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Resistência aos antimicrobianos na terapêutica da acne
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Resumo(s)
A acne vulgar é considerada uma das principais e mais prevalentes doenças de pele. Estima-se que afeta cerca de 9,4% da população mundial, tornando-se a oitava doença mais comum a nível mundial. Tem origem nas unidades pilossebáceas e os quatro principais fatores responsáveis pela sua formação são: hipersecreção sebácea, alterações na queratinização folicular, colonização por Cutibacterium acnes e inflamação. O tratamento da acne permite tratar e controlar as lesões existentes, prevenir o aparecimento de cicatrizes permanentes, limitar a duração da doença e minimizar os efeitos na qualidade de vida do paciente. A resistência aos antimicrobianos utilizados no tratamento da acne, foi observada pela primeira vez nos anos 70, e desde então, tem vindo a ganhar impacto na prática de dermatologia. A utilização de agentes antimicrobianos é feita de forma frequente e prolongada no tratamento da acne, o que tem contribuído para o desenvolvimento de estirpes resistentes de Cutibacterium acnes (bactéria Gram positivo anaeróbia) que atua como patógenico na acne. Os mecanismos principiais para o aparecimento de resistência incluem: formação de biofilme, mutações genéticas com modificação de RNAr, alterações de bomba de efluxo e inativação enzimática. Isto permite ao microrganismo ganhar resistências às terapêuticas antimicrobianas na acne, razões pelas quais os antimicrobianos usados na acne tem vindo a perder eficácia. A eficácia da eritromicina diminui ao longo dos anos e vários países tem relatado resistências predominante à eritromicina e a clindamicina e em menor percentagem às tetraciclinas. O aparecimento de resistências tem como resultado a diminuição da eficácia dos antimicrobianos no tratamento da acne, assim como originar alterações no microbioma humano e infeções oportunistas.
Acne vulgaris is considered one of the main and most prevalent skin diseases. It is estimated that it affects around 9.4% of the world's population, making it the eighth most common disease worldwide. It´s originates in the pilosebaceous units and the four main factors responsible for its formation are: sebum hypersecretion, changes in follicular keratinization, colonization by Cutibacterium acnes and inflammation. The treatment of acne makes it possible to treat and control existing lesions, prevent the appearance of permanent scars, limit the duration of the disease and minimize the effects on the patient's quality of life. Resistance to the antimicrobials used to treat acne was first observed in the 1970s, and has since gained impact in dermatology practice. The use of antimicrobial agents is frequent and prolonged in the treatment of acne, which has contributed to the development of resistant strains of Cutibacterium acnes (an anaerobic Gram-positive bacterium) that acts as a pathogen in acne. The main mechanisms for the emergence of resistance include: biofilm formation, genetic mutations with rRNA modification, efflux pump alterations and enzymatic inactivation. This allows the microorganism to gain resistance to antimicrobial therapies in acne, which is why the antimicrobials used in acne have been losing efficacy. The efficacy of erythromycin has decreased over the years and several countries have reported predominant resistance to erythromycin and clindamycin and, to a lesser extent, to tetracyclines. The emergence of resistance results in a decrease in the efficacy of antimicrobials in the treatment of acne, as well as causing changes in the human microbiome and opportunistic infections.
Acne vulgaris is considered one of the main and most prevalent skin diseases. It is estimated that it affects around 9.4% of the world's population, making it the eighth most common disease worldwide. It´s originates in the pilosebaceous units and the four main factors responsible for its formation are: sebum hypersecretion, changes in follicular keratinization, colonization by Cutibacterium acnes and inflammation. The treatment of acne makes it possible to treat and control existing lesions, prevent the appearance of permanent scars, limit the duration of the disease and minimize the effects on the patient's quality of life. Resistance to the antimicrobials used to treat acne was first observed in the 1970s, and has since gained impact in dermatology practice. The use of antimicrobial agents is frequent and prolonged in the treatment of acne, which has contributed to the development of resistant strains of Cutibacterium acnes (an anaerobic Gram-positive bacterium) that acts as a pathogen in acne. The main mechanisms for the emergence of resistance include: biofilm formation, genetic mutations with rRNA modification, efflux pump alterations and enzymatic inactivation. This allows the microorganism to gain resistance to antimicrobial therapies in acne, which is why the antimicrobials used in acne have been losing efficacy. The efficacy of erythromycin has decreased over the years and several countries have reported predominant resistance to erythromycin and clindamycin and, to a lesser extent, to tetracyclines. The emergence of resistance results in a decrease in the efficacy of antimicrobials in the treatment of acne, as well as causing changes in the human microbiome and opportunistic infections.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Resistência aos antibióticos Resistência antimicrobiana Cutibacterium acnes Acne