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Of the four primary pathogenic factors that drive acne vulgaris—androgen excess, increased sebum production, faulty keratinization, and overgrowth of C. acnes—androgen excess has been the most elusive therapeutic target. Oral contraceptive pills (OCPs) have direct effect on circulating hormones, but their potential use is limited to a subset of women. As such, a sizable portion of the population affected by acne vulgaris cannot even consider treatment with OCPs. While these systemic agents are generally associated with a low risk profile and have a history of safe and effective use, they are not entirely risk-free. Indirect androgen modulation has become increasingly popular. Again, while generally safe and effective, this systemic treatment is not without risks and contraindications and it is also limited to a subset of female patients.
Acne vulgaris (AV) is one of the most common diseases that we encounter in our clinics every day. Yet, despite the dermatology community’s perceived familiarity with acne vulgaris, it is worthwhile to note that we continue to learn more and more about the epidemiology and the pathogenesis of AV as well as novel therapeutic options. Patients with acne desire clearance. Dermatology providers today have more options than ever to tailor treatment to each patient’s needs, in light of current best evidence regarding the pathogenesis and treatment of the disease. While no new chemical entities for topical delivery have revolutionized our approach to acne management, ongoing evolution in topical vehicle formulation is optimizing therapeutic benefit and the patient experience, leading to better clinical outcomes.
The history of a specific retinoid and the use in dermatology is a testament both to the drug’s well-established efficacy and its potential to cause skin irritation. Over more than four decades, the drug that launched the retinoid class into the market has been used in the topical management of acne, either alone or in combination. In fact, current consensus acne treatment guidelines rely heavily on retinoids, as they address several aspects of acne pathogenesis— they are comedolytic, resolve the precursor microcomedone, and are anti-inflammatory— without posing any risk for antibiotic resistance.1
JDD Podcast host Dr. Adam Friedman gets first-hand insight from internationally acclaimed pediatric dermatologist Dr. Lawrence Eichenfield on his recent study entitled “Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients” published in the June 2016 edition of the Journal of Drugs of Dermatology. Want a refresher on the use of OCPs in Acne?
Interested in learning how to initiate a patient based survey study? Just curious how a leader in the field gets an uninterested adolescent to be compliant and engaged in his/her acne care? These are just a few of the practical pearls provided.
There is a need for new oral antibiotics for acne with improved safety profiles and targeted antibacterial spectra. Sarecycline is a novel, tetracycline-class antibiotic specifically designed for acne, offering a narrow spectrum of activity compared with currently available tetracyclines, including less activity against enteric Gram-negative bacteria. This phase 2 study evaluated the efficacy and safety of three doses of sarecycline for moderate to severe facial acne vulgaris.
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