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Persistent Effects of Adapalene Gel After Chemical Peeling with Glycolic Acid in Patients with Acne Vulgaris

Persistent Effects of Adapalene Gel After Chemical Peeling with Glycolic Acid in Patients with... Send Orders for Reprints to [email protected] 42 The Open Dermatology Journal, 2013, 7, 42-46 Open Access Persistent Effects of Adapalene Gel After Chemical Peeling with Glycolic Acid in Patients with Acne Vulgaris *,1 1,2 3 1 1,2 Mikiko Uede , Chikako Kaminaka , Nozomi Yonei , Fukumi Furukawa and Yuki Yamamoto Department of Dermatology, Wakayama Medical University, Japan Department of Cosmetic Dermatology and Photomedicine, Wakayama Medical University, Japan Department of Dermatology, Public Naga Hospital, Japan Abstract: We investigated the usefulness of adapalene gel as maintenance therapy following chemical peeling with glycolic acid in patients with acne vulgaris. The study period was 14 weeks. The subjects were 23 patients with mild to moderate acne vulgaris (1 male, 22 females). After chemical peeling (CP) of the face was performed 3 times at 2-week intervals, adapalene was applied for 6 weeks using a randomized, double-blind half-side method. On the day of observation, dermatologists examined dermal findings, and measurement was conducted using instruments to analyze the physiological skin function. After the third session of CP was completed, both the inflammatory and non-inflammatory lesion counts significantly decreased. Subsequently, on the adapalene-treated side there were no change in the inflammatory and non-inflammatory lesion counts after the CP 3 times, but on placebo-treated side, there significant increase in the inflammatory and non inflammatory lesion counts. Concerning the results of measurement with instruments, the sebum capacity significantly decreased after the third session of CP. Subsequently, there were no changes after the 6-week application of adapalene or a placebo. These results suggest that post-CP adapalene application is an effective acne treatment method to improve efficacy and treatment adherence. Keywords: Acne vulgaris(AV), chemical peeling(CP), adapalene. INTRODUCTION acids (macrogol base) were recommended as recommendation grade C1 (recommended as options, although there was little Acne vulgaris is frequent in clinical practice. It is a evidence) [5-7]. On the other hand, adapalene (6-[3-(1- chronic, inflammatory dermal disease involving sebaceous adamantyl)-4-methoxyphenyl]-2-naphthoic acid), a naphthoic hair follicles [1]. Its clinical characteristics include acid derivative [8], was approved as an external retinoid seborrhea, comedones, red papules, and pustules [1]. This preparation in Japan in 2008 [9]. In patients with acne, this disease frequently develops on the faces and thoracic/dorsal drug corrects the alteration of the hyperkeratinization process regions of persons aged 10 to 29 years, and is experienced by of the hair follicle infundibular, reducing microcomedones, more than 90% of Japanese persons [2,3]. comedones and inflammatory lesions. Furthermore, it was Chemical peeling (CP) is a technique to treat dermal also strongly recommended as maintenance therapy after the symptoms related to acne, pigment anomalies, and reduction of inflammation. In the guidelines, the photoaging or cosmetically improve the skin (anti-aging, recommendation grade was established as A (Strongly reduction of spots/dullness, and improvement in the skin recommended to perform (there should be at least one level quality) [4]. In patients with acne, the thickening cornified  or  study that supports effectiveness) [5-7]. However, layer of the hair follicle infundibulais exfoliated, reducing no study has compared CP with adapalene, although CP may sebum retention in hair follicles. In particular, this procedure exhibit immediate actions on comedones and cosmetic is effective for pimples [4]. Glycolic acid belongs to  - effects such as whitening [4]. In this study, we used an hydroxy acids, with the smallest molecular weight. It is external adapalene preparation (recommendation grade A) appropriate for peeling of the most superficial (level 1) and after CP, which reduces lesion in the early phase, and superficial (level 1,2) layers [5]. Neither systemic toxicity examined its usefulness for acne vulgaris treatment. nor serious complications have been reported, and various SUBJECTS AND METHODS products are commercially available. In 2008, the Japanese Dermatological Association prepared the “Guidelines for Subjects Acne Vulgaris Treatment” for Japanese [6]. Concerning The subjects were 23 patients with mild to moderate inflammatory/non-inflammatory lesion, glycolic and salicylic acne, aged over 20 years, in whom there was no laterality in the acne count, and from whom written informed consent was obtained in the Department of Dermatology, Wakayama *Address correspondence to this author at the Department of Dermatology, Medical University between 2009 and 2010. Patients were Wakayama Medical University, Postal code: 641-0012, 811-1, Kimiidera, Wakayama City, Wakayama Prefecture, Japan; Tel.: 073-441-0661; excluded if they had cyst, scar, and keloids, or other Fax: 073-441-1908; E-mail: [email protected] dematologic conditions requiring systemic treatment. 1874-3722/13 2013 Bentham Open Persistent Effects of Adapalene Gel After Chemical Peeling The Open Dermatology Journal, 2013, Volume 7 43 Exclusion criteria included males/females aged 19 years or RESULTS younger and pregnant or lactating women. The purpose and The subjects were 23 patients with acne vulgaris (1 male, contents of this study were examined and approved by the 22 females), with a mean age of 25.3±5.8 (standard Ethic Review Board of Wakayama Medical University in deviation) years. accordance with the Helsinki Declaration. Changes in the Lesion Methods Time dependent changes in the inflammatory lesion are The study period was 12 weeks. Chemical peeling with shown in Fig. (1). After the completion of the third session 40% glycolic acid (pH3.2) was performed 3 times at 2-week th of CP (6 week), the lesion significantly decreased in intervals [9]. From 2 weeks after the completion of CP, comparison with the pre-study value (p<0.001). adapalene or a placebo (supplied by Galderma, Inc.) was Subsequently, there was a significant decrease after the 6- applied to the half-face before bedtime every day for 6 th week (12 week) application of adapalene in comparison weeks. Each drug was randomly assigned using the double- th with the pre-study value (p<0.01). However, 6 weeks (12 blind method. week) after the start of application in adapalene group, there EVALUATION was no significant difference in comparison with the value th after the third session of CP (6 week), although there was a The severity of acne was evaluated according to the th slight decrease from 2 weeks after the start of application (8 guidelines [6]. The exanthema count and skin condition were week). In the placebo group, the lesion significantly examined by dermatologists every two weeks (total: 7 increased in comparison with that after the third session of times). For physiological skin function analysis, the water th CP (12 week) (p<0.01). content (%) was measured using a CORNEOMETER , the The changes in the non-inflammatory lesion are shown in sebum capacity (μg/cm ) using a SEBMETER , and the 2 th Fig. (2). After the third session of CP (6 week), the non- transepidermal water loss (TEWL) (g/cm ) using a inflammatory lesion significantly decreased in comparison TEWAMETER (Multi-probe adaptor, Courage + Khazaka with the pre-study value (p<0.001). Subsequently, there were Co., Ltd., Cologne, Germany) at the start of this study, 2 th significant decreases after the 6-week (12 week) application weeks after the completion of the third session of CP, and 6 of adapalene or the placebo in comparison with the pre-study weeks after the start of adapalene application (total: 3 times) value (p<0.01). In the adapalene group, there was no in a room with constant temperature(2223 ) and significant difference in comparison with the value after the humidity (relative humidity 4045%). th third session of CP (6 week), although there was a slight STATISTICAL ANALYSIS decrease. In the placebo group, the exanthema was th significantly greater than after the third session of CP (6 Statistical analysis was conducted using Wilcoxon’s t- week) (p<0.05). test. A p-value <0.05 was regarded as significant. Number *p<0.01 adapalene アダパレン **p<0.001 placebo プラセボ 3 * vs before * vs CP 3times ** vs before * vs before ** vs before 4 weeks after 6 weeks after the 2 weeks after Before Second Third Before First 1 2 3 2W 4W 6W the start of start of adapalene the start of session of this session of session of adapalene adapalene application CP CP study CP application application Fig. (1). Changes in the inflammatory lesion count (N=23). Lesion count 44 The Open Dermatology Journal, 2013, Volume 7 Uede et al. Number adapalene アダパレン * p<0.05 ** p<0.01 プラセボ placebo *** p<0.001 *** vs before * vs CP3times vs before *** *** vs before *** vs before 6 weeks after the First 2 weeks after Before Second Third 4 weeks after Before 1 2 3 2W 4W 6W start of adapalene the start of the start of session of session of this session of application adapalene adapalene CP CP study CP application application Fig. (2). Changes in the non-inflammatory lesion count (N=23). value (p<0.05). Subsequently, the values in the adapalene Analysis of the Physiological Skin Function and placebo groups were significantly higher than after the Changes in the Sebum Secretion third session of CP (Fig. 4). After the third session of CP, the sebum secretion Changes in the Cornified Layer Water Content significantly decreased in comparison with the pre-study There was no significant difference in the cornified layer value (p<0.05). Subsequently, there were slight increases in water content before and after this study. both the adapalene and placebo groups, although there were no significant differences (Fig. 3). Safety Changes in TEWL During the study period, there were no side effects of CP. In the adapalene group, more than 90% (21/23) of the After the third session of CP, the TEWL value patients complained of dryness, desquamation, erythema, or significantly decreased in comparison with the pre-study μμg/cm *p<0 0.05 アダ ダパレン プラ ラセボ pla acebo 6 weeks afte er the Before this After the third d afte er CP 3times adapalene 6w 開始前 start of adap palene session of CP study application Fig. (3). Changes in the sebum secretion (N=23). Lesion count Persistent Effects of Adapalene Gel After Chemical Peeling The Open Dermatology Journal, 2013, Volume 7 45 g/hm *p<0.05 * * 15 adapalene アダパレン placebo プラセボ 6 weeks after the after CP 3times adapalene 6w 開始前 Before this After the third start of adapalene study session of CP application Fig. (4). Changes in the TEWL (N=23). irritation within 2 weeks. However, in all patients, it was hormones, especially androgen, are closely involved in post- possible to continue treatment until the completion of this adlescent acne [15]. Androgen acts on the sebaceous gland, study. promoting sebum production and leading to comedones formation through the excessive cornification of hair DISCUSSION follicles. Furthermore, marked mental stress enhances the production of corticotropin-releasing and adrenocorticotropic Recently, patients have been strongly interested in acne hormones, increasing the secretion of androgen. As a result, treatment, and acne has been reviewed as an important acne exacerbates, reducing the treatment responsiveness dermal disease. Chemical peeling shows immediate actions [15]. on acne vulgaris, and its results are satisfactory for females and young patients, who have a strong esthetic sense. For physiological skin function analysis, the sebum According to several studies, CP with glycolic acid secretion, TEWL, and cornified layer water content were significantly decreases the lesion count 2 weeks after the measured before this study, after the third session of CP, and start of treatment; glycolic acid may exhibit more immediate after the completion of this study. The sebum secretion actions compared to adapalene [10,11]. However, as a significantly decreased after the third session of CP. limitation of CP, continuous visits are required, which is Subsequently, it increased after the application of stressful. In this study, we examined the usefulness of adapalene/a placebo. As the facial secretion of sebum in adapalene application as maintenance therapy following CP patients with acne is higher than in healthy adults, sebum with glycolic acid. After the third session of CP, both secretion is associated with the onset of acne [16]. Several inflammatory and non-inflammatory lesion significantly studies have reported that retinoid/hormonal/laser therapies reduced. Subsequently, adapalene was applied for 6 weeks. decrease sebum secretion through the destruction/reduction The lesion count slightly increased with no statistical of the sebaceous gland, leading to the remission of acne. significance 2 to 4 weeks after the start of application, but However, there are few studies on a CP-related decrease in there was a significant decrease in comparison with the pre- sebum secretion [17]. A study indicated that glycolic acid study value. These results suggest that adapalene application penetratedpores of the skin, acting on the sebaceous gland is useful for maintaining the therapeutic effects of CP. cells and contributing to a decrease in sebum secretion [17]. There was a significant decrease in the TEWL after CP, Acne is often thought to affect the teenaged group. whereas there was a significant increase following adapalene However, a significant number of patients either continue to application. This was possibly because the side effects of experience acne or develop new-onset acne after the adapalene, such as erythema, desquamation, and dryness, teenaged years. As acne frequently develops on the face, it reduced the barrier function of the skin [9,18]. There were no influences the patient’s quality of life (QOL) [12]. In changes in the water content before and after this study. particular, QOL of most patients with post adolescent acne markedly reduces because of their strong esthetic sense The results of this study suggest that the application of [12,13]. adapalene after CP remission of acne treatment is an effective acne treatment method to maintain and further In this study, the mean age of subjects are 25.3±5.8 improve treatment effect and adherence in patients wishing (standard deviation) years, mostof who have post-adlescent to completely cure acne earlier. acne [14]. Irregular menstruation, mental stress, and 46 The Open Dermatology Journal, 2013, Volume 7 Uede et al. [9] Kawashima M, Harada S, Christian Loesche, et al. Adapalene gel CONFLICT OF INTEREST 0.1% is effective and safe for Japanese patients with acne vulgaris: Adapalene and placebo were given by Galderma R&D, A ranomized, multicenter, investigator-blinded, controlled study. J Dermatol Sci 2008; 49(3): 241-8. France. [10] Hayashi N, Kawashima M. The usefulness of chemical peeling with 30% glycolic acid (pH1.5) for acne vulgaris. Jpn J Clinic ACKNOWLEDGEMENTS Dermatol 2003; 57: 1213-6 (in Japanese). Funding for this study was provided by Galderma R&D, [11] Kishioka A, Yamamoto Y, Miyazaki T, et al. Clinical evaluation of chemical peeling with glycolic acid for acne. Aesthet Dermatol Tokyo. 2004; 14: 195-202. [12] Hayashi N, Higaki Y, Kawamoto K, et al. A crosssectional analysis REFERENCES of quality of life in Japanese acne patients using the Japanese [1] Arnold Odom J. William LAndrew’s Diseases of the skin Clinical version of Skinde-16. J Dermatol 2004; 31(12): 971-6. th Dermatology. 8 ed. Philadelphia: Harcourt Brace Jovanovich, Inc. [13] Golden V, Clark SM, Cunliffe WJ. Post-adolescent-acne : a review 1990; pp. 250-7. of clinical features. Br J Dermatol 1997; 136(1): 66-70. [2] Miyachi Y, Hayashi N, Furukawa F, et al. Acne management in [14] Chiristina W, Layton AM. Persistent acne in woman. Am J Clin Japan: study of patient adherence. Dermatology 2011; 223(2): 174- Dermatol 2006; 7(5): 281-90. [15] George R, Clarke S, Thompson EB, et al. Hormonal therapy for [3] Shimizu H. Shimizu’s Textbook of Dermatology. Tokyo: acne. Semin Cutan Med Surg 2008; 27(3): 188-96. Nakayama Ltd 2007; pp. 316-9. [16] Watanabe R, Ito M. The structure and functional of sebaceous [4] Harold J. Chemical Peeling and Resurfacing. St.Louis: Mosby Inc glands Aesthet Dermatol 2009; 19: 155-9 (abstract in English). 1997; pp. 94-100. [17] Lee SH, Huh CH, Park KC, Youn SW.Effects of repetitive [5] Yamamoto Y, Funasaka Y, Matsunaga K, et al. Guidelines for superficial chemical peels on facial sebum secretion in acne rd chemical peeling in Japan (3 edition). J Dermatol 2011; 38: 1-5. patients. J Eur Acad Dermatol Venereol 2006; 20: 964-8. [6] Hayashi N, Akamatsu H, Iwatsuki K, et al. The guideline for the [18] Yonei N, Yamamoto Y, Kaminaka C, et al. Effect of chemical treatment of acne vulgaris. Jpn J Dermatol 2004; 14: 195-202. peeling with Keisei jorbi GA gel in treatment of acne vugaris, [7] Hayashi N, Akamatsu H, Kawashima M, et al. Establishment of lichen pilaris, and postinflammatory pigmentation in aopic grading criteria for acne severity. J Dermatol 2008; 35(5): 255-60. dermatitis. Aesthet Dermatol 2002; 12: 103-8 (abstract in English). [8] Michel S, Jomard A, Demarchez M. Pharamacology of adapalene. Br J Dermatol 1998; 139: 3-7 Received: June 24, 2013 Revised: August 5, 2013 Accepted: August 6, 2013 © Uede et al.; Licensee Bentham Open. This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Open Dermatology Journal Unpaywall

Persistent Effects of Adapalene Gel After Chemical Peeling with Glycolic Acid in Patients with Acne Vulgaris

Uede, Mikiko; Kaminaka, Chikako; Yonei, Nozomi; Furukawa, Fukumi; Yamamoto, Yuki
The Open Dermatology Journal – Sep 20, 2013
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Abstract

Send Orders for Reprints to [email protected] 42 The Open Dermatology Journal, 2013, 7, 42-46 Open Access Persistent Effects of Adapalene Gel After Chemical Peeling with Glycolic Acid in Patients with Acne Vulgaris *,1 1,2 3 1 1,2 Mikiko Uede , Chikako Kaminaka , Nozomi Yonei , Fukumi Furukawa and Yuki Yamamoto Department of Dermatology, Wakayama Medical University, Japan Department of Cosmetic Dermatology and Photomedicine, Wakayama Medical University, Japan Department of Dermatology, Public Naga Hospital, Japan Abstract: We investigated the usefulness of adapalene gel as maintenance therapy following chemical peeling with glycolic acid in patients with acne vulgaris. The study period was 14 weeks. The subjects were 23 patients with mild to moderate acne vulgaris (1 male, 22 females). After chemical peeling (CP) of the face was performed 3 times at 2-week intervals, adapalene was applied for 6 weeks using a randomized, double-blind half-side method. On the day of observation, dermatologists examined dermal findings, and measurement was conducted using instruments to analyze the physiological skin function. After the third session of CP was completed, both the inflammatory and non-inflammatory lesion counts significantly decreased. Subsequently, on the adapalene-treated side there were no change in the inflammatory and non-inflammatory lesion counts after the CP 3 times, but on placebo-treated side, there significant increase in the inflammatory and non inflammatory lesion counts. Concerning the results of measurement with instruments, the sebum capacity significantly decreased after the third session of CP. Subsequently, there were no changes after the 6-week application of adapalene or a placebo. These results suggest that post-CP adapalene application is an effective acne treatment method to improve efficacy and treatment adherence. Keywords: Acne vulgaris(AV), chemical peeling(CP), adapalene. INTRODUCTION acids (macrogol base) were recommended as recommendation grade C1 (recommended as options, although there was little Acne vulgaris is frequent in clinical practice. It is a evidence) [5-7]. On the other hand, adapalene (6-[3-(1- chronic, inflammatory dermal disease involving sebaceous adamantyl)-4-methoxyphenyl]-2-naphthoic acid), a naphthoic hair follicles [1]. Its clinical characteristics include acid derivative [8], was approved as an external retinoid seborrhea, comedones, red papules, and pustules [1]. This preparation in Japan in 2008 [9]. In patients with acne, this disease frequently develops on the faces and thoracic/dorsal drug corrects the alteration of the hyperkeratinization process regions of persons aged 10 to 29 years, and is experienced by of the hair follicle infundibular, reducing microcomedones, more than 90% of Japanese persons [2,3]. comedones and inflammatory lesions. Furthermore, it was Chemical peeling (CP) is a technique to treat dermal also strongly recommended as maintenance therapy after the symptoms related to acne, pigment anomalies, and reduction of inflammation. In the guidelines, the photoaging or cosmetically improve the skin (anti-aging, recommendation grade was established as A (Strongly reduction of spots/dullness, and improvement in the skin recommended to perform (there should be at least one level quality) [4]. In patients with acne, the thickening cornified  or  study that supports effectiveness) [5-7]. However, layer of the hair follicle infundibulais exfoliated, reducing no study has compared CP with adapalene, although CP may sebum retention in hair follicles. In particular, this procedure exhibit immediate actions on comedones and cosmetic is effective for pimples [4]. Glycolic acid belongs to  - effects such as whitening [4]. In this study, we used an hydroxy acids, with the smallest molecular weight. It is external adapalene preparation (recommendation grade A) appropriate for peeling of the most superficial (level 1) and after CP, which reduces lesion in the early phase, and superficial (level 1,2) layers [5]. Neither systemic toxicity examined its usefulness for acne vulgaris treatment. nor serious complications have been reported, and various SUBJECTS AND METHODS products are commercially available. In 2008, the Japanese Dermatological Association prepared the “Guidelines for Subjects Acne Vulgaris Treatment” for Japanese [6]. Concerning The subjects were 23 patients with mild to moderate inflammatory/non-inflammatory lesion, glycolic and salicylic acne, aged over 20 years, in whom there was no laterality in the acne count, and from whom written informed consent was obtained in the Department of Dermatology, Wakayama *Address correspondence to this author at the Department of Dermatology, Medical University between 2009 and 2010. Patients were Wakayama Medical University, Postal code: 641-0012, 811-1, Kimiidera, Wakayama City, Wakayama Prefecture, Japan; Tel.: 073-441-0661; excluded if they had cyst, scar, and keloids, or other Fax: 073-441-1908; E-mail: [email protected] dematologic conditions requiring systemic treatment. 1874-3722/13 2013 Bentham Open Persistent Effects of Adapalene Gel After Chemical Peeling The Open Dermatology Journal, 2013, Volume 7 43 Exclusion criteria included males/females aged 19 years or RESULTS younger and pregnant or lactating women. The purpose and The subjects were 23 patients with acne vulgaris (1 male, contents of this study were examined and approved by the 22 females), with a mean age of 25.3±5.8 (standard Ethic Review Board of Wakayama Medical University in deviation) years. accordance with the Helsinki Declaration. Changes in the Lesion Methods Time dependent changes in the inflammatory lesion are The study period was 12 weeks. Chemical peeling with shown in Fig. (1). After the completion of the third session 40% glycolic acid (pH3.2) was performed 3 times at 2-week th of CP (6 week), the lesion significantly decreased in intervals [9]. From 2 weeks after the completion of CP, comparison with the pre-study value (p<0.001). adapalene or a placebo (supplied by Galderma, Inc.) was Subsequently, there was a significant decrease after the 6- applied to the half-face before bedtime every day for 6 th week (12 week) application of adapalene in comparison weeks. Each drug was randomly assigned using the double- th with the pre-study value (p<0.01). However, 6 weeks (12 blind method. week) after the start of application in adapalene group, there EVALUATION was no significant difference in comparison with the value th after the third session of CP (6 week), although there was a The severity of acne was evaluated according to the th slight decrease from 2 weeks after the start of application (8 guidelines [6]. The exanthema count and skin condition were week). In the placebo group, the lesion significantly examined by dermatologists every two weeks (total: 7 increased in comparison with that after the third session of times). For physiological skin function analysis, the water th CP (12 week) (p<0.01). content (%) was measured using a CORNEOMETER , the The changes in the non-inflammatory lesion are shown in sebum capacity (μg/cm ) using a SEBMETER , and the 2 th Fig. (2). After the third session of CP (6 week), the non- transepidermal water loss (TEWL) (g/cm ) using a inflammatory lesion significantly decreased in comparison TEWAMETER (Multi-probe adaptor, Courage + Khazaka with the pre-study value (p<0.001). Subsequently, there were Co., Ltd., Cologne, Germany) at the start of this study, 2 th significant decreases after the 6-week (12 week) application weeks after the completion of the third session of CP, and 6 of adapalene or the placebo in comparison with the pre-study weeks after the start of adapalene application (total: 3 times) value (p<0.01). In the adapalene group, there was no in a room with constant temperature(2223 ) and significant difference in comparison with the value after the humidity (relative humidity 4045%). th third session of CP (6 week), although there was a slight STATISTICAL ANALYSIS decrease. In the placebo group, the exanthema was th significantly greater than after the third session of CP (6 Statistical analysis was conducted using Wilcoxon’s t- week) (p<0.05). test. A p-value <0.05 was regarded as significant. Number *p<0.01 adapalene アダパレン **p<0.001 placebo プラセボ 3 * vs before * vs CP 3times ** vs before * vs before ** vs before 4 weeks after 6 weeks after the 2 weeks after Before Second Third Before First 1 2 3 2W 4W 6W the start of start of adapalene the start of session of this session of session of adapalene adapalene application CP CP study CP application application Fig. (1). Changes in the inflammatory lesion count (N=23). Lesion count 44 The Open Dermatology Journal, 2013, Volume 7 Uede et al. Number adapalene アダパレン * p<0.05 ** p<0.01 プラセボ placebo *** p<0.001 *** vs before * vs CP3times vs before *** *** vs before *** vs before 6 weeks after the First 2 weeks after Before Second Third 4 weeks after Before 1 2 3 2W 4W 6W start of adapalene the start of the start of session of session of this session of application adapalene adapalene CP CP study CP application application Fig. (2). Changes in the non-inflammatory lesion count (N=23). value (p<0.05). Subsequently, the values in the adapalene Analysis of the Physiological Skin Function and placebo groups were significantly higher than after the Changes in the Sebum Secretion third session of CP (Fig. 4). After the third session of CP, the sebum secretion Changes in the Cornified Layer Water Content significantly decreased in comparison with the pre-study There was no significant difference in the cornified layer value (p<0.05). Subsequently, there were slight increases in water content before and after this study. both the adapalene and placebo groups, although there were no significant differences (Fig. 3). Safety Changes in TEWL During the study period, there were no side effects of CP. In the adapalene group, more than 90% (21/23) of the After the third session of CP, the TEWL value patients complained of dryness, desquamation, erythema, or significantly decreased in comparison with the pre-study μμg/cm *p<0 0.05 アダ ダパレン プラ ラセボ pla acebo 6 weeks afte er the Before this After the third d afte er CP 3times adapalene 6w 開始前 start of adap palene session of CP study application Fig. (3). Changes in the sebum secretion (N=23). Lesion count Persistent Effects of Adapalene Gel After Chemical Peeling The Open Dermatology Journal, 2013, Volume 7 45 g/hm *p<0.05 * * 15 adapalene アダパレン placebo プラセボ 6 weeks after the after CP 3times adapalene 6w 開始前 Before this After the third start of adapalene study session of CP application Fig. (4). Changes in the TEWL (N=23). irritation within 2 weeks. However, in all patients, it was hormones, especially androgen, are closely involved in post- possible to continue treatment until the completion of this adlescent acne [15]. Androgen acts on the sebaceous gland, study. promoting sebum production and leading to comedones formation through the excessive cornification of hair DISCUSSION follicles. Furthermore, marked mental stress enhances the production of corticotropin-releasing and adrenocorticotropic Recently, patients have been strongly interested in acne hormones, increasing the secretion of androgen. As a result, treatment, and acne has been reviewed as an important acne exacerbates, reducing the treatment responsiveness dermal disease. Chemical peeling shows immediate actions [15]. on acne vulgaris, and its results are satisfactory for females and young patients, who have a strong esthetic sense. For physiological skin function analysis, the sebum According to several studies, CP with glycolic acid secretion, TEWL, and cornified layer water content were significantly decreases the lesion count 2 weeks after the measured before this study, after the third session of CP, and start of treatment; glycolic acid may exhibit more immediate after the completion of this study. The sebum secretion actions compared to adapalene [10,11]. However, as a significantly decreased after the third session of CP. limitation of CP, continuous visits are required, which is Subsequently, it increased after the application of stressful. In this study, we examined the usefulness of adapalene/a placebo. As the facial secretion of sebum in adapalene application as maintenance therapy following CP patients with acne is higher than in healthy adults, sebum with glycolic acid. After the third session of CP, both secretion is associated with the onset of acne [16]. Several inflammatory and non-inflammatory lesion significantly studies have reported that retinoid/hormonal/laser therapies reduced. Subsequently, adapalene was applied for 6 weeks. decrease sebum secretion through the destruction/reduction The lesion count slightly increased with no statistical of the sebaceous gland, leading to the remission of acne. significance 2 to 4 weeks after the start of application, but However, there are few studies on a CP-related decrease in there was a significant decrease in comparison with the pre- sebum secretion [17]. A study indicated that glycolic acid study value. These results suggest that adapalene application penetratedpores of the skin, acting on the sebaceous gland is useful for maintaining the therapeutic effects of CP. cells and contributing to a decrease in sebum secretion [17]. There was a significant decrease in the TEWL after CP, Acne is often thought to affect the teenaged group. whereas there was a significant increase following adapalene However, a significant number of patients either continue to application. This was possibly because the side effects of experience acne or develop new-onset acne after the adapalene, such as erythema, desquamation, and dryness, teenaged years. As acne frequently develops on the face, it reduced the barrier function of the skin [9,18]. There were no influences the patient’s quality of life (QOL) [12]. In changes in the water content before and after this study. particular, QOL of most patients with post adolescent acne markedly reduces because of their strong esthetic sense The results of this study suggest that the application of [12,13]. adapalene after CP remission of acne treatment is an effective acne treatment method to maintain and further In this study, the mean age of subjects are 25.3±5.8 improve treatment effect and adherence in patients wishing (standard deviation) years, mostof who have post-adlescent to completely cure acne earlier. acne [14]. Irregular menstruation, mental stress, and 46 The Open Dermatology Journal, 2013, Volume 7 Uede et al. [9] Kawashima M, Harada S, Christian Loesche, et al. Adapalene gel CONFLICT OF INTEREST 0.1% is effective and safe for Japanese patients with acne vulgaris: Adapalene and placebo were given by Galderma R&D, A ranomized, multicenter, investigator-blinded, controlled study. J Dermatol Sci 2008; 49(3): 241-8. France. [10] Hayashi N, Kawashima M. The usefulness of chemical peeling with 30% glycolic acid (pH1.5) for acne vulgaris. Jpn J Clinic ACKNOWLEDGEMENTS Dermatol 2003; 57: 1213-6 (in Japanese). Funding for this study was provided by Galderma R&D, [11] Kishioka A, Yamamoto Y, Miyazaki T, et al. Clinical evaluation of chemical peeling with glycolic acid for acne. Aesthet Dermatol Tokyo. 2004; 14: 195-202. [12] Hayashi N, Higaki Y, Kawamoto K, et al. A crosssectional analysis REFERENCES of quality of life in Japanese acne patients using the Japanese [1] Arnold Odom J. William LAndrew’s Diseases of the skin Clinical version of Skinde-16. J Dermatol 2004; 31(12): 971-6. th Dermatology. 8 ed. Philadelphia: Harcourt Brace Jovanovich, Inc. [13] Golden V, Clark SM, Cunliffe WJ. Post-adolescent-acne : a review 1990; pp. 250-7. of clinical features. Br J Dermatol 1997; 136(1): 66-70. [2] Miyachi Y, Hayashi N, Furukawa F, et al. Acne management in [14] Chiristina W, Layton AM. Persistent acne in woman. 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Jpn J Dermatol 2004; 14: 195-202. peeling with Keisei jorbi GA gel in treatment of acne vugaris, [7] Hayashi N, Akamatsu H, Kawashima M, et al. Establishment of lichen pilaris, and postinflammatory pigmentation in aopic grading criteria for acne severity. J Dermatol 2008; 35(5): 255-60. dermatitis. Aesthet Dermatol 2002; 12: 103-8 (abstract in English). [8] Michel S, Jomard A, Demarchez M. Pharamacology of adapalene. Br J Dermatol 1998; 139: 3-7 Received: June 24, 2013 Revised: August 5, 2013 Accepted: August 6, 2013 © Uede et al.; Licensee Bentham Open. This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

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Published: Sep 20, 2013

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