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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
ly superior efficacy in some cases, as compared to some older
formulations (F i g u re 6). A “triple moisturizer- i n g redient formulation”
(Benziq), available as a wash and “leave on” gel, was
shown to be less irritating than some other comparator BPO
p roducts in a cumulative irritancy study. The micro s p h e re
c ream formulation of BPO 5.5% (NeoBenz Micro) has demonstrated
efficacy in clinical studies with a very favorable tolerability
profile; one study demonstrated superior efficacy with the
t retinoin micro s p h e re cream (NeoBenz Micro) as compared to
benzoyl peroxide gel 6% (Triaz) in patients with acne vulgaris.
A “direct from the doctor” 3-part acne treatment system
(Clenziderm MD, Normal to Oily Skin) utilizing a salicylic acid
2%-containing cleanser and “pore gel” followed by a 5% gel
containing solubilized BPO has been evaluated in several trials.
Unlike conventional BPO formulations, the solubilized BPO in
the 3-part proprietary system is micronized such that individual
BPO particles are small enough to penetrate into the follicular
orifice where P. acnes resides. This 3-part acne treatment system
has demonstrated both reduction in P. acnes and eff i c a c y
comparable to benzoyl peroxide/clindamycin gel (Benzaclin) in
p reliminary trials along with high patient pre f e rence ratings.
Another 3-part acne treatment system, available from the
same manufacture r, contains solubilized BPO 5% lotion combined
with a gentle cleanser and moisturizer (Clenziderm MD,
Normal to Dry Skin) and does not contain the components with
salicylic acid 2%.
O R A L CONTRACEPTIVES IN ACNE T H E R A P Y
The majority of post-teenage females with acne exhibit
normal serum androgen levels. Acne appears to occur secondary
to increased local androgen production within sebaceous
glands. Many adult-onset or adult-persistent cases of
acne vulgaris in females present with a preponderance of
inflammatory lesions involving the lower cheeks, jawline,
chin and lateral neck.
The only progestin available in an oral contraceptive (OC)
formulation that exhibits antiandrogen activity is dro s p e r i n o n e
found in a formulation that also contains 20 mcg of ethinyl
estradiol (YAZ). This formulation is approved for moderate acne
and is comprised of 24 days of active therapy and 4 hormonef
ree days, resulting in a short menstrual cycle. In a placeboc
o n t rolled, randomized, double-blind, 6-cycle clinical study,
451 females received the active OC formulation and 442
received placebo. After the first cycle, subjects receiving active
OC treatment demonstrated a markedly greater reduction in
total acne lesions, which continued to pro g ress throughout the
sixth cycle (study endpoint).
ACNE APPEARS TO OCCUR
SECONDARY TO INCREASED LOCAL
ANDROGEN PRODUCTION WITHIN
SEBACEOUS GLANDS.
When using OCs to treat females with acne vulgaris, side
effects may be decreased by using formulations that contain
lower doses of the estrogenic component (ethinyl estradiol).
In addition to reduction in acne lesions, other potential benefits
of OC use include regulation of menstrual cycle, reduction
in perimenstrual symptoms, such as cramping, decrease in
ovarian cyst formation, reduction in bone demineralization,
and decrease in risk of ovarian and colorectal cancer.
Potential side effects of OC use include thromboembolism
and cerebral vascular accident. It has been recommended
that clinicians not prescribe OCs to women who smoke due
to an increased risk of vascular-related complications.
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