How Patients Experience and Manage Dryness and Irritation From Acne Treatment

June 2011 | Volume 10 | Issue 6 | Original Article | 605 | Copyright © June 2011

Steven R. Feldman MD PhDa and Diana M. Chen MDb

aCenter for Dermatology Research, Departments of Dermatology, Pathology and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC bCoria Laboratories, a division of Valeant Pharmaceuticals, North America, Redwood City, CA

Abstract

Background: Products that may cause irritation are widely used to treat acne. Irritation has the potential to reduce treatment adherence. How patients manage irritation and dryness is not well characterized.
Objectives: To study self-reported irritation, its impact and coping mechanisms in patients who had been treated for acne with a clindamycin-5% benzoyl peroxide (BPO) product.
Methods: An Internet-based survey of 200 subjects, aged 15-40 years who had used a clindamycin-5% BPO fixed combination product in the last six months on at least 50 percent of their face, at least five days per week.
Results: The majority of subjects (57%) had moderate acne, 28 percent had severe acne. Bothersome side effects of the clindamycin- 5% BPO combination included dry skin (55%), flaky/peeling skin (45%), irritated skin (44%), itchy skin (39%) and redness (37%). As a result, subjects used the product only as a spot treatment (33%), only when breakouts seemed worse (28%), or less often than recommended (32%); stopped using from time to time (32%); switched to a different prescription medication and/or an over-thecounter acne product (28%); or stopped using altogether (10%). 41 percent of subjects reported using moisturizers to counteract dryness and redness.
Limitations: We queried patients concerning use of combination clindamycin/BPO products and not other products.
Discussion: Irritation to clindamycin-5% BPO is a common problem that reduces patients' use of the medication. Strategies to improve treatment include communication with patients on possible side effects, providing written instruction on how to manage irritation and dryness and consideration of alternative topical treatments and treatment regimens.

J Drugs Dermatol. 2011;10(6):605-608.

INTRODUCTION

The management of patients with chronic disease is complicated by patients' propensity to be poorly adherent to treatment.1,2 While topical treatments have safety advantages over oral agents, adherence (previously termed "compliance") to topical treatment is still problematic.3-5 Clinical trials in which acne patients' use of medication is assessed with electronic monitors reveal a rapid decay in the patients' use of recommended treatments.6,7
The adverse effects associated with some topical acne treatments may limit patients' adherence.8,9 Among the most commonly used acne treatments are fixed-combination products containing clindamycin and benzoyl peroxide (BPO).10-11 Products containing BPO are rapidly bactericidal and reduce development of antibiotic-resistant bacteria.12 However, a potential limitation of BPO is concentration-dependent dryness and irritation that may impact patient compliance and limit product use.13 How much patients are bothered by dryness and irritation from acne treatment and what patients do to manage the problem are not well characterized.
The propensity of 5% BPO to cause dryness and irritation offers the opportunity to understand how patients change their treatment in response to adverse events. The purpose of this research survey was to assess the frequency and impact of self-reported dryness and irritation due to clindamycin-BPO (5%) fixed combination acne treatment. We also assessed how patients with acne cope with dryness and irritation to better understand the implications for adherence and clinical practice.

METHODS

200 subjects were enrolled in an Internet-based survey study conducted by Kelton Research on behalf of Coria Laboratories. The participants were obtained from a database of individuals who had opted to participate in consumer research and were randomly selected to receive an email invitation to participate in this study. Survey participants were Americans aged 15-40 years (targeted enrollment of 100 15-21 year olds and 100 22-40 year olds) who had used a commercially available clindamycin- BPO (5%) fixed combination (either BenzaClin® or Duac®: Aventis Pharmaceuticals, Inc.; Stiefel Laboratories, Inc.) in the last six