Acne vulgaris is a widespread chronic inflammatory skin condition affecting a significant portion of the population, with nearly 50 million individuals affected in the USA alone. This condition frequently leads to the development of acne sequelae, including atrophic acne scars, acne-induced macular erythema, and acne-induced hyperpigmentation (AIH), all of which can substantially reduce a patient’s quality of life.
Topical retinoids are considered essential for improving treatment outcomes due to their established efficacy, safety, and tolerability. This review focuses on topical retinoids, especially trifarotene cream 0.005%, for managing acne and its sequelae, emphasizing its efficacy and safety profile demonstrated in recent clinical trials.
Recommendations and Supporting Evidence
•First-Line Therapy: Topical retinoids are recommended as first-line therapy for acne and acne sequelae unless contraindicated or not well-tolerated.
•Efficacy of Retinoids: Adapalene, tretinoin, tazarotene, and trifarotene have demonstrated efficacy in treating acne.
•Trifarotene Studies: The START study showed a greater reduction in total atrophic acne scar count with trifarotene compared to the vehicle group5…. Trifarotene also modulates gene expression, downregulating genes upregulated in acne lesions7. The LEAP study demonstrated a significant reduction in total post-acne hyperpigmentation index (PAHPI) score with trifarotene.
•Early Intervention: Early use of topical retinoids can reduce the onset of atrophic acne scars and AIH.
•Photoprotection: Comprehensive skincare regimens should include adequate photoprotection, especially for patients with darker Fitzpatrick phototypes.
•Maintenance Therapy: Trifarotene can be used as a first-line and maintenance treatment option for acne and acne sequelae. Patient education improves compliance and adherence to treatment regimens.
Topical Retinoids in Treatment
•Foundation of Acne Therapy: Retinoids are considered the foundation of acne therapy, targeting multiple aspects of acne pathophysiology.
•Multiple Benefits: They normalize desquamation, block inflammatory pathways, reduce visible lesions, and inhibit microcomedone development. Topical retinoids can improve atrophic acne scarring by stimulating collagen synthesis.
•Reduced Need for Other Therapies: Early retinoid use can reduce the need for other therapies like antibiotics.
Current US-Based Guidelines
•AAD Emphasis: The American Academy of Dermatology (AAD) emphasizes retinoids as the cornerstone of acne treatment.
•Research Gaps: Acne sequelae, AIH, atrophic acne scarring, and patient diversity are acknowledged as research gaps in current guidelines.
•PACE Project: The 2020 Personalising Acne Consensus Project (PACE) provided expert recommendations for long-term management of acne sequelae.
This review underscores the critical role of topical retinoids, especially trifarotene, in managing acne and its sequelae. Trifarotene’s novelty lies in its demonstrated efficacy in Phase 4 studies for treating atrophic acne scarring across all Fitzpatrick skin types, along with its favorable safety and tolerability.
Further research, including biomarker and transcriptomic analyses, is warranted to optimize retinoid use and personalize treatment strategies. Improving the classification of skin type will likely enhance the quality of data from clinical trials. By addressing the gaps in current guidelines and improving patient education, retinoids like trifarotene can significantly improve outcomes for patients with acne and acne sequelae.
Link to the study: https://link.springer.com/article/10.1007/s13555-025-01344-y
