Optimizing the choice of topical retinoids in the treatment of acne

Objective — to analyze current scientific data on the pathogenesis of acne, especially the role of C. acnes, first-line topical therapies according to international guidelines for the management of dermatosis; to compare topical retinoids and their combinations, in particular adapalene and clindamycin, in terms of mechanism of action, efficacy, and safety. Materials and methods. Based on an in-depth analysis of data from special literature and taking into account the results of domestic research, the feasibility of a differentiated approach to the prescription of topical retinoids and their combinations was determined. Results and discussion. Modern approaches to local therapy of patients with acne are considered. The effectiveness and tolerability of topical retinoids (tretinoin, tazarotene, adapalene, trifarotene) are analyzed. The issue of antibiotic resistance in treatment with antibiotics is discussed, ways of solving it through a combination with retinoids or benzoyl peroxide (BPO). A comparative analysis of the combination of adapalene and clindamycin, adapalene and benzoyl peroxide is conducted. Special attention is paid to the gels Deriva, Deriva С, and Deriva С MS, which are used in domestic practice, ensuring a rapid clinical result with minimal side effects. An algorithm for their appointment is proposed depending on the form, severity, and skin type. Conclusions. An individual approach is important when choosing external therapy for patients with acne, taking into account clinical manifestations, skin type, drug tolerability, and patient preferences. Effectiveness and safety should be balanced, and the benefits of use should outweigh the risks. The presence of monoforms of retinoids and combined preparations (retinoid and antibiotic) suggests a differentiated approach to the choice of therapy. Adapalene gel (Deriva gel) is effective mainly in non-inflammatory acne of mild to moderate severity, and has the best tolerability among retinoids. The combination of clindamycin and adapalene in the form of Deriva C gel is effective in inflammatory acne, mainly pustular, of mild to moderate severity. It can be considered the best option for starting therapy due to its rapid action and good tolerability. The combination of clindamycin and adapalene in microspheres (Deriva C MS gel) is effective in inflammatory acne, mainly pustular, of mild to moderate severity, with concomitant sensitive skin, atopic dermatitis, and seborrhea.