Acne Treatment Efficacy Does Not Appear to Be Affected by BMI

The following article is part of our coverage of the American Academy of Dermatology’s annual meeting (AAD 2021) that is being held virtually from April 23-25, 2021. Dermatology Advisor‘s staff will report on the top research in dermatologic advances and clinical care. Check back for the latest news from AAD 2021.


The efficacy of topical acne treatments was not affected by body mass index (BMI) according to study results presented at the American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2021, held online from April 23 to April 25, 2021.

Researchers analyzed data from 5 phase 3 double-blind studies for this post hoc analysis. Patients with moderate to severe acne (Elevator’s Global Severity Score [EGSS], 3 or 4) were randomly assigned in a 1:1 ratio to receive once-daily clindamycin/benzoyl peroxide 1.2%/3.75% gel (C/BPO; n=250), tazarotene 0.045% lotion (n=798), tretinoin 0.05% lotion (n=816), or matched placebo vehicle for 12 weeks. Participants were stratified into underweight to normal (<25), overweight (25 to<30), or obese (≥30) subgroups. Number of inflammatory and noninflammatory lesions were assessed.

Among all active treatment recipients, acne lesions were reduced by more than 50% at 12 weeks. Compared with matched placebo cohorts, a grade reduction of at least 2 was observed in the normal and underweight participants in EGSS and a rating of at least “almost clear” was seen in all treatment groups (C/BPO: 29% vs 15%; tretinoin: 22% vs 10%; tazarotene: 30% vs 16%; all P <.05). The same pattern was observed among participants who were overweight (C/BPO: 31% vs 12%; tretinoin: 19% vs 11%; tazarotene: 29% vs 18%; all P <.05).

However, among the participants who were obese, only tazarotene (34% vs 22%; P <.05) effectively reduced EGSS scores and ratings at week 12. Neither C/BPO (22% vs 18%) nor tretinoin (16% vs 14%) outcomes differed significantly compared with placebo.

The number of inflammatory lesions were significantly reduced among all active treatment recipients who were normal weight or underweight (all P <.001) and overweight (C/BPO: P<.001; tretinoin: P <.05; tazarotene: P <.001) compared with placebo. Of the participants who were obese, inflammatory lesions were significantly reduced among the C/BPO group (least squares [LS] mean change, -56.0% vs -30.3%; P <.05) but not the tretinoin (LS mean change, -53.1% vs -45.9%) or tazarotene (LS mean change, -56.8% vs -52.6%) cohorts.

For noninflammatory lesions, all active treatments reduced lesion counts at week 12 compared with placebo (all P £.01) except among tretinoin recipients who were obese (LS mean change, -44.9% vs -38.5%). All reported adverse effects were mild to moderate.

The study authors concluded that topical treatments for acne were effective among all participants, reducing inflammatory and noninflammatory lesion counts and with an acceptable safety profile.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

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Cook-Bolden FE, Green L, Keri J, et al. Impact of body mass index (BMI) on efficacy of three topical acne treatments in patients with moderate-to-severe acne. Presented at: American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2021; April 23-25, 2021. Abstract/Poster 27615.