Optimal topical retinoid use for acne

Retinoids are the preferred initial and maintenance therapy for most acne patients, except those planning a pregnancy or with a strong history of skin sensitivity to topical irritants, according to Michael Kolodney, M.D., Ph.D., dermatology chief, West Virginia University School of Medicine, Morgantown, W.V. 

“Most patients can tolerate once daily dosing. However, patients experiencing irritation, can use alternate day dosing for the first two weeks before transitioning to daily dosing,” he said.

Dr. Kolodney’s go-to retinoids for acne treatment are tretinoin, adapalene and tazarotene.

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Adapalene stands out for several reasons, according to the dermatologist. It’s inexpensively available over-the-counter; it may be slightly less irritating than other retinoids; it’s stable in combination with benzoyl peroxide; and it’s more photostable than tretinoin.

Tazarotene, however, may be slightly more effective than other retinoids, according to Dr. Kolodney.

Whether it’s best to use gels or creams depends on the retinoid’s preparation.

“I use adapalene in gel formulation and tretinoin and tazarotene in cream formulations,” he says.

When using retinoids for acne, patient education to manage expectations is key.

“I warn patients they may appear to get worse in the first two weeks and not to expect much improvement for about one to two months. I emphasize the use of sunscreen in an emollient base and to use only a mild non-detergent cleanser,” Dr. Kolodney says. 

REFERENCE

Coman GC, Holliday AC, Mazloom SE, et al. "A randomized,split-face, controlled, double-blind, single-centre clinical study: transient addition of a topical corticosteroid to a topical retinoid in patients with acne to reduce initial irritation," British Journal of Dermatology. August 2017. DOI:10.1111/bjd.15150.