Acne Treatment Insights From SDPA Fall

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Shanna Miranti, MPAS, PA-C, Shares Expert Acne and Pediatric Dermatology Insights

“We want dermatology PAs to know that sometimes it's not enough to just prescribe one topical generic medication. If we are going to use combination therapy, we really want to try to check each one of those 4 pillars of acne pathogenesis when creating regimens for our patients with acne,” said Shanna Miranti, MPAS, PA-C, in an interview with Dermatology Times at the 2024 Society of Dermatology Physician Associates (SDPA) Fall Conference in Las Vegas, Nevada.

Miranti, a board-certified physician assistant at Riverchase Dermatology in Naples, Florida, and Dermatology Times’ Summer 2024 Editor in Chief, kicked off the conference on the first day in a collaborative session with Hilary Baldwin, MD, medical director of the SDPA conference, to discuss “Acne Insights: Expert Strategies and Solutions From the Pros.”

Miranti highlighted the importance of addressing multiple pillars simultaneously, advocating for combination therapies tailored to acne severity (mild, moderate, or severe) and patient-specific concerns like scarring. She referenced the groundbreaking triple-combination topical launched in 2024 (Cabtreo), which targets 3 of the 4 acne pillars: reducing bacteria, inflammation, and follicular plugging. Additionally, clascoterone cream (Winlevi), the only topical targeting sebum production, was presented as an effective option to round out comprehensive treatment plans. These advancements improve therapeutic outcomes and patient compliance.

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Clascoterone Cream 1% Deemed Stable When Combined With Other Topical Acne Treatments

In a recent poster presented at the SDPA Fall Conference, investigators developed a method to evaluate the stability of clascoterone cream (Winlevi) when combined with other commonly prescribed topical acne medications such as retinoids, antibiotics, and benzoyl peroxide. Overall, Draelos et al determined that clascoterone cream was “consistently and reproducibly stable in the presence of other topical acne medications.”

Clascoterone cream 1% is an androgen receptor inhibitor that was FDA-approved for the treatment of acne vulgaris in patients aged 12 years and older in August 2020. To analyze clascoterone cream’s stability with other topicals, tretinoin cream 0.025%, adapalene gel 0.3%, dapsone gel 7.5%, azelaic acid 15%, benzoyl peroxide 5%/clindamycin 1%, benzoyl peroxide 2.5%/adapalene 0.1%, and encapsulated benzoyl peroxide 5% (0.5 mL each) were placed separately on individual microscope slides followed by 0.5 mL of clascoterone cream and incubated for 8 hours at 37 °C.

“Clascoterone was consistently and reproducibly stable in the presence of other topical acne medications. The combination of clascoterone cream 1% with topical retinoids, topical antibiotics, and/or benzoyl peroxide may be a viable strategy for the treatment of acne vulgaris. This method may be adaptable for testing the stability of other topical acne medications,” concluded Draelos et al.

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Advocating for Innovation and Education in Acne Care

“Whenever I'm prescribing a medication to people, I like to apply what I call the ‘mother rule’ or the ‘daughter rule.’ What would I do if this patient was my mother or my daughter? What I would do is: do what I have to do to get the prior authorization, the step edits, whatever it is that has to be done, in order to get these beautiful products for our patients, maximize the efficacy, maximize the speed with which they get better, and reduce their irritancy profile,” said Hilary Baldwin, MD, in an interview with Dermatology Times at the SDPA Fall Conference.

Baldwin, a 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, shared expert treatment tips for acne regimens and discussed her role as the medical director of this year’s meeting.

She highlighted the superiority of branded acne products over generics, focusing on their advanced vehicles, which enhance efficacy and tolerability. She criticized the common "recipe" approach to acne treatment—pairing a topical retinoid with clindamycin—calling out that that combination will not be effective long-term. Clindamycin, she stressed, should always be combined with benzoyl peroxide to prevent antibiotic resistance, a critical consideration often overlooked.

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Test Your Knowledge: Acne Pearls From SDPA

Hilary Baldwin, MD, and Shanna Miranti, MPAS, PA-C, reviewed the pathophysiology and treatment of acne in their session, “Acne Insights: Expert Strategies and Solutions from the Pros” at the SDPA Fall Conference. The experts reminded attendees that a multifaceted approach to managing this condition is warranted, and shared insights from recent research and their combined experience to a packed audience.

If you missed the session, are you leveraging best practices? Test your knowledge and read some of the clinical pearls they shared.

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