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Merk, Kathrin (2004): In-vivo-Porphyrinproduktion von Propionibacterium acnes unter systemischer Aknetherapie mit Isotretinoin und Minozyklin. Dissertation, LMU München: Medizinische Fakultät



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.