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Aktuelle Dermatologie 2003; 29(1/2): 49-57
DOI: 10.1055/s-2003-38236
Ästhetische Dermatologie
© Georg Thieme Verlag Stuttgart · New York

Moderne Aknetherapie

Modern Acne TreatmentCh.  C.  Zouboulis1
  • 1Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin
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Publication History

Publication Date:
27 March 2003 (online)

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Zusammenfassung

Akne ist die häufigste dermatologische Erkrankung: Rund 70 - 87 % aller Jugendlichen weisen Akneläsionen auf, 10 - 30 % davon benötigen eine medikamentöse Therapie. Bei der Mehrzahl der Patienten erfolgt nach der Pubertät eine spontane Rückbildung, davon 2 - 7 % mit erheblicher Narbenbildung. In 10 % der Fälle persistiert die Erkrankung über das 25. Lebensjahr hinaus. Die Auswahl eines Behandlungsschemas ist von der exakten Klassifikation der Akne und der Einordnung des Schweregrades abhängig. Insbesondere stellt die Entwicklung von Narben das Hauptkriterium für die Wahl einer systemischen Therapie dar. Retinoide für die nicht-entzündlichen und Benzoylperoxid für die entzündlichen Akneläsionen sind die Medikamente der ersten Wahl für eine topische Aknetherapie, wobei die Azelainsäure für milde Akneformen und zur Erhaltung eines Therapierfolges geeignet ist. Die Anwendung topischer Antibiotika nimmt - insbesondere aufgrund der Entwicklung resistenter Bakterienstämme durch ihren Einsatz - kontinuierlich ab. Bei der topischen Therapie spielt die Wahl der Grundlage eine übergeordnete Rolle. Antibiotika, Antiandrogene - in der Form von hormonellen Kontrazeptiva - und Isotretinoin sind die aktuellen Pfeiler der systemischen Aknetherapie. Kortikosteroide werden bei der Therapie der Acne fulminans, niedrig dosiert auch bei der Behandlung von Patienten mit adrenalem Hypergonadismus eingesetzt. Aktuelle neue Entwicklungen könnten interessante Perspektiven in der zukünftigen Therapie der Akne anbieten.

Abstract

Acne is the most common skin disease with a prevalence of 70 - 87% in adolescents. Ten to 30% of the individuals involved require medical treatment. The majority of patients experiences a spontaneous resolution of the disease after puberty, however in 2-7% the lesions heal with significant scarring. Ten percent of the patients exhibit persistence of their lesions over the age of 25 years. The selection of a therapeutic regimen is dependent on the classification type of acne and its severity grade. In particular, the major criterium leading to the decision for a systemic treatment is the development of scars. Retinoids and benzoyl peroxide are first choice topical drugs for the non inflammatory and the inflammatory lesions, respectively. Azelaic acid is only recommended for mild acne lesions and for the preservation of a successful therapeutic result obtained by another regimen. The application of topical antibiotics is continuously reduced, especially due to the development of resistant bacterial strains. The type of the vehicle is essential for the effectiveness of the topical treatment. Antibiotics, antiandrogens (in hormonal contraceptive preparations), and isotretinoin are the milestones of systemic acne treatment. Corticosteroids are administered in acne fulminans, also as low dose regimen in acne patients with adrenal hypergonadism. Currently, new developments offer interesting perspectives for the future acne treatment.

Literatur

  • 1 Gollnick H, Zouboulis C C, Akamatsu H, Kurokawa I, Schulte A. Pathogenesis and pathogenesis related treatment of acne.  J Dermatol. 1991;  18 489-499
    CrossrefPubMedGoogle Scholar
  • 2 Brown S K, Shalita A R. Acne vulgaris.  Lancet. 1998;  351 1871-1876
    CrossrefPubMedGoogle Scholar
  • 3 Zouboulis C C. Acne: Current aspects on pathology and treatment.  Dermatol Experiences. 1999;  1 6-37
    PubMedGoogle Scholar
  • 4 Zouboulis C C, Piquero-Martin J. Update and future of systemic acne treatment.  Dermatology. 2003;  206 37-53
    CrossrefPubMedGoogle Scholar
  • 5 Cunliffe W J, Eady E A. A reappraisal and update on the pathogenesis and treatment of acne.  Cur Opin Infect Dis. 1992;  5 703-710
    PubMedGoogle Scholar
  • 6 Dreno B, Poli F. Epidemiology of acne.  Dermatology. 2003;  206 7-10
    CrossrefPubMedGoogle Scholar
  • 7 Stern R. Medication and medical service utilization for acne 1995-1998.  J Am Acad Dermatol. 2000;  43 1042-1048
    CrossrefPubMedGoogle Scholar
  • 8 Leyden J J. Therapy for acne vulgaris.  N Engl J Med. 1997;  336 1156-1162
    CrossrefPubMedGoogle Scholar
  • 9 Zouboulis C C, Fimmel S, Ortmann J, Turnbull J R, Boschnakow A, Pochi P E. Sebaceous Glands. In: Hoath SB, Maibach H (Hrg) Neonatal Skin - Structure and Function. 2nd ed. New York, Basel; Marcel Dekker in press
    Google Scholar
  • 10 Cunliffe W J, Holland D B, Clark S M, Stables G I. Comedogenesis: some new aetiological, clinical and therapeutic strategies.  Dermatology. 2003;  206 11-16
    CrossrefPubMedGoogle Scholar
  • 11 Eady E A, Gloor M, Leyden J J. Propionibacterium acnes resistance - A world wide problem.  Dermatology. 2003;  206 54-56
    Google Scholar
  • 12 Zouboulis C C. Is acne vulgaris a genuine inflammatory disease?.  Dermatology. 2001;  203 277-279
    CrossrefPubMedGoogle Scholar
  • 13 Green J, Sinclair R D. Perceptions of acne vulgaris in final year medical student written examination answers.  Australas J Dermatol. 2001;  42 98-101
    CrossrefPubMedGoogle Scholar
  • 14 Herane M I, Ando I. Acne in infancy and acne genetics.  Dermatology. 2003;  206 24-28
    CrossrefPubMedGoogle Scholar
  • 15 Zouboulis C C, Seltmann H, Hiroi N, Chen W, Young M, Oeff M, Scherbaum W A, Orfanos C E, McCann S M, Bornstein S R. Corticotropin releasing hormone: an autocrine hormone that promotes lipogenesis in human sebocytes.  Proc Natl Acad Sci USA. 2002;  99 7148-7153
    CrossrefPubMedGoogle Scholar
  • 16 Toyoda M, Morohashi M. New aspects in acne inflammation.  Dermatology. 2003;  206 17-23
    CrossrefPubMedGoogle Scholar
  • 17 O'Brien S C, Lewis J B, Cunliffe W J. The Leeds revised acne grading system.  J Dermatol Treat. 1998;  9 215-220
    PubMedGoogle Scholar
  • 18 Pochi P E, Shalita A R, Strauss J S, Webster S B, Cunliffe W J, Katz H I, Kligman A M, Leyden J J, Lookingbill D P, Plewig G. et al . Report of the consensus conference on acne classification.  J Am Acad Dermatol. 1991;  24 495-500
    PubMedGoogle Scholar
  • 19 Cunliffe W J, van de Kerkhof P C, Caputo R, Cavicchini S, Cooper A, Fyrand O L, Gollnick H, Layton A M, Leyden J J, Mascaro J M, Ortonne J P, Shalita A. Roaccutane treatment guidelines: results of an international survey.  Dermatology. 1997;  194 351-357
    PubMedGoogle Scholar
  • 20 Orfanos C E, Adler Y D, Zouboulis C C. The SAHA syndrome.  Horm Res. 2000;  54 251-258
    CrossrefPubMedGoogle Scholar
  • 21 Thiboutot D M. Endocrinological evaluation and hormonal therapy for women with difficult acne.  J Eur Acad Dermatol Venereol. 2001;  15 57-61
    CrossrefPubMedGoogle Scholar
  • 22 Madden W S, Landells I D, Poulin Y, Searles G E, Smith K C, Tan J K, Toole J, Zip C M, Degreef H. Treatment of acne vulgaris and prevention of acne scarring: Canadian consensus guidelines.  J Cutan Med Surg. 2000;  4 2-13
    PubMedGoogle Scholar
  • 23 Kaminsky A. Less common methods to treat acne.  Dermatology. 2003;  206 68-73
    CrossrefPubMedGoogle Scholar
  • 24 Gollnick H PM, Krautheim A. Topical treatment in acne: Current status and future aspects.  Dermatology. 2003;  206 29-36
    CrossrefPubMedGoogle Scholar
  • 25 Gollnick H, Schramm M. Topical drug treatment in acne.  Dermatology. 1998;  196 119-125
    CrossrefPubMedGoogle Scholar
  • 26 Orfanos C, Ehlert R, Gollnick H. The retinoids - at review of their clinical pharmacology and therapeutic use.  Drugs. 1987;  34 459-503
    CrossrefPubMedGoogle Scholar
  • 27 Orfanos C E, Zouboulis C C, Almond-Roesler B, Geilen C C. Current use and future potential role of retinoids in dermatology.  Drugs. 1997;  53 358-388
    PubMedGoogle Scholar
  • 28 Brogden R N, Goa K E. Adapalene. A review of its pharmacological properties and clinical potential in the management of mild to moderate acne.  Drugs. 1997;  53 511-519
    PubMedGoogle Scholar
  • 29 Toyoda M, Morohashi M. An overview of topical antibiotics for acne treatment.  Dermatology. 1998;  196 130-134
    CrossrefPubMedGoogle Scholar
  • 30 Berson D S, Shalita A R. The treatment of acne: The role of combination therapies.  J Am Acad Dermatol. 1995;  32 31-41
    PubMedGoogle Scholar
  • 31 Meynadier J, Alirezai M. Systemic antibiotics for acne.  Dermatology. 1998;  196 135-139
    CrossrefPubMedGoogle Scholar
  • 32 Leyden J J. Current issues in antimicrobial therapy for the treatment of acne.  J Eur Acad Dermatol Venereol. 2001;  15 51-55
    PubMedGoogle Scholar
  • 33 Chosidow O, Poli F, Naline E, Advenier C, Revuz J. Comedonal diffusion of minocycline in acne.  Dermatology. 1998;  196 162
    CrossrefPubMedGoogle Scholar
  • 34 Colvin J H, Sheth A P. Minocycline hypersensitivity syndrome with hypotension mimicking septic shock.  Pediatr Dermatol. 2001;  18 295-298
    CrossrefPubMedGoogle Scholar
  • 35 Kiessling S, Forrest K, Moscow J, Gewirtz A, Jackson E, Roszman T, Goebel J. Interstitial nephritis, hepatic failure, and systemic eosinophilia after minocycline treatment.  Am J Kidney Dis. 2001;  38 36
    PubMedGoogle Scholar
  • 36 Seaman H E, Lawrenson R A, Williams T J, MacRae K D, Farmer R D. The risk of liver damage associated with minocycline: a comparative study.  J Clin Pharmacol. 2001;  41 852-860
    CrossrefPubMedGoogle Scholar
  • 37 Gollnick H P, Graupe K, Zaumseil R P. Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne.  Eur J Dermatol. 2001;  11 538-544
    PubMedGoogle Scholar
  • 38 Orfanos C E, Zouboulis C C. Oral retinoids in the treatment of seborrhoea and acne.  Dermatology. 1998;  196 140-147
    CrossrefPubMedGoogle Scholar
  • 39 Layton A M, Knaggs H, Taylor J, Cunliffe W J. Isotretinoin for acne vulgaris - 10 years later: A safe and successful treatment.  Br J Dermatol. 1993;  129 292-296
    PubMedGoogle Scholar
  • 40 Lehucher-Cheyrac D S, Weber-Buisset M J. Isotretinoin and acne in practice: at prospective analysis of 188 cases over 9 years.  Dermatology. 1993;  186 123-128
    PubMedGoogle Scholar
  • 41 Leyden J J, McGinley K J, Foglia A N. Qualitative and quantitative changes in cutaneous bacteria associated with systemic isotretinoin therapy for acne conglobata.  J Invest Dermatol. 1986;  86 390-393
    CrossrefPubMedGoogle Scholar
  • 42 Tsukada M, Schröder M, Roos T C, Chandraratna R AS, Reichert U, Merk H F, Orfanos C E, Zouboulis C C. 13-cis Retinoic acid exerts its specific activity on human sebocytes through selective intracellular isomerization to all-trans retinoic acid and binding to retinoid acid receptors.  J Invest Dermatol. 2000;  115 321-327
    CrossrefPubMedGoogle Scholar
  • 43 Stainforth J M, Layton A M, Taylor J P, Cunliffe W J. Isotretinoin for the treatment of acne vulgaris: Which factors may predict the need for more than one course?.  Br J Dermatol. 1993;  129 297-301
    PubMedGoogle Scholar
  • 44 Karvonen S J. Acne fulminans. Report of clinical findings and treatment of twenty-four patients.  J Am Acad Dermatol. 1993;  28 572-579
    PubMedGoogle Scholar
  • 45 Mitchell A A, Van Bennekom C M, Louik C. A pregnancy-prevention program in women of childbearing age receiving isotretinoin.  N Engl J Med. 1995;  333 101-106
    CrossrefPubMedGoogle Scholar
  • 46 Dai W S, LaBraico J M, Stern R S. Epidemiology of isotretinoin exposure during pregnancy.  J Am Acad Dermatol. 1992;  26 599-606
    CrossrefPubMedGoogle Scholar
  • 47 Altman R S, Altman L J, Altman J S. A proposed set of new guidelines for routine blood tests during isotretinoin therapy for acne vulgaris.  Dermatology. 2002;  204 232-235
    CrossrefPubMedGoogle Scholar
  • 48 Margolis D J, Attie M, Leyden J J. Effects of isotretinoin on bone mineralization during routine therapy with isotretinoin for acne vulgaris.  Arch Dermatol. 1996;  132 769-774
    PubMedGoogle Scholar
  • 49 Thiboutot D, Chen W. Update and future of hormonal therapy in acne.  Dermatology. 2003;  206 57-67
    CrossrefPubMedGoogle Scholar
  • 50 Chen W, Thiboutot D, Zouboulis C C. Cutaneous androgen metabolism - Basic research and clinical perspectives.  J Invest Dermatol. 2002;  119 992-1007
    CrossrefPubMedGoogle Scholar
  • 51 Shaw J C. Hormonal therapies in acne.  Expert Opin Pharmacother. 2002;  3 865-874
    CrossrefPubMedGoogle Scholar
  • 52 Fritsch M, Orfanos C E, Zouboulis C C. Sebocytes are the key regulators of androgen homeostasis in human skin.  J Invest Dermatol. 2001;  116 793-800
    CrossrefPubMedGoogle Scholar
  • 53 Carmina E, Lobo R A. A comparison of the relative efficacy of antiandrogens for the treatment of acne in hyperandrogenic women.  Clin Endocrinol (Oxf). 2002;  57 231-234
    CrossrefPubMedGoogle Scholar
  • 54 van Vloten W A, van Haselen C W, van Zuuren E J, Gerlinger C, Heithecker R. The effect of 2 combined oral Contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea.  Cutis. 2002;  69 2-15
    PubMedGoogle Scholar
  • 55 Worret I, Arp W, Zahradnik H P, Andreas J O, Binder N. Acne resolution rates: results of a single-blind, randomized, controlled, parallel phase III trial with EE/CMA (Belara) and EE/LNG (Microgynon).  Dermatology. 2001;  203 38-44
    CrossrefPubMedGoogle Scholar
  • 56 Beylot C, Doutre M S, Beylot-Barry M. Oral contraceptives and cyproterone acetate in female acne treatment.  Dermatology. 1998;  196 148-152
    CrossrefPubMedGoogle Scholar
  • 57 Schmidt J B. Other antiandrogens.  Dermatology. 1998;  196 153-157
    CrossrefPubMedGoogle Scholar
  • 58 Dodin S, Faure N, Cedrin I, Mechain C, Turcot-Lemay L, Guy J, Lemay A. Clinical efficacy and safety of low-dose flutamide alone and combined with an oral contraceptive for the treatment of idiopatic hirsutism.  Clin Endocrinol (Oxf.). 1995;  43 578-582
    PubMedGoogle Scholar
  • 59 Lubbos H G, Hasinski S, Rose L I, Pollock J. Adverse effects of spironolactone therapy in women with acne.  Arch Dermatol. 1998;  134 1162-1163
    CrossrefPubMedGoogle Scholar
  • 60 Seukeran D C, Cunliffe W J. The treatment of acne fulminans: a review of 25 cases.  Br J Dermatol. 1999;  141 307-309
    CrossrefPubMedGoogle Scholar
  • 61 Bass D, Zouboulis C C. Behandlung der Acne fulminans mit Isotretinoin und Prednisolon.  Z Hautkr. 2001;  76 473
    PubMedGoogle Scholar
  • 62 Vexiau P, Baspeyras M, Chaspoux C, Foin N, Allaert F A, Abramovici Y. Acne in adult women: data from a national study on the relationship between type of acne and markers of clinical hyperandrogenism.  Ann Dermatol Venereol. 2002;  129 174-178
    PubMedGoogle Scholar
  • 63 Koreck A, Pivarcsi A, Dobozy A, Kemény L. The Role of Innate Immunity in the Pathogenesis of Acne.  Dermatology. 2003;  206 96-105
    CrossrefPubMedGoogle Scholar
  • 64 Zouboulis C C, Nestoris S, Adler Y D, Picardo M, Camera E, Orth M, Orfanos C E, Cunliffe W J. A new concept for acne therapy - A pilot study with Zileuton, an oral 5-lipoxygenase inhibitor.  Arch Dermatol. 2003;  139 im Druck
    PubMedGoogle Scholar
  • 65 Strauss J S, Leyden J J, Lucky A W, Lookingbill D P, Drake L A, Hanifin J M, Lowe N J, Jones T M, Stewart D M, Jarratt M T, Katz I, Pariser D M, Pariser R J, Tschen E, Chalker D K, Rafal E S, Savin R P, Roth H L, Chang L K, Baginski D J, Kempers S, McLane J, Eberhardt D, Leach E E, Bryce G, Hong J. A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne.  J Am Acad Dermatol. 2001;  45 187-195
    CrossrefPubMedGoogle Scholar
  • 66 Akamatsu H, Tomita T, Horio T. Effects of roxithromycin on the production of lipase and neutrophil chemotactic factor by Propionibacterium acnes.  Dermatology. 2002;  204 277-280
    CrossrefPubMedGoogle Scholar
  • 67 Inui S, Nakajima T, Fukuzato Y, Fujimoto N, Chang C, Yoshikawa K, Itami S. Potential anti-androgenic activity of roxithromycin in skin.  J Dermatol Sci. 2001;  27 147-151
    CrossrefPubMedGoogle Scholar
  • 68 Lemay A, Dewailly S D, Grenier R, Huard J. Attenuation of mild hyperandrogenic activity in postpubertal acne by a triphasic oral contraceptive containing low doses of ethynyl estradiol and d,l-norgestrel.  J Clin Endocrinol Metabolism. 1990;  71 8-14
    PubMedGoogle Scholar
  • 69 Thiboutot D, Archer D F, Lemay A, Washenik K, Roberts J, Harrison D D. A randomized, controlled trial of a low-dose contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel for acne treatment.  Fertil Steril. 2001;  76 461-468
    CrossrefPubMedGoogle Scholar
  • 70 Vree M L, Schmidt J. A large observational clinical evaluation of a desogestrel-containing combiphasic oral contraceptive in Germany.  Eur J Contracept Reprod Health Care. 2001;  6 108-114
    PubMedGoogle Scholar
  • 71 Maloney M, Arbit D, Flack M, McLaughlin-Miley C, Sevilla C, Derman R. Use of a low-dose oral contraceptive containing norethindrone acetate and ethinyl estradiol in the treatment of moderate acne vulgaris.  Clin J Women's Health. 2001;  1 124-131
    PubMedGoogle Scholar
  • 72 Lucky A, Henderson T, Olson W, Robisch D, Lebwohl M, Swinyer L. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris.  J Am Acad Dermatol. 1997;  37 746-754
    PubMedGoogle Scholar
  • 73 Pugeat M, Ducluzeau P H. Insulin resistance, polycystic ovary syndrome and metformin.  Drugs. 1999;  58 41-46
    PubMedGoogle Scholar
  • 74 Chen W-C, Zouboulis C C, Orfanos C E. The 5α-reductase system and its inhibitors; recent development and its perspective in treating androgen-dependent skin disorders.  Dermatology. 1996;  193 177-184
    PubMedGoogle Scholar
  • 75 Cilotti A, Danza G, Serio M. Clinical application of 5alpha-reductase inhibitors.  J Endocrinol Invest. 2001;  24 199-203
    PubMedGoogle Scholar
  • 76 Fimmel S, Saborowski A, Bogdanoff B, Orfanos C E, Zouboulis C C. Inhibition of androgen receptor expression and of androgen activity on human sebocytes by antisense oligonucleotides.  Ann Dermatol Venereol. 2002;  129 375
    PubMedGoogle Scholar

Prof. Dr. med. Christos C. Zouboulis

Klinik und Poliklinik für Dermatologie · Universitätsklinikum Benjamin Franklin · Freie Universität Berlin

Fabeckstraße 60 - 62 · 14195 Berlin ·

Email: zouboulis@medizin.fu-berlin.de