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Non-erythematous lesions
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Small blackheads on the nose in elderly patients are very common. They are due to the failure of shedding of vellus hairs in the hair follicles of the nose. If the patient complains about the problem and wants treatment, adapalene (Differin) cream or gel applied at night for 6–8 weeks will give a fairly dramatic improvement. It can be kept clear by using it twice a week.
Adapalene
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Adapalene is a member of the retinoid drug class that is typically found in topical formulations used for the treatment of acne. It is a modulator of cellular differentiation, keratinization, and inflammatory processes, all of which represent important features in the pathology of acne vulgaris. Adapalene may also be used off-label to treat keratosis pilaris and certain other skin conditions (1).
Mechanism of Action of Topical Retinoids
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Sümeyre Seda Ertekin, Mehmet Salih Gurel
Adapalene is a chemically stable, photostable, and highly lipophilic synthetic retinoid which has a selective affinity for retinoid receptors RAR-β and RAR-γ. Although it does not bind to CRABPs, it has been shown to induce expression of CRABP-II. Its FDA-approved indication is acne. Due to its lipophilic properties, it is selectively uptaken by the follicular unit, and that may contribute to its success in anti-acne activity. It normalizes the differentiation and keratinization of follicular epithelial cells, thus leading to a comedolytic effect. In addition, in contrast to other classical retinoids, adapalene is a naphthoic acid derivate which has an NSAID-like structure and increased anti-inflammatory effect. It decreases leukotriene and prostaglandin production through inhibition of lipoxygenase activity and arachidonic acid metabolism (25). Adapalene can modulate the epidermal immune system by increasing CD1d expression and decreasing IL-10 expression by keratinocytes. Decreasing expression of toll-like receptor-2 (TLR-2) by keratinocytes can help to explain the anti-inflammatory activity of adapalene observed in clinical practice (26). These mechanisms may explain the reason for decreased risk of irritation with adapalene. Systemic absorption of adapalene is negligible. Only trace amounts have been found in the plasma of acne patients following chronic topical application of adapalene.
Emerging drugs for the treatment of acne: a review of phase 2 & 3 trials
Published in Expert Opinion on Emerging Drugs, 2022
Siddharth Bhatt, Rohit Kothari, Durga Madhab Tripathy, Sunmeet Sandhu, Mahsa Babaei, Mohamad Goldust
Topical usage of retinoids achieves an effective concentration in the skin and precludes from getting systemic adverse effects. Topical retinoids while targeting the epidermal proliferation, reduces the earliest precursor lesions of acne viz comedone. Thereby, making it the first-line therapy in the management of acne vulgaris currently. Retinoids, especially tretinoin being photolabile should ideally be applied during the night. Adapalene and tazarotene in this respect have the added advantage of being photostable and can be applied during the day. It has additional anti-inflammatory properties due to the inhibition of the lipo-oxygenase pathway and chemotaxis, along with free oxygen radical release from neutrophils. Adapalene at 0.3% has also been shown to reduce scar formation and pigmentation due to acne lesions. Erythema, scaling, pruritus, burning, stinging, dryness and irritation are common side effects. It can rarely lead to allergic contact dermatitis.
An overview of adapalene and benzoyl peroxide once-daily topical gel as a therapeutic option for acne
Published in Expert Opinion on Pharmacotherapy, 2021
Veronica K. Emmerich, Caitlin G. Purvis, Steven R. Feldman
Adapalene acts upon three of the four main pathogenic factors in acne: Adapalene inhibits sebum production and leads to sebaceous gland atrophy [11,26].Adapalene normalizes keratinocyte differentiation, which loosens comedones and prevents obstruction of the follicular canal [11].Adapalene decreases the expression of toll-like receptor 2 (TLR2) and activator protein-1 (AP-1) [4]. Toll-like receptors are part of the innate immune system, and TLR2 recognizes C. acnes and is responsible for propagating an inflammatory response to the bacteria [4]. AP-1 induces the synthesis of matrix metalloproteinases, which break down collagen and contribute to scarring [11].
Adverse events related to topical drug treatments for acne vulgaris
Published in Expert Opinion on Drug Safety, 2020
Agnieszka Otlewska, Wojciech Baran, Aleksandra Batycka-Baran
Adapalene is synthetic, third-generation topical retinoid derived from naphthoic acid [30]. The available topical formulations of adapalene are 0.1% gel, cream, solution, and 0.3% gel [28]. Adapalene can be used in monotherapy or in combination therapies [30]. An important aspect in the treatment of acne with adapalene is that it can be safely used for acne in children who have not reached adolescence [26]. However, the safety and efficacy of this medicine in children under the age of 12 years have not been determined [12]. Topical adapalene is usually administered once-nightly to acne-prone skin. When applying it is recommended to put a thin film of the product on the skin and avoid eyes and mucous membranes contact with the drug [12]. Most common adverse effects are related to local side effects, including erythema, scaling, dryness, pruritus, and burning, but usually the intensity of the symptoms is mild [30]. The intensity of skin irritation related to topical treatment with adapalene increases in intensity to a maximum at week 2 of treatment and regularly decreases to week 12 [31].