Highly Prevalent, Scarcely Supported: Common Skin Issues Remain Underserved

Attendees at the Maui Derm NP+PA Fall 2024 Conference, held in Nashville, Tennessee, in September, filled the presentation space for the session titled “Acne and Rosacea Update 2024,” which was presented by Julie Harper, MD; Hilary Baldwin, MD; and James Del Rosso, DO.¹ Del Rosso is president of the American Acne and Rosacea Society; both Harper and Baldwin are past presidents.

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Acne Update With Julie Harper, MD

In her portion of the session, Harper started with an overview of the new triple fixed-dose combination product, clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (Cabtreo; Bausch Health Companies), which she says combines the benefits of multidrug treatment with the simplicity of monotherapy. She noted that the efficacy data was impressive, showing that 50% of patients achieve clear or nearly clear skin by week 12, along with over 70% reduction in lesion count—unprecedented results in the acne treatment field.² She also discussed the role of oral contraceptives in managing acne, noting that although FDA-approved combinations can help, progestin-only contraceptives may exacerbate acne in some patients, which is crucial for practitioners to consider.

Additionally, she touched on acne scarring, emphasizing preventive treatment and the efficacy of topical trifarotene in reducing scarring over 6 months. She suggested a reevaluation of isotretinoin usage, indicating that many procedures, including laser treatments, can proceed without delay. Lastly, Harper talked about what she referred to as “JAK-ne,” a less-recognized acne variant associated with Janus kinase inhibitors, emphasizing the need for awareness and appropriate treatment.

“I think the triple has changed my practice a lot, and I was thinking about that over the last few days. I think, over time, I am prescribing fewer oral antibiotics, and I guess that’s in part about just wanting to be a responsible prescriber,” Harper said in an exclusive interview with Dermatology Times. She noted ongoing challenges in achieving complete resolution of scarring and highlighted the need for better, more predictable treatments.

Rosacea Pearls With Hilary Baldwin, MD

Baldwin, director of the Acne Treatment and Research Center in Brooklyn, New York, focused on rosacea treatment, emphasizing a personalized approach over outdated categorical descriptions. “The newer way to look at a rosacea patient is to examine the patient as an individual and look for every single 1 of those phenotypes,” Baldwin said.

One of the biggest takeaways from her portion of the discussion was the importance of patient engagement in the treatment process. She urged clinicians to understand what aspects of their condition matter most to patients. “I like to give them a mirror and have them look at themselves well,” Baldwin said in an interview with Dermatology Times. “I point out the salient features of their disorder, and then ask them, ‘OK, of those things that I just told you, what do you care about?’” She said this tailored strategy can involve multiple treatments, including newer, more effective topical options such as ivermectin and modified-release doxycycline, which show promising efficacy and tolerability compared with older medications.

During her interview, Baldwin addressed the challenges of treatment access, particularly for Medicare patients, due to the high costs associated with new therapies that often require out-of-pocket payments. She finds the disparity in funding and research investment for acne and rosacea to be concerning because it limits the development of innovative treatments. “Acne and rosacea are becoming the poor cousin compared to psoriasis and atopic dermatitis,” she said. “Dr Harper made a very good point today that she doesn’t understand why it’s OK to be spending vast amounts of money on top medications for psoriasis and atopic dermatitis. Valuable and necessary—but making it so that acne and rosacea can’t be treated at all.” For Baldwin, this raises questions about the future of treatment options for these conditions.

Case Studies With James Del Rosso, DO

To wrap up the session, Del Rosso, research director and principal investigator at JDR Dermatology Research in Las Vegas, Nevada, brought forth 2 cases, starting with that of a teenage girl with recurrent acne. Starting as a teenager, she underwent multiple treatments, including oral isotretinoin, yet continued to experience flare-ups into adulthood. Despite initial improvements, the patient’s strict vegan diet, minimal fat intake, and reluctance to use benzoyl peroxide posed challenges for effective treatment. Further investigation revealed that the patient had polycystic ovary syndrome (PCOS), which Del Rosso said can complicate acne management. This case highlighted the need to consider diverse factors, such as dietary habits and hormonal imbalances, when treating acne, with Del Rosso emphasizing that PCOS can affect individuals regardless of body composition or medical background.

The second case involved a follow-up patient typically managed by another clinician. The patient had requested refills of oral minocycline for rosacea. During the consultation, Del Rosso said it became clear that the patient was experiencing joint swelling, prompting further investigation into her medical history. This led him to the identification of a drug-associated lupus-like syndrome linked to minocycline, an adverse effect that could have been overlooked if the refill request had simply been processed without additional inquiry. This led Del Rosso to emphasize the need for careful patient communication: “It easily could have slipped by in just refilling the prescription, or not by happenstance, getting some information of what that patient is doing.” Collaboration with the patient’s rheumatologist facilitated the resolution of her symptoms.

Del Rosso said that both cases highlighted the importance of comprehensive patient evaluations and communication among health care providers to prevent potential complications in treatment.

References

1. Baldwin H, Harper J, Del Rosso J. Acne and rosacea update 2024. Presented at: Maui Derm NP+PA Fall 2024, September 15-18, 2024; Nashville, TN.
2. Baldwin H, Harper J, Zeichner J. Efficacy and safety of fixed-dose clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% gel in participants with moderate-to-severe acne: the patient journey. Poster presented at: Maui Derm NP+PA Fall 2024, September 15-18, 2024; Nashville, TN.