For several years, the treatment of acne vulgaris has been based on the use of oral or topical medication, isolated or in association with other medications. Such options still represent excellent therapeutic alternatives; however, there are cases in which they cannot be used either because of their side effects or the lack of response to treatment due to the growing bacterial resistance to antibiotics. Based on the observation that light has been successfully used to treat many pathologies – including acne – a number of therapeutic devices have been developed that demonstrate good results.The objective of this article is to present a review of the pathology of acne and of the photobiological principles used in its treatment, considering some of the main current phototherapeutic modalities.

Keywords: ACNE VULGARIS, PHOTOTHERAPY, LASER THERAPY

Acne is a multifactorial disease encountered on a daily basis by general medical practitioners and, especially, dermatologists. It has been a constant focus of studies that increasingly unveil details of its physiopathology and help refine treatments in order to address the majority - if not all - pathogenic factors.This article''''''''s objective is to draw attention to the therapeutic associations and combinations in acne management, highlighting its chronic disease character, typified by recurrence, and the requirement for continued treatment that is not only effective but also safe.

Keywords: ACNE VULGARIS, ACNE VULGARIS/PHYSIOPATHOLOGY, BACTERIAL DRUG RESISTENCE

Introduction: Isotretinoin was initially used to treat severe inflammatory acne and is now widely recognized as an effective therapy for acne vulgaris. Many factors are associated with the recurrence of this condition, which ranges from 5.6-65.4%. There is much con- troversy regarding the importance and contribution of each factor.
Objectives: To determine the recurrence rate in patients who underwent full treatment with oral isotretinoin (dose between 120 and 150 mg/kg) and risk factors.
Methods: Retrospective study of data from 276 patients treated with isotretinoin. The analysis was carried out after a minimum of 30 months after the end of the treatment. Recurrence was defined as the appearance of new active lesions that required retreatment.
Results: While the recurrence rate in patients who underwent the full dose was 25.53%, it reached 81.03% in those who received an incomplete dose. The other studied factors presented no statistical significance.
Conclusion: Oral isotretinoin therapy is effective in producing a significant and long- term reduction of acne. Nevertheless, it is important to note that recurrence can occur, especially when recommended doses are not reached.

Keywords: ACNE VULGARIS, ISOTRETINOIN, RECURRENCE

Introduction: Acne scars are common, and their treatment is challenging. Several techniques have been used to remove, reposition, and flatten acne scars to improve the appearance of the skin’s surface. More recently, fractional CO₂ laser has been used to correct such scars due its good results and shorter recovery time.
Objective: To evaluate and compare fractional CO₂ laser vs. dermabrasion-based treatment of acne scars.
Methods: Nine patients were assessed – six received fractional CO₂ laser and three were treated with dermabrasion. Subjective and objective parameters were evaluated for both treatment modalities.
Results: Both patient groups showed objective and subjective improvement.
Conclusions: This study has demonstrated that fractional CO₂ laser and dermabrasion-based treatments have similar efficacy in moderate to severe acne scars.

Keywords: CICATRIX; ACNE VULGARIS; LASER THERAPY.

Introduction: Acne is one of the most prevalent skin conditions, representing a constant challenge to dermatologists, especially in severe cases as nodulocystic acne, which can be resistant to medicament based treatment. Traditional therapy includes topical and oral drugs that are not always effective and often lead to bacterial resistance and side effects. The use of lasers in the treatment of inflammatory acne has increased lately due to the ease, clinical efficacy, and minimal side effects of this type of therapy. Objective: To evaluate the effects of fractional laser in patients with nodulocystic acne resistant to treatment with isotretinoin. Methods: Application of laser therapy sessions with Nd:YAP in 9 patients. Assessment of the degree of patient satisfaction and comparison of photographs taken before and after treatment by dermatologists not linked to the study. Results: Average reduction of 65% in inflammatory lesions, satisfaction of all patients who underwent treatment, and approval in the assessment carried out by dermatologists. Conclusions: The fractional Nd:YAP laser was proven effective in the treatment of inflammatory acne and may represent a new therapeutic option for this pathology, especially for patients who do not respond to conventional treatment.

Keywords: ACNE VULGARIS; LASERS; LASER THERAPY.

Introduction: The best option for treating distensible acne scars is cutaneous filling, however many such lesions cannot be seen properly under traditional lighting. Objective: To investigate whether an LED light spot helps in the technique of filling acne scars with hyaluronic acid. Methods: Twelve patients were treated with and without the diagonal and posterior focus of LED lighting. The patients themselves and two physicians deemed that the treatment has provided improvement. The median percentage of improvement attributed by the patients was 60% (without LED lighting) and 70% (with LED lighting). Results: The average median percentage of improvement attributed by the physicians was 55.0% / 65.0% (without LED lighting) and 70.0% / 72.5% (with LED lighting). Conclusion: The use of diagonal and posterior LED light spots enhances outcomes and patient satisfaction rates.

Keywords: ACNE VULGARIS; CICATRIX; HYALURONIC ACID.

Introduction: With several treatment options available - including laser - atrophic acne scars are nonetheless difficult to treat. The use of fractional technology results in dermal-epidermal ablation columns, interspersed with intact skin islands, allowing selective thermal damage, effective treatment and faster recovery. The objective of the present study is to demonstrate the efficacy and safety of fractional laser use in the treatment of atrophic acne scars among the Brazilian population. Methods: An open, prospective, interventional study was carried out with patients with acne scars, without restriction regarding the gender and skin phototype. Exclusion criteria were: pregnancy, breast-feeding, presence of infections or blood dyscrasias and the use of anticoagulants. The evaluation was performed by comparing texture, appearance, and relief as observed in digital photographs. Results: Of the 30 selected patients, 24 were included in the study. An improvement was noted in the parameters evaluated in the cases that underwent fractional laser (CO2, Erbium-Glass or both). Individuals who underwent multiple treatments showed better results. All those treated with 4 sessions had improvements greater than 50%. Post-inflammatory hyperpigmentation was detected in 7 of the 24 treated patients. Conclusion: The present study showed that, when using appropriate parameters and adequate care, fractional laser-assisted resurfacing is an effective and safe method for treating atrophic acne scars in the Brazilian population.

Keywords: ACNE VULGARIS; CICATRIX; LASERS; CHEMEXFOLIATION

Introduction: Progressive macular hypomelanosis is characterized by the emergence of hypopigmentation, predominantly in the trunk region of young women of mixed racial origin. Although recent studies suggest that Propionibacterium acnes may have an important role in the pathogenesis, its etiology remains unclear. Objective: To evaluate the prevalence of the condition with regards to gender, age, skin phototype, affected areas and disease onset, and the relationship with ordinary acne and oily skin in the city of Niterói, Rio de Janeiro State, in the coastal region of Southeast Brazil. Methods: Retrospective epidemiological study that uses the analysis of medical records of 103 patients with diagnosis of progressive macular hypomelanosis, from 2001 to 2012. Results: Eighty-two percent of studied patients were women and 18% men, with a predominance of phototypes III (42.7%) and IV (42.7%). The average age of onset of the disease at diagnosis was 26 years. In 46.0% of patients the disease duration ranged from 1 to 4 years. When two areas were affected (50%), the dorsum was the most frequent (79.0%), followed by the abdomen (20.0%). In 98% of cases, patients had oily skin, and 71.8% had active acne. Conclusion: Progressive macular hypomelanosis is a chronic condition that primarily affects the skin of the dorsum and abdomen of young women with skin phototypes III and IV, who are also bearers of oily skin and acne. There are still many doubts regarding the true etiology and treatment of progressive macular hypomelanosis. The high percentage of association with skin oiliness and acne vulgaris suggests that these clinical conditions are possibly related.

Keywords: HYOPIGMENTATION; EPIDEMIOLOGY; ACNE VULGARIS

Acne in adult women is defined as an acneic picture present in women from 25 years of age. It can onset in adolescence and continue into adulthood or appear in the latter phase. It has an impact on personal relationships and can lead to introspection and depression. It is predominantly characterized by inflammatory lesions located preferentially on the chin and neck. Its causes have not yet been fully elucidated. Its pathogenesis involves circulating androgens in combination with other factors such as heredity, stress, ultraviolet exposure, obesity, diet, smoking habits and the presence of associated endocrine disorders. Treatment includes the arsenal for treating acne vulgaris combined with other therapies.

Keywords: ACNE; HYPERANDROGENISM; PROPIONIBACTERIUM ACNES; HYPERINSULINISM

Acne scars present at the end of the inflammatory phase of acne vulgaris have been treated with procedures that stimulate the production of collagen, such as microneedling. Six patients with acne scars were selected. Microneedling was performed with 2.5 mm needles. Subjective improvement was observed in all patients. In the technique of percutaneous collagen induction there is release of cytokines, growth factors and angiogenesis, with final production of type I collagen, making microneedling an excellent option for the treatment of acne scars, both for its cost/ benefit and for not drawing patients away from their daily activities.

Keywords: ACNE VULGARIS; CICATRIX; TREATMENT OUTCOME

Introduction: Acne scars result from inflammation of acne vulgaris and are a frequent cause of complaints in dermatology practices. Atrophic scars are the most common, and may be classified into superficial, medium, and deep. There are several treatment options for deep atrophic scars, however they have limited efficacy in general, undesirable side effects and are expensive.
Objective: To evaluate the treatment of deep atrophic scars with high frequency electrosurgery.
Methods: Ten patients with deep atrophic acne scars received 3 high frequency electrosurgery treatment sessions with intervals of 1 month. The following were used to evaluate the outcome 1 month after the last session: histological aspects of selected scars as compared to the baseline; ratings attributed to the results by the patients (worsened, unchanged or improved); and standardized photographs at baseline and 1 month after the last session performed by a physician not related to the study, who also rated the results (worsened, unchanged or improved).
Results: Histological analysis evidenced a reduction in local fibrosis. All patients noticed improvement in the lesions. The evaluator dermatologist physician verified the presence of clinical improvement in all patients.
Conclusion: High frequency electrosurgery is a straightforward, inexpensive and effective method for the treatment of atrophic deep acne scars.

Keywords: CICATRIX; ACNE VULGARIS; ELECTROSURGERY

Acne is a common condition that often results in scarring. We propose a novel treatment of acne scarring using: 1- chemical reconstruction of skin scars (CROSS), mainly with carbolic acid, 2- blunt bi-level cannula subcision, and 3- microneedling. A total of 139 patients were treated from 2017- 2018, of which 89 (64%) were Fitzpatrick Skin Types IV-VI. This triple approach to treating acne scars resulted in consistent high satisfaction from patients and photographic evidence of improvement. A combination of CROSS (to stimulate neocollagenesis), subcision (to release dermal connective tissue tethering), and microneedling (to stimulate neocollagenesis) is effective for acne scar treatment.

Keywords: Acne vulgaris; Acne keloid; Cicatrix; Cosmetic techniques

INTRODUCTION: Acne vulgaris, considered a chronic inflammatory and multifactorial disease, presents several therapeutic options. The use of probiotics is a good adjunctive treatment option due to its anti-inflammatory effect.
OBJECTIVE: Based on the promising character of these studies, which derive mostly from oral probiotic therapy, we decided to investigate what results could come from the topical use of a probiotic bacterium that has undergone the tyndallization process.
METHODS: In this study, we demonstrated the topical use of Lactobacillus plantarum GMNL06, alone, for three months.
RESULTS: We obtained a therapeutic response considered good or very good in 90% of mild or moderate acne cases.
CONCLUSIONS:Vulgar acne, considered a chronic inflammatory and multifactorial disease, presents several therapeutic options. The use of probiotics has become an adjunct treatment due to its anti-inflammatory effect. In this study, we demonstrated that the use of topical probiotics, in monotherapy, for three months obtained therapeutic response considered good or very good in 90% of mild or moderate acne cases.

Keywords: Probiotics; Bacteria; Acne; Treatment

BACKGROUND: The microneedling technique and the transdermal drug delivery are indicated to treat acne scars.
OBJECTIVE: Evaluation of the microneedling technique associated with the drug delivery of the epidermal growth factor (EGF).
METHODS: Randomized double-blind clinical trial of 30 patients divided into two groups: (1) - two microneedling sessions with a 30-day interval, (2) - two microneedling sessions with the same interval but associated with EGF drug delivery. The patients were evaluated clinically (global acne scarring grading system - Goodman and Baron) global acne scarring grading system via multispectral image and through self-perception questionnaires. The statistical analysis (Student T-test, SNK test, analysis of variance) was performed with the SisVar software (UFLA, 1996).
RESULTS: The groups were homogeneous regarding age, gender, and phototype. Clinical assessments showed a reduction in severity scores for both groups. The multispectral analysis revealed a decrease in porphyrins (p = 0.0296) and an improvement in skin texture in group 2 subjects.
CONCLUSION: Microneedling therapy was effective and safe for the acne scars treatment, and EGF demonstrated to be a promising strategy as well.

Keywords: Acne vulgaris; Cicatrix; Skin

INTRODUCTION: Acne is a chronic inflammatory disease of the pilosebaceous unit of multifactorial origin, which causes a significant impact on quality of life.
OBJECTIVE: Clinical trial assessing the superiority of efficacy of a treatment regimen with an oral probiotic associated with a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% compared to an oral placebo with the same topical treatment in patients with acne.
METHODS: This was a randomized, double-blind, placebo-controlled study conducted with 212 patients aged from 12 to 35 years. The study was divided into two phases of 90 days each. In the first phase, patients received treatment with adapalene 0.1% and benzoyl peroxide 2.5% associated with a probiotic (IT), or adapalene 0.1% and benzoyl peroxide 2.5% associated with placebo (CT). In the second phase (90 days), patients received only oral treatment with a probiotic or placebo. Efficacy criteria were: reduced Investigator Global Assessment (IGA) scale to 0 or 1 and reduced lesion count.
RESULTS: There was a significant difference in the proportion of participants with IGA 0 or 1 - the arm receiving the test treatment was superior to the control (p<0.05). Both treatments were safe and well tolerated.
CONCLUSION: In light of the evidence on efficacy and safety, treatment with probiotics should be considered as an adjuvant therapy for acne control.

Keywords: Acne vulgaris; Probiotics; Gastrointestinal microbiome