Acne may be a side effect of treating cystic fibrosis with Trikafta: a case study

Acne may be a side effect of Tricavta treatment cystic fibrosis CF patients, according to a new case series in the US

Tricafta (elexacaftor, tezacaftor, ivacaftor) is a modulator of CFTR (cystic fibrosis transmembrane conductance regulator) that helps Defective CFTR protein It works most effectively in cystic fibrosis patients. Developed by Vertex Pharmaceuticals It is approved for patients with cystic fibrosis, including those with F508del Mutation, which is the most common cause of cystic fibrosis CFTR Genetic mutation.

the study “Medication-induced acne with elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis“in Cystic Fibrosis Journal.

Acne can be an adverse effect of medications and can be distinguished by the appearance of inflammatory papules (small bumps), pustules (white bumps surrounded by red skin containing fluid or pus), comedones (small skin-colored bumps) or abscesses.

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Rash — abnormal changes in skin color and texture — is a known cutaneous side effect of Tricavta, affecting 4-10.9% of patients in clinical trials. Being a woman and using hormonal contraceptives appear to be risk factors for treatment-related rashes.

Researchers in the United States described 19 patients with acne that appeared or got worse after starting Trikafta. All were eligible for Tricafta therapy, according to age (21-38 years) and genotype (at least one copy of F508del leap).

Nine had acne before starting treatment and 18 reported acne within eight months of starting treatment, including nine who reported it within the first three months and four who reported it within six months or later.

“Due to the non-emergent nature of this adverse effect and the unclear association with medication, not all patients reported it to the cystic fibrosis care team at the time of its first occurrence, so our understanding of the true time of onset is limited by patient recall,” the researchers note.

The face was the part of the body most affected, with some patients also reporting chest and back involvement.

No patient has discontinued Tricavta because of acne because the treatment’s lung function benefits outweigh the risks.

There is no standard treatment for acne in people with cystic fibrosis. In this study, therapeutic approaches varied from over-the-counter products to medications used to treat acne in the general population. These include topical treatments, such as benzoyl peroxide, antibiotics, and retinoids. and systemic treatments for moderate or severe cases resistant to topical treatments.

Although only a third of patients went to a dermatologist for their acne, the majority (16 patients) reported at least partial improvement.

“Based on the broad range of treatment regimens observed in these patient cases and overall positive reports from patients regardless of the treatment regimen chosen, we cannot conclude from this case series alone that any particular regimen is preferable,” the research team wrote.

How Trikafta leads to acne is unknown. The researchers hypothesized that it might be related to changes in the salt content of sweat, due to changes in the skin microbiome. This would be similar to the changes in the lung microbiome observed in patients treated with Tricavta.

However, there is little research in cystic fibrosis patients on the skin microbiome, the collection of microbes, such as fungi, bacteria, and viruses, that live naturally in the body.

An alternative hypothesis could be that a rapid decrease in sweat chloride itself triggers an inflammatory response, the researchers wrote. The researchers emphasized that “More research is needed to gain a better understanding of the various skin changes that may occur with initiation.” [Trikafta]. “

The researchers encourage “patients to report their symptoms to CF care teams and CF care teams to report new acne outbreaks or worsening to the drug manufacturer and the Food and Drug Administration for post-marketing monitoring.”