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Christopher S. Carter, MD

Emily Bell Casey, MD

Ricardo E. Colberg, MD

José O. Ortega, MD

Cherie B. Miner, MD

Rachel G. Henderson, MD

Jay S. Umarvadia, MD


James R. Andrews, MD

E. Lyle Cain, Jr., MD

Andrew M. Cordover, MD

Jeffrey C. Davis, MD

Jeffrey R. Dugas, MD

Benton A. Emblom, MD

James A. Flanagan, Jr., MD

Samuel R. Goldstein, MD

Wayne McGough, Jr., MD

Kathleen E. McKeon, MD

K. David Moore, MD

Steven R. Nichols, MD

Michael K. Ryan, MD

Norman E. Waldrop, III, MD


Foot & Ankle • General Orthopaedics • Hand & Wrist • Hip • Joint Replacement Spine & Neck • Sports Medicine • Non-Surgical Sports Medicine for Adults & Children Birmingham

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Birmingham Medical News


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Rethinking the Approach to Acne

Putting the Evidence to Work for Patients By CINDY SANDERS

New evidence and agents have clinicians rethinking traditional approaches to treating acne, the most common skin condition in the United States affecting an estimated 40-50 million Americans at any given time. While the occasional pimple or breakout might not warrant a doctor’s appointment, dealing with moderate to severe acne takes an evidence-based approach and the recognition that acne often takes a serious toll on self-esteem, as well as the skin. “It can be devastating for anyone,” said Linda F. Stein Gold, MD, FAAD, a board-certified dermatologist with Henry Ford Health System in Michigan and member of the American Academy of Dermatology (AAD) Board of Directors and Executive Committee. For teens and young adults, Linda F. Stein Gold, MD, FAAD dealing with persistent acne can contribute to isolation, a decreased quality of life, anxiety, isolation and a poor self-image … particularly when surrounded by picture perfect images of peers on social media. Stein Gold said the emotional impact is very real for older acne sufferers, as well. “Don’t underestimate the effect on adults with acne,” she noted. “For a teenager or a 20-year-old, it’s acceptable to have some acne lesions. For adults, it’s not socially acceptable.” It is, however, a growing problem. Although dermatologists are unsure why, an increasing number of women in their 30s, 40s and beyond are dealing with acne. The AAD estimates adult acne now affects up to 15 percent of women. While some providers might still subscribe to the theory of just letting acne ‘run its course,’ dermatologists are quick to note that isn’t necessarily the best advice. A growing number of options are available

to effectively treat the condition, lessening both the emotional and physical scarring.

Treating Acne “Our thought process on acne has changed over the past few years,” said Stein Gold. Today, she explained, dermatologists are using oral antibiotics in combination with a potent topical treatment for a shorter course of time. “Before, we might have kept patients on antibiotics much longer … maybe a year or two. Now, we understand (antibiotic) resistance is a real problem.” Additionally, she said, dermatologists are increasingly considering other hormonal therapies. “For women, we think of spironolactone or birth control pills; and for all patients, we think about going more quickly to isotretinoin.” Spironolactone is an androgen blocker used to treat hormonal acne. Isotretinoin is typically a second line treatment for cystic acne when other options have failed to yield the desired clearing. When evidence of scarring is present, Stein Gold suggests isotretinoin be started more promptly. “We have a number of agents in the pipeline,” Stein Gold added. “For the first time, we have a topical agent that looks like it can reduce excess sebum production. They’ve just finished Phase III trials on clascoterone. It blocks the androgen receptor; it decreases sebum production and decreases inflammation.” This first-in-class androgen receptor inhibitor by specialty pharmaceutical company Cassiopea SpA penetrates the skin to reach androgen receptors in the sebaceous glands. The 1 percent cream quickly metabolizes to cortexolone, which is found throughout human tissue, thereby minimizing any systemic side effects. In the completed Phase III clinical trials of more than 1,400 patients with moderate-tosevere acne across 112 clinical sites in the U.S. and Europe, 17.5 percent of patients assigned to clascoterone and 5.8 percent receiving vehicle cream achieved treatment success at week 12 (P<0.0001). (CONTINUED ON PAGE 6)

Profile for Medical News

June 2019 BMN  

Birmingham Medical News June 2019

June 2019 BMN  

Birmingham Medical News June 2019