Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Vulgaris?

Answer

Retinoid-like Agents

These agents stimulate cellular retinoid receptors and help normalize keratinocyte differentiation and are comedolytic. In addition, they have anti-inflammatory properties. Oral isotretinoin also reduces sebum production in the skin. Retinoids are classified into 3 generations. The first comprises topical tretinoin and systemic isotretinoin. Acitretin is a second-generation retinoid used to treat psoriasis. The third-generation retinoids include topical adapalene tazarotene.

Topical tretinoin (Retin-A Micro, Atralin, Avita, Tretin-X, Renova)

Topical tretinoin inhibits microcomedo formation. It decreases cohesiveness of keratinocytes in sebaceous follicles, which allows for easy removal. It has anti-inflammatory properties. Topical tretinoin is available as a cream or gel.

Adapalene (Differin)

Adapalene inhibits microcomedo formation. It decreases cohesiveness of keratinocytes in sebaceous follicles, which allows for easy removal. It has anti-inflammatory properties. Adapalene is available as a cream, lotion, or gel.

Tazarotene (Tazorac, Fabior, Avage)

Tazarotene inhibits microcomedo formation. It decreases cohesiveness of keratinocytes in sebaceous follicles, which allows for easy removal. It has anti-inflammatory and immunological properties. Tazarotene is available as a cream or gel.

Trifarotene (Aklief)

Trifarotene is an agonist of retinoic acid receptors (RARs), with particular activity at the gamma subtype of RAR. The stimulation of the RAR results in modulation of target genes that are associated with various processes, including cell differentiation and mediation of inflammation. The exact process by which trifarotene ameliorates acne is unknown. It is indicated for acne vulgaris for patients aged 9 years and older. Trifarotene is available as cream.

Isotretinoin (Claravis, Amnesteem, Absorica, Zenatane)

Isotretinoin is an oral retinoid indicated for recalcitrant, nodulocystic acne. It addresses all four pathogenic factors involved in the development of acne: follicular hyperkeratinization, inflammation, sebum production, and Cutibacterium acnes (formerly Propionibacterium acnes) growth. Treatment is weight-based, usually dosed initially 0.5 mg/kg and increased to 1 mg/kg in 2 divided doses for 15-20 weeks. Once-daily dosing is not recommended. The dose may be adjusted to administer up to 2 mg/kg/day. The patients must be registered into the government-regulated iPledge program in order to receive the medication.

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Media Gallery

Acne, grade I; multiple open comedones.
Acne, grade II; closed comedones.
Acne, grade III; papulopustules.
Acne, grade IV; multiple open comedones, closed comedones, and papulopustules, plus cysts.
Acne with reactive hyperpigmentation; before treatment.
Acne with reactive hyperpigmentation; after treatment.

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Author

Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry, Canada

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Dermatology Association, Canadian Medical Association, Canadian Medical Protective Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer Chen, MD Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Vulgaris?

Retinoid-like Agents

Topical tretinoin (Retin-A Micro, Atralin, Avita, Tretin-X, Renova)

Adapalene (Differin)

Tazarotene (Tazorac, Fabior, Avage)

Trifarotene (Aklief)

Isotretinoin (Claravis, Amnesteem, Absorica, Zenatane)

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Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Vulgaris?

Retinoid-like Agents

Topical tretinoin (Retin-A Micro, Atralin, Avita, Tretin-X, Renova)

Adapalene (Differin)

Tazarotene (Tazorac, Fabior, Avage)

Trifarotene (Aklief)

Isotretinoin (Claravis, Amnesteem, Absorica, Zenatane)

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