Topical therapy in acne

The majority of acne patients will receive a topical treatment either as monotherapy or in combination with a systemic drug therapy depending on the severity of the disease. The currently available topical agents affect at least one of the four main pathogenetic factors responsible for the development of acne, i.e. hyperkeratosis, microbial colonization, immune response and inflammation. Retinoids, azelaic acid, benzoyl peroxide and topical antibiotics represent the spectrum of the established and proven topical agents. Presumably, antiandrogenic agents will soon be available for topical use to treat the important factor of seborrhea. In general, by combining topical agents, their potency can be enhanced and toxicity diminished. Unfortunately, bacterial resistances are beginning to emerge as a significant problem.     

Topical dermocosmetics and acne vulgaris

Acne is a highly common skin disease especially among teenagers. Modern acne treatments are based also on the use of moisturizers, cleansers and sunscreens. In choosing the right cleanser, it is important to consider some aspects: the interaction between skin type and the cleanser, the optimal time and method of cleaning and the cosmetic perception of the patient. The aim of our review is to highlight the importance of choosing the most suitable topical dermocosmetics for the different skin types, as well as the most effective timing and method to combine dermocosmetics with the standard acne treatment. A search in literature for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Treatment of acne patients should include education for proper daily skin hygiene, including protection from environmental damage. However, given the low number of clinical studies on cleansers, it is difficult to make reliable recommendations. The correct choice and use of topical dermocosmetics are fundamental in the management of acne patients. Daily use of moisturizers, cleansers and sunscreens can reduce both inflammatory and non‐inflammatory acne lesion counts and may be helpful for acne treatment if combined with specific drugs.     

Topical retinoids in the treatment of acne vulgaris

Topical retinoids are highly effective in the treatment of both comedonal and inflammatory lesions of acne and are a vital part of almost any acne regimen. A better understanding of the structure and function of this class of medications has led to better outcomes in treatments of patients with acne. In this article, the structure and function of retinoids is first reviewed. Then, the clinical effectiveness and tolerability of each of the available topical retinoid formulations is summarized.     

Topical cimetidine treatment of acne

We present first results of topically applied cimetidine in acne. Ten patients suffering from papulopustular and comedone acne administered 2% cimetidine in indifferent lotion on their face twice a day. Clinical controls were performed every two weeks; sebum was monthly determined. After treatment of 13 weeks on the average, the clinical success was generally good. Comedones responded best, followed by papules. Pustules were hardly reduced. There was no significant reduction of SER and the lipid fractions at the end of treatment. Low concentration or insufficient penetration might be possible explanations. The efficient reduction of comedones might be an antiandrogenic effect due to modulation of the keratinization in the follicle excretory duct. Immune-modulatory effects of cimetidine and effects on the skin vessels are other possible explanations for the clinical efficacy of topical application of cimetidine in acne.     

5-氨基酮戊酸光动力疗法治疗痤疮

目的 探索5-氨基酮戊酸光动力疗法（ALA-PDT）治疗中、重度痤疮的安全性及有效性。方法 将70例中、重度痤疮患者随机分为两组。治疗组35例,给予ALA-PDT治疗,每2周治疗1次,共治疗1 ~ 3次;对照组35例,口服异维A酸胶囊治疗,共服用6周。在治疗第2、4、6周对两组患者进行疗效判断和比较。结果 35例接受ALA-PDT治疗的患者经过1 ~ 3次治疗后（第2、4、6周）,总有效率达97.1%;对照组于6周时总有效率为80.0%,治疗组疗效明显优于对照组（P < 0.05）。另外,ALA-PDT组复发程度明显轻于对照组,且病情控制时间明显延长。ALA-PDT组有个别患者局部出现暂时性色素沉着,但无瘢痕发生。结论 ALA-PDT是一种简单、高效、不良反应轻微的治疗中、重度痤疮的新疗法。     

痤疮的治疗进展

痤疮是一种最常见的发生于毛囊皮脂腺的慢性炎症性损容性皮肤病。各年龄段人群均可患病,但以青少年发病率为高。痤疮影响容貌,极易反复发生,除了影响身体健康外,也会给患者带来心理障碍和社会心理问题。对于痤疮,应该高度重视,痤疮分级是痤疮治疗的重要依据,综合应用药物、物理、医学护肤品等手段早期治疗,达到治疗与美容的效果。本文就各种常用治疗方法进行综述。     

Overview of treatments for acne

Acne vulgaris is a chronic inflammatory condition of the pilosebaceous units. Antibiotics are widely used in acne therapy and can be administrated topically or systemically. The main negative effect of antibiotic treatment is bacterial resistance to antibiotics.     

Topical vitamin A acid in the treatment of acne vulgaris

Summary A controlled non-blind multicenter trial was conducted in 211 acne patients to test the activity of topical retinoic acid against sulfur-resorcinol—salicylic acid and placebo. Uniform evaluation criteria were used. After 8 weeks' treatment in comparable groups of patients, retinoic acid proved to be superior to the standard and to the placebo. The difference was statistically significant.Side effects were present in a number of patients treated with the active substances and with the placebo (mainly erythema), but rarely was the treatment discontinued.

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Zusammenfassung Um die lokale Wirksamkeit von Retinoic Säure im Vergleich zu Schwefel-Resorzin — Salizylsäure und Placebo zu testen, wurde im Rahmen einer multizentrischen Prüfung bei 211 Acne-Patienten eine kontrollierte Untersuchung durchgeführt. Es kamen einheitliche Auswertungskriterien zur Anwendung. Nach einer 8wöchigen Behandlung mit vergleichbaren Patientengruppen hat sich die Retinoic-Säure dem Vergleichspräparat und dem Placebo als überlegen gezeigt. Der Unterschied war statistisch signifikant.Nebenwirkungen waren in einer Anzahl von Patienten sei es unter der Behandlung mit den Wirksubstanzen als auch mit Placebo vorhanden (hauptsächlich Erytheme); eine Unterbrechung der Behandlung war jedoch nur selten notwendig.

     

Topical ALA-photodynamic therapy for the treatment of acne vulgaris

Topical aminolevulinic acid is converted into a potent photosensitizer, protoporphyrin, in human hair follicles and sebaceous glands. Photodynamic therapy with topical aminolevulinic acid was tested for the treatment of acne vulgaris, in an open-label prospective human study. Each of 22 subjects with acne on the back was treated in four sites with aminolevulinic acid plus red light, aminolevulinic acid alone, light alone, and untreated control. Half of the subjects were treated once; half were treated four times. Twenty percent topical aminolevulinic acid was applied with 3 h occlusion, and 150 J per cm2 broad-band light (550-700 nm) was given. Sebum excretion rate and auto-fluorescence from follicular bacteria were measured before, and 2, 3, 10, and 20 wk after, treatment. Histologic changes and protoporphyrin synthesis in pilosebaceous units were observed from skin biopsies. Aminolevulinic acid plus red light caused a transient acne-like folliculitis. Sebum excretion was eliminated for several weeks, and decreased for 20 wk after photodynamic therapy; multiple treatments caused greater suppression of sebum. Bacterial porphyrin fluorescence was also suppressed by photodynamic therapy. On histology, sebaceous glands showed acute damage and were smaller 20 wk after photodynamic therapy. There was clinical and statistically significant clearance of inflammatory acne by aminolevulinic acid plus red light, for at least 20 wk after multiple treatments and 10 wk after a single treatment. Transient hyperpigmentation, superficial exfoliation, and crusting were observed, which cleared without scarring. Topical aminolevulinic acid plus red light is an effective treatment of acne vulgaris, associated with significant side-effects. Aminolevulinic acid plus red light causes phototoxicity to sebaceous follicles, prolonged suppression of sebaceous gland function, and apparent decrease in follicular bacteria after photodynamic therapy. Potentially, aminolevulinic acid plus red light may be useful for some patients with acne.