Dr Del Rosso on Managing Acne With Topical Treatments

Topical therapies are an important part of acne treatment. Adherence to topical treatments, however, can be challenging due to an array of factors, from complex regimens to irritation from the medication. At George Washington University’s Advances in Acne conference, James Del Rosso, DO, FAAD, FAOCD, discussed the latest updates in topical acne therapies, as well as important considerations for selecting appropriate treatment and counseling patients. Dr Del Rosso is a research director of JDR Dermatology Research and a clinical dermatologist at Thomas Dermatology in Las Vegas, NV.

He reviewed the mechanism and pathophysiology of acne, the psychosocial impact of acne, and how he examines patients during the initial visit. “Unless they are very severe already, I magnify what they are presenting with by 25% to 30% more acne as I know they are worse on some days. This allows us to stay ahead of their acne over time,” said Dr Del Rosso.

In addition, Dr Del Rosso discussed new formulations of topical treatments in the pipeline, including newer retinoids, benzoyl peroxide monotherapy and in combination with other topical acne treatments, and minocycline foam. “Many new vehicles improve tolerability, which is very important. Many times, such brands make all the difference to the success of treatment,” he said.

According to Dr Del Rosso, it is importance to educate patients about topical therapies and their chosen treatment regimen. Lack of adherence to topical medications can impact treatment outcomes.

To ensure patients achieve treatment success, Dr Del Rosso gives the following advice:

My strong belief is to follow WHY, HOW, AND WHEN.

This applies to cases not being treated with oral isotretinoin, which is a different scenario. It is important after reviewing the history and completing the exam to determine how motivated the patient is to treat their acne and together determine a regimen that matches the severity of their acne and is practical for them. It is important to explain WHY each medication is being used and the reasons for using a combination of medications that includes topical therapy and sometimes an oral agent. The combination is what achieves the optimal benefit, and it can take 6 to 8 weeks before they can see the acne lesions decreasing. 

Then, it is important to review the full regimen, which includes skin care products and medications. Discuss what cleanser you recommend they use and HOW to use it, and the same with a moisturizer and sunscreen you suggest they use. Patients look to their dermatologist for specific suggestions. With each medication, it is vital to explain exactly how you want them to apply, and be sure to discuss locations such as the face and the trunk if treating acne on both, so they do not confuse what medication goes where. With oral medication, be sure to explain if it is taken with food or not and what liquids are fine to ingest with the medication.  

Be sure to tell them WHEN they are to use each product, including the skin care and medications, with the topical program. The order of use is very important. Basically, you are defining a regimen to them. 

Reference

Del Rosso J. Topical management of acne. Presented virtually at: The GW Virtual Appraisal of Advances in Acne Conference; July 30, 2020.