Vehicle Formulation Impacts Tolerability and Patient Preference: Comparison of Tretinoin Branded Lotion and Generic Cream

August 2022 | Volume 21 | Issue 8 | 875 | Copyright © August 2022


Published online August 1, 2022

doi:10.36849/JDD.6945

Zoe D. Draelos MDa, Emil A. Tanghetti MDb, Eric Guenin PharmD PhD MPHc

aDermatology Consulting Services, PLLC, High Point, NC
bCenter for Dermatology and Laser Surgery, Sacramento, CA
cOrtho Dermatologics,* Bridgewater, NJ

*Ortho Dermatologics is a division of Bausch Health US, LLC

Abstract
Background: Topical retinoids like tretinoin are a mainstay of acne treatment but associated cutaneous irritation and drying may lead to poor adherence. As vehicle optimization can improve patient preference and adherence, tretinoin 0.05% lotion (Altreno®) was formulated using polymeric emulsion technology for uniform delivery of micronized tretinoin and moisturizing/hydrating excipients. This study compared tolerability and participant preference of a branded tretinoin 0.05% lotion versus generic cream.
Methods: In this single-center, double-blind, split-face study, 25 adult females with acne were randomized to apply lotion and cream to opposite cheeks once daily for 2 weeks. Investigator-assessed skin irritation and appearance, as well as participant ratings of the products and skin sensations, were evaluated immediately after first use and after 2 weeks.
Results: At week 2, there was significantly greater erythema, scaling, and dryness (122%–144%; P<0.01 each) and decreased skin softness, smoothness, radiance, and brightness (~40% difference; P<0.01 each) on the cream-treated versus lotion-treated side of the face. More participants agreed that the lotion was gentle, comfortable/soothing, spreadable, absorbent, not sticky, and left minimal residue versus cream (range: 72%–92% vs 8%–36%). Agreement scores on skin sensations (eg, soft, not dry, less dull) were similarly higher for lotion versus cream. Overall, ~70% of participants preferred to take home the lotion over the cream.
Conclusions: After 2 weeks of once-daily use, tretinoin 0.05% lotion was associated with less irritation and superior skin appearance/ sensation versus generic 0.05% cream, with most participants preferring the lotion over cream. These results demonstrate the importance of a well-designed vehicle formulation on tolerability and patient preference.

J Drugs Dermatol. 2022;21(8): 875-880. doi:10.36849/JDD.6945

INTRODUCTION

Efficacy and tolerability of topical treatments for acne and other dermatological conditions are impacted not only by the active drug but also by the vehicle used for its delivery.1,2 For example, drug distribution and absorption characteristics of a topical agent are largely impacted by the vehicle, which can also be formulated to increase skin hydration and decrease transepidermal water loss.3 Product attributes—such as moisturization, rapid absorption into the skin, non-greasiness, and ease of use—also strongly impact patient preference for, and subsequent adherence to, topical therapies.4-6 Further, these skin-sensation properties of topical therapeutics can impact patient quality of life, well-being, and self-esteem.7 Vehicle design and optimization of topical formulations are thus critical to the drug-development process and may profoundly influence patient use and treatment success.

Topical retinoids, including tretinoin, are a mainstay of acne treatment as they address multiple aspects of acne pathogenesis.3 However, tretinoin gel, cream, and foam formulations can be associated with significant cutaneous irritation and drying, which can lead to poor adherence.8,9 Traditional semisolid formulations can also leave a sticky and greasy feel on the skin, leading to poor patient adherence.10 To mitigate these issues, tretinoin 0.05% lotion (Altreno®, Ortho Dermatologics, Bridgewater, NJ) was formulated using a unique polymeric emulsion technology in an aesthetically pleasing vehicle.11 The lotion formulation incorporates a honeycomb matrix, allowing for efficient and uniform delivery of micronized tretinoin along with moisturizing/hydrating ingredients.11 The efficacy and tolerability of tretinoin 0.05% lotion were demonstrated in patients with moderate-to-severe acne, leading to its US approval in 2018 for the treatment of acne vulgaris in patients 9 years of age and older.12,13 Compared with studies of other tretinoin formulations, tretinoin 0.05% lotion has demonstrated lower rates of dryness, pain (ie, stinging, burning, or pain), erythema, and irritation11,12,14; however, lack of head-to-head trials makes direct comparisons difficult.