SF | DERMATOLOGY
January 2022 | Vol. 22 No. 1
This article was independently sourced by Specialist Forum.
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www.medicalacademic.co.za
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Acne therapy redesigned An innovative treatment option for acne vulgaris – combining clindamycin (1%) and tretinoin (0.025%) – was launched in South Africa in November, by Viatris. This new gel combination formulation is indicated for patients ≥12-years with moderate acne vulgaris when papules and pustules are present.
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his article is based on presentations made at the virtual launch of the new combination treatment, sponsored by Viatris/Mylan. The keynote speakers were Emeritus Prof Harald Gollnick, Drs Willie Visser, and Pholile Mpofu.
Current clinical management of acne in South Africa
Dr Willie Visser, Head of Dermatology at University of Stellenbosch, Tygerberg Academic Hospital (Western Cape) Acne vulgaris is a common, sebaceous skin condition caused by the blocking of hair follicles. Due to hormonal influences, the sebaceous gland enlarges and more sebaceous fluid is produced, which accumulates in a blocked pore, causing a waxing, solidified sebum.1 This environment is conducive to the proliferation of bacteria, which may lead to the formation of an open or closed comedone. If the comedone ruptures and disperses the bacteria into the skin tissue – as opposed to on the skin’s surface – the body responds with inflammation to fight the bacteria. This inflamed lesion forms
a papule, which can result in permanent scarring if not treated early and effectively.1 Numerous studies have shown that acne negatively impacts the psychological wellbeing and quality of life of patients, which may result in depression, anxiety, and social isolation.1 Close to 100% of teenagers develop acne at some point. However, it is a misnomer that acne does not affect older people. A significant number of patients either continue to experience acne or develop new-onset acne after the teenaged years.1 A study by Collier et al assessed the prevalence of acne in different age groups. They found in the age group, 20 to 29 years, the prevalence of acne was 50.9% in women versus 42.5% in men. In those between 30 to 39 years, the prevalence was 35.2% in women and 20.1% in men complained of acne. In the group 40 to 49 years, the prevalence was 26.3% in women versus 12% in men and in those 50 years and older, the prevalence was 15.3% in women and 7.3% in men. 2,12 The authors concluded that acne continues to be a common skin problem past the teenaged years, with women being affected at higher rates than men in all age groups.2,12
What causes acne? Patients should be viewed holistically and factors that may cause acne should be discussed at their first visit. Examples include:1 _ Nutrition: skim milk, assimilated saccharides, nibbling, and nutritional supplements containing whey protein/ leucine. Dr Visser did point out that the role of nutrition as a cause of acne is controversial _ Medication: contraceptives (type of progestin used) and the use of anabolic steroids or testosterone _ Occupational: Cosmetics and mechanical factors _ Pollution: air and industrial pollutants, tobacco, and cannabis use _ Climate: heat, humidity, ultraviolet radiation _ Psychological: stress _ Smoking status.
Factors that guide treatment Dr Visser explained that different treatment modalities are recommended based on:1 _ Lesion/acne type: blackheads, pimples, cysts, scarring The type of lesion should guide the
