Acne
13 July 2023
If you have acne or are into anti-aging skincare, you might already have heard of retinoids. Retinoids are the cornerstone of acne treatment; as they improve multiple aspects of acne pathophysiology; as well as offer collagen building; and hyperpigmentation lightening benefits for younger looking skin.
In 2019, I shared about a new, fourth generation retinoid that’s received US FDA approval for treatment of acne in The Beginner’s Guide to Starting Retinoids. Good news is, this ingredient, Trifarotene, has finally received Singapore’s HSA approval in Singapore in 2023. This is exciting news for many doctors like myself, as Trifarotene (also known as Aklief) as pivotal studies have shown Aklief (Trifarotene) to be efficacious for treating acne on the face and body; and may be associated with lesser risk of retinoid dermatitis.
Here’s everything you need to know about the new kid in town for acne- Aklief (Trifarotene); and how it can help your acne. And I guess the question on everyone’s mind- is Aklief (Trifarotene) as effective as the OG of retinoids, retinoic acid (Tretinoin)? Answering these questions with all the evidence and studies.
Aklief is a medication for treating acne on the face and body. The active ingredient in Aklief is Trifarotene, a fourth generation retinoid. In 2019, Aklief (Trifarotene) received US FDA approval for treatment of acne vulgaris.
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Originally developed as a treatment for a dermatological condition called congenital ichthyosis, trifarotene was also found to improve acne. As a retinoid, trifarotene reduces acne by inhibiting the formation of microcomedones; and exerting anti-inflammatory and immunomodulatory effects on acne.
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The first retinoid to receive US FDA approval for treatment of acne in 1971 is tretinoin (retinoic acid). Over the years, retinoids have undergone chemical modifications that have improved their efficacy and safety. From the first generation of retinoids (retinol and isotretinoin); came the second and third generation retinoids; and finally the fourth generation- Trifrarotene aka Aklief.
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Similar to its predecessor retinoids, Aklief (Trifarotene) reduces acne by addressing the key steps in the pathophysiology of acne. Retinoids exert these effects by binding to receptors known as retinoic acid receptors, of which there are different subtypes.
The most abundant of the RAR subtypes in the epidermis is the gamma subtype (RAR-γ). Trifarotene (Aklief) is the only topical retinoid that selectively targets this gamma subtype of retinoic acid receptor. This specific property of trifarotene (Aklief), gives this fourth generation retinoid more targeted, skin-specific effects than earlier generation retinoids for treatment of acne on the face and body.
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Short term and long term clinical trials have demonstrated that Aklief (Trifarotene) is effective in treating acne on the face and trunk; in adults and in the paediatric population. Topical use of Aklief (Trifarotene) was also shown to be safe and well tolerated.
Both Aklief (Trifarotene) and Tretinoin (retinoic acid) are retinoids that have received US FDA approval for the treatment of acne. Aklief (Trifarotene) has high specificity for the gamma subtype of retinoic acid receptor (RAR-γ); whereas Tretinoin (retinoic acid) binds to all three subtypes of retinoic acid receptors.
Currently, there are no published studies that compare Aklief (Trifarotene) to Tretinoin (retinoic acid), so conclusions cannot be drawn about the effectiveness of one over the other. However, based on the high specificity of Aklief (Trifarotene) for RAR-γ in the skin, it can be hypothesised that Aklief (Trifarotene) may be better tolerated than Tretinoin (retinoic acid).
The most common reported side effects of using Aklief (Trifarotene) are:
• Itching
• Erythema
• Burning
• Stinging
• Dryness
Severe side effects of Aklief (Trifarotene) are rarer and these include:
• Sunburn sensation,
• Allergic dermatitis,
• Pain, and
• Cutaneous erosion
If you have acne on your face and body; Aklief (Trifarotene) is a possible treatment option. Please see your doctor to assess your suitability for a prescription of Aklief (Trifarotene); and please follow the instructions for use as prescribed by your doctor.
Aklief (Trifarotene) is available in my clinic in Singapore.
Aklief is the newest US FDA approved retinoid for the treatment of acne on the face and body; and it is now available in Singapore. Although Aklief (Triafarotene) has been heralded as the alternative to Tretinoin; there are some differences that distinguish their mechanisms of action. The high specificity of Aklief (Triafarotene) for RAR-γ receptors makes this fourth generation retinoid an exciting development for acne. I’ll update this post with more studies on Aklief (Trifarotene) as they continue to be published.
References:
1. Trifarotene: A Current Review and Perspectives in Dermatology. Cosio et al. Biomedicines. 2021 Feb 26;9(3):237.
2. Management of Acne Vulgaris With Trifarotene. Tan et al. J Cutan Med Surg. 2023 Mar 16; 12034754231163542.
3. Long-term safety and efficacy of trifarotene 50 lg/g cream, a first-in-class RAR-c selective topical retinoid, in patients with moderate facial and truncal acne. Blume-Peytavi et al. J Eur Acad Dermatol Venereol . 2020 Jan;34(1):166-173. 4. Trifarotene: A Novel Therapeutic Option for Acne. Naik. Dermatol Res Pract. 2022 May 27;2022:1504303.
