| Background: Severe acne is a kind of chronic damaging inflammatory skin disease commonly occurring in adolescents,which seriously affects patients’ normal life and social interaction,and even produces low self-esteem,depression and other adverse emotions.Tumor Necrosis Factor-α(TNF-α)plays an important role in the pathogenesis of acne by participating in the local inflammatory reaction of hair follicle and sebaceous units.Previous studies have shown that the loss of the diversity of acnes subgroups plays an important role in the pathogenesis of acne.In the field of dermatology related to invasive skin diseases,there is increasing evidence that adalimumab is effective in treating hidradenitis suppurative,follicular atresia triad,SAPHO syndrome,etc.Based on the pathogenesis of this disease and the therapeutic effect of TNF-α inhibitors in other invasive skin diseases,we speculate that TNF-α inhibitors may play an important therapeutic role in controlling the early inflammatory response in patients with severe acne.Objective: To evaluate the clinical efficacy and safety of adalimumab in the treatment of severe acne,its effect on related serological indexes and recurrence after withdrawal of adalimumab.Methods: Patients with severe acne > 12 years old who received adalimumab treatment in Guangdong Dermatology Hospital from November 2020 to November 2022 were recruited(the clinical diagnosis was in line with the diagnosis of acne in Chinese Clinical Dermatology,and the severity grading was in line with the 2019 edition of China Acne Treatment Guidelines as Grade IV).All enrolled patients were followed up for at least 16 weeks,and clinical data were collected at 0,4,8,12,and 16 weeks,respectively.The clinical efficacy was evaluated by inflammatory skin count,non-inflammatory skin count,total skin count,Global Acne Grading System(GAGS),and Investigator Global Assessment(IGA).Improvements in mental health and quality of life were assessed using the Cardiff Disability Index(CADI).Serum samples were collected before and after treatment(at week 0,8 and 16),and the concentrations of IFN-γ,TNF-α,IL-2,IL-4,IL-6,IL-10 and IL-17 as well as the levels of testosterone and estradiol were determined by ELISA.The effect of adalimumab treatment on serological indexes was evaluated.Adverse reactions throughout the treatment were recorded,and patients were followed up for recurrence after stopping adalimumab treatment.Results: A total of 29 patients with severe acne were included in this study,and all enrolled patients completed 16 weeks of follow-up.(1)At the 16 th week,the effective rate,improvement rate and recovery rate of patients were 100%,100% and 31%,respectively.100% of patients achieved a CADI improvement of >5 from baseline at week 16.(2)Univariate logistic regression analysis showed that age,number of inflammatory lesions and course of disease were influencing factors of clinical effectiveness.(3)After treatment,the serum levels of IFN-γ,TNF-α,IL-2,IL-6 and IL-17 cytokines in acne patients were decreased,while the levels of IL-4 were increased.(4)Adalimumab treatment did not cause drug-related serious adverse events.Conclusion:(1)Adalimumab can be used to control the early inflammatory reaction of skin lesions in acne patients,and has good clinical effectiveness in the treatment of severe acne patients;(2)Adalimumab can quickly control clinical symptoms in early stage and improve patients’ mental health and quality of life;(3)Adalimumab can down-regulate the levels of inflammatory cytokines IFN-γ,TNF-α,IL-2,IL-6,and IL-17 in peripheral blood of patients,and up-regulate the levels of IL-4.The anti-inflammatory effect in acne treatment was further verified.(4)There were no serious adverse reactions in the treatment of adalimumab,which proved that adalimumab has good clinical safety and can be used as an optimal treatment for severe acne... |
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