LIVE BLOG | Clinical Considerations in the Treatment of Acne and Rosacea
This live blog from the SDPA Annual Summer Dermatology Conferencere in Austin, TX, highlights Dr. Del Rosso’s product theater on “Clinical Considerations in the treatment of Acne and Rosacea.”
- Rosacea treatment should be individually tailored to the patient’s clinical features since there is not a single subtype in every patient.
- Soolantra (ivermectin 1%) outperformed metronidazole 0.75%, worked faster, and patients stayed clear longer versus the gold standard.
- The sub-antimicrobial dose of doxycycline in Oracea will not produce the same side effects as the typical antimicrobial dose found in most doxycycline products, but provides the same anti-inflammatory effects as doxycycline 100mg.
- The longer patients use Mirvaso (brimonidine 0.33%) gel, the better it works with reduced adverse events. It is the only medication designed and indicated to reduce erythema of rosacea.
- Epiduo Forte (adapalene 0.3%/benzoyl peroxide) addresses inflammation, bacterial growth, and comedones in acne and can be used as a foundational treatment.
- Epiduo Forte is more efficacious in treating acne than if patients were to apply both drugs separately, and may be used in patients with both inflammatory and non-inflammatory acne.
Dr. Del Rosso explained that although inflammation is an underlying process in all rosacea, there is no single subtype of rosacea in every patient. He said that therapy needs to be individually tailored to each patient’s clinical features and often has to be adjusted as treatment goes along.
Dr. Del Rosso spoke about Soolontra (ivermectin 1%) cream for the treatment of inflammatory lesions of rosacea. He noted that Soolantra outperformed metronidazole 0.75% by 10% in bringing patients with rosacea down to an IGA of 1 or 0 in clinical trials. Patients also stayed treatment-free longer, an average of 115 days, with Soolontra compared to 85 days in those who used metronidazole.
Dr. Del Rosso addressed concerns that the dose of ivermectin in Soolantra is “nowhere near” levels used to kill exoparasites (i.e. mites), and would have no neurological effects on humans.
Dr. Del Rosso discussed the use of Oracea, a 40 mg capsule containing 30 mg immediate release and 10 mg delayed release doxycycline. He noted that this dose of doxycycline stays under the antimicrobial threshold, thus the anti-inflammatory effect is comparable to doxycycline 100mg. As a result, Oracea won’t produce the same side effects an antimicrobial doses of 50 mg or higher would (i.e. vaginal yeast infections) and promotes antibiotic stewardship when treating rosacea.
Next, Dr. Del Rosso discussed Mirvaso (brimonidine 0.33%) gel for treating background facial redness associated with rosacea. Mirvaso has vasoconstricting effects and was shown in studies to noticeably decrease redness, often within an hour. Dr. Del Rosso emphasized that the longer a patient uses Mirvaso, the better it works at reducing redness and is associated with less adverse events.
Finally, when discussing acne treatments, Dr. Del Rosso highlighted that acne is an inflammatory condition, even when inflammation is not readily apparent, such as before the eruption of a lesion or after an acne lesion flattens out and is in the hyperpigmentation stage.
Dr. Del Rosso explained that Epiduo Forte, a combination of the retinoid adapalene 0.3% with benzoyl peroxide, addresses the inflammatory component, bacterial component, and comedonal aspects of acne. He noted that Epiduo Forte was shown in studies to be more efficacious in treating acne than if patients were to apply both adapalene 0.3% and benzoyl peroxide separately.
Posted: June 2, 2016