Learn more about the in-depth topics covered in the August 2023 Frontline Forum acne vulgaris supplement of Dermatology Times.
The August Frontline Forum acne supplement of Dermatology Times, "A Greater Understanding of the Acne Vulgaris Armamentarium", includes a collection of thought-provoking discussions and acne treatment tips from James Del Rosso, DO; Hilary Baldwin, MD; Neal Bhatia, MD; Christopher Bunick, MD, PhD; and Leon Kircik, MD. Be sure to take a look at the highlights from the supplement below. Also, don’t miss a moment of Dermatology Times by signing up for our eNewsletters and subscribing to receive the print issue and supplements each month.
Although the pathogenesis of acne is not fully understood, the 4 main factors thought to contribute include follicular hyperkeratinization, microbial colonization with Cutibacterium acnes (C acnes), production of sebum, and complex inflammatory mechanisms, with interleukin-1 (IL-1), tumor necrosis factor, IL-8, and IL-12 cited as notable cytokines involved in the development of acne lesions and inflammatory response. The C acnes is also thought to trigger inflammatory reactions in the pilosebaceous units and adjacent areas of the skin through interactions with keratinocytes, sebocytes, and tissue macrophages in the skin.
Knowing the patient’s routine and lifestyle and counseling them on the appropriate timing and sequence of application are also important when prescribing multiple medications, and Baldwin typically budgets 30 minutes for an initial acne visit to go over these topics with patients. The panelists added that they (and, likely, the majority of other clinicians who treat acne) do not rely on the treatment recommendations from clinical practice guidelines because they introduce a mandate for step therapy, often do not include the latest therapies, and are frequently created by individuals who are not in clinical practice.
Because it takes 8 to 12 weeks of use to observe the effects of clascoterone, the panelists noted that it should be used in combination with a quick-acting agent and for an extended period of time. Bunick said that he typically uses clascoterone with a retinoid and has high rates of satisfaction among his patients, with improvements first observed at 8 to 12 weeks and continued improvement in 3 to 6 months. The panelists said that although they generally try to minimize the use of antibiotics, they may give a narrow-spectrum antibiotic in addition to clascoterone, a retinoid, and BP for a patient who wants a quick response for an upcoming event.
A new formulation of micronized isotretinoin (Absorica LD) is dispersed in a lipid carrier system, resulting in greater surface area per unit mass and thereby higher rates of dissolution and bioavailability. A study found that micronized isotretinoin 32 mg was bioequivalent to lidose isotretinoin 40 mg when patients had eaten, but its bioavailability in the fasted state was almost 2 times greater compared with lidose isotretinoin. Giving micronized isotretinoin with a high-fat meal did not affect rate of absorption and had a minimal effect on the extent of absorption. The panelists noted the higher bioavailability of the newer isotretinoin formulations raises the question of the cumulative dose to target.