Addressing Antibiotic Stewardship and Acne Guidelines at AAD

“I really think that as a whole, we need to talk more about antibiotic stewardship. I think this is a problem that continues to compound not just year after year, but day after day, given that millions and billions of patients worldwide are continuing to use antibiotics,” said Naiem Issa, MD, PhD, FAAD, in an interview with Dermatology Times at the 2024 American Academy of Dermatology (AAD) Annual Meeting. “We need to figure out collectively as a society, through our sub-societies such as the Acne and Rosacea Society, how to limit unnecessary usage of systemic antibiotics and those with broad spectrums that are going to cause harm down the road.”

Issa, a board-certified dermatologist at Forefront Dermatology in Vienna, Virginia, and an adjunct professor of dermatology at the University of Miami in Florida and the George Washington University School of Medicine in Washington DC, shared not only his thoughts on antibiotic stewardship related to acne, but also his thoughts on the recently updated AAD acne guidelines that only conditionally recommended topical clascoterone and sarecycline due to cost.

“These 2 medications are first-in-class at what they do, and they help bridge gaps in acne treatment. For clascoterone, it's a first-in-class topical antigen blocker, which is important because now we filled a gap where even male patients, let alone female patients, who need that kind of blockade to help one of the pillars of acne, it will help to treat that aspect of that,” said Issa.

He added, “For the females, it's a way to get away from oral systemic medications that could have risks that could harm them. Then for sarecycline, there's a big component of antibiotic stewardship, which the Academy has been trying to put into full force, especially with the continued uses of antibiotics, not just for acne, but for all disease states. And we have millions of people on antibiotics every day. Antibiotic resistance is a huge problem.”

In his interview, Issa also discussed new research he is working on, including repurposing mebendazole, formerly known as Vermox, which is used for intestinal helminth infection. Issa is using this medication for rosacea and is hoping to complete phase 2 studies. Issa and his team at the University of Miami have replaced epinephrine midodrine, an alpha agonist, with the hope of disrupting the supply chain problem of epinephrine.

Transcript

Naiem Issa, MD, PhD, FAAD: Hi, my name is Naiem Issa, I'm a dermatologist with Forefront Dermatology in Vienna, Virginia. I'm also an adjunct professor of dermatology over at the University of Miami as well as George Washington University School of Medicine in Washington DC.

Dermatology Times: What current research are you working on that you are excited to share?

Issa: All right, so today I would like to talk to you about 2 major aspects of research that I'm working on. The first one is that I've repurposed a medication called mebendazole, formerly known as Vermox, which is used for intestinal helminth infections, which is a parasite. And one may ask, what on earth are you doing with anti-parasitic medication? Well, I've discovered that I could repurpose it for rosacea. And so currently, I've made a gel out of this oral medication and currently looking to do phase 2 studies for this, and hopefully get it approved down the pipeline for the redness of rosacea, as well as the papules and pustules. So, looking forward to that.

Then for the second aspect of research, what I think is really, really exciting is that everyone knows lidocaine with epinephrine, right? We use that in our dermatologic surgery cases, ambulatory cases, and what have you. And what my team at the University of Miami has done is that we've actually replaced epinephrine with a medication called midodrine, which is an alpha agonist. Because of the supply chain issues and the cost of getting epinephrine, we have been able to replace epinephrine with midodrine, which is a much lower-cost medication and found that midodrine can also achieve the same hemostatic effects as epinephrine in lidocaine. And hopefully, we're looking to disrupt that supply chain problem with this new medication.

Dermatology Times: What have you enjoyed about AAD so far?

Issa: Everybody loves AAD, right? It is the one meeting of the year where everyone's friends and families come together, we talk about dermatology, we talk about everybody's lives, see how everybody's doing; the social aspect is by far my favorite part. However, the AAD has also transformed. There's new science, there's new medicine, there's a lot of new innovation, and this is the place to get it. It's been a lot of great talks, you know, a lot of great innovation happening. And really, this is the one time of year where we really see all of that coming together. So. I love all of that.

Dermatology Times: As acne is one of your passions, how have the recently updated AAD acne guidelines been discussed or received at this year's meeting?

Issa: One thing I've been passionate about is treating acne. And I see a lot of acne patients day in and day out just like each and every one who is here at this meeting. There has been recent AAD guidelines that talked about what is strongly recommended with a conditional statement to go with it. And the thing is, there are 2 medications that got a conditional statement because of their costs. And both of these medications which are topical clascoterone, which is an androgen blocker, as well as sarecycline, which is a narrow-spectrum antibiotic. These 2 medications are first in class at what they do and they help bridge gaps you know, in acne treatment for clascoterone, it's a first-in-class topical antigen blocker, which is important because now we filled a gap where you know, even male patients, let alone female patients who need that kind of blockade to help one of the pillars of acne, it will help to treat that aspect of that. For the females, it's a way to get away from oral systemic medications that could have you know, risks that could harm them. Then for sarecycline, there's a big component of antibiotic stewardship, which is the Academy has been trying to, you know, put into full force especially with the continued uses of antibiotics, not just for acne, but for all disease states. And we have millions of people on antibiotics every day. Antibiotic resistance is a huge problem. With sarecycline that helps to fulfill that need. So sarecycline being narrow spectrum has a low risk of resistance in a targeting the cutibacterium acnes, and is quite effective for moderate to severe acne. So getting a conditional recommendation because of cost is very unfortunate because that will limit our usage in an era where we need to practice antibiotic stewardship.

Dermatology Times: What is one topic in dermatology that you wished was talked about more?

Issa: I really think that as a whole, we need to talk more about antibiotic stewardship.I think this is a problem that continues to compound not just year after year, but day after day, given that millions and billions of patients worldwide are continuing to use antibiotics. You also find antibiotics, you know, in the environment, you know, in the fauna and the flora, your name is everywhere, in the in the livestock, feed stock, you name it. How are we going to be stewards of preventing resistance when for the cases where we really need to use antibiotics, right? Because one day we're going to wish if we were sick ourselves, and antibiotics don't work, that we're going to run into a big problem. We need to figure out what's collectively as a society, through our sub-societies such as the acne and rosacea society, how to limit unnecessary usage of systemic antibiotics and those with broad spectrums that are going to cause harm down the road.

[Transcript lightly edited for space and clarity.]