BACKGROUND Propionibacterium acnes is a common cause of infection following shoulder surgery. Studies have shown that standard surgical preparation does not eradicate P acnes. The purpose of this study was to examine whether topical application of benzoyl peroxide (BPO) gel could decrease the presence of P acnes compared with today's standard treatment with chlorhexidine soap (CHS). We also investigated and compared the recolonization of the skin after surgical preparation and draping between the BPO- and CHS-treated groups. METHODS In this single-blinded nonsurgical study, 40 volunteers-24 men and 16 women-were randomized to preoperative topical treatment at home with either 5% BPO or 4% CHS on the left shoulder at the area of a deltopectoral approach. Four skin swabs from the area were taken in a standardized manner at different times: before and after topical treatment, after surgical skin preparation and sterile draping, and 120 minutes after draping. RESULTS Topical treatment with BPO significantly reduced the presence of P acnes measured as the number of colony-forming units on the skin after surgical preparation. P acnes was found in 1 of 20 subjects in the BPO group and 7 of 20 in the CHS group (P = .044). The results remained after 2 hours (P = .048). CONCLUSION Topical preparation with BPO before shoulder surgery may be effective in reducing P acnes on the skin and preventing recolonization.

The results of a randomized double-blind study show that benzoyl peroxide 5% combined with miconazole nitrate 2% in a cream formulation brought about a good to excellent result in 88% of 51 patients with moderate to severe acne, compared with benzoyl peroxide 5% alone which gave improvement in 41 % of 51 comparable patients. The difference is highly significant. Moreover, the frequency of the well-known irritating and drying effect of benzoyl peroxide was shown to be reduced from 10 cases in the benzoyl peroxide group to only 1 case in the miconazole/benzoyl peroxide-treated group. The combination of miconazole nitrate 2% and benzoyl peroxide 5% may therefore offer an effective and well-tolerated alternative to available therapies in the treatment of acne vulgaris.

Acne vulgaris is a prevalent dermatological condition characterized by comedones, papules, and pustules, with significant physical and psychological implications. Conventional treatments for this condition, including antibiotics and retinoids, face challenges, such as side effects and antibiotic resistance, necessitating alternative treatments. Recent studies show the potential of probiotics to modulate skin microbiome and alleviate acne symptoms. Therefore, this study aimed to consolidate evidence from randomized controlled trials (RCTs) and clinical investigations, evaluating the efficacy of probiotics in acne management. A comprehensive literature search was conducted across PubMed, Scopus, and Cochrane databases using several keywords, such as "probiotic", "microbiome", and "acne vulgaris". Inclusion criteria are RCTs and clinical studies from 2009 to 2024 examining probiotics for acne treatment. Studies were selected, screened, and analyzed based on population, intervention, design, and results. Descriptive statistics were used to summarize study characteristics. Fifteen studies including 811 participants met the inclusion criteria. The studies tested various oral and topical probiotics, including <i>Lactobacillus, Bifidobacterium, Bacillus</i>, and <i>Enterococcus</i> strains, over treatment periods ranging from 4 to 12 weeks. The results showed that probiotics, reduced acne lesions, improved skin barrier function, and decreased inflammatory markers. Both oral and topical probiotics showed potential in balancing skin microbiome and reducing acne severity. Some studies reported outcomes comparable to conventional acne treatments, such as antibiotics and benzoyl peroxide. However, there is variability in individual responses to different probiotic strains, and potential side effects, though rare, have been reported in some cases. Probiotics presented a natural, effective alternative to conventional acne treatment. However, future studies are needed to determine optimal treatment protocols.

<h4>Background</h4>Trifarotene, a fourth-generation topical retinoid, offers a novel therapeutic option for facial and truncal acne. However, its role was only briefly addressed in Malaysia's 2022 Clinical Practice Guidelines (CPGs) due to its unavailability at the time. This paper aims to provide expert advisory statements on the integration of trifarotene into acne management in Malaysia, addressing evidence gaps in guideline coverage, particularly for truncal acne and acne-induced sequelae.<h4>Methods</h4>A literature review was conducted to synthesize evidence on trifarotene's efficacy, safety, and clinical positioning. An advisory panel of 10 Malaysian dermatologists reviewed the evidence and provided consensus through structured surveys and discussion meetings. Three illustrative case studies were included to demonstrate the real-world application of trifarotene.<h4>Results</h4>Ten advisory statements were finalized, addressing trifarotene's role in acne algorithms, patient selection, dosing strategies, combination therapy, and management of acne sequelae. Evidence supports its use for both facial and truncal acne, with additional benefits in acne-induced hyperpigmentation and atrophic scarring. The panel recommended practical approaches to optimize tolerability and adherence, such as the CTMP (Cleanse-Treat-Moisturize-Photoprotect) regimen and incremental application strategies. Real-world cases demonstrated trifarotene's utility in diverse clinical settings.<h4>Conclusion</h4>These advisory statements provide clinical guidance on the use of trifarotene in Malaysia and support its integration into routine acne management. As current CPGs may remain unchanged in the near term, these recommendations aim to inform evidence-based practice while bridging gaps in local dermatologic care.

Various treatments for acne vulgaris exist, but little is known about their comparative effectiveness in relation to acne severity. To identify best treatments for mild-to-moderate and moderate-to-severe acne, as determined by clinician-assessed morphological features. We undertook a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, published up to May 2020. Outcomes included percentage change in total lesion count from baseline, treatment discontinuation for any reason, and discontinuation owing to side-effects. Risk of bias was assessed using the Cochrane risk-of-bias tool and bias adjustment models. Effects for treatments with ≥ 50 observations each compared with placebo are reported below. We included 179 RCTs with approximately 35 000 observations across 49 treatment classes. For mild-to-moderate acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with benzoyl peroxide (BPO) [mean difference 26·16%, 95% credible interval (CrI) 16·75-35·36%]; physical - chemical peels, e.g. salicylic or mandelic acid (39·70%, 95% CrI 12·54-66·78%) and photochemical therapy (combined blue/red light) (35·36%, 95% CrI 17·75-53·08%). Oral pharmacological treatments (e.g. antibiotics, hormonal contraceptives) did not appear to be effective after bias adjustment. BPO and topical retinoids were less well tolerated than placebo. For moderate-to-severe acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with lincosamide (clindamycin) (44·43%, 95% CrI 29·20-60·02%); oral pharmacological - isotretinoin of total cumulative dose ≥ 120 mg kg-1 per single course (58·09%, 95% CrI 36·99-79·29%); physical - photodynamic therapy (light therapy enhanced by a photosensitizing chemical) (40·45%, 95% CrI 26·17-54·11%); combined - BPO with topical retinoid and oral tetracycline (43·53%, 95% CrI 29·49-57·70%). Topical retinoids and oral tetracyclines were less well tolerated than placebo. The quality of included RCTs was moderate to very low, with evidence of inconsistency between direct and indirect evidence. Uncertainty in findings was high, in particular for chemical peels, photochemical therapy and photodynamic therapy. However, conclusions were robust to potential bias in the evidence. Topical pharmacological treatment combinations, chemical peels and photochemical therapy were most effective for mild-to-moderate acne. Topical pharmacological treatment combinations, oral antibiotics combined with topical pharmacological treatments, oral isotretinoin and photodynamic therapy were most effective for moderate-to-severe acne. Further research is warranted for chemical peels, photochemical therapy and photodynamic therapy for which evidence was more limited. What is already known about this topic? Acne vulgaris is the eighth most common disease globally. Several topical, oral, physical and combined treatments for acne vulgaris exist. Network meta-analysis (NMA) synthesizes direct and indirect evidence and allows simultaneous inference for all treatments forming an evidence network. Previous NMAs have assessed a limited range of treatments for acne vulgaris and have not evaluated effectiveness of treatments for moderate-to-severe acne. What does this study add? For mild-to-moderate acne, topical treatment combinations, chemical peels, and photochemical therapy (combined blue/red light; blue light) are most effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy (light therapy enhanced by a photosensitizing chemical) are most effective. Based on these findings, along with further clinical and cost-effectiveness considerations, National Institute for Health an

<h4>Background</h4>Acne vulgaris is one of the most prevalent disorders affecting 9%-10% of the global population, representing as papules, pustules, and comedones, with a pathogenesis involving increased sebum production, C. acnes colonization, and inflammation. Conventional treatments like retinoids and antibiotics often cause side effects, thus diverting attention toward probiotics as an alternative therapy. Lactobacillus probiotics, having their immunomodulatory, anti-inflammatory, and antimicrobial properties, are useful in managing acne by reducing inflammation and oxidative stress with proved safety profile and the potential to reduce antibiotic reliance. This systematic review and meta-analysis evaluate the efficacy of Lactobacillus-based probiotics compared to placebo and benzoyl peroxide in reducing inflammatory lesions, non-inflammatory lesions, and total acne lesion counts. The findings aim to clarify their therapeutic role and provide evidence on their effectiveness and safety.<h4>Objectives</h4>This systematic review and meta-analysis investigated the effectiveness of oral and topical Lactobacillus-based probiotics or postbiotics, compared with placebo or benzoyl peroxide, in patients with acne vulgaris.<h4>Methods</h4>A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, including studies evaluating oral or topical Lactobacillus-based probiotic or postbiotic interventions in patients with acne vulgaris. Primary outcomes were changes in inflammatory lesion counts, while secondary outcomes included non-inflammatory and total lesion counts, skin hydration, and sebum concentration. All analyses were performed using random-effects models with 95% confidence intervals (CI), and heterogeneity was quantified using the I² statistic.<h4>Results</h4>A total of five RCTs involving 332 participants were included. The pooled mean difference for non-inflammatory lesions was -1.39 (95% CI -5.10 to 2.32, p = 0.46), for inflammatory lesions was -0.08 (95% CI -1.28 to 1.11, p = 0.89), and for total lesion counts was -9.07 (95% CI -20.71 to 2.57, p = 0.13). These results concluded that there was no significant reduction in lesion counts with Lactobacillus-based probiotics as compared to placebo or benzoyl peroxide. Heterogeneity was moderate to low across studies.<h4>Conclusion</h4>This meta-analysis indicates that Lactobacillus-based probiotics do not provide significant clinical benefits in reducing inflammatory lesions, non-inflammatory lesions, and total acne lesion counts in Acne vulgaris patients compared to placebo or benzoyl peroxide.

Diet is considered to be one of the main factors influencing the induction and aggravation of acne, though this is still debatable. Previous researches have focused on glycemic load, and hyperinsulinemia which lead to an increase in the concentration of insulin-like growth factor (IGF-1), which has been reported to affect androgen metabolism and lipogenesis Additionally, IGF-1 has been shown to upregulate inflammatory cytokines. A correlation between the severity of acne and the level of serum IGF-1 has also been reported. Previous clinical studies showed that a low glycemic diet can decrease both the size of the sebaceous gland and the number of inflammatory lesions Several treatment modalities have been used to treat AV. Topical therapies include antibiotics, azelaic acid, benzoyl peroxide, and retinoids. Systemic treatments include antibiotics, hormonal therapy, and isotretinoin in addition to physical modalities as chemical peeling . Chemical peeling is a safe, efficacious, and cost-effective procedure for treating various skin disorders and for enhancing cosmetic appearance.

Background: Acne vulgaris is one of the most common dermatological disorder affecting the pilo sebaceous glands resulting in their blockage or inflammation. Symptoms of acne may include local erythema and tenderness and pain. Medication include benzoyl peroxide, retinoids, salicylic acid, alpha hydroxy acid, nicotinamide, azelaic acid, anti-seborrheic medications, hormonal treatment, anti-androgen medications and keratolytic soaps.Methods: About 166 patients who were treated for acne vulgaris were included into the study after taking the informed consent from the patients. This study was approved by the Institutional Ethics Committee. The demographic details of the patients with regards to their, age sex, weight, BMI were taken. The acne was medically diagnosed, and the grade was assessed.Results: Out of the 166 patients included into the study, 92 (55%) were females while 74 (45%) were males and the mean age was 25.4±1.6 of the patients belonged to the middle class. Of the patients, most of them were adolescents or less than 25 years of age (54.2%). 64 of the patients were between 26-45 years while only 12 were >45 years of age. A total of 521 drugs were prescribed. Of them, 37.6% were through the oral route and 62.4% were topical the most common prescribed drugs were antimicrobials, both topical and oral.Conclusions: The multidrug prescription in most of the cases can be rationalized if a drug monitoring system can be effectively put into place. This would not only reduce t