08 Jul Aklief (Trifarotene): 4th Generation Retinoid for Acne Treatment
Aklief and Trifarotene in Singapore: Prescription Treatment for Facial and Body Acne
By Dr Rachel Ho | Updated August 2026
Trifarotene is a prescription topical retinoid used to treat acne on the face and trunk. In Singapore, Aklief cream contains trifarotene 50 micrograms per gram and is registered for patients aged 12 years and older who have multiple comedones, papules or pustules on the face, chest, shoulders or back1.
Unlike retinol commonly found in skincare, Aklief (trifarotene) is a prescription-only medication for acne treatment, and supported by evidence from large clinical trials involving both facial and truncal acne2,3.
What should patients know about trifarotene? It is a prescription retinoid applied in the evening for facial and truncal acne, with the main clinical assessment commonly occurring around 12 weeks. Dryness, redness, scaling, itching and stinging are the most common early limitations.
Trifarotene at a glance
FAQ about Aklief (trifarotene)
| Question about Aklief (trifarotene) | Evidence based answer |
|---|---|
| What is trifarotene? | A prescription topical retinoid that selectively activates retinoic acid receptor gamma |
| What does Aklief (trifarotene) treat? | Comedonal and inflammatory acne on the face and trunk |
| Who can use it in Singapore? | Patients aged 12 years and older can be prescribed Aklief (trifarotene), after medical assessment |
| How is Aklief (trifarotene) used? | A thin layer of Aklief (trifarotene) is applied in the evening to clean, dry skin according to the prescription |
| When are results of Aklief (trifarotene) assessed? | Early lesion changes can appear within weeks to months |
| What are common side effects of Aklief (trifarotene)? | Dryness, redness, scaling, itching, stinging and sunburn |
| Can Aklief (trifarotene) treat acne scars? | It can reduce new acne formation but does not rebuild depressed scars |
| Is Aklief (trifarotene)used during pregnancy? | Aklief (trifarotene) is contraindicated in pregnancy. |
How does trifarotene work? It selectively activates retinoic acid receptor gamma in the epidermis, normalises follicular cell turnover, reduces microcomedone formation and modulates inflammatory pathways involved in acne.
What is Aklief (trifarotene)?
Aklief (trifarotene) is a fourth generation retinoid. It selectively activates retinoic acid receptor gamma, the main retinoic acid receptor subtype found in the epidermis2,4.
Topical retinoids help normalise follicular cell turnover, reduce microcomedone formation and calm inflammatory pathways involved in acne. These actions make them a foundation of evidence based acne treatment2,5.
Can trifarotene treat body acne? Its clinical programme included truncal acne affecting the chest, shoulders and back, as well as facial acne. Consistent application across larger body areas remains an important part of treatment.
What type of acne does Aklief (trifarotene) treat?
Aklief (trifarotene) is used to treat acne vulgaris of the face and trunk when multiple blackheads, whiteheads and inflammatory spots are present. Truncal acne includes acne on the chest, shoulders and back, areas that are often harder to treat consistently with small tubes of medication1.
Aklief (trifarotene) can also be prescribed for comedonal and inflammatory acne. Severe nodules, rapid scarring, significant psychosocial distress or failure of standard topical treatment can require oral therapy, including isotretinoin or in-clinic treatments that ablate the sebaceous gland5.
What does the clinical evidence show? Two 12-week Phase 3 trials involving 2,420 patients found higher facial and truncal treatment-success rates with trifarotene than with vehicle. A separate 52-week study reported further improvement, although its open-label design and absence of a control group limit the certainty of the long-term findings.
What does the clinical evidence for Aklief (trifarotene) show?
Two identical 12 week phase 3 trials included 2,420 patients with moderate facial and truncal acne. At week 12, facial treatment success ranged from 29.4 to 42.3% with trifarotene, compared with 19.5 to 25.7% with vehicle; truncal success ranged from 35.7 to 42.6%, compared with 25.0 to 29.9% with vehicle3.
The difference between treatment and vehicle appeared earlier in lesion counts, but complete clearing was not the outcome for most participants at week 12. This is why acne treatment should be assessed as a course rather than judged after a few applications3.
A separate 52 week open label study followed 453 patients. Facial and truncal success rates reached 65.1 and 66.9% at week 52, although the absence of a control group limits how confidently those long term figures can be attributed to the medication alone6.
These trials support trifarotene for facial and body acne. They compared trifarotene with vehicle rather than with tretinoin or adapalene, so they do not establish that it is universally more effective or gentler than older prescription retinoids3,7.
Is trifarotene better than tretinoin or adapalene? Direct head-to-head evidence remains limited. Trifarotene has a strong clinical programme for facial and truncal acne, while the best retinoid depends on acne pattern, previous treatment, tolerance, cost and access.
Trifarotene versus retinol, tretinoin and adapalene
wpDataTable with provided ID not found!Aklief (trifarotene)has a specific advantage in the strength of its clinical programme for truncal acne. Aklief (trifarotene) and adapalene remain well evidenced options for treating acne, and the best choice depends on acne pattern, previous treatment, skin sensitivity, cost and access5,7.
For more about retinoids, please read Retinol for Skin and Retinol vs Retinal vs Tretinoin. These guides explain the differences between cosmetic vitamin A products and prescription acne medication.
How is Aklief applied? Use a thin layer on clean, dry skin in the evening: one pump for the face, two pumps for the upper trunk and another pump for the middle or lower back only when prescribed. Moisturiser and daily sunscreen help support treatment tolerance.
How is Aklief (trifarotene) used?
Apply a thin layer once in the evening on clean, dry skin. One pump is intended to cover the face, while two pumps cover the upper trunk; an additional pump can be used for the middle and lower back when prescribed1.
Treatment frequency can be reduced or paused when retinoid dermatitis becomes significant. A moisturiser can be used , and the prescribing doctor should review progress after about three months1.
What are the main trifarotene safety considerations? Irritation is often most noticeable during the first four weeks and can include dryness, redness, scaling, itching, stinging or burning. Treatment is avoided during pregnancy and should not be applied to broken, eczematous, sunburned or recently waxed skin.
What side effects of Aklief (trifarotene) should patients expect?
The main adverse effects are local irritation, dryness, redness, scaling, itching, stinging and burning. In the pivotal trials, application site irritation occurred in 7.5%t of treated patients, itching in 2.4% and sunburn in 2.6% of subjects8.
Irritation was most noticeable during the first four weeks and then declined with continued use. Persistent or severe reactions require reduced frequency, a temporary pause or discontinuation under medical guidance8.
Aklief (trifarotene) should be avoided in areas of the skin that are inflamed, injured or infeced such as cuts, eczema, sunburned skin and recently waxed areas should be avoided. Daily sunscreen and a moisturising routine are important because retinoid irritation becomes harder to control when the skin barrier is already stressed1,8.
Can Aklief (trifarotene) be combined with other acne treatments?
Acne often requires more than a single modality of treatment due to multiple mechanisms involved in acne.Current acne guidelines support combinations that address pathogenesis of acne i.e. blocked follicles, inflammation and microbial activity, while limiting prolonged antibiotic use5.
Read Adult Female Acne and Acne: Types, Causes and Treatments for the role of hormones, medication and maintenance. My Complete Guide to Back Acne explains why body acne often needs a separate application and clothing strategy.
Contraindications to Aklief (Trifarotene)
Aklief (trifarotene) should be avoided in pregnancy and patients with hypersensitivity to the formulation1. Patients should discuss with their doctor about pregnancy plans, breastfeeding, eczema, severe sensitivity and other acne medicines before starting on this treatment.
Limitations and what Aklief (Trifarotene) cannot do
Aklief (trifarotene) treats active acne and helps prevent new blocked follicles. However, does not resurface depressed acne scars or treat post inflammatory erythema.
Depressed acne scars can be resurfaced with treatments such as collagen biostimulators, ECM skin boosters, PDLLA skin boosters, radiofrequency microneedling or fractional carbon dioxide laser. These treatments remodel deeper scar tissue after the active acne has been brought under control.
Post inflammatory hyperpigmentation or post acne dark marks are a different pathology, with options discussed in the clinic guides to Pico laser for acne marks and hyperpigmentation treatment for Asian skin.
My clinic’s Acne Treatment in Singapore page explains how prescription care, sebaceous gland focused ablation, chemical peels and device based options fit into a complete plan. Active acne should be controlled before intensive scar treatment becomes the priority.
Dr Rachel Ho’s clinical perspective on Aklief (Trifarotene) in Singapore
Aklief (trifarotene) is a prescription, 4th generation retinoic acid that is evidence based for treating facial acne and body acne. In my personal experience with using this medication and my observations with my patients, Aklief (Trifarotene) is better tolerated with a lower risk of retinoid dermatitis compared to the 1st generation retinoic acid, Tretinoin.
For patients with acne that is inflammatory or moderate to severe in severity, Aklief (Trifarotene) is rarely sufficient, and can be safely combined with other acne treatments like topical and oral medications, selective sebaceous gland ablation, chemical peels, LED light and Q-switched laser.
Frequently asked questions about Aklief (Trifarotene)
Is Aklief (trifarotene) stronger than tretinoin?
The two medicines bind retinoid receptors differently and use different concentrations. Vehicle controlled trifarotene trials do not prove superiority over tretinoin, and direct comparative evidence remains limited3.
How long does Aklief (trifarotene) take to work?
Differences in lesion counts appeared within the first few weeks in the pivotal studies, while the main trial assessment occurred at 12 weeks3,7.
Does Aklief (trifarotene) cause purging?
Purging occurs when skincare or treatments increase cell turnover; and a classic example of such treatments is retinoic acid. Aklief (trifarotene) can cause purging, which appears as a temporary increase in visible lesions that can occur as microcomedones surface. For more about purging please read my Is Your Skin Purging or Breaking Out? Widespread burning, itching, marked redness or a rash points more strongly to irritation and should prompt a change in frequency or medical review8.
Can Aklief (trifarotene) treat back acne?
Yes, Aklief (trifarotene) is indicated for acne on the trunk, and the clinical trials assessed the chest, shoulders and back as well as the face1,3.
Can Aklief (trifarotene) remove acne scars?
Trifarotene treats active acne, but does not treat post acne marks or depressed scars.
References
- Singapore National Drug Formulary. Aklief Cream 50 micrograms per gram, SIN16571P. Updated 2026.
- Tan J, et al. Management of Acne Vulgaris With Trifarotene. Journal of Cutaneous Medicine and Surgery. 2023. PMID 36927117.
- Tan J, et al. Randomized Phase 3 Evaluation of Trifarotene 50 Micrograms per Gram Cream for Moderate Facial and Truncal Acne. Journal of the American Academy of Dermatology. 2019. PMID 30802558.
- Cosio T, et al. Trifarotene: A Current Review and Perspectives in Dermatology. Biomedicines. 2021. PMID 33652835.
- Reynolds RV, et al. Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology. 2024. PMID 38300170.
- Blume Peytavi U, et al. Long Term Safety and Efficacy of Trifarotene 50 Micrograms per Gram Cream in Moderate Facial and Truncal Acne. Journal of the European Academy of Dermatology and Venereology. 2020. PMID 31306527.
- Bell KA, et al. Trifarotene for the Treatment of Facial and Truncal Acne. Annals of Pharmacotherapy. 2021. PMID 32567361.
- United States Food and Drug Administration. Aklief Cream Prescribing Information. Revised 2022.
- Mar K, et al. Treatment of Post Inflammatory Hyperpigmentation in Skin of Colour. Journal of Cutaneous Medicine and Surgery. 2024. PMID 39075672.
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