Topical retinoids: role and place in acne therapy

Retinoids are derivatives of vitamin A that have a pleiotropic (multiple) effect on cell differentiation, proliferation, and apoptosis. Topical retinoids alone or in combination with other agents have been used in the topical treatment of acne for more than half a century. The biological effects of retinoids are mediated and regulated by cytosolic binding proteins and nuclear receptors of retinoic acid and retinoid X-receptor. At the same time, the expression of cellular proteins changes, which affects numerous pathways involved in the pathogenesis of acne — a chronic inflammatory disease of the sebaceous hair follicle. Retinoids have evolved from first-generation drugs such as tretinoin and isotretinoin through chemical modifications, which led to the creation of second-generation (etretinate and acitretin for the treatment of psoriasis), third-generation (adapalene and tazarotene) and recently fourth-generation (tripharotene) products.Topical retinoids are central to the treatment of patients with acne, being the first-line treatment for mostly comedonal acne, and in combination with antimicrobial agents — for mostly mild to moderate papulopustular acne. The advantages of adapalene 0.1 % gel and its combination with an antimicrobial agent (clindamycin 1 %) in topical treatment, the importance of modern technologies for the delivery of active substances in retinoids are presented. Adapalene and fixed combinations of anti-acne agents have gained leading role not only in initial (induction) but also in maintenance treatment due to rapid onset and long duration of action, favorable safety/tolerability profile. Attention was paid to the effectiveness and good tolerability of the drugs Deriva (adapalen 0.1 % gel), Deriva C (adapalen 0.1 % and clindamycin phosphate 1 %), Deriva C MS (adapalen micronized 0.1 % in microspheres and clindamycin phosphate 1 %), available today for the treatment of acne. Quick action and better tolerability of Deriva C MS gel improves patient adherence to therapy.