The modern market is full of various forms of products intended for a problem skin of the face, prone to acne and postacne. A lot of dermatologists use a significant percentage of symptomatic remedies, for example, antibiotics, or alcohol mixtures. However, the microflora of the skin becomes resistant to the antibiotic, alcohol is drying up the skin, and the sebum removal of is inevitably caused the dissolution of a part of epidermal lipids, violating the lipid barrier of the skin.
Key words: skin diseases, dermatological treatment, acne, skins microflora, probiotic.
Purpose: To study medicines for the treatment of various forms of acne used in local practice, in order to find promising substances for the further development of the composition and technology of an effective acne treatment and prophylactic remedy.
Results and discussion:
Acne is among the most widespread skin diseases in the practice of a dermatologist. The disease usually develops in adolescence, but at 7% of patients might develop the late acne at 40 years .
Acne could be divided into two large groups:
- endogenous - emergence due to internal factors;
- exogenous - emergence due to external factors.
Endogenous forms of acne may also occur due to reaction of the body to elevated levels of male hormones in the blood. In adults, among the causes of endogenous acne, experts call the seborrhea, which reduces the bactericidal effect of sebum and leads to the activation of coccal flora. An important role in the mechanism of acne is given by bacteria Propionibacterium acnes and products of its life. Moreover, skin rash may appear as a result of the development of some infectious or chronic diseases that disturb the metabolism. In some cases, the location of acne may indicate the occurrence of concomitant diseases in the body.
Causes of acne exogenous origin are quite diverse. Rash may appear after exposed to substances that have a comedogenic effect - the property of causing blockage of the sebaceous glands. In addition, acne may also appear for the following reasons: - side effects of some medications; - heat and humid climate; - contact with toxic substances; - malnutrition .
There are a lot of reasons that don’t cause acne, but affect the endocrine and immune status, leading to the emergence of dermatological problems, for example, stress.
More often, dermatological diseases are caused by a complex of interrelated reasons.
That is, the pathogenesis of acne is caused by a huge number of exogenous and endogenous factors, therefore acne treatment requires an integrated approach.
In 2002 at the XX World Congress on Dermatology, Paris, were developed recommendations and algorithms for the treatment of various forms of acne, in which the drugs of the first choice of a physician in the treatment of acne are local retinoids .
Topical retinoids affect the keratinization (keratinization and desquamation), reduce fat excretion, enhance the proliferation of epithelial cells and have a certain anti-inflammatory effect. The most promising is adapalene (Efferin), which is well tolerated, has no photosensitizing effect, and is characterized by high efficiency .
Benzoyl peroxide, after application on the skin, leads to the release of active forms of oxygen, reducing the synthesis of free fatty acids and the formation of microcomedones. The drug has a pronounced effect against P. acnes, Staphylococcus epidermidis, Malassezia furfur and reduces the risk of developing resistance in combination with antibiotics. Side effects of the drug are irritating effects, especially with the use of high concentrations, as well as increased photosensitivity due to the thinning of the stratum corneum .
Azelaic acid is widely used for external treatment of acne, which has normalized processes of keratinization of the follicle, antimicrobial and anti-inflammatory action that can reduce the pigmentation of the skin . Topical antibiotics are used for pustular acne of mild to moderate severity in combination with topical retinoids or benzoyl peroxide. Among antibiotics for external use at the first place are: erythromycin, clindamycin, fusidic acid. Preparations have some advantages and disadvantages, but long-term external use of antibiotics could instigate the development of bacterial resistance P. acnes . Local antibiotic monotherapy does not have positive effect, as there is no sufficient influence on the main pathogenetic factors, except for the colonization of P. acnes. Local forms of antibiotics are usually well tolerated, allergic reactions develops rarely.
a-hydroxy acids (AHA) - apple, tartar, citrus, milk, glycolic - have comedilic properties. In concentration of (10-15) % are prescribed to patients with acne daily. In low concentrations of AHA remedies are prescribed in the inter-recurrence period and for the prevention of acne (scarring and pigmentation) but their use in combination therapy is effective.
в-hydroxy acids - salicylic acid, resorcinol - affects for follicular hyperkeratosis, as a weak keratolytics and have anti-inflammatory properties.
Hyaluronic acid in combination with zinc is used as a prophylactic agent for acne. Side effects include burning, skin sensation, and light hyperemia, which disappear independently with the continuation of therapy . Systemic acne treatment is indicated for the treatment of patients with moderate to severe acne, especially in cases of scarring, dyschromia, or significant psychosocial disorder. Systemic therapy may be necessary in case of intolerance or ineffectiveness of local treatment.
The most effective medication for the treatment of moderate to severe forms of acne is isotretinoin, is a retinoid, affects processes of differentiation and keratinization of cells of the epidermis, including sebaceous glands, has a pronounced sebostatic and anti-inflammatory effect.
Among systemic antibiotics, most widespread are erythromycin and tetracycline, but the treatment is carried out for a long time .
Oral contraceptives have a pharmacological effect associated with the blockage of androgen receptors and the reduction of their endogenous synthesis and as a result the secretion of sebaceous glands. The preparation is prescribed only to women, has a large number of contraindications and limited use .
Conclusions: The degree of retinoid effect is the most effective for controlling the hyperkeratinization of follicles and preventing the development of microcomedones. The lower effect at this process has benzoyl peroxide, azelaic acid and salicylic acid.
By influence on P. acnes at the first place is benzoyl peroxide, then antibiotics and azelaic acid and to a lesser extent isotretinoin.
Decrease secretion of sebum is promoted by retinoids and hormonal drugs. The least modern drugs affect the process of inflammation of acne.
None of the modern acne treatment methods could guarantee the absence of recurrence of the disease in the future. Therefore, the microflora of the skin becomes resistant to the antibiotic, alcohol is drying up the skin, and the sebum removal of is inevitably caused the dissolution of a part of epidermal lipids, violating the lipid barrier of the skin. In addition, attention should be paid to the problem of violation of the skins microflora, which is associated with the infectious-inflammatory process that develops in acne, or occurs as a consequence of treatment with antiacne remedies. Furthermore, keeping the normal level of the microflora of the skin will contribute to more effective protection against the infectious form of acne and the prevention of the disease and its relapse.
The solution of these problems is the use of therapeutic and preventive remedies of complex action that will affect various aspects of dermatological problems, suppressing pathogenic and opportunistic microflora, treating inflammation, removing excess of sebum, and normalizing the microflora of the skin. Nowadays there is no such a complex composition, therefore, in the thesis research; we are working on the development of the composition and technology of a complex medicine with a probiotic for the treatment of dermatological diseases. First stage is selection of components to compose the base of such a preparation.
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