Review of modern acne treatment methods
Acne vulgaris (acne vulgaris) is a fairly common medical problem in the practice of dermatologists, cosmetologists and also doctors of other specialties. An overview of modern acne treatments is discussed by Dr. G. Webster of the College of Medicine. Jefferson (Philadelphia, USA), published in the British Medical Journal (British Medical Journal).
In the treatment of acne (comedones), topical retinoids (tretinoin, isotretinoin, adapalene or tazarotene), azelaic or salicylic acid once a day locally in the affected area are most often prescribed. Papulopustular forms of acne are usually treatable, including aggressive local therapy - the use of topical forms of medication twice a day on the affected area. Most often, a combination of an antibacterial drug (erythromycin or clindamycin) with comedonolytic agents (benzoyl peroxide) is prescribed, the effectiveness of which is greater than monotherapy with an antibiotic (for example clindamycin) in dosage form topical. A cream containing 20% azelaic acid can be considered as an alternative and is not inferior in the effectiveness of local therapy with macrolide antibiotics.
In recent years, the medical literature has reported numerous strains of Propionibacterium acnes resistant to antibiotics, most often resistance to erythromycin and clindamycin in topical dosage form. According to Dr. Webster, monotherapy with these drugs is unnecessary, but they can be effective in combination with benzoyl peroxide. Alternative treatments include the administration of oral antibiotics or isotretinoin.
According to the author of the article, oral administration of antibiotics is indicated in the treatment of forms of acne resistant to local therapies, as well as in the presence of spherical acne and severe scars. Erythromycin was previously the drug of choice, but the spread of resistance to it in P.acnes has significantly reduced the effectiveness of this antibiotic. In this regard, oral administration of doxycycline or minocycline is considered more preferable, however, their use should be strictly limited only to cases of the disease in which the use of other drugs is ineffective. In cases where antibiotics from the tetracycline group are contraindicated, trimethoprim / sulfamethoxazole or ciprofloxacin may be alternative drugs. In his article, Dr. Webster repeatedly emphasizes that efforts should be made to minimize the use of antibiotics in the treatment of acne, because it is not known how quickly the resistance of P. acnes will develop with prolonged administration of antibacterial drugs. Oral administration of antibiotics should be combined with the use of local comedonolytic agents. In addition, the use of topical retinoids or benzoyl peroxide allows you to obtain a long-term effect after antibiotic treatment.
With treatment-resistant forms of acne in women, further examination is necessary, including the determination of total and free testosterone and plasma dehydroepiandrosterone. With high levels of these hormones, acne treatment should include measures to suppress androgen production, for example, the appointment of low doses of oral corticosteroids, oral contraceptives, cyproterone or spironolactone.
Isotretinoin is indicated for severe nodular forms of acne, but is also used in cases of disease resistant to oral antibiotic therapy. The author emphasizes that during treatment with isotretinoin, it is necessary to constantly monitor the condition of the patients in order to identify possible undesirable drug reactions of this drug.
When treating acne in pregnant women, it is considered safe to use benzoyl peroxide, as well as erythromycin, both topically and orally. When using topical forms of tretinoin during pregnancy, the occurrence of birth defects is also not described.