Overview of New Therapeutic Developments for Acne

Anja Thielitz; Harald Gollnick


April 13, 2009

In This Article

Maintenance Treatment With Topical Retinoids

The nature of acne as a 'chronic disease'[3] requires the definition of maintenance treatment regimens to preserve the initial treatment success and prevent frequent relapses. Retinoids are suitable for maintenance treatment due to their multifactorial anti-acne efficacy without inducing bacterial resistance during long-term treatment and their ability to prevent microcomedone formation. It has been shown that, after cessation of retinoid treatment, the number of microcomedones increases again,[11] which might explain the occurrence of frequent relapses when treatment is withdrawn following successful initial therapy.

The fact that many subjects experience an acne history of several years underlines the necessity for a safe and effective maintenance therapy regimen, which is supported by several studies demonstrating the efficacy of a topical retinoid for this strategy for at least a short-term maintenance phase of 3 months. In a 12-week maintenance study involving 241 patients, adapalene 0.1% was significantly better than no therapy in maintaining remission after initial combination therapy with topical clindamycin 1% or clindamycin monotherapy.[39] Furthermore, the maintenance effect of adapalene 0.1% gel relative to its vehicle was demonstrated in 253 subjects previously treated successfully with a combination of adapalene and doxycycline 100 mg/day during the initial 12-week combination treatment phase[40] and in another multicenter, investigator-blinded, randomized, controlled study involving 136 patients after an initial 12-week adapalene/lymecycline 300 mg combination therapy.[41] In patients with mild-to-moderate acne, the application of adapalene 0.1% gel monotherapy daily or every other day was also recently shown to significantly control microcomedone formation during a 12-week maintenance treatment after a previous combination therapy with BPO.[42] In a study investigating the maintenance effect of tazarotene 0.1% gel, 110 patients were randomized to receive either tazarotene monotherapy, minocycline monotherapy or a combination of both after a 12-week combination treatment phase of minocycline 100 mg and tazarotene 0.1% gel. Tazarotene was shown to be equally effective as the combination therapy during maintenance, although there was a trend for a greater efficacy with the combination treatment.[43] These results provide evidence for the necessity, efficacy, mode of action and safety of topical retinoid monotherapy to maintain therapeutic success in the treatment of acne as a chronic disease.


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