Novel advances in acne therapy

New agents targeting the different factors that contribute to the pathogenesis of the disease appear to be very effective and result in excellent clinical outcomes, according to one expert.

The currently available therapeutic modalities for acne include numerous treatment approaches such as antibacterial washes, topical creams, antibiotic pills, lasers, pulsed-light therapies, photodynamic therapy, and isotretinoin.

Linda F. Stein Gold, M.D.“There are several new breakthroughs we are seeing in acne therapy today including medications that have novel mechanisms of action, more effective vehicles, as well as newly FDA-approved combination therapies. These new agents are proving to be very effective for all severities of acne and could herald a new age in acne therapy,” says Linda F. Stein Gold, M.D., director of clinical research and division head of the Department of Dermatology at Henry Ford Hospital, Detroit, Mich.

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Two topical drugs in particular that are currently under development have a novel mechanism of action and also target the production of sebum in the skin; thereby potentially ameliorating the clinical symptoms of acne. The experimental drug known as SB204 (Novan Therapeutics) just completed a phase IIb clinical trial and has been shown to not only effectively decrease the sebum production in the skin but also reduce both the comedone and inflammatory lesions seen in acne.

According to Dr. Stein Gold, this novel nitric oxide based agent appears to have antimicrobial and anti-inflammatory activity, reduces sebum production, and affects the keratinocytes, while avoiding resistances so commonly associated with standard antibiotic therapies.

“Although it still has to go through phase III clinical trials starting early next year, the interim results look very promising,” Dr. Stein Gold adds.

The other experimental drug in the pipeline that also has been shown to reduce the production of sebum in preclinical studies is DRM01 (Dermira).

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“Both of these pipeline drugs could change the way we approach acne therapy, as these may be the first two agents that can achieve a reduction in sebum production topically, not orally, making them so unique and exciting. In addition, they could serve as a treatment alternative to help curb the overuse of topical and oral antibiotics in standard acne regimens,” Dr. Stein Gold says.

NEXT: Combination therapies

Combination therapies

Epiduo Forte (Galderma) gel, which recently received FDA-approval, is a new combination product that has also been shown to be very effective in the treatment of moderate to severe acne vulgaris. According to Dr. Stein Gold, the novel combination of adapalene 0.3% and benzoyl peroxide (BPO) 2.5% can be very useful in the improvement of acne lesions, particularly severe papulopustular acne.

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Onexton gel (Valeant) is another relatively new combination acne therapy consisting of clindamycin 1.2% and benzoyl peroxide 3.75%. Upping the concentration of BPO from the standard 2.5% (as in Acanya gel, Valeant) to 3.75% has been shown to be very effective and can achieve significant improvements in moderate to severe acne.

It was previously thought that the concentration of benzoyl peroxide did not have any consequence on clinical outcome; however, the successes seen with Onexton gel has caused dermatologists to reconsider. In fact, it appears that the concentration of BPO does matter, Dr. Stein Gold says, as higher concentrations of BPO may increase the efficacy of combination therapies.

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“This is a really an exciting time in acne therapy. We have some new formulations, some new molecules, and we are actually in a better position than ever before to get our patients under control and maintain control of their acne, from moderate to severe,” Dr. Stein Gold says.

Disclosure: Dr Stein Gold is an investigator/advisor for Galderma, Valeant, Dermira, Novan, and Allergan.