Acne can occur at any age and has a huge psychological impact on quality of life. It can lead to anxiety, depression, and permanent physical and emotional scars in patients, which could be prevented by actively treating them for this condition early. The guidelines promote the use of treatments with different modes of combined action in order to modulate two or more aetiological factors simultaneously, resulting in faster onset of action and or greater efficacy. Retinoids are important to target the microcomedones. “An effective strategy is to initiate topical retinoids therapy at the same time as oral or topical antibiotics or antimicrobials and continue until reasonable clearing of inflammatory lesions occurs,” said Prof Gollnick. Clindamycin and tretinoin are far more effective combined than when used separately. He explained that the new form of 0.025% tretinoin is a solubilised form that is immediately available, and a crystalline form, with slower dissolution, enhancing follicular penetration. It effectively treats inflammatory and non-inflammatory lesions.
This formulation of tretinoin and clindamycin combination significantly reduced the P. acnes counts in patients after six weeks, even in those with highly resistant acne. Studies reviewed indicate that Treclin does not lead to an increase in development of antibiotic resistance when used for up to 16 weeks and that it can effectively eradicate P. acnes, even in highly resistant strains. “These findings demonstrate favourable efficacy and tolerability profile, and support the use of Treclin for patients with papulopustular acne,” said Prof Gollnick. “Speed is of the essence when dealing with acne patients in general and teenagers in particular. The fixed-combination Treclin works six weeks faster than tretinoin alone against inflammatory lesions and 10 weeks faster than clindamycin against noninflammatory lesions,” he emphasised.
Most dermatologists and patients find the tolerability of topical retinoids to be problematic. The rapid delivery of this solubilised tretinoin on the skin surface allowed for rapid follicular penetration. Treclin allows better and deeper penetration of clindamycin into the follicles, increasing the efficacy of the antibiotic. This leads to better tolerability and lower irritation.
The anti-inflammatory properties of clindamycin may also contribute to the low irritation potential of Treclin. Medication adherence has a prominent role in the success of therapy and it is important to choose agents that are as compatible as possible with a patient’s lifestyle. Treclin is a convenient, fixed dose combination, that is applied once a day, at night. “For adherence, we need effective education of patient from first visit with co-education of parents, set time aside for this. Explain that topical treatment must go over the entire area and not just spot treatment,” said Prof Gollnick. Providing specific skin care recommendations is an important part of the management of acne and may adjunctively augment the efficacy of topical medication‘s in reducing acne lesions.
References available on request.
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