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FA L L C L I N I C A L D E R M AT O L O G Y C O N F E R E N C E P R O C E E D I N G S
FALL CLINICAL
DERMATOLOGY 2007
AN UPDATE ON ADVANCES IN ACNE AND EXCERPTS FROM
WHAT’S NEW IN THE MEDICINE CABINET
BY JAMES Q. DEL ROSSO, D.O., F.A.O.C.D.
DERMATOLOGY RESIDENCY DIRECTOR
VALLEY HOSPITAL MEDICAL CENTER
LAS VEGAS, NV
Acne vulgaris is one of the
most common diagnoses
e n c o u n t e red in clinical
practice. Most advances relate to
i m p rovements in vehicle technology
and new data, especially on
combination therapy.
C O M B I N ATION TO P I C A L
T H E R A P Y
Topical retinoids are a vital component of both initial tre a t-
James Q. Del Rosso,
D.O., F.A.O.C.D.
ACNE UPDATE
ment and maintenance therapy for acne vulgaris. They
exhibit the ability to reduce both non-inflammatory lesions
and inflammatory acne lesions. Benzoyl peroxide also
remains a foundation of acne treatment, exhibiting the ability
to markedly reduce P ropionibacterium acnes c o u n t s
and prevent emergence of P. acnes strains that are less
sensitive to antibiotics, such as erythromycin and tetracycline.
Benzoyl peroxide, including formulations that also
contain clindamycin, is well established for reducing inflammatory
acne lesions but also for decreasing non-inflammatory
lesions by approximately 25% to 30% in clinical trials.
Multiple clinical trials have evaluated tretinoin (Retin-A
M i c ro, Tretin-X, Atralin), adapalene (Differin), and tazaro t e n e
( Tazorac), including initial pivotal monotherapy studies and
trials utilizing combination therapy with a benzoyl pero x i d e
(BPO)-containing formulation. The availability of newer vehicles
that decrease the potential for and the intensity of initial
skin irritation observed with topical retinoid therapy (“re t i n o i d
dermatitis”), such as tretinoin formulated in the micro s p h e re
gel (Retin-A Micro) and the aqueous-based gel (Atralin), has
allowed for effective combination topical therapy of acne vulgaris
from the outset. With these newer vehicles, more
patients are able to tolerate combination topical tre a t m e n t
with few or no signs of skin irritation.
B E N Z O Y L PEROXIDE/CLINDAMYCIN +
TO P I C A L RETINOID T H E R A P Y
Clinical studies have evaluated BPO-clindamycin gel (Duac)
used in combination with either tazarotene cream 0.1% (Ta z o r a c ) ,
t retinoin micro s p h e re gel 0.04% or 0.1% (Retin-A Micro), or adapalene
gel 0.1% (Differin). The BPO-clindamycin gel and the topical
retinoid were applied in the morning and at bedtime, re s p e c-
t i v e l y, in all of the studies. The combination topical approach of a
retinoid used along with BPO-clindamycin from the outset of therapy
exhibited inflammatory and non-inflammatory lesion re d u c-
NEWER VEHICLES T H AT D E C R E A S E
THE POTENTIAL FOR AND THE
I N T E N S I T Y OF INITIAL SKIN IRRITAT I O N
O B S E RVED WITH TO P I C A L R E T I N O I D
T H E R A P Y H AVE ALLOWED FOR
EFFECTIVE COMBINATION TO P I C A L
T H E R A P Y OF ACNE VULGARIS.
tions after 12 weeks of at least 60% and 55%, re s p e c t i v e l y, with
all 3 retinoids (F i g u res 1–4). In one of the trials, the study arm
using both BPO-clindamycin gel (Duac) and tazarotene 0.1%
c ream (Tazorac) demonstrated a marked reduction in non-inflammatory
lesions at Week 4 (34%) and Week 8 (64%) (F i g u re 3) .
Tolerability results were very favorable in all 3 trials. A case re p o r t
series of BPO micro s p h e re cream (NeoBenz Micro) applied once
daily in the morning used in combination with tretinoin micro s-
p h e re gel 0.04% (Retin-A Micro) once daily at night also proved to
exhibit effective results with no reports of skin irritation.
PROPER SKIN CARE IN ACNE T H E R A P Y
The use of appropriate skin care is vital in the management
of acne vulgaris, allowing for preservation of epidermal barrier
integrity and function. The use of a gentle facial cleanser and
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