The Effectiveness of Retinoids in the Treatment of Acne

Acne is a widespread skin condition. According to an estimation, it is the eighth most prevalent skin condition, affecting 9.4% of people worldwide (Tan, 2015). According to the British Academy of Dermatology, it is also considered the most prevalent skin condition in British men. While acne might not be considered a serious medical issue, it is known to pose a £3 million burden in terms of healthcare costs. (Pena, 2016). These numbers depict the need for paying proper attention to acne treatments and not treat it as a minor complaint.

If we look at the available treatment options for dealing with acne, a combination of topical retinoids and antimicrobial therapy is widely used by dermatologists. Topical retinoids are known to play a vital role in treating acne. This fact is backed by the British Academy of Dermatology and the European Dermatology Forum (Nast, 2012; Zaenglein, 2016).

Before we get into the details of retinoids and how they can help with acne problems, let us first take a brief look at common signs and symptoms of acne.

Acne: An Overview

Acne is caused by clogged pores. Pores can be blocked by pollutants or excess sebum produced from the skin's sebaceous glands. Dead skin cells can also clog skin pores and cause acne. Genetics can also be a culprit for the acne-prone skin.

Acne commonly has the following symptoms:

• Blackheads
• Whiteheads
• Small red bumps (papules)
• Small pus-filled bumps (pustules)
• Nodules
• Cysts
• Excess oil

Acne is classified into mild, moderate, and severe depending on its type, location, scarring or non-scarring, and how much acne is present. This information is vital as the course of your treatment will depend on these factors.

Role of Retinoids in Acne Management

Your acne can result from different mechanisms, including (Thiboutot, 2009; Gollnick, 2016; Plewig, 2000):

• Obstruction of the pilosebaceous canal resulting from abnormal desquamation within the sebaceous follicles
• Excess production of sebum resulting from abnormal androgen or sex hormones production
• Abnormal activity of the immune system and excessive inflammation
• Presence of proinflammatory stimuli

Topical retinoids play an excellent role in resolving comedones and new lesions and reducing visible lesions (Thielitz, 2008; Thielitz, 2001). Retinoids remove the dead skin cells and make room for the new skin cells. They also contain anti-inflammatory properties and are known to block several inflammatory pathways.

Tropical retinoids include tretinoin, tazarotene, and adapalene. These retinoids come in different strengths and are prescribed according to the severity of the condition.

Tretinoin

Tretinoin has been used for decades for treating acne and was the first retinoid treatment approved by the FDA for acne vulgaris. Tretinoin is available in the form of cream and gel and can only be bought with a doctor's prescription. Many studies have proven the efficacy of tretinoin. However, it could take months to see significant improvements. Tretinoin is available in different strengths. If needed, you should start with a low-strength cream or gel and then move to a stronger formulation.

Another important fact that you need to know about tretinoin and other retinoids is that you might notice an acne flare-up on starting the treatment before your condition gets better. This is known as tretinoin purge and can happen in the first week of tretinoin usage. The good news is that it is only temporary and can be managed by using sunscreen and other skincare products.

Tretinoin can also increase your sensitivity to sunlight. As topical tretinoin can degrade in direct sunlight, it is advised to use it at bedtime. It is recommended that you use sunscreen during the day while on tretinoin treatment.

Adapalene

Adapalene is another FDA-approved drug to treat skin conditions. It is a third-generation retinoid available as a prescription or over-the-counter medication (lower strength).

Adapalene effectively prevents and treats acne vulgaris and acts by clearing micrcomedones, reducing inflammation, and exfoliating mature comedones. Adapalene has an advantage over tretinoin as it has a more stable chemical structure, which makes it okay to use it with other acne medications. Adapalene also carries the risk of a few side effects, especially during the first week of usage. The most common side effects include skin sensitivity, itchiness, redness, and dryness (Tolaymat, 2022).

Tazarotene

Tazarotene is a prescription medication for adults and children 12 years and older. It is beneficial in treating pitted scars and acne scars. Tazarotene is also a third-generation retinoid.

Treatment of acne scars by tazarotene 0.1% cream and micro-needling has shown similar efficacy (Afra, 2019).

Tretinoin Vs. Tazarotene Vs. Adapalene for Treating Acne

Numerous studies have been conducted to establish the efficacy of topical retinoids. Let us see how different retinoids have been proven effective in treating acne in the light of scientific research.

According to a 12-week study, 0.1% tretinoin cream significantly reduced acne. Tretinoin helped resolve acne by removing 50% of micrcomedones within six weeks. This percentage increased to 80% by 12 weeks (Lavker, 1992).

Adapalene gel 0.1% and 0.3% has been shown to resolve both the total and the inflammatory lesion count. The 0.3% Adapalene gel strength showed superior results compared to 0.1% gel. The results were especially noticeable in people with higher lesions count at the start of the treatment (Thiboutot, 2006).

Both adapalene and tretinoin can produce dramatic improvements in acne vulgaris. In a Chinese study, adapalene and tretinoin showed impressive results and resolved an average of 69 to 74% of lesions. In 70% of participants, both adapalene and tretinoin caused 100% skin clearing. While the results were similar for both treatments, adapalene produced less irritation than tretinoin (Tu, 2001).

Another study compared the efficacy of adapalene 0.1% and tretinoin 0.025% cream in treating mild to moderate acne. Both creams showed similar efficacy in treating acne while applied daily at night. Adapalene produced rapid results in the first four weeks of the research, but the results were similar for both creams at the end of 8 weeks (Diba, 2020).

A 2000 study compared the efficacy of tazarotene gel 0.1% with the tretinoin 0.025% gel and adapalene 0.1% gel in treating acne vulgaris. Tazarotene showed better outcomes compared to tretinoin when used once daily. Tazarotene was more effective and rapid in treating papules, open comedones, and pustules. On the other hand, the comparison of tazarotene and adapalene showed similar outcomes, where adapalene was used daily, and tazarotene was used on alternative days. Both drugs resolved the inflammatory and non-inflammatory lesions with the same efficacy. The same study showed that the tolerance of all three retinoids was also comparable (Kakita, 2000).

According to a randomized controlled trial, treating acne scars with tretinoin 0.05% gel has shown quicker improvements in resolving acne than adapalene 0.1% gel. Adapalene caused more skin irritation compared to tretinoin (Jain, 2014).

How to Use Retinoids for Acne Treatment?

Following are a few standard guidelines for using topical retinoids:

• Retinoids are known to cause skin thinning. This, in turn, can make your skin sensitive to sunlight exposure. It is recommended that you use sunscreen when you are using a retinoid. This will help you protect against the harmful effects of UV rays.
• Retinoids are not only effective for treating acne and acne scars, but they are also helpful in preventing acne breakouts. Using them on areas not affected by acne is okay, but you should avoid using them around the corners of your lips and close to your eyes. The skin around these areas is thinner, and applying retinoids can cause irritation.
• As dryness is one of the side effects of retinoids, using moisturizer is a good option.
• One important thing you should know before starting any retinoid product is that it will take some time to see results. Topical retinoids can take up to 3 months to take effect.
• Retinoids are mainly used once daily or on alternative days. Wait 20 to 30 minutes after cleaning your face before applying the retinoid product. However, as there are many variations in retinoid formulations and concentrations, it is recommended that you visit a dermatologist before getting started on any of these products.

Conclusion

Tretinoin, tazarotene, and adapalene are different types of retinoids and act through slightly different mechanisms to treat acne. All three of these drugs have shown to be beneficial for people struggling with acne problems. Some side effects are associated with these topical drugs, like irritation and dry skin.

The “purge” period for these drugs is also similar as they all exhibit worsening symptoms during the first week of treatment before showing any improvements.

To effectively combat your acne problem, your best option is to visit your dermatologist to get advice on what type of treatment you should choose for your acne. They can also prescribe a combination therapy to get the best results and prevent significant side effects.