Preliminary Studies Say Yes, but Using These Drugs Is Risky, so They Are Reserved for Very Severe Cases of Acne
The Essential Info
Drugs that treat auto-immune diseases (i.e. rheumatoid arthritis or psoriasis) work by reducing inflammation in the body. Since acne is at its core an inflammatory disease, they may also help reduce acne, and initial studies have shown they are effective.
However, since these drugs work by repressing the immune system, that means the likelihood of getting a severe infection increases when taking them. For this reason, doctors do not regularly prescribe them for acne, and when they are prescribed, it is normally only for very severe cases.
Examples of so-called small molecule auto-immune drugs, which are taken orally:
(research shows they may reduce acne to a modest degree)
- Otezla® (apremilast)
- Zyflo CR® (zileuton)
Examples of so-called biosimilar auto-immune drugs, which are injected:
(research shows they may completely eradicate acne)
- Humira® (adalimumab)
- Enbrel® (etanercept)
- Remicade® (infliximab)
- How Do Auto-immune Drugs Counteract Acne?
- What Is the Evidence for the Effectiveness of Auto-immune Drugs for Acne?
- Side Effects and Risks: Why Auto-Immune Drugs Are Not Often Used in the Treatment of Acne
Auto-immune diseases, such as rheumatoid arthritis and psoriasis, occur when the body’s immune system confuses certain body cells for “foreign invaders” and attacks itself. Drugs that treat auto-immune disorders work by inhibiting the immune system so it is less able to attack.
So why would this be of interest to us when it comes to acne? Because when the immune system gets confused and attacks the body, one hallmark of this immune response is inflammation. Inflammation is the redness, pain, swelling, and heat that often accompany disease or injury.1-3 Since acne is at its core an inflammatory disease, it stands to reason that drugs that decrease the immune response and inflammation could also treat acne.
As we will see, it appears these drugs do in fact work to help clear acne, and in some cases completely eradicate acne, but their side effects relegate them to only the most severe cases.
How Do Auto-immune Drugs Counteract Acne?
Drugs intended for use against auto-immune diseases function by blocking key enzymes in the immune system and preventing the immune response. By achieving this, these drugs also prevent inflammation.
There are two major types of drug for auto-immune diseases:
- Small molecule drugs such as: Otezla® (apremilast), Zyflo CR® (zileuton)
- Biosimilar drugs such as: Humira® (adalimumab), Enbrel® (etanercept), Remicade® (infliximab)
Expand to Learn How These Drugs Work in the Body
What Is the Evidence for the Effectiveness of Auto-immune Drugs for Acne?
Good evidence for the effectiveness of auto-immune drugs in acne treatment would consist of published studies or clinical trials with hundreds or thousands of acne patients as participants. Unfortunately, there have been no such large studies done. However, several small studies provide some information concerning the effectiveness of auto-immune drugs for acne.
Small molecule drugs: A study of 10 participants was published in 2009 and tested zileuton, a small molecule drug used for auto-immune disorders, on people with acne. After three months of treatment, the severity of the patients’ acne decreased by 41%.7 This suggests that zileuton is at least partially effective against acne.
Biosimilar drugs: Because biosimilar drugs come with such serious risks, for safety reasons, no studies that include more than one person at a time have been conducted on biosimilar drugs for acne. However, doctors have administered biosimilar drugs to a few individual patients for the treatment of serious types of acne or rare syndromes often associated with acne, like acne inversa and SAPHO syndrome,8 and reported the results in medical journals. In these cases, the researchers determined that the benefits to these patients outweighed the risks of an inhibited immune system. Below we can see that, at least in these particular individuals with severe acne, biosimilar drugs provided dramatic clearing of the skin.
Expand to read details of studies
Side Effects and Risks: Why Auto-Immune Drugs Are Not Often Used in the Treatment of Acne
From these impressive study results, it might seem like auto-immune drugs, particularly biosimilar drugs, might be a great resource that people could use to clear up acne. But because immune-suppressing drugs are so good at repressing the immune system, that means anyone taking them is more susceptible to serious infections, and if an infection happens, that infection will be more difficult to treat. Because this is such a concern, doctors do not regularly prescribe auto-immune drugs for acne.
Based on the one small study and several individual cases, both of the two major types of drug for auto-immune disorders, small molecule drugs and biosimilar drugs, show promise in treating acne, with small molecule drugs helping perhaps only partially and biosimilar drugs perhaps producing dramatic clearing of acne. However, more studies of both of these drug types are needed to prove the effectiveness and reliability of auto-immune drugs as an acne therapy.
Caution: Since auto-immune drugs suppress the immune system, treatment with them leaves the patient open to potentially dire infections, particularly in the case of treatment with biosimilar drugs. Therefore, therapy for acne with auto-immune drugs should be considered only in particularly severe acne cases and under the recommendation and supervision of a physician.
- Farrar, M. D. & Ingham, E. Acne: inflammation. Clin Dermatol 22, 380 – 384 (2004). https://www.ncbi.nlm.nih.gov/pubmed/15556722
- Marta Guarna, M., Coulson, R. & Rubinchik, E. Anti-inflammatory activity of cationic peptides: application to the treatment of acne vulgaris. FEMS Microbiol Lett 257, 1 – 6 (2006). https://www.ncbi.nlm.nih.gov/pubmed/16553825
- Vowels, B. R., Yang, S. & Leyden, J. J. Induction of pro-inflammatory cytokines by a soluble factor of Propionibacterium acnes: implications for chronic inflammatory acne. Infect Immun 63, 3158 – 3165 (1995). https://www.ncbi.nlm.nih.gov/pubmed/7542639
- Gooderham, M. & Papp, K. Apremilast in the Treatment of Psoriasis and Psoriatic Arthritis. Skin Therapy Lett 20 (2015). https://www.ncbi.nlm.nih.gov/pubmed/26382906
- Zouboulis, C. C. & Piquero-Martin, J. Update and future of systemic acne treatment. Dermatology 206, 37 – 53 (2003). https://www.ncbi.nlm.nih.gov/pubmed/12566804
- Sand, F. L. & Thomsen, S. F. Adalimumab for the treatment of refractory acne conglobata. JAMA Dermatol 149, 1306 – 1307 (2013). https://www.ncbi.nlm.nih.gov/pubmed/24048280
- Zouboulis, C. C. Zileuton, a new efficient and safe systemic anti-acne drug. Dermatoendocrinol 1, 188 – 192 (2009). https://www.ncbi.nlm.nih.gov/pubmed/20436887
- Włodarek, K., Ponikowska, M., Matusiak, Ł., Szepietowski, J. C. Biologics for hidradenitis suppurativa: an update. Immunotherapy 11, 45-59 (2019). https://www.ncbi.nlm.nih.gov/pubmed/30702012
- Yiu, Z. Z., Madan, V. & Griffiths, C. E. Acne conglobata and adalimumab: use of tumour necrosis factor-alpha antagonists in treatment-resistant acne conglobata, and review of the literature. Clin Exp Dermatol 40, 383 – 386 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25545016
- Arias-Santiago, S., Sanchez-Cano, D., Callejas-Rubio, J. L., Fernandez-Pugnaire, M. A. & Ortego-Centeno, N. Adalimumab treatment for SAPHO syndrome. Acta Derm Venereol 90, 301 – 302 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20526553
- Miguel, D., Tittelbach, J., Elsner, P. A dramatic case of acne fulminans responding to adalimumab. J Dtsch Dermatol Ges Aug;17, 837-838 (2019). https://www.ncbi.nlm.nih.gov/pubmed/31056852
- Shahada, O. O. et al. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome diagnosis in adolescent and isotretinoin as a possible serious exacerbating factor. Cureus 14, 1-12 (2022). https://pubmed.ncbi.nlm.nih.gov/35371846/
- Schuttelaar, M. L. & Leeman, F. W. Sustained remission of nodular inflammatory acne after treatment with infliximab. Clin Exp Dermatol 36, 670 – 671 (2011). https://www.ncbi.nlm.nih.gov/pubmed/21595742
- Campione, E., Mazzotta, A. M., Bianchi, L. & Chimenti, S. Severe acne successfully treated with etanercept. Acta Derm Venereol 86, 256 – 257 (2006). https://www.ncbi.nlm.nih.gov/pubmed/16710590