What’s new on acne and rosacea for 2021?
At the Symposium for Cosmetic Advances and Laser Education (SCALE) Acne and Rosacea Update, Emmy Graber, MD, Certified Dermatologist and Founder of the Dermatology Institute of Boston, and Affiliate Clinical Instructor, Northeastern University, Boston, Massachusetts presented further updates on the treatment of these conditions.1
The update included sarecycline as a potential treatment for rosacea. Sarecycline is already approved by the FDA for acne, but it is a new treatment for rosacea.2 The objective of the prospective, parallel-group, investigator-blind, pilot study of oral sarecycline was to examine its efficacy and safety in adults with moderate to severe papulopustular rosacea. .
There were 102 patients included in the study, 72 of these patients being treated with oral sarecycline and 25 with placebo. Primary outcomes included the percentage of patients with an Investigator’s Overall Assessment Score (IGA) of 0 or 1 (clear or almost clear) at week 12 and reduction in inflammatory lesions.
The secondary endpoints were a percentage of patients with IGA scores of 0 or 1 at weeks 4 and 8, a percentage reduction in inflammatory lesions at weeks 4 and 8, and an overall subject assessment (GAS) at each visit. The researchers also looked for adverse events (AEs) and local signs and symptoms on the skin.
At weeks 4, 8, and 12, sarecycline outperformed placebo in the percentage of patients with IGA 0/1. At week 12, 75% of patients had IGA scores 0/1 in the sarecycline arm vs. 16% in the placebo arm.
For the AEs, all were resolved except for one mild case of nausea and a headache at the end of the study.
For acne updates, a retrospective study of oral spironolactone (Aldactone; Pfizer) evaluated 403 adult patients with acne.3
The results of the study suggest that spironolactone maintains its effectiveness even with long-term use. In addition, 23% of the stops were due to AEs, of which 6 were related to menstrual problems, and the remaining 15 were due to symptoms such as dizziness, headache, frequent urination, fatigue, dry skin, anxiety and pain. abdominal.
There was also an update on isotretinoin dosing.4 There was a retrospective review of patients reviewing 1 or 2 courses of isotretinoin. Patients who received 2 courses tended to have a lower cumulative dose and shorter isotretinoin treatment duration after the acne cleared.
According to Graber, this suggests that a cumulative dose and the length of treatment after clearance are strong predictors of acne relapse. The study authors recommended treating up to the peak dose of 120 to 150 mg / kg for 6 months and prolonging treatment for 1 to 2 months.
The full SCALE conference will take place in Nashville, Tennessee, August 18-22.
1. Gold M, Graber E, Sawyer, T. Webinar IMPROVING Your Practice: Update on Acne and Rosacea. Presented at: Acne and Rosacea Update; June 9, 2021.
2. Rosso JQ, Draelos ZD, Effron C, Kircik LH. Oral sarecycline for the treatment of papulopustular rosacea: results of a pilot efficacy and safety study. J Drugs Dermatol. 2021; 20 (4): 426-431. doi: 10.36849 / JDD.2021.5923
3. Garg V, Choi JK, James WD, Barbieri JS. Long-term use of spironolactone for acne in women: a case series of 403 patients. Journal of the American Academy of Dermatology. 2021; 84 (5): 1348-1355. doi: 10.1016 / j.jaad.2020.12.071
4. Tran PT, Berman HS, Leavitt E, Hogeling M, Cheng CE. Analysis of factors associated with relapse in patients on their second course of isotretinoin for acne vulgaris. J Am Acad Dermatol. 2021; 84 (3): 856-859. doi: 10.1016 / j.jaad.200.10.030
E. Graber, MD has received research grants / support from Sebacia, Ortho Dermatologics, Hovione, consulting fees from SolGel, Verrica, Sebacia, Hovione, Almirall, Digital Diagnostics, part of the speakers bureau for Almirall, and royalty holder for Walter Kluwer Health.