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Newer Fixed-dose Combinations in the Treatment of Acne
Treatment of acne is directed towards its cause. Acne occurs due to the following reasons:
Increased activity of the sebaceous or oil glands
Blockage of the pores due to increased cellular proliferation, resulting in the formation of comedone or blackhead
Growth of a bacterium called P. acnes within the hair follicles
Inflammation
Drugs used in acne act through different mechanisms:
Antimicrobials like benzoyl peroxide, clindamycin, erythromycin and sodium sulfcetamide inhibit the growth of P. acnes
Dapsone acts by reducing inflammation. It may also reduce the levels and activity of P. acnes.
Benzoyl peroxide acts against the bacteria and exerts a mild effect on comedones.
Retinoids such as adapalene, tazarotene and tretinoin act at multiple sites to treat acne. They reduce the cellular proliferation, inhibit formation of comedones and have anti-inflammatory effect. Retinoids are now available as emollient creams and microsphere gel to reduce irritation and improve efficacy.
If a combination of medications is used, it will not only be effective through multiple mechanisms, it will also help to simplify treatment and improve patient adherence to treatment.
A combination of benzoyl peroxide and clindamycin has been found to be more effective than benzoyl peroxide alone. Benzoyl peroxide, through its effect on bacteria, may also help to reduce bacterial resistance when used in combination.
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