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Tumpukan sampah di beberapa titik atau lokasi Kabupaten Subang cukup mengundang perhatian warga setempat. Selain itu Dinas Kebersihan Kabupaten Subang telah menurunkan satu alat berat dan beberapa mobil truk untuk mengangkut tumpukan sampah tersebut. Proses pengangkutan sampah oleh alat berat itu berdampak pada terjadinya kemacetan sepanjang kurang lebih meter dari dua arah di Jalan Pejuang 45 yakni mulai dari perempatan lampu merah Sinta hingga Lampu Merah Pasar Panjang.
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Mr Justice Haddon-Cave dealt with these points when granting permission to the Plantagenet Alliance to proceed with its application for judicial review of the decision to re-inter Richard III in Leicester Cathedral under arrangements made by the Leicester authorities.
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The new PMC design is here! Learn more about navigating our updated article layout. The PMC legacy view will also be available for a limited time. Federal government websites often end in. The site is secure. Acne is a disease of the pilosebaceous unit with involving abnormalities in sebum production, microbial flora changes, abnormal keratinization, and inflammation. There are several therapeutic options like topical and systemic retinoids, antibiotics, and systemic hormonal drugs.
The topical retinoids a play very important role in the treatment of acne vulgaris. However, their use is limited due to skin irritation. A new generation product, adapalene is a good choice in the treatment of acne vulgaris with less side effects and high efficacy confirmed by numerous clinical studies. Acne vulgaris is a chronic, inflammatory disease of the pilosebaceous unit, that affects seborrhoeic areas like face, back, and chest and characterized by comedones, papules, pustules, nodules, cysts, and scars.
Almost every individual has some degree of is benzac ac over the counter during puberty with spontaneous resolution occurring in early adult life. Occasionally, the disease persists into the fourth decade or even remains a lifelong problem. Because of the involvement of the face with considerable cosmetic problems, acne is a major psychosocial problem for many teenagers and young adults Cunliffe and Simpson ; Strauss and Thiboutot ; Braun-Falco et al In the pathogenesis of acne, the most important site is costo benzac crema unit which consists of a hair follicle and several sebaceous glands.
These units are found everywhere on the body except the palms and soles. Pilosebaceous density is greatest on the face, upper neck, and chest, in roughly nine times the concentration found elsewhere on the body Leyden ; Habif and Habie To be able to treat acne, these factors should be targeted. The aim is to reduce or eliminate the primary clinical lesion, microcomedone, which is the precursor of almost all other acne lesions Cunliffe et al There are a lot of topical or systemic agents for this purpose.
The treatment of acne vulgaris is not curative. The purpose is to reduce discomfort due to inflamed lesions, to improve the appearance, and to prevent scars. Acne management is a long-term treatment and requires patience. The patient should be informed on the issue Cunliffe and Simpson ; Oberomok and Shalita Topical preparations constitute the sole treatment in many patients with acne vulgaris and are a part of therapeutic regimen in almost all patients.
Topical treatment is enough for comedonal acne. In case of more severe acne, topical treatment can be combined with systemic treatment Cunliffe and Simpson Topical treatment of acne vulgaris has changed over the years.
Agents containing sulphur or resorcinol were used in especially first part of 20th century. Salicylic acid which is a keratolytic agent was popular in some time. Nowadays, the most popular topical agents were retinoids, benzac fiyat peroxide, azelaic acid, and topical antibiotics Bergfeld Topical retinoids, derivatives of vitamin A have been used to treat acne for almost three decades.
They are the most effective comedolytic agents for the treatment of acne vulgaris by normalizing or even increasing the desquamation process, thereby decreasing the formation and the number of microcomedones.
They also promote the clearing of preexisting comedones Bergfel and decrease in papulopustular lesions Ellis et al ; Thiboutot et al ; Bershad et al In addition, they have a marked anti-inflammatory effect by inhibiting the activity of leukocytes, the release of pro-inflammatory cytokines and other mediators, and the expression of transcription factors and toll-like receptors involved in immunomodulation. They also help penetration of other active agents.
Thus, they should be utilized in nearly every patient with acne and are the preferred agents in maintenance therapy James et al Until recently, tretinoin, which is the active form of a metabolic product of vitamin A, was the only available topical retinoid Leyden However, its use has been limited by local irritation after initiation of therapy.
This side effect is a minimal problem with the third generation topical retinoids, such as adapalane. Tretinoin is available in a new delivery system Retin-A Micro to decrease the irritative effects.
The purpose in this delivery system is benzac 5 siamzone provide the drug directly to the follicle by entrapping it in microspheres Skov et al Adapalene is a synthetic naphthoic acid derivative with retinoid activity. The chemical name of adapalene is 6-[3- 1-adamantyl methoxyphenyl]naphthoic acid. Adapalene is a white to off-white powder which is soluble in tetrahydrofuran, sparingly soluble in ethanol, and practically insoluble in water.
The molecular formula is C 28 H 28 O 3 and molecular weight is Adapalene is represented by the structural formula represented on Figure 1. Some of its biologic activities are the same with tretinoin, however it is chemically more stable and lipophilic. By this way, it can reach higher concentrations in pilosebaceous unit. Adapalene modulates cellular keratinization and inflammatory process. This anti-inflammatory effect is due to inhibition of the lipooxygenase activity and also to oxidative metabolism of arachidonic acid.
These mechanisms may be the reason for decreased risk of irritation with adapalene. Adapalene has a very low percutaneous absorption once the drug has penetrated the stratum corneum, so that it becomes entrapped in the epidermis and hair follicle, which are targeted areas Millikan Absorption of adapalene through human skin is low.
Only trace amounts 0. Excretion appears to be primarily by the biliary route. Erythema, peeling, dryness and burning are the most frequent encountered side effects. Over the past five years, numerous clinical trials have been conducted on comparing the efficacy and tolerability of adapalene and tretinoin in the treatment of acne vulgaris.
A meta-analysis of five large studies with more than patients over 12 weeks demonstrated that adapalene 0. After 12 weeks, both agents were equally effective but adapalene had a faster onset of action and less irritation. However, the comparison of adapalene 0. Grosshans et al compared 0. In both of these studies, there was no difference between these drugs in terms of efficacy. In another study, Cunliffe et al compared 0. They found that adapalene caused more decrease in total and noninflammatory lesions than tretinoin.
However, there was no significant difference in terms of inflammatory lesions. Korkut and Piskin demonstrated that adapalane is more effective in noninflammatory lesions than inflammatory lesions. Adapalene 0. Both lesion counts and global assessment showed a better degree of efficacy with adapalene than isotretinoin, although the difference between two drugs was not significant. Although isotretinoin is less irritating than tretinoin, adapalene is significantly less irritating than isotretinoin.
In the study comparing tazarotene applied every other day and adapalene applied daily by Guentherboth drugs had comparable efficacy and tolerability. Dosik et al performed a study to compare the ability of epidermis to tolerate adapalene 0.
The mean day cumulative irritancy indices for adapalene 0. A multicenter, randomized, double-blind study by Thiboutot et al a on patients demonstrated that adapalene 0. In another study, the efficacy and safety of adapalene 0. The results of this study demonstrated that adapalene gel 0. Benzoyl peroxide and adapalene are among the most effective topical agents used in the treatment of acne vulgaris.
Despite the fact that there are a lot of studies with benzoyl peroxide and adapalene alone, there are only a few studies comparing these two drugs. They found benzoyl peroxide more effective than adapalane on noninflammatory and inflammatory lesions at weeks 2 and 5, and they found both drugs safe.
The study revealed that all three therapeutic protocols were effective in treating noninflammatory and inflammatory lesions and that there were no significant difference between the groups in terms of efficacy or side effects.
Adapalene and benzoyl peroxide are effective and well tolerated agents for acne vulgaris; combination therapy has no superiority over adapalene or benzoyl peroxide alone. There are a few studies that compare the side effects of benzoyl peroxide and adapalene. Brand et al demonstrated that 0. Thiboutot et al compared the efficacy and safety of the combination of adapalene 0. This study demonstrated that the combination of adapalene and an oral antibiotic provide a superior and faster benefit than antibiotic alone and should be considered in the initiation treatment.
Adapalene is also useful in maintenance therapy. Thiboutot et al b performed a study on subjects to assess the maintenance effect of adapalene 0.
The study demonstrated a clinical benefit of continued treatment with adapalene 0. In another study by Zhang et ala total of acne subjects entered the multicentre, randomized, investigator-blinded study comparing the efficacy and safety of adapalene 0. In the second part of the study weeks 12—24 completed by subjects, the efficacy and safety of adapalene 0. This study confirmed the importance of a maintenance therapy after a successful initial treatment and underlined the benefit of a combination therapy with a topical retinoid such as adapalane and a topical antibiotic in the treatment of inflammatory acne.
Adapalene treatment has a theoretical risk for retinoid embryopathy. However, manufacturer reports that only trace amounts of adapalene are absorbed into the skin. There have not been performed human studies to date, so the risk is undetermined for adapalene usage in pregnancy.
However, because only trace amounts of the drug absorb into skin, it seems unlikely the drug induces malformations. In summary, numerous clinical studies demonstrating that adapalene treatment is a good choice for topical treatment of acne vulgaris with less side effects and high efficacy. Ther Clin Risk Manag. Suleyman Piskin and Erol Uzunali. Author information Copyright and License information Disclaimer.
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