WASHINGTON (FRONTLINE MEDICAL NEWS) – Adding a topical steroid to tretinoin may be useful in reducing some of the retinoid-induced dermal irritation commonly seen with this treatment in patients with acne.

The reduction in dryness and peeling could, potentially, increase compliance with tretinoin treatment, especially in the first few weeks when retinoid reactions are most likely to occur, Dr. Garrett Coman said at the annual meeting of the American Academy of Dermatology.

“Patients definitely preferred adding the topical steroid to tretinoin-alone treatment,” said Dr. Coman, a clinical research fellow in the department of dermatology at the Virginia Tech Carilion School of Medicine and Research Institute, Roanoke. “At week 2, 64% already exhibited a strong preference, and that had increased to 86% by week 4.”

He and his colleagues conducted the 8-week, randomized, split-face trial of 20 patients who were treated with tretinoin for acne. In addition to 0.05% tretinoin, they applied 0.025% triamcinolone to one side of the face and a vehicle emollient to the other side.

Patients were a typical acne treatment population, with a mean age of 18 years and most were female. They had already tried a number of acne treatments, including benzoyl peroxide, topical and oral antibiotics, and tretinoin.

They were assessed at baseline and at weeks 1, 2, 4, and 8. The outcome measures were acne severity; dryness, peeling, and erythema; and overall irritation.

Patients said that irritation increased significantly on the tretinoin-only (control) side by the end of week 1, while dryness did not change on the steroid combination side. By week 4 those scores were converging; by week 8 they were similar.

Physicians scored three categories of irritation: dryness, peeling, and erythema. They felt that dryness was significantly worse on the control side, peaked at week 2, and then slowly decreased, while dryness on the steroid side slowly increased and the scores converged by week 8. Peeling followed a similar pattern. Erythema was not significantly different at any time point.

Overall, acne severity decreased more quickly and dramatically on the steroid side, according to physicians. This finding, combined with the early decreases in symptoms of irritation, might improve compliance. “We have all noticed that the early irritation can be a significant inhibitor of compliance. Our results suggest that topical corticosteroids reduce peeling and dryness early in treatment. We think this could increase compliance and boost outcomes in patients starting topical retinoids,” Dr. Coman commented.

He had no disclosures. The Carilion Clinic funded the study.

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