Topical retinoids are a mainstay for the treatment of acne vulgaris (acne), a prevalent skin condition that affects an estimated 40–50 million people in the United States.1,2However, tolerability issues associated with retinoids (eg, skin irritation or dryness) can make it difficult for patients to adhere to treatment.
Acne is a common dermatologic condition, affecting up to 85% of adolescents and young adults.1 The prevalence of adult acne appears to be increasing in both females and males; however, there are differences in treatment needs and physiology between the sexes that should be taken into account when prescribing acne treatments. While most patients experience onset during adolescence, persistent adult acne is more common in female patients.2,3 Additionally, females are more likely to experience recurrences of acne throughout their lives, requiring long-term maintenance treatment.3,4 In terms of skin physiology, males tend to have less epidermal water loss, higher sebum production, and a lower pH than females.5 In females, sebum production is not only lower, it also decreases with age leading to drier skin later in life.5 Along these lines, females are more likely to report dry, sensitive skin,4 which may become more apparent with age.6 These differences between female and male patients with acne could affect treatment efficacy, tolerability, or adherence.
Acne vulgaris is one of the most common dermatologic conditions for which all patients seek treatment, including those with darker skin tones.1 Given the growing non-white population, estimated to be nearly one-half of the United States population by 2050,2 more information is needed regarding the effects of acne treatment in all skin types. Recent articles highlighting the treatment of acne in Asian patients,3 Hispanic patients,4 and women of color5 have set the stage for understanding how race and ethnicity might affect treatment outcomes. In all skin types, acne development has the same causes: follicular hyperkeratinization, increased sebum production, proliferation of Cutibacterium acnes (formerly Propionibacterium acnes) bacteria on the skin surface, and inflammation.6,7 More highly pigmented skin can have properties that increase the risk of acne and inflammation-related sequalae.6 These sequelae occur in 50%-75% of black women with acne and include dyspigmentation and scarring.8,9Post-inflammatory hyperpigmentation (PIH) can be associated with acne resolution or irritation from harsh treatments or skin care.10-12
Acne is one of the most common skin diseases1,2 particularly in adolescence, affecting approximately 85% of adolescents and young adults.2 Additionally, acne is increasingly occurring earlier in life, with a younger age associated with greater symptom severity.3 Acne occurs in adolescence due to increases in androgen levels in puberty, which lead to increased sebum production and follicular occlusion, C. acnes bacterium proliferation, and release of proinflammatory factors in the skin.4-6 Recent research reveals that inflammation is a crucial feature of the disease process.7
Topical retinoids remain the mainstay of therapy for acne vulgaris.1 They are, however, associated with skin irritation during the initial weeks of application. Erythema, scaling, dryness, burning, and pruritis of varying severities can occur, depending on the retinoid, dose, and vehicle. These unwanted effects, along with unpleasantly greasy or sticky-feeling formulations,2 can potentially affect comfort and treatment adherence. More importantly, traditional semisolid formulations—such as creams, lotions, and ointments—may not provide an even dispersion of drug onto the skin.2
Although acne prevalence is comparable among adolescents of both genders,1 it is much more common in adult females than adult males.2,3 While there has been increased interest in adult female acne,4 acne in adult males has largely been ignored and data specifically looking at their management sparse. The mechanisms behind the development of acne lesions are multifactorial. Increased sebum production has been shown to play an important role,5,6 and it has been suggested that acne may be less common in adult males because of the declining rate of sebum secretion observed with increasing age.7 If acne pathogenesis in men is more dependent on sebum production, treatments that can reduce sebum such as retinoids may be beneficial.8-10
Topical tazarotene 0.1% gel, foam and cream have been shown to be highly effective for the treatment of acne vulgaris (acne), both as monotherapy and in combination with other agents. Several studies have shown tazarotene to markedly reduce both comedonal and inflammatory facial acne lesions.1-13
All topical retinoids can produce irritant contact dermatitis during the first few weeks of application; with many patients experiencing erythema, scaling, dryness, burning, and pruritus that can vary in severity, that appear to be compound, quantity applied and vehicle dependent, and can be sufficiently symptomatic to reduce adherence with treatment.
Topical retinoids (eg, tazarotene, tretinoin, adapalene) have played an important role in the management of acne vulgaris (acne). They reduce visible lesions and inhibit the development of microcomedones and new lesions.1-3 Retinoids normalize the abnormal desquamation process by reducing keratinocyte proliferation and promoting differentiation,4 as well as modulating several important inflammatory pathways.4-10Extensive clinical data have shown retinoids to be highly effective in acne, and they are recommended as the cornerstone of topical therapy.11 Comparative studies between tazarotene, tretinoin and adapalene have generally reported greater efficacy with tazarotene, but more irritation.12-20
