Inflammatory Acne Treatment: Review of Current and New Topical Therapeutic Options

January 2016 | Volume 15 | Issue 1 | Supplement Individual Articles | 11 | Copyright © January 2016


Joshua A. Zeichner MD

Department of Dermatology, Mount Sinai Hospital, New York, NY

properties. SB204 is a topical nitric oxide-releasing gel currently being developed. Its active ingredient, NVN1000, is anti-inflammatory, has demonstrated antimicrobial activity against P. acnes, and inhibited lipogenesis in an in vitro model. A phase 2, multi-center, randomized, double-blind, vehicle-controlled study treating moderate to severe acne has been completed in Latin America. Enrolled subjects were randomized to receive either SB204 1%, SB204 4%, or vehicle for 12 weeks. There was a 57% and 25% reduction in inflammatory and comedonal lesions, respectively, at week 12 in the 4% drug arm. Moreover, in a sebum analysis using sebutapes, 80% les sebum was measured from the skin in both the high and low concentration SB204 groups compared with the vehicle group. A concentration-dependent decrease in squalene and free fatty acids was observed. The drug was well tolerated, and only mild local skin reactions were reported.66
SEB002
Photodynamic therapy is a commonly used treatment for various skin conditions such as actinic keratoses. Its use in AV has been reported, but efficacy has been limited by the ability of the photosensitizer and light source to penetrate deep enough into the sebaceous glad where the pathology in acne occurs.67 SEB002 is a suspension of gold-coated silica microparticles that can be delivered into the sebaceous gland using mechanical vibration. Subsequent activation using a light source leads to selective targeting and destruction of the sebaceous glands. Preliminary results are promising, with an excellent tolerability profile. In one European study, 48 patients were randomized to receive 3 treatments at 2-week intervals or to treat the skin initially with an OTC face wash for 12 weeks, then crossed over to the SEB002 treatment. At the week 28 evaluation, subjects treated initially with SEB002 experienced a 61% reduction in inflammatory lesions, while the cross-over group achieved a 50% reduction. The procedure was well tolerated. No anesthetic was used during the procedure, and most subjects reported only mild to moderate pain. Mild erythema was not uncommon, and it subsided within 30 to 60 minutes of the procedure.68

CONCLUSION

Acne vulgaris is a multifactorial skin condition that dermatologists treat on a daily basis. The clinical picture ranges from mild comedones to severe nodular cystic disease. However, recent data suggest that all acne lesions are in fact inflammatory despite the frequently used term “non-inflammatory” rather than “comedonal” lesions. Consensus guidelines recommend combination therapy using drugs with different, complimentary mechanisms of action. There is a variety of individual agents that may be combined to suit the individual patient’s needs. The newest formulations offer enhanced efficacy with minimal irritation. These, along with several novel acne drugs in the pipeline, will continue to improve the landscape of topical anti-acne therapies.

DISCLOSURES

Dr. Zeichner has worked as an Advisory Board Member, Consultant, and Speaker for Allergan, Galderma, and Valeant and an Advisory Board Member for Foamix.

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