the result of an unbalanced equilibrium between C. acnes and S. epidermidis,according to dedicated interactions. Current treatments act on C. acnesonly. Other treatment options may be considered, such as probiotics derived from S. epidermidis to restore the naturally balanced microbiota or through targeting the regulation of the host's AMP mediators. Key Messages: Research seems to confirm the beneficial role of S. epidermidis in acne by limiting C. acnes over-colonisation and inflammation., (© 2019 S. Karger AG, Basel.)

Acne is based on a complex, multifactorial pathophysiology beginning with a microcomedo. Comedogenesis involves follicular hyperproliferation and disturbed keratinization, hyperseborrhea and hyperplasia of sebaceous glands as well as disturbances in skin microbiome. Acne is treated with antibiotics, retinoids, keratolytics, hormonal and anti-inflammatory agents. Efficacy and side effects of given medications are well known. The uppermost layer of the stratum corneum is acidic. The low pH provides protection by slowing down the growth of some bacteria. Increase of skin surface pH leads to impaired barrier function, disturbances in skin microbiome and inflammation. Acne-predisposed skin is in a constant state of subclinical inflammation. Subclinical inflammation may be linked to changes in skin surface pH and disturbances of the stratum corneum, allowing microorganisms to stimulate the production of pro-inflammatory cytokines. Here, based on the current literature, the possible link between the skin surface pH, epidermal barrier function and acne is reviewed., (© 2018 S. Karger AG, Basel.)

Introduction: The incidence of adult acne is increasing worldwide. Despite clinical overlap with conventional acne, it has distinct features. Areas covered: A literature search of English-language review articles, randomized control studies and retrospective studies conducted over the past 30 years was performed using PubMed and Google Scholar. Search terms included acne, adult, topical medication, oral medication and skin of color. We highlight important clinical features and treatment modalities pertinent to the evaluation and management of adult acne. Given the relative dearth of literature detailing treatment options specific to adult acne, we offer expert opinion regarding management of the condition especially in special populations such as skin of color and pregnancy. Expert Opinion: It is unclear whether adult acne represents a distinct entity or a continuum of adolescent disease. Providers may opt to use topical medication as first-line, but should have a low threshold for switching to systemic therapy given the magnitude of psychosocial and emotional burden associated with the condition.

Acne is a chronic inflammatory illness of the pilosebaceous follicle where innate immunity plays a central role. In acne, the density of Propionibacterium acnes is increased in the pilosebaceous unit. We hypothesized that the severity of acne is not only dependent on the proliferation of P. acnes but also dependent on the pro-inflammatory potential of P. acnes strains and consequently constitutes potential triggering factor for acne scarring. We investigated pro-inflammatory potential of five different strains of P. acnes and P. avidum in skin explants and the preventive effect of zinc gluconate. The expression of immune markers was studied by immunohistochemistry, RT-qPCR and ELISA. P. acnes strains modulate differently the expression of immune markers both at gene and at protein levels. P. acnes type III had the highest pro-inflammatory potential by up-regulating the expression of PAR-2, TNF-alpha, MMP-13 and TIMP-2, whereas P. avidum had the weakest by up-regulating only MMP-13 and TIMP-2. Preincubation of zinc gluconate, which is a modulator of innate immunity, down-regulates the expression of most immune markers induced by P. acnes, PAR-2, TIMP-2, up-regulates MMP-1, TIMP-1. Our results demonstrate that different P. acnes strains have different inflammatory potential targeting markers of cutaneous innate immunity, and that inflammatory potential can be down-regulated by zinc gluconate. As such, the inflammatory potential of P. acnes strains on acne skin may influence the severity of inflammatory acne lesions and scars., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose of Review: The diagnosis of many childhood endocrine disorders can be facilitated by an awareness of the associated dermatologic findings. In this review, we will survey examples of endocrine disorders in children that include a prominent or diagnostic dermatologic sign/symptom., Recent Findings: A key concept is that skin findings often accompany hormonal conditions, both those of hormone excess and hormone deficiency/resistance. Some dermatologic signs may also represent the hallmark lesion, or provide the first clinical sign in childhood, for both familial tumoral and nontumoral syndromes. Moreover, skin as an endocrine organ itself may provide new avenues both to understand disease mechanisms as well as to provide targeted therapy., Summary: Early diagnosis, often aided by recognition of a keynote dermatologic lesion, may permit prompt, timely treatment that, in some cases, may even prove life saving. Conversely, when these associated signs go undetected or misdiagnosed, therapeutic intervention may be delayed unnecessarily.

Background: Some past studies reported that oxidative stress components such as reactive oxygen species (ROS) or lipid peroxide (LPO) are involved in the pathogenesis and progression of acne vulgaris. In this study, we hypothesized that the pathogenesis of acne vulgaris may depend on the differences in antioxidative activity among antioxidants in our body. We collected samples of stratum corneum from acne patients and healthy subjects and compared the quantity of gluthathione (GSH), one of many antioxidative components in our body, for comparison., Methods: Samples of stratum corneum were collected from facial acne-involved lesion, facial uninvolved area, and the medial side of the upper arm in acne vulgaris patients. Similarly, samples were collected from a facial uninvolved area and the medial side of the upper arm in healthy subjects. The quantity of GSH was measured in each area. In vitro effects of alpha-melanocyte stimulating hormone (α-MSH) on GSH synthesis-related gene were also examined., Results: The quantity of GSH in stratum corneum from each area was significantly lower in acne vulgaris patients than that of healthy subjects. There was no significant difference in quantity of GSH between the acne-involved lesion and uninvolved area in acne patients. In vitro studies showed that the expression level of Glutamate-cysteine ligase catalytic subunit (GCLC), one of the GSH synthesis-related genes, was significantly decreased by the additional use of α-MSH., Conclusions: We conclude that a decline in antioxidative activity led by a decrease in GSH quantity may play an important role in pathogenesis of acne vulgaris. The use of α-MSH may further decrease the GSH level., (© 2011 Wiley Periodicals, Inc.)

Acne vulgaris affects as much as 80% of the adolescent population and persists in approximately 3% of middle-aged adults. Only a percentage of these persons seek medical help, however, acne can cause levels of anxiety and depression akin to a chronic illness. A recurring question from patients who seek help from various healthcare professionals - their pharmacist, family doctor or dermatologist, is "why?" They also ask questions about a possible familial link, the impact of their diet and the association with their hormones. The following review aims to link these factors with the end result - inflammation.

The epidemic-like high prevalence of acne of more than 85% of adolescents exposed to westernized life style points to the role of nutritional factors. Insulinotropic foods, especially milk, dairy products and carbohydrates with high glycemic index and smoking lead to pathological exaggeration of already physiologically increased growth factor signaling of puberty. Food-derived growth factors activate the oncogenic phosphoinositide-3-kinase/Akt signaling pathway, which increases androgen receptor transcriptional activity and de-represses FoxO1-suppressed target genes of follicular keratinocyte proliferation and sebaceous lipogenesis. Thus, acne is the visible metabolic syndrome of skin exaggerated by growth factor signaling of westernized malnutrition. These insights allow a new classification of western life style acne as acne alimentaris and provide the rationale for dietary intervention. All efforts should be undertaken to eliminate the insulinotropic effector mechanism of milk in order to reduce the prevalence of acne and even more serious civilization diseases associated with malnutrition-dependent oncogenic signal transduction.

For the initiation of acne multiple factors are required from endogenous to exogenous sources. The morphogenesis of acne is well studied, and the principle steps are discussed in the paper. Acne is a disease of humans, developing in sebaceous follicles. The first step is a proliferation-retention hyperkeratosis in the infundibulum, thus forming a follicular filament, from which a microcomedo arises. Finally open and closed comedones appear. This sequence is not strictly followed, but quite typical. Androgen stimulation activates sebaceous lipogenesis. At this point propionibacteria colonize the follicle and comedones. At earlier or later stages of the comedo development inflammatory phenomena appear, ranging from subtle to severe. Depending on the amount of inflammation, scars may develop. There is an undisputable genetic component for the initiation of acne, as twin studies have shown. The or these genetic factors have not been determined yet. The inflammatory cascade is up-regulated by immunological factors. Exogenous factors, underestimated in the past, seem to play an important role as well, as epidemiological studies and recent publications from different investigators have shown. Nutrition, particularly hyperglycemic food and milk products, are directly involved in the pathogenesis of acne.

Peripherally active androgens control cellular functions by binding to androgen receptors. Follicular keratinocytes and sebocytes are target cells for androgens, which, directly or indirectly, stimulate keratinocyte proliferation and the volume of sebaceous glands as well as the sebum secretion rate. Acne often begins with the adrenarche, namely with the up- regulation of adrenal synthesis of dehydroepiandrosterone sulfate, a hormone that is upstream to testosterone. The majority of acne patients exhibit normal levels of circulating androgens, while sebaceous glands from acne regions exhibit a stronger sensitivity to androgens than the sebaceous glands from other parts of the body. Hormone-like active lipids, hormones in diet and neuropeptides may also play a role in the development of acne lesions. The target of antiandrogen treatment of the skin is mainly the sebaceous gland and the primary effect is sebostasis.

In this paper, the link between high glycemic index and load will be reviewed. The data from the literature discussed relate to a short presentation of the physiopathology of acne, including the influence of hyperinsulinemia as a key factor at the beginning of acne.

Background: It is generally accepted that the severity of acne is correlated with facial sebum secretion. However, previous studies on the relation between seborrhoea and the development of acne did not consider topographical differences in facial sebum secretion and used relatively vague acne severity grading systems., Objectives: To elucidate the relation between topographical variations in facial sebum secretion and the severity of acne in women., Methods: Forty-six female controls and 46 women with acne were included in this study. The Sebumeter was used to measure facial sebum secretion in the following facial areas: forehead, nose, chin, and right and left cheek. We counted noninflammatory comedones and inflammatory acne lesions in the same areas. We compared sebum secretion between patients with acne and controls, and analysed the relation between the quantity of sebum secreted and the number of acne lesions., Results: Sebum secretions in the whole face and in the T- and U-zones (areas of high and low sebum secretion, respectively) were higher in patients with acne than in controls. There was no correlation between sebum quantity and acne lesion count in most facial regions., Conclusions: Increased levels of facial sebum secretion were observed in patients with acne. Our findings indicate that increased sebum levels do not directly cause development of acne lesions.

Acne fulminans is a syndrome of fulminant, necrotizing acne associated with bone lesions, constitutional symptoms, and laboratory abnormalities. A case report of an adolescent male with acne fulminans following withdrawal of isotretinoin and prednisone is presented.

A moderate degree of friction is unavoidable in everyday contact between man's skin and his environment. However, excessive friction and other forms of microtrauma can cause various dermatoses as well as lesions of hair and nails. This paper illustrates that microtraumata significantly influence many skin disorders, including those of occupational origin.

The skin of healthy men kept in an enclosed environment was examined. It was found that exposure resulted in increases of the secretions of the sebaceous glands and sebum cutaneum, number and size of comedones, lipolytic activity of microorganisms, concentration of comedonogenic acids and skin irritating acids. It also caused a greater risk of papular and pustular rashes. Changes in lipid metabolism were consistent with the skin clinical state as well as with the subjective sensations of dirty skin, desquamation and itching. The severity of the above changes was correlated with the pretest physiological and hygienic status of the subjects.

Comedonal lipids and skin surface lipids were collected from six acne patients and surface lipids were collected from sex- and age-matched controls without acne. Six series of ceramides were found in each sample, the relative amounts of which were determined by thin-layer chromatography/photodensitometry. Acylceramides (ceramide 1) were isolated by preparative thin-layer chromatography and their ester-linked fatty acids were analyzed by gas-liquid chromatography. The comedonal acylceramides contained higher proportions of 16:0, 16:1 delta 6, and 18:1 delta 6 + delta 8 and much less linoleate (18:2 delta 9,12) than the acylceramides from the skin surface. In the surface lipids from legs, acylceramides from the acne patients contained less linoleate than the acylceramides from control subjects. Free fatty acids from the comedones were also isolated and analyzed, and had a composition very similar to the esterified fatty acids of comedonal acylceramides. The results confirm that fatty acids derived from sebum become incorporated into comedonal acylceramides, displacing linoleate, and show that this process even affects the acylceramides of surface epidermis, more so in acne patients than in normal subjects.

Culture supernatants from four species of skin micro-organisms were tested against VERO (monkey kidney cells) and skin fibroblasts for cytotoxic activity. Cytotoxic activity was produced by the three species of Propionibacterium tested (P. acnes, P. avidum and P. granulosum), and this activity was highest when cultures were grown in the presence of glucose. In contrast, Staphylococcus epidermidis was devoid of cytotoxic activity whether grown in the presence of glucose or not. The agent responsible for the cytotoxic activity was heat stable, of low molecular weight and removable from supernatants by ether extraction. These properties, coupled with the finding that the levels of cytotoxicity are directly proportional to the concentrations of propionate measured in samples, suggests that propionate is the agent responsible for the cytotoxicity of the culture supernatants. Pure propionate and the salts of other carboxylic acids (CI to C5) were tested at the same concentrations and showed different degrees of cytotoxicity depending on their chain length. Propionate may have an important role in the aetiology of the disease acne vulgaris.

Sebaceous wax esters and epidermal acylceramides were isolated from skin surface lipid obtained from children and from young adults. Fatty acid methyl esters (FAME) were prepared from the esterified fatty acids of these lipid classes and analyzed to ascertain the proportions of methyl linoleate (18:2 delta 9,12), methyl sebaleate (18:2 delta 5,8), and methyl sapienate (16:1 delta 6). On the same subjects, 2 measures of sebum secretion rate were obtained, namely the sustainable wax ester secretion rate (WESR) on the forehead and the ratio of wax esters/(cholesterol + cholesterol esters) [WE/(CH + CE)] in the surface lipid. The proportions of methyl linoleate in FAME from the wax esters decreased, and the proportions of methyl sebaleate increased, with increased rates of sebum secretion. For both methyl linoleate and methyl sebaleate, a better correlation was obtained when the ratio of WE/(CH + CE) was used as a measure of sebum secretion rather than the WESR. The proportions of methyl linoleate in the FAME from the acylceramides were also inversely related to ratios of WE/(CH + CE). In acylceramides, linoleate was replaced by sapienate, a major fatty acid of human sebum. It appears, therefore, that sebum fatty acid composition may change with changes in sebaceous gland activity, and that sebum fatty acids can enter the epidermis and be incorporated into epidermal lipids.

Precursor and target tissue-produced androgens were measured in the plasma of eighteen women with mild to moderate acne. Mean plasma levels of the precursor androgens (total testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulfate) wer similar to levels in a group of carefully selected acne-free and hirsute-free, age-matched female controls. In contrast, plasma 3 alpha-androstanediol glucuronide (3 alpha-diol G) values were elevated in 13 of the patients, with a mean value for the entire group nearly threefold that of the normal controls (117 vs 43 ng/dl; p less than 0.001). These results support the concept that target tissue androgen production plays an important hormonal role in the pathogenesis of acne in women and that plasma 3 alpha-diol G may be the most sensitive marker of this process.

Skin surface lipids and lipids from open and closed comedones in acne patients were analysed by thin layer chromatography. The results showed that these lipids were enriched in polar lipids, as compared with the skin surface lipids obtained from controls without acne. In both open and closed comedones, these polar lipids appeared to be derived mainly from the oxidation of squalene, which is in agreement with our previous in vitro results. We suggest that squalene oxidation is the link between comedogenesis and bacterial colonization, and based on this, we propose a hypothesis of the pathogenesis of acne.