February 8, 2023

WINLEVI HORMONAL ACNE TREATMENT 🤔 DERMATOLOGIST @Dr Dray on CLASCOTERONE 1% CREAM acne treatment. How to use Winlevi for acne. How long does it take to see results with Winlevi? What are the side effects of Winlevi? Winlevi vs tretinoin. Winlevi vs spironolactone. Winlevi for hormonal acne. #acne #acnetreatment #dermatologist

Boy guys get excited because in this video we are going to be doing a deep dive look at the new acne treatment when levy is it worth it how does it compare to tretinoin and what are the side effects i’m going to be covering all of that in this video but before we dive into the topic if you like skin care content from a board-certified dermatologist then hit the

Subscribe button also hit that little bell because that little bell is going to notify you as soon as my videos go live and definitely give me a follow over on tik-tok and instagram i’m very consistent posting on those platforms as well acne is the eighth most prevalent disease worldwide and it affects over 640 million people globally while many people view it

As a cosmetic issue it has profound impacts on one’s psychological and emotional health and it can lead to scarring the root causes of acne are threefold first is keratinocyte hyperproliferation that is a lot of medical jargon to basically say that the skin cells they’re a little confused and they’re very sticky and that’s what leads to clogging of the pores the

Second factor is androgen hormones these hormones testosterone and dihydrotestosterone they bind to receptors in the oil gland in your skin and they cause the oil gland to first make more oil and also to make a lot of inflammatory mediators so they’re responsible for oiliness and inflammation the third factor is a little bacteria called cutie bacterium acnes that

Lives in the pore breaks down all this oil and causes a lot of ruckus and inflammation further driving breakouts we have a landscape of treatments available to us that address one or more of these different components retinoids tretinoin adaptolene zeratine and the oral retinoid isotretinoin address the skin stickiness issue and they address the inflammatory issue

We have medications that target the hormonal issue oral contraceptive pills spironolactone there are oral and topical antibiotics that address cutie bacterium acnes and the inflammation in the skin but medications they are not always 100 perfect and of course they come with side effects not every medication is going to be right for every patient so it is imperative

That we’re constantly innovating and coming out with new therapeutics to address diseases especially one that is so common so here we have a new drug classic terror on one percent cream otherwise known as wind leaves this is a novel treatment and that is something that you apply to the skin that addresses that hormonal component the only other medications that we

Have that really target that are oral pills namely oral contraceptive pills otherwise known as birth control pills and the medication spironolactone both of these can be incredibly effective for addressing the hormonal component in women can’t give these medications to men and some women don’t want to take oral contraceptive pills they do have side effects and

The medication spironolactone while very safe and low risk of side effects and some people it just may not be a good option so we need more treatments to reach a broader array of patients and to limit side effects so how does this new medication when levy work well we don’t 100 know all the ways in which it works but it is a topical anti-androgen throughout your

Skin you have androgen receptors the androgens specifically dihydrotestosterone bind to receptors on the cells that make up the oil gland and lead to more oil production and more inflammatory mediators the way this new drug is thought to work is that it competes with the potent androgen dihydrotestosterone for the androgen receptor and in doing so it inhibits

The downstream consequences of dihydrotestosterone binding to that androgen receptor which is going to be an increase in oiliness and an increase in inflammation because it is rapidly metabolized in the skin the systemic effects meaning to your total body are significantly significantly diminished in comparison to taking an oral pill like spironolactone or an oral

Contraceptive pill to be clear those medications are perfectly safe but they do have side effects and as a reminder those treatments are not suitable for males this newer topical treatment addresses the hormonal component but is suitable for male patients and the side effect profile is much safer from a total body perspective in comparison to an oral contraceptive

Pill or spironolactone the other clear advantage of topical class keteron otherwise known as wind levy is that it has a very quick onset of action you have heard throughout the years on my channel about being very patient with acne treatments they take a while to start working this newer treatment is actually pretty quick and it’s on onset to begin to improve the

Lesions of acne you can start to see improvement with this new treatment in as little as two weeks and the skin continues to improve outwards to eight weeks with ongoing use how effective is it clinical experience as well as clinical trials point to the efficacy of topical class keteron for reducing the number of inflammatory acne lesions when we’re talking about

The trials anywhere from 44.8 percent to 46.9 percent improvement in the number of inflammatory acne lesions at 12 weeks this is in comparison to the vehicle alone and if you’re new here what do i mean by vehicle alone well you have wind levy cream right it’s a cream and it’s got classic taron in it for this trial they’re comparing the results to the the cream

Without the classical terrain that’s a really important control because just the cream alone without the actual drug in it you still get some benefits anywhere from a 29.6 percent to 36.5 percent decrease in inflammatory acne lesions at 12 weeks i’m pointing that out because a it’s an important control to have in trials and b it points to the fact that using a cream

A moisturizer can benefit acne okay so always keep that in mind the control group did see benefit just using a moisturizing cream but it’s clear from these studies that having the active that having the actual drug in there further improved their acne so it’s doing something beyond just the benefit of using a moisturizer at 12 weeks and we see that clinically as

Well in patients using this cream how does it compare to retinoid it actually is a little bit better at eight weeks in comparison to tretinoin when and when research investigators in these trials actually evaluated the patients of course they were blinded they didn’t know if they were getting tretinoin or when levy but overall their global assessment was slightly

Better for the win levy group in comparison to tretinoin but that was not statistically significant i will point out however these studies comparing tretinoin to when levy they only looked out to eight weeks tretinoin can take some time to really start yielding maximal improvement so that is something to keep in mind now speaking of tretinoin a lot of you guys

Know that tretinoin has many other skin benefits besides addressing acne now classical terrain is not going is not likely to have those benefits and by benefits i’m talking about improving collagen production smoothing out wrinkles and fine lines removing sun damage and helping to treat and prevent hyperpigmentation classical terrorine it’s an androgen receptor

Inhibitor so it’s not going to do all these other things so don’t think of it as superior to tretinoin globally we’re just talking at eight weeks it was slightly better than tretinoin but again we’ve got to look at a broader timeline and knowing that tretinoin has multiple other benefits behind it and a lot more data behind it as well the appeal of this creams

Presumably is going to have fewer risks fewer side effects classical terrorism is metabolized to something called cortex alone and in theory that cortex alone could suppress something called the hypothalamic pituitary adrenal access basically the communication points and hormone signaling between the brain and your adrenal glands in theory it could affect that and

That downstream may lead to problems with things like blood pressure is that a reality in the clinical trials at the indicated dosage it does not appear to be a reality when it comes to toxicity and adverse side effects you’ve heard me say over and over again it’s not the poison it’s the dose and that’s the case here using high amounts probably more likely to lead

To adverse effects obviously but the other thing to bear in mind is the body surface area that it’s being being applied to shouldn’t be used to like your whole back in theory you may be getting too much in those areas actually recommended that you only apply about one gram of the drug twice a day to the affected area sparing around the eyes the mouth the mucous

Membranes and so using a small amount to the face is very unlikely to result in hpa axis suppression the other factor that can influence risk for hpa axis suppression is if you apply it under occlusion so if you’re using it to the face for example you don’t want to put it on and then be applying your pimple patch over it you guys know i’m a huge fan of those pimple

Patches to help cut down on the risk of picking but in the case of this drug that could increase the risk of hp hpa axis suppression so that would not necessarily be a good idea the other thing is your age and very young children it would be a greater risk their skin you know absorbs to a greater extent when levy is fda approved for ages 12 years and older in theory

The metabolite of this drug could lead to high levels of potassium uh there were some people whose potassium increased and that was five percent of people actually getting the drug as opposed to four percent of people getting just the cream so it doesn’t appear to be a significant risk we don’t know how safe this is in pregnancy we don’t have any data on if it

You know could lead to birth defects or anything like that so we don’t know if it’s safe in pregnancy so to be clear when we’re talking about risks to total body health very very very safe overall the things i’m pointing out here are incredibly rare events overall the incidence of adverse effects with topical classical terrain when levy is actually lower than with

Tretinoin 0.05 percent cream if you’ve ever used tretinoin which many of you have on this channel you know it’s very drying it’s irritating it’s you know can cause a lot of peeling flaking people like to refer to it as the retinoid uglies that doesn’t really occur with this drug but what does can happen in terms of effects to the skin that are negative it can be

Drying and it can cause some itch you can have some itch as a result and also some redness may happen but nothing that really seems to get in the way of complying with using it quite to the extent as the retinoid uglies can you apply a one gram which is a very small pea-sized amount to the affected areas on the face twice a day so in the morning and in the evening

And you want to avoid getting it around the eyes because again absorption is going to be much greater there you don’t want to put this on your lips in your mouth in your nose it’s only approved for people 12 years of age and older but both men and women can use it and so the advantage here is that we have a new drug that addresses the hormonal component unlike

Prior drugs that address the hormonal component this one can be used in both men and women so this is an exciting new development in the treatment of acne in women who deal with a lot of hormonal acne and it’s also an exciting development for young males because they often have pretty severe acne with a major hormonal component that up into the development of this

Drug we had nothing to offer them that would tackle that young males tend to respond quite well to isotretinoin systemic medication by mouth that addresses the sticky skin cell thing and oiliness young males adolescent males tend to respond quite well to that but there’s really nothing that specifically addresses the androgen signaling part of things so having this

New medication you know it really opens up some additional doors for them in terms of optimizing treatment i don’t envision this as being a stand-alone acne treatment however because it doesn’t necessarily address all components of acne and i think it’s something that is going to be an add-on to our acne treatment for the most part for most patients so say for

Example you are on you’ve done accutane this might be something that can be used alongside accutane and or post accutane to control the hormonal component which accutane doesn’t really address it hasn’t been around for very long so only time will tell i don’t think it’s going to be a replacement for topical retinoids limitations that i see with this drug are the

Fact that patients have to apply it twice a day twice a day application compliance tends to plummet i don’t know to what extent it’s going to be effective applied once a day and i would have concerns with long-term uninterrupted use of this especially to widespread areas uh in terms of hpa axis suppression given that you know that is something that has come up so

Just something that we need you know more information on to tease out how long you could safely use this and lastly the other limitation with this drug is that it is significantly more expensive than tretinoin now the cost is going to vary depending on your location pharmacies insurance coverage it’s about 500 to 600 for a tube of it so that is not inexpensive

And insurance companies oftentimes are not so quick to approve it so your doctor may have to write a letter and even that doesn’t guarantee that the insurance company will cover it they often will want you to use other things first and prove that those fail so that is that is actually a big stumbling block when it comes to actually executing this as a treatment

In your acne treatment plan a major benefit of this is that the onset is pretty quick two weeks uh nowadays delayed gratification is a thing of the past people want more instant results so two weeks is is a lot better than you know six weeks eight weeks uh that most acne treatments take to start working um and so you know that’s beneficial in that regard a lot of

You guys have shared with me that you have been prescribed this so let us know in the comments only if you feel comfortable of course uh what your experience with that has been positive negative uh you know somewhere in between i hope this video was informative to you all um on the end slate i’m going to put my video on uh building an oily skincare routine so if

You’ve got oily acne prone skin definitely check that one out but if you like this video give it a thumbs up share it with your friends and as always don’t forget sunscreen and subscribe i’ll talk to you guys tomorrow bye you

Transcribed from video