Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Vulgaris?

Answer

Retinoid-like Agents

These agents stimulate cellular retinoid receptors and help normalize keratinocyte differentiation and are comedolytic. In addition, they have anti-inflammatory properties. Oral isotretinoin also reduces sebum production in the skin. Retinoids are classified into 3 generations. The first comprises topical tretinoin and systemic isotretinoin. Acitretin is a second-generation retinoid used to treat psoriasis. The third-generation retinoids include topical adapalene tazarotene.

Topical tretinoin (Retin-A Micro, Atralin, Avita, Tretin-X, Renova)

Topical tretinoin inhibits microcomedo formation. It decreases cohesiveness of keratinocytes in sebaceous follicles, which allows for easy removal. It has anti-inflammatory properties. Topical tretinoin is available as a cream or gel.

Adapalene (Differin)

Adapalene inhibits microcomedo formation. It decreases cohesiveness of keratinocytes in sebaceous follicles, which allows for easy removal. It has anti-inflammatory properties. Adapalene is available as a cream, lotion, or gel.

Tazarotene (Tazorac, Fabior, Avage)

Tazarotene inhibits microcomedo formation. It decreases cohesiveness of keratinocytes in sebaceous follicles, which allows for easy removal. It has anti-inflammatory and immunological properties. Tazarotene is available as a cream or gel.

Trifarotene (Aklief)

Trifarotene is an agonist of retinoic acid receptors (RARs), with particular activity at the gamma subtype of RAR. The stimulation of the RAR results in modulation of target genes that are associated with various processes, including cell differentiation and mediation of inflammation. The exact process by which trifarotene ameliorates acne is unknown. It is indicated for acne vulgaris for patients aged 9 years and older. Trifarotene is available as cream.

Isotretinoin (Claravis, Amnesteem, Absorica, Zenatane)

Isotretinoin is an oral retinoid indicated for recalcitrant, nodulocystic acne. It addresses all four pathogenic factors involved in the development of acne: follicular hyperkeratinization, inflammation, sebum production, and Cutibacterium acnes (formerly Propionibacterium acnes) growth. Treatment is weight-based, usually dosed initially 0.5 mg/kg and increased to 1 mg/kg in 2 divided doses for 15-20 weeks. Once-daily dosing is not recommended. The dose may be adjusted to administer up to 2 mg/kg/day. The patients must be registered into the government-regulated iPledge program in order to receive the medication.

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Dawson AL, Dellavalle RP. Acne vulgaris. BMJ. 2013 May 8. 346:f2634. [Medline].
Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009 May. 60(5 Suppl):S1-50. [Medline].
Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol. 1999 Aug. 141(2):297-300. [Medline].
Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. 1999 Feb. 140(2):273-82. [Medline].
Kelhälä HL, Fyhrquist N, Palatsi R, et al. Isotretinoin treatment reduces acne lesions but not directly lesional acne inflammation. Exp Dermatol. 2016 Jun. 25 (6):477-8. [Medline]. [Full Text].
Saluja SS, Walker ML, Summers EM, Tristani-Firouzi P, Smart DR. Safety of non-ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split-face controlled trial. Lasers Surg Med. 2017 Dec. 49 (10):886-890. [Medline].
Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008 Jan. 58(1):56-9. [Medline].
Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003 Jul. 121(1):20-7. [Medline].
Norris JF, Cunliffe WJ. A histological and immunocytochemical study of early acne lesions. Br J Dermatol. 1988 May. 118(5):651-9. [Medline].
Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002 Aug 1. 169(3):1535-41. [Medline].
Webster GF. Inflammatory acne represents hypersensitivity to Propionibacterium acnes. Dermatology. 1998. 196(1):80-1. [Medline].
Pochi PE, Strauss JS. Sebaceous gland activity in black skin. Dermatol Clin. 1988 Jul. 6(3):349-51. [Medline].
Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr. 1997 Jan. 130(1):30-9. [Medline].
Baek JH, Ahn SM, Choi KM, Jung MK, Shin MK, Koh JS. Analysis of comedone, sebum and porphyrin on the face and body for comedogenicity assay. Skin Res Technol. 2016 May. 22 (2):164-9. [Medline].
Trivedi NR, Cong Z, Nelson AM, Albert AJ, Rosamilia LL, Sivarajah S, et al. Peroxisome proliferator-activated receptors increase human sebum production. J Invest Dermatol. 2006 Sep. 126(9):2002-9. [Medline].
Smith TM, Cong Z, Gilliland KL, Clawson GA, Thiboutot DM. Insulin-like growth factor-1 induces lipid production in human SEB-1 sebocytes via sterol response element-binding protein-1. J Invest Dermatol. 2006 Jun. 126(6):1226-32. [Medline].
Zouboulis CC, Böhm M. Neuroendocrine regulation of sebocytes -- a pathogenetic link between stress and acne. Exp Dermatol. 2004. 13 Suppl 4:31-5. [Medline].
Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthet Dermatol. 2010 Apr. 3(4):24-38. [Medline]. [Full Text].
Momin SB, Peterson A, Del Rosso JQ. A status report on drug-associated acne and acneiform eruptions. J Drugs Dermatol. 2010 Jun. 9(6):627-36. [Medline].
Mango D, Ricci S, Manna P, Miggiano GA, Serra GB. Clinical and hormonal effects of ethinylestradiol combined with gestodene and desogestrel in young women with acne vulgaris. Contraception. 1996 Mar. 53(3):163-70. [Medline].
Basler RS. Acne mechanica in athletes. Cutis. 1992 Aug. 50(2):125-8. [Medline].
American Academy of Dermatology. Skin conditions by the numbers. www.aad.org. Available at https://www.aad.org/media/stats/conditions/skin-conditions-by-the-numbers. Accessed: March 26, 2019.
Smith RN, Mann NJ, Braue A, Makelainen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007 Aug. 57(2):247-56. [Medline].
Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol. 2001 Sep. 137(9):1252-3. [Medline].
[Guideline] Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013 May. 131 Suppl 3:S163-86. [Medline].
Kligman AM. Postadolescent acne in women. Cutis. 1991 Jul. 48(1):75-7. [Medline].
Barnes LE, Levender MM, Fleischer AB Jr, Feldman SR. Quality of life measures for acne patients. Dermatol Clin. 2012 Apr. 30(2):293-300, ix. [Medline].
Ugge H, Udumyan R, Carlsson J, Andrén O, Montgomery S, Davidsson S, et al. Acne in late adolescence and risk of prostate cancer. Int J Cancer. 2017 Dec 4. [Medline].
Mulcahy N. Teen Acne Tied to Prostate Cancer Risk. Medscape News & Perspective. Available at https://www.medscape.com/viewarticle/890102#vp_1. December 14, 2017; Accessed: December 15, 2017.
Sutcliffe S, Giovannucci E, Isaacs WB, Willett WC, Platz EA. Acne and risk of prostate cancer. Int J Cancer. 2007 Dec 15. 121 (12):2688-92. [Medline].
Housman E, Reynolds RV. Polycystic ovary syndrome: a review for dermatologists: Part I. Diagnosis and manifestations. J Am Acad Dermatol. 2014 Nov. 71 (5):847.e1-847.e10; quiz 857-8. [Medline].
Schmidt TH, Khanijow K, Cedars MI, Huddleston H, Pasch L, Wang ET, et al. Cutaneous Findings and Systemic Associations in Women With Polycystic Ovary Syndrome. JAMA Dermatol. 2016 Apr. 152 (4):391-8. [Medline].
[Guideline] Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May. 74 (5):945-973.e33. [Medline].
Cunliffe WJ, Holland DB, Jeremy A. Comedone formation: etiology, clinical presentation, and treatment. Clin Dermatol. 2004 Sep-Oct. 22(5):367-74. [Medline].
Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003 Jul. 49(1 Suppl):S1-37. [Medline].
Thielitz A, Gollnick H. Topical retinoids in acne vulgaris: update on efficacy and safety. Am J Clin Dermatol. 2008. 9(6):369-81. [Medline].
Zaenglein AL. Topical retinoids in the treatment of acne vulgaris. Semin Cutan Med Surg. 2008 Sep. 27(3):177-82. [Medline].
Eichenfield LF, Lain T, Frankel EH, Jones TM, Chang-Lin JE, Berk DR, et al. Efficacy and Safety of Once-Daily Dapsone Gel, 7.5% for Treatment of Adolescents and Adults With Acne Vulgaris: Second of Two Identically Designed, Large, Multicenter, Randomized, Vehicle-Controlled Trials. J Drugs Dermatol. 2016 Aug 1. 15 (8):962-9. [Medline].
Raoof TJ, Hooper D, Moore A, Zaiac M, Sullivan T, Kircik L, et al. Efficacy and Safety of a Novel Topical Minocycline Foam for the Treatment of Moderate-to-Severe Acne Vulgaris: A Phase 3 Study. J Am Acad Dermatol. 2019 Jun 1. [Medline]. [Full Text].
Gold LS, Dhawan S, Weiss J, Draelos ZD, Ellman H, Stuart IA. A novel topical minocycline foam for the treatment of moderate-to-severe acne vulgaris: Results of 2 randomized, double-blind, phase 3 studies. J Am Acad Dermatol. 2019 Jan. 80 (1):168-177. [Medline].
Cunliffe WJ, Holland KT. The effect of benzoyl peroxide on acne. Acta Derm Venereol. 1981. 61(3):267-9. [Medline].
Hebert A, Thiboutot D, Stein Gold L, Cartwright M, Gerloni M, Fragasso E, et al. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatol. 2020 Apr 22. [Medline]. [Full Text].
Moore A, Green LJ, Bruce S, Sadick N, Tschen E, Werschler P, et al. Once-Daily Oral Sarecycline 1.5 mg/kg/day Is Effective for Moderate to Severe Acne Vulgaris: Results from Two Identically Designed, Phase 3, Randomized, Double-Blind Clinical Trials. J Drugs Dermatol. 2018 Sep 1. 17 (9):987-996. [Medline].
Eady EA, Jones CE, Gardner KJ, Taylor JP, Cove JH, Cunliffe WJ. Tetracycline-resistant propionibacteria from acne patients are cross-resistant to doxycycline, but sensitive to minocycline. Br J Dermatol. 1993 May. 128(5):556-60. [Medline].
Toossi P, Farshchian M, Malekzad F, Mohtasham N, Kimyai-Asadi A. Subantimicrobial-dose doxycycline in the treatment of moderate facial acne. J Drugs Dermatol. 2008 Dec. 7(12):1149-52. [Medline].
Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and Safety of Subantimicrobial Dose, Modified-Release Doxycycline 40 mg Versus Doxycycline 100 mg Versus Placebo for the treatment of Inflammatory Lesions in Moderate and Severe Acne: A Randomized, Double-Blinded, Controlled Study. J Drugs Dermatol. 2015 Jun. 14 (6):581-6. [Medline].
Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clin Cosmet Investig Dermatol. 2009 Aug 12. 2:129-40. [Medline].
Miller YW, Eady EA, Lacey RW, Cove JH, Joanes DN, Cunliffe WJ. Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts. J Antimicrob Chemother. 1996 Nov. 38(5):829-37. [Medline].
Fanelli M, Kupperman E, Lautenbach E, Edelstein PH, Margolis DJ. Antibiotics, Acne, and Staphylococcus aureus Colonization. Arch Dermatol. 2011 Aug. 147(8):917-21. [Medline].
Bottomley WW, Cunliffe WJ. Oral trimethoprim as a third-line antibiotic in the management of acne vulgaris. Dermatology. 1993. 187(3):193-6. [Medline].
Fernandez-Obregon AC. Azithromycin for the treatment of acne. Int J Dermatol. 2000 Jan. 39(1):45-50. [Medline].
Koulianos GT. Treatment of acne with oral contraceptives: criteria for pill selection. Cutis. 2000 Oct. 66(4):281-6. [Medline].
Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000 Sep. 43(3):498-502. [Medline].
Charny JW, Choi JK, James WD. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017 Jun. 3 (2):111-115. [Medline].
Grandhi R, Alikhan A. Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study. Dermatology. 2017. 233 (2-3):141-144. [Medline].
Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatol. 2015 Sep. 151 (9):941-4. [Medline].
Trivedi MK, Shinkai K, Murase JE. A Review of hormone-based therapies to treat adult acne vulgaris in women. Int J Womens Dermatol. 2017 Mar. 3 (1):44-52. [Medline].
Ward A, Brogden RN, Heel RC, Speight TM, Avery GS. Isotretinoin. A review of its pharmacological properties and therapeutic efficacy in acne and other skin disorders. Drugs. 1984 Jul. 28(1):6-37. [Medline].
Lee JW, Yoo KH, Park KY, Han TY, Li K, Seo SJ, et al. Effectiveness of Conventional, Low-dose and Intermittent Oral Isotretinoin in the Treatment of Acne: A Randomized, Controlled Comparative study. Br J Dermatol. 2010 Nov 29. [Medline].
White GM, Chen W, Yao J, Wolde-Tsadik G. Recurrence rates after the first course of isotretinoin. Arch Dermatol. 1998 Mar. 134(3):376-8. [Medline].
Huang YC, Cheng YC. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jun. 76 (6):1068-1076.e9. [Medline].
Bremner JD, Shearer KD, McCaffery PJ. Retinoic acid and affective disorders: the evidence for an association. J Clin Psychiatry. 2012 Jan. 73 (1):37-50. [Medline].
Suarez B, Serrano A, Cova Y, Baptista T. Isotretinoin was not associated with depression or anxiety: A twelve-week study. World J Psychiatry. 2016 Mar 22. 6 (1):136-42. [Medline].
Crockett SD, Gulati A, Sandler RS, Kappelman MD. A causal association between isotretinoin and inflammatory bowel disease has yet to be established. Am J Gastroenterol. 2009 Oct. 104 (10):2387-93. [Medline].
Alhusayen RO, Juurlink DN, Mamdani MM, Morrow RL, Shear NH, Dormuth CR, et al. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. J Invest Dermatol. 2013 Apr. 133 (4):907-12. [Medline].
Rashtak S, Khaleghi S, Pittelkow MR, Larson JJ, Lahr BD, Murray JA. Isotretinoin exposure and risk of inflammatory bowel disease. JAMA Dermatol. 2014 Dec. 150 (12):1322-6. [Medline].
Etminan M, Bird ST, Delaney JA, Bressler B, Brophy JM. Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data. JAMA Dermatol. 2013 Feb. 149 (2):216-20. [Medline].
Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2010 Sep. 105 (9):1986-93. [Medline].
Lee SY, Jamal MM, Nguyen ET, Bechtold ML, Nguyen DL. Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis. Eur J Gastroenterol Hepatol. 2016 Feb. 28 (2):210-6. [Medline].
Bagatin E, dos Santos Guadanhim LR, Yarak S, Kamamoto CS, de Almeida FA. Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg. 2010 Apr. 36(4):483-9. [Medline].
Barbaric J, Abbott R, Posadzki P, Car M, Gunn LH, Layton AM, et al. Light therapies for acne. Cochrane Database Syst Rev. 2016 Sep 27. 9:CD007917. [Medline].
Boen M, Brownell J, Patel P, Tsoukas MM. The Role of Photodynamic Therapy in Acne: An Evidence-Based Review. Am J Clin Dermatol. 2017 Jun. 18 (3):311-321. [Medline].
Keyal U, Bhatta AK, Wang XL. Photodynamic therapy for the treatment of different severity of acne: A systematic review. Photodiagnosis Photodyn Ther. 2016 Jun. 14:191-9. [Medline].
Wiznia LE, Stevenson ML, Nagler AR. Laser treatments of active acne. Lasers Med Sci. 2017 Aug 4. [Medline].
Fulton JE Jr, Plewig G, Kligman AM. Effect of chocolate on acne vulgaris. JAMA. 1969 Dec 15. 210(11):2071-4. [Medline].
LaRosa CL, Quach KA, Koons K, Kunselman AR, Zhu J, Thiboutot DM, et al. Consumption of dairy in teenagers with and without acne. J Am Acad Dermatol. 2016 Aug. 75 (2):318-22. [Medline].
Di Landro A, Cazzaniga S, Parazzini F, Ingordo V, Cusano F, Atzori L, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012 Dec. 67 (6):1129-35. [Medline].
[Guideline] American Academy of Dermatology. Ten Things Physicians and Patients Should Question. Choosing Wisely. April 30, 2016. Available at http://www.choosingwisely.org/societies/american-academy-of-dermatology/. August 19, 2015;
[Guideline] Asai Y, Baibergenova A, Dutil M, Humphrey S, Hull P, Lynde C, et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2015 Nov 16. [Medline]. [Full Text].
Harding A. Canadian dermatologists issue new acne treatment guidelines. Reuters Health Information. Available at http://www.medscape.com/viewarticle/854601. November 18, 2015; Accessed: December 11, 2015.
FDA safety alert. Over-The-Counter Topical Acne Products: Drug Safety Communication - Rare But Serious Hypersensitivity Reactions. U.S. Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm402722.htm. Accessed: June 30, 2014.

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Acne, grade I; multiple open comedones.
Acne, grade II; closed comedones.
Acne, grade III; papulopustules.
Acne, grade IV; multiple open comedones, closed comedones, and papulopustules, plus cysts.
Acne with reactive hyperpigmentation; before treatment.
Acne with reactive hyperpigmentation; after treatment.

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Author

Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry, Canada

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Dermatology Association, Canadian Medical Association, Canadian Medical Protective Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer Chen, MD Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Vulgaris?

Retinoid-like Agents

Topical tretinoin (Retin-A Micro, Atralin, Avita, Tretin-X, Renova)

Adapalene (Differin)

Tazarotene (Tazorac, Fabior, Avage)

Trifarotene (Aklief)

Isotretinoin (Claravis, Amnesteem, Absorica, Zenatane)

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Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Vulgaris?

Retinoid-like Agents

Topical tretinoin (Retin-A Micro, Atralin, Avita, Tretin-X, Renova)

Adapalene (Differin)

Tazarotene (Tazorac, Fabior, Avage)

Trifarotene (Aklief)

Isotretinoin (Claravis, Amnesteem, Absorica, Zenatane)

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