bromochloroacetic-acid and Acne-Vulgaris

The management of acne is a gratifying experience. Available treatments are effective, relatively nontoxic and generally safe. However, there is no quick fix. Antibiotics, hormone therapies and topical therapies are maintenance treatments. Isotretinoin can induce remission, as can some of the newer physical modalities of lights, lasers and radiofrequency devices. Effective management of acne often requires using a combination of treatments that act on different parts of the pathogenic process of acne development.

Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Adolescent; Adult; Androgens; Anti-Bacterial Agents; Benzoyl Peroxide; Child; Contraceptives, Oral; Dermatologic Agents; Dicarboxylic Acids; Drug Therapy, Combination; Female; Humans; Hydroxy Acids; Isotretinoin; Keratins; Keratolytic Agents; Male; Phototherapy; Retinoids; Sebum; Treatment Outcome

Hypercornification is an early feature of acne and usually precedes inflammation. It is associated with ductal hyperproliferation, and there are many controlling factors such as androgens, retinoids, sebum composition and cytokines. Cycling of normal follicles and of comedones may explain the natural resolution of comedones and, in the longer term, resolution of the disease itself. There is a need to tailor treatment according to comedonal type. Suboptimal therapy can often result from inappropriate assessments of comedones, especially microcomedones, sandpaper comedones, submarine comedones and macrocomedones. Macrocomedones can produce devastating acne flares, particularly if patients are inappropriately prescribed oral isotretinoin. Gentle cautery under topical local anaesthesia is a useful therapy in the treatment of such lesions. The newer retinoids and new formulations of all-trans-retinoic acid show a better benefit/risk ratio.

Topics: Acne Vulgaris; Administration, Cutaneous; Humans; In Situ Hybridization; Keratinocytes; Keratins; Retinoids

Hormonal aspects of acne are of particular interest in treating adult women. A review of the role of hormones in the pathogenesis of acne, guidelines for the workup of a suspected endocrine disorder, and an overview of the use of hormonal therapy in women with endocrine problems and in normal women is presented.

Topics: Acne Vulgaris; Androgens; Contraceptives, Oral, Hormonal; Drug Therapy, Combination; Estrogens; Female; Growth Hormone; Humans; Keratins; Sebaceous Glands; Sebum; Spironolactone; Testosterone

The retinoids are synthetic derivatives of vitamin A. Isotretinoin (13-cis-retinoic acid) is now being widely used in the United States for severe acne and etretinate is available in Europe and other countries for psoriasis. These drugs are also effective for a number of other skin diseases. This is an attempt to review basic knowledge of retinoids with which the practicing dermatologist should be familiar, to review the current status of studies, and to speculate on the present and future roles of these drugs in dermatology.

Topics: Acne Vulgaris; Etretinate; Humans; Inflammation; Isotretinoin; Keratins; Psoriasis; Retinoids; Sebum; Skin Diseases; Skin Neoplasms; Sweat Gland Diseases; Tretinoin; Vitamin A

Topics: Acne Vulgaris; Adolescent; Child; Child, Preschool; Darier Disease; Etretinate; Female; Humans; Ichthyosis; Infant; Isomerism; Isotretinoin; Keratins; Keratoderma, Palmoplantar; Male; Pityriasis Rubra Pilaris; Psoriasis; Skin Diseases; Skin Diseases, Vesiculobullous; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adrenal Cortex Hormones; Androgens; Animals; Anti-Bacterial Agents; Contraceptives, Oral, Synthetic; Cryosurgery; Drug Synergism; Fatty Acids, Nonesterified; Female; Hair; Humans; Keratins; Keratolytic Agents; Lipase; Male; Propionibacterium acnes; Sebaceous Glands; Sebum; Soaps; Stress, Psychological; Tetracycline; Ultraviolet Therapy; Vitamin A

Topics: Acne Vulgaris; Animals; Dermatologic Agents; Disease Models, Animal; Epithelial Cells; Epithelium; Female; Humans; Keratins; Mice; Mitosis; Psoriasis; Swine; Vagina

The effects of azelaic acid (AZA) on the epidermis of 47 individuals (12 with normal skin, 15 with seborrheic skin and 20 suffering from acne) and on in vitro cultured keratinocytes are reported. Topical application of a 20% AZA cream significantly improved the lesions of acne patients, but failed to induce clinically detectable changes in normal or seborrheic epidermis. Complementary investigations clearly showed that AZA treatment failed to induce specific changes in sebum composition, excretion rate, or in the size of sebaceous glands, but modified epidermal keratinization. Keratohyalin granules and tonofilament bundles were reduced in size and number, mitochondria were swollen and the rough endoplasmic reticulum of malpighian keratinocytes enlarged. The infundibular epidermis of acne individuals showed marked reduction of the horny layer thickness, widening of the horny cell cytoplasm, transitional corneal cells, normalization of filaggrin distribution, and the comedo contained few bacteria and spores. In vitro, AZA exerted marked time- and dose-dependent antiproliferative cytostatic effects on cultured keratinocytes, with a 50% inhibitory dose of 20 mM, decreased some keratinocyte proteins (highly soluble fractions S2, keratohyalin macroaggregate R2, and non-cross-linked fibrous protein S4) and a 95 kD and a 35 kD protein of the cytosolic fraction. Mitochondria were frequently damaged and the rough endoplasmic reticulum enlarged. Our results indicate that AZA is an antikeratinizing agent, displaying antiproliferative cytostatic effects on keratinocytes and modulating the early and terminal phases of epidermal differentiation.

Topics: Acne Vulgaris; Cell Differentiation; Cell Division; Cells, Cultured; Clinical Trials as Topic; Dermatitis, Seborrheic; Dicarboxylic Acids; Filaggrin Proteins; Humans; Keratins; Microscopy, Electron; Protein Synthesis Inhibitors; Random Allocation; Sebum; Skin; Skin Physiological Phenomena

Orally administered retinoids are synthetic derivatives of vitamin A. This new group of drugs (not yet available for general use in the United States) has been effective in experimental trials for treatment of a wide range of skin diseases. The current status of two of these drugs, isotretinoin (13-cis-retinoic acid) and etretinate (Ro 10-9359), is herein reviewed.

Topics: Acne Vulgaris; Administration, Oral; Child; Clinical Trials as Topic; Facial Dermatoses; Female; Humans; Isomerism; Isotretinoin; Keratins; Keratitis; Neoplasms; Psoriasis; Skin Diseases; Tretinoin; Xerostomia

The mode of action of benzoyl peroxide in acne is three-fold, i.e. sebostatic, comedolytic and inhibitory to P. acnes in-vivo. Benzoyl peroxide is the topical treatment of choice in acne vulgaris. This agent is well tolerated by most patients. Primary irritant dermatitis can be avoided by less frequent application and the true incidence of contact sensitivity is low. The gel preparation has achieved a high degree of cosmetic acceptability. A synergistic effect with retinoic acid can be demonstrated. Tolerance to benzoyl peroxide develops in most subjects necessitating more vigorous therapy, usually after two or three weeks of treatment. Many acne sufferers with mild or moderate disease can avoid long-term oral antibiotic treatment by the judicious use of benzoyl peroxide topically.

Topics: Acne Vulgaris; Benzoyl Peroxide; Clinical Trials as Topic; Drug Combinations; Humans; Keratins; Peroxides; Propionibacterium acnes; Sebaceous Glands; Tretinoin

Acne vulgaris is a disease of pilosebaceous units with multifactorial pathogenesis, including hyperkeratinization, increased sebum secretion, and inflammation. Recently, it was suggested that acne subjects may have also impaired skin barrier. We hypothesized that excess unsaturated free fatty acids (UFFA) present in the sebum may cause barrier impairment associated with increased follicular stratum corneum (SC) thickening and inflammation seen in acne. Therefore, epidermal and sebaceous lipid profiles from acne and healthy subjects were analyzed and an in vitro epidermal tissue model was developed to validate this hypothesis. Significantly increased levels of free fatty acids (p < 0.05) were observed in skin lipids of human acne vs. healthy subjects. Exposure of human epidermal equivalents (HEEs) to the UFFA oleic acid (OA), also present in sebum, led to barrier impairment associated with increased SC lipid disorder, increased secretion of interleukin-1α (IL-1α), and excessive SC thickening. Furthermore, the expression of genes encoding for inflammatory cytokines and epidermal differentiation proteins was also increased both in acne lesions and in OA-treated HEEs. Taken together, these data are in agreement with the hypothesis that excess UFFAs in sebum of acne subjects may contribute to impaired skin barrier associated with the increased follicular SC thickness and inflammation seen in acne. Moreover, OA induces similar molecular and phenotypic changes in HEEs as those seen in acne lesions and suggests that an UFFA-treated epidermal tissue model can be used to study the UFFA-mediated pathways involved in the pathogenesis of inflammatory acne and for the development of appropriate therapies.

Topics: Acne Vulgaris; Adolescent; Adult; Fatty Acids, Nonesterified; Female; Humans; Inflammation; Interleukin-8; Keratins; Lipids; Propionibacterium acnes; Sebum; Skin; Young Adult

The formation of epithelial tubes underlies the development of diverse organs. In the skin, hair follicles resemble tube-like structures with lumens that are generated through poorly understood cellular rearrangements. Here, we show that creation of the hair follicle lumen is mediated by early outward movement of keratinocytes from within the cores of developing hair buds. These migratory keratinocytes express keratin 79 (K79) and stream out of the hair germ and into the epidermis prior to lumen formation in the embryo. Remarkably, this process is recapitulated during hair regeneration in the adult mouse, when K79(+) cells migrate out of the reactivated secondary hair germ prior to formation of a new hair canal. During homeostasis, K79(+) cells line the hair follicle infundibulum, a domain we show to be multilayered, biochemically distinct and maintained by Lrig1(+) stem cell-derived progeny. Upward movement of these cells sustains the infundibulum, while perturbation of this domain during acne progression is often accompanied by loss of K79. Our findings uncover previously unappreciated long-distance cell movements throughout the life cycle of the hair follicle, and suggest a novel mechanism by which the follicle generates its hollow core through outward cell migration.

Topics: Acne Vulgaris; Animals; Cell Line; Cell Movement; Hair; Hair Follicle; HEK293 Cells; Humans; Keratinocytes; Keratins; Keratins, Hair-Specific; Keratins, Type II; Membrane Glycoproteins; Mice; Mice, Transgenic; Morphogenesis; Nerve Tissue Proteins; Regeneration

Topics: Acne Vulgaris; Darier Disease; Filaggrin Proteins; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratins; Male; Young Adult

Propionibacterium acnes is one of the most significant pathogenic factors of acne vulgaris. This bacteria relates to acne by various pathways. It has also been reported that P. acnes influences pro-inflammatory cytokine production in keratinocytes in vitro. However, the influence on the differentiation of keratinocytes by P. acnes has not been studied extensively. We analyzed the expression of keratinocyte differentiation-specific markers, keratins, and pro-inflammatory cytokines in normal human epidermal keratinocytes (NHEK) exposed to P. acnes in vitro. All P. acnes strains used in this study increased transglutaminase (TGase), keratin 17 (K17) and interleukin (IL) mRNA expression levels in NHEK, and decreased K1 and K10 expression levels. Some P. acnes strains increased involucrin and K6 mRNA expression levels in NHEK and decreased filaggrin, K6 and K16 expression levels in vitro. This experiment clarified that P. acnes influences the differentiation of NHEK in vitro. As a result, P. acnes influenced the expression of not only pro-inflammatory cytokines but also some keratinocyte differentiation-specific markers and keratins in NHEK. Our results suggest that P. acnes relates to acne pathogenesis by not only the induction of inflammation but also in the differentiation of keratinocytes. Moreover, it was considered that the reaction of NHEK to P. acnes may be different depending on the type of bacteria.

Topics: Acne Vulgaris; Base Sequence; Cell Differentiation; Cells, Cultured; DNA Primers; Filaggrin Proteins; Gene Expression; Humans; In Vitro Techniques; Interleukins; Intermediate Filament Proteins; Keratinocytes; Keratins; Propionibacterium acnes; Protein Precursors; RNA, Messenger; Transglutaminases

Topics: Acne Vulgaris; Axilla; Humans; Hyperhidrosis; Keratins; Male; Odorants; Skin

Topics: Acne Vulgaris; Adolescent; Adult; Calcium-Binding Proteins; Cell Differentiation; Epidermis; Female; Follicular Phase; Hair Follicle; Humans; Immunoenzyme Techniques; Keratinocytes; Keratins; Male; S100 Calcium Binding Protein A7; S100 Proteins; Sebaceous Gland Diseases

Abnormal follicular keratinization is involved in comedogenesis in acne vulgaris. We recently demonstrated that calcium influx into epidermal keratinocytes is associated with impaired skin barrier function and epidermal proliferation. Based on these results, we hypothesized that sebum components affect calcium dynamics in the keratinocyte and consequently induce abnormal keratinization. To test this idea, we first observed the effects of topical application of sebum components, triglycerides (triolein), saturated fatty acids (palmitic acid and stearic acid), and unsaturated fatty acids (oleic acid and palmitoleic acid) on hairless mouse skin. Neither triglyceride nor saturated fatty acids affected the skin surface morphology or epidermal proliferation. On the other hand, application of unsaturated fatty acids, oleic acid, and palmitoleic acid induced scaly skin, abnormal keratinization, and epidermal hyperplasia. Application of triglycerides and saturated fatty acids on cultured human keratinocytes did not affect the intracellular calcium concentration ([Ca(2+)](i)), whereas unsaturated fatty acids increased the [Ca(2+)](i) of the keratinocytes. Moreover, application of oleic acid on hairless mouse skin induced an abnormal calcium distribution in the epidermis. These results suggest that unsaturated fatty acids in sebum alter the calcium dynamics in epidermal keratinocytes and induce abnormal follicular keratinization.

Topics: Acne Vulgaris; Animals; Calcium; Cell Differentiation; Epidermis; Fatty Acids, Unsaturated; Hyperplasia; Keratinocytes; Keratins; Male; Mice; Mice, Hairless

Topics: Acne Vulgaris; Animals; Diagnosis, Differential; Female; Gene Expression Regulation; In Situ Hybridization; Keratins; Mice; Mice, Hairless; Mice, Inbred C57BL; Polychlorinated Dibenzodioxins; RNA, Messenger; Skin

Acne is not uncommon in the neonatal period. Acne neonatorum is characterized by a mainly facial eruption of inflammatory and noninflammatory lesions. It is most commonly mild and transient. Hyperactivity of sebaceous glands, stimulated by neonatal androgens, has been implicated as the underlying pathogenetic mechanism.. All patients diagnosed with acne neonatorum in "A. Sygros" Hospital, Athens, Greece, during the years 1993-1996, were evaluated clinically and epidemiologically. Histologic examination and smears for Propionibacterium acnes and Pityrosporum ovale were performed in selected cases.. Of the 22 patients studied, 18 were male (81.8%) and 4 were female. The mean age at onset was 3 weeks and the mean duration of the disease was 4 months. Papules and pustules were the most frequent types of lesions (72.7%), followed by comedones only (22.7%). The cheeks were the most common site of predilection (81.8%). A family history of acne was reported in only three patients. Histologic examination showed hyperplastic sebaceous glands with keratin-plugged orifices. Smears for P. ovale were negative.. Our findings are consistent with previous experience, although inflammatory lesions were encountered more often than previously reported. Hereditary factors did not seem to play a significant role in our series. Topical treatment hastened the resolution of this self-limited condition. Recalcitrant cases warrant investigation for underlying androgen excess.

Topics: Acne Vulgaris; Female; Greece; Humans; Infant, Newborn; Keratins; Male; Sebaceous Glands; Skin

Topics: Acne Vulgaris; Aged; Diagnosis, Differential; Hair Follicle; Humans; Keratins; Keratosis; Male; Skin; Skin Diseases

A case of actinic comedonal plaque is reported. We comment on the case as well as describe the skin surface microscopic features.

Topics: Acne Vulgaris; Aged; Carcinoma, Basal Cell; Diagnosis, Differential; Facial Dermatoses; Humans; Keratins; Male; Photosensitivity Disorders; Skin; Skin Neoplasms

Topics: Acne Vulgaris; Acyclovir; Adult; Aged; Antiviral Agents; Epithelium; Female; Follow-Up Studies; Hair Follicle; Herpes Zoster; Humans; Keratins; Lymphocytes; Male; Middle Aged; Skin Diseases, Viral

To help elucidate the factors responsible for the infundibular changes seen in acne, the human sebaceous pilosebaceous infundibulum was isolated by microdissection and maintained for 7 d in keratinocyte serum-free medium supplemented with 50 micrograms/ml bovine pituitary extract, 100 units/ml penicillin and streptomycin, 2.5 micrograms/ml amphotericin B and CaCl2(10H2O) to give a final Ca2+ concentration of 2 mM. Infundibular structure was maintained over 7 d in this medium; the pattern of cell division mimicked that in vivo. The rate of cell division was significantly higher than previously described for infundibula maintained in supplemented William's E medium, and moreover did not fall over 7 d. The addition of 1 ng/ml interleukin-1 alpha (IL-1 alpha) caused hypercornification of the infundibulum similar to that seen in comedones; this could be blocked by 1000 ng/ml interleukin-1 receptor antagonist (IL-1ra). In about 20% of subjects there was spontaneous hypercornification of the infundibulum that could be blocked by 1000 ng/ml IL-1ra, suggesting that the infundibulum is capable of synthesising IL-1 alpha. The addition of 5 ng/ml epidermal growth factor or 5 ng/ml transforming growth factor-alpha to the medium caused a disorganisation of the keratinocytes of the infundibulum that resulted in rupturing similar to that seen in the more severe, purulent grades of acne. The addition of 1 microM 13-cis retinoic acid caused a significant reduction in the rate of DNA synthesis and apparent parakeratosis. We are now, therefore, able to model histologically the major infundibular changes in acne.

Topics: Acne Vulgaris; Animals; Cattle; Cell Survival; Culture Techniques; Epidermal Growth Factor; Female; Humans; Interleukin-1; Isotretinoin; Keratins; Parakeratosis; Skin; Time Factors

This study compared the pattern of keratin expression in pilosebaceous follicles in uninvolved trunk skin of acne patients, comedones, and normal control skin by immunohistochemistry, using both immunofluorescent (IF) and immunoperoxidase (IP) techniques. The shape, size and gross morphology of truncal follicles varied greatly. There was no difference in keratin expression between normal skin and uninvolved skin of patients with acne. The upper part of the pilosebaceous duct expressed keratins K1, K5, K10 and K14, whereas the lower duct expressed keratins K5, K6, K14, K16, K17 and K19. The sebaceous gland showed considerable heterogeneity in keratin expression, with some lobules expressing keratins K1, K5, K7, K10, K14 and K17. The comedone wall showed a pattern of keratin expression similar to that of the upper follicle, except that there was, in addition, expression of keratins K6 and K16 suprabasally, and panepithelial expression of K17 in the comedone wall. IF techniques were found to be less sensitive than the IP method in the detection of individual keratins, but the use of multiple antibodies and many different transverse and longitudinal sections of follicles permitted full conclusions to be made. The increased expression of keratins K6, K16 and K17 in the comedone wall is likely to represent a secondary effect of increased cell turnover due to the primary underlying mechanism of comedogenesis, which is as yet unknown.

Topics: Acne Vulgaris; Adolescent; Adult; Epithelium; Female; Fluorescent Antibody Technique; Hair Follicle; Humans; Immunoenzyme Techniques; Keratins; Male; Sebaceous Glands; Skin

The mechanisms of comedogenesis and comedolysis were investigated at the ultrastructural level after applying oleic acid (OA) only, or oleic acid together with vitamin A acid (VAA), to rabbit ears daily for two weeks. 1) In the follicular epithelium of the experimentally-induced comedo (EIC) by OA, several ultrastructural changes similar to those in human comedo were observed. EIC in rabbit ears appeared to be induced both by the hyperkeratinization of the follicular epithelium and by the delayed desquamation of horny cells due to the persistence of intercellular binding apparatus. 2) VAA strongly inhibited the formation of EIC. In the follicular epithelium, two different types of changes, non-cohesive hyperkeratinization and inhibition of keratinization, were observed. These represent the cell injury and recovery stages, respectively. VAA induced the disturbance of follicular epithelial keratinization and reduction of intercellular bindings between horny cells. These effects might prevent the cohesion and accumulation of horny cells and inhibit EIC formation. 3) The number of Odland bodies (Ods) showed an inverse correlation with the cohesion of horny layer. These findings support the theory that Ods have a desquamating function as extracellular lysosomes. The change in Ods would also contribute to both EIC formation by OA and the inhibition by VAA. In addition, VAA caused a characteristic increase in Ods with lamellar structures. It is suggested that Ods with lamellar structures have a desquamating function.

Topics: Acne Vulgaris; Animals; Cytoplasmic Granules; Desmosomes; Hair; Hyalin; Keratins; Keratosis; Male; Microscopy, Electron; Oleic Acid; Oleic Acids; Rabbits; Vitamin A

Sulfur is a time-honored therapeutic agent useful in a variety of dermatologic disorders. Its keratolytic action is due to formation of hydrogen sulfide through a reaction that depends upon direct interaction between sulfur particles and keratinocytes. The smaller the particle size, the greater the degree of such interaction and the greater the therapeutic efficacy. When applied topically, sulfur induces various histologic changes, including hyperkeratosis, acanthosis, and dilatation of dermal vasculature. One study showed that sulfur was comedogenic when applied onto human and rabbit skin, findings that were not reproduced in other studies. About 1% of topically applied sulfur is systemically absorbed. Adverse effects from topically applied sulfur are uncommon and are mainly limited to the skin. In infants, however, fatal outcome after extensive application has been reported.

Topics: Acne Vulgaris; Chemical Phenomena; Chemistry; Dermatitis, Seborrheic; Epidermis; Humans; Keratins; Skin Diseases; Sulfur

The distribution of cytokeratins and filaggrin in human pilosebaceous unit was investigated in specimens obtained from normal (n = 15), seborrhoeic (n = 6), and acne skin (n = 6), using the monoclonal antibodies CK8.12, CK8.13, CK4.62, CK8.60, KL1, PKK2, RPN 1160, and an antibody for filaggrin. The type and amount of cytokeratin content was correlated with the stage of cell differentiation in these three skin types. In all specimens studied the sebocytes. The sebaceous duct cells, and the infundibular cells contained cytokeratins, no clear differences were found between normal, seborrhoeic, and acne skin. During sebocytic maturation the amount and type of cytokeratin content changed gradually and the labeling pattern was partly different compared to the interfollicular epidermal pattern. In the sebaceous duct and the infundibulum, the labeling pattern using KL1, CK8.12, and CK8.13 was similar to that seen in interfollicular epidermis, whereas labeling with CK8.60 and PKK2 was different. These findings indicate that sebaceous duct and infundibular cells express transitional patterns of differentiation between epidermal keratinocytes and sebocytes. Filaggrin was expressed only in some sebaceous duct cells and in infundibular cells. In seborrhoeic and in acne skin, however, the reactivity of antibody to filaggrin was more intense and was already observed in the lower parts of the sebaceous duct and the infundibulum. Although no filaggrin was found in the intermediate cells of the sebaceous duct and the infundibulum in normal skin, these cell types clearly contained filaggrin in seborrhoeic and acne skin.

Topics: Acne Vulgaris; Antibodies, Monoclonal; Dermatitis, Seborrheic; Epithelial Cells; Filaggrin Proteins; Humans; Intermediate Filament Proteins; Keratins; Sebaceous Glands; Skin

Topics: Acne Vulgaris; Etretinate; Humans; Isotretinoin; Keratins; Papillon-Lefevre Disease; Skin Diseases; Tretinoin

Isotretinoin is of undisputed benefit in the treatment of acne. In doses of 1 mg/kg/day for 4 months the drug produces a highly significant reduction in sebum excretion rate (90 +/- 3%) in comedone formation as measured by assessing follicular casts (70 +/- 5%), and in surface Propionibacterium acnes. However, the mechanisms of long-term clinical remission are not well understood. There are however, risk factors which predetermine the outcome to treatment with isotretinoin. Younger subjects (14-19 years) and those who have had acne for less than 6 years, respond less well than older subjects. Subjects with more truncal acne also fare less well than those with predominantly facial acne. A return of the reduced sebum excretion rate to within 10% of the pre-treatment level also is a poor prognostic factor. This and future studies could lead to development of more logical dose regimes depending, for example, on the age of the patient; duration of acne and its site. However, until proven otherwise, this study confirms our earlier data, and that of the German multi-centres and Strauss et al (1), that the optimum dose schedule for treating acne patients is 1 mg/kg/day regime.

Topics: Acne Vulgaris; Adolescent; Adult; Follow-Up Studies; Humans; Isotretinoin; Keratins; Microbial Sensitivity Tests; Prognosis; Propionibacterium acnes; Tretinoin

The primary change found in cellular material expressed from open comedones of patients who had been treated with isotretinoin was disintegration of desmosomes. Consequently, there was lack of cohesion between cornified cells. A marked decrease in the quantity of sebaceous material and bacteria was also evident within the comedones.

Topics: Acne Vulgaris; Bacteria; Desmosomes; Hair; Humans; Intermediate Filaments; Isotretinoin; Keratins; Sebum; Tretinoin

Characteristic early lesions in acne vulgaris are the open and closed comedones (blackheads and whiteheads) which are well known to contain a "plug" of cornified material. Histological analysis of these lesions has indicated that their protein content, presumed in part to be keratin, may be degraded, possibly by bacterial action, though this has never been adequately demonstrated biochemically. We have analysed the keratin content in a pool of material taken from a number of open comedones (approximately 200-500 mg by weight). Using a highly sensitive silver stain technique which can detect minute quantities of protein we have also been able to analyse individual lesions. In normal keratin extracted from human stratum corneum using a Tris-urea-mercaptoethanol buffer, SDS/polyacrylamide gel electrophoresis reveals the presence of a group of polypeptides with molecular weights in the range 66 000-44 000. Comedonal material contained bands of the same molecular weight but in addition to these undegraded keratin polypeptides, showed bands corresponding to molecular weights in the region of 15 000-10 000 and 30 000-25 000 indicating that the keratins in this material are partially degraded. Similar groups of low molecular weight polypeptides were observed when keratin was digested with purified V8 protease from Staphylococcus aureus. It is possible that inflammation around the follicle could involve the leakage of keratin digestion products into the dermis.

Topics: Acne Vulgaris; Antibodies; Electrophoresis, Polyacrylamide Gel; Humans; Immunologic Techniques; Keratins; Peptide Hydrolases; Proteins; Staphylococcus aureus

Topics: Acne Vulgaris; Adolescent; Adult; Age Factors; Anti-Bacterial Agents; Benzoyl Peroxide; Female; Humans; Hydrogen-Ion Concentration; Keratins; Male; Sebum; Sex Factors

Topics: Acne Vulgaris; Humans; Isotretinoin; Keratins; Psoriasis; Skin Diseases; Skin Neoplasms; Tretinoin; Vitamin A

Topics: Acne Vulgaris; Eyelid Diseases; Female; Humans; Keratins; Middle Aged; Xanthomatosis

The structural organization and bacteriological profile of follicular casts and early comedones in prepuberal children were investigated. Follicular casts were present in all samples but were not as abundant as usually seen in older individuals with acne. When examined with the light microscope, all casts and comedones were composed of numerous layers of horny cells and sebum, but were devoid of bacteria. Neither follicular casts nor comedones yielded bacteria when cultured. Electron microscopy of the follicular casts revealed the presence of small round, discrete lipid droplets, and alternating dense and less dense lamellar configurations within the horny cells. Some horny cells closest to the sebum-filled lumen contained large lipid masses, resulting in "balloon-shaped" regions. Prepuberal follicular horny cells contained all of the abnormalities usually seen in follicular casts and biopsy material from acne patients, which suggests that these casts are potential comedones. These aberrations occurred in the complete absence of bacteria indicating that bacteria are not essential to the formation of casts or comedones. Furthermore, our findings indicate that bacteria play little if any role in the initial events of pathological keratinization.

Topics: Acne Vulgaris; Bacteria; Child; Child, Preschool; Face; Female; Hair; Humans; Keratins; Male; Propionibacterium acnes; Sebaceous Glands; Skin

Topics: Acne Vulgaris; Cell Membrane; Hair; Humans; Inclusion Bodies; Keratins; Lipids; Skin

After two decades of using systemic antibiotics as a main treatment for acne, emphasis is again being placed on topical agents. Thus, it is highly desirable to have a procedure whereby the activity of the various compounds can be evaluated by direct visualization. Scanning electron microscopy combined with transmission electron microscopy provide the tools for such in assay. This study describes the ultrastructure of untreated comedones and provides the baseline or control data necessary for testing topical treatments. Comedones obtained by punch biopsies or comedo extractors were processed for electron microscopy and studied with an ETEC Autoscan Scanning Electron Microscope and with Philips EM 300 and EM 301 Transmission Electron Microscopes. Microorganisms, keratinized cells, sebum, and hairs interact with each other to form the comedonal mass. Corynebacterium acnes and Pityrosporum ovale proliferate abundantly in close association with sebum and penetrate the keratinized cells. Fine structural details of bacteria and yeasts as well as features of host-microbial relationship have been elucidated.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Anti-Bacterial Agents; Corynebacterium; Female; Hair; Humans; Keratins; Male; Microscopy, Electron, Scanning; Sebum; Skin; Yeasts

Membrane coating granules (MCGs) may be required for normal keratinization. Comedone formation is associated with abnormal keratinization, and so the MCGs in sebacaous follicles were counted during experimental comedogenesis in the rabbit. During induced comedo formation with 50% oleic acid in paraffin oil, the numbers of MCGs decreased significantly; first, at the epidermis and mouth of the follicle and then later, at the follicular canal and common sebaceous duct. The maximum decrease of about 40% was reached by the 6th day in these regions. Throughout the treatment, the MCG count in the individual sebaceous ducts remained fairly constant.

Topics: Acne Vulgaris; Animals; Cell Membrane; Cytoplasmic Granules; Hair; Keratins; Microscopy, Electron; Rabbits

Topics: Acne Vulgaris; Adolescent; Adult; Fatty Acids, Nonesterified; Female; Humans; Keratins; Lipids; Male; Propionibacterium acnes; Sebum; Skin; Squalene; Staphylococcus

Sebum excretion rate was measured before and after occlusions of the skin in eleven subjects. The sebum excretion rate rose significantly following occlusion, confirming the view that there is an obstruction to the outflow of sebum with keratin hydration.

Topics: Acne Vulgaris; Adolescent; Adult; Humans; Keratins; Sebaceous Glands; Sebum; Secretory Rate; Skin Temperature; Temperature; Water

Comedones contain a considerable quantity of water. In some cases a water content of more than 40% can be detected. The comedo consists of two parts, an inner nucleus built up to unorganized materials and a capsule with concentrically arranged shells. The material of the nucleus contains small scales produced by normal keratinization. The materials of the capsule consists of larger scales, which result from hyperkeratosis. The nucleus of the comedo seems to be identical with the early comedo. A similar structure can be formed in vitro by adding water to sebum. Microorganisms have optimal growth conditions in the early comedo.

Topics: Acne Vulgaris; Keratins; Lipids; Sebaceous Glands; Sebum; Triglycerides; Water

Topics: Acne Vulgaris; Adolescent; Adrenal Cortex Hormones; Anti-Bacterial Agents; Humans; Keratins; Malassezia; Propionibacterium acnes; Staphylococcus; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Autoradiography; Cell Count; Epithelial Cells; Humans; Keratins; Lipids; Male; Sebaceous Glands; Sebum; Thymidine; Tritium

Topics: Acne Vulgaris; Adolescent; Adult; Female; Hair; Humans; Humidity; Keratins; Male; Polyethylenes; Sebaceous Glands; Sebum; Temperature; Tropical Climate; Water

Topics: Acne Vulgaris; Adolescent; Age Factors; Androgen Antagonists; Endocrine Glands; Humans; Infant; Keratins; Lipid Metabolism; Sebaceous Glands; Sebum; Skin

Topics: Acne Vulgaris; Female; Humans; Keratins; Lipids; Menstruation; Sebaceous Glands; Sebum; Skin

A satisfactory clinical response to long-term oral tetracycline treatment was associated with a mean serum tetracycline of 1.98 mug/ml. The surface lipid showed an increased triglyceride, decreased free fatty acids, and decreased cholesterol, and the amount of keratin within the pilosebaceous duct was reduced. At this dose level there was no quantitative decrease in the bacterial flora though there was a decrease in the fatty acids. We believe that the latter was due to a direct inhibition by tetracycline on extracellular lipases.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Cholesterol; Chromatography, Thin Layer; Fatty Acids, Nonesterified; Humans; Keratins; Lipids; Micrococcus; Skin; Squalene; Staphylococcus; Tetracycline; Triglycerides

Topics: Acne Vulgaris; Cyanoacrylates; Hair; Humans; Keratins; Lipids; Microscopy, Electron; Sebaceous Glands; Sebum; Tetracycline

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Chlorine; Ear, External; Epithelial Cells; Female; Hair; Humans; Keratins; Male; Middle Aged; Nose; Sebum; Skin; Steroids

Topics: Acne Vulgaris; Animals; Chloroform; Chromatography, Thin Layer; Ear Canal; Fatty Acids, Nonesterified; Female; Keratins; Lipase; Lipids; Male; Mitosporic Fungi; Rabbits; Triglycerides

Topics: Acne Vulgaris; Adolescent; Corynebacterium; Dermabrasion; Diet Therapy; Female; Gonadal Steroid Hormones; Humans; Keratins; Menstruation; Temperature; Tetracycline; Ultraviolet Rays

Topics: Acne Vulgaris; Animals; Basement Membrane; Female; Humans; Injections, Intramuscular; Keratins; Male; Microscopy, Fluorescence; Psoriasis; Rats; Rosacea; Sebaceous Glands; Skin; Tail; Tetracycline

Topics: Acne Vulgaris; Cysts; Edema; Folliculitis; Hair; Humans; Hyperplasia; Keratins; Male; Rupture; Sebaceous Glands; Skin