Clinical experience with topical isotretinoin in the treatment of comedonal acne

Introduction. The prevalence and recurrence of acne makes it relevant to develop practical recommendations for treatment of this disease with drugs with anti-inflammatory and seborrheic activity (ointment containing 0.1 and 0.05% isotretinoin). Aim of study. Evaluation of the clinical efficacy of ointment containing isotretinoin 0.1 and 0.05% in patients with comedonal acne. Material and methods. All patients with comedonal acne (n=62) were examined with a determination of the dermatological index of acne (DIA) and the level of sebum gland production. In patients of the main group (n=42), monotherapy was performed using an ointment containing isotretinoin 0.1 and 0.05%. Patients of the comparison group (n=20) received external therapy with cream containing adapalene. The efficacy, tolerability, and duration of clinical remission were evaluated in patients with comedonal acne who applied an ointment containing 0.1 and 0.05% isotretinoin for 12 months, and in patients of the comparison group. Results. After therapy, clinical efficacy was recorded in all patients, but in the main group the results of therapy were better — 85.5% versus 78% in the comparison group. Good tolerance of therapy and a high level of compliance were noted. Conclusion. The high efficacy and tolerability of therapy when using an ointment containing isotretinoin 0.1 and 0.05% in patients with comedonal form of acne was ascertained. © 2020, Media Sphera Publishing Group. All rights reserved

Clinical experience with the use of topical isotretinoin in the treatment of papulopustular acne

The high prevalence of acne all over the world and in Russia, including its influence on the patients’ quality of life, the role of numerous en-vironmental factors, dietary habits and lifestyle on the disease determine the relevance of increasing the effectiveness of its treatment and the continuous search for affordable and convenient medicines safe in use. Objective. To demonstrate the high efficacy and safety of solution containing 0.025% isotretinoin in alcohol-glycol base in patients with pap-ulopustular acne. Material and methods. The study included 88 patients with papulopustular acne at the age from 18 to 47 years. In group 1 (n 48), patients were prescribed topically a drug containing 0.025% isotretinoin 1—2 times a day for 4—6 weeks. Patients of the 2nd group (n=40) received external therapy with a cream containing 0.1% adapalene up to 12 weeks according to medical direction to use. Results. After 12 weeks, the number of papules and pustules in patients of 1st group became less than in patients of 2d group (p<0.001), and a significant difference relative to the initial value was observed at each observation point (p<0.001) throughout the treatment. When as-sessing the global therapeutic effect (GTE), reliable positive results were obtained: already on the 30th day of treatment in the 1st group half of the patients noted a good efficacy of the drug — 2.1 points, and after 90 days, almost all rated the therapeutic efficacy at 2.9 points against 1.9 and 2.1 points in the 2nd group. © 2021, Media Sphera Publishing Group. All rights reserved

Основные эффекты воздействия ретинола пальмитата на структуры кожи и принципы его применения в дерматологической практике

Vitamin A and its synthetic analogues are used in the treatment of numerous skin diseases. The main genomic effects of the natural form of vitamin A (retinol palmitate) are associated with its active metabolite all-trans-retinoic acid and are compensated by several restrictive mechanisms. Numerous studies have proved that retinol stimulates the proliferation of keratinocytes of the basal layer of the epidermis and endothelial cells, and also activates dermal fibroblasts to synthesize proteins of the extracellular matrix of the dermis. As a result, the thickening the epidermis, increases the mechanical strength of the skin and the hydrating ability of the dermis, angiogenesis increase. The ability of retinol to enhance the adhesion of endothelial cells and leukocytes, regulate the processes of keratinization and sebum secretion was found. Vitamin A is also a powerful antioxidant. Retinol palmitate is used as the main or auxiliary drug for the treatment of a wide range of dermatoses. The principle of application is based on clinical studies and confirmed by existing experimental data. In the treatment, the following algorithm is followed. If retinol palmitate is necessary to improve epithelialization and strengthen the epidermal barrier, medium therapeutic doses should be used. For the treatment of disorders of keratinization processes, depending on the severity of the pathological condition, medium and high therapeutic doses of the drug are used. Violation of the processes of sebum secretion and severe hyperkeratosis respond better to treatment at high therapeutic doses. It should be noted that many skins clinical manifestations mostly regress under the action of vitamin A in doses that do not lead to the appearance of signs of toxicity of the drug.Витамин А и его синтетические аналоги используют при лечении многочисленных кожных заболеваний. Основные геномные эффекты натуральной формы витамина А ретинола пальмитата связаны с его активным метаболитом полностью транс-ретиноевой кислотой и компенсированы несколькими ограничительными механизмами. Многочисленными исследованиями доказано, что ретинол стимулирует пролиферацию кератиноцитов базального слоя эпидермиса и эндотелиальных клеток, а также активирует дермальные фибробласты к синтезу белков внеклеточного матрикса дермы. В результате происходит утолщение эпидермиса, усиливаются механическая прочность кожи и гидратирующая способность дермы, оказывается положительное влияние на ангиогенез. Обнаружена способность ретинола усиливать способность к адгезии эндотелиальных клеток и лейкоцитов, регулировать процессы ороговения и салоотделения. Витамин А также является мощным антиоксидантом. Ретинола пальмитат используется как основной или вспомогательный препарат для лечения большого спектра дерматозов. Принцип применения основан на клинических исследованиях и подтвержден существующими экспериментальными данными. В лечении придерживаются следующего алгоритма. Если ретинола пальмитат необходим для улучшения эпителизации и укрепления эпидермального барьера, необходимо использовать средние терапевтические дозы. Для лечения нарушений процессов ороговения в зависимости от тяжести патологического состояния применяют средние и высокие терапевтические дозы препарата. Нарушение процессов салоотделения и выраженный гиперкератоз лучше поддаются лечению высокими терапевтическими дозами. Следует отметить, что клинические проявления преимущественно регрессируют под действием витамина А в дозах, не приводящих к появлению признаков токсичности препарата