Japanese Dermatological Association Guidelines: Guidelines for the treatment of acne vulgaris 2017

The emergence of bacterial resistance is a global crisis. Prolonged use of antibiotics especially in acne is one issue of concern among dermatologists. Ketoconazole (KTZ) cream, a topical antifungal with anti‐inflammatory and antiandrogenic actions, can decrease lipase activity of Cutibacterium acnes in vitro. We evaluated the efficacy and safety of KTZ cream in mild adult female acne (AFA) by conducting a randomized, double‐blind, placebo‐controlled trial using KTZ 2% and placebo cream twice daily for 10 weeks. We assessed the improvement of clinical severity, measured by AFA score graded by investigators and participants, and the change of acne count. Forty‐one participants enrolled in our study. The proportion of participants with acne improvement from baseline (42.9% vs 9.5%, P = 0.015) and the success rate (45.0% vs 14.3%, P = 0.043) in the KTZ group were significantly higher than that of the placebo group. The most common adverse events were dryness and itching. The percentage change of acne count decreased significantly compared with baseline but did not differ statistically between the two groups (P = 0.268). We concluded that the KTZ monotherapy showed a plausible effect in improving AFA with excellent safety profile. It should be considered as a viable option for mild AFA treatment.

Section: Discussionmentioning

confidence: 99%

“…Dermatologists are among the physicians most commonly prescribing antibiotics in the USA, and acne vulgaris (AV) is the most common indication . As a result, antibiotic stewardship has been strongly encouraged in several guidelines during the last few years …”

Section: Introductionmentioning

confidence: 99%

Topical 2% ketoconazole cream monotherapy significantly improves adult female acne: A double‐blind, randomized placebo‐controlled trial

Chottawornsak

Chongpison

Asawanonda

et al. 2019

“…For these reasons, antimicrobial agents are used for acne treatment against C. acnes . However, a heavy use of antibiotics causes an increase in bacterial resistance, limiting the continued use of antimicrobial treatment for acne . Some natural medicines with antimicrobial and antipathogenic activity have been reported .…”

Section: Introductionmentioning

confidence: 99%

“…Kampo medicines, traditional Japanese herbal medicines, have been used for acne treatment. Of these, Keigairengyoto, Seijoboufuto and Jumihaidokuto are considered as one of the options in acne treatment guidelines . However, there is no current understanding regarding the mechanism by which these medicines contribute to acne treatment.…”

Section: Introductionmentioning

confidence: 99%

Shiunko and Chuoko, topical Kampo medicines, inhibit the expression of gehA encoding the extracellular lipase in Cutibacterium acnes

Nakase

Tashiro

Yamada

et al. 2019

Antimicrobial agents have been used for eradication of Cutibacterium (formerly Propionibacterium) acnes that is an exacerbation factor of the skin disease acne vulgaris. However, the use of antibiotics is associated with an increased risk of promoting the emergence of resistant bacteria and leading to skin dysbiosis. Traditional Japanese Kampo medicines, such as Keigairengyoto, are used to treat acne. However, there is incomplete understanding regarding their functional mechanism in treatment of acne. In this study, we examined the antimicrobial and anti‐lipase activity of the Kampo medicines used empirically for acne treatment. Three oral medicines, Keigairengyoto, Seijoboufuto and Jumihaidokuto, were found to inhibit the growth of C. acnes and decrease the lipase activity. Especially, Keigairengyoto caused remarkable decrease of bacterial lipase activity. Furthermore, topical medicines such as Shiunko and Chuoko significantly decreased the lipase activity in a dose‐dependent manner, without inhibiting C. acnes growth. The topical medicines were found to inhibit the expression of gehA, which codes for extracellular lipase. Our results indicate that Shiunko and Chuoko have potential as effective acne therapeutic agents, especially because they do not promote the emergence of antimicrobial‐resistant bacteria and skin dysbiosis.

“…Of all antimicrobial agents, the amount of quinolone use is the third highest after that of macrolides and β‐lactams . In particular, topical nadifloxacin and ozenoxacin and oral levofloxacin are used for treatment of skin diseases such as acne vulgaris . We previously reported that the antimicrobial resistance of Cutibacterium (formerly Propionibacterium ) acnes isolated from acne patients is affected by antimicrobial use .…”

Section: Introductionmentioning

confidence: 99%

Relationship between quinolone use and resistance of Staphylococcus epidermidis in patients with acne vulgaris

Nakase

Yoshida

Saita

et al. 2019

Self Cite

Staphylococcus epidermidis is a bacterium known to inhabit the skin. In treatment of acne vulgaris, the cutaneous milieu is exposed to oral or topical antimicrobials. We previously reported that the antimicrobial resistance of Cutibacterium acnes isolated from acne patients is affected by antimicrobial use. The aim of this study was to investigate the relationship between quinolone use and resistance in skin bacteria, particularly S. epidermidis, from acne patients. A total of 92 and 87 S. epidermidis strains isolated from clinic patients and hospital outpatients with acne vulgaris, respectively, were tested. No significant difference was found between the prevalence of methicillin‐resistant S. epidermidis (MRSE) strains from clinic patients (37.0%) and hospital outpatients (39.1%). The MRSE strains (20.6%, 14/68 strains) showed a significantly higher ratio of high‐level levofloxacin resistance (minimum inhibitory concentrations were 64 to ≥256 μg/mL) compared with methicillin‐susceptible S. epidermidis strains (2.7%, 3/111 strains) (P < 0.01). The rate of levofloxacin resistance in C. acnes strains, which were isolated from the same samples of acne patients, showed a strong positive correlation with that in S. epidermidis strains (r = 0.93, P < 0.01). The high‐level levofloxacin‐resistant strains were frequently found in patients with history of quinolone use compared with those without (P < 0.01). Our data showed for the first time that antimicrobial administration for acne treatment affects the antimicrobial resistance in not only C. acnes but also S. epidermidis. Thus, caution should be exercised in antimicrobial use for acne treatment to prevent increasing antimicrobial resistance in these species.