Topical retinoids in acne - An evidence-based overview

Journal der Deutschen Dermatologischen Gesellschaft (Impact Factor: 2.05). 12/2008; 6(12):1023-1031. DOI: 10.1111/j.1610-0387.2008.06741.x


Topical retinoids are important tools in the management of acne because they act against comedones and microcomedones and have direct anti-inflammatory effects. The substances approved for acne treatment comprise tretinoin (all-trans-retinoic acid),isotretinoin (13-cis retinoic acid) as well as the synthetic third-generation polyaromatic retinoids adapalene and tazarotene,the latter being approved for acne treatment in the US only.Retinaldehyde is used in cosmetic preparations against acne.
All topical retinoids are effective as single agents in mild to moderate acne but differ in efficacy and tolerability. Tazarotene 0.1% is more effective than tretinoin 0.025% or 0.1% microsphere gel or adapalene 0.1% gel or cream (EBM-level 2c). Adapalene 0.1% is equally effective to tretinoin 0.025% or tretinoin microsphere 0.1% gel or tretinoin 0.05% cream or isotretinoin 0.05% gel (EBM-level 2c). Adapalene 0.1% gel is significantly better tolerated than tazarotene 0.1% gel, tretinoin 0.025% and tretinoin 0.05% gel, tretinoin 0.05% cream,tretinoin microsphere 0.1% gel or isotretinoin 0.05% gel (EBM-level 2c).The safety profile of topical retinoids differs from their systemic counterparts and is related mainly to local adverse effects, such as erythema, dry-ness,itching and stinging.The currently available evidence justifies the use of topical retinoids in most types of acne and during maintenance treatment.

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    ABSTRACT: Note d'excellence 10%: « Le Jury, à l'unanimité, juge ce mémoire excellent et le classe parmi les 10% des mémoires de la discipline » - selon le Rapport définitif du jury d'éxamen d'un mémoire de maîtrise. RÉSUMÉ: Introduction : La Vitamine A (rétinol, ROL) et son métabolite l’acide rétinoïque (AR) sont essentielles pour l’embryogénèse. L’excès comme l’insuffisance d’AR sont nocives. L’AR est régularisé dans l’embryon par des gènes spécifiques (ALDH, CRABP, CYP). Hypothèse : Les grandes variations d’AR dans le plasma des adultes normaux, nous ont orienté à mesurer les rétinoïdes (ROL et RA) dans le sang de cordon ombilical, pour évaluer des corrélations avec des polymorphismes des gènes impliquées dans le métabolisme de l’AR et le développement rénal-(RALDH2, CRABP2, CYP26A1; B1). Vérifier pour des corrélations entre ces rétinoïdes et/ou avec la taille de reins à la naissance. Méthodes : Extraction du ROL et RA du sang de cordon ombilical de 145 enfants et analyse par HPLC. Le volume des reins a été mesuré par ultrasonographie et l’ADN génomique leucocytaire extrait (FlexiGene DNA-Kit). 10 échantillons d’ADN ont été exclus (qualité). Les htSNP : ALDH1A2, CRABP2, CYP26A1;B1 du génome humain (HapMap) ont été séquencés et génotypés (Sequenom iPlex PCR).Des testes bio-statistiques des fréquences génotypiques et alléliques ont été effectués (Single-Locus, χ2, Kruskal-Wallis, Allelic-Exact).Des corrélations (ROL, RA, SNPs, V-reins) ont été analysés (Kendall-tau /Oakes). Résultats : La Δ RA (0.07-550.27 nmol/l) non corrélé avec la Δ ROL (51.39-3892.70 nmol/l). Il n’y a pas d’association ROL ou RA avec les volumes des reins ou avec les SNPs/ CYP21A1;B1. Corrélations trouvées : 1. (p=0.035), polymorphisme génétique ALDH1A2-SNP (rs12591551:A/C) hétérozygote/CA, (25enfants, 19%) avec moyennes d’AR (62.21nmol/l). 2. (p=0.013), polymorphisme CRABP2-SNP (rs12724719:A/G) homozygote/AA (4 enfants, 3%) avec hautes valeurs moyennes d’AR (141,3 nmol/l). Discussion-Conclusion : Les grandes ΔRA suggèrent une variabilité génique individuelle du métabolisme de ROL. Les génotypes (CA)-ALDH1A2/ SNP (rs12591551:A/C) et (AA) -CRABP2/SNP (rs12724719:A/G) sont associés à des valeurs moyennes hautes d’AR, pouvant protéger l’embryogénèse lors d’une hypovitaminose A maternelle. Mots clé: sang de cordon ombilical, ROL-rétinol, AR-acide rétinoïque, HPLC, SNP- polymorphisme, ALDH1A2, CRABP2, CYP26A1,développement rénal,embryogénèse. ABSTRACT Introduction: Vitamin A (retinol, ROL) modulate the embryogenesis thorough RA, its metabolite. Excess or deficiency being pathologic, the RA is tight regulated in the embryo thorough specific genes (ALDH, CRABP, CYP, etc.) important for Vitamin A metabolism. Hypothesis: High RA variations in healthy adults plasma, oriented to ROL, RA evaluation in human cord blood, in regard of possible correlations with polymorphisms of genes involved in RA metabolism and kidney development (RALDH2, CRABP2, CYP26A1,B1). Correlations between ROL and RA and/or with birth kidney size might also occur. Methods: Cord blood ROL and RA were extracted and HPLC analysed, from 145 Montreal healthy newborns. Kidney volumes already measured by ultrasonography. Genomic leucocytary DNA extraction was performed with FlexiGene DNA-Kit. 10 samples excluded (DNA quality). htSNP choices: ALDH1A2, CRABP2, CYP26A1;B1 were made on HapMap human genome. Sequencing, genotyping (Sequenom iPlex PCR) was made for these genes eventual SNPs. Biostatistics tests for genotype and allelic frequencies (Single-Locus, χ2, Kruskal-Wallis, Allelic-Exact) and Kendall-tau /Oakes analysis for eventual ROL, RA, SNPs, V-reins correlations, were performed. Results: No correlation found between Δ RA (0.07-550.27 nmol/L) and Δ ROL (51.39-3892.70 nmol/L). No association ROL or RA with kidney volumes nor with SNPs/ CYP21A1;B1. Found correlations: 1. (p=0.035), polymorphism ALDH1A2-SNP (rs12591551:A/C) heterozygous/CA, (25babies, 19%) with RA (mean ~62.21nmol/L). 2. (p=0.013), polymorphism CRABP2-SNP (rs12724719: A/G) homozygous/AA (4babies, 3%) with RA (mean~141, 3 nmol/L). Discussion/Conclusion: Big Δ RA not correlated with Δ ROL suggests individual genetic variance on RA metabolism. Genotypes (CA)-ALDH1A2/SNP (rs12591551:A/C) and (AA)-CRABP2/SNP (rs12724719: A/G) are associated with high cord blood RA mean and may be embryogenesis protective in a maternal hypovitaminosis-A, environment. Key words: umbilical cord blood, ROL-retinol, AR-retinoic acid, HPLC, SNP- polymorphism, ALDH1A2, CRABP2, CYP26A1,kidney development,embryogenesis.
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    ABSTRACT: Tazarotene (Tazorac, Avage, Allergan, Inc., Irvine, CA, USA) is a synthetic retinoic acid receptor- betagamma topical retinoid approved for the treatment of plaque psoriasis and acne vulgaris. To review a decade of experience using tazarotene as a monotherapy or as combination therapy for approved and other indications: acne, psoriasis, photoaging, basal cell carcinomas and various keratinization disorders. We reviewed the published literature available on PubMed for safety and efficacy of topical tazarotene gel or cream preparations. Tazarotene, in both gel and cream formulations, has been used both as monotherapy and as an adjuvant therapy. For psoriasis it has been combined with steroids, calcipotriene and phototherapy, and for acne, with antibiotics. Tazarotene has been shown to upregulate the tumor suppressor, tazarotene induced gene 3, which is overexpressed in psoriasis and skin cancer. Adverse effects are limited to mild to moderate local irritation and erythema as seen with the 'retinization period' of other topical retinoid therapies. Daily application of tazarotene is effective with sustained benefits and limited local side effects.
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