Keratolytic Treatments for Acne: A Review

By: Ali Alikhan, MD, Mayo Clinic; and Howard I Maibach, MD, University of California School of Medicine

Posted: September 29, 2010, from the October 2010 issue of Cosmetics & Toiletries.

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Tazarotene: Tazarotene, a topical acetylenic retinoid frequently used to treat both psoriasis and acne vulgaris, is hydrolyzed by keratinocyte esterases to tazarotenic acid, its active metabolite. Local side effects typically occur with tazarotene acne treatment, including itching, burning, irritation and erythema. Tazarotene is thought to be the most irritating of the topical retinoids. Half of consumers who use tazarotene for only 2–10 min daily have reported local skin irritation.⁹ Side effects are most common during the first two weeks of therapy; cream formulations, alternate-day applications and short contact therapy can curtail these side effects.

A randomized, double-blind, vehicle-controlled study demonstrated that 0.05% and 0.1% tazarotene gel significantly decreased total lesions and noninflammatory lesions during treatment with the vehicle alone at 12 weeks. Moreover, 0.1% gel was more efficacious than 0.05% gel, demonstrating a significant decrease in inflammatory acne at 12 weeks.¹⁰

A more recent randomized trial comparing 0.1% tazarotene cream to 0.1% adapalene cream demonstrated tazarotene to be more significantly and rapidly effective in reducing comedone count and producing global improvement with no significant difference in side effects at 12 weeks. Furthermore, even short contact application, i.e. less than 5 min, daily for 12 weeks produced a significant reduction in both inflammatory and non-inflammatory acne lesions.⁹

A multicenter trial found that the regimen of daily 5% BPO/ 1% clindamycin gel followed by 0.1% tazarotene cream was more effective than daily tazarotene monotherapy in reducing comedone count and inflammatory lesion count in patients with > 25 baseline inflammatory lesions, with a similar, if not slightly improved, side effect profile.¹¹

Adapalene: Adapalene has comedolytic, anti-proliferative and anti-inflammatory properties. Furthermore, adapalene may have a dose-dependent response, with 0.3% statistically superior to 0.1% in several different measures of efficacy.¹²