Prevention and Reduction of Atrophic Acne Scars with Adapalene 0.3%/Benzoyl Peroxide 2.5% Gel in Subjects with Moderate or Severe Facial Acne: Results of a 6-Month Randomized, Vehicle-Controlled Trial Using Intra-Individual Comparison

Abstract

BackgroundVery few clinical trials have investigated the effect of topical acne treatment on scarring.ObjectivesOur objective was to evaluate the efficacy of adapalene 0.3%/benzoyl peroxide 2.5% gel (A0.3/BPO2.5) in atrophic acne scar formation in patients with acne.MethodsIn this multicenter, randomized, investigator-blinded, vehicle-controlled study, subjects with moderate or severe facial acne (Investigator’s Global Assessment [IGA] score 3 or 4; ≥ 25 inflammatory lesions; ten or more atrophic acne scars) applied A0.3/BPO2.5 or vehicle daily per half face for 24 weeks. Subjects with acne requiring systemic treatment were excluded. Assessments included investigator atrophic acne scar count, Scar Global Assessment (SGA), acne lesion count, IGA, skin roughness and skin texture, subject self-assessment of clinical acne-related scars and satisfaction questionnaire, tolerability, and safety.ResultsIncluded subjects (n = 67) had mainly moderate acne (92.5% IGA 3); mean scores at baseline were approximately 40 acne lesions and 12 scars per half face. By week 24, the change from baseline in total scar count was − 15.5% for A0.3/BPO2.5 versus + 14.4% for vehicle (approximately 30% difference), with a mean of 9.5 scars versus 13.3 per half face, respectively (p < 0.0001). For SGA at week 24, a total of 32.9% with A0.3/BPO2.5 versus 16.4% with vehicle (p < 0.01) were clear/almost clear. Inflammatory acne lesions decreased by 86.7% for A0.3/BPO2.5 versus 57.9% for vehicle (p < 0.0001), and 64.2 versus 19.4% of subjects, respectively, were IGA clear/almost clear (p < 0.0001) at week 24. Treatment-related AEs were reported by 20.9% for A0.3/BPO2.5 versus 9% for vehicle side, most commonly skin irritation (14.9 vs. 6%, respectively).ConclusionsTopical A0.3/BPO2.5 prevented and reduced atrophic scar formation. Scar count increased with vehicle (+ 14.4%) but decreased with A0.3/BPO2.5 (− 15.5%) over 24 weeks.Trial registryClinicalTrials.gov identifier NCT02735421.

Selective RAR agonists for acne vulgaris: A narrative review

“…The combination treatment was superior to doxycycline and gel vehicle in reducing both inflammatory and noninflammatory lesions . Similar results were observed with combination treatment with oral lymecycline 300 mg daily with adapalene 0.1% gel . The chemical composition of adapalene is such that less than 0.01% of the total applied dose is absorbed systemically through the skin and is almost completely cleared from the plasma within 72 hours of application .…”

Modern Outlooks on Pathogenesis, Clinical Picture, Diagnosis and Management of Acne Vulgaris in Children and Adolescents

“…Наиболее эффективным подходом в профилактике развития рубцов после акне признано раннее назначение фиксированной комбинации топического ретиноида в сочетании с БПО [98]. Данный подход имеет доказательную базу, основанную на исследовании B. Dreno и соавт., в котором было определено, что назначение фиксированной комбинации адапалена и БПО пациентам со среднетяжелым или тяжелым течением ВА в режиме 1 раз в день на протяжении 6 мес является эффективным методом предотвращения образования рубцов [110]. Специалисты отметили уменьшение количества атрофических рубцов на 30% по сравнению с группой плацебо, а также улучшение общей выраженности рубцов при ВА [110].…”

“…Данный подход имеет доказательную базу, основанную на исследовании B. Dreno и соавт., в котором было определено, что назначение фиксированной комбинации адапалена и БПО пациентам со среднетяжелым или тяжелым течением ВА в режиме 1 раз в день на протяжении 6 мес является эффективным методом предотвращения образования рубцов [110]. Специалисты отметили уменьшение количества атрофических рубцов на 30% по сравнению с группой плацебо, а также улучшение общей выраженности рубцов при ВА [110]. Также фиксированная комбинация топического ретиноида с БПО занимает центральное значение в плане поддерживающей терапии ВА, особенно после отмены системных препаратов.…”

Acne Protection: Measures & Miseries

“…Acne scars result from an altered wound healing response to cutaneous inflammation, with inflammatory cell infiltrates found in nearly 80% of atrophic scars. Almost all scars (99%) originate from papules and pustules (inflammatory lesions) and postinflammatory lesions [175]. Different P. acnes phylotypes differentially activate epidermal innate immunity, contributing to variations in acne severity.…”