Andrew F. Alexis, MD, MPH: Discussing Controversies in Acne, Rosacea

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A post-AAD 2024 discussion on the importance of tailoring acne and rosacea management to individual patients’ needs, focusing more attention on diverse skin types and backgrounds.

The 2024 American Academy of Dermatology (AAD) Annual Meeting featured a wide variety of presentations and new late-breaking data, with many dermatologists focusing their talks on the value of improving care by tailoring treatments more to patients’ individual needs.

In this episode of DocTalk, we spoke with Andrew F. Alexis, MD, MPH, vice-chair for diversity in the department of dermatology and a professor of clinical dermatology at Weill Cornell Medical College in New York. Alexis discussed the major takeaways from his talk at AAD titled ‘Controversies in Acne and Rosacea.’

Alexis first touched upon acne, highlighting the common challenge of post-inflammatory hyperpigmentation (PIH) among individuals with skin of color, a condition known to often surpasses acne as far as driving forces of concern among patients. He emphasized different treatment approaches, noting the efficacy of topical retinoids.

“I go over approaches to treating both acne and PIH at the same time to get that desired endpoint of clearance of both the papules, pustules, and comedones, or in other words the acne,” Alexis said. “And the sequelae, or the acne hyperpigmentation. So one of the most helpful strategies to address both things at the same time is using topical retinoids. I highlighted a new study that has just released data with a new retinoid, a novel retinoid, which is the fourth generation retinoid trifarotene cream.”

The recent study described by Alexis had shown that trifarotene led to substantial improvements in PIH as early as the twelfth week of treatment. Alexis’s example highlighted the value of tailored approaches for patients with diverse skin tones.

“When it comes to rosacea, the condition is really under-recognized in patients with skin of color,” Alexis explained. “There tends to be a low index of suspicion for patients belonging to various racial or ethnic populations that have skin of color. But it turns out that rosacea is indeed a condition that affects the broad spectrum of the patient population, including those with skin of color. The erythema may not be as prominent, the redness may not be as visible.”

Alexis added that, with careful inspection using dermoscopy or diascopy, as well as the use of symptomatology of the patient, the features of rosacea can be identified more clearly and improve rates of diagnoses.

Considering the diverse patient populations affected by acne and rosacea, Alexis was also asked about the improvement of diversity in clinical trials and other methods for improving diagnosis among patients with diverse skin types.

“I think improving our knowledge and understanding of rosacea across diverse patient populations, including those with skin of color, would be helped by including more diverse patients in our clinical trials,” Alexis said. “...That would allow us to be able to potentially perform comparative analyses, if the sample sizes are large enough to allow that, and it would also help to change the perception that rosacea is something that one is only going to see in individuals with lighter skin complexion of Northern European ancestry, etc., and really just raise awareness that we can see it across a whole range of racial ethnic groups.”

Alexis also highlighted the importance of diversity in educational images, including in educational materials, so that patients and clinicians alike may recognize images that reflect the patients’ specific skin types.

To learn more about Alexis’s presentation at AAD 2024, listen to the full interview posted above.

The quotes contained in this summary were edited for the purposes of clarity.

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