Current nanotechnological approaches for an effective delivery of bio-active drug molecules in the treatment of acne

Figures & data

Table I. Characteristics of various grade of acne.

Acne grade	Characteristics of acne
Comedonal acne	• Consist of comedones only. • Less than about 10 on the face. • None on the trunk. • No scaring and non-inflammatory in nature. • Comedones that are 1 mm or larger are called micro comedones.
Papular acne	• Consist of 10–25 papules on the face and trunk with mild scarring. • The presence of inflammatory lesions (less than 5 mm in diameter). • Papular acne is caused due to bacteria, oil, dirt and heat. • Mostly found on the face, back and posterior parts.
Pustular acne	• It is a subset of acne vulgaris. • Pustules are small bumps on the skin that fill with fluid or pus. • Consists of more than 25 pustules with moderate scarring. • These bumps can form on any part of the body, but they are most common on the back, neck, chest, and face.
Severe pustulocystic acne	• Consist of nodules or cysts with extensive scarring. • Inflammatory lesions over 5 mm in diameter. • Extensive nodules and cysts. • Appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts. • Cystic acne affects deeper skin tissue than does common acne.

Figure 1. Role of androgen involved in pathogenesis of acne.

Figure 2. Basic mechanism of acne induction by P. acne.

Table II. Topical drug for acne treatment.

Topical drug	Mechanism of action/Advantages	Adverse effects
Topical retinoid (Tretinoin, Adapalene, Tazarotene, Isotretinoin, Metretinide)	Target the micro comedo precursor lesion of acne. Target the abnormal follicular epithelial hyper proliferation, reduces follicular plugging, micro comedones, non-inflammatory and inflammatory acne lesion.	Irritant dermatitis, erythema, scaling, burning sensation
Topical antibiotics (Clindamycin, Erythromycin, Clarithromycin, Azithromycin, Nadifloxacin)	Inhibit the growth of P. acne and reduce inflammation. Topical antibiotics such as erythromycin and clindamycin are the most popular in the management of acne.	Erythema, peeling, itching, dryness, burning, bacterial resistance, cross resistance
New agents (Clindamycin, Benzoyl peroxide, Tretinoin)	Prevent and eliminate the development of P. acne resistance. Reducing both inflammatory and non-inflammatory acne lesions.	Skin irritation, burning, erythema, peeling, dryness, skin sensitivity
Herbal agents (Azelaic acid, Tea tree oil)	Effective for mild-to-moderate acne when applied topically at a 20% concentration. Act as antimicrobial, anti-inflammatory, and antioxidant.	Skin irritation

Table III. Systemic drug for acne treatment.

Systemic drug	Mechanism of action/Advantages	Adverse effects
Systemic antibiotics (Tetracycline, Doxycycline, Minocycline, Erythromycin, Azithromycin)	Inhibit the growth of P. acne and reduce inflammation. Mainly moderate-to-severe inflammatory acne. Tetracycline's and derivatives still remain the first choice.	Gastrointestinal upset, vaginal candidiasis, pigment deposition in the skin & teeth
Hormonal therapy (Spironolactone, Flutamide, Cyproterone acetate)	Prevent the effects of androgens on the sebaceous gland and probably follicular keratinocytes	Hyperkalaemia, menstrual irregularities

Figure 3. Novel approaches for acne treatment.

Table IV. Applications of nano-carrier systems for treatment of acne.

Nano-carrier	Bioactive molecule	Results/Applications
Solid lipid nanoparticles	Isotretinoin (ITR)	Increasing the therapeutic performance of all types of acne, including recalcitrant, severe and nodulocystic (Raza et al. 2013).
Solid lipid nanoparticles	Tretinoin (TRE)	Increase the therapeutic effectiveness of drug for treatment of various skin diseases including acne and psoriasis (Ridolfi et al. 2012).
Solid lipid nanoparticles	Retinoic acid	Reduce skin irritation without reducing efficacy, for the topical treatment of acne (Castro et al. 2011).
Solid lipid nanoparticles	All-trans retinoic acid (RA)	Improve the entrapment efficiency of RA in SLN using a low surfactant/lipid ratio (Castro et al. 2007).
Solid lipid nanoparticles	Tretinoin (TRE)	Increase the therapeutic effectiveness of drug for treatment of various skin diseases including acne (Shah et al. 2009).
Microspheres	Adapalene	Improve the therapeutic index of drug for the treatment of acne (Rolland et al. 1993).
Microspheres	Tretinoin (TRE)	Showed excellent safety and efficacy of drug for the treatment of acne in the preadolescent population (Eichenfield et al. 2012).
Microspheres	Tretinoin (TRE)	Showed anti-inflammatory effects against acne after oral administration of Isotretinoin (Vender 2012).
Microspheres	Tretinoin (TRE)	Tretinoin gel microsphere 0.1% showed better cutaneous tolerability profile (Lucky and Sugarman 2011).
Microspheres	Tretinoin (TRE)	Showed greater therapeutic efficiency against mild-to-moderate acne (Leyden et al. 2009).
Liposomes	Clindamycin	Showed therapeutic effectiveness acne vulgaris in pig ear skin (Honzak and Sentjurc 2000).
Liposomes	Benzoyl peroxide (BPO)	Showed a significantly greater antibacterial efficacy for Propionibacteria and Micrococca-ceae (Fluhr et al. 1999).
Liposomes	Tretinoin (TRE)	Allows reduction of the concentration of the active agent without a decline in efficacy for acne vulgaris (Schafer-Korting et al. 1994).
Liposomes	5-aminolevulinic acid (5-ALA)	Reduced inflammatory facial acne in Asians, with a low risk of persistent phototoxic effects (Yeung et al. 2011).
Liposomes	5-aminolevulinic acid (ALA)	Improved inflammatory acne with minimal side effects in Asians (An et al. 2011).
Niosomes	Isotretinoin	Great potential for skin targeting, prolonging drug release, reduction of photo degradation, reducing skin irritation and improving topical delivery of drug (Kaur et al. 2010).
Niosomes	Curcumin	Curcumin-loaded vehicles could efficiently accumulate in the skin and inhibit P. acnes (Liu and Huang 2013).
Micro-emulsion	Thai basil oil, Holi basil oil	Showed therapeutic activity against P. acnes (Viyoch et al. 2006).
Nano-emulsion	Adapalene, Clindamycin	Showed more efficacious and better tolerated for the treatment of acne vulgaris in Indian patients (Prasad et al. 2012).
Aerosols foams	Povidone iodine	Act as skin cleanser in the management of acne vulgaris (Brown 1977).
Micro sponge	Tretinoin (TRE)	Showed an excellent treatment of face acne vulgaris (Leyden et al. 2002).
Fullerenes	Fullerenol C60(OH)44	Beneficial skin care reagent for controlling acne vulgaris by suppressing sebum in the inflammatory response and by reducing P. acnes lipase activity (Inui et al. 2012).
Fullerenes	Fullerenes	Fullerene gel help in controlling acne vulgaris with skin care benefit (Inui et al. 2011).

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