After pills, gels keep acne at bay

People with severe acne who achieve clearer skin with a combination of an oral antibiotic and anti-acne gels applied to the skin are often able to maintain their clearer complexion by using gels alone, according to two studies in the Archives of Dermatology.

"This approach is especially attractive in an environment with rising concerns ... regarding long-term antibiotic use," note the authors of one report.

For some people, acne may be so severe that a doctor may prescribe oral antibiotics and a gel containing retinoids derived from vitamin A that is applied directly to the skin. But because acne can return, "maintenance" therapy is often needed, and keeping patients on long-term oral antibiotics is not ideal.

In the first study, investigators tested the efficacy of a topical retinoid-like gel sold as Differin (adapalene gel 0.1 percent) in maintaining the clearer skin achieved after 12 weeks' treatment with an oral antibiotic alone or with Differin gel in 253 people with severe acne.

According to Dr. Diane M. Thiboutot from Pennsylvania State University and colleagues, 75 percent of patients who continued with Differin gel maintained the improvements they achieved when on combination therapy. In contrast, only 54 percent of those on placebo gel maintained their clearer skin.

Moreover, during the 16-week maintenance study, the number of breakouts gradually increased in the placebo gel group, while in the Differin gel group, the number of breakouts remained stable or decreased.

The study was funded by Differin maker Galderma Laboratories.

In the second study, researchers got similar results using a retinoid gel called tazarotene, sold as Tazorac or Avage. This study, led by Dr. James Leyden of the Skin Study Center in Broomall, Pennsylvania, involved 90 people with severe acne whose skin improved over 12 weeks with tazarotene gel plus an antibiotic.

In the 12-week maintenance phase of the study, tazarotene gel alone was effective in sustaining acne improvement. This study was funded by Tazorac maker, Allergan Inc.

These two studies, notes Dr. Lee T. Zane in an editorial, demonstrate that many people with severe acne can continue to do well for several months after stopping oral antibiotics by continuing topical retinoid gels.

"For many dermatologists, the concept that topical retinoids alone may be effective in the maintenance phase of therapy for inflammatory acne may represent a substantial departure from their traditional thinking about the role of this class of medications," Zane from the University of California, San Francisco adds.

SOURCE: Archives of Dermatology, May 2006.