Benzoyl Peroxide, Adapalene, and Their Combination in the Treatment of Acne Vulgaris

Abstract

Benzoyl peroxide and adapalene are among the most effective topical agents used in the treatment of acne. We planned an open-labeled, prospective study to compare the effects and side effects of these two drugs alone and in combination in the treatment of acne vulgaris. One hundred and five consecutive patients (30 men and 75 women) with acne vulgaris were included in this study. The patients were randomly divided into three groups with 35 patients in each. The groups were randomly assigned to 0.1% adapalene gel, 5% benzoyl peroxide lotion, or combination of 0.1% adapalene gel +5% benzoyl peroxide treatment. Acne lesions were classified as noninflammatory (open and closed comedones) and inflammatory (papule, pustule, nodule, cyst), and the lesions on the face were counted before the therapy, during the control visits, and after the treatment. Erythema, dryness, burning, and other side effects were recorded during the treatment. The mean age of the patients was 18.44 +/- 3.75 years. Eight patients were excluded because of noncompliance with the treatment regimen or the follow-up schedule, and four patients were excluded due to allergic contact dermatitis. The study revealed that all three therapy protocols were effective in treating noninflammatory and inflammatory lesions in acne vulgaris (p<0.05) and that there was no significant difference between the groups in efficacy or side effects (p>0.05). Adapalene and benzoyl peroxide are effective and well tolerated agents for acne vulgaris; combination therapy has no superiority over adapalene or benzoyl peroxide alone.

‘Keratolytic’ Properties of Benzoyl Peroxide and Retinoic Acid Resemble Salicylic Acid in Man

“…It has been shown by some that such a combination is not more effi cacious than either agent alone [24] , whereas others have shown addition of BP to RA therapy may be more effective than RA alone [25] . We presume that if present, the latter effect is likely due at least in part to the increased deep barrier disruption provided by BP, although this hypothesis requires further study.…”

Keratolytic Treatment

“…A study comparing 0.1 % adapalene gel, 5 % BPO, and a 0.1 % adapalene/5 % BPO combination demonstrated no signifi cant difference between the groups in effi cacy or side effects (erythema, dryness, or burning) [ 48 ]. Additionally, all three treatments were signifi cantly effective in reducing infl ammatory and non-infl ammatory acne lesions [ 48 ].…”

“…Additionally, all three treatments were signifi cantly effective in reducing infl ammatory and non-infl ammatory acne lesions [ 48 ]. Adapalene reduced non-infl ammatory lesion counts by 68.75 %, infl ammatory lesion counts by 55.45 %, and total lesion counts by 65.48 % [ 48 ]. A more recent study testing a 0.1 % adapalene/2.5 % BPO combination gel against vehicle and individual monotherapies demonstrated combination therapy to have faster onset of action, signifi cantly greater reductions in all lesion types, and no increase in adverse effects compared to monotherapy [ 26 ].…”

“…Additionally, all three treatments were signifi cantly effective in reducing infl ammatory and non-infl ammatory acne lesions [ 48 ]. Adapalene reduced non-infl ammatory lesion counts by 68.75 %, infl ammatory lesion counts by 55.45 %, and total lesion counts by 65.48 % [ 48 ].…”

Current and future treatment options for acne

“…The combination of adapalene gel with clindamycin appeared to be an effective initiation therapy, with adapalene as monotherapy for a subsequent 6 months maintaining the positive effects (21). Combination use of benzoyl peroxide with adapalene is well endured but has no advantages over monotherapies (22).…”