Recommendations for Using Over-The-Counter Products as Adjunctive Acne Care in Asian Phototypes: Improving Treatment Outcomes and Managing Side Effects

November 2021 | Volume 20 | Issue 11 | Original Article | 1213 | Copyright © November 2021


Published online October 14, 2021

Anneke Andriessen PhDa, Xian Jiang MD PhDb, Kanokvalai Kulthanan MDc, Chih-Hung Lee PhDd, Rodney Sinclair MBBS, MD, FACDe, Cheng-Feng Zhang MD PhDf

aRadboud University Medical Center, Nijmegen, The Netherlands; Andriessen Consultants, Malden, The Netherlands
bDepartment of Dermatology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
cSiriraj Hospital of Mahidol University, Bangkok, Thailand
dDepartment of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
eUniversity of Melbourne, Victoria, Australia; Wellington Parade, East Melbourne, Australia
fDepartment of Dermatology, Hushan Hospital of Fudan University, Shanghai, China

Abstract
Background: Acne vulgaris (acne) is a common inflammatory skin disorder prevalent among all ethnic groups. This review aimed to investigate the current literature regarding the potential benefit of over-the-counter (OTC) adjuncts (eg, moisturizers, cleansers) for acne patients focusing on Asian phenotypes.
Methods: An online procedure was employed to review the role of adjunctive OTC acne treatment. A panel consisting of dermatologists with expertise in treating Asian acne patients participated in a pre-meeting survey that collected information regarding their recommendation habits for OTC products in acne patients. Recommendations on using OTC products as an adjunct for treating acne in Asians are based on the pre-meeting survey results, evidence from literature presented during a series of plenary lectures, and discussions conducted during a stepwise program of sessions.
Results: Many topical treatments have been associated with adverse events (AEs) (eg, skin dryness, erythema, scaling, stinging, burning, pruritus). Multiple studies on topical acne treatments have found that Asians display greater sensitivity and less tolerability than Caucasians to acne treatment. Skincare as an adjunct to acne treatment may reduce dryness or irritation, particularly important in Asians with acne.
Conclusions: Advisors agreed that cleansers and moisturizers should be considered for their beneficial adjunctive role in the armamentarium of acne treatment and maintenance strategies.

J Drugs Dermatol. 2021;20(11): 1213-1221. doi:10.36849/JDD.6259

INTRODUCTION

Acne: Etiology, Pathogenesis, Epidemiology, Quality of Life
Acne vulgaris (acne) is an inflammatory skin disorder with multifactorial etiopathogenesis. Factors including follicular epidermal hyperproliferation, sebum hyperproduction, inflammation, and colonization by Cutibacterium acnes are implemented in the development and/or exacerbation of acne.1 Depending on disease severity, acne breakouts can consist of non-inflammatory (ie, open blackheads or closed comedones) and/or inflammatory lesions (ie, papules, pustules, nodules, cysts and/or macules), frequently appearing on the face but also occurring in other body regions (eg, back, chest). The Global Burden of Disease Project ranks acne as the eighth most prevalent disease worldwide,2,3 with a global prevalence rate estimated at 9.4%. Acne most often occurs in adolescence, with incidence rates peaking between the ages of 14–17 years for females and 16-19 years for males.4,5 This inflammatory skin disorder, however, is also becoming more prevalent among the adult population.5,6 Being a distressing disorder, acne negatively affects the quality of life and psychosocial wellbeing (eg, anxiety, depression, low self-esteem). Acne can also lead to physical complications, such as permanent scarring.7,8

Acne: Prescription Treatments
The choice of prescription treatment for acne depends strongly on the type (inflammatory versus non-inflammatory), underlying causes (eg, polycystic ovarian syndrome), and