The aim of treatment is simultaneous prevention of excessive keratosis of the skin, inhibition of the development of hostile bacteria and reduction of seborrhea. Each of these factors alone contributes to the development of acne. Therefore, the principle is to avoid monotherapy. Optimal results of acne treatment are achieved by using a combination of medicines at the same time to inhibit excessive sebum production in sebaceous glands, increased keratosis of the sebaceous glands, proliferation of tallow decay bacteria and reduce inflammation.
SOUND THERAPY TREATMENT- means medicines applied to the skin
Due to the therapeutic effects, we distinguish three groups of preparations for topical treatment:
- anti-seborrhoea
- anti-fungal
- antibacterial
Anti-seborrheic preparations
Popular means for washing, exfoliating and drying the skin are:
- salicylic alcohol
- chemically pure sulfur
- zinc
Salicylic acid
Anti-seborrhoeic preparations are ancillary or complementary medicines. These are mainly alcoholic solutions with the addition of menthol, thymol or salicylic acid. The most popular and multilateral drug action is salicylic acid at a concentration of 0.5-3% - in alcoholic solution. It has a comprehensive action: anti-coarse (comedolytic), exfoliating excess of keratinized epidermis (keratolytic) and anti-inflammatory and disinfectant. It is usually well tolerated, although it can sometimes cause slight skin irritation.
Chemically pure sulfur
Chemically pure sulfur is another agent acting anti-acne. This chemical element applied to the skin undergoes transformation to sulphides which have a bactericidal and fungicidal effect. The sulfur itself has a drying effect.
Zinc preparations
Zinc compounds are used in the treatment of acne. Zinc oxide is used locally at a concentration of 10 to 25%. It has a drying effect, a powerful effect, which is helpful in the so-called eczema oozing and in skin inflammation.
Anti-exoric preparations are:
- azelaic acid
- benzoyl peroxide
- alpha-hydroxy acids
- retinoids
Azelaic acid
Azelaic acid has antibacterial, keratolytic and decolouring properties, so it is also used in the removal of post-inflammatory hyperpigmentation. It also affects the composition of sebum. It is well tolerated, used as a single drug or in combination, most often with general treatment. It is available in a concentration of 15-20%
Benzoyl peroxide
Benzoyl peroxide is often used in external treatment, mainly due to the keratolytic effect and antibacterial activity that occurs during the drug decomposition and the subsequent release of oxygen. The preparations are available in concentrations: 2.5%, 4%, 5% and 10%, in the form of creams, solutions, lotions and gels. When using these preparations, especially at the beginning of the treatment, patients may observe irritation, drying and exfoliation of the skin, therefore it is recommended to use them cautiously: starting treatment from lower concentrations and applying them every other day. The drug may cause slight discoloration of the skin.
Alpha-hydroxy acids
Alpha-hydroxy acids are simple chemical compounds contained in fruits. These compounds gently exfoliate the epidermis, thanks to which the skin becomes smoother and the pores of the pilosebaceous follicles open wider. The biochemical mechanism of this action is not fully explained. It is assumed that alpha-hydroxy acids have the dissolution properties of the substance sticking to individual cells, as a result of which their cohesion decreases. As a consequence, the natural process of removing the layers of dead epidermal cells accumulating on the skin surface accelerates. This prevents the pores from closing and the development of blackheads.
Retinoids - synthetic derivatives of vitamin A acid:
Popular retinoids - tretinoin and isotretinoin
Retinoids reduce sebaceous glands and sebum secretion, reduce the number of bacteria in the hair follicles, have anti-inflammatory and anti-fungal properties. They block practically all the mechanisms initiating the formation of acne. Common treatments for acne include tretinoin (the so-called all-trans vitamin A acid) and isotretinoin (13-cis vitamin A acid). They are usually used in the form of gels, creams and solutions. In contact with the skin, they normalize abnormal keratosis in the hair follicles. They also act anti-inflammatory and antibacterial. When used, skin irritation may initially occur (especially under the influence of sunlight!) And its excessive drying and exfoliation. Therefore, the preparations are used with caution under medical supervision. The standard time of local therapy with retinoids ranges from 5 to a dozen or so weeks. Note - their use is contraindicated in pregnant women.
Third generation retinoids
A / Adapalen is a third generation retinoid. It is more anti-inflammatory than previous, and indirectly also anti-bacterial and anti-seborrhoeic. It is also safer when it is used in the summer. It is more effective and is better tolerated. It is used on the skin in monotherapy and in combination with other external medicines: antibiotics, and also in more severe forms of acne, with antibiotics administered generally.
B / Tazarotene - is in the form of a gel with a concentration of 0.05 and 0.1%. It works like adapalene, but much more strongly - so it has a therapeutic effect after a short time of therapy. However, it may cause slight skin irritation due to its strong action. It is sometimes used in combination with antibiotics.
Antimicrobial preparations
- antibiotics
- azelaic acid, (discussed above)
- adapalene, tazarotene (discussed above)
The role of antibiotics
Topical antibiotics are used willingly, due to good tolerability and rare side effects. They act primarily on Propionibacterium acnes. They are most desirable in papule-pustular acne. First of all, preparations are used:
- erythromycin at a concentration of 2.5%, (also produced in combination with zinc oxide, miconazole, tretinoin and benzene peroxide)
- clindamycin at a concentration of 1%, also combined with benzoyl peroxide
- tetracycline at a concentration of 3%
ed. Edward Ozga Michalski, MA
And generation - retinol, tretinoin, isotretinoin
II generation - etretinate, acitretin
3rd generation - .adalen, tazarotene
dermatological consultation drug. med Dorota Bystrzanowska
Literature
1 / Advances in the treatment of acne vulgaris - Dr med. Maria Barancewicz-Łosek, lek. med. Wojciech Baran Chair and Department of Dermatology, Venereology and Allergology of Medical University in Wroclaw; Head: prof. dr hab. med. Eugeniusz Baran WYd. THERAPY- DERMATOLOGY - MARCH 2005
2 / Błaszczyk-Kostanecka M., Chodynicka B., Gliński W. et al .: Acne vulgaris: pathogenesis and principles of treatment. Overview. Dermatol. 1998, 85 (1), 3-19.
3 / Practical Dermatology; dermatologists: Małgorzata Opalińska, Katarzyna Prystupa, Wadim Stąpór, Wyd. Lek. PZWL 1997.
