A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuously improves efficacy among patients with severe acne vulgaris: results of a randomized controlled trial.

BACKGROUND: Acne vulgaris is a chronic and frequently recurring disease. A fixed-dose adapalene-benzoyl peroxide (adapalene-BPO) gel is an efficacious and safe acne treatment. OBJECTIVES: To assess the long-term effect of adapalene-BPO on relapse prevention among patients with severe acne after successful initial treatments. METHODS: This is a multicentre, double-blind, randomized and controlled study. In total, 243 subjects who had severe acne vulgaris and at least 50% global improvement after a previous 12-week treatment were randomized into the present study to receive adapalene-BPO gel or its vehicle once daily for 24 weeks. RESULTS: At week 24, compared with vehicle, adapalene-BPO resulted in significantly higher lesion maintenance success rate (defined as having at least 50% improvement in lesion counts achieved in initial treatment) for all types of lesions (total lesions: 78·9% vs. 45·8%; inflammatory lesions: 78·0% vs. 48·3%; noninflammatory lesions: 78·0% vs. 43·3%; all P < 0·001). Significantly more subjects with adapalene-BPO than with vehicle had the same or better Investigator's Global Assessment score at week 24 than at baseline (70·7% vs. 34·2%; P < 0·001). The time when 25% of subjects relapsed was 175 days with adapalene-BPO and 56 days with vehicle (17 weeks earlier; P < 0·0001). Adapalene-BPO led to further decrease of lesion counts during the study and 45·7% of subjects were 'clear' or 'almost clear' at week 24. It was also safe and well tolerated in the study. CONCLUSIONS: Adapalene-BPO not only prevents the occurrence of relapse among patients with severe acne, but also continues to reduce disease symptoms during 6 months.

A review of systemic retinoid therapy for acne and related conditions.

Oral isotretinoin, since its introduction more than 20 years ago, has been and still is the "gold standard" in the treatment of acne and its variants. This is the only approach to acne with the possibility of a permanent "cure" or long term remission. The role of isotretinoin has evolved with higher dosage schedules and use earlier in the course of the disease. The frequency of laboratory monitoring has diminished along with associated costs based on 2 decades of experience. Pregnancy-associated safeguards have become a more prominent facet of oral retinoid therapy leading to increased safety for its use in females of child-bearing potential.

Systemic antibiotic therapy for acne: a review.

Acne is a multifactorial disease of the pilosebaceous unit in the skin. Four contributing pathogenic factors need to be elucidated and include excess sebum production, follicular hyperkeratinization, colonization of the pilosebaceous unit by Propionibacterium acnes, which is a gram positive anaerobic diphtheroid, and the release of inflammatory mediators into the follicle and dermis. One or more of these factors are targeted by each of the systemic therapies for this disease and its variant, including systemic antibiotic therapies, which will be reviewed here.