ISSN 0001-5555 Volume 92 2012 No. 3 Theme Section A Non-profit International Journal for Skin Research, Clinical Dermatology and Sexually Transmitted Diseases Official Journal of - The International Forum for the Study of Itch - European Society for Dermatology and Psychiatry THEME ISSUE: FROM ACNE TO RETINOIDS AND LYMPHOMAS COMPOSED BY ANDERS VAHLQUIST, Editor-IN-CHIEF Acta Dermato-Venereologica www.medicaljournals.se/adv Acta Derm Venereol 2012; 92: 227–289 THEME ISSUE: FROM ACNE TO RETINOIDS AND LYMPHOMAS Composed by Anders Vahlquist, Editor-in-Chief This theme issue of Acta Dermato-Venereologica bridges two bexarotene exert positive and negative effects far beyond seemingly unrelated diseases, acne and lymphoma, by inclu- those of pure RAR agonists. For the former drug, this is il- ding papers on retinoid therapy for both conditions. Beginning lustrated in a large trial on chronic hand eczema (p. 251) and with acne vulgaris, accumulating evidence suggests that diet in a pilot study of its use for congenital ichthyosis (p. 256). after all plays a role, which is ventilated in a commentary (p. For bexarotene, a new Finnish study shows 10 years expe- 228) of a prospective study using low- and high-calorie diets rience of this therapy in severe cutaneous lymphoma (p. 258). in adolescents with acne (p. 241). Acne treatment regimes Depending on the stage of the disease, lymphomas can also usually differ from one country to another; a Korean survey be treated for instance with photodynamic therapy (p. 264) (p. 236) combined with a review on how to treat post-acne and methotrexate (p. 276). Eventually, novel therapies for hyperpigmentation with hydroquinone (p. 232) add valuable cutaneous lymphoma will hopefully be developed based on information to this field. While isotretinoin is still the drug the expanding knowledge about its pathogenesis, as exempli- of choice for severe acne, the optimal dosage needs to be re- fied in this issue by studies of cytokine release and receptor peatedly discussed (p. 247). Interestingly, isotretinoin is also expression (p. 280 and 282). worth trying (off-label) in large condylomas (p. 249). Two In preparing this theme issue the following colleagues newer types of retinoids, alitretinoin and bexarotene, are used have provided invaluable help: Tilo Biedermann, Reinhard in treating such diverse conditions as eczema and cutaneous Dummer, Bodo Melnik, Annamari Ranki, and Kristian lymphomas. By binding to RXR receptors, alitretinoin and Thestrup-Pedersen. Uppsala, March 5, 2012 Anders Vahlquist Editor-in-Chief CONTENTS Acne Vulgaris: Clinical and Experimental Commentary: Diet in Acne: Further Evidence for the Role of Nutrient Signalling in Acne Pathogenesis, Melnik 228 Review: Hydroquinone Therapy for Post-inflammatory Hyperpigmentation Secondary to Acne: Not Just Prescribable 232 by Dermatologists, Chandra et al. A Nationwide Study of Acne Treatment Patterns in Korea: Analysis of Patient Preconceived Notions and Dermatologist 236 Suggestion for Treatment, Kwon et al. Clinical and Histological Effect of a Low Glycaemic Load Diet in Treatment of Acne Vulgaris in Korean Patients: A 241 Randomized, Controlled Trial, Kwon et al. Retinoid Therapy in Relation to Acne, Eczema, Ichthyosis and Lymphoma Treatment of Severe Acne with Low-dose Isotretinoin, Mehra et al. 247 Large Benign Condyloma Acuminatum: Successful Treatment with Isotretinoin and Interferon Alpha, Pasmatzi et al. 249 Efficacy and Tolerability of Alitretinoin for Chronic Hand Eczema Under Daily Practice Conditions: Results of the 251 TOCCATA Open Study Comprising 680 Patients, Diepgen et al. Alitretinoin in Congenital Ichthyosis: Pilot Study Shows Variable Effects and Risk of Hypothyroidism, Gånemo et al. 256 Ten-year Experience of Bexarotene Therapy for Cutaneous T-cell Lymphoma in Finland, Väkevä et al. 258 Cutaneous lymphomas: Alternative therapies and Case reports Photodynamic Therapy with Methyl-aminolaevulinic Acid for Mycosis Fungoides, Kim et al. 264 Distribution and Maturation of Skin Dendritic Cell Subsets in Two Forms of Cutaneous T-cell Lymphoma: Mycosis Fungoides and Sézary Syndrome, Schwingshackl et al. 269 Epstein-Barr Virus-positive Mucocutaneous Ulcers as a Manifestation of Methotrexate-associated B-cell Lympho- 276 proliferative Disorders, Hashizume et al. A Case of Lymphomatoid Papulosis with Extensive Limb Disease Followed by Extracutaneous Involvement and 278 Acquired Ichthyosis, A.Tokuriki, T. Kiyohara, T. Ido and M. Kumakiri Serum Levels of CC Chemokine Receptor 4 and CXC Chemokine Receptor 3 Ligands in CD8+ Sézary Syndrome, H. Uchi, 280 et al. Serum IL-31 Levels are Increased in Patients with Cutaneous T-cell Lymphoma, H. Ohmatsu, et al. 282 Localized AL Amyloidosis in a Patient with Diffuse Large B-cell Lymphoma of the Breast, Chiu et al. 284 Cutaneous Cryptococcosis Mimicking Basal Cell Carcinoma in a Patient with Sézary Syndrome, Töröcsik et al. 286 Mycosis Fungoides in the Setting of T-cell Large Granular Lymphocyte Proliferative Disorder, Saggini, et al. 288 © 2012 The Authors. doi: 10.2340/00015555-1339 Acta Derm Venereol 92 Journal Compilation © 2012 Acta Dermato-Venereologica. ISSN 0001-5555 Included in the theme issue: Acta Derm Venereol 2012; 92: 228–231 ACNE, RETINOIDS AND LYMPHOMAS Acta Derm Venereol 2012; 92: 227–289 COMMENTARY to Kwon et al. on p. 241 Diet in Acne: Further Evidence for the Role of Nutrient Signalling in Acne Pathogenesis Bodo C. MELNIK Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany Recent evidence underlines the role of Western diet in a substantial role in the pathogenesis and treatment of the pathogenesis of acne. Acne is absent in populations acne. Subjects within the low glycaemic group demon- consuming Palaeolithic diets with low glycaemic load strated significant clinical improvement in the number of and no consumption of milk or dairy products. Two ran- both non-inflammatory and inflammatory acne lesions. domized controlled studies, one of which is presented in Remarkably, Kwon et al. (3) now provide the first his- this issue of Acta Dermato-Venereologica, have provided topathological and immunohistochemical evidence that evidence for the beneficial therapeutic effects of low gly- a low glycaemic load diet reduced the size of sebaceous caemic load diets in acne. Epidemiological evidence con- glands, decreased inflammation, and diminished the firms that milk consumption has an acne-promoting or expression of pro-inflammatory interleukin-8 and sterol acne-aggravating effect. Recent progress in understan- regulatory element binding protein-1 (SREBP-1), the key ding the nutrient-sensitive kinase mammalian target of transcription factor of lipid biosynthesis. rapamycin complex 1 (mTORC1) allows a new view of nutrient signalling in acne by both high glycaemic load and increased insulin-, IGF-1-, and leucine signalling due HIGH GLYCAEMIC LOAD AND MILK ACTIVATE to milk protein consumption. Acne should be regarded THE NUTRIENT-SENSITIVE KINASE mTORC1 as an mTORC1-driven disease of civilization, like obe- Experimental evidence has been provided for the sity, type 2 diabetes and cancer induced by Western diet. important role of insulin/insulin-like growth factor-1 Early dietary counselling of teenage acne patients is thus (IGF-1) signalling in SREBP-1-mediated sebaceous a great opportunity for dermatology, which will not only lipogenesis (4, 5). Although the impact of hypergly- help to improve acne but may reduce the long-term ad- caemic carbohydrates on enhanced insulin-/IGF-1 verse effects of Western diet on more serious mTORC1- signalling in acne has been robustly supported by the driven diseases of civilization. Key words: acne; diet; gly- studies of Smith et al. (2) and Kwon et al. (3), until caemic load; milk; mTORC1. recently only a weak association has been accepted for (Accepted February 29, 2012.) the role of milk and dairy products in acne pathogenesis (6). There is, however, substantial epidemiological and Acta Derm Venereol 2012; 92: 228–231. biochemical evidence supporting the effects of milk and dairy products as enhancers of insulin-/IGF-1 signalling Bodo C. Melnik, Department of Dermatology, Environmen- and acne aggravation (7–12). In fact, milk signalling tal Medicine and Health Theory, University of Osnabrück, potentiates the signalling effects of hyperglycaemic Sedanstrasse 115, DE-49090 Osnabrück, Germany. E-mail: carbohydrates (13) (Fig. 1). [email protected] We have to ask whether there is a unifying link con- necting the nutrient signalling pathways induced by The influence of diet on the induction and aggravation hyperglycaemic carbohydrates with those of milk con- of acne has been a matter of intense debate over the last sumption. We will answer this question only when we few years. The pioneering observation by Cordain et al. change our perception of milk and dairy as simple food. (1), who demonstrated that acne is a disease of Western We have to appreciate that milk is a species-specific civilization and is absent in populations consuming endocrine signalling system that activates a central Palaeolithic diets without refined sugars, grains, milk signalling node in cellular metabolism for stimulation and dairy products, resulted in a paradigm change. The of growth and cell proliferation: the nutrient-sensitive randomized, controlled Australian study by Smith et al. kinase mammalian target of rapamycin complex 1 (2) provided the first clinical evidence for the beneficial (mTORC1) (14). Both puberty-induced