Miss me? Its been a busy time and working my hardest with my acne patients on a daily basis lately, has been rewarding. I constantly strive to stay on top of the latest clinical guidelines and new emerging treatments. Especially with hormonal acne. Hormonal acne, is not just an issue teenagers but also affecting many adults, particularly women, and is driven by fluctuations and imbalances in androgens. These hormones increase oil production and dead skin cell build up, leading to clogged pores and outbreaks. Typically manifesting along the jawline, cheeks, and chin, hormonal acne can persist well into adulthood and menopause. I have learned every case is unique and has challenges in its management.
Current Treatment Landscape
Traditionally, medical practioners have tackled hormonal acne with a mix of topical and oral medications. Topical agents like retinoids and benzoyl peroxide target surface-level symptoms by reducing inflammation and promoting cell turnover. Oral treatments, such as birth control pills and anti-androgens like spironolactone, work internally to decrease androgen levels, thereby reducing oil production.
For those seeking non-prescriptive options, supplements like DIM (Diindolylmethane) are popular for their purported ability to balance hormones naturally, addressing symptoms of hormonal imbalances, including acne.
Clascoterone: A Newer Approach
Emerging as a newer approach to treatment, clascoterone cream 1% (Winlevi®) offers a targeted approach by inhibiting androgens directly at the skin's surface, effectively reducing oil production without systemic effects. Let’s break it down further:
Understanding Acne:
- Skin Function and Acne Development: Your skin has pores that can become blocked by oil, bacteria, dead skin cells, and dirt. When this happens, you might develop a pimple.
- Sebum Production: Sebaceous glands in your skin produce an oily substance called sebum, which helps keep your skin hydrated and healthy. But sometimes, these glands go into overdrive and produce too much sebum.
- Role of Bacteria: A type of bacteria that lives on the skin, Cutibacterium acnes, thrives on this excess oil. When they overgrow, it can lead to skin inflammation and acne.
- Inflammation's Role: Inflammation is a natural response of your body trying to protect itself against bacteria and to heal. However, in the case of acne, this response can become excessive, leading to red, swollen, and painful pimples as the body reacts to the overgrowth of bacteria and the clogging of pores.
What Happens on a Cellular Level:
- Sebocytes and Androgens: Sebocytes are special cells in your skin that help produce sebum. These cells can create androgens (hormones like testosterone and dihydrotestosterone (DHT)), which stimulate more oil production.
- Impact of DHT: DHT is potent and binds to specific receptors in the sebocytes. Once DHT is attached, it can travel into the nucleus of the cell (control center), where it can turn on genes that pump out more oil and trigger inflammation.
How Clascoterone Helps:
- Blocking DHT: Clascoterone cream works by getting in the way of DHT’s usual path. When you apply the cream to your skin, clascoterone molecules find and attach to the same receptors that DHT would normally bind to.
- Preventing Excess Oil and Inflammation: Because clascoterone is blocking these receptors, DHT can't bind and tell the cell to produce extra oil and inflammatory substances. This action helps calm down the skin, reducing oiliness and inflammation, thus helping to clear up acne.
Think of clascoterone as a bouncer at the door of a club (my acne clients know this analogy i always discuss regarding barrier function). If DHT is like someone who shouldn't be there (more oil and inflammation), clascoterone inhibits that. This targeted action stays local and the rest of the body isn’t affected, making clascoterone a precise and effective treatment for acne. Game changer!
Clinical Trial Studies
With its approval by the FDA in August 2020, clascoterone has shown significant promise and safety through rigorous testing:
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Clinical Trials:Trials shown clascoterone cream to be highly effective in reducing both inflammatory and non-inflammatory acne lesions.
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Safety Profile: Clascoterone cream's side effects were generally mild and included symptoms like inflammation, itching, and scaling, similar to those observed with placebo treatments.
While predominantly used for acne, clascoterone has also shows potential in treating androgenetic alopecia, suggesting its versatility in addressing androgen-related conditions. However, its use in this context remains off-label, pending further studies.
So What Does This Mean For You As a Patient?
For those struggling with persistent acne, especially adults worried about the side effects from systemic treatments, clascoterone cream is an option. By specifically targeting one of the root causes of acne—the effect of androgens—without systemic involvement, clascoterone offers an alternative.
If you are interested in more information on how clascoterone cream can help manage your acne? Contact our clinic today and find out if this is suitable for you.