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If you suffer from acne, with or without acne scarring, you should read more. This video is based upon the latest research over the past two years.

Adapalene 0.3% Gel Shows Efficacy for the Treatment of Atrophic Acne Scars. Journal Dermatol Ther. March 2018 Authors Loss M.J, Leung S, Chien A et al.

Synopsis: Dermatologists know the value of retinoids as part of a skincare routine. Retinoids including retinol, and retinoic acid are one of the most researched molecules in dermatology. Retinoids can treat acne, wrinkles, sundamage & skinpigmentation.

Acne & retinoids: Retinoids are the most powerful molecules in the fight against acne. The mechanism of action includes reduction of inflammation, decrease in sebum (oil), & normalization of cell turnover. Retinoids also kill acne forming bacteria. Recent studies published in 2018 and 2019 have shown promising clinical data in the context of acne scar reduction.

What’s the big deal? The main focus of acne scarring over the past three decades are heavily skewed towards energy devices such as laserresurfacing, microneedling, RF microneedling as well as chemicalpeels and surgical methods such as subcision. These modalities are invaluable in the fight against acne scars. Very little work has been done on topical modalities (creams/gels) to prevent and treat acne scars. This paper, along with other recent publications highlights the role of retinoids in established atrophic acne scars including box car scars, pick, enlarged pits, ice-pick scars and to a limited degree rolling acne scars. Hypertrophic scars were excluded from these studies.

Study: Application of Adapelene gel 0.3%to atrophic acne scars. Once a day application for the first 4 weeks, increasing to twice a day for another 20 weeks. Phase II single-center, open-label, pilot study. Grade 3/4 scars rated by the Goodman - Baron scale.

Conclusion: Adapelene gel 0.3% showed a reduction of atrophic acne scars and an improvement in skin texture. This was noted both objectively and subjectively. Therapy had minimal side effects, and patients had an improved quality of life Under the microscope researchers found an increase in type 1 & type 2 Collagen.

How could this paper change clinical practice? As a procedural dermatologist, I spend
a considerable amount of time revising acne scars. The proposition of a topical modality that can improve new and old acne scars is promising. Physicians should consider prescribing topical retinoids as adjunctive treatment for atrophic acne scars.

Points to consider: This study was performed on 0.3% adapelene gel. 2 additional studies used both adapelene and benzoyl peroxide. Results of these studies confirmed improvements in atrophic acne scars. Differin 0.1% is available as an over the counter gel in the United States. These studies were funded by Galderma, however the analysis of the end points and method of studies can not be overlooked. Perhaps further studies on third generation retinoids such as Tazoretene may show similar, if not better results. Combing topical retinoids to activate all RAR - retinoid receptors would be a sensible step. Obviously the rate limiting factor would be skin irritation- retinoid dermatitis.

The best portal for acne and acne scar patients is acne.org, based in the United States. This site first started as a forum for acne and acne scar patients to chat about their condition. The site now has a 'shop' with clinically proven acne treatments, based upon the scientific literature. Given the fact that adapelene is freely available in the United States, perhaps acne.org should stock this simple, cost effective topical gel/cream?

More videos on Instagram with easy to read snippets on acne scar revision. IGTV has more detailed podcasts and videos on this topic.

Dr Davin S. Lim
@cliniccutis, 2019
Brisbane, Australia.
#acnescars #acnescarring #acnescarrevision #acne #pimples #laserresurfacing

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