Unmet Needs in the Management of Acne Vulgaris: A Consensus Statement
June 2023 | Volume 22 | Issue 6 | 582 | Copyright © June 2023
Published online May 5, 2023
Hilary Baldwin MDa, Aaron Farberg MD FAADb, Cheri Frey MDc, Corey Hartman MD FAADd, Edward Lain MDe, Rachel Meltzer MD MPHf, Zoe Draelos MDg
aMedical Director, The Acne Treatment and Research Center, Brooklyn NY, and Clinical Associate Professor of Dermatology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
bBare Dermatology, Dallas, TX, and Baylor Scott & White Health System, Dallas, TX
cHoward University, Washington, DC
dSkin Wellness Dermatology and University of Alabama at Birmingham Dermatology, Birmingham, AL
eSanova Dermatology, Austin, TX
fBrigham and Women’s Hospital and Harvard Medical School, Boston, MA
gDermatology Consulting Services, High Point, NC
Abstract
Acne vulgaris is the most common skin condition in the US, affecting up to 50 million Americans. The American Academy of Dermatology (AAD) guidelines on acne treatment were developed to provide recommendations for the diagnosis, grading, and treatment of acne in adolescents and adults to support clinicians in their therapeutic decision-making process. The most recent acne guidelines were published in 2016, and the approach to care and the therapeutic landscape of acne have evolved since that time. The Acne Management Consensus Roundtable was convened in 2022 to discuss unmet needs in the management of acne. The main focus of the meeting was the role of androgens in acne pathology; the evaluation of clascoterone, the first topical anti-androgen that specifically addresses sebum production in acne; and the identification of the place of clascoterone in therapy. Clascoterone was approved by the US Food and Drug Administration for the treatment of acne in patients 12 years and older in 2020. This report aims to highlight important limitations of the 2016 AAD treatment guidelines and to familiarize practitioners with clascoterone and its indication, efficacy and safety profile, and potential use across diverse patient populations. With its new mechanism of action, clascoterone may be able to fulfill important unmet needs in acne treatment.
Baldwin H, Farberg AS, Frey C, et al. Unmet needs in the management of acne vulgaris: a consensus statement. J Drugs Dermatol. 2023;22(6):582-587. doi:10.36849/JDD.7587
INTRODUCTION
The most recent American Academy of Dermatology (AAD) guidelines on acne treatment were published in 2016.1 The Acne Management Consensus Roundtable, a group of dermatologists, was convened in 2022 to discuss unmet needs in the management of acne. The meeting focused on the role of androgens in acne development; evaluation of the novel mechanism of action and clinical success of clascoterone, which was approved by the US Food and Drug Administration (FDA) in 2020 for the treatment of acne in patients 12 years and older; and identification of the place of clascoterone in acne therapy.
This report was developed to highlight unmet needs in acne treatment and to educate practitioners on how clascoterone, with its novel mechanism of action, may help to fill some of those gaps.
Pathogenesis of Acne
The pathophysiology of acne is multifactorial and involves 4 key, interrelated factors2: inflammation, follicular hyperkeratinization, increased sebaceous gland activity and sebum production, and colonization by Cutibacterium acnes (formerly Propionibacterium acnes).3
Abundant evidence indicates that androgen-stimulated sebum production drives acne pathogenesis by promoting growth, reproduction, and accumulation of skin cells in the hair follicle and providing an anaerobic environment that facilitates C. acnes proliferation and consequent inflammation4,5; androgens can also directly induce expression of inflammatory cytokines.6 Increased levels of facial sebum secretion are observed in patients with acne compared with people without acne and positively correlate with lesion counts.3,7-9 Alterations
