A peel-off facial mask comprising myoinositol and trehalose-loaded liposomes improves adult female acne by reducing local hyperandrogenism and activating autophagy

Background: Hyperandrogenism and reduced skin autophagy have been implicated in the pathogenesis of adult female acne (AFA). Here, we tested whether a readyto- use peel-off facial mask containing myoinositol (an androgen inhibitor) and trehalose- loaded liposomes (as activators of cutaneous autophagy) applied overnight every other day for 60 days can improve AFA. We also sought to investigate the molecular mechanisms underlying the clinical effects. Objectives: We conducted an uncontrolled, open-label clinical study in 40 cases of AFA to investigate the effect of the facial mask on lesion count, sebum production (measured with the Sebutape (R) technique), and Global Acne Grading System (GAGS) scale. We also investigated the changes from baseline to the end of treatment in androgen and beclin-1 levels (as a marker of authophagy) in skin biopsy supernatants. Methods: Forty Caucasian patients with AFA were enrolled. Changes in clinical and molecular endpoints before and after treatment were investigated. Results: The mean counts of comedones, papules, pustules, and nodular lesions decreased significantly (all P<. 001). The mean Sebutape (R) score was reduced from 3.4 +/- 0.6 to 1.8 +/- 0.2 (P<. 001), whereas the mean GAGS scale score decreased from 16.8 +/- 5.3 at baseline to 9.8 +/- 4.6 after treatment (P<. 001). A significant decrease in testosterone and dehydroepiandrosterone sulfate in skin biopsy supernatants was observed, whereas beclin-1 levels increased significantly (P<. 001). Conclusion: A ready-to-use peel-off facial mask containing myoinositol and trehalose- loaded liposomes improved the cosmetic appearance of AFA by reducing cutaneous androgen content and promoting skin autophagy.