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)
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