After several decades, this is the first real breakthrough against acne.

Clascoterone, a promising treatment, has been prescribed for several months in the United States, but in Europe it is not known when this drug will be available.

“What is really promising with clascoterone is that it acts by a completely new mechanism on (the causes) of hormonal acne,” summarizes American dermatologist John Barbieri to AFP.

Since the end of 2021, American doctors have been able to prescribe this cream against acne, a skin disease from which it is very rare to escape during one's life.

Acne, oily skin and pimples affect about three out of four teenagers.

Many adults are also affected.

Nothing new for 40 years

Faced with such a widespread disease, therapeutic innovations are rare, although research has recently progressed on other levels such as the effects of diet.

Before the appearance of clascoterone, anti-acne treatments had not registered any novelty for almost 40 years.

Topical treatments were previously divided into two broad categories: those that eliminate the bacteria causing acne with antibiotics, and those that limit the accumulation of dead cells, a process that promotes inflammation.

Clascoterone makes skin cells less receptive to the hormones that cause sebum, the fatty substance that acne sufferers produce in excessive quantities.

Other treatments, taken orally, also act on the hormonal level.

But these are usually birth control pills, so exclusively given to women.

And, by directly influencing the production of hormones, they cause much heavier upheavals in the body.

Not a miracle drug

However, a new mechanism of action is far from ensuring the interest of a drug, it must also prove that it works.

This is the case of clacosterone, which a study, published in 2020 in Jama Dermatology, found to be more effective than a placebo given blindly, and without significant side effects.

This study was conclusive enough for the American authorities to approve the treatment.

But don't expect a miracle drug or an acne revolution either.

The study "does not compare with existing treatments, so we don't know very well how to place all that," tempers French dermatologist Emilie Sbidian to AFP.

However, she considers this new drug “very interesting” because it could offer new hope to patients reluctant to other treatments, or even be given in addition to them to increase their effectiveness.

Pharmacy giants not interested in dermatology

Yet it is not on the agenda in Europe, where there is no indication when the treatment will be available.

Reluctance of health authorities?

Not even: the European Medicines Authority (EMA) told AFP that it had not started to evaluate the drug.

The answer is to be found in the choices of the company that produces the drug, the Swiss Cosmo Pharma.

"As we are a very small group, we first focused on authorization in the world's largest market, the United States" where the treatment is now distributed by another company, Sun Pharma, explained to AFP. Diana Harbort, head of Cosmo's dermatology unit.

According to Ms. Harbort, the dermatology market does not interest the pharmaceutical giants, such as the American Pfizer and the French Sanofi, and Cosmo must find a different partner for each region of the world.

It has just achieved this in China, which it announced at the end of July during its quarterly results.

But, in Europe, nothing new.

Strategic error?

Why does it take so long to find a partner?

The group evokes a market slowed down for a long time by the Covid-19 crisis, but this explanation does not convince all observers.

"The dermatological market is rather buoyant," notes financial analyst Jamila El Bougrini to AFP.

“I think there were mistakes in group strategy.

»

The analyst, who does not understand why no evaluation has been launched with the European authorities, notably evokes an unfortunate choice by Cosmo in recent years: the group wanted to resell its dermatology division, of which clascoterone was the only product, before d give it up for lack of a buyer.

"Weren't they too greedy?"

asks Ms. El Bougrini, who finds it difficult to interest investors if a treatment does not appear more effective than existing drugs.

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