How Narrow Spectrum Antibiotics Changed Acne Treatment Strategy


For many who follow the dermatology headlines, it can be easy to overlook the importance of acne vulgaris.

Atopic dermatitis, plaque psoriasis, vitiligo and alopecia areata – among other skin diseases – have seen major developments in research, US Food and Drug Administration (FDA) approvals States and more promising news over the past year.

And yet they pale in comparison to the reach of acne in the world.

“A lot of times we forget with all these new FDA approvals — of cutting-edge precision medicine in dermatology — we forget that acne vulgaris is the eighth most common disease on planet Earth,” said Christopher Bunick, MD. , PhD. HCP Live. “There are almost a billion people here on Earth with acne vulgaris.”

In an interview with HCP Live during the Fall 2022 Dermatology Clinical Congress this week, Bunick, an associate professor of dermatology at the Yale School of Medicine, explained how while many of his colleagues would spend the meeting highlighting the advancement of precision drugs for other chronic skin diseases, he remains a fundamental need to understand and properly treat acne—a condition that is “more skin-centric” than any other.

Bunick’s talks at Fall Clinical this year examine the progression from broad-spectrum antibiotics such as doxycycline and minacycline – agents that make up about 75% of all acne prescriptions – to alternatives that offer less concerning risks .

“It turns out that in the last few years there has been, at least in the treatment of moderate to severe inflammatory acne, a pretty big breakthrough in antibiotics,” Bunick said. “Now there’s still a lot of controversy over the use of antibiotics to treat acne, but ultimately for many patients, oral antibiotics – both for their antibacterial effectiveness…as well as their anti-inflammatory properties – are very effective for our patients.

Bunick discussed the advancement of narrow-spectrum antibiotics such as sarecycline, a first-in-class agent approved for acne vulgaris that mitigates the risks of broad-spectrum antibiotics, including gut microbiome damage, digestive distress , photosensitivity and penetration of the blood-brain barrier. He called solving the latter problem an “incredible benefit in reducing vestibular side effects” such as dizziness or vertigo in elderly patients.

The advancement of narrow-spectrum antibiotics in acne also warrants discussion of antibiotic stewardship in dermatology – a topic that Bunick says has been quietly covered for the past 2 decades. The risk of antibiotic resistance has caused part of the general public to completely oppose the use of drugs. But narrow-spectrum agents have been shown to have the least association with antibiotic resistance.

Later, Bunick discussed other innovations in acne treatment, including a topical triple therapy currently being studied, as well as advances in case-by-case strategy: managing patients on birth control, prescribing patients on spironolactone, among others.


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