Topical Adapalene Research Articles

English

A fixed dose combination gel with adapalene 0.1% and benzoyl peroxide 2.5% has been developed for the once daily treatment of acne vulgaris .This fixed combination was approved by U.S FDA in December 2008. This study was done in the Department of Dermatology, KIMS, Bangalore to assess the efficacy and adverse effects of topical adapalene 0.1%-benzoyl peroxide 2.5% combination gel as compared to topical adapalene 0.1% gel and 2.5% benzoyl peroxide gel (monotherapies) in the treatment of facial acne vulgaris. To the best of our knowledge, this is one of the few studies conducted in India. It was an open label study. Participants received either adapalene 0.1% gel, benzoyl peroxide 2.5% gel or adapalene 0.1% - benzoyl peroxide 2.5% combination gel for 12 weeks. Follow up was done at the end of 1,2,4,8 and 12 weeks. Evaluation included lesion count and adverse events. Participants included males and females aged between 18-38 years with grade 2 or 3 facial acne vulgaris as per investigators global assessment of acne scale. A total of 62 participants were recruited out of which 23 were males and 39 were females.88.71% participants completed the study. The study revealed that combination of adapalene 0.1% and benzoyl peroxide 2.5% gel was more effective in the treatment of facial acne as compared to adapalene 0.1% gel and benzoyl peroxide 2.5% gel (topical) monotherapies. The safety of combination of adapalene 0.1% and benzoyl peroxide 2.5% gel was comparable with adapalene 0.1% gel and benzoyl peroxide 2.5% gel monotherapies.

Improvement in atrophic acne scars by topical adapalene (0.3% gel)

Improvement in atrophic acne scars by topical adapalene (0.3% gel)

Treatment of capecitabine-induced hand-foot syndrome using a topical retinoid: A case report

Capecitabine is a chemotherapeutic drug used in patients with breast, colon and gastric cancer. Hand-foot syndrome (HFS) is a type of dermatitis that frequently occurs as a reaction to capecitabine. To date, no effective strategies have been found to prevent or reverse HFS. Furthermore, chemotherapy induces an elevation in the expression of heparin-binding epidermal growth factor-like growth factor (HB-EGF), and this activation represents a critical mechanism for the induction of chemotherapeutic resistance. Adapalene is a third-generation synthetic retinoid. Topical retinoids are important therapeutic anti-aging agents for managing photodamaged skin, and are known to increase HB-EGF levels, which is important for skin wound healing. Accordingly, the current report focused on the topical retinoids that increase HB-EGF expression in the skin, and we hypothesized that these topical retinoids induce local chemotherapeutic resistance in the skin of patients receiving chemotherapy and consequently, decrease the cutaneous side-effects of chemotherapy. This report presents a case of the successful treatment of refractory HFS induced by capecitabine using the topical application of adapalene. Topical adapalene was applied for 3 months and significantly reduced inflammation and pain following chemotherapy. Topical retinoids may have the potential to effectively treat capecitabine-induced HFS by increasing HB-EGF expression and decreasing cutaneous side-effects. Further studies are required to establish the therapeutic efficacy of topical retinoids on HFS.

Comparative side-effects of adapalene and benzoyl peroxide combination gel with Adapalene monotherapy and Benzoylperoxide monotherapy in the treatment of Acne vulgaris

A controlled clinical trial was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to compare the side-effects of adapalene and benzoyl peroxide combination gel with adapalene monotherapy and benzoyl peroxide monotherapy in the treatment of acne vulgaris. The study conducted in sixty patients. Group A (case) 20 patients were treated with adapalene and benzoyl peroxide combination gel, group B (control) 20 patients were treated with topical adapalene and group C (control) 20 patients were treated with topical benzoyl peroxide. The side effects experienced by patients of different groups in their first follow up were noticed. In group A - erythema, scaling, dryness, burning and pruritus were present in 45%, 10%, 35%, 40% and 10% of patients and in group B, 35%, 25%, 30%, 35% and 15% respectively. However in group C dryness and pruritus were absent in all the patients and the erythema, scaling and burning were 30%, 25% and 25% respectively. In 5th follow-up visit, in group A- erythema, scaling, dryness and pruritus were present in 15%, 5%, 15%, and 5% of patients respectively and burning was absent in group A. In group B erythema, scaling, dryness, and pruritus were 15%, 5%, 5% and 5% and burning was absent in group B. However in group C scaling, burning, dryness and pruritus were absent in all the patients. Erythema was present in 10% cases in 5th follow-up visit. It was evidenced in the present study that the overall adverse effect is slightly higher with the adapalene- benzoyl peroxide combination therapy in relation to the adapalene and benzoyl peroxide (BPO) monotherapies in the treatment of acne vulgaris. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16699 Community Based Medical Journal 2013 July: Vol.02 No 02: 52-56

1597P - Prophylactic Topical Adapalene and Oral Minocycline for Panitumumab-Induced Skin Toxicity

ABSTRACT Background Panitumumab (Pmab) has been associated with a high incidence of skin toxicity. The STEPP study evaluated whether prophylactic treatment with a topical steroid and oral doxycycline during the first 6 weeks of Pmab-containing therapy reduced incidence of grade 2 or higher skin toxicities compared to reactive treatment. Prophylactic treatment resulted in skin toxicity incidence of 29% compared with 62% in the reactive treatment arm. Purpose The aim of this study was to evaluate the efficacy of combination prophylactic therapy with topical adapalene and oral minocycline in patients receiving Pmab. Methods Patients with KRAS wild-type unresectable/recurrent colorectal cancer enrolled in a prospective phase II clinical trial of third-line Pmab plus irinotecan (CPT-11) or Pmab monotherapy were included. Prophylactic therapy with topical adapalene, a third-generation topical retinoid used in the treatment of mild-to-moderate acne, and oral minocycline were started from one day prior to the first Pmab dose and continued for 6 weeks. Adapalene was administered once daily in the evening, along with oral minocycline 100 mg twice per day. Skin toxicity was evaluated according to NCI CTCAE, version 4. The primary endpoint was incidence of grade 2 or higher skin toxicities during the 6-week skin treatment period. Results Between January 2011 and December 2011, 48 patients were included in this study (27 men, 21 women; median age, 62.0 years; 43 CPT-11 + Pmab, 5 Pmab alone). During the 6 weeks of prophylactic therapy, incidence of skin toxicities (rash, dry skin, and paronychia) was 83.3%. The incidence of skin toxicities of grade 2 or higher was 29.2%, similar to STEPP trial results (29%). The median adherence to topical adapalene was 90% (range, 0-100%), while minocycline was 100% (range, 17-100%). In the good adapalene adherence group (≥median), the incidence of skin toxicity of grade 2 or higher was 20.8% compared to 37.5% in the poor adherence group ( Conclusion The incidence of skin toxicities during the 6 weeks of prophylactic therapy was similar to the STEPP trial. These results suggest that adapalene may be an effective prophylactic treatment option for management of Pmab-related skin toxicity. Disclosure All authors have declared no conflicts of interest.

Multicenter randomized controlled trial on combination therapy with 0.1% adapalene gel and oral antibiotics for acne vulgaris: Comparison of the efficacy of adapalene gel alone and in combination with oral faropenem

We conducted a randomized controlled trial in patients with acne vulgaris with moderate to severe inflammatory lesions. The patients were assigned to the following three treatment groups: group A received monotherapy with 0.1% topical adapalene gel for 4 weeks; group B received combination therapy with 0.1% topical adapalene gel and 600 mg oral faropenem for 2 weeks followed by 0.1% topical adapalene gel alone for 2 weeks; and group C received combination therapy with 0.1% topical adapalene gel and 600 mg oral faropenem for 4 weeks. The result of the analysis indicated that the percentage reduction in inflammatory lesion counts after 2 weeks of treatment was significantly higher in groups B and C than in group A (P < 0.05). After 4 weeks of treatment, group C showed significantly higher percentage reduction in inflammatory lesion counts than in groups A and B (P < 0.05), whereas no significant difference was noted between the latter two groups. Adverse reactions included dryness and irritation at the adapalene application sites that were observed in 10.1% of cases (16/158 patients) and diarrhea and loose stool because of oral faropenem that were observed in 7.5% of cases (8/106 patients). Taken together, our results suggest that combination therapy with oral antibiotics and adapalene results in earlier improvement in patients with moderate to severe inflammatory acne compared to the application of adapalene alone, and that 4 weeks of the combination therapy is preferable to 2 weeks of treatment.

Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel

Adapalene 0.1%/benzoyl peroxide 2.5% gel (Epiduo™, Tactuo™) is the only fixed-dose combination product available that combines a topical retinoid with benzoyl peroxide; it targets three of the four main pathophysiologic factors in acne. This article reviews the therapeutic efficacy and tolerability of topical adapalene 0.1%/benzoyl peroxide 2.5% gel in the treatment of patients aged ≥ 12 years with acne vulgaris, as well as summarizing its pharmacologic properties. In three 12-week trials in patients aged ≥ 12 years with moderate acne, success rates were significantly higher with adapalene 0.1%/benzoyl peroxide 2.5% gel than with adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone, and combination therapy had an earlier onset of action. In addition, significantly greater reductions in total, inflammatory, and noninflammatory lesion counts were seen in patients receiving adapalene 0.1%/benzoyl peroxide 2.5% gel than in those receiving adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone. Adapalene 0.1%/benzoyl peroxide 2.5% gel did not significantly differ from clindamycin 1%/benzoyl peroxide 5% gel in terms of the reduction in the inflammatory, noninflammatory, or total lesion counts in patients with mild to moderate acne, according to the results of a 12-week trial. Twelve-week studies showed that topical adapalene 0.1%/benzoyl peroxide 2.5% gel in combination with oral lymecycline was more effective than oral lymecycline alone in patients with moderate to severe acne, and topical adapalene 0.1%/benzoyl peroxide 2.5% gel in combination with oral doxycycline hyclate was more effective than oral doxycycline hyclate alone in patients with severe acne. In patients with severe acne who responded to 12 weeks' therapy with topical adapalene 0.1%/benzoyl peroxide 2.5% gel plus oral doxycycline hyclate or oral doxycycline hyclate alone, an additional 6 months' therapy with adapalene 0.1%/benzoyl peroxide 2.5% gel was more effective than vehicle gel at maintaining response, with further improvement seen in adapalene 0.1%/benzoyl peroxide 2.5% gel recipients. A noncomparative study also demonstrated the efficacy of 12 months' therapy with adapalene 0.1%/benzoyl peroxide 2.5% gel in patients with acne vulgaris. Topical adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in patients with acne. In 12-week trials, the most commonly occurring treatment-related adverse events included erythema, scaling, dryness, and stinging/burning; these dermatologic treatment-related adverse events were usually of mild to moderate severity, occurred early in the course of treatment, and resolved without residual effects. Topical adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in the longer term, with dry skin being the most commonly occurring treatment-related adverse event over 12 months of treatment. In conclusion, adapalene 0.1%/benzoyl peroxide 2.5% gel is a valuable agent for the first-line treatment of acne vulgaris.

What’s new in acne? An analysis of systematic reviews published in 2009–2010

This review highlights clinically important findings about acne treatment identified in nine systematic reviews published or indexed in the period March 2009 to February 2010. A systematic review of dietary influences on acne suggested that a possible role of dietary factors in acne cannot be dismissed, as the studies to date have not been sufficiently large or robust. Another review looked at benzoyl peroxide, which may be enjoying a comeback because of increasing bacterial resistance to antibiotics, and suggested that there was a lack of evidence that stronger preparations were more effective than weaker ones. The same team also carried out a systematic review addressing the question of whether topical retinoids cause an initial worsening of acne. They found no evidence to suggest initial worsening of acne severity, although there was evidence of skin irritation that typically settled by 8-12 weeks. A review of oral isotretinoin and psychiatric side-effects reinforced a possible link between the two, although it pointed out that the better-quality primary studies were still inconclusive. An updated Cochrane Review confirmed the efficacy of combined oral contraceptives (COCs) in reducing acne lesion counts. It also found that the evidence to support COCs containing cyproterone acetate over others was very limited. Another Cochrane Review failed to show any benefit of spironolactone for acne, based on limited studies. Three reviews examined laser and light therapies, and found some evidence of superiority only for blue or blue/red light treatment over placebo light, but a general absence of comparisons against other acne treatments. Photodynamic therapy had consistent benefits over placebo but was associated with significant side-effects and was not shown to be better than topical adapalene.

Successful Treatment of Darier’s Disease with Adapalene Gel

We report a 12-year-old Japanese boy with a 3-year history of skin lesions that had been unsuccessfully treated with topical steroids. We initiated two different topical treatments with adapalene gel 0.1% (Differin(®) Gel 0.1%) and high-concentration vitamin D3 (tacalcitol) ointment; the lesions treated with adapalene gel improved dramatically in the first 2 months, whereas the high-concentration vitamin D3 ointment resulted in little improvement. Topical adapalene gel 0.1% may be a promising choice as a topical treatment of Darier's disease because of its high efficiency and lack of adverse effects.

Effect of sequential application of topical adapalene and clindamycin phosphate in the treatment of Japanese patients with acne vulgaris

The efficacy of combined therapy with a retinoid and antibiotic for Japanese patients with acne vulgaris remains to be established. Further, maintenance strategies limiting the use of topical retinoids must be identified. The objectives of this study are to determine the efficacy of sequential application of topical adapalene and clindamycin phosphate and to assess the impact of this regimen on patients' quality of life. Sixty-six patients were recruited. The regimen comprised two phases. For the 4-week initial treatment, 1% clindamycin phosphate gel was applied twice daily and 0.1% adapalene gel, once. In the 4-week maintenance phase, patients were randomly assigned to the OD group (adapalene applied once daily) or the TW group (adapalene applied once daily on 2 days per week). The acne severity score, lesion counts, microcomedone count, and sebum amount were measured. Quality of life (QOL) was assessed using Skindex-16. All parameters improved significantly by week 4 of initial treatment. No statistically significant differences were found in the improvement of clinical findings between the groups. All QOL scores improved significantly and did not significantly differ between the groups. Our regimen may enable clinical control of acne in Japanese patients and improve their QOL. For limiting retinoid use, weekly application of adapalene during maintenance is suitable.

Plantar warts treated with topical adapalene

Background:Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful.Purpose:The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts.Materials and Methods:A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts.Findings:Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene.Conclusion:Adapalene clears the plantar warts faster compared to other modalities available.Limitation:Need trial with large number of patients.

Spotlight on adapalene

Background: In the field of dermatology, topical retinoids represent a mainstay in acne treatment. Adapalene is a naphthoic acid derivative showing some pharmacological activities similar to the regular retinoids. The drug is used singly or in combination for treating acne and a few other miscellaneous skin disorders. Objective: To critically review the pharmacokinetic, pharmacologic aspects and clinical benefits and adverse effects associated with topical adapalene. Method: A systematic literature review was conducted primarily based on PubMed citations. Results/conclusions: Adapalene shares some biological activities in common with retinoic acid. However, it exhibits distinct physicochemical and binding properties for selective retinoic acid receptors. In acne, adapalene is expected to reduce comedogenesis, expel mature comedones and exert some anti-inflammatory effects. The drug is effective as monotherapy in mild comedonal acne and in combination with benzoyl peroxide for mild-to-moderate inflammatory acne. The safety profile of adapalene is good. Indeed, only discrete to moderate adverse events including erytheme, xerosis, itching and stinging may develop during the early treatment phase. Clinical experience has established that adapalene represents a valuable addition to the other current treatments for acne.

Successful treatment of linear Darier's disease with topical adapalene

Successful treatment of linear Darier's disease with topical adapalene

Clinical and Microbiological Comparisons of Isotretinoin vs. Tetracycline in Acne Vulgaris

The aim of this study was to compare the clinical and microbiological effect on Propionibacterium acnes of oral tetracycline plus topical adapalene vs. oral isotretinoin in moderate to severe acne vulgaris. Male and female acne patients with moderate or severe inflammatory disease were enrolled and assigned randomly to 6 months of treatment with oral tetracycline hydrochloride plus topical adapalene, or oral isotretinoin, in a controlled, open study. After cessation of oral treatment the antibiotic-treated group received topical adapalene for the 2-month follow-up period. Clinical and microbiological assessments were performed. Skin samples for microbial identification and quantification were taken at baseline, after 2, 4 and 6 months of treatment, and 2 months after cessation of treatment. Patients treated with isotretinoin showed prolonged significant remission compared with the other group. The density of resistant propionibacteria did not change significantly in any of the groups and there was no correlation between resistant P. acnes and the clinical response in any of the regions investigated. Antibiotic treatment was found to be a good alternative to isotretinoin, regardless of the presence of antibiotic-resistant P. acnes, although isotretinoin had a better effect, with prolonged remission after treatment.

Comparative evaluation of effectiveness of adapalene and azithromycin, alone or in combination, in acne vulgaris

<b>Introduction:</b> Acne vulgaris, a disorder of the pilosebaceous structure, is a common disorder in adolescents and young adults that is associated with significant morbidity. <b> Aim:</b> The aim of this study was to compare the effects of the drugs adapalene and azithromycin, given separately and in combination in acne vulgaris. <b> Methodology:</b> A total of 61 newly attending cases of inflammatory acne vulgaris were considered the study. They were randomly allocated into three groups. Group 1 received topical adapalene (0.01%) gel, group 2 received oral azithromycin, whereas group 3 was given a combination of these two. The patients were treated for a period of 12 weeks, being reviewed every fortnightly. The results obtained were analyzed in detail using statistical methods. <b> Results:</b> The combination of adapalene and azithromycin caused the highest reduction in the inflamed lesion count followed by azithromycin given singly. Further, monotherapy with adapalene was used. However, this difference in efficacy was small and not statistically significant (<i> P</i> = 0.717). Azithromycin lead to a rapid reduction in the inflammatory lesion count, but it had negligible action on noninflamed lesions. <b> Conclusion:</b> At the end of 12 weeks of treatment, the three treatment groups showed no statistically significant difference in the efficacy in inflammatory acne.

Acneiform eruptions associated with epidermal growth factor receptor–targeted chemotherapy

A relatively newer class of chemotherapy agents, known as the epidermal growth factor receptor inhibitors (EGF-RIs), is being used to treat advanced stages of solid tumors. Acneiform eruptions are a frequent adverse effect and one which has been associated with increased survival in some studies. We describe 3 patients who presented shortly after initiation of EGF-RI therapy. Characteristics included an absence of comedones, facial and truncal involvement, and a perifollicular lymphoneutrophilic infiltrate detected on biopsy. Lesion counts were reduced with topical adapalene and oral tetracyclines in two patients. Patient 3 had dramatic clearance with low-dose isotretinoin (20 mg daily) until completion of EGF-RI therapy. Acneiform eruptions are a common adverse reaction to EGF-RI therapy and can be treated with traditional acne therapy. This should not be considered a drug hypersensitivity eruption or allergy, and patients should continue therapy. For patients with severe eruptions, oral isotretinoin is a consideration.

Combined strategies and adjuvant therapies

The success of therapy for acne vulgaris depends on control of seborrhea, keratinization, bacterial flora and inflammation of the pilosebaceous units. In order to control these factors, with minimum risks of side effects, combined therapeutic strategies become beneficial. These include: topical retinoids and superficial peelings in comedonian acne; adapalene and benzoil peroxide or oral limecycline in inflammatory acne grade II; oral isotretinoin and topical adapalene in acne grade III; isotretinoin, prednisone and azathioprine in conglobate acne and acne fulminans. The main therapeutic indications for acne vulgaris are discussed here.

Topical retinoids in acne therapy

The author discusses the use of topical retinoids, including tretinoin, isotretinoin, adapalene and tazarotene. Besides historical and pharmacologic aspects, the efficacy, advantages and disadvantages of the various topical retinoids, their application, and how to advise patients suffering from acne vulgaris to obtain the best results, are discussed. Tolerance to isotretinoin, adapalene and tazarotene is better than to tretinoin and, although tazarotene is as effective as adapalene, the latter is better tolerated.

Comparison of Two Different Dosing Regimens with Lymecycline, in Association with Adapalene, in Inflammatory Acne

Combined treatment with oral lymecycline and topical adapalene has been shown to induce greater and faster improvement of acne than monotherapy with lymecycline. We wanted to evaluate the effects of combined therapy with topical adapalene (cream or gel) plus oral lymecycline used at different dosages (group A: 300mg/day for 2 weeks and then 150mg/day for 14 weeks; group B: 300mg/day for 16 weeks) in 242 patients with inflammatory acne. Both dosage regimens were well tolerated in the majority of patients and significantly improved both the acne lesion count and seborrhoea. There was a trend towards a greater reduction of seborrhoea and nodules in patients of group B. After the initial 16-week phase, patients entered an 8-week follow-up phase, consisting of the use of adapalene monotherapy. The results obtained after this phase confirm the therapeutic value and the favourable tolerability of adapalene as maintenance treatment after successful treatment of inflammatory acne. At the same time, a significantly reduced count of comedones was observed in patients of group B as compared with group A, suggesting that prolonged use of high-dose lymecycline may have a more pronounced influence on comedogenesis.

Adapalene vs. metronidazole gel for the treatment of rosacea

Rosacea is a common, chronic dermatosis that requires long-term therapy. Oral isotretinoin and topical and/or oral antibiotics are effective, but their usage may be limited due to side-effects. The goal of the study was to compare the efficacy of topical adapalene gel (0.1%) and topical metronidazole gel (0.75%) in the treatment of patients with papulopustular rosacea. This study included 55 patients with papulopustular rosacea. Diagnostic efforts were focused on clinical and histological features. Patients were randomly assigned to the adapalene (n = 30) and metronidazole (n = 25) groups. Sunlight protection factor 20 cream was used to protect all patients from sunlight. The characteristics and numbers of inflammatory papules, pustules, erythema and telangiectasia were scored at baseline and after 2, 4, 8 and 12 weeks. Side-effects were recorded at each visit. Fifty patients, 27 in the adapalene group and 25 in the metronidzaole group, completed the study. Significant reductions in the total number of inflammatory lesions were found in the adapalene group compared with the metronidazole group. There was no significant difference in the scores of erythema and telangiectasia in the adapalene group. However, a significant reduction in erythema was seen in the metronidazole group. Adapalene gel is well tolerated and can be used as an alternative for topical treatment of papulopustular rosacea.