Examining the available evidence of topical retinoid use in acne vulgaris: does initial exacerbation of acne commonly precede improvement and is it necessary to induce irritation in order to achieve clinical benefit?

Abstract

A common perception related to the use of topical retinoid therapy is that initial exacerbation of acne commonly precedes clinical improvement. Market research and informal surveys completed by the author suggest that many dermatologists limit the use of topical retinoids when initiating acne therapy due to concern regarding initial exacerbation. A second observation, likely related to previous availability and usage of formulations associated with a high incidence of irritation, is that clinically results are optimized only if irritation is induced by topical retinoid therapy. The availability of several studies evaluating the use of the topical retinoids (ie, tretinoin, adapalene, and tazarotene) formulated in a variety of vehicles, allows for a critical assessment of response patterns, including those occurring early in the course of treatment. Assessments do not appear to support the contention that initial exacerbation of acne is a common finding after initiation of topical retinoid therapy. Efficacy data coupled with the development of less irritating formulations suggests that irritation is not a prerequisite. This poster focuses on (1) efficacy-response patterns over time after initiation of topical retinoid therapy, and (2) correlations of levels of irritation with clinical efficacy.