A new article published in Pediatrics stated that acne vulgaris is a common skin condition among adolescents, and the mainstays of acne treatment have remained largely unchanged over recent past. Here, the authors reported that isotretinoin has now become the drug of choice by dermatologists for moderate-to-severe acne. 

Owing to the ubiquitous nature of acne in teenagers, there remains a need for novel therapies—a multimodal approach with a combination of products is recommended. Topical and oral antibiotics should be avoided as a step in preventing bacterial resistance. Topical benzoyl peroxide is a broad-spectrum bactericidal agent to which bacterial resistance has not been reported, and may be used. Topical retinoids are vitamin A derivatives that modulate gene expression, and have been approved by the US Food and Drug Administration (FDA) for the treatment of acne vulgaris, including – adapalene, tretinoin and tazarotene. These are known to prevent come done formation by regulating keratinocyte proliferation and differentiation. Additionally, they have anti inflammatory properties. 

Topical retinoids are the preferred in the treatment and maintenance therapy for all acne as they reduce both, comedonal and inflammatory acne lesion counts. Furthermore, they help in preventing an reducing the appearance of atrophic scars and dyspigmentation. Due to common and limiting side effects of dryness, irritation, redness and peeling, retinoid-naive patients are typically started on low concentrations of topical adapalene or tretinoin and escalated stepwise to higher concentrations or to tazarotene as needed and tolerated.

Moreover, adapalene has demonstrated a favorable tolerability profile and therefore, could be the preferred treatment of retinoid-naive or sensitive eczema-prone skin. 

Source: Pediatrics. May 2020, 145 (Supplement 2) S225-S230; DOI:https://doi.org/10.1542/peds.2019-2056L