Treatment Of Acne Patients Research Articles

40 years’ experience of using isotretinoin in treatment of acne: efficacy, optimal dosage, relapses

Objective — to analyze domestic and foreign literature sources on the use of systemic isotretinoin (SI) in the treatment of acne, focus on aspects of the evolution of the isotretinoin molecule, new routes of action and dosing regimens of the drug, the effectiveness of therapy, relapses and prognostic factors of their development. Materials and methods. We conducted the analysis of publications (systematic reviews, clinical trials and observational studies) from the databases of the Vernadskyi National Library of Ukraine, PubMed, MEDLINE, Web of Science and Scopus by June 2023. The search criteria were the words «acne», «systemic therapy», «isotretinoin», «isotre­tinoin-LIDOSE», «mechanism of action», «efficacy», «daily dose», «cumulative dose», «relapses» and their analogues in the English language. The final choice of 60 sources was based on the author’s judgments about their completeness and significance for solving the goals. Results and discussion. The clinical efficacy of SI is due to its powerful effect on the leading links of the pathogenesis: hyperproliferation of follicular keratinocytes, hyperactivity of sebocytes, excessive colonization of Cutibacterium acnes and immune-mediated inflammation. A comparative analysis of two forms of SI existing in Ukraine was carried out, the advan­tages of isotretinoin-LIDOSE over standard isotretinoin in clinical practice were determined. It is not possible to draw a clear conclusion about the indications for SI use in acne because there are conflicting recommendations in national guidelines (USA, UK, Canada) and the international consensus of the Global Alliance. At present, in addition to the standard daily doses of SI, a number of regimens have been proposed in the treatment of moderate and mild acne, suggesting a certain reduction in the corresponding doses that decreases the risk of side effects and has sufficient therapeutic efficacy. The advantages and disadvantages of standard, high-dose and low-dose isotretin regimens are described in terms of effectiveness, duration of remission, and relapse rate. Conclusions. Isotretinoin has a high profile of clinical efficacy. It is a treatment for severe and moderate forms of acne that provides a stable therapeutic effect at standard (0.5—1 mg/kg/day) or high doses (more than 1 mg/kg/day). The treatment of acne of moderate and mild severity with low daily doses of SI (less than 0.5 mg/kg) leads to the preservation of the effectiveness of therapy while improving tolerability and reducing the possible risk of side effects. It was determined that the rate of regression of clinical manifestations of acne does not depend on the daily dose (low, standard, high), but the frequency of relapses increases in patients who received low doses. The effectiveness of treatment is higher with the use of fixed (daily) standard, low or high doses of SI compared with intermittent use (every other day, 1 week or 10 days per month). Achieving a cumulative dose (120 to 150 mg/kg) is supported by clinical studies, consensus and dermatological practice. The duration of therapy with standard doses is 16—24 weeks, in the low-dose regimen — for a long time (more than 8 months). It is determined individually until a clinical effect is achieved. In cases of earlier regression of acne manifestations, when patients have not reached the cumulative dose, treatment with SI should be continued until complete regression of the rash and for the following 4—8 weeks. The use of isotretinoin-LIDOSE due to extrabioavailability, high solubility, independence from food intake allows obtaining better clinical results and improving compliance in the treatment of acne patients.

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.

<p>Correlation Between Lipid Profile and Acne Vulgaris</p>

Background and AimAcne is a common skin disease resulting from a complex interaction of various pathogenetic factors. The aim of this study was to find out lipid profile abnormalities in acne vulgaris patients.Material and MethodsThis descriptive analytic cross-sectional study was conducted on 45 acne patients and 45 age- and sex-matched healthy controls to assess plasma total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride (TG) levels.ResultsWe showed a higher cholesterol level in acne patients (P=0.025), particularly in men (P=0.04). Other plasma lipids including TG, LDL, and HDL in male and female patients were higher compared to controls, but this is not statistically significant.Discussion and ConclusionIn conclusion, lipid profile was altered in our patients, with high cholesterol level as the commonest derangement, particularly in men. Therefore, screening for lipid profile abnormalities could be considered in the treatment of acne patients.

Comprehensive treatment of acne patients with gastroduodenal pathology and manifest herpesvirus infection

Objective -increasing the efficiency of treatment of acne patients by using anti-Helicobacter, antiviral and immunotropic drugs in their complex therapy, taking into account the clinical features of dermatosis, identifying concomitant H. pylori diseases and associated mani­festations of herpes simplex type I and II and individual indicators of systemic immunity. Material and methods. 134 acne patients aged 18 to 30 years, among which 74 women and 60 men, were under the supervision. In patients with acne, the presence of concomitant H. pylori and manifest herpes virus infection, as well as individual immunological parameters by known methods, were in­vestigated. Results. We have established the incidence of concomitant H. pylori and herpes manifest infection, their effect on the clinical course of dermatosis, quality of life and immune status of patients and, based on this, we worked out measures to improve their comprehen­sive treatment by means of anti-Helicobacter (amoxi­cillin, clarithromycin), antivirus (inosine pranobex) and immunotropic (thymalin) drugs that improve significantly immediate and long-term results of acne treatment in these patients. Conclusions. The developed improved methods for the treatment of acne patients, taking into account the presence of concomitant H. pylori - associ­ated diseases and manifest forms of herpes virus infec­tion, changes in systemic immunity and the clinical fea­tures of dermatosis, can improve both the immediate and long-term results of acne treatment, which is confirmed by the reliable positive dynamics of the studied clinical and laboratory indicators.

Acne vulgaris and acne conglobata: resistance to treatment and modern ways of its overcoming

The article presents with the data on the peculiarities of etiology and pathogenesis of acne vulgaris and acne conglobata, as well as a clinical description of various forms of acne. The main causes of the resistance of acne vulgaris and acne conglobata to treatment by topical and systemic medicines are considered. The algorithms of examination and treatment of patients in cases of severe forms of acne and their therapeutic resistance are given. New possibilities of treatment of acne patients with the use of Acnetin® are shown.

Large-Scale Integrative Analysis of Epigenetic Modifications Induced by Isotretinoin, Doxycycline and Metronidazole in Murine Colonic Intestinal Epithelial Cells

Environmental factors are playing a central role in triggering inflammatory responses in the intestine. There is increasing evidence that the development of inflammatory bowel disease (IBD) is deriving from an aberrant immune response to the commensal gut microbiota triggered by various environmental factors in a susceptible host. A vitamin A derivate used in acne therapy (isotretinoin) has been inconsistently associated with the onset of IBD. However, what needs to be considered is the previous treatment of acne patients with antibiotics that are also associated with the development of IBD, thus representing a crucial confounding factor. Here, we studied whether doxycycline (acne therapy), metronidazole (IBD therapy) or isotretinoin are able to induce alterations in DNA methylation and microRNA expression patterns in murine colonic intestinal epithelial cells (IECs). Additionally, we analyzed time-dependent changes in the aforementioned epigenetic mechanisms to study how epigenetic signatures evolve over time. As for changes in DNA methylation, we found isotretinoin to have strong demethylating effects, while antibiotic treatment had only a moderate impact. Isotretinoin-mediated demethylation resolved after a washout phase, not supporting an association between isotretinoin treatment and IBD. Regarding microRNA and mRNA expression, isotretinoin and doxycycline, but not metronidazole, potentially induce long-term changes in microRNA/mRNA expression profiles towards the down-regulation of immune responses. Analysis of time-dependent DNA methylation showed stable marks over a time frame of 4 weeks. Furthermore, novel microRNAs were identified (e.g., microRNA-877-3p), which might be of relevance in IEC development.

Feasibility of combination the outer antibakterialnoy therapy and preparation azelaic acid for treatment of acne

The review presents modern views on the pathogenesis of acne. The data of foreign and domestic clinical trials to study the efficacy and safety of drugs containing 1% clindamycin and 15% azelaic acid used to treat acne. The mechanisms of the effects of these drugs on the main elements of the pathogenesis of acne. Substantiates the appropriateness of the drug combination of clindamycin and azelaic acid in the treatment of acne patients.

Systemic treatment of severe forms of acne: experience of using Isotretinoin in the Russian Federation

The article presents the results of a large-scale Russian program of the follow-up and treatment of acne patients with Isotretinoin (Roaccutane). The analysis of the results included information about 1,349 acne patients. In 71% of patients, the therapy was initiated at the dose of 0.5-1.0 mg/kg of the body weight. The average duration of treatment was 21.5±0.16 weeks while the average course dose was 119.9±0.8 mg/kg of the body weight. As many as 96% of patients achieved a positive result; women demonstrated a higher improvement rate than men. On the whole, Roaccutane was well-tolerated while adverse effects included dry lips (43.4%), dry skin in different areas (12.45%), retinoid dermatitis (6.45%), epistaxis (2.45%), conjunctivitis (1.41%) and hoarseness (0.22%). The Russian experience of using Roaccutane confirmed high efficacy of the systemic therapy for severe forms of acne.

Assessment of efficacy of a new tretinoin plus clindamycin gel: Treatment of acne patients from Brazil

Assessment of efficacy of a new tretinoin plus clindamycin gel: Treatment of acne patients from Brazil

Experience of treating acne patients with acnecutan

The author describes her own positive experience of using a new innovation form of isotretinoin, the Acnecutan drug, for the treatment of acne patients. The author provides the drug efficacy and tolerability assessment, describes the frequency and intensity of adverse effects and discloses the methods for their prevention and elimination

Acne in Adolescents: Quality of Life, Self-Esteem, Mood and Psychological Disorders

Acne is a significant adolescent problem and may precipitate emotional and psychological effects. The impact of acne on psychological parameters and implications for acne treatment are not fully understood. We performed a MEDLINE search using the terms "acne" and "adolescent" along with "psychological," "depression," or "psychiatric," which yielded 16 reviewed studies. Qualitative review of the selected articles revealed that the presence of acne has a significant impact on self-esteem and quality of life. Depression and other psychological disorders are more prevalent in acne patients and acne treatment may improve symptoms of these disorders. The reviewed studies were semi-quantitative analyses utilizing various standardized surveys or questionnaires. Therefore, quantitative analysis of selected studies was not possible. The presence of co-morbid psychological disorders should be considered in the treatment of acne patients and future prospective trials are needed to assess the impact of treatment on psychological outcomes.

Comparison of therapeutic effects of oral doxycycline and azithromycin in patients with moderate acne vulgaris: What is the role of age?

Background: Acne vulgaris is the most common dermatological disorder in adolescence and young adults. In past decades, systemic antibiotics have had the main role in the treatment of acne patients with inflammatory papules and cysts. They are sometimes associated with side effects, contributing to reduced compliance. Objective: This study aimed at comparing the efficacy and safety of oral azithromycin and doxycycline in the treatment of moderate acne vulgaris, considering the age of patients as an influencing parameter. Methods: In a randomized, double-blind, clinical trial, 100 patients with moderate acne vulgaris who attended the outpatient dermatology clinic were evaluated during a 15-month period. They were randomized into two equal groups: A and D. Patients in group A received oral azithromycin (500 mg daily, 4 consecutive days per month for 3 consecutive months) and patients in group D took doxycycline (100 mg daily for 3 consecutive months). The number and types of lesions (all over the body) were determined at baseline and at the end of each month for 90 days afterwards. Michaelson's acne severity score was also determined at baseline and at the end of the third month after initiating treatment. Patients were followed up for another 3 months after discontinuation of treatment to determine the recurrence rate. Results: Both antibiotics were comparably effective in the treatment of moderate acne vulgaris. There was no significant side effect in the A group and the complications were minor in the D group. Doxycycline was significantly more effective in patients older than 18 years. Conclusion: Azithromycin is at least as effective as doxycycline in the treatment of moderate acne vulgaris; however, in patients older than 18 years doxycycline is better.

Bacterial resistance to antibiotics in acne vulgaris: An in vitro study

Background:Acne vulgaris is one of the most common skin disorders in youth especially during the puberty.Objective:This in vitro study was performed to determine the antibiotic resistance and sensitivity in acne vulgaris.Materials and Methods:Samples were collected from normal skin and nodulocystic and pustular skin lesions of one hundred youngsters (64 girls, 36 boys) among college students in the age range of 18-24 years old. The specimens were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2 to 7 days. Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures.Results:In aerobic culture of pustular and nodulocystic skin lesions, Staphylococcus aureus was present in 41% of subjects, Staphylococcus epidermidis in 53% and Micrococcus spp in 45% of subjucts. In anaerobic bacterial culture of pustular and nodulocystic skin lesions, Staphylococcus aureus was present in 39%, Propionibacterium acne in 33% and Staphylococcus epidermidis in 21% of subjects. The results of present study revealed that clindamycin and erythromycin were the least effective antibiotics for Propionibacterium acne while tetracycline was the least effective for Staphylococcus aureus in vitro. A synergic effect of benzoyl peroxide, erythromycin or clindamycin was noticed. Rifampin was the most effective antibiotic in vitro.Conclusion:Our results showed that rifampin was the most sensitive antibiotic in vitro for acne vulgaris. To achieve a better treatment, a combination of rifampin with other antibiotics may be more efficient. We suggest in vivo studies for better evaluation and treatment of acne patients with rifampin.

Clinical efficacy and safety comparison of adapalene gel and tretinoin gel in the treatment of acne vulgaris: Europe and U.S. multicenter trials

Background: Adapalene is a new chemical entity that exhibits tretinoin-like activities in the terminal differentiation process. Objective: We evaluated a dose range effect of two concentrations of adapalene gel as acne treatment and compared adapalene 0.1% gel with tretinoin 0.025% gel in the treatment of acne patients in two large multicenter studies. Methods: Multicenter, investigator-masked, parallel group studies including 89 acne patients in the dose range study and 591 patients in the concurrent controlled studies were conducted. Results: Adapalene gel 0.1% was significantly more effective in treating acne lesions than 0.03% adapalene gel. Adapalene gel 0.1% was significantly more effective than 0.025% or tretinoin gel in one study and of the same effectiveness in the other study. Adapalene gel was always better tolerated than tretinoin gel. Conclusion: Adapalene 0.1% gel is a safe and effective treatment of acne vulgaris. (J Am Acad Dermatol 1997;36:S126-34.)

Safety of minocycline for acne

Minocycline is the most commonly used oral antibiotic for the treatment of acne in the UK. In this week's issue Eisen reports on the prevalence of one complication, oral hyperpigmentation. Two recent articles1,2 record serious adverse events resulting from the treatment of acne patients with this drug, including autoimmune hepatitis, a serum-sickness type of reaction, and drug-induced lupus erythematosus. It is difficult to assess the true incidence because most of the evidence has come from specialty centres in the USA and UK that collect patients with adverse reactions to medications.

Efficacy and safety comparison of adapalene (CD271) gel and tretinoin gel in the topical treatment of acne vulgaris. A European multicentre trial

BACKGROUND: Adapalene is a new chemical entity which binds with high affinity to specific nuclear retinoic acid receptors and exhibits tretinoin-like activities in the terminal differentiation process. OBJECTIVE: The purpose of the trial was to compare adapalene 0.1% gel (Differin Gel, Galderma Laboratories) with tretinoin 0.025% gel (Retin A Gel, Cilag Laboratories) in the treatment of acne patients, methods: A multicentre, investigator-masked, parallel-group study included 268 male and female patients with mild to moderate facial acne vulgaris. Treatments were applied once daily for 12 consecutive weeks. RESULTS A total of 134 patients (74 males and 60 females, mean age 19.7 years) received adapalene gel and 134 patients (69 males and 65 females, mean age 19.2 years) tretinoin gel. Among these patients, 259 were evaluable for efficacy and safety and 236 completed the study. The inflammatory, noninflammatory and total lesion counts, and the global facial acne grade were not significantly different between the two treatment groups after 12 weeks of treatment, but the onset of action of adapalene gel appeared to be slightly but not significantly more rapid in reducing inflammatory and total lesion counts at weeks 2 and 4. Some skin irritation was observed with both products, reaching a maximal intensity during week 2 of treatment. Significantly lower mean scores were obtained with adapalene gel than with tretinoin gel for burning (from weeks 2 to 12) dryness and scaling (at weeks 8 and 12). conclusions: Adapalene 0.1% gel was as effective as tretinoin 0.025% gel in a 12-week once-daily treatment of mild to moderate acne vulgaris. Adapalene gel was safe, with low systemic exposure, no detectable systemic toxicity and a significantly better skin tolerability than tretinoin gel.

Topical spironolactone reduces sebum secretion rates in young adults.

The effects of topically applied spironolactone on the sebum secretion rates (SSR) of young adults were investigated. SSR was expressed as the ratio of wax esters/[cholesterol+cholesterol esters] (WE/[C+CE]) and the amount of sebaceous lipids (squalene, triacylglycerol and wax esters). Topical spironolactone 5% gel applied to the right cheeks of the subjects produced a significant reduction in the SSR at 12 weeks (4 weeks after termination of application), but not at 8 weeks (the end of treatment). Untreated "control" areas (the left cheeks of the subjects) showed no significant change during the study. None of the subjects experienced skin rash or signs of local irritation. This results suggests that topical spironolactone may be effective in the treatment of acne patients with high SSR.

The effects of isotretinoin on follicular and sebaceous gland differentiation.

Follicular and sebaceous gland cell differentiation was investigated during treatment of acne patients with isotretinoin. Sebaceous glands were significantly reduced in volume and showed decreased metabolic activity as measured by glucose-6-phosphate dehydrogenase and succinic dehydrogenase enzyme activities. There was no measurable change in the volume of follicular duct epithelium or in its metabolic activity during treatment. Metabolic activity was also unchanged in the interfollicular epidermis, contrasting with the effects of another retinoid, etretinate. These findings provide no support for the proposition that alteration in the process of follicular keratinization forms a substantial part of the mode of action of isotretinoin.