Mastering Acne Management with Patient-Specific Topical Treatment Plans

In Las Vegas, Nevada, James Del Rosso, DO, board-certified dermatologist, Mohs micrographic surgeon, and research director at JDR Dermatology Research, led a Dermatology Times Case-Based Roundtable event titled “Individualized Approaches to Acne Management: Aligning Topical Treatment with Patient Profiles.” The session was dedicated to exploring real-world approaches to acne, emphasizing topical therapy, but allowing for broader discussion around alternative and adjunctive treatments utilized in clinic.

Case #1: Comedonal Acne in a Teenage Athlete

The first case centered on a 16-year-old high school student-athlete with moderate comedonal acne, mainly affecting her cheeks and forehead. The patient’s history included the use of a salicylic acid cleanser (with minimal effect), regular sports participation, heavy makeup use, and inadequate makeup removal. Through vibrant discussion, the clinicians highlighted the common hurdles teenagers face, especially with skin care compliance, given busy lifestyles and peer-driven factors like appearance and photos.

Suggestions for initial management underscored the importance of a thorough history—clarifying what skin care products the patient actually uses, the potential role of cosmetic products, and the impact of sweat and sports equipment on acne. Del Rosso and attendees advocated for patient-centered education: discussing realistic expectations, the significance of consistent regimen adherence, and using teaching tools such as handouts and motivational interviewing to avoid patient discouragement.

“I educate my patient really well,” one participant said. “The more you tell them, and the more you educate them, I think they're going to be more compliant and it's going to be a lot easier for them.”

The panel considered several topical options, with a strong focus on starting with gentle cleansers and moisturizers to acclimatize the skin before introducing tretinoin or adapalene. They also addressed techniques for minimizing irritation, such as starting retinoids every other night, layering with moisturizer, and providing guidance on when and how to cleanse, especially after sports practices. Practical pearls included advice on hypoallergenic makeup removal and the adjunctive use of hypochlorous acid sprays or pre-moistened cleansing wipes for athletes. When little improvement was noted at the 8-week follow-up, the patient transitioned to twice-daily clascoterone cream, 1%.

Case #2: Inflammatory Acne in a Competitive Swimmer

The second scenario described a 15-year-old competitive swimmer with inflammatory acne that worsened during swim season. This case prompted discussion of extrinsic aggravators, including chlorine exposure, tight swim caps, and lifestyle stresses. Del Rosso and the attendees explored the impact of supplements like whey protein or biotin and possible confounding factors such as energy drinks high in B12, highlighting the necessity of a holistic patient history.

Potential therapeutic strategies for this patient included oral doxycycline for its anti-inflammatory effects, combined with topical agents such as a triple-combination gel (adapalene, benzoyl peroxide, clindamycin). The conversation contrasted the pros and cons of agents like minocycline or sarecycline and stressed the importance of explainers for families to set expectations, especially around slower-acting treatments like clascoterone (for sebum reduction) versus faster-acting combinations like the triple-combination gel.

“They want to see fast results, even though you tell them...the problem with teenagers is they want everything fast,” one clinician said.

Compliance challenges were a recurring theme, with clinicians suggesting scheduling follow-up within a month to support patients through the initial adjustment period, particularly for adolescents dissatisfied with slow results.

“I tell them they don't have to be perfect, just so they know that it's okay if they miss one dose here or there. Do your best,” an attendee said. Del Rosso agreed. “Don't be getting down on yourself, because that's the last thing you want.”

In this case, the dermatologists recommended an initial treatment of clascoterone and triple combination gel as the parents preferred to hold off on oral treatment. Four weeks later, the patient remained compliant and his skin had improved, but fabrics were getting bleached. Thus, the combination gel was switched out for trifarotene cream, 0.005%.

Case #3: Post-Inflammatory Hyperpigmentation in a Patient of Color

The final case focused on managing acne and post-inflammatory hyperpigmentation in a 27-year-old Black female. Here, the experts discussed tailored regimens sensitive to cultural, cosmetic, and pigmentary needs. Topical azelaic acid, niacinamide, and gentle retinoids were championed for their efficacy in hyperpigmentation and reduced risk of irritation. Del Rosso referred to advice given by Pearl Grimes, MD, FAAD.

“She taught us years ago...You don't have to be afraid of retinoids on darker skin types. That's a misconception people get nervous about,” he said.

The panel also explored newer agents (e.g., thiamidol) and non-traditional adjuncts, reinforcing the vital role of sun protection in all skin types. Emphasis was placed again on patient education, both about the nature of pigmentation and on differentiating between active lesions and residual marks.

Final Thoughts

Each real-world case demonstrated the significance of personalized acne care, underscoring the need for combination therapies and maintenance strategies that align with a patient’s wants and needs. Del Rosso concluded by reminding attendees to ask not just how much patients are bothered by acne, but also how committed they are to addressing it and remaining consistent.

“Not everybody's the same. Some people can adapt to whatever problem they have, but it doesn't mean it doesn't bother them, and they wouldn't want to get rid of it,” he said.