Oral antibiotic and topical gel combo for severe acne: JDD Study

USA: Opening new horizons of otherwise limited treatment options for acne, a recent study in the Journal of Drugs in Dermatology, has found a combination of oral antibiotic (doxycycline) plus topical gel (combo of adapalene 0.3% and benzoyl peroxide 2.5% gel) to be safe and effective for the management of severe acne.

Options for management of severe acne are somewhat limited. Acne treatment guidelines emphasize antibiotic stewardship in light of increasing concerns about antibiotic resistance and call for judicious use of conventional systemic antibiotics.

This combo of antibiotic and topical gel could be a viable alternative for isotretinoin which is not suitable or appealing to many patients.

The study by Leon H. Kircik, Icahn School of Medicine at Mount Sinai, New York, NY, assessed the effects of combination treatment using anti-inflammatory dose doxycycline plus adapalene 0.3% and benzoyl peroxide 2.5% gel on IGA scores as well as an inflammatory lesion, non-inflammatory lesion, and nodule counts.

This single-center, open-label pilot study enrolled 20 patients with severe acne (average age, 19 years; 55% male). Participants attended study visits at baseline and weeks 4, 8, and 12. Cohort members received doxycycline 40 mg daily and combination adapalene 0.3% and benzoyl peroxide 2.5% gel.

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Key findings of the study include:

• At baseline, all patients had a score of ≥4 (Severe) on the Investigator Global Assessment (IGA), ≥20 inflammatory lesions, ≥20 noninflammatory lesions, and ≤4 nodules.


• A one-grade IGA improvement was seen in 75% of the patients by week 4; at week 8, 40% of patients had improved two grades to Mild and 10% had a three-grade improvement to Almost Clear.


• By the final visit, 95% of subjects had at least a two-grade improvement in IGA scores.


• Statistically significant reductions in nodules and inflammatory and noninflammatory lesion counts began at week 4.


• By week 12, 90% of patients had no nodules, and counts were reduced by 80% and 71% of inflammatory and noninflammatory lesions, respectively.


• Treatment was well-tolerated with no serious treatment-related adverse events.

“Combination treatment with anti-inflammatory dose doxycycline plus combination adapalene 0.3% and benzoyl peroxide 2.5% gel is safe and effective for the management of severe acne,” the investigator concluded.

The study, "Anti-Inflammatory Dose Doxycycline Plus Adapalene 0.3% and Benzoyl Peroxide 2.5% Gel for Severe Acne," is published in the Journal of Drugs in Dermatology.