The utility of benzoyl peroxide in hydrophase base in the treatment of acne vulgaris

Abstract

Available for more than 5 decades, benzoyl peroxide has been a "workhorse" of acne therapy. The benefits of this agent include reduction in Propionibacterium acnes (P acnes) with decrease in inflammatory lesions, efficacy as the one and the other "leave on" and cleanser formulations and reduc emerging see the verb of antibiotic-resistant P. acnes strains. As the result of benzoyl peroxide on P acnes is a direct toxic result rather than as a "true" antibiotic, resistance to benzoyl peroxide does not present itself and has never been reported.

Benzoyl peroxide in hydrophase base (Brevoxyl[R] Creamy Washes and Gels) has shown significant efficacy in the treatment of acne, with lower irritancy than other benzoyl peroxide preparations. It is felt that the depressed irritancy of this product is related to a unique delivery vehicle containing dimethyl isosorbide, which dissolves benzoyl peroxide crystals upon the skin. Clinical studies demonstrating the efficacy and safety of benzoyl peroxide in hydrophase base will be reviewed.

Introduction

Acne vulgaris is the greatest in quantity common skin disease among children and adolescents, with estimates indicating that 80% to 95% of adolescents will have acne. (1-3) Acne characteristically involves the face, back, upper chest, and shoulders. Based upon data from the National Ambulatory Medical Care observe 2000, acne vulgaris represented 152% of dermatology visits in the US, accounting for 5256000 office-based visits among non-federal dermatologists. (4)

The majority of patients are early adolescents and teenagers; however, persistence into later adulthood is not exceptional Post-teenage acne, especially in females, also come into views in a subset of patients. Goulden et al (5) reviewed the clinical features of post-adolescent acne in 200 patients above the age of 25 years, referr for treatment of acne. greatest in quantity patients had persistent acne, on the other hand true late-onset acne (onset after the age of 25 years) was seen in 28 (184%) women and 4 (83%) men Thirty-seven percent of women had features of hyperandrogenicity. individual hundred and sixty-four patients (82%) had failed to reply to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with individual or more courses of isotretinoin. External factors, of the like kind as cosmetics, drugs, and occupation, were not rest to be significant etiological factors. A family history revealed that 100 (50%) patients had a first-degree relative with post-adolescent acne. (5)

Pathogenesis of Acne

The origin of acne vulgaris is composed of several elements and incompletely understood. At least 4 pathophysiologic circumstances take place within acne-involved hair follicles: (1) androgen-mediated stimulation of sebaceous gland activity, (2) abnormal keratinization leading to follicular plugging (comedo formation), (3) proliferation of the bacterium Propionibacterium acnes (P acnes) within the follicle, and (4) inflammation.

Acne vulgaris is the rise of the obstruction of specialized follicles (sebaceous follicles), (67) which are located primarily upon the face and trunk, by the agency of excessive amounts of sebum produc through sebaceous glands in the follicles combined with excessive numbers of desquamated epithelial confined apartments from the walls of the follicles. (8-11) The obstruction causes the formation of a microcomedo. This micrcomedo then may unfold into either a comedo or an inflammatory lesion. A resident anaerobic organism, P acnes, proliferates in the environment created by means of the mixture of excessive sebum and follicular small rooms (12,13) and produces chemotactic factors and proinflammatory mediators that may lead to inflammation. (14-20)

Therapies for acne exist that effectively counteract the exces production of sebum the abnormal desquamation of epithelial small rooms in sebaceous follicles, and the proliferation of P acnes. The choice of therapy for an individual patient be pendents on the extent, severity, and duration of the disease; the mark of lesions; and the psychological results of the disease. (20)

Topical Antimicrobials in Acne

Topical antibacterial agents are an essential part of the armamentarium for treating acne vulgaris. They are indicated for mild-to-moderate acne, and are a useful alternative for patients who cannot take systemic antibacterials. (21) Topical antibacterials similar as clindamycin and erythromycin are bacteriostatic for P acnes, and have also been demonstrated to have anti-inflammatory activities end inhibition of lipase production by the agency of P. acnes, as well as inhibition of leukocyte chemotaxis. Benzoyl peroxide is a non-antibiotic antibacterial agent that is bactericidal against P acnes.

Despite years of widespread use of systemic tetracyclines and erythromycin, change in P acnes sensitivity to antibiotics was not seen until the early 1980 (22) The first clinically relevant changes in P acnes antibiotic sensitivity were fix in the US shortly after the introduction of topical formulations of erythromycin and clindamycin. through the late 1980s, P. acnes strains with actual high MIC levels for erythromycin and elevated MICs for tetracycline were increasingly ground in the UK and the US. Mutations in the gene encoding the 23 and 16 subunits of ribosomal RNA were first identified in the UK and also seen in a new survey from clinics in Europe Japan, Australia, and the US. In addition, strains were fix in which these known mutations could not be identified, indicating that as nevertheless unidentified resistance mechanisms have evolv (22)