Fluhr Joachim W, Degitz Klaus
Bioskin GmbH, Bergmannstr. 5, 10961 Berlin und Klinik für Dermatologie und Allergologie, Charité, Berlin, Germany.
J Dtsch Dermatol Ges. 2010 Mar;8 Suppl 1:S24-30. doi: 10.1111/j.1610-0387.2009.07169.x.
Benzoyl peroxide was introduced as a basic treatment already in acne therapy 1934. The mechanism of action is the reduction of anaerobe bacteria by strong oxidation processes. No resistancies have been ever reported. BPO is available in 2.5, 5 and 10 % formulations. Its efficacy is slightly related to the strength of concentrations, but the side effect profile with burning, erythema and desquamation is increasing with concentrations. BPO 5% mostly is efficient enough to control acne of grades I to II according to the Kligman & Plewig classification. BPO my bleach clothes and hair. It is the most costeffective topical drug in acne of grades I-II. Inflammatory acne of the papular-pustular type I-II can also be treated by topical antibiotics such as erythromycin, clindamycin, and, less frequent and today not anymore recommended tetracyclines. Mechanism of action is not alone an antibacterial but anti inflammatory effect. The efficacy and penetration of the topical antibiotics between the groups are similar. Randomized studies have shown that concentrations of 2-4% are equivalent to oral tetracycline and minocycline in mild to moderate acne. Combinatory formulations with BPO and with retinoids enhance the efficacy significantly. Topical antibiotics plus BPO show less bacterial resistancies as topical antibiotics alone. Antibiotics should therefore not be used as monotherapy. Moreover gram negative folliculitis may develop. Azelaic acid is acting as an antimicrobial and can also reduce comedones. It can also be used in pregnancy and during the lactation period.
早在1934年，过氧化苯甲酰就被引入痤疮治疗作为一种基本疗法。其作用机制是通过强烈的氧化过程减少厌氧菌。从未有过耐药性的报道。过氧化苯甲酰有2.5%、5%和10%的制剂。其疗效与浓度强度略有相关，但灼烧、红斑和脱屑等副作用会随着浓度增加而增多。根据克利格曼和普莱维希分类，5%的过氧化苯甲酰大多足以控制I至II级痤疮。过氧化苯甲酰可能会漂白衣服和头发。它是治疗I-II级痤疮最具成本效益的外用药物。I-II级丘疹脓疱型炎性痤疮也可用外用抗生素治疗，如红霉素、克林霉素，以及使用频率较低且如今不再推荐的四环素。作用机制不仅是抗菌，还有抗炎作用。各外用抗生素组之间的疗效和渗透性相似。随机研究表明，2-4%的浓度在轻度至中度痤疮中与口服四环素和米诺环素等效。与过氧化苯甲酰和维甲酸的联合制剂可显著提高疗效。外用抗生素加过氧化苯甲酰比单独使用外用抗生素产生的细菌耐药性更少。因此，抗生素不应作为单一疗法使用。此外，可能会发生革兰氏阴性毛囊炎。壬二酸具有抗菌作用，还可减少粉刺。它也可在孕期和哺乳期使用。
