What is acne and why does it occur?
Acne, or acne vulgaris, is one of the most common chronic inflammatory skin diseases, affecting millions of people worldwide. It is characterized by the appearance of comedones (blackheads and whiteheads), papules, pustules, and sometimes deeper cysts and nodules, predominantly on the face, chest, and back. The development of acne is linked to several key factors: excessive sebum production, clogging of hair follicles by dead skin cells, the proliferation of Cutibacterium acnes (formerly Propionibacterium acnes) bacteria, and an inflammatory response. This condition can significantly impact quality of life, causing psychological discomfort and leaving scars.
Acne treatment: traditional approaches and challenges
Traditional acne treatments include a wide range of options, from topical preparations to systemic medications. Topical agents include retinoids, benzoyl peroxide, azelaic acid, and antibiotics. Systemic therapy may include oral antibiotics, hormonal drugs, and isotretinoin. However, these approaches are not always ideal. For example, long-term use of antibiotics can lead to the development of antibiotic resistance, which is a serious problem in modern dermatology [5]. Furthermore, many drugs have side effects, and their efficacy can vary, highlighting the need for the development of new, more targeted, and safer treatment methods.
Specifics of acne treatment during pregnancy
Pregnancy is a special period when the choice of medications for treating any condition, including acne, requires maximum caution. Many drugs commonly used to treat acne are contraindicated due to potential harm to the developing fetus. In a review focused on dermatological treatment during pregnancy, acne is highlighted as one of the common conditions requiring a specific approach [4].
- Contraindicated drugs: Systemic retinoids (e.g., isotretinoin) are strictly contraindicated due to a high teratogenic risk. Some oral antibiotics, such as tetracyclines, are also not recommended due to their impact on fetal bone and tooth development [4].
- Relatively safe options: Topical agents are often recommended for acne treatment during pregnancy. These include topical antibiotics (e.g., erythromycin, clindamycin), azelaic acid, and benzoyl peroxide. Salicylic acid in low concentrations and on limited areas may also be considered, but with caution [4].
It is important that any acne therapy during pregnancy be prescribed and monitored by a physician to minimize risks to both mother and child [4].
Innovations in dermatology: the potential of phage therapy
In light of the growing problem of antibiotic resistance and the search for more targeted treatment methods, phage therapy represents a promising direction in dermatology. Bacteriophages, or phages, are viruses that selectively infect and destroy bacteria without affecting human cells [5].
Research shows that many dermatological diseases, including acne, psoriasis, and atopic dermatitis, are associated with an imbalance of the skin microbiome, characterized by a decrease in the number of phages and the overgrowth of certain bacteria [5]. In the case of acne, this may be linked to an imbalance of Cutibacterium acnes. Phage replacement therapy, aimed at restoring the microbiome balance by introducing specific phages capable of destroying pathogenic bacteria, is considered a promising strategy [5].
Preliminary studies have shown promising results for the treatment of acne, psoriasis, and atopic dermatitis using phages. However, the authors note that these studies are currently limited by small sample sizes and the lack of control groups in some cases, which requires further large-scale research to confirm the efficacy and safety of phage therapy [5].
General trends in the development of dermatological treatments
Modern dermatology is actively evolving, offering new, more effective, and safer approaches to treating various skin diseases. This progress is driven by a deep understanding of pathophysiological mechanisms and the development of targeted drugs. In recent years, there has been an emergence of new medications that demonstrate attractive efficacy and safety profiles, allowing physicians to be more ambitious in achieving treatment goals [3].
One of the key trends is the development of topical forms of drugs that were previously available only in systemic form. This allows for the reduction of systemic side effects characteristic of oral or injectable agents. For example, topical Janus kinase (JAK) inhibitors, such as ruxolitinib, have been developed as safe topical alternatives to systemic drugs. Topical ruxolitinib has shown improvement in conditions such as atopic dermatitis, vitiligo, and psoriasis, demonstrating minimal bioavailability and a low frequency of mild to moderate side effects [6]. Although ruxolitinib is not used to treat acne, its development is an example of the general trend in dermatology toward creating safer, localized, and targeted therapeutic solutions, which opens prospects for future innovations in the field of acne treatment as well.
Perspectives and personalized approach
Acne treatment continues to evolve, offering new opportunities for patients. From the careful selection of therapy during pregnancy to innovative approaches like phage therapy, dermatology strives for more effective and safer solutions. It is important to remember that every case of acne is unique, and the treatment approach must be strictly individualized. Only a qualified dermatologist can correctly diagnose the type of acne, determine its causes, and prescribe the most appropriate and safe treatment regimen, taking into account all the characteristics of the body and co-existing conditions.
Sources
- 1. Efficacy and Safety of Abrocitinib in Patients with Severe and/or Difficult-to-Treat Atopic Dermatitis: A Post Hoc Analysis of the Randomized Phase 3 JADE COMPARE Trial. https://pubmed.ncbi.nlm.nih.gov/37213005/
- 2. Phototherapy for atopic eczema. https://pubmed.ncbi.nlm.nih.gov/34709669/
- 3. Pruritus in Dermatology: Part 2—Diseases and Their Treatment. https://pubmed.ncbi.nlm.nih.gov/37302478/
- 4. Dermatologic treatment during pregnancy: practical overview. https://pubmed.ncbi.nlm.nih.gov/17234117/
- 5. Bacteriophages and the Microbiome in Dermatology: The Role of the Phageome and a Potential Therapeutic Strategy. https://pubmed.ncbi.nlm.nih.gov/36769020/
- 6. Utilization of Topical Ruxolitinib in Dermatology: A Review. https://pubmed.ncbi.nlm.nih.gov/37339609/
- 7. Safety and Efficacy of Phototherapy in the Management of Eczema. https://pubmed.ncbi.nlm.nih.gov/29124712/
- 8. Effectiveness and clinical predictors of rimegepant for acute vertigo in vestibular migraine: A real-world cohort study. https://pubmed.ncbi.nlm.nih.gov/42377393/
Disclaimer: The information presented in this article is for reference purposes only and does not replace professional consultation, diagnosis, or treatment provided by a qualified medical professional.