Summer 2023 • Vol. 29 • Issue 6
A
The Science of Acne Care …Roger L. McMullen
cne vulgaris is a common cutaneous multifactorial disorder that afflicts a large portion of society at some point in their life, especially during the adolescence years as well as during pregnancy and menopause. It affects approximately 85% of individuals aged 12-24 years and 50% of individuals aged 20-29 years.1 It develops on the face or trunk of the body and can cause permanent scarring, which can be psychologically devastating to the individual.
Development of Acne
Acne is caused when the pilosebaceous unit becomes obstructed with sebum and differentiated keratinocytes, due to hyperkeratinization and excessive oil production, resulting in the formation of comedones (obstruction of the pores that appear as small bumps on the surface of the skin). Comedones can be open (black heads) or closed (white heads), which are both non-inflammatory forms of acne. On the other hand, if the comedones become infected by bacteria, they can develop inflammatory lesions such as papules, pustules, nodules, and cysts. Hypercolonization of the pilosebaceous duct by the bacterium Cutibacterium acnes (formerly Propionibacterium acnes) has traditionally been considered as mostly responsible for the ensuing bacterial infection. Excessive sebaceous gland activity has been associated with the onset of puberty and is believed to be the result of the activity of the androgens. A comprehensive review of the literature demonstrated that serum levels of testosterone, progesterone, glucocorticoids, insulin, and insulin-like growth factors are elevated in patients with acne while serum estrogen levels are low.2
Topical Treatment of Acne
Mild to moderate acne can be treated with topical ingredients such as retinoids, benzoyl peroxide, antibiotics, and other chemistries (e.g., azelaic acid, salicylic acid, sulfur-containing compounds, etc.). Retinoids are known for their ability to increase proliferation of keratinocytes, decrease enzyme activity in lipogenesis, and impede sebocyte reproductive activity—all factors important for acne-effected skin.3 Retinoids approved by the Food and Drug Adminstration (FDA) in the United States for the treatment of acne are adapalene, tazarotene, tretinonin, and trifarotene. Benzoyl peroxide functions as a reactive oxygen species (ROS), which forms free radicals that destroy the bacterial cell wall of Cutibacterium acnes. Unlike antibiotics, benzoyl peroxide provides the advantage that bacteria do not develop resistance to it. Treatment of skin with topical antibiotics is another strategy to combat the manifestations of acne vulgaris. There are three topically approved antiobiotics for acne treatment in the United States, which consist of clindamycin, erythromycin, and minocycline. Azelaic acid, salicylic acid, and sulfur-containing compounds are also important topical modalities to treat acne. Azelaic acid is a diacid that is found in wheat, barley, and rye. It is known for its ability to ameliorate acne through its keratolytic and antimicrobial activity. It also is a tyrosinase inhibitor and therefore reduces melanin synthesis. Salicylic acid is a beta-hydroxyacid, which has comedolytic (inhibits the formation of comedones) and desmolytic properties, which promotes the exfoliation of stratum (continued on Page 7)
NYSCC ACNE CARE SYMPOSIUM
•
...see page 10-26 for more information.
JUNE 14TH