Advances in Topical Acne Treatments: Balancing Efficacy with Patient Safety

On day 2 of Dermatology Week, Steven Feldman, MD, PhD, was joined by Hilary Baldwin, MD; Ruth Ann Vleugels, MD, MPH, MBA; and Vincent Richer, MD, FRCPC, to discuss advances and considerations in topical acne treatments, emphasizing the importance of balancing efficacy and patient safety.

They began with a review of new topical options, including minocycline foam, which is currently unavailable in some regions, like Canada. This foam-based antibiotic treatment showed promising results in reducing inflammatory lesions quickly and with minimal systemic absorption, which helps reduce side effects, such as hyperpigmentation and photosensitivity, often seen with oral minocycline. Unlike oral formulations, the foam delivers high concentrations to the skin while keeping systemic levels low, which is particularly valuable for patients prone to autoimmune responses triggered by oral antibiotics. A unique feature of minocycline foam is its formulation in mineral oil, which minimizes skin irritation despite the yellow coloration it imparts.

Next, they discussed benzoyl peroxide, a longstanding treatment for acne, as it came under scrutiny due to concerns about benzene, a known carcinogen. Benzene contamination, often seen in sunscreen and other products, was highlighted as a potential issue with benzoyl peroxide, especially when exposed to higher temperatures. Studies showed that benzoyl peroxide can degrade and release benzene at levels that increase with temperature, raising concerns about its use in warm environments, such as in hot showers. While benzoyl peroxide remains effective in reducing antibiotic resistance when used with antibiotics, the panel had mixed views on its safety, with some experts advising patients to refrigerate products and avoid using cleansers in hot showers. Despite this, some clinicians continue to use benzoyl peroxide, particularly prescription versions, as they may contain lower benzene levels compared to over-the-counter options.

 They then introduced a new triple-combination treatment combining benzoyl peroxide, clindamycin, and adapalene, showing high efficacy in clinical trials, with a reported 76% reduction in inflammatory lesions and 71% reduction in non-inflammatory lesions. Although benzoyl peroxide’s benzene concerns affected its reception, the combination’s tolerability and synergy were notable. Despite hesitations, some practitioners were using it successfully in practice, indicating promising outcomes, although it remains a relatively new addition.

Their discussion transitioned to new retinoid formulations, emphasizing their improved tolerability due to advancements in vehicle technology. New delivery mechanisms, such as polymeric emulsions, encapsulate retinoids within moisturizers and emulsifiers, allowing for uniform distribution on the skin and reducing irritation. This advancement has made retinoids more accessible as first-line treatments, even for sensitive areas like the neck and chest, where irritation previously limited their use. They noted that these retinoid formulations, particularly tazarotene, have changed patient adherence by making application easier and less uncomfortable. Dr Richer shared similar experiences with the availability of these formulations in Canada, highlighting their value for broader acne management beyond facial areas.

As the session concluded, the panelists offered valuable insights into current acne treatment options, particularly the balance between efficacy, safety, and patient adherence. Recent advances in topical antibiotics, benzoyl peroxide alternatives, triple-combination therapies, and retinoid formulations have expanded the tools available for clinicians, yet considerations around carcinogenic risk and patient education remain central to effective acne management.

Reference
Baldwin H, Feldman S, Richer V, Vleugels RA. Are new topicals for acne any better than older options? Presented at: Dermatology Week; Nove