Tretinoin 0.025% / Erythromycin 4% solution

Acne vulgaris, commonly called acne, is a skin condition affecting many individuals globally. It is a chronic condition characterized by developing pimples, blackheads (open comedones), whiteheads (closed comedones), and other skin lesions. Acne usually appears on the face, neck, chest, and back. It is commonly associated with puberty and adolescence but can also affect adults of all ages. Acne can be very frustrating and embarrassing, leading to low self-esteem and social isolation. The condition arises from various factors, including clogged pores, excessive sebum production, bacteria, and inflammation. This systematic review assesses the effectiveness of topical antibiotics, retinoids, niacinamide, azelaic acid, and clascoterone in treating mild-to-moderate acne vulgaris. A comprehensive search across PubMed, PubMed Central, and Google Scholar yielded 10 articles focused on topical antibiotics, with findings from 198 subjects indicating the efficacy of doxycycline against inflammatory lesions. Retinoids, such as tretinoin and adapalene, significantly improved both lesion types (open and closed comedones). Niacinamide, examined in a randomized controlled trial involving 41 participants, reduced sebum production. Another study with 60 patients revealed that azelaic acid effectively reduced both inflammatory and non-inflammatory lesions. Clascoterone emerged as a promising antiandrogenic treatment, supported by a randomized controlled trial involving 4,440 patients. It is essential that individualized therapy, incorporating patient preferences and considering adverse effects, is emphasized for optimizing acne management.

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Acne vulgaris is the most common skin disease, and its pathogenesis has been the subject of extensive research over the last 3 to 4 decades. Its most important pathophysiologic pillars include a dysfunction in the keratinization of the follicular epithelium, which is tightly intertwined with an aberrant immunologic response, both innate and adaptive.1 The interplay between epithelial cells and commensal bacteria such as Cutibacterium acnes leads to a proinflammatory microenvironment. Other factors, such as seborrhea, altered fatty acid composition and hormonal imbalance also contribute to the pathogenesis of this complex disease.2 Several topical compounds have been developed and are effectively used for the treatment of mild-to-moderate acne, targeting one or more of the aforementioned factors. Retinoids exhibit both antiproliferative, comedolytic (keratolytic) and anti-inflammatory effects. Benzoyl peroxide (BPO) has bactericidal properties against C. acnes as well as mild comedolytic and anti-inflammatory properties. As for antibiotics, topical clindamycin is particularly effective against inflammatory acne lesions, but it can also affect biofilm and follicular microcomedone formation.3 Erythromycin is also an effective alternative, but concerns have been raised regarding its potential to easily promote C. acnes resistance. In a recent meta-analysis by Kakpovbia et al.4 different topical treatments were compared by evaluating randomized control trials for topical treatments in acne with focus on efficacy. Publications based on absolute inflammatory and non-inflammatory lesion counts and the semiquantitative method of assessing treatment success based on the Investigator's Global assessment scale were included. Despite the dual targets of several compounds, the authors did not notice any significant differences among adapalene, azelaic acid, BPO, dapsone, erythromycin, clindamycin, salicylic acid, tretinoin and tazarotene. Combination treatments with retinoid or topical antibiotic with BPO were the most effective among all treatments for inflammatory acne, while for non-inflammatory acne combination treatments with BPO and clindamycin did not outperform BPO4: The authors provide evidence supporting a differentiation of the therapeutic approach in patients according to their acne phenotype in order to achieve the maximal efficacy and contribute in avoiding unnecessary prescription of topical clindamycin for chronic skin disorders, which raises antibiotic resistance concerns.5 The compound is ranked 125th most commonly prescribed medicine in the US and remains on the World Health Organization list of Essential Medicines, while its use is very often not limited to “in label” indications. Dermatologists frequently face constructive criticism concerning antibiotic stewardship practices. Despite this, they are among the few specialties that are familiar with the anti-inflammatory properties of antibiotics and they prescribe them effectively in sub-bactericidal doses for inflammatory skin diseases, such as acne vulgaris, rosacea and hidradenitis suppurativa.6 Another important factor that plays a crucial role in topical treatments is the tolerability profile. Compounds which cause irritation, erythema, dryness, burning or stinging on a regular basis are more likely to be associated with a reduced compliance. This is particularly important in the real-world situation, where patients receive a treatment from their dermatologist and are seen in three-month intervals, without the exhausting compliance practices which usually follow a randomized controlled study. The authors found that BPO alone or in combination with clindamycin is better tolerated than certain retinoids combined with BPO. The extensive and rigorous inclusion criteria used did not allow for the inclusion and efficacy evaluation of new compounds such as the topical antiandrogen clascoterone and the new selective retinoid trifaroten. Despite this, this systematic review and metanalysis provide the evidence of an indirect comparison between commonly prescribed single agents and combination treatments and provides the rationale for a correct and phenotype-oriented therapeutic strategy. None. Georgios Nikolakis has received honoraria and travel grants from UCB, Novartis, Almirall, BMS, Abbvie and Elli Lilly, and his institution received honoraria from Mölnlycke GmbH for his participation in advisory boards. Christos C. Zouboulis has received disease-relevant consulting/lecture honoraria from Estée Lauder, L'Oréal, NAOS-BIODERMA and PPM. His departments have received grants from his participation as a clinical and research investigator for AstraZeneca, Boehringer Ingelheim, BMS, Brandenburg Medical School Theodor Fontane, EADV, European Union, German Federal Ministry of Education and Research, GSK, Incyte, InflaRx, MSD, Novartis, Relaxera, Sanofi and UCB. He is chair of the ARHS Task Force group of the EADV and Editor of the EADV News. Not applicable. Not applicable. Data sharing is not applicable to this article as no new data were created or analysed in this study.

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Acne vulgaris is a common dermatologic disorder that affects approximately 85% of teenagers, which significantly impacts the quality of life in adolescents. It is a chronic disease of the sebaceous follicles that is multifactorial in etiology. Topical treatment is the first choice for mild and moderate acne, while systemic therapy is reserved for severe and certain moderate cases. Topical treatments include retinoids (e.g., tretinoin and adapalene), antibiotics (e.g., clindamycine), and other agents (e.g., benzoyl peroxide and azelaic acid), often applied in combination. The mechanisms of action include antimicrobial, anti-inflammatory, and keratolytic activities, as well as sebum secretion reduction, and the normalization of follicular keratinization. However, these topical agents commonly induce side effects, such as dryness, burning, stinging, peeling, redness, erythema, and photosensitivity. Therefore, there is a need to reduce the side effects of anti-acne drugs, while maintaining or enhancing their therapeutic effectiveness. This article aims to comprehensively outline nanotechnology strategies, particularly the use of phospholipid-based nanocarriers like liposomes and related vesicles, to enhance therapeutic efficacy, skin tolerability, and patient compliance in the treatment of acne vulgaris. In addition, novel active ingredients encapsulated in vesicles beyond those recommended in official guidelines are discussed.

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Abstract Background Tretinoin or all-trans retinoic acid is used in the treatment of acne vulgaris and photo-aging. This work aims to develop tretinoin-loaded nanofibers as a potential anti-acne patch and to investigate its physicochemical characteristics. Method Nanofibers were produced via electrospinning method and surface topography was evaluated by Field Emission Scanning Electron Microscopy (FESEM). The functional groups of polymer and the drug molecule and the possible interactions were studied by Fourier Transform Infrared Spectroscopy (FTIR). Drug release studies were carried out by total immersion method at 25 °C and 32 °C. Tretinoin stability was evaluated at room temperature and fridge for 45 days. The possibility of synergistic antibacterial activity of tretinoin and erythromycin combination was investigated on Staphylococcus aureus (ATCC® 25923™) and (ATCC® 29213™) by Kirby Bauer disc diffusion method. Results Uniform fibers without drug crystals were fabricated via electrospinning. Drug-loaded nanofibers show inherent stability under various storage conditions. Electrospun nanofibers showed a prolonged release of tretinoin. The stability of formulations in FT was higher than RT. Disc diffusion tests did not show any synergism in the antibacterial activity of erythromycin when used in combination with tretinoin. Conclusion It can be anticipated that the easy fabrication, low costs and dosing frequency of the construct reported here provide a platform that can be adapted for on-demand delivery of tretinoin. Graphical abstract

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BACKGROUND: Acne vulgaris is an inflammatory disease affecting the pilosebaceous unit, which also has psychological effects. AIMS: Our aim in our study is to compare the recovery levels and side effect profiles of patients diagnosed with acne during pregnancy and who used topical erythromycin, clindamycin, or topical azelaic acid. METHODS: After ethical approval was obtained for the study, the files of patients who applied to the outpatient clinic with acne complaints in 2018-2022 were retrospectively examined, and the files of 75 pregnant patients who used topical erythromycin, 96 who used clindamycin, and 26 who used azelaic acid were included in the study. Pre- and post-treatment IGA values, lesion numbers, side effects during the treatment process, and patient satisfaction levels were examined. RESULTS: When the groups were compared in terms of IGA value at the end of treatment and percentage improvements in all lesion numbers, it was seen that there was more improvement in the group using azelaic acid than the others (p < 0.001 for both). When the groups were compared in terms of side effects, no difference was found (p = 0.093). When the groups were compared in terms of satisfaction levels, there were significantly more patients who were very satisfied in the azelaic acid group (p < 0.001). CONCLUSION: As a result of the study, we see that azelaic acid is more successful in terms of both effectiveness and patient satisfaction. Therefore, azelaic acid is a good option in the treatment of mild to moderate acne during pregnancy.

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Facial Afro-Caribbean childhood eruption (FACE), also known as childhood granulomatous periorificial dermatitis, is a rare and benign granulomatous condition first described by Gianotti et al. in 1970 [1]. This condition primarily affects dark-skinned prepubescent children and should be differentiated from perioral dermatitis, sarcoidosis, granulomatous rosacea, and lupus miliaris disseminatus faciei. Here, we present the first case of FACE successfully treated with topical erythromycin and tretinoin (TRT), suggesting a new potential therapy for this condition. A 16-year-old boy presented with a 3-month history of yellowish, nonitchy micropapules around the mouth, nose, and upper and lower eyelids. He had no personal or family history of skin disorders and no history of atopy. The rash had not been preceded by the use of corticosteroids or other topical products. Physical examination revealed multiple monomorphic, lupoid, red-to-yellow papules ranging from 1 to 3 mm in diameter, accompanied by erythema and scaling (Figure 1a). There were no pustules or comedones. The rest of the skin and general physical examination were normal. Dermoscopic evaluation showed a yellow-orange background with yellow-white globules and white scales. Laboratory tests, including calcium level, conversion enzyme assay, and tuberculin reaction, were normal. Chest X-ray and ophthalmological examination results were also normal. Histological examination of one of the perioral papules showed a diffuse granulomatous infiltrate in the dermis with histiocytes, multinucleated giant cells, and a heavy lymphocytic component. There was no caseation necrosis (Figure 2). No Demodex Folliculorum was observed, and special stains for fungi and acid-fast bacilli were negative. These findings were consistent with a diagnosis of FACE. Standard patch testing, including European baseline and cosmetic allergens, showed no positive reactions. Treatment with topical erythromycin and tretinoin (Erylik gel: erythromycin 4%, tretinoin 0.025%) was initiated with one application daily. The patient responded well, showing improvement in skin lesions after 4 weeks (Figure 1b). FACE is a rare, benign condition that presents as small, monomorphic papular eruptions around the mouth, nose, and eyes, without pustules, comedones, or scarring [2]. Histologically, it features nonspecific perifollicular granulomatous inflammation [2]. The etiology remains unknown, but some reports suggest associations with allergens or irritants such as bubble gum, formaldehyde, cosmetic preparations, and antiseptic solutions [3]. Long-term use of topical steroids can induce or worsen FACE [3]. The condition, which primarily affects prepubertal children with darker skin types, tends to resolve spontaneously over several months without scarring. Management typically involves discontinuing topical corticosteroids [4, 5]. Although FACE is self-limiting, treatment aims to reduce the duration of the condition. Oral tetracyclines, minocycline, doxycycline, erythromycin, and metronidazole have shown good results, as have topical treatments like metronidazole, pimecrolimus, and tacrolimus. Topical agents combined with oral treatments, including adapalene, clindamycin, azelaic acid, and photodynamic therapy, may also be effective [4, 5]. Oral isotretinoin may be considered for persistent cases. To date, there have been no reports of TRT as a treatment for FACE [6]. Patients and their families should be reassured that FACE is benign and self-limited. We propose that TRT may be considered an effective first-line treatment for FACE in children. Further research is needed to confirm its efficacy and establish optimal dosing and duration. N.B.S., I.L., M.K., and H.B.A. performed the research and contributed essential reagents or tools. N.B.S., I.L., M.K., H.B.A., H.B., and J.Z. analyzed the data. N.B.S., M.K., and J.Z. wrote the paper. S.M. and M.Y. performed the research and analyzed the data. Written informed consent was obtained from the parent's patient to publish this report in accordance with the journal's patient consent policy. The authors declare no conflicts of interest. Data sharing is not applicable—no new data generated.

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