What’s New in Acne and Rosacea for 2021?

At the Symposium for Cosmetic Advances and Laser Education (SCALE) Acne and Rosacea Update, Emmy Graber, MD, board certified dermatologist and founder of the Dermatology Institute of Boston, and affiliate clinical instructor, Northeastern University, Boston, Massachusetts presented new updates on the treatments of these conditions.¹ 

On updated included sarecycline as a potential treatment for rosacea. Sarecycline is already FDA approved for acne, but it is a new treatment for rosacea.² The objective of the prospective, parallel-group, randomized, investigator-blinded, pilot study of oral sarecycline was to examine its efficacy and safety in adults with moderate to severe papulopustular rosacea. 

There were 102 patients enrolled in the study with 72 of those patients being treated with oral sarecycline and 25 with placebo. The coprimary endpoints included the percentage of patients with an Investigator Global Assessment (IGA) score of 0 or 1 (clear or almost clear) at week 12 and a reduction of inflammatory lesions. 

Secondary endpoints were a percentage of patients with IGA scores of 0 or 1 at weeks 4 and 8, a percent reduction of inflammatory lesions at weeks 4 and 8, and Subject Global Assessment (SGA) rating at each visit. Researchers also looked for any adverse events (AEs) and local signs and symptoms on the skin. 

At weeks 4, 8, and 12, sarecycline outperformed placebo in the percentage of patients with IGA 0/1. At week 12, 75% of patients had scores of IGA 0/1 in the sarecycline arm vs 16% of the placebo arm. 

For AEs, all were resolved except for a mild case of nausea and a headache by the end of the study. 

For updates in acne, a retrospective study investigating oral spironolactone (Aldactone; Pfizer),evaluated 403 female adult patients with acne.³ 

Results of the study suggested that spironolactone maintains its efficacy even with long-term use. Also, 23% of discontinuations were due to AEs, 6 of which were related to menstrual issues, and the other 15 were due to symptoms such as dizziness, headache, frequent urination, fatigue, dry skin, anxiety, and abdominal pain. 

There was also an update on isotretinoin dosing.⁴ There was a retrospective review of patients revieing either 1 or 2 courses of isotretinoin. Patients who received 2 courses tended to have a lower cumulative dose and a shorter duration of isotretinoin treatment after acne clearance.

According to Graber, this suggests a cumulative dose and duration of treatment after clearance are strong predictors of acne relapse. The authors of the study recommended treating until culminative dose of 120 – 150 mg/kg for 6 months, and extended treatment for 1 to 2 months. 

The full SCALE conference will be happening in Nashville, Tennessee from August 18 through 22. 

Reference:

1. Gold M, Graber E, Sawyer, T. SCALE UP Your Practice Webinar: Acne and Rosacea Update. Presented at the: Acne and Rosacea Update; June 9, 2021.

2. Rosso JQ, Draelos ZD, Effron C, Kircik LH. Oral sarecycline for treatment of papulopustular rosacea: results of a pilot study of effectiveness and safety. J Drugs Dermatol. 2021;20(4):426-431. doi:10.36849/JDD.2021.5923

3. Garg V, Choi JK, James WD, Barbieri JS. Long-term use of spironolactone for acne in women: A case series of 403 patients. Journal of the American Academy of Dermatology. 2021;84(5):1348-1355. doi:10.1016/j.jaad.2020.12.071

4. Tran PT, Berman HS, Leavitt E, Hogeling M, Cheng CE. Analysis of factors associated with relapse in patients on their second course of isotretinoin for acne vulgaris. J Am Acad Dermatol. 2021;84(3):856-859. doi:10.1016/j.jaad.2020.10.030

Disclosure:

E. Graber, MD has received grants/research support from Sebacia, Ortho Dermatologics, Hovione, consulting fees from SolGel, Verrica, Sebacia, Hovione, Almirall, Digital Diagnostics, a part of the speakers bureau for Almirall, and royalty holder for Walter Kluwer Health.