Clinical effectiveness of early use of systemic antibacterial therapy for acne

Background. Activation of Cutibacterium acnes is one of the key links in the development of acne. Changes in the species composition of bacteria, increased enzymatic and pro-inflammatory activity determine the development of comedones, papules, pustules and other inflammatory elements. Early use of systemic antibiotics contributes to rapid and positive dynamics of the clinical symptoms of the disease, the formation of remission in a larger number of patients and an increase in the number of patients adherent to treatment.

Objective. Justification of the use of systemic antibiotics as initial therapy in patients with moderate acne.

Methods. We followed-up 60 patients (28/46.67% men and 32/53.33% women) with moderate to severe acne aged from 18 to 50 years (mean age 29.28±3.17 years). Patients were randomized into 2 comparison treatment groups. Group I consisted of 30 patients (12 men and 18 women) who received monotherapy using a gel whose active ingredient was a fixed combination of adapalene 1 mg/g and benzoyl peroxide 25 mg/g once a day for 28 weeks. Group II included 30 patients (16 men and 14 women) who were prescribed complex therapy using a fixed combination of adapalene 1 mg/g and benzoyl peroxide 25 mg/g once a day for 28 weeks and dispersible tablets of doxycycline monohydrate 100 mg 2 times a day for the first 4 weeks. All patients were recommended to use specialized cosmetics to care for problem skin throughout the entire course of treatment.

Results. It was found that initial therapy with the inclusion of an antibiotic increased the effectiveness of treatment. After completing the course of therapy, the number of patients with acne remission or excellent improvement in group II was 20 and 17% higher, respectively, than in the group receiving topical monotherapy.

Conclusion. A more rapid reduction in the activity of symptoms of moderate acne with the gradual use of systemic antibiotic therapy and topical treatment helps to increase patient’s adherence to therapy.