Despite being among the most common conditions dermatologists encounter in practice, acne remains a challenge to treat. It presents in a variety of settings and at different stages of development. Moreover, it often affects patients—primarily teenagers— in serious ways. June is National Acne Awareness Month, marking a unique opportunity for physicians. While raising awareness for the disease may not be as crucial in the broader public view, it remains important to ensure that individuals suffering from acne are aware of its impact and seek appropriate medical intervention. Thus, as we await the start of National Acne Awareness Month, it is incumbent upon physicians to stay abreast of the latest developments in practice, research, and media, and to consider how such developments may affect their patients.
The State of Care
Several changes on the therapeutics front have affected the general management of acne, according to Julie C. Harper, MD, Clinical Associate Professor of Dermatology at the University of Alabama-Birmingham and Director of the Dermatology and Skin Care Center of Birmingham, in Alabama. “Our acne products, both topical and oral, have become easier to use,” she explains. “We have seen a shift to QD dosing of our systemic medications, and combination topical products offer the benefit of two medications QD,” says Dr. Harper. “In addition, topical products are also better tolerated than in years past. Vehicles have been developed that more effectively deliver our medications and lessen irritation,” Dr. Harper notes. “These advances add up to enhanced patient adherence to treatment, meaning better results for acne sufferers.” Regarding specific formulations that have yielded positive results, Dr. Harper points to combination products used in moderate to severe acne, such as adapalene and benzoyl peroxide gel (EpiDuo, Galderma). “The individual ingredients in EpiDuo are not thought to be our best acne medications for severe acne, yet in combination and with a systemic agent, they work quite well,” Dr. Harper observes. The reason for such efficacious results, notes Dr. Harper, is likely the quality of the formulation and ease with which it is applied and tolerated.
Though these advances have had a measured impact on patient care, a major gap permeates widespread developments in acne therapy: new molecules. On Dr. Harper's wish list is a drug as effective as isotretinoin without the risks. There are other wishes, as well. Notes Dr. Harper, “We need more acne treatments that do not promote bacterial resistance to antibiotics. We also need topical sebosuppressive medications that we can use in men and women.” While Dr. Harper observes that the current pipeline is largely based on reformulations and combinations of molecules already available, she believes that new molecules will be essential in shaping the evolving therapeutic regimens that patients need.
Compliance is also an ongoing issue that poses roadblocks to effective care. To foster greater compliance, Dr. Harper explains that educating your patients is the foundation of ensuring adherence to therapy. “Make sure patients understand why medications are prescribed, how to use the medication, and what to expect from treatment,” she notes. Aside from managing expectations, Dr. Harper suggests that involving the patient in the development of the treatment plan (when possible) is also a touchstone method to increasing likelihood of compliance. “Patients are more likely to be adherent to treatment when they feel that they have been a part of developing the treatment approach,” says Dr. Harper. For example, it might be helpful to ask patients if the patient is more efficient at applying or taking a medication in the morning or the evening. According to Dr. Harper, the patient's response should provide a basis for a dialogue that may enable you to work with the patient to determine a regimen conducive with her or his daily habits. “Some of our patients are very regimented and can follow a detailed plan, whereas others need a simple, once-a-day approach,” says Dr. Harper. Moreover, scheduling regular follow-ups can be a simple way to keep patients on their regimen. “Patients are most adherent to a treatment plan right before and right after an appointment. If compliance appears to be an issue, schedule follow-up visits closer together,” she explains.
See an update on acne compliance research at DermTube. com: http://dermtube.com/series/dermmentor-resident-ofdistinction- award/an-internet-based-survey-and-contest-anovel- method-for-improving-acne-outcomes-/
Join the Cause
Meeting the continual challenges of acne treatment requires acknowledgement of the limitations in available therapy and some patient's willingness to adhere with therapy. However, as Dr. Harper observes, there are countless ways that clinicians can tweak their approach to treatment and patient interaction that may result in positive results. Nevertheless, any physician treating an acne patient is aware of the built-in difficulties to successful care.
For physicians who not only treat acne patients day-in and day-out, but who may also want to increase awareness about the disease and the importance of seeking appropriate intervention, Dr. Harper suggests joining the American Acne and Rosacea Society (AARS). “The AARS offers educational resources to its members and promotes overall acne awareness to the lay population,” says Dr. Harper. Among its offerings, the AARS holds an annual scientific symposium, as well as regular national and regional educational conferences, meetings, and webinars. In addition, the society publishes a newsletter highlighting member and Society news and the latest clinical research findings.
According to Dr. Harper, the AARS's emphasis on supporting young clinicians and researchers interested in furthering understandings of the pathogenesis and appropriate treament of acne vulgaris is particularly significant. In addition to providing numerous mentorship and grant opportunities, the AARS offers clinical and research audiopearls on its website (www.acneandrosacea.org). Encompassing topics such as the use of oral contraceptives in acne care, novelties in acne pathogenesis, childhood acne, P. acnes decreased sensitivity to antibiotics, and truncal acne vulgaris, the audiopearls delve into the latest research with concise, expert analysis that is particularly beneficial to younger physicians.
As National Acne Awareness Month nears, clinicians can use the extensive resources available through the AARS to further their understanding of the disease and embolden the cause for heightened public awareness about its impact on the life quality of patients.