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Most of the significant recent advances in acne treatment involve changes in vehicle formulation that may improve medications' tolerability, efficacy or both, a leading clinician and researcher says. For treating tough acne cases, another expert adds, dermatologists must use simpler, more patient-friendly regimens.
Meanwhile, dermatologists must simplify acne treatment regimens to compete with over-the-counter alternatives, according to another expert.
"Most of the more recent advances in acne have been advances in vehicle formulation, which may enhance efficacy, improve tolerability or both," says James Q. Del Rosso, D.O., dermatology residency director, Valley Hospital Medical Center, Las Vegas.
"This BP formulation appears to be advantageous, because it may possess enhanced efficacy against noninflammatory lesions, based on studies to date," Dr. Del Rosso tells Dermatology Times.
Somewhat similarly, he says a recently approved product containing BP 2.5 percent and clindamycin 1 percent (Acanya, Arcutis) has demonstrated favorable efficacy and is very well tolerated, based on clinical studies (Thiboutot D et al. J Am Acad Dermatol. 2008 Nov;59(5):792-800).
"Several studies have looked at BP 5 percent/clindamycin 1 percent (Duac, Stiefel) in combination with topical retinoids, including tretinoin microsphere 0.04 percent, tazarotene 0.1 percent cream and adapalene 0.1 percent gel," Dr. Del Rosso says.
In all of these studies, he says, "The patients had a more rapid response, and the greatest decrease in acne lesions, when they used the BP/clindamycin gel in the morning and the retinoid at night from the beginning of treatment."
Topical dapsone 5 percent gel (Aczone, Allergan) represents a new topical compound, Dr. Del Rosso says.
"It's been shown to be effective and safe in treatment of acne in both the phase 3 pivotal 12-week trials (Draelos ZD et al. J Am Acad. Dermatol. 2007 Mar; 56(3):439.e1-10. Epub 2007 Jan 17) and in a one-year study," he says.
Furthermore, Dr. Del Rosso says, in clinical studies that included approximately 2,000 patients, including patients with G6PD deficiency, topical dapsone was not associated with any cases of hemolytic anemia.
Therefore, he says, with topical dapsone, "The Food and Drug Administration (FDA)-approved product labeling does not recommend baseline blood testing for G6PD deficiency."
Benzoyl peroxide 2.5 percent /adapalene 0.1 percent gel (Epiduo, Galderma) represents a new formulation that's been studied in more than 1,600 patients, Dr. Del Rosso says.
"The efficacy evaluation showed that the combination was significantly superior to the individual components and the vehicle, and that the formulation was well-tolerated," he says.
Oral acne agents
Among oral acne agents, Dr. Del Rosso says enteric-coated doxycycline (Doryx, Warner Chilcott) has been shown to significantly reduce gastrointestinal upset.
"This medicine may be given once a day at doses up to 200 mg," he says.
Extended-released minocycline tablets (Solodyn, Medicis), have demonstrated a more consistent pharmacokinetic profile than immediate-release minocycline formations have, Dr. Del Rosso says.
"Available studies demonstrate the importance of weight-based dosing, with the same efficacy observed at 1 mg/kg per day, as compared to higher doses, using the extended-release tablet formulation of minocycline," he says. "However, 1 mg/kg per day demonstrated the same risk of the vestibular side effects as placebo."