Zusammenfassung
Die Aknetherapie erfordert häufig eine dauerhafte Kombination von Wirkstoffen mit
komplementären, aber unterschiedlichen Wirkungsmechanismen. Zur lokalen Behandlung
der leichten bis mittelschweren Akne steht ein neues Kombinationspräparat zur Verfügung,
das zwei der effektivsten Wirkstoffe, Clindamycin (1 %) und Benzoylperoxid (5 %),
in einer galenisch stabilen, wässrigen Formulierung enthält (DuacR). Es hat antimikrobielle, anti-inflammatorische und komedolytische Eigenschaften.
Die überlegene Wirksamkeit dieser Wirkstoffkombination im Vergleich zu den Einzelsubstanzen
ist in mehreren Doppelblindstudien belegt. Ein wichtiger Vorteil des Kombinationspräparates
besteht in einem raschen Wirkungseintritt, der vielfach bereits nach 2 Wochen zu einer
klinisch erkennbaren, deutlichen Befundbesserung führt. Die hohe Wirksamkeit in Kombination
mit der guten bis sehr guten Verträglichkeit und der einfachen, einmal täglichen Anwendung
führen zu einer verbesserten Patientencompliance. Gleichzeitig wirkt die Kombination
von Clindamycin und Benzoylperoxid einer bakteriellen Resistenzentwicklung gegenüber
dem Antibiotikum entgegen.
Abstract
Acne therapy often requires continuous treatment with a combination of agents with
complementary but different mechanisms of action. A new topical anti-acne drug combines
two of the most effective agents, clindamycin (1 %) and benzoyl peroxide (5 %), in
a stable, aqueous formulation (DuacR). The combination product has antimicrobial, anti-inflammatory, and comedolytic effects.
Several double-blind clinical studies have demonstrated that the combination is more
effective than either individual agent. Clinical efficacy leading to marked improvement
as early as week 2 is an important advantage of the combination. The high efficacy
and good to excellent tolerability of the combination as well as the simple, once-a-day
application encourages the compliance of acne patients. In addition, the combination
of clindamycin and benzoyl peroxide is helpful to prevent the development of bacterial
resistance against the antibiotic.
Literatur
- 1
Breneman D, Savin R, Van de Pol C, Vamvakias G, Levy S, Leyden J.
Double-blind, randomized, vehicle-controlled clinical trial of once-daily benzoyl
peroxide/clindamycin topical gel in the treatment of patients with moderate to severe
rosacea.
Int J Dermatol.
2004;
43
381-387
- 2
Berson D S, Shalita A R.
The treatment of acne: the role of combination therapies.
J Am Acad Dermatol.
1995;
32
S31-S41
- 3
Bikowski J.
Clinical experience with clindamycin 1 % benzoyl peroxide 5 % gel (DuacR) as monotherapy and in combination.
J Drugs Dermatol.
2005;
4
164-171
- 4 Bojar R A, Holland K T. Unveröffentlichte Daten. Offenbach am Main; Stiefel Laboratorium
GmbH 2003
- 5
Cook-Bolden F E, Barba A, Halder R, Taylor S.
Twice-daily applications of benzoyl peroxide 5 %/clindamycin 1 % gel versus vehicle
in the treatment of pseudofolliculitis barbae.
Cutis.
2004;
73 (Suppl 6)
18-24
- 6
Decker L C, Deuel D M, Sedlock D M.
Role of lipids in augmenting the antibacterial activity of benzoyl peroxide against
Propionibacterium acnes.
.
Antimicrob Agents Chemother.
1989;
33
326-330
- 7
de Groot A C.
Contact allergy to clindamycin.
Contact Dermatitis.
1982;
8
428
- 8 Donald A E, Langner A, Sheehan-Dare R, Layton A. Efficacy of a new topical acne
gel containing 1 % clindamycin and 5 % benzoyl peroxide compared with a solution containing
40 mg/ml erythromycin and 12 mg/ml zinc acetate. New Orleans, USA; 63th Annual Meeting
of the American Academy of Dermatology 18. 02. - 23. 02. 2005 (Abstract P130)
- 9
Draelos Z D.
Therapeutic moisturizers.
Dermatol Clin.
2000;
18
597-607
- 10
Eady E A, Gloor M, Leyden J J.
Propionibacterium acnes resistance: a worldwide problem.
Dermatology.
2003;
206
54-56
- 11
Esterly N B, Furey N L, Flanagan L G.
The effect of antimicrobial agents on leukocyte chemotaxis.
J Invest Dermatol.
1978;
70
51-55
- 12 Fachinformation DuacR Akne Gel .. Offenbach am Main; Stiefel Laboratorium GmbH
Stand: April 2005
- 13
Fagundes D S, Fraser J M, Klauda H C.
New therapy update - A unique combination formulation in the treatment of inflammatory
acne.
Cutis.
2003;
72 (Suppl 1)
16-19
- 14
Forssmann T, Gloor M, Gehring W.
Antibiotikaresistenzen bei Acne vulgaris - Eine retrospektive Untersuchung an einem
antibiotisch vorbehandelten und einem unbehandelten Kollektiv.
Zeitschr Hautkr.
1994;
69
828-832
- 15
Goldstein J A, Pochi P E.
Failure of benzoyl peroxide to decrease sebaceous gland secretion in acne.
Dermatologica.
1981;
162
287-291
- 16
Guin J D, Lummis W L.
Comedonal levels of free clindamycin following topical treatment with a 1 % solution
of clindamycin phosphate.
J Am Acad Dermatol.
1982;
7
265-268
- 17
Guin J D, Reynolds R, Gielerak P L.
Penetration of topical clindamycin into comedones.
J Am Acad Dermatol.
1980;
3
153-156
- 18
Harkaway K S, McGinley K J, Foglia A N, Lee W L, Fried F, Shalita A R, Leyden J J.
Antibiotic resistance patterns in coagulase-negative staphylococci after treatment
with topical erythromycin, benzoyl peroxide, and combination therapy.
Br J Dermatol.
1992;
126
586-590
- 19
Jansen T, Plewig G, Kligman A M.
Pathophysiology of acne.
Dermatol Ther.
1998;
6
7-17
- 20
Kligman A M, Leyden J J, Stewart R.
New uses for benzoyl peroxide: a broad-spectrum antimicrobial agent.
Int J Dermatol.
1977;
16
413-417
- 21 Korting H C, Callies R, Reusch M, Schlaeger M, Sterry W (Hrsg). Dermatologische
Qualitätssicherung. Leitlinien und Empfehlungen. 4. Aufl. Berlin; ABW Wissenschaftsverlag
2005: 62-69
- 22
Leyden J J, Hickman J G, Jarratt M T, Stewart D M, Levy S F.
The efficacy and safety of a combination benzoyl peroxide/clindamycin topical gel
compared with benzoyl peroxide alone and a benzoyl peroxide/erythromycin combination
product.
J Cutan Med Surg.
2001;
5
37-42
- 23
Leyden J J, Thiboutot D, Shalita A R.
Photographic review of results from a clinical study comparing benzoyl peroxide 5
%/clindamycin 1 % topical gel with vehicle in the treatment of rosacea.
Cutis.
2004;
73 (Suppl 6)
11-17
- 24
Lookingbill D P, Chalker D K, Lindholm J S, Katz H I, Kempers S E, Huerter C J, Swinehart J M,
Schelling D J, Klauda H C.
Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with
clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind
investigations.
J Am Acad Dermatol.
1997;
37
590-595
- 25
Milstone E B, McDonald A J, Scholhamer C F Jr.
Pseudomembranous colitis after topical application of clindamycin.
Arch Dermatol.
1981;
117
154-155
- 26
Naidoo J, Noble W C.
Skin as a source of transferable antibiotic resistance in coagulase-negative staphylococci.
Zentralbl Bakteriol Microbiol Hyg.
1987;
263 (Suppl 16)
225-234
- 27
Ozolins M, Eady E A, Avery A J, Cunliffe W J, Po A L, O’Neill C, Simpson N B, Walters C E,
Carnegie E, Lewis J B, Dada J, Haynes M, Williams K, Williams H C.
Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory
facial acne vulgaris in the community: randomised controlled trial.
Lancet.
2004;
364
2188-2195
- 28
Pagnoni A, Kligman A M, Kollias N, Goldberg S, Stoudemayer T.
Digital fluorescence photography can assess the suppressive effect of benzoyl peroxide
on Propionibacterium acnes.
.
J Am Acad Dermatol.
1999;
41
710-716
- 29
Parry M F, Rha C K.
Pseudomembranous colitis caused by topical clindamycin phosphate.
Arch Dermatol.
1986;
122
583-584
- 30
Plewig G, Schöpf E.
Anti-inflammatory effects of antimicrobial agents: an in vivo study.
J Invest Dermatol.
1975;
65
532-536
- 31
Rozman T A, Kompa H, Klövekorn G.
Klinische Erfahrungen mit Benzoylperoxid in alkoholfreien Grundlagen in der Behandlung
der Acne vulgaris.
Dtsch Dermatol.
1984;
32
519-531
Dr. Thomas Jansen
Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie der Universität
Essen
Hufelandstraße 55 · 45122 Essen
eMail: thomas.jansen@medizin.uni-essen.de
