Ointment for acne: which one to choose?

In dermatology, local remedies are most often used to treat rashes that appear due to hypersecretion of sebum and the development of inflammation caused by the proliferation of the anaerobic bacterium Propionibacterium acnes.

Most of these products are acne ointments, as well as non-fat-based gels and special creams with antiseptic and antimicrobial properties. And the indications for the use of acne ointments are acne (adolescent acne, acne disease), oily seborrhea of the skin, folliculitis and follicular hyperkeratosis.

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Pharmacodynamics

Salicylic acid in the form of acne ointment acts as an antiseptic, and also reduces sebum secretion and removes dead skin cells.

The active ingredient of the drug Clindovit is the semi-synthetic antibiotic clindamycin, which has a bacteriostatic effect on P. Acne, staphylococci and streptococci by binding to their RNA and inhibiting the synthesis of amino acids in the cells of microorganisms.

The active ingredient of Azelex is azelaic acid (from the heptane dicarboxylic acid group) – it has a detrimental effect on bacteria, reduces the level of fatty acids in sebum and simultaneously slows down the process of accelerated keratinization of the skin.

Pharmacodynamics of Adapalene (and its synonyms) is determined by the substance adapalene, which is similar in structure to vitamin A and binds to retinol receptors in skin cells, preventing the formation of excess sebum and comedones. Under the influence of this ointment, keratinization and exfoliation of skin cells are also accelerated, which prevents their accumulation in the mouths of hair follicles.

And the drug Isotrexin (on a gel base) in addition to the retinol derivative isotretinoin contains the antibiotic erythromycin, under the influence of which bacteria stop multiplying and die. In addition, retinoids promote the regeneration of epidermal cells.

Unlike regular zinc ointment, which contains zinc oxide (which reduces sebum production and dries out the skin), Zinc Hyaluronate Gel (Curiosin) is a mixture of zinc chloride and sodium hyaluronate. Thanks to zinc, this acne ointment acts as an antiseptic and drying agent, and sodium hyaluronate (synthetic hyaluronic acid) promotes the regeneration of damaged skin.

The mechanism of action of the Ugrin phyto-gel is based on the combined bacteriostatic and anti-inflammatory effects of the medicinal plants included in its composition (celandine, chamomile, calendula, yarrow, mint, lavender and tansy), as well as the antiseptic chlorhexidine.

Pharmacokinetics

Ointments are applied locally, and their active substances, as a rule, do not enter the systemic bloodstream. In addition, the pharmacokinetics of most drugs in this group have not been studied by manufacturers.

The antibiotic clindamycin - when using the ointment Clindovit - can accumulate in comedones, which consist of lipids and keratinocytes, and from there get into the blood. However, the concentration of the drug is minimal, so there is no systemic effect. And the remains of the antibiotic, in case of its adsorption, are completely excreted by the kidneys after 8 hours.

Part of the azelaic acid (Azelex and its synonyms) is absorbed into the deeper layers of the skin and enters the blood, but is also excreted by the kidneys, both unchanged and in the form of acidic metabolites.

Names of acne ointments

First, it should be clarified that the P. acnes bacterium is part of the synanthropic microflora of the skin of most healthy people, but it feeds on lipids and therefore begins to multiply rapidly with increased production of sebum. The damage caused by this bacterium makes the skin more susceptible to colonization by pathogenic bacteria, such as Staphylococcus epidermidis. Acne occurs at the site of comedones - sebaceous-horny plugs that clog the hair follicles of the skin, creating all the conditions for the reproduction of bacteria and the development of a local inflammatory process.

And now - the main names of acne ointments that help stop the inflammatory process and promote skin cleansing from rashes: salicylic ointment, Clindovit (other trade names Clindatop, Dalacin T, Ugricil), Azeleks (Skinoren, Skinomaks, AcneStop, Aziks-derm, Azilin, Finevin, etc.), Adapalene gels (Adaklin, Adolen, Klenzit, Differin, Bezugray), Isotrexin, Zinc hyaluronate (Curiosin) and Ugrin.

Ointments with a hydrophilic base (gels) and ointments based on polyethylene glycols are better absorbed into the skin, increase the bioavailability of active substances and have a faster therapeutic effect.

How to use acne ointments

The acne ointment has only one method of application - local: at least once or twice a day, the product should be applied pointwise to problem areas of the skin (the skin should be clean and dry) 1-1.5 g (depending on the area of the rash). The duration of use depends on the condition of the skin, the extent of the rash and the intensity of its inflammation. To determine the duration of the course of treatment, you should consult a dermatologist.

It is necessary to take into account that ointments based on clindamycin, erythromycin and other antibiotics can cause an individual negative reaction, and their overdose can cause long-term intestinal dysfunction and diarrhea.

According to the instructions for other drugs described, there have been no reports of overdose cases, and such cases are unlikely due to the minimal systemic absorption of these topical agents.

Contraindications for use

Salicylic ointment is contraindicated for use in cases of severe renal failure and increased individual sensitivity to salicylates.

Contraindications for use: Clindovita - intestinal dysbacteriosis and colitis, as well as age under 12 years. Isotrexin and Adapalene are contraindicated for use in children under 12 years of age, with allergic reactions to retinoids, seborrheic dermatitis and eczema. The instructions for the other drugs mentioned earlier report the absence of contraindications, with the exception of hypersensitivity to their components.

The ban on the use of acne ointments during pregnancy concerns products that contain antibiotics. Adapalene and Isotrexin gels are strictly contraindicated for pregnant women due to their teratogenic effect on the fetus.

Since there is no reliable and substantiated data on how safe such drugs as Azeleks (Skinoren, etc.), Zinc hyaluronate and Ugrin are during pregnancy, their use is not recommended. Pregnant women themselves should avoid using any pharmacological agents of local action as much as possible.

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Side effects

Almost all ointments, gels and creams for acne have side effects in the form of

Local irritation and redness of the skin at the site of application, burning and itching, as well as a noticeable decrease in moisture content in the epidermis and peeling.

Isotrexin and Adapalene can cause severe hyperemia of the skin (erythema) and lead to a temporary increase in the sensitivity of the epidermis to UV radiation.

And the drug Azelex (and all creams and gels based on azelaic acid), in addition to the above-mentioned side effects, can provoke an attack in patients with a history of bronchial asthma.

Interaction with other drugs

When using drugs locally in the form of an ointment, interactions with other drugs occur extremely rarely.

However, clindamycin (as part of the gel Clindovit, etc.) is completely incompatible with erythromycin, barbiturates and magnesia, and the simultaneous use of ointments to relieve muscle spasms enhances the effect of the latter.

Isotrexin and Adapalene gels should not be used simultaneously with keratolytic agents and facial scrubs, as well as with products containing salicylic acid, zinc compounds and sulfur; vitamin A should not be taken internally.

Optimal storage conditions for ointments are temperatures from +18 to 25°C.

The shelf life of most products is 2 years, ointments with azelaic acid - 3 years from the date of manufacture.