Acne resistance issues: solutions

Abstract

Acne is one of the most common dermatoses, especially among young people. The worldwide prevalence reaches up to 80% of young people aged 15 to 17 who have symptoms of acne, and the condition often persists into adulthood. In the pathogenesis of acne, in addition to pathological hyperkeratosis and inflammation, an important role is played by such factors as massive microbial contamination, species composition, biological properties of pathogens, in particular, their drug resistance. For the treatment of acne of moderate and severe severity, antibacterial drugs are used – tetracycline, erythromycin, doxycycline. These drugs have a bacteriostatic effect on Cutibacterium acnes by inhibiting the synthesis of bacterial proteins. Antibiotics for acne demonstrate antimicrobial and anti-inflammatory effects and act in two directions: they reduce the colonization of C. acnes and inhibit the production of inflammatory mediators associated with С. acnes. Side effects in antibiotic treatment are rare, but the main problem in their appointment is resistance, the frequency of which is increasing every year. The review part of the article presents the literature data of domestic and foreign authors on the formation of С. acnes resistance to antibiotic therapy in acne patients in the process of therapy evolution. Cause-and-effect relationships of the formation of resistance in the application of antibacterial drugs of various classes are described. The strategy and tactics of a doctor to limit the spread of C. acnes antibiotic resistance are considered. A special place in the article is given to the important role of benzoyl peroxide, clindamycin and the synergistic effect of the fixed combination of clindamycin / benzoyl peroxide in overcoming the resistance of С. acnes and achieving the effectiveness and safety of therapy. The second part of the article presents our own clinical observations of the effectiveness of the domestic combined preparation of the Klindavit Combo gel (clindamycin / benzoyl peroxide) in the treatment of patients with papulopustular acne who are on outpatient treatment by a dermatologist.