Antibiotic therapy of acne and antibiotic resistance: State of the art

Abstract

Acne is one of the most common dermatoses, with 117 million people diagnosed with the disease each year. Acne has a complex multifactorial genesis, including genetic predisposition and the influence of exposome factors. The direct mechanisms of the disease are associated with increased sensitivity of sebaceous glands to androgens, sebum hyperproduction, impaired keratinization at the mouth of hair follicles, and inflammation, in the induction of which Propionobacterium acnes is involved.
 The treatment of acne is complex, and one of its strategies is to regulate the number and activity of P. acnes through the use of antibacterial therapy. Antibacterial drugs have been used in the treatment of acne since the 1950s. They are included in a number of clinical guidelines and expert consensus documents for the treatment of the disease. However, the use of antibacterial drugs is limited by the formation of antibiotic resistance. Antibacterial drugs resistance in acne was first noted in the 1970s and was labeled as a global problem in the 2000s. The rapid increase in antibiotic resistance has prompted the development of strategies to prevent it and limit the use of antibacterial drugs in acne.
 This review presents information on the efficacy and place of antibacterial drugs in the treatment of acne, the epidemiology and mechanisms of antibiotic resistance, and strategies to overcome it. The authors consider and substantiate the effectiveness of a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5%, based on the effect on the key links in the pathogenesis of acne, synergism of action and suppression of even antibiotic-resistant strains of P. acnes.