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Acne Vulgaris is one of the most common dermatologic diagnoses requiring long-term maintenance therapy. Promising results of oral zinc gluconate in improving acne vulgaris has been described.
A randomized, double blind, placebo-controlled clinical trial was utilized for this study with the objective to assess the efficacy of oral zinc gluconate in the improvement of disease activity in acne vulgaris patients as measured by the inflammatory score and Global Acne Grading System (GAGS) score.
Acne has four main pathogenic contributors: follicular hyperkeratinization, increased sebum production, Propionibacterium acnes (P. acnes) within the follicle, and inflammation. Treatment options for acne vulgaris include benzoyl peroxide, topical and oral retinoids, topical and oral antimicrobials, oral corticosteroids, and physical modalities such as acne surgery, laser and light therapy. Reports show that antibiotic resistance is a growing issue in the treatment regimen of acne vulgaris, making it less and less suitable for long-term treatment, hence other options that can be substitutes or adjuncts to treatment may be useful in this condition. For long-term or maintenance therapy, physicians should consider effectivity, cost, and adverse effects. Several studies have explored the effect of oral zinc on acne vulgaris. Since zinc is more cost-effective and has less adverse effects compared to most antibiotics, this may prove helpful for the Filipino patient in terms of safety and economy for long-term therapy.
The aim of this study is to assess the efficacy of oral zinc gluconate in the improvement of disease activity in acne vulgaris patients, to determine the demographic and clinical profile of Acne Vulgaris patients, to determine the disease activity measured by the inflammatory score and GAGS score of acne vulgaris patients on initial consult, at 4 weeks, and at 8 weeks, and to determine if there is a significant difference in disease activity as measured by the inflammatory score and GAGS score among acne vulgaris patients given placebo and oral zinc gluconate.
A randomized, double blind, placebo-controlled clinical trial was utilized. Adults with moderate to severe acne vulgaris were included in the study. Patients were evaluated using the inflammatory score and Global Acne Grading System (GAGS) at the start, at midpoint, and at the end of the trial. One group of participants received zinc gluconate supplementation and another group received placebo for 60 days. All participants received topical adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening. Improvement in acne severity was then determined and compared.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Zinc gluconate group | Active Comparator | interventions: Zinc gluconate (200g/capsule) one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. |
|
| Placebo group | Placebo Comparator | interventions: Placebo capsule, one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Zinc gluconate | Dietary Supplement | oral zinc gluconate 200mg |
|
| Measure | Description | Time Frame |
|---|---|---|
| Global Acne Grading System Score | changes in Global Acne Grading System (GAGS) score. Minimum score is 0, maximum score is 44. Cut off scores are as follows: no lesion (0), mild (1-18), moderate (19-30), severe (31-38), and very severe (≥39) | upon enrollment, at 4 weeks, at 8 weeks |
| Inflammatory Score | changes in inflammatory score. Minimum score is 0, maximum score is 144. Higher score indicates presence of more inflammation. | upon enrollment, at 4 weeks, at 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Examiner's Assessment Score | examiner's assessment of acne improvement graded as no improvement (0%), slight improvement (<50%), marked improvement (≥50%) | at 8 weeks |
| Patient's Self-assessment Score |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Monique Lianne C. Lim-Ang, MD,MBA,DPDS | East Avenue Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| East Avenue Medical Center | Quezon City | National Capital Region | Philippines |
| Label | URL |
|---|---|
| Evaluation of Severity in Patients of Acne Vulgaris by Global Acne Grading System in Bangladesh | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Zinc Gluconate Group | interventions: Zinc gluconate (200g/capsule) one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Zinc gluconate: oral zinc gluconate 200mg Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening |
| FG001 | Placebo Group | interventions: Placebo capsule, one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening Placebo: contains cornstarch |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
the analysis population only consisted of participants who were able to complete 8 weeks of the intervention.
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| ID | Title | Description |
|---|---|---|
| BG000 | Zinc Gluconate Group | interventions: Zinc gluconate (200g/capsule) one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Zinc gluconate: oral zinc gluconate 200mg Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Global Acne Grading System Score | changes in Global Acne Grading System (GAGS) score. Minimum score is 0, maximum score is 44. Cut off scores are as follows: no lesion (0), mild (1-18), moderate (19-30), severe (31-38), and very severe (≥39) | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Posted | Median | Full Range | score on a scale | upon enrollment, at 4 weeks, at 8 weeks |
|
6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Zinc Gluconate Group | interventions: Zinc gluconate (200g/capsule) one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Zinc gluconate: oral zinc gluconate 200mg Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| vomiting | Gastrointestinal disorders | Non-systematic Assessment |
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Monqiue Lianne Lim-Ang | East Avenue Medical Center | 0287100957 | moniquelianne.lim@gmail.com |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Dec 19, 2018 | Mar 17, 2022 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D000152 | Acne Vulgaris |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D017486 | Acneiform Eruptions |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D012625 | Sebaceous Gland Diseases |
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| ID | Term |
|---|---|
| C030691 | gluconic acid |
| D000068816 | Adapalene |
| D001585 | Benzoyl Peroxide |
| D005782 | Gels |
| D000068801 | Adapalene, Benzoyl Peroxide Drug Combination |
| ID | Term |
|---|---|
| D009281 | Naphthalenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
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| Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo] | Drug | Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening |
|
|
| Placebo | Other | contains cornstarch |
|
patient's assessment of acne improvement graded as no improvement (0%), slight improvement (<50%), marked improvement (≥50%)
| at 8 weeks |
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| NIH Zinc fact sheet | View source |
| Zinc for testosterone | View source |
| Serum Trace Elements (Zinc, Copper and Magnesium) Status in Iraqi Patients with Acne Vulgaris: (Case- Controlled Study) | View source |
| BG001 | Placebo Group | interventions: Placebo capsule, one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening Placebo: contains cornstarch |
| BG002 | Total | Total of all reporting groups |
| Count of Participants |
| Participants |
|
| Sex: Female, Male | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Count of Participants | Participants |
|
| Race (NIH/OMB) | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Count of Participants | Participants |
|
| Region of Enrollment | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Count of Participants | Participants |
|
| Inflammatory Score | The inflammatory score is a grading system that measures inflammatory lesions (papules, pustules, nodules). Locations for assessment include the face, chest and back. For each location, papules, pustules and nodules are counted. A factor based on the lesion (papule=3, pustule=4, nodule=5) is multiplied to a grade equivalent to the number of lesions (0= No lesions, 1= 1-5 lesions, 2= 6-10 lesions, 3= 11-20 lesions, 4= more than 20 lesions). The subtotal scores are added to come up with the total inflammatory score. A maximum possible total score of 144. | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Median | Full Range | units on a scale |
|
| Global Acne Grading System score | The Global Acne Grading System (GAGS) is an acne severity scale. A factor is provided for each location based on size (forehead=2, right cheek=2, left cheek=2, nose=1, chin=1, chest and upper back=3). Each location is graded based on the most severe lesion present (no lesion=0, comedones=1, papules=2, pustules=3, nodules=4). The local score per location is equal to location factor multiplied by the score for the most severe lesion. The sum of local scores for all locations is the global score. Acne is rated as mild (1-18), moderate (19-30), severe (31-38), and very severe (≥39). | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Median | Full Range | units on a scale |
|
| OG001 | Placebo Group | interventions: Placebo capsule, one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening Placebo: contains cornstarch |
|
|
| Primary | Inflammatory Score | changes in inflammatory score. Minimum score is 0, maximum score is 144. Higher score indicates presence of more inflammation. | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Posted | Median | Full Range | score on a scale | upon enrollment, at 4 weeks, at 8 weeks |
|
|
|
| Secondary | Examiner's Assessment Score | examiner's assessment of acne improvement graded as no improvement (0%), slight improvement (<50%), marked improvement (≥50%) | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Posted | Count of Participants | Participants | at 8 weeks |
|
|
|
| Secondary | Patient's Self-assessment Score | patient's assessment of acne improvement graded as no improvement (0%), slight improvement (<50%), marked improvement (≥50%) | the analysis population only consisted of participants who were able to complete 8 weeks of the intervention. | Posted | Count of Participants | Participants | at 8 weeks |
|
|
|
| 0 |
| 11 |
| 0 |
| 11 |
| 1 |
| 11 |
| EG001 | Placebo Group | interventions: Placebo capsule, one capsule once in the morning after breakfast for 60 days. Adapalene 0.3% + benzoyl peroxide 2.5% gel to be applied once at night for 60 days. Adapalene 0.003 MG/MG / Benzoyl Peroxide 0.025 MG/MG Topical Gel [Epiduo]: Adapalene 0.3% + Benzoyl peroxide 2.5% gel applied once daily in the evening Placebo: contains cornstarch | 0 | 12 | 0 | 12 | 0 | 12 |
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| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D011083 | Polycyclic Compounds |
| D001565 | Benzoates |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D001555 | Benzene Derivatives |
| D003102 | Colloids |
| D045424 | Complex Mixtures |
| D004304 | Dosage Forms |
| D004364 | Pharmaceutical Preparations |
| D004338 | Drug Combinations |
| 8 weeks |
|
| Marked Improvement (≥50%) |
|
| Marked improvement (≥50%) |
|