INTRODUCTION
In the treatment of acne, therapies that address multiple pathophysiological pathways are recommended for most patients.1 Combination therapies are generally more efficacious; in a meta-analysis of 221 clinical trials of 37 different acne interventions, triple-combination therapies incorporating a topical or oral antibiotic, topical retinoid, and benzoyl peroxide were consistently more efficacious than 2-product combinations or topical monotherapy.2 However, the real-world effectiveness of combining multiple products is less certain, as the addition of products to a treatment regimen increases the cost and complexity of treatment, both of which have been associated with decreases in treatment adherence.3,4
The effectiveness of topical acne treatment is further impacted by a medication’s physical properties. Aesthetic characteristics such as ease and uniformity of application, spreadability, and skin feel can influence patient acceptance of and adherence to treatment5-9 as well as drug delivery, efficacy, and tolerability.8-10
A thin, uniform film of the drug is ideal as it allows for greater absorption and penetration of active ingredients without leaving greasy or sticky residues on the skin.11,12 In contrast, thick or uneven applications may contain drugs that are never able to contact, much less penetrate, the skin;8 and excess drug remaining on the skin can contribute to treatment-related irritation.13 Beyond these clinical implications, excessively thick applications can be economically wasteful by decreasing the number of applications available from a given amount of product.
Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB; Cabtreo®, Ortho Dermatologics) gel is the first fixed-dose triple-combination topical treatment approved by the US Food and Drug Administration (FDA) for the treatment of acne, and is indicated for patients 12 years of age and older.14 The active ingredients in CAB address 3 of the 4 pathophysiological mechanisms in acne (Table 1),1,15-17 and are
The effectiveness of topical acne treatment is further impacted by a medication’s physical properties. Aesthetic characteristics such as ease and uniformity of application, spreadability, and skin feel can influence patient acceptance of and adherence to treatment5-9 as well as drug delivery, efficacy, and tolerability.8-10
A thin, uniform film of the drug is ideal as it allows for greater absorption and penetration of active ingredients without leaving greasy or sticky residues on the skin.11,12 In contrast, thick or uneven applications may contain drugs that are never able to contact, much less penetrate, the skin;8 and excess drug remaining on the skin can contribute to treatment-related irritation.13 Beyond these clinical implications, excessively thick applications can be economically wasteful by decreasing the number of applications available from a given amount of product.
Clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB; Cabtreo®, Ortho Dermatologics) gel is the first fixed-dose triple-combination topical treatment approved by the US Food and Drug Administration (FDA) for the treatment of acne, and is indicated for patients 12 years of age and older.14 The active ingredients in CAB address 3 of the 4 pathophysiological mechanisms in acne (Table 1),1,15-17 and are
