Acne Vulgaris is the most common skin disorder in the United States, affecting 85% of people 12-24 years of age, 8% of people 25-35 years of age, and 3% of people 35-44 years of age.7 Topical preparations constitute the sole treatment in many patients with acne, and are part of the therapeutic regimen for almost all patients. Choice of drug delivery vehicle is important to the success of topical therapy as it can impact patient compliance. Teens are a particularly non-compliant segment. Simplified treatments appear to be associated with the greatest success10.
The goal of therapy for patients with inflammatory acne is to interrupt the pathophysiological cycle. Due to the central role of Propionibacterium acnes (P. acnes) in the genesis and progression of inflammation, treatment of inflammatory acne should include a topical antibiotic. The antibacterial activity of clindamycin kills P.acnes by inhibiting bacteria protein synthesis. An important pharmacological factor of this antibiotic is its ability to modulate the release of pro-inflammatory cytokines.13
Untreated acne vulgaris can have serious physical and psychological consequences.9 Most commonly, a lack of treatment can result in permanent scarring or disfigurement, depression, anxiety, low self-esteem, social inhibition and lowered professional expectations.9 Treatment failure can usually be attributed to sub-optimal medication adherence, lack of motivation to adhere to maintenance treatments, and underlying affective disorders such as depression.10
Motivating patients to adhere to treatment, especially during the maintenance phase, remains a challenge.10 Using a simple, effective, well-tolerated regimen along with various non-pharmacological interventions can do much to encourage adherence. The relationship that dermatologists and their healthcare staff establish with patients is critical to long-term adherence to acne medication regimens. A multi-factorial approach combining non-pharmacologic interventions and effective, well-tolerated, and simplified drug regimens appears to be associated with the greatest success.11
Main points to consider when selecting appropriate acne therapy:
- Which formulation will provide the maximum therapeutic benefit?
- Which vehicle is the easiest and least messy to apply to the affected body areas?
- Which vehicle is most likely to result in the best patient adherence to therapy?
Application considerations:
- Ease of application
- Tolerability
- Regimen Simplicity
- Utility in large surface areas or hair-bearing regions
Types of Therapy
There are various therapies available for acne. Topical therapies include salicylic acid, retinoids, benzoyl peroxide (BPO) and antibiotics. Systemic therapy includes both antibiotics and retinoids, as well as hormonal therapy. Adjunctive therapy includes comedo extraction and draining of cysts, intralesional corticosteriods, and ultraviolet light. Adjunctive therapy for the treatment of acne scars includes microdermabrasion and laser skin resurfacing.
Among the topical therapies, salicylic acid, which is used to treat mild acne, can lead to dryness and skin irritation as common side effects.15 The use of retinoids, which can treat mild to severe acne, can also result in dryness and skin irritation as well as photosensitivity. BPO treatments, which are usually administered in combination with other treatments, can also result in skin irritation and contact sensitivity. The peroxide component in BPO treatments can also bleach clothing and linens.
Topical antibiotics exert a bacteriostatic or bactericidal effect on P.acnes depending on the concentration of the drug at the site of infection.16 Topical antibiotics are used to treat mild, moderate and severe acne, but do cause resistance in some patients14. There are three main types of topical antibiotics: azelaic acid, clindamycin, and erythromycin.16
Clindamycin is the most widely used topical antibiotic, and has been prescribed for over twenty years in the treatment of acne vulgaris. It is effective and well-tolerated. An important pharmacological factor of this antibiotic is its ability to modulate the release of pro-inflammatory cytokines. This undermines the lesion production cycle. Previously, it has only been available in gel and solution formulations. With EVOCLIN, it is for the first time available in a foam vehicle.17
EVOCLIN is a once-a-day topical clindamycin foam for the treatment of acne vulgaris.
The most common adverse events in clinical trials were headache (3%) and application-site reactions including burning (6%), itching (1%), and dryness (1%).
EVOCLIN is contraindicated in individuals with a history of hypersensitivity to preparations containing clindamycin or lincomycin, or a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis. Diarrhea, bloody diarrhea, and pseudomembranous colitis have been reported with systemic and rarely with topical clindamycin. Discontinuation is recommended if diarrhea develops.