The central role of
inflammation in
acne is now more clearly understood.
Adapalene, a third-generation topical
retinoid, down-regulates
toll-like receptor 2 expression and inhibits
activator protein-1 activity. In a fixed-dose combination,
adapalene and
benzoyl peroxide (BPO) act synergistically on inflammatory patterns through regulation of innate immunity. In addition to reducing inflammatory and non-inflammatory lesions,
adapalene/BPO helps prevent lesion and microcomedone formation. The combination of a topical
retinoid and
antimicrobial agent remains the preferred approach for almost all patients with
acne. In cases of more severe disease, there is a clinical benefit in combining
adapalene/BPO with an oral
antibiotic for 12 weeks. Most recently,
adapalene/BPO plus
doxycycline 200 mg was found to be highly effective when compared with
isotretinoin in the treatment of patients with severe
acne with nodules. Long-term maintenance
therapy is needed for most patients.
Retinoids are the preferred agents, with BPO added in patients with more severe disease if needed.
Adapalene is anticomedogenic, reduces comedones and has anti-inflammatory properties, while BPO is a unique
antimicrobial agent not shown to induce microbial resistance after more than 50 years of use. Maintenance
therapy for 6 months with
adapalene/BPO prevents relapse among patients with severe
acne and continues to reduce disease symptoms.