To promote the development of dermatology prevention and treatment in Asia, the “13th Asian Dermatology Annual Conference” was held in Shanghai from May 9 to 11, 2024, organized by the Asian Dermatology Association, in collaboration with the Chinese Medical Association, the Dermatology and Venereology Branch of the Chinese Medical Association, and Huashan Hospital affiliated to Fudan University.
The acne session on May 10 was exciting, featuring four keynote speeches covering topics such as diet, skincare, classification, and new treatment targets for acne. The four speakers came from different countries, with diverse cultural and academic backgrounds. Their research findings exhibited unique regional characteristics, combining interest with professionalism and rigor, allowing us to learn together.
1 What? Can Eating Kimchi Prevent and Treat Acne?
Professor Dae Hun SUH from Seoul National University in South Korea detailed the role of dietary supplements in acne treatment.
As early as 2010, Professor SUH’s team pointed out the relationship between Korean dietary patterns and acne, indicating that diets with high glycemic load, dairy intake, high-fat diets, iodine intake, and irregular eating patterns could worsen acne symptoms[1]. Subsequent randomized controlled studies showed that low glycemic load diets could improve inflammation and clinical symptoms of acne while reducing the expression of sterol regulatory element-binding protein 1 (SREBP-1) and interleukin 8[2].
Besides glycemic load, the rich Ω-3 fatty acids in fish have been confirmed to have anti-inflammatory properties, inhibiting leukotriene B4, reducing sebum production, and negatively correlating with androgen levels. They can reduce IGF-1 and increase insulin-like growth factor-binding protein 3 (IGFBP-3), which also aids in acne treatment; gamma-linolenic acid may improve acne symptoms by catalyzing the production of PGE-1 and 15-OH-DGLA[3].
Vitamin D metabolites have been shown to inhibit Th17 differentiation induced by Propionibacterium acnes[4]. Several studies indicate that serum vitamin D levels in acne patients are significantly lower than in healthy individuals and negatively correlate with the severity of acne[5]. After vitamin D supplementation, inflammatory lesions can significantly decrease. Although controversial, some meta-analyses regard vitamin D supplementation as a potential acne treatment[6]. Other vitamins like A, E, and B also show potential in improving acne lesions.
Zinc can inhibit Propionibacterium acnes, suppress chemotaxis, reduce TNF-α and IL-6 production, and modulate the expression of ICAM-1 and LFA-3. Fourteen articles report the benefits of zinc for acne treatment. Some literature indicates reduced efficacy when used alone, but gastrointestinal symptoms like nausea and vomiting must be monitored when supplementing zinc.
Selenium can regulate lipid generation and has anti-inflammatory and antioxidant properties. Some studies suggest increased selenium levels in the serum of acne patients. Magnesium ascorbyl phosphate reduces lipid peroxidation and IL-1β expression in sebaceous gland cells. Some studies show that magnesium has no significant effect on acne treatment, while others indicate that supplementing magnesium, phosphate, and fatty acid mixtures can completely alleviate acne symptoms[7], though its role remains controversial.
In addition, many plant extracts are gradually showing their role in acne treatment, typically possessing antibacterial or anti-inflammatory properties. For example, berberine can improve insulin resistance and reduce keratinocyte proliferation. Professor SUH’s team has found that green tea epigallocatechin gallate (EGCG) improves acne symptoms by modulating intracellular molecular targets and inhibiting Propionibacterium acnes[8]. Lupeol significantly inhibits lipid generation in sebaceous gland cells by regulating the IGF-1R/PI3K/Akt/SREBP-1 pathway and alleviates inflammation by inhibiting the NF-κB pathway in sebaceous gland and keratinocyte cells[9]. However, the mechanisms of these plant extracts still require further research. Finally, Professor SUH suggested that kimchi, containing lactic acid bacteria, might also benefit acne treatment and prevention.
2 Classifying Acne Treatment According to Microecological Differences is Effective!
Professor He Li from the First Affiliated Hospital of Kunming Medical University shared insights on the relationship between microecological changes and acne classification and treatment.
Common acne is a chronic inflammatory disease of sebaceous glands commonly found on the face, chest, and back, and is one of the most common disfiguring skin diseases. The incidence of acne among college students in China is about 46.8%, with over 90% of the population affected.
The Pillsbury classification divides acne lesions into I-IV grades, with severe cases significantly affecting the mental and physical health of patients. The pathogenesis of acne is recognized to include excessive androgen and sebum production, follicular keratinization, microorganisms like Propionibacterium acnes, inflammation, and genetic influences.
To explore the differences in microecology among different skin types and identify the microbial composition in different types of lesions, Professor He Li’s team collected samples from the comedones, pustules, and cystic lesions of nine acne patients aged 15-35 for gene extraction and metagenomic sequencing, followed by species and functional annotation.
The results showed significant differences in species diversity between comedones and pustules/cysts, with a relatively increased proportion of bacteria, fungi, and viruses. Microbial biomarkers differed among various lesions. In pustules and cysts, disease-related functional gene expression increased. Gene annotations indicated the presence of broad-spectrum antibiotic resistance genes in cysts, which are difficult to penetrate topically, necessitating the search for new drugs with permeability. For Pillsbury I-II grade lesions, a normal flora induced inflammation by TLR2 was observed, while III-IV grade lesions exhibited microbial imbalance and increased inflammation. GWAS studies indicated that susceptibility loci DDB2 and SELL genes may participate in the inflammatory process and collagen metabolism of severe acne in the Han population in China, mediating the release of IL6 and IL8 through the NF-κB pathway[10].
Professor He Li pointed out the possibility of classifying and treating acne based on microecological differences. For instance, zinc can inhibit toll-like receptor expression in keratinocytes in I-II grade lesions, thereby suppressing the generation of inflammatory mediators[11]. Meanwhile, a plant called Yunnan heavy tower has been found to inhibit the action of Propionibacterium acnes and inflammatory factors[12]. Ongoing clinical trials have shown that zinc and Yunnan heavy tower extracts are effective in acne treatment, and more research on acne microecological classification and corresponding treatments is anticipated.
3 International Consensus: There is a Way to Acne Skincare!
Professor Brigitte Dréno from the Southern Medical University in France discussed the international consensus on the use of medical-grade skincare products (dermocosmetics, DC) for acne. Medical-grade skincare products are generally defined as skincare agents containing ingredients proven effective in clinical trials, tailored for different skin types and skin problems, and can be used as sole or adjunctive treatments to alleviate skin symptoms.
Professor Dréno pointed out that the basic skincare recommendations for acne patients include:
Basic Skincare Recommendations for Acne Patients
1. Cleanse (twice a day, to remove follicular obstruction)
2. Use moisturizers (to help repair the barrier, isolate irritating cosmetics, and provide optical protection)
3. Sun protection (provide UVB protection, to be selected according to skin type)
Research shows that for patients with mild acne, the sole use of medical-grade skincare products can improve clinical scores, reduce the number of lesions, increase patient compliance, decrease sebum secretion, and help maintain treatment efficacy.
As an additional treatment strategy for regular acne treatment, the consensus proposed six bases:
01
Medical-grade skincare products can increase skin tolerance to standardized systemic/topical acne treatments;
02
Can reduce daily sebum secretion in oily skin patients;
03
Effective ingredients can enhance skin barrier function;
04
Can help improve patient compliance with acne treatment;
05
Moisturizing ingredients may enhance the clinical efficacy of acne medications.
06
For acne patients with darker skin, medical-grade skincare products containing effective ingredients can help improve post-inflammatory pigmentation.
4 PPARγ: A New Target for Acne Treatment
Professor Mauro Picardo from Unicamillus International University introduced a new acne treatment strategy, namely the latest progress in treating acne with peroxisome proliferator-activated receptor gamma (PPARγ) modulators NAC-GED.
Common acne, as a highly prevalent skin disease, still has room for further exploration in treatment methods compared to other inflammatory skin diseases like psoriasis and atopic dermatitis.
Studies indicate that the differentiation and maturation of sebaceous glands play a crucial role in the pathogenesis of common acne. Additionally, different genetic backgrounds, such as mutations at the EDAR and WNT10A loci leading to changes in follicular morphology, can also increase the incidence of acne[13].
PPARγ is the most extensively studied member of the peroxisome proliferator-activated receptor family, playing a role in adipogenesis, glucose metabolism, inflammation, bone metabolism, cell proliferation, apoptosis, and fibrosis. Studies have confirmed that PPARγ is a marker of sebaceous gland cell differentiation. In acne skin, decreased expression of PPARγ and lower differentiation levels of sebaceous gland cells are observed, while mTOR expression is elevated, and the Akt/mTOR signaling pathway is upregulated. PPARγ modulator NAC-GED0507 can reduce insulin-induced sebum secretion, downregulate the expression of sebum secretion-related genes like SREBP-1, and reduce the release of pro-inflammatory mediators.
Detection of low-differentiation SZ95 cells cultured without serum for 24 hours showed downregulated PPARγ gene expression, further confirming that PPARγ is a marker of sebaceous gland cell differentiation. Low PPARγ expression, high IGFR/IR, and the expression of harmful enzyme activity components together lead to increased insulin sensitivity in poorly differentiated sebaceous gland cells compared to normally differentiated sebaceous gland cells, along with mTOR signaling pathway activation and increased inflammatory factors and monounsaturated fatty acids, which together lead to increased acne-like sebum secretion[14].
Topical PPARγ modulator NAC-GED0507 can induce sebaceous gland differentiation and reduce inflammatory factor levels, thereby providing therapeutic effects on moderate to severe acne, demonstrating both safety and efficacy. It has recently passed a phase II clinical trial conducted among facial acne patients aged 12-30 in Germany, Italy, and Poland[15], laying the groundwork for a large phase III clinical trial.
In summary, PPARγ can serve as a new target for acne treatment, providing new ideas for the treatment of common acne.
Team
Medical Observation Group
This article was compiled and reviewed by the medical observation team led by Professor Ju Qiang from Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine.
Expert Team Introduction
Ju Qiang
Chief Physician, Director of Dermatology
Professor, Doctoral Supervisor
Director of Dermatology at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Vice Chairman of the Dermatology Branch of Shanghai Medical Association, Executive Member and Leader of the Acne Group of the Dermatology Physician Branch of the Chinese Medical Association, Vice Chairman of the Dermatology Specialty Committee of the China Research Hospital Association, Secretary-General of the Dermatology Branch of the China Human Health Promotion Association, Executive Member of the Dermatology and Venereology Specialty Committee of the Chinese Association of Traditional Chinese and Western Medicine, Member of the European Acne Foundation, “New Hundred People” of Shanghai Health System, Assistant Editor of Dermatology, Editorial Board Member of the Chinese Journal of Dermatology, Practical Dermatology, and Journal of Dermatology and Venereology of Traditional Chinese and Western Medicine.
Compiled by
Wu Xinyi
Doctoral Student at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine
Editor/Layout: Ke Ruina
References:
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