Retinoids in Acne Management: Review of Current Understanding, Future Considerations, and Focus on Topical Treatments

December 2018 | Volume 17 | Issue 12 | Supplement Individual Articles | 51 | Copyright © December 2018


Anna L. Chien MD

Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD

and can only be employed once scarring has occurred. A topical retinoid offers an easier to use and more economical approach in acne scar treatment while preventing and targeting the persistent dermal tissue loss not addressed by many of the non-pharmacological treatments.Future Directions The area of retinoid research remains robust with the development of a new retinoid, trifarotene, on the horizon. This medication is the first fourth generation topical retinoid with potent and selective RARγ agonist activity with minimal RARβ-mediated effects, thus lending it greater efficacy with potentially decreased side effect of skin irritation. Furthermore, trifarotene has also been shown to possess increased hepatic instability compared to first and third generation retinoids, thus theoretically giving it a more tolerable systemic safety profile. This is an important consideration with more extensive topical use. In early studies, this medication demonstrated significant comedolytic and anti-inflammatory activities. Trifarotene was also shown to regulate many of the traditional retinoid-induced pathways. Its role in that regard along with its depigmenting properties can potentially expand its use in acne-related post-inflammatory hyperpigmentation and scarring.20 figure3

CONCLUSIONS

Acne vulgaris affects 85% of individuals 12-24 years of age and persistence into adulthood is not uncommon. Its pathogenesis centers around follicular dyskeratosis, increased sebum production, and Cutibacterium (formerly Propionibacterium) acnes. Acne can have tremendous psychosocial impact on the patient and can lead to permanent post-acne changes such as atrophic scarring. Retinoid is the cornerstone of acne treatment given it addresses the key pathogenic pathways in acne, which enables it to both treat and prevent acne. Furthermore, given its ability to downregulate MMPs seen with acne inflammation and restore dermal collagen, retinoid can also improve and prevent acne scars. Trifarotene is a new fourth generation topical retinoid with significant comedolytic, anti-inflammatory, and depigmenting properties. Its introduction to the acne therapeutic ladder will expand options for patients and further treatment success.

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