Academic literature on the topic 'Acne Vulgaris therapy'

Acne vulgaris is a highly prevalent inflammatory skin disease involving sebaceous follicle. Although the pathogensis of acne remains uncertain, skin microbes are considered to plays an essential role in acne vulgaris. Cutibacterium acnes is the most important microbe in acne pathogenesis and its several processes: colonization, over-proliferation and inflammation have long been thought to contribute to the disease. Moreover, Staphylococcus epidermidis and Malassezia also synergistically collaborate with Cutibacterium acnes. Besides, given the growing number of patients who are treatment resistant, assessments are needed on phenotypic changes in the skin microbiome with retinoids and antibacterial therapy. Further research on the role of microbes in the pathogenesis of acne and the relationship between pathogenic microbes is expected to provide a new theoretical basis for clinical treatment of acne.

Early rapid treatment of acne vulgaris is mandatory for improving the psychological behavior of acne patients and to avoid the occurrence of post acne scars that are still more frustrating and challenging condition in their treatment up till now. The current first line of treatment of acne vulgaris is the conventional pharmacological therapy including; keratolytics, topical or oral antibiotics, retinoids, and hormonal agents. Meanwhile, the use of this pharmacological therapy is not always beneficial because of poor compliance of the patients, occurrence of side effects of drugs and antibiotic resistance to Cutibacterium (C.) acne with high rate of recurrence. Therefore, non-pharmacological treatment is developed as safe and effective options for treating acne vulgaris. They are applied either as independent treatment modality, an adjunct to pharmacological therapy, or as maintenance therapy. There is no sufficient data on the classification of this treatment category. This review discusses the non-pharmacological therapy in management of acne vulgaris besides efficacy and safety of each type of treatment modality. The most commonly applied non-pharmacological therapies are diet control, counseling, dermocosmetics, comedo extraction, chemical peeling, cryotherapy, chemical peels, platelets rich plasma (PRP), botulinum neurotoxin A (BoNTA), light-based therapy and laser and photodynamic therapy (PDT). Regarding lasers and light sources, they can be subclassified according to their mechanism of action into devices targeting levels of C. acnes, function of the sebaceous unit, or both.

Purpose of the study. To determine the safety and efficacy of 20% azelaic acid cream in the treatment of patients with papulopustular acne vulgaris. Materials and methods. 65 patients with acne vulgaris were examined. The control group consisted of 30 healthy individuals. Acne severity was evaluated according to G. Michaelsson et al. scale, Cook’s scale, absolute number of papules and pustules. Assessment of quality of life was performed. Facial skin microbiocenosis was assessed. All patients with acne vulgaris applied 20% azelaic acid cream during 15 ± 2 days. Results and discussion. The use of 20% azelaic acid cream contributed to the rapid regression of inflammatory acne. After 10 days of treatment, the number of papulopustular elements decreased in 3 times. After 10 days of therapy acne score according to G. Michaelsson et al. decreased in 1,5 times and after 15 days of treatment – in 1,9 times. After 10 days of therapy the acne score on the Cook’s scale decreased in 1,4 times. At the end of the study the acne score on the Cook’s scale was 2,4 points. There was a significant decrease in the total number of bacteria, the number of coagulase-positive staphylococci, quantity of Propionibacterium acnes on facial skin in 15 days after the start of therapy. A significant difference in the average value of the DLQI was fixed before (18,9 ± 0,31) and at the end (8,1 ± 0,54) of treatment. Conclusions. The high effectiveness of 20% azelaic acid cream in treatment of papulopustular acne vulgaris was proved. 20% azelaic acid cream provides a rapid regression of inflammatory forms of acne, reduction of total quantity of bacteria and Propionbacterium acnes on skin.

Background: Propionibacterium acnes (P. acnes) has been implicated in the pathogenesis of acne vulgaris since the beginning of the last century. Over several decades, topical and systemic antibiotics have been the main line of treatment for acne vulgaris. However, in the present era of increased antibiotic usage, resistant strains have emerged. Objectives: The aim of this study is to determine the antibiotic resistance pattern of P. acnes isolated from patients with acne vulgaris at the dermatology clinics of Kasr Al-Ainy teaching Hospital. Methodology: Specimens from 100 patients with acne vulgaris were extracted from the pustules, taken by sterile cotton swabs and transported by thioglycolate media. Each swab was inoculated onto two blood agar plates, one incubated aerobically at 37ºC for 24h and the other anaerobically for one week. P. acnes was identified by Gram stain and biochemical tests. Their sensitivity to doxycycline, erythromycin, clindamycin, tetracycline, azithromycin and trimethoprimsulfamethoxazole was determined on Muller Hinton media by disc diffusion method. Results were interpreted according to the National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Results: A total of 44 P. acnes isolates were identified from 100 patients with acne vulgaris, out of which 22.7% were resistant to clindamycin, 11.4% were resistant to trimethoprim-sulfamethoxazole and 9% were resistant to erythromycin. Resistance to doxycycline, tetracycline or azithromycin was not detected. Trimethoprim-sulfamethoxazole showed statistically significant difference in the resistance pattern compared to patient’s sex (p = 0.029) and to receiving previous treatment (p = 0.018). Conclusion: P. acnes is prevalent in patients with acne vulgaris (44%) and resistant strains are detected especially in those who have received previous therapy for more than 2 weeks (68%). It is recommended that dermatologists and family physicians follow the guidelines for proper management of acne, with the judicious use of antibiotics, in order to prevent antibiotic resistance.

Acne vulgaris is a highly prevalent skin disorder requiring treatment and management by dermatologists. Antibiotics such as clindamycin are commonly used to treat acne vulgaris. However, from both medical and public health perspectives, the development of alternative remedies has become essential due to the increase in antibiotic resistance. Topical therapy is useful as a single or combined treatment for mild and moderate acne and is often employed as maintenance therapy. Thus, the current study investigated the anti-inflammatory, antibacterial, and restorative effects of sesquiterpene farnesol on acne vulgaris induced by Cutibacterium acnes (C. acnes) in vitro and in a rat model. The minimum inhibitory concentration (MIC) of farnesol against C. acnes was 0.14 mM, and the IC50 of 24 h exposure to farnesol in HaCaT keratinocytes was approximately 1.4 mM. Moreover, 0.8 mM farnesol exhibited the strongest effects in terms of the alleviation of inflammatory responses and abscesses and necrotic tissue repair in C.acnes-induced acne lesions; 0.4 mM farnesol and clindamycin gel also exerted similar actions after a two-time treatment. By contrast, nearly doubling the tissue repair scores, 0.4 mM farnesol displayed great anti-inflammatory and the strongest reparative actions after a four-time treatment, followed by 0.8 mM farnesol and a commercial gel. Approximately 2–10-fold decreases in interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, found by Western blot analysis, were predominantly consistent with the histopathological findings and tissue repair scores. The basal hydroxypropyl methylcellulose (HPMC) gel did not exert anti-inflammatory or reparative effects on rat acne lesions. Our results suggest that the topical application of a gel containing farnesol is a promising alternative remedy for acne vulgaris.

Acne is a disorder of the pilosebaceous unit often complicated by scarring. Five studies were performed to test the hypothesis that acne is common among Chinese and that the use of laser and light source is safe and effective for the treatment of acne and acne scars in Asians. The self-reported prevalence of acne in Hong Kong was assessed using a questionnaire among a randomised sample of 522 persons aged 15-25 years. The prevalence was 91.3% with a point prevalence of 52.2%, and acne scars and pigmentation were reported by 52.6%. The existing topical and oral anti-acne medications are limited by their efficacy, adverse effects and patient compliance. Light can target the pilosebaceous unit and reduce the growth of Propionibacterium acnes, for which lasers or light sources have been explored as therapeutic options. The aim of this study was to determine whether lower fluence and shorter cooling of the 1450-nm diode laser would improve acne while minimising post-laser hyperpigmentation in Asians. A total of 26 Chinese subjects received four treatments of three passes with this laser at a fluence of 8 J/cm2 with dynamic cooling of 25 ms. A 40% reduction (p<0.03) in mean lesion count was observed 6 months after treatment with a significant improvement in sebum production and a hyperpigmentation rate of 3.8%. A split-face, controlled study was performed to evaluate the effectiveness of intense pulsed light (IPL) alone or in combination with short-contact 16% methyl aminolevulinate photodynamic therapy (PDT) in 30 Chinese subjects with acne. Among the PDT-treated group, 25% withdrew due to treatment discomfort. No significant differences in the reduction of inflammatory lesions were observed between the intervention groups and the control group. A delayed effect with reductions in non-inflammatory lesions was observed in the PDT-treated (38%; p=0.05) and IPL-treated (43%; p=0.01) groups 12 weeks after treatment. Liposome was used to deliver 5-aminolevulinic acid (5-ALA) into the pilosebaceous unit to lower the concentration of 5-ALA by 40-fold during PDT. The study aimed to investigate the tolerability and efficacy of PDT with IPL using 0.5% liposomal 5-ALA for inflammatory acne. A mean reduction of 65% in the inflammatory lesion count was observed after 6 months (p=0.043) in 12 Chinese subjects. No dropout or significant side effects were observed. The treatment of acne scars has often been complicated by Asian skin phototypes regarding the risk of post-inflammatory hyperpigmentation. Fractionated radiofrequency induces deep dermal heating with less epidermal disruption. The aim of this study was to examine the efficacy and safety of combined bipolar radiofrequency and fractional diode 915 nm laser followed by fractional radiofrequency in 24 Chinese subjects with acne scars. The mean grade improved by 29% (p<0.001), and 52% subjects were rated as having at least a moderate global improvement at 3 months. Subjective improvement was moderate to significant in 36.8%. Hyperpigmentation occurred after 6.5% of the treatments. In conclusion, the studies indicated that laser and light source can be used effectively and safely for the treatment of acne and acne scars commonly found in Asians.
published_or_final_version
Medicine
Master
Doctor of Medicine

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
A acne vulgar é uma das dermatoses mais frequentes em jovens e a infecção causada pela bactéria Cutibacterium acnes (antigo Propionibacterium acnes) tem importante papel na patogênese da acne. Existem várias opções de tratamento que variam de acordo com a gravidade da doença, porém são associados com reações indesejadas e resistência aos antimicrobianos. A terapia fotodinâmica antimicrobiana (TFDa) então é proposta como tratamento alternativo para inativar C. acnes juntamente com a incorporação do fotossensibilizador (FS) em uma formulação tópica para otimizar a terapia. Este trabalho objetivou avaliar a eficácia in vitro da TFDa mediada pelo azul de metileno (AM) incorporado em hidrogel de quitosana e poloxamer (HG-AM) contra C. acnes em fase planctônica e biofilme. A viabilidade celular após TFDa foi avaliada através da quantificação das colônias formadas por mililitro de amostra (UFC/mL). Para caracterizar estruturalmente os HGs foram realizadas as análises oscilatórias e de comportamento de fluxo em reômetro de estresse controlado com geometria placa-cone e a bioadesão em pele de orelha de porco utilizando um texturômetro. A análise estatística dos dados feita foi a Análise de Variância (one way ANOVA) com pós-teste de Tukey. Os resultados deste estudo mostrou que a TFDa contra C. acnes foi eficaz utilizando HG-AM em fase plactônica. A concentração bactericida mínima foi de 12,5 µg/mL associada a uma fluência de 90 J/cm2. O biofilme de C. acnes não foi totalmente eliminado pela TFDa com HG-AM nas condições testadas. A máxima redução microbiana alcançada com o HG-AM foi de 1,9 log10 com 75 µg/mL do FS utilizando 150 J/cm2 e 30 minutos de pré-incubação do biofilme com o HG-AM. O HG a 0,25% de quitosana (HG1) mostrou-se adequado para aplicação na superfície da pele pois concentrações maiores de quitosana aumentam a elasticidade do hidrogel, podendo atrasar a liberação do FS. A incorporação do AM não afetou suas características reológicas e bioadesivas de forma significativa. Foi possível concluir que a TFDa mediada por HG-AM foi mais eficiente do que AM em solução para a redução total da carga microbiana em fase planctônica nas mesmas condições.
Acne vulgaris is one of the most frequent dermatosis in young people and the infection caused by the bacteria Cutibacterium acnes (formerly Propionibacterium acnes) plays an important role in the pathogenesis of acne. There are several treatments options that vary according to the severity of the disease, but are associated with unwanted reactions and antimicrobial resistance. Antimicrobial photodynamic therapy (aPDT) is then proposed as an alternative treatment to inactivate C. acnes together with the incorporation of the photosensitizer (PS) into a topical formulation to optimize therapy. This work aimed to evaluate the in vitro efficacy of methylene blue (MB) mediated TFDa incorporated in chitosan and poloxamer (HG-MB) hydrogels against planktonic and biofilm C. acnes. Cell viability after aPDT was evaluated by quantifying the colonies formed per milliliter of sample (CFU / mL). To characterize structurally the HG were performed the oscillatory and behavior of flow in a controlled stress rheometer with cone-plate geometry and bioadhesion in pig ear skin using a texture analyser. The statistical analysis of the data was the Analysis of Variance (one way ANOVA) with post-test of Tukey. The results of this study showed that aPDT was effective using HG-MB in planktonic phase. The minimum bactericidal concentration was 12.5 μg/mL associated with a fluence of 90 J/cm2. The C. acnes biofilm was not totally eliminated by the aPDT with HG-MB under the conditions tested. The maximum microbial reduction achieved with HG-MB was 1.9 log10 with 75 μg/mL of the PS using 150 J/cm2 and 30 minutes biofilm incubation with HG-MB. HG at 0.25% of chitosan (HG1) was adequate for application to the skin surface because higher concentrations of chitosan increase the elasticity of the hydrogel and may delay PS release. The incorporation of MB did not significantly affect its rheological and bioadhesive characteristics. It was possible to conclude that HG-MB mediated aPDT was more efficient than MB solution for the total reduction of planktonic microbial load under the same conditions.
133456/2016-1

Дисертаційне дослідження містить раціональний підхід до вирішення завдання, що передбачає вивчення впливу вугрової хвороби (ВХ) та коморбідних із нею станів (демодекозу та дискінезії жовчного міхура) на ступінь тяжкості клінічного перебігу, морфологію еритроцитів (ступінь пойкілоцитозу), якість життя хворих та розробку алгоритму комбінованого лікування з використанням лазерної терапії. Метою роботи є удосконалення діагностики та лікування хворих на вугрову хворобу у коморбідності з демодекозом та дискінезією жовчного міхура шляхом застосування в комплексній терапії високо- і низькоінтенсивного лазерного випромінювання для зменшення запалення і застійної еритеми постакне, елімінації кліщів роду Демодекс та корекції гіпомоторних порушень жовчного міхура. Під час вивчення поширеності вугрової хвороби серед молоді було досліджено 378 осіб віком 19–36 років з різними фототипами (ФТ), з яких ВХ виявлено у 82,7 % II–III ФТ та в 68,5 % V–VI ФТ. З метою підвищення інформативності діагностики демодексного ураження шкіри та скорочення часу дослідження було розроблено і запатентовано епітеліальний скотч-тест, який було використано для встановлення коморбідності ВХ з демодекозом у 305 осіб (268 з II–III / 37 із V–VI ФТ). Наявність кліщів встановлено у 67,1 % осіб із II–III та у 27,02 % осіб із V–VI ФТ. Коморбідність вугрової хвороби з дискінезією жовчного міхура (ДЖМ) вивчали серед 268 осіб із ІІ–ІІІ ФТ, яким було проведено двоетапне УЗ-дослідження із застосуванням жовчногінного стимулятору. Гіпокінетична дисфункція була встановлена серед 44 % обстежених осіб. Для оцінювання ризиків виникнення демодексного ураження шкіри у осіб з ВХ було залучено 132 особи: 56 – без вугрових елементів та 76 – із вугровими елементами. На момент залучення у дослідження серед пацієнтів не було виявлено кліщів роду Демодекс. Повторне обстеження, проведене через 12 місяців, установило наявність кліща в 3,57 % осіб без ВХ та в 21,05 % із ВХ. Показник відношення шансів (OR) становив 7,2 (довірчий інтервал 95 %: 1.582; 32.765), що достовірно підтверджує істотний ризик виникнення демодекозу у осіб з вугровою хворобою (p = 0,00533). Для реалізації поставлених у дослідженні завдань було відібрано 150 пацієнтів із ВХ середнього ступеня тяжкості (40 пацієнтів із ВХ без наявності супутньої патології; 50 пацієнтів із ВХ у коморбідності з демодекозом (Д); 50 пацієнтів із ВХ у коморбідності з демодекозом і ДЖМ із II–III ФТ, 10 пацієнтів із ВХ у коморбідності з демодекозом із V–VI ФТ, та 35 практично здорових осіб, зівставних за віком і статтю. Установлення впливу коморбідних патологій на тяжкість клінічної картини вугрової хвороби проводили з використанням міжнародної шкали Global Acne Grading System (GAGS). Тяжкість клінічної картини в пацієнтів із ВХ була нижчою на 6,9 %, ніж в осіб з ВХ і демодекозом, та на 13,8 % нижчою, ніж у групі з ВХ, демодекозом (Д) і ДЖМ. Асоціацію між тяжкістю клінічних проявів ВХ та наявністю коморбідності з Д і ДЖМ було підтверджено встановленим сильним прямим зв’язком r = + 0,91 (p < 0,001). При оцінюванні інтенсивності свербежу за візуальною аналоговою шкалою VAS (Visual analogue scale) у групі з коморбідністю ВХ із Д показник був на 9,3 %, а у групі ВХ + Д+ ДЖМ – на 20,9 % вищим, ніж у 1 групі хворих з ВХ (р ˂ 0,05). За показником площі постзапальної еритеми, обчисленої з використанням програми Image J, та за шкалою клінічного оцінювання еритеми (Clinician Erythema Assessment Scale) встановлено достовірну різницю між пацієнтами з ВХ та досліджуваними групами з коморбідними станами. Вивчення морфологічних характеристик формених елементів крові на підставі даних, одержаних під час проведення світлової та растрової електронної мікроскопії, продемонструвало істотне збільшення відносної кількості змінених форм еритроцитів до 17,8 % ± 8,94 % (р ˂ 0,05) за рахунок збільшення ехіноцитів 1-го та 2-го порядків за наявності коморбідних станів, тоді як у контрольній групі цей показник склав 7,48 % ± 2,43 %. Асоціація між наявністю ДЖМ та рівнем пойкілоцитозу у пацієнтів з вугровою хворобою підтверджена встановленням прямого зв'язку середньої сили під час проведення кореляційного аналізу за Пірсоном r = +0,75 (p < 0,05). Вплив вугрової хвороби на якість життя, встановлений за результатами анкетування DLQI, демонструє істотну різницю між групами: серед пацієнтів з коморбідністю ВХ із демодекозом та ДЖМ середній загальний бал становив 8,88 бала порівняно з 5,97 у пацієнтів з ВХ. Асоціацію обтяженості ВХ коморбідною патологією та якості життя пацієнтів з ВХ було доведено під час обчислення кореляційних зв’язків: r = +0,71 (p < 0.005). З метою вдосконалення лікування вугрової хвороби у коморбідності з демодекозом і дискінезією ЖМ було розроблено алгоритм комбінованої терапії з поетапним застосуванням топічної та системної лазерної терапії. Для зменшення проявів запалення та елімінації кліщів роду Демодекс пацієнтам був проведений курс лазерних процедур із використанням лазерного апарата з довжиною хвилі 1 064 нм з дистантною обробкою шкіри за наступними параметрами: довжина хвилі (λ) = 1 064 нм; діаметр робочої плями (Ø) – 6 мм; флюенс – 35 Дж/см2; довжина імпульсу – 0,6 мс. Для корекції гіпомоторної дисфункції ЖМ застосовували внутрішньовенну лазерну терапію (ВЛТ) із використанням випромінювальної головки з λ = 635 нм у безперервному режимі потужністю випромінювання 1,5 мВт із 15 хвилинною експозицією. Для зменшення площі застійної еритеми було розроблено та запатентовано спосіб фотодинамічної терапії (ФДТ) з використанням фотосенсибілізатора хлоринового ряду, який проводили за такими режимами: λ = 660 нм, середня сумарна доза енергії за одну процедуру 500–700 Дж. Ефективність проведеної терапії було встановлено за результатами контрольного оцінювання на 60-й день дослідження: клінічні прояви ВХ за шкалою GAGS серед пацієнтів ВХ + Д зменшилися на 50,1 %, серед пацієнтів групи ВХ + Д + ДЖМ – на 49,7 % порівняно з вихідним рівнем. У той самий час покращення якості життя за шкалою DLQI порівняно з вихідним рівнем відбулося на 68,0 % і 72,8 % серед пацієнтів ВХ + Д та ВХ + Д + ДЖМ відповідно (р ˂ 0,05). Під час аналізування ефективності проведення елімінаційної терапії встановлено, що кліщі роду Демодекс відсутні у 88 % пацієнтів групи ВХ + Д та у 82 % пацієнтів групи ВХ + Д + ДЖМ. Нормалізація функції жовчного міхура, що відбулася у 100 % пацієнтів групи ВХ + Д + ДЖМ (48 % ± 7,9 %), та зменшення кількості ехіноцитів в середньому до 8,89 % ± 1,36 % зі збільшенням кількості дискоцитів в середньому до 88,11 % ± 5,78 % (р˂ 0,05) підтвердили ефективність проведення курсу ВЛТ. Було обгрунтовано ефективність застосування лазерної терапії для пацієнтів з V–VI фототипами: використання довгохвильового неодимового лазера (λ = 1064 нм) для елімінації кліщів роду Демодекс та зменшення проявів запалення в групі пацієнтів із V–VI ФТ забезпечило елімінацію кліща в 70 % пацієнтів та зменшення клінічних проявів на 58,9 % (р ˂ 0,05). Наукова новизна дослідження полягає в установленні асоціації між наявністю мультиморбідності ВХ + Д + ДЖМ та погіршенням клінічного статусу, включаючи загальну площу еритеми й інтенсивність свербежу, якість життя хворих, а також в установленні асоціації коморбідних станів у пацієнтів із ВХ + Д + ДЖМ зі збільшенням патологічних форм еритроцитів. Уперше вивчено поширеність вугрової хвороби та її коморбідності з демодекозом та дискінезією жовчного міхура в когорті осіб 19–36 років із різними фототипами, а також проведено порівняльний аналіз для визначення особливостей клінічної картини в пацієнтів із різними фототипами. Уточнено ризики виникнення ураження шкіри кліщами роду Демодекс серед осіб із вугровою хворобою. Покращено діагностику демодексного ураження шкіри шляхом розроблення способу, що передбачає використання клейкої стрічки розміром 2 см х 2 см, яку накладали на попередньо оброблену 0,05 % розчином хлоргексидину біглюконату шкіру з подальшою мікроскопією та підрахунком кількості особин кліща, що підвищує точність дослідження і може бути використано як експрес-тест. Розроблено, доведено ефективність та запатентовано спосіб корекції постзапальних змін на шкірі після регресу папулопустульозних елементів із застосуванням фотосенсибілізатора хлоринового ряду, який активували дистантним лазерним випромінюванням із довжиною хвилі λ = 660 нм, середньою сумарною дозою енергії за одну процедуру 500–700 Дж. Адаптовано методику дистантного лазерного лікування ВХ та елімінаційної терапії кліщів роду Демодекс із використанням довгохвильового Nd:YAG-випромінювання λ = 1064 нм; Ø – 4, 6, 9 мм; флюенс – 35 Дж/см2; довжина імпульсу – 0,6 мс. Таким чином, у дослідженні уперше розроблено та обгрунтовано алгоритм комбінованої терапії вугрової хвороби середнього ступеня тяжкості у коморбідності з демодекозом та дискінезією жовчного міхура з урахуванням стадійності процесу та особливостей перебігу із застосуванням додатково до стандартної терапії високоінтенсивних лазерних джерел випромінювання (для зменшення ознак запалення й елімінації кліщів роду Демодекс), низькоінтенсивного лазерного випромінювання (для корекції постзапальних змін), ВЛТ (для корекції функціональних порушень жовчного міхура та нормалізації співвідношення нормальних форм еритроцитів), ФДТ (для зменшення проявів постзапальної еритеми).
The total result of the research contains a rational approach to solving the problem, which involves studying the impact of acne vulgaris (AV) and comorbid conditions (demodecosis and gallbladder dyskinesia) on the severity of the clinical course, morphology of erythrocytes (degree of poikilocytosis), quality of life combination therapy using laser therapy. The aim of the study is to improve the diagnosis and comprehensive treatment of patients with acne in comorbidity with demodicosis and gallbladder dyskinesia using high - and low - intensity laser radiation to reduce inflammation, congestive erythema and correction of hypomotor disorders of the gallbladder. The prevalence of acne among 378 young people aged 19–36 years with different phototypes (PT) were studied, of which AV was detected in 82.7 % of II–III PT and 68.5 % of V–VI PT. In order to increase the informativeness of the diagnosis of demodex skin lesions and reduce the time of the study, an epithelial scotch test was developed and patented, which was used to establish the comorbidity of AV with demodectic mange in 305 people (268 from II–III / 37 from V–VI PT). The presence of ticks was found in 67.1 % of people with II–III and 27.02 % of people with V–VI PT. Comorbidity of acne with gallbladder dyskinesia (GBD) was studied among 268 people with II–III PT, who underwent a two-stage ultrasound study using a choleretic stimulant. Hypokinetic dysfunction was found among 44 % of subjects. To assess the risks of demodex skin lesions in people with acne, 132 people were involved: 56 without acne elements and 76 with acne elements. At the time of enrollment, no Demodex mites were found among the patients. A re-examination 12 months later revealed the presence of ticks in 3.57 % of people without AV and in 21.05 % of AV. The odds ratio (OR) was 7.2 (CI 95 %: 1.582, 32.765), which reliably confirms the impact of acne on the risk of demodicosis (p = 0.00533). 150 patients with moderate acne (40 patients with acne without comorbid pathology; 50 patients with acne in comorbidity with demodicosis (D); 50 patients with acne in comorbidity with demodecosis and gallbladder dyskinesia, 10 people with acne and demodicosis with V–VI PT and 35 people were selected to implement the objectives of the study. practically healthy people, comparable in age and sex. The influence of comorbid pathologies on the severity of the clinical picture of acne was established using the international scale Global Acne Grading System GAGS. The severity of the clinical picture in patients with acne was lower by 6.9 % than in people with acne and demodicosis, and 13.8% lower than in the group with acne, demodicosis and GBD. The association between the severity of clinical manifestations of acne and the presence of comorbidity with demodicosis and GBD was confirmed by a strong direct relationship r = +0.91 (p < 0.001). When assessing the intensity of itching on the visual analog scale VAS (Visual analogue scale) in the group with comorbidity acne with demodecosis mange was 9.3 %, and in the group AV + D + GBD – 20.9 % higher than in patients with AV (p ˂ 0.05). The area of post-inflammatory erythema calculated using the Image J program and the Clinician Erythema Assessment Scale showed a significant difference between patients with acne and study groups with comorbid conditions. The study of morphological characteristics of blood cells on the basis of data obtained by light and scanning electron microscopy, found a significant increase in the relative number of altered forms of erythrocytes to 17.8 % ± 8.94 % (p˂0.05) due to an increase in echinocytes 1 and 2 order in the presence of comorbid states, while in the control group this figure was 7.48 % ± 2.43%. The association between the presence of GBD and the level of poikilocytosis in patients with acne was confirmed by the establishment of a direct relationship of medium strength during Pearson's correlation analysis r = +0.75 (p < 0.05). The impact of acne on quality of life, determined by the DLQI questionnaire, shows a significant difference between the groups: among patients with comorbidity of acne with demodicosis and GBD the average overall score was 8.88 points compared to 5.97 in patients with acne. The association of the burden of acne with comorbid pathology and the quality of life of patients with acne was proved by calculating the correlations r = +0.71 (p <0.005). In order to improve the treatment of acne in comorbidity with demodicosis and gallbladder dyskinesia, an algorithm of combination therapy with the gradual use of topical and systemic laser therapy was developed. To reduce the manifestations of inflammation and elimination of ticks of the genus Demodex, patients underwent a course of laser procedures using a laser device with a wavelength of 1064 nm with remote treatment of the skin on the following parameters: wave length (λ) = 1064 nm; spot diameter (Ø) – 6 mm; fluence – 35 J/cm2; pulse length – 0.6 ms. Intravenous low laser therapy (LLT) using a radiation head with λ = 635 nm in a continuous mode with a radiation power of 1.5 mW with a 15-minute exposure was used to correct hypomotor dysfunction of the gallbladder. To reduce the area of post-inflammatory erythema, a course of photodynamic therapy (PDT) was developed and patented using a chlorine-type photosensitizer, which was performed according to the following modes: λ = 660 nm, average total energy dose for one procedure 500-700 J. The effectiveness of the therapy was determined by the results of a follow-up evaluation on day 60 of the study: clinical manifestations of acne on the GAGS scale among patients with AV + D decreased by 50.1 %, among patients of the group 3 and 49.65 % of AV + D + GBD compared to baseline. At the same time, the improvement in quality of life by the DLQI scale compared to baseline occurred by 68 % and 72.8 % among patients in groups AV + D and AV + D + GBD, respectively (p ˂ 0.05). When analyzing the effectiveness of elimination therapy, it was found that ticks of the genus Demodex are absent in 88 % of patients in the group with AV + D, and in 82 % of patients in the group with AV + D + GBD. Normalization of gallbladder function in 100 % of patients of the group with AV + D + GBD (48.0 % ± 7.9 %) and a decrease in the number of echinocytes to 8.89 ± 1.36 % with an increase in the number of discocytes to 88.11 % ± 5.78 % (p˂ 0.05 ) confirmed the effectiveness of the LLT course. The use of a long-wave neodymium laser (λ = 1 064 nm) to eliminate the Demodex mites and reduce inflammation in the group of patients with V–VI phototype ensured the elimination of mites in 70 % of patients and reduced clinical manifestations by 58.9 % (p ˂ 0.05) , which proves the effectiveness and validity of the use of laser therapy for patients with V–VI phototype. The scientific novelty of the study includes an establishing of the association between the presence of multimorbidity AV + D + GBD and deterioration of clinical status, including the total area of post- inflammatory erythema and itching intensity, quality of life, and an establishing of the association of comorbid conditions in the patients with AV + D + GBD with increasing pathological forms of erythrocytes. The prevalence of acne and its comorbidity with demodicosis and gallbladder dyskinesia was studied for the first time in a cohort of 19–36 years with different phototypes. A comparative analysis was performed to determine the clinical picture in patients with different phototypes. The risks of the Demodex skin lesions have been clarified among people with acne. Improved diagnosis of demodex skin lesions was rich by developing a method involving the use of adhesive tape measuring 2 x 2 cm, which was applied to pre-treated with 0.05 % solution of chlorhexidine bigluconate skin, followed by microscopy and counting the number of mites. This method allows to increases the accuracy of the study and this method can be used as an express test. The method of correction of post-inflammatory changes in the skin after the resolution of papulopustular elements was developed and patented. This approach includes using a photosensitizer of the chlorine series, with activation by distant laser radiation λ = 660 nm, an average total dose of 500 J. For elimination therapy of the Demodex mites in AV patients the method with using long-wave Nd: YAG radiation λ =1 064 nm was applied (Ø – 4, 6, 9 mm; fluence – 35 J/cm2; pulse length – 0.6 ms). As conclusion, an algorithm for combined laser therapy of moderate acne in comorbidity with demodecosis and gallbladder dyskinesia was developed and substantiated, taking into account the stages of the process and the peculiarities of the course: high-intensity laser radiation sources (to reduce symptoms); low-intensity laser radiation (for correction of post-inflammatory changes), LLT (for correction of functional disorders of the gallbladder and normalization of the ratio of normal forms of erythrocytes); PDT (to reduce the manifestations of post-inflammatory erythema, in addition to standard therapy).

Acne is prevalent amongst youth in Hong Kong and has considerable psychological effects. The application of a TCM approach led to the detection of significant associations between diet and the occurence of acne. TCM-syndrome-tailored dietary manipulation was effective in reducing the clinical severity of acne for patients with imbalance of chong-ren subtype. (Abstract shortened by UMI.)
In (1), 1068 Chinese subjects were sampled from the general health evaluation and eight governmental secondary schools in Hong Kong were assessed for their clinical severity of acne. Over 93% of the subjects had a certain degree of acne and the prevalence of clinical acne was of 40.4% and coexisted with a high frequency of acne disability. Assessment of the clinical severity of acne did not correlate strongly with the effect on QOL (gammas= 0.445, P < 0.001). Multivariate logistic regression showed that female gender (P = 0.002), higher GAGS score (P < 0.001), higher perceived stress (P = 0.01) and willingness to pay Hong Kong $15,000 for a hypothetical permanent cure (P = 0.03) were positive predictors for acne disability.
In (2), 322 university entrants completed a dietary questionnaire capturing 11 categories of food intake and were examined for body constitutions of yin-predominance or yang-predominance with a published TCM diagnostic assessment procedure/method. There were 155 (48.1%) participants in the yin-predominant group and 167 (51.9%) in the yang-predominant group. No association of diet and acne was found when the participants were considered as a whole group. In yin-predominant group, intake of foods from street stalls (P = 0.04) was significantly associated with a lower likelihood of acne occurence. In yang-PG, the intake of desserts (P = 0.04) and fresh fruit juices (P = 0.02) was significantly associated with a higher likelihood of acne occurence, whereas the intake of dairy and soy products (P = 0.04) was significantly associated with a lower likelihood of acne occurence.
In (3), 233 students with clinical acne as assessed by GAGS were diagnosed for his or her TCM syndrome subtype, namely wind-heat subtype, damp-heat subtype, stagnant blood or phlegm subtype, and imbalance of chong-ren subtype. They were then randomly assigned to either intervention group (IG) or control group (CG). There were respectively 60 students belonged to each of the wind-heat, damp-heat, and stagnant blood or phelgm subtypes, and 53 students belonged to imbalanced of chong-ren subtype. With the use of a computer generated randomisation list using blocks of six, 30 (50%) students were assigned to either IG or CG for wind-heat, damp-heat, and stagnant blood or phelgm subtypes accordingly, whilst 26 (49%) and 27 (51%) students were assigned to either IG or CG for imbalance of chongren subtype. TCM-syndrome-tailored diet advice plus standard medical advice were given to IG whilst standard medical advice alone was given to CG over 12-week study period. The primary analysis was to compare the percentage change of GAGS from baseline to 12 weeks between the groups using univariate analysis for each TCM syndrome, controlling for the variation in the dependent variables due to gender, age, BMI, schools, physical exercise, and female contraceptive use. Within the imbalance of chong-ren subtype, there was a significant reduction of acne severity in IG compared with that in CG (-11.8% vs 2.1%; p=0.046), after adjusting for gender, age, body mass index, schools, physical exercise, and female contraceptive use. In the other three subtypes, there were no significant differences of acne severity between IG and CG
This research was composed of three major parts: (1) a cross-sectional study investigating the prevalence of acne and the acne disability amongst adolescents and young adults from August 2006 to March 2008 in Hong Kong; (2) a cross sectional study investigate the diet-acne connection from a traditional Chinese medicine (TCM) perspective performed amongst young adults in August 2006; and (3) a randomised controlled trial on the effectivenss of TCM-syndrome-tailored dietary advice for adolescents implemented between November 2007 and March 2008 in Hong Kong.
Law, Pui Man.
Adviser: Albert Lee.
Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 140-154).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese; appendix 2-3 in Chinese.

Relatório de Estágio do Mestrado Integrado em Ciências Farmacêuticas apresentado à Faculdade de Farmácia
Relatórios de estágio: Durante o período compreendido entre janeiro e julho de 2021, tive a oportunidade de realizar dois estágios curriculares, um em Farmácia Comunitária e outro em Indústria Farmacêutica. Estes estágios assumem elevada importância no percurso académico do estudante do Mestrado Integrado em Ciências Farmacêuticas, pois permitem adquirir conhecimentos e desenvolver competências, essenciais no seu futuro profissional. Os relatórios de estágio são estruturados na forma de análise SWOT (do inglês, Strengths, Weaknesses, Opportunities and Threats), nos quais são identificados os pontos fortes e fracos do respetivo estágio, bem como oportunidades e ameaças encontradas ao longo do mesmo. Monografia: A acne vulgar é uma doença dermatológica crónica comum. Os seus fatores-chave de desenvolvimento podem ser influenciados por um conjunto de fatores externos. É uma patologia multifatorial, que origina lesões de várias etiologias e cuja classificação varia em função da gravidade e tipo de lesões. O tratamento da acne vulgar tem como objetivo controlar os fatores-chave do seu desenvolvimento, variando em função da sua classificação. O seu tratamento farmacológico assenta em terapêutica tópica e/ou sistémica. Nos últimos anos, têm sido desenvolvidas terapêuticas inovadoras para o tratamento e resolução das lesões da acne, onde se incluem os dispositivos médicos, nomeadamente a terapia fotodinâmica, os dispositivos médicos tópicos, as técnicas de microneedling, entre outras. Esta é ainda uma área em desenvolvimento, no sentido em que novos estudos devem ser realizados no futuro.
Internship reports: During the period between January and July of 2021, I had the opportunity to carry out two curricular internships, one in Community Pharmacy and the other in Pharmaceutical Industry. These internships are of great importance in the academic path of the Integrated Master in Pharmaceutical Sciences student, as they allow them to acquire knowledge and develop skills, which are essential for their professional future. The internship reports are structured in the form of SWOT analysis (Strengths, Weaknesses, Opportunities and Threats), in which the strengths and weaknesses of the respective internship are identified, as well as the opportunities and threats found throughout it. Monograph: Acne vulgaris is a common chronic dermatological disease. Its key development factors can be influenced by a set of external factors. It is a multifactorial pathology, which causes injuries of various etiologies and whose classification depends on the severity and type of lesions. Acne vulgaris treatment aims to control the key development factors, depending on its classification. Its pharmacological treatment is based on topical and/or systemic therapy. In recent years, innovative therapies have been developed for the treatment and resolution of acne lesions, including medical devices, namely photodynamic therapy, topical medical devices, microneedling techniques, among others. This is still an area under development, in the sense that further studies must be carried out in the future.