Update and Future of Systemic Acne Treatment

Zouboulis, Christos C.; Piquero-Martín, Jaime

doi:10.1159/000067821

Cited by 121 publications

(112 citation statements)

References 87 publications

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“…Increased sebum secretion is associated with the development of acne lesions, since sebum serves as a nutrient source (24). Other sebaceous gland functions, such as the production of proinflammatory lipids, cytokines, periglandular peptides, and neuropeptides, are also associated with the pathophysiology of acne (30). Proinflammatory cytokines/chemokines secreted by various cell types play a fundamental role in attracting neutrophils and leukocytes to the place of skin infection.…”

Section: Discussionmentioning

confidence: 99%

Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris

Abulnaja¹

2009

Braz J Med Biol Res

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Acne vulgaris is a multifactorial disease affecting a majority of the adolescent population. The objective of this study was to test for a correlation between fasting serum lipid profiles and levels of testosterone, insulin, leptin, and interleukin 1-β (IL-1β) and the incidence of severe acne vulgaris in obese adolescent females. Four groups of adolescent females were studied: obese with acne, obese without acne, non-obese with acne, and non-obese without acne. Obese females with acne, compared to obese females without acne and non-obese subjects, had significantly higher serum triglycerides, low-density lipoprotein cholesterol and apolipoprotein-B (apo-B) (mean ± SD: 197 ± 13.7 vs 171 ± 11.5, 128 ± 8.3 vs 116 ± 7.7, 96 ± 13.7 vs 85 ± 10.3 mg/dL, respectively) but significantly lower high-density lipoprotein cholesterol and apo-A1 levels (40 ± 3.3 vs 33 ± 3.5 and 126 ± 12 vs 147 ± 13 mg/dL). Serum testosterone, insulin and leptin levels were significantly higher in obese subjects with or without acne compared to non-obese females with or without acne (3 ± 0.5 vs 2.1 ± 0.47, 15.5 ± 3.3 vs 11.6 ± 3, 0.9 ± 0.2 vs 0.6 ± 0.15 nmol/ mL, respectively). Serum IL-1β was significantly elevated in obese and non-obese subjects with acne compared to subjects without acne; in those without acne, these levels were higher in obese than non-obese subjects (2.4 ± 0.2, 1.4 ± 0.1 vs 1.8 ± 0.12 and 1.3 ± 0.11 pg/mL, respectively). Our results indicate that there is a relationship between obesity (BMI >27) and acne. By early recognition, the etiology and treatment protocol of acne may prevent unwanted conditions.

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Section: Discussionmentioning

confidence: 99%

Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris

Abulnaja¹

2009

Braz J Med Biol Res

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“…Die Patienten erhielten 6,5 Millionen neue Rezepte einer systemischen AntiakneTherapie (Antibiotika oder Isotretinoin) pro Jahr in Wert von über eine Milliarde US-Dollar [7]. Die weltweiten Ausgaben für die topische und systemische Akne-Therapie entsprachen 1996 12,6 % der weltweiten medikamentösen Kosten zur Behandlung von Hautkrankheiten [3,4].…”

Section: Einführungunclassified

“…1). Während eine noch nicht vernarbende Akneform ausreichend mit topischen Medikamenten behandelt werden kann, ist bei einer schweren Akneform assoziiert mit der Entwicklung von physischen oder psychischen Narben eine spezifische systemische Therapie notwendig [3,4,18]. Für die Ermittlung des Schweregrades, insbesondere im Rahmen klinischer Studien, stehen verschiedene Methoden zur Verfügung [3].…”

Section: Allgemeine Richtlinien Zur Aknetherapieunclassified

“…Neue Entwicklungen in der Aknetherapie [4] Neue antientzündliche, perorale oder topische nicht-steroidale Antiphlogistika, wie die 5-Lipoxygenasehemmer, sind als wirksam bei entzündlichen Akne-Formen bewiesen und stellen eine mögliche gute therapeutische Alternative in der Zukunft dar [63,64]. Neue Isotretinoin-Formulierungen [65] und Isotretinoin-Metaboliten, neue Antibiotika mit starker antientzündli-cher oder antiandrogener Aktivität [66,67], neue orale Kontrazeptiva [52, 54, 55, 68 ± 72], Insulin-Sensitizers [73], 5a-Reduktase-Inhibitoren [74,75] und Antisense-Oligonukleotide [76] könnten neue Zukunftsperspektiven in der Therapie der Akne anbieten.…”

Section: Allgemeine Richtlinien Zur Aknetherapieunclassified

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Moderne Aknetherapie

Zouboulis¹

2003

Akt Dermatol

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ZusammenfassungAkne ist die häufigste dermatologische Erkrankung: Rund 70 ± 87 % aller Jugendlichen weisen Akneläsionen auf, 10 ± 30 % davon benötigen eine medikamentöse Therapie. Bei der Mehrzahl der Patienten erfolgt nach der Pubertät eine spontane Rück-bildung, davon 2 ± 7 % mit erheblicher Narbenbildung. In 10 % der Fälle persistiert die Erkrankung über das 25. Lebensjahr hinaus. Die Auswahl eines Behandlungsschemas ist von der exakten Klassifikation der Akne und der Einordnung des Schweregrades abhängig. Insbesondere stellt die Entwicklung von Narben das Hauptkriterium für die Wahl einer systemischen Therapie dar. Retinoide für die nicht-entzündlichen und Benzoylperoxid für die entzündlichen Akneläsionen sind die Medikamente der ersten Wahl für eine topische Aknetherapie, wobei die Azelainsäure für milde Akneformen und zur Erhaltung eines Therapierfolges geeignet ist. Die Anwendung topischer Antibiotika nimmt ± insbesondere aufgrund der Entwicklung resistenter Bakterienstäm-me durch ihren Einsatz ± kontinuierlich ab. Bei der topischen Therapie spielt die Wahl der Grundlage eine übergeordnete Rolle. Antibiotika, Antiandrogene ± in der Form von hormonellen Kontrazeptiva ± und Isotretinoin sind die aktuellen Pfeiler der systemischen Aknetherapie. Kortikosteroide werden bei der Therapie der Acne fulminans, niedrig dosiert auch bei der Behandlung von Patienten mit adrenalem Hypergonadismus eingesetzt. Aktuelle neue Entwicklungen könnten interessante Perspektiven in der zukünftigen Therapie der Akne anbieten. AbstractAcne is the most common skin disease with a prevalence of 70 ± 87% in adolescents. Ten to 30% of the individuals involved require medical treatment. The majority of patients experiences a spontaneous resolution of the disease after puberty, however in 2-7% the lesions heal with significant scarring. Ten percent of the patients exhibit persistence of their lesions over the age of 25 years. The selection of a therapeutic regimen is dependent on the classification type of acne and its severity grade. In particular, the major criterium leading to the decision for a systemic treatment is the development of scars. Retinoids and benzoyl peroxide are first choice topical drugs for the non inflammatory and the inflammatory lesions, respectively. Azelaic acid is only recommended for mild acne lesions and for the preservation of a successful therapeutic result obtained by another regimen. The application of topical antibiotics is continuously reduced, especially due to the development of resistant bacterial strains. The type of the vehicle is essential for the effectiveness of the topical treatment. Antibiotics, antiandrogens (in hormonal contraceptive preparations), and isotretinoin are the milestones of systemic acne treatment. Corticosteroids are administered in acne fulminans, also as low dose regimen in acne patients with adrenal hypergonadism. Currently, new developments offer interesting perspectives for the future acne treatment.

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“…2 Systemic treatment is required in patients with moderate to severe acne, especially when acne scars start to occur. 3 For the last 2-3 decades, systemic antibiotics mainly tetracycline and erythromycin, have assumed the main role in the management of acne patients with inflammatory lesions. They require frequent administration and are sometimes associated with side effects, contributing to reduced compliance.…”

Section: Introductionmentioning

confidence: 99%

STUDY OF EFFICACY, SAFETY & TOLERABILITY OF ORAL ISOTRETINOIN IN PATIENTS OF MODERATE TO SEVERE ACNE VULGARIES

Rajput¹,

Saphale²

2014

jemds

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BACKGROUND:Acne vulgaris is an almost universal problem of adolescence characterized by inflammation in and around sebaceous gland. Effective treatment is essential to prevent physical and psychological scarring. Antibiotic requires frequent administration and associated with side effects contributing to reduced compliance . Isotretinoin was a major therapeutic advanced which revolutionized the treatment of acne. Thus it is important to analyze its risk-benefit ratio at lower dosages. Hence the present study carried out with the objective of oral Isotretinoin in patients of moderate to severe grade acne vulgaris. METHODOLOGY: The present prospective study carried out among the acne vulgaris cases attending the out-patient department of dermatology at a tertiary care Centre during January 2007 to December 2007. Oral is otretinoin was started at a dose of 0.5 mg/kg/day for a total duration of 20 weeks. Patients were scheduled for 3 visits i.e. at the end of 1 st , 2nd & 5 th month after start of treatment. All collected data entered and analyzed using SPSS for efficacy of drug on different lesions. RESULTS: 38 (95%) patients completed the study and same were evaluated for efficacy and safety. 50% decrease in comedons at the end of 2 month from the initiation of treatment. The efficacy of oral isotretinoin on inflammatory lesions shows decreased from baseline 36.13 to 4.87 at the time of last visit at 5 month. This was statistically significant (0.0001). Side effects observed an 11% case includes dryness, palmoplantar peeling, exfoliative dermatitis, photosensitivity, facial dermatitis. CONCLUSION: The oral is otretino in is effective and safe as well as showing early response especially for inflammatory lesions.

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Update and Future of Systemic Acne Treatment

Cited by 121 publications

References 87 publications

Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris

Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris

Moderne Aknetherapie

STUDY OF EFFICACY, SAFETY & TOLERABILITY OF ORAL ISOTRETINOIN IN PATIENTS OF MODERATE TO SEVERE ACNE VULGARIES

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