Retinoids in Acne Management: Review of Current Understanding, Future Considerations, and Focus on Topical Treatments

Acne vulgaris is the most common skin condition affecting adolescents and young adults with a tremendous psychosocial impact. Its pathogenic hallmarks include follicular dyskeratosis, increased sebum production, and inflammation induced by Cutibacterium (formerly Propionibacterium) acnes within the follicle. Retinoids, derived from vitamin A, are the mainstays of acne treatment given they address the key pathogenic pathways of acne. Retinoids exert their effects through the binding of their nuclear receptors leading to downstream biological effects. The understanding of retinoid pharmacology has increased the diversity of retinoids with now both natural and synthetic retinoids available for use. For acne, retinoids can be administered both topically in a variety of formulations and combinations as well as systemically. With judicious use, this class of medication is well tolerated and very efficacious in managing acne. Furthermore, there is evidence showing its role in improving and preventing one of the most challenging post-acne changes, atrophic acne scarring. With a promising topical retinoid, trifarotene, on the horizon, the acne armamentarium will be further broadened to better manage acne and its related sequelae. J Drugs Dermatol. 2018;17(12 Suppl):s51-55