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The effect of ketoconazole on sebum secretion in patients suffering from acne and seborrhoea.

Ketoconazole, an imidazolic antimycotic derivative, has proved to have an antiandrogenous effect, which may be observed to inhibit the adrenal and gonadal steroid synthesis. The authors wished to verify this effect of the drug in men and women suffering from acne and seborrhoea, conditions believed to indicate a heightened androgenous effect in the sebaceous gland. They aimed to do this by studying the cutaneous sebum, which is considered a reliable indirect indicator of androgenous activity. They found a statistically significant decrease in the rate of sebum production in all patients administered with a single daily oral dose of ketoconazole (200 mg). Moreover no untoward side-effects were reported. The anti-androgenous property of ketoconazole would therefore suggest that the drug could be proposed as a useful alternative in the treatment of acne and seborrhoea.

Acne Vulgaris

The structure of triglyceride in human sebum.

1) A relatively large quantity of branched chain and odd-carbon-number fatty acids were found in human sebum. 2) These acids were present in each lipid fraction (cholesterol ester, triglyceride and free fatty acid) of sebum. 3) In the triglyceride molecule, these acids were found mainly on the 2-position.

Chemical Phenomena

Composition of the ventral gland-pad sebum from the Mongolian gerbil, Meriones unguiculatus.

The chemical composition of the gland-pad sebum of gerbils of both sexes is analysed using gas-liquid chromatographical and mass spectroscopical techniques and compared with the lipids from distal skin areas. Cholesterol esters, with (omega-1)-methyl-substituted fatty acids as acidic constituents, were shown to occur in the gland-pad sebum of both sexes in high concentrations, whereas cholesta-3,5-diene could be detected in the males only.

Animals

Sebum: analysis by infrared spectroscopy. II. The suppression of fatty acids by systemically administered antibiotics.

Various tetracyclines and erythromycins have been used rather empirically for the systemic treatment of acne vulgaris for more than a decade. It has been impossible to accurately evaluate clinically the numerous derivatives and to compare their effectiveness with other antibiotics such as clindamycin. As a substitute for this approach, this present study ranks these antibiotics, when given orally, as to their effectivensss in suppressing the fatty acids in sebum in normal volunteers. As a group, the tetracyclines were more effective than the erythromycins in decreasing the fatty acids, but clindamycin was significantly more potent than either.

Acne Vulgaris

Inhibition of sebum excretion by an H2 blocker.

Cimetidine, 1g orally per day, partially inhibited sebum excretion in patients with acne. Whether this was the result of H2-receptor blockade or an antiandrogen action is unknown.

Acne Vulgaris

Unusual cholesterol esters in the sebum of young children.

Cholesterol esters (CE) having fatty acids of more than 18 carbons are a prominent feature of fetal skin surface lipid (vernix caseosa), but are a minor component of adult lipid. The difference may be related to the fact that fetal sebaceous glands generally synthesize little lipid. If so, it would be expected that prepuberal children, who also have very inactive glands, would secrete CE with a large proportion of very-long-chain fatty acids. To test this conjecture, skin surface CE from young children were isolated and analyzed. Sebum was extracted from the hair of 38 children, aged six to nine. To obtain a measure of sebaceous lipogenesis, the class composition of the lipid was determined by quantitative thin-layer chromatography and the ratio of wax esters/[cholesterol + cholesterol esters] (WE/[CH + CE]) was calculated. CE were then isolated from the lipid and hydrolyzed. The freed fatty acids were converted to fatty acid methyl esters (FAME) and analyzed by capillary gas chromatography to determine the proportion with more than 18 carbons. FAME from five of the subjects were then separated into saturated and monounsaturated fractions and analyzed again by gas chromatography to identify chain types. Ratios of WE/[CH + CE] ranged from 0.08 to 2.8 in the subjects. The proportion of CE FAME with more than 18 carbons ranged from 15 to 72%, with the highest proportion being found in the children with the lowest WE/[CH + CE]. The saturated FAME were mostly iso- or anteiso-branched, whereas the monounsaturated FAME were mostly straight-chain extension products of 16: 1 delta 9 or 18: 1 delta 9.

Child

The sebum excretion rate in rosacea.

The sebum excretion rate (SER) was measured in fifty-five patients with rosacea and 126 control subjects. The mean SER in the patients with rosacea was not increased, nor was there any correlation between SER and severity of rosacea. Our data suggest that seborrhoea plays no part in the pathogenesis of rosacea.

Adult

Nutritional influences of pellagra on sebum composition.

Sebum composition has been measured in 51 patients with varying degrees of pellagra and compared with a control group of subjects in the same geographic area. In the pellagra group the wax ester percentage was 14-9 versus the normal of 21-9%. The squalene percentage was increased in the pellagra group (11-6%) versus a control value of 8-4%. A small increase in the percentage of cholesterol was also noted. These changes, which previously have been observed in starved but otherwise normal subjects, were reversible with adequate refeeding.

Adult

Measurement of sebum excretion rate and skin temperature above and below the neurological lesion in paraplegic patients.

The sebum excretion rate (SER) was measured above and below the neurological lesion in seventeen male and four female paraplegic patients and at comparable sites in a similar number of age-matched controls. There was no significant difference between paraplegics and controls for forehead SER. For the thigh SER there was a highly significant difference between paraplegics and controls (t = 6.27:P less than 0.001), the level for paraplegics being twice that for controls. Simultaneous thigh skin temperature measurements showed no significant difference between paraplegics and controls.

Acne Vulgaris

Effect of oral contraceptives on sebum excretion rate.

Oral contraceptives containing a high dose of oestrogen reduce the sebum excretion rate (SER) and improve acne vulgaris, but more progestogenic preparations may exacerbate acne. The effect on the SER of several oral contraceptives with varying progestogenic potencies was studied in 81 women. The predominantly progestogenic pills (Eugynon 30, Gynovlar) produced no significant change in SER, whereas the rate in women taking a more oestrogenic pill (Minovlar) was significantly reduced compared with the rate in controls. Progestogens therefore do not exacerbate acne by inducing seborrhoea, but in the doses we studied they nullified the inhibitory effect of oestrogens on the sebaceous glands. Acne-prone women who require an oral contraceptive should be given a predominantly oestrogenic preparation.

Acne Vulgaris

Rate and topography of follicular sebum excretion.

We have designed a combined method using a lipid-absorbent tape and skin surface stripping to evaluate the relationship between the follicular sebum excretion rate and the microanatomy of the follicular duct openings. Many sebaceous follicles appear quiescent in normals and with acne patients. Most of the large spots on the lipid-absorbent tape are due to the confluence of smaller ones. 'Open' comedones in acne are functionally closed.

Acne Vulgaris

Sebum suppression by benzoylperoxide.

Sebum excretion rate (SER) was determined by thin-layer chromatography and based on densitometric data in 9 male and 5 female patients suffering from acne during treatment with 10% benzoylperoxide (BPO). BPO was applied to the forehead (treatment area), whereas gel only was applied to the chest (control area) for 6 weeks. SER decreased in 10/14 subjects, no change was found in 1 subject and 3 patients exhibited an increase in SER. Suppression varied between 12 and 86%. Concomitant SER reduction in control and treatment areas was noted in 6 patients. When treatment and control areas of individual patients were considered for data evaluation, SER decrease was noted in only 4 out of 14 subjects. Similar results were obtained when free fatty acids, triglycerides and squalene data were analyzed. Combined, these data suggest that BPO may affect SER in some patients. The present experiments indicate the importance of adequate controls in such studies.

Acne Vulgaris

The effect of oral zinc administration on sebum free fatty acids in acne vulgaris.

Free fatty acids in sebum arise from lipolytic action of bacterial lipases. We have demonstrated an inhibitory effect of zinc on the lipase of the three Propionibacterium species found in human pilosebaceous follicles. We were also able to show a small corresponding fall in the free fatty acid content of skin surface lipid in vivo in acne patients treated with zinc, though this failed to reach statistical significance.

Acne Vulgaris

Effects of azelaic acid on sebaceous gland, sebum excretion rate and keratinization pattern in human skin. An in vivo and in vitro study.

The effects of azelaic acid (AZA) on the epidermis of 47 individuals (12 with normal skin, 15 with seborrheic skin and 20 suffering from acne) and on in vitro cultured keratinocytes are reported. Topical application of a 20% AZA cream significantly improved the lesions of acne patients, but failed to induce clinically detectable changes in normal or seborrheic epidermis. Complementary investigations clearly showed that AZA treatment failed to induce specific changes in sebum composition, excretion rate, or in the size of sebaceous glands, but modified epidermal keratinization. Keratohyalin granules and tonofilament bundles were reduced in size and number, mitochondria were swollen and the rough endoplasmic reticulum of malpighian keratinocytes enlarged. The infundibular epidermis of acne individuals showed marked reduction of the horny layer thickness, widening of the horny cell cytoplasm, transitional corneal cells, normalization of filaggrin distribution, and the comedo contained few bacteria and spores. In vitro, AZA exerted marked time- and dose-dependent antiproliferative cytostatic effects on cultured keratinocytes, with a 50% inhibitory dose of 20 mM, decreased some keratinocyte proteins (highly soluble fractions S2, keratohyalin macroaggregate R2, and non-cross-linked fibrous protein S4) and a 95 kD and a 35 kD protein of the cytosolic fraction. Mitochondria were frequently damaged and the rough endoplasmic reticulum enlarged. Our results indicate that AZA is an antikeratinizing agent, displaying antiproliferative cytostatic effects on keratinocytes and modulating the early and terminal phases of epidermal differentiation.

Acne Vulgaris