Effective and Safe Pharmacotherapy of Acne vulgaris and the Treatment of SolarImpairment of the Skin

Overview

An inevitable condition for the pharmacist is a basic knowledge of dermatological changes whichare prominent in acne and solar impairment of the skin to be able to recommend in a qualifiedmanner an effective and safe treatment to the patient. However, sufferers of the more serious formsof acne should always be referred to their general practitioner, or preferentially a dermatologist.Acne vulgaris is an androgen-induced disorder, but three major mechanisms for the developmentof the disease have been identified: hypertrophy of the sebaceous gland, hyperkatosis of the follicularepithelium, and proliferation of microbial flora, particularly Propionibacterium acnes. The basis ofall lesions is the microcomedone which is developed into the ripe comedone. Inflammatory lesionsare thought to be due to proliferation of P. acnes. In the selfmedication of common acne, benzoylperoxide, which in a 5–10 % lotion exerts antimicrobial and keratolytic properties, proved to beuseful. Patients appreciate a lot its instant effect which is visible after just one day of treatment.Salicylic acid is another effective drug, which, when used on the long-term basis, has comedolyticproperties; it reduces the number of microcomedones and counteracts plugging of the follicles. Inaddition, in healthy young women who take oral contraception, a triphasic combined oral prepara-tions of contraceptives with newer progestins, notably with norgestimmate, which is practically freeof androgenic effects, are recommended with advantage for the treatment of moderate acne vulgariswithout any adverse effects. Solar impairment of the skin, the so-called solar ageing, is clinicallyindistinguishable from biological ageing. Changes connected with solar impairment appear mostlyin the dermis, where solar elastosis develops, the skin gets drier and wrinkle formation appears.For the treatment, hydroxy acids are recommended, namely salicylic acid, which is very effective,because in combination with a suitable vehicle it produces desquamation or exfoliation. Desquama-tion is beneficial as it gives a youthful apperance to the skin.

Key words:
acne vulgaris – solar ageing – benzyl peroxide – salicylic acid – combined oralcontraception