What’s New in the Medicine Chest: Acne Vulgaris

In an insightful presentation at the Winter Clinical Miami 2025, James Del Rosso, DO, a dermatologist based in Las Vegas, Nevada, shared groundbreaking insights on a novel approach to treating mild to moderate acne. Del Rosso, who runs a clinical dermatology research center, highlighted the results of a recent case series published in the Journal of Clinical and Aesthetic Dermatology by Emmy Graber’s group out of Boston.

The study explored the combined use of a topical androgen receptor inhibitor, clascoterone 1% cream, applied twice daily, and a triple-combination gel containing clindamycin, adapalene, and benzoyl peroxide, applied once daily. According to Del Rosso, “What made it interesting was that it wasn’t a phase 3 study. It was designed not necessarily to mirror what you would do in a pivotal phase 3 trial. It was a small number of patients but was really the first time we were utilizing the triple combination, which gives us the best nominal lesion reductions that we've had with acne, with acne studies with similar types of patients. Not head-to-head, but certainly the best in terms of the absolute lesion reductions and the quickest onset of effect.”

This innovative treatment regimen demonstrated significant efficacy, particularly in addressing inflammatory and non-inflammatory acne lesions. While the study involved a relatively small patient cohort, it offered compelling evidence of the benefits of combining these agents. Del Rosso emphasized that the triple combination gel showed significant improvements in patients. Moreover, the regimen’s rapid onset of action made it a standout approach compared to traditional therapies.

Advancing Acne Management

Traditionally, oral therapies such as spironolactone and oral contraceptives have been used to manage androgen-driven acne. However, these treatments are limited in scope, often restricted to women, and come with systemic adverse effects. The introduction of clascoterone cream marks a significant advancement in dermatology. “It’s the only agent we have topically that can inhibit androgens by blocking androgen receptors and affect the androgen-sebum pathway,” Del Rosso noted. “We’ve not had that before, especially with a topical and especially something that could be used in both males and females.”

This is particularly important for mild to moderate acne, which can still lead to scarring and progression if not treated aggressively. Del Rosso likened the approach to a boxing match: “Why are you going to play around and jab for 15 rounds when you can knock the guy out within a couple of rounds?” He stressed the importance of addressing all 4 pillars of acne pathophysiology, including inflammation, follicular hyperkeratinization, microbial proliferation, and increased sebum production, to achieve optimal results.

Real-World Implications

The case series included photographic evidence demonstrating the efficacy of this combination therapy. Patients with milder forms of acne achieved significant lesion reductions, underscoring the importance of early and aggressive intervention. “We have to remember that milder acne can scar and can get worse,” Del Rosso cautioned.

The findings also suggest that this combination therapy could be a game-changer in the treatment landscape. While further large-scale studies are warranted, the current evidence positions clascoterone and the triple-combination gel as valuable tools for dermatologists aiming to optimize acne outcomes.

Conclusion

Del Rosso’s presentation at Winter Clinical Miami 2025 highlighted a paradigm shift in acne management. By combining clascoterone 1% cream with a triple-combination gel, dermatologists can now offer patients a powerful, topical solution that addresses the multifaceted nature of acne. The approach not only delivers rapid and effective results but also expands treatment options to a broader patient population, including men.

This innovative regimen is a step forward in the quest to “clobber” acne effectively, preventing its progression and long-term sequelae. As Del Rosso aptly summarized, “The adage is to first of all, be thinking about optimizing our topical therapy, addressing all 4 pillars of the pathophysiology, and really hit the acne as hard as possible.”

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