Differentiated approach to external acne therapy

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Abstract

Acne is a serious medical and social problem due to the widespread prevalence of the disease. Localized mainly on the face, acne leads to the development of disorders in the psycho-emotional sphere, significantly reducing the quality of life.

The aim of the study was to study the effectiveness and safety of Epiduo/Effezel gel (adapalene 0.1% and benzoyl peroxide 2.5%) in patients with papulopustular acne.

The Clinic of Skin and Sexually Transmitted Diseases of the Clinical Hospital No. 2 of Sechenov University has accumulated extensive experience in the treatment of acne. In the diagnostic and treatment department, patients with mild to moderate acne receive consultations and treatment almost every day. A dermatological examination is carried out visually with a simple count of eruptive elements: papules, pustules and nodes, on the basis of which the degree of severity is determined. Patients with severe forms of acne receive systemic retinoids with corrective therapy until a certain cumulative dose is reached, and then patients receive topical maintenance therapy intermittently for 12 months.

Despite the development of effective methods for treating this dermatosis, patient adherence to treatment remains low. This is due, first of all, to the duration of therapy, not always the rapid achievement of the expected result, and to the development of psycho-emotional disorders in patients. In the latest edition of the Russian Society of Dermatovenerologists and Cosmetologists clinical guidelines for the treatment of mild to moderate acne with a high level of evidence A1, it is recommended to use benzoyl peroxide and a fixed combination of adapalene and benzene peroxide. When prescribing benzene peroxide (Baziron AS), we observed the best results in clearing the skin of rashes in the presence of a few papulopustular elements in the clinical picture due to the triple action of benzoyl peroxide ― antimicrobial, keratolytic and sebostatic. In our experience, it usually took 4 to 6 weeks to achieve clinical remission, and we did not note a single case of the development of bacterial resistance during treatment. For moderately widespread papulopustular acne rashes of moderate severity, as well as in cases of severe forms of the disease, when it is impossible to prescribe systemic isotretinoin or there is a tendency to scarring of the primary elements, we used a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% (Effezel) with anti-inflammatory, antimicrobial, keratolytic, sebostatic, comedolytic and anticomedogenic effects.

In the arsenal of dermatologists and cosmetologists there are drugs for the external treatment of mild to moderate papulopustular acne with a high level of evidence. Thus, for papulopustular acne with a few inflammatory (papules and pustules) rashes, benzoyl peroxide gel may be recommended. For moderately widespread papulopustular acne with the presence of comedones (moderate severity), a fixed combination of adapalene and benzoyl peroxide can be recommended as the first line of therapy.

About the authors

Olga Yu. Olisova

The First Sechenov Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN-code: 2500-7989

MD, Dr. Sci. (Med.), Professor, Corresponding member of the Russian Academy of Sciences

Russian Federation, 4/1 Bolshaya Pirogovskaya street, 119991 Moscow

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Supplementary files

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2. Fig. 1. Russian Society of Dermatovenerologists and Cosmetologists clinical guidelines (2020): acne treatment regimen.

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3. Fig. 2. Global Alliance to Improve Outcomes in Acne recommendations to improve acne treatment outcomes (2018).

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4. Fig. 3. Antibiotic resistance rates globally for the period 1970–2020.

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5. Fig. 4. Mild papulopustular acne (few papulopustular elements) in a 19-year-old female patient before (a) and after (b) treatment with benzoyl peroxide for 6 weeks 1–2 times a day: Clinical remission.

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6. Fig. 5. Moderate papulopustular acne (moderate number of papules and pustules, open comedones) in a 20-year-old female patient before (a) and after (b) treatment with a fixed combination of adapalene and benzoyl peroxide (Effezel) for 9 weeks daily once a day in the evening: Clinical remission.

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7. Fig. 6. Mild papulopustular acne (single papulopustular elements) in a 14-year-old patient before (a) and after (b) treatment with benzoyl peroxide for 8 weeks 1–2 times a day: Clinical remission.

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8. Fig. 7. Moderate papulopustular acne (moderate number of papules and pustules, open comedones) in an 18-year-old female patient before (a, b) and after treatment (c, d) treatment with a fixed combination of adapalene and benzoyl peroxide for 7 weeks daily once a day in the evening: Clinical remission.

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9. Fig. 8. Moderate papulopustular acne (grade IV post-acne scars, 27 points) in a 20-year-old patient (a). He was treated with systemic isotretinoin for 9 months (b), at the end of the course Longidaza 3000 units intramuscularly (№ 15) and gel with a fixed combination of adapalene 0.1% and benzoyl peroxide 2.5% daily for 4 months, once a day in the evening: Clinical remission (postacne scars grade III, 10 points) (c).

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10. Fig. 9. Severe acne (papules, pustules, isolated nodules, grade IV post-acne scars, 25 points) in a 21-year-old patient (a). He was treated with systemic isotretinoin, followed by a fixed combination of adapalene 0,1% and benzoyl peroxide 2,5% daily once a day in the evening for 6 months: Clinical remission (absence of inflammatory elements, post-acne scars of III degree; 12 points, smoothing of facial skin relief) (b).

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