Presentation from Maui Derm for Dermatologists Virtual CME Dermatology Conference 2021 provides updates on new drugs, research, and insights into the management of acne.

Panel session, Update 2021: Acne and Rosacea, presented January 27, moderated by Guy Webster, MD, PhD, clinical professor of dermatology at Thomas Jefferson University , Lawrence Eichenfield, MD, vice chair of dermatology and chief of pediatric and adolescent dermatology at the University of California San Diego, and James Layton, MD, CE emeritus professor of dermatology at the University of Pennsylvania School of Medicine.

Dr. Webster discussed the latest insights from acne research and treatment, including discussions on the use of metformin for polycystic ovary syndrome (PCOS), eliminating the concept of spironolactone is the breast cancer risk and safety of isotretinoin, as well as new drugs to treat acne.

Metformin for acne PCOS

Notably, Webster discussed a number of studies that showed favorable outcomes in treating patients with metformin, including metformin alone and in combination with traditional acne medications that improved improve patient outcomes. However, the majority of studies were not completed by dermatologists and investigators found room to criticize the methods.

Spironolactone: Not a Breast Cancer Risk

The presentation follows studies demonstrating that spironolactone does not increase breast cancer risk or interact with hormone therapies, nor does it increase breast cancer recurrence rates.

New drug for acne

New drugs on the market for acne include:

  • Topical minocycline foam, effective in treating inflammatory acne
  • Topical clascoterone, a “soft” androgen blocker
  • Encapsulated BP + tretinoin, a treatment with minimal irritation and good effect
  • Topical trifarotene, a new fourth-generation retinoid approved for the face and trunk

“Maskne” in cases of acne in children

Dr. Eichenfield presented the latest updates on childhood acne and highlighted outbreaks of mask-related acne. “I’ve seen a series of breakouts in the form of acne and acne masquerades associated with masks,” says Eichenfield.

Eichenfield says there is literature suggesting specific acne management with maskne. While criteria can be helpful, Eichenfield believes maskne is a combination of several factors. “Maskne” can be

  1. Regular acne is more noticeable,
  2. Mechanism of acne and/or
  3. Outbreaks of acne caused by fabric factors and microorganisms

“Generally speaking, most of us are controlling the acne we see by applying masks like regular acne. But the material includes antibacterial cleaners, and certainly changes to the style of the mask could make a difference,” says Eichenfield.

New acne therapy and pediatric data

The panel also covers recent acne treatment studies and approvals including children. Regarding retinoids, Eichenfield mentions trifarotene 0.005% cream and tazarotene 0.045%, both of which are approved for patients 9 years of age and older; In an analysis in children, tazarotene was well tolerated, with no significant difference in response between age groups.

Minocycline 4% foam has been approved to treat moderate to severe nodular acne for ages 9 and older. The drug uses molecular stabilization technology and investigators found no evidence of phototoxicity, photoallergic reactions, or skin sensitization.

Other new drugs include clascoterone 1% cream and sarecycline, which is taken by mouth. Furthermore, the session addresses studies focusing on energy-based treatments for active acne and scarring, including blue light and pulsed dye laser (PDL). However, no double-blind placebo-controlled studies have been completed to date, and much of the care is multimodal, according to Eichenfield.

“I hope in the future we will be able to combine potentially medical acne care with procedural acne care, as it tends to be a dermatological surgeon or a laser surgeon. are doing some acne, and then most of us, who are managing acne medically. So, trying to fix it together, I think it might be appropriate that we try to bring more to patients of these ages with acne,” Eichenfield said.

Isotretinoin Difficult Cases

Dr. Layton focused his presentation on issues associated with isotretinoin treatment, including recurrence, worsening of acne with acute inflammation, sinus area, and keratolytic cysts. inflammation.

“In my opinion, there are still too many cases where patients get worse, and sometimes catastrophically worse,” says Layton.

The session reviewed recent research suggesting that higher doses may reduce relapse rates, with age being the most important factor in withdrawal. Layton presented data showing that, in a patient population of over 3000, the number of patients requiring discontinuation of isotretinoin therapy was highest in the youngest patients – 10-11 years of age – and this rate generally decreased with the age. Layton also mentions factors other than age, including not taking isotretinoin after a high-fat meal, as absorption can be up to 78% lower when fasting occurs.

You can find Maui Derm Live 2021 slides, posters, and other resources here.

Authority to solve:

1. Webster G. Eichenfield E, Layton J, et al. Update 2021: Acne and Rosacea. Presented at: Maui Derm Live. January 25-29, 2021; virtual.

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