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Acne Treatment: The Additional Help of Antidiabetic Drugs (Metformin)

Take Home Massage: The benefit of added Metformin in the treatment of Acne Vulgaris is still a matter of debate and more studies are needed. The benefit of metformin would be on inflammatory lesions (Full Abstracts below)(Studies from Malaysia and the Philippines)

 

Comments:

In both studies metformin is added to oral tetracycline and benzoyle peroxide

1. The study showing a beneficial effect of antidiabetic drugs against acne is a prospective study. The benefit seen was observed for inflammatory lesions (papules, pustules). No difference was seen for non-inflammatory lesions (whiteheads=closed comedones and blackheads=open comedones) No conflict of interest is declared but benzoyle peroxide, adapalene and lymecycline are all produced by Galderma Laboratories.

2. The study with INSUFFICIENT DATA  conclusions is also a prospective study. Results sound a trend in lesion reduction, but the difference was not statistically significant.

To read a short introduction on the use of antidiabetic drugs in dermatology: click HERE 

 

 

1.Abstract of the Study showing a beneficial effect:

Introduction: Acne vulgaris has multifactorial causes. Prolonged systemic antibiotics are often necessary because relapse of lesions occur upon its discontinuation. Currently, antimicrobial resistance is a growing concern. Metformin may decrease need for antibiotics and maintain adequate control of the disease.

Objective: To determine the efficacy and safety of metformin versus placebo as an adjunct to lymecycline and adapalene+benzoyl peroxide gel in the treatment of moderate to severe acne vulgaris.

Methods: Patients with moderate to severe acne vulgaris received either metformin or placebo tablets, together with lymecycline and adapalene+benzoyl peroxide gel. Lymecycline was taken for 6 weeks. The rest were given for 18 weeks. Evaluation was done biweekly using the mean reduction rates of non-inflammatory, inflammatory and total lesion count, modified global severity score, subjective self-assessment score, Dermatology life quality index (DLQI) score, cutaneous and systemic adverse events.

Results: Forty patients were included. Mean reduction rates of the non-inflammatory lesion counts of the 2 groups were comparable (p>0.05). Mean reduction rates of the inflammatory and total lesion count in the metformin group were higher than the placebo group (p<0.05). The mean modified global severity score of the metformin group was lower than the placebo group (p=0.034). Mean DLQI scores decreased in both groups (p<0.0001). Subjective self-assessment scores improved in both groups with comparable results. Cutaneous adverse events (erythema, pain, scaling and dryness) were tolerable. Systemic adverse events (diarrhea, flatulence, headache and epigastric pain) were self-limited.

Conclusion: Metformin is an effective and safe adjunct in the treatment of moderate-severe acne vulgaris.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore.  RCD16-0116 Acne & Rosacea DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL ON EFFICACY AND SAFETY OF METFORMIN AS ADJUNCT TO LYMECYCLINE AND TOPICAL ADAPALENE/BENZOYL PEROXIDE GEL IN THE TREATMENT OF MODERATE-SEVERE ACNE N. Gabaton1, A. Paliza1, E. Letran1 1University of Santo Tomas Hospital, Dermatology, Manila, Philippines

 

 

2. Abstract of the inconclusive study:

Background: Acne is proposed to be an insulin-like growth factor-1 (IGF-1) mediated disease. Pharmacological down-regulation of IGF-1 and insulin resistance by metformin may be a promising new option for the treatment of acne vulgaris.

Objective: To evaluate the efficacy and safety of metformin as an adjunct therapy to oral tetracycline 250mg bd and topical benzoyl peroxide 2.5% for the treatment of moderate to severe facial acne vulgaris.

Method: In total, 84 patients were randomized to a 1:1 ratio to receive metformin 850mg daily with oral tetracycline 250mg bd and topical benzoyl peroxide 2.5% or oral tetracycline 250mg bd and topical benzoyl peroxide 2.5%. Evaluations constituted acne lesion counts, Cardiff Acne Disability Index (CADI) scores and treatment success rate (percentage of subjects with an Investigators Global Assessment score of 0 or 1 or improvement of two grades from baseline).

Results: The mean percentage reduction from baseline in total lesion counts at week 12 in the metformin group was -71.4 % compared to -65.3% in the control group (p=0.278). CADI scores at week 12 showed a greater mean reduction of -4.8 in the metformin group compared to -4.2 (p=0.451) from baseline. Treatment success rate was significantly higher in the metformin group (66.7% vs 43.2%; p=0.04). In the metformin group, 31.7% developed gastrointestinal symptoms but no hypoglycaemia was reported.

Conclusion: Metformin might be an option for the adjunct treatment of moderate to severe acne. However, randomized placebo-controlled studies with longer follow up periods are required to support its use.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore.  RCD16-0109 Acne & Rosacea METFORMIN AS AN ADJUNCT THERAPY FOR THE TREATMENT OF MODERATE TO SEVERE ACNE VULGARIS: A PILOT STUDY S. Robinson1, A. Mohd Affandi1 1Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia