Conference Coverage
• The second-generation oral tetracyclines, doxycycline and minocycline, are sometimes preferable to tetracycline because of their greater ease of use, better absorption, and less frequent dosing. But none of these drugs should be used in children under age 8, for whom the options are erythromycin, azithromycin, and trimethoprim/sulfamethoxazole.
• Combined oral contraceptives are useful as second-line therapy in pubertal girls with moderate to severe acne after assessment for tobacco use and family history of thromboembolic events. Because of concerns about possible deleterious effects on growth and bone density, however, it’s worth considering withholding oral contraceptives for acne until 1 year after onset of menstruation.
• First-line therapy for severe acne is an oral antibiotic in combination with a topical retinoid, benzoyl peroxide, and sometimes a topical antibiotic as well.
"I know there’s a practice gap there because some dermatologists like to go straight to oral isotretinoin. But many acne experts feel that the use of an oral cycline-based antibiotic is highly useful prior to initiating isotretinoin, because the anti-inflammatory effect helps minimize the severe flares we sometimes get with initiation of isotretinoin," Dr. Eichenfield explained.
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Dr. Eichenfield reported having served as a clinical investigator and/or consultant to Allergan, Galderma, GlaxoSmithKline (Stiefel), and Medicis/Valeant.