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Acne may significantly impact quality of life, self-esteem and self-worth. The aim of this paper was to provide an overview of the knowledge and perception of acne and its risk factors in adolescents and young adults. The most critical issues reported for an optimal management of this specific population were identified. A PubMed literature review of results from patient-oriented surveys published between 2007 and 2018 was conducted. Two different types of survey were used: those using either validated questionnaires or specifically developed questionnaires. No consistency or directly comparable data with regards to age, onset, duration, severity and treatment of acne and by whom and where data were collected were observed. Acne affected female patients psychologically more than male patients. The majority referred to their treating physician in order to obtain information, and all surveys pointed out that specific treatment programs would allow to increase awareness about acne. Beliefs, traditions and economic factors continue to impact the perception of and treatment choices for acne in almost all countries and cultures, maintaining the improvement of awareness about acne a major global health challenge. In conclusion, identifying, considering and managing the patient's concerns about acne may improve the young patient's well-being and thus decrease additional healthcare expenses for emerging psychological comorbidities. This can be achieved by creating substantial and structured awareness through local and global information campaigns via the treating physicians, Internet, social networks and education.

Background: Cutibacterium acnes has been identified as one of the main triggers of acne. However, increasing knowledge of the human skin microbiome raises questions about the role of other skin commensals, such as Staphylococcus epidermidis, in the physiopathology of this skin disease. Summary: This review provides an overview of current knowledge of the potential role of S. epidermidis in the physiopathology of acne. Recent research indicates that acne might be the result of an unbalanced equilibrium between C. acnes and S. epidermidis,according to dedicated interactions. Current treatments act on C. acnesonly. Other treatment options may be considered, such as probiotics derived from S. epidermidis to restore the naturally balanced microbiota or through targeting the regulation of the host’s AMP mediators. Key Messages: Research seems to confirm the beneficial role of S. epidermidis in acne by limiting C. acnes over-colonisation and inflammation.

Acne is a chronic disease that may cause sequels such as atrophic or hypertrophic scars or post-inflammatory hyperpigmentation. Topical and systemic medications with proven pharmacologic activity and which have received marketing authorization are the key actors in the treatment of acne. However, these topical or systemic treatments frequently cause adverse effects related to impairment of the skin barrier, and cosmetics must therefore be used in combination to help protect the skin barrier. Nowadays, new cosmetic products containing active ingredients tested in vitro or in a small number of subjects have changed the world of cosmetics. In being described as "dermo-cosmetic" and in integrating active ingredients in their formulations, these cosmetics are now being presented as being specifically adapted for a given disease, and no longer limited to skin care and hygiene but suitable as an adjunctive or even an alternative to current medications. The aim of this article is to provide a better understanding of the respective roles of medications and cosmetics in the management of acne.

Cutibacterium acnes has been identified as one of the main triggers of acne. However, increasing knowledge of the human skin microbiome raises questions about the role of other skin commensals, such as Staphylococcus epidermidis, in the physiopathology of this skin disease.This review provides an overview of current knowledge of the potential role of S. epidermidis in the physiopathology of acne. Recent research indicates that acne might be the result of an unbalanced equilibrium between C. acnes and S. epidermidis,according to dedicated interactions. Current treatments act on C. acnesonly. Other treatment options may be considered, such as probiotics derived from S. epidermidis to restore the naturally balanced microbiota or through targeting the regulation of the host's AMP mediators. Key Messages: Research seems to confirm the beneficial role of S. epidermidis in acne by limiting C. acnes over-colonisation and inflammation.

International audience; Acne is an inflammatory and multifactorial skin disease. Different external and internal factors, including air pollution, aggressive skincare products, medication, mechanical, hormonal and familial factors and, more recently, lifestyle and stress, have been suggested as having an impact on acne. Moreover, for many years nutrition was believed to cause or worsen acne. Over the last decades, however, it has become a dermatological doctrine that there is no direct association between diet and acne. Even if recent research has allowed to identify certain nutritional elements and behaviour that may impact on acne, including the excessive intake of dairy products and hyperglycaemic food, modern lifestyle nutrition, obesity and eating disorders, knowledge about the role of nutrition in the physiopathology of acne still remains sparse and hypotheses and myths continue to dominate the debate. Thus, further clinical and translational research is necessary to investigate and confirm the association between nutrition and acne.

Acne vulgaris (acne) is a chronic inflammatory disease of the sebaceous gland, characterized by follicular hyperkeratinization, excessive colonization by Propionibacterium acnes (P. acnes) as well as immune reactions and inflammation. Despite an armamentarium of topical treatments available including benzoyl peroxide, retinoids and azelaic acid, topical antibiotics in monotherapies, especially erythromycin and clindamycin, are still used in Europe to treat acne. This intensive use led to antimicrobial-resistant P. acnes and staphylococci strains becoming one of the main health issues worldwide. This is an update on the current topical acne treatments available in Europe, their mechanism of action, their potential to induce antimicrobial resistance and their clinical efficacy and safety.

Resume Introduction Cette etude avait pour but de comparer les caracteristiques cliniques des acnes de la femme adulte en France et en Afrique sub-saharienne. Malades et methodes Les femmes âgees de 25 ans et plus consultant pour acne dans les services hospitaliers de dermatologie de Creteil, de Dakar et de Bamako ont ete incluses. Les donnees recueillies comportaient un questionnaire de sante, un historique de l’acne, un examen clinique, l’usage de depigmentants. Les caracteristiques des patientes etaient exprimees en effectifs et pourcentages pour les variables qualitatives et en moyennes et ecarts-types ou medianes, premiers et troisiemes quartiles pour les variables quantitatives selon leur distribution. Resultats L’indice de masse corporelle, le tabagisme, l’âge des premieres regles et la prise de contraceptifs n’etaient pas significativement differents entre les groupes. La presence d’une hyperpilosite losangique abdominale etait plus frequente chez les femmes de phototype fonce, sans autres signes d’hyperandrogenie. A Dakar et a Bamako, l’acne etait plus grave qu’a Creteil. Les pigmentations post-inflammatoires, l’atteinte des joues et du front etaient significativement plus frequente sur phototype fonce. L’atteinte du menton etait plus frequente sur peau claire. Aucune femme ne pratiquait la depigmentation volontaire parmi les femmes qui n’etaient pas originaires d’Afrique, alors que cette pratique etait presente chez la moitie des femmes africaines a Creteil et en Afrique. Conclusion Cette etude met en evidence des differences cliniques de l’acne de la femme adulte selon les phototypes et les zones geographiques.

In recent years, significant progress has been made in the understanding of the pathophysiological mechanisms of acne and the role of Propionibacterium acnes. With this review, the authors aim to provide an update on the current understanding of the role of P. acnes in the development of acne lesions and analysing the potential implications for future treatments. A total of 188 articles published between January 1980 and March 2013 were searched using key words such as acne, P. acnes, microbiology, Corynebacterium acnes, acne vulgaris, pathogenesis, antibiotic, vaccination and a combination of those key words. From those articles, 77 were analysed in depth. Recent data confirm that P. acnes has a strong proinflammatory activity and targets molecules involved in the innate cutaneous immunity, keratinocytes and sebaceous glands of the pilosebaceous follicle and leads to the development of comedones. Furthermore, the profile of its different strains may differ between healthy subjects and acne patients. The better understanding of the role of P. acnes may allow for new perspectives in the treatment of acne. Novel therapies should target molecules implicated in the activation of innate immunity, including toll-like receptors, protease-activated receptors and topical antimicrobial peptides; the latter may be an alternative to topical antibiotics and thus a solution for limiting bacterial resistance induced by topical macrolides. Vaccines may also be promising. However, the most appropriate candidate remains to be selected.

To identify the underlying subtypes of hidradenitis suppurativa (HS), we performed latent class analysis on prospective clinical data of 618 consecutive patients seen between 2002 and 2010. The median patient age was 31 years (Q1=26; Q3=38), median age at HS onset was 20 years (16–25), and median Sartorius score was 18 (11–19); 34.4% of patients were of Hurley stage II or III. A three-class model showed the best fit. Latent class 1 (LC1) patients (48%) had a high probability of breast and armpit lesions (0.74) and hypertrophic scars (0.41). LC2 patients (26%) had a high probability not only of breast and armpit lesions (0.96) but also of lesions in the ears, chest, back, or legs (0.55); follicular lesions (pilonidal sinus: 0.48; comedones: 0.74); severe acne (0.47); and a family history of HS (0.44). Compared with LC1 patients, LC2 patients were more often male (odds ratio, 4.6; 95% confidence interval, 3–7; P

International audience; Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating, follicular disease of the skin. Despite a high prevalence in the general population, the physiopathology of HS remains poorly understood. The use of antibiotics and immunosuppressive agents for therapy suggests a deregulated immune response to microflora. Using cellular and gene expression analyses, we found an increased number of infiltrating CD4(+) T cells secreting IL-17 and IFN-γ in perilesional and lesional skin of patients with HS. By contrast, IL-22-secreting CD4(+) T cells are not enriched in HS lesions contrasting with increased number of those cells in the blood of patients with HS. We showed that keratinocytes isolated from hair follicles of patients with HS secreted significantly more IL-1β, IP-10, and chemokine (C-C motif) ligand 5 (RANTES) either constitutively or on pattern recognition receptor stimulations. In addition, they displayed a distinct pattern of antimicrobial peptide production. These findings point out a functional defect of keratinocytes in HS leading to a balance prone to inflammatory responses. This is likely to favor a permissive environment for bacterial infections and chronic inflammation characterizing clinical outcomes in patients with HS.

This study aimed at evaluating the antiproliferative, antibacterial, and anti-inflammatory properties of an ethanolic myrtle extract (Myrtacine®) in vitro, characterising its potential active compounds (myrtucommulones A and B') by structural analysis, and evaluating their biological activity. Antiproliferative activity was assessed by the BrdU incorporation assay in HaCat keratinocytes and inhibitory and bactericidal activities against P. ACNES strains by measuring the minimal inhibitory concentration (MIC) and D value. Anti-inflammatory effect was evaluated by measuring 6-keto-prostaglandin F1 α and [³H]-arachidonic acid metabolite production in keratinocytes stimulated for inflammation. Myrtacine® inhibited keratinocyte proliferation by 27 % and 76 % at 1 and 3 µg/mL, respectively (p < 0.001). A comparable effect, though less marked, was observed with 5 µg/mL myrtucommulones A and B' (-36 % and -28 %, respectively). Myrtacine® inhibited erythromycin-sensible and -resistant P. ACNES strains growth with MICs of 4.9 µg/mL and 2.4 µg/mL, respectively. Myrtucommulone B' and myrtucommulone A displayed a similar inhibitory activity against both strains (for both strains, MIC = 1.2 µg/mL and about 0.5 µg/mL, respectively). At 3 and 10 µg/mL, Myrtacine® significantly decreased all metabolite production from cyclooxygenase (81 % and 107 %, p < 0.0001) and lipoxygenase (52 % and 95 %, p < 0.001) pathways. Finally, Myrtacine® exhibited a concentration-dependent anti-lipase activity at 100 µg/mL and 1 mg/mL, as it decreased lipase activity by respectively 53 % and 100 % (p < 0.01 for both). In conclusion, in vitro, Myrtacine® demonstrated antiproliferative, antibacterial, and anti-inflammatory properties that may be of value to exert a global action in the treatment of acne lesions.

Background and objective Many acne grading methods exist; however, there is no agreed-upon standard. Our objective was to create and validate a reproducible acne assessment scale for rating the severity of juvenile facial acne suitable for use in France and Europe. Methods The scale we created described the different types of acne lesions in a manner similar to global assessment scales used in clinical trials. The scale was then validated by seven expert dermatologists in the field of acne [the Global Evaluation Acne (GEA) group] first on 34 photographic cases of Caucasian acne patients and second by clinical examination of 22 acne patients. Results There was good agreement in Investigators’ assessments of acne both on photographs and patients (R = 0.8057; P

Background Superficial chemical peels offer therapeutic results in a convenient, affordable treatment. Many clinicians use these peels in the treatment of acne and acne-prone oily skin. Objectives This article examines the evidence base that supports the widespread use of superficial peels in this setting. Methods A search of the English language medical literature was performed to identify clinical trials that formally evaluated the use of chemical peeling in active acne. Results Search of the literature revealed very few clinical trials of peels in acne (N = 13); a majority of these trials included small numbers of patients, were not controlled and were open label. The evidence that is available does support the use of chemical peels in acne as all trials had generally favourable results despite differences in assessments, treatment regimens and patient populations. Notably, no studies of chemical peels have used an acne medication as a comparator. As not every publication specified whether or not concomitant acne medications were allowed, it is hard to evaluate clearly how many of the studies evaluated the effect of peeling alone. This may be appropriate, however, given that few clinicians would use superficial chemical peels as the sole treatment for acne except in rare instances where a patient could not tolerate other treatment modalities. Conclusions In the future, further study is needed to determine the best use of chemical peels in this indication.

Peelings are among the oldest and most widespread aesthetic procedures used in aesthetic dermatology worldwide. More than 50 commercial peelings are currently available on the European market.In the present review, we summarise the current knowledge on chemical peels.A state-of-the-art peeling procedure will take into account the depth of the targeted structure and the skin condition of the patient to choose carefully among the variables such as chemical class of the peeling agent, concentration, frequency and pressure of the application. The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels alpha-hydroxy-acids and most recently lipo-hydroxy acid are used to induce an exfoliation of the epidermis. Medium-depth agents such as trichloroacetic acid (50%) cause an epidermal to papillary dermal peel and regeneration. Deep peels using trichloroacetic acid (50%) or phenol based formulations reach the reticular dermis to induce dermal regeneration. The success of any peel is crucially dependent on the physicians understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedures.

Background: Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne. Objective: To describe the skin lesions of a group of patients with HS. Methods: Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions. Results: The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, ‘worm-eaten scars’ and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect. Conclusion: Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.

Factors associated with the severity of hidradenitis suppurativa (HS) are not known.We sought to identify factors associated with the severity of HS.The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score.Atypical locations were more common in men than in women (47.1% vs 14.8%; P.001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P.001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values.001).The referral center base of the study may have biased recruitment.Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.

Background: Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available. Objective: To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS. Methods: Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment. Results: The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects. Conclusion: The combination of clindamycin and rifampicin is effective in the treatment of severe HS.

Background Acne is a highly heterogeneous disorder with respect to its regional involvement, demographics, lesion types and response to treatment. Homogeneous patient groups must therefore be created before measuring the severity of acne and interpreting the results of therapeutic trials. The individualization of ‘juvenile acne of the face’ is a first step in this direction. Methods Based on textbooks, major reviews of acne and a ′Medline′ literature search, we identified four key points to delineate sub groups of acne patients. Result ‘Juvenile acne of the face’ is defined by four main clinical criteria: (1) age (from puberty to age 25 years), (2) site (face), (3) lesion type (polymorphous), (4) absence of a causal factor. Other subgroups of ‘true’ acne are listed with their distinctive characteristics. Non-acne follicular diseases (i.e. without sebum retention) are listed. Discussion We chose ‘juvenile acne of the face’ to define the first homogeneous group of patients because it is the most frequent form of acne and the target of most acne drugs. It has a sufficiently uniform prognosis to devise a functional and reproducible severity rating scale with the aim of facilitating the evaluation and comparison of therapeutic methods. Conclusion The next step in our work will be to elaborate severity scales which are dedicated to a single type of acne.

Resume Introduction Le retentissement psychologique de l’acne est souvent independant de l’intensite des lesions d’acne. Ainsi, certaines echelles ont ete construites et validees dans le but de quantifier la severite de l’acne telle que l’Echelle de Cotation des Lesions d’Acne (ECLA) alors que d’autres ont pour objectif d’evaluer la qualite de vie comme le questionnaire Cardiff Acne Disability Index (CADI) recemment valide en francais. L’objectif de ce travail a ete d’utiliser ces deux echelles chez un meme patient acneique afin de determiner s’il existait une correlation ou non entre ces deux echelles specifiques de l’acne et de determiner les groupes de malades influences par l’acne. Methodes Cent vingt-huit patients acneiques (21 ± 6,8 ans) vus par sept dermatologues ont ete inclus dans cette etude. La severite de l’acne a ete evaluee a l’aide de la grille ECLA, les sept dermatologues ayant ete formes a cette echelle. Par ailleurs, les patients remplissaient le questionnaire de qualite de vie CADI apres la consultation. Chaque facteur de l’echelle ECLA a ete croise avec chaque item du questionnaire CADI a l’aide d’une analyse de variance. Resultats Il n’existait pas de correlation entre les scores globaux des deux echelles ECLA et CADI (r2 = 0.0242). Cependant une correlation positive etait observee entre le score global CADI et les facteurs F1 et F3 de la grille ECLA (p = 0,0085 et p = 0,0373 respectivement). Inversement, le score global de l’echelle ECLA etait significativement correle a l’item 5 du questionnaire CADI c’est-a-dire la perception de l’acne (p = 0,0035). Conclusion L’acne a un impact sur la composante psychologique du patient meme dans des formes minimes. La grille ECLA associee au CADI apparaissent deux outils interessants et complementaires pour le dermatologue dans sa prise en charge complete du patient acneique.

Background: Acne can have important psychological repercussions. Objectives: We studied adolescents’ perceptions of acne, in a nonmedical context. Methods: Between November 2004 and January 2005, a questionnaire was presented to adolescents calling a youth helpline. It focused on perceptions of acne and, among callers with personal experience of acne, its severity and treatment. Callers were divided into those with acne, those having had acne and those never having had acne. Results: The questionnaire was completed by 1,566 callers. It showed that 51% of respondents with acne did not seek medical help; acne has as big a psychological impact as some far severer diseases; many respondents with no history of acne said they were very worried that they would develop this skin disorder. Conclusions: This study underlines the major psychological impact of acne. Young people need to be informed that acne can be treated.

Background Acne is a concern in adults, especially in women. The specifications in current acne grading systems are not applicable to this particular population. Objective To develop and validate a measurement tool (AFAST: adult female acne scoring tool) for acne in women by taking into account the specific locations of adult female acne, and to evaluate the impact of the photographic modalities on rating reproducibility. Methods Six experts in dermatology rated pictures of 54 women with a phototype from I to IV during two sessions, with an interval of 24 h. They rated the acne severity on the face using the GEA scale (Score 1) together with a new scale to assess acne on the mandibular zone (Score 2). Pictures of 30 women were taken using a standardized photographic device; pictures of the other 24 women were taken by their own dermatologists during daily practice. Results At session 1, the inter-rater's reproducibility was good for Score 1 with an ICC of 0.77 [0.72–0.83], and excellent for Score 2 with an ICC of 0.87 [0.82–0.91]. Between sessions 1 and 2, the mean intra-rater's reproducibility was excellent for both scores with an ICC of 0.88 [0.84–0.92] for Score 1, and an ICC of 0.87 [0.78–0.92] for Score 2. Photographic modalities had no significant effect on the inter- and intra-rater's reproducibility. Conclusion For the first time, it has been demonstrated that AFAST can accurately rate acne severity in women. It is a promising, easy-to-use tool for both daily practice and clinical investigation.

Resume Le diagnostic d’acne est habituellement facile, certains pieges sont neanmoins aeviter. « L’ acne cheloidienne de la nuque » et la folliculite de la barbe ne sont pas des acnes au sens propre: ce sont toutes deux des reactions inflammatoires puis fibreuses des follicules porteurs de cheveux et poils crepus, il n’y a pas de lesions retentionnelles – comedons et microkystes- visibles. Les folliculites a gram negatifs surviennent classiquement chez les sujets masculins acneiques traites de facon prolongee par antibiotherapie generales ou antiseptiques locaux, mais il existe des cas « de novo ». Sur peau noire, cette affection n’est pas exceptionnelle, elle survient dans les deux sexes et prend habituellement la forme nodulaire. Devant toute aggravation d’une acne, resistante au traitement classique, comportant des nodules douloureux des joues, le diagnostic est aevoquer. Le traitement repose sur une antibiotherapie adaptee pendant plusieurs semaines et eventuellement dans un deuxieme temps sur l’Isotretinoine. Les folliculites pityrosporiques sont localisees principalement sur le tronc. Plus frequente chez l’homme que chez la femme, elles s’observent sur-tout chez les sujets vivants en climat chaud et humide. La demodecie se manifeste par des poussees de lesions papuleuses ou papulo-pustuleuses du visage. Sur peau noire, le principal diagnostic differentiel est l’acne. La presence de nombreux parasites est necessaire au diagnostic. Cliniquement, un signe important est l’atteinte des paupieres. L’Ivermectine est efficace. Une dermatose acneiforme peut etre induite par les preparations depigmentantes contenant des dermocorticoides puissants. Il est donc important, devant une acne tres inflammatoire, de rechercher les autres signes cliniques de la depigmentation volontaire. L’hydradenite du visage et du dos peut etre confondue avec une acne nodulaire. En pays d’endemie, il faut penser a la lepre lepromateuse. D’autres dermatoses courantes peuvent simuler une acne ou bien lui etre associees, comme les hidradenomes eruptifs ou les molluscum contagiosum, L’analyse des differentes lesions elementaires et l’absence de lesions retentionnelles permet en general de retablir le diagnostic.

The diagnosis of acne is usually easy, but there are some pitfalls to be avoided. 'Keloid acne of the neck' and beard folliculitis are not acnes in the usual sense: both are inflammatory and fibrous reactions of the hair follicles and frizzy hair; no retentional lesions, blackheads and microcysts--are visible. Gram negative folliculitis classically occurs in acneic male subjects who have undergone extensive treatment with general antibiotics or local antiseptics, but 'de novo' cases do exist. On black skin, this condition is not exceptional, it occurs in both sexes and usually takes the nodular form. The diagnosis should be considered if there is any aggravation of acne which is resistant to classic treatment, with painful nodules on the cheeks. Treatment is based on appropriate antibiotherapy for several weeks and possibly, in a second phase, on Isotretinoin. Pityrosporum folliculitis occurs mainly on the trunk. More frequent in men than in women, it is chiefly observed in subjects living in a hot, humid climate. Demodicidosis is manifested by outbreaks of papular or papulopustular lesions of the face. On black skin the principal differential diagnosis is acne. The presence of numerous parasites is necessary for diagnosis. Clinically speaking, an important sign is when the eyelids are affected. Ivermectin is effective. Acneiform dermatitis may be induced by depigmenting preparations containing powerful dermocorticoids. It is therefore important, in cases of very inflammatory acne, to look for the other clinical signs of voluntary depigmentation. In countries where it is endemic, lepromatous leprosy should be considered. Other common dermatitis may simulate acne or else be associated with it, such as eruptive hidradenoma or molluscum contagiosum. Analysis of the different elementary lesions and the absence of retentional lesions generally enable a diagnosis to be established.

Thalidomide is effective in several cutaneous diseases. Peripheral neuropathy is the most important adverse event limiting its use. Its incidence rate and its relation to thalidomide doses remain unclear. We prospectively monitored 135 patients treated with thalidomide for various dermatologic diseases for 2 y in order to estimate the annual incidence rate and risk factors for neuropathy. Patients underwent standardized neurologic examination and nerve conduction studies prior to, and regularly during treatment. Risk factors for neuropathy were assessed using a Cox proportional-hazards model. Clinical and electrophysiologic evidence of a thalidomide-induced neuropathy were present in 25.2% of the patients; however, when considering all potential cases, this rate reached 55.6%. The incidence rate was maximal during the first year of treatment (20%). The risk of neuropathy was related to the daily dose whatever the duration of treatment (p10-3). Considering a daily doseor =50 mg per day as reference, the relative risk for thalidomide neuropathy was 8.2 for a daily dose comprised between 50 and 75 mg per day and 20.2 for a daily dose75 mg per day (p10-3). No neuropathy occurred for daily dosesor =25 mg per day. The neuropathy was subclinical in nearly a quarter of patients with such an adverse event. These data confirm the high rate of thalidomide neuropathy and identify the daily dose as the main risk factor. The risk of neuropathy seems to be negligible for doses less than 25 mg per day, whatever the duration of therapy.

Background Acne is usually perceived as a disease of teenagers, and most epidemiological studies have focused on adolescents. Objective The primary objective was to investigate the prevalence of acne in a representative sample of French females. Information about skin type, life-style factors influencing acne and quality of life were also recorded. Methods A self-administered questionnaire was sent to 4000 adult women aged 25–40 years, after a validation test by three dermatologists. A definition of acne severity, according to questionnaire answers, was established before the questionnaire was sent out. Results A total of 3394 women completed the questionnaire of which 3305 were useable. The data showed a prevalence of acne in 17% of the population, and physiological acne in 24%. Thus, the total acne prevalence was 41%. Forty-nine per cent of the acne patients had acne sequelae (scars and/or pigmented macules). Forty-one per cent of adult acne patients had not experienced acne during their adolescence. A premenstrual flare and stress was recorded as causing acne in 78% and 50%, respectively. Twenty-two per cent of acne subjects were currently receiving therapy. For most patients, acne did not severely impair their quality of life. Conclusion This study shows a prevalence of acne in 41% of women in the general population. A high proportion of these acne cases are late onset acne.

Background: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. Objective: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. Methods: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). Results: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and weremoderate (5 dropouts with zinc gluconate and 4 with minocycline). Conclusion: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

Background The three-grade acne classification (mild, moderate, severe) is widely used to define the licensed indications of acne treatments, and for therapeutic decision-making in clinical practice, but its reproducibility has never been assessed. Methods Ten photographs of facial acne were scored independently by eight experts using the three-grade acne classification. We conducted a descriptive analysis of the results, based on graphical representation of the scores for each photograph. Results Inter-observer agreement on acne severity based on the three-grade acne classification was very poor. Conclusion The classical three-grade acne classification is poorly reproducible. A new rating tool accompanied by a clinical description of each severity level would be extremely useful.

Existing scoring systems for facial acne focus on the lesions themselves, but clinical decisions are based on a general assessment of severity, including the time since onset, the site(s) of involvement, the patient's history, and the response to prior treatments. The aim of this study was to investigate the influence of some of these factors on the global assessment of acne severity. Involvement of the trunk, prior systemic treatment and a positive family history of acne increased the severity score. Inclusion of these factors could help to compose more homogeneous groups for clinical trials.

Acne on pigmented skin occurs in Africans and their descendants, as well as in patients with a skin phototype above IV. Acne is common in Africans and is often the primary reason for consulting a dermatologist. Acne on pigmented skin is principally inflammatory acne. The sequelae in terms of pigmentation are often the main reason for consulting a dermatologist, and take precedence over the acne itself. Research is needed into cosmetic acne and steroid-induced dermatitis, which are common in users of skin bleaching products. The treatment for acne in pigmented skin involves the same medicines as used in acne in white skin. Of the available topical treatments, benzoyl peroxide is particularly effective for the inflammatory component. Retinoids act on both the retentional and inflammatory components of acne and have skin bleaching properties. Tetracyclines are essential on initiation of treatment, regardless of severity. They prevent an inflammatory episode at the onset of acne and rapidly improve the inflammatory component. Minocycline should not be prescribed in African patients. Fatal cases of hypersensitivity have been described, with a particular frequency in this population. Doxycycline is effective, but has photosensitizing properties. Lymecycline is well tolerated. Isotretinoin is indicated for nodular acne. The same precautions for use should be followed as in all cases of acne. The skin bleaching effects are considerable. Photoprotection should generally be imposed, but, in patients with black skin, photoprotective agents are often not applied. The administration of a cosmetic containing a skin bleaching agent combined with a photoprotective agent for application in the morning, instead of hydrating cream, is acceptable to patients, improves compliance, and is effective.

Resume Introduction Nous rapportons les observations de deux femmes et un homme âges de 36 a 52 ans souffrant d’hidradenite suppuree depuis de nombreuses annees, compliquee d’un lymphœdeme sus-pubien. Observations L’aspect clinique etait celui d’une tumefaction en ballon de rugby, retombant en besace sur les organes genitaux dans un cas, a consistance ferme voire dure. Il n’y avait pas d’atteinte ganglionnaire ou de blocage des voies lymphatiques abdominales. Une exerese chirurgicale large des lesions suivie secondairement de greffe a entraine la guerison chez un malade. L’examen de la piece operatoire revelait des lymphangiectasies et de la fibrose. Discussion La survenue de lymphœdeme est due au blocage et/ou a la destruction des voies lymphatiques secondaire a l’inflammation et a la suppuration chronique. Une fois la maladie presente, aucun traitement medical n’est efficace.

Acne can have an important psychological impact. We surveyed 852 adolescents aged 12-25 years about their knowledge of acne and its treatment in a non-medical context. The study involved a questionnaire administered to callers to a youth telephone helpline in France. Callers were categorized into those who currently had acne, those who had had acne previously, and those who had never had acne. Most respondents (66.2%) had experienced acne symptoms, which were mild in 50.2% of cases and severe in 16% of cases. Often, acne had been long-lasting (>12 months in 49.6% of cases). Many thought that gender, excess weight, eating dairy products, and physical activity did not influence acne, and that frequent washing could improve acne. Eating chocolate and snacks, smoking cigarettes, sweating, not washing, touching/squeezing spots, eating fatty foods, using make-up, pollution, and menstruation were thought to worsen acne. The majority (80.8%) did not believe acne to be a disease, but rather a normal phase of adolescence, yet 69.3% agreed it should be treated. There was a preference for topical vs. systemic treatment. Many (38.6%) of the respondents with acne had not consulted a physician. Almost two-thirds of respondents wanted more information about acne. Providing more information about acne might increase the likelihood of them consulting a physician and getting better treatment for the condition.

Practicing dermatologists rarely evaluate therapeutic trials. This study was designed to build a simple evaluation tool, use it to evaluate the quality of published trials and thereby consider their applicability. Reports on 146 therapeutic trials, published from 1969 to 2004, were selected. A 50-item list was used for an initial assessment. After comparison with existing grids, a shortened nine-item list was established and used for this analysis. The results were analyzed item by item (logistic regression) and globally (principal component analysis). An index was then established and validated using Cronbach's coefficient alpha. The overall quality of trials was poor: 9% to 73% positive response range. This rate increased after 1990 for six items. Two factors explained almost 60% of the total variance: factor 1 summing six items concerning the formal content of the articles and factor 2 its underlying basis. Using the sum of these six variables, Cronbach's coefficient alpha reached 0.716; their mean sum improved from 1969 to 1970-2001-2005. The significantly improved quality of trials, based on the mean sum over time, supports well-founded basis of this tool. Regarding the application of evidence-based medicine in clinical practice, this tool is user friendly and should facilitate the updating of our knowledge.

Background: In analogy to acne, oral isotretinoin has been considered in the treatment of hidradenitis suppurativa (HS). Objectives: To assess the efficacy of oral isotretinoin according to patients. Methods: From 1999 to 2006, 358 consecutive HS patients were interviewed and examined. A standardized record of the data was performed for each patient during the first consultation. Patients were questioned regarding the effect of previous treatment with oral isotretinoin: patients had to grade the effect as either ‘improved’, ‘no effect’ or ‘worse’. Results: Fourteen patients (16.1%) declared an improvement, 67 patients (77%) no effect and 6 patients (6.9%) worsening of HS. Conclusion: According to our patients, oral isotretinoin is not effective in the treatment of HS.

Background Conflicting opinions have been reported regarding the epidemiology of hidradenitis suppurativa. Objective We sought to evaluate the prevalence of hidradenitis suppurativa and to identify associated factors. Methodology Prevalence was evaluated using a representative sample of the French population (n = 10,000). Associated risk factors were assessed using two case-control studies, one population-based with 67 self-reported patients and 200 control subjects, and the other clinic-based with 302 medically assessed patients and 906 control subjects. Results The prevalence was 1% of the French population. Multivariate analyses showed a strong association with current smoking in self-reported (odds ratio=4.16, 95% confidence interval [2.99-8.69]) and in medically assessed (odds ratio=12.55 [8.58-18.38]) populations. Association with body mass index was significant in medically assessed patients (odds ratio=1.12 [1.08-1.15]) for each increase of 1 U of BMI. Limitations A causal relationship could not be established with such a cross-sectional study. Conclusion Hidradenitis suppurativa is a common disease, frequently associated with smoking and being overweight.

Acne is a disorder in which adherence has a major impact on treatment outcome.To create an easy-to-use tool to assess treatment adherence, based on a questionnaire that can be used on a daily basis by dermatologists.First, we evaluated adherence by comparing responses to a self-administered questionnaire with the dermatologist's prescription. Second, concordance was assessed between adherence and each question of a dermatologist-directed questionnaire (DDQ) administered during the consultation. Third, DDQ questions were combined to construct a mini-questionnaire, and these combinations were tested to maximize specificity.The study included 246 patients, who were prescribed topical treatment alone, combined treatment (excluding oral isotretinoin) or oral isotretinoin alone. The mini-questionnaires for oral and topical treatments had 89% specificity for detecting poor adherence. An inappropriate answer to one question classified the patient as a probable poor compliance.Our mini-questionnaires provide dermatologists with specific tools to rapidly identify poor compliance.

Acne can have important psychological repercussions.We studied adolescents' perceptions of acne, in a nonmedical context.Between November 2004 and January 2005, a questionnaire was presented to adolescents calling a youth helpline. It focused on perceptions of acne and, among callers with personal experience of acne, its severity and treatment. Callers were divided into those with acne, those having had acne and those never having had acne.The questionnaire was completed by 1,566 callers. It showed that 51% of respondents with acne did not seek medical help; acne has as big a psychological impact as some far severer diseases; many respondents with no history of acne said they were very worried that they would develop this skin disorder.This study underlines the major psychological impact of acne. Young people need to be informed that acne can be treated.

Cosmetic products contribute to the efficacy of anti-acneic treatment. Cleaning bars without soap and lotions are to be preferred to soaps. Morning application of moisturizing creams compensate for dryness and irritation induced by topical treatment. Some of these cosmetic products may have a limited efficacy of the shiny appearance and/or acne lesions. Scrubs, abrasive sponges, masks and patches have a very limited usefulness. Make up and camouflage techniques are authorized, provided that the products have been tested non comedogenic and non acne-genic.