Skin care treatment for acne
Which products are used for the treatment of acne vulgaris?
Next to ordinary acne (acne vulgaris) several other forms of acne are known, such as acne conglobata (a severe form of acne, mainly with males) and acne keloidalis. Acne ectopica (hidradenitis suppurativa, caused Staphylococcus epidermidis) is a variant form of acne that shows up in unusual places, such as the armpits, groin and on the buttocks. It can be very serious and painful. Recurrent infections and abscesses are highly inconvenient for the patient. This form of acne usually occurs after the age of 20, especially with smokers. Acne-like anomalies may also be caused by mechanical influences such as acne under a chin strap or head band (helmet), or because of contact with comedogenic products such as tar, oil, chlorine, steroids (oral contraceptives) and particular cosmetics. Mallorca acne may occur upon (over)exposure to direct sun light. It shows up as a large ensemble of white spots on the skin, and has little to do with the opportunistic behaviour of Propionibacterium acnes.
Medications for acne include benzoyl peroxide, salicylic acid, -hydroxy acids, retinoids, antibiotics (doxycycline, clindamycin), nicotinamide (vitamin B3) and keratolytic preparations. Especially benzoyl peroxide and salicylic acid are under scrutiny. The use of topically or orally applied antibiotics is frequently identified as “healing is worse than the disease”. The same can be said from the oral use of retinoids, that eventually may lead to birth defects.
These side effects are virtually absent with azelaic acid. Azelaic acid is believed to function on the basis of its antimicrobial activity and normalization of keratinization (the process by which epithelial cells mature as they move towards the skin surface and then desquamated). The limitation for the use of azelaic acid is its solubility; significant progress has been made by improving the water solubility. The European Union considers azelaic acid as a cosmetic ingredient that can be applied without concentration restrictions. In the USA azelaic acid is FDA approved for the treatment of acne and rosacea. A variety of commercial products containing 10-25% azelaic acid are available.
The effect of the topical acne treatment azelaic acid on the transmembrane pH gradient (pH) of Propionibacterium acnes and Staphylococcus epidermidis was studied in vitro at external pH values found on human skin (pH 4.0-6.0). The results indicate that the antibacterial activity of azelaic acid is associated with the perturbation of intracellular pH of the organisms.
The use of azelaic acid as anti-acne ingredient is highly favourable compared to the traditional anti-acne ingredients, as the side effects are minimal and can easily be controlled by adjustment of the concentration azelaic acid in the cream or gel.
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