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LIVE BLOG: The Role of Adapalene & Benzoyle Peroxide in Acne Magagement [Product Theater: Galderma / Epiduo Gel]

In this 1st Live Blog from the SDPA Summer Conference in St. Louis, learn from an MD speaking for Galderma on Epiduo Gel, particularly in terms of treating our pediatric derm patients.
Pathogenesis:  Adapalene & benzoyl peroxide treatment
New data on Acne
+ Study done by biopsying the back of patient’s with acne
+ Acne lesion and normal skin
+ Patients with normal skin did show sub-clinical inflammation
+ This may precede the Microcomedone
+ “Normal skin” has inflammation
+ Closed comedone
+ Open comedone
+ Papular/pustular lesion
Inflammatory lesions can develop directly from microcomedones.  One study even showed irregular lesions that could develop de-novo.
Note: Even the non-inflammatory comedones are considered lesions now.
A Timeline of Guidelines for Acne Treatment
1. Global Alliance to Improve Outcomes in Acne –> these guidelines are retinoid based (topical)
2. Pediatrics have traditional focused on dental peroxide (BPO)
3. Current recommendations for treatment of pediatric acnes rom AARS (endorsed by AAP), emphasize value of BOTH dental peroxide and topical retinoids
Based on current understanding of acne pathophysiology and lesion progression, topical retinoids and BPO are both important in treating acne patients.
Let’s take a closer look at:
+ Lipophilicity allows penetration in the sebaceous follicle
+ Anti-inflammatory 
+ Stable in the presence of BPO 
+ Low flux through the skin, keeps it where you put it
+ both once daily application
+ known retinoid anti-inflammatory
+ low potential for irritation
+ fine in light
+ stays where you put it
Adapalene gave a more significant in the mouse ear in comparison to tretinoin use
When you use higher doeses, frewer comedones will be seen over time
Quick Rewind: What are p acnes?
Short for propinibacterium acnes, p acnes are the bacteria that causes acne.
Synergistic Activity of Adapalene and BPO: 
Biopsies were taken, markers were looked at in terms of either proliferation, adhesion/differentiation, or innate immunity.
Overall, all markers were significantly reduced when using Adapalene and BPO together: decreased markers of cell turn over, adhesion, differentiation, and immune system markers.
BPO 2.5%
+ 97% after 1 week reduction of P acnes on the skin
+ 99% after 2 weeks
+ Reduces generation of inflammatory mediators by P acnes
+ No resistance to BPO ha been documented
+ Can present P acne resistance 
BPO 2.5% was equally efficacious as 5% or 10%.  Clearly, if you can have lower concentration but get the same affects, it is advantageous 

Epiduo Gel
Epiduo gel is indicated for topical treatment of acne vulgaris in patients 9 years age and older.  
In total, over 5000 patients have been evaluated with Epiduo.  There are studies showing efficacy and safety for all skin types and colors and age groups.
New data in treating patients between 9-11 years old:
Multi-center, randomized, vehicle-controlled, double-blind study evaluated safety and efficacy of Epiduo.  They were instructed to use a moisturizer.

[image by webtreats]

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