Massimo Milani - Academia.edu (original) (raw)

Papers by Massimo Milani

Biomedical Journal of Scientific and Technical Research, Feb 20, 2023

The combination of retinoids and antibacterial agents are considered as first line treatment appr... more The combination of retinoids and antibacterial agents are considered as first line treatment approach in subjects with mild to moderate acne. Hydroxypinacolone retinoate (HPR) is a cosmetic grade ester of all-trans retinoic acid which is able to bind directly with retinoid receptors without the need for metabolic breakdown to more biologically active forms. It has been demonstrated to possess anti-acne and anti-ageing effects, causing less skin irritation than retinoic acid. The Retinsphere technology, which is a patented dual combination of hydroxipinacolone retinoate in glycosphereencapsulated retinol, and BIOPEP-15, a plant-derived antimicrobial peptide, is available and used in several anti-acne products. The aim of this narrative review was to summarize all available scientific evidence on topical Retinsphere HPR-BIOPEP-15 (RB) therapy for acne, alone or in combination with nicotinamide, salicylic and glycolic acids (RB+NSG). In detail, 3 studies analysed RB and 2 studies analysed RB+NSG efficacy and tolerability. All studies measured acne lesions count changes over time, two studies analysed microscopic skin changes with reflectance confocal microscopy (RCM), and two studies assessed sebum production changes. In conclusion, collective data derived from current literature demonstrated that RB induced a median 51% reduction of total acne lesion (TL), comprising a 43% reduction of non-inflammatory lesions (NIL) and a 67% reduction of inflammatory lesions (IL). RB+NSG showed increased efficacy, with an average of 69% reduction of TL, 50% reduction of NIL and a 77% reduction of IL. Both RB and RB+NSG can significantly reduce sebum production (-57%), without affecting skin barrier function and being characterized by a good skin tolerability.

As a result of an estrogen deficiency caused by the onset of menopause, substantial modifications... more As a result of an estrogen deficiency caused by the onset of menopause, substantial modifications of the hormone-dependent tissues and the urogenital tract occur, including a rise in vaginal pH, decreased or discontinued production of glycogen, a reduction in the elasticity and thickness of the vaginal wall, and reduced blood flow and secretions in the vagina. Vaginal atrophy, which occurs in 40% of postmenopausal women, may occur with characteristic symptoms such as itching, dryness, dyspareunia, and dysuria, and with repercussions on the woman’s quality of life. Vaginal atrophy can be treated with hormonal therapy either topically or systemically. When these treatments are poorly tolerated or contraindicated (history of cancer, thromboembolism, etc.), local, non-hormonal therapies with a moisturizing and/or lubricating action, such as cremes or gels, may be a valid alternative. The VALYD (Vaginal Dryness and Quality of Life in Menopausal Women) study conducted under the auspices o...

Plastic and Aesthetic Research, 2020

The impact of the interaction of all combined environmental agents to which an individual is expo... more The impact of the interaction of all combined environmental agents to which an individual is exposed during his/her lifetime, as well as how his/her organism responds to these influences, defines health, aging, and disease. The systematic, integrative characterization of the different elements making up the "exposome" is thus necessary to identify and exploit the potential of compounds capable of conferring protection with minimal side effects. Extracts from the natural world, containing synergistic combinations of compounds with antioxidant and protective properties, have long been used in traditional medicine. Modern science has the opportunity to leverage these substances honed by evolution and use them safely and reliably, with a profound mechanistic knowledge and guaranteeing standardization and absence of toxicity. Here, we discuss our current knowledge regarding the potential of a soluble extract of the hair grass Deschampsia antarctica (as its standardized commercial preparation Edafence®) to counteract the skin exposome and its impact on skin aging and disease.

Journal of Clinical & Experimental Dermatology Research, 2019

Background: Topical retinoid and antibacterial agents are commonly used as first-line treatments ... more Background: Topical retinoid and antibacterial agents are commonly used as first-line treatments in mild/moderate acne vulgaris (AV). Adherence to retinoid treatment could be limited by the low local tolerability. Literature data show that up to 15% of patients prematurely stop the treatment with retinoids because of skin irritation. A medical device in gel formulation containing tretinoin (0.02%), glycolic acid (4%) and clindamycin (0.8%) is available. So far, no real-life, prospective data regarding efficacy and tolerability of this gel are available. We performed a prospective, multicenter, pragmatic 12-week, assessor-blinded trial. Primary outcomes were the changes of Total acne lesions (TL) count. Secondary outcomes were the evolution of Global Acne Grading System score (GAGS) e and Noninflammatory (NI-L) and Inflammatory (I-L) lesions count. An additional secondary outcome was also to evaluate the local tolerability of the gel. Materials and methods: In a real-life multicenter trial, 159 subjects with mild/moderate AV of the face were enrolled after their informed consent in a 12-week trial. Subjects were instructed to apply the gel once daily at evening.

Journal of Clinical & Experimental Dermatology Research, 2016

Background: Skin dryness is commonly observed in diabetic patients. Purified Omental lipids (POL)... more Background: Skin dryness is commonly observed in diabetic patients. Purified Omental lipids (POL) are considered an effective emollient and hydrating topical product in subjects at risk of skin fissuring and damage. In addition, topical POL could express a wound-healing and skin regenerative effect. Aim: We evaluated the efficacy of topical 25% concentrated POL product (P.O.L. cream; Difa Cooper, Italy) (POL-C) in Type 2 diabetic patients with (YES-C) or without (NO-C) vascular or neurological complications in comparison with non-treated healthy volunteers. Presence of vascular or neurological ulcers was an exclusion criterion. Methods: We assessed the efficacy of POL-C on skin hydration and skin integrity in a prospective, evaluatorblinded controlled study in 30 type II diabetic patients (YES-C: n=15) (NO-C: n=15), aged 40-75 years, treated with POL-C twice daily for 3 months. Ten subjects, matched for age and sex, without diabetes, formed the control group. Primary outcomes were the Dryness Area Severity Index (DASI) Score evaluating xerosis, erythema, scaling and skin fissuration (minimum-maximum score values: 4-20) and Patient-Assessed Skin Score (PASS) evaluating dryness, itching and irritation (minimum-maximum score values: 3-15). DASI score was evaluated at baseline, after 1 and 3 months by an investigator unaware of treatment allocation (patients or controls) and unaware of the type of diabetes (with or without complications). PASS scores were collected at the same study times in YES-C and NO-C only groups. Results: One subject (YES-C group) dropped out prematurely from the trial. At baseline mean(SD) DASI score was 7.4 (2.5) in YES-C group, 4.9 (0.7) in NO-C group and 5.0 (0.7) in control subjects. DASI score in YES-C was significantly higher in comparison with NO-C and control groups. POL induced significantly DASI score reductions in both diabetic patients' groups at month 1 and month 3 (p < 0.001) in comparison with baseline values. At month 3, DASI score was 4.5 (1.5) in YES-C and 4.1 (0.3) in NO-C. PASS score was significant reduced in comparison with baseline in YES-C group (from 5.2 to 3.5; p=0.02) and in NO-C group (from 3.7 to 3.0; p=0-05). The product was well tolerated. Conclusion: In diabetic subjects, skin xerosis is significantly worse in the presence of vascular or neuropathy in comparison with diabetic subjects without complication and in comparison with matched healthy control subjects. The use of POL cream improves and normalizes skin xerosis both assessed by the investigator or by the subject with a clinical effect correlated with the baseline level of skin dryness severity. Application of Purified Omental Lipids cream increases skin hydration and relieves the condition of skin dryness in Type 2 diabetic patients with or without complications.

American Journal of Hypertension, 1997

Angiotensin (ANG) II contracta vascular amooth muscle by mobilizingCa2+from internal stores. Whet... more Angiotensin (ANG) II contracta vascular amooth muscle by mobilizingCa2+from internal stores. Whether ANG II actssimilarlyon endothelial cellais unclear. Our Ca2+ imagingstudiescomparedthe influenceof ANG 1, II and Ill on cytosolic Ca2+ m cultured bovine pulmonary artery endothelialcella loaded with fura 2. The endothelialcells were plated on glass bottompetridishes and were 40-80Y0 confluentat the time of experiment. In Caz+-freeHEPES medium,the percentageof respondingcellswere O, 38 and 30% for ANG I (n=21), II (n=91) and Ill (n=28), respectively. In the presenceof externalCa2+(1 mM), 43, 31 and 37% of cellsrespondedto ANG I (n=23), II (n=88) and Ill (n=25). All cellstested,respondedto cyclopiazonic acid, an agentwhich increases cytosolicCa2+by blockingCa2+uptake into tha endoplasmic reticulum. The preaence of captopril in concentrations whichpreventedANG I to ANG II conversion abolishedthis effect of ANG 1. Interestingly, when central and peripheralchangea were examined, it was found that responsesto ANG Ill were significantly enhancedin central regions of the cells only. However, changes in Ca2+ in response to ANG II were significantlyenhanced in both central and peripheralregions. In all cases, EGTA (5 mM), a Ca2+chelator,returnedCa2+elevationto baaal Ievela. In conclusion,ANG II and ANG Ill cause Ca2' release from internalstoreswhereasANG I does not. ANG I may promote Ca2+entry or requiredconversionto ANG II to act.

International Journal of Immunopathology and Pharmacology, 2008

The aim of this paper is to assess in an open prospective pilot case-control study the tolerabili... more The aim of this paper is to assess in an open prospective pilot case-control study the tolerability, safety and efficacy of an ultra-rush sublingual immunotherapy (SLIT) protocol with Vespula venom in wasp allergic patients compared to subcutaneous immunotherapy (SCIT). Forty-one wasp allergic patients were treated with sublingual (SLIT group) or subcutaneous (SCIT group) ultrarush immunotherapy with Vespula venom extract. All patients underwent skin tests and serum specific IgE and IgG4detection before enrolment and after 6, 12 and 24 months of immunotherapy. The SLIT group consisted of 21 (6 females and 15 males) patients who received increasing doses of Vespula venom (Aquagen, ALK-Abelló) until the final dose of 30 drops of extract in 3 hours, containing 100,000 SQ-U/ml. The maintenance dose was of 10 drops of pure venom extract 3 times a week, for a total dose of 100,000 SQ-U weekly (corresponding to 100 μg of venom extract). The SCIT group consisted of 20 patients (16 males and...

OA Dermatology, 2013

Introduction The epidermal barrier is a crucial component of the defensive function of the skin. ... more Introduction The epidermal barrier is a crucial component of the defensive function of the skin. The main skin protective functions are related to water loss modulation/prevention, UV-protection, anti-oxidant and antimicrobial actions. It is well established that epidermal barrier function is abnormal in subjects suffering from atopic dermatitis. Several evidences have shown that this alteration could be considered as the initial pathogenic factor starting the pathological process of atopic dermatitis. The aim of this review was to discuss the role of topical modulation in the epidermal barrier function and antimicrobial peptides in atopic dermatitis. Conclusion The use of emollients has shown to reduce the risk of atopic dermatitis flares and to reduce the need for topical corticosteroid. New emollient and moisturizing products seem promising not only in controlling symptoms and signs of atopic dermatitis but also in improving the skin barrier functions acting specifically in the ceramide component and in normalising antimicrobial peptides production of keratynocites.

Journal of Dermatological Research, 2018

The omentum is a large peritoneal fold. It begins at the stomach and extends downwards to cover t... more The omentum is a large peritoneal fold. It begins at the stomach and extends downwards to cover the abdominal organs. It serves a primarily protective role, especially in defending against infective agents and to promote tissue reparation after injuries. The omentum is characterized by extensive vascularization, sign of a metabolically active environment. Furthermore, omentum is the tissue with the highest production of vascular endothelial growth factor (VEGF) in the body. The lipids contained in this tissue carry out very important activities for the organism, and the presence of neutral glycerides, phospholipids, glycolipids, and gangliosides suggests the potential usefulness of heterologous omental lipid fractions in dermatology. Omentum stimulates vascular proliferation, therefore is possible to

Dermatologic Therapy, 2021

Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to m... more Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to moderate acne. However, irritant contact dermatitis is a common side effect of topical retinoids. A strategy to increase local tolerability is the “short contact therapy” (SCT) approach, consisting in the application of the product with the complete removal after 30 to 60 minutes using a non‐aggressive cleanser. A gel containing tretinoin 0.02%, clindamycin 0.8%, and glycolic acid 4% in polyvinyl alcohol (MP‐gel) has shown to be effective as monotherapy in mild to moderate acne with a tolerability profile similar to other topical retinoids. So far, no trials have been performed with this gel comparing the tolerability profile of SCT with standard application therapy (SAT). We conducted a 2‐center randomized parallel groups, controlled, assessor‐blinded study, comparing MP‐gel applied as SCT in comparison with MP‐gel used as SAT (The “MASCOTTE” trial). Forty‐six subjects (nine men and 37 women, mean age 23 ± 4 years, range 18‐31 years) with mild‐to‐moderate acne were enrolled, after their written informed consent in a randomized, parallel groups controlled, assessor‐blinded 8‐week trial. Twenty‐three were assigned to MP‐gel once daily (evening application) using the SCT approach (ie, complete removal of product after 1 hour using a gentle cleanser), and 23 were randomized to the SAT approach with the same gel. The primary endpoint was the evolution of the tolerability score (TS) assessed evaluating four items: erythema, dryness, stinging, and burning, using a 4‐point score scale (from 0: no symptom to 3: severe symptom). Secondary endpoints were the evolution of global acne grading system (GAGS) score (range: from 0 to >39) and the investigator global assessment (IGA of acne severity) score (range from 0 to 4). TS was evaluated at 2, 4, and 8 weeks. GAGS and IGA scores were evaluated at baseline and at week eight. At week eight, an efficacy global score (EGS) (from 1: no efficacy to 4: very good efficacy) and a tolerability global score (TGS) (from 1: very low tolerability to 3: very good tolerability) evaluation were also done. All the evaluations were performed by an investigator unaware of treatment groups allocation (SCT or SAT). Thirty‐eight subjects (83%) completed the 8‐week treatment period. Eight subjects (two in the SCT group and six in the SAT group) dropped out prematurely due to low skin tolerability. In the SCT the TS at week two was 1.3 ± 1.7, in the SAT group TS was significantly higher (3.1 ± 1.7) (P = .028). TS was significantly lower in SCT group vs SAT also at weeks four and eight (P = .01; ANOVA test). The GAGS score at baseline was 19 ± 7 in the SCT group and 23 ± 4 in the SAT group (NS). At week 8 the GAGS score in SCT was significantly reduced to 8.5 ± 2.8 (−55%) (P = .001 vs baseline) and was also significantly lower in comparison with SAT group (8.5 vs 15; P = .0054). The IGA scores at baseline were 1.9 ± 0.6 in SCT and 2.4 ± 0.7 in SAT group. At week eight, in comparison with baseline values IGA score was reduced significantly by 48% in SCT and by 30% in SAT. EGS and TGS were significantly higher (better clinical efficacy and better tolerability) in SCT in comparison with SAT (3.6 ± 0.5 and 2.9 ± 0.3 vs 2.7 ± 0.6 and 1.5 ± 0.7; respectively). This tretinoin, clindamycin, glycolic acid gel, applied as SCT, has shown a better skin tolerability and at least a comparable clinical efficacy in comparison with the standard application modality in the treatment of mild‐to‐moderate acne. The SCT therefore could be an effective treatment strategy which could improve subjects' compliance and adherence.

Copyright © 2012 Roberta Alesina et al. This is an open access article distributed under the Crea... more Copyright © 2012 Roberta Alesina et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Allergen-specific sublingual immunotherapy (SLIT) is considered a causal treatment of respiratory allergies. Compliance to the SLIT is an important aspect for a positive clinical outcome. Study Aim. To evaluate if compliance with grass Allergy Immunotherapy Tablet (AIT) can be increased by providing an electronic compliance device (CED) (Memozax; a tabletcontainer with a programmable daily acoustic alarm). Patients and Methods. 261 patients with grass allergy were enrolled and randomized (1: 1) to 1-year treatment with AIT (Grazax) using a CED (group A; n = 122) or without (Group B, n = 139). Compliance was measured through tablet count at each visit. Results. The 12-month compliance, mean (SD), in group A was 83% (21) a...

Sulodexide (SLX) is a peculiar and interesting antithrombotic drug. It is a highly purified mixtu... more Sulodexide (SLX) is a peculiar and interesting antithrombotic drug. It is a highly purified mixture of glycosaminoglycans (GAG) with anticoagulant and antithrombotic properties used for the prophylaxis and treatment of thromboembolic diseases. The pharmacological effects of SLX differ substantially from other GAG and are mainly characterized by a prolonged half-life and reduced effect on global coagulation and bleeding parameters. SLX is able to potentiate the antiprotease activities of both antithrombin III and heparin cofactor II. SLX shows also in vitro and in vivo profibrinolytic actions. SLX exhibits antithrombotic and profibrinolytic properties in several animal models of venous and arterial thrombosis and has relatively high affinity for endothelial cells. By oral route SLX is able to release tissue plasminogen activator and increase fibrinolytic activities. SLX is clinically effective in the treatment of peripheral arterial vascular diseases and in the treatment of deep veno...

Purpose To investigate the efficacy of a cream containing purified omental lipids 10% and three a... more Purpose To investigate the efficacy of a cream containing purified omental lipids 10% and three anti-itching substances (polidocanol/stimutex/palmitoylethanolamine) in elderly subjects with chronic pruritus/prurigo nodularis (CP/CPN). Patients and Methods Thirty-five subjects (6 men; mean age 67±4 years) with CP/CPN were enrolled in a prospective, assessor-blinded, 4-week study. The cream was applied twice daily in the most affected body area. The primary endpoints were the evolution of the 10-cm visual analogue itch severity scale (VAS) and the 4-point verbal itching rating scale (VRS) (from 0 to 3). Secondary endpoints were the evolution of optical coherence tomography (OTC) of four skin parameters (acanthosis/hyperkeratosis/scale/dermal vascular pattern), assessed in a target lesioned area, and the transepidermal water loss (TEWL). Study endpoints were evaluated at baseline and after 2 and 4 weeks by an investigator unaware of the type of treatment. Results All the enrolled subje...

Clinical, Cosmetic and Investigational Dermatology, 2018

Background: We evaluated the effects of 3-month prebiotic oral supplementation with fructooligosa... more Background: We evaluated the effects of 3-month prebiotic oral supplementation with fructooligosaccharides (FOS) and galacto-oligosaccharides (GOS) on glucose and lipid metabolic parameters in women with adult acne (female adult acne). Methods: Twelve women, mean age 35 years, with mild to moderate acne were enrolled. Exclusion criteria were severe acne, body mass index (BMI) >25, history of diabetes mellitus, polycystic ovary syndrome, regular intake of prebiotics or probiotics, and history of inflammatory intestinal diseases. At baseline visit (T0), at month 1 (T1), and at month 3 (T2) fasting glucose, blood insulin, glycated hemoglobin (HbA1c), C-peptide, triglycerides, total cholesterol levels, and BMI were measured. Subjects were treated with a food supplement containing FOS (100 mg) and GOS (500 mg), one sachet daily, for 3 months. Subjects were instructed to follow their regular diet, and no dietary restrictions were suggested. Results: At baseline, the BMI, mean ± SD, was 23±0.7. No modification of BMI was observed during the study. At baseline, fasting blood glucose levels were 92±7 mg/dL. A significant (P=0.02) reduction was observed at month 1 (86±5 mg/dL) and at month 3 (85±7 mg/dL) (-10%). Total cholesterol levels were reduced significantly (P=0.018) from 184±19 to 161±10 mg/dL (-13%) at the end of the study. Triglycerides at baseline were 51 mg/dL and were reduced to 46 mg/dL (P=0.05). Insulin and C-peptide plasma levels showed a nonsignificant reduction trend from baseline to the end of the study. In subjects with baseline insulin level >6 µUI/mL (n=6) the FOS/GOS supplementation induced a significant (P=0.03) reduction from 7.8 to 4.3 µUI/mL at day 90 (-45%). C-peptide was reduced from 2.1 to 1.6 ng/mL (month 3). HbA1c at baseline was 35 mg/dL and 32 mg/dL at the end of the study (NS). Conclusion: In adult female acne, supplementation with prebiotic FOS and GOS was associated with positive effects on glycemic and lipid metabolic parameters.

Clinical Dermatology & Therapy, 2015

Photodiagnosis and Photodynamic Therapy, 2020

Clinical, Cosmetic and Investigational Dermatology, 2019

Introduction: Air pollution causes skin damage and favors skin aging processes such as dark spots... more Introduction: Air pollution causes skin damage and favors skin aging processes such as dark spots and wrinkles, through oxidative stress. Pollutant substances accelerate skin aging through a specific activation of intracellular receptors called AhR (aryl-hydrocarbon receptors). Deschampsia antartica aqueous extract (DAE) has shown to counteract the pollutantinduced AhR activation. Ferulic acid (FA) and vitamin C (VC) are potent antioxidant substances. A serum containing DAE/FA/VC has been recently developed. So far, no clinical data are available regarding the protective actions of this serum against the detrimental effects of air pollution on the skin. Objective: We conducted a prospective, single-blind, 28-day study to assess efficacy and protective effects against air pollution skin damage of a new serum containing Deschampsia antartica extract. Materials and methods: Twenty, photo type I-III, women (mean age 42 years) with at least three dark spots on the face, living in a homogenous urbanized, high pollution area (Rome) were evaluated. The objectives of the study were to evaluate the effects of treatment on skin barrier function, assessed by transepidermal water loss (TEWL) measurement (Tewameter), the effect on dark spots, evaluated by means of colorimetry (Colorimeter CL 400), and the effect on squalene peroxide (SQOOH)/squalene (SQ) skin ratio assessed with face swabs. Results: The trial was conducted between November 20 and December 19, 2018. In comparison with baseline, the product induced a significant improvement of skin hydration (−19% of TEWL), a significant improvement of dark spots (+7%) and a significant improvement of SQOOH/SQ ratio (−16%). The product was evaluated very well by >90% of the treated subjects regarding cosmetic acceptability. Discussion: A serum containing DAE/FA/VC has shown to improve skin barrier function, to reduce dark spots and to counteract the skin oxidative stress in women living in high pollution urban area.

Clinical, Cosmetic and Investigational Dermatology, 2019

Objective: A new cream formulation containing hyaluronic acid 5%, complexed with a mix of a bacte... more Objective: A new cream formulation containing hyaluronic acid 5%, complexed with a mix of a bacterial-wall-derived glycoprotein and peptide glycan complex (EDS), has been recently developed. We evaluated in a prospective, assessor-blinded, 6-week study the efficacy and tolerability of EDS in the treatment of facial seborrheic dermatitis (SD) and the effects on skin microbiota. Subjects and methods: Seventy-five subjects (mean age 46; 60 men) with moderatesevere SD of the face were enrolled. EDS cream was applied twice daily. The primary outcome was the evolution of the Investigator Global Assessment (IGA) score, evaluating erythema, scale/flaking, grade of seborrhea and itch. Superficial skin bacterial microbiome at baseline and after treatment was assessed, using the 16S rRNA gene methodology, in affected and non-affected face areas. Local tolerability was evaluated checking selfreported side effects at each visit. Results: Baseline IGA scores (mean±SD) was 10±3. The use of EDS reduced IGA score significantly by 70% at week 3 and by 88% at week 6. An increase in the abundance of Cutibacterium acnes genera associated with a significant drop of Staphylococcus genera presence was detected in affected areas. The ratio of relative abundance of genera Cutibacterium/Staphylococcus increased significantly after treatment in affected areas. The product was very well tolerated. Conclusion: Treatment with EDS applied twice daily for 6 consecutive weeks was associated with a reduction of the signs and symptoms of SD. Furthermore, after EDS cream treatment, a reequilibrating effect on facial skin microbiota was observed. The product was very well tolerated.

BMC dermatology, Jan 11, 2015

In acne, several studies report a poor adherence to treatments. We evaluate, in a real-life setti... more In acne, several studies report a poor adherence to treatments. We evaluate, in a real-life setting conditions, the impact of compliance to physician's instructions, recommendations and adherence to the treatments on clinical outcome in patients with mild to moderate acne in an observational, non-interventional prospective study carried out in 72 Dermatologic Services in Spain (ACTUO Trial). Six-hundred-forty-three subjects were enrolled and 566 patients (88 %) completed the 3 study visits. Study aimed to evaluate the impact of adherence (assessed with ECOB scale) on clinical outcome, as well as how the use of specific adjuvant treatments (facial cleansing, emollient, moisturizing and lenitive specific topical products) influences treatment's adherence and acne severity (0-5 points score). Recommendation of specific adjuvant skin barrier repair products was made in 85.2 %. Overall, clinical improvement was observed throughout follow-up visits with an increased proportion of ...

Biomedical Journal of Scientific and Technical Research, Feb 20, 2023

The combination of retinoids and antibacterial agents are considered as first line treatment appr... more The combination of retinoids and antibacterial agents are considered as first line treatment approach in subjects with mild to moderate acne. Hydroxypinacolone retinoate (HPR) is a cosmetic grade ester of all-trans retinoic acid which is able to bind directly with retinoid receptors without the need for metabolic breakdown to more biologically active forms. It has been demonstrated to possess anti-acne and anti-ageing effects, causing less skin irritation than retinoic acid. The Retinsphere technology, which is a patented dual combination of hydroxipinacolone retinoate in glycosphereencapsulated retinol, and BIOPEP-15, a plant-derived antimicrobial peptide, is available and used in several anti-acne products. The aim of this narrative review was to summarize all available scientific evidence on topical Retinsphere HPR-BIOPEP-15 (RB) therapy for acne, alone or in combination with nicotinamide, salicylic and glycolic acids (RB+NSG). In detail, 3 studies analysed RB and 2 studies analysed RB+NSG efficacy and tolerability. All studies measured acne lesions count changes over time, two studies analysed microscopic skin changes with reflectance confocal microscopy (RCM), and two studies assessed sebum production changes. In conclusion, collective data derived from current literature demonstrated that RB induced a median 51% reduction of total acne lesion (TL), comprising a 43% reduction of non-inflammatory lesions (NIL) and a 67% reduction of inflammatory lesions (IL). RB+NSG showed increased efficacy, with an average of 69% reduction of TL, 50% reduction of NIL and a 77% reduction of IL. Both RB and RB+NSG can significantly reduce sebum production (-57%), without affecting skin barrier function and being characterized by a good skin tolerability.

As a result of an estrogen deficiency caused by the onset of menopause, substantial modifications... more As a result of an estrogen deficiency caused by the onset of menopause, substantial modifications of the hormone-dependent tissues and the urogenital tract occur, including a rise in vaginal pH, decreased or discontinued production of glycogen, a reduction in the elasticity and thickness of the vaginal wall, and reduced blood flow and secretions in the vagina. Vaginal atrophy, which occurs in 40% of postmenopausal women, may occur with characteristic symptoms such as itching, dryness, dyspareunia, and dysuria, and with repercussions on the woman’s quality of life. Vaginal atrophy can be treated with hormonal therapy either topically or systemically. When these treatments are poorly tolerated or contraindicated (history of cancer, thromboembolism, etc.), local, non-hormonal therapies with a moisturizing and/or lubricating action, such as cremes or gels, may be a valid alternative. The VALYD (Vaginal Dryness and Quality of Life in Menopausal Women) study conducted under the auspices o...

Plastic and Aesthetic Research, 2020

The impact of the interaction of all combined environmental agents to which an individual is expo... more The impact of the interaction of all combined environmental agents to which an individual is exposed during his/her lifetime, as well as how his/her organism responds to these influences, defines health, aging, and disease. The systematic, integrative characterization of the different elements making up the "exposome" is thus necessary to identify and exploit the potential of compounds capable of conferring protection with minimal side effects. Extracts from the natural world, containing synergistic combinations of compounds with antioxidant and protective properties, have long been used in traditional medicine. Modern science has the opportunity to leverage these substances honed by evolution and use them safely and reliably, with a profound mechanistic knowledge and guaranteeing standardization and absence of toxicity. Here, we discuss our current knowledge regarding the potential of a soluble extract of the hair grass Deschampsia antarctica (as its standardized commercial preparation Edafence®) to counteract the skin exposome and its impact on skin aging and disease.

Journal of Clinical & Experimental Dermatology Research, 2019

Background: Topical retinoid and antibacterial agents are commonly used as first-line treatments ... more Background: Topical retinoid and antibacterial agents are commonly used as first-line treatments in mild/moderate acne vulgaris (AV). Adherence to retinoid treatment could be limited by the low local tolerability. Literature data show that up to 15% of patients prematurely stop the treatment with retinoids because of skin irritation. A medical device in gel formulation containing tretinoin (0.02%), glycolic acid (4%) and clindamycin (0.8%) is available. So far, no real-life, prospective data regarding efficacy and tolerability of this gel are available. We performed a prospective, multicenter, pragmatic 12-week, assessor-blinded trial. Primary outcomes were the changes of Total acne lesions (TL) count. Secondary outcomes were the evolution of Global Acne Grading System score (GAGS) e and Noninflammatory (NI-L) and Inflammatory (I-L) lesions count. An additional secondary outcome was also to evaluate the local tolerability of the gel. Materials and methods: In a real-life multicenter trial, 159 subjects with mild/moderate AV of the face were enrolled after their informed consent in a 12-week trial. Subjects were instructed to apply the gel once daily at evening.

Journal of Clinical & Experimental Dermatology Research, 2016

Background: Skin dryness is commonly observed in diabetic patients. Purified Omental lipids (POL)... more Background: Skin dryness is commonly observed in diabetic patients. Purified Omental lipids (POL) are considered an effective emollient and hydrating topical product in subjects at risk of skin fissuring and damage. In addition, topical POL could express a wound-healing and skin regenerative effect. Aim: We evaluated the efficacy of topical 25% concentrated POL product (P.O.L. cream; Difa Cooper, Italy) (POL-C) in Type 2 diabetic patients with (YES-C) or without (NO-C) vascular or neurological complications in comparison with non-treated healthy volunteers. Presence of vascular or neurological ulcers was an exclusion criterion. Methods: We assessed the efficacy of POL-C on skin hydration and skin integrity in a prospective, evaluatorblinded controlled study in 30 type II diabetic patients (YES-C: n=15) (NO-C: n=15), aged 40-75 years, treated with POL-C twice daily for 3 months. Ten subjects, matched for age and sex, without diabetes, formed the control group. Primary outcomes were the Dryness Area Severity Index (DASI) Score evaluating xerosis, erythema, scaling and skin fissuration (minimum-maximum score values: 4-20) and Patient-Assessed Skin Score (PASS) evaluating dryness, itching and irritation (minimum-maximum score values: 3-15). DASI score was evaluated at baseline, after 1 and 3 months by an investigator unaware of treatment allocation (patients or controls) and unaware of the type of diabetes (with or without complications). PASS scores were collected at the same study times in YES-C and NO-C only groups. Results: One subject (YES-C group) dropped out prematurely from the trial. At baseline mean(SD) DASI score was 7.4 (2.5) in YES-C group, 4.9 (0.7) in NO-C group and 5.0 (0.7) in control subjects. DASI score in YES-C was significantly higher in comparison with NO-C and control groups. POL induced significantly DASI score reductions in both diabetic patients' groups at month 1 and month 3 (p < 0.001) in comparison with baseline values. At month 3, DASI score was 4.5 (1.5) in YES-C and 4.1 (0.3) in NO-C. PASS score was significant reduced in comparison with baseline in YES-C group (from 5.2 to 3.5; p=0.02) and in NO-C group (from 3.7 to 3.0; p=0-05). The product was well tolerated. Conclusion: In diabetic subjects, skin xerosis is significantly worse in the presence of vascular or neuropathy in comparison with diabetic subjects without complication and in comparison with matched healthy control subjects. The use of POL cream improves and normalizes skin xerosis both assessed by the investigator or by the subject with a clinical effect correlated with the baseline level of skin dryness severity. Application of Purified Omental Lipids cream increases skin hydration and relieves the condition of skin dryness in Type 2 diabetic patients with or without complications.

American Journal of Hypertension, 1997

Angiotensin (ANG) II contracta vascular amooth muscle by mobilizingCa2+from internal stores. Whet... more Angiotensin (ANG) II contracta vascular amooth muscle by mobilizingCa2+from internal stores. Whether ANG II actssimilarlyon endothelial cellais unclear. Our Ca2+ imagingstudiescomparedthe influenceof ANG 1, II and Ill on cytosolic Ca2+ m cultured bovine pulmonary artery endothelialcella loaded with fura 2. The endothelialcells were plated on glass bottompetridishes and were 40-80Y0 confluentat the time of experiment. In Caz+-freeHEPES medium,the percentageof respondingcellswere O, 38 and 30% for ANG I (n=21), II (n=91) and Ill (n=28), respectively. In the presenceof externalCa2+(1 mM), 43, 31 and 37% of cellsrespondedto ANG I (n=23), II (n=88) and Ill (n=25). All cellstested,respondedto cyclopiazonic acid, an agentwhich increases cytosolicCa2+by blockingCa2+uptake into tha endoplasmic reticulum. The preaence of captopril in concentrations whichpreventedANG I to ANG II conversion abolishedthis effect of ANG 1. Interestingly, when central and peripheralchangea were examined, it was found that responsesto ANG Ill were significantly enhancedin central regions of the cells only. However, changes in Ca2+ in response to ANG II were significantlyenhanced in both central and peripheralregions. In all cases, EGTA (5 mM), a Ca2+chelator,returnedCa2+elevationto baaal Ievela. In conclusion,ANG II and ANG Ill cause Ca2' release from internalstoreswhereasANG I does not. ANG I may promote Ca2+entry or requiredconversionto ANG II to act.

International Journal of Immunopathology and Pharmacology, 2008

The aim of this paper is to assess in an open prospective pilot case-control study the tolerabili... more The aim of this paper is to assess in an open prospective pilot case-control study the tolerability, safety and efficacy of an ultra-rush sublingual immunotherapy (SLIT) protocol with Vespula venom in wasp allergic patients compared to subcutaneous immunotherapy (SCIT). Forty-one wasp allergic patients were treated with sublingual (SLIT group) or subcutaneous (SCIT group) ultrarush immunotherapy with Vespula venom extract. All patients underwent skin tests and serum specific IgE and IgG4detection before enrolment and after 6, 12 and 24 months of immunotherapy. The SLIT group consisted of 21 (6 females and 15 males) patients who received increasing doses of Vespula venom (Aquagen, ALK-Abelló) until the final dose of 30 drops of extract in 3 hours, containing 100,000 SQ-U/ml. The maintenance dose was of 10 drops of pure venom extract 3 times a week, for a total dose of 100,000 SQ-U weekly (corresponding to 100 μg of venom extract). The SCIT group consisted of 20 patients (16 males and...

OA Dermatology, 2013

Introduction The epidermal barrier is a crucial component of the defensive function of the skin. ... more Introduction The epidermal barrier is a crucial component of the defensive function of the skin. The main skin protective functions are related to water loss modulation/prevention, UV-protection, anti-oxidant and antimicrobial actions. It is well established that epidermal barrier function is abnormal in subjects suffering from atopic dermatitis. Several evidences have shown that this alteration could be considered as the initial pathogenic factor starting the pathological process of atopic dermatitis. The aim of this review was to discuss the role of topical modulation in the epidermal barrier function and antimicrobial peptides in atopic dermatitis. Conclusion The use of emollients has shown to reduce the risk of atopic dermatitis flares and to reduce the need for topical corticosteroid. New emollient and moisturizing products seem promising not only in controlling symptoms and signs of atopic dermatitis but also in improving the skin barrier functions acting specifically in the ceramide component and in normalising antimicrobial peptides production of keratynocites.

Journal of Dermatological Research, 2018

The omentum is a large peritoneal fold. It begins at the stomach and extends downwards to cover t... more The omentum is a large peritoneal fold. It begins at the stomach and extends downwards to cover the abdominal organs. It serves a primarily protective role, especially in defending against infective agents and to promote tissue reparation after injuries. The omentum is characterized by extensive vascularization, sign of a metabolically active environment. Furthermore, omentum is the tissue with the highest production of vascular endothelial growth factor (VEGF) in the body. The lipids contained in this tissue carry out very important activities for the organism, and the presence of neutral glycerides, phospholipids, glycolipids, and gangliosides suggests the potential usefulness of heterologous omental lipid fractions in dermatology. Omentum stimulates vascular proliferation, therefore is possible to

Dermatologic Therapy, 2021

Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to m... more Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to moderate acne. However, irritant contact dermatitis is a common side effect of topical retinoids. A strategy to increase local tolerability is the “short contact therapy” (SCT) approach, consisting in the application of the product with the complete removal after 30 to 60 minutes using a non‐aggressive cleanser. A gel containing tretinoin 0.02%, clindamycin 0.8%, and glycolic acid 4% in polyvinyl alcohol (MP‐gel) has shown to be effective as monotherapy in mild to moderate acne with a tolerability profile similar to other topical retinoids. So far, no trials have been performed with this gel comparing the tolerability profile of SCT with standard application therapy (SAT). We conducted a 2‐center randomized parallel groups, controlled, assessor‐blinded study, comparing MP‐gel applied as SCT in comparison with MP‐gel used as SAT (The “MASCOTTE” trial). Forty‐six subjects (nine men and 37 women, mean age 23 ± 4 years, range 18‐31 years) with mild‐to‐moderate acne were enrolled, after their written informed consent in a randomized, parallel groups controlled, assessor‐blinded 8‐week trial. Twenty‐three were assigned to MP‐gel once daily (evening application) using the SCT approach (ie, complete removal of product after 1 hour using a gentle cleanser), and 23 were randomized to the SAT approach with the same gel. The primary endpoint was the evolution of the tolerability score (TS) assessed evaluating four items: erythema, dryness, stinging, and burning, using a 4‐point score scale (from 0: no symptom to 3: severe symptom). Secondary endpoints were the evolution of global acne grading system (GAGS) score (range: from 0 to >39) and the investigator global assessment (IGA of acne severity) score (range from 0 to 4). TS was evaluated at 2, 4, and 8 weeks. GAGS and IGA scores were evaluated at baseline and at week eight. At week eight, an efficacy global score (EGS) (from 1: no efficacy to 4: very good efficacy) and a tolerability global score (TGS) (from 1: very low tolerability to 3: very good tolerability) evaluation were also done. All the evaluations were performed by an investigator unaware of treatment groups allocation (SCT or SAT). Thirty‐eight subjects (83%) completed the 8‐week treatment period. Eight subjects (two in the SCT group and six in the SAT group) dropped out prematurely due to low skin tolerability. In the SCT the TS at week two was 1.3 ± 1.7, in the SAT group TS was significantly higher (3.1 ± 1.7) (P = .028). TS was significantly lower in SCT group vs SAT also at weeks four and eight (P = .01; ANOVA test). The GAGS score at baseline was 19 ± 7 in the SCT group and 23 ± 4 in the SAT group (NS). At week 8 the GAGS score in SCT was significantly reduced to 8.5 ± 2.8 (−55%) (P = .001 vs baseline) and was also significantly lower in comparison with SAT group (8.5 vs 15; P = .0054). The IGA scores at baseline were 1.9 ± 0.6 in SCT and 2.4 ± 0.7 in SAT group. At week eight, in comparison with baseline values IGA score was reduced significantly by 48% in SCT and by 30% in SAT. EGS and TGS were significantly higher (better clinical efficacy and better tolerability) in SCT in comparison with SAT (3.6 ± 0.5 and 2.9 ± 0.3 vs 2.7 ± 0.6 and 1.5 ± 0.7; respectively). This tretinoin, clindamycin, glycolic acid gel, applied as SCT, has shown a better skin tolerability and at least a comparable clinical efficacy in comparison with the standard application modality in the treatment of mild‐to‐moderate acne. The SCT therefore could be an effective treatment strategy which could improve subjects' compliance and adherence.

Copyright © 2012 Roberta Alesina et al. This is an open access article distributed under the Crea... more Copyright © 2012 Roberta Alesina et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Allergen-specific sublingual immunotherapy (SLIT) is considered a causal treatment of respiratory allergies. Compliance to the SLIT is an important aspect for a positive clinical outcome. Study Aim. To evaluate if compliance with grass Allergy Immunotherapy Tablet (AIT) can be increased by providing an electronic compliance device (CED) (Memozax; a tabletcontainer with a programmable daily acoustic alarm). Patients and Methods. 261 patients with grass allergy were enrolled and randomized (1: 1) to 1-year treatment with AIT (Grazax) using a CED (group A; n = 122) or without (Group B, n = 139). Compliance was measured through tablet count at each visit. Results. The 12-month compliance, mean (SD), in group A was 83% (21) a...

Sulodexide (SLX) is a peculiar and interesting antithrombotic drug. It is a highly purified mixtu... more Sulodexide (SLX) is a peculiar and interesting antithrombotic drug. It is a highly purified mixture of glycosaminoglycans (GAG) with anticoagulant and antithrombotic properties used for the prophylaxis and treatment of thromboembolic diseases. The pharmacological effects of SLX differ substantially from other GAG and are mainly characterized by a prolonged half-life and reduced effect on global coagulation and bleeding parameters. SLX is able to potentiate the antiprotease activities of both antithrombin III and heparin cofactor II. SLX shows also in vitro and in vivo profibrinolytic actions. SLX exhibits antithrombotic and profibrinolytic properties in several animal models of venous and arterial thrombosis and has relatively high affinity for endothelial cells. By oral route SLX is able to release tissue plasminogen activator and increase fibrinolytic activities. SLX is clinically effective in the treatment of peripheral arterial vascular diseases and in the treatment of deep veno...

Purpose To investigate the efficacy of a cream containing purified omental lipids 10% and three a... more Purpose To investigate the efficacy of a cream containing purified omental lipids 10% and three anti-itching substances (polidocanol/stimutex/palmitoylethanolamine) in elderly subjects with chronic pruritus/prurigo nodularis (CP/CPN). Patients and Methods Thirty-five subjects (6 men; mean age 67±4 years) with CP/CPN were enrolled in a prospective, assessor-blinded, 4-week study. The cream was applied twice daily in the most affected body area. The primary endpoints were the evolution of the 10-cm visual analogue itch severity scale (VAS) and the 4-point verbal itching rating scale (VRS) (from 0 to 3). Secondary endpoints were the evolution of optical coherence tomography (OTC) of four skin parameters (acanthosis/hyperkeratosis/scale/dermal vascular pattern), assessed in a target lesioned area, and the transepidermal water loss (TEWL). Study endpoints were evaluated at baseline and after 2 and 4 weeks by an investigator unaware of the type of treatment. Results All the enrolled subje...

Clinical, Cosmetic and Investigational Dermatology, 2018

Background: We evaluated the effects of 3-month prebiotic oral supplementation with fructooligosa... more Background: We evaluated the effects of 3-month prebiotic oral supplementation with fructooligosaccharides (FOS) and galacto-oligosaccharides (GOS) on glucose and lipid metabolic parameters in women with adult acne (female adult acne). Methods: Twelve women, mean age 35 years, with mild to moderate acne were enrolled. Exclusion criteria were severe acne, body mass index (BMI) >25, history of diabetes mellitus, polycystic ovary syndrome, regular intake of prebiotics or probiotics, and history of inflammatory intestinal diseases. At baseline visit (T0), at month 1 (T1), and at month 3 (T2) fasting glucose, blood insulin, glycated hemoglobin (HbA1c), C-peptide, triglycerides, total cholesterol levels, and BMI were measured. Subjects were treated with a food supplement containing FOS (100 mg) and GOS (500 mg), one sachet daily, for 3 months. Subjects were instructed to follow their regular diet, and no dietary restrictions were suggested. Results: At baseline, the BMI, mean ± SD, was 23±0.7. No modification of BMI was observed during the study. At baseline, fasting blood glucose levels were 92±7 mg/dL. A significant (P=0.02) reduction was observed at month 1 (86±5 mg/dL) and at month 3 (85±7 mg/dL) (-10%). Total cholesterol levels were reduced significantly (P=0.018) from 184±19 to 161±10 mg/dL (-13%) at the end of the study. Triglycerides at baseline were 51 mg/dL and were reduced to 46 mg/dL (P=0.05). Insulin and C-peptide plasma levels showed a nonsignificant reduction trend from baseline to the end of the study. In subjects with baseline insulin level >6 µUI/mL (n=6) the FOS/GOS supplementation induced a significant (P=0.03) reduction from 7.8 to 4.3 µUI/mL at day 90 (-45%). C-peptide was reduced from 2.1 to 1.6 ng/mL (month 3). HbA1c at baseline was 35 mg/dL and 32 mg/dL at the end of the study (NS). Conclusion: In adult female acne, supplementation with prebiotic FOS and GOS was associated with positive effects on glycemic and lipid metabolic parameters.

Clinical Dermatology & Therapy, 2015

Photodiagnosis and Photodynamic Therapy, 2020

Clinical, Cosmetic and Investigational Dermatology, 2019

Introduction: Air pollution causes skin damage and favors skin aging processes such as dark spots... more Introduction: Air pollution causes skin damage and favors skin aging processes such as dark spots and wrinkles, through oxidative stress. Pollutant substances accelerate skin aging through a specific activation of intracellular receptors called AhR (aryl-hydrocarbon receptors). Deschampsia antartica aqueous extract (DAE) has shown to counteract the pollutantinduced AhR activation. Ferulic acid (FA) and vitamin C (VC) are potent antioxidant substances. A serum containing DAE/FA/VC has been recently developed. So far, no clinical data are available regarding the protective actions of this serum against the detrimental effects of air pollution on the skin. Objective: We conducted a prospective, single-blind, 28-day study to assess efficacy and protective effects against air pollution skin damage of a new serum containing Deschampsia antartica extract. Materials and methods: Twenty, photo type I-III, women (mean age 42 years) with at least three dark spots on the face, living in a homogenous urbanized, high pollution area (Rome) were evaluated. The objectives of the study were to evaluate the effects of treatment on skin barrier function, assessed by transepidermal water loss (TEWL) measurement (Tewameter), the effect on dark spots, evaluated by means of colorimetry (Colorimeter CL 400), and the effect on squalene peroxide (SQOOH)/squalene (SQ) skin ratio assessed with face swabs. Results: The trial was conducted between November 20 and December 19, 2018. In comparison with baseline, the product induced a significant improvement of skin hydration (−19% of TEWL), a significant improvement of dark spots (+7%) and a significant improvement of SQOOH/SQ ratio (−16%). The product was evaluated very well by >90% of the treated subjects regarding cosmetic acceptability. Discussion: A serum containing DAE/FA/VC has shown to improve skin barrier function, to reduce dark spots and to counteract the skin oxidative stress in women living in high pollution urban area.

Clinical, Cosmetic and Investigational Dermatology, 2019

Objective: A new cream formulation containing hyaluronic acid 5%, complexed with a mix of a bacte... more Objective: A new cream formulation containing hyaluronic acid 5%, complexed with a mix of a bacterial-wall-derived glycoprotein and peptide glycan complex (EDS), has been recently developed. We evaluated in a prospective, assessor-blinded, 6-week study the efficacy and tolerability of EDS in the treatment of facial seborrheic dermatitis (SD) and the effects on skin microbiota. Subjects and methods: Seventy-five subjects (mean age 46; 60 men) with moderatesevere SD of the face were enrolled. EDS cream was applied twice daily. The primary outcome was the evolution of the Investigator Global Assessment (IGA) score, evaluating erythema, scale/flaking, grade of seborrhea and itch. Superficial skin bacterial microbiome at baseline and after treatment was assessed, using the 16S rRNA gene methodology, in affected and non-affected face areas. Local tolerability was evaluated checking selfreported side effects at each visit. Results: Baseline IGA scores (mean±SD) was 10±3. The use of EDS reduced IGA score significantly by 70% at week 3 and by 88% at week 6. An increase in the abundance of Cutibacterium acnes genera associated with a significant drop of Staphylococcus genera presence was detected in affected areas. The ratio of relative abundance of genera Cutibacterium/Staphylococcus increased significantly after treatment in affected areas. The product was very well tolerated. Conclusion: Treatment with EDS applied twice daily for 6 consecutive weeks was associated with a reduction of the signs and symptoms of SD. Furthermore, after EDS cream treatment, a reequilibrating effect on facial skin microbiota was observed. The product was very well tolerated.

BMC dermatology, Jan 11, 2015

In acne, several studies report a poor adherence to treatments. We evaluate, in a real-life setti... more In acne, several studies report a poor adherence to treatments. We evaluate, in a real-life setting conditions, the impact of compliance to physician's instructions, recommendations and adherence to the treatments on clinical outcome in patients with mild to moderate acne in an observational, non-interventional prospective study carried out in 72 Dermatologic Services in Spain (ACTUO Trial). Six-hundred-forty-three subjects were enrolled and 566 patients (88 %) completed the 3 study visits. Study aimed to evaluate the impact of adherence (assessed with ECOB scale) on clinical outcome, as well as how the use of specific adjuvant treatments (facial cleansing, emollient, moisturizing and lenitive specific topical products) influences treatment's adherence and acne severity (0-5 points score). Recommendation of specific adjuvant skin barrier repair products was made in 85.2 %. Overall, clinical improvement was observed throughout follow-up visits with an increased proportion of ...