Acne Review

A review of recent news, research, and treatment related to acne vulgaris. 

Twin Study Highlights Factors Associated With Acne Severity 

A recent study with twins found a potential link between acne severity and genetic phenotype and social and environmental factors. Suggs and colleagues surveyed 279 identical and fraternal twins, with 1 set of triplets, during the Annual Twins Day Festival in Twinsburg, Ohio. The survey assessed demographics, medical history, family history, social history, physical activity, acne incidence, severity, and triggers.

The proportion of concordant pairs was significantly higher among identical twins (64%) compared with fraternal twins (49%). Acne was associated with anxiety, asthma, and polycystic ovarian syndrome. Identical twin pairs with acne had a higher body mass index and exercised significantly less compared with those without acne. Among concordant twin pairs, aggravation of acne associated with sugar intake and cosmetic product use was more likely to be reported by twins with more severe acne.

“This twin study further supports that there may be a genetic phenotypic link, though social and environmental factors may also have an influence in the disease process,” the researchers concluded.

Reference

Suggs A, Loesch M, Ezaldein H, Luisa C, Dawes D, Baron E. An acne survey from the world’s largest annual gathering of twins. J Drugs Dermatol. 2018;17(4):380-382.

Teledermatology Platform Effective for Evaluating Acne Lesions 

Self-photography submitted to Network Oriented Research Assistant (NORA), a teledermatology platform, was found to be as effective as in-person visits for evaluating patients with acne vulgaris, according to a recent study published in JAMA Dermatology

The pilot study included 69 participants with acne vulgaris who were patients at a general dermatology practice. Participants were trained on how to use NORA on the iPhone 6 and took pictures of their face using the rear-facing camera. All participants underwent in-person and individual evaluation of their acne by the same dermatologist, with at least a 1-week period separating each assessment. Total lesion count and Investigator’s Global Assessment (IGA) were used to assess acne severity, and the reliability of patient-taken photographs was compared with in-person evaluations.

The researchers found that the intraclass correlation coefficients of NORA photographs and in-person acne evaluations indicated strong agreement. The intraclass correlation coefficient for total lesion count was 0.81 and for IGA was 0.75. The intraclass correlation coefficients for inflammatory lesions count was 0.72, noninflammatory lesion count was 0.72, and for cyst count was 0.82. 

“This study found agreement between acne evaluations performed in person and from self-photographs with NORA,” the researchers concluded. “As a reliable telehealth technology for acne, NORA can be used as a teledermatology platform for dermatology research and can increase access to dermatologic care.” 

Reference

Singer HM, Almazan T, Craft N, et al. Using Network Oriented Research Assistant (NORA) technology to compare digital photographic with in-person assessment of acne vulgaris. JAMA Dermatol. 2018;154(2):188-190.

Fixed-Combination Acne Treatments Offer Similar Benefits

A recent study found that fixed-combination therapies provided similar benefits to patients with inflammatory acne vulgaris. In the study, the researchers searched Medline, EMBASE, and the Web of Science for clinical trials using acne, comendonal, and noninflammatory as key terms. 

While comparative data was limited, the results of their analysis showed the importance of fixed combinations with and without retinoids, where treatment benefits were comparable, they noted. Adapalene 0.1% and benzoyl peroxide 2.5% gel (Epiduo Forte) was shown to be comparable to clindamycin 1% and benzoyl peroxide 5% gel, and adapalene 0.3% and benzoyl peroxide 2.5% gel. A meta-analysis found that clindamycin phosphate 1.2% and benzoyl peroxide 2.5% gel (Acanya) was more effective for noninflammatory lesions compared with clindamycin and benzoyl peroxide 5% gel and 2 equivalent clinical programs suggested additional benefits for higher doses of benzoyl peroxide (3.75% vs 2.5%) in this fixed combination.

“Clindamycin 1.2%-benzoyl peroxide 3.75% gel may afford similar benefits to adapalene 0.3%-benzoyl peroxide 2.5% gel in this sometimes difficult to treat patient population,” the researchers concluded. 

Reference

Gold MH, Baldwin H, Lin T. Management of comedonal acne vulgaris with fixed-combination topical therapy. J Cosmet Dermatol. 2018;17(2):227-231. 

Topical Therapy Effectively Treats Acne

A combination gel of 0.3% adapalene and 2.5% benzoyl peroxide gel (0.3% A/BPO) (Epiduo Forte) may be a safe and effective treatment option for patients with severe inflammatory acne vulgaris prior to or in place of initiating oral isotretinoin (OI) therapy, according to the findings of a recent study.

The open-label, multicenter, phase 4, 12-week, single-arm investigational study included 186 participants with severe inflammatory acne vulgaris. Participants applied 0.3% A/BPO gel and took 100-mg dose of oral doxycycline twice daily for 12 weeks. Efficacy endpoints included the reduction of inflammatory lesions by week 12, Investigator’s Global Assessment (IGA) success, defined as IGA 0 or 1 (clear or almost clear), at weeks 4, 8, and 12, percent reduction in lesions at weeks 4, 8, and 12, and subject questionnaires completed at week 12. Adverse events and tolerability were assessed, as well as candidacy for OI at each visit. 

The mean inflammatory lesion counts and mean percent reduction in lesions were significantly reduced by the end of the study compared with baseline. Overall, 37.1% of participants achieved IGA success by week 12 (n=69). Additionally, most participants reported at least moderate improvement in acne vulgaris (90.2%) and were “satisfied” or “very satisfied” with the study therapy overall (83.2%). 

In addition, 41.9% of participants were no longer considered candidates for OI at week 4 and only 19.9% were still considered candidates for OI at week 12. 

Reference

Del Rosso JQ, Stein Gold L, Johnson SM, et al. Efficacy and safety of adapalene 0.3%/benzoyl peroxide 2.5% gel plus oral doxycycline in subjects with severe inflammatory acne who are candidates for oral isotretinoin. J Drugs Dermatol. 2018;17(3):264-273.

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