Acne Medications

Chlorhexidine digluconate has been used as a topical antiseptic in the treatment of acne vulgaris and periodontitis. The acute phase of these diseases involves neutrophilic infiltration. Neutrophil activation and recruitment to inflammatory sites are crucial in both protection against bacterial infections and induction of hystotoxic damage.

Activated neutrophils release several enzymes (elastase and myeloperoxidase [MPO]), which contribute to tissue injury through the direct toxic activity, the generation of oxidants and the inactivation of protective factors, such as alpha-1-antitrypsin (alpha-1-AT). In the present study, we investigated if chlorhexidine might modulate neutrophil-mediated histotoxicity.

2. Human primary neutrophils were isolated from healthy donors. Inactivation of alpha-1-AT by neutrophils or reagent hypochlorous acid (HOCl) was evaluated by spectrophotometer and SDS-PAGE analysis of its capacity to complex with porcin pancreatic elastase (PPE). Neutrophil generation of HOCl, superoxide anion and MPO release were assessed spectrophometrically.

3. Chlorhexidine dose-dependently prevented HOCl-induced alpha-1-AT inactivation and reduced HOCl recovery by PMA-treated human neutrophils. Chlorhexidine did not inhibit superoxide anion and MPO release by phorbol-12-myristate-13-acetate (PMA)-treated neutrophils. Chlorhexidine directly inhibited HOCl recovery from neutrophils and HOCl-induced inactivation of alpha-1-AT in a cell-free assay.

Accordingly, chlorhexidine reversed HOCl-mediated inhibition of alpha-1-AT capacity to complex with PPE. 4. These data suggest that chlorhexidine prevents neutrophil-induced alpha-1-AT inactivation through the direct inhibitory activity on HOCl. Although highly speculative, the present article indicates that chlorhexidine might protect inflamed tissues not only through its antimicrobial properties, but also through a direct anti-inflammatory activity on neutrophil toxic products.



"Chlorhexidine prevents hypochlorous acid-induced inactivation of alpha-1-antitrypsin (alpha-1-AT)."
Clin Exp Pharmacol Physiol. 2009 Aug 4; Montecucco F, Bertolotto M, Ottonello L, Pende A, Dapino P, Quercioli A, Mach F, Dallegri F1.(hubmed.org)


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Hidradenitis suppurativa (acne inversa) is a chronic suppurative and scarring inflammatory disease with predilection in the apocrine gland-bearing areas. Histological investigations in the 1990s showed keratotic occlusion of the terminal follicle structure to be the initial cause.

Our investigations describe and reproduce the morphology and try to figure out very early lesions of HS. A total of 262 operative specimens from 60 patients were investigated by routine histology and 11 operative specimens by immunohistochemistry: HS is dominated by a heterogeneous histological image. 82% of the surgical specimens showed mild or pronounced follicular hyperkeratosis, whereas an isotopic hyperplasia of follicular epithelium was evident in 77%.

Pronounced perifolliculitis was seen in 68% and rupture of the follicle structure in 28%. Features which had not so far been described in detail were: epidermal psoriasiform hyperplasia (43%) and subepidermal interfollicular inflammatory infiltrate (78%).

In all 11 specimens, immunohistochemical investigations showed a perifollicular and subepidermal inflammation of CD-3-, CD-4-, CD-68-, CD-79- and CD-8-cells, the latter with a striking selective epitheliotropism. To conclude, we could show follicular hyperkeratosis and lymphocytic perifollicular inflammation as early patterns in pathogenesis, whereas rupture of the follicle structure takes place later.

Finally, it seems that there are two hot spots of inflammatory events (perifollicular and subepidermal) composed of a comparable inflammatory cell mixture. The CD-8 cell epitheliotropism (follicular and epidermal) described here and its influence in follicular hyperkeratosis, in hyperplasia of follicular epithelium and in epidermal psoriasiform hyperplasia will be of further interest, for instance, concerning early pharmacological intervention.


Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis
Exp Dermatol. 2009 Jul 29; Laffert MV, Helmbold P, Wohlrab J, Fiedler E, Stadie V, Marsch WC (Hubmed.org)



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Photodynamic therapy (PDT) is used for the prevention and treatment of non-melanoma skin cancer. Until recently, clinically approved indications have been restricted to actinic keratoses, nodular and superficial basal cell carcinoma, and, since 2006, Bowen disease.

However, the range of indications has been expanding continuously. PDT is also used for the treatment of non-malignant conditions such as acne vulgaris and leishmaniasis, as well as for treating premature skin aging due to sun exposure.

The production of reactive oxygen intermediates like singlet oxygen depends on the light dose applied as well as the concentration and localization of the photosensitizer in the diseased tissue.

Either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory skin conditions are induced. Treating superficial non-melanoma skin cancer, PDT has been shown to be highly efficient, despite the low level of invasiveness. The excellent cosmetic results after treatment are beneficial, too.


Photodynamic therapy in dermatology: a review.
Lasers Med Sci. 2009 Aug 5; Choudhary S, Nouri K, Elsaie ML (Hubmed.org)



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