Early Treatment With Topical Retinoids Helps Prevent Acne Scarring

Acne scars on the back
Scars pitting the skin on the back in an adult male patient caused by acne vulgaris. Acne vulgaris begins in adolescence and the pustules that caused this scarring were due to overactivity of the sebaceous glands in the skin.
Researchers discuss emerging evidence supporting the role of topical retinoids, such as adapalene 0.3%/benzoyl peroxide 2.5%, in treatment of acne, acne scars, and prevention of scarring.

Early and effective acne treatment with topical retinoid preparations leads to reduction in the development of new acne scars, according to an article published in the Journal of Drugs in Dermatology.

This article discussed emerging evidence for topical retinoids along with an antimicrobial, especially benzoyl peroxide, as the front line of acne therapy, as opposed to traditional treatments for acne scars like fillers, dermabrasion, microneedling, and fractional ablative and non-ablative laser resurfacing, which do not completely resolve acne scars. In addition to treating acne, retinoids treat microcomedones, and when used along with an antimicrobial, target 3 out of 4 pathogenic factors in acne: desquamation, inflammations, and P acnes. Retinoid efficacy increases with increasing dose.

Study researchers cited that the transcription factor activator protein-1 pathway plays an important role in acne lesions and scarring, and topical retinoids inhibit this pathway. The researchers also discussed the results of a study that analyzed the effect of adapalene 0.3% in the treatment of atrophic acne scars. In this study, participants aged 18 to 50 years with a history of acne and moderate-to-severe facial atrophic acne scars with no active acne were treated with adapalene 0.3% gel every day for 4 weeks and then twice daily for a subsequent 20 weeks. At week 24, 50% of participants had improvement in skin texture, and more than 80% of participants had improvements in atrophic scars.

A split-face, randomized, investigator-blinded study also found that adapalene 0.1%/benzoyl peroxide 2.5% was able to prevent formation of new scars. Another study that evaluated adapalene 0.3%/benzoyl peroxide 2.5% in comparison with vehicle in participants with moderate or severe facial acne observed a mean increase of 2 acne scars with vehicle but a mean decrease of 2 acne scars on the adapalene 0.3%/benzoyl peroxide 2.5% side, proving the drug to be superior to the vehicle.

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Early treatment with retinoids may prevent early scars from becoming permanent by improving the remodeling process. However, further study is needed to understand the benefit of the addition of benzoyl peroxide. Also, topical retinoids may cause erythema, dryness, itching, and burning sensation during the first 1-4 weeks. Therefore, there needs to be education about skin care, avoiding irritating products, use of moisturizing products, and adherence to wash techniques.

Disclosure: Editorial services for the publication of this study were provided by Galderma Laboratories, LP. All authors have served as consultants for Galderma.

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Tan J, Tanghetti E, Baldwin H, Stein Gold L, Lain E. The role of topical retinoids in prevention and treatment of atrophic acne scarring: understanding the importance of early effective treatment. J Drugs Dermatol. 2019;18(3):255-260.