Physician Spotlight: Emmy M. Graber, MD, MBA

Emmy M. Graber, MD, MBA, the founder of the Dermatology Institute of Boston and member of the Board of Directors at The American Acne and Rosacea Society, loves treating acne patients as it allows her to change patients’ skin and enhance their quality of life. She spoke to Practical Dermatology® magazine about the latest acne treatments and what’s on the horizon, including potential changes to the isotretinoin iPLEDGE Risk Evaluation and Mitigation Strategy (REMS).

Is acne more than skin deep?

Emmy Graber, MD: Yes. We all know that acne patients suffer psychologically, but we didn’t understand to what degree and didn’t understand the real impact that successful treatment can have on improving patients’ psyches until recently. There has been research that really portrays the severity of acne on one’s psyche and depicts how it affects presence on social media and real-life plans. This research captures the impact that acne has on a patient’s self-confidence and ability to function and socialize. We have the power to change patients’ skin and mindset when we treat acne. It’s a really powerful thing, and this is why I love treating acne.

What’s the biggest recent advance in treating acne?

Dr. Graber: The big thing in the last few months is the availability of 1,726-nanometer (Nm) lasersfor acne. Both Cutera’s AviClear and Accure fit into this category; AviClear was just FDA cleared for the long-term treatment of acne. They selectively target the sebaceous glands and are the first lasers to do that. We have had lasers for acne in the past, but none have been as effective as these. These lasers work for all skin types, patients of all ages, and all types of acne except acne excoriée. Some people with very mild acne will want to be treated with a laser, and there are patients with severe acne who have lots of nodules who may also benefit from laser treatment.

Is anything else exciting coming down the pike?

Dr. Graber: Yes, IDP-126 is exciting. IDP-126 is a gel that contains clindamycin 1.2%/adapalene 0.15%/benzoyl peroxide 3.1%. It will be great to give patients one topical rather than three different topicals. If approved, it may be the first fixed-dose triple combination treatment for acne. The initial data is very impressive in that the triple combination did better at reducing acne lesions than either of the dyads alone.

You recently testified before the FDA on potential modifications to the isotretinoin iPLEDGE REMS. Tell us about that.

Dr. Graber: We want to maintain patient safety while improving access to isotretinoin. iPLEDGE can be a hassle and a burden and hinder care. We want to make sure treatment is available for patients, keep patients safe, and protect providers and pharmacies. Some of the changes we suggested will make isotretinoin more easily accessible to patients using longer-acting birth control methods, male patients, and easier to prescribe via telemedicine. There has been a big shift in the last 10 years as far as patients who identify as transgender, and they have unique needs. It took some time for physicians to catch up and be comfortable prescribing isotretinoin to these patients. I am happy to see that a lot of my colleagues, myself included, are very willing to treat acne patients of all types regardless of how they identify.

Telemedicine was really new at the start of the pandemic, and providers may now feel more comfortable with it as a way of seeing patients and prescribing isotretinoin. The iPLEDGE landscape has changed in many different ways, and we really haven’t seen the outcome of the testimony before FDA yet.

How do you counsel acne patients who get skincare advice from social media influencers?

Dr. Graber: We have to listen to what they learned to make sure they are not doing anything to harm themselves. We need to approach them in a non-judgmental way. Whether right or wrong, acne patients may find TikTok to be a valid source of information. That is hard to change.