Combination Topical Treatment Effective in Minimising Acne
Acne is a common skin condition that can affect people of all ages. It is caused by a combination of factors.
Generally, pimples appear when the skin pores become blocked because excess sebum and an abnormal number of dead skin cells form a plug.
Once the skin pores are blocked by the plug, bacteria that normally lives on the skin begins to thrive.
The body’s immune system then attacks the bacteria, causing the pain and swollen tenderness of a pimple.
This bacterium is called Cutibacterium Acnes (C. Acnes).
An overgrowth of C. Acnes can in turn lead to acne.
While getting an acne diagnosis may be relatively straightforward, understanding the best treatment option may be challenging for many people.
However, modern dermatology has shed light there is a complex interaction within the skin.
This highlights the importance of individualised treatment, with no single solution working for everyone.
New research has shown that a combination topical treatment may be a new method to reduce acne development.
The Four Key Factors to Acne Development.
For decades, research has shown that acne is caused by four key factors:
- Excessive sebum production
- Inflammation
- Abnormal skin cell shedding
- C. Anes
Modern understanding has revealed a deep connection between the factors, creating a feedback loop that together drives acne development.
What is C. Acnes?
C. Acnes is one of the most prevalent bacteria found in the skin’s makeup and generally resides near the sebaceous glands.
Excess sebum production on the skin, giving you an ‘oily’ appearance, is often related to the presence of C. Acnes.
An overpopulation of the bacteria on the skin often causes symptoms associated with acne, such as inflammation and oily skin.
New Research
Recent research published in the Journal of Drugs in Dermatology reviewed current acne research and topical treatments available for targeting acne development.
The researchers investigated how different treatments can target these four key factors and the efficacy of combination treatments.
What is a combination treatment?
A dermatologist will sometimes recommend a combination treatment because each person’s acne can be treated in many ways.
Some treatments work to unblock pores while others work to reduce sebum production.
A fixed combination treatment is where two or more treatments have been formulated into one.
This can be convenient for a patient because both agents, when combined, can be more efficient and provide better results.
A combined treatment is also effective at limiting potential side effects.
The Results
The results of this latest research found the importance of choosing topical treatments that addressed multiple factors of acne development.
‘Topical’ simply means you apply the product to your skin, which is different from an oral medication that you swallow.
Topical treatments can come as creams, gels or lotions.
Common Topical Prescription Medications
There are three main topical prescription medications available for treating acne:
- Retinoid and retinoid-like drugs: Retinoids are derivatives of Vitamin A. Retinoid creams and gels are often useful for treating moderate acne. They can be very effective at unblocking pores of pimple spots and preventing new blockages from appearing.
- Antibiotics: An antibiotic topical medication works to kill excess skin bacteria and reduce overall redness and inflammation. It can sometimes be used in conjunction with a retinoid.
- Azelaic acid and salicylic acid: Azelaic acid is a naturally occurring acid produced by yeast and has antibacterial properties. It is often used to manage skin discolouration that occurs with some types of acne. Salicylic acid may help prevent new blocked pores.
Your Dream Tropical Treatment
Despite recent advances in treating acne, currently there is no single agent that addresses the key factors of acne development.
The exception to this is an oral isotretinoin.
Researchers have discovered that topical treatments should target the key areas of acne development.
By creating a unique combination treatment, acne development will be easily targeted.
A topical treatment is recommended to target the increased sebum production, reduce C. Anes bacterium growth and reduce inflammation.
Limiting Skin Cell Build-up
Topical treatments should first aim to target skin cell build-up in Pilosebaceous hair follicles.
The skin’s hair follicles become plugged due to a process called hyperkeratinization.
This occurs when keratinocytes (skin cells) overproduce keratin.
The plug is invisible to the naked-eye and can be completely unseen for up to eight weeks before a pimple appears on the skin.
Retinoids can reduce hyperkeratinization and are considered the cornerstone of treating acne.
Managing Excess Sebum Production
Topical treatments should target increased sebum production in the skin.
Clascoterone is a newly approved topical treatment prescribed to treat moderate-to-severe acne for patients 12 years of age and older.
It is the first topical treatment used to reduce sebum production by blocking the hormonal effects of androgens.
Other studies also suggest it may have anti-inflammatory effects.
By inhibiting the presence of sebum on the skin, Clascoterone will reduce the ‘oily’ appearance and acne development.
Goodbye Inflammation
Inflammation can affect all stages of acne.
The immune system can recognise the presence of C. Acnes and release proteins to try to control it.
However, this process can be damaging to the skin, often causing redness and swelling.
Topical treatments, such as Clindamycin, are effective at removing inflammation.
The prescription combines antibacterial and anti-inflammatory properties, effectively reducing the C. Acnes population and calming the skin.
To reduce antibiotic resistance, Clindamycin is often paired with Benzoyl Peroxide.
Benzoyl Peroxide is a broadly available treatment found in over-the-counter cleansers and spot treatment.
Alongside Clindamycin, it reduces C. Acnes and prevents the skin’s resistance to antibiotic retreatment.
What is the solution?
The research concluded that a triple-combination gel is highly effective in reducing acne by targeting multiple factors simultaneously.
The triple-combination gel includes the treatments:
- Clindamycin: An antibiotic to target inflammation and excessive bacteria.
- Benzoyl Peroxide: A broad-targeting treatment to prevent the development of bacterial strains.
- Retinoid: An anti-inflammatory treatment to unplug pores.
Talking To Your Dermatologist
A combination therapy may be a new treatment option to discuss next with your dermatologist.
Proved to be more effective than a singular treatment, a combination treatment will target multiple factors of acne development simultaneously.
Topical treatments, especially combination, offer an effective solution with minimal side effects.
Reference: Graber E, Vincent N, Pathophysiologic Targets of Acne Treatment. Journal of Drugs in Dermatology; 2024 October;23(10):54122s4-54122s11.
