Rediscovering Topical Antimicrobial Therapy for Acne Vulgaris

Practical Dermatology 55 G iven that 40 to 50 million people in the US are affected by acne vulgaris, dermatologists are comfortable with its management and familiar with the range of available topical and systemic treatment options. Yet familiarity with the condition can lead clinicians to overlook new treatment options or emerging evidence about acne and the experiences of affected patients. Because current evidence suggests that acne is a result of increased sebum production and follicular hyperkeratinization compounded by host responses to the proinflammatory activities of Propionibacterium acnes, combination therapy targeting the multiple components of acne is commonplace. Studies have documented multiple benefits associated with various combination therapies, including the superiority of combinations to constituent parts alone as well as improved convenience for patients and, subsequently, better compliance. Among popular topical combination therapies are fixed combination formulations of clindamycin and benzoyl peroxide, including the recently approved formulation Acanya (clindamycin-BPO 2.5%, Arcutis). Familiar Agents Benzoyl peroxide (BPO) has been a mainstay of topical acne management for years. It is safe and effective for treating acne. Its efficacy is maintained over many years of use with the distinct advantage of not being associated with antimicrobial resistance. In addition, BPO has anticomedogenic and keratolytic properties. The primary limitation of BPO has been concentration-dependent cutaneous irritation and dryness that develops in certain patients. Furthermore, a small subset of patients can also have By Joseph Bikowski, MD Rediscovering Topical Antimicrobial Therapy for Acne Vulgaris