Medesthetics Special

AR Supplement

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Prescribing Topicals A wide range of prescription topicals helps physicians offer the best fit for each patient. By Inga Hansen © PROACTIV—WITH ITS OMNIPRESENT TELEVISION COMMERCIALS and close ties to pop culture celebrities—has helped drive awareness of the treatability of acne, which in turn is driving patients to their local dermatologists and skincare specialists. "We're seeing more and more cases with patients who now understand that acne is a treatable condition, and they're not willing to suffer with it anymore," says dermatologist Jeanine Downie, MD, Image Dermatology, Montclair, New Jersey. While mass market acne products now have a place in virtually every teenage bathroom cabinet, they do have some glaring limitations. "Proactiv, for example, is a great idea. But it treats mild acne, not moderate or severe acne," says Dr. Downie. Prescription vitamin A-based products remain the gold standard in the topical treatment of moderate-to-severe acne. Tretinoin has been joined by second generation retinoids adapalene and tazarotene. "They are all very effective in preventing future breakouts," says dermatologist Sonia Badreshia-Bansai, MD, Danville, California. "I prescribe them based on patient experience, skin type, side effect profile and compliance. For example, someone with very sensitive and dry skin may begin with adapalene due to its side effect profile minimizing dryness and irritation. Someone with oily skin may be able to tolerate Retin-A or tazarotene. A patient who has been on retinoids in the past without any issues may be able to titrate up to tazarotene, which is the most effective retinoid, but also has a higher incidence of dryness, redness, peeling and irritation." Dr. Downie uses her own experience as an acne sufferer when choosing medications for her patients. "Personally, I do very well with Tazorac .05% (tazarotene, Allergan, tazorac. com)," she says. "I just dot it on problem areas. I do not use it all over the skin because it would be too drying." For teenagers with oily, less sensitive skin, Dr. Downie starts with a 5% benozyl peroxide product. "I pick something like Epiduo (Galderma, or Acanya Gel (Valeant,, a clindamycin and benzoyl peroxide mix or ACZONE (Allergan,, which is a 5% dapsone," she says. "These are my favorite morning products for acne patients. Epiduo is more for patients with oily skin. The Acanya and definitely the ACZONE are for patients with sensitive skin." Topical antibiotic clindamycin has become a mainstay in acne treatment, used in combination with topical retinoids or BP. "Mild acne may deserve only a topical antibiotic with a retinoid," says Dr. Badreshia-Bansai. "In moderate and severe | July/August 2012 5

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