среда, 16 июня 2010 г.

Roaccutane in the treatment of acne: the standard modes of therapy and a new scheme of low-dose

About 25 years ago, the world's scientific literature, the first reports about the possibility of oral isotretinoin (13-cis-retinoic acid - Roaccutane ®, «F. Hoffmann-La Roche Ltd., Switzerland) for the treatment of severe acne. Therapeutic triumph of this technique in complex inflammatory and sclerosing forms of acne and other dermatoses (eg, rosacea), supported by numerous, continuously increasing from year to year the number of reputable publications that from the standpoint of evidence-based medicine has not only reliably assess the clinical efficacy, but also to objectify his tolerability, as well as drawing up a clear spectrum of indications and contraindications.

What, then, is now firmly established principles of systemic acne therapy Roaccutane and what are the possible ways to modify a well-known schemes? Before answering this question, we turn to the unique tsitoregulyatornym and pharmacokinetic properties of the drug, allowing, in accordance with current evidence and the individual situation in most cases, once regarded it as a first-line drugs for the initial treatment of acne.
Top 70 of the XX century literature began to appear information about the presence of one of the cis-retinoic acid derivatives distinct regulatory properties with respect to the sebaceous glands of animals and humans. A few years later the drug was introduced into clinical practice under the international name isotretinoin (13-cis isomer of retinoic acid), patented as Roaccutane ® (F. Hoffmann-La Roche Ltd, Switzerland). Explore the unique properties of the drug have devoted a substantial number of studies around the world. Found that Roaccutane ®, interacting with nuclear receptors, affects the processes of cell differentiation of sebaceous glands, which leads to marked decrease of the size of sebaceous glands, suppression of activity and a dramatic reduction in sebum excretion. Depending on the dose and duration of drug action sebostaticheskoe reaches 90% of the baseline. Advanced Roaccutane ® has moderate immunomodulating effect and has a gentle anti-inflammatory effect. In this regard, Roaccutane ® quickly became the number one tool in the world for the treatment of severe (konglobatnoy, abscess and cystic) forms of acne. The drug is currently appointed by and with the milder forms of acne (involving, in particular, pronounced psycho disorders, social maladjustment, as well as the presence of propensity to scarring, etc.) due to a significant improvement in the quality of life of patients on a background of effective treatment. The latter is an indirect confirmation of the fact that often the benefits obtained from the use Roaccutane ® in any group of patients, significantly higher than the potential risk.

You can say that by studying the mechanisms of action Roaccutane ® largely understood pathogenesis of acne. As is known, starting point for the acne is caused by genetically hyperandrogenic or sensitivity sebotsitov to derivatives of testosterone. Ultimately, this background determines the prime importance of four factors: follicular hyperkeratosis, hypertrophy of the sebaceous glands with their hypersecretion, microbial giperkolonizatsii and inflammatory reaction. Pathogenic validity and effectiveness of Roaccutane ® by the fact that this drug acts in varying degrees in all links of the pathogenesis of acne.