Search Results (271)

Acne vulgaris is a multifactorial disease with high heritability, but the genetic determinants of severity remain incompletely defined. This study evaluated 650 individuals genotyped with a 60-single-nucleotide polymorphism (SNP) panel covering immune, lipid, endocrine, and barrier pathways. Acne severity was graded as 1 (n = 193), 2–3 (n = 383), or 4 (n = 74). Single-SNP analysis highlighted associations in loci such as LHCGR (rs13405728), TGF-β2 (rs1159268), FST (rs38055), WNT10A (rs74333950), PIK3R1 (rs10515088), and THADA (rs13429458) and barrier-related variants (FLG, FLG-AS1). Epistasis analysis of 44 quality-controlled SNPs revealed 190 significant interactions (false discovery rate, FDR ≤ 0.10), with TLR4 as the main hub (degree = 22), bridging immune (IL10, TNF), lipid (PNPLA3, APOE), and barrier (FLG-AS1, OVOL1) genes. Polygenic risk scoring (PRS) showed a monotonic increase across severity grades, with Grade 4 displaying higher median scores (0.319) compared to Grade 1 (−0.129) and Grades 2–3 (0.034). Discrimination was modest but consistent (AUC: 0.661 for Grade 4 vs. 1; 0.662 vs. 2–3; 0.679 vs. all others). These results support a framework where microbial sensing, lipid metabolism, and barrier function converge to drive severe acne, underscoring the potential of genetic profiling for risk stratification and precision therapy. Full article

Objectives: Oral isotretinoin remains the most effective therapy for severe acne, but its exceptional efficacy is often accompanied by relatively frequent adverse effects. In this study, we quantified the frequency- and dose-related predictors of clinical and biochemical adverse effects during isotretinoin treatment in routine Polish practice. Methods: The records of 370 patients (mean age: 28 ± 12 years) who began isotretinoin treatment between June 2020 and June 2025 were reviewed. The mean daily isotretinoin and cumulative isotretinoin doses were 23.4 ± 9.1 mg and 88.3 ± 31.5 mg/kg, respectively. The adverse events documented at two-monthly visits were correlated with age and dosing. Lipid, hepatic, thyroid and prolactin panels were compared with age- and sex-matched controls using χ² statistics and odds ratios (ORs). Results: Xerosis (70%), retinoid dermatitis (20%) and cheilitis (15.5%) predominated. Hand eczema rose with higher daily isotretinoin doses (ρ = 0.082; p = 0.037), whereas pruritus declined with greater cumulative isotretinoin exposure (ρ = −0.088; p = 0.037). Retinoid dermatitis was linked to a younger age (ρ = −0.080; p = 0.0286), whereas desquamation increased slightly with age (ρ = +0.083 p = 0.0228). Overall, dyslipidemia was twice as common as in the controls (OR: 2.06; 95% CI: 1.49–2.86; p-value: <0.0001), which was driven by an elevated total cholesterol (OR: 1.93; 95% CI: 1.34–2.77; p-value: 0.0004), LDL (OR: 3.40; 95% CI: 2.26–5.10; p-value: <0.0001) and triglycerides (OR: 1.95; 95% CI: 1.20–3.17; p-value: 0.0062) and decreased HDL (OR: 2.68; 95% CI: 1.75–4.10; p-value: <0.0001). Interestingly, hyperprolactinemia occurred eight-fold more often (OR: 8.42; 95%; 95% CI: 2.97–23.84; p-value: <0.00001). Aminotransferase and TSH elevations were infrequent and statistically non-significant. Conclusions: At moderate cumulative doses, isotretinoin was generally well tolerated; however, clinically relevant lipid and prolactin disturbances were frequent. Routine lipid and endocrine monitoring, early emollient prophylaxis and dose individualization are recommended to ensure safe isotretinoin usage in everyday practice. Full article

Background/Objectives: Acne vulgaris can be non-inflammatory lesions, i.e., closed comedones, open comedones, inflammatory lesions, i.e., papules, pustules, cysts, and post-acne lesions. This study aimed to evaluate the expression of TLR2 and TLR4 receptors on classical, intermediate, and non-classical monocyte subpopulations in 38 women with acne vulgaris and to correlate the results with clinical features of the disease and selected skin parameters. Methods: The skin parameters were assessed: level of oiliness, hydration, pH, skin pigmentation (phototype, erythema) using a special diagnostic device (Scientific multi-probe system MPA 6, Courage + Khazaka) with simultaneous determination of monocyte subpopulations in peripheral blood expressing TLR2 and TLR4 using a CytoflexLX flow cytometer (Beckman Coulter). Results: In the study group, the percentage of non-classical monocytes expressing TLR2 was statistically significantly lower than the classical and intermediate monocytes expressing TLR2 (p < 0.001). However, the level of TLR2 receptor expression (MFI) was significantly higher on intermediate monocytes compared to the level of TLR2 expression on classical and non-classical monocytes. In the group of patients with post-acne lesions, a statistically significantly higher percentage of non-classical monocytes with TLR4 expression was observed compared to patients without post-acne lesions (p = 0.009). A statistically significant negative correlation was also observed between the percentage of intermediate and non-classical monocytes with TLR4 expression and the results of the mexameter measurements. Acne has a significant impact on the percentage of monocyte subpopulations expressing TLR2 and TLR4. A higher percentage of non-classical monocytes TLR4+ in the blood is associated with a higher incidence of post-acne lesions. Conclusions: The positive correlation between the degree of skin hydration and the level of TLR2 expression on classical monocytes suggests that these cells play an important role in skin homeostasis and defense against C. acnes. Proper acne care is not only important for aesthetic aspects, but may also have a positive impact on immunological phenomena. Full article

Inflammatory facial dermatoses (atopic dermatitis [AD], acne vulgaris, contact dermatitis, seborrheic dermatitis, rosacea, perioral dermatitis, and demodicosis, etc.) often profoundly impact patients’ appearance and psychological well-being. In this narrative review, we wanted to present the current knowledge on the role of skin microbiota in common facial dermatoses. Skin keratinocytes are the primary producers of antimicrobial peptides (AMPs) and express Toll-like receptors (TLRs), which stimulate the T helper (Th1) immune response, with the production of interferon (IFN). They can also produce certain pro-inflammatory cytokines, namely IL-1β, IL-18, IL-6, IL-10, and the tumor necrosis factor (TNF). In healthy infants, the bacterial skin microbiota is predominantly composed of Firmicutes (genera Staphylococcus and Streptococcus), as well as Actinobacteria, Proteobactera, and Bacteroidota. The genera Cutibacterium and Staphylococcus, which have antimicrobial effects and compete with pathogens for nutrients/ecological niches, coexist symbiotically on the skin and can reduce the expression of TLR2 and TLR4. In patients with AD, lesional/non-lesional skin was found to have increased colonization by Staphylococcus aureus which reduces effector T lymphocytes’ ability to produce cytokines, such as IL-17A and IFN-γ, leading to decreased AMP production and impaired skin microbiota immune functionality. In patients with rosacea, the overexpression of TLR2 may stimulate elevated pro-inflammatory cytokine production (IL-8, IL-1β, and TNF-α, etc.), exacerbating the inflammatory response. Also, increased colonization by Malassezia yeasts triggers a Th2 immune response and cytokine secretion (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, TNF-α, beta-defensin, IFN-γ, nitric oxide, and histamine), and participates in signaling pathways. Insight into these factors may further improve clinical approaches to patients with facial dermatoses. Full article

Malassezia folliculitis, previously known as Pityrosporum folliculitis, is a common yet frequently misdiagnosed dermatologic condition caused by Malassezia yeast overgrowth in hair follicles. Its monomorphic, pruritic papules and pustules closely mimic acne vulgaris, often leading to inappropriate antibiotic use. This review summarizes current evidence on the epidemiology, clinical presentation, diagnostic challenges, and management of Malassezia folliculitis. A high index of clinical suspicion is critical in patients with recalcitrant acneiform eruptions. Diagnosis is supported by dermoscopy, potassium hydroxide preparation, Wood’s lamp, and response to antifungal therapy. Topical and oral antifungal agents are highly effective although relapses are common and access to off-label treatments may be limited. Greater awareness of the distinct clinical features of Malassezia folliculitis and treatment response can improve diagnostic accuracy and enhance patient outcomes. Full article

Background and objectives: Antibiotic resistance in Cutibacterium acnes is undermining topical macrolides and clindamycin, prompting renewed interest in zinc oxide nanoparticles (ZnO-NPs) as non-antibiotic alternatives. We aimed to (i) determine the antimicrobial and anti-inflammatory performance of topical ZnO-NP formulations across in vitro, animal and early human models; (ii) identify physicochemical parameters that modulate potency and tolerance; and (iii) delineate translational gaps and priority design elements for randomised trials. Methods: We systematically searched PubMed, Scopus and Web of Science until 1 June 2025 for in vitro, animal and human studies that evaluated ≤100 nm ZnO-NPs applied topically to C. acnes cultures, extracting data on bacterial load, lesion counts, biophysical skin parameters and acute toxicity. Eight eligible investigations (five in vitro, two animal, one exploratory human) analysed particles 20–50 nm in diameter carrying mildly anionic zeta potentials. Results: Hyaluronic acid-coated ZnO-NPs achieved a sixteen-fold higher selective kill ratio over Staphylococcus epidermidis at 32 µg mL¹, while centrifugally spun polyvinyl alcohol dressings reduced C. acnes burden by 3.1 log₁₀ on porcine skin within 24 h, and plant-derived nanogels generated inhibition zones that were 11% wider than benzoyl-peroxide’s 5%. In human subjects, twice-daily 0.5% hyaluronic–ZnO nanogel cut inflammatory-lesion counts by 58% at week four and lowered transepidermal water loss without erythema. Preclinical safety was reassuring, zero mortality among animals at 100 µg mL¹ and no irritation among patients, although high-dose sunscreen-grade ZnO (20 nm) delayed rat wound closure by 38%, highlighting dose-dependent differences. Conclusions: Collectively, the evidence indicates that nanoscale reformulation markedly augments zinc’s antibacterial and anti-inflammatory performance while maintaining favourable acute tolerance, supporting progression to rigorously designed, adequately powered randomised trials that will benchmark ZnO-NPs against benzoyl peroxide and retinoids, optimise dosing for efficacy versus phototoxicity, and establish long-term dermatological safety. Full article

Background/Objectives: The human skin provides a protective barrier composed of bacteria, fungi, viruses, and archaea that prevents the invasion of harmful organisms. Recent advancements in genomic sequencing have allowed for greater accuracy of species detection. This review aims to summarize the most up-to-date skin microbiome shifts in various dermatological diseases. Methods: A systematic search was conducted to examine microbiome shifts comparing lesional and nonlesional or diseased and healthy skin across various dermatological conditions. A literature search was conducted on PubMed, Web of Science, and Embase Databases from inception through April 2024, yielding 38 studies. Results: Staphylococcus aureus was reported unanimously in all skin conditions. Most studies in this review, except those investigating acne vulgaris, showed a decreased microbiome diversity in diseased skin. Finally, there was a greater shift in the proportion of pro-inflammatory bacterial and fungal strains. Conclusions: The skin microbiome is significantly altered in the progression of numerous dermatological diseases. Diversity of the skin microbiome is decreased, and there is an increased proportion of pro-inflammatory bacterial and fungal strains. The skin microbiome also provides a more comprehensive understanding of the development and progression of many inflammatory skin diseases. Prebiotic treatments may propose a much safer and cheaper alternative to antibiotics, which can have highly toxic side effects and negative implications for public health regarding antibiotic resistance. More research is required to fully understand both the microbiome changes and efficacy and viability of using probiotic treatments to restore the skin microbiome, thereby improving patient outcomes in all dermatological conditions. Full article

Acne vulgaris is a chronic disease that occurs in the pilosebaceous units and ranks eighth in the global prevalence of all diseases. In its severe forms such as pustules, cysts, and nodules, acne can lead to permanent scarring and post-inflammatory hyperpigmentation, which are often difficult to reverse in the short term and significantly affect patients’ psychological well-being and social interactions. Although a variety of pharmacological treatments are available, including retinoids, antibiotics, anti-androgens, benzoyl peroxide, and corticosteroids, the high recurrence rate and limited efficacy in scar prevention highlight the urgent need for innovative therapeutic strategies. Electrospinning technology has recently gained attention for fabricating nanofibrous patches with high porosity, biocompatibility, and biodegradability. These patches can offer antibacterial activity, absorb exudates, and provide mechanical protection, making them promising platforms for acne wound care. This review first outlines the pathophysiology of acne and the biological mechanisms underlying scar formation. We then present an overview of electrospinning techniques, commonly used polymers, and recent advancements in the field. Finally, we explore the potential of electrospun nanofibers loaded with mesenchymal stem cells or exosomes as next-generation therapeutic systems aimed at promoting scarless acne healing. Full article

Current acne therapies face major limitations, including antibiotic resistance and skin irritancy. In this study, a synergistic strategy combining cryptotanshinone and madecassoside was developed through functional complementarity. Antibacterial activity against Cutibacterium acnes was evaluated using minimum inhibitory concentration (MIC) and inhibition zone assays, while cytotoxicity was assessed using human keratinocytes (HaCaTs). Anti-inflammatory efficacy was quantified by measuring tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and prostaglandin E₂ (PGE₂) in lipopolysaccharide-stimulated macrophages and a copper sulfate (CuSO₄)-induced zebrafish inflammatory model. Systemic safety was examined in zebrafish models (developmental toxicity and sodium dodecyl sulfate-induced irritation). Finally, macroscopic severity, histopathology, and serum cytokines were used to assess an oleic acid-induced rat acne model. Cryptotanshinone inhibited Cutibacterium acnes (minimum inhibitory concentration = 62.5 μg/mL) but exhibited cytotoxicity (>5 μg/mL) and irritancy (≥1000 μg/mL). Madecassoside eliminated cryptotanshinone-induced cytotoxicity and reduced irritation. Importantly, the combination maintained antibacterial efficacy while synergistically enhancing anti-inflammatory effects, achieving a 94% reduction in follicular hyperkeratosis compared with 39% for cryptotanshinone alone (p < 0.01), alongside normalization of histopathology and cytokine levels. In conclusion, madecassoside functionally complements cryptotanshinone by neutralizing its cytotoxicity and irritancy, enabling a safe, synergistic therapy that concurrently targets antibacterial and anti-inflammatory pathways in acne pathogenesis Full article

Azelaic acid (AzA), a saturated dicarboxylic acid, is indicated for the treatment of acne vulgaris, rosacea, melasma, and post-inflammatory hyperpigmentation. Its antimicrobial, anti-inflammatory, and antimelanogenic properties support its use; however, its poor aqueous solubility and limited skin permeability constrain its optimal topical delivery. This review summarizes clinical evidence and advances in formulations—including conventional vehicles, polymeric/lipid nanocarriers, and deep eutectic solvent (DES) systems—to promote more effective and well-tolerated use. Across indications, 15–20% azelaic acid (AzA) formulations produced clinically meaningful improvements with mild, transient local irritation. For acne vulgaris, reductions in inflammatory and noninflammatory lesions were comparable to those of topical retinoids/adapalene, and tolerability was superior in some studies. For rosacea, the 15% gel formulation was comparable to metronidazole in reducing papules, pustules, and erythema while maintaining negligible systemic exposure. In melasma and other dyschromias, 20% cream demonstrated efficacy similar to hydroquinone, exhibiting a favorable safety profile. Advanced delivery systems, including liposomes, niosomes/ethosomes, nanostructured lipid carriers, microemulsions, nanosponges, and DES platforms, increased AzA solubilization, cutaneous deposition, and stability. This enabled dose-sparing strategies and improved adherence. Data on AzA cocrystals and ionic salts suggest additional control over release and irritation. AzA remains a versatile and well-tolerated dermatologic agent whose performance is strongly vehicle-dependent. Rational selection and engineering of carriers, particularly DES-integrated polymeric and lipid systems, can mitigate solubility and permeability limitations, enhance skin targeting, and reduce irritation in the treatment of acne and rosacea. Full article

Background/Objectives: Adapalene is a synthetic retinoid used as a treatment for acne vulgaris. In this study, we attempted to evaluate the dermal pharmacokinetics of adapalene utilizing experimental and in silico tools. Methods: We utilized three over the counter (OTC) adapalene gels to evaluate local dermal pharmacokinetics. A data-driven, robust, mechanistic dermal physiologically based pharmacokinetic (PBPK) model was developed by integrating the physicochemical properties of adapalene, the formulation attributes of the gels, and the biophysical aspects of dermal absorption. The dermal PBPK model was validated against experimental data using in vitro release studies and in vitro permeation studies with human cadaver skin. A clinical study was performed to evaluate the effects of adapalene from the three gel formulations. The impact of adapalene delivery from three gels on the stratum corneum (SC) thickness, pilosebaceous unit area, keratinocyte number, and epidermal thickness was captured using a non-invasive technique, line-field confocal optical coherence tomography (LC–OCT). These responses were evaluated using an Emax model. Results: The dermal PBPK model has successfully predicted adapalene penetration profiles across different gel formulations. The model accuracy, in predicting drug release and permeation characteristics, was confirmed using the experimental data. Clinical evaluation revealed formulation-dependent differences in adapalene’s effects on measured skin parameters, with distinct pharmacodynamic profiles observed for each gel formulation. Conclusions: The overall study gave us a detailed insight into potential effects of formulation on the dermal pharmacokinetics and pharmacodynamics of adapalene using three marketed gels. Full article

Background/Objectives: Acne vulgaris is a prevalent dermatological condition, yet clear, region-specific management guidelines, particularly for India’s diverse population, remain limited. Effective acne management extends beyond pharmacologic therapy, emphasizing proper skincare, patient education, and adherence strategies. This consensus aims to provide tailored, evidence-based recommendations for optimizing acne treatment in the Indian context. Methods: A panel of 14 dermatology experts with ≥15 years of experience reviewed literature, real-world clinical practices, and patient-centric factors relevant to acne management in India. Using a modified Delphi process with two virtual voting rounds, 61 statements across seven clinical domains were evaluated. Consensus was defined as ≥75% agreement. Results: Topical retinoids remain the first-line therapy, with combination regimens (benzoyl peroxide or topical antibiotics) preferred to enhance efficacy and minimize antibiotic resistance. Hormonal therapies, including combined oral contraceptives and spironolactone, are recommended for females with resistant acne. Guidance includes individualized treatment plans, baseline investigations, and selection of appropriate topical and systemic agents. Special considerations for pregnancy and lactation prioritize maternal and fetal safety. Conclusions: This expert consensus provides practical, evidence-based recommendations for acne management in India, integrating pharmacological and non-pharmacological approaches. The tailored guidance supports individualized care, antibiotic stewardship, and improved treatment adherence, aiming to enhance patient outcomes nationwide. Full article

Background and Clinical Significance: As a common inflammatory skin disorder, acne vulgaris is classically associated with sebum overproduction, follicular hyper keratinization, and Cutibacterium acnes proliferation. Emerging evidence suggests a link between severe or treatment-resistant acne and metabolic syndrome, characterized by central obesity, insulin resistance, dyslipidemia, and hypertension. This case series aims to explore the clinical overlap between acne and metabolic dysfunction and highlight the relevance of multidisciplinary evaluation. Case Presentation: Three patients with severe acne vulgaris and coexisting metabolic abnormalities were evaluated at a dermatology clinic in Oradea, Romania, between 2023 and 2024. Each patient underwent dermatologic examination, laboratory testing for metabolic and hormonal parameters, and individualized treatment. Management strategies included topical/systemic acne therapies combined with metabolic interventions (lifestyle modifications, metformin (in two cases), and lipid-lowering agents). Case 1 (female, 23) had obesity, insulin resistance, dyslipidemia, and polycystic ovary syndrome (PCOS). Case 2 (male, 19) presented with central obesity and atherogenic dyslipidemia. Case 3 (male, 18) showed insulin resistance, overweight status, and elevated inflammatory markers. All three showed suboptimal response to standard acne treatment. Adjunct metabolic management resulted in partial improvement within 3 months. One patient required isotretinoin after metabolic stabilization. Conclusions: These cases underscore the interplay between acne and metabolic dysfunction. Insulin resistance and systemic inflammation may contribute to therapeutic resistance in acne. Early recognition of metabolic syndrome features in patients with severe acne may improve treatment outcomes. Dermatologists should consider metabolic screening to guide comprehensive, multidisciplinary care. Full article

The complex interrelationship between the gut microbiota and the skin, commonly known as the “gut–skin axis” has become a crucial field of study for comprehending skin health and illness. Systemic immunity, inflammation, and metabolism are all modulated by this two-way communication mechanism, which ultimately affects skin homeostasis. Numerous dermatological disorders, such as rosacea, psoriasis, atopic dermatitis, and acne vulgaris, have been linked to dysbiosis in the gut microbiota. On the other hand, the composition of the gut microbiome may be impacted by skin disorders. Highlighting the important microbial metabolites and immunological processes involved in this interaction, this abstract examines the current understanding of the gut–skin axis. It also talks about the possible therapeutic benefits of using probiotics, synbiotics, and prebiotics to target the gut microbiota to treat and prevent skin conditions. Gaining insight into this intricate interaction opens up exciting possibilities for creating innovative, all-encompassing dermatological treatment strategies. Full article

Cutibacterium acnes is linked to the prevalent inflammatory skin disorder known as Acne Vulgaris (AV). Some topical agents exhibit unfavorable side effects like dryness and skin inflammation, and antimicrobial resistance (AMR) poses an increasing risk to effective AV management. This study develops and characterizes stable topical essential oil (EO)-loaded microemulgels with in vitro validated antimicrobial activities against C. acnes ATCC 6919, providing a solid scientific basis for their effectiveness. These microemulgels, with their potential to serve as an alternative to AMR-prone synthetic agents, could revolutionize the field of acne treatment. The MICs of the EOs (citronella, tea tree, and lemongrass) against C. acnes were determined. EO-loaded microemulgels were developed using a blend of microemulsion and carbopol/hyaluronic acid gel in a ratio of 1:1 and characterized, and their stability was observed over three months. The MICs of citronella, tea tree, and lemongrass EOs were 0.08, 0.16, and 0.62% v/v, respectively. The microemulgels were whitish and smooth, with characteristic EO odors. They demonstrated pH values ranging between 4.81 ± 0.20 and 5.00 ± 0.03, good homogeneity, a spreadability of 9.79 ± 0.6 and 12.76 ± 0.8 cm², a viscosity of 29,500 and 31,130 cP, and retained stability at 4, 25, and 40 °C. EO-loaded microemulgels were developed with the potential of C. acnes management. The formulation shows adequate potential for further pharmaceutical development towards translational adoption in acne management. Full article