Journal of Kerman University of Medical Sciences

A Survey to Compare the Efficacy of Niosomal Erythromycin Alone versus Combination of Erythromycin and Zinc Acetate in the Treatment of Acne Vulgaris

Document Type : Original Article

Authors

Saman Mohammadi 1
Saeedeh Farajzadeh 2
Abbas Pardakhti 3
Maryam khalili 1
Azadeh Mohebbi 1
Mohammad Reza Yousefian 4
Mahin Aflatoonian 1

1 Assistant professor of dermatology, Department of Dermatology, Kerman University of Medical Sciences, Iran

2 Professor of dermatology, Leishmaniasis Research Center, Kerman University of Medical Sciences, Iran

3 Professor of Pharmaceutics, Neuropharmacology Institute, Pharmaceutics Research Center, Kerman University of Medical Sciences, Kerman, Iran

4 Resident of dermatology, Kerman University of Medical Sciences, Iran

Abstract
Background: Acne vulgaris is one of the most common inflammatory skin diseases. Topical antibiotics and retinoids are the first-line therapy in mild to moderate acne vulgaris. Due to increased resistance of Propionibacterium acnes (P. acnes) to topical antibiotics, searching for new formulations of drug release such as niosomes is considered in order to increase efficacy and decrease drug resistance. This study compared the efficacy of niosomal erythromycin4% versus combination of erythromycin 4% and zinc acetate 1.2% in the treatment of mild to moderate acne vulgaris.
Methods: In this double-blind clinical trial, 70 patients with mild to moderate acne vulgaris of both genders aged between 12 to 30 years were included. The patients were evaluated by counting of the lesions and assessment of quality of life during the 2nd, 4th, 8th and 12th weeks.
Results: At the end of the study, 40% and 66.6% of the patients in niosomal erythromycin group showed a reduction in the number of non-inflammatory and inflammatory lesions, respectively. These percent for erythromycin and zinc acetate group were 46.6% and 63.3%. One hundred percent of excellent response (8 out of 30 patients) was observed in niosomal group (P=0.002). A significant improvement in the quality of life was also observed in niosomal group (P=0.001). Side effects were much less severe in the niosomal group than control group.
Conclusion: The results showed that niosomal erythromycin has higher efficacy and less severe side effects in comparison with combination of erythromycin and zinc acetate.

Keywords

Acne Vulgaris
Niosomal
Erythromycin
Zinc Acetate
  1. Leyden JJ. A review of the use of combination therapies for the treatment of acne vulgaris. J Am Acad Dermatol 2003; 49(3 Suppl):S200-10.
  2. Hacivelioglu S, Gungor AN, Gencer M, Uysal A, Hizli D, Koc E, et al. Acne severity and the Global Acne Grading System in polycystic ovary syndrome. Int J Gynaecol Obstet 2013; 123(1):33-6.
  3. Witkowski JA, Parish LC. The assessment of acne: an evaluation of grading and lesion counting in the measurement of acne. Clin Dermatol 2004; 22(5):394-7.
  4. Thiboutot D, Zaenglein A, Weiss J, Webster G, Calvarese B, Chen D. An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 2.5% for the once-daily treatment of moderate to severe acne vulgaris: assessment of efficacy and safety in 2813 patients. J Am Acad Dermatol 2008; 59(5):792-800.
  5. Gollnick HP, Dreno B. Pathophysiology and management of acne. J Eur Acad Dermatol Venereol 2015; 29 Suppl 4:1-2.
  6. Gollnick HP. From new findings in acne pathogenesis to new approaches in treatment. J Eur Acad Dermatol Venereol 2015; 29 Suppl 5:1-7.
  7. Dréno B. Treatment of adult female acne: a new challenge. J Eur Acad Dermatol Venereol 2015; 29 Suppl 5:14-9.
  8. Gieler U, Gieler T, Kupfer JP. Acne and quality of life - impact and management. J Eur Acad Dermatol Venereol 2015; 29 Suppl 4:12-4.
  9. Gollnick HP, Friedrich M, Peschen M, Pettker R, Pier A, Streit V, et al. Safety and efficacy of adapalene 0.1% / benzoyl peroxide 2.5% in the long-term treatment of predominantly moderate acne with or without concomitant medication - results from the non-interventional cohort study ELANG. J Eur Acad Dermatol Venereol 2015; 29 Suppl 4:15-22.
  10. Krejci-Manwaring J, Kerchner K, Feldman SR, Rapp DA, Rapp SR. Social sensitivity and acne: the role of personality in negative social consequences and quality of life. Int J Psychiatry Med 2006; 36(1):121-30.
  11. Stainforth J, MacDonald-Hull S, Papworth-smith J, Eady E, Cunliffe W, Norris J, et al. A single-blind comparison of topical erythromycin/zinc lotion and oral minocycline in the treatment of acne vulgaris. Journal of Dermatological Treatment 1993; 4(3):119-22.
  12. Bershad S. Developments in topical retinoid therapy for acne. Semin Cutan Med Surg 2001; 20(3):154-61.
  13. Rigopoulos D, Ioannides D, Kalogeromitros D, Katsambas AD. Comparison of topical retinoids in the treatment of acne. Clin Dermatol 2004; 22(5):408-11.
  14. Ozolins M, Eady EA, Avery AJ, Cunliffe WJ, Po AL, O'Neill C, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet 2004; 364(9452):2188-95.
  15. Mahmoudi M, Hajheydari Z, Vahidshahi K, Nozari A. Comparison of efficacy of Azithromycin vs. Clindamycin and Erythromycin in the treatment of mild to moderate acne vulgaris. Pakistan Journal of Medical Sciences 2011; 27(1): 68-72.
  16. Bernstein JE, Shalita AR. Topically applied erythromycin in inflammatory acne vulgaris. J Am Acad Dermatol 1980; 2(4):318-21.
  17. Leccia MT, Auffret N, Poli F, Claudel JP, Corvec S, Dreno B. Topical acne treatments in Europe and the issue of antimicrobial resistance. J Eur Acad Dermatol Venereol 2015; 29(8):1485-92.
  18. Mills O, Thornsberry C, Cardin CW, Smiles KA, Leyden JJ. Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Acta Derm Venereol 2002; 82(4):260-5.
  19. Chu A, Huber FJ, Plott RT. The comparative efficacy of benzoyl peroxide 5%/erythromycin 3% gel and erythromycin 4%/zinc 1.2% solution in the treatment of acne vulgaris. Br J Dermatol 1997; 136(2):235-8.
  20. Strauss JS, Stranieri AM. Acne treatment with topical erythromycin and zinc: effect of Propionibacterium acnes and free fatty acid composition. J Am Acad Dermatol 1984; 11(1):86-9.
  21. Bagheri A, Chu BS, Yaakob H. Niosomal drug delivery systems: Formulation, preparation and applications. World Applied Sciences Journal 2014; 32(8): 1671-85.
  22. Pola Chandu V, Arunachalam A, Jeganath S, Yamini K, Tharangini K, Chaitanya G. Niosomes: a novel drug delivery system. International Journal of Novel Trends in Pharmaceutical Sciences 2012; 2(1):25-31.
  23. Ochsendorf F. Clindamycin phosphate 1.2% / tretinoin 0.025%: a novel fixed-dose combination treatment for acne vulgaris. J Eur Acad Dermatol Venereol 2015; 29 Suppl 5:8-13.
  24. Aghaei S, Mazharinia N, Jafari P, Abbasfard Z. The Persian version of the Cardiff Acne Disability index. Reliability and validity study. Saudi Med J 2006; 27(1):80-2.
  25. Thielitz A, Lux A, Wiede A, Kropf S, Papakonstantinou E, Gollnick H. A randomized investigator-blind parallel-group study to assess efficacy and safety of azelaic acid 15% gel vs. adapalene 0.1% gel in the treatment and maintenance treatment of female adult acne. J Eur Acad Dermatol Venereol 2015; 29(4):789-96.
  26. Leyden JJ, Shalita AR, Saatjian GD, Sefton J. Erythromycin 2% gel in comparison with clindamycin phosphate 1% solution in acne vulgaris. J Am Acad Dermatol 1987; 16(4):822-7.
Journal of Kerman University of Medical Sciences
Volume 24, Issue 5
2017
Pages 420-430

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