Evaluation of Seasonal Changes in Facial Skin With and Without Acne

June 2015 | Volume 14 | Issue 6 | Original Article | 593 | Copyright © June 2015

Karen Meyer BS, Apostolos Pappas PhD, Kelly Dunn BS, Gabriela O. Cula PhD, InSeok Seo PhD, Eduardo Ruvolo JR MS, and Nikoleta Batchvarova PhD

Johnson & Johnson Consumer Companies, Inc., Skillman, NJ

Abstract
The objective of this study was to compare facial skin of adolescent males with (acne) and without acne (non-acne) over the course of 1 year. At study entry, presence of acne was determined by clinical image analysis (acne n=7, non-acne n=10). Monthly evaluations of skin condition were made using standard and fluorescent imaging, fluorescence spectroscopic analysis, sebum analysis, skin high frequency conductivity (moisture content), transepidermal water loss (TEWL), and sampling of skin bacteria (aerobic and anaerobic). Data were evaluated seasonally. Over the course of the study, subjects in the acne and non-acne groups had no significant increase in their clinical acne score. Sebum production was significantly greater in subjects with acne than in those without for each season examined (P<0.019) and was lowest in the winter and highest in the fall. TEWL was higher in those with acne than without acne across all seasons (P=0.001). Skin moisture in both groups was increased during summer and fall compared with winter (P≤0.016 for both seasons). Subjects with acne had a higher recovery of both aerobic and anaerobic bacteria compared with subjects without acne (P≤0.015). Analysis of cheek skin in the nasal area revealed significantly higher fluorescence (500-800 nm) in image-based and spectroscopic analysis from subjects with acne, suggesting the greater presence of the bacterial metabolite porphyrin in those with acne. In these cohorts of adolescent males, significant differences in sebum production, skin barrier function, moisture content, and microbial load (anaerobic and aerobic) were noted between those with and without acne. Evidence for seasonality was observed, with lower lipid production and reduced barrier function during the winter. More studies to quantify differences in skin lipid components and bacterial species among these cohorts are planned.

J Drugs Dermatol. 2015;14(6):593-601.

INTRODUCTION

Acne is common in adolescents, with prevalence as high as 80% reported in subjects 11-30 years of age.1-3 Most studies of acne or acne therapy are for relatively short periods (eg, 4 months) and most acne sufferers visit dermatologists for 1 year or less.4 In one longitudinal study from 1981, Fellowes et al. studied a cohort of 1,510 British school children for approximately 8 years (age range 9-17 years).3 They found that acne became more common in males than females at approximately 16 years of age and peaked at 17-18 years of age.
Although often characterized as a normal feature of adolescence, acne can have significant effects on quality of life. When evaluated against the known effects of other chronic medical conditions using standardized measures, acne is similar to asthma, epilepsy, diabetes, back pain, arthritis, psoriasis, and coronary heart disease in decreasing quality of life.5
Acne is a multi-factorial disease, with expression of acne symptoms (ie, comedones, skin inflammation, papules, pustules) thought to result from the combined actions of androgens, neuropeptides, pro-inflammatory mediators, changes in follicular desquamation, sebum secretion, and proliferation of certain bacteria.6
The objective of this study was to determine how facial skin of adolescent males living in New Jersey, USA, changed over the course of 1 year, comparing subjects with and without mild to moderate acne. Parameters monitored included acne severity, skin hydration, skin barrier function, bacterial load, sebum production, and subject self-reports.

METHODS

Subjects

This was a 1-year exploratory observational study in adolescent males (13-18 years old) with and without acne living in New Jersey, beginning in December 2011 after approval by the Allendale Institutional Review Board (Old Lyme, CT). Only male subjects were included in this study to avoid potential effects of monthly hormonal cycling on skin parameters in females. Subjects were required to be healthy males with Fitzpatrick skin types I-III and were recruited into the study after both subjects and guardians signed an informed consent form and a photograph release. Subjects were compensated for participating in the study.
Those with acne had mild to moderate acne as determined by expert clinical image grading at study initiation (modified Cook’s score of grade 2-5, Table 1).7 Subjects in the non-acne