Tazarotene Gel an Option for Post-Acne Scarring

By Marilynn Larkin

November 27, 2018

NEW YORK (Reuters Health) - Home treatment with tazarotene gel was as effective as microneedling in improving acne scar severity, in a small trial in India.

"Post-acne scarring (results) in long-lasting physical disfigurement and low self-esteem in affected individuals," Dr. Tarun Narang of the Postgraduate Institute of Medical Education and Research in Chandigarh told Reuters Health.

Methods such as microneedling, chemical peeling, cryorolling and ablative lasers address post-acne atrophic scarring, he said by email. "However, these procedures are physician-dependent. A home-based treatment...with comparable efficacy to the procedural treatment modalities will be beneficial to patients."

Dr. Narang and colleagues conducted an observer-blinded randomized trial with 34 patients with grade 2 to 4 facial atrophic post-acne scars and no history of procedural treatment of acne scars within the previous year (mean age, 23; 36% men). Median duration of acne was six years.

For each participant, half of the face was randomly treated with microneedling and the other half with topical tazarotene. Microneedling was conducted with a dermaroller with a needle length of 1.5 mm for four sessions over three months. Participants were instructed to apply topical tazarotene gel, 0.1%, to the other side of the face once every night during the same period.

Improvements in acne scar severity were assessed at three and six months based on Goodman and Baron quantitative and qualitative scores and a subjective independent dermatologist score. Patient satisfaction was assessed using a global assessment score at the same follow-up visits.

As reported online November 15 in JAMA Facial Plastic Surgery, significant and comparable improvements were seen for both treatments at six months. The median quantitative score for acne scar severity for tazarotene decreased from a baseline of 8.0 to 5.0, and for microneedling, from 7.0 to 4.5.

By contrast, median qualitative acne scar scores were the same for both treatment groups at baseline and did not change significantly following either treatment.

Notably, only previous isotretinoin exposure was correlated with improvement in acne scarring as perceived by participants. Those previously exposed to isotretinoin were more satisfied with the individual treatment modality even though no difference was observed for the quantitative or qualitative score.

No serious complications were reported for either treatment method throughout the study period. All patients had procedural pain and erythema following microneedling. Erythema lasted for more than 24 hours in seven participants (19.4%), and two had postinflammatory hyperpigmentation on the microneedling side.

Tazarotene caused dryness in 13 patients (36.1%) and scaling in eight (22.2%). No adverse effects were substantial enough to discontinue the medication.

Dr. Narang said, "The findings suggest commencing acne scar procedures during or soon after oral retinoid therapy for active acne. This is especially important since oral retinoid therapy was believed to be a contraindication to procedural therapy until recently."

"The comparable efficacy we observed with this topical home-based modality to that of office-based microneedling may reduce treatment expenses for people with atrophic post-acne scars," he concluded.

Dr. David Spurlin, a dermatologist at Beaumont Health in Birmingham, Michigan, commented by email, "I agree with the premise of what appears to be a well-controlled study: tazarotene gel can be effective at this concentration in treating post-acne scarring."

"This product has been around for quite some time, so there aren't any strong concerns regarding its usage," he told Reuters Health. "When used over a long period of time, tazarotene gel is also known to help ease wrinkles and fine lines, as well as improving general skin tone."

However, like Dr. Narang, he noted that "it can initially cause significant irritation in some people, such as inflammation and dryness, as well as producing a little bit of acne. Typically, these side effects subside, but not always. Some people cannot tolerate this medication at any percentage."

"I think any of the retinoic acids, like tretinoin, would be a similarly effective treatment," he said. "It stands to reason that tretinoin as well as adapalene would get similar results, although I'm not aware of any study that that looks at their effectiveness versus microneedling. Each of these (modalities) works by activating the same receptors."

"I'm not aware of any non-retinoic acids as effective in treating post-acne scarring," he added.

SOURCE: http://bit.ly/2OXuEri

JAMA Facial Plast Surg 2018.

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