Patients who were first treated with an oral antibiotic and topical gel for acne were often able to maintain their clearer skin by using topical agents alone, according to two studies in the May issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Acne is a common, recurring disease, according to background information in the article. Acne treatment can be complex, often requiring aggressive combination therapy of oral antibiotics and medication applied directly to the skin (topical), as well as a long-term strategy. Because acne can return after successful treatment, maintenance therapy is necessary for many patients. However, due to reduced sensitivity of acne to some antibiotics, it has been recommended that antibiotic use be limited to three months. Topical retinoids, medications derived from vitamin A, have been identified as a choice for maintenance therapy.
Diane M. Thiboutot, M.D., of the Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center, Hershey, and colleagues studied the efficacy of a gel containing adapalene, a retinoid-like compound, in maintaining the effects of successful acne treatment. Patients from a previous study were included if they had shown at least moderate improvement in their acne when treated with either adapalene gel and 100 mg of doxycycline (an oral antibiotic) or doxycycline and an unmedicated gel. A total of 253 patients aged 12 to 30 years were randomly assigned to receive either adapalene gel or unmedicated gel once daily for 16 weeks. Patients' acne was evaluated at the beginning of the study and after four, eight, 12 and 16 weeks.
The group that continued treatment with adapalene gel had significantly higher rates of maintaining previous treatment success, defined as at least 50 percent improvement since beginning therapy, than the unmedicated gel group, 75 percent vs. 54 percent. During the study, the number of breakouts gradually increased in the unmedicated gel group, while remaining stable or decreasing in the adapalene gel group. In a survey, a significantly larger percentage of patients treated with adapalene gel were "very satisfied" or "satisfied" with the overall treatment, compared with patients treated with unmedicated gel (75 percent vs. 58 percent).
"The present 16-week and previous 12-week studies provide data to support regimens, such as those recommended in the recent acne treatment guidelines, wherein oral antibiotics can be used initially in combination with topical retinoids to gain control over the acne, and maintenance with adapalene can delay the recurrence of acne," the authors write. (Arch Dermatol. 2006;142:597-602)