Acne and Rosace Updates at SBS 2023

"Most of our patients suffer from rosacea, and I really mean suffer, right? Not everybody with rosacea is held back by the disease, but most of our patients clearly are,” said Hilary Baldwin, MD, board-certified dermatologist, medical director of the Acne Treatment & Research Center in Brooklyn, New York, and clinical associate professor of dermatology at Rutgers Robert Wood Johnson Medical Center.

Baldwin spoke at the 2023 South Beach Symposium meeting in Miami Beach, Florida, where she presented her session, “What’s New in Topicals for Acne and Rosacea.” Baldwin began her session by noting that every patient with rosacea that comes to a clinical typically has a combination of rosacea subtypes. She also mentioned that over the last decade, dermatologists have been shying away from talking about subtypes and are now starting to talk about the phenotypes. Instead of trying to determine the old subtypes a patient may have, dermatologists should instead look at the patient in front of them and assess what they are seeing based on redness, papules, itching and other symptoms.

The treatment options of rosacea by phenotype are broken down below:

1. Telangiectasias and flushing

- Approved treatments: none

- Procedures: IPL and vascular lasers

- Other available treatments: alpha antagonists and beta blockers

2. Background erythema

- Approved treatments: brimonidine and oxymetazoline

- Procedures: IPL and vascular lasers

- Other available treatments: none

3. Papules and pustules

- Approved treatments: azelaic acid, microencapsulated benzoyl peroxide (BP), ivermectin, metronidazole, minocycline, SSA, sub antimicrobial dose of doxycycline

- Procedures: none

- Other available treatments: tetracycline antibiotics, isotretinoin

4. Ocular disease

- Approved treatments: none

- Procedures: none

- Other available treatments: doxycycline, topical ivermectin

Regarding acne, there has been a “boom” in the last 5 years of available acne treatments, according to Baldwin. To name a few, Baldwin mentioned:

• Microencapsulated BP 3%/tretinoin 0.1% combo
  • The benzoyl peroxide and tretinoin are microencapsulated separately, preventing them from negatively interacting with each other. In clinical trials, 33% of patients achieved clear or almost cleat at 12 weeks
• Clascoterone 1% cream
  • The first new mechanism of action for acne in many years, clascoterone cream is an androgen receptor inhibitor with anti-inflammatory properties. Previous anti-androgens had significant adverse event profiles, and spironolactone and oral contraceptives were only for female patients
• IDP-16 (clindamycin phosphate 1.2%, benzoyl peroxide 3.1%, adapalene 0.15%) 
  • A soon to be approved topical gel acne treatment. In clinical trials, over 50% of patients achieved clear or almost clear skin at week 12

Baldwin concluded her session by urging dermatologists to consider what acne and rosacea tools they have in their toolbox.

Reference

1. Baldwin H. What’s new in topicals for acne and rosacea. Presented at the 2023 South Beach Symposium Meeting; February 9-12, 2023; Miami Beach, FL.