Systemic treatments Acne Vulgaris

2010-06-12T13:32:00.000-07:00

Effective treatment of acne vulgaris (common acne) can prevent the physical and so to speak, moral scars. Treatment of acne varies depending on the severity of condition. Local preparations are effective mainly when removing eels, whereas for the treatment of inflammatory acne require additional oral medication. The most effective systemic antibiotics. Modern combined contraceptives also help regulate the formation of sebum in female patients. Severe nodular acne who are unresponsive to topical retinoids and systemic antibiotics can be cured isotretinoin (isotretinoin). Nevertheless, marked by pronounced side effects, and physicians should be well informed about possible side effects.

Acne vulgaris or common acne - Dermatology violation greasy, which usually develops in adolescents and decreases in later years. In particular, adolescent boys can suffer greatly from this disease and if left untreated, can remain scarred for life.

Figure 1. Stages of eel. (A) Normal follicle; (B) open comedo (black head) (C) closed comedo (D) papule (E).

Pathophysiology of acne

At least four factors are important for the development of acne: plugging of the follicle viscous remnants of desquamated cells, increased activity of sebaceous glands, and bacterial growth (especially Propionibacterium acnes) stimulated cutaneous fat (fat) and inflammation (Figure 1).

The first changes in the hair follicles develop when the hair canal is blocked pathologically ceratinized desquamated cells. This tube is formed above the opening of the sebaceous glands in the follicular canal and causes gradual spread of cells and sebum in the canal. This tube becomes visible under the surface of the skin as white papula("white head" or closed comedo). In the event that follicular canal is widened, the tube protrudes from the channel and is painted in black ("black head or open comedones).

Although higher education sebum teenage boys, as a result of increased androgen stimulation increases the production of sebum - this is not the only cause of the acne.

Bacteria (predominantly P. acnes) are available for many individuals suffering from acne. In most cases, inflammation occurs through the action of enzymes are produced by this bacterium. These enzymes hydrolyzed sebum to free fatty acids, which stimulate the inflammatory process. Chemotactic factors released during this reaction, attracting neutrophils. If the follicle wall is inflamed, the skin surface formed erythematous papules. The increasing production of sebum, obstruction and bacterial growth, follicular complex tear, pouring its contents into the skin. The influx of neutrophils contributes to the formation of pustules. Continued severe inflammation leads to the formation of nodes and the subsequent cysts.

Isotretinoin, Accutane

Nodulos acne, if left untreated, can leave not only physical and mental scars. This form of acne is rarely yields topical therapy. At the beginning of these patients should appoint oral antibiotics. In the event that acne within six months did not yield the appropriate therapy should be recommended treatment Isotretinoin.

Isotretinoin oral retinoids, which reduces the size and secretion of the sebaceous glands, normalizes follicular keratinization, inhibits the growth of P. acnes and provides antieffect.

Isotretinoin is indicated for the treatment of patients with acne and causes nodulos improve these conditions in most patients. According to international consensus, isotretinoin is the drug of first choice nodulos acne. Furthermore, patients who are not adequately responding to appropriate therapy, and with less severe blackheads can also be useful such treatment. Patients who are atrophica inflammatory blackheads and those with blackheads cause psychological trauma can also be candidates for treatment isotretinoin. However, isotretinoin is recommended by the FDA only for treatment of severe persistent nodular acne.

The usual dose of isotretinoin from 0.5 to 1 mg per day in two divided doses, with a standard cumulative maximum of 120 to 150 mg / kg per treatment . Due to the fact that the side effects of isotretinoin are dose-dependent manner shall be elected by the possibility of a small dose. However, a dosage of 0.5 mg / kg per day and less, more frequent failure lechenie.In the early treatment, isotretinoin can cause worsening of acne. Therefore, the usual practice is to gradually increase the dose, ranging from 0,1 to 0,5 mg / kg per day and increasing dose referred to 1 mg / kg per day by the end of the first month of treatment. 6,15 The average duration of treatment for five months. During this time, achieved the desired total dose of 120 to 150 mg per kg body weight. Thus, patients require a longer course of treatment. Who begin with lower initial or daily dosage.

Acne vulgaris treatment

Systemic treatments Acne Vulgaris