A New Treatment For Acne Vulgaris

A New Treatment For Acne Vulgaris Posted By:
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When treating acne vulgaris in the clinical setting, the focus is placed on the 4 key aspects involved in its pathogenesis—excess sebum production, Cutibacterium acnes proliferation in the pilosebaceous unit, follicular hyperkeratinization, and inflammation. Historically, the mechanism of action of most acne medications targeted all of the above factors except sebum production, with the exception of oral isotretinoin, which targets all 4 factors. In addition to isotretinoin, the only prescription therapies available to assist with the control of excess sebum were oral anti-androgens, which are limited to use in females. However, the FDA recently approved clascoterone cream (1%)—a topical androgen receptor inhibitor—for acne treatment in females and males 12 years of age and older. It is the first topical agent for acne that specifically targets sebum production and the first acne drug with a novel mechanism of action approved in nearly 40 years.

Staring at puberty, androgens such as testosterone and dihydrotestosterone (DHT) influence sebaceous gland stimulation in both females and males. These androgens interact with androgen receptors within the basal layer of the sebaceous gland; their binding leads to transcription of genes involved in sebum production and the promotion of inflammatory cytokines. Clascoterone has a molecular structure that closely resembles the structure of DHT, allowing it to bind to the androgen receptor and block the binding of natural androgens—thereby preventing downstream signaling, and leading to inhibited sebum production and reduced secretion of inflammatory cytokines. Clascoterone is rapidly converted and hydrolyzed by the skin, limiting systemic activity.

This topical agent is an exciting development in the treatment armamentarium for patients with acne vulgaris.

Reference
  • Clascoterone cream, 1% [prescribing information]. Cranbury, NJ: Sun Pharmaceuticals; 2021.
  • Rosette C, et al. Cortexolone 17α-propionate (clascoterone) is a novel androgen receptor antagonist that inhibits production of lipids and inflammatory cytokines from sebocytes in vitro. J Drugs Dermatol. 2019;18:412.

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Filed under: Dermatology

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