From researchers to drug formulators, there’s increased interest in understanding acne in women.
all of us want to know more about what’s causing inflammatory effects and it shows superior efficacy in female adult female acne; we really don’t know,” observes dermatologist Julie C. Harper, MD. “We do know Oral contraceptive pills remain an option for the manage- “ that we see it in our clinics and many of us would ment of acne in women, despite concerns about their risks. say that we’re seeing it more and more in our clinics.” “All birth control pills carry with them some increased risk, so Adult female acne has a unique presentation. “Along the basically a woman’s baseline risk of having a clot if they’re not jaw line and the neck that is so classic for an adult female— on a birth control pill is about three per 10,000 woman years. we never see that in the male,” Dr. Harper notes. That leads If you take a birth control pill, maybe six per 10,000 woman experts to question whether adult female acne may be a unique “kind” of acne, different than that kind seen in adult The oral birth control pills commonly used to treat acne males, or adolescents of both sexes, she says. “They may be contain the progestin drospirenone, such as Yaz (Bayer very, very distinct. They may have a different pathogenesis; Healthcare). “Drospirenone now we know may be associated they likely have a different treatment.” even with a little bit higher risk than some of the other pills,” Topical treatment options for acne in non-pregnant adult Dr. Harper says. “But to put that into perspective, instead of females generally include the same formulations used for three or six per 10,000 woman years, now we’re talking about other patient groups. Benzoyl peroxide (BPO) is commonly used, but adult patients may be concerned about tolerability. Using lower concentrations can help reduce irritation with- out sacrificing efficacy. “Lower percentages, like 2.5% BPO, In addition to providing an effective treatment regimen, seem to work as well as higher percentages and are associated patients require education, including tips on skincare. “Skincare with less irritation,” says Dr. Harper. Formulations such as the is very important in acne for a couple of reasons. It’s a very combination adapalene and benzoyl peroxide 2.5% (Epiduo, important part of actually treating and managing acne, but it’s Galderma) offer lower concentrations of BPO. Fixed combi- also important to help patients to tolerate the topical medica- nation products may increase adherence by simplifying regi- tions that we’re prescribing…Patients who are irritated from mens. Nonetheless, stand-alone agents are still used. topical medications don’t use them and then they don’t get Like benzoyl peroxide, topical retinoids are also consid- the results,” Dr. Harper insists. In addition, sunscreen is a must.
ered standard treatment options for acne. Topical retinoids Advise patients to expect at least minor irritation upon ini- primarily function to regulate hyperkeratinization and pre- tiating topical acne therapy so that they will be prepared for vent the formation of microcomedones. They also confer mild peeling or erythema, Dr. Harper says. Excessive reactions anti-inflammatory effects. Next-generation retinoids, such as adapalene (Differin Cream, Gel, or Lotion, Galderma) target different retinoid receptors than does tretinoin, providing Dr. Harper spoke with our editors for upcoming coverage in potentially better tolerability. Furthermore, these next-gener- Practical Dermatology. For more on acne, visit: http://bmcto- ation formulations may be more appealing to adult patients who may have already tried tretinoin to treat adolescent acne. There is also recent evidence suggesting that adapalene Julie C. Harper, MD, FAAD is Clinical Associate may be better tolerated on darker skin types (J Cosmet Professor of Dermatology at the University of Alabama-Birmingham. She is also director A relative newcomer to the acne treatment scene, topical of the Dermatology and Skin Care Center of Birmingham, Alabama.
dapsone (Aczone, Allergan) has been shown to have anti-



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