ARTICLE: Clinical Insights About the Role of pH in Acne

December 2019 | Volume 18 | Issue 12 | Supplement Individual Articles | 221 | Copyright © December 2019


Charles Lynde MD FRCPC

American Board of Dermatology, Royal College of Physicians and Surgeons of Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada, Lynderm Research, Markham, ON, Canada 

Jerry Tan MD FRCPC

Royal College of Physicians and Surgeons of Canada, Schulich School of Medicine and Dentistry, Department of Medicine, Western University, Windsor, ON, Canada, Windsor Clinical Research Inc., The Healthy Image Centre, Windsor, ON, Canada Sandra Skotnicki MD FRCPC

American Board of Dermatology, the Royal College of Physicians and Surgeons of Canada, Department of Medicine, Divisions of Dermatology, and Occupational and Environmental Health, University of Toronto, Toronto, ON, Canada, Bay Dermatology Centre, Toronto, ON, Canada Anneke Andriessen PhD

Radboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands 

Jennifer Beecker MD CCFP(EM) FRCPC DABD

Royal College of Physicians and Surgeons of Canada, American Board of Dermatology, University of Ottawa, Ottawa, ON, Canada, The Ottawa Hospital, Director of Research, The Ottawa Hospital Research Institute, Ottawa, ON, Canada 

Joël Claveau MD FRCPC

American Board of Dermatology, Royal College of Physicians and Surgeons of Canada, Department of Medicine, Laval University, Quebec City, QC, Canada; Melanoma and Skin Clinic, Le Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada 

Monica K. Li MD FRCPC

Royal College of Physicians and Surgeons of Canada, Faculty of Medicine, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada, Enverus Medical, Surrey, BC, Canada and Cosmetic Dermatologist, City Medical Aesthetics Center, Vancouver, BC, Canada 

Jaggi Rao MD FRCPC

Royal College of Physicians and Surgeons of Canada, Division of Dermatology, University of Alberta, Edmonton, AB, Canada 

Jennifer Salsberg MD FRCP

Royal College of Physicians and Surgeons of Canada, University of Toronto, Women’s College Hospital, Toronto, ON, Canada, Bay Dermatology Centre, Toronto, ON, Canada Maxwell B. Sauder MD FRCPC FAAD

Royal College of Physicians and Surgeons of Canada, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, Harvard Medical School, Boston, MA, Toronto Dermatology Centre, Toronto, ON, Canada 

Catherine Zip MD FRCPC

Royal College of Physicians and Surgeons of Canada, Department of Medicine, University of Calgary, Calgary, AB, Canada, Dermatologist, Dermatology Centre, Calgary, AB, Canada

Abstract
Acne vulgaris is the most common dermatological disorder globally.1,2 Psychological and emotional distress due to acne, including poor self-esteem, social anxiety, depression, and suicidal ideation have been reported in various studies.3,4, Acne is a complex multifactorial disease with its pathophysiology incompletely elucidated.

INTRODUCTION

Acne vulgaris is the most common dermatological disorder globally.1,2 Psychological and emotional distress due to acne, including poor self-esteem, social anxiety, depression, and suicidal ideation have been reported in various studies.3,4 Acne is a complex multifactorial disease with its pathophysiology incompletely elucidated. An impaired skin barrier function in acne as well as decreased amounts of ceramide levels have been reported.5,6 In acne, when skin barrier integrity is compromised, functional properties (eg, higher sebum excretion, larger sebaceous glands, evident subclinical inflammation), and ultrastructural ones (eg, enhanced filaggrin expression, reduced free fatty acids, linoleic acid, free sphingosine, and total ceramides) are altered.8 Maintaining a light acidic skin surface pH (of 4 to 5) to keep the skin barrier intact, which in turn reduces the risk for dry and irritated skin, may be of benefit to those individuals suffering from acne.

SCOPE

The current consensus paper explores the influence of skin surface pH on acne. We further investigate clinical insights into the role of pH in acne, and the influence of cleansing and moisturizer use as a measure to sustain skin pH at physiological levels.

The statements discussed in the consensus paper are intended for health care providers, such as dermatologists, and family physicians caring for individuals with acne in all age groups.

METHODS

Literature Review
A literature review explored clinical insights into the role of pH in acne and the influence of cleansing and moisturizers. For this purpose searches were performed on PubMed and Google *Excluded were: Duplications, In case of an update on a review article the latest version was used; Poor quality. Systematic literature (syst.lit.); Retrospective study (RS); Randomized Controlled Trial (RCT); Clinical evaluation (CE); Laboratory studies (LS) Scholar of the English-language literature (2010–2018) using the terms: Acne vulgaris; Acid mantle; Skin pH; Stratum corneum pH; Acne pathogenesis; Inflammation in acne; Risk factors for acne; Immune response and epidermal skin barrier function; Skin barrier deficiency; Stratum corneum hydration and skin surface pH in acne; Prevention; Emollients; Cleansers; Moisturizers.

The selected publications were manually reviewed for additional resources by a dermatologist and a clinical scientist with experience in this field (AA). The searches yielded 53 papers. After exclusion of duplicates and papers not relevant for skin surface pH in acne, 44 papers were included (Figure 1). The two reviewers together with the expert panel chair (JT) prepared statements for discussion by the expert panel, using the results of the literature review.

Role of the Panel
The expert panel of dermatologists convened for a one-day meeting (January 13, 2019; Toronto, ON) to define statements on the role of skin surface pH in acne as well as on the influence of cleansing and moisturizer use. For this purpose, selected information from the literature searches coupled with expert opinion and experience of the panel in acne was used to adopt statements. The consensus process consisted of a nominal group technique.8 The panel then voted on the inclusion of statements after nominal group discussion.8 Consensus required a minimum of 80% agreement.

Statements Defined by the Panel
The panel members reached consensus on six statements, the votes being unanimous except for statement number three, which was passed with 9/10 (90%) agreement.
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