A Salicylic Acid-Based Dermocosmetic is Effective as an Adjunct to Benzoyl Peroxide for Mild to Moderate Acne and as Monotherapy in Maintenance Post Benzoyl Peroxide

December 2023 | Volume 22 | Issue 12 | 1172 | Copyright © December 2023


Published online November 29, 2023

Amir Khammari MDa, Ann Laure Demessant-Flavigny MDb, Delphine Kerob MDb, Sophie Seite MDb, Brigitte Dreno MD PhDa

aNantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, Nantes, France
bLa Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France

Abstract
Background: A dermocosmetic (DC) containing salicylic acid, niacinamide, and thermal spring water has been developed for the management of mild to moderate acne.
Aim: To assess the efficacy of DC as an adjunct to benzoyl peroxide (BPO) every other day compared with BPO over 3 months, and its efficacy as maintenance post-BPO care compared with vehicle for another 3 months.
Methods: Single-center, randomized, double-blind study in 100 patients with mild to moderate facial acne according to the Global Acne Severity (GEA) Scale. During phase 1, subjects received either BPO + vehicle (vehicle group) or BPO + DC (DC group) for 12 weeks. During phase 2, patients were re-randomized to receive either the vehicle or the DC for 12 weeks. Assessments included inflammatory and non-inflammatory lesion count, acne severity using the GEA Scale, local tolerance, quality of life, and quantity of product used.
Results: During phase 1, both groups, DC and vehicle, reached the same level of efficacy at month 3, although the quantity of BPO used was significantly reduced in the DC group (P=0.0001). During phase 2, acne continued to significantly improve (all P<0.05) in the DC group, as did clinical signs and symptoms; while patients randomized to vehicle reported relapses of their acne and related symptoms.
Conclusion: The use of DC significantly reduces the need for BPO with no impact on the efficacy of mild to moderate acne. The use of DC as a maintenance post-BPO allowed a significant reduction of acne relapse compared with vehicle after 3 months of follow-up, with a good tolerance.

J Drugs Dermatol. 2023;22(12):1172-1177. doi:10.36849/JDD.7449R1

INTRODUCTION

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicle. The main factors of acne pathophysiology are hyperkeratinization of the pilosebaceous infundibulum, leading to the formation of comedones, increased sebum production, and dysbiosis or alteration of the skin microbiota. This is mainly through changes in the microbiome diversity including Cutibacterium acnes (C. acnes) strains, and ultimately activation of the innate immunity leading to inflammation.1 The disease is highly prevalent in adolescents but can be seen in adults as well, with an increased prevalence of adult female acne these past years.2-4 Acne severity and response to treatment may be influenced by various external or environmental factors.2,5-9

To date, several topical and systemic treatments exist to manage acne, such as topical retinoids, oral isotretinoin, benzoyl peroxide (BPO), fixed drug combination of topical retinoids and BPO or topical antibiotics, systemic antibiotics, and hormonal treatments.4,10-12 BPO is an oxidizing agent that is bactericidal against C acnes. In addition to its primary bactericidal properties, BPO shows anti-inflammatory and mild comedolytic activities.13,14 However, the use of BPO may cause skin irritations, including erythema, pruritus, and skin burning, as well as skin allergies.15

With acne being a chronic disease, maintenance care is currently recommended to avoid flare-ups of the condition.11,12,16 In addition to the different pharmacological classes of acne treatment, several dermocosmetics have been developed over the last decades to be used as adjuvant care, limiting treatment-related side effects or managing the milder forms of acne when used alone.
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