New developments in acne treatment: Novel topical, oral, photodynamic therapies help manage common condition

November 1, 2008

Dapsone gel, Oracea capsules and modified photodynamic therapy are three brand-new approaches to acne therapy, all of which may change current acne treatment and management.

Key Points

Philadelphia - Research has led to new and exciting acne treatments, including a topical dapsone cream, Oracea (Galderma) capsules for oral therapy, as well as a modified-light therapy - all of which are to enrich the armamentarium of drugs used to treat skin conditions with acne.

Topical therapy

Dapsone, a sulfone derivative, has been useful in the treatment of a number of skin disorders, including dermatitis herpetiformis, lichen planus and leprosy.

"In my opinion, topical 5 percent dapsone gel will work best in inflammatory acne lesions, as the drug seems to be effective in inhibiting neutrophil-mediated inflammation.

During the developmental stages of the drug, as a precautionary measure, patients using the medication were required to take blood tests to verify that they did not have a glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, because of the possibility that dapsone could cause hemolytic anemia as was reported with oral dapsone.

However, further studies have proven that patients who are G-6-PD deficient can use the drug safely (at least up to a year) and that no blood tests are required.

Topical dapsone gel offers a fresh treatment avenue for mild-to-moderate acne, and Dr. Webster says many dermatologists are eager to start using this medication in their patients to see how it compares to longer-established acne treatments.

Oral therapy

Oracea, a new oral therapy used for rosacea and acneiform skin conditions, has drawn much interest.

Oracea is chemically identical to doxycycline, but in the slow-release and low-dose approach in which it is used, Oracea does not have any antibiotic activity. Therefore, there is no concern about antibiotic resistance or antibiotic overuse.

"For years, people have known that doxycycline works mainly as an anti-inflammatory agent, and recently, we have begun to understand that the drug is also effective at a fairly low dosage," Dr. Webster tells Dermatology Times.

There was some initial concern that a lower dose was not as effective in acne lesions as a higher dose; however, recent studies have proven that low-dose Oracea is just as effective as higher-dosed doxycycline treatment.

A study in which Oracea was administered to patients of varying weights found that patients of low weight and high weight fared equally well on the same dosage of the drug.

"What's important here is that the low therapeutic dose of Oracea makes it effective for acne lesions without having any antibiotic activity, allowing a long-term and safe therapy," Dr. Webster says.

Photodynamic therapy

Most experts would agree that oral isotretinoin is still the most effective treatment for acne conglobata and a cornerstone of therapy for this severe form of the condition.

Researchers have been studying a new phototherapy regimen for acne that has proven to be very successful in animal studies. It may soon be at least as effective as the well-established isotretinoin therapy.

A photosensitizing agent, lemuteporfin, is injected intravenously and specifically targets the sebaceous glands. Then ultra-violet light is directed to the acne lesions at a fairly high intensity and selectively destroys the sebaceous glands.

"If this therapy could work as well as Accutane (Roche), people would love it, because it is a one-time treatment with much fewer needle pricks in the arm compared to Accutane, because of the monthly blood tests," Dr. Webster says.