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Year : 2009  |  Volume : 75  |  Issue : 7  |  Page : 34

Combination therapy

members Indian Acne Alliance, India

Correspondence Address:
Raj Kubba
Consultant Dermatologist, Kubba Clinic,10, Aradhana Enclave, Ring Road, New Delhi - 110066
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Source of Support: Production and publication of this supplement is made possible by an educational grant from Galderma India Pvt. Ltd., Conflict of Interest: Indian Acne Alliance (IAA) meetings logistics to formulate IAA consensus document DQAcne in India: Guidelines for managementDQ were supported by Galderma India Pvt. Ltd.

PMID: 19282588

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How to cite this article:
Kubba R, Bajaj A K, Thappa D M, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar A J, Khopkar U, Kohli M, Kuriyipe V P, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu K K, Sacchidanand S, Sharma V K, Thomas J. Combination therapy. Indian J Dermatol Venereol Leprol 2009;75, Suppl S1:34

How to cite this URL:
Kubba R, Bajaj A K, Thappa D M, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar A J, Khopkar U, Kohli M, Kuriyipe V P, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu K K, Sacchidanand S, Sharma V K, Thomas J. Combination therapy. Indian J Dermatol Venereol Leprol [serial online] 2009 [cited 2020 May 25];75, Suppl S1:34. Available from: http://www.ijdvl.com/text.asp?2009/75/7/34/45479

With the availability of different topical antiacne agents targeting different pathogenetic factors, it makes sense to combine them to enhance therapeutic efficacy, to make therapy more user-friendly, to minimize adverse effects, and to prevent or reduce bacterial resistance. This has been achieved through loose and fixed combinations.

Topical retinoids in combination with topical or oral antimicrobials have been proven to reduce acne lesions, both comedones and inflammatory, faster and to a greater degree than antimicrobial therapy alone.[1] Together they target three out of four pathogenetic factors, namely: ductal hypercornification, P. acnes colonization, and inflammation. [1] Further, topical retinoids, through a thinning effect on stratum corneum, facilitate percutaneous penetration of topical antibiotics, and help achieve higher concentrations of the antimicrobial agent in the pilosebaceous canal which P. acnes inhabits. [1] Several clinical studies have evaluated loose [2],[3] and fixed [4],[5] combinations. All studies have arrived at the same conclusion that combinations are more effective. It has been recommended that combination of topical retinoid and topical antimicrobial be employed early in the treatment of mild to moderate acne, and a combination of topical retinoid and systemic antibiotic in severe acne. [6]

Combination topical therapy is quite popular in our country. Often we go overboard and mix topical agents with gay abandon. It is common to come across prescriptions where four or more topical agents are mixed with no indication of methodology, leaving it to the poor patient to figure it out! This is proof of our professional freedom. The problem is mainly with loose combinations where chemistry and compatibility need to be understood. We also have available an array of fixed combinations [Table 9]. Recent market data from Europe and USA reveal that the prescriptions for fixed combinations have increased while those for BPO have declined, and the market curve for topical antibiotics is flat. [7] Fixed combinations offer therapeutic breadth and practical convenience.

  References Top

1.Gollnick H, Cunliffe W. Management of acne: A report from a global alliance to improve outcomes in acne. J Am Acad Dermatol 2003;49:S1-37.  Back to cited text no. 1    
2.Mills OH Jr, Kligman AM. Treatment of acne vulgaris with topically applied erythromycin and tretinoin. Acta Derm Venereol (Stockh)1978;58:555-7.  Back to cited text no. 2    
3.Wolf JE, Kaplan D, Kraus SJ, Loven KH, Rist T, Swinyer LJ, et al . Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: A multicenter, randomized, investigator-blind study. J Am Acad Dermatol 2003;49:S211-7.  Back to cited text no. 3    
4.Zouboulis CHC, Derumeaux L, Decroix J, Maciejewska-Udziela B, Cambazard F, Stuhlert A. A multicentre, single-blind, randomized comparison of a fixed clindamycin phosphate/tretinoin gel formulation (Velac) applied once daily and a clindamycin lotion formulation (Dalacin-T) applied twice daily in the topical treatment of acne vulgaris. Br J Dermatol 2000;143:498-505.  Back to cited text no. 4    
5.Richter JR, Forstrom LR, Kiistala UO, Jung EG. Efficacy of the fixed 1.2% clindamycin phosphate, 0.025% tretinoin gel formulation (Aberela) in the topical control of facial acne. J Eur Acad Dermatol Venereol 1998;11:227-33.  Back to cited text no. 5    
6.Thibutot D, Gollnick HP. Treatment considerations for inflammatory acne: Clinical evidence for adapalene 0.1% in combination therapies. J Drugs Dermatol 2006;5:785-94.   Back to cited text no. 6    
7.Hatton L. Data presented at the 4 th Global Alliance for Acne Meeting. Miami, USA: May 3-5, 2007.  Back to cited text no. 7    


  [Table 9]


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