Comparison of the effectiveness of Skinoren and Skinoclear
The effectiveness of Skinoren is quite similar to Skinoclear - this means that the ability of the drug substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Skinoren is more pronounced, then using Skinoklir even in large doses will not achieve this effect.
Also, the speed of therapy - an indicator of the speed of therapeutic action - for Skinoren and Skinoklir are approximately the same. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.
How does Skinoren work?
The therapeutic effect of Skinoren is due to the healing properties of azelaic acid, which can reach the deep layers of the epidermis, but practically not enter the general circulatory system.
According to the instructions for use, Skinoren has an effect in four areas:
- cleanses the skin of acne by suppressing the growth of bacteria located on the skin and causing blockage of the sebaceous glands;
- relieves inflammation, thereby preventing the appearance of new acne;
- helps exfoliate dead skin particles from its surface;
- fights skin pigmentation due to the ability to block the production of melanin in excess.
With regular use of the gel or cream, acne, manifestations of rosacea or seborrheic dermatitis, and increased pigmentation of the skin disappear.
A noticeable effect can be seen after 14-28 days of proper use.
Thanks to its more liquid consistency and the absence of an oily base, the gel penetrates the dermis faster and gives faster results compared to cream. In addition, the gel is more suitable for people with oily skin, as it has a watery base.
Comparison of safety of Skinoren and Skinoklir
The safety of a drug includes many factors.
At the same time, in Skinoren it is quite similar to Skinoclear. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing metabolism in Skinoren, as well as in Skinoclear, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Skinoren does not have any risks when used, just like Skinoklir.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Skinoren and Skinoklir.
Types of the drug Skinoren
Skinoren is produced only for the purpose of application to problem skin. The pharmacy sells gel and cream of the same name.
The main component in both drugs is azelaic acid. One gram of gel contains 150 mg of acid, one gram of cream contains a little more - 200 mg.
The 15% gel also contains: triglycerides, sodium hydroxide, lecithin, propylene glycol, disodium ededate, polyacrylic and benzoic acids, polysorbate and purified water.
The gel is a mass of grayish or slightly yellowish color with a weak medicinal odor, opaque. You can buy it in tubes of 15, 30 or 50 g, placed in a box complete with instructions.
Cream 20% additionally contains: benzoic acid, glycerol, macrogol glyceryl stearate, propylene glycol, a mixture of cetostearyl alcohol and coconut oil fatty acid glycerides, cetostearyl ethyl capronate and purified water.
Skinoren cream has a uniform structure and white color. Sold in 30 g aluminum tubes, placed in a cardboard package along with instructions.
Comparison of addiction between Skinoren and Skinokleer
Like safety, addiction also involves many factors that must be considered when evaluating a drug.
So, the totality of the values of such parameters as “o syndrome” in Skinoren is quite similar to the similar values in Skinoklir. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Skinoren has quite a small amount of “syndrome”, just like Skinclear.
Acne and rosacea are the most common diseases in the practice of dermatologists and cosmetologists. Diagnosis and choice of treatment algorithm present certain difficulties. The high prevalence, chronic relapsing course, severe psycho-emotional disorders, decreased quality of life of patients with acne and rosacea explain the importance of the task of further improving therapy.
Rosacea
The mechanisms that cause the pathological process in rosacea and acne are not fully understood. Rosacea is a chronic skin disease with areas of redness (mainly in the facial area), the formation of pustules and other rashes. The RISE study, conducted in Russia and Germany and including 3013 and 3052 individuals aged 18–65 years, respectively, identified 5% of patients with rosacea in Russia and 12% in Germany [1]. Among patients with rosacea in both countries, women accounted for 75% (average age 40 years), patients were characterized by fair skin (phototypes II and III on the Fitzpatrick scale) [2]. The prevalence of rosacea correlates with skin phototype and general solar activity in the region of residence, which demonstrates the key role of insolation in provoking the disease [3].
Rosacea is classified into four subtypes and one disease variant:
- erythematotelangiectatic (subtype 1);
— papulopustular (subtype 2);
— phymatous (subtype 3);
- ophthalmic rosacea (subtype 4).
There is a variant of granulomatous rosacea, which is more often registered in people with skin phototypes IV and V. In the RISE study, the main subtype was erythematotelangiectatic (subtype 1), which is confirmed by the results of other studies [4, 5].
Rosacea is characterized by the formation of erythema, edema, and a sensation of burning pain. Histologically, dilated blood vessels without signs of neoangiogenesis are detected. In all forms of the disease, accumulation of mast cells and fibroblasts is observed in the affected area, which indicates the synthesis of chemokines and growth factors that cause migration of these cells into the dermis. In the erythematous form (the most common), the number of sensory neurons directly involved in the pathogenesis of the disease is increased. Since rosacea causes vasodilation, leading to local enrichment of tissues with nutrients, this may be the cause of a secondary infection. In some patients, Demodex mites are found in areas of inflammation. The role of mites in the pathogenesis of rosacea remains controversial. It has been shown that rosacea is associated with pathology of the digestive tract, dysfunction of the endocrine system, changes in the pilosebaceous apparatus and connective tissue of the dermis, immune disorders, psychovegetative disorders, and an increase in the number of microorganisms on the skin [6-9]. The cause of somatic diseases can be increased vascular reactivity not only of the skin, but also of other organs.
Acne is a skin disease characterized by hyperplasia of the sebaceous glands, hyperkeratosis and the formation of comedones - sebaceous-horny plugs in the ducts of the sebaceous glands with partial or complete blockage. The disease most often begins in puberty with adrenarche and is characterized by increased production of sebum, which leads to a decrease in local immunity in the sebaceous glands and the addition of a secondary infection, most often caused by Propionibacterium acne s
- anaerobic gram-positive bacterium.
Bacteria P.
_
acnes
uses fatty acids in sebum, including propionic acid, which stimulates the proliferation of the microorganism. With excess production, the composition of sebum changes, the level of linoleic acids decreases, the level of squalene and peroxide lipids increases, and the level of saturated fats increases [3, 10, 11]. Comedones develop in areas rich in sebaceous glands: on the face (99%), back (60%) and chest (15%) [12].
Unlike rosacea, acne is a common skin disease, accounting for 20–30% of all cases of dermatological diseases [12]. The progressive course of acne, tolerance to therapy, and cosmetic defects reduce the quality of life of patients, cause significant discomfort and psycho-emotional disorders, mainly of a depressive nature [13, 14].
The pathogenesis of acne is associated with increased sebum production and an imbalance of lipids in the secretions of the sebaceous glands. Colonization of P. acnes
is a consequence of a decrease in local immunity and an additional stimulus for its activation.
Normally, P. acnes
constitutes up to 50% of microorganisms colonizing the skin with a large number of sebaceous glands and only 5-10% in other areas of the body [15]. The inflammatory process in the area of the pilosebaceous follicle leads to the development of follicular hyperkeratosis and obstruction of the ducts of the sebaceous glands (microcomedone, comedo).
Common Characteristics of Rosacea and Acne
Analysis of gene polymorphism shows the presence of a genetic predisposition to both diseases in at least half of the patients [16–25]. However, the prevalence of acne indicates that the pathogenesis of the disease is associated with the polymorphism of many genes [3].
Common to both diseases is the predominant localization of the process on the skin of the face. Innate immunity takes an active part in the effector phase of rosacea and acne. The stratum corneum of the skin represents the main barrier to pathogens. Of great importance is maintaining a certain acidity of the skin, the so-called “Marchionini acid mantle”, consisting of components of sweat and sebaceous secretions, which includes lactic acid, free fatty acids, urocanic acid and other components that provide the skin with an acidic pH (5.3– 5.6). It has been shown that in acne, the pH of the skin increases, which supports the proliferation of the main commensals in the sebum - the P
.
acnes
and, as a result, promotes the activation of innate immune mechanisms, in particular the synthesis of antimicrobial peptides (AMPs) by the cells lining the sweat and sebaceous glands [26].
AMPs are low molecular weight compounds consisting of amino acids (peptides) and have antimicrobial activity against a wide range of microorganisms: gram-negative and gram-positive bacteria, viruses, protozoa and fungi [27]. AMPs are the first line of defense and are constitutionally present; their levels increase with inflammation or injury. AMPs include α-, β- and θ-defensins, cathelicidins, S100 proteins, and RNases.
In the pathogenesis of rosacea, the role of antimicrobial peptides, the synthesis of which is carried out by neutrophils, mast cells, and macrophages located in the perivascular space, has been shown [28–32]. Activation of mast cells results from vasodilation and is associated with the antimicrobial and reparative functions of these cells. A special role in the pathogenesis of rosacea is played by cathelicidin, from which, as a result of proteolytic hydrolysis in cells, the peptide LL-37 is formed, which plays a major role in the pathogenesis of rosacea [32].
The innate immune system is also involved in the development of acne. Changing the amount and composition of sebum activates the immune system long before comedones appear [33]. The main AMPs involved in the pathogenesis of acne are β-defensins 1 and 2 [34–36]. Just like with rosacea, the nerve endings of skin vessels are involved in the pathogenesis of acne; the role of increased production of the neuropeptide corticotropin-releasing hormone and increased expression of the melanocortin 1 receptor has been proven [37-39]. In acne, activation of toll-like receptors on cells of the innate system is also shown [40].
Thus, with acne and rosacea, for various reasons, the normal homeostasis of the facial skin is disrupted, which causes activation of innate immunity, disruption of skin acidity, and the addition of a specific infection, which additionally stimulates innate immunity.
Azelaic acid in the treatment of acne and rosacea
One of the widely used topical agents in dermatology and cosmetology is azelaic acid (AA). AA is the end product of linoleic acid oxidation, which is formed naturally in normal skin. After application to the skin, AK preparations easily penetrate the epidermis and dermis. Up to 4% of the total dose enters the systemic circulation. AK restores the acidity of the skin, which in itself has a healing effect. Thus, other acids, such as retinoic, acetylsalicylic, and fruit acids, also have a therapeutic effect [41, 42]. In addition to influencing skin pH, AA, in particular, suppresses the synthesis of reactive oxygen species by neutrophils and enhances the expression of the p 53
in sebocytes, which leads to their death; has a local antiandrogenic effect by reducing the activity of type I 5a-reductase and, accordingly, reduces the concentration of dihydrotestosterone in sebocytes, thereby normalizing the processes of keratinization and sebum secretion [43, 44]. AA has been shown to have an antioxidant effect, reduce the production of superoxide and hydroxyl radicals, and reduce inflammation [45]. With long-term use of AA, normalization of the differentiation process of epidermal cells is observed, and post-inflammatory hyperpigmentation decreases [46].
According to clinical studies [47], AK is effective both as monotherapy and in combination with antibiotics. AK in the form of monotherapy can be recommended for the treatment of comedonal acne, mild to moderate papulopustular acne, and for maintenance therapy [48, 49]. For severe papulopustular and conglobate acne, a combination of AK with systemic antibiotics is recommended. Monotherapy with AK, benzoyl peroxide (BPO) and topical retinoids has comparable effects [48]. Thus, in the work of H. Gollnick et al. [48] presented data from two clinical studies that included 351 and 229 acne patients on the comparative effectiveness of 15% AA gel with 5% BPO gel and 1% clindamycin gel. The authors showed that the use of drugs for 4 weeks provided equal 70% effectiveness in reducing the number of inflammatory elements in all groups. Side effects in the form of local burning and irritation were more pronounced in the group of patients using BPO than in the group of patients using AK [48]. Minimal side effects were observed in the group of patients treated with clindamycin gel. In a study by G. Stinco et al. [49] studied the sebostatic effect of AA, adapalene and BPO in the treatment of 65 patients with moderate acne. Using sebumetry, the level of sebum secretion in the facial area was assessed. All drugs used had a comparable therapeutic effect, but only AA and BPO provided a decrease in sebum production. According to patients, AA is better tolerated than topical retinoids or BPO. In cosmetology, AK is actively used in the form of peeling for problematic, porous skin and for the treatment of post-inflammatory hyperpigmentation. In Russian recommendations for the management of patients with acne, AK (25% cream or 15% gel) is indicated as a first-line drug for monotherapy of comedonal and inflammatory acne. For the treatment of acne in women, retinoids in combination with AA are recommended as basic therapy.
For external treatment of type 2 rosacea (papulopustular), the Russian Society of Dermatovenereologists and Cosmetologists, as well as the American Acne and Rosacea Society, recommend metronidazole, AK, clindamycin and other drugs [50, 51]. Data from a number of clinical studies have shown the effectiveness of rosacea monotherapy with 15% AA gel [52–55]. A 2016 meta-analysis, which included 57 randomized clinical trials with a total of 13,630 participants (patients with rosacea subtypes 1 and 2), compared the effectiveness of topical drugs metronidazole, AA, ivermectin, brimonidine and others, as well as systemic antibiotics or their combinations with topical retinoids. The best results were shown with the use of topical metronidazole and AA [56, 57]. During long-term therapy, to maintain control of papulopustular rosacea, the use of AC is recommended as maintenance therapy for up to 6 months [58].
Micronization
AK is slightly soluble in aqueous solutions; therefore, the effective concentration is proportional to the dissolved fraction of AK. To increase the effectiveness of poorly soluble substances, micronization and nanonization of drugs are used. Nanized and micronized forms of drugs can increase the bioavailability, solubility and stability of drugs, and improve the penetration of colloids through tissue barriers and cell membranes. From the point of view of biopharmaceuticals, the nanosize is ideal, but from the point of view of drug production, obtaining nanoparticles is problematic, which is associated with the existing methods for their production. For these reasons, micronization of poorly soluble drugs is the most suitable solution. Micronization may involve grinding the active substance using various methods and then introducing it into various carriers (hydrogels, creams, foams).
Russian doctors today have several drugs containing AK in their arsenal, one of them is a micronized drug - 15% Azelik
(JSC Akrikhin).
To increase the effectiveness of high concentrations of AA, it is necessary to increase the solubility of the acid in the gel base. Gel Azelik
15% (JSC Akrikhin, Russia) is the only domestic micronized preparation, the particle size of AA is less than 100 μm [59].
The micronized form ensures easy penetration of the drug through the stratum corneum of the skin, which contributes to the antibacterial, keratolytic and depigmenting effects of AK [59]. This allows Azelik
the drug of choice for the treatment of acne, as well as the first-line drug in the treatment of papulopustular rosacea.
The authors declare no conflict of interest.
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Comparison of side effects of Skinoren and Skinoklir
Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.
Skinoren's side effects are almost the same as Skinoclear's. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Skinoren are similar to Skinoclear: how quickly the body recovers after taking it and whether it recovers at all.
Cautions when using the product
Cream and gel are contraindicated in case of hypersensitivity to azelaic acid or excipients from the composition of the drugs.
In children:
- Do not use both forms of the drug to combat acne until the age of 12;
- not prescribed for the treatment of rosacea and hyperpigmentation in adolescents under 18 years of age.
When diagnosed with bronchial asthma, drugs are prescribed with caution.
The manufacturer of the products warns about the possible occurrence of side effects:
- most often possible: an unpleasant burning sensation and itching, local redness of the skin, peeling of the top layer of skin, tightness and dryness;
- hypersensitivity reactions - swelling of the eyes and face, Quincke's edema, bronchospasm;
- deterioration of the condition - manifestations of seborrhea, discoloration of skin areas, increased appearance of acne.
If the condition worsens or discomfort occurs during the course of treatment, you must stop the drug and visit a doctor.
Comparison of ease of use of Skinoren and Skinoklir
This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.
The ease of use of Skinoren is approximately the same as Skinoclear. However, they are not convenient enough to use.
The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.
Last update date: 2020-12-04 13:47:29
Cream and gel Skinoren: what are the properties?
Skinoren cream has a thick, cream-like consistency. The product is ideal for restoring metabolic processes and improving the condition of problem skin.
Cream Skinoren
Skinoren gel has a light consistency. At the same time, the possibility of rapid and deep absorption of available nutrients is assumed.
Gel Skinoren
In each case, the same effects of the drug are manifested, regardless of the form of release. It is this fact that guarantees the high level of effectiveness of Skinoren. What action is recommended to expect?
- Effective elimination of bacterial microflora. If you do not fight the existing bacteria, there is a serious risk of infection of areas of the skin.
- Normalization of the sebaceous glands. Otherwise, the glands will produce excess sebum, which will lead to acne and other types of rashes.
- Elimination of inflammatory signs, skin irritation, redness. The above signs are typical for any rash.
- Improved skin condition. It is expected to improve the color and texture of the skin.
Despite the high level of effectiveness and similar action, there are serious differences in the use of the proposed means. In each case, you can successfully treat acne and eliminate any skin rashes. At the same time, Skinoren gel acts instantly and is as pronounced as possible, which is why it is recommended for the treatment of inflammatory processes. Skinoren cream is suitable for the treatment of melasma, which leads to pigmentation of the epidermis under the influence of acne or ultraviolet rays.
Skinoren cream is a suitable product for sensitive and dry skin because it has a mild effect. The gel is ideal for oily skin, as it can mattify the face and refresh it. For oily skin, the cream may be too thick, which will only complicate the situation once the pores become clogged.
How to use Skinoren
The cream or gel should be applied only to clean, dry skin. After using the drug, you must wash your hands with soap, and the application area should not be covered with a bandage.
The gel or cream is applied twice a day - in the morning and in the evening. For application to the face, a strip 2.5 cm long is enough; the composition can be lightly rubbed into the skin. This regimen is also suitable for the treatment of acne in adolescents aged 12-18 years.
The minimum duration of treatment for acne is one month, longer use is allowed.
The use of the drug in the treatment of melasma should last for at least three months, rosacea - for at least two months.
If irritation occurs during treatment, it is necessary to reduce the amount of the drug applied or reduce the number of applications to once a day.
If Skinoren is prescribed for the treatment of increased pigmentation, then to prevent exacerbation or relapse it is necessary to use sunscreen.
