The Tolerable Future of Acne Treatment Reducing Sebum

The first episode of the series provides a comprehensive summary of optimizing new acne treatments using the topical androgen receptor inhibitor, clascoterone cream 1%, highlighting data from the Fall Clinical Dermatology Conference 2025.¹ The discussion centered on the findings from the study titled, "Reduction in facial sebum production following treatment with clascoterone cream 1% for 52 weeks," a study co-authored by Zoe D. Draelos, MD, clinical faculty member of dermatology at Duke University School of Medicine, who was a key investigator.

Draelos emphasized that sustained sebum reduction is critical because sebum is the "final common pathway" in acne pathogenesis, feeding C. acnes bacteria and resulting in inflammatory and non-inflammatory lesions. She argues that managing acne by starving the bacteria through sebum reduction is a "more direct and healthier approach" that avoids relying on antibiotics. The 12-week interim analysis of the exploratory study involving 40 patients showed statistically significant reductions in casual sebum measurements (27%), inflammatory lesion counts (54%), and noninflammatory lesion counts (34%).²

Draelos noted an excellent correlation between the objective decrease in sebum and improved subjective characteristics like reduced oily skin appearance, decreased facial shine, and reduced pore size, explaining that these characteristics are fundamentally measuring the effects of sebaceous gland secretions. Specifically, when sebum secretions decrease, the oily appearance lessens, reducing the light-reflecting film (shine), and the sebaceous gland decreases in size, leading to reduced pore size.

A key insight from Draelos is the medication's absolute tolerability, which she calls "truly unique" among acne medications. Unlike retinoids and benzoyl peroxide, which "require some sacrifices in terms of tolerability on the part of the patient," clascoterone resulted in no recorded occurrences of peeling, dryness, redness, or swelling by investigators, and patient-reported stinging, burning, and itching were none or minimal. This profile is crucial for ensuring high compliance with the twice-daily topical regimen.

Looking forward, Draelos suggests the topical ability to modulate the androgen receptor opens up unique research questions, including whether clascoterone alters the chemical composition of sebum and exploring its potential to address other conditions, such as inhibiting male pattern hair loss or decreasing facial hair in women with polycystic ovary disease.