Treating all acne early with a topical retinoid and an antibiotic can help patients avoid scarring and its psychosocial consequences, experts say. The aggressive approach also may help stave off medicolegal concerns, they add.
Medical dermatology can address subtle scars, says Hilary Baldwin, M.D., director of the Acne Treatment and Research Center in Morristown, N.J. In this regard, the OSCAR study showed that benzoyl peroxide plus adapalene improved scars approximately 30% at six months versus the untreated side in a split-face study.1
"Treatment not only prevented the development of new scars," says Dr. Baldwin, "but it also eradicated some of the pre-existing scars."
Mechanistically, she says, the retinoid adapalene is more likely than benzoyl peroxide to explain these effects. Tretinoin has shown similar effects in reducing2 and preventing scars.3
A recent study by Loss et al. showing that adapalene 0.3% gel alone achieved significant improvements in moderate-to-severe acne scarring of 19.3 years' mean duration4 is another important piece of the puzzle, says Emil Tanghetti, M.D. He is director of the Center for Dermatology and Laser Surgery in Sacramento, Calif.
Together, he says, Loss et al. and OSCAR show that treating early and effectively can stop acne and scarring and possibly improve some pre-existing scars. "With lasers and lights, you can go so far. But having an extra tool that can work in concert makes eminent sense," he says.
Dr. Tanghetti is a consultant for Cynosure, DEKA, Quanta, Cartessa and Aesthetics Biomedical but owns no stock in these companies. He holds an ownership interest in a laser under development for active acne. Dr. Baldwin is a consultant and/or researcher for Galderma and Ortho Dermatologics.
1. Dréno B, Bissonnette R, Gagné-Henley A, et al. Am J Clin Dermatol. 2018;19:275-286.
2. Schmidt JB, Donath P, Hannes J, Perl S, Neumayer R, Reiner A. Int J Dermatol. 1999;38:149-153.
3. Mandy SH. J Am Acad Dermatol. 1986;15(4 Pt 2):878-879, 888-889.
4. Loss MJ, Leung S, Chien A, Kerrouche N, Fischer AH, Kang S. Dermatol Ther (Heidelb). 2018;8.245-257.
5. Dréno B, Layton A, Bettoli V, Torres Lozada V, Kang S. 23rd EADV Congress; October 8-12, 2014; Amsterdam.
6. Layton AM, Henderson CA, Cunliffe WJ. Clin Exp Dermatol. 1994;19:303-308.
7. Tan JK, Tang J, Fung K, et al. J Cutan Med Surg. 2010;14:156-160.
8. Dréno B, Tan J, Kang S, et al. Dermatol Ther (Heidelb). 2016;6:207-218.