With over one thousand medications available, how do we choose which to use? There are newer medications that come out every few years with some benefits and usually one major disadvantage–cost!

Trifarotene: A new topical retinoid to help with clogged pores. This topical product works much faster than other products, which is the major advantage. It also if approved for use on the trunk, although the other retinoids can be used there as well. In as little as 2 weeks patients can see improvement. Unfortunately, this comes with a hefty price tag of over $500 for a 45 gram tube. Is it worth it? Well, you decide. Differin gel costs about $28 ($5 coupons are often found at CVS to further lower the cost) and has been available for over 2 decades, is stable, and works well.

Sarecycline: A new “narrow spectrum” tetracycline class antibiotic, which is more specific for the bacteria that causes acne with less resistance. It has a once a day dosing and a side effect profile that is somewhat similar to other medications in its class. Unfortunately, it has up to 3% risk of vulvovaginal yeast infections. What is the cost? As of now it is about $1000 for a 30 day supply. Is it worth it? You decide if it is worth the price tag compared to about $15 to $20 for a 90 day supply of generic doxycycline.

Tazarotene Lotion and Tretinoin Lotion: Two new formulations of older products. Tazarotene lotion is less irritating than the cream, but less irritating. These two products are far more expensive than Differin gel, which is available without a prescription.

Minocycline Foam: A new topical antibiotic that has the advantage of little to no resistance. The foam is flammable so one must keep away from open flames. It is a once a day formulation and costs around $500. In comparison one can get a clindamycin/benzoyl peroxide for less than $50 with a coupon. Is it worth it? It appears to be well tolerated and very effective, but you decide if it is worth the higher price tag.

Clascoterone: a new topical anti-androgen. This can be used in patients 12 years of age and older, is well tolerated, and should not be used on large areas. This product works differently than other medications as it is thought to decrease the production of oils, which the bacteria feed on.

There are a few “improved” products that may be available in the future.

In summary, there are some newer products available that appear to be safe and effective. Like all new medications, these are associated with a high price tag. In most cases, I do not believe that the significantly higher cost is worth the added benefit for most patients, as this will greatly increase the cost of care. For some patients, these newer options may be worth trying, but as always, one must weigh the cost to benefit to side-effect ratios to determine if it is feasible.

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Robert S. Bader, M.D., Dermatologist

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