Prevention and treatment of acne scarring: a theoretical aspect

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Natalia Chuiko, dermatologist of the highest category, academician of the Academy of Technical Sciences of Ukraine, member of the US Academy of Acne Specialists, member of the UADV, co-owner of a clinic for the treatment of acne and acneiform dermatoses

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International protocols for the treatment of acne include the following groups of drugs: tetracycline antibiotics and some macrolides, hormonal drugs (mainly androgen inhibitors), systemic retinoids. This list practically exhausts the arsenal of drugs taken orally and having not only verified dosages and regimens of use, but also proven pathogenetic mechanisms of action. When my patients with severe and moderate forms of acne express their assumptions that taking drugs orally has side effects and limitations in use for certain concomitant diseases, I always tell them that they are certainly right, but nothing else, Unfortunately, humanity has not yet come up with a truly effective one. And indeed it is. But fortunately, today we can really help people get rid of not only acne, but also prevent disfiguring scarring of the skin of the face and body.

Medicines for external application used for acne and included in the international treatment protocol are represented by topical retinoids (isotretinoin, adapalene), azelaic acid preparations, benzoyl peroxide — and evidence-based medicine is exhausted with these drugs. All these products, to one degree or another, regulate keratinization, reduce sebum secretion, change its chemical composition, and affect the qualitative and quantitative composition of the natural moisturizing factor and the water-lipid mantle of Marchionini.

In addition, even with mild acne, a significant number of drugs are used for topical application with a drying and sometimes dehydrating effect: alpha hydroxy acid, salicylic acid, resorcinol, drugs containing zinc, copper, sulfur, etc. They are not included in the international treatment protocol, but traditionally, since the time of the galenic prescriptions of our teachers, outstanding clinicians of the past, they are included in the arsenal of many manufacturers of cosmeceuticals for problem skin. Often, abuse of these substances leads to excessive inhibition of the sebaceous glands, excessive peeling and disruption of water metabolism in the skin and, of course, discomfort, itching and irritation. Therefore, oily and problematic skin requires hydration no less than dry skin.

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Preparations containing pre- and probiotics are a relatively new direction in dermatology and cosmetic chemistry, which is actively developing and is of significant clinical interest. So, why did our skin need these “trillions of neighbors” — bacteria that colonized our body during the process of evolution? Modern microbiome researchers have proven that the bacteria inhabiting the skin and other tissues of our body outnumber the cells of the human body hundreds of times. They form dynamically developing communities that can not only help us resist infections and absorb nutrients, but also regulate our development.

According to Julia Segrae, a microbiome researcher at the National Genomic Research Institute in Maryland, «Human beings are an amalgam of human and bacterial genomes.» This is what prompted the US National Institutes of Health to prioritize the study of the human microbiome in 2007 with more than $100 million in initial funding. As part of this project, over the first few years, the genomes of more than 600 species of human symbiont bacteria were sequenced. This accounted for about 99% of the known bacteria that cannot be cultivated, but inhabit our skin, natural orifices, intestines, mouth and vagina, because the main interest is the healthy microflora.

About practical experience in the treatment of acne — in the next publication.

*Full version of the access article in Ukrainian and Russian

First published in the magazine «PRO Cosmetology by “#Cosmetologist”» No. 3, 2021