INTRODUCTION
Acne vulgaris is a chronic skin condition characterized by excess sebum production, hyperkeratinization, Cutibacterium acnes colonization, and inflammation.1 Acne vulgaris affects approximately 85% of adolescents and young adults between 12 and 25 years of age, attributable in part to the influence of pubertal hormonal changes, but can also persist into adulthood.2 Androgens such as dihydrotestosterone (DHT) play a key role in driving acne pathogenesis via expression of genes that mediate sebum production and inflammation.2-4 Antiandrogen medications for acne vulgaris include off-label use of spironolactone and combined oral contraceptives,3,5 although these medications are not suitable for use in males.3 Long-term spironolactone treatment is also associated with a potential risk of hyperkalemia, and laboratory monitoring is recommended, particularly for patients with impaired renal function or concomitant use of drugs that elevate potassium levels.6
Clascoterone cream 1%, a novel topical androgen receptor inhibitor,7 was approved in the US in 2020 for the treatment of acne vulgaris in males and females greater than or equal to 12 years of age.8 Clascoterone has a steroidal structure similar to DHT and inhibits the binding of DHT to androgen receptors in vitro.9,10 Clascoterone is rapidly hydrolyzed to cortexolone, a primary inactive metabolite, resulting in low quantifiable plasma levels of clascoterone after topical application, and therefore, low systemic exposure.11,12 The efficacy and safety of clascoterone
