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Take a look at a selection of our recent media coverage:

Oral isotretinoin confirmed as most effective treatment for acne in network meta-analysis

27th July 2023

A network meta-analysis of 221 randomised controlled trials with over 65,000 patients, has confirmed that oral isotretinoin is the most effective acne treatment.

Acne is extremely common, affecting virtually everyone between the ages of 15 and 17 years to some extent, but is moderate to severe in up to 20% of cases. Acne can be managed with broad range of topical and oral agents including antibiotics and even aldosterone receptor antagonists such as spironolactone.

Now, in the largest network meta-analysis into pharmacological interventions in acne vulgaris to date, published in the Annals of Family Medicine, researchers from Taiwan and the US concluded that oral isotretinoin is the most effective treatment.

The team sought to provide broad and detailed comparative efficacy data for a range of pharmacological interventions in acne to reduce both inflammatory and noninflammatory lesions. The primary outcome of interest was the mean percentage reduction in total, inflammatory, and noninflammatory lesions, and the mean absolute reduction in lesion counts were secondary outcomes.

Oral isotretinoin and reduction in lesion count

The analysis included a total of 210 articles describing 221 trials, which enrolled a total of 65,601 patients. Across all of the trials, the mean age of patients was 20 years and the median duration of treatment was 12 weeks. In addition, the median baseline lesion counts were 71.5 for the total lesions, 27 for inflammatory lesions and 44 for noninflammatory lesions.

The comprehensive analysis compared 37 treatment nodes, which included six oral antibiotics, five topical antibiotics, oral isotretinoin, five topical retinoids, six combined oral contraceptives, topical clascoterone, 10 combination therapies, benzoyl peroxide (BPO), azelaic acid and placebo.

The most effective treatment, compared to placebo, was oral isotretinoin (mean difference, MD = 48.41, p = 1.0). The second most effective option was triple therapy containing a topical antibiotic, a topical retinoid and BPO (MD = 38.15, p = 0.95). This was followed closely by triple therapy with an oral antibiotic, a topical retinoid and BPO (MD = 34.83, p = 0.90).

The researchers also found a similar ranking of treatment efficacy in the analysis of absolute reduction in total lesion count.

When examining mono-therapies, both oral and topical antibiotics had comparable efficacy to topical retinoids for inflammatory lesions. In contrast, oral or topical antibiotic therapy was far less effective for noninflammatory lesions and the researchers advised against monotherapy due to the risk of developing bacterial resistance.

Another comparison revealed how the combination of a topical retinoid and BPO was as effective as a combination of an oral antibiotic with a topical retinoid at reducing inflammatory lesion counts.

Ceramide routine significantly reduces local adverse effects from topical acne therapy

22nd June 2023

Use of a ceramide-containing cleanser and lotion significantly reduces the localised adverse effects of a retinoid-benzoyl peroxide gel used to treat acne, according to a recent randomised, placebo-controlled trial.

It was suggested in 1995 that an impaired water barrier function in the skin due to reduced amounts of ceramides may be responsible for the formation of acne lesions. Topical retinoids combined with benzoyl peroxide represent an effective treatment regime for acne. However, the combination is association with localised adverse effects characterised by burning, itching, tightness and dryness. Some evidence suggests that changes to the composition of the vehicle for acne medications, enhances tolerability.

Since a more tolerable vehicle might reduce skin irritation and possibly enhance treatment adherence, in the current study published in the Journal of Drugs in Dermatology, researchers performed a double-blind study was to measure the impact of acne treatment on skin barrier function when paired with a ceramide routine.

Participants using an adapalene and benzoyl peroxide (A/BPO) gel for the treatment of their acne, were recruited and randomised to an intervention or placebo group. The intervention group received a ceramide-containing foaming facial cleanser and facial lotion whereas the placebo group received basic foaming face wash, both of which were for twice-daily use. Participants applied the A/BPO gel once daily and self-reported measures of skin irritation. Both transepidermal water loss (TEWL) and the efficacy of A/BPO were also assessed.

Ceramide containing routine and skin irritation

A total of 91 participants completed the study, of whom 45 were in the ceramide arm.

Among those using the ceramide routine, TEWL was significantly lower after four weeks of treatment and remained so for all 12 weeks of the study (p < 0.05). Measures of skin dryness and scaling were significantly improved in the ceramide group after one week (p < 0.05), whereas erythema was only significantly improved at week four. Overall, a higher proportion of the intervention group reported having less skin dryness, tightness and that their skin felt more comfortable throughout the duration of the study.

The total mean count of inflammatory lesions was significantly lower after four weeks in the intervention group and this was maintained thereafter until week 12 (p < 0.05). However, there were no significant differences in the mean non-inflammatory lesion counts.

The authors concluded that while a topical A/BPO gel caused damage to the skin barrier, the associated symptoms such as irritation could be significantly reduced through the use of a ceramide routine.

Spironolactone safe and effective for treating acne in women, research confirms

22nd May 2023

Spironolactone is a cheap, safe and effective for treating women with acne that can also be used in the longer term, a large UK study has shown.

The randomised controlled trial of 410 women over the age of 18 years with mild, moderate and severe acne found a significant difference in both in quality of life and self-reported acne improvement compared with placebo.

Reporting the results in the BMJ, researchers from the University of Southampton said the NIHR-funded trial was the first to provide clinical evidence that spironolactone was effective for the skin condition.

Differences were seen by 12 weeks but were more marked and statistically significant by 24 weeks, they said.

By this time, the number needed to treat for participants to report improvement in the condition of their skin was five.

There did not seem to be a difference in effectiveness between women who had PCOS and those who did not, the researchers noted.

It could mean a change in the way the condition is treated including a reduction in the number of antibiotics prescribed, as currently recommended in UK guidelines when topical treatments have not worked, they concluded.

More frequent headaches was the only difference in adverse effects between the two groups who were started on 50 mg spironolactone or matched placebo, increasing to two tablets daily at six weeks if tolerated, which was the case for more than 95% of participants.

Two other trials underway are looking at higher starting doses of the treatment.

Questions relative effectiveness in comparison with other treatments, use in younger age groups and which subgroups benefit would be answered in other studies, the team added.

Spironolactone is ‘fantastic alternative’

A linked editorial said the women in the study had already heard about spironolactone as a possible treatment on social media and were keen to try it.

Study author Professor Miriam Santer, a GP and professor of primary care research at the University of Southampton, said spironolactone could provide a ‘fantastic alternative’ to oral antibiotics in women where topical treatments had not worked.

‘We hope the publication of these results will mean more GPs and dermatologists feel confident to prescribe spironolactone as a treatment for acne,’ she said. ‘The drug is already included in treatment guidelines for persistent acne in the US and Europe, and we hope this trial will lead to a change in the UK guidelines.’

Professor Alison Layton from Harrogate and District NHS Foundation Trust and the Skin Research Centre at the University of York, who also worked on the study, said dermatologists had been prescribing the drug for severe acne for some time.

‘This is a cheap medication which has been used for decades in the treatment of high blood pressure. The drug also reduces the main hormone that leads to the development of acne.

‘However, previous studies of spironolactone for acne have been very small and there was no definitive proof that it actually worked.’

Professor Andrew Farmer, director of NIHR’s Health Technology Assessment programme, said: ‘The findings from this important trial provide compelling evidence which could help thousands of women affected by persistent acne.

‘The treatment provides a valuable alternative to antibiotics and ensures clinicians can also better avoid the harms that can arise from antimicrobial resistance.’

A version of this story was originally published by our sister publication Pulse.