While laser and light-based therapies continue to make their mark on many dermatologic procedures, some dermatologists believe the tried-and-true oral medications for treating moderate to severe acne offer patients the best long-term treatment outcomes. In fact, the introduction of new oral acne medications demonstrates that the demand for systemic acne therapies is still strong.
Speaking at the American Academy of Dermatology?s Summer Academy Meeting 2007, dermatologist Hilary E. Baldwin, MD, FAAD, associate professor of clinical dermatology at the State University of New York (SUNY) in Brooklyn, N.Y., discussed the newest developments in oral medications for the treatment of acne.
?The current systemic acne medications have staying power for one simple reason ? they work,? said Dr. Baldwin. ?Recently, some exciting new treatments have expanded our options for acne patients and have even addressed some of the potential drawbacks of oral acne medications, such as bacterial resistance with long-term antibiotic use.?
New Oral Medications
Dr. Baldwin reported that one of the most innovative new systemic acne medications is extended-release minocycline, which is the first time a weight-based oral medication has been introduced to control acne. This dose-based medication is taken once per day, and the extended-release nature of the drug means that the peak serum levels that are obtained in the bloodstream are not nearly as high as with immediate-release minocycline. Dr. Baldwin added that it is the peak serum levels in the bloodstream that is thought to cause the relatively high degree of side effects, such as dizziness, headaches and nausea.
Since extended-release minocycline can be taken with or without meals, Dr. Baldwin noted that patient compliance with taking this medication improves dramatically ? especially among teenage boys who tend to eat frequently throughout the day and find it hard to take a medication that needs to be taken on an empty stomach once a day, much less twice a day.
Another new area of acne research that is proving promising is using antibiotics for a period of a few months to start a successful treatment regimen, then replacing them with other non-antibiotic medications to maintain results over time. Dr. Baldwin explained that this ?step-down? approach is important, as an increasing concern of long-term antibiotic use is that bacteria are evolving to become resistant to these medications ? prompting dermatologists to seek alternative therapies in order to get their patients off of oral antibiotics as soon as possible. Recent clinical studies using the step-down approach from antibiotics and a topical retinoid to topical retinoids alone have shown positive results in maintaining improvement in acne patients, despite the abrupt discontinuation of oral antibiotics.
Another category of oral medications that dermatologists are using to treat acne is anti-inflammatory medications, which can be used in some cases to lessen the severity of acne. Used by some dermatologists to reduce the redness and swelling of acne, controlled-release doxycycline is one new anti-inflammatory medication recently approved by the U.S. Food and Drug Administration (FDA) for treating rosacea.
?Since controlled-release doxycycline is not an antibiotic, it does not kill the bacteria involved in the pathogenesis of acne and is therefore not expected to be as effective as antibiotics in controlling acute acne,? said Dr. Baldwin. ?But for some patients, such as women who may be prone to yeast infections from using antibiotics, this anti-inflammatory medication may offer noticeable improvement in the inflammation caused by acne.?
Dr. Baldwin also added that a new oral medication on the horizon could be another viable alternative for acne patients in the next few years. Incyclinide, a chemically modified tetracycline that is not an antibiotic, is now in phase two of clinical trials and shows promise in treating both acne and rosacea.
?We?re hopeful that the new systemic acne medications will lead to improved treatment outcomes for acne patients,? said Dr. Baldwin. ?However, with so many treatment options available, it?s important that acne patients involve a dermatologist to oversee their treatment regimen ? as only a dermatologist can determine which acne medications are best for each patient.?