Spotlight on Acne

Prof Fabbrocini gave an overview of the current European and American guidelines for acne treatment. She highlighted some important new recommendations from the Global Alliance consensus, including that oral isotretinoin should be continued until full acne clearance and that early, effective treatment is important to minimise scarring. She then discussed various gaps between guidelines and clinical practice, including adherence, scar prevention, physical modalities, dermocosmetics, skin of colour, diet, and truncal acne. Dr Stein Gold then spoke about the epidemiology of acne and the traditional and emerging concepts relating to its pathogenesis. She discussed the important role of inflammation, which is now known to be present throughout acne progression, and highlighted that inflammation is not just a response to Cutibacterium acnes proliferation. She then discussed the impact of the inflammatory process on the risk of acne scarring, the negative effects of scarring on patients, and the importance of early treatment to minimise or even prevent scarring; the problem of post-inflammatory hyperpigmentation (PIH) in patients with skin of colour; and adult acne, which predominantly affects women. Lastly, she highlighted the under-recognised problem of truncal acne which, despite affecting approximately 50–60% of patients with facial acne, lacks specific treatment guidelines. Prof Tan then discussed some interesting studies on the current and emerging treatments for PIH (tretinoin 0.1% cream, azelaic acid 15.0% gel, dapsone 7.5% gel), adult female acne (dapsone 5.0% gel, azelaic acid 15.0% gel, adapalene 0.1% gel, spironolactone), acne scarring (adapalene 0.3% gel, adapalene 0.1% or 0.3% plus benzoyl peroxide [BPO] 2.5% gel), and truncal acne (dapsone 7.5% gel, azelaic acid 15.0% foam, drospirenone 3 mg/ethinyl oestradiol 0.02 mg, trifarotene 50 µg/g cream). Trifarotene is one of the first treatments that has been shown to be effective and safe for the treatment of truncal acne in a robust Phase III programme.