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Background: Isotretinoin is an effective treatment for acne but can cause side effects such as changes in blood lipids and liver enzymes. Laboratory monitoring is essential during treatment, but there is variation in monitoring practices. Aim: This study aims to investigate the relationship between isotretinoin therapy and its effects on complete blood count in Saudi Arabia to improve patient outcomes. Methods: The study was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, between January 2016 and December 2020. Following the inclusion and exclusion criteria, 515 patients were randomly selected for the study. The data was analyzed using SPSS, and descriptive statistics and paired samples t-tests were employed to analyze the data. Results: In this study, 515 patients were enrolled. Of these participants, 76.7% (n=395) were females and 23.3% (n=120) were males. The mean age of the study participants was 23.98± 7.4 years and ranged between 16 and 65 years. The mean dose of Isotretinoin administered was 27.65± 9.6 mg/day, with a range of 10– 60 mg/day. The mean BMI of the study participants was 24.3± 4.1 kg/m2, ranging from 14.3 to 44.8 kg/m2. Regarding the effect of Isotretinoin on laboratory measures, significant statistical differences were found in hemoglobin measurements (t=− 3.379, p=0.001), platelets (t=− 3.169, p=0.002), neutrophils (%) (t=3.107, p=0.002), total cholesterol (t=− 13.017, p=0.000), AST (t=− 6.353, p=0.000), ALT (t=− 4.352, p=0.000), HDL (t=2.446, p=0.015), and LDL (t=− 12.943, p=0.000). However, there were no significant statistical differences in the measurements of WBC, neutrophils (count), or triglycerides. In the Chi-square analysis and Fisher's Exact test to identify the interaction between BMI, dose, and gender on abnormal lab results, significant interaction was found between participants' BMI and abnormal HDL measurements (p=0.006). Furthermore, there were significant interactions between Isotretinoin dose (either less than 30 mg/day or 30 mg/day or more) and abnormal neutrophil count (p=0.04), abnormal HDL measurements (p=0.010), and abnormal triglycerides measurements (p=0.020). Moreover, a statistically significant interaction was found between participants' gender and abnormal hemoglobin measurements (p=0.006), abnormal total cholesterol (p=0.016), abnormal AST measurements (p=0.001), abnormal ALT measurements (p=0.000), abnormal HDL measurements (p=0.000), and abnormal triglycerides measurements (p=0.007). Conclusion: In conclusion, the study found that isotretinoin therapy has significant effects on several laboratory measures, including hemoglobin, platelets, neutrophils, total cholesterol, AST, ALT, HDL, and LDL. The study also revealed significant interactions between BMI, dose, gender, and abnormal lab results. [ABSTRACT FROM AUTHOR]

Abstract Background Acne is a common pilosebaceous unit chronic inflammatory disease, with a multifactorial pathogenesis. It involves several processes: increased sebum production, alteration of the follicular keratinization process and bacterial colonization by Cutibacterium acnes. Objectives To evaluate the effectiveness of reflectance confocal microscopy (RCM) in evaluating the reduction of mild to severe acne lesions in patients treated with an investigational product containing Silybum marianum fruit extract (SMFE). Methods Subjects previously examined for counting acne lesions were topically treated in the face, with an investigational product containing SMFE in monotherapy over the course of 60 days (n = 31). They were examined for counting acne lesions. Efficacy and quality of life, tolerability, and safety assessments were performed. The infundibular diameter (ID) measurement of normal and acne skin areas was analyzed using RCM. Results The RCM data statistical analysis allowed us to identify two ID patterns, 300–750 µm, with a reduction of 33.33% (p

Introduction: Topical therapy is the mainstay treatment of acne, and topical retinoids such as tretinoin, tazarotene, and adapalene are recommended as the first‐line therapy for mild to moderate acne. However, the cutaneous irritations may occur, and the dermocosmetics are recommended to prevent side effects of anti‐acne drugs and adhere to treatment. Thus, this study aims to compare the efficacy and tolerability of ceramides and niacinamide‐containing moisturizer (CCM) versus hydrophilic cream in combination with topical anti‐acne treatment in mild to moderate acne vulgaris. Methods: This was an 8‐week, randomized, double‐blinded, split face study in 40 patients assigned for topical anti‐acne medications (5% benzoyl peroxide and 0.1% adapalene gel), then randomly applied CCM or hydrophilic cream. All patients were followed at week 0, 2, 4, and 8 for acne improvement, adverse reactions, biometric, and biophysical evaluation. Results: CCM could significantly improve the non‐inflammatory, inflammatory, and total acne lesions compared with hydrophilic cream after week 8 of treatment. Interestingly, there was an improvement of global worst score, hemoglobin index, melanin index, TEWL, skin hydration, sebum production, and skin surface pH, with no statistically significant differences between the two treatments. No serious side effects from clinical application of CCM and hydrophilic cream in mild to moderate acne vulgaris patients. Conclusion: Ceramide and niacinamide‐containing moisturizer in combination with anti‐acne medication can significantly improve acne lesions and decrease cutaneous irritations toward a satisfactory treatment outcome of mild to moderate acne vulgaris. [ABSTRACT FROM AUTHOR]

Abstract Acne, a common skin condition, is primarily seen in teenagers and young adults and is characterised by large pus‐filled bumps beneath the skin. Cystic acne is a common form and is linked to a high incidence of acne‐related skin diseases. Causes include age, sex, and lifestyle changes. Treatment options for severe acne include medications, laser therapy, chemical peels, and microneedling patches. This review focuses on cystic acne treatment options and discusses their advantages and disadvantages. Medications like isotretinoin reduce inflammation but have side effects. Laser therapy targets bacteria without medication but may require multiple sessions for optimal results.

Photopneumatic therapy (PPT) combines vacuum and pulsed, broadband light to extract debris and bacteria from the pilosebaceous units; monotherapy is unexplored. Facial acne lesions and skin texture were evaluated after up to six PPT treatments, 1–2 weeks apart for 15–20 minutes per treatment using customized energy settings, in seven female patients with inflammatory, comedonal and pustular lesions. Lesion and redness reduction with improvement in skin texture and pore size were observed after 1–3 treatments; adverse effects were infrequent. PPT may optimize lesion clearance as monotherapy and/or as an adjuvant. The ability to change pulse structure, pulse duration, vacuum pressure and fluence allow for treatment that best matches skin type and acne severity. [ABSTRACT FROM AUTHOR]

Background: Houttuynia cordata Thunb. has long been widely used as a daily vegetable and traditional medicine. The flavonoid component of H. cordata has plenty of pharmacological effects, such as antibacterial, anti-inflammatory, and antioxidant. In this study, we applied the aqueous two-phase system (ATPS) combined with ultrasonic extraction for extracting H. cordata leaves. Methods: We optimized the extraction process to improve the extraction efficiency of the two flavonoids, hyperin and quercitrin, by Surface Method Response - Central Composite Design (RSM-CCD). Next, we investigated the antibacterial ability of H. cordata ATPS extract from optimal conditions against two bacterial strains, Cutibacterium acnes and Staphylococcus epidermidis. Results: The results showed that using 10% (NH4)2SO4 and 35% ethanol for ATPS extraction resulted in the highest hyperin and quercitrin contents. From the RSM-CCD results, the optimal extraction conditions were determined to be ultrasonic extraction at 50 °C for 30 min, giving results consistent with the predicted model and obtaining hyperin and quercitrin contents at 1.5681 ± 0.0114 and 4.6225 ± 0.0327 mg/g, respectively.Furthermore, ATPS extract has excellent antibacterial activity with a minimum inhibitory concentration (MIC) value of 250 μg/mL on both C. acnes and S. epidermidis. This MIC is significantly lower than the H. cordata ultrasound-assisted (UA) extract, with MICs of 1500.00 and 156.25 μg/mL on C. acnes and S. epidermidis, respectively. In addition, the results from the disk diffusion assay also showed that ATPS extraction has superior internal antibacterial activity with a zone of inhibition diameter at 250 μg/mL of 8.67 ± 1.15 and 5.00 ± 2.00 mm. Meanwhile, those of UA extract on C. acnes is 5.67 ± 1.53 mm (at 1500 μg/mL), and on S. epidermidis is 1.34 ± 0.58 mm (at 156.25 μg/mL). Conclusion: To sum up, our research highlights the potential of H. cordata ATPS extracts as the starting material for topical preparations for effectively treating acne.

Background: Globally, Acne Vulgaris is a widespread, chronic inflammatory condition of the pilosebaceous follicles. Acne is not fatal, but depending on its severity, it can leave the sufferer with scars, irritation, and significant psychological effects (including depression). In the current review, we have included various factors for acne and their treatment explained. It also narrated the current medicament and the new investigation dosage forms with clinical phases information provided. Main body of the abstract: Acne's pathophysiology involves four important factors: excessive sebum production, hyperkeratinization of pilosebaceous follicles, hyperproliferation of propionibacterium acnes (P. acnes), and inflammation. Identifying both inflammatory (Papule, pustule, nodule, and cyst) and non-inflammatory (black heads, white heads) acne lesions is necessary for diagnosing and treating acne vulgaris. Short conclusion: In this review, traditional therapy approaches such as topical (i.e., retinoids and antibiotics), systemic (i.e., retinoids, antibiotics, and hormonal), and physical therapies are briefly discussed. In addition, we highlight the issues posed by P. acne's resistance to the antibiotics used in commercially available medications and the necessity for novel therapeutic techniques. Finally, we examined a few innovative acne therapies pending clinical trial approval and commercial acne medications.

Objective In this study, photosensitivity and other side effects due to the usage of systemic doxycycline in summer during acne treatment and whether these side effects were related to the demographic and clinical properties of the patients were investigated. Methods Before conducting the study, approval of the ethics committee of the hospital was obtained. 251 patients who applied to the dermatology outpatient clinic between 01.05.2021-30.09.2021 and were diagnosed with moderate-severe acne were included in the study. Demographic characteristic of the patients, clinical and treatment features, and development of photosensitivity or other side effects during or after the treatment were examined. Results Side effects were seen in 9 out of a total of 251 patients (3.6%). Among these patients, 5 patients (2%) had erythematous papules or plaque-like lesions on the face, and 4 patients (1.6%) had erythematous papules on the forearms. A statistically significant difference for age, sex, the severity of the disease, and treatment dose was not detected between groups classified according to the side effects (p values were respectively: 0.67, 0.058, 0.343, and 0.858). Statistically, a significant difference was found between these groups for the treatment period and usage of sun protection (p values were respectively: 0.011 and 0.003). Conclusion In patients who have erythematous papules and plaques on the face, these findings regressed with topical treatment. Therefore these findings were considered to be due to the usage of the topical acne agent. However, most patients having erythematous papules on their forearms were not using sunscreens and had personal and/or familial history of atopy. Because side effects did not require cessation of the systemic treatment and regressed with administered treatment; in the case of regular usage of sunscreen and utilization of benzoyl peroxide in combination, the photosensitivity side effect was thought to be minimal. [ABSTRACT FROM AUTHOR]

Background and Design: Social media is extremely popular for obtaining information on dermatological diseases and their treatments. The present study aimed to evaluate Turkish YouTube videos on acne treatment and compare them in terms of quality, reliability, and popularity based on the upload source. Materials and Methods: The first 120 Turkish YouTube videos on acne treatments were reviewed. The number of views, likes, dislikes, comments, video age, and video length were recorded. The quality and reliability of the videos were evaluated with the video power index (VPI). Then, the findings were compared based on the upload source. Results: A total of 104 videos uploaded by 52 physicians and 52 non-physicians (female: male ratio: 3.3: 1) were assessed in this study. The DISCERN Score and Global Quality Score (GQS) were higher in the physicians' group (n=52, 50%) (p

Wiktoria Odrzywołek,1 Anna Deda,2 Julita Zdrada,1 Sławomir Wilczyński,1 Barbara Błońska-Fajfrowska,1 Aleksandra Lipka-Trawińska1 1Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland; 2Department of Cosmetology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, PolandCorrespondence: Wiktoria Odrzywołek, Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 41-200 Sosnowiec, ul. Kasztanowa 3, Katowice, Poland, Tel +32269 98 30, Email wiktoria.odrzywolek@wp.plPurpose: Acne vulgaris is a chronic, inflammatory disease accompanied by lesions affecting the structure of the skin. Chemical peels are one of the methods of reducing acne vulgaris. There is still a lack of quantitative methods of assessing impact of cosmetic procedure on the skin. Skin condition depends on skin texture characterization; therefore, the analysis that provides data about the textures can be helpful in assessing the effectiveness of cosmetic treatments.Patients and Methods: The study involved 24 volunteers with acne lesions. Each participant underwent 4 treatments using chemical peels at two-week intervals. Before, during and after procedure clinical photography were made. To assess effectiveness of chemical peeling in acne lesion reduction, we were used gray-level co-occurrence matrix (GLCM) analysis. Qualitative assessment of acne severity was made by 12 experts in dermatology.Results: After a series of treatments, the GLCM contrast value decreased in each area of the face, and the GLCM homogeneity value increased, which means that the number of acne lesions was reduced. Expert assessment according to the IGA scale confirms the effectiveness of therapy with both salicylic and glycolic acid and pyruvic acid.Conclusion: The results of this study prove that GLCM analysis is a useful tool for assessing the effectiveness of chemical peel treatments. It can also be used for quantitative assessment of skin texture.Keywords: gray-level co-occurrence matrix, acne, chemical peelings, acne treatment, skin texture

Background and Design: Social media is extremely popular for obtaining information on dermatological diseases and their treatments. The present study aimed to evaluate Turkish YouTube videos on acne treatment and compare them in terms of quality, reliability, and popularity based on the upload source. Materials and Methods: The first 120 Turkish YouTube videos on acne treatments were reviewed. The number of views, likes, dislikes, comments, video age, and video length were recorded. The quality and reliability of the videos were evaluated with the video power index (VPI). Then, the findings were compared based on the upload source. Results: A total of 104 videos uploaded by 52 physicians and 52 non-physicians (female: male ratio: 3.3:1) were assessed in this study. The DISCERN Score and Global Quality Score (GQS) were higher in the physicians' group (n=52, 50%) (p<0.001). The number of views, likes, dislikes, comments and VPI were significantly higher in the non-physicians group. The time elapsed since the upload day was longer in the videos uploaded by physicians, and the video duration was longer in the videos uploaded by non-physicians (p<0.001). The DISCERN and GQS in videos uploaded by dermatologists (n=30, 54%) were higher (p<0.001) than in those uploaded by non-dermatologists (n=22, 46%). No statistically significant difference was found in other findings. Conclusion: This study's findings confirmed that Turkish YouTube videos on acne treatment uploaded by doctors, especially dermatologists, were of higher quality and reliable, albeit with lower viewing rates and popularity. [ABSTRACT FROM AUTHOR]

Borneol essential oil (BEO), a plant essential oil derived from hydrodistillation of fresh branches and leaves of Cinnamomum camphora (L.). This study optimized cellulase and xylanase-assisted BEO, extraction using an orthogonal design. Additionally, it explored the inhibitory effects of BEO on Propionibacterium acnes and elucidated the anti-bacterial mechanisms via molecular docking. Furthermore, the acne treatment mechanism of BEO was investigated using network pharmacology-molecular docking. The findings indicated that the concentration of borneol in BEO was 2.34 times higher than that achieved through hydrodistillation. This enhancement was achieved by adding enzymes in a volume equivalent to 2 % of the raw material, followed by a 2-hour enzymolysis process conducted at 40℃. BEO exhibited a significant inhibition zone of 31.6±0.5 mm against Propionibacterium acnes. Molecular docking analysis revealed that six, three, and one chemical components in BEO exhibited molecular binding energies exceeding 5.00 kJ/mol with key target proteins involved in the pathogenesis of Propionibacterium acnes : deoxyribonuclease I (DNase I), dermatan sulfate (DsA1), and Christie, Atkins, Munch-Peterson (CAMP), respectively. This indicates a close relationship between the chemical components and the target proteins. Network pharmacology analysis identified 40 common targets between BEO and acne formation, from which 12 key targets were identified. Among these, ovarian steroidogenesis exhibited the highest degree of enrichment in the signaling pathway. These findings provide a scientific foundation for the development of acne treatment cosmetics utilizing BEO. [Display omitted] • Cellulase and xylanase-assisted method improved the effect of BEO extraction. • BEO significantly inhibits P. acnes. • Docking energy between linalool and key proteins of P. acnes is the strongest. • Ovarian steroidogenesis is the most involved signaling pathway in the targets. [ABSTRACT FROM AUTHOR]

Acne affects approximately 9% of people worldwide and is the most common skin condition in the USA. There are abundant topical and oral treatment options available for patients with acne. First‐line agents include topical retinoids, azelaic acid, benzoyl peroxide, and combinations of these agents. For recalcitrant or more severe acne, oral medications, including oral antibiotics, isotretinoin, or hormonal therapy, may be considered. This review will also discuss the many advances being made in the treatment of acne vulgaris, from the development of microencapsulated medications to targeted treatments. [ABSTRACT FROM AUTHOR]

Multiple approaches are used to treat acne scars, but some are expensive, ineffective, and cause complications. We aimed to evaluate the efficacy and safety of ultra‐pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid in the treatment of acne scars in a prospective split‐face control study. Twenty patients with facial symmetrical acne scars were enrolled. One side of face was randomly treated with 30% supramolecular salicylic acid, and two sides were treated with ultra‐pulsed CO2 fractional laser. The Echelle d'evaluation clinique des cicatrices d'acne (ECCA) scale was used to evaluate the clinical efficacy before and 3 months after treatment, and a quartile scale was used to self‐evaluate the improvement of patients. A visual analog scale was used to record pain scores after each treatment, and side effects and other adverse reactions on the face were recorded. All the patients completed treatment and follow‐up. There was statistical difference in ECCA scores of bilateral facial acne scars after three treatments (p < 0.001). ECCA scores on the combined side were lower after three treatments than those on the laser side (p = 0.003). The patient satisfaction quartile scale on the combined side was higher than that on the laser side alone (p = 0.015). Ultra‐pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid has better efficacy in the treatment of acne scars than laser alone, and patient self‐assessment of combined treatment has a greater degree of improvement in acne scars, and does not increase patient pain scores and related adverse reactions. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: El acné es una enfermedad inflamatoria crónica, en cuya patogenia intervienen diferentes actores, siendo Cutibacterium acnes (C. acnes) uno de ellos. La resistencia de esta bacteria a los diferentes fármacos antimicrobianos utilizados en su tratamiento ha sido descrita en diferentes regiones del mundo. El objetivo de este estudio fue estimar la resistencia de C. acnes a las ciclinas en pacientes mayores de 18 años con acné de moderado a severo. Materiales y métodos: Se realizó un estudio transversal analítico. Se obtuvieron muestras de las lesiones inflamatorias con un extractor de comedones. Se incubó el contenido de las muestras en ambiente anaeróbico para aislar C. acnes. Por último, se estimó la susceptibilidad de C. acnes a la tetraciclina, minociclina y doxiciclina. Resultados: Se obtuvieron muestras de 147 pacientes, observándose crecimiento de C. acnes en 129 de ellos, y encontrándose que el 5,43% de las cepas era resistente a tetraciclina, el 5,43% a doxiciclina, el 0,78% a minociclina, y una resistencia cruzada entre doxiciclina y tetraciclina en todos los casos. Se encontró una asociación entre resistencia y edad igual o superior a 25 años. No se encontró asociación con el uso previo de antibióticos, historia de mal uso de antibióticos orales o tópicos y otras características demográficas y clínicas evaluadas. Conclusiones: La resistencia a las ciclinas encontrada en C. acnes fue menor que la reportada en otros estudios. Aunque no se encontró relación con el uso previo de antibióticos, se trata de un factor descrito en estudios previos, por lo que el uso correcto de los mismos es imperativo para evitar la aparición de resistencia. Abstract: Introduction: Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. Materials and Methods: An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. Results: Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. Conclusions: The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance.

Background: Acne is highly prevalent among teenagers and young adults, with proven negative psychological and emotional impact. To our knowledge, no study has been conducted to quantify the repercussions of acne on quality of life (QoL) and self-esteem in Lebanon. Objective: This study aimed to highlight the effect of acne treatment on QoL and self-esteem of Lebanese adolescents and young adults. Methods: In this observational prospective study, patients between 15 and 40 years old with moderate-to-severe acne were allocated to one of two treatment groups (isotretinoin vs. systemic antibiotics combined with topical treatments) and followed for a period of 6 months. The effect of acne on QoL was measured using the Dermatology Life Quality Index, Cardiff Acne Disability Index, and Rosenberg Self-esteem Scale before treatment initiation (T1), after 3 months (T2), and after 6 months (T3). A multivariate analysis of covariance model was used. Results: Sixty-two patients were included, of whom 79% were female and 61.3% had moderate acne. Fifty-five percent of patients were treated with systemic antibiotics combined with topical treatments, and 45% received isotretinoin. Mean scores of Cardiff Acne Disability Index, Dermatology Life Quality Index, and Rosenberg Self-esteem Scale at T1 were comparable between the two groups. A significant improvement was noticed in both groups at T2 and T3. The multivariate analysis of covariance model showed an interaction of time and age that concerned 25- to 40-year-old patients in both groups, who were the most negatively affected by acne at T1 and improved the most at T3. Conclusion: This study demonstrated the equivalence between acne treatments in improving QoL and revealed the social obstacle that acne creates and its recrudescence in the subgroup of women of childbearing age.

Introduction and purpose: Acne is a dermatological condition usually associated with adolescents. Although acne occurs less frequently in adults, it can have a major impact on self-esteem and functioning in daily life. In the adult population, acne is far more common in women than in men. Brief description of the state of knowledge: Adult acne lesions are usually localised in the U-zone, i.e. around the chin, jawline and mouth. There are several forms of adult acne, depending on the time of onset and clinical picture. Several factors are responsible for the occurrence of adult acne. The most important of these are the colonisation of the skin with the anaerobic bacterium Propionibacterium acnes, the overproduction of sebum and excessive keratinisation at the sebaceous gland mouths. In addition, chronic stress, nicotinism, sleep deprivation, obesity, as well as genetic predisposition, hormonal changes or sun exposure have a significant impact. The treatment of adult acne is difficult and long-lasting, usually combining pharmacology with cosmetological treatments. In the initial stage, it is based on topical retinoids, followed by the addition of azaleic acid, benzoyl peroxide and antibiotics. Summary: The treatment of adult acne is a challenge for dermatologists. It is important to inform the patient about the months-long course of the disease and treatment before the beginnig of treatment. Acne is often associated with lower self-esteem and reduced self-confidence, and even depression and relationship difficulties. For this reason, a holistic approach to the patient and treatment, is extremely important. With proper patient awareness, the chances of successful treatment are much higher.

Staphylococcus epidermidis, a major skin bacterium, can cause opportunistic infections. Use of antimicrobial agents against Cutibacterium acnes for acne treatment becomes a risk factor for emergence of antimicrobial-resistant skin bacteria. In this study, the impact of antimicrobial treatment of acne vulgaris on S. epidermidis antimicrobial resistance was assessed. A total of 344 S. epidermidis strains isolated from patients with acne vulgaris who visited hospital (165 strains) and dermatological clinics (179 strains), respectively, were analyzed. Except for doxycycline, the resistance rates were higher in strains isolated from patients who had used antimicrobials for acne treatment than in those isolated from patients who had not used antimicrobials. The prevalence rates of strains with erm(C) from patients who used macrolides and clindamycin (hospital, 78.0%; clinics, 61.3%) and those of strains with tet(M) from patients who used tetracyclines (hospital, 27.5%; clinics, 42.4%) were significantly higher than those of strains from patients who did not use antimicrobials (p < 0.05). All strains with erm(A) (8/8) and 91.7% strains with erm(C) (156/170) showed high-level resistance to macrolides and clindamycin (MIC ≥256 μg/mL). Furthermore, almost all strains with tet(M) showed resistance to minocycline. Our results showed that the use of antimicrobials for acne treatment may lead to an increased prevalence of antimicrobial-resistant S. epidermidis. In particular, the emergence of minocycline-resistant strains with tet(M) owing to the use of tetracyclines (doxycycline and minocycline) is a critical issue. Appropriate antimicrobial use for acne treatment may be an important strategy to prevent the emergence of antimicrobial-resistant skin bacteria. [ABSTRACT FROM AUTHOR]

Keywords: Lilium plant; polyphenols; polysaccharides; cosmetic application; antiaging; ultraviolet blocker; skin whitening; moisturizing; freckle removal; acne treatment EN Lilium plant polyphenols polysaccharides cosmetic application antiaging ultraviolet blocker skin whitening moisturizing freckle removal acne treatment N.PAG N.PAG 17 08/29/22 20220801 NES 220801 1. [Extracted from the article]

Introduction: Acne vulgaris is a chronic inflammatory skin disease of the pilosebaceous follicles that affects patients of all ages. Aim: Use of isotretinoin in the early stages of the disease to prevent subsequent lesions of acne, including prolonged treatment and acne scars at a later age. Material and methods: A retrospective, comparative study was carried between January 2010 and November 2018. The study population consisted of 90 children aged 9-18 years with acne. During treatment by isotretinoin the clinical evaluation was done every month. Patients were divided into three groups according to age. One of the qualification criteria was follow-up visits. Results: A total of 90 children (67.8% females; mean age: 13.5 years) were enrolled. In group A (30 individuals - aged 9-11) and B (30 individuals - aged 12-13), treatment was terminated 2 months after clinical improvement (mean: 3 months). In control group C (30 individuals - aged 14-18), treatment was carried out using average cumulative dose 135 mg/kg bw/day. All groups showed up for follow-up. after 1 to 8 years. In groups A and B, 13 people underwent a second acne treatment; in 3.33% oral isotretinoin was used, in 18.33% topical treatment. In group C, 30 (100%) individuals underwent a second acne treatment; in 20% oral isotretinoin was used, and 80% required a topical treatment. Acne scars and post acne hyperpigmentation have been documented in 73.33% in group C. Conclusions: Early, reasonable and short-term use of isotretinoin can reduce the incidence of acne in the future and reduce the occurrence of secondary acne symptoms. [ABSTRACT FROM AUTHOR]

Azadirachta indica (Neem) is a large tree that is native to India and is traditionally used due to its several properties, mainly to treat skin diseases, as well as its "herbicidal" activity. Its bark, leaves, seeds, fruits and flowers are widely used in medicinal treatment due to the presence of active secondary metabolites with biological effects, mainly limonoids and tetranortriterpenoids, such as azadirachtin. Thus, A. indica was studied in a variety of conditions, such as anticancer, antiseptic, anti-inflammatory and chemopreventive agents, as well as a biopesticide. Furthermore, differentiated cell tissue in A. indica cultivation was reported to produce active metabolites for different purposes. However, only a few studies have been developed regarding its potential use in cosmetics. For instance, most studies explained the antimicrobial properties in health conditions, such as acne, dandruff and personal health care. Here, we summarized not only the most common cosmetic claims to treat acne but also mitigating other skin disorders related to inflammatory and oxidant processes in recent in vivo studies and patents to aid researchers and industrialists to select A. indica derivatives as novel cosmetic ingredients. [ABSTRACT FROM AUTHOR]

Background: In the treatment of acne, skin parameters such as sebum secretion, hydration, and the content of hemoglobin and melanin are very important. The values of these parameters at the appropriate level show the maintenance of good functionality of the epidermal barrier and the impact of a given treatment procedure on the condition and physiology of the epidermis. Aims: The aim of the study was to evaluate the effectiveness of anti‐acne therapy with IPL by volunteers, as well as to quantify parameters such as sebum secretion, hydration level, and the content of melanin and hemoglobin in the skin. Patients/Methods: The study involved 27 volunteers with moderate acne. A series of 4 treatments was performed with intense pulse light at weekly intervals. The secretion of sebum, skin hydration, and the content of melanin and hemoglobin was measured. Results: A decrease in sebum secretion in the forehead area after light treatments was observed, the level of hydration remained the same in all areas examined, as did the levels of melanin and hemoglobin. The volunteers were asked about the satisfaction with the effects of the treatment: 100% answered that they were satisfied with the effects of the treatment to a degree of 7.8 ± 1.5. Conclusions: During anti‐acne therapy, therapists usually focus only on reducing acne lesions, forgetting that proper care has a large impact on the success of dermatological therapies. It is very important to know the influence of treatment procedures on the parameters of the skin in order to choose the right care for the best treatment effect. [ABSTRACT FROM AUTHOR]

Background: P. acnes is a pleomorphic rod that is aerotolerant, anaerobic, Gram positive, non-spore-forming, and a member of the class Propionibacteriales in the phylum Actinobacteria. Antibiotic therapy for acne is widely recognized as an effective strategy for managing this common skin condition. P. acnes skin colonization can also lead to Pseudomonas folliculitis, a Gram-negative folliculitis. By stimulating a regional upsurge in keratinocyte autophagic activity, P. acnes strains may play a role in antimicrobial defence pathways. Objective: This review article aimed to assess the antimicrobial resistance during acne treatment. Methods: We searched PubMed, Google Scholar, and Science Direct for information on Antimicrobial Resistance with Acne Treatment. However, only the most current or comprehensive study from January 2000 to May 2021 was considered. The authors also assessed references from pertinent literature. Documents in languages other than English have been disregarded since there aren't enough resources for translation. Unpublished manuscripts, oral presentations, conference abstracts, and dissertations were examples of papers that weren't considered to be serious scientific research. Conclusion: Antibiotic resistance in P. acnes could compromise the success of acne treatments. Extensive use of antibiotics to treat acne may have consequences in other illnesses where P. acnes may be the etiological culprit. Recent research has shown that the phylotype IA1 is the most common among resistant strains. Variants of this genotype that are resistant to antibiotics have been discovered all over the world, including on the skin of otherwise healthy people. [ABSTRACT FROM AUTHOR]

Topical and oral antibiotic therapy is also a popular method of treatment. The effectiveness of this method is limited by the increasing resistance of bacteria to antibiotics. Over the decades since the introduction of antibiotics to treat acne, the resistance levels of bacteria have changed. This defense mechanism is developed evolutionarily. Modifications of antibiotic receptor sites, alteration of drug influx/efflux, or enzymatic degradation are common mechanisms used by bacteria to initiate and strengthen internal antibiotic resistance. The basic chromophores used in light therapy are hemoglobin, melanin, water bound to proteins, and porphyrins. Hemoglobin absorbs light mainly at 580 nm, while melanin absorbs the entire visible spectral range (400–750 nm). Porphyrins are aromatic compounds, classified as photosensitizing substances, intensively absorbing blue light, and to a lesser extent in long visible bands, such as orange and red light. Using IPL makes it possible to cover the maximum light absorption of porphyrins and hemoglobin, therefore it can be an effective tool in the treatment of inflammatory lesions in acne vulgaris. In view of the effectiveness of light therapy and its effect even on antibiotic‐resistant bacteria, it is worth considering the possibility of using light therapy instead of antibiotic therapy. Due to the increasing resistance of bacteria to antimicrobials, they should be used with caution and as a last resort. The high‐energy light treatment act only locally (unlike with antibiotics taken orally) and on a chromophore, such as melanin, hemoglobin, or porphyrins. [ABSTRACT FROM AUTHOR]

Purpose: Azelaic acid is a natural keratolytic, comedolytic, and antibacterial drug that is used to treat acne. The topical application of azelaic acid is associated with problems such as irritation and low permeability. For dissolving, the problem is that microemulsion (ME) is used as a drug carrier. The aim of this study was to increase the azelaic acid affinity in the follicular pathway through ME. Methods: Azelaic acid-loaded MEs were prepared by the water titration method. The properties of the MEs included formulation stability, particle size, drug release profile, thermal behavior of MEs, the diffusion coefficient of the MEs and skin permeability in the non-hairy ear skin and hairy abdominal skin of guinea pig were studied in situ. Results: The MEs demonstrated a mean droplet size between 5 to 150 nm. In the higher ratios of surfactant/co-surfactant, a more extensive ME zone was found. All MEs increased the azelaic acid flux through both hairy and non-hairy skin compared with an aqueous solution of azelaic acid as a control. This effect of the ME was mainly dependent on the droplet diffusion coefficient and hydrodynamic radius. MEs with a higher diffusion coefficient demonstrated higher azelaic acid flux through hairy and non-hairy skin. Drug flux through both skins was affected by the surfactant/co-surfactant ratio in that the higher ratio increased the azelaic acid affinity into the follicular pathway. Conclusion: Finally, the ME with the highest droplet diffusion coefficient and the lowest surfactant/co-surfactant ratio was the best ME for azelaic acid delivery into the follicular pathway.

Background: Scarring is one of the most dreadful complications of acne for which patients seek surgical treatment. Objective: The aim of this research was to study the morphological features of acne scarring and the relationship between severity of acne and its treatment with type and severity of acne scars. Materials and Methods: This was a hospital-based, noninterventional, cross-sectional study carried out over a period of 1 month on 100 patients with post-acne scarring. A morphological evaluation of the types, sites, and severity of acne scars was done, and details of the severity and treatment of acne were recorded. Results: Of 100 patients included in the study, 61 were male and 39 were females. Females had an earlier onset of acne (15.8 years) as compared to males (16.5 years). The mean duration of active acne was longer in males (99.3 months) than that in females (74.4 months). Male patients had more severe acne vulgaris as compared to females (P = 0.0001). Of 100 patients, 52 started treatment 1 year after the onset of acne, and 18 patients had never taken any anti-acne medication. Morphologically, majority of post-acne scars were ice pick scars in 94% patients, followed by rolling scars in 86%, boxcar scars in 54%, and keloidal scars in 10% patients. Male patients had more severe acne scarring than females (P < 0.05). Of 54 patients with severe acne, 22 progressed to moderate grade and 32 patients progressed to severe grade of acne scarring. Significant reduction in the severity of acne scarring was observed in patients who received isotretinoin as compared to that in patients who received oral antibiotics. Conclusion: Majority of patients with active acne delay treatment, which leads to increased acne scarring. Ice pick scars are the most common type of acne scars, and keloidal scars are more common in males. Males have a longer duration of acne, they delay treatment, and have more severe acne scarring. Early introduction of oral isotretinoin may help to reduce the severity of acne scarring. Public education is essential to urge patients to seek early and appropriate treatment of acne that can reduce the incidence and severity of acne scarring and its psychosocial consequences.

The serum level of zinc and vitamin E were measured to understand the association of various nutrients on acne pathogenesis. Both zinc and vitamin E are antioxidants used as a supplement in acne treatment. However, their effect and status in acne patients are not fully understood. This study included 48 acne patients and 48 sex- and age-matched healthy controls. The zinc and vitamin E concentration was measured in the serum by flame atomic absorption spectroscopy (AAS) and HPLC methods. Compared to the healthy control, a significant deficiency of serum vitamin E level in acne patients (p<0.001) was found, although the patients were not deficient in serum zinc level (p=0.22). In addition, female acne patients had a slightly lower zinc level than male patients (p=0.06). The low serum vitamin E level suggests that supplementation of vitamin E might be helpful in acne treatment. However, further studies are required to understand the dose and mechanism of vitamin E supplements in acne treatment. [ABSTRACT FROM AUTHOR]

Vincenzo Bettoli,1 Christine Coutanceau,2 Victor Georgescu2 1Department of Medical Sciences, Operational Unit of Dermatology, Azienda Ospedaliera – University of Ferrara, Ferrara, Italy; 2Laboratoires Dermatologiques AVENE, Pierre Fabre Dermo-Cosmétique, Lavaur, FranceCorrespondence: Christine CoutanceauLaboratoires dermatologiques Avène, Pierre Fabre Dermo-Cosmétique, Les Cauquillous, Lavaur Cedex 81 506, FranceTel +33 5 6358 9652Fax +33 5 6358 8667Email christine.coutanceau@pierre-fabre.comPurpose: Cosmetic emulsions are increasingly being used as supportive care products to alleviate the severe side effects and improve the clinical outcomes associated with conventional acne treatments. The objectives of this study were to determine, in a real-life setting, the global effectiveness of an emulsion with antiseborrheic, keratolytic and anti-Propionibacterium acnes activities as an adjunct to anti-acne therapy, and to evaluate the effect of the product on acne severity, noninflammatory and inflammatory lesions, hyperseborrhea, skin irritation and patient quality of life (QoL). Tolerance of the product was also assessed.Patients and methods: This international observational study involved 3960 patients aged 12 years and over with mild-to-moderate acne. The conventional acne prescriptions for these patients were either initiated at inclusion or were reviewed. Reviewed prescriptions may have been left unchanged, switched, or an addition made to ongoing treatment. At inclusion, participants were instructed to apply the cosmetic product daily for 2–3 months in combination with their medical acne treatment.Results: After 2 to 3 months of use, the combined therapy resulted in moderate-to-large improvements in acne in over 75% of the patients whose acne prescriptions were left unchanged (n=859). The combination treatment led to an improvement in acne severity (−38.3% change in the mean investigator’s global assessment score; p

Azadirachta indica (Neem) is a large tree that is native to India and is traditionally used due to its several properties, mainly to treat skin diseases, as well as its “herbicidal” activity. Its bark, leaves, seeds, fruits and flowers are widely used in medicinal treatment due to the presence of active secondary metabolites with biological effects, mainly limonoids and tetranortriterpenoids, such as azadirachtin. Thus, A. indica was studied in a variety of conditions, such as anticancer, antiseptic, anti-inflammatory and chemopreventive agents, as well as a biopesticide. Furthermore, differentiated cell tissue in A. indica cultivation was reported to produce active metabolites for different purposes. However, only a few studies have been developed regarding its potential use in cosmetics. For instance, most studies explained the antimicrobial properties in health conditions, such as acne, dandruff and personal health care. Here, we summarized not only the most common cosmetic claims to treat acne but also mitigating other skin disorders related to inflammatory and oxidant processes in recent in vivo studies and patents to aid researchers and industrialists to select A. indica derivatives as novel cosmetic ingredients.

Background Acne vulgaris is a prevalent dermatological condition worldwide, with its impact significantly influenced by various genetic, environmental, and lifestyle factors. Despite its global prevalence, data on acne's prevalence and risk factors in Saudi Arabia remain sparse. This study aims to fill this gap by examining the prevalence of acne vulgaris and identifying associated lifestyle and environmental risk factors within the Saudi population. Methodology Employing a cross-sectional survey-based design, this study collected data from a representative sample of the Saudi population aged 18 years and older. Participants were selected through stratified random sampling and completed a self-administered online questionnaire covering demographic information, lifestyle factors, and acne history. Statistical analyses, including descriptive statistics, chi-square tests, and multivariable logistic regression, were utilized to identify significant risk factors associated with acne vulgaris. Results The survey, completed by 1,983 participants, revealed a diverse age distribution with a slight predominance of the 21-25-year age group (32.5%). Gender distribution was nearly balanced (52% female, 48% male), and the majority were single (67.3%). Lifestyle assessments indicated varied water intake, with a significant portion consuming less than 1-2 L per day. Sleep duration for most fell within the 5-7 hours range. Fast food consumption was frequent among 24% of respondents, and physical activity levels showed 40% of participants exercised minimally. Notably, 72% reported a history of acne, predominantly beginning between ages 16 and 20. Acne was mainly mild to moderate in severity and primarily affected the face. Treatment was sought by 60%, with a preference for topical solutions. Awareness around acne causes was moderate, with a high consensus on the impact of stress and diet on acne development. Conclusions Acne vulgaris in Saudi Arabia is significantly associated with various modifiable lifestyle factors, suggesting that interventions focusing on lifestyle modifications may be effective in managing and preventing acne. This study advocates for the integration of lifestyle counseling into acne treatment protocols, offering a holistic approach to managing this pervasive condition., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khormi et al.)

Purpose: Azelaic acid is a natural keratolytic, comedolytic, and antibacterial drug that is used to treat acne. The topical application of azelaic acid is associated with problems such as irritation and low permeability. For dissolving, the problem is that microemulsion (ME) is used as a drug carrier. The aim of this study was to increase the azelaic acid affinity in the follicular pathway through ME. Methods: Azelaic acid-loaded MEs were prepared by the water titration method. The properties of the MEs included formulation stability, particle size, drug release profile, thermal behavior of MEs, the diffusion coefficient of the MEs and skin permeability in the non-hairy ear skin and hairy abdominal skin of guinea pig were studied in situ. Results: The MEs demonstrated a mean droplet size between 5 to 150 nm. In the higher ratios of surfactant/co-surfactant, a more extensive ME zone was found. All MEs increased the azelaic acid flux through both hairy and non-hairy skin compared with an aqueous solution of azelaic acid as a control. This effect of the ME was mainly dependent on the droplet diffusion coefficient and hydrodynamic radius. MEs with a higher diffusion coefficient demonstrated higher azelaic acid flux through hairy and non-hairy skin. Drug flux through both skins was affected by the surfactant/co-surfactant ratio in that the higher ratio increased the azelaic acid affinity into the follicular pathway. Conclusion: Finally, the ME with the highest droplet diffusion coefficient and the lowest surfactant/co-surfactant ratio was the best ME for azelaic acid delivery into the follicular pathway. [ABSTRACT FROM AUTHOR]

Background Acne vulgaris (AV) is a chronic inflammatory pilosebaceous follicular disease, with significant psychosocial impact and challenging in its management. Data in Indonesian population is still lacking. This study also highlights AV management according to Indonesian Acne Expert Meeting (IAEM) guideline, which was introduced and implemented nationally since 2012. Aim To analyse a five-year AV clinical profile and its management in Dermatology Outpatient Clinic, Dr. Hasan Sadikin General Hospital, a tertiary teaching hospital in Bandung, Indonesia. Materials and Methods A descriptive retrospective study was conducted from January 1st, 2012 to December 31st, 2016, with total sampling data from outpatient's medical records. Results In this study 670 medical records collected, consisted of 77.16% female and 22.84% male patients. Most prevalent AV was found in females at ages 20-24 years (39.10%), followed by ages 15-19 years (32.25%), and in males at ages 15-19 years (11.94%). In female patients, AV were still found as much as 2.39% at age 35-39 years and 3.28% at age >40 years. By Lehman classification, 332 patients (49.55%) were diagnosed as mild, 292 (43.58%) were moderate and 46 (6.87%) were severe AV. The most used topical preparation were combination of tretinoin, benzoyl peroxide and topical erythromycin or clindamycin in 567 (85.9%) patients. Doxycycline almost always prescribed antibiotics for systemic treatment in accordance with acne severity (99.03%), followed with azithromycin. Patients with mild acne were not given systemic antibiotics. Conclusion This study showed adolescent AV similar in both gender group, and there were manifestations of adults AV in the female group. Most patients even with mild AV generally seek medication. The management of AV generally were found to be consistent with IAEM guideline recommendation. [ABSTRACT FROM AUTHOR]

Treatment of acne is an art as much as a science. Women at reproductive age and presence of any systemic disease are two important considerations in personalizing the treatment and providing appropriate treatment to appropriate patient. Acne treatment should be organised in a way to be safe for those who try to become pregnant, who are pregnant and breastfeeding, and who have systemic diseases. This section will cover acne treatment in the presence of pregnancy, breastfeeding and some systemic diseases including neuropsychiatric, cardiovascular, respiratory, hepatic, renal, and gastrointestinal. [ABSTRACT FROM AUTHOR]

In this study, α-mangostin, extracted from mangosteen peel, was developed in to a topical film-forming gel antiacne preparation using different film-forming polymers as carriers. The physicochemical properties and α-mangostin incorporation efficiency were evaluated. In vitro permeation of α-mangostin-loaded film-forming gels, antibacterial activity against Propionibacterium acnes and Staphylococcus aureus were examined. The optimal formulations were viscous gels, which could convert into a dry film within 30 min after application. The films were transparent, flexible and easy to peel off. Scanning electron micrographs of the α-mangostin-loaded film-forming gels revealed a rough surface with an interior porous structure while blank film-forming gels showed smooth and compact morphology. The high α-mangostin incorporation efficiency up to 96 % was achieved. In vitro permeation studies showed a biphasic permeation profile with a fast permeation characteristic within 30 min followed by a slow permeation up to 8 h. α-Mangostin-loaded film-forming gels demonstrated efficient antibacterial activities against P. acnes and S. aureus. Moreover, α-mangostin-loaded film-forming gels showed good physicochemical stability during storage at 4º for 6 mo. In summary, the developed α-mangostin-loaded film-forming gels are good candidates for topical antiacne treatments. [ABSTRACT FROM AUTHOR]

Thymol-loaded PLGA nanoparticles (TH-NPs) were incorporated into different semi-solid formulations using variable gelling agents (carbomer, polysaccharide and poloxamer). The formulations were physicochemically characterized in terms of size, polydispersity index and zeta potential. Moreover, stability studies were performed by analyzing the backscattering profile showing that the gels were able to increase the nanoparticles stability at 4 °C. Moreover, rheological properties showed that all gels were able to increase the viscosity of TH-NPs with the carbomer gels showing the highest values. Moreover, the observation of carbomer dispersed TH-NPs under electron microscopical techniques showed 3D nanometric cross-linked filaments with the NPs found embedded in the threads. In addition, cytotoxicity studies showed that keratinocyte cells in contact with the formulations obtained cell viability values higher than 70 %. Furthermore, antimicrobial efficacy was assessed against C. acnes and S. epidermidis showing that the formulations eliminated the pathogenic C. acnes but preserved the resident S. epidermidis which contributes towards a healthy skin microbiota. Finally, biomechanical properties of TH-NPs dispersed in carbomer gels in contact with healthy human skin were studied showing that they did not alter skin properties and were able to reduce sebum which is increased in acne vulgaris. As a conclusion, TH-NPs dispersed in semi-solid formulations and, especially in carbomer gels, may constitute a suitable solution for the treatment of acne vulgaris. [Display omitted] • Thymol PLGA nanoparticles (TH-NP) were incorporated into semi-solid gels. • TH-NP showed antimicrobial efficacy against C. acnes preserving S. epidermidis. • TH-NP gel biomechanical properties in human skin showed no skin alteration. • TH-NP gel biomechanical properties reduced sebum in human skin. [ABSTRACT FROM AUTHOR]

The review presents modern views on the pathogenesis of acne. The data of foreign and domestic clinical trials to study the efficacy and safety of drugs containing 1% clindamycin and 15% azelaic acid used to treat acne. The mechanisms of the effects of these drugs on the main elements of the pathogenesis of acne. Substantiates the appropriateness of the drug combination of clindamycin and azelaic acid in the treatment of acne patients.

Katie Rodan, Kathy Fields, Timothy J Falla Rodan + Fields, San Francisco, CA, USA Background: Acne vulgaris (acne) is the most common skin disorder producing physical and emotional scars that can persist for years. An estimated 83% of acne sufferers self-treat, but there is lack of studies documenting the effectiveness of over-the-counter (OTC) acne treatment products.Objective: This study was conducted to determine the effectiveness of an OTC, 3-step, anti-acne skincare regimen in treating acne and improving the appearance of red/inflamed facial skin.Methods: This 6-week, open-label clinical study included both genders aged between 12 and 35 years with mild-to-moderate acne. All subjects were required to have an acne score of 1–3 (Cook’s acne grading scale: 0=clear to 7=very severe) and a moderate redness score of ≥2 (0=none and 4=severe). Subjects completed a 3-step facial treatment regimen every morning and evening using an OTC cleanser, toner, and acne treatment. Evaluations for effectiveness and safety were done at baseline and weeks 2, 4, and 6 using digital photographs (Visia-CR® digital imaging system) of the face and analyzed using Image-Pro® software for the grading of acne, red/inflamed skin, and the number and type of lesions.Results: Thirty subjects (12 males and 18 females) were enrolled (mean age of 19 years; range 12–34 years). This skincare regimen resulted in statistically significant improvements in acne grading scores after 2 weeks of use, with mean scores continuing to improve after 4 and 6 weeks of use (P

Background: Houttuynia cordata Thunb. has long been widely used as a daily vegetable and traditional medicine. The flavonoid component of H. cordata has plenty of pharmacological effects, such as antibacterial, anti-inflammatory, and antioxidant. In this study, we applied the aqueous two-phase system (ATPS) combined with ultrasonic extraction for extracting H. cordata leaves., Methods: We optimized the extraction process to improve the extraction efficiency of the two flavonoids, hyperin and quercitrin, by Surface Method Response - Central Composite Design (RSM-CCD). Next, we investigated the antibacterial ability of H. cordata ATPS extract from optimal conditions against two bacterial strains, Cutibacterium acnes and Staphylococcus epidermidis ., Results: The results showed that using 10% (NH 4 ) 2 SO 4 and 35% ethanol for ATPS extraction resulted in the highest hyperin and quercitrin contents. From the RSM-CCD results, the optimal extraction conditions were determined to be ultrasonic extraction at 50 °C for 30 min, giving results consistent with the predicted model and obtaining hyperin and quercitrin contents at 1.5681 ± 0.0114 and 4.6225 ± 0.0327 mg/g, respectively.Furthermore, ATPS extract has excellent antibacterial activity with a minimum inhibitory concentration (MIC) value of 250 μg/mL on both C. acnes and S. epidermidis . This MIC is significantly lower than the H. cordata ultrasound-assisted (UA) extract, with MICs of 1500.00 and 156.25 μg/mL on C. acnes and S. epidermidis , respectively. In addition, the results from the disk diffusion assay also showed that ATPS extraction has superior internal antibacterial activity with a zone of inhibition diameter at 250 μg/mL of 8.67 ± 1.15 and 5.00 ± 2.00 mm. Meanwhile, those of UA extract on C. acnes is 5.67 ± 1.53 mm (at 1500 μg/mL), and on S. epidermidis is 1.34 ± 0.58 mm (at 156.25 μg/mL)., Conclusion: To sum up, our research highlights the potential of H. cordata ATPS extracts as the starting material for topical preparations for effectively treating acne., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)