Dermatology: Acne Neena Khanna, Raj Kubba
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1World Clinics: Dermatology: Acne2
3World Clinics: Dermatology: Acne
Editor-in-Chief Neena Khanna MD Guest Editor Raj Kubba MBBS MRCP (UK) FRCP (Canada) FRCP (Edinburgh)
December 2013 Volume 1 Number 1
4
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Cover images: (Left) Mixed inflammatory, non-inflammatory lesions at lower face and chin. Courtesy: Alison M Layton and Rebecca L Mawson. (Middle) Inflammatory acne and scarring. Courtesy: Alison M Layton and Rebecca L Mawson. (Right) Lower face acne aggravated by topical pimecrolimus. Courtesy: Raj Kubba.
WORLD CLINICS Dermatology: Acne
December 2013, Volume 1, Number 1
ISSN: 2347-7156
9789350909768
Printed in India
5Contributors
Editor-in-Chief
Guest Editor
Contributing Authors
11Editorial
Neena Khanna md
Editor-in-Chief
Acne is an extremely complex disease with elements of pathogenesis involving defects in epidermal keratinzation, androgen secretion, sebaceous function, bacterial growth, inflammation and immunity. In the past 30 years, much has been worked out, and we now have a fairly detailed understanding of the events that result in an acne pimple, although there is also much left to be discovered.
Occurrence of adolescent acne is so universal that it is almost considered physiological is an old dermatological adage and this is more true today, than ever. So acne could well be the commonest skin disease for which advice is sought. Hence, the inaugural issue of World Clinics is dedicated to this ubiquitous condition. In this issue, which is a culmination of efforts of an international team of experts who are leaders in their own field, we have reviewed some of the latest developments in the pathogenesis and management of acne.
The contents cover a wide range of aspects of acne, each covering the most relevant literature with personal insights from the authors, wherever and whenever necessary. The issue begins with a discussion on the pathogenesis of acne including the role of P. acnes biofilms and the all important molecular and cell biological aspects of sebocytes and sebaceous glands. Nutrition and acne are strange partners, their relationship blowing sometimes hot, sometimes cold. Recent evidence has tilted the balance in favor of a pathogenic role of insulinotropic Western (now ubiquitous!) diet in the induction and aggravation of acne. So an article on nutrient signaling… in acne. There is also a growing body of evidence on systemic associations of acne, so a look at these aspects as well in a couple of articles. The clinical aspects of acne are discussed in articles on adult acne and acneiform eruption. Therapeutic aspects of acne are covered in sections on isotretinon (a favorite for the past few decades and likely to remain so for the next few too, thanks to the gratifying response of acne to it) and on light and laser therapy. And 12of course, no account of acne is complete, if acne scars are not discussed. Then there is an article on acne in Indian patients- ironically, India, which probably has the largest population of acne patients has very little data available on acne, including antibiotic resistance pattern of P. acnes.
Neena Khanna md
Professor, Department of Dermatology and Venereology
All India Institute of Medical Sciences
New Delhi 110 029, India
13Abbreviations 13cRA
13-cis-retinoic acid
17-OHP
17-hydroxyprogesterone
21-OH
21-hydroxylase
24OHase
D-24-hydroxylase
4E-BP
Eukaryotic initiation factor 4E-binding protein
5FU
5-fluorouracil
5-LOX
5-lipoxygenase
5α-DHT
5α-dihydrotestosterone
9cRA
9-cis-retinoic acid
α-MSH
Alpha-melanocyte-stimulating hormone
AAD
American Academy of Dermatology
AAS
Anabolic androgenic steroid
AchR
Acetylcholine receptors
ACTH
Adrenocorticotropic hormones
ADL
Activities of daily living
ADSC
Adipose-derived stem cells
Akt
Akt-kinase (protein kinase B)
AMP
Adenosine monophosphate
AMPK
Adenosine monophosphate-activated protein kinase
AMPs
Antimicrobial peptides
AN
Acanthosis nigricans
AP-1
Activator protein-1
AR
Androgen receptor
ASI
Acne Severity Index
ATP
Adenosine triphosphate
AtRA
all-trans-retinoic acid
AzA
Azelaic Acid
BMD
Bone mineral density
BMI
Body mass index
Bnip3
Bcl-2/adenovirus E1B 19-kDa-interacting protein 3
BPO
Benzoyl peroxide
BSA
Body surface area
CAH
Congenital adrenal hyperplasia
CAMP
Christie, Atkins, Munch-Petersen
CBR
Cannabinoid receptors
CCR7
C-C chemokine receptor 7
CD
Clusters of differentiation
CD2BP1
Chromosome 15q encoding CD2-binding protein 1
CFUs
Colony forming units
CGRP
Calcitonin gene-related peptide
CHG
Chlorhexidine gluconate
CMC-Lys
Carboxymethyl cysteine-lysine
c-MET
Proto-oncogene c-met product
CO2
Carbon dioxide
COX
Cyclooxygenase
COX2
Cycloxygenase-2
CP
Clindamycin phosphate
CPA
Cyproterone acetate
CRABP-2
Cellular retinoic acid binding protein-2
CRH
Corticotropin-releasing hormone
CRH-R
Corticotropin-releasing hormone receptor
CRM1
Chromosomal region maintenance protein-1 (exportin-1)
CSL
Casual sebum level
CT
Clinical trial
CTCAE
National Cancer Institute Criteria for Adverse Events
CYP1A1
Cytochrome P-450 1A1 gene
CYP21
Steroid 21-hydroxylase gene
δ-ALA
Delta-aminolevulinic acid
D
Day
DHC
Dehydrocholesterol
DHEA
Dehydroepiandrosterone
DHEA-S
Dehydroepiandrosterone sulfate
DHT
Dihydrotestosterone
DLE
Discoid lupus erythematosus
DLQI
Dermatology life quality index
DNA
Deoxyribonucleic acid
DPNs
Dermatosis papulomis nigra
ECCA
Echelle d'Evaluation clinique des Cicatrices d'acné scale
EGCG
Epigallocatechin-3-gallate
EGF
Epidermal growth factor
EGF-R
Epidermal growth factor receptor
14eIF
Eukaryotic initiation factor
ER
Estrogen receptors
ERK
Extracellular signal-regulated kinase
ER-α
Estrogen receptor-alpha
ESHRE
European Society for Human Reproduction and Embryology
FBS
Fasting blood sugar
FDA
Food and Drug Administration
FGF-R
Fibroblast growth factor receptor
FGFs
Fibroblast growth factors
FoxO
Forkhead box class O transcription factor
FSH
Follicle-stimulating hormone
fT3
Free triiodothyronine
G6Pase
Glucose-6-phosphatase
GA
Glycolic acid
GAP
GTPase-activating protein
GDP
Guanosine diphosphate
GEF
Guanine nucleotide exchange factor
GH
Growth hormone
GHR
Growth hormone receptor
GI
Gastrointestinal
GIP
Glucose-dependent insulinotropic polypeptide
GSH-Px
Glutathione peroxidase
GSK
Glycogen synthase kinase
GTP
Guanosine triphosphate
H-1R
Histamine-1 receptors
H2 O2
Hydrogen peroxide
HA
Hyperandrogenism
HAIRAN
Hyperandrogenic, insulin-resistant and acanthosis nigricans
hBD-1
Human ß-defensin 1
HCL
Hydrochloride salt
HO-1
Heme oxygenase-1
HOMA-IR
Homeostasis model assessment for insulin resistance
IBD
Inflammatory bowel disease
ICAM-1
Intercellular cell adhesion molecule type-1
ICG
Indocyanine green
IF
Inflammatory
IFN-γ
Interferon gamma
IgE
Immunoglobulin E
IGF
Insulin-like growth factor
IGF-1
Insulin-like growth factor-1
IGF-1R
Insulin-like growth factor-1 receptor
IGFBP-3
Insulin-like growth factor-binding protein 3
IL
Interleukin
iNOS
Inducible nitric oxide synthase
IPL
Intense pulsed light
IR
Insulin receptor; insulin resistance
IRAA
Insulin Resistance-associated acne
IRS
Insulin receptor substrate
I-V IPL
I to V interpeak latency
JNK
Jun N-terminal kinase
K6
Markers of keratin
Klf2
Krüppel-like factor 2
KTP
Potassium titanyl phosphate
LA
Lactic acid
LAT
Low-affinity transport
LED
Light-emitting diode
LH
Luteinizing hormone
LKB
Liver kinase B
LL-37
Cathelicidin
LMB
Leptomycin B
LPS
Lipopolysaccharide
LTB4
Leukotriene-B4
LXR
Liver X receptor
LXR-α
Liver X receptor-alpha
MA
Malic acid
MAL
Methyl-ALA
MAPK
Mitogen-activated protein kinase
MAT
Moisture accumulation test
MC-1R
Melanocortin-1 receptor
MC-5R
Melanocortin-5 receptor
MCP-1
Monocyte chemoattractant protein-1
MCs
Melanocortins
MDA
Malondialdehyde
MIF
Macrophage migration inhibitory factor
MMP
Matrix metalloproteinase
MN
Myrtacine + nicotinamide
mRNA
Messenger ribonucleic acid
MS
Metabolic syndrome
MST1
STE20-like protein kinase-1
mTOR
Mammalian target of rapamycin
MUFAs
Monounsaturated fatty acids
N
Nicotinamide
15NAD(P)H
Nicotinamide adenine dinucleotide phosphate hydrogen
Nd:YAG
Neodymium:yttrium-aluminum-garnet
NES
Nuclear export signal
NESs
Nuclear export signals
NF-κB
Nuclear factor-kappa B
NGAL
Neutrophil gelatinase-associated lipocalin
NIF
Non-inflammatory
NLS
Nuclear localization signal
NOX
NAD(P)H oxidase
NP
Nicotinamide + panthenol
NS
Non-specified
NY
Neuropeptide Y
OCPs
Oral contraceptive pills
OPR
μ-opiate receptors
OTC
Over-the-counter
PA
Pyruvic acid
PAK1
p21-activated kinase-1
PAMPs
Pathogen-associated molecular patterns
PAPA
Pyogenic arthritis, pyoderma gangrenosum and acne syndrome
PAR-2
Proteinase-activated receptor 2
Pck1
Phosphoenolpyruvate carboxykinase 1
PCOS
Polycystic ovarian syndrome
PDGF
Platelet-derived growth factor
Pdk4
Pyruvate dehydrogenase kinase isoenzyme 4
PDL
Pulsed dye laser
PDT
Photodynamic therapy
PEM
Polymorphic epithelial mucin
PG
Pyoderma gangrenosum
PI3K
Phosphoinositide-3-kinase
PP
Postprandial
PPARs
Peroxisome proliferator-activated receptors
PPAR-γ
Peroxisome proliferator-activated receptor-gamma
PPBS
Postprandial blood sugar
PR
Progesterone receptor
PRRs
Pattern recognition receptors
PS
Phytosphingosine
PS-HCL
Phytosphingosine -hydrochloride
PSTPIP1
Proline-serine-threonine-phosphatase-interactive protein 1
PTEN
Phosphatase and tensin homolog deleted on chromosome 10
PUVA
Psoralen-ultraviolet A
Rag
Ras-related GTP-binding protein
RAL
Retinaldehyde
RALGA
Diacneal (retinaldehyde and glycolic acid)
Raptor
Regulatory associated protein of mTOR
RAR
Retinoic acid receptor
RARE
Retinoic acid response element
RCT
Randomized controlled trial
RF
Radiofrequency
Rheb
Ras homolog enriched in brain
Rictor
Rapamycin-insensitive companion of mTOR
RNA
Ribonucleic acid
ROS
Reactive oxygen species
RSK
Ribosomal S6 kinase
RXR
Retinoid X receptor
S6K
p70 S6 kinase
SA
Salicylic acid
SAPHO
Synovitis, acne, pustulosis, hyperostosis and osteitis
SC
Stratum corneum
SCD
Stearoyl CoA desaturase
SCL-90-R
Symptom check list
SCTT
Stratum corneum turnover time
SD
Standard deviation
SER
Sebum excretion rate
SFAs
Saturated fatty acids
SG
Sebaceous gland
SHBG
Sex hormone-binding globulin
Shh
Sonic hedgehog
SI
Severity index
SIBO
Small intestinal bacterial overgrowth
SNPs
Single nucleotide polymorphisms
SOD
Superoxide dismutase
SORT
Strength of recommendation taxonomy B criteria
SREBP
Sterol regulatory element binding protein
16SREBP-1
Sterol regulatory element-binding protein-1
SSL
Skin surface lipids
STRA8
Stimulated by retinoic acid 8
T2DM
Type 2 diabetes mellitus
TBARS
Thiobarbituric acid reactive substances
TC
Triclosan
TCA
Trichloroacetic acid
TCF
T cell factor
TES
Triethyl citrate + ethyl linoleate + salicylic acid
TEWL
Trans epidermal water loss
TGF-ß
Transforming growth factor-beta
TGs
Triglycerides
Th2
T-helper type-2
TIMP
Metalloproteinase inhibitor
TLC
Total lesion count
TLR
Toll-like receptor
TNFR2
Type 2 tumor necrosis factor receptors
TNF-α
Tumor necrosis factor-alpha
TOR
Target of rapamycin
Trb3
Tribbles3
TRH
Thyrotropin-releasing hormone
TSC
Tuberous sclerosis complex
TSC1
Hamartin
TSC2
Tuberin
TSH
Thyroid-stimulating hormone
UK
United Kingdom
USA
United States of America
UV
Ultraviolet
UVA
Ultraviolet A
UVB
Ultraviolet B
VDR
Vitamin D receptor
VEGF
Vascular endothelial growth factor
VIP
Vasoactive intestinal polypeptide
Vit
Vitamin
VNTR
Variable number of tandem repeat
VR
Vanilloid receptor
W
Week