The New York Society of Cosmetic Chemists hosted the Acne Care Symposium on Wednesday, June 14.

 

Ten guest speakers, a number of them PhDs and medical doctors, lectured on the complex skin condition and the most sought-after treatments available. The daylong event drew droves of entrepreneurs, industry professionals and skin care experts from L’Oréal to Crown Laboratories and other brands to the Florham Campus of Fairleigh Dickinson University in Madison, NJ. 

 

Speakers included Dr. Mary Wu Chang, of the University of Connecticut School of Medicine; Ratan K. Chaudhuri, Ph.D., of Sytheon Ltd.; Dr. Hilary Baldwin, of the Acne Treatment Research Center; Sachin V. Patwardhan, Ph.D of Canfield Scientific Inc.; Francine Krenicki of Crown Laboratories; Nathan Brown, Ph.D., of Parallel Health; Aminda Bouslimani, PhD., of L’Oréal; James V. Gruber of Vantage Personal Care; Dr. Ayman Grada of Case Western Reserve University School of Medicine; and Sophia Bull of Lucas Meyer Cosmetics.

 

The NYSCC’s acne care symposium committee consists of Chair Roger L. McMullen, PhD, Ashland Inc. and Fairleigh Dickinson University; Co-Chair Miao Wang, L’Oréal USA; and  moderators Ramine Parsa, PhD, Kenvue; Gopinathan Menon, PhD, California Academy of Sciences; and Raymond Clark, Ashland, Inc.

 

The event was sponsored by Elevations, Biocogent, LucasMeyer Cosmetics by IFF, Health & Beauty Solutions Amcol, Aurorium, LEI and Coptis.

Dr. Mary Wu Chang, associate professor of dermatology and pediatrics at the University of Connecticut School of Medicine, discussed the pathophysiology of acne and the various types of acne and its mimickers, such as rosacea and eczema. The skin condition, she said, is multifactorial, which means its causes are rooted in four main categories: genes; hormones (tied to issues such as the menstrual cycle and stress); and external factors, which range from hair product usage to occupational—such as working in kitchens and constant exposure to grease, or from sports equipment like a helmet or chin guard rubbing against the skin (a type of acne called acne mechanica). Certain drugs can also induce acne, including corticosteroids, anabolic steroids, phenytoin, lithium and isoniazid.

 

Of course, genetics is the top causation.

 

“There’s definitely a genetic component,” said Chang. “When I see a teenager, there’s often a parent who is very distressed about their history of acne and they remember it very well and they really want their child to avoid experiencing their severe acne.”

 

Whatever the cause, acne—sometimes, a chronic, recurring, lifelong condition—is curable and controllable. 

 

“It’s not necessarily fast, but our patients and the public needs to know that we can treat acne and reoccurring acne,” she said.

 

Acne, she added, is coincident with earlier puberty, affecting children well under 13. If left untreated, the skin condition carries scars, both physical and psychological. Having acne is also an independent risk factor for depression, anxiety and suicidal ideation. Depression is two to three times more common in acne patients than the general population (8.8%); suicidal ideation is two times more common in girls and three times more common in boys with severe acne.

 

“We don’t know why puberty is happening at a younger age, but it’s definitely happening earlier. And to see a 7-year-old girl with comedonal acne is now normal. And of course, I have to do a whole examination, but it’s probably an early bloomer child and puberty is going to happen earlier.”

 

To demonstrate the reality of acne rearing its ugly head in younger demographics, Hilary Baldwin, a board-certified dermatologist and medical director of the Acne Treatment and Research Center in Brooklyn, NY took attendees through the story of one patient who experienced bouts of intermittent acne through all the stages of her life from childhood to senior citizen. 

 

At 11, her condition emerged as a nose speckled with comedones, or blackheads; i.e., a skin pore or hair follicle clogged with oil, dead skin cells, and bacteria. 

 

Women reported having adult female acne (AFC) in their 20s, 30s and 40s, with 51%, 35% and 26%, respectively, and fell within one of three groups: new onset, continuous and resolved and returned. Alexandra’s case was the latter.

 

When treating AFC, several factors are considered including child-bearing potential, hormonal imbalance due to Hirsutism, alopecia, acanthosis nigricans or menstrual irregularities, along with lesion type and location. 

Baldwin, who is also clinical associate professor of dermatology at Rutgers Robert Wood Johnson Medical Center, explained there are four pillars of acne pathogenesis: increased sebum production, attributed to androgen hormones at puberty; increased C. acnes; follicular hyperkeratosis (clogged pores); and inflammation. 

 

“The interesting thing about the increase in C. acnes is that every single one of us in this group has the same amount of C. acnes living in our follicles, yet some of us have acne and some of us don’t. It’s not just the number as was mentioned, it’s the subtype of these C. acnes that happens to be living in the follicle,” she explained.

 

Like any other commitment, Baldwin says the first step to acne treatment begins with caring about the concern enough to do something about it. A good place to start is retinoids, which Baldwin called “comedone busters.” She prescribes retinoids for a month before the patient visits a facialist who can extract the blackheads without damaging skin. 

 

“Topical retinoids are the mainstay of therapy,” she said. “I recognize that not everybody likes to use them. I recognize that it changes the microbiome. I recognize that it destroys the barrier function of the skin, but it also works.”

 

Baldwin said topical retinoids also decrease physical existing lesions, and prevent the development of new ones. 

 

“Also, it can accelerate the absence, or it can prevent inflammatory hyperpigmentation and also accelerate the removal of it in our patients with dark skin colors,” she added. “It increases the penetration of other medications with which it’s co-applied so that they work better. It can improve acne scars and is great for maintenance therapy because it stops the production of next month’s pimples.”

 

As an example, after a once-daily, 12-week trial of Tazarotene 0.1% cream, one of her patients experienced significant improvement in his T-zone, where the moderate acne was present.

 

“I would have given him antibiotics when he first walked in the door, to make him better, but he got better just from retinoids which do not increase the risk of developing antibiotic resistance. So it’s a win-win situation,” she said.

 

For patients who are non-compliant with retinoid treatment, she opts for a combination product with a retinoid and a benzoyl peroxide, “attacking acne from at least two different directions,” she said. 

 

Depending on the type of acne there are different treatments. For acne caused by increased sebum production, treatment options include hormonal therapy, clascoterone and isotretinoin. To reduce hyperkeratosis of the follicle, topical retinoids, benzoyl peroxide and isotretinoin is the preferred method; and antibiotics and isotretinoin for C. acnes. 

 

“I always think of them as roaches,” she offered. “The exterminator can come and kill the ones that are there right now, but they’re coming back. So, antibiotics or isotretinoin again. Isotretinoin doesn’t kill C. acnes but it starves the little suckers to death because it does such a good job suppressing the sebum. And the bottom line is no sebum, no acne.”

 

The use of isotretinoin is associated with significantly improved depression symptoms as reflected in a meta-analysis and systematic review inclusive of 20 studies meeting criteria. Three studies indicated no association of depression and isotretinoin, and 17 studies showed improved psychological well-being.

Antimicrobial resistance is a serious health threat. According to the CDC, antimicrobial resistance was to blame in more than million illnesses and 23,000 deaths. Proven public health strategies and “antibiotic stewardship” is encouraged among health care practitioners. The first reports of resistance date back to the early 1970s following the introduction of topical erythromycin. 

 

By 1978, there were 20% resistant strains and in 1996, it was up to 60%. In 2023, antibiotics are less effective for acne vulgaris with individual patients being less responsive. 

 

“Resistance C. acnes is the least of our concerns. What about all the other bugs out there?” asked Baldwin. “When you take an antibiotic to treat the C. acnes in your follicles, the rest of the bacteria in your body don’t know it’s not intended for them. So they’re dying too, if the bacterium isn’t able to suppress them in altering the gut flora, changing staph epidermidis and the surface of the skin… who is the king of acquiring resistance? Staph aureus. And once a staph aureus bacterium becomes resistant, it keeps it for life. With C. acnes, they actually can revert back to wild type, but not staph aureus. So, we’re not really worried about C. acnes so much; we’re worried about whoever they share genes with.”

 

When it comes to acute therapy versus chronic, maintenance therapy should not include antibiotics. 

Per Baldwin, Spironolactone was approved by the FDA in 1960 for hypertension. It is most commonly used in the US for androgen-related disorders in women. Though poorly studied, consensus groups and expert opinion favor its use. Dosing is between 50-200 mg every day and takes three to six months to reach potential. For mothers use experience post-partum acne, limiting systemic exposure to broad spectrum antibiotics is advised, favoring use of topical retinoids, benzoyl peroxide, oral contraceptives and laser/light therapy for long-term maintenance. Peri-menopausal acne, which followed Alexandra to age 47 in the form of flare-ups, is also common due to hormonal imbalance, or elevated androgens, but cleared when she reached menopause by 55.

Sachin V. Patwardhan, PhD., chief intellectual property officer and senior principal scientist at Canfield Scientific, Inc., developed a multi-spectral imaging device for early diagnosis of melanoma during his PhD. At New Jersey Institute of Technology. He was instrumental in establishing the optical radiology lab at Washington University School of Medicine in Saint Louis while conducting postdoctoral research, which involved developing a small animal diffuse optical and fluorescence tomography system for studying disease models with targeted treatment. For the past 16 years, optimal imaging techniques and image analysis algorithms for objective assessment of skin diseases and aesthetic conditions has been his primary focus at Canfield. He spoke about the technological advancements in multi-modal and 3D Imaging for Objective Evaluation of Acne dating back to 2008 to the present. He said lesion counts and Investigators Global Assessment are the primary endpoints in acne clinical studies. The characteristics of acne lesions can be captured, detected and objectively measured using multi-modal imaging, identifying both inflammatory and non-inflammatory lesions, which can be translated into a global severity score. Canfield Scientific’s VISIA-CRP combines multi-modal imaging with micron-resolution 3D facial imaging, which has improved the ability to detect and measure topographical characteristics of acne lesions. 

Ratan K. Chaudhuri, PhD., president and CEO of Sytheon, an innovative global specialty ingredient company based in Parsippany with affiliates in France and Singapore, discussed targets of mitigating acne-prone skin. Chaudhuri developed Sytenol A (Bakuchiol) and Synovea HR (Hexylresorcinol) – both gold standards – with more than 100 US and international patents. 

 

Skin barrier dysfunction, he said, is a key factor in all skin disorders including acne, with harmful environmental substances, like the sun, a lack of moisture, inflammation and proper innate immune function all causations of a weakened skin barrier. Oxidative stress, specifically, lipid peroxidation, may be an early event that helps drive the acne process. Lipid peroxidation causes ferroptosis, or cell death, in association with free iron ion. Squalene production is upregulated in acne by 2.2-fold versus controls. In the case of severe acne, oral Isotretinoin increases erythrocyte lipid peroxidation. Side effects of the treatment include a significant decrease in GSH and GPX.

 

Regarding the selection process of ingredients in acne care, the use of multi-functional actives in mitigating acne include an antibacterial effect (built-in anti-biofilm property); anti-inflammatory agent; pigmentation control; broad antioxidant (lipid peroxidation inhibitor); and sebum control. Maintaining and repairing skin barrier function is key for acne relief, along with achievement of skin microbiome homeostasis and including an approved anti-acne agent like salicylic acid over benzoyl peroxide or retinoic acid. 

 

Antiseptic ingredient Hexylresorcinol, first reported in 1925, is safe for human use, with J&J the first multi-national to use it for topical applications. Clinically validated by dermatologists, it is two- to four-fold more effective than hydroquinone and reduces post-inflammatory pigmentation. 

 

Ethyl Linoleate, an ester of Safflower fatty acids, is also safe for human use. An anti-inflammatory, it decreases sebum production and maintains and repairs the skin barrier function in addition to the stratum corneum acidity and prevents hyper-keratinization.