Patient Inquiry:

Aczone is a new topical drug approved dec 2008. I was wondering if Dr. Ali could look into it and prescribe it to me. People with cystic acne have seen great results. Dermatologists have been prescribing it to their patients already. Please let me know.
http://www.acne.org/messageboard/Before-and-Pics-2-weeks-t222896.html

Dr. Dima’s Response:

Dapsone is not a new drug. It's been around a long time but, when it's given a new name or indication, it gets press coverage and, for people looking for "the ultimate acne answer," it becomes the new best thing. Orally it is primarily indicated for leprosy, lupus and HIV opportunistic infections such as pneumocystis pneumonia and toxoplasmosis but must be closely monitored as it can have a deleterious effect on red blood cells. Topically it was originally used for rosacea and, although the mechanism of action remains unknown, it may work for some types of inflammatory acne but is unlikely to work for cystic acne. Doctors should screen patients potentially predisposed to G6PD enzyme deficiency (glucose 6-phosphate dehydrogenase) as use of dapsone can cause a blood disorder called hemolytic anemia (more likely if taken orally). I would caution against long term (over 12 weeks) topical use on extensive body surface area to avoid systemic absorption (many people have acne on the face, back, shoulders and chest).

The gel form of dapsone was made by Canadian company QLT Inc., and sold as Aczone Gel, 5%.This past summer, Allergan announced its purchase of Aczone 5% from the Canadian company. Allergan paid about $150 million for all assets related to Aczone with estimated revenues in excess of $75 million per year. Patients can actually get a free sample sent to them from Allergan by filling out a form on-line. If they want to give it a try, I would caution use of anything that contains benzoyl peroxide (even as a face wash) as your skin may turn orange. In my opinion, as with many "acne miracle meds," it's really just a lot of good marketing and with a name like Allergan now backing it up, it will likely get more press coverage than it's worth. For the topical treatment of acne, nothing comes close to the tried and true tretinoin.