Minolexin in acne vulgaris treatment standards
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Department of Skin and Venereal Diseases, Faculty of Advanced Professional Education for Physicians, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia;
E.V. Kuznetsova, Postgraduate Student,
Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia;
M.E. Minakova, Chief Physician, Dermatovenerologic Dispensary, Ramenskoye, Moscow Region
In the epidermis, TLRs are expressed on epithelial cells, keratinocytes, Langerhans cells, macrophages, monocytes, and granulocytes, directly participating in the formation of the antimicrobial response. The role of PARs in the pathogenesis of acne consists of inducing and enhancing the existing inflammatory process by increasing the expression of IL-1α, tumor necrosis factor-α, human β-defensin 2 (hBD2), and matrix metalloproteinases MMP-1, MMP-2, MMP-3, MMP-9, MMP-13. Thus, P. acnes participates in many processes in the pathogenesis of acne vulgaris, including inflammation, hyperkeratosis, and excess sebum production, which necessitates its eradication and is an important component of complex therapy.
Minocycline Minolexin® (minocycline) is a highly effective drug for the treatment of moderate to severe forms of acne vulgaris and is included in the European treatment guidelines. The drug has a pronounced bacteriostatic effect and a high level of lipophilicity, quickly penetrates the lipid layer of bacteria, and intensively accumulates in the sebaceous glands.
Factors in the Development of Acne Vulgaris
The main factors in the pathogenesis of acne vulgaris are hyperseborrhea (excessive sebum production), follicular hyperkeratosis, the development of inflammation inside and around the sebaceous gland, and the proliferation of Propionibacterium acnes (P. acnes) bacteria [1]. The mechanism of action of the latter remains a subject of detailed study by scientists (Fig. 1).
It has been established that P.acnes can interact with markers of innate immunity, such as Toll-like receptors (TLR) and protease-activated receptors (PAR) [2]. TLRs (Toll-like receptors) are transmembrane cellular receptors, part of the immune system, namely innate immunity, and are located in barrier tissues (skin and mucous membranes, digestive tract, lungs). In the epidermis, TLRs are expressed on epithelial cells, keratinocytes, Langerhans cells, macrophages, monocytes, and granulocytes, directly participating in the formation of the antimicrobial response [3]. TLRs recognize pathogen-associated molecular patterns (PAMPs) of microorganisms (bacteria, yeast-like fungi, or viruses), and disturbances in receptor processes lead to dysregulation of the body's response. Mutations in the genes of these receptors increase the risk of developing infectious diseases, as well as chronic inflammatory skin diseases [4].
Histological examination of biopsy specimens from lesions of the skin of patients with acne vulgaris revealed increased expression of TLR2 on macrophages localized around hair follicles, as well as TLR4 on keratinocytes of the epidermis in the lesions. Furthermore, it was established that the ligand for TLR2 is a main component of the P. acnes cell wall – peptidoglycan, and for TLR4, it is presumably lipopolysaccharides of the P. acnes cell wall [5].
The full text of the article is available in the file: "Minolexin and Its Place in the Treatment Guidelines for Acne Vulgaris" "
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