Novel Tretinoin 0.05% Lotion for the Once-Daily Treatment of Moderate-to-Severe Acne Vulgaris in an Asian Population
September 2019 | Volume 18 | Issue 9 | Original Article | 910 | Copyright © September 2019
George Han MD PhD,ª April W. Armstrong MD MPH,B Seemal R. Desai MD,c, d Eric Guenin PharmD PhDe
ªIcahn School of Medicine at Mount Sinai, New York, NY
BKeck School of Medicine at University of Southern California, Los Angeles, CA
cInnovative Dermatology, PA Plano, TX
dThe University of Texas Southwestern Medical Center, Dallas, TX
eOrtho Dermatologics, Bridgewater, NJ
Background: Acne is a common problem among Asian adolescents and adults. Generally, Asian skin is more pigmented, with a higher risk of acne sequelae. Potential for skin irritation and dryness, as well as pigmentary changes are key concerns that can have significant impact on Quality of Life (QoL). The first lotion formulation of tretinoin was developed using novel polymeric emulsion technology to provide an important alternative option to treat acne patients who may be sensitive to the irritant effects of other tretinoin formulations.
Objective: To evaluate the efficacy, tolerability, and safety of tretinoin 0.05% lotion in treating moderate-to-severe acne in an Asian population.
Methods: Post hoc analysis of two multicenter, randomized, double-blind, vehicle-controlled phase 3 studies. Asian subjects (aged 12 to 48 years, N=69 with 61% female) were randomized (1:1) to receive tretinoin 0.05% lotion or vehicle, once-daily for 12 weeks. Efficacy assessments included changes in baseline inflammatory and noninflammatory lesions and treatment success (at least 2-grade reduction in Evaluator’s Global Severity Score [EGSS] and clear/almost clear). Quality of Life (QoL) was assessed using the validated Acne QoL scale. Safety, adverse events (AEs), cutaneous tolerability and hyper- or hypo-pigmentation (using 4-point scales where 0=none and 3=severe) were evaluated.
Results: At week 12, mean percent reduction in inflammatory and noninflammatory lesion counts were 58.6% and 51.4% respectively compared with 41.5% and 23.9% with vehicle (P=0.012 for noninflammatory lesions from week 8). Treatment success was achieved by 27.2% of subjects treated with tretinoin 0.05% lotion by week 12. For each Acne QoL domain, changes from baseline achieved with tretinoin 0.05% lotion were statistically significant compared to vehicle. Only five subjects reported any AE; all AEs were mild or moderate and transient. There were no serious AEs (SAEs). There were no treatment-related AEs with tretinoin 0.05% lotion. There were slight transient increases in scaling and burning over the first 4-8 weeks. Mild hyperpigmentation was reported at baseline (mean score, 0.8) and remained mild throughout the study.
Conclusions: Post hoc analysis showed that tretinoin 0.05% lotion was significantly more effective than its vehicle in achieving reductions in noninflammatory acne lesions and improvements in QoL in an Asian population. The novel lotion formulation was well-tolerated, with no treatment-related AEs and no concerns with skin dryness, irritation, or hyperpigmentation.
J Drugs Dermatol. 2019;18(9):910-916.
Acne is common in Asian adolescents and adults, although data on Asian populations living in the United States are limited. A general population survey of women of different ethnicities in four large cosmopolitan cities worldwide (including Los Angeles) reported a prevalence of 30% in the Asian subgroup of over 500 individuals, higher than in Caucasians (24%). Surveys of Asians living in other countries have reported higher prevalence in adolescents and preadolescents, males, and those living in urban areas.2-5 Unlike other racial groups, inflammatory acne was reported to be more prevalent than comedonal acne (20% versus 10%).1
Asians have diverse Fitzpatrick skin types, with some subgroups more prone to sensitive skin than others.6-9 Their skin tends to be more pigmented than Caucasians and a high proportion are predisposed to acne sequelae. In a sequential evaluation of 342 acne patients in seven Asian countries, 58.2% of patients had postinflammatory hyperpigmentation (PIH).10 Postinflammatory hyperpigmentation was a chronic, bothersome problem, present for more than 5 years in 22.3% of patients, with an impact on Quality of Life (QoL) greater than the acne itself in some patients.10 Other groups have also reported that inflammatory acne is more common in Asian women than other population groups, suggesting inflammation may play an important role in their tendency to PIH.11
Controversies remain regarding racial differences in skin sensitivity; however, increased susceptibility to irritation with topical retinoid therapy is an established challenge in the Asian popu-