Posted on the Pediatric SuperSite on March 11, 2009
New therapies for acne offer choices
Determining the optimal
therapies for patients with persistent acne should start with the patient
interview, according to a presenter at the 67th American Academy of
Dermatology Annual Meeting, held here.
Sara Dill, MD, of Kaiser Permanente Medical
Group, offered some clinical pearls for managing patients with persistent acne.
“I always ask the patient what they did that morning [to manage their
acne],” she said. She added that she asks her patients how much their acne
bothers them. The answers to those questions guide Dill about how aggressive
she will be in prescribing medications.
“I show them how much retinoid I want them to
apply, and I never write ‘apply to affected area.’ I always put
specific instructions on each prescription,” Dill said.
Dill said she often uses isotretinoin, since that
remains the mainstay of treatment. But her discussion focused on other
treatment modalities for those patients who have ‘tried everything,’
or those who have poor tolerability for isotretinoin.
There are several new topicals that have just been
approved and are in the pipeline, Dill said. Two of these – Epiduo
(Galderma), which was just approved in December 2008, and Acanya (Arcutis
Pharmaceuticals), which was featured at the meeting this week – both
feature lower doses of benzoyl peroxide (2.5%, which is lower than the amount
contained in many of the other gels on the market). This lower dose of BP has
been shown in some studies to result in less irritation but does not seem to so
far in studies to diminish efficacy, Dill said. Epiduo gel contains adapalene
0.1% and benzoyl peroxide. Acanya contains clindamycin phosphate and benzoyl
peroxide.
Dill said current recommendations urge limiting the use
of oral antibiotics for acne management, to minimize the development of
resistance. She typically will prescribe oral antibiotics for a few months
until the acne has improved, and then she said she prescribes maintenance
therapy with topicals.
“I will also add oral contraceptives or go to
isotretinoin as needed,” Dill said. “I never use oral or topicals
alone without a benzoyl peroxide product to minimize the risk of antibiotic
resistance.”
Dill said oral contraceptives are gaining popularity in
the long-term treatment of acne. She said patients taking orthotrycycline saw a
50% to 60% reduction in inflammatory lesions after six months of treatment in
studies. Similar reductions have been noted with other oral contraceptives, but
many of these products have not sought a specific indication for acne. She said
she prescribes oral contraceptives to girls who have had their period for at
least a year, those that do not smoke or have histories of clotting disorders
or high blood pressure, and those girls with extreme acne flares. She said
girls that have acne “along the jaw line or neck seem to respond very well
to oral contraceptives.”
Another possibility for acne treatment is laser and
light therapy, but Dill cautioned that cost is an issue and long-term effects
of altering the sebaceous glands are unknown. – by Colleen Zacharyczuk
For more information:
- Dill S. #S004. Presented at: the 67th Annual Meeting of the
American Academy of Dermatology; March 6-10, 2009; San Francisco.
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