Currents: The Resurging Focus on Acne and Rosacea

Acne Survey at Twins Convention Affirms Genetic Link

Acne may be primarily caused by genetics, according to results of a survey of identical and fraternal twin pairs at the Twins Days Festival in Twinsburg, OH. Study findings, published in the April issue of the Journal of Drugs in Dermatology, show the proportion of pairs where twins have acne was significantly higher in identical (64 percent) versus fraternal (49 percent) twins.

“Since identical twins have the same genetic makeup, they make the perfect study group to see if acne is caused more by genetics or environmental factors,” explains dermatologist Elma Baron, MD, professor of dermatology at Case Western Reserve University, Cleveland, and chief of dermatology at Louis Stokes Cleveland VA Medical Center.

Participating in the survey were 202 (101 pairs) identical and 53 (26 sets) fraternal twins, including one set of fraternal triplets. Both groups were young, predominantly female, and the majority of the participants were Fitzpatrick Skin Types II or III. The survey was conducted at the 2016 festival.

Researchers also attempted to determine social and environmental factors that influence acne severity. A twin-to-twin analysis of 56 identical twin pairs who had acne yet differed in self-reported severity revealed differences that may serve as triggers, including a high-glycemic diet, higher BMI, and lower frequency of exercise compared to twins without acne.

“There is some suggestion that factors other than genetics may contribute to acne severity,” says Dr. Baron in a news release. “As was demonstrated in our study and others, people genetically predisposed to acne can reduce the intake of sugar and refined carbohydrates to help keep acne on the mild side. Using cosmetics that are non-comedogenic can also help reduce acne severity.”

Survey participants were also asked additional health questions to discover possible associations with other health conditions. Identical twins with acne were found to have a higher incidence of polycystic ovarian syndrome (PCOS), anxiety, and asthma.

“Other studies have linked acne with PCOS and anxiety, but further research is needed to determine if there is a true association between acne and asthma,” Dr. Baron adds.

How Does Rosacea Impact QoL?

To evaluate the impact of rosacea on self-perception, emotional, social, and overall well-being and quality of life in individuals with erythematotelangiectatic rosacea (ETR) and papulopustular rosacea (PPR), researchers distributed a cross-sectional email invitation for participants in the US to fill out a web-based survey.

Six hundred participants enrolled and completed the survey, with most rating their rosacea as mild or moderate. In the erythematotelangiectatic rosacea and papulopustular rosacea cohorts, respectively, 45 and 53 percent disagreed/strongly disagreed that they were satisfied with their appearance due to rosacea; 42 and 27 percent agreed/strongly agreed that they “worry how people will react when they see my rosacea”; and 43 and 59 percent agreed/strongly agreed that they feel their rosacea is unattractive to others.

In the study, published in the Journal of Clinical and Aesthetic Dermatology, the authors concluded, “Rosacea had wide-ranging, negative effects on self-perceptions and emotional, social, and overall well-being as well as rosacea-specific quality of life. Overall, both erythematotelangiectatic rosacea and papulopustular rosacea cohorts reported a substantial negative impact of rosacea on quality of life on a range of instruments.”

New Phase 4 Data on Epiduo Forte Gel

Results from OSCAR, a Phase 4, multicenter, randomized, investigator-blinded, vehicle-controlled, intra-individual comparison study (right/left half-face), reveal that Epiduo Forte (adapalene and benzoyl peroxide) Gel 0.3%/2.5% not only decreased acne lesions, as measured over a period of 24 weeks, but also reduced the risk of atrophic acne scars in patients with moderate-to-severe acne.  The OSCAR results were published in the American Journal of Clinical Dermatology. To learn more about the study, read Hilary Baldwin, MD's article in this issue.

Another Phase 4 study, the ALAMO study published in the Journal of Drugs in Dermatology evaluated the efficacy and safety of Epiduo Forte Gel, 0.3%/2.5% plus oral doxycycline 200mg given over 12 weeks to treat severe, inflammatory acne.

After 12 weeks of treatment with Epiduo Forte Gel plus oral doxycycline 200mg:

• There was a 66.2 percent reduction in inflammatory lesions, a 58.7 percent reduction in non-inflammatory lesions, and a 62.6 percent reduction in total lesions compared to baseline (P<0.0001).
• 80.1 percent of study participants were no longer considered candidates for oral isotretinoin.
• 90.2 percent of study participants reported moderate (28.8 percent; severity scale: 2), marked (44.2 percent; severity scale: 1) or complete (17.2 percent; severity scale: 0) improvement in their acne using the Assessment of Acne Improvement, an efficacy-related subject-reported survey that uses a scale of 0 to 5 (with 0 indicating complete improvement and 5 indicating worse).

All study participants were 12 years of age or older, had severe inflammatory acne, and were considered to be candidates for oral isotretinoin.

Highlights from PracticalDermatology.com’s Acne Resource Center

Become the go-to-source for your teen patients’ skincare needs. “I take the time to discuss three points with teens: 1) Sunscreen will help with the prevention and resolution of post-inflammatory hyperpigmentation. 2) The right moisturizer can help them better tolerate their acne regimen so they clear faster. 3) They can absolutely find formulations that will not worsen acne.”

— Deirdre O. Hooper, MD

Add procedures to the acne armamentarium. “In terms of procedures for the acne patient, I generally recommend light chemical peels or light laser treatments. The targeted energy from an Nd:YAG laser, for example, may gently heat the skin to reduce inflammation. Combination red and blue light therapy is both effective and popular, as there is no downtime. I recommend that patients return to the office once per month for procedures for fastest remission.

— Nancy Samolitis, MD, FAAD

Prevent acne-related PIH. “Topical therapies that target acne while providing anti-inflammatory effects are ideal. Topical retinoids can be beneficial for addressing PIH, as they are recognized to provide anti-inflammatory effects while they promote epidermal cell turnover. … Acne-related PIH is indeed a challenge, and we welcome development of new treatment options. In the meantime, if we start treating acne early, there’s much more likelihood of success preventing PIH from even developing.”

—Seemal R. Desai, MD

For more acne content, including video interviews, visit PracticalDermatology.com/acne/n