Which medications in the drug class Retinoid-like Agents are used in the treatment of Acne Keloidalis Nuchae (AKN)?

Updated: Nov 13, 2020
  • Author: Elizabeth K Satter, MD, MPH; Chief Editor: William D James, MD  more...
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Answer

Retinoid-like Agents

Although the exact mechanism of action for AKN is unknown, retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes, modulate keratinocyte differentiation, and have anti-inflammatory properties.

Isotretinoin (Claravis, Amnesteem, Sotret)

Isotretinoin is an oral retinoid indicated for recalcitrant, nodulocystic acne. It addresses all four pathogenic factors involved 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. The total dosage ranges from 120-150 mg/kg and is achieved over 4-6 months. Patients must be registered into the government-regulated iPledge program in order to receive the medication.

Tretinoin topical (Retin-A, Avita, Refissa, Renova, Tretin X, Atralin)

Although the exact mechanism of action of tretinoin is unknown, retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes, modulate keratinocyte differentiation, and have anti-inflammatory properties. Tretinoin topical is available as 0.025%, 0.05%, and 0.1% creams and 0.01% and 0.025% gels.

Adapalene (Differin)

Adapalene inhibits microcomedo formation. It normalizes keratinocyte differentiation in sebaceous follicles and it has anti-inflammatory properties. Adapalene is available as 0.1% gel, cream, and lotion and 0.3% gel..

Tazarotene (Tazorac)

Tazarotene inhibits microcomedo formation. It normalizes keratinocyte differentiation in sebaceous follicles and has anti-inflammatory properties. Tazarotene is available as 0.05% and 0.1 creams and gels.


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