Acne vulgaris is the most common skin condition affecting late adolescents across the globe. According to the Global Burden of Disease study, it affects up to 85% of young adults between 12-25 years. It is often associated with anxiety, depression and unemployment and has a greater negative effect on emotions and social functioning than epilepsy and asthma.1,4

Acne vulgaris is a recurring condition involving multiple aetiological factors, including follicular hyperkeratinisation, increased sebum production, Propionibacterium acnes proliferation, and inflammation. Management can be complex, often requiring aggressive combination therapy and a long-term therapeutic strategy. Maintenance therapy is necessary for many patients because acne lesions have been shown to return after discontinuing a successful treatment regimen.2,3 The purpose of treatment is to reduce discomfort due to inflamed lesions, to improve the appearance, and to prevent scars.3

Treatment and management

An effective maintenance therapy should prevent acne recurrence by targeting the early stages of comedogenesis and the precursor of mature acne lesions, the microcomedo. At present, the most effective comedolytic agents are oral isotretinoin and topical retinoids. Oral isotretinoin is an impractical choice for long-term therapy owing to the potential for toxic and teratogenic effects. Topical antiacne medications, such as retinoids, could be associated with elevated skin irritation. Therefore, careful consideration must be given to the tolerability of a potential maintenance therapy because cutaneous adverse effects may decrease treatment adherence.2

The retinoid, adapalene is a naphthoic acid derivative with anti-inflammatory properties that is being used to treat acne. Studies have shown that it may decrease the severity of acne, swelling and inflammation and promote quick healing. 2,3

In a multicentre, investigator-blind, randomised, controlled study, a total of 467 subjects were randomised to receive doxycycline once daily in the morning and either adapalene or gel vehicle once daily in the evening for 12 weeks. Eligible subjects (253) completing the combination study were re-randomised consecutively in a 1:1 ratio to receive either adapalene plus doxycycline (126) or doxycycline plus gel vehicle (89) for an additional 16 weeks. The aim of the study was to show superior efficacy of maintenance therapy with adapalene gel relative to gel vehicle. Evaluations for this study occurred at baseline and at weeks 4, 8, 12, and 16. 219 subjects completed the study.2

Continued treatment with adapalene gel, 0.1%, resulted in significantly higher maintenance rates in total lesion counts (75% vs 54%; P<.001), inflammatory lesion counts (74% vs 57%; P = .003), and noninflammatory lesion counts (71% vs 55%; P = .007) compared with treatment with vehicle.2

“Overall, the results of this study demonstrate clinical benefit of continued adapalene use as a maintenance therapy for acne and underscore the importance of treatment adherence for the success of long-term maintenance therapy. After 16 weeks of treatment, adapalene provided statistically significantly superior results relative to gel vehicle for all efficacy assessments including total, inflammatory, and noninflammatory lesion counts as well as the maintenance rate and global severity. A statistically significant difference between adapalene and vehicle was first observed at 4 months. These results confirm those seen in a recent open-label adapalene maintenance study, the authors wrote.2

In summary, this study demonstrates the clinical benefit of continued treatment with adapalene gel, 0.1%, as a maintenance therapy following therapy with an oral antibiotic, the authors concluded.2

In other studies comparing the efficacy and tolerability of adapalene 0.1% gel with agents such as tretinoin 0.025% gel and isotretinoin 0.05% gel, adapalene was shown to be equally effective as tretinoin but adapalene had a faster onset and cause less irritation while adapalene was also associated with a bigger decrease in total and noninflammatory lesions.3  In a study comparing adapalene with isotretinoin, both lesion counts and global assessment showed a better degree of efficacy with adapalene than isotretinoin.3

Deriva® the first generic adapalene gel4

Deriva®, the first generic 0.1% adapalene gel is now available in South Africa. It has been shown to normalise follicular desquamation, to inhibit and reduce early lesions and mature comedone, to maintain remission and to reduce inflammation. It has been found to be the least irritating of the four retinoids which is especially important in South Africa’s drier regions.4

Deriva® gel is a convenient once-daily application and can be applied to the face, chest and back but should be avoided near the eyes, lips and mucous membranes.

Possible side effects include: Hypersensitivity, burning and stinging, itching and redness of skin and contact dermatitis.4

Topical use of Deriva® gel in patients with eczema is not recommended due to the severe irritation caused by this medicine on the eczematous skin while caution is advised in using the gel in patients with sunburnt skin due to the increased risk of extreme irritation of the skin.4

References

  1. Lynn DD, et al. The epidemiology of acne vulgaris in late adolescence. Adolescence Health, Medicine and Therapeutics. 2016; 7: 13–25. Published online 19 January 2016.
  2. Thiboutot DM, et al. Adapalene gel, 0.1%, as maintenance therapy for acne vulgaris: a randomized, controlled, investigator-blind follow-up of a recent combination study. Archives of Dermatology. May 2006;142(5):597-602.
  3. Piskin S, et al. A review of the use of adapalene for the treatment of acne vulgaris. Therapeutic Clinical Risk Management. August 2007; 3(4): 621–624.
  4. Deriva® Product Information