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Retinoids as good as antibiotics for acne

By Nerys Hairon

GPs should use topical retinoids for long-term acne treatment as they are as effective as anti-

biotics, researchers conclude.

Two new trials, published together in the Archives of Dermatology this week, found topical retinoids were effective as maintenance therapy following initial antibiotic treatment.

In an accompanying editorial, Dr Lee Zane, from the department of dermatology at the University of California, said the two studies represented 'the first rigorous clinical data in support of their efficacy in this role'.

GP experts said the new evidence would further encourage the move away from antibiotic use to reduce the risk of resistance.

A study of 90 patients found a retinoid gel produced sim-

ilar reductions in lesion count to antibiotics over a 12-week

period (see box, right).

Tazarotene gel cut inflammatory and non-inflammatory lesions by 54 and 60 per cent respectively, compared with 66 and 52 per cent respectively with minocycline, and 66 and 64 per cent with a combination of the two.

The researchers concluded many patients with moderate to severe acne could maintain improvement using a topical retinoid only. 'Topical retinoid monotherapy should be considered for maintenance to help minimise antibiotic exposure,' they said.

The second study, based on 219 patients who had undergone initial treatment, found maintenance with adapalene gel was significantly more effective than gel vehicle.

Professor Tony Avery, who recently conducted a Health Technology Assessment review of

acne treatments, said GPs should aim to use topical agents more often.

Professor Avery, professor of primary health care at the University of Nottingham and a GP in the city, said: 'My feeling is we should be trying to see whether we can manage people with topical non-antibiotic therapy ­ retinoids or benzoyl peroxide.

'There is quite a lot of antibiotic prescribing for acne and I think we could rein that back a bit. These studies would

suggest that retinoids can be an effective maintenance treatment.'

Dr Mike Lacey, a GPSI in dermatology in Chichester, West Sussex, said: 'You do get resistance to antibiotics if you use them for any length of time. I think you should not use them for more than six months.'

Studies backing topical treatment

Study 1

US researchers randomised 90 pre-treated patients with moderate to severe acne to 12 weeks' maintenance with tazarotene plus placebo, gel vehicle plus minocycline, or tazarotene plus minocycline.

All regimes were effective in sustaining improvements in acne.

At week 24, more than 80 per cent of patients in each

group had maintained a

50 per cent or greater improvement.

Study 2

US/French study randomised 219 pre-treated patients with severe acne to adapalene or gel vehicle once daily for 16 weeks.

Adapalene successfully maintained 75 per cent of patients, compared with 54 per cent with gel vehicle.

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