Dr. Diane Thiboutot is a Professor of Dermatology and Vice-Chair for Research for Dermatology at Penn State Hershey. Both in her practice and research, Dr. Thiboutot specializes in the care of patients with acne, rosacea, and hair disorders. In addition to serving as a reviewer for the National Institutes of Health and several dermatology journals, she has authored or co-authored many studies, articles, and book chapters relating to acne and hormone metabolism in the skin. She is also a frequent lecturer at medical conferences. Ahead, Dr. Thiboutot reflects on the state of care in acne and sheds light on how a strong relationship between physicians and patients may boost treatment outcomes.
What is your current impression of the treatment field for acne and what do you foresee on the horizon?
Substantial progress has been made in the treatment of mild to moderate acne, according to Dr. Thiboutot. “Many excellent treatments are available, including topical retinoids, benzoyl peroxide, dapsone, and combination products,” she notes. However, there are still challenges with managing patients with moderate to severe acne, particularly those with scarring. “Overuse of antibiotics has become a worldwide concern. Moving forward, more emphasis will be placed on designing treatment regimens that limit the duration of antibiotic use similar to protocols used in Europe,” says Dr. Thiboutot. “It will be interesting to learn if subantimicrobial doses of antibiotics will be beneficial in acne, perhaps in combination with use of benzoyl peroxide to target P. acnes.”
Another development that’s worth following is the potential for device-based interventions for acne and acne scarring, notes Dr. Thiboutot. “There are many small case series of patients treated with laser and light therapy including PDT. Data on these devices from larger randomized controlled trials would be welcomed to help us determine the place of these modalities in the acne therapeutic armamentarium.”
From a global health perspective, many challenges still remain, however. ”Models of health care delivery are changing, with more emphasis on cost-effective treatment choices. Doing clinical trials to compare therapies head-to head is expensive, and conducting meta analyses of data from various clinical trials is not always possible because the methods to grade acne are not standardized,” states Dr. Thiboutot. Nevertheless, the potential for progress remains high. “The NIH has very recently funded a project to develop standardized outcome measures for acne in clinical trials. Investigators from the US, Canada, the UK, and other countries will be working together to develop and test standard tools to assess acne that will help us in the future to compare data across studies.”
Are there any tips you can offer when it comes to counseling and interacting with patients with acne?
It is important to help patients manage their expectations for acne treatment, particularly regarding when to expect improvement, Dr. Thiboutot observes. “Many patients, particularly teenagers, feel that if they don’t see results within a week or two that their medications don’t work, so they stop using them. A brief explanation that it takes about six to eight weeks for an acne lesion to develop and that treatment mostly works to prevent new lesions from forming, often helps patients to understand that it takes about six to eight weeks to see noticeable improvement.” Another tip to improve adherence is to instruct the patient to apply the medication to the entire affected area, such as the face. “Despite mentioning this to every patient, when I question patients on the return visit about how they are applying the medication, some still apply it only to the lesion itself, so re-educating is important too,” she observes.
What would you like to see emphasized by both physicians and researchers in acne care going forward?
Dr. Thiboutot sees a need for new agents to reduce sebum production, as well as a need for agents that are a safer alternative to isotretinoin. These areas will constitute the focus of much research in coming years. However, in terms of clinical care, Dr. Thiboutot believes that interacting with patients is key. “Many of us respond to a patient who hasn’t responded to an acne regimen by recommending a more aggressive regimen, often involving more medications. But in many of these cases, it’s more likely that the patient isn’t really using the medication or not using it properly,” says Dr. Thiboutot. “Researchers in biobehavioral health show that better results are obtained when patients are involved in the process.” Thus, “involving the patient in the design of the treatment plan and determining what they are willing (or not willing) to do is key,” Dr. Thiboutot notes.