In-vivo-Porphyrinproduktion von Propionibacterium acnes unter systemischer Aknetherapie mit Isotretinoin und Minozyklin

The production of porphyrins by Propionibacterium acnes (P. acnes)
as a contributing pathogenic factor in the aetiology of acne is the
object of this investigation. High–performance liquid
chromatographic (HPLC) analysis was used to investigate in vivo
samples of porphyrins produced by P. acnes from comedones prior to
treatment of a set of 55 patients with a variety of systemic forms
of treatment. For all patients mainly coproporphyrin III was
identified, but also coproporphyrin I and protoporphyrin at
considerably lower concentrations. Polar porphyrins could not be
detected. Wide variations of porphyrin concentrations between
individual patients were found. Collective evaluation showed that
only systemic isotretinoin monotherapy for more than three months
led to a reduction of porphyrins. Other systemic forms of therapy,
such as minocycline, a combination of oral isotretinoin with local
treatment or various combinations of local therapy (benzoyl
peroxide, benzoyl peroxide and retinoids, benzoyl peroxide and
azelaic acid) had no persistent effect on porphyrin production.
When the porphyrin production of individual patients was analysed
repeatedly over time, clinical improvement was associated with
lowered concentrations of porphyrins with local forms of therapy.
An unchanged or worsening skin condition was associated with
increased porphyrin production. The reduction of coproporphyrin III
production by P. acnes where there is improvement as a result of
therapy supports the pathogenetic significance of P. acnes and of
the porphyrin fractions it produces for the emergence of acne.