Freedom from resistance: the future of topical acne therapy
11 November 2011
The antibacterial agent, once a favourite weapon in the healthcare professional arsenal against acne, is losing favour as the medical community become more aware of the issue of bacterial resistance.
Faced with a long-term disease such as acne, which often persists for 4-6 years - or 12 years plus in severe cases1 - bacterial resistance presents a problem. For example, some of the strains of P. acnes are increasingly resistant to traditional treatment.1
Current clinical opinion recommends avoiding antibacterials as acne monotherapy.1
It has also been suggested that where an antibacterial is used, treatment duration should be limited, and at 6-12 weeks an assessment made to determine whether the antibacterial is having any positive effect.1
One systematic review of randomised and non-randomised trials of topical erythromycin published between 1966 and 2003 found a decrease in treatment efficacy on lesions when used for 12 weeks or more.1 Until the early 1990s, topical erythromycin reduced inflammatory lesion count by 40-60%, but the rate fell to 20% for the decade to 2003.
Take effective action
PRODIGY (formerly NHS Clinical Knowledge Summaries) recommend a topical retinoid or benzoyl peroxide as first-line treatment for mild acne.2 For moderate acne, where inflammatory lesions predominate, PRODIGY suggest combination treatment.
Epiduo® (0.1% adapalene, 2.5% benzoyl peroxide) is the latest topical combination treatment to target mild to moderate acne. It is a once daily fixed-dose combination of adapalene and benzoyl peroxide. Neither ingredient is associated with long-term bacterial resistance. In fact, benzoyl peroxide is known to prevent or eliminate P. acnes resistance.3
Since it is antibiotic free, Epiduo® also gives the practitioner the freedom to use it concomitantly in severe acne cases with an oral antibiotic, such as lymecycline.
In clinical trials Epiduo® has been shown to:
- Significantly reduce acne lesions in just 7 days.4
- Provide long-term efficacy up to 1 year.5
- Be well tolerated, with the majority of patients experiencing mild or no irritation4 (any symptoms easily managed with moisturisers during a 2-week ‘skin adaptation phase’).6
Maintaining acne defence
As well as alleviating symptoms and healing lesions through effective treatment, patients should be advised on the importance of adherence to improve their acne and minimise scarring.1 PRODIGY recommend checking patient adherence if the acne fails to respond to treatment.2
To lend support to healthcare professionals and patients alike, Epiduo® now has its own website, providing a range of useful resources to help users to understand the condition and to maintain an effective acne management regime.
A key resource is the educational video advice, presented by Dr Dawn Harper, during which she provides patient information on skin care and how to use once-daily Epiduo® gel for optimal results.
- For more information go to www.epiduo.co.uk
1. Drug and Therapeutics Bulletin. BMJ 2010; 48(12): 141-144.
2. PRODIGY. Acne vulgaris [online]. Available: http://prodigy.clarity.co.uk/acne_vulgaris [Accessed August 2011].
3. Layton AM, Eady EA. BJD 2009; 161: 971–976.
4.Gollnick HPM, Draelos Z, Glenn MJ et al. Br J Dermatol 2009; 161(5): 1180-1189.
5. Pariser DM, Westmoreland P, Morris A et al. J Drugs Dermatol 2007; 6(9): 899-905.
6. Stein Gold L, Tan J, Cruz-Santana A et al. Cutis 2009; 84: 110-116. August 2011 EPI/515/0211
This is a promotional feature article that has been produced by Galderma.
Epiduo Gel Abbreviated Prescribing Information
Presentation: 0.1% adapalene & 2.5% benzoyl peroxide Indications: Cutaneous treatment of acne vulgaris when comedones, papules and pustules are present. Dosage and Administration: A thin film should be applied to the entire acne affected areas once a day in the evening to clean & dry skin. If irritation occurs, apply non- comedogenic moisturizers, use the medication less frequently, suspend use temporarily, or discontinue use altogether. Duration of treatment should be determined on the basis of clinical condition; early signs of improvement usually appear after 1 to 4 weeks. The safety and effectiveness of Epiduo have not been studied in children below 12 years of age. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Precautions and Warnings: Should not be applied to damaged, broken or eczematous skin, or come into contact with eyes, mouth, nostrils or mucous membranes (wash immediately with warm water if product enters eyes). Contains propylene glycol (E1520) which may cause skin irritation. Avoid excessive exposure to sunlight or UV light. Avoid contact with any coloured material including hair and dyed fabrics as this may result in bleaching and discoloration. Epiduo should not be used during pregnancy. Interactions: No interaction studies have been conducted with Epiduo. There are no known interactions with other medicinal products which might be used cutaneously and concurrently with Epiduo. However, other retinoids, benzoyl peroxide or drugs with a similar mode of action should not be used concurrently. Caution should be exercised if cosmetics with desquamative, irritant or drying effects are used, as they may produce additive irritant effects with Epiduo. Absorption of adapalene & benzoyl peroxide through human skin is low therefore interaction with systemic medicinal products is unlikely. Undesirable Effects: Epiduo may cause the following localized adverse reactions: Common (≥ 1/100 to <1/10): dry skin, irritative contact dermatitis, burning and skin irritation. Uncommon (≥ 1/1000 to ≤1/100): pruritus and sunburn. Unknown (cannot be estimated from the available data): allergic contact dermatitis, swelling face. If skin irritation appears after application of Epiduo, the intensity is generally mild or moderate, with local tolerability signs and symptoms (erythema, dryness, scaling, burning and pain of skin (stinging pain)) peaking during the first week and then subsiding spontaneously.
Packaging Quantities and Cost: 45g tube £17.91 (NHS) MA Number: PL 10590/0057 Legal Category: POM Full Prescribing Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts, WD17 1DS. UK. Tel: +44 (0)1923 208950 Fax: +44 (0)1923 208998.
Date of Revision: November 2010
|Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Galderma (UK) Ltd.|
- Related Drug Categories
- Acne, rosacea
- Related MIMS Tables
- Topical Steroids, Potential Skin Sensitisers as Ingredients
- Lice and Scabies Treatments
- Emollients, Potential Skin Sensitisers as Ingredients
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