Reflectance confocal microscopy shows promise for evaluating acne
Today's report also covers topical clascoterone 1%, combined laser and supramolecular salicylic acid, acne in middle-aged adults, and more (1,400 words, 7 minutes, 30 seconds)
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Good morning and welcome to the third issue of Focus on Acne presented by Skin Spectrum Weekly. This series provides up-to-date information on developing therapies and trends in acne treatment. We appreciate your feedback and suggestions and invite you to be in touch. Please write to us at health@chronicle.org
Reflectance confocal microscopy shows promise for evaluating acne
Researchers conducting a systematic literature review of the utility of in vivo reflectance confocal microscopy (RCM) imaging in acne show that findings concerning follicles of acne patients reported across studies were consistent. The authors of the review say their analysis indicates that RCM is a promising tool for acne evaluation, though standardization, a unified terminology, consistent research methods, and unitary reporting of RCM findings are necessary.
Published online ahead of print in the Journal of the European Academy of Dermatology and Venereology (July 9, 2023), the review involved a search of three databases: PubMed, Clarivate and Google Scholar. Researchers included studies that used RCM to investigate acne in human patients and reported the investigated skin area and type (acne lesions or clinically uninvolved skin), and the substance used in the case of treatment.
From 1,608 records, the authors selected 35 for full-text assessment and included 14 in this review.
The total number of patients from all studies was 291, with 216 acne patients and 60 healthy participants aged between 13 and 45 years. The 14 considered studies analyzed 456 follicles from healthy participants, 1,445 follicles from uninvolved skin in acne patients and 1,472 acne lesions.
Elevated potassium not a significant concern with topical clasoterone 1%
The risk of elevated potassium levels in patients with acne vulgaris (AV) treated with topical clascoterone cream 1% does not warrant baseline or subsequent laboratory monitoring of potassium levels, according to a paper published in The Journal of Clinical and Aesthetic Dermatology (June 2023; 16(6):20–24).
Clascoterone is a first-in-class topical androgen receptor inhibitor for AV treatment in both male and female patients that might provide an alternative to systemic antiandrogen medications which are limited for use only in female patients, such as spironolactone.
In the paper, the authors note that while spironolactone generally has a favourable safety profile, laboratory monitoring is recommended with long-term treatment due to the potential risk of systemic adverse effects including hyperkalemia.
They write that in the clinical studies supporting the U.S. Food and Drug Administration’s (FDA) approval of clascoterone 1% for this indication in patients aged 12 years or older, blood potassium levels above the upper limit of normal were reported in both clascoterone-treated and vehicle-treated patients. Specifically, reported rates of hyperkalemia were approximately 5% and 4%, respectively. None of the cases of hyperkalemia were reported as adverse events and none led to study discontinuation or adverse clinical sequelae.
Exposure-response analysis showed no correlation between plasma concentrations of clascoterone or its metabolite cortexolone and cases of hyperkalemia.
Safety findings demonstrated in Phase I and Phase II studies of clascoterone led investigators to not require baseline or subsequent laboratory monitoring in the Phase III studies, and this monitoring is also not recommended in the FDA-approved prescribing information.
The authors note that the highest frequency of shifts to elevated potassium levels in the original studies was in patients younger than 12 years of age, and clascoterone 1% is not FDA-approved in this age group.
Combined Tx with 1,927 nm laser and supramolecular salicylic acid for acne, scars
According to a recent paper, both 1,927 nm fractional thulium fibre laser (TFL) and TFL combined with 30% supramolecular salicylic acid (SSA) chemical peeling are safe and effective for the treatment and prevention of acne and acne scars, though the combined therapy has higher efficacy.
These findings were published online ahead of print in Lasers in Surgery in Medicine (July 16, 2023).
The authors note that TFL is known to be effective in scar improvement and chemical peels with 30% SSA can be applied for the treatment of acne. They conducted this study to evaluate and compare the efficacy and safety of TFL monotherapy versus the concomitant application of TFL and 30% SSA on acne and acne scars.
Researchers enrolled 33 patients with acne and acne scars, and randomly assigned each side of the face to receive either TFL and SSA chemical peeling or TFL alone.
Each patient received four sessions of TFL treatments at four-week intervals for both sides of the face. The SSA-treated sides received eight SSA chemical peels at two-week intervals.
The authors recorded Global Acne Grading System (GAGS), Échelle d'évaluation Clinique des Cicatrices d'Acné (ECCA) scores, the number of acne lesions, melanin index (MI) and erythema index (EI), transepidermal water loss (TEWL), and side effects at Weeks 0, 4, 8, 12, and 18. They also recorded patient satisfaction.
Among the 30 patients who completed the study, all patients experienced significantly improved GAGS and ECCA scores. The SSA group showed higher efficacy in terms of GAGS and ECCA scores, acne lesion count, TEWL, MI, EI, and patient satisfaction than the TFL-alone group. All the side effects were temporary and tolerable, no adverse effects were observed.
Acne common in middle-aged adults, associated with metabolic issues in males
A study of the prevalence and clinical characteristics of adult acne has found the condition is common in middle-age and clinically presents slightly differently in females than in males. Male subjects with acne also may have a higher risk of metabolic disturbances than do controls, suggesting a comprehensive evaluation of patients with adult acne is needed.
This research was published in Acta Dermato-Venereologica (July 10, 2023; 103:adv5921).
Data from the study came from the Northern Finland Birth Cohort 1966 (NFBC1966) study. A total of 3,181 persons of the NFBC1966 living in a given geographical area were invited to attend a clinical total-body skin examination. Of those, 1,932 participated (60.7%), including 1,036 (53.7%) females.
Researchers found a prevalence of adult acne of 7.9% (n=150) with no statistical difference between the sexes. Most of the subjects presented with papulopustular acne (77.1%).
Comedonal acne (10.8% of all subjects) was more common in females than in males (p<0.005).
Males with acne had more abnormalities in their metabolic factors than did acne-free controls. Specifically, they had increased insulin secretion as assessed by Homeostasis Model Assessment—beta-cell function compared to male controls (p<0.05). Plasma glucose and insulin levels at 60 min after a 75 g glucose load were higher in males with acne than in controls (p<0.01 for both). The researchers also found body mass index, waist circumference, and visceral fat area tended to be higher in males with acne than in controls, but the difference was not statistically significant (p>0.5).
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