Acne Vulgaris Discussions and Research

A new analysis of data from an earlier study found that an acne medication that was investigated as a possible preventive treatment for skin cancer did not cause the excessive deaths that led to the premature termination of that study.

The earlier study, known as the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) trial, ran from 1998 to May 2004. It enrolled 1,131 veterans with an average age of 71. Most were men. The participants were randomly assigned to two groups. One group applied a cream containing 0.1% tretinoin (the highest dose available commercially) to their face and ears twice daily. The other group applied a placebo cream.

The retinoid tretinoin, an acid form of vitamin A, is a common topical treatment for acne. It’s sold under several brand names, including Retin-A, Avita and Renova.

The VATTC trial was designed to determine if a high dose of topical tretinoin could prevent certain types of skin cancer in high-risk people. The trial was stopped, however, when an unexpectedly high mortality rate was observed in the study’s treatment arm (82 deaths in the treatment arm versus 53 in the placebo arm).

The authors of the new analysis, which was funded by the U.S. Department of Veterans Affairs and published in the Archives of Dermatology, found no evidence for a cause-and-effect relationship between the tretinoin treatment and the increased risk of death. “We observed an association of topical tretinoin therapy with death, but we do not infer a causal association that current evidence suggests is unlikely,” they concluded.

Source: Weinstock MA, Bingham SF, Lew RA, et al. Topical tretinoin therapy and all-cause mortality. Arch Dermatol. 2009;145:18-24

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Epiduo, a new once-a-day prescription gel that combines adapalen and benzoyl peroxide for the topical treatment of mild-to-moderate acne, is now on pharmacy shelves. The gel, which is marketed by Galderma Laboratories, received Food and Drug Administration (FDA) approval late last year.

Both the retinoid adapalen and the antimicrobial benzoyl peroxide have a long history of being used separately to treat acne. Studies have shown that the two treatments are more effective when combined than when either is used alone, reducing total acne lesions by about 18% as early as one week after the start of treatment.

Last year, a 517-patient study published in the Journal of the American Academy of Dermatology reported that Epiduo reduced the median number of total acne lesions by more than 50% over a 12-week period. Another study published in the Journal of Drugs in Dermatology reported that the discontinuation rate of the medication due to adverse events was a low 2%.

Common side effects include dryness, redness, scaling, stinging, and burning.  When using the medication, patients should minimize their exposure to sunlight and other skin products that contain resorcinol, salicyclic acid and sulfer.

Source: FDA: Label and Approval History: Epiduo.

The information found on this website is not designed to replace the patient/physician relationship.

New research showing how combination laser therapy can clear acne lesions was presented at the annual meeting of the American Academy of Dermatology in March.

Macrene Alexiades-Armenakas, MD, of the Yale University School of Medicine, reported on the findings from a small, preliminary study that investigated whether photodynamic therapy (PDT) combined with topical 5-aminolevulnic acid (ALA) and activated by a long-pulse, pulsed-dye laser could effectively clear mild to severe cases of acne.

Eighteen acne patients were recruited for the study. Fourteen received 1 to 6 treatments of ALA PDT, depending on the severity of their symptoms. Each was also prescribed a topical acne medication. The study’s control group consisted of 4 patients. They were treated either with systemic or topical medications or with non-ALA PDT laser therapy.

The acne cleared up completely among all 14 patients in the ALA PDT treatment arm. By contrast, none of the patients in the control group experienced a complete clearance of their acne.

Dr. Alexiades-Armenakas also found a significant improvement in the appearance of acne scars among the treatment group, a result attributed to the penetrating effects of the pulsed dye laser.

Side effects from the combination laser therapy were mild: a slight redness that lasted for about 2 days. No hyperpigmentation was observed, even among patients of color.

SOURCE: American Academy of Dermatology

The information found on this website is not designed to replace the patient/physician relationship.

A new study published in the journal Dermatologic Therapy (2008 Mar-Apr;21(2):86-95) discusses the latest developments in the treatments available for acne. Of great concern recently has been the emergence of antibiotic resistance and the implications of this for the use of topical antibiotics.

In the study by Drs. Katsambas & Dessinioti from the University of Athens Department of Dermatology, treatments alternatives such as low-dose long-term isotretinoin are discussed. Here is an excerpt:

Topical retinoids, benzoyl peroxide, azelaic acid, and topical and oral antibiotics remain the milestone of treatment for mild to moderate acne vulgaris. Oral isotretinoin is useful for the treatment of severe nodular acne, treatment-resistant acne, and acne with a risk of physical or psychological scarring. Hormonal treatment in female acne is useful in resistant or late-onset acne.

With increasing concerns regarding teratogenicity of isotretinoin and increasing antibiotic resistance, there is a clear need for therapeutic alternatives to these long-used treatments. Research in the pathogenesis of acne has allowed for new therapies and future perspectives regarding acne to evolve. They include low-dose long-term isotretinoin regimens, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, topical photodynamic therapy, new combination formulations, dietary interventions, and antiinflammatory agents such as lipoxygenase inhibitors.

Hopefully as we come to develop a better understanding of the pathogenesis of acne we can tailor even better treatment methods for this common and trouble skin disorder.

The information found on this website is not designed to replace the patient/physician relationship.