What’s New & What’s Coming (Part 4)

Acne Part IV - What’s New and What’s Coming

At the present time there are twelve or more products and pharmaceutical agents in Phase 2 and 3 testing to potentially treat acne, including both topical and systemic treatments. They hold the promise of more effective and even safer acne treatments in the next few years.

Altreno was recently FDA approved (August, 2018) as the only retinoid treatment in a lotion base on the market and it has been approved for patients 9 years older.  It is in a formulation of known moisturizers, hyaluronic acid, collagen and glycerin. It allows important retinoid treatment with much less potential redness, swelling and irritation, compared to other topical retinoid therapies. (Johanek E. Deramtol Times, June 2019)

Trifarotene is another topical retinoid nearing FDA approval for moderate acne. It was the first retinoid cream tested in truncal acne as well as facial acne.  It demonstrated significant and similar effectiveness in treating both facial and back acne and re-emphasized the effectiveness of a topical retinoid in treating both blackhead and papulo-pustular acne on the back, an area usually neglected. (Tan J, et al. J Am Acad Dermatol. 2019 – Epub)

4% Topical Minocycline was developed as a way to get much of the known therapeutic benefit of systemic minocycline for acne, without many of the potential side effects of systemic treatment and it has finished Phase 3 testing for moderate to severe acne, demonstrating significant effectiveness.  (Gold, LS et al. J Amer Acad Dermatol. 2019;80:168-177)

Anti-androgen treatment with spironolactone and birth control pills has become increasingly common place to treat acne with a strong hormonal component (primarily in women), but which is also often avoided or discontinued because of side effects. There has long been a need for a topical anti-androgen, now there is one coming for acne treatment, Clascoterone 1%. Initially, it has shown significant benefit for both papulo-pustular and comedonal acne, by reducing and modifying oil gland production of sebum that contributes to formation of acne lesions, much like oral anti-androgens do.  The cream is used twice a day and has very little irritation or redness. (Herbert A. AAD 2019. Abstract 5034)

Sarecycline is a new tetracycline derivative that was recently approved by the FDA and is the first new antibiotic approved for acne in 4 decades.  It is dosed strictly by weight 1.5mg per kg., once daily.  It is effective for moderate to severe acne and a nice addition to the acne therapeutic armamentarium, especially for short term (3 months or less) control of the inflammation in acne. (Moore A. J Drugs Dermatoll. 2018;17:987-996)

A unique topical medication Novan SB204 is in phase three testing as monotherapy for acne. It increases localized topical delivery of nitrous oxide to provide anti-inflammatory activity by inhibiting the NLRP3 inflammasome, decreasing the release of cytokines and killing the bacteria that helps cause acne, propionobacterium acnes. (Johanek)

The future of acne treatment looks bright, with positive changes in understanding the disease and treatment.