Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Am J Clin Dermatol. 2019 Jun;20(3):345-365. doi: 10.1007/s40257-019-00423-z.
Topical retinoids are a first-line treatment for acne vulgaris.
This systematic review aims to evaluate the efficacy, safety, and tolerability of topical retinoids approved in the United States for the treatment of acne vulgaris.
A PubMed and Embase search was conducted using the search terms 'adapalene,' 'tretinoin,' 'tazarotene,' and 'acne vulgaris.' Selection of articles fit the following inclusion criteria: clinical trials evaluating both efficacy and safety/tolerability of topical retinoids approved in the United States for the treatment of acne vulgaris and published between January 1, 2008 and September 1, 2018. Exclusion criteria included clinical trials involving 20 subjects or fewer, subjects under 12 years of age, and topical retinoid combination therapies with moisturizers or aloe vera. Of 424 search results found, a total of 54 clinical trials were chosen based on selection criteria.
Topical retinoids are superior to vehicle in improving Investigator Global Assessment and Investigator's Static Global Assessment (24.1-28.8% and 13.3-17.3%, respectively; p < 0.001). A topical retinoid combined with benzoyl peroxide led to IGA improvement compared with vehicle (26.1-34.9% vs 7-11.8%; p < 0.001) at Week 12. Topical retinoid plus an oral antibiotic was superior to vehicle in reducing lesion counts (64-78.9% vs 41-56.8%, p < 0.001). There was no significant difference in efficacy between tretinoin and tazarotene. Tretinoin 0.05% resulted in 62% of patients experiencing AEs compared with adapalene 0.1% (19%) and adapalene 0.3% (40%). More patients receiving adapalene were tolerant of the AEs compared with tazarotene (55.4% vs 24.4%; p < 0.0012).
Topical retinoids are safe and efficacious for the treatment of acne vulgaris. They should be used in combination with benzoyl peroxide to optimize results in patients. The differences in efficacy of topical retinoids appears minor; therefore, the type of topical retinoid is not as important as choosing a particular strength of topical retinoid and combining it with an antimicrobial agent. Adapalene has a superior tolerability profile amongst topical retinoids.
局部维 A 酸是治疗寻常痤疮的一线药物。
本系统评价旨在评估在美国获批用于治疗寻常痤疮的局部维 A 酸的疗效、安全性和耐受性。
使用“阿达帕林”、“维 A 酸”、“他扎罗汀”和“寻常痤疮”等检索词在 PubMed 和 Embase 上进行检索。选择符合以下纳入标准的文章：评估在美国获批用于治疗寻常痤疮的局部维 A 酸的疗效和安全性/耐受性的临床试验，且发表于 2008 年 1 月 1 日至 2018 年 9 月 1 日之间。排除标准包括涉及 20 名或更少受试者、12 岁以下受试者以及含有保湿剂或芦荟的局部维 A 酸联合疗法的临床试验。在 424 项搜索结果中，根据选择标准共选择了 54 项临床试验。
与赋形剂相比，局部维 A 酸在改善研究者全球评估和研究者静态全球评估方面更优（分别为 24.1%-28.8%和 13.3%-17.3%；p<0.001）。在第 12 周时，与赋形剂相比，局部维 A 酸联合过氧化苯甲酰可改善 IGA（26.1%-34.9%比 7%-11.8%；p<0.001）。局部维 A 酸联合口服抗生素在减少皮损计数方面优于赋形剂（64%-78.9%比 41%-56.8%；p<0.001）。他扎罗汀与维 A 酸的疗效无显著差异。与 0.05%维 A 酸相比，0.1%阿达帕林导致 62%的患者发生不良反应，而 0.3%阿达帕林导致 40%的患者发生不良反应。与他扎罗汀相比，接受阿达帕林治疗的患者对不良反应的耐受性更高（55.4%比 24.4%；p<0.0012）。
局部维 A 酸治疗寻常痤疮安全有效。它们应与过氧化苯甲酰联合使用，以优化患者的疗效。局部维 A 酸的疗效差异似乎较小；因此，局部维 A 酸的类型不如选择特定强度的局部维 A 酸并将其与抗菌药物联合使用重要。阿达帕林在局部维 A 酸类药物中的耐受性更好。
