Zenerite: will cure skin from acne

A combined antimicrobial and anti-inflammatory drug for external use is one of the most effective for clearing acne from the skin. In just a few applications, Zinerit dries and eliminates painful rashes, allowing you to avoid subsequent troubles with scars and uneven complexion.

Composition and release form

Table

Composition of the drug before mixing the contents of the bottles and after preparing the solution

* the amount of active components, erythromycin and zinc acetate dihydrate, was increased by 3.35% in order to compensate for their concentrations in the preparation of the finished product, the nominal volume of which increases when the active components are mixed with the solvent (every 1000 mg of powder is equivalent to 0.79 ml).

** an additional increase in the amount of active components, erythromycin and zinc acetate dihydrate, by 5% is associated with maintaining the declared concentrations of the finished drug during storage.

in a bottle, complete with solvent in a 30 ml bottle and an applicator; 1 set in box.

How does Zinerit work?

The combination of zinc salt and erythromycin provides strong activity against various infectious pathogens that provoke the development of acne:

• against epidermal streptococcus;
• propionibacterium acne.

The antibiotic suppresses the proliferation of pathogenic bacteria, promoting their death. Zinc has an astringent and antiseptic effect, dries out rashes, reduces inflammatory reactions, forms a thin protective film on the surface, and accelerates cell regeneration. Zinerite helps cleanse pores of impurities and accumulations of sebum clots, facilitates the removal of excess secretions, and prevents the progression of acne and its relapses.

When applied topically, the drug is almost not absorbed orally; the mixture of its components forms tight compounds with biological components, unable to penetrate the bloodstream. Microscopic doses of Erythromycin may appear in the body, but do not lead to further resistance of the opportunistic microflora of the body to antibiotics of this group.

Contraindications and side effects

It is necessary to refuse treatment for acne with Zinerit if the body has developed immunity to macrolides or there is intolerance to one or more pharmaceutical components of the solution. Signs of an allergic reaction to Zinerit can be: increasing redness of the skin at the sites where the drug is applied, increased pain, unbearable itching, swelling.

Normally, after using the solution, a feeling of tightness, dryness, and a slight burning sensation is likely to appear. The discomfort is short-term and goes away on its own within a few hours. Most people who use Zinerit do not have any unpleasant symptoms.

Zinerit 30ml powder for preparing a solution for external use

pharmachologic effect

Acne rash treatment.

Composition and release form Zinerit 30ml powder for preparing a solution for external use

The packaging of the drug consists of two bottles, one of which contains active substances in the form of a powder, and the other contains auxiliary components in the form of a solution. Before mixing, the contents of the bottles have the following composition:

• Active substances (in the first bottle): Erythromycin 100% (Ph.Eur.) - Nominal amount 1200 mg/30 ml; *Quantity including 3.35% 1240; **Quantity including 5% 1302; Zinc acetate dihydrate, micronized (Ph.Eur.) - Nominal amount 360.0 mg/30 ml; *Quantity including 3.35% 372.0; **Quantity including 5% 389.4;
• Auxiliary components (in the second bottle): Diisopropyl sebacate (monograph) - Nominal amount 7.81 (8.36 ml) g/30 ml; Ethanol (Ph.Eur.) - Nominal amount 17.1 (21.6 ml) g/30 ml.

1 ml of the prepared drug has the following composition:

• Erythromycin 100% - 40 mg;
• Zinc acetate dihydrate, micronized - 12 mg;
• Diisopropyl sebacate - 0.25 g;
• Ethanol - 0.55 g.

* the amount of active components, erythromycin and zinc acetate dihydrate, was increased by 3.35% in order to compensate for their concentrations in the preparation of the finished product, the nominal volume of which increases when the active components are mixed with the solvent (every 1000 mg of powder is equivalent to 0.79 ml).

** an additional increase in the amount of active components, erythromycin and zinc acetate dihydrate, by 5% is associated with maintaining the declared concentrations of the finished drug during storage.

Powder for preparing a solution for external use (complete with solvent).

In 30 ml bottles and an applicator in a cardboard box with instructions for use.

Description of the dosage form

The prepared solution is a colorless transparent liquid.

Characteristic

Erythromycin-zinc complex.

Directions for use and doses

Tilting the bottle down, with light pressure on the applicator, apply a thin layer to the entire affected area of ​​the skin 2 times a day: in the morning (before applying makeup) and in the evening (after washing).

The speed of applying the lotion is regulated by the force of pressing the applicator on the skin. An approximate single dose is 0.5 ml.

After drying, the lotion becomes invisible.

The course of treatment is 10-12 weeks. (improvement is possible within 2 weeks).

Pharmacodynamics

Zenerit is an erythromycin-zinc complex.

It has anti-inflammatory, antimicrobial and comedolytic effects.

Erythromycin has a bacteriostatic effect on microorganisms that cause acne: Propionibacterium acne and Streptococcus epidermidis.

Zinc reduces the production of sebaceous gland secretions and has an astringent effect.

Pharmacokinetics

The complex connection of the drug components ensures good penetration of the active substances into the skin.

Zinc is primarily bound to the follicular epithelium and is not resorbed into the systemic circulation.

A small part of erythromycin undergoes systemic distribution and is subsequently excreted from the body.

Indications for use Zinerit 30ml powder for preparing a solution for external use

Acne

.

Contraindications

Increased sensitivity.

Application of Zinerit 30ml powder for the preparation of a solution for external use during pregnancy and breastfeeding

There are no contraindications.

special instructions

The possibility of developing cross-resistance to other macrolides, lincomycin, and clindamycin should be taken into account. Avoid contact with eyes, mucous membranes of the mouth and nose (possible irritation or burns).

Overdose

Accidental overdose is unlikely due to the nature of the topical use of the drug.

Side effects of Zinerit 30ml powder for the preparation of a solution for external use

• burning sensation;
• skin irritation;
• dry skin.

Drug interactions

To date, no clinically significant interactions of Zinerit® with other drugs have been established.

How to use the drug: instructions

Before the first procedure, it is necessary to properly prepare the solution:

• unscrew the caps from the bottles;
• pour the solvent into a container with antibiotic and zinc powder;
• screw the bottle on and shake vigorously until all components are mixed;
• open the preparation again and screw the applicator.

Apply the prepared solution onto the skin, moistening all inflammatory elements and nodules, then close tightly. After the first use, the drug remains active for about 5 weeks. It must then be disposed of. Store the liquid tightly closed, preferably in a cool place away from sunlight.

The solution is applied to the acne areas by placing the applicator on the skin and lightly pressing the bottle.

• After moistening the rash with liquid, you need to refrain from water procedures and the use of cosmetics for 2 hours. After drying, Zinerite becomes transparent and is not visible visually, so you should not be afraid of additional cosmetic problems.
• The procedure is repeated twice a day, applying the drug to cleansed skin. You can reapply Zenerite before going to bed.
• Duration of treatment: from 4 to 10 weeks; if the rash is eliminated earlier, the course can be completed ahead of schedule. Too long use can provoke the development of microbial resistance to macrolide antibiotics.

When using the solution, it is important to be careful not to allow it to come into contact with the mucous membranes of the eyes and skin of the lips, otherwise severe irritation may occur.

Acne (acne vulgaris, acne) is one of the most common skin diseases, affecting up to 85% of people aged 12 to 24 years. In the age groups 25–34 and 35–44 years, the incidence of acne is 8 and 3%, respectively. The incidence of severe forms, according to various authors, is 5–14% of the total incidence of acne.

Acne as a skin lesion in adolescence has been known since ancient times. Until the 17th century Three terms have been used to characterize these lesions. Ionthos is a Greek word meaning “bearded” and describes the rash that appears along with the growth of a beard. The Latin word varus means “papular eruptions on the face.” The term “acne” appears to be due to a scribal error that transformed the Greek word akme (top) or achne (foam) into acne. The term “acne” was first used in literature in 542 BC. e. Aethius is the personal physician of Emperor Justinian. The Viennese physician Herba (1816–1877) associated acne with damage to the sebaceous gland (SG) in the pilosebaceous follicle (SVF) and gave a description of the process close to modern ones.

Pathogenesis of acne

Most SGs are structurally associated with hair follicles of long, bristly or vellus hair. Depending on the type of hair and the size of the SF flowing into its follicle, it is customary to distinguish three types of SVF. The first is represented by terminal hair and large SGs (involved in the pathological process in hidradenitis). SVF of the second type - vellus hair - has tiny hair, a large excretory opening and disproportionately large SGs. The third type of SVF, which is involved in the pathological process in acne to the greatest extent, consists of rudimentary hair, which practically does not come to the surface of the skin, and large multi-lobed SGs.

SF flow into the follicular canal at a certain level, due to which the SVF duct is usually divided into two parts - acro- and infrainfundibulum. The epithelium of the upper part, like the epidermis, is keratinized, and the longer lower part of the duct (4/5 of the length), like the SG ducts, is lined with multilayered squamous non-keratinizing epithelium. Normally, the cohesion of cells in it is low, and they are quickly washed away by sebum onto the surface of the epidermis.

In the pathogenesis of acne, leading importance is given to four factors (see figure). The initial link is hereditarily caused hyperandrogenism (HA), which can manifest itself in the form of an absolute increase in the amount of hormones (absolute GA) or increased sensitivity of receptors to a normal or reduced amount of androgens in the body (relative GA).

The onset of functioning in puberty of the hypothalamus–pituitary–gonadal system is characterized by a sharp increase in the synthesis of testosterone, the main steroid of the testes. The formation of estrogens (mainly estradiol) begins in the ovaries, the immediate precursor of which is androstenedione, the main androgen of the ovaries.

A certain contribution to the synthesis of androgens in the body (especially in women) is made by the adrenal cortex. Its zona reticularis produces the main androgen precursor, dehydroepiandrosterone, which, after isomerization to androstenedione, is reduced to testosterone. The production of androgens in the adrenal glands increases markedly if the biosynthesis of glucocorticoids is disrupted due to a deficiency of one of the hydroxylases (adrenogenital syndrome).

Hyperandrogenism of gonadal origin is possible with excessive stimulation of the gonads by luteinizing hormone of the pituitary gland, with tumor degeneration of androgen-producing cells (Leydig in the testes and theca cells in the ovaries) or with a deficiency of enzymes that catalyze the transition of testosterone to estradiol. The main part of testosterone (97–99%) circulating in the blood is in a bound state (with sex hormone binding globulin - SHBG).

Conditions of relative GA are more common with normal or reduced levels of androgens in the body. In SG cells - sebocytes - testosterone under the action of the enzyme 5α-reductase type 1 is converted into a more active metabolite - dihydrotestosterone, which is a direct stimulator of the growth and maturation of sebocytes, the formation of sebum. The main causes of relative GA are increased activity of 5α-reductase type 1, increased density of nuclear receptors for dehydrotestosterone, or an increase in the free fraction of testosterone in the blood as a result of decreased synthesis of SHBG in the liver. Thus, the changes in hormonal levels noted above lead to an increase in the size of the SG and their increased functioning.

The key element in the pathogenesis of acne is follicular hyperkeratosis. In the increased volume of sebum, the concentration of essential α-linolenic (cis-9,12,15-octadecatrienoic) acid (LA) decreases. Its deficiency may be due to both a deficiency in food and a deficiency of enzymatic systems that ensure the entry of LA into the body and distribution in it. By suppressing the expression of the transglutaminase enzyme, LA is the main regulator of keratinocyte differentiation. Transglutaminase is involved in the synthesis of keratin 1 and 10 fractions, proteins involucrin, loricrin and fillagrin - the main components of the cementing intercellular substance of corneocytes. Increased transglutaminase activity causes retention hyperkeratosis in the infrainfundibulum of the SVF. The predominance of the processes of proliferation and dyskeratosis over desquamation of the epithelium ultimately leads to the closure of the SVF duct. If obstruction predominates in the acroinfundibulum, an open comedon is formed, the black color of which is due to the oxidation products of sebum lipids, mainly squalene, and not melanin, as previously thought. Obturation in the infrainfundibulum area of ​​the SVF leads to the formation of a closed comedon. Obstruction of the SVF duct by comedones creates favorable anaerobic conditions for the proliferation of facultative anaerobes Propionibacterium acnes and Propionibacterium granulosum.

The SVF duct is inhabited by aerobic staphylococcus and micrococci, facultative anaerobes P. acnes and P. granulosum. Anaerobic conditions in the infrainfundibulum of the SVF are unacceptable for aerobic bacteria, therefore staphylococcus and micrococci are localized in the acroinfundibulum and do not play a significant role in the pathogenesis of acne, unlike P. acnes [4].

The density of skin colonization with P. acnes changes with age, reaching a maximum during puberty. The highest density of P. acnes is observed in seborrheic areas, since sebum is a breeding ground for these microorganisms.

It has been established that P. acnes has a direct and indirect effect on the occurrence of both non-inflammatory (open and closed comedones) and inflammatory acne (papules, pustules, nodules). Extracellular lipase of microorganisms hydrolyzes sebum triglycerides to glycerol, which is a nutrient substrate for microorganisms, and free fatty acids, which have comedogenic properties.

Pro-inflammatory factors, such as interleukins (IL) 1a, 1b and 8, tumor necrosis factor a, acting on the SVF wall, activate keratinization processes, making a significant contribution to the implementation of the second factor in the pathogenesis of acne - follicular hyperkeratosis. The concentration of IL-1a in the area of ​​open comedones is 1000 times higher than that in areas of healthy skin [4, 5].

IL-1a activates hyperkeratotic processes by directly stimulating receptors on keratinocytes and increasing the release of other bioactive molecules, such as vascular endothelial growth factor and retinoic acid binding protein. In addition, P. acnes has been shown to produce vasoactive amines similar to histamine, which increase inflammation.

Pro-inflammatory cytokines activate the enzyme cyclooxygenase, as a result of which the main inflammatory mediator, leukotriene B4, is formed from arachidonic acid, which stimulates Langerhans cells, neutrophils, T-lymphocytes, monocytes and eosinophils with their subsequent release of hydrolytic enzymes and nitric oxide. Destruction of the SG wall with the release of its contents into the dermis causes a picture of inflammation, which manifests itself in the form of papules, pustules, nodules and cysts.

Clinical picture of acne

Acne rashes are represented by a pseudopolymorphic rash, which is characterized by a clear stage in the evolution of elements. Initial skin changes in acne are represented by open or closed (according to the level of obstruction of the SVF duct) comedones. A comedon is a “cast” of the SVF duct, consisting of rejected corneocytes and microorganisms glued together with sebum. Open comedones, unlike closed comedones, resolve spontaneously and without a trace in approximately 80% of cases. The addition of an inflammatory reaction around the comedone leads to its destruction and the subsequent formation of papules and then pustules. The development of an inflammatory reaction in the dermis leads to the formation of nodes, and when they suppurate, cysts. The resolution of comedones, papules and pustules occurs without a trace. Nodules and cysts leave behind foci of dyspigmentation and, depending on the fibroplastic response of the skin, hypotrophic (ice-pick), hypertrophic or keloid scars. True acne must be differentiated from acne-like rashes based on the signs presented in table. 1.

To assess the severity of acne in practical conditions, the most convenient classification is proposed by the American Academy of Dermatology (in our modification):

• I degree is characterized by the presence of comedones (open and closed) and up to 10 papules;
• II degree – comedones, papules, up to 5 pustules;
• III degree – comedones, papulopustular rash, up to 5 nodes;
• IV degree is characterized by a pronounced inflammatory reaction in the deep layers of the dermis with the formation of multiple painful nodes and cysts; the severity of skin lesions was within grades II and III.

Acne treatment

To cope with grade I acne and prevent further transformation of comedones into inflammatory elements, it is often sufficient to prescribe medicinal cosmetics that provide both regression of acne elements and skin care. For more severe forms of acne, a properly selected range of medicinal cosmetics used during drug therapy, as well as after its completion, can reduce the treatment time and achieve consolidation of the results of anti-acne treatment.

Anti-acne agents used today include both systemic and local drugs. The choice of treatment method should be determined by the severity and distribution of the rash (face, torso).

A fairly large group of products is represented by retinoids for local and systemic use. Retinoids are any agents capable of inducing specific biological responses by binding and activating retinoic acid receptors. Based on their chemical structure, all retinoids are divided into four groups, or generations. In the treatment of acne, first-generation retinoids are used - derivatives of retinoic acid (retinol, tretinoin, isotretinoin) and retinoid-like compounds (fourth generation retinoids) for local therapy - adapalene, a derivative of naphthoic acid. The therapeutic effectiveness of retinoids is associated with the activation of retinoid-sensitive receptors of type g, localized in the SVF duct, which leads to a decrease in the cohesion of keratinocytes and accelerates their desquamation, i.e., an anti-comedogenic effect is realized.

Benzoyl peroxide (BP) preparations have antimicrobial, anti-inflammatory and comedolytic activity. Being a powerful oxidizing agent, BP, in contact with the cell membrane of bacteria, has a bactericidal effect. Benzoic acid formed during the destruction of BP acts bacteriostatically. Benzoic acid does not accumulate in tissues, does not have a systemic effect and is quickly excreted unchanged in the urine. The anti-inflammatory effect of BP consists of the inactivation of free radical oxygen species at the site of inflammation and the destruction of free fatty acids (a 50% reduction in the amount within 15 days). The comedolytic effect is explained by the fact that BP, by its chemical structure, is a peroxide (i.e., a strong oxidizing agent), which destroys the structures of the comedones. Preparations based on BP effectively act on P. acnes and other microorganisms without the development of microbial resistance, which allows them to be used for a long time.

Based on the etiopathogenesis of acne, for the treatment of this disease in women, substances that have a suppressive effect on the GA state, i.e., antiandrogens, seem to be adequate and pathogenetically substantiated means.

Among the drugs that affect the severity of androgenization, combined oral contraceptives (COCs) are the most widely used. Taking into account the anti-acne effect in dermatological practice, preference among COCs is given to monophasic low-dose drugs that include a gestogen with antiandrogenic activity. COCs containing 0.035 mg ethinyl estradiol and 2 mg cyproterone acetate or 0.03 mg ethinyl estradiol and 3 mg drospirenone meet these requirements.

The anti-acne effect of COCs is complex. Firstly, exogenously administered ethinyl estradiol and gestogen through a negative feedback mechanism, suppressing the production of follicle-stimulating and luteinizing hormones by the pituitary gland, reduce the synthesis in the ovaries of both estrogens and progesterone, and their precursors - androgens. Secondly, ethinyl estradiol increases the production of SHBG in the liver, with which it binds (i.e. is in an inactive state) up to 99% of androgens.

Exacerbation of acne in the second half of the menstrual cycle is caused, on the one hand, by increased stimulation of the androgen receptors of the SVF by progesterone and androgens, and on the other hand, by perifollicular edema, which aggravates the obstruction of the SVF duct. A significant increase in the amount of estrogen in the second phase of the cycle stimulates the synthesis of angiotensinogen (the precursor of angiotensin II) in the liver, which in turn induces the production of aldosterone by the adrenal glands.

Azelaic acid (15% gel, 20% cream) has a comedolytic, antibacterial and anti-inflammatory effect, which is applied to a previously cleansed face with acne severity I–II twice a day for at least six months.

Antibiotics have pronounced antimicrobial and anti-inflammatory effects in acne. As monotherapy and in combination with other anti-acne drugs, systemic antibiotics for grades II–IV of the process (especially when the rash is localized other than the face on the torso) are used for three to six months. The most common among them are: doxycycline (100 mg 2 times a day), tetracycline (500 mg 2 times a day), clindamycin (150–300 mg 3 times a day) and erythromycin (500 mg 2 times a day) [2, 7, 9]. In Europe, minocycline (100 mg/day) is widely used, which is one of the most effective antibiotics for acne, associated with a minimal risk of developing resistance to it and the development of adverse reactions (disorders from the gastrointestinal tract, vaginal candidiasis, etc.). Less commonly, sulfonamides are used as antimicrobial agents (co-trimoxazole - 480 mg 2 times a day) [1, 5, 6].

Among local antibacterial agents, erythromycin (Zinerit) and clindamycin (Dalacin-T) preparations deserve attention. Local antibacterial drugs are used for acne of II–III severity, both as monotherapy and in combination with topical retinoids for at least 3 months.

The main adverse reaction during long-term antibiotic therapy for acne is gram-negative folliculitis (GNF). Type 1 GNF is characterized by a rash grouped in the perioral and perinasal areas (but other localization is also possible) in the form of pustules with whitish contents, surrounded by a narrow rim of hyperemia; type 2 GNF is characterized by a papular-nodular rash, from which microorganisms of the genus Proteus are inoculated. Etiopathogenetically, the basis of GNF is a violation of the bacterial biocenosis in the SVF. Long-term use of antibiotics suppresses the vital activity of the gram-positive saprophytic flora of the skin, which inhibits the growth of gram-negative microorganisms [3, 8].

Slower healing of inflammatory acne is due to the presence of inflammatory mediators synthesized by P. acnes, the expressed resistance of P. acnes to destruction by neutrophils and monocytes, and the persistence of P. acnes (phagocytosed bacteria remain viable for a long time, despite the antimicrobial effect). In addition, hypersecretion of sebum does not allow creating the necessary concentration of the antibiotic in the ducts of the gastrointestinal tract. Therefore, to reduce the mass of P. acnes in spill elements by 10% of their initial amount, at least a three-week treatment period is required.

Among the antibiotics recommended for the treatment of acne presented on the domestic pharmaceutical market, we focused on a drug for external use - Zenerit lotion (Astellas Pharma, the Netherlands), which is a combination of erythromycin (4%) and zinc acetate (1.2%).

Zinerit lotion is available without a prescription. Using an applicator, it is applied in a thin layer to the acne-affected area of ​​the skin. To do this, tilt the bottle down with light pressure. The application speed can be adjusted by the pressure applied by the applicator. An approximate single dose is 0.5 ml, in a bottle – 30 ml. After drying, the solution becomes transparent and leaves no marks on the skin or clothing. Zinerit must be used 2 times a day, the average duration of treatment is 10–12 weeks. Zinerit can be combined with other local and systemic anti-acne drugs.

The pronounced anti-acne effect of Zinerit lotion is explained by its reaction to all parts of the pathogenesis of acne. Erythromycin binds to the 50S ribosomal subunit, which is found only in bacteria, which leads to disruption of protein synthesis and stops the growth of microorganisms. An important effect of erythromycin on acne is its effect on P. acnes. The concentration of erythromycin (4%) promotes optimal penetration of the drug into the skin. By reducing microbial contamination, erythromycin eliminates or sharply weakens both follicular hyperkeratosis and the inflammatory response.

Zinc, which is part of Zinerit, inhibits 5α-reductase type 1, thereby preventing the transformation of testosterone into DTS and, as a result, weakens the initial factor in the pathogenesis of acne - androgen-induced hypersecretion of sebum. In addition, zinc has an anti-inflammatory and antiseptic effect and promotes epithelization.

The purpose of our work was to evaluate the anti-acne effectiveness and tolerability of Zinerit lotion, used as monotherapy in men and women with acne of II and III severity, as well as in combination with COCs in women with acne of III severity.

5 men and 9 women with acne of II severity and 12 men and 10 women with acne of III severity received monotherapy with Zenerit lotion for 3 months. During the first three months of treatment, 27 women with grade III acne who were prescribed systemic anti-acne therapy in the form of COCs (0.035 mg ethinyl estradiol and 2 mg cyproterone acetate) for a period of 6 months were also prescribed local anti-acne therapy with Zinerit lotion.

The dynamics of the number of open and closed comedones, papules and pustules was assessed before the start of treatment, after 1, 2 and 3 months of therapy. Before the start of treatment and after 3 months, along with counting acne elements, the level of sebum secretion (USS) was determined using the Sebumeter SM 810 device (Courage + Khazaka electronic GmbH, Germany), the operating principle of which is based on the quantitative determination of sebum by photometry. The normal level of USCS is 60–90 and 10-6 g/cm2.

After three months of treatment, a more pronounced anti-acne effect was observed in patients receiving COCs in combination with Zinerit lotion. By the end of the course of monotherapy with Zinerit lotion, a state of clinical cure was recorded in 28.6 and 31.8% of patients with acne of II and III severity, respectively. In patients with grade III acne who received COCs in combination with Zinerit lotion, clinical cure was observed in 48.2% of cases (Table 2).

During the first half of the course of treatment, in the first two groups of patients receiving monotherapy with Zinerit lotion, there was a more pronounced regression of pustules (by 81.6%) and open comedones (by 64.5%) than during the second half of the course. During the second half of the course of therapy (compared to the first), more pronounced dynamics were noted in the regression of closed comedones (by 75.3%) and papules (by 74.2%). During the first half of the course of therapy, the degree of regression of these elements was 50.3 and 46.5%, respectively.

In patients of the third group who received COCs in combination with Zinerit lotion, during the first and second half of the treatment period there was a more pronounced regression of inflammatory elements (by 62.8 and 64.2%) compared to non-inflammatory elements (by 48.6 and 56. 6%). The dynamics of regression of open comedones, papules and nodes was approximately the same during the first and second half of the treatment period. During the second half of the course of therapy, the dynamics of regression of pustules was ahead of that during the first half of the course (86.0 compared to 76.7%).

SVR (10-6 g/cm2) before treatment and after 3 months of therapy was respectively: 212 ± 25 and 163 ± 12.3 – in patients of the first group, 226 ± 28.3 and 142 ± 18.1 – in patients of the second group and 241 ± 35 and 108 ± 12.8 – in women of the third group.

Treatment with Zinerit lotion was well tolerated in all patients. Four patients from the third group during the first week from the start of treatment noted slight dry skin after applying the drug. Additionally, they were recommended moisturizing medicinal cosmetics, which allowed them to eliminate the phenomenon of dryness within three to five days.

Thus, taking into account the effect of Zinerit lotion on all parts of the pathogenesis of acne, as well as the results of our own observations on the effectiveness of therapy with this drug, Zinerit lotion can be recommended as a first-line treatment for up to three months for patients with acne of degrees II and III with pronounced inflammatory changes . Women with acne of III severity when the process is localized on the face and torso should be prescribed combination therapy with Zinerit lotion and COC containing 0.035 mg of ethinyl estradiol and 2 mg of cyproterone acetate.

Zenerite

Zinerit (erythromycin + micronized zinc acetate dihydrate) is a combination drug for the treatment of acne from the Dutch pharmaceutical company ASTELLAS PHARMA EUROPE. Acne is a disease of the sebaceous glands. Acne (comedones) are formed due to blockage of the sebaceous gland ducts with sebum and dead epidermis. Comedones that lie under a thin layer of skin are called closed comedones. For bacteria, they are an ideal place for growth and reproduction, and therefore for the development of a local source of inflammation. Conventional cosmetics, due to their high fat content, only aggravate acne and are contraindicated for this dermatological disease. The problem can be solved exclusively with medication, and treatment should begin as early as possible to prevent scarring. If treatment is started late, the risk of scar tissue forming that cannot be removed is much higher. Zenerite is a reliable remedy for acne. Available in powder form for dissolution. The kit also includes a solvent and an applicator for external application of the resulting solution. It has anti-inflammatory, antibacterial and acnelytic and comedolytic effects. The antibiotic erythromycin is a bacteriostatic and inhibits the growth and development of bacteria that cause acne: propionbacterium acne and epidermal streptococcus. The complex composition of the drug ensures good penetration and rapid penetration of the active ingredients into the area of ​​therapeutic action.

Zinc interacts with the epithelium of the follicles and is not absorbed into the systemic circulation. Erythromycin enters the systemic circulation, but in negligible quantities, insufficient to develop systemic side effects. Zinc has an astringent effect and suppresses the activity of the sebaceous glands in secretion production. Zinerit is indicated for use for all types of acne. Visible results are observed after 10-14 days of regular use of the solution. The drug is compatible with cosmetics (with one caveat: the latter should not be too greasy). One of the advantages of the drug is ease of use, in which the built-in applicator plays an important role. The drug is well tolerated. The auxiliary substances included in its composition soften the skin, preventing its irritation. Zinerit can be used during pregnancy and breastfeeding. After eight weeks of medication, the severity of acne in severe cases of the disease is reduced by half. Frequency of use: twice a day (morning and evening). The approximate single dose is 0.5 ml. The duration of the treatment course is 10-12 weeks. The only side effect is local reactions (slight burning, feeling of dry skin). Precautions must be taken to prevent the solution from coming into contact with the eyes.